Transplantation proceedings最新文献

{"title":"Case Report: Falsely Elevated Tacrolimus Concentrations in a Kidney Transplant Recipient","authors":"Lucas Nascimento Diniz Teixeira,&nbsp;Diogo Buarque Cordeiro Cabral,&nbsp;Alexandre de Holanda Cavalcanti Pinto,&nbsp;Tatiana Cristina Manzi Sena,&nbsp;Joaquim de Oliveira Borba Junior,&nbsp;Maria Carolina Romeiro Figueirôa Benício Coelho,&nbsp;Frederico Castelo Branco Cavalcanti","doi":"10.1016/j.transproceed.2026.07.007","DOIUrl":"10.1016/j.transproceed.2026.07.007","url":null,"abstract":"<div><div>Tacrolimus (TAC) is a cornerstone of immunosuppressive therapy after kidney transplantation but has a narrow therapeutic window, requiring strict therapeutic drug monitoring. Several analytical methods are available for serum concentration measurement and methodological interference may lead to clinically misleading results. We report the case of a 67-year-old female kidney transplant recipient who presented with persistently elevated tacrolimus concentrations despite drug discontinuation. TAC concentrations were initially measured using the affinity column–mediated immunoassay (ACMIA), showing markedly supratherapeutic values that prompted repeated suspension of the medication. Given the discrepancy between laboratory results and TAC withdrawal, measurement was repeated using the microparticle enzyme immunoassay (MEIA), which demonstrated undetectable results, confirming false-positive values associated with ACMIA interference. TAC was safely reintroduced at a reduced dose, with subsequent concentrations remaining within the therapeutic range. During follow-up, the patient developed antibody-mediated rejection, which was successfully treated and maintained good graft function. This case highlights the importance of recognizing analytical limitations of TAC assays and emphasizes that unexpected results should prompt confirmatory testing using alternative methodologies. Integration of clinical judgment with laboratory data is essential to avoid inappropriate immunosuppressive management and to ensure graft safety.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1388-1390"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148595240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"19th Brazilian Congress of Transplantation: Challenges and New Frontiers","authors":"Tainá Veras de Sandes Freitas MD (Guest Editor),&nbsp;José Huygens Parente Garcia (Co-Guest Editor),&nbsp;Cristina Jorge MD President (Co-Guest Editor)","doi":"10.1016/j.transproceed.2026.08.002","DOIUrl":"10.1016/j.transproceed.2026.08.002","url":null,"abstract":"","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Page 1229"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148870982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FRONT MATTER ACKNOWLEDGEMNET- ABTO 2025","authors":"","doi":"10.1016/S0041-1345(26)00407-0","DOIUrl":"10.1016/S0041-1345(26)00407-0","url":null,"abstract":"","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Page 1228"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148870981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver Transplantation for Polycystic Liver Disease: A Retrospective Analysis From a University Center","authors":"Aline Garcia,&nbsp;Fernanda Dias Teramoto,&nbsp;Paolla Ravida Alves de Macedo,&nbsp;Juan Mariano Huertas Aguilar,&nbsp;Beatriz Piaulino de Araujo,&nbsp;Alexandre Foratto,&nbsp;Cristhian Jaillita Meneses,&nbsp;Carla Batista Moisés,&nbsp;Simone Reges Perales,&nbsp;Ilka de Fatima Santana Ferreira Boin,&nbsp;Elaine Cristina de Ataíde","doi":"10.1016/j.transproceed.2026.05.007","DOIUrl":"10.1016/j.transproceed.2026.05.007","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1308-1310"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver Transplantation for Metastatic Neuroendocrine Tumors: A Single-Center Experience in a Brazilian Referral Center","authors":"Maria Pilz,&nbsp;Patrícia Almeida,&nbsp;Giovana Fernandes,&nbsp;Andre Souza,&nbsp;Celso Matielo,&nbsp;Lilian Curvelo,&nbsp;Guilherme Felga,&nbsp;Marcelo Viveiros,&nbsp;Igor Calil,&nbsp;Marcelo Rezende","doi":"10.1016/j.transproceed.2026.06.019","DOIUrl":"10.1016/j.transproceed.2026.06.019","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Liver transplantation (LT) has emerged as a potential therapeutic option for selected patients with unresectable liver-confined metastatic neuroendocrine tumors (NETs), although evidence remains limited, particularly in low- and middle-income countries.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Liver transplantation (LT) has emerged as a potential therapeutic option for selected patients with unresectable liver-confined metastatic neuroendocrine tumors (NETs), although evidence remains limited, particularly in low- and middle-income countries.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To describe the experience of a Brazilian referral center with orthotopic LT for metastatic NETs and to evaluate post-transplant outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;To describe the experience of a Brazilian referral center with orthotopic LT for metastatic NETs and to evaluate post-transplant outcomes.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A retrospective descriptive cohort study was conducted, including patients who underwent deceased-donor LT between 2002 and 2025 at a tertiary referral center in Brazil. Among 2312 liver transplants, six patients transplanted for unresectable hepatic metastases from well-differentiated NETs were identified. Demographic, clinical, oncological, and transplant-related variables were analyzed, with outcomes assessed over a 5-year follow-up period.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;A retrospective descriptive cohort study was conducted, including patients who underwent deceased-donor LT between 2002 and 2025 at a tertiary referral center in Brazil. Among 2312 liver transplants, six patients transplanted for unresectable hepatic metastases from well-differentiated NETs were identified. Demographic, clinical, oncological, and transplant-related variables were analyzed, with outcomes assessed over a 5-year follow-up period.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The cohort consisted predominantly of middle-aged men, with a median age of 47.5 years. All patients had preserved liver function at transplantation, reflected by low MELD-Na scores. The median Ki-67 index was 10% (range: 1%-20%). Overall survival was 100%, and tumor recurrence occurred in two patients (33.3%). Acute rejection was infrequent and successfully managed, with no cases of chronic rejection. Post-transplant complications were limited, mainly involving biliary events. Immunosuppressive regimens were predominantly tacrolimus-based, with selective use of mycophenolate and everolimus.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;The cohort consisted predominantly of middle-aged men, with a median age of 47.5 years. All patients had preserved liver function at transplantation, reflected by low MELD-Na scores. The median Ki-67 index was 10% (range: 1%-20%). Overall survival was 100%, and tumor recurrence occurred in two patients (33.3%). Acute rejection was infrequent and successfully managed, with no cases of chronic rejection. Post-transplant complications were limited, mainly involving biliary events. Immunosuppressive regimens were predominantly ta","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1284-1287"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ex Situ Hepatectomy and Autologous Liver Transplantation for Recurrent Pheochromocytoma invading the Retrohepatic Vena Cava: Case report","authors":"Gabriel Bayona,&nbsp;Daniel Reis Waisberg,&nbsp;Rafael Soares Pinheiro,&nbsp;Maciana Santos Silva,&nbsp;Rubens Macedo Arantes,&nbsp;Liliana Ducatti,&nbsp;Luciana Bertocco Haddad,&nbsp;Alice Tung Song,&nbsp;Vinicius Rocha-Santos,&nbsp;Rodrigo Bronze Martino,&nbsp;Wellington Andraus","doi":"10.1016/j.transproceed.2026.06.024","DOIUrl":"10.1016/j.transproceed.2026.06.024","url":null,"abstract":"<div><h3>Introduction</h3><div>Tumors involving the hepatic venous confluence and the retrohepatic inferior vena cava (IVC) remain among the most formidable challenges in hepatobiliary surgery. Conventional <em>in situ</em> resection is often unfeasible due to limited vascular control and the high risk of massive bleeding or incomplete oncologic margins. Liver autotransplantation with <em>ex situ</em> hepatectomyhas emerged as an advanced surgical strategy that allows total vascular exclusion, hypothermic perfusion, and complex vascular reconstruction on the back table. Recurrent pheochromocytoma with major vascular invasion is rare, but when present, demands aggressive management in highly specialized centers to achieve radical resection and long-term disease control.</div></div><div><h3>Case Report</h3><div>A 64-year-old woman presented with recurrent pheochromocytoma infiltrating the retrohepatic IVC. She had undergone right adrenalectomy 4 years earlier. Due to the impossibility of achieving an R0 resection with standard techniques, liver autotransplantation was performed. The procedure consisted of total hepatectomy under veno-venous bypass, hypothermic perfusion with preservation solution, <em>ex situ</em> caudate lobe resection, and <em>en bloc</em> resection of the retrohepatic inferior vena cava (IVC). On the back table, the hepatic venous outflow was reconstructed, and a neocava was created using deceased-donor iliac vein allografts before liver autotransplantation. Total ischemia time was 191 minutes, and operative time reached 770 minutes. Postoperative complications—hypernatremia, bronchopneumonia, and catheter-related jugular vein thrombosis—were successfully managed in the intensive care unit. Postoperative liver function was preserved, and the patient was discharged home on postoperative day 24.</div></div><div><h3>Conclusion</h3><div>In experienced transplant centers, liver autotransplantation with <em>ex situ</em> hepatectomy is a feasible and effective strategy for selected patients with complex vascular tumor recurrence, facilitating radical resection, vascular reconstruction, and favorable postoperative outcomes.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1402-1405"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Operational Evaluation of Hypothermic Machine Perfusion for Kidney Transplantation in a Brazilian Reference Center","authors":"Petrúcia Maria Antero Pinheiro,&nbsp;Geraldo Bezerra da Silva Junior,&nbsp;Tainá Veras Sandes-Freitas,&nbsp;Janaína Maria Maia Freire,&nbsp;Marilha Braga Alves Andrade,&nbsp;Ronaldo de Matos Esmeraldo","doi":"10.1016/j.transproceed.2026.06.030","DOIUrl":"10.1016/j.transproceed.2026.06.030","url":null,"abstract":"<div><h3>Background</h3><div>Hypothermic machine perfusion (MP) improves outcomes in kidney transplantation, but evidence from low- and middle-income countries (LMICs) and public health settings is limited. This study evaluated clinical and operational performances of MP in the first and largest Brazilian renal perfusion service.</div></div><div><h3>Methods</h3><div>This single-center study was conducted at a Brazilian public hospital. Operational performance was evaluated through a qualitative observational analysis using a 20-item questionnaire applied to 7 transplant surgeons and perfusion nurses, based on national medical device assessment guidelines. Clinical outcomes were assessed in a longitudinal cohort of 212 deceased-donor kidney transplant recipients. Kidneys preserved with MP after an initial period of static cold storage (MP group, n = 100) were compared with those preserved exclusively with static cold storage (SCS group, n = 112). Outcomes included delayed graft function (DGF), dialysis requirement, length of hospital stay, and one-year graft and patient survival. Final data collection and analysis were completed in September 2025.</div></div><div><h3>Results</h3><div>Operational evaluation was preponderantly favorable, supporting the sustainable use of MP, which was associated with a lower incidence of DGF compared with SCS (25% vs 46.5%; <em>p</em> = .002) and independently associated with lower odds of DGF (OR = 0,38; CI 95%: 0,21–0,69). MP recipients required fewer dialysis sessions and had shorter hospital stays. Graft function, rejection rates, and one-year graft and patient survival were similar between groups.</div></div><div><h3>Conclusions</h3><div>In a real-life LMIC public health setting, MP was operationally sustainable and reduced DGF after kidney transplantation, supporting its use in resource-constrained transplant programs.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1279-1283"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver Transplantation in a Patient With Fulminant Failure and Bone Marrow Aplasia Due to Methimazole: A Case Report","authors":"Leonardo Yuri Kasputis Zanin,&nbsp;Bruno Kosa Lino Duarte,&nbsp;Ana Carolina Arrais Maia,&nbsp;Cainã Dabbous de Liz,&nbsp;Pedro Barbosa de Albuquerque Maranhão,&nbsp;Fabricio Inacio de Moraes Nascimento,&nbsp;Erica Karen Dextre Torres MD,&nbsp;Lucas Souto Nacif","doi":"10.1016/j.transproceed.2026.06.021","DOIUrl":"10.1016/j.transproceed.2026.06.021","url":null,"abstract":"<div><h3>Background</h3><div>Fulminant hepatitis is a rare but highly lethal complication associated with various drugs, including antithyroid thionamides used for hyperthyroidism. While propylthiouracil (PTU) is more commonly linked to severe hepatotoxicity, methimazole can also cause acute liver failure and, rarely, bone marrow suppression such as aplastic anemia or agranulocytosis. Drug-induced liver injury accounts for a significant proportion of acute liver failure cases requiring transplantation, with antithyroid drugs occasionally implicated. The pathogenesis is thought to be immune-mediated and potentially dose-dependent, with cross-reactivity between thionamides. Simultaneous occurrence of severe hepatotoxicity and aplastic anemia is exceptionally rare, particularly with methimazole.</div></div><div><h3>Case Report</h3><div>A 37-year-old man with Graves' disease, on methimazole for 4 years without recent follow-up, presented in February 2024 with jaundice, choluria, and acholic stools. Investigations revealed hyperbilirubinemia, elevated transaminases, negative viral/autoimmune serologies, and normal imaging. Liver biopsy confirmed drug-induced injury with ductopenia, portal fibrosis, inflammation, and bilirubinostasis. Methimazole was discontinued. One month later, progressive pancytopenia developed, unresponsive to corticosteroids. Bone marrow biopsy showed hypocellularity consistent with aplastic anemia, requiring transfusions. Liver failure progressed to grade II encephalopathy, bilirubin 30.23 mg/dL (516.93 µmol/L), MELD 29, meeting King's College Criteria. He underwent urgent cadaveric orthotopic liver transplantation on June 13, 2024. Post-transplant, aplastic anemia was managed with erythropoietin, G-CSF, eltrombopag, and transfusions. An opportunistic CMV infection was treated with ganciclovir. Hematopoietic support was eventually discontinued without further transfusions, and the patient was discharged with stable graft and hematological recovery.</div></div><div><h3>Conclusion</h3><div>This case illustrates the rare simultaneous occurrence of methimazole-induced fulminant hepatitis and aplastic anemia necessitating liver transplantation. It underscores the challenges in perioperative management of profound pancytopenia and posttransplant complications in such patients. Multidisciplinary care was key to successful outcome, highlighting the need for vigilant monitoring of antithyroid drug therapy and avoidance of cross-use in cases of severe adverse reactions.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1395-1397"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148498594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Liver Transplantation in Patients With Incidental Combined Hepatocellular–Cholangiocarcinoma: A Follow-Up Study","authors":"Pedro Marin-Castro,&nbsp;Daniel Reis Waisberg,&nbsp;Rafael Soares Pinheiro,&nbsp;Rubens Macedo Arantes,&nbsp;Vinicius Rocha Santos,&nbsp;Rodrigo Bronze Martino,&nbsp;Liliana Ducatti,&nbsp;Luciana Bertocco Haddad,&nbsp;Alice Tung Song,&nbsp;Andre Dong Lee,&nbsp;Paola Espinoza Alvarez,&nbsp;Joel Avancini Rocha,&nbsp;Ryan Yukimatsu Tanigawa,&nbsp;Venancio Avancini Ferreira Alves,&nbsp;Wellington Andraus","doi":"10.1016/j.transproceed.2026.06.022","DOIUrl":"10.1016/j.transproceed.2026.06.022","url":null,"abstract":"<div><h3>Introduction</h3><div>Surgical resection is the standard treatment for combined hepatocellular carcinoma–cholangiocarcinoma (cHCC-CC). However, recent studies suggest that liver transplantation (LT) may be a viable alternative for selected patients, with encouraging survival outcomes. The objective of this study is to report the outcomes of LT in patients with incidental cHCC-CC.</div></div><div><h3>Methods</h3><div>This single-center retrospective study included adult patients who underwent LT for hepatocellular carcinoma (HCC) and were found to have an incidental histopathological diagnosis of cHCC-CC between January 2015 and December 2024.</div></div><div><h3>Results</h3><div>During the study period, 1321 LT were performed, of which 24 patients (2.57%) had a histopathological diagnosis of cHCC-CC. The mean age was 58.5 years (range: 31–71), and 75% of patients were male. Regarding radiological findings, 16 patients had a LI-RADS 5 classification. On explant analysis, 3 patients (12.5%) had a single nodule confirmed as cHCC-CC on histopathology. In the remaining cases, the disease was multifocal (ranging from 2 to 25 nodules), with HCC as the predominant lesion and at least one nodule identified as cHCC-CC. During follow-up, 2 patients developed pulmonary recurrence of HCC, with a mean time between LT and recurrence of 314 days.</div></div><div><h3>Conclusions</h3><div>Liver transplantation may represent a therapeutic option for selected patients with cHCC-CC. However, these results should be interpreted with caution due to the retrospective design of the study and the limited number of cases analyzed.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1322-1325"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renoportal Anastomosis in Liver Transplantation for Complex Portal Vein Thrombosis: A Single-Center Experience From Latin America","authors":"Jhosimar Alvarez De La Hoz,&nbsp;Daniel Reis Waisberg,&nbsp;Grecia Lizzetti-Mendoza,&nbsp;Rodrigo Bronze Martino,&nbsp;Vinicius Rocha-Santos,&nbsp;Rafael Soares Pinheiro,&nbsp;Rubens Macedo Arantes,&nbsp;Liliana Ducatti,&nbsp;João Paulo Costa Santos,&nbsp;Paola Espinoza Alvarez,&nbsp;Luciana Bertocco Haddad,&nbsp;Flavio Henrique Galvao,&nbsp;Wellington Andraus","doi":"10.1016/j.transproceed.2026.07.005","DOIUrl":"10.1016/j.transproceed.2026.07.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Complex portal vein thrombosis (PVT) represents a major challenge in liver transplantation, as anatomical portal vein reconstruction may be unfeasible. Renoportal anastomosis (RPA), particularly in the presence of a spontaneous splenorenal shunt (SRS), constitutes an option for ensuring adequate portal inflow. This study reports a single-center Brazilian experience with RPA in liver transplantation for complex PVT.</div></div><div><h3>Methods</h3><div>This retrospective observational study included adult patients who underwent liver transplantation with RPA between January 2019 and December 2024 at a single quaternary referral center. For complex PVT cases associated with large SRS, RPA using an interposed iliac vein allograft was performed, with additional portal vein anastomosis in selected cases to augment portal inflow.</div></div><div><h3>Results</h3><div>Among 887 liver transplants performed during the study period, including 152 patients with PVT, 5 patients underwent RPA and 2 underwent a double inflow approach (RPA and primary portal vein anastomosis). The median recipient age was 50 years, and most patients were male (85.71%). Five patients had Yerdel Grade IV PVT and 2 had grade III. All of them had SRS. All patients demonstrated adequate liver graft function. In the early postoperative period, 3 patients developed ascites, and 4 required hemodialysis. One patient died perioperatively, because of thrombosis of the interposed vascular allograft. One-year patient survival rate was 71.42%, and none of them required chronic hemodialysis nor develop persistent ascites.</div></div><div><h3>Conclusion</h3><div>RPA represents a valuable salvage strategy for complex PVT cases with SRS and may expand transplant eligibility in selected patients, particularly in regions with limited reported experience.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1330-1335"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}