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Portal hypertension occurs secondary to increased resistance to portal blood flow. It is a principle consequence of liver cirrhosis and leads to severe life-threatening complications, such as variceal bleeding, ascites and hepatic encephalopathy. Acute variceal bleeding is a medical and surgical emergency requiring a multidisciplinary management approach. Prompt resuscitation along with pharmacotherapy agents (terlipressin or somatostatin analogues) followed by early endoscopic variceal banding is the cornerstone of effective treatment. Refractory bleeding despite endoscopic band ligation requires emergency trans-jugular intrahepatic portosystemic shunt (TIPSS). Diuretic therapy with spironolactone and furosemide are the first line of management of ascites. If ascites becomes refractory, repeat large volume paracentesis (LVP) and TIPSS are potential treatment options. Liver transplantation remains the only curative option for all patients with portal hypertension, but a careful selection policy and assessment is mandatory when considering transplantation. [ABSTRACT FROM AUTHOR]

Portal hypertension is secondary to increased resistance to blood flow and increased blood flow through the portal system. The most common cause is liver cirrhosis. The most severe and life-threatening presentation of portal hypertension is acute variceal bleeding. Pharmacotherapy with vasoactive agents (terlipressin or somatostatin), endoscopic band ligation and radiological treatment with transjugular intrahepatic portosystemic shunt (TIPSS) are the most common treatment options for variceal bleeding. However, where surgical expertise exists, portosystemic shunts can be considered for refractory bleeding in patients without significant liver failure, especially when TIPSS is unavailable or contraindicated. Diuretic therapy with spironolactone and furosemide are the basis for the management of ascites. If ascites becomes refractory, repeat large volume paracentesis and TIPSS are potential treatment options. Liver transplantation offers the definitive treatment for portal hypertension secondary to cirrhosis as it cures the underlying liver disease. [ABSTRACT FROM AUTHOR]

Kidney transplant (KT) recipients of HLA identical siblings (HLAid) have lower immunological risk, but there are no specific recommendations for immunosuppression. Our aim was to analyze evidence about results from HLAid living-donor recipients under different immunosuppression in the current era of immunological risk assessment. Systematic review of studies describing associations between outcomes of HLAid living-donor KT recipients according to their immunological risk and applied immunosuppression. From 1351 studies, 16 (5636 KT recipients) were included in the analysis. All studies were retrospective, ten comparing immunosuppression strategies, and six immunological risk strata. Of those ten, six studies were published in 1990 or earlier and only three included tacrolimus. The evidence is poor, and the inclusion of calcineurin inhibitors does not demonstrate better results. Furthermore, only few studies describe different immunosuppression regimens according to the patient immunological risk and, in general, they do not include the assessment with new solid phase assays. There are no studies analyzing the association of outcomes of HLAid KT recipients with current immunological risk tools. In the absence of evidence, no decision or proposal of immunosuppression adapted to modern immunological risk assessment can be made currently by the Descartes Working Group. • Kidney transplantation of recipients with HLA identical siblings as donors has been considered privileged • Rejection occurs in this setting too • Our systematic review shows poor evidence of the association of outcomes of HLA identical KT and immunosuppression. • No studies have analyzed the outcomes of HLA identical KT according to immunolical risk assessed with current sensitive tools. • No proposal of immunosuppression adapted to modern immunological risk assessment can be made currently [ABSTRACT FROM AUTHOR]

Portal hypertension is secondary to increased resistance to blood flow and increased blood flow through the portal system. The commonest cause is liver cirrhosis. The most severe and life-threatening presentation of portal hypertension is acute variceal bleeding. Pharmacotherapy with vasoactive agents (terlipressin or somatostatin), endoscopic band ligation and radiological treatment with transjugular intra-hepatic portosystemic shunt (TIPSS) are the commonest treatment options for variceal bleeding. However, where surgical expertise exists, portosystemic shunts can be considered for refractory bleeding in patients without significant liver failure, especially when TIPSS is unavailable or contraindicated. Diuretic therapy with spironolactone and furosemide are the basis for the management of ascites. If ascites becomes refractory, repeat large volume paracentesis and TIPSS are potential treatment options. Liver transplantation offers the definitive treatment for portal hypertension secondary to cirrhosis as it cures the underlying liver disease. [ABSTRACT FROM AUTHOR]

Abstract: Benign conditions of the liver are relatively common and can pose diagnostic problems due to the difficulty in differentiating them from malignant hepatic lesions. They are usually asymptomatic and are discovered incidentally during investigations. They occasionally produce chronic non-specific symptoms and seldom present as an emergency. Liver function tests are usually within normal range, and diagnosis is established by abdominal ultrasound, computed tomography, magnetic resonance imaging or positron emission tomography. Further diagnostic tests include hepatic angiography, diagnostic laparoscopy and intraoperative ultrasonography. Biopsy or aspiration in the diagnosis of benign disease of the liver is controversial, but is clearly contraindicated in certain scenarios. Management strategies may vary from simple observation to complex hepatic resections. Awareness of the natural history, clinical presentation and management strategies ensures appropriate initial treatment and prompt referral to specialist hepatobiliary units. [ABSTRACT FROM AUTHOR]

Background: Despite the increasing use of laparoscopic techniques, the optimal surgical approach for cystic liver disease has not been well defined. This study aims to determine the optimum operative approach for these patients. Methods: Data were identified from the Lothian Surgical Audit, case note review and general practitioner contact. Patients were contacted and asked to complete the SF-36 questionnaire on quality of life. Results: A total of 102 patients (67 with simple cysts, 31 with polycystic liver disease [PCLD], four with cystic tumours) underwent 62 laparoscopic deroofings, 15 open deroofings, 36 resections and one liver transplant between June 1985 and April 2006. The median follow-up was 77 months (range 3-250 months). Morbidity and recurrent symptom rates after laparoscopic surgery were greater in PCLD patients compared with simple cyst patients, at 31%(four patients) vs. 15%(seven patients) and 85%(11 patients) vs. 29% (24 patients), respectively. Four patients with simple cysts and eight with PCLD required further surgery. All patients with simple cysts had comparable quality of life after surgery. Patients with recurrent symptoms after surgery for PCLD had a significantly better quality of life following laparoscopic deroofing than after resection. Conclusions: Most simple cysts can be managed laparoscopically, but there is a definite role for open resection in some patients. Open deroofing is the preferred approach for a dominant cyst pattern in PCLD, whereas resection is necessary for diffuse cystic disease. [ABSTRACT FROM AUTHOR]

Abstract: Benign conditions of the liver are relatively common and can pose diagnostic problems due to the difficulty in differentiating them from malignant hepatic lesions. They are usually asymptomatic and are discovered incidentally during investigations. They occasionally produce chronic non-specific symptoms and seldom present as an emergency. Liver function tests are usually within normal range, and diagnosis is established by abdominal ultrasound, CT, MRI or PET. Further diagnostic tests include hepatic angiography, diagnostic laparoscopy and intraoperative ultrasonography. Biopsy or aspiration in the diagnosis of benign disease of the liver is controversial, but is clearly contraindicated in certain scenarios. Management strategies may vary from simple observation to complex hepatic resections. Awareness of the natural history, clinical presentation and management strategies ensures appropriate initial treatment and prompt referral to specialist Hepatobiliary Units. [Copyright &y& Elsevier]

Abstract: Benign conditions of the liver are relatively common and can pose diagnostic problems due to the difficulty in differentiating them from malignant hepatic lesions. They are usually asymptomatic and are discovered incidentally during investigations. They occasionally produce chronic non-specific symptoms and seldom present as an emergency. Liver function tests are usually within the normal range and diagnosis is established by abdominal ultrasound, CT, MRI or PET. Further diagnostic tests include hepatic angiography, diagnostic laparoscopy and intraoperative ultrasonography. Biopsy or aspiration in the diagnosis of benign disease of the liver is controversial, but is clearly contraindicated in certain scenarios. Management strategies may vary from simple observation to complex hepatic resections. Awareness of the natural history, clinical presentation and management strategies ensures appropriate initial treatment and prompt referral to specialist Hepatobiliary Units. [Copyright &y& Elsevier]

The liver is the most frequently injured intra-abdominal organ and associated injury to other organs increases the risk of complications and death. This has highlighted the critical need for an accurate classification system as a basis for the clinical decision-making process. Several classification systems have been proposed in an attempt to incorporate the aetiology, anatomy and extent of injury and correlate it with subsequent clinical management and outcome. The widely accepted Organ Injury Scale is based on anatomical criteria that quantify the disruption of the liver parenchyma and defines six groups which may influence management strategies and relate to outcome. The less common pancreatic injury remains a major source of morbidity and mortality due to the likelihood of associated solid or hollow-organ injuries. The implication of a delay in diagnosis and management emphasizes the need for an accurate classification system. The Organ Injury Scale is widely used for pancreas trauma and recognizes the importance of progressive parenchymal injury and in particular ductal injury. Advances in imaging techniques have led to the development of newer radiological classification systems; however, validation of their accuracy remains to be proven. An accurate classification of liver and pancreatic trauma is fundamental for the development of treatment protocols in which clinical decisions are based on the severity of injury. [ABSTRACT FROM AUTHOR]

Introduction Liver transplantation is a recognised treatment for extensive bile duct injuries with secondary biliary cirrhosis or recurring sepsis. However, there have been no reports of successful liver transplantation from a donor who sustained a previous bile duct injury. Presentation of case Here we discuss the case of a liver transplant from a 51-year-old brain dead donor who had suffered a Strasberg E1 bile duct injury and had undergone a Roux-en-Y hepaticojejunostomy 24 years prior to donation. The liver was successfully recovered and transplanted into a 56-year-old male recipient with end stage liver disease consequent to alpha 1 antitrypsin deficiency. The graft continues to function well 36 months post-transplant, with normal liver function tests and imaging revealing a patent hepaticojejunostomy. Discussion The potential associated vascular injuries should be identified during bench preparation whilst the management of biliary reconstruction at the time of transplant should follow the principles of biliary reconstruction in cases with biliary injuries, extending the hilar opening into the left duct. Conclusion This case highlights the successful utilisation of a post bile duct injury repair liver, employing an experienced procurement team and careful bench assessment and reconstruction. [ABSTRACT FROM AUTHOR]

Background This study evaluates long-term outcomes and body mass index (BMI) following liver transplantation (LT) for non-alcoholic fatty liver disease (NAFLD) in comparison with alcoholic liver disease (ALD). Methods Patient and graft survival were compared using Kaplan Meier curves and log rank test. Multivariable analysis of recipient and donor characteristics was performed as determinants of patient survival. BMI at listing was compared with BMI post-LT. Results Patient survival at 1-, 3-, 5- and 10 years post-LT was similar in the ALD group (n = 195) compared with the NAFLD group (n = 84) (93% vs. 93%, 91% vs. 89%, 86% vs. 77%, 64% vs. 66% respectively, p = 0.21). One patient in the NAFLD group was re-transplanted and none in the ALD group therefore graft survival was also similar (p = 0.20). Multivariable analysis didn't identify any significant predictors of reduced survival. In comparison with the ALD group, BMI was significantly higher in the NAFLD group at listing (31 vs. 27, p < 0.001), 3-months post-LT (28 vs. 26, p < 0.05) and 6-months post-LT (29 vs. 27, p < 0.05) but was equivalent by 5-years post-LT (29 vs. 30, p = 0.80). Conclusions NAFLD patients had similar patient and graft survival post-LT compared to ALD. NAFLD patients returned to listing BMI by one-year post-LT but by 5-years post-LT there was no difference in BMI between the groups. [ABSTRACT FROM AUTHOR]

Objectives: To report health-state utility values measured using the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) in a large sample of patients with end-stage renal disease and to explore how these values vary in relation to patient characteristics and treatment factors.Methods: As part of the prospective observational study entitled "Access to Transplantation and Transplant Outcome Measures," we captured information on patient characteristics and treatment factors in a cohort of incident kidney transplant recipients and a cohort of prevalent patients on the transplant waiting list in the United Kingdom. We assessed patients' health status using the EQ-5D-5L and conducted multivariable regression analyses of index scores.Results: EQ-5D-5L responses were available for 512 transplant recipients and 1704 waiting-list patients. Mean index scores were higher in transplant recipients at 6 months after transplant surgery (0.83) compared with patients on the waiting list (0.77). In combined regression analyses, a primary renal diagnosis of diabetes was associated with the largest decrement in utility scores. When separate regression models were fitted to each cohort, female gender and Asian ethnicity were associated with lower utility scores among waiting-list patients but not among transplant recipients. Among waiting-list patients, longer time spent on dialysis was also associated with poorer utility scores. When comorbidities were included, the presence of mental illness resulted in a utility decrement of 0.12 in both cohorts.Conclusions: This study provides new insights into variations in health-state utility values from a single source that can be used to inform cost-effectiveness evaluations in patients with end-stage renal disease. [ABSTRACT FROM AUTHOR]