scholarly journals Alcoholic cirrhosis is a good indication for liver transplantation, even for cases of recidivism

Gut ◽  
1999 ◽  
Vol 45 (3) ◽  
pp. 421-426 ◽  
Author(s):  
G-P Pageaux ◽  
J Michel ◽  
V Coste ◽  
P Perney ◽  
P Possoz ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Survival Rates ◽  
Alcoholic Cirrhosis ◽  
Immunosuppressive Regimen ◽  
Recidivism Rate ◽  
Ethical Considerations ◽  
Alcohol Relapse ◽  
Two Factors ◽  
Alcoholic Disease

BACKGROUND/AIMSAlcoholic cirrhosis remains a controversial indication for liver transplantation, mainly because of ethical considerations related to the shortage of donor livers. The aim of this study was to review experience to date, focusing on survival rates and complications, and the effect of alcohol relapse on outcome and alterations in marital and socioprofessional status.METHODSThe results for 53 patients transplanted for alcoholic cirrhosis between 1989 and 1994 were compared with those for 48 patients transplanted for non-alcoholic liver disease. The following variables were analysed: survival, rejection, infection, cancer, retransplantation, employment and marital status, alcoholic recurrence. The same variables were compared between alcohol relapsers and non-relapsers.RESULTSRecovery of employment was the only significantly different variable between alcoholic (30%) and non-alcoholic patients (60%). Two factors influenced survival in the absence of alcohol recidivism: age and abstinence before transplantation. For all other variables, there were no differences between alcoholic and non-alcoholic patients, and, within the alcoholic group, between relapsers and non-relapsers. The recidivism rate was 32%.CONCLUSIONThe data indicate that liver transplantation is justified for alcoholic cirrhosis, even in cases of recidivism, which did no affect survival and compliance with the immunosuppressive regimen. These good results should help in educating the general population about alcoholic disease.

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

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
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.

scholarly journals Liver Transplantation: Past Accomplishments and Future Challenges

1999 ◽  
Vol 13 (3) ◽  
pp. 257-263 ◽  
Author(s):  
William J Wall
Keyword(s):  
Liver Transplantation ◽  
Survival Rates ◽  
Alcoholic Cirrhosis ◽  
Liver Transplants ◽  
Recidivism Rates ◽  
Societal Challenges ◽  
Therapeutic Value ◽  
Future Challenges ◽  
Will Force ◽  
End Stage

Liver transplantation has evolved from a rare and risky operation of questionable therapeutic value to the preferred treatment for an extensive list of end-stage liver diseases. Superior immunosuppression (cyclosporine), and improvements in surgery and anesthesia brought liver grafting to its current level of success. Nearly 60,000 liver transplants have been performed, and survival rates are very good; however liver grafting faces serious immediate and long term challenges, mainly due to the widening gap between donor supply and recipient demand. Increasing numbers of sick candidates, recurrent disease (especially hepatitis C) and recidivism rates after transplantation for alcoholic cirrhosis will force increasingly difficult decisions on candidate selection and priority listing of potential recipients. Although xenotransplantation may be the ultimate solution, it has its own specific set of biological and societal challenges - the full extent of which should be revealed in the next several years.

scholarly journals Risk factors for alcohol relapse after liver transplantation for alcoholic cirrhosis in Japan

2014 ◽  
Vol 20 (3) ◽  
pp. 298-310 ◽  
Author(s):  
Hiroto Egawa ◽  
Katsuji Nishimura ◽  
Satoshi Teramukai ◽  
Masakazu Yamamoto ◽  
Koji Umeshita ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Alcoholic Cirrhosis ◽  
Alcohol Relapse

Alcohol relapse after liver transplantation for alcoholic liver disease: does it matter?

2003 ◽  
Vol 38 (5) ◽  
pp. 629-634 ◽  
Author(s):  
Georges-Philippe Pageaux ◽  
Michael Bismuth ◽  
Pascal Perney ◽  
Valérie Costes ◽  
Samir Jaber ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Alcoholic Liver Disease ◽  
Alcohol Relapse

scholarly journals Multiple Hepatic Veins Reconstruction in Right Lobe Grafts in Living Donor Liver Transplantation … Accept or Reject?

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M A S Al-Meteini ◽  
M M Bahaaeldin ◽  
K M K Elsayed ◽  
A S N Sadary
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Survival Rates ◽  
Mortality Rates ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Right Lobe

Abstract Background chronic liver disease and cirrhosis are important causes of morbidity and mortality in the world. Moreover, the burden of chronic liver disease is projected to increase due in part to the increasing prevalence of end-stage liver disease and HCC secondary to NAFLD and HCV. Aim of the Work in this study we will aim to clarify the importance of adequate venous drainage in right lobe grafts in living donor liver transplantation to determine its impact on the graft survival and avoidance of small for size graft syndrome as regard operative time, operative mortality rates (throughout the first month), normalization of liver functions and 6 month, 1 year survival rates of the patients. Patients and Methods our study population includes all the patients who performed right lobe living donor liver transplantation from January 2014 till June 2018 at the liver transplantation unit at Ain Shams Specialized University Hospital and will be classified in our study into 2 groups: First group Patients for whom we performed a single venous anastmosis including 42 cases. Second group Patients for whom we performed multiple venous anastmoses whether an additional single or double or triple anastmoses including 43 cases. Results our study was held as a retrospective cohort study to compare between the patients who received a single venous anastmosis as the first group (n = 42) and the patients who received multiple venous anastmosis as the second group (n = 43). Conclusion so here we can declare, according to our results, that the second group has better survival rates, less mortality rates, better graft survival, better course when daily follow up with full labs is done concerning platelets levels, ALT, direct bilirubin, INR and according to those results we highly recommend multiple hepatic venous anastmosis, if indicated, to acheive the best results in every single LDLT despite the longer cold and warm ischemic time.

scholarly journals The Impact of Sirolimus on hepatitis C Recurrence after Liver Transplantation

2011 ◽  
Vol 25 (1) ◽  
pp. 28-34 ◽  
Author(s):  
Sonal Asthana ◽  
Christian Toso ◽  
Glenda Meeberg ◽  
David L Bigam ◽  
Andrew Mason ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Hepatitis C ◽  
Patient Survival ◽  
De Novo ◽  
Survival Rates ◽  
Area Under The Curve ◽  
Immunosuppressive Drugs ◽  
Initial Recurrence ◽  
The Impact

BACKGROUND: While some immunosuppression strategies may accelerate hepatitis C virus (HCV) recurrence after liver transplantation (LT), the impact of sirolimus (SRL) is not known.OBJECTIVE: To assess the risk of biopsy-proven HCV recurrence and patient survival using known and suspected risk factors for HCV recurrence as covariates.METHODS: A retrospective analysis of 141 consecutive patients, including 88 who received de novo SRL therapy, who had undergone a first LT for HCV cirrhosis was conducted. Known and suspected risk factor covariates including transplant era, donor and recipient age, Model for End-stage Liver Disease score, cold ischemia time, immunosuppressive drugs and steroid treatment rejection rates were used in the assessment.RESULTS: Overall, 72.3% of the cohort developed biopsy-proven HCV recurrence. The incidence of HCV recurrence was not significantly different for patients treated with SRL (75% versus 69.8%; P=0.5). There was no difference found for time to recurrence, nor did mean activity or fibrosis scores differ at the time of initial recurrence. However, on follow-up using serial biopsies in patients with recurrence, the mean activity and fibrosis scores were significantly lower in the SRL group. Donor age and acute rejection episodes were the only factors affecting the HCV recurrence rate (expB 1.02 [95% CI 1.01 to 1.03]); P=0.03; and expB 2.8 [95% CI 1.8 to 4.3]; P<0.01], respectively). SRL treatment did not alter patient survival rates. Among patients treated with SRL-based immunosuppression, higher drug area under the curve levels were associated with a trend to lower disease activity and fibrosis at diagnosis; however, higher SRL levels were associated with shorter recurrence-free survival (P=0.038).CONCLUSION: Results of the present analysis suggest that de novo SRL-based immunosuppression can be safely used in patients undergoing LT for HCV-associated liver disease; however, SRL-based immunosuppression did not significantly affect the timing or severity of post-transplant HCV recurrence. HCV recurrence in SRL-treated patients had lower progressive activity and fibrosis levels on serial biopsy.

Immunosuppressive regimen and risk for de novo malignancies after liver transplantation for alcoholic liver disease

2018 ◽  
Vol 42 (5) ◽  
pp. 427-435 ◽  
Author(s):  
Jérôme Dumortier ◽  
Delphine Maucort-Boulch ◽  
Domitille Poinsot ◽  
Elsa Thimonier ◽  
Christine Chambon-Augoyard ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Alcoholic Liver Disease ◽  
De Novo ◽  
Immunosuppressive Regimen
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