Pancreas-preserving duodenectomy after living donor liver transplantation for invasive cytomegalovirus disease.

Autor: Vincenzi R; Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.; A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil., Fonseca EA; Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.; A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil., Chapchap P; Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil., Machado MCC; Hospital Sirio-Libanes, Sao Paulo, SP, Brazil., Roda KMO; Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.; A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil., Candido HL; Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.; A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil., Benavides MR; Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.; A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil., D'Assuncao MA; Gastrointestinal Endoscopy Unit, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil., Afonso RC; Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.; A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil., Turine P; Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.; A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil., Marson FP; Gastrointestinal Endoscopy Unit, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil., Neto JS; Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.; A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil.
Jazyk: angličtina
Zdroj: Pediatric transplantation [Pediatr Transplant] 2017 Dec; Vol. 21 (8). Date of Electronic Publication: 2017 Sep 07.
DOI: 10.1111/petr.13059
Abstrakt: CMV infection plays an important role in the postoperative course following solid organ transplantation. We present the case of an 11-year-old male patient who underwent LDLT due to severe hepatopulmonary syndrome and biliary cirrhosis. Four weeks after LDLT, he developed persistent GI bleeding and was subjected to repeated endoscopic treatment and radiological arterial embolization to stop the bleeding from duodenal ulcers. Diagnostic workup was negative for CMV disease. Because the bleeding persisted, surgical treatment was indicated, and a pancreas-preserving duodenectomy was performed. Immunohistochemical staining of the surgical specimen demonstrated diffuse endothelial infiltration by CMV. Despite ganciclovir treatment, the patient developed new erosions in the jejunal mucosa and melena; ganciclovir was discontinued, and foscarnet was started, resulting in clinical improvement and the cessation of bleeding. This case highlights the technical aspects of performing a complex upper GI resection in a patient recently subjected to LDLT, taking care to avoid injury to the previous liver graft anastomosis and restore GI continuity. Moreover, CMV tissue-invasive disease compartmentalized in the GI tract may be difficult to diagnose, as indicated by the negative results of antigenemia and PCR assays and endoscopic superficial mucosal biopsies.
(© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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