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

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Endoscopic Management of Primary Sclerosing Cholangitis: State of the Art. American Journal of Gastroenterology. 102:S32-S37 p. 2007.

Primary sclerosing cholangitis (PSC) is a chronic, idiopathic disorder of the bile ducts that progresses from inflammation to fibrotic stricturing in the bile ducts, which in turn leads to biliary obstruction and, ultimately, chronic liver disease. This article brings readers up-to-date on the use of endoscopy in the management of patients with PSC. Fifty to 80 percent of patients with PSC have coexisting inflammatory bowel disease (IBD), more commonly presenting as ulcerative colitis (UC) than Crohn’s disease. The author discusses the clinical presentation of PSC, diagnostic approaches, the medical and surgical treatments used to manage PSC, cholangiographic findings and endoscopic management, and managing strictures. The author describes endoscopic retrograde cholangiopancreatography (ERCP). ERCP is a technique that has increasingly-limited purely diagnostic application in the management of PSC but is of great use in tissue acquisition and in the treatment of cholestatic symptoms in the long-term management of the complications of PSC, notably those due to biliary strictures and bile duct stones. Liver transplantation remains the only definitive treatment for PSC. 3 figures. 32 references.

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Liver Transplants: What You Need to Know. New York, NY: American Liver Foundation. 2007. 2 p.

Liver transplantation is needed for patients who are likely to die because of liver failure. In a living donor transplantation, a segment of a healthy person’s liver is transplanted into the sick patient. In cadaveric donation, the deceased donors typically die of accidents or head injuries and have arranged in advance to be an organ donor or their family grants permission for organ donation. This brochure from the American Liver Foundation reviews the indications for liver transplantation and what recipients can expect before and after a liver transplant. Written in a question-and-answer format, the brochure discusses when liver transplants may be needed; eligibility for liver transplant; the average amount of time patients wait for a donated liver; where donated livers come from; what happens during transplant surgery; the risks of liver transplants; the side effects after receiving a liver transplant, including side effects due to immunosuppressive drugs; the lifestyle changes that may happen after liver transplantation; the prognosis for liver recipients; and the importance of becoming registered as an organ donor. The back cover of the brochure lists facts about transplantation in a summarized format. Contact information for the American Liver Foundation is provided.

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Management of Alcoholic Hepatitis. Gastroenterology and Hepatology. 3(2): 97-99. February 2007.

This article answers common questions physicians may have about the management of alcoholic hepatitis. Topics covered include the pathophysiology of alcoholic hepatitis, the presenting symptoms and attributes of patients with alcoholic hepatitis, the typical course of treatment in these patients, the impact of cessation of drinking alcohol on the course and effects of alcoholic hepatitis, concerns regarding liver transplantation for patients with severe alcoholic hepatitis, and new research in this area. The hallmark of alcoholic hepatitis is jaundice. Most clinicians in the United States do not perform a liver biopsy to make the diagnosis; rather, they base diagnosis on a long history of alcohol use, elevated bilirubin, characteristic AST and ALT values, and no evidence of other liver diseases. The author cautions that approximately 20 to 50 percent of people who have alcoholic hepatitis also have chronic hepatitis C infection. After diagnosis, most patients are treated with oral prednisolone or pentoxifylline. Abstinence from alcohol is required for long-term survival. 6 references.

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Pediatric Liver Transplantation. Gastroenterology and Hepatology. 3(3): 194-196. March 2007.

This article answers questions physicians may have about pediatric liver transplantation, one-third of which is performed to treat biliary atresia, a fibro-inflammatory disorder of the extrahepatobiliary ducts. The author reports on the experiences with pediatric liver transplantation at his institution, describing how patients are referred to the transplant center, how monitoring and supportive care are provided to pediatric transplant candidates, specific concerns for pediatric transplantation, the donor pool for pediatric transplant candidates, and the inclusion of age as a factor for determining a patient’s prioritization within the donor pool. The author notes that most children receive a technical variant gift, which is a reduced-size, split, or living-donor graft rather than a whole liver graft. The advantages of this approach are to reduce mortality on the transplant waiting list. However, these techniques incur a heightened risk of additional postoperative complications following the very complex surgical procedures required with this type of transplantation. 7 references.

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Screening And Outcomes in Biliary Atresia: Summary of a National Institutes of Health Workshop. Hepatology. 46(2): 566-581. August 2007.

Biliary atresia is a congenital disorder characterized by persistent jaundice and progressive cholestasis, caused by the obstruction of both extrahepatic and intrahepatic bile ducts. This article summarizes a National Institutes of Health (NIH) workshop held in Bethesda, Maryland, in September 2006, on screening and outcomes in biliary atresia, a common cause of end-stage liver disease in infants and the leading indication for liver transplantation in children. The authors stress that earlier diagnosis, when the child is younger than 30 to 45 days of life, is associated with improved outcomes following the Kasai portoenterostomy and longer survival with their native liver. However, early diagnosis is not easy because the problem is quite rare, there is a high incidence of hyperbilirubinemia in the newborn period, and routine health care visits occur after the child is 1 month of age. The prognosis after portoenterostomy include the age of the child at surgery, the center's experience, the presence of associated congenital anomalies, and the postoperative occurrence of cholangitis. The authors note that the most promising screening strategies in infants are early measurements of serum conjugated bilirubin and a stool color card given to new parents that alerts them and their primary care providers to acholic stools. 3 figures. 4 tables. 121 references.

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Terlipressin For The Treatment of Hepatorenal Syndrome. Gastroenterology and Hepatology. 3(10): 773-774. October 2007.

This article describes the use of terlipressin for the treatment of hepatorenal syndrome, a complication of the portal hypertension that occurs in patients with cirrhosis. The author answers common questions about hepatorenal syndrome and the use of terlipressin, including the rationale for the use of this drug, research studies on the use of terlipressin for hepatorenal syndrome, the difficulties of conducting clinical research on patients with a disease that has a rapid clinical course and a high mortality rate, new directions for future research, the use of terlipressin in patients undergoing liver transplantation, and how future monitoring of patients with cirrhosis could be improved to optimize terlipressin therapy. Terlipressin is an analog of the vasoconstrictor vasopressin, which is used to treat bleeding esophageal varices, another complication of portal hypertension. Terlipressin, a prodrug of vasopressin, is a much safer drug than vasopressin, with fewer side effects. Terlipressin is often given in combination with albumin, which expands the blood volume, resulting in improved renal function in patients with hepatorenal syndrome. 5 references.

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Autoimmune Hepatitis. IN: Lichtenstein, G.; Reddy, K.R.; Faust, T., eds. Clinician’s Guide to Liver Disease. Thorofare, NJ: Slack Incorporated. 2006. pp 105-120.

This chapter about autoimmune hepatitis is from a user-friendly reference book that provides gastroenterologists with an overview of the management of acute and chronic liver disease. The author describes autoimmune hepatitis as a condition of unresolving liver inflammation, which primarily affects young women. The condition is characterized by elevated liver enzymes, hypergammaglobulinemia, serum autoantibodies, interface hepatitis, plasma cell infiltrates on liver biopsy, extrahepatic manifestations, and steroid responsiveness. The chapter provides a brief historical perspective and discussion of epidemiology. It discusses pathogenesis, natural history and prognosis, clinical features, diagnosis and diagnostic tests, complications, and treatment options including medial therapy and liver transplantation. The author cautions that diagnosis of autoimmune hepatitis requires a high index of clinical suspicion because several liver conditions can mimic the disease. Most patients respond to immunosuppressive medications with improvement in clinical symptoms, biochemical liver tests, hepatic histology, and patient survival; however, relapse is common. Up to 40 percent of patients progress to cirrhosis despite therapy. The chapter includes tables and a patient care algorithm and concludes with a list of references. 1 figure. 6 tables. 19 references.

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Benign Lesions of the Liver. Gastroenterology and Hepatology. 2(5): 325-326. May 2006.

This article describes benign lesions of the liver and patient care strategies for people who have these tumors. Benign lesions of the liver are generally of three types: hemangioma, focal nodular hyperplasia (FNH), and hepatic adenoma. Hemangiomas contain fibrous tissue and small blood vessels than can range in size from less than 1 centimeter in diameter to over 10 centimeters. FNH lesions are also solid with a typical central scar and nodule formation. Hepatic adenoma is an infrequently encountered, typically solitary lesion which carries a small risk of spontaneous rupture or malignancy. The author discusses indications for screening patients for these lesions, the interplay between liver lesions and oral contraceptive (OC) use, presenting symptoms that should prompt screening for these lesions, the lack of medical therapies for these lesions, surgical treatment (i.e., operative resection), the importance of differentiating between benign lesions and those that are potentially cancerous, the use of liver biopsy, and liver transplantation in patients with benign lesions (usually reserved only for those patients with other systemic diseases that also present with multiple hepatic adenomas). 5 references.

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Biliary Atresia. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2006. 6 p.

This fact sheet reviews the problem of biliary atresia, a serious but rare disease of the liver that affects newborn infants. Biliary atresia is defined as the loss or lack of the bile ducts that drain bile from the liver. Bile is made by the liver and passes through the bile ducts and into the intestines where it helps to digest food, fats, and cholesterol. The fact sheet reviews the symptoms, causes, diagnosis, surgical treatments, and postoperative care of biliary atresia. Diagnostic tests that may be used to confirm the condition include physical exam, ultrasound of the abdomen and liver, liver scans, and liver biopsy. The usual surgical correction for biliary atresia is the Kasai procedure (hepato-porto-enterostomy), in which a loop of intestine is brought up to replace the bile ducts and drain the liver. The benefits of this surgery make the early diagnosis of biliary atresia very important, preferably before the infant is several months old and has suffered permanent liver damage. Liver transplantation may be required in infants for whom the Kasai procedure is not effective or successful. The fact sheet concludes with a sidebar about current research studies on biliary atresia, a brief list of resource organizations for readers wanting additional information, and a description of the activities of the National Digestive Diseases Information Clearinghouse. 1 figure.

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Biliary Complications of Liver Transplantation. IN: Clavien, P.; Baillie, J., eds. Diseases of the Gallbladder and Bile Ducts: Diagnosis and Treatment. 2nd ed. Williston, VT: Blackwell Publishing Inc. 2006. pp 289-305.

This chapter on biliary complications of liver transplantation is from a textbook that provides a comprehensive and critical approach to both established and new diagnostic and therapeutic modalities for diseases of the gallbladder and bile ducts. The authors caution that biliary complications as well as the therapeutic interventions that follow may lead to a decreased quality of life. Biliary tract complications occur in 11 to 31 percent of liver transplantations. They describe the types of biliary reconstruction used in liver transplantation, the advantages and disadvantages associated with each type of reconstruction, the most common post-transplantation biliary complications and their causes, the techniques used to evaluate and treat biliary complications, and the role of biliary complications in living donor liver transplantation. The chapter includes a summary of objectives, a list of suggested readings, extensive references, and a set of self-test questions that focus on the material covered in the chapter. 11 figures. 3 tables. 61 references.

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