Search

Ischemia of the liver in hepatic resection under inflow occlusion is tolerable for at least up to 60 min. For protection of the liver from ischemic injury, steroids are frequently used. In liver transplantation, cold ischemia of 6-8 h for the graft is considered to be acceptable. Organ preservation is most frequently accomplished by in situ perfusion of the liver with Euro Collins solution in the donor and consecutive hypothermic storage after hepatectomy, resulting in 96% of all grafts in primary function.

A 34 year old patient was diagnosed as suffering from congestive cirrhosis due to constrictive pericarditis 18 years ago. A terminal dystrophic episode of additionally acquired chronic aggressive hepatitis B led to rapidly progressive liver failure. Orthotopic liver transplantation was carried out. 10 months after transplantation the patient is alive and well. Presence of HBsAg and HBcAg can again be demonstrated in the liver graft, however, without histologic evidence of hepatitis. Problems of prognosis after liver transplantation for hepatitis B virus infection are discussed.

The role of hepatic transplantation in patients with nonresectable liver or bile duct cancer remains a controversial issue. An analysis of 95 consecutive cases was undertaken to evaluate retrospectively the pathological tumor stage--in accordance with the TNM system--and outcome after transplantation. Included were patients with the following diagnoses: hepatocellular carcinoma (n = 52), cholangiocellular carcinoma (n = 10), hepatoblastoma (n = 2), hemangiosarcoma (n = 2), bile duct carcinoma (n = 20), and liver metastases from different primary tumors (n = 9). The overall actuarial survival rate at 5 years was 20.4%. Median survival improved significantly within the last 4 years as compared to the preceding era (18.06 vs. 4.0 months). Currently 27 patients are alive, with the longest follow-up more than 12 years. The incidences of residual or recurrent tumor were 27 and 28, respectively. Particularly in patients who underwent transplantation for hepatocellular or bile duct carcinoma without extra-hepatic tumor spread, the results were significantly better; median survival time achieved for these two groups were 120 (p less than 0.01) and 35 months (p less than 0.05). Prolonged survival without tumor recurrence was not seen in patients with cholangiocellular carcinoma or liver metastases. These results demonstrate clearly that liver transplantation for hepatobiliary malignancy is still justified on the premises of careful patient selection by adequate tumor staging.

Assessment of collateral circulation of the palmar arcade prior to percutaneous radial artery cannulation is necessary because a thrombosing radial artery together with insufficient collateral circulation may lead to gangrene of the hand. A new method for assessment of collateral circulation of the palmar arcade by use of a spectrophotometric monitoring device for arterial oxygen saturation is described. This method is contrasted with current methods (Allen's test, Brodsky's test, ultrasound Doppler).