Speciality
Spotlight

 




 


Gastroenterologist


     

 





Liver Transplant

   

  • O
    Abbasoglu, MF Levy, Brkic BB, et al (Baylor Univ, Dallas. Tex):

    Ten years of liver transplantation: An evolving understanding of late graft loss.

    Transplantation 64: 1801-1807, 1997.

       


    Despite progress in long-term outcome of orthotopic liver transplantation
    (OLT) , late graft loss is still a concern. OLT patients who live beyond the first year have excellent survival rates. The main causes of late graft loss are recurrent diseases, new malignancies, cardiovascular diseases, and stroke.

       

  • J.
    Belghiti and F. Durand [ Departments of Digestive
    Surgery and ‘Hepatology, Hospital Beaujon,
    University Paris VII, 92118 Clichy Cedex, France

    Living Donor Liver Transplantation : Present and
    Future


    Br.
    Jour. of  Sur.
    Volume 87, No.11, November 2000, Pgs- 1441-1443

       

    Living donor liver transplantation has been
    an acceptable modality of therapy for ten years now.  
    The  progress 
    in  this 
    field   
    has been seen mainly in Japan. [ Almost 1000
    such procedures have been done] because of absence
    of cadaveric donors and the technical expertise of
    south east surgeons in hepato biliary surgery. 
    As a  result
    of this, left hepatectomy for living donation for
    children and small adults has almost become routine.
    The results of living donation proved to be better
    than cadaveric donation in pediatric cases. 
    This was attributed to factors other than
    immunological ones because the need for
    immunosuppression and the incidence of rejection
    were almost similar. 
    The non immunologic factors contributing to
    better results were likely to be 
    [1] good quality of graft [2] very short
    period of cold ischaemia [3] the ability to plan the
    procedure both from the availability of surgical
    expertise and choosing the optimal time for the
    recipient. The good results of this procedure
    illustrate its superiority over the partial graft
    procedure.

       

    However in adults this procedure is problematical. 
    Several reports suggest that a liver graft
    representing less than 0.8% of the recipient’s
    body weight has a high risk of failure. 
    As a result an attempt is now being made with
    right side grafts in adults. 
    This has raised some concerns [ 1] It carries
    a potential 200% mortality risk [2] Complications
    such as peptic ulcer and pulmonary embolism remain a
    major concern, in addition to the development of
    coagulation disorders. [3] The number of adults
    awaiting liver transplantation is ten times higher
    than children and this poses a major problem of
    donor availability, donor morbidity and mortality.

       

    This has led to efforts to set up definite
    guidelines aimed at selection of recipient. Those at
    high risk are therefore kept out or excluded, which
    can be misconstrued; it may not be applicable to
    those who have their own donors available. More
    centers therefore need to be developed to address
    the increasing demand.

       

    Then there is the psychological dilemma as, in the
    absence of living donation a patient may be
    condemned to  die
    without a transplant. 
    Again relatives who
    have participated in a palliative
    transplantation may face psychological morbidity
    because life expectancy may be very short.

       

    Finally,
    in order to prevent commerce in transplantation,
    living donation has been limited in several European
    countries to first degree relatives with the
    possibility of extension to spouses in emergency
    situations.  In
    France, – bioethical law – [informed consent of
    potential living donor has to be given to a judge]
    gives added protection against commerce in
    transplantation.

       

  • A.
    O’Bichere, S. Shurey, P. Sibbons, C. Green and R.K.
    S. Phillips [ St Marks Hospital and Northwick Park
    Institute for Medical Research, Harrow, UK]

    Expertimental Model of Anorectal Transplantation

    Br.
    Jour. of  Sur.
    Volume 87, No.11, November 2000, Pgs- 1534-1539

       

    This
    study investigates the possibility of anorectal
    transplantation with pudendal nerve and inferior
    artery and vein anastomosis in a porcine model. This
    would avoid a colostomy and recreate potentially
    normal anorectal function.

       

    Four
    female pigs provided donor anorectum for four male
    recipients under standard general anaesthesia. The
    donor operation involved abdominoperineal excision
    of rectum [APR] taking the anal sphincter, pudendal
    neurovascular bundle and inferior mesenteric
    vessels. The recipient underwent APR,
    transperitoneal introduction of donor graft,
    anastomoses of rectum, 
    inferior mesenteric vessels and pudendal
    neurovascular bundle, and perineal closure.

       

    The
    duration of each slip, ischaemic time, dimensions of
    anastomosed structures and postoperative graft
    viability was recorded. 
    The animals were killed at 24 hours, the
    state of the graft was noted and tissue was taken
    for confirmatory histology.

        

    The
    mean operation time was 372 min. the mean ischaemic
    time was 118 min. Before death, 2 grafts were pink,
    1 was dusky, and one was an outright failure.

        

    Anorectal
    transplantation is technically feasible in a pig
    model. Long-term studies are needed to assess return
    of function and to overcome rejection.

        

 



 

 

Speciality Spotlight

 

 
Gastroenterologist
     

 

Liver Transplant
   

  • O Abbasoglu, MF Levy, Brkic BB, et al (Baylor Univ, Dallas. Tex):
    Ten years of liver transplantation: An evolving understanding of late graft loss.
    Transplantation 64: 1801-1807, 1997.
       
    Despite progress in long-term outcome of orthotopic liver transplantation (OLT) , late graft loss is still a concern. OLT patients who live beyond the first year have excellent survival rates. The main causes of late graft loss are recurrent diseases, new malignancies, cardiovascular diseases, and stroke.
       

  • J. Belghiti and F. Durand [ Departments of Digestive Surgery and ‘Hepatology, Hospital Beaujon, University Paris VII, 92118 Clichy Cedex, France
    Living Donor Liver Transplantation : Present and Future
    Br. Jour. of  Sur. Volume 87, No.11, November 2000, Pgs- 1441-1443
       
    Living donor liver transplantation has been an acceptable modality of therapy for ten years now.   The  progress  in  this  field    has been seen mainly in Japan. [ Almost 1000 such procedures have been done] because of absence of cadaveric donors and the technical expertise of south east surgeons in hepato biliary surgery.  As a  result of this, left hepatectomy for living donation for children and small adults has almost become routine. The results of living donation proved to be better than cadaveric donation in pediatric cases.  This was attributed to factors other than immunological ones because the need for immunosuppression and the incidence of rejection were almost similar.  The non immunologic factors contributing to better results were likely to be  [1] good quality of graft [2] very short period of cold ischaemia [3] the ability to plan the procedure both from the availability of surgical expertise and choosing the optimal time for the recipient. The good results of this procedure illustrate its superiority over the partial graft procedure.
       
    However in adults this procedure is problematical.  Several reports suggest that a liver graft representing less than 0.8% of the recipient’s body weight has a high risk of failure.  As a result an attempt is now being made with right side grafts in adults.  This has raised some concerns [ 1] It carries a potential 200% mortality risk [2] Complications such as peptic ulcer and pulmonary embolism remain a major concern, in addition to the development of coagulation disorders. [3] The number of adults awaiting liver transplantation is ten times higher than children and this poses a major problem of donor availability, donor morbidity and mortality.
       
    This has led to efforts to set up definite guidelines aimed at selection of recipient. Those at high risk are therefore kept out or excluded, which can be misconstrued; it may not be applicable to those who have their own donors available. More centers therefore need to be developed to address the increasing demand.
       
    Then there is the psychological dilemma as, in the absence of living donation a patient may be condemned to  die without a transplant.  Again relatives who have participated in a palliative transplantation may face psychological morbidity because life expectancy may be very short.
       
    Finally, in order to prevent commerce in transplantation, living donation has been limited in several European countries to first degree relatives with the possibility of extension to spouses in emergency situations.  In France, – bioethical law – [informed consent of potential living donor has to be given to a judge] gives added protection against commerce in transplantation.
       

  • A. O’Bichere, S. Shurey, P. Sibbons, C. Green and R.K. S. Phillips [ St Marks Hospital and Northwick Park Institute for Medical Research, Harrow, UK]
    Expertimental Model of Anorectal Transplantation
    Br. Jour. of  Sur. Volume 87, No.11, November 2000, Pgs- 1534-1539
       
    This study investigates the possibility of anorectal transplantation with pudendal nerve and inferior artery and vein anastomosis in a porcine model. This would avoid a colostomy and recreate potentially normal anorectal function.
       
    Four female pigs provided donor anorectum for four male recipients under standard general anaesthesia. The donor operation involved abdominoperineal excision of rectum [APR] taking the anal sphincter, pudendal neurovascular bundle and inferior mesenteric vessels. The recipient underwent APR, transperitoneal introduction of donor graft, anastomoses of rectum,  inferior mesenteric vessels and pudendal neurovascular bundle, and perineal closure.
       
    The duration of each slip, ischaemic time, dimensions of anastomosed structures and postoperative graft viability was recorded.  The animals were killed at 24 hours, the state of the graft was noted and tissue was taken for confirmatory histology.
        
    The mean operation time was 372 min. the mean ischaemic time was 118 min. Before death, 2 grafts were pink, 1 was dusky, and one was an outright failure.
        
    Anorectal transplantation is technically feasible in a pig model. Long-term studies are needed to assess return of function and to overcome rejection.
        

 

 

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