Small‐for‐size graft in living donor liver transplantation: How far should we go?

Tetsuya Kiuchi, Koichi Tanaka, Takashi Ito, Fumitaka Oike, Yasuhiro Ogura, Yasuhiro Fujimoto, Kohei Ogawa – 30 December 2003 – With the extensive use of living donor liver grafts in adult patients, controversy over small‐for‐size syndrome has escalated in recent years. Although several symptoms have been suggested as manifestations of the syndrome, small‐for‐size syndrome remains difficult to diagnose because these symptoms are neither specific nor inevitable. The occurrence of small‐for‐size syndrome also seems to depend on a number of recipient and graft factors.

Liver transplantation with allografts from hepatitis B core antibody‐positive donors: A new approach

Emilio Fábrega, Covadonga García‐Suarez, Armando Guerra, Aitor Orive, Fernando Casafont, Javier Crespo, Fernando Pons‐Romero – 30 December 2003 – The enduring shortfall of organ donors has inspired the widespread utilization of hepatic allografts from donors with hepatitis B core antibodies in spite of the potential risk of transmitting hepatitis B virus (HBV) infection to the recipient. Here we report a protocol of naive recipients receiving livers from hepatitis B core antibody‐positive donors.

Outcome of liver transplantation for patients infected by hepatitis C, including those infected by genotype 4

Mohamed H. Wali, Mathis Heydtmann, Rebecca F. Harrison, Bridget K. Gunson, David J. Mutimer – 30 December 2003 – Predictors of hepatitis C virus (HCV)‐related liver disease posttransplantation are still unclear. The impact of HCV genotype on outcome of transplantation has been studied, but conclusions are not in agreement. The role of HCV genotype 4 on the result of liver transplantation requires further study. The aim of this study is to examine the outcome of liver transplantation for patients with HCV genotype‐4 infection.

Beta tryptase levels are not elevated in patients undergoing liver transplantation

Harvey J. Woehlck, Christopher P. Johnson, Allan M. Roza, Mark B. Adams – 30 December 2003 – Reperfusion syndrome during liver transplantation and anaphylaxis are clinical syndromes that share similarities in physiological responses. The liver and intestine contain a variety of immunologically active cells, including mast cells. The purpose of this study is to investigate the possibility that mast‐cell degranulation occurs routinely during transplantation and thereby contributes to hemodynamic instability and coagulopathy.

Serial measurements of bone density at the lumbar spine do not predict fracture risk after liver transplantation

Karen L. Hardinger, Bing Ho, Mark A. Schnitzler, Niraj Desai, Jeffrey Lowell, Surendra Shenoy, William Chapman, Jeffrey S. Crippin – 30 December 2003 – Bone disease has emerged as a serious and complex complication after liver transplantation. The purpose of this study is to determine risk factors for fracture and bone loss after liver transplantation. Dual‐energy x‐ray absorptiometry (DEXA) of the lumbar spine was performed routinely pretransplantation, 6 months posttransplantation, and at yearly intervals thereafter at our center.

Extensive chimerism in liver transplants: Vascular endothelium, bile duct epithelium, and hepatocytes

W. Rogier ten Hove, Bart van Hoek, Ingeborg M. Bajema, Jan Ringers, Johan H.J.M. van Krieken, Emma L. Lagaaij – 30 December 2003 – The transplanted liver has been shown to be particularly capable of inducing tolerance. An explanation may be the presence of chimerism. Cells of donor origin have been found in recipient tissues after transplantation of any solid organ. Evidence for the presence of cells of recipient origin within the transplanted liver is very limited. We investigated whether nonlymphoid cells of recipient origin can be found within human liver allografts.

Adult living donor liver transplantation: Perspectives from 100 liver transplant surgeons

Scott J. Cotler, Sheldon Cotler, Michele Gambera, Enrico Benedetti, Donald M. Jensen, Giuliano Testa – 30 December 2003 – The involvement of healthy living donors and the degree of technical difficulty make adult living donor liver transplantation (LDLT) different from any other surgical procedure. We surveyed 100 liver transplant surgeons to assess their views on the complex issues raised by LDLT. Data were collected at meetings on LDLT and by electronic mail. The study instrument was divided into general, donor, surgeon, recipient, and donor and recipient issues.

Recurrent primary biliary cirrhosis

James Neuberger – 30 December 2003 – Liver transplantation remains the only effective treatment for end‐stage primary biliary cirrhosis (PBC). It appears now well accepted that the disease recurs in the allograft. The diagnosis of recurrent PBC is made on the basis of a consistent history and demonstrating the histologic features of PBC on liver biopsy and exclusion of other causes of bile duct damage

Sirolimus as primary immunosuppression in liver transplantation is not associated with hepatic artery or wound complications

Jeffrey C. Dunkelberg, James F. Trotter, Michael Wachs, Thomas Bak, Marcello Kugelmas, Tracy Steinberg, Gregory T. Everson, Igal Kam – 30 December 2003 – Sirolimus is a new immunosuppressive agent increasingly being used in liver transplant recipients. There is concern that sirolimus may be associated with wound complications and hepatic artery thrombosis (HAT). We have used sirolimus as primary immunosuppression in 170 liver transplant recipients and therefore reviewed our experience with wound complications and HAT in our cohort of patients.

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