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To improve current data systems for institutional decision-making, the Adult Liver Transplant Registry was established at the Hospital Italiano de Buenos Aires, Argentina. This article describes its design and implementation and reports on the outcomes for patients transplanted since its January 2020 launch. A multidisciplinary team designed the registry by identifying key variables from a literature review while considering balance between data depth and feasibility. Rigorous quality control measures were enforced, including monthly audits and staff training. Benchmark indicators for post-transplant outcomes were established. As of November 2023, the registry included 136 transplants. Its implementation and maintenance were straightforward, with no significant difficulties encountered. Cirrhosis was the predominant indication (77%) for transplant. Only one living donor transplantation was performed. Post-transplant results generally aligned with benchmarks, but rates of biliary complications slightly exceeded the recommended thresholds. The one-year post-transplant survival rate was 87%. The successful registry implementation provides a robust framework for research, treatment management, and patient care enhancement within a liver transplant unit.

Introduction Hepatic artery complications (HACs), such as a thrombosis or stenosis, are serious causes of morbidity and mortality after paediatric liver transplantation (LT). This study will investigate the incidence, current management practices and outcomes in paediatric patients with HAC after LT, including early and late complications.Methods and analysis The HEPatic Artery stenosis and Thrombosis after liver transplantation In Children (HEPATIC) Registry is an international, retrospective, multicentre, observational study. Any paediatric patient diagnosed with HAC and treated for HAC (at age

La vacunación COVID-19 ayuda a limitar la pandemia. En Argentina, se aprobaron tres vacunas y se priorizó a los trabajadores de la salud (TDS). El objetivo fue determinar la efectividad de las vacunas COVID-19, analizando el cambio en los niveles de Inmunoglobulina G y la incidencia de nuevos casos de COVID-19 hasta 12 meses después de la segunda dosis. Métodos: Cohorte prospectiva de TDS entre marzo de 2021 y 2022. Se utilizó la prueba COVIDAR IgG para medir los anticuerpos. Se empleó un modelo de efectos mixtos para comparar los niveles de inmunoglobulina G en diferentes puntos temporales, se utilizó Kaplan Meier para estimar los casos de COVID-19 incidentes. Resultados: se incluyeron 82 participantes. Los eventos adversos fueron frecuentes pero leves. Todos los participantes mostraron anticuerpos positivos a los 12 meses. Los niveles de anticuerpos mostraron un aumento un año después de la segunda dosis. Sinopharm tardó mucho tiempo en arrojar resultados positivos. Más de la mitad de las personas tuvieron una enfermedad leve de COVID-19. Conclusión: Las vacunas COVID-19 son seguras y efectivas.

Introduction Portal vein obstruction (PVO) consists of anastomotic stenosis and thrombosis, which occurs due to a progression of the former. The aim of this large-scale international study is to assess the prevalence, current management practices and efficacy of treatment in patients with PVO.Methods and analysis The Portal vein Obstruction Revascularisation Therapy After Liver transplantation registry will facilitate an international, retrospective, multicentre, observational study, with 25 centres around the world already actively involved. Paediatric patients (aged

Liver transplantation is an extremely complex procedure performed in an extremely complex patient. With a successful technique and acceptable long-term survival, a new challenge arose: overcoming donor shortage. Thus, living donor liver transplant and other techniques were developed. Aiming for donor safety, many liver transplant units attempted to push the viable limits in terms of size, retrieving smaller and smaller grafts for adult recipients. With these smaller grafts came numerous problems, concepts, and definitions. The spotlight is now aimed at the mirage of hemodynamic changes derived from the recipients prior alterations. This article focuses on the numerous hemodynamic syndromes, their definitions, causes, and management and interconnection with each other. The aim is to aid the physician in their recognition and treatment to improve liver transplantation success.

Background Common bile duct injuries (CBDIs) remains a rare but serious complication in children undergoing laparoscopic cholecystectomy (LC), with an incidence of 0.44%. In severe lesions, a major liver resection may be necessary as a definitive treatment. The current principles for safe hepatectomy are mainly focused on the liver parenchyma that remains after resection. Therefore, one of the main factors related to posthepatectomy hepatic insufficiency is the quantity and quality of the future liver remnant (FLR). To achieve an optimal FLR, techniques such as portal vein embolization (PVE) are available.Case presentation We present the case of a 5-year-old child with a severe CBDI after LC, treated with preoperative PVE followed by a right hepatectomy as definitive treatment. No reports of liver resections and PVE are described in the literature concerning the pediatric population.

Introducción. El rol de la resección hepática (RH) en pacientes con lesiones hepáticas no tumorales (LHNT) permanece controversial. Objetivos. Analizar las indicaciones y resultados de la RH en pacientes con diagnóstico de LHNT. Métodos. Estudio multicéntrico retrospectivo. Resultados. Se realizaron 114 hepatectomías en pacientes con LHNT desde enero de 2002 a febrero de 2012. Catorce pacientes presentaban lesiones quirúrgicas de la vía biliar (LQVB), 18 litiasis intra-hepática (LI), 32 quistes hidatídicos (QHH), 10 poliquistosis hepática (PH), 19 enfermedad de Caroli (EC) y 21 otras patologías no tumorales. En 49 pacientes se realizó una hepatectomía mayor y en 65 una hepatectomía menor. El 29% de los pacientes presentaron complicaciones relacionadas a la cirugía. No hubo mortalidad intra o postoperatoria. En los resultados a largo plazo, el 85% de los pacientes permaneció asintomático. Solo 7 pacientes requirieron una reintervención quirúrgica. Conclusiones. La RH es un procedimiento efectivo y seguro para tratar la patología benigna no tumoral, evitando múltiples procedimientos quirúrgicos, percutáneos o endoscópicos.

Introducción. El tratamiento quirúrgico es el tratamiento de elección en el colangiocarcinoma hiliar (CCH). La obtención de márgenes libres (resección R0) ha sido reportada como el único factor pronóstico asociado a un aumento de la supervivencia. El objetivo de este trabajo es analizar una serie consecutiva de pacientes operados con intención curativa en un período de 14 años. Material y métodos. Es un estudio descriptivo retrospectivo sobre pacientes operados con intención curativa entre los años 1994 y 2008. La resección hepática se asoció a resección del segmento 1, de la vía biliar extrahepática y vaciamiento ganglionar en todos los casos. Resultados. Sobre un total de 40 pacientes, 62% eran de sexo masculino con una edad media de 58,2 años. La ictericia fue el motivo de consulta más frecuente (70%). El 62% de los tumores comprometía la confluencia biliar. En 39 de los 40 pacientes se realizó una hepatectomía mayor con 95% de resecciones R0. Se llevaron a cabo 6 resecciones vasculares asociadas. La morbilidad postoperatoria fue de 37,5% y la mortalidad de 10%. La supervivencia global y libre de enfermedad a 1, 3 y 5 años fue de 88% y 63%, 55% y 34%, y, 43% y 24%, respectivamente. Conclusión. La asociación de una hepatectomía mayor con resección del lóbulo caudado y resección vascular, cuando fue necesaria, se asoció a un 95% de márgenes libres de tumor y una tasa de morbi-mortalidad acorde a los estándares de la literatura internacional. Si bien es necesario un mayor número de casos, la resección vascular asociada parece ser una opción factible y segura en el tratamiento del CCH localmente avanzado.

Background: Liver transplantation (LT) has been used as a last resort in patients with end-stage liver disease due to bile duct injuries (BDI) following cholecystectomy. Our study aimed to identify and evaluate factors that cause or contribute to an extended liver disease that requires LT as ultimate solution, after BDI during cholecystectomy., Methods: Data from 8 high-volume LT centers relating to patients who underwent LT after suffering BDI during cholecystectomy were prospectively collected and retrospectively analyzed., Results: Thirty-four patients (16 men, 18 women) with a median age of 45 (range 22-69) years were included in this study. Thirty of them (88.2%) underwent LT because of liver failure, most commonly as a result of secondary biliary cirrhosis. The median time interval between BDI and LT was 63 (range 0-336) months. There were 23 cases (67.6%) of postoperative morbidity, 6 cases (17.6%) of post-transplant 30-day mortality, and 10 deaths (29.4%) in total after LT. There was a higher probability that patients with concomitant vascular injury (hazard ratio 10.69, P=0.039) would be referred sooner for LT. Overall survival following LT at 1, 3, 5 and 10 years was 82.4%, 76.5%, 73.5% and 70.6%, respectively., Conclusion: LT for selected patients with otherwise unmanageable BDI following cholecystectomy yields acceptable long-term outcomes., Competing Interests: Conflict of Interest: None, (Copyright: © 2021 Hellenic Society of Gastroenterology.)