scholarly journals Liver Transplant Imaging prior to and during the COVID-19 Pandemic

2022 ◽  
Vol 2022 ◽  
pp. 1-9
Author(s):  
Maria Irene Bellini ◽  
Daniele Fresilli ◽  
Augusto Lauro ◽  
Gianluca Mennini ◽  
Massimo Rossi ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Chest Ct ◽  
Imaging Method ◽  
Life Saving ◽  
Highly Sensitive ◽  
Immunosuppressed Patients ◽  
Transplant Candidates ◽  
End Stage ◽  
Additional Value

Background. The suspension of the surgical activity, the burden of the infection in immunosuppressed patients, and the comorbidities underlying end-stage organ disease have impacted transplant programs significantly, even life-saving procedures, such as liver transplantation. Methods. A review of the literature was conducted to explore the challenges faced by transplant programs and the adopted strategies to overcome them, with a focus on indications for imaging in liver transplant candidates. Results. Liver transplantation relies on an appropriate imaging method for its success. During the Coronavirus Disease 2019 (COVID-19) pandemic, chest CT showed an additional value to detect early signs of SARS-CoV-2 infection and other screening modalities are less accurate than radiology. Conclusion. There is an emerging recognition of the chest CT value to recommend its use and help COVID-19 detection in patients. This examination appears highly sensitive for liver transplant candidates and recipients, who otherwise would have not undergone it, particularly when asymptomatic.

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

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.

scholarly journals Barriers Preventing Liver Transplantation in Canadians with HIV Infection – Perceptions of HIV Specialists

2007 ◽  
Vol 21 (3) ◽  
pp. 179-182 ◽  
Author(s):  
Curtis L Cooper ◽  
Joanne DeForest ◽  
John Gill ◽  
Richard Lalonde ◽  
Keyword(s):  
Liver Transplantation ◽  
Hepatitis C Virus ◽  
Liver Disease ◽  
Hepatitis C ◽  
Liver Transplant ◽  
Life Saving ◽  
B Virus ◽  
Key Issues ◽  
End Stage ◽  
Living With Hiv

Liver transplantation is a life-saving procedure with demonstrated utility. There are accumulating data indicating that this procedure is helpful in HIV-infected patients as well. Liver transplantation is currently largely unavailable to those living with HIV in Canada. Understanding the obstacles to this procedure is the first step to increasing access. Between August 2005 and November 2005, HIV physicians, one from each Canadian HIV Trials Network site, were asked to complete a quantitative questionnaire on adult liver transplant access and need. Forty-six per cent (16 of 35) of sites responded. A median 20% of the nearly 12,700 HIV patients followed at these sites had concurrent liver disease (20% caused by hepatitis C virus, 5% caused by hepatitis B virus and 5% were alcohol-related). On average, two patients per site were thought to be appropriate candidates for liver transplant evaluation. Eighty per cent of respondents anticipated increased need for liver transplantation over the next five years. Organ supply was universally identified as the chief obstacle to transplantation in patients with HIV. Other key issues included risk of hepatitis C virus reinfection and transplant surgical team willingness. Based on these data, it is believed that these issues should be the focus of efforts designed to increase access to transplantation in Canadians with end-stage liver disease and concurrent HIV.

scholarly journals CLINICAL SIGNIFICANCE OF CYTOMEGALOVIRUS INFECTION IN PEDIATRIC LIVER TRANSPLANT RECIPIENTS

2016 ◽  
Vol 18 (1) ◽  
pp. 67-77 ◽  
Author(s):  
O. M. Tsiroulnikova ◽  
I. V. Zhilkin ◽  
D. G. Akhaladze
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Graft Loss ◽  
Transplant Recipients ◽  
Cmv Infection ◽  
Pediatric Liver ◽  
Life Saving ◽  
End Stage ◽  
Liver Transplant Recipients ◽  
Pediatric Liver Transplant

Liver transplantation is a life-saving procedure for many forms of end-stage liver disease in pediatrics. Cytomegalovirus (CMV) is the most common and signifi cant posttransplant infection after pediatric liver transplant (PLT) with developing an episode of CMV infection or disease. It is well known that CMV increases risk of graft loss. The review presents aspects of etiology and epidemiology of CMV after PLT, approaches employed in diagnostics and prophylaxis of CMV, algorithms for valganciclovir dosing and methods to prevent complications associated with CMV. The latest data on current prevention strategies in pediatric liver transplantation centers in the world are also presented.

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

2014 ◽  
Vol 25 (3) ◽  
pp. 159-162 ◽  
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.

scholarly journals Five-Year Experience of Liver Transplant at Kerman University of Medical Sciences: Afzalipoor Hospital

2020 ◽  
Author(s):  
Masood Dehghani
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Cross Sectional Study ◽  
Outcome Data ◽  
Time Interval ◽  
Cross Sectional ◽  
The Past ◽  
Transplantation Center ◽  
Set Up ◽  
End Stage

Introduction: The only option for treatment of end stage liver diseases is liver transplantation. Afzalipour Hospital in Kerman, Iran is the third largest liver transplantation center in Iran. In this study, the outcomes of this center have been studied during the past 5 years. Methods: In this cross-sectional study, the pre and post transplantation’s clinical, demographic and outcome data of all patients who received liver transplant at Afzalipour Hospital during the past 5 years have been collected and reviewed. SPSS software ver. 16 was used to analyze the data. Results: Forty-three patients have received liver transplantation during this time interval. The 3-year survival rate of patients was 77%. The most common cause of death was primary nonfunction graft after transplantation. The most common complication was acute rejection (15%), all of which were successfully treated with corticosteroids. Conclusion:  Due to increment of cases of acute and chronic liver failure in the community and since the final treatment of these cases is liver transplantation, so there is need to develop liver transplant centers in the future. Quantitative and qualitative study of the activity of centers based liver transplant in Iran is necessary to set up successful centers.

scholarly journals Demographic profile in liver transplant candidates on waiting list

2010 ◽  
Vol 10 (1) ◽  
pp. 660-663
Author(s):  
Camila César Winckler ◽  
Daniela Salate Biagioni ◽  
Regina Célia Callile de Paula ◽  
Milene Regina Bailo Gomes ◽  
Juan Carlos Llanos ◽  
...  
Keyword(s):  
Liver Transplant ◽  
White Male ◽  
Alcoholic Cirrhosis ◽  
Waiting List ◽  
Clinical Aspects ◽  
Team Approach ◽  
High Concentration ◽  
Transplant Candidates ◽  
Liver Transplant Waiting List ◽  
End Stage

Liver transplantation is a life-saving therapy for patients with end-stage liver diseases. The post-transplant outcome depends on a wide knowledge of the patient's status and factors that may influence results and complications, as well as an interdisciplinary team approach. The assessment of liver transplant candidates includes both demographic and clinical aspects. Purpose: To assess the liver transplant candidates' profile in a Brazilian Medical School. Methods: Data from a retrospective analysis were attained from the records of patients included on the waiting list between October, 2003 and January, 2005. Results: Forty-four patients were included on the waiting list, being 90% (n=40) older than 40 years, and 84% male (n=37); white, 84% (n=37); married, 75% (n=33), and catholic, 72.8% (n=32). Patients' blood typing was A, B, AB, or O in 45.4%, 11.4%, 4.5%, and 38.7% patients, respectively. The occupation profile showed eleven patients in working active status (24.9%), with a lower than U$130.00 average monthly income in 18 (40.9%) patients. The most frequent diagnosis was alcoholic cirrhosis (n=19; 43.2%) followed by hepatitis C virus in 9 patients (20.4%). According to the Child-Turcotte-Pugh scores, patients were classified as in B or C (81.8%). Discussion: The high concentration of the sugar cane in that region is probably responsible by the increasing distilled drink intake among patients. The resulting lack of activity of the terminal hepatic disease deprives them to offer support for their families, and the multi professional support is the most important approach to incentive the avoidance of a relapse of the after-transplant alcoholic ingestion. Conclusion: Patients' profile on our liver transplant waiting list showed poor, white, male, and inactive patients with alcoholic liver disease as the main reason for the transplantation.

scholarly journals SPECIALIST SERVICE IN LIVER TRANSPLANT IN A UNIVERSITY HOSPITAL: A CASE STUDY

2017 ◽  
Vol 26 (2) ◽  
Author(s):  
Sílvia Ferrazzo ◽  
Mara Ambrosina de Oliveira Vargas ◽  
Diana Coelho Gomes ◽  
Francine Lima Gelbcke ◽  
Karina Silveira de Almeida Hammerschimidt ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Care Service ◽  
University Hospital ◽  
Structured Interviews ◽  
Specialist Service ◽  
Immunosuppressed Patients ◽  
Structures Of Care ◽  
The Impact

ABSTRACT Objective: was to describe the flow of a specialist service in the care of liver transplant in a university hospital. Method: a qualitative research in the form of a case study, performed in a transplant service in southern Brazil. Data collection occurred from November 2013 to February 2014 through the triangulation of data, document analysis, structured interviews with 11 professional and semi direct observations interviews. Data analysis was performed by analysis of thematic content. Results: describes the flow of service and revealed the involvement of a multidisciplinary team in a cohesive manner, with competence recognized by patients and other sectors of the institution and structural deficiencies in care service for immunosuppressed patients. Conclusion: it was found that there is a need for studies that address the structures of care in liver transplantation services and to evaluate the impact of the quality of the life expectancy and proper recovery of persons undergoing liver transplantation.

Abstract 16533: Heterogeneity of Fibrosis in Patients Undergoing Combined Heart-Liver Transplant

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Joshua Rushakoff ◽  
Evan P Kransdorf ◽  
Maha Guindi ◽  
Jignesh K Patel ◽  
Jon A Kobashigawa
Keyword(s):  
Heart Failure ◽  
Liver Injury ◽  
Liver Transplant ◽  
Cardiac Cirrhosis ◽  
Stage 4 ◽  
End Stage Heart Failure ◽  
Transplant Candidates ◽  
End Stage ◽  
Parenchymal Injury ◽  
Pathology Of The Liver

Introduction: Combined heart-liver transplant (CHLT) is indicated for patients with end-stage heart failure and concomitant irreversible liver injury. Given that liver dysfunction from congestive hepatopathy is common in patients with end-stage heart failure, it can be difficult to determine reversible from irreversible liver injury. Transjugular liver biopsy (TJLB) is frequently used to evaluate the severity of parenchymal injury, but is limited by heterogeneity of fibrosis across biopsy specimens. We sought to compare the fibrosis evaluation of the TJLB specimens as compared to the pathology of the liver explant at the time of CHLT. Methods: All CHLT cases at CSMC between 2007 and 2017 were included. Demographic and liver ultrasound (US) or abdominal computed tomography (CT) imaging was retrieved by chart review. TJLB was performed prior to transplant to determine the severity of liver fibrosis and was compared to the pathology of the liver explant. A biopsy was considered to show heterogenous fibrosis if there was at least a 2 stage difference between the predominant and secondary patterns. Results: Thirteen CHLTs were performed at our center during the study period. The median follow-up was 59 months (IQR 48-67). Mean age at transplant was 53 years (SD +/- 14.9) and 77% of patients were male. Indications for CHLT included cardiac cirrhosis (7), amyloidosis (2), HCV cirrhosis (2), and congenital heart disease (2). By imaging, 3/7 patients (43%) had US and CT evidence, 2/7 (29%) had US or CT evidence, and 2/7 (29%) had no evidence of liver nodularity US or CT. All patients diagnosed with cardiac cirrhosis had both TJLB and explant pathology for review. All TJLBs were graded as stage 4 fibrosis. Fibrosis on analysis of the liver explant was variable: stage 4 (2), stage 3-4 (3), stage 2-4 (1), and stage 1-4 (1). Thus, 2/7 patients (29%) showed heterogeneity of fibrosis in their explant as compared to their TJLB. Conclusions: We found heterogeneity of fibrosis in liver explants of patients that had stage 4 fibrosis (cirrhosis) by TJLB and underwent CHLT. Further work is needed to identify which heart transplant candidates will most benefit from CHLT.

PATIENTS' PREFERENCES REGARDING THE PROCESS AND OUTCOMES OF LIFE-SAVING TECHNOLOGY

1999 ◽  
Vol 15 (2) ◽  
pp. 340-351 ◽  
Author(s):  
Julie Ratcliffe ◽  
Martin Buxton
Keyword(s):  
Health Outcome ◽  
Liver Transplantation ◽  
Liver Transplant ◽  
Conjoint Analysis ◽  
Qualitative Interviews ◽  
Extreme Case ◽  
Queen Elizabeth Hospital ◽  
Relative Importance ◽  
Process Of Care ◽  
Life Saving

The economic technique of conjoint analysis was used to assess the relative importance of health outcome versus several process attributes (e.g., waiting time, continuity of contact with the same medical staff) in determining patients' preferences for liver transplantation services. The attributes were established by reference to the literature and through initial qualitative interviews with liver transplant recipients (n = 12). Following a pilot study of 40 patients, a sample of patients (n = 213) who have received a liver transplant at the Queen Elizabeth Hospital in Birmingham were surveyed. The technique of conjoint analysis was used to ascertain the relative importance of the attributes included in the exercise and to estimate the marginal rates of substitution (MRS) between different attributes. A useable response rate of 89% was achieved. Although a small proportion of respondents (15%) exhibited dominant preferences for the chance of success attribute, the majority of respondents indicated that they would be prepared to exchange a reduction in health outcome for an improvement in the process characteristics of the liver transplantation service. The results of this study have potentially important implications for the assessment of the benefits of medical technologies since they suggest that, even in the extreme case of life-saving interventions, the preferences of respondents may not be dependent solely upon health outcomes but may also be determined by attributes associated with the process of care.

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