Hospitalization and Life Support before Liver Transplantation – Easily available Predictors for Post-Transplant Patient Survival

2018 ◽  
Vol 102 ◽  
pp. S273
Author(s):  
Leke Wiering ◽  
Paul Ritschl ◽  
Michael Hippler-Benscheidt ◽  
Felix Aigner ◽  
Matthias Biebl ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Transplant Patient ◽  
Life Support ◽  
Patient Survival ◽  
Post Transplant

scholarly journals A220 AN UNEXPECTED CAUSE OF ACUTE JAUNDICE IN A POST-TRANSPLANT PATIENT

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 253-254
Author(s):  
K W Wong ◽  
J Silverman
Keyword(s):  
Liver Transplantation ◽  
Abdominal Pain ◽  
Liver Transplant ◽  
Diaphragmatic Hernia ◽  
Biliary Obstruction ◽  
Transplant Patient ◽  
Hepatic Duct ◽  
Liver Transplant Patient ◽  
Unique Case ◽  
Post Transplant

Abstract Background Complications post liver transplantation are common. These may include thromboses, primary graft nonfunction, biliary complications, chylothorax, infection, and rejection. Hepaticojejunostomy with Roux-en-Y limb is a common technique for pediatric liver transplantation. Complications of hepaticojejunostomy include small bowel obstruction due to incarceration of the Roux-en-Y limb within an internal hernia. Acquired diaphragmatic hernia has previously been reported in liver transplant patients. Here we present a unique case of acute biliary obstruction secondary to incarceration of a Roux limb within an acquired diaphragmatic hernia. Aims To describe a unique case of incarcerated Roux-en-Y limb in a diaphragmatic hernia leading to acute jaundice in a pediatric liver transplant patient. Methods Retrospective chart review and case review with the surgical and medical teams. Results A 14 month old girl with unresectable hepatoblastoma received a living donor, left lateral segment liver transplant using standard venous reconstruction, microvascular plastics arterial reconstruction, and the recipient common hepatic duct was anastomosed to the donor left hepatic duct. Serial ultrasounds showed persistent intrahepatic duct dilatation with cholestasis. Given the concern of biliary obstruction, 10 days post-transplant, she underwent repeat laparotomy and was found to have a dilated common bile duct with a proximal obstruction. A Roux-en-Y hepaticojejunostomy was performed to establish adequate biliary drainage. Three months post-transplant she developed lung metastases that required wedge resection and chemotherapy. 7 months post-transplant, while admitted for routine chemotherapy she acutely developed jaundice, pruritus, and transaminitis. Liver ultrasound showed an apparent fluid collection at the cut surface of the liver and biliary dilatation. Extrinsic compression of the biliary tree was suspected, and so a percutaneous biliary drain was placed to drain the collection and decompress the biliary system. Despite improvement in the transaminitis and cholestasis, several days later, she developed severe abdominal pain and associated grunting respirations. An MRI with MRCP to reassess the previous findings and rule out a new intraabdominal cause for her symptoms was completed and unexpectedly showed herniation of her Roux-en-Y limb into a diaphragmatic hernia. She had urgent diaphragmatic hernia repair with reduction of the incarcerated bowel loop, with resolution of her pain and jaundice. Conclusions Post liver transplant Roux-en-Y herniation is uncommon, but can occur with internal hernias and in diaphragmatic hernias. This uncommon complication should be considered for the post liver transplant patient with hepaticojejunostomy in the setting of acute jaundice, particularly if accompanied by acute onset abdominal pain and/or increased work of breathing. Funding Agencies None

scholarly journals A207 DE NOVO DONOR-SPECIFIC ANTIBODY FORMATION IN LIVER TRANSPLANTS: RISK FACTORS FOR DEVELOPMENT AND IMPACT ON GRAFT SURVIVAL.

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 236-237
Author(s):  
C Wang ◽  
A J Montano-Loza ◽  
P M Campbell ◽  
V Bain
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Liver Disease ◽  
Organ Transplantation ◽  
Graft Survival ◽  
Patient Survival ◽  
De Novo ◽  
Single Center ◽  
Liver Transplants ◽  
Post Transplant

Abstract Background Antibody mediated rejection (AMR) is an area of great importance in solid organ transplantation. Donor-specific antibodies (DSA) have emerged as relevant biomarkers in predicting graft function and survival. DSA detected post-transplant may either be preformed or de novo and emerging evidence suggests de novo DSA, in particular, is associated with inferior graft outcomes. In contrast to the clear role that AMR plays in renal and thoracic organ transplantation, its importance in liver transplants remains controversial. Aims The aim of this study was to determine the risk factors associated with de novo DSA formation and to evaluate its role in determining clinical outcomes after liver transplantation. Methods This single-center retrospective study compiled data on liver transplants performed between 2005 and 2019 in Edmonton, Canada. Data collected from medical charts included gender, age at transplant, reason for transplant, and immunosuppressive regimens, among several others. The presence of DSA was determined by single antigen flow beads until 2009 and by Luminex thereafter. Potential predictors of DSA formation were evaluated using Cox proportional hazard models. Graft survival estimates were obtained using the Kaplan-Meier method and comparisons between patient groups were conducted using the log-rank test. Results Between 2005–2019, 131 patients had measurements of DSA both before and after liver transplantation. In this cohort, 17 patients (13%) tested negative on DSA screening before transplant but developed new antibodies against either Class I or Class II molecules post-transplant. Risk factor analysis revealed transplants performed in the setting of autoimmune liver disease (PSC, PBC, and autoimmune hepatitis) had higher risks of developing de novo DSA post-transplant (p=0.002. See Table 1). Graft survival probability at 5- and 10-years was 72% and 61% in those with de novo DSA formation, compared to 93% and 89% in patients without de novo DSA formation (p=0.04. See Figure 1). Overall patient survival was similar between the two groups. Conclusions In this single-center study, a transplant done in the setting of autoimmune liver disease had a higher risk of de novo DSA formation. Furthermore, de novo DSA formation lead to a decreased graft survival time in liver transplant patients but overall patient survival was not significantly decreased. A standard approach to DSA monitoring, especially in high risk populations, is required to better understand its prevalence and impact in liver transplantation. Funding Agencies None

scholarly journals New Indications for Liver Transplantation

2021 ◽  
Vol 10 (17) ◽  
pp. 3867
Author(s):  
Alberto Zanetto ◽  
Sarah Shalaby ◽  
Martina Gambato ◽  
Giacomo Germani ◽  
Marco Senzolo ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Transplant Patient ◽  
Patient Survival ◽  
Therapeutic Option ◽  
Chronic Liver Failure ◽  
Exclusion Criteria ◽  
Cancer Metastases ◽  
Colorectal Cancer Metastases ◽  
Clinical Conditions

Liver transplantation (LT) is an important therapeutic option for the treatment of several liver diseases. Modern LT is characterized by remarkable improvements in post-transplant patient survival, graft survival, and quality of life. Thanks to these great improvements, indications for LT are expanding. Nowadays, clinical conditions historically considered exclusion criteria for LT, have been considered new indications for LT, showing survival advantages for patients. In this review, we provide an updated overview of the principal newer indications for LT, with particular attention to alcoholic hepatitis, acute-on-chronic liver failure (ACLF), cholangiocarcinoma and colorectal cancer metastases.

Predictors of Liver Transplant Patient Survival

2016 ◽  
Vol 27 (1) ◽  
pp. 98-106 ◽  
Author(s):  
Lisiane Pruinelli ◽  
Karen A. Monsen ◽  
Cynthia R. Gross ◽  
David M. Radosevich ◽  
György J. Simon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Liver Transplant ◽  
Large Scale ◽  
Transplant Patient ◽  
Patient Survival ◽  
The United States ◽  
Liver Transplant Patient ◽  
Holistic View ◽  
Donor Liver Transplantation

Objective: Liver transplantation is a costly and risky procedure, representing 25 050 procedures worldwide in 2013, with 6729 procedures performed in the United States in 2014. Considering the scarcity of organs and uncertainty regarding prognosis, limited studies address the variety of risk factors before transplantation that might contribute to predicting patient’s survival and therefore developing better models that address a holistic view of transplant patients. This critical review aimed to identify predictors of liver transplant patient survival included in large-scale studies and assess the gap in risk factors from a holistic approach using the Wellbeing Model and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Data Source: Search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, and PubMed from the 1980s to July 2014. Study Selection: Original longitudinal large-scale studies, of 500 or more subjects, published in English, Spanish, or Portuguese, which described predictors of patient survival after deceased donor liver transplantation. Data Extraction: Predictors were extracted from 26 studies that met the inclusion criteria. Data Synthesis: Each article was reviewed and predictors were categorized using a holistic framework, the Wellbeing Model (health, community, environment, relationship, purpose, and security dimensions). Conclusions: The majority (69.7%) of the predictors represented the Wellbeing Model Health dimension. There were no predictors representing the Wellbeing Dimensions for purpose and relationship nor emotional, mental, and spiritual health. This review showed that there is rigorously conducted research of predictors of liver transplant survival; however, the reported significant results were inconsistent across studies, and further research is needed to examine liver transplantation from a whole-person perspective.

The Role of Visceral Transplantation for Neoplastic Disease

2020 ◽  
Vol 04 (03) ◽  
pp. 273-281
Author(s):  
Masato Fujiki ◽  
Amit Nair ◽  
Giuseppe D'amico ◽  
Mohammed Osman
Keyword(s):  
Patient Survival ◽  
Ex Vivo ◽  
Tumor Resection ◽  
Case Series ◽  
National Database ◽  
Neuroendocrine Neoplasms ◽  
Neoplastic Disease ◽  
Desmoid Tumors ◽  
Post Transplant ◽  
Recipient Tissue

AbstractVisceral transplantation has been utilized as the most radical surgical treatment for neoplasms not amenable to conventional resection. The main indications for this procedure include mesenteric desmoid tumors threatening the root of mesentery and metastatic neuroendocrine neoplasms. Published case-series of visceral transplantation for such indications are reviewed in this article. Patients with desmoid tumors associated with familial adenomatous polyposis are transplanted with intestinal or multivisceral allografts. With surgical modification of technique, the native spleen is preserved while duodenopancreatic complex is removed to obviate the risk of malignant transformation of duodenal polyposis after transplantation. Preservation of spleen decreased incidence of post-transplant lymphoproliferative disorder, conferring therapeutic advantage. Patient survival is comparable to that of other indications, and desmoid tumor recurrence has been observed in the recipient tissue but not in the donor allograft. For visceral transplantation of metastatic neuroendocrine neoplasms, the majority of these patients have diffuse liver involvement, thus requiring full multivisceral transplantation. Post-transplant patient survival is acceptable with limited data available on recurrence. Autotransplantation following ex vivo tumor resection using visceral allografts has been also performed in a limited, select cohort of patients with various pathologies. Adenocarcinomas are associated with a prohibitive recurrence rate following the procedure, and its use for this indication is therefore not recommended. A national database of visceral transplantation undertaken for neoplastic disease should be developed to better understand predictors of outcomes and to help produce and standardize selection criteria.

scholarly journals Single Balloon Enteroscopy for Endoscopic Retrograde Cholangiography in a Patient with Hepaticojejunostomy after Liver Transplant

2010 ◽  
Vol 2010 ◽  
pp. 1-3 ◽  
Author(s):  
Marta Di Pisa ◽  
Roberto Miraglia ◽  
Riccardo Volpes ◽  
Salvatore Gruttadauria ◽  
Mario Traina
Keyword(s):  
Small Bowel ◽  
Liver Transplant ◽  
Transplant Patient ◽  
Biliary Tree ◽  
Endoscopic Retrograde ◽  
Balloon Enteroscopy ◽  
Post Transplant ◽  
Biliary Anastomosis ◽  
Single Balloon ◽  
Single Balloon Enteroscopy

We report a case of a post-transplant patient with hepaticojejunostomy in whom we used a single balloon enteroscopy to access the biliary tree. This procedure seems to be safe and feasible for approaching the biliary anastomosis by means of the overtube and fixation of the small bowel by the balloon.

scholarly journals Is post‐transplant chemotherapy feasible in liver transplantation for colorectal cancer liver metastases?

2020 ◽  
Vol 40 (9) ◽  
pp. 461-464
Author(s):  
Giovanni Brandi ◽  
Angela Dalia Ricci ◽  
Alessandro Rizzo ◽  
Chiara Zanfi ◽  
Simona Tavolari ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Transplantation ◽  
Liver Metastases ◽  
Colorectal Cancer Liver Metastases ◽  
Post Transplant
Sign in / Sign up

Export Citation Format

Share Document