Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 6 de 6
Filtrar
1.
Pediatr Transplant ; 25(3): e13934, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33314615

RESUMO

BACKGROUND: Impairment of hepatic arterial flow including hepatic arterial thrombosis (HAT), hepatic arterial stenosis (HAS), and splenic artery steal syndrome (SASS) is potentially life-threatening complications. The proposed early diagnosis and urgent treatment strategy of graft arterial flow reduction aim to decrease morbidity and mortality. METHODS: Pediatric patients with known hepatic arterial flow impairment were retrospectively reviewed. Patients were grouped by occlusive (HAT) and non-occlusive (HAS/SASS) arterial flow reduction. Patients with HAT were further divided in two groups based on the estimated maximal hepatic artery occlusion time ≤8 and >8 hours. RESULTS: Impairment of hepatic arterial flow developed in 32 of 416 pediatric liver transplant recipients. HAT, HAS, and SASS incidences were 4.1% (n = 17), 2.2% (n = 9), and 1.4% (n = 6), respectively. Neither graft loss nor death occurred in the non-occlusive group. The probabilities of sepsis (OR, 1.7; 95% CI, 1.14-2.53; P=.008) and graft loss or death (OR, 1.42; 95% CI, 1.04-1.92; P=.046) were higher in the occlusive group. Patients with estimated maximal duration of hepatic artery occlusion ≤ 8 hours (n = 7; 41.2%) did not have ischemic-type biliary lesions and sepsis (P=.044 and 0.010, respectively) but had excellent 3-year graft survival compared with > 8 hours group (100% vs 40%; P=.037). Multivariate analysis revealed HAT manifestation by fever was associated with increased chances of graft loss or death. CONCLUSION: Occlusive arterial complications impose higher risks of graft loss and death. Thorough arterial supply monitoring by Doppler ultrasonography and urgent endovascular arterial flow restoration may salvage both graft and the recipient.


Assuntos
Arteriopatias Oclusivas , Artéria Hepática , Transplante de Fígado , Complicações Pós-Operatórias , Adolescente , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/fisiopatologia , Arteriopatias Oclusivas/terapia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Circulação Hepática , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos
2.
J Clin Lab Anal ; 34(6): e23219, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31967359

RESUMO

INTRODUCTION: In conditions of limited experience of pediatric simultaneous liver-kidney transplantation (SLKT) using grafts from living and deceased donors, there is a certain need to validate the approach. PATIENTS: The retrospective study of 18 pediatric patients who received SLKT between 2008 and 2019. RESULTS: Grafts were obtained from both living and deceased donors. The patients' age ranged from 2 to 16 years (9 years ±4). The body weight of the children varied from 9.5 to 39 kg (22 kg ±9). The follow-up period lasted from 1 to 109 months (median 38 months ±35). The various graft combinations were used in both groups. There was no mortality during the follow-up. There was no significant difference in baseline parameters in recipients who received grafts from living and deceased donors except age (7.5 years ±2.2 vs 11.8 years ±4.1; P = .038). Rate of complications > grade II was higher among recipients of deceased donor SLKT (7.7% vs 60%; OR, 7.8; 95% CI, 1.04-58.48; P = .044). All the patients are alive with both grafts functioning. All the living donors returned to the normal life. CONCLUSION: SLKT is a safe and effective procedure for children with both simultaneous end-stage liver disease and end-stage renal disease. Both living donor partial liver and kidney transplantation and deceased donor liver-kidney transplantation can be considered as safe and feasible options.


Assuntos
Transplante de Rim/métodos , Transplante de Fígado/métodos , Doadores Vivos , Adolescente , Cadáver , Criança , Pré-Escolar , Feminino , Humanos , Transplante de Rim/efeitos adversos , Transplante de Fígado/efeitos adversos , Masculino , Morbidade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
3.
Am J Transplant ; 19(6): 1847-1851, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30768839

RESUMO

With the presence of organ shortage, living donors remain important sources of grafts, especially for pediatric recipients. Laparoscopic nephrectomy has become the gold standard for living donors. Additionally, laparoscopic partial liver procurement in living donors has proven its safety and feasibility in the latest studies. We have combined both approaches to perform a simultaneous liver-kidney transplantation in a pediatric patient from the same living donor. Our experience of laparoscopic left lateral sectionectomy and laparoscopic nephrectomy in living donors was the basis for adapting to this procedure. A 29-year-old mother was an ABO-incompatible (ABOi) donor for the left lateral section (LLS) of the liver and left kidney for her 2-year-old son. The postoperative period was uneventful. Two sessions of plasmapheresis and rituximab induction were necessary to prepare for ABOi transplantation. The donor and recipient were discharged on postoperative days 5 and 28, respectively. Simultaneous laparoscopic left lateral sectionectomy and nephrectomy in the same living donor is feasible for transplantation from the parent to the child with advanced laparoscopic expertise.


Assuntos
Hepatectomia/métodos , Doadores Vivos , Nefrectomia/métodos , Coleta de Tecidos e Órgãos/métodos , Sistema ABO de Grupos Sanguíneos , Adulto , Pré-Escolar , Doença Hepática Terminal/complicações , Doença Hepática Terminal/cirurgia , Feminino , Humanos , Transplante de Rim/métodos , Laparoscopia/métodos , Transplante de Fígado/métodos , Masculino , Rim Policístico Autossômico Recessivo/complicações , Rim Policístico Autossômico Recessivo/cirurgia
4.
Clin Transplant ; 32(9): e13374, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30080281

RESUMO

BACKGROUND: Laparoscopic living donor liver procurement for transplantation has increased in popularity over the past decade. The purpose of this study was to compare the laparoscopic and open approaches in living donor left lateral sectionectomy (LLS) and to assess the safety and feasibility of this laparoscopic approach. METHODS: A total of 103 living donor LLSs were performed at our center from May 2016 to December 2017. Of these, 35 were completely laparoscopic procedures, which represented the subject of this study. An additional 68 open living donor LLSs performed during the same period were studied as a comparison group. To overcome selection bias, LLS donors were balanced on a 1:1 ratio (laparoscopic [n = 35]: open [n = 35]) according to covariates with similar values. The PSM was based on the operation date, recipient age, diagnosis, recipient weight, and donor age. RESULTS: There were significant differences between the laparoscopic and open LLS groups (P < 0.001) in terms of blood loss (96.8 ± 16.5 vs 155.8 ± 17.8 mL) as well as the duration of hospital stay (4 ± 0.4 vs 6.9 ± 0.5 days). CONCLUSION: Laparoscopic LLS is a feasible and efficacious in the setting of a developed program with advanced laparoscopic expertise.


Assuntos
Sobrevivência de Enxerto , Hepatectomia/métodos , Laparoscopia/métodos , Hepatopatias/cirurgia , Transplante de Fígado , Doadores Vivos/provisão & distribuição , Coleta de Tecidos e Órgãos/métodos , Adulto , Estudos de Casos e Controles , Criança , Seleção do Doador , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Duração da Cirurgia , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos
5.
Exp Clin Transplant ; 22(7): 497-508, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-39223808

RESUMO

The shortage of donor organs remains an unresolved issue in livertransplantation worldwide. Consequently, strategies for expanding the donor pool are currently being developed. Donors meeting extended criteria undergo thorough evaluation, as livers obtained from marginal donors yield poorer outcomes in recipients, including exacerbated reperfusion injury, acute kidney injury, early graft dysfunction, and primary nonfunctioning graft. However, the implementation of machine perfusion has shown excellent potential in preserving donor livers and improving their characteristics to achieve better outcomes for recipients. In this review, we analyzed the global experience of using machine perfusion in livertransplantation through the history ofthe development ofthis method to the latest trends and possibilities for increasing the number of liver transplants.


Assuntos
Sobrevivência de Enxerto , Transplante de Fígado , Perfusão , Animais , Humanos , Seleção do Doador/história , Desenho de Equipamento , História do Século XX , História do Século XXI , Transplante de Fígado/história , Preservação de Órgãos/história , Preservação de Órgãos/métodos , Perfusão/história , Perfusão/métodos , Fatores de Risco , Doadores de Tecidos/provisão & distribuição , Doadores de Tecidos/história , Resultado do Tratamento
6.
Clin Transplant Res ; 38(2): 116-127, 2024 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-38895775

RESUMO

Background: Living donor liver transplantation (LDLT) is an effective treatment for patients with end-stage liver disease. This study was performed to evaluate the outcomes of the initial series of LDLT procedures performed in the Republic of Uzbekistan and to demonstrate that liver transplantation is viable under the conditions in this country. Methods: Between October 2021 and December 2023, we performed 40 LDLTs. We evaluated both immediate and long-term outcomes. Results: Thrombosis of the hepatic artery developed in one case (2.5%). Arterial anastomotic stenoses were diagnosed in three cases (7.5%) and were successfully treated with endovascular balloon vasodilation. Splenic artery steal syndrome arose in three patients (7.5%) and was managed with endovascular embolization of the splenic artery. One patient (2.5%) developed portal vein thrombosis. Portal vein stenosis occurred in two patients (5%) at 10 months posttransplantation and was addressed with endovascular balloon angioplasty, yielding good clinical outcomes. Biliary complications were observed in 45% of the cases, with bile leakages accounting for 89% of these issues and strictures of the biliary anastomoses for 11%. The in-hospital mortality rate was 12.5%. Conclusions: Our research findings and analysis of complications align with the international literature, and the results are deemed acceptable during this implementation phase of the liver transplantation program. Accordingly, liver transplantation is feasible in the Republic of Uzbekistan; however, improvements in surgical and therapeutic methods are necessary to minimize the development of both early and late postoperative complications.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA