studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 629A
were more likely to die from technical/operative complications
or multi-organ failure/hemorrhage than “Normal.” Pre-transplant
functional status is a reliable predictor of postoperative
mortality for US liver transplant recipients.
Disclosures:
The following authors have nothing to disclose: Natasha Dolgin, Paulo N. Martins,
Adel Bozorgzadeh
846
Recanalization of complete anastomotic biliary obstruction
after liver transplantation by using a through the
scope magnet: A case series
Erkan Parlak 1 , Fahrettin Küçükay 2 , Aydin Koksal 1 , Ahmet T. Eminler
1 , Mustafa I. Uslan 1 ; 1 Gastroenterology, Sakarya University,
Faculty of Medicine, Sakarya, Turkey; 2 Radiology, Yüksek Ihtisas
Hospital, Ankara, Turkey
Aim: It is necessary to traverse a guidewire through the anastomotic
biliary obstructions after liver transplantation in order to
perform an endoscopic and/or percutaneous treatment. Otherwise
the patient either undergoes a surgical revision or lives
with an external biliary drainage catheter. Herein we evaluated
the efficacy of a novel ‘’through the scope (TTS)’’ magnet
in patients with anastomotic biliary obstructions. Methods:
The magnetic compression anastomotic (MCA) technique: A
‘’Ni coated cylindirical Neodymium-Iron-Boron rare earth magnet’’with
a 5 mm length and 2.4 mm diameter was advanced
over a guidewire to the proximal site of the obstruction via percutaneous
route and to the distal site of the obstruction through
a duodenoscope (Figure). Magnets were removed after recanalization
was achieved. The patients were put on a stent
exchange programme. Results: One hundred and ten patients
(93 LRLT, 17 OLT) with biliary anastomotic stricture underwent
ERCP. TTS MCA was performed in 7 of them (5 LRLT, 2 OLT).
The procedure was unsuccesfull in 2 LRLT patients with dual
anastomosis because of long strictures. The procedure was
successfull in the remaining 5 patients. All of them had a priorly
placed external biliary drainage catheter. Recanalization was
achieved after a mean duration of 9 days (range:5-14). No
magnet related complications were observed. Conclusions: TTS
MCA is effective and safe in the treatment of complete anastomotic
biliary obstructions after liver transplantation. Advantages
and disadvantages with respect to previously defined
larger magnets should be evaluated in future studies in order to
determine its indications.
Disclosures:
The following authors have nothing to disclose: Erkan Parlak, Fahrettin Küçükay,
Aydin Koksal, Ahmet T. Eminler, Mustafa I. Uslan
847
Patient Safety in Living Donor Liver Transplantation –
We have a lot to learn
Daniela Ladner 1 , Elizabeth A. Pomfret 2 , Mary Ann Simpson 2 ,
James V. Guarrera 3 , Robert A. Fisher 4 , Anton I. Skaro 1 , Rebeca
Khorzad 1 , Ella F. Reyes 1 , Amna Daud 1 , Erin Wymore 1 , Andy
Hung-Yi Lee 1 , Donna Woods 1 ; 1 CHS, Northwestern University,
Chicago, IL; 2 Lahey Medical Center, Boston, MA; 3 Columbia Medical
Center, New York, NY; 4 Virginia Commonwealth University,
Richmond, VA
Background: Living donor hepatectomies (LDH) are amongst
the most scrutinized surgeries by clinicians and patients alike.
Hence, LDH are probably amongst the most streamlined surgeries
performed today. To examine the streamlining we focused
on equipment, an essential element to LDH. Equipment malfunction
(EM), has been reported in other settings to lead to patient
injury and in fact, 6% of deaths in hospitalized patients were
found to be related to equipment errors. Methods: Direct or
video observation were conducted at four large LDLT centers
(Feb 2012 - March 2014). Web-based Safety (WBS) Debriefings
were sent to every clinician (e.g. nursing, physician, technician)
who participated in an LDH. Results: 110 LDHs were
debriefed and 22% of all debriefings, reported issues related
to equipment. Of those 21% related to incorrect, incomplete or
unavailable instruments, 17% problems related to disposable
accessories, 7% with surgical lights/monitors and 7% with surgical
bed (missing/not working). 34 LDH which were directly
or video observed, demonstrated equipment related issues in
100% of the cases. Similar issues were observed as reported
through WBS, but in addition provider’s frustration, lack of