AIMTo analyze the incidence, risk factors, prevention, treatment and outcome of small for size syndrome (SFSS) after living donor liver transplantation (LDLT).METHODSThrough-out more than 10 years: During the period from April 2003 to the end of 2013, 174 adult-to-adults LDLT (A-ALDLT) had been performed at National Liver Institute, Menoufiya University, Shibin Elkoom, Egypt. We collected the data of those patients to do this cohort study that is a single-institution retrospective analysis of a prospectively collected database analyzing the incidence, risk factors, prevention, treatment and outcome of SFSS in a period started from the end of 2013 to the end of 2015. The median period of follow-up reached 40.50 m, range (0-144 m).RESULTSSFSS was diagnosed in 20 (11.5%) of our recipients. While extra-small graft [small for size graft (SFSG)], portal hypertension, steatosis and left lobe graft were significant predictors of SFSS in univariate analysis (P = 0.00, 0.04, 0.03, and 0.00 respectively); graft size was the only independent predictor of SFSS on multivariate analysis (P = 0.03). On the other hand, there was lower incidence of SFSS in patients with SFSG who underwent splenectomy [4/10 (40%) SFSS vs 3/7 (42.9%) no SFSS] but without statistical significance, However, there was none significant lower incidence of the syndrome in patients with right lobe (RL) graft when drainage of the right anterior and/or posterior liver sectors by middle hepatic vein, V5, V8, and/or right inferior vein was done [4/10 (28.6%) SFSS vs 52/152 (34.2%) no SFSS]. The 6-mo, 1-, 3-, 5-, 7- and 10-year survival in patients with SFSS were 30%, 30%, 25%, 25%, 25% and 25% respectively, while, the 6-mo, 1-, 3-, 5-, 7- and 10-year survival in patients without SFSS were 70.1%, 65.6%, 61.7%, 61%, 59.7%, and 59.7% respectively, with statistical significant difference (P = 0.00).CONCLUSIONSFSG is the independent and main factor for occurrence of SFSS after A-ALDLT leading to poor outcome. However, the management of this catastrophe depends upon its prevention (i.e., selecting graft with proper size, splenectomy to decrease portal venous inflow, and improving hepatic vein outflow by reconstructing large draining veins of the graft).

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Background The current SARS-CoV-2 pandemic may negatively impact the care of liver transplant candidates and recipients. Main body of the abstract Accordingly, each country must have its national guidelines based on the current situation and according to available tools. Liver Transplantation Scientific Committee of Waiting List Project in Egypt was established in 13 April 2020. One of the major objectives of this Scientific Committee is the preparation of national protocol for Transplant Centers in Egypt to deal with living donor liver transplantation (LDLT) during SARS-CoV-2 pandemic. Conclusions The protocol highlights basic hospital requirements for LDLT during SARS-CoV-2 pandemic, the patient selection from the waiting list, management of patients on the waiting list, and post-transplant management.

Concomitant vascular injury with post cholecystectomy bile duct injury is possible. It is considered as an increasing finding during repair. Thus, assessment of those injuries is crucial for defining the optimal surgical management. Methods: One hundred and thirty patients were managed surgically for post cholecystectomy bile duct injury between January 2010 and December 2014 in the department of HPB surgery, National Liver Institute, Menoufiya University in Egypt. Patient's records were revised including preoperative, intraoperative and postoperative data. Follow up visits were also revised. Vascular injury was identified intra-operatively at the beginning of the study while, later, all patients were carried out Computed Topographic hepatic angiography. Results: Twenty eight patients had concomitant vascular injury. Majority were females (75%) with mean age 35years (range, 30e50years). Most of the injuries were post open cholecystectomy (71%). All the patients had right hepatic artery injury while seven had added right portal vein injury. Fifteen patients had right hepatectomy and left hepatico-jejunostomy (53%). Three patients died (11%) due to sepsis and multi-organ failure. The remaining patients had conventional hepatico-jejunostomy. Conclusions: Assessment of vascular injury is an important part in the management of patients with bile duct injuries. Isolated arterial or combined portal injuries may lead to hepatectomy while mortality occurred due to cholangitic abscesses, severe cholangitis with subsequent sepsis.

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developed intra hepatic biliary abscess at segment VIII managed by liver resection. HA stenosis and HA bleeding from anastomotic site developed in 1 patient for each. Conclusion: Urgent surgical management is lifesaving in cases of early HAT. Left gastric artery may be used in cases of failure of reconstruction of right hepatic artery. Interventional radiology and medical treatment are the management of late HAT.