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Your search term(s) "liver transplantation" returned 172 results.

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Treatment of Patients with Hepatitis C and Cirrhosis. Hepatology. 36(5 Supplemental 1): S185-S194. November 2002.

This article offers guidelines for the treatment of patients with hepatitis C and cirrhosis (scarring of the liver). The author notes that determining recommendations for this patient population is difficult. Few prospective studies have focused on the treatment of patients with advanced disease, and response rates appear to be lower and serious side effects more frequent in patients with cirrhosis. In patients with compensated cirrhosis, combination therapy with interferon alfa and ribavirin results in a sustained virological response (SVR) in 33 to 41 percent of patients. Responses to combination therapy are not significantly higher using peginterferon alfa 1a or 2b, compared with standard interferon. In using peginterferon in combination therapy, the benefits of once weekly dosing need to be weighed against the higher risks of cytopenias and greater costs with the pegylated formulations. Combination therapy results in some degree of histological improvement even in patients who are virological non-responders. These findings provide the scientific basis for ongoing studies of maintenance therapy with peginterferon to prevent complications of cirrhosis in nonresponders patients with hepatitis C. Recommendations for the management of decompensated cirrhosis and of recurrent hepatitis C after liver transplantation are difficult because of limitations of data, most of which are derived from uncontrolled case series. Combination therapy is poorly tolerated in both groups and rates of response are low. Thus, while the medical need is great, treatment of patients with decompensated cirrhosis or with recurrent hepatitis C after transplantation should be undertaken cautiously and only within the confines of prospective clinical trials. 2 figures. 1 table. 16 references.

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Viral Hepatitis. In: Edmundowicz, S.A., ed. 20 Common Problems in Gastroenterology. New York, NY: McGraw-Hill, Inc. 2002. p. 219-232.

Viral hepatitis (inflammation of the liver) is the most common cause of chronic liver disease, cirrhosis (scarring), and hepatocellular carcinoma (HCC, liver cancer) in the United States. This chapter on viral hepatitis is from a book that focuses on the most common gastroenterological problems encountered in a primary practice setting. The chapter is organized to support rapid access to the information necessary to evaluate and treat most patients with this problems. Topics include incidence and background; an overview of the hepatotropic viruses (hepatitis A, B, C, D and E) and the clinical syndromes, including acute viral hepatitis, fulminant hepatic failure, chronic viral hepatitis, end stage liver disease, and HCC; key history, notably risk factors for the subvarieties of hepatitis; the physical examination and ancillary tests, including routine blood tests, serologic evaluation, imaging, and liver biopsy; treatment options, including prevention of the hepatitis A, B, and C viruses, prophylaxis of exposed individuals, vaccination, antiviral therapy, and liver transplantation; patient education; common errors in diagnosis and treatment; and controversies, including HIV coinfection. The chapter includes an outline for quick reference, the text itself, a diagnostic and treatment algorithm, and selected references. 5 figures. 2 tables. 21 references.

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What is Autoimmune Hepatitis?. Cedar Grove, NJ: American Liver Foundation. 2002. [2 p.].

This brochure describes autoimmune hepatitis, a disease of young women that is associated with increased gamma globulin in the blood and chronic hepatitis (liver inflammation) on liver biopsy. The brochure summarizes the symptoms of autoimmune hepatitis, which can include fatigue, abdominal discomfort, aching joints, itching, jaundice, enlarged liver, and spider angiomas (blood vessels) on the skin. A liver biopsy is important to confirm the diagnosis and provide a prognosis. The remainder of the brochure outlines treatment options, including anticipated prognosis. The treatment of autoimmune hepatitis is immunosuppression with prednisone alone or prednisone and azathioprine. However, the majority of patients relapse within six months after therapy is ended. Therefore, most patients need long-term maintenance therapy. For patients who do not respond to medical therapy, liver transplantation can be considered. The brochure concludes with a description of the work of the American Liver Foundation (ALF) and its contact information (www.liverfoundation.org).

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What is Hepatitis B?: An Introduction. In: Everson, G.T.; Weinberg, H. Living with Hepatitis B: A Survivor's Guide. Long Island, NY: Hatherleigh Press. 2002. p.1-17.

Chronic hepatitis B can lead to cirrhosis (liver scarring), liver cancer, and the need for liver transplantation. This introductory chapter is from a book that helps readers diagnosed with hepatitis B virus (HBV) infection educate themselves about the disease and its treatment. The authors discuss some basic facts and statistics about hepatitis B, the history and discovery of the hepatitis B virus and vaccines, and information about viruses in general and other forms of viral hepatitis. Throughout the chapter the authors include quotes from real people who are living with hepatitis. 1 figure. 1 reference.

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When You Have Hepatitis B: Understanding the Diagnosis: Blood Tests and Biopsies. In: Everson, G.T.; Weinberg, H. Living with Hepatitis B: A Survivor's Guide. Long Island, NY: Hatherleigh Press. 2002. p.18-37.

Chronic hepatitis B can lead to cirrhosis (liver scarring), liver cancer, and the need for liver transplantation. This chapter on diagnostic tests is from a book that helps readers diagnosed with hepatitis B virus (HBV) infection educate themselves about the disease and its treatment. The authors answer questions about the testing process for hepatitis B, from diagnosis through monitoring during the years of ongoing care. The chapter covers hepatitis B virus tests, including proteins, antigens, and antibodies; liver imaging tests, including ultrasound, computed tomography, and magnetic resonance imaging (MRI); liver biopsy, including the procedure used and how to interpret the results obtained; liver blood tests, including liver enzymes, bilirubin, albumin, clotting factors, alpha-fetoprotein, and complete blood count (CBC); and patterns of hepatitis B tests in patients, including for acute and chronic disease, and for chronic carriers. Throughout the chapter the authors include quotes from real people who are living with hepatitis. 6 figures. 3 tables.

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Why Me? What About Them?: How You Got Infected and How to Avoid Infecting Others. In: Everson, G.T.; Weinberg, H. Living with Hepatitis B: A Survivor's Guide. Long Island, NY: Hatherleigh Press. 2002. p.38-52.

Chronic hepatitis B can lead to cirrhosis (liver scarring), liver cancer, and the need for liver transplantation. This chapter on transmission is from a book that helps readers diagnosed with hepatitis B virus (HBV) infection educate themselves about the disease and its treatment. The authors first offer an overview of how infectious the hepatitis B virus is, then summarize documented ways that hepatitis B is transmitted, including: intravenous drug abuse, sexual transmission, childbirth and delivery, immigrants and travelers from countries with high rates of HBV, transfusion of blood or blood products (for surgery or medical treatment and for hemophilia), needle-stick accidents, tattooing and body piercing, household contact, institutional contact, and organ transplantation. The chapter concludes with a section on how to prevent transmitting the disease. Throughout the chapter the authors include quotes from real people who are living with hepatitis. 1 figure. 1 reference.

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Acute Liver Failure. Journal of Clinical Gastroenterology. 33(3): 191-198. 2001.

Acute liver failure is defined as hepatic encephalopathy (a brain manifestation of extensive liver damage) complicating acute liver injury. This article reviews the definitions, etiologies, prognostic factors, and issues in the management of patients with acute liver failure (ALF). The most common etiologies (causes) are acute viral hepatitis A and B, medication overdose (e.g., acetaminophen), idiosyncratic drugs reactions, ingestion of other toxins (e.g., amanita mushroom poisoning), and metabolic disorders (e.g., Reye's syndrome). Despite advances in intensive care management, mortality (death) continues to be high (40 to 80 percent) and is partly related to ALF's complications, such as cerebral edema (fluid accumulation), sepsis, hypoglycemia (low blood glucose), gastrointestinal bleeding, and acute renal (kidney) failure. Several prognostic models have been developed to determine which patients will spontaneously recover. Treatment is directed at early recognition of the complications and general supportive measures. The only proven therapy for those who are unlikely to recover is liver transplantation. Therefore, recognition of ALF is paramount, and urgent referral to a transplant center is critical to assess transplantation status. 2 figures. 5 tables. 62 references.

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Biliary Atresia. Toronto, Ontario: Canadian Liver Foundation. 2001. 2 p.

This brochure describes biliary atresia, a condition in infants in which the bile duct outside the liver that carries bile from the liver to the small intestine is damaged. This prevents bile from leaving the liver so it accumulates and causes progressive damage to the liver tissue. In addition, there is ongoing damage to smaller bile ducts inside the liver. Unless bile flow can be established, liver function is gradually lost and affected children rarely survive beyond two years. The brochure describes the role of bile, the causes of the disease, the typical symptoms, treatment strategies (a surgery called the Kasai procedure is usually the first option), secondary treatment options, complications of the disease, and the indications for liver transplantation in children with biliary atresia. The brochure concludes with the contact information of the Canadian Liver Foundation (www.liver.ca).

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Bleeding Esophageal Varices: How to Treat This Dreaded Complication of Portal Hypertension. Postgraduate Medicine. 109(2): 75-76, 81-86, 89. February 2001.

Bleeding esophageal varices, one of the most feared complications of portal hypertension (high blood pressure in the liver venous system), contribute to the estimated 32,000 deaths annually attributed to cirrhosis (liver scarring). This article describes the care of patients with this complication. The authors stress that successful control requires knowledge of the pertinent anatomy, underlying pathophysiology of portal hypertension, and natural history of gastroesophageal varices. The authors discuss the various prophylactic (preventive) and therapeutic approaches to management, including pharmacologic agents (drug therapy), endoscopic sclerotherapy, and transjugular intrahepatic portosystemic shunt (TIPS). Nonselective beta blockers are the treatment of choice for prevention of the first bleeding episode. Active bleeding is managed with octreotide and endoscopic sclerotherapy. Goals in the management of active bleeding are hemodynamic resuscitation, prevention and treatment of complications, and control of bleeding. Complications related to bleeding or its treatment can substantially increase the risk of death in each episode. TIPS and shunt surgery are reserved for those in whom octreotide and endoscopic surgery have failed. Endoscopic band ligation (tying off) should be used for prevention of recurrent bleeding. If endoscopic band ligation fails, patients can be offered TIPS or surgical therapy; they should be evaluated for liver transplantation. 4 figures. 4 tables. 11 references.

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Current Therapy of Chronic Hepatitis C Infection. Practical Gastroenterology. 25(7): 14, 16, 19-21, 25. July 2001.

Hepatitis C virus (HCV) is a major cause of end stage liver disease worldwide and a leading indication for liver transplantation. This review article considers the current treatments for chronic CHV which can eradicate the virus and improve liver histology in certain patients. The current most efficacious treatment for patients with HCV is interferon combined with ribavirin, which eradicates the virus long term in 35 to 40 percent of treated patients. For those in whom ribavirin is contraindicated, interferon alone may be used with successful viral eradication in approximately 15 percent of patients. The authors discuss the current recommended initial treatment, indications and contraindications to therapy, workup and monitoring of patients during and after therapy, the side effects associated with treatment, the predictors of response, and the therapy response. The authors conclude by discussing potential future treatment regimens that may lead to improved efficacy in the management of chronic HCV patients. 1 figure. 4 tables. 25 references.

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