ABSTRACT Purpose: After partial hepatectomy (PH), the remaining liver (RL) undergoes regenerative response proportional to the host. Limited literature exists on hepatic viability after tissue injury during hypothermic preservation. Spectroscopy measures cellular fluorescence and is explored for tissue characterization and parameter investigation. This study aimed to assess fluorescence analysis (spectroscopy) in evaluating liver viability and its relationship with hepatic tissue regeneration 24 hours after PH. Additionally, we analyzed liver regeneration in RL after 70% partial hepatectomy under hypothermic conditions with laser irradiation. Methods: Fifty-six Wistar rats were divided into four groups: total non-perfused liver (control), total perfused liver, partial hepatectomy “in situ”, and partial hepatectomy “ex situ”. Tissue analysis was performed at 0 and 24 hours using spectroscopy with laser devices emitting at 532 (green) and 405 nm (violet). Results: Spectroscopy identified tissue viability based on consistent results with Ki67 staining. The fluorescence spectra and Ki67 analysis displayed similar patterns, linking proliferative activity and absorption intensity. Conclusions: Fluorescence spectroscopy proves to be promising for real-time analysis of cellular activity and viability. Metabolic activity was observed in groups of live animals and hypothermically preserved samples, indicating cellular function even under blood deprivation and hypothermic conditions. Purpose PH, PH , (PH) (RL host preservation investigation (spectroscopy 2 Additionally 70 irradiation Methods Fiftysix Fifty six nonperfused non control, control (control) situ, situ situ” ex situ. . 53 green (green 40 violet. violet (violet) Results Ki Ki6 staining patterns intensity Conclusions realtime real time samples (PH 7 (control 5 4 (violet

RESUMO RACIONAL: Desde 2002, após validação em múltiplos tipos de hepatopatias, o escore MELD foi adotado como padrão pelo qual os candidatos a transplante de fígado com doença hepática terminal têm sido priorizados para alocação de órgãos nos Estados Unidos, e em 2006 no Brasil. OBJETIVOS: Analisar a mortalidade de pacientes em lista de espera para transplante de fígado correlacionando com o MELD, no momento do transplante. MÉTODOS: Foram utilizados os dados da Secretaria de Saúde do Estado de São Paulo, Brasil, onde foram listados 22.522 pacientes, desde 2006 (quando o escore MELD foi introduzido no Brasil) até junho de 2009. Foram incluídos pacientes com falência hepática e tumores. A mortalidade de pacientes não transplantados e transplantados também foi considerada em função do escore MELD. RESULTADOS: Nosso modelo mostrou que o melhor valor do MELD, em pacientes em lista de espera para transplante e com melhores resultados, foi de 26. Este valor minimiza mortalidade em pacientes não transplantados bem comem pacientes na lista de espera para transplante de fígado. CONCLUSÕES: O escore MELD ótimo para entrar na lista de espera para transplante de fígado, no estado de São Paulo, é em torno de 26. Esse é o valor que minimiza a mortalidade tanto dos pacientes não transplantados em lista de espera, quanto dos submetidos à transplante de fígado. RACIONAL 2002 hepatopatias Unidos 200 Brasil OBJETIVOS MÉTODOS Paulo 22522 22 522 22.52 quando 2009 tumores RESULTADOS resultados 26 CONCLUSÕES 20 2252 2 52 22.5 225 5 22.

ABSTRACT BACKGROUND: After validation in multiple types of liver disease patients, the MELD score was adopted as a standard by which liver transplant candidates with end-stage liver disease were prioritized for organ allocation in the United States since 2002, and in Brazil, since 2006. AIMS: To analyze the mortality profile of patients on the liver transplant waiting list correlated to MELD score at the moment of transplantation. METHODS: This study used the data from the Secretary of Health of the São Paulo State, Brazil, which listed 22,522 patients, from 2006 (when MELD score was introduced in Brazil) until June 2009. Patients with acute hepatic failure and tumors were included as well. We also considered the mortality of both non-transplanted and transplanted patients as a function of the MELD score at presentation. RESULTS: Our model showed that the best MELD score for patients on the liver transplant waiting list associated to better results after liver transplantation was 26. CONCLUSIONS: We found that the best score for applying to liver transplant waiting list in the State of São Paulo was 26. This is the score that minimizes the mortality in both non-transplanted and liver transplanted patients. BACKGROUND endstage end stage 2002 Brazil AIMS METHODS 22522 22 522 22,52 200 when 2009 well nontransplanted non presentation RESULTS 26 CONCLUSIONS 2252 2 52 22,5 20 225 5 22,

RESUMO Racional: A lesão celular da pancreatite aguda (PA) envolve sobrecarga de cálcio, regulada pela atividade da Cálcio ATPase de membrana (PMCA), Cálcio ATPase do Retículo (SERCA2) e pelo Trocador Sódio Cálcio (NCX1). A melatonina (antioxidante) e o Dissacarídeo Trissulfatado (acelerador do NCX1) poderiam reduzir a lesão celular na PA. Objetivo: Avaliar a expressão do RNAm da SERCA2 e NCX1 em modelo animal de pancreatite aguda tratados com melatonina e/ou dissacarídeo trissulfatado (DT). Método: Ratos Wistar foram divididos em grupos: 1) sem pancreatite aguda; 2) com pancreatite aguda por taurocolato; 3) PA e Melatonina; 4) PA e DT; 5) PA e Melatonina com DT. Amostras de tecido foram colhidas para detecção dos níveis de RNAm da SERCA2 e NCX1 por PCR. Resultados: Houve aumento da expressão do RNAm da SERCA2 no grupo com PA tratados com Melatonina, porém sem aumento de expressão do NCX1. O DT não afetou os níveis de SERCA2 e NCX1. O tratamento conjunto com Melatonina e DT diminuiu a expressão da SERCA2. Conclusões: O efeito da Melatonina é restrito ao aumento da expressão da SERCA2. O DT não tem ação na expressão gênica, porém sua ação na aceleração do trocador na retirada do cálcio pode explicar a menor expressão da SERCA2 quando associado à Melatonina, pela ação conjunta de drogas com mecanismos diferentes e possivelmente complementares.

ABSTRACT Background: Intracellular calcium overload is known to be a precipitating factor of pancreatic cell injury in acute pancreatitis (AP). Intracellular calcium homeostasis depends of Plasmatic Membrane Calcium ATPase (PMCA), Sarcoplasmic Endothelial Reticulum Calcium ATPase 2 (SERCA 2) and the Sodium Calcium Exchanger (NCX1). The antioxidant melatonin (Mel) and Trisulfate Disaccharide (TD) that accelerates NCX1 action could reduce the cell damage determined by the AP. Aim: To evaluate m-RNA expressions of SERCA2 and NCX1 in acute pancreatitis induced by sodium taurocholate in Wistar rats pre-treated with melatonin and/or TD. Methods: Wistar rats were divided in groups: 1) without AP; 2) AP without pre-treatment; 3) AP and Melatonin; 4) AP and TD; 5) AP and Melatonin associated to TD. Pancreatic tissue samples were collected for detection of SERCA2 and NCX1 m-R NA levels by polymerase chain reaction (PCR). Results: Increased m-RNA expression of SERCA2 in the melatonin treated group, without increase of m-RNA expression of the NCX1. The TD did not affect levels of SERCA2 and NCX1 m-RNA expressions. The combined melatonin and TD treatment reduced the m-RNA expression of SERCA2. Conclusions: The effect of melatonin is restricted to increased m-RNA expression of SERCA2. Although TD does not affect gene expression, its action in accelerating calcium exchanger function can explain the slightest expression of SERCA2 m-RNA when associated with Melatonin, perhaps by a joint action of drugs with different and but possibly complementary mechanisms.

RESUMO CONTEXTO: A isquemia/reperfusão leva a grave lesão de órgãos, mas ocorre obrigatoriamente no transplante hepático, no trauma e em outras cirurgias hepáticas complexas, quando a manobra de Pringle é aplicada com o intuito de minimizar o sangramento durante os procedimentos. É bem conhecido que a isquemia/reperfusão do fígado leva a distúrbios microcirculatórios e lesões celulares. Neste cenário, a hipotermia é conhecida por reduzir a demanda de oxigênio, diminuindo o metabolismo intracelular. OBJETIVO: Avaliar os efeitos da hipotermia na lesão de isquemia/reperfusão hepática utilizando-se um novo modelo de hipotermia isolada do fígado. MÉTODOS: Utilizaram-se ratos Wistar do sexo masculino com peso aproximado de 250 gramas, mantidos em regime de alimentação ad libitum e divididos aleatoriamente em dois grupos de nove animais: 1) Grupo Normotérmico - os ratos foram submetidos a isquemia normotérmica dos lobos hepáticos mediano e esquerdo, com posterior ressecção dos lobos direito e caudado durante a reperfusão hepática; e 2) Grupo Hipotérmico - os ratos foram submetidos a isquemia hepática sob hipotermia a 10°C. A isquemia hepática foi realizada durante 45 minutos. Os animais foram sacrificados 48 horas após a reperfusão hepática para coleta de sangue e tecido hepático para análise. RESULTADOS: As transaminases AST e ALT apresentaram diminuição significativa no grupo Hipotérmico (P<0,01) em relação ao grupo Normotérmico (1403±1234 x 454±213 e 730±680 x 271±211 U/L, respectivamente). A histologia mostrou necrose grave em 50% e necrose leve em 50% dos casos no grupo Normotérmico, porém, necrose grave em 10% e necrose leve ou ausente em 90% dos casos no grupo Hipotérmico. CONCLUSÃO: Foi demonstrado modelo simplificado de isquemia/reperfusão do fígado que simula o autotrasplante de fígado. A hipotermia tópica dos lóbulos hepáticos isolados mostrou proteção do fígado a ischemia/reperfusão, sendo um método viável e prático para qualquer tipo de estudo de preservação hepática in vivo.

ABSTRACT BACKGROUND Ischemia/reperfusion causes organ damage but it is mandatory in hepatic transplantation, trauma and other complex liver surgeries, when Pringle maneuver is applied to minimize bleeding during these procedures. It is well known that liver ischemia/reperfusion leads to microcirculatory disturbance and cellular injury. In this setting hypothermia is known to reduce oxygen demand, lowering intracellular metabolism. OBJECTIVE: To evaluate the effects of hypothermia in liver ischemia/reperfusion injury, using a new model of topic isolated liver hypothermia. METHODS We used male Wistar rats weighting about 250 grams, kept in ad libitum feeding regime and randomly divided into two groups of nine animals: 1) Normothermic group, rats were submitted to normothermic ischemia of the median and left hepatic lobes, with subsequent resection of right and caudate lobes during liver reperfusion; and 2) Hypothermic group, rats were submitted to liver ischemia under hypothermia at 10°C. Liver ischemia was performed for 45 minutes. The animals were euthanized 48 hours after liver reperfusion for blood and liver tissue sampling. RESULTS The transaminases analyses showed a significant decrease of AST and ALT in Hypothermic group (P<0.01) compared to Normothermic group (1403±1234 x 454±213 and 730±680 x 271±211 U/L, respectively). Histology showed severe necrosis in 50% and mild necrosis in 50% of cases in Normothermic group, but severe necrosis in 10% and mild or absent necrosis 90% of the cases in hypothermic group. CONCLUSION: A simplified model of liver ischemia/reperfusion that simulates orthotopic liver autotransplantion was demonstrated. Topical hypothermia of isolated hepatic lobules showed liver protection, being a viable and practical method for any kind of in vivo liver preservation study.

Among the innovations for the treatment of type 1 diabetes, islet transplantation is a less invasive method of treatment, although it is still in development. One of the greatest barriers to this technique is the low number of pancreas donors and the low number of pancreases that are available for transplantation. Rodent models have been chosen in most studies of islet rejection and type 1 diabetes prevention to evaluate the quality and function of isolated human islets and to identify alternative solutions to the problem of islet scarcity. The purpose of this study is to conduct a review of islet xenotransplantation experiments from humans to rodents, to organize and analyze the parameters of these experiments, to describe trends in experimental modeling and to assess the viability of this procedure. In this study, we reviewed recently published research regarding islet xenotransplantation from humans to rodents, and we summarized the findings and organized the relevant data. The included studies were recent reports that involved xenotransplantation using human islets in a rodent model. We excluded the studies that related to isotransplantation, autotransplantation and allotransplantation. A total of 34 studies that related to xenotransplantation were selected for review based on their relevance and current data. Advances in the use of different graft sites may overcome autoimmunity and rejection after transplantation, which may solve the problem of the scarcity of islet donors in patients with type 1 diabetes.

PURPOSE: To evaluate the underlying mechanisms by which sevoflurane protects the liver against ischemia/reperfusion injury evaluate the mechanism by which sevoflurane exerts this protective effect. METHODS: Twenty-six rats were subjected to partial ischemia/reperfusion injury for 1h: one group received no treatment, one group received sevoflurane, and sham group of animals received laparotomy only. Four hours after reperfusion, levels of alanine and aspartate aminotransferases, tumor necrosis factor-a, and interleukins 6 and 10 were measured. Analyses of mitochondrial oxidation and phosphorylation, malondialdehyde content, histology, and pulmonary vascular permeability were performed. RESULTS: Serum levels of alanine and aspartate aminotransferases were significantly lower in the sevoflurane group compared to untreated controls (p<0.05). The sevoflurane group also showed preservation of liver mitochondrial function compared to untreated controls (p<0.05). Sevoflurane administration did not alter increases in serum levels of tumor necrosis factor-a, and interleukins 6 and 10. Sevoflurane treatment significantly reduced the coagulative necrosis induced by ischemia/reperfusion (p<0.05). Pulmonary vascular permeability was preserved in the sevoflurane group compared to untreated controls. CONCLUSION: Sevoflurane administration protects the liver against ischemia/reperfusion injury, via preservation of mitochondrial function, and also preserves lung vascular permeability.

PURPOSE: To evaluate which is the best route of administration for cell therapy in experimental rat model of small-for size syndrome. METHODS: A total of 40 rats underwent partial hepatectomy (70%) that induces the small-for-size syndrome and were divided into four groups of route administration: intravenous, intraperitoneal, enteral and tracheal. The small-for-size syndrome model was designed with extended partial hepatectomy (70%). The animals were divided into four groups of routes administration: intravenous (n=10) - intravenously through the dorsal vein of the penis; intraperitoneal (n=10) - intraperitoneally in the abdominal cavity; enteral (n=10) - oroenteral with the placement of a number 4 urethral probe and maintained at third duodenal portion; tracheal (n=10) - after tracheal intubation. We track the animals and monitor them for 21 days; during this follow-up we evaluated the result of cell therapy application tracking animals using ultrasound, radiography and PET-scan. Statistical analysis was performed using GraphPad Prism Software(r). Differences were considered significant with the p<0.05. Data are presented as the median and variation for continuous variables. Comparisons between groups were made using analysis of the imaging test by the researchers. RESULTS: All four groups underwent partial hepatectomy of 70% liver tissue targeting the same weight of resected liver. Initially the PET-scan tests showed similarity in administered cells by different routes. However, in few days the route of intravenous administration showed to be the most appropriated to lead cells to the liver followed by enteral. The tracheal and peritoneal routes were not as much successful for this goal. CONCLUSION: The intravenous route is the best one to cell therapy in experimental rat model of small-for size-syndrome.

Contexto A estenose biliar figura como uma das complicações mais frequentes pós-transplante hepático. São classificadas em anastomóticas e não anastomóticas, sendo estas últimas geralmente isquêmicas. Dentre as várias opções de tratamento, destacam-se a dilatação balonada, a colocação de próteses plásticas e a colocação de próteses metálicas autoexpansíveis, que podem ser realizadas tanto por via endoscópica, como por via percutânea. Não há consenso quanto ao melhor tratamento para a estenose da anastomose biliar. Objetivos O objetivo deste estudo foi realizar revisão sistemática da literatura sobre o resultado do tratamento endoscópico da estenose da anastomose biliar após transplante hepático. Métodos Revisão sistemática da literatura foi realizada sobre o tratamento da estenose da anastomose biliar pós transplante hepático, através do acesso aos bancos de dados pesquisados eletronicamente: Medline - PubMed, EMBASE, Scielo- Lilacs, Cochrane de janeiro de 1966 a abril de 2013. Resultados Não foi encontrado estudo clinico controlado e randomizado. A maioria dos estudos são comparativos retrospectivos ou prospectivos. Um estudo (86 pacientes) avaliou o acesso endoscópico e percutâneo. As taxas de sucesso clínico sustentados foram semelhantes, mas a duração do tratamento foi maior no grupo de acesso percutâneo. Dois estudos (56 pacientes) compararam a dilatação por balão com dilatação por balão e múltiplas próteses plásticas. Não houve diferenças em relação as taxas de sucesso e de complicações clínicas sustentadas. Conclusões A dilatação com balão é tão eficaz quanto a dilatação associada à colocação de múltiplas próteses plásticas para a resolução da estenose da anastomose biliar. Estudos randomizados bem desenhados ainda são necessários para comparar a simples dilatação balonada e a colocação de próteses plásticas.

Context Biliary strictures after liver transplantation are recognized as its Achilles’ heel. The strictures are classified in anastomotic and ischemic or non-anastomotic biliary strictures, and they figure among the most common complications after liver transplantation. There are some treatment options including balloon dilation, the placement of multiple plastic stents and the placement of self-expandable metal stents and all of them seem to have good results. Objectives The aim of this study was to systematically review the literature concerning the results of the endoscopic treatment of anastomotic biliary strictures after liver transplantation. Methods A systematic review of the literature was performed on the management of anastomotic biliary strictures post- orthotopic liver transplantation. The Medline-PubMed, EMBASE, Scielo-LILACS, and Cochrane Databases were electronically searched from January 1966 to April 2013. Results No well-designed randomized controlled trial was found. Most studies were retrospective or prospective comparisons in design. One study (86 patients) compared the endoscopic and the percutaneous accesses. The sustained clinical success rates were similar but the treatment duration was longer in the percutaneous group access. Two studies (56 patients) compared balloon dilation with balloon dilation and multiple plastic stents. There were no differences concerning sustained clinical success and complication rates. Conclusions Balloon dilation is as effective as balloon dilation plus multiple plastic stenting for the resolution of the anastomotic biliary strictures. Well-designed randomized trials are still needed to compare balloon dilation versus multiple plastic stenting versus metallic stenting.

RESUMO INTRODUÇÃO: A autoimunidade e a rejeição após o transplante ainda precisam ser superadas no desenvolvimento técnico de transplante de ilhotas para o tratamento de diabetes tipo 1. Inibir a rejeição de enxertos de ilhotas, mantendo a capacidade do enxerto para segregar insulina é uma estratégia essencial. O uso de agentes imunossupressores reduz a taxa de rejeição aguda em transplantados, mas os efeitos colaterais a longo prazo deve ser evitados. OBJETIVOS: O objetivo do presente estudo é o de organizar e analisar os parâmetros de imunossupressão envolvidos em tentativas experimentais de alotransplante em roedores. METODOLOGIA: Esta avaliação foi realizada utilizando o banco de dados PUBMED para pesquisar artigos publicados que contenham a palavra-chave "o transplante de ilhotas de roedores". Os critérios de inclusão envolveram alotransplante com ilhotas de roedores e as listas de referências das publicações recuperadas que eram elegíveis. Os critérios de exclusão incluíram isotransplante, autotransplante, e xenotransplante definido como o transplante para outras espécies. RESULTADOS: Vinte estudos relacionados ao alotransplante foram selecionados para esta revisão sistemática baseada em imunossupressão. CONCLUSÃO: Novas drogas imunossupressoras aumentaram as taxas de sobrevivência de alotransplante em roedores, reduzindo os efeitos colaterais. Os avanços na imunossupressão levantam a possibilidade de superar a autoimunidade e rejeição após alotransplante.

INTRODUCTION: Autoimmunity and rejection after transplantation must still be overcome in the technical development of islet transplantation for the treatment of type 1 diabetes. It is therefore necessary to inhibit rejection of islet grafts while maintaining the graft's ability to secrete insulin. Although the use of immunosuppressants reduces the acute rejection rate in transplant patients, long-term side effects must be prevented. OBJECTIVES: The aim of the present study is to organize and analyze the parameters of immunosuppression involved in experimental attempts of allotransplantation in rodents. METHODOLOGY: This review was performed using the Pubmed database to search for published articles containing the keywords "rodent islet transplantation". The inclusion criteria involved allotransplantation with rodents' islets and the reference lists of the publications retrieved that were eligible. The exclusion criteria involved isotransplantation, autotransplantation, and xenotransplantation such as transplantation in other species. RESULTS: Twenty studies related to allotransplantation were selected for this systematic review based on immunosuppression. CONCLUSION: New immunosuppressive drugs increased the survival rates of allotransplantation in rodents by reducing the side effects. The advances in immunosuppression raise the possibility of overcoming autoimmunity and rejection after allotransplantation.

PURPOSE:To analyze the role of hyperbaric oxygen therapy as hepatic preconditioning in rats submitted to hepatic ischemia and reperfusion.METHODS:Wistar rats were randomly divided into three groups: SHAM, rats submitted to surgical stress without hepatic ischemia and reperfusion, I/R, rats submitted to total hepatic pedicle ischemia for 30 min, followed by 5 min of reperfusion; HBOI/R, rats submitted to 60 minutes of hyperbaric oxygen therapy at 2 atm and immediately submitted to the experimental protocol of ischemia and reperfusion. Liver function was assessed by measuring serum alanine aminotransferase and aspartate aminotransferase, as well as mitochondrial function by determining states 3 and 4 of mitochondrial respiration, respiratory control rate and mitochondrial permeability transition (mitochondrial swelling). The results were analyzed by the Mann-Whitney test and all P-values <0.05 were considered significant.RESULTS: There were significant differences in serum aspartate aminotransferase values in groups SHAM vs. HBOI/R, I/R vs HBOI/R, alanine aminotranferase in groups SHAM and I/R; State 3 in SHAM groups vs. I/R, SHAM vs. HBOI/R, State 4 in I/R vs HBOI/R groups, respiratory control rate in SHAM vs I/R groups; mitochondrial swelling in SHAM vs. I/R groups, and SHAM vs HBOI/R.CONCLUSION: Hyperbaric preconditioning improved hepatic mitochondrial function and decreased serum markers of liver injury in the ischemia and reperfusion process.

INTRODUÇÃO: O escore para modelo de doença terminal do fígado (MELD) introduzido em 2002 foi criado para melhorar a seleção de pacientes que estavam morrendo na lista de espera para o transplante de fígado. OBJETIVO: Avaliar a sobrevida precoce dos pacientes submetidos ao transplante de fígado quando o MELD é aplicado como critério de seleção. MÉTODOS: Foi realizada revisão "online" na base de dados PubMed/Medline/Scielo. Os termos utilizados foram transplante de fígado e/ou MELD e/ou análise de sobrevida no período de 2002 a 2009. Entre 124 artigos analisados, 94 foram excluídos devido a irrelevância do assunto e a falta de dados. Foram considerados L1, L2A e MELD>20 os pacientes mais afetados; L2B; L3 e MELD<20 os mais saudáveis. Foram compilados os dados dos pacientes transplantados, sobrevida de um ano, correlacionando-se os achados com MELD e as sobrevidas da era pré-MELD. RESULTADOS: O MELD foi aplicado principalmente em pacientes dos Estados Unidos e Europa com escore variando de 8,4 a 30. A sobrevida de um ano variou de 66,5 a 92%. A sobrevida de um ano antes e depois da era MELD mostrou: Grupo I (L1 e L2A) x Grupo III (MELD>20) com significância (p< 0,0001); Grupo II (L2B e L3) x Grupo IV (MELD<20) não significante. Também foi comparada a sobrevida média dos pacientes em um ano por países na era MELD. CONCLUSÃO: O escore MELD melhorou significativamente a sobrevida dos pacientes a curto prazo, principalmente naqueles considerados mais doentes na lista de espera para o transplante de fígado. Por outro lado não houve impacto naqueles considerados mais saudáveis da lista de espera.

INTRODUCTION: The Model for End-Stage Liver Disease (MELD) score introduced in 2002 has come to improve selection of patients dying in the liver transplantation waiting list. OBJECTIVE: To evaluate the short-term survival in liver transplantation around the world when MELD score was applied as selection criteria. METHODS - A review has been done at the online database PubMed/ Medline/Scielo. The expressions applied for the search were "liver transplantation and/or MELD and/or survival analysis" from 2002 to 2009. Among the 124 analyzed articles, 94 were excluded due to irrelevance of the subject and lack of information. Were considered L1, L2A and MELD>20 the sickest patient; L2B, L3 and MELD< 20 the healthiest. Was compiled the data of transplanted patients, their one-year survival rate related to MELD score and compare it with pre-MELD era. RESULTS: MELD score has been applied, mainly in America and Europe patients, range from 8.4 to 30. One-year survival ranged from 66.5 to 92%. Analysis of patient survival rate significance between the pre-MELD and post-MELD era showed: Group I (L1 and L2A) x Group III (MELD>20), significant (p<0,0001); Group II (L2B and L3) x Group IV(MELD<20), not significant. Also, comparative one-year survival by country in the MELD era was search. CONCLUSION: The MELD score have significantly improved short-term survival for the sickest patient on the waiting list for liver transplantation; additionally, it does not have any significant impact in survival for the healthiest patient.

RACIONAL: A síndrome hepatopulmonar é formada por tríade clínica composta de doença hepática, dilatação vascular intrapulmonar e alterações de gases sanguíneos. Sua patogênese não é bem definida, mas especula-se que uma combinação de fatores, tais como o desequilíbrio das respostas dos receptores de endotelina, remodelação microvascular pulmonar e predisposição genética, leva à translocação bacteriana e dilatação vascular intrapulmonar. OBJETIVO: Avaliar a atividade da mieloperoxidase em modelo experimental de síndrome hepatopulmonar em ratos. MÉTODO: Foram estudados 29 animais divididos em grupos controle, sham e experimental de síndrome hepatopulmonar. O modelo experimental utilizado para induzir a síndrome foi a ligadura de ducto biliar comum. RESULTADOS: Os níveis de mieloperoxidase foram significativamente maiores no grupo ligadura de ducto biliar comum em comparação com os outros grupos. A atividade da mieloperoxidase foi maior no grupo ligadura de ducto biliar comum que o grupo controle (p<0,05) e do grupo sham (p<0,05). CONCLUSÃO: A atividade da mieloperoxidase estava aumentada na síndrome hepatopulmonar experimentais em ratos.

BACKGROUND: Hepatopulmonary syndrome is formed by a triad of liver disease, intrapulmonary vascular dilatation and changes in blood gases. Its pathogenesis is not well defined, but it is speculated that a combination of factors, such as the imbalance of endothelin receptor responses, pulmonary microvascular remodeling, and genetic predisposition, leads to bacterial translocation and intrapulmonary vascular dilatation. AIM: To evaluate the myeloperoxidase activity in hepatopulmonary syndrome in rat model. METHOD: Twenty-nine rats were divided into control, sham and experimental hepatopulmonary syndrome groups. Was evaluated the myeloperoxidase activity and the experimental model used to induce hepatopulmonary syndrome was common bile duct ligation. RESULTS: The myeloperoxidase activity levels were significantly increased in the common bile duct ligation group as compared with the other groups. Myeloperoxidase activity was higher in the common bile duct ligation group than control group (p<0.05) and than sham group (p<0.05). CONCLUSION: The myeloperoxidase activity is increased in experimental hepatopulmonary syndrome in rats.

CONTEXTO: Em pacientes bem selecionados, o transplante ortotópico de fígado é um excelente tratamento para pacientes com carcinoma hepatocelular. Algumas instituições atualmente tendem a expandir os critérios de Milão. São os chamados Critérios de Milão Expandidos, que incluem tumores maiores do que 5 cm e também aqueles associados com múltiplos tumores, não maiores do que 3 cm, a fim de beneficiar o maior número possível de pacientes submetidos ao transplante ortotópico de fígado. MÉTODOS: Os dados foram coletados na base de dados do PubMED. A palavra-chave para procura foi Critérios de Milão expandidos, no período de 2000 a 2009. Foram excluídos 19 trabalhos devido à falta de dados de sobrevida e à recurrência tumoral, não compatíveis com a língua inglesa e fora do assunto em questão. Foram analisadas a sobrevida do paciente e a taxa de recurrência do tumor de 1 a 5 anos de pacientes submetidos ao transplante hepático com critérios de Milão expandidos em diferentes centros internacionais. RESULTADOS: Esta revisão agregou 23 trabalhos. Catorze diferentes critérios foram encontrados e descritos em detalhes. No entanto, os critérios da Universidade da Califórnia em São Francisco foram os mais estudados entre todos os analisados. CONCLUSÃO: Os Critérios de Milão Expandidos são úteis para ampliar os protocolos para adesão de doentes na lista de espera para transplante de fígado, não havendo diferença significante na sobrevida do doente e nem na taxa livre de recurrência tumoral quando comparados aos critérios de Milão.

CONTEXT: Orthotopic liver transplantation is an excellent treatment approach for hepatocellular carcinoma in well-selected candidates. Nowadays some institutions tend to Expand the Milan Criteria including tumor with more than 5 cm and also associate with multiple tumors none larger than 3 cm in order to benefit more patients with the orthotopic liver transplantation. METHODS: The data collected were based on the online database PubMED. The key words applied on the search were "expanded Milan criteria" limited to the period from 2000 to 2009. We excluded 19 papers due to: irrelevance of the subject, lack of information and incompatibility of the language (English only). We compiled patient survival and tumor recurrence free rate from 1 to 5-years in patients with hepatocellular carcinoma submitted to orthotopic liver transplantation according to expanded the Milan criteria from different centers. RESULTS: Review compiled data from 23 articles. Fourteen different criteria were found and they are also described in detail, however the University of California - San Francisco was the most studied one among them. CONCLUSION: Expanded the Milan criteria is a useful attempt for widening the preexistent protocol for patients with hepatocellular carcinoma in waiting-list for orthotopic liver transplantation. However there is no significant difference in patient survival rate and tumor recurrence free rate from those patients that followed the Milan criteria.