I Garcı́a

Reuse of Liver Grafts after Early Death of the First Recipient

Abstract. Three cases are reported of reuse of a transplanted liver graft after early death of the first recipient due to cerebral hemorrhage. The good condition of the donors; the excellent biochemical evolution of the graft in the first recipients; total ABO compatibility and donor-recipient crossmatch; the absence of positivity to hepatitis B virus (HBV), hepatitis C virus (HCV), and bacteriologic cultures; and early death made reuse possible. The shortage of donors in relation to patients on the waiting list and the poor clinical condition of the second recipients made it necessary to adopt the decision to reuse the graft in an attempt to save their lives. The evolution of the patients and the reused grafts was satisfactory, and there were no complications that could be attributed to the fact that the graft had been transplanted before.

Upper aerodigestive tract and lung tumors after liver transplantation

BACKGROUND The purpose of this study was to analyze the incidence, clinical characteristics, treatment, and outcome of upper aerodigestive (UAD) and lung de novo tumors after ortothopic liver transplantation (OLT). PATIENTS AND METHODS Between April 1986 and June 2002, we performed 851 OLT in 753 patients. We excluded pediatric, partial, and hepatorenal transplants and recipients who died within 2 months after OLT. Thus, we analyzed the incidence and outcome of these tumors in 605 patients after OLT. RESULTS We found 21 (3.5%) tumors in 20 (3.3%) recipients: 14 were UAD tumors (three in floor of the mouth, two in tonsil, one in tongue, one in pharynx, three in larynx, and four in esophagus) and seven were lung tumors. Nineteen patients were men and one was a woman, with a mean age at transplantation of 47.7+/-8.6 years. Mean time from OLT to tumor diagnosis was 61.7+/-35.1 years. As risk factors, 70% were heavy smokers, 75% were heavy drinkers, and 70% developed acute rejection. The incidence of these tumors was significantly higher in transplanted patients for alcoholic cirrhosis compared to the nonalcoholic cirrhosis (8.1% vs 0.8%; P<.0001). After surgical excision in 65% of patients, 1-, 2-, and 3-year patient survival were 47.6%, 37.0%, and 19.7%, respectively. CONCLUSION There is a significantly higher incidence of these tumors in male heavy drinkers and/or smokers who underwent OLT for alcoholic cirrhosis; in spite of aggressive surgical treatment, the prognosis is poor.

Liver transplantation and transjugular intrahepatic portosystemic shunt

OBJECTIVE Describe the results of liver transplantation after installing Transjugular Intrahepatic Portosystemic Shunt (TIPS) and compare them with those of a control group in a comparative, longitudinal, retrospective study. MATERIALS AND METHODS Between April 1986 and October 2002, we performed 875 liver transplantations. Between January 1996 and October 2002, 26 transplantations were performed on TIPS carriers. This group was compared with a control cohort of 50 randomly selected patients who underwent transplantation in this period (non-TIPS carriers). Both groups were homogeneous with no significant differences between age, sex United Network for Organ Sharing (UNOS) score, Child stage, or etiology. RESULTS Actuarial survival rates at 1 and 3 years: TIPS group 96.15% and 89.29% versus control cohort 87.8% and 81%, respectively. In 73.9%, the TIPS was clearly effective; in 88.9%, a postoperative Doppler revealed normal flow. There were no statistically significant differences compared with time on the waiting list for transplant, duration of the operation, ischemia times, intraoperative consumption of hemoderivates, vascular or nonvascular postoperative complications, duration of stay in the intensive care unit, hospital stay, or retransplantation rate. CONCLUSIONS In our experience, TIPS insertion does not affect either the intraoperative or postoperative evolution and is not associated with an increased time on the liver transplant waiting list.

Changes in the incidence and severity of recurrent hepatitis C after liver transplantation over 1990–1999

BACKGROUND/AIM Changes in immunosuppression and other factors may have changed the severity of recurrent hepatitis C during recent years. This study sought to establish the changes in incidence and severity of recurrent hepatitis C, and its association with the changes in acute rejection and induction immunosuppressive therapy between 1990 and 1999. PATIENTS AND METHODS Among 213 liver transplants in HCV-infected recipients, 129 grafts were selected for this study: all grafts with severe recurrent hepatitis C (fibrosis 3-4 in Scheuers score or fibrosing cholestatic hepatitis), and those grafts without severe recurrence with at least 2 years of follow up. Grafts were divided in 5 groups depending on the year of transplantation to compare recurrent hepatitis C-related variables, AR incidence and induction immunosuppression. RESULTS Hepatitis-free survival decreased in recent years (p=0.015). The incidence of fibrosing cholestatic hepatitis was higher among 1996-1997 and the 1998-1999 periods (p=0.019). Survival free of severe hepatitis at 1 year follow up was 95% in 1990-1991 and 80% in 1998-1999; however, in the long-term the survival was similar between groups (p=0.933). HCV-related graft survival at 5 years was 93.5% in the 1990-95 period and 82.5% in 1996-99 (p=0.068). Neither AR nor any regimen of induction immunosuppression was associated with changes in the occurrence of recurrent hepatitis C related survival. CONCLUSIONS Severity of recurrent hepatitis C and HCV-related graft loss after liver transplantation were higher in the second half of the 1990s; however, there was no association with AR or induction immunosuppression.

Liver transplantation in chronic viral B and C hepatitis.

Liver transplantation is a valid treatment in chronic viral B and C hepatitis. But disease recurrence is very frequent in HBV hepatitis after the procedure, and its prevention and treatment are unresolved problems. Hepatitis C recurrence in the graft seems also to be common, and further studies of its pathobiology are needed.

Results in split liver transplantation

INTRODUCTION The shortage in cadaveric grafts has prompted the development of alternative surgical techniques to expand the donor pool. OBJECTIVE To evaluate the feasibility of split liver transplantation using an observational, retrospective, and longitudinal study. MATERIALS AND METHODS Between April 1986 and October 2002 we performed 875 liver transplants. From April 1991 to date, we performed 18 split liver transplantations in patients of mean age 42.27+/-25.65 years; five children and 13 adults; and 83.3% women. Urgent transplants accounted for 38.9%. Mean patient weight was 52.29+/-20.87 kg. Ex situ splitting was performed in 33%. The mean cold ischemia time was 460+/-265.69 minutes with a mean warm time of 64.33+/-11.78 minutes. Mean consumption of packed blood was 5.59+/-4.87 units; of frozen fresh plasma, 11.56+/-7.42 units; and of platelets 4.89+/-4.99 units. RESULTS After a mean follow-up of 10.83+/-12.51 months, 55.56% of the recipients are alive. Actuarial patient and graft survival rates at 1 year are 55.6% and 44.12%, respectively. Actuarial patient and graft survival rates at 1 year, excluding operative mortality were 77% and 68%, respectively. Actuarial patient and graft survival rates at 1 year, comparing urgent and elective transplantations are: 14.29 and 14%, respectively, for urgent cases and 90.91 and 90% for elective ones. Operative mortality was 16.6% while mortality during follow-up was 26.6%. The late complications included arterial thrombosis (n=2): of whom the first needed liver retransplantation 4 months after split liver transplantation; chronic rejection (n=2), recurrence of hepatitis (n=1). CONCLUSIONS Split liver transplantation is a useful way to expand the graft pool and shows better results in elective liver transplantation.