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Author: Gregory T. Everson
Editor: Gregory T. Everson, James F. Trotter
Title: Liver Transplantation Challenging Controversies and Topics
Publisher: Humana Press
ISBN/ISSN: 9781603270281
Edition: 1
Price: CHF 178.50
Publication date: 01/01/2009
Content
Category: Medizin & Pharmazie
Language: English
Technical Data
Pages: 268
Kopierschutz: DRM
Geräte: PC/MAC/eReader/Tablet
Formate: PDF
Table of contents
Liver Transplantation: Challenging Controversies and Topics grew out of a need I perceived within the fields of transplant hepatology and liver transplantation. Liver transplantation has rightly gained recognition as an established therapy for end-stage liver disease. Few would argue that liver transplantation is one of the few truly lifesaving and life-altering treatments within medicine and surgery. Not many realize that 20 years passed from the time of the first human liver transplantation in 1963 to its acceptance as therapy by the 1983 NIH Consensus Conference on Liver Transplantation. In 2008, 25 years will have passed since the 1983 NIH conference-a mere 25 years for a field that has provided patients hope, doctors options, and to some the 'gift of life. ' Many issues in liver transplantation involve indications, patient selection, and outcomes after transplantation-these are standard topics, covered by textbooks of hepatology and transplantation. In contrast, the field of liver tra- plantation is young, evolving, dynamic, and issues and decisions are often controversial. Thus, Dr. Trotter and I, as well as our colleagues at the University of Colorado, felt that a text with a different focus was required, one that highlighted controversy and challenged dogma. Out of this perceived need emerged Liver Transplantation: Challenging Controversies and Topics. To meet the transplant community's need for emerging information about liver transplantation, Dr. Larry Chan, Dr. Igal Kam, and I initiated the Controversies in Transplantation Conference.
Table of contents
Preface6
Acknowledgments8
Contents9
Contributors10
1 Tolerance in Liver Transplantation12
Introduction13
Defining the Challenges14
Unique Aspects of the Liver Influencing Immune Outcome16
Clinical Tolerance21
Conclusions24
Acknowledgments25
2 Novel Approaches to Immunosuppression in Liver Transplantation30
Introduction31
Anti-IL-2 Receptor (Anti-CD25) Monoclonal Antibodies32
Daclizumab32
Basiliximab35
Campath-1H36
Rapamycin37
Sirolimus and Side Effects in Liver Recipients38
Sirolimus for Liver Recipients with Hepatocellular Carcinoma (HCC)39
Sirolimus for Liver Recipients with Renal Dysfunction42
SDZ-RAD42
Compounds in Development: FTY720, FK778, and LEA29Y42
Immunosuppression of HCV-Positive Recipients44
Prospectus47
3 Pre- and Posttransplant Management of Hepatitis C56
Introduction57
Factors Influencing the Natural History of Posttransplant HCV Disease57
Treatment Strategies for Patients with Chronic HCV Undergoing Liver Transplantation59
Pretransplant Management of Chronic HCV60
Posttransplant Management of the Patient with Chronic HCV62
Preemptive Treatment of Recurrent HCV Infection62
Treatment of Posttransplant HCV Disease65
Summary69
4 The Dilemma of Adult-to-Adult Living Donor Liver Transplantation 75
Introduction76
Historical Background76
Donor Outcomes80
Recipient Outcomes84
Left Lobe Allografts84
North American and European Outcomes85
Living Donor Liver Transplantation in Asia89
Adult-to-Adult Living Donor Liver Transplantation Outcomes When Applied to a Specific Indication90
Hepatitis C90
Hepatocellular Carcinoma (HCC)91
Discussion92
5 The Share 15 Rule100
Introduction101
Acknowledgment101
6 Hepatocellular Carcinoma112
Introduction113
Expanding the Selection Criteria for Transplantation and HCC114
OLT and Cadaveric Donation114
Living Donor Liver Transplant116
Marginal Cadaveric Donors and HCC117
Accuracy of Preoperative Staging118
Loco-Regional Ablative Therapy119
Recurrence of HCC After Transplant121
Role of Immunosuppression122
Surgical Strategy for Recurrent HCC123
Liver Resection as a ``Bridge123
124123
7 Liver Transplantation and the Hepatopulmonary Syndrome132
Background133
Significance of HPS in OLT133
Outcome of HPS Without OLT133
Outcome of HPS with OLT135
MELD Exception136
Diagnosis and Screening137
Transplant Candidacy and Management138
Summary140
8 Long-Term Metabolic Complications Posttransplantation143
Background144
Hypertension145
Dyslipidemia146
Diabetes Mellitus146
Metabolic Syndrome146
Osteoporosis147
Metabolic Complication Management147
Conclusion149
9 Hepatitis B and Liver Transplantation153
Burden of Disease154
Indications for Liver Transplantation154
Pretransplant Antiviral Therapy155
Lamivudine156
Posttransplant Antiviral Therapy158
Monotherapy: Hepatitis B Immune Globulin (HBIg)158
Monotherapy: Lamivudine159
Combination Therapy: Hepatitis B Immune Globulin and Lamivudine161
Combination Therapy: Lamivudine and Adefovir163
Can HBIg Be Discontinued?164
LAM Monotherapy After HBIg Withdrawal or After Combined HBIg/LAM164
Vaccination After or During HBIg Withdrawal165
Posttransplant De Novo HBV Infection166
Outcomes of Liver Transplantation for HBV-Related Liver Disease166
Future Directions167
Conclusions168
10 Liver Transplantation for Nonalcoholic Fatty Liver Disease176
Introduction177
Clinical Features and Diagnosis of NASH177
Pathogenesis of NAFLD178
Lipid Metabolism in NAFLD179
Insulin Resistance in NAFLD180
Oxidative Stress in NAFLD181
Frequency of NAFLD/NASH as a Cause of Liver Failure183
Liver Transplantation for NAFLD/NASH185
Clinical Characteristics185
Outcomes Following Liver Transplantation for NAFLD/NASH186
Treatment of NAFLD Before and After Liver Transplantation186
Choice of Immunosuppression189
The Role of Protocol Liver Biopsy189
Index198