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1.
Liver Int ; 41(4): 851-862, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33217193

RESUMO

BACKGROUND & AIM: Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) has a poor prognosis, and the adjusted effect of different treatments on post-recurrence survival (PRS) has not been well defined. This study aims to evaluate prognostic and predictive variables associated with PRS. METHODS: This Latin American multicenter retrospective cohort study included HCC patients who underwent LT between the years 2005-2018. We evaluated the effect of baseline characteristics at time of HCC recurrence diagnosis and PRS (Cox regression analysis). Early recurrences were those occurring within 12 months of LT. To evaluate the adjusted treatment effect for HCC recurrence, a propensity score matching analysis was performed to assess the probability of having received any specific treatment for recurrence. RESULTS: From a total of 1085 transplanted HCC patients, the cumulative incidence of recurrence was 16.6% (CI 13.5-20.3), with median time to recurrence of 13.0 months (IQR 6.0-26.0). Factors independently associated with PRS were early recurrence (47.6%), treatment with sorafenib and surgery/trans-arterial chemoembolization (TACE). Patients who underwent any treatment presented "early recurrences" less frequently, and more extrahepatic metastasis. This unbalanced distribution was included in the propensity score matching, with correct calibration and discrimination (receiving operator curve of 0.81 [CI 0.72;0.88]). After matching, the adjusted effect on PRS for any treatment was HR of 0.2 (0.10;0.33); P < .0001, for sorafenib therapy HR of 0.4 (0.27;0.77); P = .003, and for surgery/TACE HR of 0.4 (0.18;0.78); P = .009. CONCLUSION: Although early recurrence was associated with worse outcome, even in this population, systemic or locoregional treatments were associated with better PRS.


Assuntos
Carcinoma Hepatocelular , Quimioembolização Terapêutica , Neoplasias Hepáticas , Transplante de Fígado , Carcinoma Hepatocelular/cirurgia , Estudos de Coortes , Humanos , América Latina/epidemiologia , Neoplasias Hepáticas/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
2.
Ann Hepatol ; 19(6): 662-667, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32683095

RESUMO

INTRODUCTION AND OBJECTIVES: The liver imaging reporting data system (LI-RADS) for hepatocellular carcinoma (HCC) was proposed to standardize and enhance consensus of reporting. However, clinical utility of LI-RADS has not been evaluated in Latin America. We therefore sought to compare LI-RADS categories with histopathology findings in liver transplant (LT) explants in a regional center. MATERIALS AND METHODS: Prospective cohort study conducted between 2012 and 2018 in a single center from Argentina including patients with HCC listed for LT. LI-RADS definitions were applied to magnetic resonance images (MRI) or computed tomography (CT) abdominal scans at time of listing and at final pre-LT reassessment and compared to explant pathology findings; specifically, major nodule (NOD1). RESULTS: Of 130 patients with HCC listed for LT (96.1% with cirrhosis and 35.6% with hepatitis C virus infection), 72 underwent LT. Overall, 65% had imaging HCC diagnosis based on MRI (n = 84), 26% with CT (n = 34) and 9% (n = 12) with both methods. Among LT patients with pre-transplant imaging at our institution (n = 42/72), 69% of the NOD1 were LR-5, 21% LR-4 and 10% LR-3. Definite HCC diagnosis was 50% in LR-3 NOD1 (CI 18-90); none presented microvascular invasion. In LR-4 NOD1, HCC was confirmed in 89% (CI 59-98), of which 11% showed microvascular invasion; whereas in LR-5 NOD1 77% (CI 64-87) had confirmed HCC, 17% with microvascular invasion. CONCLUSIONS: LI-RADS was useful to standardize reports; however, no significant differences were observed between LR-4 and LR-5 HCC probability when compared to explant pathology.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Idoso , Argentina , Carcinoma Hepatocelular/cirurgia , Tomada de Decisão Clínica , Feminino , Humanos , Neoplasias Hepáticas/cirurgia , Transplante de Fígado , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
3.
Future Oncol ; 15(27): 3149-3157, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31426677

RESUMO

Aim: To determine the impact of KRAS mutation status on survival in patients undergoing surgery for colorectal liver metastases (CLM). Patients & methods: Patients with resected CLM and KRAS mutations. Survival was compared between mt-KRAS and wt-KRAS. Results: Of 662 patients, 174 (26.3%) were mt-KRAS and 488 (73.7%) wt-KRAS. mt-KRAS patients had significantly lower recurrence-free survival (HR: 1.42; 95% CI: 1.10-1.84). There were no differences between the groups for sidedness. Poorer survival was associated with mt-KRAS with positive lymph nodes, >1 metastases, tumors >5 cm, synchronous tumors and R1-R2. Conclusion: KRAS mutation status can help predict recurrence-free survival. Primary tumor location was not a prognostic factor after resection. KRAS mutation status can help design a multidisciplinary approach after curative resection of CLM.


Assuntos
Biomarcadores Tumorais , Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Mutação , Proteínas Proto-Oncogênicas p21(ras)/genética , Adulto , Idoso , Neoplasias Colorretais/mortalidade , Terapia Combinada , Feminino , Humanos , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Análise de Sobrevida
4.
Pediatr Transplant ; 22(3): e13159, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29417691

RESUMO

Controversy exists whether NE after LT are more frequently observed in children or adults. We aimed to compare the incidence and outcomes for NE after LT in pediatric and adult recipients. A single-center cohort study, including all LT between 2001 and 2013, was performed. Definition of NE included impaired consciousness, delirium, seizures, focal neurologic deficit, visual impairment, or slurred speech. A cohort of 443 consecutive LT recipients was included: 307 adults and 136 children. Cumulative incidence of NE was similar between adults 15% (n = 41) and children 16% (n = 20; P = .73) with a complete neurological recovery in 62% and 95% of the patients, respectively (P < .0001). Adults with NE had significantly lower survival (70% vs 76%; P = .015) with a HR of 2.36; this was similarly observed in children (45% vs 66%; HR 2.05, CI 0.66; 6.34). Independent risk factors for NE in adults were pre-LT ascites, delta sodium, and post-LT hypomagnesemia, whereas in children pre-LT encephalopathy ≥II and serum albumin were associated with NE. Although a similar incidence of NE after LT was observed, children were more likely to achieve neurological recovery. Risk factors for the development of NE are difficult to assess in both populations.


Assuntos
Transplante de Fígado , Doenças do Sistema Nervoso/etiologia , Complicações Pós-Operatórias/etiologia , Adulto , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/epidemiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Fatores de Risco
5.
Ann Hepatol ; 17(2): 256-267, 2018 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29469048

RESUMO

BACKGROUND AND AIMS: Heterogeneous data has been reported regarding liver transplantation (LT) for hepatocellular carcinoma (HCC) in Latin America. We aimed to describe treatment during waiting list, survival and recurrence of HCC after LT in a multicenter study from Latin America. MATERIAL AND METHODS: Patients with HCC diagnosed prior to transplant (cHCC) and incidentally found in the explanted liver (iHCC) were included. Imaging-explanted features were compared in cHCC (non-discordant if pre and post-LT were within Milan, discordant if pre-LT was within and post-LT exceeding Milan). RESULTS: Overall, 435 patients with cHCC and 92 with iHCC were included. At listing, 81% and 91% of cHCC patients were within Milan and San Francisco criteria (UCSF), respectively. Five-year survival and recurrence rates for cHCC within Milan, exceeding Milan/within UCSF and beyond UCSF were 71% and 16%; 66% and 26%; 46% and 55%, respectively. Locoregional treatment prior to LT was performed in 39% of cHCC within Milan, in 53% beyond Milan/within UCSF and in 83% exceeding UCSF (p < 0.0001). This treatment difference was not observed according to AFP values (≤100, 44%; 101-1,000, 39%, and > 1,000 ng/mL 64%; p = 0.12). Discordant imaging-explanted data was observed in 29% of cHCC, showing lower survival HR 2.02 (CI 1.29; 3.15) and higher recurrence rates HR 2.34 when compared to AFP <100 ng/mL. Serum AFP > 1,000 ng/mL at listing was independently associated with a higher 5-year recurrence rate and a HR of 3.24 when compared to AFP <100 ng/mL. CONCLUSION: Although overall results are comparable to other regions worldwide, pre-LT treatment not only considering imaging data but also AFP values should be contemplated during the next years.


Assuntos
Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/cirurgia , Transplante de Fígado , Idoso , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/mortalidade , Feminino , Humanos , América Latina/epidemiologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/mortalidade , Transplante de Fígado/efeitos adversos , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Listas de Espera
6.
Liver Transpl ; 22(1): 63-70, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26369269

RESUMO

Grafts from split livers (SLs) constitute an accepted approach to expand the donor pool. Over the last 5 years, most Argentinean centers have shown significant interest in increasing the use of this technique. The purpose of this article is to describe and analyze the outcomes of right-side grafts (RSGs) and left-side grafts (LSGs) from a multicenter study. The multicenter retrospective study included data from 111 recipients of SL grafts from between January 1, 2009 and December 31, 2013. Incidence of surgical complications, patient and graft survival, and factors that affected RSG and LSG survival were analyzed. Grafts types were 57 LSG and 54 RSG. Median follow-up times for LSG and RSG were 46 and 42 months, respectively. The 36-month patient and graft survivals for LSG were 83% and 79%, respectively, and for RSG were 78% and 69%, respectively. Retransplantation rates for LSG and RSG were 3.5% and 11%, respectively. Arterial complications were the most common cause of early retransplantation (less than 12 months). Cold ischemia time (CIT) longer than 10 hours and the use of high-risk donors (age ≥ 40 years or body mass index ≥ 30 kg/m2 or ≥ 5 days intensive care unit stay) were independent factors for diminished graft survival in RSG. None of the analyzed variables were associated with worse graft survival in LSG. Biliary complications were the most frequent complications in both groups (57% in LSG and 33% in RSG). Partial grafts obtained from liver splitting are an excellent option for patients in need of liver transplantation and have the potential to alleviate the organ shortage. Adequate donor selection and reducing CIT are crucial for optimizing results.


Assuntos
Transplante de Fígado/mortalidade , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Argentina/epidemiologia , Criança , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
7.
Ann Hepatol ; 14(6): 845-55, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26436356

RESUMO

BACKGROUND & RATIONALE: Limited information related to Liver Transplantation (LT) costs in South America exists. Additionally, costs analysis from developed countries may not provide comparable models for those in emerging economies. We sought to evaluate a predictive model of Early Discharge from Hospital after LT (ERDALT = length of hospital stay ≤ 8 days). A predictive model was assessed based on the odds ratios (OR) from a multivariate regression analysis in a cohort of consecutively transplanted adult patients in a single center from Argentina and internally validated with bootstrapping technique. RESULTS: ERDALT was applicable in 34 of 289 patients (11.8%). Variables independently associated with ERDALT were MELD exception points OR 1.9 (P = 0.04), surgery time < 4 h OR 3.8 (P = 0.013), < 5 units of blood products consumption (BPC) OR 3.5 (P = 0.001) and early weaning from mechanical intubation OR 6.3 (P = 0.006). Points in the predictive scoring model were allocated as follows: MELD exception points (absence = 0 points, presence = 1 point), surgery time < 4 h (0-2 points), < 5 units of BPC (0-2 points), and early weaning (0-3 points). Final scores ranged from 0 to 8 points with a c-statistic of 0.83 (95% CI 0.77-0.90; P < 0.0001). Transplant costs were significantly lower in patients with ERDALT (median $23,078 vs. $28,986; P < 0.0001). Neither lower patient and graft survival, nor higher rates of short-term re-hospitalization and acute rejection events after discharge were observed in patients with ERDALT. In conclusion, the ERDALT score identifies patients suitable for early discharge with excellent outcomes after transplantation. This score may provide applicable models particularly for emerging economies.


Assuntos
Técnicas de Apoio para a Decisão , Tempo de Internação , Transplante de Fígado , Alta do Paciente , Adulto , Idoso , Argentina , Distribuição de Qui-Quadrado , Análise Custo-Benefício , Feminino , Sobrevivência de Enxerto , Custos Hospitalares , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação/economia , Transplante de Fígado/efeitos adversos , Transplante de Fígado/economia , Transplante de Fígado/mortalidade , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Duração da Cirurgia , Alta do Paciente/economia , Seleção de Pacientes , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Desmame do Respirador
8.
Transpl Int ; 27(12): 1244-52, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25052132

RESUMO

The aim of this study was to identify potential risk factors linked to neurologic events (NE) occurring after liver transplantation (LT) and use them to construct a model to predict such events. From odds ratios (OR) of risk factors, a scoring system was assessed using multivariate regression analysis. Forty-one of 307 LT patients presented NE (13.3%), with prolonged hospital stay and decreased post-LT survival. On multivariate analysis, factors associated with NE included: severe pre-LT ascites OR 3.9 (1.80-8.41; P = 0.001), delta sodium ≥12 mEq/l OR 3.5 (1.36-8.67; P = 0.01), and post-LT hypomagnesemia OR 2.9 (1.37-5.98; P = 0.005). Points were assigned depending on ORs as follows: ascites 4 points, and hypomagnesemia and delta sodium ≥12 mEq/l, 3 points each (score range = 0-10 points). ROC curve analysis suggested good discriminative power for the model, with a c-statistic of 0.72 (CI 0.62-0.81; P < 0.0001), best performance for a cutoff value >3 points (71% sensitivity, 60% specificity). NE risk increased progressively from 6.4%, to 10.3%, 12.8%, 31.5% and 71.0% as scores rose from 0 to 3, 4, 6-7 and 10 cumulative points, respectively. The score described helps to identify patients potentially at risk for neurologic events, and its prevention would decrease morbidity and mortality after LT.


Assuntos
Transtornos da Consciência/epidemiologia , Delírio/epidemiologia , Disartria/epidemiologia , Transplante de Fígado , Transtornos dos Movimentos/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Convulsões/epidemiologia , Transtornos da Visão/epidemiologia , Adulto , Idoso , Intervalos de Confiança , Transtornos da Consciência/etiologia , Delírio/etiologia , Disartria/etiologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação/estatística & dados numéricos , Magnésio/sangue , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/etiologia , Razão de Chances , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Risco , Convulsões/etiologia , Sódio/sangue , Transtornos da Visão/etiologia
9.
Ann Hepatol ; 13(2): 288-92, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24552872

RESUMO

Severe liver dysfunction during pregnancy implies a serious risk for both mother and fetus, and represents a technical and ethical challenge for treating physicians. We report a case of a previously healthy 32-year old woman who was admitted to our hospital with idiopathic fulminant hepatic failure and underwent successful orthotopic liver transplantation (OLT) at gestation week 21. Patient's and fetus' immediate postoperative course were relatively uneventful until week six after OLT, when the mother developed oligohydramnios and preeclampsia. At pregnancy week 27, after inducing baby's lung maturation, a cesarean section was performed with the delivery of an otherwise healthy girl. After 3 years of follow-up, mother and child are leading normal lives with no complications related either to pregnancy or to OLT. We describe the case of a successful emergency liver transplant in a woman during the second trimester of pregnancy, demonstrating that OLT can be a viable option to preserve the life of the mother and an otherwise unviable fetus. Intrauterine baby's growths until the attainment of a viable gestational age was feasible despite the mother's fulminant hepatic failure and liver transplant surgery.


Assuntos
Falência Hepática Aguda/cirurgia , Transplante de Fígado , Complicações na Gravidez/cirurgia , Resultado da Gravidez , Segundo Trimestre da Gravidez , Adulto , Cesárea , Feminino , Seguimentos , Humanos , Recém-Nascido , Gravidez , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
10.
Arch Argent Pediatr ; : e202310222, 2024 08 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-39058378

RESUMO

Primary liver tumors are an increasing indication for pediatric liver transplantation. Here we report the cases of 10 patients who underwent liver transplantation for primary liver tumors in our hospital, from 2001 to date. Up to 2011, 1 transplant due to hepatoblastoma was done out of 117 liver transplants (0.8%). Since 2012, there were 9 patients out of 141 (6.4%) (5 due to hepatoblastoma, 2 due to hepatocellular carcinoma, 1 due to hepatic epithelioid hemangioendothelioma, and 1 due to hepatic mesenchymal hamartoma). Follow-up: 13.2 months (median); age at transplantation: living 4.7 years (median); weight: 17.6 kg (median). Eighty percent of patients received grafts from living donors. No tumor recurrence was observed. Survival was 100% in the follow-up period. In our series, patients with primary liver tumors requiring transplantation showed an adequate course, even in the case of hepatocellular carcinoma, Related living donors liver transplantation shortened the time between the indication and the surgery.


Los tumores hepáticos primarios son indicación creciente de trasplante hepático pediátrico. Reportamos los 10 pacientes con trasplantes hepáticos por tumores hepáticos primarios en nuestro centro desde 2001 hasta la actualidad. Hasta el año 2011, se realizó un trasplante por hepatoblastoma de 117 trasplantes hepáticos (0,8 %). Desde 2012, fueron 9 pacientes de 141 (6,4 %) (5 hepatoblastomas, 2 hepatocarcinomas, 1 hemangioendotelioma epitelioide hepático y 1 hamartoma mesenquimático hepático). Seguimiento 13,2 meses (media), edad al trasplante 4,7 años (media), peso 17,6 kg (mediana). El 80 % recibió injertos desde donantes relacionados. No hubo recurrencia tumoral y la sobrevida fue del 100 % en el período de seguimiento. En nuestra serie, los pacientes con tumores hepáticos primarios que requirieron trasplante presentaron buena evolución, aun en hepatocarcinoma. El trasplante hepático con donante relacionado acortó los tiempos entre la indicación y la realización.

11.
Arch Argent Pediatr ; 120(4): e187-e191, 2022 08.
Artigo em Espanhol | MEDLINE | ID: mdl-35900961

RESUMO

Hepatic epithelioid hemangioendothelioma (HEHE) is a rare vascular tumor of less malignancy than hemangiosarcoma. In the rare unilobar cases, partial hepatectomy may be indicated with risk of aggressive recurrence; in extensive liver disease, even with extrahepatic involvement, liver transplantation has been performed successfully. Metastases are more common in the lung, peritoneum, lymph nodes, spleen, and nervous system. We present the case of an asymptomatic adolescent with HEHE with lung metastases and abdominal lymph node involvement who received a liver transplant with a favorable outcome.


El hemangioendotelioma epiteloide hepático (HEHE) es un tumor vascular raro de menor malignidad que el hemangiosarcoma. En los poco frecuentes casos unilobulares, puede indicarse hepatectomía parcial con riesgo de recurrencia agresiva; en enfermedad hepática extensa, incluso con compromiso extrahepático, el trasplante hepático ha resultado efectivo. Las metástasis son más frecuentes en pulmón, peritoneo, ganglios linfáticos, bazo y sistema nervioso. Se presenta el caso de un adolescente asintomático con HEHE con metástasis pulmonares y compromiso ganglionar abdominal que recibió trasplante hepático con evolución favorable.


Assuntos
Hemangioendotelioma Epitelioide , Neoplasias Hepáticas , Transplante de Fígado , Neoplasias Pulmonares , Adolescente , Hemangioendotelioma Epitelioide/diagnóstico , Hemangioendotelioma Epitelioide/patologia , Hemangioendotelioma Epitelioide/cirurgia , Humanos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Neoplasias Pulmonares/cirurgia , Resultado do Tratamento
13.
Clin Transplant ; 23(4): 437-46, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19496790

RESUMO

In this single-institution study, we compared outcomes in diabetic recipients of living donor (LD) kidney transplants that did vs. did not undergo a subsequent pancreas transplant. Of 307 diabetic recipients who underwent LD kidney transplants from January 1, 1995, through December 31, 2003, a total of 175 underwent a subsequent pancreas after kidney (PAK) transplant; 75 were deemed eligible (E) for, but did not receive (for personal or financial reasons), a PAK, and thus had a kidney transplant alone (KTA); and 57 deemed ineligible (I) for a PAK because of comorbidity also had just a KTA. We analyzed the three groups (PAK, KTA-E, KTA-I) for differences in patient characteristics, glycemic control, renal function, patient and kidney graft survival rates, and causes of death. Kidney graft survival rates (actuarial) were similar in the PAK vs. KTA-E groups at one, five, and 10 yr post-transplant: 98%, 82%, and 67% (PAK) vs. 100%, 84%, and 62% (KTA-E) (p = 0.9). The long-term (greater than four yr post-transplant) estimated glomerular filtration rate (GFR) was higher in the PAK than in the KTA-E group: 53 +/- 20 mL/min (PAK) vs. 43 +/- 16 mL/min (KTA-E) (p = 0.016). The patient survival rates were also similar for the PAK and KTA-E groups. We conclude that the subsequent transplant of a pancreas after an LD kidney transplant does not adversely affect patient or kidney graft survival rates; in fact, it is associated with better long-term kidney graft function.


Assuntos
Nefropatias Diabéticas/cirurgia , Sobrevivência de Enxerto , Transplante de Rim , Doadores Vivos , Transplante de Pâncreas , Adulto , Cadáver , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Sobrevida , Fatores de Tempo , Obtenção de Tecidos e Órgãos , Listas de Espera
14.
Curr Opin Organ Transplant ; 13(3): 259-65, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18685314

RESUMO

PURPOSE OF REVIEW: This review focuses on the recently described or revised refinements or innovations in small bowel transplantation. RECENT FINDINGS: Changes in donor selection criteria; cadaveric procurement techniques; organ preservation solutions; management of the recipient abdominal wall; technical modifications, pitfalls and recommendations to be applied during the engraftment as well as intestinal living donation will be covered. SUMMARY: Intestinal transplantation has evolved over time to become a clinically accepted therapy for patients with intestinal failure. Short- and long-term results have improved. The surgical procedures have been standardized and the applications broaden, but there have been recently published refinements that might affect the future results of clinical intestinal transplantation and guide research.


Assuntos
Intestino Delgado/transplante , Transplante de Órgãos/tendências , Obtenção de Tecidos e Órgãos/tendências , Seleção do Doador , Humanos
15.
Arch. argent. pediatr ; 120(4): e187-e191, Agosto 2022. ilus
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1379154

RESUMO

El hemangioendotelioma epiteloide hepático (HEHE) es un tumor vascular raro de menor malignidad que el hemangiosarcoma. En los poco frecuentes casos unilobulares, puede indicarse hepatectomía parcial con riesgo de recurrencia agresiva; en enfermedad hepática extensa, incluso con compromiso extrahepático, el trasplante hepático ha resultado efectivo. Las metástasis son más frecuentes en pulmón,peritoneo, ganglios linfáticos, bazo y sistema nervioso. Se presenta el caso de un adolescente asintomático con HEHE con metástasis pulmonares y compromiso ganglionar abdominal que recibió trasplante hepático con evolución favorable.


Hepatic epithelioid hemangioendothelioma (HEHE) is a rare vascular tumor of less malignancy than hemangiosarcoma. In the rare unilobar cases, partial hepatectomy may be indicated with risk of aggressive recurrence; in extensive liver disease, even with extrahepatic involvement, liver transplantation has been performed successfully. Metastases are more common in the lung, peritoneum, lymph nodes, spleen, and nervous system. We present the case of an asymptomatic adolescent with HEHE with lung metastases and abdominal lymph node involvement who received a liver transplant with a favorable outcome.


Assuntos
Humanos , Masculino , Adolescente , Transplante de Fígado , Hemangioendotelioma Epitelioide/cirurgia , Hemangioendotelioma Epitelioide/diagnóstico , Hemangioendotelioma Epitelioide/patologia , Neoplasias Hepáticas/cirurgia , Neoplasias Hepáticas/patologia , Neoplasias Pulmonares/cirurgia , Resultado do Tratamento
16.
Arch Argent Pediatr ; 110(3): e35-8, 2012.
Artigo em Espanhol | MEDLINE | ID: mdl-22760756

RESUMO

Hepatoxicity of isoniazid, mainly in association with rifampin, is a rare secondary effect of tuberculostatic treatment. In the United States, it accounts for 0.2% of all pediatric orthotropic liver transplant, and 14% of transplants for drug hepatotoxicity. We report the case of a 10 year-old patient who presented with acute liver failure requiring orthotropic liver transplant after forty days of tuberculostatic treatment with isoniazid, rifampin and pyrazinamide.


Assuntos
Antituberculosos/efeitos adversos , Isoniazida/efeitos adversos , Falência Hepática Aguda/induzido quimicamente , Pirazinamida/efeitos adversos , Rifampina/efeitos adversos , Criança , Feminino , Humanos
17.
Transplantation ; 90(5): 547-54, 2010 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-20625354

RESUMO

BACKGROUND: Kaposi's sarcoma (KS) is an infrequent vascular neoplasm commonly diagnosed as an isolated cutaneous lesion that can involve other organs. So far, there are no data in the literature about the development of KS after intestinal transplant. METHODS: In this study, the authors describe a case of "visceral KS" with pulmonary and intestinal involvement and perform a systematic literature review of case reports and single-center series identified in MEDLINE. RESULTS: This case was a 42-year-old man, diagnosed with visceral KS 9 months after receiving an isolated intestinal transplant. He was successfully treated with a combination of sirolimus and liposomal doxorubicin and achieved an 18-month disease-free survival. A total of 54 cases from 27 manuscripts and the present case were analyzed in this study. The mean time from transplant to diagnosis was 17.2 months. Lungs and gastrointestinal tract were the main organs involved. Immunosuppressants were discontinued in two of the three (66.7%) cases, and sirolimus was added in eight cases. Doxorubicin was used in 12 cases. In a univariate analysis, the use of Tacrolimus, type of transplant, and presence of cutaneous KS seem to be the significant predictors of response to therapy and survival; the addition of doxorubicin showed a reduction in graft loss. CONCLUSIONS: Treatment of KS in posttransplant patients should be designed aiming to obtain a complete response, irrespective of the organ affected. Only recipients who are able to achieve a sustained response would be able to obtain long-term disease-free survival.


Assuntos
Intestinos/transplante , Sarcoma de Kaposi/cirurgia , Adulto , Antibióticos Antineoplásicos/uso terapêutico , Intervalo Livre de Doença , Doxorrubicina/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Masculino , Recidiva , Sirolimo/uso terapêutico , Resultado do Tratamento
18.
Transplantation ; 87(12): 1884-8, 2009 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-19543069

RESUMO

INTRODUCTION: Abdominal wall closure management has become an important challenge during recipient candidate selection, at the time of donor to recipient matching and during the planning of the surgical procedure for intestinal or multiorgan transplantation. Different strategies have been proposed to overcome the lack of abdominal domain: to reduce the graft size or to increase the abdominal domain. Based on the recent concept of using an acellular dermis matrix (Alloderm) and the availability of abdominal wall tissues from the same organ donor, we conceived the idea of using the fascia of the rectus muscle (FoRM) as a nonvascularized tissue allograft. MATERIALS AND METHODS: This is a retrospective report of a series of 16 recipients of FoRM as part of a liver, intestinal, or multiorgan transplant procedure performed between October 2004 and May 2008 at three different transplant centers. RESULTS: Of the 16 recipients of FoRM, all but one case was performed during their transplantation (four multivisceral, two modified multivisceral, three isolated intestine, and two livers). Five patients underwent a retransplant surgery (two livers, two multivisceral, and one isolated intestine). Abdominal wall infection was present in 7 of 16 cases. Nine patients are still alive. No deaths were related to wound infection. Long-term survival showed complete wound healing and only one ventral hernia. DISCUSSION: The use of a nonvascularized FoRM is a novel and simple surgical option to resolve complex abdominal wall defects in liver/intestinal/multivisceral transplant recipients when it can be covered with the recipient skin.


Assuntos
Músculos Abdominais/transplante , Parede Abdominal/cirurgia , Intestinos/transplante , Transplante de Fígado/métodos , Transplante Homólogo/métodos , Vísceras/transplante , Músculos Abdominais/anatomia & histologia , Adolescente , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos
19.
Arch. argent. pediatr ; 110(3): e35-e38, mayo-jun. 2012. ilus
Artigo em Espanhol | LILACS | ID: lil-639616

RESUMO

La toxicidad hepática por isoniacida, sobre todo asociada a rifampicina, es un raro efecto adverso de la terapia antituberculosa. En EE.UU., es la causa de 0,2% de los trasplantes hepáticos pediátricos y del 14% de los trasplantes por toxicidad medicamentosa. Comunicamos el caso de una paciente de 10 años de edad con falla hepática fulminante que requirió trasplante hepático luego de cuarenta días de tratamiento tuberculostático con isoniacida, rifampicina y pirazinamida.


Hepatoxicity of isoniazid, mainly in association with rifampin, is a rare secondary effect of tuberculostatic treatment. In the United States, it accounts for 0.2% of all pediatric orthotropic liver transplant, and 14% of transplants for drug hepatotoxicity. We report the case of a 10 year-old patient who presented with acute liver failure requiring orthotropic liver transplant after forty days of tuberculostatic treatment with isoniazid, rifampin and pyrazinamide.


Assuntos
Criança , Feminino , Humanos , Antituberculosos/efeitos adversos , Isoniazida/efeitos adversos , Falência Hepática Aguda/induzido quimicamente , Pirazinamida/efeitos adversos , Rifampina/efeitos adversos
20.
Rev. argent. cir ; 92(1/2): 28-36, ene.-feb. 2007. tab, graf
Artigo em Espanhol | LILACS | ID: lil-508471

RESUMO

Antecedentes: Algunos factores que generan una alta morbilidad de hapatectomías en pacientes con carcinoma hepatocelular sobre hepatopatías crónicas pueden modificarse para aumentar la aplicabilidad y reducir la morbilidad. Objetivo: Analizar las estrategias utilizadas en la selección de pacientes candidatos a la resección, su evaluación funcional y el manejo preoperatorio. Lugar: Unidad de cirugía hepatobiliar. Diseño: Coherte retrospectivo. Población: 42 pacientes con CHC sobre hepatopatía crónica (11 fibrosis, 31 cirrosis) que recibieron 44 hepatectomías entre 1995 y 2005. Método: Se analizaron los criterios de selección, tipos de resección, manejo anestésico, requerimientos transfusionales, morbilidad y supervivencia alejada. Análisis estadísticos con log-rank test y Kaplan Meier. Resultados: De las 44 resecciones, 33 (75%) fueron hepatectomías menores. de ellas, 20 (60%) resecciones segmento-orientadas. Sólo 25% de los casos recibió sangre de banco. La morbilidad fue de 23% y la mortalidad 2,3%. La supervivencia actuarial a 1 y 5 años fue de 85 y 50% respectivamente, 72 y 50% libre de enfermedad. Conclusiones: Una correcta selección y racional manejo anestésico y de táctica quirúrgica permite obtener resultados alentadores con morbimortalidad similar a las hepatectomías en pacientes con fusión hepática normal.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Carcinoma Hepatocelular/cirurgia , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/terapia , Hepatectomia/efeitos adversos , Hepatectomia/normas , Embolização Terapêutica , Fibrose , Cuidados Intraoperatórios , Cirrose Hepática , Cuidados Pós-Operatórios , Complicações Pós-Operatórias , Cuidados Pré-Operatórios , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
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