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
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- ". The relevance of diagnosing asymptomatic IBD in a transplant recipient is essentially that the associated colorectal cancer risk could expectedly be reduced by an appropriate dysplasia surveillance program as proposed by guidelines   . Cancer is the number 1 cause of premature death in the long term after LT for PSC , and colorectal cancer is one of the cancer types that occur with increased frequency . "
ABSTRACT: Guidelines recommend colonoscopy screening for possible asymptomatic inflammatory bowel disease (IBD) in all patients diagnosed with primary sclerosing cholangitis (PSC). PSC-IBD warrants regular dysplasia-surveillance colonoscopy. However, no consensus exists regarding follow-up colonoscopy in PSC patients without IBD who remain asymptomatic. We describe a 43-year-old female who had undergone liver transplantation (LT) due to advanced PSC. Previous colonoscopies had been normal. The post-transplantation course was uneventful, with no rejections and signs of PSC recurrence. Immunosuppression was by tacrolimus monotherapy. She was asymptomatic with normal inflammation markers. A protocol colonoscopy, performed as general dysplasia surveillance 8 years post-transplantation, revealed mucopurulent-covered small superficial ulcerations and erythema diffusely distributed from the cecal to sigmoid colon with intervening normal mucosa and rectal sparing. Histologic examination showed patchy chronic colitis with crypt architectural distortion and mild-moderate inflammation activity. Infection samples were negative. Findings complied with de novo IBD, type unclassified. In conclusion, the link between PSC and clinically silent IBD may manifest after the PSC diagnosis and even several years after LT. Given the increased colorectal cancer risk associated with PSC, IBD, and LT, repeat colonoscopy might be warranted in PSC patients without IBD at initial assessment, and also after LT.
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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 . A common immunosuppressive regimen was the combination of mycophenolate mofetil (MMF) with a calcineurin inhibitor (Tacrolimus or Cyclosporine). "
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.
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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   ; however, this may differ between centers and countries and may depend on graft quality. "
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.
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