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1.
Situs inversus of donor or recipient in liver transplantation 总被引:1,自引:0,他引:1
Felix Braun Burckhard Rodeck Thomas Lorf Ruben Canelo Perdita Wietzke Heinz Hartmann Giuliano Ramadori B. Ringe 《Transplant international》1998,11(3):212-215
Situs inversus is a rare anatomical abnormality that is often associated with multiple, complex malformations. In the past,
patients with situs inversus were considered unsuitable candidates for transplantation or organ donation because associated
visceral, and especially vascular, anomalies pose special technical difficulties. Recently, several cases of successful liver
transplantation in recipients with situs inversus have been published using modified surgical techniques. This report reviews
the literature and describes our own experience, including two liver graft recipients with complete and incomplete situs inversus,
and one patient who underwent successful transplantation using a liver from a donor with situs inversus.
Received: 10 October 1997 Received after revision: 22 December 1997 Accepted: 9 January 1998 相似文献
2.
V. Mazzaferro Enrico Regalia Andrea Pulvirenti Dario Baratti Giuseppe Montagnino Federico Bozzetti 《Transplant international》1997,10(5):392-394
Inferior vena cava thrombosis after liver transplantation is uncommon. We describe a case of this unusual complication occurring
after piggy-back (end-to-side) graft implantation. Renal failure, lower limb edema, and hemodynamic instability were the presenting
symptoms requiring immediate surgical correction with a left renal-to-splenic vein shunt over a ringed 2.5-cm prosthesis.
The decision to go ahead with the shunt was preceded by an intraoperative confirmation of a 10-cm H2O pressure gradient between the caval and portal circulations. This gradient, unlike that observed in liver cirrhosis, ultimately
turned a splenorenal shunt into a renal-splenic one. Six months after the procedure, the patient is alive and well with normal
liver and renal function. The technique described may be useful in the management of other clinical conditions of acute infrahepatic
caval hypertension.
Received: 17 January 1997 Received after revision: 2 May 1997 Accepted: 13 May 1997 相似文献
3.
Auxiliary liver transplantation with arterialization of the portal vein for acute hepatic failure 总被引:15,自引:0,他引:15
J. Erhard Reinhard Lange Ursula Rauen Ralf Scherer Jürgen Friedrich Michael Pietsch Herbert de Groot Friedrich Wilhelm Eigler 《Transplant international》1998,11(4):266-271
Six adult patients suffering from acute hepatic failure and with a high urgent status underwent heterotopic auxiliary liver
transplantation. In four of these patients, the portal vein of the liver graft was arterialized in order to leave the native
liver and the liver hilum untouched and to be able to place the liver graft wherever space was available in the abdomen. The
arterial blood flow via the portal vein was tapered by the width of the anastomosis. Two patients died, one of sepsis on postoperative
day 17 (POD), the other after 3 months due to a severe CMV pneumonia. There were no technically related deaths. The native
liver showed early regeneration in all cases. In one patient, the auxiliary graft was removed 6 weeks after transplantation.
Four weeks later, he had to undergo orthotopic retransplantation due to a recurrent fulminant failure of the recovered native
liver. This patient is alive more than 1 year after the operation. We conclude that heterotopic auxiliary liver transplantation
with portal vein arterialization is a suitable approach to bridging the recovery of the acute failing native liver.
Received: 15 September 1997 Received after revision: 4 February 1998 Accepted: 2 March 1998 相似文献
4.
Reduced grafts represent an important technical development in paediatric liver transplantation. The use of a left lateral
segment graft has required preservation of the native inferior vena cava to “piggy-back” the graft onto it. We report four
children who underwent left lateral segment transplantation with caval replacement using the donor iliac vein because the
native retrohepatic inferior vena cava was small, friable or difficult to preserve. There were no caval or hepatic vein complications
post-transplant and the donor iliac vein proved to be a satisfactory interpositional graft. The technique offers the advantages
of a wider retrohepatic cava avoiding venous outflow or caval obstruction, provides good tissue to suture and is well suited
for the triangulation technique of the left hepatic vein.
Received: 24 January 1997 Received after revision: 20 June 1997 Accepted: 30 June 1997 相似文献
5.
R. Troisi Ilse Kerremans Eric Mortier Luc Defreyne Uwe J. Hesse Bernard de Hemptinne 《Transplant international》1998,11(2):147-151
Portal vein arterialization (PVA) is an acquired concept in shunt surgery for portal hypertension. This technique, recently
described as both a temporary and permanent procedure in adult liver transplantation, is reported by the authors in two cases
of pediatric transplantation. The indication was low portal blood flow after reperfusion with poor graft function due to persistence
of spontaneous retroperitoneal venous shunts. In both cases described, PVA allowed for satisfactory macroscopic liver reperfusion.
The increase in portal blood flow from 150 to 500 ml/min in the second patient enabled the liver to be reperfused correctly
and led to successful transplantation. The graft function in both cases improved in the 1st postoperative week, but thrombosis
of the PVA occurred in the 1st patient 2 months after transplantation. Signs of hepatic hyperarterialization occurred in the
second patient and this necessitated a dearterialization of the portal vein 2 weeks later. Although the benefit of this procedure
appears to be beyond doubt in the immediate postoperative period, we have no data on long-term arterialization. We do think
that PVA can be performed in pediatric liver transplantation, but it may need to be done only in special, individual situations
when no valid alternative can be proposed, such as in the absence of a mesenteric vein and/or the presence of spontaneous
retroperitoneal venous shunts.
Received: 24 June 1997 Received after revision: 27 November 1997 Accepted: 28 November 1997 相似文献
6.
Luis Carlos Feitosa Tajra Marwan Dawhara Mehdi Benchaib Nicole Lefrançois Xavier Martin J. M. Dubernard 《Transplant international》1998,11(4):295-300
To date there is no general consensus as to the best surgical technique for pancreas transplantation. Patients with a pancreas
transplant functioning for 3 years or more were retrospectively investigated to compare three surgical techniques: segmental
graft with duct obstruction (DO), whole graft with bladder drainage (BD), and whole graft with enteric drainage (ED). Several
parameters were studied: patient and graft survival, rejection, long-term surgical and medical complications, and endocrine
function. The best results in terms of graft survival and quality of metabolic control were obtained in the group that underwent
whole graft transplantation with ED. At 3 years, overall pancreas graft survival was 65 % for ED, 60 % for BD, and 47 % for
DO. This surgical method has become the preferred technique in our unit.
Received: 9 October 1997 Received after revision: 29 January 1998 Accepted: 30 March 1998 相似文献
7.
Masaki Kaibori S. Uemoto Shiro Fujita Yukihiro Inomata Hiroto Egawa Katsuhiro Asonuma Tetsuya Kiuchi Michihiro Hayashi Masahiko Nakamura Koichi Tanaka 《Transplant international》1999,12(5):383-386
In countries where a living donor is the only source of the graft, the limited size of the graft is of serious concern when
considering extending the procedure to adult recipients. In order to overcome this problem, auxiliary partial orthotopic liver
transplantation (APOLT) was applied to the concept that the residual native liver would support the graft function until the
graft expanded enough to work by itself. We herein report on a 20-year-old woman with primary sclerosing cholangitis (PSC),
who received a small-size liver graft by APOLT. Computed tomography and scintigraphy showed that the graft had regenerated
sufficiently 1 month after the operation. The diseased residual native liver is potentially carcinogenetic. Therefore, second-stage
native hepatectomy was done 35 days after the first operation. Histopathologic examination of the resected native liver revealed
biliary cirrhosis with PSC but no evidence of cholangiocarcinoma. Second-stage native hepatectomy after APOLT seems to be
a curative treatment for chronic end-stage liver disease with graft size mismatch that may be as good as orthotopic liver
transplantation.
Received: 22 October 1998 Received after revision: 15 January 1999 Accepted: 26 February 1999 相似文献
8.
E. Domínguez Fernández K. H. Albrecht U. Heemann M. Kohnle J. Erhard F. Stöblen F. W. Eigler 《Transplant international》1998,11(1):28-31
Sigmoid perforation due to diverticulitis is a life-threatening complication in the postoperative course of allogenic kidney
transplantation. The incidence of diverticulosis is especially high among patients with autosomal dominant polycystic kidney
disease (ADPKD). Thus, those who undergo allogenic kidney transplantation represent a high-risk group. The aim of this study
was to evaluate the prevalence of diverticulosis in ADPKD patients awaiting renal transplantation and the incidence of bowel
perforation following allogenic kidney transplantation due to ADPKD. Within the group of 1128 patients who underwent transplantation
between January 1974 and January 1990, there were 46 patients (4.07 %) whose indication for transplantation was ADPKD. There
was one patient who developed a sigmoid perforation under postoperative immunosuppression. Surgical treatment was a discontinuity
resection of the sigmoid (Hartmann's procedure). The postoperative course was favorable, the bowel continuity has already
been restored, and the graft is still functioning well. Fifteen of the 28 (53.5 %) ADPKD patients awaiting transplantation
had colon diverticulosis (12 male and 3 female patients). No case of bowel perforation has thus far been observed in 15 of
these patients who have undergone transplantation. A sigmoid resection was necessary in one patient due to diverticulitis
without perforation. We did not find a higher prevalence of diverticulosis in patients with ADPKD, nor did we see a higher
incidence of sigmoid perforation during post-transplant immunosuppression in this study.
Received: 30 January 1997 Received after revision: 15 July 1997 Accepted: 19 August 1997 相似文献
9.
J. de Ville de Goyet Y. Struye de Swielande R. Reding E. M. Sokal J. B. Otte 《Transplant international》1998,11(2):117-122
Due to the shortage of size-matched liver donors, relatively oversized liver grafts (even after ex situ volume reduction)
are frequently used for liver transplantation in children. This was recently observed when livers from large, living related
donors were procured for transplantation in very small recipients. Given that abdominal hyperpressure can compromise vascular
flow in the new graft, primary closure of the abdomen was delayed by temporary Silastic prosthetic closure in selected cases.
The new technique was original in that the skin was closed, avoiding fluid loss and reducing the risk of infections reported
with other techniques, and in that reoperation allowed for a delayed, but primary-type, closure (fascia and skin) that resulted
in an esthetically correct aspect. Over a period of 7 years, 330 pediatric liver transplantations were performed, and delayed
prosthetic closure was achieved successfully and safely in 47 cases. The present report outlines this clinical experience.
Received: 26 May 1997 Received after revision: 14 October 1997 Accepted: 19 November 1997 相似文献
10.
We report on the successful regrafting of a transplanted kidney. The donor kidney was first transplanted into a 32‐year‐old patient with renal atrophy. More than 2 years later, he suffered from severe grand mal seizure with brain edema and the patient met the criteria for brain death. The well‐functioning graft was recovered and subsequently transplanted into a 66‐year‐old woman with chronic glomerular nephritis. Neither the first nor the second recipient experienced any acute rejection. To date, more than 14 years later, she is in good health with excellent graft function. This case report implies that excellent long‐term graft function is viable in a graft reused 2 years after the initial transplantation. 相似文献
11.
J. P. Lerut Nicolas Claeys Olga Ciccarelli Roberto Pisa Christine Galant Pierre-François Laterre Ugo Palazzo 《Transplant international》1998,11(4):320-322
Syncytial giant cell hepatitis is a severe form of hepatitis characterized by diffuse giant cell transformation of hepatocytes.
The disease may evolve to chronic cholestatic cirrhosis necessitating liver transplantation. We report the case of an adult
liver transplant recipient presenting with early recurrent disease without concomitant clinicobiochemical syndrome. Early
recurrence of giant cell hepatitis after liver transplantation favors the hypothesis of a transmissible agent as the etiology
of the disease. Routine follow-up liver biopsy is necessary in these cases in order to gain more information about the precise
incidence and aggressivity of disease recurrence in the allograft.
Received: 4 July 1997 Received after revision: 12 January 1998 Accepted: 11 February 1998 相似文献
12.
At our center, since 1982, a body mass index (BMI) of less than 30 has been a prerequisite for placing a patient on the waiting
list for renal transplantation. This decision was made because obese transplant recipients seemed to have a less than favorable
post-transplant outcome. The aim of this study was to evaluate whether this requirement is still justified. Forty-six patients
with a BMI above 30 underwent primary cadaveric renal transplantation between 1972 and 1993. For each of these obese patients,
five consecutive non-obese (BMI 20–25) control patients were selected. Patient and graft survival, causes of graft loss, and
acute rejection rate were evaluated for the two patient groups before and after the year 1982. Within the first 30 post-transplant
days, one patient (2 %) and 11 grafts (24 %) were lost in the group of obese patients whereas seven patients (3 %) and 36
grafts (16 %) were lost in the control group. Among the obese patients, renal circulatory complications were a major cause
of graft loss. In the period 1973–1981, the 1-year patient survival rate was 65 % among obese patients versus 75 % among controls
from 1982 to 1993, this was 90 % versus 93 %. From 1973 to 1981, the 1-year graft survival rate was 25 % among obese patients
versus 53 % among controls (P < 0.05); from 1982 to 1993, it was 68 % versus 84 % (P = NS). Multivariate analysis showed that the immunosuppressive regimen,
age of the patient, BMI, and cold ischemia time of the graft had a significant influence on graft survival. The acute rejection
rate within the first 30 days was 28 % among obese patients and 35 % among controls (P = NS). We conclude that a BMI below
or equal to 30 is still justified as a prerequisite for placement on the waiting list for renal transplantation, for despite
an overall improvement, the outcome of renal transplantation in obese patients remains worse than that in non-obese patients.
Received: 3 February 1997 Received after revision: 4 April 1997 Accepted: 8 April 1997 相似文献
13.
T. Scholz Ø. Mathisen A. Bergan S. Osnes R. Innes T. Pedersen A. O. Aasen O. Søreide 《Transplant international》1997,10(3):180-184
We have introduced and evaluated several modifications of the conventional venovenous bypass (VVBP) in 29 adult patients
undergoing liver transplantation (OLT). A percutaneous technique for insertion of a jugular venous return cannula and a femoral
vein cannula was applied. The inferior mesenteric vein (IMV) was used for splanchnic decompression, which facilitated dissection
of the recipient liver and allowed portal anastomosis to be performed without disconnecting the portal bypass. A heat exchanger
was introduced into the bypass circuit to prevent heat loss. The percutaneous technique prevented complications related to
dissection in the axilla and groin. Hemodynamic characteristics corresponded to those found using the traditional technique.
Complications related to the VVBP were seen in only one patient in whom the femoral catheter was accidentally introduced into
the femoral artery. We conclude that percutaneous cannulas, use of the IMV for splanchnic decompression and the introduction
of a heat exchanger offer significant benefits and that they are safe and reliable.
Received: 23 August 1996 Received after revision: 14 January 1997 Accepted: 27 January 1997 相似文献
14.
K. Hamano Hiroshi Ito Andrew Bushell Kathryn J. Wood Kensuke Esato 《Transplant international》1997,10(4):293-298
In this study, the effect of combining anti-CD4 monoclonal antibody (mAb) and cyclosporin (CyA) therapy at the time of transplantation
was examined. A mouse cardiac allograft model was used. Anti-CD4 mAb administered perioperatively induces long-term survival.
The addition of a short course of CyA given subcutaneously in a regimen of either a high-dose treatment or a standard dose
treatment to the anti-CD4 mAb treatment protocol did not have a detrimental effect on graft survival. Despite having no significant
effect on graft survival, the addition of CyA to the treatment protocol did result in a significant decrease in the level
of IL-2 present in the hearts 7 days after transplantation. The decrease in IL-2 production was directly related to the presence
of CyA in vivo. When CyA treatment was continued throughout the period during which unresponsiveness to the graft is induced
by anti-CD4 mAb therapy, 50 % of the grafted hearts were rejected once the CyA was discontinued. In conclusion, the combined
use of anti-CD4 mAb therapy and CyA did not have a negative effect on graft survival in this model when the two agents were
used concurrently at the time of transplantation.
Received: 2 October 1996 Received after revision: 31 January 1997 Accepted: 5 February 1997 相似文献
15.
Kubota T Thomson A Clouston AD Nakazawa Y Steadman C Kerlin P Shimada H Balderson GA Lynch SV Strong RW 《Journal of Hepato-Biliary-Pancreatic Surgery》1999,6(4):377-381
Whether primary sclerosing cholangitis (PSC) occurs after orthotopic liver transplantation is controversial, largely because
the pre-transplant diagnosis of PSC is based on nonspecific radiological and histological findings. We reviewed clinical,
radiological, and histological records of 53 patients who underwent liver transplantation for PSC between 1985 and 1998. Three
patients with patent hepatic arteries and no evidence of chronic rejection had radiological and histological findings that
may have been due to recurrent PSC. Bile duct stricturing in these patients proved permanent and progressive and affected
both the quality of life and graft survival. The first patient, who is 110 months after transplantation, has had repeated
episodes of cholangitis for the last year. The second patient underwent excision of a strictured hepatic duct 45 months after
transplantation and was ultimately retransplanted 95 months after initial transplantation. The third patient underwent left
hemihepatectomy of an atrophied lobe 50 months after transplantation. Although the patient population assessed in this study
is limited, putative recurrent PSC in the allografts has led either to graft loss or to clinically significant hepatobiliary
complications of the graft.
Received for publication on March 8, 1999; accepted on April 30, 1999 相似文献
16.
Jürgen von Schönfeld Jochen Erhard Mechtild Beste Marc Mahl Rainer B. Zotz Reinhard Lange Norbert Breuer Harald Goebell Friedrich W. Eigler 《Transplant international》1997,10(3):212-216
In long-term survivors of liver transplantation, hepatic function is obviously of vital importance. Therefore, we prospectively
performed conventional and quantitative liver function tests in patients who had survived a first transplantation for at least
4 years. Compared to 6 months after transplantation, serum bilirubin concentration and γGT activity were significantly lower after 3, 4, and 5 years (bilirubin 1.2 ± 0.2 mg/dl at 6 months vs 1.0 ± 0.1, 1.0 ± 0.2,
and 0.8 ± 0.1 mg/dl respectively; γGT 106 ± 33 U/l at 6 months vs 56 ± 17, 67 ± 35, 39 ± 10 U/l respectively). At these points in time, blood levels of cyclosporin
A were also significantly lower. Other parameters of liver cell function and liver cell integrity (AP, AST, ALT, GLDH, total
protein, thromboplastin time, partial thromboplastin time) were unchanged over time. Serial quantitative liver function tests
(indocyanine green half-life, galactose elimination capacity, lidocaine half-life, and MEGX formation) also remained stable.
Thus, we conclude that hepatic function remains stable in long-term survivors of liver transplantation for at least several
years.
Received: 16 July 1996 Received after revision: 8 January 1997 Accepted: 27 January 1997 相似文献
17.
J. Klupp W. O. Bechstein K. P. Platz H. Keck H. P. Lemmens M. Knoop J. M. Langrehr R. Neuhaus J. Pratschke P. Neuhaus 《Transplant international》1997,10(3):223-228
Mycophenolate mofetil (MMF) has been used successfully as an immunosuppressive agent after kidney and heart transplantation,
but experience with MMF after liver transplantation is still limited. Between August 1995 and January 1996, we treated 20
patients with MMF after orthotopic liver transplantation in an open, prospective study. Five out of eight patients with acute
rejection and one patient with early chronic rejection showed a complete response after MMF was added to the immunosuppression.
Three patients with chronic rejection did not improve, one died, and two have stable graft function at present. In eight patients
who suffered from toxicity, a reduction in the dosage of tacrolimus was attempted with simultaneous MMF therapy. One patient
died due to multiple organ failure. Liver function improved completely in one other patient, and partially in three patients
after adding MMF. In the remaining three patients, a reduced dosage of tacrolimus or cyclosporin, together with MMF, reduced
toxicity, not significantly. In conclusion, MMF appears to be a safe and potentially useful adjuvant immunosuppressive agent
for rescue and maintenance therapy.
Received: 15 August 1996 Accepted: 6 December 1996 相似文献
18.
M. Pera Juan C. García-Valdecasas Luis Grande Antoni Rimola Josep Fuster Antonio M. Lacy Andres Cifuentes Isabel Cirera Miquel Navasa Josep Visa 《Transplant international》1997,10(4):289-292
The results of orthotopic liver transplantation (OLT) in patients with alcoholic liver cirrhosis (ALC) are currently similar
to those obtained in patients with other indications. However, the frequent association of ALC with hepatitis C virus (HCV)
infection may impair these results. We retrospectively studied the consequences of HCV infection on survival and graft function
in 59 patients with ALC undergoing OLT. Patients were classified into two groups depending on their HCV serology before transplantation:
group 1 comprised 24 anti-HCV-positive patients, and group 2, 35 anti-HCV-negative patients. Patient and graft survival were
similar in both groups. Liver function tests 1 and 4 years after OLT showed AST and ALT values that were significantly higher
in group 1 patients and post-transplant histologically proven chronic hepatitis was found in 45 % and 61 % of these patients
at 1 and 4 years, respectively. We conclude that pretransplant HCV infection in patients with ALC does not affect survival
after OLT. However, one must bear in mind the high incidence of post-transplant chronic hepatitis secondary to recurrence
of HCV infection and be cautious when drawing this conclusion.
Received: 1 October 1996 Received after revision: 3 March 1997 Accepted: 17 March 1997 相似文献
19.
Long-term outcome of liver retransplantation in children 总被引:5,自引:0,他引:5
Deshpande RR Rela M Girlanda R Bowles MJ Muiesan P Dhawan A Mieli-Vergani G Heaton ND 《Transplantation》2002,74(8):1124-1130
BACKGROUND: Retransplantation of the liver is the only means of prolonging survival in children whose initial graft has failed. Patient and graft survival rates after retransplantation in most series have been inferior to rates after first transplantation. PATIENTS AND METHODS: Of 450 pediatric liver transplantations performed between January 1990 and March 2001, 50 were first retransplantations, 9 were second retransplantations, and 1 was a third retransplantation. The overall retransplantation rate was 13.3% (median age at retransplantation 4 years and median weight 15 kg). The median post-retransplantation follow-up was 73 (range, 6-139) months. RESULTS: Kaplan-Meier patient survival rates for the group (n=50) were 71.7%, 64.7%, and 64.7% at 1, 3, and 5 years, respectively. Graft survival rates were 65.6%, 56.7%, and 56.7% at 1, 3, and 5 years, respectively. This is significantly worse than rates for children undergoing first liver transplantation. There were 17 deaths, of which 9 occurred in the first month. Biliary complications occurred in 5 (10%) patients and vascular complications in 6 (12%). Improved patient and graft survival rates were observed in the later phase of the program, although the difference was not significant. Higher preoperative serum creatinine (P=0.001) and serum bilirubin (P=0.02) levels were associated with a higher postoperative mortality. CONCLUSION: Results of retransplantation in children remain inferior to those after first transplantation. There is a trend toward improving results. Liver retransplantation makes an important contribution to overall survival in children. 相似文献
20.
Complications due to ureteric obstruction are an occasional cause for renal transplant dysfunction. Here we report an unusual
case of orthostatic renal failure in a renal transplant recipient. Our patient had the previously reported predisposing risk
factors including: female sex, obesity, and lax abdominal musculature. It is important to recognize this unusual complication
of renal transplantation early in order to preserve long-term graft function.
Received: 23 December 1996 Received after revision: 6 May 1997 Accepted: 13 May 1997 相似文献