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Concurrent Sessions Posters View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector CONCURRENT SESSIONS POSTER 189 tify risk factors predisposing an individual to one dis- PREDICTION OF EARLY POST ease but not to the other. Methods: Consecutive patients presenting with US/ OPERATIVE MORTALITY IN CECT proven pancreatitis, liver disease or a combina- DECEASED DONOR LIVER tion were included in the study. Controls were men TRANSPLANTATION BY USING who consuming alcohol for more than 5 years, but had CLINICAL PROFILE normal liver and pancreas on biochemical and radio- logical evaluation. Female gender, pancreatitis and liver Arunkumar Krishnan disease due to other etiological factors or alcohol con- Stanley Medical College, Chennai, India sumption less than 5 years were excluded from the Background: Liver transplant often results in hemody- study. Patients were categorized as GpI: Alcoholic namic and biochemical changes in the immediate post- related pancreatitis, GpII: Alcoholic liver disease, operative period, often causing concern to the treating GpIII: combination of pancreatic and alcohol related physician. To study the pre-operative clinical profile, liver disease. Patient details included were age, baseline the hematological and biochemical changes in the demographic characteristics, literacy status, per capita immediate post-operative period up to 7 days following income, details of alcohol consumption, smoking and DDLT patients. diet details. Pertaining to the disease, information on Patients and Methods: A detailed assessment of the age of onset of disease, the duration of disease and patient’s pre-operative clinical diagnosis, presence of date/month of diagnosis were recorded. All patients co-morbid illness and postoperative hematological, bio- had liver function tests, baseline amylase and lipase chemical, microbiological and clinical events was made estimation, ultrasound and CECT. Likewise definite between survivors and those who died. Various param- evidence of chronic pancreatitis on CECT was consid- eters were compared between two groups to understand ered mandatory for inclusion in the study. the various that determined early postoperative out- Results: There were 53 controls. There were 59 patients come in DDLT patients. with pancreatitis (GpI), 97 with liver disease (GpII), 7 Results: A total of 35 patients, categorized into group I- with both liver and pancreatic disease (GpIII). The 26 patients (Survivors) and group II-9(mortality). There demographic profile, socioeconomic status, pan chewing, was no difference in the fluctuation of hemoglobin levels diet pattern and smoking pattern in the three groups Æ between the two groups (10 4%). Early leukocytosis were similar. Age of first consumption of alcohol was and persistent azotemia predicted early morbidity and also similar in all the 3 groups. The mean age of presen- mortality. A significant fall of platelet count predicted tation in the three groups was 37.4 Æ 10.2, 44.6 Æ 9.4, mortality. Transaminases showed a significant rise Æ nd rd and 45.3 6.9 years respectively. Current alcohol con- between the 2 and 3 postoperative days and stabilized sumption was more in Gp I (71.2%) compared to Gp II – and showed a downwards trends by the 7th 9th postop- (50.5%), and Gp III (57.1%) (p < 0.05). The mean dura- erative days in both group. Hypernatremia predicated tion of alcohol consumption was 13.1, 16.5 and 15.4 early mortality. Cause of death was intra-operative years respectively. The average current consumption of events like cardiac arrhythmias, and in ischemic cardiac alcohol per week was similar in all, i.e. Gp II (765.3 g), events(3),pulmonary thromboembolism(1),and hepatic Gp I and III (653 g each). Average consumption and artery thrombosis(1),sepsis and multi-organ failure(4). duration of consumption of alcohol was not significantly Two patients required renal replacement therapy for different in all the 3 groups. resistance renal failure in group II. Conclusion: Unlike the western reports, the age of Conclusion: Pre-operative co-morbid illness, postopera- presentation for both alcoholic liver disease and pan- tive worsening azotemia, persistent leukocytosis, and creatic disease is similar i.e. 13 Æ 2 years. What predis- sepsis and cardiac events in the immediate postopera- poses an individual to develop liver or pancreatic tive period predicts an outcome post DDLT. disease is probably genetically determined. 197 220 IS ALCOHOLIC PANCREATITIS AND SUCCESSFUL TREATMENT OF LIVER DISEASE ARE FRIENDS OR MALIGNANT BILIARY-CUTANEOUS FOES? FISTULA USING A T-TUBE Arunkumar Krishnan Sung Kyun Park Stanley Medical College, Chennai, India Incheon St. Mary’s Hospital, bupyung-dong, bupyung-gu, Background: Alcohol is known cause for chronic liver Incheon, South Korea disease and chronic pancreatitis. The two diseases often Background and aims: Biliary-cutaneous fistulas are do not co-exist. This study compares the similarities uncommon but can be a source of significant morbidity and dissimilarities on a case to case basis between after hepato-biliary surgery. Residual malignancy may alcohol related acute recurrent pancreatitis and alcohol be associated with the development of postoperative fis- related chronic liver disease with an intention to iden- © 2013 The Authors HPB 2013, 15 (Suppl. 2), 85–244 HPB © 2013 Americas Hepato-Pancreato-Biliary Association 86 CONCURRENT SESSIONS POSTER tula. Conservative treatment and invasive treatment icant elevation in GpII than GpI (p < 0.01). Serum including surgery is considered. We report a case of creatinine increased in both groups, but it is much post operative biliary-cutaneous fistula which was suc- higher in GpII compare to GpI (p < 0.05). The serum cessfully treated by resection of fistula tract including platelet count in groupI was 350000 Æ 180000 platelets/ wide excision of hepaticojejunostomy site with T-tube mL, whereas in groupII it had reduced to insertion. 80000 Æ 120000 platelets/ mL(p < 0.001). PT was Methods: Right hepatectomy with Roux-en-Y hepati- correlated well with outcome, although the trend was cojejunostomy was performed for a 78-year-old man the same in both groups. INR was also significantly with Klatskin tumor Bismuth type IIIA. Postoperative 4 higher in GpII patients. Transaminases showed a sig- weeks, bilious discharge was found in the wound and CT nificant rise between the 2nd and 3rd postoperative showed biliary-cutaneous fistula. The liver function sus- days and stabilized and showed a downwards trends by tained normal so we decided to observe. To 1 month the 7th–9th postoperative days in both group. Cause of after the development of fistula, closure of the fistula was death was intra-operative events like cardiac arrhyth- not found so we performed percutaneous transhepatic mias, and in ischemic cardiac events (2), pulmonary biliary drainage but closure did not occur. Thus, we per- thromboembolism (1), and hepatic artery thrombosis formed resection of fistula tract including wide excision (1), sepsis and multiorgan failure (4). Two patients around the hepaticojejunostomy site and T-tube inser- required renal replacement therapy for resistance renal tion. Malignancy was found in the fistula tract, and T- failure in groupII. tube was removed after 2 months. No recurrence was Conclusion: Pre-operative co-morbid illness, postopera- found for 12 months after the first operation. tive worsening azotemia, persistent leukocytosis, and Results: Postoperative biliary-cutaneous fistula was sepsis and cardiac events in the immediate postopera- successfully treated with resection of fistula tract tive period predicts an outcome post DDLT. including wide excision of hepaticojejunostomy site and T-tube insertion. 226 Conclusions: There may be possibility of malignancy in cases of biliary-cutaneous fistula which is not success- RISK FACTORS FOR EARLY fully treated with conservative treatment, so wide exci- OCCURRENCE OF LUNG METASTASIS sion of hepaticojejunostomy site should be included in IN PATIENTS WITH the surgery for postoperative biliary-cutaneous fistula HEPATOCELLULAR CARCINOMA and this treatment strategy may increase the curative AFTER TRANSARTERIAL potential. CHEMOEMBOLIZA 1 1 1 225 Yong-Bo Yang , Yu-Fang Chen , Ning-Yang Jia , Dong Chen1, Xing-An Long1, Hong Meng2 and INITIAL POSTOPERATIVE DECEASES Hong-Yan Cheng1 CLINICAL OUTLINE IN DECEASE 1Department of Radiology, Eastern Hepatobiliary DONOR LIVER TRANSPLANT Surgery Hospital, Second Military Medical University, 225 Changhai Rd, Shanghai 200438, China; RECIPIENTS: A PRELIMINARY 2 REPORT Department of Health Statistics, Second Military Medical University, 800 Xiangyin Rd, Shanghai 200433, Arunkumar Krishnan China Stanley Medical College, Chennai, India Aim: To analyze the risk factors for early occurrence Background and Aim: Liver transplant often results in of lung metastasis in patients with hepatocellular carci- hemodynamic and biochemical changes in the immedi- noma (HCC) after transarterial chemoembolization ate postoperative period, often causing concern to the (TACE). treating physician. Aim of the study to determine the Methods: 202 patients diagnosed as HCC without pre- pre-operative clinical profile, the hematological and vious treatment and detected lung metastases after trea- biochemical changes in the immediate postoperative ted with TACE were studied retrospectively. Patient’s period up to 7 days following DDLT patients. laboratory tests and imaging around TACE, parame- Method: A detailed assessment of the patients pre
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