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Saritaş S, Tarlaci S, Bulbuloglu S, Guneş H. Investigation of Post-Transplant Mental Well-Being in Liver Transplant Recipients with Hepatic Encephalopathy. J Clin Med 2024; 13:3249. [PMID: 38892960 PMCID: PMC11172876 DOI: 10.3390/jcm13113249] [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: 04/26/2024] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Objective: In this study, we aimed to examine the healing trend of hepatic encephalopathy after transplantation surgery in patients with liver failure. Method: We conducted this descriptive and cross-sectional study with the participation of liver transplant recipients. A personal information form, the West Haven Criteria (WHC), the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS), and the Richmond Agitation Sedation Scale (RASS) were used for data collection. The data were analyzed using Chi-squared tests, ANOVA, and paired-samples t-tests. Results: As time progressed after liver transplantation, hepatic encephalopathy stages regressed (p < 0.01). We found that liver transplant recipients with end-stage hepatic encephalopathy were mostly within the first 6 months after transplantation, while patients with first-stage hepatic encephalopathy had received liver transplants more than 2 years ago (p < 0.01). Conclusions: The results of our study revealed that hepatic encephalopathy stages regressed after transplantation, but there was no complete recovery. This highlights the need to develop new treatment strategies other than liver transplantation for the treatment of hepatic encephalopathy.
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Affiliation(s)
- Serdar Saritaş
- Department of Medical Biology, Faculty of Medicine, Malatya Turgut Ozal University, 44000 Malatya, Turkey;
| | - Sultan Tarlaci
- Division of Neuroscience, Psychology Department, Faculty of Medicine, Uskudar University, 34662 Istanbul, Turkey;
| | - Semra Bulbuloglu
- Division of Surgical Nursing, Nursing Department, Health Sciences Faculty, Istanbul Aydin University, 34662 Istanbul, Turkey
| | - Hüseyin Guneş
- Division of Surgical Nursing, Nursing Department, Health Sciences Faculty, Bayburt University, 69000 Bayburt, Turkey;
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Giglio MC, Dolce P, Yilmaz S, Tokat Y, Acarli K, Kilic M, Zeytunlu M, Unek T, Karam V, Adam R, Polak WG, Fondevila C, Nadalin S, Troisi RI. Development of a model to predict the risk of early graft failure after adult-to-adult living donor liver transplantation: An ELTR study. Liver Transpl 2023:01445473-990000000-00296. [PMID: 38079264 DOI: 10.1097/lvt.0000000000000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 11/18/2023] [Indexed: 01/12/2024]
Abstract
Graft survival is a critical end point in adult-to-adult living donor liver transplantation (ALDLT), where graft procurement endangers the lives of healthy individuals. Therefore, ALDLT must be responsibly performed in the perspective of a positive harm-to-benefit ratio. This study aimed to develop a risk prediction model for early (3 months) graft failure (EGF) following ALDLT. Donor and recipient factors associated with EGF in ALDLT were studied using data from the European Liver Transplant Registry. An artificial neural network classification algorithm was trained on a set of 2073 ALDLTs, validated using cross-validation, tested on an independent random-split sample (n=518), and externally validated on United Network for Organ Sharing Standard Transplant Analysis and Research data. Model performance was assessed using the AUC, calibration plots, and decision curve analysis. Graft type, graft weight, level of hospitalization, and the severity of liver disease were associated with EGF. The model ( http://ldlt.shinyapps.io/eltr_app ) presented AUC values at cross-validation, in the independent test set, and at external validation of 0.69, 0.70, and 0.68, respectively. Model calibration was fair. The decision curve analysis indicated a positive net benefit of the model, with an estimated net reduction of 5-15 EGF per 100 ALDLTs. Estimated risks>40% and<5% had a specificity of 0.96 and sensitivity of 0.99 in predicting and excluding EGF, respectively. The model also stratified long-term graft survival ( p <0.001), which ranged from 87% in the low-risk group to 60% in the high-risk group. In conclusion, based on a panel of donor and recipient variables, an artificial neural network can contribute to decision-making in ALDLT by predicting EGF risk.
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Affiliation(s)
- Mariano Cesare Giglio
- Department of Clinical Medicine and Surgery, Division of HPB and Robotic Surgery, Federico II University Hospital Naples, Italy
| | - Pasquale Dolce
- Department of Translational Medicine, Federico II University of Naples, Naples, Italy
| | - Sezai Yilmaz
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Yaman Tokat
- International Liver Center & Acibadem Healthcare Hospitals, Istanbul, Turkey
| | - Koray Acarli
- Department of Organ Transplantation, Istanbul Memorial Hospital, Istanbul, Turkey
- Department of Surgery, Istanbul Memorial Hospital, Istanbul, Turkey
| | - Murat Kilic
- Department of Liver Transplantation, Izmir Kent Hospital, Izmir, Turkey
| | - Murat Zeytunlu
- Departments of General Surgery and Gastroenterology, Ege University, School of Medicine, Izmir, Turkey
| | - Tarkan Unek
- Department of General Surgery, Hepatopancreaticobiliary Surgery and Liver Transplantation Unit, Dokuz Eylul University Faculty of Medicine, Narlidere, Izmir, Turkey
| | - Vincent Karam
- Paul Brousse Hospital, Univ Paris-Sud, Inserm, Villejuif, France
| | - René Adam
- Paul Brousse Hospital, Univ Paris-Sud, Inserm, Villejuif, France
| | | | - Constantino Fondevila
- Department of General and Digestive Surgery, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Roberto Ivan Troisi
- Department of Clinical Medicine and Surgery, Division of HPB and Robotic Surgery, Federico II University Hospital Naples, Italy
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3
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Yun SO, Kim J, Rhu J, Choi GS, Joh JW. Benefit of living donor liver transplantation in graft survival for extremely high model for end-stage liver disease score ≥35. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2023; 30:1293-1303. [PMID: 37799067 DOI: 10.1002/jhbp.1376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/23/2023] [Accepted: 07/27/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND AIMS Living liver donation with high model for end-stage liver disease (MELD) score was discouraged despite organ shortage. This study aimed to compare graft survival between living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT) recipients with extremely high-MELD (score of ≥35). METHODS Between 2008 and 2018, 359 patients who underwent liver transplantation with a MELD score ≥35 were enrolled. We compared graft survival between LDLT and DDLT after propensity score matching (PSM) and performed subgroup analysis according to donor type. RESULTS After PSM, there was no statistical difference in graft survival between the LDLT and DDLT groups (p = .466). Old age, acute on chronic liver failure, re-transplantation, preoperative intensive care unit stay and red blood cell (RBC) transfusion during the operation were risk factors for graft failure (p = .046, .005, .032, .015 and .001, respectively). Biliary complications were more common in the LDLT group (p = .021), while viral infection, postoperative uncontrolled ascites, and postoperative hemodialysis were more common in the DDLT group (p = .002, .018, and .027, respectively). In the LDLT group, acute chronic liver failure, intraoperative RBC transfusion, and early postoperative complications were risk factors for graft failure (p = .007, <.001, and .001, respectively). CONCLUSION Our study showed that LDLT is not inferior to DDLT in graft survival if appropriate risk evaluation is performed in cases of extremely high-MELD scores. This result will help overcome organ shortages in high-MELD liver transplantation.
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Affiliation(s)
- Sang Oh Yun
- Department of Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Dongdaemun-gu, Seoul, Korea
| | - Jongman Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Gangnam-gu, Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Gangnam-gu, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Gangnam-gu, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Gangnam-gu, Korea
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4
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Matoba D, Noda T, Kobayashi S, Sasaki K, Iwagami Y, Yamada D, Tomimaru Y, Takahashi H, Doki Y, Eguchi H. Analysis of Short-Term and Long-Term Outcomes of Living Donor Liver Transplantation for Patients with a High Model for End-Stage Liver Disease Score. Transplant Proc 2023:S0041-1345(23)00149-5. [PMID: 37120341 DOI: 10.1016/j.transproceed.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/13/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND The Model of End-Stage Liver Disease (MELD) scoring system can predict short-term survival among patients awaiting liver transplantation and is used to allocate organs prioritizing liver transplantation. Patients with high MELD scores have been reported to have worse early graft dysfunction and survival. However, recent studies have shown that patients with high MELD scores had satisfactory graft survival, although they showed more postoperative complications. In this study, we examined the effect of the MELD score on the short-term and long-term prognosis of living donor liver transplantation (LDLT). METHODS This study included 102 patients who underwent LDLT in our institution between 2005 and 2020. The patients were divided into 3 groups according to MELD score (low MELD group: ≤20, moderate MELD group: 21-30, and high MELD group: ≥31). Perioperative factors were compared among the 3 groups, and cumulative overall survival rates were calculated using the Kaplan-Meier method. RESULTS The patients' characteristics were comparable, and the median age was 54 years. Hepatitis C virus cirrhosis was the most common primary disease (n = 40), followed by hepatitis B virus (n = 11). The low MELD group consisted of 68 patients (median score: 16, 10-20); the moderate MELD group, 24 patients (median score: 24, 21-30); and the high MELD group, 10 patients (median score: 35, 31-40). The mean operative time (1241 min versus 1278 min versus 1158 min, P = .19) and mean blood loss (7517 mL vs 11162 mL vs 8808 mL, P = .71) were not significantly different among the 3 groups. The vascular and biliary complication rates were similar. The periods of intensive care unit and hospital stay tended to be longer in the high MELD group, but the difference was insignificant. The 1-year postoperative survival rate (85.3 % vs 87.5 % vs 90.0 %, P = .90) and overall survival rate were also not significantly different among the 3 groups. CONCLUSIONS Our study showed that LDLT patients with high MELD scores do not have a worse prognosis than those with low scores.
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Affiliation(s)
- Daijiro Matoba
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takehiro Noda
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Shogo Kobayashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
| | - Kazuki Sasaki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yoshifumi Iwagami
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Daisaku Yamada
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yoshito Tomimaru
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hidenori Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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5
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Living-Donor Liver Transplantation for Hepatocellular Carcinoma: Impact of the MELD Score and Predictive Value of NLR on Survival. Curr Oncol 2022; 29:3881-3893. [PMID: 35735419 PMCID: PMC9221955 DOI: 10.3390/curroncol29060310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/18/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Patients with hepatocellular carcinoma (HCC) tend to be referred for liver transplantation (LT) at an early stage of cirrhosis, with lower pre-LT Model of End-Stage Liver Disease (MELD) scores. We investigated the impact of high MELD scores on post-LT outcomes in patients with HCC and validated the prognostic significance of the neutrophil-to-lymphocyte ratio (NLR). Patients and Method: This retrospective single-center cohort study enrolled 230 patients with HCC who underwent LDLT from 2004−2019 in our institute. We defined a high MELD score as ≥20. Results: The MELD < 20 and MELD ≥ 20 groups comprised 205 and 25 cases, respectively. Although there was no significant difference in disease-free survival between the two groups (p = 0.629), the incidence of septic shock (p = 0.019) was significantly higher in the high MELD group. The one-, three-, and five-year overall survival rates were not significantly different between the two groups (p = 0.056). In univariate analysis, a high pre-LT NLR was associated with poorer survival in the high MELD group (p = 0.029, hazard ratio [HR]: 1.07, 90% confidence interval [CI]: 1.02−1.13). NLR cut-off values of ≥10.7 and <10.7 were predictive of mortality, with an AUC of 0.705 (90% CI: 0.532−0.879). The one-, three-, and five-year post-LT survival rates were significantly higher among the recipients with an NLR < 10.7 than those with an NLR ≥ 10.7 (p = 0.005). Conclusions: Pre-LT MELD score ≥ 20 was associated with a higher risk of developing post-LT septic shock and mortality. The pre-LT serum NLR is a useful predictive factor for clinical outcomes in patients with HCC with high MELD scores.
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6
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Kao TL, Chen YL, Kuan YP, Chang WC, Ho YC, Yeh S, Jeng LB, Ma WL. Estrogen-Estrogen Receptor α Signaling Facilitates Bilirubin Metabolism in Regenerating Liver Through Regulating Cytochrome P450 2A6 Expression. Cell Transplant 2018; 26:1822-1829. [PMID: 29338386 PMCID: PMC5784527 DOI: 10.1177/0963689717738258] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND After living donor liver transplantation (LDLT), rising serum bilirubin levels commonly indicate insufficient numbers of hepatocytes are available to metabolize bilirubin into biliverdin. Recovery of bilirubin levels is an important marker of hepatocyte repopulation after LDLT. Cytochrome P450 (CYP) 2A6 in humans (or cyp2a4 in rodents) can function as "bilirubin oxidase." Functional hepatocytes contain abundant CYP2A6, which is considered a marker for hepatocyte function recovery. The aim of our study was to determine the impact of estradiol/estrogen receptor signaling on bilirubin levels during liver function recovery. METHODS We conducted a hospital-based cohort study of bilirubin levels after LDLT surgery in both liver graft donors and recipients, performed a transcriptome comparison of wild-type versus estrogen receptor (ER)α knockout mice and a bioinformatics analysis of transcriptome changes in their regenerating liver after two-third partial hepatectomy (PHx), and assayed in vitro expression of cytochrome (CYP2A6) in human hepatic progenitor cells (HepRG) treated with 17β-estradiol (E2). RESULTS The latency of bilirubin level reduction was shorter in women than in men, suggesting that a female factor promotes bilirubin recovery after liver transplantation surgery. In the PHx mouse model, the expression of the cyp2a4 gene was significantly lower in livers from the knockout ERα mice than in livers from their wild-type littermates; but the expression of other bilirubin metabolism-related genes were similar between these groups. Moreover, E2 or bilirubin treatments significantly promoted CYP2A6 expression in hepatocyte progenitor cells (HepRG cells). Sequence analysis revealed similar levels of aryl hydrocarbon receptor (AhR; bilirubin responsive nuclear receptor) and ESR1 binding to the promoter region of CYP2A6. CONCLUSIONS This is the first report to demonstrate, on a molecular level, that E2/ERα signaling facilitates bilirubin metabolism in regenerating liver. Our findings contribute new knowledge to our understanding of why the latency of improved bilirubin metabolism and thereby liver function recovery is shorter in females than in males.
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Affiliation(s)
- Ta-Lun Kao
- 1 Graduate Institution of Clinical Medical Science and Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,2 Department of Trauma and Critical Care, Changhua Christian Hospital, Changhua, Taiwan
| | - Yao-Li Chen
- 3 Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Yu-Ping Kuan
- 4 Department of Obstetrics and Gynecology, Sex Hormone Research Center, Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Wei-Chun Chang
- 4 Department of Obstetrics and Gynecology, Sex Hormone Research Center, Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Chen Ho
- 1 Graduate Institution of Clinical Medical Science and Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,4 Department of Obstetrics and Gynecology, Sex Hormone Research Center, Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Shuyuan Yeh
- 5 Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Long-Bin Jeng
- 1 Graduate Institution of Clinical Medical Science and Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,4 Department of Obstetrics and Gynecology, Sex Hormone Research Center, Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Lung Ma
- 1 Graduate Institution of Clinical Medical Science and Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,4 Department of Obstetrics and Gynecology, Sex Hormone Research Center, Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,6 Department of Nursing, Asia University, Taichung, Taiwan
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7
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Engelmann C, Thomsen KL, Zakeri N, Sheikh M, Agarwal B, Jalan R, Mookerjee RP. Validation of CLIF-C ACLF score to define a threshold for futility of intensive care support for patients with acute-on-chronic liver failure. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:254. [PMID: 30305132 PMCID: PMC6180662 DOI: 10.1186/s13054-018-2156-0] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 08/10/2018] [Indexed: 02/07/2023]
Abstract
Background Acute-on-chronic liver failure (ACLF) is a severe complication of cirrhosis and is defined by organ failure and high rates of short-term mortality. Patients with ACLF are managed with multiorgan support in the intensive care unit (ICU). Currently, it is unclear when this supportive care becomes futile, particularly in patients who are not candidates for liver transplant. The aim of this study was to determine whether the currently available prognostic scores can identify patients with ACLF in whom prolonged ICU care is likely to be futile despite maximal treatment efforts. Methods Data of 202 consecutive patients with ACLF admitted to the ICU at the Royal Free Hospital London between 2005 and 2012 were retrospectively analyzed. Prognostic scores for chronic liver diseases, such as Child-Pugh, Model for End-Stage Liver Disease (MELD), European Foundation for the study of chronic liver failure (CLIF-C) organ failure (OF), and CLIF-C ACLF, were calculated 48 hours after ICU admission and correlated with patient outcome after 28 days. Results The CLIF-C ACLF score, compared with all other scores, most accurately predicted 28-day mortality, with an area under the receiver operator characteristic of 0.8 (CLIF-C OF, 0.75; MELD, 0.68; Child-Pugh, 0.66). A CLIF-C ACLF score cutoff ≥ 70 identified patients with a 100% mortality within 28 days. These patients had elevated inflammatory parameters representing a systemic inflammatory response, most often renal failure, compared with patients below this cutoff. Conclusions Patients with ACLF and high CLIF-C ACLF score (≥ 70) after 48 hours of intensive care may reach a threshold of futility for further ongoing intensive support. The best treatment options in this scenario remain to be determined but may include palliative care. Electronic supplementary material The online version of this article (10.1186/s13054-018-2156-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cornelius Engelmann
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW32PF, UK.,Section of Hepatology, Department of Internal Medicine, Neurology, Dermatology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Karen Louise Thomsen
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW32PF, UK.,Department of Hepatology and Gastroenterology, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark
| | - Nekisa Zakeri
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW32PF, UK
| | - Mohammed Sheikh
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW32PF, UK
| | - Banwari Agarwal
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW32PF, UK.,Intensive Care Medicine, Royal Free Hospital, Pond Street, London, NW32QG, UK
| | - Rajiv Jalan
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW32PF, UK
| | - Rajeshwar P Mookerjee
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW32PF, UK.
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8
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Mishra A, Lo A, Lee GS, Samstein B, Yoo PS, Levine MH, Goldberg DS, Shaked A, Olthoff KM, Abt PL. Liver paired exchange: Can the liver emulate the kidney? Liver Transpl 2018; 24:677-686. [PMID: 29427562 DOI: 10.1002/lt.25030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/14/2018] [Accepted: 02/05/2018] [Indexed: 02/07/2023]
Abstract
Kidney paired exchange (KPE) constitutes 12% of all living donor kidney transplantations (LDKTs) in the United States. The success of KPE programs has prompted many in the liver transplant community to consider the possibility of liver paired exchange (LPE). Though the idea seems promising, the application has been limited to a handful of centers in Asia. In this article, we consider the indications, logistical issues, and ethics for establishing a LPE program in the United States with reference to the principles and advances developed from experience with KPE. Liver Transplantation 24 677-686 2018 AASLD.
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Affiliation(s)
- Ashish Mishra
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Alexis Lo
- Temple University School of Medicine, Philadelphia, PA
| | - Grace S Lee
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.,Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA
| | - Benjamin Samstein
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Weill Cornell Medical College, New York, NY
| | - Peter S Yoo
- Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Matthew H Levine
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - David S Goldberg
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, PA.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Abraham Shaked
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Kim M Olthoff
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Peter L Abt
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
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9
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Yadav SK, Saraf N, Saigal S, Choudhary NS, Goja S, Rastogi A, Bhangui P, Soin AS. High MELD score does not adversely affect outcome of living donor liver transplantation: Experience in 1000 recipients. Clin Transplant 2017; 31. [DOI: 10.1111/ctr.13006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Sanjay K. Yadav
- Institute of Liver Transplant and Regenerative Medicine; Medanta-The Medicity; Gurgaon Delhi (NCR) India
| | - Neeraj Saraf
- Institute of Liver Transplant and Regenerative Medicine; Medanta-The Medicity; Gurgaon Delhi (NCR) India
| | - Sanjiv Saigal
- Institute of Liver Transplant and Regenerative Medicine; Medanta-The Medicity; Gurgaon Delhi (NCR) India
| | - Narendra S. Choudhary
- Institute of Liver Transplant and Regenerative Medicine; Medanta-The Medicity; Gurgaon Delhi (NCR) India
| | - Sanjay Goja
- Institute of Liver Transplant and Regenerative Medicine; Medanta-The Medicity; Gurgaon Delhi (NCR) India
| | - Amit Rastogi
- Institute of Liver Transplant and Regenerative Medicine; Medanta-The Medicity; Gurgaon Delhi (NCR) India
| | - Prashant Bhangui
- Institute of Liver Transplant and Regenerative Medicine; Medanta-The Medicity; Gurgaon Delhi (NCR) India
| | - Arvinder S. Soin
- Institute of Liver Transplant and Regenerative Medicine; Medanta-The Medicity; Gurgaon Delhi (NCR) India
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10
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Moon D, Lee S, Kang W, Song G, Jung D, Park G, Cho H, Jwa E, Kim W, Ha T, Kim H. Adult Living Donor Liver Transplantation for Acute-on-Chronic Liver Failure in High-Model for End-Stage Liver Disease Score Patients. Am J Transplant 2017; 17:1833-1842. [PMID: 28097804 PMCID: PMC5516156 DOI: 10.1111/ajt.14198] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 12/22/2016] [Accepted: 12/30/2016] [Indexed: 01/25/2023]
Abstract
The large volume of adult living donor liver transplantations (ALDLTs) at our center affords a unique opportunity to examine the impact of acute-on-chronic liver failure (ACLF) among high-Model for End-Stage Liver Disease MELD score patients. From February 1998 to March 2010, 1958 cirrhotic recipients were analyzed to study the relationship between MELD scores and ALDLT outcomes. A total of 327 high-MELD score recipients were categorized into ACLF and non-ACLF groups, and their outcomes were compared. The 5-year graft and patient survival in the high-MELD group were 75.2% and 76.4%, respectively, which were significantly worse than the low and intermediate MELD groups. The presence of ACLF associated with higher MELD scores appeared to be the dominant factor responsible for the inferior results of patients with MELD score of 30-34 points. The 5-year graft survivals in the ACLF group was 70.5% and in the non-ACLF group it was 81.0% (p = 0.035). Therefore, ALDLT should be performed as soon as possible in high-MELD score patients prior to ACLF development. Moreover, ACLF patients should be separately categorized when analyzing the outcomes of ALDLT. ALDLT for ACLF patients should not be discouraged because favorable outcomes can be expected through timely ALDLT and comprehensive management.
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Affiliation(s)
- D.‐B. Moon
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of SurgeryAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - S.‐G. Lee
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of SurgeryAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - W.‐H. Kang
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of SurgeryAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - G.‐W. Song
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of SurgeryAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - D.‐H. Jung
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of SurgeryAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - G.‐C. Park
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of SurgeryAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - H.‐D. Cho
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of SurgeryAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - E.‐K. Jwa
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of SurgeryAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - W.‐J. Kim
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of SurgeryAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - T.‐Y. Ha
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of SurgeryAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - H.‐J. Kim
- Department of Preventive MedicineUniversity of Ulsan College of MedicineSeoulKorea
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11
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Marubashi S, Nagano H, Eguchi H, Wada H, Asaoka T, Tomimaru Y, Tomokuni A, Umeshita K, Doki Y, Mori M. Minimum graft size calculated from preoperative recipient status in living donor liver transplantation. Liver Transpl 2016; 22:599-606. [PMID: 26684397 DOI: 10.1002/lt.24388] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/10/2015] [Accepted: 12/01/2015] [Indexed: 02/07/2023]
Abstract
Small-for-size graft syndrome is an inevitable complication in living donor liver transplantation (LDLT). We hypothesized that graft weight (GW) measured after graft procurement is one of the variables predicting postoperative graft function. A total of 138 consecutive recipients of adult-to-adult LDLT between March 1999 and October 2014 were included in this study. We investigated the factors associated with small-for-size-associated graft loss (SAGL) to determine the GW required for each patient. Both preoperatively assessed and postoperatively obtained risk factors for SAGL were analyzed in univariate and multivariate logistic regression analysis. Twelve (8.8%) of the transplant recipients had SAGL. In multivariate logistic regression analyses using preoperatively assessed variables, the preoperative Model for End-Stage Liver Disease (MELD) score (P < 0.001) and actual GW/recipient standard liver volume (SLV) ratio (P = 0.008) were independent predictors of SAGL. The recommended graft volume by preoperative computed tomography volumetry was calculated as SLV × (1.616 × MELD + 0.344)/100/0.85 (mL) [MELD ≥ 18.2], or SLV × 0.35 (mL) [MELD < 18.2]. The required allograft volume in LDLT can be determined by the preoperative MELD score of the recipient, and patients with higher MELD scores require larger grafts or deceased donor whole liver transplant to avoid SAGL. Liver Transplantation 22 599-606 2016 AASLD.
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Affiliation(s)
- Shigeru Marubashi
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hiroaki Nagano
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hiroshi Wada
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Tadafumi Asaoka
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yoshito Tomimaru
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Akira Tomokuni
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Koji Umeshita
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yuichiro Doki
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Masaki Mori
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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12
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Kaido T, Tomiyama K, Ogawa K, Fujimoto Y, Ito T, Mori A, Uemoto S. Section 12. Living donor liver transplantation for patients with high model for end-stage liver disease scores and acute liver failure. Transplantation 2014; 97 Suppl 8:S46-7. [PMID: 24849834 DOI: 10.1097/01.tp.0000446276.59051.ae] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Living donor liver transplantation (LDLT) for patients with high model for end-stage liver disease score and acute liver failure patients have little or not gained any substantial following among Western centers because of the "donor high risk-low recipient benefit scenario" that puts the donor at a significant risk against the survival odds for a recipient who is receiving a partial graft and considered marginal by Western standards. In most Asian countries, there is sometimes no other source of live graft but a willing live liver donor. There are individual Asian center reports that conclude that LDLT has comparable outcome to deceased donor liver transplant. However, the outcomes of a large number of patients after undergoing adult LDLT for high model for end-stage liver disease scores and acute liver failure at a single center have not been investigated. Here in, we present our experience with such subgroup of patients undergoing LDLT.
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Affiliation(s)
- Toshimi Kaido
- 1 Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 2 Address correspondence to: Toshimi Kaido, M.D., Ph.D., Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
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13
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Survival outcomes of right-lobe living donor liver transplantation for patients with high Model for End-stage Liver Disease scores. Hepatobiliary Pancreat Dis Int 2013; 12:256-62. [PMID: 23742770 DOI: 10.1016/s1499-3872(13)60042-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Controversy exists over whether living donor liver transplantation (LDLT) should be offered to patients with high Model for End-stage Liver Disease (MELD) scores. This study tried to determine whether a high MELD score would result in inferior outcomes of right-lobe LDLT. METHODS Among 411 consecutive patients who received right-lobe LDLT at our center, 143 were included in this study. The patients were divided into two groups according to their MELD scores: a high-score group (MELD score ≥25; n=75) and a low-score group (MELD score <25; n=68). Their demographic data and perioperative conditions were compared. Univariable and multivariable analyses were performed to identify risk factors affecting patient survival. RESULTS In the high-score group, more patients required preoperative intensive care unit admission (49.3% vs 2.9%; P<0.001), mechanical ventilation (21.3% vs 0%; P<0.001), or hemodialysis (13.3% vs 0%; P=0.005); the waiting time before LDLT was shorter (4 vs 66 days; P<0.001); more blood was transfused during operation (7 vs 2 units; P<0.001); patients stayed longer in the intensive care unit (6 vs 3 days; P<0.001) and hospital (21 vs 15 days; P=0.015) after transplantation; more patients developed early postoperative complications (69.3% vs 50.0%; P=0.018); and values of postoperative peak blood parameters were higher. However, the two groups had comparable hospital mortality. Graft survival and patient overall survival at one year (94.7% vs 95.6%; 95.9% vs 96.9%), three years (91.9% vs 92.6%; 93.2% vs 95.3%), and five years (90.2% vs 90.2%; 93.2% vs 95.3%) were also similar between the groups. CONCLUSIONS Although the high-score group had significantly more early postoperative complications, the two groups had comparable hospital mortality and similar satisfactory rates of graft survival and patient overall survival. Therefore, a high MELD score should not be a contraindication to right-lobe LDLT if donor risk and recipient benefit are taken into full account.
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14
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Ikegami T, Shirabe K, Yoshiya S, Yoshizumi T, Yamashita YI, Harimoto N, Toshima T, Uchiyama H, Soejima Y, Maehara Y. A high MELD score, combined with the presence of hepatitis C, is associated with a poor prognosis in living donor liver transplantation. Surg Today 2013; 44:233-40. [DOI: 10.1007/s00595-013-0523-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 11/05/2012] [Indexed: 02/07/2023]
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15
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Poon KS, Chen TH, Jeng LB, Yang HR, Li PC, Lee CC, Yeh CC, Lai HC, Su WP, Peng CY, Chen YF, Ho YJ, Tsai PP. A high model for end-stage liver disease score should not be considered a contraindication to living donor liver transplantation. Transplant Proc 2012; 44:316-9. [PMID: 22410005 DOI: 10.1016/j.transproceed.2012.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To analyze the outcomes of patients with high Model for End-Stage Liver Disease (MELD) scores who underwent adult-to-adult live donor liver transplantation (A-A LDLT). MATERIALS AND METHODS From September 2002 to October 2010, a total of 152 adult patients underwent A-A LDLT in our institution. Recipients were stratified into a low MELD score group (Group L; MELD score≤30) and a high MELD score group (Group H; MELD score>30) to compare short-term and long-term outcomes. RESULTS Of the 152 adult patients who underwent A-A LDLT, 9 were excluded from the analysis because they received ABO-incompatible grafts. Group H comprised 23 and Group L 120 patients. The median follow-up was 21.5 months (range, 3 to 102 m). The mean MELD score was 15.6 in Group L and 36.7 in Group H. There were no significant differences in the mean length of stay in the intensive care unit (Group L: 3.01 days vs Group H: 3.09 days, P=.932) or mean length of hospital stay (Group L: 17.89 days vs. Group H: 19.91 days, P=0.409). There were no significant differences in 1-, 3-, or 5-year survivals between patients in Groups L versus H (91.5% vs 94.7%; 86.4% vs 94.7%; and 86.4% vs 94.7%; P=.3476, log rank). CONCLUSION The short-term and long-term outcomes of patients with high MELD scores who underwent A-A LDLT were similar to those of patients with low MELD scores. Therefore, we suggest that high MELD scores are not a contraindication to LDLT.
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Affiliation(s)
- K-S Poon
- Organ Transplantation Center, Department of Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
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16
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Kim SJ, Yoon YC, Yoo YK, Park JH, Kim DG. Clinical analysis of emergency liver transplantation: the role of living donor liver transplantation. Clin Transplant 2012; 26:833-41. [DOI: 10.1111/j.1399-0012.2012.01634.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2012] [Indexed: 12/19/2022]
Affiliation(s)
- Say-June Kim
- Department of Surgery; Daejeon St. Mary's Hospital; the Catholic University of Korea; Daejeon; Korea
| | - Yung-Chul Yoon
- Department of Surgery; Seoul St. Mary's Hospital; the Catholic University of Korea; Seoul; Korea
| | - Young-Kyung Yoo
- Department of Surgery; Seoul St. Mary's Hospital; the Catholic University of Korea; Seoul; Korea
| | - Jung-Hyun Park
- Department of Surgery; Seoul St. Mary's Hospital; the Catholic University of Korea; Seoul; Korea
| | - Dong-Goo Kim
- Department of Surgery; Seoul St. Mary's Hospital; the Catholic University of Korea; Seoul; Korea
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17
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Abstract
BACKGROUND In 2002, the New York State Committee on Quality Improvement in Living Liver Donation prohibited live liver donation for potential recipients with Model for End-stage Liver Disease (MELD) scores greater than 25. Despite the paucity of evidence to support this recommendation, many centers in North America remain reluctant to offer living donor (LD) to patients with moderate to high MELD scores. METHODS We analyzed 271 consecutive adult-to-adult right lobe LD liver transplants performed at our institution between 2002 and 2008 to study the relationship, between recipient MELD scores and the outcome of LD liver transplantation. The recipients were categorized according to their MELD score into a low (Low: <25)and high (Hi: >or=25) MELD group. We compared short-term donor morbidity, graft loss within 30 days, length of hospital stay, biochemical markers of hepatocyte injury and graft function, and 90 day posttransplant complications including infection, rejection, bleeding, and renal failure. Long-term posttransplant outcome was measured by graft and patient survival after 1-, 3-, and 5-years. RESULTS Donor and recipient characteristics were similar between groups. Donor outcomes were similar in both groups. Peak recipient aspartat aminotransferase, alanine aminotransferase, and length of hospital stay were similar between both groups. The proportional decrease in postoperative INR and creatinine within the first week was greater in the high versus low MELD score group. High MELD score recipients had more frequent postoperative pneumonia (Low: 2.2% vs. Hi: 14%, P = 0.003), while no differences were observed in rates of biliary complications, rejection, renal failure, or overall infections. Recipients with a MELD <25 versus >or=25 had a similar 1-year (Low: 92% vs. Hi: 83%), 3-year (Low: 86% vs. Hi: 80%), and 5-year (Low: 78% vs. Hi: 80%) graft survival after LD liver transplantation (P = 0.51). CONCLUSION LD liver transplantation can provide excellent graft function and survival rates in high MELD score recipients. Thus, when deceased donor organs are scare, a high MELD score alone should not be an absolute contraindication to living liver donation.
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18
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Zhuang ZG, Qian LJ, Wang BX, Zhou Y, Li QG, Xu JR, Cheng YF. Computed tomography perfusion in living donor liver transplantation: an initial study of normal hemodynamic changes in liver grafts. Clin Transplant 2009; 23:692-9. [DOI: 10.1111/j.1399-0012.2009.00991.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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19
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Ikegami T, Shimada M, Imura S, Arakawa Y, Nii A, Morine Y, Kanemura H. Current concept of small-for-size grafts in living donor liver transplantation. Surg Today 2008; 38:971-82. [PMID: 18958553 DOI: 10.1007/s00595-008-3771-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Accepted: 02/18/2008] [Indexed: 12/16/2022]
Abstract
The extended application of living donor liver transplantation (LDLT) has revealed the problem of graft size mismatching called "small-for-size (SFS) graft syndrome." The initial trials to resolve this problem involved increasing the procured graft size, from left to right, and even extension to include a right lobe graft. Clinical cases of living right lobe donations have been reported since then, drawing attention to the risks of increasing the liver volume procured from a living donor. However, not only other modes of increasing graft volume such as auxiliary or dual liver transplantation, but also control of the increased portal pressure caused by an SFS graft, such as a portosystemic shunt or splenectomy, have been trialed with some positive results. To establish an effective strategy for transplanting SFS grafts and preventing SFS graft syndrome, it is essential to have precise knowledge and tactics to evaluate graft quality and graft volume, when performing these LDLTs with portal pressure control. We reviewed the updated literature on the pathogenesis of and strategies for using SFS grafts.
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Affiliation(s)
- Toru Ikegami
- Department of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
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20
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Whole Liver Versus Split Liver Versus Living Donor in the Adult Recipient—An Analysis of Outcomes by Graft Type. Transplantation 2008; 85:1420-4. [DOI: 10.1097/tp.0b013e31816de1a3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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21
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Marubashi S, Dono K, Nagano H, Asaoka T, Hama N, Kobayashi S, Miyamoto A, Takeda Y, Umeshita K, Monden M. Postoperative hyperbilirubinemia and graft outcome in living donor liver transplantation. Liver Transpl 2007; 13:1538-44. [PMID: 17969209 DOI: 10.1002/lt.21345] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Little information is available on the characteristics and clinical significance of serum bilirubin level early after liver transplantation. The aim of this study was to clarify the risk factors for early graft loss and to assess the significance of postoperative hyperbilirubinemia as a predictor of graft outcome in living donor liver transplantation (LDLT). We retrospectively analyzed perioperative parameters in 68 patients who underwent LDLT. Graft loss within 1 year post-LDLT was confirmed in 9 patients (13.4%). Univariate analysis of risk factors showed that preoperative Model for End-Stage Liver Disease score, donor age, postoperative peak serum bilirubin level (p-BIL) within 28 days after LDLT, and surgical complications were significant determinants of early graft loss (<1 year post-transplant). Multivariate analysis identified p-BIL (odds ratio = 1.170, 95% confidence interval = 1.030-1.329, P = 0.016) as the only independent predictor of early graft loss. The incidence of such loss was high in patients with p-BIL over 27.0 mg/dL (area under the receiver operating characteristic curve = 0.988). In conclusion, serum bilirubin level is a useful predictor of short-term (<1 year) graft outcome and for considering retransplantation in a timely fashion.
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Affiliation(s)
- Shigeru Marubashi
- Department of Surgery, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan
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22
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Avolio AW, Agnes S, Gasbarrini A, Barbarino R, Nure E, Siciliano M, Barone M, Castagneto M. Allocation of nonstandard livers to transplant candidates with high MELD scores: Should this practice be continued? Transplant Proc 2006; 38:3567-71. [PMID: 17175333 DOI: 10.1016/j.transproceed.2006.10.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Indexed: 02/07/2023]
Abstract
MELD and PELD scores of 255 consecutive grafts were calculated (236 adult cases and 19 pediatric cases). No correction for the etiology of liver disease was performed. Retransplants were excluded. Three categories of patients were identified: low MELD (scores <12, n = 61); intermediate MELD (scores between 12-24, n = 159); high MELD (scores > or =25, n = 35). Grafts were categorized according to donor quality: standard livers (n = 199), vs nonstandard livers (n = 56). Nonstandard livers were identified by age > or =60, or at least by two of the following conditions: severe hemodynamic instability, ultrasound evidence of steatosis, natriemia > or =155 mEq/L, ICU stay >7 days, liver trauma, protracted anoxia as cause of brain death, transaminases levels x 4. In standard livers, the 12-month graft survival (GS) for low, intermediate, and high MELD classes were 88%, 74%, and 77%, respectively. In nonstandard livers, the 12-month GS for the low, intermediate, and high MELD classes were 84%, 55%, and 44%, respectively; differences between low MELD class and both intermediate and high MELD classes were significant (P < .05). Cox regression analysis of all cases identified the following parameters as independent predictors of GS: donor status; donor age; and recipient creatinine. The highest correlation with GS was found using donor age and recipient creatinine as covariates. In standard livers no variable was able to predict GS. In nonstandard livers the MELD-PELD score was the unique variable able to predict GS. We suggest avoiding the use of nonstandard livers for patients with high MELD scores.
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Affiliation(s)
- A W Avolio
- Department of Surgery, A. Gemelli Hospital, Catholic University of Rome, Rome, Italy.
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