RESUMO
AIM: Despite the evolution in surgical technique, the biliary anastomosis remains the technical Achilles' heel of liver transplantation, especially in living donor liver transplantation. Interventional radiology or endoscopic procedures constitute the most common options to treat complications from the biliary anastomosis. We report a novel technique to prevent biliary complications following the transplant. METHODS: During the donor procedure a wire guide was introduced in the severed duct, left or right, in retrograde fashion. The liver surface was then perforated and the wire guide exposed. A 4F catheter was then attached to the wire guide and pulled into the bile duct passing through the end-to-end duct-to-duct anastomosis or hepaticojejunostomy. RESULTS: This technique was performed in six living donor grafts: one right lobe, two left lobes, and three left lateral segments. All patients had no complications from the stent placement, biliary strictures, or leaks. One developed a hepatic artery thrombosis on the posttransplant day 14 with no major biliary complications.
Assuntos
Ductos Biliares/cirurgia , Transplante de Fígado/métodos , Doadores Vivos , Adulto , Anastomose Cirúrgica , Cateterismo , Criança , Colangiografia , Feminino , Doenças da Vesícula Biliar/etiologia , Doenças da Vesícula Biliar/prevenção & controle , Humanos , Jejunostomia , Masculino , Monitorização IntraoperatóriaRESUMO
AIMS: Immunosuppression therapy for the control of immunologic rejection is a key aspect in liver transplantation. The objective of this study was to evaluate induction therapy with daclizumab (DAC) in living donor liver transplantation (LDLT) in children. METHODS: We compared 2 different immunosuppression protocols in 30 children undergoing LDLT. The patients were divided into 2 groups: 12 patients received tacrolimus with mycophenolate mofetil (TAC-MMF), and 18 patients received tacrolimus with MMF and DAC induction therapy at days 0 and 14 after LDLT (DAC-TAC-MMF). Both groups were similar with regard to age, sex, weight, and indication for liver transplantation. The incidence of biopsy-proved rejection episodes, posttransplantation lymphoproliferative disease (PTLD), and renal dysfunction were evaluated. Tacrolimus levels at posttransplantation day 14 and at 2 months after transplantation were compared in the 2 groups. RESULTS: Acute rejection episodes were observed in 8 patients in the TAC-MMF group (66%), and none in the DAC-TAC-MMF group (0%; P < .05). Neither PTLD nor renal dysfunction was seen in any patient. Mean Tacrolimus level on posttransplantation day 14 was 10.67 +/- 5.4 ng/mL in the TAC-MMF group and 5.65 +/- 3.6 ng/mL in the DAC-TAC-MMF group (P < .05). After the second month the mean tacrolimus levels were 7.2 +/- 2.9 ng/mL and 6.8 +/- 3.5 ng/mL in the TAC-MMF and DAC-TAC-MMF groups, respectively. (P = NS). CONCLUSION: Induction therapy with DAC is safe and associated with a lower incidence of rejection episodes among children undergoing LDLT.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Imunoglobulina G/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Fígado/imunologia , Ácido Micofenólico/análogos & derivados , Tacrolimo/uso terapêutico , Corticosteroides/uso terapêutico , Anticorpos Monoclonais Humanizados , Criança , Creatinina/sangue , Daclizumabe , Quimioterapia Combinada , Feminino , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/epidemiologia , Humanos , Doadores Vivos , Masculino , Ácido Micofenólico/uso terapêuticoRESUMO
Several technical improvements have been made to increase donor pool for pediatric liver transplantation, including reduced-size grafts, split-liver, and recently living donors. The objective of the present study is to report our single-center experience with 60 hepatectomies for living donor liver transplantation in pediatric recipients between June 2000 and December 2002. Donor workup consisted of a complete history and physical examination followed by laboratory test and liver function tests. Graft size was estimated using computed tomography scan or abdominal ultrasound. Liver biopsy was performed in all donors. Arteriogram was performed to evaluate hepatic arterial anatomy. All donors survived the procedure. Only seven patients experienced complications (10.2%), most of which were short term. We conclude that liver living donation for pediatric population is a safe procedure.
Assuntos
Hepatectomia/métodos , Transplante de Fígado/estatística & dados numéricos , Doadores Vivos , Coleta de Tecidos e Órgãos/métodos , Adolescente , Adulto , Peso Corporal , Criança , Humanos , Testes de Função Hepática , Doadores Vivos/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Angiostrongylus vasorum infection was detected for the first time in eight foxes (Dusicyon vetulus) captured in the south of the State of Minas Gerais, Brazil. Two crossbred dogs were successfully infected orally with larvae from the foxes' faeces.