Liver Transplantation (eBook)

Preface 6
Acknowledgments 8
Contents 9
Contributors 10
1 Tolerance in Liver Transplantation 12
Introduction 13
Defining the Challenges 14
Unique Aspects of the Liver Influencing Immune Outcome 16
Clinical Tolerance 21
Conclusions 24
Acknowledgments 25
2 Novel Approaches to Immunosuppression in Liver Transplantation 30
Introduction 31
Anti-IL-2 Receptor (Anti-CD25) Monoclonal Antibodies 32
Daclizumab 32
Basiliximab 35
Campath-1H 36
Rapamycin 37
Sirolimus and Side Effects in Liver Recipients 38
Sirolimus for Liver Recipients with Hepatocellular Carcinoma (HCC) 39
Sirolimus for Liver Recipients with Renal Dysfunction 42
SDZ-RAD 42
Compounds in Development: FTY720, FK778, and LEA29Y 42
Immunosuppression of HCV-Positive Recipients 44
Prospectus 47
3 Pre- and Posttransplant Management of Hepatitis C 56
Introduction 57
Factors Influencing the Natural History of Posttransplant HCV Disease 57
Treatment Strategies for Patients with Chronic HCV Undergoing Liver Transplantation 59
Pretransplant Management of Chronic HCV 60
Posttransplant Management of the Patient with Chronic HCV 62
Preemptive Treatment of Recurrent HCV Infection 62
Treatment of Posttransplant HCV Disease 65
Summary 69
4 The Dilemma of Adult-to-Adult Living Donor Liver Transplantation 75
Introduction 76
Historical Background 76
Donor Outcomes 80
Recipient Outcomes 84
Left Lobe Allografts 84
North American and European Outcomes 85
Living Donor Liver Transplantation in Asia 89
Adult-to-Adult Living Donor Liver Transplantation Outcomes When Applied to a Specific Indication 90
Hepatitis C 90
Hepatocellular Carcinoma (HCC) 91
Discussion 92
5 The Share 15 Rule 100
Introduction 101
Acknowledgment 101
6 Hepatocellular Carcinoma 112
Introduction 113
Expanding the Selection Criteria for Transplantation and HCC 114
OLT and Cadaveric Donation 114
Living Donor Liver Transplant 116
Marginal Cadaveric Donors and HCC 117
Accuracy of Preoperative Staging 118
Loco-Regional Ablative Therapy 119
Recurrence of HCC After Transplant 121
Role of Immunosuppression 122
Surgical Strategy for Recurrent HCC 123
Liver Resection as a ``Bridge" to Transplantation 124
7 Liver Transplantation and the Hepatopulmonary Syndrome 132
Background 133
Significance of HPS in OLT 133
Outcome of HPS Without OLT 133
Outcome of HPS with OLT 135
MELD Exception 136
Diagnosis and Screening 137
Transplant Candidacy and Management 138
Summary 140
8 Long-Term Metabolic Complications Posttransplantation 143
Background 144
Hypertension 145
Dyslipidemia 146
Diabetes Mellitus 146
Metabolic Syndrome 146
Osteoporosis 147
Metabolic Complication Management 147
Conclusion 149
9 Hepatitis B and Liver Transplantation 153
Burden of Disease 154
Indications for Liver Transplantation 154
Pretransplant Antiviral Therapy 155
Lamivudine 156
Posttransplant Antiviral Therapy 158
Monotherapy: Hepatitis B Immune Globulin (HBIg) 158
Monotherapy: Lamivudine 159
Combination Therapy: Hepatitis B Immune Globulin and Lamivudine 161
Combination Therapy: Lamivudine and Adefovir 163
Can HBIg Be Discontinued? 164
LAM Monotherapy After HBIg Withdrawal or After Combined HBIg/LAM 164
Vaccination After or During HBIg Withdrawal 165
Posttransplant De Novo HBV Infection 166
Outcomes of Liver Transplantation for HBV-Related Liver Disease 166
Future Directions 167
Conclusions 168
10 Liver Transplantation for Nonalcoholic Fatty Liver Disease 176
Introduction 177
Clinical Features and Diagnosis of NASH 177
Pathogenesis of NAFLD 178
Lipid Metabolism in NAFLD 179
Insulin Resistance in NAFLD 180
Oxidative Stress in NAFLD 181
Frequency of NAFLD/NASH as a Cause of Liver Failure 183
Liver Transplantation for NAFLD/NASH 185
Clinical Characteristics 185
Outcomes Following Liver Transplantation for NAFLD/NASH 186
Treatment of NAFLD Before and After Liver Transplantation 186
Choice of Immunosuppression 189
The Role of Protocol Liver Biopsy 189
Index 198