BACKGROUND:Although data about the incidence and management of biliary complications after deceased-donor liver transplantation (DDLT) are well defined, those pertaining to adult living-donor liver transplantation (LDLT) are conflicting.METHODS:We retrospectively compared endoscopic retrograde cholangio-pancreatography (ERCP) findings in 30 LDLT vs. 357 DDLT consecutive adult recipients with duct-to-duct biliary reconstruction. LDLT and DDLT recipients were followed up for median durations of 30.5 and 36.0 months after the last ERCP, respectively.RESULTS:Postoperative biliary complications were more frequently identified at ERCP after LDLT versus DDLT (10/30 [33.3%] vs. 34/357 [9.5%]; P<0.001). Complications mainly consisted of anastomotic biliary strictures (10/30 [33.3%] vs. 27/357 [7.6%]; LDLT vs. DDLT recipients, respectively; P<0.001) and biliary leaks (4/30 [13.3%] vs. 6/357 [1.7%]; LDLT vs. DDLT recipients, respectively; P=0.005; some patients had both complications). Stricture dilation was successful in 4/10 (40%) LDLT vs. 27/27 (100%) DDLT recipients (P<0.001), and bile ducts remained patent up to the end of follow-up without further intervention in 2/10 (20.0%) vs. 21/27 (77.8%) patients, respectively (P=0.002). Endoscopic treatment of bile leaks was successful in 3/4 (75.0%) vs. 5/6 (83.3%) LDLT versus DDLT recipients, respectively (NS).CONCLUSIONS:Biliary complications were more frequent after LDLT compared with DDLT. Endoscopic treatment of anastomotic biliary strictures was successful in a minority of patients after LDLT, in contrast with DDLT. Most biliary leaks were successfully treated at endoscopy after LDLT or DDLT.

P551 Aims: to describe technical aspects of PTPVS and results in the follow up. Methods: consists in percutaneous transhepatic placement of a vascular introducer in the branche of portal vein, the progression of a guide wire distal to the stenosis, to measure the pressure of portal vein above and below the stenosis, the dilatation of the stenosis with an angioplasty balloon, the occlusion of main collateral branches (left gastric veins) with coils and finally place autoexpandable metallic stents in the area of the stenosis. Results: two pediatric patients (6 and 13 yo) with symptomatic portal vein stenosis 11 and 38 months after LT, were treated by percutaneous approach. The main clinical symptoms were: splenomegaly, hypersplenism, and upper gastro-intestinal (GI) bleeding. In both cases a left portal vein approach was done and all the technical steps described above were completed. Metallic autoexpandable Wallstents (8 and 10 mm diameter) were employed, and left gastric veins and lower esophageal varices were occluded with coils. The portal vein pressure decreased significantly after the percutaneous procedure. There was not post-procedure complications. In the follow up of 14 and 16 month respectivelly, both patients are in good clinically conditions, with normal blood test and without episodes of upper GI bleeding. The stents are patent in US Doppler controls, and spleen decreased his volume. Conclusions: the percutaneous treatment of portal vein stenosis in pediatric patients is a safe and effective technique, and avoids most invasive surgical treatments (meso cava shunt) for the resolution of this vascular complication.

BACKGROUND Intra-operative bile duct injuries (IBDI) are potentially severe complications of the treatment of benign conditions, with unpredictable long-term results. Multiple procedures are frequently needed to correct these complications. In spite of the application of these procedures, patients with severe injuries can develop irreversible liver disease. Liver transplantation (LT) is currently the only treatment available for such patients, but little information has been published concerning the results of LT. METHODS Eight patients with LT for end-stage liver disease for IBDI were studied retrospectively. They had failure of multiple previous treatments and experienced recurrent episodes of cholangitis, oesophageal variceal bleeding, severe pruritus, refractory ascites and spontaneous peritonitis. RESULTS Mean recipient hepatectomy time was of 243 minutes (range 140-295 min), the complete procedure averages 545 minutes (260-720) and intraoperative red-blood-cells consumption was 6.5 units (1-7). One patient required reoperation due to perforation of a Roux-en-Y loop, and three developed minor complications (2 wound infections, I inguinal lymphocele). One patient died due to nosocomial pneumonia (mortality rate 12.5%). One patient required retransplantation due to delayed hepatic artery thrombosis. At follow-up 75% of patients are alive with normal graft function and an excellent quality of life. CONCLUSIONS LT represents a safe curative treatment for end-stage liver disease after IBDI, albeit a major undertaking in the context of a surgical complication in the treatment of benign disease. The complications of the surgical procedure and the long-standing immunosuppression impart a high cost for resolutions of these sequelae but LT represents the only long-term effective treatment for these selected patients.

BACKGROUND:Several options now available create the need for a multidisciplinary approach to the treatment of patients with hepatocellular carcinoma (HCC).OBJECTIVE:To describe the experience with a group of patients with HCC diagnosed and treated with the current modalities for control of this entity.POPULATION AND METHOD:A total of 169 consecutive patients with HCC treated between January 1990 and February 1998; 41 liver resections, 14 liver transplants, 87 chemoembolizations and 8 alcoholizations were performed. The median follow-up time was 23.6 months (range: 0.2-94). In the other 29 patients, only support treatment was administered.RESULTS:Resected patients had a lower median hospitalization rate, blood transfusions, and hospitalization mortality. Recurrence was 42.1% in the resected group but 0% in transplanted patients. The overall survival at 36 months was better for transplanted than for resected patients (100% vs. 62.3%; p < 0.02). The median survival time was 13 months (IC: 95%: 11-15 months) in chemoembolizated patients.CONCLUSIONS:1. The outcome of patients with HCC is influenced by several factors, therefore calling for multimodal approach. 2. Surgical procedures should be indicated with low morbimortality rates. 3. The overall survival and disease free survival time is better in transplanted patients than in the resected group. 4. The survival time of patients with unresectable HCC without extra-liver disease could be improved with chemoembolization.

A shortage of liver donors for low-weight transplant recipients has prompted the development of procedures for liver-reduction, split-liver, and living related donor transplantations. For pediatric recipients weighing less than 10 kg, the left lateral segment is often still too large. We describe the procedure of monosegmental transplantation using segment II after segment III was resected in situ from a living related donor. Successful monosegmental transplantation is technically feasible and is a valid alternative to be considered for cases of size discrepancy between the recipient's volume and the donor's left lateral segment.

WHOLE pancreas transplantation may be the best therapeutic option for type I diabetic patients in advanced stages of their disease. However, those patients who are not eligible for whole pancreas transplantation may still benefit from pancreatic cell transplantation, which in spite of its lower rate of insulin independence, involves a minor surgical procedure and a lower posttransplant risk. We herein report our initial experience on pancreatic islet transplantation at a kidney and pancreas transplantation program based in Argentina since 1995.