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Bulbuloglu S, Gunes H. Mindfulness-based cognitive therapy for adherence of immunosuppressive treatment in liver transplant recipients: A randomized controlled trial. Explore (NY) 2024:S1550-8307(24)00005-3. [PMID: 38245470 DOI: 10.1016/j.explore.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/03/2024] [Accepted: 01/15/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE The aim of this study was to analyze the effects of mindfulness-based cognitive therapy on the adherence of liver transplant recipients to immunosuppressive therapy with a randomized controlled design. METHOD This randomized controlled trial was performed with 120 liver transplant recipients hospitalized at the liver transplant department of a research and practice hospital (n = 120). While we administered no intervention to the patients in the control group (n = 60), we provided Mindfulness-Based Cognitive Therapy to those in the experimental group (n = 60). We used the Mindful Attention Awareness Scale and the Immunosuppressant Therapy Adherence Scale to collect data. We utilized descriptive statistics, paired-samples t-tests, independent-samples t-tests, one-way analysis of variance, and chi-squared tests to analyze the data. RESULTS After the intervention, the immunosuppressive therapy adherence levels of the experimental group increased significantly (p < 0.01). On the other hand, the control group had significantly higher adherence to immunosuppressive therapy and significantly higher levels of mindfulness in the pretest phase than it did in the posttest phase (p < 0.01). CONCLUSIONS Complete adherence to immunosuppressive therapy is imperative for the prevention of graft rejection in liver transplant recipients. In our study, the experimental group equipped with enhanced mindfulness had higher adherence to immunosuppressive therapy. Therefore, the use of Mindfulness-Based Cognitive Therapy in the promotion of adherence to immunosuppressive therapy is recommended.
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Affiliation(s)
- Semra Bulbuloglu
- Division of Surgical Nursing, Nursing Department, Health Sciences Faculty, Istanbul Aydin University, Istanbul, Turkey.
| | - Hüseyin Gunes
- Division of Surgical Nursing, Nursing Department, Health Sciences Faculty, Bayburt University, Bayburt, Turkey
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Qiu Y, Hilmi I. The applications of ECMO in liver transplant recipients. Transplant Rev (Orlando) 2024; 38:100816. [PMID: 38104398 DOI: 10.1016/j.trre.2023.100816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/23/2023] [Accepted: 12/03/2023] [Indexed: 12/19/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) has emerged as a vital instrument for sustaining respiratory and cardiac functions when traditional methods have failed. Its function in managing acute pulmonary and cardiac challenges during liver transplantation (LT) has expanded significantly. While ECMO was initially viewed as a rescue strategy for acute intraoperative or posttransplant complications, its application now also encompasses the pretransplant stage of LT. Our review aims to thoroughly summarize both research and specific cases where ECMO has been utilized across pre- and perioperative phases in liver transplant recipients. By assessing the published literature, we discuss specific indications, the types of ECMO employed, their outcomes, and the unique challenges of applying ECMO during LT. In particular, the pretransplant use of ECMO is increasing, and its prudent introduction prior to LT, supported by meticulous planning, has the potential to optimize patient outcomes. It is challenging to manage liver transplant patients on ECMO. More research and experience are needed to refine the techniques and improve patient outcomes. Furthermore, decision-making must be tailored to each patient's unique circumstances, and a clear, practical, and well-defined plan for subsequent steps is essential.
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Affiliation(s)
- Yue Qiu
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Department of Anesthesiology and Perioperative Medicine Education Office, Liliane S. Kaufmann Building, 3471 Fifth AVE, Suite 402, Pittsburgh, PA 15213, USA.
| | - Ibtesam Hilmi
- Anesthesiology and Perioperative Medicine, Clinical and Translational Science Institute, University of Pittsburgh, School of Medicine, Montefiore Anesthesiology Office 200 Lothrop St, Pittsburgh, PA 15213, USA.
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3
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Ducasa N, Benencio P, Mauro E, Anders M, Mazzitelli B, Bleichmar L, Quiroga MF, Barbero M, Cairo F, Alter A, Etcheves P, Scarton G, Sobenko N, Biglione M, Mendizabal M. Evaluation of the humoral response to the third dose of SARS-COV-2 vaccines in liver transplant recipients. Vaccine 2023; 41:7663-7670. [PMID: 38007341 DOI: 10.1016/j.vaccine.2023.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/17/2023] [Accepted: 11/18/2023] [Indexed: 11/27/2023]
Abstract
Solid organ transplant recipients (SOTR) commonly develop an unsatisfactory humoral response to vaccines compared to immunocompetent individuals (IC). We have previously evaluated the humoral response in liver transplant recipients (LTR) who received two-dose vaccines against SARS-CoV-2 and reported that 38 % of LTR did not produce anti-Spike antibodies. Thus, we set out to evaluate the humoral response after the third dose of SARS-CoV-2 vaccines. For this purpose, samples from a cohort of 81 LTR and 27 IC were extracted between 21 and 90 days after the third dose. Serology for anti-Spike IgG antibodies and neutralizing antibodies against Wuhan, Delta and Omicron variants were evaluated. We found that 73.5 % of LTR were responders for anti-Spike IgG, while all the IC mounted a measurable response. LTR who responded to the third dose showed significantly lower anti-Spike IgG levels and neutralizing antibodies than IC. We found that there is less neutralization in LTR compared to IC across all variants. Specifically, the neutralization titers in both groups decrease when encountering the Delta variant, and this decline is even more pronounced with the Omicron variant, compared to the Wuhan variant. Furthermore, we identified that the use of high doses of mycophenolate and advanced age were factors that negatively affected the development of anti-Spike IgG antibodies. Regarding vaccine regimes, the regime viral vector/mRNA/mRNA elicited significantly higher responses in LTR compared to other vaccine schemes. In addition to the recommended and necessary booster doses in this population, strategies that achieve adequate immunization should be evaluated.
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Affiliation(s)
- Nicolás Ducasa
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA, CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina.
| | - Paula Benencio
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA, CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Ezequiel Mauro
- Liver Transplant Unit and Liver Unit, Hospital Italiano de Buenos, Aires, Buenos Aires, Argentina
| | - Margarita Anders
- Hepatology and Liver Transplant Unit, Hospital Alemán, Buenos Aires, Argentina
| | - Bianca Mazzitelli
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA, CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Lucía Bleichmar
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA, CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Maria Florencia Quiroga
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA, CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Manuel Barbero
- Liver Transplant Unit, Hospital El Cruce, Florencio Varela, Buenos Aires, Argentina
| | - Fernando Cairo
- Liver Transplant Unit, Hospital El Cruce, Florencio Varela, Buenos Aires, Argentina
| | | | | | | | - Natalia Sobenko
- Liver Transplant Unit and Liver Unit, Hospital Italiano de Buenos, Aires, Buenos Aires, Argentina
| | - Mirna Biglione
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA, CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Manuel Mendizabal
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Buenos Aires, Argentina.
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4
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Li ZR, Shen CH, Li RD, Wang B, Li J, Niu WJ, Zhang LJ, Zhong MK, Wang ZX, Qiu XY. Individual dose recommendations for drug interaction between tacrolimus and voriconazole in adult liver transplant recipients: A semiphysiologically based population pharmacokinetic modeling approach. Eur J Pharm Sci 2023; 184:106405. [PMID: 36775255 DOI: 10.1016/j.ejps.2023.106405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/18/2022] [Accepted: 02/09/2023] [Indexed: 02/12/2023]
Abstract
The magnitude of drug-drug interaction between tacrolimus and voriconazole is highly variable, and individually tailoring the tacrolimus dose when concomitantly administered with voriconazole remains difficult. This study aimed to develop a semiphysiologically based population pharmacokinetic (semi-PBPK) model and a web-based dashboard to identify the dynamic inhibition of tacrolimus metabolism caused by voriconazole and provide individual tacrolimus regimens for Chinese adult liver transplant recipients. A total of 264 tacrolimus concentrations and 146 voriconazole concentrations were prospectively collected from 32 transplant recipients. A semi-PBPK model with physiological compartments including the gut wall, portal vein, and liver was developed using the nonlinear mixed-effects modeling software NONMEM (version 7.4). A web-based dashboard was established in R software (version 3.6.1) to recommend the individual tacrolimus regimens when concomitantly administered with voriconazole. The reversible inhibition of tacrolimus metabolism caused by voriconazole was investigated in both the liver and the gut wall. Moreover, voriconazole could highly inhibit the CYP3A activity in the gut wall more than in the liver. BMI and postoperative days were identified as significant covariates on intrinsic intestinal and hepatic clearance of tacrolimus, respectively. Age and postoperative days were identified as significant covariates on the volume of distribution of voriconazole. The individual tacrolimus regimens when concomitantly administered with voriconazole could be recommended in the dashboard (https://tac-vor-ddi.shinyapps.io/shinyapp3/). In conclusion, the semi-PBPK model successfully described the dynamic inhibition process between tacrolimus and voriconazole, and the web-based dashboard could provide individual tacrolimus regimens when concomitantly administered with voriconazole.
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Affiliation(s)
- Zi-Ran Li
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Cong-Huan Shen
- Department of General Surgery and Liver Transplant Center, Huashan Hospital, Fudan University, Shanghai 200040, China; Institute of Organ Transplant, Fudan University, Shanghai 200040, China
| | - Rui-Dong Li
- Department of General Surgery and Liver Transplant Center, Huashan Hospital, Fudan University, Shanghai 200040, China; Institute of Organ Transplant, Fudan University, Shanghai 200040, China
| | - Bei Wang
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Juan Li
- Department of General Surgery and Liver Transplant Center, Huashan Hospital, Fudan University, Shanghai 200040, China; Institute of Organ Transplant, Fudan University, Shanghai 200040, China
| | - Wan-Jie Niu
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Li-Jun Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Ming-Kang Zhong
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai 200040, China.
| | - Zheng-Xin Wang
- Department of General Surgery and Liver Transplant Center, Huashan Hospital, Fudan University, Shanghai 200040, China; Institute of Organ Transplant, Fudan University, Shanghai 200040, China.
| | - Xiao-Yan Qiu
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai 200040, China.
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5
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Shafiq M, Gibson C. Clinical outcomes of coronavirus disease 2019 in liver transplant recipients. World J Hepatol 2022; 14:1142-1149. [PMID: 35978674 PMCID: PMC9258250 DOI: 10.4254/wjh.v14.i6.1142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/07/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver transplant patients are at higher risk of infection due to immunosuppression. Whether liver transplant recipients are also more susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and will have worse outcomes than the general population if they develop coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 is a topic of ongoing studies, including ours.
AIM To assess the clinical outcomes of COVID-19 in liver transplant recipients.
METHODS This was a case-control study, with a database search performed (at the study site) from March 1, 2020 through February 28, 2021. Patients 18 years or older who tested positive for SARS-CoV-2 via polymerase chain reaction (PCR) were included in the study. Patients with infection other than pneumonia at the time of admission were excluded. After selection, patients who had been the recipient of liver transplant were considered cases and those without as controls. After being matched by age, sex, and obesity, two controls were randomly selected for each case. Death and hospitalization due to COVID-19 infection were the primary outcomes. Secondary outcomes were pertinent only to patients who were hospitalized, and they included duration of hospital stay, need for supplemental oxygen, presence of at least one type of end-organ damage, effects on liver enzymes, incidence of acute liver failure, effect on d-dimer levels, and incidence of venous thromboembolism (VTE). Chi-square or Fisher’s exact test was used to compare all primary and secondary outcomes with the exception of duration of hospital stay and d-dimer levels, which were compared using the Wilcoxon signed-rank test. Alpha criterion was set at 0.05. Logistic regression was performed for each primary outcome (as the dependent variable). Statistical analyses were performed using R software.
RESULTS Of the 470 Liver transplant recipients who were tested for COVID-19 via the PCR test, 39 patients tested positive (8.3%). There was no significant difference between cases and controls regarding death [odds ratio (OR): 2.04, 95% confidence interval (CI): 0.14–29.17; P = 0.60] and hospitalization rates (OR: 1.38, 95%CI: 0.59–3.24; P = 0.46). There also was no significant difference between cases and controls with respect to all secondary outcomes. Among all patients who had elevated liver enzymes, their levels were either normalized, improving, or remained stable at the time of discharge. No patient developed acute liver failure. Of the 31 hospitalized patients, 27 received a prophylactic anticoagulation dose and no patient developed VTE in either group. Among cases who were hospitalized, immunosuppression was decreased in 5 patients and there was no change in immunosuppression among the remaining 7 patients. One patient died in each of these two subgroups. Logistic regression analysis was done, but all of the models had poor model predictions as well as insignificant predictors (independent variables). Therefore, they could not be used for either prediction or inference.
CONCLUSION Clinical outcomes of COVID-19 in liver transplant recipients are not different than those without transplantation. COVID-19 should not impact timely health care access and immunosuppression continuation among these patients.
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Affiliation(s)
- Muhammad Shafiq
- Department of General and Geriatric Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Cheryl Gibson
- Department of General and Geriatric Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
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Visco-Comandini U, Castilletti C, Lionetti R, Meschi S, Montalbano M, Rianda A, Taibi C, Sorace C, Guglielmo N, Piccolo P, Paci P, Ettorre GM, Gianpiero D. High prevalence of asymptomatic SARS-CoV-2 infection in a cohort of liver transplant recipients in central Italy. J Liver Transpl 2022; 5:100064. [PMID: 38620857 PMCID: PMC8684051 DOI: 10.1016/j.liver.2021.100064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/12/2021] [Accepted: 12/16/2021] [Indexed: 11/25/2022] Open
Abstract
Asymptomatic subjects account for 25 to 45% of SARS-CoV-2 infections, and in particular, subjects on mild immunosuppressive therapy may have symptoms masked and could spread virus for an extended period of time. To determine the cumulative incidence of symptomatic and asymptomatic SARS-CoV-2 infections and associated risk factors, we conducted a prospective clinical and serological survey in a cohort of 278 liver transplant recipients (LTRs) from Central Italy. Three different serology tests were performed every 4 months in 259 LTRs between April 2020 and April 2021: one based on raw extract of whole SARS-CoV-2 virus and two on specific viral antigens (nucleoprotein and receptor binding domain) to detect specific IgG, IgM and IgA. Hundred fifteen LTRs who reported symptoms or close contact with a SARS-CoV-2-positive subject, or had a positive serological result underwent molecular testing by standard screening procedures (RT-PCR on naso-pharyngeal swab). Thirty-one past or active SARS-CoV-2 infections were identified: 14 had positive molecular test (64% symptomatic), and 17 had positive serology only (18% symptomatic). SARS-CoV-2 infection was not statistically related to gender, age, obesity, diabetes, renal impairment, type of anti-rejection therapy or time from transplant. Asymptomatic SARS-CoV-2 cases (61.3%) were more frequent in males and in those with glomerular filtrate rate >50 ml/min. Overall, the addition of repeated serology to standard diagnostic molecular protocols increased detection of SARS-CoV-2 infection from 5.1% to 10.9%. Anti-SARS-CoV-2 seroprevalence among our LTRs (11.2%) is comparable to the general population of Central Italy, considered a medium-impact area. Only one asymptomatic subject (6%) was found to carry SARS-CoV-2 in respiratory tract at the time of serological diagnosis.
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Affiliation(s)
- Ubaldo Visco-Comandini
- Infectious Diseases - Hepatology Division, POIT Department, National Institute for Infectious Diseases L. Spallanzani, UOC Infectious Diseases - Hepatology, Via Portuense 292, Rome, RM 00149, Italy
| | - Concetta Castilletti
- Laboratory of Virology, National Institute for Infectious Diseases L. Spallanzani, Rome, Italy
| | - Raffaella Lionetti
- Infectious Diseases - Hepatology Division, POIT Department, National Institute for Infectious Diseases L. Spallanzani, UOC Infectious Diseases - Hepatology, Via Portuense 292, Rome, RM 00149, Italy
| | - Silvia Meschi
- Laboratory of Virology, National Institute for Infectious Diseases L. Spallanzani, Rome, Italy
| | - Marzia Montalbano
- Infectious Diseases - Hepatology Division, POIT Department, National Institute for Infectious Diseases L. Spallanzani, UOC Infectious Diseases - Hepatology, Via Portuense 292, Rome, RM 00149, Italy
| | - Alessia Rianda
- Infectious Diseases - Hepatology Division, POIT Department, National Institute for Infectious Diseases L. Spallanzani, UOC Infectious Diseases - Hepatology, Via Portuense 292, Rome, RM 00149, Italy
| | - Chiara Taibi
- Infectious Diseases - Hepatology Division, POIT Department, National Institute for Infectious Diseases L. Spallanzani, UOC Infectious Diseases - Hepatology, Via Portuense 292, Rome, RM 00149, Italy
| | - Chiara Sorace
- Infectious Diseases - Hepatology Division, POIT Department, National Institute for Infectious Diseases L. Spallanzani, UOC Infectious Diseases - Hepatology, Via Portuense 292, Rome, RM 00149, Italy
| | - Nicola Guglielmo
- Transplant and Oncological Surgery Division, POIT Department, San Camillo Hospital, Rome, Italy
| | - Paola Piccolo
- Internal Medicine, S. Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - Paola Paci
- Department of Computer, Control and Management Engineering A. Ruberti, Sapienza University of Rome, Italy
| | - Giuseppe Maria Ettorre
- Transplant and Oncological Surgery Division, POIT Department, San Camillo Hospital, Rome, Italy
| | - D'Offizi Gianpiero
- Infectious Diseases - Hepatology Division, POIT Department, National Institute for Infectious Diseases L. Spallanzani, UOC Infectious Diseases - Hepatology, Via Portuense 292, Rome, RM 00149, Italy
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Panaro F, Al Taweel B, Leon P, Ghinolfi D, Testa G, Kalisvaart M, Muiesan P, Romagnoli R, Lesurtel M, Cassese G, Truant S, Addeo P, Sainz-Barrica M, Baccarani U, De Simone P, Belafia F, Herrero A, Navarro F. Morbidity and mortality of iatrogenic hemothorax occurring in a cohort of liver transplantation recipients: a multicenter observational study. Updates Surg 2021; 73:1727-1734. [PMID: 34216370 PMCID: PMC8254062 DOI: 10.1007/s13304-021-01098-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/19/2021] [Indexed: 12/14/2022]
Abstract
Hemothorax (HT) is a life-threatening condition, mainly iatrogenic and poorly explored in Liver Transplantation (LT) recipients. The aim of this study is to report and analyze for the first time incidence and outcomes of HT in LT recipients, as well as to suggest a management strategy. Data concerning 7130 consecutive adult liver and liver-kidney transplant recipients were retrospectively collected from ten Transplantation Centers' institutional databases, over a 10-year period. Clinical parameters, management strategies and survival data about post-operative HT were analyzed and reported. Thirty patients developed HT during hospitalization (0.42%). Thoracentesis was found to be the most common cause of HT (16 patients). A non-surgical management was performed in 17 patients, while 13 patients underwent surgery. 19 patients developed thoracic complications after HT treatment, with an overall mortality rate of 50%. The median length of stay in Intensive Care Units was 22 days (IQR25-75 5-66.5). Postoperative hemothorax is mainly due to iatrogenic causes in LT recipients. Despite rare, it represents a serious complication with a high mortality rate and a challenging medical and surgical management. Its occurrence should always be prevented.
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Affiliation(s)
- Fabrizio Panaro
- Division of Digestive Surgery and Transplantation, Department of Surgery, Montpellier University Hospital, 34070, Montpellier, France. .,Division of HBP Surgery and Transplantation, Department of Surgery, St. Eloi Hospital, Montpellier University Hospital-School of Medicine, 80 Avenue Augustin Fliche, 34090, Montpellier, France.
| | - Bader Al Taweel
- Division of Digestive Surgery and Transplantation, Department of Surgery, Montpellier University Hospital, 34070, Montpellier, France
| | - Piera Leon
- Division of Digestive Surgery and Transplantation, Department of Surgery, Montpellier University Hospital, 34070, Montpellier, France
| | - Davide Ghinolfi
- Division of Transplantation, Department of Surgery, Pisa University Hospital, Pisa, Italy
| | - Giuliano Testa
- Liver Transplantation Unit, Department of Surgery, Baylor University Hospital, Dallas, TX, USA
| | | | - Paolo Muiesan
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Renato Romagnoli
- Liver Transplantation Unit, Department of Surgery, Turin University Hospital, Turin, Italy
| | - Mickael Lesurtel
- Division of Liver Transplantation, Department of Surgery, Lyon University Hospital, Lyon, France
| | - Gianluca Cassese
- HPB Surgery Unit, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Stephanie Truant
- Division of Transplantation, Department of Surgery, Lille University Hospital, Lille, France
| | - Pietro Addeo
- Department of Surgery, HPB Surgery and Liver Transplantation, Hôpital de Hautepierre, University Hospital, Strasbourg, France
| | - Mauricio Sainz-Barrica
- Division of Transplantation, Department of Surgery, Leuven University Hospital, Leuven, Belgium
| | - Umberto Baccarani
- Division of Transplantation, Department of Surgery, Udine University Hospital, Udine, Italy
| | - Paolo De Simone
- Division of Transplantation, Department of Surgery, Pisa University Hospital, Pisa, Italy
| | - Fouad Belafia
- Department of ICU, Montpellier University Hospital, 34070, Montpellier, France
| | - Astrid Herrero
- Division of Digestive Surgery and Transplantation, Department of Surgery, Montpellier University Hospital, 34070, Montpellier, France
| | - Francis Navarro
- Division of Digestive Surgery and Transplantation, Department of Surgery, Montpellier University Hospital, 34070, Montpellier, France
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8
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Eriksson M, Käyhty H, Lahdenkari M, Mäkisalo H, Anttila VJ. A randomized, controlled trial comparing the immunogenicity and safety of a 23-valent pneumococcal polysaccharide vaccination to a repeated dose 13-valent pneumococcal conjugate vaccination in adult liver transplant recipients. Vaccine 2021; 39:2351-2359. [PMID: 33812743 DOI: 10.1016/j.vaccine.2021.03.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 02/27/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Solid organ transplant (SOT) patients are at significant risk for invasive pneumococcal disease. The optimal pneumococcal vaccination strategy for SOT patients is not known. METHODS The potential adult liver transplant recipients were randomised into two arms: to receive a 23-valent pneumococcal polysaccharide vaccine (PPV23) before the transplantation or to receive a 13-valent pneumococcal conjugate vaccine (PCV13) before the transplantation and a second dose of PCV13 six months after the transplantation. Serotype-specific antibody concentrations and opsonophagocytic activity (OPA) were measured before and after the first vaccination (visits V1,V2) and six and seven months after the transplantation, e.g. before and after the second PCV13 (visits V3,V4). RESULTS Out of 47 patients, 19 (PCV13 arm) and 17 (PPV23 arm) received a liver transplant and all these patients completed the study (36/47, 76,6%). Each vaccine schedule elicited a good immune response. At V2, the geometric mean concentrations (GMĆs) of antibodies for serotypes 6A, 7F and 23F, and the geometric mean titers (GMT́s) of OPA for serotypes 4, 6A, 6B and 23F were significantly higher for PCV13, but the proportions of patients reaching OPA cut-off ≥ 8 or ELISA cut-off ≥ 1.0 µg/ml did not differ between the arms. At V3 the antibody concentrations and the OPA had declined to baseline in both arms. The second PCV13 vaccination elicited an immune response. There was no difference in adverse events. No vaccine-related allograft rejection was detected. CONCLUSIONS The immunogenicity of PPV23 and PCV13 was comparable in this patient material, but the seroresponses waned after transplantation. The second dose of PCV13 restored the immune responses and was well tolerated.
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Affiliation(s)
- Mari Eriksson
- HUH Inflammation Center, Division of Infectious Diseases of Helsinki University Hospital and Helsinki University, Finland.
| | - Helena Käyhty
- National Institute for Health and Welfare, Helsinki, Finland
| | - Mika Lahdenkari
- National Institute for Health and Welfare, Helsinki, Finland
| | - Heikki Mäkisalo
- HUH Abdominal Center, Division of Liver Diseases and Transplantation, Helsinki University Hospital and Helsinki University, Finland
| | - Veli-Jukka Anttila
- HUH Inflammation Center, Division of Infectious Diseases of Helsinki University Hospital and Helsinki University, Finland
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9
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Gavriilidis P, Pai M. The Impact of COVID-19 Global Pandemic on Morbidity and Mortality of Liver Transplant Recipients Children and Adults: A Systematic Review of Case Series. J Clin Med Res 2020; 12:404-408. [PMID: 32655733 PMCID: PMC7331863 DOI: 10.14740/jocmr4223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/04/2020] [Indexed: 02/06/2023] Open
Abstract
The pandemic of coronavirus disease 2019 (COVID-19) changed the surgical everyday practice overnight. Currently, the first articles reporting outcomes of liver transplant recipients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are published. The aim of the present study was to summarise the existing evidence of impact of COVID-19 global pandemic on liver transplant recipients. Electronic databases were searched in accordance with Preferred Reporting Items in Systematic Reviews and Meta-Analyses (PRISMA). Five studies were selected from a pool of 12 studies with a total of 854 liver transplant recipients of whom 700 were children and the rest 154 were adults. The present evidence, based on case reports and series demonstrated lower mortality in liver transplant recipients compared to general population.
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Affiliation(s)
- Paschalis Gavriilidis
- Division of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, W12 0HS, UK
| | - Madhava Pai
- Division of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, W12 0HS, UK
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Righi E, Ivaldi F, La Rosa A, Carnelutti A, Londero A, Bassetti M. Immunological profiles of HIV-positive recipients of liver transplant. Transpl Immunol 2019; 57:101208. [PMID: 31102654 DOI: 10.1016/j.trim.2019.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 05/08/2019] [Accepted: 05/13/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Scarce data are available about immune cell frequencies in HIV-positive recipients of liver transplant. Alterations in immune subsets can lead to persistent immune activation and disease progression or reduced HIV-specific responses. In liver transplantation, impaired immune tolerance can lead to organ rejection. METHODS HIV-positive subjects with undetectable HIVRNA and CD4 > 100/mm3 were included. Control groups were non-transplanted HIV-positive patients with similar immunovirological parameters and healthy subjects. B cells (memory, transitional, and mature subsets), T cells (effector TH1, nonclassic TH1, TH17, TH1/17; T regulatory naïve and effector subsets and CD8+ T regulatory cells), and NK cells (CD56dim and CD56bright subsets) were analyzed by flow cytometry. RESULTS A total of 56 patients, including 14 HIV-positive transplant recipients (HIV-LT), 14 HIV-positive controls, and 28 healthy controls were included. Median age of HIV-LT patients was 54.9 years with median time from transplant of 7.6 years. Eleven (79%) were HIV/HCV coinfected. Compared to nontransplanted patients, HIV-LT displayed significantly increased frequency of T CD8+ cells, lower percentage of T CD4+ cell, and lower number of nonclassic TH1, TH1/17 cells and naïve T CD4+ regulatory cells (Tregs). Healthy controls showed increased numbers of B cell subsets and decreased percentage of T effector subpopulations compared to HIV-LT. Compared to HIV-positive patients, healthy controls had higher B cells, NK cells, CD4+ T cells, naïve CD4+ Tregs but lower CD8+ T cells, effector Tregs, CD8+ Tregs, and all T effector cell subsets. CONCLUSIONS Immune cell subpopulations potentially associated with HIV progression and organ rejection were detected in HIV-positive transplant recipients. We confirmed altered frequencies of B, T, and NK cell populations in HIV-positive liver transplant recipients compared to healthy controls. The imbalance among immune cell subsets deserves further studies to identify markers of transplant outcome and potential therapeutic targets.
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Affiliation(s)
- Elda Righi
- Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy; Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
| | - Federico Ivaldi
- Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy; Center of Excellence for Biomedical Research (CEBR), University of Genoa, Italy
| | - Alessandro La Rosa
- Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Alessia Carnelutti
- Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Angela Londero
- Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Matteo Bassetti
- Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy
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Righi E. Management of bacterial and fungal infections in end stage liver disease and liver transplantation: Current options and future directions. World J Gastroenterol 2018; 24:4311-4329. [PMID: 30344417 PMCID: PMC6189843 DOI: 10.3748/wjg.v24.i38.4311] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/11/2018] [Accepted: 10/05/2018] [Indexed: 02/06/2023] Open
Abstract
Patients with liver cirrhosis are susceptible to infections due to various mechanisms, including abnormalities of humoral and cell-mediated immunity and occurrence of bacterial translocation from the intestine. Bacterial infections are common and represent a reason for progression to liver failure and increased mortality. Fungal infections, mainly caused by Candida spp., are often associated to delayed diagnosis and high mortality rates. High level of suspicion along with prompt diagnosis and treatment of infections are warranted. Bacterial and fungal infections negatively affect the outcomes of liver transplant candidates and recipients, causing disease progression among patients on the waiting list and increasing mortality, especially in the early post-transplant period. Abdominal, biliary tract, and bloodstream infections caused by Gram-negative bacteria [e.g., Enterobacteriaceae and Pseudomonas aeruginosa (P. aeruginosa)] and Staphylococcus spp. are commonly encountered in liver transplant recipients. Due to frequent exposure to broad-spectrum antibiotics, invasive procedures, and prolonged hospitalizations, these patients are especially at risk of developing infections caused by multidrug resistant bacteria. The increase in antimicrobial resistance hampers the choice of an adequate empiric therapy and warrants the knowledge of the local microbial epidemiology and the implementation of infection control measures. The main characteristics and the management of bacterial and fungal infections in patients with liver cirrhosis and liver transplant recipients are presented.
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Affiliation(s)
- Elda Righi
- Department of Infectious Diseases, Santa Maria della Misericordia University Hospital, Udine 33100, Italy
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Huang JG, Lim T, Quek SC, Quak SH, Aw MM. De novo aortopathy and cardiovascular outcomes in paediatric liver transplant recipients. Cardiol Young 2018; 28:986-94. [PMID: 29972110 DOI: 10.1017/S104795111800063X] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
With the increase in long-term survival of post-transplant children, there is a paradigm shift in the emphasis of post-transplant care. We describe de novo cardiovascular abnormalities, which occurred in otherwise asymptomatic paediatric liver transplant recipients, who received liver allografts between 1991 and 2014 at the National University Hospital, Singapore, detected during routine post-transplant monitoring. A total of 96 paediatric liver transplants were performed in 90 children. After transplant, 7/90 (7.8%) recipients were identified with new-onset aortopathy. Glycogen storage disease type I (42.9% versus 2.4%; p<0.001) and recipient Epstein-Barr virus seropositivity (85.7 versus 31.0%, p=0.004) were significant risk factors for aortopathy on univariate analysis. On multivariate analysis, only glycogen storage disease type I remained as the significant risk factor (odds ratio 51.3 [95% confidence intervals: 1.1-2498.1, p=0.047]). Liver transplant is a double-edged sword that reverses certain cardiopulmonary complications of end-stage liver disease but may induce de novo structural cardiac injury in the form of aortic dilation.
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Abe K, Shiba H, Furukawa K, Sakamoto T, Ishida Y, Yanaga K. Repeated Clostridium difficile infection after living donor liver transplantation. Clin J Gastroenterol 2018; 11:309-311. [DOI: 10.1007/s12328-018-0840-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 02/19/2018] [Indexed: 12/19/2022]
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Chiereghin A, Petrisli E, Ravaioli M, Morelli MC, Turello G, Squarzoni D, Piccirilli G, Ambretti S, Gabrielli L, Pinna AD, Landini MP, Lazzarotto T. Infectious agents after liver transplant: etiology, timeline and patients' cell-mediated immunity responses. Med Microbiol Immunol 2016; 206:63-71. [PMID: 27783145 DOI: 10.1007/s00430-016-0485-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 10/20/2016] [Indexed: 12/21/2022]
Abstract
Infections continue to be one of the leading causes of morbidity and mortality in liver transplant recipients. We retrospectively reviewed the symptomatic infectious episodes that occurred during the first year post-transplant to determine time of onset, causative pathogens and cell-mediated immunity response patterns. Ninety-eight of the 202 (48.5%) recipients enrolled developed at least one infectious episode. The total number of infectious episodes was 135: 77 (57.1%) bacterial, 45 (33.3%) viral and 13 (9.6%) fungal. The most frequently isolated bacteria were Escherichia coli (21 isolates) and Klebsiella pneumoniae (19 isolates). Overall, extended-spectrum beta lactamase-producing and methicillin-resistant organisms were responsible for 29 (29/77; 37.7%) infectious episodes. Members of the herpes virus group, in particular cytomegalovirus (34/45 viral infections, 75.5%), were detected. Candida species (9 isolates) followed by Aspergillus species (4 isolates) were isolated. The majority of infections (63%) occurred during the early post-transplant phase (<1 month), whereas only 8/135 episodes (5.9%) were detected after the sixth month (late phase). Significantly lower median ImmuKnow® intracellular ATP values in patients who developed bacterial and fungal infections compared to infection-free patients were observed (P < 0.0001 and P = 0.0016, respectively), whereas patients who developed a viral infection had a median intracellular ATP level not statistically different compared to uninfected patients (P = 0.4). Our findings confirm that bacteria are responsible for the majority of symptomatic infections and occur more frequently during the first month post-transplant. The ImmuKnow® measurements can be a useful tool for identifying patients at high risk of developing infection, particularly of fungal and bacterial etiology.
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Affiliation(s)
- Angela Chiereghin
- Operative Unit of Clinical Microbiology, St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Evangelia Petrisli
- Operative Unit of Clinical Microbiology, St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy.,Italian National Transplant Centre - Italian National Institute of Health, Via Giano Della Bella 34, 00162, Rome, Italy
| | - Matteo Ravaioli
- Department of General Surgery and Transplantation, St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Maria Cristina Morelli
- Department of General Surgery and Transplantation, St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Gabriele Turello
- Operative Unit of Clinical Microbiology, St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Diego Squarzoni
- Operative Unit of Clinical Microbiology, St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Giulia Piccirilli
- Operative Unit of Clinical Microbiology, St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Simone Ambretti
- Operative Unit of Clinical Microbiology, St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Liliana Gabrielli
- Operative Unit of Clinical Microbiology, St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Antonio Daniele Pinna
- Department of General Surgery and Transplantation, St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Maria Paola Landini
- Department of Specialized, Experimental, and Diagnostic Medicine, Operative Unit of Clinical Microbiology, St. Orsola-Malpighi University Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Tiziana Lazzarotto
- Department of Specialized, Experimental, and Diagnostic Medicine, Operative Unit of Clinical Microbiology, St. Orsola-Malpighi University Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
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Umbro I, Tinti F, Muiesan P, Mitterhofer AP. Different behaviour of BK-virus infection in liver transplant recipients. World J Gastroenterol 2016; 22:1532-1540. [PMID: 26819520 PMCID: PMC4721986 DOI: 10.3748/wjg.v22.i4.1532] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 10/10/2015] [Accepted: 11/24/2015] [Indexed: 02/06/2023] Open
Abstract
Polyomavirus BK (BKV) infects up to 90% of the general population. After primary infection, occurring early during childhood, a state of non-replicative infection is established in the reno-urinary tract, without complications for immunocompetent hosts. In immunocompromised individuals, particularly transplanted patients, asymptomatic BKV viremia and/or viruria can be observed. Renal grafts may also be sources of infection as BKV prefers kidneys rather than other solid organs for transplantation such as the liver. The mechanism behind the higher incidence of BKV infection in kidney transplant patients, compared to liver or heart transplantation, is unclear and the prevalence of BKV infection in non-renal solid organ transplants has not been yet thoroughly investigated. We evaluated the prevalence of Polyomavirus BK infection among liver transplant recipients. A PubMed search was conducted using the terms BKV infection AND liver transplant recipients; BKV AND non-renal solid organ transplant*; BKV infection AND immunosuppression; the search was limited to title/abstract and English-language articles published from 2000, to March 2015. Eleven relevant studies suggest that the prevalence of BKV viruria and/or viremia among liver transplant recipients is less than that reported in kidney or heart transplant recipients, except when chronic kidney disease (CKD) is present at the same time. Data also suggest that viruric and viremic patients have higher levels of serum creatinine than BKV negative patients. Moreover, no specific immunosuppressive drugs are associated with the onset of BKV nephropathy. The comorbidity of transplantation and CKD could play a major role in promoting BKV replication.
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Konidis SV, Hrycko A, Nightingale S, Renner E, Lilly L, Therapondos G, Fu A, Avitzur Y, Ng VL. Health-related quality of life in long-term survivors of paediatric liver transplantation. Paediatr Child Health 2015; 20:189-94. [PMID: 26038635 DOI: 10.1093/pch/20.4.189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Long-term survival after paediatric liver transplantation is now the rule rather than the exception. Improving long-term outcomes after transplantation must consider not only the quantity but also the quality of life years restored. OBJECTIVES To characterize health-related quality of life (HRQOL) of LT recipients ≥15 years after paediatric LT. METHODS Recipients of a paediatric LT performed before December 1996 in a single institution with continuous follow-up at either the paediatric or adult partner centre were identified. Patients with severe developmental or neurological impairment were excluded. HRQOL was assessed using the Pediatric Quality of Life Inventory 4.0, the Medical Outcomes Study Short Form-36 version 2 and the Pediatric Liver Transplant Quality of Life Tool. RESULTS A total of 27 (67% male) subjects (mean age 24.3±6.7 years [median 23.2 years; range 16.6 to 40.3 years]) participated. The median age at transplant was 1.7 years (range 0.5 to 17.0 years). Seven (26%) participants underwent retransplantation. Seventeen (63%) participants were engaged in full-time work/study. Mean Short Form-36 version 2 scores included physical (49.6±11.1) and mental (45.3±12.5) subscale scores. The mean score for the disease-specific quality of life tool for paediatric liver transplant recipients (the Pediatric Liver Transplant Quality of Life Tool) was 64.70±15.2. The physical health of the young adults strongly correlated with level of involvement in work/study (r=0.803; P<0.05). CONCLUSIONS The self-reported HRQOL of participants <18 years of age was comparable with a standardized healthy population. In contrast, participants between 18 and 25 years of age had HRQOL scores that were more similar to a group with chronic illness. Participants engaged in full-time work/study experienced enhanced physical health.
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Affiliation(s)
- Stacey V Konidis
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, University of Toronto; ; Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario
| | - Alexander Hrycko
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, University of Toronto
| | - Scott Nightingale
- Department of Gastroenterology, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Eberhard Renner
- Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario
| | - Leslie Lilly
- Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario
| | - George Therapondos
- Multi-Organ Transplant Institute, Ochsner Clinic Foundation, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Ann Fu
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, University of Toronto
| | - Yaron Avitzur
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, University of Toronto
| | - Vicky Lee Ng
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, University of Toronto
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