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Herpetic ocular disease is one of the major causes of corneal blindness. Clinical diagnosis of corneal disease is based principally on corneal appearance. However, abnormal morphology of the corneal epithelium (CE) is not an indicator for the presence of a herpes virus. Further, it has not been established if herpes viruses are present in normal corneal epithelial tissue. In these studies, the polymerase chain reaction was used to evaluate normal and diseased corneal epithelium for the presence of herpes simplex virus type 1 (HSV-1), Epstein-Barr virus (EBV) and cytomegalovirus (CMV) genomic sequences. Thirty-two normal corneal epithelium specimens obtained from cadavers shortly after death were analyzed for HSV-1, EBV and CMV genomic sequences. Three of the 32 normal CE specimens were positive for amplified EBV DNA, 1 was positive for HSV-1 DNA, and none was positive for CMV DNA. We also tested eight herpetic dendritic lesions of which 3 were HSV-1 culture and PCR positive. The remaining five dendritic lesions were HSV-1 culture and PCR negative. Since these lesions were not evaluated for other herpesviruses, the etiology of these dendritic lesions is unknown. Six corneal epithelium samples from HIV-infected donors were negative for EBV, CMV and HSV-1 amplified sequences. Positive EBV, CMV and HSV-1 serology on all normal donors and on donors with clinically apparent disease did not correlate with positive PCR results. The results of these studies suggest that EBV and HSV-1 DNA can be amplified from a small percentage of apparently normal corneal epithelium.

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Pellow em Córnea e Doenças Externas. (2) Professor Adjunto do Dept2• de Córnea e D. Externas. (3) Médica Visitante. (4) Médico Residente R2.Microbiologista do Bascom Palmer Eye Insti tute.

1 5 5 Supplement to Transplantation July 27, 2008, Volume 86 Number 2S lobe precluded usage of the liver as a whole allograft. Hence 2 left lobes [from back table cut down] and one left lateral segment [from in-situ split] were procured for transplantation. In 3/15 (20%) of the liver allografts intimal trauma of donor vessels required management on the back table (suturing of hepatic veins in 2, discarding coeliac axis proximal to the hepatic artery in one). The median recipient age was 43 years (2 paediatric recipients). The median cold ischaemic time was 9. 58 (4. 59-15. 5) hours. There were no cases of primary non function or initial poor graft function. No relaparotomies were required for haemorrhage. The median peak ALT and AST post transplantation were 812 (93-2170) IU/ml and 926 (161-1820) IU/ml. Patient and allograft survival at 1 year were 9/13 (69%) for primary grafts and 10/15 (66%) overall. There were 3 early deaths post transplantation [<3 months] from hepatopulmonary syndrome, acute rejection and cerebral haemorrhage. The 2 other recipient deaths were due to a cerebrovascular accident and renal failure. Conclusions: Acceptable results can be achieved using allografts from deceased donors with a history of abdominal trauma. Management of the liver trauma is dictated by the severity of the trauma. Consideration should be given to discarding the right lobe and using the left lobe in cases of severe trauma to the right lobe of the liver. DOMINO LIVER TRANSPLANTATION (LT) IN 441 CHILDREN AND ADULTS WITH MAPLE SYRUP URINE DISEASE (MSUD) Background:Classic MSUD has been treated successfully by LT. Extrahepatic expression of branched-chain (BC) keto acid dehydrogenase complex in non-MSUD patients allows for the consideration of domino LT of MSUD livers into these recipients. Aim: Data from MSUD patients whose livers were domino transplanted were analyzed to develop guidelines for consideration of MSUD livers for domino LT. Results: 5 patients underwent LT for MSUD and had their livers transplanted into 5 non-MSUD patients. Demographic and outcome data are presented in Table 1. Table 1. MSUD Pt Age (yr)/WT (kg) Domino Recipient Age/WT Domino Recipient Diagnosis Current Follow-Up (mo) Patient and graft survival is 100% at a mean of 13. 6 months and liver function is normal in all. 4/5 MSUD donors received veno-venous bypass and hepatic vein back table reconstruction with donor iliac vein. Implantation was by piggyback technique in all non-MSUD patients and 2/5 MSUD patients. Mean leucine, isoleucine, and valine levels (M/L +/-SD) in MSUD patients were 333 +/-159. 9, 125+/-64, 290 +/-119 (Pre) and 205. 3+/-49. 3, 130. 5 +/-46. 5, and 310 +/-98. 1 (Post) respectively. Non-MSUD domino recipient values were normal (138. 3 +/-36. 8, 60+/-28. 1 and 247. 2+/-58. 1) post LT and BC homeostasis has been maintained on unrestricted diet in all pts. One domino recipient underwent successful angioplasty of the hepatic venous anastamosis; there were no other complications noted related to the domino procedure in either don...