Expanding the use of transjugular intrahepatic portosystemic shunts for veno‐occlusive disease

Pankaj Rajvanshi, George B. McDonald – 30 December 2003 – Severe veno‐occlusive disease (VOD) of the liver is a leading cause of mortality after bone marrow transplantation (BMT). Vascular and parenchymal injuries account for acute portal hypertension and liver failure is frequently present. We describe the results of transjugular intrahepatic portosystemic shunt (TIPS) for the management of VOD after BMT. TIPS was performed in 10 patients with histologically proven severe VOD.

Combination low‐dose hepatitis B immune globulin and lamivudine therapy provides effective prophylaxis against posttransplantation hepatitis B

Peter W. Angus, Geoffrey W. McCaughan, Edward J. Gane, Darryl H.G. Crawford, Hugh Harley – 30 December 2003 – Although antiviral prophylaxis with lamivudine monotherapy appears to reduce post–liver transplantation recurrence of hepatitis B virus (HBV) infection, breakthrough infections occur in at least 20% of the patients because of the development of drug resistance. Combined lamivudine and intravenous hepatitis B immune globulin (HBIG) therapy (10,000‐IU doses) may reduce this risk, but its use is limited by cost (∼US $45,000/yr) and availability.

Accuracy of doppler echocardiography in the assessment of pulmonary hypertension in liver transplant candidates

W. Ray Kim, Michael J. Krowka, David J. Plevak, Jaeho Lee, Steven R. Rettke, Robert P. Frantz, Russell H. Wiesner – 30 December 2003 – Pulmonary hypertension has been associated with poor outcome after liver transplantation. We assessed the diagnostic accuracy of Doppler echocardiography in detecting significant pulmonary hypertension. Seventy‐four potential liver transplant candidates underwent Doppler echocardiography in which the systolic right ventricular pressure (RVsys) was used to estimate the systolic pulmonary artery pressure (PAsys).

Experience with the use of sirolimus in liver transplantation—use in patients for whom calcineurin inhibitors are contraindicated

George J. Chang, Harish D. Mahanty, David Quan, Chris E. Freise, Nancy L. Ascher, John P. Roberts, Peter G. Stock, Ryutaro Hirose – 30 December 2003 – Sirolimus (SRL) provides effective immunosuppression for kidney transplantation and may be useful in patients with delayed allograft function after kidney transplantation. We review our experience with SRL in liver transplant recipients for whom calcineurin inhibitors are undesirable. Fourteen patients with renal insufficiency or acute mental status impairment were administered SRL after liver transplantation (5‐ to 10‐mg load, 1 to 4 mg/d).

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