Treatment of fibrolamellar hepatoma with subtotal hepatectomy or transplantation.

Fibrolamellar hepatoma (FL-HCC) is an uncommon variant of hepatocellular carcinoma (HCC), distinguished by histopathological features suggesting greater differentiation than conventional HCC. However, the optimal treatment and the prognosis of FL-HCC have been controversial. Follow-up studies are available from 1 year to 27 years, after 41 patients with FL-HCC were treated with partial hepatectomy (PHx) (28 patients) or liver transplantation (13 patients).

The prediction of risk of recurrence and time to recurrence of hepatocellular carcinoma after orthotopic liver transplantation: a pilot study.

Orthotopic liver transplantation (OLTx) in the presence of hepatocellular carcinoma (HCC) has been complicated by high recurrence rates. The ability to determine the risk and timing of HCC recurrence on an individual basis would greatly aid in the candidate selection process resulting in a more efficient use of donated organs and allow the individualization and better evaluation of adjuvant chemotherapy. The 214 patients who underwent OLTx in the presence of HCC were analyzed.

Distribution of infecting hepatitis C virus genotypes in end-stage liver disease patients at a large American transplantation center.

The distribution of hepatitis C virus (HCV) genotypes was studied in 202 anti-HCV-positive liver transplant candidates with end-stage liver disease. HCV sequences were successfully amplified from 185 patients: In the first 100, the genotype was determined by direct sequencing in the NS5 region, and in the remaining 85, type-specific primers were used for genotyping. Eighty-five patients (46.

Cadaveric liver donors; what are the limits?

The current crisis in organ availability will only be solved by aggressive and innovative solutions. One approach, outlined here, is to more carefully assess current donors and determine how to safely "push the limits" of acceptable cadaveric liver donors. Our experience, as well as that of others, indicates that donors with these higher risk factors may be used in certain carefully defined situations.

Experience with liver and kidney allografts from non-heart-beating donors.

Given the shortage of cadaveric organs, we began a study utilizing NHBD for OLTx and KTx. There were 24 NHBD between January 1989 and September 1993. These donors were divided into 2 groups: uncontrolled NHBD (G1) (n = 14) were patients whose organs were recovered following a period of CPR; and controlled NHBD (G2) (n = 10) were patients whose organs were procured after sustaining cardiopulmonary arrest (CA) following extubation in an operating room setting.

Disease gravity and urgency of need as guidelines for liver allocation.

One thousand one hundred and twenty-eight candidates for liver transplantation were stratified into five urgency-of-need categories by the United Network for Organ Sharing (UNOS) criteria. Most patients of low-risk UNOS 1 status remained alive after 1 yr without transplantation; the mortality while waiting was 3% after a median of 229.5 days.

Small intestinal transplantation in humans with or without the colon.

Under FK506-based immunosuppression, 16 cadaveric small bowel transplantations were performed in 15 recipients with (n = 5) or without (n = 11) the large bowel. Twelve (80%) patients are alive after 1.5 to 19 months, 11 bearing their grafts, of which 4 include colon.

The incidence, timing, and management of biliary tract complications after orthotopic liver transplantation.

Objective: This study analyzed the incidence and timing of biliary tract complications after orthotopic liver transplantation (OLTx) in 1792 consecutive patients. These results were then compared with those of previously reported series. Finally, recommendations were made on appropriate management strategies.

Lymphoma resembling Hodgkin disease after posttransplant lymphoproliferative disorder in a liver transplant recipient.

Background: Posttransplant Epstein-Barr virus (EBV)-associated lymphoproliferative disorders (PTLD) are B-cell derived tumors of polymorphic to monomorphic histologic type. Hodgkin disease (HD) is not considered part of this spectrum and rarely occurs in the post-transplant population. A liver allograft recipient is reported who had a PTLD develop that resolved after a reduction of immunosuppression.

Lack of association between HLA antigen DR3 and alpha 1-antitrypsin deficiency in liver transplant recipients.

The relationship between alpha 1-antitrypsin deficiency (alpha 1-ATD) and the HLA antigen system was studied in 32 liver transplant recipients. Despite previous reports of an association of HLA antigen DR3 with homozygosity for alpha 1-AT ZZ, no such association was seen in this population of alpha 1-ATD homozygous ZZ patients with advanced hepatic disease. Thus, the reported association of HLA class II antigens and homozygosity for the Z allele for alpha 1-AT may be an artifact of either a small study population or geographic inbreeding and a coincidental association of certain HLA antigens with the presence of homozygosity for the Z allele of alpha 1-AT.

Intestinal transplantation in children under FK 506 immunosuppression.

Intestinal transplantation, solitary (n = 3) or in combination with the liver (n = 7), was performed in 10 pediatric patients with intestinal failure. The liver was only replaced if there was liver failure and portal hypertension. Immunosuppression was based on FK 506.