OBJECTIVES:Liver transplantation has not increased with the number of patients requiring this treatment, increasing deaths among those on the waiting list. Models predicting post-transplantation survival, including the Model for Liver Transplantation Survival and the Donor Risk Index, have been created. Our aim was to compare the performance of the Model for End-Stage Liver Disease, the Model for Liver Transplantation Survival and the Donor Risk Index as prognostic models for survival after liver transplantation.METHOD:We retrospectively analyzed the data from 1,270 patients who received a liver transplant from a deceased donor in the state of São Paulo, Brazil, between July 2006 and July 2009. All data obtained from the Health Department of the State of São Paulo at the 15 registered transplant centers were analyzed. Patients younger than 13 years of age or with acute liver failure were excluded.RESULTS:The majority of the recipients had Child-Pugh class B or C cirrhosis (63.5%). Among the 1,006 patients included, 274 (27%) died. Univariate survival analysis using a Cox proportional hazards model showed hazard ratios of 1.02 and 1.43 for the Model for End-Stage Liver Disease and the Model for Liver Transplantation Survival, respectively (p<0.001). The areas under the ROC curve for the Donor Risk Index were always less than 0.5, whereas those for the Model for End-Stage Liver Disease and the Model for Liver Transplantation Survival were significantly greater than 0.5 (p<0.001). The cutoff values for the Model for End-Stage Liver Disease (≥29.5; sensitivity: 39.1%; specificity: 75.4%) and the Model for Liver Transplantation Survival (≥1.9; sensitivity 63.9%, specificity 54.5%), which were calculated using data available before liver transplantation, were good predictors of survival after liver transplantation (p<0.001).CONCLUSIONS:The Model for Liver Transplantation Survival displayed similar death prediction performance to that of the Model for End-Stage Liver Disease. A simpler model involving fewer variables, such as the Model for End-Stage Liver Disease, is preferred over a complex model involving more variables, such as the Model for Liver Transplantation Survival. The Donor Risk Index had no significance in post-transplantation survival in our patients.

exposing the lesion in laparoscope, risk of massive bleeding and the difficulty of managing intra-operative emergencies. This procedure was performed routinely in our institute. The aim of this study was to report outcomes of laparoscopic resection of right posterior lobe. Methods: 20 Consecutive patients who underwent laparoscopic resection of right posterior lobe in Sir Run Run Shaw Hospital. The patients' characteristics, surgical features, postoperative course, and so on were reviewed. All procedures were performed under general anesthesia with the patients in the left side position. Liver parenchyma was transected with the special instrument of laparoscopic peng's multifunctional operative dissector. Results: No peri-operative death. 5 patients were converted to open hepatectomy. 3 Complications occurred. The mean operating time was 217.3 ml. The mean volume of intraoperative blood loss was 698.3 ml and 6 patients had intraoperative blood transfusion. The length of post-operative hospital stay was 8.4 days. Conclusion: laparoscopic resection of right posterior lobe was supposed to be a safe and effective procedure according to current results in our institute.

papilla. To achieve a corresponding size to the major duodenal papilla in humans a dilatation of the minor papilla is required in pigs. The extent of dilatation without damage to the minor papilla and the proximal pancreatic duct is unknown in pigs and humans. Methods: For the porcine model freshly explanted pancreas with the adjacent duodenum from adult pigs (weighing approximately 120 kg) were used. Balloon-dilatation of the minor duodenal papilla and proximal pancreatic duct was performed on 15 ex-vivo specimens to three diameters (4mm, 6-mm, 8-mm) followed by a macro-and microscopic evaluation with interest in ductal wall disruption and perforation of the papilla and proximal pancreatic duct. Results: The diameter of the undilated papilla measured 0.96 AE 0.16 mm. After dilatation to 4-mm, 6-mm and 8mm ductal wall disruption occurred in 1/5, 3/5 and 4/5 specimens. No perforation was recorded at any diameter. Disruption of the papilla and the proximal pancreatic duct appeared simultaneously. Conclusion: Dilatation of the minor papilla and pancreatic duct from 4-mm to 8-mm is increasingly associated with wall disruption but not with perforation. The study suggest that a dilatation over 4-mm has an increased risk of ductal wall tear and thus complications.

Introduction: Minimally invasive applications accessing the pancreas over the papilla and the pancreatic duct are likely to become more common. Porcine models are often used to test novel endoscopic and surgical procedures. Unlike in humans the porcine pancreatic duct enters the duodenum separately to the bile duct in the minor duodenal HPB 2016, 18 (S1), e385ee601

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