Delayed domino liver transplantation: use of the remnant liver of a recipient of a temporary auxiliary orthotopic liver transplant as a liver graft for another patient

2004 ◽  
Vol 77 (2) ◽  
pp. 324 ◽  
Author(s):  
Yasuhiko Hashikura ◽  
Toshihiko Ikegami ◽  
Yuichi Nakazawa ◽  
Koichi Urata ◽  
Shiro Ogino ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Orthotopic Liver Transplant ◽  
Liver Graft ◽  
Remnant Liver ◽  
Domino Liver Transplantation

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.

Outcomes of Patients With Familial Transthyretin Amyloidosis After Liver Transplantation

2017 ◽  
Vol 27 (3) ◽  
pp. 246-250 ◽  
Author(s):  
Dipti Banerjee ◽  
Lindsey E. Roeker ◽  
Martha Grogan ◽  
Paul Swiecicki ◽  
John Poterucha ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Overall Survival ◽  
Liver Transplant ◽  
Research Question ◽  
Organ Transplant ◽  
Early Death ◽  
Multiple Organ ◽  
Orthotopic Liver Transplant ◽  
Transthyretin Amyloidosis ◽  
Organ Systems

Background: Familial transthyretin amyloidosis is a disease caused by misfolded transthyretin aggregates that can impair multiple organ systems. Liver transplantation is the first-line treatment for familial transthyretin amyloidosis. Research Question: Our objective is to study outcomes and survival among patients with familial transthyretin amyloidosis after transplantation. Design: All patients undergoing orthotopic liver transplant for familial transthyretin amyloidosis at Mayo Clinic between 1997 and 2012 were reviewed. Baseline clinical characteristics, organs transplanted, and posttransplant clinical course were assessed. Results: Of the 40 patients, 7 patients had the V30M mutation and 33 had other mutations. Nineteen patients received liver only, 19 liver and heart, and 2 combined liver, heart, and kidney transplants. The 5-year overall survival was 85% for those receiving multiple organ transplant and 52% for those receiving liver transplant only ( P = .057). There was no difference in overall survival based on mutation (V30M vs other mutations), but survival was confounded by varied disease involvement and organs transplanted. Those who had early death (≤24 months from liver transplant) had a higher incidence of baseline peripheral neuropathy, autonomic neuropathy, lower modified BMI, and higher alkaline phosphatase. Discussion: Outcomes of orthotopic liver transplant in familial transthyretin amyloidosis are variable due to heterogeneity in mutations and patient status at the time of transplant. Familial transthyretin amyloidosis can progress, despite liver transplantation. Patients receiving combined liver, heart/kidney transplant demonstrated improved survival compared to liver transplant alone.

scholarly journals Domino Liver Transplantation from a Child with Propionic Acidemia to a Child with Idiopathic Fulminant Hepatic Failure

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Marina Moguilevitch ◽  
Ellise Delphin
Keyword(s):  
Liver Transplantation ◽  
Informed Consent ◽  
Liver Transplant ◽  
De Novo ◽  
Propionic Acidemia ◽  
Careful Planning ◽  
Proper Selection ◽  
Domino Liver Transplantation ◽  
Selection Of ◽  
Innovative Concept

Domino liver transplant has emerged as a viable strategy to increase the number of grafts available for transplantation. In the domino transplant organs explanted from one patient are transplanted into another patient. The first successful domino liver transplant was performed in Portugal in 1995. Since then this innovative concept has been applied to several genetic or biochemical disorders that are treated by liver transplantation. An important consideration during this operation is that such livers can pose a risk of the de novo development of the disease in the recipient. That is why this surgical procedure requires careful planning, proper selection of the patients, and informed consent of both donor and recipient.

scholarly journals Treatment of a Giant Haemangioma of the Liver With Kasabach-Merritt Syndrome by Orthotopic Liver Transplant

HPB Surgery ◽  
1997 ◽  
Vol 10 (3) ◽  
pp. 159-162 ◽  
Author(s):  
J-H. Longeville ◽  
P. De La M. Hall ◽  
P. Dolan ◽  
A. W. Holt ◽  
P. E. Lillie ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Resection ◽  
Liver Transplant ◽  
Initial Treatment ◽  
Tooth Extraction ◽  
Orthotopic Liver Transplant ◽  
Cavernous Haemangioma ◽  
Disseminated Intravascular Coagulopathy ◽  
Intravascular Coagulopathy ◽  
Hepatic Haemangioma

We describe a case of giant cavernous haemangioma of the liver with disseminated intravascular coagulopathy (Kasabach-Merritt syndrome) which was cured by orthotopic liver transplant.A 47 year old man presented with bleeding and tender massive hepatomegaly after tooth extraction. Investigations showed disseminated intravascular coagulopathy and a giant hepatic haemangioma involving both lobes of the liver. Initial treatment failed to resolve the coagulopathy and liver resection was attempted. At laparotomy the turnout was unresectable and the only option for cure was to offer a liver transplantation. The orthotopic liver transplant was performed 20 days after initial laparotomy. Subsequently, all coagulation parameters returned to normal and the patient remains well after 12 months. Orthotopic liver transplant can be considered for giant hepatic haemangioma with Kasabach-Merritt syndrome when resection is necessary and a partial hepatectomy is not technically feasible.

scholarly journals Uncommon Occurrence of an Air Embolism during the Preanhepatic Phase of an Orthotopic Liver Transplant

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Klint J. Smart ◽  
Saman Yaghoubian
Keyword(s):  
Liver Transplantation ◽  
Case Report ◽  
Liver Transplant ◽  
Air Embolism ◽  
Air Entrainment ◽  
Neurological Complications ◽  
Orthotopic Liver Transplant ◽  
Hemodynamic Support ◽  
Air Embolus

Vascular air embolism (VAE) during liver transplantation usually occurs during the dissection phase of the procedure or during liver reperfusion. If this phenomenon occurs, it can cause significant cardiovascular, pulmonary, and neurological complications. Prompt identification of VAE is essential, and the surgeon should be immediately notified. The mainstay treatment is identification and rectification of the source of the air embolus, hemodynamic support, and prevention of further air entrainment. This case report describes the occurrence of a pulmonary air embolism during the preanhepatic phase of an orthotopic liver transplant.

scholarly journals Dendritic Cell-Mediated Regulation of Liver Ischemia-Reperfusion Injury and Liver Transplant Rejection

2021 ◽  
Vol 12 ◽  
Author(s):  
Ryosuke Nakano ◽  
Lillian M. Tran ◽  
David A. Geller ◽  
Camila Macedo ◽  
Diana M. Metes ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
T Cell ◽  
Liver Transplant ◽  
Reperfusion Injury ◽  
Immune Cells ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Liver Graft ◽  
Liver Allograft

Liver allograft recipients are more likely to develop transplantation tolerance than those that receive other types of organ graft. Experimental studies suggest that immune cells and other non-parenchymal cells in the unique liver microenvironment play critical roles in promoting liver tolerogenicity. Of these, liver interstitial dendritic cells (DCs) are heterogeneous, innate immune cells that appear to play pivotal roles in the instigation, integration and regulation of inflammatory responses after liver transplantation. Interstitial liver DCs (recruited in situ or derived from circulating precursors) have been implicated in regulation of both ischemia/reperfusion injury (IRI) and anti-donor immunity. Thus, livers transplanted from mice constitutively lacking DCs into syngeneic, wild-type recipients, display increased tissue injury, indicating a protective role of liver-resident donor DCs against transplant IRI. Also, donor DC depletion before transplant prevents mouse spontaneous liver allograft tolerance across major histocompatibility complex (MHC) barriers. On the other hand, mouse liver graft-infiltrating host DCs that acquire donor MHC antigen via “cross-dressing”, regulate anti-donor T cell reactivity in association with exhaustion of graft-infiltrating T cells and promote allograft tolerance. In an early phase clinical trial, infusion of donor-derived regulatory DCs (DCreg) before living donor liver transplantation can induce alterations in host T cell populations that may be conducive to attenuation of anti-donor immune reactivity. We discuss the role of DCs in regulation of warm and liver transplant IRI and the induction of liver allograft tolerance. We also address design of cell therapies using DCreg to reduce the immunosuppressive drug burden and promote clinical liver allograft tolerance.

scholarly journals Doppler ultrasound values after liver transplantation in children and their association with graft outcomes: a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e033887
Author(s):  
Martha M Ruiz ◽  
Rashid Alobaidi ◽  
Michelle Lisa Noga ◽  
Robin Featherstone ◽  
James Shapiro ◽  
...  
Keyword(s):  
Systematic Review ◽  
Liver Transplantation ◽  
Liver Transplant ◽  
Doppler Ultrasound ◽  
Data Extraction ◽  
Meta Analysis ◽  
Liver Graft ◽  
Cochrane Library ◽  
Second Phase ◽  
Plain Language

IntroductionLiver graft and patient survival in children have improved substantially over the years; nevertheless, graft-related complications persist as the most important risk factor for mortality and graft loss. Doppler ultrasound evaluation is routinely used after liver transplantation; however, there is no consensus defining normal values, timing or frequency of Doppler ultrasound postoperative evaluation. Identification of patients who require an intervention or change in postoperative management is therefore challenging.Methods and analysisWe will conduct a systematic review and meta-analysis to appraise and synthesise evidence describing Doppler ultrasound measurements and their association with graft complications in children who have received a liver transplant. We will search multiple databases: Ovid Medline, Embase, Wiley Cochrane Library, Web of Science—Science Citation Index Expanded, trial registry records and meeting abstracts using a combination of subject headings and keywords for liver transplantation, Doppler ultrasound and paediatric patients. All identified titles and abstracts of studies will be assessed for potential relevance. Selected studies will be retrieved and subjected to a second phase of screening, both selection phases will be done in duplicate by two independent reviewers, and discrepancies will be documented and resolved by a third reviewer. Data extraction will be done independently by two reviewers using a standardised data extraction form. Quality of evidence and risk of bias will be assessed, synthesised and pooled for meta-analysis if possible. We will perform a subgroup analysis if enough data are available.Ethics and disseminationStrategies to disseminate our review include presenting in liver transplant review sessions, publishing in high-impact peer-reviewed medical journals, and presenting at national and international paediatric radiology and liver transplant meetings, conference presentations, events, courses and plain-language summaries. This knowledge will allow easier identification of patients with a higher risk of developing graft-related complications and could potentially improve patient and graft outcomes. We wish to disseminate our results to discover potential areas for future research and drive improved future practices and policies. Our target audience includes researchers, institutions, healthcare professionals, health system decision-makers, policy-makers and research funders community.Trial registration numberCRD42019119986.

scholarly journals The concept of “domino” in liver and hepatocyte transplantation

2020 ◽  
Vol 13 ◽  
pp. 175628482096875
Author(s):  
Guang-Peng Zhou ◽  
Li-Ying Sun ◽  
Zhi-Jun Zhu
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Liver Transplant ◽  
Hepatocyte Transplantation ◽  
Transplant Recipients ◽  
Primary Hepatocytes ◽  
The Status ◽  
Domino Liver Transplantation ◽  
End Stage ◽  
Liver Transplant Recipients

Although orthotopic liver transplantation remains the only proven treatment for end-stage liver disease and inherited metabolic liver disease, its application has been limited by the scarcity of donor organs available for transplantation. Among feasible approaches developed to expand the donor organ pool, domino liver transplantation is a strategy in which explanted genetically defective livers of liver transplant recipients are used as grafts in other patients. Another promising therapeutic strategy is hepatocyte transplantation, an alternative to liver transplantation for certain groups of patients. However, the availability of primary hepatocytes is also hindered by the shortage of donor liver tissues. Against this background, domino hepatocyte transplantation, a strategy that utilizes the hepatocytes derived from the explanted livers of liver transplant recipients with noncirrhotic inherited metabolic liver diseases as the source of primary hepatocytes, may help increase the supply of liver cells available for transplantation. In this review, we focus on the status quo of domino liver transplantation and domino hepatocyte transplantation. We also describe recent innovative transplant strategies based on domino transplantation.

scholarly journals Outflow reconstruction in domino liver transplantation with interposition of autologous portal vein graft. A new technical option in living donor domino liver transplant scenario

2006 ◽  
Vol 12 (8) ◽  
pp. 1298-1300 ◽  
Author(s):  
Alexandre Cerqueira ◽  
Lucio Pacheco-Moreira ◽  
Marcelo Enne ◽  
Jefferson Alves ◽  
Rodrigo Amil ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Portal Vein ◽  
Liver Transplant ◽  
Vein Graft ◽  
Living Donor ◽  
Domino Liver Transplantation

scholarly journals Management of Autoimmune Liver Diseases after Liver Transplantation

2021 ◽  
Vol 2 (2) ◽  
pp. 162-182
Author(s):  
Romelia Barba Bernal ◽  
Esli Medina-Morales ◽  
Daniela Goyes ◽  
Vilas Patwardhan ◽  
Alan Bonder
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Liver Diseases ◽  
Hepatitis A ◽  
Calcineurin Inhibitor ◽  
Liver Graft ◽  
Primary Biliary Cholangitis ◽  
Autoimmune Liver Diseases ◽  
Immune Mediated ◽  
Disease Modifying Agents

Autoimmune liver diseases are characterized by immune-mediated inflammation and eventual destruction of the hepatocytes and the biliary epithelial cells. They can progress to irreversible liver damage requiring liver transplantation. The post-liver transplant goals of treatment include improving the recipient’s survival, preventing liver graft-failure, and decreasing the recurrence of the disease. The keystone in post-liver transplant management for autoimmune liver diseases relies on identifying which would be the most appropriate immunosuppressive maintenance therapy. The combination of a steroid and a calcineurin inhibitor is the current immunosuppressive regimen of choice for autoimmune hepatitis. A gradual withdrawal of glucocorticoids is also recommended. On the other hand, ursodeoxycholic acid should be initiated soon after liver transplant to prevent recurrence and improve graft and patient survival in primary biliary cholangitis recipients. Unlike the previously mentioned autoimmune diseases, there are not immunosuppressive or disease-modifying agents available for patients with primary sclerosing cholangitis. However, colectomy and annual colonoscopy are key components during the post-liver transplant period.

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