Bacteremia following liver biopsy in transplant recipients with Roux-en-Y choledochojejunostomy

Between 1990 and 1995, 666 percutaneous liver biopsies were performed in 196 patients at Gregorio Marañón General Hospital (mean 3.4 biopsies/patient); 533 biopsies (80.03%) were carried out in patients with choledochostomy biliary anastomosis and 133 (19.97%) in patients with choledochojejunostomy. Infectious complications, in the form of sepsis, occurred in two patients, who recovered favorably with antibiotic therapy. These two patients had undergone Roux-en-Y choledochojejunostomy (1.5%, not significant). Our findings suggest that the incidence of infectious complications after liver biopsy in transplant recipients is very low. Antibiotic prophylaxis at the time of liver biopsy in patients with Roux-en-Y choledochojejunostomy may decrease the frequency of infectious complications.

[Chemoembolization and posterior liver transplantation as therapeutic strategy for hepatocarcinoma]

Orthotopic Liver Transplantation (OLT) is the only surgical approach to non-resectable hepatocellular carcinoma (HCC) but, so far its results has been poor. During 41 months 112 patients underwent 123 OLT, nine of them had HCC over cirrhosis with a mean age 60 years. The etiology of cirrhosis was: alcohol in 1 and viral hepatitis in 8. Child's grade: A in 4, B in 5. HCC was: 5 cm or less in 5 and more in 4. According pTNM staging: I in one, II in 5, II in 2 and IVb in 1. Differentiation degree: low in 1, moderate in 4, and well in 3 (one case with complete necrosis after embolization). Eight patients were previously embolized with lipiodol, adriamycin and gelfoam, obtaining central necrosis without viable features in periphery. There were no postoperative deaths, and all the patients were discharged from the hospital. During follow up, 3 recurrences were observed, one massive with death of the patient after 6 months, and the other was surgically removed (segmentectomy V, VI) after 4 months after OLT without recurrence at 18 months of resection. In the third case a focal lesions was detected in the U.S. and T.C. study, 4 months after OLT, but in wasn't possible to obtain a biopsy because its posterior location; no treatment was made, and she's alive today. In conclusion, OLT is a good surgical option for non resectable HCC complicating cirrhosis if the patient is adequately selected. Chemoembolization has a good local effect, obtaining tumoral necrosis, but it does not decrease the posterior growth of the tumor in other localizations.