Acute Graft Versus Host Disease Following Liver Transplantation: Case Report With Review of Current Literature.

Graft verus host disease (GVHD) following Liver transplantation is rare life threatening complication with very high mortality rate around 85%. Due to increased recognition of this condition management approach is rapidly evolving due to newer diagnostic methods and drugs. Etiology, risk factors, pathogenesis, preventive strategies, management approach and newer drugs are discussed. We present our experience of 2 cases from a large cohort of 1052 Liver transplant operations over a decade.

Initial Poor Function and Primary Nonfunction in Deceased-Donor Orthotopic Liver Transplantation Maintaining Short Cold Ischemic Time.

BACKGROUND: Nations with emerging deceased-donor liver transplantation programs, such as India, face problems associated with poor donor maintenance. Cold ischemic time (CIT) is typically maintained short by matching donor organ recovery and recipient hepatectomy to achieve maximum favorable outcome. We analyzed different extended criteria donor factors including donor acidosis, which may act as a surrogate marker of poor donor maintenance, to quantify the risk of primary nonfunction (PNF) or initial poor function (IPF). METHODS: A single-center retrospective outcome analysis of prospectively collected data of patients undergoing deceased-donor liver transplantation over 2 years to determine the impact of different extended criteria donor factors on IPF and PNF. RESULTS: From March 2013 to February 2015, a total of 84 patients underwent deceased-donor liver transplantation. None developed PNF. Thirteen (15.5%) patients developed IPF. Graft macrosteatosis and donor acidosis were only related to IPF ( P = .002 and P = .032, respectively). Cold ischemic time was maintained short (81 cases ≤8 hours, maximum 11 hours) in all cases. CONCLUSION: Poor donor maintenance as evidenced by donor acidosis and graft macrosteatosis had significant impact in developing IPF when CIT is kept short. Similar study with larger sample size is required to establish extended criteria cutoff values.

Duodenojejunal flexure tumors: surgical difficulties with case series.

BACKGROUND: Distal duodenal and duodenojejunal flexure tumors are rare. They present late due to vague symptomatology and difficulties in establishing a diagnosis. Due to vague symptoms, these tumors would have had spread locally or metastasized to regional nodes or distant organs at presentation. Though the present standard is to achieve R0 resection for any tumor, it is quite difficult in these tumors because of their proximity to many important named vessels and viscera. Role of neoadjuvant and adjuvant therapy is not established yet. METHODS: Medical records of patients searched who were admitted and diagnosed to have duodenal tumors between January, 2011 and March, 2014. Patients with duodenal tumors arising from third or fourth part were analysed. Radiological, endoscopic findings were noted and compared with operative and histopathological report. RESULTS: Nine patients (seven males and two females) were found to have tumor in the third and fourth part of the duodenum. All had undergone laparotomy with curative intention in eight patients. R0 resection was feasible only in five (55%) patients. The most common histopathological type is adenocarcinoma in 66% patients. CONCLUSIONS: Segmental resection is feasible and may be curative in most of the patients with duodenojejunal flexure tumors, without the need for vascular resections and reconstructions. Adenocarcinomas are the most common variant. Lymph node involvement and microvascular invasion indicates poor prognosis.