Journal of Liver Transplantation最新文献

Kidney utilization for simultaneous liver-kidney transplantation (SLK) has seen a significant increase in recent years, driven by the rising prevalence of renal dysfunction among liver transplant candidates. However, a substantial proportion of SLK recipients experience native kidney function recovery post-transplant, rendering the kidney transplant unnecessary. This case report presents a remarkable instance of native renal function recovery in a SLK recipient, discovered eleven years after transplantation, when the transplanted kidney was found to have undergone extensive fibrosis and atrophy, masked by native kidney recovery. This case highlights the challenges posed by evaluation of SLK candidates and the need for improved tools to predict native kidney recovery. Safety net mechanism for those who do not recover kidney function should be utilized more to avoid the unnecessary utilization of scarce kidney allografts, which are critically needed for waitlisted patients with kidney failure.

With improvements in medical management and surgical technique in the field of solid organ transplantation, many historically prominent causes of liver allograft injury have been ameliorated or, in the case of Hepatitis C virus, eliminated altogether. In this transformed clinical landscape, antibody-mediated rejection (AMR) has emerged as a defining barrier to maintenance of long-term liver allograft function. The liver's unique anatomy, high regenerative capacity, and tolerogenic immunological environment tend to mitigate the severest AMR manifestations. Consequently, the clinical importance of AMR in the liver has been recognized more slowly than for other solid organ allografts. Significant strides have been made in elucidating clinical and histopathologic features of acute and chronic liver AMR, with the Banff 2016 criteria among the most notable. However, current histopathologic definitions of AMR are lacking in sensitivity and specificity. C4d staining is an imperfect biological surrogate for antibody-mediated injury, and suffers from significant technical limitations. The frequent co-occurrence of T cell mediated rejection and non-immunologic allograft damage (including recurrence of primary disease) also hinders definitive identification of AMR and results in misattribution of its effects. The goal of this review is to summarize the current understanding of AMR in the context of liver transplantation, including risk factors, pathogenesis, and current diagnostic and treatment strategies. Potential directions of future research are also addressed.

Hepatopulmonary syndrome (HPS) is a rare pulmonary complication of cirrhosis for which the only curative treatment is liver transplantation (LT). Patients with severe HPS prior to LT are at high risk of postoperative complications and mortality, and may develop refractory HPS after LT. To date, no therapeutic strategy has been validated for these patients. To our knowledge, we describe the first case of successful use of high-flow nasal cannula oxygen therapy for severe post-LT hypoxemia in a 23-year-old adult.

BACKGROUND

In liver transplantation, qualitative methodologies can offer important insights from a range of perspectives into the meaning and impact of health experiences. This review aims to characterize the existing qualitative research in liver transplantation to understand how this work has evolved over time, its contribution to understanding clinical issues, and to conceptualize under-developed areas for future research.

METHODS

Studies from MEDLINE, Embase, Cochrane Database of Systematic Reviews, CENTRAL, CINAHL, and Web of Science were searched from database inception to January 2024. All English language studies focused on a liver transplant population with qualitative methodological components were included. Using VOSviewer network mapping software we constructed a visualization of the thematic networks within included studies.

RESULTS

Our initial search yielded 9092 studies from which 229 were included in the final review. Data extraction revealed significant increases in the publication of qualitative studies since 2015, predominantly utilizing interviews and focus groups. The thematic network map we constructed placed “social support” as a dominant and central concept across many different studies, with related themes tending to cluster within four domains of research: Care of the Organ & Patienthood; Identity, Embodiment, Adjustment; Relational & Ethical Issues; Existential Themes. Medicalized subject such as “self-management” were less well-networked with identity-related, ethical, and existential topics.

DISCUSSION

There is a growing body of rich qualitative research in liver transplantation. Future research would benefit from more longitudinal approaches as well as increased attention to the interrelation between “clinical” issues (adherence, quality of life) and ethical, relational, and existential ones.

The precision of liver tumor segmentation heavily depends on the doctor's expertise, hence it is required to produce an algorithm for automatic liver tumor segmentation to reduce the manual intervention in assessing liver disease identification. We propose a CNN-based UNet architecture designed to segment liver tumors from CT images of size 128×128. In this model, modifications were made to the encoder, decoder, and bridge paths to enhance feature extraction efficiency. The performance of the modified UNet was evaluated against an existing segmentation method using the same CT image size. The comparison focused on the Dice similarity coefficient and accuracy. Our proposed method demonstrated a high Dice similarity coefficient of 75.37 % and an accuracy of 99.75 % on the 3Dircadb dataset. These results indicate that our modified UNet achieved superior segmentation metrics compared to state-of-the-art methods, showcasing its effectiveness in liver tumor segmentation.

Background

Polycystic liver disease is a rare hereditary disease that can occur as an isolated disease. Because of its benign nature, polycystic liver disease rarely needs treatment. If treatment is needed, there are no standard guidelines, but usually, a liver resection or medical therapy is performed. A liver transplant is the last resort when all other possibilities have been exhausted, or complications arise. However, the risks and benefits must be carefully weighed.

Methods and materials

A retrospective registry analysis of the SRTR database was done for liver transplants performed in the United States from January 2001 to May 2023.

Results

The analysis of the data indicated a notable improvement in 5-year graft survival rates between the 2001–2010 group (mean of 92 %) and the 2011–2023 group (mean of 97 %) (P < .001). The 2011–2023 group had a higher proportion of simultaneous kidney and liver transplants, more than 3 times, from 106 cases to 374 cases (57.7 % vs. 42.3 %, P = .001). The type of transplant was also considered when analyzing the 5-year survival of grafts. Patients who underwent both kidney and liver transplants simultaneously had a slightly better outcome. It was found that the only hazard affecting LT graft survival in the cohort was the cold ischemic time (HR: 2.80, P = .03).

Conclusion

With all the surgical techniques and post-operation improvements, a liver transplant can be a feasible option for polycystic liver disease when the medical treatments are not sufficient to eliminate the symptoms.

Background

The risk of HBV reactivation after solid organ transplantation and the strategies to prevent it are not well defined.

Methods

We reviewed patients who received liver, kidney, pancreas, or heart transplants at our center between September 2015 and November 2020. We collected recipient and donor data on HBV serologies, prophylactic strategies, and known risk factors that associate with HBV reactivation in post-transplant patients.

Results

In the study period, 2126 solid organs were transplanted into 1951 patients. The recipient (R), donor (D), or both were HBcAb(+)/HBsAg(-) in 360 transplants. Post-transplant HBV DNA developed in 0/10 heart, 0/3 pancreas-kidney, 2/1517 (0.1 %) kidney, and 10/430 (2.3 %) liver recipients. Both kidney recipients with HBV DNA tested negative on re-testing without treatment. HBV DNA developed in 17.5 % of liver recipients who were D+/R- for HBcAb (10/57). All 10 liver recipients developing HBV DNA received prophylaxis. 5 patients developed detectable HBV DNA while on prophylaxis at a median 886 days (range 139 to 2287) after transplant. 5 patients developed HBV DNA after prophylaxis was discontinued at a median 955 days (range 756 to 2003) after transplant and 596 days (395 to 1638) after discontinuation.

Conclusion

HBcAb is found in a significant portion of our solid organ transplant donors and recipients, and HBcAb(+)/HBsAg(-) liver allografts represent the primary risk factor for HBV post-transplant. HBV infection in non-liver solid organ transplant is minimal risk using current monitoring strategies. Infection can occur long after the transplant event. Monitoring and prophylaxis strategies in this group should be reassessed.

Metabolic dysfunction-associated steatotic liver disease (MASLD) has an alarmingly high global prevalence. Its progressive subtype, metabolic dysfunction-associated steatohepatitis (MASH), is the leading indication for liver transplantation overall. Although MASLD has been associated with increased risk for several cardiac abnormalities including cardiac arrhythmias, structural disease, heart failure, valvular disease, and coronary artery disease, little is known about the clinical course and effects of these abnormalities in post-liver transplant patients with MASH as an etiology of their cirrhosis. This narrative review presents clinical and mechanistic evidence for the association of MASLD with the aforementioned cardiac abnormalities, as well as characterizes what is known about their significance in the post-operative period for those undergoing liver transplantation for MASH. Additionally, this review emphasizes knowledge gaps and highlights areas for further study of the impact of cardiac abnormalities in patients undergoing liver transplantation for MASH.