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Upregulation of heme oxygenase‐1 (HO‐1) has been proposed as an adaptive mechanism protecting against ischemia/reperfusion (I/R) injury. We investigated HO‐1 expression in 38 human liver transplants and correlated this with I/R injury and graft function. Before transplantation, median HO‐1 mRNA levels were 3.4‐fold higher (range: 0.7–9.3) in donors than in normal controls. Based on the median value, livers were divided into two groups: low and high HO‐1 expression. These groups had similar donor characteristics, donor serum transaminases, cold ischemia time, HSP‐70 expression and the distribution of HO‐1 promoter polymorphism. After reperfusion, HO‐1 expression increased significantly further in the initial low HO‐1 expression group, but not in the high HO‐1 group. Postoperatively, serum transaminases were significantly lower and the bile salt secretion was higher in the initial low HO‐1 group, compared to the high expression group. Immunofluorescence staining identified Kupffer cells as the main localization of HO‐1.

Abstract This study was performed to assess the main reasons for the unfavorable cost effectiveness of lung transplantation compared with that of heart and liver transplantation. Costs, effects, and cost‐effectiveness ratios of Dutch lung, heart, and liver transplantation programs were compared. The data are based on three Dutch technology assessments of transplantation, with minor adjustments for time and methods. In result, mainly follow‐up costs of lung transplantation are higher than costs of heart and liver transplantation ‐ US $150,300, US $121,500, and US $95,300, respectively ‐ in the first 3 years after transplantation. The survival gain realized by lung transplantation is small (4.4 years) compared with heart (8.8 years) and liver (14.7years) transplantation. Costs per life‐year gained were US $77,000, US $38,000, and US $26,000 for lung, heart, and liver transplantation, respectively. The unfavorable cost effectiveness of lung transplantation is largely related to a relatively small survival gain and high follow‐up costs.

Abstract Peri‐operative endotoxaemia during liver transplantation has been linked to compromised graft function and infection. Selective decontamination of the digestive tract (SDD) could prevent endotoxaemia by eradicating Gram‐negative bacteria from the intestine. In a randomized placebo controlled study we investigated the effects of endotoxaemia and the efficacy of SDD to prevent its occurrence. Thirty‐one patients undergoing elective orthotopic liver transplantation received either SDD (n= 15) or placebo (n= 16), which was started at least 7 days before transplantation. Endotoxin levels were measured in blood peroperatively. Patients were scored daily for signs of liver dysfunction and infection. Endotoxaemia was neither associated with initial poor function nor any routine liver function test. Infections were more prominent in patients without endotoxaemia. SDD did not prevent endotoxameia. Endotoxaemia does not affect post‐operative graft function or the incidence of post‐operative infections. SDD cannot prevent peri‐operative endotoxaemia. Translocation of endotoxin may not be relevant in liver transplantation.

Background/Aims: The aim of the study was to compare the serum response of regeneration factors and acute phase proteins in patients treated with partial hepatectomy or cryosurgery.

Large transfusion requirements, i.e., excessive blood loss, during orthotopic liver transplantation (OLT) are correlated with increased morbidity and mortality. Recombinant factor VIIa (rFVIIa) has been shown to improve hemostasis in a variety of conditions, but has never been studied in liver transplantation.

To alleviate the shortage of size-matched whole-donor organs, too-large-for-size cadaveric donor grafts are modified by liver resection techniques. These modifications result in technical-variant liver transplantation (TVLTx). Patient and graft survival rates after TVLTx are considered comparable to those after full-size liver transplantation (FSLTx). However, morbidity after TVLTx is often underexposed. The aim of this study was to analyze the results of FSLTx and TVLTx in terms of patient and graft survival rates and morbidity.

Background/Aim: The recent cloning and sequencing of the Wilson disease gene indicates that hepatic copper (Cu) transport is mediated by a P-type ATPase. The location of this Cu-transporting protein within the hepatocyte is not known; in view of its proposed function and current concepts of hepatic Cu transport, it may reside in intracellular membranes (endoplasmic reticulum (ER), lysosomes) and/or in the bile canalicular membrane. The objective of this study was to establish characteristics and localization of ATP-dependent Cu transport in human liver. Methods: We have investigated Cu transport in vesicles of human liver plasma membranes showing a gradual increase in enrichment of canalicular domain markers: i.e. basolateral liver plasma membranes (blLPM), a mixed population of basolateral and canalicular (XLPM) and canalicular liver plasma membranes (cLPM). Results: In the presence of ATP (4 mM) and an ATP-regenerating system, uptake of radiolabeled Cu ( 64 Cu, 10 μM) into cLPM vesicles and, to a lesser extent, into blLPM and XLPM was clearly stimulated when compared to control AMP values. Initial uptake rates of ATP-dependent Cu transport were 5.6, 7.8 and 13.7 nmol·min·mg protein for blLPM, XLPM and cLPM, respectively, and showed no relationship with marker enzyme activity of ER and lysosomes (glucose-6-phosphatase and acid-phosphatase, respectively). Leucine aminopeptidase activity, as a marker for the cLPM, significantly correlated with ATP-dependent uptake rates measured in different membrane preparations: r =0.70 ( n =9, p <0.05). Estimated K m and V max values of ATP-dependent Cu uptake were 49.5 μM and 36.9 nmol·min·mg protein, respectively. Conclusion: This study provides biochemical evidence for the presence of an ATP-dependent Cu transport system in human liver (cCOP), mainly localized at the canalicular domain of the hepatocytic plasma membrane.

Methods to quantitate the effects of immunosuppressive drugs on immune reactivity might be helpful for monitoring immunosuppressive treatment. Cyclosporine (CsA) inhibits the induction of cytokine synthesis in T cells, and measurement of interleukin (IL)-2 production might constitute a parameter of this drug's effect.

The development of immunological donor-specific hyporeactivity may account for the low incidence of chronic rejection after clinical liver transplantation. We investigated whether hyporeactivity commonly develops after liver transplantation by analyzing precursor frequencies of donor-reactive cytotoxic (CTLp) and helper (HTLp) T lymphocytes and mixed lymphocyte culture (MLC) reactivity in liver allograft recipients. We further studied whether CTLp hyporeactivity correlated with changes in donor-specific HTLp frequencies or suppressor cell activity.

Analysis of quality-of-life effects is part of the current technology assessment of the Dutch orthotopic liver transplant-program.

We report a case of a neurogenic bladder in which hydronephrosis recurred early after renal transplantation. After 2 unsuccessful attempts at ureteroneovesicostomy of the donor ureter a vesicocalicostomy was performed, since reconstruction with the donor pelvis or ureter was impossible owing to the extended fibrosis and scar formation around the renal hilus and ureter. During the 23 months of followup renal function has been good without serious infectious sequela with a regimen of self-catheterization and no antibiotic maintenance therapy.