RESUMO
We report the case of an obese woman with a large hepatocellular adenoma (HCA) of 8.0 cm in diameter, followed for 5 years after Roux-en-Y Gastric Bypass, with a complete radiologic remission of the liver mass. Four other cases have been published with HCA regression after bariatric surgery, but none with long-term follow-up. As the association between obesity and HCA has been increasingly described, bariatric surgery should be considered a therapeutic option for stage 2 obese patients.
Assuntos
Adenoma de Células Hepáticas , Cirurgia Bariátrica , Carcinoma Hepatocelular , Derivação Gástrica , Laparoscopia , Neoplasias Hepáticas , Obesidade Mórbida , Adenoma de Células Hepáticas/diagnóstico por imagem , Adenoma de Células Hepáticas/etiologia , Adenoma de Células Hepáticas/cirurgia , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Obesidade Mórbida/cirurgia , Resultado do TratamentoRESUMO
INTRODUCTION: Size mismatch between donor and recipients may negatively influence postoperative results of liver transplantation (LT). In deceased donor LT for adults, large grafts are occasionally rejected due to the fear of primary nonfunction. The aim of this study is to assess the feasibility of using large liver grafts in adults undergoing deceased donor LT. METHODS: We performed a retrospective study including adult patients who underwent deceased donor LT at our center between January 2006 and September 2019. Recipients with donors aged less than 18 years and those receiving split-liver grafts were excluded. Graft weight of 1800 grams was the cutoff used to divide patients in 2 groups: group 1 (graft weighing < 1800 g) and group 2 (grafts weighing ≥ 1800 g). RESULTS: A total of 806 patients were included in the study. group 1 and 2 included 722 and 84 recipients, respectively. A larger proportion of male recipients was obseved in group 2: 64.8% vs 76.2% (P = .0037). Mean graft weight in group 1 and 2 was, respectively, 1348 ± 231.81 g and 1986.57 ± 165.51 g (P < .001), which resulted in significantly higher graft weight/recipient weight ratio and graft weight/standard liver volume ratio in group 2. In group 2, there were 9 (10.71%) patients with portal vein thrombosis as well as 24 patients (28.5%) with bulky ascites and 44 grafts (52.3%) with steatosis. Primary closure of the abdominal wall was not possible in 5 patients (5.9%) from this group. Primary nonfunction was diagnosed in 14 cases (16.6%), with liver retransplantation being performed in 6 of them. Male to female sex combination occurred in 19% of LT in group 2. CONCLUSION: The use of large grafts is feasible; however, proper matching between donor and recipient is paramount, especially taking into consideration graft steatosis, portal vein thrombosis and the presence of bulky ascites.