scholarly journals The kidney in liver transplantation.

1993 ◽  
Vol 4 (2) ◽  
pp. 129-136
Author(s):  
D A Distant ◽  
T A Gonwa
Keyword(s):  
Liver Transplantation ◽  
Renal Function ◽  
Liver Transplant ◽  
Renal Dysfunction ◽  
Survival Rates ◽  
Renal Perfusion ◽  
Transplant Recipients ◽  
Nephrotoxic Drugs ◽  
End Stage ◽  
Liver Transplant Recipients

Renal dysfunction often complicates the course of liver transplant recipients. Preoperative renal dysfunction, including hepatorenal syndrome (HRS) may be present. Assessment of renal function in the pretransplant patient with end-stage liver disease is fraught with pitfalls. Direct measurement of GFR by a method other than creatinine clearance is recommended wherever possible. Preoperative renal biopsy should also be considered in those patients with renal dysfunction in whom the diagnosis of HRS is not definite. With the routine use of veno venous bypass, renal perfusion is maintained and intraoperative events generally do not play a significant role in the development of postoperative dysfunction. Postoperatively immunosuppressive medications such as CsA or FK506 account for most of the renal dysfunction that is observed. Other factors such as graft dysfunction, sepsis, and nephrotoxic drugs may also participate in renal impairment. The exact mechanism of cyclosporine or FK506 nephrotoxicity remains unknown. In liver transplant recipients, no convincing therapeutic strategies exist to combat nephrotoxicity other than dose reduction of immunosuppressive therapy. Patients with HRS can be successfully treated by liver transplantation with recovery of renal function and with patient survival rates comparable to recipients without HRS, despite increased morbidity.

Preoperative Trapped Lung Is Associated With Increased Mortality After Orthotopic Liver Transplantation

2020 ◽  
pp. 152692482097860
Author(s):  
Kathryn H. Melamed ◽  
David Dai ◽  
Natasha Cuk ◽  
Daniela Markovic ◽  
Robert Follett ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Liver Transplant ◽  
Orthotopic Liver Transplantation ◽  
Meld Score ◽  
Transplant Recipients ◽  
End Stage Liver Disease ◽  
Trapped Lung ◽  
End Stage ◽  
Liver Transplant Recipients

Introduction: Trapped lung, characterized by atelectatic lung unable to reexpand and fill the thoracic cavity due to a restricting fibrous visceral pleural peel, is occasionally seen in patients with end-stage liver disease complicated by hepatic hydrothorax. Limited data suggest that trapped lung prior to orthotopic liver transplantation may be associated with poor outcomes. Research Question: What is the clinical significance of trapped lung in patients receiving orthotopic liver transplantation? Design: We performed a retrospective analysis of patients who underwent liver transplantation over an 8-year period. Baseline clinical characteristics and postoperative outcomes of adult patients with trapped lung were analyzed and compared to the overall cohort of liver transplant recipients and controls matched 3:1 based on age, sex, Model for End-Stage Liver Disease (MELD) score, and presence of pleural effusion. Results: Of the 1193 patients who underwent liver transplantation, we identified 20 patients (1.68%) with trapped lung. The probability of 1 and 2-year survival were 75.0% and 57.1%, compared to 85.6% and 80.4% (p = 0.02) in all liver transplant recipients and 87.9% and 81.1% (p = 0.03) in matched controls respectively. Patients with trapped lung had a longer hospital length of stay compared to the total liver transplant population (geometric mean 54.9 ± 8.4 vs. 27.2 ± 0.7 days, p ≤ 0.001), when adjusted for age and MELD score. Discussion: Patients with trapped prior to orthotopic liver transplantation have increased probability of mortality as well as increased health care utilization. This is a small retrospective analysis, and further prospective investigation is warranted.

scholarly journals Pregnancy Following Liver Transplantation: Review of Outcomes and Recommendations for Management

2012 ◽  
Vol 26 (9) ◽  
pp. 621-626 ◽  
Author(s):  
Kuljit S Parhar ◽  
Paul S Gibson ◽  
Carla S Coffin
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Recent Literature ◽  
Liver Transplant Recipient ◽  
Optimal Timing ◽  
Transplant Recipients ◽  
Childbearing Age ◽  
Key Issues ◽  
End Stage ◽  
Liver Transplant Recipients

Liver transplantation is considered to be the treatment of choice for end-stage liver disease and its success has led to an increase in the number of female liver transplant recipients who are of childbearing age. Several key issues that are noted when counselling patients who are considering pregnancy following liver transplantation include the optimal timing of pregnancy, optimal contraception methods and the management of immunosuppression during pregnancy. The present review summarizes the most recent literature so that the clinician may address these issues with their patient and enable them to make informed decisions about pregnancy planning. The authors review recent studies examining maternal and fetal outcomes, and the rates of complications including risk of graft rejection. Subsequently, the authors provide recommendations for counselling prospective mothers and the management of the pregnant liver transplant recipient.

scholarly journals Improvement of renal function after the switch from a calcineurin inhibitor to everolimus in liver transplant recipients with chronic renal dysfunction

2009 ◽  
Vol 15 (12) ◽  
pp. 1792-1797 ◽  
Author(s):  
Javier F. Castroagudín ◽  
Esther Molina ◽  
Rafael Romero ◽  
Esteban Otero ◽  
Santiago Tomé ◽  
...  
Keyword(s):  
Renal Function ◽  
Liver Transplant ◽  
Renal Dysfunction ◽  
Calcineurin Inhibitor ◽  
Transplant Recipients ◽  
Liver Transplant Recipients

scholarly journals Renal Safety of Tenofovir Disoproxil Fumarate and Entecavir in Liver Transplant Patients: A Nationwide Korean Registry Study

2021 ◽  
Author(s):  
Juhan Lee ◽  
Jae Geun Lee ◽  
Shin Hwang ◽  
Kwang-Woong Lee ◽  
Jong Man Kim ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Renal Dysfunction ◽  
Transplant Recipients ◽  
Post Transplantation ◽  
Transplant Patients ◽  
Increased Risk ◽  
B Virus ◽  
Liver Transplant Recipients ◽  
Renal Safety

Abstract Background and aims: Tenofovir disoproxil fumarate (TDF) and entecavir (ETV) have been recommended after liver transplantation to prevent recurrence of hepatitis B virus infection. Despite its proven efficacy, the renal safety of TDF has not been established in liver transplant recipients. We aimed to compare the effects of TDF and ETV on renal function in liver transplant recipients and to evaluate risk factors for renal dysfunction after liver transplantation. Methods: This is a retrospective, observational multicenter study of data from the Korean Organ Transplantation Registry. We included adults who underwent liver transplantation for hepatitis B virus-related complications from April 2014 to December 2017 and received TDF or ETV post-transplantation. Renal dysfunction was defined as an estimated glomerular filtration rate decline by at least 20% from baseline (1 month post-transplantation). Median duration of follow-up was 29 months (interquartile range 19–42).Results: A total of 804 liver transplant patients were included. The cumulative probability of renal dysfunction was significantly higher in the TDF group than in the ETV group. Multivariable analysis confirmed that TDF was independently associated with an increased risk of renal dysfunction (hazard ratio = 1.47, 95% confidence interval 1.12-1.92; P = 0.005). Independent risk factors for renal dysfunction included older age, worse baseline renal function, and low body mass index. Renal dysfunction after liver transplantation was independently associated with increased mortality.Conclusions: In this nationwide study, use of TDF was associated with an increased risk of renal dysfunction, when compared with ETV.

scholarly journals Quality of Life in Liver Transplant Recipients: A Retrospective Study

2020 ◽  
Vol 17 (11) ◽  
pp. 3809
Author(s):  
Rosario Girgenti ◽  
Alessandro Tropea ◽  
Maria Antonina Buttafarro ◽  
Rosalia Ragusa ◽  
Martina Ammirata
Keyword(s):  
Quality Of Life ◽  
Liver Transplantation ◽  
Liver Transplant ◽  
Deceased Donor ◽  
Transplant Recipients ◽  
Therapeutic Adherence ◽  
The Individual ◽  
End Stage ◽  
Liver Transplant Recipients

Background: This study aims to investigate the quality of life and the therapeutic compliance of the patients who received a liver transplant, from a living or deceased donor, at IRCCS ISMETT in the last three years. Liver transplantation is an effective therapeutic strategy for patients with end-stage liver failure. The quality of life (QOL) of liver disease patients is placed under considerable stress due to the debilitating clinical conditions and related issues experienced in everyday life by these individuals. The concept of QOL is being increasingly used to define the individual perception of health, including physical, mental, and social wellbeing. The success of a liver transplant should therefore be intended not only in terms of survival, but also of recovery of a satisfying quality of life. For this reason, our liver transplant recipients are closely monitored and supported from a psychological standpoint. This is done to monitor their ability to adapt to and comply with their clinical condition and to verify their gradual resumption of their path of life Methods: We retrospectively analyzed data collected by the IRCCS ISMETT Clinical Psychology Service during routine psychological follow-up of liver transplant recipients. Data refer to 82 patients who received a liver transplant between January 2017 and September 2019 and describe their QOL and therapeutic adherence. The obtained results were compared with the main studies on this issue available in literature. Results: Ninety-four percent of liver transplant recipients reported high mean scores of quality of life and therapeutic adherence 28% of patients reported at least one persistent annoying symptom after transplantation, although in some cases this did not affect the overall QOL. The results also refer to patients with a pre-transplant diagnosis of alcohol-related cirrhosis, who confirm their complete abstinence from alcohol. Conclusions: Our results confirm the efficacy of the liver transplantation to achieve of a good QOL. Furthermore, these patients seem to maintain high therapeutic adherence, thus ensuring a good outcome of the care received during the transplantation process.

scholarly journals The effect of early everolimus administration on the renal function while reducing the dosage of calcineurin inhibitors in liver transplant recipients in a long-term follow-up

2021 ◽  
Vol 13 (2) ◽  
pp. 121-129
Author(s):  
V. E. Syutkin ◽  
A. A. Salienko ◽  
O. D. Olisov ◽  
S. V. Zhuravel ◽  
M. S. Novruzbekov
Keyword(s):  
Liver Transplantation ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Liver Transplant ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Calcineurin Inhibitors ◽  
Transplant Recipients ◽  
Liver Transplant Recipients

Introduction. The lifelong use of calcineurin inhibitors in liver transplant recipients leads to an increased incidence of chronic kidney disease.Objective. To compare the changes in glomerular filtration rate over five years in liver transplant recipients between those on everolimus with a reduced exposure to calcineurin inhibitors and those on standard doses of calcineurin inhibitors.Material and methods. Fourteen liver transplant recipient switched to everolimus with a minimization of calcineurin inhibitors exposure in the first months after liver transplantation from February 2009 to February 2015 who had received that therapy continuously for at least 60 months were included in the case-control study. Twenty eight liver transplant recipients (matched by sex, etiology of the underlying disease, calcineurin inhibitors) who were followed-up for at least 60 months after liver transplantation, who had received no dose of everolimus, in whom the glomerular filtration rate could be calculated at all points of analysis were selected as a comparison group (1:2). Glomerular filtration rate was calculated immediately before liver transplantation; 12, 24, 36, 48, and 60 months after liver transplantation. The glomerular filtration rate after liver transplantation was also calculated for liver transplant recipients from the main group immediately before the conversion to everolimus.Results. Before liver transplantation, the median of glomerular filtration rate in the main group of liver transplant recipients was lower (81.2 ml/min) than in the comparison group (97.5 ml/min, p=0.01). After liver transplantation, the renal function worsened in both groups of patients. In a pairwise comparison, the medians of glomerular filtration rate were statistically significantly lower after 12 months, 24 months, 36 months, 48 months after liver transplantation, than before liver transplantation. The median of glomerular filtration rate at the time of immunosuppression conversion was 44.3 ml/min. After the conversion of immunosuppression, the median of glomerular filtration rate gradually increased, and after 36 months the differences in glomerular filtration rate reached statistical significance compared with the level before conversion (69.4 ml/min;p=0.048). These differences still increased after 60 months after conversion (72.3 ml/min; p=0.041).Conclusion. Long-term administration of everolimus with minimization of calcineurin inhibitors exposure with the early conversion to this immunosuppression regime provides a steady improvement in renal function in liver transplant recipients with a low glomerular filtration rate in the preoperative and early post-transplant period.

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 The concept of “domino” in liver and hepatocyte transplantation

2020 ◽  
Vol 13 ◽  
pp. 175628482096875
Author(s):  
Guang-Peng Zhou ◽  
Li-Ying Sun ◽  
Zhi-Jun Zhu
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Liver Transplant ◽  
Hepatocyte Transplantation ◽  
Transplant Recipients ◽  
Primary Hepatocytes ◽  
The Status ◽  
Domino Liver Transplantation ◽  
End Stage ◽  
Liver Transplant Recipients

Although orthotopic liver transplantation remains the only proven treatment for end-stage liver disease and inherited metabolic liver disease, its application has been limited by the scarcity of donor organs available for transplantation. Among feasible approaches developed to expand the donor organ pool, domino liver transplantation is a strategy in which explanted genetically defective livers of liver transplant recipients are used as grafts in other patients. Another promising therapeutic strategy is hepatocyte transplantation, an alternative to liver transplantation for certain groups of patients. However, the availability of primary hepatocytes is also hindered by the shortage of donor liver tissues. Against this background, domino hepatocyte transplantation, a strategy that utilizes the hepatocytes derived from the explanted livers of liver transplant recipients with noncirrhotic inherited metabolic liver diseases as the source of primary hepatocytes, may help increase the supply of liver cells available for transplantation. In this review, we focus on the status quo of domino liver transplantation and domino hepatocyte transplantation. We also describe recent innovative transplant strategies based on domino transplantation.

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