Recurrência da hepatite C após transplante hepático de doador vivo e falecido / Hepatitis C recurrence after living donor and cadaveric liver transplantation

OBJETIVO: Determinar a recurrência da hepatite C em pacientes submetidos a transplante hepático de doador vivo comparados com os submetidos a transplante hepático de doador falecido. MÉTODOS: Do total de 333 transplantes hepáticos, 279 (83,8 por cento) eram de doador falecido e 54 (16,2 por cento) de doador vivo. Hepatopatia crônica pelo vírus da hepatite C foi a indicação mais comum tanto de transplante hepático de doador falecido (82 pacientes) como de doador vivo (19 pacientes). O protocolo de estudo eletrônico de todos pacientes com hepatopatia crônica pelo vírus da hepatite C foi avaliado. Os dados coletados foram analisados estatisticamente conforme a idade, sexo, resultado dos exames laboratoriais, recidiva do vírus da hepatite C e rejeição aguda. RESULTADOS: O total de 55 transplantes hepáticos de doador falecido e 10 de doador vivo realizados em pacientes com cirrose hepática pelo vírus da hepatite C, foi incluído no estudo. As características clínicas e laboratoriais pré-transplante dos dois grupos foram similares, exceto o tempo de atividade de protrombina que foi maior no grupo de transplante hepático de doador falecido do que no de doador vivo (P = 0,04). A recidiva da hepatite C foi similar nos grupos de transplante hepático de doador falecido (n = 37; 69,3 por cento) e de doador vivo (n = 7; 70 por cento) (P = 0,8). A incidência de rejeição aguda foi igual no grupo de transplante hepático de doador falecido (n = 27; 49 por cento) e no grupo de doador vivo (n = 2; 20 por cento) (P = 0,08). A recurrência do vírus da hepatite C nos pacientes do grupo de transplante hepático de doador falecido que receberam pulsoterapia (9 de 11 pacientes) foi similar aos demais pacientes (28 de 44 pacientes) (P = 0,25). A recurrência também foi similar nos pacientes do grupo de transplante hepático de doador vivo que receberam pulsoterapia (1 de 1 paciente) em relação aos que não receberam (6 de 9 pacientes) (P = 0,7). CONCLUSÕES: A recurrência...

OBJECTIVE: To determine the recurrence of hepatitis C in patients subjected to living donor liver transplantation compared to those subjected to cadaveric liver transplantation. METHODS: Of a total of 333 liver transplantations, 279 (83.8 percent) were cadaveric liver transplantation and 54 (16.2 percent) living donor liver transplantation. Hepatic cirrhosis due to hepatitis C virus was the most common indication of both cadaveric liver transplantation (82 patients) and living donor liver transplantation (19 patients). The electronic study protocols of all patients with hepatic cirrhosis due to hepatitis C virus were reviewed. All data, including patients' age and sex, laboratory tests, hepatitis C virus recurrence and acute rejection were evaluated statistically. RESULTS: A total of 55 cadaveric liver transplantation and 10 living donor liver transplantation performed in patients with liver cirrhosis due to hepatitis C virus was included in the study. Clinical and laboratory characteristics of the two groups before the transplantation were similar, except for the prothrombin time that was higher for the cadaveric liver transplantation than the living donor liver transplantation (P = 0.04). Hepatitis C virus recurrence was similar in the cadaveric liver transplantation (n = 37; 69.3 percent) and living donor liver transplantation (n = 7; 70 percent) groups (P = 0.8). The incidence of acute rejection was similar in cadaveric liver transplantation (n = 27; 49 percent) and living donor liver transplantation (n = 2; 20 percent) groups (P = 0.08). Hepatitis C virus recurrence in patients of the cadaveric liver transplantation group who received bolus doses of corticosteroids (9 of 11 patients) was similar to the remained patients (28 of 44 patients) (P = 0.25). Recurrence was also similar in patients of the living donor liver transplantation group who received bolus doses of corticosteroids (one of one patient) in relation to those who did...

Comparação entre exames de imagem e achados operatórios em doadores para transplante hepático intervivos / Comparison of pre-operative exams and per-operative findings in living donor liver transplantation

RACIONAL: No transplante hepático intervivos a anatomia da tríade portal e da drenagem venosa hepática do doador são de suma importância para o sucesso do procedimento. OBJETIVO: Analisar comparativamente os achados de exames de imagem no pré-operatório com os achados cirúrgicos em relação à anatomia da tríade portal e veias de drenagem hepática em doadores para transplante hepático intervivos. MÉTODOS: No período de março de 1998 a agosto de 2005 foram revisados os prontuários dos doadores para transplante hepático intervivos realizados no Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR. A anatomia no pré-operatório foi analisada através de: a) arteriografia celíaca e mesentérica para a artéria hepática e veia porta (fase venosa); b) ressonância magnética para a drenagem venosa, veia porta e vias biliares. Critérios de normalidade foram estabelecidos de acordo com estudos da literatura. Os achados pré-operatórios foram comparados com os achados peroperatórios no doador. RESULTADO: Em relação à anatomia da veia porta e artéria hepática foram estudados 44 pacientes, 16 do sexo feminino e 28 do sexo masculino, com idade média de 33 anos. Em 8 casos foi captado o lobo hepático esquerdo para receptor pediátrico e em 36 casos o lobo hepático direito para receptor adulto. Em relação à anatomia biliar foram estudados 37 casos e em relação à anatomia da drenagem venosa, 32 casos. No total, em 36,36 por cento dos casos, os achados referentes à anatomia nos exames pré-operatórios não coincidiram com os achados peroperatórios. Para a artéria hepática os achados foram discordantes em 11,36 por cento dos casos, para a veia porta foram discordantes em 9,1 por cento, para a drenagem venosa em 9,37 por cento e para as vias biliares em 21,6 por cento. CONCLUSÃO: São freqüentes achados discrepantes referentes à anatomia da tríade portal e drenagem venosa hepática na análise pré-operatória do doador para transplante hepático intervivos...

BACKGROUND: Success in living donor liver transplantation is associated to donor vascular and biliar anatomy. AIM: Compare pre-operative and per-operative findings in living liver donors related to portal vein, hepatic artery, bile duct and hepatic venous drainage anatomy. METHODS: Donors charts of living donor liver transplants done at Clinics Hospital of the Federal University of Paraná, Curitiba, PR, Brazil, were reviewed between March 1998 and August 2005. On the pre-operative period the anatomy was analysed through: celiac and mesenteric arteriography of the hepatic artery and portal vein (venous phase); magnetic resonance imaging of the venous drainage, portal vein and bile duct. Normality was determined based on data of the literature. Pre-operative findings were compared to per-operative findings. RESULTS: Portal vein and hepatic artery were studied in 44 patients, 16 females and 28 males, mean age of 33 years old. In 8 cases the left liver lobe was used to pediatric receptor, in 36 cases the right liver lobe was used to adult receptor. Bile duct anatomy was studied in 37 cases and venous drainage in 32. Over all, the findings related to pre-operative and per-operative anatomy were not coincident in 36.36 percent of the cases. In the case of hepatic artery, they were not coincident in 11.36 percent, in the case of the portal vein in 9.1 percent, in the case of the venous drainage in 9.37 percent and in the case of the bile duct in 21.6 percent. CONCLUSION: The pre-operative and per-operative findings related to vascular and bile duct donor anatomy are frequently different in living donor liver transplantation.

Successful twin pregnancy after orthotopic liver transplantation

Report of a case of successful twin pregnancy following liver transplantation. PATIENT AND METHOD: A 42-year-old nulliparous-woman was subjected to an orthotopic liver transplantation due to Budd-Chiari syndrome. Sixteen months after the transplantation, an ultrasonography revealed twin pregnancy. Her prenatal course was uneventful, except for mild arterial hypertension. The immunosuppressive agents used during pregnancy were cyclosporine and prednisone. RESULT: The patient gave birth to two healthy girls at 37 weeks of gestation. The patient's postpartum course was uneventful with normal liver and renal function tests. CONCLUSION: Following successful pregnancy, women may become pregnant and give birth to normal children, including twins

Resultados do transplante hepático em portadores de hepatocarcinoma / Results of liver transplantation in patients with hepatocellular carcinoma

Hepatocellular carcinoma is one of the most common malignancies worldwide. Liver transplantation has emerged as a good option for early-stage hepatocellular carcinoma yielding survival rates as good as for recipients without this type of tumor. OBJECTIVE: To assess the outcome of cirrhotic patients with hepatocellular carcinoma undergoing liver transplantation at the Liver Transplantation Service of the "Hospital de Clinicas", Federal University of Parana, Curitiba, PR, Brazil. METHODS: Retrospective study of cirrhotic patients with hepatocellular carcinoma undergoing orthotopic liver transplantation at the mentioned Institution between September 1991 and September 2000. The diagnosis of hepatocellular carcinoma was established during the pretransplant workup in five patients and the tumor was an incidental finding in the native liver in three. The indication for liver transplantation was restricted to solitary tumor equal to or less than 5 cm or up to 3 nodules, with each nodule measuring less than 3 cm, and no evidence of vascular invasion or extrahepatic spread. Patient survival and evidence of tumoral recurrence posttransplant were evaluated. RESULTS: The most common cause for pretransplantation liver disease was hepatitis C virus (50%). On examination of the explanted liver, the majority of patients (6/8, 75%) had a single lesion; one patient had two nodules and one had a multifocal hepatocellular carcinoma found incidentally in the native liver. Tumor size ranged from 0.2 to 5.0 cm. All cases had neither vascular invasion nor linfonodal envolvement. All patients remained alive and free of tumor recurrence at the time of the study with a mean follow-up of 18.5 months (range, 5-29 months). CONCLUSION: Liver transplantation is a good therapeutic option for early stage hepatocellular carcinoma arising in cirrhotic patients. With proper selection, liver transplantation can offer excellent survival rates free of tumor recurrence