Three patients who had liver transplant due to yellow fever complications are progressing well at the Clínicas Hospital of the Medical School of USP (HCFMUSP). Two patients from this group did not resist. The first one to be transplanted left ICU last week and already walks around the hospital, she should be discharged this week.
The fulminant hepatitis and yellow fever transplants are unseen worldwide. For this reason, authorizing the proceeding wasn’t an easy decision for Doctor Luiz Carneiro D’Albuquerque, director of the Transplant Division of Liver and Digestive Tract Organs from the Clínicas Hospital of the Medical School of USP and professor of Liver and Digestive Tract Organs Transplants subject at FMUSP. “Of the epidemics, Yellow Fever has 50% mortality. From 10 to 15% of patients has a very critical progress, from the hepatic point of view, caused by liver destruction.”. Parallel, the doctor explains that the subjects presents encephalitis, pancreatitis, fulminant hepatitis and severe renal damage, beyond the virus circulating through the organism.
“About fulminant hepatitis patients, we believe that by taking the infected liver (an organ which suffers from self-destruction for containing the highest viral load) and placing another in its place, this viral load would decrease improving the patient’s conditions”, explains Dr. Carneiro. Although the opinion wasn’t a consensus among the doctors.
The transplant can reverse the viral reproduction and stop the progression of the cerebral edema, improving encephalitis progression. The problem, according to the doctor, was knowing when to transplant, to define the right time. The urgencies of critical Yellow Fever cases were decisive upon the decision to perform the first transplant. “We rehearsed for this precedent for a long time”, the doctor says.
The decision has shown to be correct when, after the first transplant, the viral replication disappeared after three days since the transplant. “We are beginning to understand the data now, but we know that the neurological time is what must define when to transplant”, assess the doctor.
The Transplant Director of HCFMUSP says it’s still a learning stage. “We are learning, exchanging experiences”. Unicamp, which has already performed two surgeries, was the first one invited. Other institutions, with or without liver transplant experience, are being invited to participate. “Many have already participated, but what we want is to share. We are not ready to train teams yet”, assess doctor Carneiro, reinforcing that while the epidemic lasts the HC team will be ready to see to the necessary cases.