Long-term Outcome of a Modified Piggyback Liver Transplantation Technique Using the Recipient's Right and Middle Hepatic Veins.

Unlabelled: In early piggyback liver transplantation (LT) descriptions, the common stump of the middle and left hepatic veins (ML) was used for upper caval anastomosis. In this variant, stenosis or kinking of graft venous outflow path was frequent. Over time, most authors adopted the use of the recipient's right, middle, and left hepatic veins (RML) or a side-to-side anastomosis (SS) between the graft's and recipient's inferior vena cava (IVC).

LIVER TRANSPLANTATION FOR CARCINOMA HEPATOCELLULAR IN SÃO PAULO: 414 CASES BY THE MILAN/BRAZIL CRITERIA.

Background: The criterion of Milan (CM) has been used as standard for indication of liver transplantation (LTx) for hepatocellular carcinoma (HCC) worldwide for nearly 20 years. Several centers have adopted criteria expanded in order to increase the number of patients eligible to liver transplantation, while maintaining good survival rates. In Brazil, since 2006, the criterion of Milan/Brazil (CMB), which disregards nodules <2 cm, is adopted, including patients with a higher number of small nodules.

Consensus, Dilemmas, and Challenges in Living Donor Liver Transplantation in Latin America.

We reviewed the history, volume, outcomes, uniqueness, and challenges of living donor liver transplantation (LDLT) in Latin America. We used the data from the Latin American and Caribbean Transplant Society, local transplant societies, and opinions from local transplant experts. There are more than 160 active liver transplant teams in Latin America, but only 30 centers have used LDLT in the past 2 years.

Prospective Randomized Trial Comparing Hepatic Venous Outflow and Renal Function after Conventional versus Piggyback Liver Transplantation.

Background: This randomized prospective clinical trial compared the hepatic venous outflow drainage and renal function after conventional with venovenous bypass (n = 15) or piggyback (n = 17) liver transplantation.

Methods: Free hepatic vein pressure (FHVP) and central venous pressure (CVP) measurements were performed after graft reperfusion. Postoperative serum creatinine (Cr) was measured daily on the first week and on the 14th, 21st and 28th postoperative days (PO).

Model for End-Stage Liver Disease, Model for Liver Transplantation Survival and Donor Risk Index as predictive models of survival after liver transplantation in 1,006 patients.

Objectives: Liver transplantation has not increased with the number of patients requiring this treatment, increasing deaths among those on the waiting list. Models predicting post-transplantation survival, including the Model for Liver Transplantation Survival and the Donor Risk Index, have been created. Our aim was to compare the performance of the Model for End-Stage Liver Disease, the Model for Liver Transplantation Survival and the Donor Risk Index as prognostic models for survival after liver transplantation.

Inflammatory cytokines during liver transplantation: prospective randomized trial comparing conventional and piggyback techniques.

Background/aims: Cytokines have a significant role in the response to injury following liver transplantation, but the origin and course of such molecules are not completely known. The aim of this study was to evaluate the production and liver metabolism of the inflammatory cytokines interleukin (IL)-1beta, IL-6, IL-8, interferon (IFN)-gamma and tumor necrosis factor (TNF)-alpha in orthotopic liver transplantation (OLT), comparing the conventional and the piggyback methods.

Methodology: We performed a study of 30 patients who underwent elective OLT and were randomized for the conventional or piggyback techniques at the beginning of the operation.

Comparative study of etiological diagnosis of nosocomial pneumonia.

Nosocomial pneumonia is a common complication in patients on mechanical ventilation and results in significant mortality. Diagnosis of pneumonia in patients who are intubated and under mechanical ventilation is difficult, even with the aid of clinical, laboratory, and endoscopic tests. The objective of this study was to compare three methods of tracheal sputum collection in patients with a clinical and radiological diagnosis of pneumonia.

Splanchnic non-hepatic hemodynamics and metabolism during liver transplantation.

Background/aims: The aim of this study is to compare the splanchnic non-hepatic hemodynamics and the metabolic changes during orthotopic liver transplantation between the conventional with bypass and the piggyback methods.

Methodology: A prospective, consecutive series of 59 primary transplants were analyzed. Oxygen consumption, glucose, potassium, and lactate metabolism were quantitatively estimated from blood samples from the radial artery and portal vein, collected up to 120 minutes after graft reperfusion.

Evaluation of the mortality rate caused by different periods of selective portal vein occlusion in rats.

Unlabelled: Mortality from acute selective portal vein occlusion (SPVO) is a matter of concern for surgeons during the management of traumatic portal vein injury. However, mortality rates related to different periods of SPVO remains undetermined.

Purpose: To determine the mortality rates resulting from different periods of acute SPVO in rats.

Bacterial translocation during liver transplantation: a randomized trial comparing conventional with venovenous bypass vs. piggyback methods.

The aim of this study was to evaluate the bacterial translocation in liver transplantation (LT), comparing the conventional and the piggyback methods. A total of 32 patients were randomized into the 2 groups. Samples of blood were collected from the radial artery, portal vein (PV) and hepatic vein (HV), in up to 120 minutes postreperfusion.

Increased hepatic expression of insulin-like growth factor-I receptor in chronic hepatitis C.

Aim: Although increased insulin-like growth factor-I receptor (IGF-IR) gene expression has been reported in hepatocellular carcinoma, studies assessing IGF-IR in chronic hepatitis C (CHC) and cirrhosis are scarce. We therefore aimed to evaluate IGF-IR and IGF-I mRNA expression in liver from patient with CHC.

Methods: IGF-IR and IGF-I mRNA content were determined by semi-quantitative RT-PCR and IGF-IR protein expression was determined by immunohisto-chemistry in hepatic tissue obtained from patients with CHC before (34 patients) and after (10 patients) therapy with interferon-alpha and ribavirin.

Influence of chronic liver disease on coronary atherosclerosis vulnerability features.

Introduction: A lower incidence of acute myocardial infarction was reported in patients with chronic liver disease.

Objective: To analyze the impact of chronic liver disease on characteristics associated with vulnerability of human coronary artery atherosclerotic plaques.

Methods: One hundred fourteen hearts were collected from 3 groups of individuals: A--38 chronic liver disease patients who died while on the waiting list for liver transplantation; B--38 individuals who died of natural causes; and C--38 individuals who died of accidental causes.

Left hemidiaphragmatic mobility: assessment with ultrasonographic measurement of the craniocaudal displacement of the splenic hilum and the inferior pole of the spleen.

Objective: The purpose of this study was to evaluate the correlation between the radiographic and ultrasonographic measurements of craniocaudal displacement of the left hemidiaphragm.

Methods: Forty-nine patients with clinical indications for interventional procedures prospectively underwent radiographic evaluation of left hemidiaphragmatic mobility and B-mode ultrasonographic measurement of craniocaudal displacement of the hilum and the inferior pole of the spleen. Ultrasonography was performed with a 3.

Randomized trial comparing pulmonary alterations after conventional with venovenous bypass versus piggyback liver transplantation.

During the anhepatic phase of conventional liver transplantation (LT), the inferior vena cava (IVC) is cross-clamped and venovenous bypass (VVB) is usually indicated for diversion of IVC and portal blood flow. VVB can theoretically lead to pulmonary complications due to the contact of the blood with the surfaces of the circuit. In the piggyback method, preservation of the IVC avoids VVB.

Risk factors for development of acute renal failure after liver transplantation.

Background: Acute renal failure (ARF) is a common complication after liver transplantation (LTx). Identification of risk factors may prevent the development and attenuate the impact of ARF on patients outcome after LTX.

Methods: Retrospective analysis of variables in the pre, intra, and postoperative periods of 92 patients submitted to LTx was performed in order to identify risk factors for development of ARF after LTx.

Use of tacrolimus in rescue therapy of acute and chronic rejection in liver transplantation.

Purpose: To study the indications and results of tacrolimus as rescue therapy for acute cellular or chronic rejection in liver transplantation.

Patients And Methods: Eighteen liver transplant recipients who underwent rescue therapy with tacrolimus between March 1995 and August 1999 were retrospectively studied. The treatment indication, patients, and graft situation were recorded as of October 31st, 1999.

Right hemidiaphragmatic mobility: assessment with US measurement of craniocaudal displacement of left branches of portal vein.

Purpose: To evaluate the correlation and agreement between ultrasonographic (US) measurement of craniocaudal displacement of the left intrahepatic branches of the portal vein and radiographic measurement of right hemidiaphragmatic mobility.

Materials And Methods: Fifty-one patients with indications for abdominal angiography or percutaneous cholangiography prospectively underwent radiographic evaluation of right hemidiaphragmatic mobility and B-mode US measurement of craniocaudal displacement of the left intrahepatic branches of the portal vein. US was performed by using a 3.

No evidence of de novo amyloidosis in recipients of domino liver transplantation: 12 to 40 (mean 24) month follow-up.

Unlabelled: Domino liver transplantation (DLT) has been performed for selected recipients at several centers, but de novo amyloidosis in recipients of livers from patients with familial amyloid polyneuropathy (FAP) remains a serious concern.

Aim: To evaluate the occurrence of de novo amyloidosis in recipients of DLT.

Patients And Methods: Seven recipients of FAP livers were followed for clinical and electroneuromyographic signs of FAP and also for de novo amyloid deposition in the gut.