Peak VO2 is severely impaired in candidates for LT and affects survival and post-LT course. Perioperative respiratory rehabilitation programs validated in lung and heart transplantation must be tested.

OBJECTIVETo investigate the influence of primary graft function (PGF) on graft survival and metabolic control after islet transplantation with the Edmonton protocol.RESEARCH DESIGN AND METHODSA total of 14 consecutive patients with brittle type 1 diabetes were enrolled in this phase 2 study and received median 12,479 islet equivalents per kilogram of body weight (interquartile range 11,072–15,755) in two or three sequential infusions within 67 days (44–95). PGF was estimated 1 month after the last infusion by the β-score, a previously validated index (range 0–8) based on insulin or oral treatment requirements, plasma C-peptide, blood glucose, and A1C. Primary outcome was graft survival, defined as insulin independence with A1C ≤6.5%.RESULTSAll patients gained insulin independence within 12 days (6–23) after the last infusion. PGF was optimal (β-score ≥7) in nine patients and suboptimal (β-score ≤6) in five. At last follow-up, 3.3 years (2.8–4.0) after islet transplantation, eight patients (57%) remained insulin independent with A1C ≤6.5%, including seven patients with optimal PGF (78%) and one with suboptimal PGF (20%) (P = 0.01, log-rank test). Graft survival was not significantly influenced by HLA mismatches or by preexisting islet autoantibodies. A1C, mean glucose, glucose variability (assessed with continuous glucose monitoring system), and glucose tolerance (using an oral glucose tolerance test) were markedly improved when compared with baseline values and were significantly lower in patients with optimal PGF than in those with suboptimal PGF.CONCLUSIONSOptimal PGF was associated with prolonged graft survival and better metabolic control after islet transplantation. This early outcome may represent a valuable end point in future clinical trials.

We have studied maintenance and recovery profiles after general anaesthesia with sevoflurane, desflurane and isoflurane in 100 patients undergoing pulmonary surgery. End-tidal concentrations of anaesthetic required to maintain mean arterial pressure and heart rate within 20% of baseline values were 1.4 +/- 0.6% for sevoflurane, 3.4 +/- 0.9% for desflurane and 0.7 +/- 0.3% for isoflurane. The three anaesthetics had comparable haemodynamic effects and arterial oxygenation during one-lung ventilation. Emergence was twice as fast with desflurane than with sevoflurane or isoflurane (mean times to extubation: 8.9 (SD 5.0) min, 18.0 (17.0) min and 16.2 (11.0) min for desflurane, sevoflurane and isoflurane, respectively). Early recovery (Aldrete score, cognitive and psychomotor functions) was also more rapid after desflurane. In pulmonary surgery, desflurane, but not sevoflurane, allowed more rapid emergence and earlier recovery than isoflurane.

The purpose of this study was to evaluate the results of percutaneous transhepatic management (PTM) of anastomotic biliary strictures (BS). Among 168 liver transplant adult recipients, BS was identified in 30 patients. In 6 patients, narrowing of the anastomosis was found early, and in all cases disappeared spontaneously with prolonged draining of the bile tube. Within a mean time of 14 months after transplantation, 24 patients had symptomatic BSs, revealed by cholestasis (n ‫؍‬ 17) or cholangitis (n ‫؍‬ 7). Twenty-two patients underwent PTM as first treatment of BS (balloon dilatation or stent placement). We evaluated the primary and secondary patency rate of PTM. In 1 patient, PTM failed because the stricture could not be passed with the guide wire, necessitating conversion to a Roux-en-Y choledochojejunostomy (CDJ). Fourteen patients were treated by percutaneous balloon dilatation from which 8 patients (57.2%) were recurrence-free with a mean follow-up of 61 months. One patient with a patent biliary anastomosis underwent retransplantation for acute rejection. Twelve patients received metallic expandable stent placement as their primary treatment (n ‫؍‬ 7) or after failure of balloon dilatation (n ‫؍‬ 5). Recurrent stricture was found in 7 cases (58%) and was treated by PTM (n ‫؍‬ 6) or surgery (n ‫؍‬ 1). The primary patency rate for PTM was 58.8% at 12 months and the secondary patency rate 88.4%, with a mean follow-up of 47 months (median: 44 months). The mortality rate was 3.5% (one death). PTM with balloon dilatation, stent placement, or both, represent a safe method to treat anastomotic BSs after orthotopic liver transplantation (OLT) resulting in a secondary patency rate of 88% at 5 years. (Liver Transpl 2003;9:394-400.) P reviously biliary complications after orthotopic liver transplantation (OLT) have been reported as a perioperative and a middle long-term event in 10% to 40% of patients 1-3 and even nowadays remain an important cause of morbidity after the surgical procedure. 4 Biliary strictures (BS) are reported to occur in 9% to 15% of adult OLT recipients with choledochojejunostomy (CDJ) or choledochocholedochostomy (CDC) and are frequently localized at the anastomosis. 2,5-7 BSs appear also to be a problem in living related liver transplantation. [8][9][10] However, the management of these BSs remains controversial. In a recent survey, 22% of transplant centers in United States reported the use of percutaneous transhepatic management (PTM), whereas 29% chose reoperation and 45% used endoscopic retrograde cholangiography (ERCP). 11 Considering the potential risks of surgical reintervention, we decided in 1990 to treat BSs with PTM as a first approach. The objectives of this retrospective study were to evaluate the longterm outcome and results of systematic PTM for anastomotic BS after OLT. Patients and MethodsBetween July, 1987 and December, 2000, 216 consecutive OLT were performed in our center. To evaluate the middleand long-term outcome of BS, 168 adult patients (85 male and 83 female, age 15 t...