Liver transplantation from situs inversus to situs inversus

Yasuhiko Sugawara, Masatoshi Makuuchi, Tadatoshi Takayama, Hiroyuki Yoshino, Koichi Mizuta, Hideo Kawarasaki – 30 December 2003 – Congenital anatomic anomalies often present technical obstacles during liver transplantation. Biliary atresia (BA) is the most common indication for liver transplantation in children, and up to 28% of children with situs inversus are complicated by BA. A boy aged 2 years 11 months with BA, situs inversus, and dextrocardia received a liver transplant from his father. The donor also had situs inversus and dextrocardia without other anomalies.

Orthotopic liver transplantation using low‐dose tacrolimus and sirolimus

Vivian C. McAlister, Kevork M. Peltekian, Dickran A. Malatjalian, Shannon Colohan, Sara MacDonald, Hinrich Bitter‐Suermann, Allan S. MacDonald – 30 December 2003 – Although sirolimus (SRL) binds the immunophilin FK506‐binding protein‐12 (FKBP‐12) with greater avidity than tacrolimus (TAC), animal studies have shown that SRL and TAC act synergistically to prevent rejection. Dose‐related toxicity is more often the cause of TAC discontinuation than rejection.

Frequency of nonalcoholic steatohepatitis as a cause of advanced liver disease

Michael Charlton, Pavla Kasparova, Shiobhan Weston, Keith Lindor, Yaakov Maor‐Kendler, Russell H. Wiesner, Charles B. Rosen, Kenneth P. Batts – 30 December 2003 – Although nonalcoholic steatohepatitis (NASH) has generally been considered a benign condition, the increasing prevalence and severity of obesity has heightened concerns about the frequency with which NASH progresses to end‐stage liver disease. The aim of this study is to determine the frequency, clinical features, and posttransplantation history of decompensated liver disease secondary to NASH.

Liver transplantation for hereditary hemochromatosis

David J. Brandhagen – 30 December 2003 – Although hereditary hemochromatosis (HHC) is relatively common, it is an uncommon indication for orthotopic liver transplantation (OLT). The diagnosis of HHC in patients with end‐stage liver disease is difficult because many of these patients have elevated serum and tissue iron levels. Of patients undergoing OLT with iron stores in the range typical for HHC, approximately 10% are homozygous for the C282Y mutation.

A multicenter study of lamivudine treatment in 33 patients with hepatitis B after liver transplantation

Robert J. Fontana, Hie‐Won L. Hann, Teresa Wright, Gregory Everson, Alfred Baker, Eugene R. Schiff, Carolyn Riely, Gaya Anschuetz, Melanie Riker‐Hopkins, Nathaniel Brown – 30 December 2003 – Hepatitis B virus (HBV) infection after liver transplantation (LT) may lead to severe and rapidly progressive graft failure. Antiviral treatment may be of benefit in selected patients with recurrent hepatitis B post‐LT. The aim of this prospective open‐label study is to determine the safety and efficacy of lamivudine in 33 liver transplant recipients with active HBV infection.

The use of hepatitis C viral RNA levels in liver tissue to distinguish rejection from recurrent hepatitis C

Michelle J. Gottschlich, Kay L. Aardema, Eileen M. Burd, Raouf E. Nakhleh, Kimberly A. Brown, Marwan S. Abouljoud, Kathryn Hirst, Dilip K. Moonka – 30 December 2003 – Persistence of hepatitis C virus (HCV) after orthotopic liver transplantation is almost universal in HCV‐infected patients. Histological examination of liver biopsy specimens can be variable in distinguishing between recurrent hepatitis C and acute cellular rejection.

Liver transplantation using sirolimus and minimal corticosteroids (3‐day taper)

James F. Trotter, Michael Wachs, T. Bak, Thomas Trouillot, Nancy Stolpman, Gregory T. Everson, Igal Kam – 30 December 2003 – At our center, we have performed liver transplantation since 1995 with a rapid‐taper steroid protocol (weaning steroids by day 14 posttransplantation). Beginning in 2000, we further reduced the use of corticosteroids to 3 days and added sirolimus to our immunosuppressive regimen.

Outcome of the use of pediatric donor livers in adult recipients

Motohiko Yasutomi, Scott Harmsmen, Franco Innocenti, Nelson DeSouza, Ruud A.F. Krom – 30 December 2003 – The prolonged waiting time caused by the lack of donor livers leads to an increasing number of terminally ill patients waiting for lifesaving liver transplantation. To rescue these patients, transplant programs are accepting donor organs from the expanded donor pool, using donors of increasingly older age, as well as from the pediatric age group, often despite significant mismatch in liver size.

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