Controversies in the management of hepatitis C virus infection after liver transplantation

Mitchell L. Shiffman, Hugo E. Vargas, Gregory T. Everson – 30 December 2003 – Recurrence of hepatitis C virus infection after liver transplantation is universal. A significant percentage of these patients develop progressive graft injury and cirrhosis. Those factors that modulate disease progression in liver transplant recipients with recurrent hepatitis C virus infection remain controversial and are poorly understood. Treatment of recurrent hepatitis C virus after liver transplantation with either interferon or interferon and ribavirin has yielded only limited success.

Intracerebral hemorrhage after liver transplantation

Wei‐Lin Wang, Zhen‐Fan Yang, Chung‐Mau Lo, Chi‐Leung Liu, Sheung‐Tat Fan – 30 December 2003 – We report 5 patients with intracerebral hemorrhage after orthotopic liver transplantation (OLT) and identify the possible risk factors. Between November 1991 and April 1999, 75 adult patients received 77 orthotopic liver transplants at Queen Mary Hospital, Hong Kong. Five patients (6.5%) developed intracerebral hemorrhage postoperatively. Clinical and laboratory data were reviewed, and potential risk factors were analyzed.

Health‐related quality of life in long‐term survivors of pediatric liver transplantation

Deborah E. Midgley, Tatum A. Bradlee, Christopher Donohoe, Kevin P. Kent, Estella M. Alonso – 30 December 2003 – The purpose of this study is to measure the health‐related quality of life (HRQOL) in children who are long‐term survivors of liver transplantation and to pilot the Liver Transplant Disability Scale (LTDS), a newly developed 12‐point scale that quantifies chronic medical disability related to liver transplantation. This study is a cross‐sectional survey of 51 children surviving liver transplantation by at least 2 years, with a median age of 4.94 years.

Single‐center analysis of the first 40 adult‐to‐adult living donor liver transplants using the right lobe

Amadeo Marcos, John M. Ham, Robert A. Fisher, Ann T. Olzinski, Marc P. Posner – 30 December 2003 – The first adult‐to‐adult living donor liver transplant using the right hepatic lobe in the United States was performed only 2 years ago. Although initial reports were encouraging, continuous review of the results and appropriate modifications in patient management will be necessary to minimize donor risk and optimize recipient outcome. The results of 40 such transplantations were analyzed and are summarized. Recipients were listed for transplantation according to the usual criteria.

Cytoprotection by fructose and other ketohexoses during bile salt‐induced apoptosis of hepatocytes

I. M. Zeid, S. F. Bronk, P. J. Fesmier, G. J. Gores – 30 December 2003 – Toxic bile salts cause hepatocyte necrosis at high concentrations and apoptosis at lower concentrations. Although fructose prevents bile salt‐ induced necrosis, the effect of fructose on bile salt‐induced apoptosis is unclear. Our aim was to determine if fructose also protects against bile salt‐induced apoptosis. Fructose inhibited glycochenodeoxycholate (GCDC)‐induced apoptosis in a concentration‐dependent manner with a maximum inhibition of 72% ± 10% at 10 mmol/L.

The synthesis rates of total liver protein and plasma albumin determined simultaneously in vivo in humans

H. Barle, B. Nyberg, P. Essén, K. Andersson, M. A. McNurlan, J. Wernerman, P. J. Garlick – 30 December 2003 – Although the metabolism of liver‐derived plasma proteins such as albumin has been extensively studied, human hepatic protein synthesis as a whole has not been well characterized, because a reproducible model for obtaining human liver tissue has not been available. In this study, the fractional synthesis rates of total liver protein and albumin in vivo were determined simultaneously in nine subjects undergoing elective laparoscopic cholecystectomy.

Prednisone withdrawal late after adult liver transplantation reduces diabetes, hypertension, and hypercholesterolemia without causing graft loss

M. D. Stegall, G. T. Everson, G. Schroter, F. Karrer, B. Bilir, T. Sternberg, R. Shrestha, M. Wachs, I. Kam – 30 December 2003 – We prospectively withdrew prednisone in 28 adult patients who had stable graft function more than 2 years after orthotopic liver transplantation (OLTx) and had been on 5 mg/d prednisone for at least 6 months. Prednisone was decreased from 5 mg/d to 2.5 mg/d for 1 month then stopped completely. Cyclosporine monotherapy was maintained at a level of approximately 200 ng/mL (TDX). Nineteen patients had prednisone withdrawn without complications.

Regional cerebral edema and chloride space in galactosamine‐induced liver failure in rats

C D Gove, R D Hughes, R J Ede, R Williams – 30 December 2003 – The pathogenesis of cerebral edema, which is a major complication of fulminant hepatic failure, is poorly understood. In previous studies, increased regional brain water content was observed in rats at an early stage of acute liver failure caused by galactosamine. At a later stage when the animals had developed deep coma, brain water content was reduced, possibly as a result of generalized dehydration.

Gene expression of glucokinase regulatory protein in regenerating rat liver

J L Rosa, J X Pérez, M Detheux, E Van Schaftingen, R Bartrons – 30 December 2003 – The activity and messenger RNA (mRNA) levels of glucokinase, and the concentration and mRNA levels of its regulatory protein, were analyzed during liver regeneration. The activity of glucokinase and the concentration of its regulatory protein decreased to 30% and 50%, respectively, after liver resection, remaining low after 1 week. No significant variations in the level of these proteins were found in sham‐operated animals.

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