title: Experience of liver transplantation for incurable alveolar echinococcosis: a 45-case European collaborative report.
abstract: BACKGROUND
  Alveolar echinococcosis (AE) of the liver is a rare and severe parasitic disease. It behaves like a slow-growing liver cancer, and liver transplantation (LT) has been proposed in advanced cases since 1985. The aim of this retrospective study was to collect all AE transplant cases in Europe, analyze the results, and specify the usefulness of LT for this unusual indication.
  
  
  METHODS
  A questionnaire was sent to 83 LT centers from July 1996 to December 1999.
  
  
  RESULTS
  Sixty-five centers responded: 45 AE patients (mean age, 45.8 years) underwent an LT procedure at 16 LT centers. The mean interval between diagnosis and LT was 5 years. One patient died during the hepatectomy phase. Five-year survival was 71%. Five-year survival without recurrence was 58%. The nine early deaths were mostly related to bacterial or fungal infections, or both, in patients in bad condition when LT was performed. Six patients had a graft AE reinfection. Five late deaths were related directly to ongoing AE. In the other cases, benzimidazole (BZM) therapy seemed to stabilize AE residues.
  
  
  CONCLUSIONS
  This unique experience indicates that LT is feasible for life-threatening AE. Specific management is needed to optimize the results: earlier decision for LT in incurable symptomatic biliary AE, pre- and post-LT BZM therapy, meticulous pre-LT evaluation to identify extrahepatic extension, and an immunosuppressive regimen kept to a minimum.
authors.affiliation: Liver Transplant Unit CHU, Besançon, France. skoch@chu-besancon.fr.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Koch
authors.forename: Solange
authors.initials: S
authors.lastname: Bresson-Hadni
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Miguet
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Crumbach
authors.forename: Michel
authors.initials: M
authors.lastname: Gillet
authors.forename: George-André
authors.initials: GA
authors.lastname: Mantion
authors.forename: Bruno
authors.initials: B
authors.lastname: Heyd
authors.forename: Dominique-Angèle
authors.initials: DA
authors.lastname: Vuitton
authors.forename: Anne
authors.initials: A
authors.lastname: Minello
authors.forename: Sabine
authors.initials: S
authors.lastname: Kurtz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000871:Anthelmintics / Q000627:therapeutic use; D001562:Benzimidazoles / Q000627:therapeutic use; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003299:Cooperative Behavior; D004444:Echinococcosis, Hepatic / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D005060:Europe; D005260:Female; D006084:Graft Rejection / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D000871:Anthelmintics; D001562:Benzimidazoles; D007166:Immunosuppressive Agents; C031000:benzimidazole