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.

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.

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.

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.

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.

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.

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.

Ribavirin dose modification based on renal function is necessary to reduce hemolysis in liver transplant patients with hepatitis C virus infection

Ashok B. Jain, Bijan Eghtesad, Raman Venkataramanan, Paulo A. Fontes, Randeep Kashyap, Igor Dvorchik, A. Obaid Shakil, Leah Kingery, John J. Fung – 30 December 2003 – Hepatitis C virus (HCV) is currently the most common etiology for liver transplantation (LTx) in the United States. A significant number of patients develop recurrent HCV after LTx. Although there is no completely satisfactory treatment for recurrent HCV, a combination of interferon‐α (INF) and ribavirin remains the most widely used.

Safety of right lobectomy in living donor liver transplantation

Kyung‐Suk Suh, Seong Hoon Kim, Sang Beom Kim, Hyuk‐Joon Lee, Kuhn Uk Lee – 30 December 2003 – The goal of this study was to examine the safety and effectiveness of right lobectomy in living donor liver transplantation (LDLT). From January 1999 to January 2002, 100 cases of LDLT were performed at Seoul National University Hospital; 45 involved right lobectomy (RL), 17 involved extended left lobectomy (ELL), 37 involved left lateral segmentectomy (LLS), and 1 involved right posterior segmentectomy. The outcome of RL was compared with those of other types of hepatectomy.

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