Portosystemic shunts in liver transplant recipients with stable graft function may be associated with hepatic encephalopathy. Pretransplant assessment to detect unknown spontaneous shunts is important. Restoration of portal flow is the preferred procedure in this setting.

Biliary complications after liver transplantation remain a serious cause of morbidity and mortality. Direct invasive cholangiographic techniques, endoscopic retrograde cholangiography (ERCP) or percutaneous transhepatic cholangiography (PTC), have procedure-related complications. Magnetic resonance cholangiopancreatography (MRCP) is non-invasive, safe, and accurate. The aim of this study was to evaluate MRCP in detecting biliary complications following liver transplantation and comparing findings with ERCP and PTC. Twenty-seven consecutive liver transplant recipients who presented with clinical and biochemical, ultrasonographic, or histological evidence of biliary complications were evaluated with MRCP. Patients were followed up for a median period of 36 months. The presence of a biliary complication was confirmed in 18 patients (66.6%): anastomotic biliary stricture in 12 (66.6%); diffuse intrahepatic biliary stricture in 5 (27.7%): ischemic (n = 3), recurrence of primary sclerosing cholangitis (n = 2), and choledocholithiasis in one. In nine patients (33.3%), MRCP was normal. Six patients underwent ERCP, and eight PTC. There was a statistically significant correlation between the MRCP and both ERCP and PTC (p = 0.01) findings. The sensitivity and specificity of the MRCP were 94.4% and 88.9%, respectively, and the positive and negative predictive values, 94.4% and 89.9%, respectively. MRCP is an accurate imaging tool for the assessment of biliary complications after liver transplantation. We recommend that MRCP be the diagnostic imaging modality of choice in this setting, reserving direct cholangiography for therapeutic procedures.

Background Desensitization protocols have been developed in order to overcome the immunological barrier of donor‐specific anti‐HLA antibodies (DSA). Methods During 2006‐2012, we implemented a program for desensitizing sensitized (positive DSA, negative NIH‐CDC crossmatch) living‐donor recipients. The long‐term outcome of 36 sensitized recipients, treated with IVIG and plasmapheresis (PP), with or without rituximab (added when > 7500 MFI), was compared to 252 non‐sensitized living‐donor recipients. Results Median peak DSA level before desensitization was 7223 (range 3567‐16 000) MFI. During a mean follow‐up of 121.9 months, graft loss occurred in 6/36 (17%) of the sensitized and 15/251 (6%) of the non‐sensitized recipients (P = 0.021). Five‐year and 10‐year death‐censored graft survival rates were 85% and 81% compared to 95% and 92%, respectively, for the non‐sensitized recipients. There was no difference in recipients’ survival. Slightly more episodes of acute rejection occurred in the sensitized group but had not influence on graft survival. At the last follow‐up, 28 recipients had functioning graft; seventeen (47%) did not have detectable DSA. Eleven recipients had excellent graft function despite having detectable DSA. Conclusion The long‐term outcomes of sensitized recipients who underwent desensitization are encouraging. Adding rituximab to PP + IVIG in candidates with very high titers may result in improved outcome.

Aims: To investigate the effects of liver resection at the moment of secondary cytoreduction in recurrent epithelial ovarian cancer Methods: At the moment of secondary cytoreduction 15 patients were submitted to liver resections in Fundeni Clinical Hospital between January 2002eApril 2014. Metastases originating from peritoneal seeding with parenchimatous invasion of at least 2 cm were classified as peritoneal lesions while lesions entirely surrounded by liver parenchyma were classified as hematogenous lesions Results: FIGO stage at the moment of initial diagnostic was IC (2 cases), IIC(1 case), IIIB (2 cases) and IIIC (10 cases). Disease free survival after primary cytoreduction was 30 months (range 7e88 months); in all cases a serous hystopathological subtype was encountered. Six patients were diagnosed with liver metastases from peritoneal origin while the other 9 cases hematogenous route was incriminated. The mean tumoral diameter of the liver lesion was3,3 cm. R0 resection was achieved in 80% of cases. Four of the 15 patients reported postoperative complications, while complications related to liver surgery were reported only in 2 cases: biliary fistula (1 case) and hepatic abscess (1 case). Postoperative mortality was 0. Long term outcomes revealed an overall survival of 10 months for patients with hematogenous liver metastases and 22 months for cases with peritoneal seeding of the liver (p = 0,591). Conclusions: Liver resection for hepatic metastases from ovarian cancer can be safely performed at the moment of secondary surgery and may increase survival.

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