scholarly journals Causes of Death and Survival in Alcoholic Cirrhosis Patients Undergoing Liver Transplantation: Influence of the Patient’s Clinical Variables and Transplant Outcome Complications

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 968
Author(s):  
J. M. Bolarín ◽  
M. D. Pérez-Cárceles ◽  
J. P. Hernández del Rincón ◽  
A. Luna ◽  
A. Minguela ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Sudden Death ◽  
Molecular Mechanisms ◽  
Causes Of Death ◽  
Viral Infections ◽  
Multiorgan Failure ◽  
Alcoholic Cirrhosis ◽  
Post Transplantation ◽  
Term Survival ◽  
Clinical Complications

Background. Clinical and molecular mechanisms involved in the cause and time of death of alcoholic cirrhosis (AC) patients undergoing liver transplantation (LT) are not entirely understood. In sudden death cases, judicial autopsy practice is mandatory for determining the cause and circumstances of death. The medico-legal autopsy data are essential for helping health authorities to guide future public health activities, assess the effectiveness of health systems, and adopt the necessary preventive measures to improve and adapt the treatments in order to increase these patients’ survival. Objective. Our study aimed to determine the different clinical and sociodemographic causes that influence the different causes of death and the short- and long-term survival of AC patients undergoing liver transplantation. Methods. A total of 122 deceased AC patients undergoing LT were analyzed at different times post-transplantation. The main pre- and post-transplant complications were analyzed in relation to the cause of death and the patient’s survival, as well as the causes and time at which the patient’s death occurred. Results. A total of 53.3% of non-sudden death was observed. A large number of the deaths of AC patients undergoing transplantation were due to non-sudden death, sepsis, and graft failure (GF), the main causes of death in the sample being similar in both sexes. In non-sudden deaths, there were no significant differences between the death rates either related or not related to the liver transplant. Sepsis was the main cause, with the highest percentage (21.3%) of mortality, followed by GF (18.9%) and multiorgan failure (15.6%) at ten years. Furthermore, our results showed how pre-transplant clinical complications, such as viral infections and encephalopathy, influence the age at which multiorgan failure occurs in the transplanted patient. Conclusion. Multiorgan failure is the leading cause of sudden death, with higher mortality during the first year after transplantation, followed by sepsis and GF. Our results show the vulnerability of AC patients, both in the hospital period after the transplant and outside.

Pre-Liver Transplantation Evaluation and Listing

2019 ◽  
Vol 03 (04) ◽  
pp. 255-262
Author(s):  
Alexander Pan ◽  
Sean Koppe
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Comprehensive Evaluation ◽  
Organ Distribution ◽  
Post Transplantation ◽  
Term Survival ◽  
Transplant Candidates ◽  
Liver Transplant Waiting List ◽  
End Stage ◽  
Survival Risk

AbstractLiver transplantation provides a curative treatment option for patients with both acute and chronic liver disease, but the decision to list a patient for transplant should be an informed one to maximize post-transplantation benefit and survivability. Potential candidates meeting transplantation indications must undergo a comprehensive evaluation consisting of both physical, as well as psychiatric, assessment to be considered for transplantation. Once listed, a candidate's place on the liver transplant waiting list is determined predominantly by his or her Model for End-Stage Liver Disease (MELD)-Na score, which is a reliable tool to stratify short-term survival risk. The severity of certain conditions, however, is not accurately reflected by the MELD-Na score, and these particular diagnoses may be assigned MELD exception points. Herein, we discuss common indications for liver transplantation: the MELD system and its exceptions, the physical and psychosocial evaluation of potential transplant candidates, and some limitations of the current organ allocation system and efforts to reduce disparity in organ distribution.

ARMS as a Genotyping PCR, a New Technique for Detection of Liver Transplantation Recipients’ C3FF, C3FS, C3SS Allotypes as Predisposing Factor For Post-Transplantation Infections

2021 ◽  
Vol 30 (1) ◽  
pp. 183-190
Author(s):  
Samah M. Awad ◽  
Sanaa S. Hamam
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Viral Infections ◽  
Fungal Infections ◽  
Microbial Colonization ◽  
Amplification Refractory Mutation System ◽  
Sample Collection ◽  
Post Transplantation ◽  
Predisposing Factor ◽  
Microbiological Methods

Background: Complement is a crucial branch of both non-specific and specific immune system. C3 is the third complement component which plays a protective role in viral infections. There are two co-dominant inherited variants or allotypes for C3: C3 fast (C3F) and C3 slow (C3S). C3F variant has been linked to multiple diseases production including infections among liver transplantation recipients. Objectives: To investigate the most common risk factors for post-liver transplantation infections especially preoperative colonization. To identify types and rates of post-liver transplantation infections and their causing organisms. To identify C3 allotypes for both liver transplantation donors and recipients, and to correlate recipients’ allotypes with post-transplantation infections. Methodology: This study is a prospective study; it was conducted from January 2017 to August 2019 on 64 chronic cirrhotic patients, experienced liver transplantation in the National Liver Institute ICU, Menoufia, Egypt, and their donors. Blood cultures and other samples were collected according to site of infection using standard Microbiological sample collection methods and bacterial isolated were identified by standard microbiological methods using VITEK2 Compact automated ID/AST instrument. CMV IgG and IgM were detected by ELISA method. DNA was extracted and the extract was used for detection of C3S and C3F alleles by using Amplification Refractory Mutation System (ARMS). Results: The most common cause for liver transplantation was HCV related liver cirrhosis (26.56%). Risk factors for postliver transplantation were Pre-operative microbial colonization (100%) and long operative time (9.875±2.45 h). 39.8% of post-transplantation infections occurred during second week post-operatively and the commonest infections were drain infections (29.5%) and urinary tract infection (27.3%). 51.7% of liver transplantation recipients were C3FF, 32.8% were C3FS and 15.6% were C3SS. C3FF recipients showed increased relative risk to develop CMV (5.2) and bacterial & fungal infections (2.2) than other recipients’ allotypes. Conclusion: A comprehensive infectious diseases workup including detection of C3 allotype of the candidate for liver transplantation should be done pre-operatively to early detect and treat infections which can improve the outcome of the operation dramatically and improve patients’ life style. More studies should be done to find out if there is relation between donors’ and recipients’ C3 allotypes as currently no clear data still present.

The long-term survival and causes of death in patients who survive at least 1 year after liver transplantation

Surgery ◽  
2002 ◽  
Vol 132 (4) ◽  
pp. 775-780 ◽  
Author(s):  
David P. Vogt ◽  
J.Michael Henderson ◽  
William D. Carey ◽  
David Barnes
Keyword(s):  
Liver Transplantation ◽  
Causes Of Death ◽  
Term Survival ◽  
Long Term Survival

scholarly journals Orthotopic Liver Transplantation in Human-Immunodeficiency-Virus-Positive Patients in Germany

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
E. Anadol ◽  
S. Beckebaum ◽  
K. Radecke ◽  
A. Paul ◽  
A. Zoufaly ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Viral Infections ◽  
Survival Rates ◽  
Hiv Positive ◽  
Post Transplantation ◽  
Immunodeficiency Virus ◽  
Chiari Syndrome ◽  
Hcv Coinfection ◽  
End Stage

Objectives. This summary evaluates the outcomes of orthotopic liver transplantation (OLT) of HIV-positive patients in Germany.Methods. Retrospective chart analysis of HIV-positive patients, who had been liver-transplanted in Germany between July 1997 and July 2011.Results. 38 transplantations were performed in 32 patients at 9 German transplant centres. The reasons for OLT were end-stage liver disease (ESLD) and/or liver failure due to hepatitis C (HCV) (), hepatitis B (HBV) (), multiple viral infections of the liver () and Budd-Chiari-Syndrome. In July 2011 19/32 (60%) of the transplanted patients were still alive with a median survival of 61 months (IQR (interquartile range): 41–86 months). 6 patients had died in the early post-transplantation period from septicaemia (), primary graft dysfunction (), and intrathoracal hemorrhage (). Later on 7 patients had died from septicaemia (), delayed graft failure (), recurrent HCC (), and renal failure (). Recurrent HBV infection was efficiently prevented in 11/12 patients; HCV reinfection occurred in all patients and contributed considerably to the overall mortality.Conclusions. Overall OLT is a feasible approach in HIV-infected patients with acceptable survival rates in Germany. Reinfection with HCV still remains a major clinical challenge in HIV/HCV coinfection after OLT.

Epidemiology, Evolution, and Long-Term Survival of Alcoholic Cirrhosis Patients Submitted to Liver Transplantation in Southeastern Spain

2016 ◽  
Vol 40 (4) ◽  
pp. 794-805 ◽  
Author(s):  
Isabel Legaz ◽  
Elena Navarro-Noguera ◽  
Jose M. Bolarín ◽  
Ana M. García-Alonso ◽  
Aurelio Luna Maldonado ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Alcoholic Cirrhosis ◽  
Term Survival ◽  
Long Term Survival ◽  
Southeastern Spain

scholarly journals Increased Cell-Free DNA Plasma Concentration Following Liver Transplantation Is Linked to Portal Hepatitis and Inferior Survival

2020 ◽  
Vol 9 (5) ◽  
pp. 1543 ◽  
Author(s):  
Felix Krenzien ◽  
Shadi Katou ◽  
Alba Papa ◽  
Bruno Sinn ◽  
Christian Benzing ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Immune Responses ◽  
Viral Infections ◽  
Inflammatory Responses ◽  
Term Survival ◽  
Cell Free Dna ◽  
Reactive Protein ◽  
Free Dna

Donor organ quality is crucial for transplant survival and long-term survival of patients after liver transplantation. Besides bacterial and viral infections, endogenous damage-associated molecular patterns (DAMPs) can stimulate immune responses. Cell-free DNA (cfDNA) is one such DAMP that exhibits highly proinflammatory effects via DNA sensors. Herein, we measured cfDNA after liver transplantation and found elevated levels when organs from resuscitated donors were transplanted. High levels of cfDNA were associated with high C-reactive protein, leukocytosis as well as granulocytosis in the recipient. In addition to increased systemic immune responses, portal hepatitis was observed, which was associated with increased interface activity and a higher numbers of infiltrating neutrophils and eosinophils in the graft. In fact, the cfDNA was an independent significant factor in multivariate analysis and increased concentration of cfDNA was associated with inferior 1-year survival. Moreover, cfDNA levels were found to be decreased significantly during the postoperative course when patients underwent continuous veno-venous haemofiltration. In conclusion, patients receiving livers from resuscitated donors were characterised by high postoperative cfDNA levels. Those patients showed pronounced portal hepatitis and systemic inflammatory responses in the short term leading to a high mortality. Further studies are needed to evaluate the clinical relevance of cfDNA clearance by haemoadsorption and haemofiltration in vitro and in vivo.

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