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All Journal The New Ropanasuri Journal of Surgery
Rahayatri, Tri H
Unknown Affiliation
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology

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Effect of Everolimus on the Liver Function of Children Receiving Liver Transplant with Chronic Rejection: An Evidence–Based Case Report Puruboyo, Adi ND; Rahayatri, Tri H; Stephanie, Marini
The New Ropanasuri Journal of Surgery Vol. 8, No. 2
Publisher : UI Scholars Hub

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Introduction. Chronic rejection, a complication after pediatric living donor liver transplantation (LDLT), is challenging to treat as management generally requires retransplantation. However, retransplantation is avoided because of rejection risks, longer operating time, higher mortality, and lower survival rates. Immunosuppressant therapy has potential as an option for nonsurgical treatment. Everolimus, a mammalian target of rapamycin inhibitors (mTOR inhibitors), is a well-known immunosuppressant in treating chronic rejection of LDLT. However, studies in the pediatric field remain minimum. Method. The discussion was based on evidence found from studies found through a systematic literature search. These three studies showed permanent liver function improvement after LDLT on immunosuppressant therapy without Everolimus. Liver function and fibrosis stability improved without mortalities. Differences in Everolimus’ efficacy in improving liver function due to the lack of facility to control Everolimus level in the blood resulted in overwhelming infection due to over-immunosuppression of this drug since Everolimus has a narrow therapeutic range. Conclusion. The administration of Everolimus pediatric after living donor liver transplantation reduces ALT and AST levels and improves fibrosis stability.
Whipple Procedure for High-Grade Pediatric Pancreatic Injury After Blunt Trauma: A Case Report El Gah, David C; Rahayatri, Tri H; Rachmawati, Asri D; Nugroho, Adianto
The New Ropanasuri Journal of Surgery Vol. 10, No. 1
Publisher : UI Scholars Hub

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Introduction: Pediatric pancreatic injury isuncommon but carries significant morbidity. While non-operative management is standard for low-grade injuries, the optimal approach for high-grade trauma (AAST grade III–V) remains debated. Pancreaticoduodenectomy (Whipple procedure) is rarely performed due to high procedural risks and is typically reserved for severe pancreatic head injury with concomitant duodenal damage. Case presentations: A 13-year-old boy presented three days after blunt abdominal trauma with epigastric pain and bilious vomiting. CT imaging revealed free fluid, a large retroperitoneal hematoma, and suspected pancreatic head injury. Despite initial stability and conservative management in the High Care Unit, worsening abdominal distension prompted an exploratory laparotomy. Discussion: Surgery revealed pancreatic head laceration and duodenal tears. Consequently, a pancreaticoduodenectomy with pancreaticojejunostomy, choledochojejunostomy, and gastrojejunostomy wasperformed. The patient recovered steadily, resumed oral intake at two weeks, and was discharged in good condition. At the one-year follow-up, he remained asymptomatic and had resumed normal activities. Conclusion. This case demonstrates that pancreaticoduodenectomy is a definitive option for stable pediatric patients with high-grade pancreatic head and duodenal injuries when local reconstruction is unfeasible. However, due to its complexity, it should remain a last-resort strategy reserved for specialized hepatopancreatobiliary centers.
Co-Authors Adianto Nugroho El Gah, David C Marini Stephanie Puruboyo, Adi ND Rachmawati, Asri D