Cryptogenic cirrhosis and posttransplantation nonalcoholic fatty liver disease

Janus Ong, Zobair M. Younossi, Vishnu Reddy, Lori Lyn Price, Terry Gramlich, James Mayes, Navdeep Boparai – 30 December 2003 – Some patients diagnosed with cryptogenic cirrhosis may have “burned‐out” nonalcoholic fatty liver disease (NAFL). To test this hypothesis, we used our liver transplant database (November 1984 to November 1998) to assess the incidence of NAFL in patients with cryptogenic cirrhosis after orthotopic liver transplantation (OLT). We also examined the clinicodemographic features associated with post‐OLT NAFL, obtained by chart review and telephone interviews.

Effects of prostaglandin E1 on the efficacy of xenogeneic extracorporeal pig liver perfusion in a canine model of acute liver failure

Osamu Takeyama, Iwao Ikai, Toshikazu Yagi, Seiji Satoh, Akiyoshi Kanazawa, Takehiko Uesugi, Ryuta Nishitai, Hiroshi Okabe, Nagato Katsura, Hiroaki Terajima, Yoshio Yamaoka – 30 December 2003 – Xenogeneic extracorporeal liver perfusion (ECLP) has the potential to become an important tool in the management of patients with severe liver failure. We previously showed that xenogeneic pig liver perfusion may be prolonged for up to 9 hours by the administration of prostaglandin E1 (PGE1).

Does tacrolimus offer virtual freedom from chronic rejection after primary liver transplantation? Risk and prognostic factors in 1,048 liver transplantations with a mean follow‐up of 6 years

Ashok Jain, Anthony Jake Demetris, Randeep Kashyap, Karen Blakomer, Kris Ruppert, Akhtar Khan, Susan Rohal, Thomas E. Starzl, John J. Fung – 30 December 2003 – Tacrolimus has proven to be a potent immunosuppressive agent in liver transplantation (LT). Its introduction has led to significantly less frequent and severe acute rejection. Little is known about the rate of chronic rejection (CR) in primary LT using tacrolimus therapy. The aim of the present study is to examine the long‐term incidence of CR, risk factors, prognostic factors, and outcome after CR.

Accuracy and utility of 3‐dimensional computed tomography in evaluating donors for adult living related liver transplants

J. Diego Bogetti, Brian R. Herts, Mark J. Sands, John F. Carroll, David P. Vogt, J. Michael Henderson – 30 December 2003 – Three‐dimensional (3D) computed tomography (CT) is an imaging technique that renders anatomic detail in 3D images from helical computed tomographic scans. The purpose of this study is to assess 3D CT in the preoperative evaluation of adult living related liver transplant donors. Nine patients underwent right‐lobe liver resection for adult living related liver transplants between October 1999 and September 2000.

Outcome of other organs recovered during in situ split‐liver procurements

Thiagarajan Ramcharan, Brooke Glessing, John R. Lake, William D. Payne, Abhinav Humar – 30 December 2003 – Split‐liver transplantation is becoming a useful technique to expand the donor pool. Whether the split should be performed in situ or ex situ is not clear. One potential disadvantage of in situ splits is that prolonged surgical time and increased blood loss may negatively affect the function of other solid organs (kidneys, pancreas, and heart) procured from the same donor. Therefore, we studied the function of other organs posttransplantation.

Temporary portocaval shunt during liver transplantation with vena cava preservation. Results of a prospective randomized study

Juan Figueras, Laura Llado, Emilio Ramos, Eduardo Jaurrieta, Antonio Rafecas, Juan Fabregat, Jaume Torras, Antonio Sabate, Antonia Dalmau – 30 December 2003 – This study aims to determine whether the use of a temporary portocaval shunt (PCS) improves hemodynamic and metabolic evolution during orthotopic liver transplantation (OLT). Preservation of the vena cava during OLT has gained wide acceptance. However, benefits of adding a temporary PCS to the piggyback technique during the anhepatic phase in patients with cirrhosis have not been shown.

Occurrence and clinical outcome of lamivudine‐resistant hepatitis B infection after liver transplantation

Daniel Seehofer, Nada Rayes, Thomas Steinmüller, Andrea R. Müller, Utz Settmacher, Ruth Neuhaus, Cornelia Radke, Thomas Berg, Uwe Hopf, Peter Neuhaus – 30 December 2003 – Lamivudine treatment of hepatitis B after orthotopic liver transplantation (OLT) is often accompanied by fast viral‐resistance formation. Although no clinical data are available, in vitro data indicate that lamivudine‐resistant reinfection has a mild course because of defective viral replication. Between 1996 and 1999, a total of 34 patients were treated with lamivudine because of hepatitis B recurrence after OLT.

Management of the pediatric liver transplant patient

Sue V. McDiarmid – 30 December 2003 – Key Points 1In pretransplant management, the prevention and treatment of malnutrition is essential for pediatric patients as malnutrition is associated with both increased pre‐ and posttransplant mortality.2Technical complications, particularly hepatic artery thrombosis, after pediatric liver transplantation are relatively common given the small size of the majority of the recipients.

Yes, hepatocellular cancer does occur in primary biliary cirrhosis

Gregory J. Gores – 30 December 2003 – Objectives: The prevalence of hepatocellular carcinoma (HCC) in primary biliary cirrhosis (PBC) is not well established, as some reports suggest a low risk, whereas others indicate that HCC may be no less frequent than in other types of cirrhosis. Methods: We compared the incidence of HCC in a series of 140 patients with PBC (five men, 135 women, mean age 54 ± 1.6 yr) followed‐up for a mean of period of 5.6 ± 0.4 yr with a group of patients with cirrhosis related to hepatitis C virus (HCV) who were matched for age, sex, and follow‐up period.

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