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Machine perfusion and the prevention of ischemic type biliary lesions following liver transplant:What is the evidence?

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World Journal of Gastroenterology 2023年第20期29卷 3066-3083页

作者： Manuel Durán Rafael Calleja Angus Hann George Clarke Ruben Ciria Anisa Nutu Rebeca Sanabria-Mateos María Dolores Ayllón Pedro López-Cillero Hynek Mergental Javier Briceño M Thamara P R Perera Department of liver transplantation Reina Sofía University HospitalCórdoba 14004Spain The liver Unit Queen Elizabeth Hospital BirminghamBirmingham B152THUnited Kingdom Centre for liver and Gastrointestinal Research Institute of Immunology and ImmunotherapyUniversity of BirminghamBirmingham B152THUnited Kingdom

The widespread uptake of different machine perfusion(MP)strategies for liver transplant has been driven by an effort to minimize graft *** to the cholangiocytes during the liver donation,preservation,or early posttransplant period may result in stricturing of the biliary tree and inadequate biliary *** problem continues to trouble clinicians,and may have catastrophic consequences for the graft and *** injury,as a result of compromised hepatic artery flow,is a well-known cause of biliary strictures,sepsis,and graft ***,very similar lesions can appear with a patent hepatic artery and these are known as ischemic type biliary lesions(ITBL)that are attributed to microcirculatory dysfunction rather than main hepatic arterial *** the warm and cold ischemic period duration appear to influence the onset of *** of the commonly used MP techniques deliver oxygen to the graft cells,and therefore may minimize the cholangiocyte injury and subsequently reduce the incidence of *** clinical experience and published evidence grows for these modalities,the impact they have on ITBL rates is important to *** this review,the evidence for the three commonly used MP strategies(abdominal normothermic regional perfusion[A-NRP],hypothermic oxygenated perfusion[HOPE],and normothermic machine perfusion[NMP])for ITBL prevention has been critically *** with ITBL definitions used in trials,coupled with variations in techniques of MP,make interpretation ***,the evidence suggests that both HOPE and A-NRP prevent ITBL in donated after circulatory death grafts compared to cold *** evidence for ITBL prevention in donor after brain death grafts with any MP technique is weak.

关键词： liver transplant Ischemic type biliary lesions Hypothermic oxygenated machine perfusion Normothermic machine perfusion Abdominal normothermic regional perfusion Donation after circulatory death

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Treatment modalities for hypersplenism in liver transplant recipients with recurrent hepatitis C

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World Journal of Gastroenterology 2009年第40期15卷 5010-5013页

作者： Lena Sibulesky Justin H Nguyen Ricardo Paz-Fumagalli C Burcin Taner Rolland C Dickson Division of transplant Surgery and transplant Hepatology Division of Interventional Radiology

Hepatitis C is the most common indication for orthotopic liver transplantation in the United States. Unfortunately, hepatitis C recurs universally in the transplanted liver and is the major cause of decreased graft and patient survival. The combination therapy of interferon and ribavirin has been shown to be the most effective therapy for recurrent hepatitis C. However, pre-and post-transplant hypersplenism often precludes patients from receiving the antiviral therapy. Splenectomy and partial splenic embolization are the two invasive modalities that can correct the cytopenia associated with hypersplenism. In this report we review the two treatment options, their associated outcomes and complications.

关键词： Hypersplenism Leukopenia Recurrenthepatitis C Thrombocytopenia liver transplant

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A case of biliary stones and anastomotic biliary stricture after liver transplant treated with the rendez-vous technique and electrokinetic lithotritor

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World Journal of Gastroenterology 2008年第18期14卷 2920-2923页

作者： Marta Di Pisa Mario Traina Roberto Miraglia Luigi Maruzzelli Riccardo Volpes Salvatore Piazza Angelo Luca Bruno Gridelli Department of Gastroenterology IsMeTT UPMC Via Tricomi Palermo 90100 Italy Department of Radiology IsMeTT UPMC Via Tricomi 1 Palermo 90100 Italy Department of Hepatology IsMeTT UPMC Palermo 90100 Italy Civico Hospital Via Tricomi Palermo 90100 Italy Department of Radiology IsMeTT UPMC Palermo 90100 Italy Department of Surgery IsMeTT UPMC Palermo 90100 Italy

The paper studies the combined radiologic and endoscopic approach (rendez vous technique) to the treatment of the biliary complications following liver transplant. The "rendez-vous" technique was used with an electrokinetic lithotripter, in the treatment of a biliary anastomotic stricture with multiple biliary stones in a patient who underwent orthotopic liver transplant. In this patient, endoscopic or percutaneous transhepatic management of the biliary complication failed. The combined approach, percutaneous transhepatic and endoscopic treatment (rendez-vous technique) with the use of an electrokinetic lithotritor, was used to solve the biliary stenosis and to remove the stones. Technical success, defined as disappearance of the biliary stenosis and stone removal, was obtained in just one session, which definitively solved the complications. The combined approach of percutaneous transhepatic and endoscopic (rendez-vous technique) treatment, in association with an electrokinetic lithotritor, is a safe and feasible alternative treatment, especially after the failure of endoscopic and/or percutaneous trans-hepatic isolated procedures.

关键词： Biliary complications liver transplant Endoscopic retrograde cholangiopancreatography Percutaneous TranshepatJc Cholangiography Percutaneous libhot^ipsy

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Clinical application of COVID-19 vaccine in liver transplant recipients

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Hepatobiliary & Pancreatic Diseases International 2024年第4期23卷 339-343页

作者： Feng-Chao Liu Man Xie Wei Rao Division of Hepatology Liver Disease CenterThe Affiliated Hospital of Qingdao UniversityQingdao 266000China Organ transplantation Center The Affiliated Hospital of Qingdao UniversityQingdao 266000China Institute of Organ Donation and transplantation of Qingdao University Qingdao 266000China Department of Gastroenterology The Affiliated Hospital of Qingdao UniversityQingdao 266000China

Background:Solid organ transplant(SOT)activities,such as liver transplant,have been greatly influenced by the pandemic of coronavirus disease 2019(COVID-19),a disease caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).Immunosuppressed individuals of liver transplant recipients(LTRs)tend to have a high risk of COVID-19 infection and related ***,COVID-19 vaccination has been recommended to be administered as early as possible in *** sources:The keywords“liver transplant”,“SARS-CoV-2”,and“vaccine”were used to retrieve articles published in ***:The antibody response following the 1st and 2nd doses of vaccination was disappointingly low,and the immune responses among LTRs remarkably improved after the 3rd or 4th dose of *** the 3rd or 4th dose of COVID-19 vaccine increased the antibody titer,a proportion of patients remained ***,recent studies showed that SARS-CoV-2 vaccine could trigger adverse events in LTRs,including allograft rejection and liver ***:This review provides the recently reported data on the antibody response of LTRs following various doses of vaccine,risk factors for poor serological response and adverse events after vaccination.

关键词： liver transplant COVID-19 SARS-CoV-2 Vaccine Antibody response

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Effect of Hepatitis C Treatment on Renal Function in liver transplant Patients

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Journal of Clinical and Translational Hepatology 2018年第4期6卷 391-395页

作者： Mohamed Shoreibah John Romano Ornar T.Sims Yuqi Guo DeAnn Jones Krishna Venkata Vishnu Kommineni Jordan Orr Paul Fitzmorris Omar I.Massoud Division of Gastroenterology&Hepatology School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA Department of Internal Medicine School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA Department of Social Work College of Arts and SciencesUniversity of Alabama at BirminghamBirminghamALUSA Department of Health Behavior School of Public HealthUniversity of Alabama at BirminghamBirminghamALUSA Center for AIDS Research School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA School of Social Work University of AlabamaTuscaloosaALUSA Department of Pharmacology University of Alabama at BirminghamBirminghamALUSA Division of Gastroenterology and Hepatology Department of MedicineVanderbilt UniversityNashvilleTNUSA

Background andAims:Hepatitis C Virus(HCV)is uniformly recurrent after liver transplant(LT)and recurrence is associated with an increased risk of *** medications increase the risk of chronic kidney disease,and the presence of chronic kidney disease presents a challenge for HCV treatment in LT *** aim of this study was to assess changes in glomerular filtration rates(GFRs)of LT recipients receiving HCV ***:This is a retrospective study of LT patients who received HCV treatment between 2015 and 2016(n=60).The outcomes of interest were differences in serum creatinine levels and in GFR,measured at treatment initiation and at 24 weeks after *** average age of the patients was 59 years-old,and 17%were cirrhotic and 67%were *** patients received sofosbuvir/ledipasvir without ***:All patients achieved sustained virologic response at 12 weeks after treatment(SVR12).At baseline,55%of patients had GFR60 mL/min per 1.73 *** those patients,GFR did not change in 81%,and 19%had worsened *** the entire cohort,65%of patients had improved or stable GFR and 35%had worsened *** average change in serum creatinine between baseline and 24 weeks was 0.10(p=0.18).Conclusions:This study showed improved or unchanged GFR in 65%and worsened GFR in 35%of LT recipients who achieved *** of GFR was more frequently encountered in those with impaired renal function at *** should be used when treating HCV in LT recipients,especially those with baseline status of renal impairment.

关键词： Hepatitis C Renal function Direct-acting antivirals liver transplant Treatment

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De novo autoimmune hepatitis in liver transplant: State-of-the-art review

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World Journal of Gastroenterology 2016年第10期22卷 2906-2914页

作者： Ranka Vukotic Giovanni Vitale Antonia D'Errico-Grigioni Luigi Muratori Pietro Andreone Dipartimento di Scienze Mediche e Chirurgiche Università di BolognaPoliclinico Sant’Orsola-Malpighi Dipartimento di Medicina Specialistica Diagnostica e SperimentaleUniversità di Bologna"F.Addarii" Institute of Oncology and Transplantation PathologyPoliclinico Sant’Orsola-Malpighi

In the two past decades, a number of communications, case-control studies, and retrospective reports have appeared in the literature with concerns about the development of a complex set of clinical, laboratory and histological characteristics of a liver graft dysfunction that is compatible with autoimmune hepatitis. The de novo prefix was added to distinguish this entity from a pre-transplant primary autoimmune hepatitis, but the globally accepted criteria for the diagnosis of autoimmune hepatitis have been adopted in the diagnostic algorithm. Indeed, de novo autoimmune hepatitis is characterized by the typical liver necroinflammation that is rich in plasma cells, the presence of interface hepatitis and the consequent laboratory findings of elevations in liver enzymes, increases in serum gamma globulin and the appearance of nonorgan specific auto-antibodies. Still, the overall features of de novo autoimmune hepatitis appear not to be attributable to a univocal patho-physiological pathway because they can develop in the patients who have undergone liver transplantation due to different etiologies. Specifically, in subjects with hepatitis C virus recurrence, an interferon-containing antiviral treatment has been indicated as a potential inception of immune system derangement. Herein, we attempt to review the currently available knowledge about de novo liver autoimmunity and its clinical management.

关键词： De novo autoimmune hepatitis Plasma-cell hepatitis liver transplant Hepatitis C virus recurrence Antiviral therapy Autoimmunity Differential diagnosis

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Recurrent hepatitis C after liver transplant

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World Journal of Gastroenterology 2014年第31期20卷 10668-10681页

作者： Andrew S deLemos Paul A Schmeltzer Mark W Russo Department of Medicine Center for Liver Diseases and Transplantation Carolinas Medical Center

End stage liver disease from hepatitis C is the most common indication for liver transplantation in many parts of the world accounting for up to 40% of liver transplants. Antiviral therapy either before or after liver transplantation is challenging due to side effects and lower efficacy in patients with cirrhosis and liver transplant recipients, as well as from drug interactions with immunosuppressants. Factors that may affect recurrent hepatitis C include donor age, immunosuppression, IL28 B genotype, cytomegalovirus infection, and metabolic syndrome. Older donor age has persistently been shown to have the greatest impact on recurrent hepatitis C. After liver transplantation, distinguishing recurrent hepatitis C from acute cellular rejection may be difficult, although the development of molecular markers may help in making the correct diagnosis. The advent of interferon free regimens with direct acting antiviral agents that include NS3/4A protease inhibitors, NS5 B polymerase inhibitors and NS5 A inhibitors holds great promise in improving outcomes for liver transplant candidates and recipients.

关键词： Hepatitis C liver transplant Donor risk factors Immunosuppression Protease inhibitors Fibrosing cholestatic hepatitis C Acute cellular rejection Cytomegalovirus

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Elimination of Hepatitis C in liver transplant Recipients

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Journal of Clinical and Translational Hepatology 2018年第3期6卷 247-250页

作者： Sammy Saab Youssef Challita Phillip H.Chen Melissa A.Jimenez Alex D.Lee Elena G.Saab Timothy Ahn Gina Choi Francisco A.Durazo Mohamed M.El-Kabany Steven-Huy B.Han Jonathan Grotts Vatche G.Agopian Ronald W.Busuttil Department of Medicine University of California at Los AngelesLos AngelesCaliforniaUSA Department of Surgery at the University of California at Los Angeles Los AngelesCaliforniaUSA

Background and Aims:Recurrent hepatitis C(HCV)disease in liver transplant(LT)recipients is associated with significant morbidity and *** the availability of noninterferon-based therapy,eliminating HCV may be achievable in LT ***:We studied all consecutive recipients who underwent LT at the University of California Los Angeles be-tween January 2005 and June *** collected data on date of transplant and last follow-up,as well as laboratory *** also recorded type and timing of antiviral therapy relative to *** were performed to assess the proportion of LT recipi-ents who are viremic after ***:Six hundred thirty-four patients underwent LTwith a diagnosis of *** was a statistically significant trend for patients to be cured be-fore(pliver transplantation(ptransplant for the study periods 2005 to 2013 and 2014 to 2016,*** was a significant decrease between the two study periods in the proportion of patients undergoing re-LT 1 year after the original LT:5.5%(n=28/510)and 1.5%(n=2/124)respec-tively for study periods 2005 to 2013 and 2014 to 2016 respec-tively(p=0.011).Conclusions:The proportion of LTrecipients who are viremic has decreased over *** HCV in LT recipients is feasible after the introduction of direct-acting *** HCV should translate to improved clinical out-comes in LT recipients who were transplanted for HCV infection with longer *** results suggest the de-creased need for transplant in the direct-acting agents era.

关键词： Hepatitis C Direct-acting agents liver transplant Elimination

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COVID-19 in liver transplant Recipients-A Series with Successful Recovery

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Journal of Clinical and Translational Hepatology 2020年第4期8卷 467-473页

作者： Ashok Choudhury Golamari Srinivasa Reddy Shantan Venishetty Viniyendra Pamecha Saggere Muralikrishna Shasthry Arvind Tomar Lalita Gauri Mitra Venkata Siva Tez Prasad Rajendra Prasad Mathur Debajyoti Bhattacharya Shiv Kumar Sarin Department of Hepatology and liver transplant Institute of Liver and Biliary SciencesNew DelhiIndia Department of HPB Surgery and liver transplant Institute of Liver and Biliary SciencesNew DelhiIndia Department of Pulmonary Medicine Institute of Liver and Biliary SciencesNew DelhiIndia Department of Critical Care Medicine Institute of Liver and Biliary SciencesNew DelhiIndia Department of Nephrology Institute of Liver and Biliary SciencesNew DelhiIndia

The severe acute respiratory syndrome corona virus-2 (referred to as SARS-CoV-2) pandemic had a great impact on public life in general as well as on populations with pre-existing disease and co-morbidities. liver transplant and immunosuppressant medication predisposes to more severe disease and is often associated with poor outcome. The clinical features, disease course, treatment and process of modulating the immunosuppression is challenging. Here, we describe the clinical presentation, treatment and outcomes in six liver transplant recipients. Out of those six patients, three had mild, one had moderate and one had severe COVID-19, and one was asymptomatic. The immunosup-pression minimization or withdrawal was done based upon the clinical severity. Consideration of tocilizumab and/or convalescent plasma as well as antivirals i.e. remdesvir done in severe cases. The routine practice of prophylactic anti-coagulation, consideration of repurposed drugs (i.e. teico-planin and doxycycline), and watchful monitoring of asymptomatic recipients helped to achieve an uneventful recovery.

关键词： liver transplant COVID-19 SARS-CoV-2 liver injury Remdesivir Convalescent plasma

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Immune thrombocytopenic purpura induced by intestinal tuberculosis in a liver transplant recipient

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World Journal of Gastroenterology 2014年第25期20卷 8304-8308页

作者： Renata dos Santos Lugao Marina Pamponet Motta Matheus Freitas Cardoso de Azevedo Roque Gabriel Rezende de Lima Flávia de Azevedo Abrantes Edson Abdala Flair José Carrilho Daniel Ferraz de Campos Mazo Hepatology Branch Clinical DivisionDepartment of GastroenterologyUniversity of S?o Paulo School of Medicine S?o Paulo 05403-000Brazil liver and Gastrointestinal transplant Division Department of GastroenterologyUniversity of S?o Paulo School of MedicineS?o Paulo 05403-000 Brazil Department of Infectious and Parasitic Diseases University of S?o Paulo School of Medicine S?o Paulo 05403-000 Brazil

A variety of clinical manifestations are associated directly or indirectly with tuberculosis. Among them, haematological abnormalities can be found in both the pulmonary and extrapulmonary forms of the disease. We report a case of immune thrombocytopenic purpura(ITP) associated with intestinal tuberculosis in a liver transplant recipient. The initial management of thrombocytopenia, with steroids and intravenous immunoglobulin, was not successful, and the lack oftuberculosis symptoms hampered a proper diagnostic evaluation. After the diagnosis of intestinal tuberculosis and the initiation of specific treatment, a progressive increase in the platelet count was observed. The mechanism of ITP associated with tuberculosis has not yet been well elucidated, but this condition should be considered in cases of ITP that are unresponsive to steroids and intravenous immunoglobulin, especially in immunocompromised patients and those from endemic areas.

关键词： Immune thrombocytopenic purpura Tuberculosis liver transplant Thrombocytopenia Intestinal tuberculosis

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