INTERNATIONAL NORMALIZED RATIO AND ACTIVATED PARTIAL THROMBOPLASTIN TIME DO NOT PREDICT PLASMA TRANSFUSION IN LIVER TRANSPLANTATION.

Background: Blood loss during liver transplantation (LT) remains a major concern associated with increased morbidity and reduced patient and graft survival. The high complexity of the procedure associated with the multifaceted origin of the bleeding urges early identification of high-risk patients and proper monitoring of hemostasis disorders in order to improve results. The accuracy of international normalized ratio (INR) and activated partial thromboplastin time (aPTT) to evaluate coagulation status in cirrhotic patients has been doubted.

Left Gastric Vein Direct Anastomosis as Alternative to Portal Flow Reconstruction in Liver Transplantation.

Introduction: The most relevant limiting factor for performing end-to-end anastomosis is portal vein thrombosis (PVT), which leads to challenging vascular reconstructions. This study aimed to analyze a single center's experience using the left gastric vein (LGV) for portal flow reconstruction in liver transplantation (LT).

Methods: This retrospective observational study reviewed laboratory and imaging tests, a description of the surgical technique, and outpatient follow-up of patients with portal system thrombosis undergoing LT with portal flow reconstruction using the LGV.

Extended left hepatectomy associated with resection of the vena cava and suprahepatic veins by in situ perfusion to treat intrahepatic cholangiocarcinoma.

Cholangiocarcinoma is a heterogeneous group of aggressive tumors that correspond to the second most common primary liver tumor. They can be classified according to their anatomical position concerning the biliary tree, and each subtype demonstrates different behavior and treatment. A 38-year-old male patient presenting solely right lumbar pain was diagnosed with a 7 cm hepatic tumor involving segments I, Iva, and VIII associated with involvement of the hepatic veins.

PERORAL ENDOSCOPIC MYOTOMY FOR ACHALASIA: SAFETY PROFILE, COMPLICATIONS AND RESULTS OF 94 PATIENTS.

Background: Achalasia is an esophageal motility disorder, with clinical presentation of dysphagia and regurgitation. This is a chronic condition with no cure. Current treatment options aim to reduce lower esophageal sphincter tone by pharmacological, endoscopic or surgical means, with the aim of improving patients' symptoms.

Assessment of the need for routine intraoperative cell salvage in liver transplantation.

Purpose: This study aimed to assess the necessity of routine intraoperative cell salvage in liver transplantations.

Methods: A total of 327 liver transplants performed between 2014 and 2016 was included in the analysis. Patient data, including pre-transplant examinations, intraoperative red blood cell transfusions, and procedural information, were collected.

Liver transplant in patients with primary sclerosing cholangitis: A retrospective cohort from Northeastern Brazil.

Background: Primary sclerosing cholangitis (PSC) manifests within a broad ethnic and racial spectrum, reflecting different levels of access to health care.

Aim: To evaluate the clinical profile, complications and survival rates of patients with PSC undergoing liver transplantation (LTx) at a Brazilian reference center.

Methods: All patients diagnosed with PSC before or after LTx were included.

LIVER TRANSPLANT FOR METASTATIC NEUROENDOCRINE TUMORS: A SINGLE-CENTER REPORT.

Background: Neuroendocrine tumors are rare neoplasms of uncertain biological behavior. The liver is one of the most common sites of metastases, occurring in 50% of patients with metastatic disease.

Aims: To analyze a clinical series in liver transplant of patients with neuroendocrine tumors metastases.

Understanding the Elevated Lethality of COVID-19 in Liver Transplant Recipients: Does Immunosuppression Management Matter? Results from a Brazilian Multicentric Historical Cohort.

Background: Infections by SARS-CoV-2 in liver transplant recipients (LT) patients are of particular concern, notably due to perceived added risks related to immunosuppression and comorbidity burden. Current literature on this topic often relies on small, non-standardized, and geographically limited studies. This manuscript describes COVID-19 presentations and causes for elevated mortality in a large cohort of LT recipients.

PANCREATECTOMY AND HEPATECTOMY: A COMBINED SURGICAL RESECTION OF PSEUDOPAPILLARY SOLID TUMOR OF PANCREAS ASSOCIATED WITH HEPATIC METASTASIS.

Background: Solid pseudopapillary tumor of the pancreas has been frequently reported in the past two decades. Surgery remains the treatment of choice, with the liver being the most frequent site of metastases.

Aims: The study aimed to present an option of surgical treatment for an 18-year-old female patient with a solid lesion in the body and tail of the pancreas associated with metastatic lesions in both hepatic lobes.

The Effect of a Comprehensive Rehabilitation Program on Respiratory Function and Functional Capacity on Patients After 1 Month to Liver Transplantation.

Background: Physical exercise is prescribed in populations with chronic diseases, but data are scarce in the liver transplantation (LT) setting.

Objective: The aim of this study was to evaluate changes in forced expiratory volume in the first second, forced vital capacity, maximal inspiratory pressure, maximal expiratory pressure, 6-minute walking test (6MWT), 6-minute step test (6MST), Duke Activity Status Index, VO (mL/kg/min), and health-related quality of life (in patients submitted to a rehabilitation program, comprising physical exercise training, breathing techniques, and educational sessions after LT.

Methods: This cohort study enrolled patients to an 8-week period of thrice weekly comprehensive supervised rehabilitation program after 1 month of LT.

Perception of Brazilian medical students toward organ donation.

Objective: Brazil ranks second in gross numbers of kidney and liver transplantations, but deceased organ donation is still far below the national demand for organs. Apart from a high family refusal rate, another significant barrier is healthcare workers' inappropriate knowledge concerning organ donation and transplantation. Since most of them have recently graduated from university, this study aimed to evaluate the awareness and attitudes of medical students concerning organ donation.

Organ Transplant From SARS-CoV-2-Positive Donors: A Brazilian Experience.

Since March 2022, donors with detectable SARS-CoV-2 RNA have been accepted for extrapulmonary organ transplants in Brazil. In this report, we described 11 successful organ transplants (6 kidney, 5 liver) from 5 asymptomatic infected donors.

BILIARY FISTULAS ASSOCIATED WITH LIVER TRANSPLANTATION VERSUS OTHER ETIOLOGIES: WHAT IS THE SUCCESS RATE OF THE ENDOSCOPIC TREATMENT?

Background: Biliary fistulas typically occur as surgical complications after laparoscopic cholecystectomy, liver transplantation, or partial liver resection.

Aims: This study aimed to evaluate the efficacy of the endoscopic treatment of biliary fistulae secondary to liver transplantation compared to that of other etiologies.

Methods: A retrospective study of 25 patients undergoing endoscopic retrograde cholangiopancreatography for biliary fistula from 2015 to 2021 was conducted at the Endoscospy Unit of Walter Cantídio University Hospital.

LIVER TRANSPLANTATION IN HIV PATIENTS: A CASE SERIES FROM THE NORTHEAST REGION OF BRAZIL.

Background: The emergence of potent combined highly active antiretroviral therapy (ART) in 1996 changed the natural history of HIV infection, with a significant reduction in mortality due to opportunistic infections but increased morbidity due to chronic cardiovascular, hepatic, and renal diseases. In May 2016, a reference center for liver transplantation in the Northeast of Brazil performed the first liver transplantations (LT) in HIV patients, with five others until 2021.

Methods: The criteria for selection of LT were good adherence and absence of resistance to ART, HIV viral load maximum suppression, T-CD4+ lymphocyte count of more than 100 cells/mm3, and absence of opportunistic infections in the last 6 months.

ACCURACY OF ELASTOGRAPHY IN THE ASSESSMENT OF REDUCTION IN LIVER STEATOSIS AND FIBROSIS IN THE EARLY POSTOPERATIVE PERIOD AFTER BARIATRIC SURGERY.

Background: Nonalcoholic hepatic steatosis is found in most obese patients and has a strong association with metabolic syndrome. The Roux-en-Y gastric bypass and the sleeve gastrectomy are the two techniques of bariatric surgery. Patients who underwent bariatric surgery have regression of nonalcoholic steatohepatitis due to a reduction in body mass index and changes in incretin hormones.

PRELIMINARY DATA ON LIVER TRANSPLANTATION IN HYDATIDOSIS DISEASE.

Aim: Hydatidosis is a rare and endemic parasitic disease in Brazil that causes the proliferation of cysts mainly in the liver, leading to many complications, such as compression of vessels and biliary ducts, liver failure, portal hypertension, and cirrhosis. The treatment of choice is the resection of the lesions combined with albendazole therapy. This disease is a rare indication for liver transplantation, a feasible treatment option in more advanced stages.

RISK FACTORS ASSOCIATED WITH HEPATIC ARTERY THROMBOSIS: ANALYSIS OF 1050 LIVER TRANSPLANTS.

Background: Hepatic artery thrombosis is an important cause of graft loss and ischemic biliary complications. The risk factors have been related to technical aspects of arterial anastomosis and non-surgical ones.

Aim: To evaluate the risk factors for the development of hepatic artery thrombosis.

Impact of Brazilian expanded criteria for liver transplantation in patients with hepatocellular carcinoma: a multicenter study.

Introduction And Objectives: Hepatocellular carcinoma (HCC) is one of the main indications for orthotopic liver transplantation (OLT). In Brazil, selection criteria for HCC is an expanded version of the Milan Criteria (MC), the so-called "Brazilian Milan Criteria" (BMC). Our aims were to evaluate post-OLT outcomes in patients with HCC and analyze the BMC performance.

Intraoperative systemic biomarkers predict post-liver transplantation acute kidney injury.

Objective: Liver transplant (LT) is a definitive therapeutic option for patients with chronic liver disease. However, acute kidney injury after LT (post-LT AKI) is a frequent complication that may lead to graft dysfunction and decrease life expectancy. Delay in AKI detection by traditional biomarkers boosted research with new biomarkers for post-LT AKI as neutrophil gelatinase-associated lipocalin (NGAL) and syndecan-1.

BRAZILIAN SOCIETY OF HEPATOLOGY UPDATED RECOMMENDATIONS FOR DIAGNOSIS AND TREATMENT OF HEPATOCELLULAR CARCINOMA.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2015 its first recommendations about the management of HCC. Since then, new data have emerged in the literature, prompting the governing board of SBH to sponsor a single-topic meeting in August 2018 in São Paulo.

Prospective evaluation of immune haemolysis in liver transplantation.

Background: Immune haemolysis in liver transplant (LT) can occur due to autoantibodies and alloantibodies. The aim of this study was to evaluate the prevalence and risk factors for immune haemolysis in LT.

Methods: A total of 175 consecutive patients were included.

LIVER TRANSPLANTATION FOR BILE DUCT INJURY AFTER CHOLECYSTECTOMY.

Background: Bile duct injury is a life-threatening complication that requires proper management to prevent the onset of negative outcomes. Patients may experience repeated episodes of cholangitis, secondary biliary cirrhosis, end-stage liver disease and death.

Objective: To report a single center experience in iatrogenic secondary liver transplantation after cholecystectomy and review the literature.

ASSOCIATION BETWEEN FATIGUE AND EXERCISE CAPACITY IN PATIENTS WITH CHRONIC LIVER DISEASE AWAITING LIVER TRANSPLANTATION.

Background: Fatigue is highly prevalent in end stage liver disease, the studies about its association with exercise capacity in cirrhotic patients before liver are scarse.

Objective: In this study, we evaluated fatigue in 95 in end stage liver disease patients awaiting transplantation, compared to healthy volunteers, and tested the association between exercise capacity and fatigue.

Methods: Cross-sectional study of patients with chronic liver disease treated at a referral center in Fortaleza, Brazil.

Hepatocellular carcinoma recurrence after liver transplantation in a Brazilian multicenter study: clinical profile and prognostic factors of survival.

Background: Liver transplantation (LT) is the treatment of choice for patients with unresectable early hepatocellular carcinoma (HCC). Post-LT HCC recurrence rates range from 8 to 20% and still impact on overall survival (OS). The aim of our study was to evaluate the impact of HCC recurrence on post-LT survival and analyze prognostic factors among those patients with recurrence.

PREOPERATIVE RISK FACTORS FOR ACUTE KIDNEY INJURY AFTER LIVER TRANSPLANTATION: RESULTS FROM A CROSS-SECTIONAL STUDY IN NORTHEAST OF BRAZIL.

Background: Acute kidney injury (AKI) is a common complication in the immediate postoperative period of patients undergoing liver transplantation.

Objective: The aim of this study was to evaluate preoperative risk factors for AKI after liver transplantation.

Methods: A cross-sectional study was conducted with adults submitted to orthotopic liver transplantation at a reference hospital in Fortaleza, Northeast of Brazil, from January to December 2016.