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.

Portal hypertension leads to the development of a complex and heterogeneous network of portosystemic collateral pathways, which represent adaptive responses to increased portal pressure. Although traditionally considered compensatory mechanisms, growing evidence indicates that Spontaneous Portosystemic Shunts (SPSS) are ineffective in normalizing portal pressure and may contribute to adverse clinical outcomes. In patients with cirrhosis, particularly those with preserved liver function, the presence and extent of SPSS are independently associated with hepatic encephalopathy, variceal bleeding, portal vein thrombosis, and reduced transplant-free survival, highlighting their prognostic relevance. Cross-sectional imaging with computed tomography (CT) and magnetic resonance imaging (MRI) plays a central role in the noninvasive assessment of portal hypertension by enabling comprehensive mapping of collateral circulation, including shunt size, anatomical course, and drainage pathways. These imaging characteristics are key determinants of clinical impact and therapeutic planning. This pictorial review illustrates the major portosystemic collateral pathways encountered in portal hypertension using representative clinical cases, emphasizing key imaging features and common diagnostic pitfalls, as well as highlighting the clinical significance in each context. Accurate recognition and standardized reporting of SPSS are essential to optimize risk stratification, guide management decisions, and improve outcomes in patients with portal hypertension.

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.

INTRODUCTION:The scarcity of donor organs necessitates the development of refined prognostic tools to optimize candidate selection and survival outcomes for patients with hepatocellular carcinoma (HCC) who receive liver transplantation. Standard computed tomography scans provide additional health indicators that reveal physiological vulnerabilities beyond tumor staging. In this observational cohort study with retrospective patient inclusion and prospective follow-up, we evaluated the effects of new computed tomography-derived biomarkers, with artificial intelligence (AI)-assisted sarcopenia assessment, on the survival of patients with hepatocellular carcinoma undergoing liver transplantation. METHODS:We used preoperative chest and abdominal computed tomography scans to measure: 1. AI-assisted sarcopenia assessment; 2. myosteatosis; 3. osteoporosis, that although tomography diagnosis has been recently validated in other cohorts, it has not yet been assessed in survival of HCC patients undergoing transplantation; and 4. thymic fatty infiltration, a novel imaging biomarker of immunosenescence, that thus far has not been studied in the transplant setting. Survival analysis was performed using Kaplan-Meier curves and multivariable Cox regression models with stepwise selection. RESULTS:Sarcopenia, myosteatosis, osteoporosis, and thymus fatty replacement occurred in 35.4%, 51.3%, 27.3% and 82.1% of patients, respectively. The presence of microvascular invasion (HR= 1.943, p=0.0003), myosteatosis (HR=3.182, p=0.0001), osteoporosis (HR=2.133, p=0.0004), and thymic fatty replacement (HR=4.613, p=0.0001) independently were associated with a higher risk of mortality. While sarcopenia was significantly associated with survival in univariate (Kaplan-Meier) analysis (p=0.0002), it was not retained as an independent predictor in the final multivariable Cox model. CONCLUSION:These opportunistic imaging biomarkers provide significant noninvasive prognostic value, suggesting they may complement existing risk models and enhance the comprehensive assessment of patients undergoing liver transplantation. However, our findings require multicenter validation before integration into clinical workflows.

Introduction: Orthotopic liver transplantation (OLT) is the primary therapy for end-stage liver disease. In Brazil, the number of liver transplants has significantly increased over the past decades, improving long-term outcomes. This study analyzes the long-term survival of patients who underwent OLT over 20 years at a reference transplant center. Methods: Medical records of 848 patients who underwent OLT between February 1995 and December 2017 were reviewed. Exclusion criteria included patients with survival below six months to minimize the impact of early postoperative complications on long-term outcomes. Thus, 174 patients were included. The analyzed variables involved the recipient, donor, graft, surgical procedure, and postoperative evolution. Survival was assessed using Kaplan–Meier analysis. Results: Among the 174 analyzed patients, 98 (56.3%) remained in outpatient follow-up, while 76 (43.7%) died. The mean age at transplantation was 47 years, and 75% of recipients were male. The main indications were viral hepatitis (59.8%) and hepatocellular carcinoma (11.6%). The mean MELD score was 18. The leading cause of death was cardiovascular events (36.4%), followed by liver disease recurrence (22.1%) and malignancies (15.6%). The mean survival time was 223 months for surviving patients and 112 months for deceased patients (p < 0.0001). Longer cold ischemia time, postoperative renal dysfunction, diabetes, and prolonged stay in the intensive care unit were associated with worse survival. Younger patients had significantly longer survival (p = 0.00007). Conclusion: The 20-year analysis demonstrated that OLT provides good long-term survival; however, factors such as diabetes, renal dysfunction, and prolonged cold ischemia time negatively impact the outcomes. Cardiovascular events and recurrence of liver disease were the leading causes of mortality.

Introdução: Infecções nosocomiais continuam sendo uma causa significativa de desfechos adversos após o transplante de fígado. Infecções relacionadas ao doador são raras, mas potencialmente fatais nesse contexto. Infecções bacterianas e fúngicas estão entre as formas mais comuns de infecções relacionadas ao doador. Dada a escassez de órgãos e o elevado número de pacientes na lista de espera, é crucial determinar se o uso de órgãos de doadores com culturas positivas é prejudicial ou viável. Objetivos: Avaliar a incidência e o impacto das infecções em geral, do uso de doadores com culturas positivas e das infecções relacionadas ao doador nos desfechos do transplante hepático. Métodos: Este estudo observacional retrospectivo foi realizado no Hospital Geral da Universidade de Campinas. Foram revisados os prontuários digitais de todos os receptores de transplante hepático entre abril de 2021 e janeiro de 2024 para identificar culturas positivas, registros de infecção no momento da cultura positiva e culturas dos doadores. Considerou-se infecção relacionada ao doador presente quando os pacientes desenvolveram infecção pelo mesmo agente isolado do doador, desde que não estivessem previamente colonizados. Curvas de Kaplan-Meier foram utilizadas para definir a sobrevida, com o teste de Breslow para comparação entre os grupos com ou sem infecção e com ou sem culturas positivas dos doadores. Resultados: Foram realizados 90 transplantes de fígado em 86 pacientes. Entre os 90 doadores, nove (10%) apresentaram culturas positivas, e quatro (4,4%) atenderam aos critérios para infecção da corrente sanguínea. Entre os receptores, 26 (30,2%) desenvolveram infecções com culturas positivas nos 60 dias após o transplante hepático. Nenhuma infecção nos receptores foi relacionada aos doadores. Não houve diferença na mortalidade entre aqueles que receberam fígados de doadores com culturas positivas e aqueles com culturas negativas. Além disso, não foi observada diferença na mortalidade entre os que desenvolveram infecções e os que não desenvolveram. O tempo de permanência na unidade de terapia intensiva foi maior nos receptores que desenvolveram infecções. Conclusão: As infecções continuam sendo uma causa importante de morbidade pós-operatória entre receptores de transplante hepático, justificando a preocupação com as infecções relacionadas ao doador. No entanto, doadores com culturas positivas podem ser adequados para transplante quando não há sepse evidente no momento da captação do órgão. O desenho deste estudo é limitado, sendo necessário confirmar esses achados com estudos prospectivos adicionais.

Introduction: Nosocomial infections remain a significant cause of adverse outcomes following liver transplantation. Donor-derived infections (DDIs) are rare but potentially life-threatening in this context. Bacterial and fungal infections are among the most common forms of DDI. Given the shortage of organs and the high number of patients on the waiting list, it is crucial to determine whether the use of organs from donors with positive cultures is harmful or feasible. Objectives: To evaluate the incidence and impact of general infections, of the use of positive-culture donors, and of DDIs on liver transplant outcomes. Methods: This retrospective observational study was conducted at the Hospital Geral, Universidade de Campinas. Digital records of all transplant recipients from April 2021 to January 2024 were reviewed to identify positive cultures, records of infection at the time of positive culture, and donor cultures. DDI was considered present when patients developed infection by the same agent isolated from the donor, provided they had not been colonized before. Kaplan-Meier curves were used to define survival, with Breslow’s test for comparison between groups with or without infection and with or without positive donor cultures. Results: Ninety liver transplants were performed in 86 patients. Among the 90 donors, nine (10%) had positive cultures, and four (4.4%) met the criteria for bloodstream infection. Among the recipients, 26 (30.2%) developed infections with positive cultures during the 60 days following liver transplantation. No infections in recipients were linked to donors. There was no difference in mortality between those who received livers from positive-culture donors and negative-culture donors. Additionally, no difference in mortality was observed between those who developed infections and those who did not. Intensive care unit length of stay was higher in recipients who developed infections. Conclusion: Infections remain an important cause of postoperative morbidity among liver transplant recipients, justifying concern about DDIs. However, positive-culture donors might be suitable for transplantation when no evident sepsis is present at the time of organ harvest. The design of this study is limited, and therefore, it is imperative to confirm these findings with further prospective studies.

Abdominal tuberculosis (TB), a potential differential diagnosis for acute and chronic abdomen, should be considered in specific situations, such as immunosuppressant or biological drug use, HIV, or in patients residing in endemic areas. Although the presence of thoracic tuberculosis may indicate abdominal TB, only 15% of patients with abdominal TB have evidence of pulmonary disease. Involvement of the liver and spleen is a common autopsy finding in patients with disseminated TB. However, the most common pattern is of fine miliary lesions. Hepatic involvement with a macronodular pattern, a rare occurrence, is linked to dissemination through the portal vein. The splenic macronodular form, an extremely rare presentation, can manifest as solitary or multiple nodules, oval or round, with a variable appearance reflecting different stages of the disease, adding to the uniqueness of this case.

OBJECTIVE:The aim of this study was to investigate the diagnosis of sarcopenia in chronic liver disease by opportunistic computed tomography screening using the Psoas Muscle Index method as a predictor of mortality after liver transplantation. METHODS:We systematically searched PubMed, Scopus, and Cochrane Central Register of Controlled Trials from July 2014 to July 2024. We restricted inclusion in this meta-analysis to observational studies and clinical trials on adult patients with chronic liver disease diagnosed with sarcopenia by computed tomography undergoing liver transplantation or on a waiting list. We included the one with a larger sample size for studies with overlapping populations. We excluded studies with therapeutic interventions, animal experiments, cell-line studies, editorial pieces, commentaries, review articles, and case reports. RESULTS:After the removal of duplicate records and ineligible studies, 163 remained and were thoroughly reviewed based on inclusion criteria. Of these, a total of 11 studies were included in qualitative synthesis and four studies were included in quantitative analysis (meta-analysis), comprising 382 patients. Patients with muscle mass loss after liver transplantation diagnosed by computed tomography scan using the Psoas Muscle Index method had a 4.1 times higher risk of death than non-sarcopenic patients (random-effects model: OR 4.1386; 95%CI 2.4215-7.0730; p<0.0001). Interpretatively, a scale with an I2 value close to 0% indicates no heterogeneity. The other criteria also did not reject the hypothesis of homogeneity among the articles. CONCLUSIONS:Patients with muscle mass loss diagnosed by computed tomography using the Psoas Muscle Index method had a fourfold increased mortality risk after transplantation. The findings reinforce the need to identify sarcopenic patients preoperatively to optimize liver transplantation outcomes. Using the Psoas Muscle Index, an opportunistic diagnosis by computed tomography scan can be helpful in this setting.

Introdução: O transplante ortotópico de fígado (TOF) é a principal terapia para doença hepática terminal. No Brasil, a realização de transplantes aumentou significativamente nas últimas décadas, com melhorias nos desfechos a longo prazo. Este estudo analisa a sobrevida de pacientes submetidos a TOF ao longo de 20 anos em um centro de referência. Métodos: Foram revisados os prontuários de 848 pacientes transplantados entre fevereiro de 1995 e dezembro de 2017. Aplicaram-se critérios de exclusão, incluindo pacientes com sobrevida inferior a 6 meses, visando minimizar o impacto de complicações precoces no desfecho de longo prazo. Dessa forma, 174 pacientes foram incluídos. As variáveis analisadas envolveram dados do receptor, doador, enxerto, procedimento cirúrgico e evolução pós-operatória. A sobrevida foi avaliada por Kaplan–Meier. Resultados: Dos 174 pacientes analisados, 98 (56,3%) mantiveram seguimento ambulatorial e 76 (43,7%) evoluíram a óbito. A média de idade no transplante foi de 47 anos, e 75% dos receptores eram do sexo masculino. As principais indicações foram hepatite viral (59,8%) e carcinoma hepatocelular (11,6%). A média do escore MELD foi 18. A principal causa de morte foi evento cardiovascular (36,4%), seguido de recidiva da doença hepática (22,1%) e neoplasias (15,6%). O tempo médio de sobrevida foi de 223 meses entre os pacientes vivos e 112 meses entre os óbitos (p < 0,0001). Maior tempo de isquemia fria, insuficiência renal pós-operatória, diabetes e maior tempo de internação em UTI foram fatores associados a pior sobrevida. Pacientes mais jovens apresentaram sobrevida significativamente superior (p = 0,00007). Conclusão: A análise de 20 anos mostrou que o TOF apresenta boa sobrevida a longo prazo, mas fatores como diabetes, disfunção renal e tempo prolongado de isquemia fria impactam negativamente os desfechos. Eventos cardiovasculares e recidiva da doença hepática foram as principais causas de mortalidade.

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.

Introduction: SARS-CoV-2 began in 2020 and caused important changes in the number of transplants performed in hospitals and in the protocols for admitting candidates to perform the procedure. The Brazilian Association of Organ Transplantation (ABTO) recommends not performing transplants from donors with active COVID-19 infection, positive test results or with Severe Acute Respiratory Syndrome. The hepatic repercussions related to COVID-19 are presented in some reports in the medical literature. Liver changes resulting from other corona viruses such as SARS-CoV and MERS-CoV are well documented. The Hospital de Clínicas of the State University of Campinas is a tertiary center that performs solid organ transplants. Objectives: To carry out a perioperative, retrospective, descriptive analysis of liver transplants in the context of the SARS-CoV-2 pandemic carried out at the Hospital das Clínicas of the State University of Campinas from March 2020 to July 2021. Materials and Methods: Retrospective, descriptive, longitudinal cohort study based on the review of medical records of patients undergoing liver transplantation in the context of the SARS-CoV-2 pandemic from March 2020 to July 2021 at the clinical hospital of the State University of Campinas. Results:Retrospective analysis was performed on 57 patients in the period. Only 1 patient needed to be excluded because he was under 18 years old. Of the 56 patients, 52 underwent RT-PCR laboratory testing and chest tomography (CT). Of these 52 patients, only 2 tested positive, one pre-transplant (TX) and one post-operatively (post-op). Regarding chest CT scans, none of them showed typical changes for COVID pre-TX, in the post-op 4 patients presented typical chest CT scans. The average age was 55.86 years. The mortality rate was 38% and no deaths were attributed to COVID 19. The average MELD-Na scale was 20.94. Conclusion: The present study carried out at the Hospital de Clínicas da Unicamp analyzed the clinical, laboratory and radiological association to better elucidate the variables determined by COVID-19 in its diagnosis and in-hospital management. It is concluded that the SARS-CoV-2 pandemic had an impact on the routine of liver transplantation worldwide and on the service in which the study was carried out.

INTRODUCTION:The use of natural products for therapeutic purposes is a common practice throughout the world, in part, due to the global obesity epidemic and the search for products with appetite suppression and weight loss properties, which include nutritional supplements, vitamins and minerals to herbal products. It is known that such products may be associated with various adverse health effects. Thus, the objective of this study is to report a series of cases of patients, who presented fulminant liver failure (HFI) requiring liver transplantation (LT), related to the consumption of products used for weight loss. MATERIAL AND METHODS:This is a retrospective cohort based on the evaluation of patients listed for LT due to IHF at the Hospital das Clínicas of the Universidade Estadual de Campinas, between 1991 and 2022, with patients who had confirmed consumption of products with the aim of loss being selected. RESULTS:During the studied period, 92 patients were listed for HT due to IHF according to the Kings College criteria, with 5 cases being selected with proven consumption of herbal products for weight loss, and other causes that could explain the IHF were excluded. Four (80%) of the patients were female, with a mean age of 40.5 years, and 40% of the cases died. DISCUSSION AND CONCLUSIONS:Unlike traditional pharmaceutical medicines, in most countries, the commercialization of these products is not conditioned on clinical and safety evidence or prior approval by regulatory bodies. Hepatoxicity can be related to several factors, such as the presence of toxins naturally found in plants, the presence of heavy metals, contamination during obtaining or processing and the addition of substances omitted from the labels. The use of weight loss products can evolve with IHF, a fact that deserves attention, due to ease of access and growing demand, and it is important to regulate the trade of these products and raise public awareness about the risks of use without professional supervision and guidance.

Giant hepatic hemangiomas are occasional in patients with cirrhosis. It remains a challenge to decide on the need for treatment and choose the most appropriate intervention. A 62-year-old woman was recently diagnosed with cirrhosis and complained of upper abdominal fullness, reduction in oral food intake, and weight loss of 6 kg over the last three years. Upper digestive endoscopy evidenced thin-caliber esophageal varices and significant extrinsic compression of the lesser gastric curvature. Abdominal computed tomography revealed an exophytic tumor in the left hepatic lobe, measuring 11.5 cm, which had progressive centripetal contrast enhancement from the arterial phase, compatible with hepatic hemangioma. Serum tumor markers were negative, and her liver function was unimpaired. The patient underwent surgical resection (non-anatomical hepatectomy of segments II and III) which had no immediate complications, and the histopathological evaluation confirmed cavernous hepatic hemangioma. Two weeks later, she was admitted to the emergency room with jaundice, signs of hepatic encephalopathy, and moderate ascites, and was further diagnosed with secondary bacterial peritonitis. As no perforations, abscesses, or fistulas were observed on subsequent imaging tests, clinical management was successfully carried out. This case highlights that giant hepatic hemangiomas may be symptomatic and warrant treatment. In the setting of cirrhosis and portal hypertension, physicians should be aware of the risk of hepatic decompensation following surgical resection, even in patients with Child-Pugh class A.

Introdução: A pandemia causada pelo SARS-CoV-2 teve início no ano de 2020 e ocasionou mudanças importantes no número de transplantes realizados nos hospitais e nos protocolos de admissão de candidatos para realização do procedimento. A Associação Brasileira de Transplante de Órgãos (ABTO) recomendava não realizar transplante de doadores com infecção COVID-19 ativa, teste positivo ou com Síndrome Respiratória Aguda Grave. As repercussões hepáticas relacionadas a COVID-19 são apresentadas em alguns relatos presentes na literatura médica. Estão bem documentadas as alterações hepáticas decorrentes de outros coronavírus tais como SARSCoV e MERS-CoV. O Hospital de Clínicas da Universidade Estadual de Campinas é um centro terciário que realiza transplantes de órgãos sólidos. Objetivos: Realizar a análise retrospectiva descritiva perioperatória dos transplantes hepáticos no contexto da pandemia por SARS-CoV-2 realizados no hospital das clínicas da Universidade Estadual de Campinas no período de março de 2020 a julho de 2021. Materiais e Métodos: Estudo retrospectivo, descritivo de coorte longitudinal baseado na revisão dos prontuários dos pacientes submetidos ao transplante hepático no contexto da pandemia por SARS-CoV-2 no período de março de 2020 a julho de 2021 no hospital de clínicas da Universidade Estadual de Campinas. Resultados: A análise retrospectiva foi realizada em 57 pacientes no período. Apenas 1 paciente precisou ser excluído por ter menos de 18 anos. Dos 56 pacientes, 52 realizaram coleta do exame laboratorial RT-PCR e tomografia (TC) de tórax. Desses 52 pacientes apenas 2 positivaram o exame, um pré transplante (TX) e um no pós-operatório (pós-op). Em relação às TC de tórax nenhuma apresentava alterações típicas para COVID pré-TX, no pós-op 4 pacientes apresentaram TC típicas. A média de idade foi de 55,86 anos. A taxa de mortalidade foi de 38% e nenhum óbito foi atribuído ao COVID 19. A escala de MELDNa média foi de 20,94. Conclusão: O presente estudo realizado no Hospital de Clínicas da Unicamp analisou a associação clínica, laboratorial e radiológica para melhor elucidar as variáveis determinadas pela COVID-19 no seu diagnóstico e manejo intra-hospitalar. Conclui-se que a pandemia por SARS-CoV-2 teve impacto na rotina de realização do transplante hepático mundialmente e no serviço no qual o estudo foi realizado.

Background:Tyrosine kinase inhibitors have been used to treat hepatocellular carcinoma (HCC), but the outcomes of patients under treatment vary. Since the roles of clinicopathological aspects and markers of chronic inflammation/immune homeostasis in the outcome of HCC patients treated with sorafenib are still unclear, these were the aims of this study.Methods:Patients with alcohol-induced and/or hepatitis C virus (HCV)-induced HCC (n = 182) uniformly treated with sorafenib were included in the study. Baseline clinicopathological aspects of patients were computed from the medical records. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic inflammation response index (SIRI), and systemic immune-inflammation index (SII) were obtained from the hematological exam performed before the administration of sorafenib. Overall survival (OS) was analyzed using Kaplan-Meier probabilities, log-rank test, and univariate and multivariate Cox proportional hazard ratio (HR) analyses.Results:In multivariate analysis, alpha-foetoprotein (AFP) level and Child-Pugh score were predictors of OS. Patients with AFP levels higher than 157 ng/mL and Child-Pugh B or C had 1.40 (95% confidence interval (CI): 1.03 - 1.91, P = 0.03) and 1.64 (95% CI: 1.07 - 2.52, P = 0.02) more chances of evolving to death than the remaining patients, respectively. NLR, PLR, LMR, SIRI, and SII did not alter the OS of HCC patients.Conclusions:AFP level and Child-Pugh score act as independent prognostic factors in patients with alcohol and/or HCV-induced HCC treated with sorafenib, but markers of chronic inflammation/immune homeostasis seem not to alter the outcome of patients with HCC induced by alcohol and/or HCV.