PAPER. Liver Transplant for Hepatitis C Virus. Effect of Using Older Donor Grafts on Short- and Medium-Term Survival
|
|
- Amanda Jackson
- 5 years ago
- Views:
Transcription
1 PAPER Liver Transplant for Hepatitis C Virus Effect of Using Older Donor Grafts on Short- and Medium-Term Survival M. B. Majella Doyle, MD; Christopher D. Anderson, MD; Neeta Vachharajani, MD; Jeffrey A. Lowell, MD; Surendra Shenoy, MD; Mauricio Lisker-Melman, MD; Kevin Korenblat, MD; Jeffrey S. Crippin, MD; William C. Chapman, MD Hypothesis: Older donor grafts will provide suitable results of liver transplant, even in recipients with hepatitis C virus (HCV). Although HCV remains the leading indication for liver transplant in adults in the United States, it is associated with HCV recurrence, increased graft loss, and reduced survival. In addition, recent studies suggest that the use of older donors in recipients with HCV is associated with significantly worsened short- and longterm survival. Design: Prospective database analysis. Setting: Washington University School of Medicine. Patients: Between January 1, 1997, and June 30, 06, a total of 579 liver transplants were performed. Ninety pediatric transplants were excluded. Of the remaining 489 adult patients (84.5%), 187 (38.2%) had HCV and 302 (61.8%) had other indications. Main Outcome Measures: Patient and graft survival, recurrence of HCV, and need for and results of retransplant. Results: At 1, 3, and 5 years, overall patient survival was 88.1%, 78.3%, and 69.2%, respectively, and graft survival was 85.6%, 75.6%, and 65.6%, respectively, in patients with HCV. There was no significant difference in patient or graft survival between patients with and those without HCV. Recurrent HCV with clinically significant disease was % at 1 year and 62% at 10 years. Seventy-two patients received transplants from donors years or older (24 of 187 [12.8%] with HCV and 48 of 302 [15.9%] without HCV). No difference was demonstrated in short- or medium-term patient or graft survival in recipients of grafts from older donors. Conclusion: The increasing use of marginal donors, including carefully selected older donors, does not seem to adversely affect short- or medium-term results and may be a source of additional organs for expanding liver transplant waiting lists. Arch Surg. 08;143(7): Author Affiliations: Section of Abdominal Transplantation, Department of Surgery (Drs Doyle, Anderson, Vachharajani, Lowell, Shenoy, and Chapman), and Division of Gastroenterology, Department of Medicine (Drs Lisker- Melman, Korenblat, and Crippin), Washington University School of Medicine, St Louis, Missouri. HEPATITIS C VIRUS (HCV) infection is currently the most common cause of cirrhosis in the United States. Based on data from the Organ Procurement and Transplant Network, 63 liver transplants were performed in the United States in 06, and the leading indication was for HCV cirrhosis. In addition, patients are currently wait-listed for liver transplant, leaving a large discrepancy and a shortage of available donors. Although the number of potential brain-dead donors has steadily increased in the past 10 years, most of this increase is from extended criteria donors (ECDs). Donation after cardiac death, ECDs, split liver transplant, living donation, and the use of HCV-positive donors for recipients with HCV are all being more widely used by many medical centers to increase the donor pool. There are concerning reports, however, in recipients with HCV that ECDs, particularly older donors, are associated with poorer outcome, especially with early and severe HCV recurrence in the donor graft. 1 Many of these reports are based on data from large multicenter databases. Although the cause of clinically significant recurrent HCV infection is likely multifactorial, donor age may be a risk factor. However, there are single-center studies suggesting that other factors, including steatosis and prolonged cold ischemia, are more significant risk factors for recurrent HCV than is donor age. 2 Furthermore, disease recurrence does not seem to be affected by the use of HCV-positive donors 3 younger than 50 years with minimal hepatitis and no fibrosis on biopsy. 4 Recurrence of HCV after liver transplant in HCV-positive recipients is nearly universal, but there are wide variations in clinical significance and allograft injury. 5 It is reported that 5% to 45% of recipients with HCV are at risk of progression to end-stage liver disease from recurrent 679
2 Table 1. Indications for Liver Transplant in 489 Patients Disease HCV infection in 5 to10 years. Recurrent HCV cirrhosis is the major cause of the increased graft loss and reduced long-term survival often reported in this patient population. 6-8 Complicating this matter is the poor efficacy of HCV treatment, with reports of % response rates and considerable associated morbidity. 8,9 Retransplant for recurrent HCV is widely debated and usually not recommended for recurrence within 1 year of initial transplant. Some researchers 8,10,11 suggest that survival is significantly reduced in these patients. However, others 12,13 maintain that in carefully selected recipients, retransplant for HCV is acceptable. The present study was undertaken to assess our experience with liver transplant for HCV during the past 10 years. We were especially interested in results with older donor graft use in the HCV-positive population. METHODS Transplants, No. (%) a HCV 187 (38.2) Non-HCV 302 (61.8) Alcoholic cirrhosis 59 (19.5) Cryptogenic cirrhosis 37 (12.3) PSC 36 (11.9) PBC 26 (8.6) Autoimmune hepatitis 24 (8.0) Hepatitis B virus 23 (7.6) Acute liver failure 18 (6.0) Metabolic disorders 17 (5.6) NASH 15 (5.0) Miscellaneous 47 (15.6) Abbreviations: HCV, hepatitis C virus; NASH, nonalcoholic steatohepatitis; PBC, primary biliary cirrhosis; PSC, primary sclerosing cholangitis. a Percentages for HCV and non-hcv are based on 489 patients, and all other percentages are based on 302 patients. Table 2. Comparison of Patients With vs Those Without HCV HCV Group (n=187) A prospectively maintained clinical transplant database that includes recipient and donor demographics, clinical details, and recipient outcomes was used for this study. All adult transplants performed between January 1, 1997, and June 30, 06, were reviewed. Adult recipients with HCV were compared with patients with other causes of liver disease, including nonalcoholic steatohepatitis, cryptogenic cirrhosis, autoimmune hepatitis, previous alcohol use, primary sclerosing cholangitis, primary biliary cirrhosis, hepatitis B virus, acute liver failure, metabolic disorders, and miscellaneous causes (Table 1). Liver grafts from standard brain dead donors, ECDs, and donation after cardiac death donors were used. The HCV-positive recipients were considered for HCV-positive grafts. Patient and graft survival rates of HCV recurrence and retransplant were evaluated. We also compared outcomes among HCV-positive recipients who received grafts from older donors ( and 65 years), HCV-positive recipients who received grafts from younger donors ( and 65 years), and HCV-negative recipients of older grafts. At Washington University School of Medicine, we use a standard 3-drug immunosuppression regimen that includes tacrolimus (Prograf; Astellas Pharma US Inc, Deerfield, Illinois), corticosteroids (discontinued by 4-6 months), and an antimetabolite. Posttransplant bolus corticosteroid administration was used only for biopsy-proved severe rejection. Antibody induction therapy is not used at Washington University in liver transplant. Cox multivariate analysis was performed to independently assess factors such as donor and recipient age, presence of HCV, warm and cold ischemia times, and Model for End-Stage Liver Disease (MELD) scores. Graft and patient survival rates were analyzed using Kaplan-Meier curves and log-rank analysis. Group homogeneity assessment was performed using the 2-tailed t test or the 2 test as appropriate. Differences were judged to be statistically significant when P.05. RESULTS Non-HCV Group (n=302) P Value Recipient age, 50.3 (30-75) 51.1 (18-75).39 mean (range), y Donor age, 38.3 (7-75) 41.2 (8-78).07 mean (range), y Warm ischemia time, (25-59) 39 (33-59).25 median (range), min Cold ischemia time, 6.3 (0:44-11:16) 6.2 (0:27-11:54).52 median (range), h a MELD score, mean 21 (6-37) 24 (7-43).001 (range) MELD score without 17.2 (6-) 21.8 (5-50).001 exception points, mean (range) Split liver transplants, 5 (2.7) 7 (2.3).06 No. (%) Living donors, No. (%) 3 (1.6) 10 (3.3).42 DCD donors, No. (%) 6 (3.2) 5 (1.7). HCV-positive donors, No. (%) 7 (3.7) NA NA Abbreviations: DCD, donation after cardiac death; HCV, hepatitis C virus; MELD, Model for End-Stage Liver Disease; NA, not applicable. a The range is given as hours:minutes. During the 10-year study period, 579 liver transplants were performed. Ninety pediatric liver transplants (15.5%) were excluded from the study. Of the 489 remaining patients included in this analysis, 187 (38.2%) had HCV and 302 (61.8%) had other indications for transplant (Table 1). The median follow-up was 55 months. In the HCV and non- HCV groups, the median donor age was and 44 years and the median recipient age was 49 and 53 years, respectively. The male to female ratio was 3:1 in the HCV group and 1.2:1 in the non-hcv group. The mean MELD score at transplant was 21 in the HCV group and 24 in the non- HCV group (P.001). The most common causes of non- HCV cirrhosis were alcoholic liver disease and cryptogenic cirrhosis. The donor organ cold ischemia times were not significantly different, averaging 6.3 and 6.2 hours for the HCV and non-hcv groups, respectively, and the median warm ischemia times were also similar, and 39 minutes, respectively (Table 2). The number of recipients with hepatocellular carcinoma was 87 (55 [29.4%] in the HCV group and 32 [10.6%] in the non-hcv group). Twentythree of these cancers were incidental findings in the explant (12 in the HCV group and 11 in the non-hcv group). 6
3 Table 3. Multivariate Analysis Variable Hazard Ratio (95% CI) P Value HCV 1.39 ( ).55 Donor age y 3.03 ( ).12 Donor age 65 y 2.89 ( ).23 Age of recipient 1.02 ( ).51 Cold ischemia 1.00 ( ).05 Warm ischemia 1.01 ( ).74 MELD score 1.16 ( ).001 MELD score, laboratory a 0.95 ( ).24 Abbreviations: CI, confidence interval; HCV, hepatitis C virus; MELD, Model for End-Stage Liver Disease. a The laboratory MELD score is the score without exception points. Increasing cold ischemia time and MELD score with exception points were the only factors that reached statistical significance. Patient Survival, % A 0 B HCV group Non-HCV group Twenty-eight recipients with HCV and 14 without HCV with hepatocellular carcinoma received MELD score upgrades for transplant. Three patients have died of recurrent hepatocellular carcinoma; 2 of these were HCVpositive recipients. Detectable pretransplant HCV RNA levels ranged from 50 to IU/mL (mean [SD], [ ] IU/ ml). The HCV genotype was available in 110 patients: 48 (43.6%) were genotype 1A, 42 (38.2%) were genotype 1B, 8 (7.3%) were genotype 2, and 12 (10.9%) were genotype 3. Of 187 patients, 73 (39.0%) had treatment for HCV recurrence after transplant, and 33 (45.2%) of these patients had a sustained virologic response after treatment. Multivariate analysis was performed to determine factors significantly associated with outcome after transplant. Only cold ischemic times and higher MELD scores were associated with a worsened outcome (Table 3). PATIENT SURVIVAL There was no significant difference in patient survival at 1, 3, and 5 years in patients with HCV infection compared with the non-hcv group (P=.45). This continued for 8 years, with survival rates of 63.0% in HCVpositive recipients vs 75.5% in HCV-negative recipients (P=.), although there seemed to be a divergence in survival at 5 years (Figure 1A). Twenty-four HCVpositive recipients received grafts from donors years or older, and 11 of these were from donors 65 years or older. Forty-eight recipients without HCV received grafts from donors years or older, and 27 of these were from donors 65 years or older. Recipients with HCV and older donor grafts had survival similar to recipients without HCV with older donor grafts, and this was true for all donor graft age groups. The 1-, 3-, and 5-year patient survival of 91.0%, 71.6%, and 71.6%, respectively, was seen in HCV-positive recipients receiving grafts from donors years or older and of 85.0%, 76.3%, and 64.6% in HCVnegative recipients receiving similar-aged grafts. There was no difference in HCV-positive recipients who received grafts from donors younger than years (P=.90) (Figure 2A). Furthermore, there was no difference between recipients with and without HCV receiving grafts from donors 65 years or older (P=.93). Graft Survival, % Time Since Transplant, y Figure 1. Overall patient (P=.45) (A) and graft (P=.22) (B) survival comparing recipients with and without hepatitis C virus (HCV). GRAFT SURVIVAL The 1-, 3-, and 5-year graft survival rates were not significantly different in the HCV group compared with the non-hcv group (Figure 1B). There was also no difference in 1-, 3-, and 5-year graft survival in recipients with HCV who received grafts from donors years or older (87.0%,.2%, and.2%, respectively) compared with recipients without HCV who received grafts from donors years or older, (79.0%, 64.1%, and 57.7%, respectively) (P=.23) (Figure 2B). Comparing recipients who received grafts from donors 65 years or older, there was no significant survival difference between recipients with and those without HCV. We also did not observe any difference comparing these recipients with HCVpositive recipients receiving grafts from donors younger than years (Figure 2B) or younger than 65 years. HCV RECURRENCE Clinically significant HCV reinfection after transplant was defined as biopsy-proved grade 2, stage 2 or a higher level of recurrent hepatitis (Table 4) All recipients were followed up at Washington University School of Medicine after transplant, and at 1 year, a protocol liver biopsy was performed, unless one had been done recently for clinical reasons. Any other biopsies (eg, from 0 to 12 months and thenfrom1yearon) aredictatedbyclinicalindications. Once a histologic diagnosis of recurrent HCV is made, follow-up biopsies are performed based on clinical variables. 681
4 Patient Survival, % Graft Survival, % A 0 B HCV donor age < y HCV donor age y Non-HCV donor age y Table 4. Pathologic Grading and Staging System for HCV-Associated Hepatitis and Fibrosis 6,14-16 Grade or Stage Description Grade 1 Chronic hepatitis with minimal activity 2 Chronic hepatitis with mild activity 3 Chronic hepatitis with moderate activity 4 Chronic hepatitis with marked activity 5 Chronic hepatitis with marked activity and bridging Stage 0 No fibrosis (no fibrosis) 1 Fibrous portal expansion (mild fibrosis) 2 Few bridges or septa (moderate fibrosis) 3 Numerous bridges or septa (severe fibrosis) 4 Cirrhosis (cirrhosis) Abbreviation: See Table Time Since Transplant, y Figure 2. Patient (P=.50) (A) and graft (P=.) (B) survival comparing hepatitis C virus (HCV) positive recipients receiving grafts from donors years or older or younger than years with recipients without HCV receiving grafts from donors years or older. Patients With Recurent HCV, % In the first year after transplant, we demonstrated a.0% incidence of biopsy-proved HCV recurrence. However, by 5 years, 51.3% of patients had recurrence of HCV, and by 10 years, 62.0% had clinically significant HCV recurrence (Figure 3). Of 187 recipients with HCV, 48 (25.7%) have died. Three of these recipients had undergone retransplant. Fifteen (31.3%) of these recipients died of graft failure secondary to recurrent HCV. Of the 89 patients who developed recurrent HCV, 51 had at least 1 episode of rejection. Twenty-six of these recipients received pulse corticosteroids to treat the rejection, and the remaining 25 were managed by adjustment of their standard immunosuppression dose. There was no difference in the number of patients who developed recurrence based on management of the rejection (13 of the 26 patients who received pulse corticosteroids [50.0%] and 12 of the 25 patients who were managed with immunosuppression readjustment [48.0%] eventually developed recurrent HCV). Fifty-five patients who developed recurrent HCV never had an episode of rejection. Of the HCV-positive recipients who received donor grafts years or older, 50.0% (12 of 24 recipients) developed recurrence vs 41.7% (68 of 163 recipients) who received donor grafts younger than years (P=.38); therefore, donor age seemed to have no significant effect on the recurrence of HCV. The median transplant-to-recurrence interval in the older donor group (aged years) was 17 months (range, 4-25 months), whereas the median interval in the younger donor group (aged years) was 14 months (range, 3 months to 8 years) (P=.10) Time Since Transplant, y Figure 3. The timing of biopsy-proved recurrence of hepatitis C virus (HCV) (stage 2, grade 2 or more severe). RETRANSPLANT Of 187 HCV-positive patients, 13(7.0%) underwent retransplant, 7 (53.8%) for transplant-related complications (4 for hepatic artery thrombosis and 3 for primary nonfunction). The remaining 6 recipients underwent retransplant for HCV recurrence. Of these 6 patients, 3 have died (1 within 30 days, 1 at 4 months of sepsis, and 1 at 4 years of recurrent HCV cirrhosis). In the 7 HCVpositive recipients who underwent retransplant for other indications, there was 1 intraoperative death and no cirrhosis from recurrent HCV to date. The median interval between the primary and second transplants was 30 months (range, months). Of 302 recipients in the non-hcv group, 28 (9.3%) required retransplant during follow-up. Overall survival in recipients with vs those without HCV at 1, 3, and 5 years was 77.8%, 66.7%, and 44.4% vs 89.3%, 89.3%, and 81.6%, respectively. When this was subdivided into retransplant for cirrhosis secondary to HCV recurrence and retransplant for reasons other than HCV in HCV-positive recipients, there is an apparent divergence because the 1- and 3-year survival rates are 66.7% and 66.7% vs 85.7% and 85.7%, respectively. Three of these recipients have 682
5 died, but only 1 of recurrent HCV, and this death was 4 years after the second liver transplant. COMMENT In the present study, we reviewed our single-center experience with transplant for HCV during the past 10 years and compared 187 recipients with HCV with 302 recipients without HCV. Demographic, donor, operative, and recipient factors between groups were similar except for the presence or absence of HCV infection. We found no difference in patient or graft survival between the 2 groups, and the 1-, 3-, and 5-year survival rates are similar to those from other studies. 17 Twenty-four recipients with HCV and 48 without HCV received grafts from donors years or older, and no significant difference was seen in patient and graft survival (Figure 2). In addition, we examined results from donors 65 years or older and did not observe a negative effect on short- or medium-term survival. However, similar to other large transplant centers, we observed a negative effect from recurrent HCV with a trend toward worsened long-term survival between years 5 and 10. We defined clinically significant HCV recurrence as stage 2, grade 2 fibrosis, and we found that the 1-, 5-, and 10-year HCV recurrence rates were.0%, 51.3%, and 62.0%, respectively. We did not see a difference in recurrence based on donor age. A recent study 18 examining United Network for Organ Sharing data suggests an improvement in 1-year graft survival from 81% to 85% comparing transplantation from the early 1990s with transplantation from 1997 to 02. However, 5-year graft survival remains similar (67%), with no change in outcome when comparing the early with the more recent transplantation period. The researchers suggest that lack of long-term survival improvement may be related to the increase in recipients with HCV in the later period. Reduced survival in HCV-positive recipients has been reported by many researchers, and at least half of the failures are related to HCV recurrence. In this study of 187 HCV-positive recipients, we did not observe a significant decrease in overall 1-, 3-, and 5-year survival. However, it seems that at 5 years, patient and graft survival curves begin to diverge, and by 8 years a trend toward decreased survival is evident. Of those who died during long-term follow-up, 30.0% of the deaths were from HCV-related graft failure. Of the HCV-positive recipients, 50.0% developed clinically significant recurrent HCV infection within 5 years (Figure 3). In the present series, graft survival mirrored patient survival, including the divergence in the curves noted at the 5-year mark. Previous studies have suggested that end-organ damage in recipients with HCV may be accelerated when older donor grafts are used. 22 However, because ideal donors are increasingly less common, many medical centers have increased the use of ECDs, including older donor grafts, to accomplish transplant. Recurrent HCV after transplant is probably multifactorial, and numerous studies suggest different contributing factors. The role of the immunosuppression used is contentious, including suggestions that the choice of calcineurin inhibitor may or may not be significant. 23,24 In addition, the risk of accelerated fibrosis when using induction agents is controversial. 25 Pulse corticosteroid therapy for acute cellular rejection can induce recurrence and should be avoided in recipients with HCV without definitive proof of rejection. 26 A high viral load before transplant and viral genotype 1B are also associated with a more aggressive recurrence risk. 27,28 Many researchers 4,27,29-33 have suggested that recipients with HCV should not receive grafts from donors older than 50 years because there may be an increased risk of HCV recurrence, accelerated disease progression to fibrosis, and reduced patient and graft survival. On the other hand, 1 study 34 suggests that the use of ECDs has significantly reduced waiting list numbers without affecting results, but it does suggest that donor age older than years is associated with reduced patient and graft survival. Because of donor shortages and lack of younger donors, having an exclusive allocation for recipients with HCV is probably impractical and has not been implemented by the United Network for Organ Sharing. Bahra and colleagues 35 suggested that donor liver histologic features are an important risk factor in the progression of HCV-positive recipients to clinically significant HCV recurrence and inferior outcome. They suggest that portal inflammation on donor biopsy, which is more commonly encountered in older donor grafts, is associated with worse outcome. However, Briceño and colleagues 2 looked at their 1 HCV-positive recipients and found that steatosis greater than 30% and a prolonged cold ischemia time of more than 12 hours were independent risk factors for poor outcome and that donor age older than 70 years was not a risk factor. A 10-year review 36 from the UK national transplant database suggested that although donor age has increased by a mean of 6.1 years, there has been no detrimental effect on results. At Washington University School of Medicine, we have used older donors in recipients with and without HCV in recent years. We do not use older donors with severe steatosis. If the donor graft is HCV positive, a nearnormal biopsy finding is a prerequisite. The donor artery must be normal (good pulse with no plaque), and cold ischemia time is kept to a minimum. Although we cannot prove that this selectivity has affected the results, we advocate for the continued use of selective older donors in adult liver transplant. These data do not suggest that the use of older donors for HCV-positive recipients has led to increased short- or medium-term graft loss or recipient mortality. Because our increased use of older donors has primarily occurred in the past 5 years, it is not yet possible to comment on the effect on longerterm outcome. It remains possible that longer follow-up will demonstrate a difference in graft or patient survival. However, we have not observed the accelerated graft loss due to recurrent HCV in recipients of older donor grafts that has been previously suggested, leading us to believe that this practice is safe. Six patients who developed end-stage liver disease from recurrent HCV underwent retransplant along with 7 HCVpositive patients who underwent retransplant for other indications. We compared this group with 28 recipients without HCV requiring retransplant. There was a trend 683
6 toward a worse outcome in HCV-positive recipients compared with HCV-negative recipients, but statistical significance was not achieved, likely because of the few retransplants performed in patients with recurrent HCV. Survival after retransplant for indications other than HCV was similar to survival after an initial liver transplant. Retransplant in HCV-positive patients who have end-stage liver disease from recurrent HCV infection or from other causes is controversial. Hepatitis C virus is an independent risk factor for decreased survival after retransplant. 10,37,38 Some researchers advocate that HCVpositive patients should at least be considered for retransplant 12 and preferably before decompensation. 13 In a review encompassing 11 US medical centers, and 3-year survival was 69% and 49%, respectively, in recipients with retransplant for recurrent HCV (n=43) and 73% and 55%, respectively, in those with transplant for non- HCV etiologies (n=73). Many patients with HCV (30%) are not considered for reevaluation, fewer are waitlisted, and most (79%) die while on the waiting list. Overall, less than 1% of patients with recurrent HCV cirrhosis actually undergo retransplant according to these authors. Poor predictors of survival are a high MELD score, recipient age older than years, and cirrhosis within 2 years of initial transplant.,41 In conclusion, overall patient and graft survival in HCV-positive recipients is comparable with that in HCVnegative patients, and there seems to be little, if any, adverse effect on short- and medium-term follow-up with the use of carefully selected older donor grafts in recipients with HCV. Data from this series suggest that the continued use of selected older donors is a safe method of expanding the liver donor pool, even for HCV-positive recipients. Accepted for Publication: February 9, 08. Correspondence: William C. Chapman, MD, Washington University School of Medicine, 6 S Euclid Ave, Campus Box 8109, St Louis, MO (chapmanw@wustl.edu). Author Contributions: Study concept and design: Doyle, Lowell, Shenoy, and Chapman. Acquisition of data: Vachharajani, Lisker-Melman, Korenblat, and Chapman. Analysis and interpretation of data: Doyle, Anderson, Vachharajani, Shenoy, Lisker-Melman, Crippin, and Chapman. Drafting of the manuscript: Doyle. Critical review of the manuscript for important intellectual content: Doyle, Anderson, Vachharajani, Lowell, Shenoy, Lisker- Melman, Korenblat, Crippin, and Chapman. Statistical analysis: Vachharajani. Administrative, technical, and material support: Doyle, Anderson, Lowell, Shenoy, Lisker- Melman, and Chapman. Study supervision: Chapman. Financial Disclosure: None reported. Previous Presentation: This paper was presented at the 07 Annual Meeting of the Western Surgical Association; November 6, 07; Colorado Springs, Colorado; and is published after peer review and revision. The discussions that follow this article are based on the originally submitted manuscript and not the revised manuscript. Additional Contributions: Yan Yan, MD, PhD, helped with the statistical analysis for this work. REFERENCES 1. Mutimer DJ, Gunson B, Chen J, et al. Impact of donor age and year of transplantation on graft and patient survival following liver transplantation for hepatitis C virus. Transplantation. 06;81(1): Briceño J, Ciria M, Pleguezuelo M, et al. Contribution of marginal donors to liver transplantation of hepatitis C virus infection. Transplant Proc. 07;39(7): Ricchiuti A, Brunati A, Mirabella S, et al. Use of hepatitis C virus positive grafts in liver transplantation: a single-centre experience. Transplant Proc. 05;37 (6): Khapra AP, Agarwal K, Fiel M, et al. Impact of donor age on survival and fibrosis progression in patients with hepatitis C undergoing liver transplantation using HCV allografts. Liver Transpl. 06;12(10): Berenguer M, Ferrell L, Watson J, et al. HCV-related fibrosis progression following liver transplantation: increase in recent years. J Hepatol. 00;32(4): Terrault NA. Treatment of recurrent hepatitis C in liver transplant recipients. Clin Gastroenterol Hepatol. 05;3(10)(suppl 2):S125-S Berenguer M, Prieto M, San Juan F, et al. Contribution of donor age to the recent decrease in patient survival among HCV-infected liver transplant recipients. Hepatology. 02;36(1): Said A, Einstein M, Lucey M. Liver transplantation: an update 07. Curr Opin Gastroenterol. 07;23(3): Crippin JS, McCashland T, Terrault N, et al. A pilot study of the tolerability and efficacy of antiviral therapy in hepatitis C virus infected patients awaiting liver transplantation. Liver Transpl. 02;8(4): Pelletier SJ, Schaubel D, Punch J, et al. Hepatitis C is a risk factor for death after liver re-transplantation. Liver Transpl. 05;11(4): Ercolani G, Grazi G, Ravaioli M, et al. Histological recurrent hepatitis C after liver transplantation: outcome and role of retransplantation. Liver Transpl. 06; 12(7): Sheiner PA, Schluger LK, Emre S, et al. Retransplantation for recurrent hepatitis C. Liver Transpl Surg. 1997;3(2): Ghobrial RM. Retransplantation for recurrent hepatitis C. Liver Transpl. 02;8 (10)(suppl 1):S38-S Goodman ZD. Grading and staging systems for inflammation and fibrosis in chronic liver diseases. J Hepatol. 07;47(4): Theise ND. Liver biopsy assessment in chronic viral hepatitis: a personal, practical approach. Mod Pathol. 07;(suppl 1):S3-S Batts KP, Ludwig J. Chronic hepatitis: an update on terminology and reporting. Am J Surg Pathol. 1995;19(12): Russo MW, Galanko J, Beavers K, et al. Patient and graft survival in hepatitis C recipients after adult living donor liver transplantation in the United States. Liver Transpl. 04;10(3): Futagawa Y, Terasaki P, Waki K, Cai J, Gjertson DW. No improvement in longterm liver transplant graft survival in the last decade: an analysis of the UNOS data. Am J Transplant. 06;6(6): Forman LM, Lewis J, Berlin J, et al. The association between hepatitis C infection and survival after orthotopic liver transplantation. Gastroenterology. 02; 122(4): Neumann UP, Berg T, Bahra M. Long-term outcome of liver transplants for chronic hepatitis C: a 10-year follow up. Transplantation. 04;77(2): Roberts MS, Angus D, Bryce C, et al. Survival after liver transplantation in the United States: a disease-specific analysis of the UNOS database. Liver Transpl. 04;10(7): Bahra M, Neumann U, Jacob D, et al. Outcome after liver re-transplantation in patients with recurrent chronic hepatitis C. Transpl Int. 07;(9): Rayhill SC, Barbeito R, Katz D, et al. A cyclosporine-based immunosuppressive regimen may be better than tacrolimus for long-term liver allograft survival in recipients transplanted for hepatitis C. Transplant Proc. 06;38(10): Berenguer M, Royuela A, Zamora J. Immunosuppression with calcineurin inhibitors with respect to the outcome of HCV recurrence after liver transplantation: results of a meta-analysis. Liver Transpl. 07;13(1): Marcos A, Eghtesad B, Fung J, et al. Use of alemtuzumab and tacrolimus monotherapy for cadaveric liver transplantation with particular reference to hepatitis C virus. Transplantation. 04;78(7): Lake JR. The role of immunosuppression in recurrence of hepatitis C. Liver Transpl. 03;9(11):S63-S Gane E. The natural history and outcome of liver transplantation in hepatitis C virus-infected recipients. Liver Transpl. 03;9(11):S28-S McCaughan GW, Zekry A. Mechanisms of HCV reinfection and allograft damage after liver transplantation. J Hepatol. 04;(3): Machicao VI, Bonatti H, Krishna M, et al. Donor age affects fibrosis progression 684
7 and graft survival after liver transplantation for hepatitis C. Transplantation. 04;77(1): Carmiel-Haggai M, Fiel M, Gaddipati H, et al. Recurrent hepatitis C after retransplantation: factors affecting graft and patient outcome. Liver Transpl. 05; 11(12): Lake JR, Shorr J, Steffen B, et al. Differential effects of donor age in liver transplant recipients infected with hepatitis B, hepatitis C and without viral hepatitis. Am J Transplant. 05;5(3): Rayhill SC, Wu Y, Katz D, et al. Older donor livers show early severe histological activity, fibrosis, and graft failure after liver transplantation for hepatitis C. Transplantation. 07;84(3): Schemmer P, Nickkholgh A, Hinz U, et al. Extended donor criteria have no negative impact on early outcome after liver transplantation: a single-center multivariate analysis. Transplant Proc. 07;39(2): Tector AJ, Mangus R, Chestovich P, et al. Use of extended criteria livers decreases wait time for liver transplantation without adversely impacting posttransplant survival. Ann Surg. 06;244(3): Bahra M, Jacob D, Neumann U, et al. Influence of donor histology on outcome in patients undergoing transplantation for hepatitis C. Transplantation. 07; 84(2): Devey LR, Friend P, Forsythe J, et al. The use of marginal heart beating donor livers for transplantation in the United Kingdom. Transplantation. 07;84(1): Yoo HY, Maheshwari A, Thuluvath P. Retransplantation of liver: primary graft nonfunction and hepatitis C virus are associated with worse outcome. Liver Transpl. 03;9(9): Rosen HR. Retransplantation for hepatitis C: implication of different policies. Liver Transpl. 00;6(6)(suppl 2):S41-S McCashland T, Watt K, Lyden E, et al. Retransplantation of hepatitis C: results of a U.S. multicenter re-transplant study. Liver Transpl. 07;13(9): Burton JR, Sonnenberg A, Rosen H. Retransplantation for recurrent hepatitis C in the MELD era: maximizing utility. Liver Transpl. 04;10(10)(suppl 2):S59-S Magee JC, Barr M, Basadonna G, et al. Repeat organ transplantation in the United States, Am J Transplant. 07;7(5, pt 2): DISCUSSION C. Wright Pinson, MD, Nashville, Tennessee: Because HCV is the leading indication for liver transplantation, close scrutiny of our results in these patients is important. Furthermore, an investigation of the results with the use of marginal donors in this population is important as it is commonly practiced at many centers, given the exigencies of the donor liver availability circumstances. As a first topic of discussion, the data presented in the manuscript and here today show no statistical difference in the longterm patient or graft survival after liver transplantation for the diagnosis of HCV than for other diagnoses. However, the concluding paragraph of the manuscript reads, In conclusion, overall patient and graft survival in HCV-positive recipients is comparable with that in HCV-negative patients, and this seems to be more reflective of the data. One question is, however, why is there not a difference in this data set for survival after HCV than non-hcv diagnosis? Is it a combination of the difference in donor age, recipient age, the difference in male to female ratio of 3:1 vs 1.2:1, and the difference in the median MELD score of 21 vs 24 all these risk factors favoring your HCV group so perhaps a selection bias? Another thought is perhaps the distribution of HCV subtypes is favorable in your patient population, although we don t have those data. I wonder if your fine record with short cold ischemia times in both groups isn t what overrides all the other risk factors. Finally, I would suggest that if we just wait long enough, the diversion of the curves probably would become significant. As a second topic of discussion, the data indicate there was no difference in outcome of older donors vs younger donors for either the HCV or non-hcv group. A second question is why is there not a difference for this data set? Is it that there is an extremely careful donor selection for the HCV recipients? For example, only 6% of the donors for the HCV group were from older donors as opposed to 13.5% for the non-hcv group. So I wonder if the reason for the equally good results is that you are very selective in your choice of older donors, as you mention in your discussion, coupled again with the point about short cold ischemia times. I am not ready to accept that a general broadening to marginal donors, including all older donors, those with steatosis, and those with longer ischemia times, will continue to give equally good results for patients receiving liver transplantation for HCV. In other words, I would agree with the concluding paragraph in your manuscript emphasizing very careful selection of older donors, and I would agree with the wording stated today, but I was somewhat uneasy about the wording in the concluding paragraph of your abstract. Dr Chapman: Dr Pinson has made a number of excellent points regarding the issues surrounding liver transplantation for patients with HCV. This is a big problem, and it s probably the major problem that we face in liver transplantation today. We are transplanting our largest group of patients who have a disease that we know has a % chance of recurrence in the new graft. And when those patients have a recurrence, a rescue therapy for an additional transplant has particularly poor results. So this is a difficult challenge that we face and likely will be continuing to face for many years to come. The first question related to the issue of whether or not there s a difference in long-term outcome for patients who have liver transplantation for HCV compared with patients who did not have HCV. In our initial analysis, which was if you look at these divergent curves at specific time points and follow-up using, for example, 2 analysis, there is a difference once you get out to 8 years in survival. However, in this data set, when we look at these results with Kaplan-Meier survival curves and logrank analysis, which is in our opinion the more appropriate way to analyze the long-term survival outcomes, we do not demonstrate a statistical difference in our data set. This is not a small series. This is almost 500 patients. But I think, as Dr Pinson pointed out, with additional time, with these curves beginning to diverge at 5 years, and with a rate of at least % clinically significant HCV that exists by 8 years, there almost certainly would be a statistical difference if these patients were followed for a longer period of time. A second major point that Dr Pinson brought up was the issue of donor age and does donor age matter. In our experience, we looked at donor age as a variable, an important consideration, but used in context with the other donor variables that are important in patients who are transplanted. So I would agree with Dr Pinson that based on our data we would not say that a 65-year-old or a 70-year-old donor is going to be the same as a -year-old donor with other variables and can be used equally. Donor age has to be considered just like other important variables, including cold ischemia, graft steatosis, hepatitis in the graft, etc. So I think it s a variable that s important, but I think certainly based on our data we feel that in properly selected donors who otherwise appear to be suitable that donor age alone should not be an exclusion criteria even in patients who have HCV. And this is a different finding than some groups who have recommended that an older donor should never be used in a patient with HCV because of the risk of early and severe recurrence of HCV leading to graft loss. Financial Disclosure: None reported. 685
Long-term Outcomes After Third Liver Transplant
ArtıcLe Long-term Outcomes After Third Liver Transplant C. Burcin Taner, 1 Deniz Balci, 1 Darrin L. Willingham, 1 Andrew P. Keaveny, 1 Barry G. Rosser, 1 Juan M. Canabal, 1 Timothy S. J. Shine, 2 Denise
More informationPOST TRANSPLANT OUTCOMES IN PSC
POST TRANSPLANT OUTCOMES IN PSC Kidist K. Yimam, MD Medical Director, Autoimmune Liver Disease Program Division of Hepatology and Liver Transplantation California Pacific Medical Center (CPMC) PSC Partners
More informationFor the past two decades, the number of patients
When Shouldn t We Retransplant? Michael A. Zimmerman and R. Mark Ghobrial Key Points 1. In the setting of early graft failure after primary transplantation, orthotopic liver retransplantation (re-olt)
More informationLiver Transplantation: The End of the Road in Chronic Hepatitis C Infection
University of Massachusetts Medical School escholarship@umms UMass Center for Clinical and Translational Science Research Retreat 2012 UMass Center for Clinical and Translational Science Research Retreat
More informationE nd stage liver disease due to hepatitis C virus infection
248 LIVER DISEASE Advancing donor liver age and rapid fibrosis progression following transplantation for hepatitis C M Wali, R F Harrison, P J Gow, D Mutimer... Gut 2002;51:248 252 See end of article for
More informationMinimal But Significant Improvement in Survival for Non Hepatitis C Related Adult Liver Transplant Patients Beyond the One-Year Posttransplant Mark
LIVER TRANSPLANTATION 16:130-137, 2010 ORIGINAL ARTICLE Minimal But Significant Improvement in Survival for Non Hepatitis C Related Adult Liver Transplant Patients Beyond the One-Year Posttransplant Mark
More informationTransplant Hepatology
Transplant Hepatology Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the certified
More informationResearch Article New Onset Diabetes Mellitus in Living Donor versus Deceased Donor Liver Transplant Recipients: Analysis of the UNOS/OPTN Database
Transplantation Volume 2013, Article ID 269096, 7 pages http://dx.doi.org/10.1155/2013/269096 Research Article New Onset Diabetes Mellitus in Living Donor versus Deceased Donor Liver Transplant Recipients:
More informationLIVER TRANSPLANTATION FOR OVERLAP SYNDROMES OF AUTOIMMUNE LIVER DISEASES
LIVER TRANSPLANTATION FOR OVERLAP SYNDROMES OF AUTOIMMUNE LIVER DISEASES No conflict of interest Objectives Introduction Methods Results Conclusions Objectives Introduction Methods Results Conclusions
More informationTreatment of Liver Transplant Recipients Who Have Chronic Hepatitis C Virus Infection
Lecture Treatment of Liver Transplant Recipients Who Have Chronic Hepatitis C Virus Infection Murat Korkmaz Abstract Chronic hepatitis C virus infection is the most common cause of chronic liver disease
More informationORIGINAL ARTICLE. Eric F. Martin, 1 Jonathan Huang, 3 Qun Xiang, 2 John P. Klein, 2 Jasmohan Bajaj, 4 and Kia Saeian 1
LIVER TRANSPLANTATION 18:914 929, 2012 ORIGINAL ARTICLE Recipient Survival and Graft Survival are Not Diminished by Simultaneous Liver-Kidney Transplantation: An Analysis of the United Network for Organ
More informationWhat Is the Real Gain After Liver Transplantation?
LIVER TRANSPLANTATION 15:S1-S5, 9 AASLD/ILTS SYLLABUS What Is the Real Gain After Liver Transplantation? James Neuberger Organ Donation and Transplantation, NHS Blood and Transplant, Bristol, United Kingdom;
More informationLiver Transplantation for Alcoholic Liver Disease in the United States: 1988 to 1995
Liver Transplantation for Alcoholic Liver Disease in the United States: 1988 to 1995 Steven H. Belle, Kimberly C. Beringer, and Katherine M. Detre T he Scientific Liver Transplant Registry (LTR) was established
More informationPediatric Liver Transplantation Outcomes in Korea
ORIGINAL ARTICLE Cell Therapy & Organ Transplantation http://dx.doi.org/6/jkms.8..4 J Korean Med Sci 0; 8: 4-47 Pediatric Liver Transplantation Outcomes in Korea Jong Man Kim,, * Kyung Mo Kim,, * Nam-Joon
More informationRecurrence of hepatitis C virus (HCV) after orthotopic. Poor Survival After Liver Retransplantation: Is Hepatitis C to Blame?
RAPID COMMUNICATION Poor Survival After Liver Retransplantation: Is Hepatitis C to Blame? Kymberly D.S. Watt, Elizabeth R. Lyden, and Timothy M. McCashland Data from 1990 to 1996 suggest that the prevalence
More informationAnne Barkman. The University of Kansas School of Nursing
Expanding Donor Criteria: Is it Safe? Anne Barkman The University of Kansas School of Nursing About the author: Anne Barkman is from Leawood, Kansas. She was an academic honor roll recipient for Fall 2010,
More informationPAPER. Short- and Long-term Outcomes After Steatotic Liver Transplantation
PAPER Short- and Long-term Outcomes After Steatotic Liver Transplantation M. B. Majella Doyle, MD; Neeta Vachharajani, MD; Jason R. Wellen, MD; Christopher D. Anderson, MD; Jeffrey A. Lowell, MD; Surendra
More informationSurvival of Liver Transplant Recipients With Hemochromatosis in the United States
GASTROENTEROLOGY 2007;133:489 495 Survival of Liver Transplant Recipients With Hemochromatosis in the United States LEI YU*, and GEORGE N. IOANNOU*, *Division of Gastroenterology, Department of Medicine
More informationEffect of Calcineurin Inhibitors on Survival and Histologic Disease Severity in HCV-Infected Liver Transplant Recipients
LIVER TRANSPLANTATION 12:762-767, 2006 ORIGINAL ARTICLE Effect of Calcineurin Inhibitors on Survival and Histologic Disease Severity in HCV-Infected Liver Transplant Recipients Marina Berenguer, 1 Victoria
More informationFrequency and Outcomes of Liver Transplantation for Nonalcoholic Steatohepatitis in the United States
GASTROENTEROLOGY 2011;141:1249 1253 Frequency and Outcomes of Liver Transplantation for Nonalcoholic Steatohepatitis in the United States MICHAEL R. CHARLTON,* JUSTIN M. BURNS, RACHEL A. PEDERSEN, KYMBERLY
More informationK For patients who have never been tested for HCV, it is. K It is suggested that HCV-infected patients not previously
http://www.kidney-international.org & 2008 DIGO Guideline 4: Management of HCV-infected patients before and after kidney transplantation idney International (2008) 73 (Suppl 109), S53 S68; doi:10.1038/ki.2008.87
More informationHepatitis C: Difficult-to-treat Patients 11th Paris Hepatology Conference 16th January 2018 Stefan Zeuzem, MD University Hospital, Frankfurt, Germany
Hepatitis C: Difficult-to-treat Patients 11th Paris Hepatology Conference 16th January 2018 Stefan Zeuzem, MD University Hospital, Frankfurt, Germany PHC 2018 - www.aphc.info Disclosures Advisory boards:
More informationThe future of liver transplantation for viral hepatitis
The future of liver transplantation for viral hepatitis François Durand Hepatology & Liver Intensive Care Hospital Beaujon, Clichy University Paris Diderot France Liver transplantation in France 2013:
More informationCurrently, the leading indication for liver transplantation
ORIGINAL ARTICLES Severe Recurrent Hepatitis C After Liver Retransplantation for Hepatitis C Virus Related Graft Cirrhosis Marina Berenguer, * Martín Prieto, * Antonio Palau, * José M. Rayón, Domingo Carrasco,
More informationa series of fact sheets written by experts in the field of liver disease HCV DISEASE PROGRESSION
www.hcvadvocate.org HCSP FACT SHEET Foreword Over years or decades, chronic hepatitis C virus (HCV) infection can progress to severe liver problems including cirrhosis and hepatocellular carcinoma (HCC).
More informationPredictors of cardiac allograft vasculopathy in pediatric heart transplant recipients
Pediatr Transplantation 2013: 17: 436 440 2013 John Wiley & Sons A/S. Pediatric Transplantation DOI: 10.1111/petr.12095 Predictors of cardiac allograft vasculopathy in pediatric heart transplant recipients
More informationIncreasing Trends in Transplantation of HCV-positive Livers into Uninfected Recipients
Accepted Manuscript Increasing Trends in Transplantation of HCV-positive Livers into Uninfected Recipients George Cholankeril, MD, Andrew A. Li, MD, Brittany B. Dennis, PhD, Alice E. Toll, MS, Donghee
More informationLiver and intestine transplantation: summary analysis,
American Journal of Transplantation 25; 5 (Part 2): 916 933 Blackwell Munksgaard Blackwell Munksgaard 25 Liver and intestine transplantation: summary analysis, 1994 23 Douglas W. Hanto a,, Thomas M. Fishbein
More informationThe pediatric end-stage liver disease (PELD) score
Selection of Pediatric Candidates Under the PELD System Sue V. McDiarmid, 1 Robert M. Merion, 2 Dawn M. Dykstra, 2 and Ann M. Harper 3 Key Points 1. The PELD score accurately predicts the 3 month probability
More informationLiver grafts for transplantation from donors with diabetes: an analysis of the Scientific Registry of Transplant Recipients database
Title Liver grafts for transplantation from donors with diabetes: an analysis of the Scientific Registry of Transplant Recipients database Author(s) Zheng, J; Xiang, J; Zhou, J; Li, Z; Hu, Z; Lo, CM; Wang,
More informationThe Effect of Donor Race on the Survival of Black Americans Undergoing Liver Transplantation for Chronic Hepatitis C
LIVER TRANSPLANTATION 15:1126-1132, 2009 ORIGINAL ARTICLE The Effect of Donor Race on the Survival of Black Americans Undergoing Liver Transplantation for Chronic Hepatitis C Phillip S. Pang, 1,2 * Ahmad
More informationIncidence and Risk Factors of HCV Recurrence after Living Donor Liver Transplantation
Incidence and Risk Factors of HCV Recurrence after Living Donor Liver Transplantation Mohsen M. Maher 1, Mahmoud S. El-Meteini 2, Mohamed F. Abd Al-Ghaffar 2, Tark M. Yousef, Maha M. Hussein 1, Ahmed I.
More informationORIGINAL ARTICLE. Hung-Tien Kuo, 1,2 Erik Lum, 1 Paul Martin, 3 and Suphamai Bunnapradist ORIGINAL ARTICLE
ORIGINAL ARTICLE Effect of Diabetes and Acute Rejection on Liver Transplant Outcomes: An Analysis of the Organ rocurement and Transplantation Network/United Network for Organ Sharing Database Hung-Tien
More informationHepatitis C Treatment Before and After Liver Transplant
BJID 2007; 11 Supplement 1 (October) 6 1 Hepatitis C Treatment Before and After Liver Transplant Edson Abdala 1,2, Daniela Rosa Magalhães Gotardo 1, Patrícia Rodrigues Bonazzi 1,2 and Telésforo Bacchella
More informationCASE 1 Plasma Cell Infiltrates: Significance in post liver transplantation and in chronic liver disease
CASE 1 Plasma Cell Infiltrates: Significance in post liver transplantation and in chronic liver disease Maria Isabel Fiel, M.D. The Mount Sinai Medical Center New York, New York Case A 57 yo man, 7 months
More informationDonor Hypernatremia Influences Outcomes Following Pediatric Liver Transplantation
8 Original Article Donor Hypernatremia Influences Outcomes Following Pediatric Liver Transplantation Neema Kaseje 1 Samuel Lüthold 2 Gilles Mentha 3 Christian Toso 3 Dominique Belli 2 Valérie McLin 2 Barbara
More informationViral Hepatitis And Liver Transplantation
Viral Hepatitis And Liver Transplantation Dr.Zeki KARASU Ege University Medical School Dep. Gastroenterology Hepatitis B 3-7 10 % HBV infection in liver transplant recipients, in western countries. 120
More informationChapter 6: Transplantation
Chapter 6: Transplantation Introduction During calendar year 2012, 17,305 kidney transplants, including kidney-alone and kidney plus at least one additional organ, were performed in the United States.
More informationRetransplantation for Recurrent Hepatitis C in the MELD Era: Maximizing Utility
Retransplantation for Recurrent Hepatitis C in the MELD Era: Maximizing Utility James R. Burton, Jr., 1,2 Amnon Sonnenberg, 1,2 and Hugo R. Rosen 1,2 Key Points 1. Retransplantation (re-lt) for hepatitis
More informationLiver Transplantation Using Donation After Cardiac Death Donors: Long-Term Follow-Up from a Single Center
American Journal of Transplantation 2009; 9: 773 781 Wiley Periodicals Inc. C 2009 The Authors Journal compilation C 2009 The American Society of Transplantation and the American Society of Transplant
More informationPeritransplant Pancreatitis: A Marker of High Mortality and Graft Failure in Liver Transplant Patients
ORIGINAL ARTICLE RUSSELL ET AL. Peritransplant Pancreatitis: A Marker of High Mortality and Graft Failure in Liver Transplant Patients Tara A. Russell, 1 Sarah Park, 2 Vatche G. Agopian, 3 Ali Zarrinpar,
More informationLIVER TRANSPLANTATION
Program and Surgical Director: Charles Miller, MD Medical Director: Nizar N. Zein, MD 216.444.8770 clevelandclinic.org/livertx Liver LIVER TRANSPLANTATION Cleveland Clinic performed 128 liver transplants
More informationORIGINAL ARTICLE. Received March 14, 2007; accepted August 29, 2007.
LIVER TRANSPLANTATION 14:173-180, 2008 ORIGINAL ARTICLE A Randomized, Prospective, Pharmacoeconomic Trial of Neoral 2-Hour Postdose Concentration Monitoring Versus Tacrolimus Trough Concentration Monitoring
More informationRepeat Organ Transplantation in the United States,
American Journal of Transplantation 2007; 7 (Part 2): 1424 1433 Blackwell Munksgaard No claim to original US government works Journal compilation C 2007 The American Society of Transplantation and the
More informationLiver transplantation and hepatitis C virus
Liver transplantation and hepatitis C virus Where do we come from? Where are we? Where are we going? François Durand Hépatologie & Réanimation Hépato-Digestive INSERM U1149 Hôpital Beaujon, Clichy HCV:
More informationORIGINAL ARTICLE. Received April 30, 2007; accepted June
LIVER TRANSPLANTATION 13:1405-1413, 2007 ORIGINAL ARTICLE Human Leukocyte Antigen and Adult Living- Donor Liver Transplantation Outcomes: An Analysis of the Organ Procurement and Transplantation Network
More informationCurrent Status of HBV and Liver Transplant
Current Status of HBV and Liver HBV as Indication for Liver ation in U.S. Significant decrease in rate of wait listing for decompensated cirrhosis since 2003 (since s) No change in rate of wait listing
More informationExperience with Liver Transplantation in patients over 65 years of Age at the Hospital Pablo Tobón Uribe in Medellin, Colombia from 2004 to 2010
Original articles Experience with Liver Transplantation in patients over 65 years of Age at the Hospital Pablo Tobón Uribe in Medellin, Colombia from 2004 to 2010 Octavio Muñoz, MD, 1 Laura Ovadía, MD,
More informationTreatment of Hepatitis C Recurrence after Liver Transplantation. Maria Carlota Londoño Liver Unit Hospital Clínic Barcelona
Treatment of Hepatitis C Recurrence after Liver Transplantation Maria Carlota Londoño Liver Unit Hospital Clínic Barcelona Agenda 1. Introduction 2. Treatment options for hepatitis C recurrence after transplantation
More informationOverall Goals and Objectives for Transplant Hepatology EPAs:
Overall Goals and Objectives for Transplant Hepatology EPAs: 1. DIAGNOSTIC LIST During the one-year Advanced Pediatric Transplant Hepatology Program, fellows are expected to develop comprehensive skills
More informationObesity is perhaps the most significant public health problem
Obesity and Its Effect on Survival in Patients Undergoing Orthotopic Liver Transplantation in the United States Satheesh Nair, 1 Sumita Verma, 2 and Paul J. Thuluvath 2 Studies assessing morbidity and
More informationLiver Transplantation for Biliary Atresia: 19-Year, Single-Center Experience
Liver Transplantation for Biliary Atresia: 19-Year, Single-Center Experience L Thomas Chin 1, Anthony M D Alessandro 1, Stuart J Knechtle 1, Luis A Fernandez 1, Glen Leverson 1, Robert H Judd 2, Elizabeth
More informationImmunosuppression status of liver transplant recipients with hepatitis C affects biopsy-proven acute rejection
pissn 2287-2728 eissn 2287-285X Original Article Clinical and Molecular Hepatology 2016;22:366-371 Immunosuppression status of liver transplant recipients with hepatitis C affects biopsy-proven acute rejection
More informationFat, ballooning, plasma cells and a +ANA. Yikes! USCAP 2016 Evening Specialty Conference Cynthia Guy
Fat, ballooning, plasma cells and a +ANA. Yikes! USCAP 2016 Evening Specialty Conference Cynthia Guy Goals Share an interesting case Important because it highlights a common problem that we re likely to
More informationDirect-acting antiviral treatment for hepatitis C in liver transplant candidates and recipients
Editorial Direct-acting antiviral treatment for hepatitis C in liver transplant candidates and recipients Nobuhisa Akamatsu, Junichi Togashi, Kiyoshi Hasegawa, Norihiro Kokudo Artificial Organ and Transplantation
More informationInformation for patients (and their families) waiting for liver transplantation
Information for patients (and their families) waiting for liver transplantation Waiting list? What is liver transplant? Postoperative conditions? Ver.: 5/2017 1 What is a liver transplant? Liver transplantation
More informationPancreas After Islet Transplantation: A First Report of the International Pancreas Transplant Registry
American Journal of Transplantation 2016; 16: 688 693 Wiley Periodicals Inc. Brief Communication Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons doi:
More informationDeath in patients waiting for liver transplantation. Liver Transplant Recipient Selection: MELD vs. Clinical Judgment
ORIGINAL ARTICLES Liver Transplant Recipient Selection: MELD vs. Clinical Judgment Michael A. Fink, 1,2 Peter W. Angus, 1 Paul J. Gow, 1 S. Roger Berry, 1,2 Bao-Zhong Wang, 1,2 Vijayaragavan Muralidharan,
More informationHow to improve long term outcome after liver transplantation?
How to improve long term outcome after liver transplantation? François Durand Hepatology & Liver Intensive Care University Paris Diderot INSERM U1149 Hôpital Beaujon, Clichy PHC 2018 www.aphc.info Long
More informationRapidly Progressive Recurrent Hepatitis C Virus Infection Starting 9 Days After Liver Transplantation
LIVER TRANSPLANTATION 13:913-917, 2007 SHORT REPORT Rapidly Progressive Recurrent Hepatitis C Virus Infection Starting 9 Days After Liver Transplantation Neeraj Saraf, 1 M. Isabel Fiel, 2 Graciela DeBoccardo,
More informationInduction Immunosuppression With Rabbit Antithymocyte Globulin in Pediatric Liver Transplantation
LIVER TRANSPLANTATION 12:1210-1214, 2006 ORIGINAL ARTICLE Induction Immunosuppression With Rabbit Antithymocyte Globulin in Pediatric Liver Transplantation Ashesh Shah, 1 Avinash Agarwal, 1 Richard Mangus,
More informationLiver Transplant: Alcoholic liver disease as first indication
Monotematica AISF The future of liver disease: beyond HCV there is a role for hepatologist? Milano, 13-15 Ottobre 2016 Liver Transplant: Alcoholic liver disease as first indication Giacomo Germani Multivisceral
More informationThe Effect of Liver Transplantation on Autonomic Dysfunction in Patients with End-Stage Liver Disease
LIVER TRANSPLANTATION 14:235-239, 2008 ORIGINAL ARTICLE The Effect of Liver Transplantation on Autonomic Dysfunction in Patients with End-Stage Liver Disease Elizabeth J. Carey, Manjushree Gautam, 3 Timothy
More informationImmunosuppressive Strategies in Liver Transplantation for Hepatitis C
Trends in Transplantation Transplant. 2010;4:78-85 Immunosuppressive Strategies in Liver Transplantation for Hepatitis C Timothy M. Clifford 1-3, Michael F. Daily 1,3 and Roberto Gedaly 1,3 1 UK HealthCare,
More informationGood outcomes of liver transplantation for hepatitis C at a low volume centre
Good outcomes of liver transplantation for hepatitis C., 2016; 15 (2): 207-214 ORIGINAL ARTICLE March-April, Vol. 15 No. 2, 2016: 207-214 207 The Official Journal of the Mexican Association of Hepatology,
More informationRECURRENT HEPATITIS C CIRRHOSIS AFTER LIVER TRANSPLANTATION: A NATURAL HISTORY STUDY
RECURRENT HEPATITIS C CIRRHOSIS AFTER LIVER TRANSPLANTATION: A NATURAL HISTORY STUDY By VIRGINIA C. CLARK A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF
More informationLiving Donor Liver Transplantation for Hepatocellular Carcinoma: It Is All about Donors?
Original Article Living Donor Liver Transplantation for Hepatocellular Carcinoma: It Is All about Donors? R. F. Saidi 1 *, Y. Li 2, S. A. Shah 2, N. Jabbour 2 1 Division of Organ Transplantation, Department
More informationLiver transplant: what is left after the viruses
Riunione Monotematica A.I.S.F. 2016 The Future of Liver Disease: Beyond HCV is there a Role for Hepatologist? Milan 15 th 2016 Liver transplant: what is left after the viruses Stefano Ginanni Corradini
More informationCase Report of Successful Treatment of Fibrosing Cholestatic Hepatitis C with Sofosbuvir and Ribavirin after Liver Transplantation
108 Diagnostic Problems in Hepatology Case Report of Successful Treatment of Fibrosing Cholestatic Hepatitis C with Sofosbuvir and Ribavirin after Liver Transplantation Brian Kim, MD 1 Anshu Trivedi, MD
More informationBasic patterns of liver damage what information can a liver biopsy provide and what clinical information does the pathologist need?
Basic patterns of liver damage what information can a liver biopsy provide and what clinical information does the pathologist need? Rob Goldin r.goldin@imperial.ac.uk @robdgol FATTY LIVER DISEASE Brunt
More informationViral Hepatitis The Preventive Potential of Antiviral Therapy. Thomas Berg
Viral Hepatitis The Preventive Potential of Antiviral Therapy Thomas Berg Therapeutic and preventive strategies in patients with hepatitis virus infection Treatment of acute infection Treatment of chronic
More informationLiver transplantation for hepatocellular carcinoma with live donors or extended criteria donors: a propensity score-matched comparison
ORIGINAL ARTICLE Annals of Gastroenterology (2018) 31, 722-727 Liver transplantation for hepatocellular carcinoma with live donors or extended criteria donors: a propensity score-matched comparison Georgios
More informationHEPATITIS WEB STUDY. Treatment of Hepatitis C following Liver Transplantation
HEPATITIS WEB STUDY Treatment of Hepatitis C following Liver Transplantation Terry D. Box, MD Associate Professor of Medicine Division of Gastroenterology/Hepatology University of Utah Health Sciences
More informationScreening for HCCwho,
Screening for HCCwho, how and how often? Catherine Stedman Associate Professor of Medicine, University of Otago, Christchurch Gastroenterology Department, Christchurch Hospital HCC Global Epidemiology
More informationDiabetes, Hypertension and Hyperlipidemia: Prevalence Over Time and Impact on Long-Term Survival After Liver Transplantation
American Journal of Transplantation 2012; 12: 2181 2187 Wiley Periodicals Inc. C Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons doi: 10.1111/j.1600-6143.2012.04077.x
More informationLeading article. Hepatitis C and liver transplantation
Gut 1999;45:159 163 159 Leading article Hepatitis C and liver transplantation Introduction Cirrhosis secondary to hepatitis C virus (HCV) infection, alone or in combination with alcohol, is the principal
More informationSerum samples from recipients were obtained within 48 hours before transplantation. Pre-transplant
SDC, Patients and Methods Complement-dependent lymphocytotoxic crossmatch test () Serum samples from recipients were obtained within 48 hours before transplantation. Pre-transplant donor-specific CXM was
More informationHwm YI Yoo, * Ernest0 Molmenti, ' and PuulJ Tbuluvutb"
The Effect of Donor Body Mass Index on Primary Nonfunction, Retransplantation Rate, and Early and Patient Survival After Liver Transplantation Hwm YI Yoo, * Ernest0 Molmenti, ' and PuulJ Tbuluvutb" Previous
More informationHepatitis C Management and Treatment
Hepatitis C Management and Treatment Kaya Süer Near East University Faculty of Medicine Infectious Diseases and Clinical Microbiology 1 Discovery of Hepatitis C Key facts Hepatitis C: the virus can cause
More informationEvaluating HIV Patient for Liver Transplantation. Marion G. Peters, MD Professor of Medicine University of California San Francisco USA
Evaluating HIV Patient for Liver Transplantation Marion G. Peters, MD Professor of Medicine University of California San Francisco USA Slide 2 ESLD and HIV Liver disease has become a major cause of death
More informationLiver Transplantation By: Kay R. Brown, CLCP
Liver Transplantation By: Kay R. Brown, CLCP Dr. Jeffrey Crippin, Director of Hepatology at the Baylor Institute of Transplantation in Dallas, Texas outlined during the Transplantation '97 seminar the
More informationSolid organ transplantation is a major achievement of. Liver Transplantation: Current Status and Novel Approaches to Liver Replacement
GASTROENTEROLOGY 2001;120:749 762 Liver Transplantation: Current Status and Novel Approaches to Liver Replacement EMMET B. KEEFFE Division of Gastroenterology and Hepatology, Department of Medicine, Stanford
More informationPrognosis of NASH VII Workshop Intenracional de Actualizaçao em Hepatologia, Aug 29th 2014
Prognosis of NASH VII Workshop Intenracional de Actualizaçao em Hepatologia, Aug 29th 2014 Vlad Ratziu, Université Pierre et Marie Curie, Hôpital Pitié Salpêtrière, Paris, France NASH : a severe hepatic
More informationHepatitis After Liver Transplantation: The Role of the Known and Unknown Viruses
Hepatitis After Liver Transplantation: The Role of the Known and Unknown Viruses Mario G. Pessoa,*00 Norah A. Terrault,*00 Linda D. Ferrell, Jill Detmer, Janice Kolberg, Mark L. Collins, Maurene Viele,
More informationLiver Transplant Pathology a general view
Liver Transplant Pathology a general view Dr S E Davies Addenbrooke s Hospital Cambridge University Hospitals NHS Trust ACP/BSG Meeting Leeds 2012 Liver transplantation When and where? Who and why? How?
More informationKidney and Pancreas Transplantation in the United States,
American Journal of Transplantation 2006; 6 (Part 2): 1153 1169 Blackwell Munksgaard No claim to original US government works Journal compilation C 2006 The American Society of Transplantation and the
More informationLiver Pathology in the 0bese
Liver Pathology in the 0bese Rob Goldin Centre for Pathology, Imperial College r.goldin@imperial.ac.uk Ludwig et al. Non-alcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease.
More informationSupplementary Digital Content
Geissler et al: Sirolimus and Hepatocellular Carcinoma in Liver Transplantation Page 1 of 10 Supplementary Digital Content Supplementary Table 1. Surgical procedures used Total Transplant technique Piggy
More informationReview Article Interferon Treatment of Hepatitis C Reinfection after Liver Transplantation: A Meta-Analysis
Gastroenterology Research and Practice Volume 215, Article ID 2632, 8 pages http://dx.doi.org/1.1155/215/2632 Review Article Interferon Treatment of Hepatitis C Reinfection after Liver Transplantation:
More informationDynamics of the Romanian Waiting List for Liver Transplantation after Changing Organ Allocation Policy
Dynamics of the Romanian Waiting List for Liver Transplantation after Changing Organ Allocation Policy Liana Gheorghe 1, Speranta Iacob 1, Razvan Iacob 1, Gabriela Smira 1, Corina Pietrareanu 1, Doina
More informationHeart Transplant: State of the Art. Dr Nick Banner
Heart Transplant: State of the Art Dr Nick Banner Heart Transplantation What is achieved Current challenges Donor scarcity More complex recipients Long-term limitations Non-specific Pharmacological Immunosuppression
More information198 Recent Advances in Liver Transplantation Mayo Clin Proc, February 2003, Vol 78 No. of patients 25,000 20,000 15,000 10,000 Cadaver liver transplan
Mayo Clin Proc, February 2003, Vol 78 Recent Advances in Liver Transplantation 197 Review Recent Advances in Liver Transplantation RUSSELL H. WIESNER, MD; JORGE RAKELA, MD; MICHAEL B. ISHITANI, MD; DAVID
More informationPeri-operative challenges and long-term outcomes in liver transplantation for polycystic liver disease
DOI:10.1111/j.1477-2574.2012.00579.x HPB ORIGINAL ARTICLE Peri-operative challenges and long-term outcomes in liver transplantation for polycystic liver disease Roberto Gedaly, Paige Guidry, Daniel Davenport,
More informationIL TRAPIANTO DI FEGATO: QUALE FUTURO CON LE NUOVE TERAPIE PER LE MALATTIE EPATICHE?
IL TRAPIANTO DI FEGATO: QUALE FUTURO CON LE NUOVE TERAPIE PER LE MALATTIE EPATICHE? Francesco Paolo Russo Department of Surgery, Oncology and Gastroenterology Multivisceral/ Gastroenterology Section University
More informationCase 1 AND. Treatment of HCV: Pre- vs Post- Transplant. 58 yo male, ESRD/diabetic nephropathy, HD for 3 weeks
Treatment of HCV: Pre- vs Post- Transplant Roy D. Bloom MD Professor of Medicine University of Pennsylvania Roy D. Bloom MD Professor of Medicine Medical Director, Kidney Transplant Program University
More informationIntentional Transplantation of Hepatitis C Positive Livers into Hepatitis C Negative Recipients- Report of the first Case Series in World
Intentional Transplantation of Hepatitis C Positive Livers into Hepatitis C Negative Recipients- Report of the first Case Series in World Paulo Martins MD PhD, Aaron Ahearn MD PhD, Babak Movahedi MD PhD,
More informationAlemtuzumab Induction in Non-Hepatitis C Positive Liver Transplant Recipients
LIVER TRANSPLANTATION 17:32-37, 2011 ORIGINAL ARTICLE Alemtuzumab Induction in Non-Hepatitis C Positive Liver Transplant Recipients Josh Levitsky, 1,2 Kavitha Thudi, 1 Michael G. Ison, 1,3 Edward Wang,
More informationEarly Allograft Dysfunction After Liver Transplantation Is Associated With Short- and Long-Term Kidney Function Impairment
American Journal of Transplantation 2016; 16: 850 859 Wiley Periodicals Inc. Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons doi: 10.1111/ajt.13527
More informationHistopathological Causes of Late Liver Allograft Dysfunction: Analysis at a Single Institution
The Korean Journal of Pathology 2013; 47: 21-27 ORIGINAL ARTICLE Histopathological Causes of Late Liver Allograft Dysfunction: Analysis at a Single Institution Eun Shin Ji Hoon Kim 1 Eunsil Yu 1 Department
More informationChronic liver failure Assessment for liver transplantation
Chronic liver failure Assessment for liver transplantation Liver Transplantation Dealing with the organ shortage Timing of listing must reflect length on waiting list Ethical issues Justice, equity, utility
More information