Selective Indication of T-Tube in Liver Transplantation: Prospective Validation of the Results of a Randomized Controlled Trial.

BACKGROUND AND AIMS: T-tube placement during choledochocholedochostomy (CCS) associated with liver transplantation (LT) remains controversial. This study was designed to validate the results of an earlier prospective randomized controlled trial (RCT) on use versus nonuse of the T-tube during CCS associated with LT. METHODS: Prospective cohort study. The primary outcome was the overall incidence of biliary complications (BCs). RESULTS: In total, 405 patients were included, and the median overall monitoring period was 29 months (interquartile range: 13-47 months). Selective use of the T-tube reduced BCs (23% vs 13%; P = .003), of which 75% were type IIIa or less in the Clavien-Dindo classification. The overall BC rate did not differ between patients with versus without T-tube placement. CONCLUSIONS: We confirmed that selective use of a rubber T-tube during CCS associated with LT, following the principles established in our prospective RCT, reduced the rate of BC by 10% without detriment, even after enrolling patients at an a priori greater risk of BCs than were the RCT patients.

Does Surgeon Fatigue Influence the Results of Liver Transplantation?

BACKGROUND: Recently, there has been an attempt to relate fatigue of the surgical team according to the start time of the transplant surgery and the surgeon's activity during the week, with the morbidity and mortality of liver transplant recipients. If this relationship could be demonstrated, it would be desirable to reconsider organization of transplant surgical teams. METHODS: We carried out a retrospective study of 439 successive cases of adult hepatic transplant from 2012 to 2016. We divided the patients into 2 groups, bearing in mind the interval between transplant procedures. Solitary liver transplantation was defined when >12 hours had elapsed since the last transplant, and consecutive liver transplant was defined when <12 hours had passed since the previous transplant. We analyzed the morbidity and mortality of the recipient (survival, vascular and biliary complications, early bleeding, and duration of surgery). Fatigue was measured as it related to the start time of the transplant, day of the week, and accumulation of daily and weekly activity of the surgical teams. RESULTS: No significant differences were found between the 2 groups with regard to donor or recipient characteristics. No variable related to the fatigue of the surgeons had an effect on the survival, biliary and vascular complications, early bleeding, or duration of the surgical intervention. CONCLUSION: We were unable to show that fatigue level of the surgical team influences the results of transplant procedures. Morbidity and mortality are likely related to other factors.

Prognostic Value of Pre-transplantation Serum Alpha-Fetoprotein Levels in Hepatocellular Carcinoma Recurrence.

Serum alpha-fetoprotein (AFP) value is still not included in the consensus guidelines to make decisions referring to liver transplantation (LT) for hepatocellular carcinoma (HCC). Many studies demonstrated the influence of high AFP level in poor prognosis after LT for HCC. We studied 301 consecutive recipients transplanted for HCC from January 2002 to December 2011. The median follow-up was 64.3 months (interquartile range, 41.6-90.8). HCC recurrence was 31.6% when AFP was >400 ng/mL and 50% when AFP was >1,000 ng/mL. Specificity to predict HCC recurrence was 95.1% (95% confidence interval [CI], 91.9-97.1) when AFP was >400 ng/mL and 98.9% (95% CI, 96.8-99.6) when AFP was >1,000 ng/mL. The overall survival (P = .008) and disease-free survival (P = .004) differed between patients groups when an AFP cutoff level of 1,000 ng/mL was used. The predictive accuracy of high pre-transplantation serum AFP level for HCC post-transplantation recurrence should be used in decision algorithms for LT.