Autores: Francisco D´Amico, Alessandra Bertacco, Michele Finotti, Chiara Di Renzo, Manuel I. Rodriguez-Davalos, Gabriel E. Gondolesi, Umberto Cillo, David Mulligan, John Geibel.

Resumen:

Objective: Historically, bile in the biliary tract has been considered sterile. Most of the series are based on patients with biliary tract diseases or the bile has been obtained with procedures susceptible to contamination.

Methods: We evaluated the bile in a heterogeneous cohort of liver donors and recipient patients, with samples obtained in a sterile way, directly from the gallbladder and the common bile duct.

Results: We assessed the bile microbiota in six liver donors and in six liver recipients after whole or split liver procedures in adult or pediatric recipients. Bile samples were studied using PCR sequencing of the 16S ribosomal RNA gene amplification (rDNA).

Conclusions: We demonstrated that the bile is sterile, thereby ruling this out as a source of contamination following transplant.

Disponible en: Frontiers

Autores: Andres Fraile, MD, Luis M. Mercado, MD, Hugo Paladini, MD, Diego A. Ramisch, MD,
Valeria Descalzi, MD, Silvina Yantorno, MD,  Pablo A. Farinelli, MD, Pablo Barros Schelotto, MD, PhD,
and Gabriel E. Gondolesi, MD.

Resumen: Strategies to extend the pool of organs include and promote the use of segmental liver grafts. While performing a living donor left lateral segment (LLS) liver transplant and in split procedures, the hepatic artery´s division becomes critical when a dominant segment 4 artery (S4A) emerges from the left hepatic artery (LHA). We aim to describe a novel technique that consists of performing microsurgical reconstruction from the pyloric artery (PA) to S4A. Case Reports. A 45-y-old living donor was evaluated to use his LLS as a graft for a pediatric recipient. During the procedure, a dominant S4A born from the LHA was dissected. To obtain an appropriate LHA length and diameter for the recipient, it was necessary to transect it. An extended right lobe split graft was used in a 61-y-old patient. The S4A born from LHA had to be sectioned during the split procedure. In both cases, segment 4 remained incompletely perfused. The PA was dissected with enough length to be rotated, to perform a microsurgical anastomosis to the S4A, recovering parenchyma’s color and Doppler signal while vascular permeability was demonstrated using CT scan. There was no biliary or cut surface complication. Conclusions. PA to S4A reconstruction is a simple and novel technique that can be used for LLS and extended right lobe split graft and
might contribute to increase donor selection and reduce living donor and recipient S4A-related complications.

Autores: Gabriel E. Gondolesi, María Laura Reyes-Toso, Liliana Bisigniano, Martín De Santibañes,
Juan Pekolj, Rafaela Maurette, Emilio G. Quiñonez, Martín A. Maraschio, Oscar Imventarza,
Javier Lendoire, Lisandro Bittetti, Andrés Ruf, Gabriel Aballay, OCctavio Gil,
Francisco J. Mattera, Pablo Barros Schelotto, Valeria I. Descalzi.

Resumen: La pandemia COVID-19 declarada en marzo del 2020, ha generado preocupación mundial por su
efecto en la salud de la población y el potencial colapso sanitario. La estrategia de “aplanar lacurva” mediante el distanciamiento social permitió adaptar los recursos del sistema de salud a pacientes con COVID-19, pero no se pudo prever su repercusión en otras áreas de la salud. El objetivo de este trabajo fue analizar las consecuencias de la pandemia sobre el trasplante hepático en general y por hepatocarcinoma (HCC).
Fueron realizados los siguientes estudios: a) un análisis retrospectivo utilizando datos del CRESI/INCUCAI para
comparar ingreso en lista de espera, mortalidad en lista, donación y trasplante hepático desde 20/03 a 15/08,
2019 e igual periodo de 2020, y b) una encuesta a los centros de trasplante de mayor actividad trasplantológica
para valorar el efecto de las medidas tomadas en diferentes situaciones institucionales y regionales. El primer
análisis evidenció una disminución del 55% de los trasplantes hepáticos, con una reducción similar en la donación
y en el ingreso a lista de espera hepática; mientras que el trasplante por HCC ascendió de 10% en 2019 a
22% en 2020. El segundo análisis, mostró que la tasa de ocupación de camas por pacientes COVID-19/semana
fue variable: de 0.4% al 42.0%. El número de cirugías, hepato-bilio-pancreática, resección de HCC y trasplante
hepático, se redujeron en 47%, 49%, 31% y 36% respectivamente. La reducción de la actividad trasplantológica
afectó mayormente los centros con alta ocupación por COVID-19. El impacto final a largo plazo deberá evaluarse.

 

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