Liver Transplantation

Starzl, Thomas E.; Demetris, Anthony J.; Thiel, David Van

doi:10.1056/nejm198910193211606

Cited by 280 publications

(64 citation statements)

References 79 publications

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“…Its success is the result of progressive improvement of surgical techniques and immunosuppressive regimens for the prevention of transplant rejection [1,2]. Among pediatric patients, over 90% of all liver transplants are prompted by the existence of cholestatic disease (Table 1) or congenital metabolic deficits; other less common causes are metabolic liver disease, cystic fibrosis, and certain types of liver tumors (in most cases, hepatoblastoma and hepatocellular carcinoma) [3].…”

Section: Introductionmentioning

confidence: 99%

Contrast-enhanced ultrasound with SonoVue in the evaluation of postoperative complications in pediatric liver transplant recipients

Bonini

Pezzotta

Morzenti

et al. 2007

Journal of Ultrasound

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KEYWORDSSplit liver; Pediatric liver transplantation; Complications; Contrast-enhanced sonography.Abstract Purpose: To evaluate the utility of contrast-enhanced sonography in the study of pediatric liver transplant recipients and its potential impact in reducing the need for invasive diagnostic procedures. Materials and methods: From October 2002 to December 2003 we performed routine color Doppler ultrasound and contrast-enhanced ultrasound studies on 30 pediatric patients who had undergone liver transplantation. Findings indicative of complications were confirmed with invasive studies (angiography, computed tomography, and PTC). Results: Contrast-enhanced sonography correctly identified four of the five cases of hepatic artery thrombosis and all those involving the portal (n Z 6) and hepatic vein (n Z 3) thrombosis. It failed to identify one case of hepatic artery thrombosis characterized by collateral circulation arising from the phrenic artery and the single case of hepatic artery stenosis. The latter was more evident on color Doppler, which revealed a typical tardus parvus waveform. The use of contrast offered no significant advantages in the study of biliary complications although it did provide better visualization of bile leaks. Conclusions: Contrast-enhanced sonography improves diagnostic confidence and reduces the need for more invasive imaging studies in the postoperative follow-up of pediatric liver transplant recipients.Sommario Scopo: Valutare l'utilità dell'ecografia con mezzo di contrasto (Mdc) ecografico di II generazione nel paziente pediatrico trapiantato di fegato, in particolare al fine di ridurre il ricorso a metodiche diagnostiche invasive. ha fornito dati falsamente negativi in un caso di trombosi dell'arteria epatica, ricanalizzata da rami provenienti dall'arteria frenica, e nell'unico caso di stenosi anastomotica dell'arteria epatica della nostra casistica, nel quale è stato indicativo il pattern ''tardus parvus'' osservato all'esame eco-Doppler. Nel caso delle complicanze biliari l'esame eco-contrastografico non ha apportato significativi vantaggi, se non una migliore definizione dei margini e dell'estensione delle raccolte biliari post-intervento. Conclusioni: L'esame ecografico con Mdc è metodica in grado di incrementare la confidenza diagnostica dell'operatore, consentendo una riduzione al ricorso ad esami radiologici invasivi; ciò è particolarmente importante nel caso di pazienti a rischio, quali i bambini sottoposti a trapianto epatico. ª 2007 Published by Elsevier Masson.

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Section: Introductionmentioning

confidence: 99%

Contrast-enhanced ultrasound with SonoVue in the evaluation of postoperative complications in pediatric liver transplant recipients

Bonini

Pezzotta

Morzenti

et al. 2007

Journal of Ultrasound

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“…1,2 This change has been the result of improvements in referral liver transplant centers. Between April 1990 and immunosuppressive regimens, surgical techniques, recipient June 1994, 772 adults underwent an initial single-organ preparation, organ preservation, anesthesia techniques, timliver transplantion.…”

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confidence: 99%

Donor age and outcome of liver transplantation

et al. 1996

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DIGESTIVE AND KIDNEY DISEASES LIVER TRANSPLANTATION DATABASEIn recent years, survival following liver transplantation To evaluate the effect of donor age on graft and pahas improved markedly, with 1-year survival rates rising tient outcome after liver transplantation an analysis of a from 30% to 40% in the early 1980s to 70% to 80% in the large-scale cohort study was performed at three tertiary 1990s. 1,2 This change has been the result of improvements in referral liver transplant centers. Between April 1990 and immunosuppressive regimens, surgical techniques, recipient June 1994, 772 adults underwent an initial single-organ preparation, organ preservation, anesthesia techniques, timliver transplantion. The age of the donors averaged 35 ing of transplantation, and donor selection. The criteria for years; 193 (25%) were 50 or above, the age used to define donor selection or exclusion are more important than ever-''older'' donors. Groups were compared for demographic, as the demand for transplantation has risen faster than the clinical, and biochemical features. Outcome was meaavailability of donor livers, with increasing numbers of pasured using results of biochemical tests after transtients referred for liver transplantation and a rising waiting plantation and by graft and patient survival. Compared list mortality rate.2 with younger donors, older donors were more commonly A maximum upper age limit for liver donation has never women (59% vs. 33%: P°.001) and died of central nerbeen defined, but organs from donors above the age of 50 vous system causes (79% vs. 28%) as opposed to trauma years were rarely used 3,4 until the late 1980s when several (13% vs. 63%: P°.001). The recipients of the two groups reports on successful use of older donor livers were pubof donor livers did not differ in important respects. Howlished. 5-10 As the acceptable upper age limit has steadily inever, intraoperatively, livers from older donors were creased, the effects of older donor livers on graft function and more likely to be assessed as either ''poor'' or ''fair'' as survival deserve continuing reassessment. In recent analyopposed to ''good'' (17% vs. 4%: P°.001) by the harvesting ses, use of older liver donors was associated with decreases surgeon and to have initial ''poor'' or ''fair'' bile producin early liver function 11 and 6-month graft survival. 12,13 We tion (29% vs. 18%: P°.001). During the first week postophave evaluated the association between donor age and outeratively, the serum aminotransferase and bilirubin levcome of liver transplantation among patients entered into a els and prothrombin times were higher in recipients of large prospective database in which extensive information older than those of younger donor livers. During followwas available on the clinical characteristics of both donors up, graft survival was less for recipients of older donor and recipients. largely among recipients of older donor livers, the qualMayo Clinic Foundation, Rochester, MN; the University of Nebraska, ity of which was assessed ...

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“…Because of its dramatic effects on decreasing morbidity and increasing survival rates in human transplants (2,3), there has been much interest in deciphering CsA's molecular mechanism of immunosuppression. Evidence has accumulated on the one hand that T-cell CyP is a primary target for CsA (1,4) and on the other hand that the key biological step in immunosuppression is the selective blockade of transcriptional activation of T-cell cytokine genes for production of such molecules as interleukin 2, interleukin 3, and granulocyte-macrophage colonystimulating factor (5,6) by the inhibition of specific transcriptional activators such as nuclear factor of activated T cells (NF-AT) (7).…”

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confidence: 99%

Cloning, expression, and purification of human cyclophilin in Escherichia coli and assessment of the catalytic role of cysteines by site-directed mutagenesis.

Albers

Chen

et al. 1990

Proc. Natl. Acad. Sci. U.S.A.

230

123

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The cDNA encoding human cyclophilin from the Jurkat T-ceil Iymphoma line has been cloned by the expression cassette polymerase chain reaction and sequenced, and an expression vector has been constructed under control of the tac promoter for efficient expression in Escherichia coli. Active cyclophilin is produced at up to 40% of soluble cell protein, facilitating a one-column purification to homogeneity.

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Liver Transplantation

Cited by 280 publications

References 79 publications

Contrast-enhanced ultrasound with SonoVue in the evaluation of postoperative complications in pediatric liver transplant recipients

Contrast-enhanced ultrasound with SonoVue in the evaluation of postoperative complications in pediatric liver transplant recipients

Donor age and outcome of liver transplantation

Cloning, expression, and purification of human cyclophilin in Escherichia coli and assessment of the catalytic role of cysteines by site-directed mutagenesis.

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