Recovery of failing liver after auxiliary heterotopic transplantation

Metselaar, Herold J.; Hesselink, E. J.; Rave, Sjoerd de; Kate, F.J.W. ten; Lameris, JS; Groenland, Theo H. N.; Reuvers, Cees B.; Weimar, W.; Terpstra, Onno T.; Sw, Schalm

doi:10.1016/0140-6736(90)91158-7

Cited by 57 publications

(24 citation statements)

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“…In the former, especially in young patients, recovery of liver function and full regeneration of liver cells of the native liver, as well as the eventual withdrawal of immunosuppression, can be expected (6). Auxiliary heterotopic liver transplantation for fulminant hepatitis has antedated APOLT (9,10). In comparison with auxiliary heterotopic liver transplantation, APOLT has some physiologic advantages, such as those relating to portal blood flow, abdominal tissue perfusion, and venous return to the heart.…”

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confidence: 99%

Sequential Observation of Liver Cell Regeneration after Massive Hepatic Necrosis in Auxiliary Partial Orthotopic Liver Transplantation

et al. 2000

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The morphogenesis of hepatocytes after massive hepatic necrosis to recovery through liver cell regeneration has not been fully understood. Sequential biopsies were performed on the native liver of a 22-year-old man who underwent auxiliary partial orthotopic liver transplantation 1 month after fulminant hepatitis. Auxiliary partial orthotopic liver transplantation was successful, and the biopsy samples permitted us to examine the regenerating process of hepatocytes after massive necrosis. At the time of auxiliary partial orthotopic liver transplantation (postoperative day 0), 95% of hepatocytes were lost and a few ductules were found in the portal areas. The ductules stained with cytokeratin 19. At postoperative day 7, the ductules began to increase in size and number and became dilated over a period of 1 month, when individual hepatocytes with clear cytoplasm appeared from the ductules. As the differentiation of hepatocytes increased, the expression of cytokeratin 19 was found to decrease. From 2 to 3 months, all of the ductules were transformed into hepatocytes, and they began to form round cell clusters. From 3 to 6 months, the round cell clusters became organized into trabecula with fibrosis. From 6 to 12 months, a lobular architecture was established, and by 14 months, the necrotic liver was fully recovered to normal. This study by examination of sequential biopsies demonstrates the progression of the regenerating process from total hepatic necrosis to complete recovery.

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confidence: 99%

Sequential Observation of Liver Cell Regeneration after Massive Hepatic Necrosis in Auxiliary Partial Orthotopic Liver Transplantation

et al. 2000

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“…[10][11][12][13][14][15][16] Although the experience with auxiliary heterotopic liver transplantation was satisfactory, it appears that auxiliary partial orthotopic liver transplantation (APOLT) had some advantages, including improved portal and systemic vein blood flow and abdominal tissue perfusion. 17,18 One also should note that although rather limited, experience with bioartificial liver systems also showed a regenerative potential of not only hepatocytes, but also of nonparenchymal cells, including the stellate cells. 19,20 The recent report published in Modern Pathology describes a 22-year-old patient who underwent APOLT for fulminant liver failure caused by hepatitis B virus infection.…”

Section: Commentsmentioning

confidence: 99%

Vitamin D receptor polymorphism and posttransplantation bone loss

Hay

2001

Liver Transplantation

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CommentsGenetic factors have an important role in bone metabolism. Epidemiological data, including twin studies, leave little doubt that bone mass and osteoporosis are predominantly influenced by genetic factors, with approximately 80% of the variance in bone density genetically determined. 1 The need for prevention of osteoporosis has logically led to an active search for its genetic predictors. The normal allelic variants of several genes are being investigated for their role in the regulation of bone mass. 2 With the importance of vitamin D in calcium homeostasis, the vitamin D receptor (VDR) gene is an obvious candidate gene, and its 3 common polymorphisms have been the most extensively investigated.Osteoporotic fracturing in the first year after liver transplantation is a major cause of morbidity, occurring in up to 40% of cholestatic patients. 3 It is caused by a combination of 2 effects. First, chronic liver disease may cause pretransplantation osteopenia, which is a major determinant for posttransplantation fracturing. The second skeletal insult is provided by the well-recognized phenomenon of accelerated bone loss in the first months after liver transplantation. The degree of pretransplantation osteopenia and early posttransplantation bone loss are both variable; their underlying causes are unknown, and predictors in the individual patient are poorly defined. The identification of genetic factors influencing hepatic osteopenia and bone loss after liver transplantation would provide clinically useful predictors for posttransplantation fracturing.The study of Guardiola et al investigates the influence of VDR genotypes on bone loss after liver transplantation. They showed that 16 men with the bb genotype (b allele is defined by the presence of the polymorphic Bsm1 restriction endonuclease site) lost less vertebral bone mass at 3 months after transplantation than 20 men with Bb or BB genotypes. This difference apparently persisted up to 24 months, although only 18 patients were followed up to this time. Although these results are very interesting, I believe they have to be assessed with caution. Patient numbers are small, and no fracture data are given. The patients are all men with predominantly viral or alcoholic disease; immunosuppression was cyclosporine based, with initial quadruple therapy; and information is not available to assess the possible beneficial mechanism of the favorable genotype. Such results, even if confirmed by a larger study in this population, may not be applicable to the general posttransplantation population.The importance of the VDR gene in the regulation of bone mass in the general and postmenopausal population is still highly controversial and adds more caution to interpretation of this study. The results of studies with much larger numbers of healthy patients have been extremely variable, 3 with some studies showing a positive correlation between bone mass and VDR alleles [5][6][7][8] and some studies showing no correlation. 2,9-12 These major discrepancies remain u...

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“…As a result, HALT has been reintroduced as a valid option [16]. However, in cases of HALT for FHF or noncirrhotic metabolic liver disease, there have been several experimental [17,18] and clinical [19][20][21] reports of insufficient portal blood flow to the graft leading to graft atrophy. This may be due in part to the fact that the vascular resistance in the nonfibrotic native liver is often lower than that in the graft.…”

Section: Introductionmentioning

confidence: 99%

“…This may be due in part to the fact that the vascular resistance in the nonfibrotic native liver is often lower than that in the graft. The strategy recommended by the authors of these studies was banding of the portal vein to the native liver [18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Portal Blood Flow and Liver Regeneration in Auxiliary Partial Orthotopic Liver Transplantation in a Canine Model

et al. 1999

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Functional competition has been shown to lead to a detrimental outcome in auxiliary liver transplantation. We evaluated the interaction in auxiliary partial orthotopic liver transplantation between the native liver and the graft in terms of portal flow and regeneration. The need for diversion of the portal flow to the graft was also assessed. Reduced-size liver grafts were transplanted orthotopically after partial hepatectomy in beagles. There were two groups: the preserved group, where portal inflow to the native liver was preserved, and the ligated group, where it was interrupted. Portal flow was measured serially and liver regeneration was evaluated on postoperative day 5. Functional competition was not observed in the preserved group. On the other hand, ligation of the native liver portal vein had no obviously detrimental effects on the remnant native liver. This leads to the conclusion that the portal vein to the native liver can be safely ligated to prevent functional competition.

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Recovery of failing liver after auxiliary heterotopic transplantation

Cited by 57 publications

References 4 publications

Sequential Observation of Liver Cell Regeneration after Massive Hepatic Necrosis in Auxiliary Partial Orthotopic Liver Transplantation

Sequential Observation of Liver Cell Regeneration after Massive Hepatic Necrosis in Auxiliary Partial Orthotopic Liver Transplantation

Vitamin D receptor polymorphism and posttransplantation bone loss

Portal Blood Flow and Liver Regeneration in Auxiliary Partial Orthotopic Liver Transplantation in a Canine Model

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