The optimal number of donor biopsy sites to evaluate liver histology for transplantation

Wendy L. Frankel, Jason G. Tranovich, Laura Salter, Ginny Bumgardner, Peter Baker – 30 December 2003 – Macrovesicular steatosis (MaS), fibrosis, and inflammation have been associated with poor graft function after liver transplantation. We evaluated histological variation in livers to determine the optimal number of biopsies to estimate pathological characteristics in livers for transplantation. Specimens from autopsies performed during 3 months in 16‐ to 70‐years‐olds without known liver disease or drug and/or alcohol abuse were examined.

The effect of donor body mass index on primary graft nonfunction, retransplantation rate, and early graft and patient survival after liver transplantation

Hwan Y. Yoo, Ernesto Molmenti, Paul J. Thuluvath – 30 December 2003 – Previous studies have suggested that moderate donor liver steatosis is associated with an increased incidence of primary graft nonfunction (PGNF), delayed graft function, early graft loss, and retransplantation rates. The objective of our study was to determine the effect of donor body mass index (dBMI), after adjusting for other known confounding variables, on PGNF, early graft failure, retransplantation rate, and patient survival.

Systemic and regional changes in plasma endothelin following transient increase in portal pressure

Dharmesh Kapoor, Doris N. Redhead, Peter C. Hayes, David J. Webb, Rajiv Jalan – 30 December 2003 – An acute increase in portal pressure or reduction in portal inflow has been shown to decrease renal plasma flow (RPF). The aim of the study was to evaluate regional and systemic hemodynamics after acute occlusion of a transjugular intrahepatic portosystemic stent‐shunt (TIPSS) and study the effect of the same on plasma endothelin (ET‐1) levels in the systemic circulation, renal vein, and hepatic vein. Sixteen patients attending for portography after previous TIPSS placement were studied.

ABO‐incompatible liver transplantation with no immunological graft losses using total plasma exchange, splenectomy, and quadruple immunosuppression: Evidence for accommodation

Douglas W. Hanto, Annie H. Fecteau, Maria H. Alonso, John F. Valente, James F. Whiting – 30 December 2003 – ABO‐incompatible liver transplants (LTX) have been associated with a high risk of antibody‐mediated rejection, poor patient and graft survival, and a high risk of vascular thrombosis and ischemic bile duct complications.

Tacrolimus as a liver flush solution to ameliorate the effects of ischemia/reperfusion injury following liver transplantation

Shawn D. St. Peter, David J. Post, Manuel I. Rodriguez‐Davalos, David D. Douglas, Adyr A. Moss, David C. Mulligan – 30 December 2003 – The goal of this report is to evaluate in a prospective randomized fashion the effect of flushing hepatic allografts with tacrolimus before transplantation. A prospective, double‐blinded, randomized trial was performed. Twenty patients receiving orthotopic liver transplants from October 2000 to October 2001 were randomized into two groups.

Effects of tacrolimus on ischemia‐reperfusion injury

Shawn D. St. Peter, Adyr A. Moss, David C. Mulligan – 30 December 2003 – In addition to efficacious immunosuppression for the benefit of organ transplantation, tacrolimus has diverse actions that result in amelioration of ischemia‐reperfusion injury. Knowledge is accumulating rapidly on the mechanisms through which tacrolimus exerts these cytoprotective effects, including alterations in microcirculation, free radical metabolism, calcium‐activated pathways, inflammatory cascades, mitochondrial stability, apoptosis, stress‐response proteins, and tissue recovery.

Outflow reconstruction in extended right liver grafts from living donors

Yasuhiko Sugawara, Masatoshi Makuuchi, Hiroshi Imamura, Junichi Kaneko, Norihiro Kokudo – 30 December 2003 – The risk of outflow obstruction in extended right liver grafts remains a concern. We developed two procedures to minimize torsion in venous anastomosis and to achieve a short warm ischemic time of the graft. When there were no major short hepatic veins in the graft, a square‐shaped vein graft was used to make a single orifice using the middle and right hepatic veins in the graft.

A correlation between the pretransplantation MELD score and mortality in the first two years after liver transplantation

Nicholas N. Onaca, Marlon F. Levy, Edmund Q. Sanchez, Srinath Chinnakotla, Carlos G. Fasola, Mark J. Thomas, Jeffrey S. Weinstein, Natalie G. Murray, Robert M. Goldstein, Goran B. Klintmalm – 30 December 2003 – The Model for End‐Stage Liver Disease (MELD) score is now the criteria for allocation in liver transplantation for patients with chronic disease. Although the score has been effective in the prediction of mortality in patients awaiting liver transplantation, its abilities to predict posttransplantation outcome need study.

Clinical and ethnic differences in candidates listed for liver transplantation with and without potential living donors

Dianne LaPointe Rudow, Mark W. Russo, Sylvia Hafliger, Jean C. Emond, Robert S. Brown – 30 December 2003 – The shortage of cadaver livers and improved outcomes in partial liver transplants has led to an increase in adult living donor liver transplantation (LDLT). Only a fraction of potential liver recipients have donors. The characteristics of candidates who have volunteers for living donation may be different than those without donors. We compared adult patients on the waiting list who had potential living donors with those who did not have living donors.

Predictive models of short‐ and long‐term survival in patients with nonbiliary cirrhosis

Gérald Longheval, Pierre Vereerstraeten, Philippe Thiry, Myriam Delhaye, Olivier le Moine, Jacques Devière, Nadine Bourgeois, Michael Adler – 30 December 2003 – The limited number of donor organs has placed a burden on the medical community to improve patient selection and timing of liver transplantation (LT). We aim to evaluate short‐ and long‐term survival of 124 consecutive patients with a diagnosis of nonbiliary cirrhosis. Seventeen clinical, biochemical, functional, and hemodynamic parameters were computed.

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