Current Concepts in Curative Surgery for Cystic Echinococcosis of Liver

Cystic echinococcosis (CE) may cause unspecific symptoms like abdominal discomfort in the right upper quadrant of the abdomen due to capsule tension pain of the liver related to an increased expansion of the cyst. Further, a growing cyst may put pressure on intrahepatic bile ducts or can get direct access to the biliary system with complications like obstruction, cholangitis and fistulas. Large or rapid growing cysts may cause compression of blood vessels with thrombosis or Budd-Chiari syndrome. However, the vast majority of patients with CE of the liver is asymptomatic. CE of the liver can be cured surgically in many cases. In the past, cystectomy with resection of the pericyst components was performed as a standard. The today’s parenchymal sparing state-of-the-art surgery is endocystectomy combined with partial cystectomy. This procedure includes (i) evacuation of paracyte-derived cyst content, (ii) sterilization of the cyst wall (host) and (iii) deroofing of the cyst (partial cystectomy). Here the advantages, risks and outcomes of the surgical approaches are discussed, and the need for an interdisciplinary treatment of these patients is outlined

Criteria for and Appropriateness of Renal Transplantation in Elderly Patients With End-Stage Renal Disease : A Literature Review and Position Statement on Behalf of the European Renal Association-European Dialysis and Transplant Association Descartes Working Group and European Renal Best Practice

During the last 20 years, waiting lists for renal transplantation (RT) have grown significantly older. However, elderly patients (ie ≥65 years of age) are still more rarely referred or accepted to waiting lists and, if enlisted, have less chances of actually receiving a kidney allograft, than younger counterparts. In this review, we looked at evidence for the benefits and risks of RT in the elderly trying to answer the following questions: Should RT be advocated for elderly patients? What should be the criteria to accept elderly patients on the waiting list for RT? What strategies might be used to increase the rate of RT in waitlisted elderly candidates? For selected elderly patients, RT was shown to be superior to dialysis in terms of patient survival. Virtually all guidelines recommend that patients should not be deemed ineligible for RT based on age alone, although a short life expectancy generally might preclude RT. Concerning the assessment of comorbidities in the elderly, special attention should be paid to cardiac evaluation and screening for malignancy. Comorbidity scores and frailty assessment scales might help the decision making on eligibility. Psychosocial issues should also be evaluated. To overcome the scarcity of organ donors, elderly RT candidates should be encouraged to consider expanded criteria donors and living donors, as alternatives to deceased standard criteria donors. It has been demonstrated that expanded criteria donor RT in patients 60 years or older is associated with higher survival rates than remaining on dialysis, whereas living donor RT is superior to all other options.Peer reviewe

Solid‐Organ Transplantation in Older Adults: Current Status and Future Research

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93680/1/j.1600-6143.2012.04245.x.pd

Implementation of a mobile application for outpatient care after liver transplantation

Background In the face of the Covid-19 pandemic and the need for social distancing new therapeutic tools like mobile health applications might gain in importance for outpatient care. Objective of the present study was to assess if and to what extent the implementation of a free available transplant application in a cohort of liver transplant recipients was possible. Methods Patients of the aftercare program at the Department of Transplant Surgery Graz in June 2016 were first asked to complete a survey concerning knowledge about mobile health and their management of everyday life. After using the application for 2 months a second survey evaluated whether the implementation of the application in the daily routine was achievable. Results Among 135 patients, 124 (91.9%) agreed to participate. Seventy-one (57.3%) owned a mobile device with which they could use the application, 42 patients (33.8%) decided to try it out for 2 months. The majority stated that the application supported them for therapy management and surveillance of vital parameters. Successful implementation of the application has been reached in 57.1% of patients after 2 months testing period. Conclusion The technical prerequisites are only partially met and should be improved. Older patients need extensive support and motivation