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An unusual type of diffuse biliary tract injury after liver transplantation that is characterized by multiple intrahepatic biliary strictures, ductal dilatations, fluid collections, or intrahepatic abscesses has been identified. Over a 5-year period, a total of 10 patients (2%) developed diffuse intrahepatic biliary injury with established vascular patency and no obvious source for their biliary tract pathology. All patients received livers preserved in University of Wisconsin solution with a mean preservation time of 16 hours. This biliary tract injury was associated with the presence of revere preservation injury and Roux limb biliary reconstruction. Of the 10 patients, 5 were treated nonoperatively with multiple stricture dilations and stent placements, 3 underwent retransplantation, 1 was treated operatively with hepaticojejunostomy, and 1 died of sepsis. This study suggests that this complication appears to be related to preservation injury and that the etiology may be ischemic in origin.

In an analysis of surgical complications following 500 consecutive orthotopic liver transplants, we identified 12 patients who developed the syndrome of multiple bowel perforations that was not due to iatrogenic injury. All cases occurred in small children (mean weight: 9.0 kg), who represented 7% of the pediatric population. Each patient had a minimum of three perforations. The typical intraoperative findings were pin-point perforations in areas of normal-appearing bowel. With only one possible exception (a patient with cytomegalovirus enteritis), no specific etiology could be determined. Management was based on multiple exploratory laparotomies and individualized operative procedures. All patients are currently alive (mean follow-up: 34.9 months). The pathogenesis of the syndrome of multiple bowel perforations remains unclear but is possibly multifactorial or related to high doses of steroids. Aggressive surgical management with semiopen treatment of peritonitis and frequent explorations has afforded excellent results., Patients who currently undergo liver transplant surgery experience longer survival as a result of improvements in anesthesia techniques and critical care. However, there is still a relatively high incidence of postoperative complications. An analysis of 500 liver transplant patients identified 12 patients who developed a syndrome of multiple bowel (intestine) perforations following liver transplant. These perforations were not due to injury during surgery. All bowel perforations occurred in very young children, ranging in age from two weeks to five years. These children represent 7 percent of the 500 children who underwent liver transplant at the University of Nebraska Medical Center from 1985 to 1990. A study was undertaken to identify the possible cause of the syndrome and describe the course of the affected patients. Patients had at least three perforations, typically pinpoint perforations in normal-appearing intestine. The children underwent many exploratory operations and specific operative procedures. At average follow-up of 34.9 months, all patients are alive. The cause of this syndrome remains unclear; it appears to have multiple causes, but may be related to high-dose steroid therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Liver transplants are a major surgical undertaking, and vascular complications can cause graft failure and death. These complications include thrombosis (clot formation) in the hepatic (liver) artery, thrombosis of the portal vein, and rupture of the hepatic artery. A study was undertaken to determine the incidence, available treatment options, and outcomes of these complications. Within a 57-month period, 430 liver transplants were performed on 372 patients. The incidence of vascular complications was 9 percent, and included 24 incidents of hepatic artery thrombosis (76 percent of all complications), six cases of portal vein thrombosis, three cases of combined hepatic artery and portal vein thrombosis, and five patients with a ruptured hepatic artery. Among the 140 children included in the study, the main reason for transplant was biliary atresia (absence or underdevelopment of one or more of the normal bile duct structures causing liver damage). Among the adults, the main indication for transplant was liver cirrhosis, degenerative disease of the liver in which the lobes are covered with fibrous tissue and the lobules are infiltrated with fat. Complications were signaled by liver failure, graft dysfunction, and bile infection; problems were also identified by screening ultrasound. Treatment of the complications included revascularization, revascularization and retransplantation, only retransplantation, and some patients were just closely observed. Four patients had infectious arteritis (inflammation of the artery). The six-month survival was 70 percent for patients who developed vascular complications following liver transplantation. It is concluded that early diagnosis of transplant failure is essential, and surgical intervention usually is the main treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)