Transplantation prognosis

Occasional exercise testing is conducted in order to ascertain disease prognosis or suitability for heart transplant. Even though these tests can demonstrate improvement in heart function and therefore slowed disease progression, patient symptoms may not improve. 

Treatment relies on the use of broad spectrum antibacterial and antifungal drugs bone marrow transplant or gene therapy are possible options. The prognosis for a child with CGD is not good and many will not live beyond their mid-teens. 

Drug therapy and the use of cardioverter defibrillators will not improve the prognosis of patients in this stage. Cardiac transplantation will be the only option. With the patient s informed consent, even inactivation of an ICD can be considered as a possible option in this stage of the disease. The critical issue is fiuid retention control. To achieve this objective, the administration of intravenous positive inotropic agents cannot be weaned off. As a strategy for palliation, vasodilators are sometimes used even though they may worsen mortality. 

Role of Disease Severity or Prognosis. It is also useful to know that the prevalence of poor compliance is seemingly irrespective of prognosis, e.g. with post-transplant immunosuppressants (Didlake et al.. 

Chueh SC, Kahan BD. Dyslipidemia in renal transplant recipients treated with a sirolimus and cyclosporine-based immunosuppressive regimen incidence, risk factors, progression, and prognosis. Transplantation 2003 76 375-82. 

Liver transplantation Like hepatorenal syndrome (s. p. 330), HPS (probably only type 1) is, in principle, reversible after transplantation of the liver. The postoperative prognosis depends on the severity of hypoxaemia prior to transplantation (postoperative lethality is < 5% if preoperative hypoxaemia is > 50 mm Hg). An increase in arterial PO2 when the patient is inhaling 100% O2 in a horizontal position is a good prognostic sign for transplantation. It was possible to demonstrate improvement and normalization regarding arterial blood gas values and intrapulmonary shunt volumes as... 

Fibrotic cholestatic hepatitis in HBV infection can be found in patients following liver transplantation and reinfection of the transplant as well as after bone marrow transplantation (S. E. Davies et al., 1991 J.W.S. Fang et al., 1993). The prognosis is poor. Therapy with lamivud-ine can be tried. (175) Usually, the transplant fails or the outcome is fatal within one year. (s. p. 417)... 

The prognosis is determined by the early onset of acute liver failure in the newborn and, in the following months or years, by the development of hepatocellular carcinoma. (163, 167) A liver transplantation is thus recommended as from the second or third year of life. (162) Dietary measures (avoidance of methionine, tyrosine and phenylalanine as nutritional components) have not proved particularly successful. Good therapeutic results were achieved when 2-(2-nitro-4-trifluoromethyl-benzoyl)-l-3-cyclohexanedione) (NTBC) was applied. This substance is an inhibitor of 4-hydroxyphenylpyru-vate dioxygenase, which prevents the accumulation of succinylacetone. (165) Even the risk of HCC development was reduced by this substance. 

Francavilla, R., Castellaneta, S.P, Hadzic, N., Chambers, S.M., Port-mann, B., Tung, J., Cheeseman, R, Heaton, N.D., Mieli-Vergani, G. Prognosis of alpha-1-antitrypsin deficiency-related liver disease in the era of pediatric liver transplantation. J. Hepatol. 2000 32 986—992... 

It is noteworthy that HBV DNA may persist in the serum and liver despite the elimination of HBsAg. Contrary to early reports, carefully performed longterm studies have shown that the prognosis is essentially more favourable with exact diagnosis and appropriate long-term treatment. (53) Coinfection with HGV and GBV-C or HCV is frequent, but it has no influence on the course and severity of chronic hepatitis C or on liver transplantation. (74)... 

Treatment A ruptured haemangioma requires immediate surgical intervention it is often necessary to ligate the hepatic artery. Enucleation is sometimes possible. (76, 87) Resection or arterial embolization are recommended for very large and symptomatic haemangiomas. Inoperable tumours should be reduced in size by external irradiation or interferon-a therapy. Liver transplantation is a rare indication. (88,89,93) All in all, prognosis is good. (94)... 

Chronic liver diseases, especially cirrhosis and alcohol-induced conditions, are accompanied by malnutrition in 50-80% of cases. The prognosis of the liver disease largely depends on the nutritional state - there is also a direct relationship between the probability of survival after liver transplantation and preoperative malnutrition. (17, 19, 20, 23 - 27, 29, 32)... 

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