RESUMO
OBJECTIVE: To identify prognostic factors for survival at 6 and 12 months in patients evaluated for liver transplantation using Child-Pugh (CP) classification and the Model for End-Stage Liver Disease (MELD) score. METHODS: We evaluated 144 patients with cirrhosis who were candidates for liver transplantation. We excluded patients with hepatocellular carcinoma, recent liver recipients, and patients who died because of factors unrelated to liver disease. The studied variables were age and sex; prothrombin time; platelet count; albumin, cholesterol, bilirubin, creatinine, and serum sodium concentrations; CP classification and MELD score; and the presence of ascites, encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis, and previous variceal bleeding. Data were processed using statistical software (SPSS version 13.0). RESULTS: Of the 144 patients, 27 (18.7%) did not survive because of complications of liver disease. Univariate analysis showed the most significant factors to be sex, prothrombin time, bilirubin and albumin levels; ascites, encephalopathy, CP classification, and MELD score. At Cox regression analysis, only CP classification proved to be a valid predictor of survival in our cohort. The lowest survival according to CP classification at 6 and 12 months corresponded to stage C and to MELD scores higher than 15. CONCLUSIONS: Child-Pugh classification is an independent prognostic factor for recipient survival. Stage C in the CP classification and a MELD score higher than 15 were strongly related to worse survival. Both scores must be taken into consideration for adequate evaluation of liver transplantation for candidates.
Assuntos
Cirrose Hepática/mortalidade , Cirrose Hepática/cirurgia , Falência Hepática/cirurgia , Transplante de Fígado/fisiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Falência Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Contagem de Plaquetas , Valor Preditivo dos Testes , Prognóstico , Tempo de Protrombina , Análise de Regressão , Reprodutibilidade dos Testes , Estudos Retrospectivos , Taxa de Sobrevida , Sobreviventes , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
From July 4, 1999, when a liver transplantation program was started in Cuba, to December 30, 2007, we performed 125 procedures in 115 patients. The most frequent reasons for transplantation were cirrhosis caused by hepatitis C virus (29%) and alcoholic cirrhosis (17.2%). Two patients received simultaneous liver-kidney transplants. Sixty-seven patients were males, and the patient ages ranged from 12 to 74 years. The average surgical time was 6 hours, and cold ischemia time was 4 to 14 hours. The average blood consumption was 1630 mL; 2900 mL of plasma and 8 units of platelets were used in 7 cases. Immunosuppression was mainly cyclosporine, mycophenolate mofetil, and prednisone. Acute cellular rejections were treated in almost all cases with 3 doses of methylprednisolone. The most frequent complications were biliary (15%), hepatic arterial thrombosis (6%), postsurgical bleeding (8%), acute cellular rejection (20%), and ductopenic rejection (2%). The overall 1-year survival was 74.7%.
Assuntos
Transplante de Fígado/estatística & dados numéricos , Cuba , Feminino , Humanos , Imunossupressores/uso terapêutico , Hepatopatias/classificação , Hepatopatias/cirurgia , Transplante de Fígado/imunologia , Transplante de Fígado/métodos , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos RetrospectivosRESUMO
INTRODUCTION: Liver transplant (LT) is today a first choice procedure in a group of hepatic diseases in their acute and chronic terminal stages. It is not, however, a technique that is completely free of complications and those of a neurological nature constitute between 8 47% of those reported. AIMS. The purpose of this study is to present the immediate neurological complications (NC) found in our patients, as well as to determine the predictive factors and their relation to the mortality rate. PATIENTS AND METHODS: From the medical records of 26 patients who received LT at the CIMEQ (July 1999 December 2001), we collected a group of variables related to the donor, the surgical procedure and the post operative period and associated them to the occurrence of NC while these patients were in the ICU. RESULTS: NC were found in 16 patients (61.5%), the most frequent being encephalopathy (30.8%), tremor (26.9%), and convulsions (19.2%). No relation was found between the presence of NC and prior hepatic encephalopathy, the use of a suboptimal donor, nor did it represent a significant increase in the mortality rate. There was a significant relation with LT to recipients rated as grade C on the Child Pugh classification system, the presence of intraoperative hypotension (p= 0.0164) and primary dysfunction of the liver graft (p= 0.041). CONCLUSIONS: NC represented a significant cause of morbidity in the period following a liver transplant in our series, although they had no significant repercussion on the mortality rate. Their presence is related to variables concerning the recipient, the surgical procedure itself and the immediate post operative period.
Assuntos
Transplante de Fígado/efeitos adversos , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/etiologia , Complicações Pós-Operatórias , Adolescente , Adulto , Cuba , Humanos , Transplante de Fígado/mortalidade , Pessoa de Meia-Idade , Testes Neuropsicológicos , Período Pós-Operatório , Valor Preditivo dos Testes , Prognóstico , Estudos RetrospectivosRESUMO
OBJECTIVE: To inform a patient with penetrating thoracic trauma and diaphragm injury that produced stomach herniation, being reduced the hernia and repaired the injury by laparoscopy though abdominal route with excellent result. REPORT: 17-years-old male, hemodynamically stable with penetrating injury in the fifth left intercostal space, at the level of the middle auxiliary line, pneumothorax and left diaphragmatic hernia. Treatment. A pleurostomy tube was inserted. By laparoscopy 600 mL of free blood in abdominal cavity were aspired, the stomach hernia was reduced and the diaphragmatic repair was performed with nylon 3-0 running suture. The evolution was excellent, being integrated to his work at the twentieth postoperative day. COMMENTARY: Our case supports that laparoscopic surgery is at therapeutic alternative in select cases of trauma.
Assuntos
Hérnia Diafragmática Traumática/cirurgia , Laparoscopia , Traumatismos Torácicos/complicações , Ferimentos Penetrantes/complicações , Adolescente , Emergências , Seguimentos , Hérnia Diafragmática Traumática/diagnóstico por imagem , Hérnia Diafragmática Traumática/etiologia , Humanos , Masculino , Radiografia Torácica , Traumatismos Torácicos/diagnóstico por imagem , Fatores de Tempo , Ferimentos Penetrantes/diagnóstico por imagemRESUMO
Se presentan los casos de dos enfermas, que fueron operadas en este centro, encontrándose que padecían de quistes coledocianos. Una de ellas, de 60 años y la otra de 17. Resulta interesante, que dentro de los quistes de la primera se encontrasen cálculos, lo que no es frecuente. Se realizó derivación interna en uno de los casos y ambos, evolutivamente, se mantienen bien. Se revisa la bibliografía (AU)