ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Liver transplantation is limited by a scarcity of donor organs. The use of marginal or expanded pool donors is increasingly common as liver donor acceptance criteria are relaxed. Of these criteria, severe steatosis is associated with a definite risk of primary nonfunction. The other criteria may be associated with an increased risk of initial graft dysfunction. There remains a need for an effective objective predictive donor test of graft function and a universal definition of primary dysfunction. Recent work on the effects of brain death on donor organ injury and graft outcome has resulted in research in preconditioning to decrease prepreservation injury. Recipient selection is crucial when a decision to use a marginal graft is made and a better understanding of marginal grafts is necessary. In order to maximize the chances of success, acceptance of a marginal graft must be made considering not only all available donor information, but also recipient and operative factors.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Hepatobiliary surgery has come a long way since Caprio successfully performed the first lobectomy in 1932. Advances in surgery, anesthesia, intensive care medicine, organ preservation, and immunosuppresion have meant that liver transplantation is now the definitive treatment for end stage liver failure. In the 1960s, Starzl achieved successful human orthotopic liver transplantation, and less than 20 years later, reduced sized grafting was successful. Shortage of available organs has stimulated study of surgical anatomy and anatomical surgery. This has led to auxiliary heterotopic and partial orthotopic liver transplantation. Recently, livers have been split for implantation in more than two recipients from one graft, or to obtain viable transplantation from a living donor. Mutual feedback over the past 70 years, with the integration of conventional surgery and transplantation techniques, has permitted innovation in liver surgery and the possibility of yet further progress.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Split liver transplantation provides an ideal means of generating size-matched liver grafts for children without reducing the organ pool for adult recipients. In the past 10 years, split liver transplantation enabled clinicians to practically eliminate pediatric waiting list mortality and to reduce morbidity. Two major techniques are applied in liver splitting. Both techniques,ex-situandin-situsplitting, usually provide a left lateral and a right (extended) liver graft to be transplanted into one child and one adult respectively. Thein-situtechnique has several advantages from a theoretical point of view, the most important being the shorter ischemia times. The patient and graft survival ofin-situsplit livers have exceeded 80 to 90% and 75 to 80% respectively, with lower incidence of postoperative complications in comparison toex-situgrafts. When transplanting elective recipients, excellent results can also be reached with theex-situtechnique.In-situsplitting is the technique of choice for sharing split liver grafts between liver transplant centers, when transplanting non-elective recipients or when performing small-for-size transplantations. Therefore, thein-situtechnique is an important advance in the quest to develop split-liver transplantation for two adult recipients.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Transplantation of livers from patients with familial amyloidotic polyneuropathy undergoing orthotopic liver transplantation is based on the normal functions of these livers, except for the production of an abnormal protein that causes the disease, which takes more than 20 years to become clinically apparent. Given the shortage of cadaver grafts, domino liver transplantation has the potential to increase the offer to some selected patients. The known experience amounts to little more than 80 cases. Domino liver transplantation has been a safe procedure with all the advantages of living donor grafts. So far, the disease has not shown up in any recipient, including the longest surviving patient (4 years). Particularly in countries where the disease is common, the potential to increase graft offer may be significantly augmented through cooperation between centers and better exploitation of technical possibilities. The combination of split and domino has been reported six times and may provide three to six transplants from only one cadaver graft.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Technical refinements and successful results in living donor liver transplantation in pediatric population, as well as accelerating general donor shortage, have finally set fire to the application of this technique to adult population. Disadvantages of small-for-size grafts are now significantly mitigated by the repertoire of left lobe, right lobe and whole left liver grafts. However, considerable controversies in technical issues and indications still remain to be resolved to maximize donor and recipient safety. Mutual sharing of any negative results and consequent learning curve is indispensable, as well as continuing maximal attention to the potential and realistic risk placed on any living donor.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

There is now unequivocal evidence for the existence of CD4+T cells that can suppress transplant rejection. If the developmental origins and special diagnostic features of such cells could be understood, then it might be possible to selectively harness their properties for therapeutic purposes. Here we review recent information on their properties and speculate that it may soon be possible to selectively manipulate the immune system so as to empower such T cells so that they might dominate those that would otherwise reject the transplant.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

More than 20 years have passed since the radical concept was first proposed that target recognition by T lymphocytes need not lead to immune system activation resulting in that target’s destruction. Rather, it was proposed that T-cell activation required antigen recognition but also a simultaneous “costimulatory” signal. A corollary of the hypothesis was that antigen recognition without costimulatory signals would not only fail to activate the immune response against that target but would also permanently and specifically impair the anti-target immune response to produce an immunologic state called “anergy.” During the past 20 years, research directed to test the costimulatory or “two-signal” hypothesis has generated a prodigious volume of data, much of it dramatic with regard to possible transplant therapies. During the same interval, however, it has become evident that the two-signal hypothesis as initially proposed was at best oversimplified. The history of costimulation research is discussed here along with current research emphasizing areas where much remains to be understood.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

One method of inducing tolerance to allografts is the use of lymphocyte depletion. This strategy has demonstrated remarkable efficacy in clinically relevant large-animal models of allotransplantation. Although the mechanism by which therapeutic lymphocyte ablation promotes tolerance remains unclear, continued research is gradually characterizing its effects on the immune system. Significant advances are also being made in our ability to develop and deliver effective lymphocyte-depleting agents. This review examines recent progress in our understanding and application of this paradigm of tolerance induction.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID