bluuebunny/crossref_metadata_2025 huggingface dataset:
Indication and contraindication for hepatic resection for liver tumors without fine-needle biopsy: Validation and extension of an Eastern approach in a Western community hospital
Authors: Torzilli Guido , Olivari Natale , Del Fabbro Daniele , Leoni Piera , Gendarini Adele , Palmisano Angela , Montorsi Marco , Makuuchi Masatoshi
Published: January 2004

Fine-needle biopsy (FNB) is associated with problems, such as tumor seeding, which are not negligible. The aim of this study was to validate prospectively the accuracy of our diagnostic work-up without FNB, not just to address but also to rule out from a surgical program patients with focal liver lesions (FLLs). From September 2001 to July 2003, 89 patients were seen at an outpatient clinic for FLLs. Nine patients were excluded because of previous FNB and 18 were excluded because carrier of advanced disease. Sixty-two patients with 101 FLLs were included. Preoperative diagnoses were established by means of clinical histories, serum tumor marker levels, ultrasonography (US), and spiral computed tomography (CT). Other imaging modalities were carried out when it was considered necessary. Forty-eight patients underwent surgery, with histological confirmation of the preoperative diagnosis. The remaining 14 patients underwent a close follow-up. The preoperative diagnoses of 47 of the 48 patients who underwent surgery were confirmed (97.9%). All of the 14 patients ruled out for surgical treatment did not show FLL progression at 6-24 months of follow-up. Of the 9 patients who had FNB previously in other centers, 2 had a wrong histological diagnosis. In view of these results, a diagnostic work-up without FNB seems adequate either to include or to exclude patients with potentially resectable FLL from the surgical program and once more highlight the fact that the use of FNB should be drastically limited. (Liver Transpl 2004;10:S30-S33.)
Surgical treatment of hepatocellular carcinoma: Similar long-term results despite geographic variations
Authors: Pawlik Timothy M. , Esnaola Nestor F. , Vauthey Jean-Nicolas
Published: January 2004

Recently, the International Cooperative Study Group for hepatocellular carcinoma (HCC) proposed a new staging based on data from multiple centers across the world. The new TNM staging has been shown to be more accurate in the prognostic classification of patients after resection for HCC. This staging is the basis for the new TNM for HCC approved by the AJCC (American Joint Committee on Cancer) and UICC (Union Internationale Contre le Cancer). Although the general applicability of the new staging system has been confirmed, there still remains a marked geographic variation in the clinicopathologic factors of HCC patients based on their country of origin. Tumor size, rates of hepatitis, and degree of underlying liver damage all vary significantly among countries. Despite these geographic variations, recent data reveal similar long-term survival in Western and Eastern centers when these clinicopathologic factors are accounted for. Uniform criteria that account for these clinicopathologic differences need to be developed to assist in stratifying patients across hepatobiliary centers. (Liver Transpl 2004;10:S74-S80.)
Multimodal image-guided tailored therapy of early and intermediate hepatocellular carcinoma: Long-term survival in the experience of a single radiologic referral center
Authors: Livraghi Tito , Meloni Franca , Morabito Alberto , Vettori Claudio
Published: January 2004

The best treatment policy for some patients with hepatocellular carcinoma (HCC) and compensated cirrhosis is still controversial. The aim of this study was to evaluate the long-term survival and related prognostic factors of patients with early and intermediate HCC (Liver Unit of Barcelona classification) treated in a radiologic referral center by a multimodal image-guided tailored therapy (MIGTT), applied over time, choosing the procedure patient by patient according to the presentation of the disease. Between May 1996 and May 2003, 374 patients (210 with early and 164 with intermediate HCC) were treated with MIGTT. Radiofrequency ablation was considered the first choice; ethanol injection was preferred for nodules at risk for radiofrequency; and selective chemoembolization was preferred for nodules not recognizable at ultrasound examination, those not retreatable after an unsuccessful ablation technique, or for satellites. The rate of perioperative mortality and major complications was 0.2% and 4.5%, respectively. The 1-, 3-, and 5-year survival rates were 90%, 69%, and 49% and 83%, 43%, and 28% for patients with early and intermediate HCC, respectively. At the univariate analysis, the indicators of a poor prognosis were Child’s class B, portal hypertension, abnormal bilirubin, infiltrating tumor, and abnormal serum alpha-fetoprotein (AFP) level. In conclusion, within the limits of historical comparisons, in early HCC, MIGTT should be considered an appropriate option for unresectable patients or for resectable patients presenting with adverse prognostic factors. In intermediate HCC, the 3-year survival rate obtained with MIGTT was better than the best survival rate reported with conventional chemoembolization; however, the benefit for patients presenting with poor prognostic factors remains unclear. (Liver Transpl 2004;10:S98-S106.)
3DCT angiography for detection of vascular complications in pediatric liver transplantation
Authors: Cheng Yu Fan , Chen Chao Long , Huang Tung Liang , Chen Tai Yi , Chen Yaw Sen , Wang Chih Chi , Tsang Leo Leung-chit , Chiu King Wah , Jawan Bruno , Eng Hock Liew
Published: January 2004

Catheter angiography for early diagnosis of vascular complications in pediatric liver transplant yields excellent results but remains an extremely invasive examination for younger children, precluding its routine use. We assessed the efficacy of three-dimensional multislice computed tomographic angiography (3DCTA) as an alternative option in these patients. Methods Twenty children suspected of vascular complications on clinical grounds, laboratory findings, or Doppler ultrasound underwent 3DCTA between April 2000 and April 2003. Interventional procedures via conventional angiography were subsequently performed in 5 cases, thrombolytic therapy in 4, surgical in 1, and conservative treatment in 10. Results Two hepatic artery stenosis,1 hepatic artery thrombosis, 5 hepatic vein stenosis, 4 portal vein occlusion, 1 portal vein stenosis, and 7 non-vascular lesions were detected, all of which paralleled the findings of catheter angiography, Doppler ultrasound, and operations. The diagnostic accuracy for vascular complication was 90%. The sensitivity and specificity were 86.7% and 100%, respectively. The positive and negative predictive values were 100% and 71.4%, respectively. To date 19 patients are alive, with a median follow-up period of 24.8 months. In conclusion, 3DCTA is accurate and efficient in the identification of pathological vascular insults and offers essential information for major decision on further management of the vascular complications in pediatric recipients of liver transplant. (Liver Transpl 2004;10:248-252.)
Switching monitoring of emulsified cyclosporine from trough level to 2-hour level in stable liver transplant patients
Authors: Langers Pieter , Cremers Serge C.L.M. , den Hartigh Jan , Veenendaal Roeland A. , ten Hove Rogier W. , Ringers Jan , Lamers Cornelis B.H.W. , van Hoek Bart
Published: January 2004

After orthotopic liver transplantation (OLT) many patients use emulsified cyclosporine. Recent data showed that blood levels 2 hours after dosing (C-2) better reflect systemic exposure to the drug (area under the blood concentration time curve) than trough levels (C-0) do. We investigated difference in dosage, creatinine clearance (CrCl), blood pressure (BP), freedom from rejection, and relation of C-2, C-0, and AUC while switching 31 stable patients more than 6 months after OLT from C-0 to C-2 monitoring. With C-0 between 90 and 150 ng/mL we collected 24-hour urine, while blood samples were taken at t = 0, 1, 2, 3, 4, 6, and 8 hours after dosing to measure cyclosporine, creatinine, liver tests, and blood pressure and calculated AUC and CrCl. Target AUC was calculated based on C-0. Then the dose was adjusted to two subsequent C-2 values of 600 ng/mL ± 15%, the above was repeated, and the differences were assessed. Cyclosporine dose was reduced in 21/31 patients (68%) and remained unchanged in 10/31 patients (32%) after conversion. Mean lowering was 69 mg daily (26.9 %, P < 0.0001). After dose reduction the mean increase of CrCl was 7.93 ml/min (11.6%, P = 0.016). Only systolic and mean morning BP decreased slightly but significantly. C-2 correlated better with AUC 0-12 (r2 = 0.75) than C-0 (r2 = 0.64). However, 13/21 patients had a second AUC below target AUC and 2 of these 13 patients developed rejection after conversion to C-2 levels. In conclusion, while C-0 monitoring frequently results in overdosing and more renal dysfunction, C-2 monitoring may lead to episodes of underdosing and rejection. Therefore better ways of monitoring cyclosporine dosing need to be devised. (Liver Transpl 2004;10:183-189.)
Fatal disseminated Kaposi’s sarcoma following human herpesvirus 8 primary infections in liver-transplant recipients
Authors: Marcelin Anne-Geneviève , Roque-Afonso Anne-Marie , Hurtova Monika , Dupin Nicolas , Tulliez Micheline , Sebagh Mylène , Arkoub Zaïna Ait , Guettier Catherine , Samuel Didier , Calvez Vincent , Dussaix Elisabeth
Published: January 2004

Human herpesvirus 8 (HHV-8) is associated with the development of Kaposi’s sarcoma (KS) and rare lymphoproliferative disorders in immunosuppressed patients. The risk of HHV-8 transmission by liver transplantation and the clinical manifestations of primary infection in this setting have yet to be determined. In order to evaluate this risk, we measured the seroprevalence of HHV-8 among 122 liver donors and their respective recipients before and after transplantation. Molecular methods and immunohistochemical analyses were performed to study the features of HHV-8 infection. Antibodies to HHV-8 were detected in sera of 4 donors before transplantation (3.3%) and of 3 recipients (2.4%). None of the 3 recipients, who were HHV-8 seropositive before transplantation, developed a KS during the follow-up. Four primary HHV-8 infections were detected among the 4 HHV-8 seronegative recipients who received a liver from an HHV-8 positive donor. Among these 4 recipients, 2 particularly immunosuppressed patients developed symptomatic diseases and died a few months after transplantation, harboring disseminated KS and HHV-8 positive lymphoproliferation. In these 2 patients, HHV-8 DNA genome sequences were detectable in peripheral blood mononuclear cells and other tissues with high viremia levels before and at the beginning of HHV-8-related diseases. In conclusion, in liver transplantation recipients, HHV-8 primary infection can be associated with fatal outcome. This study raises the question of screening liver donors for HHV-8—even in low HHV-8 infection prevalence countries—not systematically to exclude the graft but to monitor, clinically and biologically, patients who received a graft from an HHV-8-infected donor. (Liver Transpl 2004;10:295-300.)
E2 quasispecies specificity of hepatitis C virus association with allografts immediately after liver transplantation
Authors: Hughes Michael G. , Rudy Christine K. , Chong Tae W. , Smith Robert L. , Evans Heather L. , Iezzoni Julia C. , Sawyer Robert G. , Pruett Timothy L.
Published: January 2004

It is unknown whether all hepatitis C virus (HCV) quasispecies variants found within patient serum have equal capacity to associate with the liver after transplantation; however, in vitro models of HCV infection suggest that variations in the hypervariable region 1 (HVR1) of the second envelope protein (E2) may be important in infectivity. The hypothesis of the current study is that the two hypervariable regions (HVR1 and HVR2) within E2 are important in the initial virus-liver interaction, and, therefore, certain HCV quasispecies variants will be isolated from the liver after reperfusion. In 8 patients with end-stage liver disease secondary to HCV infection, HCV envelope quasispecies were determined from intraoperative serum samples obtained before the anhepatic phase of transplantation and from liver biopsies 1.5 to 2.5 hours after the transplanted liver was perfused. Explanted (native) liver biopsies were taken as a control. Sequence analysis was performed on clones of specific HCV reverse transcriptase-polymerase chain reaction products spanning HVR1 and HVR2 of the E2 protein. HVR1 was more variable than HVR2 for all samples. Quasispecies isolated from postperfusion liver differed more from serum than did explanted liver quasispecies at HVR1 (P = 0.03) but not at HVR2 (P = 0.2). Comparison of HVR1 sequences from postperfusion liver versus serum revealed significantly less HVR1 genetic complexity and diversity (P = 0.02 and P = 0.04, respectively). Immediately after transplantation but before actual infection, liver allografts select out from the infecting serum inoculum a less heterogeneous, more closely related population of quasispecies variants. (Liver Transpl 2004;10:208-216.)
Complement membrane attack complex and hemodynamic changes during human orthotopic liver transplantation
Authors: Bellamy Mark C. , Gedney Jacqui A. , Buglass Helen , Gooi Jimmy H.C.
Published: January 2004

Hemodynamic changes and elevation of intracellular calcium following reperfusion in human liver transplantation occur rapidly and do not match the time course of cytokine expression, therefore, we postulate involvement of other, pre-formed substances, such as complement. We studied 40 adult patients undergoing liver transplantation. Blood was drawn for estimation of C3, C4, C3 degradation product, membrane attack complex, and CH100 levels and elastase (a marker of neutrophil activation) at induction of anesthesia, 5 minutes before reperfusion, 5 minutes and 60 minutes after reperfusion. Cardiac output was measured by thermodilution and systemic vascular resistance was calculated at these same time points. There was a significant rise in C5b-9 membrane attack complex (P = .0012) with a corresponding fall in C3 (P = .0013) and C4 (P = .0002) levels and a rise in C3 degradation product levels (P = .0006). There was no significant change in CH100. These changes very closely followed the hemodynamic changes of a significant fall in systemic vascular resistance index (P = .0024) and increase in cardiac index (P = .0005). Elastase rose from 356 ± 53 to 557 ± 40 μg/L (P < .0001). There is complement activation and neutrophil activation at reperfusion in liver transplantation. Dilution alone cannot explain the fall in C3 and C4 levels as there is a corresponding increase in membrane attack complex and C3 degradation product levels with time. As both C3 and C4 are consumed, the classical pathway must be active, though alternative and lectin activated pathways may also be involved. These findings may, at least in part, explain the hemodynamic changes typically seen at reperfusion in liver transplantation. (Liver Transpl 2004;10:273-278.)
Protective anti-donor IgM production after crossmatch positive liver-kidney transplantation
Authors: McAlister Chloe C. , Gao Zu-hua , McAlister Vivian C. , Gupta Rekha , Wright James R. , MacDonald Allan S. , Peltekian Kevork
Published: January 2004

The mechanism by which a liver transplantation might protect a simultaneous kidney transplant in a crossmatch-positive recipient is unknown. Flow cytometry crossmatch (FCXM) has increased the sensitivity of donor-specific antibody (DSA) detection compared with complement-dependant cytotoxicity (CDC). Here we compare the outcome of a liver-kidney transplantation (LKT), which was CDC and FCXM positive, to the mate-isolated kidney transplantation (KT), which was CDC negative but FCXM positive, from the same donor. Immunoglobulin G (IgG) and immunoglobulin M (IgM) DSAs were measured by FCXM using splenocytes and purified T cells. The KT graft was hyperacutely rejected and removed, but the LKT graft survived without episodes of rejection. Both the KT and the LKT recipients had high levels of circulating antidonor IgG, but not IgM, before transplantation. By day 3, antidonor IgG and IgM in the LKT recipient increased 2 and 7 fold respectively, whereas the KT recipient maintained the high IgG level but did not increase IgM. Histology of the KT graft showed IgG and complement (C1q) deposition, but in the LKT grafts, IgM was deposited without IgG or C1q. Circulating IgG and IgM DSAs returned to background by day 10 and were still at background on day 100. We report a crossmatch-positive LKT where posttransplantation production of IgM DSA, which failed to fix complement, appeared to protect the grafts. (Liver Transpl 2004;10:315-319.)
De novo sarcoma of donor origin in a liver allograft determined by microsatellite analysis: A short report
Authors: Chan See-Ching , Cheung Siu-Tim , Leung Suet Yi , Liu Chi-Leung , Fan Sheung-Tat , Lo Chung-Mau
Published: January 2004

This case report describes a patient who underwent liver transplantation for HCV cirrhosis for hepatocellular carcinoma. At 3.5 years post transplant, 6 cm tumor was found with CT scanning. With microsatellite analysis it was determined that the tumor was of donor origin. The patient underwent successful right hepatectomy of the tumor that proved to be sarcoma. The patient is doing well without recurrence 1.5 years after resection and 5 years post transplant. (Liver Transpl 2004;10:320-323.)
Intravascular thrombosis and thromboembolism during liver transplantation: Antifibrinolytic therapy implicated?
Authors: Ramsay Michael A.E. , Randall Henry B. , Burton Elizabeth C.
Published: January 2004

This case report describes a patient who underwent orthotopic liver transplantation and developed extensive hyperacute venous and arterial intravascular thromboses and thromboemboli intraoperatively. The patient was receiving antifibrinolytic therapy with aprotinin. The safety of routine aprotinin therapy in liver transplantation is examined. The value of the thrombelastograph (TEG) as a qualitative assessment of the coagulation system is emphasized. (Liver Transpl 2004;10:310-314.)
Genetic variability of hepatitis C virus NS3 protein in human leukocyte antigen-A2 liver transplant recipients with recurrent hepatitis C
Authors: López-Labrador Xavier F. , Berenguer Marina , Sempere Amparo , Prieto Martín , Sirera Rafael , González-Molina Andrés , Ortiz Vicente , Marty Ma Luisa , Berenguer Joaquín , Gobernado Miguel
Published: January 2004

The association between the severity of chronic hepatitis C and the variability of the hepatitis C virus (HCV) genome remains controversial, but to our knowledge few data are available to date regarding T-cell epitope coding regions in transplant patients. In the current study, we identified 21 human leukocyte antigen (HLA)-A2-positive Spanish patients with chronic hepatitis C, 14 immunosuppressed liver transplant recipients, and 7 immunocompetent controls. Alanine aminotransferase, aspartate aminotransferase, viral load, and rate of fibrosis progression were determined. Genetic distances of HCV isolates and variations in epitopes of the HCV nonstructural 3 protein (NS3-1393 LIFCHSKKK and NS3-1406 KLVALGINAV) were compared between patients with slow or fast progression of fibrosis. Isolates from transplant patients with fast progression were found to be more divergent (P =.03), had a higher mean value of synonymous (dS) variations (P =.02), and some were differentiated in a phylogenetic tree, compared with isolates from patients with slow progression. The HLA-A2-restricted NS3-1406 epitope was found to be more variable (20 of 21 isolates differed from the prototype) compared with the A3-restricted NS3-1392 epitope (19% vs. 1.25% variation). A shift in the viral peptide was not detected in a subset of transplant patients, but was evident in two of three nontransplant patients with follow-up. There was no correlation noted between a particular amino acid variation and fibrosis progression (slow or fast) in either transplant or nontransplant patients. The results of the current study suggest that 1) there may be different HCV-1b strains in our geographic area, 2) immunosuppression appears to have little effect in amino acid variation at the HCV NS3-1406 epitope, and 3) variations over time might be more frequent in nonimmunosuppressed patients. (Liver Transpl 2004;10:217-227.)
Outcome of liver transplantation in adult recipients: Influence of neighborhood income, education, and insurance
Authors: Yoo Hwan Young , Thuluvath Paul J.
Published: January 2004

Poor socioeconomic status (SES) may be associated with lower survival after liver transplantation. In a previous study, we showed that African-American race was an independent predictor of poor survival, and one of the major criticisms of our study was that we had not adjusted the survival for SES as a confounding variable. The objective of the present study was to determine the posttransplant outcome of adult liver transplant recipients based on neighborhood income, education, and insurance using the United Network for Organ Sharing (UNOS) database from 1987 to 2001. Patients (n = 29,481) were divided into 5 groups based on median income as determined by zip code: <$30,000, $30,001-$40,000, $40,001-$50,000, $50,001-$60,000, and >$60,000). Patients (n = 14,814) were divided into 4 groups based on level of education: higher than bachelor’s degree; college attendance or technical school; high school education (grades 9-12); less than high school education. Insurance payer status (n = 23,440) was divided into Medicaid, Medicare, government agency, HMO/PPO, and private. Cox regression analysis was used to adjust the survival for other known independent predictors such as age, race, UNOS status, diagnosis, and creatinine. Results showed that neighborhood income had no effect on graft or patient survival either in the entire cohort or within different racial groups. Education had only marginal influence on the outcome; survival was lower in those with a high school education than in those with graduate education. Patients with Medicaid and Medicare had lower survival when compared to those with private insurance. African-Americans had a lower 5-year survival when compared to white Americans after adjusting for SES and other confounding variables. In conclusion, neighborhood income does not influence the outcome of liver transplantation. Education had minimal influence, but patients with Medicare and Medicaid had lower survival compared to those with private insurance. (Liver Transpl 2004;10:235-243.)
Intermittent inflow occlusion in living liver donors: Impact on safety and remnant function
Authors: Miller Charles M. , Masetti Michele , Cautero Nicola , DiBenedetto Fabrizio , Lauro Augusto , Romano Antonio , Quintini Cristiano , Siniscalchi Antonio , Begliomini Bruno , Pinna Antonio D.
Published: January 2004

Clamping of the portal triad accomplishes complete inflow occlusion. This maneuver is commonly used during liver surgery to minimize blood loss but is not widely used in living donors undergoing resection for liver transplantation. We compared outcomes in living donors who underwent resection with and without inflow occlusion. We reviewed data on 2 nonsimultaneous living liver donor cohorts. The first 20 donors (group 1) underwent resection without inflow occlusion. In the next 15 donors (group 2), inflow occlusion was used during parenchymal transection, using cycles of 10-15 minutes occlusion and 6 minutes reperfusion. In donors, we recorded type of resection; ischemia times; blood loss; transfusions; peak ALT, AST, bilirubin, and INR in the first 5 days; hospital length of stay (LOS), and major complications. In recipients, we recorded peak ALT. In group 1, 19 of 20 donors underwent right hepatectomy. In group 2, 8 donors underwent right hepatectomy, and 7 donors had left lobectomies. Total ischemic time ranged from 16-49 minutes (mean, 31 ± 9 minutes). In group 1, two donors received a total of 5 U of allogeneic blood. In group 2, no donor required transfusion. Mean peak ALT was significantly higher in group 1 (521 ± 336 U/L) than group 2 (322 ± 162 U/L; P = 0.03). Mean INR was significantly higher in group 1 (1.8 ± 0.2) vs. group 2 (1.5 ± 0.2; P = 0.001). There were 4 major complications in group 1 (incisional hernia, transient liver failure, biliary stricture, and biliary leak) and no major intraoperative or postoperative complications in group 2. Mean LOS was significantly longer in group 1 (7.9 ± 2.9 days) than group 2 (6.2 ± 1.1 days; P = 0.04). Mean peak ALT in recipients trended lower in group 2. In conclusion, inflow occlusion was associated with reduced blood loss and less ischemic injury to hepatic remnants in the donors and the grafts in the recipients. These benefits were associated with a diminished incidence of major complications and shorter LOS. Inflow occlusion should be an essential part of living donor hepatectomy. (Liver Transpl 2004;10:244-247.)
Effect of sirolimus on infection incidence in liver transplant recipients
Authors: Fisher Adrian , Seguel Joseph M. , de la Torre Andrew N. , Wilson Dorian , Merchant Anand , Arora Rakesh K. , Koneru Baburao
Published: January 2004

Sirolimus is a new immunosuppressive agent that lacks the nephrotoxicity and neurotoxicity associated with calcineurin inhibitors.1-3 The addition of sirolimus to immunosuppressive protocols may thus allow sparing of calcineurin inhibitors and reduction or elimination of associated toxicities.1
,
6 Between January 2000 and July 2001, sirolimus was administered to 55 of 116 consecutive liver recipients. The remaining 61 patients served as the comparison group in the retrospective analysis. In the sirolimus group, perioperative steroids were reduced, and calcineurin inhibitor initiation was delayed. All infectious episodes that occurred within 60 days of liver transplantation were evaluated but were limited to 1 per patient for statistical analysis of sepsis. Demographic variables were comparable between groups. Patients receiving sirolimus experienced more infection (47.2% vs. 18.03%, P<0.001), and this effect persisted across high and low dosage ranges and sirolimus levels. A trend toward increased length of stay was noted (P=0.07). No difference between groups was found in acute rejection rates (17.5% vs. 22.5%), 1-year graft (81% vs. 89%), patient survival (86% vs. 89%), or hepatic artery thrombosis. In conclusion, despite reduction of other immunosuppressants, patients receiving even low doses of sirolimus experienced increased sepsis rates. This agent may have greater usefulness for patients with threatened renal function or patients with chronic rejection after wound healing has occurred. (Liver Transpl 2004;10:193-198.)
Porcine partial liver transplantation: A novel model of the “small-for-size” liver graft
Authors: Kelly Dympna M. , Demetris Jake A. , Fung John J. , Marcos Amadeo , Zhu Yue , Subbotin Vladimir , Yin Lu , Totsuka Eishi , Ishii Tomohiro , Lee Ming C. , Gutierrez Jorge , Costa Guilherme , Venkataraman Raman , Madariaga Juan R.
Published: January 2004

Increasing shortage of cadaveric grafts demands the utilization of living donor and split liver grafts. The purpose of this study was to 1) define the “small-for-size” graft in a pig liver transplant model 2) evaluate pathological changes associated with small-for-size liver transplantation. Pigs were divided into four groups based on the volume of transplanted liver: (a) control group (n=4), 100% liver volume (LV) (b) group I (n=8), 60% LV (c) group II (n=8), 30% LV (d) group III (n=15), 20% LV. Tacrolimus and methyl prednisone were administered as immunosuppression. Animals were followed for 5 days with daily serum biochemistry, liver biopsies on day 3 and 5 for light microscopy, and tissue levels of thymidine kinase (TK) and ornithine decarboxylase (ODC). Liver grafts were weighed pretransplant and at sacrifice. All the recipients of 100%, 60%, and 30% grafts survived. Transplantation of 20% grafts (group III) resulted in a 47% mortality rate. Group III animals showed significantly prolonged prothrombin times (p<0.05), elevated bilirubin levels (p<0.05), and ascites. The rate of regeneration, as indicated by TK activity and graft weight was inversely proportional to the size of the transplanted graft. The severity of the microvascular injury was inversely proportional to graft size and appeared to be the survival-limiting injury. Frank rupture of the sinusoidal lining, parenchymal hemorrhage, and portal vein injury were prominent in group III animals 1 hour following reperfusion. This study established a reproducible large animal model of partial liver grafting; it defined the small-for-size syndrome in this model and described the associated microvascular injury. (Liver Transpl 2004;10:253-263.)
Sustained viral response to interferon and ribavirin in liver transplant recipients with recurrent hepatitis C
Authors: Abdelmalek Manal F. , Firpi Roberto J. , Soldevila-Pico Consuelo , Reed Alan I. , Hemming Alan W. , Liu Chen , Crawford James M. , Davis Gary L. , Nelson David R.
Published: January 2004

Recurrent hepatitis C infection is an important cause of progressive fibrosis, cirrhosis, and graft loss following orthotopic liver transplantation. Treatment for posttransplant recurrence of hepatitis C with interferon-based therapy is difficult but results in loss of detectable virus in up to 30% of patients. However, the durability of viral clearance and the associated histologic response in this setting is unknown. The aim of this study was to determine whether viral loss in response to antiviral therapy is durable and associated with improvement in liver histology. All liver transplant recipients who received interferon-based treatment for recurrent hepatitis C virus (HCV) at the University of Florida from 1991 to 2002 were included in this study. Patients who lost detectable HCV after treatment with interferon alone or in combination with ribavirin were followed to assess the durability of viral response and its impact on liver histology. One hundred nineteen transplant recipients were treated with interferon or combination therapy. Twenty-nine (20 men, 9 women; mean age, 54 yrs [range, 42-74 yrs]) lost detectable HCV RNA and remained virus negative for at least 6 months after discontinuing therapy (sustained viral response[SVR]). The mean follow-up after discontinuing therapy was 24.7 months (range, 6-70 mos). Our study cohort included one patient with SVR following interferon monotherapy and 28 patients with SVR following combination therapy with interferon plus ribavirin. All patients remained HCV RNA negative (assessed by polymerase chain reaction or branched-DNA assay) during follow-up of up to 5 years. Liver histology assessed 2 years after treatment showed less inflammation compared with before treatment in 50% and showed no change in 38%. By 3 to 5 years post-treatment (n = 15 recipients), inflammation was reduced in 60% and remained unchanged in 33%. Fibrosis stage at 2 years improved by ≥ 1 stage in 27 %, remained unchanged in 38 %, and worsened in 35% despite viral clearance. At 3 to 5 years, the fibrosis stage had improved in 67%, remained unchanged in 13%, and worsened in 20%. Both grade of inflammation and fibrosis stage improved by 3 to 5 years posttreatment compared with baseline histology (p < 0.05). In conclusion, loss of HCV after treatment of recurrent chronic hepatitis C with interferon and ribavirin is durable, and the durability of the SVR is associated with improvement in hepatic inflammation and regression of fibrosis. (Liver Transpl 2004;10:199-207.)
The prophylactic use of tranexamic acid and aprotinin in orthotopic liver transplantation: A comparative study †
Authors: Dalmau Antonia , Sabaté Antoni , Koo Maylin , Bartolomé Carlos , Rafecas Antoni , Figueras Juan , Jaurrieta Eduard
Published: January 2004

The efficacy of tranexamic acid (TA) and aprotinin (AP) in reducing blood product requirements in orthotopic liver transplantation (OLT) was compared in a prospective, randomized and double-blind study. One hundred and twenty seven consecutive patients undergoing OLT were enrolled; TA was administered to 64 OLT patients at a dose of 10mg /kg/h and aprotinin was administered to 63 OLT patients at a loading dose of 2x106 KIU followed by an infusion of 500,000 KIU/h. The portocaval shunt could not be performed in 14 OLT patients in the TA group and in 13 OLT patients in the AP group. However, all OLT patients that received either drug were included in the analysis. Perioperative management was standardized. Hemogram, coagulation tests, and blood product requirements were recorded during OLT and during the first 24 hours. No differences in diagnosis, Child score, preoperative coagulation tests, and intraoperative data were found between groups. No significant differences were observed in hemogram and intraoperative coagulation tests with the exception of activated partial thromboplastin time (aPTT). Similarly, there were no intergroup differences in transfusion requirements. Thromboembolic events, reoperations and mortality were similar in both groups. In conclusion, administration of regular doses of TA and AP during OLT did not result in large differences between the two groups. (Liver Transpl 2004;10:279-284.)
Psychosocial adjustment to orthotopic liver transplantation in 266 recipients
Authors: Blanch Jordi , Sureda Barbara , Flaviá Montse , Marcos Victoria , de Pablo Joan , De Lazzari Elisa , Rimola Antoni , Vargas Victor , Navarro Victor , Margarit Carlos , Visa Josep
Published: January 2004

Although the survival rate of patients undergoing orthotopic liver transplantation (OLT) is highly satisfactory, one of the most important objectives for liver transplantation teams at the present time is to achieve the best possible quality of life and psychosocial functioning for these patients after transplantation. We present the preliminary results of a study designed to determine which domains of psychosocial functioning are most affected in liver transplant recipients, and to examine the factors associated with poorer adjustment after OLT, using a utility-based standardized measure. Patients who had undergone liver transplant more than 12 months previously were eligible. They were administered the Psychosocial Adjustment to Illness Scale (PAIS), and they provided the answers themselves. Multivariate regression models showed that attitudes toward health care were poorer in women (β = 0.916, P < .001), in patients who were employed at the moment of transplantation (β = 0.530, P = .032), and in patients of lower social class (β = 0.722, P = .026) than in men, unemployed patients, and patients of higher social class. Sexual functioning was worse in women (β = 0.907, P = .001) and older patients (β = 0.999, P < .001) than in men or younger patients. Psychological distress was higher in women (β = 0.981, P = .001) than in men, and lower in currently employed patients (β = −0.937, P = .001) than in the unemployed. Only gender remained significantly associated with the total PAIS score (β = 0.969, P < .001), with women showing a poorer overall psychosocial adjustment to OLT. In conclusion, there seems to be no doubt that liver transplantation improves quality of life, but special attention should be paid to female recipients, who seem to have more difficulty than their male counterparts in adjusting to the psychosocial consequences of the procedure. (Liver Transpl 2004;10:228-234.)
Thromboelastogram monitoring in the perioperative period of hepatectomy for adult living liver donation
Authors: Cerutti Elisabetta , Stratta Chiara , Romagnoli Renato , Schellino Maria Maddalena , Skurzak Stefano , Rizzetto Mario , Tamponi Giacomo , Salizzoni Mauro
Published: January 2004

Living donor liver transplantation (LDLT) is becoming a widespread procedure. However, the risk of surgical and medical complications in healthy donors is still a major concern. Hypercoagulability contributes to thromboembolic complications after surgery, but alterations of hemostasis after liver resection are difficult to predict. This study aims to define the perioperative coagulation profile of living liver donors by the use of both routine tests and thromboelastogram (TEG).

Ten subjects undergoing right hepatectomy for LDLT were studied. A complete coagulation screening was performed before operation. The coagulation profile was evaluated by platelet count, prothrombin time-international normalized ratio (PT-INR), activated partial thromboplastin time (aPTT), and TEG at the beginning and at the end of surgery, and on days 1, 3, 5, and 10 after operation, while the donors were under low molecular weight heparin (LMWH) prophylaxis. At preoperative screening, no subject showed evidence of a prothrombotic state. In all cases, TEG was normal at the beginning of surgery. In the postoperative period, despite decreased platelet counts, increased PT-INR, and normal aPTT values, TEG evidenced the progressive development of hypercoagulability in 4 subjects on day 5 and in 6 subjects on day 10. One donor with a definitely hypercoagulable TEG on day 5 experienced deep venous thrombosis (DVT) on day 8, which was resolved with therapeutic doses of LMWH.

In conclusion, despite routine tests suggesting hypocoagulability and LMWH prophylaxis, TEG monitoring showed the unexpected occurrence of hypercoagulability in the majority of the subjects after hepatectomy for LDLT. TEG monitoring could be useful in the perioperative management of donors to guide antithrombotic treatment and increase the safety of the procedure. (Liver Transpl 2004;10:289-294.)
Steroid-free liver transplantation using rabbit antithymocyte globulin and early tacrolimus monotherapy
Authors: O’Grady John G.
Published: January 2004

Background

In 2001, we published early results of a prospective randomized trial of 71 patients who received either steroids or rabbit antithymocyte globulin (RATG) for orthotopic liver transplantation (OLT). We now report follow-up on these patients and additional patients undergoing steroid-free OLT.

Methods

A total of 119 adult OLT recipients were prospectively randomized to receive either methylprednisolone 1,000 mg followed by a 3-month steroid taper or a steroid-free regimen of RATG 1.5 mg/kg during the anhepatic phase followed by a 1.5 mg/kg dose on posttransplant day 1. Maintenance immunosuppression consisted of tacrolimus and mycophenolate mofetil in both groups. Mycophenolate mofetil was weaned over 3 months in the first 71 patients and over 2 weeks in the last 48 patients, achieving tacrolimus monotherapy by 2 weeks posttransplant. Subsequently, a group of 24 sequential OLT recipients received the steroid-free (RATG) protocol. Endpoints of the study were survival, rejection, infectious complications, posttransplant diabetes, and recurrent hepatitis C virus.

Results

One-year patient survival was 85% in each group of the prospective randomized trial with a mean follow-up of 18.5 months. One-year graft survival was 82% in the RATG group and 80% in the steroid group (P = not significant). Patient and graft survival of the 24 nonrandomized RATG patients was 96% with a mean follow-up of 3 months. The incidence of rejection was not significantly different; however, 50% of the patients in the steroid group required pulse steroids to reverse the rejection compared with only one patient (1.6%) in the RATG group (P= 03). The incidence of cytomegalovirus infection (P < .05) and posttransplant diabetes was higher in the steroid group (P = .03). There was a trend toward decreased severity of hepatitis C virus in the RATG group.

Conclusions

Steroid-free liver transplantation using RATG and early tacrolimus monotherapy effectively reduces immunosuppression-related complications with excellent survival.
Reduction of the second and third harmonics for a rectangular microstrip patch antenna
Authors: Lee Sin Keng , Qin Yi , Korolkiewicz E.
Published: February 2004

This paper shows that, by using the current density distribution on a patch, the positions of shorting pins and slots can be determined so that the unwanted modes are suppressed. An example of applying this technique to a rectangular patch to suppress the second and third harmonics is presented. © 2004 Wiley Periodicals, Inc. Microwave Opt Technol Lett 40: 455–460, 2004; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/mop.20004
Analysis of transient electromagnetic scattering from dielectric objects using a combined‐field integral equation
Authors: Jung Baek Ho , Sarkar Tapan Kumar , Chung Young‐seek , Ji Zhong , Salazar‐Palma Magdalena
Published: February 2004

In this paper, we analyze the transient electromagnetic response from three‐dimensional (3D) dielectric bodies using a time‐domain combined‐field integral equation. The solution method in this paper is based on the method of moments (MoM), which involves separate spatial and temporal testing procedures. Triangular‐patch basis functions are used for spatial expansion and testing functions for arbitrarily shaped 3D dielectric structures. The time‐domain unknown coefficients of the equivalent electric and magnetic currents are approximated by a set of orthonormal basis functions derived from the Laguerre polynomials and exponential functions. These functions are also used as temporal testing. In addition to use of the Laguerre polynomials as expansion functions for the transient portion of the response, two new source vectors related to the equivalent currents enables one to handle the time derivative terms of the vector potential in the integral equation in an analytic fashion. Numerical results computed by the proposed method are presented and compared. © 2004 Wiley Periodicals, Inc. Microwave Opt Technol Lett 40: 476–481, 2004; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/mop.20009
Combined field integral equation for the analysis of scattering from 3D conducting bodies coated with a dielectric material
Authors: Jung Baek Ho , Sarkar Tapan Kumar , Salazar‐Palma Magdalena
Published: February 2004

In this paper, we present an analysis of electromagnetic scattering from arbitrarily shaped three‐dimensional (3D) conducting objects coated with dielectric materials. The integral equation treated here is the combined field integral equation (CFIE). The objective of this paper is to illustrate that only the CFIE formulation is a valid methodology in removing defects, which occur at a frequency corresponding to an internal resonance of the structure. Numerical results of radar cross sections (RCS) for coated conducting structures are presented and compared with other available solutions. © 2004 Wiley Periodicals, Inc. Microwave Opt Technol Lett 40: 511–516, 2004; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/mop.20019
Capacitance extraction for multiconductor transmission lines in multilayered dielectric media using the numerical Green's function
Authors: Shu Weiwei , Xu Shanjia
Published: February 2004

An effective and universal method for calculating capacitance matrix is presented in this paper. Calculations for extracting the capacitance of a multilayer medium are rather time consuming when traditional approaches are used. To accelerate the procedure, the concept of the numerical Green's function is proposed. A database is constructed using the technique of interpolation to acquire the elements of the matrix, and then the Method of Moments (MoM) is used to solve the integral equations. The effectiveness of the present method is justified by the results given in the literature. The present approach is particularly effective in synthetic problems. © 2004 Wiley Periodicals, Inc. Microwave Opt Technol Lett 40: 529–531, 2004; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/mop.20024
Morphology and spherulitic growth kinetics in poly(ethylene oxide)/poly(n‐butyl methacrylate) blends
Authors: El Shafee E
Published: February 2004

Results of a study concerning the morphology and the spherulite growth rates of poly(ethylene oxide) (PEO) in binary blends with poly(n‐butyl methacrylate) (PnBMA) are reported. Microscopic observations show that blending causes the spherulite structure to become coarser and less birefringent and confirms that the spherulitic growth rates of PEO were reduced by the addition of PnBMA. X‐ray diffraction studies show no change in the unit cell dimensions and a decrease in the degree of crystallinity upon blending. Analysis of the spherulite radial growth rate data by using Lauritzen–Hoffman theory indicates that crystallization in the range of 300 to 330 K occurs solely within regime III. The calculated surface free energy of folding, σe, for pure PEO is 57 erg cm−2 and decreases with increasing the content of PnBMA in the blend. Copyright © 2004 Society of Chemical Industry
Novel synthesis and solution properties of hyperbranched poly(ethyl methacrylate)s by quasi‐living radical copolymerization using photofunctional inimer
Authors: Ishizu Koji , Shibuya Takeshi , Park Jaebum , Uchida Satoshi
Published: February 2004

Hyperbranched poly(ethyl methacrylate)s (PEMA) were prepared by quasi‐living radical copolymerization of 2‐(N,N‐diethylaminodithiocarbamoyl)‐ethyl methacrylate (inimer: DTEM) with ethyl methacrylate (EMA) under UV irradiation. DTEM monomers play an important role in this copolymerization system as inimers capable of initiating living radical polymerization of the vinyl group. Two monomers (DTEM and EMA) showed almost equal reactivity toward both propagating species, and the copolymer composition was the same as the comonomer feed. This result means that both the branching and chain length of the hyperbranched molecules can be controlled statistically by the feed monomer ratios. The compact nature of the hyperbranched macromolecules is demonstrated by comparison of their solution properties with the linear analogues. Copyright © 2004 Society of Chemical Industry
The role of tissue harmonic imaging in fetal echocardiography
Authors: Paladini D. , Vassallo M. , Tartaglione A. , Lapadula C. , Martinelli P.
Published: February 2004

Objective

To define the role of tissue harmonic imaging (THI) in fetal echocardiography.

Method

Three trials were conducted in a tertiary referral center: Study A was a prospective randomized trial including 50 women referred for fetal echocardiography. Those allocated to Arm 1 underwent conventional fundamental frequency ultrasound (FFU) and those allocated to Arm 2 underwent THI. Study B was conducted in 21 patients who were obese or overweight with significant weight gain in pregnancy. In these patients, both THI and FFU echocardiography were performed and compared. In Study C, THI was employed as a second‐line rescue technique in cases of inadequate or incomplete examination by FFU. A subjective scoring system was used by a reviewer who had not performed the examinations to assess the comprehensiveness of the examination and the image resolution. The reviewer was blinded to the image modality.

Results

In Study A, no difference was found in the diagnostic accuracy between THI and FFU echocardiography but the resolution was significantly poorer in the THI arm. In studies B and C, THI performed significantly better than FFU (P < 0.001).

Conclusions

THI echocardiography seems to be the best technique to employ in obese women and in those in whom FFU fails to provide diagnostic information. However, due its poorer resolution in women of average weight, FFU echocardiography should remain the technique of choice. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.