IMPACT OF EXPERIENCE ON RISK OF BILIARY COMPLICATIONS IN LIVING-DONOR LIVER TRANSPLANTION
Bibliographic record
Abstract
P496 Aims . The reported frequency of biliary complications after living donor liver transplantation (LDLT) of the right lobe grafts is >30%. Whether this high rate is inherent to the procedure or reflects surgical experience is poorly defined. Methods. We therefore analyzed the rate of biliary tract complications in 61 patients (age range 14-71 years; 59% male) that received right lobe LDLT between May 00 and June 03 and lived > 30 days. Biliary reconstruction consisted of 42 single anastomoses (25 single duct, 17 double-ducts plastied together), 16 double anastomoses for two ducts, and 5 triple anastomoses for three ducts Donor bile duct(s) was drained into a roux-en Y of jejunum (n=31) or the native bile duct (n=30). Temporary internal stents were used in 18 patients. Complications were recorded prospectively. Results. A bile leak was identified in 11 patients (cut-surface (n=5), bile duct (4), roux (2)) at 13±9 days after surgery. Leaks were successfully treated by open (n=9) or percutaneous drainage (n=2). Stricture developed in 9 patients at 129±110 days; 6 were treated with percutaneous (5) or endoscopic dilation (1), 1 was repaired surgically, and 2 with mild strictures received antibiotics alone for cholangitis. The frequency of bile duct complication within the first 6 months was 47% in the first 30 patients and 17% in the last 31 patients (p=0.02 by log rank test). Biliary complications have not developed after the first 6 months. The rate of biliary complications was not affected by the method of biliary drainage (roux 36% vs duct 21%); use of internal stents (stent 27%, no stent 37%); or the number of anastomoses. Patient and graft survival rates at 1 year were similar in the first 30 and last 31 patients (87% and 86% vs. 88% and 85%). No grafts have failed because of a biliary complication. Conclusion. The frequency of biliary complications declines with experience. As for other complex surgical procedures, volume of activity may be a critical determinant of outcome. Transplantation, Volume 78, Number 2, July 27, 2004
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".