Successful Liver Transplantation Research Articles

Successful Liver Transplantation in a Patient With Acute COVID-19 Infection and Acute Liver Failure: A Case Report.

Current liver transplantation societies recommend recipients with active coronavirus disease 2019 (COVID-19) be deferred from transplantation for at least 2 wks, have symptom resolution and at least 1 negative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test.1 This approach does not address patients who require urgent transplantation and will otherwise die from liver failure. We report a successful orthotopic liver transplant (OLT) in a patient with active COVID-19 infection. This is only the second to be reported worldwide and the first in Canada.

Estimation of fibrosis and steatosis of liver using electrochemical impedance spectroscopy on a needle: A preliminary result

Preoperative estimation of the liver function is mandatory for safe hepatectomies and successful liver transplantations. Aim of this study is to evaluate the diagnostic and predictive value of electrochemical impedance in estimation of the degree of fibrosis and steatosis of the liver. A specialized electrochemical impedance spectroscopy on a needle (EoN) for measurement of tissue impedance was designed and made in Gwangju Institute of Science and Technology (GIST). The electrical impedances for nine resected liver parenchyma were measured at two different points of each specimens in the frequency range of 100 Hz to 1 Mhz. The electrical impedance were analyzed comparing to pathologic grading of fibrosis and steatosis. The nine specimens were diagnosed with one of fibrosis grade 0, two of fibrosis grade 1, one of fibrosis grade 2, three of fibrosis grade 3, and two of fibrosis grade 4. Of these data, one preoperative portal vein embolization case, and one preoperative chemotheraphy were excluded. The specimens with higher fibrosis grade have shown the significantly higher impedance value. The fibrosis grade was significantly correlated to electrical impedance in all current frequency range (p < 0.001-0.022, R = 0.341-0.753, R2 = 0.1335-0.566). The highest correlation coefficient was observed at the current frequency of 735703 Hz (p < 0.001, R = 0.753, R2 = 0.566). Macrosteatosis was significantly correlated to electrical impedance in the current frequency from 100 to 544 Hz (p < 0.001, R = -0.583, R2 = 0.340). The electrical impedance of liver parenchyma was significantly correlated to fibrosis and steatosis. This study have shown the possibility of preoperative quantification of hepatic fibrosis and steatosis using the electrical impedance spectroscopy on a needle.

Dextroplantation of a reduced left lateral section graft in an infant undergoing living donor liver transplantation

Graft size matching is essential for successful liver transplantation in infant recipients. We present our technique of graft dextroplantation used in an infant who underwent living donor liver transplantation (LDLT) using a reduced left lateral section (LLS) graft. The patient was an 11-month-old 7.8 kg-weighing female infant with hepatoblastoma. She was partially responsive to systemic chemotherapy, thus LDLT was performed to treat the tumor. The living donor was a 34-year-old mother of the patient. After non-anatomical size reduction, the weight of the reduced LLS graft was 235 g, which was 3.0% of the graft-recipient weight ratio. Recipient hepatectomy was performed according to the standard procedures of pediatric LDLT. At the beginning of graft implantation, the graft was temporarily placed at the abdomen to determine the implantation location. The graft portal vein was anastomosed with an interposed external iliac vein homograft. As the liver graft was not too large and it was partially accommodated in the right subphrenic fossa, the abdominal wall wound was primarily closed. The patient recovered uneventfully. An imaging study revealed deep accommodation of the graft within the right subphrenic fossa. The patient has been doing well for 3 months without any vascular complications. Dextroplantation of a reduced LLS graft can be a useful technical option for LDLT in infant patients.

Impact Of Oct Diagnostics In Wilson-Konovalov Disease. Correlation Between Ocular Changes And Severity Of The Disease

Wilson disease is a genetically transmitted disease with severe hepatic, neurological and psychiatric findings. Purpose: The aim of our survey is to show a new method for objective evaluation of the Keiser-Fleisher Ring in the cornea in patients with Wilson-Konovalov disease. Material and method: In our prospective study 7 patients with Wilson disease and decreased levels of ceruloplasmine under 5.2 g/l were enrolled. They were divided into two groups – with initial finding of the disease – 3 patients and with developed clinical picture – 4 patients. Two patients were after successful liver transplantation. The Keiser-Fleisher ring has been evaluated biomicroscopically, with color photography and with anterior segment ОСТ (Rtvue, Optovue, 3D OCT 2000, Topcone). Results: In the first group of patients with initial stage of the disease on biomicroscopy a slight yellow orange ring in the corneal periphery has been spotted in some of the cases. The AS OCT showed a well outlined hyper-reflective band on the level of the Descemet membrane corresponding to the cooper accumulation in the cornea. In the second group of patients with developed disease, this hyper reflective band was larger with more than 60 mc in comparison to the previous group. In patients after liver transplantation disappearance of the ring and cooper accumulation was observed. The ring vanished form the periphery to the center. Conclusion: Wilson disease is always suspected in cases of undiagnosed liver dysfunction. Its confirmation however, is in many cases subjective and connected with the detection of Keiser-Fleisher Ring. The proposed method with anterior segment OCT is noninvasive, repeatable and can objectively show the presence or absence of cooper depositions in the cornea. OCT diagnostics might be useful also in the follow up of these patients after liver transplantation.

Utilization of a Reduced Graft from a Severely Traumatized Liver: A Case Report and Strategy to Increase Availability of Livers for Transplant

Background: Trauma victims with liver lacerations in the hilum are typically excluded from liver donation. We report a case of a successful liver transplant from a deceased donor with a grade 4 hilar liver laceration. Case Presentation: We used a liver with a high-grade laceration from a 28-year-old brain-dead traffic accident victim. The liver had grade IV lacerations in the right and caudate lobes. In situ split liver technique was applied to control the lacerations after an intraoperative cholangiogram revealed favourable anatomy. The left hemi-liver graft was procured, retaining the entire vena cava and the full length of the main hepatic vasculature. The recipient was a 62-year-old female patient with end-stage liver disease, with a Model for End-Stage Liver Disease-Sodium score of 19. The left lobe graft was transplanted using the standard piggy-back technique. The patient was discharged on postoperative day 7 after an uneventful recovery. At two-month follow-up, she continues to do well, with normal hepatic function and unremarkable imaging studies. Conclusion: This is the first reported case of a successful liver transplant of a severely lacerated liver made possible by the application of split liver techniques. In situ splitting of a severely traumatized liver could permit the utilization of a reduced graft for small recipients.

A novel microRNA-based prognostic model outperforms standard prognostic models in patients with acetaminophen-induced acute liver failure

Acetaminophen (APAP)-induced acute liver failure (ALF) remains the most common cause of ALF in the Western world. Conventional prognostic models, utilising markers of liver injury and organ failure, lack sensitivity for mortality prediction. We previously identified a microRNA signature that is associated with successful regeneration post-auxiliary liver transplant and with recovery from APAP-ALF. Herein, we aimed to use this microRNA signature to develop outcome prediction models for APAP-ALF. We undertook a nested, case-control study using serum samples from 194 patients with APAP-ALF enrolled in the US ALF Study Group registry (1998-2014) at early (day 1-2) and late (day 3-5) time-points. A microRNA qPCR panel of 22 microRNAs was utilised to assess microRNA expression at both time-points. Multiple logistic regression was used to develop models which were compared to conventional prognostic models using the DeLong method. Individual microRNAs confer limited prognostic value when utilised in isolation. However, incorporating them within microRNA-based outcome prediction models increases their clinical utility. Our early time-point model (AUC= 0.78, 95% CI 0.71-0.84) contained a microRNA signature associated with liver regeneration and our late time-point model (AUC= 0.83, 95% CI 0.76-0.89) contained a microRNA signature associated with cell-death. Both models were enhanced when combined with model for end-stage liver disease (MELD) score and vasopressor use and both outperformed the King's College criteria. The early time-point model combined with clinical parameters outperformed the ALF Study Group prognostic index and the MELD score. Our findings demonstrate that a regeneration-linked microRNA signature combined with readily available clinical parameters can outperform existing prognostic models for ALF in identifying patients with poor prognosis who may benefit from transplantation. While acute liver failure can be reversible, some patients will die without a liver transplant. We show that blood test markers that measure the potential for liver recovery may help improve identification of patients unlikely to survive acute liver failure who may benefit from a liver transplant.

EP030 - Successful liver transplantation in an adult patient with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE)

eP030 - Successful liver transplantation in an adult patient with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE)

Successful auxiliary two-staged partial resection liver transplantation (ASPIRE-LTx) for end-stage liver disease to avoid small-for-size situations

BackgroundRisks for living-liver donors are lower in case of a left liver donation, however, due to lower graft volume, the risk for small-for-size situations in the recipients increases. This study aims to prevent small-for-size situations in recipients using an auxiliary two-staged partial resection liver transplantation (LTX) of living-donated left liver lobes.Case presentationTwo patients received a two-stage auxiliary LTX using living-donated left liver lobes after left lateral liver resection. The native extended right liver was removed in a second operation after sufficient hypertrophy of the left liver graft had occurred. Neither donor developed postoperative complications. In both recipients, the graft volume increased by an average of 105% (329 ml to 641 ml), from a graft-to-body-weight ratio of 0.54 to 1.08 within 11 days after LTX, so that the remnant native right liver could be removed. No recipient developed small-for-size syndrome; graft function and overall condition is good in both recipients after a follow-up time of 25 months.ConclusionsAuxiliary two-staged partial resection LTX using living-donor left lobes is technically feasible and can prevent small-for-size situation. This new technique can expand the potential living-donor pool and contributes to increase donor safety.

Full-split liver transplantation. The first experience in Russian Federation

Aim. To present the first successful full-split liver transplantation for two adults recipients in Russia.Materials and methods. The first successful full-split liver transplantation for two adults in ex situ way in Russia was made on 26th of September 2014 in the Burnasyan Federal Medical Biophysical Center of FMBA. The deceased donor was inside UNOS, Lee. The GRWR index in both recipients was near 1. The first recipient had been in a waiting list for 1 year, the second for 4 months. Both recipients had got liver cirrhosis in terminal stage.Results. The surgical procedure length was 650 and 660 min. The overall time of cold ischemia was 510 min. We observed a primary function of each graft. ISGLS B and Clavien-Dindo 3A biliary leak complications were observed in both recipients. Both patients were discharged after 33 and 34 days. Overall survival for this moment is 68 months.Conclusion. Full-split liver transplantation for two adults in ex situ way seems to be a complicated procedure both from the technical and organizing points of view. It demanding good mastership and coordination between surgical team members. At the same time, that treatment method has to be spread widely to improve treatment of patients with end-stage cirrhosis results.

Post–Covid-19 Cholangiopathy—A New Indication for Liver Transplantation: A Case Report

Liver injury is one of the nonpulmonary manifestations described in coronavirus disease 2019 (COVID-19). Post–COVID-19 cholangiopathy is a special entity of liver injury that has been suggested as a variant of secondary sclerosing cholangitis in critically ill patients (SSC-CIP). In the general population, the outcome of SSC-CIP has been reported to be poor without orthotopic liver transplantation (OLT). However, the role of OLT for post–COVID-19 cholangiopathy is unknown. We present a case report of a 47-year-old man who recovered from acute respiratory distress syndrome from COVID-19 and subsequently developed end-stage liver disease from post–COVID-19 cholangiopathy. The patient underwent OLT and is doing well with normal liver tests for 7 months. To our knowledge, this is the first case report of a patient who underwent successful liver transplantation for post–COVID-19 cholangiopathy.

Hepatic Artery Reconstruction in Living Donor Liver Transplantation With the Radial Artery Interpositional Graft

IntroductionReconstitution of hepatic artery inflow is essential for a successful liver transplantation. Living donor transplantation presents additional challenges in the form of a short and small donor vessel stump, exacerbating the poor surgical access for microsurgery. Few reports have described the use of the radial artery as an interposition graft in liver transplantation; we present a series of 6 cases and discuss the technical merits of this procedure. MethodsRetrospective review of consecutive patients undergoing living donor liver transplantation from December 2015 to December 2019 was performed. Demographics, operative details, and postoperative outcomes were reviewed. ResultsTwenty-two patients underwent living donor liver transplantation. Radial artery interposition grafting was used in 6 cases, including 1 salvage case for hepatic artery thrombosis. One patient developed hepatic artery stenosis (2 weeks postoperatively) that was conservatively managed. After radial artery grafting, all patients had normal resistive indices on duplex ultrasonography at up to 20 months postoperatively. The mean follow-up was 15.2 months. ConclusionWhen faced with a significantly short vessel stump or caliber mismatch, radial artery interpositional grafting is a safe and useful technique for reducing tension and overcoming vessel size mismatch in hepatic artery reconstruction.

Liver Transplantation for Glycogen Storage Disease Type IV.

Glycogen storage disease type IV (GSD IV) is a rare autosomal recessive disorder caused by glycogen–branching enzyme (GBE) deficiency, leading to accumulation of amylopectin–like glycogen that may damage affected tissues. The clinical manifestations of GSD IV are heterogeneous; one of which is the classic manifestation of progressive hepatic fibrosis. There is no specific treatment available for GSD IV. Currently, liver transplantation is an option. It is crucial to evaluate long–term outcomes of liver transplantation. We reviewed the published literature for GSD IV patients undergoing liver transplantation. To date, some successful liver transplantations have increased the quantity and quality of life in patients. Although the extrahepatic manifestations of GSD IV may still progress after transplantation, especially cardiomyopathy. Patients with cardiac involvement are candidates for cardiac transplantation. Liver transplantation remains the only effective therapeutic option for treatment of GSD IV. However, liver transplantation may not alter the extrahepatic progression of GSD IV. Patients should be carefully assessed before liver transplantation.

Wilson’s Disease with Hepatogenous Diabetes: A Case Report

Introduction: Wilson’s disease (WD) is a hereditary autosomal recessive disorder caused by pathogenic variants within the ATP7B gene. Early diagnosis of WD is important but it can be difficult in pediatric clinical practice because of varied presentations. Fortunately, with the development of genetic testing, molecular analysis of the ATP7B gene is helpful in the early diagnosis of WD. Hepatogenous diabetes (HD) is defined as a state of impaired glucose regulation caused by chronic liver disease. Here we report a child with WD with HD. Case Presentation: A 4-year-old girl was admitted to our hospital with diarrhea for two months. On admission, urine glucose was 4+, fasting glucose was 2.6 mmol/L, and postprandial blood glucose was 7.2 mmol/L. Further clinical manifestations and laboratory tests showed coagulation dysfunction, hemolytic anemia, and cirrhosis. After admission, she developed hepatic encephalopathy. Significant abnormal glucose metabolism was later detected, but by then, hypoglycemic convulsions had taken place. The final diagnosis of WD was confirmed by detection of mutations in the ATP7B gene. Genetic sequencing revealed compound heterozygous mutations in ATP7B, including c.2975C&gt;T, p.Pro992Leu and c.3809A&gt;G, p.Asn1270Ser. On day 40 of admission, the patient underwent successful orthotopic liver transplantation. Her liver function, blood glucose levels, and coagulation test results returned to normal one month after the liver transplantation. The symptom of diarrhea was also relieved after surgery. Her abnormal glucose level in hospital was considered to be HD. Conclusions: Blood glucose levels must be carefully monitored in Wilson’s disease. Moreover, genetic sequencing provides an accurate and minimally invasive diagnostic tool for WD.

Splenic Artery Transposition for Liver Transplantation: An Underutilized Technique?

Background.Successful liver transplantation is dependent on restoration of hepatic arterial (HA) flow. Although uncommon, some native recipient HAs are not suitable or inadequate for anastomosis, thereby necessitating extra-anatomic HA reconstruction. Splenic artery transposition (SAT) is 1 method of HA reconstruction, in which the recipient splenic artery is transposed to reestablish perfusion of the donor liver. Due to the rarity of the technique, literature describing outcomes is limited. In the current report, we describe 3 patients (2 adults, 1 pediatric) who underwent complex upper abdominal surgery before whole-organ deceased donor liver transplantation with SAT.Methods.The demographic and patient care information was collected prospectively and subsequently reviewed retrospectively. Given the de-identified nature of the data included, this study was exempt from approval from an ethics board.Results.Recipient splenic arteries were dissected from their origin at the celiac trunk, for approximately 3–5 cm to ensure a gentle anterior-cranial curve toward the right upper quadrant, allowing anastomosis to the donor celiac trunk in an end-to-end fashion. Postoperatively, all 3 patients had rapid normalization of liver function tests and brisk HA flow demonstrated by Doppler ultrasound. Longer-term follow-up, ranging from 1 to 3 years, reveals continued patency of the reconstructed HAs and liver function tests within normal limits.Conclusions.Our experience points to SAT as a safe and effective technique for extra-anatomic HA reconstruction.

Трансплантация донорской печени при циррозе печени: опыт работы Федерального Cибирского научно-клинического центра

Prevalence and mortality in terminal stages of diffuse liver diseases amount to 60 %. Foremost, liver transplantation is required by hepatic cirrhosis patients with life expectancy below one year or low quality of life conditioned by the disease. Over the past decade, it has become apparent that only orthotropic liver transplantation is a radical, eff ective and life-saving treatment for hepatic cirrhosis patients. Th is article reports our own results of operative treatment provided for 13 patients using orthotropic liver transplantation advised in relation to diff erent reasons. Th e patients underwent surgery at the surgical department of the Federal Siberian Research Clinical Centre under FMBA of Russia. The earliest outcomes observed during the postoperative period and the structure of complications have been analysed. A clinical case of successful orthotropic liver transplantation is presented. It is postulated that development of this fi eld leads to correction of indications to transplantation and the number of absolute contraindications decreases. Consequently, a possible increase in the number of patients advised to undergo transplantation is to be expected.

Acute fatty liver of pregnancy leading to a delayed hepatic failure necessitating liver transplantation: A case report

Acute fatty liver of pregnancy (AFLP) is a potentially fatal metabolic disorder in pregnant patients that requires urgent delivery and aggressive medical and aesthetic management of maternal complications associated with acute liver failure. A 41-year-old female (79 kg) G1P0 at 31 weeks gestation presented with nausea, vomiting, pruritus, and jaundice. A diagnosis of severe liver dysfunction secondary to AFLP was made. We proceeded with urgent delivery under general anaesthesia. The patient had an uncomplicated caesarean section and gave birth to female infant with Apgar scores of 7 and 8. The patient remained stable for the following 2 weeks, however, given the lack of further recovery of hepatic function, a transjugular liver biopsy was performed, revealing persistent AFLP. She received N-acetylcysteine infusion and 4 cycles of plasma exchange with no improvement. Over the next few days her mental status worsened and her liver functions further deteriorated. She was listed for a deceased liver donor transplant and underwent successful orthotopic liver transplantation. She was discharged on post-operative day (POD) 14 of liver transplant.

Medicines management in adult patients undergoing liver transplantation

Since the first successful human liver transplant was performed by surgeon Thomas Starzl in 1967, liver transplantation (LT) has evolved to become a life-saving treatment​[1]​. The service is currently provided by seven adult and three paediatric centres in the UK. Waiting times are around four months; although, as demand continues to exceed supply of grafts, […]

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.

Introducing EL-FIT (Exercise and Liver FITness): A Smartphone App to Prehabilitate and Monitor Liver Transplant Candidates.

Preserved physical function is key for successful liver transplantation (LT); however, prehabilitation strategies are underdeveloped. We created a smartphone application (app), EL-FIT (Exercise and Liver FITness), to facilitate exercise training in end-stage liver disease (ESLD). In this feasibility study, we tested EL-FIT app usage and the accuracy of physical activity data transfer and obtained feedback from initial users. A total of 28 participants used the EL-FIT app and wore a physical activity tracker for 38±12days (age, 60±8years; 57% males; Model for End-Stage Liver Disease-sodium, 19±5). There was fidelity in data transfer from the tracker to the EL-FIT app. Participants were sedentary (1957 [interquartile range, 873-4643] steps/day) at baseline. Level of training assigned by the EL-FIT app agreed with that from a physical therapist in 89% of cases. Participants interacted with all app features (videos, perceived exertion, and gamification/motivational features). We rearranged training data to generate heart rate-validated steps as a marker of performance and showed that 35% of the participants had significant increases in their physical performance. Participants emphasized their interest in having choices to better engage in exercise, and they appreciated the sense of community the EL-FIT app generated. We showed that patients with ESLD are able to use and interact with the EL-FIT app. This novel smartphone app has the potential of becoming an invaluable tool for home-based prehabilitation in LT candidates.

Successful liver transplantation in hyperornithinemia‐hyperammonemia‐homocitrullinuria syndrome: Case report

HHH syndrome is a rare autosomal recessive disorder of the urea cycle, caused by a deficient mitochondrial ornithine transporter. We report the first successful liver transplantation in HHH syndrome performed in a seven-year-old boy. The patient presented at 4weeks of age with hyperammonemic coma. The plasma amino acid profile was suggestive of HHH syndrome, and the diagnosis was confirmed when sequencing of the SLC25A15 gene identified two mutations p.R275Q and p.A76D. Although immediate intervention resulted in normalization of plasma ammonia levels within 24hours, he developed cerebral edema, coma, convulsions, and subsequent neurological sequelae. Metabolic control was difficult requiring severe protein restriction and continued treatment with sodium benzoate and L-arginine. Despite substantial developmental delay, he was referred to our center for liver transplantation because of poor metabolic control. Following cadaveric split liver transplantation, there was complete normalization of his plasma ammonia and plasma amino acid levels under a normal protein-containing diet. This excellent metabolic control was associated with a markedly improved general condition, mood and behavior, and small developmental achievements. Twelve years after liver transplantation, the patient has a stable cognitive impairment without progression of spastic diplegia. This first case of liver transplantation in HHH syndrome demonstrates that this procedure is a therapeutic option for HHH patients with difficult metabolic control.