ABSTRACT
La hiperplasia nodular focal (HNF) del hígado es una tumoración benigna probablemente secundaria a una alteración en la vascularización del parénquima hepático, rara en la edad pedíatrica. Objeto: reportar un caso clínico de HNF que requirió transplante hepático ortotópico (THO) y revisar la literatura actual con respecto a la conducta terapéutica a seguir. Caso clínico: niño de 15 años de edad con una masa abdominal palpable. Ecografía y tomografía axial computada de abdomen demostraron un tumor multifocal en ambos lóbulos hepáticos de características irresecables. Biopsia operatoria del hígado confirmo una HNF. El paciente desarrolló hipertensión portal debido a compresión tumoral de la vena porta, con ascitis, encefalopatía hepática e insuficiencia renal, por lo que se decidió su manejo mediante un THO en injerto total, con una excelente evolución a 5 años de seguimiento. Conclusión: la decisión entre un enfoque conservador o quirúrgico depende de las características de cada caso, siendo el THO una alternativa terapéutica en pacientes con tumores hepáticos benignos e irresecables
Subject(s)
Humans , Male , Adolescent , Focal Nodular Hyperplasia , Liver Neoplasms , Liver Transplantation , Hepatic Encephalopathy/etiology , Focal Nodular Hyperplasia , Hypertension, Portal/etiology , Renal InsufficiencyABSTRACT
Background: The success of orthotopic liver transplantation (OLT) has resulted in its widespread use for different liver diseases. Aim: To report our 8 years experience with adult OLT at Clinica Alemana de Santiago. Patients and methods: In all transplantations done at the center, we recorded patient's overall data and survival, postoperative medical and surgical complications and causes of death. Results: Between November 1993 and September 2001, 51 consecutive OLT were performed in 44 patients (22 females, median age 45 years old). Thirty eight patients presented with chronic and 6 with acute or sub-acute liver failure. Cryptogenic cirrhosis and hepatitis C infection were the most common causes for OLT. Postoperative bleeding and extra-hepatic biliary complications were seen in 17.6 and 21.5 percent of cases respectively. Acute rejection, bacterial infections, CMV infection or disease and post OLT hemodialysis were the most common medical complications (51, 31, 19.6 and 19.6 percent of cases respectively). The overall 1 and 5 years survival rates were 80 percent and 73 percent respectively. Considering exclusively the last 22 OLT performed since January 1999, the 1 year survival rate has improved to 91 percent. Conclusions: Liver transplantation in Chile provides a good long term survival with acceptable morbidity, due to a multidisciplinary approach management. The survival rates have improved over the last few years probably due to better surgical techniques, ICU care and immunosuppression. These overall results are comparable with those from other Centers in developed countries