Avaliação da transecção do fígado no transplante hepático pediátrico

• Ano de defesa: 2013
• Autor(a) principal: Benini, Barbara Burza [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• dARK ID: ark:/48912/001300002txbr
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: graft liver; liver transplantation; Children; enxerto de fígado; transplante de fígado; transplante hepático; Crianças
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=87940; http://repositorio.unifesp.br/handle/11600/46901

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.