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Clinics in Liver Disease Feb 2023Abnormal liver tests are common after liver transplantation. The differential diagnosis depends on the clinical context, particularly the time course, pattern and degree... (Review)
Review
Abnormal liver tests are common after liver transplantation. The differential diagnosis depends on the clinical context, particularly the time course, pattern and degree of elevation, and donor and recipient factors. The perioperative period has distinct causes compared with months and years after transplant, including ischemia-reperfusion injury, vascular thrombosis, and primary graft nonfunction. Etiologies seen beyond the perioperative period include biliary complications, rejection, infection, recurrent disease, and non-transplant-specific causes. The evaluation begins with a liver ultrasound with Doppler as well as appropriate laboratory testing and culminates in a liver biopsy if the imaging and laboratory testing is unrevealing.
Topics: Humans; Liver Transplantation; Postoperative Complications; Liver Function Tests; Tissue Donors; Liver
PubMed: 36400460
DOI: 10.1016/j.cld.2022.08.006 -
Medicine Oct 2021Liver transplantation has become a routine operation in many transplantation centers worldwide. However, liver graft availability fails to meet patient demands. Split... (Review)
Review
Liver transplantation has become a routine operation in many transplantation centers worldwide. However, liver graft availability fails to meet patient demands. Split liver transplantation (SPLT), which divides a deceased donor liver into 2 partial liver grafts, is a promising strategy for increasing graft availability for transplantation and ameliorating organ shortage to a certain degree. However, the transplantation community has not yet reached a consensus on SPLT because of the variable results. Specifically, SPLT for 2 adult recipients using full right/left hemi-liver grafts is clinically more challenging in terms of surgical technique and potential postoperative complications. Therefore, this review summarizes the current status of SPLT, focusing on the transplantation of adult recipients. Furthermore, the initiation of the SPLT program, donor allocation, surgical aspects, recipient outcomes, and obstacles to developing this procedure will be thoroughly discussed. This information might help provide an optimal strategy for implementing SPLT for 2 adult recipients among current transplantation societies. Meanwhile, potential obstacles to SPLT might be overcome in the near future with growing knowledge, experience, and refinement of surgical techniques. Ultimately, the widespread diffusion of SPLT may increase graft availability and mitigate organ donation shortages.
Topics: Adult; Female; Graft Survival; Humans; Liver Transplantation; Male; Postoperative Complications; Tissue and Organ Procurement
PubMed: 34596151
DOI: 10.1097/MD.0000000000027369 -
International Journal of Surgery... Oct 2020The lack of adequate financial coverage, education, and the organization has been the main limiting factor for the development of transplantation in Latin America. As... (Review)
Review
The lack of adequate financial coverage, education, and the organization has been the main limiting factor for the development of transplantation in Latin America. As occurred worldwide, the number of patients on liver waiting lists in Latin America grows disproportionately compared to the number of liver transplantations (LTs) performed. Although many law modifications have been made in the last year, most countries lack social awareness about the importance of donation and the irreversibility of brain death. The mechanisms and norms for organ procurement and infrastructure development, capable of supporting this high demand, are still in slow progress in most countries. Access to LT in the region is very heterogeneous. While some countries have no active LT programs so far, others are an international model of a public transplantation system (Brazil) or a national information system (Argentina). While some countries have only a few LT centers, others have too many LT centers performing an inadequate low number of LTs. Disparity to access transplantation remains the major challenge in the region. Cultural and educational efforts have to be accompanied by transparent public policies that will likely increase organ donation and activity in transplantation. The purpose of this article is to review the trends and current activity in LT within Latin America, based on prior publications and the information available in each country of the region.
Topics: Health Services Accessibility; Healthcare Disparities; Humans; Latin America; Liver Transplantation; Tissue and Organ Procurement; Waiting Lists
PubMed: 32247089
DOI: 10.1016/j.ijsu.2020.03.039 -
Texas Heart Institute Journal 2012Improvements in surgical techniques, postoperative care, and donor and recipient selection have all contributed to the increased success of OLT and to higher survival... (Review)
Review
Improvements in surgical techniques, postoperative care, and donor and recipient selection have all contributed to the increased success of OLT and to higher survival rates in patients with advanced liver disease. This progress in liver transplantation has occurred in only 45 years, since the preliminary work of Dr. Starzl, and provides a basis for future advances.
Topics: Global Health; Graft Survival; Humans; Liver Failure; Liver Transplantation; Survival Rate; Tissue Donors
PubMed: 23304042
DOI: No ID Found -
Critical Care Nursing Clinics of North... Mar 1992Liver transplantation is indicated for many patients with irreversible end-stage liver disease. This article discusses patient evaluation and selection, causes of...
Liver transplantation is indicated for many patients with irreversible end-stage liver disease. This article discusses patient evaluation and selection, causes of end-stage liver disease, donor liver recovery, the transplant surgical procedure, and acute postoperative care of the adult liver transplant recipient.
Topics: Humans; Liver Transplantation; Patient Care Planning; Postoperative Care
PubMed: 1567603
DOI: No ID Found -
Annals of the Academy of Medicine,... Apr 2009With the technical advances and improvements in perioperative management and immunosuppressants, liver transplantation is the standard treatment for patients with... (Review)
Review
With the technical advances and improvements in perioperative management and immunosuppressants, liver transplantation is the standard treatment for patients with end-stage liver diseases. In Asia, a shortage of deceased donor liver grafts is the universal problem to be faced with in all transplant centres. Many surgical innovations are then driven to counteract this problem. This review focuses on 3 issues that denote the development of liver transplantation in Asian countries. These include living donor liver transplantation (LDLT), split liver transplantation (SLT) and liver transplantation for hepatocellular carcinoma (HCC). Minimal graft weight, types of liver graft to donate and the inclusion of the middle hepatic vein with the graft are the main issues to be established in LDLT. The rapid growth and wide dissemination of LDLT has certainly alleviated the supply-and-demand problem of liver grafts in Asia. SLT is another attractive approach. Technical expertise, donor selection and graft allocation are the main determinants for its success. Liver transplantation plays a key role in the management of HCC in Asia. LDLT would be the main strategy in this aspect. The issue of extending the selection criteria for HCC patients for LDLT is still controversial. On the whole, future developments to increase the donor pool for the expanding recipient need in Asia would involve transplantation from non-heart beating donor and ABO incompatible transplantation.
Topics: Asia; Carcinoma, Hepatocellular; History, 20th Century; Humans; Liver Neoplasms; Liver Transplantation; Living Donors
PubMed: 19434335
DOI: No ID Found -
Revista Do Colegio Brasileiro de... 2016
Topics: Brazil; Humans; Liver Transplantation
PubMed: 27679940
DOI: 10.1590/0100-69912016004014 -
Liver Transplantation : Official... Jul 2016Liver transplantation as an established form of treatment for end-stage liver disease has gained acceptance in India over the last 10 years. Liver transplantation in...
Liver transplantation as an established form of treatment for end-stage liver disease has gained acceptance in India over the last 10 years. Liver transplantation in India has unique features that have contributed to the growth of both deceased donor and living donor transplantations of which living donor currently dominates the picture. Living donor contributes to 80% and deceased donor to 20% of the liver transplants currently performed in India. The majority of these transplants are performed within the private sector with public sector hospitals lagging behind significantly. This article gives an overview of the evolution of liver transplantation in India and the potential future challenges. Liver Transplantation 22 1019-1024 2016 AASLD.
Topics: Delivery of Health Care; End Stage Liver Disease; Hospitals, Private; Humans; India; Liver Transplantation; Living Donors; Private Sector; Quality Improvement; Tissue and Organ Harvesting; Tissue and Organ Procurement; Treatment Outcome
PubMed: 27082718
DOI: 10.1002/lt.24459 -
Surgery Today Jun 2020An aging population has prompted us to evaluate the indications of liver transplantation (LT) in elderly patients more frequently. In this review, we summarize the... (Review)
Review
An aging population has prompted us to evaluate the indications of liver transplantation (LT) in elderly patients more frequently. In this review, we summarize the short- and long-term results after LT in elderly patients and also discuss the criteria used to select patients and how recipient age can challenge current allocation systems. Briefly, the feasibility and early outcomes of LT in elderly patients compare favorably with those of younger patients. Although long-term survival is less than satisfactory, large-scale studies show that the transplant survival benefit is similar for elderly and younger patients. Therefore, age alone does not contraindicate LT; however, screening for cardiopulmonary comorbidities, and asymptomatic malignancies, evaluating nutritional status, and frailty, is crucial to ensure optimal results and avoid futile transplantation.
Topics: Age Factors; Aged; Aged, 80 and over; Comorbidity; Female; Frailty; Humans; Liver Transplantation; Male; Nutritional Status; Patient Selection; Tissue and Organ Procurement; Treatment Outcome
PubMed: 32279191
DOI: 10.1007/s00595-020-01996-7 -
Paediatric Anaesthesia Dec 2022Anesthetic and surgical techniques for the liver transplantation have progressed considerably over the past sixty years; however, this procedure is still fraught with... (Review)
Review
Anesthetic and surgical techniques for the liver transplantation have progressed considerably over the past sixty years; however, this procedure is still fraught with substantial morbidity. To increase the safety culture associated with the liver transplantation, we detail nine error traps associated with anesthesia for pediatric liver transplantation. These potential pitfalls are divided into the operative phases: pre-operative preparation (Failure to have a dedicated anesthesia team for pediatric liver transplantation); pre-anhepatic (Failure to prepare for massive blood loss, Failure to monitor for coagulation abnormalities); anhepatic including reperfusion (Failure to prepare for clamping of the inferior vena cava, Failure to recognize metabolic changes, Failure to maintain homeostasis for reperfusion, Failure to prepare for Post-reperfusion syndrome); and post-anhepatic (Failure to optimize liver perfusion, Failure to maintain hemostatic balance). By offering practical advice on the preparation and treatment of these error traps, we aim to better prepare anesthesiologists to take care of pediatric patients undergoing the liver transplantation.
Topics: Humans; Child; Liver Transplantation; Anesthesia
PubMed: 36178188
DOI: 10.1111/pan.14565