Orthotopic liver transplantation has become the treatment of choice for patients with end-stage nonmalignant liver disease. The surgical techniques and immunosuppressive therapy for this procedure have improved considerably. Nevertheless, there are still significant complications, particularly those of vascular origin, which can lead to graft failure and require retransplantation unless prompt treatment is instituted. These complications include arterial and venous thrombosis and stenosis; arterial pseudoaneurysm; biliary leakage, stricture, and obstruction; liver ischemia, infarction, and abscess; fluid collections and hematomas; lymphoproliferative disorders; recurrent tumors; hepatitis C virus infection; and splenic infarction. Since the clinical presentation of posttransplantation complications is frequently nonspecific and varies widely, imaging studies are critical for early diagnosis. Helical computed tomography (CT) is a valuable complement to ultrasonography (US) in the postoperative period and is a safe, accurate, and noninvasive method of demonstrating hepatic vessels (hepatic artery, portal vein, hepatic veins, and inferior vena cava) and evaluating nonvascular complications (in the hepatic parenchyma and bile duct abnormalities) and extrahepatic tissues. Knowledge and early recognition of these complications is essential for graft salvage, and CT can provide valuable information, particularly for patients with indeterminate US results or in whom US examination is difficult.

Aneurysm, False↗

PubMedDate not supplied

[Nutrition in the first 100 liver transplants performed at the Hospital General Vall d'Hebrón].

The orthotopic liver transplant (OLT) is a therapeutic alternative in the terminal stages of liver pathology. It is a surgical procedure which is being used on a steadily increasing basis. In our Hospital, a OLT program was started in 1988. Coinciding with the one hundredth OLT, we have gathered, retrospectively the methods of nourishing these patients, as well as the possible connections existing between the nutritional support system and the time spent by these patients in the intensive care unit on one hand, and the mortality presented on the other hand. Parenteral nutrition (PN) was the initial nutritional support system most used by the patients in our unit. Those patients needing PN as the primary nutritional support system, presented significantly longer stays in the ICU and a tendency towards higher mortality than did those who required another type of nutrition as the primary nutritional support system. In 21% of the patients, the PN could, possibly, have been avoided. Oral nutrition (ON) was the next most frequent method of primary nutritional support, and the most frequent method as far as global nutrition, with enteral nutrition (EN) being used in very few cases.

Adolescent↗

PubMedDate not supplied

[The nutrition of liver transplant patients in an intensive medicine service comparing the years 1989 and 1992].

We examined the possible changes undergone in the form of feeding post liver-transplant patients admitted to our Intensive Care Unit (ICU), comparing 1989 and 1992. As biological nutritional parameters, we reviewed blood lymphocyte values and albumin prior to the transplant, immediately after, seven days following and on discharge from the ICU. In the two periods studied, we assessed the features of the nutritional support received by these patients (type and chronology). We found that, in 1992, parenteral nutrition (in significant form, p = 0.04) and oral diet (as trend, p = 0.06) was initiated earlier than in 1989. We noted a tendency to change the overall nutritional pattern, with an increase seen in 1992 in oral diet and a reduction in parenteral nutritional when compared to the 1989 period. In 1992, 24% of patients received oral diet as a first nutrition as against none in 1989. These data must be correlated with the time in the Intensive Medicine Service and the tendency to reduce mortality, even though transplant patients in 1992 were significantly older than in 1989, while their selection and the base pathology altered the pattern of these patients.

Adolescent↗