| 1. |
- Yamamoto, Shinji, et al.
(författare)
-
Long-term consequences of domino liver transplantation using familial amyloidotic polyneuropathy grafts
- 2007
-
Ingår i: Transplant International. - : Frontiers Media SA. - 0934-0874 .- 1432-2277. ; 13:6, s. S223-S223
-
Tidskriftsartikel (refereegranskat)abstract
- Domino liver transplantation (DLT) using grafts from patients with familial amyloidotic polyneuropathy (FAP) is an established procedure at many transplantation centers. However, data evaluating the long-term outcome of DLT are limited. The aim of the present study was to analyze the risk of de novo polyneuropathy, possibly because of amyloidosis, and the patient survival after DLT. At our department, 28 DLT using FAP grafts were conducted between January 1997 and December 2005. One patient was twice subjected to DLT. Postoperative neurological monitoring of peripheral nerve function was performed with electroneurography (ENeG) in 20 cases. An ENeG index based on 12 parameters was calculated and correlated to age and/or height. Three patients developed ENeG signs of polyneuropathy 2-5 years after the DLT, but with no clinical symptoms. The 1-, 3- and 5-year actuarial patient survival in hepatocellular carcinoma (HCC) patients (n = 12) and non-HCC patients (n = 15) was 67%, 15%, 15% and 93%, 93%, 80%, respectively (P = 0.001). Development of impaired nerve conduction in a proportion of patients may indicate that de novo amyloidosis occurs earlier than previously expected. Survival after DLT was excellent except in patients with advanced HCC.
|
|
| 2. |
- Aberg, Fredrik, et al.
(författare)
-
Differences in long-term mortality among liver transplant recipients and the general population: A population-based Nordic study.
- 2015
-
Ingår i: Hepatology (Baltimore, Md.). - : Ovid Technologies (Wolters Kluwer Health). - 1527-3350 .- 0270-9139. ; 61:2, s. 668-677
-
Tidskriftsartikel (refereegranskat)abstract
- Dramatic improvement in first-year outcomes post-liver transplantation (LT) has shifted attention to long-term survival, where efforts are now needed to achieve improvement. Understanding the causes for premature death is a prerequisite for improving long-term outcome. Overall and cause-specific mortality of 3299 Nordic LT patients (1985-2009) having survived 1 year post-LT were divided by expected rates in the general population, adjusted for age, sex, calendar time, and country to yield standardized mortality ratios (SMRs). Data came from the Nordic Liver-Transplant Registry and WHO mortality-indicator database. Stagnant patient survival rates >1 year post-LT were 21% lower at 10 years than expected survival for the general population. Overall SMR for death before age 75 (premature mortality) was 5.8 (95%CI 5.4-6.3), with improvement from 1985-1999 to 2000-2010 in hepatitis C (HCV) (SMR change 23.1-9.2), hepatocellular carcinoma (HCC) (SMR 38.4-18.8), and primary sclerosing cholangitis (SMR 11.0-4.2), and deterioration in alcoholic liver disease (8.3-24.0) and acute liver failure (ALF) (5.9-7.6). SMRs for cancer and liver disease (recurrent or transplant-unrelated disease) were elevated in all indications except primary biliary cirrhosis (PBC). Absolute mortality rates underestimated the elevated premature mortality from infections (SMR 22-693) and kidney disease (SMR 13-45) across all indications, and from suicide in HCV and ALF. SMR for cardiovascular disease was significant only in PBC and alcoholic liver disease, owing to high mortality in the general population. Transplant-specific events caused 16% of deaths. Conclusion: standardized premature mortality provided an improved picture of long-term post-LT outcome, showing improvement over time in some indications, not revealed by overall absolute mortality rates. Causes with high premature mortality (infections, cancer, kidney and liver disease, and suicide) merit increased attention in clinical patient follow-up and future research. (Hepatology 2014;).
|
|
| 3. |
|
|
| 4. |
- Ericzon, Bo-Göran, et al.
(författare)
-
Liver transplantation for hereditary transthyretin amyloidosis : after 20 years still the best therapeutic alternative?
- 2015
-
Ingår i: Transplantation. - 0041-1337 .- 1534-6080. ; 99:9, s. 1847-1854
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Until recently, liver transplantation (Ltx) was the only available treatment for hereditary transthyretin (TTR) amyloidosis; today, however, several pharmacotherapies are tested. Herein, we present survival data from the largest available database on transplanted hereditary TTR patients to serve as a base for comparison.METHODS: Liver transplantation was evaluated in a 20-year retrospective analysis of the Familial Amyloidosis Polyneuropathy World Transplant Registry.RESULTS: From April 1990 until December 2010, data were accumulated from 77 liver transplant centers. The Registry contains 1940 patients, and 1379 are alive. Eighty-eight Ltx were performed in combination with a heart and/or kidney transplantation. Overall, 20-year survival after Ltx was 55.3%. Multivariate analysis revealed modified body mass index, early onset of disease (<50 years of age), disease duration before Ltx, and TTR Val30Met versus non-TTR Val30Met mutations as independent significant survival factors. Early-onset patients had an expected mortality rate of 38% that of the late-onset group (P < 0.001). Furthermore, Val30Met patients had an expected mortality rate of 61% that of non-TTR Val30Met patients (P < 0.001). With each year of duration of disease before Ltx, expected mortality increased by 11% (P < 0.001). With each 100-unit increase in modified body mass index at Ltx, the expected mortality decreased to 89% of the expected mortality (P < 0.001). Cardiovascular death was markedly more common than that observed in patients undergoing Ltx for end-stage liver disease.CONCLUSIONS: Long-term survival after Ltx, especially for early-onset TTR Val30Met patients, is excellent. The risk of delaying Ltx by testing alternative treatments, especially in early-onset TTR Val30Met patients, requires consideration.
|
|
| 5. |
- Ericzon, Bo-Göran, et al.
(författare)
-
Liver Transplantation for Transthyretin Amyloidosis
- 2009
-
Ingår i: Recent Advances in Transthyretin Evolution, Structure and Biological Functions. - New York : Springer Berlin/Heidelberg. - 9783642006456 - 9783642006463 ; , s. 239-260
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Liver transplantation has until now proved to be the only treatment available that halts the progression of hereditary transthyretin (TTR) associated amyloidosis. The rationale behind the procedure is to replace the liver producing variant TTR with one that produces wild type TTR only, and thereby cease the production of amyloidogenic TTR (ATTR). Even though the transplantation does not improve the patient's symptoms, the progression of the disease comes to a halt for a majority of patients. However, unforeseen complications after the transplantation have emerged, in particular a continuous amyloid formation in the heart observed in non-ATTR Val30Met mutations. Thus, combined liver and heart transplantation has been performed in selected cases. Since the ATTR liver functions normally apart from a synthesis of the variant TTR, utilisation of ATTR-amyloid patients' livers for transplantation of liver disease patients has been performed. In a few patients, development of amyloid disease has been reported, but the procedure remains an important source of organs, especially for patients with hepatocellular cancer.
|
|
| 6. |
|
|
| 7. |
- Friman, Styrbjörn, 1948, et al.
(författare)
-
Liver transplantation for cholangiocarcinoma: Selection is essential for acceptable results.
- 2011
-
Ingår i: Scandinavian journal of gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 46:3, s. 370-375
-
Tidskriftsartikel (refereegranskat)abstract
- Abstract Background and aims. Cholangiocarcinoma (CCA) is considered a contraindication for liver transplantation by most liver transplant centers. The aim of this study has been to report our results as well as to explore factors that influence patient survival after liver transplantation for CCA. Patients. All transplant patients with CCA in Norway, Sweden and Finland during 1984-2005 were included (n = 53). Thirty-three patients (62%) had intrahepatic CCA. Twenty-one patients (40%) had a more advanced tumor (>TNM stage 2). Thirty-four of the 53 recipients (64%) had primary sclerosing cholangitis (PSC). Results. Patients with TNM stage ≤2 transplanted after 1995 had a 5-year survival rate of 48%. The overall 5-year patient survival rate was 25%. There was no difference in survival between patients with extrahepatic and intrahepatic CCA. The 5-year survival rate among patients with TNM stage ≤2 was 36%. Patients with TNM stage >2 had a 10% 5-year survival rate; the difference was significant at p < 0.01. Patients transplanted after 1995 had a significantly better 5-year survival rate than pre-1995 patients (38% vs. 0%, p < 0.01). Patients transplanted after 1995 with TNM ≤2 and CA 19-9 ≤100 had the 5-year survival of 58%. Conclusion. By selecting CCA patients with TNM stage ≤2 and a CA 19-9 ≤100 a reasonable 5-year survival rate is possible. We think that CCA in selected cases can be an acceptable indication for liver transplantation.
|
|
| 8. |
- Iwata, Takashi, et al.
(författare)
-
Microdialysis monitoring for evaluation of the influence exertedby pneumoperitoneum on the kidney: an experimental study
- 2008
-
Ingår i: Surgical Endoscopy. - : Springer Science and Business Media LLC. - 0930-2794 .- 1432-2218. ; 22, s. 938-942
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundLaparoscopic donor nephrectomy hasbecome the first choice for living donor kidney transplantation,offering advantages over open donor nephrectomy.This study aimed to evaluate kidney tissue metabolismduring and after pneumoperitoneum using a microdialysistechnique.MethodsEight pigs underwent laparotomy and implantationof two microdialysis catheters: one in the cortex andone in the medulla of the left kidney. After laparotomy, theabdominal wall was closed, and pneumoperitoneum wasinduced with a constant standard pressure of 16 to 18mmHg for 4 h, followed by rapid desufflation. In microdialysissamples collected from intrarenal catheters,markers of ischemia (glucose, lactate, pyruvate, and lactate–pyruvate ratio) and the marker of cell membraneinjury (glycerol) were monitored.ResultsThere were no changes in glucose, lactate, orpyruvate level before, during, or after pneumoperitoneum,either in the cortex or in the medulla. Additionally, thecalculated lactate–pyruvate ratio did not show signs ofischemia during or after pneumoperitoneum. However,with regard to the marker of cell injury, glycerol increasedin the medulla after decompression from 22.57 ± 3.76 to35.67 ± 5.43 mmol/l (p < 0.01). This release of glycerol inthe medulla was significantly higher than in the cortex(area under the curve [AUC], 22.18 ± 4.87 vs34.79 ± 7.88 mmol/l;p < 0.01).ConclusionsThe pattern of metabolic changes monitoredin the kidney during and after pneumoperitoneum indicatessome kind of cell injury predominant in the medulla withoutany signs of kidney ischemia. This nonischemic injury couldbe related to hyperperfusion of the kidney after decompressionor injury to cells attributable to mechanical cellexpansion at the point of rapid decompression.
|
|
| 9. |
- Kaxiras, Anastasios, et al.
(författare)
-
Cyclosporin A, but not tacrolimus, negatively affects the hepatic extraction fraction of hepatobiliary scintigraphy in liver transplant recipients
- 2014
-
Ingår i: EJNMMI Research. - : Springer Science and Business Media LLC. - 2191-219X. ; 4:73
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundHepatobiliary scintigraphy using 99mTc-mebrofenin has been used as an investigation to study liver function after liver transplantation (LTx). Hepatic extraction fraction (HEF) is a measurement of the hepatic extraction efficiency and hepatic extraction rate. With the purpose of evaluating a possible diverging effect of cyclosporin A (CSA) and tacrolimus (TAC) on the HEF, we compared the HEF with biochemical and histological parameters in LTx patients receiving either CSA or TAC.MethodsThirty-nine adult patients who underwent LTx due to hepatitis C virus (HCV) cirrhosis were evaluated. All patients underwent a 3-month and 1-year follow-up that included hepatobiliary scintigraphy and biochemistry tests. Liver biopsy was performed at 1 year. These clinical parameters were compared between the two groups, TAC (n = 15) and CSA (n = 24).ResultsThe average HEF was significantly lower in the CSA group compared to the TAC group both at 3 months and 1 year after LTx. The liver biochemistry tests, average donor and recipient age, average cold ischemia time (CIT), and a clearance were comparable in the two groups. The TAC group had more inflammation than the CSA group. Moreover, three patients who converted from CSA to TAC increased their HEF values.ConclusionsCSA-treated patients presented a lower HEF value on hepatobiliary scintigraphy in spite of comparable liver function by traditional measurements indicating a decrease on HEF values by CSA.
|
|
| 10. |
- Melum, Espen, et al.
(författare)
-
Hepatitis C impairs survival following liver transplantation irrespective of concomitant hepatocellular carcinoma.
- 2007
-
Ingår i: Journal of hepatology. - : Elsevier BV. - 0168-8278 .- 1600-0641. ; 47:6, s. 777-83
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND/AIMS: Liver transplantation (LTX) is the only curative treatment for end-stage liver disease caused by hepatitis C (HCV). Hepatocellular carcinoma (HCC) is common in patients with HCV cirrhosis. METHODS: Two hundred and eighty-two HCV patients listed for LTX in the Nordic countries in a 17-year period were included. For comparison a group of patients with non-viral chronic liver disease (n=1552) was used. RESULTS: Two hundred and fifty-three (90%) patients received a first liver allograft. HCC was found in 38% of the explanted livers. Survival at 1, 3 and 5years was 82%, 69% and 61% vs. 85%, 80% and 76% for the comparison group (p<0.0001), this survival difference was also evident when excluding patients with HCC (p=0.007). HCV patients with HCC had 1, 3 and 5year survival of 73%, 52% and 46% compared with 88%, 80% and 71% for the HCV patients without HCC (p=0.0005). In an intention-to-treat analysis (from time of acceptance to the waiting list) HCV was also associated with an impaired survival. CONCLUSIONS: HCV cirrhosis, which is now also an important indication for LTX in the Nordic countries, and significantly impairs survival following LTX. Concomitant HCC and donor age are the two most important factors contributing to an impaired survival.
|
|
