Liver Transplantation (Liver Transplant)

Publications in this journal

• Article: Near-miss events: A vastly missed opportunity.

  Daniela P Ladner, Talia Baker
  Liver Transplantation 05/2013; 19(5):467-9.
• Article: In Memoriam, David Hull, M.D.

  Angel E Alsina, John McNab
  Liver Transplantation 04/2013;
• Article: Emergent non-conventional meso-systemic shunt for diffuse porto-mesenteric thrombosis: Spare the chance for liver/multivisceral transplantation.

  Shunji Nagai, Marwan S Abouljoud, Marwan Kazimi, Atsushi Yoshida
  Liver Transplantation 04/2013;
• Article: Echocardiography for detection of portopulmonary hypertension in liver transplantation candidates: Analysis of cutoff values.

  Sarah Raevens, Isabelle Colle, Koen Reyntjens, Anja Geerts, Frederik Berrevoet, Xavier Rogiers, Roberto I Troisi, Hans Van Vlierberghe, Michel De Pauw
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  ABSTRACT: Background Portopulmonary hypertension (POPH), a complication of chronic liver disease, may be a contraindication to liver transplantation because of the elevated risk of peri- and post-transplantation morbidity and mortality. Because POPH is frequently asymptomatic, screening with echocardiography is recommended. The only reliable technique, however, to diagnose POPH is right heart catheterization. The aims of this study were to evaluate the current cutoff value of 30 mmHg estimated systolic pulmonary artery pressure (sPAP) and to determine a better cutoff value. Methods One hundred fifty-two patients had a pre-transplantation echocardiography between January 2005 and December 2010. These echocardiographic results were compared with pulmonary artery pressures measured during pre-transplantation work-up or at the beginning of the transplantation procedure, both by catheterization. Results Using a cutoff value of 30 mmHg, 74 of 152 patients met the criteria for POPH on echocardiography, although the diagnosis was confirmed in only 7 patients during catheterization, which results in a specificity of 54%. More accurate would be using a cutoff value of 38 mmHg, which carries a maximal specificity of 82%, at the same time guaranteeing a sensitivity and negative predictive value of 100%. By incorporating the presence or absence of right ventricular dilatation, the specificity even increases to 93% for this new cutoff value. Conclusions In this study, the prevalence of POPH among liver transplantation candidates was 4,6%. We can advise that liver transplantation candidates with a sPAP more than 38 mmHg should be referred for right heart catheterization. By increasing the cutoff value from 30 mmHg to 38 mmHg, the amount of patients who should undergo an invasive right heart catheterization at evaluation could be safely reduced. Liver Transpl , 2013. © 2013 AASLD.
  Liver Transplantation 04/2013;
• Article: False positivity for the human immunodeficiency virus antibody after influenza Vaccination in a living donor for liver transplantation.

  Susumu Eguchi, Mitsuhisa Takatsuki, Akihiko Soyama, Yasuhiro Torashima, Ayumi Tsuji, Tamotsu Kuroki
  Liver Transplantation 04/2013;
• Article: Reply (to LT-13-036).

  Michael R Lucey, Norah Terrault
  Liver Transplantation 04/2013;
• Article: Role of toll-like receptor-4 in mediating multi-organ dysfunction in acetaminophen induced acute liver failure in mice.

  Naina Shah, Montserrat Montes de Oca, Maria Jover-Cobos, Ken-Ichi Tanamoto, Masashi Muroi, Kei-Ichi Sugiyama, Nathan A Davies, Rajeshwar P Mookerjee, Dipok Kumar Dhar, Rajiv Jalan
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  ABSTRACT: Background and aim: Strategies for prevention of multi-organ dysfunction (MOD) in acetaminophen (APAP) induced acute liver failure (ALF) is an unmet need. Our study tested the hypothesis that sterile inflammation induced by APAP in a mouse model activates toll like receptor 4 (TLR4) in liver and extra hepatic organs leading to progression of ALF and MOD. Administration of the novel TLR4 antagonist, STM28 would prevent liver injury and the associated MOD. Method: ALF and subsequent MOD was induced in TLR4 KO (C57BL/B6.B10ScN-Tlr4lpsdel /JthJ) and C57/BL6 wild type (WT) mice with APAP (500mg/Kg). A second set of experiment was conducted to evaluate the effect of pretreatment of a novel TLR4 antagonist, STM28; in APAP induced MOD in CD1 mice. Animals were sacrificed at coma stage and plasma, peripheral blood cells, liver, kidneys and brain were collected. Biochemistry and cytokines were measured. Liver and kidney were studied histologically, stained for TLR4 and activated Kupffer cells and, expression of NFkBp65 was quantified by western blot. Brain water was measured in the frontal cortex. Results: Following APAP administration, TLR4 KO mice were relatively protected from liver necrosis and end organ dysfunction and had significantly better survival compared with WT controls (p<0.01). STM28 attenuated liver injury and necrosis, reduced creatinine and delayed time to coma significantly. The increase in cytokines in the plasma and liver including TLR4 expression and activation of Kupffer cells following APAP administration was reduced significantly in the STM28 treated animals. The increased number of circulating myeloid cells was reduced significantly following STM28 treatment. Conclusion: These data provide evidence for an important role of TLR4 antagonist in the prevention of progression of APAP induced ALF and MOD. Liver Transpl , 2013. © 2013 AASLD.
  Liver Transplantation 04/2013;
• Article: Clinical predictors of post liver transplant new onset heart failure.

  Waqas Qureshi, Chetan Mittal, Umair Ahmad, Zaid Alirhayim, Syed Hassan, Sophia Qureshi, Fatima Khalid
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  ABSTRACT: OBJECTIVES: To evaluate the pre-operative predictors of systolic and diastolic heart failure in patients undergoing liver transplantation To describe the prognostic implications of systolic and diastolic heart failure in patients underoing liver transplantation BACKGROUND: Heart failure (HF) onset following orthotopic liver transplantation (LT) remains a poorly understood clinical entity. This is largely due to the lack of adequate data describing predictors of post liver transplant heart failure. METHODS: Data was obtained for all LT recipients between Jan 2000 - Dec 2010. The primary outcome was post LT heart failure: either systolic HF (EF<50%), diastolic HF or mixed HF. Patients underwent echocardiographic evaluation before and after liver transplantation. Pre transplant variables were evaluated as predictors of heart failure using a Cox proportional hazard model. RESULTS: We included 970 liver transplant recipients that were followed for a mean duration of 5.3 ± 3.4 years. Of these, 98 patients (10.1%) developed clinical heart failure in the post-transplant period. There were 67 (6.9%) systolic, 24 (2.5%) diastolic and 7 (0.7%) mixed systolic/diastolic patients with left ventricular dysfunction. The etiology was ischemic in 18 (18.3%), tachycardia induced in 8 (8.4%), valvular in 7 (7.1%), alcohol related in 4 (4.1%), hypertensive heart disease in 3 (3.1%) of these patients and non-ischemic in the majority of these patients (59.1%). Pre - transplant grade III diastolic dysfunction, diabetes, hypertension, mean arterial pressure ≤65mmHg, mean pulmonary artery pressure ≥30, mean pulmonary capillary wedge pressure ≥15, hemodialysis, BNP level and QT interval ≥450 ms were found to be predictive for development of new onset systolic heart failure. On the other hand, beta blocker use prior to liver transplantation or the continued use of tacrolimus post-liver transplantation was associated with the reduced development of new onset systolic heart failure. CONCLUSION: Pre transplant risk factors, hemodynamic variables and echocardiographic variables are important predictors of post-liver transplant heart failure. In patients undergoing liver transplantation, the post-operative onset of systolic or diastolic heart failure was found to be an independent predictor of mortality. Liver Transpl , 2013. © 2013 AASLD.
  Liver Transplantation 04/2013;
• Article: Prevention of de novo hepatitis B with adefovir plus vaccination in recipients of liver transplants from core antibody-positive donors.

  Matthew S Chang, Sonja K Olsen, Elsa M Pichardo, Scott Heese, Jessica B Stiles, James V Guarrera, Jean C Emond, Robert S Brown
  Liver Transplantation 04/2013; 19(4):462.
• Article: Improving access to liver transplantation: Another part of the puzzle.

  Janet E Tuttle-Newhall, Krista L Lentine
  Liver Transplantation 04/2013; 19(4):353-354.
• Article: Portal vein arterialization using an accessory right hepatic artery in liver transplantation.

  Siegfredo Paloyo, Seigo Nishida, Ji Fan, Akin Tekin, Gennaro Selvaggi, David Levi, Andreas Tzakis
  Liver Transplantation 03/2013;
• Article: Transformation of cavo-portal to reno-portal inflow to the graft during liver transplantation for stage iv portal vein thrombosis.

  Riccardo Memeo, Chady Salloum, Daren Subar, Nicola De'angelis, David Zantidenas, Philippe Compagnon, Alexis Laurent, Daniel Azoulay
  Liver Transplantation 03/2013;
• Article: Serum alpha-fetoprotein level independently predicts post-transplantation survival in patients with hepatocellular carcinoma.

  Kristin Berry, George N Ioannou
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  ABSTRACT: We aimed to determine whether combining serum AFP level with HCC tumor burden allows better stratification of post-transplantation survival in patients with HCC undergoing liver transplantation. We calculated the risk of post-transplantation mortality associated with serum AFP level or HCC tumor burden, adjusting for donor and recipient characteristics, among all adult, first-time liver transplantations performed in the US between 2002-2011 (n=45,267). Serum AFP level, rather than tumor burden, was the tumor characteristic most strongly associated with post-transplantation survival. While recipients with HCC and serum AFP ≤ 15 ng/mL at the time of transplantation had no excess post-transplantation mortality (adjusted hazard ratio [AHR] 1.02, 95% CI 0.93-1.12), those with serum AFP 16-65 (AHR 1.38, 95% CI 1.23-1.54), 66-320 (AHR 1.65, 95% CI 1.45-1.88), and >320 ng/ml (AHR 2.37, 95% CI 2.06-2.73) had progressively worse post-transplantation mortality, compared to recipients without HCC. Patients with tumor burden exceeding the Milan criteria, who are usually excluded from transplantation, had excellent post-transplantation survival if their serum AFP was 0-15 ng/mL (AHR 0.97, 95% CI 0.66-1.43). In contrast, patients within the Milan criteria, who are routinely considered to be transplant candidates, had poor survival if their serum AFP was substantially elevated (AHR 1.92, 95% CI 1.71-2.14, for serum AFP ≥66 ng/mL). Changes in serum AFP level while on the waiting list corresponded closely to changes in post-transplantation mortality. In conclusion, absolute serum AFP level and changes in serum AFP level strongly predict post-transplantation survival independently of tumor burden. We hope that these data may be used, in combination with other factors, to inform future studies and ongoing discussions aiming to improve eligibility criteria for liver transplantation in patients with HCC. Liver Transpl , 2013. © 2013 AASLD.
  Liver Transplantation 03/2013;
• Article: Liver transplantation in hepatitis B core negative recipients using livers from hepatitis B core positive donor: 13 years experience.

  Humberto E Bohorquez, Ari J Cohen, Nigel Girgrah, David S Bruce, Ian C Carmody, Shoba Joshi, Trevor W Reichman, George Therapondos, Andrew L Mason, George E Loss
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  ABSTRACT: Use of livers from hepatitis B (HBV) HBsAg (-) / HBc (+) donors in HBsAg (-) / HBc (-) recipients for liver transplantation (LT) is still controversial due to lack of standard antiviral prophylaxis and long-term follow-up. We present our 13 year experience using HBc (+) donor livers in HBc (-) recipients. Patients received prophylaxis with hepatitis B immunoglobulin (HBIG) at the time of LT and then lamivudine (LAM) daily. De-novo HBV was defined as positive HBV-DNA detection. Between January 1999 and December 2010, 1013 adult LT were performed in our center. Of them, 64 (6.3%) HBsAg (-)/HBc (-) patients received an HBsAg (-)/HBc (+) liver. All donor sera were negative for HBc IgM and HBV-DNA. Mean follow up was 48.8 + 40.1 months (Range 1- 148.8). Both patient and graft survival at 1 and 5 y were 92.18 and 69.2%. No graft loss or deaths were related to de-novo HBV. Nine of 64 (14.06%) patients developed de-novo HBV. Mean time from LT to de-novo HBV was 21.4 + 26.1 months (Range 10.8-92.8). De-novo HBV was successfully treated with adefovir or tenofovir. In conclusion, HBc (+) allografts can be safely used in HBc (-) recipients without increasing mortality or graft loss. Lifelong prophylaxis, continuous surveillance and compliance are imperative for success. Should de-novo infection occur, our experience suggests a variety of treatments may be employed to salvage the graft and obtain serum HBV-DNA clearance. © 2013 American Association for the Study of Liver Diseases.
  Liver Transplantation 03/2013;
• Article: An update on donor-derived infections in liver transplantation.

  Ignacio A Echenique, Michael G Ison
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  ABSTRACT: Advances in surgical technique, immunosuppressive medications and robust infectious diseases prophylaxis have resulted in liver transplantation becoming the treatment of choice for patients with end stage liver disease and unresectable hepatocellular carcinoma. Nonetheless, organ transplantation is not without risk. Unexpected donor-derived disease transmission is a newly recognized risk that complicates approximately 0.2% of all organ transplantation. We shall review the epidemiology and methods of risk mitigation against donor-derived infectious diseases with a focus on liver transplantation. © 2013 American Association for the Study of Liver Diseases.
  Liver Transplantation 03/2013;
• Article: Sequential liver and kidney transplantation from a single living donor in two young adults with primary hyperoxaluria type-1.

  Eytan Mor, Eviatar Nesher, Ziv Ben-Ari, Irit Weissman, Ezra Shaharabani, Sigal Eizner, Evegny Solomonov, Ruth Rahamimov, Marius Braun
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  ABSTRACT: Using a live donor organ for sequential liver and kidney transplantation (SLKTx) in patients with primary hyperoxaluria type 1 (PH-1) has emerged as a viable approach. Using both organs from a single donor however is rare. There are 8 reported cases of SLKTx in the literature, all excluding one case were done in children. We present our experience with SLKTx in two young adults with PH-1. CASE REPORTS: First case - SLKTx was performed (interval between procedures 4.5 months) using a right liver lobe from a 47 y/o father to his 19 y/o son with PH-1 who was on dialysis for 2 years prior to transplant. Both the donor and the recipient had an uneventful recovery albeit re-exploration for control of bleeding in the recipient after liver transplantation. At 33 months after transplantation the patient has normal liver and renal function. Second case - SLKTx was performed (interval 22 days) from a 44 y/o father to his 19 y/o daughter with PH1 who was on dialysis for 8 months. The recipient procedures including right liver lobe and kidney transplantation were uneventful. The donor underwent percutaneous drainage of a subphrenic collection with subsequent full recovery. At 18 months after transplantation the recipient's liver and renal allograft function are normal. CONCLUSIONS: In view of severe organ shortage, sequential living related liver-kidney transplantation from the same donor should be carefully considered in young adults with PH-1. © 2013 American Association for the Study of Liver Diseases.
  Liver Transplantation 03/2013;
• Article: Innovative technique to prevent hepatic artery kinking in living donor liver transplantation.

  Yu-Shu Cheng, Ping-Yi Lin, Kuo-Hua Lin, Chih-Jan Ko, Chia-Cheng Lin, Yao-Li Chen
  Liver Transplantation 03/2013;
• Article: Long-term follow-up of endoscopic therapy in stenosis of the bilio-biliary anastomosis associated with orthotopic liver transplantation.

  Jörg G Albert, Natalie Filmann, Julia Elsner, Christian Moench, Jörg Trojan, Jörg Bojunga, Christoph Sarrazin, Mireen Friedrich-Rust, Eva Herrmann, Wolf Otto Bechstein, Stefan Zeuzem, Wolf Peter Hofmann
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  ABSTRACT: BACKGROUND: Endoscopic treatment of stenosis of the anastomotic biliary stricture (ABS) after orthotopic liver transplantation (OLT) has been proven to be effective and safe, but long term outcome and risk factors for recurrence are unknown. METHODS: All 374 patients who underwent OLT at Frankfurt University hospital were screened for occurrence of ABS. ABS was treated by endoscopic insertion of plastic endoprosthesis (29.8%), balloon dilation (12.8%), or a combination of both (57.4%). Long-term outcome and risk factors for occurrence and recurrence of ABS was determined through competing risk analysis. Mean follow-up time was 151 weeks and mean survival was 3.4 years. RESULTS: ABS was observed in 47 patients (12.6%). Mean (median) time from OLT to ABS was 16.3 months (3.3 months). Cumulative incidence rates of ABS were 0.09 after 12 months, 0.10 after 24 months and 0.11 after 36 months. In 12 cases (25.5%), ABS was observed later than 12 months after OLT. ABS recurred in 14 of 47 (29%). Ocurrence of ABS more than six weeks after OLT was a significant predictor of ABS recurrence (p=0.04, H.R. 0.235). There was a trend of HCV infection to be predominant in patients with recurrence of ABS (30% HCV vs. 4% non-HCV) in comparison to patients with non-recurrence (HCV 36%, non-HCV 30%); p > 0.05. Severity of initial stricture predicted recurrence of ABS (p = 0.046, HR=2.78), but did not influence overall survival. Long-term resolution of ABS was observed in 45 of 47 patients (95.7%), recurrence of ABS was treated with a second (n= 16, 34%), or a third endoscopic treatment attempt (1). CONCLUSION: Long-term success of endoscopic treatment of ABS is highly probable if recurrent strictures are again treated endoscopically. ABS might occur late (>36 months) after OLT and life-long follow-up is essential in OLT patients to identify patients with ABS. © 2013 American Association for the Study of Liver Diseases.
  Liver Transplantation 03/2013;
• Article: Use of rifabutin for the treatment of a latent tuberculosis infection in a patient after solid organ transplantation.

  Matthew D Hickey, David J Quan, Peter V Chin-Hong, John P Roberts
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  ABSTRACT: Latent tuberculosis infection is an important problem for solid organ transplant recipients because of the frequency of its occurrence and its potential for reactivation. Because of the high mortality rate associated with active tuberculosis infections in transplant recipients, guidelines from the American Thoracic Society recommend treatment for latent tuberculosis in this population. However, the choice of treatments is often difficult because liver transplant recipients may be more sensitive to isoniazid hepatotoxicity, and rifampin has significant drug interactions with the calcineurin inhibitors used for immunosuppression. Two prior case reports described success with the use of rifabutin, a rifampin alternative, as part of a multidrug treatment regimen for active tuberculosis in posttransplant patients; however, there is no prior literature describing any experience with rifabutin for the treatment of latent tuberculosis in the posttransplant setting. We present a summary of tacrolimus drug levels and corresponding dose requirements for a single posttransplant patient during the administration of 3 different latent tuberculosis drug regimens: rifampin alone, rifampin plus ketoconazole, and rifabutin. In this patient's case, rifabutin allowed the maintenance of adequate tacrolimus levels, although an approximate 2.5-fold increase in the dose was required. Rifampin alone was associated with inadequate immunosuppressant levels, and rifampin plus ketoconazole was associated with a problematically prolonged QT interval and concerns about inadequate tuberculosis treatment. Liver Transpl 19:457-461, 2013. © 2013 AASLD.
  Liver Transplantation 03/2013;
• Article: Chronic kidney disease (CKD) after liver transplantation in HIV/HCV coinfected versus HIV/non-HCV infected recipients: Results from the NIH multi-site study.

  Ranjeeta Bahirwani, Burc Barin, Kim Olthoff, Peter Stock, Barbara Murphy, K Rajender Reddy
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  ABSTRACT: Hepatitis C virus (HCV) and Human Immunodeficiency Virus (HIV) are both associated with chronic kidney disease (CKD), a major complication after orthotopic liver transplantation (OLT). The aim of this study was to assess predictors of post-OLT CKD in HIV/HCV coinfected versus HIV/non-HCV infected recipients. METHODS: Data from the NIH Solid Organ Transplantation in HIV: Multi-Site Study of 116 OLT recipients (35 HIV/non-HCV and 81 HIV/HCV co-infected) from 2003 to 2010 were analyzed for pre-transplant CKD prevalence (estimated glomerular filtration rate (eGFR) < 60 ml/min for ≥ 3 months) and incidence of CKD up to 3 years post-transplant. Proportional hazards models were performed to assess predictors of post-transplant CKD. A contemporaneous cohort of HCV monoinfected transplant recipients from the SRTR database was also analyzed. RESULTS: Median age at transplant was 48 years, serum creatinine was 1.1 mg/dl, and median eGFR was 77 ml/min. Thirty-four patients had suspected pre-transplant CKD; 20 of these (59%) had post-transplant CKD. Among the 82 patients without pre-transplant CKD (26 HIV/non-HCV and 56 HIV/HCV coinfected), the cumulative incidence of stage 3 CKD at 3 years post-OLT was 62% (55% HIV/non-HCV versus 65% HIV/HCV coinfected) and stage 4/5 CKD was 8% (0% HIV/non-HCV versus 12% HIV/HCV coinfected). In multivariate proportional hazards analysis, older age (HR 1.05 per year; p 0.03) and CD4 count (HR 0.90 per 50 cells/μL; p 0.01) were significant predictors of CKD. HCV coinfection was significantly associated with stage 4/5 CKD (HR 10.8; p 0.03) after adjustment for age on multivariate analysis. The cumulative incidence of stage 4/5 CKD was significantly higher in HIV/HCV coinfected patients compared to HIV/non-HCV and HCV monoinfected transplant recipients (p=0.001). CONCLUSIONS: CKD occurs frequently in HIV infected transplant recipients. Predictors of post-transplant CKD include older age, and lower post-transplant CD4 count. HCV co-infection is associated with a higher incidence of stage 4/5 CKD. Liver Transpl , 2013. © 2013 AASLD.
  Liver Transplantation 03/2013;