The role and limitation of living donor liver transplantation for hepatocellular carcinoma

Chung‐Mau Lo, Sheung‐Tat Fan, Chi‐Leung Liu, See‐Ching Chan, John Wong – 26 February 2004 – Liver transplantation for hepatocellular carcinoma (HCC) is restricted by the scarcity of cadaver grafts. Living donor liver transplantation (LDLT) may potentially increase the applicability but its role and limitation are not clear. We studied the outcome of a cohort of 51 patients with unresectable HCC who were accepted on list for both options of deceased donor liver transplantation (DDLT) and LDLT. Twenty‐five of 51 (49%) patients had voluntary living donors (group 1) and 26 did not (group 2).

Pharmacokinetic and immunosuppressive effects of tacrolimus‐loaded biodegradable microspheres

Yasunori Miyamoto, Takeji Uno, Hiromitsu Yamamoto, Li Xiao‐Kang, Koh‐ichi Sakamoto, Hisakuni Hashimoto, Hirofumi Takenaka, Yoshiaki Kawashima, Hideo Kawarasaki – 26 February 2004 – The objective of this study was to characterize the pharmacokinetics and immunosuppression of a tacrolimus‐loaded biodegradable microsphere (TLBM) in rats. We prepared TLBM. DA/Slc rats were given TLBM at a dose of 1.6 mg/kg (n = 9), 2.4 mg/kg (n = 5), or 7.2 mg/kg (n = 7) tacrolimus contents by a single subcutaneous administration to achieve sustained release over a long period.

Altered hematologic profiles following donor right hepatectomy and implications for perioperative analgesic management

Roman Schumann, Luis Zabala, Michael Angelis, Iwona Bonney, Hocine Tighiouart, Daniel B. Carr – 26 February 2004 – Living liver donors for adult liver transplant recipients undergo extensive liver resection. Partial donor hepatectomies may alter postoperative drug metabolism and hemostasis; thus, the risks and the benefits of pain management for this unique patient population may need to be reassessed. The safety and efficacy of combined epidural analgesia and field infiltration in our initial living liver donor group are presented.

Aerobic capacity is associated with 100‐day outcome after hepatic transplantation

Scott K. Epstein, Richard B. Freeman, Ahmad Khayat, John N. Unterborn, Daniel S. Pratt, Marshall M. Kaplan – 26 February 2004 – The shortage of donor organs highlights the need to better identify patients most likely to benefit from hepatic transplantation. Reduced aerobic capacity (decreased peak oxygen consumption [V̇O2] during symptom‐limited cardiopulmonary exercise testing) is frequently present in cirrhosis. Peak V̇O2 during cardiopulmonary exercise testing may predict short‐term outcome after hepatic transplantation.

Randomized trial comparing pulmonary alterations after conventional with venovenous bypass versus piggyback liver transplantation

Maria Rita Montenegro Isern, Paulo Celso Bosco Massarollo, Eliane Maria de Carvalho, Carlos Eduardo Sandoli Baía, Jorge Kavakama, Poliana de Andrade Lima, Sérgio Mies – 26 February 2004 – During the anhepatic phase of conventional liver transplantation (LT), the inferior vena cava (IVC) is cross‐clamped and venovenous bypass (VVB) is usually indicated for diversion of IVC and portal blood flow. VVB can theoretically lead to pulmonary complications due to the contact of the blood with the surfaces of the circuit. In the piggyback method, preservation of the IVC avoids VVB.

New onset diabetes mellitus after liver transplantation: The critical role of hepatitis C infection

Mandana Khalili, Jessica Watson Lim, Nathan Bass, Nancy L. Ascher, John P. Roberts, Norah A. Terrault – 26 February 2004 – Epidemiological studies suggest diabetes mellitus (DM) may be an extrahepatic manifestation of chronic hepatitis C virus (HCV) infection. Since diabetes and HCV are common in liver transplant recipients, we sought to examine the unique contribution of HCV infection to risk of de novo diabetes posttransplantation. Using a cohort of 555 liver transplant recipients (median age 49 years, 54% males, 82% Caucasian) without preexisting diabetes from 3 U.S.

Nontumoral dermatologic problems after liver transplantation

Edmond Schmied, Jean‐François Dufour, Sylvie Euvrard – 26 February 2004 – The skin, easily accessible for medical examination, is affected in many ways by liver transplantation. Mucocutaneous manifestations of advanced liver disease and dermatologic conditions associated with specific hepatic diagnoses generally improve after liver transplantation. Vasculitic lesions due to cryoglobulinemia associated with hepatitis C, and photosensitivity due to porphyria are occasional exceptions. Dermatologic diseases complicating the posttransplantation course can be challenging.

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