Improved survival after live donor adult liver transplantation (LDALT) using right lobe grafts: program experience and lessons learned.

We present our program experience with 85 live donor adult liver transplantation (LDALT) procedures using right lobe grafts with five simultaneous live donor kidney transplants using different donors performed over a 6-year period. After an "early" 2-year experience of 25 LDALT procedures, program improvements in donor and recipient selection, preoperative imaging, donor and recipient surgical technique and immunosuppressive management significantly reduced operative mortality (16% vs. 3.3%, p = 0.038) and improved patient and graft 1-year survival in recipients during our "later" experience with the next 60 cases (January 2001 and March 2005; patient survival: early 70.8% vs. later 92.7%, p = 0.028; graft survival: Early 64% vs. later 91.1%, p = 0.019, respectively). Overall patient and graft survival were 82% and 80%. There was a trend for less postoperative complications (major and minor) with program experience (early 88% vs. later 66.7%; p = 0.054) but overall morbidity remained at 73.8%. Biliary complications (cholangitis, disruption, leak or stricture) were not influenced by program experience (early 32% vs. later 38%). Liver volume adjusted to 100% of standard liver volume (SLV) within 1 month post-transplant. Despite a high rate of morbidity after LDALT, excellent patient and graft survival can be achieved with program experience.

Bleeding peptic ulcers: audit of eradication treatment for H pylori.

AIMS: To determine the outcomes after presentation with bleeding peptic ulcer and to assess the implementation of H. pylori testing, treatment and follow-up testing. METHODS: Case notes and endoscopy records of patients presenting to Auckland Hospital between 1993-95 were reviewed. Patients were recalled for interview and urea breath test. RESULTS: Mean follow-up after presentation was three years. Eighty-nine patients were reviewed; 62% were confirmed as H. pylori positive, although 20% had no biopsies. H. pylori eradication treatment was given to 49 patients. Thirty-five patients had a definite treatment success; eight were failures (eradication rate of 81%) and six received treatment without proof of H. pylori by biopsy. Forty patients received acid suppression only. Twelve patients had biopsy evidence of H. pylori, and a further nine were proven H. pylori positive at follow-up by urea breath test (initial tests had been negative or not performed). Nine patients had a rebleed; seven were confirmed H pylori positive either at presentation, or by follow-up breath test or endoscopic biopsies. CONCLUSIONS: The incidence of H. pylori in patients with bleeding peptic ulcer is underestimated and many infected patients do not receive eradication treatment. Rebleeding is largely preventable if more attention is given to diagnosis and treatment of H. pylori and follow-up of treatment with a urea breath test.

Functional comparison of spleen dendritic cells and dendritic cells cultured in vitro from bone marrow precursors.

We have compared dendritic cells (DC) isolated from mouse spleen, or generated in vitro from bone marrow (BM) precursors cultured in granulocyte macrophage-colony stimulating factor (GM-CSF) and interleukin-4 (IL-4), for the ability to process and present soluble antigen and stimulate major histocompatibility complex (MHC) Class II-restricted T cells. DC from spleen or BM cultures were equally able to stimulate the in vitro proliferation of allogeneic T cells or of antigen-specific T-cell receptor (TCR)-transgenic T cells. Both DC populations also induced comparable levels of IL-2 secretion by a T-cell hybridoma. Therefore, splenic and BM-derived DC express comparable levels of (Antigen + MHC Class II) ligands and/or costimulatory molecules and have comparable ability to stimulate T-cell responses. When presentation of a native protein antigen, rather than peptide, was evaluated, BM-derived DC were at least 50 times better than splenic DC at stimulating the proliferation of TCR-transgenic T cells. The antigen processing ability of the two populations was similar only when splenic DC were used immediately ex vivo. Therefore, unlike spleen DC, BM-derived DC maintain the capacity to process protein antigen for MHC Class II presentation during in vitro culture. Due to these characteristics, BM-derived DC may represent a useful tool in immunotherapy studies, as they combine high T-cell stimulatory properties with the capacity to process and present native antigen.