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Mettu Srinivas Reddy, Rajesh Rajalingam, Mohamed Rela
Even though Auxiliary Partial Orthotopic Liver Transplantation (APOLT) as a technique was popularized in the late eighties, its role in metabolic liver disease remains controversial. The slow progress in gene therapy research, high incidence of technical complications and the problem of long term graft atrophy have been roadblocks to its wider application. Better understanding of reciprocal dynamics of portal flow and regeneration between the graft and native liver along with multiple refinements in surgical technique have improved outcomes of this operation making it a safe alternative to OLT for patients with a wide range of noncirrhotic metabolic liver diseases (NCMLD)...
September 8, 2016: Transplantation
Cheng-Yen Chen, Chinsu Liu, Niang-Cheng Lin, Hsin-Lin Tsai, Che-Chuan Loong, Cheng-Yuan Hsia
Hepatic-based metabolic disorders are characterized by an enzyme deficiency expressed solely or mainly in the liver. They are divided into cirrhotic or non-cirrhotic metabolic liver diseases (NCMLDs), and most of them can be treated by liver transplantation. Because the livers with NCMLDs are usually structurally and functionally normal, the primary aim of the liver graft is to support the deficient enzymes rather than maintaining liver functions. Hence, we hypothesize that the exchange of partial liver grafts by the technique of auxiliary partial orthotopic liver transplantation (APOLT) between patients with 2 different NCMLDs may be feasible to replace the deficient enzymes in each patient...
2016: Annals of Transplantation: Quarterly of the Polish Transplantation Society
Sarwat B Ahmad, Michael Miller, Steven Hanish, Stephen T Bartlett, William Hutson, Rolf N Barth, John C LaMattina
BACKGROUND: Lecithin cholesterol acyl transferase (LCAT) deficiency is a rare autosomal recessive disorder of lipoprotein metabolism that results in end-stage renal disease (ESRD) necessitating transplantation. As LCAT is produced in the liver, combined kidney and liver transplantation was proposed to cure the clinical syndrome of LCAT deficiency. METHODS: A 29-year-old male with ESRD secondary to LCAT deficiency underwent a sequential kidney-liver transplantation from the same living donor (LD)...
October 2016: Clinical Transplantation
Mohamed Rela, Ilankumaran Kaliamoorthy, Mettu Srinivas Reddy
Auxiliary partial orthotopic liver transplantation (APOLT) is a technique of liver transplantation (LT) where a partial liver graft is implanted in an orthotopic position after leaving behind a part of the native liver. APOLT was previously considered technically challenging with results inferior to orthotopic liver transplantation. Results of this procedure have continued to improve with improving surgical techniques and a better understanding of the natural history of acute liver failure (ALF) and liver regeneration...
September 2016: Liver Transplantation
T Kobayashi, K Miura, H Ishikawa, D Soma, Z Zhang, K Yuza, Y Hirose, K Takizawa, M Nagahashi, J Sakata, H Kameyama, S Kosugi, T Wakai
Endoscopic management of acute necrotic pancreatitis and walled off necrosis is less invasive than surgical treatment and has become the 1st choice for treating pancreatic necrosis and abscess. We treated a case of acute necrotic pancreatitis and walled off necrosis after auxiliary partial orthotopic living-donor liver transplantation (APOLT). A 24-year-old woman was admitted to our university hospital for removal of the internal biliary stent, which had already been placed endoscopically for the treatment of biliary stricture after APOLT...
May 2016: Transplantation Proceedings
Faisal Saud Dar, Abu Bakar Hafeez Bhatti, Syeda Shaheera Hashmi, Haseeb Zia, Munir Iqbal Malik
Auxiliary partial orthotopic liver transplant (APOLT) is a treatment option for certain liver disorders where liver structure is preserved. It includes Criggler Najjar syndrome (CNS), urea cycle defects and familial hypercholesterolaemia. Liver transplant as a treatment modality has only recently become available in Pakistan. Here we report two paediatric cases of CNS type 1 where auxiliary liver transplant was performed to correct jaundice and prevent inevitable brain damage. Both recipients and their respective living donors had successful surgery and are doing well...
May 2016: JPMA. the Journal of the Pakistan Medical Association
Rama S Ayyala, Mercedes Martinez, Steven J Lobritto, Tomoaki Kato, Carrie Ruzal-Shapiro
Auxiliary partial orthotopic liver transplant (APOLT) is a treatment technique for people who have acute hepatic failure secondary to fulminant hepatic failure and might ultimately recover normal liver function. This surgical procedure is complicated, involving the placement of a liver graft while maintaining viability of the remaining native portion of the liver. This method allows the native liver to recover hepatic function, therefore eliminating the need for long-term immunosuppression, as is typically needed in post-transplant settings...
July 2016: Pediatric Radiology
Joshua Weiner, Adam Griesemer, Eddie Island, Steven Lobritto, Mercedes Martinez, Gennaro Selvaggi, Jay Lefkowitch, Monica Velasco, Panagiotis Tryphonopoulos, Jean Emond, Andreas Tzakis, Tomoaki Kato
By preserving part of the native liver, auxiliary partial orthotopic liver transplantation (APOLT) provides the advantage of potential immunosuppression (ISP) withdrawal if the native liver recovers but has had limited acceptance, especially in the United States, due to technical complications and low rates of native liver regeneration. No previous study has evaluated APOLT specifically for preadolescent children with fulminant hepatic failure (FHF). This population might benefit especially based on greater capacity for liver regeneration...
April 2016: Liver Transplantation
Guo-Yong Chen, Si-Dong Wei, Zhong-Wu Zou, Gao-Feng Tang, Jian-Jun Sun, Shao-Tang Zhou
Primary hyperoxaluria type I (PH1), the most severe form of primary hyperoxalurias, is a liver disease of the metabolic defect in glyoxylate detoxification that can be corrected by liver transplantation. A 21-year-old man presented to our center after 4 months of regular hemodialysis for kidney failure caused by nephrolithiasis. A diagnosis of PH1 was confirmed by mutations of the AGXT gene. Left lateral sectionectomy of the native liver was performed; and auxiliary partial orthotopic liver transplantation (APOLT) and kidney transplantation were carried out synchronously using a living donor...
August 2015: Medicine (Baltimore)
Qi Cheng, Song-Qing He, Dan Gao, Biao Lei, Xin Long, Hui-Fang Liang, Peng Zhu, Jun-Fei Jin, Bo Tang, Stephen Tomlinson, Zhi-Ying Wu, Xiao-Ping Chen
BACKGROUND: Liver transplantation (LT) is the only option of treatment for Wilson disease (WD) when chelation therapy fails, but it is limited due to the shortage of donor. Auxiliary partial orthotopic LT (APOLT) has been performed successfully in end-stage WD patients, which expands the donor pool. METHODS: Atp7bmice were used as experimental model of WD. Eight- and 20-week-old mice were used as different timepoints to perform APOLT. Serum copper, tissue copper, serum ceruloplasmin (CP), and liver histological examination were observed after operation...
November 2015: Transplantation
Mohamed Rela, Anand Bharathan, Kumar Palaniappan, Pradeep T Cherian, Mettu S Reddy
APOLT is a suitable technique of liver transplantation in patients with ALF and some types of MLD. Portal venous steal is a problem with this procedure that leads to graft dysfunction and failure. Modulation of the portal flow to the graft and native liver can help in preventing this problem. We discuss the pathophysiology of this complication, review available literature regarding its management, and describe our results using the technique of graded hemiportal banding to achieve adequate perfusion for the graft and native liver...
May 2015: Pediatric Transplantation
Y K Park, H C Kim, B-W Kim, W Xu, H-W Lee, H-J Wang
A 37-year-old man with moderately severe hemophilia A (factor VIII of 1.2%), who had a normal liver without liver cirrhosis or hepatocellular carcinoma, was referred to our liver transplantation (LT) team. LT was planned for sufficient coagulation factor level maintenance and prophylaxis against future hemorrhagic complications. The donor was the patient's 35-year-old wife, who was nonhemophilic. We performed an auxiliary partial orthotopic liver transplantation (APOLT) with the approval of the Institutional Ethics Committee...
January 2015: Transplantation Proceedings
Karina Schleimer, Johannes Kalder, Jochen Grommes, Houman Jalaie, Samir Tawadros, Andreas Greiner, Michael Jacobs, Maria Kokozidou
In acute hepatic failure auxiliary liver transplantation is an interesting alternative approach. The aim is to provide a temporary support until the failing native liver has regenerated.(1-3) The APOLT-method, the orthotopic implantation of auxiliary segments- averts most of the technical problems. However this method necessitates extensive resections of both the native liver and the graft.(4) In 1998, Erhard developed the heterotopic auxiliary liver transplantation (HALT) utilizing portal vein arterialization (PVA) (Figure 1)...
2014: Journal of Visualized Experiments: JoVE
Y Ohno, A Mita, T Ikegami, Y Masuda, K Urata, Y Nakazawa, A Kobayashi, M Terada, S Ikeda, S Miyagawa
Donor shortage is a major issue in liver transplantation. We have successfully performed temporary auxiliary partial orthotopic liver transplantation (APOLT) using a small volume graft procured from a living donor for recipients with familial amyloid polyneuropathy (FAP). The aim of this study was to evaluate this procedure by comparing it with standard living donor liver transplantation (LDLT). We compared 13 recipients undergoing this procedure with 23 recipients undergoing a standard LDLT for the treatment of FAP...
August 2012: American Journal of Transplantation
Yasunari Ohno, Akira Kobayashi, Toshihiko Ikegami, Yuichi Masuda, Atsuyoshi Mita, Koichi Urata, Yuichi Nakazawa, Masaru Terada, Shu-Ichi Ikeda, Shinichi Miyagawa
To introduce duct-to-duct biliary anastomosis to conventional temporary auxiliary partial orthotopic liver transplantation (APOLT) using living donor graft for patients with familial amyloid polyneuropathy, we modified the conventional APOLT procedure in a manner characterized by the use of the recipient's common hepatic duct for biliary reconstruction and the preservation of the right posterior section alone for the certain placement of a tube into the corresponding biliary tree for external biliary drainage (modified APOLT)...
May 2012: Liver Transplantation
Bum Soo Kim, Sun Hyung Joo, Suk Hwan Lee, Jung Il Lee, Hyun Cheol Kim, Deok Ho Nam, Ho Chul Park
Adult-onset type II citrullinemia (CTLN2) is a disorder caused by an inborn error of metabolism affecting the liver. CTLN2 is an autosomal recessive disorder characterized by recurrent encephalopathy with hyperammonemia due to highly elevated plasma levels of citrulline and ammonia, caused by a deficiency of argininosuccinate synthetase in the liver. A small number of patients have undergone liver transplantation with favorable results. In Korea, the limitations of the deceased donor pool have made living donor liver transplantation a common alternative treatment option...
June 2011: Journal of the Korean Surgical Society
Lai Wei, Zhishui Chen, Xiaoping Chen, Dunfeng Du, Kaiyan Li, Jipin Jiang
We report a case of reversible hepatofugal portal flow after auxiliary partial orthotopic liver transplantation (APOLT) from a living donor in this study. On postoperative day 6, continuous hepatofugal portal flow was observed in the grafted liver without portal thrombosis and obstruction of the hepatic vein. Based on histological findings, acute rejection was the suspected cause. The normal portal venous flow was restored after steroid pulse and antithymocyte globulin (ATG) therapies. The patient was discharged on the 30th postoperative day...
December 2010: Journal of Huazhong University of Science and Technology. Medical Sciences
Toshiharu Matsuura, Yuji Soejima, Tomoaki Taguchi
Congenital absence of the portal vein (CAPV) with an extrahepatic portosystemic shunt is a rare malformation; the completely absent type, Abernethy malformation type I, is especially rare. Liver transplantation for CAPV type I has been recently recognized as the only curative operation, but few reports have been published so far; meanwhile, auxiliary partial orthotopic liver transplantation (APOLT) has been proposed to be a very effective option, especially for pediatric patients. Here we present an 18-year-old adult patient with CAPV, asplenia, and an iliac shunt vessel who was managed successfully with APOLT using a small-for-size graft...
December 2010: Liver Transplantation
T Kobayashi, Y Sato, S Yamamoto, T Takeishi, H Oya, N Hideki, H Kokai, I Kurosaki, K Hatakeyama
A 54-year-old woman with hepatic encephalopathy grade IV (coma) and flat electroencephalogram (EEG) due to fulminant liver failure (FHF) due to hepatitis B virus infection was admitted to our hospital on May 24, 2002. We performed a living donor auxiliary partial orthotopic liver transplantation (APOLT) emergently on the day of admission. The donor was the patient's son, whose ABO blood group was identical. The immunosuppressant regimen consisted of tacrolimus and low-dose steroids. The left lobe (260 g) of the recipient, which was removed using a Pringle maneuver, was reconstructed with a left lobe (417 g) graft from the donor, which was orthotopically positioned as an auxiliary support...
April 2010: Transplantation Proceedings
D Noto, K Takahashi, T Hamaguchi, K Inamura, K Nobata, M Yazaki, S Ikeda, K Kobayashi, M Yamada
A 48-year-old woman who had conscious disturbance and abnormal behaviors had been misdiagnosed as having hepatic encephalopathy due to hyperammonemia and portal-systemic shunt, and retrograde transvenous obliteration of the shunt did not improve her symptoms. Thereafter, analyses of plasma amino acids and citrin gene revealed a diagnosis of adult onset type II citrullinemia (CTLN2). She underwent auxiliary partial orthotopic liver transplantation (APOLT) using a left lobe graft from her brother, and her symptoms as well as hyperammonemia improved...
June 15, 2009: Journal of the Neurological Sciences
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