Contraindication For Liver Transplantation Research Articles

Comparative Study for the Outcome of Living Donor Liver Transplantation in Patients with Portal Vein Thrombosis in Comparison to Patients without Portal Vein Thrombosis

Abstract Background Portal vein thrombosis (PVT) is a relative contraindication in living donor liver transplantation (LDLT). We monitored the outcome of adult patients with PVT in comparison to patients without PVT in LDLT. Methods This study is a retrospective cohort study. LDLTs that was performed at Liver Transplantation Unit in Air Forces Specialized Hospital and Nasser Institute for Research and Treatment, Cairo, Egypt, between July 2019 to July 2020 were evaluated. 176 cases were divided into two groups according to presence of PVT, group A included 55 recipients who had PVT compared to group B including 121 recipients without PVT. Results In our study (N = 176), postoperative PV complications was recorded in 11 cases (6.3%). Five case in each group had postoperative PVT (9.8% versus 4.1%) respectively and a single case of PV stenosis (0.8%) was documented in non-PVT group. All patients who develop early postoperative PV (n = 3/10) complications unfortunately died because of it, unlike those who developed late PV complications, their one year survival rate was 70% of cases (n = 7/10) and the overall mortality rate in patients developed PV complications was 40%; 4 out of 10 cases. Conclusion PVT is established not to be a contraindication for liver transplantation but needs complex procedures and sophisticated techniques and Surgeons should be aware with these techniques to restore adequate portal flow in transplant for recipients with PVT.

Recent trends and new developments in liver transplantation.

Liver transplantation (LT) has been an established treatment for end-staged liver disease for acute, chronic, metabolic diseases and liver cancer. Advanced surgical techniques, refined indications and contraindications for LT, improvements of donor selection, prognostic scorings system and immunosuppressive regimens have contributed to the improved outcomes of liver transplantation. The etiologies of cirrhosis have been shifting from viral hepatitis to metabolic associated fatty liver disease. New indications include peripheral or mass forming bile duct cancer, metastases from bowel cancers or neuroendocrine tumors. Resection and partial liver segments 2-3 transplantation with delayed total hepatectomy has been performed to the limited cases, which was the explored technique of auxiliary partial orthotopic LT. Minimally invasive donor hepatectomy (laparoscopic or robotic) has been increasingly done. In this review are described the recent pressing topics in LT.

Is Being In The Geriatric Age Group An Additional Risk Factor Or Contraindication For Living Donor Liver Transplantation?

Introduction: While advanced age was once a contraindication for liver transplantation, it is now routinely performed for individuals over (≥) 65. This study aimed to analyze preoperative findings, preoperative findings, perioperative graft-related and surgical factors, and postoperative complications in geriatric recipients (≥65 years) to assess the feasibility and outcomes of living-donor liver transplantation in this age group. Materials and Method: Data regarding sex, model for end-stage liver disease score, Child score, body mass index, blood type, graft type (right or left lobe), ascites, esophageal variceal hemorrhage, hepatic encephalopathy, spontaneous bacterial peritonitis, preoperative INR, platelet, sodium, albumin, total bilirubin and creatinine, diabetes, hypertension, coronary artery disease, anhepatic phase, cold ischemia time, operation time, blood products transfusion rates, graft-to-recipient weight ratio, intensive care unit and hospital stay, biliary complications, hepatic vein thrombosis, portal vein thrombosis, postoperative hemorrhage, sepsis, and primary graft dysfunction were analyzed statistically in geriatric patients. Results: The use of the right lobe was significantly higher in the ≥65 age group (p=0.036). Additionally, body mass index (p=0.039) and creatinine (p=0.018) were statistically higher in the group. Conclusion: Living-donor liver transplantation can be safely performed in patients aged ≥65 years. Keywords: Liver; Survival; Transplantation.

Analysis of the Survival of Patients Transplanted for Hepatocarcinoma According to Age at Transplantation

In recent years, the age at which liver transplantation is considered indicated has been extended. Currently, age alone is not a contraindication for liver transplantation. Studies are being carried out that reflect the increased survival and similar technical success of transplantation in these patients compared to younger patients. We set out to conduct an analysis in real clinical practice on the survival benefit in transplanted patients over 65 years of age in the indication of hepatocarcinoma.

Portal Vein Thrombosis in Liver Transplantation: A Retrospective Cohort Study.

Portal vein thrombosis was considered a contraindication for liver transplantation. This study analyzes the perioperative complications and survival of liver transplant patients with portal vein thrombosis (PVT). A retrospective observational cohort study of liver transplant patients was conducted. The outcomes were early mortality (30 days) and patient survival. A total of 201 liver transplant patients were identified and 34 (17%) patients with PVT were found. The most frequent extension of thrombosis was Yerdel 1 (58.8%), and a portosystemic shunt was identified in 23 (68%) patients. Eleven patients (33%) presented any early vascular complication, PVT being the most frequent (12%). The multivariate regression analysis showed a statistically significant association between PVT and early complications (OR = 3.3, 95% confidence interval 1.4-7.7; p = 0.006). Moreover, early mortality was observed in eight patients (24%), of which two (5.9%) presented Yerdel 2. For Yerdel 1, patient survival according to the extent of thrombosis was 75% at 1 year and 3 years, while for Yerdel 2, it was 65% at 1 year, and 50% at 3 years (p = 0.04). Portal vein thrombosis significantly influenced early vascular complications. Furthermore, portal vein thrombosis Yerdel 2 or higher impacts the survival of liver grafts in the short and long term.

Endovascular Lymphatic Decompression via Thoracic Duct Stent Placement for Refractory Ascites in Patients with Cirrhosis: A Pilot Study

PurposeTo evaluate the technical and clinical success of endovascular lymphatic decompression via thoracic duct (TD) stent placement in patients with cirrhosis with refractory ascites. Materials and MethodsNine patients (6 men and 3 women; median age, 66 [interquartile range {IQR}, 65–68] years; range, 62–78 years) who underwent TD stent placement for refractory ascites with contraindications for liver transplantation and transjugular intrahepatic portosystemic shunt creation were included in this retrospective study. TD stent placement was performed under local anesthesia using retrograde access from the venous system. Self-expanding stents from 5 to 8 mm in diameter were used and extended into the subclavian vein by approximately 1 cm. Technical (correct positioning of the stent) and clinical success (no more requirement of paracentesis) were evaluated. In addition, the safety of the procedure and TD pressure evolution were evaluated. ResultsThe technical success rate was 100%, and 3 (33%) patients reported clinical success. Five (56%) patients reported 7 minor adverse events (Grade I), among which 2 TD perforations were induced by stent angioplasty, with no clinical manifestation or treatment required. The median TD pressure decreased from 19 mm Hg (IQR, 11–24 mm Hg) at the beginning of the procedure to 6 mm Hg (IQR, 5–11 mm Hg) after TD stent placement. The median survival time after the procedure was 7.1 months. ConclusionsEndovascular lymphatic decompression via TD stent placement is feasible and safe and was effective on ascites in some patients with cirrhosis with refractory ascites.

A novel approach for portal system reconstruction in liver transplant patients with grade IV portal vein thrombosis: Case study and literature review.

Portal vein thrombosis is a common problem of end-stage liver disease in patients with portal hypertension and Yerdel grade IV thrombosis may be a contraindication for liver transplantation. Advances in surgical technique have indicated the feasibility of liver transplantation with PVT such as Reno-portal anastomosis, cavo-portal hemitransposition, but low graft portal blood perfusion and regional portal hypertension were the limitations. We introduce a new approach for portal system reconstruction in a patient underwent liver transplantation: A 28-year-old male was diagnosed with Budd-Chari syndrome and portal hypertension with grade IV portal vein thrombosis. The "Pull-out" technique was applicated for thrombectomy, which can aid in exposing the superior mesenteric vein and portal vein branches and reducing technical difficulties associated with the identification and dissociation of surrounding anatomical structures. To collect sufficient portal vein blood perfusion and avoid regional portal hypertension, the portal vein system was reconstructed through double-approach procedure: reno-portal anastomosis combined with portal-portal anastomosis. Based on a precision preoperative evaluation, application of the Pull-out technique and double-approach procedure may be an effective method of thrombectomy especially in cases of grade IV portal vein thrombosis.

Clinical analysis of deceased donor liver transplantation in the treatment of hepatocellular carcinoma with segmental portal vein tumor thrombus: A long-term real-world study.

BackgroundHepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) have conventionally been regarded as a contraindication for liver transplantation (LT). However, the outcomes of deceased donor liver transplantation (DDLT) in patients with segmental PVTT remain unknown. The aim of this study is to evaluate the feasibility and effectiveness of DDLT in the treatment of HCC with segmental PVTT.MethodsWe retrospectively analyzed 254 patients who underwent DDLT for HCC in our institution from January 2015 to November 2019. To assess the risks of PVTT, various clinicopathological variables were evaluated. Overall (OS) and recurrence-free survival (RFS) analyses based on different PVTT types were performed in HCC patients.ResultsOf the 254 patients, a total of 46 patients had PVTT, of whom 35 had lobar PVTT and 11 had segmental PVTT in second-order branches or below. Alpha-fetoprotein (AFP) level, tumor maximal diameter, histological grade, micro-vascular invasion (MVI), RFS, and OS were significantly different between the control and PVTT groups. Lobar PVTT was associated with unfavorable 5-year RFS and OS compared with MVI group (28.6% and 17.1%, respectively). Instead, no significant difference was observed between the segmental PVTT and MVI group in terms of 5-year RFS and OS (RFS: 36.4% vs. 40.4%, p=0.667; OS: 54.5% vs. 45.1%, p=0.395). Further subgroup analysis showed segmental PVTT with AFP levels ≤100 ng/ml presented significantly favorable RFS and OS rates than those with AFP level >100 ng/ml (p=0.050 and 0.035, respectively).ConclusionsIn summary, lobar PVTT remains a contraindication to DDLT. HCC patients with segmental PVTT and AFP level ≤100 ng/ml may be acceptable candidates for DDLT.

P9.49: Efficacy and Long-term Prognosis of Liver Transplantation For Porto-Pulmonary Hypertension

Objective: Porto-pulmonary hypertension (PoPH) refers to pulmonary hypertension based on severe portal hypertension. Severe PoPH has a very high perioperative mortality rate and is still considered a contraindication for liver transplantation (LT). We analyze efficacy and long-term prognosis of liver transplantation for porto-pulmonary hypertension from our center. Methods: A retrospective analysis was performed on 5 patients with PoPH who received liver transplantation in Beijing Friendship Hospital from Jan. 2013 to March 2022, in order to analyze postoperative follow-up results and long-term survival. Results: Five patients with PoPH with a mean age of 35.6 ± 18.6 years (60% females), were included in the analysis. Their primary diseases were hepatic spongiosis, Caroli disease, hepatitis B cirrhosis, drug-induced cirrhosis and primary sclerosing cholangitis. All patients were measured by Swan-Ganz catheterization of right heart, among them, the mean of the highest mean pulmonary artery pressure(mPAP) level before LT were 46.6mmHg(27-58mmHg). The mean of their highest systolic pulmonary artery pressure(SPAP) level measured under echocardiography was 101.36mmHg(51-154mmHg) before LT. The median Model for End-Stage Liver Disease (MELD) score was 16(14-20) at PoPH diagnosis. All patients had been on pulmonary vasodilator therapy(including ambrisentan, remodulin and sildenafil) for more than six months to lower pulmonary artery pressure to mPAP<35mmHg, that can achieve surgical indications before LT. The operations went smoothly, except in one case where pulmonary artery pressure suddenly increased during surgery ended smoothly after the addition of remodulin. Two patients underwent a second liver transplant at 6 months and 65 months postoperatively, and one patient died of acute heart failure after the second transplantation, while the remaining four patients survived. The follow-up time of the survived patients were 29.7, 46.9, 56, 85.2 months. The longest follow-up among them was over seven years. SPAP of them decreased 15.4, 129, 65.3, 20mmHg after LT. Two patient was discontinued pulmonary arterial pressure medications within 1 year after surgery because SPAP were down to normal, and other patients still on medication. Conclusion: Patients with pulmonary vasodilator therapy before LT can have excellent long-term outcomes post-transplant. Oral pulmonary vasodilator therapy can be effective treatment to qualify patients for LT.

Outcomes of Surgical Strategies for Living Donor Liver Transplantation in Patients With Portal Vein Thrombosis: A Cohort Study

Adequate portal flow to the liver graft is the requirement of a successful liver transplant (LT). Historically, portal vein thrombosis (PVT) was a contraindication for LT, especially for living donor LT (LDLT), demanding technically more difficult operations and advanced technique. In this study, the outcomes of patients with and without PVT after LDLT were compared. Adult LDLTs performed by 2 centers (n=335) between 2013 and 2020 were included into this large cohort study. PVT was classified based on Yerdel classification grade 1 to 4. Sixty-two patients with PVT constituted 19% of the study cohort of 335 recipients. While mean platelet count was found to be lower (P=.011) in the PVT group, patient age (P=.035), operation duration (P=.001), and amount of intraoperative blood transfusion (P=.010) were found to be higher. Incidence of PVT was higher in female patients than males (22.7% vs 16.1%, P=.037). There was no significant difference in survival between patients with and without PVT on 30-day (P=.285), 90-day (P=.565), 1-year (P=.777), and overall survival (P=.917). Early thrombosis did not show a better survival rate than Grades 2, 3, or 4 PVT. Thrombosis limited to portal vein was not found to bring a survival advantage compared with Grade 3 and 4 thromboses. Eversion thrombectomy was the most common procedure (66%) to overcome PVT intraoperatively. Although technically more challenging, PVT is not a contraindication of LDLT. Similar outcomes can be achieved in LDLT in patients with PVT after proper restoration of portal flow, which eliminates the default survival disadvantage of patients with PVT.

Liver transplantation for malignant liver tumors

Liver transplantation is a highly effective treatment not only for acute or chronic liver failure but also for primary liver cancer such as hepatocellular carcinoma, perihilar cholangiocarcinoma, intrahepatic cholangiocarcinoma, and metastatic tumors such as from neuroendocrine or colorectal liver metastases. The success strongly relies on strict adherence to stringent selection criteria, which lead to excellent outcomes, while previously regarded as contraindication for liver transplantation. These impressive results are, however, mostly achieved with a combination of pretreatment strategies and convincing control of the tumor growth prior to transplantation, as well as minimizing long-term immunosuppression. With this emergence of oncologic liver transplantation, we expect an increasing need of grafts, and therefore included in this report strategies to improve the number of available grafts by maximizing liver utilization rates. Modern machine liver perfusion approaches may play in this respect an important role.

An Update on the Current Management of Hepatitis B Virus in Special Populations

Hepatitis B (HBV) in special populations within this article is considered as acute on chronic liver failure due to HBV, coinfection with Hepatitis C (HCV), Hepatitis D (HDV), or Human Immunodeficiency Virus (HIV), and HBV infection in patients who are in immunosuppressive states due to specific therapies and liver transplant recipients. Patients within these special populations are at higher risk of liver-related complications such as fibrosis, accelerated cirrhosis, acute on chronic liver failure, and/or development of hepatocellular carcinoma (HCC). Given their respective complex pathophysiology, specific treatment approaches are required for each population. With the introduction of effective antiviral HBV therapies over the past decade and the respective treatment options for the special population diseases, patient outcomes have seen improvement. With the advent of HCV direct antivirals, treatment of HBV-HCV coinfection has been more successful and consistently shown high rates of sustained virologic response. Treatment of HBV-HDV coinfection remains primarily as interferon-based, though new promising therapies have shown greater improvement in viral suppression. HBV-HIV coinfection has also shown promising results given overlapping mechanisms for treatment and specific regimens should be chosen to decrease risk of resistance. HBV reactivation in patients undergoing immunosuppressive therapies have been reported and guidelines recommend close monitoring and in certain cases, HBV antiviral therapy prophylaxis. With the effective HBV therapies, the perception of HBV as a contraindication for liver transplant has been diminishing and prolonged graft survival with effective antiviral therapies have shown promising outcomes.

Proceedings of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition Monothematic Conference, 2020: "Acute Liver Failure in Children": Treatment and Directions for Future Research.

The Hepatology Committee of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) aims to educate pediatric gastroenterologists, members of ESPGHAN and professionals from other specialties promoting an exchange of clinical expertise in the field of pediatric hepatology. The 2020 single topic ESPGHAN monothematic 3-day conference on pediatric liver disease, was organized in Athens, Greece and was entitled " Acute Liver Failure" (ALF). ALF is a devastating disease with high mortality and in a considerable fraction of patients, the cause remains unresolved. As knowledge in diagnosis and treatment of ALF in infants and children has increased in the past decades, the objective was to update physicians in the field with developments in medical therapy and indications for liver transplantation (LT) and to identify areas for future research in clinical and neurocognitive outcomes in ALF. We recently reported the epidemiology, diagnosis, and initial intensive care management issues in separate manuscript. Herewith we report on the medical treatment, clinical lessons arising from pediatric studies, nutritional and renal replacement therapy (RRT), indications and contraindications for LT, neurocognitive outcomes, new techniques used as bridging to LT, and areas for future research. Oral presentations by experts in various fields are summarized highlighting key learning points. The current report summarizes the current insights in medical treatment of pediatric ALF and the directions for future research.

An arachnoid cyst you don’t see every day

A 53 years-old male, diagnosed with ulcerative colitis and liver cirrhosis due to HCV infection, was hospitalized at the Gastroenterology Department for paraclinical workup, prior to inclusion on the liver transplantation waiting list. The patient was known with a gigantic arachnoid cyst and presented a transient ischemic attack one year prior, for which treatment with aspirin was initiated. Consequently, we performed a brain MRI examination, which disclosed a left-sided gigantic arachnoid cyst with mass effect, midline shift of 9 mm and subfalcine herniation. No focal neurologic deficits or signs of increased intracranial pressure were found on neurological examination. Following neurosurgical evaluation, the presence of the cyst was not deemed to be a contraindication for liver transplantation.

Acute liver failure caused by metastatic malignant melanoma of liver

Abstract Introduction: Malignant melanoma of liver is an exceedingly rare cause of acute liver failure (ALF), whether primary or metastatic. Only few cases have been reported in the worldwide literature, and all the patients with ALF secondary to diffuse hepatic infiltration by melanoma subsequently died within days. Patient concerns: The patient was a 70-year-old man admitted to our hospital for abdominal distention and progressive jaundice for 15 days. Diagnoses: Ultrasonography and computed tomography findings indicated the presence of hepatomegaly with homogeneous normal echogenicity without focal lesions. Due to the history of alcohol consumption, acute liver failure (ALF) caused by alcoholic live disease was suspected. Interventions: After 4 time artificial liver treatment, the patient continued to deteriorate and deceased donor liver transplantation was performed after discussion with the next-of-kin. Outcomes: Postoperative pathology revealed clusters of malignant melanoma cells that had diffusely infiltrated the liver parenchyma. The patient was discharged on the eleventh day post-operation. Three months post-transplantation, he was readmitted because of elevated liver enzymes, and died of acute liver failure 9 days later. Conclusions: To our knowledge, this is the first report of liver transplantation for ALF due to diffuse hepatic melanoma. When the etiology of liver failure is unclear, diffuse metastatic tumor infiltration should be considered and early liver biopsy would be helpful in establishing the diagnosis and guiding treatment, particularly when liver transplantation is a treatment option as a metastatic malignancy is a contraindication for liver transplantation.

Incidental intrahepatic cholangiocarcinoma in patients undergoing liver transplantation: A multi-center study in Japan.

Intrahepatic cholangiocarcinoma had been considered a contraindication for liver transplantation because of poorer outcomes. However, incidental intrahepatic cholangiocarcinoma in the explanted liver has been reported because of the difficulty of obtaining an accurate diagnosis in cirrhotic livers on preoperative imaging. We conducted a nationwide survey to analyze the incidence of incidental intrahepatic cholangiocarcinoma and outcomes after liver transplantation, in Japan. Forty-five of 64 institutions (70%) responded to our initial investigation. Between January 2001 and December 2015, 6627 liver transplantations were performed in these 45 institutions, with 19 cases (0.3%) of incidental intrahepatic cholangiocarcinoma reported from 12 transplant centers. Six cases were diagnosed as hepatocellular carcinoma preoperatively. The 1-, 3-, and 5-year recurrence-free survival rates were 79%, 45%, and 45%, respectively. Tumor recurrence after liver transplantation was found in 10 patients (53%). The 1-, 3-, and 5-year overall survival rates were 79%, 63%, and 46%, respectively. Intrahepatic cholangiocarcinoma at liver transplantation is associated with a high risk of recurrence and poor prognosis, even these tumors are detected incidentally in the explanted liver.

Outcomes of Liver Transplantation in Patients with Situs Inversus

Introduction: Situs Inversus was considered a contraindication for liver transplant in the past, due to the anatomical difficulties and the associated vascular abnormalities. Nowadays, several studies and series reported successful liver transplant in situs inversus recipients and also from donors. However, it is still rare. Therefore, we conducted a systematic review to assess the transplant techniques and their outcomes in situs inversus individuals. Methods: We searched through four database engines; PubMed, EMBASE, Web of Science, and CINAHL. Articles were included if they reported our main outcomes of surgical technique, morbidity, and mortality of liver transplant in adult patients. Results: 31 reports, including 35 situs inversus individuals, were included in this review. Of which 19 patients were situs inversus recipients, and 14 were donors. The most common reported transplant technique is orthotopic liver transplant with 180° rotation. HBV, HCV, and alcohol-related liver disease were the most common etiologies for end-stage liver disease in situs inversus recipients. The mean MELD score for the situs inversus recipients was 22 (ranged 9-36), the mean hospital stay was 19 days (ranged 7-45), and the operation time ranged from 3.5 to 11.5 hours. The overall complication rate was higher in situs inversus recipients than in patients who receive grafts from situs inversus donors 50% (9/18) and 33.3% (4/12), respectively. Conclusion: Liver transplant in situs inversus recipients is feasible, and liver grafts from situs inversus donors are considered safe. Despite the anatomical intricacy, preoperative planning and the use of proper techniques can lead to successful outcomes.

Retrospective-prospective study of safety and efficacy of sofosbuvir-based direct-acting antivirals in HIV/HCV-coinfected participants with decompensated liver disease pre- or post-liver transplant.

Direct-acting antiviral (DAA) therapy has transformed the management of human immunodeficiency virus (HIV) and hepatitis C (HCV) coinfected patients with advanced liver disease. STOP-Coinfection was a multicenter prospective and retrospective, open-label study using sofosbuvir-based DAA therapy to treat HIV/HCV-coinfected participants pre- or post-liver transplant (LT). Sixty-eight participants with end-stage liver disease (Child-Turcotte-Pugh score ≥7 and Model for End-Stage Liver Disease score 6-29) were enrolled, 26 had hepatocellular carcinoma. Forty-two participants were treated pre-LT and 26 post-LT. All participants completed therapy without need for dose reduction or transfusion; eight required two or more courses of therapy. Ninety-three percent achieved a sustained virologic response and DAA therapy was well tolerated. Despite HCV cure, 12 end-stage liver disease participants required subsequent LT, 7 for decompensated liver disease. Thirteen participants died, 10 with decompensated liver disease pre-LT and three post-LT. Overall, transplant free survival was 42.8% at 4years and post-LT survival was 87.9% at 5years. We conclude that sofosbuvir-based DAA therapy is safe and highly effective in HCV-HIV patients with decompensated liver disease and post-LT, with post-LT survival rates comparable to other indications. This removes one of the last barriers to liver transplantation in this challenging cohort of recipients.

Analysis of the organ allocation system for liver transplantation in Chile

In Chile, organ allocation for liver transplantation (LT) in adults is prioritized according to the MELD-Na score. Exceptions such as Hepatocellular Carcinoma (HCC) and other non-HCC exceptions receive a score called Operational MELD score. To evaluate the effectiveness of the MELD-Na score and the operational MELD score as a prioritization system for LT in Chile. Retrospective analysis of the waiting list (WL) of adult candidates (≥ 15 years) for elective LT in Chile from 2011 to 2017. The probability of leaving the WL, defined by death or contraindication for LT was compared in three groups: 1) Cirrhotic patients prioritized according to their real MELD-Na score (CPM), 2) HCC and 3) other non-HCC exceptions. We analyzed 730 candidates for LT, with a median age of 57 years, 431 (56%) were men. In the study period, 352 LT were performed (48%). The annual exit rate was significantly higher in the CPM group (45.5%) compared to HCC (33.1%) and non-HCC (29.3%), (p < 0.001). Post LT survival was 86% at 1 year and 85% at 5 years, without significant differences between groups. In the CPM group, post-transplant survival was significantly lower (p < 0.05) in patients with MELD-Na ≥ 30 at transplant (81% per year) compared to patients with patients with MELD-Na < 30 (91% per year). MELD-Na score can discriminate very well patients who have a higher risk of death in the short and medium term. However, the assignment of operational scores for situations of exception produces inequities in the allocation of organs for LT and must therefore be carefully adjusted.

Successful experience of liver transplantation at the Samara Center of organ and tissue transplantation (a clinical case)

Objective to summarize the available data on the liver transplantation (LT) case.&#x0D; The work describes the indications and contraindications for LT, examination of a potential recipient before the operation, the maintenance of a waiting list. A clinical case is presented the first successful liver transplantation in the Samara Center of organ and tissue transplantation.