Current Status Of Liver Transplantation Research Articles

Review article: current status of liver transplantation in HIV‐infected patients

The increases in survival of patients infected with human immunodeficiency virus is attributed to the introduction of combination human immunodeficiency virus antiviral therapy, better known as highly active anti-retroviral therapy. In fact, survival statistics have improved such that individuals often succumb to other disease entities, notably liver failure and not from acquired immunodeficiency syndrome complications. Liver transplantation has been introduction in this patient population in several centres around the world. This review will discuss the current clinical status of liver transplantation in individuals suffering from human immunodeficiency virus infection.

Liver transplantation in Latin America: Current status

The current status of liver transplantation in Latin America is reviewed. For an estimated population of 470 million people, approximately 1100 liver transplantations were performed in 2002, namely, 2.3 liver transplantations per million people per year (pmp). The top transplantation rates were in Argentina 4.5, Brazil 3.9, and Chile 3.6 pmp. In 2001, liver transplantations were not performed in 2 of 10 South American countries nor were liver transplantations performed in 5 of 6 Central American countries. In the Latin American countries performing this procedure, living donor liver transplantation has been performed to palliate the organ shortage for pediatric patients in most of these countries. However, only 3 countries have used the procedure for adult liver transplantation. The lack of adequate financial coverage, education, and organization are the main limiting factors to the development of liver transplantation in Latin America.

Current status of liver transplantation.

Liver transplantation is accepted therapy for acute or chronic liver failure. Survival after LT has improved significantly in developed countries and this has increased the awareness of this treatment modality in the developing world. Successful LT in both children and adults have now been reported from India. Chronic liver failure secondary to cholestatic liver disease in the most frequent indication for LT, with biliary with atresia as the single commonest cause. Innovative techniques such as reduced size, splint, and living donor liver transplantation are being applied more often to decrease long waiting times and reduce associated morbidity and mortality. Early postoperative complications include primary graft failure, venous thrombosis, rejection, biliary complications and infections. Late complication includes CMV or EBV infections, side effects of immunosuppression, post transplantation lymphoproliferative disease and late biliary strictures. Most children achieve good quality of life. There are still many lessons to learn and there are future challenges such as the ever increasing problems of donor scarcity and the search for potent but less toxic immunosuppressive agents.

Current Status of Liver Transplantation — an Asian Perspective

Professor Tan Sri GB Ong, chair of the Department of Surgery, The University of Hong Kong between 1962 and 1983, innovated many operations for the treatment of head and neck cancer, oesophageal cancer, liver cancer and urinary bladder cancer during his tenure. He has moulded the department into one of the best surgical units in the world. Following his footsteps in pursuance of liver surgery, liver transplantation is now a routine treatment at the University of Hong Kong Medical Centre, Queen Mary Hospital for patients with terminal liver diseases. With the improvement and refinement of surgical techniques, it is believed that an even larger number of patients will benefit.

Current status of liver transplantation for hepatocellular cancer

The incidence of hepatocellular cancer is increasing in the United States and is one of the most common cancers worldwide. Traditionally, the gold standard treatment for hepatocellular cancer has been surgical resection, but most patients were not suitable candidates due to advanced disease. Other treatments include locally ablative techniques (cryosurgery, radiofrequency ablation and various injection therapies), chemotherapeutic options and rarely, radiation therapies. In the 1980s, liver transplant emerged as the treatment of choice for end-stage liver disease and also became an option for patients with hepatocellular cancer. When comparing liver transplant with resection in retrospective studies, liver transplant patients had better survival and reduced recurrence. However, not all patients with hepatocellular cancer will be candidates for liver transplant. Size, stage, and histological grade of tumor all affect prognosis after transplant. Use of chemotherapeutic treatments and locally ablative techniques may be beneficial prior to liver transplant, but larger controlled studies are needed. Liver transplant is the most effective treatment for hepatocellular cancer in the subgroup of smaller tumors, but ultimately we are limited by the number of available donors. Future goals in this area include increasing the donor pool and determining optimal management to allow patients to wait for an appropriate donor.

Current Status of Liver Transplantation

Liver transplantation is widely accepted as an effective therapeutic modality for a variety of irreversible acute and chronic liver diseases for which no satisfactory therapy is available. Following the first unsuccessful efforts at human liver transplantation in 1963, development of the procedure evolved at first slowly and steadily for 20 years and then rapidly over the past two decades. The growth of liver transplantation was facilitated by the conclusion of the national institutes of health consensus development conference in 1983 that liver transplantation is not an experimental procedure but an effective therapy that deserves broader application. The number of liver transplantations increased 2.4-fold(from 1.713 to 4.058) from 1988 to 1996. but the number of patients on the UNOS(united network of organ sharing) liver list increased 12.1-fold(from 616 to 7,467); as would be expected, the number of deaths of listed patients increased 4.9-fold(from 195 to 954), The current supply of donor livers is insufficient to meet this need, and organ donation has been stagnant or increased by only a few percent in recent years. These facts underscore the importance of the appropriate selection of candidates for liver transplantation and the development of operative procedures, such as living donor liver transplant, split liver transplant and auxiliary partial liver transplant.

Liver transplantation and alcoholics: is the glass half full or half empty?

See article on page 421 Over the past 15 years, opinion regarding the suitability of alcoholic patients for liver transplantation has fluctuated from overt disapproval to optimism that liver transplantation...

Liver transplantation in virus-induced chronic liver disease

The current status of liver transplantation (OLTx) for chronic viral hepatitis is reviewed. The major issues addressed include the rate of recurrence of disease, its severity and natural history, and the potential for therapy. These issues vary markedly for each type of viral hepatitis. The development of new antiviral agents for clinical use may change the current restriction on liver transplantation for hepatitis B virus (HBV)-related liver disease such that it begins to challenge hepatitis C virus (HCV) as the principal indication for OLTx world-wide.

Current status of liver transplantation (LT) in France and specificities of French ethical attitudes concerning LT

The authors report first on the current status of liver transplantation in France and underline its exponential development. The main indications for this procedure are outlined for adults as well as for children. The modalities of distribution of livers harvested by strictly controlled university teams are also briefly described. The specificities of French ethical attitudes towards liver transplantation are discussed. They concern the donor, the recipient and the society. Legal dispositions stipulating the presumed consent of the donor and accrediting the notion of "cerebral death" have eased the development of liver transplantation in France. Despite these measures shortage in liver available for grafts results in still too large waiting list and fosters nation-wide campaign to encourage organ donation. There is, in France, a strong consensus for a strict sticking to the absolute principles of gratuity of organ donation and non-marketing of excised organs available for graft. As stated recently by Thomas Starzl, liver transplantation has become the second most commonly performed solid organ transplant after kidney transplant. In the latin Europe, the idea of organ transplantation is in the mind of people for a long time as illustrated from paintings or carvings that can still be seen in several roman catholic churches of the Middle Age. Although, liver transplantation in man developed only after the pioneer work of Thomas Starzl in Pittsburg, it is fair to recall that Alexis Carrel (1908, Noble Prize), from France, opened the way to organ transplantation by performing in animals the first vascular sutures and organ auto- or homografts.(ABSTRACT TRUNCATED AT 250 WORDS)

Current status of liver transplantation.

Liver transplantation has become a practical therapeutic option for thousands of children and adults with irreversible liver damage. Development of a highly effective immunosuppressive agent, cyclosporine, and improvements in surgical technique and postoperative care have so reduced morbidity and mortality that 85% of adults who survive the surgery are able to resume normal activity.

HEPATIC TRANSPLANTATION: THE STATE OF PLAY

The author presents a brief review of the current status of liver transplantation in the management of liver disease and of clinical indications for the procedure. She advocates greater support for the treatment in the United Kingdom.

The Current Status of Liver Transplantation

More than thirty patients have now undergone liver transplantation in Denver, some more than once, and survivals of up to two and a half years have been achieved. Through this and other experience it has been learned that graft viability is more critical than histocompatibility matching but that the most important factor in the ultimate outcome is prevention of rejection through vigorous immunosuppressive therapy.