ABSTRACT
Arterial reconstructions are pivotal, particularly in pediatric LDLT. We describe microsurgical reconstruction technique with 6x loupes and the clinical course of the first 23 less than 10 kg recipients in an initial LDLT program at a developing country. From March 2002 to October 2008, 286 liver transplantation were performed in 279 patients at our unit. There were 73 children and 206 adults. Among the children, 23 weighing less than 10 kg were recipients from living donors. Arterial reconstructions were with end-to-end interrupted suture using a 6x magnification loupe, according to the untied suture technique. All patients were prospectively followed by color Doppler ultrasound protocol. In our initial experience there were no arterial complications. With mean 24 months of follow-up, 19 patients (82%) are alive with good graft function. Hepatic artery in LDLT can be safely reconstructed with microsurgical techniques without microscope using, with 6x loupe magnification, and can achieve good results in patients under 10 kg.
Subject(s)
Body Weight , Hepatectomy/methods , Hepatic Artery/surgery , Liver Transplantation/methods , Living Donors , Microsurgery/methods , Vascular Surgical Procedures/methods , Adult , Anastomosis, Surgical/methods , Follow-Up Studies , Hepatic Artery/diagnostic imaging , Humans , Infant , Microscopy , Retrospective Studies , Suture Techniques , Treatment Outcome , Ultrasonography, Doppler, ColorSubject(s)
Hemangioma/diagnosis , Hepatectomy , Liver Transplantation , Liver/blood supply , Living Donors , Adult , Contraindications , Humans , Liver/surgery , Magnetic Resonance Imaging , MaleABSTRACT
The shortage of organ donors for low-weight liver transplant recipients, especially small children, has led to the development of new surgical techniques to increase the donor pool. Almost all of these techniques use the left lateral segment (Couinaud's segments II and III), but even this graft could be too large for children under 10 kg, and further reduction could be necessary. Few articles address the issue of monosegmental liver transplantation. Available articles are with small sample sizes or even case reports, which makes it difficult to draw conclusions about indication and outcome for monosegmental grafts. A search of the MEDLINE databases using the terms "Liver Transplantation" and "Monosegmental" or "Monosegments" limited to title or abstract with publication in the English language was conducted. The data from each study were selected and analyzed, regarding donor status (living or cadaveric), donor weight, surgical techniques used in left lateral further reduction, recipient indication for liver transplantation, age and recipient weight, graft-to-recipient body weight ratio, segment utilized, type of abdominal closure, postoperative complications, and survival. Seven publications were identified from 1995 to 2004 and fulfilled the criteria. A total of 27 pediatric patients who received a monosegment transplant were identified, median age 211 days (range, 27 to 454 days) and median weight 4.6 kg (range, 2.45 to 7.4 kg). Segment III was utilized in 21 (78%) and segment II in 6 (22%). Patient survival was 85.2%. In conclusion, monosegment liver transplantation appears to be a satisfactory option for infants weighing less than 10 kg who require a liver transplant.
Subject(s)
Liver Transplantation/mortality , Liver Transplantation/methods , Tissue and Organ Procurement/statistics & numerical data , Humans , Treatment OutcomeABSTRACT
The shortage of organ donors for low-weight liver transplant recipients, especially for small children, has led to the development of new surgical techniques to increase the donor pool. Almost all of these techniques use the left lateral segment (Couinaud's segments II and III), but even this graft could be too large for children under 10 kg. We report here the case of an 8-month-old boy, weighing 6.1 kg, who received a monosegmental graft (segment III) from his grandmother weighing 68 kg. The graft was reduced at the donor surgery, before clamping of the vessels. The donor was discharged on the fourth post-operative day; the recipient had an uneventful post-operative period and was discharged after 22 days.
Subject(s)
Liver Transplantation/methods , Living Donors , Bile Ducts, Intrahepatic/abnormalities , Hepatectomy/methods , Humans , Infant , Male , Organ SizeSubject(s)
Humans , Hepatitis C/transmission , Hepatitis Delta Virus , Chronic Disease , Hepatitis C/diagnosis , Serologic TestsSubject(s)
Infant, Newborn , Child, Preschool , Child , Infant , Humans , Hepatitis A , Hepatitis B , Hepatitis A/diagnosis , Hepatitis A/etiology , Hepatitis A/therapy , Hepatitis A/transmission , Hepatitis B/diagnosis , Hepatitis B/etiology , Hepatitis B/prevention & control , Hepatitis B/therapy , Hepatitis B/transmission , Hepatitis/prevention & controlSubject(s)
Child, Preschool , Humans , Carbohydrates/metabolism , Lactose Intolerance , Diet , Intestinal AbsorptionABSTRACT
Faz-se uma revisäo sobre colestase neonatal, mostrando as múltiplas etiologias que podem determinar esta síndrome. Abordam-se conceitos modernos sobre conduta no diagnóstico diferencial, especialmente entre hepatite neonatal e atresia de vias biliares. Descreve-se o tratamento atual centrado na nutriçäo, uso de drogas e cirurgia
Subject(s)
Infant, Newborn , Humans , Cholestasis/diagnosis , Cholestasis, Extrahepatic/diagnosis , Cholestasis/therapy , Diagnosis, Differential , Hepatitis/diagnosisABSTRACT
Faz-se uma revisäo sobre hidrataçäo oral nas diarréias agudas, considerando-se primordialmente os aspectos históricos e fisiológicos deste procedimento, que apesar de näo ser uma inovaçäo em Medicina, passou por várias fases de aperfeiçoamento, sendo hoje uma das maiores armas no controle da desidrataçäo, principalmente nos países subdesenvolvidos
