R B Freeman

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..5. Liver allocation for HCC candidates in the context of increasing HCC prevalence requires better and evidence-based prioritization policies...

..Although there are many areas for improvement, which will be addressed in future refinements, the new US liver allocation plan has provided a more objective, patient-specific system to better rank waiting liver transplant candidates...

..In conclusion, current imaging requirements for RS prior to liver transplantation are unacceptably inaccurate. Future policy should require more accurate modalities or combinations of techniques...

..Children younger than 2 years, however, still have a considerably higher rate of death on the waiting list than adults. A limited definition of ECD livers suggests that they are used more frequently for patients with lower MELD scores...

..The high bioavailability and convenient dosing formulation make valganciclovir an attractive option for these indications...

..Although recipients with MELD scores in the highest quartile have reduced survival compared with other quartiles, their 1-year survival rate is acceptable when their extreme risk of dying without a transplant is taken into consideration...

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..Cytomegalovirus (CMV) D+/R- solid-organ transplant (SOT) recipients carry increased risk of developing CMV disease; however, other risk factors in these patients have not been delineated...

..Survival rates have increased over time. Small children waiting for intestine grafts continue to have the highest waiting list mortality...

..Liver transplant candidates with HCC may be prioritized using a risk score analogous to the MELD score...

..It is hoped that through continued data collection and assessment, a consensus can be reached to further optimize the use of deceased donors in HCC recipients...

..We conclude that a continuous medical urgency score system allocates donor livers much more fairly to those in medical need and reduces waiting list mortality without sacrificing efficacy...

..CONCLUSIONS: Living-donor liver transplantation should confer a substantial survival advantage for patients with compensated cirrhosis and non-resectable early stage hepatocellular carcinoma...

..Waiting time and center transplant rates should not influence liver allocation policy...

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..Oral VGC delivers systemic GCV exposure equivalent to that of standard oral GCV (at 450 mg) or i.v. GCV (at 900 mg of VGC). VGC has promise for effective CMV prophylaxis or treatment with once-daily oral dosing in transplant recipients...

..Overall, there is strong support within the ASTS membership for changes to NOTA that would permit the implementation and careful evaluation of indirect, government-regulated strategies to increase organ donation...

..Recommendations for the transplant community, based on the analysis of the MELD data, were discussed and are presented in the summary document...

..We offer alternative policy options to address some of the unmet needs and issues that were brought to light during this interesting process...

..Although cytokines play a pivotal role in the inflammatory responses that mediate the severity of acute renal failure (ARF), the importance of pro- and anti-inflammatory cytokine gene promoter polymorphisms has been unexplored...

..Identification of predictors of survival at the time of listing for transplantation might lead to better resource allocation...

..68). In conclusion, liver allocation within the Status 1 designation may need to be further stratified by diagnosis, and MELD score may be useful for prioritizing FHF-NA candidates...

..Application of such risk models provides an evidenced-based approach on which to base further refinements and improve the model...

..Our regional analysis highlights the high degree of variability of hospital DCD policies, which may contribute to misunderstanding and confusion among providers and patients that may influence acceptance of this mode of donation...

..To ensure that these patients have a fair opportunity to receive a cadaveric organ, HCC-specific scores predicted by our model could be added to MELD scores of patients with HCC...

..As the demand for organs rises relentlessly, more research must be devoted to understanding how to make the marginal donor organs function better...

..We hypothesized that donor postextubation parameters, including duration and severity of hemodynamic instability or hypoxia might be a better predictor of subsequent graft function...

..These comparisons can be helpful for informing patients and guiding future policy development...

..Our objective was to determine whether fetal cells participate in the response to specific murine post-partum hepatic injuries...

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..Enlarging liver distribution units likely will result in significant shifts in organs across current OPO boundaries, which will have a significant impact on the activity of many transplant centers...

..At less advanced MELD scores, the survival benefit depends on the risk of PGF associated with the ECD organ...

..Early histologic evidence suggests that there is severe hepatocyte and biliary cell disruption in our DCD model. Further research using this model may provide a deeper understanding of the pathophysiology of the DCD liver...

..This review focuses on the immunosuppressive and inflammatory mechanisms that have been attributed to CMV and will relate them to some of the clinical sequellae that have been associated with the indirect effects of CMV infection...

..These issues are critically important to maximize the use of donated organs but also minimize recipient morbidity and graft dysfunction...

..Recipients with identified risk factors may be candidates for prophylactic treatment and should be followed more intensively after liver transplantation...

..With 1 year post-transplant follow-up, patients at lower risk of pre-transplant death do not have a demonstrable survival benefit from liver transplant...

..The cause of these results, however, remains obscure with the need for a more in-depth confirmation of these findings readily apparent...

..This article details the data reviewed by the liver committee and their recommendations on policy development for the expanded application of split-liver transplantation...

..9%, p<0.0001). Demographics did not differ among regions requesting non-REDs.Widespread regional variations exist in the handling of requests for non-REDs. These variations point to the need for reform to standard exception criteria...

..Furthermore, these analyses will serve to support future developments of prospective clinical trials. ..