Serum Cholesterol Changes in Long-Term Survivors of Liver Transplantation: A Comparison Between Cyclosporine and Tacrolimus Therapy
|
|
- Abner Benedict Jordan
- 5 years ago
- Views:
Transcription
1 Serum Cholesterol Changes in Long-Term Survivors of Liver Transplantation: A Comparison Between Cyclosporine and Tacrolimus Therapy Ramón Charco,* Carme Cantarell, Victor Vargas,* Luis Capdevila, Jose Luis Lázaro,* Ernest Hidalgo,* Enrique Murio,* and Carlos Margarit* The aim of this study was to compare the longterm effect of tacrolimus and cyclosporine therapies on serum cholesterol levels in liver transplant recipients. We retrospectively studied 127 consecutive adult liver transplant recipients who survived for at least 1 year after transplantation. Basal immunosuppression consisted of cyclosporine plus prednisone in 100 patients and tacrolimus plus prednisone in 27 patients. was defined as a fasting serum cholesterol level greater than 220 mg/dl. Mean follow-up was 39 months. No statistical significance was found between cyclosporine- and tacrolimus-treated patients regarding age, sex, diagnosis, and previous cholesterol levels; both groups were similar. Significantly more tacrolimus-treated patients were steroid free in the first and second year of follow-up (tacrolimus, 37% and 63%; cyclosporine, 13% and 32%, respectively; P F.01). In the third year of follow-up, this difference was not significant (77% v 56%). The overall incidence of hypercholesterolemia was 34.6% (44 patients). At the end of the study, hypercholesterolemia was found in 24 of 51 and 14 of 70 patients with and without steroids, respectively (P F.002). Also, mean cholesterol levels were and mg/dl before and after steroid withdrawal, respectively, P F.001. was found in 43.7% of the patients during cyclosporine plus prednisone therapy compared with 46.1% of the patients during tacrolimus plus prednisone therapy (P F.9). Greater mean cholesterol levels were found in the cyclosporine group, particularly in the second and third years of follow-up (P F.01). was found in 22% of the patients during cyclosporine monotherapy compared with 15% during tacrolimus monotherapy (P F.5). No differences were found in mean cholesterol levels during follow-up when both monotherapy groups were compared. In conclusion, a lower incidence of hypercholesterolemia was achieved in tacrolimus-treated patients, mainly when steroids were still part of the immunosuppressive treatment. Copyright 1999 by the American Association for the Study of Liver Diseases From the *Liver Transplantation Unit and the Department of Nephrology, Hospital General Universitario Vall d Hebron, Universidad Autónoma de Barcelona, Spain. Address reprint requests to Ramón Charco, MD, Liver Transplantation Unit, Hospital General Universitario Vall d Hebron, Paseo Vall d Hebron , Barcelona, Spain. Copyright 1999 by the American Association for the Study of Liver Diseases /99/ $3.00/0 D espite improved survival of liver transplant recipients, long-term complications of chronic immunosuppressive therapy continue to be a great source of morbidity. 1 Hyperlipidemia is recognized as a common complication after kidney and heart transplantation, 2,3 but the natural history of posttransplantation hyperlipidemia after orthotopic liver transplantation has been less well described. The initial report by Muñozetal 4 showed that mean cholesterol levels increased after liver transplantation and appeared to be related to blood cyclosporine A levels. Because no studies have been performed that actually showed a survival disadvantage for transplant recipients with hyperlipidemia or hypercholesterolemia, clinicians have been reluctant to treat these patients. Conversely, compared with cyclosporine, tacrolimus therapy seems to be associated with less alteration of cholesterol metabolism. 5 However, to date, a controlled randomized study of the long-term influence of tacrolimus- or cyclosporine-based therapy on cholesterol metabolism is lacking. The aim of this study is to compare the longterm effect of tacrolimus and cyclosporine as basal immunosuppressive drugs on serum cholesterol levels in liver transplant recipients. Material and Methods We retrospectively studied 127 consecutive adult liver transplant recipients who underwent transplantation 204 Liver Transplantation and Surgery, Vol 5, No 3 (May), 1999: pp
2 Cholesterol Changes After Liver Transplantation 205 between January 1989 and July 1996 who survived for at least 1 year after liver transplantation. Basal immunosuppression consisted of cyclosporine and prednisone in 100 patients and tacrolimus and prednisone in 27 patients. During follow-up, 24 patients were switched to tacrolimus therapy after cyclosporine-based immunosuppression failed. Mean follow-up was 39 months (range, 12 to 96 months). Immunosuppression Cyclosporine therapy. The cyclosporine immunosuppression protocol was changed during the study period. The first 40 patients were maintained by cyclosporine (Sandimmune, Novartis, Basel) and prednisone. Induction therapy consisted of 1 g of methylprednisolone intravenously before revascularization, followed by prednisone, 200 mg/d, decreasing to 20 mg/d over 6 days. Cyclosporine was begun in the postoperative period at 2 mg/kg/d by continuous intravenous infusion, with the dose increasing to a steady-state level of 300 to 350 ng/ml, determined by enzyme immunoassay technique during the first week. The remaining patients were maintained by a new oral microemulsion formulation of cyclosporine (Sandimmune Neoral, Novartis, Basel) and prednisone. Cyclosporine Neoral was begun in the postoperative period at 10 mg/kg/d by nasogastric probe, with the dose increasing to achieve a trough level of 250 to 350 ng/ml, determined by enzyme immunoassay technique during the first week. Tacrolimus therapy. Tacrolimus was always started in the postoperative period at 0.05 mg/kg twice daily by nasogastric probe. Dosage adjustments were based on monitoring serum tacrolimus levels to achieve a 12-hour trough level of 5 to 20 ng/ml, determined by monoclonal antibody technique. The steroid regimen was the same as in the cyclosporine group. Steroid withdrawal. During follow-up, prednisone was tapered from 20 mg/d over 6 days after liver transplantation to a minimum dose in both groups for approximately the following 3 months and was discontinued in all patients with normal biochemical parameters or in patients with allograft dysfunction caused by hepatitis C recurrence proved by biopsy. The minimum dosage of prednisone was administered to patients in whom steroids could not be discontinued in the first months, with the dosage tapered until complete withdrawal in the following months. Rejection therapy. Acute rejection episodes were treated in both groups with a 3-day bolus course of1gof methylprednisolone. If rejection persisted, a 14-day course of 5 mg/d of OKT3 was administered, mainly in cyclosporine-treated patients when tacrolimus was not available. Protocol for Conversion Indications for conversion to tacrolimus were steroidresistant rejection, chronic rejection, duct damage in the context of cholestasic hepatitis C virus recurrence, and repeated episodes of acute rejection in 1 patient, with malabsorption of cyclosporine (Sandimmune, classic formulation). Tacrolimus was always started orally after withdrawal of the final dose of cyclosporine. Initial dosage was calculated at 0.05 mg/kg twice daily. Dosage adjustments were based on monitoring serum tacrolimus levels to achieve a 12-hour trough level of 5 to 20 ng/ml and also by adjustment according to clinical and biochemical parameters. Patients converted to tacrolimus were included in the tacrolimus group after 1 year of conversion. was defined as a fasting serum cholesterol level greater than 220 mg/dl, determined in routine transplant laboratories. Normal range was 130 to 220 mg/dl. Statistical Analysis Comparisons of steroid-free patients between the cyclosporine and tacrolimus groups during follow-up and hypercholesterolemia between different treatment groups were analyzed using the chi-squared test. Cholesterol levels were analyzed using the Student s t-test. Mean cholesterol levels before and after steroid withdrawal were analyzed using paired t-test. The difference was considered statistically significant for P less than.05. Data are shown as mean values standard deviation. Results No statistical significance was found between cyclosporine- and tacrolimus-treated patients regarding age, sex, diagnosis, and previous cholesterol levels; both groups were similar (Table 1). Five patients died during follow-up. At the end of the study, 70 patients were steroid free. Significantly more tacrolimus-treated patients were steroid free in the first and second years of follow-up (tacrolimus, 37% and 63%; cyclosporine, 13% and 32%, respectively; P.01). In the third year of followup, this difference was not significant (77% v 56%). Cholesterol Changes During the study, the overall incidence of hypercholesterolemia was 34.6% (44 patients). At the end of the study, hypercholesterolemia was found in 24 of 51 and 7 of 70 patients with and without steroids, respectively (P.002). Furthermore, mean cholesterol levels were and mg/dl in
3 206 Charco et al Table 1. Patient Characteristics Cyclosporine A Tacrolimus P No. of patients Age (yr)* NS Men/Women 67/33 17/10 NS Mean pretransplant SCH (mg/dl)* NS Original disease NS Postnecrotic cirrhosis HCC/HCV ( ) 20 6 Cholestasic diseases 6 2 Alcoholic cirrhosis 19 4 Retransplantation 10 2 Others 5 1 Abbreviations: SCH, serum cholesterol; NS, not significant; HCC, hepatocellular carcinoma; HCV, hepatitis C virus. *Mean standard deviation. patients with and without steroids, respectively (P.01). In all patients in whom steroids were stopped, mean cholesterol levels were and mg/dl before and after steroid withdrawal, respectively (P.001). The mean cholesterol levels of 50 cyclosporine-treated patients were mg/dl before steroid withdrawal compared with mg/dl after steroid withdrawal (P.005). In contrast, no statistical differences were found in 20 tacrolimus-treated patients when mean cholesterol levels before and after steroid withdrawal were compared ( v mg/dl, respectively; P.2). was found in 18 of 38 patients (47.3%) during cyclosporine and prednisone therapy compared with 6 of 13 patients (46.1%) during tacrolimus and prednisone therapy (P.9). Greater mean cholesterol levels were found in the cyclosporine group, particularly in the second and third years of follow-up (Table 2). Conversely, hypercholesterolemia was found in only 11 of 50 patients (22%) during cyclosporine monotherapy (once steroids were stopped) compared with 3 of 20 patients (15%) during tacrolimus monotherapy (P.5). No differences were found in mean cholesterol levels during follow-up Table 2. and Cholesterol Levels in Patients With Double Therapy when both groups of monotherapy were compared (Table 3). Discussion CyA P Tacrolimus P 12/38 (47%) 6/13 (46%).9 Mean SCH (mg/dl) 1st year nd year rd year Abbreviations: SCH, serum cholesterol; CyA, cyclosporine A; P, prednisone. Cholesterol disorders of chronic liver diseases usually normalize after liver transplantation. However, a high percentage of transplant recipients present with hypercholesterolemia during followup. This fact, also described in heart and kidney transplantation, supports the hypothesis that immunosuppression therapy is the main culprit. 2,3 Few data exist on the natural history of hypercholesterolemia after liver transplantation. An initial report from Jefferson Medical College in 1991 found that type II hypercholesterolemia developed in 6 of 21 patients (29%) and type IV hypercholesterolemia in 5 patients. 4 Its biochemical mechanism after solid organ transplantation is unknown. Several lines of evidence, however, strongly suggest a Table 3. and Cholesterol Levels in Patients With Monotherapy CyA Monotherapy Tacrolimus Monotherapy 11/50 (22%) 3/20 (15%).5 Mean SCH (mg/dl) 1st year nd year rd year Abbreviations: SCH, serum cholesterol; CyA, cyclosporine A; P, prednisone. P P
4 Cholesterol Changes After Liver Transplantation 207 causal relationship between serum cholesterol and blood cyclosporine levels. 3,4 Cyclosporine may interfere with bile acid synthesis, thereby decreasing cholesterol degradation, 4 or may stimulate collateral synthesis by increasing hydroxy-methylglutarylcoenzyme A (HMG-CoA) reductase activity. 4,6 To our knowledge, neither of these hypotheses has yet been proven. The introduction of tacrolimus as a new immunosuppressive drug has signified a great advance in preventing rejection, particularly in severe episodes or steroid-resistant rejection. Tacrolimus side effects are similar to those of cyclosporine, despite the fact that tacrolimus appears to exert little effect on serum cholesterol levels. 7 However, lower steroid usage for tacrolimus-treated patients typically confounds these studies. Complete withdrawal of prednisone after liver transplantation is an increasingly common practice at most transplantation centers and seems to be more successful in liver transplant recipients than those with other types of transplants. 8 The majority of studies of steroid withdrawal after liver transplantation have been conducted in pediatric transplant recipients. 9 The fact that immunologic graft loss is rare after liver transplantation, combined with the severe side effects of long-term prednisone therapy, supports steroid withdrawal in liver transplant recipients. 8,10 In our series, as in other groups, steroid withdrawal was achieved earlier and in more patients receiving tacrolimus than cyclosporine therapy. 11,12 However, other studies showed no difference in steroid withdrawal between tacrolimus- and cyclosporine-treated patients. 13 Numerous reports showed that steroid withdrawal is safe in liver transplant recipients, but its effect on metabolic complications has been variable. 9,10,14,15 The low incidence of hypercholesterolemia and low mean cholesterol levels in our patients after prednisone was discontinued provide strong evidence that prednisone is a major causative agent in this metabolic complication. Although differences were only statistically significant in cyclosporinetreated patients, more low mean cholesterol levels were also found in the tacrolimus-treated patients after steroid withdrawal. Several reports, mainly of kidney transplantation, have found that tacrolimus-based immunosuppression reduces cholesterol levels more than cyclosporine-based regimens. 16,17 This feature, also proved in our patients, was found mainly when steroids formed part of the double therapy. Although the differences in hypercholesterolemia were not statistically significant, greater mean cholesterol levels were found in cyclosporine plus prednisone treated patients compared with those receiving tacrolimus plus prednisone. After steroids were stopped completely, the cyclosporine and tacrolimus groups showed similar cholesterol levels. Although tacrolimus seems to exert little effect on serum cholesterol levels, our results suggest that the main contributor to hypercholesterolemia was steroids. Because the serum cyclosporine or tacrolimus levels required to prevent rejection decrease progressively over time, they could have a role in reducing cholesterol levels. Despite certain limitations of a retrospective study and differences in the number of patients in each treatment group, we can conclude that a lower incidence of hypercholesterolemia was achieved in tacrolimus-treated patients, particularly when steroids still formed part of the immunosuppressive therapy. We recommend steroid withdrawal as soon as possible from the immunosuppressive treatment because low mean cholesterol levels will be achieved. Acknowledgment The authors thank Christine O Hara for useful manuscript corrections. References 1. Stegall MD, Everson G, Schroter G, Bilir B, Karrer F, Kam I. Metabolic complications after liver transplantation: Diabetes, hypercholesterolemia, hypertension and obesity. Transplantation 1995;60: Hricik DE, Mayes JT, Schulak JA. Independent effects of cyclosporine and prednisone on posttransplant hypercholesterolemia. Am J Kidney Dis 1991;18: Ong CS, Pollock CA, Caterson RJ, Mahony JF, Waugh DA, Ibels LS. Hyperlipidemia in renal transplant recipients: Natural history and response to treatment. Medicine 1994;73: Muñoz SJ, Deems RO, Mortiz MJ, Martin P, Jarrell BE, Madrey WC. Hyperlipidemia and obesity after orthotopic liver transplantation. Transplant Proc 1991;23: Loss M, Winkler M, Schneider A, Brinkman C, Manns M, Ringe B, et al. Influence of long-term cyclosporine or FK 506 therapy on glucose and lipid metabolism in stable liver graft recipients. Transplant Proc 1995;27: Everson TG. Bile acid metabolism and its role in human cholesterol balance. Semin Liver Dis 1992;12: Starzl TE, Fung J, Jordan M, Shapiro R, Tzakis A,
5 208 Charco et al McCauley, et al. Kidney transplantation under FK 506. JAMA 1990;264: Stegall M, Everson G, Schroter G, Karrer F, Bilir B, Sternberg T, et al. Prednisone withdrawal late after adult liver transplantation reduces diabetes, hypertension and hypercholesterolemia without causing graft loss. Hepatology 1997;25: Margarit C, Martinez-Ibañez V, Tormo R, Infante D, Iglesias H. Maintenance immunosuppression without steroids in pediatric liver transplantation. Transplant Proc 1989;21: Punch JD, Shieck VL, Campbell DA, Bromberg JS, Turcotte JG, Merion RM. Corticosteroid withdrawal after liver transplantation. Surgery 1995;118: US Multicenter FK 506 Liver Study Group. A comparison of tacrolimus (FK 506) and cyclosporine for immunosuppression in liver transplantation. N Engl J Med 1994;331: Jindal RM, Popescu I, Emre S, Schwartz ME, Boccagni P, Meneses P, et al. Serum lipid changes in liver transplant recipients in a prospective trial of cyclosporine versus FK 506. Transplantation 1994;57: Imagawa D, Dawson S III, Holt CD, Kirk PS, Kaldas FM, Shackleton CR, et al. Hyperlipidemia after liver transplantation. Transplantation 1996;62: De Carlis L, Belli LS, Rondinara GF, Alberti A, Sansalone CV, Colella G, et al. Early steroid withdrawal in liver transplant patients: Final report of a prospective randomized trial. Transplant Proc 1997;29: McDiarmid SV, Farmer D, Goldstein LI, Martin P, Vargas J, Tipton JR, et al. A randomized, prospective trial of steroid withdrawal after liver transplantation. Transplantation 1995;60: Ochai T, Ishibashi M, Fukao K, Takahasi K, Endo T, Yokoyama I, et al. Japanese multicenter studies of FK 506 in renal transplantation. Transplant Proc 1995;27: Satterthwaite R, Aswad S, Sunga V, Shidban H, Bogaard T, Asai P, et al. Incidence of new-onset hypercholesterolemia in renal transplant patients treated with FK 506 or cyclosporine. Transplantation 1998;65:
Successful Withdrawal of Prednisone After Adult Liver Transplantation for Autoimmune Hepatitis
Successful Withdrawal of Prednisone After Adult Liver Transplantation for Autoimmune Hepatitis Thomas E. Trouillot,* Roshan Shrestha,* Igal Kam, Michael Wachs, and Gregory T. Everson* SEE EDITORIAL ON
More informationDavid A.J. Neal, * Alexander E.S. Gimson, * Paul Gibbs, and Graeme J.M. Alexander * Methods. Patients
Beneficial Effects of Converting Liver Transplant Recipients From Cyclosporine to Tacrolimus on Blood Pressure, Serum Lipids, and Weight David A.J. Neal, * Alexander E.S. Gimson, * Paul Gibbs, and Graeme
More informationSteroid Minimization: Great Idea or Silly Move?
Steroid Minimization: Great Idea or Silly Move? Disclosures I have financial relationship(s) within the last 12 months relevant to my presentation with: Astellas Grants ** Bristol Myers Squibb Grants,
More informationI topic liver transplantation (OLT) to avoid organ
ORIGINAL ARTICLES Long-Term Immunosuppression Without Corticosteroids After Orthotopic Liver Transplantation: A Positive Therapeutic Aim Gerald M. Fraser, * Kons tantinos Grammous tianos, Jayendravandan
More informationIncreased Early Rejection Rate after Conversion from Tacrolimus in Kidney and Pancreas Transplantation
Increased Early Rejection Rate after Conversion from Tacrolimus in Kidney and Pancreas Transplantation Gary W Barone 1, Beverley L Ketel 1, Sameh R Abul-Ezz 2, Meredith L Lightfoot 1 1 Department of Surgery
More informationPrednisone Withdrawal Late After Adult Liver Transplantation Reduces Diabetes, Hypertension, and Hypercholesterolemia Without Causing Graft Loss
Transplantation and Surgery Prednisone Withdrawal Late After Adult Liver Transplantation Reduces Diabetes, Hypertension, and Hypercholesterolemia Without Causing Graft Loss MARK D. STEGALL, 1 GREGORY T.
More informationNIH Public Access Author Manuscript Transplant Proc. Author manuscript; available in PMC 2010 July 14.
NIH Public Access Author Manuscript Published in final edited form as: Transplant Proc. 1990 February ; 22(1): 17 20. The Effects of FK 506 on Renal Function After Liver Transplantation J. McCauley, J.
More informationInduction Immunosuppression With Rabbit Antithymocyte Globulin in Pediatric Liver Transplantation
LIVER TRANSPLANTATION 12:1210-1214, 2006 ORIGINAL ARTICLE Induction Immunosuppression With Rabbit Antithymocyte Globulin in Pediatric Liver Transplantation Ashesh Shah, 1 Avinash Agarwal, 1 Richard Mangus,
More informationImmunosuppression Switch in Pediatric Heart Transplant Recipients: Cyclosporine to FK 506
JACC Vol. 25, No. 5 1183 April 1995:1183-8 Immunosuppression Switch in Pediatric Heart Transplant Recipients: Cyclosporine to FK 506 JEANINE M. SWENSON, MD, F. JAY FRICKER, MD, FACC, JOHN M. ARMITAGE,
More informationNIH Public Access Author Manuscript Transplant Proc. Author manuscript; available in PMC 2011 April 6.
NIH Public Access Author Manuscript Published in final edited form as: Transplant Proc. 1991 December ; 23(6): 2777 2779. Pharmacokinetics of Cyclosporine and Nephrotoxicity in Orthotopic Liver Transplant
More informationSerum samples from recipients were obtained within 48 hours before transplantation. Pre-transplant
SDC, Patients and Methods Complement-dependent lymphocytotoxic crossmatch test () Serum samples from recipients were obtained within 48 hours before transplantation. Pre-transplant donor-specific CXM was
More informationEfficacy and Safety of Thymoglobulin and Basiliximab in Kidney Transplant Patients at High Risk for Acute Rejection and Delayed Graft Function
ArtIcle Efficacy and Safety of Thymoglobulin and Basiliximab in Kidney Transplant Patients at High Risk for Acute Rejection and Delayed Graft Function Guodong Chen, 1 Jingli Gu, 2 Jiang Qiu, 1 Changxi
More informationTDM. Measurement techniques used to determine cyclosporine level include:
TDM Lecture 15: Cyclosporine. Cyclosporine is a cyclic polypeptide medication with immunosuppressant effect. It has the ability to block the production of interleukin-2 and other cytokines by T-lymphocytes.
More informationOUT OF DATE. Choice of calcineurin inhibitors in adult renal transplantation: Effects on transplant outcomes
nep_734.fm Page 88 Friday, January 26, 2007 6:47 PM Blackwell Publishing AsiaMelbourne, AustraliaNEPNephrology1320-5358 2006 The Author; Journal compilation 2006 Asian Pacific Society of Nephrology? 200712S18897MiscellaneousCalcineurin
More informationPost Transplant Immunosuppression: Consideration for Primary Care. Sameh Abul-Ezz, M.D., Dr.P.H.
Post Transplant Immunosuppression: Consideration for Primary Care Sameh Abul-Ezz, M.D., Dr.P.H. Objectives Discuss the commonly used immunosuppressive medications and what you need to know to care for
More informationDate: 23 June Context and policy issues:
Title: Basiliximab for Immunosuppression During a Calcineurin Inhibitor Holiday in Renal Transplant Patients with Acute Renal Dysfunction: Guidelines for Use and a Clinical and Cost-Effectiveness Review
More informationEffect of Calcineurin Inhibitors on Survival and Histologic Disease Severity in HCV-Infected Liver Transplant Recipients
LIVER TRANSPLANTATION 12:762-767, 2006 ORIGINAL ARTICLE Effect of Calcineurin Inhibitors on Survival and Histologic Disease Severity in HCV-Infected Liver Transplant Recipients Marina Berenguer, 1 Victoria
More informationLiver Transplantation: The End of the Road in Chronic Hepatitis C Infection
University of Massachusetts Medical School escholarship@umms UMass Center for Clinical and Translational Science Research Retreat 2012 UMass Center for Clinical and Translational Science Research Retreat
More informationLiterature Review: Transplantation July 2010-June 2011
Literature Review: Transplantation July 2010-June 2011 James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver Kidney Transplant Top 10 List: July Kidney
More informationNIH Public Access Author Manuscript Transplant Proc. Author manuscript; available in PMC 2010 September 22.
NIH Public Access Author Manuscript Published in final edited form as: Transplant Proc. 1990 February ; 22(1): 57 59. Effect of Hepatic Dysfunction and T Tube Clamping on FK 506 Pharmacokinetics and Trough
More informationResearch Article The Hyperlipidemia Caused by Overuse of Glucocorticoid after Liver Transplantation and the Immune Adjustment Strategy
Hindawi Immunology Research Volume 2017, Article ID 3149426, 5 pages https://doi.org/10.1155/2017/3149426 Research Article The Hyperlipidemia Caused by Overuse of Glucocorticoid after Liver Transplantation
More informationHypertension frequently occurs early after liver
Late Hypertension After Liver Transplantation: A Comparison of Cyclosporine and Tacrolimus (FK 506) Vincent J. Canzanello,* Stephen C. Textor,* Sandra J. Taler,* Lora L. Schwartz,* Michael K. Porayko,*
More informationNIH Public Access Author Manuscript Transplant Proc. Author manuscript; available in PMC 2010 December 3.
NIH Public Access Author Manuscript Published in final edited form as: Transplant Proc. 1993 February ; 25(1 Pt 1): 628 634. Adverse Effects of FK 506 Overdosage After Liver Transplantation M. Alessiani,
More informationEmerging Drug List EVEROLIMUS
Generic (Trade Name): Manufacturer: Everolimus (Certican ) Novartis Pharmaceuticals NO. 57 MAY 2004 Indication: Current Regulatory Status: Description: Current Treatment: Cost: Evidence: For use with cyclosporine
More informationLiver Transplantation for Biliary Atresia: 19-Year, Single-Center Experience
Liver Transplantation for Biliary Atresia: 19-Year, Single-Center Experience L Thomas Chin 1, Anthony M D Alessandro 1, Stuart J Knechtle 1, Luis A Fernandez 1, Glen Leverson 1, Robert H Judd 2, Elizabeth
More informationLiterature Review Transplantation
Literature Review 2010- Transplantation Alexander Wiseman, M.D. Associate Professor, Division of Renal Diseases and Hypertension Medical Director, Kidney and Pancreas Transplant Programs University of
More informationOrgan rejection is one of the serious
Original Article Outcomes of Late Corticosteroid Withdrawal after Renal Transplantation in Patients Exposed to Tacrolimus and/or Mycophenolate Mofetil: Meta-Analysis of Randomized Controlled Trials A.
More informationORIGINAL ARTICLE. Received March 14, 2007; accepted August 29, 2007.
LIVER TRANSPLANTATION 14:173-180, 2008 ORIGINAL ARTICLE A Randomized, Prospective, Pharmacoeconomic Trial of Neoral 2-Hour Postdose Concentration Monitoring Versus Tacrolimus Trough Concentration Monitoring
More informationImmunosuppression: evolution in practice and trends,
American Journal of Transplantation 25; 5 (Part 2): 874 886 Blackwell Munksgaard Blackwell Munksgaard 25 Immunosuppression: evolution in practice and trends, 1993 23 Ron Shapiro a,, James B. Young b, Edgar
More informationNIH Public Access Author Manuscript Transplant Proc. Author manuscript; available in PMC 2010 November 29.
NIH Public Access Author Manuscript Published in final edited form as: Transplant Proc. 1991 February ; 23(1 Pt 2): 1444 1447. The Question of FK 506 Nephrotoxicity After Liver Transplantation J. McCauley,
More informationPharmacology notes Interleukin-2 receptor-blocking monoclonal antibodies: evaluation of 2 new agents
BUMC Proceedings 1999;12:110-112 Pharmacology notes Interleukin-2 receptor-blocking monoclonal antibodies: evaluation of 2 new agents CHERYLE GURK-TURNER, RPH Department of Pharmacy Services, BUMC wo mouse/human
More informationOral mizoribine pulse therapy for patients with steroid-resistant and frequently relapsing steroid-dependent nephrotic syndrome
Nephrol Dial Transplant (2005) 20: 2243 2247 doi:10.1093/ndt/gfh996 Advance Access publication 19 July 2005 Brief Report Oral mizoribine pulse therapy for patients with steroid-resistant and frequently
More informationREACH Risk Evaluation to Achieve Cardiovascular Health
Dyslipidemia and transplantation History: An 8-year-old boy presented with generalized edema and hypertension. A renal biopsy confirmed a diagnosis of focal segmental glomerulosclerosis (FSGS). After his
More informationAlemtuzumab Induction in Non-Hepatitis C Positive Liver Transplant Recipients
LIVER TRANSPLANTATION 17:32-37, 2011 ORIGINAL ARTICLE Alemtuzumab Induction in Non-Hepatitis C Positive Liver Transplant Recipients Josh Levitsky, 1,2 Kavitha Thudi, 1 Michael G. Ison, 1,3 Edward Wang,
More informationUse of mycophenolate mofetil in steroid-dependent and -resistant nephrotic syndrome
Pediatr Nephrol (2003) 18:833 837 DOI 10.1007/s00467-003-1175-4 BRIEF REPORT Gina-Marie Barletta William E. Smoyer Timothy E. Bunchman Joseph T. Flynn David B. Kershaw Use of mycophenolate mofetil in steroid-dependent
More informationReview Article The Role of mtor Inhibitors in Liver Transplantation: Reviewing the Evidence
Hindawi Publishing Corporation Journal of Transplantation Volume 2014, Article ID 845438, 45 pages http://dx.doi.org/10.1155/2014/845438 Review Article The Role of mtor Inhibitors in Liver Transplantation:
More informationAcute rejection and late renal transplant failure: Risk factors and prognosis
Nephrol Dial Transplant (2004) 19 [Suppl 3]: iii38 iii42 DOI: 10.1093/ndt/gfh1013 Acute rejection and late renal transplant failure: Risk factors and prognosis Luis M. Pallardo Mateu 1, Asuncio n Sancho
More informationOverview of New Approaches to Immunosuppression in Renal Transplantation
Overview of New Approaches to Immunosuppression in Renal Transplantation Ron Shapiro, M.D. Professor of Surgery Surgical Director, Kidney/Pancreas Transplant Program Recanati/Miller Transplantation Institute
More informationImpact of early cyclosporin average blood concentration on early kidney transplant failure
M. Ferda Senel Charles T. Van Buren Maria Welsh Barry D. Kahan Impact of early cyclosporin average blood concentration on early kidney transplant failure Received: 7 May 997 Received after revision: August
More informationIntruduction PSI MODE OF ACTION AND PHARMACOKINETICS
Multidisciplinary Insights on Clinical Guidance for the Use of Proliferation Signal Inhibitors in Heart Transplantation Andreas Zuckermann, MD et al. Department of Cardio-Thoracic Surgery, Medical University
More informationSINCE the introduction of Imuran and
Cadaveric Renal Transplantation With Cyclosporin-A and Steroids T. R. Hakala, T. E. Starzl, J. T. Rosenthal, B. Shaw, and S. watsuki SNCE the introduction of muran and prednisone in 1961, and despite the
More informationSolid Organ Transplantation 1. Chapter 55. Solid Organ Transplant, Self-Assessment Questions
Solid Organ Transplantation 1 Chapter 55. Solid Organ Transplant, Self-Assessment Questions Questions 1 to 9 are related to the following case: A 38-year-old white man is scheduled to receive a living-unrelated
More informationConsidering the early proactive switch from a CNI to an mtor-inhibitor (Case: Male, age 34) Josep M. Campistol
Considering the early proactive switch from a CNI to an mtor-inhibitor (Case: Male, age 34) Josep M. Campistol Patient details Name DOB ESRD Other history Mr. B.I.B. 12 January 1975 (34yo) Membranous GN
More informationFK506 In clinical organ transplantation
FK506 In clinical organ transplantation Fung 11, Abu-Elmagd K, Todo S, Shapiro R, Tzakis A, Jordan M, Armitage J, Jain A, Martin M, Bronster 0, Stieber A, Kormos R, Selby R, Gordon R, Starzl TE. FK506
More informationHow to improve long term outcome after liver transplantation?
How to improve long term outcome after liver transplantation? François Durand Hepatology & Liver Intensive Care University Paris Diderot INSERM U1149 Hôpital Beaujon, Clichy PHC 2018 www.aphc.info Long
More informationRon Shapiro, MD, Abdul S. Rao, MD, D. Phil., Paulo Fontes, MD, Adrianna Zeevi, Ph.D., Mark Jordan, MD, Velma P. Scantlebury, MD,
Kidney IBone Marrow Transplantation Ron Shapiro, MD, Abdul S. Rao, MD, D. Phil., Paulo Fontes, MD, Adrianna Zeevi, Ph.D., Mark Jordan, MD, Velma P. Scantlebury, MD, Carlos Vivas, MD, H. Albin Gritsch,
More informationRESULTS previously reported from this center
Cyclosporine-Steroid Combination Therapy in 84 Cadaveric Renal Transplants Robert D. Gordon, MD, Shunzaburo Iwatsuki, MD, Byers W. Shaw, Jr, MD, and Thomas E. Starzl, MD, PhD Sixty-three primary and 21
More informationSELECTED ABSTRACTS. All (n) % 3-year GS 88% 82% 86% 85% 88% 80% % 3-year DC-GS 95% 87% 94% 89% 96% 80%
SELECTED ABSTRACTS The following are summaries of selected posters presented at the American Transplant Congress on May 5 9, 2007, in San Humar A, Gillingham KJ, Payne WD, et al. Review of >1000 kidney
More informationScottish Medicines Consortium
Scottish Medicines Consortium tacrolimus, 5mg/ml concentrate for infusion and 0.5mg, 1mg, 5mg hard capsules (Prograf ) No. (346/07) Astellas Pharma Ltd 12 January 2007 The Scottish Medicines Consortium
More informationBK Virus (BKV) Management Guideline: July 2017
BK Virus (BKV) Management Guideline: July 2017 BK virus has up to a 60-80% seroprevalence rate in adults due to a primary oral or respiratory exposure in childhood. In the immumocompromised renal transplant
More informationPediatric Liver Transplantation Outcomes in Korea
ORIGINAL ARTICLE Cell Therapy & Organ Transplantation http://dx.doi.org/6/jkms.8..4 J Korean Med Sci 0; 8: 4-47 Pediatric Liver Transplantation Outcomes in Korea Jong Man Kim,, * Kyung Mo Kim,, * Nam-Joon
More informationNAPRTCS Annual Transplant Report
North American Pediatric Renal Trials and Collaborative Studies NAPRTCS 2014 Annual Transplant Report This is a privileged communication not for publication. TABLE OF CONTENTS PAGE II TRANSPLANTATION Section
More informationControversies in Renal Transplantation. The Controversial Questions. Patrick M. Klem, PharmD, BCPS University of Colorado Hospital
Controversies in Renal Transplantation Patrick M. Klem, PharmD, BCPS University of Colorado Hospital The Controversial Questions Are newer immunosuppressants improving patient outcomes? Are corticosteroids
More informationLong-term prognosis of BK virus-associated nephropathy in kidney transplant recipients
Original Article Kidney Res Clin Pract 37:167-173, 2018(2) pissn: 2211-9132 eissn: 2211-9140 https://doi.org/10.23876/j.krcp.2018.37.2.167 KIDNEY RESEARCH AND CLINICAL PRACTICE Long-term prognosis of BK
More informationLIVER TRANSPLANTATION
LIVER TRANSPLANTATION Selection 0 / Patients and Results Late Mortality and Morbidity After Liver Transplantation S. Iatsuki. T.E. Starzl. R.D. Gordon, C.O. Esquivel. S. Todo, A.G. Tzakis, L. Makoka. J.W.
More information/03/ /0 TRANSPLANTATION Vol. 75, , No. 7, April 15, 2003 Copyright 2003 by Lippincott Williams & Wilkins, Inc.
0041-1337/03/7507-1020/0 TRANSPLANTATION Vol. 75, 1020 1025, No. 7, April 15, 2003 Copyright 2003 by Lippincott Williams & Wilkins, Inc. Printed in U.S.A. THE ABSENCE OF CHRONIC REJECTION IN PEDIATRIC
More informationDiltiazem use in tacrolimus-treated renal transplant recipients Kothari J, Nash M, Zaltzman J, Prasad G V R
Diltiazem use in tacrolimus-treated renal transplant recipients Kothari J, Nash M, Zaltzman J, Prasad G V R Record Status This is a critical abstract of an economic evaluation that meets the criteria for
More informationWithdrawal of Immunosuppression in Pediatric Liver Transplant Recipients in Korea
Original Article DOI 10.3349/ymj.2009.50.6.784 pissn: 0513-5796, eissn: 1976-2437 Yonsei Med J 50(6): 784-788, 2009 Withdrawal of Immunosuppression in Pediatric Liver Transplant Recipients in Korea Jee
More informationThe New England Journal of Medicine
The New England Journal of Medicine Copyright, 2, by the Massachusetts Medical Society VOLUME 342 M ARCH 2, 2 NUMBER 9 IMPROVED GRAFT SURVIVAL AFTER RENAL TRANSPLANTATION IN THE UNITED STATES, 1988 TO
More informationManagement of Post-transplant hyperlipidemia
Management of Post-transplant hyperlipidemia B. Gisella Carranza Leon, MD Assistant Professor of Medicine Lipid Clinic - Vanderbilt Heart and Vascular Institute Division of Diabetes, Endocrinology and
More informationWhat Is the Real Gain After Liver Transplantation?
LIVER TRANSPLANTATION 15:S1-S5, 9 AASLD/ILTS SYLLABUS What Is the Real Gain After Liver Transplantation? James Neuberger Organ Donation and Transplantation, NHS Blood and Transplant, Bristol, United Kingdom;
More informationEuropean Risk Management Plan. Measures impairment. Retreatment after Discontinuation
European Risk Management Plan Table 6.1.4-1: Safety Concern 55024.1 Summary of Risk Minimization Measures Routine Risk Minimization Measures Additional Risk Minimization Measures impairment. Retreatment
More informationRapamune (sirolimus) Oral Solution and Tablets
Rapamune (sirolimus) Oral Solution and Tablets only This product s label may have been revised after this insert was used in production. For further product information and current package insert, please
More informationPredictors of cardiac allograft vasculopathy in pediatric heart transplant recipients
Pediatr Transplantation 2013: 17: 436 440 2013 John Wiley & Sons A/S. Pediatric Transplantation DOI: 10.1111/petr.12095 Predictors of cardiac allograft vasculopathy in pediatric heart transplant recipients
More informationNAPRTCS Annual Transplant Report
North American Pediatric Renal Trials and Collaborative Studies NAPRTCS 2010 Annual Transplant Report This is a privileged communication not for publication. TABLE OF CONTENTS PAGE I INTRODUCTION 1 II
More informationCurrently, the leading indication for liver transplantation
ORIGINAL ARTICLES Severe Recurrent Hepatitis C After Liver Retransplantation for Hepatitis C Virus Related Graft Cirrhosis Marina Berenguer, * Martín Prieto, * Antonio Palau, * José M. Rayón, Domingo Carrasco,
More informationLong term liver transplant management
Long term liver transplant management Dr Bill Griffiths Cambridge Liver Unit Royal College of Physicians 5.7.17 Success of Liver Transplantation Current survival, 1 st elective transplant: 1 yr survival
More informationNephrology Dialysis Transplantation
Nephrol Dial Transplant (1999) 14: 394 399 Original Article Nephrology Dialysis Transplantation Reduced kidney transplant rejection rate and pharmacoeconomic advantage of mycophenolate mofetil Rudolf P.
More informationDRUG LEVEL MONITORING AND ADJUSTMENT Silvio Sandrini, Brescia, Italy Chairs: Ryszard Grenda, Warsaw, Poland Julio Pascual, Barcelona, Spain
DRUG LEVEL MONITORING AND ADJUSTMENT Silvio Sandrini, Brescia, Italy Chairs: Ryszard Grenda, Warsaw, Poland Julio Pascual, Barcelona, Spain Prof. Silvio Sandrini Division and Chair of Nephrology University
More informationResearch Article A Decade of Experience Using mtor Inhibitors in Liver Transplantation
Transplantation Volume 2011, Article ID 913094, 7 pages doi:10.1155/2011/913094 Research Article A Decade of Experience Using mtor Inhibitors in Liver Transplantation Jeffrey Campsen, 1, 2 Michael A. Zimmerman,
More informationVictims of success: Do we still need clinical trials? Robert S. Gaston, MD CTI Clinical Trials and Consulting University of Alabama at Birmingham
Victims of success: Do we still need clinical trials? Robert S. Gaston, MD CTI Clinical Trials and Consulting University of Alabama at Birmingham Disclosure Employee: CTI Clinical Trials and Consulting
More informationImmunosuppressants. Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia
Immunosuppressants Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia Immunosuppressive Agents Very useful in minimizing the occurrence of exaggerated or inappropriate
More informationThe increase in the number of liver transplant candidates
Evaluation of Potential Liver Donors: Limits Imposed by Donor Variables in Liver Transplantation Ramón Rull, Oscar Vidal, Dulce Momblan, Francisco Xavier González, Miguel Angel López-Boado, Jose Fuster,
More informationPost Transplant Diabetes Mellitus in Ahmed Gasim Kidney Transplant Center, Sudan
Arab Journal of Nephrology and Transplantation Original Article AJNT Post Transplant Diabetes Mellitus in Ahmed Gasim Kidney Transplant Center, Sudan Abdul-Rahman A El-Magzoub a*, Sarra Elamin b a. Consultant
More informationLiver Transplantation Evaluation: Objectives
Liver Transplantation Evaluation: Essential Work-Up Curtis K. Argo, MD, MS VGS/ACG Regional Postgraduate Course Williamsburg, VA September 13, 2015 Objectives Discuss determining readiness for transplantation
More informationSCI.RWDSING GLOXERULONEPHRITIS (FSGN) OF CHILDHOOD. Jerry XcCauley, X.D. Andreas G. Tzakis, X.D. John J. Fung, X.D., Ph.D. satoru Todo, M.D.
~TEKEHT WITH FK 506 OF STEROID RESISTENT FOCAL /106 SCI.RWDSING GLOXERULONEPHRITIS (FSGN) OF CHILDHOOD Jerry XcCauley, X.D. Andreas G. Tzakis, X.D. John J. Fung, X.D., Ph.D. satoru Todo, M.D. Thomas E.
More informationTolerance Induction in Transplantation
Tolerance Induction in Transplantation Reza F. Saidi, MD, FACS, FICS Assistant Professor of Surgery Division of Organ Transplantation Department of Surgery University of Massachusetts Medical School Percent
More informationA come the standard for surgical treatment of endstage
Cardiac Transplantation With CorticosteroidFree Immunosuppression: LongTerm Results K. Francis Lee, D, Janet D. Pierce, PhD, ichael L. Hess, D, Andrea K. Hastillo, D, Andrew S. Wechsler, D, and Albert
More informationBasiliximab in pediatric liver transplantation: A pharmacokinetic-derived dosing algorithm
Pediatr Transplantation 2002: 6: 224 230 Printed in UK. All rights reserved Copyright # 2002 Blackwell Munksgaard Pediatric Transplantation ISSN 1397-3142 Basiliximab in pediatric liver transplantation:
More informationUse of immune function test in monitoring immunosuppression in liver transplant recipients
Clin Transplant 2012: 26: 826 832 DOI: 10.1111/j.1399-0012.2012.01632.x 2012 John Wiley & Sons A/S. Use of immune function test in monitoring immunosuppression in liver transplant recipients Te HS, Dasgupta
More informationDra. Irma Esther del Moral Espinosa Nefrología Pediátrica Hospital Infantil de México Federico Gómez
Dra. Irma Esther del Moral Espinosa Nefrología Pediátrica Hospital Infantil de México Federico Gómez drairma.nefroped@gmail.com Many children with idiopathic nephrotic syndrome initially respond to steroid
More informationSteroid-Free Maintenance Immunosuppression After Heart Transplantation
Steroid-Free Maintenance Immunosuppression After Heart Transplantation Timothy E. Oaks, MD, Thomas Wannenberg, MD, Sherry A. Close, BSN, Laura E. Tuttle, BSN, and Neal D. Kon, MD Departments of Cardiothoracic
More information2017 BANFF-SCT Joint Scientific Meeting. Personalized Medicine in Liver Transplantation
2017 BANFF-SCT Joint Scientific Meeting Personalized Medicine in Liver Transplantation Miquel Navasa Liver Transplant Unit. Hospital Clínic. Barcelona. Barcelona, March 2017 Disclosures Consultant for
More informationIncreasingly sophisticated surgical techniques and refinements
Tacrolimus as Intervention in the Treatment of Hyperlipidemia after Liver Transplant André Roy, 1,8 Norman Kneteman, Leslie Lilly, 3 Paul Marotta, Kevork Peltekian, 5 Charles Scudamore, 6 and Jean Tchervenkov
More informationLothar Bernd Zimmerhackl
What works in current paediatric practice of off-label dose adjustment of adult doses? Lothar Bernd Zimmerhackl Medical University Innsbruck Austria AGAH Workshop: Pediatric Investigation Plan. Bonn 13-14.1.
More informationSerologic Markers CONVENTIONAL ANTIBODIES ANTIBODIES UNCONVENTIONAL. AIH Type I
Autoimmune Hepatitis By Thomas Frazier Objective What we need to know about AIH Diagnosis Treatment Difficulties in both Liver transplantation concerns AASLD Guidelines: Hepatology. 2010 Jun;51(6):2193-213.
More informationExperience with Liver Transplantation in patients over 65 years of Age at the Hospital Pablo Tobón Uribe in Medellin, Colombia from 2004 to 2010
Original articles Experience with Liver Transplantation in patients over 65 years of Age at the Hospital Pablo Tobón Uribe in Medellin, Colombia from 2004 to 2010 Octavio Muñoz, MD, 1 Laura Ovadía, MD,
More informationNatural History of Clinically Compensated Hepatitis C Virus Related Graft Cirrhosis After Liver Transplantation
Natural History of Clinically Compensated Hepatitis C Virus Related Graft Cirrhosis After Liver Transplantation MARINA BERENGUER, 1 MARTÍN PRIETO, 1 JOSÉ M. RAYÓN, 2 JULIO MORA, 1 MIGUEL PASTOR, 1 VICENTE
More informationJames E. Cooper, M.D. Assistant Professor, University of Colorado at Denver Division of Renal Disease and Hypertension, Kidney and PancreasTransplant
James E. Cooper, M.D. Assistant Professor, University of Colorado at Denver Division of Renal Disease and Hypertension, Kidney and PancreasTransplant Program Has no real or apparent conflicts of interest
More informationFigure 1. Actuarial survival of patients with ABO I, ABO compatible, and ABO identical grafts.
New Insights into Antibody Mediated Graft Injury after Pediatric Liver Transplantation S.V. McDiarmid MD Professor of Pediatrics and Surgery David Geffen School of Medicine University of California, Los
More informationImmunosuppressive Strategies in Liver Transplantation for Hepatitis C
Trends in Transplantation Transplant. 2010;4:78-85 Immunosuppressive Strategies in Liver Transplantation for Hepatitis C Timothy M. Clifford 1-3, Michael F. Daily 1,3 and Roberto Gedaly 1,3 1 UK HealthCare,
More informationTransplant Hepatology
Transplant Hepatology Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the certified
More informationNovel Therapies in Autoimmune Hepatitis
Novel Therapies in Autoimmune Hepatitis Paul W. Rassam,MD Ass. Clinical Professor of Medicine Div. of Gastroenterology and Hepatology St George Hospital University Medical Center University of Balamand
More informationCyclosporine (CsA) dose adjustments based on. C 2 Monitoring of Cyclosporine in De Novo Liver Transplant Recipients: The Clinician s Perspective
REVIEW C 2 Monitoring of Cyclosporine in De Novo Liver Transplant Recipients: The Clinician s Perspective Federico Villamil 1 and Stephen Pollard 2 Adjusting cyclosporine (CsA) dose based on blood concentration
More informationReduced graft function (with or without dialysis) vs immediate graft function a comparison of long-term renal allograft survival
Nephrol Dial Transplant (2006) 21: 2270 2274 doi:10.1093/ndt/gfl103 Advance Access publication 22 May 2006 Original Article Reduced graft function (with or without dialysis) vs immediate graft function
More informationDesensitization in Kidney Transplant. James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver
Desensitization in Kidney Transplant James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver Organ Shortage Currently there are >90,000 patients on the kidney
More informationTreatment of Hepatitis C Recurrence after Liver Transplantation. Maria Carlota Londoño Liver Unit Hospital Clínic Barcelona
Treatment of Hepatitis C Recurrence after Liver Transplantation Maria Carlota Londoño Liver Unit Hospital Clínic Barcelona Agenda 1. Introduction 2. Treatment options for hepatitis C recurrence after transplantation
More informationTRANSPLANTATION IN DIABETIC PATIENTS. A.Tarik Kizilisik, MD, MSc, FACS, FICS Director & Primary Transplant Surgeon Lutheran Transplant Center
TRANSPLANTATION IN DIABETIC PATIENTS A.Tarik Kizilisik, MD, MSc, FACS, FICS Director & Primary Transplant Surgeon Lutheran Transplant Center Diabetes is the pandemic of the new millennium 24 million diabetics
More informationRECURRENT HEPATITIS C CIRRHOSIS AFTER LIVER TRANSPLANTATION: A NATURAL HISTORY STUDY
RECURRENT HEPATITIS C CIRRHOSIS AFTER LIVER TRANSPLANTATION: A NATURAL HISTORY STUDY By VIRGINIA C. CLARK A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF
More informationRAPID COMMUNICATION Preexisting malignancy is considered a relative contrain- dication to orthotopic liver transplantation (OLT) be-
RAPID COMMUNICATION Successful Outcome of Orthotopic Liver Transplantation in s With Preexisting Malignant States Sanjiv Saigal, Suzanne Norris, Parthi Srinivasan, Paolo Muiesan, Mohamed Rela, Nigel Heaton,
More information