Journal of Liver Transplantation最新文献

Introduction

Methods

Results

Conclusion

Background

While liver transplant effectiveness in treating life-limiting liver disease is uncontested, challenges remain in organ preservation.

Methods

Following PRISMA guidelines, a systematic review was performed to determine the impact of Hypothermic Oxygenated Perfusion (HOPE) on liver transplant outcomes compared to static cold storage (SCS).

Results

A total of five studies were included, totaling 586 patients, out of which 267 patients had HOPE-preserved grafts and 319 SCS-preserved grafts. Analysis showed a significant decrease in early graft dysfunction and biliary complications in the HOPE group when compared to SCS (RR = 0.52; 95 % CI = 0.33–0.81]; p = 0.01) (RR = 0.75; 95 % CI = [0.60–0.94]; p = 0.02), respectively. Similarly, non-anastomotic biliary strictures were significantly reduced in the HOPE group (RR = 0.41; 95 % CI = [0.20–0.86]; p = 0.03). Of note, no statistical significance was found on the one-year graft loss and recipient death (RR = 0.40; 95 % CI = [0.09–1.83]; p = 0.12 and RR = 0.62; 95 % CI = [0.29–1.32]; p = 0.14, respectively). Likewise, no statistical difference was evident in acute rejection (RR = 0.54; 95 % CI = [0.04–7.14]; p = 0.20) and postreperfusion syndrome rate (RR = 0.92; 95 % CI = [0.35–2.41]; p = 0.73). After statistical analysis, no significant differences in major complications, primary nonfunction, re-transplantation, hepatic artery thrombosis, need for renal replacement therapy, intensive care unit, and hospital length of stay were evident.

Conclusions

Liver preservation techniques are gaining popularity by enabling rescue and transplantation of marginal livers. In this study, HOPE showed statistically significant differences in reducing rates of biliary complications, biliary stricture, and early graft dysfunction. Further studies are needed to evaluate financial burden and long-term outcomes to completely elucidate the impact of this organ preservation technique.

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

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.

Introduction

This study presents our experience with Epstein Barr virus (EBV) and Cytomegalovirus (CMV) infections in the pediatric liver transplant population and their potential association with the development of the post-transplant lymphoproliferative syndrome (PTLD).

Patients and methods

This retrospective descriptive study covers the period from 2014 to 2017 and includes pediatric liver transplanted recipients who underwent viral load monitoring for EVB and CMV during the first-year post-transplant.

Results

A total of 89 patients were included in the study, with a median age of 0.68 years (RIQ 0.31–0.96) (10.8 months RIQ 8.4–25.2). The most common underlying pathology leading to transplantation was biliary atresia, observed in 55 (61.6 %) cases. Regarding EBV viral loads, values exceeding 10,000 copies/ml were observed in 9 (8 %) patients at 3 months, 33 (29.3 %) at 6 months, 31 (27.6 %) at 9 months and 25 (22.3 %) at 12 months post-transplantation. The probability of developing EBV infection within one-year post-transplantation was 81.3 %, while the probability of CMV infection was 29 %. A total of 8 (8.9 %) biopsy-confirmed graft rejections occurred, only 1 was EBV and CMV-negative. The likelihood of graft rejection in patients with EBV infection was 21.5 %, and for CMV it was 20.8 %. Importantly, only one case of PTLD was documented during 12 months follow-up.

Conclusion

Characterizing this pediatric liver transplant population and monitoring EBV and CMV viral loads enables timely interventions, potentially reducing the risk of PTLD and graft rejection.

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.

Introduction

The prevalence of cardiac disease is high in patients with liver cirrhosis, making it one of the leading causes of death in this population. However, the presence of cardiac diseases (coronary artery disease and valvular heart disease) often leads to disqualification of potential liver transplantation (LT) candidates, resulting in limited treatment options available for these complex patients. In recent years, some medical centers, including Cleveland Clinic, have provided concomitant cardiac surgery (CS) and LT to carefully selected patients.

Methods

A comprehensive literature review was conducted, compiling our experience and that of other medical centers performing concomitant CS and LT. We highlight Cleveland Clinic's approach for LT candidates with cardiac diseases. This includes a description of our initial evaluation, designed to detect cardiac diseases, followed by an explanation of our patient selection criteria and intraoperative strategies for concomitant CS and LT.

Conclusion

In patients with liver cirrhosis who are candidates for LT but also present cardiac diseases, a cautious evaluation by a multidisciplinary team is required to determine the feasibility of performing concomitant CS and LT. Available evidence suggests that this combined approach is a potential treatment option, offering acceptable postoperative outcomes and overall survival, despite the often perceived high-risk nature of this complex patient population.

Introduction

In pediatric patients undergoing liver transplantation, infections are one of the primary complications. The etiology varies depending on the time elapsed post-transplant, with early presentations of bacterial and fungal infections, followed by viral and parasitic infections. There is limited literature describing the prevalence of infectious complications in this group of patients in Colombia.

Objective

To describe infectious complications in patients undergoing liver transplantation within the first 3 months post-procedure at the Fundación Valle del Lili, Cali, Colombia.

Methods

A case series of 165 pediatric liver transplant patients during the period 2011–2017. A descriptive analysis of all entered data was conducted. Survival analysis using the Kaplan-Meier method was performed, with an exploratory analysis comparing patient survival based on the presence of infection, censored for death related to postoperative complications.

Results

The primary diagnosis at the time of transplantation was biliary atresia in 65% of cases. A total of 215 infectious episodes were recorded in 92 pediatric liver transplants. The most frequent microorganisms were Klebsiella pneumoniae (21%), Cytomegalovirus (CMV) (7%), Pseudomonas aeruginosa (7%), Escherichia coli (6%), and Epstein Barr Virus (EBV) (6%). Three-month patient survival was 92% for infection-related mortality.

Discussion

Infectious complications within the first three months post-pediatric liver transplantation were predominantly bacterial in origin. Bacterial and fungal infections manifested earlier, while viral infections appeared later. Infectious complications did not impact the three-month patient survival in this group.