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Chen G, Jiang J, Wang X, Yang M, Xie Y, Guo H, Tang H, Zhou L, Hu D, Kamel IR, Chen Z, Li Z. Evaluation of hepatic steatosis before liver transplantation in ex vivo by volumetric quantitative PDFF-MRI. Magn Reson Med 2020; 85:2805-2814. [PMID: 33197060 DOI: 10.1002/mrm.28592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE Over the last two decades, extended criteria have promoted an increased number of donor livers available for liver transplantation. But posttransplant graft loss is still a major concern. Macrovesicular hepatic steatosis (MHS) is recognized as the most significant prognostic histologic parameter in predicting posttransplant graft loss. We aimed to evaluate the utility of ex vivo volumetric quantitative MRI for quantifying MHS before liver transplantation using proton density fat-fraction (PDFF-MRI) histogram analysis. METHODS PDFF-MRI was performed at 3.0T in 40 livers. We obtained histogram parameters of whole-liver volume of interest, including the mean, median, 5th, 10th, 25th, 75th, 90th, and 95th percentile PDFF; skewness; kurtosis; entropy; and volume. RESULTS Livers from 40 cadaveric donors were included, and histologic ex vivo fat quantification was available for 33 livers. Ten livers had MHS and 23 had normal fat content. The MHS group had higher mean, median, 5th, 10th, 25th, 75th, 90th, and 95th percentile PDFF, and entropy than the group with normal fat content (P < .05). Median PDFF had greater area under the curve value than other parameters. Mean PDFF showed an excellent correlation with entropy and a moderate correlation with MHS quantification on histology. CONCLUSIONS Ex vivo volumetric quantitative PDFF-MRI histogram analysis is a very useful and noninvasive method to detect MHS before liver transplantation. Median PDFF was the best predictor of the presence of MHS. Entropy is a very promising parameter.
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Affiliation(s)
- Gen Chen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jipin Jiang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education NHC Key Laboratory of Organ Transplantation, Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - Xinqiang Wang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education NHC Key Laboratory of Organ Transplantation, Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - Min Yang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yalong Xie
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education NHC Key Laboratory of Organ Transplantation, Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - Hui Guo
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education NHC Key Laboratory of Organ Transplantation, Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - Hao Tang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lifen Zhou
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ihab R Kamel
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zhishui Chen
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education NHC Key Laboratory of Organ Transplantation, Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Herzer K, Sterneck M, Welker MW, Nadalin S, Kirchner G, Braun F, Malessa C, Herber A, Pratschke J, Weiss KH, Jaeckel E, Tacke F. Current Challenges in the Post-Transplant Care of Liver Transplant Recipients in Germany. J Clin Med 2020; 9:jcm9113570. [PMID: 33167567 PMCID: PMC7694452 DOI: 10.3390/jcm9113570] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/25/2020] [Accepted: 11/04/2020] [Indexed: 02/07/2023] Open
Abstract
Improving long-term patient and graft survival after liver transplantation (LT) remains a major challenge. Compared to the early phase after LT, long-term morbidity and mortality of the recipients not only depends on complications immediately related to the graft function, infections, or rejection, but also on medical factors such as de novo malignancies, metabolic disorders (e.g., new-onset diabetes, osteoporosis), psychiatric conditions (e.g., anxiety, depression), renal failure, and cardiovascular diseases. While a comprehensive post-transplant care at the LT center and the connected regional networks may improve outcome, there is currently no generally accepted standard to the post-transplant management of LT recipients in Germany. We therefore described the structure and standards of post-LT care by conducting a survey at 12 German LT centers including transplant hepatologists and surgeons. Aftercare structures and form of cost reimbursement considerably varied between LT centers across Germany. Further discussions and studies are required to define optimal structure and content of post-LT care systems, aiming at improving the long-term outcomes of LT recipients.
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Affiliation(s)
- Kerstin Herzer
- Department of Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany;
- Knappschafts-Klinik Bad Neuenahr, 53474 Bad Neuenahr-Ahrweiler, Germany
| | - Martina Sterneck
- Department of Medicine, University Medical Center Hamburg Eppendorf, 20251 Hamburg, Germany;
| | - Martin-Walter Welker
- Department of Internal Medicine I, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany;
| | - Silvio Nadalin
- Department for General, Visceral and Transplant Surgery, University Hospital Tuebingen, 72016 Tuebingen, Germany;
| | - Gabriele Kirchner
- Department of Surgery, University Hospital of Regensburg, 93053 Regensburg, Germany;
- Innere Medizin I, Caritaskrankenhaus St. Josef, 93053 Regensburg, Germany
| | - Felix Braun
- Department for Transplantation Surgery, University Hospital Kiel, 24105 Kiel, Germany;
| | - Christina Malessa
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, 07747 Jena, Germany;
| | - Adam Herber
- Department of Gastroenterology and Rheumatology, University Hospital Leipzig, 04103 Leipzig, Germany;
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte/Campus Virchow-Klinikum, Charité University Medicine Berlin, 13353 Berlin, Germany;
- Berlin Institute of Health, 13353 Berlin, Germany
| | - Karl Heinz Weiss
- Department of Internal Medicine, University of Heidelberg, 69120 Heidelberg, Germany;
- Department of Internal Medicine, Salem Medical Center, 69120 Heidelberg, Germany
| | - Elmar Jaeckel
- Integrated Research and Treatment Centre Transplantation (IFB-Tx), Hannover Medical School, 30625 Hannover, Germany;
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, 30625 Hannover, Germany
| | - Frank Tacke
- Department of Hepatology & Gastroenterology, Campus Charité Mitte/Campus Virchow-Klinikum, Charité University Medicine Berlin, 13353 Berlin, Germany
- Correspondence:
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Gao W, Song Z, Ma N, Dong C, Sun C, Meng X, Zhang W, Wang K, Wu B, Li S, Qin H, Han C, Li H, Shen Z. Utility of neonatal donors in pediatric liver transplantation: A single-center experience. Pediatr Transplant 2019; 23:e13396. [PMID: 31081216 DOI: 10.1111/petr.13396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 11/07/2018] [Accepted: 01/28/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The lack of age- and size-matched organs result in higher waiting list mortality in pediatric recipients than adults. Organs from deceased newborns and infants are a valuable source to increase donor pool in pediatric liver transplantation. However, the feasibility and safety of using neonatal donors have not been well evaluated. METHODS From 2014 to 2016, 48 deceased donor pediatric liver transplantations with donor age younger than 1 year old in our center were enrolled in this study. The recipients were divided into three groups based on the donor age (<1 month, 1 month ≤ to <3 months, and 3 months ≤ to <1 year). Recipient's characteristics, perioperative data, and postoperative complications were compared. RESULTS Two-year patient survival rates were 87.5%, 94.4%, and 95.5%, and 2-year graft survival rates were 75%, 94.4%, and 95.5%, respectively, without significant difference. The liver grafts from donors younger than 3 months were more advantageous in terms of acute rejection and virus infection, while the young grafts were related to slight higher incidence of hepatic artery thrombosis and SFSS. Those complications could be effectively prevented or treated by our perioperative care strategies. In addition, eight recipients who received neonatal livers achieved comparable outcomes with recipients with older livers. CONCLUSION Our data revealed that the application of liver grafts from donors younger than 1 year old could achieve excellent outcome. In particular, neonatal donors could be safely used in well-selected patients.
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Affiliation(s)
- Wei Gao
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Zhuolun Song
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Nan Ma
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Chong Dong
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Chao Sun
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Xingchu Meng
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Wei Zhang
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Kai Wang
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Bin Wu
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Shanni Li
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Hong Qin
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Chao Han
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Haohao Li
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Zhongyang Shen
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
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Boteon YL, Boteon APCS, Attard J, Mergental H, Mirza DF, Bhogal RH, Afford SC. Ex situ machine perfusion as a tool to recondition steatotic donor livers: Troublesome features of fatty livers and the role of defatting therapies. A systematic review. Am J Transplant 2018; 18:2384-2399. [PMID: 29947472 DOI: 10.1111/ajt.14992] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/13/2018] [Accepted: 06/18/2018] [Indexed: 02/06/2023]
Abstract
Long-standing research has shown that increased lipid content in donor livers is associated with inferior graft outcomes posttransplant. The global epidemic that is obesity has increased the prevalence of steatosis in organ donors, to the extent that it has become one of the main reasons for declining livers for transplantation. Consequently, it is one of the major culprits behind the discrepancy between the number of donor livers offered for transplantation and those that go on to be transplanted. Steatotic livers are characterized by poor microcirculation, depleted energy stores because of an impaired capacity for mitochondrial recovery, and a propensity for an exaggerated inflammatory response following reperfusion injury culminating in poorer graft function postoperatively. Ex situ machine perfusion, currently a novel method in graft preservation, is showing great promise in providing a tool for the recovery and reconditioning of marginal livers. Hence, reconditioning these steatotic livers using machine perfusion has the potential to increase the number of liver transplants performed. In this review, we consider the problematic issues associated with fatty livers in the realm of transplantation and discuss pharmacological and nonpharmacological options that are being developed to enhance recovery of these organs using machine perfusion and defatting strategies.
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Affiliation(s)
- Yuri L Boteon
- Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Amanda P C S Boteon
- Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Joseph Attard
- Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Hynek Mergental
- Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Darius F Mirza
- Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ricky H Bhogal
- Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Simon C Afford
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, UK
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