cWe describe a case of chronic hepatitis E virus (HEV) infection in a 13-year-old female liver transplant recipient with recurrent increased aminotransferase levels and acute cellular rejection. This finding demonstrates that chronic HEV infection can occur and should be further investigated in immunocompromised patients in Latin America. CASE REPORTA 4-year-old girl who had undergone orthotopic liver transplantation in 2003 presented with increased aminotransferase levels and biopsy-confirmed acute cellular rejection in 2006. Liver enzyme levels were normalized after 3 days of methylprednisolone pulse therapy and increased tacrolimus dosage. In 2009, the alanine aminotransferase concentration reached 715 IU per liter and thereafter plateaued at nearly 2.5 times the upper limit of the normal range. Acute cellular rejection was additionally confirmed by biopsy. Results of serology and molecular testing for hepatitis A virus, hepatitis B virus, hepatitis C virus, cytomegalovirus, and Epstein-Barr virus were negative. Results of molecular testing for cytomegalovirus and Epstein-Barr virus in liver tissue and testing for autoantibodies and antinuclear antibodies were also negative. Serum transaminase levels remained elevated, and in 2011, histological examination showed prominent inflammatory activity and fibrosis compatible with viral infection. Hepatitis E was diagnosed in February 2012 on the basis of positive results for anti-hepatitis E virus (HEV) IgG and IgM antibody testing (Mikrogen, Germany) and, later, in May 2013, HEV RNA detection (genotype 3b, Brazil h4; GenBank accession number KF152884), with a load of 4.5 log 10 copies per ml. The patient did not report any recent travel, and no potential route of HEV transmission other than consumption of pork was identified. The living organ donor tested negative for anti-HEV antibodies. No prior serum samples were available. However, retrospective examination of viral RNA extracted from paraffin-embedded formalin-fixed liver tissue (RNeasy FFPE kit; Qiagen, Germany) from 2009 showed the presence of HEV with Ͼ99% homology to the sequence found in the serum sample from 2013, thus characterizing chronic hepatitis E infection (Brazil h4.1; GenBank accession number KM502569). At the time of HEV RNA detection, the alanine aminotransferase concentration was 120 IU per liter. The patient received ribavirin treatment (500 mg/day) for 10 months, and her HEV RNA load became undetectable (Ͻ100 copies per liter) in August 2013.Infections caused by HEV can become chronic, with persistently elevated aminotransferase levels and persistent viremia in immunocompromised adults and children; certain chronic cases have been described in pediatric patients with HIV or hematological malignancies and in pediatric patients who have received solid-organ transplants (1-4).Increased levels of aminotransferases are frequently observed after solid-organ transplantation (5). In certain patients, after ruling out viral and alcohol-, toxin-, and drug-related causes, no etiology is established. I...

therapies with loco regional and other modalities are important to stay within the Milan criteria and to prevent dropout. Aim: To evaluate the efficacy of pre transplant bridging therapy on post-transplant outcome. Methods: We revised 70 cases (73% males) with HCC in Hadassah Liver Unit, who underwent liver transplantation along 2001-2015. Results: HCV found in 46%, HBV 37%, NASH 10%, Alcohol 7% and others 7%. CHILD-A 66%, CHILD-B 26% and CHILD-C 9%. Mean aFP at HCC diagnosis was 390 AE 1586. Pre transplant anti-cancer therapy included TACE in 73%, Radiofrequency 20%, Resection 6%, Nexavar 6% and TARE 1%. 79% of cases transplanted within Milan criteria. While 63% underwent liver transplantation in Israel, the rest abroad. The transplant calculated MELD was 12.5 AE 5.9. Mean age at liver transplantation was 56.8 AE 10.9 (84% were >50 years), mean pre transplant HCC diagnosis 1.1 AE 0.7 and mean post-transplant follow up 3.9 AE 3.6 years. Survivors of >3 months after transplantation were divided into dead (12/59, 20%) and alive (47/59, 80%) groups. Pre transplant anti-cancer treatment was significantly more frequent in the dead group, TACE 92 vs. 86% (p = 0.05), Nexavar 17 vs. 2% (p = 0.02. HCC recurred in 11% after transplantation. Conclusion: The overall survival was 79% in a post transplantation follow up of 3.9 AE 3.6 years (up to 14 years). The need for higher use of pre transplant anti-cancer therapy reflects higher malignant potentials that revealed to a higher rate of HCC recurrence and mortality.

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required insulin, two were able to discontinue insulin, and the third demonstrated a 93% reduction (270 U/day to 20 U/day). Conclusion: By adhering to strict pre-operative guidelines, laparoscopic sleeve gastrectomy is a safe and effective means of weight loss in cirrhotic patients awaiting transplantation. Application of these guidelines will lead to improvement of obesity-related conditions in the cirrhotic population and potentially eliminate their need for liver transplantation.

Introdução: A leucinose ou doença da urina de xarope de bordo (DXB) de caráter genético causa deficiência do complexo enzimático e acúmulo de aminoácidos leucina, valina e isoleucina, resultando em déficits neurológicos. O tratamento indicado é o transplante (TX) hepático intervivos dominó, onde o fígado é disponibilizado para a lista de espera da Central de Transplantes. Objetivo: Relatar a experiência do Hospital Sírio-Libanês (HSL) na realização de TX hepático em crianças portadoras de DXB. Método: Estudo de relato de experiência qualitativo, descritivo e observacional. Resultado: Desde 2007, foram transplantadas 213 crianças; destas, sete eram portadoras de DXB e três transplantaram. Após avaliação multiprofissional, foram inscritas no Cadastro Técnico Único da Central de TX de São Paulo e submetidas a TX hepático intervivos. Procedentes do Estado do Amazonas e do Rio de Janeiro, as idades, no momento do TX, eram: um ano e sete meses, um ano e onze meses e dois anos e dez meses. Todas possuíam déficit inicial de sucção, a partir dos cinco dias de vida; duas crianças com PELD inicial corrigido de 1 para 3 e uma criança de 4 para 12, impossibilitando ativação em lista. Os doadores vivos eram aparentados, sendo, a mãe para dois e o pai para um. O tempo médio de internação na UTI foi de quatro dias e, na unidade de internação, de 10 dias. Não houve recidiva da DXB nas crianças transplantadas, bem como nas receptoras do fígado portador da doença. Conclusão: As crianças portadoras de DXB puderam ser beneficiadas com o TX de fígado intervivos e doaram seus órgãos para outras crianças em lista de espera. Observamos que o TX dominó proporciona a não manifestação da DXB em todos os receptores e há melhora progressiva dos déficits neurológicos.