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Feng S, Roll GR, Rouhani FJ, Sanchez Fueyo A. The future of liver transplantation. Hepatology 2024:01515467-990000000-00817. [PMID: 38537154 DOI: 10.1097/hep.0000000000000873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/02/2024] [Indexed: 06/15/2024]
Abstract
Over the last 50 years, liver transplantation has evolved into a procedure routinely performed in many countries worldwide. Those able to access this therapy frequently experience a miraculous risk-benefit ratio, particularly if they face the imminently life-threatening disease. Over the decades, the success of liver transplantation, with dramatic improvements in early posttransplant survival, has aggressively driven demand. However, despite the emergence of living donors to augment deceased donors as a source of organs, supply has lagged far behind demand. As a result, rationing has been an unfortunate focus in recent decades. Recent shifts in the epidemiology of liver disease combined with transformative innovations in liver preservation suggest that the underlying premise of organ shortage may erode in the foreseeable future. The focus will sharpen on improving equitable access while mitigating constraints related to workforce training, infrastructure for organ recovery and rehabilitation, and their associated costs. Research efforts in liver preservation will undoubtedly blossom with the aim of optimizing both the timing and conditions of transplantation. Coupled with advances in genetic engineering, regenerative biology, and cellular therapies, the portfolio of innovation, both broad and deep, offers the promise that, in the future, liver transplantation will not only be broadly available to those in need but also represent a highly durable life-saving therapy.
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Affiliation(s)
- Sandy Feng
- Department of Surgery, Division of Transplant Surgery, University of California, San Francisco, California, USA
| | - Garrett R Roll
- Department of Surgery, Division of Transplant Surgery, University of California, San Francisco, California, USA
| | - Foad J Rouhani
- Tissue Regeneration and Clonal Evolution Laboratory, The Francis Crick Institute, London, UK
- Institute of Liver Studies, King's College London, King's College Hospital, NHS Foundation Trust, London, UK
| | - Alberto Sanchez Fueyo
- Institute of Liver Studies, King's College London, King's College Hospital, NHS Foundation Trust, London, UK
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Cattral MS, Ghanekar A, Selzner N. Anonymous Living Donor Liver Transplantation: The Altruistic Strangers. Gastroenterology 2023; 165:1315-1317. [PMID: 37659671 DOI: 10.1053/j.gastro.2023.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/07/2023] [Accepted: 08/13/2023] [Indexed: 09/04/2023]
Affiliation(s)
- Mark S Cattral
- Ajmera Transplant Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Anand Ghanekar
- Ajmera Transplant Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nazia Selzner
- Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Feldman AG, Adams M, Griesemer AD, Horslen S, Kelly B, Mavis AM, Mazariegos GV, Ng VL, Perito ER, Rodriguez-Davalos MI, Squires JE, Tiao G, Yanni GS, Hsu EK. Advancing the Field of Pediatric Liver Transplantation: Urgent Action Items Identified During the 2022 Society of Pediatric Liver Transplantation Meeting. Transplantation 2023; 107:1223-1225. [PMID: 37220339 DOI: 10.1097/tp.0000000000004584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Amy G Feldman
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, The University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO
| | - Megan Adams
- Department of Surgery, Colorado Center for Transplantation Care, Research and Education, The University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO
| | | | - Simon Horslen
- Division of Gastroenterology, Hepatology and Nutrition, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | | | - Alisha M Mavis
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Duke University, Durham, NC
| | - George V Mazariegos
- Department of Surgery, Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Vicky L Ng
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Emily R Perito
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Manuel I Rodriguez-Davalos
- Transplant and Hepatobiliary Surgery, Primary Children's Hospital- Intermountain Healthcare; University of Utah, Salt Lake City, Utah
| | - James E Squires
- Division of Gastroenterology, Hepatology and Nutrition, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Greg Tiao
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - George S Yanni
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Los Angeles, The Keck USC School of Medicine, Los Angeles, CA
| | - Evelyn K Hsu
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
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Yoeli D, Adams MA, Pomfret EA. The current landscape of pediatric living donor liver transplantation in the United States: Benefits, challenges, and future directions. Clin Liver Dis (Hoboken) 2023; 21:107-110. [PMID: 37197222 PMCID: PMC10184998 DOI: 10.1097/cld.0000000000000036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/14/2023] [Indexed: 05/19/2023] Open
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Liapakis A, Agbim U, Bittermann T, Dew MA, Deng Y, Gan G, Emre S, Hunt HF, Olthoff KM, Locke JE, Jesse MT, Kumar V, Pillai A, Verna E, Lentine KL. A survey of transplant providers regarding attitudes, barriers, and facilitators to living donor liver transplantation in the United States. Clin Transplant 2023:e14967. [PMID: 36938716 DOI: 10.1111/ctr.14967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/24/2023] [Accepted: 03/05/2023] [Indexed: 03/21/2023]
Abstract
INTRODUCTION A successful living donor liver transplant (LDLT) is the culmination of a multifaceted process coordinated among key stakeholders. METHODS We conducted an electronic survey of US liver transplant (LT) centers (August 26, 2021-October 10, 2021) regarding attitudes, barriers, and facilitators of LDLT to learn how to expand LDLT safely and effectively in preparation for the American Society of Transplantation Living Donor Liver Transplant Consensus Conference. RESULTS Responses were received from staff at 58 programs (40.1% of US LT centers). There is interest in broadening LDLT (100% of LDLT centers, 66.7% of non-LDLT centers) with high level of agreement that LDLT mitigates donor shortage (93.3% of respondents) and that it should be offered to all suitable candidates (87.5% of respondents), though LDLT was less often endorsed as the best first option (29.5% of respondents). Key barriers at non-LDLT centers were institutional factors and surgical expertise, whereas those at LDLT centers focused on waitlist candidate and donor factors. Heterogeneity in candidate selection for LDLT, candidate reluctance to pursue LDLT, high donor exclusion rate, and disparities in access were important barriers. CONCLUSION Findings from this study may help guide current and future expansion of LDLT more efficiently in the US. These efforts require clear and cohesive messaging regarding LDLT benefits, engagement of the public community, and dedicated resources to equitably increase LDLT access.
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Affiliation(s)
- AnnMarie Liapakis
- Department of Medicine, Yale University, New Haven, Connecticut, USA
| | - Uchenna Agbim
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri, USA
| | | | | | - Yanhong Deng
- Yale Center for Analytical Sciences, New Haven, Connecticut, USA
| | - Geliang Gan
- Yale Center for Analytical Sciences, New Haven, Connecticut, USA
| | - Sukru Emre
- Ege University School of Medicine, Izmir, Turkey
| | - Heather F Hunt
- United Network for Organ Sharing, Richmond, Virginia, USA
| | - Kim M Olthoff
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | - Anjana Pillai
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Elizabeth Verna
- Center for Liver Disease and Transplantation, Columbia University, New York, New York, USA
| | - Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri, USA
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Yoeli D, Feldman AG, Choudhury RA, Moore HB, Sundaram SS, Nydam TL, Wachs ME, Pomfret EA, Adams MA, Jackson WE. Can non-directed living liver donation help improve access to grafts and correct socioeconomic disparities in pediatric liver transplantation? Pediatr Transplant 2023; 27:e14428. [PMID: 36329627 PMCID: PMC10132215 DOI: 10.1111/petr.14428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 02/10/2022] [Accepted: 05/05/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Each year, children die awaiting LT as the demand for grafts exceeds the available supply. Candidates with public health insurance are significantly less likely to undergo both deceased donor LT and D-LLD LT. ND-LLD is another option to gain access to a graft. The aim of this study was to evaluate if recipient insurance type is associated with likelihood of D-LLD versus ND-LLD LT. METHODS The SRTR/OPTN database was reviewed for pediatric LDLT performed between January 1, 2014 (Medicaid expansion era) and December 31, 2019 at centers that performed ≥1 ND-LLD LDLT during the study period. A multivariable logistic regression was performed to assess relationship between type of living donor (directed vs. non-directed) and recipient insurance. RESULTS Of 299 pediatric LDLT, 46 (15%) were from ND-LLD performed at 18 transplant centers. Fifty-nine percent of ND-LLD recipients had public insurance in comparison to 40% of D-LLD recipients (p = .02). Public insurance was associated with greater odds of ND-LLD in comparison to D-LLD upon multivariable logistic regression (OR 2.37, 95% CI 1.23-4.58, p = .01). CONCLUSIONS ND-LLD allows additional children to receive LTs and may help address some of the socioeconomic disparity in pediatric LDLT, but currently account for only a minority of LDLT and are only performed at a few institutions. Initiatives to improve access to both D-LLD and ND-LLD transplants are needed.
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Affiliation(s)
- Dor Yoeli
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Abdominal Transplant Surgery, Department of Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Amy G Feldman
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatric Medicine, The Digestive Health Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rashikh A Choudhury
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Hunter B Moore
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Shikha S Sundaram
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatric Medicine, The Digestive Health Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Trevor L Nydam
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Michael E Wachs
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Abdominal Transplant Surgery, Department of Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Elizabeth A Pomfret
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Megan A Adams
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Abdominal Transplant Surgery, Department of Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Whitney E Jackson
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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