Subject(s)
Fatty Liver/epidemiology , Fatty Liver/therapy , Liver Transplantation/physiology , Postoperative Complications , Adolescent , Adult , Age Factors , Aged , Analysis of Variance , Bile/metabolism , Blood Loss, Surgical , Child , Child, Preschool , Female , Follow-Up Studies , Graft Survival , Humans , Liver Transplantation/mortality , Male , Middle Aged , Multivariate Analysis , Retrospective Studies , Risk Factors , Sex Factors , Survival Rate , Time FactorsSubject(s)
Gallbladder/surgery , Liver Transplantation/adverse effects , Postoperative Complications/surgery , Stents , Adult , Cholangiopancreatography, Endoscopic Retrograde , Endoscopy, Digestive System , Female , Follow-Up Studies , Humans , Jaundice/surgery , Male , Middle Aged , Retrospective Studies , Time FactorsSubject(s)
Cell Transplantation/adverse effects , Lymphoproliferative Disorders/epidemiology , Neoplasms/epidemiology , Organ Transplantation/adverse effects , Postoperative Complications/epidemiology , Cell Transplantation/mortality , Follow-Up Studies , Gene Rearrangement , Genes, Immunoglobulin , Humans , Immunophenotyping , Incidence , Italy/epidemiology , Multiple Myeloma/epidemiology , Organ Transplantation/mortality , Sarcoma, Kaposi/epidemiology , Skin Neoplasms/epidemiology , Survival Rate , Time FactorsSubject(s)
Adrenal Cortex Hormones/administration & dosage , Antiviral Agents/therapeutic use , Hepatitis C/prevention & control , Liver Transplantation/immunology , Ribavirin/therapeutic use , Drug Administration Schedule , Follow-Up Studies , Hepatitis C/enzymology , Humans , Interferons/therapeutic use , Liver/enzymology , Postoperative Complications/prevention & control , Prospective Studies , Secondary PreventionSubject(s)
Liver Transplantation/mortality , Adult , Emergencies , Humans , Prognosis , Reoperation/mortality , Time Factors , Treatment FailureSubject(s)
Lymphoproliferative Disorders/etiology , Organ Transplantation/adverse effects , Adult , B-Lymphocytes/pathology , Humans , Hyperplasia/etiology , Lymphoma, B-Cell/etiology , Lymphoma, B-Cell/pathology , Lymphoma, B-Cell/therapy , Lymphoma, T-Cell/etiology , Lymphoma, T-Cell/pathology , Lymphoma, T-Cell/therapy , Lymphoproliferative Disorders/epidemiology , Lymphoproliferative Disorders/therapy , Plasma Cells/pathologyABSTRACT
A patient with severe haemophilia A underwent orthotopic liver transplantation because of changes correlated to end-stage liver cirrhosis due to hepatitis B, C and D infection. Replacement therapy was carried out for 4 days and the clinical course was uneventful. At the time of reporting the patient has a normal working life. FVIII plasma concentration is normal. The indirect hyperbilirubinaemia may be related to the Gilbert's anomaly of the donor.
Subject(s)
Hemophilia A/surgery , Liver Cirrhosis/surgery , Liver Transplantation , Activities of Daily Living , Adult , Factor VIII/therapeutic use , Flaviviridae/genetics , Gilbert Disease/blood , Hemophilia A/complications , Hemophilia A/virology , Hepatitis, Viral, Human/complications , Humans , Hyperbilirubinemia/etiology , Liver Cirrhosis/complications , Liver Cirrhosis/virology , Male , RNA, Viral/blood , WorkSubject(s)
Adrenal Cortex Hormones/administration & dosage , Cyclosporine/therapeutic use , Immunosuppressive Agents/therapeutic use , Lipids/blood , Liver Transplantation/physiology , Adrenal Cortex Hormones/therapeutic use , Adult , Azathioprine/therapeutic use , Cholesterol/blood , Cyclosporine/pharmacokinetics , Drug Administration Schedule , Female , Follow-Up Studies , Graft Rejection/blood , Graft Rejection/prevention & control , Humans , Immunosuppressive Agents/pharmacokinetics , Lipoproteins/blood , Liver Transplantation/immunology , Male , Middle Aged , Postoperative Complications/classification , Triglycerides/bloodSubject(s)
Age Factors , Graft Survival , Liver Transplantation/physiology , Tissue Donors/statistics & numerical data , Adolescent , Adult , Aged , Analysis of Variance , Bile/metabolism , Child , Child, Preschool , Drug Therapy, Combination , Female , Histocompatibility Testing , Humans , Immunosuppressive Agents/therapeutic use , Liver , Liver Transplantation/immunology , Liver Transplantation/mortality , Male , Middle Aged , Multivariate Analysis , Organ Preservation , Regression Analysis , Reoperation , Retrospective Studies , Survival RateSubject(s)
Hepacivirus/genetics , Hepatitis C/diagnosis , Hepatitis C/surgery , Liver Transplantation , Alleles , Follow-Up Studies , Genotype , Graft Survival , HLA-DR Antigens/genetics , HLA-DR Antigens/immunology , HLA-DRB1 Chains , Hepacivirus/isolation & purification , Hepatitis C/complications , Histocompatibility Testing , Humans , Liver Cirrhosis/etiology , Liver Cirrhosis/surgery , Liver Transplantation/immunology , Postoperative Complications , Recurrence , Retrospective Studies , Time FactorsABSTRACT
Between January 1989 and June 1997, 533 patients (423 male, 110 female, mean age 61 years, range 22-89 years) with hepatocellular carcinoma (HCC) were observed at our center. We report on 419 patients retrospectively compared for different treatments: liver transplantation (LT; 55 patients), resective surgery (RS; 41 patients), transarterial chemoembolization (TACE; 171 patients) and percutaneous ethanol injection (PEI; 152 patients). The 3- and 5-year actuarial survival rates were, respectively, 72% and 68% for LT, 64 and 44% for RS, 54 and 36% for PEI, and 32 and 22% for TACE. Survival curves were compared for sex, age, tumor characteristics, alphafetoprotein level, Child class, and etiology of cirrhosis. All patient-related characteristics examined (sex, age) are not significantly related to patient survival. Tumor-related variables and associated liver disease variables significantly conditioned survival in relation to different treatments. LT seems to be the treatment of choice for monofocal HCC less then 5 cm in diameter and in selected cases of plurifocal HCC.
Subject(s)
Carcinoma, Hepatocellular/therapy , Chemoembolization, Therapeutic , Ethanol/therapeutic use , Hepatectomy , Liver Neoplasms/therapy , Liver Transplantation , Actuarial Analysis , Adult , Aged , Aged, 80 and over , Carcinoma, Hepatocellular/mortality , Female , Humans , Injections , Liver Neoplasms/mortality , Male , Middle Aged , Retrospective Studies , Survival RateSubject(s)
Ileum/surgery , Pancreas Transplantation , Urinary Bladder/surgery , Adult , Drainage , Female , Humans , Male , Middle Aged , Pancreas Transplantation/methodsABSTRACT
UNLABELLED: Focal nodular hyperplasia (FNH) and adenoma are rare benign hepatic tumors, and the standards for diagnosis and treatment still remain controversial. Usually adenoma is an indication for resection, due to its tendency to bleed and to degenerate; FNH, on the contrary, may be treated conservatively. Preoperation differential diagnosis is, however, difficult, often impossible. MATERIALS AND METHODS: Thirty-eight patients with presumed hepatic adenoma and/or FNH were studied at our department from 1984 to 1996. Preoperative assessment included clinical evaluation and symptoms, laboratory tests, liver biopsy, ultrasound scan, computed tomography scan, magnetic resonance imaging, scintigraphy, and angiography. Thirteen patients had a presumed diagnosis of FNH, 16 of adenoma, and 9 of undetermined benign lesions; 27 had hepatic resections (3 with laparoscopic technique), and 11 were not operated on and are actually under a strict follow-up observation. RESULTS: The final diagnosis was 19 FNH and 19 adenomas (2 of which contained areas of hepatocarcinoma). Presumed diagnosis was confirmed in 71% of cases. Use of oral contraceptives, abdominal symptoms, and pathologic liver test results were frequent in patients with adenomas. There were no deaths after surgery. All resected patients were tumor free during the follow-up, and in 10 of the 11 nonoperated cases, the size of the nodules remained unchanged. We conclude that precise diagnosis of these benign liver tumors remains difficult and sometimes impossible, despite new imaging techniques. Hepatic resections can be performed under very safe conditions; laparoscopic surgery may play a role in selected cases. Adenomas and uncertain cases are clear indications for surgery. Only when a diagnosis of FNH can be firmly confirmed in asymptomatic patients is strict observation without surgery recommended.
Subject(s)
Adenoma/diagnosis , Hyperplasia/diagnosis , Liver Neoplasms/diagnosis , Liver/pathology , Adenoma/diagnostic imaging , Adult , Angiography , Biopsy , Diagnosis, Differential , Female , Humans , Hyperplasia/diagnostic imaging , Liver Neoplasms/diagnostic imaging , Magnetic Resonance Imaging , Male , Middle Aged , Tomography, X-Ray ComputedSubject(s)
Carcinoma, Hepatocellular/surgery , Liver Cirrhosis/complications , Liver Neoplasms/surgery , Liver Transplantation , Actuarial Analysis , Adult , Carcinoma, Hepatocellular/complications , Carcinoma, Hepatocellular/mortality , Carcinoma, Hepatocellular/pathology , Cause of Death , Female , Humans , Liver Cirrhosis/mortality , Liver Cirrhosis/surgery , Liver Neoplasms/complications , Liver Neoplasms/mortality , Liver Neoplasms/pathology , Liver Transplantation/mortality , Male , Middle Aged , Neoplasm Invasiveness , Neoplasm Staging , Retrospective Studies , Survival Rate , Time FactorsSubject(s)
Hepacivirus/genetics , Hepatitis C/physiopathology , Hepatitis C/surgery , Liver Transplantation , Biopsy , Follow-Up Studies , Genotype , Hepacivirus/isolation & purification , Hepatitis C/pathology , Humans , Liver Function Tests , Liver Transplantation/mortality , Liver Transplantation/pathology , Predictive Value of Tests , RNA, Viral/analysis , Recurrence , Retrospective Studies , Survival Rate , Time FactorsSubject(s)
Immunosuppressive Agents/administration & dosage , Liver Transplantation/immunology , Steroids/administration & dosage , Adult , Cholesterol/blood , Diabetes Mellitus/epidemiology , Drug Administration Schedule , Female , Graft Rejection/epidemiology , Humans , Hypertension/epidemiology , Immunosuppressive Agents/therapeutic use , Liver Diseases/surgery , Male , Middle Aged , Patient Selection , Postoperative Complications/epidemiology , Prospective Studies , Steroids/therapeutic useABSTRACT
Between December 1985 and February 1995, 260 orthotopic liver transplantations (OLTX) were performed on 238 patients at Niguarda Hospital. Sixty-three patients had hepatocellular carcinoma (HCC); in 13 of the patients HCC was incidental. All patients had negative lymph nodes. According to the Child classification, 13 patients were Child A, 30 Child B, and 18 Child C. According to the TNM classification, 11 patients were stage I, 22 stage II, 15 stage III, and 15 stage IVa. Pre-OLTX chemoembolization was performed on 25 patients. The perioperative mortality rate was 27% (17 patients). Overall survival and disease-free actuarial survival rates at 1, 3, and 5 years were 94%, 76%, 76%, and 83%, 75%, 75%, respectively. Survival curves were compared for 16 different variables. No difference was observed for all parameters analyzed except tumor site, TNM stage, pre-OLTX AFP levels and vascular infiltration. These results seem to demonstrate that the OLTX for unresectable HCC can be considered in specifically selected cases as the treatment of choice. An adequate tumor staging is also necessary for a better patient selection in order to increase survival.
Subject(s)
Carcinoma, Hepatocellular/surgery , Liver Neoplasms/surgery , Liver Transplantation , Adult , Carcinoma, Hepatocellular/mortality , Female , Humans , Liver Neoplasms/mortality , Male , Middle Aged , Prognosis , SurvivorsABSTRACT
A discrepancy exists worldwide between the number of suitable liver donors and the increasing demand for transplantation. Thus many centers have considered widening their liver donor acceptance criteria and this may increase the incidence of primary dysfunction (PD) with negative effect on the results of transplantation. In order to reduce the incidence of PD and improve patient and graft survival it becomes important to identify those risk factors associated with its occurrence. In a retrospective univariate and multivariate analysis we evaluated several donor, preservation and recipient parameters and their correlation with PD. In our Department 282 orthotopic liver transplantations (OLT) were performed on 256 adult patients over a 10-year period. Excluded were 15 cases with early vascular problems and 4 intraoperative deaths. A complete series of donor, recipient and procedure-related data were analyzed. About 30% of donors showed abnormal values. In 70 cases of PD (26%) there was a 61.4% graft failure rate compared with 15% in the group with immediate function (P < 0.05). Univariate analysis showed donor age, steatosis, ischemia time, amines, oliguria, hypotension and ICU stay to be significantly associated with PD. Multivariate analysis showed steatosis, ischemia time and amine dosage to be independent risk factors for the development of primary non function. In conclusion, the acceptance of marginal donors worsened the results of transplantation, but the rejection of these donors would reduce by about 30% our transplant activity resulting in increased mortality in the waiting list. Combinations of risk factors when possible should be avoided, and ischemia time, as the only variable that can be controlled, should be kept as short as possible.