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Helicobacter pylori infection after liver transplantation
Transplantation,
1 co1/017
surgery,
mute
1.55
liver fuihre
1
HELICOBACIER PYLORl INFEXXION AFTFR LIVER TRANSPL.4NTATION F. Conti (1). P. Soti (2). Tuliez (3). F. Menraud (4). D. B Dousse (1). S. &aussade (2). Y C&W cl)_ ‘de Chikugie G&&ale, (2) ‘Service d”H&ato&oenttkologie. (3) Sekice d’.4natomi&kathologique, Hdpital Co&in, Paris, (4) Laboratoire de Bactkriologie Enfants, HGpital Pellegrin, Bordeaux. France. Helicobacter pylori (HP) plays an impomt role in the pathogenesis of gastritis and peptic ulcer disease, and may promote lymphoma. Gastritis and lymphoproliferative disease are frequent complications after transplantation. The aim of this study was to evaluate HP prevalence in liver transplant recipients. 33 asymptomatic liver transplant recipients (mean age: 50 years) were included in this study, at least one year after transplantation (mean: 2 years). Serum samples were obtained, and gastroduodenoscopy and gastric biopsies performed during an annual work up. Serum HP antibodies were detected by EIA (Kit Pyloriset, Orion Diagnostica). Histological analysis was performed by HES staining, and HP infection was assessed by Cresyl Violet staining. Only 1 serum was HP positif. In Contras& HP infection was observed in 14 (42%) gastric biopsies: in 10 patients (30%) HP numeration was low, and in 4 patients (12%) HP numeration was high. Gastroduodenoscopy was normal in 17 (89%) of the 19 patients without HP, and in 9 patients with HP. Concerning histologic findings, lesions were observed in 6 HP negative patients (5 superficial gastritis and 1 pre-atrophic gastritis) and in all HP positive patients (8 superficial gastritis and 6 pre-atrophic gastritis). This study suggests that prevalence of HP infection in liver recipients is similar to that observed in the general population. However, serodiagnostic failed to detect HP infection in those patients. HP presence in gastric biopsies was strongly associated with histologic&lesions. Taking into account the high prevalence of gastritis, HP should be detected by gastroduodenoscopy with gastric biopsies after liver transplantation.
1 co1/019
1
USE OF COLOR DOPPLER ULTRASOUND AND ULTRASOUND CONTRAST IN LIVER TRANSPLANTATION V Como, M Salc.uni*.A Risaliti, M Pirisi“, A Donini; MG Bolligan, G Anania, F Bresadola. Department of Surgery, *Department of RadiologJ;,“Department of Internal Medicine, University of Udine School of Medicine, Udine, Italy Introduction: Color doppler ultrasound (CDUS) is an useful tool for the assessment of the patency of the hepatic artery, portal vein and the inferior wna cava after liver transplantation Due to the condition of the patients, to the presence of surgical scars or to the small diameters of the vessels, sometime the CDUS is not able to determine the presence of blood flow within the vessels. The development of ultrasound contrast (USC) able, if given intravenously, to overcome the pulmonary capillary bed. offers the possibility to amplify the color and reach a better definition of the ultrasound imaging. Methods: Between March 1996 and October 1997 39 liver transplantation have been performed at our Institution. All patients underwent to a CDUS examination daily during the fmt five days a&r transplantation and then once a week for the fust month.In 4 patients (2 male and 2 female, age 32-53 years) in which the US scan was not able to prove the patency of the vena cava 8 ml (300 mg/ml) of the ultrasound contrast Levovist (Schering AGGermany) was administered intravenous. In all patients an inferior venacavography was also performed. Resulfs:The color amplification lasted for 2-3 minutes and allowed to formulate a diagnosis in all cases. In one case the CDUS + USC showed the presence of a thrombosis of the inferior vena cava with the involvement of the renal veins. Inferior venacavography confirmed the presence of a thrombosis with a stenosis of the upper caval anastomosis. In the other 3 cases the CDUS+USC showed the patency of the inferior vena cava. In these cases cavography showed a little discrepancy between the lumen of the donor IVC and that of the recipient, but no signs of thrombosis. Conclusion: Use of CDUS+USC Levovist allowed an accurate evaluation of the vessels of the graft in those cases in which the CDUS alone was dubious.
1 c01/020 -1 THE PROTECTIVE EFFECT OF DIABEl’ES MELLITUS ON PARACETAMOL INDUCED DECREASE OF LIVER POLYAfvfINE SALVAGE PATHWAY
CONVERSlON TO MYCOPHEWIATE MOFETIL (MM) INSTEAD OF CYCLOSPDRINE A (CYA) IN LIVER TRANSPLANT (LT) RECIPIENTS WITH RENAL FUNCTION IMPAIRMENT. A PILOT STUDY. J.I. Herrero. J. Quirwa B. Sanoro. M. Girda. N. G&W. A. B&&I. F. Parr& J.A. Cii. J PI@@ Lbr Unit and De&mani of Surgery. Clinica Universita~a. Pfm@ona. Spain. Nephro~oxicityis a major adverse effect of CYA. However, graft mjection may follow CYA withdrawal. MMF is a new potent imrrrrmOSuprsSSantwithout nqhmtoxicity. &I To assess whether total or pahal conversion from CYAbased immurosuppregsion to MMF results in improved renal function. &jg& gxl methc& Nine LT recipients ware induded that fulfilled the following inclusion ctiteria: CYAbsad immu nosuppression (plus azathi@ne andlor steroids),sennrcreatinineabovel.5mglb,normalgraftfunctionandapeciod freeof~onofatleestoneyear.MMFwas~etadailydoseof2000 mg,azalhioprinewasdscontinuedandCYAdoeewasslavRyreduced(25mg ebwiy 2 we&s) until dacontirmation 01 lii functh tests worwning. &g& CYAwaswithchnin4patients(p)andCYAbsewasr&cedin5p(m2 becaweofincreaseinliverfunctiontes$andin3duetoatooahatfdlowup) from190mgto86mg.NophedtostopMMF,but4prequireddosereductions bcauseofanemiain3pandmildneubqz&ainone.Twopdm&pedamiM imeaseofGPTthatremainedetable~MherCYAdosedecreaae.~a mean fokwq~ of 4.89 (range: 2 to 7) month8 Serum GPT md total bihtkin b& dmd aWe (mean&EM; bssal vs last debminath): 249 vs 2ld IUA (P=NS) and 0.79i~O.11 M O.SO&IS m@I (P=NS), respectively. &urn creatinine deaeased in all but one p: 2.1iO.l v8 I.&o.1 m@l (W.01) and BUN decreased in all the p: 0.44&&l vs 0344.03 gk (PUl.01). Eight p sufferedfromarlelialhypertensionbefore mmmWontoMMF.Inthelasttisit, 1 pwasfreeofantihypertensivedNgeandin5/8thentmbrofentihjputhve hgscuddbem&md(P=O.O2).~Pahlortotdwnvershh CYAtoMMFinste#eLTrecipientswithrenalfunctionimpairmentmayinprove tifullChlandconbolof~lhypertensionwithCUtgraffdamage
1 co1/017
surgery,
mute
1.55
liver fuihre
1
HELICOBACIER PYLORl INFEXXION AFTFR LIVER TRANSPL.4NTATION F. Conti (1). P. Soti (2). Tuliez (3). F. Menraud (4). D. B Dousse (1). S. &aussade (2). Y C&W cl)_ ‘de Chikugie G&&ale, (2) ‘Service d”H&ato&oenttkologie. (3) Sekice d’.4natomi&kathologique, Hdpital Co&in, Paris, (4) Laboratoire de Bactkriologie Enfants, HGpital Pellegrin, Bordeaux. France. Helicobacter pylori (HP) plays an impomt role in the pathogenesis of gastritis and peptic ulcer disease, and may promote lymphoma. Gastritis and lymphoproliferative disease are frequent complications after transplantation. The aim of this study was to evaluate HP prevalence in liver transplant recipients. 33 asymptomatic liver transplant recipients (mean age: 50 years) were included in this study, at least one year after transplantation (mean: 2 years). Serum samples were obtained, and gastroduodenoscopy and gastric biopsies performed during an annual work up. Serum HP antibodies were detected by EIA (Kit Pyloriset, Orion Diagnostica). Histological analysis was performed by HES staining, and HP infection was assessed by Cresyl Violet staining. Only 1 serum was HP positif. In Contras& HP infection was observed in 14 (42%) gastric biopsies: in 10 patients (30%) HP numeration was low, and in 4 patients (12%) HP numeration was high. Gastroduodenoscopy was normal in 17 (89%) of the 19 patients without HP, and in 9 patients with HP. Concerning histologic findings, lesions were observed in 6 HP negative patients (5 superficial gastritis and 1 pre-atrophic gastritis) and in all HP positive patients (8 superficial gastritis and 6 pre-atrophic gastritis). This study suggests that prevalence of HP infection in liver recipients is similar to that observed in the general population. However, serodiagnostic failed to detect HP infection in those patients. HP presence in gastric biopsies was strongly associated with histologic&lesions. Taking into account the high prevalence of gastritis, HP should be detected by gastroduodenoscopy with gastric biopsies after liver transplantation.
1 co1/019
1
USE OF COLOR DOPPLER ULTRASOUND AND ULTRASOUND CONTRAST IN LIVER TRANSPLANTATION V Como, M Salc.uni*.A Risaliti, M Pirisi“, A Donini; MG Bolligan, G Anania, F Bresadola. Department of Surgery, *Department of RadiologJ;,“Department of Internal Medicine, University of Udine School of Medicine, Udine, Italy Introduction: Color doppler ultrasound (CDUS) is an useful tool for the assessment of the patency of the hepatic artery, portal vein and the inferior wna cava after liver transplantation Due to the condition of the patients, to the presence of surgical scars or to the small diameters of the vessels, sometime the CDUS is not able to determine the presence of blood flow within the vessels. The development of ultrasound contrast (USC) able, if given intravenously, to overcome the pulmonary capillary bed. offers the possibility to amplify the color and reach a better definition of the ultrasound imaging. Methods: Between March 1996 and October 1997 39 liver transplantation have been performed at our Institution. All patients underwent to a CDUS examination daily during the fmt five days a&r transplantation and then once a week for the fust month.In 4 patients (2 male and 2 female, age 32-53 years) in which the US scan was not able to prove the patency of the vena cava 8 ml (300 mg/ml) of the ultrasound contrast Levovist (Schering AGGermany) was administered intravenous. In all patients an inferior venacavography was also performed. Resulfs:The color amplification lasted for 2-3 minutes and allowed to formulate a diagnosis in all cases. In one case the CDUS + USC showed the presence of a thrombosis of the inferior vena cava with the involvement of the renal veins. Inferior venacavography confirmed the presence of a thrombosis with a stenosis of the upper caval anastomosis. In the other 3 cases the CDUS+USC showed the patency of the inferior vena cava. In these cases cavography showed a little discrepancy between the lumen of the donor IVC and that of the recipient, but no signs of thrombosis. Conclusion: Use of CDUS+USC Levovist allowed an accurate evaluation of the vessels of the graft in those cases in which the CDUS alone was dubious.
1 c01/020 -1 THE PROTECTIVE EFFECT OF DIABEl’ES MELLITUS ON PARACETAMOL INDUCED DECREASE OF LIVER POLYAfvfINE SALVAGE PATHWAY
CONVERSlON TO MYCOPHEWIATE MOFETIL (MM) INSTEAD OF CYCLOSPDRINE A (CYA) IN LIVER TRANSPLANT (LT) RECIPIENTS WITH RENAL FUNCTION IMPAIRMENT. A PILOT STUDY. J.I. Herrero. J. Quirwa B. Sanoro. M. Girda. N. G&W. A. B&&I. F. Parr& J.A. Cii. J PI@@ Lbr Unit and De&mani of Surgery. Clinica Universita~a. Pfm@ona. Spain. Nephro~oxicityis a major adverse effect of CYA. However, graft mjection may follow CYA withdrawal. MMF is a new potent imrrrrmOSuprsSSantwithout nqhmtoxicity. &I To assess whether total or pahal conversion from CYAbased immurosuppregsion to MMF results in improved renal function. &jg& gxl methc& Nine LT recipients ware induded that fulfilled the following inclusion ctiteria: CYAbsad immu nosuppression (plus azathi@ne andlor steroids),sennrcreatinineabovel.5mglb,normalgraftfunctionandapeciod freeof~onofatleestoneyear.MMFwas~etadailydoseof2000 mg,azalhioprinewasdscontinuedandCYAdoeewasslavRyreduced(25mg ebwiy 2 we&s) until dacontirmation 01 lii functh tests worwning. &g& CYAwaswithchnin4patients(p)andCYAbsewasr&cedin5p(m2 becaweofincreaseinliverfunctiontes$andin3duetoatooahatfdlowup) from190mgto86mg.NophedtostopMMF,but4prequireddosereductions bcauseofanemiain3pandmildneubqz&ainone.Twopdm&pedamiM imeaseofGPTthatremainedetable~MherCYAdosedecreaae.~a mean fokwq~ of 4.89 (range: 2 to 7) month8 Serum GPT md total bihtkin b& dmd aWe (mean&EM; bssal vs last debminath): 249 vs 2ld IUA (P=NS) and 0.79i~O.11 M O.SO&IS m@I (P=NS), respectively. &urn creatinine deaeased in all but one p: 2.1iO.l v8 I.&o.1 m@l (W.01) and BUN decreased in all the p: 0.44&&l vs 0344.03 gk (PUl.01). Eight p sufferedfromarlelialhypertensionbefore mmmWontoMMF.Inthelasttisit, 1 pwasfreeofantihypertensivedNgeandin5/8thentmbrofentihjputhve hgscuddbem&md(P=O.O2).~Pahlortotdwnvershh CYAtoMMFinste#eLTrecipientswithrenalfunctionimpairmentmayinprove tifullChlandconbolof~lhypertensionwithCUtgraffdamage