Liver transplantation from 73-year-old cadaveric donor

Orthotopic liver transplantation is the only way to cure chronic liver failure and certain liver tumors. Deceased donor organs are the prevailing source in most transplantation centers. However, there is an organ shortage because of the increasing number of patients in need of transplantation. Using expanded criteria deceased donors is a routine way to overcome organ shortage. The majority of transplantation centers take older donors depending on the local rules. Successful liver transplantation from 73-year-old deceased donor. Recipient suffered from liver neuroendocrine tumor without signs of extrahepatic spread. Liver function is adequate during 90-day follow-up. Liver transplantation from older deceased donors has good outcome according to world experience. Careful donor-recipient selection is the key to success. The first positive trial in our center enlightens the way for further practice.

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EVALUATION AND SELECTION OF CANDIDATES FOR LIVER TRANSPLANTATION: AN ECONOMIC PERSPECTIVE

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.202000000-07 ◽

2020 ◽

Vol 57 (1) ◽

pp. 31-38 ◽

Cited By ~ 1

Author(s):

Santiago RODRÍGUEZ ◽

Fabio Da MOTTA ◽

Giacomo BALBINOTO NETO ◽

Ajacio BRANDÃO

Keyword(s):

Liver Transplantation ◽

Care Center ◽

Tertiary Care ◽

Deceased Donor ◽

Waiting List ◽

Transplant Center ◽

Number Of Patients ◽

Common Problems ◽

Selection Of

ABSTRACT BACKGROUND: Over the next 20 years, the number of patients on the waiting list for liver transplantation (LTx) is expected to increase by 23%, while pre-LTx costs should raise by 83%. OBJECTIVE: To evaluate direct medical costs of the pre-LTx period from the perspective of a tertiary care center. METHODS: The study included 104 adult patients wait-listed for deceased donor LTx between October 2012 and May 2016 whose treatment was fully provided at the study transplant center. Clinical and economic data were obtained from electronic medical records and from a hospital management software. Outcomes of interest and costs of patients on the waiting list were compared through the Kruskal-Wallis test. A generalized linear model with logit link function was used for multivariate analysis. P-values <0.05 were considered statistically significant. RESULTS: The costs of patients who underwent LTx ($8,879.83; 95% CI 6,735.24-11,707.27; P<0.001) or who died while waiting ($6,464.73; 95% CI 3,845.75-10,867.28; P=0.04) were higher than those of patients who were excluded from the list for any reason except death ($4,647.78; 95% CI 2,469.35-8,748.04; P=0.254) or those who remained on the waiting list at the end of follow-up. CONCLUSION: Although protocols of inclusion on the waiting list vary among transplant centers, similar approaches exist and common problems should be addressed. The results of this study may help centers with similar socioeconomic realities adjust their transplant policies.

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Coronary sinus catalase and ceruloplasmin levels predict all-cause mortality in patients with end-stage heart failure awaiting heart transplantation

European Heart Journal ◽

10.1093/ehjci/ehaa946.1005 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

W Szczurek ◽

M Gasior ◽

M Skrzypek ◽

G Kubiak ◽

A Kuczaj ◽

...

Keyword(s):

Heart Failure ◽

Heart Transplantation ◽

Coronary Sinus ◽

Public Institution ◽

Funding Source ◽

Organ Shortage ◽

Number Of Patients ◽

End Stage ◽

Medical University

Abstract Background, As a consequence of the worldwide increase in life expectancy and due to significant progress in the pharmacological and interventional treatment of heart failure (HF), the proportion of patients that reach an advanced phase of disease is steadily growing. Hence, more and more numerous group of patients is qualified to the heart transplantation (HT), whereas the number of potential heart donors has remained invariable since years. It contributes to deepening in disproportion between the demand for organs which can possibly be transplanted and number of patients awaiting on the HT list. Therefore, accurate identification of patients who are most likely to benefit from HT is imperative due to an organ shortage and perioperative complications. Purpose The aim of this study was to identify the factors associated with reduced survival during a 1.5-year follow-up in patients with end-stage HF awating HT. Method We propectively analysed 85 adult patients with end-stage HF, who were accepted for HT at our institution between 2015 and 2016. During right heart catheterization, 10 ml of coronary sinus blood was additionally collected to determine the panel of oxidative stress markers. Oxidative-antioxidant balance markers included glutathione reductase (GR), glutathione peroxidase (GPx), glutathione transferase (GST), superoxide dismutase (SOD) and its mitochondrial isoenzyme (MnSOD) and cytoplasmic (Cu/ZnSOD), catalase (CAT), malondialdehyde (MDA), hydroperoxides lipid (LPH), lipofuscin (LPS), sulfhydryl groups (SH-), ceruloplasmin (CR). The study protocol was approved by the ethics committee of the Medical University of Silesia in Katowice. The endpoint of the study was mortality from any cause during a 1.5 years follow-up. Results The median age of the patients was 53.0 (43.0–56.0) years and 90.6% of them were male. All included patients were treated optimally in accordance with the guidelines of the European Society of Cardiology. Mortality rate during the follow-up period was 40%. Multivariate logistic regression analysis showed that ceruloplasmin (odds ratio [OR] = 0.745 [0.565–0.981], p=0.0363), catalase (OR = 0.950 [0.915–0.98], p=0.0076), as well as high creatinine levels (OR = 1.071 [1.002–1.144], p=0.0422) were risk factors for death during 1.5 year follow-up. Conclusions Coronary sinus lower ceruloplasmin and catalase levels, as well as higher creatinine level are independently associated with death during 1.5 year follow-up. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Medical University of SIlesia, Katowice, POland

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Expanded criteria donor grafts for deceased donor liver transplantation under the MELD system: A decision analysis

Liver Transplantation ◽

10.1002/lt.20304 ◽

2004 ◽

Vol 10 (12) ◽

pp. 1468-1475 ◽

Cited By ~ 83

Author(s):

Manish G. Amin ◽

Michael P. Wolf ◽

John A. TenBrook ◽

Richard B. Freeman ◽

Steve J. Cheng ◽

...

Keyword(s):

Liver Transplantation ◽

Decision Analysis ◽

Deceased Donor ◽

Donor Liver ◽

Donor Liver Transplantation ◽

System A ◽

Expanded Criteria Donor ◽

Deceased Donor Liver Transplantation ◽

Expanded Criteria

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Liver transplantation: a 10-year single center experience in Pernambuco- northeastern Brazil

Brazilian Journal of Transplantation ◽

10.53855/bjt.v13i2.227 ◽

2010 ◽

Vol 13 (2) ◽

pp. 1288-1292

Author(s):

Luiz Eduardo C. Miranda ◽

Paulo Sérgio Vieira de Melo ◽

Diego Laurentino Lima ◽

Bernardo Sabat ◽

Américo Gusmão Amorim ◽

...

Keyword(s):

Liver Transplantation ◽

Survival Curve ◽

Deceased Donor ◽

Conventional Technique ◽

University Hospital ◽

Northeastern Brazil ◽

Organ Shortage ◽

Single Center ◽

Liver Donor ◽

Single Center Experience

Purpose: The aim of this study is to analyze a ten-year single center experience in liver transplantation in Pernambuco - Northeastern region of Brazil. Methods: Data were retrospectively collected from medical records of 302 patients who underwent Orthotopic Liver Transplantation (OLT) between 1998 and 2008 at Oswaldo Cruz University Hospital, Pernambuco – Brazil. We analyzed just the outcomes and survival curve of 195 adult liver transplantation recipients from deceased donor. Results: Data concern liver donor, surgery technical aspects and liver transplantation recipients’ postoperative evolution are presented and discussed. This center has a significant experience in liver transplantation using conventional technique with no venovenous bypass. Efficient management of liver transplantation practice has made it feasible to keep the cold ischemia time within 6-7 hours. Because of the organ shortage, we have used a large amount of extended criteria liver donor. The survival 1-year rata was 76.4%. Conclusion: It is possible to provide a high-quality public medical assistance in an efficient and continuous manner in less developed areas of Brazil.

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Nanosensors for therapeutic drug monitoring: implications for transplantation

Nanomedicine ◽

10.2217/nnm-2019-0150 ◽

2019 ◽

Vol 14 (20) ◽

pp. 2735-2747 ◽

Cited By ~ 8

Author(s):

Ashkan Shafiee ◽

Elham Ghadiri ◽

Jareer Kassis ◽

Anthony Atala

Keyword(s):

State Of The Art ◽

Point Of Care ◽

Therapeutic Drug ◽

Organ Rejection ◽

Number Of Patients ◽

Deceased Donors ◽

Transplanted Organs ◽

Further Development

The number of patients requiring organ transplantations is exponentially increasing. New organs are either provided by healthy or deceased donors, or are grown in laboratories by tissue engineers. Post-surgical follow-up is vital for preventing any complications that can cause organ rejection. Physiological monitoring of a patient who receives newly transplanted organs is crucial. Many efforts are being made to enhance follow-up technologies for monitoring organ recipients, and point-of-care devices are beginning to emerge. Here, we describe the role of biosensors and nanosensors in improving organ transplantation efficiency, managing post-surgical follow-up and reducing overall costs. We provide an overview of the state-of-the-art biosensing technologies and offer some perspectives related to their further development.

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An Overview of Current Status, Recent Techniques and Challenges of Liver Transplantation

International Journal of Applied Sciences and Biotechnology ◽

10.3126/ijasbt.v6i2.20417 ◽

2018 ◽

Vol 6 (2) ◽

pp. 67-74

Author(s):

Bharata Regmi ◽

Manoj Kumar Shah

Keyword(s):

Liver Transplantation ◽

Liver Disease ◽

Deceased Donor ◽

Current Status ◽

Organ Shortage ◽

Donor Organ ◽

Donor Liver ◽

Donor Liver Transplantation ◽

Split Liver

A liver transplantation (LT) is a surgical procedure that removes a liver that no longer functions properly and replaces it with a healthy liver from a living or deceased donor. It is a viable treatment option for end-stage liver disease and acute liver failure. The most commonly used technique is orthotopic transplantation or deceased donor liver transplantation (DDLT) in which the native liver is removed and replaced by the donor organ in the same anatomic location as the original liver. Ongoing challenges of LT include those concerning donor organ shortages, recipients with more advanced disease at transplant, growing need for transplantation, side effects associated with long-term immunosuppression, toxicities and obesity. Organ shortage has become the most vexing problem in LT, with 10–25% of patients dying while awaiting transplantation. Different ideas has been evolved like living donor liver transplantation (LDLT), marginal donor liver transplantation (MDLT) and split liver transplantation (SLT) to overcome the growing problem of organ shortage. These techniques are becoming very important in an attempt to narrow the gap between demand and supply of organs. The advances in surgical and anaesthetic techniques, greater understanding of the physiological, haematological, biochemical, microbiological and immunological changes in liver disease and transplantation allowed a multidisciplinary approach that led to better outcomes. These changes, coupled with more effective immunosuppressive and anti-microbial agents and improvements in patient and donor selection, mean that now liver replacement is a routine procedure with excellent long term outcomes.Int. J. Appl. Sci. Biotechnol. Vol 6(2): 67-74

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Liver Transplantation in Malignancies: A Comprehensive and Systematic Review on Oncological Outcome

Visceral Medicine ◽

10.1159/000517328 ◽

2021 ◽

pp. 1-12

Author(s):

Emina Talakić ◽

Elmar Janek ◽

Saulius Mikalauskas ◽

Peter Schemmer

Keyword(s):

Systematic Review ◽

Liver Transplantation ◽

Liver Tumors ◽

Single Case ◽

Primary Liver Cancer ◽

Oncological Outcome ◽

High Volume ◽

Organ Shortage ◽

Concomitant Treatment ◽

Life Years

Introduction: Liver transplantation (LT) is today’s standard treatment for both end-stage liver disease and tumors; however, suitable grafts for LT are a scarce resource and outcome after LT is highly dependent on its underlying indication. Thus, patients must be carefully selected to optimize the number of life years gained per graft. This comprehensive and systematic review critically reflects the most recently published oncological outcome data after LT in malignancies based on the preoperative radiological findings. Methods: A systematic literature search was conducted to detect preferentially most recent high-volume series or large database analysis on oncological outcomes after LT for both primary liver cancer and liver metastases between January 1, 2019, and November 14, 2020. A comprehensive review on the radiological assessment of the reviewed liver malignancies is included and its preoperative value for an outcome-driven indication reflected. Results: Twenty most recent high-volume or relevant studies including a total number of 2,521 patients were identified including 4, 4, 4, 4, 3, and 1 publications on oncological outcome after LT for hepatocellular carcinoma, cholangiocellular carcinoma, hepatic epitheloid hemangioendothelioma, hepatoblastoma, and both metastatic neuroendocrine tumors and colorectal cancer, respectively. The overall survival is comparable to patients without tumors if patients with malignancies are well selected for LT; however, this is highly dependent on tumor entity, tumor stage, and both neoadjuvant and concomitant treatment. Discussion/Conclusion: LT is a promising option for better survival in patients with malignant liver tumors in selected patients; however, the indication must be critically discussed prior to LT in every single case in the context of organ shortage.

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The long-term outcomes of deceased-donor liver transplantation for primary biliary cirrhosis: a two-center study in China

PeerJ ◽

10.7717/peerj.9563 ◽

2020 ◽

Vol 8 ◽

pp. e9563

Author(s):

Lin Chen ◽

Xiaodong Shi ◽

Guoyue Lv ◽

Xiaodong Sun ◽

Chao Sun ◽

...

Keyword(s):

Liver Transplantation ◽

Survival Rate ◽

Primary Biliary Cirrhosis ◽

Liver Function ◽

Deceased Donor ◽

Biliary Cirrhosis ◽

Donor Liver ◽

Donor Liver Transplantation ◽

Deceased Donor Liver Transplantation

Background & Aims Factors that influence the outcomes after deceased-donor liver transplantation (DDLT) for primary biliary cirrhosis (PBC) are not well known. We aimed to clarify these effects on the outcomes after DDLT. Methods We retrospectively analyzed patients with PBC who underwent DDLT from March 2006 to July 2018 at the organ transplantation center of the First Hospital of Jilin University and the First Central Hospital of Tianjin. Changes in liver function were assessed posttransplantation. Recurrence, survival rate, and complications were recorded at follow-up. The effect of liver transplantation on survival and recurrence was evaluated using univariate and/or multivariate Cox regression analyses. Results In total, 69 patients with PBC undergoing DDLT were included in this study. At 4 weeks posttransplant, all liver function tests were normal. During a median follow-up time of 32 months, 5-year overall survival and recurrence rates were estimated as 95.1% and 21.8%, respectively. A recipient aspartate aminotransferase-to-platelet ratio index (APRI) greater than 2 was negatively associated with survival (P = 0.0018). Multivariate regression analysis demonstrated that age younger than 48 years was an independent risk factor for recurrent PBC in recipients undergoing liver transplantation (hazard ratio 0.028, 95% confidence interval 0.01–0.71, P = 0.03). Posttransplant infections (62%) and biliary tract complications (26%) were the most common complications. Conclusion Liver transplantation is an effective treatment for patients with PBC. Liver function normalizes by 4 weeks posttransplant. Although posttransplant survival rate is high, recurrence is possible. To some extent, survival rate and recurrence rate can be predicted by APRI and age, respectively.

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Results of Deceased Donor Kidney Transplantation in Young Recipients after Age-matched and Mismatched (Old-to-young) Transplantation

Acta Chirurgica Latviensis ◽

10.1515/chilat-2017-0002 ◽

2016 ◽

Vol 16 (2) ◽

pp. 8-11

Author(s):

Janis Jushinskis ◽

Vadims Suhorukovs ◽

Aleksandrs Malcevs ◽

Ieva Ziedina ◽

Rafails Rozentals

Keyword(s):

Graft Function ◽

Deceased Donor ◽

Rejection Rate ◽

Donor Age ◽

Donor Kidney ◽

Deceased Donor Kidney ◽

Significant Difference ◽

Deceased Donors ◽

Kidney Transplantations

SummaryIntroduction.During the previous years the number of organ transplantations from elderly donors increased, and lack of young donors leads to necessity to allocate organs from elderly into young recipients.Aim of the Study.Was to analyse results of “old-to-young” allocation.Material and methods.This retrospective study analysed results of all consecutive deceased donor kidney transplantations (DDKT) performed in one transplant centre during the period from 01.01.2004 till 31.12.2007. Patients were selected based on availability of 5-year follow-up and age < 50 years (158 DDKT). Patients were divided into 2 groups according to donor age: age-mismatched group (donor age was > 55 years and at the same time > 15 years older than recipient; n=8, male/female=2/6, age 39,4 + 4,8 years, donor age 59,4 + 2,4 years), and age-matched group (n=150, male/female=88/62, age 36,0 + 11,0 years, donor age 37,3 + 12,0 years). Groups were compared for clinical and demographical features and posttransplant outcomes (delayed graft function, s-creatinin levels at discharge and after 5 years, acute rejection rate, graft and patient 5-year survival).Results.Comparison of demographical and clinical features revealed only relatively higher BMI in elderly donors (p=0.081) and higher frequency of age-mismatched allocation into female recipients (p=0.066). Early and late post-transplant outcomes showed no significant difference between groups, with similar 5-year graft and patient survival (p=NS for all compared factors).Conclusion.Results showed good kidney allograft function even in cases of age-mismatched allocation, which is significant opportunity in current situation with increasing age of deceased donors.

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Liver transplantation using grafts from donors after circulatory death – the first Czech Republic experience

Perspectives in Surgery ◽

10.33699/pis.2020.99.9.391-396 ◽

2020 ◽

Vol 99 (9) ◽

Keyword(s):

Liver Transplantation ◽

Czech Republic ◽

Supply And Demand ◽

Donation After Cardiac Death ◽

Organ Shortage ◽

Liver Transplantations ◽

Recipient Age ◽

The Mean ◽

Hepatitis C Recurrence

Introduction: Liver transplantation is established as a lifesaving procedure for patients with acute and chronic liver failure, as well as certain selected malignancies. Due to a continuing organ shortage and ever-growing patient waiting lists, donation after cardiac death (DCD) is becoming more frequently utilized in order to close the gap between “supply and demand”. Methods: A retrospective analysis of DCD and subsequent liver transplantations was performed. Results: From May 2016 to September 2019, a total of 9 DCD liver transplantations were performed in our institution. All cases except one were primary liver transplantations. The recipients comprised 5 (56%) males and 4 (44%) females. The mean DCD donor age was 41±12 (22–57) years, with ventilation duration of 7±1 days and warm ischemia time 19±3 minutes. The average recipient age was 51±22 (4–73) years, with an average cold ischemia 3h:59m±27m and manipulation time of 23±5 minutes. Periprocedural mortality was 1 (11%). Hepatitis C recurrence was documented in 1 (11%) patient. The mean follow-up time was 19±13 (7–37) months. Until now, we have not observed any signs of ischemic cholangiopathy. Conclusion: DCD liver transplantation allows us to enlarge the pool of potential liver grafts, thus decreasing the time spent on the liver recipient waiting list. This paper documents the first series of DCD liver transplantations in the Czech Republic.

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