RESUMO
OBJECTIVE: The objective of this study was to identify the incidence of posttransplantation lymphoproliferative disease (PTLD) among children within 1 year after liver transplantation. METHODS: This retrospective review analyzed information in medical charts of pediatric (younger than 18 years of age) recipients of liver transplants between September 2000 and December 2007. RESULTS: Seventy-one patients underwent a liver transplantation and 7 (9.85%) developed PTLD. Among this group, 6 children were girls and 1 was a boy. The median age at transplantation was 35.14 months. Indications that led the children to have their transplantation were 1 case of hemangioendothelioma, 1 case of autoimmune hepatic cirrhosis, 1 case of alpha-1-antitrypsin deficiency, and 4 cases of biliary atresia. The most frequent symptoms were splenomegaly, diarrhea, and fever. The median time from the first symptoms to the initial treatment was 9.7 days. The standard treatment was withdrawal of immunosuppression and close observation of tacrolimus levels and liver function tests associated with antiviral drugs and chemotherapy. Four among 7 children died; 3 children recovered. All 3 children who recovered has presented at the transplantation center within 5 days of initiation of symptoms (P = .033896). CONCLUSION: Despite its rarity, when it occurs, PTLD shows a high mortality rate. Therefore, it is necessary to have interdisciplinary work between the medical team that performs the transplantation and those promoting the primary care to diagnose the disease early and treat it effectively.
Assuntos
Transplante de Fígado/efeitos adversos , Transtornos Linfoproliferativos/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Atresia Biliar/cirurgia , Criança , Pré-Escolar , Infecções por Vírus Epstein-Barr/cirurgia , Feminino , Humanos , Imunossupressores/uso terapêutico , Lactente , Hepatopatias/classificação , Hepatopatias/cirurgia , Transplante de Fígado/mortalidade , Masculino , Prevalência , Estudos Retrospectivos , Esplenomegalia/etiologia , Tacrolimo/uso terapêutico , Deficiência de alfa 1-Antitripsina/cirurgiaRESUMO
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.