Polycystic liver disease (PLD) is an autosomal dominant disorder, frequently associated with polycystic kidney disease. Although often asymptomatic, progressive hepatomegaly may cause debilitating compressive symptoms, recurrent infections, and significant impairment in quality of life. Liver transplantation (LT) remains the only curative option for highly symptomatic patients. The objective was to evaluate the evolution and outcomes of patients undergoing LT for PLD between January 1994 and December 2024 at a tertiary university hospital. This retrospective observational study analyzed preoperative variables, including symptom burden, indication for transplantation, and waiting time, as well as postoperative data such as operative time, ischemia times, complications, length of hospital stay, survival, morbidity, and mortality. Data were obtained from medical record review and analyzed using descriptive statistics. Among 1,188 liver transplants performed during the study period, 9 (0.75%) were indicated for PLD. Most patients were female (88.8%), with a mean age of 47.3 years. The main indication for LT was severe impairment in quality of life due to compressive symptoms. Mean warm ischemia time was 45.6 minutes, and cold ischemia 6.3 hours. Mean waiting time was 7.1 months, and mean hospital stay was 12.4 days. Three patients required retransplantation due to hepatic artery thrombosis. Survival rates were 66.6% at 30 days and 55.5% at 5 years. It was observed that LT is an effective option for symptom relief and quality-of-life improvement in PLD. Given its technical complexity and associated morbidity, careful patient selection remains essential.

INTRODUCTION:Liver transplantation (LT) is the main treatment for liver cirrhosis and other conditions. Hepatic artery thrombosis (HAT) is a complication described in up to 15% of LTs in adults. OBJECTIVE:To evaluate the characteristics of patients who developed HAT, describe the different treatments performed in a tertiary center, and compare outcomes. METHODS:This study is a retrospective cohort study based on medical record review of patients who underwent LT between January 2013 and December 2023. RESULTS:A total of 548 LTs were evaluated, of which 88 patients (16.05%) developed HAT. The proposed treatments were: expectant management in 7 patients (7.95%); endovascular treatment in 14 patients (15.90%); and LrT in 59 patients (67.05%). All patients in the expectant management group died, with a mean survival of 672.8 days (range 93-1583); 1- and 5-year mortality 40% and 100%, respectively. In the endovascular treatment group, 9 patients (69.23%) died, with a mean survival of 132 days (range 4-571); 1- and 5-year survival rates were 38.46% and 30.76%, respectively. Among patients indicated for LrT, 23 (26.13%) died before undergoing the procedure; thus, LrT was performed in 36 patients (40.9% of diagnosed HAT and 61.01% of those listed for re-LT). Of these, 22 (61.11%) died, with a post-LrT mean survival of 1290.45 days (range 1-4184); 1- and 5-year survival rates were 55.55% and 38.88%, respectively. CONCLUSION:HAT after LT represents a therapeutic challenge. Endovascular management was associated with positive outcomes; however, Lrt demonstrated the greatest long-term survival benefit.

BACKGROUND:Hepatocellular carcinoma (HCC) is the most common primary liver cancer and a leading cause of cancer-related mortality worldwide. It is strongly associated with chronic liver diseases such as viral hepatitis, alcohol-related liver disease, and nonalcoholic steatohepatitis. Transarterial chemoembolization (TACE) is indicated for intermediate-stage HCC and may be used for downstaging, bridging to liver transplantation, or palliative treatment. METHODS:This cross-sectional observational study evaluated patients with HCC referred for TACE at the University Hospital of Campinas between 2022 and 2023, who underwent the procedure until 2024. Demographic data, liver disease etiology, laboratory findings, tumor staging (Child-Pugh, BCLC, and MELD), transplant listing status, alpha-fetoprotein (AFP) levels, and tumor characteristics were analyzed. RESULTS:A total of 158 patients were included, with a mean age of 64 years and male predominance (77.85%). Hepatitis C virus infection was the most frequent etiology (31%), followed by alcohol-related liver disease (20.9%) and combined HCV and alcohol use (17%). TACE was performed in 100 patients, mainly for downstaging (37.3%) and prevention of transplant waiting-list dropout (32.3%). Half of the patients presented with a single tumor nodule, with a mean lesion size of 3.8 cm. The mean MELD score was 12.5 and AFP levels showed wide variability. CONCLUSION:The study population demonstrated an epidemiological profile consistent with the literature. TACE was widely used as an effective strategy for tumor control in liver transplant candidates, highlighting its importance in the management of HCC in the Brazilian clinical setting.

In some specific cases, the surgical technique involved in liver transplantation can be challenging, as, for example, in cases of Budd-Chiari syndrome.This case describes a case of liver transplantation in a patient diagnosed with Budd-Chiari syndrome due to a previous surgery that required retrohepatic vena cava resection. During the liver transplantation procedure, a cavo-atrial anastomosis was performed through transdiaphragmatic access, with a good postoperative result, showing that, although challenging, this technique is a feasible option in specific cases.

Drug-induced liver injury has become the main cause of acute liver failure (ALF). Injury may be dose-dependent or occur idiosyncratically. We report the case of a 37-year-old female patient admitted with grade 4 hepatic encephalopathy. Morosil use was initiated 30 days prior, and after 2 weeks, the case evolved with jaundice and diarrhea interspersed with constipation when the medication was discontinued. Morosil is a dry extract of the juice of red Moro oranges (Citrus species), grown in eastern Sicily (Italy). It is an important source of anthocyanidin pigments, which act as antioxidants and are used in the care and prevention of obesity, insulin resistance, hepatic steatosis, and cardiovascular diseases. According to the clinical picture and tests performed, the diagnosis of ALF was confirmed, by the criteria of Clichy and King's College. The patient was listed for liver transplantation as a priority, with the model for end stage liver disease (MELD) score: 41. Orthotopic liver transplantation was uneventfully performed using the Piggyback technique. There are few reports in the literature of acute liver injury by other Citrus species, and we found no case reports of ALF related to the use of Morosil.

The use of herbal medicines is growing exponentially despite the lack of scientific evidence regarding their effectivity and toxicity. ( , ) Moreover, the use of herbal medicines have been reported to be common in patients with chronic liver disease (30–62%); these medicines can lead to hepatotoxicity and serious hepatic side effects. ( ) Hepatic encephalopathy is a complication of acute liver failure and chronic liver disease that causes cognitive dysfunction, motor deficits, and seizures. ( , ) Gastrointestinal hemorrhage, [...]

Hepatocellular carcinoma (HCC) is the sixth leading cause of cancer in the world, and liver transplant (LT) is a good therapeutic option in selected cases because it treats the neoplasm and the underlying disease. Recurrence after LT is usually aggressive and has low survival; thus, an adequate selection of recipients is ideal. The new models aim to assess the individual risk of HCC recurrence in patients undergoing LT and to improve post-LT survival. In this study, our aim was to assess the applicability of the "Metroticket" score, correlating it with our rates of recurrence and survival after LT. Overall survival at 5 years in our study differed from that in Metroticket 2.0 because that study did not consider only recurrence as the cause of death; our study evaluated only patients with recurrence, so we were able to validate the score as a predictor of greater tumor aggressiveness after LT.

Introduction: The covid-19 pandemic has led to changes in the care of transplant patients, including authorization from the SNT/MS/Brazil for its use since April 2020. Objective: To assess the impact of COVID-19 on kidney and liver transplantation and the use of telemedicine. Method: To verify the number of visits, number of transplants, types of assessments, incidence of COVID-19 in transplant recipients, use of immunosuppression and impact on the number of transplants, descriptive statistics were used. Result: A specific TCLE was implemented for the pandemic season, teleguidance and teleconsultations were carried out institutionally with medical, nursing, psychology and social assistance assessments, the return frequency changed thanks to the 6-month LME (saving in TFD about 20 thousand/patient). 4,000 consultations were carried out in 2020, with a 50% drop in face-to-face consultations (4 outpatient clinics/week) with directed anamnesis, the sending of images and outpatient results was done by institutional email as well as renewal of the MELD (for patients in list). There was a 25% reduction in the number of transplants (lack of an ICU bed and patient refusal due to fear/fear), a 50% drop in the number of patients enrolled in the list. The immunosuppression adjustment was mainly performed in the second wave (November 2020 to March 2021). We observed 30 COVID cases in 750 follow-up liver transplants and 100 cases in 3000 follow-up kidney transplants. In liver transplantation the mortality was 25% and in kidney transplantation it was 26%. The most frequent comorbidities were age > 60 years, presence of diabetes and time greater than ten years after transplantation. 2 patients with COVID-19 and 2 with kidney transplants were transplanted with liver, which evolved well and there was 1 patient transplanted due to complications after IVM/COVID-19 who also evolved well. Conclusion: COVID-19 had a high impact on transplantation in our service and telemedicine is probably here to stay.

Hepatocellular carcinoma (HCC) is the most common primary neoplasm of the liver, mainly secondary to cirrhosis caused by hepatitis C virus. Liver transplant (LT) is considered the best treatment because, in addition to removing the tumor, it also removes the underlying cirrhotic liver. The Milan criteria for LT have limitations because they do not consider the biological characteristics of the tumor. Thus, our objective was to evaluate the association of α-fetoprotein (AFP) levels before LT performed for HCC with recurrence of this tumor, and, based on the results, a new predictive model that combines the AFP values at the list entry with the usual criteria of tumor size and number of nodules was validated. In present study, the Score AFP model, we were able to correlate a greater occurrence of relapse with scores of 3 and 4 (P = .0001), indicating the usefulness of using AFP as a predictor of recurrence.

Liver transplant is the main treatment for hepatocellular carcinoma and there is currently an important demand from patients waiting in transplant queues. Thus, it is extremely important to improve the criteria for selecting patients who will undergo transplant to mitigate graft loss and reduce cases of recurrence. Thus, it becomes necessary to use models, such as the New York/California (NYCA), that include alpha fetoprotein as a marker of recurrence and prognosis. The aim of this study was to assess whether the NYCA score correlated with the presence of tumor recurrence after transplant in patients undergoing orthotopic liver transplant at the Clinics Hospital of the University of Campinas. We had 214 patients undergoing liver transplant who met the inclusion Milan criteria. The age of the patients ranged from 34 to 77 years, with a median age of 61 years. The mean waiting time on the transplant list was 6.12 months. After calculating the NYCA score, it was possible to stratify 13 patients (6.1%) as high risk, 64 patients (29.9%) as medium risk, and 137 patients (64%) as low risk. Patients with recurrence had higher scores with a mean of 4 points in relapse and 2 points in the absence of relapse (P = .0011). Patients with recurrence had statistically higher high- and medium-risk scores (P = .0010). Therefore, the NYCA score was higher in patients with recurrence. Therefore, in this study, our findings suggest the possibility of using the NYCA score as an aid to detect patients with a higher risk of tumor recurrence.