PAULO CELSO BOSCO MASSAROLLO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
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- Consensus, Dilemmas, and Challenges in Living Donor Liver Transplantation in Latin America(2016) SALVALAGGIO, Paolo R.; NETO, Joao Seda; ALVES, Jefferson Andre; FONSECA, Eduardo A.; ALBUQUERQUE, Luiz Carneiro de; ANDRAUS, Wellington; MASSAROLLO, Paulo B.; GARCIA, Valter Duro; MAURETTE, Rafael J.; RUF, Andres E.; PACHECO-MOREIRA, Lucio F.; RUSCA, Luis A. Caicedo; OSORIO, Veronica Botero; MATAMOROS, Maria Amalia; VARELA-FASCINETTO, Gustavo; JARUFE, Nicolas P.We reviewed the history, volume, outcomes, uniqueness, and challenges of living donor liver transplantation (LDLT) in Latin America. We used the data from the Latin American and Caribbean Transplant Society, local transplant societies, and opinions from local transplant experts. There are more than 160 active liver transplant teams in Latin America, but only 30 centers have used LDLT in the past 2 years. In 2014, 226 LDLTs were done in the region (8.5% of liver transplant activities). Living donor liver transplantation is mainly restricted to pediatric patients. Adult-to-adult LDLT activities decreased after the implementation of the model for end-stage liver disease score and a concomitant increase on the rate of deceased donors per million population. Posttransplant outcome analysis is notmandatory, transparent or regulated in most countries. More experienced teams have outcomes comparable to international expert centers, but donor and recipient morbidity might be underreported. Latin America lags behind in terms of the number of adult LDLT and the rate of living donor utilization in comparison with other continents with similar donation rates. Local alliances and collaborations with major transplant centers in the developed world will contribute to the development of LDLT in Latin America.
- LIVER TRANSPLANTATION FOR CARCINOMA HEPATOCELLULAR IN SÃO PAULO: 414 CASES BY THE MILAN/BRAZIL CRITERIA(2016) SÁ, Gustavo Pilotto D.; VICENTINE, Fernando P. P.; SALZEDAS-NETTO, Alcides A.; MATOS, Carla Adriana Loureiro de; ROMERO, Luiz R.; TEJADA, Dario F. P.; MASSAROLLO, Paulo Celso Bosco; LOPES-FILHO, Gaspar J.; GONZALEZ, Adriano M.ABSTRACT Background: The criterion of Milan (CM) has been used as standard for indication of liver transplantation (LTx) for hepatocellular carcinoma (HCC) worldwide for nearly 20 years. Several centers have adopted criteria expanded in order to increase the number of patients eligible to liver transplantation, while maintaining good survival rates. In Brazil, since 2006, the criterion of Milan/Brazil (CMB), which disregards nodules <2 cm, is adopted, including patients with a higher number of small nodules. Aim: To evaluate the outcome of liver transplantation within the CMB. Methods: The medical records of patients with HCC undergoing liver transplantation in relation to recurrence and survival by comparing CM and CMB, were analyzed. Results: 414 LTx for HCC, the survival at 1 and 5 years was 84.1 and 72.7%. Of these, 7% reached the CMB through downstaging, with survival at 1 and 5 years of 93.1 and 71.9%. The CMB patient group that exceeded the CM (8.6%) had a survival rate of 58.1% at five years. There was no statistical difference in survival between the groups CM, CMB and downstaging. Vascular invasion (p<0.001), higher nodule size (p=0.001) and number of nodules >2 cm (p=0.028) were associated with relapse. The age (p=0.001), female (p<0.001), real MELD (p<0.001), vascular invasion (p=0.045) and number of nodes >2 cm (p<0.014) were associated with worse survival. Conclusions: CMB increased by 8.6% indications of liver transplantation, and showed survival rates similar to CM.
- Favorable Long-term Outcome in Patients Submitted to Liver Transplantation After Downstaging of Hepatocellular Carcinoma According to a Brazilian Selection Protocol(2016) MASSAROLLO, P. C. B.; COPPINI, A. Z.; SALZEDAS-NETTO, A. A.; COELHO, F. F.; MINAMI, T.; GONZALEZ, A. M.Background. In October 2008, the Brazilian Ministry of Health authorized listing of downstaged hepatocellular carcinoma (HCC) for liver transplantation, according to a standardized protocol. The aim of this study was to compare the outcome of patients submitted to liver transplantation after downstaging of HCC with the results other standard indications in Brazil. Methods. We conducted a retrospective analysis of 2,667 adult 1st elective deceased donor liver transplantations registered at the database of the Transplant Notification Center of the Sao Paulo State Health Secretariat. These cases are classified into 3 groups: ""cirrhosis,"" including 1,709 patients transplanted because of end-stage liver disease; ""Milan-HCC,"" including 873 HCC patients initially meeting the Milan criteria; and ""downstaging"" group, including 85 HCC patients submitted to tumor downstaging to the Milan criteria before liver transplantation. Results. One-, 3-, 5-, and 6-year patients survivals were, respectively, 82.7%, 72.0%, 66.1%, and 66.1%, in the ""downstaging"" group and 76.7%, 68.4%, 63.9%, and 63.5% in the ""Milan-HCC"" group (P = .483). At the same time intervals, patient survivals were 67.8%, 62.9%, 60.9%, and 60.2% in the ""cirrhosis"" group. These probabilities were significantly lower than those of both ""downstaging"" (P = .047) and ""Milan-HCC"" (P = .001) groups. Conclusions. Patients submitted to liver transplantation after downstaging of HCC, according to a Brazilian selection protocol, present long-term outcomes similar to HCC patients initially within the Milan criteria and better survival than recipients with end-stage liver disease.