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Digestive Diseases (Basel, Switzerland) 2023Partial liver transplantation has recently been proposed to alleviate organ shortages. However, transplantation of a small-for-size graft is associated with an increased... (Review)
Review
BACKGROUND
Partial liver transplantation has recently been proposed to alleviate organ shortages. However, transplantation of a small-for-size graft is associated with an increased risk of posttransplant hepatic dysfunction, commonly referred to as small-for-size syndrome (SFSS). This review describes the etiology, pathological features, clinical manifestations, and diagnostic criteria of SFSS. Moreover, we summarize strategies to improve graft function, focusing on graft inflow modulation techniques. Finally, unmet needs and future perspectives are discussed.
SUMMARY
In fact, posttransplant SFSS can be attributed to various factors such as preoperative status of the recipients, surgical techniques, donor age, and graft quality, except for graft size. With targeted improvement measures, satisfactory clinical outcomes can be achieved in recipients at increased risk of SFSS. Given the critical role of relative portal hyperperfusion in the pathogenesis of SFSS, various pharmacological and surgical treatments have been established to reduce or partially divert excessive portal inflow, and recipients will benefit from individualized therapeutic regimens after careful evaluation of benefits against potential risks. However, there remain unmet needs for further research into different aspects of SFSS to better understand the correlation between portal hemodynamics and patient outcomes.
KEY MESSAGES
Contemporary transplant surgeons should consider various donor and recipient factors and develop case-specific prevention and treatment strategies to improve graft and recipient survival rates.
Topics: Humans; Liver Transplantation; Liver Diseases; Tissue Donors; Hemodynamics; Liver; Organ Size; Graft Survival
PubMed: 35753308
DOI: 10.1159/000525540 -
Journal of Hepatology Apr 2015A growing literature has highlighted important differences in transplant-related outcomes between men and women. In the United States there are fewer women than men on... (Review)
Review
A growing literature has highlighted important differences in transplant-related outcomes between men and women. In the United States there are fewer women than men on the liver transplant waitlist and women are two times less likely to receive a deceased or living-related liver transplant. Sex-based differences exist not only in waitlist but also in post-transplant outcomes, particularly in some specific liver diseases, such as hepatitis C. In the era of individualized medicine, recognition of these differences in the approach to pre and post-liver transplant care may impact short and long-term outcomes.
Topics: End Stage Liver Disease; Female; Graft Survival; Humans; Liver Transplantation; Male; Outcome Assessment, Health Care; Perioperative Period; Postoperative Complications; Sex Factors; Tissue and Organ Procurement; Waiting Lists
PubMed: 25433162
DOI: 10.1016/j.jhep.2014.11.023 -
World Journal of Gastroenterology May 2018To perform a systematic review and meta-analysis on donor-to-recipient gender mismatch as a risk factor for post-transplant graft loss. (Meta-Analysis)
Meta-Analysis Review
AIM
To perform a systematic review and meta-analysis on donor-to-recipient gender mismatch as a risk factor for post-transplant graft loss.
METHODS
A systematic literature search was performed using PubMed, Cochrane Library database and EMBASE. The primary outcome was graft loss after liver transplantation. Odds ratios and 95% confidence intervals were calculated to compare the pooled data between groups with different donor-to-recipient gender matches. Three analyses were done considering (1) gender mismatches (F-M and M-F) matches (M-M and F-F); (2) Female-to-Male mismatch other matches; and (3) Male-to-Female mismatch other matches.
RESULTS
A total of 7 articles were analysed. Gender mismatch (M-F and F-M) was associated with a significant increase of graft loss respect to match (M-M and F-F) (OR: 1.30; 95%CI: 1.13-1.50; < 0.001). When F-M mismatch was specifically investigated, it confirmed its detrimental role in terms of graft survival (OR: 1.83; 95%CI: 1.20-2.80; = 0.005). M-F mismatch failed to present a significant role (OR: 1.09; 95%CI: 0.73-1.62; = 0.68).
CONCLUSION
Gender mismatch is a risk factor for poor graft survival after liver transplantation. Female-to-male mismatch represents the worst combination. More studies are needed with the intent to better clarify the reasons for these results.
Topics: End Stage Liver Disease; Female; Graft Survival; Humans; Liver Transplantation; Male; Risk Factors; Sex Factors; Tissue Donors; Transplant Recipients; Treatment Outcome
PubMed: 29853738
DOI: 10.3748/wjg.v24.i20.2203 -
Liver Transplantation : Official... Nov 2014After years of expecting new advances in immunosuppression, we have not seen a newly developed drug in the past decade. Recent efforts have been centered on minimizing... (Review)
Review
After years of expecting new advances in immunosuppression, we have not seen a newly developed drug in the past decade. Recent efforts have been centered on minimizing the known side effects of steroids and CNI. It is unlikely that a new CNI will be developed; however, extended-release tacrolimus is available. Most clinical research trials are designed to determine when and how to withdraw steroids or CNI, either substituting mTOR inhibitors or withdrawing an agent completely. As with CNI, there is little evidence that new mTOR inhibitors are in the “publicly viewable” pharmaceutical pipeline. New antibodies that block costimulatory pathways currently have been approved or are being studied in both kidney and liver transplantation (Fig. 14). Most studies are initially performed with other diseases requiring immune modulation such as RA or psoriasis psoriasis. Other blocking antibodies are being studied in kidney transplantation. It is unlikely that these newer agents will be generally available in the next 2 to 3 years. It seems likely that they may find specialized use in specific populations of patients (HCC or HCV infection) for whom the risk of side effects is adequately balanced by the beneficial effects of immunosuppression and prevention of infection or cancer progression.
Topics: Diffusion of Innovation; Graft Rejection; Graft Survival; Humans; Immunosuppressive Agents; Liver Transplantation; Time Factors; Treatment Outcome
PubMed: 25164576
DOI: 10.1002/lt.23971 -
International Journal of Molecular... Jun 2018The complement system anchors the innate inflammatory response by triggering both cell-mediated and antibody-mediated immune responses against pathogens. The complement... (Review)
Review
The complement system anchors the innate inflammatory response by triggering both cell-mediated and antibody-mediated immune responses against pathogens. The complement system also plays a critical role in sterile tissue injury by responding to damage-associated molecular patterns. The degree and duration of complement activation may be a critical variable controlling the balance between regenerative and destructive inflammation following sterile injury. Recent studies in kidney transplantation suggest that aberrant complement activation may play a significant role in delayed graft function following transplantation, confirming results obtained from rodent models of renal ischemia/reperfusion (I/R) injury. Deactivating the complement cascade through targeting anaphylatoxins (C3a/C5a) might be an effective clinical strategy to dampen reperfusion injury and reduce delayed graft function in liver transplantation. Targeting the complement cascade may be critical in donor livers with mild to moderate steatosis, where elevated lipid burden amplifies stress responses and increases hepatocyte turnover. Steatosis-driven complement activation in the donor liver may also have implications in rejection and thrombolytic complications following transplantation. This review focuses on the roles of complement activation in liver I/R injury, strategies to target complement activation in liver I/R, and potential opportunities to translate these strategies to transplanting donor livers with mild to moderate steatosis.
Topics: Animals; Complement Activation; Delayed Graft Function; Donor Selection; Fatty Liver; Humans; Liver Transplantation; Tissue Donors
PubMed: 29899265
DOI: 10.3390/ijms19061750 -
Liver Transplantation : Official... Jul 2016The Irish National Liver Transplant program commenced in 1993 in St. Vincent's University Hospital in Dublin. It is an adult-only program and is the only liver...
The Irish National Liver Transplant program commenced in 1993 in St. Vincent's University Hospital in Dublin. It is an adult-only program and is the only liver transplant program in Ireland. Pediatric recipients are referred to King's College Hospital in the United Kingdom. To date, almost 1000 adult liver transplants have been performed. Current 1-year patient survival is 93%, and 5-year survival is 79%. The program is fully funded by the government health service. There is a close collaboration with the United Kingdom Organ Donation and Transplant Directorate, and there is an arrangement for organ sharing for super-urgent transplants. Traditionally, organ donation rates have been high in Ireland. However, demand for liver transplant has increased over the past 20 years, and waiting lists are now lengthening. Deceased cardiac death donation is now being considered, but there are no plans for living related donor liver transplant. Donor coordinators have recently been appointed to the major hospitals in Ireland, and it is hoped that this initiative will lead to an increase in organ donation rates. Liver Transplantation 22 1014-1018 2016 AASLD.
Topics: Adult; Child; Humans; International Cooperation; Ireland; Liver Diseases; Liver Transplantation; Living Donors; National Health Programs; Survival Rate; Tissue and Organ Procurement; United Kingdom; Waiting Lists
PubMed: 27065358
DOI: 10.1002/lt.24456 -
Liver Transplantation : Official... Sep 2016Over 1700 liver transplantations (LTs) are performed annually in Brazil. In absolute terms, the country performs more LT surgeries than anywhere else in Latin America...
Over 1700 liver transplantations (LTs) are performed annually in Brazil. In absolute terms, the country performs more LT surgeries than anywhere else in Latin America and is third worldwide. However, due to its increasing population and inadequate donor organ supply, the country averages 5-10 LTs per million population, far lower than required. There is a marked heterogeneity in organ donation and LT activity throughout the country. Access to LT in the underprivileged North, Midwest, and Northeast regions of Brazil is scarce. Major challenges for the future of LT in Brazil will be to increase organ donation and access to LT. The reduction of those geographical disparities in donation, organ procurement, and LT due to political and financial constraints is of utmost importance. Liver Transplantation 22 1254-1258 2016 AASLD.
Topics: Adult; Brazil; Child; End Stage Liver Disease; Healthcare Disparities; Humans; Liver Transplantation; Severity of Illness Index; Socioeconomic Factors; Tissue and Organ Procurement; Waiting Lists
PubMed: 27228568
DOI: 10.1002/lt.24487 -
Best Practice & Research. Clinical... 2020Survival following liver transplantation has changed dramatically owing to improvement in surgical techniques, peri-operative care and optimal immunosuppressive therapy.... (Review)
Review
Survival following liver transplantation has changed dramatically owing to improvement in surgical techniques, peri-operative care and optimal immunosuppressive therapy. Post-Liver transplant (LT) de novo or recurrent viral infection continues to cause major allograft dysfunction, leading to poor graft and patient survival in untreated patients. Availability of highly effective antiviral drugs has significantly improved post-LT survival. Patients transplanted for chronic hepatitis B infection should receive life-long nucleos(t)ide analogues, with or without HBIg for effective viral control. Patients with chronic hepatitis C should be commenced on directly acting antiviral (DAA) drugs prior to transplantation. DAA therapy for post-LT recurrent hepatitis C infection is associated with close to 100% sustained virological response (SVR), irrespective of genotype. De novo chronic Hepatitis E infection is an increasingly recognised cause of allograft dysfunction in LT recipients. Untreated chronic HEV infection of the graft may lead to liver fibrosis and allograft failure. CMV and EBV can reactivate leading to systemic illness following liver transplantation. With COVID-19 pandemic, post-transplant patients are at risk of SARS-Co-V2 infection. Majority of the LT recipients require hospitalization, and the mortality in this population is around 20%. Early recognition of allograft dysfunction and identification of viral aetiology is essential in the management of post-LT de novo or recurrent infections. Optimising immunosuppression is an important step in reducing the severity of allograft damage in the treatment of post-transplant viral infections. Viral clearance or control can be achieved by early initiation of high potency antiviral therapy.
Topics: Humans; Liver Transplantation; Recurrence; Risk Factors; Survival Analysis; Virus Diseases
PubMed: 33158469
DOI: 10.1016/j.bpg.2020.101689 -
Liver Transplantation : Official... Feb 2007
Topics: China; Humans; Liver Transplantation
PubMed: 17256774
DOI: 10.1002/lt.21079 -
International Journal of Molecular... Feb 2020Liver ischaemia-reperfusion injury (IRI) is an intrinsic part of the transplantation process and damages the parenchymal cells of the liver including hepatocytes,... (Review)
Review
Liver ischaemia-reperfusion injury (IRI) is an intrinsic part of the transplantation process and damages the parenchymal cells of the liver including hepatocytes, endothelial cells and cholangiocytes. Many biomarkers of IRI have been described over the past two decades that have attempted to quantify the extent of IRI involving different hepatic cellular compartments, with the aim to allow clinicians to predict the suitability of donor livers for transplantation. The advent of machine perfusion has added an additional layer of complexity to this field and has forced researchers to re-evaluate the utility of IRI biomarkers in different machine preservation techniques. In this review, we summarise the current understanding of liver IRI biomarkers and discuss them in the context of machine perfusion.
Topics: Animals; Biomarkers; Endothelin-1; Fibroblast Growth Factor 2; Humans; Interleukins; Liver Transplantation; MicroRNAs; Reperfusion Injury
PubMed: 32106626
DOI: 10.3390/ijms21051578