Transplantation

Article Abstract:

The field of organ transplantation concerns itself with organ preservation, immunosuppression (in the recipient), and tissue typing (to enable appropriate organ-recipient matching). Improved preservation methods are now in use. The immunosuppressive drug cyclosporine, used in combination with steroid compounds, has made possible widespread transplantation of cadaveric organs (that is, from people who have died). However, cyclosporine causes undesirable side effects, including toxicity in the kidney and hypertension (high blood pressure). Another immunosuppressive drug, FK 506, which has a different structure, also inhibits T lymphocytes (cells of the immune system). Extensive clinical studies with FK 506 are ongoing. After one year's administration of this drug (and steroids) to transplant patients suffering intractable rejection, the survival rates are: all thoracic organ recipients (14 patients), 90 percent of liver recipients (of 151 patients), and 80 percent of kidney recipients (of 36 patients). Adverse effects of FK 506 are similar, but less severe than those associated with cyclosporine. Although cyclosporine and FK 506 are chemically different, they produce similar effects because they have binding sites (the region that produces the drug's effect) with actions that are similar to an enzyme (PPI, peptidyl-prolyl isomerase) which facilitates a broad range of physiological effects. Results from studies of the 20,000 cadaveric kidney transplantations performed in the US since November 1987 will indicate the extent to which HLA (human leukocyte antigen, molecules that help mediate the body's response to invasion) matching between donor and recipient tissues should serve as a basis for kidney distribution. Partial liver transplantation from live donors has been performed with variable results, and should only be attempted at the most sophisticated transplantation centers. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Usage, Reports, HLA histocompatibility antigens, HLA antigens, Cyclosporine, Cyclosporins, Transplantation immunology, Preservation of organs, tissues, etc., Organ preservation, Cadaver homografts

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Liver transplantation in patients with previous portasystemic shunt

Article Abstract:

Esophageal varices (enlarged, swollen and tortuous veins at the lower end of the esophagus) are a complication of portal hypertension and liver cirrhosis. Liver cirrhosis can obstruct the flow of blood in the portal vein, thus increasing the venous pressure and resulting in high pressure in the portal vein. Operative procedures (portasystemic shunts) can reduce the pressure in the portal vein of the liver and control bleeding varices. A review was undertaken of 58 patients who over a nine-year period underwent liver transplant after they had previously undergone portasystemic shunt procedures. These patients were followed from 6 months to 10 years following transplant. All patients were given immunosuppressive therapy when needed. The average interval between shunt procedure and transplantation was six years. The two main diagnoses for patients undergoing liver transplantation were postnecrotic cirrhosis (15 patients) and primary biliary cirrhosis (11 cases). There was no statistically significant difference in actuarial nine-year survival between these patients with previous shunt procedures and the entire group of patients who had primary liver transplant performed at the same institution during the same period. The type of previous shunt procedure did influence survival; those shunt procedures that did not dissect the hilum of the liver were safer. Distal splenorenal and mesocaval shunts were found to be the safest shunt procedures for patients in whom liver transplantation is a possibility. (Consumer Summary produced by Reliance Medical Information, Inc.)

Injuries, Liver, Liver transplantation, Esophageal varices, Splenorenal shunt, Surgical, Surgical splenorenal shunt

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