title: Liver transplantation at Cleveland Clinic.
abstract: This review describes our program and its outcomes and then provides an in-depth focuses into many of the unique aspects of our practice that have been important to the success of the program. These include a global appreciation for the impact and various presentations of chronic portal hypertension. We have sought to better understand and describe the various effects it can have on local allograft hemodynamics and graft survival. Intraoperative blood flow measurements of the hepatic artery and portal vein are important. Postoperative follow-up with Doppler ultrasound has been essential for both partial and whole grafts. A better understanding of systemic and graft hemodynamics has changed our clinical practice with regards to the intra- and post-operative management of the hepatic artery and portal vein. We have also focused on the issue of hepatocellular carcinoma, one of the major indications for liver transplantation. We have sought to better understand the heterogeneous clinical presentations of this disease and how to best approach them in a multidisciplinary fashion. Finally, we describe the various methods we have utilized to increase the number of hepatic grafts available for our patients. We have aggressively utilized all forms of grafts; living and deceased; partial and whole; and extended and standard criteria donors. We have done this with the focus on living donor safety and then concentrated on finding the best graft for the individual patient in the context of the national allocation systems in which we all work.
authors.affiliation: Liver Transplant Program, Digestive Disease Institute, Cleveland Clinic, Cleveland OH, USA.
authors.forename: Koji
authors.initials: K
authors.lastname: Hashimoto
authors.forename: Federico
authors.initials: F
authors.lastname: Aucejo
authors.forename: Cristiano
authors.initials: C
authors.lastname: Quintini
authors.forename: Galal
authors.initials: G
authors.lastname: El-Gazzaz
authors.forename: Peter
authors.initials: P
authors.lastname: Hodgkinson
authors.forename: Masato
authors.initials: M
authors.lastname: Fujiki
authors.forename: Teresa
authors.initials: T
authors.lastname: Diago
authors.forename: Dympna
authors.initials: D
authors.lastname: Kelly
authors.forename: Charles
authors.initials: C
authors.lastname: Winans
authors.forename: David
authors.initials: D
authors.lastname: Vogt
authors.forename: Bijan
authors.initials: B
authors.lastname: Eghtesad
authors.forename: John
authors.initials: J
authors.lastname: Fung
authors.forename: Charles
authors.initials: C
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006439:Hemodynamics; D006498:Hepatectomy; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000503:physiopathology; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009820:Ohio; D016730:Program Development; D015397:Program Evaluation; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D055815:Young Adult