Background - Biliary complications (BC) represent the most frequent complication after liver transplantation, up to 34% of cases. Aim: To identify modifiable risk factors to biliary complications after liver transplantation, essential to decrease morbidity. Method: Clinical data, anatomical characteristics of recipient and donors, and transplant operation features of 306 transplants with full arterial patency were collected to identify risk factors associated with BC. Results: BC occurred in 22.9% after 126 days (median) post-transplantation. In univariate analyses group 1 (without BC, n=236) and group 2 patients (with BC, n=70) did not differ on their general characteristics. BC were related to recipient age under 40y (p=0.029), CMV infection (p=0.021), biliary disease as transplant indication (p=0.018), lower pre-transplant INR (p=0.009), and bile duct diameter <3 mm (p=0.033). CMV infections occurred sooner in patients with postoperative biliary complications vs. control (p=0.07). In a multivariate analysis, only CMV infection, lower INR, and shorter bile duct diameter correlated with BC. Positive CMV antigenemia correlated with biliary complications, even when titers lied below the treatment threshold. Conclusions: Biliary complications after liver transplantation correlated with low recipient INR before operation, bile duct diameter <3 mm, and positive antigenemia for CMV or disease manifestation. As the only modifiable risk factor, routine preemptive CMV inhibition is suggested to diminish biliary morbidity after liver transplant.

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Purpose: In Model for End-stage Liver Disease (MELD)-based allocation systems patients with cancer and some other diseases are assigned a special score. The goal of this study was to assess the fairness of organ distribution by the MELD system among different groups of diseases. Methods: Retrospective study with adult patients between 2009 and 2013. Demographics and MELD scores were compared with the incidence of transplant or death, patient origin and disease groups. Results: 260 selected patients were submitted to transplant or died before the transplant. Their median age was 54.9 years (12.1 -73.9 years); 70.4% were men; 63.3% had chronic liver diseases (alcoholic cirrhosis 33.1%, C-virus cirrhosis 24.2%). Exception score was assigned to 26.5% of listed patients. These patients received 31% of transplanted organs and had lower pre-transplant mortality or dropout (14.2 times less) rates than the other patients (p <0.001). Receiving exception points resulted in a higher likelihood of being transplanted. Conclusion: The authors propose the use of a regional variable score for transplantation in special situations, which should be based on the median MELD score of the latest transplants for chronic liver diseases, to refrain from harming patients who have access to transplant according to the calculated MELD score.

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