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Clinics (Sao Paulo, Brazil) 2014In the last 25 years, liver transplantation in children has become an effective, definitive, and universally accepted treatment for terminal liver diseases. Long-term... (Review)
Review
In the last 25 years, liver transplantation in children has become an effective, definitive, and universally accepted treatment for terminal liver diseases. Long-term survival exceeds 80% and improves each year as the result of constant technical advancements and improvements in immediate postoperative intensive care and clinical control.
Topics: Adult; Child; Communicable Diseases; Graft Rejection; Hepatectomy; Humans; Liver Transplantation; Medical Illustration; Postoperative Care; Recurrence; Surgical Wound Dehiscence
PubMed: 24860858
DOI: 10.6061/clinics/2014(sup01)08 -
World Journal of Gastroenterology Oct 2001This paper provides a review of the practice of liver transplantation with the main emphasis on UK practice and indications for transplantation. (Review)
Review
INTRODUCTION
This paper provides a review of the practice of liver transplantation with the main emphasis on UK practice and indications for transplantation.
REFERRAL AND ASSESSMENT
This section reviews the process of referral and assessment of patients with liver disease with reference to UK practice.
DONOR ORGANS
The practice of brainstem death and cadaveric organ donation is peculiar to individual countries and rates of donation and potential areas of improvement are addressed.
OPERATIVE TECHNIQUE
The technical innovations that have led to liver transplantation becoming a semi-elective procedure are reviewed. Specific emphasis is made to the role of liver reduction and splitting and living related liver transplantation and how this impacts on UK practice are reviewed. The complications of liver transplan-tation are also reviewed with reference to our own unit. Immunosuppression:The evolution of immunosuppression and its impact on liver transplantation are reviewed with some reference to future protocols.
RETRANSPLANTATION
The role of retransplantation is reviewed.
OUTCOME AND SURVIVAL
The results of liver transplantation are reviewed with specific emphasis on our own experience.
FUTURE
The future of liver transplantation is addressed.
Topics: Humans; Liver Failure; Liver Transplantation; United Kingdom
PubMed: 11819840
DOI: 10.3748/wjg.v7.i5.602 -
Liver Transplantation : Official... Apr 2006With ever-increasing demand for liver replacement, supply of organs is the limiting factor and a significant number of patients die while waiting. Live donor liver... (Review)
Review
With ever-increasing demand for liver replacement, supply of organs is the limiting factor and a significant number of patients die while waiting. Live donor liver transplantation has emerged as an important option for many patients, particularly small pediatric patients and those adults that are disadvantaged by the current deceased donor allocation system. Ideally there would be no need to subject perfectly healthy people in the prime of their lives to a potentially life-threatening operation to procure transplantable organs. Donor safety is imperative and cannot be compromised regardless of the implication for the intended recipient. The evolution of split liver transplantation is the basis upon which live donor transplantation has become possible. The live donor procedures are considerably more complex than whole organ decreased donor transplantation and there are unique considerations involved in the assessment of any specific recipient and donor. Donor selection and evaluation have become highly specialized. The critical issue of size matching is determined by both the actual size of the donor graft and the recipient as well as the degree of recipient portal hypertension. The outcomes after live donor liver transplantation have been at least comparable to those of deceased donor transplantation. Nevertheless, all efforts should be made to improve deceased donor donation so as to minimize the need for live donors. Transplant physicians, particularly surgeons, must take responsibility for regulating and overseeing these procedures.
Topics: Hepatectomy; Humans; Liver; Liver Regeneration; Liver Transplantation; Living Donors; Organ Size; Patient Selection; Postoperative Complications; Tissue and Organ Harvesting
PubMed: 16555328
DOI: 10.1002/lt.20754 -
Discovery Medicine Aug 2012Successful transplant outcomes require optimal patient selection and timing. Currently the major limitation facing liver transplant centers is the shortage of organs.... (Review)
Review
Successful transplant outcomes require optimal patient selection and timing. Currently the major limitation facing liver transplant centers is the shortage of organs. The limited availability of organs has led to long waiting periods for liver transplantation and consequently many patients become seriously ill or die while on the waiting list. This has major implications in the selection of patients, as well as the timing of transplant, for optimal use of these scarce organs. Indications and contraindications have changed slightly over the years and will be reviewed in this article. Timing for transplantation has changed more dramatically in recent years since major changes to organ allocation systems have been undertaken to provide clinicians with a better way to prioritize patients for liver transplant.
Topics: Animals; Contraindications; History, 20th Century; History, 21st Century; Humans; Liver Diseases; Liver Transplantation; Patient Selection; Postoperative Care; Severity of Illness Index; Tissue and Organ Procurement
PubMed: 22935210
DOI: No ID Found -
Transplantation Proceedings 2021Biliary complications in liver transplantation (LT) can cause significant morbidity or even lead to a potential graft loss and patient mortality. Oftentimes biliary...
BACKGROUND
Biliary complications in liver transplantation (LT) can cause significant morbidity or even lead to a potential graft loss and patient mortality. Oftentimes biliary internal stents (ISs) are used at the time of LT to lower the risk for or prevent these biliary complications; however, their efficacy and outcomes remain controversial.
METHODS
A retrospective cohort study was conducted on all of the adult patients who underwent a deceased-donor LT (DDLT) with an end-to-end choledococholedocostomy. An IS was placed across the biliary anastomosis, passing through the ampulla. We compared the demographic profiles and various outcomes between the 2 groups (no-IS group vs IS group) and examined risk factors associated with anastomotic biliary complications.
RESULTS
The study comprised 350 patients in the no-IS group and 132 patients in the IS group. Anastomotic biliary fistula (ABF) occurred in 5 (1.4%) and 1 (0.8%) patients in the no-IS group and the IS group, respectively (P = .55). Anastomotic biliary stricture (ABS) occurred in 53 (15.1%) and 18 (13.6%) patients, respectively (P = .68). No significant difference was found in the overall biliary complications between the 2 groups (P = .33). In multivariate logistic regression analysis, acute rejection was the only risk factor for ABS (P = .02). One biliary complication-induced mortality occurred in the no-IS group in which the patient died of an ABF-induced hepatic artery pseudoaneurysm rupture.
CONCLUSION
The use of biliary ISs in DDLT did not reduce the overall risk for biliary complications, but more research is needed to draw definite conclusions.
Topics: Adult; Anastomosis, Surgical; Biliary Tract Surgical Procedures; Cohort Studies; Female; Humans; Liver Transplantation; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Factors; Stents; Treatment Outcome
PubMed: 32684369
DOI: 10.1016/j.transproceed.2020.06.019 -
Seminars in Perioperative Nursing Jan 1992Nationwide, healthcare professionals are more involved with liver transplantation. Although providing a new lease on life is very rewarding within itself, it can also be...
Nationwide, healthcare professionals are more involved with liver transplantation. Although providing a new lease on life is very rewarding within itself, it can also be stressful for all involved. Through a better understanding of the actual procedure, healthcare professionals can alleviate some of their own stress as well as understand the anxiety of the recipient.
Topics: Academic Medical Centers; Humans; Liver Transplantation; Patient Care Planning; Texas
PubMed: 1301863
DOI: No ID Found -
International Anesthesiology Clinics 1991
Review
Topics: Anesthesia; Humans; Liver Transplantation; Postoperative Care; Postoperative Complications; Treatment Outcome
PubMed: 1937859
DOI: 10.1097/00004311-199122000-00005 -
Transplantation Jan 2022Deceased donor and recipient predictors of posttransplant steatosis/steatohepatitis and fibrosis are not well known. Our aim was to evaluate the prevalence and assess...
BACKGROUND
Deceased donor and recipient predictors of posttransplant steatosis/steatohepatitis and fibrosis are not well known. Our aim was to evaluate the prevalence and assess donor and recipient predictors of steatosis, steatohepatitis, and fibrosis in liver transplantation recipients.
METHODS
Using the immune tolerance network A-WISH multicenter study (NCT00135694), donor and recipient demographic and clinical features were collected. Liver biopsies were taken from the donor liver at transplant, and from recipients per protocol and for-cause (ie, abnormal transaminases and to rule out rejection) and were interpreted by a central pathologist.
RESULTS
One hundred eighty-three paired donor/recipients liver biopsies at the time of transplant and posttransplant follow-up (median time 582 d; average time to last biopsies was 704 d [SD ± 402 d]) were analyzed. Donor steatosis did not influence recipient steatosis or fibrosis. Ten of 183 recipients had steatohepatitis on the last biopsy. Recipient body mass index at the time of liver biopsy was the most influential factor associated with posttransplant steatosis. Both donor and recipient metabolic syndrome features were not associated with graft steatosis. Untreated hepatitis C viral (HCV) infection was the most influential factor associated with the development of allograft fibrosis.
CONCLUSIONS
In a large experience evaluating paired donor and recipient characteristics, recipient body mass index at the time of liver biopsy was most significantly associated with posttransplant steatosis. Untreated HCV etiology influenced graft fibrosis. Thus relative to untreated HCV, hepatic fibrosis in those with steatosis/steatohepatitis is less common though long-term follow-up is needed to determine the course of posttransplant fibrosis. Emphasis on recipient weight control is essential.
Topics: Fatty Liver; Humans; Liver Cirrhosis; Liver Transplantation; Living Donors; Treatment Outcome
PubMed: 33982909
DOI: 10.1097/TP.0000000000003681 -
Liver Transplantation : Official... Apr 2006
Topics: Child; Humans; Liver Transplantation; United States
PubMed: 16555337
DOI: 10.1002/lt.20669 -
Transplant International : Official... Sep 2011The only arterial pathway available after liver transplantation is the hepatic artery. Therefore, hepatic artery thrombosis can result in graft loss necessitating...
The only arterial pathway available after liver transplantation is the hepatic artery. Therefore, hepatic artery thrombosis can result in graft loss necessitating re-transplantation. Herein, we present evidence of neovascularization at long-term follow-up in a series of transplant patients with hepatic artery thrombosis. We termed this phenomenon "neovascularized liver". Hepatic artery thrombosis was noted in 30/407 cases (7.37%), and occurred early in 13 patients (43.3%) and late (>30 days) in 17 (56.7%) patients. At the time of this study, 11 (36.7%) patients had a neovascularized liver. Those patients with neovascularized liver and normal liver function were closely followed. Of these patients, 10 (91%) showed evidence of neovascularized liver by imaging, and an echo-Doppler arterial signal was recorded in all patients. The mean interval between the diagnosis of hepatic artery thrombosis and neovascularized liver was 4.1 months (range of 3-5.5 months). Liver histology showed an arterial structure in 4 (36.4%) patients. Four factors were associated with development of neovascularized liver: late hepatic artery thrombosis, early hepatic artery stenosis, site of thrombosis, and Roux-en-Y anastomosis. The overall survival rate at 54 months was 90.9%. In conclusion, a late hepatic artery thrombosis may be quite uneventful and should not automatically lead to re-transplantation.
Topics: Adult; Anastomosis, Surgical; Hepatic Artery; Humans; Liver; Liver Transplantation; Neovascularization, Physiologic; Thrombosis
PubMed: 21740470
DOI: 10.1111/j.1432-2277.2011.01293.x