Liver transplantation

case report of the first patient submitted to this procedure at the hospital das clínicas da faculdade de medicina de Ribeirão Preto - USP

Abstract

Liver transplantation is the main treatment option for patients with acute or chronic liver diseases when other surgical and clinical options haven´t been effective. In chronic liver diseases, the presence of hepatocellular carcinoma, when small in size, is an indication for liver transplantation. The authors present the first patient submitted to liver transplantation at the Hospital das Clínicas da Faculdade de Medicina – USP. The patient had cirrhosis due to hepatitis C virus, as well as hepatocellular carcinoma. While awaiting the transplant, he was submitted arterial embolization and percutaneous ethanol injection of the tumor, in order to delay it´s progression. There were no surgical complications. The piggy-back technique was used, with a choledoco-choledocal biliary anastomosis, stented with a T-tube. Immunosuppression was established using cyclosporin A and prednisone. Acute cellular rejection, on the ninth postoperative day was successfully treated with methylprednisolone (1g/day, IV, for 3 days). The patient was discharged on the 13th post-operative day. This case demonstrates the importance of early diagnosis and indication of liver transplantation in patients with hepatocellular carcinoma associated with cirrhosis, as well as one of the possible complications. The establishment of this group, specialized in the treatment of liver diseases, along with the technological and scientific developments have made this procedure a reality in the region of Ribeirão Preto, situated in the interior of the state of São Paulo.