The role of donor‐recipient body size mismatch (DRSM) on outcomes after whole liver transplantation (LT) is not clearly defined. At our center, in presence of considerable DRSM, objective assessment of the donor liver by a radiology or intraoperative evaluation by procuring surgeon was incorporated. To evaluate the impact of DRSM on graft outcomes with this approach, adult deceased donor whole liver transplants between July 2001 and December 2017 at our center were studied. DRSM was considered when the donor‐recipient body surface area (BSA) ratio (DR‐BSAr) was either <0.69 or >1.25. There were 54 (3.2%) transplants with DR‐BSAr <0.69 and 61 (3.6%) with DR‐BSAr >1.25. One‐year graft survival was 85% vs. 89% vs. 89%; (p = .64) for transplants with DR‐BSArs of <0.69, 0.69–1.25, and >1.25, respectively. Early allograft dysfunction (EAD) (28% vs. 27% vs. 37%; p = .07), post‐transplant coagulopathy, bilirubinemia, and renal function were also comparable. In conclusion, with the actual measurement of the donor liver and recipient abdominal cavity, significant DRSM did not have a negative impact on early and long‐term outcomes. Routine measurement of donor liver size by radiology may be incorporated in liver allocation to improve utilization.
Penetrating thoracoabdominal trauma, with potential injury to two anatomic cavities, poses a significant diagnostic and therapeutic challenge. This is especially true with reference to detection of diaphragmatic injuries, where development of a bilio-pleural fistula is a rare phenomenon. The optimal management in such cases has not been clearly defined as both conservative and emergency surgical approaches have been tried in acute settings. We report a patient who suffered an accidental penetrating wound to the right thoracoabdominal region. The patient developed a bilio-pleural fistula immediately following the injury with imaging showing an intact diaphragm. The case was managed conservatively using endoscopy as the primary modality for treating the primary condition as well as a rare complication of biliary stent migration. Thus an endoscopic approach is feasible in management of bilio-pleural fistula when used in properly selected cases.
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