Gene therapy: Lessons learned from liver transplantation for transthyretin‐amyloidosis

Ole B. Suhr, Gösta Holmgren, Erik Lundgren – 19 November 2004 – Familial amyloidotic polyneuropathy is the common form of hereditary generalized amyloidosis and is characterized by the accumulation of amyloid fibrils in the peripheral nerves and other organs. Liver transplantation (LTx) has been utilized as a therapy for familial amyloidotic polyneuropathy because the variant transthyretin (TTR) is predominantly synthesized by the liver, but this therapy has several problems. Thus, we need to develop a new treatment that prevents the production of the variant TTR in the liver.

UW is superior to Celsior and HTK in the protection of human liver endothelial cells against preservation injury

Hermann Janßen, Petra H.E. Janßen, Christoph E. Broelsch – 19 November 2004 – Celsior solution (CS), a new preservation solution in thoracic organ transplantation, was evaluated for its efficacy in cold preservation of human liver endothelial cells (HLEC) and was compared to University of Wisconsin solution (UW) and histidine‐tryptophan‐ketoglutarate solution (HTK, Custodiol). HLEC cultures were preserved at 4°C in CS, UW, and HTK, for 2, 6, 12, 24, and 48 hours, with 6 hours of reperfusion.

Determination of the optimal model for end‐stage liver disease score in patients with small hepatocellular carcinoma undergoing loco‐regional therapy

Teh‐Ia Huo, Jaw‐Ching Wu, Han‐Chieh Lin, Fa‐Yauh Lee, Ming‐Chih Hou, Yi‐Hsiang Huang, Pui‐Ching Lee, Full‐Young Chang, Shou‐Dong Lee – 19 November 2004 – The model for end‐stage liver disease (MELD) has been a prevailing system to prioritize cirrhotic patients awaiting liver transplantation. An “exceptional” MELD score of 20 and 24 points is assigned for stage T1 and T2 patients with small hepatocellular carcinoma (HCC), respectively. However, this strategy is based on scarce data and the optimal score for these patients remains uncertain.

Steroid withdrawal at day 14 after liver transplantation: A double‐blind, placebo‐controlled study

Georges‐Philippe Pageaux, Yvon Calmus, Olivier Boillot, Christian Ducerf, Claire Vanlemmens, Karim Boudjema, Didier Samuel, and the French CHI‐F‐01 Study Group – 19 November 2004 – Some clinical studies in liver transplantation have recently reported safety advantages and similar acute rejection rates with early steroid withdrawal. The aim of this study was to evaluate the efficacy and safety of an immunosuppressive regimen with steroid withdrawal at day 14. A multicenter, 1‐year, comparative, double blind, placebo‐controlled study was performed.

Resolution of alcoholic neuropathy following liver transplantation

Edward Gane, Rachael Bergman, David Hutchinson – 19 November 2004 – Between 10 and 20% of adult liver transplants are performed for end‐stage alcoholic liver disease. Severe extrahepatic end‐organ damage from alcoholism (cardiomyopathy, pancreatitis, central nervous system injury, and neuropathy) is widely regarded as an absolute contraindication to liver transplantation, despite a lack of data on the effect of transplantation on these complications. We describe such a patient who presented with decompensated alcoholic liver disease and moderately severe peripheral neuropathy.

Cardiac morbidity and mortality related to orthotopic liver transplantation

George Therapondos, Andrew D. Flapan, John N. Plevris, Peter C. Hayes – 19 November 2004 – This article briefly discusses the cardiac status of liver transplant recipients and their preoperative cardiac evaluation. It describes in detail perioperative and early and late postoperative complications as well as the cardiac problems associated with immunosuppression. The preoperative cardiovascular status of patients is important in determining how they cope with the stresses imposed by liver transplantation.

Binding of bilirubin and bromosulphthalein to albumin: Implications for understanding the pathophysiology of liver failure and its management

Christian Steiner, Sambit Sen, Jan Stange, Roger Williams, Rajiv Jalan – 19 November 2004 – The binding/transporting functions of albumin provide the rationale for using albumin dialysis (e.g., molecular adsorbents recirculating system [MARS]) in liver failure. This study investigates these properties in vitro, validating the findings in vivo. In vitro bromosulphthalein (BSP) and bilirubin‐spiked plasma were dialyzed against albumin and sampled.

Expanded criteria donor grafts for deceased donor liver transplantation under the MELD system: A decision analysis

Manish G. Amin, Michael P. Wolf, John A. TenBrook, Richard B. Freeman, Steve J. Cheng, Daniel S. Pratt, John B. Wong – 19 November 2004 – Expanded criteria donor (ECD) liver grafts have a higher likelihood of primary graft failure (PGF) compared with standard criteria donor (SCD) grafts. Given a choice between an available ECD graft versus waiting for an SCD graft that may not always become available, what should liver transplant candidates do? The study's aim was to estimate 1‐year survival comparing immediate ECD liver grafting with waiting for an SCD organ.

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