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post liver transplant management

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https://www.readbyqxmd.com/read/28331444/post-liver-transplant-delirium-increases-mortality-and-length-of-stay
#1
Nathan Oliver, Humberto Bohorquez, Stephanie Anders, Andrew Freeman, Kerry Fine, Emily Ahmed, David S Bruce, Ian C Carmody, Ari J Cohen, John Seal, Trevor W Reichman, George E Loss
BACKGROUND: Incidence of delirium after liver transplantation (LT) has been reported to occur in 10%-47% of patients and is associated with increased hospital and intensive care unit lengths of stay and poor outcomes. METHODS: Our primary objective was to evaluate the incidence and predisposing risk factors for developing delirium after LT. Our secondary objectives were to describe how delirium is managed in patients after LT, to examine the utilization of resources associated with delirium after LT, and to analyze the outcomes of patients who were treated for delirium after LT...
2017: Ochsner Journal
https://www.readbyqxmd.com/read/28323126/elita-consensus-statements-on-use-of-daas-in-liver-transplant-candidates-and-recipients
#2
REVIEW
Luca S Belli, Christophe Duvoux, Thomas Berg, Mario Strazzabosco, Stefano Fagiuoli, Saye Khoo, Georges Philippe Pageaux, Isabelle Colle, Massimo Puoti, Audrey Coilly, Didier Samuel, Marina Berenguer
The advent of safe and highly effective direct acting antivirals (DAA) had huge implications for the HCV transplant field and changed our management of both, patients on the waiting list and those with HCV graft reinfection after Liver Transplantation (LT). When treating HCV infection before LT, HCV reinfection of the graft may be prevented in nearly all patients. In addition some candidates show a remarkable clinical improvement and are possibly delisted. Alternatively, HCV infection can be treated post LT either soon after the transplant, taking advantage of the removal of the infected native liver, or at the time of disease recurrence as done in the past...
March 18, 2017: Journal of Hepatology
https://www.readbyqxmd.com/read/28293378/hepatorenal-syndrome-update-on-diagnosis-and-therapy
#3
EDITORIAL
Juan G Acevedo, Matthew E Cramp
Hepatorenal syndrome (HRS) is a manifestation of extreme circulatory dysfunction and entails high morbidity and mortality. A new definition has been recently recommended by the International Club of Ascites, according to which HRS diagnosis relies in serum creatinine changes instead that on a fixed high value. Moreover, new data on urinary biomarkers has been recently published. In this sense, the use of urinary neutrophil gelatinase-associated lipocalin seems useful to identify patients with acute tubular necrosis and should be employed in the diagnostic algorithm...
February 28, 2017: World Journal of Hepatology
https://www.readbyqxmd.com/read/28280694/effectiveness-and-versatility-of-biological-prosthesis-in-transplanted-patients
#4
Giovanni Vennarecci, Gianluca Mascianà, Edoardo De Werra, Giovanni Battista Levi Sandri, Daniele Ferraro, Mirco Burocchi, Giovanni Tortorelli, Nicola Guglielmo, Giuseppe Maria Ettorre
AIM: To emphasize the effectiveness and versatility of prosthesis, and good tolerance by patients with incisional hernia (IH). METHODS: From December 2001 to February 2016, 270 liver transplantations were performed at San Camillo Hospital. IH occurred in 78 patients (28.8%). IH usually appeared early within the first year post-orthotopic liver transplantation. In the first era, fascial defect was repaired by primary closure for defects smaller than 2.5 cm or with synthetic mesh for greater defects...
February 24, 2017: World Journal of Transplantation
https://www.readbyqxmd.com/read/28239947/analysis-of-early-hepatic-artery-thrombosis-after-liver-transplantation
#5
Zhicheng Xue, Maogen Chen, Xuzhi Zhang, Guodong Wang, Xiaoshun He, Linwei Wu, Yi Ma
BACKGROUND: Hepatic artery thrombosis (HAT) is one of the deadliest complications after orthotopic liver transplantation (OLT). This study aimed to identify risk factors and summarize the experience of HAT management after OLT. METHODS: Clinical data of 407 adult patients who received OLT in our centres from July 2011 to December 2015 were retrospectively investigated. RESULTS: The incidence rate of early HAT was 2.0% (8/407). Recipient/donor weight ratio ≥1...
February 27, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28219595/comparison-of-post-liver-transplantation-outcomes-in-portopulmonary-hypertension-and-pulmonary-venous-hypertension-a-single-center-experience
#6
P Rajaram, A Parekh, M Fisher, J Kempker, R Subramanian
BACKGROUND: In potential liver transplant candidates, pulmonary vascular diseases, including portopulmonary hypertension (PoPH) and pulmonary venous hypertension (PVH), can be associated with high morbidity and mortality. Although there are clear guidelines regarding management and transplant listing criteria for patients with PoPH, the listing criteria for PVH are not well defined. OBJECTIVE: The aim of this study was to describe and compare the perioperative and postoperative morbidity and mortality associated with PoPH and PVH in patients undergoing liver transplantation...
March 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28214240/bridging-locoregional-therapy-longitudinal-trends-and-outcomes-in-patients-with-hepatocellular-carcinoma
#7
REVIEW
Hayley C Oligane, Orrie N Close, Minzhi Xing, Hyun S Kim
The purpose of this article is to analyze longitudinal trends in locoregional therapy (LRT) use and review locoregional therapy's role in the management of hepatocellular carcinoma prior to orthotropic liver transplantation Porrett et al. (2006) . LRT has a role in both bridge to transplantation and downstaging of patients not initially meeting Milan or UCSF Criteria. Due to the lack of randomized controlled trials, no specific bridging LRT modality is recommended over another for treating patients on the waiting list, however each modality has unique and patient-specific advantages...
February 2, 2017: Transplantation Reviews
https://www.readbyqxmd.com/read/28212256/hepatic-epithelioid-hemangioendothelioma-and-adult-liver-transplantation-proposal-for-a-prognostic-score-based-on-the-analysis-of-the-eltr-elita-registry
#8
Quirino Lai, Estelle Feys, Vincent Karam, Rene Adam, Jurgen Klempnauer, Martin Oliverius, Vincenzo Mazzaferro, Andreas Pascher, Piotr Remiszewski, Helena Isoniemi, Jacques Pirenne, Aksel Foss, Bo G Ericzon, Sasa Markovic, Jan P Lerut
BACKGROUND: Hepatic epithelioid hemangioendothelioma (HEHE) is a rare vascular tumor which has an intermediate aggressive behavior. Although the value of liver transplantation (LT) is well established, its place in the management of HEHE is still unclear. The aim of this study is to confirm, based on a very large patient cohort, the value of LT in the management of HEHE and to identify risk factors for post-LT recurrence. METHODS: The outcome of 149 transplant recipients with HEHE recorded in the European Liver Transplant Registry during the period November 1984 to May 2014 was analyzed...
2017: Transplantation
https://www.readbyqxmd.com/read/28209105/navajo-neurohepatopathy%C3%A2-a-case-report-and-literature-review-emphasizing-clinicopathologic-diagnosis
#9
REVIEW
C P Bitting, J A Hanson
Navajo Neurohepatopathy (NNH) is a rare hepatocerebral mitochondrial DNA (mtDNA) depletion syndrome (MDS) with nonspecific clinical or pathologic features aside from Navajo ancestry. Because of the rarity of NNH, diagnosis rests on close clinicopathologic correlation and appropriate tissue triage for quantitative mtDNA analysis. We present a new case of NNH in which the clinical presentation and H&E liver biopsy histology indicated the need for NNH workup. Quantitative analysis of mtDNA in liver tissue was significantly reduced, and mutational analysis of the MPV17 gene confirmed homozygosity for the NNH-associated missense mutation, R50Q...
September 2016: Acta Gastro-enterologica Belgica
https://www.readbyqxmd.com/read/28187493/recurrence-of-hepatocellular-carcinoma-after-liver-transplantation-is-there-a-place-for-resection
#10
Elena Fernandez-Sevilla, Marc-Antoine Allard, Jasmijn Selten, Nicolas Golse, Eric Vibert, Antonio Sa Cunha, Daniel Cherqui, Denis Castaing, René Adam
Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) is widely considered as a terminal condition. Therefore, the role of surgery is uncertain in this case. The purpose of this study was to identify the prognostic factors of survival after post-LT HCC recurrence and to evaluate the impact of surgery in this setting. All patients transplanted for HCC between 1991 and 2013 in a single institution and who further developed a post-LT recurrence were included in this study. Univariate and multivariate analyses were performed to identify factors affecting postrecurrence survival...
April 2017: Liver Transplantation
https://www.readbyqxmd.com/read/28147371/crohn-s-disease-and-intestinal-transplantation
#11
Pavel Drastich, Martin Oliverius
BACKGROUND: Most patients with Crohn's disease (CD) require one or more operations during their lifetime. Repeated resections and surgical complications may result in short gut in a subset of patients, typically those with extensive small bowel disease or a penetrating CD phenotype. The effects of short bowel syndrome (SBS) can range in seriousness from mild to life-threatening advanced intestinal failure. Worldwide, CD is the second leading indication for intestinal transplantation (ITx) in SBS, but the overall incidence of ITx is quite low...
2017: Digestive Diseases
https://www.readbyqxmd.com/read/28144391/impact-of-transjugular-intrahepatic-porto-systemic-shunt-on-post-liver-transplantation-outcomes-study-based-on-the-united-network-for-organ-sharing-database
#12
Khalid Mumtaz, Sherif Metwally, Rohan M Modi, Nishi Patel, Dmitry Tumin, Anthony J Michaels, James Hanje, Ashraf El-Hinnawi, Don Hayes, Sylvester M Black
AIM: To determine the impact of transjugular intrahepatic porto-systemic shunt (TIPS) on post liver transplantation (LT) outcomes. METHODS: Utilizing the United Network for Organ Sharing (UNOS) database, we compared patients who underwent LT from 2002 to 2013 who had underwent TIPS to those without TIPS for the management of ascites while on the LT waitlist. The impact of TIPS on 30-d mortality, length of stay (LOS), and need for re-LT were studied. For evaluation of mean differences between baseline characteristics for patients with and without TIPS, we used unpaired t-tests for continuous measures and χ(2) tests for categorical measures...
January 18, 2017: World Journal of Hepatology
https://www.readbyqxmd.com/read/28133934/a-novel-immune-function-biomarker-identifies-patients-at-risk-of-clinical-events-early-following-liver-transplantation
#13
Siddharth Sood, Craig Haifer, Lijia Yu, Julie Pavlovic, Leonid Churilov, Paul J Gow, Robert M Jones, Peter W Angus, Kumar Visvanathan, Adam G Testro
Balancing immunosuppression after liver transplant is difficult, with clinical events common. We investigate whether a novel immune biomarker based on a laboratory platform with widespread availability that measures interferon γ (IFNγ) after stimulation with a lyophilized ball containing an adaptive and innate immune stimulant can predict events following transplantation. A total of 75 adult transplant recipients were prospectively monitored in a blinded, observational study; 55/75 (73.3%) patients experienced a total of 89 clinical events...
April 2017: Liver Transplantation
https://www.readbyqxmd.com/read/28127943/fungal-endotipsitis-a-case-report-and-literature-review
#14
Thomas R McCarty, Jordan Sack, Bakhtiar Syed, Roger Kim, Basile Njei
Endotipsitis is a broad term used to describe sustained and clinically significant bacteremia or fungemia from a suspected vegetation or thrombus within the transjugular intrahepatic portosytemic shunt (TIPS) device. Endotipsitis is a rare infection in post-TIPS patients and given the diagnostic challenges, there is a need to establish formal diagnostic criteria. Bacterial causes of endotipsitis have been well documented in the literature, but few fungal-associated etiologies have been published to date. With this paucity of data, treatment strategies are lacking regarding the role of antifungal duration, the aggressiveness of medical therapy, and the role of liver transplantation...
January 27, 2017: Journal of Digestive Diseases
https://www.readbyqxmd.com/read/28105981/cryopreservation-of-hepatocyte-microbeads-for-clinical-transplantation
#15
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 optimised protocol for cryopreservation of hepatocyte microbeads for clinical transplantation using modified freezing solutions. Four freezing solutions with potential for clinical application were investigated...
January 20, 2017: Cell Transplantation
https://www.readbyqxmd.com/read/28076479/dietary-management-for-dyslipidemia-in-liver-transplant-recipients
#16
Andressa S Pinto, Marcio F Chedid, Léa T Guerra, Daiane D Cabeleira, Cleber D P Kruel
Background: Dyslipidemia occurs in approximately 70% of all liver transplant (LT) recipients, and no prior control studies have demonstrated any dietary intervention to change it. Aim: To analyze the effects of a dietary intervention on the lipid profile of dyslipidemic LT recipients. Methods: All LT recipients with dyslipidemia on clinical follow-up were enrolled. Anthropometric evaluation, food history, body composition (bioimpedance) and assessment of basal metabolism through indirect calorimetry were performed...
November 2016: Arquivos Brasileiros de Cirurgia Digestiva: ABCD, Brazilian Archives of Digestive Surgery
https://www.readbyqxmd.com/read/28070117/re-transplantation-higher-creatinine-levels-in-hepatitis-c-virus-patients-and-donor-age-are-predictors-of-mortality-in-long-term-analysis-of-late-acute-rejection-in-liver-transplantation
#17
Lucas Souto Nacif, Rafael Soares Pinheiro, Rafael Antônio de Arruda Pécora, Ryan Yukimatsu Tanigawa, Vinicius Rocha-Santos, Wellington Andraus, Venancio Avancini Ferreira Alves, Luiz Carneiro D'Albuquerque
BACKGROUND Late acute rejection (LAR) differs in its clinical and histological presentation and management from early acute rejection. This clinical entity is not completely understood; thus, we aimed to identify significant prognostic factors that can influence post-transplant survival in LAR patients. The purpose of this study was to evaluate the incidence and post-transplant survival of patients from a single center with a focus on late acute rejection. MATERIAL AND METHODS From January 2002 to June 2013, all liver biopsies from patients with rejection were scored using the Banff criteria...
January 10, 2017: Annals of Transplantation: Quarterly of the Polish Transplantation Society
https://www.readbyqxmd.com/read/28058211/organ-transplantation-and-drug-eluting-stents-perioperative-challenges
#18
REVIEW
Aparna Dalal
Patients listed for organ transplant frequently have severe coronary artery disease (CAD), which may be treated with drug eluting stents (DES). Everolimus and zotarolimus eluting stents are commonly used. Newer generation biolimus and novolimus eluting biodegradable stents are becoming increasingly popular. Patients undergoing transplant surgery soon after the placement of DES are at increased risk of stent thrombosis (ST) in the perioperative period. Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor such as clopidogrel, prasugrel and ticagrelor is instated post stenting to decrease the incident of ST...
December 24, 2016: World Journal of Transplantation
https://www.readbyqxmd.com/read/28053303/management-of-liver-allograft-trauma-resulting-in-massive-subcapsular-hematoma-after-living-donor-liver-transplantation-can-we-salvage-the-liver-allograft
#19
Shih-Chao Hsu, Ashok Thorat, Kin-Shing Poon, Chun-Chieh Yeh, Te-Hung Chen, Horng-Ren Yang, Long-Bin Jeng
BACKGROUND Liver allograft trauma resulting in subcapsular hematoma after living donor liver transplantation (LDLT), although rare, is a life-threatening condition and requires prompt management to avoid any catastrophe. Herein we describe our successful experience in dealing with liver allograft hematoma that developed in the post-operative period after LDLT. MATERIAL AND METHODS From January 2002 to May 2015, a total of 616 recipients underwent LDLT at our institute. The intra-operative and postoperative records of these patients were analyzed to study the cases of liver allograft hematoma...
January 5, 2017: Annals of Transplantation: Quarterly of the Polish Transplantation Society
https://www.readbyqxmd.com/read/28024124/developing-therapies-to-treat-hepatitis-c-infection-in-post-liver-transplant-recipients
#20
REVIEW
Thomas R McCarty, Joseph K Lim
Currently, hepatitis C virus (HCV) infection remains the most common indication for liver transplant in the United States (US) with almost universal HCV recurrence in the post-liver transplant setting. Previous interferon (IFN)-related efficacy and tolerability concerns about worsening liver function have limited treatment options for many patients with HCV-associated decompensated liver disease and post-liver transplant recipients. However, the last decade has seen a seen a radical shift in the management of HCV with multiple direct-acting antiviral (DAA) treatments that provide more effective, all-oral, IFN-free alternatives...
February 2017: Expert Opinion on Pharmacotherapy
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