To identify factors predictive of early postoperative graft function, we analyzed 54 variables--including easily available clinical and laboratory data prospectively obtained from organ donors, transplant recipients and surgical procedures in 168 consecutive liver transplantations. Early postoperative graft function was classified into three groups according to a scoring system ranging from 3 to 9 based on peak serum ALT values, mean bile output and lowest prothrombin activity measured during the 72 hr after transplant: group 1 (score 3 to 4, good graft function; n = 73), group 2 (score 5 to 6, moderate dysfunction; n = 50) and group 3 (score, 7 to 9, severe dysfunction; n = 45). In univariate analyses, 8 of the 54 variables analyzed were statistically significant (p < 0.05) predictors of severe graft dysfunction: high serum sodium concentration and brain death caused by cranial trauma in organ donors, advanced age and low prothrombin activity in transplant recipients, prolonged total ischemia time and large transfusions of red blood cells, fresh frozen plasma and platelets during surgery. After introduction of these eight variables in a multivariate analysis, only four were found to independently predict early postoperative graft function: donor serum sodium concentration, total ischemia time, platelet transfusion during surgery and recipient prothrombin activity. In 52 liver transplantations, in which the predictive value of liver tissue adenine nucleotide concentration and several biochemical sensitive markers of donor nutritional status was also analyzed, only the ATP level in liver tissue obtained at the time of organ reperfusion was identified as an independent predictor of initial graft function.(ABSTRACT TRUNCATED AT 250 WORDS)

Although preoperative chemotherapy does not seem to benefit the outcome of patients with solitary, metachronous CRLM, postoperative chemotherapy is associated with better OS and DFS, mainly when the tumor diameter exceeds 5 cm.

1-8 To reduce the intensity of these hemodynamic ent perioperative periods (anesthesia induction, hepa-derangements, venovenous bypass (VVBP) from infetectomy, anhepatic phase, biliary anastomosis, and 24 rior caval vein and portal vein territories to superior hours after surgery). A significant decrease in inulin caval vein territory was introduced in 1984.9,10 In addiclearance and increase in tubular damage markers were tion to its beneficial hemodynamic effect during the observed in the anhepatic phase, which only partly imanhepatic phase of liver transplantation, VVBP has proved in the subsequent phases. No significant differences were observed between groups 1 and 2 at any peri-been suggested by several authors to protect the kidoperative phase, except during the anhepatic phase, in neys from the damage secondary to the interruption which a more marked renal function impairment oc-of renal venous outflow. 3,10 Because of these potential curred in group 2 patients. However, renal function on benefits of VVBP, a number of transplant centers are the 7th postoperative day and the need for hemodialysis/ routinely performing VVBP during orthotopic liver hemofiltration during the 1st week were similar in both transplantation. 6,11 However, the systematic use of groups. Among 40 variables analyzed, only low mean ar-VVBP has been questioned by other authors who have of VVBP on perioperative renal function in patients PATIENTS AND METHODS

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Post-transplantation pancreatitis is an infrequent complication with a high risk of mortality. In a 7-year period, there were five patients who had documented pancreatitis out of a total of 488 renal homograft recipients, an incidence of 1 per cent. Two cases occurred in patients with an orthotopic transplant, one of them as a result of surgical injury of the pancreas and the other as a consequence of cytomegalovirus infection. The third case was an acute pancreatitis of hypercalcaemic origin, the fourth patient developed postoperative pancreatitis and acute acalculous cholecystitis, and the fifth had acute pancreatitis and sepsis associated with cytomegalovirus infection. Three patients died as a direct result of the complication. The mean incidence and mean mortality rate of post-transplantation pancreatitis, as determined from our review of the literature of the last 15 years, are 2.3 and 61.3 per cent, respectively; these are similar to the figures found up to 1970 of 1.7 and 52.2 per cent. A multiplicity of factors present in the uraemic patient may be responsible for the continued frequency of post-transplant pancreatitis despite advances in surgical technique and immunosuppressive therapy.