Your browser doesn't support javascript.
loading
Early hepatic arterial thrombosis in liver transplantation: Systemic intravenous alteplase as a potential rescue treatment after failed surgical revascularization.
Feier, Flávia H; Melere, Melina U; Trein, Cristine S; da Silva, Carolina Soares; Lucchese, Angelica; Horbe, Alex; Tonet, Fabio; Ricachinevsky, Claudia; Ferreira, Cristina T; Chedid, Marcio F; Kalil, Antonio N.
Afiliação
  • Feier FH; Pediatric Liver Transplantation Unit, Hospital Santa Casa, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil.
  • Melere MU; Pediatric Liver Transplantation Unit, Hospital Santa Casa, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil.
  • Trein CS; Pediatric Liver Transplantation Unit, Hospital Santa Casa, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil.
  • da Silva CS; Pediatric Liver Transplantation Unit, Hospital Santa Casa, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil.
  • Lucchese A; Pediatric Liver Transplantation Unit, Hospital Santa Casa, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil.
  • Horbe A; Interventional Radiology Unit, Hospital Santa Casa, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil.
  • Tonet F; Division of Radiology, Hospital Santa Casa, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil.
  • Ricachinevsky C; Pediatric Liver Transplantation Unit, Hospital Santa Casa, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil.
  • Ferreira CT; Pediatric Liver Transplantation Unit, Hospital Santa Casa, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil.
  • Chedid MF; Postgraduation Program in Surgery, Medical School of UFRGS, Porto Alegre, Brazil.
  • Kalil AN; Pediatric Liver Transplantation Unit, Hospital Santa Casa, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil.
Pediatr Transplant ; 25(5): e13902, 2021 Aug.
Article em En | MEDLINE | ID: mdl-33111470
eHAT is one of the most dreaded post-LT complication. Treatment approaches include retransplantation, revascularization, or observation. Systemic thrombolytic therapy is used in pediatric patients with thromboembolic events. However, there is no previous study reporting on the use of systemic r-tPA to treat eHAT. The treatment strategies used in patients with eHAT are described, focusing on two children who failed SR and were treated with systemic heparinization plus systemic r-tPA infusion. r-tPA-RP consists of intravenous systemic infusion at a dose of 0.3 mg/kg/h during 6 hours, for 5 days. First case (3-year) was transplanted with a whole liver, and second case (6-year) received a LLS from a living donor. HAT was diagnosed by doppler US and confirmed by angioCT scan in both patients in the first day after LT. They underwent SR and were clinically stable. Re-thrombosis occurred in both patients the day after, and r-TPA-RP was started-one patient required two r-TPA-RP for HAT recurrence. They presented minor bleeding, without repercussion. Hepatic artery recanalized after 10 and 3 days in the first and second patient, respectively. Retransplant was avoided, and one developed biliary strictures, successfully managed in the follow-up. r-TPA-RP avoided retransplantation after eHAT in these cases. To our knowledge, this is the first report of the use of systemic r-TPA to treat eHAT in children. This strategy may compose an algorithm to treat eHAT that failed SR in stable patients.
Assuntos
Palavras-chave

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações Pós-Operatórias / Trombose / Ativador de Plasminogênio Tecidual / Fibrinolíticos / Fígado Limite: Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Revista: Pediatr Transplant Assunto da revista: PEDIATRIA / TRANSPLANTE Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Brasil País de publicação: Dinamarca

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações Pós-Operatórias / Trombose / Ativador de Plasminogênio Tecidual / Fibrinolíticos / Fígado Limite: Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Revista: Pediatr Transplant Assunto da revista: PEDIATRIA / TRANSPLANTE Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Brasil País de publicação: Dinamarca