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Biomedical subjects

R Y Calne

Publications and source records attributed to R Y Calne.

At least 109 records · Page 6Linked to original sources
PubMed1991

Surgical anatomy of donor extended right trisegmentectomy before orthotopic liver transplantation in children.

Liver transplantation is now accepted as the treatment of choice for children with end stage liver disease. A major constraint has been the shortage of donor organs of appropriate size. The use of reduced size adult organs has partially alleviated this problem but the previous technique employed was limited to a donor:recipient body-weight disparity of not greater than 3:1. Recently a new technique has been described that allows safe transplantation with a donor:recipient weight ratio of greater than 10:1. This should greatly increase the paediatric donor pool. Anatomical landmarks and techniques necessary for donor reduction hepatectomy are described from the dissection of 50 adult cadaveric livers. Variations in all important biliary and vascular structures necessitated adjustments in operative technique.

Bile Ducts↗
PubMed1991

Surgical restraint in the management of liver trauma.

Previous experience in Cambridge in the management of liver trauma has led to the evolution of a protocol for surgical intervention to secure control of haemorrhage from the injured liver. We report 80 cases of liver trauma including 12 who were initially managed non-operatively; three of these subsequently required operation. Of the 80, all but five suffered blunt abdominal trauma. Perihepatic packing was used to manage 29 patients, of whom 21 were initially treated elsewhere before being transferred to Cambridge. Six of these required a hemihepatectomy at subsequent exploration. Of the 39 patients who underwent urgent laparotomy and definitive surgery, 11 (28 per cent) died; only three out of 29 (10 per cent) died after initial packing. Only one death from hepatic complications occurred after packing and subsequent transfer.

Hemorrhage↗
PubMed1991

Graft-versus-host disease in solid organ transplantation.

Graft-versus-host disease is well recognized in bone marrow transplantation, but has only recently been described in solid organ transplantation. Two such cases in liver graft recipients, proven by the demonstration of donor type HLA antigens in the peripheral blood and marrow on tissue typing, are described in this paper. The literature on this subject is reviewed and the treatment discussed. It is postulated that there is an order of risk of development of graft-versus-host disease depending on the amount of viable lymphoid tissue included with the transplanted organ as follows: small bowel greater than heart-lung greater than liver greater than kidney greater than heart. It seems likely that this condition has been substantially underdiagnosed in the past and that greater awareness of the possibility of graft-versus-host disease in solid organ recipients will lead to the recognition of further cases and allow appropriate treatment to be promptly instituted.

Adult↗
PubMed1991

Combined hepatic and renal transplantation in primary hyperoxaluria type I: clinical report of nine cases.

PURPOSE AND PATIENTS AND METHODS: The purpose of this article is to report the experience of three centers with combined hepatic and renal transplantation for pyridoxine-resistant primary hyperoxaluria type I (alanine:glyoxylate aminotransferase [EC 2.6.1.44] deficiency), with particular emphasis on the selection criteria and timing of the operation. Nine patients with this inherited disease were treated by combined hepatic and renal transplantation. The former replaces the enzyme-deficient organ while the latter replaces the functionally affected organ. RESULTS: One patient with gross systemic oxalosis died in the immediate postoperative period and another died 8 weeks postoperatively of a generalized cytomegalovirus infection, having shown evidence of biochemical correction. One patient with particularly severe osteodystrophy at the time of the operation died 14 months postoperatively from renal failure due to progressive calcium oxalate nephrocalcinosis involving the transplanted kidney, plus thromboembolic disease. He also had very extensive systemic oxalosis. An additional patient with severe osteodystrophy died 9 months postoperatively. One patient developed hyper-rejection of the kidney and died later of gastrointestinal hemorrhage. The four long-term survivors (22 to 38 months) have remained asymptomatic from the standpoint of their renal disease, with resolution of any manifestations of systemic oxalosis that they may have had. They are either employed or continuing their education. CONCLUSIONS: A prolonged period of end-stage renal failure treated by dialysis regimens that are suitable for non-hyperoxaluric renal failure and extensive systemic oxalosis, particularly oxalotic osteodystrophy, are poor prognostic features. We propose that hepatic transplantation should be considered as definitive treatment before end-stage renal failure develops. This should be supplemented by renal transplantation with vigorous pre- and perioperative hemodialysis to deplete the body stores of oxalate. Although some authorities would reserve hepatic transplantation for patients in whom renal transplantation has failed, we suggest that combined liver and kidney transplantation is appropriate in patients who have never had a renal graft. Furthermore, the time has come to consider hepatic transplantation before any irreversible renal damage has occurred in these patients.

Adolescent↗
PubMed1991

Liver transplantation for Budd-Chiari syndrome, 1976-1990.

Between November 1976 and May 1990, twenty-six patients with Budd-Chiari syndrome underwent 28 liver transplants in the Cambridge-Kings College Hospital program. Twelve patients were male, average age 36.6 (range 19-54) and fourteen were female, average age 26 (range 10-47). Possible aetiological factors were identified in 13 cases; polycythaemia rubra vera (4), megakaryocytosis (2), antithrombin III deficiency (1), trauma (1), pregnancy (1), oral contraceptive pill (4). Because of the high incidence of thrombotic complications a protocol of early anticoagulation was introduced early in the series commencing with subcutaneous heparin and progressing to formal full anticoagulation with heparin and then long term anticoagulation with warfarin. Twelve patients have died giving one, three and five year actuarial survival figures of 69.2%, 69.2% and 49.7% respectively, there are currently six patients alive beyond five years. Orthotopic liver grafting in Budd-Chiari syndrome and subsequent anticoagulant thus represents a major treatment option with good long term survival and is the optimal treatment for patients with end stage liver disease.

Adult↗
PubMed1990

Liver transplantation in patients with alcoholic cirrhosis: selection criteria and rates of survival and relapse.

OBJECTIVE: To evaluate the outcome of liver transplantation in patients with alcoholic cirrhosis with respect to selection criteria, survival, and evidence suggesting a return to harmful drinking. DESIGN: Nine year retrospective study. SETTING: Cambridge and King's College Hospital liver transplant programme. SUBJECTS: 24 Patients (three women, 21 men) with alcoholic cirrhosis. MAIN OUTCOME MEASURES: Survival, rehabilitation, and clinical and laboratory evidence of a return to harmful drinking after transplantation. RESULTS: 15 Patients were selected for transplantation because of repeated admission to hospital for the complications of advanced portal hypertension despite abstinence, and six because they had a hepatocellular carcinoma superimposed on alcoholic cirrhosis. Three patients who were not abstinent received transplants. The one year survival rate was 66%, and of the 18 patients surviving at least three months, 17 had been rehabilitated. In three patients laboratory variables and histological examination of the liver suggested a return to drinking, though they did not admit to taking alcohol. These patients represented the only cases in the series that were not abstinent before transplantation. CONCLUSIONS: The survival and rehabilitation of patients who received transplants for alcoholic cirrhosis compared favourably with those of patients who received transplants for cirrhosis of other aetiology. The criteria for selection for liver transplantation in patients with alcoholic cirrhosis should include recurrent complications related to severe portal hypertension despite maximum medical treatment in addition to a minimum period of six months of abstinence before transplantation.

Adult↗