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Yoon J, Kim H, Choi D, Park B. Causes of death and associated factors with death after liver transplantation: a nationwide database study. HPB (Oxford) 2024; 26:54-62. [PMID: 37775353 DOI: 10.1016/j.hpb.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND/AIMS This study investigated overall, 1-year, and 5-year mortality rate, the causes of death, and associated factors with death in liver transplantation recipients. METHODS A total of 11,590 liver transplant recipients identified from National Health Insurance Service database between 2006 and 2017 were included. Factors associated with all-cause of death were analyzed by Cox proportional regression models. Cumulative mortality rate according to the underlying indication was estimated by Kaplan-Meier method. RESULTS The 12-year survival rate for all liver transplant recipients was 68%. In the overall, 1-year, and 5-year mortality of liver transplant recipients, hepatic death was the highest contributing risk, accounting for >65% of the causes of death. Deaths from cirrhosis and liver failure accounted for a high proportion of deaths within 1 year after transplantation, and deaths from malignant tumors such as hepatocellular carcinoma were high among late-stage deaths. DISCUSSION Although the most common cause of death from liver transplantation is due to primary disease, there was a difference in the pattern of major causes of death according to the period from transplantation to death. If appropriate medical intervention is performed at each period after transplantation, the survival rate can be improved.
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Affiliation(s)
- Junghyun Yoon
- Department of Preventive Medicine, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Hanjoon Kim
- Department of Surgery, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Dongho Choi
- Department of Surgery, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Boyoung Park
- Department of Preventive Medicine, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
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2
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Sawinski D, Lai JC, Pinney S, Gray AL, Jackson AM, Stewart D, Levine DJ, Locke JE, Pomposelli JJ, Hartwig MG, Hall SA, Dadhania DM, Cogswell R, Perez RV, Schold JD, Turgeon NA, Kobashigawa J, Kukreja J, Magee JC, Friedewald J, Gill JS, Loor G, Heimbach JK, Verna EC, Walsh MN, Terrault N, Testa G, Diamond JM, Reese PP, Brown K, Orloff S, Farr MA, Olthoff KM, Siegler M, Ascher N, Feng S, Kaplan B, Pomfret E. Addressing sex-based disparities in solid organ transplantation in the United States - a conference report. Am J Transplant 2023; 23:316-325. [PMID: 36906294 DOI: 10.1016/j.ajt.2022.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/17/2022] [Accepted: 11/04/2022] [Indexed: 01/15/2023]
Abstract
Solid organ transplantation provides the best treatment for end-stage organ failure, but significant sex-based disparities in transplant access exist. On June 25, 2021, a virtual multidisciplinary conference was convened to address sex-based disparities in transplantation. Common themes contributing to sex-based disparities were noted across kidney, liver, heart, and lung transplantation, specifically the existence of barriers to referral and wait listing for women, the pitfalls of using serum creatinine, the issue of donor/recipient size mismatch, approaches to frailty and a higher prevalence of allosensitization among women. In addition, actionable solutions to improve access to transplantation were identified, including alterations to the current allocation system, surgical interventions on donor organs, and the incorporation of objective frailty metrics into the evaluation process. Key knowledge gaps and high-priority areas for future investigation were also discussed.
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Affiliation(s)
- Deirdre Sawinski
- Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA.
| | - Jennifer C Lai
- Division of Gastroenterology and Hepatology, University of California, San Francisco, California, USA
| | - Sean Pinney
- University of Chicago Medicine, Chicago, Illinois, USA
| | - Alice L Gray
- University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Annette M Jackson
- Department of Surgery, Duke University, Department of Surgery, Durham, Carolina, USA
| | - Darren Stewart
- United Network for Organ Sharing, Richmond, Virginia, USA
| | | | - Jayme E Locke
- University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, Alabama, USA
| | - James J Pomposelli
- Department of Surgery University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA; Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado, USA
| | | | | | - Darshana M Dadhania
- Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA
| | - Rebecca Cogswell
- University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Richard V Perez
- Department of Surgery, University of California, Davis, School of Medicine, Sacramento, California, USA
| | - Jesse D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Jon Kobashigawa
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Jasleen Kukreja
- Department of Surgery, University of California, San Francisco, California, USA
| | - John C Magee
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - John Friedewald
- Northwestern University Feinberg School of Medicine, Chicago, Illinois USA
| | - John S Gill
- Division of Nephrology, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Gabriel Loor
- Baylor College of Medicine Lung Institute, Houston, Texas, USA
| | | | - Elizabeth C Verna
- Center for Liver Disease and Transplantation, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Mary Norine Walsh
- Ascension St Vincent Heart Center, Indianapolis, Indianapolis, Indiana, USA
| | - Norah Terrault
- Keck Medicine of University of Southern California, Los Angeles, California, USA
| | - Guiliano Testa
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Joshua M Diamond
- Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter P Reese
- Division of Renal, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Susan Orloff
- Division of Abdominal Organ Transplantation and Hepatobiliary Surgery, Department of Surgery, Portland, Oregon, USA
| | - Maryjane A Farr
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kim M Olthoff
- Department of Surgery, Penn Transplant Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark Siegler
- University of Chicago Medicine, Chicago, Illinois, USA; MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois, USA
| | - Nancy Ascher
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Sandy Feng
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Bruce Kaplan
- Department of Surgery University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA; Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado, USA
| | - Elizabeth Pomfret
- Department of Surgery University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA; Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado, USA
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3
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Chauhan M, Zhang T, Thuluvath PJ. Gender Differences in Liver Transplantation Outcomes in Polycystic Liver Disease. Dig Dis Sci 2022; 67:3445-3454. [PMID: 34191186 DOI: 10.1007/s10620-021-07125-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/16/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND In this study, our objective was to determine gender differences in the outcomes of patients with PLD undergoing liver (LT) or liver/kidney transplantation (SLK). METHODS We analyzed the UNOS datasets of all adults who had transplanted for PLD between 1988 and 2018. RESULTS During the study period, 663 LT/SLK (51% LT only and 49% SLK) were done for PLD patients and of these 500 (75%) were in women. Women were younger (52.8 vs. 56.7 years, p < 0.001), had lower MELD at transplant (16.6 vs. 19.4, p < 0.001), had higher serum albumin (3.7 vs. 3.5, p < 0.001), and had a lower CTP class (p < 0.008). During the follow-up, 18% (n = 89) women and 29% (n = 47) men died (p = 0.002). Kaplan-Meier (KM) survival estimates showed similar survival rate for patients who had LT and SLK (p = 0.459), but survival rate was significantly higher for women compared to men (p < 0.001). Multivariable analysis showed that female gender (aHR 0.54, 95% CI 0.33-0.90) was associated with a lower mortality. Moreover, Karnofsky Performance Status was excellent for 70% of women and 55% of men (p = 0.03) after LT. Women had better survival whether they received liver or SLK. The era of transplant, whether they were transplanted with MELD exception points or whether they were on dialysis at the time of transplant, did not have an effect on the gender differences in outcomes. CONCLUSIONS Women had 46% lower risk of mortality after adjusting for other covariates compared to men after LT/SLK for PLD.
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Affiliation(s)
- Mahak Chauhan
- Institute of Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD, USA
| | - Talan Zhang
- Institute of Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD, USA
| | - Paul J Thuluvath
- Institute of Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD, USA. .,Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
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4
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Serrano MT, Sabroso S, Esteban LM, Berenguer M, Fondevila C, Lorente S, Cortés L, Sanchez-Antolin G, Nuño J, De la Rosa G, Salcedo M. Mortality and Causes of Death After Liver Transplantation: Analysis of Sex Differences in a Large Nationwide Cohort. Transpl Int 2022; 35:10263. [PMID: 35615539 PMCID: PMC9124758 DOI: 10.3389/ti.2022.10263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022]
Abstract
In the last few years, several studies have analyzed sex and gender differences in liver transplantation (LT), but none have performed a disaggregated analysis of both mortality and causes of death. Data from 15,998 patients, 11,914 (74.5%) males and 4,069 (25.5%) females, transplanted between 2000 and 2016 were obtained from the Liver Transplantation Spanish Registry. Survival analysis was applied to explore recipient sex as a risk factor for death. The causes of death at different follow-up duration were disaggregated by recipient sex for analysis. Short-term survival was higher in males, whereas long-term survival was higher in females. Survival at 1, 5 and 10 years post-transplant was 87.43%, 73.83%, and 61.23%, respectively, in males and 86.28%, 74.19%, and 65.10%, respectively, in females (p = 0.05). Post-LT mortality related to previous liver disease also presented sex differences. Males had 37% increased overall mortality from acute liver failure (p = 0.035) and 37% from HCV-negative cirrhosis (p < 0.001). Females had approximately 16% increased mortality when the liver disease was HCV-positive cirrhosis (p = 0.003). Regarding causes of death, non-malignancy HCV+ recurrence (6.3% vs. 3.9% of patients; p < 0.001), was more frequently reported in females. By contrast, death because of malignancy recurrence (3.9% vs. 2.2% of patients; p = 0.003) and de novo malignancy (4.8% vs. 2.5% of patients; p < 0.001) were significantly more frequent in male recipients. Cardiovascular disease, renal failure, and surgical complications were similar in both. In summary, male patients have lower short-term mortality than females but higher long-term and overall mortality. In addition, the post-LT mortality risk related to previous liver disease and the causes of mortality differ between males and females.
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Affiliation(s)
- M. Trinidad Serrano
- Digestive Diseases Department, Lozano Blesa University Hospital, Zaragoza, Spain
- Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Sergio Sabroso
- Genetic and Molecular Epidemiology Group (GMEG), Spanish National Cancer Research Center (CNIO), Madrid, Spain
| | - Luis M. Esteban
- Department of Applied Mathematics, Escuela Universitaria Politécnica La Almunia, University of Zaragoza, Zaragoza, Spain
| | - Marina Berenguer
- Hepatology and Liver Transplant Unit, La Fe University Hospital, La Fe Health Research Institute (IIS La Fe), Universidad de Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas Ciberehd, Madrid, Spain
| | - Constantino Fondevila
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas Ciberehd, Madrid, Spain
- Department of General and Digestive Surgery, Institut de Malalties Digestives I Metabòliques (IMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Sara Lorente
- Digestive Diseases Department, Lozano Blesa University Hospital, Zaragoza, Spain
- Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Luis Cortés
- Digestive Diseases Department, Lozano Blesa University Hospital, Zaragoza, Spain
- Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain
| | | | - Javier Nuño
- Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Madrid, Spain
| | - Gloria De la Rosa
- Organización Nacional de Trasplantes (ONT), Secretaria Del Registro Español de Trasplante Hepático (RETH), Madrid, Spain
| | - Magdalena Salcedo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas Ciberehd, Madrid, Spain
- Digestive Diseases Department, Gregorio Marañón University Hospital, Complutense University of Madrid, Zaragoza, Spain
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Yoeli D, Choudhury RA, Moore HB, Sauaia A, Simpson MA, Pomfret EA, Nydam TL. Are Hepatitis C Positive Female Liver Transplant Recipients Still at Increased Risk for Graft Failure? Reexamining the Disparity in the Modern Era of Direct-acting Antiviral Agents. Transplantation 2022; 106:129-137. [PMID: 33577252 DOI: 10.1097/tp.0000000000003683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to compare the outcomes of hepatitis C virus (HCV) positive (+) female liver transplant recipients to HCV negative (-) female and HCV+ male recipients before and after the direct-acting-antiviral (DAA) era. METHODS The United Network for Organ Sharing liver transplant database was retrospectively reviewed from 2002 to 2017. The DAA era was defined as ≥2014. RESULTS In the pre-DAA era, HCV+ female recipients had greater risk for graft failure compared with HCV+ male (hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.01-1.11; P = 0.03) and HCV- female (HR, 1.51; 95% CI, 1.43-1.60; P < 0.001) recipients. In the post-DAA era, HCV+ female recipients had lower risk for graft failure compared with HCV+ male recipients (HR, 0.82; 95% CI, 0.70-0.97; P = 0.02) and equivalent outcomes to HCV- female recipients. HCV+ female recipients with graft failure had increased likelihood of graft failure due to disease recurrence compared with HCV+ male recipients in the pre-DAA era (odds ratio, 1.23; 95% CI, 1.08-1.39; P = 0.001) but not in the post-DAA era. CONCLUSIONS Although historically HCV+ female recipients were at disproportionately increased risk for graft failure and disease recurrence, this disparity has been eliminated in the DAA era.
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Affiliation(s)
- Dor Yoeli
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Rashikh A Choudhury
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Hunter B Moore
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Angela Sauaia
- Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Mary Ann Simpson
- Department of Transplantation, Lahey Hospital and Medical Center, Burlington, MA
| | - Elizabeth A Pomfret
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Trevor L Nydam
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
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6
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Rodgers SK, Horrow MM. Acute (fulminant) liver failure: a clinical and imaging review. Abdom Radiol (NY) 2021; 46:3117-3127. [PMID: 33635361 DOI: 10.1007/s00261-021-02973-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/22/2021] [Accepted: 02/09/2021] [Indexed: 12/13/2022]
Abstract
Acute liver failure (ALF) is a rare clinical entity with high morbidity and mortality frequently requiring liver transplantation for survival. Imaging, particularly with ultrasound, plays an important role, especially to distinguish patients with underlying chronic liver disease who have lower transplant priority. We discuss the clinical and imaging findings in the three subtypes of ALF using a multi-modality approach with an emphasis on ultrasound.
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7
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Paradigm Shift in Utilization of Livers from Hepatitis C-Viremic Donors into Hepatitis C Virus-Negative Patients. Clin Liver Dis 2021; 25:195-207. [PMID: 33978579 DOI: 10.1016/j.cld.2020.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Despite record-breaking numbers of liver transplants (LTs) performed in the United States in each of the last 7 years, many patients remain on the wait list as the demand for LT continues to exceed the supply of available donors. The emergence of highly effective and well-tolerated direct-acting antiviral therapy has transformed the clinical course and management of hepatitis C virus (HCV) in both the pretransplant and posttransplant setting. Historically, donor livers infected with HCV were either transplanted into patients already infected with HCV or discarded.
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8
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Wang H, Han B, Wang N, Lu Y, Gao T, Qu Z, Yang H, Yang Q. Oxymatrine attenuates arsenic-induced endoplasmic reticulum stress and calcium dyshomeostasis in hepatic stellate cells. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1171. [PMID: 33241020 PMCID: PMC7576087 DOI: 10.21037/atm-20-5881] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Oxymatrine is the main bioactive component of Sophora flavescens. It exhibits various biological activities and has been used in various liver diseases, including hepatic fibrosis (HF). Hepatic stellate cells (HSCs) are the primary cell type involved during HF progression. Oxymatrine treatment could suppress the proliferation of HSCs and degrade the extracellular cell matrix (ECM), presumed to be associated with HF. However, the mechanism is still unknown. Methods NaAsO2 induces HF in LX2 cells. Oxymatrine was used to treat NaAsO2- induced LX2 cells. Then, the LX2 cell proliferation, apoptosis, ECM secretion protein, oxidative stress index, and intracellular calcium concentration were respectively measured. Furthermore, after knocking down GRP78 [endoplasmic reticulum (ER) chaperone BiP] or overexpressing of SERCA2 (ATPase sarcoplasmic/ER Ca2+ transporting 2) in NaAsO2-induced LX2 cells, we detected the changes in ER stress and calcium homeostasis in LX2 cells. Results NaAsO2 exposure promoted apoptosis, increased ECM secretion, produced ER stress, and disrupted calcium homeostasis, which could be attenuated by oxymatrine treatment. Furthermore, knockdown of GRP78 to alleviate ER stress, or overexpression of SERCA2 to restore intracellular calcium homeostasis can inhibit the NaAsO2 effect. Conclusions Oxymatrine treatment could improve calcium homeostasis and attenuate ER stress to reverse NaAsO2-induced HSC activation and ECM secretion, which are the significant phenotypes of HF. The ER stress and calcium homeostasis may be the therapeutic targets for HF.
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Affiliation(s)
- Huiqun Wang
- Guizhou Provincial Key Laboratory of Pathogenesis & Drug Research on Common Chronic Diseases, Ministry of Education, Guizhou Medical University, Guiyang, China.,Department of Pathophysiology, Ministry of Education, Guizhou Medical University, Guiyang, China.,Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Bing Han
- Guizhou Provincial Key Laboratory of Pathogenesis & Drug Research on Common Chronic Diseases, Ministry of Education, Guizhou Medical University, Guiyang, China.,Department of Pathophysiology, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Nanlan Wang
- Guizhou Provincial Key Laboratory of Pathogenesis & Drug Research on Common Chronic Diseases, Ministry of Education, Guizhou Medical University, Guiyang, China.,Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Yang Lu
- Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Ting Gao
- Department of Pathology, the Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Zihan Qu
- Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Hongmei Yang
- Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Qin Yang
- Guizhou Provincial Key Laboratory of Pathogenesis & Drug Research on Common Chronic Diseases, Ministry of Education, Guizhou Medical University, Guiyang, China.,Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
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9
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Abstract
BACKGROUND AND AIMS Gender disparities exist in outcomes among patients with cirrhosis. We sought to evaluate the role of gender on hospital course and in-hospital outcomes in patients with cirrhosis to help better understand these disparities. STUDY We analyzed data from the National Inpatient Sample (NIS), years 2009 to 2013, to identify patients with any diagnosis of cirrhosis. We calculated demographic and clinical characteristics by gender, as well as cirrhosis complications. Our primary outcome was inpatient mortality. We used logistic regression to associate baseline characteristics and cirrhosis complications with inpatient mortality. RESULTS Our cohort included 553,017 patients with cirrhosis admitted from 2009 to 2013. Women made up 39% of the cohort; median age was 57 with 66% non-Hispanic white. Women were more likely than men to have noncirrhosis comorbidities, including diabetes and hypertension but were less likely to have most cirrhosis complications, including ascites and variceal bleeding. Women were more likely than men to have acute bacterial infections (34.9% vs. 28.2%; P<0.001), and were less likely than men to die in the hospital on univariable (odds ratio, 0.88; 95% confidence interval, 0.86-0.90; P<0.001) and multivariable (odds ratio, 0.86; 95% confidence interval, 0.83-0.88; P<0.001) analysis. CONCLUSIONS In patients hospitalized with cirrhosis, women have lower rates of hepatic decompensating events and higher rates of nonhepatic comorbidities and infections, resulting in lower in-hospital mortality. Understanding differences in indications for and disposition following hospitalization may help with the development of gender-specific cirrhosis management programs to improve long-term outcomes in women and men living with cirrhosis.
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10
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Wu ZF, Lin WL, Lee MS, Hung NK, Huang YS, Chen TW, Lu CH. Propofol vs desflurane on the cytokine, matrix metalloproteinase-9, and heme oxygenase-1 response during living donor liver transplantation: A pilot study. Medicine (Baltimore) 2019; 98:e18244. [PMID: 31770287 PMCID: PMC6890360 DOI: 10.1097/md.0000000000018244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND We investigated the effects of propofol vs desflurane on ischemia and reperfusion injury (IRI)-induced inflammatory responses, especially in matrix metalloproteinase-9 (MMP-9) downregulation and heme oxygenase-1 (HO-1) upregulation, which may result in different clinical outcomes in liver transplant recipients. METHODS Fifty liver transplant recipients were randomized to receive propofol-based total intravenous anesthesia (TIVA group, n = 25) or desflurane anesthesia (DES group, n = 25). We then measured the following: perioperative serum cytokine concentrations (interleukin 1 receptor antagonist [IL-1RA], IL-6, IL-8, and IL-10); MMP-9 and HO-1 mRNA expression levels at predefined intervals. Further, postoperative outcomes were compared between the 2 groups. RESULTS The TIVA group showed a significant HO-1 level increase following the anhepatic phase and a significant MMP-9 reduction after reperfusion, in addition to a significant increase in IL-10 levels after the anhepatic phase and IL-1RA levels after reperfusion. Compared to DES patients, TIVA patients showed a faster return of the international normalized ratio to normal values, lower plasma alanine aminotransferase concentrations 24 hours after transplantation, and fewer patients developing acute lung injury. Moreover, compared with DES patients, TIVA patients showed a significant reduction in serum blood lactate levels. However, there were no differences in postoperative outcomes between the two groups. CONCLUSION Propofol-based TIVA attenuated inflammatory response (elevated IL-1RA and IL-10 levels), downregulated MMP-9 response, and increased HO-1 expression with improved recovery of graft function and better microcirculation compared with desflurane anesthesia in liver transplant recipients.
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Affiliation(s)
- Zhi-Fu Wu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan
- Department of Anesthesiology, National Defense Medical Center and Tri-Service General Hospital
| | - Wei-Lin Lin
- Department of Anesthesiology, National Defense Medical Center and Tri-Service General Hospital
| | | | - Nan-Kai Hung
- Department of Anesthesiology, National Defense Medical Center and Tri-Service General Hospital
| | - Yuan-Shiou Huang
- Department of Anesthesiology, National Defense Medical Center and Tri-Service General Hospital
| | - Teng-Wei Chen
- Division of General Surgery, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan
| | - Chueng-He Lu
- Department of Anesthesiology, National Defense Medical Center and Tri-Service General Hospital
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11
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Offspring Versus Nonoffspring to Parent Living Donor Liver Transplantation: Does Donor Relationship Matter? Transplantation 2019; 104:996-1002. [PMID: 31568397 DOI: 10.1097/tp.0000000000002977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Offspring (donor) to parent (recipient) transplant is the most common form of living donor liver transplant in the United States. In kidney transplantation, it has been suggested that female recipients of offspring living donor kidney allografts have inferior outcomes. It is unknown whether such a phenomenon also occurs following living donor liver transplantation. METHODS A retrospective analysis was completed of recipients of a living donor liver transplant from January 1998 to January 2018 in the Organ Procurement and Transplantation Network/United Network for Organ Sharing database. Patients were grouped as having received a living donor liver allograft from either an offspring or a nonoffspring, with exactly 3 HLA matches, as would be expected between an offspring and parent. Graft and patient survival were analyzed using Cox proportional hazards modeling. RESULTS A total of 279 offspring to parent and 241 nonoffspring donor liver transplants were included in the analysis. Female recipients of offspring liver allografts had both inferior 10-year graft (52% versus 72%; P < 0.001) and patient survival (52% versus 81%; P < 0.001) compared with female recipients of nonoffspring allografts. No such difference in outcomes was discovered among male recipients. A stratified analysis of sex of offspring donors to female recipients demonstrated that donor male gender was associated with graft failure (HR = 2.87; P = 0.04) and mortality (hazard ratio = 3.89; P = 0.03). Again, this association was not seen with male recipients. CONCLUSIONS Among female recipients, offspring to parent living donor liver transplantation yields inferior long-term graft and patient survival. Furthermore, among offspring donors, male sex was strongly associated with inferior outcomes. These findings have significant implications for donor selection.
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12
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Verna EC, Schluger A, Brown RS. Opioid epidemic and liver disease. JHEP Rep 2019; 1:240-255. [PMID: 32039374 PMCID: PMC7001546 DOI: 10.1016/j.jhepr.2019.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/27/2019] [Accepted: 06/29/2019] [Indexed: 12/12/2022] Open
Abstract
Opioid use in the United States and in many parts of the world has reached epidemic proportions. This has led to excess mortality as well as significant changes in the epidemiology of liver disease. Herein, we review the impact of the opioid epidemic on liver disease, focusing on the multifaceted impact this epidemic has had on liver disease and liver transplantation. In particular, the opioid crisis has led to a significant shift in incident hepatitis C virus infection to younger populations and to women, leading to changes in screening recommendations. Less well characterized are the potential direct and indirect hepatotoxic effects of opioids, as well as the changes in the incidence of hepatitis B virus infection and alcohol abuse that are likely rising in this population as well. Finally, the opioid epidemic has led to a significant rise in the proportion of organ donors who died due to overdose. These donors have led to an overall increase in donor numbers, but also to new considerations about the better use of donors with perceived or actual risk of disease transmission, especially hepatitis C. Clearly, additional efforts are needed to combat the opioid epidemic. Moreover, better understanding of the epidemiology and underlying pathophysiology will help to identify and treat liver disease in this high-risk population.
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Affiliation(s)
- Elizabeth C. Verna
- Center for Liver Disease and Transplantation, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Aaron Schluger
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Robert S. Brown
- Center for Liver Disease and Transplantation, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY
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13
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Busch CJ, Siegler BH, Werle H, Lichtenstern C, Bruckner T, Heininger A, Mehrabi A, Weiss KH, Weigand MA, Hochreiter M. Risk factors for early viral infections after liver transplantation. Langenbecks Arch Surg 2018; 403:509-519. [DOI: 10.1007/s00423-018-1672-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/28/2018] [Indexed: 12/12/2022]
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14
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Bodro M, Sanclemente G, Crespo G, Linares L, Marcos MA, Marco F, Miquel R, Forns X, Navasa M, Moreno A. Severe Hepatitis C Recurrence as a Risk Factor for Opportunistic Infections in Liver Transplant Recipients. Transplant Proc 2018; 50:1437-1443. [PMID: 29880367 DOI: 10.1016/j.transproceed.2018.02.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/13/2017] [Accepted: 02/17/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of the study was to determine the clinical characteristics, frequency of opportunistic infections (OI), and the outcomes for liver transplant recipients with severe hepatitis C virus (HCV) recurrence. In addition, the objective was to evaluate HCV recurrence as a risk factor for developing an OI. METHODS We conducted a retrospective observational study recording all liver transplant recipients from July 1, 2003, to December 31, 2012. Patients with liver disease due to HCV were selected. Active surveillance of infections was conducted periodically, and patients were classified according to presence of severe HCV recurrence. RESULTS Three hundred seventy patients underwent liver transplantation because of chronic HCV. One hundred forty-seven patients presented severe recurrence (SR) (49%) and 50 (17%) of them had post-liver transplant cholestatic hepatitis C. Patients with SR presented OI, especially cytomegalovirus (CMV) infections and invasive fungal infections, more frequently than patients without SR (33% vs 13%; P < .001). From the diagnosis of SR to the presentation of OI, the median number of days was 169 (6-2083). Acute allograft rejection (OR 1.8 95% confidence interval [CI] 1.1-3.3) donor age ≥60 years (OR 2.9 95% CI 1.3-6.8), and SR (OR 2.8, 95% CI 1.6-5.1) were independently associated with the development of OI in liver transplant recipients. CONCLUSION A high index of suspicion of opportunistic infections must be maintained when faced with severe HCV recurrence in liver transplant recipients. Moreover, active surveillance against CMV infection and other prophylactic strategies against opportunistic infections should be considered.
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Affiliation(s)
- M Bodro
- Infectious Diseases Department, Hospital Clínic-IDIBAPS-CIBERHED, University of Barcelona, Barcelona, Spain.
| | - G Sanclemente
- Infectious Diseases Department, Hospital Clínic-IDIBAPS-CIBERHED, University of Barcelona, Barcelona, Spain
| | - G Crespo
- Liver Transplant Unit, Hospital Clínic-IDIBAPS-CIBERHED, University of Barcelona, Barcelona, Spain
| | - L Linares
- Infectious Diseases Department, Hospital Clínic-IDIBAPS-CIBERHED, University of Barcelona, Barcelona, Spain
| | - M A Marcos
- Microbiology Department, Hospital Clínic-IDIBAPS-CIBERHED, University of Barcelona, Barcelona, Spain
| | - F Marco
- Microbiology Department, Hospital Clínic-IDIBAPS-CIBERHED, University of Barcelona, Barcelona, Spain
| | - R Miquel
- Pathology Unit, Hospital Clínic-IDIBAPS-CIBERHED, University of Barcelona, Barcelona, Spain
| | - X Forns
- Liver Transplant Unit, Hospital Clínic-IDIBAPS-CIBERHED, University of Barcelona, Barcelona, Spain
| | - M Navasa
- Liver Transplant Unit, Hospital Clínic-IDIBAPS-CIBERHED, University of Barcelona, Barcelona, Spain
| | - A Moreno
- Infectious Diseases Department, Hospital Clínic-IDIBAPS-CIBERHED, University of Barcelona, Barcelona, Spain
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15
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Dultz G, Graubard BI, Martin P, Welker MW, Vermehren J, Zeuzem S, McGlynn KA, Welzel TM. Liver transplantation for chronic hepatitis C virus infection in the United States 2002-2014: An analysis of the UNOS/OPTN registry. PLoS One 2017; 12:e0186898. [PMID: 29088255 PMCID: PMC5663425 DOI: 10.1371/journal.pone.0186898] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 09/20/2017] [Indexed: 12/19/2022] Open
Abstract
Chronic hepatitis C virus (HCV) infection is a leading cause for orthotopic liver transplantation (OLT) in the U.S. We investigated characteristics of HCV-infected patients registered for OLT, and explored factors associated with mortality. Data were obtained from the United Network for Organ Sharing and Organ Procurement and Transplantation network (UNOS/OPTN) registry. Analyses included 41,157 HCV-mono-infected patients ≥18 years of age listed for cadaveric OLT between February 2002 and June 2014. Characteristics associated with pre- and post-transplant survival and time trends over the study period were determined by logistic and Cox proportional hazard regression analyses and Poisson regressions. Most patients were white (69.1%) and male (70.8%). At waitlist registration, mean age was 54.6 years and mean MELD was 16. HCC was recorded in 26.9% of the records. A total of 51.2% of the patients received an OLT, 21.0% died or were too sick; 15.6% were delisted and 10.4% were still waiting. Factors associated with increased waitlist mortality were older age, female gender, blood type 0, diabetes, no HCC and transplant region (p<0.001). OLT recipient characteristics associated with increased risk for post OLT mortality were female gender, age, diabetes, race (p<0,0001), and allocation MELD (p = 0.005). Donor characteristics associated with waitlist mortality included age, ethnicity (p<0.0001) and diabetes (p<0.03). Waitlist registrations and OLTs for HCC significantly increased from 14.4% to 37.3% and 27.8% to 38.5%, respectively (p<0.0001). Pre- and post-transplant survival depended on a variety of patient-, donor-, and allocation- characteristics of which most remain relevant in the DAA-era. Still, intensified HCV screening strategies and timely and effective treatment of HCV are highly relevant to reduce the burden of HCV-related OLTs in the U.S.
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Affiliation(s)
- Georg Dultz
- University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Barry I. Graubard
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States of America
| | - Paul Martin
- Hepatology Division, University of Miami, Miami, FL, United States of America
| | | | | | - Stefan Zeuzem
- University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Katherine A. McGlynn
- HREB, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States of America
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16
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Berge E, Otón E, Reina Z, Díaz L, Márquez A, Cejas L, Acosta S, Pérez F. Predictors of Poor Prognosis in Recurrent Hepatitis C After Liver Transplantation. Transplant Proc 2017; 48:2997-2999. [PMID: 27932129 DOI: 10.1016/j.transproceed.2016.07.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/27/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatitis C is a common indication for liver transplantation (LT). Hepatitis C virus (HCV) recurrence is universal in viremic patients. This recurrence is frequently very aggressive, with graft loss in less than 5 years. Our aim is to detect which factors are related to worse fibrosis at 1 year post-LT. PATIENTS AND METHODS Records of all HCV-positive transplanted patients in Hospital Universitario Nuestra Señora de la Candelaria from 1996 to 2014 were collected. The variables analyzed were donor and recipient age and gender, hypertension, diabetes, viral genotype, viral load at LT, hepatocellular carcinoma in the explant, anticoagulation or antiplatelet treatment, year of transplantation, and mean levels of tacrolimus in the first month. Severe recurrence was defined as fibrosis F3 by biopsy, liver stiffness > 9.5 kPa by transient elastography, or hepatic venous pressure gradient > 5 mm Hg at 1 year post-LT. Univariate and multivariate analyses were performed. RESULTS From a sample of 112 patients, 88 patients met inclusion criteria. Mean recipient age was 52.8 ± 8.0 years and 70.5% were men. Mean donor age was 46.4 ± 16.1 years and 59.1% were men. Severe recurrence occurred in 23.9%. Univariate analyses showed 3 variables were statistically significant: donor age (P = .03), recipient age (P = .008), and presence of hepatocellular carcinoma (P = .01). Only the 2 first variables remained significant in the multivariate model (P = .009 and P = .044 respectively). Hepatocellular carcinoma was probably related to older recipients becoming a confounding factor. CONCLUSIONS In our study, donor and recipient age both conferred a worse prognosis in terms of fibrosis progression in patients with liver transplant due to HCV.
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Affiliation(s)
- E Berge
- Liver Transplantation Unit, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - E Otón
- Liver Transplantation Unit, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain.
| | - Z Reina
- Occupational Medicine Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - L Díaz
- Liver Transplantation Unit, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - A Márquez
- Liver Transplantation Unit, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - L Cejas
- Liver Transplantation Unit, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - S Acosta
- Liver Transplantation Unit, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - F Pérez
- Liver Transplantation Unit, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
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17
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ARFI elastography: Changes after direct-acting antiviral treatment in transplanted livers with relapse of hepatitis C virus infection. RADIOLOGIA 2017. [DOI: 10.1016/j.rxeng.2016.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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18
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Alfageme Zubillaga M, Fontanilla Echeveste T, Pérez González I, Royuela Vicente A, Duca A, Ruiz Peralbo R, González Hernando C. Elastografía tipo ARFI: modificación tras tratamiento antiviral en el trasplante hepático con recidiva por VHC. RADIOLOGIA 2017; 59:139-146. [DOI: 10.1016/j.rx.2016.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/29/2016] [Accepted: 12/30/2016] [Indexed: 02/07/2023]
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19
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Genotype distribution of hepatitis C virus among Lebanese patients: Results from a major tertiary care center. GENE REPORTS 2016. [DOI: 10.1016/j.genrep.2016.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Teegen EM, Krebs I, Langelotz C, Pratschke J, Rau B. Gender Mainstreaming and Transplant Surgery. Visc Med 2016; 32:286-289. [PMID: 27722166 DOI: 10.1159/000446357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Gender differences in medicine are gaining in importance. In transplant surgery, not only the patient's gender but also that of the donor play an important role in the outcome of transplantation due to sociocultural and genetic factors. METHODS This review article gives an overview of the latest investigations into gender-related influences in the field of visceral transplantation. For this purpose, a systematic review of the literature was performed. RESULTS In general, women are less often evaluated for and subjected to transplantation worldwide. Significantly poorer outcome can be observed in women with liver transplantation following hepatitis C cirrhosis. Furthermore, female renal grafts are less favorable in terms of outcome and survival. Gender disparities affect transplant medicine due to subtle gender-specific immunological factors. Sociocultural factors also lead to differences in the clinical treatment of men and women, which may influence overall survival. CONCLUSION For a better understanding of gender-specific differences in transplant medicine and a possible improvement in outcome, further research in this field is necessary.
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Affiliation(s)
- Eva Maria Teegen
- Department of General, Visceral and Transplant Surgery, Campus Virchow, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Isabell Krebs
- Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Corinna Langelotz
- Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johann Pratschke
- Department of General, Visceral and Transplant Surgery, Campus Virchow, Charité - Universitätsmedizin Berlin, Berlin, Germany; Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Beate Rau
- Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
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21
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Influence of donor-recipient sex mismatch on long-term survival of pancreatic grafts. Sci Rep 2016; 6:29298. [PMID: 27403718 PMCID: PMC4941418 DOI: 10.1038/srep29298] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 06/17/2016] [Indexed: 12/11/2022] Open
Abstract
To assess the role of sex mismatch on graft survival after pancreas transplantation. We evaluated 24,195 pancreas-transplant recipients reported in the Scientific Registry of Transplant Recipients over a 25-year period. Pancreatic graft survival (PGS) was analyzed according to donor–recipient sex pairing using Kaplan–Meier estimations. Hazard ratios were estimated using Cox proportional hazard models. A total of 14,187 male and 10,008 female recipients were included in final analyses. Mean follow-up was 8.3 ± 5.7 years. In multivariate analyses, neither recipient sex nor donor sex was associated with pancreatic graft failure (PGF), but donor–recipient sex mismatch (regardless of recipient sex) was an independent predictor of PGS (HR, 1.09; 95% CI, 1.04–1.14; p < 0.001). Compared with M → M sex-matched recipients in univariate analyses, M → F and F → M sex mismatches were associated with an increased risk of PGF. Adjustment for significant recipient and donor factors eliminated the association between F → M sex mismatch and PGF (HR, 1.02; 95% CI, 0.93–1.10; p = 0.752), but not M → F (1.09; 1.02–1.17; 0.020). Stratified analyses suggested that the negative effect of donor–recipient sex mismatch could be neutralized in older patients. These findings suggest that donor–recipient sex pairing should be taken into consideration in organ-allocation strategies.
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22
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Management of post liver transplantation recurrent hepatitis C infection with directly acting antiviral drugs: a review. Hepatol Int 2016; 10:749-61. [PMID: 27337961 DOI: 10.1007/s12072-016-9744-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/17/2016] [Indexed: 12/20/2022]
Abstract
Recurrent HCV infection (rHCV) of the liver allograft following transplantation is universal and is associated with poor graft and patient survival in comparison with other indications. Treatment of rHCV infection in the previous era with pegylated interferon and ribavirin was associated with low sustained virological response (SVR) due to poor tolerability, adverse events and graft rejection. Recently, directly acting antiviral drugs (DAA) have been approved for the treatment of hepatitis C infection and a number of clinical trials have been conducted across various centers in the management of rHCV infection of the graft. In this review we discuss about recent studies that have emerged on the use of NS5b polymerase inhibitor, sofosbuvir in combination with second generation protease inhibitor, simeprevir, fixed dose ledipasvir or daclatasvir with or without ribavirin in the treatment of post transplant rHCV infection.
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23
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Giard JM, Terrault NA. Women with Cirrhosis: Prevalence, Natural History, and Management. Gastroenterol Clin North Am 2016; 45:345-58. [PMID: 27261903 DOI: 10.1016/j.gtc.2016.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cirrhosis is less frequent in women than in men, in large part due to the lower prevalence of hepatitis B, hepatitis C, and alcohol use in women. The most common causes of cirrhosis among women are hepatitis C, autoimmune etiologies, nonalcoholic steatohepatitis, and alcoholic liver disease. For most chronic liver diseases, the risk of progression to cirrhosis and rates of liver failure and hepatocellular carcinoma are lower in women than in men. Pregnancy is very infrequent in women with cirrhosis due to reduced fertility, but when it occurs, requires specialized management.
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Affiliation(s)
- Jeanne-Marie Giard
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Norah A Terrault
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA.
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24
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[Hepatitis C during pregnancy, vertical transmission and new treatment possibilities]. Med Clin (Barc) 2016; 147:499-505. [PMID: 27209226 DOI: 10.1016/j.medcli.2016.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/04/2016] [Accepted: 04/07/2016] [Indexed: 02/08/2023]
Abstract
Hepatitis C virus (HCV) infection has been recognised as a worldwide health problem. HCV is the most common cause of cirrhosis, hepatocellular carcinoma and liver transplantation. The HCV prevalence reported in pregnant women is similar to that found among the general population and does not appear to have an adverse effect on the course of pregnancy. The vertical transmission of HCV (HCV-VT) is a major route of HCV infection in children in the developed countries (>90%). The overall rate of mother-to-child transmission and chronification is about 3%-8%; however, this rate is higher for mothers who are co-infected with the human immunodeficiency virus (15-20%). In this review, we analyse the course of HCV infection during gestation, the risk factors associated with HCV-VT, the diagnostic methods/clinical monitoring recommended and the new possibilities of treatment in the era of direct-acting antiviral agents, which are essential to guide future public health efforts appropriately.
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25
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Paulino J, Vigia E, Marcelino P, Abade O, Sobral J, Ligeiro D, Carvalho A, Alves M, Papoila AL, Trindade H, Barroso E. Clinical outcomes and genetic expression profile in human liver graft dysfunction during ischemia/reperfusion injury. Transplant Proc 2016; 47:882-7. [PMID: 26036478 DOI: 10.1016/j.transproceed.2015.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION This study aims to compare the molecular gene expression during ischemia reperfusion injury. Several surgical times were considered: in the beginning of the harvesting (T0), at the end of the cold ischemia period (T1), and after reperfusion (T2) and compared with graft dysfunction after liver transplant (OLT). METHODS We studied 54 patients undergoing OLT. Clinical, laboratory data, and histologic data (Suzuki classification) as well as the Survival Outcomes Following Liver Transplantation (SOFT) score were used and compared with the molecular gene expression of the following genes: Interleukin (IL)-1b, IL-6, tumor necrosis factor-α, perforin, E-selectin (SELE), Fas-ligand, granzyme B, heme oxygenase-1, and nitric oxide synthetase. RESULTS Fifteen patients presented with graft dysfunction according to SOFT criteria. No relevant data were obtained by comparing the variables graft dysfunction and histologic variables. We observed a statistically significant relation between SELE at T0 (P = .013) and IL-1β at T0 (P = .028) and early graft dysfunction. CONCLUSIONS We conclude that several genetically determined proinflammatory expressions may play a critical role in the development of graft dysfunction after OLT.
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Affiliation(s)
- J Paulino
- Centro Hepatobiliopancreático e de Transplantação, Hospital Curry Cabral, Universidade Nova de Lisboa, Lisboa, Portugal.
| | - E Vigia
- Centro Hepatobiliopancreático e de Transplantação, Hospital Curry Cabral, Universidade Nova de Lisboa, Lisboa, Portugal
| | - P Marcelino
- CEDOC, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - O Abade
- Centro de Histocompatibilidade do Sul, Universidade Nova de Lisboa, Lisboa, Portugal
| | - J Sobral
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - D Ligeiro
- Centro de Histocompatibilidade do Sul, Universidade Nova de Lisboa, Lisboa, Portugal
| | - A Carvalho
- Serviço de Anatomia Patológica, Hospital Curry Cabral, Universidade Nova de Lisboa, Lisboa, Portugal
| | - M Alves
- Departamento de Bioestatística, Universidade Nova de Lisboa, Lisboa, Portugal
| | - A L Papoila
- Departamento de Bioestatística, Universidade Nova de Lisboa, Lisboa, Portugal
| | - H Trindade
- Centro de Histocompatibilidade do Sul, Universidade Nova de Lisboa, Lisboa, Portugal
| | - E Barroso
- Centro Hepatobiliopancreático e de Transplantação, Hospital Curry Cabral, Universidade Nova de Lisboa, Lisboa, Portugal
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26
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Burra P, De Martin E, Zanetto A, Senzolo M, Russo FP, Zanus G, Fagiuoli S. Hepatitis C virus and liver transplantation: where do we stand? Transpl Int 2015. [DOI: 10.1111/tri.12642] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Patrizia Burra
- Multivisceral Transplant Unit, Gastroenterology; Department of Surgery, Oncology and Gastroenterology; Padua University Hospital; Padua Italy
| | - Eleonora De Martin
- Multivisceral Transplant Unit, Gastroenterology; Department of Surgery, Oncology and Gastroenterology; Padua University Hospital; Padua Italy
- Centre Hepato-Biliaire Paul Brousse; Villejuif France
| | - Alberto Zanetto
- Multivisceral Transplant Unit, Gastroenterology; Department of Surgery, Oncology and Gastroenterology; Padua University Hospital; Padua Italy
| | - Marco Senzolo
- Multivisceral Transplant Unit, Gastroenterology; Department of Surgery, Oncology and Gastroenterology; Padua University Hospital; Padua Italy
| | - Francesco Paolo Russo
- Multivisceral Transplant Unit, Gastroenterology; Department of Surgery, Oncology and Gastroenterology; Padua University Hospital; Padua Italy
| | - Giacomo Zanus
- Hepatobiliary Surgery and Liver Transplantation Unit; Department of Surgery, Oncology and Gastroenterology; Padua University Hospital; Padua Italy
| | - Stefano Fagiuoli
- Gastroenterology and Transplant Hepatology; Papa Giovanni XXIII Hospital; Bergamo Italy
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27
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Belli LS, Romagnoli R, Nardi A, Marianelli T, Donato F, Corradini SG, Iemmolo RM, Morelli C, Pasulo L, Rendina M, De Martin E, Ponziani FR, Volpes R, Strazzabosco M, Angelico M. Recipient female gender is a risk factor for graft loss after liver transplantation for chronic hepatitis C: Evidence from the prospective Liver Match cohort. Dig Liver Dis 2015; 47:689-94. [PMID: 26055490 DOI: 10.1016/j.dld.2015.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 03/28/2015] [Accepted: 04/08/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Female gender has been reported to be a risk factor for graft loss after liver transplantation for hepatitis C virus (HCV)-related cirrhosis but evidence is limited to retrospective studies. AIMS To investigate the impact of recipient gender and donor/recipient gender mismatch on graft outcome. METHODS We performed a survival analysis of a cohort of 1530 first adult transplants enrolled consecutively in Italy between 2007 and 2009 and followed prospectively. After excluding possible confounding factors (fulminant hepatitis, human immunodeficiency virus co-infection, non-viremic anti-HCV positive subjects), a total of 1394 transplant recipients (604 HCV-positive and 790 HCV-negative) were included. RESULTS Five-year graft survival was significantly reduced in HCV-positive patients (64% vs 76%, p=0.0002); Cox analysis identified recipient female gender (HR=1.44, 95% CI 1.03-2.00, p=0.0319), Mayo clinic End stage Liver Disease score (every 10 units, HR=1.25, 95% CI 1.03-1.50; p=0.022), portal thrombosis (HR=2.40, 95% CI 1.20-4.79, p=0.0134) and donor age (every 10 years, HR=1.14, 95% CI 1.05-1.24, p=0.0024) as independent determinants of graft loss. All additional mortality observed among female recipients was attributable to severe HCV recurrence. CONCLUSIONS This study unequivocally shows that recipient female gender unfavourably affects the outcome of HCV-infected liver grafts.
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Affiliation(s)
- Luca Saverio Belli
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy.
| | - Renato Romagnoli
- Liver Transplant Center, Azienda Ospedaliera Città della Salute e della Scienza, University of Turin, Italy
| | - Alessandra Nardi
- Department of Mathematics, Tor Vergata University Hospital, Rome, Italy
| | - Tania Marianelli
- Department of Mathematics, Tor Vergata University Hospital, Rome, Italy
| | - Francesca Donato
- Division of Digestive Diseases, "Maggiore" University Hospital, Milan, Italy
| | | | | | | | - Luisa Pasulo
- Gastroenterology and Transplant Hepatology, San Giovanni XXIII Hospital, Bergamo, Italy
| | - Maria Rendina
- Department of Emergency and Organ Transplantation, University Hospital, Bari, Italy
| | | | | | | | - Mario Strazzabosco
- Digestive Disease Section, University Hospital Milano Bicocca and Yale University Center, New Haven, USA
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Abstract
There are numerous physiologic and biochemical changes in menopause that can affect the function of the liver and mediate the development of liver disease. Menopause represents a state of growing estrogen deficiency, and this loss of estrogen in the setting of physiologic aging increases the likelihood of mitochondrial dysfunction, cellular senescence, declining immune responses to injury, and disarray in the balance between antioxidant formation and oxidative stress. The sum effect of these changes can contribute to increased susceptibility to development of significant liver pathology, particularly nonalcoholic fatty liver disease and hepatocellular carcinoma, as well as accelerated progression of fibrosis in liver diseases, as has been particularly demonstrated in hepatitis C virus liver disease. Recognition of the unique nature of these mediating factors should raise suspicion for liver disease in perimenopausal and menopausal women and offer an opportunity for implementation of aggressive treatment measures so as to avoid progression of liver disease to cirrhosis, liver cancer and liver failure.
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Abstract
BACKGROUND In nontransplant patients with chronic hepatitis C virus (HCV), HCV genotype has been linked with a differential response to antiviral therapy, risk of steatosis and fibrosis, as well as all-cause mortality, but the role of HCV genotypes in posttransplant disease progression is less clear. METHODS Using the multicenter CRUSH-C cohort, genotype-specific rates of advanced fibrosis, HCV-specific graft loss and response of antiviral therapy were examined. RESULTS Among 745 recipients (605 [81%] genotype 1, 53 [7%] genotype 2, and 87 [12%] genotype 3), followed for a median of 3.1 years (range, 2.0-8.0), the unadjusted cumulative rate of advanced fibrosis at 3 years was 31%, 19%, and 19% for genotypes 1, 2, and 3 (P = 0.008). After multivariable adjustment, genotype remained a significant predictor, with genotype 2 having a 66% lower risk (P = 0.02) and genotype 3 having a 41% lower risk (P = 0.07) of advanced fibrosis compared to genotype 1 patients. The cumulative 5-year rates of HCV-specific graft survival were 84%, 90%, and 94% for genotypes 1, 2, and 3 (P = 0.10). A total of 37% received antiviral therapy, with higher rates of sustained virologic response in patients with genotype 2 (hazard ratios, 5.10; P = 0.003) and genotype 3 (hazard ratios, 3.27; P = 0.006) compared to patients with genotype 1. CONCLUSION Risk of advanced fibrosis and response to therapy are strongly influenced by genotype. Liver transplantation recipients with HCV genotype 1 have the highest risk of advanced fibrosis and lowest sustained virologic response rate. These findings highlight the need for genotype-specific management strategies.
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Peyton A, Bhamidimarri KR. Hepatitis C treatment in liver transplant setting. Clin Liver Dis (Hoboken) 2015; 5:145-149. [PMID: 31040972 PMCID: PMC6490518 DOI: 10.1002/cld.475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 02/28/2015] [Accepted: 03/08/2015] [Indexed: 02/04/2023] Open
Affiliation(s)
- Adam Peyton
- From the Division of HepatologyUniversity of Miami–Miller School of MedicineMiamiFL
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31
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Stock PG, Terrault NA. Human immunodeficiency virus and liver transplantation: Hepatitis C is the last hurdle. Hepatology 2015; 61:1747-54. [PMID: 25292153 DOI: 10.1002/hep.27553] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/11/2014] [Indexed: 01/16/2023]
Affiliation(s)
- Peter G Stock
- Departments of Surgery and Medicine, University of California San Francisco, San Francisco, CA
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Li DL, Liu BR. A review of differences in cirrhosis between men and women and characteristics of cirrhosis in females. Shijie Huaren Xiaohua Zazhi 2015; 23:1763-1769. [DOI: 10.11569/wcjd.v23.i11.1763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
There are differences in the disease susceptibility, natural history of liver disease, complications and treatment response between females and males with cirrhosis. Pre-menopausal status for female patients is protective against viral hepatitis C, non-alcoholic steatohepatitis and primary biliary cirrhosis. Smoking accompanied with drinking is a strong risk factor for cirrhosis and malignancies in women with chronic liver disease. Pregnancy increases the incidence of variceal hemorrhage and hepatic encephalopathy in patients with cirrhosis. The choice of contraceptive measures between patients with liver cirrhosis and normal people is the same. The selection of drugs and surgical treatment in female patients with liver cirrhosis before and after pregnancy complications have obvious differences. The organ distribution of model for end-stage liver disease (MELD) scoring system is detrimental to female patients, but the introduction of new drugs for viral hepatitis C is expected to change this difference.
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33
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Fortune BE, Martinez-Camacho A, Kreidler S, Gralla J, Everson GT. Post-transplant survival is improved for hepatitis C recipients who are RNA negative at time of liver transplantation. Transpl Int 2015; 28:980-9. [PMID: 25818896 DOI: 10.1111/tri.12568] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/13/2014] [Accepted: 03/13/2015] [Indexed: 12/16/2022]
Abstract
UNLABELLED Hepatitis C virus (HCV) infection recurs universally in patients who are viremic at liver transplantation and likely accounts for the diminished post-transplant graft and patient survival. We evaluated whether undetectable HCV RNA pretransplant improves graft and patient survival after transplantation. Cases, defined by HCV listing diagnosis and positive HCV antibody, were selected from the Scientific Registry of Transplant Recipients database and further grouped as HCV RNA-positive (n = 4978) or negative (n = 445) based upon pretransplant testing. Controls were non-HCV recipients (n = 2995). RNA-negative cases had significantly better 5-year graft (72% vs. 64%) and patient (79% vs. 69%) survival than RNA-positive cases (P < 0.01 for both), and similar survival as controls (Graft: 72% vs. 74%, PATIENT 79% vs. 80%; P > 0.05 for both). Nonproportional hazards modeling of RNA-positive cases identified a subgroup with rapid progression leading to early graft loss and death. Multivariable analyses confirmed that a positive HCV RNA prior to transplantation was a significant independent predictor of graft loss and death. In conclusion, HCV patients who have undetectable RNA at the time of liver transplantation experience improved long-term graft and patient outcomes. We speculate that the post-transplant survival of HCV recipients could be improved by safe and tolerable pretransplant antiviral strategies.
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Affiliation(s)
- Brett E Fortune
- Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Sarah Kreidler
- Department of Radiology, University of Colorado Denver, Aurora, CO, USA
| | - Jane Gralla
- Department of Pediatrics, University of Colorado Denver, Aurora, CO, USA
| | - Gregory T Everson
- Division of Gastroenterology and Hepatology, University of Colorado Denver, Aurora, CO, USA
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34
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Sarkar M, Watt KD, Terrault N, Berenguer M. Outcomes in liver transplantation: does sex matter? J Hepatol 2015; 62:946-55. [PMID: 25433162 PMCID: PMC5935797 DOI: 10.1016/j.jhep.2014.11.023] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/05/2014] [Accepted: 11/16/2014] [Indexed: 02/06/2023]
Abstract
A growing literature has highlighted important differences in transplant-related outcomes between men and women. In the United States there are fewer women than men on the liver transplant waitlist and women are two times less likely to receive a deceased or living-related liver transplant. Sex-based differences exist not only in waitlist but also in post-transplant outcomes, particularly in some specific liver diseases, such as hepatitis C. In the era of individualized medicine, recognition of these differences in the approach to pre and post-liver transplant care may impact short and long-term outcomes.
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Affiliation(s)
- Monika Sarkar
- Division of Gastroenterology and Hepatology, University of California, San Francisco, 513 Parnassus Avenue, S-357, San Francisco, CA 94143, USA.
| | - Kymberly D Watt
- Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, 200 First St, Rochester, MN 55905, USA
| | - Norah Terrault
- Division of Gastroenterology and Hepatology, University of California, San Francisco, 513 Parnassus Avenue, S-357, San Francisco, CA 94143, USA
| | - Marina Berenguer
- Hepatology and Liver Transplantation Unit, La Fe Hospital and Ciberehd, Universidad Valencia, C/Bulevar Sur sn (Torre F-5) 46026 Valencia, Spain
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35
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Oloruntoba OO, Moylan CA. Gender-based disparities in access to and outcomes of liver transplantation. World J Hepatol 2015; 7:460-467. [PMID: 25848470 PMCID: PMC4381169 DOI: 10.4254/wjh.v7.i3.460] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 12/03/2014] [Accepted: 12/17/2014] [Indexed: 02/06/2023] Open
Abstract
Despite comprising 35% of transplants, the number of female transplant recipients has continued to decline. Accordingly, there is a growing attention to the issue of access to and outcomes of liver transplantation in women. The purpose of this review is to critically evaluate the published literature on etiologies contributing to gender-based disparities in liver transplantation focusing on the steps from chronic liver disease through transplantation including disparities in liver disease prevalence, access to liver transplant centers and transplant waiting list, receipt of liver transplantation once listed and disparities in post-liver transplantation outcomes. Our review finds factors contributing to this disparity may include gender differences in the etiology of underlying liver disease and patient and physician referral patterns, lifestyle and health care, but also utilization of an imperfect organ allocation system based on the model for end stage liver disease score and donor-recipient liver size matching. The review also highlights the need for further research in the area of gender disparity in order to develop appropriate approaches to address it and to improve allocation of this precious resource in the future.
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36
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Rodríguez-Castro KI, De Martin E, Gambato M, Lazzaro S, Villa E, Burra P. Female gender in the setting of liver transplantation. World J Transplant 2014; 4:229-242. [PMID: 25540733 PMCID: PMC4274594 DOI: 10.5500/wjt.v4.i4.229] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 05/27/2014] [Accepted: 07/15/2014] [Indexed: 02/05/2023] Open
Abstract
The evolution of liver diseases to end-stage liver disease or to acute hepatic failure, the evaluation process for liver transplantation, the organ allocation decision-making, as well as the post-transplant outcomes are different between female and male genders. Women’s access to liver transplantation is hampered by the use of model for end-stage liver disease (MELD) score, in which creatinine values exert a systematic bias against women due to their lower values even in the presence of variable degrees of renal dysfunction. Furthermore, even when correcting MELD score for gender-appropriate creatinine determination, a quantifiable uneven access to transplant prevails, demonstrating that other factors are also involved. While some of the differences can be explained from the epidemiological point of view, hormonal status plays an important role. Moreover, the pre-menopausal and post-menopausal stages imply profound differences in a woman’s physiology, including not only the passage from the fertile age to the non-fertile stage, but also the loss of estrogens and their potentially protective role in delaying liver fibrosis progression, amongst others. With menopause, the tendency to gain weight may contribute to the development of or worsening of pre-existing metabolic syndrome. As an increasing number of patients are transplanted for non-alcoholic steatohepatitis, and as the average age at transplant increases, clinicians must be prepared for the management of this particular condition, especially in post-menopausal women, who are at particular risk of developing metabolic complications after menopause.
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37
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Allen AM, Hay JE. Review article: the management of cirrhosis in women. Aliment Pharmacol Ther 2014; 40:1146-54. [PMID: 25263269 DOI: 10.1111/apt.12974] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 07/21/2014] [Accepted: 09/09/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are differences in the predisposition, natural history of liver disease, complications and treatment response between men and women. AIM To review clinical differences in cirrhosis between men and women and to address unique management issues of fertility, pregnancy and contraception in this patient population. METHODS PubMed and MEDLINE were searched using the terms 'cirrhosis' and 'chronic liver disease', each cross-referenced with specific liver diseases, as well as terms such as 'cancer', 'hepatocellular carcinoma', 'smoking', 'liver transplantation', 'metabolic bone disease', 'fertility',' pregnancy' and 'contraception'. RESULTS Pre-menopausal status is protective in viral hepatitis C and non-alcoholic steatohepatitis. However, smoking, especially in combination with alcohol, is a stronger risk factor for cirrhosis and malignancies in women with chronic liver disease compared to men, although they are less likely than men to develop hepatocellular carcinoma. Women with cirrhosis have more osteopenic bone disease than men and require active management. Successful pregnancy is possible in well-compensated cirrhosis or with mild portal hypertension, although the maternal and foetal mortality and morbidity are higher than in the general population. The maternal risk correlates with liver disease severity and derives mostly from variceal bleeding. The choices for contraception in compensated cirrhosis are generally the same as for the general population. Women with cirrhosis are disadvantaged by the current MELD system of organ allocation, at least in part due to body size. CONCLUSION The management of women with chronic liver disease is unique in regards to counselling, screening for complications, fertility and pregnancy.
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Affiliation(s)
- A M Allen
- Hepatology and Liver Transplantation, Mayo Clinic, Rochester, MN, USA
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38
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Campos-Varela I, Esteban JI, Bes M, Caralt M, Allende H, Rodríguez-Frías F, Salcedo MT, Sauleda S, Charco R, Guardia J, Esteban R, Castells L. Early predictors of antiviral treatment response in liver transplant recipients with recurrent hepatitis C genotype 1. J Viral Hepat 2014; 21:e118-28. [PMID: 24620835 DOI: 10.1111/jvh.12246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 01/14/2014] [Indexed: 12/09/2022]
Abstract
The success of current antiviral treatment for hepatitis C virus (HCV) recurrence in liver transplant (LT) recipients remains limited. We aimed at evaluating the value of IL28B genotype and early viral kinetics to predict response to standard treatment in the transplant setting. We retrospectively evaluated 104 LT recipients treated for HCV genotype 1 recurrence between 2001 and 2010. Baseline variables, including IL28B genotype, and early viral kinetics were compared among patients who did or did not achieve a sustained virological response (SVR). Logistic regression analyses of candidate variables were conducted to generate a reliable predictive model based on the minimum set of variables. Twenty-nine (28%) achieved an SVR. On multivariate analysis, the magnitude of HCV RNA decline at 4 weeks (OR: 3.74, 95% CI: 1.64-9.39; P = 0.003) and treatment compliance (OR: 35.27, 95% CI: 3.35-365.54; P = 0.003) were the only independent predictors of SVR. Favourable recipient IL28B genotype significantly correlates with virological response at week 4 (OR 3.23; 95% CI, 1.12-9.15; P = 0.03). By logistic regression analysis, a model including donor age, recipient rs12979860 genotype and viral load at 4 weeks showed the best predictive value for SVR with an area under the receiver operating curve of 0.861. Favourable recipient IL28B genotype strongly correlates with the viral response at week 4 which is the strongest predictor of response. The combination of recipient IL28B genotype and donor age with the week 4 response reliably estimates the probability of SVR early on-treatment and may facilitate therapeutic strategies incorporating new antiviral agents.
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Affiliation(s)
- I Campos-Varela
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
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39
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Flemming JA, Vagefi PA, Freise CE, Yao FY, Terrault NA. Restricting liver transplant recipients to younger donors does not increase the wait-list time or the dropout rate: the hepatitis C experience. Liver Transpl 2014; 20:1202-10. [PMID: 24961679 PMCID: PMC4803440 DOI: 10.1002/lt.23937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 06/06/2014] [Indexed: 01/12/2023]
Abstract
Older donor age is associated with lower graft and patient survival among all recipients of liver transplantation (LT). Among patients with hepatitis C virus (HCV), donor age is one of the strongest predictors of fibrosis severity and graft loss. We evaluated the implementation of a donor age restriction policy for LT patients with HCV at a single center and the effects that this policy had on wait-list (WL) and post-LT outcomes for HCV and non-HCV patients. This was a cohort study of 2388 WL patients and 1015 LT recipients between March 2002 and January 2013 and reflected 3 different eras of donor age policies. With the donor age restriction, the median donor age was reduced in LT recipients with HCV versus LT recipients without HCV (30 versus 48 years, P < 0.001) without differences in the WL time (10.6 versus 8.0 months, P = 0.23). According to a competing risks regression, those with HCV and those without HCV had lower subhazard ratios (SHRs) of dropout or death on the WL during the donor age restriction era versus the era without donor age restriction [SHR = 0.68 (P < 0.01) and SHR = 0.64 (P = 0.01), respectively]. No differences were seen in early post-LT survival for patients with or without HCV between eras (P = 0.7 and P = 0.88, respectively). In conclusion, we show that donor age restriction for HCV results in a lower donor age for HCV recipients without obvious adverse WL consequences. Although additional studies are needed, our results demonstrate the feasibility of donor age restriction for LT recipients with HCV, and such information may be relevant to programs with limited access to new antiviral therapies for which modifying the risk of severe disease remains of paramount importance.
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Affiliation(s)
- Jennifer A. Flemming
- Department of Medicine, Queen’s University, Kingston, Canada,Division of Cancer Care and Epidemiology, Queen’s University, Kingston, Canada
| | - Parsia A. Vagefi
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Chris E. Freise
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Francis Y. Yao
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Norah A. Terrault
- Department of Medicine, University of California San Francisco, San Francisco, CA
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40
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Liu Z, Chen Y, Tao R, Xv J, Meng J, Yong X. Tacrolimus-based versus cyclosporine-based immunosuppression in hepatitis C virus-infected patients after liver transplantation: a meta-analysis and systematic review. PLoS One 2014; 9:e107057. [PMID: 25198195 PMCID: PMC4157850 DOI: 10.1371/journal.pone.0107057] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 08/05/2014] [Indexed: 02/06/2023] Open
Abstract
Background Most liver transplant recipients receive calcineurin inhibitors (CNIs), especially tacrolimus and cyclosporine, as immunosuppressant agents to prevent rejection. A controversy exists as to whether the outcomes of hepatitis C virus (HCV)-infected liver transplant patients differ based on the CNIs used. This meta-analysis compares the clinical outcomes of tacrolimus-based and cyclosporine-based immunosuppression, especially cases of HCV recurrence in liver transplant patients with end-stage liver disease caused by HCV infection. Methods Related articles were identified from the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, Medline, and Embase. Meta-analyses were performed for the results of homogeneous studies. Results Nine randomized or quasi-randomized controlled trials were included. The total effect size of mortality (RR = 0.98, 95% CI: 0.77–1.25, P = 0.87) and graft loss (RR = 1.05, 95% CI: 0.83–1.33, P = 0.67) showed no significant difference between the two groups irrespective of duration of immunosuppressant therapy after liver transplantation. In addition, the HCV recurrence-induced mortality (RR = 1.11, 95% CI: 0.66–1.89, P = 0.69), graft loss (RR = 1.62, 95% CI: 0.64–4.07, P = 0.31) and retransplantation (RR = 1.40, 95% CI: 0.48–4.09, P = 0.54), as well as available biopsies, confirmed that histological HCV recurrences (RR = 0.92, 95% CI: 0.71–1.19, P = 0.51) were similar. Conclusion These results suggested no difference in posttransplant HCV recurrence-induced mortality, graft loss and retransplantation, as well as histological HCV recurrence in patients treated with tacrolimus-based and cyclosporine-based immunosuppresion.
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Affiliation(s)
- Zhenmin Liu
- Department of Periodontology and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, Guangxi, China
| | - Yi Chen
- Department of Periodontology and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, Guangxi, China
| | - Renchuan Tao
- Department of Periodontology and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, Guangxi, China
- * E-mail:
| | - Jing Xv
- Department of Hepato-biliary Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jianyuan Meng
- Department of Hepato-biliary Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiangzhi Yong
- Department of Periodontology and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, Guangxi, China
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41
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Kakati B, Seetharam A. Hepatitis C Recurrence after Orthotopic Liver Transplantation: Mechanisms and Management. J Clin Transl Hepatol 2014; 2:189-96. [PMID: 26355427 PMCID: PMC4521242 DOI: 10.14218/jcth.2014.00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/06/2014] [Accepted: 07/07/2014] [Indexed: 12/04/2022] Open
Abstract
Chronic Hepatitis C (HCV) infection is the leading indication for orthotopic liver transplantation and recurrence is nearly universal. Chronic HCV infection is frequently established through evasion of the innate immune system. Priming of adaptive immune responses modulate the severity and rate of fibrosis progression. Those with demonstrable viremia entering the transplant period uniformly suffer recurrence post-transplant. Progression to cirrhosis is accelerated post-transplant secondary to systemic immunosuppression. In addition, a number of factors, including donor, host, and viral characteristics, influence severity and rate of fibrosis progression. Interferon-based therapy, the previous standard of care, in those with advanced cirrhosis or post-transplant has been limited by a number of issues. These include a relative lack of efficacy and poor tolerability with higher incidence of infection and anemia. Recently, approval of direct acting antivirals have ushered in a new era in HCV therapeutics and have applicability in these special populations. Their use immediately prior to or post-transplant is expected to improve both morbidity and mortality.
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Affiliation(s)
- Bobby Kakati
- Banner Transplant and Advanced Liver Disease Center, Phoenix, AZ, USA
| | - Anil Seetharam
- Banner Transplant and Advanced Liver Disease Center, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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42
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deLemos AS, Schmeltzer PA, Russo MW. Recurrent hepatitis C after liver transplant. World J Gastroenterol 2014; 20:10668-81. [PMID: 25152571 PMCID: PMC4138448 DOI: 10.3748/wjg.v20.i31.10668] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/25/2014] [Accepted: 04/02/2014] [Indexed: 02/06/2023] Open
Abstract
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, IL28B 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, NS5B polymerase inhibitors and NS5A inhibitors holds great promise in improving outcomes for liver transplant candidates and recipients.
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43
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Verna EC. Hepatitis viruses and liver transplantation: evolving trends in antiviral management. Clin Liver Dis 2014; 18:575-601. [PMID: 25017077 DOI: 10.1016/j.cld.2014.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Viral hepatitis is both a leading indication for liver transplant (LT) and an important cause of posttransplant graft loss and mortality. Treatment and prevention of hepatitis B virus in LT recipients, with the observed corresponding improvement in post-LT outcomes, is among the great success stories in transplantation. By comparison, treatment of hepatitis C virus with safe and effective regimens is only just becoming a reality. Chronic hepatitis E virus infection in LT recipients represents a newly described phenomenon that can also lead to graft loss; early diagnosis and treatment may be key in the management of these patients.
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Affiliation(s)
- Elizabeth C Verna
- Division of Digestive and Liver Diseases, Center for Liver Disease and Transplantation, Columbia University College of Physicians and Surgeons, 622 West 168th Street, New York, NY 10032, USA.
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44
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Abstract
The greatest challenge facing liver transplantation today is the shortage of donor livers. Demand far exceeds supply, and this deficit has driven expansion of what is considered an acceptable organ. The evolving standard has not come without costs, however, as each new frontier of expanded donor quality (i.e., advancing donor age, donation after cardiac death, and split liver) may have traded wait-list for post-transplant morbidity and mortality. This article delineates the nature and severity of risk associated with specific deceased donor liver characteristics and recommends strategies to maximally mitigate these risks.
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Affiliation(s)
- Sandy Feng
- Division of Abdominal Transplantation, Department of Surgery, University of California, 505 Parnassus Avenue, UCSF Box 0780, San Francisco, San Francisco, CA 94143, USA.
| | - Jennifer C Lai
- Division of Gastroenterology/Hepatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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45
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Dhanasekaran R, Firpi RJ. Challenges of recurrent hepatitis C in the liver transplant patient. World J Gastroenterol 2014; 20:3391-3400. [PMID: 24707122 PMCID: PMC3974506 DOI: 10.3748/wjg.v20.i13.3391] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 11/22/2013] [Accepted: 03/10/2014] [Indexed: 02/06/2023] Open
Abstract
Cirrhosis secondary to hepatitis C virus (HCV) is a very common indication for liver transplant. Unfortunately recurrence of HCV is almost universal in patients who are viremic at the time of transplant. The progression of fibrosis has been shown to be more rapid in the post-transplant patients than in the transplant naïve, hence treatment of recurrent HCV needs to be considered for all patients with documented recurrent HCV. Management of recurrent HCV is a challenging situation both for patients and physicians due to multiple reasons as discussed in this review. The standard HCV treatment with pegylated interferon and Ribavarin can be considered in these patients but it leads to a lower rate of sustained virologic clearance than in the non-transplanted population. Some of the main challenges associated with treating recurrent HCV in post-transplant patients include the presence of cytopenias; need to monitor drug-drug interactions and the increased incidence of renal compromise. In spite of these obstacles all patients with recurrent HCV should be considered for treatment since it is associated with improvement in survival and a delay in fibrosis progression. With the arrival of direct acting antiviral drugs there is renewed hope for better outcomes in the treatment of post-transplant HCV recurrence. This review evaluates current literature on this topic and identifies challenges associated with the management of post-transplant HCV recurrence.
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Hibi T, Nishida S, Sageshima J, Levi DM, Ruiz P, Roth D, Martin P, Okabayashi K, Burke GW, Ciancio G, Tzakis AG. Excessive immunosuppression as a potential cause of poor survival in simultaneous liver/kidney transplantation for hepatitis C. Transpl Int 2014; 27:606-16. [PMID: 24606223 DOI: 10.1111/tri.12303] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 08/26/2013] [Accepted: 03/03/2014] [Indexed: 02/06/2023]
Abstract
Appropriate recipient selection of simultaneous liver/kidney transplantation (SLKT) remains controversial. In particular, data on liver graft survival in hepatitis C virus-infected (HCV+) SLKT recipients are lacking. We conducted a single-center, retrospective study of HCV+ SLKT recipients (N = 25) in comparison with HCV- SLKT (N = 26) and HCV+ liver transplantation alone (LTA, N = 296). Despite backgrounds of HCV+ and HCV- SLKT being similar, HCV+ SLKT demonstrated significantly impaired 5-year liver graft survival of 35% (HCV- SLKT, 79%, P = 0.004). Compared with HCV+ LTA, induction immunosuppression was more frequently used in HCV+ SLKT. Five-year liver graft survival rate for HCV+ SLKT was significantly lower than that for LTA (35% vs. 74%, respectively, P < 0.001). Adjusted hazard ratio of liver graft loss in HCV+ SLKT was 4.9 (95% confidence interval 2.0-12.1, P = 0.001). HCV+ SLKT recipients were more likely to succumb to recurrent HCV and sepsis compared with LTA (32% vs. 8.8%, P < 0.001 and 24% vs. 8.8%, P = 0.030, respectively). Ten HCV+ SLKT recipients underwent anti-HCV therapy for recurrent HCV; only 1 achieved sustained virological response. HCV+ SLKT is associated with significantly decreased long-term prognosis compared with HCV- SLKT and HCV+ LTA.
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Affiliation(s)
- Taizo Hibi
- Miami Transplant Institute, University of Miami Leonard M. Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA; DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA; Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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El Awady MK, Bader El Din NG, Abdel Aziz Riad M, Omran MH, Abdelhafez TH, Elbaz TM, Hunter SS, Dawood RM, Abdel Aziz AO. Predictors of disease recurrence post living donor liver transplantation in end stage chronic HCV patients. DISEASE MARKERS 2014; 2014:202548. [PMID: 24695489 PMCID: PMC3948502 DOI: 10.1155/2014/202548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 12/14/2013] [Accepted: 12/24/2013] [Indexed: 12/22/2022]
Abstract
HCV recurrence represents a universal phenomenon after liver transplantation. In this study Fifty HCV patients who underwent living donor liver transplantation were enrolled and factors that may accelerate HCV reinfection of the allograft such as donor's age and degree of liver steatosis, recipient's age, gender, BMI, MELD score, liver functions, HCV viral load, type of immunosuppressive drug, and genetic polymorphisms of IL28B, OAS, and IL1B were studied. The results of disease-free survival (DFS) rates showed inverse correlation with the recipient's postoperative levels of ALT, AST, ALP (P < 0.001, <0.001, and 0.006 resp.) as well as pre- and postoperative titers of HCV RNA (P < 0.003 and <0.001 resp.). Recipient's IL28B SNP was a significant factor in predicting postoperative DFS (P < 0.025). However, SNPs in OAS and IL1B genes had no apparent correlation with DFS. Cox proportional hazards model revealed that patients with elevated levels of ALT, preoperative viral titers, IL28B CT, and IL28B TT were 8.28, 4.22, 3.35, and 1.36 times, respectively, more likely to develop recurrence. In conclusion IL28B SNP, ALT level, and preoperative HCV titer besides proper choice of immunosuppressant are helpful for predicting posttransplant HCV recurrence and DFS.
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Affiliation(s)
- Mostafa K. El Awady
- Department of Microbial Biotechnology, National Research Center, Dokki, Cairo, 12622, Egypt
| | - Noha G. Bader El Din
- Department of Microbial Biotechnology, National Research Center, Dokki, Cairo, 12622, Egypt
| | | | - Moataza H. Omran
- Department of Microbial Biotechnology, National Research Center, Dokki, Cairo, 12622, Egypt
| | - Tawfeek H. Abdelhafez
- Department of Microbial Biotechnology, National Research Center, Dokki, Cairo, 12622, Egypt
| | - Tamer Mahmoud Elbaz
- Department of Tropical Medicine, Kasr El Aini, Cairo University, Cairo, Egypt
| | | | - Reham M. Dawood
- Department of Microbial Biotechnology, National Research Center, Dokki, Cairo, 12622, Egypt
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Reddy MS, Varghese J, Venkataraman J, Rela M. Matching donor to recipient in liver transplantation: Relevance in clinical practice. World J Hepatol 2013; 5:603-611. [PMID: 24303088 PMCID: PMC3847943 DOI: 10.4254/wjh.v5.i11.603] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 10/23/2013] [Accepted: 11/05/2013] [Indexed: 02/06/2023] Open
Abstract
Achieving optimum outcomes after liver transplantation requires an understanding of the interaction between donor, graft and recipient factors. Within the cohort of patients waiting for a transplant, better matching of the donor organ to the recipient will improve transplant outcomes and benefit the overall waiting list by minimizing graft failure and need for re-transplantation. A PubMed search was conducted to identify published literature investigating the effects of donor factors such as age, gender, ethnicity, viral serology; graft factors such as size and quality, recipient factors such as age, size, gender and transplant factors such as major or minor blood group incompatibility and immunological factors. We also report technical and therapeutic modifications that can be used to manage donor-recipient mismatch identified from literature and the authors’ clinical experience. Multiple donor and recipient factors impact graft survival after liver transplantation. Appropriate matching based on donor-organ-recipient variables, modification of surgical technique and innovative peri-transplant strategies can increase the donor pool by utilizing grafts from marginal donors that are traditionally turned down.
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Ruiz-Extremera Á, Muñoz-Gámez JA, Abril-Molina A, Salmerón-Ruiz MA, Muñoz-de-Rueda P, Pavón-Castillero EJ, Quiles-Pérez R, Carazo Á, Gila A, Jimenez-Ruiz SM, Casado J, Martín AB, Sanjuán-Núñez L, Ocete-Hita E, Viota JL, León J, Salmerón J. Variation of transaminases, HCV-RNA levels and Th1/Th2 cytokine production during the post-partum period in pregnant women with chronic hepatitis C. PLoS One 2013; 8:e75613. [PMID: 24130726 PMCID: PMC3794969 DOI: 10.1371/journal.pone.0075613] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 08/15/2013] [Indexed: 12/15/2022] Open
Abstract
This study analyses the evolution of liver disease in women with chronic hepatitis C during the third trimester of pregnancy and the post-partum period, as a natural model of immune modulation and reconstitution. Of the 122 mothers recruited to this study, 89 were HCV-RNA+ve/HIV-ve and 33 were HCV-RNA-ve/HIV-ve/HCVantibody+ve and all were tested during the third trimester of pregnancy, at delivery and post-delivery. The HCV-RNA+ve mothers were categorized as either Type-A (66%), with an increase in ALT levels in the post-partum period (>40 U/L; P<0.001) or as Type-B (34%), with no variation in ALT values. The Type-A mothers also presented a significant decrease in serum HCV-RNA levels in the post-delivery period (P<0.001) and this event was concomitant with an increase in Th1 cytokine levels (INFγ, P = 0.04; IL12, P = 0.01 and IL2, P = 0.01). On the other hand, the Type-B mothers and the HCV-RNA-ve women presented no variations in either of these parameters. However, they did present higher Th1 cytokine levels in the partum period (INFγ and IL2, P<0.05) than both the Type-A and the HCV-RNA-ve women. Cytokine levels at the moment of delivery do not constitute a risk factor associated with HCV vertical transmission. It is concluded that differences in the ALT and HCV-RNA values observed in HCV-RNA+ve women in the postpartum period might be due to different ratios of Th1 cytokine production. In the Type-B women, the high partum levels of Th1 cytokines and the absence of post-partum variation in ALT and HCV-RNA levels may be related to permanent Th1 cytokine stimulation.
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Affiliation(s)
- Ángeles Ruiz-Extremera
- Paediatric Unit, San Cecilio University Hospital, Granada, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Ciberehd, Granada, Spain
- Paediatric Unit, Granada University, Granada, Spain
| | | | | | | | - Paloma Muñoz-de-Rueda
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Ciberehd, Granada, Spain
- Clinical Management Unit of Digestive Disease, San Cecilio University Hospital, Granada, Spain
| | | | - Rosa Quiles-Pérez
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Ciberehd, Granada, Spain
- Clinical Management Unit of Digestive Disease, San Cecilio University Hospital, Granada, Spain
| | - Ángel Carazo
- Clinical Management Unit of Digestive Disease, San Cecilio University Hospital, Granada, Spain
| | - Ana Gila
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Ciberehd, Granada, Spain
- Clinical Management Unit of Digestive Disease, San Cecilio University Hospital, Granada, Spain
| | - Sergio Manuel Jimenez-Ruiz
- Clinical Management Unit of Digestive Disease, San Cecilio University Hospital, Granada, Spain
- Medicine Department, Granada University, Granada, Spain
| | - Jorge Casado
- Clinical Management Unit of Digestive Disease, San Cecilio University Hospital, Granada, Spain
| | - Ana Belén Martín
- Clinical Management Unit of Digestive Disease, San Cecilio University Hospital, Granada, Spain
| | - Laura Sanjuán-Núñez
- Clinical Management Unit of Digestive Disease, San Cecilio University Hospital, Granada, Spain
- Medicine Department, Granada University, Granada, Spain
| | - Esther Ocete-Hita
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Ciberehd, Granada, Spain
- Paediatric Unit, Granada University, Granada, Spain
- Paediatric Unit, Virgen de las Nieves Hospital, Granada, Spain
| | - Julián López Viota
- Clinical Management Unit of Digestive Disease, San Cecilio University Hospital, Granada, Spain
| | - Josefa León
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Ciberehd, Granada, Spain
- Clinical Management Unit of Digestive Disease, San Cecilio University Hospital, Granada, Spain
| | - Javier Salmerón
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Ciberehd, Granada, Spain
- Clinical Management Unit of Digestive Disease, San Cecilio University Hospital, Granada, Spain
- Medicine Department, Granada University, Granada, Spain
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Guy J, Peters MG. Liver disease in women: the influence of gender on epidemiology, natural history, and patient outcomes. Gastroenterol Hepatol (N Y) 2013; 9:633-639. [PMID: 24764777 PMCID: PMC3992057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Women more commonly present with acute liver failure, autoimmune hepatitis, benign liver lesions, primary biliary cirrhosis, and toxin-mediated hepatotoxicity. Women less commonly have malignant liver tumors, primary sclerosing cholangitis, and viral hepatitis. There is a decreased rate of decompensated cirrhosis in women with hepatitis C virus infection, no survival difference in alcohol-related liver disease, and improved survival from hepatocellular carcinoma. In general, men are 2-fold more likely to die from chronic liver disease and cirrhosis than are women. Liver transplant occurs less commonly in women than in men, with variable disease outcomes based on etiology. This review highlights the epidemiology, natural history, treatment outcomes, and pathophysiology of common liver diseases in women and discusses how gender influences disease incidence, presentation, progression, and outcomes. Pregnancy-related liver disease is not covered.
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Affiliation(s)
- Jennifer Guy
- Dr Guy is the medical director of the Liver Cancer Program and a gastroenterologist in the Division of Hepatology at the California Pacific Medical Center in San Francisco, California. Dr Peters is chief of hepatology research and a professor of medicine at the University of California, San Francisco in San Francisco, California
| | - Marion G Peters
- Dr Guy is the medical director of the Liver Cancer Program and a gastroenterologist in the Division of Hepatology at the California Pacific Medical Center in San Francisco, California. Dr Peters is chief of hepatology research and a professor of medicine at the University of California, San Francisco in San Francisco, California
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