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https://www.readbyqxmd.com/read/29198691/successful-liver-transplantation-from-a-donor-with-a-continuous-flow-left-ventricular-assist-device-for-9-months
#1
K Munawar, N Rajagopalan, A Grigorian, D Dennis, M Guglin
Organ donor criteria continue to be extended in an attempt to meet growing demands. Patients with continuous-flow left ventricular assist devices are one group of potential donors being considered. One concern with this group is the effect of continuous flow for a prolonged duration, as opposed to normal pulsatile flow, on end-organ function. We report the 1st case of a liver transplantation from a donor who had a continuous-flow left ventricular assist device for 9 months. The recipient was a 69-year-old woman with a history of cryptogenic cirrhosis and hepatocellular carcinoma...
December 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/29192646/development-of-a-novel-histologic-diagnostic-algorithm-for-hepatic-graft-versus-host-disease
#2
Ashley E Stueck, Thomas D Schiano, M Isabel Fiel
The histopathologic diagnosis of hepatic graft-versus-host disease post bone marrow and stem cell transplantation can be challenging, but timely and unambiguous diagnosis is essential for appropriate patient management. To address this diagnostic dilemma, we identified histologic features specific for hepatic graft-versus-host disease and developed a diagnostic algorithm. Two hepatopathologists blindly evaluated 40 liver biopsies from patients with clinically and biologically confirmed graft-versus-host disease, as well as 44 controls, for percent bile duct loss, bile duct damage, intraepithelial lymphocytes, ductular reaction, acidophilic bodies/10 high power fields (HPF), cholestasis, portal and lobular inflammation, and endotheliitis...
December 1, 2017: Modern Pathology: An Official Journal of the United States and Canadian Academy of Pathology, Inc
https://www.readbyqxmd.com/read/29192137/application-of-fully-covered-self-expandable-metallic-stents-with-and-without-antimigration-waist-versus-repeated-plastic-biliary-stent-placement-in-management-of-anastomotic-biliary-strictures-after-orthotopic-liver-transplantation
#3
Samir Zeair, Filip Butkiewicz, Jacek Butkiewicz, Robert Stasiuk
BACKGROUND Standard methods for endoscopic retrograde cholangiopancreatography (ERCP) management of anastomotic strictures (AS) after OLT includes repeated balloon dilation of the stricture with subsequent insertion of a plastic biliary stent (PBS). In post-OLT patients not responding to standard endoscopic treatment, the placement of fully covered self-expanding metal stents (FCSEMS) is a valid alternative to surgical treatment. The aim of this study was to compare the results of new FCSEMS implantation with the standard ERCP stricture management protocol and with conventional FCSEMS insertion...
December 1, 2017: Annals of Transplantation: Quarterly of the Polish Transplantation Society
https://www.readbyqxmd.com/read/29187911/oval-cells-contribute-to-fibrogenesis-of-marginal-liver-grafts-under-stepwise-regulation-of-aldose-reductase-and-notch-signaling
#4
Xiao-Bing Liu, Chung-Mau Lo, Qiao Cheng, Kevin Tak-Pan Ng, Yan Shao, Chang-Xian Li, Sookja K Chung, Irene Oi Lin Ng, Jun Yu, Kwan Man
Background and Aims: Expanded donor criteria poses increased risk for late phase complications such as fibrosis that lead to graft dysfunction in liver transplantation. There remains a need to elucidate the precise mechanisms of post-transplant liver damage in order to improve the long-term outcomes of marginal liver grafts. In this study, we aimed to examine the role of oval cells in fibrogenic development of marginal liver grafts and explore the underlying mechanisms. Methods: Using an orthotopic rat liver transplantation model and human post-transplant liver biopsy tissues, the dynamics of oval cells in marginal liver grafts was evaluated by the platform integrating immuno-labeling techniques and ultrastructure examination...
2017: Theranostics
https://www.readbyqxmd.com/read/29160655/quality-of-life-and-adherence-in-liver-transplant-recipients
#5
Patrizia Burra, Alberto Ferrarese, Giuseppe Feltrin
The assessment of Quality of Life (QoL) after transplantation represents an ancillary tool to evaluate the efficacy of solid organ transplantation, in addition to graft and patient survival rates and complication. The global assessment of QoL after transplantation usually confirms the improvement when compared to pre-transplant setting. However, whereas significant improvement in physical activity has been widely reported, several studies have demonstrated that social domain and cognitive function do not reach the level of general population after surgery...
November 21, 2017: Minerva Gastroenterologica e Dietologica
https://www.readbyqxmd.com/read/29155313/a-phase-ii-multicenter-single-arm-study-to-evaluate-the-safety-and-efficacy-of-deferasirox-after-hematopoietic-stem-cell-transplantation-in-children-with-%C3%AE-thalassemia-major
#6
Mehmet Akif Yesilipek, Gulsun Karasu, Zuhre Kaya, Baris B Kuskonmaz, Vedat Uygun, Ilkiz Dag, Onur Ozudogru, Mehmet Ertem
We conducted a prospective, phase II, multicenter, single-arm study to evaluate the efficacy and safety of deferasirox in patients (aged >2 to <18 years) with β-thalassemia major (TM) who have undergone hematopoietic stem cell transplantation (HSCT) and had evidence of iron overload (serum ferritin >1000 µg/L, cardiac MRI T2* <20 ms, or liver iron concentration [LIC; by MRI R2] ≥5 mg/g). Patients received deferasirox at an initial dose of 10 mg/kg/day, with up-titration to a maximum of 20 mg/kg/day...
November 16, 2017: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/29152988/value-and-innovation-of-direct-acting-antivirals-long-term-health-outcomes-of-the-strategic-plan-for-the-management-of-hepatitis-c-in-spain
#7
Juan Turnes, Raquel Domínguez-Hernández, Miguel Ángel Casado
OBJECTIVE: To assess the long-term healthcare costs and health outcome in association with the access to new direct-acting antivirals (DAAs), during the first year of the National Strategic Plan for Chronic Hepatitis C (SPCHC) in patients with chronic hepatitis C (CHC) in Spain. METHODS: A decision tree and a lifetime Markov model were developed to simulate the natural history, morbidity, and mortality of a cohort of 51,900 patients with CHC before (pre-DAA strategy) and after (post-DAA strategy) access to DAA, following SPCHC approval...
November 20, 2017: Revista Española de Enfermedades Digestivas
https://www.readbyqxmd.com/read/29149976/clinical-challenges-of-tacrolimus-for-maintenance-immunosuppression-post-lung-transplantation
#8
S Ivulich, M Dooley, C Kirkpatrick, G Snell
Lung transplantation (LTx) is a successful treatment option for end-stage lung disease, and immunosuppressant regimens, utilized to prevent rejection of the transplanted graft, are paramount to maintaining long-term graft survival. Immunosuppression can be classified as induction, maintenance, and antirejection therapy. This article focuses on maintenance immunosuppression that includes a combination of a calcineurin inhibitor (CNI), cell cycle inhibitor, and corticosteroid. CNIs remain the cornerstone of immunosuppression following LTx, and tacrolimus is now the preferred CNI, based on a better adverse effect profile and some limited evidence for enhanced efficacy...
November 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/29149970/thromboelastography-as-a-predictor-of-outcomes-following-liver-transplantation
#9
C L Trautman, W C Palmer, C B Taner, J M Canabal, T Getz, A Goldman, M G Heckman, N N Diehl, D D Lee, F F Stancampiano
BACKGROUND: Thromboelastography (TEG) has been used perioperatively during liver transplantation (LT) to provide a real-time global hemostasis assessment for targeted blood product replacement. We aimed to analyze the relationship between post-LT TEG results and outcomes. METHODS: We retrospectively analyzed patients undergoing LT from November 2008 to December 2014 at Mayo Clinic Florida. All 441 single-organ 1st-time LT patients aged ≥18 years requiring post-LT intensive care unit management were included...
November 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/29142192/successful-post-transplant-psychiatric-interventions-during-long-term-follow-up-of-patients-receiving-liver-transplants-for-alcoholic-liver-disease
#10
Hiroyuki Kimura, Yasuharu Onishi, Shinichi Kishi, Nobuhiko Kurata, Satoshi Ogiso, Hideya Kamei, Chisato Tsuboi, Naoko Yamaguchi, Azusa Shiga, Mai Kondo, Yushun Yokoyama, Fumika Takasato, Hiroshige Fujishiro, Kanako Ishizuka, Takashi Okada, Yasuhiro Ogura, Norio Ozaki
BACKGROUND Around 20-30% of patients who undergo liver transplantation (LT) for alcoholic liver disease (ALD) will resume heavy drinking after LT. It is crucial to control post-transplant relapse of alcohol use, because alcoholic recidivism has been shown to have a negative impact on post-transplant compliance and long-term outcomes of LT recipients. However, there is currently no specific, effective psychiatric intervention for preventing additional alcohol consumption in clinical practice. CASE REPORT We present 3 patients who underwent LT for ALD at Nagoya University Hospital who were followed up for prolonged periods (7...
November 16, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/29130583/endoscopic-retrograde-cholangio-pancreatography-in-the-management-of-biliary-complications-after-paediatric-liver-transplantation
#11
Sivaramakrishnan Venkatesh Karthik, Seng-Hock Quak, Marion M Aw
BACKGROUND: The published paediatric experience with Endoscopic retrograde cholangio-pancreatography (ERCP) in the diagnosis and management of biliary complications following liver transplantation (LT) is limited. AIMS: We describe our experience with ERCP in the management of children following LT who presented with biliary complications, over a 20 year period (1995-2014). METHODS: The retrospectively reviewed data is summarized descriptively...
November 11, 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/29114099/risk-factors-and-management-for-biliary-complications-following-adult-living-donor-liver-transplantation
#12
Tsukasa Nakamura, Taku Iida, Hidetaka Ushigome, Masafumi Osaka, Koji Masuda, Takehisa Matsuyama, Shumpei Harada, Shuji Nobori, Norio Yoshimura
BACKGROUND Biliary complications (BCs) following liver transplantation are very serious. Nevertheless, it is still uncertain which components influence the incidence of BCs the most. MATERIAL AND METHODS A consecutive sample of 74 adult recipients who underwent living-donor liver transplantation were enrolled in this study. BCs that were Clavien-Dindo classification grade II or higher were determined as BCs. RESULTS There were 11 out of the 74 recipients who experienced BCs. There were no differences in preoperative background factors between the BCs+ and BCs- group...
November 8, 2017: Annals of Transplantation: Quarterly of the Polish Transplantation Society
https://www.readbyqxmd.com/read/29092970/extracorporeal-membrane-oxygenation-for-post-transplant-hypoxaemia-following-very-severe-hepatopulmonary-syndrome
#13
Lakshmi Kumar, Dinesh Balakrishnan, Rekha Varghese, Sudhindran Surendran
Hepatopulmonary syndrome (HPS) associated with end-stage liver disease has a high morbidity when room air PaO2 is less than 50 mm Hg. Safe levels of oxygenation to facilitate transplantation have not been defined despite advancement in care. Postoperatively, hypoxaemia worsens due to ventilation perfusion mismatch contributed by postoperative pulmonary vasoconstriction and due to decrease in endogenous nitric oxide. A 16-year-old boy with cirrhosis presented with HPS and a PaO2 of 37 mm Hg on room air and underwent living donor liver transplant...
November 1, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29068155/longitudinal-assessment-of-t-cell-inhibitory-receptors-in-liver-transplant-recipients-and-their-association-with-post-transplant-infections
#14
Krupa R Mysore, Rafik M Ghobrial, Sunil Kannanganat, Laurie J Minze, Edward A Graviss, Duc T Nguyen, Katherine K Perez, Xian C Li
Current immunosuppression regimens in organ transplantation primarily inhibit T cells. However, T cells are also critical in protective immunity, especially in immune compromised patients. In this study, we examined the association of T cell dysfunction, as marked by expression of T cell exhaustion molecules, and post-transplant infections in a cohort of liver transplant patients. We focused on Programmed Death 1(PD-1) and T-cell Ig-and mucin-domain molecule3 (Tim-3) which are potent co-inhibitory receptors, and their persistent expression often leads to T cell dysfunction and compromised protective immunity...
October 25, 2017: American Journal of Transplantation
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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