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Afonso RC, Yien RMK, de Siqueira LBDO, Simas NK, Dos Santos Matos AP, Ricci-Júnior E. Promising natural products for the treatment of cutaneous leishmaniasis: A review of in vitro and in vivo studies. Exp Parasitol 2023; 251:108554. [PMID: 37268108 DOI: 10.1016/j.exppara.2023.108554] [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: 01/11/2023] [Revised: 04/04/2023] [Accepted: 05/24/2023] [Indexed: 06/04/2023]
Abstract
Although there are available treatments for cutaneous leishmaniasis (CL), the drugs used are far from ideal, toxic, and costly, in addition to the challenge faced by the development of resistance. Plants have been used as a source of natural compounds with antileishmanial action. However, few have reached the market and become phytomedicines with registration in regulatory agencies. Difficulties related to the extraction, purification, chemical identification, efficacy, safety, and production in sufficient quantity for clinical studies, hinder the emergence of new effective phytomedicines against leishmaniasis. Despite the difficulties reported, the major research centers in the world see that natural products are a trend concerning the treatment of leishmaniasis. The present work consists of a literature review of articles with in vivo studies, covering the period from January 2011 to December 2022, providing an overview of promising natural products for CL treatment. The papers show encouraging antileishmanial action of natural compounds with reduced parasite load and lesion size in animal models, suggesting new strategies for the treatment of the disease. The results reported in this review show advances in using natural products as safe and effective formulations, which can stimulate clinical studies to establish clinical therapy. In conclusion, the information in this review article serves as a preliminary basis for establishing a therapeutic protocol for future clinical trials that can validate the safety and efficacy of natural compounds, providing the development of affordable and safe phytomedicines for the treatment of CL.
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Affiliation(s)
- Rhuane Coutinho Afonso
- Galenic Development Laboratory (LADEG), Department of Drugs and Medicines, Faculty of Pharmacy, Federal University of Rio de Janeiro, RJ, Brazil
| | - Raíssa Mara Kao Yien
- Galenic Development Laboratory (LADEG), Department of Drugs and Medicines, Faculty of Pharmacy, Federal University of Rio de Janeiro, RJ, Brazil; Laboratory of Natural Products and Biological Assays, Department of Natural Products and Food, Faculty of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Naomi Kato Simas
- Laboratory of Natural Products and Biological Assays, Department of Natural Products and Food, Faculty of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Ana Paula Dos Santos Matos
- Galenic Development Laboratory (LADEG), Department of Drugs and Medicines, Faculty of Pharmacy, Federal University of Rio de Janeiro, RJ, Brazil
| | - Eduardo Ricci-Júnior
- Galenic Development Laboratory (LADEG), Department of Drugs and Medicines, Faculty of Pharmacy, Federal University of Rio de Janeiro, RJ, Brazil.
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Salvalaggio PR, Felga GE, Afonso RC, Ferraz-Neto BH. Early allograft dysfunction and liver transplant outcomes: a single center retrospective study. Transplant Proc 2013; 44:2449-51. [PMID: 23026617 DOI: 10.1016/j.transproceed.2012.08.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Early allograft dysfunction (EAD) had been related to poor transplant outcomes during the early years of liver transplantation. We sought to determine the incidence of EAD at our unit and to evaluate its impact on posttransplant outcomes. METHODS This single-center retrospective study included primary deceased donor liver grafts transplanted under the model for end-stage liver disease system. EAD was defined as a peak values of aminotransferase >2000 IU/mL during the first week or an international normalized ratio of ≥1.6 and/or bilirubin ≥10 mg/dL at day 7. The main endpoints were patient and graft survivals. RESULTS Patients with versus without EAD showed similar recipient characteristics. Donors who experienced EAD who comprises 56% of recipients were heavier with larger body mass indices. EAD was an independent risk factor for allograft loss. Most retransplants were performed early due to nonfunction. The primary nonfunction rate among subjects with versus without EAD were 7% and 12% respectively (P < .05). Patient survival among those with EAD was 87.4%, while without EAD it was 90% (P = NS) with graft survivals of 81.4% and 88.7% respectively (P < .05). CONCLUSION Patients with EAD show a significantly higher risk for allograft loss, but with a comparable survival after transplantation. Despite their worse outcomes, it seems that not all of these recipients behave equally.
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Affiliation(s)
- P R Salvalaggio
- Liver Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
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Felga G, Evangelista AS, Salvalaggio PR, Curvelo LA, Della Guardia B, Almeida MD, Afonso RC, Ferraz-Neto BH. Clinical profile and liver explant findings in patients with and without pretransplant downstaging for hepatocellular carcinoma. Transplant Proc 2012; 44:2399-402. [PMID: 23026605 DOI: 10.1016/j.transproceed.2012.07.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Since August 2010, The Brazilian National Transplantation System has allowed performance of liver transplantation (OLT) for patients with hepatocellular carcinoma (HCC) beyond the Milan criteria (MC) who have been successfully treated with preoperative downstaging (DS). Herein we sought to compare the clinical profiles and liver explant findings among patients with versus without preoperative DS. METHODOLOGY Prospective cohort of patients with HCC within and beyond the MC undergoing OLT. Patients were considered for DS if they were beyond the MC without evidence of vascular invasion or extrahepatic disease. Transcatheter arterial chemoembolization was used for DS, which was considered to be successful if the MC were achieved at any moment during the follow-up. RESULTS Between May 2006 and May 2010, we performed 130 OLTs in HCC patients, among whom 10 received preoperative DS. Both groups were comparable for gender, age, viral etiology, serum levels of alpha fetoprotein, and Child-Pugh and Model for End-Stage Liver Disease (MELD) scores (P > .05). The liver explants were within the MC in 80% of patients with preoperative DS and 90% of those without preoperative DS. They were comparable for the number of HCC nodules, total tumor size, histologic grade, and presence of microvascular invasion. Patients with pretransplant DS showed larger HCC nodules (33.3 ± 9.65 vs 26.3 ± 9.62 mm; P .029) and more frequent macrovascular invasion (1 vs 1 patient, P = .024). CONCLUSION Preoperative DS for unresectable HCC may provide a curative treatment for patients who would otherwise be candidates for palliative therapy only. The baseline characteristics and liver explant findings were similar in both groups. We have yet to determine whether the differences observed regarding the size of the largest nodule and the higher frequency of macrovascular invasion have an impact on outcome.
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Affiliation(s)
- G Felga
- Abdominal Organ Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Salvalaggio PR, Afonso RC, Pereira LA, Ferraz-Neto BH. Testing liver allocation in São Paulo, Brazil: the relationship of model for end-stage liver disease implementation with a reduction in waiting-list mortality. Transplant Proc 2012; 44:2283-5. [PMID: 23026574 DOI: 10.1016/j.transproceed.2012.07.045] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In 2006, the model for end-stage liver disease (MELD) was launched as a new liver allocation system in Sao Paulo, Brazil. We designed this study to assess the results of the new allocation policy on waiting list mortality. METHODS We reviewed the state of Sao Paulo liver transplant database from July 2003 through July 2009. Patients were divided in those who were transplanted before (pre-MELD group) and those who were transplanted after (post-MELD group) the implementation of the MELD system. Included were adult liver transplant candidates. Waiting list mortality was the primary endpoint. RESULTS The unadjusted death rate in patients on the waiting list decreased significantly after the implementation of the MELD system (from 91.2 to 33.5/1000 patients/year, P < .0001). Multivariate analysis has shown a significant drop of the risk of waiting list death for post-MELD patients (odds ration 0.34, P < .0001). CONCLUSION There was a reduction in waiting time and list mortality after the implementation of the MELD system in Brazil. Patients listed in the post-MELD era had a significant reduction of death risk on the waiting list. Future studies should assess posttransplant outcomes.
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Affiliation(s)
- P R Salvalaggio
- Liver Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
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Salvalaggio PR, Afonso RC, Pereira LA, Ferraz-Neto BH. Increasing the donor pool reduces the severity of liver disease: lessons learned from São Paulo, Brazil. Transplant Proc 2012; 44:2286-8. [PMID: 23026575 DOI: 10.1016/j.transproceed.2012.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION A new liver allocation system driven by the model for end-stage liver disease (MELD) score was implemented in Brazil in 2006. In association with the new allocation policy, there was a concomitant expansion of the number of donors. We designed this study to assess whether a potential expansion of the donor pool with these educational campaigns had reduced the severity of liver disease at transplantation. METHODS We retrospectively reviewed the state of São Paulo liver transplant database from July 2003 through July 2009. Patients were divided into groups: those who were transplanted before (pre-MELD group) and those who were transplanted after (post-MELD group) the implementation of the MELD system. The number of transplantations and the severity of liver disease were the endpoints of the study. RESULTS There has been a significant shift towards an older donor population, mainly those who are dying of cerebrovascular accidents. The average MELD score has changed over time. Approximately one quarter of the patients have been transplanted with a MELD score of more than 30 in the post-MELD era. However, this number has decreased over the past 3 years (P = .012). Currently, it has been possible to transplant patients with a MELD score from 25 to 30. The number of transplantations due to hepatocarcinoma (HCC) has increased 8-fold. CONCLUSION An aggressive educational campaign has successfully expanded the donor pool with a concomitant yearly reduction of the average MELD score at the time of transplantation. Patients with HCC have been benefited tremendously with the new allocation system.
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Affiliation(s)
- P R Salvalaggio
- Liver Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
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Werneck M, Afonso RC, Coelho GR, Sboarini C, Coelho MPV, Thomé T, Lisboa LF, Ferraz Neto BH. Obese and nonobese recipients had similar need for ventilatory support after liver transplantation. Transplant Proc 2011; 43:165-9. [PMID: 21335178 DOI: 10.1016/j.transproceed.2010.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Obesity is a risk factor for patients undergoing major surgery. In liver transplantation, the morbidity and mortality in these patients may be higher owing to concomitant diseases that may prolong hospital stay. Moreover, the restrictive respiratory pattern in these patients, associated with pulmonary complications related to liver disease can impact the postoperative recovery. We sought to analyze the impact of high body mass index (BMI) on hospital and intensive care unit (ICU) stay, necessity and length of use either invasive and noninvasive ventilatory support in the early postoperative period after liver transplantation. PATIENTS AND METHODS Between January 2007 and March 2009, we performed 85 liver transplantations in adult patients. BMI was calculated on the day of the transplantation. Data from 136 recipients undergoing OLT were reviewed by age, gender, etiology of liver disease, Model for End-Stage Liver Disease score, Child-Pugh class, cold and warm ischemic times, ICU stay, duration of invasive mechanical, and use of noninvasive ventilation (NIV). We divided the patients into 3 groups: Group 1, (normal weight BMI 18.5-24.99), versus group 2 overweight--BMI 25-29.99; versus group 3, obese--BMI ≥30. RESULTS Groups 1, 2, and 3 had similar lengths of stay in the ICU, necessity of NIV as well as 6 month, 1- and 2-year survivals (P > .05). CONCLUSION High BMI patients showed similar results to normal or overweight patients. Obesity should not be contraindication to liver transplantation.
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Affiliation(s)
- M Werneck
- Programa Integrado de Transplante, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Andreoli MCC, Coelho MPV, Matos ACC, Rangel ÉB, Souza NKG, Góes MÂ, Ammirati AL, Matsui TN, Iizuca IJ, Carneiro FD, Ramos ACMS, Souza MA, Afonso RC, Ferraz-Neto B, Durão MS, Batista MC, Monte JCM, Pereira VG, Santos OFP, Santos BC. Previous renal support is a predictor for chronic renal replacement therapy after orthotopic liver transplantation. Crit Care 2011. [PMCID: PMC3124182 DOI: 10.1186/cc10180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Afonso RC, Hidalgo R, Zurstrassen MPVC, Fonseca LEP, Pandullo FL, Rezende MB, Meira-Filho SP, Ferraz-Neto BH. Impact of renal failure on liver transplantation survival. Transplant Proc 2008; 40:808-10. [PMID: 18455024 DOI: 10.1016/j.transproceed.2008.02.062] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Renal failure after orthotopic liver transplantation (OLT) is a common complication (ranging from 12% to 70%) associated with worse outcomes, particularly when it requires renal replacement therapy (RRT). Renal dysfunction is a common scenario among waiting list patients. It can lead to a worse prognosis after OLT, due to an increased incidence of postoperative renal failure. The aim of this study was to analyze the incidence of renal failure after OLT, its relationship to pretransplant renal dysfunction, and its impact on outcomes. We analyzed data collected prospectively from 152 consecutive OLTs in 139 patients performed by the same team from March 2003 to November 2007. Exclusion criteria for 34 cases included transplantation due to acute liver failure, combined liver-kidney transplantation, retransplantation, and patients who died up to 2 days posttransplantation. Based on creatinine clearance (CCr) calculated at the time of OLT, the 118 patients were classified in two groups: group I, normal pre-OLT renal function (CCr > or = 70 mL/min) versus group II, pre-OLT renal failure (CCr < 70 mL/min). Each group was analyzed according to the development of post-OLT renal failure, being classified as subgroup A (normal renal function post-OLT), subgroup B (mild renal impairment post-OLT-serum creatinine level between 2.0 and 3.0 mg/dL or doubled basal value up to 3.0 mg/dL) versus subgroup C (severe renal impairment post-OLT-serum creatinine level > or = 3.0 mg/dL or utilization of RRT). The overall incidence of post-OLT renal impairment was 41.52% with RRT in 22 patients (18.64%). Group II patients showed a greater incidence of post-OLT renal failure when compared with other patients (P < .05), but without a statistical difference when compared according to RRT requirement. Comparison of average hospital stay was similar between groups I and II, and also among its subgroups (A, B, and C, respectively). There was no statistical difference in early (30-day) and 1-year survival rates between groups I and II. Comparing all subgroups for early and 1-year survival, we observed that patients who developed severe renal failure post-OLT (subgroups I-C and II-C) showed worse outcomes compared with other patients (subgroups I-A, I-B, II-A, and II-B), respectively 95.29% versus 69.69% and 86.95% versus 41.66% for early and 1-year survivals (P < .001). In conclusion, our findings suggested that patients who developed severe renal failure post-OLT, independent of pretransplant renal function, showed worse outcomes.
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Affiliation(s)
- R C Afonso
- Liver Transplantation Unit, Albert Einstein Jewish Hospital, São Paulo, Brazil
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9
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Ferraz-Neto BH, Moraes-Junior JMA, Hidalgo R, Zurstrassen MPVC, Lima IK, Novais HS, Rezende MB, Meira-Filho SP, Afonso RC. Total hepatectomy and liver transplantation as a two-stage procedure for toxic liver: case reports. Transplant Proc 2008; 40:814-6. [PMID: 18455026 DOI: 10.1016/j.transproceed.2008.02.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Total hepatectomy with temporary portocaval shunt was employed as a bridging procedure before liver transplantation, in the setting of fulminant hepatic failure with "toxic liver syndrome"; acute, severe, and extensive liver necrosis associated with cardiovascular shock and acute renal failure with or without respiratory failure. This procedure sought to improve metabolic acidosis and hemodynamic instability related to advanced liver necrosis. The aim of this study was to report our experience with three patients who underwent total hepatectomy and protocaval shunt, followed by liver transplantation (two-stage procedure).
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Affiliation(s)
- B H Ferraz-Neto
- Liver Transplantation Unit, Albert Einstein Jewish Hospital, São Paulo, Brazil.
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Ferraz-Neto BH, Zurstrassen MPVC, Hidalgo R, Meira-Filho SP, Rezende MB, Paes AT, Afonso RC. Analysis of liver transplantation outcome in patients with MELD Score > or = 30. Transplant Proc 2008; 40:797-9. [PMID: 18455020 DOI: 10.1016/j.transproceed.2008.03.016] [Citation(s) in RCA: 32] [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] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Since July 2006, the liver graft allocation has been changed from the waiting time to the Model for End-stage Liver Disease (MELD), prioritizing the sickest patients, who have a higher risk of dying on the waiting list, and sometimes in such poor clinical condition that it compromises transplantation outcomes. The aim of this study was to analyze the impact of a MELD score > or = 30 on 30-day survival after liver transplantation (OLT). We prospectively collected the data on 178 liver transplants on 163 patients performed from March 2003 to August 2007. The subjects were divided in two groups according to their MELD scores: group 1, MELD > or = 30 (n = 15) and group 2, MELD < 30 (n = 96). The groups were compared with regard to hospital and intensive care unit (ICU) length of stay, intraoperative blood products transfusion, early survival (30 days), and need for retransplantation. We excluded, patients with prioritization criteria, those receiving extra points for any special situation, and six other patients without significant data for MELD calculation (of whom only one has died after transplantation). Patients under a "special situation" were those with hepatocelular carcinoma, hepatopulmonary syndrome, and metabolic diseases, who initially received a MELD/PELD score 20, and 24, and 29. The mean MELD score at group I was 34 (range, 30 to 42), and for group II it was 16 (range, 6 to 29). Group I displayed a mean hospital length of stay of 24 days (4 to 155), with 12.60 days (ranges, 1 to 103) in the ICU versus 15.55 (range, 1 to 48) and 5.13 (range, 1 to 45) days, respectively, for group II. The need for blood component transfusions were greater in group I; 25.28% of patients in group II did not receive any transfusion during the entire inpatient period. There were nine retransplants in group II, and none in group I. The 30-day survivals were 93.3% for group I and 84.37% for group II. Besides the increased complexity of these sickest patients, there was no negative impact on early survival rates.
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Affiliation(s)
- B H Ferraz-Neto
- Liver Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
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Della-Guardia B, Almeida MD, Meira-Filho SP, Torres MA, Venco F, Afonso RC, Ferraz-Neto BH. Antibody-mediated rejection: hyperacute rejection reality in liver transplantation? A case report. Transplant Proc 2008; 40:870-1. [PMID: 18455039 DOI: 10.1016/j.transproceed.2008.02.061] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hyperacute rejection is rare among ABO-compatible liver transplantations. The mechanism is donor preformed antibodies causing graft loss within a few days. Herein, we have described a case of an ABO-compatible liver transplantation that underwent hyperacute rejection, needing retransplantation for treatment. A 27-year-old man of blood group A positive who displayed fulminant hepatic failure due to hepatitis B (in agreement with the O'Grady criteria), received an ABO-compatible graft. He developed significant asthenia, fever, hypotension, oliguria, and coagulopathy. Ultrasonography revealed total thrombosis of the portal vein and absence of dilatation of bile ducts. The patient was priorized for retransplantation and underwent a good subsequent evolution. On anatomopathologic exam the explant revealed thrombosis of the intrahepatic branches of the portal vein with venous and ischemic infarcts compatible with a diagnosis of hyperacute rejection. The clinical findings of hyperacute rejection were characterized by progressive elevation of bilirubin and thrombocytopenia associated with signs of hepatic failure during the first days after transplantation. In this case, the histological exam was compatible with hyperacute rejection, excluding the diagnoses of hepatic artery thrombosis or biliary obstruction, despite the negative test for anti-HLA antibodies. The diagnosis of hyperacute rejection could be made associated with a short ischemic time and a good response after retransplantation.
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Affiliation(s)
- B Della-Guardia
- Liver Transplantation Unit, Albert Einstein Jewish Hospital, São Paulo, Brazil
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Ferraz-Neto BH, Zurstrassen MPVC, Hidalgo R, Fonseca LEP, Motta TDB, Pandullo FL, Rezende MB, Meira-Filho SP, Sá JR, Afonso RC. Donor liver dysfunction: application of a new scoring system to identify the marginal donor. Transplant Proc 2007; 39:2516-8. [PMID: 17954162 DOI: 10.1016/j.transproceed.2007.07.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Livers from marginal donors are increasingly used for transplantation due to the shortage of donor organs. The definition of a marginal donor remains unclear; prediction of organ function is a challenge. In the literature the use of steatotic livers has been associated with poor liver function or even primary dysfunction of the allograft. Tekin et al created a scoring system that classifies a donor as marginal or nonmarginal, using a mathematical model based on donor age and steatosis degree. The aims of this study were to apply the Tekin method to identify marginal and nonmarginal donors and evaluate the influence of the cold ischemia time (CIT) on allograft evolution. We retrospectively reviewed deceased donor liver transplantations performed from October 1995 to March 2006, namely, 177 adult liver transplantations in 163 patients. Fifty-five were excluded due to retransplantation (14) or insufficient data (41). Donor age and macrovesicular steatosis were evaluated according to the mathematical formula proposed by Tekin et al, classifying the donors as marginal versus nonmarginal. The authors also analyzed the CIT, 3-month mortality, and development of primary nonfunction or primary dysfunction. The median donor age was 38.9 years (range, 6-71). The postreperfusion biopsy specimen showed moderate to intense steatosis (>30%) in 14.75% of specimens, with no steatosis or mild steatosis in 85.25%. Sixty-one grafts (50%) developed primary graft dysfunction (PGD): 10 grafts, with primary nonfunction (PNF); and 51 with initial poor function (IPF). Using the criteria provided by Tekin et al, we obtained 41 marginal and 81 nonmarginal allografts. The marginal group showed 61.9% PGD, compared with 59.2% of PGD by the nonmarginal group. The CIT was greater than 12 hours in 5 marginal group transplants and 4 PGD cases (80%). Of the nonmarginal allografts, the CIT was greater than 12 hours in 29.6%, with 75% PGD. The 3-month graft survival rate was 80% in the marginal group with ischemia time more than 12 hours: 86.1% of the same group when CIT was less than 12 hours, and 82.7% in the nonmarginal group. In contrast, when we analyzed the occurrence of allograft dysfunction, the 3-month mortality rate was 34% among, grafts with dysfunction, whereas, in those without initial dysfunction, it was 4.1%. In conclusion, the score suggested by Tekin et al that classifies the donors as ideal (nonmarginal) or marginal was not able to predict initial primary dysfunction.
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Affiliation(s)
- B H Ferraz-Neto
- Albert Einstein Jewish Hospital, Av. Albert Einstein 627/701, 05652-900 São Paulo/SP, Brazil.
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Ferraz-Neto BH, Zurstrassen MPVC, Hidalgo R, Rezende MB, Meira-Filho SP, Pandullo FL, Fonseca LEP, Pereira LA, Afonso RC. Results of urgent liver retransplantation in the state of São Paulo, Brazil. Transplant Proc 2006; 38:1911-2. [PMID: 16908320 DOI: 10.1016/j.transproceed.2006.06.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The treatment of end-stage liver disease includes transplantation as a life-saving procedure although it has serious complications of hepatic artery thrombosis, liver dysfunction, or primary nonfunction, which frequently lead to the need for retransplantation. According to various reports, the incidence of retransplantation is around 10%. Given the critical organ shortage, the chance for a second transplant remains a controversial discussion in medical, ethical, and economic grounds because patient and graft survival rates after retransplantation are lower than those for primary transplantations. We retrospectively reviewed all of the urgent liver retransplants from October 2001 to February 2005 (52 months) by analyzing the number of retransplants, blood group, time between first and second liver transplantation, age, sex, and mortality. Data were obtained from the Transplantation System, State of Sao Paulo Health Secretariat. Among 1252 liver transplants performed during this period, 98 (7.82%) were urgent retransplantations. The primary procedure employed 955 (76.28%) deceased donors and 297 (23.72%) living donors. All 98 retransplants were performed using an organ from the pool of deceased donors. The retransplant rate was acceptable according to the literature, although we observed high rates of early mortality (<60 days), leading to a discussion of which patients had a better chance of survival and the best time to perform the second transplantation to use this scarce and precious resource in the best possible way.
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Affiliation(s)
- B H Ferraz-Neto
- Liver Transplant Team, Figado-HIAE, Albert Einstein Hospital, Av. Albert Einstein 627-701, CEP 05652-900 São Paulo, SP, Brazil.
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14
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Afonso RC, Saad WA, Parra OM, Leitão R, Ferraz-Neto BH. Impact of steatotic grafts on initial function and prognosis after liver transplantation. Transplant Proc 2005; 36:909-11. [PMID: 15194312 DOI: 10.1016/j.transproceed.2004.03.099] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Steatotic grafts are considered a risk factor for dysfunction or even primary nonfunction of liver transplants; grafts with more than 50% fatty infiltration are routinely discarded. This retrospective study evaluated the impact of macrovesicular and microvesicular steatosis on postoperative initial liver function and prognosis by comparing outcomes to nonsteatotic grafts in 48 liver transplantation patients. Fifteen grafts had macrovesicular steatosis, 13 (27.09%) up to 50% fatty infiltration (MG2), and 2 (4.16%) more than 50% (MG3). Thirty-three (69.75%) grafts had no macrovesicular steatosis (MG1). Initial liver function was adequate in 26 (78.78%), 10 (76.93), and 2 (100%) patients, respectively, in subgroups MG1, MG2, and MG3 (P =.892). Thirty-day survival rates were 90.90%, 100%, and 100%, respectively, in subgroups MG1, MG2, and MG3 (P =.606). Twenty-six grafts showed microvesicular steatosis: 18 (37.50%) showed less than 50% fatty infiltration (mG2), and 8 (16.67%) more than 50% (mG3). Twenty-two (45.83%) grafts had no microvesicular steatosis (mG1). Initial liver function was adequate in 16 (72.72%), 16 (88.88%), and 6 (75%) patients, respectively, in subgroups mG1, mG2, and mG3 (P =.547). Thirty-day survival rates were 90.90%, 100%, and 87.5% respectively, in subgroups mG1, mG2, and mG3 (P =.380). In conclusion, macrovesicular and microvesicular steatotic liver grafts displayed adequate initial function, did not compromise survival, and thus should not be routinely discarded.
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Affiliation(s)
- R C Afonso
- Oswaldo Cruz German Hospital, Sao Paulo, Brazil
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Abstract
OBJECTIVE A case of intrahepatic portal vein aneurysm in the late postoperative period after liver transplantation, as well its complications, is reported. CASE REPORT A 59-year-old man underwent orthotopic liver transplantation in 1996 for treatment of hepatitis C virus cirrhosis. The patient received a graft from a 10-year-old child. During the follow-up from 1996 to 1998, the patient did not show any alterations. In 1999, during an annual routine exam, a portal vein aneurysm was identified; however, it had no impact on graft function. In November 2002, the patient developed jaundice and serious graft dysfunction requiring hospital admission. Helicoidal CT scan showed an intrahepatic image compatible with a portal vein aneurysm without biliary tract dilatation. During the same hospitalization, he developed upper gastrointestinal bleeding due to variceal rupture as well as kidney and liver failure, and expired on December 31, 2002. The necropsy demonstrated an intrahepatic portal vein aneurysm with portal vein thrombosis and chronic liver disease. The evolution in this case suggests that if there is an intrahepatic portal vein aneurysm after liver transplantation, the patient is likely to experience an eventual recurrence of portal hypertension; retransplant may be an alternative.
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Affiliation(s)
- B H Ferraz-Neto
- Department of Surgery, Medical Sciences School, Center of Medical and Biological Sciences-Pontifical University Catholic of São Paulo, Sorocaba SP, Brazil.
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16
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Abstract
OBJECTIVE To evaluate the knowledge and the opinion of medical students at the Pontifical Catholic University of São Paulo related to the general aspects of donation, organ and tissue procurement, and basic concepts of brain death (BD). MATERIALS AND METHODS Questionnaires of 24 items were distributed among all students related to the concept and diagnosis of BD, personal aspects of tissue and organ donation, and general question concerning organ donation. The answers classified students as good versus bad experts of the concept and the diagnosis of BD. RESULTS Of a total of 580 students, 361 (62.24%) answered the questionnaire. Although the concept of BD was known to 70%, only 35% had a good knowledge of the diagnosis. One percent of the students were opposed to the organ donation and 76% of them were donors. Approximately 90% would authorize organ retrieval from their family members but 27% had never discussed organ donation with their families. Most students were interested in the general aspects of donation and organ procurement (88.36%). CONCLUSION The majority of the students know the concept of BD. General aspects regarding tissue and organ donation and diagnosis of BD might be improved with the continued education on the subject.
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Affiliation(s)
- R C Afonso
- Department of Surgery, São Paulo Pontifical Catholic University, Sao Paulo, Brazil
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Ferraz-Neto BH, Afonso RC, Leitão R, Macedo CPF, Parra OM, Goehler F, Silva ED. Liver transplantation using "refused grafts": analysis of initial function and survival. Transplant Proc 2002; 34:521-2. [PMID: 12009611 DOI: 10.1016/s0041-1345(02)02616-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Ben-Hur Ferraz-Neto
- Unifigado, Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1856 Conj. 31, São Paulo/SP, CEP 01327-020, Brazil
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De Felice FG, Houzel JC, Garcia-Abreu J, Louzada PR, Afonso RC, Meirelles MN, Lent R, Neto VM, Ferreira ST. Inhibition of Alzheimer's disease beta-amyloid aggregation, neurotoxicity, and in vivo deposition by nitrophenols: implications for Alzheimer's therapy. FASEB J 2001; 15:1297-9. [PMID: 11344119 DOI: 10.1096/fj.00-0676fje] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- F G De Felice
- Departamento de Bioquímica Médica, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ 21944-590, Brazil
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Ferraz-Neto BH, Silva ED, Afonso RC, Gregory FH, Goehler F, Meira-Filho SP, Macedo CP, Leitao RM, Parra OM, Saad WA. Early extubation in liver transplantation. Transplant Proc 1999; 31:3067-8. [PMID: 10578398 DOI: 10.1016/s0041-1345(99)00675-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Ferraz-Neto BH, Silva ED, Afonso RC, Gregory FH, Meira-Filho SP, Macedo CP, Parra OM, Leitão RM, Saad WA. Acute normovolemic intraoperative hemodilution in liver transplantation. Transplant Proc 1999; 31:3069-70. [PMID: 10578399 DOI: 10.1016/s0041-1345(99)00676-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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