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da Fonseca EA, Feier FH, Costa CM, Benavides MAR, Vincenzi R, de Oliveira Roda Vincenzi KM, Pugliese RPS, Porta G, Miura IK, de Oliveira CMV, Chapchap P, Neto JS. Hepatic venous reconstruction of the left lateral segment with emphasis on anomalous hepatic vein in pediatric liver transplantation. Liver Transpl 2023; 29:827-835. [PMID: 36847137 DOI: 10.1097/lvt.0000000000000108] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/05/2023] [Indexed: 03/01/2023]
Abstract
Left lateral segment grafts have become a suitable option in pediatric liver transplantation (PLT). The correlation between hepatic vein (HV) reconstruction and outcome is relevant when assessing the safe use of these grafts. We retrospectively reviewed the medical records prospectively collected from a pediatric living donor liver transplantation database and conducted a comparative analysis of the different left lateral segment graft types according to HV reconstruction. Donor, recipient, and intraoperative variables were analyzed. Post-transplant outcomes included vascular complications such as hepatic vein outflow obstruction, early (≤30 d) and late (>30 d) PVT, hepatic artery thrombosis, and graft survival. From February 2017 to August 2021, 303 PLTs were performed. According to venous anatomy, the distribution of the left lateral segment was as follows: single HV (type I) in 174 (57.4%), close HVs, simple venoplasty for reconstruction (type II) in 97 (32.01%), anomalous hepatic vein (AHV) with a distance between the HVs orifices that allowed simple venoplasty (type IIIA) in 25 (8.26%) and AHV with a distance between the HVs orifices requiring homologous venous graft interposition (type IIIB) in 07 (2.31%) grafts. Type IIIB grafts came from male donors ( p =0.04) and had a higher mean donor height ( p =0.008), a higher mean graft weight, and a higher graft-to-recipient weight ratio, both p =0.002. The median follow-up time was 41.4 months. The overall cumulative graft survival was 96.3%, and comparative graft survival showed no difference (log-rank p =0.61). No hepatic vein outflow obstructions were observed in this cohort study. There was no statistically significant difference in the post-transplant outcomes between the graft types. The venous reconstruction of the AHV with homologous venous graft interposition had similar outcomes in the short and long term.
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Affiliation(s)
- Eduardo Antunes da Fonseca
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Flavia Heinz Feier
- Hepatology and Liver Transplantation, Santa Casa de Porto Alegre, Porto Alegre, Brazil
| | - Carolina Magalhães Costa
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Marcel Albeiro Ruiz Benavides
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Rodrigo Vincenzi
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Karina Moreira de Oliveira Roda Vincenzi
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Renata Pereira Sustovich Pugliese
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Gilda Porta
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Irene Kazuo Miura
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Caio Marcio Vieira de Oliveira
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Paulo Chapchap
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
| | - João Seda Neto
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, AC Camargo Cancer Center, São Paulo, SP, Brazil
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Reine PK, Feier F, da Fonseca EA, Hernandes RG, Seda-Neto J. Quality of life, depression and anxiety in potential living liver donors for pediatric recipients: A retrospective single center experience. World J Hepatol 2022; 14:1899-1906. [PMID: 36340749 PMCID: PMC9627440 DOI: 10.4254/wjh.v14.i10.1899] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/21/2022] [Accepted: 09/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Living donor liver transplantation is a safe alternative for patients on a liver transplant list. Donor evaluation goes beyond physical variables to include social, emotional, and ethical aspects. The role of pre-donation sociopsychological evaluation of the donor candidate is as important to the success of the procedure as is the medical assessment. Success implies recovery from the operation and prompt engagement in pre-transplant professional and social activities, without leading to psychological or physical distress. Psychological profiling of potential living liver donors (PLLD) and evaluation of quality of life (QOL) can influence outcomes.
AIM To evaluate the socio-demographics and psychological aspects (QOL, depression, and anxiety) of PLLD for pediatric liver transplantation in a cohort of 250 patients.
METHODS This was a retrospective cohort study of 250 PLLD who underwent psychological pre-donation evaluation between 2015 and 2019. All the recipients were children. The Beck anxiety inventory, Beck depression inventory, and 36-item short-form health survey (SF-36) scores were used to evaluate anxiety (Beck anxiety inventory), depression (Beck depression inventory), and QOL, respectively.
RESULTS A total of 250 PLLD were evaluated. Most of them were women (54.4%), and the mean age was 29.2 ± 7.2 years. A total of 120 (48.8%) PLLD were employed at the time of evaluation for donation; however, most had low income (57% earned < 2 times the minimum wage). A total of 110 patients (44%) did not finish the donation process, and 247 PLLD answered a questionnaire to evaluate depression, anxiety, and QOL (SF-36). Prevalence of depression was of 5.2% and anxiety 3.6%. Although most of the PLLD were optimistic regarding the donation process and never had doubts about becoming a donor, some traces of ambivalence were observed: 46% of the respondents said they would feel relieved if a deceased donor became available.
CONCLUSION PLLD had a low prevalence of anxiety and depression. The foundation for effective and satisfactory results can be found in the pre-transplantation process, during which evaluations must follow rigorous criteria to mitigate potential harm in the future. Pre-donation psychological evaluation plays a predictive role in post-donation emotional responses and mental health issues. The impact of such findings on the donation process and outcomes needs to be further investigated.
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Affiliation(s)
- Paula K Reine
- Department of Psychology, Hospital Sírio-Libanês, São Paulo 01308901, Brazil
| | - Flavia Feier
- Department ofLiver Transplantation, Santa Casa de Porto Alegre, Porto Alegre 90020090, Brazil
| | | | - Rosely G Hernandes
- Department of Psychology, Hospital Sírio-Libanês, São Paulo 01308901, Brazil
| | - Joao Seda-Neto
- Department of Liver Transplantation, Hospital Sírio-Libanês, São Paulo 01308901, Brazil
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Belotto M, Coutinho L, Pacheco-Jr AM, Mitre AI, Fonseca EAD. INFLUENCE OF MINIMALLY INVASIVE LAPAROSCOPIC EXPERIENCE SKILLS ON ROBOTIC SURGERY DEXTERITY. Arq Bras Cir Dig 2022; 34:e1604. [PMID: 35019119 PMCID: PMC8735341 DOI: 10.1590/0102-672020210003e1604] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/04/2021] [Indexed: 12/02/2022]
Abstract
Background:
It is unclear if there is a natural transition from laparoscopic to robotic surgery with transfer of abilities.
Aim: To measure the performance and learning of basic robotic tasks in a simulator of individuals with different surgical background.
Methods:
Three groups were tested for robotic dexterity: a) experts in laparoscopic surgery (n=6); b) experts in open surgery (n=6); and c) non-medical subjects (n=4). All individuals were aged between 40-50 years. Five repetitions of four different simulated tasks were performed: spatial vision, bimanual coordination, hand-foot-eye coordination and motor skill.
Results:
Experts in laparoscopic surgery performed similar to non-medical individuals and better than experts in open surgery in three out of four tasks. All groups improved performance with repetition.
Conclusion:
Experts in laparoscopic surgery performed better than other groups but almost equally to non-medical individuals. Experts in open surgery had worst results. All groups improved performance with repetition.
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Affiliation(s)
- Marcos Belotto
- Department of Surgery, Pancreas Division, Santa Casa de São Paulo, São Paulo, SP, Brazil.,Sirio-Libanes Hospital, São Paulo, Brazil
| | | | - Adhemar M Pacheco-Jr
- Department of Surgery, Pancreas Division, Santa Casa de São Paulo, São Paulo, SP, Brazil
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Turine Neto P, Seda Neto J, da Fonseca EA, Porta G, Pugliese R, Benavides MAR, Vincenzi R, Roda KMO, Danesi VLB, Hirschfeld APM, Feier FH, Chapchap P, Miura IK. Impact of hypoxemia on pediatric liver transplantation for hepatopulmonary syndrome. Pediatr Transplant 2021; 25:e13968. [PMID: 33590638 DOI: 10.1111/petr.13968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/20/2020] [Accepted: 12/27/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND The treatment of choice for patients with cirrhosis and HPS is LT. The clinical manifestations associated with hypoxemia result in limitations and a poor health-related quality of life of affected patients. The present report aims to study the differences in outcomes between patients with PaO2 < 50 mm Hg and those with PaO2 ≥ 50 mm Hg. METHODS This was a retrospective study of 21 patients under 18 years of age conducted from 2001 to 2018; the patients were divided into 2 groups: G1-PaO2 ≥ 50 mm Hg, 11 patients, and G2-PaO2 < 50 mm Hg, 10 patients. Demographic, clinical, laboratory, and perioperative data; outcome variables; and post-transplant survival were compared between the groups. RESULTS In total, 2/11 (18.2%) patients in G1 and 8/10 (80%) patients in G2 required supplemental oxygen therapy at home (P = .005). Patients in G2 required prolonged MV (median 8.5 days in G2 vs 1 day in G1, P = .015) and prolonged ICU and hospital stays (P = .002 and P = .001, respectively). Oxygen weaning time was longer in G2 (median 127.5 days) than in G1 (median 3 days; P = .004). One (9.1%) patient in G1 and three (30%) patients in G2 died (P = .22). The survival at 90 months was 90.9% in G1 and 70% in G2 (P = .22). CONCLUSION The survival between groups was similar. Patients with very severe HPS required a longer MV time, longer ICU and hospital stays, and a longer O2 weaning time than those with mild, moderate, or severe HPS.
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Affiliation(s)
- Plínio Turine Neto
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - João Seda Neto
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Eduardo Antunes da Fonseca
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Gilda Porta
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Renata Pugliese
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Marcel Albeiro Ruiz Benavides
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Rodrigo Vincenzi
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Karina Moreira Oliveira Roda
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Vera Lúcia Baggio Danesi
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Adriana Porta Miche Hirschfeld
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Flavia Heinz Feier
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Paulo Chapchap
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Irene Kazue Miura
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
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Gordon K, Figueira ERR, Rocha-Filho JA, Mondadori LA, Joaquim EHG, Seda-Neto J, da Fonseca EA, Pugliese RPS, Vintimilla AM, Auler Jr JOC, Carmona MJC, D'Alburquerque LAC. Perioperative blood transfusion decreases long-term survival in pediatric living donor liver transplantation. World J Gastroenterol 2021; 27:1161-1181. [PMID: 33828392 PMCID: PMC8006094 DOI: 10.3748/wjg.v27.i12.1161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/20/2021] [Accepted: 03/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The impact of perioperative blood transfusion on short- and long-term outcomes in pediatric living donor liver transplantation (PLDLT) must still be ascertained, mainly among young children. Clinical and surgical postoperative complications related to perioperative blood transfusion are well described up to three months after adult liver transplantation.
AIM To determine whether transfusion is associated with early and late postoperative complications and mortality in small patients undergoing PLDLT.
METHODS We evaluated the effects of perioperative transfusion on postoperative complications in recipients up to 20 kg of body weight, submitted to PLDLT. A total of 240 patients were retrospectively allocated into two groups according to postoperative complications: Minor complications (n = 109) and major complications (n = 131). Multiple logistic regression analysis identified the volume of perioperative packed red blood cells (RBC) transfusion as the only independent risk factor for major postoperative complications. The receiver operating characteristic curve was drawn to identify the optimal volume of the perioperative RBC transfusion related to the presence of major postoperative complications, defining a cutoff point of 27.5 mL/kg. Subsequently, patients were reallocated to a low-volume transfusion group (LTr; n = 103, RBC ≤ 27.5 mL/kg) and a high-volume transfusion group (HTr; n = 137, RBC > 27.5 mL/kg) so that the outcome could be analyzed.
RESULTS High-volume transfusion was associated with an increased number of major complications and mortality during hospitalization up to a 10-year follow-up period. During a short-term period, the HTr showed an increase in major infectious, cardiovascular, respiratory, and bleeding complications, with a decrease in rejection complications compared to the LTr. Over a long-term period, the HTr showed an increase in major infectious, cardiovascular, respiratory, and minor neoplastic complications, with a decrease in rejection complications. Additionally, Cox hazard regression found that high-volume RBC transfusion increased the mortality risk by 3.031-fold compared to low-volume transfusion. The Kaplan-Meier survival curves of the studied groups were compared using log-rank tests and the analysis showed significantly decreased graft survival, but with no impact in patient survival related to major complications. On the other hand, there was a significant decrease in both graft and patient survival, with high-volume RBC transfusion.
CONCLUSION Transfusion of RBC volume higher than 27.5 mL/kg during the perioperative period is associated with a significant increase in short- and long-term postoperative morbidity and mortality after PLDLT.
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Affiliation(s)
- Karina Gordon
- Division of Anesthesiology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil
- Department of Anesthesiology, AC Camargo Cancer Center, São Paulo 01509-010, Brazil
| | - Estela Regina Ramos Figueira
- Department of Gastroenterology, Discipline of Liver and Gastrointestinal Transplantation, Laboratory of Medical Investigations LIM37 Hospital das Clinicas, University of São Paulo School of Medicine, São Paulo 05402-000, Brazil
| | - Joel Avancini Rocha-Filho
- Division of Anesthesiology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil
| | | | | | - Joao Seda-Neto
- Department of Liver Transplantation, AC Camargo Cancer Center, São Paulo 01525-901, Brazil
| | | | | | - Agustin Moscoso Vintimilla
- Department of Gastroenterology, Division of Liver and Gastrointestinal Transplant, Hospital das Clinicas, University of São Paulo School of Medicine, São Paulo 05402-000, Brazil
| | - Jose Otavio Costa Auler Jr
- Division of Anesthesiology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil
| | - Maria Jose Carvalho Carmona
- Division of Anesthesiology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil
| | - Luiz Augusto Carneiro D'Alburquerque
- Department of Gastroenterology, Division of Liver and Gastrointestinal Transplant, Hospital das Clinicas, University of São Paulo School of Medicine, São Paulo 05402-000, Brazil
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Horvat N, Marcelino ASZ, Horvat JV, Yamanari TR, Batista Araújo-Filho JDA, Panizza P, Seda-Neto J, Antunes da Fonseca E, Carnevale FC, Mendes de Oliveira Cerri L, Chapchap P, Cerri GG. Pediatric Liver Transplant: Techniques and Complications. Radiographics 2018; 37:1612-1631. [PMID: 29019744 DOI: 10.1148/rg.2017170022] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Liver transplant is considered to be the last-resort treatment approach for pediatric patients with end-stage liver disease. Despite the remarkable advance in survival rates, liver transplant remains an intricate surgery with significant morbidity and mortality. Early diagnosis of complications is crucial for patient survival but is challenging given the lack of specificity in clinical presentation. Knowledge of the liver and vascular anatomy of the donor and the recipient or recipients before surgery is also important to avoid complications. In this framework, radiologists play a pivotal role on the multidisciplinary team in both pre- and postoperative scenarios by providing a road map to guide the surgery and by assisting in diagnosis of complications. The most common complications after liver transplant are (a) vascular, including the hepatic artery, portal vein, hepatic veins, and inferior vena cava; (b) biliary; (c) parenchymal; (d) perihepatic; and (e) neoplastic. The authors review surgical techniques, the role of each imaging modality, normal posttransplant imaging features, types of complications after liver transplant, and information required in the radiology report that is critical to patient care. They present an algorithm for an imaging approach for pediatric patients after liver transplant and describe key points that should be included in radiologic reports in the pre- and postoperative settings. Online supplemental material is available for this article. ©RSNA, 2017.
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Affiliation(s)
- Natally Horvat
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Antonio Sergio Zafred Marcelino
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Joao Vicente Horvat
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Tássia Regina Yamanari
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Jose de Arimateia Batista Araújo-Filho
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Pedro Panizza
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Joao Seda-Neto
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Eduardo Antunes da Fonseca
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Francisco Cesar Carnevale
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Luciana Mendes de Oliveira Cerri
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Paulo Chapchap
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Giovanni Guido Cerri
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
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7
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Seda-Neto J, Antunes da Fonseca E, Pugliese R, Candido HL, Benavides MR, Carballo Afonso R, Neiva R, Porta G, Miura IK, Teng HW, Iwase FC, Rodrigues ML, Carneiro de Albuquerque LA, Kondo M, Chapchap P. Twenty Years of Experience in Pediatric Living Donor Liver Transplantation: Focus on Hepatic Artery Reconstruction, Complications, and Outcomes. Transplantation 2017; 100:1066-72. [PMID: 27014791 DOI: 10.1097/tp.0000000000001135] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatic artery thrombosis (HAT) increases morbidity and mortality after liver transplantation (LT). The identification of risk factors for HAT may aid transplant teams in the development of strategies aimed at reducing HAT. This article describes the risk factors for HAT and outcomes after LT. METHODS This report describes a retrospective study (1995 to 2015) of primary pediatric living donor LT (LDLT). Pretransplant and technical variables were included in the study. Binary logistic regression was used for data analysis. RESULTS This study included 656 primary LDLT. The median age, body weight, and pediatric end-stage liver disease score at the time of transplant were 13 months, 8.4 kg and 15, respectively. Twenty-one (3.2%) patients developed HAT. Intraoperative HAT (odds ratio, 62.63; 95% confidence interval, 12.64-310.19; P < 0.001) and the use of liver grafts with a graft-to-recipient weight ratio less than 1.1% (odds ratio, 24.46; 95% confidence interval, 4.55-131.56; P < 0.001) retained statistical significance in the multivariate model. Patient and graft survivals were significantly worse in cases with HAT. The overtime trend analysis revealed a decrease in the incidence of HAT (P = 0.008) and an increase in the use of 2-arterial anastomosis (P < 0.001). CONCLUSIONS A graft-to-recipient weight ratio of 1.1% or less and intraoperative HAT were independently associated with HAT. Trend analysis further revealed a significant reduction in the incidence of HAT over time, as well as the increased use of 2 hepatic arteries for anastomosis during graft implantation. The double artery anastomosis may represent an extra protection to pediatric recipients undergoing LDLT.
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Affiliation(s)
- João Seda-Neto
- 1 Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, SP, Brazil. 2 Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil. 3 Liver Transplant Service, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
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8
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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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9
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Vincenzi R, Seda-Neto J, Fonseca EAD, Ketzer BM, Benavides M, Cândido HL, Porta G, Miura IK, Pugliese R, Danesi VB, Guimaraes TC, Porta A, Borges CB, Kondo M, Chapchap P. Technical aspects and outcomes of living donor liver transplantation for pediatric patients with situs inversus. Liver Transpl 2013; 19:431-6. [PMID: 23447137 DOI: 10.1002/lt.23611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 12/23/2012] [Indexed: 02/07/2023]
Abstract
The vascular anomalies encountered in patients with biliary atresia associated with polysplenia syndrome and situs inversus (SI) demand technical refinements when liver transplantation is being performed. The available data describing the technique used in living donor liver transplantation (LDLT) in this population are limited; the short vascular stumps of the donor's liver can impart additional technical difficulties during vascular reconstruction. Here we describe our experience with 9 children with biliary atresia and SI who underwent LDLT. In our series, the retrohepatic vena cava was absent for 7 patients, 7 had a preduodenal portal vein (PV), and 4 had a variant arterial anatomy. The donor's left hepatic vein was anastomosed to the confluence of the recipient's 3 hepatic veins in 7 patients. Vascular grafts were used for PV reconstruction in 3 cases. A left lateral segment graft was used in all but 1 patient who needed a graft reduction. All grafts were placed in the upper left abdomen. There were no vascular complications after transplantation. All patients were alive and well at a median follow-up of 55 months. In conclusion, LDLT can be successfully performed in pediatric patients with SI. Complex vascular anomalies associated with the use of partial liver grafts obtained from living donors are not associated with an increased occurrence of vascular complications.
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Affiliation(s)
- Rodrigo Vincenzi
- Sirio-Libanes Hospital/A. C. Camargo Hospital, São Paulo, Brazil
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Alves RCP, Fonseca EAD, Mattos CALD, Abdalla S, Gonçalves JE, Waisberg J. Predictive factors of early graft loss in living donor liver transplantation. Arq Gastroenterol 2012; 49:157-61. [PMID: 22767004 DOI: 10.1590/s0004-28032012000200011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 03/16/2012] [Indexed: 02/07/2023]
Abstract
CONTEXT Living donor liver transplantation has become an alternative to reduce the lack of organ donation. OBJECTIVE To identify factors predictive of early graft loss in the first 3 months after living donor liver transplantation. METHODS Seventy-eight adults submitted to living donor liver transplantation were divided into group I with 62 (79.5%) patients with graft survival longer than 3 months, and group II with 16 (20.5%) patients who died and/or showed graft failure within 3 months after liver transplantation. The variables analyzed were gender, age, etiology of liver disease, Child-Pugh classification, model of end-stage liver disease (MELD score), pretransplantation serum sodium level, and graft weight-to-recipient body weight (GRBW) ratio. The GRBW ratio was categorized into < 0.8 and MELD score into >18. The chi-square test, Student t-test and uni- and multivariate analysis were used for the evaluation of risk factors for early graft loss. RESULTS MELD score <18 (P<0.001) and serum sodium level > 135 mEq/L (P = 0.03) were higher in group II than in group I. In the multivariate analysis MELD scores > 18 (P<0.001) and GRBW ratios < 0.8 (P<0.04) were significant. CONCLUSIONS MELD scores >18 and GRBW < 0.8 ratios are associated with higher probability of graft failure after living donor liver transplantation.
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