Search

Objective: To analyse the influence of ceftriaxone on bacterial translocation and survival after small bowel transplantation in an experimental model with large animals., Design: We performed 21 small bowel transplantation in pigs. Group 1 (n = 5): small bowel transplantation (SBT). Group 2 (n = 5): SBT and immunosuppression with cyclosporine, azathioprine and prednisolone. Group 3 (n = 5): SBT and ceftriaxone. Group 4 (n = 6): SBT, ceftriaxone and immunosuppression., Subjects: Minipig of 25-45 Kg body weight., Measures: Blood, spleen, liver, and mesenteric lymph nodes for bacterial culture and biopsy of ileum on postoperative days POD 0.3 and 7., Results: Cultures were positive for bacteria in 22% (10/41) before perfusion, and 43% (28/67) post-reperfusion. Groups 1 and 2: cultures were positive for bacteria in 93% (28/30) on POD 3 degrees, and in 100% (30/30) on POD 7 degrees. Cultures were positive for enterobacteria in 80% (24/30) on POD 3 degrees. Groups 3 and 4: cultures were positive for bacteria in 79.5% (33/41) on POD 3 degrees and in 100% (31/31) on POD 7 degrees. Cultures were positive for enterobacteria in 36.5% (15/41) on POD 3 degrees. Early mortality (before POD 7 degrees), not related with technical complications was 50% (5/10) in groups 1 and 2 and 0% (0/11) in groups 3 and 4. There were no differences with the use of immunosuppression., Conclusions: Ceftriaxone could decrease bacterial translocation (especially enterobacteria), and early mortality post-small bowel transplantation in pigs.

Introduction: Liver resections over 50% of hepatic volume can be achieved with a low morbi-mortality, although occasionally they are followed by severe complications. Postoperative evolution and complications after this type of hepatic resections with intermittent occlusion of the portal triad have been studied., Patients and Methods: 13 right hepatectomies, 5 enlarged right hepatectomies and 2 enlarged left hepatectomies were performed consecutively, with intraoperative ultrasound evaluation and intermittent portal triad occlusion., Results: Maximum time of continuous hepatic hilum occlusion was 15 minutes, with a mean isquemia time of 25 +/- 8.6 minutes. Peak of disturbance of hepatic function was at 24 hours and recovered totally at 7th postoperative day. Nine of the 20 patients (45%) did not need intraoperative transfusion and the average of transfusion was 1.8 +/- 1.9 blood units. Four biliary leaks (20%), with no severe hepatic disfunction were observed during postoperative period, and there was no hospital mortality., Conclusions: Intermittent portal triad occlusion during hepatic resections in more than 50% of liver volume is a safe surgical maneuver.

Purpose: Small bowel transplantation is a last resort treatment for intestinal insufficiency. Although the disorder is occasionally associated with chronic hepatopathy of variable severity, it may require simultaneous liver transplantation. We present a new model of heterotopic small bowel and reduced partial liver transplantation to an infrahepatic site., Subjects and Methods: "Mini-pig" breed pigs weighing 28 to 35 kg were divided into four experimental transplant groups: intestine only (IO) without immunosuppression (group 1A, n = 11); IO with immunosuppression (group 1B, n = 10); intestine + reduced liver (IRL) without immunosuppression (group 2A, n = 12); IRL with immunosuppression (group 2B, n = 10)., Results: Overall mortality from technical causes (first 3 days) was 23/43 animals (53.4%). All animals in group 1A displayed rejection, which was the main cause of death. Rejection occurred in 1 animal in each of the other three groups., Conclusions: Heterotopic small bowel-reduced liver transplant is a multivisceral model that has the technical advantage of not requiring hepatectomy, and the immunological advantages of delayed appearance of acute rejection and the possibility of reducing immunosuppression during the first postoperative days.

Splenic artery aneurysms (SAA) are not uncommon in patients with hepatic transplant (HT). Three in 150 transplanted patients in our institutions were diagnosed with SAA and two of them had a spontaneous rupture. In two patients embolization with interventionist radiology was performed with excellent results. SAA should be investigated before and after HT and be treated with embolization as soon as possible because of the high risk of rupture.