Pediatric liver transplantation activity in a high-volume program during the COVID-19 pandemic in Brazil

BACKGROUND

The impact of the COVID pandemic on liver transplant (LT) programs varied among countries. Few data are available about that impact in pediatric liver transplant (PLT) programs. This study aimed at comparing the data of our program in Brazil (2019 vs. 2020).

METHODS

Retrospective cohort study.

RESULTS

One hundred and seventy-four PLT were performed in the period (93% living donors). Patients were divided into two groups according to the LT date: pre-COVID-19 period (march/2019-February/2020) and COVID-19 period (March/2020-February 2021). In the pre-COVID-19 period, 97 LTs were performed, and 77 LTs were performed in the COVID-19 period. Patients in the COVID-19 period were younger (10.9 months vs. 16 months, p 0.009), had higher PELD scores (15 vs. 14, p 0.04), more ascites (66.2 vs. 51.5%, p 0.03), and more frequently hospitalized before LT (27.3 vs. 17.5%). However, there was no difference in post-LT complications, retransplantation nor survival rates. Six (6.2%) patients from pre-COVID-19 period were COVID positive at a median of 15.5 months (14-17.5), and 6 (7.8%) patients from COVID-19 period were COVID positive at a median of 3 months (20 days-6 months) from LT. There was neither mortality nor complications in those patients. Four (33%) were hospitalized, and one had prolonged intubation. Four (33%) were asymptomatic, 4 (33%) had upper airways symptoms, and the remaining had gastrointestinal symptoms.

CONCLUSION

Overall, PLT was not affected during COVID-19 period. Even though patients from COVID-19 period were sicker, there was no significant impact in LT outcomes. All the recipients who tested positive for COVID had a favorable outcome.

Surgical treatment for colorectal endometriosis

The authors studied the surgical treatment of patients with intestinal endometriosis. A total of 10 patients, with a median age range of 43 years, underwent an operation. Cramp abdominal pain (100%), diarrhea (30%), constipation and enterorrhagia (20%) dominated the clinical picture. At the time of surgery, four patients presented intestinal obstructive symptoms. Five (50%) patients reported gynecological complaints. Four patients were infertile and five had prior surgical gynaecological events. Seven cases presented sigmoid involvement, and three had involvement of the cecal appendix. Pre-operative diagnosis was carried out in two patients only. Surgical indications were due to suspicion of cancer (4 patients), appendicitis (3 patients), diverticular disease (1 patient) and unmanageable pain (2 patients). The following procedures were performed: left colectomy (2 cases), rectosigmoidectomy (3 cases), sigmoidectomy (3 cases), colostomy (2 cases) and three appendicectomy cases associated with concomitant gynecological interventions. No postoperative complications or deaths were observed. The authors emphasize that intestinal stenotic lesions should be treated by means of extirpation while the parietal nodule should be treated by exeresis. Intestinal endometriosis should be suspected in cases of lower abdomen recurrent pain in premenopausal infertile women or with previous surgical, gynecological events associated with intestinal symptoms or distal colon stenosis.

[Watermelon stomach and gastric carcinoid tumor in a cirrhotic patient]

Gastric antral vascular ectasia or watermelon stomach is a rare but important cause of upper gastrointestinal bleeding. The authors report the first case of gastric antral vascular ectasia associated with a gastric carcinoid in a cirrhotic patient. The article provides a literature review with emphasis on etiology, endoscopic features and treatment of this entity.

[Hereditary pancreatitis]

Hereditary pancreatitis (HP) is a rare cause of chronic pancreatitis. Recurrent abdominal pain is the most common clinical manifestation, with onset in childhood or adolescence. PURPOSE--Report of a case of HP with atypical presentation and a review of the literature. METHODS--A non-alcoholic patient, without history of abdominal pain, with steatorrhea and malnutrition was investigated. The diagnostic evaluation revealed severe chronic pancreatitis. Two close relatives with early onset calcifying pancreatitis were detected. Epidemiologic and clinical features of HP were reviewed. CONCLUSION--Although uncommon, HP should be regarded in the differential diagnosis of chronic pancreatitis. Familial screening of suspected cases should be routinely performed.