Adult Liver Transplant Patients Research Articles

Population pharmacokinetics and dosage optimisation of tacrolimus coadministration with Wuzhi capsule in adult liver transplant patients

This study aimed to establish a population pharmacokinetic model of tacrolimus coadministration with Wuzhi capsule and optimise the dosage regimen in adult liver transplant patients. Totally 1327 tacrolimus trough concentrations from 116 adult liver transplant patients were obtained for model development. A one-compartment model with first-order absorption and elimination was used to analyse the data, and the final model was internally verified using a goodness-of-fit diagnostic plot, bootstrap methods, and visual prediction test. A total of 29 patients with 250 tacrolimus trough concentrations were used for external validation via prediction-based diagnostics. Additionally, the simulation was used to optimise the recommended dose of tacrolimus and Wuzhi capsules. The estimated apparent clearance and volume of the distribution of tacrolimus were 15.4 L/h and 1210 L, respectively. The tacrolimus daily dose, Wuzhi capsule daily dose, postoperative time, alanine transaminase, haemoglobin, total bilirubin, direct bilirubin, estimated glomerular filtration rate, and urea, concomitant with voriconazole and fluconazole, were identified as significant covariates affecting the pharmacokinetic parameters. Internal and external validation showed that the final model was stable and reliable for predicting performance. The final model could provide guidance for dosage optimisation of tacrolimus coadministered with Wuzhi capsules in adult liver transplantation patients.

Humoral response to 2-dose BNT162b2 mRNA vaccine for Covid-19 in liver transplant recipients

Introduction: In the context of the Italian SARS-CoV-2 vaccination program, liver transplant (LT) recipients were prioritized for vaccine administration, although the lower response to vaccines is a well known problem in this population. Aim: We aimed to evaluate immunogenicity of BNT162b2 mRNA vaccine in LT recipients and healthy controls and to identify factors associated with negative response to vaccine. Materials and Methods: We prospectively evaluated a cohort of adult LT patients the humoral response (with anti-Spike protein IgG-LIAISON SARS-CoV-2 S1/S2-IgG chemiluminescent assay) at 1 and 3 months after 2-dose vaccination. A group of 307 vaccinated healthcare workers, matched by age and sex, served as controls. Results: Overall, 492 LT patients were enrolled (75.41% male, median age 64.85 years). Detectable antibodies were observed in the 75% of patients with a median value of 73.9 AU/mL after 3 months from 2-dose vaccination. At multivariable analysis, older age (>40years, p=0.016), shorter time from liver transplantation (<5years, p=0.004), and immunosuppression with antimetabolites (p=0.029) were significantly associated with non-response to vaccination. Moreover, the LT recipients showed antibody titers statistically lower than the control group (103 vs 261 AU/ml, p<0.0001) (fig. 1). Finally, both in controls and LT patients we found a trend of inverse correlation between age and antibody titers (correlation coefficient: -0.2023 and -0.2345, respectively). Conclusions: Three months after vaccination, LT recipients showed humoral response in 75% of cases. Older age, shorter time from transplantation and use of antimetabolites were factors associated with non-response to vaccination and needed to be kept under close monitoring.

Current status of liver transplantation for adult patients with acute-on-chronic liver failure

Acute-on-chronic liver failure(ACLF) is the most severe form of acute decompensation that develops in patients with chronic liver disease or liver cirrhosis,and is always accompanied by one or more extrahepatic organ failure, and has an extremely poor short-term prognosis. The causes triggering ACLF are complex and diverse,and the clinical stage and the type and the definition of organ failure differ greatly from one another. Therefore, a universally accepted diagnostic criteria for ACLF is not to be defined, and the epidemiological data and patient outcomes on ACLF are not easy to predict and compare among different regions. Accumulating evidence has shown that liver transplantation(LT) plays a significant role in the surgical treatment of patients with ACLF,but its clinical value is still controversial. The specific management and treatment strategy after the admission of patients with ACLF has not yet formed a unified and standardized process or opinions, which includes the monitoring in the ICU,the support and maintenance of organ functions, the selection of the surgical indication and the timing for LT and so on. Moreover, there still exists many controversies concerning, for example, whether patients with ACLF should receive greater priority for organ allocation compared to other potential candidates on the waiting list. Besides, more prospective controlled studies are urgently needed to investigate the role of the artificial liver support system in the bridging therapy to LT. The aim of this article is to review the indication selection of patients with ACLF suitable for LT,the survival outcomes and prognostic factors after LT, the selection of timing, the organ allocation policy and the bridging therapy to LT, which intends to provide new direction for designing the future clinical studies on LT in patients with ACLF.

Comparison of the Incidence of Postreperfusion Syndrome During Liver Transplantation Between Radial and Femoral Artery

BackgroundPostreperfusion syndrome (PRS) is a serious complication that can occur during liver transplantation (LT) and is known to affect morbidity and mortality after surgery. However, PRS definition does not include which artery is used to measure blood pressure. Until now, various studies have reported on the incidence, prognosis, and prevention strategies of PRS, but the arterial pressure used in these studies shows heterogeneity. Moreover, femoral arterial pressure and radial arterial pressure show a significant difference especially immediately after reperfusion. To the best of our knowledge there was no study about the comparison of the incidence of PRS according to artery. Therefore, in this study, we would like to investigate if there is a difference in the incidence of PRS between the radial and femoral artery. MethodsWith approval of IRB, we retrospectively reviewed medical records of adult LT patients from April 2017 to April 2019. We reviewed each patient's anesthesia record and confirmed if PRS has occurred. ResultsA total of 251 patients were enrolled. The PRS was measured in radial artery from 84 patients (33.5%) and femoral artery from 71 patients (28.3%). McNemar's test was performed and there was a significant difference (P value .007). ConclusionsThis study confirmed that radial artery had higher incidence of PRS than femoral artery. However, it was not confirmed if PRS measurement at any artery is appropriate for predicting morbidity and mortality after surgery. Therefore, in the future, it is better to conduct research based on arteries that predict the prognosis better.

Deceased Donor Liver Transplantation in an Adult Recipient with Situs Inversus Totalis: A Case Report

Introduction: The feasibility of liver transplantation (LT) in adult patients with situs inversus (SI) was demonstrated with advances in surgical techniques. However, due to the rare incidence of 0.01% of the population, the experience of LT in adult patients with SI is very limited.

Outcome of liver transplantation for autoimmune hepatitis in South Africa

Background: Liver Transplantation (LT) is the definitive treatment for Autoimmune Hepatitis (AIH) in patients with decompensated cirrhosis, liver failure and hepatocellular carcinoma. Outcomes of LT in AIH among black-Africans are not well-defined. We performed a single-center retrospective-review of adult LT patients. The study period was from 1st August 2004-31st August 2019. The primary aim was to document 1- &amp; 5- year patient and graft survival. A secondary aim was to compare the survival of black-Africans to Caucasians. Data was analyzed using survival-analysis. Results: A total of 56 LT were performed for AIH. Sixty-seven percent (n = 38/56) had confirmed AIH on explant histology. Of these, the majority i.e., 79% (30/38) were female and 21% (8/38) were male. There were equal numbers of black-African 42% (n = 16/38) and Caucasian 42% (n = 16/38) patients. Rejection was four-times higher in black-Africans as compared to Caucasians. Forty-four percent (n = 17/38) had an acute rejection episode and 13% (5/38) had chronic rejection. Recurrence was found in four black-African females. Post-LT patient survival at 1- and 5- years was 86.5% and 80.7%, and graft survival was 94% and 70.8% respectively. The 5- year patient survival was insignificantly lower for black-Africans (73.9%) as compared to Caucasians (83.7%) (p - value 0.26, CI 6.3 - 12.2). Five-year graft survival was significantly lower among black-Africans (55%) as compared to Caucasians (84.8%) (p - value 0.003 CI 3.8 - 8.1) Conclusion: Black-Africans had a four-fold higher rate of rejection compared to Caucasians. Recurrent AIH was only found in patients of black ethnicity. Similar 1- &amp; 5- year patient survival rates were observed between the two ethnicities. The 5-year graft survival among black-Africans was significantly lower than Caucasians.

Pediatric T-tube in adult liver transplantation: Technical refinements of insertion and removal.

BACKGROUNDWith the increasing use of extended-criteria donor organs, the interest around T-tubes in liver transplantation (LT) was restored whilst concerns regarding T-tube-related complications persist. AIMTo describe insertion and removal protocols implemented at our institution to safely use pediatric rubber 5-French T-tubes and subsequent outcomes in a consecutive series of adult patients.METHODSData of consecutive adult LT patients from brain-dead donors, treated from March 2017 to December 2019, were collected (i.e., biliary complications, adverse events, treatment after T-Tube removal). Patients with upfront hepatico-jejunostomy, endoscopically removed T-tubes, those who died or received retransplantation before T-tube removal were excluded. RESULTSSeventy-two patients were included in this study; T-tubes were removed 158 d (median; IQR 128-206 d) after LT. In four (5.6%) patients accidental T-tube removal occurred requiring monitoring only; in 68 (94.4%) patients Nelaton drain insertion was performed according to our protocol, resulting in 18 (25%) patients with a biliary output, subsequently removed after 2 d (median; IQR 1-4 d). Three (4%) patients required endoscopic retrograde cholangiopancreatography (ERCP) due to persistent Nelaton drain output. Three (4%) patients developed suspected biliary peritonitis, requiring ERCP with sphincterotomy and nasobiliary drain insertion (only one revealing contrast extravasation); no patient required percutaneous drainage or emergency surgery.CONCLUSIONThe use of pediatric rubber 5-French T-tubes in LT proved safe in our series after insertion and removal procedure refinements.

The role of extracorporeal membrane oxygenation in adult liver transplant patients: A qualitative systematic review of literature.

A paucity of evidence exists regarding risks and benefits of extracorporeal membrane oxygenation (ECMO) in adult liver transplantation. This was a systematic review conducted from January 1, 2000 to April 24, 2020 of adult liver transplant recipients (pre- or post-transplant) and donors who underwent Veno-arterial or Veno-venous ECMO cannulation. Death was the primary outcome, with graft function and complications as secondary outcomes. Forty-one articles were identified that fit criteria. A total of 183 donors were placed on ECMO, with recipient complication profiles and mortality that mirrored rates from standard criteria donors. Sixty-one recipients were placed on ECMO intraoperatively or postoperatively. Most patients experienced at least one complication with infections as the most common cause and minimal complications specifically related to ECMO use. Multisystem organ failure (MSOF) and infections were more common among liver recipients who died compared to those who survived. Overall mortality at 90days was 45.9%. Causes of death were most commonly MSOF and infections. ECMO use in adult liver transplantation is a useful adjunct. Recipient morbidity and mortality from donors placed on ECMO parallel that of recipients from standard criteria donors, and morbidity and mortality of recipients placed on ECMO are similar to other ECMO populations.

The effect of a viscoelastic-guided bleeding algorithm implementation on blood products use in adult liver transplant patients. A propensity score-matched before-after study

BackgroundPerioperative blood products transfusion is correlated with increased morbidity and mortality in liver transplantation (LTx). The objectives of our study are to assess the effect of a standardized viscoelastic test (VET)-guided bleeding management algorithm implementation on intraoperative bleeding, allogenic blood products and factor concentrates requirements and on early postoperative complications in LTx. MethodsRetrospective before-after study comparing two matched cohorts of patients undergoing LTx before (control cohort) and after (intervention cohort) the implementation of a VET-based bleeding algorithm in a single center academic hospital. ResultsAfter propensity score matching, we included 94 patients in each cohort. Patients in intervention cohort received significantly less blood products, fresh frozen plasma (FFP), and cryoprecipitate (p < 0.001 for each), while the amount of fibrinogen concentrate used was significantly higher (p < 0.001). Postoperatively, intervention cohort patients had significantly lower postoperative hemoglobin and fibrinogen levels and longer prothrombin time compared to control cohort. There were no significant differences in red blood cells transfusions, intraoperative bleeding, early postoperative complications, and short term survival. ConclusionsThe implementation of a VET-guided bleeding algorithm decreases allogenic blood products requirements, mainly FFP use and allows a more restrictive management of coagulopathy in patients with chronic liver disease undergoing LTx.

Applicability of the medication level variability index (MLVI) in adult hepatic transplantation and association with graft rejection rates

Introduction: Calculation of the Tacrolimus variation index by using the MLVI (Medication Level Variability Index) is set in pediatric liver transplant patients, and it is useful in controlling treatment adherence by associating MLVI values &gt; 2.5 to acute graft liver rejection. Purpose: To verify the association between MLVI values and rejection in adult liver transplant patients. Methods: A retrospective cohort study including liver transplant patients over 18 years of age from December 2012 to December 2017 using orally tacrolimus. For MLVI calculation, tacrolimus serum level outpatient samples were used after 1 year of transplantation. Results: A total of 125 patients were transplanted, of which 86 met criteria for inclusion in the study. The most frequent reason for transplantation was C virus infection (55.8%, n = 48). Rejection was identified in 18.6% of patients (n = 16). The mean MLVI among rejection and nonrejection patients was 2.5 and 2.1 respectively (RR = 0.95, CI: 0.4-2.1, p = 0.57). The frequency of non-immunological complications was 56.2% (n = 9) in patients with rejection versus 62.8% (n = 44) in patients without rejection, most of them with recurrence of virus C (56,8%, n = 25). Conclusion: Although the mean value of MLVI was higher in patients with rejection, our data showed no statistical difference between both groups, which differs from previous studies in pediatric patients. A higher number of nonimmune complications were observed in patients without rejection. The findings suggest that new MLVI cutoffs should be explored in the adult population.

P-86 MELD SCORE AND EARLY EXTUBATION IN THE INTENSIVE CARE UNIT AFTER LIVER TRANSPLANTATION: 20 YEARS EXPERIENCE IN A SINGLE CENTER IN PERU

Liver transplantation (LTx) is an effective therapy and is the only definitive treatment for acute and chronic liver diseases in selected patients. Time on mechanical ventilation and early extubation after liver transplantation (LTx) influences in morbidity and mortality and is a prognostic factor for early complications after transplantation. To show the MELD score and the tracheal extubation time in the immediate postoperative period after liver transplantation. Descriptive, retrospective study. The medical records of 209 adult liver transplant patients were reviewed, carried out from March 23, 2000 to November 30, 2020, treated in the Intensive Care Unit (ICU) by the Transplant team at the Guillermo Almenara National Hospital in Lima, Peru. Inclusion criteria: adults over 18 years old, exclusion criteria: under 18 years old, fast track in the operating room, double transplant, SPLIT, Domino technique. In 146 of 209 patients (69.9%) we performed successful tracheal extubation < 1 day: 31 patients (14.8%), 1-3 days, 26 patients (12.4%) 4-7 days, > 7 days:(0.47%). The MELD score did not have any impact in the time of tracheal extubation in ICU in the diferents groups In our study. In our experience, 69.9% of the patients were successful extubated on the first day after liver transplantation. There were no differences between the tracheal extubation time and MELD score in our patients. There is a trend to reduce mechanical ventilation time after liver transplantation to facilitate early discharge from the ICU, reducing costs and optimizing resources. Our experience shows that early post-transplant extubation is safe, optimizing available resources.

Applications and Outcomes of Extracorporeal Life Support Use in Adult Liver Transplantation: A Case Series and Review of Literature.

The use of extracorporeal life support (ECLS) is increasingly reported in adult liver transplantation (LT). However, neither the role of ECLS in the perioperative setting for LT nor its outcomes has been well defined. We performed a retrospective chart review of all adult LT patients at our institution who received ECLS from 2004 to 2021. We also conducted a comprehensive literature search for adult LT cases that involved perioperative ECLS for respiratory or cardiac failure. Over the study period, 11 LT patients required ECLS at our institution, two for respiratory and nine for cardiac failure. Both patients with respiratory failure received ECLS as a bridge to LT and survived to discharge. Nine patients required ECLS for acute cardiac failure either intraoperatively or postoperatively, and two survived to discharge. In the literature, we identified 35 cases of respiratory failure in LT patients requiring perioperative ECLS. Applications included preoperative bridge to LT (n = 6) and postoperative rescue (n = 29), for which overall survival was 44%. We identified 31 cases of cardiac failure in LT patients requiring either ECLS or cardiopulmonary bypass for cardiac support or rescue for intraoperative or postoperative cardiac failure (n = 30). There is evidence for consideration of ECLS as a bridge to LT in patients with potentially reversible respiratory failure or as rescue therapy for respiratory failure in posttransplant patients. ECLS has a prohibitively high risk of futility in pretransplant patients with cardiac failure but may have a role in LT patients with a functioning graft and potentially reversible cardiac failure.

Long-Term Tacrolimus Blood Trough Level and Patient Survival in Adult Liver Transplantation.

Tacrolimus is the most widely used immunosuppressant in liver transplant (LT) patients. However, the ideal long-term target level for these patients is unknown. This retrospective study aimed to investigate the impact of tacrolimus blood concentration five years after LT on long-term patient survival outcomes in adult LT recipients. Patients who underwent LT between January 2004 and July 2014 at a tertiary medical center were included in this study (n = 189). The mean tacrolimus blood concentrations of each patient during the fifth year after LT were recorded and the overall survival rate was determined. A multivariate analysis of factors associated with long-term survival was conducted using a Cox’s model. The median follow-up period was 9.63 years, and 144 patients (76.2%) underwent live donor LT. Sixteen patients died within 5 years of LT. In the Cox’s model, patients with a mean tacrolimus blood trough level of 4.6–10.2 ng/mL had significantly better long-term survival than those with a mean tacrolimus blood trough level outside this range (estimated hazard ratio = 4.76; 95% confidence interval: 1.34–16.9, p = 0.016). Therefore, a tacrolimus level no lower than 4.6 ng/mL would be recommended in adult LT patients.

Validation of a Capillary Dry Blood Sample MITRA-Based Assay for the Quantitative Determination of Systemic Tacrolimus Concentrations in Transplant Recipients.

Background:Tacrolimus is a narrow therapeutic index medication, which requires therapeutic drug monitoring to optimize dosing based on systemic exposure. MITRA microsampling offers a convenient, minimally invasive approach for the collection of capillary blood samples from a finger prick versus conventional venous blood sampling for quantitation of tacrolimus blood concentrations. However, the suitability of MITRA microsampling for the determination of tacrolimus concentrations requires assessment in clinical settings.Methods:Paired venous (2 mL) and capillary (10 μL) blood samples were collected pre–tacrolimus dose and 1 and 3 hours postdose during routine outpatient visits from stable adult liver or kidney transplant patients receiving prolonged-release tacrolimus. Tacrolimus concentrations were determined by liquid chromatography–tandem mass spectrometry, and the concentrations obtained by the 2 sampling methods were compared by linear regression and Bland–Altman agreement analyses.Results:Samples were available for 82 transplant recipients (kidney, n = 41; liver, n = 41). A high correlation was observed between tacrolimus concentrations in capillary and venous blood samples (Pearson correlation coefficient, 0.97; Lin concordance coefficient, 0.87; slope of the fitted line, >1.0). Tacrolimus concentrations in capillary samples were 22.5% higher on average than in the corresponding venous blood samples (95% limits of agreement, 0.5%–44.6%). Similar results were observed in both transplant subgroups.Conclusions:MITRA finger prick sampling provides a convenient alternative to venipuncture for therapeutic drug monitoring in transplant recipients maintained on prolonged-release tacrolimus. When using the finger prick MITRA method, the positive bias in tacrolimus concentrations observed with this technique, when compared with venipuncture, needs to be taken into consideration.

Prognosis of split liver transplantation compared with whole liver transplantation in adult patients: single-center results under the Korean MELD score-based allocation policy

Prognosis of split liver transplantation compared with whole liver transplantation in adult patients: single-center results under the Korean MELD score-based allocation policy

LIVER TRANSPLANTATION FOR PORTAL VEIN THROMBOSIS: SINGLE CENTER EXPERIENCE

Introduction: Portal vein thrombosis (PVT) is a common complication of liver cirrhosis. The presence of portal thrombosis leads to the progression of portal hypertension and potentially complicate the liver transplantation. The most common classification (Yerdel) is based on the prevalence of thrombosis of the portal system (IV stages). For a long time, severe PVT (III-IV) was considered as a contraindication to liver transplantation due to the complexity of portal revascularisation. However, the current development of vascular surgery suggests a few effective surgical options for these patients. Purpose: Analysis of deceased donor liver transplantation in patients with the presence of PVT. Materials and Methods: The study included the period from January 2016 to February 2020. During this period at the National Medical Research Center of Transplantology and Artificial Organs were performed 241 deceased donor liver transplantation for adult patients. Of these, 25 recipients (10,3%) obtained PVT before transplantation. Fifteen patients had PVT stage I-II, ten patients had severe thrombosis of III and IV stage (six and four respectively). To revascularization of portal flow in the patients with local thrombosis, thrombectomy was performed in 15 cases, in 6 cases (with PVT III stage) an eversion thrombectomy technique was used to remove the thrombus. In four cases (PVT stage IV) were performed various techniques of portal flow bypass. One case was applied by rent portal transposition witch was supplemented by jump-graft between superior mesenteric vein (SMV) and graft’s portal vein (PV). In another case, just a jump-graft technique using donor IVC graft was applied. In two cases, portal supply was carried out from the varicose left gastric vein. When comparing with the control group (n = 216), there were no statistically significant differences in-hospital mortality rates or the length of hospital stay, however, in the group of patients with severe portal vein thrombosis (stages III-IV), early postoperative bleeding was more common. Conclusions: Portal vein thrombosis, including severe thrombosis (Yardel III-IV stages) is not a contraindication for liver transplantation. In a high-volume centers, the presence of PVT is not impact on the results of transplantation.

Preoperative high-sensitivity troponin I and B-type natriuretic peptide, alone and in combination, for risk stratification of mortality after liver transplantation.

BackgroundGiven the severe shortage of donor liver grafts, coupled with growing proportion of cardiovascular death after liver transplantation (LT), precise cardiovascular risk assessment is pivotal for selecting recipients who gain the greatest survival benefit from LT surgery. We aimed to determine the prognostic value of pre-LT combined measurement of B-type natriuretic peptide (BNP) and high-sensitivity troponin I (hsTnI) in predicting early post-LT mortality.MethodsWe retrospectively evaluated 2,490 consecutive adult LT patients between 2010 and 2018. Cut-off values of BNP and hsTnI for predicting post-LT 90-day mortality were calculated. According to the derived cut-off values of two cardiac biomarkers, alone and in combination, adjusted hazard ratios (aHR) of post-LT 90-day mortality were determined using multivariate Cox regression analysis.ResultsMortality rate after 90 days was 2.9% (72/2,490). Rounded cut-off values for post-LT 90-day mortality were 400 pg/ml for BNP (aHR 2.02 [1.15, 3.52], P = 0.014) and 60 ng/L for hsTnI (aHR 2.65 [1.48, 4.74], P = 0.001), respectively. Among 273 patients with BNP ≥ 400 pg/ml, 50.9% of patients were further stratified into having hsTnI ≥ 60 ng/L. Combined use of pre-LT cardiac biomarkers predicted post-LT 90-day mortality rate; both non-elevated: 1.0% (21/2,084), either one is elevated: 9.0% (24/267), and both elevated: 19.4% (27/139, log-rank P < 0.001; aHR vs non-elevated 4.23 [1.98, 9.03], P < 0.001).ConclusionsConcomitant elevation of both cardiac biomarkers posed significantly higher risk of 90-day mortality after LT. Pre-LT assessment cardiac strain and myocardial injury, represented by BNP and hsTnI values, would contribute to prioritization of LT candidates and help administer target therapies that could modify early mortality.

AIUM Practice Parameter for the Performance of an Ultrasound Examination of Solid-Organ Transplants.

AIUM Practice Parameter for the Performance of an Ultrasound Examination of Solid-Organ Transplants.

Posttransplant Complications Predict Alcohol Relapse in Liver Transplant Recipients.

Alcohol relapse after liver transplantation (LT) in patients with alcohol-related liver disease (ALD) is a major challenge. Although its association with pretransplant psychosocial factors was extensively studied, the impacts of posttransplant courses on alcohol relapse have not been well investigated. The aim of this study is to analyze peritransplant factors associated with posttransplant alcohol relapse in patients with ALD. This study evaluated 190 adult LT patients with ALD from 2013 to 2019. Risk factors for alcohol relapse were analyzed, focusing on posttransplant chronic complications, which were classified as Clavien-Dindo classification 3a or higher that lasted over 30days. The posttransplant alcohol relapse rate was 13.7% (26/190) with a median onset time of 18.6months after transplant. Multivariate Cox regression analysis revealed that posttransplant chronic complications were an independent risk factor for posttransplant alcohol relapse (hazard ratio [HR], 5.40; P=0.001), along with psychiatric comorbidity (HR, 3.93; P=0.001), history of alcohol relapse before LT (HR, 3.00; P=0.008), and an abstinence period <1.5years (HR, 12.05; P=0.001). A risk prediction model was created using 3 pretransplant risk factors (psychiatric comorbidity, alcohol relapse before LT, and abstinence period <1.5years). This model clearly stratified the risk of alcohol relapse into high-, moderate-, and low-risk groups (P<0.001). Of the 26 patients who relapsed, 11 (42.3%) continued drinking, of whom 3 died of severe alcoholic hepatitis, and 13 (50.0%) achieved sobriety (outcomes for 2 patients were unknown). In conclusion, posttransplant chronic complications increased the risk of alcohol relapse. Recognition of posttransplant chronic complications in conjunction with the risk stratification model by pretransplant psychosocial factors would help with the prediction of posttransplant alcohol relapse.

Prognosis of Split Liver Transplantation Compared with Whole Liver Transplantation in Adult Patients: Single-center Results under the Korean MELD Score-based Allocation Policy.

BackgroundSplit liver transplantation (SLT) has been occasionally performed in Korea. This study compared the incidence and prognosis of SLT with whole liver transplantation (WLT) in adult patients.MethodsBetween June 2016 and November 2019, 242 adult patients underwent a total of 256 deceased donor liver transplantation operations. SLT was performed in 7 patients (2.9%).ResultsThe mean age of SLT donors was 29.7 ± 7.4 years, and the mean age of recipients was 55.7 ± 10.6 years, with the latter having a mean model for end-stage liver disease score of 34.6 ± 3.1. Mean split right liver graft weight was 1,228.6 ± 149.7 g and mean graft-recipient weight ratio was 1.97 ± 0.39. Of the seven SLT recipients, Korean Network for Organ Sharing (KONOS) status was one in status 1, one in status 2 and five in status 3. The graft (P = 0.72) and patient (P = 0.84) survival rates were comparable in the SLT and WLT groups. Following propensity score matching, graft (P = 0.61) and patient (P = 0.91) survival rates remained comparable in the two groups. Univariate analysis showed that pretransplant ventilator support and renal replacement therapy were significantly associated with patient survival, whereas KONOS status category and primary liver diseases were not. Multivariate analysis showed that pretransplant ventilator support was an independent risk factor for patient survival.ConclusionSurvival outcomes were similar in adult SLT and WLT recipients, probably due to selection of high-quality grafts and low-risk recipients. Prudent selection of donors and adult recipients for SLT may expand the liver graft pool for pediatric patients without affecting outcomes in adults undergoing SLT.