scholarly journals Liver transplant waitlist removal, transplantation rates and post-transplant survival in Hispanics

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244744
Author(s):  
Paul J. Thuluvath ◽  
Waseem Amjad ◽  
Talan Zhang
Keyword(s):  
Liver Transplant ◽  
Graft Survival ◽  
Propensity Scores ◽  
Patient Survival ◽  
Hazard Ratio ◽  
Lower Probability ◽  
Matched Cohort ◽  
The Usa ◽  
Waitlist Mortality ◽  
Patient And Graft Survival

Background and objectives Hispanics are the fastest growing population in the USA, and our objective was to determine their waitlist mortality rates, liver transplantation (LT) rates and post-LT outcomes. Methods All adults listed for LT with the UNOS from 2002 to 2018 were included. Competing risk analysis was performed to assess the association between ethnic group with waitlist removal due to death/deterioration and transplantation. For sensitivity analysis, Hispanics were matched 1:1 to Non-Hispanics using propensity scores, and outcomes of interest were compared in matched cohort. Results During this period, total of 154,818 patients who listed for liver transplant were involved in this study, of them 23,223 (15%) were Hispanics, 109,653 (71%) were Whites, 13,020 (8%) were Blacks, 6,980 (5%) were Asians and 1,942 (1%) were others. After adjusting for differences in clinical characteristics, compared to Whites, Hispanics had higher waitlist removal due to death or deterioration (adjusted cause-specific Hazard Ratio: 1.034, p = 0.01) and lower transplantation rates (adjusted cause-specific Hazard Ratio: 0.90, p<0.001). If Hispanics received liver transplant, they had better patient and graft survival than Non-Hispanics (p<0.001). Compared to Whites, adjusted hazard ratio for Hispanics were 0.88 (95% CI 0.84, 0.92, p<0.001) for patient survival and 0.90 (95% CI 0.86, 0.94, p<0.001) for graft survival. Our analysis in matched cohort showed the consistent results. Conclusions This study showed that Hispanics had higher probability to be removed from the waitlist due to death, and lower probability to be transplanted, however they had better post-LT outcomes when compared to whites.

scholarly journals The Influence of Donor and Recipient Complement C3 Polymorphisms on Liver Transplant Outcome

2021 ◽  
Vol 2021 ◽  
pp. 1-14
Author(s):  
Maria Pires ◽  
James Underhill ◽  
Abdel Douiri ◽  
Alberto Quaglia ◽  
Wayel Jassem ◽  
...  
Keyword(s):  
Brain Death ◽  
Liver Transplant ◽  
Graft Survival ◽  
Proportional Hazards ◽  
Patient Survival ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Complement C3 ◽  
Patient And Graft Survival ◽  
Circulatory Death

Despite early reports of an impact of complement C3 polymorphism on liver transplant patient and graft survival, subsequent evidence has been conflicting. Our aim was to clarify the contributions of donor and recipient C3 genotype, separately and together, on patient and graft outcomes and acute rejection incidence in liver transplant recipients. Eight donor/recipient groups were analyzed according to their genotype and presence or absence of C3 F allele (FFFS, FFSS, FSFF, FSFS, FSSS, SSFF, SSFS, and SSSS) and correlated with clinical outcomes of patient survival, graft survival, and rejection. The further impact of brain death vs. circulatory death during liver donation was also considered. Over a median 5.3 y follow-up of 506 patients with clinical information and matching donor and recipient tissue, five-year patient and graft survival (95% confidence interval) were 90(81-91)% and 77(73-85)%, respectively, and 72(69-94)% were rejection-free. Early disadvantages to patient survival were associated with donor C3 F variant, especially in brain-death donors. Recipient C3 genotype was an independent determinant of graft survival by Cox proportional hazards analysis (hazard ratio 0.26, P = 0.04 ), and the C3 F donor variant was again associated with worse liver graft survival, particularly in brain-death donors. C3 genotype did not independently determine rejection incidence, but a greater proportion of recipient C3 F carriers were rejection-free in the circulatory death, but not the brain-death cohort. Cox proportional hazards analysis revealed significant effects of acute rejection on patient survival (hazard ratio 0.24, P = 0.018 ), of retransplantation on rejection risk (hazard ratio 6.3, P = 0.009 ), and of donor type (circulatory-death vs. brain-death) on rejection incidence (hazard ratio 4.9, P = 0.005 ). We conclude that both donor and recipient complement C3 genotype may influence patient and graft outcomes after liver transplantation but that the type of liver donor is additionally influential, possibly via the inflammatory environment of the transplant.

Endoscopic management of biliary strictures in liver transplant recipients: effect on patient and graft survival

1998 ◽  
Vol 47 (2) ◽  
pp. 128-135 ◽  
Author(s):  
Rafat S. Rizk ◽  
John P. McVicar ◽  
Mary J. Emond ◽  
Charles A. Rohrmann ◽  
Kris V. Kowdley ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Graft Survival ◽  
Endoscopic Management ◽  
Transplant Recipients ◽  
Biliary Strictures ◽  
Liver Transplant Recipients ◽  
Patient And Graft Survival

The impact of sarcopenia and myosteatosis in liver transplant candidates on peritransplant course and patient and graft survival

2021 ◽  
Vol 75 (4) ◽  
pp. 311-322
Author(s):  
Irena Míková ◽  
Denisa Kyselová ◽  
Dana Kautznerová ◽  
Marek Tupý ◽  
Marek Kysela ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Graft Survival ◽  
Blood Transfusions ◽  
Term Survival ◽  
Skeletal Muscle Index ◽  
Long Term Survival ◽  
Psoas Major Muscle ◽  
The Impact ◽  
Patient And Graft Survival

Introduction: Sarcopenia (severe muscle depletion) and myosteaosis (pathological fat accumulation in muscle) are frequent muscle abnormalities in patients with cirrhosis associated with unfavorable prognosis. The aim of our study was to evaluate the impact of sarcopenia and myosteatosis in liver transplant (LT) candidates in our center on the peritransplant course and patient and graft survival. Methods: This prospective study included adult LT candidates who underwent clinical and laboratory examination. The skeletal muscle index (SMI) at L3 level and radiodensity of psoas major muscle (PM-RA) were evaluated by CT. Results: Pretransplant sarcopenia was found in 49 of 103 patients (47.6%) and myosteatosis in 53 (51.5%) patients. Patients with sarcopenia had lower BMI, waist circumference, occurrence of hypertension and metabolic syndrome and lower triglyceride and C-peptide levels than patients without sarcopenia. Patients with myosteatosis had higher Child-Pugh score and lower HDL-cholesterol levels than patients without myosteatosis. Pretransplant SMI negatively correlated with the amount of blood transfusions given during LT and occurrence of biliary complications. Patients with myosteatosis had higher need for blood transfusions during LT and after LT, and higher number of surgical revisions. Occurrence of sarcopenia had no significant effect on patient and graft survival. Patients with myosteatosis had worse long-term survival than patients without myosteatosis, the graft survival did not differ. Conclusion: Sarcopenia and myosteatosis are frequent muscle abnormalities in LT candidates with negative impact on peritransplant course. Myosteatosis was associated with a worse long-term survival in our study. Key words: sarcopenia – myosteatosis – liver transplantation – prevalence – complications – survival

MO943IMPACT OF NON-ACTIVE HEPATITIS B ON PATIENT SURVIVAL AFTER RENAL TRANSPLANTATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Anissa Paschereit ◽  
Klemens Budde ◽  
Michael Dürr ◽  
Marcel Naik
Keyword(s):  
Regression Analysis ◽  
Kidney Transplantation ◽  
Hepatitis B ◽  
Graft Survival ◽  
Graft Failure ◽  
Patient Survival ◽  
Kaplan Meier ◽  
Primary Endpoints ◽  
Increased Risk ◽  
Patient And Graft Survival

Abstract Background and Aims Dialysis patients (pts) have an increased risk for hepatitis B (HB) infection and impaired response to HB vaccine compared to the general population. As shown in other studies, patient and graft survival in pts with chronic HB is worse. This study assesses the outcome of HBc-positive patients after kidney transplantation (KTx). Method In our retrospective analysis we included all patients &gt;18 years old, who underwent kidney transplantation from 01.01.1990 to 31.08.2019 in our center. Patients were grouped by their serostatus prior to kidney transplantation into “A: naïve” (HB negative), “B: HBc-positive” (non-active HB) and “C: HBsAg-positive” (chronic HB). Primary endpoints included patient and graft survival analyzed with Kaplan-Meier and log-rank test. Regression analysis was applied to determine independent risk factors for the occurrence of primary endpoints. Results In 2487 kidney transplant patients, serologic markers were retrievable. We identified n=2198 HB naïve, n=218 non-active HB and n=75 chronic HB pts. Overall 29.1% (A:27.7%, B:37.6%, C:45.3%) pts died and 20.3% (A:19.1%, B:27.5%, C:37.3%) pts suffered from graft failure. The 5-year pts survival (Fig. 1) was A: 87.0%, B: 82.8%, C: 82.2%. The 10-year pts survival was A: 71.7%, B: 61.1%, C: 64.5% and the 20-year pts survival was A: 43.1%, B: 26.1%, C: 40.9% (p=0.01). Kaplan-Meier-analysis showed a 5-year graft survival (Fig. 2) of 87.7% in the naïve, 86.1% in non-active HB and 84.3% in chronic HB group. The 10-year graft survival was A: 77.3%, B: 64.9%, C: 76% and the 20-year graft survival was A: 59.7%, B: 52.2%, C: 33.4% (p&lt;0.001). The overall 5-year pts and graft survival (Fig. 3) was A: 78.7%, B: 74.2%, C: 68.6%. The 10-year pts and graft survival was A: 59.8%, B: 46.4%, C: 51.8%. The 20-year overall rate was A: 30.8%, B: 26.4%, C: 14.9% (p&lt;0.001). Regression analysis (Table 1) showed that anti-HBs positivity (≥100 IE/l) was a protective factor for graft failure and death (p&lt;0.001). Conclusion HB leads to earlier graft loss and inferior patient survival. Beside the already known negative effect of chronic HB infection, also in patients with non-active HB infection overall survival was significant worse to HB naïve patients. Thus, non-active HB status is an important risk factor for overall transplant outcome. Next, influence of antiviral and immunosuppressive regimens and incidence of HB-reactivation are to be analyzed.

scholarly journals The impact of cyclosporine dose and level on acute rejection and patient and graft survival in liver transplant recipients

1998 ◽  
Vol 4 (1) ◽  
pp. 34-41 ◽  
Author(s):  
Russell H. Wiesner ◽  
Robert M. Goldstein ◽  
Jeremiah P. Donovan ◽  
Charles M. Miller ◽  
John R. Lake ◽  
...  
Keyword(s):  
Acute Rejection ◽  
Liver Transplant ◽  
Graft Survival ◽  
Transplant Recipients ◽  
Liver Transplant Recipients ◽  
The Impact ◽  
Patient And Graft Survival

Dispelling the myth of Asian homogeneity: Improved outcomes of Chinese Americans after kidney transplantation

2018 ◽  
Vol 3 ◽  
pp. 5-9
Author(s):  
Farah Karipineni ◽  
Afshin Parsikia ◽  
PoNan Chang ◽  
John Pang ◽  
Stalin Campos ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Survival ◽  
Patient Survival ◽  
Graft Loss ◽  
Graft Function ◽  
Chinese Americans ◽  
The United States ◽  
Chinese Patients ◽  
One Year ◽  
Patient And Graft Survival

Objectives: Asians represent the fastest growing ethnic group in the United States. Despite significant diversity within the group, many transplant studies treat Asians as a homogeneous entity. We compared patient and graft survival among major Asian eth- nicities to determine whether any subgroup has superior out- comes. Methods: We conducted a retrospective analysis of kidney trans- plants on Asian and White patients between 2001 and 2012. Co- variates included gender, age, comorbidities, and donor category. Primary outcomes included one-year patient and graft survival. Secondary outcomes included delayed graft function (DGF) and rejection as cause of graft loss and death. Results: Ninety-one Asian patients were identified. Due to the large proportion of Chinese patients (n=37), we grouped other Asians into one entity (n=54) for statistical comparison among Chinese, other Asians, and Whites (n=346). Chinese subjects had significantly lower body mass index (BMI) (p=0.001) and had the lowest proportion of living donors (p>0.001). Patient survival was highest in our Chinese cohort (p>0.001)Discussion: Our study confirms outcome differences among Asian subgroups in kidney transplantation. Chinese demonstrate better patient survival at one year than Whites and non-Chinese Asians despite fewer live donors. Lower BMI scores may partly explain this. Larger, long-term studies are needed to elucidate outcome disparities among Asian subgroups

The Impact of Treatment Delay on Hepatitis C Liver Transplant Outcomes

2021 ◽  
pp. 089719002110342
Author(s):  
Ian A. Booth ◽  
Jacqueline E. Clark ◽  
John C. LaMattina ◽  
Rolf N. Barth ◽  
Abdolreza Haririan ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Liver Transplant ◽  
Graft Survival ◽  
Patient Survival ◽  
Virologic Response ◽  
Nucleic Acid Amplification ◽  
Hcv Treatment ◽  
One Year ◽  
Direct Acting ◽  
The Impact

Background: Direct-acting antivirals for the treatment of hepatitis C virus (HCV) have improved outcomes in liver transplant recipients (LTRs). However, the timing of HCV treatment and approach to treating rejection have not been well described. Additionally, pharmacists’ roles in these comprehensive areas have not been investigated. Methods: This single-center, retrospective, cohort review compared 1-year graft and patient survival between HCV-positive and HCV-negative LTRs. Secondary endpoints included 1-year rejection rates, HCV sustained virologic response and time to HCV treatment. Results: Ninety-two HCV Nucleic Acid Amplification Test (NAT)-positive LTRs were matched 1:1 to HCV-seronegative LTRs. One-year graft and patient survival were similar between groups. HCV-positive LTRs were more likely to experience biopsy-proven acute rejection (BPAR), and despite treatment with pulse steroids, there was no impact on graft survival or occurrence of fibrosing cholestatic hepatitis (FCH). Time to HCV treatment was 5.4–6.4 months post-transplant, with no treatment failures or impact on graft or patient survival. Conclusions: No difference was seen in graft survival at 1 year between HCV-positive and HCV-seronegative LTRs. Delayed time to treatment of HCV and treatment of rejections in the HCV-positive cohort did not impact outcomes. However, pharmacist-driven protocols could ensure more efficient initiation of HCV treatment in the future.

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