Liver transplantation in the state of Rio de Janeiro: retrospective analysis of the period 2013-2017

Submitted by Repositório Arca ([email protected]) on 2019-09-10T12:46:59Z No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) victor_senna.pdf: 1920958 bytes, checksum: 921f70760c9d4945c98f1b3f8d886258 (MD5)Approved for entry into archive by Erasmo Martins ([email protected]) on 2019-10-08T15:30:44Z (GMT) No. of bitstreams: 2 victor_senna.pdf: 1920958 bytes, checksum: 921f70760c9d4945c98f1b3f8d886258 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Made available in DSpace on 2019-10-08T15:30:44Z (GMT). No. of bitstreams: 2 victor_senna.pdf: 1920958 bytes, checksum: 921f70760c9d4945c98f1b3f8d886258 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2019Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.O presente estudo teve como objetivo analisar o perfil da demanda, a utilização e os resultados do Programa de Transplante de Fígado no estado do Rio de Janeiro. Foram analisados 1.258 prontuários de pacientes adultos inscritos em lista para o transplante de fígado por doador cadáver, no período de janeiro de 2013 até dezembro de 2017, com observação até dezembro de 2018. Elegeram-se as variáveis sociodemográficas, clínicas e de logística captação-transplante. A matriz conceitual de qualidade utilizada baseou-se na abordagem proposta por Donabedian (1980) e pelo Institute of Medicine (2001). Como método estatístico, foram utilizadas as análises univariada, bivariada e multivariada (regressão logística e análise de sobrevida por regressão de Cox). O perfil dos pacientes em lista é composto em sua maioria por homens brancos, de meia-idade, moradores da capital, com hepatopatia moderada a grave de causa viral, que se correlacionam com o acesso à lista de espera. Entre aqueles pacientes que estão em lista, o sexo masculino, a gravidade da doença hepática, o tipo sanguíneo ABO, o centro de transplante vinculado e a presença de hepatocarcinoma ou hemodiálise influenciam a chance de obtenção do fígado para transplante. Entre os pacientes submetidos ao transplante de fígado, o Meld médio encontrado foi de 24,4 com tempo de isquemia fria média de 6,9 horas nos transplantes, cuja sobrevida após 1 ano foi de 78,6% no período analisado. Entre os fatores preditivos de maior mortalidade após o transplante, destacam-se idade >65 anos, Meld >30, hemodiálise, isquemia fria >8 horas e cor de pele não branca. Observou-se que quanto maior o volume de transplantes melhor o desempenho do programa ao longo do tempo, reduzindo taxas de perda do enxerto e de mortalidade, mesmo quando ajustado por gravidade clínica do paciente. Observou-se um aumento da proporção de pagamento privado no transplante de fígado no estado do Rio de janeiro, sem apresentar diferenças de fontes de pagamento nos desfechos analisados. Conclui-se que variáveis clínicas, sociodemográficas, de logística de captação-transplante e centro transplantador influenciaram o acesso, a adequação do cuidado e os resultados do transplante de fígado.The aim of this study was to analyze the profile of the demand, use and results of the Liver Transplantation Program in the state of Rio de Janeiro. A total of 1258 adult patients medical records in waiting list for deceased donor liver transplantation from January 2013 to December 2017 were analyzed, with observation until December 2018. Sociodemographic, clinical and organ transplant logistics variables were chosen. The conceptual quality matrix used was based on the approach proposed by Donabedian (1980) and by the Institute of Medicine (2001). As statistical method, the univariate, bivariate and multivariate analyzes (logistic regression and Cox regression analysis) were used. The waiting list patients is mainly composed by white, middle-aged men living in the capital with moderate to severe liver disease, which correlate with the access to the waiting list. Among those listed patients, patient sex, severity of liver disease, ABO blood type, transplant center and hepatocarcinoma or hemodialysis influence the chance of liver transplantation. Among the patients submitted to liver transplantation, the mean MELD found was 24,4, the mean cold ischemia time was 6,9 hours, whose survival after one year was 78,6% in the analyzed period. The predictive factors of higher mortality after transplantation were age > 65 years, MELD> 30, hemodialysis, cold ischemia> 8 hours and non-white skin color. It was observed that the larger the volume of transplants, the better the program performance over time, reducing graft loss rates and mortality, even with clinical severity adjustment. There was an increase in the proportion of private payment in liver transplantation in the state of Rio de Janeiro, without statistical differences of payment sources in the analyzed outcomes. In conclusion, clinical, sociodemographic, logistic-transplantation and transplantation center variables play a role in the access, the adequacy of care and the results of liver transplantation

Cholecystectomy during ceftriaxone therapy. A translational study with a new rabbit model

<div><p>Abstract Purpose: To evaluate the actual incidence of both microlithiasis and acute cholecystitis during treatment with intravenous ceftriaxone in a new rabbit model. Methods: New Zealand rabbits were treated with intravenous ceftriaxone or saline for 21 days. Ultrasound monitoring of the gallbladder was performed every seven days until the 21st day when histopathology, immunohistochemistry for proliferating cell nuclear antigen (PCNA), pro-caspase-3 and CD68, liver enzyme biochemistry, and chromatography analysis of the bile and sediments were also performed. Results: All animals treated with ceftriaxone developed acute cholecystitis, confirmed by histopathology (P<0.05) and biliary microlithiasis, except one that exhibited sediment precipitation. In the group treated with ceftriaxone there was an increase in pro-caspase-3, gamma-glutamyl transpeptidase concentration, PCNA expression and in the number of cells positive for anti-CD68 (P<0.05). In the ceftriaxone group, the cholesterol and lecithin concentrations increased in the bile and a high concentration of ceftriaxone was found in the microlithiasis. Conclusion: Ceftriaxone administered intravenously at therapeutic doses causes a high predisposition for lithogenic bile formation and the development of acute lithiasic cholecystitis.</p></div