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Article ; Online: Effects of Intensive Blood Glucose Control on Surgical Site Infection for Liver Transplant Recipients: A Randomized Controlled Trial.

Oliveira, Ramon Antônio / Tanner, Judith / Mancero, Jorge Marcelo Padilla / de Brito Poveda, Vanessa

2022 Volume 55, Issue 1, Page(s) 170–177

Abstract: Background: The evidence supporting intensive blood glucose control to prevent surgical site infections (SSIs) among liver transplant recipients is insufficient. We aimed to assess the effects of postoperative intensive blood glucose control (IBGC) ... ...

Abstract	Background: The evidence supporting intensive blood glucose control to prevent surgical site infections (SSIs) among liver transplant recipients is insufficient. We aimed to assess the effects of postoperative intensive blood glucose control (IBGC) against standard blood glucose control (SBGC) on the incidence of SSIs among adult liver transplant recipients. Methods: We performed a randomized controlled trial (ClinicalTrials.gov identifier NCT03474666). The IBGC target was 80 to 130 mg/dL, and the SBGC target was below 180 mg/dL. Analyses were made on an intention-to-treat basis. Results: Of the 41 recipients enrolled onto the trial, 20 were randomly allocated to the IBGC group and 21 to the SBGC group. There were no significant differences in SSIs among recipients allocated to either group (relative risk [RR], 0.78; 95% confidence interval [CI], 0.21-2.88; P = .69). Mean (SD) blood glucose levels were significantly lower in the IBGC group in the 24-hour period after surgery (145.0 [20.7] mg/dL and 230.2 [51.6] mg/dL; P = .001). While there were fewer episodes of hypoglycemia in the IBGC group, this was not statistically significant. There were no episodes of severe hypoglycemia in either group. Hyperglycemia and severe hyperglycemia were significantly more frequent in the SBGC group (RR, 0.70; 95% CI, 0.52-0.93; P = .001 and RR, 0.07; 95% CI, 0.01-0.48; P = .001, respectively). Length of hospital stay was significantly shorter for recipients in the IBGC group (13.1 [5.5] days vs 19.3 [12.1] days; P = .04). Conclusions: Although this small trial did not find intensive control reduced SSI, it was associated with lower blood glucose levels, fewer episodes of hyperglycemia and severe hyperglycemia, and shorter length of hospital stay.
MeSH term(s)	Adult ; Humans ; Hypoglycemic Agents ; Surgical Wound Infection/prevention & control ; Insulin ; Blood Glucose ; Glycemic Control/adverse effects ; Liver Transplantation/adverse effects ; Hypoglycemia/complications ; Diabetes Mellitus ; Hyperglycemia/complications
Chemical Substances	Hypoglycemic Agents ; Insulin ; Blood Glucose
Language	English
Publishing date	2022-12-24
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	82046-5
ISSN	1873-2623 ; 0041-1345
ISSN (online)	1873-2623
ISSN	0041-1345
DOI	10.1016/j.transproceed.2022.10.062
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Article ; Online: A Retrospective Cohort Study of Risk Factors for Surgical Site Infection Following Liver Transplantation.

Oliveira, Ramon Antônio / Mancero, Jorge Marcelo Padilla / Faria, Dalila Fernanda / Poveda, Vanessa de Brito

Progress in transplantation (Aliso Viejo, Calif.)

2019 Volume 29, Issue 2, Page(s) 144–149

Abstract: Background: Surgical site infection is an important complication in the postoperative period among liver transplant recipients. However, little is known about the risk factors in this patient group. Therefore, the objective of this study was to analyze ... ...

Abstract	Background: Surgical site infection is an important complication in the postoperative period among liver transplant recipients. However, little is known about the risk factors in this patient group. Therefore, the objective of this study was to analyze the incidence and risk factors for surgical site infections among adult liver transplant recipients. Methods: Medical records of adult liver transplant recipients from January 1, 2009, to December 31, 2015, were analyzed in this retrospective cohort study. Results: We enrolled 156 recipients' medical records. Forty-two (26.9%) cases of surgical site infections were identified. The main isolated microorganisms were methicillin-resistant Staphylococcus species, extended spectrum β-lactamase-producing Klebsiella species, carbapenem-resistant Pseudomonas aeruginosa, carbapenem-resistant Acinetobacter baumannii, and vancomycin-susceptible Enterococcus faecalis. We found that long operative times (≥487 minutes) and differences in body mass index between donor and recipient (≥1.3 kg/m Conclusions: There was a high incidence of surgical site infections among the studied population and that some risk factors identified differ from those reported in the scientific literature.
MeSH term(s)	Acinetobacter Infections/epidemiology ; Acinetobacter Infections/etiology ; Acinetobacter Infections/microbiology ; Acinetobacter Infections/mortality ; Acinetobacter baumannii/isolation & purification ; Brazil/epidemiology ; Cohort Studies ; Female ; Humans ; Incidence ; Liver Transplantation ; Male ; Medical Records ; Methicillin-Resistant Staphylococcus aureus/isolation & purification ; Middle Aged ; Retrospective Studies ; Risk Factors ; Staphylococcal Infections/epidemiology ; Staphylococcal Infections/etiology ; Staphylococcal Infections/microbiology ; Staphylococcal Infections/mortality ; Surgical Wound Infection/epidemiology ; Surgical Wound Infection/etiology ; Surgical Wound Infection/microbiology ; Surgical Wound Infection/mortality
Language	English
Publishing date	2019-03-07
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2864264-8
ISSN	2164-6708 ; 1526-9248
ISSN (online)	2164-6708
ISSN	1526-9248
DOI	10.1177/1526924819835831
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Article ; Online: Encapsulating Peritoneal Sclerosis in a kidney transplant recipient - Case Report.

Ribeiro, Bruno Henrique Dantas / Takenaka, Vanessa Suemi / Borges, Felipe Sbrolini / Andrade, Thales Franco de / Lessa, Sibele Braga / Mancero, Jorge Marcelo Padilla / Noronha, Irene L / David, André Ibrahim

Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia

2020 Volume 42, Issue 3, Page(s) 370–374

Abstract: Encapsulating Peritoneal Sclerosis (EPS) is a severe and rare condition frequently associated with peritoneal dialysis, characterized by bowel obstruction, with lethal consequences in 20% of the patients. The disease presents as a mass of fibrous tissue ... ...

Abstract	Encapsulating Peritoneal Sclerosis (EPS) is a severe and rare condition frequently associated with peritoneal dialysis, characterized by bowel obstruction, with lethal consequences in 20% of the patients. The disease presents as a mass of fibrous tissue encapsulating visceral organs that may potentially compromise digestive tract function. This report describes the case of a patient under peritoneal dialysis (PD) due to chronic kidney disease secondary to focal segmental glomerulosclerosis diagnosed with EPS. The patient had undergone two living-donor kidney transplant procedures. Surgical techniques and clinical measures employed to unravel bowel obstruction are described, which have been shown to ameliorate EPS secondary complications. Parenteral nutrition has significantly contributed to afford adequate nutrition, improving tissue healing as well as serum protein levels, vitamins and electrolytes. Therapy with tamoxifen and sodium thiosulfate effectively delayed the development of EPS.
MeSH term(s)	Adult ; Child, Preschool ; Female ; Humans ; Immunosuppressive Agents ; Kidney Transplantation ; Peritoneal Dialysis ; Peritoneal Fibrosis ; Peritonitis
Chemical Substances	Immunosuppressive Agents
Language	Portuguese
Publishing date	2020-05-14
Publishing country	Brazil
Document type	Case Reports ; Journal Article
ZDB-ID	2057873-8
ISSN	2175-8239 ; 2175-8239
ISSN (online)	2175-8239
ISSN	2175-8239
DOI	10.1590/2175-8239-JBN-2019-0193
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Article ; Online: Understanding the Elevated Lethality of COVID-19 in Liver Transplant Recipients: Does Immunosuppression Management Matter? Results from a Brazilian Multicentric Historical Cohort.

Boin, Ilka Fsf / Riccetto, Eduardo / Genzini, Tercio / Santos, Regina Gomes / Moreira, Lucio Figueira Pacheco / Pinto, Laura Cristina Machado / Garcia, Jose Huygens Parente / Stucchi, Raquel Sb / Perales, Simone Reges / Zanaga, Leticia / Da Silva, Renato Fereira / Da Silva, Rita Cm Fereira / Haddad, Luciana / Ac D Albuquerque, Luiz / Dealmeida, Marcio Dias / Watanabe, Andre / Peixoto, Gustavo S / De Melo, Claudio Moura Lacerda / Bezerra, Renata Ferreira /

Tefilli, Nertan Luiz / Halpern, Marcia / Godoy, Maira Silva / Nogara, Marcelo / Mancero, Jorge Marcelo Padilla / Noujaim, Huda Maria / Rangel, Erika Bevilaqua / Ataide, Elaine Cristina

Transplantation proceedings

2023 Volume 55, Issue 8, Page(s) 1815–1821

Abstract: Background: Infections by SARS-CoV-2 in liver transplant recipients (LT) patients are of particular concern, notably due to perceived added risks related to immunosuppression and comorbidity burden. Current literature on this topic often relies on small, ...

Abstract	Background: Infections by SARS-CoV-2 in liver transplant recipients (LT) patients are of particular concern, notably due to perceived added risks related to immunosuppression and comorbidity burden. Current literature on this topic often relies on small, non-standardized, and geographically limited studies. This manuscript describes COVID-19 presentations and causes for elevated mortality in a large cohort of LT recipients. Methods: This study was designed as a multicentric historical cohort, including LT recipient patients with COVID-19 in 25 study centers, with the primary endpoint being COVID-related death. We also collected demographic, clinical, and laboratory data regarding presentation and disease progression. Results: Two hundred and thirty-four cases were included. The study population was predominantly male and White and had a median age of 60 years. The median time from transplantation was 2.6 years (IQR 1-6). Most patients had at least one comorbidity (189, 80.8%). Patient age (P = .04), dyspnea (P < .001), intensive care unit admission (P < .001), and mechanical ventilation (P < .001) were associated with increased mortality. Modifications of immunosuppressive therapy (P < .001), specifically the suspension of tacrolimus, maintained significance in multivariable analysis. Conclusions: Attention to risk factors and the individualization of patient care, especially regarding immunosuppression management, is crucial for delivering more precise interventions to these individuals.
MeSH term(s)	Humans ; Male ; Middle Aged ; Female ; COVID-19/epidemiology ; SARS-CoV-2 ; Liver Transplantation/adverse effects ; Brazil/epidemiology ; Immunosuppression Therapy/adverse effects ; Transplant Recipients
Language	English
Publishing date	2023-05-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	82046-5
ISSN	1873-2623 ; 0041-1345
ISSN (online)	1873-2623
ISSN	0041-1345
DOI	10.1016/j.transproceed.2023.05.007
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Article ; Online: Are the imaging findings used to assess the portal triad reliable to perform living-donor liver transplant?

Dazzi, Francisco Leôncio / Ribeiro, Marcelo Augusto Fontenelle / Mancero, Jorge Marcelo Padilla / Gonzalez, Adriano Miziara / Leão-Filho, Hilton Muniz / de Oliveira e Silva, Adávio / D'Albuquerque, Luiz Augusto Carneiro

Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery

2013 Volume 26, Issue 4, Page(s) 296–301

Abstract: Background: A crucial aspect of living-donor liver transplant is the risk imposed to the donor due to a procedure performed in a healthy individual that can lead to a high postoperative morbidity rate: Aim: To correlate the pre- and intraoperative ... ...

Abstract	Background: A crucial aspect of living-donor liver transplant is the risk imposed to the donor due to a procedure performed in a healthy individual that can lead to a high postoperative morbidity rate Aim: To correlate the pre- and intraoperative hepatic imaging findings of living adult donors. Methods: From 2003 to 2008 the medical charts of 66 donors were revised; in that, 42 were males (64%) and 24 females (36%), mean age of 30 ± 8 years. The preoperative anatomy was analyzed by magnetic resonance cholangiography to study the bile ducts and by computed tomography angiography to evaluate the hepatic artery and portal vein. Normalcy criteria were established according to previously published studies. Results: Anatomic variations of the bile ducts were found in 59.1% of donors, of the artery hepatic in 31.8% and of the portal vein in 30.3% of the cases during the preoperative period. The magnetic resonance cholangiography findings were in agreement in 44 (66.6%) of donors and in disagreement in 22 (33.3%). With regards to hepatic artery, in all donors the findings of the imaging examination were in agreement with those of the intraoperative period. As to the portal vein, the computed tomography findings were in agreement in 59 (89.4%) donors and in disagreement in seven (10.6%). Conclusions: The bile duct anatomic variations are frequent, and the magnetic resonance cholangiography showed moderate accuracy (70%) in reproducing the surgical findings; the computed tomography reproduced the intraoperative findings of the hepatic artery in 100% of donors, and of the portal vein in 89.4% of the cases, thus demonstrating high accuracy (89%).
MeSH term(s)	Adult ; Anatomic Variation ; Bile Ducts/anatomy & histology ; Cholangiography ; Female ; Hepatic Artery/anatomy & histology ; Hepatic Artery/diagnostic imaging ; Humans ; Intraoperative Care ; Liver Transplantation ; Living Donors ; Male ; Multimodal Imaging ; Portal Vein/anatomy & histology ; Portal Vein/diagnostic imaging ; Preoperative Care ; Reproducibility of Results ; Retrospective Studies ; Tomography, X-Ray Computed
Language	Portuguese
Publishing date	2013-07-13
Publishing country	Brazil
Document type	Journal Article
ISSN	2317-6326
ISSN (online)	2317-6326
DOI	10.1590/s0102-67202013000400009
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Article: Laparoscopic cholecystectomy in cirrhotic patients with symptomatic cholelithiasis: a case-control study.

Mancero, Jorge Marcelo Padilla / D'Albuquerque, Luiz Augusto Carneiro / Gonzalez, Adriano Miziara / Larrea, Frans Ivan Serpa / de Oliveira e Silva, Adavio

World journal of surgery

2007 Volume 32, Issue 2, Page(s) 267–270

Abstract: Background: In this study we retrospectively evaluated a group of symptomatic cirrhotic (n=30) and non-cirrhotic (n=60) patients submitted to laparoscopic cholecystectomy (LC) in a public hospital in Brazil.: Methods: The groups were compared for ... ...

Abstract	Background: In this study we retrospectively evaluated a group of symptomatic cirrhotic (n=30) and non-cirrhotic (n=60) patients submitted to laparoscopic cholecystectomy (LC) in a public hospital in Brazil. Methods: The groups were compared for surgical time, duration of hospitalization after surgery, period of permanence in the intensive care unit (ICU), use of blood derivatives, mortality rates, and transoperative and post-surgery complications. Other parameters, such as hepatic reserve capacity and presence of ascites, were also analyzed. Results: Twenty-three (76.7%) of the patients of the cirrhosis group (CG) were classified as Child-Pugh A, and seven (23.3%) were Child-Pugh B. Six of them (20%) had ascites. Differences between the two groups included surgery time (p=0.008), duration of hospitalization (p=0.014), and post-surgery (p=0.000) or ambulatory (p=0.008) complications. The worst results were observed among Child B patients and in those with ascites. Blood derivatives were used in only 3.3% of the CG patients. No cases of conversion to laparotomy were observed among the two groups of patients included in this study, nor were there any deaths. Conclusions: These results indicate that videolaparoscopic cholecystectomy may be safely performed in public hospitals in Brazil, with low levels of complications, no associated mortality, and no need for blood derivatives.
MeSH term(s)	Brazil ; Cholecystectomy, Laparoscopic ; Cholelithiasis/complications ; Cholelithiasis/diagnosis ; Cholelithiasis/surgery ; Cohort Studies ; Developing Countries ; Female ; Hospitals, General ; Hospitals, Public ; Humans ; Liver Cirrhosis/complications ; Liver Cirrhosis/pathology ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2007-12-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-007-9314-x
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Article ; Online: Living donor right liver lobe transplantation with or without inclusion of the middle hepatic vein: analysis of complications.

Mancero, Jorge Marcelo Padilla / Gonzalez, Adriano Miziara / Ribeiro, Marcelo Augusto Fontenelle / Peron, Gilberto / Wahle, Raul Carlos / Dazzi, Francisco Leôncio / de Oliveira e Silva, Adávio / D'Albuquerque, Luiz Augusto Carneiro

World journal of surgery

2010 Volume 35, Issue 2, Page(s) 403–408

Abstract: Background: For living-related liver transplantation, harvesting a right hepatic graft that includes the middle hepatic vein (MHV) has been recommended to improve venous drainage of the graft. However, it may result in congestion of the donor's ... ...

Abstract	Background: For living-related liver transplantation, harvesting a right hepatic graft that includes the middle hepatic vein (MHV) has been recommended to improve venous drainage of the graft. However, it may result in congestion of the donor's remaining segment IV, increasing the potential risk to the donor. This study aimed to compare safety levels for liver donors during procedures with or without removal of the MHV. Methods: A total of 68 living donor liver transplantations were performed from March 2001 to May 2007. In 39 procedures, the MHV was not included in the graft (group A), and in 29 the MHV was included in the graft (group B). The analyzed data included surgical time, use of blood derivatives, length of hospital stay, laboratory analyses, weight of the graft, and clinical complications. Results: No differences were observed regarding the need for blood derivatives or laboratory parameters. The frequency of postoperative complications was similar in the two groups, with 10 cases (25.6%) in group A and 7 cases (24.1%) in group B (P=0.887). No deaths were seen. The rate of observed complications was 25% among living donors, most of them being managed without surgical intervention. Conclusions: The inclusion of the MHV does not add morbidity in living donors in selected cases.
MeSH term(s)	Adult ; Algorithms ; Female ; Hepatic Veins ; Humans ; Liver Transplantation/methods ; Living Donors ; Male ; Postoperative Complications/epidemiology ; Prospective Studies ; Tissue and Organ Harvesting/adverse effects ; Tissue and Organ Harvesting/methods
Language	English
Publishing date	2010-11-24
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-010-0857-x
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Article ; Online: Liver transplantation for subacute hepatocellular failure due to massive steatohepatitis after bariatric surgery.

D'Albuquerque, Luiz Augusto Carneiro / Gonzalez, Adriano Miziara / Wahle, Raul Carlos / de Oliveira Souza, Evandro / Mancero, Jorge Marcelo Padilla / de Oliveira e Silva, Adávio

Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society

2008 Volume 14, Issue 6, Page(s) 881–885

Abstract: New therapeutic options for obesity include restrictive bowel surgery and surgery that promotes malabsorption, such as the Fobi-Capella (gastric bypass) and Scopinaro (biliopancreatic diversion) techniques. Complications associated with these procedures, ...

Abstract	New therapeutic options for obesity include restrictive bowel surgery and surgery that promotes malabsorption, such as the Fobi-Capella (gastric bypass) and Scopinaro (biliopancreatic diversion) techniques. Complications associated with these procedures, such as hepatocellular failure, have been observed with increasing frequency. Reported here are 3 patients who, 7 to 24 months after bariatric surgery, developed hepatocellular failure, for which liver transplantation was considered to be indicated. Liver transplantation was undertaken in 2 of the patients; the third patient died while waiting for this procedure. We discuss the possible causes of this uncommon and poorly understood complication of surgery for obesity. One possibility is that it might arise as a result of progression of steatohepatitis. An alternative concept is that this complication may be secondary to rapid, massive loss of body weight.
MeSH term(s)	Adult ; Bariatric Surgery/adverse effects ; Body Weight ; Fatal Outcome ; Fatty Liver/etiology ; Fatty Liver/therapy ; Female ; Hepatitis/etiology ; Hepatitis/therapy ; Humans ; Liver Failure/surgery ; Liver Failure/therapy ; Liver Function Tests ; Liver Transplantation/methods ; Obesity/surgery ; Obesity, Morbid/complications ; Obesity, Morbid/surgery ; Postoperative Complications ; Surgical Procedures, Operative
Language	English
Publishing date	2008-06
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2006866-9
ISSN	1527-6473 ; 1527-6465
ISSN (online)	1527-6473
ISSN	1527-6465
DOI	10.1002/lt.21472
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