{"id":3526,"date":"2014-08-20T23:27:52","date_gmt":"2014-08-20T23:27:52","guid":{"rendered":"https:\/\/lpfch.org\/expanding-the-realm-of-possibility-10-breakthroughs-in-pediatric-organ-transplantation-pioneered-at-lucile-packard-childrens-hospital\/"},"modified":"2024-09-13T18:27:35","modified_gmt":"2024-09-13T18:27:35","slug":"expanding-the-realm-of-possibility-10-breakthroughs-in-pediatric-organ-transplantation-pioneered-at-lucile-packard-childrens-hospital","status":"publish","type":"post","link":"http:\/\/lpfch.org\/es\/impact-stories\/expanding-the-realm-of-possibility-10-breakthroughs-in-pediatric-organ-transplantation-pioneered-at-lucile-packard-childrens-hospital\/","title":{"rendered":"Ampliando el horizonte de las posibilidades: 10 avances en trasplantes de \u00f3rganos pedi\u00e1tricos logrados en el Hospital Infantil Lucile Packard"},"content":{"rendered":"

1. Gran organizaci\u00f3n<\/span>an para ni\u00f1os peque\u00f1os<\/span><\/p>\n

\u201cDebido a la escasez cr\u00f3nica de \u00f3rganos para ni\u00f1os, hemos tenido que ser creativos\u201d, dice Carlos Esquivel, MD, PhD. Fue uno de los primeros cirujanos en adaptar un h\u00edgado de un donante adulto fallecido dividi\u00e9ndolo en dos partes viables para dos pacientes: un ni\u00f1o y un adulto.<\/p>\n

Esquivel y sus colegas tambi\u00e9n estuvieron entre los primeros en lograr con \u00e9xito un trasplante parcial de h\u00edgado de un donante adulto vivo a un ni\u00f1o. Sorprendentemente, la porci\u00f3n trasplantada crece hasta alcanzar un tama\u00f1o normal a medida que el ni\u00f1o crece, y el h\u00edgado del donante adulto tambi\u00e9n recupera su tama\u00f1o original.<\/p>\n

2. De padres a hijos<\/h2>\n

Los padres donantes pueden transmitir cierta inmunidad a sus hijos, por lo que los pacientes menores de dos a\u00f1os que reciben un trasplante de ri\u00f1\u00f3n suelen recibir un \u00f3rgano de su madre o padre. En el Hospital Infantil Packard, el trasplante renal de padre a hijo dura, en promedio, m\u00e1s de 20 a\u00f1os. Gracias a una mejor comprensi\u00f3n de los mecanismos de rechazo y al desarrollo de mejores estrategias de inmunosupresi\u00f3n, se espera que aumenten las tasas de supervivencia renal.<\/p>\n

3. No se requiere coincidencia<\/h2>\n

Hace treinta a\u00f1os, pocos hospitales pedi\u00e1tricos realizaban trasplantes de h\u00edgado de donantes cuyo grupo sangu\u00edneo no coincid\u00eda con el del ni\u00f1o. Hoy en d\u00eda, los m\u00e9dicos del Hospital Infantil Packard realizan con frecuencia trasplantes de h\u00edgado incompatibles incluso en los pacientes m\u00e1s peque\u00f1os. La posibilidad de que los grupos sangu\u00edneos sean compatibles reduce el tiempo de espera para un trasplante.<\/p>\n

4. Los pacientes m\u00e1s peque\u00f1os<\/h2>\n

En los ni\u00f1os peque\u00f1os, los vasos sangu\u00edneos que intervienen en los trasplantes de h\u00edgado y ri\u00f1\u00f3n son tan diminutos que los cirujanos deben usar suturas invisibles a simple vista. Para los pacientes j\u00f3venes que reciben ri\u00f1ones de adultos, los m\u00e9dicos del Hospital Infantil Packard tambi\u00e9n fueron pioneros en una t\u00e9cnica intensiva de reposici\u00f3n de l\u00edquidos para aumentar el flujo sangu\u00edneo. Adem\u00e1s de una precisi\u00f3n quir\u00fargica absoluta, el equipo de trasplantes brinda atenci\u00f3n integral a los ni\u00f1os antes y despu\u00e9s del trasplante para garantizar los mejores resultados posibles. Hoy en d\u00eda, en el Hospital Infantil Packard, la tasa de supervivencia de los pacientes de trasplante de h\u00edgado menores de 2 a\u00f1os es de casi el 100 %, e incluso los reci\u00e9n nacidos se salvan gracias a las cirug\u00edas de trasplante.<\/p>\n

5. Ni\u00f1os \u201cno trasplantables\u201d<\/h2>\n

Como reacci\u00f3n a trasplantes, transfusiones de sangre o vacunaciones previas, muchos ni\u00f1os que necesitan un trasplante de ri\u00f1\u00f3n presentan sistemas inmunitarios altamente sensibilizados que atacar\u00edan sus nuevos \u00f3rganos. El Hospital Infantil Packard es uno de los pocos hospitales que ofrece atenci\u00f3n a ni\u00f1os considerados \u00abno aptos para trasplante\u00bb. Un tratamiento, la plasmaf\u00e9resis, elimina los anticuerpos que podr\u00edan atacar un ri\u00f1\u00f3n de un donante con un grupo sangu\u00edneo diferente. Las pruebas de laboratorio desarrolladas en Stanford tambi\u00e9n pueden determinar si un paciente tiene anticuerpos espec\u00edficos que pueden eliminarse mediante infusiones intravenosas de inmunoglobulina.<\/p>\n

6. Trasplantes multiorg\u00e1nicos<\/h2>\n

El Hospital Infantil Packard es uno de los pocos hospitales pedi\u00e1tricos que realizan trasplantes multiorg\u00e1nicos, incluyendo trasplantes de h\u00edgado y ri\u00f1\u00f3n, h\u00edgado y coraz\u00f3n, h\u00edgado e intestino, y el primer trasplante pedi\u00e1trico de h\u00edgado y pulm\u00f3n doble. \u00abUna ventaja de recibir tratamiento en este hospital es que contamos con muchos especialistas en trasplantes\u00bb, afirma Esquivel.<\/p>\n

7. Alternativas al trasplante<\/h2>\n

El Dr. Kenneth Cox, profesor de gastroenterolog\u00eda pedi\u00e1trica, y otros investigadores est\u00e1n desarrollando terapias innovadoras que evitan la necesidad de algunos trasplantes. En 1993, el Dr. Cox descubri\u00f3 que un antibi\u00f3tico llamado vancomicina era \u00fatil para tratar no solo infecciones bacterianas, sino tambi\u00e9n una enfermedad rara del h\u00edgado y el colon denominada colangitis esclerosante primaria. Anteriormente, el trasplante era la \u00fanica forma de combatir esta enfermedad. Adem\u00e1s, la Dra. Rebecca Berquist McKenzie, investigadora postdoctoral, est\u00e1 desarrollando un nuevo protocolo para tratar a ni\u00f1os con insuficiencia hep\u00e1tica causada por hepatitis aguda. Hasta la fecha, nueve ni\u00f1os con hepatitis inmunomediada han recibido tratamiento. M\u00e1s de la mitad ya no padecen hepatitis y tienen un h\u00edgado completamente funcional, evitando as\u00ed la necesidad de un trasplante.<\/p>\n

8. Basta de esteroides<\/h2>\n

Durante d\u00e9cadas, los ni\u00f1os con trasplantes de ri\u00f1\u00f3n recibieron esteroides para prevenir el rechazo del \u00f3rgano. Sin embargo, el uso cr\u00f3nico de esteroides a menudo provocaba complicaciones graves, como displasia de cadera, artritis, diabetes, infecciones y diversas afecciones metab\u00f3licas. En la d\u00e9cada de 1990, los m\u00e9dicos del Hospital Infantil Packard tomaron la audaz decisi\u00f3n de suspender el tratamiento con esteroides para los pacientes trasplantados. En aquel entonces, la idea se consideraba de alto riesgo, pero se demostr\u00f3 que las tasas de rechazo eran bajas y los pacientes se libraron de los efectos secundarios de los esteroides. Hoy en d\u00eda, el protocolo sin esteroides se est\u00e1 convirtiendo en el est\u00e1ndar de atenci\u00f3n para los trasplantes de ri\u00f1\u00f3n pedi\u00e1tricos en todo el mundo.<\/p>\n

9. Combatiendo virus mortales<\/h2>\n

El exceso de medicamentos inmunosupresores puede desencadenar infecciones mortales como el virus de Epstein-Barr, que puede causar c\u00e1ncer de los gl\u00f3bulos blancos, o el virus BK, que destruye los ri\u00f1ones trasplantados. Con el apoyo de los Institutos Nacionales de la Salud y donantes privados, los investigadores buscan comprender mejor estos virus, identificar a los pacientes de alto riesgo y eliminar el riesgo de estas peligrosas infecciones.<\/p>\n

10. Terapia con c\u00e9lulas madre<\/h2>\n

Alg\u00fan d\u00eda, las c\u00e9lulas madre hep\u00e1ticas podr\u00edan utilizarse como alternativa al trasplante de h\u00edgado. Aunque ambicioso, el objetivo es emplear una infusi\u00f3n de c\u00e9lulas madre hep\u00e1ticas como terapia de apoyo en ni\u00f1os con hepatitis fulminante aguda hasta que su h\u00edgado se recupere, o como puente al trasplante. En ni\u00f1os con trastornos metab\u00f3licos que provocan la producci\u00f3n de toxinas que da\u00f1an el cerebro por parte del h\u00edgado, la terapia con c\u00e9lulas madre podr\u00eda ser un tratamiento eficaz y menos invasivo que el reemplazo total del h\u00edgado. \u00abActualmente, si un gen est\u00e1 defectuoso, tenemos que reemplazar todo el h\u00edgado\u00bb, afirma Esquivel. \u00abPara aquellos ni\u00f1os que necesitan trasplantes, nuestros equipos est\u00e1n preparados. Pero, al mismo tiempo, tambi\u00e9n estamos comprometidos con la b\u00fasqueda de tratamientos que ayuden a nuestros pacientes a evitar los trasplantes, si es posible\u00bb.<\/p>\n

Este art\u00edculo apareci\u00f3 en la publicaci\u00f3n Lucile Packard Children's News en el oto\u00f1o de 2013.<\/em><\/p>","protected":false},"excerpt":{"rendered":"

1. \u00d3rganos grandes para ni\u00f1os peque\u00f1os \u201cDebido a la escasez cr\u00f3nica de \u00f3rganos para ni\u00f1os, hemos tenido que ser creativos\u201d, dice Carlos Esquivel, MD, PhD\u2026.<\/p>","protected":false},"author":17,"featured_media":3527,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[148,22],"class_list":["post-3526","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-in-the-news","category-patient-stories","health_topic-transplant"],"acf":[],"yoast_head":"\nExpanding the Realm of Possibility: 10 Breakthroughs in Pediatric Organ Transplantation Pioneered at Lucile Packard Children\u2019s Hospital - Lucile Packard Foundation for Children's Health<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"http:\/\/lpfch.org\/es\/impact-stories\/expanding-the-realm-of-possibility-10-breakthroughs-in-pediatric-organ-transplantation-pioneered-at-lucile-packard-childrens-hospital\/\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Expanding the Realm of Possibility: 10 Breakthroughs in Pediatric Organ Transplantation Pioneered at Lucile Packard Children\u2019s Hospital\" \/>\n<meta property=\"og:description\" content=\"1. 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