Reduced use of intensive care after liver transplantation: Influence of early extubation

M. Susan Mandell, Dennis Lezotte, Igal Kam, Stacy Zamudio – 30 December 2003 – Postoperative ventilation and admission to the intensive care unit (ICU) is the standard of care in liver transplantation and comprises a significant proportion of transplantation costs. Because immediate postoperative extubation has been reported previously in a selected group of liver transplant recipients, we questioned whether this protocol could be extended to a larger group of patients.

Recurrent portal hypertension after composite liver/small bowel transplantation

Thomas M. Fishbein, Sander Florman, Gabriel Gondolesi, Neal S. LeLeiko, Harold A. Mitty, Allan Tschernia, Stuart S. Kaufman – 30 December 2003 – Late technical complications of composite liver/small bowel transplantation procedures are often complex and have not been well defined. Here we describe the unusual presentation and management of two cases of recurrent thrombocytopenia due to hypersplenism resulting from portacaval shunt stenosis. Both patients presented with portal hypertension late after composite liver/small bowel transplantation.

Vertical portal vein clamping in right hepatic lobectomy for live donation or neoplasm

Katsuhiko Yanaga, Yukio Kamohara, Mitsuhisa Takatsuki, Junichiro Furui, Takashi Kanematsu – 30 December 2003 – A modified technique is described in clamping the right branch of the portal vein in right hepatic lobectomy for live donation or neoplasm that allows flush division of the origin of the right branch without causing portal vein stenosis.

Routine endoscopic retrograde cholangiography in the detection of early biliary complications after liver transplantation

Sudeep R. Shah, James Dooley, Raj Agarwal, David Patch, Andrew K. Burroughs, Keith Rolles, Brian R. Davidson – 30 December 2003 – The value of routinely performing endoscopic retrograde cholangiography (ERC) to detect biliary complications in patients undergoing orthotopic liver transplantation (OLT) with duct‐to‐duct anastomosis without a T‐tube is not known. Eighty‐nine of 171 liver transplant recipients (61 men; mean age, 49.9 years) underwent ERC 14.5 ± 4.5 (SD) days after surgery between January 1997 and August 1999.

Utility of pulse oximetry in the detection of arterial hypoxemia in liver transplant candidates

Gary A. Abrams, Michael K. Sanders, Michael B. Fallon – 30 December 2003 – Hepatopulmonary syndrome, arterial hypoxemia caused by intrapulmonary vasodilatation, occurs in approximately 10% of patients with cirrhosis. The severity of hypoxemia affects liver transplant candidacy and is associated with increased morbidity and mortality posttransplantation. Screening guidelines for detecting the presence of arterial hypoxemia do not exist.

Predictors of mortality and stenosis after transjugular intrahepatic portosystemic shunt

Mark W. Russo, Paul F. Jacques, Matthew Mauro, Pat Odell, Robert S. Brown – 30 December 2003 – Transjugular intrahepatic portosystemic shunts (TIPSs) are used to treat variceal hemorrhage and refractory ascites. We sought to determine factors associated with stenosis and mortality after TIPS placement in patients with end‐stage liver disease. This is a retrospective review of 90 TIPSs placed over a 3‐year period. Demographic, clinical, and biochemical parameters were analyzed in univariate analyses to determine their association with stenosis and death.

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