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Ciaramella M, LoGerfo F, Liang P. Lower Extremity Bypass for Occlusive Disease: A Brief History. Ann Vasc Surg 2024; 107:17-30. [PMID: 38582212 DOI: 10.1016/j.avsg.2023.11.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 04/08/2024]
Abstract
BACKGROUND This is a narrative review that aims to highlight key advancements that led to the current state of lower extremity bypass surgery. It focuses on key contributors during the last century who have driven the standardization of surgical treatment of peripheral arterial occlusive disease. METHODS A narrative review was conducted utilizing available resources in the scientific and historical literature to track landmark achievements in the development of modern lower extremity bypass surgery for occlusive disease, focusing primarily on the last century of advancement. RESULTS Several critical conceptual, technological, and technical landmarks were identified as critical components of modern lower extremity bypass surgery. This includes fundamental developments in the techniques of vascular anastomosis led by Carrel and others, a developing understanding of vascular occlusive disease as a localized and segmental process with broad implementation of the techniques of arteriography, and the development of safe thromboendarterectomy aided by the development and utilization of heparin for anticoagulation. These factors led to the first femoral-to-popliteal artery bypass by Jean Kunlin in 1948. From here, advances in vascular prosthetic material pioneered by Voorhees and others, alternative vascular conduits, increasing acceptance of tibial revascularization, and dispelling the myth of diabetic "small vessel" disease broadened revascularization options for patients with complex patterns of occlusive disease and those who have limited conduit availability. CONCLUSIONS Modern lower extremity bypass surgery for occlusive disease arose steadily over a course of a century, driven by complex problem-solving in the pathophysiological understanding of atherosclerosis, technical developments in vascular anastomosis and arteriography, and evolution of conduit materials and pharmacologic therapy. Future advancements in bypass surgery are targeted at solving the complex problems of anastomotic intimal hyperplasia, expanding technology for alternative vascular conduits, ongoing optimization of risk factors, and scrutinizing of outcomes to make patient-centered, evidence-based decisions regarding revascularization strategy.
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Affiliation(s)
- Michael Ciaramella
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Frank LoGerfo
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Patric Liang
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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2
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Barron JO, Radhakrishnan K, Coppa C, Goldman D, Hupertz V, Leonis M, Eghtesad B, Hashimoto K. Ten-year follow-up of cavoportal hemitransposition in pediatric liver transplantation for complete portomesenteric venous thrombosis: A case report and literature review. Pediatr Transplant 2024; 28:e14738. [PMID: 38436520 DOI: 10.1111/petr.14738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/13/2023] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Portal vein thrombosis is a potentially devastating complication following pediatric liver transplantation. In rare instances of complete portomesenteric thrombosis, cavoportal hemitransposition may provide graft inflow. Here we describe long-term results following a case of pediatric cavoportal hemitransposition during liver transplantation and review the current pediatric literature. METHODS A 9-month-old female with a history of biliary atresia and failed Kasai portoenterostomy underwent living donor liver transplantation, which was complicated by portomesenteric venous thrombosis. The patient underwent retransplantation with cavoportal hemitransposition on postoperative day 12. OUTCOME The patient recovered without further complication, and 10 years later, she continues to do well, with normal graft function and no clinical sequelae of portal hypertension. CT scan with 3-D vascular reconstruction demonstrated recanalization of the splanchnic system, with systemic drainage to the inferior vena cava via an inferior mesenteric vein shunt. The cavoportal anastomosis remains patent with hepatopetal flow. Of the 12 previously reported cases of pediatric cavoportal hemitransposition as portal inflow in liver transplantation, this is the longest-known follow-up with a viable allograft. Notably, sequelae of portal hypertension were also rare in the 12 previously reported cases, with no cases of long-term renal dysfunction, lower extremity edema, or ascites. CONCLUSIONS Long-term survival beyond 10 years with normal graft function is feasible following pediatric cavoportal hemitransposition. Complications related to portal hypertension were generally short-lived, likely due to the development of robust collateral circulation. Additional reports of long-term outcomes are necessary to facilitate informed decision making when considering pediatric cavoportal hemitransposition for liver graft inflow.
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Affiliation(s)
- John O Barron
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kadakkal Radhakrishnan
- Department of Pediatric Hepatology and Gastroenterology, Pediatric Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christopher Coppa
- Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Deborah Goldman
- Department of Pediatric Hepatology and Gastroenterology, Pediatric Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Vera Hupertz
- Department of Pediatric Hepatology and Gastroenterology, Pediatric Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mike Leonis
- Department of Pediatric Hepatology and Gastroenterology, Pediatric Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bijan Eghtesad
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Koji Hashimoto
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
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3
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Transhepatic Coil Embolization for Ectopic Varices After Pediatric Liver-intestine Transplantation. Transplantation 2022; 106:e240-e241. [PMID: 35333849 DOI: 10.1097/tp.0000000000003985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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4
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Hefler J, Marfil-Garza BA, Pawlick RL, Freed DH, Karvellas CJ, Bigam DL, Shapiro AMJ. Preclinical models of acute liver failure: a comprehensive review. PeerJ 2021; 9:e12579. [PMID: 34966588 PMCID: PMC8667744 DOI: 10.7717/peerj.12579] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/10/2021] [Indexed: 12/14/2022] Open
Abstract
Acute liver failure is marked by the rapid deterioration of liver function in a previously well patient over period of days to weeks. Though relatively rare, it is associated with high morbidity and mortality. This makes it a challenging disease to study clinically, necessitating reliance on preclinical models as means to explore pathophysiology and novel therapies. Preclinical models of acute liver failure are artificial by nature, and generally fall into one of three categories: surgical, pharmacologic or immunogenic. This article reviews preclinical models of acute liver failure and considers their relevance in modeling clinical disease.
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Affiliation(s)
- Joshua Hefler
- Division of General Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Braulio A Marfil-Garza
- Division of General Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.,National Institutes of Medical Sciences & Nutrition Salvador Zubiran, Mexico City, Mexico.,CHRISTUS-LatAm Hub Excellence & Innovation Center, Monterrey, Mexico
| | - Rena L Pawlick
- Division of General Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Darren H Freed
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Constantine J Karvellas
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Department of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - David L Bigam
- Division of General Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - A M James Shapiro
- Division of General Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Clinical Islet Transplant Program, University of Alberta, Edmonton, Alberta, Canada
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5
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Fontes P, Komori J, Lopez R, Marsh W, Lagasse E. Development of Ectopic Livers by Hepatocyte Transplantation Into Swine Lymph Nodes. Liver Transpl 2020; 26:1629-1643. [PMID: 32810371 PMCID: PMC7756213 DOI: 10.1002/lt.25872] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/01/2020] [Accepted: 08/09/2020] [Indexed: 12/16/2022]
Abstract
Orthotopic liver transplantation continues to be the only effective therapy for patients with end-stage liver disease. Unfortunately, many of these patients are not considered transplant candidates, lacking effective therapeutic options that would address both the irreversible progression of their hepatic failure and the control of their portal hypertension. In this prospective study, a swine model was exploited to induce subacute liver failure. Autologous hepatocytes, isolated from the left hepatic lobe, were transplanted into the mesenteric lymph nodes (LNs) by direct cell injection. At 30-60 days after transplantation, hepatocyte engraftment in LNs was successfully identified in all transplanted animals with the degree of ectopic liver mass detected being proportional to the induced native liver injury. These ectopic livers developed within the LNs showed remarkable histologic features of swine hepatic lobules, including the formation of sinusoids and bile ducts. On the basis of our previous tyrosinemic mouse model and the present pig models of induced subacute liver failure, the generation of auxiliary liver tissue using the LNs as hepatocyte engraftment sites represents a potential therapeutic approach to supplement declining hepatic function in the treatment of liver disease.
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Affiliation(s)
- Paulo Fontes
- WVU MedicineDepartment of SurgerySchool of MedicineWest Virginia UniversityMorgantownWV,LyGenesis, Inc.PittsburghPA
| | - Junji Komori
- McGowan Institute for Regenerative MedicineDepartment of PathologySchool of MedicineUniversity of PittsburghPittsburghPA,Department of SurgeryTakamatsu Red Cross HospitalKagawaJapan
| | - Roberto Lopez
- WVU MedicineDepartment of SurgerySchool of MedicineWest Virginia UniversityMorgantownWV,LyGenesis, Inc.PittsburghPA
| | - Wallis Marsh
- WVU MedicineDepartment of SurgerySchool of MedicineWest Virginia UniversityMorgantownWV
| | - Eric Lagasse
- LyGenesis, Inc.PittsburghPA,McGowan Institute for Regenerative MedicineDepartment of PathologySchool of MedicineUniversity of PittsburghPittsburghPA
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6
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Sterpetti AV, Kappes SK. Cirrhosis and Bleeding Esophageal Varices: Historic Perspectives. J Gastrointest Surg 2020; 24:1929-1936. [PMID: 32500417 DOI: 10.1007/s11605-020-04674-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/25/2020] [Indexed: 01/31/2023]
Abstract
The paper describes the fundamental discoveries in the definition and treatment of patients with bleeding esophageal varices and cirrhosis.
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Affiliation(s)
- Antonio V Sterpetti
- University of Rome Sapienza, Rome, Italy. .,Policlinico Umberto I, Viale del Policlinico, 00167, Rome, Italy.
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Soldozy S, Costello JS, Norat P, Sokolowski JD, Soldozy K, Park MS, Tvrdik P, Kalani MYS. Extracranial-intracranial bypass approach to cerebral revascularization: a historical perspective. Neurosurg Focus 2020; 46:E2. [PMID: 30717070 DOI: 10.3171/2018.11.focus18527] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/26/2018] [Indexed: 11/06/2022]
Abstract
While the majority of cerebral revascularization advancements were made in the last century, it is worth noting the humble beginnings of vascular surgery throughout history to appreciate its progression and application to neurovascular pathology in the modern era. Nearly 5000 years of basic human inquiry into the vasculature and its role in neurological disease has resulted in the complex neurosurgical procedures used today to save and improve lives. This paper explores the story of the extracranial-intracranial approach to cerebral revascularization.
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Affiliation(s)
- Sauson Soldozy
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - John S Costello
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Pedro Norat
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Jennifer D Sokolowski
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Kamron Soldozy
- 2Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey
| | - Min S Park
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Petr Tvrdik
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - M Yashar S Kalani
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
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8
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Henderson JM, Anderson CD. The Surgical Treatment of Portal Hypertension. Clin Liver Dis (Hoboken) 2020; 15:S52-S63. [PMID: 32140214 PMCID: PMC7050955 DOI: 10.1002/cld.877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 08/25/2019] [Indexed: 02/04/2023] Open
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9
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Lemoine C, Nilsen A, Brandt K, Mohammad S, Melin-Aldana H, Superina R. Liver histopathology in patients with hepatic masses and the Abernethy malformation. J Pediatr Surg 2019; 54:266-271. [PMID: 30528201 DOI: 10.1016/j.jpedsurg.2018.10.083] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 10/30/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND/PURPOSE The Abernethy malformation (AM) is a congenital venous malformation in which the splanchnic venous return bypasses the liver and drains directly into the systemic circulation. This deprives the liver of hepatotrophic growth factors and allows metabolic products of digestion to enter the systemic veins without the benefit of passing through the liver. The histologic features of liver biopsies in children with an AM were reviewed. METHODS A retrospective review of liver biopsies in patients with AM between 1997 and 2017 was performed. Patients were divided into two groups for comparison of histologic features: presence (M+) or absence (M-) of a coexistent liver mass on imaging. Biopsies were reviewed by a pediatric pathologist. Chi-square test was used for statistical analysis between groups. Significance was assigned to p values <0.05. RESULTS Eighteen liver biopsies were reviewed. Masses were present in only 6 patients who had a liver biopsy. Masses were observed with similar frequencies in either type of the Abernethy malformation (I or II). Nine of 12 M- patients and 3/6 M+ patients had the type I AM. Histologically, all patients were noted to have small or absent portal veins. Isolated capillaries were seen more frequently in patients with a known liver mass (p = 0.045), while crowding of portal tracts was more commonly seen in patients without a liver mass (p = 0.019). CONCLUSION Liver biopsies in patients with AM demonstrate abnormal vascular and parenchymal histologic features. Livers with coexistent masses were more commonly found to have features suggesting an increased dependence on arterial blood supply. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Caroline Lemoine
- Division of Transplant Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA
| | - Annika Nilsen
- Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA
| | - Katherine Brandt
- Division of Transplant Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA
| | - Saeed Mohammad
- Division of Gastroenterology, Hepatology & Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA
| | - Hector Melin-Aldana
- Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA
| | - Riccardo Superina
- Division of Transplant Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA.
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10
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Levitt DG, Levitt MD. A model of blood-ammonia homeostasis based on a quantitative analysis of nitrogen metabolism in the multiple organs involved in the production, catabolism, and excretion of ammonia in humans. Clin Exp Gastroenterol 2018; 11:193-215. [PMID: 29872332 PMCID: PMC5973424 DOI: 10.2147/ceg.s160921] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Increased blood ammonia (NH3) is an important causative factor in hepatic encephalopathy, and clinical treatment of hepatic encephalopathy is focused on lowering NH3. Ammonia is a central element in intraorgan nitrogen (N) transport, and modeling the factors that determine blood-NH3 concentration is complicated by the need to account for a variety of reactions carried out in multiple organs. This review presents a detailed quantitative analysis of the major factors determining blood-NH3 homeostasis – the N metabolism of urea, NH3, and amino acids by the liver, gastrointestinal system, muscle, kidney, and brain – with the ultimate goal of creating a model that allows for prediction of blood-NH3 concentration. Although enormous amounts of NH3 are produced during normal liver amino-acid metabolism, this NH3 is completely captured by the urea cycle and does not contribute to blood NH3. While some systemic NH3 derives from renal and muscle metabolism, the primary site of blood-NH3 production is the gastrointestinal tract, as evidenced by portal vein-NH3 concentrations that are about three times that of systemic blood. Three mechanisms, in order of quantitative importance, release NH3 in the gut: 1) hydrolysis of urea by bacterial urease, 2) bacterial protein deamination, and 3) intestinal mucosal glutamine metabolism. Although the colon is conventionally assumed to be the major site of gut-NH3 production, evidence is reviewed that indicates that the stomach (via Helicobacter pylori metabolism) and small intestine and may be of greater importance. In healthy subjects, most of this gut NH3 is removed by the liver before reaching the systemic circulation. Using a quantitative model, loss of this “first-pass metabolism” due to portal collateral circulation can account for the hyperammonemia observed in chronic liver disease, and there is usually no need to implicate hepatocyte malfunction. In contrast, in acute hepatic necrosis, hyperammonemia results from damaged hepatocytes. Although muscle-NH3 uptake is normally negligible, it can become important in severe hyperammonemia. The NH3-lowering actions of intestinal antibiotics (rifaximin) and lactulose are discussed in detail, with particular emphasis on the seeming lack of importance of the frequently emphasized acidifying action of lactulose in the colon.
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Affiliation(s)
- David G Levitt
- Department of Integrative Biology and Physiology, University of Minnesota
| | - Michael D Levitt
- Research Service, Veterans Affairs Medical Center, Minneapolis, MN, USA
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11
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Balducci G, Sterpetti AV, Ventura M. A short history of portal hypertension and of its management. J Gastroenterol Hepatol 2016; 31:541-5. [PMID: 26510487 DOI: 10.1111/jgh.13200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/11/2015] [Accepted: 10/07/2015] [Indexed: 12/11/2022]
Abstract
The aim of our study was to review the changing trends in the treatment of complications from portal hypertension. A short history of portal hypertension and of the treatment of its complications is reported, underlying the most important achievements and changes.
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12
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Rela M, Bharathan A, Palaniappan K, Cherian PT, Reddy MS. Portal flow modulation in auxiliary partial orthotopic liver transplantation. Pediatr Transplant 2015; 19:255-60. [PMID: 25692474 DOI: 10.1111/petr.12436] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2015] [Indexed: 12/14/2022]
Abstract
APOLT is a suitable technique of liver transplantation in patients with ALF and some types of MLD. Portal venous steal is a problem with this procedure that leads to graft dysfunction and failure. Modulation of the portal flow to the graft and native liver can help in preventing this problem. We discuss the pathophysiology of this complication, review available literature regarding its management, and describe our results using the technique of graded hemiportal banding to achieve adequate perfusion for the graft and native liver.
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Affiliation(s)
- Mohamed Rela
- Institute of Liver Disease & Transplantation, Global Hospital & Health City, National Foundation for Liver Research, Chennai, Tamil Nadu, India; Institute of Liver Studies, Kings College Hospital, Denmark Hill, London, UK
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13
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Wei W, Dirsch O, Mclean AL, Zafarnia S, Schwier M, Dahmen U. Rodent models and imaging techniques to study liver regeneration. Eur Surg Res 2014; 54:97-113. [PMID: 25402256 DOI: 10.1159/000368573] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 09/19/2014] [Indexed: 12/16/2022]
Abstract
The liver has the unique capability of regeneration from various injuries. Different animal models and in vitro methods are used for studying the processes and mechanisms of liver regeneration. Animal models were established either by administration of hepatotoxic chemicals or by surgical approach. The administration of hepatotoxic chemicals results in the death of liver cells and in subsequent hepatic regeneration and tissue repair. Surgery includes partial hepatectomy and portal vein occlusion or diversion: hepatectomy leads to compensatory regeneration of the remnant liver lobe, whereas portal vein occlusion leads to atrophy of the ipsilateral lobe and to compensatory regeneration of the contralateral lobe. Adaptation of modern radiological imaging technologies to the small size of rodents made the visualization of rodent intrahepatic vascular anatomy possible. Advanced knowledge of the detailed intrahepatic 3D anatomy enabled the establishment of refined surgical techniques. The same technology allows the visualization of hepatic vascular regeneration. The development of modern histological image analysis tools improved the quantitative assessment of hepatic regeneration. Novel image analysis tools enable us to quantify reliably and reproducibly the proliferative rate of hepatocytes using whole-slide scans, thus reducing the sampling error. In this review, the refined rodent models and the newly developed imaging technology to study liver regeneration are summarized. This summary helps to integrate the current knowledge of liver regeneration and promises an enormous increase in hepatological knowledge in the near future.
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Affiliation(s)
- Weiwei Wei
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
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14
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Klarik Z, Toth E, Kiss F, Miko I, Furka I, Nemeth N. A modified microsurgical model for end-to-side selective portacaval shunt in the rat: intraoperative microcirculatory investigations. Acta Cir Bras 2013; 28:625-31. [DOI: 10.1590/s0102-86502013000900001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 08/22/2013] [Indexed: 01/13/2023] Open
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15
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Goyal N, Vij V, Wadhawan M, Srivastav A, Dargan P, Lohia P, Gupta S. Cavoportal Hemitransposition for Post Living Related Liver Transplant Portal Vein Thrombosis: A Valid Option. APOLLO MEDICINE 2008. [DOI: 10.1016/s0976-0016(11)60173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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16
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Marik PE. Maximizing efficacy from parenteral nutrition in critical care: appropriate patient populations, supplemental parenteral nutrition, glucose control, parenteral glutamine, and alternative fat sources. Curr Gastroenterol Rep 2007; 9:345-53. [PMID: 17883985 DOI: 10.1007/s11894-007-0040-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The gastrointestinal tract is the preferred route for nutritional support in hospitalized patients. Patients with a functioning gastrointestinal tract, including those with pancreatitis or inflammatory bowel disease and those receiving chemotherapy, should be fed enterally. Parenteral nutrition (PN) should be limited to patients with gastrointestinal failure, including those with short gut syndrome, high-output fistula, prolonged ileus, or bowel obstruction. PN is associated with numerous complications, most notably increased risk of serious infection. Emerging data suggest that immunologic complications of PN may result from hyperglycemia and use of n-6 polyunsaturated fatty acids. Safety may be improved with a low-calorie formula and ensuring tight glycemic control with an insulin protocol. A lipid emulsion containing fish oil, olive oil, or both should replace soybean-containing emulsions. Supplemental glutamine, 0.2 g/kg/d to 0.5 g/kg/d, has been shown to reduce the risk of infection and to improve glycemic control.
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Affiliation(s)
- Paul E Marik
- Pulmonary and Critical Care Medicine, Thomas Jefferson University, 834 Walnut Street, Suite 650, Philadelphia, PA, 19107, USA.
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18
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Baade S, Aupperle H, Grevel V, Schoon HA. Histopathological and Immunohistochemical Investigations of Hepatic Lesions Associated with Congenital Portosystemic Shunt in Dogs. J Comp Pathol 2006; 134:80-90. [PMID: 16423574 DOI: 10.1016/j.jcpa.2005.07.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2004] [Accepted: 07/26/2005] [Indexed: 11/17/2022]
Abstract
Canine livers with congenital portosystemic shunt were investigated histopathologically and immunohistochemically before and 8-272 days after partial ligation of the shunt. Lesions included hypoplasia of portal veins, arteriolar and ductular proliferation, lymphangiectasis, mild to moderate fibrosis, fatty cysts, and mostly mild hepatocellular damage with frequent atrophy and steatosis, regardless of the location of the shunting vessel. Perisinusoidal hepatic stellate cells (HSCs) in normal canine liver expressed alpha-smooth muscle actin (alpha-SMA), but no desmin. In altered livers, however, raised expression of alpha-SMA was detected, together with expression of desmin, in varying numbers of HSCs. This was interpreted as a sign of cellular proliferation and transformation to myofibroblast-like cells. Additionally, there was an obvious perisinusoidal increase of several extracellular matrix components. Postoperative biopsy samples showed basically the same lesions as those of pre-operative samples, except that signs of resolution of hepatic changes were apparent.
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Affiliation(s)
- S Baade
- Institute of Pathology, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
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Starzl TE. The saga of liver replacement, with particular reference to the reciprocal influence of liver and kidney transplantation (1955-1967). J Am Coll Surg 2002; 195:587-610. [PMID: 12437245 PMCID: PMC2993503 DOI: 10.1016/s1072-7515(02)01498-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Thomas E Starzl
- Thomas E Starzl Transplantation Institute, Pittsburgh, PA, USA
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20
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Gandhi CR, Murase N, Subbotin VM, Uemura T, Nalesnik M, Demetris AJ, Fung JJ, Starzl TE. Portacaval shunt causes apoptosis and liver atrophy in rats despite increases in endogenous levels of major hepatic growth factors. J Hepatol 2002; 37:340-8. [PMID: 12175629 PMCID: PMC2975525 DOI: 10.1016/s0168-8278(02)00165-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND/AIMS The response to the liver damage caused by portacaval shunt (PCS) is characterized by low-grade hyperplasia and atrophy. To clarify mechanisms of this dissociation, we correlated the expression of 'hepatotrophic factors' and the antihepatotrophic and proapoptotic peptide, transforming growth factor (TGF)-beta, with the pathologic changes caused by PCS in rats. METHODS PCS was created by side-to-side anastomosis between the portal vein and inferior vena cava, with ligation of the hilar portal vein. Hepatic growth mediators were measured to 2 months. RESULTS The decrease in the liver/body weight ratio during the first 7 days which stabilized by day 15, corresponded to parenchymal cell apoptosis and increases in hepatic TGF-beta concentration that peaked at 1.4 x baseline at 15 days before returning to control levels by day 30. Variable increases in the concentrations of growth promoters (hepatocyte growth factor, TGF-alpha and augmenter of liver regeneration) also occurred during the period of hepatocellular apoptosis. CONCLUSIONS The development of hepatic atrophy was associated with changes in TGF-beta concentration, and occurred despite increased expression of multiple putative growth promoters. The findings suggest that apoptosis set in motion by TGF-beta constrains the amount of hepatocyte proliferation independently from control of liver volume.
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Affiliation(s)
- Chandrashekhar R Gandhi
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, E-1540 BST, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
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21
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Abstract
Currently, for the patient with type 1 diabetes, a definitive treatment without resorting to the use of exogenous insulin can be achieved only with pancreas or islet cell transplantation. These means of restoring beta-cell mass can completely maintain essentially normal long-term glucose homeostasis, although the need for powerful immunosuppressive regimens limits their application to only a subgroup of adult patients. Apart from the shortage of donors that has limited all kinds of transplantation, however, the widespread use of beta-cell replacement has been precluded until recently by the drawbacks associated with both organ and islet cell transplantation. Although the study of recurrence of diabetes has generated attention, the fundamental obstacle to pancreas and islet transplantation has been, and remains, the alloimmune response. With a better elucidation of the mechanisms of alloengraftment achieved during the last 3 years, the stage has been set for further advances.
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Affiliation(s)
- Rita Bottino
- Division of Immunogenetics, Diabetes Institute, Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh, School of Medicine, Pittsburgh, PA 15213, USA
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22
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Starzl TE. The mother lode of liver transplantation, with particular reference to our new journal. LIVER TRANSPLANTATION AND SURGERY : OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION FOR THE STUDY OF LIVER DISEASES AND THE INTERNATIONAL LIVER TRANSPLANTATION SOCIETY 1998; 4:1-14. [PMID: 9457961 PMCID: PMC2993429 DOI: 10.1002/lt.500040101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- T E Starzl
- Pittsburgh Transplantation Institute University of Pittsburgh Medical Center, PA, USA
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23
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Affiliation(s)
- I E Konstantinov
- Department of Cardiothoracic Surgery, Linköping Heart Center, University Hospital, Sweden
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24
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Affiliation(s)
- K P de Jong
- Department of Surgery, University Hospital, Groningen, The Netherlands
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25
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Asfar S, Atkison P, Ghent C, Duff J, Wall W, Williams S, Seidman E, Grant D. Small bowel transplantation. A life-saving option for selected patients with intestinal failure. Dig Dis Sci 1996; 41:875-83. [PMID: 8625758 DOI: 10.1007/bf02091526] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Thirty-seven patients were listed for small bowel transplantation; 16 were transplanted and 15 died while waiting for a donor. Cyclosporine (N = 6) or tacrolimus (N = 10) were used for immune suppression. Graft rejection rates were lower in the combined liver/small bowel grafts than the isolated intestinal transplants (1/7 vs 5/7; P < 0.01) All of the cyclosporine group have died; the median survival was 25.7 months with two patients living more than five years. The tacrolimus group had fewer infections and a shorter hospital stay. All but two are alive with a median survival of 13 months. Seven of eight long-term survivors are off intravenous feedings. We conclude that small bowel transplantation is a life-saving option for patients with intestinal failure who cannot be maintained on total parenteral nutrition.
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Affiliation(s)
- S Asfar
- Multi-Organ Transplant Service, University Hospital, London, Ontario, Canada
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26
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Maddison JE, Mickelthwaite C, Watson WE, Johnston GA. Synaptosomal and brain slice cerebrocortical [3H]L-glutamate uptake in a rat model of chronic hepatic encephalopathy. Neurochem Int 1996; 28:89-93. [PMID: 8746768 DOI: 10.1016/0197-0186(95)00054-c] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cerebrocortical [3H]L-glutamate uptake was examined using brain slices and synaptosomes obtained from rats with portal vein and bile duct ligation. In addition, the effect of in vitro addition of 5 mM ammonia on glutamate uptake parameters was determined. There was no significant difference in brain slice or synaptosomal glutamate uptake in rats with portal vein and bile duct ligation compared to control rats. In vitro addition of ammonia had no effect on uptake kinetics in either brain slices or synaptosomes. These results suggest that glutamate uptake kinetics are not perturbed in this animal model of chronic hepatic encephalopathy.
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Affiliation(s)
- J E Maddison
- Department of Pharmacology, University of Sydney, Australia
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27
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28
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Francavilla A, Hagiya M, Porter KA, Polimeno L, Ihara I, Starzl TE. Augmenter of liver regeneration: its place in the universe of hepatic growth factors. Hepatology 1994. [PMID: 8076931 DOI: 10.1002/hep.1840200328] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- A Francavilla
- Pittsburgh Transplant Institute, University of Pittsburgh Medical Center, Pennsylvania 15213
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29
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Todo S, Tzakis A, Abu-Elmagd K, Reyes J, Starzl TE. Current status of intestinal transplantation. Adv Surg 1994; 27:295-316. [PMID: 8140977 PMCID: PMC2954648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- S Todo
- Pittsburgh Transplantation Institute, University of Pittsburgh School of Medicine, Pennsylvania
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30
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Abstract
Intestinal transplantation is often the only alternative form of treatment for patients dependent on total parenteral nutrition for survival. Although a limited number of intestinal transplantations have been performed, results with FK 506 immunosuppression are comparable to those for other organ transplants. The impact of successful intestinal transplantation on gastroenterology will likely be similar to the impact of kidney and liver transplantation on nephrology and hepatology.
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Affiliation(s)
- A G Tzakis
- Department of Surgery, University Health Center of Pittsburgh, University of Pittsburgh, Pennsylvania
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31
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Rokicki M, Rokicki W. Liver regeneration in rats after complete and partial occlusion of the portal blood influx. RESEARCH IN EXPERIMENTAL MEDICINE. ZEITSCHRIFT FUR DIE GESAMTE EXPERIMENTELLE MEDIZIN EINSCHLIESSLICH EXPERIMENTELLER CHIRURGIE 1993; 193:305-13. [PMID: 7506442 DOI: 10.1007/bf02576238] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The role of portal blood influx in liver regeneration was studied in rats. Partial hepatectomy with removal of 45% of the liver mass was performed after end-to-side portacaval shunt (PCS) leading to complete diversion of portal blood from the liver, or after side-to-side PCS causing partial portal blood deprivation. Liver resection was limited to 45% to avoid the high mortality rate in rats with vascular anastomoses and 70% hepatectomy, but it did not change the pattern of liver regeneration. The total RNA and DNA content, the rate of DNA synthesis and the number of hepatocyte mitoses in regenerating liver were measured in comparison to sham-operated controls. Complete occlusion of the portal blood influx did not block hepatoproliferative response, but caused a significant decrease and delay of regeneration. Partial preservation of portal flow in rats with side-to-side PCS markedly improved liver regeneration in comparison to end-to-side PCS, but the process was slower than in the control group.
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Affiliation(s)
- M Rokicki
- Department of Thoracic Surgery, 1st Hospital of Silesian Medical Academy, Zabrze, Poland
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32
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Francavilla A, Azzarone A, Carrieri G, Scotti-Foglieni C, Zeng QH, Cillo U, Porter K, Starzl TE. Effect on the canine Eck fistula liver of intraportal TGF-beta alone or with hepatic growth factors. Hepatology 1992. [PMID: 1427665 DOI: 10.1002/hep.1840160524] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Transforming growth factor-beta canceled the hepatocyte proliferation caused by transforming growth factor-alpha when the two substances were mixed and administered through a disconnected central portal vein branch after creation of an Eck fistula. In contrast, transforming growth factor-beta had no antidotal action on the stimulatory effects of insulin or full test doses of insulinlike factor-2, hepatocyte growth factor, epidermal growth factor or triiodothymanine. A minor antidotal effect on hepatic stimulatory substance activity could be detected, but only with hepatic stimulatory substance was given in doses smaller than those known to cause maximum stimulatory response. These results suggest a highly specific pharmacological and physiological interaction between transforming growth factor-alpha and transforming growth factor-beta in the modulation of liver growth control.
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Affiliation(s)
- A Francavilla
- Transplantation Institute, University Health Center of Pittsburgh, Pennsylvania 15213
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33
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Abstract
Hepatic encephalopathy occurs in a number of different species as a result of either congenital portacaval shunts or acquired liver disease. Despite intensive research, the neurochemical basis of the disorder has not been defined. Theories to explain the cerebral dysfunction that accompanies acute or chronic hepatic failure include 1) ammonia acting as the putative neurotoxin, 2) perturbed monoamine neurotransmission as a result of altered plasma amino acid metabolism, 3) an imbalance between excitatory amino acid neurotransmission, mediated by glutamate, and inhibitory amino acid neurotransmission, mediated by gamma-aminobutyric acid, and 4) increased cerebral concentrations of an endogenous benzodiazepine-like substance.
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Affiliation(s)
- J E Maddison
- Department of Pharmacology, University of Sydney, Australia
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34
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Todo S, Tzakis AG, Abu-Elmagd K, Reyes J, Nakamura K, Casavilla A, Selby R, Nour BM, Wright H, Fung JJ. Intestinal transplantation in composite visceral grafts or alone. Ann Surg 1992; 216:223-33; discussion 233-4. [PMID: 1384443 PMCID: PMC1242598 DOI: 10.1097/00000658-199209000-00002] [Citation(s) in RCA: 178] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Under FK 506-based immunosuppression, the entire cadaver small bowel except for a few proximal and distal centimeters was translated to 17 randomly matched patients, of whom two had antigraft cytotoxic antibodies (positive cross-match). Eight patients received the intestine only, eight had intestine in continuity with the liver, and one received a full multivisceral graft that included the liver, stomach, and pancreas. One liver-intestine recipient died after an intestinal anastomotic leak, sepsis, and graft-versus-host disease. The other 16 patients are alive after 1 to 23 months, in one case after chronic rejection, graft removal, and retransplantation. Twelve of the patients have been liberated from total parenteral nutrition, including all whose transplantation was 2 months or longer ago. The grafts have supported good nutrition, and in children, have allowed growth and weight gain. Management of these patients has been difficult and often complicated, but the end result has been satisfactory in most cases, justifying further clinical trials. The convalescence of the eight patients receiving intestine only has been faster and more trouble free than after liver-intestine or multivisceral transplantation, with no greater difficulty in the control of rejection.
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Affiliation(s)
- S Todo
- Department of Surgery, University of Pittsburgh School of Medicine, Pennsylvania
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35
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Murase N, Demetris AJ, Furuya T, Todo S, Fung JJ, Starzl TE. Comparison of the small intestine after multivisceral transplantation with the small intestines transplanted with portal or caval drainage. Transplant Proc 1992; 24:1143-4. [PMID: 1604559 PMCID: PMC2962583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- N Murase
- Department of Surgery, University Health Center of Pittsburgh, University of Pittsburgh, Pennsylvania
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36
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Ricordi C, Zeng Y, Carr B, Carroll P, Rilo HL, Demetris AJ, Alejandro R, Bereiter DR, Fung JJ, Tzakis A. Survival of human hepatocellular aggregates in athymic mice. Transplant Proc 1992; 24:986. [PMID: 1604699 PMCID: PMC2983484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- C Ricordi
- Transplant Institute, University of Pittsburgh School of Medicine, PA 15213
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37
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Todo S, Tzakis AG, Abu-Elmagd K, Reyes J, Fung JJ, Casavilla A, Nakamura K, Yagihashi A, Jain A, Murase N. Cadaveric small bowel and small bowel-liver transplantation in humans. Transplantation 1992; 53:369-76. [PMID: 1738932 PMCID: PMC2962580 DOI: 10.1097/00007890-199202010-00020] [Citation(s) in RCA: 131] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Five patients had complete cadaveric small bowel transplants under FK506 immunosuppression, one as an isolated graft and the other 4 in continuity with a liver. Three were children and two were adults. The five patients are living 2-13 months posttransplantation with complete alimentation by the intestine. The typical postoperative course was stormy, with sluggish resumption of gastrointestinal function. The patient with small intestinal transplantation alone had the most difficult course of the five, including two severe rejections, bacterial and fungal translocation with bacteremia, renal failure with the rejections, and permanent consignment to renal dialysis. The first four patients (studies on the fifth were incomplete) had replacement of the lymphoreticular cells in the graft lamina propria by their own lymphoreticular cells. Although the surgical and after-care of these patients was difficult, the eventual uniform success suggests that intestinal transplantation has moved toward becoming a practical clinical service.
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Affiliation(s)
- S Todo
- Department of Surgery, University of Pittsburgh School of Medicine, Pennsylvania
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38
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Francavilla A, Starzl TE, Porter K, Foglieni CS, Michalopoulos GK, Carrieri G, Trejo J, Azzarone A, Barone M, Zeng QH. Screening for candidate hepatic growth factors by selective portal infusion after canine Eck's fistula. Hepatology 1991; 14:665-70. [PMID: 1916668 PMCID: PMC2975974 DOI: 10.1016/0270-9139(91)90055-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Completely diverting portacaval shunt (Eck's fistula) in dogs causes hepatocyte atrophy, disruption of hepatocyte organelles, fatty infiltration and low-grade hyperplasia. The effect of hepatic growth regulatory substances on these changes was assessed by constantly infusing test substances for four postoperative days after Eck's fistula into the detached left protal vein above the shunt. The directly infused left lobes were compared histopathologically with the untreated right lobes. In what has been called an hepatotrophic effect, stimulatory substances prevented the atrophy and increased hepatocyte mitoses. Of the hormones tested, only insulin was strongly hepatotrophic; T3 had a minor effect, and glucagon, prolactin, angiotensin II, vasopressin, norepinephrine and estradiol were inert. Insulin-like growth factor, hepatic stimulatory substance, transforming growth factor-alpha and hepatocyte growth factor (also known as hematopoietin A) were powerfully hepatotrophic, but epidermal growth factor had a barely discernible effect. Transforming growth factor-beta was inhibitory, but tamoxifen, interleukin-1 and interleukin-2 had no effect. The hepatotrophic action of insulin was not altered when the insulin infusate was mixed with transforming growth factor-beta or tamoxifen. These experiments show the importance of in vivo in addition to in vitro testing of putative growth control factors. They illustrate how Eck's fistula model can be used to screen for such substances and possibly to help delineate their mechanisms of action.
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Affiliation(s)
- A Francavilla
- Department of Surgery, University Health Center of Pittsburgh, Pennsylvania 15213
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39
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Ricordi C, Zeng Y, Tzakis A, Alejandro R, Demetris AJ, Fung J, Bereiter DR, Mintz DH, Starzl TE. Evidence that canine pancreatic islets promote the survival of human hepatocytes in nude mice. Transplantation 1991; 52:749-51. [PMID: 1926362 PMCID: PMC3007091 DOI: 10.1097/00007890-199110000-00037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- C Ricordi
- Department of Surgery, University of Pittsburgh, Pennsylvania
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40
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Francavilla A, Starzl TE, Porter K, Foglieni CS, Michalopoulos GK, Carrieri G, Trejo J, Azzarone A, Barone M, Zeng QH. Screening for candidate hepatic growth factors by selective portal infusion after canine Eck's fistula. Hepatology 1991. [PMID: 1916668 DOI: 10.1002/hep.1840140415] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Completely diverting portacaval shunt (Eck's fistula) in dogs causes hepatocyte atrophy, disruption of hepatocyte organelles, fatty infiltration and low-grade hyperplasia. The effect of hepatic growth regulatory substances on these changes was assessed by constantly infusing test substances for four postoperative days after Eck's fistula into the detached left protal vein above the shunt. The directly infused left lobes were compared histopathologically with the untreated right lobes. In what has been called an hepatotrophic effect, stimulatory substances prevented the atrophy and increased hepatocyte mitoses. Of the hormones tested, only insulin was strongly hepatotrophic; T3 had a minor effect, and glucagon, prolactin, angiotensin II, vasopressin, norepinephrine and estradiol were inert. Insulin-like growth factor, hepatic stimulatory substance, transforming growth factor-alpha and hepatocyte growth factor (also known as hematopoietin A) were powerfully hepatotrophic, but epidermal growth factor had a barely discernible effect. Transforming growth factor-beta was inhibitory, but tamoxifen, interleukin-1 and interleukin-2 had no effect. The hepatotrophic action of insulin was not altered when the insulin infusate was mixed with transforming growth factor-beta or tamoxifen. These experiments show the importance of in vivo in addition to in vitro testing of putative growth control factors. They illustrate how Eck's fistula model can be used to screen for such substances and possibly to help delineate their mechanisms of action.
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Affiliation(s)
- A Francavilla
- Department of Surgery, University Health Center of Pittsburgh, Pennsylvania 15213
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41
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Katz S, Jimenez MA, Lehmkuhler WE, Grosfeld JL. Liver bacterial clearance following hepatic artery ligation and portacaval shunt. J Surg Res 1991; 51:267-70. [PMID: 1881140 DOI: 10.1016/0022-4804(91)90105-u] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The reticuloendothelial system (RES) plays an important role in removing bacteria, endotoxins, and immune complexes from the circulation. Hepatic phagocytosis accounts for more than 80% of RES function. The dual hepatic blood supply (hepatic artery/portal vein) may be altered by pathologic states and surgical procedures. This study evaluates and compares the effect of hepatic artery ligation and portacaval shunt on hepatic trapping of viable Escherichia coli. Thirty rats were placed in three groups: Group I was composed of sham operated controls; Group II underwent end-to-side portacaval shunt (PCS); and in Group III, hepatic artery ligation (HAL) was performed. At 2 weeks following the operation 10(9) 35S-radiolabeled viable E. coli were injected via the tail vein. At 10 min, bacterial distribution in the different organs was determined. Tissue samples were processed for liquid scintillation counting. The final distribution of bacteria was calculated from the input specific activity (dpm/bacteria) and expressed as the mean percentage of injected viable E. coli per gram of tissue and per organ weight. There was a significant decrease of bacterial trapping by the liver in rats following PCS (Group II), 45.0 +/- 10.4% vs controls 77.1 +/- 3.73% (P less than 0.005). This was partially compensated for by a significant increase of bacterial trapping by the lung. The decreased clearance in PCS rats is due to a reduction in liver mass compared to that in controls. Bacterial localization in HAL (Group III) rats was similar to that in controls. These data show that PCS decreases hepatic clearance and increases pulmonary localization of viable E. coli. This phagocytic dysfunction may contribute to increased susceptibility to infection following portacaval shunt.
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Affiliation(s)
- S Katz
- Department of Surgery, Indiana University School of Medicine, Indianapolis 46202
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42
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Murase N, Demetris AJ, Matsuzaki T, Yagihashi A, Todo S, Fung J, Starzl TE. Long survival in rats after multivisceral versus isolated small-bowel allotransplantation under FK 506. Surgery 1991; 110:87-98. [PMID: 1714104 PMCID: PMC2975982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Abdominal multivisceral allotransplantation (MVTX) from Brown Norway donor rats to Lewis recipient rats was performed under a 14-day course of low (0.32 mg/kg) or high-dose (0.64 mg/kg) intramuscular FK 506 to which weekly further injections were added in some of the high-dose animals. With all three regimens, long survival was frequently achieved with good intestinal adsorption and weight gain, but histopathologic evidence of intestinal rejection existed in the most lightly treated animals. The liver, stomach, and pancreas had only minor abnormalities. Rejection of isolated intestinal grafts was more difficult to control based on histopathologic criteria, and satisfactory results were obtained only with the most aggressive treatment protocol, suggesting that the liver in the MVTX had provided an advantage to the companion organs of the graft, of which the intestine was most vulnerable. Histopathologically, the lymphoid elements of the intestine, including the Peyer's patches, appeared to be the most immunogenic component of the intestine. Epithelium near lymphoid areas was secondarily involved with villous atrophy, cryptitis, and abscess formation. Beginning within 12 days in successful MVTX experiments, the lymphoreticular components of the graft intestine, including the Peyer's patches, lamina propria, and mesenteric nodes, were shown with anti-Ia monoclonal antibodies to be repopulated with recipient cells. This finding in grafts that appeared to be permanently accepted was surprising and contrary to expectations from the literature on intestinal allotransplantation.
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Affiliation(s)
- N Murase
- Department of Surgery, University Health Center, Pittsburgh, Pa
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43
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Rossaro L, Mazzaferro V, Scotti-Foglieni CL, Porter KA, Williams DS, Simplaceanu E, Simplaceanu V, Francavilla A, Starzl TE, Ho C. Cyclosporine and liver regeneration studied by in vivo 31P nuclear magnetic resonance spectroscopy. Dig Dis Sci 1991; 36:687-92. [PMID: 2022171 DOI: 10.1007/bf01297039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The changes in fructose-1-phosphate (F-1-P), intracellular pH, and ATP content of the liver after a fructose challenge were investigated noninvasively in vivo using phosphorus-31 nuclear magnetic resonance spectroscopy of dog liver four days after a portacaval shunt (PCS) with or without portal venous infusion of cyclosporin (CsA). The F-1-P metabolism was slower in PCS dogs (N = 2) as compared to either the normal (N = 2) or PCS + CsA-treated dogs (N = 3) (P less than 0.05). The intracellular pH temporarily decreased from 7.3 +/- 0.05 to 7.0 +/- 0.05 during the fructose challenge. The regenerative indexes were increased in the PCS + CsA group (P less than 0.01). These data obtained in vivo using 31P-NMR spectroscopy in the liver following a portacaval shunt, suggest that: (1) the energy status of the liver and the metabolic response to fructose are reduced in PCS compared to normal animals and (2) CsA treatment enhances the regenerative response of the liver and prevents the reduction in hepatic function associated with portacaval shunting.
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Affiliation(s)
- L Rossaro
- Cattedra di Malattie dell'Apparato Digerente, Universita di Padova, Italy
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44
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Abu-Elmagd KM, Ezzat FA, Fathy OM, el-Ghawlby NA, Aly MA, el-Fiky AM, el-Barbary MH, el-Ebady GE, el-Hak NG. Should both schistosomal and nonschistosomal variceal bleeders be disconnected? World J Surg 1991; 15:389-97; discussion 398. [PMID: 1853619 DOI: 10.1007/bf01658738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Splenopancreatic disconnection (SPD) was conceived and implemented as a technical addition to distal splenorenal shunt (DSRS) to maintain its selectivity and preserve portal perfusion. The proposed hemodynamic and metabolic stability of hepatocytes after DSRS-SPD should improve survival. In this nonrandomized study, 145 consecutive (Child A/B) variceal bleeders were electively subjected to selective shunt with DSRS in 93 and DSRS-SPD in 52 patients. The 2 groups were similar before surgery with a mean follow up of 24 +/- 12 (DSRS) and 27 +/- 14 (DSRS-SPD) months. DSRS-SPD had an operative mortality of 3.8%. Postoperative pancreatitis occurred in 7.7% after DSRS-SPD and 3.2% after DSRS alone, with schistosomal hepatic fibrosis representing 86% of morbid cases. Shunt patency was high and recurrent variceal hemorrhage was low in both groups. Clinical encephalopathy was significantly reduced after DSRS-SPD (p less than 0.05). The addition of SPD significantly reduced both the incidence of chronic hyperbilirubinemia in the schistosomal patients (p less than 0.05) and the difference between the changes in total serum bilirubin in all patients (p = 0.001). Portal perfusion was preserved after DSRS-SPD in all of the angiographically-studied patients. The overall survival was 84% after DSRS and 88% after DSRS-SPD. The schistosomal patients showed an incidence of 95% and 96% survival after DSRS and DSRS-SPD, respectively. DSRS-SPD was able to improve survival (92%) better than DSRS (77%) among well-matched nonschistosomal patients. These data show: (1) DSRS-SPD still has low operative mortality and a high patency rate with a low incidence of recurrent variceal hemorrhage, (2) DSRS-SPD maintains portal perfusion, achieves better survival, and reduces the incidence of encephalopathy, especially in patients with nonalcoholic cirrhosis and mixed liver disease, (3) in the schistosomal population, DSRS-SPD reduces the incidence of chronic hyperbilirubinemia but increases the risk of postoperative pancreatitis.
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Affiliation(s)
- K M Abu-Elmagd
- Department of Surgery, Mansoura University School of Medicine, Egypt
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45
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Starzl TE, Todo S, Tzakis A, Alessiani M, Casavilla A, Abu-Elmagd K, Fung JJ. The many faces of multivisceral transplantation. SURGERY, GYNECOLOGY & OBSTETRICS 1991; 172:335-44. [PMID: 2028370 PMCID: PMC2655210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The transplantation of multiple abdominal viscera, including liver-duodenum-pancreas, liver-stomach-duodenum-pancreas and liver-intestine, is being performed with increasing frequency and success. These procedures and other variations are derived from a seldom used multivisceral operation in which all of the foregoing organs are transplanted en bloc. It is described herein how the full multivisceral transplantation and its less extensive derivatives are based on the same principles of procurement, preservation and postoperative management. With all of these multiple organ permutations and with intestinal transplantation alone, management is complicated by inclusion in the grafts of a large lymphoreticular component that is capable of causing graft versus host disease (GVHD). Because of a systematic error in therapeutic philosophy, past efforts have been directed at altering or damaging the lymphoreticular cells by pretreatment of the donor or of the organs with drugs, irradiation or other means. From recent observations, the alternative approach is suggested of keeping these lymphoid depots intact, which then become the site of two way cell traffic after transplantation. With the use of powerful immunosuppression, such as that provided with FK 506, the donor lymphoreticular cells can circulate in the recipient without causing clinical GVHD, and the lymphoreticular cells in the graft become those of the recipient (local chimerism) without causing rejection. Even with avoidance of rejection and GVHD, metabolic interrelations between the grafted organs, and also between the graft organs and retained recipient viscera can affect the fate of the individual transplanted organs or retained recipient organs. The best delineated of these metabolic influences are mediated by the endogenous splanchnic hepatotrophic factors, of which insulin has been the most completely studied. An understanding of these various immunologic and nonimmunologic factors combined with more potent immunosuppression that is now available is sure to stimulate efforts at transplantation of abdominal organs and particularly of the hollow viscera that have resisted such clinical efforts.
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Affiliation(s)
- T E Starzl
- Department of Surgery, University of Pittsburgh, Pennsylvania 15213
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The clinical significance of the arterial ketone body ratio as an early indicator of graft viability in human liver transplantation. Transplantation 1991; 51:164-71. [PMID: 1987686 PMCID: PMC2978641 DOI: 10.1097/00007890-199101000-00025] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Arterial ketone body ratio (AKBR) was measured sequentially in 84 liver transplantations (OLTx). These transplantation procedures were classified into 3 groups with respect to graft survival and patient condition at the end of the first month (Group A, the grafts survived longer than 1 month with satisfactory patient condition; Group B, the grafts survived longer than 1 month but the patients were ICU-bound; Group C, the grafts were lost and the patients died or underwent re-OLTx). In Group A, the AKBR was elevated to above 1.0 by the second postoperative day. In Group B, the AKBR was elevated to above 0.7 but stayed below 1.0 during this period. In Group C, the AKBR remained below 0.7 longer than 2 days after operation. Although conventional liver function tests showed significant increases in Groups B and C as compared with Group A, they were less specific in predicting ultimate graft survival.
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47
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Stauber RE, Rosenblum E, Eagon PK, Gavaler JS, Van Thiel DH. The effect of portal-systemic shunting on hepatic sex hormone receptors in male rats. Gastroenterology 1991; 100:168-74. [PMID: 1983818 DOI: 10.1016/0016-5085(91)90597-e] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Signs of feminization are seen in men with cirrhosis of alcoholic but also of nonalcoholic origin even in the absence of markedly increased plasma estrogen levels. Recently identified alterations of hepatic sex hormone receptor levels have provided a hypothetical mechanism for the pathogenesis of the feminization seen in cirrhotic men. The aim of the present study was to determine the effect of experimental portal-systemic shunting in adult male rats on hepatic sex hormone receptor levels, plasma sex hormones, and two markers for sex hormone action in the liver. The following alterations were found in male rats with surgically created portacaval shunts compared with sham-operated controls: the hepatic content of cytosolic estrogen receptors was reduced by 35% and the cytosolic androgen receptors content by 59%; plasma levels of estradiol increased 6.7-fold while those of testosterone were reduced by 71%; the estrogen-responsive ceruloplasmin levels were decreased by 31% and the androgen-responsive male-specific estrogen binder by 72%. Based on these data, it can be concluded that portal-systemic shunting reduces the hepatic cytoplasmic content of several sex hormone related proteins. These changes are paralleled by a decreased estrogen responsiveness of the liver, as evidenced by the plasma ceruloplasmin level.
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Affiliation(s)
- R E Stauber
- Department of Surgery and Medicine, University of Pittsburgh School of Medicine, Pennsylvania
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48
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Mazzaferro V, Porter KA, Scotti-Foglieni CL, Venkataramanan R, Makowka L, Rossaro L, Francavilla A, Todo S, Van Thiel DH, Starzl TE. The hepatotropic influence of cyclosporine. Surgery 1990; 107:533-9. [PMID: 2185568 PMCID: PMC3005359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The effect of cyclosporine on liver regeneration has been investigated in 25 dogs that underwent an end-to-side portacaval shunt (Eck fistula) followed by 4 days continuous infusion of the drug into the left branch of the portal vein. Three different cyclosporine infusion rates were used: 0.06, 0.6, and 4.0 mg/kg/day. Control animals received the intravenous vehicle of cyclosporine at the same rate as the treated animals; a second control group received insulin, 0.42 units/kg/day. Hepatocyte 3H-thymidine-labeled mitoses (index of hyperplasia) and hepatocyte volume (index of hypertrophy) were studied in the left (infused) and right (control) lobes in each animal. Cyclosporine vehicle had no measurable effect on hepatocytes that suffered typical atrophy and moderate increase in mitotic index after the Eck fistula. Cyclosporine infusion stimulated cell renewal significantly and restored hepatocyte size in the infused lobes with a dose-response relation. Similar positive effects were observed in the right (nonperfused) lobes, although they were less than those in the left (infused) lobes. This was because of an unmistakable spillover of cyclosporine from the infused lobes, especially in the large-dose group. No sign of hepatotoxicity was detected at any cyclosporine infusion rate. Cyclosporine has a remarkable hepatotropic effect that may be helpful in the context of liver transplantation.
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Affiliation(s)
- V Mazzaferro
- Department of Surgery, School of Pharmacy, University Health Center of Pittsburgh, Pa
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Mazzaferro V, Scotti-Foglieni CL, Porter KA, Trejo Bellido J, Carrieri G, Todo S, Fung JJ, Francavilla A, Starzl TE. Studies of the hepatotrophic qualities of FK 506 and CyA. Transplant Proc 1990; 22:93-5. [PMID: 1689913 PMCID: PMC3005695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- V Mazzaferro
- Department of Surgery, University of Pittsburgh, PA
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Affiliation(s)
- T E Starzl
- Department of Surgery, University of Pittsburgh School of Medicine, Pennsylvania
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