Navegando por Palavras-chave "liver transplantation"
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- ItemSomente MetadadadosAvaliação da transecção do fígado no transplante hepático pediátrico(Universidade Federal de São Paulo (UNIFESP), 2013-12-20) Benini, Barbara Burza [UNIFESP]; Gonzalez, Adriano Miziara Gonzalez [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Liver transplantation is an effective technique in the treatment of end-stage liver disease. Purpose: The aim of this study was to evaluate the impact of hepatic transection, advanced surgical techique able to tailor size to generate two grafts to from a single donor. Methods: A retrospective study between January 2000 and September 2013, reviewing 91 pediatric patients who underwent 96 liver transplants from deceased donors. Patients were distributed into two groups: whole organ (WO, n 39) and transected liver grafts (TLG, n 57). The folowing was evaluated etiology, anthrophometric parameters (age, weight, height, z score weight/age and height/age), meld or peld, previous surgeries, transfusion of blood components, 1-year survival rate, preoperative laboratory testing, from the second and seventh postoperative days, lactate during surgery, postoperative complications, duration of surgery, duration of cold and warm ischemia, types of biliary reconstruction and laboratory testing of the donor. Results and discussion: The anthropometric values showed significant differences (p<0.05) between the groups. The average age was 124.7 months in the WO and 33.6 months in the TLG group (P<0.0001), while the weight was 28.0 kg and 7.4 kg, respectively (P<0.0001). The analysis of z score weight/age showed that the TLG had greater acute and chronic malnutrition, probably due to the etiology of liver disease, present from birth in patients as young. Red blood transfusion was higher in the group TLG (P<0.0006) due to the cut surface of the graft, emphasizing the use and improvement of hemostatic techniques. Despite differences between the groups, clinical or surgical complications were similar, showing that liver transection injury didn’t change the results of transplantation. Conclusion: There was no impact on liver function, graft or 1-year patient survival after liver transection. Transection liver transplantation is an effective method as an alternative to liver pediatric transplantation. Among the factors related to death, lactate and rate of blood transfusion were statistically relevant.
- ItemAcesso aberto (Open Access)Capacidade física e reprodutibilidade do teste de caminhada de seis minutos em crianças e adolescentes após o transplante hepático(Universidade Federal de São Paulo (UNIFESP), 2011-05-25) Silva, Rosangela Maria da [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introdução: O transplante hepático pediátrico é um dos mais bem sucedidos transplantes de órgãos sólidos. Independente do tipo de transplante de órgãos, a fase pós-operatória representa um período de importante redução na capacidade de exercício do receptor. Unnitban et al., 2006, reportaram baixo nível de condicionamento cardiopulmonar, em crianças após o transplante hepático, quando comparadas a crianças saudáveis. O teste de esforço cardiopulmonar é o padrão-ouro para avaliação do condicionamento cardiopulmonar. No entanto, não é um procedimento disponível para avaliação diária, sobretudo na população pediátrica, pois requer equipamentos e habilidade técnica específica. Em contraste, o teste da caminhada de seis minutos (TC6’) é um teste prático, seguro, barato, de fácil execução, que reflete melhor as atividades de vida diária. Objetivo: Avaliar a reprodutibilidade e a capacidade física do TC6’, em crianças e adolescentes após o transplante hepático, comparando-as com valores de referência obtidos em crianças brasileiras saudáveis e, secundariamente, analisar a relação entre a distância caminhada em seis minutos (DC6’) com variáveis antropométricas e clínicas. Método: Estudo transversal prospectivo, realizado de Janeiro de 2009 a Dezembro de 2010. Amostra de conveniência de 23 crianças e adolescentes no pós- transplante hepático, entre seis a dezessete anos de idade, ambos os sexos, acompanhadas no ambulatório de transplante hepático, da Universidade Federal de São Paulo, UNIFESP/EPM, São Paulo (Brasil). Medidas antropométricas e de função pulmonar foram obtidas utilizando protocolos padrão. O TC6’ foi conduzido, de acordo com os critérios da ATS 2002, em um corredor de 20 metros. Dois testes foram realizados em intervalos de trinta minutos. Os critérios de interrupção ocorreram na presença de sintomas clínicos. As variáveis fisiológicas foram mensuradas no repouso e ao final do teste. A reprodutibilidade do TC6’ foi avaliada em todas as crianças do estudo. A relação entre a distância caminhada e o trabalho (produto da distância caminhada pelo peso corpóreo) foi avaliada com medidas antropométricas, clínicas e de função pulmonar.Resultados: 23 participantes (56,5%) foram do sexo feminino e média de idade (148,87 ± 34,58 meses). A reprodutibilidade do TC6’ (ICC= 0,63) foi boa na população do estudo. Comparada aos valores de referência de Aquino et al., 2010, a média da distância caminhada das crianças e adolescentes no póstransplante foi significantemente reduzida (p<0,001). A DC6’ apresentou moderada correlação com o volume corrente (r=0,5, p<0,015). O trabalho da distância caminhada mostrou significante correlação com a idade (r=0,6 p<0,004), peso (r=0,9 p<0,001), altura (r=0,8 p<0,001), IMC (r=0,6 p<0,002), CVF (r=0,7 p<0,001), pico de fluxo (r=0,6 p<0,002) e VM (r=0,4 p<0,038). Na análise de regressão múltipla as variáveis idade, CVF e VM influenciaram em 78,6% a variância do trabalho da distância caminhada (ω). Conclusão: O TC6’ é reprodutível em crianças e adolescentes após o transplante hepático. Estes pacientes apresentaram menor capacidade física, comparativamente aos valores de referência de crianças saudáveis. O trabalho da distância caminhada (ω) parece ser um parâmetro adicional na determinação da capacidade física destes pacientes, comparado à distância caminhada isoladamente.
- ItemAcesso aberto (Open Access)Epidemiology of fungal infections in liver transplant recipients: a six-year study of a large Brazilian liver transplantation centre(Instituto Oswaldo Cruz, Ministério da Saúde, 2011-05-01) Zicker, Michelle [UNIFESP]; Colombo, Arnaldo Lopes [UNIFESP]; Ferraz-neto, Ben-hur; Camargo, Luis Fernando Aranha [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital Israelita Albert EinsteinLiver transplant seems to be an effective option to prolong survival in patients with end-stage liver disease, although it still can be followed by serious complications. Invasive fungal infections (ifi) are related to high rates of morbidity and mortality. The epidemiology of fungal infections in Brazilian liver transplant recipients is unknown. The aim of this observational and retrospective study was to determine the incidence and epidemiology of fungal infections in all patients who underwent liver transplantation at Albert Einstein Israeli Hospital between 2002-2007. A total of 596 liver transplants were performed in 540 patients. Overall, 77 fungal infections occurred in 68 (13%) patients. Among the 77 fungal infections, there were 40 IFI that occurred in 37 patients (7%). Candida and Aspergillus species were the most common etiologic agents. Candida species accounted for 82% of all fungal infections and for 67% of all IFI, while Aspergillus species accounted for 9% of all fungal infections and for 17% of all IFI. Non-albicans Candida species were the predominant Candida isolates. Invasive aspergillosis tended to occur earlier in the post-transplant period. These findings can contribute to improve antifungal prophylaxis and therapy practices in Brazilian centres.
- ItemSomente MetadadadosFactors associated with nutritional status in liver transplant patients who survived the first year after transplantation(Wiley-Blackwell, 2010-02-01) Carvalho, Luciana de [UNIFESP]; Parise, Edison Roberto [UNIFESP]; Samuel, Didier; Universidade Federal de São Paulo (UNIFESP); Univ Paris 11Background and Aims: Most studies published focus on the evaluation of the impact of nutritional status on the morbidity and mortality during the immediate postoperative period or on the short-term evolution of liver transplant patients. the aim of the study was to evaluate long-term trends in nutritional status.Methods: Seventy patients consecutively submitted to liver transplantation were studied. Nutritional assessment was performed the day before transplantation and the 45, 90, 180 and 365 days after transplantation, consisting of determination of dietary intake, anthropometric and biochemical analysis.Results: Sixty-nine percent of the patients presented with malnutrition on the day before liver transplantation, decreasing to 44% at end of the first year. the prevalence of protein-calorie malnutrition (PCM) was 63% at 90 days post-transplant. A significant difference of PCM was observed between patients with cirrhosis and non-cirrhotic disease (53.6% x 100%) at 90 days post-transplant. the pre-transplant nutritional diagnosis and 90-day calorie intake were identified as variables independently associated with nutritional status at 90 days post-transplant. the variables independently associated with nutritional status in the 1-year assessment were pre-transplant PCM and 365-day calorie requirements.Conclusion: No influence on nutritional status was observed for peri- or postoperative factors after 3 or 12 months of follow up. As expected, dietary factors, especially adequate calorie intake, were always associated with nutritional status during all periods analyzed.
- ItemSomente MetadadadosFunctional capacity after pediatric liver transplantation: A pilot study(Wiley-Blackwell, 2014-09-01) Silva, Rosangela Maria da [UNIFESP]; Carvalho, Werther Brunow de; Johnston, Cintia [UNIFESP]; Castro, Mariela Borba de [UNIFESP]; Ferreira, Israel Manta [UNIFESP]; Patti, Camilla L. [UNIFESP]; Azevedo, Ramiro Anthero de [UNIFESP]; Gonzalez, Adriano Miziara [UNIFESP]; Linhares, Marcelo Moura [UNIFESP]; Salzedas-Netto, Alcides Augusto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)The prospective cross-sectional study investigated the 6MWT performance in pediatric group of liver transplant recipients (6-17 yr, median post-transplantation time of 22 months) and compared to the normal values obtained in healthy children as well as evaluated the reproducibility of the 6MWT. We analyzed the relationship between walked distance and the 6MWw, distance walked x body weight) with the anthropometric, clinical, and pulmonary functions. in post-transplanted group, the average walked distance was significantly shorter compared with control (687 +/- 80 m vs. 511 +/- 72 m, p < 0.001). the calculated ICC coefficient confirmed the reproducibility among tests. the Pearson correlation revealed that only walked distance in the 6MWT was moderately correlated with tidal volume. Conversely, the 6MWw was significantly correlated with age, weight, height, BMI, FVC, PEF rate, and volume expiratory. According to multiple regression analysis, age, VE and FVC factors explained 80% of the variance in the 6MWw. in conclusion, the pediatric liver transplant recipients' performance in the 6MWT is significantly lower than the values for healthy children of the same age. Notably, the 6MWw may provide relevant information, constituting an additional parameter in the determination of functional capacity.
- ItemSomente MetadadadosIschemic preconditioning prevents apoptotic cell death and necrosis in early and intermediate phases of liver ischemia-reperfusion injury in rats(Taylor & Francis Inc, 2006-07-01) Quireze Junior, Claudemiro [UNIFESP]; Montero, Edna Frasson de Souza [UNIFESP]; Leitao, Regina Maria Cubero [UNIFESP]; Juliano, Yara [UNIFESP]; Fagundes, Djalma José [UNIFESP]; Poli de Figueiredo, Luiz Francisco [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Ischemic preconditioning (IPC) may be useful in attenuating the hepatic ischemia reperfusion (IR) syndrome by means of improving cell resistance to anoxia and reoxygenation and preventing cell death. Since there are insufficient data available regarding the chronology of preconditioning effects, we investigated the role of IPC, to test the hypothesis that liver protection would occur during the early and intermediate phases of the reperfusion period. Wistar rats ( n = 72) were randomly assigned into six experimental groups, 12 animals each. A 40-min ischemia to the left lateral and median liver lobes was induced by selective hepatic pedicle clamping followed by 30 min or 240 min of reperfusion (IR30 and IR240). IPC groups (IPC30 and IPC240) underwent a 10 min of ischemia followed by 10 min of reperfusion preceding the definitive 40-min ischemic period. Sham-operated animals were followed for 30 and 240 min. Hepatic enzymes and histological evaluation were performed after the reperfusion period. Hepatic ischemia-reperfusion (IR30 and IR240) induced marked increases in liver enzymes levels after 30 min and particularly after 240 min. IPC effectively attenuated those enzymatic increases. Microvesicular steatosis was observed after 30 min, but not 240 min, of reperfusion in both IPC and IR livers. Necrosis was detected in 66.7% of IR240 and only in 8.3% of IPC240. Both hepatocyte and sinusoidal apoptosis were markedly attenuated by IPC. We conclude that IPC provided protection against hepatic ischemia reperfusion injury in early and intermediate phases of the reperfusion period, reducing hepatic enzymatic leakage and ameliorating hepatic apoptosis and necrosis.
- ItemSomente MetadadadosLiver retransplantation: A model for determining long-term survival(Lippincott Williams & Wilkins, 2006-04-15) Linhares, M. M.; Azoulay, D.; Matos, D.; Castelo, A.; Trivino, T.; Goldenberg, A.; Castaing, D.; Adam, R.; Delvart, V; Ichai, P.; Saliba, F.; Lemoine, A.; Samuel, D.; Bismuth, H.; Universidade Federal de São Paulo (UNIFESP); Hop Paul Brousse; Univ Paris SudBackground. Because of the worse results from retransplantation in relation to the initial liver transplantation, there is a need to refine the indication for retransplantation, such that fair distribution of this benefit is obtained.Methods. This was a Study of 139 patients who underwent liver retransplantation. Thirty variables were studied: 18 relating to the recipient and 12 to the donor. All the independent variables were initially compared with the length of survival using univariate analyses. Variables presenting significance were compared with the dependent variable of length of survival, to determine which factors were related to longer survival among patients, when evaluated together.Results. A multivariate model for determining long-term survival among patients with retransplants was built up using the following variables: recipient's age, creatinine, urgency of retransplantation and early failure of the first graft. Through this multivariate model it was possible to determine a score that was categorized according to tertile distributions (below the 33rd percentile, score < 24; 33rd to 66th percentile, 24 <= score <= 32; above the 66th percentile, score > 32). One-year, 3-year, and 5-year patient survival rates following retransplantation were respectively 85%, 82%, and 77% for scores < 24; 69%, 66%, and 61% for scores between 24 and 32; and 21%, 19%, and 16% for scores > 32 (P < 0.0001).Conclusion. the variables of recipient's age, creatinine, urgency of retransplantation, and early failure of the initial transplantation were factors that were independently related to the long-term survival of patients with liver retransplants.