PATIENTS' PREFERENCES REGARDING THE PROCESS AND OUTCOMES OF LIFE-SAVING TECHNOLOGY

1999 ◽  
Vol 15 (2) ◽  
pp. 340-351 ◽  
Author(s):  
Julie Ratcliffe ◽  
Martin Buxton
Keyword(s):  
Health Outcome ◽  
Liver Transplantation ◽  
Liver Transplant ◽  
Conjoint Analysis ◽  
Qualitative Interviews ◽  
Extreme Case ◽  
Queen Elizabeth Hospital ◽  
Relative Importance ◽  
Process Of Care ◽  
Life Saving

The economic technique of conjoint analysis was used to assess the relative importance of health outcome versus several process attributes (e.g., waiting time, continuity of contact with the same medical staff) in determining patients' preferences for liver transplantation services. The attributes were established by reference to the literature and through initial qualitative interviews with liver transplant recipients (n = 12). Following a pilot study of 40 patients, a sample of patients (n = 213) who have received a liver transplant at the Queen Elizabeth Hospital in Birmingham were surveyed. The technique of conjoint analysis was used to ascertain the relative importance of the attributes included in the exercise and to estimate the marginal rates of substitution (MRS) between different attributes. A useable response rate of 89% was achieved. Although a small proportion of respondents (15%) exhibited dominant preferences for the chance of success attribute, the majority of respondents indicated that they would be prepared to exchange a reduction in health outcome for an improvement in the process characteristics of the liver transplantation service. The results of this study have potentially important implications for the assessment of the benefits of medical technologies since they suggest that, even in the extreme case of life-saving interventions, the preferences of respondents may not be dependent solely upon health outcomes but may also be determined by attributes associated with the process of care.

Paediatric liver transplantation

2018 ◽  
Author(s):  
Van Jain ◽  
Stephen Mouat
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Survival Rates ◽  
Assessment Process ◽  
Life Saving ◽  
Paediatric Liver Transplantation

The chapter on paediatric liver transplantation presents the indications and contraindications of this potentially life-saving procedure. It explains the pre-transplant assessment process and the survival rates that can be expected. It also covers the types of different transplants as well as the initial post-liver transplant management and commonly associated complications.

scholarly journals Barriers Preventing Liver Transplantation in Canadians with HIV Infection – Perceptions of HIV Specialists

2007 ◽  
Vol 21 (3) ◽  
pp. 179-182 ◽  
Author(s):  
Curtis L Cooper ◽  
Joanne DeForest ◽  
John Gill ◽  
Richard Lalonde ◽  
Keyword(s):  
Liver Transplantation ◽  
Hepatitis C Virus ◽  
Liver Disease ◽  
Hepatitis C ◽  
Liver Transplant ◽  
Life Saving ◽  
B Virus ◽  
Key Issues ◽  
End Stage ◽  
Living With Hiv

Liver transplantation is a life-saving procedure with demonstrated utility. There are accumulating data indicating that this procedure is helpful in HIV-infected patients as well. Liver transplantation is currently largely unavailable to those living with HIV in Canada. Understanding the obstacles to this procedure is the first step to increasing access. Between August 2005 and November 2005, HIV physicians, one from each Canadian HIV Trials Network site, were asked to complete a quantitative questionnaire on adult liver transplant access and need. Forty-six per cent (16 of 35) of sites responded. A median 20% of the nearly 12,700 HIV patients followed at these sites had concurrent liver disease (20% caused by hepatitis C virus, 5% caused by hepatitis B virus and 5% were alcohol-related). On average, two patients per site were thought to be appropriate candidates for liver transplant evaluation. Eighty per cent of respondents anticipated increased need for liver transplantation over the next five years. Organ supply was universally identified as the chief obstacle to transplantation in patients with HIV. Other key issues included risk of hepatitis C virus reinfection and transplant surgical team willingness. Based on these data, it is believed that these issues should be the focus of efforts designed to increase access to transplantation in Canadians with end-stage liver disease and concurrent HIV.

scholarly journals CLINICAL SIGNIFICANCE OF CYTOMEGALOVIRUS INFECTION IN PEDIATRIC LIVER TRANSPLANT RECIPIENTS

2016 ◽  
Vol 18 (1) ◽  
pp. 67-77 ◽  
Author(s):  
O. M. Tsiroulnikova ◽  
I. V. Zhilkin ◽  
D. G. Akhaladze
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Graft Loss ◽  
Transplant Recipients ◽  
Cmv Infection ◽  
Pediatric Liver ◽  
Life Saving ◽  
End Stage ◽  
Liver Transplant Recipients ◽  
Pediatric Liver Transplant

Liver transplantation is a life-saving procedure for many forms of end-stage liver disease in pediatrics. Cytomegalovirus (CMV) is the most common and signifi cant posttransplant infection after pediatric liver transplant (PLT) with developing an episode of CMV infection or disease. It is well known that CMV increases risk of graft loss. The review presents aspects of etiology and epidemiology of CMV after PLT, approaches employed in diagnostics and prophylaxis of CMV, algorithms for valganciclovir dosing and methods to prevent complications associated with CMV. The latest data on current prevention strategies in pediatric liver transplantation centers in the world are also presented.

scholarly journals Liver Transplant Imaging prior to and during the COVID-19 Pandemic

2022 ◽  
Vol 2022 ◽  
pp. 1-9
Author(s):  
Maria Irene Bellini ◽  
Daniele Fresilli ◽  
Augusto Lauro ◽  
Gianluca Mennini ◽  
Massimo Rossi ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Chest Ct ◽  
Imaging Method ◽  
Life Saving ◽  
Highly Sensitive ◽  
Immunosuppressed Patients ◽  
Transplant Candidates ◽  
End Stage ◽  
Additional Value

Background. The suspension of the surgical activity, the burden of the infection in immunosuppressed patients, and the comorbidities underlying end-stage organ disease have impacted transplant programs significantly, even life-saving procedures, such as liver transplantation. Methods. A review of the literature was conducted to explore the challenges faced by transplant programs and the adopted strategies to overcome them, with a focus on indications for imaging in liver transplant candidates. Results. Liver transplantation relies on an appropriate imaging method for its success. During the Coronavirus Disease 2019 (COVID-19) pandemic, chest CT showed an additional value to detect early signs of SARS-CoV-2 infection and other screening modalities are less accurate than radiology. Conclusion. There is an emerging recognition of the chest CT value to recommend its use and help COVID-19 detection in patients. This examination appears highly sensitive for liver transplant candidates and recipients, who otherwise would have not undergone it, particularly when asymptomatic.

scholarly journals Peritoneal Dialysis After Liver Transplantation: A Systematic Review

2021 ◽  
Vol 8 ◽  
pp. 205435812110297
Author(s):  
Jean Maxime Côté ◽  
Isabelle Ethier ◽  
Héloïse Cardinal ◽  
Marie-Noëlle Pépin
Keyword(s):  
Systematic Review ◽  
Liver Transplantation ◽  
Liver Transplant ◽  
Kidney Failure ◽  
Liver Graft ◽  
Transplant Recipients ◽  
Technique Survival ◽  
Liver Transplant Recipients

Background: Chronic kidney disease following liver transplantation is a major long-term complication. Most liver transplant recipients with kidney failure will be treated with dialysis instead of kidney transplantation due to noneligibility and shortage in organ availability. In this population, the role of peritoneal dialysis (PD) as a modality of kidney replacement therapy (KRT) remains unclear. Objective: To determine the feasibility regarding safety, technique survival, and dialysis efficiency of PD in liver transplant recipients requiring KRT for maintenance dialysis. Design: Systematic review. Setting: Interventional and observational studies reporting the use of PD after liver transplantation. Patients: Adult liver transplant recipients with kidney failure treated with maintenance KRT. Measurements: Extracted data included eligibility criteria, study design, demographics, and PD modality. The following outcomes of interest were extracted: rate of peritonitis and microorganisms involved, noninfectious peritoneal complications, technique survival, and kidney transplantation-censored technique survival. Non-PD complications included overall survival, liver graft dysfunction, and hospitalization rate. Methods: The following databases were searched until July 2020: MedLine/PubMed, EMBASE, CINAHL, and Cochrane Library. Two reviewers independently screening all titles and abstracts of all identified articles. Due to the limited sample size, observational designs and study heterogeneity expected, no meta-analysis was pre-planned. Descriptive statistics were used to report all results. Results: From the 5263 identified studies, 4 were included in the analysis as they reported at least 1 outcome of interest on a total of 21 liver transplant recipients, with an overall follow-up duration on PD of 19.0 (Interquartile range [IQR]: 9.5-29.5) months. Fifteen episodes of peritonitis occurred in a total cumulative PD follow-up of 514 patient-months, representing an incidence rate of 0.35 per year. These episodes did not result in PD technique failure, mortality, or impairment of liver graft function. Limitations: Limitations include the paucity of studies in the field and the small number of patients included in each report, a risk of publication bias and the impossibility to directly compare hemodialysis to PD in this population. These results, therefore, must be interpreted with caution. Conclusions: Based on limited data reporting the feasibility of PD in liver transplant recipients with kidney failure, no signal was associated with an increased risk of infectious complications. Long-term studies evaluating this modality need to be performed. Registration (PROSPERO): CRD42020218374.

scholarly journals Wilson Disease-Induced Acute Liver Failure (NWI = 13) Salvaged without Liver Transplant by Plasmapheresis

2021 ◽  
Vol 11 (01) ◽  
pp. e145-e147
Author(s):  
Nida Mirza ◽  
Ravi Bharadwaj ◽  
Smita Malhotra ◽  
Anupam Sibal
Keyword(s):  
Liver Transplantation ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Wilson Disease ◽  
Prognostic Score ◽  
Prognostic Index ◽  
Kidney Injury ◽  
Copper Metabolism ◽  
Life Saving ◽  
The Brain

AbstractWilson disease (WD) is a disorder of copper metabolism resulting in accumulation of copper in vital organs of the human body, predominantly in the liver and the brain. Acute liver failure in WD has a bad prognosis, especially with a score ≥11 in the revised WD prognostic index; emergency liver transplantation is considered the only life-saving option in this scenario. Here, we reported a girl patient with WD-induced liver failure and poor prognostic score who was rescued by plasmapheresis. She also manifested severe Coombs negative hemolytic anemia and acute kidney injury. This case report highlights the utility of an adjunctive modality besides liver transplantation for the management of fulminant liver failure caused by WD.

scholarly journals Risk factors predicting Cytomegalovirus infection in post liver transplant recipients

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M G Abdelrahman ◽  
H A Mahmoud ◽  
M K Mohsen ◽  
M O Ali ◽  
A M N Mohamed
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Liver Transplant ◽  
Organ Transplantation ◽  
Chronic Rejection ◽  
Cytomegalovirus Infection ◽  
Transplant Recipients ◽  
Cmv Infection ◽  
Donor Liver Transplantation ◽  
Liver Transplant Recipients

Abstract Background Liver transplantation is considered to be the only curative treatment for patients with end stage liver disease. Postoperative infection remains to be one of the most common causes of morbidity and mortality throughout the past years. Cytomegalovirus (CMV) infection although considered to be a weak viral infection that usually passes asymptomatic in immunocompetent patients, however, it is considered one of the most common pathogens causing morbidities and mortality in liver transplant recipients. Multiple studies have been done to assess the risk factors for developing CMV infection. Objective Identification of risk factors predicting Cytomegalovirus infection in liver transplant recipients following transplantation. Methods This retrospective study was conducted on 194 patients and their donors who underwent living donor liver transplantation operation at Ain Shams centre for organ transplantation (ASCOT) at Ain Shams specialized hospital in the period between January 2010 and December 2016 with at least one year follow up period after operation for the recipient group. Results In our study, 194 patients undergoing liver transplantation at Ain shams centre for organ transplantation over seven years from January 2010 to December 2016 have been followed to assess risk factors affecting CMV infection development. Chronic rejection was found to be the most common factor associated with CMV infection followed by Cyclosporin (Neoral) as main postoperative immunosuppressant following liver transplantation. Other factors that were found to carry risk for CMV infection included younger age, advanced MELD score, positive CMV IgM status of the donors and recipients. Conclusion Differentiation of Cytomegalovirus disease from Cytomegalovirus infection isn’t always available as it requires tissue invasive techniques. Multiple risk factors have been attributed to cause Cytomegalovirus infection (viremia) . In our study, rejection (chronic rejection) was the factor that carries highest risk for Cytomegalovirus infection development followed by Cyclosporin .

scholarly journals The Role of Liver Transplantation in the Management of Paediatric Liver Tumours

2007 ◽  
Vol 89 (1) ◽  
pp. 12-21 ◽  
Author(s):  
Mark D Stringer
Keyword(s):  
Liver Transplantation ◽  
Hepatocellular Cancer ◽  
Good Prognosis ◽  
Liver Tumours ◽  
Primary Hepatic Malignancies ◽  
Life Saving ◽  
Time Of Presentation ◽  
Benign Liver ◽  
Hepatic Malignancies

In recent years, considerable progress has been made in the treatment of children with hepatoblastoma largely due to effective pre-operative chemotherapy. Total hepatectomy and liver transplantation has emerged as an effective treatment for the small proportion of children with unresectable hepatoblastoma limited to the liver. A 5-year survival of 70% can be achieved in such cases. In contrast, the results of liver transplantation in children with hepatocellular cancer remain poor because these tumours are usually advanced with evidence of major vascular invasion and/or extrahepatic spread at the time of presentation. An exception is those children in whom the hepatocellular carcinoma is detected during surveillance of chronic liver disease – they typically have smaller tumours and frequently have a good prognosis after liver transplantation. The role of liver transplantation in children with other primary hepatic malignancies remains uncertain because experience is very limited. Liver transplantation is rarely needed in the management of children with benign liver tumours but, if other treatments have failed, it can be a life-saving intervention.

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