摘要:

Living donor liver transplantation has revolutionized adult liver transplantation and has been the focus of significant attention in both the professional and lay media this past year. The evaluation of potential donors has almost become a specialty itself, and considerable progress has been made in the radiologic evaluation of these patients that is both comprehensive and, even more importantly, noninvasive. Our understanding of donor psychosocial outcomes has also increased significantly. Donor safety issues have become the focus of the transplant community. There have also been many technical advances, particularly with regard to biliary reconstructions and, in the case of right lobes, segmental venous drainage. As the indications for living donor liver transplantation for adults broaden, these issues will become even more important. Donor safety must remain paramount. Donors and recipients need to be carefully and responsibly chosen. All efforts should be made to improve cadaveric donation and to make the best use of this precious and, unfortunately, limited resource.

ISSN:1087-2418    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Major advancements have been made in the past decade with regard to immunosuppressive therapy in liver transplant recipients. Experimental and clinical evidence suggests that the liver is an immunologically privileged organ, and an episode of acute rejection does not appear to have a negative impact on patient or graft survival. Today, the most pressing issue related to immunosuppression therapy in liver transplantation is minimizing toxicity, the incidence and severity of recurrent disease, and avoiding cardiovascular and cancer risk. Studies have identified a number of factors that have been associated with acute rejection, and similarly a number of factors have been associated with an increased risk of and severity of recurrent disease. Therefore, tailoring immunosuppression to the individual patient should become more popular, particular as it relates to patients with hepatitis C virus. This review aims to highlight the evolving trends in immunosuppressive therapy in liver transplantation.

ISSN:1087-2418    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The current outcome typical of hepatitis C virus-infected liver recipients after a first transplant is worrisome. Prophylaxis with antivirals has yielded a low rate of success. Without effective prophylaxis, the attention should be focused on the one factor that can be controlled: immunosuppression. A summarized review of the impact of immunosuppressive agents used for the past few years is presented in the context of hepatitis C virus recurrence. Steroids have been blamed for years as the main culprit in the higher incidence of hepatitis C virus recurrence reported in some series. New experience with these agents may prove the opposite. Purine synthesis inhibitors such as azathioprine and mycophenolate mofetil may help to reduce the incidence of hepatitis C virus recurrence after liver transplantation, although further studies are needed to confirm these recent reports. Antilymphocytic therapy with monoclonal or polyclonal antibodies does not seem to be harmful when used at induction. Most reports have analyzed these agents in the context of steroid-resistant rejection, a confounding factor in many studies. The calcineurin-inhibitors, cyclosporine and tacrolimus, appear with similar incidences of hepatitis C virus recurrence and their current use is only center-dependent. Newer agents like sirolimus and antibodies against IL-2 receptors still need to pass the test of time before firm recommendations can be given in any sense. Larger, randomized studies will finally answer questions concerning the best immunosuppressive agent combinations for treating the high-risk hepatitis C virus-infected population of liver transplant recipients.

ISSN:1087-2418    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1087-2418    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The authors review publications in the past year on the risks and benefits of living donation. As of early 2003, the current morbidity and mortality of laparoscopic and open nephrectomy were described. The advantages of laparoscopic nephrectomy were further demonstrated; some centers described right-sided laparoscopic nephrectomy with the same results as left-sided nephrectomy. Long-term follow-up of living donors (20 to 37 years) showed that most had good renal function. A survey of insurance companies found that all would provide life insurance to a healthy donor. Several publications dealt with ethical issues associated with living donation and with kidney sales.

ISSN:1087-2418    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The availability of potent new immunosuppressive drugs has led to a dramatic decrease in the incidence of early episodes of acute rejection in kidney transplant recipients. However, toxicities of currently available immunosuppressants ironically may influence long-term allograft and patient outcomes negatively by causing renal dysfunction and promoting cardiovascular disease. This review summarizes recent clinical experience with immunosuppression protocols designed to minimize these long-term toxicities by reducing or eliminating doses of calcineurin inhibitors or corticosteroids. Long-term follow-up of patients enrolled in such studies is needed to establish the durability of encouraging preliminary results.

ISSN:1087-2418    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1087-2418    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

There have been several recent advances in the use of immunosuppression after organ transplantation. The main goal is to induce transplantation tolerance without immunosuppressive drug toxicity. We reviewed both experimental and clinical organ transplantation studies such as costimulatory blockade agents, sphingosine 1-phosphate receptor analogs, lymphocyte depletion strategies, and chemokine blockade agents in the context of renal transplantation. The newer and safer immunosuppression protocols might provide significant benefit to organ transplant recipients as alternatives to conventional immunosuppressive therapy.

ISSN:1087-2418    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Vascularized pancreas transplantation is currently the only treatment for insulin-requiring diabetes mellitus that can consistently achieve an insulin-free, euglycemic state. Due to the operative risks, requisite immunosuppression, and limitations of insurance coverage, pancreas transplantation is usually performed in the setting of advanced diabetic nephropathy, either simultaneous with or sequential to a kidney transplant. In the recent past, the results of simultaneous kidney–pancreas transplantation were superior to sequential pancreas after kidney transplantation. With advances in surgical techniques and clinical immunosuppression, however, the outcomes of pancreas after kidney transplantation are now nearly equivalent to simultaneous kidney-pancreas transplantation. Consequently, the uremic diabetic patient may be offered a number of potential transplant options including (1) simultaneous kidney-pancreas transplantation from a cadaver donor; (2) living donor kidney transplantation followed by sequential cadaver donor pancreas transplantation; (3) simultaneous living donor kidney-pancreas transplantation; or (4) simultaneous cadaver donor pancreas and living donor kidney transplantation.

ISSN:1087-2418    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Calcineurins and steroids have been the foundation in immunosuppression regimens for pancreas transplants since the introduction of the procedure. Although steroids have several side effects such as hypertension, osteoporosis, and gastric ulcerations while calcineurins can cause hyperglycemia, hirsutism, and hyperlipidemia, these immunosuppressive regimens in combination have resulted in a significant reduction in acute rejection rates. In recent reports, steroid withdrawal or avoidance in kidney transplantation has been associated with excellent rejection-free graft survival, particularly when induction therapy is used. Although there is no clear evidence of the ability of steroid-free protocols in pancreas transplants to achieve success, early results in pancreas kidney patients are extremely encouraging. With more studies, the use of nontoxic immunosuppressants will be possible and will result in further improvement in patients' quality of life after pancreas transplantation.

ISSN:1087-2418    

出版商:OVID    

年代:2003

数据来源: OVID