Evolution of Liver Transplantation

Starzl, Thomas E.; Iwatsuki, Shunzaburo; Thiel, David H. Van; Gartner, J. Carlton; Zitelli, Basil J.; Malatack, J. Jeffrey; Schade, Robert R.; W., Shaw Jr . Byers; Hakala, Thomas R.; Rosenthal, J. Thomas; Porter, Kenneth Wiggins

doi:10.1002/hep.1840020516

Cited by 732 publications

(159 citation statements)

References 84 publications

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“…Technical and pharmacologic developments have resulted in longer-term survival after liver transplantation (LT) [1]. Most long-term complications after LT, including renal failure, are caused by the adverse effects of immunosuppressant treatments [2].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Renal Function in Liver Transplant Recipients After Conversion From Calcineurin Inhibitors to mTOR Inhibitors

et al. 2015

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Background:Renal dysfunction often occurs in liver transplant (LT) recipients receiving calcineurin inhibitor (CNI)-based immunosuppressive regimens, increasing morbidity and mortality rates. Replacement of CNIs by mTOR inhibitorbased immunosuppressive protocols may prevent renal impairment in LT recipients. Material/Methods:Outcomes in patients who underwent LT between 1996 and 2010 at our center and who were switched from CNI-based to mTOR inhibitor-based immunosuppression were retrospectively analyzed. Renal course, hyperlipidemia, and graft rejection were assessed in patients maintained on this CNI-free regimen for at least 24 months. Results:Of the 85 patients switched from CNI-based to mTOR inhibitor-based, CNI-free immunosuppression, 78 met the inclusion criteria. Within the first 6 weeks after switching, the covariable adjusted estimated glomerular filtration rate (eGFR) increased 5.6 mL/min [95% confidence interval 2.6-8.7 mL/min, p<0.001], but there were no further statistically noticeable changes in eGFR. Concentrations of cholesterol and triglycerides increased statistically, noticeable within the first 12 months after drug conversion. Histologically proven graft rejection was observed in 4 patients (5.1%) after conversion. Conclusions:Conversion from CNI-based to CNI-free, mTOR inhibitor-based immunosuppression after LT is safe and can result in significant renal recovery. CNI-free, mTOR inhibitor-based immunosuppression is a potential option for patients with contraindications for CNIs and for LT recipients with rapid reduction in kidney function due to CNIs.

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Section: Introductionmentioning

confidence: 99%

Long-Term Renal Function in Liver Transplant Recipients After Conversion From Calcineurin Inhibitors to mTOR Inhibitors

et al. 2015

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“…Liver transplantation (LT) has become a highly promising treatment for end-stage liver diseases [1]. Living donor LT (LDLT) has prevailed in Asian countries due to religious and cultural influences resulting in a shortage of deceased donors.…”

Section: Introductionmentioning

confidence: 99%

Impact of younger donors on outcomes after living donor liver transplantation

Kamo¹,

Kaido²,

Yagi³

et al. 2017

Trends in Transplant

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AbstractClinical progress in the field of liver transplantation has been largely supported by animal models 1,2 . Since the publication of the first orthotopic rat liver transplantation in 1979 by Kamada et al 3 , this model has remained the gold standard despite various proposed alternative techniques 4 .

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confidence: 99%

Orthotopic Liver Transplantation in Rats

Oldani

Lacotte

Morel

et al. 2012

JoVE

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Clinical progress in the field of liver transplantation has been largely supported by animal models 1,2 . Since the publication of the first orthotopic rat liver transplantation in 1979 by Kamada et al. 3 , this model has remained the gold standard despite various proposed alternative techniques 4 . Nevertheless, its broader use is limited by its steep learning curve 5 .In this video paper, we show a simple and easy-to-establish revision of Kamada's two-cuff technique. The suprahepatic vena cava anastomosis is performed manually with a running suture, and the vena porta and infrahepatic vena cava anastomoses are performed utilizing a quick-linker cuff system 6 . Manufacturing the quick-linker kit is shown in a separate video paper. Video LinkThe video component of this article can be found at https://www.jove.com/video/4143/ Protocol 1. Donor Operation 1. Anesthetize male rats weighing 200±20 grams with isoflurane on cone mask (3% for the induction, 2% during the operation, 1 l/min air flow, FiO2 70%). 2. Perform a large median and transverse laparotomy and cauterize the epigastric vessels on both sides. 3. Cut the falciform ligament, and separate the left diaphragmatic vein from the suprehepatic vena cava. Finally, divide the diaphragmatic vein between two 7-0 silk ligatures. 4. Cut the left triangular and the gastro-hepatic ligaments. 5. Divide the hepato-esophageal ligament and artery between 7-0 ligatures (coagulation is a valid alternative). 6. Isolate the infrahepatic vena cava down to the left renal vein. Separate the right renal vein from the surrounding tissues and divide it between a 10-0 and a 7-0 ligature, on its proximal and distal ends, respectively. 7. Divide the right suprarenal vein between 7-0 ligatures and free the liver from its posterior ligaments by cutting under gentle traction. 8. Isolate the gastrosplenic vein and divide it between a 10-0 and a 7-0 ligature, on its proximal and distal ends, respectively. 9. Divide the proper hepatic artery between 7-0 ties. 10. Isolate the duodeno-pancreatic vein and divided it between a 10-0 and a 7-0 ligature, on its proximal and distal end, respectively. 11. Insert a 22G, 3.5 mm stent into the common bile duct by practicing a small incision at 1 cm distance from the hepatic hilum. Secure the stent in position with a 7-0 ligature. 12. Inject 10 UI of heparin, diluted into 1 ml of normal saline, through the dorsal vein of the penis. 13. Cannulate the vena porta (as far as possible from the hilum) with a 21G needle and gently flush the liver with 20 ml of cold ringer lactate (or other preservation solutions). At the same time, cut the vena cava below the renal veins to allow an adequate outflow. Liver cold perfusion should last between one and two minutes. 14. Cut the vena porta below the duodeno-pancreatic vein. 15. Cut the common bile duct distally to the ligature around the stent. 16. Complete the incision of the infrahepatic vena cava. 17. Cut the suprahepatic vena cava skim to the diaphragm and remove the liver. 18. Place the liver into...

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Evolution of Liver Transplantation

Cited by 732 publications

References 84 publications

Long-Term Renal Function in Liver Transplant Recipients After Conversion From Calcineurin Inhibitors to mTOR Inhibitors

Long-Term Renal Function in Liver Transplant Recipients After Conversion From Calcineurin Inhibitors to mTOR Inhibitors

Impact of younger donors on outcomes after living donor liver transplantation

Orthotopic Liver Transplantation in Rats

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