Key Points (key + point)

Distribution by Scientific Domains

Selected Abstracts

Identification of operationally tolerant liver transplant recipients,

Alberto Sánchez-Fueyo
KEY POINTS: (1) Liver allografts exhibit intrinsic tolerogenic properties that result in their spontaneous acceptance in many experimental animal models. (2) In clinical transplantation, liver allografts require milder immunosuppression (IS) regimens than other organs, are remarkably resistant to antibody-mediated rejection, and only very rarely are lost because of immunological insults. (3) A fraction of stable liver transplant recipients can withdraw from all IS therapy and then maintain normal graft function and not experience rejection. This phenomenon is known as spontaneous operational tolerance. (4) The intentional discontinuation of IS in stable liver transplant recipients has led to successful weaning in almost 20% of recipients, but the true prevalence of spontaneous operational tolerance in unselected recipients is still unknown. (5) The prevalence could be higher in pediatric recipients undergoing transplantation before 1 year of age and in adult recipients with more than 10 years of posttransplant follow-up. (6) Rejection occurring during medically supervised IS weaning trials tends to be mild and, in the overwhelming majority of cases, can be easily resolved without the administration of high-dose IS. (7) Tolerant liver recipients exhibit specific transcriptional patterns in peripheral blood and in liver tissue that may constitute future diagnostic markers of tolerance. (8) There is still no formal proof that the discontinuation of low-dose IS in long-term surviving liver recipients improves the morbidity and mortality rates associated with IS therapy. Liver Transpl 16:S82-S86, 2010. © 2010 AASLD. [source]

Liver transplantation for malignancies in children,

Sue V. McDiarmid
Key Points 1. Hepatoblastoma (HB) is the most common primary pediatric liver malignancy. The majority of children with HB are resection candidates. Determining which children should undergo resection or primary liver transplantation is essential to the prognosis. 2. Hepatocellular carcinoma (HCC) is the second most common pediatric primary liver malignancy. Most children with HCC are not resection candidates. Transplantation offers improved survival for appropriate candidates in comparison with nontransplant options. 3. Unlike children with HCC, children with HB and extrahepatic spread to the lungs have acceptable transplant outcomes if the disease has been eradicated by chemotherapy or surgical removal at the time of transplantation. 4. Chemotherapy is an important adjuvant for improving outcomes for children with HB, but its benefits for children with HCC are unproven. 5. Demonstrated extrahepatic spread at the time of transplantation is a contraindication to transplantation for patients with HCC or HB. Macroinvasion at the time of transplantation is a relative contraindication to transplantation. 6. Children with primary hepatic malignancies who are transplant candidates should be prioritized on the deceased donor waiting list. However, the criteria for prioritizing adult HCC patients have not been proven to be relevant for children. Liver Transpl 16:S13-S21, 2010. © 2010 AASLD. [source]

What is the real gain after liver transplantation?

James Neuberger
Key Points 1. For most liver allograft recipients, both the quality and length of life are greatly improved after transplantation. However, neither the quality of life nor the length of life in the survivors returns to that seen in age-matched and sex-matched normal subjects. 2. The gain in survival after transplantation can be estimated by a comparison of the actual outcome after transplantation and the predicted survival in the absence of transplantation. 3. The reduction in graft and patient survival, in comparison with a normal age-matched and sex-matched population, is determined by several factors: short-term survival is affected by the patient's condition pre-transplant and the quality of the graft, and for longer term survival, recurrent disease accounts for most of the differences seen between different indications. Some of the causes of premature death (such as infection, de novo malignancy, and cardiovascular and cerebrovascular disease) that are increased in the liver allograft recipient may be reduced by improved management with more aggressive surveillance and treatment. 4. The aims of selection and allocation vary in different health care systems: transparency, objectivity, equity of access, justice, mortality awaiting transplantation, utility, and transplant benefit are all important but often competing demands. Understanding the associated increase in survival will allow for a rational approach to this complex area. Liver Transpl 15:S1,S5, 2009. © 2009 AASLD. [source]

Long-term outcomes in pediatric liver transplantation

John Bucuvalas
Key Points 1. Critical clinical outcomes for pediatric liver transplantation (LT) recipients include (1) patient and graft survival, (2) complications (immune and nonimmune) of chronic immunosuppressive medications, and (3) long-term graft function. 2. Recurrence of malignancy, sepsis, and posttransplant lymphoproliferative disorder account for more than 65% of deaths occurring more than 1 year after LT. 3. Chronic rejection, late hepatic artery thrombosis, and biliary strictures account for 70% of graft loss occurring more than 1 year after LT. 4. Late histological changes in the allograft are emerging as a common problem in patients more than 5 years after LT. The pathogenesis of these findings and the impact on graft survival remain to be determined. Liver Transpl 15:S6,S11, 2009. © 2009 AASLD. [source]

Late surgical complications following liver transplantation

Paige M. Porrett
Key Points 1. Biliary strictures and incisional hernias are the most common surgical complications encountered late after liver transplantation. 2. Anastomotic biliary strictures are amenable to endoscopic intervention and rarely need surgical intervention. 3. The presence of a biliary stricture mandates an evaluation of the patency of the hepatic artery. 4. Ischemic-type intrahepatic strictures are common indications for retransplantation. 5. Recipients of living related liver transplantation and donation after cardiac death allografts are at the highest risk for biliary and vascular complications late after transplantation. Liver Transpl 15:S12,S18, 2009. © 2009 AASLD. [source]

Obesity, hyperlipidemia, and metabolic syndrome

Michael Charlton
Key Points 1. Obesity is increasingly common among liver transplantation (LT) recipients and donors. Outcomes following LT for selected patients with class I-III obesity are similar to those for nonobese recipients. In patients who are otherwise satisfactory candidates for LT, a high body mass index, as long as it does not present a technical barrier, should not be considered to be an absolute contraindication to LT. 2. The most common causes of death beyond the first year of LT are, in descending order of frequency, graft failure (especially secondary to hepatitis C virus recurrence), malignancy, cardiovascular disease, infections, and renal failure. Metabolic syndrome is an important risk factor for each of these etiologies of posttransplant death. Posttransplant diabetes, posttransplant hypertension, and an original diagnosis of cryptogenic cirrhosis, which is commonly associated with metabolic syndrome, are all associated with an increased risk of post-LT mortality. Features of metabolic syndrome should be screened for and treated in LT recipients. 3. Because of the physiological mechanism of post-LT hypertension, which includes renal arteriolar constriction secondary to calcineurin inhibition, calcium channel blocking agents are a good pharmacological treatment modality and have been shown to be effective in renal protection in randomized controlled trials of posttransplant hypertension. 4. It is rare for dietary changes and weight reduction to result in normalization of the lipid profile. Statins should thus be initiated early in the course of management of post-LT dyslipidemia. Forty milligrams of simvastatin per day, 40 mg of atorvastatin per day, and 20 mg of pravastatin per day are reasonable starting doses for post-LT hypercholesterolemia. It is important to remember that the effects of statin therapy are additive to those of a controlled diet (eg, a Mediterranean diet rich in omega-3 fatty acids, fruits, vegetables, and dietary fiber). 5. Nonalcoholic steatohepatitis, an increasingly common etiology of cirrhosis and liver failure, recurs commonly after LT and may also arise de novo. Treatment should be directed at managing obesity and complications of metabolic syndrome. Optimal immunosuppression in patients with nonalcoholic steatohepatitis is still evolving but should include steroid minimization. Liver Transpl 15:S83,S89, 2009. © 2009 AASLD. [source]

De novo malignancies following liver transplantation: Impact and recommendations

J. Ignacio Herrero
Key Points 1. De novo malignancy is one of the leading causes of late mortality after liver transplantation. 2. The risks of skin cancers and lymphoma are more than 10-fold greater than the risks in an age-matched and sex-matched general population. 3. Some types of neoplasia, such as lung, head and neck, and colorectal cancer, are more frequent in liver transplant recipients than in an age-matched and sex-matched population. The risks of other frequent malignancies, such as prostate and breast cancer, do not seem to be increased. 4. The most important risks for posttransplant malignancy are Epstein-Barr virus seronegativity (for lymphoma), sun exposure (for skin cancer), smoking, and increasing age. 5. Despite the absence of evidence, general recommendations (such as avoidance of overimmunosuppression, sunlight protection, and cessation of smoking) should be given. Screening protocols may help to detect neoplasia at an early stage of disease. Liver Transpl 15:S90,S94, 2009. © 2009 AASLD. [source]

Management of patients with decompensated hepatitis B virus associated cirrhosis

Fabien Zoulim
Key Points 1Hepatitis B virus replication is associated with a severe outcome in patients with decompensated cirrhosis. 2Viral suppression induced by antivirals results in a clinical improvement that allows liver transplantation to be delayed or avoided. 3Early treatment intervention is mandatory in patients with decompensated cirrhosis because of the delay in the restoration of liver functions. 4Lamivudine is no longer the drug of choice because the initial enthusiasm has been tempered by the high rate of resistance development. 5Early add-on therapy with adefovir allows us to rescue lamivudine resistance, but its use may be limited by nephrotoxicity. 6Studies are ongoing with the newer generation of antivirals (telbivudine, tenofovir, entecavir, and emtricitabine) in monotherapy or in combination to determine the best strategy for achieving rapid and prolonged suppression of viral replication. These improved strategies should enhance treatment success enough to obtain clinical stabilization, to delay or prevent the need for transplantation, and to reduce the risk of hepatitis B virus recurrence on the graft. Liver Transpl 14:S1,S7, 2008. © 2008 AASLD. [source]

How to diagnose and treat hepatitis B virus antiviral drug resistance in the liver transplant setting

Anna S. F. Lok
Key Points 1Hepatitis B virus variants with antiviral drug,resistant mutations and/or hepatitis B immune globulin,resistant mutations are the main cause of hepatitis B virus reinfections post,liver transplant. 2Early diagnosis of antiviral drug resistance and prompt initiation of rescue therapy are important in preventing hepatitis flares and hepatic decompensation. 3Virologic breakthrough is the first indication of antiviral drug resistance. 4Genotypic resistance testing should be performed when possible to avoid unnecessary modification of treatment in patients who do not have confirmed antiviral drug resistance and to permit appropriate selection of rescue therapy in those who have confirmed antiviral drug resistance. 5Choice of rescue therapy requires knowledge of the past history of hepatitis B virus treatments and virologic response to those treatments, patterns of mutations detected at the time of virologic breakthrough, and in vitro cross-resistance data. 6Occurrence of antiviral drug resistance can be reduced by the use of the most potent nucleos(t)ide analogue(s) with the highest genetic barrier to resistance, emphasis of medication compliance, and close monitoring of virologic response. Liver Transpl 14:S8,S14, 2008. © 2008 AASLD. [source]

Application of intensive care medicine principles in the management of the acute liver failure patient

David J. Kramer
Key Points 1Acute liver failure is a paradigm for multiple system organ failure that develops as a consequence of sepsis. 2In the United States, systemic inflammatory response, sepsis, and septic shock are common reasons for intensive care unit admission. Intensive care management of these patients serves as a template for the management of patients with acute liver failure. 3Acute liver failure is attended by high mortality. Although intensive care results in improved survival, the key treatment is liver transplantation. Intensive care unit intervention may open a "window of opportunity" and enable successful liver transplantation in patients who are too ill at presentation. 4Intracranial hypertension complicates the course for many patients with acute liver failure. Initially, intracranial hypertension results from hyperemia, which is cerebral edema that reduces cerebral blood flow and eventuates in herniation. The precepts of neurocritical care,monitoring cerebral perfusion pressure, cerebral blood flow, and cortical activity,with rapid response to hemodynamic abnormalities, maintenance of normoxia, euglycemia, control of seizures, therapeutic hypothermia, osmotic therapy, and judicious hyperventilation are key to reducing mortality attributable to neurologic failure. Liver Transpl 14:S85,S89, 2008. © 2008 AASLD. [source]

Prevention and management of brain edema in patients with acute liver failure

Fin Stolze Larsen
Key Points 1Intracranial pressure is the pressure exerted by the cranial contents on the dural envelope and consists of the partial pressures of the brain, blood, and cerebrospinal fluid. 2Severe cases of acute liver failure are frequently complicated by brain edema (due to cytotoxic edema) and an increase in cerebral blood flow while the cerebrospinal fluid volume remains constant. 3The development of intracranial hypertension in patients with acute liver failure may be controlled by manipulation of the position, body temperature, plasma tonicity, arterial carbon dioxide tension, and arterial pressure. 4If intracranial hypertension evolves despite these first-tier interventions, increased sedation, induction of hypothermia (body temperature of 33°C to 34°C), and the use of anti-inflammatory drugs may help secure brain viability. Liver Transpl 14:S90,S96, 2008. © 2008 AASLD. [source]

AASLD/ILTS transplant course: Is there an extended donor suitable for everyone?

Andrew Cameron
Key Points 1The clinical success of liver transplantation coupled with the current era of organ shortage has caused many centers to expand their criteria for acceptable donors. 2The definition of "Extended Criteria Donor" (ECD) is becoming better understood and quantified. 3Recipient factors that portend poor outcome must be recognized and factored in as well. Grafts and recipients must be "matched" to manage and minimize the risk from ECDs. 4Maintaining acceptable outcomes as ECD concepts evolve is paramount. 5Absolute risk factors for poor graft function still exist and must be respected, but relative risk factors are now well identified, quantified, accepted, and managed as an alternative to high waiting list mortality. (Liver Transpl 2005;11:S2,S5.) [source]

Live donor/split liver grafts for adult recipients: When should we use them?

Peter Neuhaus
Key Points 1Split liver transplantation for a child and an adult recipient is standard today. Living donor liver transplantation for small children should only be necessary in exceptional situations in a country with a well-organized organ donation program. 2True split liver transplantation for two adults is still not very common. In the United States between April 2000 and May 2001, 89 surgical teams transplanted only 15 left lobes and 13 right lobes. Especially left lobes from deceased donors have a poor outcome; in Europe the ELTR shows a 1-year graft survival of 47%. 3While in Asia left lobes, right lateral segments, and dual left lateral segments are more frequently used, living donor liver transplantation for adults in Europe and the United States is predominantly performed with right lobes.7, 8 This carries a significant morbidity and mortality risk for the donor. Outcome compared to deceased donor liver transplantation (DDLTx) is similar with a trend towards more short-term and long-term biliary complications. 4Living donor and split liver transplantation should be used mainly in an elective situation. Candidates are tumor patients, patients with cholestatic liver disease, and elective patients with bile disease. 5Urgent liver transplantation is not a good option for living donor and split liver transplantation. Hepatic assist devices may change the picture in the future. 6Living donor liver transplantation for metabolic disorders like Alpha-1-Antitrypsin deficiency, Hyperoxaluria, and others cannot be recommended at present since the genetically related donor and the patient may carry an unknown risk. (Liver Transpl 2005;11:S6,S9.) [source]

Cardiovascular risk factors after liver transplantation

Santiago J. Muñoz
Key Points 1Yearly screening of liver recipients with serum cholesterol, triglycerides, and lipoproteins, and assessment for risk factors for atherosclerotic cardiovascular disease, is an important component of comprehensive post transplant care. 2Revised guidelines and target levels of LDL-cholesterol levels specific for moderate and high cardiovascular risk patients have been recently revised. 3Transplant physicians should be aware of advances in the management of post transplant arterial hypertension, diabetes mellitus, obesity, and nicotine dependence. (Liver Transpl 2005;11:S52,S56.) [source]

Recurrence of hepatitis C infection: Where are we now?

Michael Charlton
Key Points 1Hepatitis C-associated liver failure is the most common indication for liver transplantation, and approximately 10% of HCV-infected recipients will die or lose their allograft secondary to recurrent HCV infection. 2Risk factors associated with histological recurrence of HCV include donor (age, fat content, ischemic time, and living donor), recipient (age and non-Caucasian race), clinical (rejection and CMV), and viral (viral load and quasispecies). 3Treatment of recipients with histological recurrence is with pegylated IFN (± ribavirin). The role of hepatitis C immunoglobulin in the management of postransplant HCV is still evolving. (Liver Transpl 2005;11:S57,S62.) [source]

Retransplantation for recurrent hepatitis C in the MELD era: Maximizing utility

James R. Burton Jr.
Key Points 1Retransplantation (re-LT) for hepatitis C virus (HCV) recurrence is controversial. Although re-LT accounts for 10% of all liver transplants (LTs), the number of patients requiring re-LT is expected to grow as primary LT recipients survive long enough to develop graft failure from recurrent disease. 2Utility, as applied to the medical ethics of transplantation, refers to allocating organs to those individuals who will make the best use of them. The utility function (U) of liver transplantation is represented by the product of outcome (O = 1-year survival with LT) times emergency (E = 3-month mortality without LT), i.e., U = O × E. 3For primary LT, maximal U is achieved by allocating organs at the highest model for end-stage liver disease (MELD) score (i.e., "sickest first"). No significant differences exist between HCV and non-HCV diagnoses. 4For re-LT, maximal utility for HCV and non-HCV diagnoses are achieved at MELD scores of 21 and 24, respectively. Utility starts to decline at MELD scores above 28. 5The current allocation system (MELD) fails to maximize utility with regard to re-LT. (Liver Transpl 2004;10:S59,S64.) [source]

Transplantation for hilar cholangiocarcinoma

Julie K. Heimbach
Key Points 1Patients with primary sclerosing cholangitis (PSC) have a 8 to 12% risk of developing cholangiocarcinoma (CCA). 2Cytologic techniques for aneuploidy such as digital image analysis and fluorescence in situ hybridization increase the detection rate for CCA. 3Survival following resection for CCA is 20% to 40% at 5 years. 4Survival following liver transplantation for unresectable, perihilar CCAs, mass lesion if present <3 cm, is greater than 80% at 5 years. 5Patients with intrahepatic CCAs are not eligible for liver transplantation. (Liver Transpl 2004;10:S65,S68.) [source]

Late hepatic allograft dysfunction

Professor of Medicine Russell H. Wiesner MD
Key Points 1Lifelong monitoring of graft function, immunosuppressive levels, and screening for drug toxicity is required in all liver recipients. 2Late hepatic allograft dysfunction is common and is caused by a variety of etiologies including rejection, infection, biliary/vascular abnormalities, recurrence of disease, and drug hepatotoxicity. 3In all patients with late hepatic allograft dysfunction, liver biopsy should be performed to assess for the presence of rejection, and to thus avoid excessive use of bolus corticosteroid therapy and guide appropriate immunosuppressive management. 4Recurrence of disease is the most common cause of late hepatic allograft dysfunction. 5Hepatitis C universally reinfects the hepatic allograft, and is associated with decreased patient and graft survival and leads to the recurrence of cirrhosis in 28% of patients within 5 years of transplantation. 6Major advances have been made in preventing recurrence of hepatitis B by the use of hepatitis B immune globulin in combination with lamivudine therapy. 7Autoimmune liver diseases such as primary biliary cirrhosis, primary sclerosing cholangitis, and autoimmune hepatitis have a recurrence rate of approximately 20% to 30%. 8In patients developing recurrence of autoimmune hepatitis, steroid withdrawal is the most common cause. 9Recurrent hepatocellular cancer can be markedly reduced if strict guidelines are adhered to in selecting patients. 10Drug hepatotoxicity must always be considered in the differential diagnosis of late hepatic allograft dysfunction. [source]

Selection of donors and recipients for living donor liver transplantation

James F. Trotter M.D.
Key Points 1. Living donor liver transplantation (LDLT) is increasingly used for adults with end-stage liver disease. 2. Standards for acceptable rates of donor morbidity, and even mortality, must be evaluated in the context of recipient risk of dying while on the waiting list and outcome after transplantation. 3. Use of our current criteria in Colorado for selection of donors and recipients indicated that 15% of recipients could undergo LDLT. [source]

Right-lobe living donor liver transplantation

Amadeo Marcos M.D.
Key Points 1. Living donor liver transplantation (LDLT) is currently performed at about 30 centers in the United States. 2. Careful and critical evaluation of donor and recipient is required for optimal outcome. 3. Right lobe donation is preferred over left lobe donation in adult LDLT. 4. There has been 1 donor death (<0.3%) in the US experiences. Donor biliary complications occur in approximately 4% of the cases. 5. Recipient survival after adult LDLT in the United States is approximately 88%. Hepatic artery thrombosis occurs in 3% and biliary complications in 18%. [source]

Peri-conceptual folic acid supplementation in type 1 diabetes

C.J. Wills Specialist Registrar in Diabetes, Endocrinology
Abstract Aim To document peri-conceptual folic acid supplementation in women with type 1 diabetes mellitus (DM) attending the diabetic ante-natal clinic of a university teaching hospital. Methods Women with pre-existing type 1 DM who booked at the diabetes antenatal clinic at University Hospital, Nottingham over 3 years (1996,98) took part in a telephone survey about folic acid supplements. Results Data was available on 50 women, 65 pregnancies. Folic acid supplements were used before 50.7% (33) pregnancies, all planned, and started on confirmation of pregnancy in 34% (22), at a mean gestation of 5.8 weeks. No folic acid was used before or during 10 (15.4%) pregnancies. 75.4% (49) pregnancies were planned. 24 planned pregnancies were in women who had never had pre-pregnancy counselling. 70.8%(17) of these were in multiparous women, and folic acid was taken before 41.1% (seven) of such pregnancies. Lack of awareness was the predominant reason for failure to take folic acid supplements in all groups. Conclusions Folic acid was taken before conception in only half of the pregnancies in the survey, due to lack of awareness of its importance. Three-quarters of pregnancies were planned but a disappointing number of women had pre-pregnancy counselling, probably due to poor advertising and the assumption that women who had been pregnant before did not need such a session. Women with DM should be informed about folic acid and offered pre-pregnancy counselling. It should not be assumed that women who have had a pregnancy know about folic acid. Copyright © 2001 John Wiley & Sons, Ltd. Key Points Folic acid supplementation prior to conception and in the first trimester helps to prevent neural tube defects. Almost half of the women in this survey failed to take folic acid prior to conception. Women who did not take folic acid were unaware of its importance. We need to ensure that women with diabetes understand the importance of folic acid. [source]

Microfluidic technologies for MALDI-MS in proteomics

Don L. DeVoe Professor
Abstract The field of microfluidics continues to offer great promise as an enabling technology for advanced analytical tools. For biomolecular analysis, there is often a critical need to couple on-chip microfluidic sample manipulation with back-end MS. Though interfacing microfluidics to MS has been most often reported through the use of direct ESI-MS, there are compelling reasons for coupling microfluidics to MALDI-MS as an alternative to ESI-MS for both online and offline analysis. The intent of this review is to provide a summary of recent developments in the integration of microfluidic systems with MALDI-MS, with an emphasis on applications in proteomics. Key points are summarized, followed by a review of relevant technologies and a discussion of outlook for the field. [source]

Feasibility and challenges of independent research on drugs: the Italian Medicines Agency (AIFA) experience

Italian Medicines Agency (AIFA) Research & Development Working Group
Eur J Clin Invest 2010; 40 (1): 69,86 Key points ,,National Health Service (NHS) is becoming increasingly aware of the need to support independent research to answer some important questions for patient care in areas of scant commercial interest. ,,This article reports the main features and strategies of the independent research programme on drugs launched by the Italian Medicines Agency (AIFA) in 2005. ,,In the three bids launched between 2005 and 2007, a total of 151 studies have been approved for funding for a total of about 78 million Euro. ,,In this article we describe the Italian legislative framework under which the programme was launched, the types of research funded and discuss how the supported studies could contribute, in an international framework, to the knowledge needed on drug efficacy, effectiveness and safety. [source]

Diagnostic issues for adolescents and adults with ADHD

Jeanette WassersteinArticle first published online: 18 FEB 200
Attention deficit hyperactivity disorder (ADHD) is a common childhood neuropsychiatric syndrome once thought to disappear with maturation. Current data indicate that ADHD remains "hidden" in many of the grownups who had it as children. Adult prevalence rates range from 1% to 6% of the population. Research suggests the core childhood symptoms of hyperactivity, inattention, and impulsivity shift with development, perhaps transforming into more overt difficulties in executive functions and affect regulation. ADHD is also usually nestled with other comorbid psychiatric conditions, especially in adolescents and adults, further complicating diagnosis and treatment. This article discusses how to recognize and diagnose ADHD in older patients. Key points include core symptoms present during childhood, appropriate family history in this strongly genetic condition, management of comorbidity, and the evolving role of diagnostic testing. Other medical causes for similar symptoms are considered. © 2005 Wiley Periodicals, Inc. J Clin Psychol/In Session 61: 535,547, 2005. [source]

The role of immunosuppression in recurrence of hepatitis C

John R. Lake
Key points 1. Recurrent hepatitis C is an increasing problem posttransplantation. 2. It is difficult to determine histologically if alloimmunity, i.e., rejection, is also plays a role in posttransplantation hepatitis C. 3. Change in the degree of immunosuppression, rather than the absolute amount of immunosuppression, is bad for HCV-infected recipients. 4. Corticosteroid boluses are bad for HCV-infected recipients. [source]

Retransplantation for recurrent hepatitis C: Positive aspects

Timothy M. McCashland
Key points 1. The prevalence of retransplantation for hepatitis C (HCV) patients is stable (around 40%). 2. Survival models to predict outcome of retransplantation do not show that HCV is an independent variable with poor outcomes. 3. Using Model for End-Stage Liver Disease (MELD) scores from the United Network for Organ Sharing (UNOS) database from 1996-2002, retransplantation for HCV had similar outcomes to other causes of retransplantation. 4. Poorer outcomes were noted for retransplantation with MELD scores greater than 25. 5. Minimal survival thresholds need to be developed for retransplantation for all causes of retransplantation. [source]

Selection of donors for living donor liver transplantation

James F. Trotter
Key points 1. The donor evaluation is performed in three staged phases to disqualify inappropriate candidates as early as possible in the process. 2. Approximately half the potential transplant recipients are unable to identify a suitable donor for evaluation. 3. Approximately half the individuals evaluated for living donation are found suitable. 4. The donor pool in many parts of the country is significantly limited by the high prevalence of obesity. [source]

The impact of the model for end-stage liver disease on recipient selection for adult living liver donation

Richard B. Freeman
Key points 1. The Model for End-Stage Liver Disease (MELD) system can be used to assess recipient pre-transplant risks and help select appropriate candidates for the adult to adult living donation liver transplant procedure. 2. Selection of candidates for the adult to adult living donation liver transplant procedure requires assessment of candidate risk of death without a transplant, risk of death with a transplant, and donor risk of death. 3. Understanding of the risks involved allows for development of clinical decision models to inform the risk benefit analyses. 4. MELD provides a useful, objective, and universal tool for clinicians around the world to estimate risks for clinical decision making in all forms of liver transplantation. [source]

Role of adult living liver donation in patients with hepatocellular cancer

John Paul Roberts
Key points 1. Transplantation represents the best therapy for hepatocellular carcinoma (HCC) as compared with resection. 2. On an intention-to-treat basis, living donor transplantation (LDLT) represents a better alternative to cadaveric transplantation (CLT). 3. Current criteria for transplantation for patients with HCC using cadaveric organs may be appropriate for living donor transplantation. [source]

Role of adult living donor liver transplantation in patients with hepatitis C

Gregory T. Everson
Key points 1. Living donor liver transplantation (LDLT) is an option for patients with end-stage liver disease or hepatoma caused by chronic hepatitis C. 2. Reports from some, but not all, transplant centers indicate that hepatitis C may recur earlier, recurrence may be more severe, and graft loss caused by recurrent hepatitis C may be more frequent in LDLT compared with cadaveric transplantation. 3. Several unique characteristics of LDLT (versus cadaveric transplantation) may favor severe recurrence of hepatitis C. These include an increase in genetic similarity between donor and recipient, higher degree of HLA matching, greater systemic bioavailability of immunosuppressive agent, and hepatic regeneration. 4. Hepatic regeneration may promote the acceleration and severity of recurrent hepatitis C by enhancement of hepatitis C viral uptake by hepatocytes through stimulation of the low-density lipoprotein receptor and increase in activity of the internal ribosomal entry site. [source]