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<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Neurological complications (NCs) are of major concern following hematological stem cell transplantation (HSCT), most of which present with seizures.</jats:p></jats:sec><jats:sec><jats:title>Procedures</jats:title><jats:p>We performed a retrospective study (2002–2018) of patients undergoing HSCT in order to analyze the incidence and aetiologies related to seizures.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of 155 children undergoing HSCT, 27 (17.4%) developed seizures at some point in 2 years of follow‐up. The most frequent etiologies were central nervous system (CNS) infection (<jats:italic>n</jats:italic> = 10), drug toxicity (<jats:italic>n</jats:italic> = 8), and vascular disease (<jats:italic>n</jats:italic> = 5). A statistically significant association was found between seizure and the HSCT type (lower risk for a related identical donor, <jats:italic>p</jats:italic> = .010), prophylactic or therapeutic mycophenolate use (<jats:italic>p</jats:italic> = .043 and .046, respectively), steroid use (<jats:italic>p</jats:italic> = .023), selective CD45RA+ depletion (<jats:italic>p</jats:italic> = .002), pre‐engraftment syndrome (<jats:italic>p</jats:italic> = .007), and chronic graft‐versus‐host disease (GVHD) severity (<jats:italic>p</jats:italic> = .030). Seizures predicted evolution to life‐threatening complications and admission to intensive care (<jats:italic>p</jats:italic> &lt; .001) and higher mortality (<jats:italic>p</jats:italic> = .023). A statistically significant association was also found between seizures and sequelae in survivors (<jats:italic>p</jats:italic> = .029). Children who developed seizures had a higher risk of CNS infection and vascular disease (odds ratio 37.25 [95% CI: 7.45–186.05] and 12.95 [95% CI 2.24–74.80], respectively).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Neurological complications highly impact survival and outcomes and need to be addressed when facing an HSCT procedure.</jats:p></jats:sec>

<jats:title>Abstract</jats:title><jats:p>The overarching goal in the care of pediatric liver transplant recipients is to optimize allograft and patient health. Balancing immunosuppression to maintain allograft health while avoiding medication side effects is essential for long‐term survival and optimal quality of life in pediatric liver transplant recipients. Utilizing precision medicine to personalize immunosuppression, which includes minimization and withdrawal, is core to this effort. The unique anatomy and physiology of the liver make it more tolerant to immune‐mediated injury and a more favorable organ for immunosuppression minimization and withdrawal. However, several challenges exist. Standard biochemical values and histologic features may not reliably predict allograft health after a reduction in immunosuppression. Additionally, biochemical values alone do not reliably identify which patients can successfully develop operational tolerance, as there may be occult allograft injury despite normal liver enzymes. Finally, the durability of tolerance after successful reduction in immunosuppression remains uncertain over time. Innovative tools show promise in circumventing these challenges, but more research is needed to determine actual clinical utility. While immunosuppression‐free transplant may not be a current reality for most pediatric liver transplant recipients, strategies to safely minimize immunosuppression without compromising allograft health are within reach. Each liver allograft and recipient pair requires a different degree of immune modulation, and through a structured process of minimization and withdrawal, immunosuppression can indeed be tailored in a precise, personalized way to optimize outcomes. This review focuses on the progress that has been made to individualize immunosuppression in pediatric liver transplantation to ensure optimal allograft and recipient health.</jats:p>

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Berardinelli–Seip syndrome is an infrequently seen and potentially fatal genetic disorder characterized by the absence of adipose tissue. Herein, we report a first‐in‐literature liver transplant done on a 7‐year‐old girl because of liver cirrhosis caused by the Berardinelli–Seip syndrome.</jats:p></jats:sec><jats:sec><jats:title>Case Report</jats:title><jats:p>Physical examination showed prominent subdermal fat tissue loss and mild muscle hypertrophy, giving her a slim appearance, hirsutism, thick hair, a large head in contrast to the body, low anterior hairline, icterus, prominent facial contours, prominent mandibula, loss of buccal fat, low set ears, and large limbs. After the diagnosis, she admitted to our clinic because of variceal esophageal bleeding and increasing liver enzymes. Transplantation decision was made and orthothopic liver transplantation done by the surgery team.</jats:p></jats:sec><jats:sec><jats:title>Discussion</jats:title><jats:p>Common causes of death in Berardinelli–Seip syndrome patients are infections and liver cirrhosis. The mean age of the patients was 27.1 at the time of death. There is no any established cure for congenital lipodystrophies so far. However, some symptomatic treatment methods are found to be helpful. The main point of the case report to be discussed is the liver transplantation done by our surgical team. There are no examples of any transplantation in Berardinelli–Seip syndrome patients, but several reports can be found of patients with kidney or liver failure.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Berardinelli–Seip syndrome is a rare disorder with no cure but a chance of improving lifestyle and life expectancy. The transplantation option should be considered in young patients after a multidisciplinary review.</jats:p></jats:sec>