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Introduction: In-hospital biliary complications (BCs) after liver transplantation (LT) are reported in up to 20 % of patients and contribute to poor outcomes and increased costs. Existing single-center outcome and cost analyses studies are limited in scope. Methods: This is a cross-sectional analysis of national data involving 7,967 patients transplanted between 2011 and 2012 with the primary aim of determining the association between BCs and clinical outcomes and costs. Age, race, diagnosis, and severity of illness are associated with the development of BCs. Results: BCs develop in 14.6 % of LT recipients and have substantial implications for perioperative outcomes, including length of hospital and ICU stay (27.9 vs 19.6 mean days, p < 0.001 and 12.0 vs 8.3 mean days, p < 0.001, respectively), in-hospital morbidity (39 vs 27 %, p < 0.001), 30-day readmissions (14.8 vs 11.2 %, p < 0.001), and in-hospital mortality (5.8 vs 4.0 %, p < 0.001). BCs contributed to a mean increase in in-hospital costs of $36,212 ( p < 0.001), due to increases in accommodations ($9,539, p < 0.001), surgical services ($3,988, p < 0.001), and pharmacy services ($8,445, p < 0.001). Discussion: BCs are a predominant etiology for in-hospital morbidity and mortality, while contributing significantly to the high cost of LT. Efforts should be focused on understanding salient and modifiable risk factors, while developing innovative strategies to reduce BCs. [ABSTRACT FROM AUTHOR]

Background Cytomegalovirus ( CMV) infection is one of the most common and important opportunistic infections following kidney transplantation. It causes significant morbidity and mortality. Valganciclovir ( VGCV) is the drug of choice for prophylaxis to prevent CMV infection. Methods We conducted a post-hoc analysis of a randomized controlled trial in 187 kidney transplant recipients to evaluate the impact of VGCV dosing and renal function on the development of CMV infection. Results and conclusion The results demonstrate that the following variables were independent risk factors for the development of CMV infection: high-risk CMV serostatus (donor positive/recipient negative; hazard ratio [ HR] 1.4, 95% confidence interval [ CI] 1.46-5.28, P = 0.002); anti-thymocyte globulin induction therapy ( HR 2.1, 95% CI 1.08-4.07, P = 0.028); higher mean tacrolimus trough concentration ( HR 1.4, 95% CI 1.09-1.74, P = 0.007); creatinine clearance <60 mL/min ( HR 3.4, 95% CI 1.64-6.85, P = 0.001); and body weight >80 kg ( HR 2.1, 95% CI 1.05-4.37, P = 0.037). VGCV dosing was appropriate for most patients, in those who did and did not develop CMV infection. These results strongly suggest that the currently recommended dose adjustments of VGCV dosing based on estimated renal function calculated using ideal body weight may underestimate the renal function of overweight patients and indirectly result in underexposure of overweight patients to VGCV. Based on these findings, further VGCV pharmacokinetic analyses are warranted in kidney transplant recipients with moderate-to-severe renal dysfunction. [ABSTRACT FROM AUTHOR]

Renal Insufficiency (RI) is a common finding in patients suffering from end-stage liver disease. The causes of RI are reported to be multifactorial and the degree of RI can range from early functional impairment to hepatorenal syndrome (HRS). The process of liver transplantation is highly likely to exacerbate the symptoms and sequelae of renal dysfunction. RI continues to be a cause of morbidity and mortality in the intraoperative and postoperative periods. With careful evaluation and monitoring in addition to appropriate intervention, a uniformly good outcome may be possible even for these most complicated patients. This paper will describe successful perfusion interventions carried out during the three phases of liver transplantation: pre-anhepatic, anhepatic and reperfusion at our institution for a three-year period. Intraoperative plasmapheresis (n = 3), continuous veno-venous hemofiltration (CVVH) (n = 7), intraoperative dialysis (n = 8), and intraoperative dialysis with fluid removal (n = 3) techniques will be presented for review. [ABSTRACT FROM AUTHOR]

Key words: diabetic nephropathy; nodular glomerulosclerosis; non-diabetic patient; renal allograft [ABSTRACT FROM PUBLISHER]

Fear of postoperative pain is a disincentive to living donor kidney transplantation. Laparoscopic donor nephrectomy (LDN) was developed in part to dispel this disincentive. The dramatic increase in the number of laparoscopic donor nephrectomies performed at our institution has been in part due to the reduction in postoperative pain as compared to traditional, open donor nephrectomy. We sought to further diminish the pain associated with this surgical technique. The purpose of this study was to compare the efficacy of three different postoperative pain management regimens after LDN. All living kidney donors performed laparoscopically (n=43) between September 1998 and April 2000 were included for analysis. Primary endpoints included postoperative narcotic requirements and length of stay. Narcotic usage was converted to morphine equivalents (ME) for comparison purposes. Patients received one of three pain control regimens (group I: oral and intravenous narcotics; group II: oral and intravenous narcotics and the On-Q™ pump delivering a continuous infusion of subfascial bupivicaine 0.5%; and group III: oral and intravenous narcotics and subfascial bupivicaine 0.5% injection). Postoperative intravenous and oral narcotic use as measured in morphine equivalents was significantly less in group III versus groups I and II (group III: 28.7 ME versus group I: 40.2 ME, group II: 44.8 ME; P<0.05). Postoperative length of stay was also shorter for group III (1.8 days) versus group I (2.5 days) and group II (2.9 days). LDN has been shown to be a viable alternative to traditional open donor nephrectomy for living kidney donation. We observed that the use of combined oral and intravenous narcotics alone is associated with greater postoperative narcotic use and increased length of stay compared to either a combined oral and intravenous narcotics plus continuous or single injection subfascial administration of bupivicaine. The progressive modification of our... [ABSTRACT FROM AUTHOR]