Recent journal articles concerning liver transplantation have focused on split-liver transplantation in two adults, the minimal-sized liver graft, and screening for varices in patients with cirrhosis.
* Investigators at Hopital Paul Brousse in Villejuif, France, reported in April in Annals of
Surgery that split-liver transplantation for two adults "is technically feasible"
(2001;233:565-574). In a study of adults who underwent split-liver transplantation and those
who received whole livers, survival rates for whole-liver, right split-liver grafts, and left
split-liver grafts were 88%, 74%, and 75%, respectively, one year after surgery and were 85%,
74%, and 43% two years after surgery. "There are no medical or ethical obstacles to more
widespread use" of the procedure, said Daniel Azoulay, MD, PhD, and coauthors.
Read the
abstract at
http://ipsapp002.lwwonline.com/servlet/GetFileServlet?J=160&I=65&A=13&U=1&T=0.
* Although the minimum graft size required for living donor liver transplantation has generally
been reported at 30% to 40% of the standard liver volume, investigators at Kyushu University in
Fukuoka, Japan, have reported that patients who received liver grafts measuring 26% to 29% of the
liver survived with good postoperative hepatic function. Such grafts "can be used with careful
intraoperative and postoperative management until the grafts regenerate," said Takashi Nishizaki,
MD, and colleagues in April in Annals of Surgery (2001;233:575-580).
Read the abstract at
http://ipsapp002.lwwonline.com/servlet/GetFileServlet?J=160&I=65&A=14&U=1&T=0.
* Screening for varices has been recommended in patients with cirrhosis to prevent variceal
hemorrhage, but researchers at the University of Alabama at Birmingham found that only 46%
of the patients they studied who presented for evaluation of liver transplantation had had
screening endoscopy or radiological studies to detect varices. "Omission of this preventive
strategy has the potential to increase the morbidity and mortality related to variceal
bleeding in cirrhotics, especially those with advanced disease awaiting liver transplantation,"
Miguel R. Arguedas, MD, MPH, and colleagues reported in March in the American Journal of
Gastroenterology (2001;96:833-837). In an editorial, Naga Chalasani, MD, of Indiana University
School of Medicine and coauthors said it is essential for clinicians to "adhere to the
published guidelines for primary prophylaxis of variceal bleeding, beginning with endoscopic
screening for their detection."
The editorial is posted at
www-east.elsevier.com/ajg/issues/9603/ajg3595edi.htm.
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