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Purpose Although liver transplantation (LT) outcomes have improved significantly over the last decades, early post-transplant vascular complications are still associated with an elevated risk of graft failure. Doppler ultrasound (DUS) enables detection of vascular complications and provides hepatic artery Resistive Index (RI). The aim of our study was to evaluate the association of the RI parameters of DUS performed in the first post-transplant week with post-transplant outcomes. Methods All consecutive patients undergoing a first LT between 2001 and 2019 at a single center were included. P were divided into three groups: RI 0.85. Patients were also divided according to the presence or absence of hepatic artery thrombosis (HAT). Graft survival was compared among groups. Results Three hundred and forty-four patients were included. HAT occurred in 23 patients (6.7%), of which 7 were partial and 16 were complete. Biliary complications were more common in patients with HAT (11 [47.8%]) vs. 44 [13.4%] [p 0.85. RI on post-operative day 3 and 5 was not predictive of graft survival. Conclusions The use of DUS on liver transplant recipients in the early post-transplant period offers the possibility of early diagnosis of vascular complications. Additionally, according to our data, low RI ( more...

Resumen:Introducción: Pacientes en acute on chronic liver failure (ACLF)presentan características distintas de aquellas presentadas por pacientes hepatopatas no ACLF. El grado de ACLF impacta en el desenlace con o sin el transplante, habiendo divergencias en la literatura principalmente en lo que se refiere al pronóstico postransplante. Objetivos: Revisar los diferentes aspectos de los pacientes en ACLF, abarcando los conceptos del síndrome adoptados por diversas instituciones, el tratamiento de las complicaciones, y describir el conocimiento acerca de los desenlaces con o sin transplante de los portadores del síndrome reportados en la literatura. Métodos: Fueron incluidos 22 artículos encontrados en la búsqueda de bases de datos PubMed, Medline y Biblioteca Electrónica Científica Online (SciELO) con los descriptores “ACLF definitions” y “Liver transplantation ACLF”. Los conceptos y datos apuntados en los textos seleccionados fueron comparados y utilizados como base para redactar este artículo. Resultados: Existen algunas diferencias en la definición del síndrome, variando especialmente entre los países del Occidente y los del Oriente. Pacientes esperando transplante hepático en ACLFpresentan características distintas de aquellas presentadas por pacientes no ACLF. El grado de ACLF también impacta en el desenlace con o sin el transplante, habiendo divergencias en la literatura principalmente en lo que se refiere al pronóstico postransplante de los pacientes en ACLF 3, con tendencia cada vez mayor en la indicación del transplante incluso para estos pacientes. Conclusiones: Los desenlaces varían entre pacientes en ACLF de acuerdo con el grado de la enfermedad. El transplante hepático ha sido más frecuentemente indicado en ACLF 3, habiendo el tiempo de espera impactado los resultados. Son necesarios más estudios para definir cuáles subgrupos de pacientes se benefician más del transplante hepático. more...

Introduction: Patients with acute-on-chronic liver failure(ACLF) have different characteristics from those presented by non-ACLF patients with liver diseases. The degree of ACLF impacts the outcome with or without transplantation, with divergences in the literature, especially regarding post-transplant prognosis. Objectives: To review the different aspects of patients with ACLF, including the concepts of the syndrome adopted by various institutions, the treatment of complications, and to describe the knowledge about the outcomes with or without transplantation of patients with the syndrome reported in the literature. Methods: Twenty-two articles were included in the PubMed, MEDLINE and the Scientific Electronic Library Online (SciELO) databases with the descriptors “ACLF definitions” and “Liver transplantation ACLF.” The concepts and data from the selected texts were compared and used as a basis for writing this article. Results: There are some differences in the definition of the syndrome, varying especially between Western and Eastern countries. ACLF patients awaiting liver transplantation have characteristics distinct from those presented by non-ACLF patients. The degree of ACLF also impacts the outcome with or without transplantation, with divergences in the literature especially regarding the post-transplant prognosis of ACLF-3 patients, with an increasing trend in the indication of transplantation even for these patients. Conclusions: Outcomes vary among ACLF patients according to the degree of the disease. Liver transplantation has been more frequently indicated in ACLF-3, with waiting time impacting outcomes. Further studies are needed to define which subgroups of patients benefit most from liver transplantation. more...

Introdução: Pacientes em acute on chronic liver failure (ACLF) apresentam características distintas daquelas apresentadas por pacientes hepatopatas não ACLF. O grau de ACLF impacta no desfecho com ou sem o transplante, havendo divergências na literatura principalmente no que tange ao prognóstico pós-transplante. Objetivos: Revisar os diferentes aspectos dos pacientes em ACLF, abrangendo os conceitos da síndrome adotados por diversas instituições, o tratamento das complicações, e descrever o conhecimento acerca dos desfechos com ou sem transplante dos portadores da síndrome reportados na literatura. Métodos: Foram incluídos 22 artigos encontrados na busca de bases de dados PubMed, Medline e Biblioteca Eletrônica Científica Online (SciELO) com os descritores “ACLF definitions” e “Liver transplantation ACLF”. Os conceitos e dados apontados nos textos selecionados foram comparados e utilizados como base para redigir este artigo. Resultados: Existem algumas diferenças na definição da síndrome, variando especialmente entre os países do Ocidente e os do Oriente. Pacientes aguardando transplante hepático em ACLF apresentam características distintas daquelas apresentadas por pacientes não ACLF. O grau de ACLF também impacta no desfecho com ou sem o transplante, havendo divergências na literatura principalmente no que tange ao prognóstico pós-transplante dos pacientes em ACLF 3, com tendência cada vez maior na indicação do transplante mesmo para esses pacientes. Conclusões: Os desfechos variam entre pacientes em ACLF de acordo com o grau da doença. O transplante hepático tem sido mais frequentemente indicado em ACLF 3, tendo o tempo de espera impactado os resultados. São necessários mais estudos para definir quais subgrupos de pacientes se beneficiam mais do transplante hepático. more...

BACKGROUND: Liver transplantation is a complex and valuable therapy. However, complications that burden postoperative quality of life, such as incisional hernia, are to be better elucidated, such as risk factors and prophylactic measures. AIM: This study aimed to define the rate of incisional hernia in patients who underwent liver transplantation in a population in southern Brazil and to assess the related risk factors in order to establish measures for prior optimization and specific prophylactic care in the future. METHODS: Patients undergoing adult Liver transplantation from January 2004 to November 2020 were retrospectively analyzed, assessing demographic features, surgical outcomes, and predisposing factors. RESULTS: Among 261 liver transplantation patients included, incisional hernia was diagnosed in 71 (27.2%). Of the 71 incisional hernia patients, 28 (39.4%) developed IH during the first post-transplant. Majority of the patients were male (52/71, 73.2%); of the 71 patients, 52 had hepatitis C virus (HCV) and 33 (46.5%) had hepatocellular carcinoma (HCC). Male gender (p=0.044), diabetes mellitus (p=0.008), and acute cellular rejection (p more...