eMedicine Specialties > Transplantation > Surgery
Liver Transplantation: Follow-up
Updated: Sep 24, 2009
Outcome and Prognosis
LT is a standard proven therapy for ESLD and should be offered to any patient who needs it. Careful selection of both donors and recipients maximizes usage by optimizing outcomes. This requires a dedicated multidisciplinary team of health care providers, usually concentrated in a transplantation center. Living-related LT may be one of the solutions to the donor shortage.
Overall patient survival rates at 1 and 5 years are 86.2% and 72.3%, respectively (UNOS data as of September 15, 2009), with corresponding graft survival rates of 80.9% and 64.3%, respectively.1 In addition, patients are surviving longer with improved quality of life compared with pretransplantation status. However, this prolonged longevity has brought about new concerns, such as the long-term effects of immunosuppression, as they relate to effects on the cardiovascular system, infections, and propensity for malignancy. Thus, the search for newer immunosuppressive strategies to minimize these adverse effects continues today.
Since the implementation of MELD, audits of the UNOS system have revealed significant changes in the dynamics of organ allocation. The average MELD score at transplant now is higher compared to the pre-MELD era (20.5 vs 17).3 Despite the shift to sicker patients, no difference has been demonstrated in 1-year patient and graft survival after the implementation of MELD.30,31 The median waiting time has been reduced from 656 to 416 days.32 Perhaps the best indicator of the superiority of MELD as an efficacious prediction model is the 3.5% reduction in waiting list mortality since its implementation.33
Renal function is an integral component of MELD; since the institution of MELD, patients with cirrhosis and renal failure have been given increased priority. An investigation of the UNOS system revealed that combined kidney-liver transplants have increased since the introduction of MELD, as have the number of transplant recipients requiring preoperative renal replacement therapy.33 Despite this, patient posttransplant survival did not change in the MELD era; however, kidney-liver recipients requiring pretransplant renal replacement therapy had better survival than liver-alone recipients requiring pretransplant renal replacement therapy.
To maximize the utility of organ allocation, a system that balances both pretransplant medical urgency and posttransplant survival is needed. Although the MELD score is a good predictor of pretransplant survival, it is only a weak predictor of posttransplant survival.3,18,34 Donor factors, surgical factors, and posttransplant complications play a significant role in posttransplant outcomes. Further changes to liver allocation schemes should include the investigation and incorporation of other objective parameters that add to the posttransplant prediction of mortality. Newer systems should incorporate donor characteristics to the MELD score to ensure the best possible recipient-donor pairing that is associated with improved posttransplant survival.35
Occasionally, improvement in quality of life does not bring a parallel increase in the employment capabilities of the patient. Much social mistrust and misconceptions about liver disease still exist because it is frequently perceived as self-inflicted. Further education of the population in this respect should alleviate this problem in the future.
For excellent patient education resources, visit eMedicine's Hepatitis Center and Liver, Gallbladder, and Pancreas Center. Also, see eMedicine's patient education articles Liver Transplant, Hepatitis B, Hepatitis C, and Cirrhosis.
Future and Controversies
A possible solution to the chronic shortage of allografts is xenotransplantation, ie, the use of tissue from an animal donor. Most experts believe that the pig will provide the most suitable solid organs for use in human beings. Animal organs are rapidly rejected by a process called hyperacute rejection. In addition, increasing evidence indicates that other barriers besides hyperacute rejection, both immune and nonimmune, might exist to limit the survival of xenografts. New strategies to overcome these barriers are needed if long-term xenograft survival equivalent to, or better than, that of allografts is ever to be achieved.
Xenografts may also offer potential benefits over allografts because they offer the possibility of manipulating donor organs before transplantation, which would help develop graft-specific immunosuppressive treatments and thus reduce the need for systemic immunosuppressive therapy and its risks.
Other concerns may limit the widespread application of xenotransplantation, notoriously the threat of transmissible zoonosis. These fears have been heightened by data showing that co-culture of porcine and human cell lines allows endogenous porcine retroviruses to begin replication. The potential risks of disease transmission must be examined carefully before clinical trials can proceed. However, addressing every concern will be difficult until after clinical xenotransplantation has begun.
Other future directions under consideration today include hepatocyte cell transplantation and use of bioartificial liver devices (ie, extracorporeal liver-assist devices). Although promising, great development in these devices is still needed, as with xenotransplantation, to bring them to the clinical arena.
Once the realm of science fiction but now within reach, the future of organ availability ultimately may depend on the cautious development of organ-cloning techniques.
The ongoing expansion of criteria for transplantation for hepatocellular carcinoma
As experience grows with transplantation for small HCC, individual centers have analyzed their data for transplantation of tumors exceeding the Milan criteria. In a retrospective study, Yao et al analyzed the outcome of 70 patients with HCC undergoing transplantation.36 Those who exceed the Milan criteria on pathologic examination of the explants had a 75% 5-year survival if they met the following criteria: single lesion less than or equal to 6.5 cm, or 2-3 nodules, with the largest £ 4.5 cm and total tumor diameter £ 8 cm. Patients who exceeded these so-called University of California at San Francisco (UCSF) criteria, however, had a 50% 1-year survival rate after transplant.
Even though these results are encouraging, the jury is still out on the expanded UCSF criteria. In a retrospective study that examined 5-year survival rates in patients with HCC after liver transplant, patients who met the pretransplant Milan criteria had a 5-year survival rate of 60% as compared to only 45% for those who exceeded the Milan criteria but met the UCSF criteria.37 Although the difference was not statistically different, such a large clinical difference warrants comparison of these criteria in large well-designed prospective studies before they are universally adopted.
The role of neoadjuvant therapy for HCC prior to liver transplant is not well defined. In a systematic review of studies reporting the impact of transarterial chemoembolization (TACE) for HCC prior to transplant from 1990 to 2005, the authors concluded that TACE, as a bridge to orthotopic liver transplantation, does not improve long-term survival, expand current criteria, or decrease dropout rates on the waiting list.38 Most studies were of poor methodological quality, and large well-designed randomized trials are needed to define the role of neoadjuvant therapies such as TACE and radiofrequency ablation as a bridge to transplantation. In another study, no difference in short-term (60-d) or long-term (5-y) survival or cumulative tumor recurrence was found in a group of 36 patients with HCC who underwent transplant after TACE compared to 21 controls with HCC who went to transplant without TACE.39
In another recent study that again examined the effect of TACE on transplant candidates,40 patients that had complete or partial response to TACE had better 1-, 2-, and 5-y survival rates than patients whose tumors had no response or progressed on TACE. In a subgroup analysis, these benefits were seen only in patients who had met the Milan criteria; they were not seen in patients who exceeded the Milan criteria but met the UCSF criteria. These patients were more likely to drop out because of tumor progression while awaiting transplant and also had higher posttransplant HCC recurrence. Downstaged patients fared worse, with higher dropout rates and worse 5-y survival rates. Thus, the response to TACE for patients meeting the Milan criteria may predict long-term outcome.
No large long-term studies exist to show that downstaging tumors to meet the Milan criteria can be justified
Transplantation in patients with HIV
In the 1990s, prior to the era of highly active antiretroviral therapy (HAART), HIV was an absolute contraindication to liver transplantation.41,42 Despite the advent of HAART and documentation of improved outcomes in these patients, most transplant centers still do not perform liver transplantation in HIV-positive recipients. A clinical trial is under way to study kidney and liver transplantation in patients with HIV. Click here for more information.
Recent data suggest that posttransplantation survival in HIV-positive recipients does not differ from that of the non-HIV liver transplant population as a whole.43,41 Several small institution-specific studies demonstrated comparable survival between HIV-positive and HIV-negative recipients, particularly those who tolerate HAART and have pretransplantation CD4 counts >200 cells/mL.41,42
In a prospective study of 11 HIV-infected liver transplant recipients, 1- and 3-y patient (91% and 64%) and graft survival (82% and 64%) rates were similar to the general liver transplant population between 1999 and 2004.44 However, posttransplantation outcomes are also reduced in co-infected patients (HIV and HCV) compared to HCV-negative, HIV-positive patients and HIV-negative, HCV-positive recipients.45 Since most patients who require liver transplantation need transplantation because of HCV progression (and not HIV), the controversy continues about whether liver transplant is a viable option for these patients.
One of the major concerns in co-infected patients is the risk for recurrence of cirrhosis and HCV posttransplantation. This subgroup of recipients exhibits earlier and more severe HCV recurrence and higher rates of posttransplantation fibrosis, cirrhosis, and fibrosing cholestatic hepatitis. Finally, the concomitant use of immunosuppressive therapy and HAART therapy raises the issue of pharmacologic interactions. Protease inhibitors interfere with the activity of cytochrome P450 3A (CYP3A). Therefore, the dosing of sirolimus and calcineurin inhibitors such as tacrolimus and cyclosporine A should be reduced and drug levels carefully monitored to reduce toxicity.46
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References
United Network for Organ Sharing (UNOS) data. UNOS Web site. Available at http://www.unos.org/. Accessed September 15, 2009.
United Network for Organ Sharing. MELD/PELD Calculator Documentation. Updated January 28, 2009. UNOS Web site. Available at http://www.unos.org/waitlist/includes_local/pdfs/meld_peld_calculator.pdf. Accessed September 15, 2009.
Kanwal F, Dulai GS, Spiegel BM, Yee HF, Gralnek IM. A comparison of liver transplantation outcomes in the pre- vs. post-MELD eras. Aliment Pharmacol Ther. Jan 15 2005;21(2):169-77. [Medline].
Saab S, Han SH, Martin P. Liver transplantation. Selection, listing criteria, and preoperative management. Clin Liver Dis. Aug 2000;4(3):513-32. [Medline].
Centers for Disease Control and Prevention (CDC). Deaths: Preliminary data for 2006. National Vital Statistics Reports. June 11, 2008;56(16):[Full Text].
Achord JL. Malnutrition and the role of nutritional support in alcoholic liver disease. Am J Gastroenterol. Jan 1987;82(1):1-7. [Medline].
Broering DC, Wilms C, Bok P. Evolution of donor morbidity in living related liver transplantation: a single-center analysis of 165 cases. Ann Surg. Dec 2004;240(6):1013-24; discussions 1024-6.
Afessa B, Gay PC, Plevak DJ, et al. Pulmonary complications of orthotopic liver transplantation. Mayo Clin Proc. May 1993;68(5):427-34. [Medline].
Slifkin M, Doron S, Snydman DR. Viral prophylaxis in organ transplant patients. Drugs. 2004;64(24):2763-92. [Medline].
Munoz SJ, Rothstein KD, Reich D, Manzarbeitia C. Long-term care of the liver transplant recipient. Clin Liver Dis. Aug 2000;4(3):691-710. [Medline].
Ojo AO, Held PJ, Port FK, et al. Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med. Sep 4 2003;349(10):931-40. [Medline].
Pawarode A, Fine DM, Thuluvath PJ. Independent risk factors and natural history of renal dysfunction in liver transplant recipients. Liver Transpl. Jul 2003;9(7):741-7. [Medline].
Cohen AJ, Stegall MD, Rosen CB, Wiesner RH, Leung N, Kremers WK, et al. Chronic renal dysfunction late after liver transplantation. Liver Transpl. Oct 2002;8(10):916-21. [Medline].
Neau-Cransac M, Morel D, Bernard PH, et al. Renal failure after liver transplantation: outcome after calcineurin inhibitor withdrawal. Clin Transplant. Oct 2002;16(5):368-73. [Medline].
Lucey MR, Abdelmalek MF, Gagliardi R, et al. A comparison of tacrolimus and cyclosporine in liver transplantation: effects on renal function and cardiovascular risk status. Am J Transplant. May 2005;5(5):1111-9. [Medline].
Marik PE, Wood K, Starzl TE. The course of type 1 hepato-renal syndrome post liver transplantation. Nephrol Dial Transplant. Feb 2006;21(2):478-82. [Medline].
Terrault NA. Treatment of recurrent hepatitis C in liver transplant recipients. Clin Gastroenterol Hepatol. Oct 2005;3(10 Suppl 2):S125-31. [Medline].
Jacob M, Copley LP, Lewsey JD, et al. Pretransplant MELD score and post liver transplantation survival in the UK and Ireland. Liver Transpl. Jul 2004;10(7):903-7. [Medline].
Beckebaum S, Cicinnati VR, Klein CG, et al. Impact of combined mycophenolate mofetil and low-dose calcineurin inhibitor therapy on renal function, cardiovascular risk factors, and graft function in liver transplant patients: preliminary results of an open prospective study. Transplant Proc. Nov 2004;36(9):2671-4. [Medline].
Kornberg A, Kupper B, Hommann M, Scheele J. Introduction of MMF in conjunction with stepwise reduction of calcineurin inhibitor in stable liver transplant patients with renal dysfunction. Int Immunopharmacol. Jan 2005;5(1):141-6. [Medline].
Raimondo ML, Dagher L, Papatheodoridis GV, et al. Long-term mycophenolate mofetil monotherapy in combination with calcineurin inhibitors for chronic renal dysfunction after liver transplantation. Transplantation. Jan 27 2003;75(2):186-90. [Medline].
Cantarovich M, Tzimas GN, Barkun J, Deschenes M, Alpert E, Tchervenkov J. Efficacy of mycophenolate mofetil combined with very low-dose cyclosporine microemulsion in long-term liver-transplant patients with renal dysfunction. Transplantation. Jul 15 2003;76(1):98-102. [Medline].
Yoshida EM, Marotta PJ, Greig PD, et al. Evaluation of renal function in liver transplant recipients receiving daclizumab (Zenapax), mycophenolate mofetil, and a delayed, low-dose tacrolimus regimen vs. a standard-dose tacrolimus and mycophenolate mofetil regimen: a multicenter randomized clinical trial. Liver Transpl. Sep 2005;11(9):1064-72. [Medline].
Herrero JI, Quiroga J, Sangro B, et al. Conversion of liver transplant recipients on cyclosporine with renal impairment to mycophenolate mofetil. Liver Transpl Surg. Sep 1999;5(5):414-20. [Medline].
Barkmann A, Nashan B, Schmidt HH, et al. Improvement of acute and chronic renal dysfunction in liver transplant patients after substitution of calcineurin inhibitors by mycophenolate mofetil. Transplantation. May 15 2000;69(9):1886-90. [Medline].
Stewart SF, Hudson M, Talbot D, Manas D, Day CP. Mycophenolate mofetil monotherapy in liver transplantation. Lancet. Feb 24 2001;357(9256):609-10. [Medline].
Hirose R, Roberts JP, Quan D, et al. Experience with daclizumab in liver transplantation: renal transplant dosing without calcineurin inhibitors is insufficient to prevent acute rejection in liver transplantation. Transplantation. Jan 27 2000;69(2):307-11. [Medline].
Ziolkowski J, Paczek L, Senatorski G, et al. Renal function after liver transplantation: calcineurin inhibitor nephrotoxicity. Transplant Proc. Sep 2003;35(6):2307-9. [Medline].
Nair S, Eason J, Loss G. Sirolimus monotherapy in nephrotoxicity due to calcineurin inhibitors in liver transplant recipients. Liver Transpl. Feb 2003;9(2):126-9. [Medline].
Yoo HY, Thuluvath PJ. Short-term postliver transplant survival after the introduction of MELD scores for organ allocation in the United States. Liver Int. Jun 2005;25(3):536-41. [Medline].
Bajaj JS, Saeian K. MELD score does not discriminate against patients with hepatic encephalopathy. Dig Dis Sci. Apr 2005;50(4):753-6. [Medline].
Freeman RB, Wiesner RH, Edwards E, Harper A, Merion R, Wolfe R. Results of the first year of the new liver allocation plan. Liver Transpl. Jan 2004;10(1):7-15. [Medline].
Gonwa TA, McBride MA, Anderson K, Mai ML, Wadei H, Ahsan N. Continued influence of preoperative renal function on outcome of orthotopic liver transplant (OLTX) in the US: where will MELD lead us?. Am J Transplant. Nov 2006;6(11):2651-9. [Medline].
Onaca NN, Levy MF, Sanchez EQ, et al. A correlation between the pretransplantation MELD score and mortality in the first two years after liver transplantation. Liver Transpl. Feb 2003;9(2):117-23. [Medline].
Haydon GH, Hiltunen Y, Lucey MR, et al. Self-organizing maps can determine outcome and match recipients and donors at orthotopic liver transplantation. Transplantation. Jan 27 2005;79(2):213-8. [Medline].
Yao FY, Ferrell L, Bass NM, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology. Jun 2001;33(6):1394-403. [Medline].
Decaens T, Roudot-Thoraval F, Hadni-Bresson S, et al. Impact of UCSF criteria according to pre- and post-OLT tumor features: analysis of 479 patients listed for HCC with a short waiting time. Liver Transpl. Dec 2006;12(12):1761-9. [Medline].
Lesurtel M, Mullhaupt B, Pestalozzi BC, Pfammatter T, Clavien PA. Transarterial chemoembolization as a bridge to liver transplantation for hepatocellular carcinoma: an evidence-based analysis. Am J Transplant. Nov 2006;6(11):2644-50. [Medline].
Kim do Y, Choi MS, Lee JH, et al. Milan criteria are useful predictors for favorable outcomes in hepatocellular carcinoma patients undergoing liver transplantation after transarterial chemoembolization. World J Gastroenterol. Nov 21 2006;12(43):6992-7. [Medline].
Millonig G, Graziadei IW, Freund MC, et al. Response to preoperative chemoembolization correlates with outcome after liver transplantation in patients with hepatocellular carcinoma. Liver Transpl. Feb 2007;13(2):272-9. [Medline].
Ragni MV, Belle SH, Im K, Neff G, Roland M, Stock P, et al. Survival of human immunodeficiency virus-infected liver transplant recipients. J Infect Dis. Nov 15 2003;188(10):1412-20. [Medline].
Stock PG, Roland ME, Carlson L, et al. Kidney and liver transplantation in human immunodeficiency virus-infected patients: a pilot safety and efficacy study. Transplantation. Jul 27 2003;76(2):370-5. [Medline].
HIV positive and HIV negative patients have similar survival rates following liver transplant. Presented April 24, 2009 at the Annual Meeting of the European Association for the Study of the Liver. [Full Text].
Roland ME, Barin B, Carlson L, Frassetto LA, Terrault NA, Hirose R. HIV-infected liver and kidney transplant recipients: 1- and 3-year outcomes. Am J Transplant. Feb 2008;8(2):355-65. [Medline].
de Vera ME, Dvorchik I, Tom K, et al. Survival of liver transplant patients coinfected with HIV and HCV is adversely impacted by recurrent hepatitis C. Am J Transplant. Dec 2006;6(12):2983-93. [Medline].
Duclos-Vallee JC, Feray C, Sebagh M, Teicher E, Roque-Afonso AM, Roche B. Survival and recurrence of hepatitis C after liver transplantation in patients coinfected with human immunodeficiency virus and hepatitis C virus. Hepatology. Feb 2008;47(2):407-17. [Medline].
Andreu M, Sola R, Sitges-Serra A, et al. Risk factors for spontaneous bacterial peritonitis in cirrhotic patients with ascites. Gastroenterology. Apr 1993;104(4):1133-8. [Medline].
Arroyo V, Gines P, Gerbes AL, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology. Jan 1996;23(1):164-76. [Medline].
Badalamenti S, Graziani G, Salerno F, Ponticelli C. Hepatorenal syndrome. New perspectives in pathogenesis and treatment. Arch Intern Med. Sep 13 1993;153(17):1957-67. [Medline].
Bernard B, Lebrec D, Mathurin P, et al. Propranolol and sclerotherapy in the prevention of gastrointestinal rebleeding in patients with cirrhosis: a meta-analysis. J Hepatol. Feb 1997;26(2):312-24. [Medline].
Boker KH, Dalley G, Bahr MJ, et al. Long-term outcome of hepatitis C virus infection after liver transplantation. Hepatology. Jan 1997;25(1):203-10. [Medline].
Bourgeois N, Deviere J, Yeaton P, et al. Diagnostic and therapeutic endoscopic retrograde cholangiography after liver transplantation. Gastrointest Endosc. Dec 1995;42(6):527-34. [Medline].
Broelsch CE, Burdelski M, Rogiers X, et al. Living donor for liver transplantation. Hepatology. Jul 1994;20(1 Pt 2):49S-55S. [Medline].
Bronster DJ, Emre S, Mor E, et al. Neurologic complications of orthotopic liver transplantation. Mt Sinai J Med. Jan 1994;61(1):63-9. [Medline].
Bussutil RW, Klintmalm GB, eds. Transplantation of the Liver. Philadelphia, Pa: WB Saunders; 1996.
Bzeizi KI, Jalan R, Plevris JN, Hayes PC. Primary graft dysfunction after liver transplantation: from pathogenesis to prevention. Liver Transpl Surg. Mar 1997;3(2):137-48. [Medline].
Cakaloglu Y, Tredger JM, Devlin J, Williams R. Importance of cytochrome P-450IIIA activity in determining dosage and blood levels of FK 506 and cyclosporine in liver transplant recipients. Hepatology. Aug 1994;20(2):309-16. [Medline].
Canzanello VJ, Schwartz L, Taler SJ, et al. Evolution of cardiovascular risk after liver transplantation: a comparison of cyclosporine A and tacrolimus (FK506). Liver Transpl Surg. Jan 1997;3(1):1-9. [Medline].
Caplan A. Must I be my brother's keeper? Ethical issues in the use of living donors as sources of liver and other solid organs. Transplant Proc. Apr 1993;25(2):1997-2000. [Medline].
Castells L, Escartín A, Bilbao I, Len O, Allende H, Vargas V. Liver transplantation in HIV-HCV coinfected patients: a case-control study. Transplantation. Feb 15 2007;83(3):354-8. [Medline].
Centers for Disease Control and Prevention. National Vital Statistics Report. 2001;49 (3):June 26.
Child CG, Turcotte JG. Surgery and portal hypertension. In: The Liver and Portal Hypertension. Philadelphia, Pa: WB Saunders; 1964.
Cooper GS, Bellamy P, Dawson NV, et al. A prognostic model for patients with end-stage liver disease. Gastroenterology. Oct 1997;113(4):1278-88. [Medline].
Cosimi AB, Cho SI, Delmonico FL, et al. A randomized clinical trial comparing OKT3 and steroids for treatment of hepatic allograft rejection. Transplantation. Jan 1987;43(1):91-5. [Medline].
D'Alessandro AM, Ploeg RJ, Knechtle SJ, Pirsch JD, Stegall MD, Hoffmann R, et al. Retransplantation of the liver--a seven-year experience. Transplantation. May 1993;55(5):1083-7. [Medline].
D'Amico G, Morabito A, Pagliaro L, Marubini E. Survival and prognostic indicators in compensated and decompensated cirrhosis. Dig Dis Sci. May 1986;31(5):468-75. [Medline].
D'Amico G, Pagliaro L, Bosch J. The treatment of portal hypertension: a meta-analytic review. Hepatology. Jul 1995;22(1):332-54. [Medline].
Darby JM, Stein K, Grenvik A, Stuart SA. Approach to management of the heartbeating 'brain dead' organ donor. JAMA. Apr 21 1989;261(15):2222-8. [Medline].
Ding YT, Xu QX, Qiu YD. Molecular adsorbent recycling system in treating patients with acute liver failure: a bridge to liver transplantation. Hepatobiliary Pancreat Dis Int. Nov 2004;3(4):508-10. [Medline].
Dodd GD 3rd, Memel DS, Zajko AB, et al. Hepatic artery stenosis and thrombosis in transplant recipients: Doppler diagnosis with resistive index and systolic acceleration time. Radiology. Sep 1994;192(3):657-61. [Medline].
Dodson SF, Issa S, Bonham A. Liver transplantation for chronic viral hepatitis. Surg Clin North Am. Feb 1999;79(1):131-45. [Medline].
Dravid VS, Shapiro MJ, Needleman L, et al. Arterial abnormalities following orthotopic liver transplantation: arteriographic findings and correlation with Doppler sonographic findings. AJR Am J Roentgenol. Sep 1994;163(3):585-9. [Medline].
Emond JC, Whitington PF, Thistlethwaite JR, et al. Transplantation of two patients with one liver. Analysis of a preliminary experience with "split-liver" grafting. Ann Surg. Jul 1990;212(1):14-22. [Medline].
Farmer DG, Rosove MH, Shaked A, Busuttil RW. Current treatment modalities for hepatocellular carcinoma. Ann Surg. Mar 1994;219(3):236-47. [Medline].
Ferenci P, Herneth A, Steindl P. Newer approaches to therapy of hepatic encephalopathy. Semin Liver Dis. Aug 1996;16(3):329-38. [Medline].
Fingerote RJ, Bain VG. Fulminant hepatic failure. Am J Gastroenterol. Jul 1993;88(7):1000-10. [Medline].
Flye MW, ed. Principles of Organ Transplantation. Philadelphia, Pa: WB Saunders; 1989.
Fong TL, Akriviadis EA, Runyon BA, Reynolds TB. Polymorphonuclear cell count response and duration of antibiotic therapy in spontaneous bacterial peritonitis. Hepatology. Mar 1989;9(3):423-6. [Medline].
Freese DK, Snover DC, Sharp HL, et al. Chronic rejection after liver transplantation: a study of clinical, histopathological and immunological features. Hepatology. May 1991;13(5):882-91. [Medline].
Fung JJ, Eliasziw M, Todo S, et al. The Pittsburgh randomized trial of tacrolimus compared to cyclosporine for hepatic transplantation. J Am Coll Surg. Aug 1996;183(2):117-25. [Medline].
Fung JJ, Todo S, Jain A, et al. Conversion from cyclosporine to FK 506 in liver allograft recipients with cyclosporine-related complications. Transplant Proc. Feb 1990;22(1):6-12. [Medline].
Goldstein RM, Secrest CL, Klintmalm GB, et al. Problematic vascular reconstruction in liver transplantation. Part I. Arterial. Surgery. May 1990;107(5):540-3. [Medline].
Grazi GL, Mazziotti A, Sama C, et al. Reversal of primary liver graft non-function using prostaglandins. Hepatogastroenterology. Jun 1991;38(3):254-6. [Medline].
Greig PD, Woolf GM, Sinclair SB, et al. Treatment of primary liver graft nonfunction with prostaglandin E1. Transplantation. Sep 1989;48(3):447-53. [Medline].
Hemming AW, Greig PD, Cattral MS, et al. A microemulsion of cyclosporine without intravenous cyclosporine in liver transplantation. Transplantation. Dec 27 1996;62(12):1798-802. [Medline].
Herrero JI, Quiroga J, Sangro B, et al. Conversion of liver transplant recipients on cyclosporine with renal impairment to mycophenolate mofetil. Liver Transpl Surg. Sep 1999;5(5):414-20. [Medline].
Hillaire S, Labianca M, Borgonovo G, et al. Peritoneovenous shunting of intractable ascites in patients with cirrhosis: improving results and predictive factors of failure. Surgery. Apr 1993;113(4):373-9. [Medline].
Hoofnagle JH, Kresina T, Fuller RK, et al. Liver transplantation for alcoholic liver disease: executive statement and recommendations. Summary of a National Institutes of Health workshop held December 6-7, 1996, Bethesda, Maryland. Liver Transpl Surg. May 1997;3(3):347-50. [Medline].
Hughes RD, Williams R. Evaluation of extracorporeal bioartificial liver devices. Liver Transpl Surg. May 1995;1(3):200-6. [Medline].
Inadomi J, Sonnenberg A. Cost-analysis of prophylactic antibiotics in spontaneous bacterial peritonitis. Gastroenterology. Oct 1997;113(4):1289-94. [Medline].
Jurim O, Shackleton CR, McDiarmid SV, et al. Living-donor liver transplantation at UCLA. Am J Surg. May 1995;169(5):529-32. [Medline].
Jurim O, Shaked A, Kiai K, et al. Celiac compression syndrome and liver transplantation. Ann Surg. Jul 1993;218(1):10-2. [Medline].
Keeffe EB. Summary of guidelines on organ allocation and patient listing for liver transplantation. Liver Transpl Surg. Sep 1998;4(5 Suppl 1):S108-14. [Medline].
Kim WR, Wiesner RH, Therneau TM, et al. Optimal timing of liver transplantation for primary biliary cirrhosis. Hepatology. Jul 1998;28(1):33-8. [Medline].
Kirsch JP, Howard TK, Klintmalm GB, et al. Problematic vascular reconstruction in liver transplantation. Part II. Portovenous conduits. Surgery. May 1990;107(5):544-8. [Medline].
Kleber G, Sauerbruch T, Ansari H, Paumgartner G. Prediction of variceal hemorrhage in cirrhosis: a prospective follow-up study. Gastroenterology. May 1991;100(5 Pt 1):1332-7. [Medline].
Klein AS, Savader S, Burdick JF, et al. Reduction of morbidity and mortality from biliary complications after liver transplantation. Hepatology. Nov 1991;14(5):818-23. [Medline].
Klintmalm GB, Gonwa TA. Nephrotoxicity associated with cyclosporine and FK506. Liver Transpl Surg. Sep 1995;1(5 Suppl 1):11-9. [Medline].
Kondrup J, Muller MJ. Energy and protein requirements of patients with chronic liver disease. J Hepatol. Jul 1997;27(1):239-47. [Medline].
Krowka MJ. Hepatopulmonary syndrome: what are we learning from interventional radiology, liver transplantation, and other disorders?. Gastroenterology. Sep 1995;109(3):1009-13. [Medline].
Laghi A, Pavone P, Catalano C, et al. MR cholangiography of late biliary complications after liver transplantation. AJR Am J Roentgenol. Jun 1999;172(6):1541-6. [Medline].
Lake JR. Changing indications for liver transplantation. Gastroenterol Clin North Am. Jun 1993;22(2):213-29. [Medline].
Langnas AN, Marujo W, Stratta RJ, et al. Vascular complications after orthotopic liver transplantation. Am J Surg. Jan 1991;161(1):76-82; discussion 82-3. [Medline].
Lemmer ER, Spearman CW, Krige JE, et al. The management of biliary complications following orthotopic liver transplantation. S Afr J Surg. May 1997;35(2):77-81. [Medline].
Lerut J, Tzakis AG, Bron K, et al. Complications of venous reconstruction in human orthotopic liver transplantation. Ann Surg. Apr 1987;205(4):404-14. [Medline].
Lidofsky SD, Bass NM, Prager MC, et al. Intracranial pressure monitoring and liver transplantation for fulminant hepatic failure. Hepatology. Jul 1992;16(1):1-7. [Medline].
Linas SL, Schaefer JW, Moore EE, et al. Peritoneovenous shunt in the management of the hepatorenal syndrome. Kidney Int. Nov 1986;30(5):736-40. [Medline].
Lu Y, Wang B, Yu L. Lamivudine in prevention and treatment of recurrent HBV after liver transplantation. Hepatobiliary Pancreat Dis Int. Nov 2004;3(4):504-7. [Medline].
Lucey MR, Brown KA, Everson GT, et al. Minimal criteria for placement of adults on the liver transplant waiting list: a report of a national conference organized by the American Society of Transplant Physicians and the American Association for the Study of Liver Diseases. Liver Transpl Surg. Nov 1997;3(6):628-37. [Medline].
Luxon BA. Liver transplantation. Who should be referred--and when?. Postgrad Med. Dec 1997;102(6):103-8, 113. [Medline].
Macedo G, Maia JC, Gomes A, et al. The role of transjugular liver biopsy in a liver transplant center. J Clin Gastroenterol. Sep 1999;29(2):155-7. [Medline].
Malloy PC, Marx MV. Diagnosis and management of biliary complications after orthotopic liver transplantation. In: LaBerge JM, Venbrux AC, eds. Biliary Interventions. San Francisco, Calif: Society of Cardiovascular & Interventional Radiology; 1995:259-80.
Manzarbeitia C, Reich DJ, Rothstein KD, et al. Tacrolimus conversion improves hyperlipidemic states in stable liver transplant recipients. Liver Transpl. Feb 2001;7(2):93-9. [Medline].
Maraj R, Jacobs LE, Contreras R, et al. Is An Inducible Left Ventricular Outflow Tract Gradient During Dobutamine Echocardiography A Contraindication to Liver Transplant. Hepatology. 2000;32(4).
Marcos A, Fisher RA, Ham JM, et al. Right lobe living donor liver transplantation. Transplantation. Sep 27 1999;68(6):798-803. [Medline].
Markmann JF, Markowitz JS, Yersiz H, et al. Long-term survival after retransplantation of the liver. Ann Surg. Oct 1997;226(4):408-18; discussion 418-20. [Medline].
Matsuzaki Y, Tanaka N, Osuga T, et al. Improvement of biliary enzyme levels and itching as a result of long- term administration of ursodeoxycholic acid in primary biliary cirrhosis. Am J Gastroenterol. Jan 1990;85(1):15-23. [Medline].
Mazariegos GV, Molmenti EP, Kramer DJ. Early complications after orthotopic liver transplantation. Surg Clin North Am. Feb 1999;79(1):109-29. [Medline].
Mazzaferro V, Esquivel CO, Makowka L, et al. Hepatic artery thrombosis after pediatric liver transplantation--a medical or surgical event?. Transplantation. Jun 1989;47(6):971-7. [Medline].
Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. Mar 14 1996;334(11):693-9. [Medline].
McDiarmid SV, Colonna JO 2nd, Shaked A, et al. A comparison of renal function in cyclosporine- and FK-506-treated patients after primary orthotopic liver transplantation. Transplantation. Oct 1993;56(4):847-53. [Medline].
McGory RW, Ishitani MB, Oliveira WM, et al. Improved outcome of orthotopic liver transplantation for chronic hepatitis B cirrhosis with aggressive passive immunization. Transplantation. May 15 1996;61(9):1358-64. [Medline].
Miller CM, Mazzaferro V, Makowka L, et al. Rapid flush technique for donor hepatectomy: safety and efficacy of an improved method of liver recovery for transplantation. Transplant Proc. 1988;20:948-50.
National Institutes of Health. National Institutes of Health Consensus Development Conference Statement: liver transplantation--June 20-23, 1983. Hepatology. Jan-Feb 1984;4(1 Suppl):107S-110S. [Medline].
Neff GW, Bonham A, Tzakis AG, et al. Orthotopic liver transplantation in patients with human immunodeficiency virus and end-stage liver disease. Liver Transpl. Mar 2003;9(3):239-47. [Medline].
Neff GW, Sherman KE, Eghtesad B. Review article: current status of liver transplantation in HIV-infected patients. Aliment Pharmacol Ther. Nov 15 2004;20(10):993-1000. [Medline].
Nghiem HV. Imaging of hepatic transplantation. Radiol Clin North Am. Mar 1998;36(2):429-43. [Medline].
No authors listed. Treatment of hepatic artery thrombosis after orthotopic liver transplantation. Asian J Surg. 7 2004;27(3):218.
O'Connor TP, Lewis WD, Jenkins RL. Biliary tract complications after liver transplantation. Arch Surg. Mar 1995;130(3):312-7. [Medline].
O'Grady JG, Alexander GJ, Hayllar KM, Williams R. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology. Aug 1989;97(2):439-45. [Medline].
Ormonde DG, de Boer WB, Kierath A, et al. Banff schema for grading liver allograft rejection: utility in clinical practice. Liver Transpl Surg. Jul 1999;5(4):261-8. [Medline].
Otte JB, de Ville de Goyet J, Sokal E. Size reduction of the donor liver is a safe way to alleviate the shortage of size-matched organs in pediatric liver transplantation. Ann Surg. Feb 1990;211(2):146-57. [Medline].
Pagliaro L, D'Amico G, Sorensen TI, et al. Prevention of first bleeding in cirrhosis. A meta-analysis of randomized trials of nonsurgical treatment. Ann Intern Med. Jul 1 1992;117(1):59-70. [Medline].
Patenaude YG, Dubois J, Sinsky AB, et al. Liver transplantation: review of the literature. Part 2: Vascular and biliary complications. Can Assoc Radiol J. Aug 1997;48(4):231-42. [Medline].
Patience C, Takeuchi Y, Weiss RA. Infection of human cells by an endogenous retrovirus of pigs. Nat Med. Mar 1997;3(3):282-6. [Medline].
Pauwels A, Mostefa-Kara N, Debenes B, et al. Systemic antibiotic prophylaxis after gastrointestinal hemorrhage in cirrhotic patients with a high risk of infection. Hepatology. Oct 1996;24(4):802-6. [Medline].
Paya CV, Hermans PE, Wiesner RH, et al. Cytomegalovirus hepatitis in liver transplantation: prospective analysis of 93 consecutive orthotopic liver transplantations. J Infect Dis. Nov 1989;160(5):752-8. [Medline].
Penn I. The effect of immunosuppression on pre-existing cancers. Transplantation. Apr 1993;55(4):742-7. [Medline].
Perrillo R, Rakela J, Martin P, et al. Long-term lamivudine therapy of patients with recurrent hepatitis B post liver transplantation. Hepatology. 1997;26:177A.
Ploeg RJ, D'Alessandro AM, Knechtle SJ, et al. Risk factors for primary dysfunction after liver transplantation--a multivariate analysis. Transplantation. Apr 1993;55(4):807-13. [Medline].
Podesta A, Lopez P, Terg R, et al. Treatment of pruritus of primary biliary cirrhosis with rifampin. Dig Dis Sci. Feb 1991;36(2):216-20. [Medline].
Poles MA, Martin P. Routine endoscopy in liver transplant candidates: is it indicated?. Am J Gastroenterol. Apr 1999;94(4):871-2. [Medline].
Porayko MK, Kondo M, Steers JL. Liver transplantation: late complications of the biliary tract and their management. Semin Liver Dis. May 1995;15(2):139-55. [Medline].
Reich D, Rothstein K, Manzarbeitia C, Munoz S. Common medical diseases after liver transplantation. Semin Gastrointest Dis. Jul 1998;9(3):110-25. [Medline].
Reich D, Sharieff K, Behrend J, Manzarbeitia C. Venovenous bypass in liver transplantation. Graft - Organ and Cell Transplantation. 2000;3:81-5.
Reich DJ, Munoz SJ, Rothstein KD, et al. Controlled non-heart-beating donor liver transplantation: a successful single center experience, with topic update. Transplantation. Oct 27 2000;70(8):1159-66. [Medline].
Reyes J, Iwatsuki S. Current management of portal hypertension with liver transplantation. Adv Surg. 1992;25:189-208. [Medline].
Reyes J, Mazariegos GV. Pediatric transplantation. Surg Clin North Am. Feb 1999;79(1):163-89. [Medline].
Rosen HR, Shackleton CR, Martin P. Indications for and timing of liver transplantation. Med Clin North Am. Sep 1996;80(5):1069-102. [Medline].
Rubin R, Munoz SJ. Clinicopathologic features of late hepatic dysfunction in orthotopic liver transplants. Hum Pathol. Jun 1993;24(6):643-51. [Medline].
Runyon BA. Management of adult patients with ascites caused by cirrhosis. Hepatology. Jan 1998;27(1):264-72. [Medline].
Runyon BA, Antillon MR, Akriviadis EA, McHutchison JG. Bedside inoculation of blood culture bottles with ascitic fluid is superior to delayed inoculation in the detection of spontaneous bacterial peritonitis. J Clin Microbiol. Dec 1990;28(12):2811-2. [Medline].
Runyon BA, McHutchison JG, Antillon MR, et al. Short-course versus long-course antibiotic treatment of spontaneous bacterial peritonitis. A randomized controlled study of 100 patients. Gastroenterology. Jun 1991;100(6):1737-42. [Medline].
Rustgi VK. Epstein-Barr viral infection and posttransplantation lymphoproliferative disorders. Liver Transpl Surg. Sep 1995;1(5 Suppl 1):100-8. [Medline].
Sale GE, Snover DC, Radio SJ. Transplantation pathology. In: Danjanou J, Linder F, eds. Anderson's Pathology. 10th ed. St. Louis: Mo: Mosby; 1996:663.
Sanchez-Urdazpal L, Gores GJ, Ward EM, et al. Ischemic-type biliary complications after orthotopic liver transplantation. Hepatology. Jul 1992;16(1):49-53. [Medline].
Sanyal AJ. The management of the cirrhotic patient after transjugular intrahepatic portosystemic shunt. Semin Gastrointest Dis. Oct 1997;8(4):188-99. [Medline].
Sanyal AJ, Freedman AM, Luketic VA, et al. Transjugular intrahepatic portosystemic shunts compared with endoscopic sclerotherapy for the prevention of recurrent variceal hemorrhage. A randomized, controlled trial. Ann Intern Med. Jun 1 1997;126(11):849-57. [Medline].
Sarin SK, Lamba GS, Kumar M, et al. Comparison of endoscopic ligation and propranolol for the primary prevention of variceal bleeding. N Engl J Med. Apr 1 1999;340(13):988-93. [Medline].
Schalm SW, van Buuren HR. Prevention of recurrent variceal bleeding: non-surgical procedures. Clin Gastroenterol. Jan 1985;14(1):209-32. [Medline].
Schmilovitz-Weiss H, Ben-Ari Z, Sikuler E. Lamivudine treatment for acute severe hepatitis B: a pilot study. Liver Int. Dec 2004;24(6):547-51. [Medline].
Schneider AW, Kalk JF, Klein CP. Effect of losartan, an angiotensin II receptor antagonist, on portal pressure in cirrhosis. Hepatology. Feb 1999;29(2):334-9. [Medline].
Shaked A, Busuttil RW. Liver transplantation in patients with portal vein thrombosis and central portacaval shunts. Ann Surg. Dec 1991;214(6):696-702. [Medline].
Sheiner PA, Schluger LK, Emre S, et al. Retransplantation for recurrent hepatitis C. Liver Transpl Surg. Mar 1997;3(2):130-6. [Medline].
Shiffman ML, Jeffers L, Hoofnagle JH, Tralka TS. The role of transjugular intrahepatic portosystemic shunt for treatment of portal hypertension and its complications: a conference sponsored by the National Digestive Diseases Advisory Board. Hepatology. Nov 1995;22(5):1591-7. [Medline].
Siegelman ES, Outwater EK. MR imaging techniques of the liver. Radiol Clin North Am. Mar 1998;36(2):263-86. [Medline].
Singh N. The current management of infectious diseases in the liver transplant recipient. Clin Liver Dis. Aug 2000;4(3):657-73, ix. [Medline].
Singh N, Gayowski T, Wagener MM, et al. Pulmonary infiltrates in liver transplant recipients in the intensive care unit. Transplantation. Apr 27 1999;67(8):1138-44. [Medline].
Snowden CP, Hughes T, Rose J, et al. Pulmonary edema in patients after liver transplantation. Liver Transpl. Jul 2000;6(4):466-70. [Medline].
Soifer B, Gelb AW. The multiple organ donor: identification and management. Ann Intern Med. May 15 1989;110(10):814-23. [Medline].
Somberg KA, Lake JR, Doherty MM, et al. The clinical course following transjugular intrahepatic portosystemic shunts (TIPS) in liver transplant candidates. Hepatology. 1993;18:103A.
Stanley MM, Ochi S, Lee KK, et al. Peritoneovenous shunting as compared with medical treatment in patients with alcoholic cirrhosis and massive ascites. Veterans Administration Cooperative Study on Treatment of Alcoholic Cirrhosis with Ascites. N Engl J Med. Dec 14 1989;321(24):1632-8. [Medline].
Starzl TE, Miller CM, Rappaport FT. Algorithm and explantation: approach to the potential organ donor. Miscellaneous care problems. In: American College of Surgeons: Care of the Surgical Patient, Elective Care. New York, NY: Scientific American; 1990:Chap 10.
Stieber AC, Gordon RD, Todo S, et al. Liver transplantation in patients over sixty years of age. Transplantation. Jan 1991;51(1):271-3. [Medline].
Stratta RJ, Wood RP, Langnas AN, et al. Diagnosis and treatment of biliary tract complications after orthotopic liver transplantation. Surgery. Oct 1989;106(4):675-83; discussion 683-4. [Medline].
Takaoka F, Brown MR, Paulsen AW, et al. Adult respiratory distress syndrome following orthotopic liver transplantation. Clin Transplant. 1989;3:294-9.
Taler SJ, Textor SC, Canzanello VJ, et al. Role of steroid dose in hypertension early after liver transplantation with tacrolimus (FK506) and cyclosporine. Transplantation. Dec 15 1996;62(11):1588-92. [Medline].
Tanaka K, Uemoto S, Tokunaga Y, et al. Surgical techniques and innovations in living related liver transplantation. Ann Surg. Jan 1993;217(1):82-91. [Medline].
Taylor HM, Ros PR. Hepatic imaging. An overview. Radiol Clin North Am. Mar 1998;36(2):237-45. [Medline].
Teran JC, Imperiale TF, Mullen KD, et al. Primary prophylaxis of variceal bleeding in cirrhosis: a cost- effectiveness analysis. Gastroenterology. Feb 1997;112(2):473-82. [Medline].
Terra SG, Tsunoda SM. Opioid antagonists in the treatment of pruritus from cholestatic liver disease. Ann Pharmacother. Nov 1998;32(11):1228-30. [Medline].
Tian MG, Tso WK, Lo CM. Treatment of hepatic artery thrombosis after orthotopic liver transplantation. Asian J Surg. Jul 2004;27(3):213-7; discussion 218. [Medline].
Tito L, Rimola A, Gines P, et al. Recurrence of spontaneous bacterial peritonitis in cirrhosis: frequency and predictive factors. Hepatology. Jan-Feb 1988;8(1):27-31. [Medline].
Todo S, Makowka L, Tzakis AG, et al. Hepatic artery in liver transplantation. Transplant Proc. Feb 1987;19(1 Pt 3):2406-11. [Medline].
Trevitt R, Whittaker C, Ball EA. Evaluation of potential transplant recipients and living donors. EDTNA ERCA J. Jan-Mar 2000;26(1):26-8. [Medline].
Tzakis A, Todo S, Stieber A, et al. Venous jump grafts for liver transplantation in patients with portal vein thrombosis. Transplantation. Sep 1989;48(3):530-1. [Medline].
Tzakis AG, Cooper MH, Dummer JS, et al. Transplantation in HIV+ patients. Transplantation. Feb 1990;49(2):354-8. [Medline].
Uriz J, Gines P, Cardenas A, et al. Terlipressin plus albumin infusion: an effective and safe therapy of hepatorenal syndrome. J Hepatol. Jul 2000;33(1):43-8. [Medline].
Wiesner RH. Liver transplantation for primary biliary cirrhosis and primary sclerosing cholangitis: predicting outcomes with natural history models. Mayo Clin Proc. Jun 1998;73(6):575-88. [Medline].
Winston DJ, Emmanouilides C, Busuttil RW. Infections in liver transplant recipients. Clin Infect Dis. Nov 1995;21(5):1077-89; quiz 1090-1. [Medline].
Wong T, Devlin J, Rolando N, et al. Clinical characteristics affecting the outcome of liver retransplantation. Transplantation. Sep 27 1997;64(6):878-82. [Medline].
Yang MD, Wu CC, Chen HC, et al. Biliary complications in long-term recipients of reduced-size liver transplants. Transplant Proc. Jun 1996;28(3):1680-1. [Medline].
Young JB. Clinical Trends in Transplant Survival. In: AST Lectures in Transplantation. Mt. Laurel, NJ: American Society of Transplantation; 2000.
Zajko AB, Sheng R, Bron K, et al. Percutaneous transluminal angioplasty of venous anastomotic stenoses complicating liver transplantation: intermediate-term results. J Vasc Interv Radiol. Jan-Feb 1994;5(1):121-6. [Medline].
Further Reading
Keywords
liver transplant, liver transplantation, LT, hepatic transplantation, liver replacement, liver allografting, transplant, orthotopic liver transplantation, OLT, living donor transplant, living-donor transplant, split-liver transplant, split liver transplant, total hepatectomy, cirrhosis, alcoholism, alcohol abuse, alcohol dependence
