scholarly journals Selected Patients with Unresectable Perihilar Cholangiocarcinoma (pCCA) Derive Long-Term Benefit from Liver Transplantation

Cancers ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3157
Author(s):  
Adiba I. Azad ◽  
Charles B. Rosen ◽  
Timucin Taner ◽  
Julie K. Heimbach ◽  
Gregory J. Gores
Keyword(s):  
Liver Transplantation ◽  
Sclerosing Cholangitis ◽  
De Novo ◽  
Perihilar Cholangiocarcinoma ◽  
Clinical Factors ◽  
Term Survival ◽  
Improve Patient Selection ◽  
Improve Patient ◽  
Term Benefit

Selected patients with unresectable perihilar cholangiocarcinoma (pCCA) derive long-term benefits from liver transplantation. Between 1993–2019, our group at Mayo Clinic performed 237 transplants for pCCA. With this experience, we note that two distinct patient populations comprise this group of pCCA patients: those with underlying primary sclerosing cholangitis (PSC) and those without identifiable risk factors termed sporadic or de novo pCCA. Long-term survival after transplant is better in PSC patients (74% five-year survival) than in those with de novo pCCA (58% five-year survival). Herein, we review the likely clinical factors contributing to the divergence in outcomes for these two patient populations. We also offer our insights on how further advances may improve patient selection and survival, focusing on the de novo pCCA patient population.

scholarly journals Cardiovascular and Metabolic Consequences of Liver Transplantation: A Review

Medicina ◽  
2019 ◽  
Vol 55 (8) ◽  
pp. 489
Author(s):  
Plotogea ◽  
Ilie ◽  
Sandru ◽  
Chiotoroiu ◽  
Bratu ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Liver Transplantation ◽  
De Novo ◽  
Current Knowledge ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Term Survival ◽  
The Metabolic Syndrome ◽  
Acute Liver Disease

Liver transplantation (LT) is considered the curative treatment option for selected patients who suffer from end-stage or acute liver disease or hepatic malignancy (primary). After LT, patients should be carefully monitored for complications that may appear, partially due to immunosuppressive therapy, but not entirely. Cardiovascular diseases are frequently encountered in patients with LT, being responsible for high morbidity and mortality. Patients with underlying cardiovascular and metabolic pathologies are prone to complications after the transplant, but these complications can also appear de novo, mostly associated with immunosuppressants. Metabolic syndrome, defined by obesity, hypertension, dyslipidemia, and hyperglycemia, is diagnosed among LT recipients and is aggravated after LT, influencing the long-term survival. In this review, our purpose was to summarize the current knowledge regarding cardiovascular (CV) diseases and the metabolic syndrome associated with LT and to assess their impact on short and long-term morbidity and mortality.

scholarly journals Motion – Patients with Primary Sclerosing Cholangitis Should Undergo Early Liver Transplantation: Arguments against the Motion

2002 ◽  
Vol 16 (10) ◽  
pp. 700-702 ◽  
Author(s):  
Jeffrey S Crippin
Keyword(s):  
Liver Transplantation ◽  
Primary Sclerosing Cholangitis ◽  
Sclerosing Cholangitis ◽  
Waiting List ◽  
Term Survival ◽  
Number Of Patients ◽  
Increased Risk ◽  
Accepted Form ◽  
Proven Benefit

Liver transplantation is an accepted form of treatment for patients with primary sclerosing cholangitis (PSC) and can provide long term survival. Cholangiocarcinoma occurs in 10% to 20% of patients with PSC, is difficult to diagnose and has a poor prognosis. It has been proposed that liver transplantation be undertaken early in the course of the PSC, before cancer develops. Such a proposal would have significant implications for the method of assigning priority to patients awaiting liver transplantation. Other patients on the waiting list would experience further delays, while there is no proven benefit for PSC patients. Few patients with this disease are removed from the waiting list because they developed cancer. If one were to state that PSC patients warrant special consideration because of the hypothetical risk of cholangiocarcinoma, the same argument could be applied to patients with hepatitis C and other causes of cirrhosis, who are at increased risk of hepatocellular carcinoma. The transplant allocation system is applied in an equitable fashion to patients with a large variety of liver diseases. Alteration of this system to benefit a small number of patients with PSC would violate the principles on which it was created, and cannot be justified.

scholarly journals Ulcerative colitis has an aggressive course after orthotopic liver transplantation for primary sclerosing cholangitis

Gut ◽  
1998 ◽  
Vol 43 (5) ◽  
pp. 639-644 ◽  
Author(s):  
G V Papatheodoridis ◽  
M Hamilton ◽  
P K Mistry ◽  
B Davidson ◽  
K Rolles ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Liver Transplantation ◽  
Primary Sclerosing Cholangitis ◽  
Bowel Disease ◽  
Sclerosing Cholangitis ◽  
De Novo ◽  
Increased Risk ◽  
Inflammatory Bowel

Background—The course of inflammatory bowel disease after liver transplantation has been reported as variable with usually no change or improvement, but there may be an increased risk of early colorectal neoplasms. In many centres steroids are often withdrawn early after transplantation and this may affect inflammatory bowel disease activity.Aims—To evaluate the course of inflammatory bowel disease in primary sclerosing cholangitis transplant patients who were treated without long term steroids.Methods—Between 1989 and 1996, there were 30 patients transplanted for primary sclerosing cholangitis who survived more than 12 months. Ulcerative colitis was diagnosed in 18 (60%) patients before transplantation; two had previous colectomy. All patients underwent colonoscopy before and after transplantation and were followed for 38 (12–92) months. All received cyclosporin or tacrolimus with or without azathioprine as maintenance immunosuppression.Results—Ulcerative colitis course after transplantation compared with that up to five years before transplantation was the same in eight (50%) and worse in eight (50%) patients. It remained quiescent in eight and worsened in four of the 12 patients with pretransplant quiescent course, whereas it worsened in all four patients with pretransplant active course (p=0.08). New onset ulcerative colitis developed in three (25%) of the 12 patients without inflammatory bowel disease before transplantation. No colorectal cancer has been diagnosed to date.Conclusions—Preexisting ulcerative colitis often has an aggressive course, while de novo ulcerative colitis may develop in patients transplanted for primary sclerosing cholangitis and treated without long term steroids.

Incidence and long-term survival of patients with de novo head and neck carcinoma after liver transplantation

Head & Neck ◽  
2015 ◽  
Vol 38 (5) ◽  
pp. 707-714 ◽  
Author(s):  
Annekatrin Coordes ◽  
Andreas E. Albers ◽  
Minoo Lenarz ◽  
Daniel Seehofer ◽  
Gero Puhl ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Head And Neck ◽  
De Novo ◽  
Head And Neck Carcinoma ◽  
Term Survival ◽  
Long Term Survival ◽  
Neck Carcinoma

Clinical factors which influence the long-term survival of kidney allografts donated from haploidentical donors

1992 ◽  
Vol 5 ◽  
pp. S153-S155
Author(s):  
T. Yasumura ◽  
T. Oka ◽  
Y. Ohmori ◽  
Y. Nakane ◽  
N. Yoshimura ◽  
...  
Keyword(s):  
Clinical Factors ◽  
Term Survival ◽  
Long Term Survival

scholarly journals Ventricular conduction abnormalities as predictors of long‐term survival in acute de novo and decompensated chronic heart failure

2015 ◽  
Vol 3 (1) ◽  
pp. 35-43 ◽  
Author(s):  
Heli Tolppanen ◽  
Krista Siirila‐Waris ◽  
Veli‐Pekka Harjola ◽  
David Marono ◽  
Jiri Parenica ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
De Novo ◽  
Term Survival ◽  
Long Term Survival ◽  
Conduction Abnormalities ◽  
Ventricular Conduction

Application of the BAR score as a predictor of short- and long-term survival in liver transplantation patients

2014 ◽  
Vol 9 (1) ◽  
pp. 113-119 ◽  
Author(s):  
Ivan Dias de Campos Junior ◽  
Raquel Silveira Bello Stucchi ◽  
Elisabete Yoko Udo ◽  
Ilka de Fátima Santana Ferreira Boin
Keyword(s):  
Liver Transplantation ◽  
Term Survival ◽  
Long Term Survival ◽  
Short And Long Term
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