Liver Transplantation最新文献

Pediatric genetic and metabolic liver diseases comprise a broad spectrum of conditions and represent the second most common indication for liver transplantation following biliary atresia. The decision to transplant can be challenging and requires consideration of several factors, including hepatic involvement, extrahepatic manifestations, and anticipated posttransplant outcomes. This review examines pediatric genetic and metabolic liver diseases, their pathophysiology, clinical presentation, and the role of liver transplantation.

Although a set period of abstinence is no longer a requirement for transplant consideration in many liver transplantation programs, it is imperative to use valid monitoring tools to detect ongoing alcohol use in candidates for transplant. Urinary ethyl glucuronide (EtG) is an objective measure of alcohol use. This single-center retrospective study aims to describe the psychosocial characteristics of patients with alcohol-associated liver disease (ALD) who provided positive EtG tests in the pretransplant phase. Data were collected between May 1, 2018, and November 30, 2021, for all patients with ALD referred to our transplantation program (n = 497). Psychosocial characteristics and transplant outcomes were recorded for all patients. Patients with a positive EtG test were compared to patients who did not have a positive EtG test. A backward logistic regression analysis was performed to assess the factors associated with a positive EtG test. Of the 497 patients evaluated, 40 (8%) provided a positive EtG test, including at the initial clinic visit (n = 20), during medical evaluation (n = 14), and while on the waitlist (n = 6). Severe alcohol use disorder ( p < 0.01), consuming <10 daily standard drinks ( p = 0.011), and longer duration of daily alcohol use ( p = 0.028) were significantly associated with a positive EtG test. Psychiatric comorbidity and previous treatment for alcohol use disorder were not significantly associated with positive tests. A minority of patients with ALD provided a positive urine EtG in the pretransplant phase. Alongside clinical interviews, biomarker testing is an objective tool to identify ongoing alcohol use in patients with ALD.

HCC has become a leading indication for liver transplant (LT), with HCC registrants increasing more than 6-fold in the past 2 decades, accompanied by a significant rise in older candidates. Given this trend and the influence of hepatitis C (HCV) treatments, updated data on aging and changing etiologies in older patients with HCC are needed. This study examines age trends, clinical characteristics, and transplant outcomes by comparing older (70+), younger patients with HCC, and patients without HCC. All adult candidates for LT (18+) in the UNOS/OPTN registry (2012-2022) were analyzed and categorized by HCC status and age (<70 or 70+). Regression coefficients compared HCC and non-HCC registrants and recipients by age group. The aging trend among LT registrants was more pronounced in patients with HCC. From 2012 to 2022, the mean age of HCC registrants rose from 58.7 to 62.9, with those aged 70+ increasing from 4.2% to 15.0%. Non-HCC registrants saw minimal change, with a stable mean age of 53 years and a modest rise in those 70+ from 2.1% to 4.7%. HCV prevalence among patients with HCC decreased from 37.5% to 27.4%, while patients without HCC dropped from 14.8% to 5%. Posttransplant outcomes for older HCC recipients remained favorable, with 1-year and 5-year survival rates of 91% and 71%, respectively, comparable to older patients without HCC (87% and 69%). Among over 132,000 LT registrants from 2012 to 2022, the age of HCC candidates increased, with a growing proportion aged 70 and older, while the age and proportion of older adults among non-HCC registrants remained stable. This demographic shift underscores the importance of enhanced frailty assessments to improve outcomes for older patients with HCC.