Journal of Liver Transplantation最新文献

Introduction

Non-alcoholic steatohepatitis (NASH) is a rising cause of liver transplantation and is linked to higher rates of cardiovascular complications. The aim of this study was to evaluate the risk of post-transplant cardiac events in patients with NASH that were exposed to sirolimus (SRL) vs. calcineurin-inhibitor (CNI) immunosuppression.

Methods

We retrospectively reviewed all adult liver transplant recipients at our institution between 2002 and 2020. Subjects were grouped based on immunosuppressive regimen. We also analyzed the subgroup of patients with NASH as the primary indication for transplant, as well as a non-NASH subpopulation. The primary outcome measure was risk of major adverse cardiovascular events (MACE) post-transplant. Comparisons between groups were conducted with chi-squared tests. Univariate Cox regression and multivariate time-dependent Cox regression models were used to analyze the relationship between immunosuppression and MACE risk.

Results

803 liver transplant patients met criteria for study inclusion. Of these, 169 patients had NASH as their primary indication for liver transplant. 18 % of the study population received SRL immunosuppression post-transplant, and the remainder received only CNI immunosuppression. Post-transplant MACE occurred in 32.65 % of patients on SRL compared to 10.27 % in patients on CNI immunosuppression (p =< 0.001). Without taking development of post-transplant CKD into account, our study showed a significantly higher risk of MACE with SRL immunosuppression in both the non-NASH cohort (HR 1.67, p = 0.036) and the NASH cohort (HR 2.48, p = 0.037. However, when accounting for post-transplant CKD, our analysis of the Non-NASH and NASH cohorts did not show a significantly greater risk of post-transplant MACE with SRL compared to CNI immunosuppression.

Conclusions

Our analysis shows that in both the NASH and non-NASH cohorts, liver transplant patients on sirolimus did not have a significantly higher risk of developing cardiovascular disease after transplant compared to immunosuppression with calcineurin inhibitors.

Thrombocytopenia in transplant period is nearly universal. Platelets are believed to have a significant role in the regeneration of hepatocytes and persistent thrombocytopenia can affect the graft function adversely. This current review discusses, in brief, the aetiology, implications, evaluation, and management of thrombocytopenia in post liver transplant period.

Background

While younger donors have better liver transplant (LT) outcomes, the median age of both the donor and recipient pools is rising. The impact of using donors ≥50 years on the LT outcomes of septuagenarians is unknown.

Methods

From 2011–2021, outcomes in septuagenarian LT recipients from donor livers <50 year-old (DON<50) and donor livers ≥50 year-old (DON≥50) were analyzed using the United Network for Organ Sharing database. Post-LT survival analysis was performed with the Kaplan-Meier method and multivariable Cox proportional-hazards model. A propensity score was utilized to conduct one-to-one matching using 14 recipient variables (1230-pairs).

Results

There were 2797 septuagenarian deceased-donor LT recipients during the study period. Of these, 1487 (53.2 %) were DON <50 with median age of 34 years and 1310 (46.8 %) were DON ≥50 with median age of 60 years. The number of LT for septuagenarians has increased over the last decade. The causes of donor and recipient deaths were different between two groups. Post-LT one-year survival (DON<50: 89.3 % vs. DON≥50: 88.3 %) and five-year survival (DON<50: 41.4 % vs DON≥50: 42.8 %) were comparable. Multivariable Cox proportional-hazards model showed that donor age ≥50 years is not associated with increased mortality after LT in the matched cohort (HR: 1.04, 95 % CI: 0.88–1.24, P = 0.63).

Conclusions

The utilization of carefully selected donor livers older than 50 years may be a viable option for septuagenarian LT candidates by lowering their waitlist time and can maximize the organ utilization without compromising the outcomes.

Solid organ transplant recipients (SOTRs) remain at high risk of progression to severe disease and hospitalization from Coronavirus disease 2019 (COVID-19). Regardless of vaccination status, burden of severe COVID-19 among SOTRs remains high and treatment of COVID-19 remains the main mitigating factor in preventing its progression. Oral antiviral therapies offer a convenient outpatient treatment option for mild-moderate COVID-19, and when used early may decrease the risk of progression of disease. Oral anti-viral therapies retain activity against all the currently known viral variants. Early diagnosis with prompt treatment and monitoring for drug-drug interactions is the key to optimal use of oral antiviral agents for COVID-19. Despite the promise to decrease morbidity and mortality from COVID-19, utilization of these medications among SOTRs remains low with existence of many barriers in their use.

Background: Living Donor Liver Transplantation (LDLT) in pediatric patients is an option to address organ shortage and diminish waitlist mortality. Small infants cannot house the entire left lateral segment (LLS) because of large for size syndrome, and abdominal wall compression may jeopardize outcomes. Sometimes, further graft reduction is required. Aim: To report outcomes of 7 liver transplants performed in our Unit 2017–2022, using monosegment left two (MLT) reduction techniques. Patients and Methods: We retrospectively reviewed digital charts of donors and recipients of MLT from our Unit 2017–2022. We analyzed surgical techniques, donors and recipients’ outcomes. Results: From 2001 to 2022, we performed 256 pediatric liver transplantation (LT). Since February 2017 (first MLT), 7 patients have received this technique transplantation until 2022. Average age at LT: 191.4 days (r 20–720 d), 2 were newborn. Average weight: 5614 gr (r 2500–9600 gr). In our series, there were no Hepatic Artery Thrombosis. Two patients showed portal vein stenosis at the distant post-transplant period. Graft and patient one-year survival rate: 85.7 % and 71 % at three years. Two patients passed away 8 and 14 months post-transplant (1 abdominal sepsis from cholangitis, during follow-up outside our country; the other, sepsis from a pneumonia, with normally functioning graft). Average follow-up time: 23.8 months (r 13–46 mo). Donors post-surgical outcome was uneventfully. Conclusions: Related LDLT and MLT reduction offer a safe and useful option for treating small and very small babies.

Antibody-mediated rejection (AMR) in liver transplantation is a frequently underestimated contributor to allograft injury. Despite advancements in defining acute and chronic AMR, challenges persist in timely identification and effective management. The complexities arise from the intricate nature of diagnosis, the absence of standardized treatment protocols, and uncertainties regarding long-term outcomes.

Understanding the specific antibodies involved, their target antigens on liver cells, and the mechanisms of complement activation is crucial for developing targeted therapies. This knowledge gap, coupled with the absence of clear diagnostic criteria and standardized treatments, adds to the intricacy of addressing AMR in liver transplantation.

Heightened clinical awareness and prompt identification of AMR post-liver transplantation are crucial. These efforts not only refine our understanding but also drive future research initiatives and the formulation of effective diagnostic and treatment protocols. Ongoing research aims to unravel AMR complexities through diagnostic tool advancements and refined histopathologic assessments, especially during acute and chronic rejection episodes.

This review delves into recent progress in clinically diagnosing and treating AMR in liver transplantation. It underscores the importance of recognizing specific histopathologic features in liver biopsy tissue during both acute and chronic phases of AMR. By shedding light on these complexities, the review aims to contribute to evolving research, fostering a deeper understanding, and paving the way for more effective management strategies in liver transplantation.