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Liver Transplantation

Carla Serra, Alessandro Cucchetti, Cristina Felicani, Cristina Mosconi, Antonio De Cinque, Rita Golfieri, Pietro Andreone, Giorgio Ercolani, Lorenzo Maroni, Matteo Ravaioli, Antonia D'Errico, Antonio Daniele Pinna, Matteo Cescon
Radiofrequency ablation (RFA) represents a potentially curative option for hepatocellular carcinoma (HCC) in the early stages. This study aims at evaluating the histologic response after RFA of small HCCs arising in cirrhosis. Data from 78 patients with de-novo HCCs, treated with RFA and subsequently transplanted were reviewed. The last radiological assessment before liver transplantation (LT) was used for comparison between Modified Response Evaluation Criteria in Solid Tumors (mRECIST) and histological findings...
November 11, 2018: Liver Transplantation
John A Geha, Joseph D Geha, Christine A O'Mahony, Ronald T Cotton, Thao Galvan, Abbas Rana, John A Goss
Variations in the donor hepatic arterial anatomy can potentially present difficulties when completing the hepatic arterial reconstruction in orthotopic liver transplantation (OLT). It has previously been reported that in roughly 20% of the population, variations in hepatic arterial anatomy are present with the most common being type III or replaced right hepatic artery (RRH) arising from the superior mesenteric artery (SMA) (1,2,3). Of the many anomalies encountered, our focus in the current letter is on the reconstruction of the replaced right hepatic artery (Type III)...
November 11, 2018: Liver Transplantation
Sapana Verma, Subhash Gupta
We read with great interest the article from the Toronto group showing similar results with grafts with one or more bile ducts in living donor liver transplantation (LDLT). (1) However, one should take this message cautiously as intuitively a graft with one duct is preferred by most surgeons. Some previous studies have demonstrated that multiple bile ducts were significant independent risk factor for development of biliary complications with no difference in patient survival when compared with single duct in pediatric LT...
November 10, 2018: Liver Transplantation
Kristel Mils, Laura Lladó, Emilio Ramos, Elena Escalante, Juan Fabregat
Chronic portal vein thrombosis is a frequent finding in patients waiting for liver transplantation. Although it is no longer considered a contraindication for transplantation, it can be a surgical challenge for the transplant surgeon. Different techniques of portal flow restoration have been described depending on the extension of the portal thrombosis, with variable results. If portomesenteric venous circulation is physiologically re-established, the outcomes of liver transplantation in patients with portal vein thrombosis are comparable to those without thrombosis...
October 31, 2018: Liver Transplantation
Manuela Cesaretti, Pietro Addeo, Luigi Schiavo, Rodolphe Anty, Antonio Iannelli
The growing number of patients on waiting lists for liver transplantation and the shortage of organs have forced many centres to adopt extended criteria for graft selection, moving the limit of acceptance for marginal livers. Steatotic grafts that were, in the past, considered strictly unacceptable for transplantation because of the high risk of early non-function, are now considered as a potential resource for organ implementation. Several methods to diagnose, measure, classify and stage steatosis exist but none can be considered qualitatively and quantitatively "the ideal method" to date...
October 31, 2018: Liver Transplantation
Jennifer Porteous, Luca Cioccari, Paolo Ancona, Eduardo Osawa, Kelly Jones, Paul Gow, Peter Angus, Stephen Warrillow, Rinaldo Bellomo
BACKGROUND & AIMS: Acetaminophen-induced acute liver failure (ALF) may require emergency liver transplantation (LT) in the presence of specific criteria, and its management may also include intracranial pressure (ICP) monitoring in selected patients at high risk of cerebral edema. We aimed to test the hypothesis that management of such patients without ICP monitoring or LT would yield outcomes similar to those reported with conventional management. METHODS: We interrogated a database of all patients treated in ICU for acetaminophen-induced ALF between November 2010 and October 2016 and obtained relevant information from electronic medical records...
October 31, 2018: Liver Transplantation
Guido Stirnimann, Maryam Ebadi, Albert J Czaja, Aldo J Montano-Loza
Clinical indications for liver transplantation (LT) in patients with autoimmune hepatitis (AIH) are identical to those of patients with other chronic liver diseases that end in acute or semi-acute liver failure, decompensated cirrhosis, or hepatocellular carcinoma. Recurrent disease after LT has been reported in 10-50% of patients with AIH, and the frequency of detection is influenced in part by the use of protocol or clinically indicated liver biopsy. De novo AIH connotes the development of AIH in patients transplanted for liver diseases other than AIH, and it has been reported in 5-10% of pediatric and 1-2% of adult recipients...
October 30, 2018: Liver Transplantation
Pablo Ruiz, Marta Martínez-Picola, Miguel Santana, Javier Muñoz, Sofía Pérez-Del-Pulgar, Giorgos Koutsoudakis, Lydia Sastre, Jordi Colmenero, Gonzalo Crespo, Miquel Navasa
The development of non-invasive biomarkers that reflect the state of immune suppression remains an unmet need in liver transplantation (LT). Torque Teno Virus (TTV) is a highly prevalent, non-pathogenic DNA virus whose plasma levels may be associated with the immune status of the host. The aim of this study was to assess the role of TTV as a biomarker of immune suppression in LT recipients. TTV DNA in plasma was quantified by real-time PCR at different time-points during the first year after transplant in a prospectively followed cohort of 63 de novo LT recipients, and any correlation between TTV DNA and biopsy-proven acute cellular rejection (ACR) and opportunistic infections was then evaluated...
October 30, 2018: Liver Transplantation
Ashwin Rammohan, Vasanthakumar Gunasekaran, Mettu S Reddy, Mohamed Rela
We read with interest the article on liver transplantation (LT) for propionic academia (PA) by Quintero et al. We congratulate the authors on their series, and for presenting their outcomes with all its granularity. The authors address this niche area and have provided a comprehensive overview on the management of PA. This article is protected by copyright. All rights reserved.
October 29, 2018: Liver Transplantation
Danielle H Moore, Neeral L Shah
The hemostasis process can be divided into 3 major components: primary hemostasis, secondary hemostasis, and fibrinolysis. Primary hemostasis is the formation of a platelet plug at the site of injury, dependent on platelet adhesion, activation, and aggregation. Its formation provides a surface that localizes and accelerates fibrin formation that ultimately produces a stable clot.(1) Secondary hemostasis results in conversion of fibrinogen to fibrin, which forms a meshlike matrix in and around the platelet plug to strengthen and stabilize a clot...
October 29, 2018: Liver Transplantation
Cristiano Quintini, Laura Lomaglio, Daniele Pezzati, Teresa Diago Uso, Qiang Liu
In the past decade, the field of transplantation has witnessed the proliferation of machine perfusion devices that hold the potential to reverse the injury caused by static cold storage (SCS), provide optimal tissue preservation, and function as an organ assessment platform. These technologies will have an enormous impact on the use of expanded criteria livers, which are at risk of primary graft nonfunction. This article is protected by copyright. All rights reserved.
October 29, 2018: Liver Transplantation
Miklos Z Molnar, Kiran Joglekar, Yu Jiang, George Cholankeril, Mubeen Khan Mohammed Abdul, Satish Kedia, Humberto C Gonzalez, Aijaz Ahmed, Ashwani Singal, Kalyan Ram Bhamidimarri, Guruprasad Padur Aithal, Ajay Duseja, Vincent Wai-Sun Wong, Agayeva Gulnare, Puneet Puri, Satheesh Nair, James D Eason, Sanjaya K Satapathy
BACKGROUND: Nonalcoholic Steatohepatitis(NASH) is one of the top three indications for liver transplantation in western countries. It is unknown whether renal dysfunction at the time of liver transplantation has any effect on post-liver transplantation outcomes in recipients with NASH. METHODS: From the United Network for Organ Sharing-Standard Transplant Analysis and Research(UNOS-STAR) dataset, we identified 4,088 NASH recipients who received deceased donor liver transplant...
October 28, 2018: Liver Transplantation
Florence Lacaille
In the last 20 years, intestinal transplantation (ITx) has become an important part of the treatment of intestinal failure. However, patients treated with home parenteral nutrition in specialized centers have far better longterm survival outcomes than those treated with ITx. The intestine remains one of the most difficult organs to transplant, with poor longterm graft survival, mostly due to its immunological properties: The innate and adaptative immune systems exchange continuously with the bowel content (food or microbiota) in the middle of 80% of our body's immune-reactive cells...
October 28, 2018: Liver Transplantation
Rajab Idriss, Jeanette Hasse, Tiffany Wu, Fatima Khan, Giovanna Saracino, Greg McKenna, Testa Giuliano, James Trotter, Goran Klintmalm, Sumeet K Asrani
Bariatric surgery (BS) is effective in treating morbid obesity but the impact of prior BS on candidacy for liver transplantation (LT) is unclear. We examined 78 cirrhotic patients with prior BS compared with a concurrent cohort of 156 patients matched by age, MELD score, and underlying liver disease. We compared rates of transplant denial after evaluation, delisting on the waitlist (WL) and survival after LT. The median time from BS to LT evaluation was 7 years. Roux-en-Y gastric bypass was the most common BS procedure performed (63% of cohort)...
October 28, 2018: Liver Transplantation
Kristopher P Croome
The Letter From the Frontline by Goldberg and Lynch in the current issue addresses patient migration or domestic transplant tourism for liver transplantation (LT) in the Unites States. The authors demonstrate that while 20% of patients receive transplants outside their home state, the number of patients that could be characterized as "tourists" applies to only 4.6% of deceased donor liver transplants. Regional variation in allocation MELD score remains a persistent concern in transplant policy. Recent legal developments have resulted in momentum to eliminate the Donor Service Area (DSA) and regional model...
October 26, 2018: Liver Transplantation
Davide Ghinolfi, Erion Rreka, Vincenzo De Tata, Maria Franzini, Daniele Pezzati, Vanna Fierabracci, Matilde Masini, Andrea Cacciatoinsilla, Maria Lucia Bindi, Lorella Marselli, Valentina Mazzotti, Riccardo Morganti, Piero Marchetti, Giandomenico Biancofiore, Daniela Campani, Aldo Paolicchi, Paolo De Simone
Ex-situ normothermic machine perfusion (NMP) might minimize ischemia/reperfusion injury (IRI) of liver grafts. Twenty primary liver transplants recipients of older grafts (≥70 years) were randomized 1:1 to NMP or cold storage (CS). The primary study endpoint was to evaluate graft and patient survival at 6 months posttransplantation. The secondary endpoint was to evaluate: IRI by means of peak transaminases within 7 days after surgery; incidence of biliary complications at month 6, and evaluation of liver and bile duct biopsies...
October 26, 2018: Liver Transplantation
Nadim Mahmud, Abraham Shaked, Kim M Olthoff, David S Goldberg
BACKGROUND AND AIMS: The five-year incidence of post-transplant hepatocellular carcinoma (HCC) recurrence is 8-20%. Several studies have evaluated pre-transplant risk factors for HCC recurrence, but nearly all data have treated HCC as a homogeneous condition across all etiologies of liver disease despite differences in tumor biology and baseline incidence of HCC. We sought to evaluate the impact of etiology of liver disease, maximum pre-transplant alpha fetoprotein (AFP), and the interaction of the two factors on the risk of HCC recurrence...
October 25, 2018: Liver Transplantation
Hiroyuki Kato, Sergio Duarte, Mary G Miller, Ronald W Busuttil, Ana J Coito
he purpose of this study was to assess the significance of tenascin-C (Tnc) expression in steatotic liver ischemia and reperfusion injury (IRI). The critical shortage in donor organs has led to the use of steatotic livers in transplantation regardless of their elevated susceptibility to hepatic IRI. Tnc is an endogenous danger signal extracellular matrix (ECM) molecule involved in various aspects of immunity and tissue injury. In the current study, mice were fed with a steatosis-inducing diet and developed approximately 50% hepatic steatosis, predominantly macrovesicular, before being subjected to hepatic IRI...
October 24, 2018: Liver Transplantation
Martin Gaillard, Hadrien Tranchart, Panagiotis Lainas, Olivier Trassard, Séverine Remy, Anne Dubart-Kupperschmitt, Ibrahim Dagher
BACKGROUND: Hepatocyte transplantation (HT) has emerged as a promising alternative to orthotopic liver transplantation, yet liver preconditioning is needed to promote hepatocyte engraftment. A method of temporary occlusion of the portal flow called reversible portal vein embolization (RPVE) has demonstrated to be an efficient method of liver preconditioning. By providing an additional regenerative stimulus, repeated RPVE (RRPVE) could further boost liver engraftment. The aim of this study was to determine the efficiency of liver engraftment of transplanted hepatocytes after RPVE and RRPVE in the rat model...
October 24, 2018: Liver Transplantation
Mauro Bernardi, Giacomo Zaccherini, Paolo Caraceni
The waitlist mortality of patients with decompensated cirrhosis awaiting liver transplantation remains elevated due to the occurrence of complications. Etiologic treatments improve patient survival and lower the incidence of complications when applied in compensated cirrhosis, but a decompensated disease does not improve or even progresses despite a response to therapy in a substantial number of patients. Thus, disease-modifying treatments, able to reduce the incidence of complications and improving survival are most needed...
October 22, 2018: Liver Transplantation
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