Biliary tract complications remain a common source of morbidity and mortality in liver transplant (LT) recipients with an estimated incidence of 5-30% after orthotopic LT and a mortality rate of up to 10%. Biliary complications after LT may be related to various factors including hepatic artery thrombosis or stenosis, ischemia reperfusion injury, immunologic injury, infections, donor pool, and technical issues which include imperfect anastomosis and T-tube-related complications. Management of the detected biliary complications includes nonsurgical and surgical methods. A majority of these post transplant biliary complications can be treated with endoscopic retrograde cholangiography. If unsuccessful, a percutaneous intervention or surgery may be required. In this article, we review the incidence, clinical presentation, and management of the main types of biliary complications. (J CLIN EXP HEPATOL 2012;2:81-85)
Acute pancreatitis (AP) remains a disease with significant morbidity and mortality, and the reported incidence is increasing. Despite a significant amount of research over the last few decades with greater understanding of the pathophysiology of AP, there are still no specific drugs available. Therefore, the current treatment is limited to supportive care such as fluid, nutrition, and treatment of complications. In this review, we discuss potential novel targeted pharmacologic approaches that may offer promise in the treatment of AP such as anti-secretory agents, protease inhibitors, probiotics, anti-inflammatory agents, anti-oxidants, and anti-TNF-α agents. While many drugs were reported to have efficacy in animal experiments, human studies have been largely disappointing. Better understanding of AP pathophysiology likely will facilitate future therapies in AP.
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