Faculty Bibliography

The inequality between supply of grafts and demand for transplants has forced the transplant community to devise ways to increase the number of available livers for transplant (ie, through use of extended criteria donor grafts and living donation). Since 2002, the number of live donor liver transplantations (LDLT) performed has declined due to concerns of donor safety and lack of clear outcome data establishing success equivalent to that of deceased donor liver transplantation (DDLT). Recent data suggest that LDLT outcomes are comparable with those of DDLT, provided a center has performed more than 20 procedures, both in patients with and without hepatitis C. Further studies are needed to define the optimal donor and the ideal recipient for LDLT. Results from a National Institutes of Health-funded consortium of nine transplant centers are highly anticipated. These data are expected to underscore the viability of LDLT as a life-saving therapy for certain patients with end-stage liver disease.

Hepatitis B affects approximately 350 million people worldwide, and an estimated 1.25 million people in the United States. Although most people infected with the virus do not develop significant hepatic disease from hepatitis B, 15-40% will develop serious complications. These complications include cirrhosis, the development of hepatocellular carcinoma , and hepatic decompensation. Patients with renal failure have increased risk of acquiring the virus through blood transfusions and contact with bodily fluids at hemodialysis centers, and of developing complications from hepatitis B virus infection. Renal transplant patients are at increased risk for exacerbations of hepatitis B with immunosuppression. Thus, it is crucial for the nephrologist to have a clear understanding of the natural history and treatment of hepatitis B, both pre- and post-renal transplant.