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Mucenic M, Bandeira de Mello Brandao A, Marroni CA, Medeiros Fleck A, Zanotelli ML, Kiss G, Meine MH, Leipnitz I, Soares Schlindwein E, Martini J, Costabeber AM, Sacco FKF, Cracco Cantisani GP. Daclatasvir and Sofosbuvir With or Without Ribavirin in Liver Transplant Recipients: A Single-Center Real-World Study. Transplant Proc 2018; 50:769-771. [PMID: 29661434 DOI: 10.1016/j.transproceed.2018.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Treatment with direct-acting antiviral drugs in interferon-free regimens is currently recommended for viral hepatitis C recurrence after liver transplantation. There are limited data regarding its results in this population, and no optimal treatment scheme has yet been singled out. METHODS We report our real-world results in liver transplant (LT) recipients. All patients were hepatitis C virus (HCV) monoinfected and completed a 12-week treatment course, followed 12 weeks later by HCV polymerase chain reaction testing with 12 IU/mL sensibility. Liver fibrosis was graded with the use of biopsies taken <12 months before treatment and stratified as early (0-1) or moderate to advanced (2-4) according to the Metavir score. RESULTS Median postoperative time was 5.2 years. Genotype 3 was found in 66.7% of the sample. The following regimens were prescribed: daclatasvir-sofosbuvir with (n = 11) or without (n = 28) ribavirin. Genotypes 1 and 3 were evenly distributed between the regimens. Sustained virologic response (SVR) was obtained in 24 out of 28 patients (85.7%) who received daclatasvir-sofosbuvir and in all patients (100%) who received daclatasvir-sofosbuvir-ribavirin (global SVR 89.7%). All patients that failed treatment had genotype 3 HCV. Fibrosis was evaluated in 79.5% of the sample: 48.4% had early and 51.6% had moderate to advanced fibrosis, for which ribavirin was more commonly prescribed (P = .001). CONCLUSIONS The SVR rate in our LT recipients was similar to that previously reported in the literature. The addition of ribavirin to DAA treatment appears to be justified in this population.
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Affiliation(s)
- M Mucenic
- Liver Transplantation Group, Irmandade Santa Casa de Misericórdia, Porto Alegre, Brazil.
| | | | - C A Marroni
- Liver Transplantation Group, Irmandade Santa Casa de Misericórdia, Porto Alegre, Brazil
| | - A Medeiros Fleck
- Liver Transplantation Group, Irmandade Santa Casa de Misericórdia, Porto Alegre, Brazil
| | - M L Zanotelli
- Liver Transplantation Group, Irmandade Santa Casa de Misericórdia, Porto Alegre, Brazil
| | - G Kiss
- Liver Transplantation Group, Irmandade Santa Casa de Misericórdia, Porto Alegre, Brazil
| | - M H Meine
- Liver Transplantation Group, Irmandade Santa Casa de Misericórdia, Porto Alegre, Brazil
| | - I Leipnitz
- Liver Transplantation Group, Irmandade Santa Casa de Misericórdia, Porto Alegre, Brazil
| | - E Soares Schlindwein
- Liver Transplantation Group, Irmandade Santa Casa de Misericórdia, Porto Alegre, Brazil
| | - J Martini
- Liver Transplantation Group, Irmandade Santa Casa de Misericórdia, Porto Alegre, Brazil
| | - A M Costabeber
- Liver Transplantation Group, Irmandade Santa Casa de Misericórdia, Porto Alegre, Brazil
| | - F K F Sacco
- Liver Transplantation Group, Irmandade Santa Casa de Misericórdia, Porto Alegre, Brazil
| | - G P Cracco Cantisani
- Liver Transplantation Group, Irmandade Santa Casa de Misericórdia, Porto Alegre, Brazil
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de Oliveira JTP, Kieling CO, da Silva AB, Stefani J, Witkowski MC, Smidt CR, Mariano da Rocha CR, Hirakata VN, Grossini MDG, Zanotelli ML, Gonçalves Vieira SM. Variability index of tacrolimus serum levels in pediatric liver transplant recipients younger than 12 years: Non-adherence or risk of non-adherence? Pediatr Transplant 2017; 21. [PMID: 29034612 DOI: 10.1111/petr.13058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 08/08/2017] [Indexed: 12/29/2022]
Abstract
MLVI has been used to assess adherence. To determine the MLVI in children <12 years of age at transplantation and to identify demographic correlates and consequences for the graft. This is a retrospective study of 50 outpatients (4.0 ± 3.5 years), at least 13-month post-liver transplantation. The outcomes evaluated were MLVI, ALT > 60 IU/L, ACR, death, and graft loss. We analyzed demographic and socioeconomic characteristics, indication for transplantation, and type of donor. Student's t test and the chi-square test were used. Statistical significance was set at P ≤ .05. Seventy-two percent were infants or preschoolers, 62% biliary atresia. Seventy-four percent of the mothers had middle-school education, and 54% of the families had an income ≤3632.4 US$/y. Twenty-two (44%) patients had a MLVI ≥ 2 SD; this was more prevalent in families with higher incomes (P = .045). ALT levels > 60 IU/L were more common in MLVI ≥ 2 SD group (P = .035). ACR episodes were similar between groups (P = 1.000). No patient died or lost the graft. MLVI ≥ 2 SD may be an indicator of the risk of medication non-adherence.
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Affiliation(s)
- Janete Teresinha Pires de Oliveira
- Postgraduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Pediatric Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Anaís Back da Silva
- Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Joel Stefani
- Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Carolina Witkowski
- Postgraduate Program in Child and Adolescent Health, Pediatric Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Camila Ribas Smidt
- Postgraduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Vania Naomi Hirakata
- Postgraduate and Research Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Maria Lúcia Zanotelli
- Surgery Unit, Pediatric Liver Transplantation Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Sandra Maria Gonçalves Vieira
- Department of Pediatrics, Postgraduate Program in Gastroenterology and Hepatology, Pediatric Unit, Pediatric Liver Transplant Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Feier F, Schwartz IVD, Benkert AR, Seda Neto J, Miura I, Chapchap P, da Fonseca EA, Vieira S, Zanotelli ML, Pinto e Vairo F, Camelo JS, Margutti AVB, Mazariegos GV, Puffenberger EG, Strauss KA. Living related versus deceased donor liver transplantation for maple syrup urine disease. Mol Genet Metab 2016; 117:336-43. [PMID: 26786177 DOI: 10.1016/j.ymgme.2016.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 11/29/2015] [Revised: 01/10/2016] [Accepted: 01/10/2016] [Indexed: 01/04/2023]
Abstract
Maple syrup urine disease (MSUD) is an inherited disorder of branched chain ketoacid (BCKA) oxidation associated with episodic and chronic brain disease. Transplantation of liver from an unrelated deceased donor restores 9-13% whole-body BCKA oxidation capacity and stabilizes MSUD. Recent reports document encouraging short-term outcomes for MSUD patients who received a liver segment from mutation heterozygous living related donors (LRDT). To investigate effects of living related versus deceased unrelated grafts, we studied four Brazilian MSUD patients treated with LRDT who were followed for a mean 19 ± 12 postoperative months, and compared metabolic and clinical outcomes to 37 classical MSUD patients treated with deceased donor transplant. Patient and graft survival for LRDT were 100%. Three of 4 MSUD livers were successfully domino transplanted into non-MSUD subjects. Following LRDT, all subjects resumed a protein-unrestricted diet as mean plasma leucine decreased from 224 ± 306 μM to 143 ± 44 μM and allo-isoleucine decreased 91%. We observed no episodes of hyperleucinemia during 80 aggregate postoperative patient-months. Mean plasma leucine:isoleucine:valine concentration ratios were ~2:1:4 after deceased donor transplant compared to ~1:1:1.5 following LRDT, resulting in differences of predicted cerebral amino acid uptake. Mutant heterozygous liver segments effectively maintain steady-state BCAA and BCKA homeostasis on an unrestricted diet and during most catabolic states, but might have different metabolic effects than grafts from unrelated deceased donors. Neither living related nor deceased donor transplant affords complete protection from metabolic intoxication, but both strategies represent viable alternatives to nutritional management.
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Affiliation(s)
- Flavia Feier
- Hospital Sirio Libanes, São Paulo, Brazil; Hospital Santa Casa de Misericórdia, Porto Alegre, Brazil
| | - Ida Vanessa D Schwartz
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Brazil; Genetics Department, Universidade Federal do Rio Grande do Sul, Brazil
| | | | | | | | | | | | - Sandra Vieira
- Pediatrics Department, Universidade Federal do Rio Grande do Sul, Brazil; Pediatrics Liver Transplantation Program, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Maria Lúcia Zanotelli
- Pediatrics Liver Transplantation Program, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Jose Simon Camelo
- Pediatrics Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - George V Mazariegos
- Hillman Center for Pediatric Transplantation, Children's Hospital of UPMC, Pittsburgh, PA, USA
| | - Erik G Puffenberger
- Clinic for Special Children, Strasburg, PA, USA; Franklin & Marshall College, Lancaster, PA, USA
| | - Kevin A Strauss
- Clinic for Special Children, Strasburg, PA, USA; Franklin & Marshall College, Lancaster, PA, USA; Lancaster General Hospital, Lancaster, PA, USA.
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Meine MH, Leipnitz I, Zanotelli ML, Schlindwein ES, Kiss G, Martini J, de Medeiros Fleck A, Mucenic M, de Mello Brandão A, Marroni CA, Craco Cantisani GP. Comparison Between IGL-1 and HTK Preservation Solutions in Deceased Donor Liver Transplantation. Transplant Proc 2016; 47:888-93. [PMID: 26036479 DOI: 10.1016/j.transproceed.2015.03.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The effectiveness of liver preservation solutions remains in evidence. Cold ischemia time, steatosis, expanded criterion donors, operational cost, and survival represent important roles in its success. In a prospective cohort study between August 2009 and April 2014, 178 patients were allocated into an Institut Georges Lopez - 1 (IGL-1) solution group (63.5%) or histidine-tryptophan-ketoglutarate (HTK) group (36.5%). There were no differences among recipient's characteristics including age, skin color, gender, Model for End-stage Liver Disease score, acute rejection, cholestasis, and reperfusion syndrome incidences. Also, donors, age average, skin color, donor risk index, time in intensive care unit, hemodynamic variables, infections, and steatosis incidences were similar. The average cold ischemia time was 494 minutes in the IGL-1 group and 489 minutes in the HTK group (P = .77). Alanine aminotransferase and aspartate aminotransferase serum levels on the first postoperative day were 707 and 1185 mg/dL, respectively, with IGL-1 and 1298 and 2291 mg/dL, respectively, with HTK (P = .016) and similar at day 15 (P > .88). The incidence of delayed graft function was 4.5% with IGL-1 and 4.6% with HTK (P = .90). The incidence primary nonfunction was 2.7% with IGL-1 and 3.1% with HTK (P = .71). The incidence of perioperative death was 11.5% with IGL-1 and 13.8% with HTK (P = .94). The survival in 30 months was 86% in IGL-1 group and 82% in HTK group (P = .66). Both preservation solutions are efficient to liver transplantations with deceased donors. Major prospective trials are necessary to evaluate each preservation solution's particularities. The preservation solution availability in each transplantation center must guide its use at the present moment.
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Affiliation(s)
- M H Meine
- Hepatic Transplant Group, Dom Vicente Scherer Hospital, HDVS, Irmandade Santa Casa de Misericórdia Hospital Complex of Porto Alegre, ISCMPA, Porto Alegre, Brazil.
| | - I Leipnitz
- Hepatic Transplant Group, Dom Vicente Scherer Hospital, HDVS, Irmandade Santa Casa de Misericórdia Hospital Complex of Porto Alegre, ISCMPA, Porto Alegre, Brazil
| | - M L Zanotelli
- Hepatic Transplant Group, Dom Vicente Scherer Hospital, HDVS, Irmandade Santa Casa de Misericórdia Hospital Complex of Porto Alegre, ISCMPA, Porto Alegre, Brazil; Federal University of Rio Grande do Sul, UFRGS, School of Medicine, Porto Alegre, Brazil
| | - E S Schlindwein
- Hepatic Transplant Group, Dom Vicente Scherer Hospital, HDVS, Irmandade Santa Casa de Misericórdia Hospital Complex of Porto Alegre, ISCMPA, Porto Alegre, Brazil
| | - G Kiss
- Hepatic Transplant Group, Dom Vicente Scherer Hospital, HDVS, Irmandade Santa Casa de Misericórdia Hospital Complex of Porto Alegre, ISCMPA, Porto Alegre, Brazil
| | - J Martini
- Hepatic Transplant Group, Dom Vicente Scherer Hospital, HDVS, Irmandade Santa Casa de Misericórdia Hospital Complex of Porto Alegre, ISCMPA, Porto Alegre, Brazil
| | - A de Medeiros Fleck
- Hepatic Transplant Group, Dom Vicente Scherer Hospital, HDVS, Irmandade Santa Casa de Misericórdia Hospital Complex of Porto Alegre, ISCMPA, Porto Alegre, Brazil
| | - M Mucenic
- Hepatic Transplant Group, Dom Vicente Scherer Hospital, HDVS, Irmandade Santa Casa de Misericórdia Hospital Complex of Porto Alegre, ISCMPA, Porto Alegre, Brazil
| | - A de Mello Brandão
- Hepatic Transplant Group, Dom Vicente Scherer Hospital, HDVS, Irmandade Santa Casa de Misericórdia Hospital Complex of Porto Alegre, ISCMPA, Porto Alegre, Brazil; Health Sciences Faculty Foundation of Porto Alegre, FFCMPA, Porto Alegre, Brazil
| | - C A Marroni
- Hepatic Transplant Group, Dom Vicente Scherer Hospital, HDVS, Irmandade Santa Casa de Misericórdia Hospital Complex of Porto Alegre, ISCMPA, Porto Alegre, Brazil; Health Sciences Faculty Foundation of Porto Alegre, FFCMPA, Porto Alegre, Brazil
| | - G P Craco Cantisani
- Hepatic Transplant Group, Dom Vicente Scherer Hospital, HDVS, Irmandade Santa Casa de Misericórdia Hospital Complex of Porto Alegre, ISCMPA, Porto Alegre, Brazil; Federal University of Rio Grande do Sul, UFRGS, School of Medicine, Porto Alegre, Brazil
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Klaus F, Keitel da Silva C, Meinerz G, Carvalho LM, Goldani JC, Cantisani G, Zanotelli ML, Duro Garcia V, Keitel E. Acute kidney injury after liver transplantation: incidence and mortality. Transplant Proc 2015; 46:1819-21. [PMID: 25131045 DOI: 10.1016/j.transproceed.2014.05.053] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Patients undergoing orthotopic liver transplantation often present with acute kidney injury (AKI) in the postoperative period. It has been associated with a greater number of complications and high mortality rates. The goal of this study was to determine the incidence of AKI during the early posttransplant period and mortality in patients undergoing orthotopic liver transplantation in our hospital. PATIENTS AND METHODS In this retrospective cohort study, we reviewed the medical records of all patients aged >18 years undergoing liver transplantation from April 2008 to April 2011. The exclusion criteria were a glomerular filtration rate (estimated by using the Modification of Diet in Renal Disease formula) <60 mL/min/1.73 m(2) or AKI at the time of transplantation. AKI was defined as an increase ≥50% from preoperative baseline serum creatinine levels during the hospitalization period. RESULTS Of 113 selected patients, 78 (69%) were male. The mean age was 54.03 ± 9.38 years. The mean preoperative baseline creatinine level was 0.94 ± 0.15 mg/dL, and the estimated glomerular filtration rate was 87.09 ± 19.67 mL/min/1.73 m(2). The mean calculated Model for End-Stage Liver Disease score was 13. Hepatitis C serology was present in 70.8%, hepatitis B in 11.5%, hepatocellular carcinoma in 75.2%, and alcohol abuse in 31.9% of patients. The incidence of AKI was 56.6% (64 of 113 patients). The main risk factors for AKI were Model for End-Stage Liver Disease score and diuretic use at baseline. Renal replacement therapy (RRT) was performed in 19.5% (22 of 113) of patients. The hospital mortality rate in the group with AKI was 25% (16 of 64 patients) and 6.1% (3 of 49 patients) between patients without AKI (odds ratio, 5.11 [confidence interval, 1.39-18.7]; P < .01]. Among patients who underwent RRT, the in-hospital mortality rate was 54.5% (12 of 22 patients) compared with 7.7% (7 of 91 patients) from the other remaining patient cohort (odds ratio, 14.40 [confidence interval, 4.60-45.00]; P < .01). CONCLUSIONS There was a high incidence of AKI in patients undergoing liver transplantation and an increased risk of mortality among patients who needed RRT.
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Affiliation(s)
- F Klaus
- Postgraduatation Program of Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre, RS, Brazil; Nephrology Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, RS, Brazil.
| | - C Keitel da Silva
- Postgraduatation Program of Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre, RS, Brazil; Nephrology Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, RS, Brazil
| | - G Meinerz
- Postgraduatation Program of Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre, RS, Brazil; Nephrology Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, RS, Brazil
| | - L M Carvalho
- Graduation Medical School, Universidade Federal de Ciências da Saúde de Porto Alegre, RS, Brazil
| | - J C Goldani
- Postgraduatation Program of Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre, RS, Brazil; Nephrology Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, RS, Brazil
| | - G Cantisani
- Graduation in Surgery, Liver Transplantation Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, RS, Brazil
| | - M L Zanotelli
- Graduation in Surgery, Liver Transplantation Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, RS, Brazil
| | - V Duro Garcia
- Nephrology Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, RS, Brazil
| | - E Keitel
- Postgraduatation Program of Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre, RS, Brazil; Nephrology Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, RS, Brazil
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Machado A, Kiss G, Ernani L, Marroni C, Zanotelli ML, Cantisani G, Cerski CT, Coral G, Brandão A. Validation of the "Metroticket" model in a cohort of patients transplanted for hepatocellular carcinoma in southern Brazil. Clin Transplant 2015; 29:806-12. [PMID: 26119109 DOI: 10.1111/ctr.12583] [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] [Subscribe] [Scholar Register] [Accepted: 06/24/2015] [Indexed: 12/21/2022]
Abstract
This retrospective study evaluated the ability of the Metroticket model to predict five-yr post-transplant survival in patients with hepatocellular carcinoma (HCC) based only on explant data. Five-yr survival after transplant was estimated using the Metroticket Calculator, and observed survival was calculated using the Kaplan-Meier method. Metroticket-predicted survival was compared between deceased and surviving patients using the Mann-Whitney test. The accuracy of Metroticket estimates in discriminating between these two patient groups was assessed using the c-statistic. Median patient age (n = 109) was 55.7 yr, and 72.5% of the sample were men. Metroticket-predicted and observed post-transplant survival at five yr was 71.1% and 58.7%, respectively. Predictions were calculated using the explant data of the 64 survivors and 45 deceased patients. Median five-yr survival was 72.9% in the former and 69.7% in the latter. The c-statistic of the Metroticket model for distinguishing surviving from deceased patients was 0.55. In this cohort, the Metroticket model was unable to accurately predict five-yr post-transplant survival based only on explant data.
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Affiliation(s)
- Adriana Machado
- Postgraduate Program in Medicine: Hepatology, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Guillermo Kiss
- Liver Transplantation Group, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Lucas Ernani
- School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Claudio Marroni
- Postgraduate Program in Medicine: Hepatology, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.,Liver Transplantation Group, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Maria Lúcia Zanotelli
- Liver Transplantation Group, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Guido Cantisani
- Liver Transplantation Group, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Carlos Thadeu Cerski
- Liver Transplantation Group, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Gabriela Coral
- Postgraduate Program in Medicine: Hepatology, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Ajacio Brandão
- Postgraduate Program in Medicine: Hepatology, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.,Liver Transplantation Group, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
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Costabeber AM, Granzotto M, Fleck ADM, Marroni CA, Zanotelli ML, Cantisani G, Lionço L, Musskopf MI, Brandão A. Liver retransplantation in adults: a 20-year experience of one center in southern Brazil. Ann Hepatol 2014; 12:942-51. [PMID: 24114825] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Liver retransplantation (LReTx) is the therapeutic option for hepatic graft failure. Survival after LReTx is poorer than after primary liver transplantation. Given the organ shortage, it is essential to optimize the use of this resource. OBJECTIVE To evaluate rates, indications and patient survival after LReTx and identify factors associated with mortality following LReTx. MATERIAL AND METHODS We conducted a retrospective cohort study of all adults undergoing LReTx based on registry data from the Liver Transplantation Group (Complexo Hospitalar Santa Casa de Porto Alegre), southern Brazil. RESULTS Between June 16, 1991 and July 19, 2011, 824 patients underwent 866 liver transplants. Forty-two procedures corresponded to LReTx (4.8% of all liver transplants performed). Thirty-eight patients who underwent a single LReTx procedure were included in this study. The leading indication for LReTx was hepatic artery thrombosis (HAT) (31.6%), followed by primary nonfunction (PNF) (18.4%). The main indication for early LReTx was PNF (58.3%) and for late LReTx was HAT (38.5%). During the follow-up period, 26 patients (68.4%) died after LReTx. Patient survival at 1 and 3 years after LReTx was 44.7% and 44.7%, respectively. Patients infected with hepatitis C virus, serum albumin < 2.5 g/dL and receiving mechanical ventilation immediately before LReTx had a significantly lower survival rate than the other patients. CONCLUSION Considering the increased mortality when the graft loss is delayed, it is necessary to define the minimum acceptable results to indicate LReTx and identify the patients who would most benefit from this treatment.
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Affiliation(s)
- Ane Micheli Costabeber
- Post-Graduate Program in Medicine: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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8
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Mariante-Neto G, Marroni CP, Fleck Junior AM, Marroni CA, Zanotelli ML, Cantisani G, Brandão ABM. Impact of creatinine values on MELD scores in male and female candidates for liver transplantation. Ann Hepatol 2013; 12:434-9. [PMID: 23619260] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION A systematic bias against women, resulting from the use of creatinine as a measure of renal function, has been identified in Model for End-stage Liver Disease (MELD)-based liver allocation. Correction of this bias by calculation of female creatinine levels using the Modification of Diet in Renal Disease (MDRD) formula has been suggested. MATERIAL AND METHODS A cohort of 639 cirrhotic candidates for first-time liver transplantation was studied. Creatinine levels were corrected for gender using the MDRD formula. The accuracy of MELD, with or without creatinine correction, to predict 3-and 6-month mortality after inclusion in a transplant waiting list was estimated. RESULTS Women exhibited significantly lower creatinine levels, glomerular filtration rate, and MELD scores than men. After creatinine correction, female MELD scores had a mean increase of 1.1 points. Creatinine correction yielded an increase of 3 points in the MELD score in 15.2% of patients, 2 points in 22.4%, and 1 point in 17.6% of patients. The likelihood of death at 3 and 6 months after enrollment in the transplant waiting list was similar in males and females and the likelihood of receiving a transplant, as assessed by Kaplan-Meier survival curves, was also similar in males and females. CONCLUSION The survival or the likelihood of receiving a transplant while on the waiting list were similar in men and women in both pre- and post-MELD eras and creatinine correction did not increase the accuracy of the MELD score in estimating 3- and 6-month mortality in female candidates for liver transplantation.
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Affiliation(s)
- Guilherme Mariante-Neto
- Post Graduate Program in Medicine-Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
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da Silva Machado AG, de Medeiros Fleck A, Marroni C, Zanotelli ML, Cantisani G, de Mello Brandão AB. Impact of MELD score implementation on liver allocation: experience at a Brazilian center. Ann Hepatol 2013; 12:440-7. [PMID: 23619261] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction. Model for end-stage liver disease (MELD) is an accurate predictor of mortality in patients with cirrhosis, and has been used on liver allocation in Brazil since 2006. However, its impact on organ allocation, waiting list and post-transplant mortality is still poorly characterized. This study aimed to assess the impact of implementation of the MELD system on liver allocation and mortality after liver transplantation (LT) in Southern Brazil. Material and methods. Adult patients with chronic liver disease on the waiting list for primary deceased-donor LT were divided into two cohorts (pre- and post-MELD implementation) according to the date of waiting list placement. Disease severity, as assessed by MELD score at placement, was similar in both cohorts. Patients were followed for at least 18 months to assess the outcomes of interest (death/LT). Results. Higher MELD scores correlated with waiting list mortality, which increased 20% with each additional point (HR 1.2; 95%CI 1.14-2.26; p < 0.001). Waiting list mortality was 30.9% before and 21.7% after MELD implementation (nonsignificant). Transplant rate increased after MELD implementation (52 vs. 40%, p = 0.002). After excluding patients with hepatocellular carcinoma, mean MELD scores at LT were significantly higher in the MELD era (p < 0.01). There was no significant correlation between MELD scores at LT and post-LT survival. During 18-month follow-up, post-LT mortality rate was 25.4% before and 20% after MELD implementation (nonsignificant). Conclusion. MELD implementation was associated with a reduction in waiting list mortality. Although sicker patients received LT in the MELD era, post-transplant survival was similar in both periods.
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Marroni CP, de Mello Brandão AB, Hennigen AW, Marroni C, Zanotelli ML, Cantisani G, Fuchs SC. MELD scores with incorporation of serum sodium and death prediction in cirrhotic patients on the waiting list for liver transplantation: a single center experience in southern Brazil. Clin Transplant 2012; 26:E395-401. [DOI: 10.1111/j.1399-0012.2012.01688.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Caroline Possa Marroni
- Post-Graduate Program in Medicine: Hepatology; Universidade Federal de Ciências da Saúde de Porto Alegre; Porto Alegre; RS; Brazil
| | | | - Alexandre Wahl Hennigen
- School of Medicine; Universidade Federal de Ciências da Saúde de Porto Alegre; Porto Alegre; RS; Brazil
| | | | - Maria Lúcia Zanotelli
- Liver Transplantation Group; Complexo Hospitalar Santa Casa de Porto Alegre; Porto Alegre; RS; Brazil
| | - Guido Cantisani
- Liver Transplantation Group; Complexo Hospitalar Santa Casa de Porto Alegre; Porto Alegre; RS; Brazil
| | - Sandra Costa Fuchs
- Post-Graduate Program in Medicine: Medical Sciences; School of Medicine; Universidade Federal do Rio Grande do Sul; Porto Alegre; RS; Brazil
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11
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Affiliation(s)
- M L Zanotelli
- HCPA, Department of Digestive Surgery, Porto Alegre, Brazil
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12
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Meine MH, Zanotelli ML, Neumann J, Kiss G, de Jesus Grezzana T, Leipnitz I, Schlindwein ES, Fleck A, Gleisner AL, de Mello Brandão A, Marroni CA, Cantisani GPC. Randomized clinical assay for hepatic grafts preservation with University of Wisconsin or histidine-tryptophan-ketoglutarate solutions in liver transplantation. Transplant Proc 2006; 38:1872-5. [PMID: 16908310 DOI: 10.1016/j.transproceed.2006.06.071] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [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: 01/25/2023]
Abstract
University of Wisconsin (UW) solution has been the standard for preservation of liver transplantation grafts since 1989. However, some studies demonstrated that histidine-tryptophan-ketoglutarate (HTK) solution is also effective. The purpose of this study was to compare the efficacy of both solutions in liver transplantation. From January 2003 to August 2004 the livers of deceased donors were randomized into HTK and UW groups. The 102 studied patients included 65 (63.7%) in the UW group and 37 (36.3%) in the HTK group. Sex, race, hemodynamic state, use of adrenergic drugs, and presence of steatosis in the donor were similarly distributed in the two groups (P > .05). The mean age of the donors was 38.1 years (SD +/-14.4) in the UW group and 44.6 years (SD +/-14.2) in the HTK cohort (P = .036). Sex, race, age, etiology of the cirrhosis, retransplant, acute liver failure, portal thrombosis, and Child-Pugh and MELD scores in the recipients were similarly distributed in the two recipient samples (P > .05). Among 89 patients who completed 4 months of follow-up, the HTK group included eight cases (25.8%) of biliary complications versus five cases (8.6%) in the UW group (P = .033; OR = 2.0 95% CI = 1.2-3.5). The incidence of graft dysfunction was 2.8% in the HTK group and 9.4% in the UW group (P = .15). In conclusion, UW and HTK solutions were equally effective for the preservation of the hepatic graft. The routine use of HTK solution can reduce the costs of liver transplantation.
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Affiliation(s)
- M H Meine
- Liver Transplantation Group, Santa Casa de Porto Alegre, Rua Professor Annes Dias 288, Porto Alegre, RS, CEP 90-020-020 Brazil.
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13
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Grezzana Filho TDJM, Corso CO, Zanotelli ML, Marroni CA, Brandão ABM, Schlindwein E, Leipnitz I, Meine MHM, Fleck A, Hoppen R, Kiss G, Cantisani GPC. Liver glutathione depletion after preservation and reperfusion in human liver transplantation. Acta Cir Bras 2006; 21:223-9. [PMID: 16862342 DOI: 10.1590/s0102-86502006000400007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Accepted: 03/21/2006] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: The oxidative stress is an important mechanism responsible for dysfunction after orthotopic liver transplantation (OLT). Glutathione (GSH) low levels after cold storage render the grafts vulnerable to reperfusion injury. Aim of this study was to evaluate GSH and oxidized glutathione (GSSG) liver concentrations, the hepatocellular injury and function in optimal and suboptimal grafts after human OLT. METHODS: Liver biopsies were taken in 33 patients before the implant and two hours after reperfusion, allowing determination of GSH, GSSG and oxidative stress ratio (GSH/GSSG). Serum transaminases, prothrombin activity (PT) and factor V were measured to evaluate injury and function respectively. Histopathological injury was analyzed by an index of five parameters. RESULTS: There was a decrease in GSH (p<0.01) after reperfusion (0.323 ± 0.062 ìmol/g to 0.095 ± 0.01 ìmol/g and 0.371 ± 0.052 ìmol/g to 0.183 ± 0.046 ìmol/g) in suboptimal and optimal groups, respectively. An increase of GSSG (p<0.05) occurred after reperfusion (0.172 ± 0.038 ìmol/g to 0.278 ± 0.077 ìmol/g and 0.229 ± 0.048 ìmol/g to 0.356 ± 0.105 ìmol/g) in suboptimal and optimal groups, respectively. A decrease (p<0.01) occurred in the GSH/GSSG ratio after reperfusion (2.23 ± 0.31 to 0.482 ± 0.042 and 2.47 ± 0.32 to 0.593 ± 0.068) in suboptimal and optimal groups, respectively. Histopathological injury scores were higher (p<0.05) in the suboptimal group than in optimal (6.46 ± 0.4 vs. 5.39 ± 1.1) and showed correlation with PT and factor V in the optimal group (p<0.05). Multivariate analysis pointed steatosis as an independent risk factor to histopathological injury (p<0.05). CONCLUSION: There was a significant GSH depletion and GSSG formation after cold storage and reperfusion due to a similar oxidative stress in optimal and suboptimal grafts, but these levels were not related to graft viability.
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14
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Hoppe L, Marroni CA, Bressane R, Lago L, Schiavo FL, Cigerza GC, Brandão ABM, Zanotelli ML, Cantisani GPC. Risk Factors Associated With Cytomegalovirus Infection in Orthotopic Liver Transplant Patients. Transplant Proc 2006; 38:1922-3. [PMID: 16908324 DOI: 10.1016/j.transproceed.2006.06.075] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [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: 10/24/2022]
Abstract
UNLABELLED Our objective was to investigate the potential risk factors associated with cytomegalovirus (CMV) infection. PATIENTS AND METHODS From January 1999 to December 2001, 163 liver transplantations were performed in 154 patients. The study inclusion criteria were absence of retransplantation and survival of more than 6 months. One hundred fifteen patients met the inclusion criteria. We determined variables such as age, gender, and number of hemecomponents as well as serum IgG CMV status of donors and recipients. We recorded the immunosuppression used by each patient. CMV infection was detected by positive antigenemia. RESULTS Recipient mean age was 50 years. The etiology of cirrhosis was viral (n = 57; 49.6%), alcoholic (n = 20; 17.4%), virus and alcohol (n = 15; 13.0%), cryptogenic (n = 14; 12.2%), or other causes (n = 9; 7.8%). CMV infection was positive in 75 patients (65.8%). There was no relation between infection and age, gender, or CMV IgG donor recipient status, or the number of hemecomponent units. The risk was 3.8-fold higher for patients receiving a three-drug compared with a two-drug regimen. When cyclosporine was used instead of tacrolimus, the risk of CMV infection was 4.3-fold higher. Logistic regression analysis revealed cyclosporine (OD=5.8) and a three-drug regimen (OD=6.7) to have stronger associations with CMV infection. CONCLUSION The use of cyclosporine (OD=5.8) and a three-drug regimen (OD=6.7) are risk factors for CMV infection.
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Affiliation(s)
- L Hoppe
- Santa Casa, Porto Alegre, FFFCMPA, Rua Uruguai 2001, 312/B Passo Fundo, Rio Grande do Sul, CEP 99010-112 Brazil.
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15
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Hoppe L, Marroni CA, Bressane R, Lago L, Schiavo FL, Cigerza GC, Brandão ABM, Zanotelli ML, Cantisani GPC. Impact of Cytomegalovirus Infection on Long-Term Survival After Orthotopic Liver Transplantation. Transplant Proc 2006; 38:1924-5. [PMID: 16908325 DOI: 10.1016/j.transproceed.2006.06.074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 10/24/2022]
Abstract
UNLABELLED Cytomegalovirus (CMV) is one of the most common and serious opportunistic infections in solid organ transplant patients. In different series the incidence of CMV infection ranges from 25% to 85%. An indirect effect of infection includes reduced long-term patient and allograft survival. Our objective was to determine the relationship between CMV infection and patient survival after orthotopic liver transplantation. PATIENTS AND METHODS From January 1999 to December 2001, 163 orthotopic liver transplantations were performed in 154 patients. The inclusion criteria for this analysis were the absence of retransplantation and survival of more than 6 months. One hundred fifteen patients met the inclusion criteria. CMV infection was detected by positive antigenemia. RESULTS CMV infection occurred in 65.8% of patients after orthotopic liver transplantation. Their 5-year survival was 85%, with no difference observed between patients with or without infection (P = .8). CONCLUSION CMV infection did not interfere with patient survival after orthotopic liver transplantation.
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Affiliation(s)
- L Hoppe
- Santa Casa, Porto Alegre, FFFCMPA, Rua Uruguai 2001, 312/B Passo Fundo, Rio Grande do Sul, CEP 99010-112 Brazil.
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Abstract
Mycophenolate sodium (EC-MPS) has been shown to be as effective and as safe as mycophenolate mofetil (MMF) in renal transplant patients. Nevertheless, compared to MMF its use in liver transplant patients has been limited. The purpose of this study was to analyze the efficacy of EC-MPS as a primary immunosuppressant or as a replacement for MMF in liver transplant patients. Ninety among 470 liver transplant recipients were receiving or had added an antimetabolite to their immunosuppressant therapy. The most common reason for this change was renal dysfunction (47.8%) or diabetes (32.2%). EC-MPS was started at a median of 30 months after liver transplantation. The mean administered daily dose was 720 mg/d. At least one gastrointestinal symptom was reported by 25 patients. Abdominal pain (16.6%) and diarrhea (14.5%) were the most frequent. EC-MPS had to be discontinued in two patients, while six others required dose reduction to resolve the symptoms. Hematological adverse events were infrequent: three patients had leukopenia and one, anemia, all of which responded to dosage reduction. There was a creatinine reduction within 6 months of drug commencement and maintenance of the lower creatinine levels at 1 year among patients who began EC-MPS for renal dysfunction. Serum low-density lipoprotein cholesterol and triglyceride levels were significantly lower among patients on EC-MPS than on MMF. In conclusion, EC-MPS appears to have a similar efficacy and safety profile as MMF in liver transplant patients. Hematological and gastrointestinal adverse events were infrequent; seldom had the drug to be discontinued.
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Affiliation(s)
- G P C Cantisani
- Grupo de Transplante Hepático, Santa Casa de Porto Alegre, Porto Alegre, Brazil.
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Maciel AC, Cerski CT, Moreira RK, Resende VL, Zanotelli ML, Matiotti SB. Hepatocellular carcinoma in patients undergoing orthotopic liver transplantation: radiological findings with anatomopathological correlation in Brazil. Arq Gastroenterol 2006; 43:24-9. [PMID: 16699614 DOI: 10.1590/s0004-28032006000100008] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND: Hepatocellular carcinoma is one of the most common malignant tumors worldwide. Imaging techniques, specially computed tomography and ultrasound, are among the most useful diagnostic tools, although the accuracy of these methods may have a significant variability. AIMS: To determine the prevalence of hepatocellular carcinoma in cirrhotic patients undergoing orthotopic liver transplantation at "Santa Casa de Misericórdia" of Porto Alegre, RS, Brazil; to estimate the sensitivity of computed tomography and ultrasound in pretransplantation detection of hepatocellular carcinoma in this population; to correlate the radiological characteristics with anatomopathological findings. MATERIALS AND METHODS: Retrospective prevalence study. Population: adult, cirrhotic patients undergoing orthotopic liver transplantation from January 1990 to July 2003. Among the 292 transplanted patients, 31 cases of hepatocellular carcinoma were diagnosed, of which 29 were included in the study. Tumor characteristics in both ultrasound and computed tomography were compared to those observed in anatomopathological examination. RESULTS: Prevalence of hepatitis C virus infection among patients with diagnosis of hepatocellular carcinoma was 93.5%, and the prevalence of hepatocellular carcinoma among transplanted patients was 10.6%. The overall sensitivity of the imaging techniques was 70.3% for computed tomography and 72% for ultrasound. CONCLUSION: The prevalence of hepatocellular carcinoma at our institution, as well as the sensitivity of both ultrasound and computed tomography to detect such tumors at pretransplantation screening were similar to those found by other authors, while the prevalence of hepatitis C virus infection, the most common etiological agent for liver disease in our patients, is one of the highest ever reported in literature. Factors influencing hepatocellular carcinoma detection rates were: time from examination to liver transplantation; acquisition of computed tomography images during arterial phase; lesion size. Arterial phase proved to be the most useful part of computed tomography examination in this study.
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Affiliation(s)
- Antônio Carlos Maciel
- Department of Radiology, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
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Hoppe L, Bressane R, Lago LS, Schiavo FL, Marroni CA, Keiserman DR, Brandão ABM, Júnior AMF, Cassal AP, Zanotelli ML, Cantisani GPC. Risk factors associated with cytomegalovirus-positive antigenemia in orthotopic liver transplant patients. Transplant Proc 2004; 36:961-3. [PMID: 15194334 DOI: 10.1016/j.transproceed.2004.03.122] [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: 10/26/2022]
Abstract
The aim of the study was to investigate risk factors associated with cytomegalovirus (CMV)-positive antigenemia in orthotopic liver transplant (OLT) patients. Sixty-nine patients undergoing OLT during 2001 were retrospectively evaluated for CMV antigenemia during a follow-up of 6 months after transplantation for demographic variables, pretransplant donor and recipient CMV serologic status, etiology of liver disease, number of blood transfusions, and type of immunosuppression. Among the 69 patients who underwent 71 OLT in this period, 43 met study criteria. Mean age was 49.7 +/- 10.8 years and 60.5% were men. End-stage liver disease was the indication for liver transplant, except in one case. The most prevalent etiology of liver disease was hepatitis C and/or alcohol in 66% of the cases. CMV-positive status was recorded in 74% of donors and 95% of recipients. None of the CMV-negative recipients received a positive donor allograft. CMV-positive antigenemia was 84% with 12% having two episodes of infection. There was no correlation between CMV infection and age, gender, etiology of liver disease, or number of blood transfusions. However, all patients using cyclosporine had CMV-positive antigenemia compared with 61% using tacrolimus (P <.032). In this study, the incidence of CMV infection after OLT in adult patients was slightly higher than reported in literature. No risk factor was associated with CMV antigenemia; however, this study suggests a higher probability of CMV infection among patients treated with cyclosporine.
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Affiliation(s)
- L Hoppe
- Liver Transplant Group, Irmandade Santa Casa de Misericórdia, Porto Alegre Federal Sciences School Foundation, Porto Alegre, Rio Grande do Sul, Brazil.
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Zanotelli ML, Vieira S, Alencastro R, Kieling C, Leipnitz I, Ferreira C, Silveira TR, Cantisani GPC. Management of vascular complications after pediatric liver transplantation. Transplant Proc 2004; 36:945-6. [PMID: 15194327 DOI: 10.1016/j.transproceed.2004.03.104] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [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: 01/03/2023]
Abstract
Sixty-five children underwent liver transplantation (LTx) from March 1995 to December 2002. Cirrhosis due to biliary atresia was the main indication, and hepatic artery thrombosis (HAT) the most common vascular complication (n = 5). Other vascular problems were portal vein thrombosis and stenosis. Another patient developed hepatomegaly and ascites due to a late stenosis of the left hepatic vein anastomosis. The two cases of venous stenosis were successfully treated by percutaneous angioplasty. One graft with HAT was saved, but four children died awaiting retransplant.
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Affiliation(s)
- M L Zanotelli
- Pediatric Liver Transplant Group, Hospital de Clinicas, Porto Alegre RS, Brazil.
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20
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Grezzana TJM, Corso CO, Zanotelli ML, Marroni CA, Brandão ABM, Schlindwein E, Leipnitz I, Meine MHM, Fleck A, Cassal A, Hope L, Hoppen R, Kiss G, Gleisner ALM, Cerski T, Bellò-Klein A, Severo V, Innocenti C, Cantisani GPC. Oxidative stress, hepatocellular integrity, and hepatic function after initial reperfusion in human hepatic transplantation. Transplant Proc 2004; 36:843-5. [PMID: 15194289 DOI: 10.1016/j.transproceed.2004.03.100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 11/20/2022]
Abstract
BACKGROUND The mechanisms underlying liver graft dysfunction are not completely defined, although much of the injury derives from oxidative stress in organ reperfusion. The antioxidant glutathione in its reduced form (GSH) is an important agent to detoxify oxygen species after reperfusion. However, this effect might be limited by low concentrations at the end of cold storage. The objective of this study was to evaluate GSH and glutathione oxidized (GSSG) hepatic levels pre- and postreperfusion and correlate with hepatocellular injury and liver function in the 5 subsequent days after transplantation. METHODS Liver biopsies were taken immediately before implant and 2 hours after venous reperfusion in 34 grafts, determining GSH, GSSG levels, and GSSG/GSH ratio. Aminotransferases (ALT, AST) and PT were measured for 5 days. RESULTS There was a strong decrease in GSH concentration (P <.0001), increase of GSSG levels (P <.01), and increase of the GSSG/GSH ratio (P <.0001). No correlations were found between GSH, GSSG, or GSH/GSSH levels and AST, ALT, and PT. CONCLUSION Glutathione levels showed significant changes after 2 hours of reperfusion, due to intense oxidative stress. Therapies to replenish GSH should be considered as a protective measure to avoid liver graft dysfunction after transplantation.
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Affiliation(s)
- T J M Grezzana
- Liver Transplantation Group, Irmandade Santa Casa de Misericórdia de Porto Alegre, Brazil.
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21
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Brandão A, Marroni CA, Cerski CT, Gleisner AL, Zanotelli ML, Cantisani G. Zigomicose após transplante hepático em adultos: relato de três casos. Rev Soc Bras Med Trop 2003. [DOI: 10.1590/s0037-86822003000600014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Relatam-se três casos de zigomicose após transplante hepático em uma série de 300 pacientes. O diagnóstico foi anatomopatológico (dois casos à necropsia e um à cirurgia). A doença manifestou-se de diferentes formas: rinomaxilar, gastrointestinal e, em um paciente, comprometeu a anastomose da artéria hepática. Neste caso, retirada cirúrgica da região comprometida e uso de anfotericina-B possibilitaram a cura.
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Affiliation(s)
- Ajacio Brandão
- Santa Casa de Misericórdia de Porto Alegre; Universidade Federal do Rio Grande do Sul
| | | | - Carlos Thadeu Cerski
- Santa Casa de Misericórdia de Porto Alegre; Fundação Faculdade Federal de Ciências Médicas de Porto Alegre
| | | | | | - Guido Cantisani
- Santa Casa de Misericórdia de Porto Alegre; Fundação Faculdade Federal de Ciências Médicas de Porto Alegre
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22
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Brandão A, Marroni CA, Cerski CT, Gleisner AL, Zanotelli ML, Cantisani G. [Zygomycosis following liver transplantation in adults: report of three cases]. Rev Soc Bras Med Trop 2003; 36:729-33. [PMID: 15049114] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
We report three cases of zygomycosis following liver transplant in a series of 300 patients. Diagnosis was determined via anatomicopathological examination (on necropsy in two cases and during surgery in one case). The disease had different manifestations: rhinomaxillary, gastrointestinal and, in one case, it compromised the liver artery anastomosis. In this case, surgical removal of the affected region and use of amphotericin B achieved resolution.
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Affiliation(s)
- Ajacio Brandão
- Grupo de Transplante Hepático do Hospital Dom Vicente Scherer da Santa Casa de Misericórdia de Porto Alegre, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS.
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Fleck A, Zanotelli ML, Meine M, Brandão A, Leipnitz I, Schlindwein E, Cassal A, Grezzana T, Marroni C, Cantisani GPC, Santos RR. Biliary tract complications after orthotopic liver transplantation in adult patients. Transplant Proc 2002; 34:519-20. [PMID: 12009610 DOI: 10.1016/s0041-1345(02)02615-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- A Fleck
- Liver Transplant Unit, Hospital São Francisco, Santa Casa Porto Alegre, RS, Brazil
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Vecino MC, Cantisani G, Zanotelli ML, Marroni CA, Brandão AB, Cassal AP, Perla AD, Freitas DM. [Neurologic disorders in patients submitted to liver transplantation: analysis of 30 consecutive cases]. Arq Neuropsiquiatr 2000; 58:304-9. [PMID: 10849632 DOI: 10.1590/s0004-282x2000000200017] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Neurologic complications are important source of morbi-mortality, in liver transplantation. They result from previous factors, alterations during the surgical procedure, effects from immunosuppressor drugs, coagulopathy and infections. We analyzed, retrospectively, the chronology, causes, and frequencies of neurologic alterations in thirty adult patients submitted to liver transplantation, and our results differ slightly from those registered in other series.
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Affiliation(s)
- M C Vecino
- Equipe de Transplante Hepático, Hospital São Francisco, Irmandade da Santa Casa de Misericórdia de Porto Alegre, RS, Brasil.
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Marroni CA, Hoppe L, Diehl JL, Leipnitz I, Brandão AB, Cassal AP, Schlindwein E, Zanotelli ML, Cantisani GP. Diabetes mellitus and liver transplantation in adults. Transplant Proc 1999; 31:3046. [PMID: 10578386 DOI: 10.1016/s0041-1345(99)00663-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C A Marroni
- Liver Transplantation Group, Hospital São Francisco, ISCMPA-Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Brasil
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Vecino MC, Cantisani G, Zanotelli ML, Marrone CA, Brandão AB, Cassal AP, Perla AS, Freitas DM. Neurological complications in liver transplantation. Transplant Proc 1999; 31:3048-9. [PMID: 10578388 DOI: 10.1016/s0041-1345(99)00665-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M C Vecino
- Liver Transplantation Group, Hospital São Francisco, Irmandadeda Santa Casa de Misericórdia de Porto Alegre, Rio Grande do Sul, Brasil
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Marroni CA, Diehl JL, Leipnitz I, Pires LM, Brandão AB, Cassal AP, Schlindwein E, Zanotelli ML, Cantisani GP. Prevalence of high blood pressure in patients submitted to liver transplantation at the ISCMPA. Transplant Proc 1999; 31:3047. [PMID: 10578387 DOI: 10.1016/s0041-1345(99)00664-8] [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: 11/16/2022]
Affiliation(s)
- C A Marroni
- Group of Liver Transplantation, Hospital São Francisco of the Irmandade Santa Casa de Porto Alegre-Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Brasil
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Brandão A, Alvaréz R, Famer S, Marroni C, Cassal A, Zanotelli ML, Cantisani G. Efficacy of a recombinant hepatitis B vaccine (Euvax-B) in adult patients awaiting liver transplantation: preliminary results. Transplant Proc 1999; 31:3055-6. [PMID: 10578391 DOI: 10.1016/s0041-1345(99)00668-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- A Brandão
- Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Brazil
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Ferreira CT, Vieira SM, Kieling C, Mello ED, Santos CM, Silveira C, Grossini MG, Silveira AE, Almeida H, Zanotelli ML, Cantisani G, Silveira TR. [Follow-up of pediatric patients evaluated for liver transplantation]. J Pediatr (Rio J) 1997; 73:75-9. [PMID: 14685420 DOI: 10.2223/jped.511] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To analyze the evolution of pediatric patients chosen for hepatic transplantation. METHODS A review was made of the clinical charts of the first 65 children and adolescents with chronic liver disease, aged 5 months to 19 years (X = 6.8%), chosen for liver transplantation during the period of August 1994 to March 1996. Data refer to the patients' demographic characteristics, etiology of their liver disease, their psychosocial situation and of their parents, and their clinical and laboratorial evaluation. According to the severity of the disease, patients were classified as active (waiting for a donor), in evaluation, inactive (compensated liver disease), and excluded for psychosocial or medical conditions, or because of bad indication. RESULTS Eight patients (12%) received transplantation, and one of them died. Seven (11%) died when in evaluation or waiting for a donor. Ten patients (15%) were excluded from the waiting list: 6 for social problems, and 4 for medical problems. No patient was excluded for bad indication. Six patients are in the active list, waiting for donor. The other 23 patients (35%) are in evaluation, and 11 (17%) are classified as inactive in the waiting list. CONCLUSIONS Eleven patients (17%) were not operated on due to the advanced stage of the liver disease. We emphasize the necessity of organ donation, and the early contact of the patients with a reference center.
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Affiliation(s)
- C T Ferreira
- Gastroenterologista Pediátrico do Programa de THI, Hospital de Clínicas de Porto Alegre, RS
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García CD, Uhlmann A, Deboni L, Keitel E, Bittar AE, Cantisani G, Vitola SP, Guerra E, Zanotelli ML, Goldani JC. Renal transplantation in children. Transplant Proc 1992; 24:3092-3. [PMID: 1466070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- C D García
- Transplantation Unit, Santa Casa de Misericórdia, Porto Alegre, Brazil
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Guerra EE, Didoné EC, Zanotelli ML, Vitola SP, Cantisani GP, Goldani JC, Keitel E, Garcia VD. Renal transplants with multiple arteries. Transplant Proc 1992; 24:1868. [PMID: 1412889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- E E Guerra
- Transplantation Service, Santa Casa de Porto Alegre, Rio Grande do Sul, Brazil
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Zanotelli ML, Guerra EE, Costa LF, Vitola SP, Garcia VD, Cantisani GP. Duct-enterostomy as a treatment of pancreatic fistula in a bladder-drained pancreas transplant. Transplant Proc 1992; 24:815-6. [PMID: 1604625] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A case of combined pancreaticoduodeno-renal transplant with good graft function was complicated by recurrent episodes of graft pancreatitis treated by vesical catheter drainage. Four months after transplantation, a fistula from the pancreatic body associated with ascitis was identified. Anastomosis between pancreatic fistula and an individualized jejunal loop was performed. The duodenocystostomy was not disconnected. A splint placed inside the wirsung was exteriorized percutaneously through the jejunal loop and removed 30 days after the operation. Both kidney and pancreas grafts are functioning normally 2 years after transplantation.
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Affiliation(s)
- M L Zanotelli
- Departamento de Transplantes, Santa Casa de Porto Alegre, Brazil
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