Split liver transplantation (SLT) allows for expansion of the deceased donor pool.
To assess outcomes and the impact of splitting technique (in situ vs ex vivo) in SLT recipients.
Single-center retrospective review (September 18, 1993, to July 1, 2010).
University medical center.
One hundred six SLT recipients.
Postoperative graft and patient survival and postoperative complications.
In adults, 1-, 5-, and 10-year overall patient survival was 93%, 77%, and 73%, respectively; overall graft survival was 89%, 76%, and 65%, respectively; ex vivo split patient survival was 93%, 85%, and 74%, respectively; and ex vivo graft survival was 86%, 77%, and 63%, respectively. In situ split patient and graft survival was 94% at 1 year and 75% at 5 years. Postoperative complications included biliary (29%), vascular (11%), unplanned reexploratory surgery (11%), incisional hernia (8%), small-for-size syndrome (n = 1), need for shunt at the time of SLT (n = 1), and primary nonfunction (n = 1). In children, 1-, 5-, and 10-year overall patient survival was 84%, 75%, and 69%, respectively; overall graft survival was 77%, 63%, and 57%, respectively; ex vivo split patient survival was 83%, 73%, and 73%, respectively; and ex vivo graft survival was 75%, 59%, and 59%, respectively. In situ split patient and graft survival was 86% at 1 and 5 years. Postoperative complications included biliary (40%), vascular (26%), and primary nonfunction (n = 1).
Split liver transplantation remains an excellent option for expansion of the deceased donor pool for adult and pediatric populations. Postoperative morbidity remains high; however, this is justifiable owing to limited resources.
"Regenerative approaches aim to promote, enhance and re-establish organ-specific repair processes to reconstitute organ structure and function after injury or in the setting of disease progression or treatment. Currently, the impact of the field of regenerative medicine in clinical practice is limited to a few specialized although highly successful practices, such as autologous bone marrow transplantation (Clift et al., 2004), partial liver transplantation (Vagefi et al., 2011) and skin grafting (Markeson et al., 2013). In many other scenarios, however, replacement of the damaged tissue or organ function has been the more commonly used approach, be it through the use of a specialized peptide (such as insulin), advanced machines (kidney dialysis) and manufactured support (pacemakers, joint replacements or prosthetics), or solid organ transplantation (heart, lung, liver, allogeneic bone marrow transplantation). "
[Show abstract][Hide abstract] ABSTRACT: Regenerative medicine has the promise to alleviate morbidity and mortality caused by organ dysfunction, longstanding injury and trauma. Although regenerative approaches for a few diseases have been highly successful, some organs either do not regenerate well or have no current treatment approach to harness their intrinsic regenerative potential. In this Review, we describe the modeling of human disease and tissue repair in zebrafish, through the discovery of disease-causing genes using classical forward-genetic screens and by modulating clinically relevant phenotypes through chemical genetic screening approaches. Furthermore, we present an overview of those organ systems that regenerate well in zebrafish in contrast to mammalian tissue, as well as those organs in which the regenerative potential is conserved from fish to mammals, enabling drug discovery in preclinical disease-relevant models. We provide two examples from our own work in which the clinical translation of zebrafish findings is either imminent or has already proven successful. The promising results in multiple organs suggest that further insight into regenerative mechanisms and novel clinically relevant therapeutic approaches will emerge from zebrafish research in the future.
[Show abstract][Hide abstract] ABSTRACT: Split liver transplantation (SLT) using extended right grafts is associated with complications related to ischemia of hepatic segment 4 (S4), and these complications are associated with poor outcomes. We retrospectively analyzed 36 SLT recipients so that we could assess the association of radiological, biological, and clinical features with S4 ischemia. The overall survival rates were 84.2%, 84.2%, and 77.7% at 1, 3, and 5 years, respectively. The recipients were mostly male (24/36 or 67%) and had a median age of 52 years (range = 13-63 years), a median body mass index of 22.9 kg/m(2) (range = 17.3-29.8 kg/m(2) ), and a median graft-to-recipient weight ratio of 1.3% (range = 0.9%-1.9%). S4-related complications were diagnosed in 22% of the patients (8/36) with a median delay of 22 days (range = 10-30 days). Secondary arterial complications were seen in 3 of these patients and led to significantly decreased graft survival in comparison with the graft survival of patients without complications (50.0% versus 85.6%, P = 0.017). Patients developing S4-related complications had significantly elevated aspartate aminotransferase (AST) levels (>1000 IU/L) on postoperative day (POD) 1 and elevated gamma-glutamyl transpeptidase (GGT) levels (>300 IU/L) on PODs 7 and 10 (P < 0.05). These AST and GGT elevations conferred a significantly high risk of developing these complications (odds ratio = 42, 95% confidence interval = 4-475, P < 0.05). The ischemic volume of S4 was extremely variable (0%-95%) and did not correlate with S4-related complications. In conclusion, our results suggest that S4-related complications are risk factors for worse graft survival, and the development of these complications can be anticipated by the early identification of a specific biological profile and a routine radiological examination.
[Show abstract][Hide abstract] ABSTRACT: In the last three decades, the management of human immunodeficiency virus (HIV) has improved dramatically. The use of combination antiretroviral therapy (ART) has been successful at preventing death and the myriad infectious, malignant, and immune-mediated complications of HIV. Once considered to be a fatal disease, HIV is now considered by many to be a chronic disease; those affected may now live to experience complications of other coexistent diseases. Liver disease has been increasingly recognized as a leading cause of non-HIV/acquired immunodeficiency syndrome- (AIDS-) related morbidity and mortality in this population.Although liver transplantation offers the opportunity to prolong life, the transplant community has been slow to recognize the chronicity of HIV and potential for transplantation within this population. The experience with liver transplantation in HIV-positive patients is evolving and successful outcomes have been observed when specific criteria are used to select candidates.
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