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OBJECTIVE: The aim of this study was to determine the prospective capacity and impact of donor risk index, preallocation survival outcomes following liver transplant, donor model for end-stage liver disease, and balance of risk on patients' 30-day survival after liver transplantation. METHODS: We prospectively analyzed patient survival in a multicentric observational cohort of adult liver transplantation through the year of 2019 at the state of Paraná, Brazil. The receiver operating characteristic curve, the area under the curve, and the best cutoff point (i.e., the Youden's index) were estimated to analyze the prognostic value of each index. RESULTS: In total, 252 liver transplants were included with an average model for end-stage liver disease score of 21.17 and a 30-day survival of 79.76%. The donor risk index was the only prognostic variable with no relation to patients' 30-day mortality model for end-stage liver disease and donor model for end-stage liver disease have no prognostic value on receiver operating characteristic curve, but preallocation survival outcomes following liver transplant, survival outcomes following liver transplant, and balance of risk presented good relationship with this observation. The cutoff value was estimated in 11-12 points for balance of risk and 9-12 for preallocation survival outcomes following liver transplant and survival outcomes following liver transplant. The 30-day survival for the group of transplants with scores up to 12 points (n=172) in all the three indexes was 87.79%, and for those transplants with scores higher than 12 it was 36.36%. CONCLUSIONS: The 30-day survival is 79.76%, and balance of risk, survival outcomes following liver transplant, and preallocation survival outcomes following liver transplant are the good prognostic indexes. The cutoff value of 12 points has clinical usefulness to predict the post-liver transplantation results.

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Living donor liver transplantation expanded the therapeutic possibilities for liver failure patients. The necessary correct match between the liver mass donated and received sometimes limits its use. A case that was used two left liver grafts from adult living donors is reported.

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RACIONAL: O transplante hepático é a melhor modalidade terapêutica para pacientes em estágio final de doença hepática. Minimização de morte, enquanto se espera o procedimento, envolve priorização de acordo com o estado clínico e a alocação adequada de fígados de doadores. OBJETIVO: Análise da mortalidade na lista de espera de fígado no estado do Paraná, PR, Brasil. MÉTODOS: Foram analisados ​​os dados sobre todos os pacientes (n = 65) que foram registrados na lista de espera de fígado durante um período de 32 meses. RESULTADOS: A morte em lista de espera foi de 41,5% (n = 27). Nenhuma diferença estatística foi observada em relação aos MELD / MELD-Na entre o grupo que faleceu (19,88 / 21,6) e não morreu (17,28 / 19,47). MELD-Na previu maior mortalidade, especialmente no subgrupo de pacientes com gravidade intermediária da doença (classe B) previsto pelo escore de CTP. CONCLUSÃO: É crítica a escassez de doadores de órgãos nessa região e a taxa de mortalidade em lista de espera excede em muito o risco inerente de um transplante de fígado, especialmente entre pacientes com MELD mais baixos. É desejável a utilização de um protocolo agressivo de doadores com critérios expandidos, split liver e transplante de doador vivo.

BACKGROUND: Orthotopic liver transplantation is the best therapeutic modality for patients with end stage of liver disease. Minimization of death, while waiting for the procedure, involves accurate priorization according to clinical status and appropriate allocation of donor livers. AIM: The mortality analysis in the liver waiting list in Paraná state, PR, Brazil. METHODS: Were analyzed the data on all patients (n=65) who were registered on the liver waiting list during a 32 months period in the state of Paraná, southern Brazil. RESULTS: The death rated in waiting list was 41,5% (n=27). No statistic difference was observed regarding the MELD/MELD-Na scores between the group who died (19,88/21,6) and not died (17,28/19,47). MELD-Na predicted a higher mortality, especially in the subgroup of patients with intermediate severity of disease (class B) predicted by the CTP score. CONCLUSION: It´s critical the shortage of donor organs in our region, waiting list mortality rate far exceeds the inherent risk of a liver transplant, especially among patients with lower MELD scores. It´s desirable to use an aggressive protocol of expanded criteria donors, split liver and living donor transplant.

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O transplante hepático inter vivos adulto expandiu as possibilidades terapêuticas para pacientes com insuficiência hepática terminal. A necessidade de um volume hepático adequado que será retirado do doador e necessário ao receptor limita sua utilização em alguns casos. Apresentamos um caso em que se utilizou dois lobos esquerdos de dois doadores vivos no intuito de prover parênquima hepático suficiente ao receptor.

Living donor liver transplantation expanded the therapeutic possibilities for liver failure patients. The necessary correct match between the liver mass donated and received sometimes limits its use. A case that was used two left liver grafts from adult living donors is reported.

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BACKGROUND: Orthotopic liver transplantation is the best therapeutic modality for patients with end stage of liver disease. Minimization of death, while waiting for the procedure, involves accurate priorization according to clinical status and appropriate allocation of donor livers. AIM: The mortality analysis in the liver waiting list in Paraná state, PR, Brazil. METHODS: Were analyzed the data on all patients (n = 65) who were registered on the liver waiting list during a 32 months period in the state of Paraná, southern Brazil. RESULTS: The death rated in waiting list was 41,5% (n = 27). No statistic difference was observed regarding the MELD/MELD-Na scores between the group who died (19,88/21,6) and not died (17,28/19,47). MELD-Na predicted a higher mortality, especially in the subgroup of patients with intermediate severity of disease (class B) predicted by the CTP score. CONCLUSION: It´s critical the shortage of donor organs in our region, waiting list mortality rate far exceeds the inherent risk of a liver transplant, especially among patients with lower MELD scores. It´s desirable to use an aggressive protocol of expanded criteria donors, split liver and living donor transplant.

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RACIONAL: A videocirurgia pode apresentar complicações inerentes ao método e dentre elas destacam-se as relacionadas ao aumento da pressão na cavidade intra-abdominal. OBJETIVO: Analisar os efeitos do pneumoperitônio em modelo experimental de endotoxemia causada por lipopolissacarídeo. MÉTODO: Foram utilizados 32 ratos Wistar dos quais foi coletado sangue 24 horas prévias para obtenção dos valores de referência nas provas de função renal, hepática e do estado endotóxico (contagens total e diferencial de leucócitos, contagem de plaquetas e dosagens de lipopolissacarídeo, TNFα, IL6). A seguir os ratos foram separados em quatro grupos com oito: grupos controle inoculados com lipopolissacarídeo (10 mg/kg via intraperitoneal) e mantidos por quatro e 11 horas (C-LPS4 e C-LPS11). Grupo C-PP, submetido ao pneumoperitônio por CO2 por uma hora e mantido sob observação por seis horas. Grupo experimento (E) inoculados com 10 mg/kg de lipopolissacarídeo por via intraperitoneal, após quatro horas submetidos ao pneumoperitônio por CO2 por uma hora e mantidos sob observação por seis horas. Ao término destes períodos foram coletadas amostras de sangue para as mesmas avaliações iniciais. Utilizou-se o método de T-Student para as comparações dos resultados, com nível de significância de 0,05. RESULTADOS: Em comparação aos valores iniciais e aos grupos controle, o grupo E apresentou maiores valores nas dosagens de creatinina e uréia, bilirrubina direta, ALT e TAP, aumento nas dosagens de IL6, TNFα e diminuição de plaquetas, aumento de leucócitos e bastonetes e detecção de endotoxina circulante. CONCLUSÃO: O pneumoperitônio por dióxido de carbono induz aumentos na liberação de TNFα, IL6, piora das funções hepática e renal em modelo experimental de endotoxemia induzida por lipopolissacarídeo.

BACKGROUND: Videosurgery can bring complications with it´s manipulation and among them the hyperpression into the abdominal cavity is important factor. AIM: To analyze the pneumoperitoneum effects in an endotoxemia experimental model caused by lipopolyssacharide. METHOD: Thirty-two Wistar rats were utilized, from which blood was collected 24 hours prior to the experiment for the initial evaluations of the renal function, the hepatic function and the endotoxic state (total counts and differential of leukocytes, platelet count and dosages of lipopolyssacharide, TNFα, IL6). The rats were then separated into four groups of eight: control groups inoculated with lipopolyssacharide (10 mg/kg via intraperitoneum) and kept for four and 11 hours (C-LPS4 and C-LPS11). Group C-PP, control of pneumoperitoneum by carbon dioxide at 10 mmHg for one hour and kept under observation for six hours. Experiment group (E) in which the rats were inoculated with 10 mg/kg of lipopolyssacharide via intraperitoneum and after four hours were submitted to pneumoperitoneum by carbon dioxide at 10 mmHg for one hour and kept under observation for six hours. At the end of these periods, blood samples were collected for the same initial evaluations. The T-student method was utilized for statistical comparisons of results, with a significance level of 0.05. RESULTS: Compared to the initial values and the control groups, Group E had higher values in the renal function tests (creatinine=0.85 ± 0.24 and urea=106.38 ± 37.61 mg/dL). In the hepatic function tests, there were higher values in the dosages of direct bilirubin (0.34 ± 0.09mg/dL), ALT (390,38 ± 351.88) and TAP (17.01 ± 2.18). The endotoxic state was confirmed by the dosages of IL6 (36.0 ± 11.23 pg/mL), TNFα (518.36 ± 203.39 pg/mL) and by the hematological alterations: reduction of platelets, increased leukocytes and band neutrophils and the detection of circulating endotoxin (0.21 ± 0.08 UE/mL). CONCLUSION...

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INTRODUCTION: The large use of plants in the prevention and treatment of different diseases is a milenar practice. In Brazil due to it's rich flora there is a huge material for research and use in popular medicine. The babassu (Orbignya phalerata) is a native tree from North of the Brazil and has a high concentration at the State of Maranhão. The powder of it's mesocarp is known as amid, and has been used as meal and medication due to the known activity against antiinflammatory reaction, pain, pyrexia and immunomodulation. PURPOSE: To analyze the effect of mesocarp of Orbignya phalerata (babassu) in gastric wound healing in rats under morphologic and tensiometric aspects. METHOD: Forty Wistar rats, male, adults were submitted to a longitudinal incision of 1 cm in the gastric body and sutured with separated stitches of polypropylene 6.0. After this common procedure the animals were allocated in the aleatory way in two groups Orbignya (GO) and Control (GC) with 20 animals each one. In the GO was used intraperitoneal doses of 50 mg/kh of Orbignya phalerata extract and in the GC water 1 ml/kg. Each group was divided in two subgroups of ten rats according to the period of death, at 3rd and 7th post-operative days. After the death, the abdominal cavity was evaluated and the stomach withdrawn. For the comparative analysis between the groups the macroscopic and histological parameters of wound healing were utilized. RESULTS: There were no abscess, fistulae and haematom in the animals of the study. Abdominal adhesions were observed in both groups of the animals at 3rd and 7th post-operative days. Dehiscence of the gastrography was identified in one 3rd day rat of subgroups GO. The resistance to air insufflation was higher in GO 3rd day (p=0.087). The analysis of histological parameters showed statistical difference related to wound coaptation in favor to subgroup GO 7th post-operative day. CONCLUSIONS: The extract of mesocarp of Orbignya phalerata in dose and path utilized positively interfered on the gastrography when compared with control group in animals at 7th post-operative day.

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INTRODUÇÃO: A utilização de plantas na prevenção e no tratamento de doenças é prática milenar. O babaçu (Orbignya phalerata) é uma palmeira nativa do meio norte do Brasil, tendo sua maior concentração no Estdo do Maranhão. O pó do mesocarpo do coco babaçu é popularmente conhecido como amido e tem sido usado como alimento e como medicamento por apresentar atividade antiinflamatória, imunomoduladora, analgésica e antipirética. OBJETIVO: Avaliar o efeito do extrato aquoso do mesocarpo de Orbignya phalerata na cicatrização do estômago em ratos, sob aspectos morfológico e tensiométrico. MÉTODOS: Quarenta ratos da linhagem Wistar, adultos, machos foram submetidos à incisão longitudinal de 1cm no corpo gástrico e síntese em plano único com pontos separados de polipropilene 6-0. Após este procedimento comum, os animais foram distribuídos aleatoriamente em dois grupos, Orbignya (GO) e Controle (GC), contendo 20 animais cada. No GO utilizou-se dose única intra-peritoneal de extrato aquoso da planta na dose de 50mg/kg e no GC, água destilada, 1ml/kg de peso. Cada grupo foi dividido em dois subgrupos de 10, conforme o dia da morte dos animais, nos 3º e 7º dias do período pós-operatório. Após a morte, foi realizado o inventário da cavidade abdominal e procedeu-se a retirada do estômago, com posterior avaliação tensiométrica e análise miccccroscópica. Na análise comparativa entre os dois grupos utilizou parâmetros macroscópicos e microscópicos da cicatrização. RESULTADOS: Não foram detectados abscessos, fístulas ou hematomas em nenhum animal. Houve aderências abdominais nos animais dos 3º e 7º dias do período pós-operatório nos dois grupos. Houve deiscência da gastrorrafia em um rato do sub-grupo GO morto no 3º dia. A resistência à insuflação de ar atmosférico foi maior no GC de três dias (p=0,087). A análise dos parâmetros histológicos demonstrou diferença estatisticamente significativa apenas quanto à coaptação das bordas, favorecendo o sub-grupo GO de sete dias...(AU)

INTRODUCTION: The large use of plants in the prevention and treatment of different diseases is a milenar practice. In Brazil due to it's rich flora there is a huge material for research and use in popular medicine. The babassu (Orbignya phalerata) is a native tree from North of the Brazil and has a high concentration at the State of Maranhão. The powder of it's mesocarp is known as amid, and has been used as meal and medication due to the known activity against antiflammatory reaction, pain, pyrexia and immunomodulation. PURPOSE: To analyze the effect of mesocarp of Orbignya phalerata (babassu) in gastric wound healing in rats under morphologic and tensiometric aspects. METHOD: Forty Wistar rats, male, adults were submitted to a longitudinal incision of 1 cm in the gastric body and sutured with separated stitches of polypropilene 6.0. After this common procedure the animals were allocated in the aleatory way in two groups Orbignya (GO) and Control (GC) with 20 animals each one. In the GO was used intraperitoneal doses of 50mg/kh of Orbignya phalerata extract and in the GC water 1ml/Kg. Each group was divided in two subgroups of ten rats according to the period of death, at 3rd and 7th post-operative days. After the death, the abdominal cavity was evaluated and the stomach withdrawn. For the comparative analysis between the groups the macroscopic and histological parameters of wound healing were utilized. RESULTS: There were no abscess, fistulae and haematom in the animals of the study. Abdominal adhesions were observed in both groups of the animals at 3rd and 7th post-operative days. Dehiscence of the gastrorraphy was identified in one 3rd day rat of subgroups GO. The resistance to air insufflation was higher in GO 3rd day (p=0,087). The analysis of histological parameters showed statistical difference related to wound coaptation in favor to subgroup GO 7th post-operative day...(AU)

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