Liver Transplantation

Abstract

Advances in the management of both chronic and acute hepatic disease have been made possible and even mandated by the development of liver transplantation. The clinical use of transplantation has proceeded at a rapid pace since a Consensus Development Conference of the National Institutes of Health concluded in June 1983 that liver transplantation had become a service and not simply an experimental procedure. 1 The liver can be transplanted as an extra (auxiliary) organ at an ectopic site, or in the orthotopic location after the removal of the host liver (Fig. 1). This article will focus primarily on the orthotopic procedure. However, there has been renewed interest in the auxiliary operation, which will be discussed separately. Candidacy for TransplantationThe conceptual appeal of liver transplantation is so great that the procedure may come to mind as a last resort for virtually every patient with lethal hepatic disease. The selection of appropriate recipients from such a large pool requires strict individual assessment. A 1982 estimate of the annual need for liver transplantation was 15 per million population, 2 but the current need is undoubtedly higher because there are now fewer restrictions on candidacy. Between 4000 and 50,000 liver transplantations a year may be needed in the United States.The supply of organs will increasingly influence the criteria for candidacy and limit the use of the procedure. Discussions about rationing transplantation services for this reason are nonetheless premature, because the balance between need and supply has not been determined. In the United States, the yearly rate of liver transplantation has reached approximately 1600; it averaged 147 a month between July and December 1988 (Vaughn W, United Network of Organ Sharing: personal communication). The annual rate in Europe approaches this figure.Policies on organ donation will have to be reexamined if substantial growth is to occur. Many potential liver donors are probably rejected unjustifiably. The arbitrary upper age limit observed by most programs 3 cannot be justified, because senescence largely spares the liver. 4 Atherosclerosis of the hepatic arteries is not usually found beyond the origin of the celiac axis. 4 Our own limited experience with livers from donors over 50 years old has been encouraging.

Contrast-enhanced ultrasound with SonoVue in the evaluation of postoperative complications in pediatric liver transplant recipients

“…This examination has a sensitivity of 92e96% for the detection of hepatic artery thrombosis in the general population of liver transplant recipients [1,6,11]. Compared with that of an adult patient, this examination is associated with certain difficulties in infants and children, who are generally less cooperative.…”

“…Its success is the result of progressive improvement of surgical techniques and immunosuppressive regimens for the prevention of transplant rejection [1,2]. Among pediatric patients, over 90% of all liver transplants are prompted by the existence of cholestatic disease (Table 1) or congenital metabolic deficits; other less common causes are metabolic liver disease, cystic fibrosis, and certain types of liver tumors (in most cases, hepatoblastoma and hepatocellular carcinoma) [3].…”

Role of nucleoside/nucleotide analogues and low-dose hepatitis B immune globulin in prophylaxis of hepatitis B recurrence among cadaveric liver transplant recipients

“…The HBsAg and Hepatitis B core antibody (HBcAb) status of an organ donor or recipient determine the risk of infection and transmission of HBV following transplantation. The rate of HBV liver transplantation (LT) failure was high in the 1980s when there was no pre-and post-LT HBV treatment (3)(4)(5). The high rates of post-LT mortality from HBV in the 1980s underlined the importance of treatment and reactivation prevention of HBV.…”

Causes of retransplantation after primary liver transplantation in 4000 consecutive patients: 2 to 19 years follow-up

“…If the transplanted liver fails, retransplantation is often the only" treatment ror long-term survival. 1 The present study examines the rate and causes of retransplantation in 4000 consecutive patients who underwent LTx from February 1981 to April 1998. All patients were followed until November 1999.…”