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Introduction: We sought to evaluate the effect of age on postoperative outcomes among patients undergoing major liver surgery for perihilar cholangiocarcinoma (PHCC). Methods: 77 patients were included. Patients were categorized into two groups: the "< 70-year-olds" group (n = 54) and the "≥ 70-year-olds" group (n = 23). Results: Median LOS was 19 both for < 70-year-old group and ≥ 70-year-old group (P = 0.72). No differences in terms of severe complication were detected (44.4% Clavien–Dindo 3–4–5 in < 70-year-old group vs 47.8% in ≥ 70-year-old group, P = 0.60). Within 90 postoperative days, 11 patients died, 6 in < 70-year-old group (11.3%) and 5 in ≥ 70-year-old group (21.7%), P = 0.29. The median follow‐up was 20 months. The death rate was 72.2% and 78.3% among patients < 70 years old and ≥ 70 years old. The OS at 2 and 5 years was significantly higher among the < 70 years old (57.0% and 27.7%) compared to the ≥ 70 years old (27.1% and 13.6%), P = 0.043. Adjusting for hypertension and Charlson comorbidity index in a multivariate analysis, the HR for age was 1.93 (95% CI 0.84–4.44), P = 0.12. Relapse occurred in 43 (81.1%) patients in the < 70-year-old group and in 19 (82.6%) patients in the ≥ 70-year-old group. DFS at 12, 24, and 36 months was, respectively, 59.6, 34.2, and 23.2 for the < 70 -year-old group and 32.5, 20.3, and 13.5 for the ≥ 70-year-old group (P = 0.26). Adjusting for hypertension and Charlson comorbidity index in a Cox model, the HR for age was 1.52 (95% CI 0.67–3.46), with P = 0.32. Conclusions: ≥ 70-year-old patients with PHCC can still be eligible for major liver resection with acceptable complication rates and should not be precluded a priori from a radical treatment. [ABSTRACT FROM AUTHOR]

Introduction: Biliary problems are very common complications in adult living donor liver transplants (ALDLTs), with a reported negative incidence of 22% to 64%. Patients and methods: From March 2001 through February 2006, we performed 27 ALDLTs, grafting segments V-VIII without the middle hepatic vein. Biliary anatomy was investigated using intraoperative cholangiography in the first 5 patients and with magnetic resonance cholangiography alone in the remaining 22. In 15 patients, we found a single right biliary duct (55.55%) and in 12 we found multiple biliary ducts (44.45%). We performed single biliary anastomoses in 20 patients (74.07%) and multiple anastomoses in the remaining 7 (25.93%). Results: With a mean follow-up of 675 days (range, 8 to 1,804 days), patient and graft survival rates were 85% and 74%. The following biliary complications were observed: 4 biliary leaks from the cut surface, 3 anastomotic leaks, 6 late anastomotic strictures, and 1 early kinking of the choledochus. These 14 biliary complications (51.85%) occurred in 11 patients (40.74%). Conclusion: Biliary complications affected our series of ALDLTs at a high percentage, but none of the grafts transplanted was lost due to biliary problems. Magnetic resonance cholangiography seems to be a reliable instrument to investigate biliary anatomy. Multiple biliary reconstructions are strongly associated with a high risk of complications. [ABSTRACT FROM AUTHOR]

Introduction: Adult living donor liver transplants (ALDLTs) have emerged as an option in the last few years. Materials and methods: From March 2001 through February 2006, we performed 27 ALDLTs. Liver volume, vascular, and biliary anatomy were assessed by CT scan and magnetic resonance cholangiography. The graft-to-recipient weight ratio was always above 0.8. The recipients were United Network for Organ Sharing (UNOS) status 2B or 3. The transplant was carried out grafting segments V-VIII to the recipient without the MHV. In the recipient we have never used a venous-venous bypass. Results: With a mean follow-up of 675 days (range, 8 to 1,804 days), 23 out of the 27 patients are alive. Three have undergone a retransplant: 2 as a consequence of an arterial thrombosis and 1 because of small-for-size-syndrome. These data show an overall patient and graft survival rate of 85% and 74%. Four deaths were caused by massive pulmonary bleeding due to Rendù-Osler syndrome, systemic aspergillosis, sepsis, and cardiac arrhythmia. Fourteen biliary complications (51.85%) occurred in 11 recipients (40.74%); 3 of these patients developed 2 consecutive and different biliary complications. All the donors are alive and well. Conclusion: An expert surgical team and proper selection of both donor and recipient are mandatory. Overall results of ALDLTs are very satisfactory, even if we have to take into account a high rate of biliary complications. [ABSTRACT FROM AUTHOR]