Multiorgan dysfunction involving the liver and kidneys is common in patients with end-stage heart failure. The first combined liver-kidney transplant (CLKT) was performed by Margreiter in 1983, and it is a routine procedure in many transplant centers representing 1-8% of liver transplant candidates5.
Hepatic and renal dysfunction may be secondary to a systemic disease process affecting the heart, liver, and kidneys or may be a consequence of heart failure with venous congestion and arterial hypoperfusion2,4.
Despite the complexity and costs involved, the results of this type of transplant are optimistic, as these are terminally ill patients.
Our objective was to report the first Latin American experience in triple transplantation in the same surgical time (heart, liver, and kidney), which took place at Hospital São Lucas Copacabana1.
The organ receiver was a 56-year-old male, physical education teacher, diagnosed with dilated cardiomyopathy with biventricular dysfunction of undetermined origin and compensated cirrhosis of probable cardiogenic etiology diagnosed in 2018 during a cholecystectomy. Chronic kidney disease was due to cardiorenal syndrome.
After follow-up of the case, triple liver-cardiac-renal transplantation was indicated.
The best site for splenic implant was not defined, mainly evaluating the functionality of the implant.
To evaluate the effects of autogenous splenic implantation on the subcutaneous tissue in the survival of splenectomized rats.
Twenty-one randomly assigned rats were studied in three groups (n=7): group 1 - manipulation of the abdominal cavity and preservation of the spleen; group 2 - total splenectomy; group 3 - splenectomy and implant of the tissue removed in the subcutaneous. The animals were followed for 90 days postoperatively.
There was a higher mortality in groups 2 (p=0.0072) and 3 (p=0.0172) in relation to group 1. There was no difference between groups 2 and 3 (p=0.9817).
The splenic implant in the subcutaneous is ineffective in the survival of rats submitted to splenectomy.
There is a lack of data regarding hyperkalemia after liver transplantation.
To evaluate the prevalence of hyperkalemia after liver transplantation and its associated factors.
This retrospective cohort study evaluated 147 consecutive post-transplant patients who had at least one year of outpatient medical follow up. The data collection included gender, age, potassium values, urea, creatinine, sodium and medication use at 1, 6 and 12 months after. Hyperkalemia was defined as serum potassium concentrations higher than 5.5 mEq/l.
Hiperkalemia was observed in 18.4%, 17.0% and 6.1% of patients 1, 6 and 12 months after tranplantation, respectively. Older age (p=0.021), low creatinine clearance (p=0.007), increased urea (p=0.010) and hypernatremia (p=0.014) were factors associated with hyperkalemia, as well as the dose of prednisone at six months (p=0.014).
Hyperkalemia was prevalent in less than 20% of patients in the 1st month after liver transplantation and decreased over time. Considering that hyperkalemia does not affect all patients, attention should be paid to the routine potassium intake recommendations, and treatment should be individualized.
Immunosuppressive drugs are essential for reducing the rejection risk in post-transplant patients, which is commonly associated with this procedure. However, side effects of those drugs on the hypothalamic nuclei involved in the food intake regulation, excessive weight gain, and also associated comorbidities are still unknown.
The purpose of this study was to analyze possible changes in the neuronal morphology and cell density in the paraventricular nuclei, lateral hypothalamic area, dorsomedial nuclei, and ventromedial and arcuate nuclei in Wistar rats submitted to immunosuppressive treatment with tacrolimus (TAC) or mycophenolate mofetil (MMF).
Adult male Wistar rats were randomly assigned to the following groups according to the oral treatment administered for 14 weeks: control, sham (placebo), TAC (1 mg/kg of weight), and MMF (30 mg/kg of weight). After treatment, the animals were sacrificed and their brains fixed for later histological staining. Subsequently, the slides were photodocumented for stereological analysis of the hypothalamic nuclei.
All experimental groups showed a weight gain throughout the study. There was no significant difference in neuronal density/number of cells in the hypothalamic nuclei between groups. Morphological changes were not detected in the hypothalamic neurons.
Treatments with immunosuppressants could not modify the morphological and cell density aspects of the hypothalamic nuclei during this supplementation period.
Desenvolvido por Surya MKT