Journal of Liver Transplantation最新文献

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.

Glatiramer acetate (GA) has been used for the treatment of relapsing multiple sclerosis (MS) since 1996. We describe a 59-year-old woman with well-controlled MS on long-term GA who presented with three weeks of jaundice and dark-colored urine and elevated liver enzymes and had biopsy-proven drug induced liver injury. The patient underwent expedited liver transplant evaluation and successfully underwent deceased donor liver transplant. Our case illustrates the first case of acute liver failure (ALF) associated with Glatiramer acetate use requiring liver transplantation. Patients on GA should have long term regular liver monitoring.

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.

Background

The impact of post liver transplantation (LT) readmissions on mortality has not been well described. Thus, the primary objective of our study was to determine predictors of readmissions post-LT and assess impact on survival.

Methods

Single center retrospective observational study investigating adult patients who underwent LT between January 1, 2010 – December 31, 2019 at Toronto General Hospital (TGH). Time-dependent cox regression model was used to investigate risk factors for 30-day, 30–90-day, and >90-day readmissions to hospital. The effect of readmission on survival was assessed with the Kaplan–Meier estimator.

Results

987 patients fulfilled inclusion criteria. Significant predictors of 30-day readmissions were BMI > 30 kg/m² (HR=0.64; CI 0.42–0.98; p-value 0.04) and autoimmune/cholestatic liver disease (HR=1.86; CI 1.01–3.42; p = 0.046) at 30-days. Post-LT length of stay (HR=1.05; CI 1.02–1.08; p<0.001) at 30–90 days. Meanwhile, living donor LT (HR=1.41; CI 1.06–1.89; p = 0.02) and distance from LT center (HR=1.05; CI 1.01–1.09; p = 0.011) after 90 days. Infection was the main reason for readmission across three time periods. An inpatient readmission across any time period was found to be significantly associated with mortality (HR=2.4; 1.6–3.6; p<0.0001).

Conclusion

Hospital readmissions post-LT are associated with increased mortality. Although infection is a common risk factor for readmission other modifiable risk factors may be an area for target of interventions to reduce post-LT readmission.

Glycogen storage disease (GSD) is a rare inborn autosomal recessive inherited disorder of carbohydrate metabolism. There are multiple types of GSD, out of which GSD type I, III, IV, VI, and IX show liver involvement. Due to a deficiency of glucose-6-phosphatase enzyme in this disorder, glycogen stored in the liver cannot be metabolised, leading to poor tolerance to fasting and increased risk of hypoglycaemia and lactate acidosis. Inability to metabolise glycogen leads to progressive accumulation of glycogen in liver leading to hepatic adenoma (HA) and/or hepatocellular carcinoma (HCC). Liver transplantation (LT) has been proposed as the preferred therapy for these types of GSD, as it helps in correcting the primary hepatic enzyme defect, thereby improving the quality of life and reducing the risk of HCC. Herein we report our experience of perioperative management of paediatric GSD type 1a (Von Gierke's disease) patient undergoing living donor liver transplant (LDLT).

Introduction

Elevation of IgA levels has not been studied in the post-transplant setting. We present a series of pediatric liver recipients with elevated IgA during follow-up and relate them to changes in renal function.

Materials and methods

We conducted a retrospective study of patients that underwent a liver transplantation at our institution between 2002 and 2022 and excluded those with less than two years of follow-up.

Results

Eighty-five patients were identified, 56% with elevated IgA. They were younger at transplantation (p 0.006) and had persistent splenomegaly (p 0.02). They were also more likely to have allergies (p < 0.001). Furthermore, 93% of those with eczema (p < 0.001) and 90% of those with food allergy had elevated IgA (p < 0.001). Glomerular filtration rate decreased over time in both groups, although it wasn't significant. However, the rate was different between the two (p < 0.001), especially after the sixth year of follow-up (p 0.02). Furthermore, of the 14 patients with values below 90 mL/min/1.73 m², 12 belonged to the group with elevated IgA (p 0.02).

Conclusion

We believe that intestinal permeability secondary to portal hypertension combined with tacrolimus exposure may facilitate the development of immune reactions increasing IgA levels, causing its deposition in kidneys, and leading to renal injury over time.

Background

Liver hemangiomas are the most common type of benign liver tumor in adults, often asymptomatic and non amenable to treatment. Liver transplantation has been suggested to be an effective treatment option in highly selected patients with non-resectable giant liver hemangiomas causing severe symptoms when other treatment options have failed or are deemed inappropriate

Methods

We report our experience at Paul Brousse Hospital with liver transplantation for giant hepatic hemangioma and a systematic review of the literature on the indication of liver transplantation, to clarify feasibility and short- and long-term outcomes.

Results

The literature search yielded 525 articles. After screening titles and abstracts, 19 articles were finally included in this review. Regarding our experience during the study period, three out of 3593 liver transplantations were carried out for giant symptomatic hemangioma. In the literature 23 cases were described, of which 5 associated to a Kasabach-Merritt syndrome, with an acceptable follow up.

Conclusions

Giant liver hemangiomas represent a rare indication for liver transplantation. Exceptionally when other treatment options have failed or are not suitable, liver transplantation is a safe and effective option.