1
|
Seda Neto J, Costa CM, Pugliese R, Vincenzi R, Benavides MR, Travassos NPR, de Oliveira CMV, Roda K, Fernandes DP, Kondo M, Fonseca EA. Living Donor Whole and Partial Liver Grafts, Deceased Donor Whole Liver and SPLIT: Outcome Comparison. J Pediatr Surg 2024:S0022-3468(24)00092-7. [PMID: 38413259 DOI: 10.1016/j.jpedsurg.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/02/2024] [Accepted: 02/14/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Currently, graft options for pediatric liver transplantation (PLT) include whole (WL) and partial (P) grafts, in the form of either deceased donor transplantation (DD) or living donor liver transplantation (LD). WL transplants from LD are commonly referred to as domino LT. The objective of this manuscript is to compare the outcomes of PLT performed with each of the available graft options. METHODS Retrospective cohort study from Jan. 2010 to Dec. 2022. The variables included data on the recipients' preoperative clinical status, intraoperative technical aspects, post-operative complications, and survival studies. There were 4 groups: SPLIT (17), DD-WL (55), LD-WL (824), and LD-P (22). RESULTS The median age and BW of the recipients was smaller in SPLIT, LD-P, and LD-WL compared to DDT-WL groups. HVOO (HR 15.87, 95% CI 1.89-133.06, P = 0.01), retransplantation (HR 7.94, 95% CI 2.63-24.02, P < 0.01), and malignancies (HR 3.08, 95% CI 1.29-7.37, P = 0.01) were independently associated with decreased patient survival. HAT (HR 27.54, 95% CI 10.44-72.68, P < 0.01) and malignancies (HR 2.42, 95% CI 1.10-5.34, P = 0.03) increased the risk of graft loss. The overall survival in this series was 91.4% (mean follow-up of 74.3 months). Patient and graft survival were not different among groups. CONCLUSION HAT and malignancies were associated with reduced graft survival. Whole liver from living donors with MSUD presented 100% patient survival at 120 months. Even without statistical differences in survival among the studied groups, LD-P and LD-WL recipients presented a trend towards better outcomes. LEVEL OF EVIDENCE LEVEL III.
Collapse
Affiliation(s)
- João Seda Neto
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil.
| | - Carolina M Costa
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Renata Pugliese
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Rodrigo Vincenzi
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Marcel R Benavides
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Nathália P R Travassos
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Caio M V de Oliveira
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Karina Roda
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Debora P Fernandes
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Mário Kondo
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Eduardo A Fonseca
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| |
Collapse
|
2
|
Seda Neto J, Magalhães Costa C, Pereira FP, Pugliese R, Travassos NP, Oliveira CM, Vincenzi R, Benavides MR, Roda K, Kondo M, Fonseca EA. Anterior hepatic resection: A simple and safe technique for reducing the antero-posterior diameter of the liver graft for small pediatric recipients. Pediatr Transplant 2023; 27:e14518. [PMID: 36973639 DOI: 10.1111/petr.14518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND The techniques involved in neonatal and infantile transplantation require approaches that can sculpt a left lateral segment (LLS) to the right shape and size and avoid large-for-size syndrome. The aim of this article is to describe the anterior hepatic resection (AHR) of the LLS in pediatric LDLT. METHODS A retrospective anatomical study of preoperative image studies, description of the technique for AHR, and short-term results. RESULTS The AHR was performed in eight cases. All donors were male, with average age, BW, and BMI of 28.3 ± 5.9 years, 74.2 ± 9.3 kg, and 24.3 ± 2.6 kg/m2, respectively. Donors were discharged at an average of 3.6 ± 0.8 days. The median recipient age and BW at transplantation were 6.9 (2.7 to 11) months and 5.9 (3.9 to 8) kg, respectively, and the recipient-to-donor body weight ratio (RDBW) was <0.1 in all but one case. The mean percentage reduction in graft weight and in the antero-posterior diameter were 33.2% ± 5.5% and 38.3% ± 12.6%, respectively. The average (SD) GRWR was 4.8% ± 1.7% before all the resections and 3.5% ± 1.0% after the procedures. Seven patients were primarily closed. CONCLUSION After LLS resection, a nonanatomical anterior resection of the LLS was accomplished without hilar vascular dissection to segments II/III. The final liver graft allowed primary abdominal wall closure in all but one patient, with meaningful adjustments in GRWR. AHR proved to be simple, safe, reproducible, and effective in the presented case series.
Collapse
Affiliation(s)
- João Seda Neto
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
| | | | | | - Renata Pugliese
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
| | | | - Caio M Oliveira
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Rodrigo Vincenzi
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Marcel R Benavides
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Karina Roda
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Mário Kondo
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Eduardo A Fonseca
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
| |
Collapse
|
3
|
Costa CM, Porta A, Miura IK, Porta G, Fonseca EA, Pugliese R, Kondo M, Chapchap P, Sindhi R, Feier FH, Seda Neto J. In vitro fertilization: an unexpected finding in a cohort of patients with biliary atresia. Braz J Med Biol Res 2023; 56:e12671. [PMID: 36995875 PMCID: PMC10041673 DOI: 10.1590/1414-431x2023e12671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/16/2023] [Indexed: 03/31/2023] Open
Abstract
In biliary atresia (BA), efforts to prevent premature liver transplantation (LT) are aimed at early diagnosis, timing of Kasai-portoenterostomy (KPE), and centralization of care. This report presents the clinical picture, treatment strategies, and outcomes of BA patients with no previous treatment. A retrospective cohort study (Jan/2001 to Jan/2021) was conducted to evaluate the outcome of patients with BA referred to a single team. Study groups were: 1) Kasai-only group (K-only) n=9), 2) LT-only group (n=7), and 3) Kasai+LT group (K+LT) (n=23). Survival with native liver and overall survival were 22.9 and 94.8%, respectively, at 120 months of follow-up. There was no difference in age at KPE in the K-only group (46.8±21.8 days) vs K+LT (52.1±22 days), P=0.4. Ten (25.6%) patients were babies conceived through in vitro fertilization (IVF). Four IVF patients (40%) presented associated congenital heart disease vs 5 patients (17%) in the remaining group (P=0.14). Two of the IVF patients were premature (<37 weeks). Median maternal age at birth was 35 years (33 to 41 years). Excellent patient survival is expected for patients with BA with the available treatment strategies. IVF+BA was an unexpected prevalent association in this cohort, and further studies are required to better understand these findings.
Collapse
Affiliation(s)
- C M Costa
- Hepatologia e Transplante Hepático, Hospital Sírio-Libanês, São Paulo, SP, Brasil
- Hepatologia e Transplante Hepático, A.C. Camargo Cancer Center, São Paulo, SP, Brasil
| | - A Porta
- Hepatologia e Transplante Hepático, Hospital Sírio-Libanês, São Paulo, SP, Brasil
- Hepatologia e Transplante Hepático, A.C. Camargo Cancer Center, São Paulo, SP, Brasil
| | - I K Miura
- Hepatologia e Transplante Hepático, Hospital Sírio-Libanês, São Paulo, SP, Brasil
- Hepatologia e Transplante Hepático, A.C. Camargo Cancer Center, São Paulo, SP, Brasil
| | - G Porta
- Hepatologia e Transplante Hepático, Hospital Sírio-Libanês, São Paulo, SP, Brasil
- Hepatologia e Transplante Hepático, A.C. Camargo Cancer Center, São Paulo, SP, Brasil
| | - E A Fonseca
- Hepatologia e Transplante Hepático, Hospital Sírio-Libanês, São Paulo, SP, Brasil
- Hepatologia e Transplante Hepático, A.C. Camargo Cancer Center, São Paulo, SP, Brasil
| | - R Pugliese
- Hepatologia e Transplante Hepático, Hospital Sírio-Libanês, São Paulo, SP, Brasil
- Hepatologia e Transplante Hepático, A.C. Camargo Cancer Center, São Paulo, SP, Brasil
| | - M Kondo
- Hepatologia e Transplante Hepático, Hospital Sírio-Libanês, São Paulo, SP, Brasil
- Hepatologia e Transplante Hepático, A.C. Camargo Cancer Center, São Paulo, SP, Brasil
| | - P Chapchap
- Hepatologia e Transplante Hepático, Hospital Sírio-Libanês, São Paulo, SP, Brasil
| | - R Sindhi
- Hillman Center for Pediatric Transplantation, Thomas E. Starzl Transplantation Institute, Department of Transplant Surgery, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - F H Feier
- Hepatologia e Transplante Hepático, Hospital Sírio-Libanês, São Paulo, SP, Brasil
- Hepatologia e Transplante Hepático, A.C. Camargo Cancer Center, São Paulo, SP, Brasil
| | - J Seda Neto
- Hepatologia e Transplante Hepático, Hospital Sírio-Libanês, São Paulo, SP, Brasil
- Hepatologia e Transplante Hepático, A.C. Camargo Cancer Center, São Paulo, SP, Brasil
| |
Collapse
|
4
|
Neto JS, Chapchap P, Feier FH, Pugliese R, Vincenzi R, Benavides MR, Roda K, Kondo M, Fonseca EA. The impact of low recipient weight [≤ 7kg] on long-term outcomes in 1078 pediatric living donor liver transplantations. J Pediatr Surg 2022; 57:955-961. [PMID: 35697543 DOI: 10.1016/j.jpedsurg.2022.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND infants who require liver transplantation represent a treatment challenge because chronic liver disease at this early age affects the child's growth and development during a critical phase. The aim is to compare demographics, operative data, and long-term outcomes according to recipient weight at the time of LDLT. METHODS This retrospective study included primary LDLT analyzed in 2 groups: BW ≤ 7 kg (n = 322) and BW > 7 kg (n = 756). A historical comparison between periods was also investigated. RESULTS BW ≤ 7 kg had significantly lower height/age and weight/age z-scores, with median PELD score of 19. Transfusion rates were higher in the BW ≤ 7 kg group (30.9 ml/kg versus 15.5 ml/kg, P < 0.001). Higher frequencies of PV complications were seen in the BW ≤ 7 kg cohort. HAT and retransplantation rates were similar. Those with BW ≤ 7 kg required longer ICU and hospital stays. Patient and graft survival were similar. Patient survival in BW≤ 7 kg was significantly better in the most recent period. CONCLUSION Malnutrition and advanced liver disease were more frequent in BW ≤ 7 kg. Despite increased rates of PVT and longer hospital stay, patient and graft long-term survival were similar between groups.
Collapse
Affiliation(s)
- João Seda Neto
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil; Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brazil.
| | - Paulo Chapchap
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil
| | - Flavia H Feier
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Renata Pugliese
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil; Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brazil
| | - Rodrigo Vincenzi
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil; Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brazil
| | - Marcel R Benavides
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil; Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brazil
| | - Karina Roda
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil; Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brazil
| | - Mário Kondo
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil
| | - Eduardo A Fonseca
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil; Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brazil
| |
Collapse
|
5
|
Costa CM, Neto JS, Benavidez MR, Vincenzi R, Roda K, Oliveira CMV, Travassos NPR, de Lima LGCA, Pereira FP, Fonseca EA. Liver transplantation for hilar inflammatory myofibroblastic tumor: Case report and review of the literature. Pediatr Transplant 2022; 27:e14445. [PMID: 36435975 DOI: 10.1111/petr.14445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/15/2022] [Accepted: 11/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Inflammatory myofibroblastic tumors (IMTs) of the liver are rare neoplasms. These tumors are difficult to distinguish from other neoplasms by radiological examination, have uncertain evolution, and there is no consensus on the treatment of these lesions. Hilar tumors can involve the portal vein, hepatic artery, bile duct, and spread to the branches of the portal triad, causing obstructive symptoms, occlusive phlebitis, and portal hypertension. Thus, liver transplantation (LT) is an excellent alternative for locally advanced hilar tumors, since it ensures complete tumor resection with free margins. METHODS/RESULTS We present a literature review and a case report showing a 3-year-old boy with liver IMT invading the hepatic hilum and inferior vena cava, who underwent a successful living donor liver transplantation that required portal vein and vena cava replacement. CONCLUSION The incidence of hilar IMTs is low and there is no well-established standard treatment. Liver transplantation for a hilar tumor with vascular invasion was acceptable in this case because the radically of the surgery was the key for the cure, and because the tumor was benign in nature.
Collapse
Affiliation(s)
- Carolina Magalhães Costa
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - João Seda Neto
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Marcel R Benavidez
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Rodrigo Vincenzi
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Karina Roda
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Caio Márcio V Oliveira
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Nathália Porto R Travassos
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
| | | | | | - Eduardo A Fonseca
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
| |
Collapse
|
6
|
Salgado PC, Oliveira DLS, Rodrigues BAM, Gomes GB, Fonseca EA, Avelar L, Barreto PR, Moreira RS, Carvalho TM, Moura PG. O NOVO NORMAL E O COMPORTAMENTO DOS DOADORES DE SANGUE NO PERÍODO PÓS-PANDEMIA – GSH BANCO DE SANGUE SERUM CENTRO RJ. Hematol Transfus Cell Ther 2022. [DOI: 10.1016/j.htct.2022.09.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
7
|
Seda Neto J, M Costa C, Fonseca EA, Vincenzi R, Pugliese R, Rocha JIX, Roda K, Benavidez MR, Oliveira CMV, Pereira FP, Assis AM, Feier FH, Chapchap P. Intestinal complications are common in patients with acquired diaphragmatic hernia after pediatric living donor liver transplantation. Pediatr Transplant 2022; 26:e14203. [PMID: 34881487 DOI: 10.1111/petr.14203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acquired diaphragmatic hernia (DH) following liver transplantation (LT) is usually considered a surgical emergency. Interplay of contributing elements determines its occurrence but, in children, LT with partial liver grafts seems to be the most important causative factor. METHODS This retrospective study describes the clinical scenario and outcomes of 11 patients with acquired DH following LDLT. RESULTS During the study period, 1109 primary pediatric LDLT were performed (0.8% DH). The median age and BW of the recipients with DH at transplantation were 17 months and 11.1 kg, respectively; 63.7% of the cases had a weight/age Z-score of less than -2 at transplantation. The median interval between transplantation and diagnosis of DH was 114 days (32-538 days). A total of 6 (54.5%) of the patients had bowel obstruction due to bowel migration into the hemithorax. Ten defects were right-sided. Three patients required enterectomy and enterorrhaphy. Two patients required a new bilioenteric anastomosis, and one of them had complete necrosis of the Roux-in-Y limb. The patient with left-side DH presented gastroesophageal perforation. CONCLUSION Most defects necessitate primary closure as the first treatment, and recurrence is rare. The associated problems encountered, especially related to intestinal complications, can determine increased morbidity following DH repair. Early diagnosis and intervention are required for achieving better outcomes.
Collapse
Affiliation(s)
- João Seda Neto
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hepatology and Liver Transplantation, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Carolina M Costa
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hepatology and Liver Transplantation, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Eduardo A Fonseca
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hepatology and Liver Transplantation, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Rodrigo Vincenzi
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hepatology and Liver Transplantation, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Renata Pugliese
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hepatology and Liver Transplantation, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - João Ivo X Rocha
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hepatology and Liver Transplantation, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Karina Roda
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hepatology and Liver Transplantation, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Marcel R Benavidez
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hepatology and Liver Transplantation, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Caio Márcio V Oliveira
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hepatology and Liver Transplantation, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | | | - André Moreira Assis
- Intervention Radiology Department, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Flavia H Feier
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Paulo Chapchap
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| |
Collapse
|
8
|
Fonseca EA, Feier F, Pugliese R, Freitas AF, Porta G, Miura I, Baggio V, Kondo M, Benavides M, Vincenzi R, Roda K, Oliveira CV, Chapchap P, Seda‐Neto J. Pediatric liver transplantation activity in a high-volume program during the COVID-19 pandemic in Brazil. Pediatr Transplant 2021; 25:e14112. [PMID: 34396644 PMCID: PMC8420104 DOI: 10.1111/petr.14112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/15/2021] [Accepted: 07/28/2021] [Indexed: 12/11/2022]
Abstract
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.
Collapse
Affiliation(s)
- Eduardo A. Fonseca
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| | - Flavia Feier
- Hepatology and Liver TransplantationSanta Casa de Porto AlegrePorto AlegreBrazil
| | - Renata Pugliese
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| | - Aline F. Freitas
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| | - Gilda Porta
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| | - Irene Miura
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| | - Vera Baggio
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| | - Mario Kondo
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| | - Marcel Benavides
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| | - Rodrigo Vincenzi
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| | - Karina Roda
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| | - Caio V. Oliveira
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| | - Paulo Chapchap
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| | - João Seda‐Neto
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| |
Collapse
|
9
|
Fujishima JS, Filho JCPS, Berg AVSVD, Carneiro TX, Pantoja LFSK, Pinto MA, Lima BLSA, Siqueira VS, Fonseca EA, Barros JRM. MIELOMA MULTIPLO COM TRANSFORMAÇÃO PARA LINFOMA PLASMABLÁSTICO: RELATO DE CASO. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
10
|
Lima BLSA, Medeiros YA, Fonseca EA, Pantoja LFSK, Pinto MA, Sirqueira VS, Fujishima JS, Barros JRM, Saraiva-Filho JCP, Carneiro TX. LINFOMA LINFOPLASMACÍTICO SECRETOR DE IGG/KAPPA EVOLUINDO COM ANEMIA HEMOLÍTICA E INSUFICIÊNCIA RENAL. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
11
|
Siqueira VS, Pantoja LFSK, Carneiro TX, Filho JCPS, Pinto MA, Barros JRM, Lima BLSA, Fujishima JS, Fonseca EA, Burbano RMR. FLT3 E BCR-ABL1 CONCOMITANTE EM LEUCEMIA MIELOIDE AGUDA: RELATO DE CASO. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
12
|
Neto JS, Fonseca EA, Vincenzi R, Pugliese R, Benavides MR, Roda K, Porta G, Miura IK, Porta A, Borges C, Baggio V, Feier FH, Teng H, Rodrigues ML, Iwase FC, Kondo M, Chapchap P. Technical Choices in Pediatric Living Donor Liver Transplantation: The Path to Reduce Vascular Complications and Improve Survival. Liver Transpl 2020; 26:1644-1651. [PMID: 32852894 DOI: 10.1002/lt.25875] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/15/2020] [Accepted: 07/16/2020] [Indexed: 12/11/2022]
Abstract
Pediatric living donor liver transplantation (PLDLT) is a successful therapeutic option for children with chronic and acute liver disease. After early transplant results, many technical advancements were introduced in the field to reduce the rate of complications and improve survival. The aim of this study is to present the outcomes of 975 primary PLDLTs in 3 periods: initial practice (period 1, 29 patients, January 1995 to December 1999), second period (period 2, 331 patients, January 2000 to December 2009), and third period (period 3 [P3], 615 patients, January 2010 to September 2019). Among the technical refinements introduced in P3 are the use of hyperreduced left lateral segment grafts, abdominal wall prosthetic mesh closure, double hepatic artery anastomosis, and increased use of vascular grafts for portal vein reconstruction. The outcomes included significant reductions of hepatic artery thrombosis (HAT), early portal vein thrombosis (EPVT), and retransplantation, with better patient and graft survival in P3. Additional analyses showed that the factors independently associated with worse 90-day patient survival were HAT, EPVT, and increasing Pediatric End-Stage Liver Disease score. In conclusion, the introduction of technical refinements in P3, in addition to improvements in patient care, determined a reduction in EPVT, HAT, and retransplantation. Consequently, patient and graft survival rates increased in all time points studied.
Collapse
Affiliation(s)
- João Seda Neto
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Eduardo A Fonseca
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Rodrigo Vincenzi
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Renata Pugliese
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Marcel R Benavides
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Karina Roda
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Gilda Porta
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Irene K Miura
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Adriana Porta
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Christian Borges
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Vera Baggio
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Flavia H Feier
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Hsiang Teng
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Mônica L Rodrigues
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Fernanda C Iwase
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Mário Kondo
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Paulo Chapchap
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| |
Collapse
|
13
|
Vincenzi R, Fonseca EA, Roda KMO, Chapchap P, Neto JS. Current Practice in Immunosuppression in Pediatric Liver Transplantation. Curr Pharm Des 2020; 26:3402-3405. [PMID: 32534559 DOI: 10.2174/1381612826666200614181526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/12/2020] [Indexed: 11/22/2022]
Abstract
The last decades have witnessed a significant improvement in the field of pediatric liver transplantation (LT), resulting in longer patient and graft survival; adequate graft selection, surgical refinement, the use of live donors and optimal postoperative care are among the reasons why pediatric recipients are living longer. With this new condition, pediatric recipients are now more exposed to the deleterious effects of immunosuppression, including metabolic, infectious and neoplastic complications, nephrotoxicity and neurotoxicity. Due to all those particularities, the approach to avoid overimmunosuppression or underimmunosuppression may be more difficult in children than in adult recipients. Moreover, pediatric recipients are exposed to growth issues and specific problems during adolescence, like nonadherence to immunosuppressive therapy. This article highlights the current immunosuppressive strategies for pediatric liver transplant recipients.
Collapse
Affiliation(s)
- Rodrigo Vincenzi
- Liver Transplant Department, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
| | - Eduardo A Fonseca
- Liver Transplant Department, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
| | - Karina M O Roda
- Liver Transplant Department, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
| | - Paulo Chapchap
- Liver Transplant Department, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
| | - João Seda Neto
- Liver Transplant Department, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
| |
Collapse
|
14
|
Cavalcante ACBS, Zurstrassen CE, Carnevale FC, Pugliese RPS, Fonseca EA, Moreira AM, Matushita JPK, Cândido HLL, Benavides MAR, Miura IK, Danesi VLB, Hirschfeld APM, Borges CBV, Porta G, ChapChap P, Seda-Neto J. Long-term outcomes of transmesenteric portal vein recanalization for the treatment of chronic portal vein thrombosis after pediatric liver transplantation. Am J Transplant 2018; 18:2220-2228. [PMID: 30019834 DOI: 10.1111/ajt.15022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 07/05/2018] [Accepted: 07/05/2018] [Indexed: 01/25/2023]
Abstract
Portal vein thrombosis (PVT) may occur at any time following liver transplantation. We describe our experience with portal vein recanalization in cases of thrombosis after liver transplantation. Twenty-eight children (5%) out of 566 liver transplant recipients underwent portal vein recanalization using a transmesenteric approach. All children received left hepatic segments, developed PVT, and had symptoms or signs of portal hypertension. Portal vein recanalization was performed via the transmesenteric route in all cases. Twenty-two (78.6%) patients underwent successful recanalization and stent placement. They received oral anticoagulants after the procedure, and clinical symptoms subsided. Symptoms recurred due to portal vein restenosis/thrombosis in seven patients. On an intention-to-treat basis, the success rate of the proposed treatment was 60.7%. Only 17 out of 28 children with posttransplant chronic PVT retained stent patency (primary + assisted) at the end of the study period. In cases of portal vein obstruction, the transmesenteric approach via minilaparotomy is technically feasible with good clinical and hemodynamic results. It is an alternative procedure to reestablish the portal flow to the liver graft that can be performed in selected cases and a therapeutic addition to other treatment strategies currently used to treat chronic PVT.
Collapse
Affiliation(s)
- A C B S Cavalcante
- Interventional Radiology Unit, A. C. Camargo Cancer Center Hospital, São Paulo, Brazil
| | - C E Zurstrassen
- Interventional Radiology Unit, A. C. Camargo Cancer Center Hospital, São Paulo, Brazil
| | - F C Carnevale
- Interventional Radiology Unit, Hospital Sirio-Libanês, São Paulo, Brazil
| | - R P S Pugliese
- Liver Transplantation Unit, A. C. Camargo Cancer Center Hospital, São Paulo, Brazil.,Liver Transplantation Unit, Hospital Sirio-Libanês, São Paulo, Brazil
| | - E A Fonseca
- Liver Transplantation Unit, A. C. Camargo Cancer Center Hospital, São Paulo, Brazil.,Liver Transplantation Unit, Hospital Sirio-Libanês, São Paulo, Brazil
| | - A M Moreira
- Interventional Radiology Unit, Hospital Sirio-Libanês, São Paulo, Brazil
| | - J P K Matushita
- Interventional Radiology Unit, A. C. Camargo Cancer Center Hospital, São Paulo, Brazil
| | - H L L Cândido
- Liver Transplantation Unit, A. C. Camargo Cancer Center Hospital, São Paulo, Brazil.,Liver Transplantation Unit, Hospital Sirio-Libanês, São Paulo, Brazil
| | - M A R Benavides
- Liver Transplantation Unit, A. C. Camargo Cancer Center Hospital, São Paulo, Brazil.,Liver Transplantation Unit, Hospital Sirio-Libanês, São Paulo, Brazil
| | - I K Miura
- Liver Transplantation Unit, A. C. Camargo Cancer Center Hospital, São Paulo, Brazil.,Liver Transplantation Unit, Hospital Sirio-Libanês, São Paulo, Brazil
| | - V L B Danesi
- Liver Transplantation Unit, A. C. Camargo Cancer Center Hospital, São Paulo, Brazil.,Liver Transplantation Unit, Hospital Sirio-Libanês, São Paulo, Brazil
| | - A P M Hirschfeld
- Liver Transplantation Unit, A. C. Camargo Cancer Center Hospital, São Paulo, Brazil.,Liver Transplantation Unit, Hospital Sirio-Libanês, São Paulo, Brazil
| | - C B V Borges
- Liver Transplantation Unit, A. C. Camargo Cancer Center Hospital, São Paulo, Brazil.,Liver Transplantation Unit, Hospital Sirio-Libanês, São Paulo, Brazil
| | - G Porta
- Liver Transplantation Unit, A. C. Camargo Cancer Center Hospital, São Paulo, Brazil.,Liver Transplantation Unit, Hospital Sirio-Libanês, São Paulo, Brazil
| | - P ChapChap
- Liver Transplantation Unit, Hospital Sirio-Libanês, São Paulo, Brazil
| | - J Seda-Neto
- Liver Transplantation Unit, A. C. Camargo Cancer Center Hospital, São Paulo, Brazil.,Liver Transplantation Unit, Hospital Sirio-Libanês, São Paulo, Brazil
| |
Collapse
|
15
|
Brito MM, Seda Neto J, Fonseca EA, Pugliese R, Danesi VB, Candido HL, Porta A, Borges CVB, Porta G, Chapchap P, Miura IK. Outcomes of liver transplantation in pediatric recipients with cardiovascular disease. Pediatr Transplant 2018; 22. [PMID: 29131462 DOI: 10.1111/petr.13081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2017] [Indexed: 11/29/2022]
Abstract
LT exerts considerable stress on the heart perioperatively. Limited data exist on impact of cardiovascular diseases on LT children. This study evaluated the outcomes of children with CVD who underwent LT and compared with pretransplant findings. From 518 LT recipients, 82 (15.8%) had CVD. Sixty patients were classified as low-risk adjustment for congenital heart surgery 1 (RACHS 1 and 2). Five patients were classified as RACHS ≥3. The most common echocardiographic finding in the CVD patients (25/82) was ASD. CVD patients had more abnormal EKG (32.4% vs 14.5%, P < .001), abnormal chest X-ray (11.8% vs 1.4%, P < .001), and altered echocardiography (89.7% vs 15.4%, P < .001) findings compared with the No-CVD group pretransplant. Post-transplant, significant differences between groups were observed related to abnormal EKG (14.7% vs 7.0%, P = .03) and echocardiography (48.5% vs 3.2%, P < .01) findings. Pretransplant ASD spontaneously closed in 22 patients. At 1 and 5 years post-transplant, there was no difference in the survival rate between groups (P = .96). The prevalence of CVD in recipients of LT was high, and its presence was associated with significantly higher cardiac decompensation before and after LT. Minor and moderate cardiovascular disease did not impact the long-term survival.
Collapse
Affiliation(s)
| | - Joao Seda Neto
- Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Eduardo A Fonseca
- Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Renata Pugliese
- Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Vera B Danesi
- Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Helry L Candido
- Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Adriana Porta
- Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Cristian V B Borges
- Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Gilda Porta
- Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | | | - Irene Kazue Miura
- Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| |
Collapse
|
16
|
Vincenzi R, Fonseca EA, Chapchap P, Machado MCC, Roda KMO, Candido HL, Benavides MR, D'Assuncao MA, Afonso RC, Turine P, Marson FP, Neto JS. Pancreas-preserving duodenectomy after living donor liver transplantation for invasive cytomegalovirus disease. Pediatr Transplant 2017; 21. [PMID: 28881059 DOI: 10.1111/petr.13059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2017] [Indexed: 12/15/2022]
Abstract
CMV infection plays an important role in the postoperative course following solid organ transplantation. We present the case of an 11-year-old male patient who underwent LDLT due to severe hepatopulmonary syndrome and biliary cirrhosis. Four weeks after LDLT, he developed persistent GI bleeding and was subjected to repeated endoscopic treatment and radiological arterial embolization to stop the bleeding from duodenal ulcers. Diagnostic workup was negative for CMV disease. Because the bleeding persisted, surgical treatment was indicated, and a pancreas-preserving duodenectomy was performed. Immunohistochemical staining of the surgical specimen demonstrated diffuse endothelial infiltration by CMV. Despite ganciclovir treatment, the patient developed new erosions in the jejunal mucosa and melena; ganciclovir was discontinued, and foscarnet was started, resulting in clinical improvement and the cessation of bleeding. This case highlights the technical aspects of performing a complex upper GI resection in a patient recently subjected to LDLT, taking care to avoid injury to the previous liver graft anastomosis and restore GI continuity. Moreover, CMV tissue-invasive disease compartmentalized in the GI tract may be difficult to diagnose, as indicated by the negative results of antigenemia and PCR assays and endoscopic superficial mucosal biopsies.
Collapse
Affiliation(s)
- Rodrigo Vincenzi
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Eduardo A Fonseca
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Paulo Chapchap
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
| | | | - Karina M O Roda
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Helry L Candido
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Marcel R Benavides
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Marco A D'Assuncao
- Gastrointestinal Endoscopy Unit, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
| | - Rogerio C Afonso
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Plinio Turine
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Fernando P Marson
- Gastrointestinal Endoscopy Unit, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
| | - João Seda Neto
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| |
Collapse
|
17
|
Vincenzi R, Fonseca EA, Roda KMO, Porta G, Candido HL, Benavides MR, Leite KRM, Afonso RC, Turine-Neto P, Ribeiro CMF, Chapchap P, Seda-Neto J. Living donor liver transplantation for neonatal fulminant hepatitis due to herpes simplex virus infection. Pediatr Transplant 2017; 21. [PMID: 28736976 DOI: 10.1111/petr.13021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2017] [Indexed: 11/28/2022]
Abstract
Although rare, ALF caused by disseminated HSV infection is associated with high mortality in the neonatal population. This condition is often diagnosed relatively late due to the absence of specific signs. We present a case involving a neonate with ALF submitted to living donor liver transplantation without a prior diagnosis. The patient had no skin or mucosal lesions, and IgM serology was negative for HSV-1 and HSV-2. Immunohistochemical staining of the liver explant was positive for herpes virus infection, and the patient subsequently received antiviral drug treatment, with a good outcome. Due to organ shortages and the rarity of the aforementioned condition, LT has seldom been reported for the treatment of ALF caused by herpes virus infection; however, LT may be the only option for neonates with fulminant hepatitis. The use of living donors in an urgent scenario is well established in Eastern countries and safely applicable for pediatric patients with ALF.
Collapse
Affiliation(s)
- Rodrigo Vincenzi
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Eduardo A Fonseca
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Karina M O Roda
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Gilda Porta
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Helry L Candido
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Marcel R Benavides
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Katia R M Leite
- Department of Pathology, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
| | - Rogerio C Afonso
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Plinio Turine-Neto
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | | | - Paulo Chapchap
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
| | - João Seda-Neto
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| |
Collapse
|
18
|
Roda KMO, Fonseca EA, Candido HL, Benavides MR, Afonso RC, Pugliese R, Vincenzi R, Chapchap P, Seda Neto J. Simultaneous or sequential gastrectomy in pediatric liver transplant recipients. Pediatr Transplant 2016; 20:994-999. [PMID: 27412691 DOI: 10.1111/petr.12755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2016] [Indexed: 01/16/2023]
Abstract
The association between LT and gastrectomy is not common. Only two studies reported the gastrectomy/LT association in children. Here, we report three children who underwent LT who required a concomitant or sequential gastrectomy for different reasons. Patient 1, a 16-yr-old boy, during the LT, underwent a partial gastrectomy due to extensive injury to the duodenum. He had a previous and unusual portoenterostomy performed in the duodenum. Bowel reconstruction was performed using an intestinal loop that was first used for the bilio-enteric anastomosis and then connected to the gastric stump. Patient 2, a 22-month-old female child, underwent a partial gastrectomy with a Roux-en-Y reconstruction during a retransplantation. She had a large perforated gastric ulcer blocked by the allograft liver. Patient 3, a 26-month-old male child, five yr after living donor LT, was submitted to a partial gastrectomy because of gastric outlet obstruction. The histopathology was compatible with eosinophilic gastritis. The association between LT and gastrectomy in the pediatric population is extremely rare. Appropriate knowledge of the previous transplantation technique is very important. Further studies are required to assess the outcomes of the different types of gastric reconstruction in pediatric recipients.
Collapse
Affiliation(s)
- Karina M O Roda
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Eduardo A Fonseca
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Helry L Candido
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Marcel R Benavides
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Rogerio C Afonso
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Renata Pugliese
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Rodrigo Vincenzi
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Paulo Chapchap
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
| | - Joao Seda Neto
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil. .,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil.
| |
Collapse
|
19
|
Neto JS, Fonseca EA, Cândido HL, Pugliese R, Feier FH, Kondo M, Azambuja RL, Chapchap P. Alternatives for vascular reconstruction in pediatric living donor liver transplantation. Pediatr Transplant 2016; 20:717-722. [PMID: 27174167 DOI: 10.1111/petr.12720] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 01/10/2023]
Abstract
Many publications discuss the various strategies for vascular reconstruction (VR) in pediatric LDLT. Having knowledge of alternative techniques is helpful in planning transplants. This article presents three case reports that illustrate some of the alternative techniques for HV, PV, and HA reconstruction in pediatric LDLT. It also reviews the available alternative strategies reported for VR in pediatric LDLT. In the first case, a 13-month-old girl presented a PRETEXT III HB with invasion of the retrohepatic vena cava. An LLS graft HV was anastomosed to a DD iliac vein graft and subsequently implanted in a "standard" fashion in the recipient. In the second case, a 44-month-old boy presented with multifocal HB and portomesenteric thrombosis and the portal inflow was done through a renoportal anastomosis. In the third case, a 22-month-old child with a failed Kasai procedure had extensive HA thrombosis. The HA reconstruction was performed with an interposition of the recipient's IMV graft. The use of alternative techniques for VR in pediatric LDLT is paramount to the success of such a complex procedure. Imaging studies can help transplant surgeons outline surgical strategies and define the best technique to be used in each case.
Collapse
Affiliation(s)
- Joao Seda Neto
- Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.,A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Eduardo A Fonseca
- Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.,A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Helry L Cândido
- Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.,A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Renata Pugliese
- Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.,A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Flavia H Feier
- Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.,A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Mario Kondo
- Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.,A.C. Camargo Cancer Center, São Paulo, Brazil
| | | | - Paulo Chapchap
- Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil
| |
Collapse
|
20
|
Neto JS, Feier FH, Bierrenbach AL, Toscano CM, Fonseca EA, Pugliese R, Candido HL, Benavides MR, Porta G, Chapchap P. Impact of Kasai portoenterostomy on liver transplantation outcomes: A retrospective cohort study of 347 children with biliary atresia. Liver Transpl 2015; 21:922-7. [PMID: 25832004 DOI: 10.1002/lt.24132] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/02/2015] [Accepted: 03/07/2015] [Indexed: 02/07/2023]
Abstract
Biliary atresia (BA) is the main diagnosis leading to liver transplantation (LT) in children. When diagnosed early in life, a Kasai portoenterostomy (Kasai-PE) can prevent or postpone LT. Instances of previous operations can result in difficulties during the LT. We hypothesized that a previous Kasai-PE could affect LT outcomes. A retrospective cohort study of 347 BA patients submitted to LT between 1995 and 2013 at Hospital Sírio-Libanês and A. C. Camargo Cancer Center was conducted. Patients were divided into those with a previous Kasai portoenterostomy early failure (K-EF), Kasai portoenterostomy late failure (K-LF), and those with no Kasai portoenterostomy (No-K). Primary outcomes were patient and graft survival. A total of 94 (27.1%) patients had a K-EF, 115 (33.1%) had a K-LF, and 138 (39.8%) had No-K before LT. Children in the K-LF group were older and had lower Pediatric End-Stage Liver Disease (PELD) scores. Patients in both K-EF and K-LF groups had more post-LT biliary complications. After Cox-multivariate analysis adjusting for confounding factors to determine the influence of Kasai-PE on patient and graft survival, the K-LF group had an 84% less probability of dying and a 55% less chance to undergo retransplantation. The K-LF group had a protective effect on posttransplant patient and graft survival. When properly performed, the Kasai procedure can postpone LT and positively affect outcomes. Having a K-EF and having not performed a Kasai-PE had the same effect in patient and graft survival; however, a previous Kasai-PE can increase post-LT complications as biliary complications and bowel perforations.
Collapse
Affiliation(s)
- Joao Seda Neto
- Hepatology and Liver Transplantation, Sao Paulo, Sao Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Flávia H Feier
- Hepatology and Liver Transplantation, Sao Paulo, Sao Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Ana Luiza Bierrenbach
- Teaching and Research Institute, Hospital Sirio-Libanes, São Paulo, São Paulo, Brazil
| | - Cristiana M Toscano
- Department of Health, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiás, Brazil
| | - Eduardo A Fonseca
- Hepatology and Liver Transplantation, Sao Paulo, Sao Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Renata Pugliese
- Hepatology and Liver Transplantation, Sao Paulo, Sao Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Helry L Candido
- Hepatology and Liver Transplantation, Sao Paulo, Sao Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Marcel R Benavides
- Hepatology and Liver Transplantation, Sao Paulo, Sao Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Gilda Porta
- Hepatology and Liver Transplantation, Sao Paulo, Sao Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Paulo Chapchap
- Hepatology and Liver Transplantation, Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
21
|
Neto JS, Fonseca EA, Feier FH, Pugliese R, Candido HL, Benavides MR, Porta G, Miura IK, Danesi VB, Guimaraes T, Porta A, Borges C, Godoy A, Kondo M, Chapchap P. Analysis of factors associated with portal vein thrombosis in pediatric living donor liver transplant recipients. Liver Transpl 2014; 20:1157-67. [PMID: 24954288 DOI: 10.1002/lt.23934] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 06/02/2014] [Indexed: 02/07/2023]
Abstract
The technique of vascular reconstruction plays a major role in the outcome of living donor liver transplantation (LDLT). An increased use of vascular grafts (VGs) as replacements for sclerotic portal veins has become a standard technique for our group. The aim of this study was to analyze the factors associated with portal vein thrombosis (PVT) in pediatric LDLT. We performed a retrospective analysis of 486 primary pediatric LDLT procedures performed between October 1995 and May 2013. VGs used for portal reconstruction included living donor inferior mesenteric veins, living donor ovarian veins, recipient internal jugular veins, deceased donor iliac arteries, and deceased donor iliac veins. Thirty-four patients (7.0%) developed PVT. The incidence of PVT dropped from 10.1% to 2%; the overall utilization of VGs increased from 3.5% to 37.1%. In a multivariate analysis, only the use of VGs remained an independent risk factor for the occurrence of PVT (hazard ratio = 7.2, 95% confidence interval = 2.8-18.7, P < 0.001). There was no difference in survival rates between patients with PVT and patients without PVT. No patient with PVT underwent retransplantation. In conclusion, the use of VGs was independently associated with the development of PVT. Over time, there was a reduction in the incidence of early PVT in this cohort, and there was a trend toward a reduction in total PVT. The occurrence of isolated PVT in this study was not associated with decreased patient or graft survival.
Collapse
Affiliation(s)
- Joao Seda Neto
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, São Paulo, Brazil; A. C. Camargo Cancer Center, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Seda Neto J, Leite KMR, Porta A, Fonseca EA, Feier FH, Pugliese R, Miura IK, Chapchap P, Porta G. HCC prevalence and histopathological findings in liver explants of patients with hereditary tyrosinemia type 1. Pediatr Blood Cancer 2014; 61:1584-9. [PMID: 24852359 DOI: 10.1002/pbc.25094] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 04/17/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Untreated tyrosinemia type 1 (HT1) is manifested by liver failure associated with renal tubular dysfunction, growth failure, and rickets. The indication for liver transplantation (LT) is restricted to non-responders to 2-(2-nitro-4-trifluoromethylbenzoyl)-1, 3-cyclohexanedione (NTBC) treatment, patients not treated with NTBC or for patients with HCC. The aim of this study is to report on a series of NTBC naive HT1 patients submitted to LT along with the prevalence of HCC in their liver explants. PROCEDURE This is a retrospective study of 16 children with HT1 who underwent liver transplantation between January 1993 and December 2012. CLINICAL FEATURES liver failure in 12 (75%), growth failure in 4 (25%), rickets in 5 (31.2%), hypertrophic cardiomyopathy in three (18.7%), and renal tubulopathy in seven patients (43.7%). Median AFP level was 64,335 ng/ml. Abdominal CT scans showed multiple nodules in most patients. Histopathology of the explants showed cirrhosis in all patients and HCC in 12 (75%), 3 with microvascular invasion. The majority of the tumors were well differentiated. Patient survival rate was 86% at a median follow-up of 6.6 years. All survivors were tumor-free with no adjuvant chemotherapy. CONCLUSION In countries where neonatal screening programs are not effective and NTBC treatment is not widely available, LT still plays an important role in the treatment of children with HT1. An early indication in patients who present with multinodular livers can also serve to treat an otherwise underdiagnosed HCC condition.
Collapse
Affiliation(s)
- Joao Seda Neto
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes/Hospital A. C. Camargo, São Paulo, SP, Brazil
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Pugliese R, Fonseca EA, Porta G, Danesi V, Guimaraes T, Porta A, Miura IK, Borges C, Candido H, Benavides M, Feier FH, Godoy A, Cardoso RA, Kondo M, Chapchap P, Neto JS. Ascites and serum sodium are markers of increased waiting list mortality in children with chronic liver failure. Hepatology 2014; 59:1964-71. [PMID: 24122953 DOI: 10.1002/hep.26776] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 09/26/2013] [Indexed: 12/22/2022]
Abstract
UNLABELLED Ascites is the most common complication of cirrhosis and in adults it is associated with 50% mortality at 5 years if patients do not receive a liver transplant. The occurrence of hyponatremia in these patients has been associated with increased mortality on the waiting list. The importance of serum sodium levels and the presence of ascites in the pediatric setting remain to be clarified. A retrospective analysis of pediatric patients with cirrhosis on the transplant list was carried out between October 2000 and February 2012. The primary objective of this study was to evaluate the association of pretransplant variables with mortality within 90 days following the inclusion of patients on the waiting list. In all, 522 patients were included in the study; 345 (66%) patients were under 1 year of age; 208 (40%) of the children presented ascites. A multivariate Cox proportional hazards analysis was conducted and total bilirubin (P < 0.001, hazard ratio [HR] = 2.09, 95% confidence interval [CI] = 1.35-3.21), international normalized ratio (INR) (P < 0.001, HR = 9.83, 95% CI = 4.51-21.45), serum sodium levels (P = 0.03, HR = 0.96, 95% CI = 0.92-0.99), ascites (P = 0.001, HR = 2.59, 95% CI = 1.44-4.64), and categorized age (0-1 versus ≥ 1 year old) (P = 0.025, HR = 2.33, 95% CI = 1.11-4.86) were independently associated with risk of death in 90 days. Malnutrition (Z score height/age, weight/age) and serum albumin (pediatric endstage liver disease [PELD] formula) were not included in the final model. CONCLUSION The presence of ascites and serum sodium levels are important variables associated with decreased patient survival while candidates wait for a liver graft. Multicenter studies are necessary to validate these findings in order to improve current allocation policies based on the PELD score.
Collapse
Affiliation(s)
- Renata Pugliese
- Hepatology and Liver Transplantation, Sirio-Libanês Hospital and Menino Jesus Hospital; Hepatology and Liver Transplantation, AC Camargo Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Feier FH, Miura IK, Fonseca EA, Porta G, Pugliese R, Porta A, Schwartz IVD, Margutti AVB, Camelo JS, Yamaguchi SN, Taveira AT, Candido H, Benavides M, Danesi V, Guimaraes T, Kondo M, Chapchap P, Neto JS. Successful domino liver transplantation in maple syrup urine disease using a related living donor. ACTA ACUST UNITED AC 2014; 47:522-6. [PMID: 24770567 PMCID: PMC4086180 DOI: 10.1590/1414-431x20143830] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 04/25/2014] [Indexed: 11/22/2022]
Abstract
Maple syrup urine disease (MSUD) is an autosomal recessive disease associated with
high levels of branched-chain amino acids. Children with MSUD can present severe
neurological damage, but liver transplantation (LT) allows the patient to resume a
normal diet and avoid further neurological damage. The use of living related donors
has been controversial because parents are obligatory heterozygotes. We report a case
of a 2-year-old child with MSUD who underwent a living donor LT. The donor was the
patient's mother, and his liver was then used as a domino graft. The postoperative
course was uneventful in all three subjects. DNA analysis performed after the
transplantation (sequencing of the coding regions of BCKDHA,
BCKDHB, and DBT genes) showed that the MSUD
patient was heterozygous for a pathogenic mutation in the BCKDHB
gene. This mutation was not found in his mother, who is an obligatory carrier for
MSUD according to the family history and, as expected, presented both normal clinical
phenotype and levels of branched-chain amino acids. In conclusion, our data suggest
that the use of a related donor in LT for MSUD was effective, and the liver of the
MSUD patient was successfully used in domino transplantation. Routine donor
genotyping may not be feasible, because the test is not widely available, and, most
importantly, the disease is associated with both the presence of allelic and locus
heterogeneity. Further studies with this population of patients are required to
expand the use of related donors in MSUD.
Collapse
Affiliation(s)
- F H Feier
- Departamento de Hepatologia e Transplante Hepático, Hospital Sírio-Libanês, São Paulo, SP, Brasil
| | - I K Miura
- Departamento de Hepatologia e Transplante Hepático, Hospital Sírio-Libanês, São Paulo, SP, Brasil
| | - E A Fonseca
- Departamento de Hepatologia e Transplante Hepático, Hospital Sírio-Libanês, São Paulo, SP, Brasil
| | - G Porta
- Departamento de Hepatologia e Transplante Hepático, Hospital Sírio-Libanês, São Paulo, SP, Brasil
| | - R Pugliese
- Departamento de Hepatologia e Transplante Hepático, Hospital Sírio-Libanês, São Paulo, SP, Brasil
| | - A Porta
- Departamento de Hepatologia e Transplante Hepático, Hospital Sírio-Libanês, São Paulo, SP, Brasil
| | - I V D Schwartz
- Departamento de Genética, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - A V B Margutti
- Departamento de Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - J S Camelo
- Departamento de Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - S N Yamaguchi
- Departamento de Nutrição, Hospital Sírio-Libanês, São Paulo, SP, Brasil
| | - A T Taveira
- Departamento de Hepatologia, Universidade Estadual do Amazonas, Manaus, AM, Brasil
| | - H Candido
- Departamento de Hepatologia e Transplante Hepático, Hospital Sírio-Libanês, São Paulo, SP, Brasil
| | - M Benavides
- Departamento de Hepatologia e Transplante Hepático, Hospital Sírio-Libanês, São Paulo, SP, Brasil
| | - V Danesi
- Departamento de Hepatologia e Transplante Hepático, Hospital Sírio-Libanês, São Paulo, SP, Brasil
| | - T Guimaraes
- Departamento de Hepatologia e Transplante Hepático, Hospital Sírio-Libanês, São Paulo, SP, Brasil
| | - M Kondo
- Departamento de Hepatologia e Transplante Hepático, Hospital Sírio-Libanês, São Paulo, SP, Brasil
| | - P Chapchap
- Departamento de Hepatologia e Transplante Hepático, Hospital Sírio-Libanês, São Paulo, SP, Brasil
| | - J Seda Neto
- Departamento de Hepatologia e Transplante Hepático, Hospital Sírio-Libanês, São Paulo, SP, Brasil
| |
Collapse
|
25
|
Feier FH, Neto JS, Porta G, Fonseca EA, Vincenzi R, Cândido HL, Benavides M, Ketzer B, Pugliese R, Miura IK, Baggio V, Guimarães T, Porta A, Foronda G, Donizete E, da Silva JP, Faria L, Kondo M, Chapchap P. Liver transplantation after stage II palliation for hypoplastic left heart syndrome. Liver Transpl 2013; 19:322-7. [PMID: 23239564 DOI: 10.1002/lt.23593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 11/25/2012] [Indexed: 01/12/2023]
Abstract
The association of biliary atresia (BA) with congenital heart diseases has been extensively described, and there are a number of reports on the outcomes of patients in this group who undergo liver transplantation (LT). The intraoperative management and the timing of LT for patients with end-stage liver disease are matters of debate, especially when complex heart diseases are involved. This report describes the outcome after LT for a pediatric recipient with BA and hypoplastic left heart syndrome. The patient underwent Norwood-Sano and Glenn procedures for heart palliation before LT. He was cyanotic, was severely malnourished, and had complications secondary to chronic liver failure. At the time of transplantation, the child was 16 months old and weighed 5175 g. Despite the critical clinical scenario and the long hospitalization period, there were no cardiac, vascular, or biliary complications after LT. At the age of 48 months, the patient was awaiting the final cardiac repair. In conclusion, the presence of complex cardiac malformations may not be a contraindication to LT. An experienced surgical team and a multidisciplinary approach are key to a successful outcome.
Collapse
Affiliation(s)
- Flavia H Feier
- Hepatology and Liver Transplantation Unit, Sírio-Libanês Hospital, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Neto JS, Pugliese R, Fonseca EA, Vincenzi R, Pugliese V, Candido H, Stein AB, Benavides M, Ketzer B, Teng H, Porta G, Miura IK, Baggio V, Guimaraes T, Porta A, Rodrigues CA, Carnevale FC, Carone E, Kondo M, Chapchap P. Four hundred thirty consecutive pediatric living donor liver transplants: variables associated with posttransplant patient and graft survival. Liver Transpl 2012; 18:577-84. [PMID: 22271646 DOI: 10.1002/lt.23393] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The availability of living donors allows transplant teams to indicate living donor liver transplantation (LDLT) early in the course of liver disease before the occurrence of life-threatening complications. Late referral to transplant centers is still a problem and can compromise the success of the procedure. The aim of this study was to examine the perioperative factors associated with patient and graft survival for 430 consecutive pediatric LDLT procedures at Sirio-Libanes Hospital/A. C. Camargo Hospital (São Paulo, Brazil) between October 1995 and April 2011. The studied pretransplant variables included the following: recipient age and body weight, Pediatric End-Stage Liver Disease score, z score for height/age, bilirubin, albumin, international normalized ratio, hemoglobin, sodium, presence of ascites, and previous surgery. The analyzed technical aspects included the graft-to-recipient weight ratio and the use of vascular grafts for portal vein reconstruction. In addition, the occurrence of hepatic artery thrombosis (HAT), portal vein thrombosis (PVT), and biliary complications was also analyzed. The liver grafts included 348 left lateral segments, 5 monosegments, 51 left lobes, and 9 right lobes. In a univariate analysis, an age < 12 months, a low body weight (≤10 kg), malnutrition, hyperbilirubinemia, and HAT were associated with decreased patient and graft survival after LDLT. In a multivariate analysis, a body weight ≤ 10 kg and HAT were significantly associated with decreased patient and graft survival. The use of vascular grafts significantly increased the occurrence of PVT. In conclusion, a low body weight (≤10 kg) and the occurrence of HAT independently determined worse patient and graft survival in this large cohort of pediatric LDLT patients.
Collapse
Affiliation(s)
- Joao Seda Neto
- Sirio-Libanes Hospital/A. C. Camargo Hospital, São Paulo, Brazil.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Vincenzi R, Neto JS, Fonseca EA, Pugliese V, Leite KRM, Benavides MR, Cândido HL, Porta G, Miura IK, Pugliese R, Danesi VB, Guimarães TC, Porta A, Kondo M, Carone E, Chapchap P. Schistosoma mansoni infection in the liver graft: The impact on donor and recipient outcomes after transplantation. Liver Transpl 2011; 17:1299-303. [PMID: 21504049 DOI: 10.1002/lt.22316] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The increasing number of transplants performed each year has led to the identification of unusual diseases in liver grafts from asymptomatic donors that were unrecognized before liver transplantation. Here we report our experience with patients who received liver grafts infected with schistosomiasis. From September 1991 to August 2010, 482 pediatric liver transplants were performed at A. C. Camargo Hospital/Sírio-Libanês Hospital (São Paulo, Brazil). For the identification of Schistosoma mansoni infections, pathology slides for the recipients were reviewed; these included postreperfusion and follow-up liver biopsy samples. We were able to identify 6 cases of schistosomiasis transmitted through infected grafts (5 of these grafts were from living donors). All living donors were confirmed to have normal liver chemistries, negative fecal tests for parasitic diseases, and normal abdominal ultrasound findings. Liver biopsy was not performed before transplantation. In all cases, features of schistosomiasis were absent in the liver explants. The living donors were treated with praziquantel and were taught to avoid risk factors for reinfection. No specific treatment for schistosomiasis was given to the recipients. There were no perioperative deaths, but 2 recipients died after living donor liver transplantation (LDLT) because of Kaposi's sarcoma and non-Hodgkin's lymphoma. In conclusion, using liver grafts infected with S. mansoni eggs did not compromise the results of LDLT in this pediatric cohort. Because of the parasite's life cycle and the therapeutic target of praziquantel, only donors should be treated for the infection. Three years of follow-up showed an uneventful recovery for the living donors.
Collapse
Affiliation(s)
- Rodrigo Vincenzi
- Department of Hepatology and Liver Transplantation, AC Camargo Hospital/Sírio-Libanês Hospital, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Neto JS, Carone E, Pugliese RPS, Fonseca EA, Porta G, Miura I, Danesi VB, Guimaraes TC, Godoy AL, Porta A, Vincenzi R, Carnevale F, Kondo M, Chapchap P. Modified pediatric end-stage liver disease scoring system and pediatric liver transplantation in Brazil. Liver Transpl 2010; 16:426-30. [PMID: 20213836 DOI: 10.1002/lt.22000] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Pediatric End-Stage Liver Disease (PELD) scoring system is a formula developed to provide a continuous numerical assessment of the risk of death in order to allocate livers to children in need of transplantation. The PELD scoring system was introduced in Brazil in July 2006. An important change was made in the system: the final number for listing patients less than 12 years old for transplantation was the calculated PELD score multiplied by 3. The consequences of this allocation policy were analyzed in 2 ways in this research: nationally and in the state of São Paulo (SP State). In the analysis of the national data, a comparison of the pre-PELD era (July 2003 to July 2006) and the post-PELD era (August 2006 to April 2009) showed that the total number of pediatric transplants for children under 12 years of age decreased 7%. Regionally, in SP State, there was a 62% increase in the number of deceased donor liver transplantation procedures for the pediatric population after the introduction of the modified PELD system. There was also a 6.1-fold increase in split liver transplantation as well as a statistically significant decrease in the time on the waiting list (P < 0.001). In conclusion, changing the allocation policy in Brazil in order to benefit pediatric patients on the waiting list had different results according to analyses of national and regional data. A significant increase in deceased donor liver transplantation/split liver transplantation and a shorter time on the waiting list were observed in SP State. The modified PELD scoring system is simple and optimizes the utilization of deceased donor liver grafts in centers performing pediatric transplants.
Collapse
Affiliation(s)
- Joao Seda Neto
- Hospital Sirio-Libanes/Hospital A. C. Camargo, São Paulo, SP, Brazil.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Neto JS, Carone E, Pugliese V, Salzedas A, Fonseca EA, Teng H, Porta G, Pugliese R, Miura I, Baggio V, Hayashi M, Beloto M, Guimaraes T, Godoy A, Kondo M, Chapchap P. Living donor liver transplantation for children in Brazil weighing less than 10 kilograms. Liver Transpl 2007; 13:1153-8. [PMID: 17663403 DOI: 10.1002/lt.21206] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Infants with end-stage liver disease represent a treatment challenge. Living donor liver transplantation (LDLT) is the only option for timely liver transplantation in many areas of the world, adding to the technical difficulties of the procedure. Factors that affect morbidity and mortality can now be determined, which opens a new era for improvement. We have accumulated an 11-year experience with LDLT for children weighing<10 kg. From October 1995 to October 2006, a total of 222 LDLT in patients<18 years of age were performed; 129 primary LDLT and 7 retransplants (4 LDLT and 3 deceased donor grafts) were performed in 129 infants weighing<10 kg. Forty-seven patients received grafts with graft-to-recipient weight ratio (GRWR) of >4%. Two patients received monosegmental grafts, and 2 patients underwent delayed abdominal wall closure. Portal vein thrombosis occurred in 5.4% of the patients, hepatic artery thrombosis in 3.1%, and both in 1.5%. Among several variables studied, only the bilirubin level at the time of transplantation was associated with increased risk of death (P=0.009). Grafts with GRWR>4% had no negative effect on patient survival. There were 7 retransplants, and 4 patients received a second parental LDLT. Patient survival rates at 1, 3, and 10 years after transplantation were 88.8%, 84.7%, and 82% for all children, and 87.5%, 84.9%, and 84.9% for infants weighing<10 kg. LDLT has results comparable to other modalities of liver transplantation in infants. Monosegment grafts were rarely required in this series, although they may be necessary in patients with lower body weight.
Collapse
Affiliation(s)
- Joao Seda Neto
- Hospital do Cancer, Hospital Sirio-Libanes, São Paulo, SP, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|