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https://www.readbyqxmd.com/read/29034347/using-a-weaning-immunosuppression-protocol-in-liver-transplantation-recipients-with-hepatocellular-carcinoma-a-compromise-between-the-risk-of-recurrence-and-the-risk-of-rejection
#1
REVIEW
Roberta Angelico, Alessandro Parente, Tommaso Maria Manzia
Hepatocellular carcinoma (HCC) recurrence rate after liver transplantation (LT) is still up to 15-20%, despite a careful selection of candidates and optimization of the management within the waiting list. To reduce tumour recurrence, the currently adopted post-transplant strategies are based on the administration of a tailored immunosuppression (IS) regimen. Drug-induced depression of the immune system is essential in preventing graft rejection, however has a well-established association with oncogenesis. The immune system has a key role as a defending mechanism against cancer development, preventing vascular invasion and metastasis...
2017: Translational Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/29026597/endoscopic-approach-for-management-of-biliary-strictures-in-liver-transplant-recipients-a-systematic-review-and-meta-analysis
#2
Dayse Pereira da Silva Aparício, José Pinhata Otoch, Edna Frasson de Souza Montero, Muhammad Ali Khan, Everson Luiz de Almeida Artifon
The most common biliary complication after liver transplantation is anastomotic stricture (AS) and it can occur isolated or in combination with other complications. Liver graft from a cadaveric donor or a living donor has an influence on the incidence of biliary strictures as well as on the response to endoscopic treatment. Endoscopic treatment using balloon dilation and insertion of biliary stents by endoscopic retrograde cholangiopancreatography (ERCP) is the initial approach to these complications. AIM: The aim of this article is to compare different endoscopic techniques to treat post-liver transplantation biliary strictures...
October 2017: United European Gastroenterology Journal
https://www.readbyqxmd.com/read/29024228/de-novo-hepatocellular-carcinoma-post-multivisceral-transplantation-in-a-child
#3
P Tran, S Zhou, L Wang, M Finegold, L Mascarenas, S Alexopolous, Y Genyk, N Kerkar
De novo hepatocellular carcinoma (HCC) post-transplantation in patients without viral hepatitis is extremely rare, with only three reported adult cases in the English literature. Here, we present a case of de novo HCC that developed in a 7-year-old female, who at 8 months of age received a liver, small bowel, spleen, and pancreas transplantation 6.5 years ago for gastroschisis and total parenteral nutrition (TPN)-related cirrhosis. The post-transplant course was complicated by Epstein-Barr virus (EBV) infection, post-transplant lymphoproliferative disease, and subsequent development of multifocal EBV-associated post-transplant smooth muscle tumors (EBV-PTSMT) in the small bowel 1 year and 10 months after transplantation, respectively...
November 2017: Pediatric Transplantation
https://www.readbyqxmd.com/read/28987263/follow-up-of-the-post-liver-transplantation-patient-a-primer-for-the-practicing-gastroenterologist
#4
REVIEW
Amanda Cheung, Josh Levitsky
The focus in liver transplantation in the next 10 years will likely change from preventing viral disease recurrence to minimizing the toll of rejection and fatty liver disease, minimizing the complications from immunosuppression with withdrawal strategies, and more optimal management of long-term risks, such as malignancy, cardiovascular disease, and renal failure. In addition, now that short-term results (<1 year) have improved significantly, there will be a shift toward improving long-term patient and graft survival, as well as a focus on primary care preventive strategies...
November 2017: Clinics in Liver Disease
https://www.readbyqxmd.com/read/28960437/safety-and-efficacy-of-biologic-agents-for-the-management-of-inflammatory-bowel-disease-after-liver-transplantation
#5
Suhail A Shaikh, Linda Stuckey, Sarah Tischer
Primary sclerosing cholangitis (PSC) frequently progresses to end-stage liver disease and cirrhosis, requiring liver transplantation. Approximately 70% of patients with PSC have concomitant inflammatory bowel disease (IBD) during their clinical course. After liver transplantation for PSC, corticosteroids and other high-intensity immunosuppressants are initiated to keep IBD in remission. Patients with IBD that is refractory to these agents may need to be managed with biologic therapies. Biologic agents, however, may further increase the risks for malignancy and infection due their immunosuppressive effects...
September 27, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28936400/diminishing-use-of-liver-biopsy-among-liver-transplant-recipients-for-hepatitis-c
#6
Elizabeth Aby, Melissa A Jimenez, Jonathan F Grotts, Vatche Agopian, Samuel W French, Ronald W Busuttil, Sammy Saab
Background and Aims: Hepatitis C virus (HCV) cirrhosis is the leading indication for liver transplantation in the United States and recurrent HCV following liver transplantation is a major cause of allograft loss and mortality. Liver biopsies are commonly used to identify recurrent HCV and determine the need for antiviral therapy. The introduction of direct-acting antiviral agents (DAAs) has changed the management of recurrent HCV infection. This study aimed to describe the role of liver biopsies in liver transplant recipients with HCV after the introduction of DAAs...
September 28, 2017: Journal of Clinical and Translational Hepatology
https://www.readbyqxmd.com/read/28931801/elizabethkingia-meningoseptica-in-a-case-of-biliary-tract-infection-following-liver-transplantation
#7
Hebah M Musalem, Yazan N Honjol, Lin M Tuleimat, Saleh I Al Abbad, Fahad I Alsohaibani
BACKGROUND Elizabethkingia meningoseptica (E. meningoseptica) is an aerobic Gram-negative bacillus known to thrive in moist environments, and is now recognized as a hospital-acquired infection, being found to contaminate hospital equipment, respiratory apparatus, hospital solutions, water, and drainage systems. Nosocomial infection with E. meningoseptica occurs in immunocompromised patients, requires specialized identification methods, and is resistant to conventional antibiotics. We report a case of E. meningoseptica infection arising from a percutaneous transhepatic biliary drainage (PTBD) tube...
September 21, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28923639/laparoscopic-repair-of-incisional-hernia-following-liver-transplantation-early-experience-of-a-single-institution-in-taiwan
#8
S-C Kuo, C-C Lin, A Elsarawy, Y-H Lin, S-H Wang, Y-J Wu, C-L Chen
BACKGROUND: Ventral incisional hernia (VIH) is not uncommon following liver transplantation. Open repair was traditionally adopted for its management. Laparoscopic repair of VIH has been performed successfully in nontransplant patients with evidence of reduced recurrence rates and hospital stay. However, the application of VIH in post-transplantation patients has not been well established. Herein, we provide our initial experience with laparoscopic repair of post-transplantation VIH. METHODS: From March 2015 to March 2016, 18 cases of post-transplantation VIH were subjected to laparoscopic repair (laparoscopy group)...
October 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28901189/cryopreservation-of-hepatocyte-microbeads-for-clinical-transplantation
#9
Suttiruk Jitraruch, Anil Dhawan, Robin D Hughes, Celine Filippi, Sharon C Lehec, Leanne Glover, Ragai R Mitry
Intraperitoneal transplantation of hepatocyte microbeads is an attractive option for the management of acute liver failure. Encapsulation of hepatocytes in alginate microbeads supports their function and prevents immune attack of the cells. Establishment of banked cryopreserved hepatocyte microbeads is important for emergency use. The aim of this study was to develop an optimized protocol for cryopreservation of hepatocyte microbeads for clinical transplantation using modified freezing solutions. Four freezing solutions with potential for clinical application were investigated...
August 2017: Cell Transplantation
https://www.readbyqxmd.com/read/28889185/statistical-approach-to-quality-assessment-in-liver-transplantation
#10
Harald Schrem, Sophia Volz, Hans-Friedrich Koch, Jill Gwiasda, Priscila Kürsch, Alon Goldis, Daniel Pöhnert, Markus Winny, Jürgen Klempnauer, Alexander Kaltenborn
PURPOSE: This study investigated the utility of retrospective two one-sided cumulative sum (CUSUM) charts combined with multivariable regression analysis in liver transplantation for transplant center benchmarking. METHODS: One thousand seven hundred and forty-nine consecutive adult primary liver transplants (January 1, 1983 to December 31, 2012) were analyzed retrospectively with two one-sided CUSUM chart analysis of 90-day mortality. RESULTS: Three eras and two subseries in latest era 3 were identified due to graphically delineated relevant shifts in mean 90-day mortality...
September 9, 2017: Langenbeck's Archives of Surgery
https://www.readbyqxmd.com/read/28859222/therapies-for-patients-with-hepatocellular-carcinoma-awaiting-for-liver-transplantation-a-systematic-review-and-meta-analysis
#11
REVIEW
Laura Kulik, Julie K Heimbach, Feras Zaiem, Jehad Almasri, Larry J Prokop, Zhen Wang, M Hassan Murad, Khaled Mohammed
Patients with hepatocellular carcinoma (HCC) who are listed for liver transplantation are often treated while on the waiting list with loco-regional therapy (LRT) which is aimed at either preventing progression of HCC or reducing themeasurable disease burden of HCC in order to receive increased allocation priority. We aimed to synthesize evidence regarding the effectiveness of LRT in the management of patients with HCC who were on the liver transplant waitlist. We conducted a comprehensive search of multiple databases from 1996 to April 25, 2016, for studies that enrolled adults with cirrhosis awaiting liver transplantation and treated with bridging or down-staging therapies before liver transplantation...
August 31, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/28856289/recommendations-for-the-treatment-of-hepatitis-b-in-2017
#12
REVIEW
Robert Flisiak, Waldemar Halota, Jerzy Jaroszewicz, Jacek Juszczyk, Piotr Małkowski, Małgorzata Pawłowska, Anna Piekarska, Krzysztof Simon, Krzysztof Tomasiewicz, Marta Wawrzynowicz-Syczewska
The therapeutic goal which is currently unfrequent but realistic in HBV infected patients is sustained HBsAg clearance. It is preceded by the loss or significant suppression of HBV replication and leads to inhibition of the progression of liver fibrosis, normalization of biochemical indicators of liver damage, reduction in the risk of hepatocellular carcinoma, prolongation of survival, prevention of HBV infection in the transplanted organ in post-transplant patients, enhancement of the quality of life, inhibition or reversal of extrahepatic changes associated with HBV infection, and halting of the spread of HBV infections...
June 2017: Clin Exp Hepatol
https://www.readbyqxmd.com/read/28839868/evolving-strategies-to-reduce-colectomy-rates-in-primary-sclerosing-cholangitis-inflammatory-bowel-disease-clinical-remission-of-corticosteroid-refractory-colitis-post-liver-transplant-with-vedolizumab
#13
Saqib Mumtaz, Jason Goh, Gideon M Hirschfield, James Ferguson, Sheldon C Cooper
Primary sclerosing cholangitis (PSC) is associated with inflammatory bowel disease (IBD) in approximately 70% of patients, with ulcerative colitis (UC) being the most common subtype of IBD identified. There is a paucity of data on the optimum management strategy for IBD flares in the post-liver transplant patient, particularly when refractory to conventional treatments. Vedolizumab is a novel gut-specific monoclonal antibody, which has recently been approved for use by National Institute for Health and Care Excellence for moderate-to-severe UC...
October 2016: Frontline Gastroenterology
https://www.readbyqxmd.com/read/28839515/addictive-behaviors-in-liver-transplant-recipients-the-real-problem
#14
REVIEW
Hélène Donnadieu-Rigole, Pascal Perney, José Ursic-Bedoya, Stéphanie Faure, Georges-Philippe Pageaux
Liver transplantation (LT) is the gold standard treatment for end-stage liver disease. Whatever the primary indication of LT, substance abuse after surgery may decrease survival rates and quality of life. Prevalence of severe alcohol relapse is between 11 and 26%, and reduces life expectancy regardless of the primary indication of LT. Many patients on waiting lists for LT are smokers and this is a major risk factor for both malignant tumors and cardiovascular events post-surgery. The aim of this review is to describe psychoactive substance consumption after LT, and to assess the impact on liver transplant recipients...
August 8, 2017: World Journal of Hepatology
https://www.readbyqxmd.com/read/28838464/clearance-of-hepatitis-c-virus-prior-to-lung-transplantation-a-case-report
#15
A E Shafii, D D Harris, M Baz
Hepatitis C virus (HCV) continues to be considered a relative contraindication to lung transplantation due to concerns of progression of liver disease with the introduction of immunosuppression. Since the recent introduction of effective antiviral therapy for HCV, new approaches in the management of the HCV-positive recipient are being utilized in liver transplantation to clear HCV pre- and post-transplant. Herein, we report use of ledipasvir/sofosbuvir for HCV clearance prior to lung transplantation in a patient with usual interstitial pneumonia...
September 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28838449/successful-blood-transfusion-management-of-a-living-donor-liver-transplant-recipient-in-the-presence-of-anti-jr-a-a-case-report
#16
N Kurata, Y Onishi, H Kamei, T Hori, M Komagome, C Kato, T Matsushita, Y Ogura
A 48-year-old Japanese woman was diagnosed with Budd-Chiari syndrome and transferred for possible living donor liver transplantation (LDLT). Examinations before LDLT revealed that the recipient had anti-Jr(a) and preformed donor-specific anti-human leukocyte antigen (HLA) antibodies (DSA). Rituximab was administrated at 16 days prior to the patient's scheduled LDLT for the prophylaxis of antibody-mediated rejection by DSA. The clinical significance of anti-Jr(a) has not been clearly established because of the rarity of this antibody, so we discussed blood transfusion strategy with the Department of Blood Transfusion Service and prepared for Jr(a)-negative packed red blood cells (RBCs)...
September 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28838434/management-of-portal-hypertension-after-liver-transplantation
#17
D Korda, P Á Deák, G Kiss, Z Gerlei, L Kóbori, D Görög, I Fehérvári, L Piros, Z Máthé, A Doros
INTRODUCTION: Post-transplantation portal hypertension has severe complications, such as esophageal varix bleeding, therapy refractory ascites, extreme splenomegaly, and graft dysfunction. The aim of our study was to analyze the effectiveness of the therapeutic strategies and how to visualize the procedure. METHODS: A retrospective study involving liver transplantation patients from the Semmelweis University Department of Transplantation and Surgery was performed between 2005 and 2015...
September 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28837510/use-of-fully-covered-self-expanding-metal-biliary-stents-in-pediatrics-a-case-series
#18
Jacob A Mark, Cara L Mack, Ahmed I Marwan, Robert E Kramer
OBJECTIVE: Endoscopic retrograde cholangiopancreatography (ERCP) is used to manage biliary pathology in pediatric patients. Plastic biliary stents have been utilized in this population for obstructive lesions and bile leaks, however they are sometimes not effective due to migration, occlusion, or ineffective sealing. Fully covered self-expanding metal stents (FCSEMS) have larger diameters making them more suitable for some situations. However, their use in pediatrics has not been defined...
August 23, 2017: Journal of Pediatric Gastroenterology and Nutrition
https://www.readbyqxmd.com/read/28815029/nodular-regenerative-hyperplasia-rarely-leads-to-liver-transplantation-a-20-year-cohort-study-in-all-dutch-liver-transplant-units
#19
Berrie Meijer, Melek Simsek, Hans Blokzijl, Robert A de Man, Minneke J Coenraad, Gerard Dijkstra, Carin Mj van Nieuwkerk, Chris Jj Mulder, Nanne Kh de Boer
BACKGROUND: Nodular regenerative hyperplasia is an uncommon liver condition associated with several autoimmune disorders and drugs. The clinical symptoms of nodular regenerative hyperplasia vary from asymptomatic to severe complications of portal hypertension (nodular regenerative hyperplasia-syndrome). OBJECTIVE: The purpose of this study was to identify the prognosis and optimal management, as well as the role of liver transplantation, in nodular regenerative hyperplasia...
August 2017: United European Gastroenterology Journal
https://www.readbyqxmd.com/read/28801969/anesthetic-management-for-intestinal-transplantation-a-decade-of-experience
#20
Jeron Zerillo, Sang Kim, Bryan Hill, David Shapiro, Hung-Mo Lin, Alyssa Burnham, Jang Moon, Kishore Iyer, Samuel DeMaria
BACKGROUND: Intestinal transplantation (ITx) is the definitive therapy for patients suffering from intestinal failure. Previously published reports suggest that these cases should be managed perioperatively with the same intensive monitors and techniques as in liver transplantation. METHODS: We retrospectively reviewed the anesthetic management of 67 isolated intestinal, intestinal-pancreas, and intestinal-kidney transplants over the previous decade (2005-2015) in our tertiary care institution...
August 12, 2017: Clinical Transplantation
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