Limits...
Liver transplantation.

Moon DB, Lee SG - Gut Liver (2009)

Bottom Line: Currently, the same indication criteria that exist for DDLT are applied to LDLT, with technical refinements for LDLT.In highly experienced centers, LDLT for high-scoring (>30 points) Model of End-Stage Liver Disease (MELD) patients and acute-on-chronic liver-failure patients yields comparably good outcomes to DDLT, because timely liver transplantation with good-quality grafting is possible.With increasing numbers of liver transplantations and long-term survivors, specialized attention should be paid to complications that develop in the long term, such as chronic renal failure, hypertension, diabetes mellitus, dyslipidemia, obesity, bone or neurological complications, and development of de novo tumors, which are highly related to the immunosuppressive treatment.

View Article: PubMed Central - PubMed

Affiliation: Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT
Liver transplantation has become a lifesaving procedure for patients who have chronic end-stage liver disease and acute liver failure. The satisfactory outcome of liver transplantation has led to insufficient supplies of deceased donor organs, particularly in East Asia. Hence, East Asian surgeons are concentrating on developing and performing living-donor liver transplantation (LDLT). This review article describes an update on the present status of liver transplantation, mainly in adults, and highlights some recent developments on indications for transplantation, patient selection, donor and recipient operation between LDLT and deceased-donor liver transplantation (DDLT), immunosuppression, and long-term management of liver transplant recipients. Currently, the same indication criteria that exist for DDLT are applied to LDLT, with technical refinements for LDLT. In highly experienced centers, LDLT for high-scoring (>30 points) Model of End-Stage Liver Disease (MELD) patients and acute-on-chronic liver-failure patients yields comparably good outcomes to DDLT, because timely liver transplantation with good-quality grafting is possible. With increasing numbers of liver transplantations and long-term survivors, specialized attention should be paid to complications that develop in the long term, such as chronic renal failure, hypertension, diabetes mellitus, dyslipidemia, obesity, bone or neurological complications, and development of de novo tumors, which are highly related to the immunosuppressive treatment.

No MeSH data available.


Related in: MedlinePlus

Postoperative follow-up CT scan of the recipient, demonstrating the balanced regeneration of both liver grafts. (A) CT scan taken 5 days after transplantation showing that the second left lobe graft in the right upper abdomen was still small and supported by a tissue expander bag. (B) CT scan made 2 weeks after transplantation, showing the rapid regeneration of both grafts. (C) CT scan made 2 months after transplantation, showing that two regenerated left lobe grafts were in the shape of a normal liver.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2852711&req=5

Figure 14: Postoperative follow-up CT scan of the recipient, demonstrating the balanced regeneration of both liver grafts. (A) CT scan taken 5 days after transplantation showing that the second left lobe graft in the right upper abdomen was still small and supported by a tissue expander bag. (B) CT scan made 2 weeks after transplantation, showing the rapid regeneration of both grafts. (C) CT scan made 2 months after transplantation, showing that two regenerated left lobe grafts were in the shape of a normal liver.

Mentions: During recipient and donor workup for adult LDLT, heartbreaking cases who can not be transplanted from a single donor due to graft-recipient size mismatching, unacceptable right-to-left lobe volume discrepancy and excessive hepatic steatosis, are not uncommon. Under those circumstance, Lee et al. has performed dual-graft adult LDLT in which two left liver (left lateral sector or left lobe) grafts are procured from two donors and implanted in one recipient, in order to achieve maximal donor safety through minimal resection of liver mass while increasing recipient actual graft volume (Fig. 14).19,92,93 Sometimes right lobe or right posterior sector graft also has been used for right-sided liver graft of dual-graft LDLT because of the recipient body size or anatomic variation of donor liver (Fig. 15). At our institution, various types of single liver graft together with dual-grafts has been used to satisfy both donor safety and recipient metabolic demands (Fig. 16).


Liver transplantation.

Moon DB, Lee SG - Gut Liver (2009)

Postoperative follow-up CT scan of the recipient, demonstrating the balanced regeneration of both liver grafts. (A) CT scan taken 5 days after transplantation showing that the second left lobe graft in the right upper abdomen was still small and supported by a tissue expander bag. (B) CT scan made 2 weeks after transplantation, showing the rapid regeneration of both grafts. (C) CT scan made 2 months after transplantation, showing that two regenerated left lobe grafts were in the shape of a normal liver.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2852711&req=5

Figure 14: Postoperative follow-up CT scan of the recipient, demonstrating the balanced regeneration of both liver grafts. (A) CT scan taken 5 days after transplantation showing that the second left lobe graft in the right upper abdomen was still small and supported by a tissue expander bag. (B) CT scan made 2 weeks after transplantation, showing the rapid regeneration of both grafts. (C) CT scan made 2 months after transplantation, showing that two regenerated left lobe grafts were in the shape of a normal liver.
Mentions: During recipient and donor workup for adult LDLT, heartbreaking cases who can not be transplanted from a single donor due to graft-recipient size mismatching, unacceptable right-to-left lobe volume discrepancy and excessive hepatic steatosis, are not uncommon. Under those circumstance, Lee et al. has performed dual-graft adult LDLT in which two left liver (left lateral sector or left lobe) grafts are procured from two donors and implanted in one recipient, in order to achieve maximal donor safety through minimal resection of liver mass while increasing recipient actual graft volume (Fig. 14).19,92,93 Sometimes right lobe or right posterior sector graft also has been used for right-sided liver graft of dual-graft LDLT because of the recipient body size or anatomic variation of donor liver (Fig. 15). At our institution, various types of single liver graft together with dual-grafts has been used to satisfy both donor safety and recipient metabolic demands (Fig. 16).

Bottom Line: Currently, the same indication criteria that exist for DDLT are applied to LDLT, with technical refinements for LDLT.In highly experienced centers, LDLT for high-scoring (>30 points) Model of End-Stage Liver Disease (MELD) patients and acute-on-chronic liver-failure patients yields comparably good outcomes to DDLT, because timely liver transplantation with good-quality grafting is possible.With increasing numbers of liver transplantations and long-term survivors, specialized attention should be paid to complications that develop in the long term, such as chronic renal failure, hypertension, diabetes mellitus, dyslipidemia, obesity, bone or neurological complications, and development of de novo tumors, which are highly related to the immunosuppressive treatment.

View Article: PubMed Central - PubMed

Affiliation: Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT
Liver transplantation has become a lifesaving procedure for patients who have chronic end-stage liver disease and acute liver failure. The satisfactory outcome of liver transplantation has led to insufficient supplies of deceased donor organs, particularly in East Asia. Hence, East Asian surgeons are concentrating on developing and performing living-donor liver transplantation (LDLT). This review article describes an update on the present status of liver transplantation, mainly in adults, and highlights some recent developments on indications for transplantation, patient selection, donor and recipient operation between LDLT and deceased-donor liver transplantation (DDLT), immunosuppression, and long-term management of liver transplant recipients. Currently, the same indication criteria that exist for DDLT are applied to LDLT, with technical refinements for LDLT. In highly experienced centers, LDLT for high-scoring (>30 points) Model of End-Stage Liver Disease (MELD) patients and acute-on-chronic liver-failure patients yields comparably good outcomes to DDLT, because timely liver transplantation with good-quality grafting is possible. With increasing numbers of liver transplantations and long-term survivors, specialized attention should be paid to complications that develop in the long term, such as chronic renal failure, hypertension, diabetes mellitus, dyslipidemia, obesity, bone or neurological complications, and development of de novo tumors, which are highly related to the immunosuppressive treatment.

No MeSH data available.


Related in: MedlinePlus