肝移植 liver transplantation - PubMed 文献(第 5 页)
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肝移植 的 PubMed 搜索结果(第 5 页)
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Liver transplantation: the challenges of the 1990s. 肝移植：1990年代的挑战
An enormous increase in liver transplantation has been observed over the last decade since it now represents a suitable therapeutic option for patients with end-stage liver disease. The overall one-year survival rate is about 75% for adults and 85% for children, when fulminant hepatic failure and malignancies are excluded. Such improvements in both survival and quality of life are due to many concurrent factors: better timing and selection; development of the UW solution for liver preservation; improvement in operative management including surgical technique, veno-venous bypass and cell-saver; progress in intensive care management of immunosuppressed patients. Nevertheless, the increasing demand for livers is now confronting the transplant teams with organ shortage, for which the introduction of graft reduction, hepatic biparition and living-related donation will contribute to alleviate the scarcity of donors. As a consequence of the increasing number of long-term survivors, greater efforts are now being directed towards the long-term outcome after liver transplantation: disease recurrence, the need for permanent immunosuppression and the quality of rehabilitation will become the challenges of the 1990s before reaching the next step towards multiple organ transplantation.
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Living donor liver transplantation and tolerance: a potential strategy in cholangiocarcinoma. 活体供者肝移植与免疫耐受：胆管癌的一种潜在策略
Donor-specific immune tolerance has been reported in isolated cases of kidney transplantation associated with bone marrow transplantation. The following is a description of a living donor liver transplantation for a hilar cholangiocarcinoma in a previous recipient of an allogeneic bone marrow transplant. A right hemi-liver transplantation was performed using a liver allograft obtained from the same previous bone marrow donor. A neoadjuvant chemo-irradiation protocol was implemented before the procedure. Because of the presence of full chimerism, no immunosuppression has been necessary for the last 22 months. Liver graft function has remained excellent, and a magnetic resonance imaging scan at one and a half years has shown no tumor recurrence. A control liver biopsy at 1 year showed no rejection. Neoadjuvant chemo-irradiation therapy and removal of all immunosuppression after liver transplantation formed the basic structure of this approach. Additional benefits provided by living donor liver transplantation included limitation of tumor progression by diminishing the pretransplantation waiting time, radical excision of the tumor through a complete hepatectomy, and optimal timing of the transplant procedure within a neoadjuvant chemo-irradiation protocol.
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Liver transplantation at the University of Pittsburgh. 匹兹堡大学的肝移植
As with other programs across the country, at the University of Pittsburgh liver transplantation continues to evolve after three decades. The shortage of organs represents the biggest problem in the field, and in response there has been an increase in the number of expanded-criteria-donor transplants and other methods to expand the donor pool such as live-donor, domino, and split-liver transplants. As the program has matured, we have seen an increasing number of recipients needing re-transplantation because--unlike with kidney transplants--recurrence of disease represents a significantly greater problem than immunologic graft failure. Modern immunosuppression, especially with agents such as tacrolimus, have significantly reduced the immunologic problems associated with liver transplantation. But as survival rates have improved and patients are living longer after transplant, the problems associated with long-term immunosuppression have become increasingly important. Our program, along with others, continues to look at methods to minimize the overall amount of long-term immunosuppression to which patients are exposed.
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Changes in heparin level in experimental liver transplantation in dog. 犬实验性肝移植中肝素水平的变化
Changes in heparin level during orthotopic liver transplantation were studied in experiments without the administration of heparin in dogs. It was established that the changes in heparin level might probably not play a role in giving rise to coagulopathy observed during liver transplantation. Their data also indicated that the rise in heparin level had originated not from the re-perfused liver but from the release of endogenous heparin.
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Liver transplantation in infants. 婴儿肝移植
In view of the earlier reports that children below 1 year of age constitute a high-risk group for liver transplantation, the authors reviewed their experience in performing orthotopic liver transplantation in this age group. The records of 9 children aged less than 1 year who underwent 6 living-related liver transplants and 3 reduced-size liver transplants between December 1993 and June 1997 were reviewed. Five reexplorations were required for 3 children who had 1 or more of the following early complications: bleeding from hepatic vein to inferior vena cava anastomosis (n = 1), right hepatic vein stump bleeding (n = 1), intraabdominal hematoma (n = 2), jejuno-jejunostomy leakage (n = 1), and colonic perforation (n = 1). Late complications include stricture at the biliary-enteric anastomosis requiring percutaneous balloon dilatation (n = 3) and hepatitis of undetermined etiology requiring retransplantation (n = 1). There was no hepatic artery thrombosis despite the small arteries available for anastomosis. Follow-up ranged from 19 to 61 months (mean, 40 months). Patient survival rate was 100%, and graft survival with good liver function was 89%. All living donors, 2 fathers and 4 mothers, are well. Liver transplantation in infants less than 1 year of age is technically demanding but feasible and still can be performed with a good outcome. Age alone (under 1 year) should not be considered as a contraindication for liver transplantation.
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Small-for-size graft problems in adult-to-adult living-donor liver transplantation. 成人间活体供者肝移植中的小肝移植物问题
The number of adult patients undergoing living donor liver transplantation (LDLT) has recently increased. According to a recent Japanese survey, the 5-year survival rate in adults after surgery is only 69.7%, which is significantly poorer than that in pediatric series. Small-for-size grafts remain a problem in adult LDLT. The most commonly used liver graft for adult patients has shifted from the left liver to the right, which alleviates the problem of size disproportion. Right hepatectomy, however, increases the extent of the donor operation and raises an important ethical issue in LDLT. Patients who truly need a right liver graft should be carefully selected using evidence-based criteria.
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Towards tolerance in liver transplantation. 肝移植中的耐受性
Life-long immunosuppression has always been considered the key in managing liver graft protection from recipient rejection. However, it is associated with severe adverse effects that lead to increased morbidity and mortality, including infections, cardiovascular diseases, kidney failure, metabolic disorders and de novo malignancies. This explains the great interest that has developed in the concept of tolerance in recent years. The liver, thanks to its marked tolerogenicity, is to be considered a privileged organ: up to 60% of selected patients undergoing liver transplantation could safely withdraw immunosuppression.
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Graft Dysfunction and Management in Liver Transplantation. 肝移植中的移植物功能障碍和管理
Graft dysfunction of the liver allograft manifests across a spectrum in both timing posttransplantation and clinical presentation. This can range from mild transient abnormalities of liver tests to acute liver failure potentially leading to graft failure. The causes of graft dysfunction can be divided into those resulting in early and late graft dysfunction. Although nonspecific, liver biochemistry abnormalities are still the mainstay investigation used in monitoring for dysfunction. This article provides a summary of the main causes and management strategies for liver graft dysfunction in the early through late posttransplant stages.
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Therapeutic Options in Alpha-1 Antitrypsin Deficiency: Liver Transplantation. α-1抗胰蛋白酶缺乏症的治疗选择：肝移植
Alpha-1 antitrypsin deficiency is the commonest genetic condition leading to liver transplantation in childhood. It remains unclear why only a minority of individuals carrying homozygous PiZ phenotype has liver disease, but also why of those only about a quarter develops end stage liver disease, requiring liver transplantation. This intervention has now become routine worldwide with 1-year patient survival rates well above 90%. As for all autosomal recessive conditions liver donation from anonymous cadaveric sources is preferred to living related parental donors, due to their presumed heterozygous state.
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Liver transplantation in children. 儿童肝移植
Liver transplantation has become the curative surgical therapy of end-stage acute, chronic and metabolic liver disease. This has been made possible by improvements in surgical techniques, such as segmental liver transplantation and by improvements in liver preservation. In parallel, advances in immunosuppression and anti-infective therapy have been achieved. As a result of this progress there is an increasing demand for liver transplantation which raises questions for ethical and socioeconomic consideration.