ABSTRACT
Current literature and policy in pediatric liver allocation and organ procurement are reviewed here in narrative fashion, highlighting historical context, ethical framework, technical/procurement considerations, and support for a logical way forward to an equitable pediatric liver allocation system that will improve pediatric wait-list and posttransplant outcomes without adversely affecting adults. Where available, varying examples of successful international pediatric liver allocation and split-liver policy will be compared to current US policy to highlight potential strategies that can be considered globally. Liver Transplantation 23:86-95 2017 AASLD.
Subject(s)
End Stage Liver Disease/surgery , Liver Transplantation/legislation & jurisprudence , Patient Selection/ethics , Tissue and Organ Harvesting/legislation & jurisprudence , Tissue and Organ Procurement/legislation & jurisprudence , Waiting Lists/mortality , Adult , Allografts/standards , Brazil , Canada , Child , End Stage Liver Disease/mortality , Europe , Graft Survival , Health Policy , Humans , International Cooperation/legislation & jurisprudence , Liver Transplantation/ethics , Liver Transplantation/trends , Severity of Illness Index , Tissue and Organ Harvesting/ethics , Tissue and Organ Harvesting/methods , Tissue and Organ Harvesting/trends , Tissue and Organ Procurement/ethics , Tissue and Organ Procurement/methods , Tissue and Organ Procurement/trends , United StatesABSTRACT
Se han indicado diferentes procedimientos quirúrgicos para la preservación y aumento del reborde alveolar, así como para el tratamiento de recesiones gingivales e incremento de la amplitud de la encía adherida, alrededor de dientes naturales e implantes. Cuando se utilizan injertos autógenos en estas intervenciones se evidencian algunas desventajas que incluyen la inconformidad asociada con un sitio quirúrgico adicional y la disponibilidad limitada de tejido donante. Recientemente, se utilizan aloinjertos de matriz dérmica acelular como sustitutos de los injertos autógenos en cirugía plástica periodontal. La matriz dérmica es un aloinjerto libre de células obtenido de la piel humana, bioestructuralmente compuesto por membrana basal y matriz extracelular que actúa como una matriz que permite la neovascularización, y proliferación de fibroblastos y células epiteliales En esta serie de casos, se presentan tres aplicaciones quirúrgicas de la matriz dérmica: cubrimiento de recesiones gingivales, manejo de dehiscencias sobre implantes y aumento de reborde alveolar(AU)
Several surgical procedures have been indicated for the preservation and increase of the alveolar ridge, and for the treatment of gingival recessions so to increase the width of attached gingiva around natural teeth or implants. The disadvantages of harvesting autogenous grafts on these procedures lie in the postoperative discomfort associated with an extra surgical site, as well as the limitation of available donor tissues. Recently, an acellular dermal matrix allograft has been approved as substitutes for autogenous grafts in periodontal plastic surgery. Dermal matrix allograft are free cells obtained from human skin, bioestructuraly formed by basement membrane and extracellular matrix that act as a matrix that allow the revascularization and proliferation of fibroblasts and epithelial cells. In this series case, we present three surgical applications of the dermal matrix: coverage of gingival recessions, management of implant dehiscence and alveolar ridge augmentation(AU)