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Current Opinion in Organ Transplantation

Armando Ganoza, Neslihan Celik, George V Mazariegos
PURPOSE OF REVIEW: The field of intestinal transplantation has shown significant growth and has become the gold standard therapy for patients that suffer from the complications of total parenteral nutrition due to irreversible intestinal failure. In the early years of intestinal transplant, retransplantation was associated with extremely high morbidity and mortality. The purpose of this review is to summarize recent encouraging reports, showing significant improvement in outcomes after intestinal retransplantation...
February 19, 2018: Current Opinion in Organ Transplantation
Constance M Mobley, Ashish Saharia
PURPOSE OF REVIEW: Patients with liver failure and liver-related diseases are often critically ill. Here, we review advances in donor organ management, tools for patient selection and highlight ICU management of liver transplant (LT) recipients. A focused discussion on the impact each of these factors have on critical care management of liver failure patients is presented. RECENT FINDINGS: Artificial liver assist devices to increase donor organ utilization are broadening the potential for transplantation of critically ill patients...
February 15, 2018: Current Opinion in Organ Transplantation
Robert S Venick
PURPOSE OF REVIEW: The review aims to describe in detail contemporary medical, nutritional, and psychosocial results in pediatric intestinal transplant (ITx) recipients greater than 10 years removed from their transplant, and to highlight significant long-term post-ITx challenges and complications. The review will draw from recent publications in the field, the ITx registry as well as detailed unpublished data from a large, well established single center. RECENT FINDINGS: The majority of long-term ITx survivors are off parenteral nutrition altogether, but a significant number require supplemental tube feeds to gain weight and grow properly...
February 15, 2018: Current Opinion in Organ Transplantation
Trevor L Nydam, Mettu Srinivas Reddy, Elizabeth A Pomfret, Mohamed Rela
PURPOSE OF REVIEW: Living donor liver transplantation (LDLT) has developed into a well tolerated and viable option when deceased donor transplantation is not available. Transplant and advanced hepatobiliary surgeons from around the world have performed living donor hepatectomies consistently for decades with acceptable donor outcomes. However, optimizing the preoperative workup, donor selection, operative technique, and perioperative care will improve these outcomes. This manuscript reviews recent worldwide literature for the living liver donor...
February 9, 2018: Current Opinion in Organ Transplantation
Fanny Turon, Virginia Hernández-Gea, Juan Carlos García-Pagán
PURPOSE OF REVIEW: To describe portal vein thrombosis (PVT) in the setting of cirrhosis especially in relation to its potential impact on liver transplantation. In addition, the safety and efficacy of anticoagulation is reviewed. RECENT FINDINGS: PVT in cirrhosis occurs in up to 26% of patients awaiting liver transplantation. Different studies have suggested that PVT impacts negatively post-liver transplantation survival, particularly in first year post-liver transplantation and when PVT is complete involving the porto-mesenteric confluence and not allowing physiological anastomosis...
February 9, 2018: Current Opinion in Organ Transplantation
AnnMarie Liapakis, Richard N Formica, Josh Levitsky
PURPOSE OF REVIEW: Strategies are needed to reduce waitlist mortality and increase transplantation rates. Advances in hepatitis C therapy has allowed the transplant community to look toward utilization of grafts from hepatitis C viremic donors to expand the organ pool. Use of such grafts for hepatitis C-negative patients is being evaluated and debated, and early trial data are emerging. RECENT FINDINGS: Both hepatitis C antibody-positive/nucleic acid test-negative and viremic donors are currently underutilized...
February 9, 2018: Current Opinion in Organ Transplantation
Brianna L Doby, Aaron A R Tobian, Dorry L Segev, Christine M Durand
PURPOSE OF REVIEW: The HIV Organ Policy Equity (HOPE) Act, signed in 2013, reversed the federal ban on HIV-to-HIV transplantation. In this review, we examine the progress in HOPE implementation, the current status of HIV-to-HIV transplantation, and remaining challenges. RECENT FINDINGS: Pursuant to the HOPE Act, the Department of Health and Human Services revised federal regulations to allow HIV-to-HIV transplants under research protocols adherent to criteria published by the National Institutes of Health...
February 9, 2018: Current Opinion in Organ Transplantation
Francisco Hernandez, Ane M Andres, Manuel Lopez-Santamaria
PURPOSE OF REVIEW: One of the biggest successes of intestinal rehabilitation programs is that more patients achieve enteral autonomy without transplantation. Many factors are responsible of this accomplishment including new parenteral formulas, better catheter management, surgical management, and the experience of the teams. The purpose of this review is to analyze recent published papers regarding intestinal lengthening procedures trying to find out how many transplantations are avoided and for which patients...
February 5, 2018: Current Opinion in Organ Transplantation
Stacey B Prenner, Laura Kulik
PURPOSE OF REVIEW: To highlight the current data for treatment of hepatitis C virus (HCV) in patients with hepatocellular carcinoma (HCC) awaiting orthotopic liver transplant and incorporation of various factors to decide the optimal time to initiate HCV therapy. RECENT FINDINGS: Viral eradication on the waiting list has been found to lead to significant clinical improvement in approximately 20% of HCV-positive patients. However, there have been concerns raised for direct-acting antiviral (DAA) therapy in patients listed with HCC...
February 5, 2018: Current Opinion in Organ Transplantation
Philippe Mathurin, Michael R Lucey
PURPOSE OF REVIEW: Review the current status of liver transplantation for patients with alcohol use disorder (AUD). RECENT FINDINGS: Alcohol-related liver disease (ALD) will increase as a source of patients requiring liver transplantation. Attitudes to use of liver transplantation as rescue therapy for patients with severe alcoholic hepatitis are changing. The long-term health of ALD liver transplantation recipients requires continued assistance to patients with AUD...
February 1, 2018: Current Opinion in Organ Transplantation
Gabriel E Gondolesi, Francisco Pattín, Hamed Nikkoupur
PURPOSE OF REVIEW: Intestinal failure is a life-threatening medical condition that remains as a rare or orphan disease in most countries. The prevalence of intestinal failure and the therapeutic options available in middle-income countries (MIC) remain unclear. We aim to provide an overview on the current differences in management of intestinal failure patients in MIC from Latin America and Asia. RECENT FINDINGS: In order to fulfil the challenge, and after facing the difficulties of going over a topic with scarce available data, from countries with an extreme variety of social and economic problems, which are closely related to the treatment of intestinal failure patients, we have used both the existing publications and personal surveys to draft this document...
January 30, 2018: Current Opinion in Organ Transplantation
Brian P Lee, Norah A Terrault
PURPOSE OF REVIEW: Alcohol-related liver disease is now the most common indication for liver transplant in the United States. Acute alcoholic hepatitis represents a subpopulation with short-term mortality approaching 70% in severe cases - these patients are not typically eligible for liver transplant, as most centers require a period of alcohol abstinence (typically 6 months) prior to transplant. Early liver transplant (prior to a requisite period of abstinence) is being increasingly offered in a minority of U...
January 30, 2018: Current Opinion in Organ Transplantation
Stephanie G Yi, Keri E Lunsford, Courtenay Bruce, R Mark Ghobrial
PURPOSE OF REVIEW: Combined thoracic organ and liver transplantation has been shown to be a viable treatment option for patients with end-stage disease lung or heart and disease. There are increasing number cases reported in the literature, as the number of institutions utilizing this strategy is growing. Herein, we review the current literature of combined thoracic and liver transplantation. RECENT FINDINGS: A larger number of combined heart or lung and liver transplants (CHLT and CLLT) are being performed...
January 30, 2018: Current Opinion in Organ Transplantation
Natalie H Bzowej
PURPOSE OF REVIEW: Nonalcoholic fatty liver disease (NAFLD) is a growing cause of chronic liver disease globally and nonalcoholic steatohepatitis is projected to become the most common indication for liver transplantation. The purpose of this review is to highlight key issues surrounding NAFLD as an indication for liver transplantation, including its increasing prevalence, outcomes related to liver transplantation, development of post liver transplant NAFLD and NAFLD in the liver donor pool...
January 19, 2018: Current Opinion in Organ Transplantation
Lafaine Grant, Shannan Tujios, Amit G Singal
PURPOSE OF REVIEW: Rates of simultaneous liver kidney (SLK) transplantation have continued to increase despite lack of clear allocation guidelines and outcomes data. The organ procurement and transplantation network (OPTN)/UNOS board approved a new SLK allocation policy to standardize medical eligibility and optimize organ utilization. This review highlights the rationale behind these new selection criteria and posttransplant outcomes in various patient populations. RECENT FINDINGS: Uniform criteria for SLK transplantation were adopted in August 2017 and state SLK should be reserved for select patients with cirrhosis who have chronic kidney disease for longer than 3 months, sustained acute kidney injury, or particular metabolic diseases...
January 19, 2018: Current Opinion in Organ Transplantation
Yaron Avitzur, Mar Miserachs
PURPOSE OF REVIEW: Long-term outcomes in patients with intestinal failure and following intestine transplantation have improved significantly over the last decade. With these improvements, listing criteria for intestine transplantation are reevaluated and the role of quality of life (QoL) in patients' outcome is increasingly studied and emphasized. Here, we review the recent literature on QoL before and after intestine transplantation and discuss whether QoL should be considered as a listing criterion for intestine transplantation...
January 17, 2018: Current Opinion in Organ Transplantation
Danielle Detelich, James F Markmann
PURPOSE OF REVIEW: Despite high demand, a severe shortage of suitable allografts limits the use of liver transplantation for the treatment of end-stage liver disease. The transplant community is turning to the utilization of high-risk grafts to fill the void. This review summarizes the reemergence of ex-vivo machine perfusion for liver graft preservation, including results of recent clinical trials and its specific role for reconditioning DCD, steatotic and elderly grafts. RECENT FINDINGS: Several phase-1 clinical trials demonstrate the safety and feasibility of machine perfusion for liver graft preservation...
January 9, 2018: Current Opinion in Organ Transplantation
Patrizia Burra, Sarah Shalaby, Alberto Zanetto
PURPOSE OF REVIEW: Since the first liver transplantation in the early 1960s, there have been significant improvements in the recipients' long-term outcome. Patients who have undergone transplantation are exposed to a high risk of developing neoplastic disease, not only because of their chronic immunosuppression, but also related to physiological aging, lifestyle, chronic viral infections, liver disease cause, and carcinogenic immunosuppressants. The present review covers the latest and most relevant data on de novo neoplasms after liver transplantation, and discusses their implications for clinical practice...
January 9, 2018: Current Opinion in Organ Transplantation
R Mark Ghobrial
No abstract text is available yet for this article.
April 2018: Current Opinion in Organ Transplantation
Keisha Bonner, Julie K Heimbach
PURPOSE OF REVIEW: The epidemic of obesity is having a marked impact on liver transplant candidates and recipients, and optimal approach for the obese liver transplant patient is not yet defined. The current review summarizes the role of bariatric surgery in obese liver transplant patients. RECENT FINDINGS: NASH is now the second most common indication for listing for liver transplantation and is the third most common reason for patients undergoing liver transplantation...
April 2018: Current Opinion in Organ Transplantation
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