Journal of Gastrointestinal Surgery 566 Abstracts group of patients it becomes vitally important to correctly identify the presence and size of the tumor. The assessment of such patients according to UNOS recommendations should include ultrasound of the patient’s liver, a CT or MRI of the abdomen that documents the tumors, a CT of the chest that rules out metastatic disease, and the alpha-fetoprotein level. We used the database of our Liver Transplant Center to analyze the relationship between the preoperative diagnosis and results of the pathological examination of explanted liver. We also used our data to assess the impact of the tumor on the transplant outcome. We realize the limitations of this study due to small number of patients and short follow-up time (average 421 days, SD 297 days). Our Liver Transplant Program is young, having started in 2002. Of 36 liver transplants performed at our center by 10/12/2004, 19 patients had liver tumor diagnosis before or after transplant. One had angiosar- coma, one had leiomyosarcoma, three had CCC, and 14 had HCC; 11 patients were diagnosed with HCC preoperatively and 10 of them received UNOS priority status; and 7 of 14 patients had elevated AFP. MRI was most sensitive tool in our hands (11 of 14), far better then conventional CT (3 of 14) or ultrasound (4 of 14). Three of 14 patients had HCC detected only after transplant (incidentals). In 9 of 14 patients HCC diagnosis was documented by pathology of explanted liver or by preoperative biopsy. Average MELD score for this group of patients was 22.5 (mean 24, ST 7.4). Average time on waiting list was 151 day (median 130, ST 98). Six of 14 patients received preoperative treatment for HCC. One patient died after transplant from sepsis. No recurrences were detected so far. Preoperative detec- tion of the liver tumors in liver transplant candidate has important implications on the priority status of the patient and on the postopera- tive prognosis. Preoperative MRI in our hands appears to be the best test to detect the HCC in liver transplant candidates. The correla- tion of preoperative and postoperative staging is poor (5 of 11 preoper- ative HCC diagnoses were not conformed by pathology or biopsy, 3 of 7 explanted liver HCC diagnoses were not detected preoperatively). Further follow-up studies will be necessary to determine the clinical significance of these findings. Perhaps newer more sensitive and more specific diagnostic modalities will help to improve the detection and staging of the liver tumors in liver transplant candidates in the future. 154 CUTANEOUS SCEDOSPORIASIS AFTER LIVER TRANSPLANTATION: REPORT OF A SUCCESSFULLY TREATED CASE Kristian Noto, MD, David J. Reich, MD, Abdaal Khan, MD, Paola Solari, MD, Jose Briceno, MD, Oscar Martinez, MD, Vergillio Mathews, MD, Cosme Manzarbeitia, MD, Albert Einstein Medical Center, Philadelphia, PA Long-term immunosuppression places transplant recipients at an in- creased risk of acquiring opportunistic infections. Scedosporium api- ospermum (SA), the asexual form of the fungus Pseudallescheria boydii, has been sporadically reported as the cause of both cutaneous and disseminated infections in transplant recipients, often with fatal conse- quences. A 68-year-old white male presented with an asymptomatic 17-mm red plaque on the dorsum of his right foot 5 months after liver transplantation for Stage 2 hepatocellular carcinoma in the setting of hepatitis C. The borders of the lesion were well demarcated and slightly elevated. There was no pain to palpation or increased tempera- ture. The patient was a farmer in central Pennsylvania and denied any trauma or barefoot walking. His immunossupression consisted of tacrolimus and prednisone. Punch biopsy reported the presence of hifae and spores, and the culture grew SA. Management consisted on tempo- rary reduction of tacrolimus as well as oral itraconazole. The lesion was then excised surgically with 1-mm margins and the patient continued antifungal treatment for 21 days. The specimen contained dark spores and hifae. The culture confirmed SA, susceptible to itraconazole. One year later the patient is doing well, without evidence of recurrent fungal disease and with excellent graft function. SA infection after liver transplantation has been shown to progress to invasive disease when opportune and appropriate therapy is not instituted. This case illustrates that aggressive treatment of SA infection after liver transplant can lead to successful eradication of this potentially fatal pathogen. 155 EXPERIENCE WITH 151 SUPRACELIAC AORTIC ANASTOMOSIS FOR ARTERIAL REVASCULARIZATION IN LIVER TRANSPLANTATION Karl J. Oldhafer, Alexandra Denz, Hans J. Schlitt, Celle General Hospital, Celle, Germany; Klinikum Lippe-Detmold, Detmold, Germany; University of Regensburg, Regensburg, Germany Between 1991 and , the aortic anastomosis for arterial reconstruction was encouraged at our institution to achieve high perfusion pressures for the liver allograft and to avoid technical problems in case of anatomical variations or small sizes of the hepatic artery. The aim of this study was to analyze the experience with the supraceliac aortic anastomosis for arterial revascularization during liver transplantation in this time period. Between January 1991 and January 1996, 367 liver transplantations were performed. Pediatric patients and patients receiving split-livers or auxiliary transplants were excluded from this study; 151 adult patients receiving a new liver with aortic anasto- moses were analyzed. The 1-year survival rate was 59% (79/133). After 3 years 69 (52%) patients were alive. The causes of death were sepsis (n = 38), recurrent diseases (n = 11), pneumonia and respiratory failure (n = 6), and brain death (n = 3). The overall rate of hepatic artery-related complications was 28 complications in 17 transplants (17/151; 11%). The most frequent artery related complications were 12 arterial occlusions in 11 transplants in 11 patients (12/28; 43%). Stenosis was observed in 6 of 28 complications (6/28; 21%) Bleeding from the side of the anastomosis occurred at the same rate (6/28; 21%). Kinking of the hepatic artery was observed in 3 cases (3/ 28; 11%). The rate of re-transplantation after hepatic artery complica- tion was 40% (6/15) and the 1-year survival after arterial complication was 47% (7/15). Arterial occlusion of the hepatic artery occurred in the early postoperative phase as well as in the later course. The presence of variations of arterial anatomy of the transplanted liver and the need for arterial reconstruction have no statistically significant impact on the rate of arterial occlusion. The only significant risk factor for arterial occlusion was the re-use of vascular graft from the first transplantation if re-transplantation was performed. If there is any doubt about a sufficient arterial blood supply or the possibility of a perfect arterial anastomosis, an aortic anastomosis should be used for re-vascularisation. As demonstrated in this study, this is an equivalent way of arterial reconstruction, it is a well-known treatment for arterial complications, and it is advantageous in cases of anatomical variations of the graft’s arterial supply as complex arterial reconstruction can be avoided in most cases. 156 THE INCLUSION OF THE MIDDLE HEPATIC VEIN IN PARTIAL LIVER GRAFTS Jorge M. Padilha, MD, M.A.F. Ribeiro, Jr., L.C. D′Albuquerque, J.L.M. Copstein, G. Peron, F. Serpa, M. Casagrande, A.O. Silva, Beneficiencia Portuguesa Hospital, Sao Paulo, Brazil In Brazil, the living related liver transplantation (LRLT) has increased in the last few years due to the insufficiency number of organ donors as well as to the exponential increase in the number of patients in the waiting list. Nearly 25% of the liver transplant cases performed