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Liver Transplantation

Jesús Quintero, Cristina Molera, Javier Juamperez, Susanna Redecillas, Silvia Meavilla, Raquel Nuñez, Camila García, Mireia Del Toro, Ángels Garcia, Juan Ortega, Óscar Segarra, Javier Martin de Carpi, Itxarone Bilbao, Ramon Charco
Despite optimal medical treatment and strict low protein diet, the prognosis of propionic acidemia patients is generally poor. We aim to report our experience with liver transplantation in the management of propionic acidemia patients. Six patients with Propionic Acidemia received a liver transplantation at a mean age of 5.2 years (1.3-7.5). The indications for liver transplantation were frequent metabolic decompensations in the first four patients and preventative in the last two. Two patients presented hepatic artery thromboses which were solved through an interventional radiologist approach...
September 22, 2018: Liver Transplantation
Jungchan Park, Seung-Hwa Lee, Jeayoun Kim, Soo Jung Park, Myung Soo Park, Gyu-Seong Choi, Suk-Koo Lee, Gaab Soo Kim
We aimed to evaluate the association between intraoperative pulmonary vascular resistance (PVR) and clinical outcome of liver transplantation (LT). Cardiovascular involvement of end-stage liver disease is relatively common and hemodynamic instability during LT can be fatal to recipients. However, the clinical impact of intraoperative PVR in LT remains undetermined. A total of 363 adult recipients with intraoperative right heart catheterization from January 2011 to May 2016 were analyzed. Patients were divided into two groups according to PVR...
September 21, 2018: Liver Transplantation
Patrick H Y Chung, Kelvin K C Ng, Tiffany C L Wong, Sui Ling Sin, Chung Mau Lo
Hepatic venous outflow obstruction (HVOO) is a rare but serious complication after liver transplantation, particularly pediatric living donor liver transplantation (LDLT). The reported incidence is up to 10%.(1) It may lead to graft dysfunction and even failure if left untreated. Commonly reported causes of HVOO include tight suture line, twisting of the anastomosis due to inappropriate graft positioning or regeneration, size discrepancy between native venous orifice and graft hepatic vein opening, and peri-anastomotic fibrosis secondary to inflammation...
September 21, 2018: Liver Transplantation
Jeannette D Widmer, Andrea Schlegel, Mohamed Ghazaly, Brian Richie Davidson, Charles Imber, Dinesh Sharma, Massimo Malago, Joerg-Matthias Pollok
The cava-preserving piggyback technique requires only partial cava clamping during anhepatic phase in liver transplantation (LT) and therefore maintains venous return and may hemodynamically stabilize the recipient. Hence, it is an on-going debate, if piggy-back implantation is more protective from acute kidney injury (AKI) after LT when compared to classic cava replacement technique. The aim of this study was therefore to assess the rate of AKI and other complications after LT comparing both transplant techniques without the use of veno-venous bypass...
September 19, 2018: Liver Transplantation
Douglas B Mogul, Xun Luo, Jacqueline Garonzik-Wang, Mary G Bowring, Allan B Massie, Kathleen B Schwarz, Andrew M Cameron, John F P Bridges, Dorry L Segev
The increased use of split liver transplantation (SLT) represents one strategy to increase the supply of organs. Although outcomes after SLT and whole liver transplantation (WLT) are similar on average among pediatric recipients, we hypothesized that the relationship between graft type and outcomes may vary depending on patient, donor, and surgical characteristics. We evaluated graft survival among pediatric (<18 years), deceased-donor, liver-only transplant recipients from March, 2002, until December, 2015, using data from the the Scientific Registry of Transplant Recipients...
September 19, 2018: Liver Transplantation
Takeo Toshima, Tomoharu Yoshizumi, Masahiro Simokawa, Toru Ikegami, Noboru Harada, Shinji Itoh, Yohei Mano, Takashi Motomura, Yuji Soejima, Yoshihiko Maehara
Various hepatic vein reconstruction techniques using such as autologous inferior vena cava (IVC) patch grafts, internal jugular vein (IJV), saphenous vein, explanted portal vein (EPV), homologous cryopreserved vein grafts, and prosthetic vascular grafts have been reported to overcome primary graft dysfunction or small-for-size graft syndrome in living donor liver transplantation (LDLT) using right lobe (RL) graft without middle hepatic vein (MHV) trunk This article is protected by copyright. All rights reserved...
September 19, 2018: Liver Transplantation
Moana Gelu-Simeon, Philippe Mathurin
Although a minority of patients with alcohol-related liver disease (ALD) meet the rigorous criteria for acceptance, liver transplantation (LT) activity for ALD has continued to increase [1]. Timing of LT for ALD differs among transplant programs, although the selection process is frequently based on the 6-month sober period prior to listing [2]. For severe alcoholic hepatitis (SAH) patients not responsive to medical therapy, a strict application of a period of sobriety as a policy for transplant eligibility remains controversial as most patients will have died prior to the end of the 6-month sober period...
September 15, 2018: Liver Transplantation
Ricardo Ulises Macías-Rodríguez, Astrid Ruiz-Margáin, Carlos Cantú-Brito, Fernando Daniel Flores-Silva, Octavio René García-Flores, Francisco Javier Cubero, Elena Larrieta-Carrasco, Aldo Torre
BACKGROUND AND AIMS: Improvement in cognitive function after orthotopic liver transplantation (LT) has been demonstrated in the acute setting immediately after LT and in acute liver failure (ALF); however, the long-term changes in cerebral hemodynamics after LT remain unexplored. Therefore, we aimed to evaluate the long-term changes in cerebral hemodynamics of cirrhotic patients after LT. METHODS: Prospective cohort study; we performed Transcranial Doppler Ultrasonography (TCD) measuring Pulsatility index (PI), Resistance index (RI) and Breath-holding index (BHI) to evaluate cerebrovascular structural integrity and reactivity, respectively, in both middle cerebral arteries pre- and post-LT...
September 12, 2018: Liver Transplantation
Laurence Renaud, Marie-Noëlle Hilleret, Elsa Thimonier, Olivier Guillaud, Francois Arbib, Gilbert Ferretti, Adrien Jankowski, Christine Chambon-Augoyard, Domitille Erard-Poinsot, Thomas Decaens, Olivier Boillot, Vincent Leroy, Jérôme Dumortier
Patients having received a liver transplant for alcoholic liver disease (ALD) have a high risk of de novo malignancies, especially in the upper aerodigestive tract and lungs due to their smoking and alcohol history. The aim of this retrospective study was to compare a group of patients transplanted for ALD who continue to smoke and who were included in an intensive screening program for tobacco-related cancers implemented at the Grenoble University Hospital, and a group of similar patients followed according to usual practice (chest CT-scan every five years) at the Edouard Herriot Hospital in Lyon...
September 12, 2018: Liver Transplantation
Michael L Volk, Antoine Sakr, Michael De Vera
Predicting cardiovascular complications after liver transplantation (LT) has traditionally focused on the acute coronary syndrome (ACS). Major noncardiac surgery is a well-known risk factor for ACS,1 and immunosuppressive medications are known to accelerate atherosclerosis.2 Transplant programs typically have protocols for pretransplant cardiovascular risk stratification to identify transplant candidates at highest risk for cardiac events and to employ medical and surgical interventions to mitigate cardiovascular risk...
September 11, 2018: Liver Transplantation
David D Lee, Mariya Samoylova, Neil Mehta, Kaitlyn R Musto, John P Roberts, Francis Y Yao, Denise M Harnois
BACKGROUND: With recent changes in UNOS policy, patients in the United States (US) with HCC are likely to spend more time on the liver transplant (LT) waiting list. The increasing wait time will allow for an opportunity to assess tumor biology prior to LT. Modified Response Evaluation Criteria in Solid Tumors (mRECIST) paradigm provides such a framework for this assessment, and yet little is understood of its utility as it would apply for patients listed for LT in the US. METHODS: Through a collaboration between the UCSF and the Mayo Clinic, Florida, the experience of 772 patients listed for LT were retrospectively reviewed to study the impact of immediate mRECIST classification following locoregional therapy (LRT) on pre- and post- LT outcomes...
September 10, 2018: Liver Transplantation
Carlos Benítez, Rodrigo Wolff
Liver transplantation was performed for the first time in Chile in 1969, but only since the 1990s has it been systematically performed. Our health system is strongly centralized, which is a severe limitation for the patients who needs to be evaluated and subsequently listed. Although proper human and technological resources are available, and our results are comparable to international outcomes (overall patient survival at 1, 5 and 10 years of 82%, 70% and 64% respectively), we are limited because of a severe scarcity of grafts, which translates into an availability of approximately 7 organs per million persons and a waiting list dropout rate of 40% every year...
September 8, 2018: Liver Transplantation
Otto B van Leeuwen, Vincent E de Meijer, Robert J Porte
Persisting donor organ shortage has led to an increased utilization of suboptimal donor livers for transplantation. Transplantation of these extended-criteria donor (ECD) livers, however, is associated with high rates of complications, including early allograft dysfunction (EAD) and primary nonfunction (PNF). As a result, a large number of ECD livers are discarded. This article is protected by copyright. All rights reserved.
September 7, 2018: Liver Transplantation
Ahmer M Hameed, Tony Pang, Peter Yoon, Glenda Balderson, Ronald De Roo, Lawrence Yuen, Vincent Lam, Jerome Laurence, Michael Crawford, Richard D M Allen, Wayne J Hawthorne, Henry C Pleass
There is lack of consensus in the literature regarding the comparative efficacy of in situ aortic-only compared to dual (aortic and portal venous) perfusion for retrieval and transplantation of the liver. Recipient outcomes from the Australia/New Zealand Liver Transplant Registry (2007-16), including patient and graft survival, and causes of graft loss, were stratified by perfusion route. Subgroup analyses were conducted for higher risk donors. A total of 1382 liver transplant recipients were analyzed (957 aortic-only; 425 dual perfusion)...
September 7, 2018: Liver Transplantation
Fien A von Meijenfeldt, Laura C Burlage, Sarah Bos, Jelle Adelmeijer, Robert J Porte, Ton Lisman
BACKGROUND & AIMS: Patients undergoing liver transplantation have complex changes in their hemostatic system, and the net effect of these changes appears a 'rebalanced' hemostatic profile. Recently, a process called NETosis, in which a neutrophil expels DNA and proteins that form a web-like structure, has been described as a mechanism of pathogen entrapment. Increasing evidence suggests a pivotal role for neutrophil extracellular traps (NETs), and their main component cell-free DNA in activation of coagulation...
August 31, 2018: Liver Transplantation
Ravi Sujan, Monica Cruz-Lemini, Jose Altamirano, Doug Simonetto, Rakhi Maiwall, Page Axley, Taylor Richardson, Vivek Desai, Joaquin Cabezas, Victor Vargas, Patrick S Kamath, Vijay H Shah, Shiv K Sarin, Ramon Bataller, Ashwani K Singal
BACKGROUND AND RATIONALE: Identifying patients at high risk for AKI during hospitalization among patients admitted with severe alcoholic hepatitis (AH0 is an unmet clinical need. METHODS: We performed a multicentric prospective cohort study using data from four different cohorts on well-characterized patients hospitalized with severe AH. RESULTS: Data collected on 773 AH patients from four cohorts across the globe was randomly split into test (n=390) and validation (n=383) cohorts...
August 28, 2018: Liver Transplantation
Joana C Branco, Ana Morbey, Américo Martins, Eduardo Barroso
We have read with great interest the review article by Feng and Bucuvalas1 . They revised from a molecular to a clinical point of view all aspects regarding immune tolerance(IT) after liver transplantation(LT), including all available evidence, comprising adult and pediatric, retrospective and prospective studies, clinical trials, and even the different IT contexts (operational or induced). The success rate on immunosuppression(IS) withdrawal in these studies varied between 6 and 63%, usually around 20-30%...
August 27, 2018: Liver Transplantation
Ivan Linares, Nicolás Goldaracena, Roizar Rosales, Luis De la Maza, Moritz Kaths, Dagmar Kollmann, Juan Echeverri, Nazia Selzner, Stuart A McCluskey, Gonzalo Sapisochin, Leslie B Lilly, Paul Greig, Mamatha Bhat, Anand Ghanekar, Mark Cattral, Ian McGilvray, David Grant, Markus Selzner
Portal vein thrombosis (PVT) is a severe complication after liver transplantation that can result in increased morbidity and mortality. Few data are available regarding risk factors, classification, and treatment of PVT after living donor liver transplant (LDLT). Between January-2004 and November-2014 421 adult-to-adult LDLTs were performed at our institution and included in the analysis. Perioperative characteristics and outcomes from patients with no-PVT (n=393) were compared to those with de-novo PVT (t-PVT) (n=28)...
August 26, 2018: Liver Transplantation
Saroja Bangru, Mark Pedersen, Amit G Singal, Arjmand Mufti
BACKGROUND AND AIMS: Liver transplant (LT) has demonstrated survival benefit in select patients with severe acute alcoholic hepatitis (SAH) who do not respond to steroids, but prior studies suggest low adoption among U.S. liver transplant centers. Our study explored current perceptions and practice patterns of LT for SAH in the U.S. METHODS: We administered a web-based survey to medical directors of U.S. liver transplant centers between May and October of 2017 to characterize practice patterns and perceptions of LT for SAH...
August 23, 2018: Liver Transplantation
Michael Leise, Andres Cardenas
Hyponatremia in cirrhosis is defined as a serum sodium level ≤ 130 meq/L and occurs in approximately 22% of patients with cirrhosis. The appearance of hyponatremia in patients with cirrhosis portends a poor prognosis before liver transplantation, independent of the MELD score. With the development of the MELDNa score, the management of hyponatremia has become more relevant than ever before. Over-correction of hyponatremia before liver transplantation or peri-operatively can lead to the devastating neurologic condition known as osmotic demyelination syndrome which is often irreversible and fatal...
August 21, 2018: Liver Transplantation
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