RESUMO
INTRODUCTION: Transplantation-mediated alloimmune thrombocytopenia (TMAT) is a rare complication affecting the recipient of an organ from a donor with immune thrombocytopenia (ITP). METHODS: We present a case of TMAT following liver transplantation successfully treated by retransplantation, along with a review of previously published cases.Clinical presentation: The liver donor had lupus and ITP and died from an intracranial hemorrhage. The recipient's platelet count fell to 2x109/L on postoperative day 2. Due to the lack of response to medical treatment, emergency retransplantation was undertaken with a steady recovery of the platelet count within a few days. DISCUSSION: Six additional cases of transplantation-mediated alloimmune thrombocytopenia after liver transplantation have been reported. In all cases, severe thrombocytopenia ensued within 3 days after liver transplantation. Four patients suffered hemorrhagic complications. Three patients died. Early retransplantation was needed in three out of four patients receiving a graft from a donor with ITP and splenectomy. All recovered shortly after the new graft was in place. CONCLUSION: Severe refractory transplantation-mediated alloimmune thrombocytopenia can develop in liver recipients from donors with ITP, especially those with previous splenectomy. Early retransplantation should be considered if there is no rapid response to medical therapy.
Assuntos
Transplante de Fígado/efeitos adversos , Lúpus Eritematoso Sistêmico/complicações , Reoperação/métodos , Trombocitopenia/etiologia , Antígenos de Plaquetas Humanas/imunologia , Feminino , Seguimentos , Humanos , Lúpus Eritematoso Sistêmico/patologia , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas/métodos , Púrpura Trombocitopênica Idiopática/complicações , Púrpura Trombocitopênica Idiopática/imunologia , Esplenectomia/efeitos adversos , Trombocitopenia/sangue , Trombocitopenia/imunologia , Doadores de Tecidos , Transplantados , Resultado do TratamentoRESUMO
Regarding the article recently published by Junquera E et al. that referenced our work, we agree with the authors that the cystic duct cyst (CDC) is type VI according to Todani's classification, which describes five different types of biliary cysts.
Assuntos
Doenças dos Ductos Biliares , Cistos , Hipertensão Portal , Gastropatias , Ducto Cístico/diagnóstico por imagem , Cistos/diagnóstico por imagem , Cistos/cirurgia , HumanosRESUMO
No disponible
Assuntos
Humanos , Masculino , Idoso , Neoplasias dos Ductos Biliares/cirurgia , Colangiocarcinoma/cirurgia , Drenagem , Recidiva Local de NeoplasiaRESUMO
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Transplante de Rim/efeitos adversos , Necrose/patologia , Esôfago/patologia , Transplante de Fígado/efeitos adversos , Mediastinite/complicações , Complicações Pós-Operatórias , Endoscopia , Cirrose Hepática/complicações , Insuficiência Renal Crônica/complicações , Esofagite/cirurgia , Esofagostomia , Gastrostomia , Fatores de Risco , Esofagite/complicaçõesAssuntos
Neoplasias dos Ductos Biliares/patologia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Drenagem/efeitos adversos , Tumor de Klatskin/terapia , Recidiva Local de Neoplasia/secundário , Idoso , Fístula Biliar/terapia , Cateteres/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Drenagem/instrumentação , Evolução Fatal , Hepatectomia/métodos , Humanos , Tumor de Klatskin/diagnóstico , Masculino , Insuficiência de Múltiplos Órgãos/complicações , Metástase Neoplásica/patologia , Estadiamento de Neoplasias , Complicações Pós-Operatórias , Período Pós-OperatórioRESUMO
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Hematoma/terapia , Fígado/lesões , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Hematoma/etiologia , Complicações Pós-Operatórias , Doença Iatrogênica , Fatores de RiscoRESUMO
Based on two clinical cases that developed subcapsular hematoma after ERCP procedure and resolved each one differently (conservative management and surgery, respectively) we have made a brief review of current status, risk factors and treatment options. We also summarize the cases that required surgery. With the increase of endoscopic procedures, it is important to consider this type of major and severe complication.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Hematoma/terapia , Hepatopatias/terapia , Idoso de 80 Anos ou mais , Tratamento Conservador , Embolização Terapêutica/métodos , Tratamento de Emergência/métodos , Hematoma/diagnóstico por imagem , Humanos , Hepatopatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
BACKGROUND: Hepatic artery avulsion following politrauma is an extremely rare condition with a very high mortality rate. Management is based on damage control surgery given the precarious situation of these patients. Ligating the artery is one option under such circumstances, despite potential consequences including ischemic cholangiopathy (IC). Ischemic cholangiopathy, which can be caused by an insufficient blood supply to the bile duct, generally results in stricture and recurrent cholangitis, and the need for a liver transplant in extreme cases. CASE PRESENTATION: We present the case of a 37-year-old male with multiple traumas after falling from the third floor of a building. He was hemodynamically unstable upon arrival at the emergencies department, with no improvement on administration of aggressive fluid therapy. A Echo-FAST exam evidenced fluid in all quadrants, so the patient was transferred to the operating room where a 4-litre hemoperitoneum secondary to total avulsion of the proper hepatic artery was observed. The patient required massive transfusion and vasoactive drugs, with instability throughout the intervention; therefore, we decided to ligate the proper hepatic artery. Hepatic dysfunction and diffuse IC with multiple episodes of recurrent cholangitis were observed during the postoperative period. Given the irreversible clinical picture, we opted for a liver transplant 70 days after the patient's initial admission. The patient died on Day 34 post-transplant due to irreversible ischemic brain damage and a right occipital hemorrhage. CONCLUSIONS: Hepatic artery avulsion due to trauma is very rare and its management very complex, and in certain situations the artery must be ligated. The main consequence of ligating the hepatic artery is IC, which is more frequently observed secondary to iatrogenic lesions or systemic diseases, while very few cases have been published in which IC is secondary to hepatic artery avulsion caused by hepatic trauma. Treatment depends on the extent of ischemia, and when the damage is diffuse, as in our case, it may involve a liver transplant.
RESUMO
Transcatheter arterial chemoembolization TACE is an effective treatment for stage BCLC-B hepatocellular carcinoma (1). The development of skin lesions in the supraumbilical region is an unusual complication following this procedure. We report the case of an 80-year-old male with alcoholic liver cirrhosis, portal hypertension PHT (Child-Pugh A) and multifocal hepatocellular carcinoma. The patient had already undergone four radiofrequency ablations, one alcoholization procedure and four TACEs via femoral access.
