Analysis of recent pediatric orthotopic liver transplantation outcomes indicates that allograft type is no longer a predictor of survivals

Natasha S. Becker, Neal R. Barshes, Thomas A. Aloia, Tuan Nguyen, Javier Rojo, Joel A. Rodriguez, Christine A. O'Mahony, Saul J. Karpen, John A. Goss – 30 July 2008 – Two strategies to increase the donor allograft pool for pediatric orthotopic liver transplantation (OLT) are deceased donor segmental liver transplantation (DDSLT) and living donor liver transplantation (LDLT). The purpose of this study is to evaluate outcomes after use of these alternative allograft types.

Iron chelation attenuates intracranial pressure and improves survival in a swine model of acute liver failure

Nikolaos Arkadopoulos, Demetrios Vlahakos, Georgia Kostopanagiotou, Dimitrios Panagopoulos, Eleni Karvouni, Christina Routsi, Konstantinos Kalimeris, Ioanna Andreadou, Evangelia Kouskouni, Vassilios Smyrniotis – 30 July 2008 – Oxidative mechanisms have been implicated in the pathogenesis of brain edema in acute liver failure (ALF). The aim of this study was to test the hypothesis that inhibition of iron‐catalyzed oxidative reactions through iron chelation using deferoxamine could attenuate brain edema in a swine model of ischemic ALF.

Total tumor volume predicts risk of recurrence following liver transplantation in patients with hepatocellular carcinoma

Christian Toso, James Trotter, Alice Wei, David L. Bigam, Shimul Shah, Joshua Lancaster, David R. Grant, Paul D. Greig, A. M. James Shapiro, Norman M. Kneteman – 30 July 2008 – Criteria for the selection of candidates for liver transplantation in the presence of hepatocellular carcinoma (HCC) should accurately predict posttransplant recurrence while not excluding excessive numbers of patients from candidacy. Existing criteria are challenged by the limited accuracy of radiological assessment. The total tumor volume (TTV) was calculated by the addition of the volume of each individual tumor.

Smoking‐related morbidity and mortality following liver transplantation

Joanna A. Leithead, James W. Ferguson, Peter C. Hayes – 30 July 2008 – Smoking is the world's leading cause of premature mortality responsible for an estimated 5 million deaths each year. Although the negative health implications of cigarette smoking in the nontransplant setting are well recognized, the effect on patient and graft survival post liver transplantation remains unclear. The aim of this study was therefore to assess the influence of smoking on morbidity and mortality following liver transplantation.

Pregnancy and cirrhosis

Jennifer Tan, Bijal Surti, Sammy Saab – 30 July 2008 – As the treatment of cirrhosis improves, pregnancy in patients with cirrhosis is likely to become more common. Although maternal and fetal mortality is expected to similarly improve, pregnant patients with cirrhosis face unique risks. These include higher rates of spontaneous abortion and prematurity and a potential for life‐threatening variceal hemorrhage, hepatic decompensation, splenic artery aneurysm rupture, and postpartum hemorrhage.

Protothecosis after liver transplantation

Masashi Narita, Robert R. Muder, Thomas V. Cacciarelli, Nina Singh – 30 July 2008 – Prototheca species are unicellular algae of low virulence that are rarely associated with human infections. We report a liver transplant recipient with disseminated protothecosis and review the literature on this unusual opportunistic infection in transplant recipients. Of 9 cases, including ours, 5 had a localized infection, and 4 had disseminated protothecosis. Seven cases were due to Prototheca wickerhamii, and 2 were due to Prototheca zopfii.

Emergency liver transplantation following severe liver trauma

Olga N. Tucker, Paul Marriott, Mohamed Rela, Nigel Heaton – 30 July 2008 – Liver trauma is a major cause of mortality after major blunt and penetrating abdominal trauma. The need for life‐saving emergency hepatectomy and liver transplantation is extremely rare. We report the management of 2 patients who required urgent liver transplantation for liver trauma. One patient developed hepatic failure following global ischemia after a gunshot injury. The second patient developed a severe postreperfusion injury following removal of a perihepatic pack after blunt abdominal trauma.

Anatomical variations of the origin of the segment 4 hepatic artery and their clinical implications

Guang Yu Jin, Hee Chul Yu, Hyung‐Sun Lim, Jang Il Moon, Jeong Hun Lee, Jin Wook Chung, Baik Hwan Cho – 30 July 2008 – The threat of ischemic complications following massive resection, especially in living donor hepatectomy or split liver transplantation, has been haunting surgeons for many years. Postmortem dissections of 62 livers were performed to investigate anatomical variations of the principal artery for segment 4 (A4). The origin of A4 was examined separately in the liver with (n = 46) or without (n = 16) an aberrant left hepatic artery (abLHA).

Pilot study of pentoxifylline in hepatopulmonary syndrome

Rajasekhar Tanikella, George M. Philips, Dorothy K. Faulk, Steven M. Kawut, Michael B. Fallon – 30 July 2008 – Hepatopulmonary syndrome (HPS) results when chronic liver disease or portal hypertension causes intrapulmonary microvascular dilatation with hypoxemia. In experimental HPS, tumor necrosis factor alpha (TNF‐α) overproduction contributes to vasodilatation, which is improved by pentoxifylline, a TNF‐α inhibitor. The effectiveness of pentoxifylline in humans is unknown.

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