RESUMO
We reviewed the history, volume, outcomes, uniqueness, and challenges of living donor liver transplantation (LDLT) in Latin America. We used the data from the Latin American and Caribbean Transplant Society, local transplant societies, and opinions from local transplant experts. There are more than 160 active liver transplant teams in Latin America, but only 30 centers have used LDLT in the past 2 years. In 2014, 226 LDLTs were done in the region (8.5% of liver transplant activities). Living donor liver transplantation is mainly restricted to pediatric patients. Adult-to-adult LDLT activities decreased after the implementation of the model for end-stage liver disease score and a concomitant increase on the rate of deceased donors per million population. Posttransplant outcome analysis is not mandatory, transparent or regulated in most countries. More experienced teams have outcomes comparable to international expert centers, but donor and recipient morbidity might be underreported. Latin America lags behind in terms of the number of adult LDLT and the rate of living donor utilization in comparison with other continents with similar donation rates. Local alliances and collaborations with major transplant centers in the developed world will contribute to the development of LDLT in Latin America.
Assuntos
Doença Hepática Terminal/cirurgia , Transplante de Fígado/métodos , Doadores Vivos , Brasil , Doença Hepática Terminal/etnologia , Humanos , Relações Interinstitucionais , Cooperação Internacional , América Latina , Índice de Gravidade de Doença , Obtenção de Tecidos e Órgãos , Resultado do TratamentoAssuntos
Equinococose Hepática/complicações , Echinococcus granulosus/isolamento & purificação , Veia Porta/parasitologia , Antagonistas Adrenérgicos beta/uso terapêutico , Albendazol/uso terapêutico , Animais , Antiprotozoários/uso terapêutico , Equinococose Hepática/diagnóstico por imagem , Equinococose Hepática/tratamento farmacológico , Equinococose Hepática/parasitologia , Varizes Esofágicas e Gástricas/tratamento farmacológico , Varizes Esofágicas e Gástricas/parasitologia , Feminino , Humanos , Hipertensão Portal/tratamento farmacológico , Hipertensão Portal/parasitologia , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Propranolol/uso terapêutico , Tomografia Computadorizada por Raios XRESUMO
Arteriovenous malformation (AVM) of the pancreas (AVMP) is uncommon and generally asymptomatic; therefore, few cases have so far been reported. The symptoms of AVMP include gastrointestinal bleeding, pain, and portal hypertension. Definitive diagnosis is confirmed by angiographic study, and surgery is the only effective treatment. We report a case of AVMP confirmed by computed tomography, magnetic resonance imaging, and angiographic study of the abdomen, in a patient who presented to us with epigastric pain. He underwent a pancreaticoduodenectomy, following which his symptoms resolved.
Assuntos
Malformações Arteriovenosas/diagnóstico , Artéria Gastroepiploica/anormalidades , Pâncreas/irrigação sanguínea , Adulto , Angiografia , Malformações Arteriovenosas/cirurgia , Diagnóstico Diferencial , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pâncreas/cirurgia , Pancreaticoduodenectomia , Tomografia Computadorizada por Raios XRESUMO
Obesity is highly prevalent in both liver transplant candidates and recipients, and can have a significant impact on perioperative morbidity and mortality and the overall cost of transplantation. Herein, we describe an obese patient who was managed sequentially with an intragastric balloon in the pre-transplant setting and a gastric sleeve following transplantation, with good long-term results. Sleeve gastrectomy is a non-malabsorptive bariatric procedure with potential benefit for liver transplant patients due to its lack of influence on the absorption of immunosuppressive agents.