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Primary LT (primary + lt)
Selected AbstractsRetransplantation for recurrent hepatitis C in the MELD era: Maximizing utilityLIVER TRANSPLANTATION, Issue S10 2004James R. Burton Jr. Key Points 1Retransplantation (re-LT) for hepatitis C virus (HCV) recurrence is controversial. Although re-LT accounts for 10% of all liver transplants (LTs), the number of patients requiring re-LT is expected to grow as primary LT recipients survive long enough to develop graft failure from recurrent disease. 2Utility, as applied to the medical ethics of transplantation, refers to allocating organs to those individuals who will make the best use of them. The utility function (U) of liver transplantation is represented by the product of outcome (O = 1-year survival with LT) times emergency (E = 3-month mortality without LT), i.e., U = O × E. 3For primary LT, maximal U is achieved by allocating organs at the highest model for end-stage liver disease (MELD) score (i.e., "sickest first"). No significant differences exist between HCV and non-HCV diagnoses. 4For re-LT, maximal utility for HCV and non-HCV diagnoses are achieved at MELD scores of 21 and 24, respectively. Utility starts to decline at MELD scores above 28. 5The current allocation system (MELD) fails to maximize utility with regard to re-LT. (Liver Transpl 2004;10:S59,S64.) [source] Does tacrolimus offer virtual freedom from chronic rejection after primary liver transplantation?LIVER TRANSPLANTATION, Issue 7 2001048 liver transplantations with a mean follow-up of 6 years, prognostic factors in Tacrolimus has proven to be a potent immunosuppressive agent in liver transplantation (LT). Its introduction has led to significantly less frequent and severe acute rejection. Little is known about the rate of chronic rejection (CR) in primary LT using tacrolimus therapy. The aim of the present study is to examine the long-term incidence of CR, risk factors, prognostic factors, and outcome after CR. The present study evaluated the development of CR in 1,048 consecutive adult primary liver allograft recipients initiated and mostly maintained on tacrolimus-based immunosuppressive therapy. They were evaluated with a mean follow-up of 77.3 ± 14.7 months (range, 50.7 to 100.1 months). To assess the impact of primary diagnosis on the rate and outcome of CR, the population was divided into 3 groups. Group I included patients with hepatitis C virus (HCV)- or hepatitis B virus (HBV)-induced cirrhosis (n = 312); group II included patients diagnosed with primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), or autoimmune hepatitis (AIH; n = 217); and group III included patients with all other diagnoses (n = 519). Overall, 32 of 1,048 patients (3.1%) developed CR. This represented 13 (4.1%), 12 (5.5%), and 7 patients (1.3%) in groups I, II, and III, respectively. The relative risk for developing CR was 3.2 times greater for group I and 4.3 times greater for group II compared with group III. This difference was statistically significant (P = .004). The incidence of acute rejection and total number of acute rejection episodes were significantly greater in patients who developed CR compared with those who did not (P < .0001). Similarly, the mean donor age for CR was significantly older than for patients without CR (43.0 v 36.2 years; P = .02). Thirteen of the 32 patients (40.6%) who developed CR retained their original grafts for a mean period of 54 ± 25 months after diagnosis. Seven patients (21.9%) underwent re-LT, and 12 patients (38.3%) died. Serum bilirubin levels and the presence of arteriopathy, arterial loss, and duct loss on liver biopsy at the time of diagnosis of CR were significantly greater among the 3 groups of patients. In addition, patient and graft survival for group I were significantly worse compared with groups II and III. We conclude that CR occurred rarely among patients maintained long term on tacrolimus-based immunosuppressive therapy. When steroid use is controlled, the incidence of acute rejection, mean donor age, HBV- and/or HCV-induced cirrhosis, or a diagnosis of PBC, PSC, or AIH were found to be predictors of CR. Greater values for serum bilirubin level, duct loss, arteriopathy, arteriolar loss, and presence of HCV or HBV were found to be poor prognostic factors for the 3 groups; greater total serum bilirubin value (P = .05) was the only factor found to be significant between patients who had graft loss versus those who recovered. [source] Liver Transplantation for Recurrent Hepatocellular Carcinoma on Cirrhosis After Liver Resection: University of Bologna ExperienceAMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2008M. Del Gaudio Liver resection (LR) for patients with small hepatocellular carcinoma (HCC) with preserved liver function, employing liver transplantation (LT) as a salvage procedure (SLT) in the event of HCC recurrence, is a debated strategy. From 1996 to 2005, we treated 227 cirrhotic patients with HCC transplantable: 80 LRs and 147 LTs of 293 listed for transplantation. Among 80 patients eligible for transplantation who underwent LR, 39 (49%) developed HCC recurrence and 12/39 (31%) of these patients presented HCC recurrence outside Milan criteria. Only 10 of the 39 patients underwent LT, a transplantation rate of 26% of patients with HCC recurrence. According to intention-to-treat analysis of transplantable HCC patients who underwent LR (n = 80), compared to all those listed for transplantation (n = 293), 5-year overall survival was 66% in the LR group versus 58% in patients listed for LT, respectively (p = NS); 5-year disease-free survival was 41% in the LR group versus 54% in patients listed for LT (p = NS). Comparable 5-year overall (62% vs. 73%, p = NS) and disease-free (48% vs. 71%, p = NS) survival rates were obtained for SLT and primary LT for HCC, respectively. LR is a valid treatment for small HCC and in the event of recurrence, SLT is a safe and effective procedure. [source] Liver transplantation in patients aged 65 and over: a case,control studyCLINICAL TRANSPLANTATION, Issue 5 2010R. Montalti Montalti R, Rompianesi G, Di Benedetto F, Ballarin R, Gerring RC, Busani S, De Pietri L, De Ruvo N, Iemmolo RM, Guerrini GP, Smerieri N, Gerunda GE. Liver transplantation in patients aged 65 and over: a case,control study. Clin Transplant 2010 DOI: 10.1111/j.1399-0012.2010.01230.x. © 2010 John Wiley & Sons A/S. Abstract:, Introduction:, The average age of patients undergoing liver transplantation (LT) is consistently increasing. The aim of this case,control study is to evaluate survival and outcome of patients ,65 yr compared to younger patients undergoing LT. Materials and methods:, From 10/00 to 4/08 we performed 330 primary LT, 31 (9.4%) of these were in patients aged 65,70. Following a case,control approach, we compared these patients with 31 patients aged between 41 and 64 yr and matched according to sex, LT indication, viral status, cadaveric/living donor, LT timing, and Model for End-Stage Liver Disease (MELD) score. Results:, There were no statistically significant differences in demographic and surgical donor characteristics. The mean MELD score was under 18 in both groups. Post-LT complications occurred with a similar incidence in the two groups. one-, three-, and five-yr survival was 83.9%, 80.6%, and 80.6%, respectively, for the elderly group, and 80.6%, 73.8%, and 73.8%, respectively, for the young group (p = 0.61). Discussion:, Patients aged between 65 and 70 with low MELD score who undergo LT have the same short- and middle-term survival expectancy, morbidity, and outcome quality as younger patients with the same indication and same pre-LT pathology severity, whatever they might be. Thus, chronological age alone should not deter LT workup in patients >65 and <70. [source] |