IS IT WORTH PERFORMING LIVER TRANSPLANTATION WITH MARGINAL DONOR ORGANS IN HIGH-RISK PATIENTS?

Abstract Background: Although liver transplantation (LT) is one of the most effective treatments for the patients with hepatocellular carcinoma (HCC), the high-risk patients suffer from a high ratio of tumor recurrence after LT. So this study was designed to evaluate the role of adjuvant lenvatinib in preventing recurrence of high-risk LT recipients with HBV-related HCC.Methods: We retrospectively analyzed 23 high-risk patients consisting of lenvatinib group (n = 14) and control group (n = 9) with HBV-related HCC who underwent LT in our center. Disease-free survival (DFS) and HCC recurrence of the two groups were compared. The adverse events (AEs) and drug tolerance of lenvatinib were evaluated.Results: The median DFS in lenvatinib group was 291 (95%CI 204–516) days, significantly longer than 182 (95%CI 56–537) days in control group (P = 0.04). Three patients in lenvatinib group (21.4%) and 5 patients in control group (55.6%) had short-term HCC recurrence (P = 0.11). All patients in lenvatinib group could tolerate oral lenvatinib for at least 3 cycles except 6 cases (42.9%) of dose reduction and 1 case of interruption (14.3%). Thirteen patients (92.9%) taking lenvatinib experienced AEs. The most common AEs were hypertension (64.3%) and proteinuria (42.9%), and the most serious AEs were CTCAE Grade 3 for 4 cases (28.5%). Additionally, no influence of lenvatinib on the dosage and blood concentration of FK506 was observed.Conclusion: Adjuvant lenvatinib had a potential benefit on prolonging the DFS and reducing the recurrence of high-risk HBV-related HCC patients following liver transplantation with an acceptable drug safety and patient tolerance.

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Evaluation of risk factors for cytomegalovirus infection and disease occurring within 1 year of liver transplantation in high-risk patients

Transplant Infectious Disease ◽

10.1111/tid.12050 ◽

2013 ◽

Vol 15 (2) ◽

pp. 171-180 ◽

Cited By ~ 10

Author(s):

J.G. Katsolis ◽

W. Bosch ◽

M.G. Heckman ◽

N.N. Diehl ◽

J.A. Shalev ◽

...

Keyword(s):

Risk Factors ◽

Liver Transplantation ◽

High Risk ◽

Cytomegalovirus Infection ◽

High Risk Patients ◽

Risk Patients

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P0253 TARGETING HIGH RISK PATIENTS BY ANTIFUNGAL PROPHYLAXIS COULD PREVENT FUNGAL INFECTIONS AFTER LIVER TRANSPLANTATION IN CHILDREN

Journal of Pediatric Gastroenterology and Nutrition ◽

10.1097/00005176-200406001-00377 ◽

2004 ◽

Vol 39 (Supplement 1) ◽

pp. S154

Author(s):

A. Verma ◽

J. J. Wade ◽

R. M. Taylor ◽

P. Muiesan ◽

M. Rela ◽

...

Keyword(s):

Liver Transplantation ◽

High Risk ◽

Fungal Infections ◽

Antifungal Prophylaxis ◽

High Risk Patients ◽

Risk Patients

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Concomitant cardiac surgery and liver transplantation: an alternative approach in patients with end stage liver failure?

Perfusion ◽

10.1177/0267659120966549 ◽

2020 ◽

pp. 026765912096654

Author(s):

Sanjay Chaubey ◽

Azhar Hussain ◽

Saad Badar Zakai ◽

Salman Butt ◽

Prakash Punjabi ◽

...

Keyword(s):

Liver Transplantation ◽

Cardiac Surgery ◽

Liver Disease ◽

High Risk ◽

Valve Replacement ◽

Tricuspid Valve Repair ◽

High Risk Patients ◽

End Stage Liver Disease ◽

Risk Patients ◽

End Stage

Background: The results of cardiac surgery in patients with end-stage-liver-disease (ESLD) are poor. Concomitant cardiac surgery and orthotopic liver transplantation (OLT) may be an alternative treatment strategy in these patients. Methods: Between 2001 and 2018, eight patients underwent concomitant cardiac surgery and OLT (Conc_OLT) in our institution. We analyzed their preoperative, intraoperative and postoperative data and compared them to seven high risk patients with ESLD who underwent isolated cardiac surgery (Iso_Surg). Results: The two groups were not significantly different in terms of gender and age (Conc_OLT: 5 males, 55 ± 15 years, Iso_Surg: 4 males, 60 ± 10 years). Causes for ESLD were primary biliary cirrhosis (Conc_OLT = 1, Iso_Surg = 1), alcoholism (Conc_OLT = 2, Iso_Surg = 2), viral hepatitis (Conc_OLT = 2, Iso_Surg = 2), cryptogenic (Conc_OLT = 2, Iso_Surg = 1), ischemic (Conc_OLT = 1) and hepatocellular carcinoma (Iso_Surg = 1). Model for End-stage-Liver-Disease (MELD) Score (Conc_OLT = 14, Iso_Surg = 13) and Child-Pugh Score (Conc_OLT = 9.5, Iso_Surg = 8) were not significantly different between the two groups. Median logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 9.5% (Conc_OLT) and 7.1% (Iso_Surg). Cardiac procedures undertaken were aortic valve replacement (Conc_OLT = 6, Iso_Surg = 3), coronary bypass grafting (Conc_OLT = 1,Iso_Surg = 2), tricuspid valve repair (Conc_OLT = 1), combined aortic and mitral valve replacement (Iso_Surg = 1) and excision of atrial myxoma (Iso_Surg = 1). Median length of in-hospital-stay was longer in the Conc_OLT group (73 vs. 42 days; p = 0.11). At 3 months, in-hospital mortality was 25% in the Conc_OLT group (n = 2) and lower compared to 71% observed in the Iso_Surg group (n = 5, p = 0.13). Conclusion: Concomitant cardiac surgery and OLT is a promising alternative compared to isolated cardiac surgery in high risk patients with ESLD. Given the high operative mortality of cardiac surgery in patients with ESLD, the complex peri-operative management of these patients should be performed in an interdisciplinary team with an expert team of liver specialists involved.

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