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  • 1
    ISSN: 1432-2277
    Keywords: Liver transplantation ; Aspiration cytology ; Rejection ; Fine needle aspiration ; Total corrected increment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The role of aspiration cytology (AC) and the total corrected increment (TCI) in the diagnosis of hepatic rejection was assessed in 30 patients following 36 liver transplants. A total of 174 AC specimens were “blindly” evaluated. Patients underwent protocol AC twice weekly and when biochemical or clinical parameters suggested rejection. Hepatic rejection was only confirmed when clinical and biochemical changes were accompanied by positive histological diagnosis. In all, 103 specimens were matched against histology, the remainder assessed against retrospective clinical and biochemical diagnoses. There were 80 cytological diagnoses of rejection, confirmed in 69 specimens, and 94 diagnoses of no rejection, confirmed in 73 specimens. These figures give a sensitivity of 76.7%, a specificity of 86.9% and a positive predictive value of 86.3%. Overall, 39.7% of specimens taken more than 2 months after grafting proved to be incorrectly diagnosed. However, the accuracy was higher in 145 specimens taken within 8 weeks of transplantation, with a sensitivity of 81.3%, a specificity of 90%, a positive predictive value of 89.7% and an accuracy of 85.5%. Although histology remains the gold standard in the diagnosis of acute rejection after hepatic grafting, AC using a TCI with a positive predictive value of 86.3% may prove to be of value in monitoring liver transplant patients in the first 2 months after grafting.
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  • 2
    ISSN: 1432-2277
    Keywords: Liver transplantation, pediatric, biliary complications ; Biliary complications, liver transplantation, pediatric ; Pediatric liver transplantation, biliary complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Between 1983 and 1992, 112 children underwent liver transplantation. Of 138 grafts, 60 (43.4%) were whole livers, 77 (55.6%) were reduced livers, and 1 (0.7%) was a split liver. Biliary complications (BC) were defined as any abnormality, even minor, related to the biliary tract. Results were analysed with a minimum follow-up of 9 months. Some 36 grafts (26.1%) in 34 patients (30.4%) presented with BC: bile leaks (17 grafts), biliary obstructions or dilatations (16 grafts), and other complications (3 grafts). Management was mainly surgical with biliary reconstruction via a Roux-en-Y loop. Interventional radiology had an increasing role in recent years. BC were associated with a mortality of 1.8% (2/112), a graft loss rate of 4.3% (6/138), and significant morbidity. Among the various factors whose association with BC was studied, the date of transplantation, the use of reduced grafts and the use of gallbladder conduits appeared to be the main determining factors for BC. From multivariate analysis the use of reduced grafts emerged as the most important factor in reducing BC. We therefore conclude that BC are associated with significant morbidity, but general improvements in both surgical and medical management seem to account for better results in recent years.
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Transplant international 5 (1992), S. 125-128 
    ISSN: 1432-2277
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Conclusion Although liver transplantation still cannot be considered as a routine therapy, the initial phase of development has now been reached and results are encouraging. The benefits to the patient from the liver transplant “revolution” are clear, since it represents the only therapeutic option for patients with advanced liver disease. In return, it has brought unexpected problems to the fore. A vast increase in potential candidates is now confronting the transplant teams, bringing the problem of organ shortage and with it the need to clarify selection and timing in order to avoid potential organ wastage in “hopeless” cases. Since more than three-quarters of transplant patients will make a complete medical recovery, the long-term effects of immunosuppression and quality of life become all-important. Our goal now must be effective utilisation of all potential livers and further improvement of results in critical groups of candidates.
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  • 4
    ISSN: 1432-2277
    Keywords: Key words Tacrolimus ; liver transplantation ; dual versus triple therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To evaluate the efficacy and safety of oral tacrolimus-based immunosuppressive induction therapy, 130 primary orthotopic liver transplant (OLT) recipients were randomised to treatment in an open, parallel-group, European multicentre trial. Following OLT, patients were immediately administered either tacrolimus (0.10 mg/kg) and prednisolone (dual therapy group) or tacrolimus (0.06 mg/kg) in conjunction with prednisolone and azathioprine (triple therapy group) both orally. Patient survival at 1 year was 79.4 % for the dual therapy group and 88.7 % for the triple therapy group (P = 0.194); 1-year graft survival rates were 76.5 % in the dual therapy group and 80.6 % in the group receiving triple therapy (P = 0.615). The frequencies of rejection (dual therapy 42.6 %, triple therapy 50.0 %; P = 0.482), infection, and other complications (renal, neurological and glucose metabolic disorders) were similar in both groups. Tacrolimus whole blood trough concentrations were detectable on days 1 and 2, respectively, in the dual and triple therapy treatment groups whilst median tacrolimus blood concentrations in the triple therapy group reached levels similar to those in the dual therapy group on postoperative day 11 following a steady increase in dose. After 1 year, 54.4 % of the patients randomised to dual therapy were receiving tacrolimus monotherapy and only 56.4 % of the patients randomised to triple therapy continued to receive azathioprine. In conclusion, oral tacrolimus-based immunosuppression is both potent and safe when administered as induction therapy after OLT. Treatment may commence at either 0.06 or 0.10 mg/kg per day, but doses may need to be increased to the latter value within the first 10 days to maintain effective immunosuppression.
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  • 5
    ISSN: 1432-2277
    Keywords: Aorta transplantation ; rat ; Heart-aorta transplantation, rat ; Rat, heart-aorta transplantation ; Rejection, heart-aorta ; transplantation ; rat
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The purpose of this study was to develop a microsurgical cluster model of heart plus entire thoracic aorta transplantation and to compare it to the isolated model of heart transplantation as a tool to study transplant rejection. Thirty-six syngeneic (DAxDA and LewxLew) and allogeneic (DAxPVG and DAxLew) cluster heart-aorta transplants were compared to 43 syngeneic and allogeneic isolated heart grafts. Graft survival, recipient survival and histological data on myocardial and aortic tissues were assessed. There was no statistically significant difference in graft survival between the two models studied (P〉0.05). In the cluster transplants, the aortic component was spared the severity of acute rejection noted for the myocardial counterpart. In conclusion, the results demonstrated that the cluster model was technically feasible and highly reproducible. Additionally, it was possible to apply this model to the study of experimental allograft rejection using novel immunosuppressants. The success of the cluster model in strongly mismatched transplant strain combinations underscores its potential for application in slower rejection combinations, making it particularly suited for chronic rejection studies. The inherent capacity for sampling a broader range of vessel sizes in one animal makes the cluster model more suitable than the isolated models of aorta or heart for application to experimental protocols.
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  • 6
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Disturbances in blood coagulation profiles combined with intraoperative technical problems may lead to hemorrhage and significant blood loss. During the postoperative period hematologic changes may result from the use of immunosuppressive drugs, so careful monitoring and review are essential parts of management. The two major aspects of hematologic change are reviewed.
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  • 7
    ISSN: 1573-904X
    Keywords: lidocaine ; conformations ; infrared (IR) ; nuclear magnetic resonance (NMR) ; hydrogen bonding ; partition coefficients
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract IR and 1H NMR studies in CDCl3 and CCl4 of a series of tertiary aminoxylidides with the amino group in the 2 to 6 position of the acyl chain are described. Lidocaine, diethylaminoaceto-2′,6′-xylidide, forms an intramolecular five-membered ring hydrogen-bonded monomer at all concentrations in both solvents. β-Diethyl-amino-propiono-2′,6′-xylidide forms an intramolecular six-membered ring hydrogen-bonded monomer in CDCl3 and CCl4 but a trans intermolecularly associated species is the major form present at high concentrations in CCl4. The longer-chain homologues are mixtures of nonassociated trans and cis monomers at low concentrations but associated trans forms predominate at high concentrations. Evidence for the presence of a hydrogen-bonded seven-membered ring intramolecular monomer in CDCl3 for γ-diethylaminobutyro-2′,6′-xylidide is presented. The relationship between the molecular conformation and the partition coefficient is discussed.
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  • 8
    ISSN: 1573-2568
    Keywords: GRAFT ; STEATOSIS ; ENERGY METABOLISM ; LIVER TRANSPLANTATION
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The present study was designed to assess energymetabolism of steatotic grafts and to determine itsrelation to early graft viability. Graft biopsies weretaken, and the triglyceride content was determined in 29 grafts for the assessment of steatosis.The peak aspartate aminotransferase level and theconcentrations of lactate and pyruvate were stronglycorrelated with the triglyceride content, suggesting that steatotic grafts are more vulnerable topreservation or reperfusion injury and that glucoseoxidation is inhibited postoperatively in the steatoticgrafts. Ketogenesis, an alternative pathway to produce energy substrates, was not accelerated evenwhen the steatotic grafts produced more free carnitineto enhance the beta-oxidation of fatty acids. Thedeterioration of energy metabolism was associated with the increase in prothrombin time ratio,hepatocyte growth factor, and hyaluronic acid thatreflected graft viability. Deterioration ofpostperfusion energy metabolism in the steatotic graftsmay be involved in the development of irreversible graftdamage.
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  • 9
    ISSN: 1436-0691
    Keywords: Key words: hepatocellular carcinoma ; liver resection ; liver transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract: Surgery remains the treatment of choice for hepatocellular carcinoma (HCC). For HCC without underlying cirrhosis resection remains the mainstay treatment option. Prognosis depends on the stage of the tumor. Survival appears to be better for small (less than 5 cm) solitary tumors with negative resection margins and absence of vascular invasion. At present, liver transplantation does not have an established role in the treatment of HCC in a non-cirrhotic liver. Because of the high recurrence rate, it should not be considered for more advanced disease which is not amenable to resection. The surgical approach in cirrhotics depends not only on the stage of the tumor but also on the liver functional reserve. Tumor size, presence of multifocal disease, and vascular invasion determine the risk of HCC recurrence after resection, and the functional stability of the liver determines both resectability and outcome. In societies in which transplantation is not available, small tumors will be treated with liver resection. The outcome in patients with well preserved liver function is relatively good, at least in the medium term. However, recurrent tumor and progressive hepatic decompensation have significant adverse effects on long-term survival. Poor functional reserve may be associated with significant perioperative mortality and lower survival due to progressive liver failure. In our opinion, for small cirrhosis-related HCCs, liver transplantation offers better long-term prospects than resection. Therefore, if liver transplantation is available as an option it should be considered as the treatment of choice, particularly for younger patients with otherwise good life expectancy.
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