RESUMO
BACKGROUND AND AIMS: Liver transplantation (OLT) in children has seen significant improvements in recent years. Long-term immunosuppressive strategies have focused on avoiding the risks of long-term immunosuppression, particularly nephrotoxicity, de novo malignancy and late infections. Since its introduction in renal transplantation in 1999, sirolimus (SRL) has been used by an increasing number of liver transplant centers. The aim of this study was to review the experience using SRL in pediatric liver transplant recipients at a single center. METHODS: Between 1989 and 2006, 318 children underwent OLT including 13 who were converted to SRL therapy because of tacrolimus-related side effects. The indications were posttransplant lymphoproliferative disease (PTLD; n = 11), nephrotoxicity (n = 1), and de novo autoimmune hepatitis (n = 1). One patient with PTLD previously concurrently displayed chronic rejection. SRL dosages ranged between 0.4 and 5 mg/d. The median duration of follow-up was 18 months. RESULTS: PTLD recurred in 1 patient. There were no episodes of acute rejection. One child developed hyperlipidemia that resolved with diet and medication. CONCLUSIONS: Conversion from tacrolimus to SRL in selected pediatric liver transplant recipients is safe. Children with PTLD may benefit from immunosuppression with SRL after liver transplantation.
Assuntos
Transplante de Fígado/imunologia , Sirolimo/uso terapêutico , Adolescente , Cadáver , Criança , Pré-Escolar , Feminino , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Lactente , Falência Hepática/cirurgia , Transplante de Fígado/efeitos adversos , Doadores Vivos , Transtornos Linfoproliferativos/etiologia , Masculino , Complicações Pós-Operatórias/imunologia , Estudos Retrospectivos , Tacrolimo/efeitos adversos , Doadores de TecidosRESUMO
BACKGROUND AND PURPOSE: Late portal vein thrombosis (PVT) can be extremely well tolerated, although portal hypertension and other consequences of the long-term deprivation of portal inflow to the graft may be hazardous, especially in young children. Recently, the "Rex shunt" has been used successfully to treat these patients. We now report the initial experience with this novel technique. METHODS: A 3-year-old girl with PVT at 7 months after whole organ cadaveric liver transplant displayed portal hypertension with an episode of gastrointestinal bleeding, requiring a mesenteric-portal surgical shunt ("Rex shunt") using a left internal jugular vein autograft. RESULTS: Upon current follow-up of 6 months, postoperative Doppler ultrasound confirmed shunt patency. Endoscopic status was significantly improved after surgery with resolution of portal hypertension. There was no recurrence of bleeding. CONCLUSIONS: The mesenteric-portal shunt ("Rex shunt"), using a left internal jugular vein autograft, should be considered for children with late PVT after liver transplantation. Although this is an initial experience, we may conclude that this technique is feasible, with great potential benefits and low risks for these patients.
Assuntos
Hipertensão Portal/cirurgia , Transplante de Fígado/efeitos adversos , Trombose Venosa/cirurgia , Cadáver , Pré-Escolar , Varizes Esofágicas e Gástricas/etiologia , Feminino , Seguimentos , Humanos , Hipertensão Portal/etiologia , Veias Jugulares/cirurgia , Esplenomegalia/cirurgia , Doadores de Tecidos , Transplante Autólogo , Trombose Venosa/etiologiaRESUMO
La malformación adenomatoidea quística(MAQ)es una enfermedad congénita pulmonar rara,con cuadro clínico variable,pudiendo ser asintomática y diagnosticada a través de radiografías de tórax ocasionales o presentar graves síntomas en la vida intrauterina llevando la hidropesía fetal y muerte antes del nacimiento.En los 16 siguientes el diagnóstico fue realizado en el periódo prenatal,siendo analizados los signos y síntomas,el pronóstico y el resultado quirúrgico.Los autores concluyen que la forma microquística y la hidropesía fetal son los factores de peor pronóstico.La desviación del mediastino sin hidropesia y la precocidad del diagnóstico no están asociados a peor pronóstico.La intervención quirúrgica del feto sólo debe ser indicada en los pacietnes menores de 32 semanas,cuando presenta asociación de un quiste pulmonar grande produciendo hidropesia.La lobectomía,tratamiento definitivo de los pacientes sintomáticos,debe efectuarse luego del nacimiento -
Assuntos
Lactente , Cirurgia Geral , Hidropisia Fetal , Malformação Adenomatoide Cística Congênita do Pulmão/cirurgia , Malformação Adenomatoide Cística Congênita do Pulmão/diagnóstico , Pneumonectomia , PediatriaRESUMO
La malformación adenomatoidea quística(MAQ)es una enfermedad congénita pulmonar rara,con cuadro clínico variable,pudiendo ser asintomática y diagnosticada a través de radiografías de tórax ocasionales o presentar graves síntomas en la vida intrauterina llevando la hidropesía fetal y muerte antes del nacimiento.En los 16 siguientes el diagnóstico fue realizado en el periódo prenatal,siendo analizados los signos y síntomas,el pronóstico y el resultado quirúrgico.Los autores concluyen que la forma microquística y la hidropesía fetal son los factores de peor pronóstico.La desviación del mediastino sin hidropesia y la precocidad del diagnóstico no están asociados a peor pronóstico.La intervención quirúrgica del feto sólo debe ser indicada en los pacietnes menores de 32 semanas,cuando presenta asociación de un quiste pulmonar grande produciendo hidropesia.La lobectomía,tratamiento definitivo de los pacientes sintomáticos,debe efectuarse luego del nacimiento -
