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 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.

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.

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.

Liver Transplant

2013 ◽  
Author(s):  
Ximena Soler ◽  
Lori A Aronson ◽  
Gillian Derrick
Keyword(s):  
Liver Transplantation ◽  
Blood Loss ◽  
Liver Failure ◽  
Liver Transplant ◽  
Orthotopic Liver Transplantation ◽  
Massive Hemorrhage ◽  
Blood Products ◽  
End Stage

Liver transplantation is an established therapy in pediatric end-stage liver failure. Blood loss during orthotopic liver transplantation (OLT) is highly variable. Massive hemorrhage and transfusion of blood products, with its related consequences, is a well-known complication of this operation.

The effect of bridging locoregional therapies on survival in hepatocellular carcinoma patients undergoing orthotopic liver transplantation: UNOS population study.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 346-346 ◽  
Author(s):  
Minzhi Xing ◽  
Hyun Sik Kim
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Large Scale ◽  
Population Based ◽  
Meld Score ◽  
Kaplan Meier ◽  
Comparison Groups ◽  
Locoregional Therapies ◽  
End Stage

346 Background: The effect of bridging locoregional therapies (LRT) on overall survival (OS) in pts with hepatocellular carcinoma (HCC) undergoing orthotopic liver transplantation (OLT) has not been investigated in large-scale population studies. Methods: TheUnited Network for Organ Sharing (UNOS) database was used to identify pts with HCC who received OLT between 2002 and 2010. Pts within Milan Criteria for whom an HCC Model for End-Stage Liver Disease (MELD) exception was approved were included. OS was compared between pts who received bridging LRT (including transarterial chemoembolization (TACE)) and those who did not. Kaplan-Meier estimation and Cox proportional hazard models were used for OS analysis. Results: Of 11,287 pts with HCC who received OLT, 9,876 pts had LRT data, mean age 56.6 yrs, 77% male; 5,103 received bridging LRT, including 3,676 who received TACE. Comparison groups were similar for age at OLT, waitlist duration, sex, race, BMI and MELD score (p>.05 for all). Significantly prolonged OS with bridging LRT vs. none was observed from both OLT (111.6 vs 106.4 mo, p<.001) and from Listing (176.1 vs 169.4 mo, p=.001). Similarly, significantly prolonged OS with bridging TACE vs. none was observed from both OLT (112.0 vs 107.2 mo, p<.001) and from Listing (177.7 vs 169.9 mo, p=.001). Conclusions: In HCC pts undergoing OLT, both bridging LRT and TACE correlated with prolonged survival from OLT and from Listing in a UNOS population-based study. [Table: see text]

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