[A biliary fistula after T-tube removal in the transplant patient: its diagnosis by Tc-99m-HIDA]. / Fístula biliar tras la retirada del tubo en T, en el paciente trasplantado: diagnóstico mediante HIDA Tc-99m.

The Tc-99m HIDA scan is a valuable study after liver transplantation, associated with other image techniques. We have used this technique as a reliable and objective diagnostic method for biliary fistula after removal of the T-tube in 5 liver transplantation patients with pain after T-tube removal. All five patients who developed fistula not only were diagnosed immediately but, furthermore, the surgical technique was indicated by the gammagraphic study. After this experience, we propose to remove the T-tube during the Tc-99 HIDA scan.

Transplante hepatico: avaliacao clinica de pacientes apos a alta hospitalar / Liver transplant: clinical evalueation of patients after hospital liberation

Apresentamos um estudo do seguimento de 44 pacientes adultos com transplante hepatico (TH) apos alta hospitalar. O seguimento medio foi de 13,22 +- 1,3 (limites:2-36) meses. Durante o seguimento faleceram 8 pacientes (18 por cento), 5 apos intervencoes, 2 por metastase e 1 por trombose portal. O restante dos pacientes apresentaram uma boa funcao hepatica, com hiperbilirrubinemias discretas em 11 casos (30 por cento), mas boa funcao hepatica em todos eles. Os pacientes estao em tratamento com triplice terapia imunossupressora mediante ciclosporina A (CsA), prednisona e azatioprina em 28 por cento dos casos. As complicacoes mais frequentemente observadas no pos-operatorio foram secundarias a imunossupressao. Podemos afirmar que o transplante (TH) oferece boa qualidade de vida e sobrevivencia (80 por cento) apos superar o pos-operatorio.

[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.