Vascular complications after orthotopic liver transplantation in Estonia.

The aim of this study was to analyse vascular complications (VC) accompanying the introduction in Estonia of orthotopic liver transplantation (OLT) for treatment of end-stage liver disease. We present the incidence and treatment of VC occurring among our first 23 OLT in 22 patients. The 11 female and 11 male patients were aged 12 to 67 years. Their diagnoses were cholestatic disease (n = 8); hepatitis C virus (HCV) cirrhosis (n = 6); tumor (n = 3); Budd-Chiari syndrome (n = 2); autoimmune hepatitis (n = 1); cystic fibrosis (n = 1); or fulminant hepatic failure (n = 1). Only end-to-end vascular reconstructions were used in OLT. The patients' 1-year post-OLT survival rate was 86%. VC were confirmed using computed tomography (CT) or magnetic resonance imaging (MRI). In cases of VC, we started a 1-week course of subcutaneous anticoagulant therapy with low-molecular weight heparin (LMWH) immediately followed by permanent oral treatment. The incidence of VC was 14% (n = 3). There was no hepatic artery thrombosis. One patient developed hepatic venous thrombosis at 3 weeks after retransplantation. She was treated successfully with immediate LMWH followed by a permanent oral anticoagulation. Two patients experienced portal vein complications: 1 with pre-OLT portal vein thrombosis developed right intrahepatic portal vein thrombosis at 5 weeks after OLT requiring portal thrombectomy. He was treated successfully with immediate LMWH followed by permanent oral anticoagulation. The other subject displayed left intrahepatic portal vein thrombosis at 1 week after OLT. Despite immediate LMWH treatment followed by a permanent oral anticoagulation, he required left lobe necrectomy and Roux-Y choledochojejunostomy for recovery. The survival and recovery of all studied patients with VC allow us to recommend immediate subcutaneous anticoagulant therapy for post-OLT portal or hepatic venous thrombosis.

Surgical complications accompanying liver transplantation in Estonia.

The purpose of this study was to evaluate surgical complications accompanying the introduction of orthotopic liver transplantation (OLT) in Estonia. Between 1999 and 2009, we performed the first 12 liver transplantations. Eight patients were males and four were females of age range 12 to 67 years. Their diagnoses were cholestatic disease (n = 5); tumor (n = 3); hepatitis C virus cirrhosis (n = 2); Budd-Chiari syndrome (n = 1); and cystic fibrosis (n = 1). Technical complications occurred in 7/12 patients. The early vascular complications in two patients were a suprahepatic vena cava lesion occurring at liver extraction, which resulted in uncontrolled suprahepatic bleeding after liver perfusion; the recipient died during transplantation. The other case displayed a right intrahepatic portal venous thrombosis, which was treated successfully with thrombolysis and anticoagulant therapy. Early biliary complications of biliary leaks occurred in three patients: two had undergone duct-to-duct reconstructions, which were treated by endoscopic retrograde cholangiography that successfully managed the anastomotic and recipient cystic duct leaks with a papillotomy and stenting. In one patient with a duct-to-jejunum anastomosis, a bile leak stopped at 3 weeks but he needed surgical therapy 2 years later due to an anastomotic stricture. Severe decubitus occurred in the lumbosacral region of the subjects with operating times of 14 hours. They required necretectomy and plastic surgery. One of them with postoperative intra-abdominal hypertension also displayed wound eventration requiring reoperations. The rate of hepatic (5/12) and extrahepatic (3/12) surgical complications, as well as of 1-year survival (9/12), in our period of implementation of OLT were satisfactory to continue OLT development in Estonia.

The effect of vagotomy and antrectomy on serum pepsinogens I and II.

Ninety-seven consecutive patients with gastric surgery for peptic ulcer were studied; 86 had duodenal ulcer (DU), and 11 gastric ulcer (GU). DU patients were surgically treated by proximal vagotomy, proximal vagotomy and pyloroplasty, truncal vagotomy and pyloroplasty, or truncal vagotomy and antrectomy. All GU patients were operated on by the Billroth I method. Serum pepsinogen I(S-PG I), serum pepsinogen II (S-PG II), basal acid output (BAO), and maximal acid output (MAO) were determined before and 3 months and 1 year after the operation. The mean preoperative S-PG I concentration in DU patients (154 +/- 7 micrograms/l; mean +/- SE) was significantly higher than that (97 +/- 9 micrograms/l) in GU patients (p less than 0.001). A significant decrease in the mean S-PG I concentration in DU patients was seen 3 months (92 +/- 6 micrograms/l) and 1 year (66 +/- 4 micrograms/l) after the operation (p less than 0.001). This change did not depend on the type of vagotomy. However, this decrease was not seen in all individual patients as it was in BAO values. Moreover, the mean BAO decrease was much greater at 3 months (7% of the preoperative value) and 1 year (23%) after the operation than the respective decrease in S-PG I concentration. There was also no correlation between S-PG I and acid output (BAO and MAO) before and after the operation. In GU patients the decrease in mean S-PG I value after the Billroth I operation was smaller than in DU patients after vagotomy.(ABSTRACT TRUNCATED AT 250 WORDS)