bluuebunny/crossref_metadata_2025 huggingface dataset:
Radical Resection of Periampullary Tumors in the Elderly: Evaluation of Long‐term Results
Authors: Bathe Oliver F. , Levi David , Caldera Humberto , Franceschi Dido , Raez Luis , Patel Ajay , Raub William A. , Benedetto Pasquale , Reddy Rajender , Hutson Duane , Sleeman Danny , Livingstone Alan S. , Levi Joe U.
Published: August 2002

Increasingly, patients of advanced age are coming for evaluation of periampullary tumors. Although several studies have demonstrated the safety of resecting periampullary tumors in older patients, few long‐term survival data have been reported. Between 1983 and 1992 various periampullary masses were resected in 70 patients over age 65 (range 65–87 years). Total pancreatectomy was performed in 11 patients, and 59 patients underwent pancreaticoduodenectomy. The mean duration of hospitalization was 17 ± 15 days. Major complications occurred in 27 patients (39%), and operative mortality rate was 8.5%. Overall median survival was 24 months; and 5‐year survival was 25%. Perioperative outcome was compared in patients aged 65 to 74 years and in patients ≥75 years old. The older age group required longer periods in the surgical intensive care unit postoperatively, but the long‐term survival was similar in the two age groups. Radical resection with the intent to cure periampullary tumors is safe in selected patients of advanced age, and long‐term survival is in the range of expected survival for younger patients with the same tumors.
Measurement of Serum Hyaluronate as a Predictor of Human Liver Failure after Major Hepatectomy
Authors: Yachida Shinichi , Wakabayashi Hisao , Kokudo Yasutaka , Goda Fuminori , Okada Setsuo , Maeba Takashi , Maeta Hajime
Published: August 2002

Serum hyaluronate can be used as an index of hepatic sinusoidal endothelial cell function. This study was designed to evaluate its application as a predictor of liver failure after major hepatectomy. Thirty‐six patients who underwent right liver lobectomy after percutaneous transhepatic right branch portal vein embolization were divided into two groups based on their postoperative clinical course (groups 1 and 2, with and without postoperative liver failure, n= 6 and n= 30, respectively). We serially measured serum hyaluronate levels using a sandwich binding protein assay system before and after hepatectomy and determined relations with progression of the underlying chronic liver disorder, portal venous pressure, and liver growth of the left lobe after portal embolization. Serum hyaluronate levels were significantly elevated, in line with the degree of severity of the underlying chronic liver disorder, and correlated well with the portal venous pressure and the hypertrophic ratio of the left lobe subsequent to portal embolization. Serum hyaluronate levels in group 1 were significantly higher than those in group 2 before surgery and increased steeply during the early period after hepatectomy. These results suggest that the serum hyaluronate reflects the hepatic functional reserve, and serial measurement of this parameter after hepatectomy can serve as a simple indicator for early detection of posthepatectomy liver failure.
Prospective Case‐controlled Trial of Adjuvant Chemotherapy after Resection of Hepatocellular Carcinoma
Authors: Huang Yi‐Hsiang , Wu Jaw‐Ching , Lui Wing‐Yiu , Chau Gar‐Yang , Tsay Shih‐Haw , Chiang Jen‐Huey , King Kuang‐Liang , Huo Teh‐Ia , Chang Full‐Young , Lee Shou‐Dong
Published: August 2002

Recurrence of hepatocellular carcinoma (HCC) after curative hepatic resection is frequent and is an important factor adversely influencing long‐term survival. The role of postoperative chemotherapy in the reduction of tumor recurrence rate is still controversial. During the period of 1992–1995 a series of 49 patients who underwent curative resection of HCC and had at least one risk factor of tumor recurrence were followed in this prospective study. Patients were allocated to adjuvant chemotherapy and control groups. Twenty‐four patients received a combination of low dose intravenous epirubicin (20 mg/m2) and mitomycin (5 mg) monthly for seven courses starting 5 to 6 weeks after surgery. Twenty‐five patients had no adjuvant treatment. The disease‐free and overall survivals were compared for the two groups. A total of 154 courses of chemotherapy were given to the 24 patients. The chemotherapy‐related side effects were mild and tolerable with no mortality. At a median follow‐up of 39 months (range 9–71 months), 9 patients in the adjuvant chemotherapy group and 16 patients in the control group developed tumor recurrence. The respective 1‐, 2‐, 3‐, and 5‐year disease‐free survival rates were 75%, 67%, 63%, and 63% for patients in the adjuvant chemotherapy group and 68%, 42%, 37%, and 32% for patients in the control group (p= 0.0575). The 1‐, 2‐, 3‐, and 5‐year overall survival rates were 100%, 96%, 77%, and 72% in the adjuvant chemotherapy group and 92%, 67%, 63%, and 51% in the control group (p= 0.0746). In conclusion, postoperative adjuvant chemotherapy using the present regimen has a tendency to reduce tumor recurrence rate and may improve long‐term survival for high risk patients.
Fatal Wounding of the Byzantine Emperor Julian the Apostate (361–363 a.d.): Approach to the Contribution of Ancient Surgery
Authors: Lascaratos John , Voros Dionysios
Published: August 2002

Byzantine surgery flourished from the early stages of the Byzantine empire (324–1453 a.d.). The first great Byzantine physicians, among the most eminent being Oribasius from Pergamun (fourth century), not only compiled anthologies of the works of ancient Greek, Alexandrian, and Roman physicians but added their own personal practical experience and observations. The circumstances surrounding, and the treatment of, the fatal abdominal wounding of one of the most renowned emperors of Byzantium, Julian the Apostate (361–363 a.d.), is examined based on historical accounts unknown in the broader medical bibliography, namely, the histories and chronicles of Byzantine writers. From this analysis it can be concluded that the emperor's physician, Oribasius, in all probability, applied knowledge of ancient Greek and Roman surgery to save his famous patient. The techniques of “gastrorrhaphy” and pharmaceutical confrontation of the wound in that era, adopted later by the surgeons of the Medieval West, seem to constitute noteworthy roots of modern surgery.
Manipulations of the Metabolic Response for Management of Patients with Severe Surgical Illness: Review
Authors: Connolly A.B. , Vernon D.R.
Published: August 2002

The metabolic response to severe surgical illness is complex and varied. Much recent laboratory and clinical research has focused on increasing our understanding of the metabolic response and the development of new therapies designed to modify this response. Antiinflammatory agents can target harmful aspects of the metabolic response; the immune system can be stimulated; and anabolic factors can be used in an attempt to enhance recovery. The nutritional support of the surgical patient remains crucial, but the effects of new additives are being studied in a variety of surgical conditions. As yet, few of these “novel” agents have found an established role in the management of surgical patients. This review focuses on many “novel” agents or those that do not yet have a clearly defined role in surgical illness. Clinical trials in the areas of severe sepsis, major surgical trauma, and major elective surgery have been emphasized.
Radical Surgical Therapy of Abdominal Cystic Hydatid Disease: Factors of Recurrence
Authors: Gollackner Bernd , Längle Friedrich , Auer Herbert , Maier Andrea , Mittlböck Martina , Agstner Irene , Karner Josef , Langer Felix , Aspöck Horst , Loidolt Heidrun , Rockenschaub Susanne , Steininger Rudolf
Published: August 2002

A series of 74 consecutive patients (48 women, 26 men) were operated for abdominal hydatid disease between June 1949 and December 1995. The patients ranged in age from 15 to 81 years (median 49 years). In 69 cases only the liver was affected; two patients had concomitant extrahepatic disease (one spleen, one spleen and lung), and 3 had cysts in the spleen only. Cysts were multiple in 11 patients and calcified in 24. Conservative surgical procedures were used for 22 cysts in 20 patients [open partial (n= 3), open total (n= 6), closed total cystectomy (n= 9), marsupialization (n= 2), drainage (n= 2)] and radical surgical procedures for 72 cysts in 54 patients [pericystectomy (n= 41), wedge liver resection or hemihepatectomy (n= 25), splenectomy (n= 5), radical resection of a lung cyst (n= 1)]. Altogether 37 patients (50%) were given perioperative antihelmintic chemotherapy with mebendazole (18 patients) or albendazole (19 patients). Operative mortality rates were 5.0% after conservative surgery and 1.8% after radical surgery. Morbidity rates were 25.0% following conservative surgery and 24.1% following radical surgery. Antihelmintic therapy was well tolerated by all but five patients. All side effects were entirely reversible. Among the 74 patients, 60 (81.0%) were available for long‐term follow‐up (median 7.2 years; range 2.0–47.0 years). Recurrence of disease was seen in 9 of 60 patients at an interval of 3 months to 20 years from the first operation. The rate of recurrence was significantly lower after radical surgical procedures (p= 0.03) and after closed removal of the cyst (p= 0.04).
Preference in flower visits and partitioning in pollen diets of stingless bees in an Asian tropical rain forest
Authors: Nagamitsu T. , Momose Kuniyasu , Inoue Tamiji , Roubik David W.
Published: August 2002

Floral resource partitioning among stingless bees (Trigona, Meliponini, Apidae) in a lowland rain forest in Sarawak, Malaysia, was investigated using tree towers and walkways in a 4‐year study that included a general flowering period. We obtained 100 collections of insect visitors to flowers of varying floral location and shape representing 81 plant species. The tendency of 11 species of stingless bees to visit specific flowers with a particular floral location and shape was analyzed by logistic regression analysis. This analysis showed that the proportion of flower visitor collections containing Trigona fuscobalteata and T. melanocephala differed according to floral location. The former was frequently collected at canopy and gap flowers, whereas the latter was most often collected at understory flowers. The analysis also suggested that T. erythrogastra was more rarely collected at shallow flowers than at deep flowers. Analysis of the pollen diets of T. collina, T. fuscobalteata, T. melanocephala, and T. melina revealed that similarity of pollen sources differed among the six permutated pairs of the four species. The lowest mean rank of similarity found was between T. fuscobalteata and T. melanocephala. This result supports the hypothesis that preference in visiting flowers in different locations leads to pollen resource partitioning.
Association between nasal methicillin-resistant staphylococcus aureus carriage and infection in liver transplant recipients
Authors: Patel Robin
Published: August 2002

Abstract Unavailable. Please See Print Journal.
Evidence that a single stem cell can lead to multi-organ engraftment
Authors: Decker Anton G.G. , Nyberg Scott L.
Published: August 2002

Purification of rare hematopoietic stem cells (HSC) to homogeneity is required to study their self-renewal, differentiation, phenotype, and homing. Long-term repopulation (LTR) of irradiated hosts and serial transplantation to secondary hosts represent the gold standard for demonstrating self-renewal and differentiation, the defining properties of HSC. We show that rare cells that home to bone marrow can LTR primary and secondary recipients. During the homing, CD34 and SCA-1 expression increases uniquely on cells that home to marrow. These adult bone marrow cells have tremendous differentiative capacity as they can also differentiate into epithelial cells of the liver, lung, GI tract, and skin. This finding may contribute to clinical treatment of genetic disease or tissue repair.
Orthotopic liver transplantation for alcoholic liver disease: A retrospective analysis of survival, recidivism, and risk factors predisposing to recidivism
Authors: Mackie Joanna , Groves Katherine , Hoyle Angela , Garcia Christian , Garcia Raquel , Gunson Bridget , Neuberger James
Published: August 2002

The aim of this study performed at the Liver Unit at the Queen Elizabeth Hospital, Birmingham, UK, is to assess posttransplantation alcohol consumption and identify risk factors associated with recidivism. This retrospective case-control study used a self-report questionnaire to assess pretransplantation and posttransplantation drinking, and a retrospective cohort study used patient notes to analyze risk factors for recidivism. Of 64 patients who underwent transplantation for alcoholic liver disease (ALD) between May 1996 and November 1999, a total of 49 surviving patients (40 men, 9 women) were available for study. The comparison group consisted of 49 patients matched for age, sex, and date of transplantation who underwent transplantation for non-alcohol-induced chronic liver disease. Two-year patient survival rates were 82% in both study groups. The questionnaire response rate was 69.3% and 75.5% in patients with and without ALD, respectively. Data on recidivism (defined as any alcohol consumption after transplantation) were available in 46 of the 49 patients with ALD. Of these, 45.6% were drinking; 21.7% reported only occasionally drinking; 17.3%, moderate drinking; and 6.5%, heavy drinking. Information on alcohol consumption was available from 41 of the 49 controls. Of these, 52.5% consumed alcohol; 22.0% reported drinking only on special occasions; 24.4%, moderate drinking; and 4.9%, a return to heavy drinking. However, these differences were not statistically significant, and log-rank analysis found no significant difference in time to resumption of drinking. In the ALD cohort, no significant risk factors were identified to predict recidivism. No pretransplantation risk factors (including period of abstinence before transplantation) correlated with recidivism. Survival after transplantation for ALD is similar to that in other forms of chronic liver disease. Recidivism rates for patients with ALD are high, but patients with ALD do not drink more than their control counterparts posttransplantation. In most instances, alcohol consumption posttransplantation is minimal to moderate (<20 units/wk) and seems to be controlled.
Successful outcome after transplantation of a donor liver with focal nodular hyperplasia
Authors: Tan Michael , Di Carlo Antonio , Robinson Patrick , Tchervenkov Jean I. , Barkun Jeffrey S.T. , Metrakos Peter
Published: August 2002

Because of the increasing gap in the number of patients awaiting organ transplantation and the supply of organ donors, reevaluation of donor criteria is an important issue in clinical transplantation. It has become necessary to make maximal use of the currently available donor pool. We describe a case of successful orthotopic liver transplantation in a 57-year-old man with Laënnec’s cirrhosis using a liver containing an 8-cm focal nodular hyperplasia (FNH) lesion involving segments II and III and the caudate lobe. The donor liver was procured from a 46-year-old woman declared brain dead after a subarachnoid hemorrhage. Definitive pathological diagnosis was made at laparotomy by obtaining a Tru-cut (Allegiance Health Care Inc, Toronto, Ontario, Canada) core biopsy specimen. The recipient operation was performed uneventfully except for bleeding from the biopsy site. The patient did well postoperatively and was discharged on tacrolimus, mofetil mycophenolate, and prednisone therapy. He continues to thrive 2½ years posttransplantation with no change in the size of the lesion. In well-selected donors, FNH should not be a contraindication for use in transplantation. However, FNH must be differentiated from hepatocellular adenoma. Although FNH has a benign course with little propensity for bleeding and almost no malignant potential, hepatic adenoma is reported to have a 15% to 33% chance of bleeding and rupture with a well-documented potential for neoplastic degeneration, making the liver unsuitable for donation.
Successful tacrolimus therapy for a severe recurrence of type 1 autoimmune hepatitis in a liver graft recipient
Authors: Hurtova Monika , Duclos-Vallée Jean-Charles , Johanet Catherine , Emile Jean-Francçois , Roque-Afonso Anne-Marie , Feray Cyrille , Bismuth Henri , Samuel Didier
Published: August 2002

A 34-year-old woman underwent orthotopic liver transplantation (OLT) for decompensated type 1 autoimmune hepatitis (AIH). She was administered standard tripledrug immunosuppressive therapy (cyclosporine, steroids, and azathioprine). Ten years after OLT, she developed a recurrence of AIH, with emergence of serological markers of autoimmunity (high anti-smooth muscle antibody [ASMA] titer, high serum gamma globulin level), abnormal liver function test results, and characteristic histological features on liver biopsy. Despite intensified steroid therapy, her clinical and liver function deteriorated. The onset of cutaneous alternariosis led to a steroid dose reduction and cyclosporine replacement by tacrolimus. Clear-cut amelioration was observed, with an improvement in liver function test results and reduction in ASMA titer. One year after the recurrence of AIH, the patient has normal liver function and physical findings. Tacrolimus therefore may be effective in patients with severe recurrent autoimmune liver disease. Further studies are needed to assess tacrolimus therapy in patients who fail to respond to standard immunosuppressive therapy.
Long-term follow-up of patients diagnosed with alcohol dependence or alcohol abuse who were evaluated for liver transplantation
Authors: Gish Robert G. , Lee Angela , Brooks Linda , Leung Janet , Lau Johnson Y.N. , Moore Dan H.
Published: August 2002

The selection of patients with cirrhosis and the diagnosis of alcohol dependence or abuse who have a long-term high probability of abstinence after orthotopic liver transplantation (OLT) may enhance patient survival and outcomes. The aim of this study is to identify factors that would predict which patients would consume alcohol after OLT. Sixty-one patients with a history of alcohol dependence or abuse underwent OLT from June 1989 to June 1994 and were followed up monthly for a median of 6.9 years after OLT (range, 2.5 to 9.3 years). Survival analysis techniques (Cox proportional hazard model) were used to identify patients at high risk for recidivism. Recidivism occurred in 12 of 61 patients (20%) after OLT during follow-up. Noncompliance, with a relative hazard of 20.9 (95% confidence interval [CI], 5.6 to 78.3; P < .001), and personality disorder, with a relative hazard of 6.0 (95% CI, 1.9 to 18.7; P = .002), independently predicted recidivism among patients who underwent OLT. These data indicate that specific behaviors and psychiatric diagnoses can be used to select patients at high risk for drinking alcohol before and after OLT.
Influence of tumor characteristics on the outcome of liver transplantation among patients with liver cirrhosis and hepatocellular carcinoma
Authors: Herrero Ignacio J. , Sangro Bruno , Quiroga Jorge , Pardo Fernando , Herraiz Maite , Cienfuegos Javier A. , Prieto Jesus
Published: August 2002

Hepatocellular carcinoma (HCC) may recur after liver transplantation (LT), mainly in patients with multinodular and large tumors. However, factors predictive of outcome after LT in patients with small tumors remain ill defined. We investigated which factors were related to mortality or tumor recurrence among 47 liver transplant recipients with liver cirrhosis and HCC and compared them with 107 patients with liver cirrhosis without tumor who underwent LT in the same period. Patients with HCC were older (P < .001), more frequently had cirrhosis of a viral origin (P < .001), and had lower Child-Pugh scores (P < .001) than patients without tumor. Survival of patients with and without tumor was not significantly different (P = .20). Among patients with HCC, those with lower recurrence-free survival rates had liver cirrhosis of a viral origin, vascular invasion, bilobar disease, and tumor-node-metastasis (TNM) stage IV. At multivariate analysis, the only factor associated with mortality or recurrence was TNM stage IV (P = .02). Our results suggest that in patients with HCC and TNM stage IV, LT might be contraindicated.
Transplant legislation: Ethical and practical issues in liver allocation—The case of Switzerland
Authors: Kadry Zakiyah , Renner Eberhard L. , Clavien Pierre-Alain
Published: August 2002

Ethical and practical issues relating to liver allocation have been discussed in many countries. Several governments, including the United States, have attempted over the past few years to impose new legislation, which has resulted in virulent debates among individual centers, organ procurement agencies, states, and various groups of interest. This report discusses the current ongoing legislative process in Switzerland. In 1999, the people of Switzerland voted to develop transplant legislation. This reflected the need to regulate poorly defined practices to adapt to the rapid progress within the field of transplantation. The main issue facing the Swiss transplant community is whether new legislation will allow medical evolution in organ allocation criteria without creating regulations that may become outdated with time. In addition, public debate has been shown to have a negative impact on organ donation, thus emphasizing an ever-present penury in cadaveric allografts. This article discusses these issues within the context of liver transplantation in Switzerland and also raises the uniform ethical and practical constraints placed on the medical transplant community in the face of an organ shortage.
Detection and treatment of coronary artery disease in liver transplant candidates
Authors: Keeffe Brian G. , Valantine Hannah , Keeffe Emmet B.
Published: August 2002

Patients with end-stage liver disease and coronary artery disease (CAD) being considered for orthotopic liver transplantation (OLT) present a difficult dilemma. The availability of multiple screening tests and newer treatment options for CAD prompted this review. Recent data suggest that the prevalence of CAD in patients with cirrhosis is much greater than previously believed and likely mirrors or exceeds the prevalence rate in the healthy population. The morbidity and mortality of patients with CAD who undergo OLT without treatment are unacceptably high, making identification of patients with CAD before OLT an important consideration. Patients with documented CAD or major clinical predictors of CAD should undergo cardiac catheterization before OLT. Those with advanced CAD not amenable to interventional therapy or with poor cardiac function are not candidates for OLT. Dobutamine stress echocardiogram appears to be an excellent means of screening patients with intermediate or minor clinical predictors of CAD before OLT. Patients found to have mild or moderate CAD should be aggressively treated medically and, if necessary and feasible based on hepatic reserve, by percutaneous or, less likely, surgical intervention pre-OLT to correct obstructive coronary lesions. Prospective studies regarding optimal screening strategies for the presence of CAD and the indications, timing, and outcomes of interventional therapy in patients with advanced cirrhosis are lacking and much needed.
Accuracy and utility of 3-dimensional computed tomography in evaluating donors for adult living related liver transplants
Authors: Bogetti Diego J. , Herts Brian R. , Sands Mark J. , Carroll John F. , Vogt David P. , Henderson Michael J.
Published: August 2002

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. All donors underwent triphasic helical CT of the liver with 3D computed tomographic reconstruction and conventional angiography. The 3D images were correlated with angiography and intraoperative findings. The origin of vessels, relative length of segments, and position of branches were considered for accuracy. The 3D computed tomographic images were compared with angiograms to determine whether angiography could be replaced by 3D CT. 3D CT identified all variations of the hepatic vein confluences and portal vein trifurcations and all hepatic arterial variants. At surgery, the 3D computed tomographic images of hepatic and portal veins were judged to be accurate and helpful in 8 of 9 cases, and images of the hepatic artery, accurate and helpful in 5 of 9 cases. The 3D computed tomographic images of hepatic and portal veins were better than or equivalent to angiograms in nearly all cases. The 3D computed tomographic images of the hepatic artery were better than or equivalent to angiography in 5 of 9 cases. By providing an accurate 3D map of the liver and its vasculature, 3D computed tomographic reconstructions of the hepatic vasculature are a useful adjunct for surgical planning in adult living related liver donors. 3D CT clearly delineates portal and hepatic veins as well as or better than the angiogram and can identify the hepatic artery and its branches well enough to consider replacing angiography, thus reducing cost, inconvenience, and risk to the donor.
Pneumocystis carinii Pneumonia prophylaxis with atovaquone in trimethoprim-sulfamethoxazole-intolerant orthotopic liver transplant patients: A preliminary study
Authors: Meyers Burt , Borrego Fernando , Papanicolaou Genovefa
Published: August 2002

Pneumocystis carinii pneumonia (PCP) is an opportunistic infection associated with increased morbidity and mortality in solid-organ and bone-marrow transplant recipients. Side effects of trimethoprim-sulfamethoxazole (TMP/SMX) are frequent; therefore, we performed a preliminary study using atovaquone suspension, 750 mg once daily, for 1 year for the prevention of PCP in liver transplant recipients intolerant to TMP/SMX therapy. Twenty-eight patients were treated, and data were analyzed for efficacy and toxicity. Adverse events occurred in 14 subjects, mainly related to the gastrointestinal tract. Side effects from TMP/SMX, i.e., rash, completely resolved and bone-marrow suppression improved in 62% of patients. No patients developed Pneumocystis carinii infection. Although a lower dose of atovaquone once daily may be effective in transplant recipients, further studies are necessary to confirm this preliminary observation.
Adult-to-adult living donor liver transplantation using right-lobe grafts: Results and lessons learned from a single-center experience
Authors: Bak Thomas , Wachs Michael , Trotter James , Everson Gregory , Trouillot Thomas , Kugelmas Marcelo , Steinberg Tracy , Kam Igal
Published: August 2002

Living donor liver transplantation (LDLT) for adults is now a practical alternative to cadaveric liver transplantation. Use of right-lobe grafts has become the preferred donor procedure. Because of the complexity of this operation, a learning curve is to be expected. We report the outcome of our first 41 LDLTs at the University of Colorado Health Sciences Center (Denver, CO). We also discuss the lessons learned and the resultant modifications in the procedure that evolved during our series. Patient records were retrospectively reviewed between August 1997 and February 2001 for the following end points: recipient survival, graft survival, and donor and recipient complications. Thirty-eight of 41 living donor liver transplant recipients (93%) are alive and well postoperatively with a mean follow-up of 9.6 months. Four patients required retransplantation secondary to technical problems (9.8%); all 4 patients were in our initial 11 cases. Modification of the donor liver plane of transection resulted in venous outflow improvement. Also, biliary management was modified during the series. Donor complications are listed; all 41 donors have returned to normal pretransplantation activity. Our results indicate that LDLT can be performed safely with excellent donor and recipient outcomes. Dissemination of our experience can help shorten the learning curve for other institutions.
Can the potential benefits of statins in general medical practice be extrapolated to liver transplantation?
Authors: Neal David A.J. , Alexander Graeme J.M.
Published: August 2002

Hypercholesterolemia is a common complication of liver transplantation and is a risk factor for cardiovascular disease after renal and heart transplant. The effect of hyperlipidemia after liver transplantation is less certain, but a less favorable outcome is to be expected. 3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors or statins have proven efficacy in reducing serum cholesterol and mortality from cardiovascular disease in the general population. Early evidence shows that statins are safe and effective in treating hypercholesterolemia after liver transplantation. Studies in cardiovascular disease have shown that statins exhibit beneficial properties independent of lipid-lowering. These include anti-inflammatory effects and improvement in endothelial function. Recently, statins were shown to repress induction of major histocompatibility complex class II complexes by interferon-γ, which in turn suppresses activation of T lymphocytes. Such effects may assume significance when using statins after solid-organ transplants. Pravastatin has been shown to reduce acute rejection after cardiac and renal transplantation and to also reduce natural killer cell cytotoxicity in these populations. It remains to be seen whether statins will demonstrate similar benefits after liver transplantation.
Hepatitis B and C in the liver transplant recipient: Current understanding and treatment
Authors: Rosen Hugo R.
Published: August 2002

Key Points
Neuropsychiatric complications of liver and other solid organ transplantation
Authors: Beresford Thomas P.
Published: August 2002

Key Points
Long-term management of the liver transplant patient: Diabetes, hyperlipidemia, and obesity
Authors: Reuben Adrian
Published: August 2002

Key Points
Hepatopulmonary syndrome occurring after orthotopic liver transplantation
Authors: Avendano Christopher E. , Flume Patrick A. , Baliga Prabhakar , Lewin David N. , Strange Charlie , Reuben Adrian
Published: August 2002

Hepatopulmonary syndrome (HPS) is an infrequent complication of liver cirrhosis. Orthotopic liver transplantation (OLT) has gained increasing acceptance as a treatment modality for HPS, although there have been reports of HPS developing after OLT with documented recurrence of cirrhosis. We describe the case of a 9-year-old boy who underwent OLT at 7 months of age because of biliary atresia. He subsequently developed HPS in the setting of chronic rejection without cirrhosis or evidence of portal hypertension. Re-OLT resulted in resolution of HPS and a good clinical outcome.
Liver transplantation for cholangiocellular carcinoma: Analysis of a single-center experience and review of the literature
Authors: Shimoda Mitsugi , Farmer Douglas G. , Colquhoun Steven D. , Rosove Michael , Ghobrial Mark R. , Yersiz Hasan , Chen Pauline , Busuttil Ronald W.
Published: August 2002

Cholangiocellular carcinoma (CCC) is a biliary malignancy that frequently presents in advanced unresectable stages. The role of liver transplantation (LT) as a surgical modality is unclear. The goal of this study is to evaluate outcomes of patients with CCC undergoing LT. A retrospective analysis of all patients undergoing LT was undertaken. Only those patients with the pathological diagnosis of CCC were included on the study. Patients were divided into two groups based on primary tumor location: extrahepatic (EH)-CCC and intrahepatic (IH)-CCC. The Kaplan-Meier method was used to calculate overall and recurrence-free survival. Log-rank analysis was used to determine the significance of prognostic variables. Twenty-five patients were identified: 9 patients with EH-CCC (5 patients, Klatskin-type; 2 patients, the middle third; and 2 patients, the distal third) and 16 patients with IH-CCC. Mean age was 47.1 ± 10.6 years. There were 14 men and 11 women. Tumor stage was local (stages I and II; n = 9) or advanced (stages III and IV; n = 16). Overall and disease-free survival rates were 71% and 67% at 1 year and 35% and 32% at 3 years, respectively. Analysis of variables showed statistically significant improved outcomes (P < .05) for the absence of contiguous organ invasion at LT, small tumor size, and single tumor foci. This study indicates that early survival after LT for CCC is acceptable. Three-year disease-free survival is achieved in approximately 30% of patients. These outcomes can be improved by applying strict selection criteria based on prognostic variables identified in this study.
Splitting the cadaveric liver into right and left lobes for two adult recipients
Authors: Shaked Abraham
Published: August 2002

Abstract

Objective:

To identify the outcomes and risks of split-liver transplantation (SLT) for two adult recipients to determine the feasibility of more widespread use of this procedure to increase the graft pool for adults.

Summary of Background:

The shortage of cadaver liver grafts for adults is increasing. Using livers from donors defined as optimal, the authors have been developing techniques for SLT for two adult recipients at their center.

Methods:

From July 1993 to December 1999, 34 adults have undergone SLT with grafts from optimal donors prepared by ex situ split (n = 30) or in situ split (n = 4), and 88 adults received optimal whole-liver grafts that were not split. Four split-grafts were transplanted at other centers. The outcomes of transplantation with right and left split-liver grafts were compared with those of whole-liver transplants. The main end points were patient and graft survival at 1 and 2 years and the incidence and types of complications.

Results:

For whole-liver, right and left split-liver grafts, respectively, patient survival rates were 88%, 74%, and 88% at 1 year and 85%, 74%, and 64% at 2 years. Graft survival rates were 88%, 74%, and 75% at 1 year and 85%, 74%, and 43% at 2 years. Patient survival was adversely affected by graft steatosis and recipients inpatient status before transplantation. Graft survival was adversely affected by steatosis and a graft-to-recipient body weight ratio of less than 1%. Primary nonfunction occurred in three left split-liver grafts. The rates of arterial (6%) and biliary (22%) complications were similar to published data from conventional transplantation for an adult and a child. SLT for two adults increased the number of recipients by 62% compared with whole-liver transplantation and was logistically possible in 16 of the 104 (15%) optimal cadaver donors.

Conclusions:

Split-liver transplantation for two adults is technically feasible. Outcomes and complications rates can be improved by rigid selection criteria for donors and recipients, particularly for the smaller left graft, and possibly also by in situ splitting in cadaver donors. Wider use will require changes in the procedures for graft allocation and coordination between centers experienced in the techniques.
Is d-penicillamine useful in fulminat Wilson’s disease?
Authors: Rakela Jorge , Vargas Hugo , Arenas Juan
Published: August 2002

Abstract

Background:

Wilson’s disease, heralded by severe hepatic insufficiency, is a rare disorder for which emergency liver transplantation is considered to be the only effective therapy.

Aims:

To report the features of Wilson’s disease with severe hepatic insufficiency in a series of 17 patients and, during the second period of the study, to assess the efficacy of a policy consisting of early administration of D-penicillamine.

Patients:

Seventeen consecutive patients with Wilson’s disease were studied. During the first period of the study (up to 1979), none of the patients received D-penicillamine. During the second period (after 1979), all patients without encephalopathy at admission received D-penicillamine.

Results:

The four patients observed during the first period who did not have encephalopathy at admission and did not receive D-penicillamine progressed to encephalopathy and died. Among the 13 consecutive patients observed during the second period, two patients with encephalopathy at admission did not receive D-penicillamine and were transplanted. The 11 remaining patients all received D-penicillamine. Ten of these patients survived without the need for transplantation and returned to compensated liver disease without liver insufficiency. In one patient, liver insufficiency progressed and transplantation had to be performed.

Conclusions:

In most patients with Wilson’s disease heralded by severe hepatic insufficiency and without encephalopathy at admission, early administration of D-penicillamine was associated with survival without transplantation. These results suggest the importance of early diagnosis of this form of Wilson’s disease before the onset of encephalopathy, and favour early administration of D-penicillamine which could avoid the need for transplantation in most cases.
Yes, hepatocellular cancer does occur in primary biliary cirrhosis
Authors: Gores Gregory J.
Published: August 2002

Abstract

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. In all patients, HCC was prospectively screened by clinical, laboratory, and ultrasound procedures.

Results:

Five patients with PBC (3.6%) developed HCC. All were in stage IV of the disease. The incidence of HCC in the 45 patients with late stages of the disease (III or IV) was 11.1%, similar to that found in patients with HCV-related cirrhosis, which was 15.0%. The relative risk for HCC in late stages of PBC was of 0.812 (95% CI, 0.229-2.883) with respect to HCV-related cirrhosis. The probability for developing HCC was significantly higher in patients with HCV-related cirrhosis than in PBC patients overall (p = 0.001), but was similar in patients with HCV-related cirrhosis and in patients with PBC in stages III and IV (p = ns).

Conclusion:

The risk for HCC in patients with late stages of PBC is similar to that in patients with HCV-related cirrhosis.
Timing of reinfection and mechanisms of hepatocellular damage in transplanted hepatitis C virus-reinfected liver
Authors: Ballardini Giorgio , De Raffele Emilio , Groff Paolo , Bioulac-Sage Paulette , Grassi Alberto , Ghetti Sabrina , Susca Micaela , Strazzabosco Mario , Bellusci Roberto , Iemmolo Rosa Maria , Grazi Gianluca , Zauli Daniela , Cavallari Antonino , Bianchi Francesco Bianco
Published: August 2002

Pathogenic mechanisms and dynamics of hepatitis C virus (HCV) reinfection in orthotopic liver transplantation (OLT) are poorly defined. This study focuses on these aspects by studying 55 frozen biopsy specimens from transplant recipients with various histological diagnoses obtained from 4 days to 4 years post-OLT and 10 patients with HCV-related chronic hepatitis. The percentage of HCV-infected hepatocytes, number and distribution of CD8 and natural killer cells, and rates of hepatocellular apoptosis and proliferation were quantified by immunohistochemistry. HCV antigens were detected in 37% of biopsy specimens obtained within 20 days and 90% of biopsy specimens obtained from 21 days to 6 months after OLT. The number of HCV-infected hepatocytes was never less than 40% in acute hepatitis specimens and never greater than 30% in the other cases. Hepatocellular apoptosis was high in biopsy specimens of acute hepatitis and moderate in those from transplant recipients with normal histological characteristics, but still greater than in specimens of chronic active hepatitis. Proliferation correlated significantly with apoptosis. Lymphocyte infiltration was high and similar among cases of acute hepatitis, chronic hepatitis, and rejection. These data: (1) show that the detection of liver HCV antigens is sensitive enough to be used in clinical practice as a diagnostic tool to detect infection of the transplanted liver and might be useful, combined with conventional histological evaluation to detect hepatitic damage, for therapeutic decision making; (2) suggest direct cytotoxicity of HCV, as well as immunologic mechanisms possibly prevalent in chronic hepatitis and rejection, at least in the phase of acute massive liver infection; and (3) show that hepatocellular apoptosis and regeneration might be active enough to lead to replacement of the entire transplanted liver in 2 weeks.
Influence of endothelin-1 on hemodynamics during liver transplantation with and without temporary portocaval shunt: Results of a clinical randomized study
Authors: Lladó Laura , Ramos Emilio , Figueras Juan , Serrano Teresa , Torras Jaume , Rafecas Antoni , Fabregat Joan , Lama Carmen , Busquets Juli , Dalmau Antonia , Sabaté Antonio , Jaurrieta Eduardo
Published: August 2002

Aims of this study are to analyze the influence of endothelin-1 (ET-1) on hemodynamic evolution during liver transplantation (LT) and study the role of a temporary portacaval shunt in ET-1 synthesis. Forty LTs in patients with cirrhosis were studied. Two groups were analyzed: the first group had a temporary portacaval shunt during the anhepatic phase, and the second group did not. Portal and systemic ET-1 levels were measured at several times. At the end of the anhepatic phase, systemic (16.1 ± 6.5 pg/mL) and portal (19.2 ± 7 pg/mL) ET-1 levels increased, whereas they decreased after reperfusion (systemic, 11.8 ± 7.1 pg/mL; portal, 13.2 ± 6.8 pg/mL). Portal flow at the beginning of LT correlated with systemic ET-1 levels (R
2 = 0.3; P = .004). A temporary portacaval shunt reduced portal pressure during the anhepatic phase, but did not modify ET-1 levels. Patients with reperfusion syndrome had greater systemic ET-1 levels in the anhepatic phase (19.1 ± 6.9 v 15.1 ± 6.1 pg/mL; P = .07). Although there is a relationship between ET-1 levels and portal flow and reperfusion syndrome, no clear clinical effect on hemodynamics could be shown. Creation of a portacaval shunt made no change in ET-1 levels.
Correlation between intraoperative blood flows and hepatic artery strictures in liver transplantation
Authors: Molmenti Ernesto P. , Levy Marlon F. , Molmenti Hebe , Casey Donna , Fasola Carlos G. , Hamilton Mark W. , Jung Ghapjoong , Marubashi Shigeru , Gogel Brian M. , Goldstein Robert M. , Gonwa Thomas A. , Klintmalm Goran B.
Published: August 2002

Hepatic artery strictures (HASs) may be a source of morbidity and mortality in liver transplant recipients. This study evaluated the potential correlation between intraoperative arterial and venous blood flows measured after implantation of the liver allograft and the occurrence of postoperative HASs requiring repair. Prospectively collected data from 1,038 patients with complete data sets who underwent initial orthotopic liver transplantations between December 1984 and December 1999 were used. Electromagnetic flow measurements were routinely obtained in these cases. Hepatic artery and portal vein patency were reassessed routinely according to our protocol in the first postoperative day by Doppler ultrasound. When considered hemodynamically significant, strictures were corrected. There was a 6.2% incidence (n = 64) of hepatic artery stenosis in our transplant population. When considered as a whole, the hepatic artery stenosis group had lower intraoperative flow volumes than transplant recipients who did not develop strictures (mean flows, 452 v 518 mL/min, respectively; P = .025). The hepatic artery stenosis group also had lower intraoperative portal vein flows compared with the group without hepatic artery stenosis (1.80 v 2.11 L/min, respectively; P = .0043). Strictures were less frequent among transplant recipients with cryptogenic cirrhosis. We did not observe differences among the groups for retransplantation or patient and graft survival. In our series, there was a 6.2% incidence of postoperative HASs. We observed a significant association between intraoperative hepatic artery and portal vein flows and postoperative HASs.
Liver allograft iron accumulation in patients with and without pretransplantation hepatic hemosiderosis
Authors: Parolin Monica B. , Batts Kenneth P. , Wiesner Russell H. , Bernstein Peter S. , Zinsmeister Alan R. , Harmsen Scott W. , Porayko Michael J. , Burgart Lawrence J. , Brandhagen David J.
Published: August 2002

There is a paucity of data regarding hepatic allograft iron accumulation in patients undergoing orthotopic liver transplantation (OLT) in whom severe iron overload was present in the native explanted liver. Our aim is to evaluate the frequency and cellular distribution of stainable iron in early and late post-OLT hepatic allograft biopsy specimens from patients undergoing their first OLT who had excess iron in their native explanted liver. We compared iron-staining patterns in hepatic allograft biopsy specimens at approximately 1 month (early) and 1 to 2 years (late) post OLT in 41 patients with hepatic iron indices greater than 1.9 in the explanted liver (cases) with a selected group of matched controls without explant hemosiderosis. Our cases included 6 patients with a pre-OLT diagnosis of hereditary hemochromatosis and 35 patients with cirrhosis and secondary iron overload. Early iron deposition was mild in most cases, commonly affected Kupffer’s cells, and was seen with similar frequency in cases and controls (41% v 27%; P = .29). Stainable iron was observed in 20 donor livers (12 cases, 8 controls), and all 20 subjects showed stainable iron in 1-month hepatic allograft biopsy specimens. Liver samples from 35 matched pairs were studied for late iron deposition. Iron deposition was observed in 43% of cases versus 17% of controls (P = .06). In conclusion, the frequency of stainable iron in early hepatic allograft biopsy specimens was not different between patients with versus without pre-OLT hepatic hemosiderosis. There was a suggestion that patients with severe pre-OLT hemosiderosis had a greater frequency of iron accumulation in late hepatic biopsy specimens.