Long-term management of the successful liver transplant: 2012 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation

Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI. .
Liver Transplantation (Impact Factor: 4.24). 01/2013; 19(1):3-26. DOI: 10.1002/lt.23566
Source: PubMed
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    • "Patients treated with oral hypoglycemic agents and/or insulin before transplantation were diagnosed as pretransplant diabetes mellitus. Patients obtained immunosuppression according to individual risk factors and comorbidities [3]. A common immunosuppressive regimen was the combination of mycophenolate mofetil (MMF) with a calcineurin inhibitor (Tacrolimus or Cyclosporine). "
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    ABSTRACT: The influence of NODAT on survival of liver transplant recipients has not been clarified. Therefore, we evaluated the effect of NODAT on survival in LT recipients. Data from 352 LT patients were totally analyzed. 97 patients with pretransplant diabetes mellitus were excluded, and 255 patients without diabetes mellitus at time of transplantation were included. NODAT was diagnosed in 41 patients (16.1%). There was no difference in frequency of NODAT according to the etiology of liver cirrhosis. NODAT was associated with a higher body weight (p=0.004) and BMI (p=0.002) 5years after LT, but not with weight gain (p=0.201) or increase in BMI (p=0.335) 5years after LT. HbA1c 5years after LT was significantly higher in patients with NODAT (p=0.001), but mean HbA1c still remained lower than 6.5% (6.4(±1.2) %). Patients with NODAT showed better survival rates (log rank: p=0.002) compared to LT recipients without diabetes. According to all existing knowledge of diabetes mellitus (DM) better survival cannot be a direct effect of this disease. Our results are rather influenced by an not known confounding factor (possibly recovery from cachexia) associated with better survival and NODAT, while complications of NODAT will not appear during the relatively short postoperative time and observation period (mean follow up 6.08 (±2.67) years). NODAT is frequently diagnosed in LT recipients and is associated with an improved 5year survival after LT due to a not exactly known confounding factor. Copyright © 2015. Published by Elsevier B.V.
    European Journal of Internal Medicine 06/2015; 26(6). DOI:10.1016/j.ejim.2015.05.018 · 2.89 Impact Factor
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    • "Itisgenerallyacceptedthatscarcelivergraftsshouldbe reserved for those LT candidates in whom a survivalbenefit from LT can be demonstrated. It has been proposed that the minimum Model for End-stage Liver Disease (MELD) score at which LT offers such survivalbenefit is 15 [1] [2] [3]; however, this may differ between centers and countries and may depend on graft quality. "
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    ABSTRACT: Thresholds for when a patient should be considered too healthy or too sick to undergo liver transplantation (LT) have been pursued, but have undergone little external validation and may differ between centers and countries. We investigated the ability of the Model for End-stage Liver Disease (MELD), D-MELD, Donor Risk Index (DRI) and Balance of Risk (BAR) scores to predict 1-year graft survival, and determined the 1-year survival-benefit of LT, compared with conservative management, according to MELD score and graft quality among 538 adult LT recipients with underlying chronic non-malignant liver disease. One-year graft survival rates showed small, but statistically significant variation according to MELD (p = 0.002) and D-MELD score (p = 0.04), and among LTs after year 2000 also according to BAR score (p = 0.01), but not according to DRI. Diagnostic accuracy of these scores was poor; area under the curve was 0.50-0.65 depending on the score. A 1-year survival-benefit of LT emerged at MELD scores ≥15, but also at lower MELD scores when using high-quality grafts (DRI <1.075). The performance of various prognostic scores in the Finnish setting was poor. Careful clinical evaluation is imperative when deciding on the timing of LT in the course of chronic liver disease.
    Scandinavian Journal of Gastroenterology 04/2015; 50(9). DOI:10.3109/00365521.2015.1028992 · 2.36 Impact Factor
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    • "Liver failure is a devastating syndrome caused by loss of hepatic cell mass below a critical level due to different diseases.[4] After improvements in both surgical techniques and immunological protocols, liver transplantation has become the treatment of choice for patients suffering from end-stage liver disease,[5] and management of liver failure has been revolutionized by transplantation of the whole liver or a portion of the liver.[23] "
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    ABSTRACT: This study was proposed to evaluate a new method for autograft transplantation of liver tissue fragments (LTF) in the lung parenchyma and bronchus of dogs and to compare the results to find out if they are suitable sites for hepatocyte implantation or not. THE DOGS WERE RANDOMLY ASSIGNED INTO TWO CATEGORIES: LTF auto-transplantation to the lung parenchyma and into the bronchus. The suspensions of normal saline and LTF were injected and implanted into the lung parenchyma and the main bronchus of the right accessory lobe in first and second groups, respectively. Two weeks later the right accessory lobe was removed and sent for a histopathological study. All samples were checked under a light microscope with regard to the presence of hepatocytes, with both the Hematoxylin and Eosin (H and E) preparation and immunohistochemistry (IHC) method, using a CK-18 marker. All results were double-checked with a polymerase chain reaction (PCR). The mean weight of all the dogs was 19.87 ± 0.93 kg and mean age was 3.58 ± 0.31 years. After 15 days, the H and E, IHC, and PCR studies revealed that in the first group, all the dogs (n = 4) had living liver tissue, which survived in the lung parenchyma successfully. In contrast, none of the dogs (n = 0) in the second group showed surviving hepatocytes in the bronchus (P < 0.001). Implantation of the LTFs into the lung parenchyma could be a source of hepatic cell production.
    Journal of research in medical sciences 09/2013; 18(9):791-4. · 0.65 Impact Factor
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