scholarly journals Adult liver transplantation: UK clinical guideline - part 2: surgery and post-operation

2020 ◽  
Vol 11 (5) ◽  
pp. 385-396
Author(s):  
Charles Millson ◽  
Aisling Considine ◽  
Matthew E Cramp ◽  
Andrew Holt ◽  
Stefan Hubscher ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Secondary Care ◽  
Cardiovascular Health ◽  
Survival Rates ◽  
Holistic Approach ◽  
Organ Allocation ◽  
Allocation Process ◽  
Organ Type ◽  
Organ Systems ◽  
Post Operation

Survival rates for patients following liver transplantation exceed 90% at 12 months and approach 70% at 10 years. Part 1 of this guideline has dealt with all aspects of liver transplantation up to the point of placement on the waiting list. Part 2 explains the organ allocation process, organ donation and organ type and how this influences the choice of recipient. After organ allocation, the transplant surgery and the critical early post-operative period are, of necessity, confined to the liver transplant unit. However, patients will eventually return to their referring secondary care centre with a requirement for ongoing supervision. Part 2 of this guideline concerns three key areas of post liver transplantation care for the non-transplant specialist: (1) overseeing immunosuppression, including interactions and adherence; (2) the transplanted organ and how to initiate investigation of organ dysfunction; and (3) careful oversight of other organ systems, including optimising renal function, cardiovascular health and the psychosocial impact. The crucial significance of this holistic approach becomes more obvious as time passes from the transplant, when patients should expect the responsibility for managing the increasing number of non-liver consequences to lie with primary and secondary care.

scholarly journals Early graft calcification without graft dysfunction after living donor liver transplantation: two case reports

2021 ◽  
Vol 14 (5) ◽  
pp. 1491-1495
Author(s):  
Peilin Li ◽  
Masaaki Hidaka ◽  
Yu Huang ◽  
Takanobu Hara ◽  
Kantoku Nagakawa ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Hepatic Artery ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Liver Graft ◽  
Graft Dysfunction ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
First Case ◽  
Post Operation

AbstractGraft calcification after liver transplantation (LT) has seldom been reported, but almost of all previously reported cases have been attributed to graft dysfunction. We herein report two cases of graft calcification without liver dysfunction after living donor liver transplantation (LDLT). Two patients who underwent LDLT were found to have graft calcification in the early postoperative period (< 1 month). Calcification in the first case was found at the cut edge of the liver at post-operative day (POD) 10, showing a time-dependent increase in calcification severity. The second patient underwent hepatic artery re-anastomosis due to hepatic artery thrombosis on POD4 and received balloon-occluded retrograde transvenous obliteration of the splenic kidney shunt due to decreased portal vein blood flow on POD6. She was found to have diffuse hepatic calcification in the distant hepatic artery area at 1-month post-operation followed by gradual graft calcification at the resection margin at 6-month post-operation. Neither case showed post-operative graft dysfunction. Calcification of the liver graft after LDLT is likely rare, and graft calcification does not seem to affect the short-term liver function in LDLT cases. We recommend strictly controlling the warm/cold ischemia time and reducing the physical damage to the donor specimen as well as monitoring for early calcification by computed tomography.

Sarco‐Model: A score to predict the dropout risk in the perspective of organ allocation in patients awaiting liver transplantation

2021 ◽  
Author(s):  
Quirino Lai ◽  
Paolo Magistri ◽  
Raffaella Lionetti ◽  
Alfonso W. Avolio ◽  
Ilaria Lenci ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Organ Allocation

Current State and Future Possibilities in Liver Transplantation

2021 ◽  
Author(s):  
Sebastian Rademacher ◽  
◽  
Niklas Aehling ◽  
Robert Sucher ◽  
Thomas Berg ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Cirrhosis ◽  
Survival Rates ◽  
Tolerance Induction ◽  
Meld Score ◽  
Long Term Results ◽  
Future Research ◽  
Industrialized Countries ◽  
Normothermic Machine Perfusion ◽  
Donor Characteristics

Due to medical and surgical progress, liver transplantation (LT) is is nowadays a routine treatment for terminal liver failure and hepatic malignancies. However, in recent years there has been a change in the indications for LT. Especially in western industrialized countries, the use of LT for chronic hepatis B and hepatitis C cirrhosis is continuously decreasing since the introduction of effective antiviral drugs. Liver cirrhosis due to non-alcoholic steatohepatitis (NASH), alcoholic liver disease and hepatocellular carcinoma (HCC) in cirrhosis are now among the leading indications for LT. Due to tremendous progress in oncology, immunology, and technical aspects, multidisciplinary cancer treatment increasingly includes LT for non-HCC hepatobiliary malignancies. Excellent 5-year survival rates of 75 to 80% can now be achieved after LT. However, in patients with liver cirrhosis, the implementation of a ‘sickest first’ principle for liver allocation has led to an increasing number of critically ill patients undergoing liver transplantation. This results in an increased morbidity and mortality after liver transplantation. Moreover, donor characteristics have markedly shifted to less ideal grafts due to an increasing shortage of donor organs in many countries. In this context, normothermic machine perfusion with oxygenated blood components using pulsatile flow has been shown to reduce liver damage despite a prolonged preservation time and might be able to provide viability testing for otherwise discarded organs. With favorable donor and recipient conditions, excellent long-term results can be obtained with a 10-year survival rate of close to 70%. However, in patients with a high MELD score (>30), survival rates markedly decrease by 12-18%. Future research should focus on optimization of organ allocation, optimization of immunosuppression including tolerance induction, and on increasing the donor organ pool to further improve and the numbers of successful LT.

scholarly journals Liver Transplantation: Past Accomplishments and Future Challenges

1999 ◽  
Vol 13 (3) ◽  
pp. 257-263 ◽  
Author(s):  
William J Wall
Keyword(s):  
Liver Transplantation ◽  
Survival Rates ◽  
Alcoholic Cirrhosis ◽  
Liver Transplants ◽  
Recidivism Rates ◽  
Societal Challenges ◽  
Therapeutic Value ◽  
Future Challenges ◽  
Will Force ◽  
End Stage

Liver transplantation has evolved from a rare and risky operation of questionable therapeutic value to the preferred treatment for an extensive list of end-stage liver diseases. Superior immunosuppression (cyclosporine), and improvements in surgery and anesthesia brought liver grafting to its current level of success. Nearly 60,000 liver transplants have been performed, and survival rates are very good; however liver grafting faces serious immediate and long term challenges, mainly due to the widening gap between donor supply and recipient demand. Increasing numbers of sick candidates, recurrent disease (especially hepatitis C) and recidivism rates after transplantation for alcoholic cirrhosis will force increasingly difficult decisions on candidate selection and priority listing of potential recipients. Although xenotransplantation may be the ultimate solution, it has its own specific set of biological and societal challenges - the full extent of which should be revealed in the next several years.

scholarly journals Long-Term Outcomes of Hepatic Resection versus Living Donor Liver Transplantation for Hepatocellular Carcinoma: A Propensity Score-Matching Study

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Toshimi Kaido ◽  
Satoshi Morita ◽  
Sachiko Tanaka ◽  
Kohei Ogawa ◽  
Akira Mori ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Propensity Score ◽  
Hepatic Resection ◽  
Propensity Score Matching ◽  
Odds Ratio ◽  
Living Donor ◽  
Survival Rates ◽  
Controlled Study ◽  
Recurrence Rates

Hepatic resection (HR) and liver transplantation (LT) are surgical treatment options for hepatocellular carcinoma (HCC). However, it is clinically impossible to perform a randomized, controlled study to determine the usefulness of these treatments. The present study compared survival rates and recurrence rates of HR versus living donor LT (LDLT) for HCC by using the propensity score method. Between January 1999 and August 2012, 936 patients (732 HR, 204 LDLT) underwent surgical therapy for HCC in our center. Using the propensity score matching, 80 well-balanced patients were defined. The 1- and 5-year overall survival rates were 90% and 53% in the HR group and 82% and 63% in the LT group, respectively. They were not significantly different between the two groups. The odds ratio estimated using the propensity score matching analysis was 0.842 (P=0.613). The 1- and 5-year recurrence rates were significantly lower in the LT group (9% and 21%) than in the HR group (43% and 74%) (P<0.001), and the odds ratio was 0.214 (P=0.001). In conclusion, HR should be considered a valid alternative to LDLT taking into consideration the risk for the living donor based on the results of this propensity score-matching study.

Recent advances in liver transplantation

2021 ◽  
pp. flgastro-2020-101425
Author(s):  
N Thomas Burke ◽  
James B Maurice ◽  
David Nasralla ◽  
Jonathan Potts ◽  
Rachel Westbrook
Keyword(s):  
Liver Transplantation ◽  
Survival Rates ◽  
Machine Perfusion ◽  
Allocation System ◽  
Life Saving ◽  
Opt Out ◽  
Normothermic Machine Perfusion ◽  
Marginal Grafts ◽  
Legislative Changes ◽  
The Uk

Liver transplant is a life-saving treatment with 1-year and 5-year survival rates of 90% and 70%, respectively. However, organ demand continues to exceed supply, such that many patients will die waiting for an available organ. This article reviews for the general gastroenterologist the latest developments in the field to reduce waiting list mortality and maximise utilisation of available organs. The main areas covered include legislative changes in organ donation and the new ‘opt-out’ systems being rolled out in the UK, normothermic machine perfusion to optimise marginal grafts, a new national allocation system to maximise benefit from each organ and developments in patient ‘prehabilitation’ before listing. Current areas of research interest, such as immunosuppression withdrawal, are also summarised.

scholarly journals Liver Transplantation from Voluntary Organ Donor System in China: A Comparison between DBD and DCD Liver Transplants

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Wei Chen ◽  
Dipesh Kumar Yadav ◽  
Xueli Bai ◽  
Jianying Lou ◽  
Risheng Que ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Organ Donation ◽  
Survival Rates ◽  
Organ Donor ◽  
Long Term Outcomes ◽  
Significant Difference ◽  
Short And Long Term ◽  
Donor System

Background. In China, the cases of liver transplantation (LT) from donation after citizens’ death have rose year by year since the citizen-based voluntary organ donor system was initiated in 2010. The objective of our research was to investigate the early postoperative and late long-term outcomes of LT from donation after brain death (DBD) and donation after circulatory death (DCD) according to the current organ donation system in China. Methods. Sixty-two consecutive cases of LT from donation after citizens’ death performed in our hospital between February 2012 and June 2017 were examined retrospectively for short- and long-term outcomes. These included 35 DCD LT and 27 DBD LT. Result. Subsequent median follow-up time of 19 months and 1- and 3-year graft survival rates were comparative between the DBD group and the DCD group (81.5% and 66.7% versus 67.1% and 59.7%; P=0.550), as were patient survival rates (85.2% and 68.7% versus 72.2% and 63.9%; P=0.358). The duration of ICU stay of recipients was significantly shorter in the DBD group, in comparison with that of the DCD group (1 versus 3 days, P=0.001). Severe complication incidence (≥grade III) after transplantation was identical among the DBD and DCD groups (48.1% versus 60%, P=0.352). There was no significant difference in postoperative mortality between the DBD and DCD groups (3 of 27 cases versus 5 of 35 cases). Twenty-one grafts (33.8%) were lost and 18 recipients (29.0%) were dead till the time of follow-up. Malignancy recurrence was the most prevalent reason for patient death (38.8%). There was no significant difference in incidence of biliary stenosis between the DBD and DCD groups (5 of 27 cases versus 6 of 35 cases, P=0.846). Conclusion. Although the sample size was small to some extent, this single-center study first reported that LT from DCD donors showed similar short- and long-term outcomes with DBD donors and justified the widespread implementation of voluntary citizen-based deceased organ donation in China. However, the results should be verified with a multicenter larger study.

scholarly journals Survival after Liver Transplantation for Hepatitis C Is Unchanged over Two Decades in Canada

2008 ◽  
Vol 22 (2) ◽  
pp. 153-154 ◽  
Author(s):  
Kymberly DS Watt ◽  
Kelly W Burak ◽  
Marc Deschênes ◽  
Les Lilly ◽  
Denis Marleau ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Cause Of Death ◽  
Survival Rates ◽  
Hcv Infection ◽  
Common Cause ◽  
Allograft Failure ◽  
Survival Difference ◽  
Registry Database

Allograft failure secondary to recurrence of hepatitis C virus (HCV) infection is the most common cause of death and retransplantation among recipients with HCV infection. It has been suggested that patients transplanted for HCV have had worse outcomes in more recent years than in previous years (the ‘era effect’). A Canadian transplantation registry database was analyzed to determine the outcomes of patients transplanted over the years for HCV. The results of the present analysis of 1002 patients show that the ‘era effect’ was not seen in liver transplantation recipients with HCV in Canada, because no survival difference was noted based on the year of transplantation. All groups had overall two-year and five-year survival rates of 76% to 83% and 69% to 72%, respectively. The present study’s national results prove continued benefit to transplantation of HCV patients.

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