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World Journal of Gastroenterology Feb 2009In previous decades, pediatric liver transplantation has become a state-of-the-art operation with excellent success and limited mortality. Graft and patient survival... (Review)
Review
In previous decades, pediatric liver transplantation has become a state-of-the-art operation with excellent success and limited mortality. Graft and patient survival have continued to improve as a result of improvements in medical, surgical and anesthetic management, organ availability, immunosuppression, and identification and treatment of postoperative complications. The utilization of split-liver grafts and living-related donors has provided more organs for pediatric patients. Newer immunosuppression regimens, including induction therapy, have had a significant impact on graft and patient survival. Future developments of pediatric liver transplantation will deal with long-term follow-up, with prevention of immunosuppression-related complications and promotion of as normal growth as possible. This review describes the state-of-the-art in pediatric liver transplantation.
Topics: Child; Family; Graft Survival; Hepatectomy; Humans; Liver; Liver Diseases; Liver Neoplasms; Liver Transplantation; Living Donors; Patient Selection; Survival Rate; Tissue and Organ Harvesting
PubMed: 19222089
DOI: 10.3748/wjg.15.648 -
International Journal of Medical... 2021Nowadays, liver transplantation is the most effective treatment for end-stage liver disease. However, the increasing imbalance between growing demand for liver... (Review)
Review
Nowadays, liver transplantation is the most effective treatment for end-stage liver disease. However, the increasing imbalance between growing demand for liver transplantation and the shortage of donor pool restricts the development of liver transplantation. How to expand the donor pool is a significant problem to be solved clinically. Many doctors have devoted themselves to marginal grafting, which introduces livers with barely passable quality but a high risk of transplant failure into the donor pool. However, existing common methods of preserving marginal grafts lead to both high risk of postoperative complications and high mortality. The application of machine perfusion allows surgeons to make marginal livers meet the standard criteria for transplant, which shows promising prospect in preserving and repairing donor livers and improving ischemia reperfusion injury. This review summarizes the progress of recent researches on hepatic machine perfusion.
Topics: Humans; Liver Transplantation; Organ Preservation; Perfusion; Reperfusion Injury; Tissue and Organ Harvesting
PubMed: 33850464
DOI: 10.7150/ijms.56139 -
International Journal of Surgery... Oct 2020In spite of early adoption of the brain death legislation, and all efforts at promoting deceased donation, various social, economic and cultural factors have acted as... (Review)
Review
In spite of early adoption of the brain death legislation, and all efforts at promoting deceased donation, various social, economic and cultural factors have acted as road blocks to the furthering of deceased donor liver transplantation (DDLT) in most Asian societies. On the other hand, Asian liver transplant centers have been the pioneers, innovators, and technical advancement catalysts for the world to follow, especially with regards to living donor liver transplantation (LDLT). With some high volume centers performing more than 200 LDLTs a year with good outcomes in the donor and recipient, techniques to expand the living donor pool have also been adopted like ABO-incompatible, paired exchange and dual lobe living donor liver transplants. Although large multicenter, and registry data as regards safety and outcomes of minimally invasive donor hepatectomy are awaited, expert centers have pioneered, and now regularly perform purely laparoscopic and robotic living donor hepatectomies, especially in Korea.
Topics: Asia; Hepatectomy; Humans; Laparoscopy; Liver Transplantation; Living Donors; Republic of Korea; Robotic Surgical Procedures; Tissue and Organ Harvesting
PubMed: 32535264
DOI: 10.1016/j.ijsu.2020.05.071 -
Liver Transplantation : Official... Aug 2016
Topics: Cross-Cultural Comparison; Directed Tissue Donation; End Stage Liver Disease; Hepatitis C; Humans; Liver Transplantation; Living Donors; Patient Selection; Severity of Illness Index; Tissue and Organ Harvesting; Treatment Outcome
PubMed: 27351294
DOI: 10.1002/lt.24508 -
Drug Discoveries & Therapeutics Oct 2015Marked improvement in the prognosis for patients with liver cancer who undergo liver transplantation has been achieved as a result of advances in liver transplantation... (Review)
Review
Marked improvement in the prognosis for patients with liver cancer who undergo liver transplantation has been achieved as a result of advances in liver transplantation techniques. Given the current shortage of organs in China, a favorable long-term survival rate might be achieved with rigorous selection of suitable patients and therefore benefit society the most. Further study of the mechanism of cancer recurrence following liver transplantation, continuing to optimize pretreatment strategies prior to liver transplantation, and paying closer attention to the prevention and treatment of cancer recurrence following liver transplantation are important steps to improve the long-term clinical benefit of liver transplantation for patients with hepatocellular carcinoma. Perfecting the techniques of liver transplantation using a marginal donor liver is the main way to solve the current problem of an organ shortage for patients with liver cancer.
Topics: Animals; Disease Progression; Disease-Free Survival; Donor Selection; Humans; Liver Neoplasms; Liver Transplantation; Risk Assessment; Risk Factors; Time Factors; Tissue Donors; Treatment Outcome; Waiting Lists
PubMed: 26632541
DOI: 10.5582/ddt.2015.01048 -
World Journal of Gastroenterology Sep 2016Split liver transplantation (SLT), while widely accepted in pediatrics, remains underutilized in adults. Advancements in surgical techniques and donor-recipient... (Review)
Review
Split liver transplantation (SLT), while widely accepted in pediatrics, remains underutilized in adults. Advancements in surgical techniques and donor-recipient matching, however, have allowed expansion of SLT from utilization of the right trisegment graft to now include use of the hemiliver graft as well. Despite less favorable outcomes in the early experience, better outcomes have been reported by experienced centers and have further validated the feasibility of SLT. Importantly, more than two decades of experience have identified key requirements for successful SLT in adults. When these requirements are met, SLT can achieve outcomes equivalent to those achieved with other types of liver transplantation for adults. However, substantial challenges, such as surgical techniques, logistics, and ethics, persist as ongoing barriers to further expansion of this highly complex procedure. This review outlines the current state of SLT in adults, focusing on donor and recipient selection based on physiology, surgical techniques, surgical outcomes, and ethical issues.
Topics: Adult; Child; Graft Survival; Humans; Liver; Liver Transplantation; Organ Size; Patient Selection; Retrospective Studies; Tissue Donors; Tissue and Organ Procurement; Treatment Outcome
PubMed: 27672272
DOI: 10.3748/wjg.v22.i33.7500 -
World Journal of Gastroenterology Nov 2013Extended hepatectomy, or liver transplantation of reduced-size graft, can lead to a pattern of clinical manifestations, namely "post-hepatectomy liver failure" and... (Review)
Review
Extended hepatectomy, or liver transplantation of reduced-size graft, can lead to a pattern of clinical manifestations, namely "post-hepatectomy liver failure" and "small-for-size syndrome" respectively, that can range from mild cholestasis to irreversible organ non-function and death of the patient. Many mechanisms are involved in their occurrence but in the recent past, high portal blood flow through a relatively small liver vascular bed has taken a central role. Therefore, several techniques of inflow modulation have been attempted in cases of portal hyperperfusion first in liver transplantation, such as portocaval shunt, mesocaval shunt, splenorenal shunt, splenectomy or ligation of the splenic artery. However, high portal flow is not the only factor responsible, and before major liver resections, preoperative assessment of the residual liver function is necessary. Techniques such as portal vein embolization or portal vein ligation can be adopted to increase the future liver volume, preventing post-hepatectomy liver failure. More recently, a new surgical procedure, that combines in situ splitting of the liver and portal vein ligation, has gradually come to light, inducing remarkable hypertrophy of the healthy liver in just a few days. Further studies are needed to confirm this hypothesis and overcome one of the biggest issues in the field of liver surgery.
Topics: Cholestasis; Hepatectomy; Humans; Liver Failure; Liver Regeneration; Liver Transplantation; Treatment Outcome
PubMed: 24307786
DOI: 10.3748/wjg.v19.i44.7922 -
British Journal of Hospital Medicine Nov 1991
Topics: Adult; Child; Humans; Liver Transplantation; Tissue Donors; Tissue and Organ Procurement
PubMed: 1958938
DOI: No ID Found -
Best Practice & Research. Clinical... 2020The number of surviving liver allograft recipients is increasing almost exponentially. The quality and length of life is increasing but most recipients have reduced... (Review)
Review
The number of surviving liver allograft recipients is increasing almost exponentially. The quality and length of life is increasing but most recipients have reduced survival and quality of life compared with healthy matched individuals. Causes of premature death include cardio and cerebrovascular disease, renal failure, graft failure, de novo malignancy and recurrent disease. Follow-up is needed lifelong to ensure graft and patient health and ensure that complications are recognised and treated early. Immunosuppression is kept to the appropriate minimum and prophylactic interventions are given early, such as use of statins and tight control of blood pressure and blood sugar. Recipients will require life-long follow-up, and this is placing an increasing burden on transplant units. Follow-up is best done by close collaboration between the Liver Transplant Unit, the local hospital and primary care team. Involvement of other health care practitioners, such as recipient coordinators, pharmacists, dermatologists and addiction specialists may improve outcomes. Key to successful follow-up are agreed protocols and good communication between the recipients and all relevant health care providers. Use of IT allows for better communication and will support use of video and telephone consultations in selected instances. The most appropriate follow-up will depend on many factors, including logistic and geographic issues, local experience. The provision of well-funded and supported registries at local, national and international levels will allow for improvements in management.
Topics: Follow-Up Studies; Humans; Liver Transplantation; Quality of Life; Survival Analysis
PubMed: 33158465
DOI: 10.1016/j.bpg.2020.101682 -
American Journal of Transplantation :... 2004The most significant development in liver transplantation in the USA over the past year was the full implementation of the MELD- and PELD-based allocation policy in... (Review)
Review
The most significant development in liver transplantation in the USA over the past year was the full implementation of the MELD- and PELD-based allocation policy in March 2002, which shifted emphasis from waiting time within broad medical urgency status to prioritization by risk of waiting list death. The implementation of this system has led to a decrease in pretransplant mortality without increasing post-transplant mortality, despite a higher severity of illness at the time of transplant. The trend over the last few years of rapidly increasing numbers of adult living donor liver transplants was reversed in 2002 by a decline of more than 30% in the number of these procedures. In 2002, a greater percentage of women received livers from living donors (43%) than deceased donors (34%), possibly because of size considerations. From 1993 to 2001, the waiting list increased more than sixfold, from 2902 patients to 18,047 patients. For the first time since 1993, the waiting list size decreased in 2002, dropping 6% to 16,974 candidates. The percentage of temporarily inactive liver candidates also increased from 2001, thus the net decrease in the active waiting list for 2002 was 12%. This may reflect a trend toward less pre-emptive listing practices under MELD. Intestine transplantation remains a low-volume procedure limited to a few transplant centers and is still accompanied by significant pre- and post-transplantation risks. As this procedure matures, its application may increase to include recipients at an earlier stage of their disease with better likelihood of success.
Topics: Humans; Intestines; Liver Transplantation; Living Donors; Registries; Survival Analysis; Tissue and Organ Procurement; Transplantation, Homologous; Waiting Lists
PubMed: 15113357
DOI: 10.1111/j.1600-6135.2004.00400.x