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Hydatid disease of the liver is a parasitic zoonosis, caused by the larval cestode of the tapeworm Echinococcus granulosus [ 1 – 6 ]. The disease was firstly alluded to by Hippocrates. The disease is also mentioned in Talmud [ 7 ]. The characteristic of the disease is that the life-cycle typically involves two hosts

Hepatic abscess was recognized by Hippocrates as a favorable evolution of local or disseminated infection because it contained the inflammation in a favorable or more accessible location and, when mature, it was treated by incision/coagulation and drainage (i.e. surgery). Based on the quality of the evacuated pus a prognosis would be established. Hepatic abscesses would be invariably fatal, if the drained pus was malodorous, dark or somehow varied from the so-called optimum pus [ 1 ]. So, for centuries the treatment and grave prognosis of hepatic abscesses remained unchanged. In 1938, for the first time, Oschner et al. reported a 62% survival rate in series of patients with liver abscesses treated by surgical drainage [ 2 ]. Soon after, antibiotics were developed and further improved the prognosis of such a former lethal disease. Surgical drainage remained the mainstay of treatment until the first report of percutaneous drainage, in 1953 [ 3 ] Despite the use of antibiotics and drainage, the mortality of the disease did not changed substantially until the introduction in the clinical practice of computer tomography, in the middle 1960s

It is estimated that benign liver tumours affect about 20% of the general population. A great variety of benign liver tumours of different embryological origin can be encountered. The most common are listed in table 39.1

With the widespread use of sensitive imaging techniques, the frequency of non-parasitic liver cysts is increasingly reported. It is a rare clinical entity that is identify through the common use of computed tomography and ultrasonography [ 1 ]–[ 4 ]. Their reported prevalence is estimated to be between 0.8% and 3.8% [ 5 ] during routine abdominal ultrasound examinations

Over the last three decades liver transplantation has become an established therapy for patients suffering from end-stage liver disease. In 1955, Welch reported the first attempt at experimental heterotopic grafting of a liver in a dog [ 1 ]. The first known experimental orthotopic liver transplantation (OLT) was reported by Cannon in 1956 at the University of California [ 2 ]. In 1963, Starzl performed a human-to-human OLT in a 3 year old child with congenital biliary atresia who died intraoperatively [ 3 ]. The following 2 transplant recipients lived for 22 days and 1 week, respectively [ 3 ]. In 1967, Starzl succesfully transplanted several patients [ 4 ]

Candidates for OLT must have irreversible acute or chronic end stage liver disease (table 41b.1). Virus or alcohol-induced liver cirrhosis constitute the most common disease indications in adults [ 1 ] (fig. 41b.1). In our department 28% of cirrhotic liver transplant recipients are transplanted for hepatitis C virus (HCV)-related liver disease and 26% undergo OLT for alcohol-related liver disease. Other indications include cholestatic liver disorders [primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), biliary atresia], hepatitis B virus (HBV) infection, autoimmune hepatitis, cystic fibrosis, inherited metabolic diseases (Wilson’s disease, hemochromatosis, alpha-1-antitrypsin deficiency), nonalcoholic steatohepatitis, nonmetastatic hepatocellular carcinoma, and acute virally-, toxin-, or drug-induced hepatic failure. The most common indications in children comprise biliary atresia and metabolic liver diseases

Evaluation of a potential transplant candidate is a complex and time consuming process that requires a multi-disciplinary approach. This process must identify extrahepatic diseases that may exclude the patient from transplantation or require treatment before surgical intervention. The protocol for evaluation of our potential transplant candidates as well as the potential contraindications to liver transplantation is demonstrated in tables 41c.1 and 41c.2

For patients with esophageal varices, non-selective beta- blockade remains the treatment of choice for prophylaxis of bleeding. In cases of recurrent variceal hemorrhage despite prior interventional endoscopic therapy or refractory ascites, transjugular intrahepatic portosystemic shunts (TIPS) have been used as an approach to lower portal pressure and as a bridging therapy for transplant candidates. The identification of predisposing factors and the application of lactulose and nonabsorbed antibiotics remain essential for prophylaxis and management of hepatic encephalopathy (HE). Hepatorenal syndrome (HRS) in end-stage liver disease patients is not infrequent. The probability of HRS occurrence among non-azotemic cirrhotic patients with ascites at 1, 2 and 5 years has been reported to be 18%, 32%, and 39-41%, respectively [1, 2]. Although its pathogenesis is complex, HRS has long been recognized as being reversible in cases of well-functioning OLT. However, depending on the duration and severity of HRS, the reversibility of HRS following liver transplantation is often delayed and incomplete. Special attention regarding specific, disease-related therapy prior to surgery should be given to transplant candidates undergoing OLT for HCC or virally-related liver diseases, especially hepatitis B

Despite some innovations in the area of the liver transplantation the orthotopic transplantation of a complete donor liver still remains the standard therapy for both chronic and acute liver failure. In principle, this requires the entire removal of patient’s own liver. Hepatectomy, however, can take place with or without receipt of the retrohepatic vena cava, which influences the haemodynamics during the anhepatic phase

The disparity between organ demand and the cadaveric donor supply for children resulted initially in a pre-transplant mortality of around 25% and was disproportionately high compared with adult patients [ 1 ]. The problem of size mismatch and the different epidemiology of pediatric donorship and terminally diseased children was chiefly responsible for that situation [ 2 ]. This stimulated the development of technical innovations, based on the segmental anatomy of the liver, which facilitated transplanting parts of large deceased donor livers into smaller recipients