Liver Transplant Program Research Articles

305.4: Educating medical students about Organ Donation and Transplantation in Mongolia.

Background: Donor law was revised and enforced since February 2018. As per the current law opt-in scheme that presumes 25 years old citizen can give his/her donor consent via written form. Organ transplantation started in 1996 and now have kidney and liver transplantation programs at the First Central hospital and National cancer center. As of 30 April 2019, local doctors performed 180 kidney, 84 liver and 17 bone marrow transplantation successfully. Brain death donation started in 2008, however general population still do not know about it fully. Therefore, we aimed to educate our current medical students on organ transplantation, donor consent form and brain death donation. Objective: To teach structured classroom education on organ donation and transplantation among students in medical universities, colleges in Ulaanbaatar. Within this approach we chose a total 13 medical universities. By the end of the this year over 5,000 college students who will be attending in formal education and promotion program. Methods: In this structured classroom education will cover the basic information about organ transplantation, donor card, brain death donor determination, donation and Istanbul Declaration. The our target 4, 5 and 6th year medical students will be given a 45 minute lesson with accompanying brochure about the donor legislations, transplantation program, data, benefits of organ and tissue donation. Post intervention questionnaire survey will conducted after a month to evaluate the effectiveness of the lesson and its promotion purpose. The questionnaire consists 12 questions of 4 sections. All questions related to donor consent form, organ transplantation program, cadaver donor status, family approach and media involvement in organ donation and transplantation. Results: We started classroom training from 5th and 6th year 460 medical students in April. Students were very keen to gather correct information and had high interest to share their knowledge with their families and friends. It was very obvious that educational intervention increased the knowledge of the students about organ transplantation, donation and legislation. Conclusions: In order to improve our current public education and promotion on organ donation and transplantation, especially brain death donation we started this program from medical university students. Based on our experience this classroom education exposure had good potential to increase knowledge levels of organ transplantation and brain death donation among students. Those 5,000 students can provide the correct information to their family members, friends and communities. Also, we can continue classroom education for the 2nd and 3th year of medical students in 2020.

Intrahepatic macrophage populations in the pathophysiology of primary sclerosing cholangitis.

Background & AimsPrimary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease characterized by progressive inflammatory and fibrotic injury to the biliary tree. We sought to further delineate the contribution of macrophage lineages in PSC pathobiology.MethodsHuman liver tissues and/or blood samples from patients with PSC, primary biliary cholangitis, other non-cholestatic/non-autoimmune diseases, including alcohol-related liver disease and non-alcoholic steatohepatitis, as well as normal liver, were sourced from our liver transplantation program. Liver fibrosis was studied using Van Gieson staining, while the frequencies of infiltrating monocyte and macrophage lineages, both in the circulation and the liver, were investigated by flow cytometry, including the expression of TGR-5, a G protein-coupled receptor (GPBAR1/TGR-5).ResultsSignificantly higher frequencies of CD68+CD206+ macrophages were detected in the livers of patients with PSC (median 19.17%; IQR 7.25–32.8%; n = 15) compared to those of patients with other liver diseases (median 12.05%; IQR 5.61–16.03%; n = 12; p = 0.0373). CD16+ monocytes, including both intermediate (CD14+CD16++) and non-classical (CD14dimCD16++) monocytes, were preferentially recruited into chronically diseased livers, with the highest recruitment ratios in PSC (median 15.83%; IQR 9.66–29.5%; n = 15), compared to other liver diseases (median 6.66%; IQR 2.88–11.64%, n = 14, p = 0.0152). The expression of TGR-5 on CD68+ intrahepatic macrophages was increased in chronic liver disease; TGR-5 expression on intrahepatic macrophages was highest in PSC (median 36.32%; IQR 17.71–63.61%; n = 6) and most TGR-5+ macrophages were CD68+CD206+ macrophages.ConclusionsUnderlying a potential role for macrophages in PSC pathobiology, we demonstrate, using patient-derived tissue, increased CD16+ monocyte recruitment and a higher frequency of CD68+CD206+ macrophages in the livers of patients with PSC; the CD68+CD206+ macrophage subset was associated with significantly higher TGR-5 expression in PSC.Lay summaryPrimary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease associated with progressive inflammation of the bile duct, leading to fibrosis and end-stage liver disease. In this study we explore the role of a type of immune cell, the macrophage, in contributing to PSC as a disease, hoping that our findings direct scientists towards new treatment targets. Our findings based on human liver and blood analyses demonstrate a greater frequency of a particular subset of immune cell, the CD68+CD206+ macrophage, with significantly higher TGR-5 expression on this subset in PSC.

2960 National Variation in Approach to HCV in Patients Listed for Liver Transplant

INTRODUCTION: Due to recent progress in the treatment of hepatitis C virus (HCV), many providers specializing in transplant medicine face the difficult clinical decision of whether to treat HCV in patients before or after liver transplantation (LT). Eradicating HCV in the pre-LT population has a powerful impact on both the LT waitlist and on the types of donors offered to recipients. Concurrently, increasing availability of organs from high-risk donors is occurring, largely due to the US overdose epidemic. We sought to better understand how some of these clinical and social dynamics impact decisions at US transplant centers. METHODS: We surveyed all medical and surgical transplant directors from adult US. LT centers via an online survey in 2017. The survey queried directors about their program's specific approach to waitlisted patients with HCV pre-LT. The survey posed broad questions about patient demographics as well as more specific questions relating to the frequency with which Public Health Service-increased risk (PHS-IR) and HCV+ donors are offered, the degree to which PHS-IR and HCV+ offers are declined due to a lack of waitlisted patients with HCV, and the existence of any cutoffs for transplantation. RESULTS: 28 respondents (17% response rate), representing programs in 10/11 UNOS regions, answered the survey. Respondents were primarily from university-affiliated LT programs (92.3%) and represented variably-sized programs (LT volume ≤50 in 46.4%, 51-100 in 35.7%, >100 in 17.9%). 93% of programs reported seeing >10% are PHS-IR offers, and 19% of programs reported >30% PHS-IR offers. 39.3% of programs reported >10% offers are from HCV+ donors. 50% of programs reported turning down offers for HCV+ organs due to lack of available HCV+ recipients on the waitlist. A minority of programs (14.3%) continue to use donor age cutoffs for HCV+ recipients and many programs do not attempt to treat chronic HCV in non-HCC patients with CPT-B (42.3%) and CPT-C (77.8%) cirrhosis. CONCLUSION: Significant heterogeneity in US LT centers' approach to HCV patients on the waitlist exists. There is a trend to leave the sickest HCV+ patients untreated, though organs may be discarded due to lack of available HCV+ recipients in some parts of the country. As utilization of HCV+ organs into HCV- recipients begins to increase in the US, consideration for a separate allocation strategy for these organs may be warranted.

2397 Successful Reversal of Sickle Cell Intrahepatic Cholestasis Associated Acute Liver Failure With Combined pRBC and Plasma Exchange Transfusion: A Case Report

INTRODUCTION: Sickle cell intrahepatic cholestasis (SCIC) with acute liver failure (ALF) is a severe variant of Sickle cell hepatopathy that has significant mortality despite aggressive supportive therapy. Even though packed red blood cells (pRBCs) exchange has vastly improved outcomes, there is little evidence on alternative therapies to treat those who show inadequate response to pRBC exchange transfusion (ET). CASE DESCRIPTION/METHODS: A 37-year-old African American male with Hemoglobin SS disease complicated by chronic pain and nephropathy ESRD on dialysis, who was referred to our liver transplant program for ALF. Patient presented with lethargy and fever. Upon arrival he was somnolent, jaundiced, cardiopulmonary and abdominal exam was unremarkable, no focal neurological deficits but presence of asterixis was noted. Hb 6 g/dL, WBC 13,000/µL, Platelet 147,000/µL, corrected reticulocyte count 5.9%, LDH 1816 IU/L, Total bilirubin 49 mg/dl, direct bilirubin 37 mg/dL, ALT 112 IU/L, AST 259 IU/L, ALP 296 IU/L, albumin 3.5 g/dL and INR 1.9. CT head was unremarkable. MRCP revealed hepatomegaly, cholecystectomy without evidence of biliary obstruction. Ultrasound duplex liver showed patent hepatic vessels. Other causes of ALF including drugs, alcohol, acetaminophen, and viral hepatitis etiology were excluded. N-acetylcysteine infusion protocol was initiated. Patient received 10 units pRBC ET. Despite successful reduction of HbS fraction from 79.5% to 16%, the patient remained encephalopathic with asterixis and developed severe headache. Furthermore, bilirubin and INR continued to rise (Figure 1). Transjugular liver biopsy revealed portosystemic gradient of 20 mmHg. Liver pathology showed sinusoidal distension by sickled erythrocytes, zone 3 predominant intracanalicular cholestasis with ballooned hepatocytes and hepatocyte siderosis (Figure 2). Total 9L of plasma ET was performed on 2 consecutive days with successful reversal of headache, encephalopathy, and coagulopathy. His bilirubin levels continue to decline. He did not require a liver transplant and was discharged home with prophylaxis pRBC ET to maintain HbS fraction < 30%. DISCUSSION: SCIC with ALF is rare with significant mortality. Plasma ET was used in our patient whom ALF was refractory despite adequate pRBC ET (HbS < 30%). Larger studies are needed to evaluate plasma ET benefit in sickle cell disease patients with end organ damage, regarding treatment outcome as well as transplant-free survival.

Waiting list mortality for pediatric deceased donor liver transplantation in a Japanese living‐donor–dominant program

Living donor liver transplantation (LDLT) has become a major life-saving procedure for children with end-stage liver disease in Japan, whereas deceased donor liver transplantation (DDLT) has achieved only limited success. The annual number of pediatric liver transplantations is approximately 100-120, with a patient 20-year survival rate of 81.0%. In 2005, the liver transplantation program at the National Center for Child Health and Development in Tokyo, Japan, was initiated, with an overall number of 560 pediatric patients with end-stage liver disease to date. In July 2010, our center was qualified as a pediatric DDLT center; a total of 132 patients were listed for DDLT up until February 2019. The indications for DDLT included acute liver failure (n=46, 34.8%), metabolic liver disease (n=26, 19.7%), graft failure after LDLT (n=17, 12.9%), biliary atresia (n=16, 12.1%), and primary sclerosing cholangitis (n=10, 7.6%). Overall, 25.8% of the patients on the waiting list received a DDLT and 52.3% were transplanted from a living donor. The 5-year patient and graft survivals were 90.5% and 88.8%, respectively, with an overall waiting list mortality of 3.0%. LDLT provides a better survival compared with DDLT among the recipients on the DDLT waiting list. LDLT is nevertheless of great importance in Japan; however, it cannot save all pediatric recipients. As the mortality of children on the waiting list has not yet been reduced to zero, both LDLT and DDLT should be implemented in pediatric liver transplantation programs.

One Hundred Fifty Liver Transplants at a New Program in the Modern Era: The University of Mississippi Experience

From 1991 to 2013, Mississippi was without liver transplant services. In 2013, a new liver transplant program was established at the University of Mississippi Medical Center. Here, we describe our experience with the first 150 transplants over a 4.5-year period. This study is a review of 147 patients who underwent the first 150 liver transplants at the University of Mississippi Medical Center between March 5, 2013, and January 4, 2018. There were no exclusion criteria for this study. Donor, recipient, and outcome variables were analyzed. Recipients were 46% female and 74% white. Age at the time of transplant was 57 [IQR 49-63]. BMI at transplant was 30 [IQR 25-35]. Thirty per cent of transplants were for alcoholic cirrhosis, 25% non-alcoholic steatohepatitis, 24% hepatitis C, and 12% cholestatic. Mean model for end-stage liver disease (MELD) at the time of transplant was 20 [95% confidence interval 19-21] and MELD-Na was 22 [95% confidence interval 20-23]. One-year patient- and graft survival were 89% and 87%, respectively, which were as expected based on Scientific Registry of Transplant Recipient reports after risk adjustment. The data published here verifies it is possible to establish a new liver transplant center in an underserved area previously lacking comprehensive liver care and to achieve results similar to other high-volume centers across the country.

Risk-adjusted survival in liver transplant patients assessed and managed by a non-transplanting centre: South West Liver Unit experience

BackgroundLiver transplant services remain a scarce resource not reflective of geography or burden of liver disease within the UK. To address geographical concerns in the South West (SW), a devolved...

Liver transplantation: development, learning curve and results after the first 300 cases

Liver transplantation (LT) is an option for people with liver failure who cannot be cured with other therapies and for some people with liver cancer. To describe, and analyze the first 300 LT clinical results, and to establish our learning curve. Retrospective cohort study with data obtained from a prospectively collected LT Program database. We included all LT performed at a single center from March 1994 to September 2017. The database gathered demographics, diagnosis, indications for LT, surgical aspects and postoperative courses. We constructed a cumulative summation test for learning curve (LC-CUSUM) using 30-day post-LT mortality. Mortality at 30 days, and actuarial 1-, and 5-year survival rate were analyzed. A total of 281 patients aged 54 (0-71) years (129 women) underwent 300 LT. Ten percent of patients were younger than 18 years old. The first, second and third indications for LT were non-alcoholic steatohepatitis, chronic autoimmune hepatitis and alcoholic liver cirrhosis, respectively. Acute liver failure was the LT indication in 51 cases (17%). The overall complication rate was 71%. Infectious and biliary complications were the most common of them (47 and 31% respectively). The LC-CUSUM curve shows that the first 30 patients corresponded to the learning curve. The peri-operative mortality was 8%. Actuarial 1 and 5-year survival rates were 82 and 71.4%, respectively. Outcome improvement of a LT program depends on the accumulation of experience after the first 30 transplants and the peri-operative mortality directly impacted long-term survival.

Expanding the Donor Pool With the Use of Extended Criteria Donation After Circulatory Death Livers.

Use of donation after circulatory death (DCD) donor livers for transplantation has remained cautious in the United States. The aim of this study was to demonstrate the expansion of a DCD liver transplantation (LT) program with the use of extended criteria donor (ECD) DCD livers. After institutional review board approval, 135 consecutive DCD LTs were retrospectively studied. ECD DCD livers were defined as those with 1 of the following factors: donor age >50 years, donor body mass index >35 kg/m2 , donor functional warm ischemia time >30 minutes, and donor liver macrosteatosis >30%. An optimization protocol was introduced in July 2011 to improve outcomes of DCD LT, which included thrombolytic donor flush and efforts to minimize ischemia times. The impact of this protocol on outcomes was evaluated in terms of graft loss, ischemic cholangiopathy (IC), and change in DCD LT volume. Of 135 consecutive DCD LTs, 62 were ECD DCDs. In total, 24 ECD DCD LTs were performed before (era 1) and 38 after the institution of optimization protocol (era 2), accounting for an increase in the use of ECD DCD livers from 39% to 52%. Overall outcomes of ECD DCD LT improved in era 2, with a significantly lower incidence of IC (5% versus 17% in era 1; P=0.03) and better 1-year graft survival (93% versus 75% in era 1; P=0.07). Survival outcomes for ECD DCD LT in era 2 were comparable to matched deceased donor LT. With the expansion of the DCD donor pool, the number of DCD LTs performed at our center gradually increased in era 2 to account for >20% of the center's LT volume. In conclusion, with the optimization of perioperative conditions, ECD DCD livers can be successfully transplanted to expand the donor pool for LT.

New challenges of liver transplantation

In the last decades, the results of liver transplantation have shown significant improvement. More patients are eligible for liver transplantation, while the indications are changing. The worldwide shortage of donor organs urges the profession for the development of new strategies. With rational extension of donor criteria, more precise organ allocation, personalized donation, living related donation, machine perfusion, and donation after cardiac death, liver transplantation is becoming available for more and more patients suffering from end stage liver disease. Hereby we summarize the new possibilities and challenges in the light of the Hungarian liver transplant program. Orv Hetil. 2019; 160(29): 1127-1135.

Healthcare transition in pediatric liver transplantation: The perspectives of pediatric and adult healthcare professionals.

Transition from pediatric to adult services of young people with a liver transplant is an important priority due to increasing numbers of young people surviving into adulthood. There is increased incidence of graft loss and non-adherence following transfer to adult services. Although studies have considered the views and perceptions of young people who have undergone liver transplantation and their parents about transition, there is currently no qualitative research with healthcare professionals working in the field of liver transplantation. The aim of this study was to elicit the views of this group of stakeholders about barriers and facilitators of an effective transition process. Semi-structured interviews were carried out with 11 HCPs from pediatric and adult liver transplant programs and from a range of professional backgrounds. Interviews were transcribed verbatim and analyzed using thematic analysis. Four themes were identified: "non-adherence and psychosocial issues," "need for better psychological support," "the role of parents," and "the emotional impact of transition on healthcare professionals." Within these themes, professionals described factors which hindered or promoted an effective transition process. Screening tools which address psychological and social aspects of the lives of young people should be used in routine practice to identify patients requiring psychosocial support and to identify those at risk of non-adherence. All staff involved with transition should be trained in the use of psychosocial screening strategies. The development of a formal referral pathway so that young people can access psychological support in adult services is recommended.

Patients' Perspectives on Early Liver Transplantation in Alcohol-Related Liver Disease.

Liver transplant programs in Canada require a period of 6 months of abstinence from alcohol before considering a patient with liver disease secondary to alcohol for transplantation. Although some studies have demonstrated good outcomes following a transplant in carefully selected patients before the 6‐month abstinence period has been met, there have been arguments against this, including the claim that the public has a general negative perception of those with alcohol dependence. We performed a multicenter cross‐sectional survey to determine the perception of people in British Columbia, Canada, toward liver transplantation in patients with liver disease due to alcohol who have not demonstrated the capacity to remain abstinent from alcohol for 6 months. A total of 304 patient questionnaires were completed, and 83.1% agreed with a period of abstinence of 6 months. In those patients who were unlikely to survive 6 months without a transplant, 34.1% of respondents agreed with, 44.1% did not agree with, and 21.4% were neutral about, early transplantation; 42.8% would have less trust in the process of transplantation if a period of abstinence was not maintained, but relaxing the requirement for an abstinence period would not have an impact on the majority's decision to donate organs. Only 30.5% would support abandoning the abstinence criteria. Conclusion: Among patients followed at general gastroenterology, medicine, or transplant clinics, there is a willingness to relax the criteria in selected patients unlikely to survive without a transplant, although a general consensus remains in support of the existing 6‐month alcohol abstinence rule. A larger scale survey of all provinces in Canada would be required to assess support for such a change in policy.

Organ Procurement and Transplantation in Italy

Organ Procurement and Transplantation in Italy

Medical Contraindications to Transplant Listing in the USA: A Survey of Adult and Pediatric Heart, Kidney, Liver, and Lung Programs.

Listing practices for solid organ transplantation are variable across programs in the USA. To better characterize this variability, we performed a survey of psychosocial listing criteria for pediatric and adult heart, lung, liver, and kidney programs in the USA. In this manuscript, we report our results regarding listing practices with respect to obesity, advanced age, and HIV seropositivity. We performed an online, forced-choice survey of adult and pediatric heart, kidney, liver, and lung transplant programs in the USA. Of 650 programs contacted, 343 submitted complete responses (response rate = 52.8%). Most programs have absolute contraindications to listing for BMI > 45 (adult: 67.5%; pediatric: 88.0%) and age > 80 (adult: 55.4%; pediatric: not relevant). Only 29.5% of adult programs and 25.7% of pediatric programs consider HIV seropositivity an absolute contraindication to listing. We found that there is variation in absolute contraindications to listing in adult programs among organ types for BMI > 45 (heart 89.8%, lung 92.3%, liver 49.1%, kidney 71.9%), age > 80 (heart 83.7%, lung 76.9%, liver 68.4%, kidney 29.2%), and HIV seropositivity (heart 30.6%, lung 59.0%, kidney 16.9%, liver 28.1%). We argue that variability in listing enhances access to transplantation for potential recipients who have the ability to pursue workup at different centers by allowing different programs to have different risk thresholds. Programs should remain independent in listing practices, but because these practices differ, we recommend transparency in listing policies and informing patients of reasons for listing denial and alternative opportunities to seek listing at another program.

Improving clinical outcome using TDM in paediatric liver transplantation

Living-donor liver transplantation is an important component of all liver transplant programs especially in those that care for the pediatric population. Over the last 30 years, innovations in surgical technique have converted living donation from an experimental procedure to a standard of care. Many of these innovations occurred in countries where culturally, deceased donation is limited leaving no alternatives but living donation. The Organ Transplantation Center at the National Center for Child Health and Development (NCCHD) in Tokyo, Japan, was established in 2005 where we have generated some of those innovations and in so doing, have performed living-donor liver transplantation in over 400 children. Here we review the indications, technical details, and outcomes of that cohort.

Graft Risk Index After Liver Transplant: Internal and External Validation of a New Spanish Indicator.

Scarcity of liver grafts has led to the use of marginal donors, consequently increasing the number of complications posttransplant. To prevent this situation, several indicators have been developed. However, important differences remain among countries. Here, we compared an early-risk liver transplant indicator based on the Spanish Liver Transplant Registry, called the Graft Risk Index, versus the US donor risk index and the Eurotransplant donor risk index. The new indicator was based on prospectively collected data from 600 adult liver transplants performed in our center. We considered 2 events to compare the indexes: graft survival and rejection-free graft survival, with Cox proportional regression for analyses. Power to predict graft survival was evaluated by calculating the receiver operating characteristic area under the curve. We found no differences between the US and Eurotransplant donor risk indexes in prediction of patients with and without early graft failure. With regard to early survival, only the Graft Risk Index allowed better survival discrimination, in which survival progressively decreased with values ≥ 3 (with probability of graft survival at 1 month of 68%; 95% confidence interval, 46.2-82.5). This increase in risk was significant compared with the standard group (hazard ratio of 10.15; 95% confidence interval, C 3.91- 26.32; P < .001). We calculated powers of prediction of 0.52 (95% confidence interval, 0.43-0.62), 0.54 (95% confidence interval, 0.45-0.65), and 0.69 (95% confidence interval, 0.61-0.77) for donor risk index, Eurotransplant donor risk index, and early Graft Risk Index, respectively. Neither the US donor risk index nor the Eurotransplant donor risk index was valid for our Spanish liver donation and transplant program. Therefore, an indicator to predict posttransplant graft survival that is adapted to our environment is necessary. This national Graft Risk Index can be a useful tool to optimize donor-recipient matching.

Encuesta a los jefes de Unidad y residentes de Cirugía sobre la accesibilidad y el trabajo en los equipos de trasplante hepático en España

IntroductionThe access of surgeons to liver transplant teams in Spain is heterogeneous. This study aims to portray the current human resources of Spanish transplant teams, distribution of transplant duties among team members, how transplant team members acquire their skills, their leaders’ view of their future, as well the motivations of Spanish General Surgery residents to choose transplantation as their future career choice. MethodsTwo different surveys were created, one for head surgeons and one for residents, about the number of team members and their training, recruitment, organization of tasks and motivation to work in transplantation. The questionnaires were e-mailed to both the transplant program directors and the surgical residents. ResultsThere are on average 8 surgeons in each transplant unit. More than four surgeons perform the hepatectomy in 54.2% of the groups, while the graft implantation is performed by more than 4 surgeons at just 25% of the centers. Forty-two percent of the transplant chiefs advocated a fellowship training system, and 87.5% believe that generational turnover is guaranteed.Out of 525 residents, 101 responded. Regarding training, 12.8% had no interest in transplantation. Concerning their work preferences, 37.6% were not interested in transplantation because it is excessively demanding, and 52.5% would not like to be part of a liver transplant team in the future. ConclusionsThe generational turnover seems to be guaranteed according to liver transplant program directors. The new generations of surgeons generally opt for other areas of surgery other than transplantation. Studies with a greater number of responses are necessary to validate these results

A Summary of Transplantation Activity in Hungary

The first kidney transplantation was performed in Hungary by András Németh in 1962. It was a living donor procedure. After many years of silence, organized cadaveric programs were established in Budapest (1973), Szeged (1979), Debrecen (1991), and Pécs (1993). The heart program was initiated by Professor Zoltán Szabó in 1992 and the liver transplant program by Professor Ferenc Perner in 1993. The pancreas transplantation program was started in Pécs in 1998 by Károly Kalmár-Nagy, followed another in Budapest by Robert Langer in 2004. The lung transplant program was started in cooperation with Vienna in 1996. This fruitful collaboration continues today, even though that the national Hungarian program was established by Ferenc Rényi-Vámos and Professor György Lang in 2015, as it is detailed in this special issue. As a framework, the Hungarian Society of Organ Transplantation was founded in 1997 to give a scientific background for the transplant professionals. The coordination and organ allocation from deceased donors is carried out in collaboration with Eurotransplant. Usually more than 200 potential cadaveric donors are reported yearly, and 168 actual donation after brain death (DBD) donors (17.17 pmp) were utilized in 2018. The multiorgan donor rate was 65.5% among all DBDs in 2018; 505 organs were donated for transplant purposes.To date, more than 10,000 organ transplantations have been performed. The living related kidney transplant program was established in all transplant centers, led by Budapest. In this paper the authors summarize the activity of the Hungarian transplant community and of the Society over the last few decades.

Use of genetic risks in pediatric organ transplantation listing decisions: A national survey.

There is a limited supply of organs for all those who need them for survival. Thus, careful decisions must be made about who is listed for transplant. Studies show that manifesting genetic disease can impact listing eligibility. What has not yet been studied is the impact genetic risks for future disease have on a patient's chance to be listed. Surveys were emailed to 163 pediatric liver, heart, and kidney transplant programs across the United States to elicit views and experiences of key clinicians regarding each program's use of genetic risks (ie, predispositions, positive predictive testing) in listing decisions. Response rate was 42%. Sixty-four percent of programs have required genetic testing for specific indications prior to listing decisions. Sixteen percent have required it without specific indications, suggesting that genetic testing may be used to screen candidates. Six percent have chosen not to list patients with secondary findings or family histories of genetic conditions. In hypothetical scenarios, programs consider cancer predispositions and adult-onset neurological conditions to be relative contraindications to listing (61%, 17%, and 8% depending on scenario), and some consider them absolute contraindications (5% and 3% depending on scenario). Only 3% of programs have formal policies for these scenarios, but all consult genetic specialists at least "sometimes" for results interpretation. Our study reveals that pediatric transplant programs are using future onset genetic risks in listing decisions. As genetic testing is increasingly adopted into pediatric medicine, further study is needed to prevent possible inappropriate use of genetic information from impacting listing eligibility.

C-reactive protein at ICU admission as a marker of early graft dysfunction after liver transplant. A prospective, single-center cohort study.

To explore the behavior of C-reactive protein (CRP) after orthotopic liver transplantation (OLT) during the first postoperative days, and its usefulness as a marker of severe early allograft dysfunction (EAD). A prospective, single-center cohort study was carried out. The Intensive Care Unit (ICU) of a regional hospital with a liver transplant program since 1997. The study comprised a total of 183 patients admitted to our ICU immediately after liver transplantation between 2009 and 2015. C-reactive protein levels upon ICU admission and after 24 and 48h, severe EAD and hospital mortality. The CRP levels after OLT were: upon ICU admission 57.5 (51.6-63.3)mg/L, after 24h 80.1 (72.9-87.3)mg/L and after 48h 69.9 (62.5-77.4)mg/L. Severe EAD patients (14.2%) had higher mortality (23.1 vs 2.5; OR 11.48: 2.98-44.19) and lower CRP upon ICU admission (39.3 [29.8-48.7]mg/L) than the patients without EAD (0.5 [53.9-67.0]; p<0.05] - the best cut-off point being 68mg/L (sensitivity 92.3%; specificity 40.1%; Youden index 0.33). Lower CRP upon ICU admission was correlated to higher mortality (24.5 [9.2-39.7] vs 59.4 [53.4-65.4]; p<0.01, AUC 0.79 [0.65-0.92]). Liver transplant is a strong inflammatory stimulus accompanied by high levels of C-reactive protein. A blunted rise in CRP on the first postoperative day after OLT may be a marker of poor allograft function and is related to hospital mortality.