ISSN:0270-9139    

DOI:10.1002/hep.1840040712

出版商:W.B. Saunders    

年代:1984

数据来源: WILEY

摘要:

AbstractHepatic vein thrombosis (Budd‐Chiari Syndrome) is a rare disorder resulting from obstruction to the outflow of blood from the liver. The characteristic pathologic findings are intense congestion most pronounced around the terminal hepatic venules, cell necrosis, and a scant inflammatory reaction. Major clinical manifestations include hepatomegaly, right upper quadrant abdominal pain, and ascites. Disorders associated with hepatic vein thrombosis include those associated with a thrombotic tendency, such as polycytermia vera and paroxysmal nocturnal hemoglobinuria. Use of oral contraceptive agents probably increases tendency to develop hepatic vein thrombosis. Biochemical tests of the liver are of little value. The hepatic scan may be useful in suggesting the diagnosis with a marked decrease in uptake of isotope over affected areas of the liver. The diagnosis is confirmed by inferior vena caval and attempted hepatic venous catheterization. An associated thrombosis of the inferior vena cava is frequently found. Therapy in hepatic vein thrombosis is directed towards correction, in so far as possible, the underlying disorder, prevention of further extention of thrombosis, and management of ascites. Side‐to‐side portacaval or mesocaval shunt operation may convert the portal vein into an effective hepatic outflow vessel and reduce intrahepatic pressure and decrease injury. Mesoatrial shunts have proven useful in a few patients with hepatic vein thrombosis and either an inferior vena caval thrombosis or a marked pressure gradient from the abdomen to the thorax from ascites and an hypertrophied caudate lobe of the liver. For patients with extensive hepatocellular disease and portal hypertension, hepatic transplantation would seem to offer the best chance for sur

ISSN:0270-9139    

DOI:10.1002/hep.1840040713

出版商:W.B. Saunders    

年代:1984

数据来源: WILEY

ISSN:0270-9139    

DOI:10.1002/hep.1840040714

出版商:W.B. Saunders    

年代:1984

数据来源: WILEY

摘要:

AbstractThe postoperative course of 138 transplants performed in 137 patients in the Cambridge and King's College Hospital series between May 2, 1968 and April 1, 1983 is presented. During the last 15 years, criteria for selection of transplant candidates has been improved and types of disease categories, both suitable and unsuitable for liver transplantation, have been defined. The acceptance of the concept of brain death and the use of heart‐beating donors in the United Kingdom since 1976 has greatly improved the quality of donor organs. Changes in surgical technique, particularly with regard to biliary tract drainage, have reduced morbidity and mortality from biliary tract complications since 1975. The use of partial cardiopulmonary bypass in selected cases and changes in immunosuppressive drug regimens have not significantly improved our overall results. Despite these changes based on our experience, the perioperative mortality in the Cambridge and King's College Hospital series remains disturbingly hig

ISSN:0270-9139    

DOI:10.1002/hep.1840040715

出版商:W.B. Saunders    

年代:1984

数据来源: WILEY

ISSN:0270-9139    

DOI:10.1002/hep.1840040716

出版商:W.B. Saunders    

年代:1984

数据来源: WILEY

摘要:

AbstractFrom March, 1979 to March, 1983, 26 orthotopic liver transplantations and 1 retransplantation were performed in our center. Sixteen patients are alive, 5 beyond22 years and 1 longer than 4 years after transplantation. The actuarial 1– and 2–year survival is 60%. Factors contributing to this result are patient selection and biliary anastomosis. In cirrhotic patients, the degree of deterioration of liver function correlated with survival; in patients with hepatocellular carcinoma, extrahepatic spread of tumor was the most frequent limiting factor. Choledochocholedochostomy with a widening plasty had a low complication rate providing that the arterial blood supply was undisturbed. Until now, HLA‐matching has not contributed to the result of liver transplantation, although the effect for long‐term survival is still unknown. The high survival rate and excellent quality of life of long‐term survivors justify liver transplantation as treatment for otherwise noncurable liver

ISSN:0270-9139    

DOI:10.1002/hep.1840040717

出版商:W.B. Saunders    

年代:1984

数据来源: WILEY

摘要:

AbstractThe incidence of prospective organ donors in the United States and the techniques which are to used to guarantee their optimal use after identification are analyzed. Attitudes of the public and health professionals toward organ donation are discussed.The organization of the Pittsburgh Organ Procurement Agency and its relationship to other such agencies is described.Finally, the presently used techniques of liver salvaging and preservation are outlined.

ISSN:0270-9139    

DOI:10.1002/hep.1840040718

出版商:W.B. Saunders    

年代:1984

数据来源: WILEY

摘要:

AbstractTrained specialists in hepatology, liver and biliary surgery, anesthesiology and pathology must form the core of a team for liver transplantation. The hospital must be a center for organ transplantation to provide the essential infrastructure to manage specific aspects of transplantation. A well‐organized blood bank is essential to cope with acute requests for large amounts of donor blood. Because of the extremely high costs, liver transplantation has to be approved medically and politically before it can be considered as a generally accepted modality of treatmen

ISSN:0270-9139    

DOI:10.1002/hep.1840040719

出版商:W.B. Saunders    

年代:1984

数据来源: WILEY

摘要:

AbstractImmunological considerations of special interest in liver transplantation are examined. It is concluded that liver transplants between human beings generate typical rejection reactions although they may, overall, be somewhat more mild than those encountered in transplanted kidneys and hearts. This is the case in some animals for reasons which are not yet clear. There is evidence that the transplanted liver can suffer immune attack better than other organs. Whether graft‐vs.–host activity is of clinical importance is uncertain. The advent of cyclosporin immunosuppression has improved the outlook for liver recipients but multiple complications of immunosuppression will still occur and demand skillful managem

ISSN:0270-9139    

DOI:10.1002/hep.1840040720

出版商:W.B. Saunders    

年代:1984

数据来源: WILEY

摘要:

AbstractThe methods used to screen prospective candidates for orthotopic liver transplantation are described. Both the indication and the contraindications for the procedure are discussed. The timing of the procedure during the course of an individual candidate's liver disease is also discussed. Additionally, the institutional requirements of a liver transplant center are identified. Finally, the problems experienced by a liver transplant patient and his physician during the postoperative period are identified and discussed.

ISSN:0270-9139    

DOI:10.1002/hep.1840040721

出版商:W.B. Saunders    

年代:1984

数据来源: WILEY