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Salimi J, Jafarian A, Yousefi I, Foroutani L, Fakhar N, Moeini M, Behzadi M. Simple Separate Sutures Versus Continuous Sutures on Hepatic Artery Anastomosis in Liver Transplant: A Prospective Study. EXP CLIN TRANSPLANT 2023; 21:36-40. [PMID: 36757166 DOI: 10.6002/ect.2022.0299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVES Liver transplant is the definitive treatment for liver failure of various causes. There are various operation methods, of which the conventional approach is most frequently performed. In the conventional technique, 4 anastomoses are required, and different subtleties in these techniques are known to cause different rates of complications. We assessed the outcome of a simple separate (ie, interrupted) suture technique compared with a the continuous suture technique in 194 patients. MATERIALS AND METHODS There were 194 patients included in this single-center, controlled study. The exclusion criteria were patients who died during the surgical procedure and patients with incomplete medical records. The data recorded were age, sex, past medical history of liver disease, tobacco use, comorbidities, and whetherthe livertransplant was for the first time or retransplant. All patients included in this study were recipients of liver transplants from deceased donors. The patients were categorized as those who received either simple sutures (n = 16) or continuous sutures (n = 178). The continuous suture operations were performed first, and the simple suture operations were performed at a later time (ie, the 2 groups were temporally separated). The results included the duration of surgery, hepatic artery thrombosis rate, hepatic artery stenosis rate, 2-year survival, and further complications. RESULTS No evidence of hepatic artery thrombosis or hepatic artery stenosis was observed in the study groups. The duration of surgery was equal in both groups. The 2-year mortality rate was significantly higher in the simple suture group. CONCLUSIONS The continuous suture method seems to be accompanied by a similar duration of operation and rate of complications compared with the simple suture process.
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Affiliation(s)
- Javad Salimi
- From the Vascular Surgery Department, Sina Hospital, Tehran, Iran
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Liu N, Yang G, Dang Y, Liu X, Chen M, Dai F, Ding X, Li W, Li G, Lou J, Chen D, Yu Y. Epidemic, risk factors of carbapenem-resistant Klebsiella pneumoniae infection and its effect on the early prognosis of liver transplantation. Front Cell Infect Microbiol 2022; 12:976408. [PMID: 36275019 PMCID: PMC9584088 DOI: 10.3389/fcimb.2022.976408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/20/2022] [Indexed: 11/20/2022] Open
Abstract
Background Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection remains a major cause of morbidity and mortality in early-stage post-liver transplantation (LT). Methods We retrospectively analyzed the demographic and clinical infections characteristics of all LT recipients in our hospital between January 2019 and December 2021. Results Among the 272 LT recipients who received LT between January 2019 and December 2021, sixty-two patients had at least one infection within 3-months post-LT, with a prevalence of 22.8% (62/272). The prevalence of CRKP infections was 7.0% (19/272), and the 3-months post-LT mortality was 19.4% (12/62). The risk factors independently related to 3-months mortality were age (Odds ratio (OR)= 1.126, 95% Confidence interval (CI): 1.009~1.257; P=0.034), mechanical ventilation (MV) (OR=1.206, 95% CI: 1.039~1.401; P =0.014), and CRKP infection (OR=18.240, 95% CI: 2.206~150.842; P =0.007). In CRKP infection, the length of ICU stay (OR=1.067, 95% CI: 1.015~1.122; P=0.011), pre-operation infection (POI) (OR=6.733, 95% CI: 1.160~39.088; P=0.034), and hepatocellular carcinoma (HCC) (OR=26.772, 95% CI: 1.747~410.187; P=0.018) were the independent risk factors. With COX multivariate regression analysis, the 3-months survival rate of CRKP infected patients was significantly lower than that without CRKP infection post-LT. Conclusions CRKP infection is closely correlated with poor prognosis in 3-months post-LT.
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Affiliation(s)
- Ning Liu
- Department of Clinical Laboratory Center, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Hepatology, Beijing Engineering Research Center for Precision Medicine and Transformation of Hepatitis and Liver Cancer, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Gengxia Yang
- Department of General Surgery, Liver Transplantation Center, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yan Dang
- Department of Clinical Laboratory Center, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xin Liu
- Department of Clinical Laboratory Center, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Ming Chen
- Department of Clinical Laboratory Center, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Fangfang Dai
- Department of Clinical Laboratory Center, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xiurong Ding
- Department of Clinical Laboratory Center, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wenlei Li
- Department of General Surgery, Liver Transplantation Center, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Guangming Li
- Department of General Surgery, Liver Transplantation Center, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Jinli Lou
- Department of Clinical Laboratory Center, Beijing Youan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Jinli Lou, ; Dexi Chen, ; Yanhua Yu,
| | - Dexi Chen
- Beijing Institute of Hepatology, Beijing Engineering Research Center for Precision Medicine and Transformation of Hepatitis and Liver Cancer, Beijing Youan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Jinli Lou, ; Dexi Chen, ; Yanhua Yu,
| | - Yanhua Yu
- Department of Clinical Laboratory Center, Beijing Youan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Jinli Lou, ; Dexi Chen, ; Yanhua Yu,
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Kim SH, Park JH, An BH. Minimal Surgical Manpower for Living Donor Liver Transplantation. J Clin Med 2022; 11:jcm11154292. [PMID: 35893383 PMCID: PMC9331439 DOI: 10.3390/jcm11154292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Living donor liver transplantation (LDLT) is widely performed with good outcomes in the current era of improved surgical techniques. However, few studies have addressed how many human resources are required in the surgery itself. This study aimed to introduce how to perform LDLT with minimal manpower and evaluate the outcomes in adult patients. Methods: The main surgical procedures of donor and recipient operations of LDLT were performed by a single specialist surgeon who led a team of minimal manpower that only included one fellow, one resident, one intern, and three nurses. He also provided postsurgical care and followed up all the patients as a primary care physician. The outcomes were analyzed from the standpoints of the feasibility and acceptability. Results: Between November 2018 and February 2020, a total of 47 patients underwent LDLT. Ten patients had ABO-incompatible donors. The median age of the overall recipients was 57 years old (36–71); 37 patients (78.7%) were male. The MELD score was 10 (6–40), and the main etiologies were hepatic malignancy (38 patients or 80.9%) and liver failure (9 patients or 19.1%). The median age of the overall donors was 34 years old (19–62); 22 patients (46.8%) were male. All the graft types were right liver except for one case of extended right liver with middle hepatic vein. All donors had an uneventful recovery with no complications. There was one intraoperative mortality due to cardiac arrest after reperfusion in one recipient. Hepatic artery thrombosis was developed in 5 (10.6%) recipients. An acute rejection episode occurred in one patient. The median follow-up period for all the patients was 32.9 months (range, 24.7–39.8). Biliary complications were developed in 11 (23.4%) recipients. In total, 7 (15%) patients died, including 1 intraoperative mortality, 5 from cancer recurrence, and 1 from intracranial hemorrhage. The 1-, 2-, and 3-year overall survival rates in the recipient group were 91.5%, 87.2%, and 85.1%, respectively. Conclusions: LDLT with minimal surgical manpower is feasible under the supervision of a single expert surgeon who has the capacity for all the main surgical procedures in both donor and recipient operations without compromising the outcomes in the present era of advanced surgical management.
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Affiliation(s)
- Seoung Hoon Kim
- Correspondence: or ; Tel.: +82-31-9201647; Fax: +82-31-9201138
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Pretransplant Evaluation and Liver Transplantation Outcome in PBC Patients. Can J Gastroenterol Hepatol 2022; 2022:7831165. [PMID: 35910038 PMCID: PMC9337972 DOI: 10.1155/2022/7831165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022] Open
Abstract
Primary biliary cholangitis (PBC) is an autoimmune chronic cholestatic liver disease characterized by progressive cholangiocyte and bile duct destruction leading to fibrosis and finally to liver cirrhosis. The presence of disease-specific serological antimitochondrial antibody (AMA) together with elevated alkaline phosphatase (ALP) as a biomarker of cholestasis is sufficient for diagnosis. Ursodeoxycholic acid (UDCA) is the first treatment option for PBC. Up to 40% of patients have an incomplete response to therapy, and over time disease progresses to liver cirrhosis. Several risk scores are proposed for better evaluation of patients before and during treatment to stratify patients at increased risk of disease progression. GLOBE score and UK PBC risk score are used for the evaluation of UDCA treatment and Mayo risk score for transplant-free survival. Liver transplantation (LT) is the only treatment option for end-stage liver disease. More than 10 years after LT, 40% of patients experience recurrence of the disease. A liver biopsy is required to establish rPBC (recurrent primary biliary cholangitis). The only treatment option for rPBC is UDCA, and data show biochemical and clinical improvement, plus potential beneficial effects for use after transplantation for the prevention of rPBC development. Additional studies are required to assess the full impact of rPBC on graft and recipient survival and for treatment options for rPBC.
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Liu Z, Xu J, Que S, Geng L, Zhou L, Mardinoglu A, Zheng S. Recent Progress and Future Direction for the Application of Multiomics Data in Clinical Liver Transplantation. J Clin Transl Hepatol 2022; 10:363-373. [PMID: 35528975 PMCID: PMC9039708 DOI: 10.14218/jcth.2021.00219] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/14/2021] [Accepted: 10/07/2021] [Indexed: 12/04/2022] Open
Abstract
Omics data address key issues in liver transplantation (LT) as the most effective therapeutic means for end-stage liver disease. The purpose of this study was to review the current application and future direction for omics in LT. We reviewed the use of multiomics to elucidate the pathogenesis leading to LT and prognostication. Future directions with respect to the use of omics in LT are also described based on perspectives of surgeons with experience in omics. Significant molecules were identified and summarized based on omics, with a focus on post-transplant liver fibrosis, early allograft dysfunction, tumor recurrence, and graft failure. We emphasized the importance omics for clinicians who perform LTs and prioritized the directions that should be established. We also outlined the ideal workflow for omics in LT. In step with advances in technology, the quality of omics data can be guaranteed using an improved algorithm at a lower price. Concerns should be addressed on the translational value of omics for better therapeutic effects in patients undergoing LT.
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Affiliation(s)
- Zhengtao Liu
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, China
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- NHC Key Laboratory of Combined Multi-organ Transplantation, Key Laboratory of the diagnosis and treatment of organ Transplantation, CAMS, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Organ Transplantation, Zhejiang Province, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jun Xu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shuping Que
- DingXiang Clinics, Hangzhou, Zhejiang, China
| | - Lei Geng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lin Zhou
- NHC Key Laboratory of Combined Multi-organ Transplantation, Key Laboratory of the diagnosis and treatment of organ Transplantation, CAMS, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Organ Transplantation, Zhejiang Province, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Adil Mardinoglu
- Science for Life Laboratory, KTH-Royal Institute of Technology, Stockholm, Sweden
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, UK
- Correspondence to: Adil Mardinoglu, Science for Life Laboratory, KTH-Royal Institute of Technology, Stockholm, Sweden. ORCID: https://orcid.org/0000-0002-4254-6090. Tel: +46-31-772-3140, Fax: +46-31-772-3801, E-mail: ; Shusen Zheng, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, China. ORCID: https://orcid.org/0000-0003-1459-8261. Tel/Fax: +86-571-87236570, E-mail:
| | - Shusen Zheng
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, China
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- NHC Key Laboratory of Combined Multi-organ Transplantation, Key Laboratory of the diagnosis and treatment of organ Transplantation, CAMS, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Organ Transplantation, Zhejiang Province, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Correspondence to: Adil Mardinoglu, Science for Life Laboratory, KTH-Royal Institute of Technology, Stockholm, Sweden. ORCID: https://orcid.org/0000-0002-4254-6090. Tel: +46-31-772-3140, Fax: +46-31-772-3801, E-mail: ; Shusen Zheng, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, China. ORCID: https://orcid.org/0000-0003-1459-8261. Tel/Fax: +86-571-87236570, E-mail:
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Chan YC, Chen CL, Wang CC, Lin CC, Yong CC, Chiu KW, Wu KL. Extremity risk factors of sepsis for gastrointestinal endoscopy in patients with liver cirrhosis. BMC Gastroenterol 2022; 22:54. [PMID: 35139804 PMCID: PMC8826657 DOI: 10.1186/s12876-022-02124-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 01/27/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Liver cirrhosis is a well-known risk factor of sepsis after emergent gastrointestinal (GI) endoscopy. Elective GI endoscopy before living donor liver transplantation (LDLT), however, may also carry the septic risk among these patients. METHODS This retrospective study reviewed the medical records of 642 cirrhotic recipients who underwent GI endoscopy from 2008 to 2016. We analyzed the incidence and risk factors of post-endoscopy sepsis during 2008-2012 (experience cohort). Our protocol changed after 2013 (validation cohort) to include antibiotic prophylaxis. RESULTS In experience cohort, 36 cases (10.5%) of the 342 LDLT candidates experienced sepsis within 48 h after endoscopy. The sepsis rate was significantly higher in patients with hepatic decompensation than patients without (22.2% vs. 9.6% vs. 2.6% in Child C/B/A groups respectively; ×2 = 20.97, P < 0.001). Using multivariate logistic regression analysis, the factors related to post-endoscopy sepsis were the Child score (OR 1.46; 95% CI 1.24-1.71), Child classes B and C (OR 3.80 and 14.13; 95% CI 1.04-13.95 and 3.97-50.23, respectively), hepatic hydrothorax (OR 4.85; 95% CI 1.37-17.20), and use of antibiotic prophylaxis (OR 0.08; 95% CI 0.01-0.64). In validation cohort, antibiotics were given routinely, and all cases of hepatic hydrothorax (n = 10) were drained. Consequently, 4 (1.3%) episodes of sepsis occurred among 300 LDLT candidates, and the incidence was significantly lower than before (1.3% vs. 10.5%, P < 0.001). CONCLUSIONS Patients with decompensated cirrhosis and hepatic hydrothorax have higher risk of sepsis following endoscopy. In advanced cirrhotic patients, antibiotic prophylaxis and drainage of hydrothorax may be required to prevent sepsis before elective GI endoscopy.
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Affiliation(s)
- Yi-Chia Chan
- Liver Transplantation Center, and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, 83303, Kaohsiung, Taiwan
| | - Chao-Long Chen
- Liver Transplantation Center, and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, 83303, Kaohsiung, Taiwan
| | - Chih-Chi Wang
- Liver Transplantation Center, and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, 83303, Kaohsiung, Taiwan
| | - Chih-Che Lin
- Liver Transplantation Center, and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, 83303, Kaohsiung, Taiwan.
| | - Chee-Chien Yong
- Liver Transplantation Center, and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, 83303, Kaohsiung, Taiwan
| | - King-Wah Chiu
- Liver Transplantation Center, and Department of Internal Medicine, Division of Hepato-Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Keng-Liang Wu
- Liver Transplantation Center, and Department of Internal Medicine, Division of Hepato-Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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7
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Fuentes-Valenzuela E, Tejedor-Tejada J, García-Pajares F, Rubiales BM, Nájera-Muñoz R, Maroto-Martín C, Sánchez-Delgado L, Alonso-Martín C, Álvarez CA, Sánchez-Antolín G. Postreperfusion Liver Biopsy as Predictor of Early Graft Dysfunction and Survival After Orthotopic Liver Transplantation. J Clin Exp Hepatol 2022; 12:1133-1141. [PMID: 35814514 PMCID: PMC9257905 DOI: 10.1016/j.jceh.2021.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/26/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Postreperfusion liver biopsy (PRB) can assess the degree of ischemia/reperfusion injury (IRI) after orthotopic liver transplantation (OLT). The influence of IRI on graft outcomes and overall survival is controversial. AIM To determine the correlation between the severity of IRI in PRB and overall graft and patient survival and, secondarily, to identify factors on PRB that predict poor graft outcomes. METHODS This is a retrospective analysis of all patients who underwent OLT using donation after brain death (DBD) with PRB. The severity of IRI in PRB was graded. Predictors of IRI were assessed using univariate and multivariate analysis and the Kaplan-Meier with log rank test for the graft and overall survival, respectively. RESULTS We included 280 OLTs (64.7%). The histopathological assessment of IRI severity was as follows: no IRI (N = 96, 34.3%), mild IRI (N = 65; 23.2%), moderate IRI (N = 101; 36.1%), and severe IRI (N = 18; 6.4%). The incidence rates of initial good graft function (IGGF), primary nonfunction and early allograft dysfunction (EAD) were 32.5%, 3.9%, and 18.6%, respectively. Severe IRI was associated with a lower incidence of IGGF (OR: 0.34, 95% CI 0.12-0.92; P = 0.03). Patients with severe IRI tended to have a higher incidence of EAD (33.2% vs. 18.6, P = 0.23). The cold ischemia time was an independent predictor of severe IRI on the multivariate analysis. Severe IRI was associated with poor 1- and 5-year overall survival rates (67% and 44%, respectively, compared with 84 and 68% in nonsevere IRI). Patients with severe IRI exhibited worse graft and overall survival. CONCLUSIONS Cold ischemia time predicts the development of severe IRI. Patients with severe IRI show worse graft and overall survival and a lower incidence of IGGF, suggesting that histopathological findings could be useful for identifying patients at high risk of worse outcomes after OLT.
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Key Words
- ALD, alcohol-related liver disease
- ALF, acute liver failure
- ALT, alanine aminotransferase
- CIHD, chronic ischaemic heart disease
- CNI, calcineurin inhibitors
- COPD, chronic obstructive pulmonary disease
- DBD, donation after brain death
- EAD, early allograft dysfunction
- H&E, hematoxylin and eosin
- HBV, hepatitis B virus
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- IGGF, initial good graft function
- IQR, interquartile range
- IRI, ischaemia/reperfusion injury
- MELD, Model for End-stage Liver Disease
- OLT, orthotopic liver transplantation
- ONT, Organización Nacional de Transplantes
- PBC, primary biliary cholangitis
- PNF, primary nonfunction
- PRB, postreperfusion liver biopsy
- SD, standard deviation
- STROBE, Strengthening the Reporting of Observational studies in Epidemiology
- cold ischemia time
- early allograft dysfunction
- ischemia reperfusion injury
- liver transplantation
- postreperfusion biopsy
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Affiliation(s)
- Esteban Fuentes-Valenzuela
- Department of Gastroenterology, Hepatology and Liver Transplantation Unit, Hospital Universitario Rio Hortega, Valladolid, Spain,Address for correspondence: Esteban Fuentes-Valenzuela, Department of Gastroenterology and Hepatology and Liver Transplantation Unit, Hospital Universitario Rio Hortega, st Dulzaina,2. 47012. Valladolid, Spain.
| | - Javier Tejedor-Tejada
- Department of Gastroenterology, Hepatology and Liver Transplantation Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Félix García-Pajares
- Department of Gastroenterology, Hepatology and Liver Transplantation Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Beatriz M. Rubiales
- Department of Pathology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Rodrigo Nájera-Muñoz
- Department of Gastroenterology, Hepatology and Liver Transplantation Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Carlos Maroto-Martín
- Department of Gastroenterology, Hepatology and Liver Transplantation Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Laura Sánchez-Delgado
- Department of Gastroenterology, Hepatology and Liver Transplantation Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Carmen Alonso-Martín
- Department of Gastroenterology, Hepatology and Liver Transplantation Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Carolina A. Álvarez
- Department of Gastroenterology, Hepatology and Liver Transplantation Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Gloria Sánchez-Antolín
- Department of Gastroenterology, Hepatology and Liver Transplantation Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
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El Masri J, El Ayoubi LM, Zreika B, Adhami F, El Masri D, El Hage S, Abou-Jaoudé M. Current state of clinical trials regarding liver transplant rejection. Transpl Immunol 2021; 70:101522. [PMID: 34954324 DOI: 10.1016/j.trim.2021.101522] [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: 11/07/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Liver transplant (LT) is the second most common transplant intervention. The rate of acute cellular rejection (ACR) is 15-25% after LT, while being higher in chronic rejection (CR). Clinical trials had a major role in getting more potent and selective immunosuppressive medications. Our study plays an important role by evaluating and tracking clinical trials related to liver transplant rejection, focusing on interventional therapeutic trials. METHODS On October 28, we searched Clinicaltrials.gov for interventional clinical trials related to liver transplant rejection. A total of 27 clinical trials included in this study. Characteristics on each trial were collected, and availability of linked publications was searched using Medline/PubMed and Embase/Scopus. Content of publications was reviewed and main findings were summarized. RESULTS Majority of trials were completed (15 out of 27). Eleven trials had between 11 and 50 participants, and 10 had above 100. The study duration was between 1 and 4 years for the majority of trials (16 trials), with an average of 3.77 years. Most of the trials were done in Europe/UK/Russia (n = 12). The results were provided in 9 trials but published in 4, showing the possible tolerogenic efficacy of MSC in liver transplantation, increased success of immunosuppression (IS) withdrawal after sirolimus addition, efficacy of Alemtuzumab, normal graft function and stability within 1 year of immunosuppression withdrawal. CONCLUSION This study revealed a low number of trials, lack of variety in location and low publishing rates. The focus of trials was mainly towards side effects and safety of immunosuppressants, and their withdrawal. These trials reached results that must be built on to reach definitive guidelines and treatment strategies. This highlights the need for better management of human and financial resources, in order to reach new and more effective therapeutic strategies, leading to the decrease in rate of LTR.
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Affiliation(s)
- Jad El Masri
- Faculty of Medicine, Lebanese University, Beirut, Lebanon; Faculty of Medicine, Neuroscience Research Center, Lebanese University, Beirut, Lebanon.
| | | | - Bachir Zreika
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Fouad Adhami
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Diala El Masri
- Faculty of Medicine, University of Balamand, Nord, Lebanon
| | - Said El Hage
- Faculty of Medicine, Lebanese University, Beirut, Lebanon; Faculty of Medicine, Neuroscience Research Center, Lebanese University, Beirut, Lebanon; INSPECT-LB (Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie-Liban), Beirut, Lebanon
| | - Maroun Abou-Jaoudé
- Faculty of Medicine, Lebanese University, Beirut, Lebanon; Department of Surgery, Middle East Institute of Health, Bsalim, Lebanon; Department of Surgery, Saint-George Hospital-UMC, Beirut, Lebanon
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Healthcare Resource Utilization After Living Liver Donation: A Retrospective Case-control Study. Transplantation 2021; 106:1201-1205. [PMID: 34560697 DOI: 10.1097/tp.0000000000003958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Living liver donation is generally considered safe, but donors may experience short or long-term complications. The purpose of this study was to assess healthcare resource utilization after liver donation in living liver donors in comparison to the general population. METHODS Outpatient or emergency department visits and hospital admissions were compared between living liver donors who underwent hepatic resection for living liver donation between 2004 and 2018 and the matched general population. Healthcare resource utilization data for 5 years after liver donation were collected from the National Health Insurance Service (NHIS) database. For every living liver donor, 4 individually matched nondonors were selected from the NHIS database using age, sex, preexisting comorbidities, and previous healthcare utilization history. RESULTS A total of 1886 living liver donors and 7309 nondonors were included. In the first year after donation, living liver donors required more outpatient department visits (7 [4-13] vs. 3 [1-7], P < 0.001) and more emergency department visits (13.33% vs. 0.15%, P < 0.001) compared to matched nondonors. A similar trend persisted for 5 years after donation. The number of hospital admissions of living liver donors was higher for up to 2 years after donation with longer hospital length of stay (13.0 [10.5-16.0] vs. 5.0 [3.0-9.0] days, P < 0.0001). CONCLUSIONS Healthcare resource utilization in living liver donors for 5 years after donation were higher compared to matched nondonors. The higher healthcare resource demand may be related to postoperative complications or lowered threshold for healthcare resource utilization after donation.Supplemental Visual Abstract; http://links.lww.com/TP/C291.
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Abdallah A, Salman AA, Sholkamy AA, Salman MA, Omar MG, Youssef A, Ameen MA, Abdel Dayem AY, El-Din Shaaban H, Youssef OR, Allah NA, Abdelaty WR. Study of factors affecting Small for Size Syndrome Post-Adult living donor liver transplantation. Asian J Surg 2020; 44:452-458. [PMID: 33189526 DOI: 10.1016/j.asjsur.2020.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/13/2020] [Accepted: 10/23/2020] [Indexed: 12/13/2022] Open
Abstract
AIM Recently, increasing evidence showed that small-for-size syndrome (SFSS) is a multifactorial disease which is precipitated by various perioperative factors other than graft size. We conducted the current work to evaluate perioperative effectors, which can increase the risk of SFSS following adult living-donor liver transplantation (LDLT). METHODS This is a retrospective study on 110 adult cirrhotic cases (mean age of 48.4 ± 6.9 years old) who underwent adult LDLT. Most cases were males (89%). Cases were categorized into two groups based on the occurrence of SFSS. The groups were compared regarding preoperative (gender, age, comorbidities, baseline investigations), intraoperative (mean blood pressure and glucose; mean operation time; number of packed red cells, plasma, platelets, and cryoprecipitate units; time of cold and warm ischemia, and anhepatic phase; preclamping and post-reperfusion portal pressures), and postoperative factors (relevant investigations, hospital stay). RESULTS Postoperatively, 23 patients developed SFSS (20.9%). SFSS group had significantly lower preoperative graft recipient weight ratio (GRWR) (0.76 ± 0.1% versus 1.03 ± 0.15, respectively; p < 0.001), and elevated MELD scores (19 ± 2.1 versus 17.9 ± 4; p = 0.024). Preclamping and post-reperfusion portal pressures of ≥22.5 and 17.5 mmHg, exhibited a sensitivity of 95.7% and 91.3% and specificity of 87.4% and 88.9% respectively, for SFSS prediction. CONCLUSION SFSS risk is significantly linked to GRWR, MELD score, and intraoperative portal haemodynamics. Intraoperative portal haemodynamics exhibited good diagnostic accuracy for SFSS prediction and represented promising indicators for the prediction of SFSS.
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Affiliation(s)
- Ahmed Abdallah
- General Surgery Department, Faculty of Medicine, Cairo University, Egypt.
| | | | | | | | - Mahmoud Gouda Omar
- Internal Medicine Department, Faculty of Medicine, Cairo University, Egypt.
| | - Ahmed Youssef
- Internal Medicine Department, Faculty of Medicine, Cairo University, Egypt.
| | - Mahmoud A Ameen
- General Surgery Department, Faculty of Medicine, Cairo University, Egypt.
| | | | | | - Ossama Ramzy Youssef
- Department of Anaesthesia and Intensive Care, Faculty of Medicine, Ain Shams University, Egypt.
| | - Nesrin Abd Allah
- Anatomy and Embryology Department, Faculty of Medicine, Menoufia University, Egypt.
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11
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Rodrigues Filho EM, Garcez A, Nedel WL. [Validation of APACHE IV score in postoperative liver transplantation in southern Brazil: a cohort study]. Rev Bras Anestesiol 2019; 69:279-283. [PMID: 31072607 DOI: 10.1016/j.bjan.2018.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 09/23/2018] [Accepted: 11/18/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Liver transplantation is the only curative therapeutic modality available for individuals at end-stage liver disease. There is no reliable method of predicting the early postoperative outcome of these patients. The Acute Physiology and Chronic Health Evaluation (APACHE) is a widely used model for predicting hospital survival and benchmarking in critically ill patients. This study evaluated the calibration and discrimination of APACHE IV in the postoperative period of elective liver transplantation in the southern Brazil. METHODS This was a clinical prospective and unicentric cohort study that included 371 adult patients in the immediate postoperative period of elective liver transplantation from January 1, 2012 to December 31, 2016. RESULTS In this study, liver transplant patients who evolved to hospital death had a significantly higher APACHE IV score (82.7±5.1 vs. 51.0±15.8; p<0.001) and higher predicted mortality (6.5% [4.4-20.2%] vs. 2.3% [1.4-3.5%]; p<0.001). The APACHE IV score showed an adequate calibration (Hosmer-Lemeshow - H-L=11.37; p=0.181) and good discrimination (Receiver Operator Curve - ROC of 0.797; Confidence Interval 95% - 95% CI 0.713-0.881; p<0.0001), although Standardized Mortality Ratio (SMR=2.63), (95% CI 1.66-4.27; p<0.001) underestimate mortality. CONCLUSIONS In summary, the APACHE IV score showed an acceptable performance for predicting a hospital outcome in the postoperative period of elective liver transplant recipients.
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Affiliation(s)
- Edison Moraes Rodrigues Filho
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Hospital Dom Vicente Scherer, Unidade de Terapia Intensiva de Transplantes, Porto Alegre, RS, Brasil.
| | - Anderson Garcez
- Universidade do Vale do Rio dos Sinos (UNISINOS), São Leopoldo, RS, Brasil
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12
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Pereira CS, Carvalho ATD, Bosco AD, Forgiarini Júnior LA. The Perme scale score as a predictor of functional status and complications after discharge from the intensive care unit in patients undergoing liver transplantation. Rev Bras Ter Intensiva 2019; 31:57-62. [PMID: 30970092 PMCID: PMC6443309 DOI: 10.5935/0103-507x.20190016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/27/2018] [Indexed: 12/31/2022] Open
Abstract
Objective To assess the Perme mobility scale score as a predictor of functional status
and complications in the postoperative period in patients undergoing liver
transplantation. Methods The sample consisted of 30 patients who underwent liver transplantation. The
patients were evaluated at two time points to determine their perception of
pain, degree of dyspnea, peripheral muscle strength, and functional status
according to the Perme scale. The collected data were analyzed by
descriptive and inferential statistics. To compare the means between the
evaluations, Student's t test for paired samples was
applied. In case of asymmetry, the Wilcoxon test was used. In the evaluation
of the association between the quantitative variables, the Pearson or
Spearman correlation tests were applied. Results A total of 30 individuals who underwent liver transplantation were included.
The patients were predominantly male, and the mean age was 58.4 ± 9.9
years. The most prevalent underlying pathology was cirrhosis C virus
(23.3%). Significant associations of the time on mechanical ventilation with
the Perme scale score at discharge from the intensive care unit (r = -0.374;
p = 0.042) and the number of physical therapy treatments (r = -0.578; p =
0.001) were recorded. When comparing the results of the initial evaluation
and the evaluation at hospital discharge, there was a significant
improvement in functional status (p < 0.001). Conclusion Functional mobility, peripheral muscle strength, pain perception, and dyspnea
are significantly improved at hospital discharge compared with those at
inpatient unit admission.
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Affiliation(s)
| | | | - Adriane Dal Bosco
- Curso de Fisioterapia e Programa de Pós-Graduação em Saúde e Desenvolvimento Humano, Universidade La Salle - Canoas (RS), Brasil
| | - Luiz Alberto Forgiarini Júnior
- Curso de Fisioterapia e Programa de Pós-Graduação em Saúde e Desenvolvimento Humano, Universidade La Salle - Canoas (RS), Brasil
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Lee DW, Han J. Endoscopic management of anastomotic stricture after living-donor liver transplantation. Korean J Intern Med 2019; 34:261-268. [PMID: 30840808 PMCID: PMC6406087 DOI: 10.3904/kjim.2019.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/08/2019] [Indexed: 12/14/2022] Open
Abstract
The most effective and fundamental treatment for end-stage liver disease is liver transplantation. Deceased-donor liver transplantation has been performed for many of these cases. However, living-donor liver transplantation (LDLT) has emerged as an alternative because it enables timely procurement of the donor organ. The success rate of LDLT has been improved by development of the surgical technique, use of immunosuppressant drugs, and accumulation of post-transplantation care experience. However, the occurrence of biliary stricture after LDLT remains a problem. This article reviews the pathogenesis, diagnosis, endoscopic management, and long-term outcomes of post-liver transplantation biliary stricture, with a focus on anastomotic stricture.
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Affiliation(s)
- Dong Wook Lee
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jimin Han
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
- Correspondence to Jimin Han, M.D. Division of Gastroenterology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, 33 Duryugongwon-ro 17-gil, Namgu, Daegu 42472, Korea Tel: +82-53-650-3442 Fax: +82-53-624-3281 E-mail:
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14
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Aguilar MT, Carey EJ. Current Status of Liver Transplantation for Primary Biliary Cholangitis. Clin Liver Dis 2018; 22:613-624. [PMID: 30259857 DOI: 10.1016/j.cld.2018.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Primary biliary cholangitis (PBC) is an autoimmune cholestatic liver disease diagnosed with elevated alkaline phosphatase in the presence of antimitochondrial antibody. With the introduction and widespread use of ursodeoxycholic acid the proportion of PBC patients undergoing liver transplant (LT) has decreased. However, up to 40% of patients are ursodeoxycholic acid nonresponders and require second-line treatment or progress to end-stage liver disease requiring LT. Several scoring systems have been developed and validated to assess treatment response and transplant-free survival in patients. Although PBC is a favorable indication for LT, recurrence of PBC may occur and requires biopsy for diagnosis.
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Affiliation(s)
- Maria T Aguilar
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
| | - Elizabeth J Carey
- Division of Gastroenterology and Hepatology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
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Dias FFDM, Almeida SSD, Almeida MDD. Assessment and enrolment process for liver transplantation: nursing management through quality indicators. ACTA ACUST UNITED AC 2018; 16:eAO3975. [PMID: 29694625 PMCID: PMC5968806 DOI: 10.1590/s1679-45082018ao3975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/23/2017] [Indexed: 11/25/2022]
Abstract
Objective To establish, measure and analyze quality indicators in the evaluation and enrolment process of patients in a liver transplant program. Methods A quantitative and non-experimental research, with data collected from the database of a liver transplant program, from September 2012 to September 2014. Descriptive statistics were used to analyze the quality indicators identified. Results We analyzed 1,311 visits in the transplant outpatient clinic, most males (66.7%), white (65.1%), mean age of 53 (±12.5) years, from the Southeastern Region (91.2%), and from the State of São Paulo (80.8%). The indicators measured were efficiency of patient admission process (54.8%), efficiency of evaluation of transplant indication (39.9%), efficacy of treatment of patients seen in the program (21.8%), and waiting time to inclusion in the waiting list, median of 84 days (36-142). Conclusion The quality indicators analyzed in this study enabled a quantitative view of the process, facilitating management of results and benchmarking with other transplant centers. Continuous monitoring can optimize resource allocation and planning of services in patient's admission process.
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Wang W, Ji G, Chen Y, Wang J, Sun J, Tang G, Xie Z, Zhao H, Liu G, Tan S, Chen G, Xue H. Changes in DNA Methylation of Glucocorticoid-Induced Tumor Necrosis Factor Receptor and Its Ligand in Liver Transplantation. Transplant Proc 2017; 49:1824-1833. [PMID: 28923633 DOI: 10.1016/j.transproceed.2017.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 05/31/2017] [Accepted: 06/16/2017] [Indexed: 10/18/2022]
Abstract
Liver transplantation (LT) is the criterion standard of care in patients with end-stage liver disease and those with tumors of hepatic origin in the setting of liver dysfunction. Chronic immune rejection of the liver transplant can lead to bad prognosis for patients. Glucocorticoid-induced tumor necrosis factor receptor (GITR) play a key role in dominant immunologic self-tolerance maintained by CD25+/CD4+ regulatory T cells. Here, we investigated the DNA methylation variations of GITR and GITR ligand (GITRL) using pyrosequencing by analyzing blood DNA samples of patients after LT. Our results showed that the methylation level of certain CpGs, such as CpG_13, in GITRL was significantly reduced after LT. Furthermore, we found that the GITRL methylation statuses of cohorts with no chronic immune rejection were significantly lower compared with cohorts with chronic immune rejection after LT treatment. However, the methylation statuses of GITR were less varied. Using linear regression analysis, we further found that factors such as upper gastrointestinal hemorrhage, splenectomy, and creatinine might affect DNA methylation patterns in chronic immune rejection cohorts. These findings provide novel insights into the pivotal role of GITRL as a potential molecular biomarker for the triage of liver transplantation.
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Affiliation(s)
- W Wang
- Department of Liver Transplantation, Zhengzhou University People's Hospital, Zhengzhou, People's Republic of China
| | - G Ji
- Shenzhen E-Gene Tech Co, ShenZhen, Guangdong, People's Republic of China
| | - Y Chen
- Department of Liver Transplantation, Zhengzhou University People's Hospital, Zhengzhou, People's Republic of China
| | - J Wang
- Shenzhen E-Gene Tech Co, ShenZhen, Guangdong, People's Republic of China
| | - J Sun
- Department of Liver Transplantation, Zhengzhou University People's Hospital, Zhengzhou, People's Republic of China
| | - G Tang
- Department of Liver Transplantation, Zhengzhou University People's Hospital, Zhengzhou, People's Republic of China
| | - Z Xie
- Department of Liver Transplantation, Zhengzhou University People's Hospital, Zhengzhou, People's Republic of China
| | - H Zhao
- Department of Liver Transplantation, Zhengzhou University People's Hospital, Zhengzhou, People's Republic of China
| | - G Liu
- Department of Liver Transplantation, Zhengzhou University People's Hospital, Zhengzhou, People's Republic of China
| | - S Tan
- Hepatic Surgery Center, GuiLin Medical University, Guilin, GuangXi, People's Republic of China
| | - G Chen
- Department of Liver Transplantation, Zhengzhou University People's Hospital, Zhengzhou, People's Republic of China.
| | - H Xue
- Department of Liver Transplantation, Zhengzhou University People's Hospital, Zhengzhou, People's Republic of China.
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Zanetto A, Shalaby S, Vitale A, Mescoli C, Ferrarese A, Gambato M, Franceschet E, Germani G, Senzolo M, Romano A, Angeli P, Rugge M, Farinati F, Forton DM, Cillo U, Burra P, Russo FP. Dropout rate from the liver transplant waiting list because of hepatocellular carcinoma progression in hepatitis C virus-infected patients treated with direct-acting antivirals. Liver Transpl 2017; 23:1103-1112. [PMID: 28544587 DOI: 10.1002/lt.24790] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/08/2017] [Accepted: 05/13/2017] [Indexed: 12/13/2022]
Abstract
Concerns about an increased hepatocellular carcinoma (HCC) recurrence rate following direct-acting antiviral (DAA) therapy in patients with cirrhosis with a prior complete oncological response have been raised. Data regarding the impact of HCV treatment with DAAs on wait-list dropout rates in patients with active HCC and HCV-related cirrhosis awaiting liver transplantation (LT) are lacking. HCV-HCC patients listed for LT between January 2015 and May 2016 at Padua Liver Transplant Center were considered eligible for the study. After enrollment, patients were divided into 2 groups, depending on whether they underwent DAA treatment while awaiting LT or not. For each patient clinical, serological, and virological data were collected. HCC characteristics were radiologically evaluated at baseline and during follow-up (FU). For transplanted patients, pathological assessment of the explants was performed and recurrence rates were calculated. A total of 23 patients treated with DAAs and 23 controls were enrolled. HCC characteristics at time of LT listing were comparable between the 2 groups. Median FU was 10 and 7 months, respectively, during which 2/23 (8.7%) and 1/23 (4.3%) dropout events due to HCC progression were registered (P = 0.90). No significant differences in terms of radiological progression were highlighted (P = 0.16). A total of 9 out of 23 (39%) patients and 14 out of 23 (61%) controls underwent LT, and histopathological analysis showed no differences in terms of median number and total tumor volume of HCC nodules, tumor differentiation, or microvascular invasion. During post-LT FU, 1/8 (12.5%) DAA-treated patient and 1/12 (8.3%) control patient experienced HCC recurrence (P = 0.60). In conclusion, viral eradication does not seem to be associated with an increased risk of dropout due to neoplastic progression in HCV-HCC patients awaiting LT. Liver Transplantation 23 1103-1112 2017 AASLD.
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Affiliation(s)
- Alberto Zanetto
- Gastroenterology/Multivisceral Transplant Unit, Padua, Italy
| | - Sarah Shalaby
- Gastroenterology/Multivisceral Transplant Unit, Padua, Italy
| | - Alessandro Vitale
- Hepatobiliary Surgery and Liver Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, Padua, Italy
| | | | | | - Martina Gambato
- Gastroenterology/Multivisceral Transplant Unit, Padua, Italy
| | | | - Giacomo Germani
- Gastroenterology/Multivisceral Transplant Unit, Padua, Italy
| | - Marco Senzolo
- Gastroenterology/Multivisceral Transplant Unit, Padua, Italy
| | - Antonietta Romano
- Unit of Internal Medicine and Hepatology, Department of Medicine, Padua University Hospital, Padua, Italy
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology, Department of Medicine, Padua University Hospital, Padua, Italy
| | - Massimo Rugge
- Surgical Pathology and Cytopathology Unit, Padua, Italy
| | | | - Daniel M Forton
- Department of Gastroenterology and Hepatology, St. George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, Padua, Italy
| | - Patrizia Burra
- Gastroenterology/Multivisceral Transplant Unit, Padua, Italy
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Mazzoni A, Giampietro C, Bianco I, Grazzini T, Nencini C, Pileggi C, Scatena F, Filipponi F, Ghinolfi D, Catalano G, Biancofiore G, Bindi M, Urbani L. Extracorporeal photopheresis and liver transplantation: Our experience and preliminary data. Transfus Apher Sci 2017; 56:515-519. [DOI: 10.1016/j.transci.2017.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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IRAK-4-shRNA Prevents Ischemia/Reperfusion Injury Via Different Perfusion Periods Through the Portal Vein After Liver Transplantation in Rat. Transplant Proc 2017; 48:2803-2808. [PMID: 27788821 DOI: 10.1016/j.transproceed.2016.06.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 06/22/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND This study analyzed the effects of short hairpin RNA targeting interleukin-1 receptor-associated kinase-4 (IRAK-4-shRNA) via portal vein perfusion during different periods on ischemia/reperfusion injury after liver transplantation. METHODS Rats were randomly divided into 3 groups: the cold ischemia transfection group (CIT group, n = 18), in which graft livers were perfused with the plasmid of pSIIRAK-4 expressing IRAK-4-shRNA for 4 minutes (0.5 mL/min) via the portal vein during the cold ischemia period; the in vivo transfection group (IVT group, n = 18), in which equivalent volumes (2 mL) of IRAK-4-ShRNA plasmid (pSIIRAK-4) were injected during the operation; and the control group (n = 18), in which the rats received equivalent volumes of blank plasmid. At 0, 60, and 180 minutes after portal vein reperfusion, blood and liver tissues were collected for examination. IRAK-4 expression, nuclear factor kB (NF-kB) activity, tumor necrosis factor α, interleukin (IL)-1β, and IL-6 serum levels, as well as histologic changes, were detected. RESULTS At 0 minutes after reperfusion, IRAK-4 expression, NF-κB activity, and serum levels of tumor necrosis factor α, IL-1β, and IL-6 showed no significant differences among the 3 groups (P > .05). At 60 and 180 minutes after reperfusion, all indices of the IVT and control groups were significantly higher than those of the CIT group (P < .01). Meanwhile, all indices of the CIT group showed no significant differences at various time points (P > .05). Liver function and histologic changes exhibited less liver injury in the CIT group than in the other groups. CONCLUSIONS IRAK-4 activity was suppressed by IRAK-4-shRNA through portal vein perfusion during the cold ischemia period, and IRAK-4-shRNA effectively prevented ischemia/reperfusion injury after liver transplantation.
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Liberal R, Grant CR. Cirrhosis and autoimmune liver disease: Current understanding. World J Hepatol 2016; 8:1157-1168. [PMID: 27729952 PMCID: PMC5055585 DOI: 10.4254/wjh.v8.i28.1157] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/14/2016] [Accepted: 08/08/2016] [Indexed: 02/06/2023] Open
Abstract
Primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) and autoimmune hepatitis (AIH) constitute the classic autoimmune liver diseases (AILDs). While AIH target the hepatocytes, in PBC and PSC the targets of the autoimmune attack are the biliary epithelial cells. Persistent liver injury, associated with chronic AILD, leads to un-resolving inflammation, cell proliferation and the deposition of extracellular matrix proteins by hepatic stellate cells and portal myofibroblasts. Liver cirrhosis, and the resultant loss of normal liver function, inevitably ensues. Patients with cirrhosis have higher risks or morbidity and mortality, and that in the decompensated phase, complications of portal hypertension and/or liver dysfunction lead to rapid deterioration. Accurate diagnosis and monitoring of cirrhosis is, therefore of upmost importance. Liver biopsy is currently the gold standard technique, but highly promising non-invasive methodology is under development. Liver transplantation (LT) is an effective therapeutic option for the management of end-stage liver disease secondary to AIH, PBC and PSC. LT is indicated for AILD patients who have progressed to end-stage chronic liver disease or developed intractable symptoms or hepatic malignancy; in addition, LT may also be indicated for patients presenting with acute liver disease due to AIH who do not respond to steroids.
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Lee DW, Jo HH, Abdullah J, Kahaleh M. Endoscopic Management of Anastomotic Strictures after Liver Transplantation. Clin Endosc 2016; 49:457-461. [PMID: 27744664 PMCID: PMC5066406 DOI: 10.5946/ce.2016.130] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 12/17/2022] Open
Abstract
Endoscopic treatment of biliary strictures involving plastic stent placement has been used widely. The use of self-expandable metal stents (SEMSs) has been described for anastomotic strictures following liver transplantation (LT). This review aimed to assess and compare the efficacy of plastic stents with SEMS in LT patients. Information was retrieved regarding technical success, stricture resolution, the number of endoscopic retrograde cholangiography procedures, follow-up, immediate, and late complications. Eight studies involving plastic stents had a stricture resolution rate of 84.5%, with the rates ranging from 63% to 100%. These rates are comparable with the stricture resolution rate of 75% determined from six studies that involved 236 patients who received metal stents and the rates ranged from 53% to 81%. The observed success rate for metal stents used to manage post-LT anastomotic biliary strictures was below the reported rate for multiple plastic stents. Hence, the currently available metal stents should not be offered for the management of post-LT anastomotic biliary strictures.
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Affiliation(s)
- Dong Wook Lee
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Hyeong Ho Jo
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Juveria Abdullah
- Department of Internal Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Michel Kahaleh
- Department of Internal Medicine, Weill Cornell Medical College, New York, NY, USA
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Limongi V, Dos Santos DC, Oliveira da Silva AMD, Boin IDFSF, Stucchi RSB. Exercise manual for liver disease patients. World J Transplant 2016; 6:429-436. [PMID: 27358789 PMCID: PMC4919748 DOI: 10.5500/wjt.v6.i2.429] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/18/2016] [Accepted: 04/18/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To increase inspiratory muscle strength and improve the quality of life of candidates for liver transplantation.
METHODS: Twenty-three candidates for liver transplantation participated in the control group and 14 made up the intervention group. The control group consisted of 18 men and 5 women, body mass index (BMI) 27.3 ± 4.5 kg/m2 and Model for End-Stage Liver Disease (MELD) 18.2 ± 6.1. The intervention group consisted of 11 men and 3 women, BMI 28.6 ± 5.4 kg/m2 and MELD 18 ± 4.5. The presence or absence of ascites was identified in the first patient evaluation and after three months. We evaluated maximal inspiratory pressure (MIP) and maximal expiratory pressure, spirometry, root mean square (RMS) of diaphragm and rectus abdominis, and the quality of life. The exercises were performed daily by patients at home for three months and were supervised at distance monthly. The manual consisted of diaphragmatic breathing exercises, diaphragmatic isometric exercise, Threshold IMT®, lifting upper limbs with a bat and strengthening the abdomen.
RESULTS: There was significant difference (P = 0.01) between the first (initial) and the third month (final) MIP in the control group and in the intervention group, but there was no difference (P = 0.45) between the groups. The RMS of the diaphragm was lower (P = 0.001) and the functional capacity was higher (P = 0.006) in the intervention group compared to the control. The general health and mental health domains received higher scores after three months in the control group (P = 0.01) and the intervention group (P = 0.004), but there was no significant difference between them. The comparison between the presence of initial ascites with the presence of ascites was performed after three months in the control group (P = 0.083) and intervention group (P = 0.31). There was no significant difference, in relation to the presence of ascites after three months between groups (P = 0.21). In the intervention group, patients with ascites at the end of the time period had decreased scores on the social aspects SF-36 domain (P = 0.023) compared to those who had no ascites.
CONCLUSION: The proposed exercises provide an increase in the inspiratory muscle strength and improve functional capacity, consequently bettering the quality of life of liver disease patients.
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Liver transplantation in acute on chronic liver failure: challenges and an algorithm for patient selection and management. Hepatol Int 2015; 9:534-42. [PMID: 26159163 DOI: 10.1007/s12072-015-9646-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 06/22/2015] [Indexed: 12/18/2022]
Abstract
Acute on chronic liver failure is an entity distinct from acute liver failure and acute decompensation of chronic liver disease. Despite best medical therapy, it is associated with high short-term mortality due to infection and organ failure. Liver transplantation is a potentially curative treatment option that has been shown to have good outcomes in this setting. As there are no reliable ways of predicting which subset of patients will recover spontaneously, early transplantation before establishment of full blown sepsis or organ failure is expected to have favorable outcomes with an acceptable risk. This article reviews current literature on liver transplantation for acute on chronic liver failure, discusses challenges in patient selection, and proposes an algorithm for management.
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Stroh G, Rosell T, Dong F, Forster J. Early liver transplantation for patients with acute alcoholic hepatitis: public views and the effects on organ donation. Am J Transplant 2015; 15:1598-604. [PMID: 25707427 DOI: 10.1111/ajt.13176] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 12/07/2014] [Accepted: 12/21/2014] [Indexed: 01/25/2023]
Abstract
Patients with severe acute alcoholic hepatitis may not survive to fulfill the standard 6 months of abstinence and counseling prior to transplantation. A prospective study demonstrated that early liver transplantation in such patients improved 2 year survival from 23% to 71% and only 3 of 26 patients returned to drinking after 1140 days; graft function was unaffected. Nonetheless, this treatment protocol may raise public concerns and affect organ donation rates. A total of 503 participants took a survey made available at an online crowdsourcing marketplace. The survey measured attitudes on liver transplantation generally and early transplantation for this patient population, in addition to measuring responses to nine vignettes describing fictional candidates. The majority of respondents (81.5%, n = 410) was at least neutral toward early transplantation for these patients; only a minority (26.3%) indicated that transplantation in any vignette would make them hesitant to donate their organs. Middle-aged patients with good social support and financial stability were viewed most favorably (p < 0.001). Age was considered the most important selection factor and financial stability the least important factor (each p < 0.001). Results indicate early transplantation for carefully selected patients with acute alcoholic hepatitis may not be as controversial to the public as previously thought.
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Affiliation(s)
- G Stroh
- University of Kansas School of Medicine, Kansas City, KS
| | - T Rosell
- Department of History and Philosophy of Medicine, University of Kansas Medical Center, Kansas City, KS
| | - F Dong
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - J Forster
- Saint Luke's Transplant Specialists, Saint Luke's Health System, Kansas City, MO
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25
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Ali JM, Davies SE, Brais RJ, Randle LV, Klinck JR, Allison MED, Chen Y, Pasea L, Harper SFJ, Pettigrew GJ. Analysis of ischemia/reperfusion injury in time-zero biopsies predicts liver allograft outcomes. Liver Transpl 2015; 21:487-99. [PMID: 25545865 DOI: 10.1002/lt.24072] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 12/04/2014] [Accepted: 12/14/2014] [Indexed: 12/12/2022]
Abstract
Ischemia/reperfusion injury (IRI) that develops after liver implantation may prejudice long-term graft survival, but it remains poorly understood. Here we correlate the severity of IRIs that were determined by histological grading of time-zero biopsies sampled after graft revascularization with patient and graft outcomes. Time-zero biopsies of 476 liver transplants performed at our center between 2000 and 2010 were graded as follows: nil (10.5%), mild (58.8%), moderate (26.1%), and severe (4.6%). Severe IRI was associated with donor age, donation after circulatory death, prolonged cold ischemia time, and liver steatosis, but it was also associated with increased rates of primary nonfunction (9.1%) and retransplantation within 90 days (22.7%). Longer term outcomes in the severe IRI group were also poor, with 1-year graft and patient survival rates of only 55% and 68%, respectively (cf. 90% and 93% for the remainder). Severe IRI on the time-zero biopsy was, in a multivariate analysis, an independent determinant of 1-year graft survival and was a better predictor of 1-year graft loss than liver steatosis, early graft dysfunction syndrome, and high first-week alanine aminotransferase with a positive predictive value of 45%. Time-zero biopsies predict adverse clinical outcomes after liver transplantation, and severe IRI upon biopsy signals the likely need for early retransplantation.
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Affiliation(s)
- Jason M Ali
- Departments of Surgery, Cambridge University Hospitals National Health Service Trust, Cambridge, United Kingdom
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26
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Squires RH, Ng V, Romero R, Ekong U, Hardikar W, Emre S, Mazariegos GV. Evaluation of the pediatric patient for liver transplantation: 2014 practice guideline by the American Association for the Study of Liver Diseases, American Society of Transplantation and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Hepatology 2014; 60:362-98. [PMID: 24782219 DOI: 10.1002/hep.27191] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 04/22/2014] [Indexed: 12/16/2022]
Affiliation(s)
- Robert H Squires
- Department of Pediatrics, University of Pittsburgh School of Medicine; Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
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27
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Kim SI. Bacterial infection after liver transplantation. World J Gastroenterol 2014; 20:6211-6220. [PMID: 24876741 PMCID: PMC4033458 DOI: 10.3748/wjg.v20.i20.6211] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 12/23/2013] [Accepted: 02/20/2014] [Indexed: 02/07/2023] Open
Abstract
Infectious complications are major causes of morbidity and mortality after liver transplantation, despite recent advances in the transplant field. Bacteria, fungi, viruses and parasites can cause infection before and after transplantation. Among them, bacterial infections are predominant during the first two months post-transplantation and affect patient and graft survival. They might cause surgical site infections, including deep intra-abdominal infections, bacteremia, pneumonia, catheter-related infections and urinary tract infections. The risk factors for bacterial infections differ between the periods after transplant, and between centers. Recently, the emergence of multi-drug resistant bacteria is great concern in liver transplant (LT) patients. The instructive data about effects of infections with extended-spectrum beta lactamase producing bacteria, carbapenem-resistant gram-negative bacteria, and glycopeptide-resistant gram-positive bacteria were reported on a center-by-center basis. To prevent post-transplant bacterial infections, proper strategies need to be established based upon center-specific data and evidence from well-controlled studies. This article reviewed the recent epidemiological data, risk factors for each type of infections and important clinical issues in bacterial infection after LT.
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28
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Song ATW, Avelino-Silva VI, Pecora RAA, Pugliese V, D’Albuquerque LAC, Abdala E. Liver transplantation: Fifty years of experience. World J Gastroenterol 2014; 20:5363-5374. [PMID: 24833866 PMCID: PMC4017051 DOI: 10.3748/wjg.v20.i18.5363] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 02/27/2014] [Indexed: 02/06/2023] Open
Abstract
Since 1963, when the first human liver transplantation (LT) was performed by Thomas Starzl, the world has witnessed 50 years of development in surgical techniques, immunosuppression, organ allocation, donor selection, and the indications and contraindications for LT. This has led to the mainstream, well-established procedure that has saved innumerable lives worldwide. Today, there are hundreds of liver transplant centres in over 80 countries. This review aims to describe the main aspects of LT regarding the progressive changes that have occurred over the years. We herein review historical aspects since the first experimental studies and the first attempts at human transplantation. We also provide an overview of immunosuppressive agents and their potential side effects, the evolution of the indications and contraindications of LT, the evolution of survival according to different time periods, and the evolution of methods of organ allocation.
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29
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Du Z, Wei Y, Chen K, Chen X, Zhang Z, Li H, Ma Y, Li B. Risk factors and criteria predicting early graft loss after adult-to-adult living donor liver transplantation. J Surg Res 2014; 187:673-82. [DOI: 10.1016/j.jss.2013.10.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 10/08/2013] [Accepted: 10/24/2013] [Indexed: 12/11/2022]
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30
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EXP CLIN TRANSPLANTExp Clin Transplant 2014; 12. [DOI: 10.6002/ect.25liver.p38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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31
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Abstract
The decision to perform liver transplantation for a particular patient is never the decision of one single individual, although a single individual could preclude transplant as an option if the opportunity for referral is missed. Every physician treating patients with cirrhosis, including primary care physicians and primary gastroenterologists, should watch for the essential turning points at which a patient may become eligible for a transplant referral. Timing of referral could be assessed according to either the type of liver disease or non–disease-specific measures of disease severity. Although the MELD score is an easily accessible and convenient tool it is not as well known as CTP classification, and many cirrhotic patients under long-term management may not be being allocated a MELD score regularly calculated by their primary physicians. Because a slow progression in MELD score may occur without a change in symptoms, reaching the MELD score acceptable for transplant referral may go unrecognized. As generalists face the rising prevalence of NAFLD and the rising prevalence of cirrhosis and HCC from HCV, there will be an increasing need for education in the management of liver disease. It will be necessary for specialists and health care systems to better inform primary care physicians about the recommendations on criteria for transplant referral and the critical windows of opportunity within which they can act. Although there is a recognized knowledge gap that needs to be addressed, once a patient is in medical care, inadequate physician knowledge should never be the cause for late timing or missing the opportunity for referral.
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Affiliation(s)
- Rena K Fox
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco School of Medicine, 1545 Divisadero Street, Suite 307, San Francisco, CA 94143-0320, USA.
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32
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APACHE IV is superior to MELD scoring system in predicting prognosis in patients after orthotopic liver transplantation. Clin Dev Immunol 2013; 2013:809847. [PMID: 24348682 PMCID: PMC3855953 DOI: 10.1155/2013/809847] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 10/21/2013] [Accepted: 10/23/2013] [Indexed: 12/12/2022]
Abstract
This study aims to compare the efficiency of APACHE IV with that of MELD scoring system for prediction of the risk of mortality risk after orthotopic liver transplantation (OLT). A retrospective cohort study was performed based on a total of 195 patients admitted to the ICU after orthotopic liver transplantation (OLT) between February 2006 and July 2009 in Guangzhou, China. APACHE IV and MELD scoring systems were used to predict the postoperative mortality after OLT. The area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow C statistic were used to assess the discrimination and calibration of APACHE IV and MELD, respectively. Twenty-seven patients died during hospitalization with a mortality rate of 13.8%. The mean scores of APACHE IV and MELD were 42.32 ± 21.95 and 18.09 ± 10.55, respectively, and APACHE IV showed better discrimination than MELD; the areas under the receiver operating characteristic curve for APACHE IV and MELD were 0.937 and 0.694 (P < 0.05 for both models), which indicated that the prognostic value of APACHE IV was relatively high. Both models were well-calibrated (The Hosmer-Lemeshow C statistics were 1.568 and 6.818 for APACHE IV and MELD, resp.; P > 0.05 for both). The respective Youden indexes of APACHE IV, MELD, and combination of APACHE IV with MELD were 0.763, 0.430, and 0.545. The prognostic value of APACHE IV is high but still underestimates the overall hospital mortality, while the prognostic value of MELD is poor. The function of the APACHE IV is, thus, better than that of the MELD.
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33
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Liberal R, Zen Y, Mieli-Vergani G, Vergani D. Liver transplantation and autoimmune liver diseases. Liver Transpl 2013; 19:1065-77. [PMID: 23873751 DOI: 10.1002/lt.23704] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 06/23/2013] [Indexed: 12/16/2022]
Abstract
Liver transplantation (LT) is an effective treatment for patients with end-stage autoimmune liver diseases such as primary biliary cirrhosis, primary sclerosing cholangitis, and autoimmune hepatitis. Indications for LT for these diseases do not differ substantially from those used for other acute or chronic liver diseases. Despite the good outcomes reported, the recurrence of autoimmune liver disease is relatively common in the allograft. In addition, it has become apparent that autoimmunity and autoimmune liver disease can arise de novo after transplantation for nonautoimmune liver disorders. An awareness of the existence of recurrent autoimmune liver diseases and de novo autoimmune hepatitis after LT has important clinical implications because their management differs from the standard antirejection treatment and is similar to the management of classic autoimmune liver diseases in the native liver.
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Affiliation(s)
- Rodrigo Liberal
- Institute of Liver Studies, King's College London School of Medicine at King's College Hospital, London, United Kingdom; Faculty of Medicine, University of Porto, Porto, Portugal
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34
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Abstract
Improved outcomes in liver transplant recipients reflect advances in surgical technique, post-operative care, immunosuppression as well as better selection of potential candidates. The pre-transplant evaluation is a multidisciplinary process intended to recognize and treat important comorbid conditions that may impair outcomes during the peri- and post-transplant periods. Important psychosocial issues should also be ascertained and tackled early during the pre-transplant evaluation with an overarching intention to improve the success of liver transplantation.
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Affiliation(s)
- Andres F Carrion
- Division of Gastroenterology, University of Miami Miller School of Medicine, 1120 NW 14th Street, suite 310E, Miami, FL 33136, USA.
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35
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Ali A, Bhardwaj HL, Heuman DM, Jovin IS. Coronary events in patients undergoing orthotopic liver transplantation: perioperative evaluation and management. Clin Transplant 2013; 27:E207-15. [DOI: 10.1111/ctr.12113] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2013] [Indexed: 12/12/2022]
Affiliation(s)
| | - Hem L. Bhardwaj
- Department of Medicine; Virginia Commonwealth University; Richmond; VA; USA
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36
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Alves RCP, Fonseca EAD, Mattos CALD, Abdalla S, Gonçalves JE, Waisberg J. Predictive factors of early graft loss in living donor liver transplantation. ARQUIVOS DE GASTROENTEROLOGIA 2012; 49:157-61. [PMID: 22767004 DOI: 10.1590/s0004-28032012000200011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 03/16/2012] [Indexed: 02/07/2023]
Abstract
CONTEXT Living donor liver transplantation has become an alternative to reduce the lack of organ donation. OBJECTIVE To identify factors predictive of early graft loss in the first 3 months after living donor liver transplantation. METHODS Seventy-eight adults submitted to living donor liver transplantation were divided into group I with 62 (79.5%) patients with graft survival longer than 3 months, and group II with 16 (20.5%) patients who died and/or showed graft failure within 3 months after liver transplantation. The variables analyzed were gender, age, etiology of liver disease, Child-Pugh classification, model of end-stage liver disease (MELD score), pretransplantation serum sodium level, and graft weight-to-recipient body weight (GRBW) ratio. The GRBW ratio was categorized into < 0.8 and MELD score into >18. The chi-square test, Student t-test and uni- and multivariate analysis were used for the evaluation of risk factors for early graft loss. RESULTS MELD score <18 (P<0.001) and serum sodium level > 135 mEq/L (P = 0.03) were higher in group II than in group I. In the multivariate analysis MELD scores > 18 (P<0.001) and GRBW ratios < 0.8 (P<0.04) were significant. CONCLUSIONS MELD scores >18 and GRBW < 0.8 ratios are associated with higher probability of graft failure after living donor liver transplantation.
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37
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Danesh A, Nedjat S, Asghari F, Jafarian A, Fotouhi A. Organ allocation for liver transplantation according to the public opinion. HEPATITIS MONTHLY 2012; 12:e6183. [PMID: 23087752 PMCID: PMC3475021 DOI: 10.5812/hepatmon.6183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 06/16/2012] [Accepted: 06/27/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although liver transplantation is the last resort for treating end stage liver diseases, this medical procedure is not available for all needful patients because of inadequate organ supply. Therefore, guidelines have been developed by medical experts to regulate the process. Some professionals believe that medical criteria are inadequate for organ allocation in all situations and may not secure fairness of organ allocation. OBJECTIVES The current study has been designed to identify decision criteria about allocation of donated liver to potential recipients from public points of view. PATIENTS AND METHODS This is a qualitative study that was conducted through individual interviews and Focus Group Discussions. Individual interviews were conducted among patients' companions and nurses in one of the two liver transplant centers in Iran. Group discussions were conducted among groups of ordinary people who had not dealt previously with the subject. Data was analyzed by Thematic Analysis method. RESULTS Most of the participants in this study believe that in equal medical conditions, some individual and societal criteria could be used to prioritize patients for receiving donated livers. The criteria include psychological acceptance, ability to pay post-operative care costs, being breadwinner of the family, family support, being socially valued, ability to be instructed, lack of mental disorders, young age of the recipient, being on waiting list for a long time, lack of patient's role in causing the illness, first time transplant recipient, critical medical condition, high success rate of transplantation, lack of concurrent medical illnesses, not being an inmate at the time of receiving transplant, and bearing Iranian nationality. CONCLUSIONS Taking public opinion into consideration may smooth the process of organ allocation to needful patients with equal medical conditions. It seems that considering these viewpoints in drafting organ allocation guidelines may increase confidence of the society to the equity of organ allocation in the country. This strategy may also persuade people to donate organs particularly after death.
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Affiliation(s)
- Ahmad Danesh
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Saharnaz Nedjat
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Fariba Asghari
- Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Ali Jafarian
- Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Hepatobiliary and Liver Transplantation Research Center (Imam Khomeini Hospital), School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Akbar Fotouhi, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, P. O. Box: 14155-6446.Tehran,IR Iran. Tel.: +98-2188987381, Fax: +98-2188987382, E-mail:
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38
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Organ Allocation for Liver Transplantation According to the Public Opinion. HEPATITIS MONTHLY 2012. [DOI: 10.5812/hapatmon.6183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Abstract
Identifying whether someone is a good candidate for liver transplantation is a complex process that requires a team approach. There are several medical and psychosocial considerations involved, each of which is thoroughly explored during the evaluation process. Both the indications and contraindications to transplantation can change over time, reflecting advances in understanding of, and ability to treat, certain disease processes. Ultimately, the goal of liver transplantation remains to provide a survival benefit to those with acute or chronic liver diseases.
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40
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Abstract
PURPOSE OF REVIEW Successful transplant outcomes require optimal patient selection and timing. This review will update clinicians with current status and challenges in liver transplantation. Currently, the major limitation facing liver transplant centers is the shortage of organs. The limited availability of organs has led to long waiting periods for liver transplantation and consequently many patients become seriously ill or die while on the waiting list. RECENT FINDINGS This has major implications in the selection of patients, as well as the timing of transplant, for optimal use of these scarce organs. Indications and contraindications have changed slightly over the years and will be reviewed in this article. SUMMARY Timing for transplantation has changed more dramatically in the recent years because major changes to organ allocation systems have been undertaken to provide clinicians with a better way to prioritize patients for liver transplant.
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41
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Kapoor ND, Goenka MK. Selection of patient for liver transplant. APOLLO MEDICINE 2012. [DOI: 10.1016/s0976-0016(12)60113-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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42
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Ilyas JA, O'Mahony CA, Vierling JM. Liver transplantation in autoimmune liver diseases. Best Pract Res Clin Gastroenterol 2011; 25:765-82. [PMID: 22117641 DOI: 10.1016/j.bpg.2011.09.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 09/30/2011] [Indexed: 01/31/2023]
Abstract
Liver transplantation is indicated for terminal phases of autoimmune hepatitis, primary biliary cirrhosis and primary sclerosing cholangitis. Indications for transplantation in autoimmune liver diseases are similar to those used in other acute or chronic liver diseases. Therapeutic advances have reduced the need for transplantation for autoimmune hepatitis and primary biliary cirrhosis but not for primary sclerosing cholangitis. Overall, outcomes of transplantation for autoimmune liver diseases are excellent. However, recurrence of autoimmune liver diseases in the allograft has variable impacts on graft and patient survivals. Treatment of recurrent diseases requires changes in immunosuppression or addition of ursodeoxycholic acid. Among autoimmune liver diseases, only autoimmune hepatitis occurs de novo in recipients transplanted for other diseases. Patients transplanted for autoimmune hepatitis or primary sclerosing cholangitis are at risk for reactivation or de novo onset of ulcerative colitis. Better understanding of the pathogenesis of recurrent autoimmune liver diseases is needed to devise effective means of prevention and treatment.
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Affiliation(s)
- Jawad A Ilyas
- Fellow in Hepatology and Liver Transplantation, Liver Center, Baylor College of Medicine and St. Luke's Episcopal Hospital, 1709 Dryden, Suite 1500, Houston, TX 77030, USA
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de David C, Rodrigues G, Bona S, Meurer L, González-Gallego J, Tuñón MJ, Marroni NP. Role of quercetin in preventing thioacetamide-induced liver injury in rats. Toxicol Pathol 2011; 39:949-57. [PMID: 21885874 DOI: 10.1177/0192623311418680] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In hepatic toxicity induced in rats by two injections of thioacetamide (TAA, 350 mg/kg with an interval of 8 hr), the action of quercetin was investigated. After 96 hr, TAA administration resulted in hepatic necrosis, significant increases in serum transaminase activity, and increases in hepatic lipoperoxidation. Thioacetamide-induced hepatotoxicity also showed changes in antioxidant enzymes in the liver of rats, with alterations in p-ERK 1/2 (phosphorylated extracellular-signal related kinase 1/2) as well as an imbalance between proapototic protein Bax and anti-apoptotic protein Bcl-2 expression. With administration of the flavonoid quercetin (50 mg/Kg i.p.) for four consecutive days following TAA, serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activity were close to normal values in rats. Histological findings suggested that quercetin had a preventive effect on TAA-induced hepatic necrosis. Quercetin treatment caused significant decreases in lipid peroxide levels in the TAA-treated rats, with some changes in antioxidant enzymes superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx). Quercetin also inhibited the change of the p-ERK1/2 by TAA and significantly prevented the increase in Bax/Bcl-2 ratio, thus preventing apoptosis. Findings indicate that quercetin may have a preventive effect on TAA-induced hepatotoxicity by modulating the oxidative stress parameters and apoptosis pathway.
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Affiliation(s)
- Cíntia de David
- Laboratory of Experimental Hepatology and Physiology, Porto Alegre Clinical Hospital, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Abstract
Biliary strictures are one of the most common complications following liver transplantation, representing an important cause of morbidity and mortality in transplant recipients. The reported incidence of biliary stricture is 5% to 15% following deceased donor liver transplantations and 28% to 32% following living donor liver transplantations. Bile duct strictures following liver transplantation are easily and conveniently classified as anastomotic strictures (AS) or non-anastomotic strictures (NAS). NAS are characterized by a far less favorable response to endoscopic management, higher recurrence rates, graft loss and the need for retransplantation. Current endoscopic strategies to correct biliary strictures following liver transplantation include repeated balloon dilatations and the placement of multiple side-by-side plastic stents. Endoscopic balloon dilatation with stent placement is successful in the majority of AS patients. In patients for whom gaining biliary access is technically difficult, a combined endoscopic and percutaneous/surgical approach proves quite useful. Future directions, including novel endoscopic retrograde cholangiopancreatography techniques, advanced endoscopy, and improved stents could allow for a decreased number of interventions, increased intervals before retreatment, and decreased reliance on percutaneous and surgical modalities. The aim of this review is to detail the present status of endoscopy in the diagnosis, treatment, outcome, and future directions of biliary strictures related to orthotopic liver transplantation from the viewpoint of a clinical gastroenterologists.
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Affiliation(s)
- Choong Heon Ryu
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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45
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Abstract
Biliary strictures are one of the most common complications following liver transplantation, representing an important cause of morbidity and mortality in transplant recipients. The reported incidence of biliary stricture is 5% to 15% following deceased donor liver transplantations and 28% to 32% following living donor liver transplantations. Bile duct strictures following liver transplantation are easily and conveniently classified as anastomotic strictures (AS) or non-anastomotic strictures (NAS). NAS are characterized by a far less favorable response to endoscopic management, higher recurrence rates, graft loss and the need for retransplantation. Current endoscopic strategies to correct biliary strictures following liver transplantation include repeated balloon dilatations and the placement of multiple side-by-side plastic stents. Endoscopic balloon dilatation with stent placement is successful in the majority of AS patients. In patients for whom gaining biliary access is technically difficult, a combined endoscopic and percutaneous/surgical approach proves quite useful. Future directions, including novel endoscopic retrograde cholangiopancreatography techniques, advanced endoscopy, and improved stents could allow for a decreased number of interventions, increased intervals before retreatment, and decreased reliance on percutaneous and surgical modalities. The aim of this review is to detail the present status of endoscopy in the diagnosis, treatment, outcome, and future directions of biliary strictures related to orthotopic liver transplantation from the viewpoint of a clinical gastroenterologists.
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Affiliation(s)
- Choong Heon Ryu
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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46
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Abstract
PURPOSE OF REVIEW To provide the nontransplant clinician with a basic understanding of the liver transplant process. RECENT FINDINGS Since its inception, the technique of liver transplantation and patient management has evolved considerably. We present an up-to-date overview of the evaluation of the transplant recipient and the listing and timing of transplant. We conclude with a brief summary of long-term complications, which should be considered when caring for the posttransplant patient. SUMMARY Liver transplantation is the only definitive treatment option for patients dying of liver failure. The growing population of patients with liver disease means that more transplants will be performed. As these patients now live longer lives, it is crucial that clinicians have a basic understanding of the process and outcomes.
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Varma V, Mehta N, Kumaran V, Nundy S. Indications and contraindications for liver transplantation. Int J Hepatol 2011; 2011:121862. [PMID: 22007310 PMCID: PMC3189562 DOI: 10.4061/2011/121862] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 08/10/2011] [Indexed: 12/12/2022] Open
Abstract
Patients with chronic liver disease and certain patients with acute liver failure require liver transplantation as a life-saving measure. Liver transplantation has undergone major improvements, with better selection of candidates for transplantation and allocation of scarce deceased donor organs (according to more objective criteria). Living donor liver transplantation came into existence to overcome the shortage of donor organs especially in countries where there was virtually no deceased donor programme. Advances in the technical aspects of the procedure, the intraoperative and postoperative care of both recipients and donors, coupled with the introduction of better immunosuppression protocols, have led to graft and patient survivals of over 90% in most high volume centres. Controversial areas like transplantation in alcoholic liver disease without abstinence, acute alcoholic hepatitis, and retransplantation for recurrent hepatitis C virus infection require continuing discussion.
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Affiliation(s)
- Vibha Varma
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital Room No. 2221, SSR Block, Rajinder Nagar, New Delhi 110060, India
| | - Naimish Mehta
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital Room No. 2221, SSR Block, Rajinder Nagar, New Delhi 110060, India
| | - Vinay Kumaran
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital Room No. 2221, SSR Block, Rajinder Nagar, New Delhi 110060, India
| | - Samiran Nundy
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital Room No. 2221, SSR Block, Rajinder Nagar, New Delhi 110060, India,*Samiran Nundy:
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Patel PR, Thompson ND, Kallen AJ, Arduino MJ. Epidemiology, surveillance, and prevention of hepatitis C virus infections in hemodialysis patients. Am J Kidney Dis 2010; 56:371-8. [PMID: 20570422 DOI: 10.1053/j.ajkd.2010.01.025] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 01/29/2010] [Indexed: 12/17/2022]
Abstract
Hepatitis C virus (HCV) infection is the most common chronic blood-borne infection in the United States; the prevalence in maintenance hemodialysis patients substantially exceeds that in the general population. In hemodialysis patients, HCV infection has been associated with increased occurrence of cirrhosis and hepatocellular carcinoma and increased mortality. Injection drug use and receipt of blood transfusions before 1992 has accounted for most prevalent HCV infections in the United States. However, HCV transmission among patients undergoing hemodialysis has been documented frequently. Outbreak investigations have implicated lapses in infection control practices as the cause of HCV infections. Preventing these infections is an emerging priority for renal care providers, public health agencies, and regulators. Adherence to recommended infection control practices is effective in preventing HCV transmission in hemodialysis facilities. In addition, adoption of routine screening to facilitate the detection of incident HCV infections and hemodialysis-related transmission is an essential component of patient safety and infection prevention efforts. This article describes the current epidemiology of HCV infection in US maintenance hemodialysis patients and prevention practices to decrease its incidence and transmission.
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Affiliation(s)
- Priti R Patel
- National Center for Preparedness, Detection, and Control of Infectious Diseases, Atlanta, GA, USA.
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Hyslop WB, Kierans AS, Leonardou P, Fritchie K, Darling J, Elazazzi M, Semelka RC. Overlap syndrome of autoimmune chronic liver diseases: MRI findings. J Magn Reson Imaging 2010; 31:383-9. [PMID: 20099347 DOI: 10.1002/jmri.22048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To describe the MR findings of overlap syndromes of autoimmune chronic liver diseases. METHODS Review of clinical and radiological databases between March 2001 and July 2008 for patients with a clinical diagnosis and liver biopsy features compatible with overlap syndrome who had also undergone an abdominal MRI yielded 15 adult patients. MR features of overlap syndrome were reviewed by two radiologists by consensus. Two radiologists independently reviewed the studies in a blinded fashion for primary sclerosing cholangitis (PSC)-type or non-PSC-type features to assess interobserver agreement. RESULTS PSC-type and non-PSC-type overlap syndrome had distinctive MR features. In the consensus review, all 12 patients with PSC-type overlap syndrome were correctly identified. Imaging findings included central macroregeneration (N = 9), peripheral atrophy (N = 7), biliary duct beading (N = 12), biliary dilation (N = 10), or a combination of all four findings (N = 7). The presence of any of the first three features had 100% specificity for a PSC-type overlap syndrome. Patients with non-PSC-type overlap (N = 3) showed relatively normal liver morphology (N = 3) and minimal biliary ductal dilatation in one patient. There was good interobserver agreement (kappa = 0.76). CONCLUSION Patients with serologic or pathologic evidence of AIH or PBC with imaging features of PSC may have PSC-type overlap syndrome.
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Affiliation(s)
- W Brian Hyslop
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA.
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Kortgen A, Rauchfuss F, Götz M, Settmacher U, Bauer M, Sponholz C. Albumin dialysis in liver failure: comparison of molecular adsorbent recirculating system and single pass albumin dialysis--a retrospective analysis. Ther Apher Dial 2009; 13:419-25. [PMID: 19788459 DOI: 10.1111/j.1744-9987.2009.00760.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Despite improvement in critical care, liver failure is still associated with high mortality. Therapeutic concepts are aimed at restoring endogenous liver function or to bridge the time to liver transplantation. In addition to standard medical treatment, extracorporeal liver support with albumin dialysis is used for this purpose. The aim of this study was to analyze the efficacy of single pass albumin dialysis (SPAD) in comparison to the molecular adsorbent recirculating system (MARS) in patients treated at our university hospital intensive care unit between July 2004 and August 2008. In this retrospective analysis we studied patients presenting with liver failure who were treated with albumin dialysis. Laboratory parameters, daily health scoring, the number of transfusions, and mortality were recorded. The (paired) t-test, Mann-Whitney U-test, and Wilcoxon test were used for statistical analysis. In all, 163 albumin dialysis treatments, 126 with MARS and 37 with SPAD, in 57 patients were performed. MARS resulted in a significant decrease in bilirubin (-38 +/- 66.5 micromol/L from a baseline of 301 +/- 154.6 micromol/L), gamma-glutamyltransferase (gamma-GT), alanine aminotransferase, creatinine, and urea. SPAD resulted in a significant decrease in bilirubin (-41 +/- 111.2 micromol/L from a baseline of 354 +/- 189.4 micromol/L) and gamma-GT, while lactate levels increased. No differences in the need for blood transfusion, health scoring, or mortality between the two treatment modalities were detected. This retrospective analysis suggests equal efficacy of MARS and SPAD; however, prospective assessment to further define the role of SPAD in the treatment of acute or acute-on-chronic liver failure is needed.
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Affiliation(s)
- Andreas Kortgen
- Department of Anesthesiology and Critical Care Medicine, Friedrich-Schiller-University Jena, Jena, Germany
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