[Aggressive management of the arterial complications of liver transplantation. Impact upon survival and biliary complications]. / Tratamiento agresivo de las complicaciones arteriales del trasplante hepático. Impacto sobre la supervivencia y las complicaciones biliares.

UNLABELLED: A study was made of the arterial complications documented in 400 transplants performed between 1997 and 2006. The patients were divided into two groups according to the type of treatment provided. Group I: invasive management (arterial treatment or re-transplant), and Group II: conservative or symptomatic management. The impact of management upon survival and biliary complications was analysed. RESULTS: There were 18 arterial complications (4.5%): 10 early (7 thromboses and 3 stenoses) and 8 late (5 thromboses and 3 stenoses). Ninety percent of the early complications were subjected to invasive management (4 emergency thrombectomies, 1 re-transplant and 3 angioplasties), while 25% of the late complications were treated in the form of re-transplant and the remaining 75% were subjected to symptomatic treatment. Survival after 12 and 60 months was lower in Group II (57% and 42%) than in Group I (90% and 68%), although without reaching statistical significance. The overall biliary complications rate among the patients with arterial thrombosis was 50%. The rate was significantly lower in Group I than in Group II (10% versus 71%) (P<04). CONCLUSIONS: Invasive management of the arterial complications of liver transplantation is associated with longer short-term survival and significantly fewer biliary complications. In our experience, patients benefit from an early diagnosis and aggressive management of complications of this kind.

[Biliary reconstruction in liver transplantation: is a biliary tutor necessary?]. / Reconstrucción biliar en el trasplante hepático: es necesario un tutor biliar.

OBJECTIVES: To assess the incidence and type of biliary complications in liver transplantation after biliary reconstruction with or without a biliary tutor. MATERIAL AND METHOD: A prospective, non-randomized study of 128 consecutive patients undergoing elective liver transplantation was performed. Retransplantations, emergency transplantations, hepaticojejunostomy and patients who died within 3 months of causes other than biliary complications were excluded. Group I (n = 64) underwent termino-terminal choledochocholedochostomy with a Kehr tube and group II (n = 64) underwent choledochocholedochostomy without Kehr tube. Complications, therapeutic procedures, reoperations and survival free of biliary complications were analyzed. RESULTS: The overall rate of biliary complications was 15% (17% in group I and 14% in group II). Types of complication (overall and in groups I and II, respectively) consisted of fistulas 4% (6% vs. 3%), stenosis 8% (4% vs. 12%), and Kehr dysfunction 3%. The mean number of therapeutic procedures, including endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, trans-Kehr cholangiography and drainage of collections, was 2.1 vs. 2 per complicated patient. The overall reoperation rate was 5% (2% vs. 9%) (p < 0.05). One-year survival free of biliary complications was 85% vs. 82% (Log Rank = 0.5). CONCLUSIONS: No statistically significant differences were found in complications after choledocho-choledocho anastomosis with or without a biliary tutor. However, the patient group that did not receive a biliary tutor required more complex procedures for treatment of complications, as well as a greater number of reoperations.

Calibrated portacaval H-graft shunt in variceal hemorrhage. Long-term results.

BACKGROUND/AIMS: To analyze the long-term outcome of the calibrated portacaval shunt in the treatment of portal hypertension. METHODOLOGY: Between 1991 and 1996 we undertook a prospective non-randomized study, including 37 cirrhotic patients who underwent small diameter portacaval shunt with polytetrafluoroethylene H-graft, 24 cases with 8 mm and 13 cases with 10 mm. Early and late complications, and survival were analyzed. RESULTS: Overall, 28 corresponded to Child-Pugh class A, 5 to class B and 4 to class C. The cause of cirrhosis was alcoholic in 16 cases, postnecrotic in 12, mixed in 5, primary biliary cirrhosis in 2 and unknown in 1. Postoperative mortality was 10%. Long-term results, after a follow-up of 3-8 years, have shown a rebleeding rate of 12%, mainly after the third postoperative year. Some degree of encephalopathy occurred in 23% of the patients, but in no case was this chronic or incapacitating. The rate of early thrombosis was 5%, but in all cases it was repermeabilized with local thrombolysis. The late thrombosis rate was 6%. The 3-, 5- and 7-year survival rates were 79%, 57%, and 36%, respectively. These rates were not statistically related with the shunt diameter or the etiology of the cirrhosis. CONCLUSIONS: Partial portacaval shunt is a safe option for the treatment of variceal bleeding due to portal hypertension. We consider it to be the treatment of choice in a selected group of cirrhotic patients with well-preserved liver function, after previous failure of medical therapy. Furthermore, it can also be used as a bridge until liver transplantation.