Adult living donor liver transplantation: Who is the ideal donor and recipient?

Tan, Henkie P.; Patel-Tom, Kusum; Marcos, Amadeo

doi:10.1016/j.jhep.2005.05.002

Cited by 31 publications

(18 citation statements)

References 31 publications

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“…In particular, living donor liver transplantation (LDLT) is a promising procedure with many advantages for the recipient (1)(2)(3). Currently, the right hemiliver is preferentially used, because the left hemiliver is usually too small for successful transplantation in an adult recipient (4).…”

mentioning

confidence: 99%

Kupffer cell-dependent TNF-α signaling mediates injury in the arterialized small-for-size liver transplantation in the mouse

Tian¹,

Jochum

Georgiev³

et al. 2006

Proc. Natl. Acad. Sci. U.S.A.

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Implantation of small liver grafts causes liver injury and defective regeneration leading to graft failure. We investigated whether Kupffer cell-dependent TNF-␣ signaling contributes to this poor outcome. Partial 30% liver transplantation was performed in C57BL͞6 wild-type mice (control group), and in three groups with down-regulation of the TNF-␣ pathway: (i) TNF receptor 1 knockout [TNFR-1(؊͞؊)] mice, and mice pretreated with (ii) gadolinium chloride or (iii) pentoxifylline (PTX). Fifty-percent partial liver transplantation, a model associated with full recovery, and transplantation in IL-6 knockout [IL-6(؊͞؊)] mice were performed in some experiments. Graft injury, regeneration, portal flow, liver microcirculation, leukocyte adhesion, and animal survival were assessed. Animal survival rates were 14% in the control group vs. 43% in the gadolinium chloride group, 57% for the TNFR-1(؊͞؊) group, and 86% in the PTX group (P < 0.001). Markers of liver injury were reduced in all treated groups when compared with controls. Each treated group disclosed better portal flow and sinusoid perfusion, decreased leukocyte adherence, particularly in the PTX group. Liver regeneration occurred only in the treated groups. IL-6 and IL-10 levels were dramatically up-regulated (50؋) in the PTX group, and at lower levels in other experimental groups. The protective effect of PTX was lost in IL-6(؊͞؊) mice and protection was restored by a single dose of r-IL-6. In conclusion, interruption of TNF-␣ signaling or depletion of Kupffer cells improves survival after 30% liver transplantation, reduces liver injury, and enhances regeneration. The superior effects of PTX are mediated by IL-6.

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mentioning

confidence: 99%

Kupffer cell-dependent TNF-α signaling mediates injury in the arterialized small-for-size liver transplantation in the mouse

Tian¹,

Jochum

Georgiev³

et al. 2006

Proc. Natl. Acad. Sci. U.S.A.

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“…In patients with chronic liver disease and severe decompensation (MELD > 30) the long-term mortality following LDLT (57%) was significantly higher compared to deceased donor transplant (18% historical control) [78,79]. Therefore, it has been recommended not to offer LDLT to donors with a MELD score >25 [80]. This policy is also reflected in the recent report from the A2ALL consortium, which retrospectively analyzed the outcome of 384 adult to adult living donor liver transplant recipients [81].…”

Section: Recipient Selectionmentioning

confidence: 99%

Hot topics in liver transplantation: Organ allocation – extended criteria donor – living donor liver transplantation

Müllhaupt¹,

Dimitroulis²,

Gerlach³

et al. 2008

Journal of Hepatology

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Liver transplantation has become the mainstay for the treatment of end-stage liver disease, hepatocellular cancer and some metabolic disorders. Its main drawback, though, is the disparity between the number of donors and the patients needing a liver graft. In this review we will discuss the recent changes regarding organ allocation, extended donor criteria, living donor liver transplantation and potential room for improvement. The gap between the number of donors and patients needing a liver graft forced the transplant community to introduce an objective model such as the modified model for end-stage liver disease (MELD) in order to obtain a transparent and fair organ allocation system. The use of extended criteria donor livers such as organs from older donors or steatotic grafts is one possibility to reduce the gap between patients on the waiting list and available donors. Finally, living donor liver transplantation has become a standard procedure in specialized centers as another possibility to reduce the donor shortage. Recent data clearly indicate that center experience is of major importance in achieving good results. Great progress has been made in recent years. However, further research is needed to improve results in the future.

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“…LDLT, which must be achieved with no donor mortality and low morbidity, provides equivalent or better outcomes, and reduced waiting times, compared with cadaveric transplantation 21 -24 . However, this assumes a normal donor liver, that the liver remnant in the donor is at least 40 per cent of the initial volume, and that the ratio of the weight of the graft to bodyweight of the recipient is at least 0·8 per cent 25 .…”

Section: Transplantationmentioning

confidence: 99%

Role of transplantation in the management of hepatic malignancy

Knight

Friend

Morris

2007

British Journal of Surgery

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In patients with primary hepatocellular carcinoma, improved selection has led to outcomes equivalent to those from surgical resection and comparable to those in patients transplanted for non-malignant indications. Recent studies suggest that selection criteria may be refined further. Surgical resection or percutaneous therapies may reduce the risk of progression while waiting for a transplant. Recent improvements have occurred in neoadjuvant therapies for cholangiocarcinoma. Nevertheless, a number of questions regarding the role of liver transplantation for hepatic malignancy remain.

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Adult living donor liver transplantation: Who is the ideal donor and recipient?

Cited by 31 publications

References 31 publications

Kupffer cell-dependent TNF-α signaling mediates injury in the arterialized small-for-size liver transplantation in the mouse

Kupffer cell-dependent TNF-α signaling mediates injury in the arterialized small-for-size liver transplantation in the mouse

Hot topics in liver transplantation: Organ allocation – extended criteria donor – living donor liver transplantation

Role of transplantation in the management of hepatic malignancy

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