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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hepatorenal syndrome (HRS) is a severe complication of liver failure with high mortality. The pathogenesis of this reversible functional renal failure is not yet clearly understood. Diagnosis is based upon the association of clinical and biological criteria. A patient was admitted to our institution for severe liver failure secondary to an exacerbation of cirrhosis, where he developed a fulminant hepatorenal syndrome. Both, the renal and hepatic failure were successfully treated by orthotopic liver transplantation. Special attention was paid to the immunosuppressive treatment with Cyclosporine whose use, we believe, should be delayed until function has partially recovered.
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PMID:Combined treatment of liver failure and hepatorenal syndrome with orthotopic liver transplantation. 146 47

Cyclosporine appears to have abrogated age as a contraindication to kidney transplantation in the elderly, although it is unclear whether this is true for other types of solid organ transplantation. We performed a retrospective analysis of liver transplant recipients who were 60 years of age and older (n = 23) versus recipients of primary transplants who were 18 to 59 years of age (n = 84). Indications in recipients over 60 included alcoholism (6), postnecrotic cirrhosis (6), cancer (4), primary biliary cirrhosis (3), sclerosing cholangitis (2), and one patient with polycystic liver disease. There were no important differences in the initial transplant hospitalization or the incidence of infection and rejection between the two groups. No patient in the over-60 population required retransplantation. Actuarial patient survival is 83% at 2 years for recipients 60 years of age and above compared to 76% patient survival in adult recipients who are under the age of 60. Liver transplant recipients over the age of 60 years have excellent patient and graft survival and the same postoperative morbidity as recipients who are under 60 years of age. Therefore, advanced age does not appear to be a contraindication to orthotopic liver transplantation.
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PMID:Orthotopic liver transplantation in patients 60 years of age and older. 199 39

Twenty three patients with primary biliary cirrhosis surviving for greater than 1 yr after liver transplantation were studied. All reported marked symptomatic improvement, and had significant falls in serum bilirubin, alkaline phosphatase (p less than 0.0001), immunoglobulin M, and antimitochondrial antibody levels (p less than 0.005). Beyond 1 yr, liver biopsies showed features compatible with disease recurrence in 9 of 10 patients, and a further 4 patients developed pruritus or associated abnormalities. Immunoglobulin M levels were raised in 80%, with elevated antimitochondrial antibody titers in all those tested. Cyclosporine treatment in some patients initially given prednisone and azathioprine was followed by regression of histologic abnormalities. Of 102 patients with nonprimary biliary cirrhosis followed similarly, 50 underwent biopsy, and although 12 showed features of bile duct damage, all had additional histologic and clinical changes supporting an alternative diagnosis. These findings are consistent with previous reports that primary biliary cirrhosis can recur after transplantation, possibly modified by the use of cyclosporine.
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PMID:Evidence for disease recurrence after liver transplantation for primary biliary cirrhosis. Clinical and histologic follow-up studies. 266 53

Patients who currently benefit the most from liver transplantation are those with end-stage, non-malignant liver disease. Primary biliary cirrhosis and cirrhosis from chronic active hepatitis (hepatitis B negative) have been the most common indications in our experience. Overall survival rates in excess of 70% at 1 year are now common and those patients who live the first year have a very good prospect of long-term survival. Complete rehabilitation occurs in about 80% of survivors. Patients on life support systems before transplantation and those awaiting urgent retransplantation have the highest mortality rates. Modern anesthetic and surgical techniques have made the operation much safer and more straightforward. Biliary tract complications remain common, especially in patients with a history of previous upper abdominal surgery. Cyclosporine has had a major impact, but in the context of its use in combination with other immunosuppressive agents (antilymphocyte globulin, steroids, azathioprine and OKT3).
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PMID:Liver transplantation: the University Hospital-Children's Hospital of Western Ontario experience. 315 93

At the University Hospital in London, Ont., 19 patients have received 24 liver transplants. The commonest indications for transplantation were primary biliary cirrhosis and cirrhosis from chronic active hepatitis. The first three patients in the series died of infectious complications. Eleven of the subsequent 16 recipients are alive from 5 months to 2 1/2 years after transplantation. Eight patients who are alive more than 1 year after the operation have an excellent quality of life. Cyclosporine and steroids in combination are used for immunosuppression. With current surgical techniques, modern immunosuppression and good patient selection, the restoration of patients with advanced irreversible liver disease to good health by liver transplantation is a realistic goal. Much effort and considerable resources are required to run a liver transplant program.
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PMID:Liver transplantation: the initial experience of a Canadian centre. 388 58

Liver transplantation has gained increasing interest. While liver grafting for tumor is successful over prolonged periods only in its early course, liver grafting for end-stage cirrhosis may lead to a long survival. Liver grafting in children is the most successful indication; in adults the results depend largely on timing and indication. Actual developments are mainly seen in the following points: a. Improvement in immunosuppression by use of Cyclosporin A. The resorption and metabolism of the drug, in relation to liver function, have to be carefully observed. b. The tendency to perform liver grafting electively instead of in emergency. c. Improvement in operative management, particularly the use of veno-venous bypass. d. The best possible anaesthesiological and intensive care management for the patients. It can be expected, that these developments will enable continuous improvement of results, particularly in an elective situation. One hundred and forty liver grafts have been done in our institution and the results are discussed herein. Progress in liver transplantation is marked by steadily growing numbers of liver grafts performed, and of centers performing grafts, as well as by improved success rates and the recommendation of the U.S. National Institutes of Health, based on discussions at a liver transplantation consent meeting, held in June 1983. This interest is also reflected in discussions among the medical and non-medical community. The first section of this paper will deal with the present state and results of liver grafting particularly, at our own institution and some actual developments in this field will be discussed.
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PMID:Developments in liver transplantation. 391 95

Partial liver transplantation (PLTR) was studied experimentally, using 60 monkeys (20 recipients, 20 donors, 20 blood donors). The left lobe of the donors was transplanted orthotopically, using a veno-venous bypass catheter that was inserted in the portal vein and the other side passed through the hepatic portion of the inferior vena cava. The donor survival rate at 1 week was 70%. Seven recipients survived for more than 58 hours (58, 60, 64, 68, 72, 110, and 252 hours), and 13 died within 48 hours of surgery because of postoperative complications. Clinical living related liver transplantation (LRLT) was performed between June 1990 and March 1992 on six patients with biliary atresia and on one with liver cirrhosis and hepatocellular carcinoma. In all, the father's left lobe was transplanted orthotopically. Cyclosporine, azathioprine, and methyl prednisolone were administered. In addition, FK-506 was given to two patients in whom rejection was observed; one died 37 days after surgery because of acute rejection followed by systemic cytomegalovirus infection. The other six patients have survived for 8 to 29 months since transplantation. All six have been discharged from the hospital and are enjoying normal daily life. The postoperative course of all donors was uneventful. They were discharged 2 weeks after the operation and returned to their jobs in 2 months. The authors conclude that PLTR from a living donor is a promising therapeutic alternative to liver transplantation from a cadaver.
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PMID:Partial liver transplantation from a living donor: experimental research and clinical experience. 801 6

Among 283 orthotopic liver transplantations made during the last 6 years at our institution, 22 (7.77%) were done on 19 patients with unresectable hepatic malignant tumors [hepatocellular carcinoma (17), angiosarcoma (1), and cholangiocarcinoma (1)]. None of them showed extrahepatic invasion, and only one had lymph node involvement. Cyclosporin A, corticosteroids, and azathioprine were administered for 3 months after the procedure, and maintenance therapy involved the first two drugs. Acute rejection rate and hospital stay were not significantly different compared with non-tumoral grafted patients. Three patients were retransplanted, one with uncontrolled acute rejection and two with chronic rejection. Intraoperative mortality was zero. Eight patients (42.1%) were alive at a mean follow-up of 31 months (range, 6-74). Four 22.2%) died with tumor recurrence, three of sepsis, two of respiratory insufficiency, one of hepatitis recurrence with cirrhosis, and one of primary lung neoplasia. If adequately selected, primary liver tumor patients may benefit from liver transplantation. Future research with adjuvant therapies will improve the results.
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PMID:Orthotopic liver transplantation in primary liver tumors. 838 77

Autoimmune hepatitis is a form of chronic liver disease characterized by progressive hepatocellular inflammation, which usually responds to treatment with corticosteroids. However, 10% of patients with autoimmune hepatitis are refractory to corticosteroids and develop progressive liver disease and cirrhosis. We describe five patients with autoimmune hepatitis who did not respond to conventional corticosteroids and azathioprine therapy who were then treated with cyclosporine A. Cyclosporine A was started at 2-3 mg/kg/day and induced biochemical remission in four of five patients within 3 months. One of the four responders relapsed within 1 month of discontinuing cyclosporine on two occasions. Each time, liver tests promptly normalized after reinitiation of cyclosporine. Two responders were managed with cyclosporine alone. The single patient who did not respond to cyclosporine developed progressive liver failure, underwent orthotopic liver transplantation, and subsequently died of disseminated cytomegalovirus infection. Cyclosporine was generally well tolerated and none of the patients developed renal insufficiency. These data and review of 11 cases in the literature show that cyclosporine can induce remission of liver disease in patients with autoimmune hepatitis who are refractory to corticosteroids.
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PMID:Cyclosporine therapy in patients with steroid resistant autoimmune hepatitis. 993 64

Liver transplantation (OLT) for end-stage chronic hepatitis-B-virus (HBV) infection is frequently complicated by HBV recurrence. In the present study we investigated whether human leucocyte antigen (HLA)-matching influences the outcome after OLT. In a retrospective analysis we reviewed 84 recipients of liver transplants for end-stage HBV-cirrhosis and complete HLA-typing for outcome after OLT. Follow-up ranges from 1 to 110 months (median = 55.6 months). Immunosuppression consisted of Cyclosporin A (CsA)-based quadruple induction therapy or Tacrolimus-based induction protocols. Immunoprophylaxis with hepatitis B immunoglobulin was started at OLT and continued long-term. Actuarial 1- and 5-yr graft survival figures were 90.5 and 80.4%, respectively. Hepatitis-B recurrence was responsible for 15 of 20 (75%) graft failures. We observed a significantly improved graft survival in patients with more HLA-A, -B compatibilities (p = 0.02), whereas the degree of HLA-DR compatibilities did not influence the outcome. The occurrence of HBV-reinfection was significantly lower in HLA-A, -B matched grafts (p < 0.05). Additionally, graft survival was prolonged in patients with HBV-reinfection and 1 or 2 HLA-B compatibilities when compared with patients with HBV-reinfection and a complete HLA-B mismatch (p = 0.02). In conclusion, this retrospective analysis shows that more HLA-A, -B compatibilities seems to be associated with an improved graft survival in patients after OLT for end-stage HBV infection.
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PMID:Impact of HLA-compatibilities in patients undergoing liver transplantation for HBV-cirrhosis. 1196 82


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