Novel biliary reconstruction techniques during liver transplantation

Biliary complications remain a significant problem following liver transplantation. Several surgical options can be used to deal with a significant size mismatch between the donor and recipient bile ducts during the biliary anastomosis. We compared biliary transposition to recipient biliary ductoplasty in cadaveric liver transplant.A total of 33 reconstructions were performed from January 1, 2005 to December 31, 2013. In the biliary transposition group (n=23), 5 reconstructions were performed using an internal stent (5 or 8 French pediatric feeding tube), and 18 were performed without. Of the 10 biliary ductoplasties, 2 were performed with a stent. All patients were managed with standard immunosuppression and ursodiol. Follow-up ranged from 2 months to 5 years.No patients in the biliary transposition group required reoperation; 1 patient had an internal stent removed for recurrent unexplained leukocytosis, and 2 patients required endoscopic retrograde cholangiography and stent placement for evidence of stricture. Three anastomotic leaks occurred in the biliary ductoplasty group, and 2 patients in the biliary ductoplasty group required reoperation for biliary complications.Our results indicate that biliary reconstruction can be performed with either biliary transposition or biliary ductoplasty. These techniques are particularly useful when a significant mismatch in diameter exists between the donor and recipient bile ducts

Calciphylaxis in simultaneous liver-kidney transplantation

We present four patients who underwent simultaneous liver–kidney transplantation (SLK) and were diagnosed with calciphylaxis, also known as calcific uremic arteriolopathy (CUA). Common characteristics included high MELD scores (mean 35.2 ± 4.8) and advanced renal disease (duration range 6–44 weeks). CUA was diagnosed within the first 2 months post-SLK based on clinical features. Severe morbidity and prolonged hospital stay were observed and one of the patients died secondary to sepsis. Treatment included metabolic support, wound care, calcium level correction and use of sodium thiosulphate. CUA should be considered in the presence of painful dermatologic changes in patients status post SLK