[Evaluation of the socio-affective adaptation of patients with liver transplant]. / Valoración de la adaptación socioafectiva del paciente con trasplante del hígado.

The quality of the socio-affective adaptation of liver transplant patients is a fundamental assessment parameter in the context of postoperative recuperation. The patient's reinsertion into the socio-occupational environment, gradual recuperation of professional and recreational habits and psycho-affective reorganization represent, in our opinion, the most significant criteria for evaluation of the "modus vivendi" of the transplant patient. A total of 21 patients between 21 and 62 years were evaluated. They were divided into three groups for study and analysis. The remission of symptoms and normalization of organic activities, in addition to achievement of an adequate quality of life, constitute the basic rationale for any surgical intervention.

[Necrosis of the bile ducts as an expression of uncontrollable rejection in the liver transplant between ABO incompatible groups]. / Necrosis de los conductos biliares como expresión del rechazo incontrolable en el trasplante hepático entre grupos ABO incompatibles.

Two cases are presented of liver transplantation in adult patients with fulminant liver failure using grafts from incompatible blood group donors due to the urgency of the situation. The patients evolved well as first but later both developed ischemia and necrosis of the bile tract secondary to severe rejection. It is concluded that the use of incompatible grafts can save the patient's life in acute irreversible liver failure, but in most cases retransplantation may be necessary as the definitive treatment of postoperative complications.

[Initial results of restoration of bile flow in liver transplant]. / Resultados iniciales en la restauración de la continuidad biliar en el trasplante hepático.

The initial results of biliary reconstruction in 72 liver transplants realized in 62 patients, 50 adults and 12 children, are presented. Three reconstruction techniques were used: end-to-end choledocho-choledochostomy on a Kehr tube in 44 transplants (61.1%); choledocho-jejunostomy on a Roux-en-Y loop in 24 transplants (33.3%); double derivation cholecysto-choledocho-jejunostomy in 2 transplants (2.7%). The number of early complications related to biliary reconstruction was 5 (7.14%): 3 fistulas in the choledocho-choledochostomy series (6.8%) and 2 fistulas among the choledocho-jejunostomies (8.3%). All complications required reoperation and mortality was nil. Thirty-two months after the onset of the program, no late complications of the biliary anastomosis have been registered.

Valorizacion de la adaptacion socio-afectiva del paciente con trasplante de higado / Social-afective adaptation assesment of liver transplanted patient

La volorizacion de la adaptacion socio-afectiva del paciente con trasplante hepatico, constituye un parametro fundamental dentro del marco de recuperacion postoperatoria del paciente trasplantado. La reinsercion al medio social-laboral, la recuperacion paulativa de habitos ocupacionales y recreativos, asi como el restablecimiento y la reorganizacion del aparato psico-afectivo conforman, a nuestro juicio, los criterios mas significativos de la evaluacion del "modus vivendi" del paciente que ha recibido trasplante de higado. La remision de la sintomatologia con la normalizacion de la actividad organica, sumado a una calidad de vida adecuada, constituyen el respaldo basico de cualquier intervencion quirurgica