Aspects Of Liver Transplantation Research Articles

Advancing the Field of Pediatric Liver Transplantation: Urgent Action Items Identified During the 2022 Society of Pediatric Liver Transplantation Meeting.

Advancing the Field of Pediatric Liver Transplantation: Urgent Action Items Identified During the 2022 Society of Pediatric Liver Transplantation Meeting.

Proceedings of the 26th Annual Virtual Congress of the International Liver Transplantation Society.

After a 1-y absence due to the coronavirus disease 2019 pandemic, the 26th Annual Congress of the International Liver Transplantation Society was held from May 15 to 18, 2021, in a virtual format. Clinicians and researchers from all over the world came together to share their knowledge on all the aspects of liver transplantation (LT). Apart from a focus on LT in times of coronavirus disease 2019, featured topics of this year's conference included infectious diseases in LT, living donation, machine perfusion, oncology, predictive scoring systems and updates in anesthesia/critical care, immunology, radiology, pathology, and pediatrics. This report presents highlights from invited lectures and a review of the select abstracts. The aim of this report, generated by the Vanguard Committee of International Liver Transplantation Society, is to provide a summary of the most recent developments in clinical practice and research in LT.

Current perspectives on the role of liver transplantation for Langerhans cell histiocytosis: A narrative review.

Langerhans cell histiocytosis (LCH) is a malignant disease of the histiocytes involving various organ systems. The spectrum of liver involvement in LCH ranges from mild transaminitis to end-stage liver disease. The hallmark of hepatic LCH is secondary sclerosing cholangitis, which manifests due to a progressive destruction of the biliary tree by malignant histiocytes. Chemotherapy remains the mainstay of treatment for active LCH. Early recognition, diagnosis and a systematic approach to the management of LCH can ameliorate the disease process. Nonetheless, the liver involvement in these patients may progress despite the LCH being in remission. Liver transplantation (LT) remains central in the management of such patients. Various facets of the management of LCH, especially those with liver involvement remain unclear. Furthermore, aspects of LT in LCH with regards to the indication, timing and post-LT management, including immunosuppression and adjuvant therapy, remain undefined. This review summarises the current evidence and discusses the practical aspects of the role of LT in the management of LCH.

Artificial Intelligence in Liver Transplantation

Advancements based on artificial intelligence have emerged in all areas of medicine. Many decisions in organ transplantation can now potentially be addressed in a more precise manner with the aid of artificial intelligence. All elements of liver transplantation consist of a set of input variables and a set of output variables. Artificial intelligence identifies relationships between the input variables; that is, how they select the data groups to train patterns and how they can predict the potential outcomes of the output variables. The most widely used classifiers to address the different aspects of liver transplantation are artificial neural networks, decision tree classifiers, random forest, and naïve Bayes classification models. Artificial intelligence applications are being evaluated in liver transplantation, especially in organ allocation, donor-recipient matching, survival prediction analysis, and transplant oncology. In the years to come, deep learning-based models will be used by liver transplant experts to support their decisions, especially in areas where securing equitability in the transplant process needs to be optimized.

Meeting Report: The Dallas Consensus Conference on Liver Transplantation for Alcohol Associated Hepatitis.

Liver transplantation (LT) for alcohol associated hepatitis (AH) remains controversial. We convened a consensus conference to examine various aspects of LT for AH. The goal was not to unequivocally endorse LT for AH; instead, it was to propose recommendations for programs that perform or plan to perform LT for AH. Criteria were established to determine candidacy for LT in the setting of AH and included the following: (1) AH patients presenting for the first time with decompensated liver disease that are nonresponders to medical therapy without severe medical or psychiatric comorbidities; (2) a fixed period of abstinence prior to transplantation is not required; and (3) assessment with a multidisciplinary psychosocial team, including a social worker and an addiction specialist/mental health professional with addiction and transplantation expertise. Supporting factors included lack of repeated unsuccessful attempts at addiction rehabilitation, lack of other substance use/dependency, acceptance of diagnosis/insight with a commitment of the patient/family to sobriety, and formalized agreement to adhere to total alcohol abstinence and counseling. LT should be avoided in AH patients who are likely to spontaneously recover. Short-term and longterm survival comparable to other indications for LT must be achieved. There should not be further disparity in LT either by indication, geography, or other sociodemographic factors. Treatment of alcohol-use disorders should be incorporated into pre- and post-LT care. The restrictive and focused evaluation process described in the initial LT experience for AH worldwide may not endure as this indication gains wider acceptance at more LT programs. Transparency in the selection process is crucial and requires the collection of objective data to assess outcomes and minimize center variation in listing. Oversight of program adherence is important to harmonize listing practices and outcomes.

An Analysis of the Liver Transplant Waiting List at the G. G. Kuvatov Republican Clinical Hospital

Introduction. Liver transplantation is currently considered to be the only method of radical treatment for adults and children with incurable liver diseases. The most important aspects of liver transplantation are the correct selection of an appropriate recipient and compilation and maintenance of a liver transplant waiting list. This article aims to analyze the structure of the severe chronic liver disease patient population included in the liver transplant waiting list at the G. G. Kuvatov Republican Clinical Hospital (the City of Ufa). Materials and methods . We analyzed the waiting list drawn and maintained over the 2007-2018 period based on the examination of 789 patients with liver cirrhosis of various etiologies. Results and discussion . Out of all the patients with liver cirrhosis of different etiologies (Child-Pugh score classes A, B, and C) 149 (18.8 %) were included in the waiting list. The ages of patients included in the liver transplant waiting list ranged from 19 to 69. The mortality rate amounted to 38.9 % (58 people); of these patients 31 (53.4 %) had hepatic cirrhosis (HC) of autoimmune etiology, 18 (31.0 %) — HC of viral etiology, and 6 (10.3 %) — alveococcosis of the liver. The rate of the waiting list expansion for patients aged 20-29 compared to those aged 0-19 amounted to 1.32 %. Such a dynamics for the 30-39 age group compared to the 20-29 age group was 11.51 %. The number of people aged 40-49 compared to the preceding age group remained the same. Conclusion. Our analysis of the waiting list sets the percentage of patients with autoimmune HC in the population of patients with this disease at 59 %. These patients are characterized by a rapid progression of liver failure and high mortality. The statistical analysis of liver transplant waiting lists facilitate the optimization of procedures used to select and manage such patients, as well as to prevent, in a timely manner, the development of complications thus improving the prognosis of survival.

Specific issues concerning the management of patients on the waiting list and after liver transplantation.

The present document is a second contribution collecting the recommendations of an expert panel of transplant hepatologists appointed by the Italian Association for the Study of the Liver (AISF) concerning the management of certain aspects of liver transplantation, including: the issue of prompt referral; the management of difficult candidates; malnutrition; living related liver transplants; hepatocellular carcinoma; and the role of direct acting antiviral agents before and after transplantation. The statements on each topic were approved by participants at the AISF Transplant Hepatology Expert Meeting organized by the Permanent Liver Transplant Commission in Mondello on 12-13 May 2017. They are graded according to the GRADE grading system.

Liver Transplantation: What Every Gastroenterologist Should Know about It

Liver Transplantation (LT) is the treatment of choice for patients with end-stage liver disease. Improvement in outcomes (allograft and patient survival) has led to widespread use of LT worldwide. This success is due to improvement in patient selection, transplantation surgery, anesthesia/postoperative care, and immunosuppression management. This review will focus on different aspects of LT, which every physician should know to provide better patient care.

Various Medical Aspects of Liver Transplantation and its Survival Prediction using Machine Learning Techniques

Objective: Prognosis models play a significant role in forecasting the patient's survival in Organ transplantation. To review the impact of machine learning methods in predicting the of survival of patients who undergoes Liver Transplantation using a Multilayer Perceptron Artificial Neural Network model with an extensive discussion of all the medical aspects is the key objective of this paper. Methods/Analysis: Medical practitioners studied various parameters during pretransplantation for predicting the survival of a patient. This study considered those parameters and reviewed whether these parameters have any vital part in the survival rate of a patient after Liver Transplantation (LT). This study also compared various scores including Model for End Stage Liver Disease (MELD) score, Emory score and Child score that are used in survival prediction. Currently the medicinal specialists estimate the outcome of LT with MELD score. We employed a detailed learning about the health aspects of LT and various machine learning techniques used in this area. In order to perform the experimentation, the dataset was congregated from the United Network for Organ Sharing transplant database (n = 65534). With the three layer architecture, the model trains the attributes of donors, recipient and transplantation using back propagation algorithm. 10-fold cross validation was applied in each training and test set before training. During the training process, the appropriate donor-recipient pairs were found out and obtained the best liver patient survival in transplantation. Findings: We conducted a comprehensive study about LT for the liver patient survival prediction. We proposed a Multilayer Perceptron Artificial Neural Network model to predict the survival rate after LT with 99.74% accuracy using United Network Organ Sharing registry. We also compared the performance of proposed model with existing models and proved that proposed model produced more accuracy than other models. Novelty/Improvement: The multilayer perceptron model succeeded clinical scores in terms of high accuracy, sensitivity and specificity. Machine learning techniques show better performance than conservative numerical methods in donor, recipient and transplantation attributes which are used to predict the survival. Due to less expensive and producing reliable solutions with rich datasets, machine learning techniques have been succeeded the conventional statistical methods and medical scoring systems. The proposed model predicts a promising accuracy for the prediction of best survival rates after.

An Update of Liver Transplantation for Nonalcoholic Steatohepatitis

Nonalcoholic steatohepatitis (NASH), obesity, and the metabolic syndrome are highly prevalent before and after liver transplantation, with NASH currently the second most common indication. This review considers established and new aspects of liver transplantation for NASH. NASH is one of many sequelae of obesity and most frequently occurs on a background of the metabolic syndrome. While recurrence of steatosis is common, recurrence of NASH with advanced stages of fibrosis is unusual, with graft loss due to recurrence of NASH cirrhosis occurring with a frequency of less than 5 %. In contrast, the components of the metabolic syndrome, which are important predictors of posttransplant outcomes, are nearly ubiquitous following liver transplantation and are exacerbated by factors such as immunosuppression. As many aspects of the metabolic syndrome are modifiable, screening for and treating complications of obesity and minimization of immunosuppression are cornerstones of optimizing outcomes for transplant recipients with NASH. The optimal approach to immunosuppression, the role of bariatric surgery, and nutritional and pharmacotherapy of NASH in liver transplant recipients are evolving rapidly. Overall, a minimalist approach to immunosuppression is advised.

Liver transplantation: fifty years of experience.

Since 1963, when the first human liver transplantation (LT) was performed by Thomas Starzl, the world has witnessed 50 years of development in surgical techniques, immunosuppression, organ allocation, donor selection, and the indications and contraindications for LT. This has led to the mainstream, well-established procedure that has saved innumerable lives worldwide. Today, there are hundreds of liver transplant centres in over 80 countries. This review aims to describe the main aspects of LT regarding the progressive changes that have occurred over the years. We herein review historical aspects since the first experimental studies and the first attempts at human transplantation. We also provide an overview of immunosuppressive agents and their potential side effects, the evolution of the indications and contraindications of LT, the evolution of survival according to different time periods, and the evolution of methods of organ allocation.

The Scottish Liver Transplant Unit: current and future perspectives

The Scottish Liver Transplant Unit (SLTU) opened in 1992 and has now performed over 900 liver transplants. During this time there have been major changes in both organ donation and transplantation. Currently liver transplantation is restricted by limited organ supply. Scotland has one of the lowest rates of organ donation in Europe and one of the most rapidly increasing rates of cirrhosis. The consequent waiting list mortality has driven innovations including increasing use of marginal grafts, organs donated after cardiac death, split-liver transplants and the development of living-donor liver transplantation. To maintain liver transplantation, there is an urgent need to increase organ donation rates and to find novel treatments which optimize outcomes from marginal grafts. This review addresses the surgical aspects of liver transplantation and how these have evolved over the two past decades. Major changes are currently underway in organ donation organization, and there is continuing refinement of organ treatment and storage. A number of measures to maintain and improve organ preservation and function are currently being evaluated in clinical trials, and cell therapy holds significant potential for the future. Scotland has a rising need for liver transplantation and the SLTU continues to provide high-quality care and to be at the forefront of the latest advances in organ transplantation.

Forty Years of Publication of Transplantation Proceedings—The Fourth Decade: Globalization of the Enterprise

m o d THE FOURTH DECADE of publication of Transplantation Proceedings illustrated the worldwide implementation of kidney, liver, pancreas, heart, lung and progressively small bowel transplantation. Documenting this therapeutic expansion, the Proceedings markedly extended its vistas to describe the activities of numerous regional, national and international societies (Table 1). The series of 50-year retrospective reviews of the field after the first successful renal transplantation between identical twins included contributions related to the kidney by Murray and by Calne; the liver by Starzl; the lung by Hardy; kidney plus pancreas by Najarian; immunobiology y Rapaport, Bach, and Brent; immunosuppression y Schwartz; human leukocyte locus A by Dausset and by Terasaki; cyclosporine (CsA) by its developer, Jean Borel, s well as Stiller, Starzl, and Kahan. Cutting edge updates in transplantation were subsequently provided by Shapiro et al who described the dmonton Protocol for islet; Barr, lung; Starling’s team, heart; Harmon, pediatric renal; Kelly, pediatric liver; Sutherland and Gruessner, pancreas; Stock et al, HIVositive patients; Ponticelli, steroid-free immunosuppresion; Grinyo’s team, gene therapy; and Moreno-Casado, combined lung plus liver procedures. The tremendous expansion of the enterprise demands implementation of strategies to maintain physician contact with patients by telematic networks, as described by Arias’ team, as well as computer-based physician training, for example, in aspects of liver transplantation as reported by Kallinowski’s group. Intestinal transplantation emerged at the horizon of routine clinical practice, as described by Tzakis’ team and by Langnas. Thiede’s group confirmed amelioration f small bowel alloimmunity by simultaneous orthotopic iver transplantation (OLT) as noted previously by Grant. lthough Tzakis et al obtained prolonged bowel survival by induction of mixed allogeneic chimerism using nonlethal irradiation and antilymphocyte serum, they later proselytized a more flexible immunosuppressive trategy employing the anti-CD52 monoclonal antibody

Non-Alcoholic Fatty Liver Disease, Non-Alcoholic Steatohepatitis and Orthotopic Liver Transplantation

Obesity, non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are becoming increasingly common medical problems in the developed world, often in the setting of the metabolic or insulin resistance syndrome (IRS). It is predicted that by the year 2025 > 25 million Americans may have NASH-related liver disease. NASH and NAFLD also affect the donor population. The use of steatotic donor livers for liver transplantation (LT) is associated with an increased risk of primary nonfunction (PNF) in the allograft. There is particular reluctance to use steatotic livers for living donor LT. There is indirect evidence to suggest that patients undergoing LT for cirrhosis resulting from NASH may have poorer outcome, despite careful selection of LT candidates. Indeed it is likely that many potential LT candidates with NASH are excluded from LT due to co-morbid conditions related to IRS. The post-LT patient is at risk of several components of IRS, such as diabetes mellitus, hypertension, hyperlipidaemia and obesity and there is increasing recognition of de novo and recurrent NAFLD and NASH after LT. Thus NAFLD and NASH affect all aspects of LT including donors, patients in evaluation and the LT recipient.

Medical Aspects of Liver Transplantation

Medical Aspects of Liver Transplantation

Finding a place for public preferences in liver allocation decisions.

Over the last decade there have been major advances in all aspects of liver transplantation with the consequence that the number of patients who could benefit from the procedure is increasing. As a result, the number of patients listed for liver transplantation is growing while the donor pool is remaining constant or even falling. The effect of this donor shortage is seen clearly both in Europe and in North America. For example, in North America data from UNOS shows that between 1988 and 1997 the number of cadaveric donor liver transplants rose from 1,713 to 4,100. The number of patients waiting for transplant rose over the same time from 616 to 9,647. This shortage of organs has tragic consequences. Although the proportion of patients dying on the waiting list is falling, the number of patients dying on the liver transplant waiting list increased from 196 to 1,129 over this same period of time.

The NIDDK liver transplantation database

Abstract The NIDDK Liver Transplantation Database was established to prospectively investigate questions related to the experience of patients evaluated for and undergoing liver transplantation. This article presents the study design, methods, and quality of data collection, along with some of the overall results. METHODS: An initial 4-year planning phase was used to develop data collection instruments and quality control procedures regarding assessment for transplantation, liver donors, and the recipients' pre-, peri- and postoperative course. During the 1990-1995 implementation phase, three clinical centers refined the data collection instruments and enrolled and followed consecutive liver transplant candidates who consented to be included in the protocol. RESULTS: The Database contains more than 49,000 data forms from 1563 candidates, 1002 donors, and 916 transplant recipients followed up to 5 years after transplantation. Overall, 95% of protocol forms were completed. The Database includes uniformly defined histology results of liver biopsies performed per protocol and for complications throughout follow-up. In addition, the Database maintains an inventory of available sera for the Serum Bank. All test results of studies performed on the sera are added to the Database. Of 1563 evaluated patients, 59% were deemed eligible for liver transplantation. Of the others who were too well or had contraindications, 15% became eligible later. Characteristics of patients in this study were generally comparable to those of patients nationally. CONCLUSIONS: The NIDDK Liver Transplantation Database has yielded comprehensive and high quality data and is a rich resource for extensive analysis about many important clinical aspects of liver transplantation. (Liver Transpl Surg 1997 Jan;3(1):10-22)

Surgical aspects of liver transplantation for tyrosinemia

Surgical aspects of liver transplantation for tyrosinemia

Immunological aspects of liver transplantation

Immunological aspects of liver transplantation

Surgical and Clinical Aspects of Liver Transplantation and Postoperative Evaluation of Complications

Surgical and Clinical Aspects of Liver Transplantation and Postoperative Evaluation of Complications