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Although they also showed that estimated whole-blood tacrolimus concentrations could be obtained from washed erythrocyte concentrations this seems difficult to implement in every center. Borrows et?al. compared factors linked to whole-blood trough-level bias when using MEIA as compared with HPLC [11]. They found that the time since transplantation, oral antimicrobials, and the recipient��s age were independently and positively correlated with the bias, whereas estimated creatinine clearance, hematocrit, serum albumin, infective diarrhea, oral prednisolone, MMF-related diarrhea, and tacrolimus dose were independently and negatively associated with the immunoassay http://www.selleckchem.com/products/Adriamycin.html bias [11]. However, this study reported no bias as large http://www.selleck.cn/products/LY294002.html as those reported by Heramida & Tutor [10] or in the present case report (where a nil concentration was taken as an elevated one). We conclude that when high tacrolimus concentrations are observed in transplant patients for no apparent reason when the ACMIA method is used, these should be reassessed immediately using another technique to rule out falsely elevated or even false positive results. LR, OC, AGJ, NK: took care of the patient. PM, ML, FSM: in charge of the lab data analysis. ""I read with interest the study from Pratschke et?al. [1] recently published in Transplant International analyzing the effects of an intraoperative porto-caval catheter shunt on graft function and survival. Decreased levels of transaminases during the first post-transplant week were observed in the shunt group with no differences in allograft function. Nevertheless, differences in early graft loss were found with an extremely low rate in shunted patients, only one case of primary graft nonfunction (PNF) in 274 recipients, while this was 6.9% in patients without a shunt (12 cases overall with 7 cases of PNF in 174 recipients) (P? http://www.selleckchem.com/products/obeticholic-acid.html The authors explain the beneficial effect on transaminase levels in patients with a shunt by a significant increase in portal blood flow following reperfusion, together with the avoidance of mediator release from splanchnic congestion. In addition, long-term graft survival excluding patients with PNF was superior when a porto-caval shunt was used (108?months vs. 88.5?months, P?=?0.002). Although these are remarkable findings, some more data are needed to understand their relationship with the usage of a porto-caval catheter shunt. It has been demonstrated that portal flow varies during the transplant procedure with clear differences between the immediate post reperfusion flow and that observed after biliary reconstruction [2]. Moreover, independent variables, not studied by the authors, such as portal hypertension, graft steatosis, cardiac output, or hyperdynamic status, may influence hepatic hemodynamics.