ABSTRACT
Although the use of cadaveric split or living donor liver transplantation is a valid option for liver transplants, they have several complications, being the "small-for-size syndrome" one of the most frequent. This entity is mainly due to the incapacity that the graft has to meet the blood drainage demands. We report a 61 year-old patient with sub-acute liver failure, transplanted with a partial liver graft that developed hyperbilirubinemia, ascites and liver function deterioration. A meso-caval shunt was performed, after which the ascites resolved, serum bilirubin normalized and the synthetic function of the liver improved. After one month, a follow-up CT seen showed the absence of blood flow in the shunt, possible due to the reduction of the hyper-perfusion of the liver. The clinical and biochemical condition of the patient continued improving despite the lack of flow through the shunt.
Subject(s)
Hepatic Veins/surgery , Hyperbilirubinemia/surgery , Liver Transplantation/adverse effects , Anastomosis, Surgical/methods , Hepatic Veins/physiopathology , Humans , Hyperbilirubinemia/etiology , Liver Transplantation/methods , Male , Middle Aged , Regional Blood Flow/physiology , SyndromeABSTRACT
Although the use of cadaveric split or living donor liver transplantation is a valid option for liver transplants, they have several complications, being the "small-for-size syndrome" one of the most frequent. This entity is mainly due to the incapacity that the graft has to meet the blood drainage demands. We report a 61 year-old patient with sub-acute liver failure, transplanted with a partial liver graft that developed hyperbilirubinemia, ascites and liver function deterioration. A meso-caval shunt was performed, after which the ascites resolved, serum bilirubin normalized and the synthetic function of the liver improved. After one month, a follow-up CT seen showed the absence of blood flow in the shunt, possible due to the reduction of the hyper-perfusion of the liver. The clinical and biochemical condition of the patient continued improving despite the lack of flow through the shunt.
Subject(s)
Humans , Male , Middle Aged , Hepatic Veins/surgery , Hyperbilirubinemia/surgery , Liver Transplantation/adverse effects , Anastomosis, Surgical/methods , Hepatic Veins/physiopathology , Hyperbilirubinemia/etiology , Liver Transplantation/methods , Regional Blood Flow/physiology , SyndromeABSTRACT
Näo há consenso em relaçäo aos efeitos da hiperbilirrubinemia direta sobre a cicatrizaçäo ou sobre o tecido íntegro do tubo digestivo. Com o objetivo de se conhecer a resistência da parede das diferentes partes do tubo digestivo e eventual efeito da icterícia sobre essa resistência, foram estudados dez camundongos, divididos em dois grupos (n=5); o primeiro submetido a laparotomia e laparorrafia e o segundo à ligadura do ducto biliopancreático, próximo à sua bifurcaçäo hepática. A resistência à ruptura foi avaliada em ambos os grupos no vigésimo oitavo dia pós-operatório, através de insuflaçäo intraluminar de ar. A resistência do esôfago foi maior que a dos demais segmentos digestivos, em ambos os grupos (p<0,001). A resistência do cólon foi maior do que a do estômago, do jejuno e do íleo (p<0,05. Nos animais com ictericia obstrutiva houve diminuiçäo da resistência do jejuno (p<0,05). Em camundongos, existem diferenças entre as resistências à insuflaçäo das diversas partes do tubo digestivo. Em presença de icterícia obstrutiva verificou-se menor resistência no jejuno.