Objectives of this study are to quantify the need for blood transfusion during liver transplantation (LT) and confirm the importance of intraoperative blood transfusion as an independent prognostic factor for postoperative outcome. Furthermore, we try to detect useful variables for the preoperative identification of patients likely to require transfusion of packed red blood cell units (PRCUs) and identify measures to reduce transfusion needs. Data were collected prospectively between September 1998 and November 2000. One hundred twenty-two LTs were included in the study. Forty-two patients (34%) did not require transfusion of PRCUs. In multivariate analysis, transfusion of more than three PRCUs was found to be the only significant variable associated with prolonged hospital stay. In addition, excluding perioperative deaths, PRCU transfusion, using a cutoff value of six units, was the only variable to reach statistical significance (P ‫؍‬ .008; risk ratio, 4.93; 95% confidence interval, 15 to 15.9) to predict survival in a multivariate analysis that also included Child's class and United Network for Organ Sharing (UNOS) classification. Moreover, only preoperative hemoglobin (Hb) level was found to significantly predict the need for transfusion of one or more PCRUs. Finally, only UNOS classification and placement of an intraoperative portacaval shunt were found to be statistically significant to predict the need to transfuse more than six PRCUs. We found the requirement of even a moderate number of blood transfusions is associated with longer hospital stay, and transfusion of more than six PRCUs is associated with diminished survival. Preoperative normalization of Hb levels and placement of an intraoperative portacaval shunt can diminish the number of blood transfusions during LT. (Liver Transpl 2003;9:1320-1327.)

OLT for nondisseminated irresectable cholangiocarcinoma has higher survival rates at 3 and 5 years than palliative treatments, especially with tumors in their initial stages, which means that more information is needed to help better select cholangiocarcinoma patients for transplantation.

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Large bowel obstruction still has a high of mortality rate. An accurate preoperative evaluation of severity factors might allow stratification of patients in terms of their mortality risk and help in the decision-making process for treatment. Such an evaluation would also enable better comparison between studies performed by different authors. Principles and stratification similar to those of distal lesions should be considered in patients with proximal colonic obstruction.

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Orthotopic liver transplantation (OLT) offers the only chance to eliminate both tumor and liver disease in patients with hepatocellular carcinoma (HCC) and cirrhosis. However, tumor progression while on the waiting list and recurrence after OLT are frequent. We undertook a large multicenter study to assess survival and related factors of recurrence after OLT. This retrospective study analyses data from 307 consecutive patients with HCC and cirrhosis treated with OLT between 1990 and 1997 in eight centers in Spain. OLT was indicated only for small (<5 cm) localized tumors. Five-year rates after OLT were 63% for survival, 58% for disease-free survival, and 21% for recurrence. Tumor diameter larger than 5 cm was associated with other tumor characteristics that were significant indicators of poor outcome (absence of capsule, three or more nodules, bilobularity, satellite nodules, and vascular invasion). However, in multivariate analysis, alpha fetoprotein (AFP) levels greater than 300 ng/mL (P ‫؍‬ .04; P ‫؍‬ .02) and macroscopic vascular invasion (P ‫؍‬ .01; P ‫؍‬ .0001) were the only factors independently associated with mortality and recurrence, respectively. OLT is indicated in patients with small HCCs who have low AFP levels and no macroscopic vascular invasion or extrahepatic disease. By increasing our ability for preoperative tumor imaging, we will achieve better selection of patients with HCC before OLT. (Liver Transpl 2001;7: 877-883.) H epatocellular carcinoma (HCC) is the most common primary hepatic malignancy, 1 and in most cases, it develops in association with liver cirrhosis. Surgical removal, either by partial hepatic resection or orthotopic liver transplantation (OLT), offers the only chance for long-term cure. Results of HCC resection in cirrhotic patients have been disappointing, mainly because of postoperative liver decompensation and, subsequently, the high rate of intrahepatic recurrence. 2 OLT has the theoretical advantage of eliminating both the tumor and liver disease. In comparison to liver resection, recurrence after OLT in patients with selected HCC is low. 3,4 However, the waiting list for OLT is increasing because of the organ shortage, and tumor growth during this time may lead to exclusion criteria for OLT. Adult living donor transplantation is emerging as a new therapeutic option to overcome this problem. Consequently, the ability to determine the relative risk for recurrence of HCC after OLT would allow a more equitable allocation of a scarce resource. However, selection criteria before OLT are not agreed on and may vary among centers.Because data about risk factors of survival and recurrence from single-center studies are insufficient, we undertook a large multicenter study to assess selection criteria and related factors in patients with cirrhosis and HCC treated by OLT. Patients and MethodsThis retrospective study was performed between January 1990 and December 2000 in eight centers in Spain. Data from 388 consecutive patients with HCC and cirrhosis treated with OLT were collected...

This study provides some evidence that postoperative chemotherapy is beneficial; however, prospective randomized studies are necessary to define its exact role.

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