RESUMO
The complement system plays an important role in innate immunity inducing liver diseases as well as signaling immune cell activation in local inflammation regulating immunomodulatory effects such as liver damage and/or liver regeneration. Our aim is to evaluate the role of complement components in acute liver failure (ALF) caused by viral hepatitis, involving virus-induced ALF in human subjects using peripheral blood, samples of liver tissues, and ex vivo assays. Our findings displayed low levels of C3a in plasma samples with high frequency of C3a, C5a, and C5b/9 deposition in liver parenchyma. Meanwhile, laboratory assays using HepG2 (hepatocyte cell line) showed susceptibility to plasma samples from ALF patients impairing in vitro cell proliferation and an increase in apoptotic events submitting plasma samples to heat inactivation. In summary, our data suggest that the complement system may be involved in liver dysfunction in viral-induced acute liver failure cases using ex vivo assays. In extension to our findings, we provide insights into future studies using animal models for viral-induced ALF, as well as other associated soluble components, which need further investigation.
Assuntos
Proteínas do Sistema Complemento/metabolismo , Hepatite Viral Humana/terapia , Falência Hepática Aguda/terapia , Regeneração Hepática/fisiologia , Fígado/imunologia , Adolescente , Adulto , Apoptose , Linhagem Celular , Proliferação de Células , Criança , Pré-Escolar , Proteínas do Sistema Complemento/uso terapêutico , Feminino , Hepatite Viral Humana/complicações , Humanos , Imunidade Inata , Imunomodulação , Lactente , Fígado/patologia , Fígado/virologia , Falência Hepática Aguda/etiologia , Masculino , Terapia de Alvo Molecular , Adulto JovemRESUMO
AIM: To study the differences in immune response and cytokine profile between acute liver failure and self-limited acute hepatitis. METHODS: Forty-six patients with self-limited acute hepatitis (AH), sixteen patients with acute liver failure (ALF), and twenty-two healthy subjects were involved in this study. The inflammatory and anti-inflammatory products in plasma samples were quantified using commercial enzyme-linked immunoassays and quantitative real-time PCR. The cellular immune responses were measured by proliferation assay using flow cytometry. The groups were divided into viral- and non-viral-induced self-limited AH and ALF. Thus, we worked with five groups: Hepatitis A virus (HAV)-induced self-limited acute hepatitis (HAV-AH), HAV-induced ALF (HAV-ALF), non-viral-induced self-limited acute hepatitis (non-viral AH), non-viral-induced acute liver failure (non-viral ALF), and healthy subjects (HC). Comparisons among HAV and non-viral-induced AH and ALF were performed. RESULTS: The levels of mitochondrial DNA (mtDNA) and the cytokines investigated [interleukin (IL)-6, IL-8, IL-10, interferon gamma, and tumor necrosis factor] were significantly increased in ALF patients, independently of etiology (P < 0.05). High plasma mtDNA and IL-10 were the best markers associated with ALF [mtDNA: OR = 320.5 (95%CI: 14.42-7123.33), P < 0.0001; and IL-10: OR = 18.8 (95%CI: 1.38-257.94), P = 0.028] and death [mtDNA: OR = 12.1 (95%CI: 2.57-57.07), P = 0.002; and IL-10: OR = 8.01 (95%CI: 1.26-50.97), P = 0.027]. In the cellular proliferation assay, NKbright, NKT and regulatory T cells (TReg) predominated in virus-specific stimulation in HAV-induced ALF patients with an anergic behavior in the cellular response to mitotic stimulation. Therefore, in non-viral-induced ALF, anergic behavior of activated T cells was not observed after mitotic stimulation, as expected and as described by the literature. CONCLUSION: mtDNA and IL-10 may be predictors of ALF and death. TReg cells are involved in immunological disturbance in HAV-induced ALF.
RESUMO
RESUMO O transplante de órgãos é a única alternativa para muitos pacientes portadores de algumas doenças terminais. Ao mesmo tempo, é preocupante a crescente desproporção entre a alta demanda por transplantes de órgãos e o baixo índice de transplantes efetivados. Dentre as diferentes causas que alimentam essa desproporção, estão os equívocos na identificação do potencial doador de órgãos e as contraindicações mal atribuídas pela equipe assistente. Assim, o presente documento pretende fornecer subsídios à equipe multiprofissional da terapia intensiva para o reconhecimento, a avaliação e a validação do potencial doador de órgãos.
ABSTRACT Organ transplantation is the only alternative for many patients with terminal diseases. The increasing disproportion between the high demand for organ transplants and the low rate of transplants actually performed is worrisome. Some of the causes of this disproportion are errors in the identification of potential organ donors and in the determination of contraindications by the attending staff. Therefore, the aim of the present document is to provide guidelines for intensive care multi-professional staffs for the recognition, assessment and acceptance of potential organ donors.
Assuntos
Humanos , Doadores de Tecidos/provisão & distribuição , Obtenção de Tecidos e Órgãos/métodos , Morte Encefálica , Transplante de Órgãos/métodos , Unidades de Terapia IntensivaRESUMO
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 TratamentoRESUMO
Background. An adequate blood flow is directly related to graft survival in living donor liver transplantation. However, in some cases, unfavorable conditions prevent the use of the hepatic artery for arterial reconstruction. Herein, we report a case in which the recipient right gastroepiploic artery was used as an option for arterial reconstruction in adult-to-adult living donor liver transplantation. Case Report. A 62-year-old woman, with cirrhosis due to hepatitis B associated with hepatocellular carcinoma, was submitted to living donor liver transplantation. During surgery, thrombosis of the hepatic artery with intimal dissection until the celiac trunk was observed, which precluded its use in arterial reconstruction. We decided to use the right gastroepiploic artery for arterial revascularization of the liver graft. Despite the discrepancy in size between donor hepatic artery and recipient right gastroepiploic artery, anastomosis was performed successfully. Conclusions. The use of the right gastroepiploic artery as an alternative for arterial revascularization of the liver graft in living donor liver transplantation should always be considered when the hepatic artery of the recipient cannot be used. For performing this type of procedure, familiarity with microsurgical techniques by the surgical team is necessary.
RESUMO
BACKGROUND: Portal vein embolization is an accepted procedure that provides hypertrophy of the future remnant liver in order to reduce post-hepatectomy complications. AIM: To present a series submitted to portal vein embolization using an adapted hysterosalpingography catheter via transileocolic route. METHODS: Were performed right portal branch embolization in 19 patients using hysterosalpingography catheter. For embolizing the vessel, was used Gelfoam(r) powder with absolute alcohol solution. Indications for hepatectomy were colorectal liver metastases in all cases. RESULTS: An adequate growth of the future remnant liver was achieved in 15 patients (78.9%) and second time hepatectomy could be done in 14 (73.7%). In one patient (5.2%), tumor progression prevented surgery. One patient presented acute renal failure after portal embolization. CONCLUSIONS: The hysterosalpingography catheter is easy to handle and can be introduced into the portal vein with a wire guide. There were no major post-embolization complication. Its use is safe, cheap and effective.
Assuntos
Embolização Terapêutica/instrumentação , Hepatectomia , Veia Porta , Catéteres , Embolização Terapêutica/métodos , Desenho de Equipamento , Humanos , Histerossalpingografia/instrumentaçãoRESUMO
BACKGROUND: Portal vein embolization is an accepted procedure that provides hypertrophy of the future remnant liver in order to reduce post-hepatectomy complications. AIM: To present a series submitted to portal vein embolization using an adapted hysterosalpingography catheter via transileocolic route. METHODS: Were performed right portal branch embolization in 19 patients using hysterosalpingography catheter. For embolizing the vessel, was used Gelfoam(r) powder with absolute alcohol solution. Indications for hepatectomy were colorectal liver metastases in all cases. RESULTS: An adequate growth of the future remnant liver was achieved in 15 patients (78.9%) and second time hepatectomy could be done in 14 (73.7%). In one patient (5.2%), tumor progression prevented surgery. One patient presented acute renal failure after portal embolization. CONCLUSIONS: The hysterosalpingography catheter is easy to handle and can be introduced into the portal vein with a wire guide. There were no major post-embolization complication. Its use is safe, cheap and effective. .
RACIONAL: Embolização da veia porta é procedimento consagrado para estimular a hipertrofia do fígado remanescente, a fim de reduzir as complicações pós-hepatectomia. OBJETIVO: Apresentar série de casos submetidos à embolização da veia porta usando cateter adaptado de histerossalpingografia, por via transileocólica. MÉTODOS: Foi realizada embolização do ramo portal direito em 19 pacientes utilizando cateter de histerossalpingografia. Foi usado Gelfoam(r) em pó com solução de álcool absoluto, como material embolizante. As indicações para hepatectomia foram metástases hepáticas colorretais em todos os casos. RESULTADOS: Hipertrofia adequada do fígado remanescente foi alcançada em 15 pacientes (78,9%) e a hepatectomia foi realizada em 14 (73,7 %). Em um (5,2 %), a progressão do tumor impediu a realização da operação. Um paciente apresentou insuficiência renal aguda após embolização portal. CONCLUSÕES: O cateter de histerossalpingografia é fácil de ser manuseado e pode ser introduzido na veia porta com um fio guia. Não houve complicação grave pós-embolização. Seu uso é seguro, barato e eficaz. .
Assuntos
Humanos , Embolização Terapêutica/instrumentação , Hepatectomia , Veia Porta , Catéteres , Embolização Terapêutica/métodos , Desenho de Equipamento , Histerossalpingografia/instrumentaçãoRESUMO
Anatomical resection of segment VIII (SVIII) is one of the most difficult hepatectomies to perform. Although it is the best choice of surgical treatment for tumors located at SVIII, its feasibility can be compromised when the right hepatic vein (RHV) must be resected en bloc with SVIII. Herein we describe a case of a cirrhotic patient that was submitted to segmentectomy VIII in bloc with the main trunk of the RHV, due to hepatocellular carcinoma. The resection could only be performed because a well developed inferior right hepatic vein (IRHV) was present. Anatomical variations of the liver vascularization should be used by liver surgeons to improve surgical results.
RESUMO
BACKGROUND & AIMS: To study immunological mechanisms of fulminant hepatic failure (FHF) derived from extensive liver lesions, 14 patients with FHF induced by different aetiologies were investigated by observance of both lymphocyte phenotyping and cytokine levels. METHODS: Five patients bearing benign acute hepatitis B (AHB) and seven healthy liver donors (HC) were used as controls. Samples of liver and blood from both FHF patients and HC were obtained during transplantation procedures. Plasma levels of IL-1ß, IL-4, IL-6, IL-8, IL-10, IFN-γ, TNF-α, MCP-1, RANTES and MIP-1α were quantified using a multiplex immunoassay. Cell characterization was carried out by flow cytometry. IFN-γ staining was performed on liver sections using immunofluorescence methods. RESULTS: An increase of peripheral frequency of natural killer (NK) cells expressing early activation markers (CD69, HLA-DR and CD38) and adhesion molecule CD44 was observed in FHF patients. Elevated frequency of T lymphocytes CD4(+) and CD8(+) expressing CD38 and adhesion molecules CD29 and CD44 was also observed in FHF. Additionally, an increase of natural killer T cells (NKT) was detected in FHF patients. High plasma cytokine levels were not statistically different between FHF and AHB patients. In comparison to HC, a strong liver expression of IFN-γ was detected in FHF patients. The increased frequency of CD4(+) CD44(+) and IL-8 cytokine was found in patients with poor prognosis. CONCLUSIONS: These findings indicate the involvement of NK and NKT cells as well as T lymphocytes CD4(+) and CD8(+) in the inflammatory process inducing FHF, confirmed by the high hepatic expression of IFN-γ.
Assuntos
Interferon gama/metabolismo , Falência Hepática/imunologia , Fígado/imunologia , Ativação Linfocitária/imunologia , Adolescente , Adulto , Idoso , Biomarcadores/metabolismo , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD4-Positivos/metabolismo , Linfócitos T CD4-Positivos/patologia , Linfócitos T CD8-Positivos/imunologia , Linfócitos T CD8-Positivos/metabolismo , Linfócitos T CD8-Positivos/patologia , Contagem de Células , Criança , Pré-Escolar , Citocinas/metabolismo , Feminino , Humanos , Imunofenotipagem , Células Matadoras Naturais/imunologia , Células Matadoras Naturais/metabolismo , Células Matadoras Naturais/patologia , Fígado/metabolismo , Fígado/patologia , Falência Hepática/diagnóstico , Falência Hepática/metabolismo , Masculino , Pessoa de Meia-Idade , Células T Matadoras Naturais/imunologia , Células T Matadoras Naturais/metabolismo , Células T Matadoras Naturais/patologia , Prognóstico , Doadores de Tecidos , Adulto JovemRESUMO
Caroli's disease (CD) is a rare autosomal recessive disorder characterized by intrahepatic cystic dilatation of the bile ducts. Patients with bilobar or progressive disease may require orthotopic liver transplantation (OLT). In the MELD era, living donor liver transplantation (LDLT) raised as the ultimate treatment option for these patients, once their MELD score is usually low. Herein, we describe 2 cases of patients (a 2-year-old girl and a 19-year-old teenager) that successfully underwent LDLT as a treatment for diffuse CD. The good postoperative courses of the two cases indicate that LDLT is a feasible option in the treatment of this disorder, even in complicated or early age patients.
RESUMO
Inflammatory pseudotumor of the liver (IPTL) is a rare condition, but an important differential diagnosis of hepatic space-occupying lesions. It may regress spontaneously and mimic other liver tumors. Complications are usually intrahepatic. Herein, we present a case of IPTL which developed pleural empyema and lung necrosis as an uncommon complication.
RESUMO
BACKGROUND: The worldwide rising demand for cadaveric donors in liver transplantation is an important incentive for the development of alternative transplantation options, such as living donors. A precise evaluation of surgical complications is, therefore, considered to be an important issue in this setting. AIM: Present a retrospective analysis of 126 living donors hepatectomies undertaken at our centre. METHODS: From December 2002 to August 2009, 126 living donors were submitted to hepatectomy. Donors' complications were stratified according to Clavien's scoring system to compare the morbidity of right hepatectomy (RH) (Group 1) and left lateral sectionectomy (LLS) (Group 2). RESULTS: Thirty-nine complications were observed in 35 patients. Sixty LLS, 3 left (LH) and 63 RH were performed. The complications were classified as: Clavien grade 1-11 (28.2%), grade 2-12 (30.7%), grade 3A-13 (33.3%), grade 3B-2 (5.1%) and grade 4A-1 (2.5%). When Group 1 (63 patients) and Group 2 (60 patients) were compared, there was no significant difference between the number of complications: 20 (31%) and 14 (23%), respectively (P > 0.3). CONCLUSIONS: Hepatectomy for living donor liver transplantation (LDLT) was a safe procedure, regardless of the type of liver resection undertaken. We found no difference in morbidity between RH and LLS, which suggests that complications may occur despite the amount of liver retrieved.
Assuntos
Hepatectomia/métodos , Transplante de Fígado/métodos , Doadores Vivos/provisão & distribuição , Adolescente , Adulto , Brasil , Distribuição de Qui-Quadrado , Feminino , Hepatectomia/efeitos adversos , Humanos , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Adulto JovemRESUMO
Arterial reconstructions are pivotal, particularly in pediatric LDLT. We describe microsurgical reconstruction technique with 6x loupes and the clinical course of the first 23 less than 10 kg recipients in an initial LDLT program at a developing country. From March 2002 to October 2008, 286 liver transplantation were performed in 279 patients at our unit. There were 73 children and 206 adults. Among the children, 23 weighing less than 10 kg were recipients from living donors. Arterial reconstructions were with end-to-end interrupted suture using a 6x magnification loupe, according to the untied suture technique. All patients were prospectively followed by color Doppler ultrasound protocol. In our initial experience there were no arterial complications. With mean 24 months of follow-up, 19 patients (82%) are alive with good graft function. Hepatic artery in LDLT can be safely reconstructed with microsurgical techniques without microscope using, with 6x loupe magnification, and can achieve good results in patients under 10 kg.
Assuntos
Peso Corporal , Hepatectomia/métodos , Artéria Hepática/cirurgia , Transplante de Fígado/métodos , Doadores Vivos , Microcirurgia/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Anastomose Cirúrgica/métodos , Seguimentos , Artéria Hepática/diagnóstico por imagem , Humanos , Lactente , Microscopia , Estudos Retrospectivos , Técnicas de Sutura , Resultado do Tratamento , Ultrassonografia Doppler em CoresRESUMO
Fulminant hepatic failure (FHF) is characterized by massive hepatocellular injury, whose physiopathology is still unclear. Hepatitis B (HBV) is probably the most common viral cause of FHF, while hepatitis A (HAV) virus seem occurs less frequently. However, the host and viral factors that determine the outcome of these infections are poorly understood. In the present study, viral load and genotyping determining regions of HAV and HBV genomes were sequenced. Eight FHF patients and one patient with severe acute hepatitis (SAH) were included. Liver and blood samples were collected during liver transplantation or necropsy procedures. HAV-RNA and HBV-DNA were extracted from serum, biopsy and paraffin liver. Nucleotide sequencing of HAV-RNA was performed from VP1/2A and HBV-DNA from PreS/S region. The amplified samples were quantified by Real-Time PCR. The cases of HAV infection were due to subgenotype IA. The cases of HBV infection were due to genotype A2 and D4. The case of HAV/HBV coinfection was infected by genotype IA and D3. Hepatitis A and B infection were associated with genotypes most prevalent in Brazil. In hepatitis A infection the mean of period evolution was 13 days. In hepatitis B, FHF patients infected by genotype D have a shorter period of evolution than FHF patients infected by genotype A (mean 15 v. 53 days). There was no association with genotype-determining region with the severity of hepatitis, however nucleotide differences and high viral load could be observed among FHF.
Assuntos
Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vírus da Hepatite A Humana/genética , Hepatite A/virologia , Vírus da Hepatite B/genética , Hepatite B/virologia , Falência Hepática Aguda/virologia , Doença Aguda , Sequência de Bases , Brasil , DNA Viral/análise , Genótipo , Vírus da Hepatite A Humana/imunologia , Hepatite A/complicações , Vírus da Hepatite B/imunologia , Hepatite B/complicações , Dados de Sequência Molecular , Mutação , Filogenia , Reação em Cadeia da Polimerase , RNA Viral/análise , Carga ViralRESUMO
BACKGROUND/AIMS: Although eosinophils are considered to play an important role in the pathogenesis of various parasitic, allergic and autoimmune digestive diseases, their role in fulminant hepatic failure (FHF) is unknown. Our contribution was to identify and quantify eosinophils and cytokine levels [interleukin (IL)-6, IL-5 and macrophage inflammatory protein (MIP)-1alpha] in liver parenchyma and peripheral blood from FHF patients at pre- and post-transplantation steps. METHODS: Histochemical methods were used to identify/quantify eosinophils in liver samples. Liver and plasma cytokine levels were quantified using immunofluorescence methods. RESULTS: Fulminant hepatic failure patients showed a high number of intrahepatic eosinophils concomitant with an increased expression of IL-6, besides the IL-6-positive eosinophils associated with the lack of IL-5. Also, an increased number of eosinophils and soluble IL-6 and MIP-1alpha with a low expression of IL-5 in peripheral blood at the pretransplantation step was observed. CONCLUSIONS: The increased number of intrahepatic eosinophils, besides the high production of IL-6, may be involved in liver dysfunction. In addition, the low presence of IL-5 in liver and peripheral blood may represent a particular pattern of eosinophil behaviour in human liver failure, which may also involve MIP-1alpha. Further ex vivo studies are necessary to evaluate the specific role of eosinophils in FHF.
Assuntos
Eosinofilia/sangue , Eosinófilos/imunologia , Interleucina-5/sangue , Interleucina-6/sangue , Falência Hepática Aguda/sangue , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Movimento Celular , Quimiocina CCL3/sangue , Pré-Escolar , Eosinofilia/fisiopatologia , Feminino , Hepatócitos/metabolismo , Humanos , Fígado/metabolismo , Falência Hepática Aguda/fisiopatologia , Falência Hepática Aguda/cirurgia , Transplante de Fígado , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Fulminant hepatic failure (FHF) is characterized by massive hepatocellular injury, whose physiopathology is still unclear. Hepatitis B (HBV) is probably the most common viral cause of FHF, while hepatitis A (HAV) virus seem occurs less frequently. However, the host and viral factors that determine the outcome of these infections are poorly understood. In the present study, viral load and genotyping determining regions of HAV and HBV genomes were sequenced. Eight FHF patients and one patient with severe acute hepatitis (SAH) were included. Liver and blood samples were collected during liver transplantation or necropsy procedures. HAV-RNA and HBV-DNA were extracted from serum, biopsy and paraffin liver. Nucleotide sequencing of HAV-RNA was performed from VP1/2A and HBV-DNA from PreS/S region. The amplified samples were quantified by Real-Time PCR. The cases of HAV infection were due to subgenotype IA. The cases of HBV infection were due to genotype A2 and D4. The case of HAV/HBV coinfection was infected by genotype IA and D3. Hepatitis A and B infection were associated with genotypes most prevalent in Brazil. In hepatitis A infection the mean of period evolution was 13 days. In hepatitis B, FHF patients infected by genotype D have a shorter period of evolution than FHF patients infected by genotype A (mean 15 v. 53 days). There was no association with genotype-determining region with the severity of hepatitis, however nucleotide differences and high viral load could be observed among FHF.
Assuntos
Vírus da Hepatite A Humana/genética , Hepatite A/virologia , Vírus da Hepatite B/genética , Hepatite B/virologia , Falência Hepática Aguda/virologia , Doença Aguda , Adulto , Idoso , Sequência de Bases , Brasil , Criança , Pré-Escolar , DNA Viral/análise , Feminino , Genótipo , Hepatite A/complicações , Vírus da Hepatite A Humana/imunologia , Hepatite B/complicações , Vírus da Hepatite B/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Dados de Sequência Molecular , Mutação , Filogenia , Reação em Cadeia da Polimerase , RNA Viral/análise , Carga ViralRESUMO
The selection of donors for living donor liver transplantation (LDLT) is one of the most important features in this kind of surgery. The aim of this study is to describe our initial experience in the donor evaluation process. From December 2001 to January 2005, 104 donors were evaluated for 70 recipients (65 potential donors were evaluated for 39 adult recipients, and 39 donors for 31 pediatric recipients). Only 30 donors were able to donate: 13 for the adult group, and 17 for the pediatric one. In general, the utilization rate of potential donors was 28.8% (30/104). For the adult patients, 65 potential donors were seen to perform 13 LDLT, which represents a utilization rate of potential donors of 20%. For the pediatric patients, this rate was 43.6%. The exclusion criteria were clinical in 22 cases (21%), anatomical in 13 cases (13%), psychosocial in nine cases (9%), and others in 12 (12%). Death of recipients led to exclusion 18 of donors (17%). Thirty-three percent of adults and 55% of pediatric recipients who had at least one potential donor to start the evaluation process were able to identify a living donor. In conclusion, the first limit for LDLT is the rigorous donor evaluation.
Assuntos
Hepatopatias/terapia , Transplante de Fígado/métodos , Doadores Vivos , Obtenção de Tecidos e Órgãos/métodos , Adolescente , Adulto , Brasil , Criança , Países em Desenvolvimento , Humanos , Avaliação de Programas e Projetos de Saúde , Fatores de TempoRESUMO
The shortage of organ donors for low-weight liver transplant recipients, especially small children, has led to the development of new surgical techniques to increase the donor pool. Almost all of these techniques use the left lateral segment (Couinaud's segments II and III), but even this graft could be too large for children under 10 kg, and further reduction could be necessary. Few articles address the issue of monosegmental liver transplantation. Available articles are with small sample sizes or even case reports, which makes it difficult to draw conclusions about indication and outcome for monosegmental grafts. A search of the MEDLINE databases using the terms "Liver Transplantation" and "Monosegmental" or "Monosegments" limited to title or abstract with publication in the English language was conducted. The data from each study were selected and analyzed, regarding donor status (living or cadaveric), donor weight, surgical techniques used in left lateral further reduction, recipient indication for liver transplantation, age and recipient weight, graft-to-recipient body weight ratio, segment utilized, type of abdominal closure, postoperative complications, and survival. Seven publications were identified from 1995 to 2004 and fulfilled the criteria. A total of 27 pediatric patients who received a monosegment transplant were identified, median age 211 days (range, 27 to 454 days) and median weight 4.6 kg (range, 2.45 to 7.4 kg). Segment III was utilized in 21 (78%) and segment II in 6 (22%). Patient survival was 85.2%. In conclusion, monosegment liver transplantation appears to be a satisfactory option for infants weighing less than 10 kg who require a liver transplant.