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Primary liver transplantation vs transplant after Kasai portoenterostomy in children with biliary atresia: A retrospective Brazilian single-center cohort

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World Journal of Transplantation 2024年第1期14卷 112-119页

作者： Melina Utz Melere Valberto Sanha Marco Farina Carolina Soares da Silva Luiza Nader Cristine Trein Angelica Maria Lucchese Cristina Ferreira Antonio Nocchi Kalil flavia heinz feier Department of Hepatology and Liver Transplantation Santa Casa de Porto AlegrePorto Alegre 90050170Brazil Department of Hepato-biliary-pancreatic Surgery and Liver Transplantation Irmandade Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90020-090Brazil Department of Surgical Oncology Santa Rita Hospital/Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90050-170Rio Grande do SulBrazil

BACKGROUND Biliary atresia(BA)is the most common indication for pediatric liver transplantation,although portoenterostomy is usually performed first.However,due to the high failure rate of portoenterostomy,liver transplantation has been advocated as the primary procedure for patients with BA.It is still unclear if a previous portoenterostomy has a negative impact on liver transplantation outcomes.AIM To investigate the effect of prior portoenterostomy in infants un-dergoing liver transplantation for BA.METHODS This was a retrospective cohort study of 42 pediatric patients with BA who underwent primary liver transplantation from 2013 to 2023 at a single tertiary center in Brazil.Patients with BA were divided into two groups:Those undergoing primary liver transplantation without portoenterostomy and those undergoing liver transplantation with prior portoenterostomy.Continuous variables were compared using the Student’s t-test or the Kruskal-Wallis test,and categorical variables were compared using theχ2 or Fisher’s exact test,as appropriate.Multivariable Cox regression analysis was performed to determine risk factors for portal vein thrombosis.Patient and graft survival analyses were conducted with the Kaplan–Meier product-limit estimator,and patient subgroups were compared using the two-sided log-rank test.RESULTS Forty-two patients were included in the study(25[60%]girls),23 undergoing liver transplantation without prior portoenterostomy,and 19 undergoing liver transplantation with prior portoenterostomy.Patients with prior portoenterostomy were older(12 vs 8 months;P=0.02)at the time of liver transplantation and had lower Pediatric End-Stage Liver Disease scores(13.2 vs 21.4;P=0.01).The majority of the patients(35/42,83%)underwent livingdonor liver transplantation.The group of patients without prior portoenterostomy appeared to have a higher incidence of portal vein thrombosis(39 vs 11%),but this result did not reach statistical significance.Prior portoenterostomy was not a protective factor against portal vein

关键词： Hepatic portoenterostomy Biliary atresia Liver transplantation Patient outcome assessment Portal vein Survival

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Liver volumetric and anatomic assessment in living donor liver transplantation: The role of modern imaging and artificial intelligence

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World Journal of Transplantation 2023年第6期13卷 290-298页

作者： Mayara Machry Luis Fernando Ferreira Angelica Maria Lucchese Antonio Nocchi Kalil flavia heinz feier Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation Irmandade Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90020-090Brazil Postgraduation Program in Medicine:Hepatology Federal University of Health Sciences of Porto AlegrePorto Alegre 90050-170Brazil

The shortage of deceased donor organs has prompted the development of alternative liver grafts for transplantation.Living-donor liver transplantation(LDLT)has emerged as a viable option,expanding the donor pool and enabling timely transplantation with favorable graft function and improved long-term outcomes.An accurate evaluation of the donor liver’s volumetry(LV)and anatomical study is crucial to ensure adequate future liver remnant,graft volume and precise liver resection.Thus,ensuring donor safety and an appropriate graftto-recipient weight ratio.Manual LV(MLV)using computed tomography has traditionally been considered the gold standard for assessing liver volume.However,the method has been limited by cost,subjectivity,and variability.Automated LV techniques employing advanced segmentation algorithms offer improved reproducibility,reduced variability,and enhanced efficiency compared to manual measurements.However,the accuracy of automated LV requires further investigation.The study provides a comprehensive review of traditional and emerging LV methods,including semi-automated image processing,automated LV techniques,and machine learning-based approaches.Additionally,the study discusses the respective strengths and weaknesses of each of the aforementioned techniques.The use of artificial intelligence(AI)technologies,including machine learning and deep learning,is expected to become a routine part of surgical planning in the near future.The implementation of AI is expected to enable faster and more accurate image study interpretations,improve workflow efficiency,and enhance the safety,speed,and cost-effectiveness of the procedures.Accurate preoperative assessment of the liver plays a crucial role in ensuring safe donor selection and improved outcomes in LDLT.MLV has inherent limitations that have led to the adoption of semi-automated and automated software solutions.Moreover,AI has tremendous potential for LV and segmentation;however,its widespread use is hindered by cost and availability.Therefore,the integrati

关键词： Liver transplantation Living-donor Diagnostic imaging Artificial intelligence Machine learning Deep learning

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Transarterial embolization is an acceptable bridging therapy to hepatocellular carcinoma prior to liver transplantation

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World Journal of Transplantation 2024年第2期14卷 126-134页

作者： Gabriel Lazzarotto-da-Silva Leandro A Scaffaro Mauricio Farenzena Lucas Prediger Rafaela K Silva Flávia heinz feier Tomaz J M Grezzana-Filho Pablo D Rodrigues Alexandre de Araujo Mario Reis Alvares-da-Silva Roberta C Marchiori Cleber Rosito Pinto Kruel Marcio Fernandes Chedid Department of Liver Transplant and Hepatobiliary Surgery Unit Hospital de Clínicas de Porto AlegrePorto Alegre 90035-007Brazil Department of Interventional Radiology Unit Hospital de Clínicas de Porto AlegrePorto Alegre 90035-007Brazil Department of Gastroenterology and Hepatology Hospital de Clínicas de Porto AlegrePorto Alegre 90035-007Brazil

BACKGROUND Hepatocellular carcinoma(HCC)is an aggressive malignant neoplasm that requires liver transplantation(LT).Despite patients with HCC being prioritized by most organ allocation systems worldwide,they still have to wait for long periods.Locoregional therapies(LRTs)are employed as bridging therapies in patients with HCC awaiting LT.Although largely used in the past,transarterial embolization(TAE)has been replaced by transarterial chemoembolization(TACE).However,the superiority of TACE over TAE has not been consistently shown in the literature.AIM To compare the outcomes of TACE and TAE in patients with HCC awaiting LT.METHODS All consecutive patients with HCC awaiting LT between 2011 and 2020 at a single center were included.All patients underwent LRT with either TACE or TAE.Some patients also underwent percutaneous ethanol injection(PEI),concom-itantly or in different treatment sessions.The choice of LRT for each HCC nodule was determined by a multidisciplinary consensus.The primary outcome was waitlist dropout due to tumor progression,and the secondary outcome was the occurrence of adverse events.In the subset of patients who underwent LT,complete pathological response and post-transplant recurrence-free survival were also assessed.RESULTS Twelve(18.5%)patients in the TACE group(only TACE and TACE+PEI;n=65)and 3(7.9%)patients in the TAE group(only TAE and TAE+PEI;n=38)dropped out of the waitlist due to tumor progression(P log-rank test=0.29).Adverse events occurred in 8(12.3%)and 2(5.3%)patients in the TACE and TAE groups,respectively(P=0.316).Forty-eight(73.8%)of the 65 patients in the TACE group and 29(76.3%)of the 38 patients in the TAE group underwent LT(P=0.818).Among these patients,complete pathological response was detected in 7(14.6%)and 9(31%)patients in the TACE and TAE groups,respectively(P=0.145).Post-LT,HCC recurred in 9(18.8%)and 4(13.8%)patients in the TACE and TAE groups,respectively(P=0.756).Posttransplant recurrence-free survival was similar between the groups(P log-rank test=0.71).CONCL

关键词： Hepatocellular carcinoma Transarterial embolization Transarterial chemoembolization Liver transplantation Locoregional therapy Bridging

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Quality of life,depression and anxiety in potential living liver donors for pediatric recipients:A retrospective single center experience

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World Journal of Hepatology 2022年第10期14卷 1899-1906页

作者： Paula K Reine flavia feier Eduardo Antunes da Fonseca Rosely G Hernandes Joao Seda-Neto Department of Psychology Hospital Sirio-LibanesSao Paulo 01308901Brazil Department ofLiver Transplantation Santa Casa de Porto AlegrePorto Alegre 90020090Brazil Department of Liver Transplantation Hospital Sirio-LibanesSao Paulo 01308901Brazil

BACKGROUND Living donor liver transplantation is a safe alternative for patients on a liver transplant list.Donor evaluation goes beyond physical variables to include social,emotional,and ethical aspects.The role of pre-donation sociopsychological evaluation of the donor candidate is as important to the success of the procedure as is the medical assessment.Success implies recovery from the operation and pro-mpt engagement in pre-transplant professional and social activities,without leading to psychological or physical distress.Psychological profiling of potential living liver donors(PLLD)and evaluation of quality of life(QOL)can influence outcomes.AIM To evaluate the socio-demographics and psychological aspects(QOL,depression,and anxiety)of PLLD for pediatric liver transplantation in a cohort of 250 patients.METHODS This was a retrospective cohort study of 250 PLLD who underwent psychological pre-donation evaluation between 2015 and 2019.All the recipients were children.The Beck anxiety inventory,Beck depression inventory,and 36-item short-form health survey(SF-36)scores were used to evaluate anxiety(Beck anxiety inventory),depression(Beck depression inventory),and QOL,respectively.RESULTS A total of 250 PLLD were evaluated.Most of them were women(54.4%),and the mean age was 29.2±7.2 years.A total of 120(48.8%)PLLD were employed at the time of evaluation for donation;however,most had low income(57%earned<2 times the minimum wage).A total of 110 patients(44%)did not finish the donation process,and 247 PLLD answered a questionnaire to evaluate depression,anxiety,and QOL(SF-36).Prevalence of depression was of 5.2%and anxiety 3.6%.Although most of the PLLD were optimistic regarding the donation process and never had doubts about becoming a donor,some traces of ambivalence were observed:46%of the respondents said they would feel relieved if a deceased donor became available.CONCLUSION PLLD had a low prevalence of anxiety and depression.The foundation for effective and satisfactory results can be found in the pre-trans

关键词： Liver transplantation Children Outcomes Living donation

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Should selection criteria for HCC be the same(or different)between LDLT and DDLT?

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Hepatoma Research 2020年第11期6卷 13-17页

作者： flavia feier Liver Transplantation Department Hospital de Clinicas de Porto AlegrePorto Alegre 90035-903Brazil Pediatric Liver Transplantation Department Irmandade Santa Casa de Porto AlegrePorto Alegre 90020-090Brazil

Since the Milan Criteria(MC)were adopted in many countries as the allocation policy criteria for patients with hepatocellular carcinoma to be transplanted,many groups started to expand it to provide a chance for patients with tumors outside the MC who could achieve similar survival rates.With the scarcity of deceased donors,Asian countries improved the results with living donor liver transplantation,allowing patients outside MC to be transplanted with a living donor.Newer prognostic models and a more profound understanding of tumor behavior are targeting better patient selection.Currently,patients are unevenly selected for liver transplantation and mostly separated into those fulfilling the MC and transplanted with a deceased donor and those with expanded criteria and transplanted with a living donor.In this paper,insight is brought into this debate.

关键词： Living donor hepatocellular carcinoma alpha-fetoprotein

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Giant hepatic extra-gastrointestinal stromal tumor treated with cytoreductive surgery and adjuvant systemic therapy:A case report and review of literature

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World Journal of Gastrointestinal Surgery 2021年第3期13卷 315-322页

作者： Michel Ribeiro Fernandes Caroline Lorenzoni Almeida Ghezzi Tomaz J M Grezzana-Filho Flávia heinz feier Ian Leipnitz Aljamir Duarte Chedid Carlos Thadeu Schmidt Cerski Marcio Fernandes Chedid Cléber RositoPinto Kruel Department of Gastrointestinal Surgery and Transplantation Hospital de Clínicas de Porto AlegrePorto Alegre 90035-007RSBrazil Division of Radiology Hospital de Clínicas de Porto AlegrePorto Alegre 90035-903RSBrazil Department of Pathology Hospital de Clínicas de Porto AlegrePorto Alegre 90035-007RSBrazil

BACKGROUND Primary extra-gastrointestinal stromal tumors(E-GIST)of the liver are rare.The clinical presentation may range from asymptomatic to bleeding or manifestations of mass effect.Oncologic surgery followed by adjuvant therapy with imatinib is the standard of care.However,under specific circumstances,a cytoreductive approach may represent a therapeutic option.We describe herein the case of an 84-year-old woman who presented with a tender,protruding epigastric mass.Abdominal computed tomography scan revealed a large,heterogeneous mass located across segments III,IV,V,and VIII of the liver.The initial approach was transarterial embolization of the tumor,which elicited no appreciable response.Considering the large size and central location of the tumor and the advanced age of the patient,non-anatomic complete resection was indicated.Due to substantial intraoperative bleeding and hemodynamic instability,only a near-complete resection could be achieved.Histopathology and immunohistochemical staining confirmed the diagnosis of primary E-GIST of the liver.Considering the risk/benefit ratio for therapeutic options,debulking surgery may represent a strategy to control pain and prolong survival.CASE SUMMARY Here,we present a case report of a patient diagnosed with E-GIST primary of the liver,which was indicated a cytoreductive surgery and adjuvant therapy with imatinib.CONCLUSION E-GIST primary of the liver is a rare conditional,the treatment is with systemic therapy and total resection surgery.However,a cytoreductive surgery will be necessary when a complete resection is no possible.

关键词： Extra-gastrointestinal stromal tumor Primary gastrointestinal stromal tumor of the liver Cytoreductive surgery Debulking surgery Case report

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Biliary complications after pediatric liver transplantation: Risk factors, diagnosis and management

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World Journal of Hepatology 2015年第18期7卷 2162-2170页

作者： flavia H feier Eduardo A da Fonseca Joao Seda-Neto Paulo Chapchap Hepatology and Liver Transplantation Hospital Sirio Libanes

The expanded indications of partial grafts in pediatric liver transplantation have reduced waiting list mortality. However, a higher morbidity is observed, including an increased rate of biliary complications(BCs). Factors such as the type of graft, the preservation methods applied, the donor characteristics, the type of biliary reconstruction, and the number of bile ducts in the liver graft influences the occurrence of these complications. Bile leaks and strictures comprise the majority of posttransplant BCs. Biliary strictures require a high grade of suspicion, and because most children have a bileoenteric anastomosis, its diagnosis and management rely on percutaneous hepatic cholangiography and percutaneous biliary interventions(PBI). The success rates with PBI range from 70% to 90%. Surgery is reserved for patients who have failed PBI. BCs in children after liver transplantation have a prolonged treatment and are associated with a longer length of stay and higher hospital costs. However, with early diagnosis and aggressive treatment, patient and graft survival are not significantly compromised.

关键词： Outcomes Live-donor Infants Strictures Bile leaks

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