Background: Alcoholic liver disease (ALD) includes a wide clinical spectrum from acute alcoholic hepatitis to severe cirrhosis and/or hepatocellular carcinoma. Until now, there has been no report revealing the bleeding tendency of ALD compared to other diseases in liver transplantation (LT). Thus, we analyzed blood loss and transfusion amounts during operation according to the etiologies of liver disease and model for end-stage liver disease (MELD) score. Methods: Out of 874 recipients who underwent LT, a total of 146 patients were excluded by our exclusion criteria. We compared 728 recipients’ baseline characteristics, operation time, blood loss, and transfusion amounts between ALD and nonALD according to MELD score. Results: The number of patients in the ALD group was 130 (17.9%), and 598 (82.1%) in the non-ALD group. The ALD group showed younger age, higher MELD score, and a higher proportion of deceased donor LT than the non-ALD group. Intraoperative blood loss and transfusions of red blood cells (RBCs), fresh frozen plasma, and platelets were significantly higher in the ALD group. When stratified by MELD score (cut-off: 20), ALD patients in both high and low MELD subgroups demonstrated greater blood loss and RBC transfusion requirements, even when international normalized ratio and platelet counts were similar. In multivariate logistic regression analysis, ALD was a significant risk factor for massive transfusion (odds ratio 1.813, 95% confidence interval 1.158–2.840, p=0.009). Conclusion The ALD group showed increased bleeding tendency than the non-ALD group during LT, irrespective of MELD score. This suggests that transplant surgeons should anticipate greater blood loss and ensure adequate transfusion resources during LT for ALD patients.

PURPOSE: We wanted to clinically evaluate the antibiotic therapy used from pre- to postlaparoscopic cholecystectomy along with the improved surgical techniques and instruments and the patient nutrition. METHODS: We prospective studied 105 patients who were treated with laparoscopic cholecystectomy for acute and chronic cholecystitis at Busan St. Mary Hospital from March 2007 to January 2008. The two groups were divided as follows: (A) the group was not injected with antibiotics, and the other group (B) was injected with antibiotics. We did not used antibiotics when the patient had no acute aggravating symptoms, and we exclude the patients with old age (<70 years), a past history of diabetes mellitus (DM) or hypertension (HTN), and a past operation history. RESULTS: Between the two group, there was no difference when they were compared for age, BMI (Body Mass Index), the operation time (minute) and the length of the hospital stay: (A) Group 49.3+/-13.0 years, 24.4+/-3.2 kg/m2, 37.9 +/- 10.0 minute and 4.6 +/- 1.3 days, respectively, and (B) Group 55.9+/-15.6 years, 23.5+/-3.5 kg/m2, 43.2 +/- 23.8 minute and 5.5 +/- 2.5 days, respectively. There was a significant different in the leukocyte count and the % of neutrophils: (A) Group 6396microliter(-1) and 53.4%, respectively and (B) Group 9354microliter(-1) and 66.6%, respectively. In (B) group, there were 2 cases of atrial fibrillation, 1 case of diarrhea and 1 case of wound seroma. There were no surgical related complications in group (A). CONCLUSION: For the well nourished chronic cholecystitis patients, the use of the prophylatic antibiotics may be less effective because of the many drug-induced side effects. More studies about the use of prophylactic antibiotics are needed.
Anti-Bacterial Agents ; Atrial Fibrillation ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Diabetes Mellitus ; Diarrhea ; Humans ; Hypertension ; Leukocyte Count ; Prospective Studies ; Seroma