Primary Living-Donor Liver Transplantation at the University of Chicago

Millis, J. Michael; Cronin, David; Brady, Lynda; Newell, Kenneth A.; Woodle, E. Steve; Bruce, David S.; Thistlethwaite, J. Richard; Broelsch, Christoph E.

doi:10.1097/00000658-200007000-00015

Cited by 131 publications

(106 citation statements)

References 33 publications

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“…19,20 Therefore, a greater proportion of sirolimus-treated patients may have been at a greater risk to develop HAT than control patients. This risk may have been offset by the use of 81 mg/d of acetylsalicylic acid in the LDLT recipients.…”

Section: Discussionmentioning

confidence: 99%

Sirolimus as primary immunosuppression in liver transplantation is not associated with hepatic artery or wound complications

Dunkelberg

Trotter

Wachs

et al. 2003

Liver Transplantation

114

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Sirolimus is a new immunosuppressive agent increasingly being used in liver transplant recipients. There is concern that sirolimus may be associated with wound complications and hepatic artery thrombosis (HAT). We have used sirolimus as primary immunosuppression in 170 liver transplant recipients and therefore reviewed our experience with wound complications and HAT in our cohort of patients. Records of all 170 patients administered sirolimus as primary immunosuppression and 180 historic controls were reviewed. Numbers of wound and hepatic artery complications were recorded, as well as the prevalence of obesity, reoperation, diabetes, and OKT3 use, all of which are risk factors for wound complications. The prevalence of wound complications was 12.4% in sirolimus-treated patients compared with 13. S irolimus, a new immunosuppressive agent, is being used increasingly in liver transplantation. 1-4 Sirolimus and tacrolimus are structurally related macrolides that bind the same intracellular receptor (FK506-binding protein-12 [FKBP12]) and potently inhibit T-cell proliferation. 5,6 The tacrolimus-FKBP12 complex, like the cyclosporine-cyclophilin complex, binds to and inhibits the Ca 2ϩ -dependent serine-threonine phosphatase calcineurin, thereby inhibiting cytokine-induced T-cell gene transcription and G 0 to G 1 transition. Conversely, the sirolimus-FKBP12 complex inhibits the target of rapamycin kinase, thereby inhibiting protein synthesis, G 1 to S transition, and cytokinedriven T-cell proliferation.Sirolimus has shown benefit in renal transplant recipients and therefore was approved for use in renal transplantation by the Food and Drug Administration in 1999. In two recent studies, a fixed dose of 2 or 5 mg/d of sirolimus in combination with cyclosporine decreased the acute rejection rate in the first year by 50% without an increase in immunosuppressant-related side effects. 7,8 Wound infection rates were not increased with sirolimus.Two recent trials have shown that liver transplantation may be performed successfully with minimal use of corticosteroids by using sirolimus and either tacrolimus or cyclosporine A. Low-dose sirolimus in the absence of prednisone in liver transplant recipients at our center was associated with a 50% decreased incidence of rejection, and the incidence of steroid-resistant rejection was decreased by 90% (compared with historic controls). 4 Similar efficacy was reported by McAlister et al 2 in an open-label report of 56 patients administered low-dose tacrolimus and sirolimus with prednisone up to 6 months after transplantation. The acute cellular rejection rate was 14%, which was approximately 50% lower than the historic rejection rate. None of the patients had steroid-resistant rejection.The well-established side-effect profile of sirolimus includes dose-dependent hyperlipidemia, thrombocytopenia, anemia, and leukopenia with an absence of neurotoxicity, nephrotoxicity, and diabetogenesis. There are anecdotal reports from some centers that sirolimus is associated with an increased incid...

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Section: Discussionmentioning

confidence: 99%

Sirolimus as primary immunosuppression in liver transplantation is not associated with hepatic artery or wound complications

Dunkelberg

Trotter

Wachs

et al. 2003

Liver Transplantation

114

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“…First, we wanted to avoid using extraanatomic venous conduits, which were reported to have a higher incidence of complications. 3 Also, having to harvest these extra-anatomic grafts necessitates additional incisions or more extensive dissection. Second, we found that when a second artery is present, it is often dominant, and its position is anterior and inferior to the portal vein while remaining in close proximity to the main bile duct.…”

Section: Discussion Evolution Of Techniquementioning

confidence: 99%

“…[1][2][3] Specifically, however, the initial experience with arterial anastomosis in segmental liver transplantation was disappointing. These vessels were of narrow caliber and often the anatomy required the use of vascular conduits.…”

mentioning

confidence: 99%

“…Through experience, use of the microscope, and the determination of the best vascular conduits, the rate of vascular complication has been reduced significantly. 3 In much the same way, RLDLT encounters the issues of aberrant anatomy and small vessel caliber, especially if multiple arteries are present. Whereas the vessels in RLDLT are not so small as to warrant the use of the microscope, we clearly have seen the advantage of sewing the donor-recipient arterial anastomosis at the back table to reduce warm ischemic time.…”

mentioning

confidence: 99%

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Hepatic arterial reconstruction in 95 adult right lobe living donor liver transplants: Evolution of anastomotic technique

Marcos

Killackey

Orloff

et al. 2003

Liver Transplantation

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The success of adult right-lobe living donor liver transplants (RLDLT) would not have been possible without the experience of the early pioneers of pediatric living donor liver transplants (LDLT). Our experience with 95 RLDLTs from July, 2000 to May, 2002 at a single institution is reported with specific emphasis on arterial reconstruction. The evolution of technique using the autogenous Y extension graft and the reverse extension bifurcated graft for arterial revascularization, which we believe has reduced the incidence of hepatic artery thrombosis, is described. Outcome and the incidence of hepatic artery thrombosis are reported. (Liver Transpl 2003;9: 570-574.)

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“…The relatively high incidence of hepatic artery thrombosis early in the history of segmental transplantation and the fulminant course so typical of this complication have shaped and reinforced this infloworiented approach. 1 Although venous complications occur, they tend to develop insidiously and seldom precipitate acute graft failure. 2 Intact organs and segmental grafts most commonly used (left lateral segments and full left lobes) retain many of the usual avenues for outflow.…”

mentioning

confidence: 99%

Functional venous anatomy for right-lobe grafting and techniques to optimize outflow

Marcos

2001

Liver Transplantation

121

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Primary Living-Donor Liver Transplantation at the University of Chicago

Cited by 131 publications

References 33 publications

Sirolimus as primary immunosuppression in liver transplantation is not associated with hepatic artery or wound complications

Sirolimus as primary immunosuppression in liver transplantation is not associated with hepatic artery or wound complications

Hepatic arterial reconstruction in 95 adult right lobe living donor liver transplants: Evolution of anastomotic technique

Functional venous anatomy for right-lobe grafting and techniques to optimize outflow

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