Right-liver Living Donor Transplantation for Decompensated End-stage Liver Disease

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Apr, 2002  |  Pubmed ID: 11965577

Adult-to-adult living donor liver transplantation (LDLT) for patients with decompensated end-stage liver disease (DELD) is controversial. Nevertheless, these patients are most in need of a timely liver transplant. We present the results of 7 patients who underwent transplantation with this procedure and discuss the rationale for its possible broader application. Seven of 51 patients who underwent right LDLT (segments 5 to 8) between August 1998 and April 2001 had DELD, defined as Child-Pugh-Turcotte score greater than 13 or Model for End-Stage Liver Disease score greater than 30. All patients also were listed for cadaveric liver transplantation. Mean age of the 7 transplant recipients was 54 years (range, 44 to 63 years). Three patients had ethyltoxic cirrhosis; 2 patients, hepatitis C; 1 patient, hepatitis B; and 1 patient, autoimmune hepatitis cirrhosis. The average intensive care unit stay was 23 days (range, 3 to 88 days), and average hospital stay was 77 days (range, 27 to 132 days). Three patients are alive 31, 21, and 17 months after LDLT. At a mean follow-up of 15.1 +/- 10 months, patient and graft survival rates are 43%. Four transplant recipients died day 30, 60, 117, and 180 after transplantation. Three of the seven donors (43%) experienced a complication. At present, all donors are well and have returned to their normal activities. No donors had regrets about the procedure, and all donors stated that they would donate again if presented with the same decision. In conclusion, with the lack of other therapeutic options, LDLT represents a timely and effective alternative to cadaveric liver transplantation. Better outcome is foreseeable with a decrease in posttransplantation complications and more experience in predicting survival of these critical patients.

Living-related Liver Transplantation from the View of the Donor: a 1-year Follow-up Survey

Transplantation. Jun, 2002  |  Pubmed ID: 12085004

In the past, follow-up surveys for living-related liver transplantation (LRLT) mainly focused on the medical outcome of recipients and donors. In this survey the prevalence of personal, familial, or economic problems of the donors and changes of quality of life after donation were studied.

Multidetector Computed Tomographic Cholangiography in the Evaluation of Potential Living Liver Donors

Transplantation. Jun, 2002  |  Pubmed ID: 12131702

Lacking awareness of biliary variations causes complications in adult living donor liver transplantation. The study was performed to determine the diagnostic value of preoperative multidetector computed tomographic cholangiography (MDCT-CA).

Potential Living Liver Donors: Evaluation with an All-in-one Protocol with Multi-detector Row CT

Radiology. Aug, 2002  |  Pubmed ID: 12147860

Multi-detector row computed tomography was performed for the preharvest evaluation of 14 potential living liver donors. Both a biliary contrast agent and a conventional iodinated contrast agent were administered intravenously. This protocol included acquisition of three subsequent scans and allowed accurate assessment of the hepatic parenchymal morphology and volumetrics and a detailed analysis of the biliary and vascular anatomies.

Histidine-tryptophan-ketoglutarate Versus University of Wisconsin Solution in Living Donor Liver Transplantation: Results of a Prospective Study

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Aug, 2003  |  Pubmed ID: 12884194

The grafts obtained from a living donor hepatectomy are perfused on the back table with either University of Wisconsin solution (UW) or histidine-tryptophan-ketoglutarate solution (HTK). The efficacy and safety of these solutions have been studied in cadaveric liver transplantation, however, there is no study comparing the two solutions in adult-to-adult living donor liver transplantation. In this study, UW and HTK were used in the perfusion of right living donor grafts. The grafts were perfused with a predetermined sequence and volume of one of the solutions. Liver biochemistries, complications, and graft and patient survival were analyzed. From January 2001 to September 2002, 30 grafts were alternately perfused with either UW (UW group) or HTK (HTK group). The perfusion was performed first via the artery and then via the portal vein with a predetermined volume. At a mean follow-up of 13 +/- 7 months, no significant statistical difference between groups UW and HTK in posttransplantation liver biochemistries, complications, or patient and graft survival (84% and 80%, respectively) was observed. In conclusion, UW and HTK are equally effective and safe in the perfusion of the living donor liver grafts. HTK has a slight practical advantage over UW because it does not need to be flushed away before reperfusion of the graft and is less expensive.

Late Onset of Tacrolimus-related Posterior Leukoencephalopathy After Living Donor Liver Transplantation

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Sep, 2003  |  Pubmed ID: 12942462

Neurotoxicity is a well-known side effect of tacrolimus-based immunosuppression after liver transplantation. Until now, only 31 cases of immunosuppression-associated leukoencephalopathy in liver transplant recipients reported in the literature are related to tacrolimus therapy. We report a patient who developed a posterior leukoencephalopathy syndrome, secondary to tacrolimus-based immunosuppression, after living donor liver transplantation. The special features of this case are the sudden and late onset of neurologic symptoms, a persistent comatose state, and increased signal intensity in follow-up MRI.

Papillomatosis Confined to the Distal Biliary Tract--a Rare Cause of Obstructive Jaundice: Report of a Case

Surgery Today. 2003  |  Pubmed ID: 14513330

Based on the findings of a patient with recurrent obstructive jaundice due to papillomatosis of the distal bile duct, we herein describe the diagnostic difficulties and therapeutic options in this very rare disease. Endoscopic retrograde cholangiopancreatography and, in particular, cholangioscopy are the imaging procedures of choice if biliary papillomatosis is suspected. Due to the tendency of such patients to demonstrate malignant transformation and develop biliary cirrhosis with septic complications, an early and radical surgical resection is recommended in rare cases of localized papillomatosis. This approach may offer the only chance of a cure although the potential risk of multifocal recurrence cannot be ruled out. When considering a radical resection, intraoperative cholangioscopy is strongly recommended to confirm any localized papillomatosis and rule out any diffuse papillomatosis of the entire biliary tract.

Early and Late Complications in the Recipient of an Adult Living Donor Liver

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Oct, 2003  |  Pubmed ID: 14528429

Right Living Donor Liver Transplantation: an Option for Adult Patients: Single Institution Experience with 74 Patients

Annals of Surgery. Dec, 2003  |  Pubmed ID: 14631222

To present an institutional experience with the use of right liver grafts in adult patients and to assess the practicability and efficacy of this procedure by analyzing the results.

Experience After the Evaluation of 700 Potential Donors for Living Donor Liver Transplantation in a Single Center

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Sep, 2004  |  Pubmed ID: 15349997

Adequate selection of donors is a major prerequisite for living donor liver transplantation (LDLT). Few centers report on the entire number of potential donors considered or rejected for living donation. From April 1998 to July 2003, a total of 111 living donor liver transplantations were performed at our institution, with 622 potential donors for 297 adult recipients and 78 potential donors for 52 pediatric recipients evaluated. In the adult group, only 89 (14%) potential donors were considered suitable, with a total of 533 (86%) potential donors rejected. Of these, 67% were excluded either at initial screening or during the first and second steps of the evaluation procedure. In 31% of all cases, the evaluation of donors was canceled because of recipient issues. In the pediatric group, 22 (28%) donors were selected, with the other 56 (72%) rejected. Costs of the complete evaluation process accounted for 4,589 Euro (Euro) per donor. The evaluation of a potential living donor is a complex and expensive process. We present the results on the evaluation of the largest group of potential donors for adults reported in the literature. Only 14% of potential donors in our series were considered suitable candidates. It has not yet been established who should cover the expenses of the evaluation of all rejected donors. In conclusion, all efforts should be made in order to develop an effective screening protocol for the evaluation of donors with the aim of saving time and resources for a liver transplantation program.

Absorption Phase Cyclosporine (C(2h)) Monitoring in the First Weeks After Pediatric Renal Transplantation

Pediatric Nephrology (Berlin, Germany). Nov, 2004  |  Pubmed ID: 15365805

Cyclosporine (CsA) monitoring using abbreviated area under the curve or 2-h blood concentration (C(2h))has been shown to predict total drug exposure in adult renal transplantation. However, pediatric experience is limited. Since 1998, we have monitored C(2h) in 45 children (age 10.6+4.7 years) during the first 6 weeks after transplantation. In 22 a 4-h CsA profile (AUC(0-4h)) was available and C(2h) in the remaining 23 patients. In addition CsA profiles from 24 children transplanted before 1998 were used to calculate the correlation between single time points and AUC(0-4h). The best correlation between AUC(0-4h) and a single time point was seen with C(2h) (r(2)=0.89). Coh did not predict AUC(0-4h) reliably (r(2)=0.27). C(2h) showed the lowest prediction error (10.0+9.6%).No dependency on age could be detected. In the first 3 months following transplantation, rejection was ob-served in 9 of 45 patients (20%). Glomerular filtration rate remained stable within the first 5 years after trans-plantation. In conclusion, in the early phase after renal transplantation, C(2h) can be used to predict drug exposure within the whole pediatric age group and should be evaluated in prospective trials.

Volumetric and Functional Recovery of the Liver After Right Hepatectomy for Living Donation

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Aug, 2004  |  Pubmed ID: 15390329

Our objective was to study the kinetics of recovery of the liver volume and liver function after right hepatectomy (RH) for living donation, comparing conventional and quantitative liver function tests, i.e., galactose elimination capacity (GEC). A total of 27 donors underwent RH averaging 61% of the whole liver volume. The conventional and quantitative liver function tests, as well as magnetic resonance imaging volumetric studies, were performed preoperatively at postoperative day (POD) 10, 90, 180, and 360. Mean residual volume increased by 88% within 10 days from RH and thereafter did not show any significant variation. After 1 year, only 83% of the original volume was reached. GEC per milliliter of liver volume expressed in percent of initial value (GEC/mL) showed a decrease of 25% at POD10, an increase up to 125% at POD 180, and returned to normal values at POD 360. Liver biochemistries, International Normalized Ratio (INR), and bilirubin returned to normal in 10 days. Cholinesterase showed a similar course like GEC. In conclusion, within 10 days of 61% loss of its initial volume, the liver is capable of regenerating a volume necessary to its function, although it corresponds to only 74% of the initial one. It takes only 10 days to normalize liver biochemistries, while cholinesterase and albumin recover over 90 days. However, a direct measure of the cytosolic liver function obtained by GEC shows that functional recovery occurs much more gradually than the recovery of volume and liver biochemistries.

An Unusual Cause of Abdominal Pain One Year After Liver Transplantation

Transplantation. Feb, 2005  |  Pubmed ID: 15699776

Hepatic Venous Outflow Reconstruction in Right Live Donor Liver Transplantation

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Mar, 2005  |  Pubmed ID: 15719402

The increasing experience with live donor liver transplantation has allowed for the identification of potential morbidities associated with technical considerations. Technical graft failure can be associated with both inflow and outflow vascular compromise. Although the latter has not always been given the relevance of the former, evidence pointing to its pivotal role continues to mount. We believe that impaired venous outflow was a cause of previously unexplained graft failures during our initial experience. Based on this observation, we developed a technique to prevent the "choking" of the graft at the outflow anastomosis with the inferior vena cava (IVC). The enhanced outflow via a cloaca maximum is achieved by reconstructing the graft vessels with preserved veins or arteries (usually iliac vessels are used) from a blood-group-identical or blood-group-compatible deceased organ donor. Alternatively, hepatic vein or portal vein obtained from the resected native liver can be used. The reconstructed common outflow is anastomosed to a triangular opening of the IVC. Such enhanced outflow provides optimal venous drainage, especially during the early phase of growth of the graft.

Sirolimus Rescue of Renal Failure in Children After Combined Liver-kidney Transplantation

Pediatric Nephrology (Berlin, Germany). May, 2005  |  Pubmed ID: 15723197

Calcineurin inhibitors (CNI) are the main immunosuppressive drugs in solid organ transplantation. However, their use is hampered by side effects like nephrotoxicity. We report an exceptional experience with three children treated with sirolimus after combined liver and kidney transplantation with prolonged renal failure and CNI-associated nephrotoxicity.

Liver Transplantation for Hepatocellular Carcinoma in Cirrhosis: is Clinical Tumor Classification Before Transplantation Realistic?

Transplantation. Feb, 2005  |  Pubmed ID: 15729176

The decision of whether to proceed with transplantation in patients with hepatocellular carcinoma (HCC) in cirrhosis is based on clinical and imaging findings. The purpose of our study was to evaluate the accuracy of the current system.

Preservation of the Synthetic and Metabolic Capacity of Isolated Human Hepatocytes by Coculture with Human Biliary Epithelial Cells

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Apr, 2005  |  Pubmed ID: 15776438

Bioartificial liver support systems have demonstrated limited efficacy in compensation of liver detoxification and substitution of liver-derived factors. However, in these devices, the biological substitution of the complex liver function has been restricted to xenogeneic or transformed hepatocytes. Therefore, we have examined the long-term effect of coculturing normal human hepatocytes (HCs) with allogeneic biliary epithelial cells (BECs). We applied functional in vitro assays to examine their metabolic potential by ammonia detoxification to urea, cytochrome P450-dependent lignocaine conversion to mono-ethyl-glycine-xylidide (MEGX), and protein expression and secretion. As the liver has a pivotal role in the synthesis of coagulation factors, we measured antithrombin III (AT III), factor VII, and albumin, comparing HCs plated on collagen or inside 3-dimensional collagen gels. Over 30 days, expression and secretion of albumin and clotting factors by human HCs were augmented by culture inside collagen gel, but were also enhanced and better maintained by coculture with BECs. Higher proportions of BECs cocultured with HCs substantially increased the protein synthesis and urea production. Remarkably, the almost absent cytochrome P450 activity of HC alone after 1 week could be reversed and maintained over 3 weeks by coculture with BECs. The pattern of these effects differed from the extent of interleukin-6 (IL-6) production and HC viability under the compared conditions. In conclusion, coculture of human HCs with BECs impressively restores the synthetic and metabolic liver function in vitro. These results suggest mechanisms of improved liver epithelial differentiation supported by coculture conditions. This technique offers new perspectives in bioartificial liver support, hepatocyte transplantation, and stem cell differentiation.

Efficacy of Transarterial Chemoembolization Prior to Liver Transplantation for Hepatocellular Carcinoma As Found in Pathology

Hepato-gastroenterology. Mar-Apr, 2005  |  Pubmed ID: 15816428

To analyze the efficacy of chemoembolization prior to liver transplantation in liver explants.

Anatomical and Physiological Comparison of Liver Volumes Among Three Frequent Types of Parenchyma Transection in Live Donor Liver Transplantation

Hepato-gastroenterology. Mar-Apr, 2005  |  Pubmed ID: 15816429

Adequate venous outflow is a prerequisite for successful live donor liver transplantation. Several techniques of liver transection have been established in both transplant and non-transplant hepatic surgery. The purpose of our study was to define and compare anatomical and physiological characteristics of venous drainage in the three most common types of liver transection techniques (Malagó, Cantlie, Pringle) encountered in live donor liver transplantation

Living Donor Liver Transplantation for Recurrent Hepatocellular Carcinoma

Transplant International : Official Journal of the European Society for Organ Transplantation. Jul, 2005  |  Pubmed ID: 15948872

Laparoscopic Inguinal Hernia Repair As a Potential Complicating Factor in Kidney Transplantation

Transplantation. Jun, 2005  |  Pubmed ID: 15973185

"All-in-one" Imaging Protocols for the Evaluation of Potential Living Liver Donors: Comparison of Magnetic Resonance Imaging and Multidetector Computed Tomography

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Jul, 2005  |  Pubmed ID: 15973711

In order to compare the performance of "all-in-one" magnetic resonance imaging (MRI) and "all-in-one" multidetector computed tomography (MDCT) in the preharvest evaluation 25 potential living donors underwent both MRI and MDCT. MRI was performed on a high-performance 1.5-T scanner, computed tomography (CT) on a 4-row multidetector-scanner. Both scan protocols included angiography of the arterial and venous hepatic systems. CT additionally included infusion of a biliary contrast agent. Data analysis was performed by 4 reviewers, based on source images, multiplanar reformats, and three-dimensional (3D) postprocessing. Determination of image quality was based on a 4-point image quality rating (IQR) scale, ranging from 1 = nondiagnostic to 4 = excellent. Preoperative and intraoperative (n = 13) findings were correlated. Magnetic resonance (MR) examinations were generally well tolerated. Within the CT scan, 2 candidates presented moderate adverse reaction to the biliary contrast agent. MRI and CT showed the same benign parenchymal lesions (IQR MR: 3.7; IQR CT: 3.4). Determination of liver volumes was easier based on CT (IQR MR: 3.3; IQR CT: 3.6). Magnetic resonance angiography (MRA) revealed 10 variants of the arterial liver supply (IQR: 3.0) and computed tomographic angiography (CTA) revealed 13 variants (IQR: 3.5). Magnetic resonance cholangiopancreatography (MRCP) identified 4 biliary variants (IQR: 1.3) and CT cholangiography identified 17 (IQR: 3.5). MRI and CT each showed 4 hepatic and portal venous variants (IQR MR: 3.4, CT: 2.8). CT and MR findings correlated well with intraoperative findings. In conclusion, both techniques proved to be efficient to evaluate potential living liver donors' anatomy in a single diagnostic step. The main advantage of CT lies in the ability to accurately assess the biliary anatomy.

Preoperative Donor Liver Biopsy for Adult Living Donor Liver Transplantation: Risks and Benefits

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Aug, 2005  |  Pubmed ID: 16035060

The role of liver biopsy (LB) in donor selection for adult living donor liver transplantation remains controversial, since the procedure is associated with additional potential risks for the donor. From April 1998 to August 2004, 730 potential living donors for 337 adult recipients underwent our multistep evaluation program. In 144 candidates, LB was performed. LB was obtained in a percutaneous ultrasound-guided fashion by means of Menghini needle (32 cases) or Tru-cut needle (112 cases). The biopsy specimen was preserved in 5% formalin and processed with hematoxylin & eosin-stained sections. Thirty-one (21%) of 144 candidates who underwent an LB had a positive finding at histological examination that induced their exclusion from donation, of whom 21 had liver steatosis of varying kind and grade (10%-80%) and 10 had a nonsteatotic hepatopathy (non-A-D hepatitis in 6 cases, diffuse granulomatosis in 2, schistosomiasis in 1, fibrosis in 1). The only observed major complications related to LB were 2 intraparenchymal haematomas, both of which resolved spontaneously within a few months. In conclusion, based on these findings, we believe that preoperative LB in the donor selection for adult LDLT is necessary, once the initial donor screening and noninvasive evaluation is complete. Because other screening modalities can be unreliable, without preoperative LB a fraction of potential donors will be operated on inappropriately, risking both donor and recipient. The main objective of LB should be to ensure the donor's safety more than the preservation of the graft function.

Development of Growth and Body Mass Index After Pediatric Renal Transplantation

Pediatric Transplantation. Aug, 2005  |  Pubmed ID: 16048595

Suboptimal final height and marked weight gain after renal transplantation (RTx) are common and may result in obesity. Steroid free immunosuppression has been advocated to improve growth and limit weight gain. We evaluated retrospectively the evolution of growth and body mass index (BMI) after renal transplantation to study risk factors for weight gain under steroid based treatment. Sixty-four pediatric patients (age 9.9 +/- 5.0 yr) were included in the study. To allow comparison between different age groups, standard deviation scores (SDS) for height and BMI for height age were calculated at time of transplantation and 3, 6, 9, 12, 24, 36, 48 and 60 months later. Induction immunosuppression consisted of basiliximab, cyclosporine and prednisone. Growth retardation at time of RTx was obvious with a SDS for height of -2.20 +/- 1.34. Height during the first year improved to an SDS of -2.0 +/- 1.27 (p < 0.01) but did further not increase in year 2 and 3. More than 40% of all patients remained 2 SDS below normal mean. SDS BMI for height age at transplantation was -0.19 +/- 0.98 and increased significantly during the first 3 months after transplantation to +0.64 +/- 1.07 (p < 0.01). Thereafter, BMI remained stable but did not decline to pretransplant values. A SDS BMI for height age of more than 2 SDS was observed in 2, 6, 9 and 11% of children at RTx and 1, 2 and 3 yr later respectively. BMI gain over 3 yr was significantly enhanced in children whose parents (especially the mother) were overweight. No influence of gender, BMI at RTx, dialysis modality prior to RTx or rejection episodes could be detected. We conclude that after RTx children exhibit some improvement in growth but height remains suboptimal. The BMI does increase significantly during the first months after RTx and does not return to baseline values under steroid-based immunosuppression. Obesity (>2 SDS above normal) does not occur more often than in the normal population. The most predictive parameter of inappropriate weight gain during 3 yr is the BMI of the mother. We would speculate that steroids may play a major role in weight gain in the early phase after RTx. However, genetic or environmental factors predict the long-term weight development.

Liver Transplantation for Hepatocellular Carcinoma in Cirrhosis Within the Eurotransplant Area: an Additional Option with "livers That Nobody Wants"

Transplantation. Oct, 2005  |  Pubmed ID: 16249736

Liver transplantation is recognized as the treatment of choice for small hepatocellular carcinomas (HCC) in patients with end-stage liver failure. However, because of limited organ availability, not all those who qualify can benefit from it.

Quantitative Liver Function Tests in Donors and Recipients of Living Donor Liver Transplantation

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Apr, 2006  |  Pubmed ID: 16482561

The unique ability of the liver to regenerate quickly after resection makes living donor liver transplantation (LDLT) possible. This technique uses the unique ability of the liver to regenerate to full size after partial resection. However, the quality and course of this regeneration process in humans are still widely unexplored. In the present study we investigated the quantitative liver function tests galactose elimination capacity (GEC), indocyanine green half-life (ICG), and lidocaine half-life as markers for the quality of the liver regeneration in the first 3 months after LDLT. In this study, 22 consecutive living liver donors and their corresponding recipients were analyzed at baseline and at 10 and 90 days after LDLT. Six recipients lost their grafts during the study period. We compared donors and recipients at the different time points. After LDLT, GEC decreased (-42.6%) and ICG increased (+50.6%) significantly in donors. ICG and GEC remained significantly altered over 3 months in donors with an improvement between days 10 and 90 (GEC, +59.3%; ICG, -9.1%). ICG and GEC improved significantly in recipients between days 10 and 90 (ICG, -63.7%; GEC, +16.3%). The lidocaine half-life showed no significant changes. The donors had better test results and recovered faster than the recipients. In conclusion, after LDLT the parameters for liver capacity and flow remain altered in donors and recipients despite rapid volume growth.

Liver Transplantation and Incidentally Found Hepatocellular Carcinoma in Liver Explants: Need for a New Definition?

Transplantation. Feb, 2006  |  Pubmed ID: 16495799

"Incidentally" identified hepatocellular carcinoma (iHCC) in liver explants after liver transplantation (LTx) is a frequently reported finding, which is characterized with a good prognosis. The purpose of this study was to evaluate the outcome of patients with these tumors in our series and in literature reports, and to compare their prognosis to that of HCC diagnosed preoperatively.

"Hepar Divisum"--as a Rare Donor Complication After Intraoperative Mortality of the Recipient of an Intended Living Donor Liver Transplantation

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Mar, 2006  |  Pubmed ID: 16498667

In this study, we present our experience with 4 healthy donors having the rare condition of "hepar divisum" after the intraoperative death of the recipient of an intended right adult living donor liver transplantation (LDLT). The study included 4 donors and 4 intended right LDLT recipients affected by neuroendocrine tumor (n = 2), hepatocellular carcinoma (n = 1), and cryptogenic cirrhosis (n = 1). All 4 recipients died intraoperatively. At the time of recipient death, the dissection of the donor liver parenchyma was complete, the vessels intact, and the hepatic duct(s) already divided. In each case, reconstruction of the donor biliary tract was performed: hepaticojejunostomy (HJ) in 2 cases, each with 3 ducts, and duct-to-duct anastomosis in 2. Of the donors receiving the HJ, 1 had a cut surface bile leak and the other experienced an anastomotic leak, treated by percutaneous drainage and reoperation, respectively. The latter patient experienced recurrent HJ stenosis at 44 months and 50 months after the operation and was treated by percutaneous balloon dilatation. One duct-to-duct reconstruction was complicated by early stenosis (postoperative day 6) and treated with endoscopic stenting. In conclusion, in the case of intraoperative death of the recipient of an intended LDLT, when the parenchyma and the hepatic duct of the donor have already been divided, the options are completion of the donor hepatectomy or the status of "fegatum divisum" with reconstruction of biliary tract. The high incidence of biliary complication, however, is of concern. When more than 1 hepatic duct is present, the donor hepatectomy should be completed and the graft reallocated according to the policy of the transplant institution.

Living Donor Liver Transplantation for Hepatocellular Carcinoma: a Single-center Preliminary Report

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Jun, 2006  |  Pubmed ID: 16528715

Liver transplantation (LT) is the treatment of choice for early hepatocellular carcinoma (HCC) in patients with end-stage liver disease but is limited by the availability of donor organs. Living donor liver transplantation (LDLT) represents an alternative therapeutic option for patients with disease confined to the liver. Between April 1998 and December 2003, 537 patients underwent liver transplantation in our center. Thirty patients with HCC and associated terminal cirrhosis and 4 patients with tumor recurrence after liver resection who underwent LDLT were reviewed. Nineteen patients (55.8%) met the Milan criteria for LT, whereas 15 patients (44.2%) "exceeded" them. The overall survival rates at 1 and 2 years were 68% and 62%, respectively, with a median follow-up of 41 months (range, 17-64 months). Five patients (14.7%) died in the first 30 days after LDLT. Hospital mortality was significantly correlated with age > 60 years. Four patients developed recurrence between 6 and 35 months after LDLT. Recurrence was significantly related to the presence of more than 3 tumor lesions in our series. In conclusion, LDLT is a promising treatment option for patients with HCC. Even longer follow-up and bigger patients' series are needed to fully assess the benefits of LDLT for HCC patients exceeding the Milan criteria.

In Situ Splitting of Deceased Donor Livers: an Additional Option for Patients with Hepatocellular Carcinoma in Cirrhosis

Surgery. Mar, 2006  |  Pubmed ID: 16546515

The Role of Surgery in Caroli's Disease

Journal of the American College of Surgeons. Jun, 2006  |  Pubmed ID: 16735207

Caroli's disease is a rare congenital disorder characterized by multifocal segmental dilation of the intrahepatic bile ducts. Whether conservative or surgical strategies should be preferred is still a matter of debate. The aim of this study was to evaluate the role of surgery in the management of Caroli's disease.

Interleukin-2 Receptor Antagonist Induction in Modern Immunosuppression Regimens for Renal Transplant Recipients

Transplant International : Official Journal of the European Society for Organ Transplantation. Jun, 2006  |  Pubmed ID: 16771865

Addition of interleukin-2 receptor antagonist (IL-2RA) induction to calcineurin inhibitor (CNI)-based regimens reduces biopsy-proven acute rejection by 30-40%. IL-2RA induction facilitates early withdrawal of steroids, and supports the safe use of reduced-exposure CNI or delayed CNI introduction. IL-2RAs and rabbit antithymocyte globulin (Thymoglobulin) show comparable efficacy in patients at standard or low immunologic risk, but the adverse event profiles of lymphocyte-depleting agents are less favorable. IL-2RAs, uniquely, provide effective immunosuppression with similar tolerability to placebo.

Resectability of Hepatocellular Carcinoma: Evaluation of 333 Consecutive Cases at a Single Hepatobiliary Specialty Center and Systematic Review of the Literature

Hepato-gastroenterology. May-Jun, 2006  |  Pubmed ID: 16795964

To determine resectability rates in patients with hepatocellular carcinoma (HCC) evaluated for surgical therapy. Liver resection constitutes a potentially curative treatment for HCC. However, because of the co-existing cirrhosis or the late diagnosis, only a percentage of the patients evaluated can undergo surgery.

Liver Transplantation for Patients with Metastatic Endocrine Tumors: Single-center Experience with 15 Patients

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Jul, 2006  |  Pubmed ID: 16799958

In contrast to other secondary liver malignancy, orthotopic liver transplantation (OLT) is considered as a treatment modality for nonresectable endocrine liver metastases in selected patients. However, only few series have assessed patient selection criteria and long-term results, and no reports have focused on the impact of new technologies in this regard. Between 1992 and 2004, 28 patients with malignant endocrine tumors underwent evaluation for OLT according to our protocol. Data were entered into a prospective database. During pretransplant evaluation, somatostatin receptor scintigraphy detected extrahepatic metastases not diagnosed in standard imaging in 10 patients. Of them, 3 showed aberrant Ki67 labeling results. One patient was excluded from further evaluation due to severe carcinoid heart. Thus far, 15 patients, 10 men and 5 women, aged 37 to 67 years, were subjected to the transplant procedure (11 deceased donor OLT, 3 living donor liver transplantations, and 1 cluster transplantation). Four patients died during the hospital treatment. The median follow-up of the discharged patients was 60.8 months. The actuarial patient survival was 78.3% at 1 year and 67.2% at 5 years. The actuarial 1-, 2-, and 5-year tumor-free survival amounted to 69.4%, 48.3%, and 48.3%, respectively. Two patients underwent surgery for isolated tumor recurrence. In 2 patients, peptide receptor radiotherapy was carried out because of multilocular recurrent disease. In conclusion, liver transplantation is a realistic therapeutic option for highly selected patients with hepatic metastases of endocrine tumors. Our strategy, which implements strict pretransplant selection and aggressive surgical approach, in case of disease recurrence, in addition to systemic radiopeptide treatment, led to an excellent long-term survival cure, however, is unlikely to be achieved.

Liver Transplantation with "rescue Organ Offers" Within the Eurotransplant Area: a 2-year Report from the University Hospital Essen

Transplantation. Aug, 2006  |  Pubmed ID: 16906024

Liver transplantation (LTx) is the only treatment for patients with end-stage liver failure. This report focuses on 45 deceased donor liver allografts allocated through Eurotransplant as "rescue offers," which were accepted and subsequently transplanted at our center over a two-year period. These organs had been officially offered to and rejected by other transplant centers a total of 162 times prior to our acceptance. Primary nonfunction was observed in six patients. Two of them died and four were retransplanted. Overall patient survival was 84.4%. LTx with such "rescue organs" constitutes an additional transplant option and a safe mechanism to "rescue" organs within Eurotransplant.

Hilar Early Division of the Hepatic Duct in Living Donor Right Hepatectomy: the Probe-and-clamp Technique

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Sep, 2006  |  Pubmed ID: 16933234

The division of the hepatic duct is one of the most challenging passages of the donor hepatectomy. We report our experience with the early division, prior to the liver parenchyma resection, of the hepatic duct and the definition of the biliary anatomy with a probe inserted in the proper hepatic duct. From February 2002 to December 2004, 40 donors (25 male, 15 female; mean age 34, range 20-57) underwent right hepatectomy. The yield was a single duct in 24 donors (60%), two ducts in 12 donors (30%), and three ducts in one donor (2.5%), and three donors had aberrant anatomy yielding two ducts (7.5%). By means of a ductoplasty, a single orifice for the recipient biliary anastomosis was obtained in 77.5% of the cases. Three donors (7.5%) suffered a resection surface bile leak. The technique of hepatic duct probing and early division provides a precise definition of the biliary anatomy and facilitates one of the most challenging passages of the donor hepatectomy. This technique should also contribute to maximizing the preservation of the vascular supply of the hepatic duct and the yield of a single orifice for the recipient anastomosis. At a median follow-up of 21 months (range 10-44), neither short- nor long-term complications had been caused by the small donor choledochotomy.

Does PEEP Impair the Hepatic Outflow in Patients Following Liver Transplantation?

Intensive Care Medicine. Oct, 2006  |  Pubmed ID: 16941166

Evaluation of the impact of end-expiratory pressure (PEEP) ventilation on venous liver outflow, portal vein, and hepatic artery flows as well as systemic hemodynamics in patients following liver transplantation (LT).

Outcome After Kidney Transplantation in Children with Thrombotic Risk Factors

Pediatric Transplantation. Nov, 2006  |  Pubmed ID: 17032424

According to the data from the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS), vascular thrombosis accounts for 11.6% of graft losses in pediatric renal transplantation. In adults, inherited and acquired thrombophilic risk factors, e.g. factor V Leiden mutation, have been associated with early graft loss and increased rejection episodes. Data on the impact of these factors on the outcome of children after renal transplantation are rare.

Portopulmonary Hypertension in the Early Phase Following Liver Transplantation

Transplantation. Oct, 2006  |  Pubmed ID: 17038902

Portopulmonary hypertension (PPH) is a severe complication of liver cirrhosis, which poses a high risk for postliver transplantation (LT) mortality. In most liver transplant centers, severe PPH is viewed as an absolute contraindication for LT, but recent reports challenge this. The purpose of our study was to determine the incidence of PPH, its influence on the 30-day mortality rate following LT and to determine the sensitivity and specificity of Doppler echocardiography and electrocardiography as noninvasive tools to determine PPH.

Successful Salvage Therapy with Tigecycline After Linezolid Failure in a Liver Transplant Recipient with MRSA Pneumonia

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Nov, 2006  |  Pubmed ID: 17058251

Pulmonary infections are a significant cause of morbidity and mortality after liver transplantation. Infections with methicillin-resistant Staphylococcus aureus (MRSA) have increased in the last 10 years. Mortality may exceed 80% in liver transplant recipients who develop MRSA pneumonia. A 57-year-old male following living-donor liver transplantation developed a right-sided MRSA pneumonia 6 weeks after transplantation, which required artificial ventilation for 14 weeks. Initially, pneumonia was treated with linezolid. However, after 12 days under current therapy, the infection spread out to both lungs. At that time. we initiated the treatment with tigecycline. Under this therapy, the patient could be cured from MRSA pneumonia and was extubated. We detected no tigecycline related hepatotoxic effect. In conclusion, this case suggests that tigecycline may be useful in the salvage therapy of pneumonia due to MRSA after linezolid failure.

Split Liver Transplantation for Hepatocellular Carcinoma

Hepato-gastroenterology. Sep-Oct, 2006  |  Pubmed ID: 17086884

Liver transplantation (LTx) is recognized as the treatment of choice for small hepatocellular carcinomas (HCC) in patients with end-stage liver failure. However, because of limited organ availability, not all those who qualify can benefit from full-size LTx.

The Symptomatic Pelvic Kidney: a New Source of Organs for Living Donor Kidney Transplantation?

Transplantation. Nov, 2006  |  Pubmed ID: 17102780

Parenchyma Transection in Adult Live Donor Liver Transplantation: the Virtual Dilemma of "where to Cut". Experience Based on Virtual 3-dimensional Computed Tomography Imaging Reconstructions

Hepato-gastroenterology. Nov-Dec, 2006  |  Pubmed ID: 17153429

Adequate venous drainage is essential to prevent parenchyma congestion in graft and remnant livers after adult live donor liver transplantation (ALDLT). The areas particularly prone to congestion are the right and left medial sectors. The purpose of our study was to evaluate two types of liver transection techniques (Cantlie, Malagó) frequently encountered in ALDLT and to determine their resulting anatomical and functional liver graft volumes.

Role and Significance of Plasma Citrulline in the Early Phase After Small Bowel Transplantation in Pigs

Transplant International : Official Journal of the European Society for Organ Transplantation. May, 2007  |  Pubmed ID: 17313447

A reliable serological marker of acute cellular rejection (ACR) after small bowel transplantation (SBTx) is still missing. Plasma citrulline level (PCL) reflects the functional integrity of intestinal mucosa which is partially lost during ACR. The aim of our study was to investigate the role of PCL as marker of ACR after SBTx. Eighteen German landrace pigs were used and divided into three groups. Group 1 (G1), autologous SBTx (n = 4) as control; group 2 (G2), allogeneic SBTx without immunosuppression (IS) (n = 7) and group 3 (G3), allogeneic SBTx with IS (n = 7). IS consisted of tacrolimus and steroids without induction treatment. Observation period was 14 days. Mucosal biopsies were obtained intraoperatively and daily using a Thiry-Vella loop. ACR was differentiated into indeterminate, mild, moderate and severe using a standardized grading schema. PCL was measured daily. An ACR onset occurred generally from postoperative day 4 both in G2 and G3 as mild form and developed differently in the two groups: moderate to severe in G2 and indeterminate to mild in G3. A significant decline of PCL occurred only in cases of moderate and severe ACR, but not in cases of indeterminate and mild ACR. The PCL failed as a marker in the early diagnosis of ACR and became reliable only when advanced mucosal damage was present.

Current Trends in Live Liver Donation

Transplant International : Official Journal of the European Society for Organ Transplantation. Apr, 2007  |  Pubmed ID: 17326772

The introduction of living donor liver transplantation (LDLT) has been one of the most remarkable steps in the field of liver transplantation (LT), able to significantly expand the scarce donor pool in countries in which the growing demands of organs are not met by the shortage of available cadaveric grafts. Although the benefits of this procedure are enormous, the physical and psychological sacrifice of the donors is immense, and the expectations for a good outcome for themselves, as well as for the recipients, are high. We report a current overview of the latest trends in live liver donation in its different aspects (i.e. donor's selection, evaluation, operation, morbidity, mortality, ethics and psychology). This review is based on our center's personal experience with almost 200 LDLTs and a detailed analysis of the international literature of the last 7 years about this topic. Knowing in detail how to approach to the different aspects of living liver donation may be helpful in further improve donor's safety and even recipient's outcome.

Paediatric Acute Liver Failure and Transplantation: the University of Essen Experience

Transplant International : Official Journal of the European Society for Organ Transplantation. Jun, 2007  |  Pubmed ID: 17355244

To report our experience with 17 children who underwent a liver transplantation (LT) for acute liver failure (ALF). All LT procedures (deceased and living donor) were offered. Since 2003 Molecular Adsorbents Recycling System (MARS) was proposed as bridging procedure. We monitored the perioperative course and the short- and long-term outcomes. All children developed pretransplant hepatic encephalopathy (mostly grades II and III); six needed ventilator support and three haemodialysis. Median PELD/MELD score was 30. MARS was used in five children with poor pretransplant prognostic factors: all five survived the LT without sequelae. We performed 13 deceased donor LT (seven whole, five split and onr reduced) and four left lateral LDLT. Postoperative complications were observed in 10 children, requiring re-operation in seven. Two children developed irreversible neurological disorders. After a median follow up of 45 months, 16 children are still alive. About 1- and 5-year cumulative patient survival rates are 94% with a corresponding graft survival of 88% and 81%, respectively. The combination of experienced paediatric ICU management, the application of new liver support devices, and the capacity to offer both living and deceased donor transplant alternatives in a timely fashion represent the best formula to achieve optimal results in children with ALF.

Long-term Production of Major Coagulation Factors and Inhibitors by Primary Human Hepatocytes in Vitro: Perspectives for Clinical Application

Liver International : Official Journal of the International Association for the Study of the Liver. Aug, 2007  |  Pubmed ID: 17617127

Patients with coagulation factor disorders require lifelong symptomatic treatment. This is associated with limited efficacy and transmission risks. From a clinical point of view, hepatocyte transplantation offers a rational alternative but is currently being hampered by lack of functional stability of engrafted cells. It was the aim of our study to devise culture conditions providing stable cell polarity, attachment and growth factor stimulation to improve longevity and coagulation factor production.

Liver Transplantation for Hepatocellular Carcinoma: University Hospital Essen Experience and Metaanalysis of Prognostic Factors

Journal of the American College of Surgeons. Nov, 2007  |  Pubmed ID: 17964442

Liver transplantation has become one of the best treatment options for early hepatocellular carcinoma in cirrhosis. The purpose of this study was to correlate pathologic findings with outcomes after liver transplantation for hepatocellular carcinoma and to evaluate associations between various tumor characteristics and patient outcomes.

The White Test: a New Dye Test for Intraoperative Detection of Bile Leakage During Major Liver Resection

Archives of Surgery (Chicago, Ill. : 1960). Apr, 2008  |  Pubmed ID: 18427029

To describe a new intraoperative bile leakage test in patients undergoing a major liver resection aimed to combine the advantages of each of the other standard bile leakage tests (accurate visualization of leaks, reproducibility, and ease of use) without their disadvantages.

Acute Rejection Episodes in Pediatric Renal Transplant Recipients with Cytomegalovirus Infection

Pediatric Transplantation. Jun, 2008  |  Pubmed ID: 18466436

CMV infection is the most important opportunistic virus infection after renal transplantation leading to increased patient mortality, graft loss, risk for acute rejection episodes and impaired renal function. The potential impact of prophylactic anti-viral therapy on long-term graft outcome is relevant. The aim of this study was to evaluate the incidence of CMV infection, its risk factors and long-term outcome in children after renal transplantation. 103 children (mean age 10.6 +/- 5.3, range 1.6-22.0 yr) were monitored weekly for pp65 for the first 6-8 wk after renal transplantation, followed by a monthly monitoring for the first year. CMV infection occurred in 23/103 children (21.1%) with 10 patients (9.7%) developing CMV disease characterized by positive pp65 in the presence of organ involvement. The CMV R-/D+ and R+/D+ serostatus was significantly associated with an increased risk of CMV infection (p < 0.0001 and p = 0.009). 14/28 R-/D+ patients developed CMV infection despite prophylactic treatment with CMV hyperimmune globulin. The incidence of acute rejection episodes after or during CMV infection was significantly increased (p = 0.003) and the D+ serostatus was significantly associated with acute rejection episodes within the first year after transplantation (p = 0.006). In summary the overall incidence of CMV infection in this single center experience is 21.1%. The D+ serostatus represents a serious risk factor for both CMV infection and acute rejection episodes. In future the potential impact of different modalities of prophylactic anti-viral therapy on the prevention of acute rejection should be considered.

Pulmonary and Blood Stream Infections in Adult Living Donor and Cadaveric Liver Transplant Patients

Transplantation. Jun, 2008  |  Pubmed ID: 18551060

Infectious complications occur in approximately 50% of cadaveric liver transplant (CDLT) recipients. Living-donor liver transplantation (LDLT) is an established alternative to shorten the waiting time. Currently, the incidence of pulmonary infections after LDLT and the microbiologic causes are unknown. In the present cohort study, we compared the incidence and profiles of pulmonary and blood stream infections (BSI) between LDLT and CDLT recipients. We hypothesized a lower incidence in LDLT recipients.

Positive End-expiratory Pressure Induces Liver Congestion in Living Donor Liver Transplant Patients: Myth or Fact

Transplantation. Jun, 2008  |  Pubmed ID: 18580483

Living-donated liver transplant (LDLT) patients may develop lung edema during reperfusion, requiring higher positive end-expiratory pressure (PEEP) levels, which may impair liver outflow. The aim of the study was to assess the effect of increased PEEP levels on venous liver outflow and systemic hemodynamics in patients after LDLT. Thirty-nine LDLT recipients were enrolled in this study. All patients were postoperatively pressure-controlled ventilated and three different PEEP levels (0, 5 and 10 mbar) were randomly set. Systemic hemodynamic parameters and flow velocities of the hepatic artery, portal vein, and right hepatic vein were recorded at each PEEP level. PEEP of 10 mbar increased significantly central venous and pulmonary capillary pressure. Flow velocities in the right hepatic vein, the portal vein, the hepatic artery, mean arterial pressure, pulmonary arterial pressure, and cardiac index were not influenced by PEEP. Our study demonstrated that PEEP up to 10 mbar did not impair liver outflow in LDLT recipients.

Preoperative Assessment of Hilar Cholangiocarcinoma by Dual-modality PET/CT

Journal of Surgical Oncology. Nov, 2008  |  Pubmed ID: 18767120

The purpose of the current study was to evaluate the accuracy of (18)F-FDG PET/CT in staging hilar cholangiocarcinoma.

Inaccurate Estimation of Donor Body Weight, Height and Consequent Assessment of Body Mass Index May Affect Allocation of Liver Grafts from Deceased Donors

Transplant International : Official Journal of the European Society for Organ Transplantation. Mar, 2009  |  Pubmed ID: 18954368

Survivin is Upregulated During Liver Regeneration in Rats and Humans and is Associated with Hepatocyte Proliferation

Liver International : Official Journal of the International Association for the Study of the Liver. Apr, 2009  |  Pubmed ID: 19018973

Survivin regulates cell division and inhibits apoptosis. Liver regeneration is a complex process involving both proliferation and apoptosis. The role of survivin is not well elucidated and no data exist in humans.

Liver Transplantation, Liver Resection, and Transarterial Chemoembolization for Hepatocellular Carcinoma in Cirrhosis: Which is the Best Oncological Approach?

Digestive Diseases and Sciences. Oct, 2009  |  Pubmed ID: 19057997

The aim of the study was to evaluate our institutional experience with monotherapies for hepatocellular carcinoma (HCC) in the setting of cirrhosis. A retrospective cohort study was carried out at the tertiary care academic referral center and involved 185 consecutive HCC patients with cirrhosis and no previous treatment who underwent resection (n = 61), transarterial chemoembolization (TACE) (n = 64), or liver transplantation (LT) (n = 60). Long-term survival and survival according to the Milan criteria were the main outcomes measured. Median survival after resection, TACE, and LT was 11, 14, and 23 months, respectively. Five-year cumulative survival after resection, TACE, and LT was 23, 10, and 59%, respectively (P = 0.001). Five-year cumulative disease-free survival after resection and LT was 15% and 77%, respectively (P = 0.002). The presence of complications in the resection group (P = 0.004), MELD score (P = 0.0003), and maximum tumor diameter (P = 0.05) in the TACE group, and tumor grade (P = 0.01) and complications (P = 0.004) in the LT group were found to be independent predictors of survival. Five-year survival for patients within the Milan criteria after resection, TACE, and LT was 26, 37, and 66%, respectively. Five-year survival for patients outside the Milan criteria for patients undergoing LT was 53%. The results suggest that LT represents the best oncological treatment option for patients with HCC in the setting of cirrhosis, even for those beyond the Milan criteria. Considering the scarcity of available organs, liver resection remains the best alternative option. TACE remains a potential therapy in patients within the Milan criteria, where it may be more beneficial than resection.

Intraoperative Application of "white Test" to Reduce Postoperative Bile Leak After Major Liver Resection: Results of a Prospective Cohort Study in 137 Patients

Langenbeck's Archives of Surgery / Deutsche Gesellschaft Für Chirurgie. Nov, 2009  |  Pubmed ID: 19104825

This study aimed to prove the clinical validation of the recently developed bile leakage test, "white test" (WT), in major liver resection.

Liver Transplantation and Neurological Side Effects

Metabolic Brain Disease. Mar, 2009  |  Pubmed ID: 19139982

Advances in liver transplantation (LT), particularly in immunosuppression and intensive care treatment have had increased the number of long-term survivors following liver transplantation. In order of more long-term survivors, reports about neurological complication following liver transplantation are increasing. Neurological complications are not uncommon in liver transplant recipients, which contribute to a longer ICU- and in-hospital stay. Every effort should be focused on early detection to prevent the patient from this life-threatening event, which is often associated with poor life quality.

Split-liver Transplantation in the High-MELD Adult Patient: Are We Being Too Cautious?

Transplant International : Official Journal of the European Society for Organ Transplantation. Jul, 2009  |  Pubmed ID: 19254241

The fear that patients with high-mathematical model for end stage liver disease (MELD) score may not be suitable candidates for segmental grafts because of their need for greater liver mass has continued to push the transplant community toward the use of whole LT (WLT) in preference to split LT (SLT). In order to define the outcome of segmental liver transplantation in a better manner in high-MELD patients (score > or =26), we queried the UNOS registry for graft and patient survival results according to MELD score in adult patients receiving WLT and SLT in the United States from the inception of MELD allocation (February 27, 2002) through March 9, 2007. A total of 316 adult patients received a SLT as compared with 20 778 WLTs. Patient and graft survival rates at 6 and 12 months were comparable for all MELD ranges, including the 'high-MELD' recipients (e.g. at MELD score 31-35, patients' and grafts' survival rates at 12 months was 87.5% in SLT group vs. 84.4% and 76.7% in WLT group respectively). The results even at higher MELD scores (i.e. >35) were more than acceptable. In conclusion, patient and graft survival rates for SLT in high-MELD adult patients are comparable to the same for WLT.

Mental and Physical Quality of Life in Actual Living Liver Donors Versus Potential Living Liver Donors: a Prospective, Controlled, Multicenter Study

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Dec, 2009  |  Pubmed ID: 19938145

In a quasi-experimental design, we investigated the quality of life (QOL) in actual liver donors (n = 43) and potential liver donors (n = 33) before and 3 months after liver transplantation. This is the first study in this field combining a prospective design with an adequate control group. Potential donors served as a control group because they also had a relative in need of a liver transplant and were as emotionally involved with the recipient as actual donors, but they were not subjected to the donor operation. Groups did not differ in age, gender, marital status, donor-recipient relationship, urgency of transplantation, or recipient group (adult versus child). Actual donors showed decreased physical QOL, whereas potential donors were not affected. However, for both groups, a decrease in anxiety was found. Furthermore, actual donors showed a better mental QOL postoperatively than potential donors. The recipients of these 2 groups did not differ with respect to postoperative complications. Furthermore, the groups did not report a different caregiver burden, but actual donors showed higher self-esteem. Because of the surgery, the worsening of physical symptoms in actual donors was expected. It is remarkable, however, that although actual donors still showed a limited physical QOL 3 months after the operation, in both groups, a similar reduction in anxiety could be observed, and actual donors even demonstrated a better mental QOL postoperatively than potential donors. The latter might be due to a psychological benefit that actual donors derived from the fact that they were able to help the recipients.

Vascular and Biliary Anatomy of the Right Hilar Window: Its Impact on Recipient Morbidity and Mortality for Right Graft Live Donor Liver Transplantation

World Journal of Surgery. Sep, 2009  |  Pubmed ID: 19603222

Intrahepatic anatomic variations have been associated with both morbidity and mortality associated with live donor liver transplantation. The aim of our study was to evaluate central hilar and peripheral segmental vascular/biliary anatomy in right graft living donor liver transplantation.

Liberal Policy in Living Donor Liver Transplantation for Hepatocellular Carcinoma: Lessons Learned

Digestive Diseases and Sciences. Feb, 2009  |  Pubmed ID: 18594985

Living donor liver transplantation (LDLT) in cases of hepatocellular carcinoma (HCC) that do not fulfil accepted tumor criteria continues to be a matter of controversy. The aim of this study was to evaluate survival and prognostic factors associated with a liberal exclusionary policy.

Neurologic Complications in Adult Living Donor Liver Transplant Patients: an Underestimated Factor?

Journal of Neurology. Feb, 2010  |  Pubmed ID: 19727899

Liver transplantation is the only curative treatment in patients with end-stage liver disease. Neurological complications (NC) are increasingly reported to occur in patients after cadaveric liver transplantation. This retrospective cohort study aims to evaluate the incidence and causes of NC in living donor liver transplant (LDLT) patients in our transplant center. Between August 1998 and December 2005, 121 adult LDLT patients were recruited into our study. 17% of patients experienced NC, and it occurred significantly more frequently in patients with alcoholic cirrhosis (42%) and autoimmune hepatitis (43%) as compared with patients with hepatitis B or C (9/10%, P = 0.013). The most common NC was encephalopathy (47.6%) followed by seizures (9.5%). The choice of immunosuppression by calcineurin inhibitor (Tacrolimus or Cyclosporin A) showed no significant difference in the incidence of NC (19 vs. 17%). The occurrence of NC did not influence the clinical outcome, since mortality rate, median ICU stay and length of hospital stay were similar between the two groups. Most patients who survived showed a nearly complete recovery of their NC. NCs occur in approximately 1 in 6 patients after LDLT and seem to be predominantly transient in nature, without major impact on clinical outcome.

Surgical Management of Segmental and Sectoral Bile Duct Injury After Laparoscopic Cholecystectomy: a Challenging Situation

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. Feb, 2010  |  Pubmed ID: 19911237

Injury to a segmental or sectoral bile duct is a rare event in laparoscopic cholecystectomy; its diagnosis and management may be difficult.

Vena Cava Sarcoma with Tumor Embolus in the Pulmonary Artery: Surgical Treatment

The Annals of Thoracic Surgery. Aug, 2010  |  Pubmed ID: 20667370

Tumors of the inferior vena cava are rarely complicated by pulmonary tumor embolism. We report a patient with a leiomyosarcoma of the inferior vena cava complicated by an embolus in the left pulmonary artery. We describe the successful treatment of this condition, which consisted of cavoplasty and pulmonary endarterectomy conducted under hypothermic circulatory arrest. Different aspects of the surgical strategy are discussed.

Influence of Exhaustive Exercise on the Immune System in Solid Organ Transplant Recipients

Exercise Immunology Review. 2010  |  Pubmed ID: 20839499

Prolonged exhaustive exercise has a great impact on the immune system of athletes and leads to a transient weakening of the immune system. A host of studies has documented changes of immune parameters in peripheral blood following exercise. Concerning the effect of exhaustive exercise in transplant recipients there is little knowledge at present. We analysed peripheral blood in healthy athletes and transplant recipients who participated in the "Euregio cycling tour 2009" before and immediately after they performed 81 km of cycling that included ascending more than 1800 m in altitude. A full blood count and an automated differential count as well as microarray analysis were performed before, immediately after and one day after exercise in 10 male patients carrying a kidney transplant and in 10 controls matched in age and gender. Comparing the absolute increase in neutrophils in these two groups, we detected that the relative increase in neutrophils was significantly smaller in transplant recipients compared to their corresponding controls after exhaustive exercise. While both groups were comparable in performance, microarray analysis revealed a markedly different pattern of gene expression in transplant recipients compared to their controls. From the 130 genes that were significantly upregulated in controls immediately after exercise, only 12 genes were also upregulated in transplant recipients. 64 different genes were upregulated in transplant recipients only. Our findings may be related to the immunosuppressive medication that the transplant recipients took and therefore it should also be discussed that regular exercise might reduce the need for immunosuppressive medication in transplant recipients.

A Pancreas-preserving Technique for the Management of Symptomatic Pancreatic Anastomotic Insufficiency Refractory to Conservative Treatment After Pancreas Head Resection

Langenbeck's Archives of Surgery / Deutsche Gesellschaft Für Chirurgie. Aug, 2010  |  Pubmed ID: 19506900

Management of symptomatic pancreatic anastomotic insufficiency after pancreas head resection remains controversial. Completion pancreatectomy as one frequently performed option is associated with poor prognosis.

Long-term Follow-up and Outcome of Liver Transplantation from Anti-hepatitis C Virus-positive Donors: a European Multicentric Case-control Study

Transplantation. Jun, 2011  |  Pubmed ID: 21478815

The growing prevalence of hepatitis C virus (HCV) infection in the general population has resulted in an increased frequency of potential organ donors that carry the virus. Given the significant disparity between organ supply and demand for transplantation, it becomes essential to consider whether livers from anti-HCV-positive donors may be considered suitable for transplantation.

Prophylactic Eculizumab Prior to Kidney Transplantation for Atypical Hemolytic Uremic Syndrome

Pediatric Nephrology (Berlin, Germany). Aug, 2011  |  Pubmed ID: 21556717

Atypical hemolytic uremic syndrome (aHUS) in childhood is a rare disease associated with high morbidity and mortality. Most cases progress to end-stage renal failure. In approximately 50% of affected patients, mutations in genes encoding complement proteins are causative of the impairment in the regulation of the complement alternative pathway. This leads to deficient host cell protection and inappropriate complement activation on platelets and endothelial cells, particularly in the kidneys. Complement factor H (FH) heterozygosity induces unregulated activation of the membrane attack complex (MAC) C5b-9. Present therapeutic strategies for aHUS include lifelong plasmapheresis and renal dialysis. Unfortunately, kidney transplantation is frequently an unsatisfactory intervention due to the high rate of post-transplantation HUS recurrence, particularly in patients with FH mutation. Combined liver-kidney transplantation is also associated with poor outcome, mostly as a result of premature liver failure secondary to uncontrolled complement activation. Eculizumab is a complement C5 antibody that inhibits complement factor 5a (C5a) and the formation of the MAC. Thus, this antibody may be a promising new agent for patients with an aHUS undergoing kidney transplantation. We present the first case of a young patient with aHUS who received eculizumab as prophylactic treatment prior to a successful kidney transplantation.

Living Donor Liver Transplantation in Adults in the MELD Era in Germany--a Multi-center Retrospective Analysis

Transplant International : Official Journal of the European Society for Organ Transplantation. Sep, 2011  |  Pubmed ID: 21668530

The aim of this analysis was to provide an update on the current trend in living donor liver transplantation (LDLT) for adult recipients in the model of end stage liver disease (MELD) era in Germany and to encourage a wider implementation of LDLT. We descriptively analysed the data of LDLTs in Germany from 15 December 2006 to 31 December 2009 using a multi-center retrospective analysis via a questionnaire and data provided by Eurotransplant. Ten German centers performed LDLTs in adults. Eighty four transplantations in 50 male recipients and 34 female recipients were performed during the review period, ranging from 1 to 16 LDLTs per center. Hepatocellular carcinoma in cirrhosis (15/84) was the most common transplantation indication. The recipient mean lab-MELD score was 15 (±8). Six re-transplantations were necessary after initial LDLTs. The 1-year patient survival was 81%. We obtained data of 79/84 donors. The incidence of complications was 30.4% (n = 24). There were no grade 5 complications according to the Clavien classification. LDLT is an established treatment option that may reduce the waiting time, provides high quality split liver grafts and should be advocated in the MELD era to reduce organ shortage and 'death on the waiting list'.

Urinary Ammonia Excretion Increases Acutely During Living Donor Liver Transplantation

Liver International : Official Journal of the International Association for the Study of the Liver. Sep, 2011  |  Pubmed ID: 21745291

Arterial ammonia concentrations increase acutely during the anhepatic phase of a liver transplantation (LTx) and return to baseline within 1 h after reperfusion of a functioning liver graft. So far, this return to baseline has solely been attributed to hepatic ammonia clearance. No data exist on the potential contribution of altered renal ammonia handling to peritransplantation ammonia homoeostasis.

[Is the Traditional Open Donor Nephrectomy in Living Donor Renal Transplantation Still Up to Date?]

Wiener Klinische Wochenschrift. Jan, 2012  |  Pubmed ID: 22124840

Living donor kidney transplantation is a well-established method to reduce time on the waiting list. Although the laparoscopic donor nephrectomy has already been established worldwide, more than 80% of the living donor nephrectomies are performed as a traditional open donor nephrectomy in Germany. The aim of our study was to analyze perioperative data and long-term outcome of donors and recipients following open donor nephrectomy.

Right Portal Vein Ligation Combined With In Situ Splitting Induces Rapid Left Lateral Liver Lobe Hypertrophy Enabling 2-Staged Extended Right Hepatic Resection in Small-for-Size Settings

Annals of Surgery. Mar, 2012  |  Pubmed ID: 22330038

: To evaluate a new 2-step technique for obtaining adequate but short-term parenchymal hypertrophy in oncologic patients requiring extended right hepatic resection with limited functional reserve.