Embargoed until 16-Oct-2000
STUDY SHOWS SPEED OF LIVER REGENERATION AFTER TRANSPLANTS
SAN FRANCISCO -- The development of adult living donor liver transplantation (LDLTx) about two years ago vastly increases the pool of potential donors for patients in need of healthy livers. The surgery offers new hope to patients with liver failure, including the 12,000 individuals in this country currently waiting for transplants.
Research conducted by anesthesiologists at the Medical College of Virginia, Commonwealth University in Richmond, presents encouraging evidence of LDLTx's safety and viability.
"Successful transplantation depends on the ability to quickly produce normal liver mass and function in the recipient," anesthesiologist Mitsuru Nakatsuka, M.D., said at the American Society of Anesthesiologists annual meeting
"Achieving this involves removing more than 50 percent of the donor's liver, or at least 0.8 percent to 1 percent of the recipient's body weight. The right lobe, the largest of the organ's four sections, provides the large chunk of tissue we need."
A study of 31 LDLTx performed at the Medical College of Virginia between June 1998 and June 1999 indicates that the livers of both donors and recipients regenerate to normal size within one to two weeks after surgery.
Measurements of liver mass using magnetic resonance imaging revealed that most of the regeneration occurs during the first week, and liver function returns to normal within one week as well, the study showed.
The findings highlight the liver's remarkable capacity to regenerate and lend credence to LDLTx's viability as a surgical alternative, Dr. Nakatsuka said.
Anesthesia plays a major role in successful LDLTx by enabling donors to recover more quickly, with fewer complications, Dr. Nakatsuka noted. In this study, anesthesiologists used general anesthesia for donors in combination with a type of regional anesthesia called a thoracic epidural. The epidural blocks the transmission of pain messages from the upper abdominal region (where the surgical incision is made) to the brain.
All donors survived and experienced minimal pain following surgery, recovered with few complications and left the hospital in an average of five days, Dr. Nakatsuka reported.
Recipients received general anesthesia and recovered in surgical intensive care, returning home an average of 14 days after surgery. Ninety percent of the recipients survived (a percentage comparable to transplantations of livers from brain-dead individuals, referred to as cadaveric donor transplantation).
"We conclude from this study that adult living donor liver transplantation using the right lobe is a reasonable alternative to cadaveric donor liver transplantation," Dr. Nakatsuka said.
An estimated 4 million Americans have hepatitis C, a virus that causes cirrhosis (a chronic, degenerative disease of the liver) and liver failure in about 25 percent of infected individuals. Without transplants, these individuals will not survive. The demand for donor livers, however, far exceeds the supply, because the number of available livers from cadaveric donors is limited.
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This research will be presented at the 2000 American Society of Anesthesiologists (ASA) annual meeting in San Francisco, California, on October 14-18. During the annual meeting, you can reach communications staff members between 8 a.m. and 5 p.m. in the ASA press room at the Moscone Center, Room 228, telephone: (415) 978-3710. ASA staff members will be on hand to assist you in scheduling interviews, locating individuals and providing general background information.
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