1
|
Sato-Espinoza K, Chotiprasidhi P, Liza E, Placido-Damian Z, Diaz-Ferrer J. Evolution of liver transplantation in the metabolic dysfunction-associated steatotic liver disease era: Tracking impact through time. World J Transplant 2024; 14:98718. [DOI: 10.5500/wjt.v14.i4.98718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 08/19/2024] [Accepted: 08/23/2024] [Indexed: 09/20/2024] Open
Abstract
Liver transplantation (LT) for metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing globally due to rising rates of obesity and metabolic syndrome, posing significant challenges. MASLD patients typically present with advanced age, higher body mass index (BMI), and metabolic comorbidities such as diabetes, hypertension, and dyslipidemia. Comprehensive pre-transplant evaluations are crucial for assessing surgical risks and preparing patients for transplantation. MASLD patients with higher BMI may experience longer operative times, potentially affecting intraoperative outcomes. In the months following LT, MASLD recipients face persistent challenges, including a higher incidence of metabolic syndrome and cardiovascular events compared to non-MASLD recipients. However, survival rates at 1-, 3-, and 5-years post-LT do not markedly differ from other etiologies, indicating comparable surgical outcomes. Optimizing outcomes in MASLD patients undergoing LT demands a multidisciplinary approach from pre-transplant assessment to post-transplant care. Strategies must address metabolic comorbidities, manage cardiovascular health, and monitor steatosis recurrence, which can be exacerbated by obesity and diabetes. This approach aims to mitigate long-term graft complications and mortality risks, ultimately enhancing transplant success and patient well-being. Continued research is essential to refine these approaches and meet the evolving challenges posed by MASLD as a leading indication for LT worldwide.
Collapse
Affiliation(s)
- Karina Sato-Espinoza
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55902, United States
| | - Perapa Chotiprasidhi
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55902, United States
| | - Estefanía Liza
- Hepatology Service, Department of Digestive Diseases, Hospital Nacional Edgardo Rebagliati Martins, Lima 15072, Peru
| | - Zuly Placido-Damian
- Hepatology Service, Department of Digestive Diseases, Hospital Nacional Edgardo Rebagliati Martins, Lima 15072, Peru
| | - Javier Diaz-Ferrer
- Hepatology Service, Department of Digestive Diseases, Hospital Nacional Edgardo Rebagliati Martins, Lima 15072, Peru
- Medicine Faculty, Universidad San Martin de Porres, Lima 02002, Peru
- Gastroenterology Service, Clinica Internacional, Lima 02002, Peru
| |
Collapse
|
2
|
Zheng K, Azhie A, You X, Naghibzadeh M, Tan E, Naimimohasses S, Sridhar VS, Gupta S, Chen S, Dash S, Tsien C, Selzner N, Lilly L, Jaeckel E, Woo M, Singh S, Cherney D, Bhat M. Glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors for the treatment of diabetes mellitus in liver transplant recipients. Diabetes Obes Metab 2024; 26:4261-4272. [PMID: 39056216 DOI: 10.1111/dom.15769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/20/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024]
Abstract
AIM To investigate the efficacy and safety of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 (SGLT2) inhibitors in liver transplant (LT) recipients with diabetes. METHODS A single-centre, retrospective analysis of prospectively collected data from an LT recipient database (1990-2023) was conducted. We included adults with pre-existing diabetes and post-transplant diabetes, newly started on GLP-1RAs and/or SGLT2 inhibitors after LT. Metabolic and biochemical parameters and outcomes were collected for up to 12 months after starting medications and were compared to those in patients receiving dipeptidyl peptidase-4 (DPP-4) inhibitors. Statistical analysis included descriptive statistics and linear mixed models. RESULTS We included participants on GLP-1RAs (n = 46), SGLT2 inhibitors (n = 87), combination therapy (n = 12), and a DPP-4 inhibitor comparator (n = 217). Both GLP-1RAs and combination therapy decreased mean glycated haemoglobin (HbA1c) levels, and combination therapy remained significant when adjusted for DPP-4 inhibitor treatment (-3.5%, 95% CI [-6.1, -0.95]; p = 0.0089) at 12 months. All three groups had significant decreases in mean weight and body mass index, but these remained significant in the GLP-1RA (-5.2 kg, 95% CI [-8.7, -1.7], p = 0.0039 and 1.99 kg/m2, 95% CI [-3.4, -0.6], p = 0.0048) and combination therapy groups (-5.4 kg, 95% CI [-10.5, -0.36], p = 0.04 and -3.4 kg/m2, 95% CI [-5.5, -1.3], p = 0.0015) when adjusted for DPP-4 inhibitor treatment at 12 months. Alanine aminotransferase levels decreased with GLP-1RA and combination therapy. There were two (1.4%) cases of graft rejection. CONCLUSION We found that GLP-1RAs, SGLT2 inhibitors, and their combination, led to significant weight loss in LT recipients with diabetes. Combination therapy, in particular, lowered HbA1c and alanine aminotransferase levels compared to DPP-4 inhibitors. Further studies are needed to assess long-term safety and efficacy.
Collapse
Affiliation(s)
- Katina Zheng
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amirhossein Azhie
- Multi Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Xiaoting You
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maryam Naghibzadeh
- Multi Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Eunice Tan
- Multi Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Sara Naimimohasses
- Multi Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Vikas S Sridhar
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Sarang Gupta
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shiyi Chen
- Multi Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Satya Dash
- Multi Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, University Health Network, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia Tsien
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Multi Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
- Division of Gastroenterology and Hepatology, University Health Network, Toronto, Ontario, Canada
- Division of Gastroenterology and Hepatology, University of Toronto, Toronto, Ontario, Canada
| | - Nazia Selzner
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Multi Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
- Division of Gastroenterology and Hepatology, University Health Network, Toronto, Ontario, Canada
- Division of Gastroenterology and Hepatology, University of Toronto, Toronto, Ontario, Canada
| | - Leslie Lilly
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Multi Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
- Division of Gastroenterology and Hepatology, University Health Network, Toronto, Ontario, Canada
- Division of Gastroenterology and Hepatology, University of Toronto, Toronto, Ontario, Canada
| | - Elmar Jaeckel
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Multi Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
- Division of Gastroenterology and Hepatology, University Health Network, Toronto, Ontario, Canada
- Division of Gastroenterology and Hepatology, University of Toronto, Toronto, Ontario, Canada
| | - Minna Woo
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, University Health Network, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada
| | - Sunita Singh
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - David Cherney
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Mamatha Bhat
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Multi Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
- Division of Gastroenterology and Hepatology, University Health Network, Toronto, Ontario, Canada
- Division of Gastroenterology and Hepatology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Soucy-Proulx M, Carrier FM, Vincelette C, Grogan T, Xia V, Wray C, Sheth M, Nguyen-Buckley C, Roullet S, Ramadan J, Toubal L, Naili S, Sa Cunha A, Azoulay D, Cherqui D, Joosten A. Association Between Liver Graft to Recipient Weight Ratio and Acute Kidney Injury Following Liver Transplantation: A Historical Cohort Study. Clin Transplant 2024; 38:e15473. [PMID: 39365116 DOI: 10.1111/ctr.15473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 08/23/2024] [Accepted: 09/14/2024] [Indexed: 10/05/2024]
Abstract
INTRODUCTION Acute kidney injury (AKI) is a frequent complication following liver transplantation (LT) that has a multifactorial etiology. While some perioperative risk factors have been associated with postoperative AKI, the impact of liver graft weight to recipient body weight ratio (GW/RBW) has been poorly explored. We hypothesized that a high GW/RBW ratio would be associated with AKI after LT. METHODS This single-center historical cohort study included all consecutive adults who had LT at Paul Brousse Hospital between 2018 and 2022. Patients requiring preoperative renal replacement therapy, combined solid organ transplantation, retransplantation, split or domino graft were excluded, as well as those with missing graft weight and creatinine values during the first postoperative week. The primary exposure was GW/RBW ratio expressed as a proportion. The primary outcome was the incidence of postoperative AKI within 7 days after surgery, defined using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The secondary outcome was the AKI severity (KDIGO grades). We estimated logistic and ordinal regression models adjusted for potential confounding factors and explored nonlinear associations. RESULTS Of 467 patients analyzed, 211 (45%) developed AKI. A high GW/RBW ratio was associated with both the risk of postoperative AKI and the severity of AKI (KDIGO grades), especially above a threshold of 2.5% (non-linear effect). CONCLUSION A high GW/RBW ratio was associated with an exponential increase in the risk of AKI after LT. A high GW/RBW ratio was also associated with an increased AKI severity. Our findings may help improve graft allocation in patients undergoing LT.
Collapse
Affiliation(s)
- Maxime Soucy-Proulx
- Department of Anesthesiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Francois Martin Carrier
- Department of Anesthesiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
- Department of Medicine, Critical Care service, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
- Innovation and Health Evaluation Hub, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Christian Vincelette
- Innovation and Health Evaluation Hub, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Tristan Grogan
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, California, USA
| | - Victor Xia
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, California, USA
| | - Christopher Wray
- Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, California, USA
| | - Mansi Sheth
- Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, California, USA
| | - Christine Nguyen-Buckley
- Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, California, USA
| | - Stephanie Roullet
- Department of Anaesthesiology and Intensive Care, Paris-Saclay University, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris, Villejuif, France
- Université Paris-Saclay, INSERM, Hémostase inflammation thrombose HITH U1176, Le Kremlin-Bicetre, France
| | - Joanna Ramadan
- Department of Anaesthesiology and Intensive Care, Paris-Saclay University, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris, Villejuif, France
| | - Leila Toubal
- Department of Anaesthesiology and Intensive Care, Paris-Saclay University, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris, Villejuif, France
| | - Salima Naili
- Department of Anaesthesiology and Intensive Care, Paris-Saclay University, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris, Villejuif, France
| | - Antonio Sa Cunha
- Department of Surgery, Hepatobiliary Center - Paris-Saclay University, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris, Villejuif, France
| | - Daniel Azoulay
- Department of Surgery, Hepatobiliary Center - Paris-Saclay University, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris, Villejuif, France
| | - Daniel Cherqui
- Department of Surgery, Hepatobiliary Center - Paris-Saclay University, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris, Villejuif, France
| | - Alexandre Joosten
- Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, California, USA
| |
Collapse
|
4
|
Brown C, Ray C, Kuketz G, Virostko J. Changes in Pancreas Volume in Living Donor Liver Transplant Recipients. Transplantation 2024; 108:e313-e320. [PMID: 38637920 PMCID: PMC11424270 DOI: 10.1097/tp.0000000000005031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
BACKGROUND Metabolic factors have a significant role in the morbidity and mortality associated with chronic liver disease. The pancreas has a central role in metabolism and metabolic risk factors but has been largely ignored in liver transplantation. Small pancreas volume has been demonstrated in pathologic conditions such as type 1 and 2 diabetes. METHODS This study assessed abdominal imaging before and after liver transplantation to determine if liver transplantation induces changes in pancreas volume in living donor liver transplant recipients. Our secondary outcome is to correlate pancreas volume with demographic, clinical, and outcome data. We conducted a retrospective study of pancreas volume in patients enrolled in the adult-to-adult living donor liver transplantation cohort study. Pancreas volume was manually calculated from 413 MRI or computed tomography images and correlated with imaging and clinical data. RESULTS Pancreas volume declined by an average of 24% (87.8 ± 25.2 mL to 66.8 ± 20.4 mL, P < 0.0001), regardless of liver disease etiology. Pancreas volume correlated with portal blood flow, spleen volume, and liver enzyme levels. We found a correlation between smaller pancreas volume pretransplant and longer intensive care unit (ICU) stay across all patients ( P < 0.05). Individuals with an ICU stay of <2 d had a larger average pancreas volume pretransplant than those with an ICU stay of 2 d or longer (91.2 versus 82.2 mL, P < 0.05). CONCLUSIONS Pancreas volume is dynamic in liver transplant recipients and may reflect altered metabolism and risk of posttransplantation complications.
Collapse
Affiliation(s)
- Cristal Brown
- Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Callaghan Ray
- Department of Diagnostic Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Garret Kuketz
- Department of Diagnostic Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - John Virostko
- Department of Diagnostic Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Livestrong Cancer Institutes, Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Department of Oncology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Oden Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin TX
| |
Collapse
|
5
|
Schiano TD, Ganger D. The future of liver transplantation in the United States: Ongoing optimism and concerns with a prescription for change. Liver Transpl 2024; 30:1072-1077. [PMID: 38713029 DOI: 10.1097/lvt.0000000000000392] [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: 12/01/2023] [Accepted: 04/29/2024] [Indexed: 05/08/2024]
Affiliation(s)
- Thomas D Schiano
- Recanati/Miller Transplantation Institute, Mount Sinai Medical Center, New York, New York, USA
| | - Daniel Ganger
- Northwestern Medicine Organ Transplantation Center, Northwestern University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
6
|
Li R, Li S, Shen L, Li J, Zhang D, Yu J, Huang L, Liu N, Lu H, Xu M. LINC00618 facilitates growth and metastasis of hepatocellular carcinoma via elevating cholesterol synthesis by promoting NSUN2-mediated SREBP2 m5C modification. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 285:117064. [PMID: 39299205 DOI: 10.1016/j.ecoenv.2024.117064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 09/03/2024] [Accepted: 09/14/2024] [Indexed: 09/22/2024]
Abstract
Dysregulation of cholesterol metabolism is an important feature of cancer development. There are limited reports on the involvement of lncRNAs in hepatocellular carcinoma (HCC) progression via the cholesterol metabolism pathway. The present study explored the effect of LINC00618 on HCC growth and metastasis, and elucidated the underlying mechanisms involved in cholesterol metabolism. Here, we found that LINC00618 expression was upregulated in cancerous tissues from 30 patients with HCC compared to that in adjacent normal tissues. High expression of LINC00618 was detected in metastatic HCC tissues. LINC00618 is predominantly localized in the nucleus and overexpression of LINC00618 facilitated HCC cell proliferation, migration and EMT progression by promoting cholesterol biosynthesis. Mechanistically, the 1-101nt region of LINC00618 bound to NSUN2. LINC00618 inhibited ubiquitin-proteasome pathway-induced NSUN2 degradation. NSUN2 stabilized by LINC00618 increased m5C modification of SREBP2 and promoted SREBP2 mRNA stability in a YBX1-dependent manner, thereby promoting cholesterol biosynthesis in HCC cells. Moreover, mouse HCC xenograft and lung metastasis models were established by subcutaneous and tail vein injections of MHCC97 cells transfected with or without sh-LINC00618. Silencing LINC00618 impeded HCC growth and metastasis. In conclusion, LINC00618 promoted HCC growth and metastasis by elevating cholesterol synthesis by stabilizing NSUN2 to enhance SREBP2 mRNA stability in an m5C-dependent manner.
Collapse
Affiliation(s)
- Rong Li
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, China
| | - Shunle Li
- Department of General Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, China
| | - Lin Shen
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, China
| | - Junhui Li
- Department of General Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, China
| | - Di Zhang
- Department of General Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, China
| | - Jinmin Yu
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, China
| | - Lanxuan Huang
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Na Liu
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, China.
| | - Hongwei Lu
- Department of General Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, China.
| | - Meng Xu
- Department of General Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, China.
| |
Collapse
|
7
|
Chung W, Wong K, Ravindranayagam N, Tang L, Grace J, Wong D, Con D, Sinclair M, Majumdar A, Kutaiba N, Hui S, Gow P, Muralidharan V, Dobrovic A, Testro A. Statin, aspirin and metformin use and risk of hepatocellular carcinoma related outcomes following liver transplantation: A retrospective study. World J Transplant 2024; 14:94914. [PMID: 39295976 PMCID: PMC11317854 DOI: 10.5500/wjt.v14.i3.94914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/13/2024] [Accepted: 05/30/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Liver transplantation (LT) is a potentially curative therapy for patients with hepatocellular carcinoma (HCC). HCC-recurrence following LT is associated with reduced survival. There is increasing interest in chemoprophylaxis to improve HCC-related outcomes post-LT. AIM To investigate whether there is any benefit for the use of drugs with proposed chemoprophylactic properties against HCC, and patient outcomes following LT. METHODS This was a retrospective study of adult patients who received Deceased Donor LT for HCC from 2005-2022, from a single Australian centre. Drug use was defined as statin, aspirin or metformin therapy for ≥ 29 days, within 24 months post-LT. A cox proportional-hazards model with time-dependent covariates was used for survival analysis. Outcome measures were the composite-endpoint of HCC-recurrence and all-cause mortality, HCC-recurrence and HCC-related mortality. Sensitivity analysis was performed to account for immortality time bias and statin dosing. RESULTS Three hundred and five patients were included in this study, with 253 (82.95%) males with a median age of 58.90 years. Aetiologies of liver disease were 150 (49.18%) hepatitis C, 73 (23.93%) hepatitis B (HBV) and 33 (10.82%) non-alcoholic fatty liver disease (NAFLD). 56 (18.36%) took statins, 51 (16.72%) aspirin and 50 (16.39%) metformin. During a median follow-up time of 59.90 months, 34 (11.15%) developed HCC-recurrence, 48 (15.74%) died, 17 (5.57%) from HCC-related mortality. Statin, aspirin or metformin use was not associated with statistically significant differences in the composite endpoint of HCC-recurrence or all-cause mortality [hazard ratio (HR): 1.16, 95%CI: 0.58-2.30; HR: 1.21, 95%CI: 0.28-5.27; HR: 0.61, 95%CI: 0.27-1.36], HCC-recurrence (HR: 0.52, 95%CI: 0.20-1.35; HR: 0.51, 95%CI: 0.14-1.93; HR 1.00, 95%CI: 0.37-2.72), or HCC-related mortality (HR: 0.32, 95%CI: 0.033-3.09; HR: 0.71, 95%CI: 0.14-3.73; HR: 1.57, 95%CI: 0.61-4.04) respectively. Statin dosing was not associated with statistically significant differences in HCC-related outcomes. CONCLUSION Statin, metformin or aspirin use was not associated with improved HCC-related outcomes post-LT, in a largely historical cohort of Australian patients with a low proportion of NAFLD. Further prospective, multicentre studies are required to clarify any potential benefit of these drugs to improve HCC-related outcomes.
Collapse
Affiliation(s)
- William Chung
- Department of Gastroenterology, Austin Health, Heidelberg 3084, Victoria, Australia
- Victorian Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Kevin Wong
- Department of Gastroenterology, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Noel Ravindranayagam
- Department of Gastroenterology, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Lauren Tang
- Department of Gastroenterology, Austin Health, Heidelberg 3084, Victoria, Australia
- Victorian Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Josephine Grace
- Department of Gastroenterology, Austin Health, Heidelberg 3084, Victoria, Australia
- Victorian Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Darren Wong
- Department of Gastroenterology, Austin Health, Heidelberg 3084, Victoria, Australia
- Victorian Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Danny Con
- Department of Gastroenterology, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Marie Sinclair
- Department of Gastroenterology, Austin Health, Heidelberg 3084, Victoria, Australia
- Victorian Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Avik Majumdar
- Department of Gastroenterology, Austin Health, Heidelberg 3084, Victoria, Australia
- Victorian Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Numan Kutaiba
- Department of Radiology, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Samuel Hui
- Department of Gastroenterology, Austin Health, Heidelberg 3084, Victoria, Australia
- Department of Gastroenterology, Monash Health, Clayton 3168, Victoria, Australia
| | - Paul Gow
- Department of Gastroenterology, Austin Health, Heidelberg 3084, Victoria, Australia
- Victorian Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
| | | | - Alexander Dobrovic
- Department of Surgery, Beacon Laboratory, Austin Precinct, The University of Melbourne, Austin Hospital, Heidelberg 3048, Victoria, Australia
| | - Adam Testro
- Department of Gastroenterology, Austin Health, Heidelberg 3084, Victoria, Australia
- Victorian Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
| |
Collapse
|
8
|
Stephens KL, Hollenbeck ST. Face Transplants Today. JAMA Surg 2024:2823893. [PMID: 39292487 DOI: 10.1001/jamasurg.2024.3755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Affiliation(s)
- Kristen L Stephens
- Department of Plastic Surgery, Maxillofacial and Oral Health, University of Virginia, Charlottesville
| | - Scott T Hollenbeck
- Department of Plastic Surgery, Maxillofacial and Oral Health, University of Virginia, Charlottesville
| |
Collapse
|
9
|
Palma-Lara I, Ortiz-López MG, Bonilla-Delgado J, Pérez-Escobar J, Godínez-Aguilar R, Luévano-Contreras C, Espinosa-García AM, Pérez-Durán J, Alonso-Themann PG, Nolasco-Quiroga M, Flores-Estrada J, Carpinteyro-Espin P, Juárez-Ascencio D, Nieto-Velazquez NG, Palacios-Reyes C. A landscape of liver cirrhosis and transplantation in Mexico: Changing leading causes and transplant as response. Ann Hepatol 2024:101562. [PMID: 39278408 DOI: 10.1016/j.aohep.2024.101562] [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: 03/14/2024] [Revised: 06/05/2024] [Accepted: 07/08/2024] [Indexed: 09/18/2024]
Abstract
Liver cirrhosis causes include alcoholism, viral infections (hepatitis B virus (HBV) and hepatitis C virus (HCV)), alcohol-associated liver disease (ALD), and metabolic dysfunction associated with steatotic liver disease (MASLD), among others. Cirrhosis frequency has increased in recent years, with a prevalence of 1395 cases per 100,000 and a mortality rate of 18 per 100,000, which corresponded to 1,472,000 deaths during 2017. In Mexico, liver disease is a public health problem since it was associated to 41,890 deaths in 2022, including liver cirrhosis (>25,000) and ALD (14,927). This represents 114 individuals daily due to these causes, and correspond to the 4th to 5th place of all causes. The global prevalence of MASLD is estimated to 25 % of the world's population, while in pediatric population could be higher. In Mexican population is more prevalent since estimations are up to 41.3 % in 2023. Alcohol consumption, a global health issue due to its high prevalence and associated morbidities, is associated to ALD in 32.9 %, with a mortality rate of 23.9 %, primarily due to liver-related causes. In Mexico, ALD is present in 23 % of all cirrhosis cases. already surpassed by hepatitis B cases in 2009. HCV and HBV frequencies changed due programs implementing screening detection, vaccines and direct-acting antivirals during the last years. A switch of causes has occurred, increasing MASLD and diminishing viral causes. Efficient performed liver transplantation has grown as response to increasing cirrhosis cases, including recent authorized centers. These efforts are necessary, whereas preventive strategies should be implemented according to leading causes.
Collapse
Affiliation(s)
- Icela Palma-Lara
- Laboratorio de Morfología Celular, Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México 11340, Mexico.
| | | | - José Bonilla-Delgado
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca 56530, Mexico; Departamento de Biotecnología, Escuela de Ingeniería y Ciencias, Instituto Tecnológico de Monterrey, Toluca de Lerdo 50110, Mexico.
| | - Juanita Pérez-Escobar
- Servicio de Trasplantes, División de Cirugía, Hospital Juárez de México, Mexico City 07760, Mexico.
| | | | - Claudia Luévano-Contreras
- Departamento de Ciencias Médicas, División de Ciencias de la Salud, Universidad de Guanajuato, Campus León, Guanajuato 37000, México.
| | | | - Javier Pérez-Durán
- Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de México 11000, México.
| | | | - Manuel Nolasco-Quiroga
- Coordinación de Enseñanza e Investigación, Clínica Hospital Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Huauchinango 73177, Mexico.
| | | | | | | | | | - Carmen Palacios-Reyes
- Laboratorio de Morfología Celular, Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México 11340, Mexico; División de Investigación, Hospital Juárez de México, Mexico City 07760, Mexico; Departamento de Ciencias Médicas, División de Ciencias de la Salud, Universidad de Guanajuato, Campus León, Guanajuato 37000, México.
| |
Collapse
|
10
|
Blaney H, Díaz LA, Li N, Malhi G, Mortuza R, Qi X, Kulkarni AV, Bataller R, Cabezas J, Louvet A, Tapper EB, Arab JP. Global differences in the management of alcohol-associated hepatitis. Lancet Gastroenterol Hepatol 2024:S2468-1253(24)00232-2. [PMID: 39270697 DOI: 10.1016/s2468-1253(24)00232-2] [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: 04/01/2024] [Revised: 07/07/2024] [Accepted: 07/16/2024] [Indexed: 09/15/2024]
Affiliation(s)
- Hanna Blaney
- Division of Gastroenterology and Hepatology, University of Maryland, College Park, MD, USA
| | - Luis Antonio Díaz
- MASLD Research Center, Division of Gastroenterology and Hepatology, University of California San Diego, San Diego, CA, USA; Department of Gastroenterology, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile; Observatorio Multicéntrico de Enfermedades Gastrointestinales (OMEGA), Santiago, Chile
| | - Nhi Li
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, ON, Canada
| | - Gurpreet Malhi
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, ON, Canada
| | - Rokhsana Mortuza
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, ON, Canada
| | - Xiaolong Qi
- Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology, Southeast University, Nanjing, China
| | - Anand V Kulkarni
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Ramon Bataller
- Liver Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joaquin Cabezas
- Gastroenterology and Hepatology Department, University Hospital Marqués De Valdecilla, Santander, Spain; Research Institute Valdecilla (IDIVAL), Santander, Spain
| | - Alexandre Louvet
- Claude Huriez Hospital, Services des Maladies de l'Appareil Digestif, CHRU Lille, Lille, France; Unité INSERM 995, Lille, France
| | - Elliot B Tapper
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA; Gastroenterology Section, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Juan Pablo Arab
- Department of Gastroenterology, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile; Observatorio Multicéntrico de Enfermedades Gastrointestinales (OMEGA), Santiago, Chile; Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA 23284, USA.
| |
Collapse
|
11
|
Pan K, Wang S, Li X, Wu S. Efficacy and safety of ultrasound-guided radiofrequency ablation combined with transhepatic artery embolization chemotherapy for hepatocellular carcinoma: A meta-analysis. PLoS One 2024; 19:e0305965. [PMID: 39240946 PMCID: PMC11379279 DOI: 10.1371/journal.pone.0305965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/08/2024] [Indexed: 09/08/2024] Open
Abstract
OBJECTIVE Meta-analysis was used to assess the efficacy and safety of ultrasound-guided radiofrequency ablation combined with transhepatic artery embolization chemotherapy for hepatocellular carcinoma. METHODS Randomized controlled studies on ultrasound-guided radiofrequency ablation combined with transhepatic artery embolization chemotherapy for hepatocellular carcinoma were searched in the databases of PubMed, Embase, Cochrane library, web of science with a search deadline of March 14, 2024. Data were analyzed using Stata 15.0. RESULT Six randomized controlled studies involving 520 individuals were finally included, the results of meta-analysis showed that ultrasound-guided radiofrequency ablation combined with TACE can improve objective response rate [RR = 1.52, 95%CI (1.28, 1.81)], improve disease control rate [RR = 1.15, 95%CI (1.06, 1.24)], The survival rate [RR = 1.34, 95%CI (1.19,1.51)] did not increase adverse reactions [RR = 1.34, 95%CI (1.00,1.79)]. CONCLUSION Based on the findings of the current study, ultrasound-guided radiofrequency ablation combined with TACE was found to improve the objective remission rate, disease control rate, and did not increase adverse events in patients with hepatocellular carcinoma.
Collapse
Affiliation(s)
- Kerui Pan
- Lianyungang First People's Hospital, China
| | - Sisi Wang
- Lianyungang First People's Hospital, China
| | - Xueping Li
- Lianyungang First People's Hospital, China
| | | |
Collapse
|
12
|
Manzia TM, Trapani S, Nardi A, Ricci A, Lenci I, Sensi B, Angelico R, De Feo TM, Agnes S, Andorno E, Baccarani U, Carraro A, Cescon M, Cillo U, Colledan M, Pinelli D, De Carlis L, De Simone P, Ghinolfi D, Benedetto FD, Ettorre GM, Gruttadauria S, Lupo LG, Tandoi F, Mazzaferro V, Romagnoli R, Rossi G, Caccamo L, Rossi M, Spada M, Vennarecci G, Vivarelli M, Zamboni F, Tisone G, Cardillo M, Angelico M. Fairness and pitfalls of the Italian waiting list for elective liver transplantation: The ECALITA registry study. Dig Liver Dis 2024:S1590-8658(24)00956-3. [PMID: 39237429 DOI: 10.1016/j.dld.2024.08.039] [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: 04/14/2024] [Revised: 08/09/2024] [Accepted: 08/15/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND The challenge of transplant waiting-lists is to provide organs for all candidates while maintaining efficiency and equity. AIMS We investigated the probability of being transplanted or of waiting-list dropout in Italy. METHODS Data from 12,749 adult patients waitlisted for primary liver-transplantation from January 2012 to December 2022 were collected from the National Transplant-Registry.The cohort was divided into Eras:1 (2012-2014);2 (2015-2018);and 3 (2019-2022). RESULTS The one-year probability of undergoing transplant increased (67.6 % in Era 1vs73.8 % in Era 3,p < 0001) with a complementary 46 % decrease in waiting-list failures. Patients with hepatocellular-carcinoma were transplanted more often than cirrhotics[at model for end-stage liver-disease (MELD)-15:HR = 1.28,95 %CI:1.21-1.35;at MELD-25:HR = 1.04,95 %CI:0.92-1.19) and those with other indications (at MELD-15:HR = 1.27,95 %CI:1.11-1.46) across all eras. Candidates with Hepatitis-B-virus (HBV)related disease had a greater probability of transplant than those with Hepatitis-C virus-related (HR = 1.13,95 %CI:1.07-1.20), alcohol-related (HR = 1.13,95 %CI:1.05-1.21), and metabolic-related (HR = 1.18,95 %CI:1.09-1.28)disease. Waiting-list failures increased by 27 % every 5 MELD-points and by 14 % for every 5-year increase in recipient-age and decreased by 10 % with each 10-cm increase in stature. Blood-group O patients showed the highest probability of waiting-list failure (HR = 1.28,95 %CI:1.15-1.43). CONCLUSIONS Liver-transplantation waiting-list success-rates have significantly improved in Italy, with patients with hepatocellular-carcinoma and/or HBV-related diseases being favored. High MELD-score, old-age, short-stature, and blood-group O were significant risk-factors for waiting-list failure. Efforts to improve organ-allocation and prioritization-policies are underway.
Collapse
Affiliation(s)
- Tommaso Maria Manzia
- Department of Surgical Science, University of Rome Tor Vergata, Hepatobiliary and Transplantation Unit, Policlinico Tor Vergata [Tor Vergata General Hospital], Rome, Italy, 00133
| | - Silvia Trapani
- Italian National Transplant Centre, National Institute of Health, Rome, Italy, 00161
| | - Alessandra Nardi
- Department of Mathematics, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Andrea Ricci
- Italian National Transplant Centre, National Institute of Health, Rome, Italy, 00161
| | - Ilaria Lenci
- Hepatology and Transplant Unit, Fondazione Policlinico Tor Vergata [Tor Vergata General Hospital Foundation], 00133
| | - Bruno Sensi
- Department of Surgical Science, University of Rome Tor Vergata, Hepatobiliary and Transplantation Unit, Policlinico Tor Vergata [Tor Vergata General Hospital], Rome, Italy, 00133
| | - Roberta Angelico
- Department of Surgical Science, University of Rome Tor Vergata, Hepatobiliary and Transplantation Unit, Policlinico Tor Vergata [Tor Vergata General Hospital], Rome, Italy, 00133.
| | - Tullia Maria De Feo
- North Italy Transplant program (NITp). Transplant Coordination Unit, Fondazione IRCSS Cà Granda Ospedale Maggiore Policlinico [Cà Granda General Research Hospital], Milan, Italy, 20122
| | - Salvatore Agnes
- Department of Surgery, Transplantation Service, Catholic University of the Sacred Heart, Foundation A. Gemelli Hospital, Rome, Italy, 00136
| | - Enzo Andorno
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation Unit. A.O.U. S. Martino [S. Martino University Hospital], Genoa, Italy, 16132
| | - Umberto Baccarani
- Department of Medicine, Università Degli Studi Di Udine [University of Udine], Udine, Italy, 33100
| | - Amedeo Carraro
- Liver Transplant Unit, Department of Surgical Science, University and Hospital Trust of Verona. Azienda Ospedaliera Verona, Verona, Italy, 37129
| | - Matteo Cescon
- Hepatobiliary and Transplant Unit, AOU Sant'Orsola IRCCS [Sant'Orsola University Research Hospital], Department of Medical and Surgical Sciences, University of Bologna, Italy, 40138
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplantation Unit, University of Padua, Padua, Italy, 35135
| | - Michele Colledan
- Department of Organ Failure and Transplantation. Ospedale Papa Giovanni XXIII [Papa Giovanni XXIII Hospital] Bergamo, University of Milano-Bicocca, Milan, Italy, 24127
| | - Domenico Pinelli
- Department of Organ Failure and Transplantation. Ospedale Papa Giovanni XXIII [Papa Giovanni XXIII Hospital] Bergamo, University of Milano-Bicocca, Milan, Italy, 24127
| | - Luciano De Carlis
- Division of General Surgery & Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda [Niguarda Metropolitan Hospital], University of Milano-Bicocca, Milan, Italy, 20161
| | - Paolo De Simone
- Hepatobiliary Surgery and Liver Transplantation, AOU Pisana [Pisana University Hospital], Pisa, Italy, 56124
| | - Davide Ghinolfi
- Hepatobiliary Surgery and Liver Transplantation, AOU Pisana [Pisana University Hospital], Pisa, Italy, 56124
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Azienda Ospedaliera Policlinico [General Hospital], University of Modena and Reggio Emilia, Modena, Italy, 41125
| | - Giuseppe Maria Ettorre
- Division of General Surgery and Liver Transplantation. Azienda Ospedaliera San Camillo Forlanini [San Camillo Forlanini Hospital], Rome, Italy, 00152
| | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneoper i Trapianti e Terapie ad alta specializzazione [Research Hospital - Highly-specialized Mediterranean Institute for Transplants and Therapies]), UPMC (University of Pittsburgh Medical Center), Palermo, Italy; Department of Surgery and Medical and Surgical Specialties, University of Catania, Catania, Italy, 90127
| | - Luigi Giovanni Lupo
- General Surgery and Liver transplantation Unit, University of Bari, Bari, Italy, 70121
| | - Francesco Tandoi
- General Surgery and Liver transplantation Unit, University of Bari, Bari, Italy, 70121
| | - Vincenzo Mazzaferro
- HPB Surgery and Liver Transplantation Unit, Department of Oncology, University of Milan and Department of Surgery, Fondazione IRCCS [Research Hospital Foundation], Istituto Nazionale Tumori [National Cancer Institute], IRCCS, Milan, 20133, Italy
| | - Renato Romagnoli
- Liver Transplant Center, General Surgery 2 U, University of Turin, AOU Città della Salute e della Scienza di Torino, Turin, Italy, 10126
| | - Giorgio Rossi
- Division of General Surgery and Liver Transplantation, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy, 20122
| | - Lucio Caccamo
- Division of General Surgery and Liver Transplantation, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy, 20122
| | - Massimo Rossi
- General Surgery and Organ Transplantation, Sapienza University of Rome, Umberto I Polyclinic of Rome, Rome, Italy, 00185
| | - Marco Spada
- Department of Specialized Surgery, Division of Hepato-Pancreato-Biliary Surgery and of Liver and Kidney Transplantation, Bambino Gesù Children's Hospital, IRCCS [Research Hospital], Rome, Italy, 00165
| | - Giovanni Vennarecci
- Unit of Hepatobiliary Surgery and Liver Transplant Center, Department of Gastroenterology and Transplantation, "A. Cardarelli" Hospital, Naples, Italy, 80131
| | - Marco Vivarelli
- Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, AOU Ospedali Riuniti [Joint Hospitals], Ancona, Italy, 60126
| | - Fausto Zamboni
- Department of Surgery, General and Hepatic Transplantation Surgery Unit, A.O.B. Brotzu, Cagliari, Italy, 09047
| | - Giuseppe Tisone
- Department of Surgical Science, University of Rome Tor Vergata, Hepatobiliary and Transplantation Unit, Policlinico Tor Vergata [Tor Vergata General Hospital], Rome, Italy, 00133
| | - Massimo Cardillo
- Italian National Transplant Centre, National Institute of Health, Rome, Italy, 00161
| | - Mario Angelico
- Hepatology and Transplant Unit, Fondazione Policlinico Tor Vergata [Tor Vergata General Hospital Foundation], 00133
| |
Collapse
|
13
|
Amini-Salehi E, Letafatkar N, Norouzi N, Joukar F, Habibi A, Javid M, Sattari N, Khorasani M, Farahmand A, Tavakoli S, Masoumzadeh B, Abbaspour E, Karimzad S, Ghadiri A, Maddineni G, Khosousi MJ, Faraji N, Keivanlou MH, Mahapatro A, Gaskarei MAK, Okhovat P, Bahrampourian A, Aleali MS, Mirdamadi A, Eslami N, Javid M, Javaheri N, Pra SV, Bakhsi A, Shafipour M, Vakilpour A, Ansar MM, Kanagala SG, Hashemi M, Ghazalgoo A, Kheirandish M, Porteghali P, Heidarzad F, Zeinali T, Ghanaei FM, Hassanipour S, Ulrich MT, Melson JE, Patel D, Nayak SS. Global Prevalence of Nonalcoholic Fatty Liver Disease: An Updated Review Meta-Analysis comprising a Population of 78 million from 38 Countries. Arch Med Res 2024; 55:103043. [PMID: 39094335 DOI: 10.1016/j.arcmed.2024.103043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 06/09/2024] [Accepted: 07/03/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is a global health challenge, with a rising rate in line with other metabolic diseases. We aimed to assess the global prevalence of NAFLD in adult and pediatric populations. METHODS PubMed, Scopus and Web of Science databases were systematically searched up to May 2023. Heterogeneity was assessed using Cochran's Q test and I2 statistics, and random-effects model was used for meta-analysis. Analyses were performed using STATA version 18. RESULTS A total of 479 studies with 78,001,755 participants from 38 countries were finally included. The global prevalence of NAFLD was estimated to be 30.2% (95% CI: 28.7-31.7%). Regionally, the prevalence of NAFLD was as follows: Asia 30.9% (95% CI: 29.2-32.6%), Australia 16.1% (95% CI: 9.0-24.8%), Europe 30.2% (95% CI: 25.6-35.0%), North America 29% (95% CI: 25.8-32.3%), and South America 34% (95% CI: 16.9-53.5%). Countries with a higher human development index (HDI) had significantly lower prevalence of NAFLD (coefficient = -0.523, p = 0.005). Globally, the prevalence of NAFLD in men and women was 36.6% (95% CI: 34.7-38.4%) and 25.5% (95% CI: 23.9-27.1%), respectively. The prevalence of NAFLD in adults, adults with obesity, children, and children with obesity was 30.2% (95% CI: 28.8-31.7%), 57.5% (95% CI: 43.6-70.9%), 14.3% (95% CI: 10.3-18.8%), and 38.0% (95% CI: 31.5-44.7%), respectively. CONCLUSION The prevalence of NAFLD is remarkably high, particularly in countries with lower HDI. This substantial prevalence in both adults and children underscores the need for disease management protocols to reduce the burden.
Collapse
Affiliation(s)
- Ehsan Amini-Salehi
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Negin Letafatkar
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Naeim Norouzi
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Farahnaz Joukar
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Arman Habibi
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mona Javid
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Nazila Sattari
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mehrdad Khorasani
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Farahmand
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Shervin Tavakoli
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Behnaz Masoumzadeh
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Elaheh Abbaspour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran; Department of Radiology, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Sahand Karimzad
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran; Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Ghadiri
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Gautam Maddineni
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Mohammad Javad Khosousi
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Niloofar Faraji
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Abinash Mahapatro
- Department of Internal Medicine, Hi-Tech Medical College and Hospital, Rourkela, Odisha, India
| | | | - Paria Okhovat
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Bahrampourian
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Maryam Sadat Aleali
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Arian Mirdamadi
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Narges Eslami
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohamadreza Javid
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Naz Javaheri
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Arash Bakhsi
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Shafipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Azin Vakilpour
- Department of Internal Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Malek Moein Ansar
- Neuroscience Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran; Department of Biochemistry and Medical Physics, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Mohamad Hashemi
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Arezoo Ghazalgoo
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Masoumeh Kheirandish
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Parham Porteghali
- Department of Internal Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Forough Heidarzad
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Taraneh Zeinali
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Fariborz Mansour Ghanaei
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Michael T Ulrich
- Department of Internal Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Joshua E Melson
- Division of Gastroenterology, Department of Medicine, University of Arizona Medical Center-Banner Health, Tucson, AZ, USA
| | - Dhruvan Patel
- Division of Gastroenterology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | | |
Collapse
|
14
|
Ladner DP, Manski CF. Financial burden of cirrhosis is significantly reduced after liver transplantation. Liver Transpl 2024; 30:875-876. [PMID: 38656265 DOI: 10.1097/lvt.0000000000000387] [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: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Daniela P Ladner
- Division of Transplant, Department of Surgery, Northwestern Medicine, Chicago, Illinois, USA
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC) Comprehensive Transplant Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Charles F Manski
- Department of Economics and Institute for Policy Research, Northwestern University, Evanston, Illinois, USA
| |
Collapse
|
15
|
Oliveira HM, Miranda HP, Rego F, Nunes R. Palliative care and end stage liver disease: A cohort analysis of palliative care use and factors associated with referral. Ann Hepatol 2024; 29:101518. [PMID: 38851396 DOI: 10.1016/j.aohep.2024.101518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/16/2024] [Accepted: 04/19/2024] [Indexed: 06/10/2024]
Abstract
INTRODUCTION AND OBJECTIVES Prevalence and mortality of chronic liver disease have risen significantly. In end stage liver disease, the survival of patients is approximately two years. Despite the poor prognosis and high symptom burden of these patients, integration of palliative care is limited. We aim to assess associated factors and trends in palliative care use in recent years. MATERIALS AND METHODS A Multicenter retrospective cohort of patients with end stage liver disease who suffered in-hospital mortality between 2017 and 2019. Information regarding patient demographics, hospital characteristics, comorbidities, etiology, decompensations, and interventions was collected. Two-sided tests and logistic regression analysis were used to identify factors associated with palliative care use. RESULTS A total of 201 patients were analyzed, with a yearly increase in palliative care consultation: 26.7 % in 2017 to 38.3 % in 2019. Patients in palliative care were older (65.72 ± 11.70 vs. 62.10 ± 11.44; p = 0.003), had a lower Karnofsky functionality scale (χ=18.104; p = 0.000) and had higher rates of hepatic encephalopathy (32.1 % vs. 17.4 %, p = 0.007) and hepatocarcinoma (61.7 % vs. 26.2 %; p = 0.000). No differences were found for Model for End-stage Liver Disease (19.28 ± 6.60 vs. 19,90 ± 5.78; p = 0.507) or Child-Pugh scores (p = 0.739). None of the patients who die in the intensive care unit receive palliative care (0 % vs 31.6 %; p = 0.000). Half of the palliative care consultations occurred 6,5 days before death. CONCLUSIONS Palliative care use differs based on demographics, disease complications, and severity. Despite its increasing implementation, palliative care intervention occurs late. Future investigations should identify approaches to achieve an earlier and concurrent care model.
Collapse
Affiliation(s)
- Hugo M Oliveira
- Palliative Care Unit, Matosinhos Local Health Unit, Rua Dr. Eduardo Torres, Senhora da Hora, Matosinhos, Portugal; Department of Social Sciences and Health, Faculty of Medicine, University of Porto, Porto, Portugal.
| | | | - Francisca Rego
- Department of Social Sciences and Health, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Rui Nunes
- Department of Social Sciences and Health, Faculty of Medicine, University of Porto, Porto, Portugal.
| |
Collapse
|
16
|
Lee WY, Lee TT, Hou IC, Guo CY, Chen MY, Mills ME. Using a Mobile Application to Promote Patient Education for Patients With Liver Cirrhosis. Comput Inform Nurs 2024:00024665-990000000-00228. [PMID: 39194408 DOI: 10.1097/cin.0000000000001189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
Patient education and self-management are essential for patients with liver cirrhosis. Based on Fisher and Fisher's Information-Motivation-Behavior Skills model, a Cirrhosis Care App was developed to support the education and self-management of these patients. To evaluate the effectiveness of the application, a randomized controlled trial was conducted with patients having liver cirrhosis who were being followed up in the outpatient area of a medical center in Taiwan. The experimental group used the app for 1 month, whereas a control group continued to receive conventional patient education. A pretest and posttest questionnaire was used to evaluate the app's effectiveness in improving the knowledge and practice of self-care. In addition, a questionnaire was developed based on the Technology Acceptance Model to understand satisfaction with the app. Results showed that following the implementation of the Cirrhosis Care App, patients' self-care knowledge and ability to promote self-care practice improved. User satisfaction with the app was measured and reflected in its frequency of use. This study confirmed that the Cirrhosis Care App, based on the Information-Motivation-Behavior Skills model, can improve patient knowledge and self-care practice and be actively promoted to benefit patients with cirrhosis.
Collapse
Affiliation(s)
- Wen-Ying Lee
- Author Affiliations: Nurse Specialist Team, Shuang Ho Hospital, New Taipei City (Ms Lee); College of Nursing (Drs Lee and Hou); Institute of Public Health (Dr Guo), National Yang Ming Chiao Tung University, Taipei; and Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine/College of Medicine/Taipei Medical University-Shuang Ho Hospital, New Taipei (Dr Chen), Taiwan; and School of Nursing, University of Maryland, Baltimore, MD (Dr Mills)
| | | | | | | | | | | |
Collapse
|
17
|
Zhou J, Li J, Pan Q, Ayada I. Efficacy of Addiction Pharmacotherapy in Alcohol Use Disorder and Their Effects on Liver Health. J Clin Transl Hepatol 2024; 12:750-754. [PMID: 39130618 PMCID: PMC11310752 DOI: 10.14218/jcth.2024.00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/28/2024] [Accepted: 05/04/2024] [Indexed: 08/13/2024] Open
Abstract
Both alcohol-associated liver disease (ALD) and metabolic dysfunction-associated steatotic liver disease are leading contributors to chronic liver diseases. These conditions often coexist, exacerbating disease progression. Despite ALD being a leading cause of liver transplantation, many individuals with alcohol use disorder (AUD) do not receive treatment. In this review, we discussed the epidemiology of ALD in AUD, various treatment options for AUD, and their efficacy on liver health. Our critical analysis of current evidence underscores the need for integrated models involving multiple stakeholders to improve ALD management.
Collapse
Affiliation(s)
- Jiahua Zhou
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | - Jiajing Li
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | - Qiuwei Pan
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | - Ibrahim Ayada
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
18
|
He C, Hu Z, Lin Z, Chen H, Cao C, Chen J, Yang X, Li H, Shen W, Wei X, Zhuang L, Zheng S, Xu X, Lu D. Chitinase-3 like-protein-1, a prognostic biomarker in patients with hepatocellular carcinoma and concomitant myosteatosis. BMC Cancer 2024; 24:1042. [PMID: 39179959 PMCID: PMC11342564 DOI: 10.1186/s12885-024-12808-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 08/14/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Chitinase-3 like-protein-1 (CHI3L1) is a member of the mammalian chitinase-like proteins and elevated serum CHI3L1 level has been proved to be associated with poor prognosis in hepatocellular carcinoma (HCC). This study aimed to investigate the relationship between serum CHI3L1 levels and body composition parameters in patients with HCC after liver transplantation (LT). METHODS This retrospective study enrolled 200 patients after LT for HCC. Blood samples were collected and serum concentrations of CHI3L1 were measured by enzyme-linked immunosorbent assay. Computer tomography (CT) were used to estimate skeletal muscle and adipose tissue mass. Spearman's rank correlation test was performed to assess associations between serum CHI3L1 levels and these body composition parameters. A Cox proportional-hazards regression model was performed to identify independent prognostic factors. Overall survival (OS) and recurrence-free survival (RFS) curves were constructed using the Kaplan-Meier method and compared by the log-rank test. RESULTS Total 71 patients (35.5%) were diagnosed with myosteatosis according to skeletal muscle radiation attenuation (SMRA). The 5-year OS rates were 66.9% in non-myosteatosis group, significantly higher than 49.5% in myosteatosis group (p = 0.025), while the RFS of myosteatosis group (5-year RFS: 52.6%) or non-myosteatosis group (5-year RFS: 42.0%) shown no significant difference (p = 0.068). The serum CHI3L1 level were significantly negative correlated with SMRA (r = -0.3, p < 0.001). Interestingly, in patients with myosteatosis, Kaplan-Meier analysis revealed that elevated serum CHI3L1 levels were associated with worse OS (p < 0.001) and RFS (p = 0.047). However, in patients without myosteatosis, Kaplan-Meier analysis found elevated serum CHI3L1 levels were not associated with OS (p = 0.070) or RFS (p = 0.104). CONCLUSIONS Elevated CHI3L1 was negatively correlated with SMRA, and predicted poorer prognosis in Chinese population after LT for HCC, especially in those patients with concomitant myosteatosis. Monitoring serum CHI3L1 can predict prognosis and effectively guide individual nutrition intervention.
Collapse
Affiliation(s)
- Chiyu He
- Zhejiang University School of Medicine, Hangzhou, China
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou, China
- NHC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou, China
| | - Zhihang Hu
- Zhejiang University School of Medicine, Hangzhou, China
| | - Zuyuan Lin
- Zhejiang University School of Medicine, Hangzhou, China
- Hangzhou First People's Hospital, Hangzhou, China
| | - Hao Chen
- Zhejiang University School of Medicine, Hangzhou, China
| | - Chenghao Cao
- Zhejiang University School of Medicine, Hangzhou, China
| | - Jinyan Chen
- Zhejiang University School of Medicine, Hangzhou, China
| | | | - Huigang Li
- Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Shen
- Zhejiang University School of Medicine, Hangzhou, China
| | - Xuyong Wei
- NHC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou, China
- Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Li Zhuang
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou, China
| | - Shusen Zheng
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou, China.
- NHC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou, China.
| | - Xiao Xu
- NHC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou, China.
- School of Clinical Medicine, Hangzhou Medical College, Hangzhou, China.
- Institute of Translational Medicine, Zhejiang University, Hangzhou, China.
| | - Di Lu
- NHC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou, China.
- Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China.
| |
Collapse
|
19
|
Harinstein ME, Gandolfo C, Gruttadauria S, Accardo C, Crespo G, VanWagner LB, Humar A. Cardiovascular disease assessment and management in liver transplantation. Eur Heart J 2024:ehae502. [PMID: 39152050 DOI: 10.1093/eurheartj/ehae502] [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: 11/14/2023] [Revised: 04/21/2024] [Accepted: 07/25/2024] [Indexed: 08/19/2024] Open
Abstract
The prevalence and mortality related to end-stage liver disease (ESLD) continue to rise globally. Liver transplant (LT) recipients continue to be older and have inherently more comorbidities. Among these, cardiac disease is one of the three main causes of morbidity and mortality after LT. Several reasons exist including the high prevalence of associated risk factors, which can also be attributed to the rise in the proportion of patients undergoing LT for metabolic dysfunction-associated steatohepatitis (MASH). Additionally, as people age, the prevalence of now treatable cardiac conditions, including coronary artery disease (CAD), cardiomyopathies, significant valvular heart disease, pulmonary hypertension, and arrhythmias rises, making the need to treat these conditions critical to optimize outcomes. There is an emerging body of literature regarding CAD screening in patients with ESLD, however, there is a paucity of strong evidence to support the guidance regarding the management of cardiac conditions in the pre-LT and perioperative settings. This has resulted in significant variations in assessment strategies and clinical management of cardiac disease in LT candidates between transplant centres, which impacts LT candidacy based on a transplant centre's risk tolerance and comfort level for caring for patients with concomitant cardiac disease. Performing a comprehensive assessment and understanding the potential approaches to the management of ESLD patients with cardiac conditions may increase the acceptance of patients, who appear too complex, but rather require extra evaluation and may be reasonable candidates for LT. The unique physiology of ESLD can profoundly influence preoperative assessment, perioperative management, and outcomes associated with underlying cardiac pathology, and requires a thoughtful multidisciplinary approach. The strategies proposed in this manuscript attempt to review the latest expert experience and opinions and provide guidance to practicing clinicians who assess and treat patients being considered for LT. These topics also highlight the gaps that exist in the comprehensive care of LT patients and the need for future investigations in this field.
Collapse
Affiliation(s)
- Matthew E Harinstein
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Caterina Gandolfo
- Unit of Interventional Cardiology, Department of Cardiothoracic Surgery, UPMC IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, UPMC IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Caterina Accardo
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, UPMC IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Gonzalo Crespo
- Liver Transplant Unit, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Lisa B VanWagner
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Abhinav Humar
- Division of Transplantation, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| |
Collapse
|
20
|
Oliveira HM, Ramos JP, Rego F, Nunes R. Palliative care and end stage liver disease: A survey study comparing perspectives of hepatology and palliative care physicians and clinical scenarios that could require palliative care intervention. Clin Res Hepatol Gastroenterol 2024; 48:102416. [PMID: 38986810 DOI: 10.1016/j.clinre.2024.102416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 07/05/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND AND AIMS The prevalence and mortality of chronic liver disease has risen significantly. In end stage liver disease (ESLD) the survival of patients is approximately 2 years. Despite the poor prognosis and high symptom burden of these patients, integration of palliative care is reduced. We aim to analyze the agreement between palliative care and hepatology physicians of clinical scenarios that could require palliative care intervention. METHODS A cross-sectional study was conducted. Palliative care and hepatology physicians were surveyed. Using a five-point Likert scale, their perceptions of palliative care in ESLD were rated. Their agreement in clinical scenarios that could require palliative care intervention were evaluated. Analyses were conducted to assess any differences by primary role (hepatology vs. palliative care) and length of practice (<10 years vs. 10 years). RESULTS A total of 123 responses were obtained: 52% from palliative care and 48% from hepatology. The majority (66.7%) work in the field for up to ten years. There was a great consensus in 4 of the 8 clinical scenarios. In scenarios with less consensus, the area of activity and length of practice influence the reliance of physicians on palliative care. Involvement of palliative care in ESLD was considered "rare" by 30% and 61% consider difficult to predict the prognosis. More than 90% support medical training in both areas of activity. CONCLUSION The current involvement of palliative care is considered low, but there are clinical conditions that reveal a clear consensus and there's a unanimous view of the relevance of training.
Collapse
Affiliation(s)
- Hugo M Oliveira
- Department of Social Sciences and Health, Faculty of Medicine, University of Porto, Porto, Portugal; Palliative Care Unit, Matosinhos Local Health Unit, Matosinhos, Portugal.
| | - José Presa Ramos
- Hepatology Unit of Internal Medicine Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Francisca Rego
- Department of Social Sciences and Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rui Nunes
- Department of Social Sciences and Health, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
21
|
Duan Y, Yang Y, Zhao S, Bai Y, Yao W, Gao X, Yin J. Crosstalk in extrahepatic and hepatic system in NAFLD/NASH. Liver Int 2024; 44:1856-1871. [PMID: 38717072 DOI: 10.1111/liv.15967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/28/2024] [Accepted: 04/26/2024] [Indexed: 07/17/2024]
Abstract
Non-alcoholic fatty liver disease (NAFLD) has emerged as the most prevalent chronic liver disease globally. Non-alcoholic steatohepatitis (NASH) represents an extremely progressive form of NAFLD, which, without timely intervention, may progress to cirrhosis or hepatocellular carcinoma. Presently, a definitive comprehension of the pathogenesis of NAFLD/NASH eludes us, and pharmacological interventions targeting NASH specifically remain constrained. The aetiology of NAFLD encompasses a myriad of external factors including environmental influences, dietary habits and gender disparities. More significantly, inter-organ and cellular interactions within the human body play a role in the development or regression of the disease. In this review, we categorize the influences affecting NAFLD both intra- and extrahepatically, elaborating meticulously on the mechanisms governing the onset and progression of NAFLD/NASH. This exploration delves into progress in aetiology and promising therapeutic targets. As a metabolic disorder, the development of NAFLD involves complexities related to nutrient metabolism, liver-gut axis interactions and insulin resistance, among other regulatory functions of extraneous organs. It further encompasses intra-hepatic interactions among hepatic cells, Kupffer cells (KCs) and hepatic stellate cells (HSCs). A comprehensive understanding of the pathogenesis of NAFLD/NASH from a macroscopic standpoint is instrumental in the formulation of future therapies for NASH.
Collapse
Affiliation(s)
- Yiliang Duan
- Jiangsu Key Laboratory of Druggability of Biopharmaceuticals and State Key Laboratory of Natural Medicines, School of Life Science and Technology, China Pharmaceutical University, Nanjing, China
| | - Yan Yang
- The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Shuqiang Zhao
- Jiangsu Institute for Food and Drug Control, NMPA Key Laboratory for Impurity Profile of Chemical Drugs, Nanjing, Jiangsu, China
| | - Yuesong Bai
- Jiangsu Key Laboratory of Druggability of Biopharmaceuticals and State Key Laboratory of Natural Medicines, School of Life Science and Technology, China Pharmaceutical University, Nanjing, China
| | - Wenbing Yao
- Jiangsu Key Laboratory of Druggability of Biopharmaceuticals and State Key Laboratory of Natural Medicines, School of Life Science and Technology, China Pharmaceutical University, Nanjing, China
| | - Xiangdong Gao
- Jiangsu Key Laboratory of Druggability of Biopharmaceuticals and State Key Laboratory of Natural Medicines, School of Life Science and Technology, China Pharmaceutical University, Nanjing, China
| | - Jun Yin
- Jiangsu Key Laboratory of Druggability of Biopharmaceuticals and State Key Laboratory of Natural Medicines, School of Life Science and Technology, China Pharmaceutical University, Nanjing, China
| |
Collapse
|
22
|
Lim N, Devuni D, German M, Guy J, Rabiee A, Sharma P, Shingina A, Shroff H, Pillai A. The rise of multidisciplinary clinics in hepatology: A practical, how-to-guide, and review of the literature. Hepatology 2024:01515467-990000000-00982. [PMID: 39212328 DOI: 10.1097/hep.0000000000001036] [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: 05/01/2024] [Accepted: 07/12/2024] [Indexed: 09/04/2024]
Abstract
Multidisciplinary clinics (MDCs) are gaining momentum throughout the medical field, having initially been pioneered in oncology clinics due to their inherent ability to streamline complex care and improve both patient outcomes and the patient care experience. Liver transplant and hepatobiliary tumor clinics are examples of established MDCs in hepatology. With the changing landscape of liver disease in regard to etiology and patient complexity and acuity, there is a clear need for efficient, highly coordinated care. These changes highlight opportunities for hepatology MDCs in alcohol-associated liver disease, metabolic dysfunction-associated steatotic liver disease, and palliative care. This review provides practical advice in navigating the complex logistics of establishing and maintaining a hepatology MDC while also reviewing the emerging evidence on clinical outcomes for patients seen in these MDCs. As hepatology looks to the future, establishment of MDCs in key clinical areas will be the cornerstone of patient care.
Collapse
Affiliation(s)
- Nicholas Lim
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Deepika Devuni
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Massachusetts, Worcester, Massachusetts, USA
| | - Margarita German
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jennifer Guy
- Department of Transplantation, California Pacific Medical Center, San Francisco, California, USA
| | - Atoosa Rabiee
- Division of Gastroenterology and Hepatology, Department of Medicine, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, USA
| | - Pratima Sharma
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Alexandra Shingina
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hersh Shroff
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Anjana Pillai
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| |
Collapse
|
23
|
Pang NQ, Chan ACY, Kow AWC. Trends of liver transplantation in Asia. Updates Surg 2024:10.1007/s13304-024-01924-1. [PMID: 39046632 DOI: 10.1007/s13304-024-01924-1] [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: 03/20/2024] [Accepted: 06/18/2024] [Indexed: 07/25/2024]
Abstract
Liver transplantation (LT) in Asia started comparatively early in 1964, just 1 year after Starzl's trail-blazing first attempt. Despite the quick start, LT was slow to develop in this region. Limited access to universal healthcare, lack of public understanding and support as well as the absence of strong legislation, on a backdrop of a wide range of diverse social, religious, economic and cultural background are all contributory factors. Through strong administrative efforts, the number of DDLTs in selected Asian countries has been slowly rising in recent years. However, Asians are generally still less likely to donate organs than Caucasians after death. The strong demand for LT with limited access to deceased organs has, therefore, led to constant need for innovation in LT this region, with the pioneering of various LDLT techniques and safe expansion of donor pool being driven primarily by Asian centers. Familiarity and the development of technical expertise in donor surgery have also resulted in Asian centers repeatedly pushing the boundaries on minimally invasive donor and recipient surgery. In this article, we focus on the past and present states of LT in Asia and explore the future trends of LT in this region.
Collapse
Affiliation(s)
- Ning Qi Pang
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, National University Health System, NUHS Tower Block, 1E, Kent Ridge Road, Level 8, Singapore, 119228, Singapore
- National University Centre for Organ Transplantation (NUCOT), National University Hospital, National University Health System, Singapore, Singapore
| | - Albert C Y Chan
- Division of Liver Transplantation, Department of Surgery, The University of Hong Kong, Hong Kong SAR, China
| | - Alfred Wei Chieh Kow
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, National University Health System, NUHS Tower Block, 1E, Kent Ridge Road, Level 8, Singapore, 119228, Singapore.
- National University Centre for Organ Transplantation (NUCOT), National University Hospital, National University Health System, Singapore, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| |
Collapse
|
24
|
Sugawara Y, Hibi T. Recent trends and new developments in liver transplantation. Biosci Trends 2024; 18:206-211. [PMID: 38945855 DOI: 10.5582/bst.2024.01176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Liver transplantation (LT) has been an established treatment for end-staged liver disease for acute, chronic, metabolic diseases and liver cancer. Advanced surgical techniques, refined indications and contraindications for LT, improvements of donor selection, prognostic scorings system and immunosuppressive regimens have contributed to the improved outcomes of liver transplantation. The etiologies of cirrhosis have been shifting from viral hepatitis to metabolic associated fatty liver disease. New indications include peripheral or mass forming bile duct cancer, metastases from bowel cancers or neuroendocrine tumors. Resection and partial liver segments 2-3 transplantation with delayed total hepatectomy has been performed to the limited cases, which was the explored technique of auxiliary partial orthotopic LT. Minimally invasive donor hepatectomy (laparoscopic or robotic) has been increasingly done. In this review are described the recent pressing topics in LT.
Collapse
Affiliation(s)
- Yasuhiko Sugawara
- Department of Transplantation/Pediatric Surgery, Postgraduate School of Life Science, Kumamoto University, Kumamoto, Japan
| | - Taizo Hibi
- Department of Transplantation/Pediatric Surgery, Postgraduate School of Life Science, Kumamoto University, Kumamoto, Japan
| |
Collapse
|
25
|
Wang S, Lin X, Tang Y, Liang Y, Zhang M, Xie Z, Guo Y, Dong Y, Zhao Q, Guo Z, Wang D, He X, Ju W, Chen M. Ischemia-free liver transplantation improves the prognosis of recipients using functionally marginal liver grafts. Clin Mol Hepatol 2024; 30:421-435. [PMID: 38600871 PMCID: PMC11261232 DOI: 10.3350/cmh.2024.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/23/2024] [Accepted: 04/11/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND/AIMS The shortage of donor liver hinders the development of liver transplantation. This study aimed to clarify the poor outcomes of functionally marginal liver grafts (FMLs) and provide evidence for the improvement of ischemia-free liver transplantation (IFLT) after FML transplantation. METHODS Propensity score matching was used to control for confounding factors. The outcomes of the control group and FML group were compared to demonstrate the negative impact of FMLs on liver transplantation patients. We compared the clinical improvements of the different surgical types. To elucidate the underlying mechanism, we conducted bioinformatic analysis based on transcriptome and single-cell profiles. RESULTS FMLs had a significantly greater hazard ratio (HR: 1.969, P=0.018) than did other marginal livers. A worse 90-day survival (Mortality: 12.3% vs. 5.0%, P=0.007) was observed in patients who underwent FML transplantation. Patients who received FMLs had a significant improvement in overall survival after IFLT (Mortality: 10.4% vs 31.3%, P=0.006). Pyroptosis and inflammation were inhibited in patients who underwent IFLT. The infiltration of natural killer cells was lower in liver grafts from these patients. Bulk transcriptome profiles revealed a positive relationship between IL-32 and Caspase 1 (R=0.73, P=0.01) and between IL-32 and Gasdermin D (R=0.84, P=0.0012). CONCLUSION FML is a more important negative prognostic parameter than other marginal liver parameters. IFLT might ameliorate liver injury in FMLs by inhibiting the infiltration of NK cells, consequently leading to the abortion of IL-32, which drives pyroptosis in monocytes and macrophages.
Collapse
Affiliation(s)
- Shuai Wang
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
| | - Xiaohong Lin
- Department of Thyroid and Breast Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yunhua Tang
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
| | - Yichen Liang
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
| | - Min Zhang
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
| | - Zhonghao Xie
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
| | - Yiwen Guo
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
| | - Yuqi Dong
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
| | - Qiang Zhao
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
| | - Zhiyong Guo
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
| | - Dongping Wang
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
| | - Xiaoshun He
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
| | - Weiqiang Ju
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
| | - Maogen Chen
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
| |
Collapse
|
26
|
Hanscom M, Law R. Transenteric Endoscopic Retrograde Cholangiopancreatography in Non-roux-en-Y Surgically Altered Anatomy. Gastrointest Endosc Clin N Am 2024; 34:511-522. [PMID: 38796296 DOI: 10.1016/j.giec.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2024]
Abstract
EDEE is a relatively safe and effective procedure when performed by expert endoscopists to establish pancreaticobiliary access in patients who have failed, or are not candidates for, traditional ERCP or alternative drainage modalities. Careful preprocedural planning with attention to the patient's specific postsurgical anatomy can optimize outcomes and minimize AEs.
Collapse
Affiliation(s)
- Mark Hanscom
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, 1283 York Avenue, 9th Floor, New York, NY 10065, USA.
| | - Ryan Law
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| |
Collapse
|
27
|
Attree C, Kokorelias K, Sinha S, Bhat M. Ageing with grace and graft. THE LANCET. HEALTHY LONGEVITY 2024; 5:e450-e451. [PMID: 38945126 DOI: 10.1016/s2666-7568(24)00111-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/17/2024] [Accepted: 06/03/2024] [Indexed: 07/02/2024] Open
Affiliation(s)
- Chloe Attree
- Ajmera Transplant Centre, University Health Network, Toronto, ON M5G 2C4, Canada; Department of Hepatology, Sir Charles Gairdner Hospital, WA, Australia.
| | - Kristina Kokorelias
- Division of Geriatric Medicine, Department of Medicine, Sinai Health and University Health Network, Toronto, ON, Canada; Department of Occupational Sciences and Occupational Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Samir Sinha
- Division of Geriatric Medicine, Department of Medicine, Sinai Health and University Health Network, Toronto, ON, Canada; Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MA, USA
| | - Mamatha Bhat
- Ajmera Transplant Centre, University Health Network, Toronto, ON M5G 2C4, Canada; Division of Gastroenterology & Hepatology, Department of Medicine, University of Toronto, Toronto, ON, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| |
Collapse
|
28
|
Qin X, Wang H, Li Q, Hu D, Wang L, Zhou B, Liao R, Liu Y. Salidroside ameliorates acute liver transplantation rejection in rats by inhibiting neutrophil extracellular trap formation. Acta Biochim Biophys Sin (Shanghai) 2024; 56:833-843. [PMID: 38716542 PMCID: PMC11214976 DOI: 10.3724/abbs.2024055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/04/2024] [Indexed: 06/14/2024] Open
Abstract
Acute rejection is an important factor affecting the survival of recipients after liver transplantation. Salidroside has various properties, including anti-inflammatory, antioxidant, and hepatoprotective properties. This study aims to investigate whether salidroside can prevent acute rejection after liver transplantation and to examine the underlying mechanisms involved. An in vivo acute rejection model is established in rats that are pretreated with tacrolimus (1 mg/kg/d) or salidroside (10 or 20 mg/kg/d) for seven days after liver transplantation. In addition, an in vitro experiment is performed using neutrophils incubated with salidroside (1, 10, 50 or 100 μM). Hematoxylin-eosin staining, terminal deoxynucleotidyl transferase dUTP nick-end labeling staining, immunosorbent assays, immunofluorescence analysis, Evans blue staining, and western blot analysis are performed to examine the impact of salidroside on NET formation and acute rejection in vitro and in vivo. We find that Salidroside treatment reduces pathological liver damage, serum aminotransferase level, and serum levels of IL-1β, IL-6, and TNF-α in vivo. The expressions of proteins associated with the HMGB1/TLR-4/MAPK signaling pathway (HMGB1, TLR-4, p-ERK1/2, p-JNK, p-P38, cleaved caspase-3, cleaved caspase-9, Bcl-2, Bax, IL-1β, TNF-α, and IL-6) are also decreased after salidroside treatment. In vitro experiments show that the release of HMGB1/TLR-4/MAPK signaling pathway-associated proteins from neutrophils treated with lipopolysaccharide is decreased by salidroside. Moreover, salidroside inhibits NETosis and protects against acute rejection by regulating the HMGB1/TLR-4/MAPK signaling pathway. Furthermore, salidroside combined with tacrolimus has a better effect than either of the other treatments alone. In summary, salidroside can prevent acute liver rejection after liver transplantation by reducing neutrophil extracellular trap development through the HMGB1/TLR-4/MAPK signaling pathway.
Collapse
Affiliation(s)
- Xiaoyan Qin
- Department of Hepatobiliary Surgerythe First Affiliated Hospital of Chongqing Medical UniversityChongqing400042China
- Department of General Surgery and Trauma SurgeryChildren’s Hospital of Chongqing Medical UniversityNational Clinical Research Center for Child Health and DisordersMinistry of Education Key Laboratory of Child Development and DisordersChongqing Key Laboratory of Structural Birth Defect and ReconstructionChongqing400014China
| | - Han Wang
- Department of Hepatobiliary Surgerythe First Affiliated Hospital of Chongqing Medical UniversityChongqing400042China
| | - Qi Li
- Department of Hepatobiliary Surgerythe First Affiliated Hospital of Chongqing Medical UniversityChongqing400042China
| | - Dingheng Hu
- Department of Hepatobiliary Surgerythe First Affiliated Hospital of Chongqing Medical UniversityChongqing400042China
| | - Liangxu Wang
- Department of Hepatobiliary Surgerythe First Affiliated Hospital of Chongqing Medical UniversityChongqing400042China
| | - Baoyong Zhou
- Department of Hepatobiliary Surgerythe First Affiliated Hospital of Chongqing Medical UniversityChongqing400042China
| | - Rui Liao
- Department of Hepatobiliary Surgerythe First Affiliated Hospital of Chongqing Medical UniversityChongqing400042China
| | - Yanyao Liu
- Department of Hepatobiliary Surgerythe First Affiliated Hospital of Chongqing Medical UniversityChongqing400042China
| |
Collapse
|
29
|
Hashem M, Medhat MA, Abdeltawab D, Makhlouf NA. Expanding the liver donor pool worldwide with hepatitis C infected livers, is it the time? World J Transplant 2024; 14:90382. [PMID: 38947961 PMCID: PMC11212581 DOI: 10.5500/wjt.v14.i2.90382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/29/2024] [Accepted: 04/12/2024] [Indexed: 06/13/2024] Open
Abstract
Liver transplantation (LT) provides a life-saving option for cirrhotic patients with complications and hepatocellular carcinoma. Despite the increasing number of liver transplants performed each year, the number of LT candidates on the waitlist remains unchanged due to an imbalance between donor organ supply and the demand which increases the waitlist time and mortality. Living donor liver transplant had a great role in increasing the donor pool and shortened waitlist time for LT candidates. Nevertheless, further strategies can be implemented to increase the pool of potential donors in deceased donor LT, such as reducing the rate of organ discards. Utilizing hepatitis C virus (HCV) seropositive liver grafts is one of the expanded donor organ criteria. A yearly increase of hundreds of transplants is anticipated as a result of maximizing the utilization of HCV-positive organs for HCV-negative recipients. Direct-acting antiviral therapy's efficacy has revolutionized the treatment of HCV infection and the use of HCV-seropositive donors in transplantation. The American Society of Transplantation advises against performing transplants from HCV-infected liver donors (D+) into HCV-negative recipient (R-) unless under Institutional Review Board-approved study rules and with full informed consent of the knowledge gaps associated with such transplants. Proper selection of patients to be transplanted with HCV-infected grafts and confirming their access to direct-acting antivirals if needed is important. National and international consensuses are needed to regulate this process to ensure the maximum benefit and the least adverse events.
Collapse
Affiliation(s)
- Mai Hashem
- Fellow of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut 71515, Egypt
| | - Mohammed A Medhat
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Doaa Abdeltawab
- Department of Tropical Medicine and Gastroenterology, Al-Rajhi Liver Hospital, Assiut University, Assiut 71515, Egypt
| | - Nahed A Makhlouf
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| |
Collapse
|
30
|
Inayat F, Patel P, Ali H, Afzal A, Tahir H, Chaudhry A, Ishtiaq R, Rehman AU, Darji K, Afzal MS, Nawaz G, Giammarino A, Satapathy SK. Impact of COVID-19 on liver transplant recipients: A nationwide cohort study evaluating hospitalization, transplant rejection, and inpatient mortality. World J Transplant 2024; 14:90866. [PMID: 38947960 PMCID: PMC11212588 DOI: 10.5500/wjt.v14.i2.90866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/22/2024] [Accepted: 04/23/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has posed a major public health concern worldwide. Patients with comorbid conditions are at risk of adverse outcomes following COVID-19. Solid organ transplant recipients with concurrent immunosuppression and comorbidities are more susceptible to a severe COVID-19 infection. It could lead to higher rates of inpatient complications and mortality in this patient population. However, studies on COVID-19 outcomes in liver transplant (LT) recipients have yielded inconsistent findings. AIM To evaluate the impact of the COVID-19 pandemic on hospital-related outcomes among LT recipients in the United States. METHODS We conducted a retrospective cohort study using the 2019-2020 National Inpatient Sample database. Patients with primary LT hospitalizations and a secondary COVID-19 diagnosis were identified using the International Classification of Diseases, Tenth Revision coding system. The primary outcomes included trends in LT hospitalizations before and during the COVID-19 pandemic. Secondary outcomes included comparative trends in inpatient mortality and transplant rejection in LT recipients. RESULTS A total of 15720 hospitalized LT recipients were included. Approximately 0.8% of patients had a secondary diagnosis of COVID-19 infection. In both cohorts, the median admission age was 57 years. The linear trends for LT hospitalizations did not differ significantly before and during the pandemic (P = 0.84). The frequency of in-hospital mortality for LT recipients increased from 1.7% to 4.4% between January 2019 and December 2020. Compared to the pre-pandemic period, a higher association was noted between LT recipients and in-hospital mortality during the pandemic, with an odds ratio (OR) of 1.69 [95% confidence interval (CI): 1.55-1.84), P < 0.001]. The frequency of transplant rejections among hospitalized LT recipients increased from 0.2% to 3.6% between January 2019 and December 2020. LT hospitalizations during the COVID-19 pandemic had a higher association with transplant rejection than before the pandemic [OR: 1.53 (95%CI: 1.26-1.85), P < 0.001]. CONCLUSION The hospitalization rates for LT recipients were comparable before and during the pandemic. Inpatient mortality and transplant rejection rates for hospitalized LT recipients were increased during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Faisal Inayat
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Punjab 54550, Pakistan
| | - Pratik Patel
- Division of Gastroenterology, Mather Hospital and Zucker School of Medicine at Hofstra University, Port Jefferson, NY 11777, United States
| | - Hassam Ali
- Division of Gastroenterology and Hepatology, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States
| | - Arslan Afzal
- Division of Gastroenterology and Hepatology, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States
| | - Hamza Tahir
- Department of Internal Medicine, Jefferson Einstein Hospital, Philadelphia, PA 19141, United States
| | - Ahtshamullah Chaudhry
- Department of Internal Medicine, St. Dominic's Hospital, Jackson, MS 39216, United States
| | - Rizwan Ishtiaq
- Department of Internal Medicine, Saint Francis Hospital and Medical Center, Hartford, CT 06105, United States
| | - Attiq Ur Rehman
- Division of Hepatology, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA 18711, United States
| | - Kishan Darji
- Department of Internal Medicine, Campbell University and Cape Fear Valley Medical Center, Fayetteville, NC 28301, United States
| | - Muhammad Sohaib Afzal
- Department of Internal Medicine, Louisiana State University Health, Shreveport, LA 71103, United States
| | - Gul Nawaz
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Punjab 54550, Pakistan
| | - Alexa Giammarino
- Department of Internal Medicine, North Shore University Hospital and Zucker School of Medicine at Hofstra University, Manhasset, NY 11030, United States
| | - Sanjaya K Satapathy
- Division of Hepatology, North Shore University Hospital and Zucker School of Medicine at Hofstra University, Manhasset, NY 11030, United States
| |
Collapse
|
31
|
Ko SH, Cao J, Yang YK, Xi ZF, Han HW, Sha M, Xia Q. Development of a deep learning model for predicting recurrence of hepatocellular carcinoma after liver transplantation. Front Med (Lausanne) 2024; 11:1373005. [PMID: 38919938 PMCID: PMC11196752 DOI: 10.3389/fmed.2024.1373005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
Background Liver transplantation (LT) is one of the main curative treatments for hepatocellular carcinoma (HCC). Milan criteria has long been applied to candidate LT patients with HCC. However, the application of Milan criteria failed to precisely predict patients at risk of recurrence. As a result, we aimed to establish and validate a deep learning model comparing with Milan criteria and better guide post-LT treatment. Methods A total of 356 HCC patients who received LT with complete follow-up data were evaluated. The entire cohort was randomly divided into training set (n = 286) and validation set (n = 70). Multi-layer-perceptron model provided by pycox library was first used to construct the recurrence prediction model. Then tabular neural network (TabNet) that combines elements of deep learning and tabular data processing techniques was utilized to compare with Milan criteria and verify the performance of the model we proposed. Results Patients with larger tumor size over 7 cm, poorer differentiation of tumor grade and multiple tumor numbers were first classified as high risk of recurrence. We trained a classification model with TabNet and our proposed model performed better than the Milan criteria in terms of accuracy (0.95 vs. 0.86, p < 0.05). In addition, our model showed better performance results with improved AUC, NRI and hazard ratio, proving the robustness of the model. Conclusion A prognostic model had been proposed based on the use of TabNet on various parameters from HCC patients. The model performed well in post-LT recurrence prediction and the identification of high-risk subgroups.
Collapse
Affiliation(s)
- Seung Hyoung Ko
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Medicine, CHA University, Seongnam-si, Republic of Korea
| | - Jie Cao
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yong-kang Yang
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhi-feng Xi
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hyun Wook Han
- Department of Medicine, CHA University, Seongnam-si, Republic of Korea
| | - Meng Sha
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiang Xia
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
32
|
Willoughby ME, Ramsey-Morrow JL, Littell KA, Hammond FM. Acute Inpatient Rehabilitation Functional Outcomes and Disposition After Liver Transplant. Arch Rehabil Res Clin Transl 2024; 6:100332. [PMID: 39006115 PMCID: PMC11240025 DOI: 10.1016/j.arrct.2024.100332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024] Open
Abstract
Objective To describe the outcomes (change in functional independence and discharge disposition) of patients who after liver transplantation received acute inpatient rehabilitation in a freestanding rehabilitation hospital. Design A retrospective chart review was conducted of patients admitted to an acute inpatient rehabilitation hospital within 6 months of undergoing liver transplantation between January 2014 and December 2018. Change in function from rehabilitation admission to discharge was measured using FIM Change and FIM Efficiency. Setting A freestanding rehabilitation hospital. Participants 107 patients who underwent acute inpatient rehabilitation at a freestanding rehabilitation hospital within 6 months after liver transplantation who met inclusion criteria (N=107). Most were men (71.96%), and the mean age of the patient population was 62.15 years. Interventions Acute inpatient rehabilitation consisting of at least 3 hours of therapy 5 days a week split between physical therapy, occupational therapy, and speech language pathology services. Main Outcome Measure FIM Change, FIM Efficiency, Discharge Disposition. Results Participants were found to have statistically significant positive FIM Change (P<.00001) and FIM Efficiency (P<.00001). The mean FIM Change and Efficiency were 35.7±11.8 and 2.4±1.0, respectively. 83.2% (n = 89) were ultimately discharged to the community. Conclusion Acute inpatient rehabilitation provides patients who have received a liver transplant with the opportunity to measurably improve their function and independence, with most patients being able to return home.
Collapse
Affiliation(s)
| | - Jacob L Ramsey-Morrow
- Indiana University Health, Department of Physical Medicine & Rehabilitation, Indianapolis, IN
| | - Kyle A Littell
- Indiana University Health, Department of Physical Medicine & Rehabilitation, Indianapolis, IN
| | - Flora M Hammond
- Indiana University School of Medicine, Department of Physical Medicine & Rehabilitation, Indianapolis, IN
| |
Collapse
|
33
|
Ghoshal A, Marks S, Esteban JP. When Is the Optimal Time to Refer Patients with End-Stage Liver Disease to Palliative Care Specialists? #481. J Palliat Med 2024; 27:813-815. [PMID: 38686513 DOI: 10.1089/jpm.2024.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
|
34
|
Laporte CCM, Brown B, Wilke TJ, Kassel CA. 2023 Clinical Update in Liver Transplantation. J Cardiothorac Vasc Anesth 2024; 38:1390-1396. [PMID: 38490899 DOI: 10.1053/j.jvca.2024.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 02/19/2024] [Indexed: 03/17/2024]
Abstract
Liver transplantation continues to provide life-saving treatment for patients with end-stage liver disease. Advances in the field of transplant anesthesia continue to support the care of more complex patients. The use of extracorporeal membrane oxygenation has been described in critical care settings and cardiac surgery but may be a valuable option for specific conditions for patients undergoing liver transplantation. Changes to the allocation process for liver grafts now focus on acuity circles to reduce regional disparities. As the number of life-saving transplant surgeries increases, so does the need for specialty knowledge in the anesthetic considerations of these procedures. The specialty of transplant anesthesia continues to grow and develop to meet the demands of complex patients and the increased number of transplants performed. Liver transplantation can be a resource-demanding procedure, and predicting the need for massive transfusion can aid in planning and preparing for significant blood loss.
Collapse
Affiliation(s)
| | - Brittany Brown
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE
| | - Trevor J Wilke
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE
| | - Cale A Kassel
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE.
| |
Collapse
|
35
|
Banerjee A, Das D, Mukherjee S, Maji BK. Comprehensive study of the interplay between immunological and metabolic factors in hepatic steatosis. Int Immunopharmacol 2024; 133:112091. [PMID: 38657500 DOI: 10.1016/j.intimp.2024.112091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
The pathophysiology of hepatic steatosis is thoroughly reviewed in this comprehensive report, with particular attention to the complex interactions between inflammatory pathways, insulin resistance, lipid metabolism, metabolic dysregulation, and immunological responses in the liver including non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH), and hepatocellular carcinoma (HCC). The study highlights the role of immune cell regulation in disease progression and explores the potential of immune cell-specific treatments for treating hepatic disorders. The development of liver disorders is significantly influenced by immune cells, including dendritic cells, T cells, and natural killer cells. Clinical investigations show that immune cell-specific treatments can effectively reduce liver fibrosis and inflammation. Future research should focus on finding new immunological targets for therapeutic interventions, as well as addressing the management challenges associated with NAFLD/NASH. Hepatic immune microorganisms also impact liver homeostasis and disorders. Improvements in immune cell regulation and liver transplantation methods give patients hope for better prognoses. Important phases include optimizing the selection of donors for malignancy of the liver, using machine perfusion for organ preservation, and fine-tuning immunosuppressive strategies. For focused treatments in hepatic steatosis, it is imperative to understand the intricate interactions between immune and metabolic variables. Understanding the liver's heterogeneous immune profile, encompassing a range of immune cell subpopulations, is crucial for formulating focused therapeutic interventions. To improve patient care and outcomes in hepatic illnesses, there is an urgent need for further research and innovation. Therefore, to effectively treat hepatic steatosis, it is important to enhance therapeutic techniques and maximize liver transplantation strategies.
Collapse
Affiliation(s)
- Arnab Banerjee
- Department of Physiology (UG & PG), Serampore College, 9 William Carey Road, Serampore, Hooghly 712201, West Bengal, India.
| | - Debasmita Das
- Department of Physiology (UG & PG), Serampore College, 9 William Carey Road, Serampore, Hooghly 712201, West Bengal, India
| | - Sandip Mukherjee
- Department of Physiology (UG & PG), Serampore College, 9 William Carey Road, Serampore, Hooghly 712201, West Bengal, India
| | - Bithin Kumar Maji
- Department of Physiology (UG & PG), Serampore College, 9 William Carey Road, Serampore, Hooghly 712201, West Bengal, India.
| |
Collapse
|
36
|
Semash KO. Post-liver transplant biliary complications. RUSSIAN JOURNAL OF TRANSPLANTOLOGY AND ARTIFICIAL ORGANS 2024; 26:72-90. [DOI: 10.15825/1995-1191-2024-3-72-90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
Biliary complications (BCs) are the most frequent complications following liver transplantation (LT). They are a major source of morbidity after LT. The incidence of BCs after LT is reported to range from 5% to 45%. The main post-LT biliary complications are strictures, biliary fistulas and bilomas, cholelithiasis, sphincter of Oddi dysfunction, hemobilia, and mucocele. Risk factors for biliary complications are diverse. In this article we seek to review the main types of biliary complications and modern approaches to their diagnosis and treatment.
Collapse
|
37
|
Feng GY, Feng X, Tao J, Ao YP, Wu XH, Qi SG, He ZB, Shi ZR. Benefits of Hypothermic Oxygenated Perfusion Versus Static Cold Storage in Liver Transplant: A Comprehensive Systematic Review and Meta-analysis. J Clin Exp Hepatol 2024; 14:101337. [PMID: 38298754 PMCID: PMC10825013 DOI: 10.1016/j.jceh.2023.101337] [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: 10/01/2023] [Accepted: 12/17/2023] [Indexed: 02/02/2024] Open
Abstract
Background The magnitude of potential benefits that hypothermic oxygenated perfusion (HOPE) may provide for liver transplantation (LT) patients compared to static cold storage (SCS) remains uncertain. In this systematic review and meta-analysis, we aimed to investigate the therapeutic effect that HOPE can offer LT recipients relative to SCS by synthesizing available evidence. Methods A literature search was conducted in Embase, Medline, Web of Science, and the Cochrane database up to 1 June, 2023. The included studies were pooled for meta-analysis to synthesize their findings. Subgroup analysis was performed to investigate potential differences between HOPE and SCS for specific subgroups. Results A total of 11 studies comprising 1765 patients were included. Compared with SCS, HOPE was associated with a significant reduction in the incidence of early allograft dysfunction (EAD) (OR: 0.36, 95% CI: 0.26-0.50), as well as a noteworthy decrease in graft loss rate within one year (OR: 0.57, 95% CI: 0.33-0.97) and a lower occurrence of Clavien-Dindo grade IIIa or higher complications (OR: 0.62, 95% CI: 0.43-0.89). Subgroup analysis revealed that HOPE significantly reduced the one-year mortality rate, any biliary complications incidence, and acute rejection of transplanted liver rate in patients who received organs from donation after cardiac death (DCD). Conclusions HOPE has demonstrated efficacy in reducing the incidence of EAD after LT and shows some potential in diminishing postoperative complications such as biliary complications and acute rejection. This ultimately leads to improved patient prognosis, particularly among those receiving DCD grafts.
Collapse
Affiliation(s)
- Guo-Ying Feng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Xu Feng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Tao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu-Pei Ao
- Infection and Liver Disease Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xin-Hua Wu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shi-Guai Qi
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ze-Bo He
- Department of General Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Zheng-Rong Shi
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
38
|
Semenova Y, Beyembetova A, Shaisultanova S, Asanova A, Sailybayeva A, Altynova S, Pya Y. Evaluation of liver transplantation services in Kazakhstan from 2012 to 2023. Sci Rep 2024; 14:9304. [PMID: 38654041 DOI: 10.1038/s41598-024-60086-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/18/2024] [Indexed: 04/25/2024] Open
Abstract
There is a scarcity of publications evaluating the performance of the national liver transplantation (LTx) program in Kazakhstan. Spanning from 2012 to 2023, it delves into historical trends in LTx surgeries, liver transplant centers, and the national cohort of patients awaiting LTx. Survival analysis for those awaiting LTx, using life tables and Kaplan-Meier, is complemented by time series analysis projecting developments until 2030. The overall per million population (pmp) LTx rate varied from 0.35 to 3.77, predominantly favoring living donor LTx. Liver transplant center rates ranged from 0.06 to 0.40. Of 474 LTx patients, 364 on the waiting list did not receive transplantation. The 30-day and 1-year survival rates on the waiting list were 87.0% and 68.0%, respectively. Viral hepatitis and cirrhosis prevalence steadily rose from 2015 to 2023, with projections indicating a persistent trend until 2030. Absent targeted interventions, stable pmp rates of LTx and liver transplant centers may exacerbate the backlog of unoperated patients. This study sheds light on critical aspects of the LTx landscape in Kazakhstan, emphasizing the urgency of strategic interventions to alleviate the burden on patients awaiting transplantation.
Collapse
Affiliation(s)
- Yuliya Semenova
- School of Medicine, Nazarbayev University, 010000, Astana, Kazakhstan
| | - Altynay Beyembetova
- RSE on PCV "Republican Center for Coordination of Transplantation and High-Tech Medical Services", Ministry of Health, 010000, Astana, Kazakhstan.
| | - Saule Shaisultanova
- RSE on PCV "Republican Center for Coordination of Transplantation and High-Tech Medical Services", Ministry of Health, 010000, Astana, Kazakhstan
| | - Aruzhan Asanova
- Corporate Fund "University Medical Center", 010000, Astana, Kazakhstan
| | - Aliya Sailybayeva
- Corporate Fund "University Medical Center", 010000, Astana, Kazakhstan
| | - Sholpan Altynova
- Corporate Fund "University Medical Center", 010000, Astana, Kazakhstan
| | - Yuriy Pya
- Corporate Fund "University Medical Center", 010000, Astana, Kazakhstan
| |
Collapse
|
39
|
Åberg F, Jiang ZG, Cortez-Pinto H, Männistö V. Alcohol-associated liver disease-Global epidemiology. Hepatology 2024:01515467-990000000-00852. [PMID: 38640041 DOI: 10.1097/hep.0000000000000899] [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: 01/29/2024] [Accepted: 03/23/2024] [Indexed: 04/21/2024]
Abstract
Alcohol-associated liver disease (ALD), as highlighted in this narrative review, is a major public health concern, increasingly impacting global disease burden and premature mortality. In 2019, ALD accounted for the loss of 11 million life-years worldwide. The rising number of deaths and disability-adjusted life-years attributed to ALD, particularly pronounced in the United States, are alarming. Projections suggest that the economic impact of ALD, as seen in the United States, could potentially double by 2040. ALD is increasingly prevalent among younger adults (20-45 y) and has become the leading cause of liver transplantation in both United States and Europe. During the COVID-19 pandemic, the existing trend was further amplified as high-risk drinking patterns coincided with a rise in hospital admissions for alcohol-associated hepatitis and increased ALD-related mortality. The prevalence of ALD is estimated at 3.5% in the general population, 26.0% among hazardous drinkers, and 55.1% among those with alcohol use disorders. Alarmingly, 5-year mortality rates for patients with ALD exceed 50%, with even higher rates in more advanced disease stages. Methodological challenges, such as underreporting, diagnostic difficulties, and variability in registry data quality, complicate the accurate assessment of the impact of ALD. Additionally, the contribution of alcohol to the progression of other liver diseases is often under acknowledged in health care registries, leading to a significant underestimation of its broader implications for liver health. Addressing the growing ALD concern requires robust public health initiatives, heightened awareness, refined diagnostic techniques, and comprehensive epidemiological studies. These measures are vital to tackle the increasing prevalence of ALD and mitigate its extensive impact on individuals and health care systems.
Collapse
Affiliation(s)
- Fredrik Åberg
- Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Z Gordon Jiang
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Helena Cortez-Pinto
- Clínica Universitária de Gastrenterologia, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Ville Männistö
- Department of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
40
|
Chiang HJ, Chuang YH, Li CW, Lin CC, Eng HL, Chen CL, Cheng YF, Chou MC. Usefulness of Diffusion-Weighted Imaging in Evaluating Acute Cellular Rejection and Monitoring Treatment Response in Liver Transplant Recipients. Diagnostics (Basel) 2024; 14:807. [PMID: 38667453 PMCID: PMC11049147 DOI: 10.3390/diagnostics14080807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/29/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Acute cellular rejection (ACR) is a significant immune issue among recipients following liver transplantation. Although diffusion-weighted magnetic resonance imaging (DWI) is widely used for diagnosing liver disease, it has not yet been utilized for monitoring ACR in patients after liver transplantation. Therefore, the aim of this study was to evaluate the efficacy of DWI in monitoring treatment response among recipients with ACR. This study enrolled 25 recipients with highly suspected ACR rejection, and all subjects underwent both biochemistry and DWI scans before and after treatment. A pathological biopsy was performed 4 to 24 h after the first MRI examination to confirm ACR and degree of rejection. All patients were followed up and underwent a repeated MRI scan when their liver function returned to the normal range. After data acquisition, the DWI data were post-processed to obtain the apparent diffusion coefficient (ADC) map on a voxel-by-voxel basis. Five regions of interest were identified on the liver parenchyma to measure the mean ADC values from each patient. Finally, the mean ADC values and biochemical markers were statistically compared between ACR and non-ACR groups. A receiver operating characteristic (ROC) curve was constructed to evaluate the performance of the ADC and biochemical data in detecting ACR, and correlation analysis was used to understand the relationship between the ADC values, biochemical markers, and the degree of rejection. The histopathologic results revealed that 20 recipients had ACR, including 10 mild, 9 moderate, and 1 severe rejection. The results demonstrated that the ACR patients had significantly lower hepatic ADC values than those in patients without ACR. After treatment, the hepatic ADC values in ACR patients significantly increased to levels similar to those in non-ACR patients with treatment. The ROC analysis showed that the sensitivity and specificity for detecting ACR were 80% and 95%, respectively. Furthermore, the correlation analysis revealed that the mean ADC value and alanine aminotransferase level had strong and moderate negative correlation with the degree of rejection, respectively (r = -0.72 and -0.47). The ADC values were useful for detecting hepatic ACR and monitoring treatment response after immunosuppressive therapy.
Collapse
Affiliation(s)
- Hsien-Jen Chiang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (H.-J.C.); (Y.-H.C.)
- Department of Diagnostic Radiology, Kaohsiung Municipal Feng Shan Hospital—Under the Management of Chang Gung Medical Foundation, Kaohsiung 83062, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Yi-Hsuan Chuang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (H.-J.C.); (Y.-H.C.)
| | - Chun-Wei Li
- Department of Medical Imaging and Radiological Sciences, College of Health Science, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Chih-Che Lin
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (C.-C.L.); (C.-L.C.)
- Department of Surgery, Kaohsiung Municipal Feng Shan Hospital—Under the Management of Chang Gung Medical Foundation, Kaohsiung 83062, Taiwan
| | - Hock-Liew Eng
- Department of Pathology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan;
| | - Chao-Long Chen
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (C.-C.L.); (C.-L.C.)
| | - Yu-Fan Cheng
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (H.-J.C.); (Y.-H.C.)
| | - Ming-Chung Chou
- Department of Medical Imaging and Radiological Sciences, College of Health Science, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| |
Collapse
|
41
|
Zhou AW, Jin J, Liu Y. Cellular strategies to induce immune tolerance after liver transplantation: Clinical perspectives. World J Gastroenterol 2024; 30:1791-1800. [PMID: 38659486 PMCID: PMC11036497 DOI: 10.3748/wjg.v30.i13.1791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/03/2024] [Accepted: 03/14/2024] [Indexed: 04/03/2024] Open
Abstract
Liver transplantation (LT) has become the most efficient treatment for pediatric and adult end-stage liver disease and the survival time after transplantation is becoming longer due to the development of surgical techniques and perioperative management. However, long-term side-effects of immunosuppressants, like infection, metabolic disorders and malignant tumor are gaining more attention. Immune tolerance is the status in which LT recipients no longer need to take any immunosuppressants, but the liver function and intrahepatic histology maintain normal. The approaches to achieve immune tolerance after transplantation include spontaneous, operational and induced tolerance. The first two means require no specific intervention but withdrawing immunosuppressant gradually during follow-up. No clinical factors or biomarkers so far could accurately predict who are suitable for immunosuppressant withdraw after transplantation. With the understanding to the underlying mechanisms of immune tolerance, many strategies have been developed to induce tolerance in LT recipients. Cellular strategy is one of the most promising methods for immune tolerance induction, including chimerism induced by hematopoietic stem cells and adoptive transfer of regulatory immune cells. The safety and efficacy of various cell products have been evaluated by prospective preclinical and clinical trials, while obstacles still exist before translating into clinical practice. Here, we will summarize the latest perspectives and concerns on the clinical application of cellular strategies in LT recipients.
Collapse
Affiliation(s)
- Ai-Wei Zhou
- Department of Liver Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Jing Jin
- Department of Nursing, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Yuan Liu
- Department of Liver Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
- Department of Liver Transplantation, Shanghai Immune Therapy Institute, Shanghai 200127, China
| |
Collapse
|
42
|
Ozturk NB, Bartosek N, Toruner MD, Mumtaz A, Simsek C, Dao D, Saberi B, Gurakar A. Approach to Liver Transplantation: Is There a Difference between East and West? J Clin Med 2024; 13:1890. [PMID: 38610655 PMCID: PMC11012910 DOI: 10.3390/jcm13071890] [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: 02/24/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Liver transplantation (LT) remains the only curative treatment for end-stage liver disease as well as acute liver failure. With the exponential increase in organ demand due to the increasing incidence and prevalence of liver diseases, the need to overcome the supply and demand mismatch has arisen. In this review, we discuss the current universal status of LT, emphasizing various LT practices worldwide.
Collapse
Affiliation(s)
- Nazli Begum Ozturk
- Department of Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI 48073, USA
| | - Nathanial Bartosek
- Department of Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI 48073, USA
| | | | - Aymen Mumtaz
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Cem Simsek
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Doan Dao
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Behnam Saberi
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Ahmet Gurakar
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD 21205, USA
| |
Collapse
|
43
|
Tan Y, Wang Z, Guo R, Zhou X, Zhang W, Wu M, Guo C, Gao H, Sun X, Zhang Z, Gong T. Dual-Targeting Macrophages and Hepatic Stellate Cells by Modified Albumin Nanoparticles for Liver Cirrhosis Treatment. ACS APPLIED MATERIALS & INTERFACES 2024; 16:11239-11250. [PMID: 38395769 DOI: 10.1021/acsami.3c17670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Hepatic cirrhosis has become a global public health concern with high mortality and currently lacks effective clinical treatment methods. Activation of hepatic stellate cells (HSCs) and the large number of macrophages infiltrating into the liver play a critical role in the development of liver cirrhosis. This study developed a novel modified nanoparticle system (SRF-CS-PSA NPs) in which Sorafenib (SRF) was encapsulated by palmitic acid-modified albumin (PSA) and further modified with chondroitin sulfate (CS). These modifications enabled the SRF-CS-PSA NPs to effectively target hepatic stellate cells (HSCs) and macrophages. SRF-CS-PSA NPs showed uniform particle size distribution of approximately 120 nm and high loading efficiency of up to 99.5% and can be taken up by HSCs and macrophages via CD44 and SR-A receptors, respectively. In a mouse model of liver cirrhosis, SRF-CS-PSA NPs demonstrated superior targeting and inhibition of HSCs and macrophages, effectively reversing the process of liver cirrhosis. Overall, our study demonstrates the potential of SRF-CS-PSA NPs as a targeted therapy for liver cirrhosis, with promising clinical applications.
Collapse
Affiliation(s)
- Yulu Tan
- Key Laboratory of Drug-Targeting & Drug Delivery System of the Education Ministry, Sichuan Engineering Laboratory for Plant-Sourced Drugs & Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610064, P. R. China
| | - Zijun Wang
- Key Laboratory of Drug-Targeting & Drug Delivery System of the Education Ministry, Sichuan Engineering Laboratory for Plant-Sourced Drugs & Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610064, P. R. China
| | - Rui Guo
- Key Laboratory of Drug-Targeting & Drug Delivery System of the Education Ministry, Sichuan Engineering Laboratory for Plant-Sourced Drugs & Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610064, P. R. China
| | - Xueru Zhou
- Key Laboratory of Drug-Targeting & Drug Delivery System of the Education Ministry, Sichuan Engineering Laboratory for Plant-Sourced Drugs & Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610064, P. R. China
| | - Wei Zhang
- Key Laboratory of Drug-Targeting & Drug Delivery System of the Education Ministry, Sichuan Engineering Laboratory for Plant-Sourced Drugs & Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610064, P. R. China
| | - Mengying Wu
- Key Laboratory of Drug-Targeting & Drug Delivery System of the Education Ministry, Sichuan Engineering Laboratory for Plant-Sourced Drugs & Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610064, P. R. China
| | - Chenqi Guo
- Key Laboratory of Drug-Targeting & Drug Delivery System of the Education Ministry, Sichuan Engineering Laboratory for Plant-Sourced Drugs & Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610064, P. R. China
| | - Huile Gao
- Key Laboratory of Drug-Targeting & Drug Delivery System of the Education Ministry, Sichuan Engineering Laboratory for Plant-Sourced Drugs & Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610064, P. R. China
| | - Xun Sun
- Key Laboratory of Drug-Targeting & Drug Delivery System of the Education Ministry, Sichuan Engineering Laboratory for Plant-Sourced Drugs & Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610064, P. R. China
| | - Zhirong Zhang
- Key Laboratory of Drug-Targeting & Drug Delivery System of the Education Ministry, Sichuan Engineering Laboratory for Plant-Sourced Drugs & Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610064, P. R. China
| | - Tao Gong
- Key Laboratory of Drug-Targeting & Drug Delivery System of the Education Ministry, Sichuan Engineering Laboratory for Plant-Sourced Drugs & Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610064, P. R. China
| |
Collapse
|
44
|
Xiang Z, Song Y, Liu J, Xu C, Zhou Z, Li J, Su R, Shu W, Lu Z, Wei X, Yang J, Yang Y, Zheng S, Xu X. Impact of preoperative infection on the outcomes of liver transplant recipients: a national propensity score-matched retrospective cohort study in China. Int J Surg 2024; 110:01279778-990000000-01016. [PMID: 38285095 PMCID: PMC11019992 DOI: 10.1097/js9.0000000000001114] [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: 10/13/2023] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Impact of preoperative infection on liver transplantation (LT) needs further investigation. MATERIALS AND METHODS From January 1, 2015 to December 31, 2022, 24,122 eligible patients receiving LT were enrolled from the China Liver Transplant Registry database. The outcomes of LT were compared after using the propensity score-matched analysis. RESULTS Compared to the non-infection group, patients in the infection group were more likely to have postoperative effusion, infection, abdominal bleeding and biliary complications (all P<0.01), and they had shorter 30-day, 90-day survival and overall survival (OS) (all P<0.01). Cox proportional hazards regression analysis revealed that MELD score and cold ischemia time were risk factors for the OS in the infection group (both P<0.05). Besides, compared to the non-pulmonary group, patients in the pulmonary group were more likely to have postoperative effusion and infection (both P<0.0001), and less likely to have postoperative abscess and early allograft dysfunction (both P<0.05). Patients in the non-abdominal group also had a higher proportion of postoperative infection than those in the abdominal group (P<0.05). Furthermore, compared to the number=1 group, patients in the number≥2 group were more prone to postoperative effusion and infection (both P<0.01), and they also had shorter 30-day and 90-day survival (both P<0.05). CONCLUSION Preoperative infection can result in a higher incidence of early postoperative complications and shorter survival in liver transplant recipients. The types and number of infection sites will also influence the prognosis of liver transplant recipients.
Collapse
Affiliation(s)
- Ze Xiang
- Zhejiang University School of Medicine
- Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province
| | - Yisu Song
- Zhejiang University School of Medicine
- Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province
| | - Jianrong Liu
- Surgical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Chenhao Xu
- Zhejiang University School of Medicine
- Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province
| | - Zhisheng Zhou
- National Center for Healthcare Quality Management in Liver Transplant
| | - Jiarui Li
- Zhejiang University School of Medicine
| | - Renyi Su
- Zhejiang University School of Medicine
- Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province
| | - Wenzhi Shu
- Zhejiang University School of Medicine
- Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province
| | - Zhengyang Lu
- Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province
| | | | - Jiayin Yang
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
| | - Yang Yang
- Department of Hepatic Surgery and Liver Transplantation Center
| | - Shusen Zheng
- NHC Key Laboratory of Combined Multi-organ Transplantation
- National Center for Healthcare Quality Management in Liver Transplant
- Shulan (Hangzhou) Hospital, Zhejiang Shuren University School of Medicine, Hangzhou
| | - Xiao Xu
- Zhejiang University School of Medicine
- NHC Key Laboratory of Combined Multi-organ Transplantation
- National Center for Healthcare Quality Management in Liver Transplant
| |
Collapse
|
45
|
Mosca A, Manco M, Braghini MR, Cianfarani S, Maggiore G, Alisi A, Vania A. Environment, Endocrine Disruptors, and Fatty Liver Disease Associated with Metabolic Dysfunction (MASLD). Metabolites 2024; 14:71. [PMID: 38276306 PMCID: PMC10819942 DOI: 10.3390/metabo14010071] [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: 12/05/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
Ecological theories suggest that environmental factors significantly influence obesity risk and related syndemic morbidities, including metabolically abnormal obesity associated with nonalcoholic fatty liver disease (MASLD). These factors encompass anthropogenic influences and endocrine-disrupting chemicals (EDCs), synergistically interacting to induce metabolic discrepancies, notably in early life, and disrupt metabolic processes in adulthood. This review focuses on endocrine disruptors affecting a child's MASLD risk, independent of their role as obesogens and thus regardless of their impact on adipogenesis. The liver plays a pivotal role in metabolic and detoxification processes, where various lipophilic endocrine-disrupting molecules accumulate in fatty liver parenchyma, exacerbating inflammation and functioning as new anthropogenics that perpetuate chronic low-grade inflammation, especially insulin resistance, crucial in the pathogenesis of MASLD.
Collapse
Affiliation(s)
- Antonella Mosca
- Hepatology and Liver Transplant Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Melania Manco
- Preventive and Predictive Medicine Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Maria Rita Braghini
- Research Unit of Genetics of Complex Phenotypes, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.R.B.); (A.A.)
| | - Stefano Cianfarani
- Endocrinology and Diabetes Unit, Bambino Gesù Pediatric Hospital, 00165 Rome, Italy;
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Department of Women’s and Children’s Health, Karolinska Institutet, University Hospital, Solnavägen 1, Solna, 171 77 Stockholm, Sweden
| | - Giuseppe Maggiore
- Hepatology and Liver Transplant Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Anna Alisi
- Research Unit of Genetics of Complex Phenotypes, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.R.B.); (A.A.)
| | | |
Collapse
|
46
|
Schilsky ML, Emre SH. An abbreviated history of liver transplantation. Clin Liver Dis (Hoboken) 2024; 23:e0244. [PMID: 38952697 PMCID: PMC11216664 DOI: 10.1097/cld.0000000000000244] [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: 04/25/2024] [Accepted: 04/25/2024] [Indexed: 07/03/2024] Open
Affiliation(s)
- Michael L. Schilsky
- Division of Digestive Diseases and Transplantation and Immunology, Department of Medicine and Surgery, Yale University Medical Center, New Haven, Connecticut, USA
| | - Sukru H. Emre
- Department of Surgery, İzmir University of Economics School of Medicine, Izmir, Turkiye
| |
Collapse
|
47
|
Yadav P, Singh SK, Rajput S, Allawadhi P, Khurana A, Weiskirchen R, Navik U. Therapeutic potential of stem cells in regeneration of liver in chronic liver diseases: Current perspectives and future challenges. Pharmacol Ther 2024; 253:108563. [PMID: 38013053 DOI: 10.1016/j.pharmthera.2023.108563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/04/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023]
Abstract
The deposition of extracellular matrix and hyperplasia of connective tissue characterizes chronic liver disease called hepatic fibrosis. Progression of hepatic fibrosis may lead to hepatocellular carcinoma. At this stage, only liver transplantation is a viable option. However, the number of possible liver donors is less than the number of patients needing transplantation. Consequently, alternative cell therapies based on non-stem cells (e.g., fibroblasts, chondrocytes, keratinocytes, and hepatocytes) therapy may be able to postpone hepatic disease, but they are often ineffective. Thus, novel stem cell-based therapeutics might be potentially important cutting-edge approaches for treating liver diseases and reducing patient' suffering. Several signaling pathways provide targets for stem cell interventions. These include pathways such as TGF-β, STAT3/BCL-2, NADPH oxidase, Raf/MEK/ERK, Notch, and Wnt/β-catenin. Moreover, mesenchymal stem cells (MSCs) stimulate interleukin (IL)-10, which inhibits T-cells and converts M1 macrophages into M2 macrophages, producing an anti-inflammatory environment. Furthermore, it inhibits the action of CD4+ and CD8+ T cells and reduces the activity of TNF-α and interferon cytokines by enhancing IL-4 synthesis. Consequently, the immunomodulatory and anti-inflammatory capabilities of MSCs make them an attractive therapeutic approach. Importantly, MSCs can inhibit the activation of hepatic stellate cells, causing their apoptosis and subsequent promotion of hepatocyte proliferation, thereby replacing dead hepatocytes and reducing liver fibrosis. This review discusses the multidimensional therapeutic role of stem cells as cell-based therapeutics in liver fibrosis.
Collapse
Affiliation(s)
- Poonam Yadav
- Department of Pharmacology, Central University of Punjab, Ghudda, Bathinda, Punjab 151401, India
| | - Sumeet Kumar Singh
- Department of Pharmacology, Central University of Punjab, Ghudda, Bathinda, Punjab 151401, India
| | - Sonu Rajput
- Department of Pharmacology, Central University of Punjab, Ghudda, Bathinda, Punjab 151401, India
| | - Prince Allawadhi
- Department of Pharmacy, Vaish Institute of Pharmaceutical Education and Research (VIPER), Pandit Bhagwat Dayal Sharma University of Health Sciences (Pt. B. D. S. UHS), Rohtak, Haryana 124001, India
| | - Amit Khurana
- Department of Pharmacology, Central University of Punjab, Ghudda, Bathinda, Punjab 151401, India; Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry (IFMPEGKC), RWTH Aachen University Hospital, Pauwelsstr. 30, D-52074 Aachen, Germany.
| | - Ralf Weiskirchen
- Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry (IFMPEGKC), RWTH Aachen University Hospital, Pauwelsstr. 30, D-52074 Aachen, Germany.
| | - Umashanker Navik
- Department of Pharmacology, Central University of Punjab, Ghudda, Bathinda, Punjab 151401, India; Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry (IFMPEGKC), RWTH Aachen University Hospital, Pauwelsstr. 30, D-52074 Aachen, Germany.
| |
Collapse
|
48
|
Aguirre-Villarreal D, Servin-Rojas M, Sánchez-Cedillo A, Chávez-Villa M, Hernandez-Alejandro R, Arab JP, Ruiz I, Avendaño-Castro KP, Matamoros MA, Adames-Almengor E, Diaz-Ferrer J, Rodriguez-Aguilar EF, Paez-Zayas VM, Contreras AG, Alvares-da-Silva MR, Mendizabal M, Oliveira CP, Navasa M, García-Juárez I. Liver transplantation in Latin America: reality and challenges. LANCET REGIONAL HEALTH. AMERICAS 2023; 28:100633. [PMID: 38058662 PMCID: PMC10696109 DOI: 10.1016/j.lana.2023.100633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 12/08/2023]
Abstract
Healthcare systems in Latin America are broadly heterogeneous, but all of them are burdened by a dramatic rise in liver disease. Some challenges that these countries face include an increase in patients requiring a transplant, insufficient rates of organ donation, delayed referral, and inequitable or suboptimal access to liver transplant programs and post-transplant care. This could be improved by expanding the donor pool through the implementation of education programs for citizens and referring physicians, as well as the inclusion of extended criteria donors, living donors and split liver transplantation. Addressing these shortcomings will require national shifts aimed at improving infrastructure, increasing awareness of organ donation, training medical personnel, and providing equitable access to care for all patients.
Collapse
Affiliation(s)
- David Aguirre-Villarreal
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Maximiliano Servin-Rojas
- Liver Transplant Unit and Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Aczel Sánchez-Cedillo
- Department of Surgery, Hospital General de Mexico Dr. Eduardo Liceaga, Ciudad de Mexico, Mexico
| | - Mariana Chávez-Villa
- Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Roberto Hernandez-Alejandro
- Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Juan Pablo Arab
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada
- Departament of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Isaac Ruiz
- Department of Hepatology and Liver Transplantation, Centre Hospitalier de l’Université de Montréal (CHUM), Canada
| | | | - Maria A. Matamoros
- Centro de Trasplante Hepatico y Cirugía Hepatobiliar, San Jose, Costa Rica
| | | | - Javier Diaz-Ferrer
- Department of Hepatology, Hospital Nacional Edgardo Rebagliati, Lima, Perú
| | | | | | - Alan G. Contreras
- Transplant Surgery, Intermountain Transplant Clinic, Salt Lake City, UT, USA
| | - Mario R. Alvares-da-Silva
- GI/Liver Unit, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Manuel Mendizabal
- Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Argentina
| | - Claudia P. Oliveira
- Department of Gastroenterology (LIM07), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Miquel Navasa
- Liver Transplant Unit, Hepatology Service, Hospital Clínic de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Ignacio García-Juárez
- Liver Transplant Unit and Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| |
Collapse
|
49
|
Hu CL, Han X, Gao ZZ, Zhou B, Tang JL, Pei XR, Lu JN, Xu Q, Shen XP, Yan S, Ding Y. Systematic sequential therapy for ex vivo liver resection and autotransplantation: A case report and review of literature. World J Gastrointest Surg 2023; 15:2663-2673. [PMID: 38111758 PMCID: PMC10725551 DOI: 10.4240/wjgs.v15.i11.2663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/30/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Perihilar cholangiocarcinoma (pCCA) is a highly malignant tumor arising from the biliary tree. Radical surgery is the only treatment offering a chance of long-term survival. However, limited by the tumor's anatomic location and peri-vascular invasion, most patients lose the chance for curative treatment. Therefore, more methods to increase the resectability of tumors as well as to improve outcomes are needed. CASE SUMMARY A 68-year-old female patient had a hepatic hilar mass without obvious symptoms. Laboratory results showed hepatitis B positivity. Magnetic resonance imaging indicated that the mass (maximum diameter: 41 mm) invaded the left and right branches of the main portal vein, as well as the middle, left and right hepatic veins; enlarged lymph nodes were also detected in the hilum. The patient was diagnosed with pCCA, and the clinical stage was determined to be T4N1M0 (stage IIIC). Considering the tumor's anatomic location and vascular invasion, systematic conversion therapy followed by ex vivo liver resection and autotransplantation (ELRA) was determined as personalized treatment for this patient. Our original systemic sequential therapeutic strategy (lenvatinib and tislelizumab in combination with gemcitabine and cisplatin) was successfully adopted as conversion therapy because she achieved partial response after three cycles of treatment, without severe toxicity. ELRA, anastomotic reconstruction of the middle hepatic vein, right hepatic vein, root of portal vein, inferior vena cava and right hepatic artery, and lymph node dissection were performed at one month after systemic therapy. Pathological and immunohistochemical examination confirmed the diagnosis of pCCA with lymph node metastasis. Although the middle hepatic vein was partially obstructed four months later, hepatic vein stent implantation successfully addressed this problem. The patient has survived for 22 mo after the diagnosis, with no evidence of recurrence or metastasis. CONCLUSION An effective therapeutic strategy for conversion therapy greatly increases the feasibility and efficiency of ELRA.
Collapse
Affiliation(s)
- Chen-Lu Hu
- Department of Nursing, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Xin Han
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Zhen-Zhen Gao
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Bo Zhou
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Jin-Long Tang
- Department of Pathology, Zhejiang University School of Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Xiang-Ru Pei
- Department of Nursing, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Jie-Nan Lu
- Department of Nursing, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Qin Xu
- Department of Nursing, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Xiao-Ping Shen
- Department of Nursing, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Sheng Yan
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Yuan Ding
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| |
Collapse
|
50
|
Wang D, Ma Y, Gu B, Li X, Yu Y, Zhang Y, Chen H. Preliminary study of donor volume changes after dual-graft liver transplantation in rats. Front Immunol 2023; 14:1183426. [PMID: 37908343 PMCID: PMC10613707 DOI: 10.3389/fimmu.2023.1183426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/27/2023] [Indexed: 11/02/2023] Open
Abstract
Dual-graft liver transplantation (DGLT) expands the pool of donors, ensures the safety of the donors, and treats a potential small for size syndrome (SFSS). However, some of the recipient graft showed atrophy. The cause and mechanism of the unbalanced proliferation and atrophy of dual grafts after clinical DGLT have not been clarified. We established and optimized the rat model of DGLT to explore the causes of growth unbalance. Continuously and dynamically observed bilateral graft volume and portal vein blood flow change by magnetic resonance imaging (MRI) and ultrasound (US). We detected liver function indexes: alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), total bilirubin (TBIL), direct bilirubin (DBIL), and indirect bilirubin (IBIL). Liver samples from receptors were obtained for morphology, and apoptosis was measured by RT-PCR and western blot. Optimization of the model improved the 7-day survival rate from former 58.3% to 87.5%, and the 30-day survival rate was 68.8%. The volume of the right graft gradually increased, and the left graft atrophied during the 30-day observation period. The portal blood flow of the left graft gradually decreased until the 30th day (0.13 ± 0.01 ml/s) compared with the sham group (0.63 ± 0.05 ml/s), and the right graft significantly increased on the 30th day (0.75 ± 0.11ml/s). The liver function initially increased and then recovered. The total volume (12.52 ± 1.60 ml vs 4.47 ± 0.08 ml) and weight (12.09 ± 1 g vs 4.91 ± 0.18 g) of the graft increased significantly compared to pre-transplantation and reached the level of the sham operation group on the 30th day. The volume and weight of the right graft increased more than those of the left graft (P < 0.05). There was more inflammatory cell infiltration in the left graft, and the right graft had obvious proliferation of hepatocytes and mature bile duct cells. Left grafts were more prone to apoptosis than right grafts (P < 0.05). In conclusion, growth of the right graft is superior to the left; after double liver transplantation, perfusion blood flow and apoptosis may be the reason contributing to the volume differences in dual grafts.
Collapse
Affiliation(s)
- Dan Wang
- The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Yanling Ma
- The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Baohong Gu
- The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Xuemei Li
- The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Yang Yu
- The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Ying Zhang
- Department of Laboratory Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Hao Chen
- The Department of Tumor Surgery, Second Hospital of Lanzhou University, Lanzhou, China
- The Key Laboratory of The Digestive System Tumors of Gansu Province, Second Hospital of Lanzhou University, Lanzhou, China
| |
Collapse
|