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- W2912128645 endingPage "730" @default.
- W2912128645 startingPage "704" @default.
- W2912128645 abstract "Liver transplantation has evolved to become a routine procedure. Donor shortage still limits access. Survival is now approaching 70% or more at 10°years for non-malignant disease. Few contraindications exist. Hepatitis B recurrence can be prevented with antiviral agents. Patients with alcohol-related cirrhosis undergo stringent evaluation, which includes monitoring of abstinence and psychosocial assessment. Hepatocellular carcinoma is an indication for transplantation, providing tumour burden is moderate; currently, a single lesion 5°cm or less diameter or three lesions each 3°cm or less diameter, without vascular invasion or extrahepatic spread based on pretransplant imaging. Allocation of donors and prioritization of recipients varies according to country. Medical urgency, based on likelihood of dying without transplantation, is the principal criterion in the USA and Eurotransplant area, which use the Model for End Stage Liver Disease (MELD score). Some countries take into account a utility criterion, that is expected survival after transplantation. Transplant benefit models are being developed, which estimate the greatest difference between pre- and post-transplantation survival, to determine priority for allocation. The number of whole grafts from brain stem dead, heart beating donors is falling. Reduced split and liver donor grafts, which are anatomical lobes or adjacent segments, allow greater rates of transplantation. Non-heart beating donors are increasingly used. The most frequent, early complication is infection; vascular complications have diminished. Biliary complications are frequent with reduced, split or live donor grafts. Ischaemic graft damage is more frequent with non-hearting beating donors. Late complications are related to cardiovascular morbidity due to an increased frequency of hypertension, diabetes and hyperlipidaemia. These modifiable diseases are due to immunosuppressive therapy. Other complications include malignancy, particularly skin cancer, but also lymphoproliferative disorders. Recurrent disease, particularly hepatitis C, but also hepatocellular carcinoma and primary sclerosing cholangitis, are major causes of late death." @default.
- W2912128645 created "2019-02-21" @default.
- W2912128645 creator A5029641877 @default.
- W2912128645 creator A5081198472 @default.
- W2912128645 date "2011-04-25" @default.
- W2912128645 modified "2023-09-27" @default.
- W2912128645 title "Hepatic Transplantation" @default.
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