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Isolated bilateral Tapia's syndrome after liver transplantation: A case report and review of the literature

World Journal of Hepatology 2016年第36期8卷 1637-1644页

作者： Itxarone Bilbao Cristina Dopazo mireia caralt Lluis Castells Elisabeth Pando Amaia Gantxegi Ramón Charco De-partment of Digestive Surgery Hepatobiliopancreatic Surgery and Liver Transplant Unit Hospital Universitario Vall d’HebrónCIBERehd Universidad Autónoma de Barcelona

AIM To describe one case of bilateral Tapia's syndrome in a liver transplanted patient and to review the *** We report a case of bilateral Tapia's syndrome in a 50-year-old man with a history of human immunodeficiency virus and hepatitis C virus child. A liver cirrhosis and a bi-nodular hepatocellular carcinoma, who underwent liver transplantation after general anesthesia under orotracheal intubation. Uneventful extubation was performed in the intensive care unit during the following hours. On postoperative day(POD) 3, he required urgent re-laparotomy due to perihepatic hematoma complicated with respiratory gram negative bacilli infection. On POD 13, patient was extubated, but required immediate re-intubation due to severe respiratory failure. At the following day a third weaning failure occurred, requiring the performance of a percutaneous tracheostomy. Five days later, the patient was taken off mechanical ventilation and severe dysphagia, sialorrea and aphonia revealed. A computerized tomography and a magnetic resonance imaging of the head and neck excluded central nervous injury. A stroboscopy showed bilateral paralysis of vocal cords and tongue and a diagnosis of bilateral Tapia's syndrome was performed. With conservative management, including a prompt establishment of a speech and swallowing rehabilitation program, the patient achieved full recovery within four months after liver transplantation. We carried out MEDLINE search for the term Tapia's syndrome. The inclusion criteria had no restriction by language or year but must provide sufficientavailable data to exclude duplicity. We described the clinical evolution of the patients, focusing on author, year of publication, age, sex, preceding problem, history of endotracheal intubation, unilateral or bilateral presentation, diagnostic procedures, type of treatment, follow-up, and *** Several authors mentioned the existence of around 70 cases, however only 54 fulfilled our inclusion cri

关键词： Liver transplantation Follow-up Outcome Postoperative complications Bilateral Tapia’s syndrome

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Multiple indications for everolimus after liver transplantation in current clinical practice

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World Journal of Transplantation 2014年第2期4卷 122-132页

作者： Itxarone Bilbao Cristina Dopazo Jose Lazaro Lluis Castells mireia caralt Gonzalo Sapisochin Ramon Charco Hepatobiliopancreatic Surgery and Liver Transplant Unit of the Department of General Surgery Hospital Vall HebrónUniversidad Autónoma Barcelona08035 BarcelonaSpain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD o Ciberehd) Hospital Vall d'Hebron08035 BarcelonaSpain Hepatology Unit of the Department of Internal Medicine Hospital Vall HebrónUniversidad Autónoma Barcelona08035 BarcelonaSpain

AIM: To assess our experience with the use and management of everolimus-based regimens post-liver transplantation and to redefine the potential role of this drug in current clinical ***: From October 1988 to December 2012, 1023 liver transplantations were performed in 955 patients in our Unit. Seventy-four patients(7.74%) received immunosuppression with everolimus at some time post-transplantation. Demographic characteristics, everolimus indication, time elapsed from transplantation to the introduction of everolimus, doses and levels administered, efficacy, side effects, discontinuation andpost-conversion survival were analyzed. RESULTS: Mean age at the time of conversion to everolimus was 57.7 ± 10 years. Indications for conversion were: refractory rejection 31.1%, extended hepatocellular carcinoma in explanted liver 19%, post-transplant hepatocellular carcinoma recurrence 8.1%, de novo tumour 17.6%, renal insufficiency 8.1%, severe neurotoxicity 10.8%, and others 5.4%. Median time from transplantation to introduction of everolimus was 6 mo(range: 0.10-192). Mean follow-up post-conversion was 22 ± 19 mo(range: 0.50-74). The event for which the drug was indicated was resolved in 60.8% of patients, with the best results in cases of refractory rejection, renal insufficiency and neurotoxicity. Results in patients with cancer were similar to those of a historical cohort treated with other immunosuppressants. The main side effects were dyslipidemia and infections. Post-conversion acute rejection occurred in 14.9% of cases. The drug was discontinued in 28.4% of ***: Everolimus at low doses in combination with tacrolimus is a safe immunosuppressant with multiple early and late indications post-liver transplantation.

关键词： Everolimus Liver transplantation Indications Off-protocol Outcome

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