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Jones O, Claasen MPAW, Ivanics T, Choi WJ, Gavaria F, Rajendran L, Ghanekar A, Hirschfield G, Gulamhusein A, Shwaartz C, Reichman T, Sayed BA, Selzner M, Bhat M, Tsien C, Jaeckel E, Lilly L, McGilvray ID, Cattral MS, Selzner N, Sapisochin G. Pursuing living donor liver transplantation improves outcomes of patients with autoimmune liver diseases: An intention-to-treat analysis. Liver Transpl 2024; 30:785-795. [PMID: 38619393 DOI: 10.1097/lvt.0000000000000374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 02/01/2024] [Indexed: 04/16/2024]
Abstract
Living donor liver transplantation (LDLT) offers the opportunity to decrease waitlist time and mortality for patients with autoimmune liver disease (AILD), autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis. We compared the survival of patients with a potential living donor (pLDLT) on the waitlist versus no potential living donor (pDDLT) on an intention-to-treat basis. Our retrospective cohort study investigated adults with AILD listed for a liver transplant in our program between 2000 and 2021. The pLDLT group comprised recipients with a potential living donor. Otherwise, they were included in the pDDLT group. Intention-to-treat survival was assessed from the time of listing. Of the 533 patients included, 244 (43.8%) had a potential living donor. Waitlist dropout was higher for the pDDLT groups among all AILDs (pDDLT 85 [29.4%] vs. pLDLT 9 [3.7%], p < 0.001). The 1-, 3-, and 5-year intention-to-treat survival rates were higher for pLDLT versus pDDLT among all AILDs (95.7% vs. 78.1%, 89.0% vs. 70.1%, and 87.1% vs. 65.5%, p < 0.001). After adjusting for covariates, pLDLT was associated with a 38% reduction in the risk of death among the AILD cohort (HR: 0.62, 95% CI: 0.42-0.93 [ p <0.05]), and 60% among the primary sclerosing cholangitis cohort (HR: 0.40, 95% CI: 0.22-0.74 [ p <0.05]). There were no differences in the 1-, 3-, and 5-year post-transplant survival between LDLT and DDLT (AILD: 95.6% vs. 92.1%, 89.9% vs. 89.4%, and 89.1% vs. 87.1%, p =0.41). This was consistent after adjusting for covariates (HR: 0.97, 95% CI: 0.56-1.68 [ p >0.9]). Our study suggests that having a potential living donor could decrease the risk of death in patients with primary sclerosing cholangitis on the waitlist. Importantly, the post-transplant outcomes in this population are similar between the LDLT and DDLT groups.
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Affiliation(s)
- Owen Jones
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Marco P A W Claasen
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
- Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Tommy Ivanics
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan, USA
- Department of Surgical Sciences, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden
| | - Woo Jin Choi
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Felipe Gavaria
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Luckshi Rajendran
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Anand Ghanekar
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Gideon Hirschfield
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Aliya Gulamhusein
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Chaya Shwaartz
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Trevor Reichman
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Blayne Amir Sayed
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Markus Selzner
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Mamatha Bhat
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Cynthia Tsien
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Elmar Jaeckel
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Les Lilly
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Ian D McGilvray
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Mark S Cattral
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Nazia Selzner
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Gonzalo Sapisochin
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
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Samji NS, Heda R, Kovalic AJ, Satapathy SK. Similarities and Differences Between Nonalcoholic Steatohepatitis and Other Causes of Cirrhosis. Gastroenterol Clin North Am 2020; 49:151-164. [PMID: 32033761 DOI: 10.1016/j.gtc.2019.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Nonalcoholic fatty liver disease includes a spectrum of liver disorders that range from simple steatosis to nonalcoholic steatohepatitis (NASH), fibrosis, and cirrhosis. Risk factors such as obesity, hypertension, hyperlipidemia, chronic kidney disease, and smoking status increase risk of progression to cirrhosis among patients with NASH. Cirrhosis derived from non-NASH causes may share similar features with patients with NASH but embody distinct pathogenetic mechanisms, genetic associations, prognosis, and outcomes. This article discusses in detail the comparison of clinical, genetic, and outcome characteristics between patients with NASH cirrhosis as opposed to alternative causes of chronic liver disease.
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Affiliation(s)
- Naga Swetha Samji
- Tenova Cleveland Hospital, 2305 Chambliss Avenue Northwest, Cleveland, TN 37311, USA
| | - Rajiv Heda
- University of Tennessee Health Science Center, College of Medicine, Memphis, TN 38163, USA
| | - Alexander J Kovalic
- Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Sanjaya K Satapathy
- Division of Hepatology, Sandra Atlas Bass Center for Liver Diseases & Transplantation, Donald and Barbara Zucker School of Medicine/Northwell Health, 400 Community Drive, Manhasset, NY 11030, USA.
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Samji NS, Heda R, Satapathy SK. Peri-transplant management of nonalcoholic fatty liver disease in liver transplant candidates . Transl Gastroenterol Hepatol 2020; 5:10. [PMID: 32190778 DOI: 10.21037/tgh.2019.09.09] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 09/23/2019] [Indexed: 12/12/2022] Open
Abstract
The incidence of non-alcoholic fatty liver disease (NAFLD) is rapidly growing, affecting 25% of the world population. Non-alcoholic steatohepatitis (NASH) is the most severe form of NAFLD and affects 1.5% to 6.5% of the world population. Its rising incidence will make end-stage liver disease (ESLD) due to NASH the number one indication for liver transplantation (LT) in the next 10 to 20 years, overtaking Hepatitis C. Patients with NASH also have a high prevalence of associated comorbidities such as type 2 diabetes, obesity, metabolic syndrome, cardiovascular disease, and chronic kidney disease (CKD), which must be adequately managed during the peritransplant period for optimal post-transplant outcomes. The focus of this review article is to provide a comprehensive overview of the unique challenges these patients present in the peritransplant period, which comprises the pre-transplant, intraoperative, and immediate postoperative periods.
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Affiliation(s)
- Naga Swetha Samji
- Tennova Cleveland Hospital, 2305 Chambliss Ave NW, Cleveland, TN, USA
| | - Rajiv Heda
- University of Tennessee Health Science Center, College of Medicine, Memphis, TN, USA
| | - Sanjaya K Satapathy
- Division of Hepatology and Sandra Atlas Bass Center for Liver Diseases, Northwell Health, Manhasset, NY, USA
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