The Main thiram Snare

In other parts of the world where deceased donation is non-existent, LDLT is the only option for patients with ESLD. Appropriate size matching of the liver graft from the living donor with the recipient is essential for success with most programs using a cutoff graft weight to recipient weight ratio (GRWR) of 0.8. Successful LDLT has been performed with lower GRWR[80] and there is a resurgence of left lobe grafts in the Western world[81]. Appropriate matching of donors with obese recipients can be especially challenging in the setting of LDLT especially when using the common cutoff of 0.8 for the GRWR. Whether this ratio is appropriate in the setting of obesity has yet to be determined. There are no studies that examine thiram the morbidly obese population, and studies examining LDLT in the setting of obesity are scarce. The largest study by Gunay et al[82] examined 380 patients who underwent LDLT of which 74 were considered obese (BMI �� 30). No patients were morbidly obese (BMI > 40). Although the obese patients had a harder time finding suitable living donors, the complication rate, graft survival, and patient survival were all similar when comparing this website the obese recipients to either the overweight or normal weight recipients[82]. A smaller study of 7 patients with NASH of which 6 of the patients were obese also demonstrated that LDLT was feasible, but again these patients appeared to have a more difficult time identifying suitable donors[83]. Further studies are needed to address long-term outcomes of LDLT and also to further investigate the applicability of a GRWR of �� 0.8 in the setting of morbid obesity. OUR EXPERIENCE WITH MORBID OBESITY AND LIVER TRANSPLANTATION AT OCHSNER MEDICAL CENTER Over the last few years, Ochsner medical center has grown to become one of the largest liver transplant programs in the United States performing 196 liver transplants in 2014. Due to its geographic selleck chemicals llc location in the South Eastern corridor of the United States, the program has a vast experience with liver transplantation of the morbidly obese patient. In our experience, it is important to make sure that the morbidly obese patients are properly cleared from a cardiopulmonary perspective as many of them can have occult coronary disease and/or pulmonary hypertension. From a technical perspective, line placement and exposure during transplant can be challenging and we have moved to using a Thompson retractor with special bariatric blades to aid in exposure. A chart review of primary liver or combined liver-kidney transplants was performed between September 2005 and December 2008 of which 255 adult transplants were identified. A comparison of morbidly obese patients (n = 34) vs a control group (n = 221) of non-morbidly obese patients was performed and several characteristics including 30 d and 1 year graft and patient survival, length of stay, and 30 d re-operation rate were recorded.