scholarly journals Recurrent and de novo non-alcoholic steatohepatitis following orthotopic liver transplantation

2001 ◽  
Vol 38 (4) ◽  
pp. 247-253 ◽  
Author(s):  
Raquel F. Liermann GARCIA ◽  
Eugenia MORALES ◽  
Christian Evangelista GARCIA ◽  
Sushma SAKSENA ◽  
Stefan G. HÜBSCHER ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Liver Disease ◽  
Orthotopic Liver Transplantation ◽  
De Novo ◽  
Fatty Infiltration ◽  
Alcoholic Steatohepatitis ◽  
Early Fibrosis ◽  
End Stage

Background — Non-alcoholic steatohepatitis was coined in 1980 to describe pathological and clinical features of non-alcoholic disease associated with pathological features, commonly seen in alcoholic-liver disease itself. It is now a well-recognised cause of end-stage liver disease and a rare cause of orthotopic liver transplantation. A small number of cases with recurrent non-alcoholic steatohepatitis following liver transplantation have been reported, however de novo non-alcoholic steatohepatitis in the liver allograft is not well recognised. Aims/Results - We report four cases of non-alcoholic steatohepatitis following orthotopic liver transplantation describing the factors related with the pathology. The recurrence of fatty infiltration occurred within 21 months and transition from mild steatosis to non-alcoholic steatohepatitis and early fibrosis was observed within 60 months post transplant in all four patients. All four cases had association with one or multiples risk factors (obesity, type 2 diabetes and/or hyperlipidemia). Conclusions - Management of this risk factors may play a therapeutic role in the prevention of recurrent and de novo non-alcoholic steatohepatitis following orthotopic liver transplantation.

A young patient with type 2 diabetes associated non-alcoholic steatohepatitis, liver cirrhosis, and hepatocellular carcinoma

2020 ◽  
Vol 58 (01) ◽  
pp. 57-62 ◽  
Author(s):  
Maurice Michel ◽  
Eva Kalliga ◽  
Christian Labenz ◽  
Beate K. Straub ◽  
Marcus-Alexander Wörns ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Type 2 Diabetes ◽  
Metabolic Syndrome ◽  
Liver Transplantation ◽  
Liver Cirrhosis ◽  
Liver Disease ◽  
Intermittent Therapy ◽  
Alcoholic Steatohepatitis

AbstractThe rising prevalence of the metabolic syndrome has led to an increase of non-alcoholic fatty liver disease (NAFLD), and its progressive-inflammatory form called non-alcoholic steatohepatitis (NASH). In recent years, NAFLD and NASH have become major risk factors for developing liver cirrhosis and hepatocellular carcinoma (HCC). In this case, we report a 46-year-old patient with type 2 diabetes mellitus and metabolic comorbidities including obesity and arterial hypertension, who was referred because of rising liver enzymes. After clinical and diagnostic evaluation, the patient was diagnosed with NASH-associated liver cirrhosis, Child-Pugh stage B. A normal blood sugar level was difficult to achieve, and the patient presented with consistently elevated HbA1c-levels irresponsive to insulin therapy. Due to the underlying liver cirrhosis, the patient was enrolled in the HCC-surveillance program. Sonography during follow up showed a focal lesion. On magnetic resonance imaging (MRI), the diagnosis of HCC (BCLC stage A) was confirmed based on typical contrast enhancement and portal-venous wash-out. The patient was evaluated for liver transplantation with a labMELD of 17, and an intermittent therapy with TACE was initiated. Only 2 months after liver transplantation, the patient developed severe and lethal complications. Overall, this case highlights the different medical issues of patients with metabolic syndrome developing a chronic liver disease. In this patient, a rapid progression from NASH-associated liver cirrhosis to HCC was seen, and therefore highlights the importance of close surveillance to identify and treat potential risk factors early in the course of the disease.

Tranexamic Acid Reduces Blood Loss, Transfusion Requirements, and Coagulation Factor Use in Primary Orthotopic Liver Transplantation

1996 ◽  
Vol 85 (5) ◽  
pp. 1043-1048 ◽  
Author(s):  
John F. Boylan ◽  
John R. Klinck ◽  
Alan N. Sandler ◽  
Ramiro Arellano ◽  
Paul D. Greig ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Orthotopic Liver Transplantation ◽  
Interquartile Range ◽  
High Dose ◽  
Intraoperative Blood Loss ◽  
End Stage ◽  
Donor Exposure

Background Patients with end-stage liver disease frequently incur large-volume blood loss during liver transplantation associated with mechanical factors, preexisting coagulopathy, and intraoperative fibrinolysis. Methods Between April 1992 and May 1994, the authors of this double-blind, randomized, placebo-controlled study examined the effect of high-dose tranexamic acid (maximum of 20 g) on blood loss and blood product requirements in patients undergoing primary isolated orthotopic liver transplantation. Primary outcome measures were volume of blood loss (intraoperative blood loss and postoperative drainage) and erythrocyte, plasma, platelet, and cryoprecipitate use during surgery and the first 24 h of intensive care unit stay. Results Patients receiving tranexamic acid (n = 25) had less intraoperative blood loss (median, 4.3 l; interquartile range, 2.5 to 7.9; P = 0.006) compared with the placebo group (n = 20; median, 8 l; interquartile range, 5 to 15.8), and reduced intraoperative plasma, platelet, and cryoprecipitate requirements. Median perioperative erythrocyte use was 9 units (interquantile range, 4 to 14 units) in patients receiving tranexamic acid and 13 units (interquantile range, 7.5 to 31 units) in controls (P = 0.03). Total perioperative donor exposure was 20.5 units (interquantile range, 16 to 41 units) in patients receiving tranexamic acid and 43.5 units (interquantile range, 29.5 to 79 units) in controls (P = 0.003). Results for postoperative wound drainage were similar. Hospital stay and need for retransplantation were comparable in both groups. No patient in either group showed clinical evidence of hepatic artery or portal venous thrombosis within 1 month of transplantation. Conclusions High-dose tranexamic acid significantly reduces intraoperative blood loss and perioperative donor exposure in patients with end-stage parenchymal liver disease who are undergoing orthotopic liver transplantation, with marked reductions in platelet and cryoprecipitate requirements.

scholarly journals Aortic Balloon Valvuloplasty Prior to Orthotopic Liver Transplantation: A Novel Approach to Aortic Stenosis and End-Stage Liver Disease

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Edward Coverstone ◽  
Kevin Korenblat ◽  
Jeffrey S. Crippin ◽  
William C. Chapman ◽  
Andrew M. Kates ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Orthotopic Liver Transplantation ◽  
Severe Aortic Stenosis ◽  
Balloon Aortic Valvuloplasty ◽  
End Stage Liver Disease ◽  
Aortic Valvuloplasty ◽  
End Stage

The combination of severe aortic stenosis and end-stage liver disease increases the morbidity and mortality of surgical aortic valve replacement or orthotopic liver transplantation resulting in a prohibitive operative risk. We propose a staged approach of balloon aortic valvuloplasty prior to orthotopic liver transplantation as a bridge to definitive aortic valve replacement. Between 2010 and 2012, four patients with severe aortic stenosis and end-stage liver disease underwent staged balloon aortic valvuloplasty followed by orthotopic liver transplantation. All patients had been deemed to be inappropriate candidates for liver transplantation or aortic valve surgery due to their comorbidity. One patient died of complications from a perivalvular abscess. Three patients went on to successful graft implantation and function and surgical recovery. Two of the three patients proceeded to definitive surgical aortic valve replacement with the remainder currently undergoing evaluation. In this case series, we present a novel approach of balloon aortic valvuloplasty prior to liver transplantation as a potential bridge to definitive treatment of severe aortic stenosis in the end-stage liver patient.

Alterations of Endothelial Glycocalyx During Orthotopic Liver Transplantation in Patients With End-Stage Liver Disease

2015 ◽  
Vol 99 (10) ◽  
pp. 2118-2123 ◽  
Author(s):  
Judith Schiefer ◽  
Diana Lebherz-Eichinger ◽  
Gabor Erdoes ◽  
Gabriela Berlakovich ◽  
Andreas Bacher ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Orthotopic Liver Transplantation ◽  
Endothelial Glycocalyx ◽  
End Stage Liver Disease ◽  
End Stage

scholarly journals Infection within 2 weeks before liver transplantation closely related to prognosis of posttransplant infection: a single-center retrospective observational study in China

2019 ◽  
Author(s):  
Yue Ying ◽  
Rui-Dong Li ◽  
Jing-Wen Ai ◽  
Yi-Min Zhu ◽  
Xian Zhou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Prognostic Factors ◽  
Liver Disease ◽  
Klebsiella Pneumoniae ◽  
Postoperative Infection ◽  
Transplant Recipients ◽  
Biliary Tract Infection ◽  
End Stage Liver Disease ◽  
End Stage

Abstract Background Infections still represent the main factors influencing morbidity and mortality following liver transplantation. This study is to evaluate the incidence and risk factors for infection and survival after liver transplantation. Methods We retrospectively examined medical records in 210 recipients who underwent liver transplantation between April 2015 and October 2017 in our center. Results During the median follow-up days of 214, the incidence of infection after liver transplantation was 46.7% (n=98): namely, pneumonia (43.4%), biliary tract infection (21.9%) and peritonitis (21.4%). Among the pathogens in pneumonia, the most frequently isolated was Acinetobacter baumanii (23.5%) and Klebsiella pneumoniae (21.1%). For biliary tract infection, the first rank was Strenotrophomonas maltophilia (14.0%) and then Klebsiella pneumoniae (11.6%). Pseudomonas aeruginosa, Strenotrophomonas maltophilia, and Klebsiella pneumoniae accounted for 21.4%, 11.9% and 11.9% of pathogens in peritonitis, respectively. The independent risk factors for infection after liver transplantation are model for end-stage liver disease (MELD) or pediatric end-stage liver disease (PELD) score, total blood loss in operation and duration of drainage tube. All-cause mortality was 11.0% (n=23). The prognostic factors for postoperative infection in transplant recipients are infection, especially pneumonia within 2 weeks before transplantation, complication with impaired renal function and higher MELD or PELD score after 7 days of transplantation. Kaplan–Meier curves of survival showed that recipients with infection within 2 weeks before transplantation had a significantly lower cumulative survival rate compared with those without infection (66.7% vs 91.9%, HR=4.480, 95% CI, 3.377-47.85; p<0.001). Conclusions Infection, especially pneumonia within 2 weeks before transplantation are independent prognostic factors for postoperative infection in transplant recipients.

scholarly journals Multidisciplinary Approach for Liver Transplantation in Patients with Nonalcoholic Steatohepatitis: It Takes a Village

2020 ◽  
Vol 04 (01) ◽  
pp. 019-030
Author(s):  
Eugenia Tsai ◽  
Ronit Patnaik ◽  
Naim Alkhouri
Keyword(s):  
Bariatric Surgery ◽  
Liver Transplantation ◽  
Liver Disease ◽  
Nonalcoholic Steatohepatitis ◽  
De Novo ◽  
Management Strategies ◽  
Genetic Determinants ◽  
Nonalcoholic Fatty Liver ◽  
Short And Long Term ◽  
End Stage

AbstractNonalcoholic fatty liver disease (NAFLD) is the leading cause of liver disease in Western countries, and its aggressive form, nonalcoholic steatohepatitis (NASH), is a leading cause of cirrhosis and end-stage liver disease. The total number of new liver transplantation waitlist registrants with NASH continues to increase rapidly, making NASH the second most common indication for liver transplantation. Compared with recipients for other etiologies, patients with NASH often have higher rates of obesity, diabetes, dyslipidemia, hypertension, kidney disease, and cardiac disease. Many of these medical comorbidities are independently associated with increased preoperative risk and both short- and long-term complications. The presence of these particular risk factors necessitates the need for early detection, medical optimization, and careful preoperative care. Bariatric surgery is an effective strategy for weight loss and ultimately reducing obesity-related medical complications. In select patients, bariatric surgery—before, during, or after liver transplantation—may be useful to help improve posttransplant outcomes. NAFLD/NASH can present after liver transplantation and occurs as either recurrent or de novo disease. Posttransplant NAFLD occurs in the setting of metabolic syndrome, immunosuppression use, and genetic determinants. Future studies and efforts should focus on optimizing medical management strategies to further improve transplant outcomes in patients with NAFLD.

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