Assuntos
Diagnóstico por Imagem , Embolização Terapêutica , Procedimentos Endovasculares , Circulação Hepática , Veia Porta/anormalidades , Malformações Vasculares/diagnóstico , Malformações Vasculares/terapia , Angiografia Digital , Diagnóstico por Imagem/métodos , Humanos , Lactente , Masculino , Tomografia Computadorizada Multidetectores , Veia Porta/diagnóstico por imagem , Veia Porta/fisiopatologia , Portografia , Valor Preditivo dos Testes , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Malformações Vasculares/fisiopatologiaAssuntos
Aneurisma/terapia , Procedimentos Endovasculares/métodos , Artéria Hepática/fisiopatologia , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Fluxo Sanguíneo Regional/fisiologia , Aneurisma/diagnóstico por imagem , Aneurisma/fisiopatologia , Angiografia , Pré-Escolar , Comorbidade , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/fisiopatologia , Aneurisma Coronário/terapia , Embolização Terapêutica , Feminino , Artéria Hepática/diagnóstico por imagem , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Stents , Resultado do TratamentoRESUMO
BACKGROUND: Clinical demand for liver transplant steadily grows while organs offer has reached a plateau years ago. To expand the donor liver pool, various options have been considered including acceptance of suboptimal donors and steatotic grafts, with a risk of poorer outcomes. The latter risk and its relation to the grade of liver graft steatosis have been studied in this prospective clinical study. METHODS: One hundred eighteen consecutive liver transplantation (115 patients) performed between May 2002 and March 2008 were prospectively analyzed. According to the grade of steatosis on a 2 hr postreperfusion biopsy, four groups were considered: absence (<5%) (n=34), mild (<30%) (n=40), moderate (30%-60%) (n=23), or severe steatosis (> or = 60%) (n=21). Donors and recipients demographic data, and patients and grafts survival rates were compared among the four groups. RESULTS: Eighty-four (71%) grafts presented some degree of steatosis (macrosteatosis: 19.5%, microsteatosis: 47%, mix type: 33.5%). Patient and graft survival were significant lower in the "severe steatosis" group, as a whole. Grafts with less than 30% predominant macro-, or microsteatosis also had poorer outcomes with lower patient and graft survival rates. CONCLUSION: Steatotic liver grafts were used on a large scale (71%) in this clinical series. The analysis confirms that using grafts with moderate (>30%) and severe steatosis (>60%) have a negative impact on outcomes. The authors conclude that using these grafts allow a significant increase in organ offer that counterbalances the negative outcome for patients who are not offered a transplant, and this supports the need for further clinical research.