Clementino Zeni Neto

Donor Complications Including the Report of One Death in Right-Lobe Living-Donor Liver Transplantation

Background/Aims: Our objective is to assess donor complications in all right hepatic lobe living-donor liver transplantation (LDLT) at our center. Methods: Of a total of 352 liver transplantations performed, 60 were right-lobe LDLT. Most donors (88.3%) were related to the recipients. Results: Mean hospital stay was 5.4 8 0.6 days. No complications occurred due to preoperative evaluation. Most donors received one or two units of autologous blood transfusion. Only 5 (8.3%) needed nonautologous blood transfusion. Most complications were minor and treated conservatively. Bile leaks from the cut surface of the liver occurred in 5 donors (8.3%). Two patients had potentially fatal complications: perforated duodenal ulcer and portal vein thrombosis (PVT). The donor with perforated ulcer developed septicemia and multiple organ failure. He was discharged from the hospital with hemiparesis due to cerebral ischemia. The patient with PVT remained asymptomatic and the portal vein was recanalized by the 3rd postoperative month. One donor died in the immediate postoperative period of cardiac arrest due to cardiac arrhythmia. Conclusion: Right hepatectomy for LDLT may be associated with significant morbidity, including death and it should be performed only by surgeons with great experience.

Oral glutamine does not prevent bacterial translocation in rats subjected to intestinal obstruction and Escherichia coli challenge but reduces systemic bacteria spread.

OBJECTIVE We investigated whether oral glutamine prevents bacterial translocation. METHODS Male Wistar rats were fed with isocaloric and isoproteic standard rat chow and randomly assigned to receive glutamine (GLN) or glycine administered through an orogastric tube at 1.5 g.kg(-1).d(-1) for 7 d. On day 8 of the study, the animals were anesthetized and intestinal obstruction was produced by ligature of the terminal ileum. A suspension containing 10(9) colony-forming units per milliliter of Escherichia coli ATCC 25992 was injected into the lumen of the ileum. Twenty-four hours later, blood was withdrawn, and mesenteric lymph nodes and fragments of spleen, liver, and lung were sent for microbiological analysis. Cultures were done on blood agar and MacConkey agar. Students t test and analysis of variance between two proportions were used. P < 0.05 was considered significant. RESULTS Rats in both groups lost body weight during the experiment (not significant). Mesenteric lymph node cultures were positive in both groups. The GLN group had a smaller percentage of E. coli in blood and organ cultures (65.45% versus 82.67% in the glycine group; P = 0.027). Positive cultures of blood, spleen, liver and lung also were higher on glycine group, although not significantly. CONCLUSIONS Oral GLN does not prevent bacterial translocation in rats after intestinal obstruction and E. coli challenge. No specific organ was protected by GLN. Nevertheless, its use was associated with a reduced number of positive E. coli cultures in blood and remote organs, and thus diminished bacteria spread. This association suggests a role for GLN in gut barrier protection, possibly by immune system enhancement.

Função sexual de homens submetidos a transplante hepático

BACKGROUND: Sexual dysfunction is very common in liver transplantation candidates. Our objective is to determine the sexual life quality of males before and after liver transplantation. METHODS: Questionnaire was sent to 56 males over 18 years of age with at least six-month survival after orthotopic liver transplantation. The self-administered questionnaire contained 15 questions with 5 or 6 alternatives to determine the male sexual function which may be divided into 5 domains: 1) erectile function; 2) orgasmic function; 3) sexual desire; 4) intercourse satisfaction; and 5) overall satisfaction with sexual life. Each answer received a score. Domains scores were computed by summing the scores for individual answers and they were compared before and after the liver transplantation. RESULTS: Twenty-five patients answered the questionnaire completely. All 5 sexual function domains improved after liver transplantation. The score of the erectile function increased from 21.12± 8.07 to 26.52± 5.22 (p=0.004), of the orgasmic function from 7.28± 3.05 to 9.36± 1.47 (p=0.008), of the sexual desire from 6.64± 2.58 to 8.68± 1.35 (p=0.005), of intercourse satisfaction from 9.16± 3.83 to 12.52± 2.65 (p<0.0001) and of overall satisfaction from 7.12± 2.64 to 9.24± 1.65 (p=0.002). CONCLUSIONS: Sexual dysfunction is common in males with severe chronic liver disease and liver transplantation improves all sexual function domains: erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction.BACKGROUND Sexual dysfunction is very common in liver transplantation candidates. Our objective is to determine the sexual life quality of males before and after liver transplantation. METHODS Questionnaire was sent to 56 males over 18 years of age with at least six-month survival after orthotopic liver transplantation. The self-administered questionnaire contained 15 questions with 5 or 6 alternatives to determine the male sexual function which may be divided into 5 domains: 1) erectile function; 2) orgasmic function; 3) sexual desire; 4) intercourse satisfaction; and 5) overall satisfaction with sexual life. Each answer received a score. Domains scores were computed by summing the scores for individual answers and they were compared before and after the liver transplantation. RESULTS Twenty-five patients answered the questionnaire completely. All 5 sexual function domains improved after liver transplantation. The score of the erectile function increased from 21.12 +/- 8.07 to 26.52 +/- 5.22 (p=0.004), of the orgasmic function from 7.28 +/- 3.05 to 9.36 +/- 1.47 (p=0.008), of the sexual desire from 6.64 +/- 2.58 to 8.68 +/- 1.35 (p=0.005), of intercourse satisfaction from 9.16 +/- 3.83 to 12.52 +/- 2.65 (p<0.0001) and of overall satisfaction from 7.12 +/- 2.64 to 9.24 +/- 1.65 (p=0.002). CONCLUSIONS Sexual dysfunction is common in males with severe chronic liver disease and liver transplantation improves all sexual function domains: erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction.

TESTOSTERONE CHANGES IN PATIENTS WITH LIVER CIRRHOSIS BEFORE AND AFTER ORTHOTOPIC LIVER TRANSPLANTATION AND ITS CORRELATION WITH MELD

CONTEXT Hypogonadism is a common clinical situation in male patients with liver cirrhosis. OBJECTIVES The aim of the present study was to evaluate the effects of orthotopic liver transplantation on testosterone, free testosterone and sex hormone-binding globulin in male with advanced liver disease and also to determine the relationship of these changes with Model for End-stage Liver Disease (MELD) score. METHODS In a prospective study, serum levels of testosterone, free testosterone and sex hormone-binding globulin of 30 male adult patients with end-stage liver disease were measured 2 to 4 hours before and 6 months after orthotopic liver transplantation. RESULTS Total testosterone levels increased after orthotopic liver transplantation and the number of patients with normal testosterone levels increased from 18 to 24. Free testosterone mean level in the pre-transplant group was 7.8 pg/mL and increased to 11.5 pg/mL (P = 0.10) and sex hormone-binding globulin level decreased after orthotopic liver transplantation returning to normal levels in MELD ≤ 18 - group (A) (P<0.05). CONCLUSIONS Serum level changes of testosterone, free testosterone and sex hormone-binding globulin are more pronounced in cirrhotic males with MELD ≤ 18. Serum levels of testosterone and free testosterone increase and serum levels of sex hormone-binding globulin decrease after orthotopic liver transplantation.

Fatores de risco e conduta nas complicações do trato biliar no transplante hepático

A reconstrucao biliar e um dos pontos vulneraveis do transplante hepatico apresentando incidencia de complicacoes biliares, variando de 10 a 35%, nos diversos estudos da literatura. Esse trabalho tem por objetivo apresentar a experiencia do nosso servico em relacao a incidencia e ao manejo das complicacoes biliares no transplante de figado. Foram incluidos no estudo 147 transplantes hepaticos ortotopicos, com idade media de 37,3 anos, correspondendo a 88 procedimentos em pacientes do sexo masculino e 59 do sexo feminino. Complicacoes biliares ocorreram em 27 transplantes (18,36%) em 25 pacientes (dois retransplantes). A presenca de rejeicao celular e de complicacoes vasculares foi identificada como fator de risco para as complicacoes biliares. A idade, o sexo, a etiologia da cirrose e a tecnica utilizada na reconstrucao biliar nao foram fatores de risco. No total, foram empregados 52 cursos terapeuticos: tratamento cirurgico em 23 vezes; tratamento endoscopico em 15 vezes; retransplante em sete vezes; drenagem biliar transparieto-hepatica em seis vezes e um paciente esta em lista de espera para retransplante. Conclui-se deste estudo que as complicacoes biliares sao frequentes apos o transplante hepatico e que as vasculares e a rejeicao celular sao fatores de risco.

Anatomia arterial hepática: estudo em 150 transplantes hepáticos

BACKGROUND: The aim of the present study is to evaluate the hepatic arterial anatomy in donors and recipients of 150 liver transplantations. METHODS: 246 patients were analyzed, 129 donors and 117 liver receptors. RESULTS: Normal arterial anatomy of the liver was seen in 189 (76,82%) patients. Anatomic anomalies were observed in the other 57 (23,18%); the most frequent were: right hepatic artery arising from the superior mesenteric artery, left hepatic artery arising from the left gastric artery, right hepatic artery arising from the superior mesenteric artery associated with left hepatic artery arising from the left gastric artery and , common hepatic artery arising from the superior mesenteric artery. Some rare anomalies were also seen. CONCLUSIONS: The findings of this study show a high anatomic variability of the hepatic arterial system. The surgeon must be careful during liver dissection both of donors and receptors in order to avoid inadvertent damage to the anomalous arteries to the liver.

Anatomia da artéria hepática em doadores e receptores de transplante hepático intervivos

BACKGROUND: Detailed knowledge of hepatic artery anatomy is essential for the success of living related liver transplantation. The purpose of this study is to describe the anatomy of the hepatic artery of donors and recipients of living related liver transplantation. METHODS: From March 1998 to September 2002, the study was retrospective (23 transplantations). From October 2002 to August 2003, the study was prospective (17 transplantations). We studied the hepatic artery anatomy of 80 consecutive patients (40 donors and 40 recipients) at the Liver Transplantation Unit of the Hospital de Clinicas of the Universidade Federal do Parana and of the Hospital Nossa Senhora das Gracas; 51 were male (27 recipients and 24 donors) and 29 female (13 recipients and 16 donors). The median age of the donors was 32.6 years and of the recipients was 36.3 years. Thirty-two recipients were adults and 8 were under than 15 years of age. RESULTS: Forty-three patients underwent abdominal arteriography and variations of the hepatic artery anatomy were found in 18 of them (41.86%). The most prevalent anomaly was the right hepatic artery arising from the superior mesenteric artery (12.5%; n=5). The anatomy of the hepatic artery was also evaluated at operation and variations were observed in 16 of the 80 patients (20%). The most common variation observed at operation was the right hepatic artery arising from the superior mesenteric artery (7.5%; n=6). CONCLUSION: It is concluded that the prevalence of hepatic arterial variations is high.

Perfuração gástrica secundária a tricobezoar gigante: descrição de caso e revisão da literatura

Gastric bezoars are impactations offoreign material in lhe stomach. When they are caused by hail; they are named tricho- bezoars. The complications oftrichobezoars are very rare. In this papel; we describe a case of a 16-year-old girl that had a previous history oftricophagia, and had an acute abdominal pain with a pneumoperitoneum in the abdomen radiography. An operation was performed and a gastric perforation was founded associated with a giant trichobezoa7: The trichobezoar was removed by traction through a gastrostomy which was performed in order to remove lhe trichobezoa7: Some fragments of the ulcer were obtained to histological study. The gastrostomy was treated by a gastrorraphy confection. In lhe post- operative period a left subfrenic abscess was revealed and has been drained by laparatomy 15 days after the fisrt operation. After the second surgical procedure the patient had a good evolution, and left the hospital in good health conditions.