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We report herein on two male liver transplant (LT) recipients who presented with cyclosporine (CsA)-related gynecomastia 6 and 10 months after transplantation. The clinical workup showed increased luteinizing hormone (LH), associated with a slight reduction in testosterone blood levels in one patient and increased prolactin levels in the other. After excluding concomitant primary endocrine and/or malignant disease, conversion to tacrolimus (TAC) was performed resulting in clinical improvement of gynecomastia and return of hormone blood levels to normal range within 3 months. Our report confirms a putative role of CsA in post-LT gynecomastia, reversible however upon conversion to TAC.

A SUCCESSFUL liver transplantation needs an adequate portal inflow. In cases of grade 4 portal vein (PV) thrombosis, ie, complete thrombosis of the PV, and the proximal and distal superior mesenteric veins, salvage procedures have been described to restore portal inflow: anastomosis of the donor PV with a suitable recipient PV tributary, arterialization of the donor PV to increase flow through the portal system, and multivisceral transplantation. Since the report of Tzakis et al, proposing cavoportal hemitransposition (CPHT) as a possible means of overcoming the problem of extensive PV thrombosis, individual case studies of CPHT have been published. The common complications after CPHT are severe ascites, renal insufficiency, and variceal bleeding. We here report the patient selection criteria and outcomes of the first eight transplantations performed using this technique at our Centre between July 2000 and February 2002.

Background/Aims: Thrombocytopenia after orthotopic liver transplantation is a recognized early post-operative complication, the etiology and the outcomes of this phenomenon are, however, still vague. The aims of this study were to identify contributing factors to thrombocytopenia and to ascertain any correlation with early rejection and survival. Methods: This study includes 541 orthotopic liver transplantations (541 grafts in 494 patients), that took place in University of Miami, during the 3-year period June 1994-Sep 1997. Tacrolimus and steroids were used as baseline immunosuppressive therapy. Donor bone marrow cells (DBMC) were infused in 264 of the patients, were not available in 275 of them (controls) and the rest two received donor peripheral blood cells (living related donors). The pre-transplant and the lowest platelet count (nadir) during the first two weeks and during the third and the fourth post-transplant weeks were used for analysis. The cross match, the recipient and donor CMV serology and the early rejection episodes (1 st post-transplant month) were factors that were considered for analysis (t-test for independent samples and multiple regression analysis). Short (< 1 month) and long term survival were analyzed (Cox Regression analysis) to identify any correlation with the nadir platelet count. Results. In 90.8 % of the patients there was a 56.5 % fall of the platelets. The 4 th post-transplant day was the mean day of the nadir platelet count. The mean pre-operative platelet count fell from 100,640 / mm 3 to a mean nadir of 44,660 / mm 3, in the total group of the patients, during the first two post-transplant weeks and rose to 145,430 / mm 3 and 197,780 / mm 3 in the third and fourth post-operative week, respectively. There was no statistically significant difference in the percentage fall of the platelets between the group of patients that received DBMC infusion versus control group. The recipient CMV status, the cross match and the pre-operative platelet count were independent predictive factors of the nadir platelet count (r = 0.16, r = 0.13 and r = 0.49, respectively). Also the cross match and the pre-operative platelet count were found to be correlated, as independent factors, with the percentage fall of the platelets (r = -0.13 and r = 0.31, respectively). The nadir platelet count and the percentage of their fall were found to be significantly correlated with early rejection (p