The field of liver transplantation is young, evolving, dynamic, and issues and decisions are often controversial, thus a text with a different focus is required, one that highlights controversy and challenges dogma. In Liver Transplantation: Challenging Controversies and Topics a useful set of chapters have been created that will take the reader step-by-step through key areas of controversy in the field of liver transplantation. The authors have tried to anticipate questions, define key issues, and provide options for resolving or approaching areas of uncertainty. The topics covered in this book impact our understanding and management of immunosuppressant, viral hepatitis, nonalcoholic fatty liver disease, organ allocation, regional differences in rates of transplantation, and hepatocellular cancer. All authors are actively practicing physicians and surgeons who deal with all the issues presented on an ongoing and daily basis. Throughout the book, emphasis is put on the need for thoughtful well-controlled clinical and basic research of transplant hepatology and liver transplantation. There is also speculation on potential breakthroughs in immunology, virology, cell biology, surgery and medicine that might influence or impact the future directions of these fields of medicine. Liver Transplantation: Challenging Controversies and Topics is an important new book meant to stimulate interest, identify topics requiring additional study, and to promote discourse among transplant professionals.
Author(s): Gregory T. Everson, James F. Trotter
Edition: 1
Publisher: Humana Press
Year: 2008
Language: English
Pages: 202
Preface......Page 5
Acknowledgments......Page 7
Contents......Page 8
Contributors......Page 9
1 Tolerance in Liver Transplantation......Page 11
Introduction......Page 12
Defining the Challenges......Page 13
Unique Aspects of the Liver Influencing Immune Outcome......Page 15
Clinical Tolerance......Page 20
Conclusions......Page 23
Acknowledgments......Page 24
2 Novel Approaches to Immunosuppression in Liver Transplantation......Page 29
Introduction......Page 30
Daclizumab......Page 31
Basiliximab......Page 34
Campath-1H......Page 35
Rapamycin......Page 36
Sirolimus and Side Effects in Liver Recipients......Page 37
Sirolimus for Liver Recipients with Hepatocellular Carcinoma (HCC)......Page 38
Compounds in Development: FTY720, FK778, and LEA29Y......Page 41
Immunosuppression of HCV-Positive Recipients......Page 43
Prospectus......Page 46
3 Pre- and Posttransplant Management of Hepatitis C......Page 55
Factors Influencing the Natural History of Posttransplant HCV Disease......Page 56
Treatment Strategies for Patients with Chronic HCV Undergoing Liver Transplantation......Page 58
Pretransplant Management of Chronic HCV......Page 59
Preemptive Treatment of Recurrent HCV Infection......Page 61
Treatment of Posttransplant HCV Disease......Page 64
Summary......Page 68
4 The Dilemma of Adult-to-Adult Living Donor Liver Transplantation......Page 74
Historical Background......Page 75
Donor Outcomes......Page 79
Left Lobe Allografts......Page 83
North American and European Outcomes......Page 84
Living Donor Liver Transplantation in Asia......Page 88
Hepatitis C......Page 89
Hepatocellular Carcinoma (HCC)......Page 90
Discussion......Page 91
5 The Share 15 Rule......Page 99
Acknowledgment......Page 100
6 Hepatocellular Carcinoma......Page 111
Introduction......Page 112
OLT and Cadaveric Donation......Page 113
Living Donor Liver Transplant......Page 115
Marginal Cadaveric Donors and HCC......Page 116
Accuracy of Preoperative Staging......Page 117
Loco-Regional Ablative Therapy......Page 118
Recurrence of HCC After Transplant......Page 120
Role of Immunosuppression......Page 121
Surgical Strategy for Recurrent HCC......Page 122
Liver Resection as a ``Bridge" to Transplantation......Page 123
7 Liver Transplantation and the Hepatopulmonary Syndrome......Page 131
Outcome of HPS Without OLT......Page 132
Outcome of HPS with OLT......Page 134
MELD Exception......Page 135
Diagnosis and Screening......Page 136
Transplant Candidacy and Management......Page 137
Summary......Page 139
8 Long-Term Metabolic Complications Posttransplantation......Page 142
Background......Page 143
Hypertension......Page 144
Metabolic Syndrome......Page 145
Metabolic Complication Management......Page 146
Conclusion......Page 148
9 Hepatitis B and Liver Transplantation......Page 152
Indications for Liver Transplantation......Page 153
Pretransplant Antiviral Therapy......Page 154
Lamivudine......Page 155
Monotherapy: Hepatitis B Immune Globulin (HBIg)......Page 157
Monotherapy: Lamivudine......Page 158
Combination Therapy: Hepatitis B Immune Globulin and Lamivudine......Page 160
Combination Therapy: Lamivudine and Adefovir......Page 162
LAM Monotherapy After HBIg Withdrawal or After Combined HBIg/LAM......Page 163
Vaccination After or During HBIg Withdrawal......Page 164
Outcomes of Liver Transplantation for HBV-Related Liver Disease......Page 165
Future Directions......Page 166
Conclusions......Page 167
10 Liver Transplantation for Nonalcoholic Fatty Liver Disease......Page 175
Clinical Features and Diagnosis of NASH......Page 176
Pathogenesis of NAFLD......Page 177
Lipid Metabolism in NAFLD......Page 178
Insulin Resistance in NAFLD......Page 179
Oxidative Stress in NAFLD......Page 180
Frequency of NAFLD/NASH as a Cause of Liver Failure......Page 182
Clinical Characteristics......Page 184
Treatment of NAFLD Before and After Liver Transplantation......Page 185
The Role of Protocol Liver Biopsy......Page 188
Index......Page 197
