International Liver Transplantation Society Consensus Statement on Immunosuppression in Liver Transplant Recipients

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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Transplantation Society Consensus Statement on Immunosuppression in Liver Transplant Recipients

Transplantation Journal ◽

10.1097/00007890-900000000-96309 ◽

2018 ◽

pp. 1

Keyword(s):

Liver Transplant ◽

Consensus Statement ◽

Transplant Recipients ◽

Liver Transplant Recipients ◽

Transplantation Society

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Peritoneal Dialysis After Liver Transplantation: A Systematic Review

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211029722 ◽

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.

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Risk factors predicting Cytomegalovirus infection in post liver transplant recipients

QJM ◽

10.1093/qjmed/hcaa052.005 ◽

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 .

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Pleural Effusions Following Liver Transplantation: A Single-Center Experience

Journal of Intensive Care Medicine ◽

10.1177/0885066620932448 ◽

2020 ◽

pp. 088506662093244

Author(s):

Justin K. Lui ◽

Lidia Spaho ◽

Shahrad Hakimian ◽

Michael Devine ◽

Rosa Bui ◽

...

Keyword(s):

Risk Factors ◽

Liver Transplantation ◽

Liver Transplant ◽

Hospital Length Of Stay ◽

Transplant Recipients ◽

Single Center ◽

Pleural Effusions ◽

Post Transplantation ◽

Significant Difference ◽

Liver Transplant Recipients

Introduction: This was a single-center retrospective study to evaluate incidence, prognosis, and risk factors in patients with postoperative pleural effusions, a common pulmonary complication following liver transplantation. Methods: A retrospective review was performed on 374 liver transplantation cases through a database within the timeframe of January 1, 2009 through December 31, 2015. Demographics, pulmonary and cardiac function testing, laboratory studies, intraoperative transfusion/infusion volumes, postoperative management, and outcomes were analyzed. Results: In the immediate postoperative period, 189 (50.5%) developed pleural effusions following liver transplantation of which 145 (76.7%) resolved within 3 months. Those who developed pleural effusions demonstrated a lower fibrinogen (149.6 ± 66.3 mg/dL vs 178.4 ± 87.3 mg/dL; P = .009), total protein (5.8 ± 1.0 mg/dL vs 6.1 ± 1.2 mg/dL; P = .04), and hemoglobin (9.8 ± 1.8 mg/dL vs 10.3 ± 1.9 mg/dL; P = .004). There was not a statistically significant difference in 1-year all-cause mortality and in-hospital mortality between liver transplant recipients with and without pleural effusions. Liver transplant recipients who developed pleural effusions had a longer hospital length of stay (16.4 ± 10.9 days vs 14.0 ± 16.5 days; P = .1), but the differences were not statistically significant. However, there was a significant difference in tracheostomy rates (11.6% vs 5.4%; P = .03) in recipients who developed pleural effusions compared to recipients who did not. Conclusions: In summary, pleural effusions are common after liver transplantation and are associated with increased morbidity. Pre- and intraoperative risk factors can offer both predictive and prognostic value for post-transplantation pleural effusions. Further prospective studies will be needed to further evaluate the relevance of these findings to limit instances of postoperative pleural effusions.

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Endoscopic Management of Biliary Complications following Liver Transplantation after Donation from Cardiac Death Donors

Canadian Journal of Gastroenterology ◽

10.1155/2012/346286 ◽

2012 ◽

Vol 26 (9) ◽

pp. 607-610 ◽

Cited By ~ 19

Author(s):

Kris P Croome ◽

Vivian McAlister ◽

Paul Adams ◽

Paul Marotta ◽

William Wall ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Transplant ◽

Cardiac Death ◽

Hepatic Duct ◽

Biliary Complications ◽

Endoscopic Management ◽

Transplant Recipients ◽

Biliary Strictures ◽

Liver Transplants ◽

Liver Transplant Recipients

BACKGROUND Previous studies have shown a higher incidence of biliary complications following donation after cardiac death (DCD) liver transplantation compared with donation after brain death (DBD) liver transplantation. The endoscopic management of ischemic type biliary strictures in patients who have undergone DCD liver transplants needs to be characterized further.METHODS: A retrospective institutional review of all patients who underwent DCD liver transplant from January 2006 to September 2011 was performed. These patients were compared with all patients who underwent DBD liver transplantation in the same time period. A descriptive analysis of all DCD patients who developed biliary complications and their subsequent endoscopic management was also performed.RESULTS: Of the 36 patients who received DCD liver transplants, 25% developed biliary complications compared with 13% of patients who received DBD liver transplants (P=0.062). All DCD allograft recipients who developed biliary complications became symptomatic within three months of transplantation. Ischemic type biliary strictures in DCD allograft recipients included disseminated biliary strictures in two patients, biliary strictures of the hepatic duct bifurcation in three patients and biliary strictures of the donor common hepatic duct in three patients.CONCLUSIONS: There was a trend toward increasing incidence of total biliary complications in recipients of DCD liver allografts compared with those receiving DBD livers, and the rate of diffuse ischemic cholangiopathy was significantly higher. Focal ischemic type biliary strictures can be treated effectively in DCD liver transplant recipients with favourable results. Diffuse ischemic type biliary strictures in DCD liver transplant recipients ultimately requires retransplantation.

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Prevention and Management of CMV Infections after Liver Transplantation: Current Practice in German Transplant Centers

Journal of Clinical Medicine ◽

10.3390/jcm9082352 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2352

Author(s):

Cornelius Engelmann ◽

Martina Sterneck ◽

Karl Heinz Weiss ◽

Silke Templin ◽

Steffen Zopf ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Transplant ◽

Antiviral Treatment ◽

Standard Of Care ◽

Threshold Value ◽

Preemptive Therapy ◽

Transplant Recipients ◽

Cmv Infection ◽

Mortality And Morbidity ◽

Liver Transplant Recipients

Human cytomegalovirus (CMV) remains a major cause of mortality and morbidity in human liver transplant recipients. Anti-CMV therapeutics can be used to prevent or treat CMV in liver transplant recipients, but their toxicity needs to be balanced against the benefits. The choice of prevention strategy (prophylaxis or preemptive treatment) depends on the donor/recipient sero-status but may vary between institutions. We conducted a series of consultations and roundtable discussions with German liver transplant center representatives. Based on 20 out of 22 centers, we herein summarize the current approaches to CMV prevention and treatment in the context of liver transplantation in Germany. In 90% of centers, transient prophylaxis with ganciclovir or valganciclovir was standard of care in high-risk (donor CMV positive, recipient CMV naive) settings, while preemptive therapy (based on CMV viremia detected during (bi) weekly PCR testing for circulating CMV-DNA) was preferred in moderate- and low-risk settings. Duration of prophylaxis or intense surveillance was 3–6 months. In the case of CMV infection, immunosuppression was adapted. In most centers, antiviral treatment was initiated based on PCR results (median threshold value of 1000 copies/mL) with or without symptoms. Therefore, German transplant centers report similar approaches to the prevention and management of CMV infection in liver transplantation.

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