Daniel Jaeck

Chronic inflammatory demyelinating polyradiculoneuropathy in patients with liver transplantation.

We report two patients with orthotopic liver transplantation (OLT) who developed a syndrome that fulfilled criteria for definite chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). One patient had OLT because of alcoholic cirrhosis and one following hepatitis C–induced hepatic failure. Both had immunosuppressive therapy, with cyclosporine and prednisolone in one case and tacrolimus in the other case. Treatment with intravenous immune globulin (IVIG) significantly improved the neuropathy in both patients. In patients with OLT developing disabling sensorimotor neuropathies, CIDP should be considered as should the use of potentially beneficial immunosuppressive treatment. Muscle Nerve 30: 501–504, 2004

Orthotopic Liver Transplantation with a Suprahepatic Vena Caval Anastomosis Over a Transjugular Intrahepatic Portosystemic Shunt

Orthotopic liver transplantation (OLT) is now the optimal treatment for patients with end-stage liver disease and portal hypertension, but severe esophageal bleeding can occur during the waiting time for donor organs. The transjugular intrahepatic portosystemic shunt (TIPS), using expandable metallic stents, allows efficient portal decompression and has proved to prevent the risk of hemorrhage. One of the major technical complications of TIPS is misplacement of the stents too far into the main portal vein or into the suprahepatic inferior vena cava (SHVC) or the right atrium, where they can seriously jeopardize the transplant operation. These technical problems are described in two of our patients with TIPS misplacement into the SHVC.

Nontraditional Resection Including the Two-Stage Hepatectomy

Liver surgery can only be offered to approximately 20% of patients with colorectal liver metastases, provided that the primary tumor is controlled. Currently, a selected subgroup of the remaining 80% of the patients, who were initially considered as unresectable and were assigned to receive palliative chemotherapy, may benefit from liver surgery and often require a multidisciplinary approach in order to achieve a curative liver resection. This multidisciplinary approach may also use additional methods such as radiofrequency, portal vein embolization, and downsizing or conversion chemotherapy. The combination of these different therapies resulted in the development of nontraditional liver resection techniques including the so-called two-stage hepatectomy procedure. The aim of these strategies is to achieve a complete tumoral resection in a curative intent, to increase safely the indications of liver resection for patients presenting with initially unresectable liver metastases, and to offer to them similar results in term of short- and long-term outcome to that observed in patients with initially resectable liver metastases.

Liver Transplantation in Malignant Disease

Since the inception of liver transplantation, the indications for use of this procedure in malignant disease has been considered. Since 20-30% of patients with primary hepatic malignancy are suitable for resection, liver transplantation offered a more radical surgical approach allowing complete removal of the primary lesion. It also avoided both the problem of liver failure from insufficient volume of the remnant liver and underlying chronic hepatic disease, such as cirrhosis. However, poor survival and the high rate of tumour recurrence put a curb on liver transplantation for hepatic malignancies.