Adult Living Donor Liver Transplantation: the Hepatologist's Perspective

Schiano, Thomas D.; Kim‐Schluger, Leona; Gondolesi, Gabriel; Miller, Charles M.

doi:10.1053/jhep.2001.21489

Cited by 97 publications

(54 citation statements)

References 47 publications

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“…The benefits of LRLT are the access to transplantation without registration on a waiting list and transplantation of a graft of quality with a short ischemic time (6)(7)(8). On the other hand, the major concern over application of LRLT for adults is graft-size disparity (9)(10)(11). Liver hepatectomy needs posterior regeneration to restore the liver/body ratio (9,12,13).…”

Section: Introductionmentioning

confidence: 99%

Protection of Reduced-Size Liver for Transplantation

Franco-Gou¹,

Peralta²,

Massip-Salcedo

et al. 2004

American Journal of Transplantation

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The shortage of available organs for liver transplantation has motivated the development of new surgical techniques such as reduced-size liver transplantation. Ischemia-reperfusion (I/R) associated with liver transplantation impairs liver regeneration. Ischemic preconditioning is effective against I/R injury in clinical practice of liver tumour resections. The present study evaluated the effect of ischemic preconditioning on reduced-size liver for transplantation and attempted to identify the underlying protective mechanisms. Hepatic injury and regeneration (transaminases, proliferating cell nuclear antigen [PCNA] labeling index, and hepatocyte growth factor [HGF]) were assessed after reduced-size orthotopic liver transplantation (ROLT). Energy metabolism, oxidative stress, tumor necrosis factor-a (TNF) and interleukin-6 (IL-6) were examined as possible mechanisms involved in liver regeneration. Ischemic preconditioning reduced transaminase levels and increased HGF levels and the percentage of PCNApositive hepatocytes after ROLT. This was associated with a decrease in oxidative stress following ROLT, whereas energy metabolism and hepatic IL-6 and TNF release were unchanged. The benefits of ischemic preconditioning on hepatic injury and liver regeneration could be mediated, at least partially by nitric oxide. These results suggest a new potential application of ischemic preconditioning in reduced-size liver transplantation.

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Section: Introductionmentioning

confidence: 99%

Protection of Reduced-Size Liver for Transplantation

Franco-Gou¹,

Peralta²,

Massip-Salcedo

et al. 2004

American Journal of Transplantation

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“…Recipient complications have decreased with experience, 1 and recipient survival is similar to that observed in transplantations performed using cadaveric donors. 2,3 After recovering from donation, living donors reported higher health-related quality of life on a number of different domains assessed by the SF-36, compared with norms for the population in the United States. 4,5 Nearly all donors questioned have endorsed living donation and stated that they would donate again, regardless of their complications.…”

Section: A Dult Living Donor Liver Transplantation (Ldlt)mentioning

confidence: 96%

Adult living donor liver transplantation: Perspectives from 100 liver transplant surgeons

Cotler

Gambera³

et al. 2003

Liver Transplantation

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The involvement of healthy living donors and the degree of technical difficulty make adult living donor liver transplantation (LDLT) different from any other surgical procedure. We surveyed 100 liver transplant surgeons to assess their views on the complex issues raised by LDLT. Data were collected at meetings on LDLT and by electronic mail. The study instrument was divided into general, donor, surgeon, recipient, and donor and recipient issues. Subjects provided the projected 1-year survival threshold that they would require for the recipient before they would perform LDLT. They listed the three topics that they thought were most critical for transplant fellows to know about LDLT. A majority agreed that transplant programs have a duty to their patients to offer LDLT, that the increasing success of the procedure will expand indications for liver transplantation, and that the risk to the donor causes them a moral dilemma. There was more divergence of opinion regarding who should have the final say about a potential donor's candidacy, whether it is difficult for donors to comprehend the risks of the procedure, and whether repeat cadaveric transplantations should be offered for failed LDLT performed for extended indications. Surgeons' median recipient survival threshold was a conservative 79%. Priorities for educating trainees focused on understanding complications and risks, technical factors, and ethical concerns such as putting the donor first. represents an exciting advance in liver transplantation. Right lobe donation provides a means of increasing the availability of donor organs, while affording control over waiting time for liver transplantation, allograft quality, and preservation time. The procedure is technically challenging at a time when liver transplantation has become routine.Reported outcomes of LDLT are excellent. Recipient complications have decreased with experience, 1 and recipient survival is similar to that observed in transplantations performed using cadaveric donors. 2,3 After recovering from donation, living donors reported higher health-related quality of life on a number of different domains assessed by the SF-36, compared with norms for the population in the United States. 4,5

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“…Among the patients about 10 to 32% are asymptomatic. [8] The cause of asymptomatic cases is mainly due to genetic makeup of different people.SBP was diagnosed using standard criteria, namely, an absolute neutrophil count of250 cells/mm3.…”

Section: Introductionmentioning

confidence: 99%

A Study of Prevalence of Asymptomatic Spontaneous Bacterial Peritonitis in Cirrhotic Patients with Ascites

2016

IJSR

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Abstract:Objectives: To detect the prevalence of asymptomatic Spontaneous Bacterial Peritonitis in Cirrhotic patients with ascites and treat them prior to complication. Study design: Observation study. Place and duration of study: Coimbatore medical college hospital, from July 2014 to July 2015. Methodology: consecutive patients admitted with ascites in the medical and gastroenterology wards for ascites. Results: Of the 50 patients, only 8 of the patients were found to have SBP (16%). Among the study members, about 40 % were non alcoholics and 60 % were alcoholics. 60% of my study population had cirrhosis for more than 5 years and 40 % had cirrhosis for less than 5 years. The ascitic fluid analysis was like only around 5 of the population had cells more than 250 / cu.mm. Culture study trend was like around 12 % of the patients were culture positive. Among the organisms studied, the majority was E. coli and the others were Streptococcus and Klebsiella. The Child Pugh scoring was calculated as per the criteria mentioned earlier and the majority came under Class B, followed by Class A and the least by Class C. There is a correlation between the ascitic fluid and the incidence of SBP. A low protein level of less than 1 g/dl has strong predilection for contracting SBP. The ascitic fluid protein level was correlated with the incidence of SBP and it was also found significant at p < 0.05. Conclusion: Prevalence of asymptomatic SBP is very low at 16%. There is also a strong correlation between low ascitic fluid protein level (<1g/dl) and SBP.

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Adult Living Donor Liver Transplantation: the Hepatologist's Perspective

Cited by 97 publications

References 47 publications

Protection of Reduced-Size Liver for Transplantation

Protection of Reduced-Size Liver for Transplantation

Adult living donor liver transplantation: Perspectives from 100 liver transplant surgeons

A Study of Prevalence of Asymptomatic Spontaneous Bacterial Peritonitis in Cirrhotic Patients with Ascites

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