Liver Transplantation

An overview of liver transplantation

Liver transplantation has evolved into an accepted therapy for those with end-stage liver disease. Since the late 1960s when Dr. Thomas Starzl pioneered the first successful human liver transplantation, it has become a surgical specialty requiring a multidisciplinary approach. Currently, more than 11,000 patients are awaiting liver transplantation. The donor shortage has led to development of techniques for reduction in size of liver grafts, split liver grafts, and living related grafts. Despite these developments, more than 1,000 patients died in 1997 while awaiting transplantation. The increasing demand has led to maximal use of potential organ donors. The complexity of problems and complications that arise during the waiting period and after the transplantation require continued and diligent care. The nurse is an integral part of the transplantation team and can provide ongoing assessment and education throughout the transplantation process to facilitate the patient's return to an independent lifestyle.

A caspase inhibitor fully protects rats against lethal normothermic liver ischemia by inhibition of liver apoptosis

Apoptosisis activated during the early phase of reperfusion after liver ischemia and after liver transplantation in animals. However, the molecular basis of ischemia-induced cell death remains poorly understood. In this study we show that hepatocytes from ischemic liver lobes undergo apoptosis after reperfusion. In vivo pretreatment of rats with a specific inhibitor of caspases abrogates the apoptotic response in ischemic liver lobes. Inhibition of apoptosis can be accounted for by total inhibition of caspase activation as assessed in an enzymatic assay and by specific affinity labeling. Treatment with a caspase inhibitor fully protects rats from death induced by ischemia/reperfusion. These findings indicate that liver injury after ischemia/reperfusion can be prevented by inhibition of caspases. Thus, caspase inhibitors may have important therapeutic implications in liver ischemic diseases and after liver transplantation.

Mortality, endotoxaemia and cytokine expression after intermittent and continuous hepatic ischaemia

This study compared mortality rates, endotoxaemia, systemic tumour necrosis factor (TNF) and interleukin (IL)-6 concentrations after continuous and intermittent hepatic ischaemia. Two groups of rats were subjected to continuous or intermittent left hepatic inflow occlusion for a total period of 120 min in each group. Intermittent ischaemia was associated with significantly lower mortality rates than continuous ischaemia (four of 20 versus 15 of 20; P = 0.0015). In a separate study, again following 120 min continuous or intermittent ischaemia, systemic blood was sampled at 0 min, 1 h, 3 h and 5 h after final clamp release for measurement of endotoxin, TNF and IL-6 concentrations. Endotoxin concentrations were significantly lower at 1 h, as were TNF and IL-6 concentrations at 3 and 5 h, after final clamp release in the group having intermittent ischaemia (P < 0.05). Intermittent ischaemia is associated therefore with significantly reduced mortality rates and lower systemic endotoxin, TNF and IL-6 concentrations when compared with continuous ischaemia.