NEW ASPECTS OF HETEROTOPIC LIVER-TRANSPLANTATION

被引：22

作者：

BLANKENSTEIJN, JD ^{[1
]}

SCHALM, SW ^{[1
]}

TERPSTRA, OT ^{[1
]}

机构：

[1] ERASMUS UNIV,HOSP DIJKZIGT,DEPT SURG,3015 GD ROTTERDAM,NETHERLANDS

来源：

TRANSPLANT INTERNATIONAL | 1992年 / 5卷 / 01期

关键词：

LIVER TRANSPLANTATION; AUXILIARY; HLT VERSUS OLT; FIBRINOLYSIS; ACUTE HEPATIC FAILURE; HLT;

D O I：

10.1007/BF00337189

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

In this report the history and clinical results of heterotopic liver transplantation (HLT) are reviewed and some special aspects of current research on HLT are highlighted. The first laboratory experiments on liver transplantation were performed with auxiliary heterotopic grafts. The initial clinical results of HLT, however, were disappointing and orthotopic liver transplantation (OLT) evolved to be the procedure of choice. Of all the patients who received a heterotopic graft before 1980, only two survived. Since 1980, 50 HLTs are known to have been performed on 48 patients. Results of HLTs after 1986 are clearly better than earlier ones, and survival rates come within the range of those reported for OLT. Intraoperative fibrinolysis is found in the anhepatic phase of OLT, something which is absent in HLT. Tissue-type plasminogen activator (t-PA) is said to be responsible for this phenomenon, as well as for the postreperfusion hyperfibrinolysis. Parallel to the hemostatic changes, the intraoperative hemodynamic stability may be impaired by deleterious substances that arise during liver transplantation. Furthermore, the interaction between the two livers, the effect of HLT on portal pressure and hypersplenism, and the possible role of HLT in inborn errors of hepatic metabolism are described. Special attention is given to the treatment of acute hepatic failure. OLT, in an early phase of the disease, negates the possibility of spontaneous recovery, while delay of the decision to transplant may lead to further deterioration of the patient's clinical condition. As the procedure of HLT is reversible, the decision to transplant can be made more quickly. The clinical experience with HLT for acute liver failure is reported in detail.

引用

页码：43 / 50

页数：8

共 66 条

[21]

Grant D., Wall W., Ghent C., Duff J., Kutt J., Stiller C., Frei J., Liver transplantation: the problem of rejection, Transplant Proc, 18, pp. 163-166, (1986)

[22]

Groenland T.H.N., Visser L., Terpstra O.T., Terpstra J.L., Reuvers C.B., Baumgartner D., Schalm S.W., Stable hemodynamics during heterotopic auxiliary partial liver transplantation for end-stage liver cirrhosis, Transplant Proc, 20, pp. 538-540, (1988)

[23]

Gubernatis G., Pichlamayr R., Kemnitz J., Gratz K., Auxiliary partial orthotopic liver transplantation (APOLT) for fulminant hepatic failure: first successful case report, World J Surg, 15, pp. 660-666, (1991)

[24]

Houssin D., Berthelot P., Franco D., Bismuth H., Heterotopic liver transplantation in end-stage HBsAg-positive cirrhosis, Lancet, 1, pp. 990-993, (1980)

[25]

Icard P., Sawyer G.J., Houssin D., Fabre J.W., Marked differences between orthotopic and heterotopic auxiliary liver allografts in the induction of class II MHC antigens on hepatocytes, Transplantation, 49, pp. 1005-1007, (1990)

[26]

Iwatsuki S., Starzl T.E., Todo S., Gordon R.D., Esquivel C.O., Tzakis A.G., Makowka L., Marsh J.W., Koneru B., Stieber A.C., Klintmalm G.B., Husberg B., Experience in 1000 liver transplants under cyclosporine-steroid therapy: a survival report, Transplant Proc, 20, pp. 498-504, (1988)

[27]

Kalayoglu M., Stratta R.J., Hoffmann R.M., Sollinger H.W., Belzer F.O., Quadruple immunosuppressive therapy for liver transplantation, Transplant Proc, 20, pp. 524-529, (1988)

[28]

Kalpokas M., Bookallil M., Sheil A.G., Rickard K.A., Physiological changes during liver transplantation, Anaesth Intensive Care, 17, pp. 24-30, (1989)

[29]

Kaplan E.L., Meier E.A., Nonparametric estimation from incomplete observations, Journal of the American Statistical Association, 53, pp. 457-481, (1958)

[30]

Klintmalm G.B., Nery J.R., Husberg B.S., Gonwa T.A., Tillery G.W., Rejection in liver transplantation, Hepatology, 10, pp. 978-985, (1991)

← 1 2 3 4 5 6 7 →