Short- and Long-Term Outcomes After Living Donor Liver Transplantation

Elola-Olaso, A. Moreno; González, Enrique Moreno; Díaz, Juan Carlos Meneu; García, Ignacio; Segurola, Carmelo Loinaz; Usera, M. Abradelo de; Romero, Carlos Jiménez; Pérez-Saborido, B.; Suárez, Y. Fundora; Oliva, Martín

doi:10.1016/j.transproceed.2005.10.080

Cited by 6 publications

(5 citation statements)

References 12 publications

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“…O presente estudo abordou doentes submetidos ao transplante com doador vivo e seus resultados foram semelhantes aos de outras séries ocidentais com doador vivo ou falecido 5,11,12,[16][17][18] . Nesta série, a etiologia mais frequente da doença hepática, que levou o doente ao transplante, foi a hepatite C e houve predomínio do sexo masculino, o que também foi observado por outros autores 5,6 .…”

Section: Discussionunclassified

“…Para a contínua melhora dos resultados, é importante buscar-se estabelecer critérios capazes de predizer o sucesso do procedimento, visto que o transplante intervivos é operação altamente complexa e envolve outro ser humano saudável (doador), que só deve ser submetido à doação caso as oportunidades de sucesso sejam expressivas 13,16 . O aumento da sobrevivência e a melhora dos resultados com doadores vivos foram obtidos quando foram usados critérios rigorosos de seleção para doadores e receptores 16,18,21 .…”

Section: Discussionunclassified

“…A atual política de alocação de órgãos em transplante de fígado é dar prioridade aos doentes mais graves, principalmente usando o modelo para a fase final da doença de fígado (MELD) para a devida pontuação [16][17][18][19] . No entanto, outros fatores, como o sódio sérico, podem ser de valor na predição de mortalidade precoce [20][21][22] .…”

Section: Introductionunclassified

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A hiponatremia como fator preditivo da perda precoce do transplante hepático na modalidade intervivos

Abdalla

Alves

Fonseca

et al. 2012

Arq. Bras. Ciên. Saúde

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Introdução: O transplante hepático intervivos representa alternativa para reduzir a falta de doação de órgãos. Objetivo: Analisar a influência da natremia como fator preditivo da perda precoce do transplante hepático nos três primeiros meses na modalidade intervivos. Método: Estudo retrospectivo, observacional e analítico de 78 doentes adultos submetidos ao transplante de fígado com doador vivo. A média etária foi 50,7±6,8 anos (18 a 65 anos) e dividiu-se os doentes transplantados em grupo I, com 62 (79,5%) pacientes com sobrevivência do enxerto superior a três meses, e grupo II com 16 (20,5%), que faleceram e/ou apresentaram falha do enxerto no prazo de até três meses após a realização do transplante hepático. Foram analisadas as seguintes variáveis: sexo, idade, etiologia da doença hepática e o nível sérico de sódio no momento do transplante. Foi considerada “perda precoce” a sobrevivência do enxerto hepático menor que três meses após a realização do transplante. Na avaliação dos fatores de risco para perda precoce do enxerto hepático foram utilizados o teste do χ2, o teste t de Student e a análise uni e multivariada. A análise de sobrevivência do enxerto foi realizada pelo modelo de Kaplan-Meier. Resultados: Sexo (p=0,4) e idade (p=0,67) não apresentaram diferença significante. O nível sérico de sódio foi significantemente (p=0,01) maior no grupo I do que no grupo II. Conclusão: Os valores da natremia estão associados à maior probabilidade de sucesso no transplante hepático na modalidade intervivos.

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Section: Discussionunclassified

Section: Introductionunclassified

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A hiponatremia como fator preditivo da perda precoce do transplante hepático na modalidade intervivos

Abdalla

Alves

Fonseca

et al. 2012

Arq. Bras. Ciên. Saúde

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“…There are examples, some controversial, in which proactive efforts to increase organ donation has met with success (11). Living liver donation continues to be evaluated and perfected as an option (21,22). There is limited experience with this procedure in patients with HIV infection (23).…”

Section: Discussionmentioning

confidence: 99%

Barriers Preventing Liver Transplantation in Canadians with HIV Infection – Perceptions of HIV Specialists

Cooper

DeForest²,

Gill³

et al. 2007

Canadian Journal of Gastroenterology

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Liver transplantation is a life-saving procedure with demonstrated utility. There are accumulating data indicating that this procedure is helpful in HIV-infected patients as well. Liver transplantation is currently largely unavailable to those living with HIV in Canada. Understanding the obstacles to this procedure is the first step to increasing access. Between August 2005 and November 2005, HIV physicians, one from each Canadian HIV Trials Network site, were asked to complete a quantitative questionnaire on adult liver transplant access and need. Forty-six per cent (16 of 35) of sites responded. A median 20% of the nearly 12,700 HIV patients followed at these sites had concurrent liver disease (20% caused by hepatitis C virus, 5% caused by hepatitis B virus and 5% were alcohol-related). On average, two patients per site were thought to be appropriate candidates for liver transplant evaluation. Eighty per cent of respondents anticipated increased need for liver transplantation over the next five years. Organ supply was universally identified as the chief obstacle to transplantation in patients with HIV. Other key issues included risk of hepatitis C virus reinfection and transplant surgical team willingness. Based on these data, it is believed that these issues should be the focus of efforts designed to increase access to transplantation in Canadians with end-stage liver disease and concurrent HIV.

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“…We must find a way to stimulate living donation. Indeed, the evaluation process itself results in the loss of many a donor (19), primarily because of inadequate volumetry (20) and ABO mismatch (21), and only 9-17% of candidates are eventually accepted (22,23). Hence, an attempt to minimize consequences (physical, psychological, financial) in transplant donors becomes essential.…”

mentioning

confidence: 99%

Liver transplantation from living donor as a sign of social intelligence

Meneu-Diaz

Elola-Olaso

2011

Rev. esp. enferm. dig.

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From a wide perspective, the general opinion held by the "international transplant community" is that living donor liver transplantation (LDLT) is justified since patients on liver transplantation (LT) waiting lists continue to die (1). Data from the Spanish Registry are telling on-list mortality has leveled out at 8% (it is up to 20% in some centers) whereas the odds of having a transplant (year 2008) never went beyond 50%. LDLT-as well as split (2,3), non-heart-beating donation (4), marginal organs, or domino transplants-represents an option for increasing the donors pool. As our country is a world leader in cadaver donation rates, LDLT has been (and still is) reasonably questioned with arguments for (5) and against (6). This is a simple supply and demand issue that forces complex decisions regarding ethics, equity, and justice. The paper published here by the Murcia University team (Martínez-Alarcón et al.) helps elucidate this controversy (7). Until January 2010, around 246 living-donor transplants had been performed in Spain (53% for adult recipients), with figures becoming more stable on a yearly basis, and representing 1-1.5% of the yearly total (8). When interannual percent growth rates for different organs were compared kidney transplants show a slight increase while the opposite is true for LDLT (9). The reported mortality of living liver donors is 0.15% (0.20% when causes potentially related to living donation are included) (6). To this day no donor deaths have occurred in Spain (5,6), and reoperation rates after donation are estimated around 10%. Survival rates for LDLT, according to data from the European Transplant Registry (10), are better for both patients (85% at 1 year and 76% at five years vs. 82 and 71%, respectively, for cadaver donation) and grafts (80% at 1 year and 70% at five years vs. 78 and 64%, respectively, for cadaver donation). The A2ALL study (11,12) described a higher incidence of grade-4 complications in living donor transplant recipients (16 vs. 9%); this percentage significantly decreases as team experience increases (> 20 transplants/year). Surveys of living donors confirm that only 3.7% are pressured into donation; reasons for donation include saving the recipient's life for 60%, and personal satisfaction for 35% (13). Martínez-Alarcón et al. confirm that, should relatives be properly informed and hence considered living donation favorably, only 44% of recipients would rather stay indefinitely on their waiting list than choose a living donor transplant. Why then are we witnessing a sustained yearly decrease in absolute numbers? Living donation is a singular, complex option to gain access to an organ for transplantation. Some factors condition living donation for the adult (organ scarcity, recipient benefits, donor risks, emotional stress, altruism, autonomy, MELD, etc.). Various (regional) lists exist, and wait times vary from one region to the next. As a consequence, on-list mortality and the odds for transplantation differ between Liver transplantation from living donor as ...

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Short- and Long-Term Outcomes After Living Donor Liver Transplantation

Cited by 6 publications

References 12 publications

A hiponatremia como fator preditivo da perda precoce do transplante hepático na modalidade intervivos

A hiponatremia como fator preditivo da perda precoce do transplante hepático na modalidade intervivos

Barriers Preventing Liver Transplantation in Canadians with HIV Infection – Perceptions of HIV Specialists

Liver transplantation from living donor as a sign of social intelligence

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