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 Adoption of MELD score increases the number of liver transplant

2014 ◽  
Vol 27 (3) ◽  
pp. 201-203 ◽  
Author(s):  
Lucas Souto NACIF ◽  
Wellington ANDRAUS ◽  
Rodrigo Bronze MARTINO ◽  
Vinicius Rocha SANTOS ◽  
Rafael Soares PINHEIRO ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Survival Rates ◽  
Sao Paulo ◽  
Meld Score ◽  
The State ◽  
São Paulo ◽  
Liver Transplants ◽  
Mean Values ◽  
Before And After ◽  
End Stage

BACKGROUND: Liver transplantation is performed at large transplant centers worldwide as a therapeutic intervention for patients with end-stage liver diseases. AIM: To analyze the outcomes and incidence of liver transplantation performed at the University of São Paulo and to compare those with the State of São Paulo before and after adoption of the Model for End-Stage Liver Disease (MELD) score. METHOD: Evaluation of the number of liver transplantations before and after adoption of the MELD score. Mean values and standard deviations were used to analyze normally distributed variables. The incidence results were compared with those of the State of São Paulo. RESULTS: There was a high prevalence of male patients, with a predominance of middle-aged. The main indication for liver transplantation was hepatitis C cirrhosis. The mean and median survival rates and overall survival over ten and five years were similar between the groups (p>0.05). The MELD score increased over the course of the study period for patients who underwent liver transplantation (p>0.05). There were an increased number of liver transplants after adoption of the MELD score at this institution and in the State of São Paulo (p<0.001). CONCLUSION: The adoption of the MELD score led to increase the number of liver transplants performed in São Paulo.

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 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 Sequential Treatment of Biliary Atresia With Kasai Hepatoportoenterostomy and Liver Transplantation: Benefits, Risks, and Outcome in 393 Children

2021 ◽  
Vol 9 ◽  
Author(s):  
Roberto Tambucci ◽  
Catherine de Magnée ◽  
Margot Szabo ◽  
Aniss Channaoui ◽  
Aurore Pire ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Biliary Atresia ◽  
Graft Survival ◽  
Bowel Perforation ◽  
Survival Rates ◽  
Sequential Treatment ◽  
Biliary Cirrhosis ◽  
End Stage ◽  
Sequential Strategy ◽  
Early Reoperation

Introduction: Surgical treatment of biliary atresia (BA) is still based on sequential strategy with Kasai hepatoportoenterostomy (KP) followed by liver transplantation (LT), in case of complicated secondary biliary cirrhosis. Concerns have been expressed regarding the risks of LT related to previous KP, suggesting primary LT as an exclusive treatment of BA.Methods: Single-center retrospective analysis including 393 pediatric patients who underwent LT for BA from 1993 to 2018, categorized into two groups: with (KP) or without (NoKP) previous KP. Pre-LT clinical condition was estimated considering age at LT, time on waiting list, pediatric end-stage liver disease score (PELD), and presence of portal vein hypoplasia. Post-LT outcome was evaluated considering patient and graft survival rates, and need for early reoperation due to abdominal or graft-related complications (&lt;45 days after LT).Results: Two-hundred ninety-six patients (75.3%) were categorized in the KP group, and 97 (24.7%) in the NoKP group. Median age at LT was 1.14 years in the KP group and 0.85 years in the NoKP group (p &lt; 0.0001). PELD score was significantly less severe in KP patients (p &lt; 0.05). One-year patient survival rates were 96.9 and 96.8% in the KP and NoKP groups, respectively (p = 0.43), and the corresponding graft survival was 92.5 and 94.8% (p = 0.97). The need for early reoperation was more frequent in the KP group (29.8%) vs. NoKP group (12.4%, p = 0.01). The rate of bowel perforation was non-significantly higher in the KP group (8.1%) vs. NoKP group (3.1%, p = 0.11).Conclusions: The sequential strategy including KP and LT allowed performing LT in patients with significant older age and better clinical conditions, when compared to those transplanted without previous KP. Patient and graft survivals were not impacted by previous KP. Although previous KP was associated with an increased rate of post-LT surgical complications, bowel perforation and bleeding did not occur significantly more frequently. Such results support the current strategy based on sequential treatment.

Unexpected Complication of Hydroxocobalamin Administration for Refractory Vasoplegia in Orthotopic Liver Transplant: A Case Report

2019 ◽  
Vol 23 (4) ◽  
pp. 409-412 ◽  
Author(s):  
Cara Crouch ◽  
Adrian Hendrickse ◽  
Samuel Gilliland ◽  
M. Susan Mandell
Keyword(s):  
Intensive Care Unit ◽  
Liver Transplantation ◽  
Kidney Transplantation ◽  
End Stage Renal Disease ◽  
Alcoholic Cirrhosis ◽  
Refractory Hypotension ◽  
Liver And Kidney ◽  
Stage Renal Disease ◽  
End Stage ◽  
Hemodialysis Machine

A 40-year-old male with alcoholic cirrhosis and end-stage renal disease presented for simultaneous liver and kidney transplantation. Hemodialysis was utilized intraoperatively during liver transplantation. During the procedure, the patient developed refractory hypotension and ultimately received hydroxocobalamin for vasoplegia. Shortly after administration, the hemodialysis machine ceased working after a “blood leak” alarm developed. Without the ability to continue intraoperative dialysis, the kidney transplantation portion of his surgery was postponed. The patient was transferred to the intensive care unit, where he underwent continuous renal replacement therapy overnight, and his kidney transplant proceeded the following morning.

scholarly journals Liver Transplants for Alcoholic Liver Disease

1991 ◽  
Vol 5 (6) ◽  
pp. 195-198
Author(s):  
RJ Fingerote ◽  
VG Bain ◽  
RN Fedorak
Keyword(s):  
Resource Allocation ◽  
Liver Transplantation ◽  
Liver Disease ◽  
Public Confidence ◽  
Moral Integrity ◽  
Liver Transplants ◽  
Scientific Validity ◽  
End Stage Liver Disease ◽  
Long Run ◽  
End Stage

Alcohol related end-stage liver disease is a principal cause of liver failure. The scarcity of donor livers and the predominance of alcohol related end-stage liver disease has raised the issue of including alcoholics as candidates for liver transplantation. In rationalizing the arguments for and against the treatment of alcoholic end-stage liver disease with transplantation, factors such as recidivism, resource allocation and principles of medical practice must be considered. Public confidence in organ transplantation depends on the scientific validity and moral integrity of the policies adopted. Sound policies will prove defensible while policies based on perceptions or prejudices will, in the long run, harm the process.

scholarly journals THE IMPACT OF THE MELD SCORE ON LIVER TRANSPLANT ALLOCATION AND RESULTS: AN INTEGRATIVE REVIEW

2017 ◽  
Vol 30 (1) ◽  
pp. 65-68 ◽  
Author(s):  
Ana Claudia Oliveira de MORAES ◽  
Priscilla Caroliny de OLIVEIRA ◽  
Olival Cirilo Lucena da FONSECA-NETO
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Liver Transplant ◽  
Alcoholic Cirrhosis ◽  
Meld Score ◽  
Terminal Phase ◽  
Post Surgery ◽  
End Stage ◽  
Donor Criteria ◽  
The Impact

ABSTRACT Introduction: Liver transplantation is intended to increase the survival of patients with chronic liver disease in terminal phase, as well as improved quality of life. Since the first transplant until today many changes have occurred in the organ allocation system. Objective: To review the literature on the Model for End-stage Liver Disease (MELD) and analyze its correlation with survival after liver transplantation. Method: An integrative literature review in Lilacs, SciELO, and Pubmed in October 2015, was realized. Were included eight studies related to the MELD score and its impact on liver transplant. Results: There was predominance of transplants in male between 45-55 y. The main indications were hepatitis C, hepatocellular carcinoma and alcoholic cirrhosis. The most important factors post-surgery were related to the MELD score, the recipient age, expanded donor criteria and hemotransfusion. Conclusion: The MELD system reduced the death rate in patients waiting for a liver transplant. However, this score by itself is not a good predictor of survival after liver transplantation.

scholarly journals Prognosis of liver transplantation: Does postoperative ileus matter?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ruiping Bai ◽  
Rui An ◽  
Kunyu Han ◽  
Mengwen Xue ◽  
Simei Zhang ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Survival Data ◽  
Postoperative Ileus ◽  
Total Bilirubin ◽  
Survival Rates ◽  
Major Complication ◽  
Meld Score ◽  
Gastrointestinal Dysfunction ◽  
End Stage ◽  
Relative Factors

Abstract Background Nowadays, liver transplantation has become a main therapy for end-stage liver disease. However, studies show that there are high mortality and severe complications after liver transplantation. Although gastrointestinal dysfunction is a common and major complication after liver transplantation, there was rarely relative research. This study aims to elucidate the factors about ileus after liver transplantation and patients’ survival. Methods We collected and analyzed the data (n = 318, 2016–2019) from the First Affiliated Hospital of Xi’an Jiaotong University. After excluding cases, a total of 293 patients were included for this study. The subjects were divided into a non-ileus group and an ileus group. We reviewed 38 variables (including preoperative, operative and postoperative relative factors). Additionally, other complications after liver transplantation and survival data were compared between two groups. Results Of the 293 patients, 23.2% (n = 68) experienced postoperative ileus. Ileus patients were not different with non-ileus patients in preoperative, operative and postoperative factors. HBV-positive patients with ileus had a lower MELD score (P = 0.025), and lower postoperative total bilirubin was correlated with ileus (P = 0.049). Besides, Child–Pugh score of HCC patients with ileus was low (P = 0.029). The complications after liver transplantation were not different between two groups. Compared with the patients without ileus, the patients with ileus had a higher mortality rate. Conclusion According to our research, ileus-patients had a lower 1-year survival rates. The preoperative MELD score and postoperative total bilirubin of HBV-positive patients with ileus were lower, and Child–Pugh score of HCC patients with ileus was also lower.

scholarly journals Post Liver Transplantation Survival and Related Prognostic Factors among Adult Recipients in Tehran Liver Transplant Center; 2002–2019

2020 ◽  
Vol 23 (5) ◽  
pp. 326-334
Author(s):  
Elham Madreseh ◽  
Mahmood Mahmoudi ◽  
Mohssen Nassiri-Toosi ◽  
Taban Baghfalaki ◽  
Hojjat Zeraati
Keyword(s):  
Liver Transplantation ◽  
Prognostic Factors ◽  
Cox Model ◽  
Survival Rates ◽  
Underlying Disease ◽  
Historical Cohort ◽  
Transplant Center ◽  
Increasing Demand ◽  
End Stage

Background: Liver transplantation is a standard treatment for patients with end-stage liver disease (ESLD). However, with increasing demand for this treatment and limited resources, it is available only to patients who are more likely to survive. The primary aim was to determine prognostic factors for survival. Methods: We collected data from 597 adult patients with ESLD, who received a single organ and initial orthotopic liver transplantation (OLT) in our center between 20 March 2008 and 20 March 2018. In this historical cohort study, univariate and multiple Cox model were used to determine prognostic factors of survival after transplantation. Results: After a median follow-up of 825 (0–3889) days, 111 (19%) patients died. Survival rates were 88%, 85%, 82% and 79% at 90 days, 1 year, 3 years, and 5 years, respectively. Older patients (HR = 1.27; 95% CI: 1.01–1.59), presence of pre-OLT ascites (HR = 2.03; 95% CI: 1.16–3.57), pre-OLT hospitalization (HR = 1.88; 95% CI:1.02–3.46), longer operative time (HR = 1.006; 95% CI: 1.004–1.008), post-OLT dialysis (HR = 3.51; 95% CI: 2.07–5.94), cancer (HR = 2.69; 95% CI: 1.23–5.89) and AID (HR = 2.04; 95% CI: 1.17–3.56) as underlying disease versus hepatitis, and higher pre-OLT creatinine (HR = 1.67; 95% CI: 1.10–2.52) were associated with decreased survival. Conclusion: In this center, not only are survival outcomes excellent, but also younger patients, cases with better pre-operative health conditions, and those without complications after OLT have superior survival.

Clinical Outcome of Orthotopic Liver Transplantation

2002 ◽  
Vol 25 (10) ◽  
pp. 935-938 ◽  
Author(s):  
G.A. Berlakovich
Keyword(s):  
Liver Transplantation ◽  
Clinical Outcome ◽  
Orthotopic Liver Transplantation ◽  
Hepatic Failure ◽  
Patient Survival ◽  
Standard Procedure ◽  
Survival Rates ◽  
Acute Hepatic Failure ◽  
Term Survival ◽  
End Stage

Orthotopic liver transplantation (OLT) has become a standard procedure for end-stage cirrhosis. The purpose of this anlysis is to give a brief overview on the clinical outcome of OLT. According to a current survey of primary indications for liver transplantation in Europe, virus-induced cirrhosis represents the largest proportion with 25%. The next frequent indication is alcoholic cirrhosis with 19%. Cholestatic diseases amount to 13%, malignancy in cirrhosis 10%, and acute hepatic failure 10%. The outcome of these main indications will be discussed and critical considerations pointed out. Patient survival rates demonstrate for cirrhosis at 1-and 5-year about 80% and 70%, respectively. In acute hepatic failure, more patients are lost in the perioperative period. Not surprisingly, patients transplanted for malignancy show decreased long-term survival. Considering an average of 5-year survival in patients with end-stage liver disease of 20% or less, excellent patient survival can be achieved by liver transplantation.

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