An Update on Usage of High-Risk Donors in Liver Transplantation

The ideal management for end stage liver disease, acute liver failure, and hepatocellular carcinoma (HCC), within specific criteria, is liver transplantation (LT). Over the years, there has been a steady increase in the candidates listed for LT, without a corresponding increase in the donor pool. Therefore, due to organ shortage, it has been substantially difficult to reduce waitlist mortality among patients awaiting LT. Thus, marginal donors such as elderly donors, steatotic donors, split liver, and donors after cardiac death (DCD), which were once not commonly used, are now considered. Furthermore, it is encouraging to see the passing of Acts, such as the HIV Organ Policy Equity (HOPE) Act, enabling further research and development in utilizing HIV grafts. Subsequently, the newer antivirals have aided in successful post-transplant period, especially for hepatitis C positive grafts. However, currently, there is no standardization, and protocols are center specific in the usage of marginal donors. Therefore, studies with longer follow ups are required to standardize its use.

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Feasibility of Split Liver Transplantation for 2 Adults in the Model of End-Stage Liver Disease Era

Annals of Surgery ◽

10.1097/sla.0b013e3182754b8e ◽

2013 ◽

Vol 258 (2) ◽

pp. 306-311 ◽

Cited By ~ 27

Author(s):

Wei-Chen Lee ◽

Kun-Ming Chan ◽

Hong-Shiue Chou ◽

Ting-Jung Wu ◽

Chen-Fang Lee ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Disease ◽

End Stage Liver Disease ◽

Split Liver Transplantation ◽

Split Liver ◽

End Stage

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Liver transplantation in children: an overview on organ allocation and surgical management

Current Pediatric Reviews ◽

10.2174/1573396317666210604111538 ◽

2021 ◽

Vol 17 ◽

Author(s):

Chiara Grimaldi ◽

Marco Spada ◽

Giuseppe Maggiore

Keyword(s):

Liver Transplantation ◽

Organ Shortage ◽

Perioperative Mortality ◽

Term Survival ◽

Early Referral ◽

End Stage Liver Disease ◽

Metabolic Defects ◽

Partial Liver Transplantation ◽

End Stage

: Liver transplantation is the standard of treatment for children with end-stage liver disease, primary hepatic neoplasms, or liver-localized metabolic defects. Perioperative mortality is almost absent, and long-term survival exceeds 90%. Organ shortage is managed thanks to advances in organ retrieval techniques. Living donation and partial liver transplantation almost eliminated waiting list mortality, thus leading to expanding indications for transplantation. The success of pediatric liver transplantation depends on the prompt and early referral of patients to transplant centers and on the close and integrated multidisciplinary collaboration between pediatricians, hepatologists, surgeons, intensivists, oncologists, pathologists, coordinating nurses, psychologists, and social workers.

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Encouraging Split Liver Transplantation for Two Adult Recipients to Mitigate the High Incidence of Wait-List Mortality in the Setting of Extreme Shortage of Deceased Donors

Journal of Clinical Medicine ◽

10.3390/jcm8122095 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2095

Author(s):

Kun-Ming Chan ◽

Yu-Chao Wang ◽

Tsung-Han Wu ◽

Chih-Hsien Cheng ◽

Chen-Fang Lee ◽

...

Keyword(s):

Liver Transplantation ◽

Characteristic Curve ◽

Graft Loss ◽

Early Mortality ◽

Organ Shortage ◽

Wait List ◽

Donor Pool ◽

Split Liver Transplantation ◽

Split Liver ◽

Graft Weight

Background: Organ demand for liver transplantation (LT) is constantly increasing. Split liver transplantation (SPLT) is an ideal option for increasing the number of available liver grafts for transplantation and ameliorating organ shortage to a certain degree. However, SPLT for two adult recipients is still not broadly applied. Methods: We retrospectively analyzed the outcomes of SPLT for adult recipients at a single center. All donor, recipient, and transplantation factors were thoroughly investigated to clarify factors affecting patient outcomes after LT. Results: One hundred consecutive adult SPLTs were performed during the study period. Early mortality and 1-year mortality occurred in 21 and 31 recipients, respectively. On multivariate analysis, graft weight (p = 0.036, odds ratio = 0.99, 95% confidence interval = 0.98–0.99) was the independent risk factor associated with early mortality; however, no factor was significantly related to 1-year mortality. On receiver operating characteristic curve analysis, a graft weight of 580 g was identified the cutoff for stratifying outcomes. Recipients transplanted with a graft weighing ≥580 g had significantly better outcome as compared with other recipients (p = 0.001). Moreover, SPLT remarkably provided a better survival benefit for recipients than those on the LT wait-list (p < 0.0001). Conclusions: Given the considerable incidence of wait-list mortality, SPLT for two adult recipients should be encouraged whenever possible to increase the donor pool and benefit patients awaiting LT. Nonetheless, caution should be taken with a smaller graft weight owing to the risk of early graft loss.

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Rewarming Machine Perfusion System for Liver Transplantation

Journal of Medical Devices ◽

10.1115/1.4025189 ◽

2013 ◽

Vol 7 (4) ◽

Cited By ~ 4

Author(s):

Hiromichi Obara ◽

Naoto Matsuno ◽

Takanobu Shigeta ◽

Shin Enosawa ◽

Toshihiko Hirano ◽

...

Keyword(s):

Liver Transplantation ◽

Organ Donor ◽

Liver Graft ◽

Donation After Cardiac Death ◽

Organ Shortage ◽

Machine Perfusion ◽

Porcine Liver ◽

Donor Pool ◽

Liver Preservation ◽

End Stage

The liver is one of the most essential organs, and transplantation is an established treatment for patients with end-stage disease who have lost their liver function. However, organ shortage is a critical problem in transplantation; thus, the development of an innovative preservation system to adopt critical grafts obtained from extended criteria donors or donation after cardiac death donors as viable organs for transplantation is necessary. We recently developed a novel rewarming machine perfusion preservation system for liver transplantation, and herein discuss this system, which allows the perfusion temperature to be controlled during the transition from hypothermic to subnormothermic conditions. This system has two functions: (1) the preservation and recovery of organ function and (2) screening the organ for viability. To achieve these functions, this system has three features: (1) temperature control of the preservation perfusate and liver graft, (2) dual-controlled perfusion of the portal vein and hepatic artery, and (3) real-time monitoring of the perfusion conditions, including the flow rate, perfusion pressure and temperature. This system was useful for liver preservation and for evaluating the graft viability and recovery of functions during machine perfusion before transplantation. This novel rewarming machine preservation system was tested in an experimental model using porcine liver grafts. We report that this system has certain advantages in liver preservation, and believe that this system will positively contribute to the expansion of the organ donor pool.

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Multicentric evaluation of model for end-stage liver disease-based allocation and survival after liver transplantation in Germany - limitations of the ‘sickest first’-concept

Transplant International ◽

10.1111/j.1432-2277.2010.01161.x ◽

2010 ◽

Vol 24 (1) ◽

pp. 91-99 ◽

Cited By ~ 108

Author(s):

Tobias J. Weismüller ◽

Panagiotis Fikatas ◽

Jan Schmidt ◽

Ana P. Barreiros ◽

Gerd Otto ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Disease ◽

End Stage Liver Disease ◽

End Stage

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Low psoas muscle index as an unfavorable factor in children with end‐stage liver disease undergoing liver transplantation

Pediatric Transplantation ◽

10.1111/petr.13996 ◽

2021 ◽

Author(s):

Settapong Jitwongwai ◽

Chatmanee Lertudomphonwanit ◽

Thitiporn Junhasavasdikul ◽

Praman Fuangfa ◽

Pornthep Tanpowpong ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Disease ◽

Psoas Muscle ◽

End Stage Liver Disease ◽

End Stage

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Combined Heart-Liver and Domino Liver Transplantation in Familial Amyloidosis

The American Surgeon ◽

10.1177/00031348211023427 ◽

2021 ◽

pp. 000313482110234

Author(s):

Angela Sickels ◽

Keyur B. Shah ◽

Brianna Ruch ◽

Adrian Cotterell ◽

Inna Tchoukina ◽

...

Keyword(s):

Liver Transplantation ◽

Total Artificial Heart ◽

Donor Pool ◽

Cardiac Rejection ◽

Recipient Age ◽

Hospital Stays ◽

The Mean ◽

Domino Liver Transplantation ◽

End Stage

Background Combined heart-liver transplantation (CHLT) is the only curative option for patients with concomitant pathology affecting the heart and liver. In some cases, the native livers of familial amyloidosis (FA) patients may be suitable for domino transplantation into other recipients. Methods Retrospective analysis (2013 to 2019) of all CHLT at our center was performed. Continuous data were presented as mean with standard deviation and discrete variables as percentages. Results Familial amyloidosis was the indication for CHLT in 5 out of 6 patients. The mean recipient age was 55 ± 5.62 years. Two patients were bridged with total artificial heart. The mean model for end-stage liver disease score at transplant was 17.17 ± 3.7. Two explanted livers were used for transplantation in a domino fashion. The median intensive care and hospital stays were 5.5 and 19 days, respectively. Complications included renal failure (1), groin abscess (1), pulmonary embolism (1), and cardiac rejection (1). Patient and graft survival for both organs was 100% at a median follow-up of 59 (range 20-76) months. Discussion Combined heart-liver transplantation for FA achieves excellent outcomes. The possible use of livers explanted from patients with FA for domino liver transplantation can contribute to the liver donor pool.

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Alkaline phosphatase isoforms in serum after liver allograft surgery

Clinical Chemistry ◽

10.1093/clinchem/40.7.1272 ◽

1994 ◽

Vol 40 (7) ◽

pp. 1272-1277 ◽

Cited By ~ 5

Author(s):

J Randolph-Habecker ◽

J A Lott ◽

R J Tesi

Keyword(s):

Liver Transplantation ◽

Alkaline Phosphatase ◽

Liver Function Tests ◽

Clinical Findings ◽

High Molecular Mass ◽

Reference Ranges ◽

Liver Allograft ◽

Postoperative Course ◽

End Stage Liver Disease ◽

End Stage

Abstract Orthotopic liver transplantation (OLT) is now the only available treatment for end-stage liver disease; the major postoperative complications of OLT are rejection and infection. Fractionation of alkaline phosphatase (ALP) isoforms in serum by isoelectric focusing can be used to identify patients with complications. Reference ranges for liver-function tests (LFT) and liver ALP isoforms were established for post-OLT patients with stable postoperative courses and compared with those of patients with complications. We found canalicular, hepatocyte, and high-molecular-mass ALP to be statistically higher in nearly all patients with complications as compared with patients who had a stable postoperative course; these tests may identify patients requiring a liver biopsy. When used in conjunction with LFT and other clinical findings, ALP isoforms could aid in the monitoring of complications and treatment and in the adjustment of immunosuppressive therapy in stable OLT cases.

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RIPK3-Mediated Necroptosis and Neutrophil Infiltration Are Associated with Poor Prognosis in Patients with Alcoholic Cirrhosis

Journal of Immunology Research ◽

10.1155/2018/1509851 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Zhenzhen Zhang ◽

Guomin Xie ◽

Li Liang ◽

Hui Liu ◽

Jing Pan ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Disease ◽

Poor Prognosis ◽

Alcoholic Cirrhosis ◽

Normal Liver ◽

Neutrophil Infiltration ◽

Meld Score ◽

End Stage Liver Disease ◽

Cirrhotic Patients ◽

End Stage

Alcoholic cirrhosis is an end-stage liver disease with impaired survival and often requires liver transplantation. Recent data suggests that receptor-interacting protein kinase-3- (RIPK3-) mediated necroptosis plays an important role in alcoholic cirrhosis. Additionally, neutrophil infiltration is the most characteristic pathologic hallmark of alcoholic hepatitis. Whether RIPK3 level is correlated with neutrophil infiltration or poor prognosis in alcoholic cirrhotic patients is still unknown. We aimed to determine the correlation of RIPK3 and neutrophil infiltration with the prognosis in the end-stage alcoholic cirrhotic patients. A total of 20 alcoholic cirrhotic patients subjected to liver transplantation and 5 normal liver samples from control patients were retrospectively enrolled in this study. Neutrophil infiltration and necroptosis were assessed by immunohistochemical staining for myeloperoxidase (MPO) and RIPK3, respectively. The noninvasive score system (model for end-stage liver disease (MELD)) and histological score systems (Ishak, Knodell, and ALD grading and ALD stage) were used to evaluate the prognosis. Neutrophil infiltration was aggravated in patients with a high MELD score (≥32) in the liver. The MPO and RIPK3 levels in the liver were positively related to the Ishak score. The RIPK3 was also significantly and positively related to the Knodell score. In conclusion, RIPK3-mediated necroptosis and neutrophil-mediated alcoholic liver inflammatory response are highly correlated with poor prognosis in patients with end-stage alcoholic cirrhosis. RIPK3 and MPO might serve as potential predictors for poor prognosis in alcoholic cirrhotic patients.

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