Complication Of Orthotopic Liver Transplantation Research Articles

Successful Treatment of Refractory Ascites after Liver Transplantation with Splenic Artery Embolization

Introduction: Refractory ascites after orthotopic liver transplantation is rare. While secondary precipitating causes can be identified in a sizable number, a small proportion of the patients with post-transplantation ascites have no identifiable cause. Splenic artery embolization has recently been reported as an effective method of treating refractory ascites in such cases. We present a case of successful treatment of refractory ascites after liver transplantation with partial splenic artery embolization. Case: A 52-year-old Caucasian male had received an orthotopic liver transplant in March, 2011 for hepatocellular carcinoma and chronic hepatitis C induced liver cirrhosis. The patient developed refractory ascites 2 months after transplantation requiring repetitive therapeutic paracenteses. Liver biopsy and echocardiography showed no evidence of rejection or recurrent hepatitis and congestive heart failure, respectively. Transjugular hepatic venogram and pressure evaluation showed a kink at the anastomosis of right hepatic vein and inferior vena cava which was successfully stented with resolution of pressure gradient post intervention. The patient continued to have refractory ascites despite these measures and underwent partial splenic artery embolization (SAE) to decrease the inflow of blood to the portal circulation. After SAE, the patient had significant reduction in ascites with decreased need for paracentesis, improved renal function and reduced diuretic requirement. Discussion: Refractory ascites (RA) is an uncommon complication of orthotopic liver transplantation which poses a serious challenge to the clinician. It is associated with increased risk of renal failure and peritoneal infections, increased hospital stay and shortened survival. In majority of patients with RA, treatment of secondary causes including right sided heart failure, acute or chronic graft rejection and hepatic inflow or outflow obstruction, leads to resolution of ascites. In the patients with no identifiable cause, treatment of ascites is challenging. Transjugular intrahepatic portosystemic shunting has shown mixed results as a treatment strategy. Splenic artery embolization leading to decreased splenic inflow and decreased portal hypertension has shown encouraging results in the recent years. Conclusion: Owing to its effectiveness in decreasing portal hypertension and low complication risk, splenic artery embolization appears to an attractive treatment option for the challenging problem of refractory ascites after liver transplantation.

Biliary Complications in Orthotopic Liver Transplantation Using Choledochocholedochostomy with a T-tube

Despite significant advances in orthotopic liver transplantation (OLT), biliary tract reconstruction is still a major source of complications. Choledochocholedochostomy with a T-tube used to be the standard procedure for biliary reconstruction after OLT. However, many centers currently avoid use of the T-tube because of the high incidence of complications. Our aim was to study the biliary complications occurring at our center when end-to-end choledochocholedochostomy (EE-CC) over a T-tube was used as the standard procedure for biliary reconstruction. A retrospective review was conducted of all patients who underwent liver transplantation from February 1, 1996, to April 30, 2010. Only patients requiring any therapy to treat biliary complications were considered, whereas those with concomitant hepatic artery complications were excluded. The study cohort consisted of 743 patients who had EE-CC with a T-tube.Of these, 73 patients (9.8%) experienced any biliary complication. Anastomotic strictures occurred in 17 patients (2.3%), and non-anastomotic strictures in 2 (0.3%). Fifteen patients with anastomotic strictures were successfully treated by dilatation and stenting. Bile leakage was diagnosed in 39 patients (5.2%). Leakage occurred at the anastomosis in 15 patients (2%), and at the exit site of the T-tube in 24 patients (3.2%). Tube opening was the only treatment used in 30 patients with bile leakage (76.9%). Seven patients experienced leaks after elective T-tube removal (1%). Overall, repeat surgery to manage biliary complications was needed in 9 patients (1.2%). The mortality rate from biliary complications was 0.13%. In conclusion, EE-CC with a T-tube was followed by a low incidence of biliary complications. The complication rate after elective T-tube removal and the repeat surgery rate were extremely low. These results might challenge the current trend to avoid T-tube stenting in OLT.

Is Duct to Duct biliary Anastomosis the Rule in Orthotopic Liver Transplantation?

Biliary complications after Liver Transplantation continue to be the major cause of morbidity in 11-25% of patients. Biliary complications in patients who underwent orthotopic liver transplantation (OLT) at our institute between March 2007 and June 2010 were analyzed retrospectively. 32 patients underwent Deceased Donor Liver Transplantation (DDLT) and in 12 patients Living Donor Liver Transplantation (LDLT) was done. No patients were lost to follow up. Follow up ranged between 4 and 44months. During the study period, 44 patients underwent orthotopic liver transplantation. Patients were divided into two groups: Biliary Complications group (BC) n = 5 and Non Biliary Complications group (NBC) n = 39. Biliary complications occurred in 15.9% of patients. Bile leaks accounted for majority of biliary complications. Fifteen variables were analyzed as possible risk factors for biliary complications. Of these, split grafts, duct to duct biliary anastomosis and total blood loss were statistically significant (P < 0.05) for biliary complications. Endoscopic treatment was successful in managing biliary complications in 75% of patients. Biliary complications are the most common major complications in orthotopic liver transplantation. Significant risk factors are split liver grafts and duct to duct biliary anastomosis. Increased blood loss is a predictor for post operative biliary complications. These complications should be managed by endoscopic interventions. Surgery is indicated following failure of endoscopic interventions.

TLR4 Overexpression After Orthotopic Liver Autotransplantation Contributes To Acute Lung Injury In Rats

Acute lung injury(ALI) is a common and severe complication of orthotopic liver transplantation(OLT), while the underlying mechanism of post‐OLT ALI is not very clear. Toll‐like receptor (TLR) 4 is an important TLR family member that plays a key role in the innate immune system. TLR4 is increased after OLT, accompanied with increased inflammatory response and ALI (Chin Med J, 2009,122:895–899). We hypothesized that TLR4‐mediated inflammation response may play a ctitical role in ALI during OLT. Healthy SD rats (n=8/group) were randomly divided into sham operated control group (C) and OLT groups with different durations (4, 8 and 16 hours) of reperfusion in the presence or absence of TLR4 siRNA interference performed 48 hours before OLT. Lung tissue TLR4 gene and protein expressions were significantly increased 8 hours after OLT and onwards, which was coincident with increased tissue levels of tumor necrosis factor (TNF) α, interleukin (IL)6 and IL‐1β, and evident lung pathological damage manifested as increased lung injury scores and increased lung water content and functional impairment manifested as reduced PaO2 (all P&lt;0.05 vs. OLT vs. C). TLR4 dominant negative siRNA prevented all the above changes after OLT. It is concluded that TLR4 overexpression, potentially by stimulting proinflammatory cytokine over production, plays a critical role in the developent of ALI after OLT.The study was supported by National Natural Science Foundation of China grant (No. 30801080 and 30972858).

Bortezomib Is Effective to Treat Acute Humoral Rejection After Liver Transplantation

IntroductionAcute humoral rejection (AHR), a rare complication in orthotopic liver transplantation (OLT), responds poorly to conventional therapies. Bortezomib, a proteasome inhibitor, has been shown to be effective in treating plasma cell–derived tumors and acute rejection episodes after renal transplantation. Herein, we have reported our clinical experience with bortezomib as a novel approach to treat AHR after OLT. MethodsWe retrospectively analyzed the 247 adult OLTs performed from January 2007 to April 2011. Patients with AHR who were treated with steroid pulses, rituximab (375 mg/m2), and plasmapheresis (PP) were assigned to group A. Group B subjects were prescribed steroid pulses, rituximab, PP, and bortezomib (1.3 mg/m2), after March 2009. ResultsAmong the 9 patients (3.6%) diagnosed with AHR, all subjects in group A (n = 3) died within several days after AHR, whereas 4/6 (66.7%) group B patients were rescued and 3 (50%) survived at a mean follow-up 22.3 months (range, 18–26). ConclusionProteasome inhibitor-based therapies provide a more effective strategy to treat AHR after OLT.

Preditores de injúria renal aguda em pacientes submetidos ao transplante ortotópico de fígado convencional sem desvio venovenoso

RADICAL: Injúria renal aguda é uma das complicações mais comuns do transplante ortotópico de fígado. A ausência de critério universal para sua definição nestas condições dificulta as comparações entre os estudos. A técnica convencional para o transplante consiste na excisão total da veia cava inferior retro-hepática durante a hepatectomia nativa. Controvérsias sobre o efeito da técnica convencional sem desvio venovenoso na função renal continuam. OBJETIVO: Estimar a incidência e os fatores de risco de injúria renal aguda entre os receptores de transplante ortotópico de fígado convencional sem desvio venovenoso. MÉTODOS: Foram avaliados 375 pacientes submetidos a transplante ortotópico de fígado. Foram analisadas as variáveis pré, intra e pós-operatórias em 153 pacientes submetidos a transplante ortotópico de fígado convencional sem desvio venovenoso. O critério para a injúria renal aguda foi valor da creatinina sérica &gt; 1,5 mg/dl ou débito urinário &lt; 500 ml/24h dentro dos primeiros três dias pós-transplante. Foi realizada análise univariada e multivariada por regressão logística. RESULTADOS: Todos os transplantes foram realizados com enxerto de doador falecido. Sessenta pacientes (39,2%) apresentaram injúria renal aguda. Idade, índice de massa corpórea, escore de Child-Turcotte-Pugh, ureia, hipertensão arterial sistêmica e creatinina sérica pré-operatória apresentaram maiores valores no grupo injúria renal aguda. Durante o período intraoperatório, o grupo injúria renal aguda apresentou mais síndrome de reperfusão, transfusão de concentrado de hemácias, plasma fresco e plaquetas. No pós-operatório, o tempo de permanência em ventilação mecânica e creatinina pós-operatória também foram variáveis, com diferenças significativas para o grupo injúria renal aguda. Após regressão logística, a síndrome de reperfusão, a classe C do Child-Turcotte-Pugh e a creatinina sérica pós-operatória apresentaram diferenças. CONCLUSÃO: Injúria renal aguda após transplante ortotópico de fígado convencional sem desvio venovenoso é uma desordem comum, mas apresenta bom prognóstico. Síndrome de reperfusão, creatinina sérica no pós-operatório e Child C são fatores associados a injúria renal aguda pós-transplante ortotópico de fígado convencional sem desvio venovenoso.

Imaging of Orthotopic Liver Transplantation: Review

Received September 23, 2010; accepted without revision September 23, 2010. 1Department of Radiology, University of Washington, VA Puget Sound Health Care System, 1660 S Columbian Way, S-114/Radiology, Mail Stop 358280, Seattle, WA 98108. Address correspondence to P. Bhargava (bhargp@u.washington.edu). 2Department of Radiology, University of Washington, Seattle, WA. 3Department of Surgery, University of Washington, Seattle, WA. AJR 2011;196:WS15–WS25 0361–803X/11/1963–S1 © American Roentgen Ray Society Objective Orthotopic liver transplantation is an established treatment for patients with end-stage liver disease or acute liver failure. Complications of liver transplantation include vascular thrombosis and stenosis; arterial pseudoaneurysm; biliary leak, stricture, and obstruction; liver ischemia, infarction, and abscess; recurrent disease; posttransplantation lymphoproliferative disease (PTLD); recurrent tumors; peritransplant fluid collections and hematomas; and splenic infarction. The incidence of graft rejection and other complications experienced in the early years after the surgery has been reduced significantly because of advances in immunosuppression and surgical techniques. The clinical presentation of these complications is often nonspecific, and early detection of these complications on imaging is necessary for appropriate management. Living related liver transplantations are performed commonly, especially in children. Orthotopic liver transplantation is distinct from living related liver transplantation with regard to surgical technique, postoperative anatomy, and some complications. This article reviews the imaging appearances of different surgical techniques as well as the early and late complications of orthotopic liver transplantation.

Imaging of Orthotopic Liver Transplantation: Self-Assessment Module

The educational objectives for this self-assessment module are for the participant to exercise, self-assess, and improve his or her understanding of imaging of orthotopic liver transplant recipients and to improve familiarity with the complications of orthotopic liver transplantation.

Microbiological analysis of bile during cholangiography

The role of microbiological analysis of bile from patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) is unclear. Although the majority of such patients have positive cultures, only a few develop postprocedural bacteremia or fever. Microbiological bile analysis might, however, have a role in patients with complications of orthotopic liver transplantation and those in whom adequate biliary drainage has not been achieved.

Strong Impact of Acute Kidney Injury on Survival After Liver Transplantation

Acute kidney injury (AKI) is a major complication in orthotopic liver transplantation (OLT). In an evaluation of Acute Kidney Injury Network (AKIN) criteria in liver transplanted patients, we retrospectively analyzed the usefulness of these criteria to predict survival of 193 consecutive patients at a single center who underwent primary OLT for clinical parameters and peak AKI. Postoperative AKI according to AKIN occurred in 60.1% of the patients, namely, stages 1, 2, and 3 in 30%, 13% and 17.1% respectively. Using multivariate logistic regression, AKIN stage 1 and 2 AKI were independently associated with the pre-OLT Model for End-Stage Liver Disease (MELD) score and age, while stage 3 AKI was independently associated with MELD and Acute Physiology and Chronic Health Evaluation (APACHE) II scores. The 28-day and 1-year mortality post-OLT of AKI patients were 15.5% and 25.9% respectively compared with 0% and 3.9% among non-AKI patients ( P < .05 for both). The survival rates of non-AKI and stages 1, 2, and 3 AKI subjects were 96%, 85.5%, 84%, and 45.3%, respectively. Cox regression analysis showed independent risk factors for mortality during the first year after transplantation to include post-OLT AKI (12.1; P < .05), post-OLT infection (HR 4.7; P < .01), pre-OLT hypertension (HR 4.4; P < .01) hazard ratio [HR] and post-OLT APACHE II ≥10 (HR 3.6; P < .05). We concluded that AKI as defined by the AKIN criteria is a major complication of OLT linked to a poor outcomes. It remains to be evaluated whether aggressive perioperative therapy to prevent AKI can improve survival among OLT patients.

Vascular Complications After Orthotopic Liver Transplantation: Hepatic Artery Thrombosis

Introduction Hepatic artery thrombosis (HAT) is the second main cause of liver graft failure after primary nonfunction. It is the most frequent arterial complication in orthotopic liver transplantation (OLT). The consensus for early HAT definition consists of an arterial thrombosis detected during the first month after OLT. HAT is associated with markedly increased morbidity, being the leading cause of graft loss (53%) and mortality. However, improvements in postoperative care have resulted in a marked reduction of its incidence. Methods We performed a review of all patients who underwent liver transplantations from January 1991 to December 2009, involving 1560 subjects who underwent 1674 OLT, excluding children. To analyze the impact of the study period on HAT, we defined 3 periods: the first between January 1991 and April 1993, the second from May 1993 to December 2003, and the last from January 2004 to December 2009. Results The total number of patients with HAT was 48 (2.8%) including 32 (1.9%) early HAT and 16 (0.9%) late HAT. The incidence of HAT diminished as the surgical team gained experience from 9.3% in the first period to 2.1% in the last. Most patients with early HAT presented acute fulminant hepatic failure (30%) and most were retransplantations (81%). Discussion In general, there are 3 modalities for HAT: revascularization, retransplantation, and observation. The choice of the treatment depended on the time of diagnosis although retransplantation was the treatment of choice for most groups. Minimizing risk factors, protocols for early detection, and good operative techniques should be the standard in all centers.

Role of magnetic resonance cholangiography in biliary complications of orthotopic liver transplantation

The aim of this study was to evaluate the role of magnetic resonance cholangiography (MRC) in the detection of biliary complications following orthotopic liver transplantation (OLT). Seventy-eight transplant patients with clinically suspected biliary complications were evaluated with 1.5-T magnetic resonance imaging (MRI) using a surface coil. All patients were imaged with the following sequences: axial T1-weighted and axial and coronal T2-weighted, 2D spin echo (SE) breath-hold radial cholangiography, and coronal 3D single-shot turbo spin echo (SS-TSE) with respiratory triggering. Patients with negative MRI underwent clinical and sonographic followup. When biliary complications were present, diagnostic confirmation was obtained by endoscopic retrograde cholangiopancreatography (ERCP) (n=13), percutaneous transhepatic cholangiography (PTC) (n=20), ultrasonography (n=10) or computed tomography (CT) (n=2). In 11 cases, surgical confirmation was also obtained. MRC detected biliary complications in 44/78 patients, in particular, 42 biliary strictures (37 anastomotic and five intrahepatic), 40 of which were confirmed by other imaging modalities. In 25/37 cases of anastomotic stricture, preanastomotic dilatation of the biliary tract was also demonstrated. Other MRC-detected biliary complications were biliary sludge (n=4), biloma (n=5), and biliary stones (n=3). In four cases, PTC revealed biliary complications that had not been detected with MRC (false negative results). In two cases, MRC showed unconfirmed strictures of the intrahepatic ducts and biliodigestive anastomosis (false positive results). The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and diagnostic accuracy of MRC were 93.5%, 94.4%, 96.7%, 89.5% and 93.9%, respectively. Our results confirm that MRC is a reliable technique for depicting biliary anastomoses and detecting biliary complications after OLT. The high diagnostic accuracy of MRC indicates that this examination should be routinely employed in all OLT patients with clinically suspected biliary complications.

RIFLE criteria for acute kidney dysfunction following liver transplantation: incidence and risk factors

Acute renal dysfunction (ARD) is one of the most common complications of orthotopic liver transplantation (OLT), with an incidence ranging from 12 to 64% [1,2]. These patients are often critically ill in the perioperative period with a number of other co-morbidities, resulting in an increased susceptibility to ARD. The RIFLE criteria were developed to provide a consensus definition for acute renal dysfunction in critically ill patients. Using the RIFLE criteria, we aimed to determine the incidence and risk factors for acute renal dysfunction in the early postoperative period.

Brain abscess due to Klebsiella pneumoniae in a liver‐transplanted child

Brain abscesses are a rare, severe complication of orthotopic liver transplantation (OLT). They are almost exclusively due to fungi, Nocardia, or Toxoplasma, and usually occur within months of surgery. Here we report the case of an adolescent who developed a brain abscess due to Klebsiella pneumoniae 11.5 years after OLT. Fever was absent and laboratory parameters were not indicative of infectious disease, and therefore the diagnosis of a central nervous system neoplasm was considered. Subsequent magnetic resonance imaging and spectroscopy led to a diagnosis of a brain abscess, and to prompt appropriate antibiotic treatment. This case shows that K. pneumoniae may cause a brain abscess long after liver transplantation. The appearance of neurological symptoms should alert clinicians to consider a brain abscess even in the absence of overt clinical/laboratory signs of inflammation, which may be blunted by chronic immunosuppression.

Vascular Complications of Orthotopic Liver Transplantation: Experience in More than 4,200 Patients

Thromboses of the hepatic artery (HAT) and portal vein (PVT) may complicate orthotopic liver transplantation (OLT) and result in graft loss and mortality. Revision and retransplantation are treatment options, but their longterm outcomes remain undefined. This study was undertaken to evaluate the incidence of major vascular complications after OLT, determine efficacy of therapies, and identify factors influencing longterm outcomes. All patients undergoing OLT from 1984 to 2007 were evaluated. Kaplan-Meier analysis was performed to define the effects of vascular complications on posttransplant survival. Anastomotic revision and arterial thrombolysis were compared with retransplantation as treatment for HAT. After 2002, porta hepatis dissection was initiated with early occlusion of common hepatic artery (CHA) inflow; its impact on HAT incidence was determined. From 1984 to 2007, 4,234 OLTs were performed. HAT occurred in 203 patients (5%) and PVT in 84 (2%). Graft survival was significantly reduced by HAT or PVT; patient survival was reduced only by PVT. Retransplantation for HAT improved patient survival over revision or thrombolysis in the first year but did not provide longterm survival advantage (56% versus 56% at 5 years; p=0.53). Patients with HAT had only 10% graft salvage with anastomotic revision or thrombolysis. HAT was significantly reduced with early CHA inflow occlusion (1.1% versus 3.7%; p=0.002). Factors increasing risk of HAT included pediatric recipients, liver cancer, and aberrant arterial anatomy requiring complex reconstruction. Both HAT and PVT significantly reduce graft survival after OLT; PVT more adversely affects patient survival. Revision and thrombolysis rarely salvage grafts after HAT; retransplantation provides superior short-term, but not longterm, survival. Avoidance of vascular complications in OLT is critical, especially with today's scarcity of donor livers. Early atraumatic CHA occlusion significantly reduces the incidence of HAT.

Salbutamol to facilitate management of acute hyperkalemia in liver transplantation: a case report

Acute hyperkalemia is a frequent, potentially life-threatening complication in orthotopic liver transplantation (OLT). We describe a case of acute hyperkalemia during the pre-anhepatic stage that remained persistent despite conventional treatment, including calcium salts, insulin and glucose, sodium bicarbonate, and furosemide. A 50-yr-old man with end-stage hepatitis B liver cirrhosis underwent living donor liver transplantation, receiving a right lobe graft donated by his son. The initial serum potassium concentration was 4.6 mEq l(-1). Despite conventional management, the serum potassium concentration increased to 6.6 mEq l(-1), intraoperatively. Since about 90 min elapsed from the division of the hepatic artery and the portal vein to the clamping of the suprahepatic inferior vena cava, the persistent hyperkalemia may have resulted from loss of potassium from ischemic liver cells into the systemic circulation. After incorporating nebulized salbutamol, a selective beta(2)-agonist, into the combined therapeutic regimen (sodium bicarbonate and insulin with glucose), the serum potassium concentrations rapidly normalized. This case suggests that acute and relatively refractory hyperkalemia can develop when surgical interruption of hepatic inflow is prolonged during hepatectomy in patients undergoing OLT using the piggyback technique. In such situations, incorporating nebulized salbutamol with a conventional anti-hyperkalemia strategy can provide an effective therapeutic option to treat hyperkalemia, even during the anhepatic stage.

Successful Diagnosis and Management of Biliary Cast Syndrome in a Liver Transplant Patient Using Single Operator Cholangioscopy

Purpose: Biliary cast syndrome is an unusual complication of orthotopic liver transplantation (OLT) with serious clinical implications. Biliary cast formation is usually associated with biliary strictures and/or hepatic ischemia. Surgical management is the mainstay of treatment. Endoscopic techniques have been recently described in the successful removal of biliary casts. We report a post OLT patient who underwent successful endoscopic removal of biliary cast using single operator cholangioscopy. Our patient is a 68 year-old male with history of OLT seven months before for hepatitis C induced cirrhosis who came for a follow up visit. He had no complaints and physical exam was normal. He had cholestatic liver enzyme elevation (Alkaline phosphatase 580 IU/L, Total bilirubin 2.3 mg/dl) with normal aminotransferases. Hepatitis C RNA was undetectable. Ultrasound demonstrated normal common bile duct (CBD) diameter with normal Doppler flow. Liver biopsy showed no rejection with suggestion of cholestasis. Endoscopic retrograde cholangiopancreatoscopy (ERCP) was performed and cholangiogram showed multiple linear filling defects in the common hepatic duct (CHD) proximal to the anastomosis with extension into the intrahepatic system. After failure of the balloon to remove the filling defect, a single-operator choledochoscope was passed into the CHD for diagnostic and possible therapeutic purposes. A dark brown tubular structure was seen resembling a cast of the bile duct. Using a basket, the distal aspect of the cast was secured and a 6 cm long cast was successfully removed in a single piece. (Image) Cholangiogram showed improvement with excellent biliary drainage both fluoroscopically and endoscopically. Liver function tests have subsequently normalized and the patient remains normal with a follow period of 10 months without recurrence. In conclusion, Biliary cast syndrome is a rare complication of OLT which should be thought of when patients present with cholestatic liver enzyme elevation usually within the first year of transplant. Single operator cholangioscopy provides a safe means of diagnosing and treating patients with Biliary cast syndrome particularly in cases with intrahepatic duct casts where surgery or percutaneous techniques are often required. Methods: N/A Results: N/A Conclusion: N/A

Management of Recurrent Thrombosis in Liver Transplant Recipients: A Case Report

Intra-abdominal thrombotic complications in orthotopic liver transplantation can cause devastating results. The management of these patients after thrombosis remains a difficult clinical problem. We present a case report of a patient who developed recurrent venous, thrombosis after liver transplantation performed because of cirrhosis due to autoimmune hepatitis. She had bleeding episodes during and early after the transplantation procedure and developed portal vein thrombosis after a single dose of recombinant factor VII, which was given for treatment of hemorrhage. She had her second thrombotic attack while she was on warfarin therapy which was initiated after the first bout. No hereditary or immunologic risk factors were found. Management of these patients can be difficult because of the liver’s effect on the coagulation profile.

Neurological complications after orthotopic liver transplantation

Background The number of orthotopic liver transplantation performed each year is increasing due to increased safety and logistic facilities. Therefore, the importance of reducing adverse events is progressively growing. Aim To review present knowledge on the neurological complications of orthotopic liver transplantation. Methods The epidemiology, the clinical features and the pathophysiology of the neurological complications of orthotopic liver transplants, resulting from a systematic review of the literature in the last 25 years, are summarized. Results and conclusions The review highlights that a relevant variety of neurological adverse events can occur in patients undergoing orthotopic liver transplantation. The knowledge of neurological complications of orthotopic liver transplantation is important for transplantation teams to reduce their prevalence and improve their management. In addition, the likelihood of neurological adverse effects provides evidence for the need of a careful cognitive and neurological work up of patients in the orthotopic liver transplantation waiting list, in order to recognize and interpret neurological dysfunction occurring after orthotopic liver transplantation.

Impact of early biliary complications in liver transplantation in the presence or absence of a T-tube: a Chinese transplant centre experience

Background: Biliary complications continue to be an important determinant of the recipient’s survival rate after orthotopic liver transplantation (OLT). The objective of this study was to evaluate the incidence of...