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Einstein (Sao Paulo, Brazil) 2015In 1958 Francis Moore described the orthotopic liver transplantation technique in dogs. In 1963, Starzl et al. performed the first liver transplantation. In the first... (Review)
Review
In 1958 Francis Moore described the orthotopic liver transplantation technique in dogs. In 1963, Starzl et al. performed the first liver transplantation. In the first five liver transplantations no patient survived more than 23 days. In 1967, stimulated by Calne who used antilymphocytic serum, Starzl began a successful series of liver transplantation. Until 1977, 200 liver transplantations were performed in the world. In that period, technical problems were overcome. Roy Calne, in 1979, used the first time cyclosporine in two patients who had undergone liver transplantation. In 1989, Starzl et al. reported a series of 1,179 consecutives patients who underwent liver transplantation and reported a survival rate between one and five years of 73% and 64%, respectively. Finally, in 1990, Starzl et al. reported successful use of tacrolimus in patents undergoing liver transplantation and who had rejection despite receiving conventional immunosuppressive treatment. Liver Transplantation Program was initiated at Hospital Israelita Albert Einstein in 1990 and so far over 1,400 transplants have been done. In 2013, 102 deceased donors liver transplantations were performed. The main indications for transplantation were hepatocellular carcinoma (38%), hepatitis C virus (33.3%) and alcohol liver cirrhosis (19.6%). Of these, 36% of patients who underwent transplantation showed biological MELD score > 30. Patient and graft survival in the first year was, 82.4% and 74.8%, respectively. A major challenge in liver transplantation field is the insufficient number of donors compared with the growing demand of transplant candidates. Thus, we emphasize that appropriated donor/receptor selection, allocation and organ preservation topics should contribute to improve the number and outcomes in liver transplantation.
Topics: Animals; Brazil; Dogs; Graft Rejection; Graft Survival; History, 20th Century; History, 21st Century; Humans; Kaplan-Meier Estimate; Liver Transplantation; Treatment Outcome
PubMed: 25993082
DOI: 10.1590/S1679-45082015RW3164 -
Pediatric Clinics of North America Jun 2017Excellent outcomes over the last 3 decades have made liver transplantation the treatment of choice for many advanced liver disorders. This success also opened liver... (Review)
Review
Excellent outcomes over the last 3 decades have made liver transplantation the treatment of choice for many advanced liver disorders. This success also opened liver transplantation to new indications such as liver tumors and metabolic disorders. The emergence of such new indications for liver transplantation is bringing a new stream of patients along with disease-specific challenges. The cumulative number of liver transplant recipients is peaking, requiring novel systems of health care delivery that meet the needs of this special patient population. This article reviews updates and new development in pediatric liver transplantation.
Topics: Child; Humans; Liver Diseases; Liver Transplantation; Pediatrics; Postoperative Complications
PubMed: 28502445
DOI: 10.1016/j.pcl.2017.02.003 -
Journal of Zhejiang University.... Mar 2013Reperfusion is the key strategy in acute ST-segment elevation myocardial infarction (STEMI) care, and it is time-dependent. Shortening the time from symptom to... (Review)
Review
Reperfusion is the key strategy in acute ST-segment elevation myocardial infarction (STEMI) care, and it is time-dependent. Shortening the time from symptom to reperfusion and choosing the optimal reperfusion strategy for STEMI patients are great challenges in practice. We need to improve upon the problems of low reperfusion rate, non-standardized treatment, and economic burden in STEMI care. This article briefly reviews the current status of reperfusion strategy in STEMI care, and also introduces what we will do to bridge the gap between the guidelines and implementation in the clinical setting through the upcoming China STEMI early reperfusion program.
Topics: Humans; Liver Failure; Liver Transplantation
PubMed: 23463760
DOI: 10.1631/jzus.B1200041 -
Critical Care Clinics Oct 1990Organ transplantation offers increased survival and improved quality of life to many patients with end-stage liver disease. Major advances in this field have included... (Review)
Review
Organ transplantation offers increased survival and improved quality of life to many patients with end-stage liver disease. Major advances in this field have included better organ acquisition and preservation as well as improved intraoperative techniques and management. An additional major factor in improved survival of transplant recipients is the elevated level of care available in intensive care units. Diligent postoperative care has led to early recognition and appropriate treatment of complications that previously were fatal. The intensive care unit team, in tandem with the transplant surgical service, significantly contributes to the successful outcome of the liver transplant recipient.
Topics: Child; Child, Preschool; Critical Care; Graft Rejection; Humans; Liver Diseases; Liver Transplantation; Postoperative Care; Quality of Life
PubMed: 2265386
DOI: No ID Found -
Frontiers of Medicine Mar 2011Partial liver transplantation, including reducedsize liver transplantation, split liver transplantation, and living donor liver transplantation, has been developed with... (Review)
Review
Partial liver transplantation, including reducedsize liver transplantation, split liver transplantation, and living donor liver transplantation, has been developed with several innovative techniques because of donor shortage. Reduced-size liver transplantation is based on Couinaud's anatomical classification, benefiting children and small adult recipients but failing to relieve the overall donor shortage. Split liver transplantation provides chances to two or even more recipients when only one liver graft is available. The splitting technique must follow stricter anatomical and physiological criteria either ex situ or in situ to ensure long-term quality. The first and most important issue involving living donor liver transplantation is donor safety. Before surgery, a series of donor evaluations-including anatomical, liver volume, and liver function evaluations-is indispensable, followed by ethnic agreement. At different recipient conditions, auxiliary liver transplantation and auxiliary partial orthotopic liver transplantation, which employ piggyback techniques, are good alternatives. Partial liver transplantation enriches the practice and knowledge of the transplant society.
Topics: Adult; Child; Humans; Liver Transplantation; Living Donors; Survival Analysis; Tissue Donors; Tissue and Organ Procurement
PubMed: 21681668
DOI: 10.1007/s11684-010-0105-7 -
Chirurgie (Heidelberg, Germany) Jan 2023Due to the demographic changes and the increasing incidence of chronic, especially nutritively toxic liver diseases, the number of patients over 65 years of age with... (Review)
Review
Due to the demographic changes and the increasing incidence of chronic, especially nutritively toxic liver diseases, the number of patients over 65 years of age with indications for liver transplantation is rising considerably. Patient age alone is not a contraindication for organ transplantation; however, in order to ensure the postoperative outcome, a structured interdisciplinary assessment is necessary, especially in older potential organ recipients. With knowledge of comorbidities, individualized prehabilitation enables the perioperative risk to be minimized. The postoperative morbidity in aged patients appears to be comparable to that of younger patients, especially after careful evaluation. Overall, there is a clear survival advantage compared with the best conservative treatment for liver disease. In addition to the perioperative procedure, differences in follow-up care and long-term outcome should also be considered. In this context, predominantly the pharmacological peculiarities, such as polypharmacy and the mutual influence of immunosuppression and comorbidities, have to be taken into account. In addition to old organ recipients, livers from old donors (so-called marginal organs) increasingly play a crucial role in transplantation medicine due to the organ shortage. These are more susceptible to ischemia reperfusion injury and thus put the recipient at a higher risk for delayed or lack of organ function recovery. New ethical issues are raised by the increasing age of donors and recipients, complicating decision making about organ acceptance or rejection for the transplantation physician.
Topics: Humans; Aged; Liver Transplantation; Tissue Donors; Organ Transplantation; Tissue and Organ Procurement; Liver Diseases
PubMed: 36633652
DOI: 10.1007/s00104-022-01776-8 -
Archives of Disease in Childhood Feb 2018In this review, we provide a state of the art of liver transplantation in children, as the procedure is now carried out for more than 30 years and most of our paediatric... (Review)
Review
In this review, we provide a state of the art of liver transplantation in children, as the procedure is now carried out for more than 30 years and most of our paediatric colleagues are managing these patients jointly with liver transplant centres. Our goal for this article is to enhance the understanding of the liver transplant process that a child and his family goes through while explaining the surgical advances and the associated complications that could happen in the immediate or long-term follow-up. We have deliberately introduced the theme that 'liver transplant is a disease' and 'not a cure', to emphasise the need for adherence with immunosuppression, a healthy lifestyle and lifelong medical follow-up.
Topics: Child; Graft Survival; Guideline Adherence; Guidelines as Topic; Healthy Lifestyle; Humans; Immunosuppressive Agents; Liver Transplantation; Patient Compliance; Patient Education as Topic
PubMed: 28918383
DOI: 10.1136/archdischild-2015-310023 -
Advances in Experimental Medicine and... 2006
Review
Topics: Adult; Graft Survival; Hepatectomy; Humans; Liver; Liver Failure; Liver Transplantation; Living Donors; Middle Aged; Tissue Donors; Tissue and Organ Procurement
PubMed: 16836236
DOI: 10.1007/0-387-29512-7_3 -
Clinics in Liver Disease May 2018With the advent of liver transplant for acute liver failure (ALF), survival rate has improved drastically. Liver transplant for ALF accounts for 8% of all transplant... (Review)
Review
With the advent of liver transplant for acute liver failure (ALF), survival rate has improved drastically. Liver transplant for ALF accounts for 8% of all transplant cases. The 1-year survival rates are 79% in Europe and 84% in the United States. Some patients with ALF may recover spontaneously, and approximately half will undergo liver transplant. It is imperative to identify patients with ALF as soon as possible to transfer them to a liver transplant center for a thorough evaluation. Emergent liver transplant in a patient with ALF may place the patient at risk for severe complications in the postoperative period.
Topics: Humans; Liver Failure, Acute; Liver Transplantation; Postoperative Care; Tissue Donors; Tissue and Organ Procurement
PubMed: 29605075
DOI: 10.1016/j.cld.2018.01.014 -
Scandinavian Journal of... 2001Since the introduction of the split-liver transplantation procedure 15 years ago a variety of partial liver transplantations have been developed. The earliest form of... (Review)
Review
Since the introduction of the split-liver transplantation procedure 15 years ago a variety of partial liver transplantations have been developed. The earliest form of split-liver transplantation consisted of reduction of a whole liver graft to just the left lateral segment or the left liver lobe, which was then small enough to transplant to a young child. The rest of the liver was discarded. This method partially solved the great need for liver grafts for children but as the remaining part of the liver was discarded the method was in fact detrimental for adults on the waiting list. Further surgical development resulted in splitting of the liver ex vivo into two transplantable partial grafts: the left part to a child and the right lobe to an adult. This procedure was successfully introduced but the complicated logistics resulted in prolonged cold ischemia times for the grafts. In order to keep the cold ischemia time as short as possible, the in situ split-liver technique was developed, in which the liver was split in the post-mortem donor. Refinement of this operation led to results which were superior to those obtained with the ex vivo method; moreover, it opened the door to living-donor liver transplantation. The first successful procedure was performed from a mother to a child, who received the mother's left liver segment. The introduction of this technique resulted over the years in a decrease in the pediatric waiting list to almost zero. As the demand for organs increases every year and the number of donors remains constant in Western countries, the right-lobe living-donor liver transplantation for adults has been introduced. Introduction of all forms of partial liver transplantation has relieved the pressure on waiting lists, especially for children but also for adults. There are, however, serious concerns regarding the high morbidity and mortality rates associated with the living-donor donation procedure.
Topics: Adult; Cadaver; Child; Humans; Liver Transplantation; Living Donors
PubMed: 11768569
DOI: 10.1080/003655201753265181