Internal biliary stenting during orthotopic liver transplantation: anastomotic complications, post-transplant biliary interventions, and survival

Orthotopic liver transplantation is the treatment of choice for selected patients with end-stage liver disease or acute liver failure. Given the excellent long-term survival associated with this procedure, increasing emphasis is being placed on the recognition and prevention of post-transplant complications, detection of recurrent liver disease, and effective management of immunosuppressive drug therapy, which involves regular monitoring of blood levels and the identification of adverse effects and drug interactions. In this context, close interaction between the transplant surgeon, the hepatologist, and the family physician is of great value. The purpose of the present article is to review the multidisciplinary, long-term care of liver transplant recipients, the detection and management of the most common post-transplant complications, and the effects of immunosuppression. The article is based on a PubMed search for articles (original research, reviews, meta-analyses) published between 1995 and 2010. The search terms used were ‘‘liver transplantation’’ AND any of the following: cardiovascular complications, long-term complications, malignancy, post-transplant care.

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Protein C in a patient with portal vein thrombosis in liver transplantation

Transplantologiya The Russian Journal of Transplantation ◽

10.23873/2074-0506-2021-13-2-151-157 ◽

2021 ◽

Vol 13 (2) ◽

pp. 151-157

Author(s):

S. V. Zhuravel ◽

V. E. Aleksandrova ◽

N. K. Kuznetsova ◽

M. S. Novruzbekov ◽

L. V. Donova

Keyword(s):

Liver Transplantation ◽

High Risk ◽

Plasma Level ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Orthotopic Liver Transplantation ◽

Protein C ◽

Post Transplant ◽

Vein Thrombosis ◽

Hemostasis System

Background. The problem of thromboses, including those associated with impaired hemostasis system, is relevant in orthotopic liver transplantation.Aim. To present the experience of intraoperative use of protein C during orthotopic liver transplantation in a patient with a high risk of recurrent portal vein thrombosis.Results. During orthotopic liver transplantation in a patient with a high risk of recurrent portal vein thrombosis, the intraoperative administration of the protein C preparation at a dosage of 500 IU contributed to the increase in plasma level of protein C by 48%. In the post-transplant period, recurrent portal vein thrombosis was not observed. Conclusion. Intraoperative administration of protein C in combination with basic therapy for orthotopic liver transplantation helps to prevent recurrent portal vein thrombosis.

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Internal Biliary Stenting in Orthotopic Liver Transplantation using a 6 Fr. Silastic™ Double J Ureteral Stent

Transplantation Journal ◽

10.1097/00007890-199904150-00764 ◽

1999 ◽

Vol 67 (7) ◽

pp. S191

Author(s):

Mark Johnson ◽

Tricia Thompson ◽

Ann Meehan ◽

Pat Odell ◽

David Gerber ◽

...

Keyword(s):

Liver Transplantation ◽

Orthotopic Liver Transplantation ◽

Ureteral Stent ◽

Biliary Stenting

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Outcome of orthotopic liver transplantation in patients with haemophilia

Gut ◽

10.1136/gut.42.5.744 ◽

1998 ◽

Vol 42 (5) ◽

pp. 744-749 ◽

Cited By ~ 103

Author(s):

F H Gordon ◽

P K Mistry ◽

C A Sabin ◽

C A Lee

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Hepatitis C ◽

Viral Hepatitis ◽

Orthotopic Liver Transplantation ◽

Clotting Factor ◽

Bleeding Complications ◽

Clotting Factors ◽

Post Transplant

Background—Many patients with haemophilia have developed cirrhosis or hepatocellular carcinoma due to transfusion acquired chronic viral hepatitis.Aims—To assess the long term outcome of all haemophilic patients reported to have undergone orthotopic liver transplantation.Methods—Transplant centres of patients identified by medical database search were contacted and survival data assessed by Kaplan-Meier analysis.Results—Twenty six haemophilic men (median age 46 years, range 5–63 years) underwent orthotopic liver transplantation in 16 centres between 1982 and 1996. Indications for transplantation were hepatitis C cirrhosis (69%), hepatitis B with or without C cirrhosis (15%), viral hepatitis related hepatocellular carcinoma (12%), and biliary atresia (4%). Six patients (23%) were infected with human immunodeficiency virus (HIV). Postoperatively, the median time to normal clotting factor levels was 24 hours (range 0–48 hours) and exogenous clotting factors were stopped at a median of 24 hours (range 0–480 hours). Four patients (15%) had bleeding complications. The one and three year survival of HIV positive recipients (67% and 23%) was significantly poorer (p=0.0003) than that of HIV negative recipients (90% and 83%). Coagulopathy was cured in all patients surviving more than 12 days post-transplant. Six of the 20 patients (30%) with hepatitis C cirrhosis pretransplant had evidence of disease recurrence at a mean of nine months post-transplant.Conclusions—Hepatitis C cirrhosis is the most common indication for orthotopic liver transplantation in patients with haemophilia. Transplantation results in long term cure of haemophilia but may be complicated by the effects of HIV infection or recurrent viral hepatitis.

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