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Einstein (Sao Paulo, Brazil) 2015In 1958 Francis Moore described the orthotopic liver transplantation technique in dogs. In 1963, Starzl et al. performed the first liver transplantation. In the first... (Review)
Review
In 1958 Francis Moore described the orthotopic liver transplantation technique in dogs. In 1963, Starzl et al. performed the first liver transplantation. In the first five liver transplantations no patient survived more than 23 days. In 1967, stimulated by Calne who used antilymphocytic serum, Starzl began a successful series of liver transplantation. Until 1977, 200 liver transplantations were performed in the world. In that period, technical problems were overcome. Roy Calne, in 1979, used the first time cyclosporine in two patients who had undergone liver transplantation. In 1989, Starzl et al. reported a series of 1,179 consecutives patients who underwent liver transplantation and reported a survival rate between one and five years of 73% and 64%, respectively. Finally, in 1990, Starzl et al. reported successful use of tacrolimus in patents undergoing liver transplantation and who had rejection despite receiving conventional immunosuppressive treatment. Liver Transplantation Program was initiated at Hospital Israelita Albert Einstein in 1990 and so far over 1,400 transplants have been done. In 2013, 102 deceased donors liver transplantations were performed. The main indications for transplantation were hepatocellular carcinoma (38%), hepatitis C virus (33.3%) and alcohol liver cirrhosis (19.6%). Of these, 36% of patients who underwent transplantation showed biological MELD score > 30. Patient and graft survival in the first year was, 82.4% and 74.8%, respectively. A major challenge in liver transplantation field is the insufficient number of donors compared with the growing demand of transplant candidates. Thus, we emphasize that appropriated donor/receptor selection, allocation and organ preservation topics should contribute to improve the number and outcomes in liver transplantation.
Topics: Animals; Brazil; Dogs; Graft Rejection; Graft Survival; History, 20th Century; History, 21st Century; Humans; Kaplan-Meier Estimate; Liver Transplantation; Treatment Outcome
PubMed: 25993082
DOI: 10.1590/S1679-45082015RW3164 -
Journal of Hepatology Apr 2023Machine perfusion is a novel method intended to optimize livers before transplantation. However, its effect on morbidity within a 1-year period after transplantation has... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND & AIMS
Machine perfusion is a novel method intended to optimize livers before transplantation. However, its effect on morbidity within a 1-year period after transplantation has remained unclear.
METHODS
In this multicenter controlled trial, we randomly assigned livers donated after brain death (DBD) for liver transplantation (LT). Livers were either conventionally cold stored (control group), or cold stored and subsequently treated by 1-2 h hypothermic oxygenated perfusion (HOPE) before implantation (HOPE group). The primary endpoint was the occurrence of at least one post-transplant complication per patient, graded by the Clavien score of ≥III, within 1-year after LT. The comprehensive complication index (CCI), laboratory parameters, as well as duration of hospital and intensive care unit stay, graft survival, patient survival, and biliary complications served as secondary endpoints.
RESULTS
Between April 2015 and August 2019, we randomized 177 livers, resulting in 170 liver transplantations (85 in the HOPE group and 85 in the control group). The number of patients with at least one Clavien ≥III complication was 46/85 (54.1%) in the control group and 44/85 (51.8%) in the HOPE group (odds ratio 0.91; 95% CI 0.50-1.66; p = 0.76). Secondary endpoints were also not significantly different between groups. A post hoc analysis revealed that liver-related Clavien ≥IIIb complications occurred less frequently in the HOPE group compared to the control group (risk ratio 0.26; 95% CI 0.07-0.77; p = 0.027). Likewise, graft failure due to liver-related complications did not occur in the HOPE group, but occurred in 7% (6 of 85) of the control group (log-rank test, p = 0.004, Gray test, p = 0.015).
CONCLUSIONS
HOPE after cold storage of DBD livers resulted in similar proportions of patients with at least one Clavien ≥III complication compared to controls. Exploratory findings suggest that HOPE decreases the risk of severe liver graft-related events.
IMPACT AND IMPLICATIONS
This randomized controlled phase III trial is the first to investigate the impact of hypothermic oxygenated perfusion (HOPE) on cumulative complications within a 12-month period after liver transplantation. Compared to conventional cold storage, HOPE did not have a significant effect on the number of patients with at least one Clavien ≥III complication. However, we believe that HOPE may have a beneficial effect on the quantity of complications per patient, based on its application leading to fewer severe liver graft-related complications, and to a lower risk of liver-related graft loss. The HOPE approach can be applied easily after organ transport during recipient hepatectomy. This appears fundamental for wide acceptance since concurring perfusion technologies need either perfusion at donor sites or continuous perfusion during organ transport, which are much costlier and more laborious. We conclude therefore that the post hoc findings of this trial should be further validated in future studies.
Topics: Humans; Organ Preservation; Perfusion; Liver; Liver Transplantation; Brain Death; Postoperative Complications; Graft Survival
PubMed: 36681160
DOI: 10.1016/j.jhep.2022.12.030 -
Current Opinion in Gastroenterology May 2005Liver transplantation continues to change as we further define appropriate criteria for allocation and utilization of this scarce resource. The following review... (Review)
Review
PURPOSE OF REVIEW
Liver transplantation continues to change as we further define appropriate criteria for allocation and utilization of this scarce resource. The following review highlights new trends and ideas in this evolving field.
RECENT FINDINGS
Although the model for end-stage renal disease (MELD) scoring system appears to fairly accurately predict mortality while waiting for transplant, the system may be less accurate in predicting outcomes following transplantation. MELD scores offer an additional advantage to patients with hepatocellular carcinoma (HCC), bringing them to transplant sooner with overall better survivals. However, despite its advantages, the MELD scoring system does not resolve the disparity in the allocation of organs between various organ procurement organizations. Several variables appear to affect patients with hepatitis C undergoing liver transplantation. Selection of appropriate donors appears to be important when transplanting patients with hepatitis C virus (HCV) infection as increasing donor age is associated with poorer outcomes. However, the controversy over whether a living donor liver transplant (LDLT) results in poorer outcomes in HCV infected patients remains. Post-transplant medical treatment of HCV may result in both a sustained virologic response and improved histology. With improved overall survival in patients undergoing orthotopic liver transplant (OLT), increasing attention has been focused on the medical complications following transplant. Identifying specific contributing factors in the development of renal dysfunction and devising strategies to prevent its occurrence are critical to further improvements in outcome following OLT.
SUMMARY
As the gap between patients and available organs remains, continued investigation into appropriate allocation and maximization of outcomes following liver transplant will continue.
Topics: Humans; Kidney Failure, Chronic; Liver Failure; Liver Transplantation; Tissue and Organ Procurement
PubMed: 15818154
DOI: 10.1097/01.mog.0000159830.36793.2b -
Critical Care Clinics Oct 1990Organ transplantation offers increased survival and improved quality of life to many patients with end-stage liver disease. Major advances in this field have included... (Review)
Review
Organ transplantation offers increased survival and improved quality of life to many patients with end-stage liver disease. Major advances in this field have included better organ acquisition and preservation as well as improved intraoperative techniques and management. An additional major factor in improved survival of transplant recipients is the elevated level of care available in intensive care units. Diligent postoperative care has led to early recognition and appropriate treatment of complications that previously were fatal. The intensive care unit team, in tandem with the transplant surgical service, significantly contributes to the successful outcome of the liver transplant recipient.
Topics: Child; Child, Preschool; Critical Care; Graft Rejection; Humans; Liver Diseases; Liver Transplantation; Postoperative Care; Quality of Life
PubMed: 2265386
DOI: No ID Found -
Journal of Zhejiang University.... Mar 2013Reperfusion is the key strategy in acute ST-segment elevation myocardial infarction (STEMI) care, and it is time-dependent. Shortening the time from symptom to... (Review)
Review
Reperfusion is the key strategy in acute ST-segment elevation myocardial infarction (STEMI) care, and it is time-dependent. Shortening the time from symptom to reperfusion and choosing the optimal reperfusion strategy for STEMI patients are great challenges in practice. We need to improve upon the problems of low reperfusion rate, non-standardized treatment, and economic burden in STEMI care. This article briefly reviews the current status of reperfusion strategy in STEMI care, and also introduces what we will do to bridge the gap between the guidelines and implementation in the clinical setting through the upcoming China STEMI early reperfusion program.
Topics: Humans; Liver Failure; Liver Transplantation
PubMed: 23463760
DOI: 10.1631/jzus.B1200041 -
Chirurgia (Bucharest, Romania : 1990) 2017In 50 years after the first liver transplantation, the medical world has witnessed the liver transplantation to become one of the widely recognized and leading branches... (Review)
Review
In 50 years after the first liver transplantation, the medical world has witnessed the liver transplantation to become one of the widely recognized and leading branches of surgery. In this period, liver transplantation combined with surgical technique, patient selection, advancements in anesthesia and postoperative care and increased experience has become the most effective treatment option in treatment of several acute and chronic liver diseases. Yet, the worldwide organ restriction and associated high mortality rates in organ transplantation waiting list has compelled referring to living donors in order to expand the donor pool. This paper explains liver transplantation indications from living donors, the surgical technique involved, the complications of the procedure and the medical treatments used.
Topics: Adult; Elective Surgical Procedures; Humans; Liver Diseases; Liver Transplantation; Living Donors; Patient Selection; Treatment Outcome
PubMed: 28675358
DOI: 10.21614/chirurgia.112.3.217 -
World Journal of Gastroenterology Feb 2009In previous decades, pediatric liver transplantation has become a state-of-the-art operation with excellent success and limited mortality. Graft and patient survival... (Review)
Review
In previous decades, pediatric liver transplantation has become a state-of-the-art operation with excellent success and limited mortality. Graft and patient survival have continued to improve as a result of improvements in medical, surgical and anesthetic management, organ availability, immunosuppression, and identification and treatment of postoperative complications. The utilization of split-liver grafts and living-related donors has provided more organs for pediatric patients. Newer immunosuppression regimens, including induction therapy, have had a significant impact on graft and patient survival. Future developments of pediatric liver transplantation will deal with long-term follow-up, with prevention of immunosuppression-related complications and promotion of as normal growth as possible. This review describes the state-of-the-art in pediatric liver transplantation.
Topics: Child; Family; Graft Survival; Hepatectomy; Humans; Liver; Liver Diseases; Liver Neoplasms; Liver Transplantation; Living Donors; Patient Selection; Survival Rate; Tissue and Organ Harvesting
PubMed: 19222089
DOI: 10.3748/wjg.15.648 -
International Journal of Radiation... Mar 2019Orthotopic liver transplantation (OLT) has been effective in managing end-stage liver disease since the advent of cyclosporine immunosuppression therapy in 1980. The... (Review)
Review
Orthotopic liver transplantation (OLT) has been effective in managing end-stage liver disease since the advent of cyclosporine immunosuppression therapy in 1980. The major limitations of OLT are organ supply, monetary cost, and the burden of lifelong immunosuppression. Hepatocyte transplantation, as a substitute for OLT, has been an exciting topic of investigation for several decades. HT is potentially minimally invasive and can serve as a vehicle for delivery of personalized medicine through autologous cell transplant after modification ex vivo. However, 3 major hurdles have prevented large-scale clinical application: (1) availability of transplantable cells; (2) safe and efficient ex vivo gene therapy methods; and (3) engraftment and repopulation efficiency. This review will discuss new sources for transplantable liver cells obtained by lineage reprogramming, clinically acceptable methods of genetic manipulation, and the development of hepatic irradiation-based preparative regimens for enhancing engraftment and repopulation of transplanted hepatocytes. We will also review the results of the first 3 patients with genetic liver disorders who underwent preparative hepatic irradiation before hepatocyte transplantation.
Topics: Animals; Cell Proliferation; Genetic Therapy; Hepatocytes; Humans; Liver Transplantation; Safety
PubMed: 30503786
DOI: 10.1016/j.ijrobp.2018.11.016 -
International Journal of Surgery... Oct 2020Orthotopic liver transplantation is an established treatment for end stage liver diseases as well as for some severe metabolic disorders. With increasing number of... (Review)
Review
Orthotopic liver transplantation is an established treatment for end stage liver diseases as well as for some severe metabolic disorders. With increasing number of patients on the waiting list and the ongoing shortage of livers available, domino liver transplantation (DLT) became an option to further expand the organ donor pool. DLT utilizes the explanted liver of one liver transplant recipient as a donor graft in another patient. Despite being a surgically, and logistically demanding procedure, excellent results could be achieved in experienced high-volume transplant centers. In this review we present the current world status of DLT.
Topics: Amyloid Neuropathies, Familial; End Stage Liver Disease; Humans; Liver; Liver Transplantation; Living Donors; Patient Selection; Registries; Transplant Recipients; Transplants; Waiting Lists
PubMed: 32244002
DOI: 10.1016/j.ijsu.2020.03.017 -
Clinics in Liver Disease Feb 2023Abnormal liver tests are common after liver transplantation. The differential diagnosis depends on the clinical context, particularly the time course, pattern and degree... (Review)
Review
Abnormal liver tests are common after liver transplantation. The differential diagnosis depends on the clinical context, particularly the time course, pattern and degree of elevation, and donor and recipient factors. The perioperative period has distinct causes compared with months and years after transplant, including ischemia-reperfusion injury, vascular thrombosis, and primary graft nonfunction. Etiologies seen beyond the perioperative period include biliary complications, rejection, infection, recurrent disease, and non-transplant-specific causes. The evaluation begins with a liver ultrasound with Doppler as well as appropriate laboratory testing and culminates in a liver biopsy if the imaging and laboratory testing is unrevealing.
Topics: Humans; Liver Transplantation; Postoperative Complications; Liver Function Tests; Tissue Donors; Liver
PubMed: 36400460
DOI: 10.1016/j.cld.2022.08.006