Liver replacement after massive hepatic trauma.

Two patients sustained massive hepatic injuries from blunt trauma in motor vehicle accidents. At the time of operation, nonreconstructable injuries to the porta hepatis were found in addition to destruction of the right lobe. Life-threatening hemorrhage was controlled, but both patients were left with nonfunctional or inadequate hepatic remnants.

A multifactorial system for equitable selection of cadaver kidney recipients.

During 1986, a total of 270 cadaver renal transplantations were performed at the University of Pittsburgh. Kidneys were allocated by a point system that awarded points to recipients for waiting time, antigen matching, antibody analyses, medical urgency, and logistic practicality. Kidneys were given to patients with the highest point totals in 98% of cases.

Complications of venous reconstruction in human orthotopic liver transplantation.

In 313 consecutive recipients of 393 orthotopic liver grafts, there were 51 (16.3%) and nine (2.9%) patients who had pre-existing portal vein and inferior vena cava abnormalities, respectively.

Liver transplantation in patients with patent splenorenal shunts.

Patent distal splenorenal shunts (Warren shunt) have been reported to cause decreases in the portal perfusion pressure and the total hepatic blood flow. Such hemodynamic alterations could have adverse effects on the transplanted liver. The experience with hepatic replacement in four patients with patent Warren shunts is reported.

Liver transplantation today.

In summary, liver transplantation has truly come of age. To put things in perspective, the recipient waiting list at the University of Pittsburgh never includes fewer than 200 suitable candidates, and it continues to grow in spite of the fact that we are now doing essentially one transplant per day. There are many excellent transplant centers throughout the United States and Europe, the only limiting factor being the supply of donors.

Liver transplantation before 1 year of age.

Since 1981, 20 infants younger than 1 year of age received 26 orthotopic liver transplants. Immunosuppression was with cyclosporine and corticosteroids. Thirteen (65%) of the recipients were discharged from the hospital.

Clinical considerations in orthotopic liver transplantation.

Progress in immunosuppression, surgical techniques, and perioperative care has promoted orthotopic liver transplantation from an experimental procedure to an accepted clinical treatment. Orthotopic liver transplantation, in turn, has changed the treatment of terminal liver disease from care that is largely treatment of symptoms and support to cure, but at the price of major surgery and life-long immunosuppression. This article reviews the current status of liver transplantation as practiced at the University of Pittsburgh.

Posttransplantation cyclosporine-induced lymphoproliferative disorders: clinical and radiologic manifestations.

Fifteen allograft transplant recipients acquired lymphoproliferative disorders after immunosuppressive therapy with cyclosporine and steroids. Many of these lymphoproliferative disorders regressed or disappeared completely after reduction of cyclosporine dose. This disease has several aspects that distinguish it from usual posttransplantation lymphomas that occur with regimens that do not contain cyclosporine.

Successful treatment of a traumatic hepatic artery-portal vein arteriovenous fistula by interpositional mesocaval shunting.

Hepatic artery-portal vein fistula is an occasional sequel to invasive procedures on the liver, such as biopsy and transhepatic cholangiography. When the fistula is large it may result in portal hypertension, gastrointestinal bleeding and histologic and functional changes in the liver. Treatment is usually directed at the fistula, either embolizing, dividing or resecting it.

OKT3 in the reversal of acute hepatic allograft rejection.

OKT3 was an effective immunosuppressant agent in patients with acute cell-mediated allograft rejection that had not responded to initial steroid therapy. OKT3 was also valuable for treating patients with early hepatic graft dysfunction caused by other factors than rejection. In such recipients, the doses of CyA can be greatly reduced, allowing recovery of frequently damaged kidneys while maintaining effective immunosuppression.

Analysis of donor criteria for the prediction of outcome in clinical liver transplantation.

The results of 219 orthotopic human liver transplants performed during 1985 at the University of Pittsburgh were reviewed to determine whether donor parameters could be used to predict the quality of early graft function. Multivariate discriminant analysis demonstrated that traditional parameters of donor assessment are unreliable predictors of poor graft function. Furthermore, 56% of the donors considered poor by conservative selection criteria produced livers with good early posttransplant function.

IN VITRO IMMUNOSUPPRESSIVE EFFECTS OF FR 900506 ON HUMAN T LYMPHOCYTE ALLOACTIVATION.

FR 900506 (FR) is a new immunosuppressive drug which prolongs allograft survival. Our studies have compared the in vitro inhibitory effects of FR and Cyclosporine (CsA) on human lymphocyte proliferation. Considerably lower doses of FR were required to induce inhibition of lymphocyte proliferation induced by concanavalin A (ConA) stimulation or in primary mixed lymphocyte reactions (MLR) Similar differences between FR and CsA were observed with the secondary stimulation of alloactivated T cells generated in MLR or propagated from liver transplant biopsies These observations provide further evidence that FR is about 500 fold more potent than CsA and may be a useful immunosuppressive agent in organ transplantation.

IMMUNOSUPPRESSION WITH FR 900506 FOR CANINE KIDNEY AND LIVER TRANSPLANTATION.

The immunosuppressive effects of FR 900506 were investigated for one month after canine kidney and liver transplantation. Eight untreated kidney recipients lived for 8 to 19 days, mean 12.1.

THE IMMUNOSUPPRESSIVE EFFECTS OF FR 900506 IN RATS RECEIVING HETEROTOPIC CARDIAC ALLOGRAFTS.

The immunosuppressive effects of FR 900506 were studied in Lewis rats given ACI heterotopic heart allografts. Intramuscular doses of 0.02 mg/kg daily for 2 weeks extended graft survival slightly, and with doses up to 1.

Transjugular intrahepatic portosystemic shunt: a nonoperative approach to life-threatening variceal bleeding.

Portosystemic venous shunts may be created nonoperatively with a Grüntzig balloon dilatation catheter using the transjugular route. The authors achieved technical success with this shunt in 15 of 20 patients with life-threatening gastrointestinal bleeding from variceal hemorrhage. All patients but one were considered at high risk for surgery because of end-stage liver disease; the exception was a patient in whom two previous operative portosystemic shunts had failed.

The Denver-Pittsburgh liver transplant series.

Liver transplantation is now the preferred treatment for many diseases leading to end-stage liver disease. Transplantation for cancer has been disappointing and there is a significant recurrence rate after transplantation in hepatitis B-virus carriers. Additional strategies will have to be developed if we are to improve the results of transplantation for these patients.