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Key Clinical Message: Afferent loop syndrome is a rare post‐operative complication following upper gastrointestinal bypass surgeries, usually occurring within the first two weeks post‐operation. This case report, however, outlines afferent loop syndrome almost a decade post‐surgery, which was managed conservatively. A 54‐year‐old woman presented with a few days' history of epigastric pain, vomiting, and constipation. She had undergone a sleeve gastrectomy and was converted to a Roux‐en‐Y gastrojejunostomy for weight loss 9 and 7 years ago, respectively. Serum lipase was elevated at 1410 IU/L. Computed tomography showed high‐grade proximal small bowel obstruction, involving the efferent and afferent loops of the Roux‐en‐Y gastric bypass. The patient was given intravenous rehydration, electrolyte replacement and had a nasogastric tube inserted. She was discharged on day 5 of admission without significant sequelae. Afferent limb syndrome should be considered in patients with altered upper gastrointestinal anatomy who present with pancreatitis, regardless of the time period post‐operatively. Future guidelines should further more outline the factors indicated for surgical versus conservative management. [ABSTRACT FROM AUTHOR]

Introduction: Patients undergoing major cardiothoracic or abdominal surgery are at increased risk of developing post‐operative pulmonary complications (PPC), but respiratory physiotherapy can prevent PPC. We have previously developed the PPC Risk Prediction Score to allocate physiotherapists' resources and stratify patients into three risk groups. In this study, we performed a temporal external validation of the PPC Risk Prediction Score. Such validation is rare and adds to the originality of this study. Methods: A cohort of 360 patients, admitted to undergo elective cardiothoracic or abdominal surgery, were included. Performance and clinical usefulness of the PPC Risk Prediction Score were estimated through discrimination, calibration and clinical usefulness, and the score was updated. Results: The score showed c‐statistics of 0.62. Related to clinical usefulness, a cut point at 8 gave a sensitivity of 0.49 and a specificity of 0.70, whereas a cut point at 12 gave a sensitivity of 0.13 and a specificity of 0.95. Two predictors included in the development sample score, thoraco‐abdominal incision odds ratio (OR) 2.74 (1.12;6.71) and sternotomy OR 2.09 (1.18;3.72), were statistically significantly associated to PPC in the validation sample. Conclusions: The score was not able to discriminate between patients with and without PPC; neither was the updated score, but the study identified clinically relevant risk factors for developing PPC. [ABSTRACT FROM AUTHOR]

Background: We examined the safety of laparoscopic surgery for colorectal cancer (CRC) in patients with pulmonary dysfunction, and evaluated risk factors (RF) for post‐operative complications. Methods: We defined pulmonary dysfunction as having any diagnosed pulmonary disease with spirometry findings of obstructive or restrictive defects. Clinicopathological factors of 213 patients with pulmonary dysfunction who underwent laparoscopic surgery for CRC at Toranomon Hospital from 1999 to 2016 were evaluated to retrospectively identify RFs for any post‐operative complications and major complications, namely post‐operative pulmonary complications (PPCs). Examined preoperative factors included age, gender, body mass index, tumour location, smoking history, percentage vital capacity (%VC), forced expiratory volume in 1 s (FEV1.0), a ratio of FEV1.0 to forced vital capacity and American Society of Anesthesiologists physical status grade. Intraoperative factors, such as operative time, blood loss and blood transfusion, were also assessed. Results: Forty patients (18.8%) developed any complications including PPCs. Multivariate analysis revealed that male, rectal cancer and spirometry findings (both low FEV1.0 (0.8 L) and low %VC (<95)) were RFs (P = 0.026, 0.003 and 0.007, respectively). Six cases (2.8%) developed PPCs. The prevalence of PPCs was higher in patients with both low %VC (<95%) and low FEV1.0 (<0.8 L), with statistical significance (P = 0.006). Conclusion: Our study suggested that not only low FEV1.0 but also low %VC was an important RF for post‐operative complications after laparoscopic surgery for CRC. [ABSTRACT FROM AUTHOR]

Background: Conservative surgical approaches, reconstructive techniques and technology are increasingly used in parotid surgery. The aim of this study was to determine the surgeon‐modifiable factors which impact the rates of post‐operative complications following parotidectomy for benign pathology. Methods: A retrospective cohort study of patients undergoing parotidectomy for benign pathology by or under the supervision of the senior author between 2006 and 2019 was performed. Clinicopathological variables, operative techniques and post‐operative complications were recorded using standardized templates. Multivariable logistic regression models were used to obtain odds ratios (ORs) whilst adjusting for the effect of other clinically relevant covariates. Results: In total, 357 parotidectomies were performed. Independent factors associated with post‐operative facial paresis were re‐operative surgery (OR 3.51, 95% CI 1.19–10.33, P = 0.023), nerve integrity monitoring (OR 0.50, 95% CI 0.26–0.99, P = 0.046) and operation type, with focused tumour dissection (FTD) having the lowest rate of paresis (OR 0.19, 95% CI 0.040–0.92, P = 0.038) compared to limited parotidectomy. Factors associated with reduced wound complications on adjusted analysis were dermofat grafting (OR 0.10, 95% CI 0.01–0.72, P = 0.023), lesion size (OR 0.68, 95% CI 0.50–0.92, P = 0.01) and FTD (OR 0.16, 95% CI 0.05–0.59, P = 0.005) compared to limited parotidectomy. Conclusion: FTD, nerve integrity monitoring and dermofat grafting are surgeon‐modifiable variables associated with lower rates of post‐operative complications following parotidectomy for benign pathology. However, the benefit of these operative techniques relies on their appropriate utilization by performing surgeons. [ABSTRACT FROM AUTHOR]

Background: The high and increasing rate of opioid use is a serious issue in the Western world affecting the population's physical and mental health. In most cases, opioid dependency starts with prescriptions by medical professionals, so efforts aimed at reducing in‐hospital opioid use should result in less long‐term dependency. The aim of the current study was to evaluate the feasibility of implementing an opioid‐scarce protocol as part of a new online modifiable Enhanced Recovery After Surgery (mERAS) programme. Methods: A single‐centre retrospective study was conducted comparing a cohort treated under the new opioid‐scarce mERAS protocol (n = 96; May 2018–Nov 2018) to those treated under the original ERAS protocol (n = 84; November 2017–April 2018). The primary outcome was the quantity and duration of opioid use. Results: Fewer patients used fentanyl via intravenous patient‐controlled analgesia in the mERAS group (54% versus 70%; P = 0.03). The mERAS group was also less likely to use oral oxycodone (80% versus 99%; P < 0.0001) and for a shorter duration (median 3 versus 5 days; P = 0.0002). More local anaesthetic transversus abdominis plane catheters were used in the mERAS group (34% versus 6% in the control group; P < 0.0001). Conclusion: Opioid use can be significantly reduced after elective colorectal surgery by employing an opioid‐scarce ERAS protocol. Further data is required to confirm the clinical benefits of this approach. [ABSTRACT FROM AUTHOR]

Background: Angiotensin-converting enzyme inhibitor (ACE-I) and angiotensin-receptor blocker (ARB) users may be associated with increased mortality in patients with post-operative acute kidney injury (AKI), but data are limited. We studied whether users of ACE-I/ARBs with AKI after colorectal cancer surgery (CRC) were associated with increased 1-year mortality after AKI.Methods: This population-based cohort study in Northern Denmark included patients with AKI within 7 days after CRC surgery during 2005-2014. From reimbursed prescriptions, patients were classified as ACE-I/ARB current, former, or non-users. We computed the cumulative 30-day and 1-year mortality after AKI with 95% confidence intervals (95% CI) using the Kaplan-Meier method (1-survival function). Hazard ratios (HRs) comparing mortality in current and former users with non-users were computed by Cox proportional hazards regression analyses, controlling for potential confounders.Results: We identified 10 713 CRC surgery patients. A total of 2000 patients had AKI and were included. Thirty-day mortality was 16.5% (95% CI 13.7-19.8), 16.2% (95% CI 11.3-22.8), and 13.4% (95% CI 11.6-15.4) for current, former, and non-users. Adjusted HR was 1.26 (95% CI 0.96-1.65) and 1.19 (95% CI 0.78-1.82) for current and former users compared with non-users. One-year mortality rates were 26.4% (95% CI 22.9-30.4), 29.8% (95% CI 23.2-37.8), and 24.7% (95% CI 22.4-27.2) in current, former, and non-users. Compared with non-users, the adjusted 1-year HR for death in current and former users were 1.29 (95% CI 0.96-1.73) and 1.11 (95% CI 0.91-1.35).Conclusion: Based on our findings, current users of ACE-I/ARB may possibly have a small increase in mortality rate in the year after post-operative AKI, although the degree of certainty is low. [ABSTRACT FROM AUTHOR]

Background: Limited data exists concerning the health economics of liver resection, with even less information on the costs emerging from complications, despite this remaining an important target from a health economic perspective. Our objective was to describe the financial burden of complications following liver resection. Methods: We conducted a systematic search and included studies reporting resource use of in‐hospital complications during the index liver resection admission. All indications for liver resection were considered. All techniques were considered. Data was collected using a data extraction table and a narrative synthesis was performed. Results: We identified 12 eligible articles. There was considerable heterogeneity in study designs, patient populations and outcome definitions. We found weak evidence of increased costs associated with major liver resection compared to minor resections. We found robust evidence supporting the increasing economic burden arising from complications after liver resection. Acceptable evidence for increased cost due to the presence and grade of complication was found. Strong evidence concerning the association of length of stay with costs was demonstrated. Conclusions: The presence and grade of complications increase hospital cost across diverse settings. The costing methodology should be transparent and complication grading systems should be consistent in future studies. [ABSTRACT FROM AUTHOR]

Background: Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention. While many studies report readmission, a meta‐analysis of readmission post‐appendectomy has not been published. This meta‐analysis was undertaken to determine rates and predictors of hospital readmission following appendectomy and to potentially provide a metric benchmark. Methods: An ethically approved PROSPERO‐registered (ID CRD42017069040) meta‐analysis following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, using databases PubMed and Scopus, was undertaken for studies published between January 2012 and June 2017. Articles relating to outcomes and readmissions after appendectomy were identified. Those scoring >15 for comparative studies and >10 for non‐comparative studies, using Methodological Index for Non‐Randomized Studies criteria were included in the final analysis. The odds ratios (OR) using random‐effects, Mantel–Haenszel method with 95% confidence intervals (CI), were computed for each risk factor with RevMan5. Results: A total of 1757 articles reviewed were reduced to 45 qualifying studies for a final analysis of 836 921 appendectomies. 4.3% (range 0.0–14.4%) of patients were readmitted within 30 days. Significant preoperative patient factors for increased readmission were diabetes mellitus (OR 1.93, CI 1.63–2.28, P < 0.00001), complicated appendicitis (OR 3.6, CI 2.43–5.34, P < 0.00001) and open surgical technique (OR 1.39, CI 1.08–1.79, P < 0.00001). Increased readmission was not associated with gender, obesity or paediatric versus general surgeons or centres. Conclusion: This meta‐analysis identified that readmission is not uncommon post‐appendectomy, occurring in one in 25 cases. The mean readmission rate of 4.3% may act as a quality benchmark for improving emergency surgical care. Targeting high‐risk groups with diabetes or complicated appendicitis and increasing use of laparoscopic technique may help reduce readmission rates. This meta‐analysis was undertaken to determine rates and predictors of hospital readmission following appendectomy. A mean readmission rate of 4.3% was found, with high‐risk groups including diabetics, complicated appendicitis, and open surgical technique. [ABSTRACT FROM AUTHOR]

Background: This study investigates the incidence of post‐operative complications and risk factors of sentinel lymph node biopsy (SLNB) in melanoma patients. Methods: A retrospective cohort study was conducted at a single cancer institution on 408 consecutive SLNBs. Results: Fifty‐five post‐operative complications occurred in 39 (9.5%) patients and included: wound infection in 24 (5.9%), seroma and lymphorrhea in 15 (3.7%), wound dehiscence in seven (1.7%), lymphocele in six (1.5%) and others in three (0.7%). Univariate analysis failed to identify possible risk factors (i.e. gender, age, lymph node region, number of excised lymph nodes, Breslow index, pT levels, comorbidities, length of surgery and hospital stay). Metastatic sentinel nodes occurred in four of 135 (3%) patients with thin melanoma (Breslow <1 mm) and in 68 of 262 (25.9%) patients with Breslow >1 mm. Conclusion: For patients with thin melanoma in whom the incidence of lymph node metastasis is low, the reported post‐operative morbidity of almost 10% of SLNB highlights the need for careful patient selection. • Role of sentinel biopsy for melanoma patients. • Post‐operative complications of sentinel node biopsy. • Cost/benefit evaluation of sentinel node biopsy and clinical efficacy for thin melanoma patients (<1 mm). [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate the correlation between serum albumin level change (ΔALB) and post‐operative complications in patients with normal preoperative serum albumin after gastrectomy of gastric cancer. Methods: A total of 193 patients undergoing curative (R0) gastrectomy from September 2015 to May 2017 were enrolled in this study. The risk factors for predicting post‐operative complications were identified by univariate and multivariate analysis. The cut‐off value and diagnostic accuracy of ΔALB were measured by receiver operating characteristic curves. ΔALB was defined as: (albumin level before surgery − albumin on post‐operative day (POD) 1)/albumin level before surgery × 100%. Results: A total of 60 patients (31.0%) had post‐operative complications. Our results showed that the cut‐off value of ΔALB was 19.0%. Using a cut‐off value of 19.0%, multivariate analysis identified that ΔALB was able to predict post‐operative complications as an independent factor (odds ratio 13.98, 95% confidence interval 6.048–32.32, P < 0.001). In addition, the area under the curve of ΔALB is higher than C‐reactive protein on POD 3 (0.773 versus 0633). Compared with patients with ΔALB <19.0%, patients with ΔALB ≥19.0% have higher risk of post‐operative complications suffered (62.3 versus 13.7%, P < 0.001) and longer post‐operative stay (22.1 ± 13.5 versus 17.5 ± 4.2, P < 0.001). Conclusion: ΔALB acted as an independent predictor in short‐term complications for patients with normal preoperative serum albumin and its diagnostic accuracy was higher than C‐reactive protein on POD 3. It is promising to be a precise and straight predictor for incidence of post‐operative complications to patients with normal preoperative serum albumin. [ABSTRACT FROM AUTHOR]

Background: Studies show that patients often sign consent documents without fully comprehending the risks, benefits and potential complications. There is currently no Asian study performed analysing adequacy of informed consent. This study aims to assess adequacy of informed consent by evaluating patient understanding and retention of key information and complications pertaining to surgery via medical student‐administered interview. Methods: A prospective study was performed on 48 patients undergoing groin hernia surgery, laparoscopic cholecystectomy and total thyroidectomy from 2017 to 2018 in a teaching hospital. Standardized assessment forms including major common complications and key details of the surgery were prepared. Structured one‐to‐one interviews between students and patients were performed and recorded on the morning of surgery. Results: Although 93.8% of the patients claimed to have understood the information regarding their surgery, only 19.4%, 44.4% and 62.5% of the patients could actually recall the serious complications of groin hernia surgery, laparoscopic cholecystectomy and thyroidectomy, respectively. Elderly patients (>65 years) had poorer understanding of surgical procedure compared to the young (80% versus 100%, respectively, P = 0.008) with 26.7% of elderly patients claiming that they did not understand the indication for surgery. High satisfaction rates with this preoperative interview were reported by both patients and students (95.8% and 97.9%, respectively). Time interval from informed consent to surgery did not make any difference. Conclusion: Understanding of information and key complications was generally low, especially in the elderly population. The structured preoperative interview achieved the dual goal of reinforcing patient gaps in knowledge and improving student communication skills. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Herpes simplex virus hepatitis is a rare but potentially fatal disease without early intervention. Impaired immunity is a major predisposing risk factor but infection in immunocompetent individuals is not unheard of. Diagnosis is complicated by its rarity and nonspecific signs and symptoms on presentation. Identification by liver biopsy is often limited due to concurrent coagulopathy. Early and aggressive treatment is centered on antiviral therapy with acyclovir. We present a case of herpes hepatitis in an immunocompetent woman following abdominal instrumentation. Herpes simplex virus hepatitis is a rare but potentially fatal disease without early intervention. Impaired immunity is a major predisposing risk factor but infection in immunocompetent individuals is not unheard of. Diagnosis is complicated by its rarity and nonspecific signs and symptoms on presentation. Identification by liver biopsy is often limited due to concurrent coagulopathy. Early and aggressive treatment is centered on antiviral therapy with acyclovir. We present a case of herpes hepatitis in an immunocompetent woman following abdominal instrumentation. [ABSTRACT FROM AUTHOR]

Post‐operative atrial fibrillation (POAF) is a common, self‐limiting complication following non‐cardiac surgery. It is associated with other complications such as pneumonia and sepsis, increased hospital stay and in‐hospital mortality. The aim of the study is to identify risk factors, morbidity and mortality associated with POAF. Methods: Retrospective cohort study of 571 consecutive patients who presented for colorectal surgery at The Canberra Hospital. Seventy‐four patients were excluded due to history of atrial fibrillation and a further 124 patients were lost to follow‐up at 1 year. Patient characteristics, intraoperative factors and post‐operative outcomes were retrospectively collected. One‐year mortality data were collected for 373 patients in the cohort. Results: A total of 497 patients were included, 33 (6.6%) developed POAF within 30 days of surgery. POAF is associated with ischaemic heart disease (24.2 versus 11.6%, P = 0.035), emergency (66.7 versus 34.1%, P = 0.0001) and open procedures (87.9 versus 70.9%, P = 0.036). There is a higher incidence of post‐operative complications including pneumonia (24.2 versus 9.1%, P = 0.006), abdominal collection (21.2 versus 9.7%, P = 0.049) and sepsis (21.2 versus 7.5%, P < 0.0001). POAF had a higher in‐hospital mortality (9.1 versus 2.6%, P = 0.035) and 1‐year mortality (33.3 versus 8.8%, P < 0.0001). Conclusion: POAF is a common presentation following colorectal surgery and is associated with infective complications, reflecting an inflammatory process. Risk factors for POAF have been clearly identified in the literature; however, further studies need to be conducted on preventative strategies. There is a significantly higher 1‐year mortality rate compared with the controls, the aetiology of which has not yet been widely reviewed. [ABSTRACT FROM AUTHOR]

The worldwide number of performed bariatric surgeries is increasing continuously, whereas laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy are conducted most frequently. Alongside with the usual post-operative and metabolic complications, luminal complications such as anastomotic bleeding, ulceration, leakage, fistula formation, enlargement and stenosis of the anastomosis may occur. Evolution of interventional endoscopy frequently allows endoscopic management of complications, avoiding surgical interventions in most cases. Here, we review the various luminal complications after bariatric surgery with a focus on their endoscopic management. [ABSTRACT FROM AUTHOR]

A best evidence topic in cardiac surgery was written according to a structured protocol addressing the question 'for post‐cardiac surgery atrial fibrillation (AF), do clinical outcomes differ between rate or rhythm control strategies?' Altogether, 2174 papers were found using the reported searches, of which 5 represented the best evidence to answer the clinical question. Hospital length of stay ranged from 5.0 to 13.2 days for rate control and 5.2 to 10.3 days for rhythm control. Freedom from AF at follow up was achieved in 84.2–91 and 84.2–96% in rate and rhythm control groups respectively. Minimal serious adverse events were noted in all studies analysed and there was no difference between rate and rhythm control groups. We conclude that in the management of post‐cardiac surgery, AF, rate control and rhythm control are equivalent in terms of hospital length of stay, freedom from arrhythmia at follow up and complication rates. [ABSTRACT FROM AUTHOR]

Background In public hospitals, the work-up and surgery for patients with appendicitis is predominantly performed by surgical registrars, whereas in private hospitals, it is performed by consultants. This study aims to demonstrate the difference, if any, in the demographics, work-up, management and complication rate of patients in these two groups. Methods This was a retrospective review of all patients who underwent laparoscopic appendicectomy at a major public hospital and major private hospital over the same 13 months. Data included demographics, admission details, work-up, length of stay, time to surgery, histology and complications. Fisher's exact test and the unpaired t-test were performed to look at the statistical difference between these two groups. Results Total laparoscopic appendicectomies were 164 (public) and 105 (private). Median waiting times to operation were 13 and 9.5 h, respectively. Histological findings of appendicitis/neoplasia/normal appendix were 83.5/3.0/13.4% and 81.9/1.9/16.2%. Histological findings of gangrene or perforation were 26.2% and 11.6% ( P = 0.0081). The proportion of those who had surgery more than 24 h after admission was 12.2% and 4.8% ( P = 0.0517). Rates of pelvic collection were 1.2% and 1.9% ( P = 0.6448), wound infection rates were 2.4% and 1.9% ( P = 1) and overall complication rates were 7.3% and 8.6% ( P = 0.8165). Mean operative time was 49.79 min for consultants and 67.98 min for registrars ( P < 0.0001). Conclusion Consultants are faster at laparoscopic appendicectomies than registrars. A consultant lead service in a private hospital has earlier operation times and less patients ending up with gangrenous or perforated appendicitis but does not alter complication rates. [ABSTRACT FROM AUTHOR]

Background & Aims Chronic liver disease is a common comorbidity in surgery. To assess post-operative morbidity and mortality in relation to progression of chronic liver disease and to identify the risk factors. Methods Six hundred and nine consecutive patients with chronic liver disease who underwent surgery were classified into two groups: non-cirrhotic ( n = 363) and cirrhotic ( n = 246). Randomly selected patients without underlying liver disease who underwent surgery were used as control group ( n = 148). Results The occurrence of major post-operative complications was higher in the non-cirrhotic group than in the control group (11.8% vs. 6.1%, P = 0.051); age, type of surgery and serum albumin level were independent predictors for post-operative morbidity. The frequency of significant post-operative liver damage (14.9% vs. 12.2%, P = 0.920) and mortality (0.6% vs. 0.7%, P = 0.871) did not differ between the two groups. The cirrhotic group had markedly higher incidences of post-operative mortality (10.2%), major complications (32.5%) and significant liver damage (43.1%) than the control and non-cirrhotic groups (all P < 0.001). Type of surgery, Child-Pugh score and model for end-stage liver disease score were independently associated with post-operative morbidity and mortality in patients with cirrhosis. Specific data regarding post-operative morbidity and mortality were presented according to progression of liver disease and type of surgery. Conclusion Non-cirrhotic chronic liver diseases were associated with higher risk of post-operative morbidity, particularly in cases of major surgery, older age and hypoalbuminaemia. Cirrhosis further increased the risk, even death, depending on degree of hepatic decompensation and type of surgery. [ABSTRACT FROM AUTHOR]

Background An acute care surgery ( ACS) model was introduced to manage emergency surgical presentations efficiently. The aim of this study was to evaluate the impact of patient handover in an ACS model on the outcomes of adhesive small bowel obstruction ( SBO). Methods A retrospective study was performed on patients who were admitted with adhesive SBO at Prince of Wales Hospital. The cohort consisted of all patients treated by the ACS team from its introduction in September 2005 to February 2011. Patients in the ACS cohort were divided into two groups: those whose care was handed over to another surgeon and those whose care was not. These groups of patients were compared with a random sample of 50 patients in the pre- ACS period. Results In the ACS period, there was no significant difference in complication rates or length of hospital stay in those who were not handed over and those who were. A significantly higher proportion of operations took place during the day for the group who had been handed over (72.7% versus 36.7%; P = 0.005). There were no significant differences in complication rates or length of hospital stay in the pre- ACS and ACS period. Conclusion Management under an ACS team does not increase adverse outcomes for adhesive SBO. Patients can be safely handed over within an ACS framework. Other members of the ACS team may help facilitate continuity of care. [ABSTRACT FROM AUTHOR]

Siniscalchi A, Cucchetti A, Miklosova Z, Lauro A, Zanoni A, Spedicato S, Bernardi E, Aurini L, Pinna AD, Faenza S. Post-reperfusion syndrome during isolated intestinal transplantation: outcome and predictors. Clin Transplant 2011 DOI: 10.1111/j.1399-0012.2011.01530.x © 2011 John Wiley & Sons A/S. Abstract: Background: Post-reperfusion syndrome (PRS) during isolated intestinal transplantation (ITx) is characterized by decreased systemic blood pressure, systemic vascular resistance, and cardiac output and by a moderate increased pulmonary arterial pressure. We hypothesize that the more severe PRS causes a poorer long-term outcome. The primary aim of this study was to determine the independent clinical predictors of intra-operative PRS, as well as to investigate the link between the severity of PRS and the intra-operative profiles and to examine the post-operative complications and their relationship with transplant outcome. Methods: This observational study was conducted on 27 patients undergoing isolated ITx in a single adult liver and multivisceral transplantation center. PRS was considered when the mean arterial blood pressure was 30% lower than the pre-unclamping value and lasted for at least one min within 10 min after unclamping. Results and conclusions: The main results of this study can be summarized in two findings: in patients undergoing ITx, the duration of cold ischemia and the pre-operative glomerular filtration rate were independent predictors of PRS and the occurrence of intra-operative PRS was associated with significantly more frequent post-operative renal failure and early post-operative death. [ABSTRACT FROM AUTHOR]

Barth E, Durand M, Heylbroeck C, Rossi-Blancher M, Boignard A, Vanzetto G, Albaladejo P, Chavanon O. Extracorporeal life support as a bridge to high-urgency heart transplantation. Clin Transplant 2011 DOI: 10.1111/j.1399-0012.2011.01525.x. © 2011 John Wiley & Sons A/S. Abstract: Extracorporeal life support (ECLS) represents an effective, emergent therapy for patients with end-stage heart failure or cardiac arrest. However, ECLS is typically not used as a bridge to heart transplantation because of the limited duration of ECLS. In France, high-urgency priority heart transplantation remains a possibility for transplant patients who are on ECLS. In this article, we present our experience with high-urgency priority heart transplantation after ECLS. From July 2004 to December 2009, 242 patients underwent emergent ECLS. Heart transplantation was performed in eight of these patients. Time of ECLS was 6.3 ± 4.6 d. Before heart transplantation, all patients on ECLS had decreased organ dysfunctions and four were conscious. Despite frequent post-operative complications, no death occurred during the first year after transplantation. In our experience, ECLS is a valid method of supporting patients awaiting high-urgency heart transplantation and can be used as a short-term bridge to heart transplantation. [ABSTRACT FROM AUTHOR]

This paper has the objective to evaluate retrospectively the long-term results of transhepatic treatment of PV stenoses after pediatric LT. During an eight-yr period, 15 children with PV stenoses underwent PTA with balloon dilation or stent placement in case of PTA failure after LT. Patients' body weights ranged from 9.3 to 46 kg (mean, 15.5 kg). PV patency was evaluated in the balloon dilation and in the stent placement groups. Technical and clinical successes were achieved in all cases with no complication. Eleven patients (11/15; 73.3%) were successfully treated by single balloon dilation. Four patients (4/15; 26.7%) needed stent placement. One patient was submitted to stent placement during the same procedure because of PTA failure. The other three developed clinical signs of portal hypertension because of PV restenoses two, eight, and twenty-eight months after the first PTA. They had to be submitted to a new procedure with stent placement. The follow-up time ranged from 3 to 8.1 yr (mean, 6.3 yr). In conclusion, transhepatic treatment of PV stenoses after pediatric LT with balloon dilation or stent placement demonstrated to be a safe and effective treatment that results in long-term patency. [ABSTRACT FROM AUTHOR]

Alcohol dehydrogenase (ADH) is an enzyme specifically located in the cytoplasm of hepatocytes. The purpose of this study was to assess the potential usefulness of serum ADH activity as a biomarker of graft function following liver transplantation. Blood samples were obtained from 26 patients who underwent living-donor liver transplantation. In patients without any post-operative complication, serum ADH activity normalized at 2.9 ± 1.2 d. Values of serum ADH activity were remarkably elevated in patients with vascular complications, whereas they were only slightly elevated or remained within the reference range in patients with acute cellular rejections. In vascular complications, serum ADH activity peaked prior to elevation of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and once the cause of damage was resolved, the values returned to reference range more quickly than did ALT and AST. In conclusion, monitoring serum ADH activity in addition to ALT and AST may provide more sensitive ongoing graft status and valuable information for the differential diagnosis of vascular complications and acute cellular rejection. [ABSTRACT FROM AUTHOR]