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Albaiz FA, Semenchuk J, Ma X, Lightfoot D, Gonska T, Tullis E, Stephenson AL. Clinical outcomes after liver transplant in people with cystic fibrosis: A systematic review and meta-analysis. J Cyst Fibros 2024:S1569-1993(24)00781-1. [PMID: 38942722 DOI: 10.1016/j.jcf.2024.06.012] [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: 03/05/2024] [Revised: 06/21/2024] [Accepted: 06/22/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Data on the impact of liver transplantation (LT) in cystic fibrosis (CF) on lung function and exacerbations are limited. The objective of this study was to summarize the literature on lung function, nutritional status, survival, and complications following LT in people with CF. METHODS Three databases were searched until September 2023, to identify the impact of LT in CF. Lung transplant prior to LT and simultaneous liver-lung transplant were excluded. Pooled hazard ratios were calculated using random-effects models. RESULTS Thirty studies were included in this review, with 3 and 9 studies included in meta-analyses for nutritional status and lung function, respectively. Eighty-three percent of the studies used data that was more than a decade old. There was a significant increase in percent-predicted forced expiratory volume with mean change of 7.16 % (2.13, 12.19; p = 0.005) one year post-LT. Pulmonary exacerbations decreased in the short-term, however there was no significant change in body mass index (BMI). One-year survival post-LT ranged between 75 and 100 %, while five-year survival was lower at 64-89 %. CONCLUSION Existing data suggest that LT improves lung function in the short term and does not increase the likelihood of pulmonary exacerbations, despite ongoing immunosuppression in the setting of chronic lung infection.
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Affiliation(s)
- Faisal A Albaiz
- Division of Respirology, St. Michael's Hospital, University of Toronto, Ontario, Canada; Organ Transplant Centre of Excellence, Lung Health Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Julie Semenchuk
- Division of Respirology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Xiayi Ma
- Division of Respirology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - David Lightfoot
- St Michael's Health Sciences Library, St Michael's Hospital, Toronto, Ontario, Canada
| | - Tanja Gonska
- The Hospital for Sick Children, Division of Gastroenterology, Toronto, Ontario, Canada
| | - Elizabeth Tullis
- Division of Respirology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Anne L Stephenson
- Division of Respirology, St. Michael's Hospital, University of Toronto, Ontario, Canada.
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2
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Palaniappan SK, Than NN, Thein AW, van Mourik I. Interventions for preventing and managing advanced liver disease in cystic fibrosis. Cochrane Database Syst Rev 2020; 3:CD012056. [PMID: 32227478 PMCID: PMC7104612 DOI: 10.1002/14651858.cd012056.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cystic fibrosis is an autosomal recessive inherited defect in the cystic fibrosis transmembrane conductance regulator (CFTR) gene resulting in abnormal regulation of salt and water movement across the membranes. In the liver this leads to focal biliary fibrosis resulting in progressive portal hypertension and end-stage liver disease in some individuals. This can be asymptomatic, but may lead to splenomegaly and hypersplenism, development of varices and variceal bleeding, and ascites; it has negative impact on overall nutritional status and respiratory function in this population. Prognosis is poor once significant portal hypertension is established. The role and outcome of various interventions for managing advanced liver disease (non-malignant end stage disease) in people with cystic fibrosis is currently unidentified. This is an updated version of a previously published review. OBJECTIVES To review and assess the efficacy of currently available treatment options for preventing and managing advanced liver disease in children and adults with cystic fibrosis. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of last search: 19 November 2019. We also searched the reference lists of relevant articles and reviews and online trials registries. Date of last search: 01 January 2020. SELECTION CRITERIA Any published and unpublished randomised controlled trials and quasi-randomised controlled trials of advanced liver disease in cystic fibrosis with cirrhosis or liver failure, portal hypertension or variceal bleeding (or both). DATA COLLECTION AND ANALYSIS Authors independently examined titles and abstracts to identify potentially relevant trials, but none were eligible for inclusion in this review. MAIN RESULTS A comprehensive search of the literature did not identify any published eligible randomised controlled trials. AUTHORS' CONCLUSIONS In order to develop the best source of evidence, there is a need to undertake randomised controlled trials of interventions for preventing and managing advanced liver disease in adults and children with cystic fibrosis.
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Affiliation(s)
- Senthil K Palaniappan
- NHS trustDepartment of Medicine, University Hospitals of LeicesterLeicester Royal InfirmaryLeicesterUKLE1 5WW
| | - Nan Nitra Than
- Faculty of Medicine, Melaka‐Manipal Medical College (MMMC), Manipal Academy of Higher Education(MAHE)Department of Community MedicineMelakaMalaysia75150
| | - Aung Win Thein
- Melaka‐Manipal Medical CollegeDepartment of SurgeryJalan Batu Hampar, Bukit BaruMelakaMelakaMalaysia75150
| | - Indra van Mourik
- Birmingham Children's HospitalLiver UnitSteelhouse LaneBirminghamUKB4 6NH
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3
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Palaniappan SK, Than NN, Thein AW, Moe S, van Mourik I. Interventions for preventing and managing advanced liver disease in cystic fibrosis. Cochrane Database Syst Rev 2017; 8:CD012056. [PMID: 28850173 PMCID: PMC6483789 DOI: 10.1002/14651858.cd012056.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Cystic fibrosis is an autosomal recessive inherited defect in the cystic fibrosis transmembrane conductance regulator (CFTR) gene resulting in abnormal regulation of salt and water movement across the membranes. In the liver this leads to focal biliary fibrosis resulting in progressive portal hypertension and end-stage liver disease in some individuals. This can be asymptomatic, but may lead to splenomegaly and hypersplenism, development of varices and variceal bleeding, and ascites; it has negative impact on overall nutritional status and respiratory function in this population. Prognosis is poor once significant portal hypertension is established. The role and outcome of various interventions for managing advanced liver disease (non-malignant end stage disease) in people with cystic fibrosis is currently unidentified. OBJECTIVES To review and assess the efficacy of currently available treatment options for preventing and managing advanced liver disease in children and adults with cystic fibrosis. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books.Date of last search: 06 April 2017.We also searched the reference lists of relevant articles and reviews and online trials registries. Date of last search: 04 January 2017. SELECTION CRITERIA Any published and unpublished randomised controlled trials and quasi-randomised controlled trials of advanced liver disease in cystic fibrosis with cirrhosis or liver failure, portal hypertension or variceal bleeding (or both). DATA COLLECTION AND ANALYSIS Authors independently examined titles and abstracts to identify potentially relevant trials, but none were eligible for inclusion in this review. MAIN RESULTS A comprehensive search of the literature did not identify any published eligible randomised controlled trials. AUTHORS' CONCLUSIONS In order to develop the best source of evidence, there is a need to undertake randomised controlled trials of interventions for preventing and managing advanced liver disease in adults and children with cystic fibrosis.
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Affiliation(s)
- Senthil K Palaniappan
- NHS trustDepartment of Medicine, University Hospitals of LeicesterLeicester Royal InfirmaryLeicesterUKLE1 5WW
| | - Nan Nitra Than
- Faculty of MedicineDepartment of Community MedicineMelaka‐Manipal Medical College (MMMC)Jalan Batu HamparMelakaMalaysia75150
| | - Aung Win Thein
- Melaka‐Manipal Medical CollegeDepartment of SurgeryJalan Batu Hampar, Bukit BaruMelakaMalaysia75150
| | - Soe Moe
- Faculty of MedicineDepartment of Community MedicineMelaka‐Manipal Medical College (MMMC)Jalan Batu HamparMelakaMalaysia75150
| | - Indra van Mourik
- Birmingham Children's HospitalLiver UnitSteelhouse LaneBirminghamUKB4 6NH
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4
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Parisi GF, Di Dio G, Franzonello C, Gennaro A, Rotolo N, Lionetti E, Leonardi S. Liver disease in cystic fibrosis: an update. HEPATITIS MONTHLY 2013; 13:e11215. [PMID: 24171010 PMCID: PMC3810678 DOI: 10.5812/hepatmon.11215] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 06/16/2013] [Accepted: 08/05/2013] [Indexed: 12/11/2022]
Abstract
CONTEXT Cystic fibrosis (CF) is the most widespread autosomal recessive genetic disorder that limits life expectation amongst the Caucasian population. As the median survival has increased related to early multidisciplinary intervention, other manifestations of CF have emerged especially for the broad spectrum of hepatobiliary involvement. The present study reviews the existing literature on liver disease in cystic fibrosis and describes the key issues for an adequate clinical evaluation and management of patients, with a focus on the pathogenetic, clinical and diagnostic-therapeutic aspects of liver disease in CF. EVIDENCE ACQUISITION A literature search of electronic databases was undertaken for relevant studies published from 1990 about liver disease in cystic fibrosis. The databases searched were: EMBASE, PubMed and Cochrane Library. RESULTS CF is due to mutations in the gene on chromosome 7 that encodes an amino acidic polypeptide named CFTR (cystic fibrosis transmembrane regulator). The hepatic manifestations include particular changes referring to the basic CFTR defect, iatrogenic lesions or consequences of the multisystem disease. Even though hepatobiliary disease is the most common non-pulmonary cause of mortality in CF (the third after pulmonary disease and transplant complications), only about the 33%of CF patients presents clinically significant hepatobiliary disease. CONCLUSIONS Liver disease will have a growing impact on survival and quality of life of cystic fibrosis patients because a longer life expectancy and for this it is important its early recognition and a correct clinical management aimed at delaying the onset of complications. This review could represent an opportunity to encourage researchers to better investigate genotype-phenotype correlation associated with the development of cystic fibrosis liver disease, especially for non-CFTR genetic polymorphisms, and detect predisposed individuals. Therapeutic trials are needed to find strategies of fibrosis prevention and to avoid its progression prior to development its related complications.
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Affiliation(s)
- Giuseppe Fabio Parisi
- Department of Medical and Pediatric Science, Bronchopneumology and Cystic Fibrosis Unit, University of Catania, Catania, Italy
| | - Giovanna Di Dio
- Department of Medical and Pediatric Science, Bronchopneumology and Cystic Fibrosis Unit, University of Catania, Catania, Italy
| | - Chiara Franzonello
- Department of Medical and Pediatric Science, Bronchopneumology and Cystic Fibrosis Unit, University of Catania, Catania, Italy
| | - Alessia Gennaro
- Department of Medical and Pediatric Science, Bronchopneumology and Cystic Fibrosis Unit, University of Catania, Catania, Italy
| | - Novella Rotolo
- Department of Medical and Pediatric Science, Bronchopneumology and Cystic Fibrosis Unit, University of Catania, Catania, Italy
| | - Elena Lionetti
- Department of Medical and Pediatric Science, Bronchopneumology and Cystic Fibrosis Unit, University of Catania, Catania, Italy
| | - Salvatore Leonardi
- Department of Medical and Pediatric Science, Bronchopneumology and Cystic Fibrosis Unit, University of Catania, Catania, Italy
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5
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Miller MR, Sokol RJ, Narkewicz MR, Sontag MK. Pulmonary function in individuals who underwent liver transplantation: from the US cystic fibrosis foundation registry. Liver Transpl 2012; 18:585-93. [PMID: 22271602 DOI: 10.1002/lt.23389] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Severe liver disease affects 4.5% to 10% of individuals with cystic fibrosis (CF) and is the third-leading cause of death. Liver transplantation (LT) is an accepted therapy, but the effects of liver disease and LT on pulmonary function in patients with CF are controversial. Our aim was to characterize changes in pulmonary function in LT patients with CF. Using mixed effect models, we analyzed pulmonary function before and after transplantation in 168 LT patients and 840 non-LT patients with CF who were matched by age, sex, pancreatic status, infections with US CF Foundation Patient Registry data (1989-2007). The primary outcome was the change in the forced expiratory volume in 1 second (FEV(1); percent predicted) in LT and non-LT in the 3-years periods before or after transplantation; second we compared FEV(1) changes. In the 3 years before transplantation, LT had lower initial FEV(1) values (71.5% ± 1.9%, P < 0.001) and a slower decline (+0.1% ± 0.4%/year, P < 0.001) than non-LT (79.6% ± 1.3% and -1.3% ± 0.2%/year, respectively). There was no difference in the FEV(1) decline after transplantation (-1.4% ± 0.4%/year for LT versus -2.1% ± 0.2%/year for non-LT, P = 0.14). Both the (P = 0.003) and (P = 0.001) had a slower FEV(1) decline in the period before transplantation versus after transplantation. In conclusion, pulmonary function is lower and declines more slowly in patients with CF before LT versus, but parallels the decline in non-LT after transplantation. LT is neither beneficial nor detrimental to pulmonary function in CF but returns FEV(1) decline to the same trajectory found for matched non-LT individuals with CF.
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Affiliation(s)
- Melissa R Miller
- Colorado School of Public Health at University of Colorado Denver, Aurora, CO, USA
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6
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Dowman JK, Watson D, Loganathan S, Gunson BK, Hodson J, Mirza DF, Clarke J, Lloyd C, Honeybourne D, Whitehouse JL, Nash EF, Kelly D, van Mourik I, Newsome PN. Long-term impact of liver transplantation on respiratory function and nutritional status in children and adults with cystic fibrosis. Am J Transplant 2012; 12:954-64. [PMID: 22225648 DOI: 10.1111/j.1600-6143.2011.03904.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Early liver transplant (LT) has been advocated for patients with cystic fibrosis liver disease (CFLD) and evidence of deterioration in nutritional state and respiratory function to prevent further decline. However, the impact of single LT on long-term respiratory function and nutritional status has not been adequately addressed. We performed a retrospective analysis of the outcomes of 40 (21 adult/19 pediatric) patients with CFLD transplanted between 1987 and 2009 with median follow-up of 47.8 months (range 4-180). One and five-year actuarial survival rates were 85%/64% for adult and 90%/85% for pediatric LT cohorts, respectively. Lung function remained stable until 4 years (FEV(1) % predicted; pretransplant 48.4% vs. 45.9%, 4 years posttransplant) but declined by 5 years (42.4%). Up to 4 years posttransplant mean annual decline in FEV(1) % was lower (0.74%; p = 0.04) compared with the predicted 3% annual decline in CF patients with comorbidity including diabetes. Number of courses of intravenous antibiotics was reduced following LT, from 3.9/year pretransplant to 1.1/year, 5 years posttransplant. Body mass index was preserved posttransplant; 18.0 kg/m(2) (range 15-24.3) pretransplant versus 19.6 kg/m(2) (range 16.4-22.7) 5 years posttransplant. In conclusion, LT is an effective treatment for selected patients with cirrhosis due to CFLD, stabilizing aspects of long-term lung function and preserving nutritional status.
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Affiliation(s)
- J K Dowman
- Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK.
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7
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Picard C. [The lungs and immunosuppressants: practical problems]. REVUE DE PNEUMOLOGIE CLINIQUE 2011; 67:226-232. [PMID: 21920282 DOI: 10.1016/j.pneumo.2011.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 03/29/2011] [Indexed: 05/31/2023]
Abstract
With a growing number of patients receiving immunosuppressive drugs, lung specialists are faced with new problems. This review addresses: 1: specific interactions between some pre-existing respiratory diseases (asthma, bronchiectasis, infiltrative lung disease, repeated pneumonia, etc) and immunosuppressants; 2: some particular issues in the care of respiratory complications (infections, thoracic surgery, neoplasia, thromboembolism, etc) in patients undergoing immunosuppressive treatment.
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Affiliation(s)
- C Picard
- Service de Pneumologie et Transplantation Pulmonaire, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
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Mendizabal M, Reddy KR, Cassuto J, Olthoff KM, Faust TW, Makar GA, Rand EB, Shaked A, Abt PL. Liver transplantation in patients with cystic fibrosis: analysis of United Network for Organ Sharing data. Liver Transpl 2011; 17:243-50. [PMID: 21384506 DOI: 10.1002/lt.22240] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The improved life expectancy of patients with cystic fibrosis (CF) has led to a change in the impact of liver disease on the prognosis of this population. Liver transplantation has emerged as the procedure of choice for patients with CF and features of hepatic decompensation and for intractable variceal bleeding as a major manifestation. We retrospectively reviewed the United Network for Organ Sharing database to analyze the outcomes of 55 adults and 148 children with CF who underwent liver transplantation, and we compared them to patients who underwent transplantation for other etiologies. We additionally compared the benefits of liver transplantation among patients who underwent transplantation for cystic fibrosis-related liver disease (CFLD) and those who remained on the waiting list. The 5-year survival rates for children and adults undergoing liver transplantation were 85.8% and 72.7%, respectively (P = 0.016). A multivariate Cox regression analysis comparing pediatric and adult CF patients to patients who underwent transplantation for other etiologies noted lower 5-year survival rates (P < 0.0001). However, compared to those remaining on the waiting list, pediatric transplant recipients with CF (hazard ratio = 0.33, 95% confidence interval = 0.16-0.70, P = 0.004) and adult transplant recipients with CF (hazard ratio = 0.25, 95% confidence interval = 0.11-0.57, P = 0.001) gained a significant survival benefit. In conclusion, long-term outcomes in patients with CFLD are acceptable but are inferior in comparison with the outcomes of those undergoing transplantation for other etiologies. Despite such observations, a survival benefit was noted in transplant patients versus those who remained on the waiting list.
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Affiliation(s)
- Manuel Mendizabal
- Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Argentina.
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9
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Current status of and prospects for the English medical journal Surgery Today. Surg Today 2010; 40:1101-4. [PMID: 21110151 DOI: 10.1007/s00595-010-4396-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Gursoy S, Ozturk AA, Ucvet A, Erbaycu AE. Surgical management of bronchiectasis: The indications and outcomes. Surg Today 2009; 40:26-30. [DOI: 10.1007/s00595-009-4013-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Accepted: 04/16/2009] [Indexed: 11/29/2022]
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11
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Huffmyer JL, Littlewood KE, Nemergut EC. Perioperative Management of the Adult with Cystic Fibrosis. Anesth Analg 2009; 109:1949-61. [PMID: 19923526 DOI: 10.1213/ane.0b013e3181b845d0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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12
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Faraj W, Marangoni G, Dar F, Mukherji D, Heaton N, Muiesan P. Liver transplantation from a non-heart-beating donor after pulmonary failure: report of a case. Surg Today 2009; 39:913-5. [PMID: 19784735 DOI: 10.1007/s00595-008-3950-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 08/10/2008] [Indexed: 11/24/2022]
Abstract
We report a case of successful liver transplantation after controlled donor after cardiac death procurement from a donor who died of pulmonary failure. The donor was a 28-year-old woman with idiopathic pulmonary fibrosis, whose life support could not continue when her condition deteriorated rapidly while waiting for a suitable donor for lung transplantation. She was on noninvasive negative pressure ventilatory support before the donor organs were procured.
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Affiliation(s)
- Walid Faraj
- King's College London School of Medicine at King's College Hospital, Institute of Liver Studies, Denmark Hill, Camberwell, London SE5 9RS, UK
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Gordon Burroughs S, Busuttil RW. Optimal utilization of extended hepatic grafts. Surg Today 2009; 39:746-51. [PMID: 19779769 DOI: 10.1007/s00595-008-4022-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 07/09/2008] [Indexed: 12/22/2022]
Abstract
Orthotopic liver transplantation has emerged as the standard treatment for end-stage liver disease. In the United States, the number of listed patients has tripled in the last two decades. Organ availability during the same period has plateaued at approximately 6000 grafts annually, resulting in a fivefold increase in wait-list mortality. The problem is not specific to the United States; European and Asian registries report similar shortages. Donor pool expansion strategies such as the use of living donors, cadaveric split livers, and "extended criteria donors"; (ECD) are being pursued. Used judiciously, ECD grafts provide an opportunity for addressing the shortage. Although there is no universally accepted definition of ECD, the term generally refers to donor factors predisposing recipients to poor initial graft function and/or increased long-term risk. These factors include advanced donor age, hypernatremia, prolonged warm ischemic time, pressor requirement, and donation after cardiac death. The transplant community is scrutinizing all factors to evaluate the degree of risk they impart on the recipient and the extent to which grafts can be "matched"; to maintain acceptable outcomes. We review the importance of selected factors and the impact of a "matching"; strategy to minimize recipient risk while optimizing graft use.
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Affiliation(s)
- Sherilyn Gordon Burroughs
- Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA 90095-7054, USA
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14
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Abstract
PURPOSE OF REVIEW This review explores the recent advances in knowledge regarding hepatobiliary disease in patients with cystic fibrosis. RECENT FINDINGS Hepatobiliary abnormalities associated with cystic fibrosis are varied in nature and range from defects attributable to the underlying genetic defect to those related to systemic disease and malnutrition. Novel research into the underlying pathogenesis of cystic fibrosis liver disease and the primary role of cystic fibrosis transmembrane conductance regulator in biliary secretory epithelium is presented. This work has been fostered by the development of new animal models of cystic fibrosis transmembrane conductance regulator dysfunction. Of the wide range of hepatobiliary complications associated with cystic fibrosis the most clinically relevant problem is progression of focal biliary cirrhosis to multilobular cirrhosis with its attendant complications of portal hypertension and potentially end-stage liver disease. However, recent studies suggest that liver transplantation may not improve survival in patients with cystic fibrosis and significant portal hypertension. SUMMARY Hepatobiliary disease is a common finding in patients with cystic fibrosis; the pathogenesis is multifactorial in nature. As new therapeutic strategies emerge, life expectancy will continue to increase as will the impact of liver disease on quality of life and survival of patients with cystic fibrosis. This review will discuss novel insights into pathogenesis as well as diagnostic and management options.
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