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Liver Transplantation

Kazunari Sasaki, Daniel J Firl, John McVey, Jesse D Schold, Giuseppe Iuppa, Teresa Diago Uso, Masato Fujiki, Federico N Aucejo, Cristiano Quintini, Bijan Eghetsad, Charles M Miller, Koji Hashimoto
BACKGROUND: A recent study using US national registry data has reported that split liver transplant (SLT) has improved over-time and no more hazardous than whole liver transplant using Cox proportional hazard (PH) models. However, the study methods violated PH assumption, the fundamental assumption of Cox modeling. As a result, the reported HR are biased and unreliable. This study aimed to investigate whether the risk of graft survival (GS) in SLT has really improved over-time, ensuring attention to the PH assumption...
January 7, 2019: Liver Transplantation
Caroline C Jadlowiec, Paige E Morgan, Nehra K Avinash, Matthew A Hathcock, Walter K Kremers, Julie K Heimbach, Russell H Wiesner, Timucin Taner
T-cell mediated rejection (TCMR) is common after liver transplantation (LT), and is often thought to have minimum impact on outcomes. Because alloimmune response changes over time, we investigated the role of the timing of TCMR on patient and allograft survival, and examined the risk factors for early and late TCMR. 787 consecutive LT recipients with protocol liver biopsies were reviewed, with an 8.6 year follow-up. The incidence of early TCMR (≤6 weeks post-LT) was 33%, with NASH patients having the lowest incidence...
January 7, 2019: Liver Transplantation
Nashila AbdulRahim, Bekir Tanriover
We thank Ekser et al. for sharing their experience with thymoglobulin as induction therapy in their population of simultaneous liver kidney transplant (SLKT) patients. The purpose of their study was to ascertain if differences in KDPI or delayed kidney transplant (KT) leads to improvement in patient survival. Choice in induction for the Indiana cohort of 130 patients was rATG and anti-CD20 monoclonal antibody (rituximab). This article is protected by copyright. All rights reserved.
January 7, 2019: Liver Transplantation
Umberto Cillo, Laura Saracino, Alessandro Vitale, Alessandra Bertacco, Mauro Salizzoni, Francesco Lupo, Michele Colledan, Vittorio Corno, Giorgio Rossi, Paolo Reggiani, Umberto Baccarani, Vittorio Bresàdola, Luciano De Carlis, Iacopo Mangoni, Raphael Ramirez Morales, Salvatore Agnes, Erida Nure
Early everolimus introduction and tacrolimus minimization after liver transplantation may represent a novel immunosuppressant approach. This phase 2, multicenter, randomized, open-label trial evaluated safety and efficacy of early everolimus initiation. Patients treated with corticosteroids, tacrolimus, and basiliximab, were randomized (2:1) to receive everolimus (1.5 mg bid) in day 8 and gradually minimize or withdraw tacrolimus when everolimus was stable >5 ng/mL, or to continue tacrolimus at 6-12 ng/mL...
December 28, 2018: Liver Transplantation
Dianne LaPointe Rudow, Samantha DeLair, Thomas Feeley, Sander Florman, James Guarrera, Milan Kinkhabwala, Mark Orloff, Lewis Teperman, Glyn Morgan
Outcomes for adult-to-adult living liver donors are largely based on short-term data drawn from single center studies. The aim of this study was to determine how living liver donation impacts self-reported Quality-of-Life up to 6 years post-donation in a sample of NYS residents. METHODS: NYS transplant programs are state-mandated to track living liver donors as part of a quality assurance and patient safety effort. Donor-reported Quality-of-Life within one year of donation and longitudinal data over a 10-year period were analyzed...
December 27, 2018: Liver Transplantation
David S K Lu, Matthew Quirk
The detection of portal vein tumor thrombus (PVTT) in patients with hepatocellular carcinoma (HCC) has important implications for prognosis and treatment. Liver transplantation (LT) is contraindicated due to high rates of recurrence, and the presence of PVTT also informs choice of locoregional therapy. PVTT and other forms of macrovascular invasion figure into most of the major staging systems for HCC. This article is protected by copyright. All rights reserved.
December 27, 2018: Liver Transplantation
Suzanne R Sharpton, Norah A Terrault, Andrew M Posselt
Morbid obesity (body mass index ≥40kg/m2 ) is a relative contraindication to liver transplantation (LT) at many transplant centers. The safety and efficacy of pre-LT bariatric surgery in morbidly obese LT candidates is unknown. Herein, we describe a cohort study of morbidly obese LT candidates who failed to achieve adequate weight loss through a medically-supervised weight loss program and subsequently underwent sleeve gastrectomy (SG) at our institution. 32 LT candidates with a median Model for End Stage Liver Disease (MELD) score of 12 (interquartile range [IQR] 10-13) underwent SG...
December 27, 2018: Liver Transplantation
Ramkiran Cherukuru, Mettu Srinivas Reddy, Naresh P Shanmugam, Rajesh Rajalingam, Venugopal Kota, Vasanthakumar Gunasekaran, Gomathy Narasimhan, Ilankumaran Kaliamoorthy, Mohamed Rela
INTRODUCTION: Split liver transplantation (SLT) is a valuable option for optimizing the use of good quality deceased donor grafts. It is not routinely reported outside the West due to limited deceased donor numbers, technical and organizational constraints, lack of experience, and predominant living donor liver transplant (LDLT) practice. Twenty percent of the liver transplants at our centre are from deceased donors. We report our experience of SLT and compare outcomes with pediatric and adult LDLT recipients...
December 26, 2018: Liver Transplantation
Raymond J Lynch
In the current issue, de Boer et al. report the Eurotransplant experience with older liver donors.1 The authors note comparable early outcomes among suitable recipients, with an as-expected decrement in longer-term survival. The data suggest that center volume or experience is not critical for success, provided that older organs are used in "preferred" candidates. This group is defined by the exclusion of those aged 45 years or less, those with BMI 35 or above, patients with HCV as the etiology of ESLD, and long cold ischemic times...
December 26, 2018: Liver Transplantation
Suzanne R Sharpton, Norah A Terrault
In the United States, bariatric surgeries for obesity-related complications increased from 158,000 in 2011 to 228,000 in 2017.(1) As obesity rates continue to rise, this trend can be expected to continue since bariatric surgery is the only therapeutic intervention shown to yield durable weight loss, remission of obesity-related comorbidities, and improved all-cause mortality.(2) Importantly, for those with nonalcoholic fatty liver disease (NAFLD) as a component of obesity-related complications, bariatric surgery results in histologic improvement and reduced likelihood of NAFLD progression...
December 26, 2018: Liver Transplantation
Monica A Konerman, Aashesh Verma, Betty Zhao, Amit G Singal, Anna S Lok, Neehar D Parikh
BACKGROUND: There are limited data on downstream effects of hepatocellular carcinoma (HCC) surveillance, including frequency of false positive results. We aimed to quantify the incidence of indeterminate nodules and follow-up testing needed to resolve these findings among patients enrolled in a structured HCC surveillance program. METHODS: We retrospectively analyzed adult cirrhosis patients enrolled in a structured HCC surveillance program in a large tertiary care center...
December 24, 2018: Liver Transplantation
Sumeet K Asrani, Jeanette Hasse
We appreciate the interest in our work by Professor Yildiz looking at the association between bariatric surgery and outcomes among patients evaluated for liver transplantation.(1) We share the sentiment that some of the outcomes noted in the study may be related to malabsorptive rather than restrictive weight reduction surgery. As reflected in the results, rates of delisting or death were high for gastric bypass versus non-gastric bypass patients (44% vs. 16.7%, p<0.01). However, rates of moderate or severe malnutrition were similar between the groups (68% vs...
December 24, 2018: Liver Transplantation
Max F Thijssen, Isabel M A Brüggenwirth, Andrew Gillooly, Anastasia Khvorova, Timothy F Kowalik, Paulo N Martins
RNA interference (RNAi) is a natural process of post-transcriptional gene regulation that has raised a lot of attention culminating with the Nobel prize in Medicine in 2006. RNAi-based therapeutics have been tested in experimental transplantation to reduce ischemia reperfusion injury (IRI) with success. Modulation of genes of the innate immune system, as well as apoptotic genes, and those involved in the NF-κB pathways can reduce liver injury in rodent liver pedicle clamping and transplantation models of IRI...
December 18, 2018: Liver Transplantation
Baris D Yildiz
We read with great interest the article titled "Impact of prior bariatric surgery on perioperative liver transplant outcomes" by Idriss et al (1). The authors gave a unique perspective to bariatric surgery and its relation to liver transplantation (LT). Although Roux and Y gastric bypass (RYGB) used to be considered as the gold standard (2) bariatric surgery procedure; since 2014 more than 50% of all bariatric procedures are sleeve gastrectomies (SG) (3). This article is protected by copyright. All rights reserved...
December 14, 2018: Liver Transplantation
Sanjay Kumar Yadav, Neeraj Saraf, Narendra S Choudhary, Jayant Kumar Saha, Sujeet Kumar Saha, Amit Rastogi, Prashanth Bhangui, Arvinder Singh Soin
INTRODUCTION: Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute decompensation of previously diagnosed or undiagnosed liver disease with organ failure(s) with high short-term mortality. This study was conducted to report the outcomes of LDLT in ACLF and assess the survival benefit of liver transplantation in these patients. MATERIALS AND METHODS: It was a retrospective study of 218 ACLF patients (based on EASL-CLIF criteria) from January 2014 through November 2017...
December 8, 2018: Liver Transplantation
Ramona Nicolau-Raducu, Thiago Beduschi, Rodrigo Vianna, Christian Diez, Mahmoud Sleem, Singh Bhavnha, Georgia Vasileiou, Yehuda Raveh
Detrimental consequences of hypofibrinolysis, also known as fibrinolytic shutdown (FS), have recently arisen, and its significance in liver transplantation remains unknown. To fill this gap, this retrospective study included 166 adults who received transplants between 2016 and 2018 for whom baseline thromboelastography was available. Based on percent (%) clot lysis 30 minutes after maximal amplitude, patients were stratified into 3 fibrinolysis phenotypes: FS, physiologic fibrinolysis, and hyperfibrinolysis...
December 7, 2018: Liver Transplantation
Franziska Meister, Georg Lurje, Ulf Peter Neumann, Christian Trautwein, Pavel Strnad
With great interest, we read the study by Schaefer et. al. suggesting that the carriage of a heterozygous PiZ variant of alpha1-antitrypsin (AAT) predisposes to a faster development of decompensated liver disease [1]. While the heterozygous PiZ carriage is fairly common, the homozygous genotype (PiZZ) is comparably rare (1:2000-1:4000) [2]. Since the course of PiZZ-related liver disease remains greatly understudied, we report a case of a PiZZ patient with a rapid decompensation of liver disease. This article is protected by copyright...
December 7, 2018: Liver Transplantation
Nashila AbdulRahim, Lee Anderson, Suman Kotla, Hao Liu, Venkatesh K Ariyamuthu, Mythili Ghanta, Malcolm MacConmara, Shannan R Tujios, Arjmand Mufti, Sumit Mohan, Jorge A Marrero, Parsia A Vagefi, Bekir Tanriover
The number of simultaneous liver kidney transplant (SLKT) and the concomitant use of induction therapy have increased over the last decade. However, there is little data comparing outcomes amongst induction agents in the context of maintenance immunosuppression regimen consisting of tacrolimus and mycophenolic acid (TAC/MPA). We queried the OPTN registry for SLKT recipients maintained on TAC/MPA at discharge in the U.S. between 2002 and 2016. The cohort was divided into three groups based on induction type: r-ATG (N=831), IL2RA (N=1,558), and no-induction (N=2,333)...
December 2, 2018: Liver Transplantation
Yukihiro Sanada, Shuji Hishikawa, Takumi Katano, Yuta Hirata, Naoya Yamada, Noriki Okada, Koichi Mizuta
The use of technical variant donation, including split liver transplantation (SLT) and living donor liver transplantation, represents a potential solution to the organ shortage. The SLT allows transplantation of two recipients from one deceased donor, thereby increasing the pool of grafts.Although SLT might have provided an opportunity to increase organ supply without compromising post-transplant outcomes, SLT may still be conflicting and limited by an uncertain long-term outcome of split liver grafts. This article is protected by copyright...
December 1, 2018: Liver Transplantation
Maryam Ebadi, Aldo J Montano-Loza
Sarcopenia and frailty are among the most common features of cirrhosis that contribute significantly to morbidity and mortality; however, sarcopenia is not identical to frailty. Sarcopenia is a critical reduction in skeletal muscle mass associated with poor outcomes. The main components of frailty are sarcopenia and physical impairment, which result in a cumulative decline in physiologic reserve (1, 2). This article is protected by copyright. All rights reserved.
November 25, 2018: Liver Transplantation
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