Liver Transplantation for Metastatic Neuroendocrine Tumors

We have thoroughly read the article “Liver Transplant for Metastatic Neuroendocrine Tumors: A Single-Center Report of 15 Cases” by Moradi and colleagues, which was published in Experimental and Clinical Transplantation.1 We would like to congratulate the authors for their success in liver transplant (LT) due to metastatic neuroendocrine tumors (NETs) and their important contribution to the scientific community.The authors reported 8 LTs, 4 multivisceral transplants, 1 LT associated with a Whipple procedure, 1 liver and pancreas transplant, and 1 LT combined with ileal resection. The inclusion criteria mentioned in the article were nonresectable well-differentiated NETs with confined liver metastases of unknown origin and resectable or resected primary tumor. During the follow-up, all patients who had received multiorgan transplants died and the 8 patients who underwent LT had remained alive and disease free.Nevertheless, there are different aspects to be considered for discussion. Although the authors mentioned the inclusion criteria, it is not explained which parameters were taken into account to enlist patients as transplant candidates; in addition, not having the primary tumor resected was not considered as a contraindication. Another topic we would like to discuss are the pathological criteria that were considered as contraindications for multivisceral and LT.The simultaneous resection of the primary tumor and LT has been carefully evaluated by Le Treut and colleagues.2 They reported 213 LTs for metastatic NETs and stated that primary site tumor resection concurrent with LT was a predictor of poor outcome. Determining the origin of the primary tumor is mandatory before deciding which therapeutic option to proceed with because the primary site of NETs has also been described as a factor associated with outcomes. Some authors have stated that tumors located in the pancreas seem to be more aggressive than those of intestinal origin.5 In the study from Moradi and colleagues, most transplant recipients had a pancreatic NET, although 6 transplants were performed in patients with primary tumor with unknown origin. The manuscript did not report any information regarding the functional status of the tumors, if patients had received somatostatin analogs as part of the pretransplant management, and if there were any priority criteria for patients on the wait list. These issues must be considered since outcomes can be different for isolated liver transplants compared with multiorgan transplants. We suggest that the authors revise the indications using more selective protocols.In our center, we have established a very restricted protocol for NETs, using as reference the criteria pro-posed by Mazzaferro and colleagues6: Ki-67 of 0% to 5%, well-differentiated or moderately differentiated tumor (grade 1 or grade 2), disease confined to the liver, primary tumor resected with stable disease for at least 6 months, and, if possible, location of primary tumor limited to the small bowel. As advised by Gedaly and colleagues, patients with non-carcinoid tumors, high-grade neuroendocrine carcinomas, and non-gastrointestinal carcinoids or with tumors not drained by the portal vein are not considered for transplant.7During patient work-up, we always perform somatostatin receptor positron emission tomo-graphy/computed tomography (PET/CT) imaging to identify extrahepatic metastatic disease; this is repeated every 6 months to ensure that the disease remains in control while the patient is on the wait list. In the study from Moradi and colleagues, there was a lack of information regarding pretransplant assessment. The use of somatostatin receptor PET/CT imaging has become an essential tool, not only to better identify primary locations but also to assess grading or follow disease stability to define the next therapeutic step.From September 2009 to July 2021 at our center, 533 LT were performed: 494 with organs procured from donors after brain death (DBD) and 39 using living related donors, 35 of which were for pediatric recipients. From the total number of LTs performed at our center, 6 (1.13%) were due to nonresectable NET liver metastases; all of these patients received grafts from DBDs.Among the 6 patients with NETs at our center, no patient was considered for multiorgan transplant. The median age was 42 years (range, 35-61 y), 4 patients were female, and median body mass index (in kilograms divided by height in meters squared) was 23.2 (range, 20-26). All patients had symptoms at the moment of diagnosis. In 5 patients (83%), diagnosis of the primary tumor and the liver metastases was simultaneous; however, in the remaining patient, the diagnosis was made 1 year after the first surgery. Five patients had the primary tumor located in the small bowel: 4 underwent partial enterectomy and 1 had a right hemicolectomy, all having primary anastomosis. The sixth patient had the primary tumor on the tail of the pancreas and underwent a distal pancreatectomy. One patient underwent 2 transarterial chemoemboliza-tions before being listed for LT. No patient underwent liver resection before the transplant. In our country Argentina, additional Model for End-Stage Liver Disease (MELD) score exception (22 points) is usually granted to these patients. The median time on the waiting list was 5.5 months (range, 2-16 months). All patients had received somatostatin analogs before LT.The 6 patients with NETs received transplants from DBDs: in 4 patients, a whole graft was used, but the other 2 patients had extended right lobe split grafts. The donor risk index was >1.7 in 4/6 cases. The median operation time was 345 minutes (range, 265-513 min). Patients were hospitalized for 6.5 days (range, 5-24 days) with no immediate posttransplant complications. Tacrolimus and mycophenolate mofetil were initially used as immunosuppressive therapy. After liver function had stabilized, patients received everolimus. After a follow-up of 43 months (range, 4-82 months), 1 patient presented with recurrent disease and 1 died of sepsis while waiting for a retransplant due to ischemic cholangiopathy (this was one of the recipients of an extended right lobe graft) (Table 1).Performing LT in patients with malignant diseases is a new challenge; the latest published data have demonstrated that short-term and long-term outcomes of LT in selected patients with NET liver metastases are comparable to patients transplanted for other malignancies. The results shown by Moradi and colleagues suggested that the selection criteria for multivisceral transplantation might require further discussion, analysis, and worldwide consensus. Criteria should be conservative, aimed at the best long-term outcomes, and with the most conscious use of the limited number of donors available.Fil: Fernandez, Maria Florencia. Fundación Favaloro; ArgentinaFil: Barros Schelotto, Pablo. Fundación Favaloro; ArgentinaFil: Mendez, Guillermo. Fundación Favaloro; ArgentinaFil: Descalzi, Valeria. Fundación Favaloro; ArgentinaFil: Gondolesi, Gabriel Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentin

Bile duct cyst type V (Caroli's disease): surgical strategy and results

AbstractBackground. Caroli's disease (CD) is a benign congenital disorder characterized by segmental cystic dilatation of the intrahepatic biliary ducts. Therapeutic strategy includes medical treatment, percutaneous, endoscopic or surgical drainage of the affected bile ducts, liver resection or transplantation. The aim of this study was to analyse the results and long-term follow-up of a consecutive series of patients who underwent surgical treatment for CD. Patients and methods. Between 1995 and 2005, 10 patients were surgically treated for CD. Variables evaluated were: age, gender, clinical presentation, diagnostic procedures, percutaneous and surgical treatments, histopathological analysis and outcome. Results. The average age of the patients was 45.8 years. Recurrent cholangitis was the main clinical manifestation (70%). In unilateral CD a liver resection was performed in nine patients (left lateral sectionectomy in seven, left hepatectomy in one and right hepatectomy in one). In bilateral disease a cholecystectomy, duct exploration, hepaticojejunostomy and liver biopsy of both lobes were performed. Average follow-up was 60 months. All the patients are alive and free of symptoms without recurrence in the remnant liver. Discussion. Liver resection is the preferred therapeutic option for unilateral CD, demonstrating good results in long-term follow-up. In bilateral disease, hepaticojejunostomy could be considered as an alternative or a previous step to liver transplantation, which still remains the ultimate option

Perioperative fluid management and postoperative complications after laparoscopic distal pancreatectomy

A pesar de que la mortalidad de la cirugía pancreática hadisminuido en las últimas décadas, la morbilidad permanecealta. Una de las causas más importantes de esta es la fístulapancreática postoperatoria. Estudios recientes han demostradola influencia de la fluidoterapia perioperatoria en losresultados postoperatorios de cirugías abdominales mayores.Esto se evidenció fundamentalmente en cirugía de colon, demostrandoque la sobrecarga hídrica aumenta las complicacionespostoperatorias. Objetivo. Evaluar la influenciade la fluidoterapia en la morbilidad post pancreatectomíadistal videolaparoscópica. Material y métodos. Estudioretrospectivo, de una base de datos prospectiva de pacientessometidos a pancreatectomía distal videolaparoscópica denoviembre de 2011 a septiembre de 2018. Se evaluaron30 pacientes que se dividieron en dos grupos según la fluidoterapiaadministrada (restrictiva o liberal). Los datos serecolectaron de los protocolos de anestesia y de los controles en sala de internación (hasta el 3° día postoperatorio).Se analizaron variables demográficas, tiempo de estadíahospitalaria, tipo de fluidoterapia y complicaciones. Parael análisis estadístico se utilizó SPSS® v.21. (p < 0,05 fueconsiderado significativo). Resultados. De los 30 pacientes,el 17% eran hombres, edad media de 54 ± 18 años; 17pacientes (57%) pertenecían a grupo liberal y 13 (43%) algrupo restrictivo. Veintitrés pacientes presentaron complicaciones,16 (53%) fueron del grupo liberal y 7 (23%) delgrupo restrictivo, (p = 0,01). Catorce pacientes del grupoliberal presentaron fístula pancreática postoperatoria vs. 6pacientes del grupo restrictivo (p = 0,04). En 7 pacientesdel grupo liberal (23%) y en 4 pacientes del grupo restrictivose presentó fistula pancreática clínicamente relevante(13%) (p = NS). La mortalidad de la serie fue de 3,3 %,no habiendo diferencias entre los grupos de estudio. Conclusión.Nuestros resultados sugieren que la restricción delíquidos en el perioperatorio reduce considerablemente latasa de complicaciones y el desarrollo de fístula pancreáticapostoperatoria, después de la pancreatectomía distal videolaparoscópica.Despite mortality in pancreatic surgery has decreased over the last decade, morbidity remains high. One of the most important causes is pancreatic fistula. Recent studies have demonstrated the importance of fluid therapy management during the perioperative period in major abdominal surgeries. This finding was observed first in colonic surgery, demonstrating that overload of fluids increases postoperative complications. Objective. To evaluate the impact of fluid management on postoperative complications after laparoscopic distal pancreatectomy. Material and methods. Descriptive, retrospective study of a prospective database of patients whom underwent laparoscopic distal pancreatectomy from November 2011 to September 2018. Thirty patients were evaluated and divided in two groups depending on the fluid management (restrictive, or liberal). The data were collected from the anesthesia protocols and nursery reports (until 3rd postoperative day). Demographics, length of stay, kind of fluid management and complications were analyzed. For statistical analysis SPSS®v.21 was used (p < 0.05 was considered significant). Results. Out of 30 patients, 17% were male, mean age was 55 ± 18 years (r 19-82); 17 patients (57%) were included in the liberal group and 13 (43%) in the restrictive group. Twenty-three patients developed complications; 16 (53%) belonged to liberal group whereas 7 (23%) to restrictive group. (p = 0.01). Fourteen patients of liberal group vs. 6 patients of restrictive group had postoperative pancreatic fistula (p = 0.04). There were 7 patients (23%) in liberal group. and 4 (13%) patients in restrictive group with clinically relevant pancreatic fistula (13%, p = NS). Ninety day-mortality was 3.3, with no differences between groups. Conclusion. After laparoscopic distal pancreatectomy, liberal fluid administration at the perioperative period is associated with an increase in the incidence of complication, specially favoring the development of pancreatic fistula.Fil: Lobos. Fernando D.. Fundación Favaloro; ArgentinaFil: Barros Schelotto, Pablo. Fundación Favaloro; ArgentinaFil: Ramisch, Diego. Fundación Favaloro; ArgentinaFil: Rubiolo, Agustín Santiago. Fundación Favaloro; ArgentinaFil: Montes, Leonardo. Fundación Favaloro; ArgentinaFil: Gondolesi, Gabriel Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentin

Partial external biliary diversion: A therapeutic alternative for Alagille syndrome. First case in Argentina

Antecedentes. El síndrome de Alagille es la principal forma sindrómica de colestasis intrahepática crónica caracterizada por la hipoplasia de la vía biliar intrahepática. Es un desorden multisistémico de herencia autosómica dominante con afectación de múltiples órganos. Suele ponerse de manifiesto en el período neonatal, entre el segundo y tercer mes de vida, presentándose desde casos subclínicos hasta grados graves de la enfermedad con el consecuente desarrollo de cirrosis hepática y posterior falla hepática, y está asociado con múltiples anomalías: defectos en los arcos vertebrales, facies típica, estenosis pulmonar, retardo mental e hipogonadismo. Objetivo. Presentar el primer caso clínico quirúrgico de derivación biliar externa parcial en Argentina, destacando la técnica quirúrgica y la mejoría en la calidad de vida, como alternativa a tener en cuenta en pacientes con este diagnóstico antes del desarrollo de cirrosis establecida. Resultados. Se ha demostrado que la derivación biliar externa parcial en algunos tipos de colestasis intrahepática detiene el proceso de fibrogénesis hepática, deteniendo a su vez la progresión de la enfermedad y evitando la necesidad de un trasplante cuando la cirrosis aún no se ha establecido. Discusión. Esta técnica quirúrgica permite mejorar la calidad de vida y la morbilidad asociada a la hipercolesterolemia en pacientes con síndrome de Alagille, postergando y tal vez evitando la necesidad de un trasplante hepático en el futuro.Background. Alagille's syndrome is the main syndromic chronic intrahepatic cholestasis characterized by hypoplasia of the intrahepatic bile ducts. It is a multisystem disorder of autosomal dominant inheritance with involvement of multiple organs. Usually it becomes apparent in the neonatal period, presenting as subclinical cases or severe degrees of the disease with the consequent development of liver cirrhosis and subsequent liver failure associated with multiple abnormalities: defects in the vertebral arches, typical facies, pulmonary stenosis, mental retardation and hypogonadism. Objective. To present the first case of partial external biliary diversion in Argentina, showing the surgical technique and the improvement in the quality of life, as an alternative to be considered in patients with Alagille's syndrome before the development of cirrhosis. Results. It has been shown that partial external biliary diversion can stop the process of liver fibrogenesis, halting the progression of the disease and avoiding the need for transplantation in some types of intrahepatic cholestasis when cirrhosis has not been established. Discussion. This surgical technique can improve the quality of life and morbidity associated with hypercholesterolemia in patients with Alagille's syndrome, delaying and maybe avoiding the need for liver transplantation.Fil: Rumbo, Carolina. Fundación Favaloro; ArgentinaFil: Sandi, Marcelo. Fundación Favaloro; ArgentinaFil: Padin, Juan Manuel. Fundación Favaloro; ArgentinaFil: Farinelli, Pablo. Fundación Favaloro; ArgentinaFil: Ramisch, Diego. Fundación Favaloro; ArgentinaFil: Barros Schelotto, Pablo. Fundación Favaloro; ArgentinaFil: Cabanne, Ana. Fundación Favaloro; ArgentinaFil: Garcia Herva, Dolores. Fundación Favaloro; ArgentinaFil: Trentadue, Julio. Fundación Favaloro; ArgentinaFil: Gondolesi, Gabriel Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación Favaloro; Argentin

Solid pseudopapillary tumor of the páncreas

Antecedentes: la neoplasia sólida pseudopapilar del páncreas es una entidad rara, que típicamente se presenta en mujeres jóvenes. Suele presentar síntomas abdominales inespecíficos. Es un tumor maligno de bajo grado de malignidad.Objetivos: el objetivo del siguiente informe de serie de casos es presentar 9 casos tratados en un centro y realizar una revisión bibliográfica del tema.Material y métodos: estudio retrospectivo descriptivo de los casos con diagnóstico anatomopatológico de neoplasia sólida pseudopapilar en el Servicio de Cirugía General, desde febrero de 2013 hasta septiembre de 2019. Se contemplaron como variables: edad, sexo, localización del tumor, tratamiento quirúrgico realizado, tiempo operatorio, complicaciones, estancia hospitalaria y seguimiento alejado.Resultados: fueron 9 casos, todos de sexo femenino con media de edad de 30 años (rango 20 a 70 años). La localización más frecuente fue en cola de páncreas en 4 casos (45%). Todas las pacientes fueron sometidas a cirugía, con abordaje laparoscópico en el 60% de los casos (n = 5); la resección pancreática distal con preservación esplénica fue la conducta más utilizada (n = 6). Se constataron tres complicaciones, de las cuales dos fueron colecciones abdominales como consecuencia de una fístula pancreática que se abordaron por vía percutánea, y la restante fue un retardo del vaciamiento gástrico por lo cual la paciente requirió internación prolongada.Conclusión: la neoplasia sólida pseudopapilar pancreática es una enfermedad poco frecuente, maligna pero con bajo riesgo de malignidad. Presenta buena sobrevida cuando se somete a cirugía de carácter curativo; la laparoscopia es la vía de abordaje de elección en centros con experiencia.Background: Solid pseudopapillary tumor of the pancreas is a rare condition that affects young women. The most common symptom is unspecific abdominal pain. It is a malignant tumor of low malignant potential. Objective: The aim of this study is to report a case series of patients treated in a single center and perform a bibliographic review. Material and methods: We conducted a retrospective study of the cases with pathological diagnosis of solid pseudopapillary tumor of the pancreas treated in the Department of General Surgery between February 2013 and September 2019. The following variables were analyzed; age, sex, tumor location, surgical treatment, operative time, complications, length of hospital stay and long-term follow-up. Results: Nine patients were included; all of them were women with mean age of 30 years (range: 20 - 70 years). The most common location of the tumor was the tail of the pancreas (n = 4; 45%). Surgery was performed in all the cases; five cases underwent video-assisted laparoscopy and spleen-preserving distal pancreatectomy was the technique more commonly used (n = 6). Three complications were recorded: two abdominal collections due to biliary leaks were trated by percutaneous approach and the other patient presented delayed gastric emptying and required prolonged hospitalization. Conclusion: Solid pseudopapillary tumor pf the pancreas is a rare low-grade malignant neoplasm. The prognosis is favorable after surgery and laparoscopy is the preferred approach in centers with experience.Fil: Montes, Leonardo Ezequiel. Fundación Favaloro; ArgentinaFil: Alaniz, Jimena. Fundación Favaloro; ArgentinaFil: Dieguez Palacios, Andres. Fundación Favaloro; ArgentinaFil: Varela, Estanislao. Fundación Favaloro; ArgentinaFil: Lobos, Fernando D.. Fundación Favaloro; ArgentinaFil: Fernandez, Florencia M.. Fundación Favaloro; ArgentinaFil: Farinelli, Pablo. Fundación Favaloro; ArgentinaFil: Ramisch, Diego. Fundación Favaloro; ArgentinaFil: Barros Schelotto, Pablo. Fundación Favaloro; ArgentinaFil: Gondolesi, Gabriel Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentin

Partial external biliary diversion: A therapeutic alternative for Alagille syndrome. First case in Argentina

Antecedentes. El síndrome de Alagille es la principal forma sindrómica de colestasis intrahepática crónica caracterizada por la hipoplasia de la vía biliar intrahepática. Es un desorden multisistémico de herencia autosómica dominante con afectación de múltiples órganos. Suele ponerse de manifiesto en el período neonatal, entre el segundo y tercer mes de vida, presentándose desde casos subclínicos hasta grados graves de la enfermedad con el consecuente desarrollo de cirrosis hepática y posterior falla hepática, y está asociado con múltiples anomalías: defectos en los arcos vertebrales, facies típica, estenosis pulmonar, retardo mental e hipogonadismo. Objetivo. Presentar el primer caso clínico quirúrgico de derivación biliar externa parcial en Argentina, destacando la técnica quirúrgica y la mejoría en la calidad de vida, como alternativa a tener en cuenta en pacientes con este diagnóstico antes del desarrollo de cirrosis establecida. Resultados. Se ha demostrado que la derivación biliar externa parcial en algunos tipos de colestasis intrahepática detiene el proceso de fibrogénesis hepática, deteniendo a su vez la progresión de la enfermedad y evitando la necesidad de un trasplante cuando la cirrosis aún no se ha establecido. Discusión. Esta técnica quirúrgica permite mejorar la calidad de vida y la morbilidad asociada a la hipercolesterolemia en pacientes con síndrome de Alagille, postergando y tal vez evitando la necesidad de un trasplante hepático en el futuro.Background. Alagille's syndrome is the main syndromic chronic intrahepatic cholestasis characterized by hypoplasia of the intrahepatic bile ducts. It is a multisystem disorder of autosomal dominant inheritance with involvement of multiple organs. Usually it becomes apparent in the neonatal period, presenting as subclinical cases or severe degrees of the disease with the consequent development of liver cirrhosis and subsequent liver failure associated with multiple abnormalities: defects in the vertebral arches, typical facies, pulmonary stenosis, mental retardation and hypogonadism. Objective. To present the first case of partial external biliary diversion in Argentina, showing the surgical technique and the improvement in the quality of life, as an alternative to be considered in patients with Alagille's syndrome before the development of cirrhosis. Results. It has been shown that partial external biliary diversion can stop the process of liver fibrogenesis, halting the progression of the disease and avoiding the need for transplantation in some types of intrahepatic cholestasis when cirrhosis has not been established. Discussion. This surgical technique can improve the quality of life and morbidity associated with hypercholesterolemia in patients with Alagille's syndrome, delaying and maybe avoiding the need for liver transplantation.Fil: Rumbo, Carolina. Fundación Favaloro; ArgentinaFil: Sandi, Marcelo. Fundación Favaloro; ArgentinaFil: Padin, Juan Manuel. Fundación Favaloro; ArgentinaFil: Farinelli, Pablo. Fundación Favaloro; ArgentinaFil: Ramisch, Diego. Fundación Favaloro; ArgentinaFil: Barros Schelotto, Pablo. Fundación Favaloro; ArgentinaFil: Cabanne, Ana. Fundación Favaloro; ArgentinaFil: Garcia Herva, Dolores. Fundación Favaloro; ArgentinaFil: Trentadue, Julio. Fundación Favaloro; ArgentinaFil: Gondolesi, Gabriel Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación Favaloro; Argentin

Papel del óxido nítrico durante la recirculación normotérmica en el trasplante hepático experimental en cerdos con donantes a corazón parado.

[spa] Debido a la falta de órganos para trasplantes, los donantes a corazón parado constituyen una posible fuente de obtención de los mismos. El principal inconveniente que se presenta en tales casos es el tiempo de "isquemia caliente" a la cual están sometidos los órganos. Nuestro grupo investigador ha demostrado que la realización después de la parada cardíaca (PC) de un periodo de recirculación extracorpórea mediante la utilización de una bomba de "bypass" cardiopulmonar y oxigenación tisular antes del enfriamiento corporal total tiene un efecto beneficioso y es capaz de evitar las lesiones hepáticas, cosa que hace viable su trasplante. Este procedimiento se ha denominado "recirculación normotérmica" (RN)

Laparoscopy in ALPPS procedure: when we can do it?

Totally laparoscopicALPPS procedure performed on a patient withbilateral colorectal liver metastases, and tocontribute to his proposal with a new conceptto accomplish these cases.1 The goal of thisprocedure is to avoid adhesions in the firstsurgery and to facilitate the second-stage hepatectomy.Therefore, a less invasive surgicalprocedure can be offered in these cases, aimingto reduce the number and severity ofpostoperative complications. LaparoscopyALPPS can be planned before surgery for apatient with a small future liver remnant.Fil: Barros Schelotto, Pablo. Universidad Favaloro. Área de Investigación y Desarrollo; ArgentinaFil: Gondolesi, Gabriel Eduardo. Universidad Favaloro. Área de Investigación y Desarrollo; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Organ Transplantation in Argentina

Argentina is a federal republic located in the southern portion of South America, with a mainland area of 2 780 400 km2. Argentina is the eighth largest country in the world, and the second largest in Latin America. Spanish is the main language; the population has been estimated at 43 847 430 in 2016, (Figure 1). The Human Development Index as a statistical composite of life expectancy, education, and per capita income indicators ranks Argentina as 45th worldwide in 2016. Healthare is provided through a combination of multipayers, including employer and labor union-sponsored plans, government insurance plans and private health insurance providing care through public and private hospitals and clinics. Argentina has reduced its infant mortality from 70 per 1000 live births in 1948, to 12.8 in 2015; life expectancy at birth had been raised from 60 years in 1948, to 76.3 in 2015.FIGURE 1FIGURE 1Organ transplantation started in South America in 1957 with the first kidney transplant in Buenos Aires. In 1979, Argentina developed a National Organization to centralize Procurement and Transplant Services, currently called Instituto Nacional Central Unico Coordinador de Ablación e Implante (INCUCAI). INCUCAI is part of the National Ministry of Health and one of the first organizations of its kind in South America.Fil: Gondolesi, Gabriel Eduardo. Fundación Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; ArgentinaFil: Bisigniano, Liliana. Ministerio de Salud; ArgentinaFil: Bertolotti, Alejandro Mario. Fundación Favaloro; ArgentinaFil: Barros Schelotto, Pablo. Fundación Favaloro; ArgentinaFil: Raffaele, Pablo. Fundación Favaloro; Argentin

Is faster always better? A comparative study between associating liver partition and portal vein ligation for staged hepatectomy vs classic portal vein ligation for two-stage hepatectomy in rats

Background: The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been proposed to avoid liver failure after major liver resection. We thought to define the mechanism by which ALPPS enlarges liver remnant and if it is really more effective than classic two-stage hepatectomy. Objectives: To compare if ALPPS is superior to portal vein ligation (PVL) to increase liver volume. Methods: Sprague-Dawley rats were divided in sham, ALPPS and PVL groups. Animal weight, volumetric assessment of the liver middle lobe, mitotic index, binucleate cells index, Ki-67 index and histological evaluation were done to assess liver regeneration. Results: No differences were found in liver volume after both procedures. (48, 65 ± 15 %, 43, 97 ± 13, 4 % and 155 ± 40 %; on 3, 7, 14 POD, for ALPPS and PVL) The liver volume/ animal weight ratios were similar in both groups. Ki67, binucleate cells and mitotic index were significantly higher in PVL and ALPPS compared with sham group, only on 3 postoperative day, (p=0.01), but were not different at the end of follow up (14 days). The histological liver damage score was slightly higher in ALPPS. Conclusion: Both procedures are useful to achieve increases in future remnant liver volume. There is no difference in the final volume reached; observing that the increase achieved by ALPPS is faster.Fil: Barros Schelotto, Pablo. Fundación Favaloro; ArgentinaFil: Moulin, Luis. Fundación Favaloro; ArgentinaFil: Meier, Dominik. Universidad Favaloro; ArgentinaFil: Almau Trenau, Hector. Fundación Favaloro; ArgentinaFil: Cabanne, Ana. Fundación Favaloro; ArgentinaFil: Descalzi, Valeria. Fundación Favaloro; ArgentinaFil: Stringa, Pablo Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentina. Universidad Favaloro; ArgentinaFil: Gondolesi, Gabriel Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentina. Fundación Favaloro; Argentin