A prospective randomised study of end-to-end bile duct reconstruction with or without T-tube drainage during orthotopic liver transplantation (OLT) was undertaken in 60 patients well matched for age, sex, aetiology of liver disease, operative blood loss, cold ischaemic time, preoperative serum bilirubin level and Child-Pugh score. Significant biliary complications in the T tube group occurred in five patients and included bile duct stricture (n = 2), bile leak/peritonitis (n = 1) and cholangitis (n = 2). Bile duct strictures occurred in six patients in the no T tube group (P > 0.05, NS). Hepatic artery stenosis was identified in one patient from each group in association with a biliary stricture. Biliary complications in both groups were associated with a prolonged graft cold ischaemic time (P < 0.01). As no significant difference was noted in the number of early and late biliary complications between the two groups, the routine use of a T tube has been discontinued.

Arterial conduits that use donor iliac arteries represent a reliable technique for graft revascularization in orthotopic liver transplantation. We reviewed 757 consecutive liver transplantations performed between 1989 and 1995 for acute or chronic liver disease in adults and children. Of these, 218 patients received arterial conduits that used donor iliac arteries. The incidence of hepatic artery thrombosis (HAT) for conduits was 4.1% (9 of 218 patients) compared with 4% (22 of 539 patients) for direct arterial anastomosis. Patients in the arterial conduit group included 66% (99 of 159) of the children younger than 5 years of age, 75% (67 of 89) of all patients who underwent retransplantation, and, in particular, 25 patients regrafted for HAT. Arterial conduits provide an effective and reliable method of revascularization in patients at higher risk of arterial thrombosis. The actuarial 3-year patency rate for conduits is 95% and the incidence of HAT is similar to that in standard arterial anastomoses. Copyright 1998 by the American Association for the Study of Liver DiseasesH epatic artery thrombosis (HAT) remains an important cause of graft loss after liver transplantation. 1,2 Because the potential collateral supply to the graft is severed at the time of hepatectomy, the transplanted liver is particularly dependent on the arterial blood flow and HAT leads to retransplantation in up to 75% of patients, with a mortality rate approaching 50%. 3 Arterial conduits that use donor iliac arteries were developed to overcome arterial inflow problems, 4-6 and we have reviewed our experience with the use of this technique. MethodsWe reviewed 757 consecutive orthotopic liver transplantations (OLTs) performed between January 1989 and December 1995 for acute or chronic liver disease in adults and children. Of these, 218 grafts were revascularized by means of donor iliac artery anastomosed to the infrarenal aorta. These conduits were prepared from donor iliac arteries, occasionally from splenic artery, and exceptionally from saphenous vein, the latter being used for the initial living related liver transplantations. The common iliac arteries were retrieved at the end of the donor operation, carefully avoiding excessive traction to reduce the risk of intimal damage, and were stored in University of Wisconsin solution at 4°C.Whenever possible, iliac arteries from the same donors were used to construct the infrarenal conduit. Occasionally, these were unsuitable because of atherosclerosis or intimal damage, and we used the most recently retrieved ABO group-compatible vessels.The vascular grafts were prepared on the back table just before use and subsequently anastomosed to the infrarenal aorta, which was side-clamped by means of either an interrupted or a continuous 5/0 or 6/0 polypropylene suture. The graft was brought to the lesser sac through the transverse mesocolon, behind the stomach and in front of the pancreas. The distal end was subsequently anastomosed to the common hepatic artery or to the celiac trunk of the donor wit...

A prospective randomised study of end-to-end bile duct reconstruction with or without T-tube drainage during orthotopic liver transplantation (OLT) was undertaken in 60 patients well matched for age, sex, aetiology of liver disease, operative blood loss, cold ischaemic time, preoperative serum bilirubin level and Child-Pugh score. Significant biliary complications in the T tube group occurred in five patients and included bile duct stricture (n = 2), bile leak/peritonitis (n = 1) and cholangitis (n = 2). Bile duct strictures occurred in six patients in the no T tube group (P > 0.05, NS). Hepatic artery stenosis was identified in one patient from each group in association with a biliary stricture. Biliary complications in both groups were associated with a prolonged graft cold ischaemic time (P < 0.01). As no significant difference was noted in the number of early and late biliary complications between the two groups, the routine use of a T tube has been discontinued.

Bowel perforation is a well-recognized complication following orthotopic liver transplantation. Of 194 paediatric liver transplantations performed in our hospital, 13 patients (6.7%) developed bowel perforation post-transplantation. Contributory factors included previous operation, steroid therapy and viral infection. The incidence was higher in children who underwent transplantation for biliary atresia after a previous Kasai portoenterostomy. Seven patients (53% of this group) reperforated. Diagnosis may be difficult and a high index of suspicion is needed.

Bowel perforation is aKey words Liver transplantation, well-recognized complication following orthotopic liver transplantation. Of 194 paediatric liver transplantations performed in our hospital, 13 patients (6.7 YO) developed bowel perforation post-transplantation. Contributory factors included previous operation, steroid therapy and viral infection. The incidence was higher in children who underwent transplantation for biliary atresia after a previous Kasai portoenterostomy. Seven patients (53 Yo of this group) reperforated. Diagnosis may be difficult and a high index of suspicion is needed.intestinal perforation . Intestinal perforation, liver transplantation