Early Diagnosis Of Postoperative Complications Research Articles

An Integrated Approach Based on Clinical Data Combined with Metabolites and Biomarkers for the Assessment of Post-Operative Complications after Cardiac Surgery.

Background: Early diagnosis of post-operative complications is an urgent task, allowing timely prescribing of appropriate therapy and reducing the cost of patient treatment. The purpose of this study was to determine whether an integrated approach based on clinical data, along with metabolites and biomarkers, had greater predictive value than the models built on fewer data in the early diagnosis of post-operative complications after cardiac surgery. Methods: The study included patients (n = 62) admitted for planned cardiac surgery (coronary artery bypass grafting with cardiopulmonary bypass) with (n = 26) or without (n = 36) post-operative complications. Clinical and laboratory data on the first day after surgery were analyzed. Additionally, patients' blood samples were collected before and on the first day after surgery to determine biomarkers and metabolites. Results: Multivariate PLS-DA models, predicting the presence or absence of post-operative complications, were built using clinical data, concentrations of metabolites and biomarkers, and the entire data set (ROC-AUC = 0.80, 0.71, and 0.85, respectively). For comparison, we built univariate models using the EuroScore2 and SOFA scales, concentrations of lactate, the dynamic changes of 4-hydroxyphenyllactic acid, and the sum of three sepsis-associated metabolites (ROC-AUC = 0.54, 0.79, 0.62, 0.58, and 0.70, respectively). Conclusions: The proposed complex model using the entire dataset had the best characteristics, which confirms the expediency of searching for new predictive models based on a variety of factors.

A Study on Early Surgical Complications in Renal Transplant Recipients

Introduction: Renal transplantation is one of the most effective treatment measures in patients with end-stage renal disease to improve their quality of life. However, postoperative surgical complications can be seen in 15% to 17% of cases, with significant morbidity in earlier periods. This study aims to study the incidence, presentation, and management of various surgical complications within 2 months of renal transplantation. Materials and Methods: This retrospective descriptive study included data from hospital records of 236 recipients who underwent renal transplantation from 2015 to 2022 at our institute. In addition, salient characteristics of the donors were also noted. Recipients whose hospital records were not available were excluded from the study. Surgery-related complications within 2 months of renal transplantation in recipients and their management were studied. Results: Of 236 cases of renal transplantation, 182 cases were live-related renal transplantation recipients, and 54 were deceased donor renal transplantation recipients. Surgical complications such as posttransplant urine leak in three patients, lymphocele in two patients, graft renal vein thrombosis in three patients, and anastomotic site pseudoaneurysm in one patient occurred. The overall incidence of early surgical complications in our study is 3.81%. The study reports the successful management of all these nine patients with necessary intervention. Conclusion: The early diagnosis of postoperative complications is essential for reducing mortality and preserving graft function.

Cohort profile of PLUTO: a perioperative biobank focusing on prediction and early diagnosis of postoperative complications

PurposeAlthough elective surgery is generally safe, some procedures remain associated with an increased risk of complications. Improved preoperative risk stratification and earlier recognition of these complications may ameliorate postoperative recovery...

Serum procalcitonin improves diagnosis of infectious complications after CRS/HIPEC

BackgroundCytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) improve the survival of selected patients with peritoneal metastasis. A major cause of treatment-related morbidity after CRS/HIPEC is infection and sepsis. HIPEC alters the diagnostic sensitivity and specificity of blood and serum markers and therefore has an impact on early diagnosis of postoperative complications. This study aimed to assess the sensitivity and specificity of blood and serum markers after CRS/HIPEC.MethodsPatients from two centers, operated between 2009 and 2017, were enrolled in this study. Perioperative blood samples were analyzed for white blood cells (WBC), C-reactive protein (CRP), and procalcitonin (PCT); postoperative complications were graded according to Clavien-Dindo and infectious complications according to CDC criteria.ResultsOverall, n=248 patients were included with peritoneal metastasis from different primary tumors treated by CRS/HIPEC. Depending on the applied HIPEC protocol, patients presented a suppressed WBC response to infection. In addition, a secondary and unspecific CRP elevation in absence of an underlining infection, and pronounced after prolonged perfusion for more than 60 min. PCT was identified as a highly specific — although less sensitive — marker to diagnose infectious complications after CRS/HIPEC.Discussion/conclusionSensitivity and specificity of WBC counts and CRP values to diagnose postoperative infection are limited in the context of HIPEC. PCT is helpful to specify suspected infection. Overall, diagnosis of postoperative complications remains a clinical diagnosis, requiring surgical expertise and experience.

Early diagnosis of postoperative intraperitoneal purulent complications in peritonitis in children

Early diagnosis of postoperative complications leads to timely surgical interventions, on which the outcome of the disease depends. This also applies to postoperative intra-abdominal complications, especially in childhood, when the progression of peritonitis is fleeting, and many defense mechanisms are immature and depressed. Timely evacuation of pus from the abdominal cavity leads to a decrease in endotoxicosis, the main component in the pathogenesis of the toxic-septic process, and to a significant improvement in the results of treatment of the disease.

Prediction and early diagnosis of post hepatectomy complications

Introduction: The role of perioperative clinical and laboratory characteristics in the prevention and early diagnosis of postoperative complications (POC) after hepatectomy has not been established despite their potential usefulness. The aim of this study was to assess some clinical and analytic variables for the prevention and early diagnosis of POC after hepatectomy. Methods: Perioperative demographic, clinical, tumor related and laboratory characteristics of 194 consecutive patients who underwent liver resection between January 2017 and July 2020 were analysed. Laboratory values included preoperative and early postoperative neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and c-reactive protein (CRP). The relationship between perioperative clinical variable, NLR, LMR, CRP and POC was evaluated using univariable and multivariable logistic regression analyses. Receiver-operating characteristic (ROC) curve was used to measure the accuracy of postoperative CRP in diagnosing complications, and Youden index was used to find the most accurate cutoff value. Results: Elevated day-3 postoperative CRP (HR: 3.4; IQR: 1.9-6.4; p=0,01); elevated day-3 postoperative NLR (HR: 1.1, IQR 1-1.2, p=0,023) and day-3 abdominal pain (HR 3.6; IQR 1.8-7; p=0.001) were independent risk factors predicting POC. Area under the curve for postoperative day-3 CRP values as a predictor of POC was 0,658 (p<0,001) and 117mgr/L was the optimal cutoff with a sensitivity and specificity of 60% and 70% respectively. Conclusion: Elevated day-3 postoperative NLR, CRP and abdominal pain are useful for early diagnosis of complications in patients undergoing liver resection. Their use should be considered especially in the implementation of enhanced recovery program to minimize the risk of hospital readmission.

Are the C-reactive protein/albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (NLR) novel inflammatory biomarkers in the early diagnosis of postoperative complications after laparoscopic sleeve gastrectomy?

PurposeC-reactive protein/albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are new generation inflammatory markers that have been investigated for use in determining disease prognosis or postoperative morbidity and mortality after many open surgeries. The aim of this study is to investigate the efficacy of CAR, NLR, and PLR on the early detection of postoperative complications (POC) after laparoscopic sleeve gastrectomy (LSG). Material-methodThe study included 448 patients, 16–65 years of age, who underwent LSG between 2015 and 2019. C-reactive protein (CRP) and albumin levels were measured on postoperative day 1 and 3 and CAR values were obtained. NLR and PLR values were evaluated preoperatively and on postoperative day 1 and 3. Statistical analyses were performed using the SPSS version 21.0 and MedCalc. ResultsA total of 326 patients with a mean age of 37 ± 11 years were analyzed. Both CAR1 and CAR3 values were correlated with the development of complications (r = 0.3, r = 0.3, respectively p < 0.001). Pre-op NLR value was found to be a significant risk factor on complication development (OR = 1.943, p = 0.043). The cut-off value for CAR1 and CAR3 were found as 0.78 and 1.25 mg/dL in ROC analysis (AUC = 0.808, AUC = 0.832, respectively). PLR3 value was diagnostic among other PLR values in the determination of POC (AUC = 0.703 Youden index = 0.36 p = 0.014). ConclusionThe most significant diagnostic value for the determination of POC was CAR3. It was followed by CAR1, CRP3, CRP1, and PLR3 values. Only preoperative NLR was found as a risk factor for the development of POC.

Does C-reactive Protein Have a Predictive Role in the Early Diagnosis of Postoperative Complications After Bariatric Surgery? Systematic Review and Bayesian Meta-analysis.

Postoperative leak and intra-abdominal infections are common after bariatric surgery with a significant impact on perioperative outcomes, hospital length of stay, and readmission rates. In the era of enhanced recovery programs, with patients being discharged from the hospital 24-36h after surgery and potentially before developing any complications, an early indicator of postoperative complications may be decisive. The aim of this study was to evaluate the predictive role of the C-reactive protein (CRP) in the early diagnosis of complications in patients undergoing laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). PubMed, Embase, and Web of Science databases were consulted. A systematic review and a fully Bayesian meta-analysis were conducted. Seven studies met the inclusion criteria for a total of 1401 patients. Overall, 57.7% underwent LSG while 42.3% underwent LRYGB. The pooled prevalence of postoperative complications was 9.8% (95% CI = 5-16%). The estimated pooled CRP cut-off value on postoperative day 1 (POD1) was 6.1mg/dl with a significant diagnostic accuracy and a pooled area under the curve of 0.92 (95% credible interval (CrI) 0.73-0.98). The positive and negative likelihood ratios were 13.6 (95% CrI 8.40-15.9) and 0.16 (95% CrI 0.04-0.31), respectively. A CRP value lower than the derived cut-off of 6.1mg/dl on POD1, combined with reassuring clinical signs, could be useful to rule out early postoperative leak and complications after LSG and LRYGB. In the context of enhanced recovery after surgery protocols, the integration of a CRP-based diagnostic algorithm as an additional complementary instrument may be valuable to reduce cost and improve outcomes and patient care.

Bile leak syndrome after laparoscopic cholecystectomy

Aim of the study was the assasement of surgical treatment results of patients with cholelithiasis, who had external or internal bile leakage (BL), for the optimization and improvement of diagnostic programme and surgical tactic of minimally invasive techniques usage. Materials and methods. Results of surgical treatment during the early postoperative period of patients with cholelithiasis, who underwent laparoscopic cholecystectomy (LC) were analysed. Results. In early post-operative period 67 (0,6%) patients, mean aged 56,9 ± 7,4 had BL. 54 (81,0%) of them were women, 13 (19,0%) were men. 21 (31,3%) patients underwent LC due to chronic cholecystitis, 46 (68,7%) patients had acute cholecystitis. In 54 (81,0%) cases there was drainage bile leakage, in 13 (19,0%) cases bile collection in abdominal cavity was identified several days after drains ejection, due to clinical manifestation and ultrasonography data. 23 (34,3%) patients were treated conservatively. Minimally invasive endoscopic manipulations, ultrasonography controlled percutaneous drainage and relaparotomy were effective in 35 (52,2%) patients, 9 (13,4%) patients underwent laparotomy with following surgical correction of BL. These patients had dense perivesical infiltrates, Mirizzi’s syndrome type I. 6 (9,0%) patients underwent laparotomy, abdominal cavity sanation and drainage. In 1 (1,5%) case partial right bile duct injury was identified, defect suturing and Vishnevsky common bile duct drainage. In 2 (3,0%) cases the cause of BL was more than 2/3 diameter injury of common bile duct. These patients underwent Roux-en-Y hepaticojejunostomy. Conclusion. Installation of drainage into the hepatic space and the right flank provide early diagnosis of postoperative complications, one of which is bile flow syndrome. Ultrasound examination of abdominal organs and endoscopic retrograde cholangiopancretography are performed to determine the cause and localization of the syndrome of the BL syndrome, depending on the volume of the BL. Repeated laparoscopy is indicated for the phenomena of bile peritonitis, significant accumulation of bile in the abdominal cavity. The complex usage of relaparoscopy, transduodenal endoscopic interventions and puncture techniques can significantly reduce the number of laparotomy operations to correct complications.

The standardisation of minimally invasive methods approaches in treatment of post-laparoscopic cholecystectomy bile leakage

The paper analyses the results of surgical treatment of 10243 patients with cholelithiasis who underwent laparoscopic cholecystectomy. In the early postoperative period 60 patients (0.59%) had bile leakage. Developed surgical technique based on ultrasound data and endoscopic retrograde cholangiopancreatography can improve the results of treatment and avoid septic complications and lethal outcomes. Conservative treatment, minimally invasive endoscopic techniques, ultrasound guided puncture methods and relaparoscopy were effective in 52 patients (86,7%). Postoperative bile leakage is currently one of the most frequent complications of LCE, routine drainage of the subhepatic space facilitates early diagnosis of postoperative complications. When choleo-excretion is more than 200 ml per day, endoscopic retrograde cholangiography is necessary to diagnose damage to the main bile ducts, while confirming the injury of the hepaticocholedochus, a reconstructive surgery with laparotomy is indicated. Drainage bile bleeding, accompanied by symptoms of biliary peritonitis or a significant accumulation of bile in the abdominal cavity in the absence of an injury to the hepaticocholedochus, requires a relaparoscopy for diagnostic and therapeutic purposes. Standardization of the complex application of relaparoscopy, transduodenal endoscopic interventions and puncture techniques can significantly reduce the number of laparotomic operations to correct the complications that have arisen.

Radiological contribution to the diagnosis of early postoperative complications after lung resection for primary tumor: a revisional study.

In the post-operative course of the interventions of lung resection for primary tumor, complications of different nature and severity can arise, recognizing different pathogenetic mechanisms and differing according to the type of resection performed and to the time elapsed after surgery. The low diagnostic accuracy of chest radiography requires a thorough knowledge of the radiologist about all radiographic findings, both normal and pathological, which can be found in the immediate post-operative period (within 30 days after surgery). This article aims to describe the incidence, the clinical features and the radiological aspects of immediate complications following pulmonary resections, with specific reference to those in which the diagnostic imaging provides a fundamental contribution.

Prospective evaluation of routine early computed tomography scanner in laparoscopic sleeve gastrectomy

BackgroundPrompt management of laparoscopic sleeve gastrectomy (LSG) complications is essential in avoiding prolonged hospital stay and associated mortality. The value of routine computed tomography (CT) scan examination in early diagnosis of postoperative complications after LSG has not been studied. ObjectivesTo prospectively assess the impact of postoperative day (POD) 2 CT scan after LSG. SettingDepartment of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-HP, Paris-Saclay University, France. MethodsData were prospectively gathered for 1000 patients undergoing single-incision LSG and POD 2 CT scan. Complications were identified and treatment modalities decided according to the severity of complications. Sensitivity, specificity, and positive and negative predictive values were calculated for the diagnosis of surgical complications on POD 2 CT scan. ResultsMean age was 40.1 years and median BMI 42.6 kg/m². Early postoperative surgical complications occurred in 66 patients (6.6%). Intraabdominal bleeding/hematoma occurred in 38 patients, with 3 requiring emergent reoperation on POD 1. POD 2 CT scan detected this complication in 32 patients (sensitivity: 91.4%). Twenty-four (63.1%) patients were treated with relaparoscopy and drainage while 14 (36.9%) received conservative management. Postoperative transfusion was required in 7 patients. Twenty-eight patients suffered a gastric staple line leak, 13 (sensitivity: 46.4%) detected on POD 2 CT scan. Three patients (10.7%) received pure surgical treatment, 16 (57.1%) combined relaparoscopy and endoscopic treatment, and 9 (32.2%) had pure endoscopic treatment. ConclusionPOD 2 abdominal CT scan is an efficient diagnostic tool for detecting active bleeding/hematoma, but shows less impressive results with gastric staple line leak detection. A combination of clinical surveillance and early imaging allowed prompt management of complicated cases, avoiding further morbidity.

C-reactive protein is a predictor of complications after elective laparoscopic colorectal surgery: five-year experience.

IntroductionWith the development and improvement of laparoscopic surgery, procedures have become common. However, post-operative complications occur when patients are released from hospital. These complications increase patients’ morbidity and mortality. They also lead to re-hospitalization, an extended recovery period, and an increase in the cost of treatment.AimTo evaluate and determine the prognostic properties of C-reactive protein in the early diagnosis of postoperative complications after a laparoscopic colon resection.Material and methodsThe prospective study included patients who underwent laparoscopic colorectal surgery in 2010–2014. The patients were divided into two groups – uncomplicated ones and those with complications. C-reactive protein concentrations in their blood serum were measured on the 2nd, 4th and 6th day after surgery. Logistic regression analysis was used to evaluate the relation between C-reactive protein values measured on the 2nd, 4th and 6th postoperative day and related complications. Receiver operating characteristic curves were used to determine the sensitivity and specificity of each C-reactive protein value measured on the 2nd, 4th and 6th postoperative day.ResultsOne hundred and six patients were included in the trial; 14 of them had complications. On the second day, a C-reactive protein cut-off value of 88.6 mmol/l provided the highest sensitivity and specificity for predicting evolving complications, being 71.4% and 84.8% respectively (p = 0.003). The significant predictive cut-off value decreases and becomes more sensitive and specific each post-operative day.ConclusionsIt is possible to detect developing post-operative complications early on by monitoring C-reactive protein concentration levels in the blood serum on the 2nd, 4th, and 6th post-operative days.

Usefulness of Serum C-Reactive Protein Level for Predicting Flap Complication After Performing Free Microvascular Head and Neck Reconstruction

Free microvascular head and neck reconstruction requires minimal complication and safety. However, clinical observation of the wound in head and neck area is very difficult because of its narrow and inaccessible anatomy. Serum C-reactive protein (CRP) level is commonly used as a marker of acute inflammatory response and quantitative test that shows predictable kinetics. Therefore, awareness of natural CRP trend of free microvascular head and neck reconstruction may help in the early diagnosis of postoperative complications. The goal of this study is to describe the time course of serum CRP level and prove the usefulness of CRP as a predictor of postoperative flap wound complication after performing free microvascular reconstruction in head and neck area. Between June 2009 and November 2012, we retrospectively analyzed the data of 25 patients who received free microvascular tissue transfer for head and neck reconstruction at Ajou University Hospital. The characteristics of patients and surgical information were analyzed. From the first day after surgery, CRP levels were daily measured for 2 weeks. The average CRP values were daily calculated for the normal group and the complicated group and compared between each groups. The amount of time taken to reach the peak CRP level and to reach half of the peak was compared. A total of 25 patients were included in this study. The amount of time taken to reach the peak of the CRP level is significantly less in the normal group (2.9 d) than the complicated group (7 d) (P < 0.001). Furthermore, the amount of time to reach half of the peak was significantly different between groups (7.2 d vs. 10.1 d, respectively, P < 0.05). In the normal group (17/25), there were 14 cases which reached peak CRP level before postoperative day 4. However, in the complicated group (8/25), there was only 1 case which reached peak CRP level before postoperative day 4 (P < 0.05). The complication rate is 32.7 times higher when CRP value reaches peak on or after postoperative day 4 (95% confidence interval, 30.26-35.14; P = 0.002). Patients in the complicated group showed significantly elevated CRP levels compared to those in the normal group at day 6 to 9 and day 12 to 13 (P < 0.05). In head and neck reconstructions, the high probability of flap wound complications are indicated through the result of having highest CRP values on or after postoperative day 4, slow normalization of plasma CRP level, and secondary rise in serial CRP values.

Video recording the Laparoscopic Surgery for the Treatment of Endometriosis should be Systematic!

Surgery is one of the cornerstones of the treatment of women with endometriosis. Video recording the surgical procedure is extremely important since it can help in the postoperative management of the patient, either with regard to the issue of infertility or pain. Moreover, it can help in the early diagnosis of postoperative complications, in the quality control of services that address deep endometriosis and in the education of new surgeons. This paper discusses the importance of systematic recording of laparoscopic procedures in women with endometriosis.

C-reactive protein and procalcitonin in early diagnosis of postoperative complications after colon surgery-is there a difference?

s and Programme: EUROANAESTHESIA 2011: The European Anaesthesiology Congress: Intensive Care Medicine

62 Early Diagnosis of Postoperative Complications After Liver Transplants in Children

Introduction: The UMCG is the only medical centre in the Netherlands that has performed liver transplants on children since 1982. In the last few years a lot has improved in the treatment thereof. At this current moment approximately 15 children are being transplanted each year. The survival rate has improved by 50%. During these admissions pitfalls may occur that can lead to postoperative complications! Aim: To give insight on the means used to recognize post operative complications in early stages in children after liver transplants. Methods: Protocols have been developed in which post operative parameters concerning monitoring, blood results and radiology imaging have been described. Nurse observation and interpretation parameters are of further essential significance. These are mainly directed towards prevention of infections, timely detubation, and keeping up with the fluid balance and temperature of the patient. Adjacent to that, the in research phase TEG-study, offers important information about the coagulation. Results: Working according to protocol makes it possible to perceive and intercept complications in early stages. Moreover we aim at thrombosis, infections and liver failure. In pediatric care parents are indissolubly attached to their child. This makes parental involvement in children's admissions of essential value. Conclusion: We use protocols that can help detect complications in an early stage after liver transplants.

Postoperative infections and sepsis

Sepsis developing on the basis of a postoperative infection is a rare, but life-threatening event. Early diagnosis of postoperative complications usually facilitates decisive intervention and a favorable prognosis. If the right moment is missed, endothelial damage leads to the release of inflammatory mediators and generalized systemic infection (SIRS). For the subsequentially developing septic shock, often combined with multiple organ failure (MOF), it is not important whether the starting point was an uncontrollable infections focus, ischemic damage following hypovolemic shock, or massive bacterial translocation with postoperative bowel obstruction. The collapse of the immune system results in immune paralysis and explains the inability of the organism to defend itself against systemic infections. For early recognition of the developing septic complication and its effective treatment, pathophysiological and clinical issues are discussed.

Changes in serum carboxyterminal telopeptide of type I collagen in an experimental model of canine osteomyelitis

Blood biochemical indices of bone turnover were followed up for 1 month in six dogs with experimental osteomyelitis. The bone infection resulted in significant increase in parameters of bone formation (serum bone alkaline phosphatase and serum osteocalcin) and bone resorption [serum carboxyterminal telopeptide of type I collagen (i-ICTP)] as early as the end of the second week after the operation and inoculation. There was strong evidence that serum i-ICTP levels could be useful for the early diagnosis of postoperative complications in veterinary orthopedics, such as posttraumatic osteomyelitis.

Use of quantitative liver function tests — caffeine clearance and galactose elimination capacity — after orthotopic liver transplantation

To establish the potential value of quantitative tests of liver function following orthotopic liver transplantation (OLT), a total of 100 determinations of caffeine clearance (CafCl) and galactose elimination capacity (GEC) were made in ten OLT recipients early in the post-operative course (days 2, 4, 6, 8 and 12) and later when clinically stable (3–12 months). Values were compared with a reference range in six normal volunteers in whom it was shown that the standard doses of caffeine (125 mg) and galactose (0.5 g per kg body weight) could be given together without interference. In orthotopic liver transplantation recipients initial GEC and CafCl measurements showed no correlation with peri-operative blood loss, donor ischaemia time, initial bile flow or survival. Throughout the early post-operative period, there were wide inter- and intraindividual variations in both CafCl (17-fold range from 0.16 to 2.7 ml · min −1 · kg −1) and GEC (2.4-fold range from 5.1 to 12 mg · min −1 · kg −1), but the only correlation of test values with standard liver function test results was between GEC and γ-glutamyltranspeptidase. However, GEC values fell by 19% during periods of acute rejection and there was an inverse correlation of GEC with white cell count probably related to sepsis. There was no consistent profile of changing CafCl or GEC values during the post-operative course with median CafCl values (0.87–1.2 ml · min −1 · kg −1) never significantly different from those in volunteers (1.1 ml · min −1 · kg −1) but median GEC results (ranging from 7.3 mg · min −1 · kg −1 at day 12 to 8.2 mg · min −1 · kg −1 at day 4) significantly lower than in normal volunteers (9.5 mg · min −1 · kg −1) at all times including late follow-up (7.7. mg · min −1 · kg −1) when six patients were clinically well. Mean CafCl increased 46% in four patients who were smoking at follow-up, while the introduction of new drug therapies was associated with decreases up to 59% for nine of eleven drugs, with corresponding changes for GEC never exceeding 11%. CafCl and GEC were of little benefit in differential diagnosis of early post-operative complications in this small heterogeneous group of orthotopic liver transplantation recipients, with interindividual variability and susceptibility to modulation by factors other than liver function (e.g., drug ingestion) severely limiting the value of these procedurally complex tests.