Risk factors and prevention of biliary anastomotic complications in adult living donor liver transplantation

To evaluate risk factors of biliary anastomotic complications （BACs） and outcomes according to type of biliary reconstruction. METHODS： A total of 33 consecutive adult living donor liver transplantation （LDLT） were reviewed, 17 of which had undergone Duct-to-Duct anastomosis （D-D）. The remaining 16 patients received Roux-en-Y anastomosis （R-Y）. The perioperative factors, such as the type of graft and the number of graft bile ducts, were analyzed retrospectively. RESULTS： The overall incidence of BACs was 39.4%. The incidence of BACs was significantly higher in the patients with than without neoadjuvant chemotherapy （71.4% vs 10%, P = 0.050）. There was no significant difference in the incidence of biliary leakage in patients with D-D vs. those with R-Y. The incidence of biliary strictures following the healing of biliary leakage was significantly higher in D-D （60%） than in R-Y （0%） （P = 0.026）. However, the incidence of BACs related bacteremia was significantly higher in R-Y than in D-D （71.4% vs 0%, P = 0.008）. In D-D, use of T-tube stent remarkably reduced the incidence of 8ACs, compared with straight tube stent （0% vs 50%, P = 0.049）. CONCLUSION： Our experience showed an increase of BACs related bacteremia in the patients with R-Y. Therefore, D-D might be a preferred biliary reconstruction. However, the surgical refinement of D-D should be required because of the high incidence of biliary strictures. Use of the T-tube stent might lead to a significant reduction of BACs in D-D.

Structure of vitreous body and its relationship with liquefaction

The aim of the study is to clarify the vitreous body structure and liquefaction phenomena. It was found that when melting a frozen rabbit vitreous body, the gel-sol transition phenomenon occurs and the gel structure is broken. This is almost like the liquefaction of the vitreous body in vivo. We try to clarify the liquefaction phenomenon by using this animal model. The native vitreous body has three dimensional meshwork structures. After liquefaction, it is changed into two parts, namely fiber aggregates and soluble amorphous aggregates. The surface of native vitreous body meshwork is mucopolysacharide, but that of fiber aggregates after liquefaction is changed into connective tissue, which means the conformational change of vitreous body in liquefaction. The soluble proteins after liquefaction were analyzed and identified as crystallin family. It is suggested that the liquefaction is induced by detachment of non-collagenous protein beads containing crystallins, resulting in the collapse of the three dimensional structure to release watery liquid trapped within. And the new gel-sol transition model of vitreous bod is proposed.