Document Detail


Potential effect of cyclosporin A in formation of cholesterol gallstones in pediatric liver transplant recipients.
MedLine Citation:
PMID:  9246038     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Recent advancements in liver transplantation have resulted in extended survival both for grafts and recipients. Such improvement, together with the shortage of donor organs has prompted expansion of the donor pool to include less than ideal donors, especially in life-threatening situations. The use of older liver donors has been associated with lower long-term survival. However, potential morbidity such as gallstone formation has not been explored. We analyzed bile composition in a child who developed cholesterol gallstones in the proximal bile duct two years after undergoing emergency liver transplantation with a liver from a 78-year-old donor. Oral administration of ursodeoxycholic acid (ursodiol) shifted the cholesterol composition of the bile from a supersaturated, potentially crystallized state to a liquid (micellar) state. Unlike cyclosporin A, FK506 showed an increase in the proportion of chenodeoxycholic acid and a decrease in the proportion of cholic acid, and thus may exhibit minimal or no hepatotoxic effect. Thus, in donor livers with factors known to be associated with cholesterol gallstone formation (such as age, sex, or obesity), one may consider analyzing the bile composition at the time of procurement. Depending on cholesterol and bile acid composition the use of FK506 with or without addition of ursodeoxycholic acid may be warranted.
Authors:
S Cao; K Cox; S S So; W Berquist; S P Lee; W G Haigh; W Concepcion; H Monge; C O Esquivel
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Digestive diseases and sciences     Volume:  42     ISSN:  0163-2116     ISO Abbreviation:  Dig. Dis. Sci.     Publication Date:  1997 Jul 
Date Detail:
Created Date:  1997-08-25     Completed Date:  1997-08-25     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7902782     Medline TA:  Dig Dis Sci     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1409-15     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Stanford University Medical Center, Palo Alto, California 94304, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Aged
Bile / chemistry
Cholagogues and Choleretics / therapeutic use
Cholelithiasis / chemistry*,  etiology
Cholesterol / metabolism*
Cyclosporine / adverse effects*,  therapeutic use
Female
Humans
Immunosuppressive Agents / adverse effects*,  therapeutic use
Liver Transplantation*
Male
Tacrolimus / therapeutic use
Tissue Donors
Ursodeoxycholic Acid / therapeutic use
Chemical
Reg. No./Substance:
0/Cholagogues and Choleretics; 0/Immunosuppressive Agents; 109581-93-3/Tacrolimus; 128-13-2/Ursodeoxycholic Acid; 57-88-5/Cholesterol; 59865-13-3/Cyclosporine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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