ESOT: Extra-Small-For-Size Grafts In Living Donor Liver Transplantation

Dr. Yuji Seojima of the Kyushu University, Fukuoka, Japan presented today his study regarding ESFS grafts.

Among their 244 LDLT (71 right lobe and 143 LL), 15 were less than 30% of the graft-to-standard liver volume ratio. All of the ESFSG were left lobe grafts. The mean graft weight was 301 grams.

Several technical modifications were necessary such as: AOLT (n=2), temporal hemiportocaval shunt (n=1), splenectomy (n=1). Four grafts were lost to chronic rejection, late portal vein thrombosis, de novo lung cancer, and hepatic infarction.

They concluded that the ESFSG can be used safely in selected cases with appropiate technical modifications, careful patient management and the accumulation of experience.

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ESOT: Adult-To-Adult Living Donor Liver Transplantation Using Dual Grafts

Dr. Chih-Chi Wang from the Department of Surgery at Kaohsiung Hospital, Taiwan, presented at the ESOT Congress, Prague, their experience with dual grafts for living donor liver transplantation.

They presented a prospective study including 150 adult LDLT and 5 dual graft transplantations. According to their results, 2 recipients received 1 right lobe and 1 left lobe, and the other two received two left lobes.

They concluded that dual graft transplantation provides sufficient volume in the recipient without jeopardizing donor safety. They also added that it should be considered and performed by an experienced center when a single donor is rejected based on volumetry requirements.

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ESOT: Approaches to Prevent Indirect Effects of CMV Infection

Dr. Cecilia Söderberg from the Karolinska Institute, Sweden, gave a lecture today at the European Society for Organ Transplantation, regarding the mechanisms by which the CMV leads to its indirect effects. It has been proposed that indirect CMV effects appear as a result of the ability of the virus to influence immunological functions, and hence the virus must replicate in its host.

Viral infection of cells may lead to indirect effects and graft damage by altered expression of growth factors and cytokines, increased antigen processing and presentation associated with the major histocompatibility complex, and up-regulation of pro-inflammatory adhesion molecules in uninfected cells.

Although ganciclovir is effective for the prevention and treatment of CMV disease in transplant patients, the intravenous form is inconvinient for long-term administration and oral ganciclovir has low bioavailability. The oral pro-drug valganciclovir has higher bioavailability.

Prophylaxis is better able to reduce the overall incidences of many of the complications of CMV compared with pre-emptive treatment.

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