Impact of hypoxemia on pediatric liver transplantation for hepatopulmonary syndrome.

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.

Living donor liver transplantation for neonatal fulminant hepatitis due to herpes simplex virus infection.

Although rare, ALF caused by disseminated HSV infection is associated with high mortality in the neonatal population. This condition is often diagnosed relatively late due to the absence of specific signs. We present a case involving a neonate with ALF submitted to living donor liver transplantation without a prior diagnosis. The patient had no skin or mucosal lesions, and IgM serology was negative for HSV-1 and HSV-2. Immunohistochemical staining of the liver explant was positive for herpes virus infection, and the patient subsequently received antiviral drug treatment, with a good outcome. Due to organ shortages and the rarity of the aforementioned condition, LT has seldom been reported for the treatment of ALF caused by herpes virus infection; however, LT may be the only option for neonates with fulminant hepatitis. The use of living donors in an urgent scenario is well established in Eastern countries and safely applicable for pediatric patients with ALF.

[Hepatitis C and pregnancy: an analysis of factors associated with vertical transmission]. / Hepatite C e gestação: análise de fatores associados à transmissão vertical.

INTRODUCTION: Data concerning hepatitis C virus infection during pregnancy in Brazilian medical services are scarce. This study aimed to verify factors associated with vertical transmission (VT) of HCV in pregnant women. METHODS: Observational transversal study of pregnant women from Campo Grande, MS, central Brazil, with confirmed reagent serology for HCV infection from 2002 to 2005. Vertical transmission was considered to be positive HCV serology by ELISA, confirmed by PCR, after 18 months of life of the newborn. The factors studied associated with VT were: delivery mode, time of premature rupture of membranes, breastfeeding, blood transfusion history, drug addiction, number of sexual partners and the presence of body tattoos. RESULTS: Fifty-eight pregnant women with HCV infection were identified, indicating a prevalence rate of 0.2% (58/31,187). Of these 58 pregnant women,23 (39.6%) fulfilled the inclusion criteria. The VT rate was 13% (3/23), and the most frequent HCV viral subtypes were 1a (53%), 1b (30%), 2b (4%) e 3a (13.0%). Two (8.7%) patients were coinfected with HIV. A significant association (p < 0.05) was observed between VT and high maternal serum viremia (> 2.5 x 10(6)) and VT and the use of illicit drugs by the mother. CONCLUSIONS: The present study demonstrates that high serum maternal viremia for HCV and the use of illicit drugs by the mother are associated with vertical transmission of HCV.

Hepatite C e gestação: análise de fatores associados à transmissão vertical / Hepatitis C and pregnancy: an analysis of factors associated with vertical transmission

INTRODUÇÃO: Informações sobre hepatite C durante a gestação em serviços brasileiros são escassas. O objetivo deste estudo foi verificar os fatores associados à transmissão vertical do vírus da hepatite C em gestantes. MÉTODOS: Estudo observacional, transversal, realizado em gestantes procedentes do município de Campo Grande/MS, que apresentaram sorologia reagente e confirmada para VHC, no período de 2002 a 2005. Considerou-se transmissão vertical sorologia VHC positiva por ELISA, confirmada com PCR, após os 18 meses de vida do recém-nascido. Considerou-se fatores associados a TV: tipo de parto, tempo de rotura de membranas, amamentação, histórico de transfusões sanguíneas prévias, uso de drogas ilícitas, número de parceiros sexuais e presença de tatuagens pelo corpo. RESULTADOS: Identificou-se 58 gestantes portadoras do VHC, revelando prevalência de infecção de 0,2 por cento (58/31.187). Das 58 pacientes, 23 (39,6 por cento) preencheram os critérios de inclusão no estudo. A taxa de TV foi de 13 por cento (3/23), sendo os subtipos virais mais frequentes: 1a (53 por cento), 1b (30 por cento), 2b (4 por cento) e 3a (13 por cento). Duas (8,7 por cento) pacientes apresentaram co-infecção pelo HIV. Houve associação (p < 0,05) entre TV e carga viral elevada (> 2,5x10(6)) e entre TV e uso de drogas ilícitas pela mãe (p < 0,05). CONCLUSÕES: O presente estudo demonstra que elevada viremia materna e o uso de drogas ilícitas pela mãe associam-se a transmissão materno-fetal do VHC.

INTRODUCTION: Data concerning hepatitis C virus infection during pregnancy in Brazilian medical services are scarce. This study aimed to verify factors associated with vertical transmission (VT) of HCV in pregnant women. METHODS: Observational transversal study of pregnant women from Campo Grande, MS, central Brazil, with confirmed reagent serology for HCV infection from 2002 to 2005. Vertical transmission was considered to be positive HCV serology by ELISA, confirmed by PCR, after 18 months of life of the newborn. The factors studied associated with VT were: delivery mode, time of premature rupture of membranes, breastfeeding, blood transfusion history, drug addiction, number of sexual partners and the presence of body tattoos. RESULTS: Fifty-eight pregnant women with HCV infection were identified, indicating a prevalence rate of 0.2 percent (58/31,187). Of these 58 pregnant women,23 (39.6 percent) fulfilled the inclusion criteria. The VT rate was 13 percent (3/23), and the most frequent HCV viral subtypes were 1a (53 percent), 1b (30 percent), 2b (4 percent) e 3a (13.0 percent). Two (8.7 percent) patients were coinfected with HIV. A significant association (p < 0.05) was observed between VT and high maternal serum viremia (> 2.5x10(6)) and VT and the use of illicit drugs by the mother. CONCLUSIONS: The present study demonstrates that high serum maternal viremia for HCV and the use of illicit drugs by the mother are associated with vertical transmission of HCV.