Andreas G. Tzakis

Early tolerance in pediatric liver allograft recipients.

The authors report on six pediatric liver transplant recipients for whom allograft tolerance occurred shortly after transplantation (ie, less than 1.5 years). All the patients had associated life-threatening viral complications. They are currently immunocompetent. The tolerant state may be related to the development of a TH2 cytokine pattern.

Early experience with FK 506 in liver transplantation

Since the introduction of cyclosporine-steroid therapy in 1980 for liver transplantation, 1 year clinical survival rates have approached 70% for most of the common indications for liver replacement and 5 year survival rates are better than 60%. Nevertheless, allograft rejection continues to be a significant cause of retransplantation or death. Clinical rejection occurs in 70% of liver allograft recipients on cyclosporine-steroid therapy. Many patients require treatment with polyclonal or monoclonal antibody preparations to control acute cellular rejection. An increased risk of opportunistic infection, especially from cytomegalovirus, is associated with such therapy.

Early clinical experience with cluster resection and transplantation for right upper quadrant abdominal malignancy

Liver transplantation for primary tumors originating in the liver or biliary tree, not suitable because of location of extent for subtotal hepatic resection, has been disappointing. So has liver transplantation for tumors metastatic to the liver. Although many patients receiving a liver transplant for malignant disease are technically easier to operate on than patients with cirrhosis and such patients often make a swift postoperative recovery, disease recurrences within 6 to 18 months is common despite the additional field of resection a transplant hepatectomy can provide. Patients with disease extending beyond the liver capsule, into regional lymph nodes, or into major vascular structures such as the portal vein or vena cava, have a particularly poor prognosis and are probably not suitable candidates for liver transplantation alone.