CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / Introduction: Liver transplantation is the only therapeutic option for patients with end-stage liver disease and acute liver failure. Aim: To evaluate the factors that might be associated with decreased graft and patient survival. Methods: All liver transplants performed in the HUWC/FUC from May 18th, 2002 to May 28th, 2011, were analyzed. In this period 555 transplants were performed in 527 patients. Risk factors for graft and patient survival related to characteristics of donors and recipients were analyzed. Results: The mean age of the donors was 34.75 years and the majority were male (68%). The leading cause of death among donors was traumatic brain injury (TBI) (60%). Five hundred and thirty-three (96%) donors had less than 30% steatosis. Fifteen (2.7%) patients had steatosis between 30 and 60%. Only seven (1.3%) patients had steatosis greater than 60%. Patients undergoing liver transplantation had a mean age of 47.35 years. The mean cold ischemia time (CIT) was 350 minutes and warm ischemia time (WIT) was 41 minutes. Most patients were male (73%) and 54.5% Child B and Child C. 38% The calculated MELD score had a mean of 18.55. The prevalence of HCC was 16% and the need for dialysis in the first thirty days after surgery was 10.1%. The retransplant rate was 5.1%. The overall graft survival was 72%, 64%, 60% and 56% and patient survival was 74%, 68%, 64% and 60% at 1, 3, 5 and 10 years. Conclusions: The CIT greater than 600 minutes decreased graft survival in univariate analysis (p <0.05 *). Recipients with fulminant hepatitis had lower survival in univariate analysis (p < 0,05*). Hepatic steatosis greater than 30% and the need for dialysis after transplantation decreased graft and patient survival in univariate and multivariate analysis (p <0.05 *). / IntroduÃÃo: O transplante de fÃgado à a Ãnica opÃÃo terapÃutica para pacientes com hepatopatia crÃnica em fase terminal e falÃncia hepÃtica aguda grave. Objetivo: Avaliar os fatores que possam està associados a diminuiÃÃo da sobrevida do enxerto e do paciente. MÃtodos: Foram analisados todos os transplantes de fÃgado realizados no HUWC/UFC no perÃodo de 18 de maio de 2002 a 28 de maio de 2011. Neste perÃodo foram realizados 555 transplantes em 527 pacientes. Foram analisados fatores de risco para a sobrevivÃncia do enxerto e do paciente relacionados com as caracterÃsticas dos doadores e dos receptores. Resultados: A mÃdia de idade dos doadores foi de 34,75 anos e a maioria era do sexo masculino(68%). A principal causa de Ãbito dos doadores foi o TCE (60%). Quinhentos e trinta e trÃs (96%) doadores tinham esteatose menor que 30%. Quinze (2,7%) pacientes apresentaram esteatose entre 30 e 60%. Somente sete (1,3%) pacientes tinha esteatose maior que 60%. Os pacientes submetidos ao transplante de fÃgado tinham mÃdia de idade de 47,35 anos. A media do tempo de isquemia fria (TIF) foi de 350 minutos e o tempo de isquemia quente (TIQ) foi de 41 minutos. A maioria dos pacientes era do sexo masculino (73%) sendo 54,5% Child B e 38% Child C. O escore MELD calculado apresentou mÃdia de 18,55. A prevalÃncia do CHC foi de 16% e a necessidade de hemodiÃlise nos primeiros trinta dias de pÃs-operatÃrio foi de 10,1%. A taxa de retransplante foi de 5,1%. A sobrevida global do enxerto foi de 72%, 64%, 60% e 56% e do paciente de 74%, 68%, 64% e 60%, em 1, 3, 5 e 10 anos. ConclusÃes: O TIF superior a 600 minutos diminuiu a sobrevida do enxerto na analise univariada (p < 0,05*). Receptores com hepatite fulminante tiveram menor sobrevida prolongada na analise univariada (p < 0,05*). A esteatose hepÃtica superior a 30% e a necessidade de hemodiÃlise no pÃs-transplante diminuÃram a sobrevida do enxerto e do paciente nas analises uni e multivariada (p < 0,05*).
| Identifer | oai:union.ndltd.org:IBICT/oai:www.teses.ufc.br:7277 |
| Date | 25 April 2013 |
| Creators | Gustavo Rego Coelho |
| Contributors | Josà Huygens Parente Garcia, Marcellus Henrique Loiola Ponte de Souza, Josà Milton de Castro Lima |
| Publisher | Universidade Federal do CearÃ, Programa de PÃs-GraduaÃÃo em Cirurgia, UFC, BR |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da UFC, instname:Universidade Federal do Ceará, instacron:UFC |
| Rights | info:eu-repo/semantics/openAccess |
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