糖皮质激素治疗肝衰竭及高胆红素血症患者的临床研究及安全性评价

目的探索应用糖皮质激素治疗肝衰竭或高胆红素血症患者的临床疗效及安全性。方法选取第四军医大学唐都医院2012年12月-2016年1月收治的76例急性/亚急性肝衰竭和高胆红素血症患者,其中对照组28例,给予常规内科综合治疗,治疗组48例,在常规内科综合治疗基础上给予糖皮质激素治疗(地塞米松10 mg,1次/d,2 d后减量至5 mg,1次/d,2 d,最后减量至2mg,1次/d,维持3 d),观察两组患者的临床疗效和并发症。结果两组患者治疗前血清总胆红素(TBil)、凝血酶原活动度(PTA)、白蛋白(ALB)水平差异无统计学意义(P0.05);治疗1周后,治疗组TBil水平(228.3±97.2)μmol/L较对照组(276.4±73.2)μmol/L降低(P=0.001),PTA(44.3±12.9)%较对照组(39.9±18.3)%提高(P=0.017),但ALB水平两组比较差异无统计学意义[(32.2±2.3)g/L vs(33.9±7.8)g/L,P=0.184)];两组间各种并发症的发生率比较,差异无统计学意义(P0.05);治疗组的救治成功率(60.4%)明显高于对照组(35.7%),差异有统计学意义(P=0.038)。结论糖皮质激素治疗可以提高急性/亚急性肝衰竭和高胆红素血症患者救治的成功率,在严格把握糖皮质激素适应证和治疗时机的前提下,其临床应用具有较好的安全性。     

原位肝移植术后胆道并发症诊治134例

目的:探讨原位肝移植术后胆道并发症的预防和治疗.方法:回顾性分析2004-10/2006-01施行的134例肝移植患者的临床资料.结果:18例患者(共20例次)出现胆道并发症,治愈17例,1例放弃治疗.其中胆道狭窄12例次,胆漏2例次,胆管结石6例次.与T管相关的胆道并发症发生率为11.7%(14/120).胆道并发症组冷缺血时间(624min)和二次热缺血时间(60min)均高于无胆道并发症组(384min,43min,均P<0.05).结论:保存性损伤和缺血性损伤是肝移植术后胆道并发症的重要原因.术后早期胆道造影并联合应用核磁共振胆管成像有助于及时诊断胆道并发症.介入技术是胆道并发症的主要治疗手段.     

茵陈芍药汤加减治疗重型肝炎高胆红素血症100例

高胆红素血症,是重型肝炎发病过程中常见的一种严重并发症和临床表现之一,又是加重重型肝炎患者病情的重要因素.通过对古代和近代文献的分析,并结合现代研究成果,认为高胆红素血症的病因病机是湿热毒淤,湿热是其基本病因,毒瘀是其发生发展过程中的病理产物.自2001年以来,我院采用茵陈芍药汤加减治疗重型肝炎高胆红素血症100例,现报告如下.     

综合疗法治疗早产儿高胆红素血症126例临床分析

2004年2月～2008年12月,我院采用综合疗法治疗早产儿高胆红素血症126例,取得较好疗效.现报告如下. 临床资料：126例高胆红素血症患儿中,男78例、女48例,胎龄（33.0±2.57）周,出生体质量900～2 800 g,血清胆红素≥255 μmol/L.病因为感染60例（肺炎36例、败血症8例、脐部感染9例、其他7例）,围产因素34例（窒息8例、宫内窘迫7例、难产5例、其他2例、产妇妊高征12例）,ABO溶血11例,母乳性黄疸6例,其他15例.     

胆红素吸附治疗心脏术后高胆红素血症的临床效果

目的 探讨胆红素吸附治疗心脏术后高胆红素血症患者的有效性和安全性。 方法 回顾性的分析我院2017年1月~2018年12月应用胆红素吸附治疗的11例心脏术后急性肝功能不全患者的临床数据。记录患者基础疾病、心脏手术名称、术后胆红素升高时间及治疗前后肝功能、胆红素、凝血功能等指标变化。 结果 患者11（男7,女4）例,年龄（45±13）岁,体外循环时间（226±104）min。治疗前血清总胆红素（409±137）μmol/L,直接胆红素（321±100）μmol/L,治疗后血清总胆红素（298±107）μmol/L,直接胆红素（166±111）μmol/L,治疗前后差异具有统计学意义（分别P<0.05,P<0.01）。转氨酶、血清总蛋白、白蛋白、国际标准化比值（INR）、血小板计数、白细胞计数、血红蛋白、尿素氮、肌酐在治疗前后差异无统计学意义。11例患者胆红素吸附共治疗22次,8例患者治疗1次,其余3例患者分别治疗2次、5次、7次。血清总胆红素下降率2.8%~47.6%。4例存活,7例死亡,生存率36%。治疗过程中未发现治疗相关副作用。 结论 胆红素吸附治疗心脏术后高胆红素血症的是一种安全较为有效的降低胆红素及肝脏支持系统技术。     

ERCP治疗肝移植术后胆道并发症的研究

目的 本研究旨在回顾本研究中心行经内镜逆行胰胆管造影(ERCP)治疗肝移植后胆道并发症的经验。方法 回顾性分析2017年4月到2021年4月武汉大学中南医院因肝移植术后胆道并发症行ERCP治疗患者的临床资料,根据患者当次ERCP指征分为吻合口狭窄组、胆结石组和胆漏组。收集不同类型胆道并发症患者的一般资料及每次行ERCP时的实验室检查、治疗结果,并对数据进行统计分析。结果 52位患者共行108例次ERCP,48人插管成功,共101例次(93.5%),治疗成功100例次(99.0%),中位操作次数为2(1～2)例次/人。吻合口狭窄病人主要行支架置入、鼻胆管引流、胆道扩张(包括球囊扩张及金属探条扩张)治疗。肝移植术后,胆漏的发病时间最早,中位时间47.5(16～793)d;发生吻合口狭窄的时间次之,中位时间390(8～2105)d;发生胆管结石的时间最晚,中位时间855(125～2 749)d;其差距具有统计学意义(P<0.01)。患者经ERCP治疗后肝功能指标(ALT、AST、TBiL、GGT)均较治疗前明显下降,差异有统计学意义(P<0.01)。发生术后高淀粉酶血症19例次(...     

人工肝血浆置换治疗淤胆型肝炎高胆红素血症的临床分析

目的探讨人工肝血浆置换治疗淤胆型肝炎高胆红素血症的疗效。方法将72例淤胆型肝炎高胆红素血症患者随机分为两组:对照组34例采用综合支持治疗,治疗组38例在综合支持治疗基础上增加人工肝血浆置换。结果治疗组38例,显效30例(78.95%),有效4例(10.53%),无效4例(10.53%),总有效率89.47%;对照组34例,显效8例(23.53%),有效10例(29.41%),无效16例(47.06%),总有效率52.94%。治疗后总有效率治疗组明显高于对照组(P<0.01)。结论人工肝血浆置换治疗淤胆型肝炎的高胆红素血症效果良好。     

活体肝移植治疗胆道闭锁儿童临床疗效研究

目的 分析比较采用Kasai术后肝移植术或直接肝移植术治疗胆道闭锁(BA)儿童的临床疗效。方法 2010年9月～2016年10月我科收治的BA儿童74例,其中在Kasai术后接受活体肝移植治疗38例,直接行活体肝移植治疗36例,随访3年。采用Kaplan-Meier生存分析。结果 序贯组接受活体肝移植时中位月龄为12.5(5.8,72.5)个月,显著大于肝移植组[7.2(5.8,36.8)个月,P<0.05],体质量为(12.8±5.2)kg,显著大于肝移植组[(10.2±6.6)kg,P<0.05],术前血清胆红素水平为158.4(20.4,500.8)μmol/L,显著低于肝移植组[250.9(60.8,468.0)μmol/L,P<0.05],儿童终末期肝病模型(PELD)评分为(12.5±9.6),显著低于肝移植组[(20.8±15.4),P<0.05],两组移植物质量、供肝质量与受体体质量比(GRWR)、热缺血时间、冷缺血时间、术中失血量和术中输血量等无显著性差异(P>0.05);在活体肝移植术后,肝移植组患儿并发症发生率为55.6%(20/36),显著低于序贯组[68.4%(26/38),P<0.05];在术后1 m、1 a和3 a,序贯组累积生存率为97.3%(37/38)、94.7%(36/38)和89.5%(34/38),肝移植组分别为97.2%(35/36)、91.7%(33/36)和86.1%(31/36),两组之间无显著性差异(P>0.05)。结论 对于BA患儿,可考虑直接接受活体肝移植手术治疗,以获得较好的临床结局。     

肝移植术后中枢神经系统并发症的特点及危险因素分析

目的 探讨肝移植术后中枢神经系统并发症(CNSC)的种类、发生率、危险因素及预后.方法 回顾性分析159例原位肝移植(OLT)患者的临床资料,以术后发生CNSC者为Ⅰ组,无CNSC者为Ⅱ组,比较两组各项临床参数.结果 本组OLT术后CNSC发生率为20.1%(32/159).弥漫性脑病占75%(24/32),桥脑中央髓...     

胰性胸水13例临床分析

急性胰腺炎并发胸水13例(64％),其中胆源性胰腺炎6例(46％),酒精性胰腺炎3例(23％),暴食1例,高胆红素血症1例,不明原因1例,腹部外伤史1例。单有胰性胸水3例(23％),并存于胰性腹水10例(76.9％),其中血性胸水2例。6例大量胸水伴气急,1例发生ARDS,1例MOF。胸水中淀粉酶均在2056u/L～130000u/L,胸水蛋白12例36～51g/L,1例30g/L(原有低蛋白血症)。胸水细菌培养1例肺炎球菌生长(可能并发肺部感染),12例(3次)均阴性,胸水癌细胞及抗酸杆菌检查(3次)均阴性。13例住院过程中,以抗胰酶、制酸及支持等疗法,大量胸水者抽水1～2次,结果内科治愈9例,1例手术治疗。死亡3例,2例分别死于ARDS和MOF,1例慢性酒精性胰腺炎,大量胸腹水,放腹水18次,抽胸水3次,输血6400ml,输血浆2000ml,补充白蛋白400 g等治疗无效,全身衰竭死亡。     

Auxiliary versus orthotopic liver transplantation for acute liver failure. EURALT Study Group. European Auxiliary Liver Transplant Registry

BACKGROUND/AIMS/METHODS: We report 1-year results after auxiliary liver transplantation for acute liver failure in a cohort of 47 patients transplanted in 12 European centers as compared with those of 384 consecutive patients undergoing orthotopic liver transplantation for acute liver failure in the Eurotransplant area. RESULTS: One-year patient survival resp. retransplant-free patient survival did not differ between orthotopic (61%, 232/384 resp. 52%, 200/384) and auxiliary liver transplantation (62%, 29/47 resp. 53%, 25/47). One-year patient survival resp. retransplant-free patient survival after auxiliary partial orthotopic liver transplantation was 71% (25/35) resp. 60% (21/35), not significantly different from orthotopic liver transplantation (61%, 232/384 resp. 52%, 200/384), while both transplantation techniques had better 1-year patient survival resp. retransplant-free patient survival than after heterotopic auxiliary liver transplantation (33%, 4/12) (p < 0.05). Primary nonfunction was more frequent after heterotopic auxiliary liver transplantation (3/12, 25%) than after orthotopic liver transplantation (21/384, 5.5%), while the incidence did not differ between orthotopic liver transplantation and auxiliary partial orthotopic liver transplantation (3/35, 8.5%). Portal vein thrombosis was more frequent after both heterotopic auxiliary liver transplantation (5/12, 42%) and auxiliary partial orthotopic liver transplantation (5/35, 14%) than after orthotopic liver transplantation (2/384, 0.5%) (p < 0.001). Of the patients, 65% (17/26) surviving auxiliary liver transplantation for 1 year without retransplantation by orthotopic liver transplantation were free of immunosuppression within 1 year, compared with none of the patients transplanted by orthotopic liver transplantation (p < 0.01). CONCLUSIONS: Auxiliary liver transplantation, especially auxiliary partial orthotopic liver transplantation, offers an advantage over orthotopic liver transplantation in acute liver failure in terms of a chance of a life free of immunosuppression, apparently without jeopardizing chances of survival. Reduction of the incidence of primary nonfunction and vascular complications should be a focus of research in auxiliary liver transplantation. These findings need to be confirmed in a prospective study.     

Splenectomy for reduction of excessive portal hypertension after adult living-related donor liver transplantation

BACKGROUND/AIMS: We investigated the effects of splenectomy on the reduction of excessive portal hypertension immediately after adult living-related donor liver transplantation, paying particular attention to peritransplanted portal pressure in seven adult patients. METHODOLOGY: We studied the relationship between portal hypertension and hyperbilirubinemia in small-for-size graft liver transplantation. RESULTS: In the three cases, the portal pressures increased beyond 30 cmH2O after living-related donor liver transplantation, despite the right lobe graft, and these patients underwent splenectomy. After splenectomy, their portal pressures decreased below 25 cmH2O. The portal pressure underwent auxiliary orthotopic partial liver transplantation due to the hypercitrullinemia and did not change after surgery (9.5 to 11.5 cmH2O). Interestingly, the hyperbilirubinemia occurring after living-related donor liver transplantation were as the primary result of direct bilirubin except for the patient with citrullinemia. The posttransplanted portal pressures were controlled below 25 cmH2O in all patients, with their peak serum total bilirubin levels not exceeding 15 mg/dL, and the patients were discharged without major complications. Three patients underwent splenectomy, and did not suffer from serious infection. The reduction in excessive portal hypertension after living-related donor liver transplantation might prevent liver injury and post-transplant hyperbilirubinemia. CONCLUSIONS: However, splenectomy remains a life-threatening factor. Therefore, transplant surgeons encountering living-related donor liver transplantation must continue to seek out additional solutions to problems with excessive portal hypertension.     

Neurological complications after liver retransplantation.

Postoperative neurological complications in 185 patients who underwent two or more orthotopic liver transplantations were reviewed. The most common neurological complications were alteration of mental status (84%), seizures (33%) and focal motor deficits (15%). The frequency of neurological complications after a second orthotopic liver transplantation was significantly greater than that after a single orthotopic liver transplantation. However, neurological complications were more frequent after a second orthotopic liver transplantation than after a third transplant. Significantly more neurological complications occurred in patients who did not survive a year than in those who did, regardless of the number of transplants they underwent. These findings indicate that the risk of neurological complications among patients with multiple orthotopic liver transplantations is greater in those who require a second transplant; this risk appears to diminish after a third transplant. Importantly, the presence of neurological complications is associated with increased post-orthotopic liver transplantation mortality rate.     

Biliary tract complications after orthotopic liver transplantation with choledochocholedochostomy anastomosis: endoscopic findings and results of therapy

BACKGROUND: Biliary tract complications are a continuing source of morbidity after orthotopic liver transplantation. This is a retrospective examination of experience with ERCP in patients with biliary tract complications after orthotopic liver transplantation to determine type and frequency of complications and outcome after endoscopic therapy. METHODS: From May 1988 to August 1999, orthotopic liver transplantation was performed 408 times; 4 additional patients who underwent orthotopic liver transplantation at another hospital were also followed. The records of 367 patients who underwent choledochocholedochostomy were reviewed. Of these, 121 underwent 325 ERCPs; 226 ERCPs were performed because of acute problems (typically cholestasis with or without cholangitis), and 99 were for reevaluation of the bile duct, stent change, or stent removal. Three patients underwent ERCP because of pancreatic problems. RESULTS: A biliary complication was identified in 24.5% of patients (90 of 367) and more than 1 complication in 32%. At ERCP, 37 patients (30.5%) had biliary stones; 9 further patients (7.4%) had only sludge. Stones were completely cleared at the initial or a subsequent ERCP. Strictures were found in 55 patients (45.5%), either at the anastomosis (n = 43) or at another site(s) in the donor duct (n = 12). Balloon or bougie dilation followed by stent insertion was performed in 54 patients. Endoscopic therapy was successful in 91% of patients with biliary strictures. A biliary leak/fistulae was found in 22 patients (18.1%) and endoscopic therapy, when attempted, was successful in all. Eight patients had possible sphincter of Oddi dysfunction based on dilated recipient and donor ducts together with elevated liver enzymes. After sphincterotomy, the liver enzymes returned to normal in only one of these patients. Three patients had blood clots in the biliary tree. CONCLUSION: When biliary tract complications are suspected after orthotopic liver transplantation, ERCP identifies biliary abnormalities if present and offers multiple therapeutic options. Endoscopic therapy is usually successful but multiple procedures are often necessary, especially when treating strictures.     

Endoscopic management of postoperative biliary complications in orthotopic liver transplantation

BACKGROUND: Surgery, percutaneous cholangiography, and endoscopic retrograde cholangiopancreatography (ERCP) have been used in the management of biliary complications after orthotopic liver transplantation with varied results. We assessed the role of ERCP in the diagnosis, treatment, and outcome of post-orthotopic liver transplantation biliary complications. METHODS: We retrospectively reviewed the records of 260 patients who underwent orthotopic liver transplantation. We examined the number of patients referred for ERCP and the indication, diagnosis, therapeutic intervention, success, and complication rate of ERCP post orthotopic liver transplantation. We compared the survival and retransplantation rates of the patients who underwent ERCP with a control group of post-orthotopic liver transplantation patients not undergoing ERCP. RESULTS: Of the 260 patients undergoing orthotopic liver transplantation, 64 (24.6%) underwent 137 ERCPs. Two categories of indications for ERCP were identified: bile leak (n = 31) and obstruction (n = 39). ERCP identified the site of the bile leak in 27 of 31 cases (87.1%) and the leak was treated by endoscopic means in 26 of 31 (83.9%). Treatment success differed significantly based on location of the leak (T tube, 95.2% vs. anastomosis, 42.9%; p = 0. 009). ERCP identified the site of obstruction in 37 of 39 cases (94. 9%) and obstruction was relieved by endoscopic means in 25 of 35 cases (71.4%). ERCP was significantly less successful in the treatment of biliary casts (25.0%, p = 0.048). There was no difference in survival or retransplantation between patients who did and did not undergo ERCP. CONCLUSION: ERCP should be the primary method for diagnosis and treatment of post-orthotopic liver transplantation biliary complications. Endoscopic therapy is safe and effective for the majority of post-orthotopic liver transplantation complications and temporizes management for those complications that may require surgery.     

Colorectal disease in liver allograft recipients -- a clinicopathological study with follow-up

OBJECTIVE : To determine the spectrum and outcome of colorectal diseases occurring in adult liver allograft recipients. DESIGN : A retrospective cohort analysis of clinical, microbiological and histopathological data regarding colorectal disease. PATIENTS : Forty three out of 302 adult primary liver allograft recipients were transplanted and followed up (at median 42 months) at a tertiary referral centre/teaching hospital. RESULTS : Out of 302 patients, 43 (14%) were investigated (by endoscopy and/or laparotomy) for symptoms of colorectal disease after orthotopic liver transplantation. The symptoms were: diarrhoea (n = 31); per-rectal bleeding (n = 5); and symptoms relating to pre-transplant ulcerative colitis (n = 7). Among the patients without known ulcerative colitis, per-rectal bleeding occurring early after orthotopic liver transplantation was most commonly caused by cytomegalovirus colitis and carried a poor prognosis. Excluding ulcerative colitis, the commonest causes of diarrhoea were Clostridium difficile, cytomegalovirus infection and medications, particularly during the first 2 months after orthotopic liver transplantation. No cases of colorectal graft-versus-host disease, cryptosporidiosis, amoebiasis, atypical mycobacterial infection or post-transplant lymphoproliferative disease were demonstrated. The activity of pre-transplant ulcerative colitis was unchanged or increased after orthotopic liver transplantation. Two further patients developed new-onset ulcerative colitis after orthotopic liver transplantation. CONCLUSIONS : Ulcerative colitis, C. difficile, cytomegalovirus infection and medications are the commonest colorectal causes of morbidity after orthotopic liver transplantation. Adult liver allograft recipients are, however, unlikely to show certain large bowel diseases encountered in other immunosuppressed groups. Amongst non-ulcerative colitis patients, those presenting with diarrhoea show a good outcome with appropriate management, whereas those with per-rectal bleeding have a more guarded prognosis.     

Liver retransplantation:report of 80 cases and review of literature

BACKGROUND: Because the orthotopic liver transplantation (OLT) was performed widely in recent 5 years throughout China, the proportion of recipients whose graft function deteriorated to be retransplantation candidates increased gradually. This study was undertaken to analyze clinical experience of orthotopic liver retransplantation (re-OLT) at our center. METHODS: The medical records of 80 patients who had undergone liver retransplantation at our center from January 1999 to July 2005 were analyzed retrospectively, including indications and timing of retransplantation, surgical techniques, and the causes of death. RESULTS: The commonest cause leading to hepatic graft loss and subsequent retransplantation was biliary complications in 36 patients (45%). The patients underwent retransplantation more than 30 days after their primary transplant recovered better than those who underwent retransplantation within 8-30 days after primary transplantation (peri-operative mortality 19.6% versus 70%). Sepsis (12 of 22 patients, 54.5%) and multiple organ failure (4 of 22 patients, 18.2%) were leading causes of re-OLT recipient deaths. CONCLUSIONS: Proper indications and optimal operative time, surgical procedures, perioperative monitoring and appropriate postoperative treatment contribute to the improvement of the survival rate of patients after liver retransplantation.     

Fatal hyperammonemia after orthotopic lung transplantation

BACKGROUND: A case of fatal hyperammonemia complicating orthotopic lung transplantation was previously reported. OBJECTIVE: To describe the incidence, clinical features, and treatment of hyperammonemia associated with orthotopic lung transplantation. DESIGN: Retrospective cohort analysis. SETTING: Academic medical center and lung transplantation center in Philadelphia, Pennsylvania. PATIENTS: 145 sequential adult patients who underwent orthotopic lung transplantation. MEASUREMENTS: Plasma ammonium levels. RESULTS: Six of the 145 patients who had had orthotopic lung transplantation developed hyperammonemia, all within the first 26 days after transplantation. The 30-day post-transplantation mortality rate was 67% for patients with hyperammonemia compared with 17% for those without hyperammonemia (P = 0.01). Development of major gastrointestinal complications (P = 0.03), use of total parenteral nutrition (P < 0.001), and lung transplantation for primary pulmonary hypertension (P = 0.045) were associated with hyperammonemia. CONCLUSIONS: Hyperammonemia is a potentially fatal event occurring after orthotopic lung transplantation. It is associated with high nitrogen load, concurrent medical stressors, primary pulmonary hypertension, and hepatic glutamine synthetase deficiency.     

Etiology and Incidence of Unconjugated Hyperbilirubinemia after Orthotopic Liver Transplantation

Obfectives: Gilbert's syndrome, or slow bilirubin glucuronidation phenotype, is a common cause of benign hyperbilirubinemia in the general population. There have heen only two previously reported cases of Gilbert's syndrome occurring in patients after liver transplantation. This study was conducted to determine the frequency of Gilbert's syndrome in liver transplant recipients. Methods: The charts of all patients followed by the Mayo Liver Transplant Clinic for 1 yr or more after transplantation, as of June 1992, were reviewed to identify all patients with a consistent pattern of unconjugated hyperbiliruhinemia greater than two times the upper limits of normal and with a normal conjugated bilirubin level. These patients were further evaluated to exclude all other causes of hyperbilirubinemia, including biliary obstruction, rejection, viral infection, cholestatic liver disease, and hemolysis. Resutts: Five of 229 patients (2.2%) had a consistent pattern of unconjugated hyperbiliruhinemia. Only three patients (1.3%) had no other identifiable cause of hyperbilirubinemia. Conclusions: This study was performed to determine the incidence of unconjugated hyperbilirubinemia and particularly to determine the incidence of Gilbert's disease in liver transplant recipients. The apparently low frequency of Gilbert's after liver transplantation may reflect the masking of the diagnosis by other transplant-associated pathology or donor selection bias because of unexplained hyperbilirubinemia. Post-transplant patients who fit the Gilbert's syndrome profile of unconjugated hyperbilirubinemia should have a postprandial bilirubin drawn as a first step. The awareness of this syndrome may avoid a costly and invasive evaluation in the liver transplant recipient.     

National survey about management and treatment options of hepatitis C recurrence after liver transplantation

BACKGROUND: Recurrence of hepatitis C after orthotopic liver transplantation is one of the major clinical challenges faced by the liver transplantation community. Treatment of hepatitis C recurrence with peguilated interferon and ribavirin has been associated with sustained virological response in 21% to 45% of treated patients. Furthermore, it has been shown to halt disease progression after orthotopic liver transplantation and to prevent graft failure and the need for retransplantation at least in those subjects with sustained virological response. However, treatment of hepatitis C recurrence after orthotopic liver transplantation in Brazil was not recommended according to ministerial Law number 863. AIMS: To assess the management and treatment options of hepatitis C recurrence after orthotopic liver transplantation in different liver transplantation centers in Brazil. METHODS: Inquiries were sent to active liver transplantation centers throughout the country. RESULTS: Nineteen centers accepted to participate and answered the questionnaire. Altogether they transplanted around 2,800 subjects, half of them with hepatitis C. Immunosuppressive regimen is comprised by tacrolimus and short-term prednisone in 53% of the centers. One third of them claim to use different schedules for hepatitis C patients. Protocol biopsies for diagnosis of recurrence are employed by 13 centers. Different histological criteria are used for the either diagnosis or decision for treatment in most of the centers. Approximately half of them (42%) indicate treatment in subjects with less severe stages of fibrosis (less than F2 according to METAVIR classification). All centers are referring patients for treatment with peguilated interferon and ribavirin, for 1 year, for 6 months or 1 year based on the genotype, or a la carte based on response, respectively, in 32%, 21% and 47% of the centers. Most of them (84%) do not stop treatment in early non-responders at the 12th week. CONCLUSIONS: Even in the absence of national guidelines and federal support, most of the liver transplantation centers in Brazil are treating patients with hepatitis C recurrence after orthotopic liver transplantation.