| 1. |
- Herlenius, Gustaf, 1961, et al.
(författare)
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Stable long-term renal function after pediatric liver transplantation.
- 2010
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Ingår i: Pediatric transplantation. - : Wiley. - 1399-3046 .- 1397-3142. ; 14:3, s. 409-16
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Tidskriftsartikel (refereegranskat)abstract
- Long-term exposure to calcineurin inhibitors increases the risk of CKD in children after LT. The aims of this study were to study renal function by measuring GFRm before and yearly after LT, to describe the prevalence of CKD (stage III: GFR 30-60 mL/min/1.73 m(2)) and to investigate if age and underlying liver disease had an impact on long-term renal function. Thirty-six patients with a median age of 2.9 years (0.1-16 yr) were studied. Median follow-up was 6.5 (2-14 yr). GFRm decreased significantly during the first six months post-transplantation with 23% (p < 0.001). Thereafter renal function stabilized. At six months, 17% (n = 5) of the children presented CKD stage III and at five yr the prevalence of CKD III was 18% in 29 children. However, in 13 children with a 10-year follow-up it was 0%. None of the children required renal replacement therapy after LT. When analyzing renal function of those children younger than two yr (n = 14) and older than two yr (n = 17) at the time of transplantation, we found that in both cohorts the filtration rate remained remarkably stable during the five-yr observational period. However, there was a statistically significant (p < 0.05) difference in the percentual decrease in GFRm between the groups during the first six months after LT 13% and 31%, respectively. Baseline GFRm according to diagnosis did not differ between the groups. During the first six months after LT, patients transplanted for hepatic malignancy (n = 6) and those with metabolic liver disease (n = 4) had a percentage loss of GFRm of 32% and 35%, respectively. The corresponding loss of GFRm in patients with other diseases was 10-19%. Six months post-transplantation mean GFRm in the group with malignant liver disease was 65 +/- 15 mL/min/1.73 m(2) and in the group with other diseases (n = 24) 82 +/- 17 mL/min/1.73 m(2) (p < 0.05). At one, three and five yr post-transplantation there was no longer a statistically significant difference between these cohorts. Our findings suggest that there can be a long-term recovery of renal function after LT in children.
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| 2. |
- Castedal, Maria, 1964, et al.
(författare)
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Long-term follow-up of living liver donors.
- 2010
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Ingår i: Transplantation proceedings. - : Elsevier BV. - 1873-2623 .- 0041-1345. ; 42:10, s. 4449-54
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Tidskriftsartikel (refereegranskat)abstract
- At our center living donor liver transplantation (LDLT) represents 4% of all transplantations. The aim of this cross-sectional study was to clarify the current well-being of the donors, their experiences of being a donor, as well as the regenerative capacity of the liver.
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| 3. |
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| 4. |
- Friman, Styrbjörn, 1948, et al.
(författare)
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Kidney transplantation--a 46-year experience from the Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
- 2011
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Ingår i: Clinical transplants. - 0890-9016. ; , s. 119-25
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Tidskriftsartikel (refereegranskat)abstract
- The limiting factor in organ transplantation is the availability of organs. Ongoing work to improve donation rates both at the public and the organizational level in donating hospitals is essential. We also think that encouragement of live donation is important, and the possibility of ABO incompatible transplantation has increased the number of LD transplantations. The one-year graft survival rate is excellent and focus has shifted towards achieving long-term results to reduce the attrition rate. There is also an increasing interest in studying and working to reduce comorbidities on a long-term basis and thus, improve survival rates and recipient quality of life.
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| 5. |
- Friman, Styrbjörn, 1948, et al.
(författare)
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Liver transplantation for cholangiocarcinoma: Selection is essential for acceptable results.
- 2011
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Ingår i: Scandinavian journal of gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 46:3, s. 370-375
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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.
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| 6. |
- Herlenius, Gustaf, 1961, et al.
(författare)
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Conversion From Calcineurin Inhibitor to Either Mycophenolate Mofetil or Sirolimus Improves Renal Function in Liver Transplant Recipients With Chronic Kidney Disease : Results of a Prospective Randomized Trial
- 2010
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Ingår i: Transplantation Proceedings. - : Elsevier BV. - 0041-1345 .- 1873-2623. ; 42:10, s. 4441-4448
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Tidskriftsartikel (refereegranskat)abstract
- Background. Chronic kidney disease (CKD) has emerged as a significant cause of morbidity and a risk factor for mortality after orthotopic liver transplantation (OLT). The use of calcineurin inhibitor (CNI)-based immunosuppression is an important etiologic factor for developing CKD. CNI discontinuation or minimization protocols with replacement of the CNI with non-nephrotoxic drugs, such as mycophenolate mofetil (MMF) or sirolimus (SRL), may have the potential to preserve or recover renal function. Patients and Methods. In this prospective, randomized, single-center study with CNI discontinuation, OLT recipients with CKD (measured glomerular filtration rate [GFRm] 15-45 mL/min/1.73 m(2)) were randomized to either SRL or MMF-based immunosuppression. The main objective was to study the effect of CNI discontinuation on renal function. Secondary aims were to assess the frequency of biopsy-proven acute rejection episodes (BPAR) and adverse events (AE). Renal function was followed with GFRm using 51-Chromium EDTA clearance at baseline, 3 months, and 1 year. Patients were stratified according to baseline GFRm > versus <30 mL/min/1.73 m(2). The 25 patients were enrolled for MMF (n = 13) or SRL (n = 12). The median age at inclusion was 59 years (range, 25-66) and the median number of years after OLT was 4.4 (range, 1-13). Twenty-two patients were followed up for a year; MMF (n = 12) and SRL (n = 10). Results. Mean GFRm for the whole cohort (n = 25) was 31+/-8 mL/min/1.73 m(2) at baseline. After 3 months the GFRm (n = 23) increased to 40+/-10 mL/min/1.73 m(2) (P = .0001) and at 1 year 42 +/- 11 mL/min/1.73 m(2) (n = 22). There was not significant difference between the MMF and the SRL study arms. The cohort (n = 8) with baseline GFRm <30 mL showed a 63% (P = .003) increased filtration after 1 year. There was no significant difference in the frequency or severity of AE between the study arms with the exception of oral ulcerations and persistent hypertriglyceridemia in the SRL group. Two deaths occurred, 1 in each study arm, both probably unrelated to the change in immunosuppression. There were no BPAR episodes. Conclusion. CNI discontinuation and replacement with either MMF or SRL resulted in a significant improvement in renal function even in those patients with severe CKD. The protocol was effective with no acute rejection episodes. The SRL arm showed a higher frequency of oral apthous ulcerations and hypertriglyceridemia. Future studies addressing long-term renal function after CNI discontinuation are needed.
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| 7. |
- Schramm, Christoph, et al.
(författare)
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Primary liver transplantation for autoimmune hepatitis: a comparative analysis of the European Liver Transplant Registry.
- 2010
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Ingår i: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. - : Ovid Technologies (Wolters Kluwer Health). - 1527-6473. ; 16:4, s. 461-9
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Tidskriftsartikel (refereegranskat)abstract
- The principal aim of this study was to compare the probability of and potential risk factors for death and graft loss after primary adult and pediatric liver transplantation in patients undergoing transplantation for autoimmune hepatitis (AIH) to those in patients undergoing transplantation for primary biliary cirrhosis (PBC; used as the reference group) or alcoholic cirrhosis (used as an example of a nonautoimmune liver disease). The 5-year survival of patients undergoing transplantation for AIH (n = 827) was 0.73 [95% confidence interval (CI) = 0.67-0.77]. This was similar to that of patients undergoing transplantation for alcoholic cirrhosis (0.74, 95% CI = 0.72-0.76, n = 6424) but significantly worse than that of patients undergoing transplantation for PBC (0.83, 95% CI = 0.80-0.85, n = 1588). Fatal infectious complications occurred at an increased rate in patients with AIH (hazard ratio = 1.8, P = 0.002 with PBC as the reference). The outcome of pediatric AIH patients was similar to that of adult patients undergoing transplantation up to the age of 50 years. However, the survival of AIH patients undergoing transplantation beyond the age of 50 years (0.61 at 5 years, 95% CI = 0.51-0.70) was significantly reduced in comparison with the survival of young adult AIH patients (0.78 at 18-34 years, 95% CI = 0.70-0.86) and in comparison with the survival of patients of the same age group with PBC or alcoholic cirrhosis. In conclusion, age significantly affects patient survival after liver transplantation for AIH. The increased risk of dying of infectious complications in the early postoperative period, especially above the age of 50 years, should be acknowledged in the management of AIH patients with advanced-stage liver disease who are listed for liver transplantation. It should be noted that not all risk factors relevant to patient and graft survival could be analyzed with the European Liver Transplant Registry database.
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| 8. |
- van Keimpema, Loes, et al.
(författare)
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Excellent survival after liver transplantation for isolated polycystic liver disease: an European Liver Transplant Registry study.
- 2011
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Ingår i: Transplant international : official journal of the European Society for Organ Transplantation. - : Frontiers Media SA. - 1432-2277. ; 24:12, s. 1239-45
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Tidskriftsartikel (refereegranskat)abstract
- Patients with end-stage isolated polycystic liver disease (PCLD) suffer from incapacitating symptoms because of very large liver volumes. Liver transplantation (LT) is the only curative option. This study assesses the feasibility of LT in PCLD. We used the European Liver Transplant Registry (ELTR) database to extract demographics and outcomes of 58 PCLD patients. We used Kaplan-Meier survival analysis for survival rates. Severe abdominal pain (75%) was the most prominent symptom, while portal hypertension (35%) was the most common complication in PCLD. The explantation of the polycystic liver was extremely difficult in 38% of patients, because of presence of adhesions from prior therapy (17%). Karnofsky score following LT was 90%. The 1- and 5-year graft survival rate was 94.3% and 87.5%, while patient survival rate was 94.8% and 92.3%, respectively. Survival rates after LT for PCLD are good.
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| 9. |
- Wolfbrandt, A, et al.
(författare)
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What are we waiting for? Analyses of factors influencing cold ischemia time.
- 2010
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Ingår i: Transplantation proceedings. - : Elsevier BV. - 1873-2623 .- 0041-1345. ; 42:10, s. 4436-4437
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Cold ischemia time (CIT) influences long-term graft survival after deceased donor (DD) kidney transplantation. The aim of the present study was to identify factors that influenced CIT at our institution, seeking to lay ground for improvement. Patients and Methods Patients who underwent DD kidney transplantations from November 2008 to April 2009 were included in the study. In a prospective protocol the times for various events were registered. The 40 DD kidney transplantations included 26 “paired” kidneys from the same donor and 14 “single” kidneys. Results The mean CIT was 15.2 hours ± 4.2 hours (range, 7.0–23.9). “First kidney” was 13.3 hours ± 3.4 versus 19.2 ± 2.8 hours for the “second kidney” (P < .001). The waiting time for the operating room (OR) was 2.4 hours (range, 0–12 hours). Twenty-five percent of the patients waited more than 4 hours. Patients arriving at the hospital at the same time as or before the kidney retrieval showed a CIT of 13.4 ± 3.9 hours compared with 17.4 ± 3.4 hours for patients that arrived after the retrieved kidney (P < .01). Conclusion We identified factors influencing CIT that could lay the foundation for improvement. An extended cooperation and exchange with another transplantation unit for the “second kidney” could reduce the CIT. To reduce the waiting time for OR at the hospital to less than 2 hours and to get the recipient into the hospital before the kidney arrives are efforts that could reduce CIT.
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| 10. |
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