37 research outputs found
Total hepatectomy and liver replacement (orthotopic liver transplantation) for primary hepatic malignancy
There has been a high incidence of tumor recurrence after liver transplantation for primary hepatic malignancy. Nevertheless, a small but significant palliation has been possible with this approach, even in patients who eventually died of recurrence. Two patients with incidental malignancies in their excised livers apparently have been cured. Further gains will be possible only with extremely discriminating selection of prospective recipients. © 1982 Société Internationale de Chirurgie
Liver and intestine transplantation
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73604/1/j.1600-6135.2004.00400.x.pd
Model for end-stage liver disease (MELD) exception guidelines: Results and recommendations from the MELD exception study group and conference (MESSAGE) for the approval of patients who need liver transplantation with diseases not considered by the standard MELD formula
No abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/55914/1/20979_ftp.pd
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Outcomes of immunosuppression minimization and withdrawal early after liver transplantation
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149209/1/ajt15205.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149209/2/ajt15205_am.pd
Design and implementation of the international genetics and translational research in transplantation network
The Role of mTOR Inhibitors in Liver Transplantation: Reviewing the Evidence
Despite the success of liver transplantation, long-term complications remain, including de novo malignancies, metabolic syndrome, and the recurrence of hepatitis C virus (HCV) and hepatocellular carcinoma (HCC). The current mainstay of treatment, calcineurin inhibitors (CNIs), can also worsen posttransplant renal dysfunction, neurotoxicity, and diabetes. Clearly there is a need for better immunosuppressive agents that maintain similar rates of efficacy and renal function whilst minimizing adverse effects. The mammalian target of rapamycin (mTOR) inhibitors with a mechanism of action that is different from other immunosuppressive agents has the potential to address some of these issues. In this review we surveyed the literature for reports of the use of mTOR inhibitors in adult liver transplantation with respect to renal function, efficacy, safety, neurological symptoms, de novo tumors, and the recurrence of HCC and HCV. The results of our review indicate that mTOR inhibitors are associated with efficacy comparable to CNIs while having benefits on renal function in liver transplantation. We also consider newer dosing schedules that may limit side effects. Finally, we discuss evidence that mTOR inhibitors may have benefits in the oncology setting and in relation to HCV-related allograft fibrosis, metabolic syndrome, and neurotoxicity
Transplant Surgery Fellow Perceptions About Training and the Ensuing Job Market—Are the Right Number of Surgeons Being Trained?
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90327/1/j.1600-6143.2010.03308.x.pd
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Impact of tacrolimus versus cyclosporine in hepatitis C virus-infected liver transplant recipients on recurrent hepatitis: a prospective, randomized trial
Hepatitis C virus (HCV)-induced cirrhosis is the commonest indication for orthotopic liver transplantation, but HCV recurrence is nearly universal and may worsen patient / graft outcomes. The frequency and severity of HCV recurrence has apparently increased in recent years, raising concern about a possible role for newer immunosuppression regimens in this increase, including potentially tacrolimus. We randomized 79 patients to receive tacrolimus or cyclosporine as primary immunosuppressant posttransplantation. A pathologist blinded to treatment reviewed serial liver biopsies. Month 12 cumulative probabilities of histological hepatitis C recurrence for tacrolimus- and cyclosporine-treated patients were .38 and .54 (P = .19) and failure / death were .25 and .28, respectively (P = .789). Although cyclosporine-treated patients had significantly larger increases in median serum HCV RNA levels (months 1, 6, and 12), no significant differences were observed between the two treatment arms in histologically-diagnosed HCV recurrence / survival rates. In conclusion, choice of calcineurin inhibitors does not impact severity of recurrent HCV