Rapid normalization of severe hypercholesterolemia mediated by lipoprotein X after liver transplantation in a patient with cholestasis - a case report.
We report a case of severe hypercholesterolemia mediated by LpX in a patient transplanted for primary biliary cirrhosis (PBC), who was qualified for liver re-transplantation (re-LTx) due to chronic cholestasis. Four months after re-LTx, the cholesterol concentration was normal. The problems in diagnosis and treatment are discussed. PMID: 26317127 [PubMed - as supplied by publisher]
We report a series of 5 solid organ transplantation recipients diagnosed with STEC-HUS between January 2017 and March 2019 in 2 French nephrology centers (Table 1). One patient had 2 episodes of STEC-HUS. All had severe acute kidney injury (requiring hemodialysis in 2). Neurological involvement was noted during 5 episodes: seizures (n = 4) and confusion/coma (n = 4).
As many as 10% to 20% of patients undergoing kidney transplantation develop post-transplant diabetes mellitus, which is associated with increased mortality. Even borderline changes in glucose metabolism, so-called prediabetes, may involve a similar risk. A recent study by Porrini et al. showed for the first time that such changes in glucose metabolism are in fact associated with future cardiovascular disease and death in kidney-transplanted patients. This commentary discusses the relevance and clinical implications of these new findings.
Kidney and urinary tract congenital anomalies are present in 9.5% of males under age 18. A donor in his 50s had head trauma and was found to have a horseshoe kidney. En bloc organ donation was performed after circulatory death with 41 minutes of warm ischemia time. The kidney donor profile index was 73%, final creatinine was 0.7 mg/dl, and kidney biopsies revealed 2% (right) and 3% (left) glomerulosclerosis with no fibrosis, arteriosclerosis, or arteriolosclerosis. Both kidneys had anteriorly positioned ureters, separated by a 2-cm isthmus (Figure 1).
A 48-year-old kidney transplant recipient was admitted to our hospital with nausea, polyuria, diffuse paresthesia, and muscle weakness of all extremities. His past medical history was remarkable for renal transplantation with impaired graft function (baseline glomerular filtration rate approximately 20 ml/min per 1.73 m2) and parathyroidectomy due to an uncontrolled hyperparathyroidism. An electrocardiogram showed pronounced concave ST-segment elevations in leads II, III, and aVF suspicious of an acute ST elevation myocardial infarction as well as ascending elevations deriving from a deep S wave especially in leads V1 &nda...
Conclusions: Our findings suggest that some subsets of XPD patients may be at risk of radiosensitivity reactions and treatment with statins and bisphosphonates may be an interesting approach of radioprotection countermeasure. Different mechanistic models were discussed to better understand the potential specificity of the p.[Arg683Trp];[Arg616Pro] XPD mutations . PMID: 31738647 [PubMed - as supplied by publisher]
Conclusions Patients are not adequately ready to change their health-related behaviors. Higher cardiovascular risk predicts higher readiness to change health behaviors.
We thank Huang et al1 for the comments on our study.2 Because there were no data on the effect of carvedilol on prophylaxis of recurrent gastric variceal bleeding (GVB), the sample size calculations were based on a study that showed that adding nonselective β-blockers (NSBBs) to band ligation reduced recurrent eso phageal variceal bleeding (EVB) by 23%.3 Although the carvedilol group had a lower risk of recurrent GVB and a longer transplantation-free survival than the control group, the differences between both groups were not significant.
Aim: Hypercholesterolemia is a common feature of cholestatic liver syndromes. However, cholesterol levels beyond 500 mg/dl rarely occur in patients with cholestasis. The data for other specific types of cholestatic syndromes except for primary biliary cirrhosis is sparse in the literature. The administration of lipid-lowering agents (LLA) in these syndromes is still controversial.
Authors: Purohit T, Cappell MS Abstract Primary biliary cirrhosis (PBC) is an autoimmune, slowly progressive, cholestatic, liver disease characterized by a triad of chronic cholestasis, circulating anti-mitochondrial antibodies (AMA), and characteristic liver biopsy findings of nonsuppurative destructive cholangitis and interlobular bile duct destruction. About 10% of PBC patients, however, lack AMA. A variant, called PBC-autoimmune hepatitis (AIH) overlap, is characterized by the above findings of PBC together with findings of elevated serum alanine aminotransferase, elevated serum immunoglobulin G, and circulatin...
Cholestasis, including primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC), results from an impairment or disruption of bile production and causes intracellular retention of toxic bile constituents, including bile salts. If left untreated, cholestasis leads to liver fibrosis and cirrhosis, which eventually results in liver failure and the need for liver transplantation. Currently, the only therapeutic option available for these patients is ursodeoxycholic acid (UDCA), which slows the progression of PBC, particularly in stage I and II of the disease. However, some patients have an incomplete response to...