Long‐term management after liver transplantation: Primary care physician versus hepatologist

J. Christie Heller, Allan V. Prochazka, Gregory T. Everson, Lisa M. Forman – 29 September 2009 – As long‐term survival after liver transplantation increases, metabolic complications are becoming increasingly prevalent. Given concerns about which group of providers should be managing liver recipients and how well metabolic complications are managed, we administered a postal survey to 280 transplant hepatologists to determine attitudes, perceptions, and practice patterns in the management of metabolic complications after transplantation. The response rate was 68.2%.

Preconditioning, organ preservation, and postconditioning to prevent ischemia‐reperfusion injury to the liver

Olivier de Rougemont, Kuno Lehmann, Pierre‐Alain Clavien – 29 September 2009 – Ischemia and reperfusion lead to injury of the liver. Ischemia‐reperfusion injury is inevitable in liver transplantation and trauma and, to a great extent, in liver resection. This article gives an overview of the mechanisms involved in this type of injury and summarizes protective and treatment strategies in clinical use today. Intervention is possible at different time points: during harvesting, during the period of preservation, and during implantation.

Plasma disappearance rate of indocyanine green: A tool to evaluate early graft outcome after liver transplantation

Eric Levesque, Faouzi Saliba, Sonia Benhamida, Philippe Ichaï, Daniel Azoulay, René Adam, Denis Castaing, Didier Samuel – 29 September 2009 – Indocyanine green clearance (Cl‐ICG) has been used to assess liver function and hepatic blood flow mainly before and after hepatic surgery. Cl‐ICG (invasive method) has been reported to be a good marker of early graft function after liver transplantation (LT).

Outcomes of liver transplantation for paracetamol (acetaminophen)‐induced hepatic failure

Sheldon C. Cooper, Roland C. Aldridge, Tahir Shah, Kerry Webb, Peter Nightingale, Sue Paris, Bridget K. Gunson, David J. Mutimer, James M. Neuberger – 29 September 2009 – Paracetamol (acetaminophen) hepatotoxicity, whether due to intentional overdose or therapeutic misadventure, is an indication for liver transplantation in selected cases. However, there is a concern that long‐term outcomes may be compromised by associated psychopathology that may predispose patients to further episodes of self‐harm or poor treatment adherence.

Donor mannose‐binding lectin gene polymorphisms influence the outcome of liver transplantation

Carlos Cervera, Domingo Balderramo, Belén Suárez, Jhon Prieto, Francisco Fuster, Laura Linares, Josep Fuster, Asunción Moreno, Francisco Lozano, Miquel Navasa – 29 September 2009 – Mannose‐binding lectin (MBL) is a C‐type lectin produced mainly by the liver that binds to a wide range of pathogens. Polymorphisms at the promoter and exon 1 of the MBL2 gene are responsible for low serum levels of MBL and have been associated with an increased risk of infections. We prospectively analyzed 95 liver transplant recipients.

Kinetics of host immune responses and cytomegalovirus resistance in a liver transplant patient

Kirsten Schaffer, Julie Moran, Margaret Duffy, Aiden P. McCormick, William W. Hall, Jaythoon Hassan – 29 September 2009 – Among solid organ transplant (SOT) recipients, donor‐seropositive/recipient‐seronegative (D+/R−) cytomegalovirus (CMV) status is associated with the highest risk of ganciclovir‐resistant CMV disease, which has been reported for patients receiving oral ganciclovir but not valganciclovir prophylaxis. We report a case of CMV breakthrough infection in a D+/R− liver transplant patient while he was receiving oral valganciclovir.

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