Perioperative blood transfusion decreases long-term survival in pediatric living donor liver transplantation.

BACKGROUND: The impact of perioperative blood transfusion on short- and long-term outcomes in pediatric living donor liver transplantation (PLDLT) must still be ascertained, mainly among young children. Clinical and surgical postoperative complications related to perioperative blood transfusion are well described up to three months after adult liver transplantation. AIM: To determine whether transfusion is associated with early and late postoperative complications and mortality in small patients undergoing PLDLT. METHODS: We evaluated the effects of perioperative transfusion on postoperative complications in recipients up to 20 kg of body weight, submitted to PLDLT. A total of 240 patients were retrospectively allocated into two groups according to postoperative complications: Minor complications (n = 109) and major complications (n = 131). Multiple logistic regression analysis identified the volume of perioperative packed red blood cells (RBC) transfusion as the only independent risk factor for major postoperative complications. The receiver operating characteristic curve was drawn to identify the optimal volume of the perioperative RBC transfusion related to the presence of major postoperative complications, defining a cutoff point of 27.5 mL/kg. Subsequently, patients were reallocated to a low-volume transfusion group (LTr; n = 103, RBC ≤ 27.5 mL/kg) and a high-volume transfusion group (HTr; n = 137, RBC > 27.5 mL/kg) so that the outcome could be analyzed. RESULTS: High-volume transfusion was associated with an increased number of major complications and mortality during hospitalization up to a 10-year follow-up period. During a short-term period, the HTr showed an increase in major infectious, cardiovascular, respiratory, and bleeding complications, with a decrease in rejection complications compared to the LTr. Over a long-term period, the HTr showed an increase in major infectious, cardiovascular, respiratory, and minor neoplastic complications, with a decrease in rejection complications. Additionally, Cox hazard regression found that high-volume RBC transfusion increased the mortality risk by 3.031-fold compared to low-volume transfusion. The Kaplan-Meier survival curves of the studied groups were compared using log-rank tests and the analysis showed significantly decreased graft survival, but with no impact in patient survival related to major complications. On the other hand, there was a significant decrease in both graft and patient survival, with high-volume RBC transfusion. CONCLUSION: Transfusion of RBC volume higher than 27.5 mL/kg during the perioperative period is associated with a significant increase in short- and long-term postoperative morbidity and mortality after PLDLT.

Risk Factors Associated with Increased Morbidity in Living Liver Donation.

Living donor liver donation (LDLD) is an alternative to cadaveric liver donation. We aimed at identifying risk factors and developing a score for prediction of postoperative complications (POCs) after LDLD in donors. This is a retrospective cohort study in 688 donors between June 1995 and February 2014 at Hospital Sírio-Libanês and A.C. Camargo Cancer Center, in São Paulo, Brazil. Primary outcome was POC graded ≥III according to the Clavien-Dindo classification. Left lateral segment (LLS), left lobe (LL), and right lobe resections (RL) were conducted in 492 (71.4%), 109 (15.8%), and 87 (12.6%) donors, respectively. In total, 43 (6.2%) developed POCs, which were more common after RL than LLS and LL (14/87 (16.1%) versus 23/492 (4.5%) and 6/109 (5.5%), resp., p < 0.001). Multivariate analysis showed that RL resection (OR: 2.81, 95% CI: 1.32 to 3.01; p = 0.008), smoking status (OR: 3.2, 95% CI: 1.35 to 7.56; p = 0.012), and blood transfusion (OR: 3.15, 95% CI: 1.45 to 6.84; p = 0.004) were independently associated with POCs. RL resection, intraoperative blood transfusion, and smoking were associated with increased risk for POCs in donors.

Anestesia subaracnoidea para cesariana com bupivacaína hiperbárica a 0.5 por cento associada a sufentanil e fentanil / Spinal anesthesia for cesarean section with 0.5 per cents hyperbaric bupivacaine associated to sufentanil or fentanyl

Opióides tem sido freqüêntemente usados associados a anestésicos locais em anestesia regional a fim de se conseguir uma instalaçäo de bloqueio mais rápida, um período de analgesia mais longo e uma anestesia de melhor qualidade. Os objetivos deste estudo foram comparar os períodos de latência e a duraçäo da analgesia entre os grupos e observar os efeitos colaterais das drogas nos neonatos e em parturientes submetidas à anestesia subaracnóidea com bupivacaína 0,5 por cento hiperbárica associada ao fentanil ou sufentanil. Método - Participaram do estudo sessenta gestantes, estado físico ASA I e II, submetidas a cesariana, sob anestesia subaracnóidea, divididas em três grupos de vinte. No grupo A (controle) foi utilizada soluçäo de bupivacaína hiperbárica a 0,5 por cento (14 mg) e soluçäo salina, no grupo B (fentanil) foi utilizada soluçäo de bupivacaína hiperbárica a 0,5 por cento (13 mg) e 20 µg de fentanil e no grupo C (sufentanil) foi utilizada uma soluçäo de bupivacaína hiperbárica a 0,5 por cento (14 mg) e 10 µg de sufentanil de modo que, em todos os grupos, o volume final das soluçöes atingiu 3,0 ml. As variáveis hemodinâmicas e ventilatórias foram registradas e analisadas em onze momentos e foram comparadas entre os três grupos. Os períodos de latência e de analgesia foram comparados e os efeitos colaterais nas parturientes e nos neonatos também foram observados. Resultados - Houve diferença significante entre os grupos A, B e C quanto ao período de latência: grupo A (283,5 seg), grupo B (234,7 seg) e grupo C (192,5 seg). Também houve diferença significante entre os três grupos quanto ao período de analgesia: grupo A (160,5 min), grupo b (244,5 min) e grupo C (432,0 min). O efeito colateral mais freqüente foi o prurido, significantemente maior no grupo C. Näo foi observado nenhum efeito colateral nos neonatos. Conclusöes - A associaçäo de fentanil e sufentanil à bupivacaína hiperbárica a 0,5 por cento, em anestesia subaracnóidea para cesariana, mostrou encurtar o período de latência e prolongar o período de analgesia quando comparados ao uso isolado do anestésico local. O prurido foi o efeito colateral de amior importância, sendo mais freqüente no grupo com sufentanil