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Liver Transplantation

Fabrizio di Francesco, Duilio Pagano, Gennaro Martucci, Davide Cintorino, Salvatore Gruttadauria
It is well known that ischemia and the reperfusion process are distinct nonimmunological events that negatively impact graft outcome and induce delayed graft function, which are associated with high rates of organ failure, retransplantation, and death. Cooling the organ slows metabolism but does not prevent its progressive dysfunction and destruction of cellular integrity. On the other hand, in the reperfusion phase, the reactive oxygen metabolites cause leukocyte accumulation and therefore increased microvascular permeability and cellular injury...
April 19, 2019: Liver Transplantation
Hajime Matsushima, Masato Fujiki, Kazunari Sasaki, Daniel M Rotroff, Mark Sands, Maria Del Pilar Bayona Molano, Federico Aucejo, Teresa Diago Uso, Bijan Eghtesad, Charles Miller, Cristiano Quintini, Koji Hashimoto
Hepatic venous pressure gradient (HVPG) is known to correlate with severity of portal hypertension in patients with liver cirrhosis. This retrospective study investigated the clinical value of preoperative measurement of HVPG in patients who underwent adult-to-adult LDLT and its predictive value for hepatic hemodynamics after graft reperfusion. For this study, seventy-five patients who underwent adult-to-adult LDLT were divided into two groups (HVPG < 16 mmHg or HVPG > 16 mmHg) to investigate the correlation between preoperative HVPG and characteristics and surgical outcomes of the patients, including portal vein flow (PVF) and hepatic artery flow (HAF) after graft reperfusion...
April 13, 2019: Liver Transplantation
Min Su You, Woo Hyun Paik, Young Hoon Choi, Bang-Sup Shin, Sang Hyub Lee, Ji Kon Ryu, Yong-Tae Kim, Kyung-Suk Suh, Kwang-Woong Lee, Nam-Joon Yi, Suk Kyun Hong
BACKGROUND/AIMS: There are usually two bile duct anastomosis sites, namely, the right anterior segmental duct (RASD) and the right posterior segmental duct (RPSD), in right lobe (RL) living donor liver transplantation (LDLT). This study aimed to evaluate the optimal treatment for biliary strictures following RL-LDLT with respect to unilateral or bilateral drainage technique. METHODS: From January 2005 to December 2017, 883 patients at Seoul National University Hospital underwent RL-LDLT...
April 12, 2019: Liver Transplantation
Yuanchang Hu, Chao Yang, Shikun Yang, Xuyu Cheng, Feng Cheng, Jianhua Rao, Xuehao Wang
BACKGROUND: Hyperglycemia aggravates hepatic ischemia/reperfusion injury (IRI) but the underlying mechanism remains elusive. Sphingosine 1-phosphate (S1P)/S1P receptors (S1PRs) have been implicated in metabolic and inflammatory diseases. Here, we clarify whether and how S1P/S1PRs are involved in hyperglycemia-related liver IRI. METHODS: In vivo, we enrolled diabetic patients with hepatic benign disease who had liver resection and used streptozotocin induced hyperglycemia mice or normal mice establish liver IRI model...
April 10, 2019: Liver Transplantation
Nneka N Ufere, John Donlan, Lauren Waldman, Arpan Patel, Jules L Dienstag, Lawrence S Friedman, Kathleen E Corey, Nikroo Hashemi, Peter Carolan, Alan C Mullen, Michael Thiim, Irun Bhan, Ryan Nipp, Joseph Greer, Jennifer Temel, Raymond T Chung, Areej El-Jawahri
BACKGROUND: Specialty palliative care (PC) is underutilized for patients with end-stage liver disease (ESLD). We sought to examine hepatologists' and gastroenterologists' attitudes about PC for patients with ESLD. METHODS: We conducted a cross-sectional survey of hepatologists' and gastroenterologists' who provide care to patients with ESLD recruited from the American Association for the Study of Liver Diseases membership directory. Using a questionnaire adapted from prior studies, we examined physicians' attitudes about PC and whether these attitudes varied based on patients' candidacy for liver transplantation...
April 9, 2019: Liver Transplantation
Z Galvin, K Patel, M Bhat
We thank Dr. Saigal and colleagues for their interest in our article entitled "Predictors of De Novo Nonalcoholic Fatty Liver Disease after Liver Transplantation and Associated Fibrosis". We agree that the bias towards the limited clinical significance of de novo NAFLD in prior studies is likely related to small cohorts and relatively short duration follow up. However, our study noted a trend toward a shorter long-term survival in the de novo NAFLD and NASH cohorts (log rank 0.54 and 0.18 respectively), but did not reach statistical significance...
April 4, 2019: Liver Transplantation
Nadim Mahmud, Samantha Halpern, Rebecca Farrell, Kate Ventura, Arwin Thomasson, Heidi Lewis, Kim M Olthoff, Matthew H Levine, Susanna Nazarian, Vandana Khungar
BACKGROUND: Hospital readmissions after liver transplantation (LT) are common and associated with increased morbidity and cost. High readmission rates at our center motivated a change in practice with adoption of a nurse practitioner (NP)-based post-transplant care program. We sought to determine if this program was effective in reducing 30- and 90-day readmissions after LT, and to identify variables associated with readmission. METHODS: We performed a retrospective cohort study of all patients undergoing LT from 7/1/2014 to 6/30/2017 at a tertiary LT referral center...
April 4, 2019: Liver Transplantation
Sapna S Humar, Jingqian Liu, Natalia Pinzon, Deepali Kumar, Mamatha Bhat, Les Lilly, Nazia Selzner
BACKGROUND: Increased Risk Donors (IRDs) are a significant proportion of the deceased organ donor pool but may be declined by patients on the liver transplant waiting list due to various factors. We conducted a survey of patients with end-stage liver disease awaiting a liver transplant in order to determine the factors leading to the acceptance of an IRD organ, and what strategies we could use to better inform and increase this rate of acceptance. METHODS: Adult liver transplant candidates who were outpatients completed a survey consisting of 51 questions on a 5-point Likert scale, with categories related to demographics, knowledge of IRDs, and likelihood of acceptance...
April 4, 2019: Liver Transplantation
Marit Kalisvaart, Andrea Schlegel, Palak J Trivedi, Keith Roberts, Darius F Mirza, Thamara Perera, John I Isaac, James Ferguson, Jeroen de Jonge, Paolo Muiesan
BACKGROUND AND AIM: The use of ECD grafts has been associated with acute kidney injury (AKI) after liver transplantation. However, the relation between graft quality and development of CKD remains unknown. The aim of this study was therefore to analyse the impact of extended criteria (ECD) grafts for chronic kidney disease (CKD) after liver transplantation. METHODS: All patients (2007-2015) transplanted for end-stage liver disease at our centre were assessed. Long-term kidney function was divided into four groups: no CKD (eGFR ≥60), mild CKD (eGFR 30-59), severe CKD (eGFR 15-29) and end-stage renal disease (ESRD)...
April 4, 2019: Liver Transplantation
S Shankar, J Valamparampil, A Rammohan, D Thiruchunapalli, M S Reddy, N Shanmugam, M Rela
Liver transplantation (LT), especially auxiliary partial LT (APOLT) is an excellent treatment option for patients with propionic academia (PA). It avoids the demerits and morbidity associated with long-term dietary modifications. Portal steal however, remains a major issue with APOLT, and is one of the reasons for it not being more widely accepted. We report the case of a child with PA who underwent APOLT. Nine months, following the transplant, he had an episode of acute cellular rejection resulting in metabolic decompensation...
April 2, 2019: Liver Transplantation
Mariusz Bral, Khaled Dajani, Dayne Leon Izquierdo, David Bigam, Norman Kneteman, Carlo D L Ceresa, Peter J Friend, A M James Shapiro
RATIONALE: Normothermic machine perfusion (NMP) has been shown to protect livers from injury between procurement and transplantation in a randomized controlled trial, where the machine was transported to and from the donor center. The aim of this study was to determine whether an alternative, more practical 'Back-to-base' approach after initial static cold storage (SCS) would compromise beneficial outcomes. METHODS: Between February 2015 and June 2018, a non-randomized pilot study was performed at a single site...
April 2, 2019: Liver Transplantation
Plamen Mihaylov, Richard Mangus, Burcin Ekser, Arianna Cabrales, Lava Timsina, Jonathan Fridell, Marco Lacerda, Marwan Ghabril, Lauren Nephew, Naga Chalasani, Chandrashekhar A Kubal
Utilization of donation after circulatory death donor (DCD) livers for transplantation has remained cautious in the U.S. The aim of this study was to demonstrate the expansion of DCD liver transplant (LT) program with the use of extended criteria DCD livers. After institutional review board approval, 135 consecutive DCD LTs were retrospectively studied. ECD DCD livers were defined as those with one of the followings: 1) donor age >50 years, 2) donor BMI >35 kg/m2 , 3) donor functional warm ischemia time (fWIT) >30 minutes, and 4) donor liver macrosteatosis >30%...
March 31, 2019: Liver Transplantation
Valérie A McLin
Cardiovascular and renal diseases are the leading causes of morbidity and death following liver transplantation (LT) in adult recipients. In children, LT is performed at a median age of 4 years, coming with its own set of complications and risks, the longterm consequences of which are still not completely understood. Given their young age at transplant, pediatric recipients are exposed to numerous low-grade, yet sustained, insults possibly compromising CV health over their lifetime. These include the adverse effects of calcineurin inhibitors, low-grade inflammation, and anemia, among others...
March 28, 2019: Liver Transplantation
Jin Ge, Jennifer C Lai
Children and adults of short stature are particularly disadvantaged in the current regional allocation system, which is under active revision by the UNOS Liver and Intestinal Organ Transplantation Committee.1 The reasons for this persistent health disparity include national policy that prioritizes local adult over national pediatric candidates,2 discordance in donor-recipient size matching, 3 and other clinical considerations not accounted for in the MELD-Na score.4 Split-liver transplantation (SLT) presents a potential opportunity to address these disparities and help improve access to transplantation for children and adults of short stature...
March 28, 2019: Liver Transplantation
Gerald Scott Winder, Robert J Fontana
Sports and military heroes frequently receive extensive public praise and admiration for their exceptional performance and acts of bravery. In that vein, an individual who donates a part of their liver to a family member or close friend is a medical "hero" to the recipient as well as the broader community. This article is protected by copyright. All rights reserved.
March 28, 2019: Liver Transplantation
Julissa Lombardo-Quezada, Jordi Colmenero, Hugo López-Pelayo, Carolina Gavotti, Ana Lopez, Gonzalo Crespo, Eva Lopez, Antoni Gual, Anna Lligoña, Miquel Navasa
BACKGROUND & AIMS: The selection of liver transplant (LT) candidates with alcohol use disorder is influenced by the risk of alcohol relapse (AR) after LT. We aimed to investigate the risk factors of AR after LT and its impact on graft and recipient outcomes. METHODS: Retrospective study including all consecutive patients with alcohol use disorder undergoing LT from January 2004 to April 2016 (n=309), excluding alcoholic hepatitis. Odds ratios (OR; 95%CI) for AR were analyzed by multinomial logistic regression...
March 28, 2019: Liver Transplantation
James Neuberger
While there is an abundance of high-quality, evidence-based guidance on many aspects to be considered in selecting candidates for liver transplantation, some areas, such as psychosocial issues and drug use, are less well covered. The lack of clear guidance is a consequence of many factors, including the lack of data and the complexity of factors that need to be considered. A Web-based survey of health care professionals in liver transplant units (1) analysed responses from 251 respondents. This article is protected by copyright...
March 26, 2019: Liver Transplantation
Yuan Liu, Yi Luo, Lei Xia, Bijun Qiu, Tao Zhou, Mingxuan Feng, Feng Xue, Xiaosong Chen, Longzhi Han, Jianjun Zhang, Qiang Xia
We evaluated the effects of liver transplantation in children with Niemann-Pick disease (NPD) type B. From October 2006 to October 2018, 7 of 1512 children that received liver transplantation at Ren Ji Hospital were diagnosed as NPD type B. The median age at diagnosis is 12-month (6-14 months) with initial presentations of hepatosplenomegaly, growth retardation, repeated pneumonia and diarrhea. Even after comprehensive supporting treatments, all patients developed liver dysfunction, severe interstitial pulmonary disease, compromised lung function and hypersplenism, with hypertriglyceridemia in four patients...
March 26, 2019: Liver Transplantation
Flavio Paterno, James V Guarrera, Koffi Wima, Tayyab Diwan, Madison C Cuffy, Nadeem Anwar, E Steve Woodle, Shimul Shah
The utilization of donor after circulatory death (DCD) liver allografts has been constrained by limitations in the duration of donor warm ischemia time (DWIT), agonal time (DAT), and cold ischemia time (CIT). The purpose of this study is to assess the impact of longer DWIT, DAT, and CIT on graft survival and other outcomes in DCD liver transplants. The Scientific Registry of Transplant Recipients was queried for adult liver transplants from DCD donors between 2009 and 2015. Donor, recipient, and center variables were included in the analysis...
March 26, 2019: Liver Transplantation
Johns Shaji Mathew, K Y Santosh Kumar, Krishnanunni Nair, Binoj Sivasankara Pillai Thankamony Amma, Lakshmi Krishnakumar, Dinesh Balakrishnan, Unnikrishnan Gopalakrishnan, Ramachandran Narayana Menon, Aleena Sunny, Puneet Dhar, Sudheer Othiyil Vayoth, Sudhindran Surendran
BACKGROUND: Traditionally, deceased donor liver grafts receive dual perfusion through the portal vein and the hepatic artery(HA) either in-situ or on the back-table. Hepatic artery perfusion is avoided in live donor liver grafts for fear of damage to the intima and consequent risk of hepatic artery thrombosis(HAT). However, biliary vasculature is predominantly derived from the HA. We hypothesized that antegrade perfusion of the HA in addition to the portal vein on the back table could reduce the incidence of post-operative biliary complications...
March 25, 2019: Liver Transplantation
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