Browsing by Author "Marino, Carlo"

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    Implementation and design of customized ex vivo machine perfusion. Analysis of its first results
    (Wiley, 2021) Riveros, Sergio; Marino, Carlo; Ochoa, Gabriela; Morales, Emilio; Soto, Dagoberto; Alegria, Leyla; Josefina Zenteno, Maria; Branes, Alejandro; Achurra, Pablo; Rebolledo, Rolando A.
    The lack of organs available for transplantation is a global problem. The high mortality rates on the waiting list and the high number of discarded livers are reasons to develop new tools in the preservation and transplantation process. New tools should also be available for low-income countries. This article reports the development of customized normothermic machine perfusion (NMP). An ex vivo dual perfusion machine was designed, composed of a common reservoir organ box (CRO), a centrifugal pump (portal system, low pressure), and a roller pump (arterial system, high pressure). Porcine livers (n = 5) were perfused with an oxygenated normothermic (37celcius) strategy for 3 hours. Hemodynamic variables, metabolic parameters, and bile production during preservation were analyzed. Arterial and portal flow remain stable during perfusion. Total bilirubin production was 11.25 mL (4-14.5) at 180 minutes. The median pH value reached 7.32 (7.25-7.4) at 180 minutes. Lactate values decreased progressively to normalization at 120 minutes. This perfusion setup was stable and able to maintain the metabolic activity of a liver graft in a porcine animal model. Design and initial results from this customized NMP are promising for a future clinical application in low-income countries.
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    Liver resection for hepatolithiasis: A multicenter experience in Latin America
    (2023) Garcia, Daniel; Marino, Carlo; Coelho, Fabricio Ferreira; Rebolledo, Patricia; Achurra, Pablo; Fonseca, Gilton Marques; Kruger, Jaime A. P.; Vinuela, Eduardo; Briceno, Eduardo; D'Albuquerque, Luiz Carneiro; Jarufe, Nicolas; Martinez, Jorge A.; Herman, Paulo; Dib, Martin J.
    Background: Hepatolithiasis is a prevalent disease in Asia but rare in Western countries. An increasing number of cases have been reported in Latin America. Liver resection has been proposed as a definitive treatment for complete stone clearance. The aim of this study was to evaluate the postoperative out-comes of liver resection for the treatment of hepatolithiasis in 2 large hepatobiliary reference centers from South America.Methods: We conducted a retrospective descriptive analysis from patients with hepatolithiasis who underwent liver resection between November 1986 and December 2018, in 2 Latin-American centers in Chile and Brazil.Results: One hundred forty-nine patients underwent liver resection for hepatolithiasis (72 in Chile, 77 in Brazil). The mean age was 49 years and most patients were female (62.4%). Hepatolithiasis was localized in the left lobe (61.7%), right lobe (24.2%), and bilateral lobe (14.1%). Bilateral lithiasis was associated with higher incidence of preoperative and postoperative cholangitis (81% vs 46.9% and 28.6% vs 6.1%) and need for hepaticojejunostomy (52.4%). In total, 38.9% of patients underwent major hepatectomy and 14.1% were laparoscopic. The postoperative stone clearance was 100%. The 30-day morbidity and mortality rates were 30.9% and 0.7%, respectively. Cholangiocarcinoma was seen in 2 specimens, and no post-operative malignancy were seen after a median follow-up of 38 months. Fourteen patients (9.4%) had intrahepatic stones recurrence.Conclusions: Liver resection is an effective and definitive treatment for patients with hepatolithiasis. Bilateral hepatolithiasis was associated with perioperative cholangitis, the need for hepaticojejunostomy, and recurrent disease. Resection presents a high rate of biliary tree stone clearance and excellent long-term results, with low recurrence rates and low risk of malignancy.(c) 2022 Elsevier Inc. All rights reserved.