scholarly journals Arterial Lactate Concentration At The End of Liver Transplantation is Independently Associated with One-Year Mortality

2021 ◽  
Author(s):  
Sean Coeckelenbergh ◽  
Leonard Drouard ◽  
Brigitte Ickx ◽  
Valerio Lucidi ◽  
Dessy Germanova ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Lactate Concentration ◽  
Roc Curves ◽  
Arterial Lactate ◽  
Transplant Patients ◽  
Increased Risk ◽  
One Year ◽  
Few Data ◽  
Youden’S Index

Abstract BACKGROUNDLiver transplant patients who develop hyperlactatemia are at increased risk of postoperative morbidity and mortality, but there are few data on longer-term outcomes. We therefore investigated whether arterial lactate concentration obtained immediately after surgery, at the time of admission to the intensive care unit (ICU), was associated with 1-year mortality. METHODS: In this retrospective cohort study, all patients who underwent liver transplant surgery between September 2013 and December 2019 were screened for inclusion. Patients who underwent combined transplantation surgery and those with a history of previous liver transplantation (i.e., redo surgery) were not included. Logistic regression modeling included univariate and multivariate analyses. Receiver operating characteristic (ROC) curves and areas under the curves (AUROCs) were calculated. Lactate thresholds and association with outcome were analyzed for specificity, sensitivity, and Youden’s index.RESULTS: Of 226 patients included, 18.4% died within 1-year of liver transplantation. Immediate postoperative lactate concentration was independently associated with 1-year mortality with an odds ratio (OR) of 1.35 (95% CI: 1.16 to 1.59; p<0.001) per mEq/L increase in lactate and an AUROC of 0.80 (95% CI: 0.72 to 0.87; p<0.001). A lactate concentration of 2.25 mEq/L (cut-off determined using Youden’s index) was associated with increased 1-year mortality with a sensitivity of 0.71 and a specificity of 0.72. CONCLUSION: Increased arterial lactate concentration on admission to the ICU immediately after orthotopic liver transplantation is independently associated with increased 1-year mortality.Trial Registration: Not Applicable

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 Association between donor and recipient Interleukin-18 gene polymorphisms and the risk of infection after liver transplantation

2017 ◽  
pp. E176-E187 ◽  
Author(s):  
Bao-Jie Shi ◽  
Xiao-Yu Yu ◽  
Hao Li ◽  
Tong-Hai Xing ◽  
Jun-Wei Fan ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Bacterial Infection ◽  
Liver Transplant ◽  
Gene Polymorphisms ◽  
Bacterial Infections ◽  
Interleukin 18 ◽  
Donor Liver ◽  
Protein Levels ◽  
Transplant Patients ◽  
Increased Risk

Purpose: The purpose of this study was to retrospectively evaluate the association between Interleukin-18 (IL-18) gene polymorphisms of the donor and recipient in liver transplant patients with bacterial infections. Methods: Five single nucleotide polymorphisms (SNPs) (rs7106524, rs5744247, rs1946518, rs549908 and rs187238) of the IL-18 gene from the donors were genotyped and their association with post-operative bacterial infections was evaluated in liver transplant patients (N=113). A second independent group of liver transplant patients from a different organ transplant centre was also recruited for validation purposes (N=44). Results: IL-18 mRNA mean expression levels and protein levels were significantly lower in liver transplant patients with bacterial infections. For the donor SNP rs1946518, more recipients carried the A allele in the bacterial-infected group than the uninfected group (61.4% vs 39.7%; P ≤0.002). The mean IL-18 mRNA expression and protein levels were significantly lower in the transplanted livers of recipients carrying the rs1946518 AA genotype compared with those from recipients with CC genotype (3.64, 3.33 vs. 2.75, P≤0.048). The A allele of rs1946518 also resulted in lower luciferase activity than the C allele in a reporter assay. The area under ROC curve indicated that the rs1946518 SNP genotype in the donor liver predicted an increased risk of bacterial infection after liver transplantation (AUROC>0.82). Conclusions: These findings indicate that the IL-18 rs1946518 SNP in the donor liver is a risk factor for developing bacterial infection after liver transplantation.

ID: 3522307 LIVER TRANSPLANT PATIENTS WITH INTRAHEPATIC STRICTURES ARE AT INCREASED RISK OF POST-ERCP INFECTIOUS COMPLICATIONS

2021 ◽  
Vol 93 (6) ◽  
pp. AB133
Author(s):  
Ian Holmes ◽  
Muhammad Bashir ◽  
Thomas E. Kowalski ◽  
David E. Loren ◽  
Anand Kumar ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Infectious Complications ◽  
Transplant Patients ◽  
Increased Risk

scholarly journals Systematic Review and Meta-Analysis on the Impact of Thrombolytic Therapy in Liver Transplantation Following Donation after Circulatory Death

2018 ◽  
Vol 7 (11) ◽  
pp. 425 ◽  
Author(s):  
Kumar Jayant ◽  
Isabella Reccia ◽  
Francesco Virdis ◽  
A. Shapiro
Keyword(s):  
Liver Transplantation ◽  
Blood Transfusion ◽  
Graft Survival ◽  
Meta Analysis ◽  
Donation After Cardiac Death ◽  
Clinical Trial Registry ◽  
Increased Risk ◽  
Increasing Demand ◽  
One Year ◽  
The Impact

Aim: The livers from DCD (donation after cardiac death) donations are often envisaged as a possible option to bridge the gap between the availability and increasing demand of organs for liver transplantation. However, DCD livers possess a heightened risk for complications and represent a formidable management challenge. The aim of this study was to evaluate the effects of thrombolytic flush in DCD liver transplantation. Methods: An extensive search of the literature database was made on MEDLINE, EMBASE, Cochrane, Crossref, Scopus databases, and clinical trial registry on 20 September 2018 to assess the role of thrombolytic tissue plasminogen activator (tPA) flush in DCD liver transplantation. Results: A total of four studies with 249 patients in the tPA group and 178 patients in the non-tPA group were included. The pooled data revealed a significant decrease in ischemic-type biliary lesions (ITBLs) (P = 0.04), re-transplantation rate (P = 0.0001), and no increased requirement of blood transfusion (P = 0.16) with a better one year graft survival (P = 0.02). Conclusions: To recapitulate, tPA in DCD liver transplantation decreased the incidence of ITBLs, re-transplantation and markedly improved 1-year graft survival, without any increased risk for blood transfusion, hence it has potential to expand the boundaries of DCD liver transplantation.

scholarly journals 3421 Evaluation of novel biomarkers of hepatocellular carcinoma development and recurrence in liver transplant patients

2019 ◽  
Vol 3 (s1) ◽  
pp. 143-144
Author(s):  
Jenna Mancinelli ◽  
David Walls ◽  
Baoli Chang ◽  
Brendan Keating ◽  
Maarouf Hoitet ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Clinical Utility ◽  
Genetic Variant ◽  
Prediction Models ◽  
Disease Recurrence ◽  
Visceral Adiposity ◽  
Transplant Patients ◽  
Increased Risk ◽  
Novel Biomarkers ◽  
Level Of Risk

OBJECTIVES/SPECIFIC AIMS: Given the poor prognosis of HCC and its increasing incidence worldwide, identifying biomarkers of HCC has been an active area of research. While biomarkers are being identified at a rapid pace, many are still in early phases of clinical study and very few have proven clinical utility. The objective of this study is to identify novel biomarkers of HCC and evaluate their clinical utility as predictors of disease development and prognosis with specific emphasis on disease recurrence after liver transplantation. Biomarkers will be identified through GWAS, as well as through analysis of qualitative and quantitative liver traits by magnetic resonance imaging (MRI). These novel biomarkers will then by implemented into risk prediction models aimed to assess an individual’s risk for development of HCC and stratify their level of risk according to predicted disease prognosis. METHODS/STUDY POPULATION: This will be a case-control study, analyzing data from previously created biorepositories from four cohorts of recipients across multiple centers which have undergone liver transplant. First, a GWAS will be performed to identify genetic variant(s). Second, pre-transplant MRI’s will be evaluated using CAVASS software to assess liver quantitative and qualitative traits, including visceral adiposity. Lastly, these findings will be implemented into risk stratification models to assess each individual’s level of risk for development of HCC and for recurrence of HCC after transplant. RESULTS/ANTICIPATED RESULTS: We hypothesize that genetic variant(s) are associated with positive HCV status and the development of HCC. Additionally, we hypothesize that increased visceral adiposity measured by MRI will have an association with recurrence of HCC after transplant. Lastly, we hypothesize that possession of these aforementioned features will be associated with an increased risk of HCC development and recurrence after transplant. DISCUSSION/SIGNIFICANCE OF IMPACT: As more is learned about the nature and reliability of these biomarkers, their potential clinical applications will be revealed. Ideally these proposed risk score models will ultimately be used by clinicians to provide personalized disease management while optimizing the allocation of health care resources. For instance, this may lead to changes in the MRI screening frequency of patients considered to be at high risk for HCC. The ability to diagnose patients early and provide personalized therapies may ultimately result in fewer disease related mortalities in the future.

Clostridium Difficile-Associated Disease in Allogeneic Transplant Patients.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5095-5095
Author(s):  
Justin S. Sadhu ◽  
Erik R. Dubberke ◽  
Robert Gatti ◽  
Steven M. Devine ◽  
Victoria J. Fraser
Keyword(s):  
Clostridium Difficile ◽  
Retrospective Chart Review ◽  
Adverse Outcomes ◽  
Allogeneic Transplant ◽  
Risk Of Death ◽  
Transplant Patients ◽  
Increased Risk ◽  
One Year ◽  
Gastric Acid Suppression ◽  
Underlying Diseases

Abstract Allogeneic transplant (allo) patients (pts) are at high risk for Clostridium difficile-associated disease (CDAD), yet there are few studies evaluating CDAD in allo pts. We carried out a retrospective chart review of all allo pts who had CDAD on a transplant (tx) unit between 8/01 and 7/03. 37 pts were identified who had CDAD during tx hospitalization (hosp) or after tx during the study period. 17 (46%) were admitted for initial tx, 13 (35%) for infection, and 7 (19%) for other reasons. 15 (40%) had acute leukemia, 6 (16%) lymphoma, 4 (11%) myelodisplastic syndrome, and 12 (32%) other underlying diseases. On admission, 17 (46%) pts were in complete remission, 4 (11%) in partial remission, 7 (19%) in relapse, and 9 (24%) presented with refractory disease. 5 pts (14%) had CDAD before day 0 (median d-2, range d-9 to d-1) and 32 pts (86%) had CDAD after tx (median d+49, d0 to d+3185). In the 60 days prior to CDAD, pts had median 1 (0–4) prior hosp and 15 days (1–50) hospitalized; 36 pts (97%) received antibiotics, 35 (95%) immunosuppressants, 33 (89%) antimotility/narcotic agents, 31 (84%) gastric acid suppression, 23 (62%) chemo, and 14 (38%) TBI. Within 48 hours of CDAD, 31 (86%) pts had diarrhea, 12 (33%) fever, 10 (28%) abdominal tenderness, 7 (19%) abdominal distention, and 7 (19%) hypothermia. 22 pts (59%) had either moderate or severe CDAD. 25 (68%) pts were treated for their primary episode of CDAD with metronizadole (met), 2 (5%) with vancomycin (vanc), 8 (22%) with met and vanc, and 2 (5%) were not treated for CDAD. 32 (86%) pts responded to therapy (median 2 days, range 0–25 days). Of the 32 pts who had CDAD post allo, 3 (9%) had gut graft-versus-host disease (GVHD) before CDAD and 8/29 (28%) developed gut GVHD after CDAD. Those 8 pts developed CDAD median d+114 (range +1 to +278) and gut GVHD d+131 (+1 to +454), with gut GVHD coming median 11 days (0 to 176) after CDAD. 7 pts (19%) died before discharge. The median survival time for all pts was 79 days after CDAD and 205 days after tx. Of the 30 (81%) pts discharged alive, 10 (33%) had recurrent CDAD episodes (median 1, range 1–3). When compared to mild CDAD, patients with severe CDAD had an increased risk of death at one year after CDAD (OR 3.3; CI 1.4–7.6). CDAD in allo pts may be associated with an increased risk of gut GVHD, death, and other adverse outcomes.

scholarly journals Care of the Liver Transplant Patient

2014 ◽  
Vol 28 (4) ◽  
pp. 213-219 ◽  
Author(s):  
Mamatha Bhat ◽  
Said A Al-Busafi ◽  
Marc Deschênes ◽  
Peter Ghali
Keyword(s):  
Liver Transplant ◽  
Transplant Patient ◽  
Keywords Liver Transplantation ◽  
Metabolic Complications ◽  
Transplant Patients ◽  
Medical Issues ◽  
Metabolic Bone ◽  
Increased Risk

OBJECTIVE: To provide an approach to the care of liver transplant (LT) patients, a growing patient population with unique needs.METHODS: A literature search of PubMed for guidelines and review articles using the keywords “liver transplantation”, “long term complications” and “medical management” was conducted, resulting in 77 articles.RESULTS: As a result of being on immunosuppression, LT recipients are at increased risk of infections and must be screened regularly for metabolic complications and malignancies.DISCUSSION: Although immunosuppression is key to maintaining allograft health after transplantation, it comes with its own set of medical issues to follow. Physicians following LT recipients must be aware of the greater risk for hypertension, diabetes, dyslipidemia, renal failure, metabolic bone disease and malignancies in these patients, all of whom require regular monitoring and screening. Vaccination, quality of life, sexual function and pregnancy must be specifically addressed in transplant patients.

Pharmacokinetic and pharmacogenetic analysis of tacrolimus in pediatric liver transplant patients in the early post-liver transplantation period

2014 ◽  
Vol 46 ◽  
pp. e71
Author(s):  
Pier Luigi Calvo ◽  
Michele Pinon ◽  
Roberto Canaparo ◽  
Antonio D’Avolio ◽  
Andrea Brunati ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Transplant Patients ◽  
Pediatric Liver ◽  
Pediatric Liver Transplant

scholarly journals Morphological Characteristics of Biliary Strictures after Liver Transplantation Visualized Using SpyGlass™ Cholangioscopy

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Yathip M. Chokpapone ◽  
Anne R. Murray ◽  
Ashwini P. Mehta ◽  
Vichin C. Puri ◽  
Alejandro Mejia ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Morphological Characteristics ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Biliary Complications ◽  
Direct Visualization ◽  
Biliary Strictures ◽  
Endoscopic Retrograde ◽  
Visualization System ◽  
Transplant Patients

Biliary complications following liver transplant are common. Endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) are the main techniques used to diagnose and treat biliary complications; however, these techniques have limits to the depth of visualization. In this report, we present five cases of orthotopic liver transplant patients with biliary complications that underwent ERCP- or MRCP-guided cholangioscopy with the SpyGlass™ DS Direct Visualization System (SDDVS). The SDDVS allowed for the visualization of the morphological characteristics of biliary strictures, and images collected using the SDDVS allowed for four of the cases to be treated endoscopically. Our findings suggest that cholangioscopy with the SDDVS is a promising method to guide the endoscopic treatment of biliary complications after liver transplantation.

scholarly journals Liver Grafts with Major Extended Donor Criteria May Expand the Organ Pool for Patients with Hepatocellular Carcinoma

2019 ◽  
Vol 8 (10) ◽  
pp. 1692 ◽  
Author(s):  
Vladimir Lozanovski ◽  
Larissa Kerr ◽  
Elias Khajeh ◽  
Omid Ghamarnejad ◽  
Jan Pfeiffenberger ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Graft Survival ◽  
Patient Survival ◽  
Laboratory Model ◽  
Transplant Patients ◽  
One Year ◽  
End Stage ◽  
Donor Criteria ◽  
Extended Donor Criteria

The major extended donor criteria (maEDC; steatosis >40%, age >65 years, and cold ischemia time >14 h) influence graft and patient outcomes after liver transplantation. Despite organ shortages, maEDC organs are often considered unsuitable for transplantation. We investigated the outcomes of maEDC organ liver transplantation in patients with hepatocellular carcinoma (HCC). Two hundred and sixty-four HCC liver transplant patients were eligible for analysis. Risk factor analysis was performed for early allograft dysfunction; primary nonfunction; 30-day and 90-day graft failure; and 30-day, 90-day, and 1-year patient mortality. One-year graft survival was higher in recipients of no-maEDC grafts. One-year patient survival did not differ between the recipients of no-maEDC and maEDC organs. The univariate and multivariate analyses revealed no association between maEDC grafts and one-year patient mortality. Graft survival differed between the recipients of no-maEDC and maEDC organs after correcting for a laboratory model of end-stage liver disease (labMELD) score with a cut-off value of 20, but patient survival did not. Patient survival did not differ between recipients who did and did not meet the Milan criteria and who received grafts with and without maEDC. Instead of being discarded, maEDC grafts may expand the organ pool for patients with HCC without impairing patient survival or recurrence-free survival.

Sign in / Sign up

Export Citation Format

Share Document