Liver transplantation at Stanford University Medical Center.
Because of the unique demographics of our patient population, we have had the opportunity to dedicate further studies of the management of hepatitis B and hepatitis C. We have experienced a very low HBV recurrence rate with the use of HBIG in patients transplanted for hepatitis B. Investigations, including the use of new antiviral agents, and the development of approaches to minimize or abrogate disease recurrence such as lower levels of immunosuppression are ongoing. Using a standardized approach to the proper evaluation and selection of patients for liver transplantation with alcoholic liver disease or other liver diseases with coexistent alcohol abuse, we report favorable long-term results in these patients. We have reviewed our results and our approach to the management of EBV and posttransplant lymphoproliferative disorder. There is a firm commitment in our laboratories and outpatient clinics to the investigation of disease prevention, reliable detection and screening methods, and treatment modalities for EBV-related disease. We have addressed specific technical considerations to pediatric liver transplant and have discussed unique aspects of postoperative management in these patients. One-third of the transplants performed at Stanford are in children, 42% of whom are less than one year old. Results with our pediatric transplant recipients compare favorably with those of our adult recipients with patient and graft survival rates approaching 90% at one year and exceeding 80% at 46 months for both groups. As a response to the limited organ supply, we have extended our criteria for suitable donors. Most notably, we have utilized older donors and grafts with significant microsteatosis and have observed good results with these grafts as long as ischemia time is minimized. We have also successfully used reduced size grafts for our pediatric patients with good results and are continuing to expand the use of living-related partial grafts and split allografts.
Millan
M T
MT
Department of Surgery, Stanford University School of Medicine, California, USA.
Keeffe
E B
EB
Berquist
W E
WE
Castillo
R O
RO
Cox
K L
KL
Garcia
G
G
Imperial
J C
JC
Monge
H
H
So
S K
SK
Esquivel
C O
CO
D000293:Adolescent; D000328:Adult; D002140:California; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D006085:Graft Survival; D006509:Hepatitis B / Q000601:surgery; D006526:Hepatitis C / Q000601:surgery; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D008108:Liver Diseases, Alcoholic / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology / Q000706:statistics & numerical data*; D018579:Patient Selection; D012189:Retrospective Studies; D015996:Survival Rate