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- Diabetes Mellitus após transplante renalPublication . Ruas, L; Bastos, M; Alves, R; Rodrigues, D; Barros, L; Mota, A; Carvalheiro, M; Ruas, A; Furtado, AL
- Sequential liver transplantationPublication . Furtado, AL; Tomé, L; Oliveira, FJ; Furtado, E; Viana, JS; Perdigoto, R
- Transplantação renal em doentes com diabetes mellitus tipo I e tipo IIPublication . Baptista, C; Bastos, M; Gomes, L; Macário, F; Ruas, L; Rodrigues, D; Alves, R; Gomes, H; Ferreira, C; Roseiro, A; Paiva, S; Barros, L; Carvalheiro, M; Mota, A; Furtado, AL; Ruas, AA total of 618 patients with end-stage renal disease received kidney transplants between 1980 and September 1996. Twenty eight of them were diabetics. Better results were achieved for type 1 diabetic patients than for type 2 (mortality: 5.9% vs 27.3%; functioning graft: 88.2% vs 72.7%). The morbility was also higher in those patients (infections: 81.8% vs 29.4%; vascular complications: 45.5% vs 17.6%). Actuarial patient and graft survival were lower for type 2 than for non diabetic patients. For type 1 diabetics the results are similar to those for non diabetics. Better results can probably be achieved by restricting the selection criteria. The decision to transplant or maintain on dialysis should be made on a case by case basis.
- Haemodynamics during liver transplantation in familial amyloidotic polyneuropathy: study of the intraoperative cardiocirculatory data of 50 patientsPublication . Viana, JS; Bento, C; Vieira, H; Neves, S; Seco, C; Elvas, L; Coelho, L; Ferrão, J; Tomé, L; Perdigoto, R; Craveiro, AL; Providência, LA; Furtado, ALBACKGROUND: Circulatory instability frequently complicates liver transplantation for familial amyloidotic polyneuropathy (FAP) and may be a source of surgical morbidity and mortality. OBJECTIVE: To evaluate FAP intraoperative haemodynamic data and their relation to the duration of surgery, and need for anaesthetic drugs. RBC and sympathomimetic amines. SETTING: Clinical study during a four year period. PATIENTS (mean +/- SD): Group I included 50 consecutive FAP ATTR Met 30 recipients of first transplantation. Age was 35.3 +/- 7.1 years, neurological score 34.3 +/- 13 in 100 and time elapsed from first symptom 5.0 +/- 2.7 years. Group II (control), not different concerning age and sex, included 51 patients transplanted during the same period with other pathologies. METHOD: Anaesthetic protocol, monitoring and surgical techniques were similar in both groups. Data of the two groups were compared either by the Student's t-test or Fisher's exact test. RESULTS: Low values of systemic vascular resistance index were observed in both groups, with no differences between them. Systemic arterial pressures were usually lower in group I, because cardiac index and heart rate were also significantly lower, although within normal values. However, in group I, isoflurane (a vasodilator anaesthetic) was used during less time (p < 0.05) and in lower concentrations (p < 0.01) and phenylephrine was necessary in 26% of patients vs 0 patients in group II (p < 0.001). CONCLUSION: FAP patients presented a different intraoperative behaviour when compared to other patients submitted to liver transplantation. From a clinical point of view, the authors stress: 1--As a result of autonomic dysfunction, the administration of anaesthetic drugs to FAP patients always presents the risk of producing significant hypotension; even the use of ketamine does not prevent hypotension; 2--Safety is ensured by beat-to-beat surveillance of arterial pressures and the capacity to act immediately to support circulation; 3--These patients seem to be very sensitive to decreases in the pre-load; 4--Hypotension is also frequent with an adequate pre-load, usually as the result of low SVR; an infusion of a vasoconstrictor drug emerges as the most frequent treatment requested and our experience supports it as an effective one.
- Peripheral blood lymphocyte phenotype can predict rejection episodes after orthotopic liver transplantationPublication . Perdigoto, R; Paiva, A; Freitas, A; Coimbra, HB; Mota, O; Ferrão, J; Tomé, L; Furtado, E; Cipriano, MA; Geraldes, B; Oliveira, FJ; Furtado, AL
- Maximum sharing of cadaver liver grafts composite split and domino liver transplantsPublication . Furtado, AL; Oliveira, FJ; Furtado, E; Geraldes, B; Reis, A; Viana, JS; Bento, C; Vieira, H; Neves, S
- Domino liver transplantation using livers from patients with familial amyloidotic polyneuropathyPublication . Furtado, ALTransplantation of livers from patients with familial amyloidotic polyneuropathy undergoing orthotopic liver transplantation is based on the normal functions of these livers, except for the production of an abnormal protein that causes the disease, which takes more than 20 years to become clinically apparent. Given the shortage of cadaver grafts, domino liver transplantation has the potential to increase the offer to some selected patients. The known experience amounts to little more than 80 cases. Domino liver transplantation has been a safe procedure with all the advantages of living donor grafts. So far, the disease has not shown up in any recipient, including the longest surviving patient (4 years). Particularly in countries where the disease is common, the potential to increase graft offer may be significantly augmented through cooperation between centers and better exploitation of technical possibilities. The combination of split and domino has been reported six times and may provide three to six transplants from only one cadaver graft
- Requirements of circulatory support during liver transplantation: are patients with familial amyloidosis different from other patients?Publication . Viana, JS; Bento, C; Vieira, H; Neves, S; Seco, C; Perdigoto, R; Craveiro, AL; Furtado, AL