International Liver Transplantation Society Consensus Statement on Hepatitis C Management in Liver Transplant Candidates

Introduction: The 2012 AHA/ACCF expert consensus statement regarding cardiac evaluation of liver transplant candidates specifies 7 risk factors for identifying candidates for cardiac evaluation prior to liver transplantation. These include age > 60 yrs, hypertension, diabetes, smoking, dyslipidemia, prior cardiovascular disease, and left ventricular hypertrophy. The prognostic value of these risk factors in predicting major adverse cardiac events (MACE) has not been established. Furthermore, the optimal threshold of the sum of risk factors to predict MACE has not been determined. Hypothesis: Risk factors set forth by the AHA/ACCF can predict MACE in liver transplant candidates. We sought to identify an optimal threshold sum of risk factors to predict MACE. Methods: We conducted a retrospective cohort study of consecutive liver transplant recipients who were followed for MACE, defined as a composite of cardiac death, myocardial infarction, or coronary revascularization. Kaplan-Meier plots, log-rank test, and Cox regression models were used in outcome analyses. Results: We retrospectively followed 193 consecutive liver transplant recipients (40% female, mean age 55±10 yrs) for a mean of 51±29 months, during which 24 MACE were observed. Having ≥2 AHA/ACCF risk factors was associated with increased MACE risk (HR, 2.75, P=0.02), whereas having ≥3 risk factors was associated with greater MACE risk (HR, 4.14, P<0.001), Figure 1. Using ≥1 risk factor threshold provided insignificant predictive value of event-free survival (P=0.29). Conclusion: This study provides prognostic validation of risk factors set forth by the AHA/ACCF consensus statement for cardiac evaluation in liver transplant candidates. Having ≥2 risk factors is most sensitive for predicting MACE and seems optimal for triggering CAD surveillance in asymptomatic liver transplant candidates.

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HIV and Liver transplantation: The British Columbia Experience, 2004 to 2013

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2014/373898 ◽

2014 ◽

Vol 25 (3) ◽

pp. 159-162 ◽

Cited By ~ 5

Author(s):

Clara Tan-Tam ◽

Pamela Liao ◽

Julio S Montaner ◽

Mark W Hull ◽

Charles H Scudamore ◽

...

Keyword(s):

British Columbia ◽

Liver Transplantation ◽

Hepatitis C Virus ◽

Liver Disease ◽

Hepatitis C ◽

Liver Transplant ◽

Clinical Outcomes ◽

Disease Status ◽

Transplant Program ◽

End Stage

BACKGROUND: The demand for definitive management of end-stage organ disease in HIV-infected Canadians is growing. Until recently, despite international evidence of good clinical outcomes, HIV-infected Canadians with end-stage liver disease were ineligible for transplantation, except in British Columbia (BC), where the liver transplant program of BC Transplant has accepted these patients for referral, assessment, listing and provision of liver allograft. There is a need to evaluate the experience in BC to determine the issues surrounding liver transplantation in HIV-infected patients.METHODS: The present study was a chart review of 28 HIV-infected patients who were referred to BC Transplant for liver transplantation between 2004 and 2013. Data regarding HIV and liver disease status, initial transplant assessment and clinical outcomes were collected.RESULTS: Most patients were BC residents and were assessed by the multidisciplinary team at the BC clinic. The majority had undetectable HIV viral loads, were receiving antiretroviral treatments and were infected with hepatitis C virus (n=16). The most common comorbidities were anxiety and mood disorders (n=4), and hemophilia (n=4). Of the patients eligible for transplantation, four were transplanted for autoimmune hepatitis (5.67 years post-transplant), nonalcoholic steatohepatitis (2.33 years), hepatitis C virus (2.25 years) and hepatitis B-delta virus coinfection (recent transplant). One patient died from acute renal failure while waiting for transplantation. Ten patients died during preassessment and 10 were unsuitable transplant candidates. The most common reason for unsuitability was stable disease not requiring transplantation (n=4).CONCLUSIONS: To date, interdisciplinary care and careful selection of patients have resulted in successful outcomes including the longest living HIV-infected post-liver transplant recipient in Canada.

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Strategies to improve outcomes for hepatitis C virus/human immunodeficiency virus coinfected liver transplant candidates

Liver Transplantation ◽

10.1002/lt.24512 ◽

2016 ◽

Vol 22 (9) ◽

pp. 1181-1182 ◽

Cited By ~ 2

Author(s):

Garrett R. Roll ◽

Peter G. Stock

Keyword(s):

Human Immunodeficiency Virus ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Liver Transplant ◽

Immunodeficiency Virus ◽

Transplant Candidates

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Direct-acting antiviral treatment for hepatitis C in liver transplant candidates and recipients

Translational Cancer Research ◽

10.21037/tcr.2017.05.14 ◽

2017 ◽

Vol 6 (S3) ◽

pp. S598-S602

Author(s):

Nobuhisa Akamatsu ◽

Junichi Togashi ◽

Kiyoshi Hasegawa ◽

Norihiro Kokudo

Keyword(s):

Hepatitis C ◽

Liver Transplant ◽

Antiviral Treatment ◽

Direct Acting Antiviral ◽

Transplant Candidates ◽

Direct Acting

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Cholecystitis in Patients Undergoing Liver Transplantation: A Five-Year Analysis of Incidence, Causes, and Impact

The American Surgeon ◽

10.1177/0003134820964210 ◽

2020 ◽

Vol 86 (10) ◽

pp. 1254-1259

Author(s):

Danielle S. Graham ◽

Takahiro Ito ◽

Michelle Lu ◽

Joseph Dinorcia ◽

Vatche G. Agopian ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Transplant ◽

Patient Population ◽

Patient Survival ◽

Kaplan Meier ◽

High Acuity ◽

Transplant Candidates ◽

Pathology Reports ◽

End Stage ◽

High Index Of Suspicion

There is a paucity of data on cholecystitis in liver transplant candidates (LTC), including the incidence of the cholecystitis and the associated outcomes in this patient population. As such, this study examines the incidence of and factors associated with cholecystitis in the high-acuity LTC population, as well as the association between cholecystitis and graft and patient survival. Liver transplant candidates undergoing orthotopic liver transplantation (OLT) at a large transplant center from January 1, 2012 to December 31, 2016 were included in the initial analysis. Surgical pathology reports were examined for the presence of cholecystitis. Univariate analyses were performed to determine the association between patient factors and cholecystitis. Kaplan-Meier analyses and multivariate Cox proportional hazard models were performed to examine the association between cholecystitis and graft and patient survival. Of the 405 patients in the final study population, 267 (65.9%) had no cholecystitis, 21 (5.2%) had acute cholecystitis, and 117 (28.9%) had chronic cholecystitis. The presence of cholecystitis was associated with preoperative WBC, sepsis within 10 days prior to transplant, location prior to transplant, and total length of stay. While this study revealed no association between cholecystitis and graft or patient survival, it also suggests that cholecystitis is under-recognized in high-model end-stage liver disease (MELD) OLT candidates. Therefore, a high index of suspicion for cholecystitis may be helpful in caring for this vulnerable patient population; however, further studies must be performed to determine the optimal management of cholecystitis in these patients.

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Chronic Hepatitis C with Cyanosis

Case Reports in Hepatology ◽

10.1155/2019/6586478 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Mahmood Alawainati ◽

Jawad Khamis ◽

Muneer Abdulla ◽

Saeed Alsaeed

Keyword(s):

Pulmonary Embolism ◽

Chronic Hepatitis ◽

Liver Disease ◽

Hepatitis C ◽

Liver Transplant ◽

Chronic Hepatitis C ◽

Hepatopulmonary Syndrome ◽

History Of ◽

Transplant Candidates ◽

One Year

Background. There are multiple aetiologies for dyspnea in patients with liver disease, including pneumonia, pulmonary embolism, hepatic hydrothorax, portopulmonary syndrome, and hepatopulmonary syndrome. The aim of this paper is to emphasize the importance of early diagnosis and management of hepatopulmonary syndrome. Case Presentation. We report a case of a 65-year-old male who was known to have chronic hepatitis C presented with one-year history of shortness of breath and cyanosis. The initial impression of pulmonary embolism was excluded by comprehensive diagnostic investigations. The correlation between the clinical picture and investigations raised the possibility of hepatopulmonary syndrome which was confirmed by contrast-enhanced transthoracic echocardiography. Conclusions. High suspicion is required to diagnose hepatopulmonary syndrome in patients with liver disease and hypoxemia. Screening for this complication is appropriate in liver transplant candidates, and diagnosed patients should be evaluated extensively for liver transplant.

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