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The use of old donors in liver transplantation.

Mon, 06/19/2017 - 12:45

The use of old donors in liver transplantation.

Best Pract Res Clin Gastroenterol. 2017 Apr;31(2):211-217

Authors: Dasari BVM, Schlegel A, Mergental H, Perera MTPR

Abstract
The process of ageing has an impact on the entire human body including the organ systems. In transplantation, professionals are daily faced with risk assessment of suitable donor offers , whether to accept a liver graft for a specific recipient. In this context, livers from elderly donors are more frequently accepted for transplantation, to increase the donor pool and compensate the high waiting list mortality. In the current practice it is not unusual to accept 60-year old donor livers for transplantation, as the donor demographics have significantly changed over the years. However, controversy exists regarding the use of livers from donors above 70 or 80 years, particular in combination with other risk factors, e.g. liver steatosis, warm ischaemia or long cold storage. This review focuses first on the impact of ageing on liver morphology and function. Second, we will highlight outcome after transplantation from elderly donors. Finally, we describe further risk factors and donor-recipient selection under the scope of old donor organs and include our institutional experience and policy.

PMID: 28624109 [PubMed - in process]

Modification of immunosuppressive therapy as risk factor for complications after liver transplantation.

Mon, 06/19/2017 - 12:45

Modification of immunosuppressive therapy as risk factor for complications after liver transplantation.

Best Pract Res Clin Gastroenterol. 2017 Apr;31(2):199-209

Authors: De Simone P, Carrai P, Coletti L, Ghinolfi D, Petruccelli S, Filipponi F

Abstract
Management of complications post-liver transplantation (LT) includes immunosuppressive manipulations with the aim to reduce the overall burden of immunologic suppression and compensate for renal, cardiovascular, metabolic toxicities, and for the increased oncologic risk. Two approaches can be implemented to reduce immunosuppression-related adverse events: upfront schedules tailored to the pretransplant individual patient's risk profile versus downstream modifications in the event of immunosuppression-related complications. Upfront strategies are supported by evidence originating from prospective randomized trials and consist of triple/quadruple schedules whereby calcineurin inhibitors (CNI)-exposure is reduced with combination of anti-CD25 monoclonal antibodies, antimetabolites and corticosteroids. Quadruple regimens allow for staggering of CNI introduction and higher renal function in the early term, but their superiority in the long term has not yet been established. A more recent upfront schedule contemplates early (4 weeks) introduction of mammalian target of rapamycin inhibitor (mTORi) everolimus and allows for reduction of CNI up to 4 years posttransplantation. Incorporation of mTORi has the potential to prolong time to recurrence for patients with hepatocellular carcinoma. However, as suggested by the available evidence, downstream immunosuppressive manipulations are more frequently adopted in clinical practice. These encompass CNI replacement and immunosuppression withdrawal. Switching CNI to mTORi monotherapy is the option most commonly adopted to relieve renal function and compensate for posttransplant malignancies. Its impact is dependent on interval from transplantation and underlying severity of renal impairment. Introduction of mTORi is associated with longer overall survival for patients with extrahepatic posttransplant malignancies, but results are awaited for recurrences of hepatocellular carcinoma. Immunosuppression withdrawal seems feasible (70%) in very long term survivors (>10 years), but is not associated with reversal of immunosuppression-related complications. Awaiting novel immunosuppressive drug categories, integration of upfront strategies with the aim to reduce CNI-exposure and a low threshold for adjustment in the posttransplant course are both advisable to improve long-term outcomes of LT.

PMID: 28624108 [PubMed - in process]

Recurrence of primary sclerosing cholangitis, primary biliary cholangitis and auto-immune hepatitis after liver transplantation.

Mon, 06/19/2017 - 12:45

Recurrence of primary sclerosing cholangitis, primary biliary cholangitis and auto-immune hepatitis after liver transplantation.

Best Pract Res Clin Gastroenterol. 2017 Apr;31(2):187-198

Authors: Visseren T, Darwish Murad S

Abstract
Liver transplantation is a well-accepted treatment for decompensated chronic liver disease due to primary sclerosing cholangitis (PSC), primary biliary cholangitis (PBC) and auto-immune hepatitis (AIH). Survival after liver transplantation is generally good with 1 and 5-year survival rates around 90% and 70-85%. After transplantation, however, these diseases recur in 8.6-27% (rPSC), 10.9-42.3% (rPBC) and 7-42% (rAIH), and this poses significant challenges in terms of management and graft outcome in these patients. In this review we discuss the incidence, clinical presentation, challenges in diagnosis, reported risk factors and impact on post-transplant outcomes of recurrence of PSC, PBC and AIH after liver transplantation. We also discuss some of the limitations of current investigations and formulate idea's for future research objectives.

PMID: 28624107 [PubMed - in process]

Alcohol use and smoking after liver transplantation; complications and prevention.

Mon, 06/19/2017 - 12:45

Alcohol use and smoking after liver transplantation; complications and prevention.

Best Pract Res Clin Gastroenterol. 2017 Apr;31(2):181-185

Authors: Ursic-Bedoya J, Donnadieu-Rigole H, Faure S, Pageaux GP

Abstract
The last thirty years have been very prosperous in the field of liver transplantation (LT), with great advances in organ conservation, surgical techniques, peri-operative management and long-term immunosuppression, resulting in improved patient and graft survival rates as well as quality of life. However, substance addiction after LT, namely alcohol and tobacco, results in short term morbidity together with medium and long-term mortality. The main consequences can be vascular (increased risk of hepatic artery thrombosis in smokers), hepatic (recurrent alcoholic cirrhosis in alcohol relapsers) and oncological (increased risk of malignancy in patients consuming tobacco and/or alcohol after LT). This issue has thus drawn attention in the field of LT research. The management of these two at-risk behaviors addictions need the implication of hepatologists and addiction specialists, before and after LT. This review will summarize our current knowledge in alcohol use and cigarette smoking in the setting of LT, give practical tools for identification of high risk patients and treatment options.

PMID: 28624106 [PubMed - in process]

Hypo- and normothermic perfusion of the liver: Which way to go?

Mon, 06/19/2017 - 12:45

Hypo- and normothermic perfusion of the liver: Which way to go?

Best Pract Res Clin Gastroenterol. 2017 Apr;31(2):171-179

Authors: Selten J, Schlegel A, de Jonge J, Dutkowski P

Abstract
The demand of donor livers for transplantation exceeds the supply. In an attempt to maximize the number of potentially usable donor livers, several centers are exploring the role of machine perfusion. This review provides an update on machine perfusion strategies and basic concepts, based on current clinical issues, and discuss challenges, including currently used biomarkers for assessing the quality and viability of perfused organs. The potential benefits of machine perfusion on immunogenicity and the consequences on post-operative immunosuppression management are discussed.

PMID: 28624105 [PubMed - in process]

Acute kidney injury after liver transplantation: Recent insights and future perspectives.

Mon, 06/19/2017 - 12:45

Acute kidney injury after liver transplantation: Recent insights and future perspectives.

Best Pract Res Clin Gastroenterol. 2017 Apr;31(2):161-169

Authors: de Haan JE, Hoorn EJ, de Geus HRH

Abstract
Acute kidney injury (AKI) is a common postoperative complication after liver transplantation (LT). The occurrence of postoperative AKI after LT (Post-LT AKI) is associated with inferior patient and graft outcomes. Post-LT AKI is multifactorial in origin and has been related to the severity of liver disease, pre-LT renal dysfunction, graft quality, perioperative events and toxicity of immunosuppressive therapy. Furthermore it is thought that hepatic ischaemia reperfusion injury might be a driving force in the aetiology of post-LT AKI. Novel biomarkers for AKI are emerging and can be useful for early identification and characterization of AKI. There is a clear need for strategies aimed at preventing or treating post-LT AKI. Several pharmacological and non-pharmacological interventions have been studied, but so far failed to show any benefit in the prevention of post-LT AKI. Further studies are needed to develop and evaluate new interventions aimed at preventing post-LT AKI and improve patient outcomes.

PMID: 28624104 [PubMed - in process]

From organoids to organs: Bioengineering liver grafts from hepatic stem cells and matrix.

Mon, 06/19/2017 - 12:45

From organoids to organs: Bioengineering liver grafts from hepatic stem cells and matrix.

Best Pract Res Clin Gastroenterol. 2017 Apr;31(2):151-159

Authors: Willemse J, Lieshout R, van der Laan LJW, Verstegen MMA

Abstract
Due to the complex function and structure of the liver, resourceful solutions for treating end-stage liver disease are required. Currently, liver transplantation is the only curative therapeutic option. However, due to a worldwide donor shortage, researchers have been looking in other fields for alternative sources of transplantable liver tissue. Recent advances in our understanding of liver physiology, stem cell and matrix biology, have accelerated tissue engineering research. Most notable is the discovery of a culture system to grow liver-like organoids from human hepatic stem cells. The extensive expansion capacity of these stem cells has contributed greatly to the availability of hepatocyte-like cells for tissue engineering. In addition, new techniques are explored to obtain biological liver scaffolds from full size donor organs. This review summarizes these state-of-art techniques which may lay the groundwork towards re-creating transplantable tissue from autologous or allogenic stem cells in the coming decade.

PMID: 28624103 [PubMed - in process]

Hepatitis E virus: A potential threat for patients with liver disease and liver transplantation.

Mon, 06/19/2017 - 12:45

Hepatitis E virus: A potential threat for patients with liver disease and liver transplantation.

Best Pract Res Clin Gastroenterol. 2017 Apr;31(2):143-150

Authors: van der Eijk AA, Pas SD, de Man RA

Abstract
Immunocompromised patients are at risk of acquiring acute hepatitis E virus infection (HEV), leading to chronicity. Chronic HEV infection is associated with persistent viraemia, raised transaminase activity, histological features associated with chronic hepatitis and evidence of rapid development of cirrhosis. Extrahepatic manifestations have been associated with HEV. Most frequently reported are neurological disorders with predominantly involvement of the peripheral nervous system. In patients using immunosuppressive drugs antibody production is often delayed and HEV RNA detection is superior to serology to detect infection. Therapeutic options for chronic HEV includes tapering immunosuppressive and secondly ribavirin, pegylated interferon alpha (PEG-IFN). Present recommendation is to treat chronic HEV patients for 3 months, asses serum HEV RNA and stool HEV RNA and stop therapy if both are undetectable. Studies are required to determine which other antiviral agents than ribavirin and (PEG-)IFN are of clinical utility in treating HEV in the minority of patients who do not respond to ribavirin.

PMID: 28624102 [PubMed - in process]

Liver failure and liver transplantation.

Mon, 06/19/2017 - 12:45

Liver failure and liver transplantation.

Best Pract Res Clin Gastroenterol. 2017 Apr;31(2):127

Authors: Metselaar HJ

PMID: 28624100 [PubMed - in process]

Radiologic evaluation of vasculobiliary anatomy in the umbilical fissure.

Mon, 06/19/2017 - 12:45

Radiologic evaluation of vasculobiliary anatomy in the umbilical fissure.

J Surg Res. 2017 Jun 15;214:254-261

Authors: Ji GW, Zhu FP, Wang K, Xia YX, Jiao CY, Shao ZC, Li XC

Abstract
BACKGROUND: Preoperative evaluation of vasculobiliary anatomy in the umbilical fissure (U-point) is pivotal for perihilar cholangiocarcinoma (PCCA) applied to right-sided hepatectomy. The purpose of our study was to review the vasculobiliary anatomy in the U-point using three-dimensional (3D) reconstruction technique, to investigate the diagnostic ability of 2D scans to evaluate anatomic variations, and to discuss its surgical implications.
METHODS: A retrospective study of 159 patients with Bismuth type I, II, and IIIa PCCA, who received surgery at our institution from November 2012 to September 2016, was conducted. Anatomic structures were assessed using multidetector computed tomography (MDCT) by one hepatobiliary surgeon, whereas 3D images were reconstructed by an independent radiologist. Normal confluence pattern of left biliary system was defined as the left medial segmental bile duct (B4) joining the common trunk of segment II (B2) and segment III (B3) ducts, whereas aberrant confluence patterns were classified into 3 types: type I, triple confluence of B2, B3, and B4; type II, B2 draining into the common trunk of B3 and B4; type III, other patterns. Surgical anatomy of B4 was classified into the central, peripheral, and combined type according to its relation to the hepatic confluence. The lengths from the bile duct branch of Spiegel's lobe (B1l) to the orifice of B4 and the junction of B2 and B3 were measured on 3D images. The anatomy of left hepatic artery (LHA) was classified according to different origins and the spatial relationship related to the U-point.
RESULTS: 3D reconstruction revealed that normal confluence pattern of left biliary system was observed in 71.1% (113/159) of all patients, and variant patterns were type I in 11.9% (19/159), type II in 12.6% (20/159), and type III in 4.4% (7/159). The length from B1l to the junction of B2 and B3 was 12.1 ± 3.1 mm in type I variation, which was significantly shorter than that in normal configuration (30.0 ± 6.8 mm, P < 0.001) but significantly longer than that in type II variation (9.6 ± 3.4 mm, P = 0.019). Surgical anatomy of B4: the peripheral type was most commonly seen (74.2%, 118/159), followed by central type (15.7%, 25/159) and combined type (10.1%, 16/159). The distance between the B1l and B4 was 8.4 ± 2.4 mm in central and combined type, which was significantly shorter than that in peripheral type (14.5 ± 4.1 mm, P < 0.001). A replaced or accessory LHA from the left gastric artery was present in 6 (3.8%) and 9 (5.7%) patients, respectively. LHA running along the left caudal position of U-point was present in 143 cases (89.9%), along the right cranial position of U-point in nine cases (5.7 %), and combined position in seven cases (4.4%). Interobserver agreement of two imaging modalities was almost perfect in biliary confluence pattern (kappa = 0.90; 95% confidence interval: 0.79-1.00), substantial in surgical anatomy of B4 (kappa = 0.74; 95% confidence interval: 0.62-0.86), and perfect in LHA (kappa = 1.00).
CONCLUSIONS: Thoroughly understanding the imaging characters of surgical anatomy in the U-point may be benefit for preoperative evaluation of PCCA by successive review of 2D images alone, whereas 3D reconstruction technique allows detailed hepatic anatomy and individualized surgical planning for advanced cases.

PMID: 28624053 [PubMed - in process]

Cardiovascular Mortality among Liver Transplant Recipients with Nonalcoholic Steatohepatitis (NASH) in the United States.

Sun, 06/18/2017 - 12:45
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Cardiovascular Mortality among Liver Transplant Recipients with Nonalcoholic Steatohepatitis (NASH) in the United States.

Transpl Int. 2017 Jun 16;:

Authors: Satapathy SK, Jiang Y, Eason JD, Kedia SK, Wong E, Singal AK, Tolley EA, Hathaway D, Nair S, Vanatta JM

Abstract
BACKGROUND: Nonalcoholic Steatohepatitis (NASH) has become an increasingly important indication for liver transplantation (LT), and there has been a particular concern of excessive cardiovascular-related mortality in this group METHODS: Using the United Network for Organ Sharing-Standard Transplant Analysis and Research (UNOS-STAR) dataset, we reviewed data on 56,995 adult transplants (January 2002 through June 2013). 3,170 NASH liver-only recipients were identified and were matched with 3,012 non-NASH HCV+ and 3,159 non-NASH HCV- controls [matched 1:1 based on gender, age at LT (±3 years), and MELD score (±3)] RESULTS: Cox regression analysis revealed significantly lower hazard of all-cause (HR 0.669; p<0.0001) and cardiovascular-related mortality (HR 0.648; P<0.0001) in the NASH compared to the non-NASH group after adjusting for diabetes, BMI, and race. Relative to the non-NASH HCV-positive group, NASH group has lower hazard of all-cause (HR 0.539; p<0.0001) and cardiovascular-related mortality (HR 0.491; p<0001). A lower hazard of all-cause mortality (HR 0.844; p=0.0094) was also observed in NASH patients compared to non-NASH HCV- negative group, but cardiovascular mortality was similar (HR 0.892; p=0.3276) CONCLUSION: LT recipients with NASH have either lower or similar risk of all-cause and cardiovascular-related mortality compared to its non-NASH counterparts after adjusting for diabetes, BMI, and race. This article is protected by copyright. All rights reserved.

PMID: 28622441 [PubMed - as supplied by publisher]

Effects of Portal Hypertension on Gadoxetic Acid-Enhanced Liver Magnetic Resonance: Diagnostic and Prognostic Implications.

Sun, 06/18/2017 - 12:45
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Effects of Portal Hypertension on Gadoxetic Acid-Enhanced Liver Magnetic Resonance: Diagnostic and Prognostic Implications.

Invest Radiol. 2017 Jun 16;:

Authors: Asenbaum U, Ba-Ssalamah A, Mandorfer M, Nolz R, Furtner J, Reiberger T, Ferlitsch A, Kaczirek K, Trauner M, Peck-Radosavljevic M, Wibmer AG

Abstract
OBJECTIVE: The aim of this study was to investigate the impact of portal hypertension (PH) on gadoxetic acid-enhanced liver magnetic resonance imaging (MRI) and assess diagnostic and prognostic implications in comparison to established imaging features of PH.
MATERIALS AND METHODS: Institutional review board-approved retrospective study of 178 patients (142 men; median age, 59.4 years) with chronic liver disease undergoing MRI and hepatic venous pressure gradient (HVPG) measurement between January 2008 and April 2015. Magnetic resonance imaging was assessed for established features of PH (splenic and portal vein diameters, portosystemic collaterals, ascites) and for features on 20 minutes delayed T1-weighted gadoxetic acid-enhanced MRI, that is, relative liver enhancement (RLE), biliary contrast excretion, or portal vein hyperintensity or isointensity (ie, portal vein hyperintensity sign, PVHS). Statistics encompassed linear regression, logistic regression, and survival analysis.
RESULTS: There was an inverse correlation between HVPG and RLE (r = 0.18, P < 0.0001). On univariate analysis, clinically significant PH (ie, HVPG ≥ 10 mm Hg, n = 109) and severe PH (ie, HVPG ≥ 12 mm Hg, n = 99) were associated with delayed biliary contrast excretion (n = 33) and the PVHS (n = 74) (P < 0.01 for all). Multivariate analysis demonstrated significant associations between the PVHS and severe PH (odds ratio [OR], 3.33; P = 0.008), independently of spleen size (OR, 1.26; P = 0.002), portosystemic collaterals (n = 81; OR, 5.46; P = 0.0001), and ascites (n = 88; OR, 3.24; P = 0.006). Lower RLE and the PVHS were associated with lower 3-year, transplantation-free survival (hazards ratios, 0.98 and 3.99, respectively, P = 0.002 for all), independently of the Child-Pugh and Model for End-Stage Liver Disease scores.
CONCLUSIONS: The presence of the PVHS on gadoxetic acid-enhanced MRI is an independent indicator of severe PH and may enable more accurate diagnosis. This feature and decreased hepatic contrast uptake may also comprise prognostic information.

PMID: 28622247 [PubMed - as supplied by publisher]

Six-Month Morbidity and Mortality among ICU Patients Receiving Life-Sustaining Therapy: A Prospective Cohort Study.

Sun, 06/18/2017 - 12:45
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Six-Month Morbidity and Mortality among ICU Patients Receiving Life-Sustaining Therapy: A Prospective Cohort Study.

Ann Am Thorac Soc. 2017 Jun 16;:

Authors: Detsky ME, Harhay MO, Bayard DF, Delman AM, Buehler AE, Kent SA, Ciuffetelli IV, Cooney E, Gabler NB, Ratcliffe SJ, Mikkelsen ME, Halpern SD

Abstract
RATIONALE: Understanding long-term outcomes of critically ill patients may inform shared decision making in the ICU.
OBJECTIVE: To quantify six-month functional outcomes of general ICU patients, and develop a multivariable model comprising factors present during the first ICU day to predict which patients will return to their baseline function 6 months later.
METHODS: We conducted a prospective cohort study in three medical ICUs and two surgical ICUs in three hospitals. We enrolled patients who spent at least 3 days in the ICU and received mechanical ventilation for >48 hours and/or vasoactive infusions for >24 hours.
RESULTS: We measured six-month outcomes included survival, return to original place of residence, and physical and cognitive function. Of 303 enrolled patients, 299 (98.7%) had complete follow up at 6 months. Among the 169 (56.5%) patients who survived to 6 months, 82.8% returned home, 81.9% were able to toilet, 71.3% were able to ambulate 10 stairs, and 62.4% reported normal cognition. Overall, 31.1% of patients returned to their baseline status on these measures. Factors associated with not returning to baseline included higher APACHE III score, being a medical patient, older age, non-white race, recent hospitalization, prior transplantation, and a history of cancer, neurologic or liver disease. A model including only these day-one factors had good discrimination (area under ROC curve = 0.778, 95% CI 0.724-0.832) and calibration (difference between observed and expected p value = 0.36).
CONCLUSIONS: Among patients spending at least three days in an ICU and requiring even brief periods of life-sustaining therapy, nearly half will be dead and less than one third will have returned to their baseline status at six months. Of those who survive, the majority of patients will be back at home at six months. Future research is needed to validate this multivariable model including readily available patient characteristics available on the first ICU day that seems to identify patients who will return to baseline at six months.

PMID: 28622004 [PubMed - as supplied by publisher]

Autoimmune Hemolytic Anemia In Solid Organ Transplantation - The Role Of Immunosuppression.

Sun, 06/18/2017 - 12:45
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Autoimmune Hemolytic Anemia In Solid Organ Transplantation - The Role Of Immunosuppression.

Clin Transplant. 2017 Jun 16;:

Authors: Kanellopoulou T

Abstract
Hemolysis after solid organ transplantation can be caused by both immune and non-immune mediated mechanisms and the evaluation must take into account issues distinctive to the post-transplant period. Autoimmune hemolytic anemia usually occurs within the first year and has been attributed to immunosuppressive treatment, infections or underlying post-transplant lymphoproliferative disorder. Review of the literature revealed 59 cases with autoimmune hemolytic anemia mostly in children after liver transplantation. Almost all of the patients at the time of diagnosis received immunosuppression with tacrolimus and first line treatment with steroids and/or intravenous immunoglobulin was ineffective for complete remission. Rituximab was used as second line treatment especially in patients with underlying lymphoproliferative disorders whereas sirolimus showed encouraging results. This article is protected by copyright. All rights reserved.

PMID: 28621877 [PubMed - as supplied by publisher]

Retransplantation after a failed donation after circulatory determination of death liver transplant: MELD exception priority and second chances.

Sun, 06/18/2017 - 12:45
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Retransplantation after a failed donation after circulatory determination of death liver transplant: MELD exception priority and second chances.

Am J Transplant. 2017 Jun 16;:

Authors: Abt PL, Goldberg DS

Abstract
Increased utilization of higher-risk liver allografts is hampered by concerns about an increased risk of post-transplant graft failure and subsequent death if the patient is not retransplanted. This dilemma faces clinicians considering broader use of livers from donation after circulatory determination of death (DCDD) donors. In the setting of primary non-function or early hepatic artery thrombosis (HAT), there is a mechanism for standardized awarding of Model for End-Stage Liver Disease (MELD) exception points. This article is protected by copyright. All rights reserved.

PMID: 28621875 [PubMed - as supplied by publisher]

Clinical Impact and Risk Factors of Portal Vein Thrombosis for Patients on Wait List for Liver Transplant.

Sun, 06/18/2017 - 12:45
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Clinical Impact and Risk Factors of Portal Vein Thrombosis for Patients on Wait List for Liver Transplant.

Exp Clin Transplant. 2017 Jun 16;:

Authors: Montenovo M, Rahnemai-Azar A, Reyes J, Perkins J

Abstract
OBJECTIVES: The effect of portal vein thrombosis on the progression of liver disease is controversial, with no consensus on optimal treatment. We aimed to assess how portal vein thrombosis affects wait list outcomes, identify risk factors associated with its development while on a wait list, and assess its effects on patient and graft survival.
MATERIALS AND METHODS: This US-based retrospective cohort study analyzed 134 109 adult patients on wait lists for or undergoing primary orthotopic liver transplant between January 2002 and June 2014. Rate of portal vein thrombosis development, time from entry on wait list to transplant, comparisons of wait list drop-off rates between patients with versus those without portal vein thrombosis, risk factors associated with its development while on a wait list, and its effects on patient and graft survival were analyzed.
RESULTS: We found that the rate of portal vein thrombosis at listing increased. Patients with the disease at listing were more likely to be removed from wait lists because of being too sick. Portal vein thrombosis at listing was an independent risk factor for being removed from a wait list. Of 63 265 patients who underwent primary orthotopic liver transplant, those with the disease were more likely to have higher Model for End-Stage Liver Disease scores and incidence of nonalcoholic steatohepatitis and diabetes mellitus. Portal vein thrombosis had a negative effect on patient and graft survival. Nonalcoholic steatohepatitis, body mass index, diabetes, and hepatocellular carcinoma were identified as risk factors for its development.
CONCLUSIONS: Portal vein thrombosis represents an increasing management and outcome burden in liver transplant. Having this disease at listing and/or at time of transplant is associated with worse patient and graft survival. Nonalcoholic steatohepatitis and hepatocellular carcinoma are among the biggest risk factors for its development while on a wait list.

PMID: 28621635 [PubMed - as supplied by publisher]

Fatigue After Liver Transplant and Combined Liver and Kidney Transplant.

Sun, 06/18/2017 - 12:45
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Fatigue After Liver Transplant and Combined Liver and Kidney Transplant.

Exp Clin Transplant. 2017 Jun 16;:

Authors: Benzing C, Krenzien F, Krezdorn N, Wiltberger G, Hinz A, Förster J, Atanasov G, Schmelzle M, Glaesmer H, Hau HM, Bartels M

Abstract
OBJECTIVES: To date, fatigue is still poorly understood in recipients of orthotopic liver transplant and simultaneous/sequential liver and kidney transplant procedures. The present study examined the appearance of fatigue in patients who received orthotopic liver and sequential liver and kidney transplant procedures compared with the general population and the influence of various clinical and socioeconomic factors on fatigue levels.
MATERIALS AND METHODS: The Multidimensional Fatigue Inventory survey was sent to all patients with a history of orthotopic liver and simultaneous/sequential liver and kidney transplant. The results were compared to data from a reference population.
RESULTS: Our survey included 276 eligible patients: 256 recipients (92.7%) of orthotopic liver transplant and 20 recipients (7.3%) of simultaneous/sequential liver and kidney transplant. Significantly lower fatigue scores were found in the general population compared with both transplant groups (P < .001). There were also no significant differences between the transplant groups. Among the clinical and socioeconomic factors, history of hepatocellular carcinoma, chronic kidney disease, age, family status, and education had a significant impact on fatigue levels.
CONCLUSIONS: This is the first study to compare fatigue in recipients of orthotopic liver and simultaneous/sequential liver and kidney transplant. We found that fatigue is an important but still poorly understood outcome after transplant.

PMID: 28621633 [PubMed - as supplied by publisher]

SLC28A3 rs7853758 as a new biomarker of tacrolimus elimination and new-onset hypertension in Chinese liver transplantation patients.

Sun, 06/18/2017 - 12:45
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SLC28A3 rs7853758 as a new biomarker of tacrolimus elimination and new-onset hypertension in Chinese liver transplantation patients.

Biomark Med. 2017 Jun 16;:

Authors: Liu Y, Zhang T, Li C, Ye L, Gu H, Zhong L, Sun H, Sun Y, Peng Z, Fan J

Abstract
AIM: The effect of SLC28A3 on tacrolimus disposition and new-onset hypertension (NOHP) after liver transplantation (LT) remains unclear. Methodology & results: A total of 169 patients in two cohorts from the China Liver Transplant Registry database were included. Rs7853758 in recipients'SLC28A3 could predict tacrolimus pharmacokinetics in two sets. The model of donors' CYP3A5 rs776746 and recipients' CYP3A4 rs2242480 could predict tacrolimus metabolism at week 1 and the model of donors' CYP3A5 rs776746, recipients' CYP3A4 rs2242480, recipients' SLC28A3 rs7853758 and hemoglobin could predict tacrolimus disposition at weeks 2, 3 and 4. Besides, recipients' SLC28A3 rs7853758 was a new risk factor of NOHP after LT.
CONCLUSION: Rs7853758 in recipients' SLC28A3 has a correlation with tacrolimus pharmacokinetics and the risk of NOHP in Chinese LT patients.

PMID: 28621555 [PubMed - as supplied by publisher]

Laparoscopic cholecystectomy for acute cholecystitis: an analysis of early versus delayed cholecystectomy and predictive factors for conversion.

Sun, 06/18/2017 - 12:45
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Laparoscopic cholecystectomy for acute cholecystitis: an analysis of early versus delayed cholecystectomy and predictive factors for conversion.

Minerva Chir. 2017 Jun 16;:

Authors: Goh JC, Tan JK, Lim JW, Shridhar IG, Madhavan K, Kow AW

Abstract
BACKGROUND: There is an increasing preference for early laparoscopic cholecystectomy (ELC) as compared to delayed LC (DLC) in the management of acute cholecystitis (AC). Conversion to open cholecystectomy (LOC) remains an important outcome. We aim to compare ELC and DLC outcomes and identify LOC predictors.
METHODS: Retrospective analysis of 466 patients who underwent LC for AC from June 2010 - June 2015 was performed. Patients were divided into ELC and DLC groups, defined as LC performed within 7 days and between 4 to 24 weeks of symptom onset respectively. Peri-operative outcomes and predictors for LOC were analyzed.
RESULTS: Conversion rates were comparable [ELC, 8.6% vs DLC, 8.0%] (p=0.867). While median operative time was longer in ELC [101.5 mins (83.0-130.1)] than DLC [88.0 mins (62.3-118.8)] (p<0.001), intra-operative [ELC, 1.9% vs DLC, 3.0%] (p=0.541) and post-operative morbidity [ELC, 13.5% vs DLC, 12.5%] (p=0.688) was comparable. Median total length of stay (LOS) was shorter in ELC [4 days (3-6)] than DLC [5 days (4-9)] (p<0.001). Univariate analysis showed increased age [LC, 57 (45-66) vs LOC, 60 (56-72)] (p=0.016), presence of comorbidities [LC, 69.0% vs LOC, 87.8%] (p=0.009), previous abdominal surgery (LC, 6.1% vs LOC, 17.1%) (p=0.014), fever (p=0.001), Murphy's sign (p=0.005) and lower albumin [LC, 42.0 (39.0-45.0) vs LOC, 40.0 (36.0-43.0)] (p=0.003) to be predictors for LOC.
CONCLUSIONS: ELC provides shorter LOS and eliminates the risk of gallstone-related morbidity while awaiting surgery. It should be advocated for patients with AC. The presence of comorbidities, increased age, previous abdominal surgery and low albumin are predictors for conversion.

PMID: 28621510 [PubMed - as supplied by publisher]

Editorial: is ribavirin needed in the treatment of post-transplant hepatitis C recurrence?

Sun, 06/18/2017 - 12:45
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Editorial: is ribavirin needed in the treatment of post-transplant hepatitis C recurrence?

Aliment Pharmacol Ther. 2017 Jul;46(2):197-198

Authors: Schmidt-Martin D, Elsharkawy AM

PMID: 28621075 [PubMed - in process]

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