Contents
David Goldberg (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - November 14, 2020 Category: Gastroenterology Source Type: research
Forthcoming Issues
Complications of Cirrhosis (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - November 14, 2020 Category: Gastroenterology Source Type: research
Paradigm Shift in Utilization of Livers from Hepatitis C –Viremic Donors into Hepatitis C Virus–Negative Patients
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 pretr ansplant and posttransplant setting. Historically, donor livers infected with HCV were either transplanted into patients already infected with HCV or discarded. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - November 4, 2020 Category: Gastroenterology Authors: Eric F. Martin Source Type: research
Advances in Rejection Management
This article discusses T-cell –mediated rejection, antibody-mediated rejection, and chronic rejection. We focus on the prevention and then discuss treatment options. Future directions of rejection management include biomarkers of rejection, which may allow for monitoring of patients who are considered high risk for rejection a nd detection of rejection before there is any clinical evidence to improve graft and patient survival. With improved graft life and survival of liver transplant recipients, the new frontier of rejection management focuses on immunosuppression minimization, withdrawal, and personalization. (Source: ...
Source: Clinics in Liver Disease - October 26, 2020 Category: Gastroenterology Authors: Claire R. Harrington, Guang-Yu Yang, Josh Levitsky Source Type: research
Cardiac and Pulmonary Vascular Risk Stratification in Liver Transplantation
Cardiovascular disease complications are the leading cause of early (short-term) mortality among liver transplant recipients. The increasingly older candidate pool has multiple comorbidities necessitating cardiac and pulmonary vascular disease risk stratification of patients for optimal allocation of scarce donor livers. Arrhythmias, heart failure, stroke, and coronary artery disease are common pretransplant cardiovascular comorbidities and contribute to cardiovascular complications after liver transplant. Valvular heart disease and portopulmonary hypertension present intraoperative challenges during liver transplant surge...
Source: Clinics in Liver Disease - October 26, 2020 Category: Gastroenterology Authors: Blessing Aghaulor, Lisa B. VanWagner Source Type: research
Transplant of Elderly Patients
This article reviews the data and discusses the pros and cons of transplants in the elderly. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - October 21, 2020 Category: Gastroenterology Authors: Claudia Cottone, Nathalie A. Pena Polanco, Kalyan Ram Bhamidimarri Source Type: research
Preface
Despite advances in the care of patients with chronic liver disease, notably the revolution of direct-acting antivirals to treat hepatitis C, the need for lifesaving liver transplants remains. The number of liver transplants performed increases every year, yet the demand continues to outstrip the supply. Despite this, the landscape of liver transplantation has been rapidly changing, with respect to expansions of the donor pool, aging of the recipient population, and changing diagnoses leading to liver transplantation. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - October 21, 2020 Category: Gastroenterology Authors: David Goldberg Source Type: research
Expanding Role of Donation After Circulatory Death Donors in Liver Transplantation
Better understanding of how to utilize donation after circulatory death (DCD) liver grafts has resulted in improved national outcomes and expansion in the number of DCD liver transplants (LTs). This improvement has been driven by better donor and recipient matching, careful evaluation of hemodynamics during withdrawal of life support, and refinement of the procurement operation. Changes to liver allocation likely will result in increased utilization of DCD liver grafts. Ischemic cholangiopathy remains the Achilles heel of DCD LTs and, although rates have fallen with improved protocols, a certain rate likely is unavoidable....
Source: Clinics in Liver Disease - October 20, 2020 Category: Gastroenterology Authors: Kristopher P. Croome, C. Burcin Taner Source Type: research
Expanding the Limits of Liver Transplantation for Hepatocellular Carcinoma
Liver transplantation is a treatment option for hepatocellular carcinoma within Milan criteria. With careful selection practices, patients with larger tumors can do well with successful downstaging followed by liver transplantation and should not be excluded based on tumor size or number alone. When considering expanded criteria for hepatocellular carcinoma, however, survival outcomes after liver transplantation should be comparable with patients without hepatocellular carcinoma. Surrogate measures of tumor biology, such as α-fetoprotein, other biomarkers, and dynamic tumor behavior including response to locoregional ther...
Source: Clinics in Liver Disease - October 17, 2020 Category: Gastroenterology Authors: Allison Kwong, Neil Mehta Source Type: research
Keeping Patients with End-Stage Liver Disease Alive While Awaiting Transplant
Complications of portal hypertension such as gastroesophageal variceal hemorrhage, ascites, and spontaneous bacterial peritonitis, as well as pulmonary complications, are often responsible for diminished quality of life, excess morbidity and mortality, increased health care resource use and expenditure, and dropout from the liver transplant (LT) waiting list. Therefore, the care of LT candidates on the waiting list must be centered on anticipation and prompt intervention for these complications. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - October 17, 2020 Category: Gastroenterology Authors: Andres F. Carrion, Paul Martin Source Type: research
Transplants for Acute Alcoholic Hepatitis
Liver transplant for severe alcohol-associated hepatitis remains a controversial practice despite evidence for a substantial survival benefit compared with medical therapy and posttransplant alcohol relapse rates comparable with previously published studies in alcohol-associated cirrhosis. The controversy stems in part from concern regarding patient selection practices, lack of long-term follow-up data, and the potential negative public perception of the practice affecting organ donation. Despite these concerns, it seems that early liver transplant for alcohol-associated hepatitis is increasingly being offered to selected ...
Source: Clinics in Liver Disease - October 17, 2020 Category: Gastroenterology Authors: Jessica Hause, John P. Rice Source Type: research
Optimizing the Selection of Patients for Simultaneous Liver-Kidney Transplant
Simultaneous liver-kidney transplantation has increased significantly in the Model for End Stage Liver Disease era. The transplantation policy has evolved significantly since the implementation of allocation based on the Model for End Stage Liver Disease. Current policy takes into account the medical eligibility criteria for simultaneous liver-kidney transplantation listing. It also provides a safety net option and prioritizes kidney transplant after liver transplant recipients who are unlikely to recover their renal function within 60 to 365 days after liver transplant alone. This review seeks to understand the underlyi...
Source: Clinics in Liver Disease - October 16, 2020 Category: Gastroenterology Authors: Khurram Bari, Pratima Sharma Source Type: research
Obesity Management of Liver Transplant Waitlist Candidates and Recipients
Obesity is increasing in prevalence in liver transplant candidates and recipients. The rise in liver transplantation for nonalcoholic steatohepatitis reflects this increase. Management of obesity in liver transplant candidates can be challenging due to the presence of decompensated cirrhosis and sarcopenia. Obesity may increase peritransplant morbidity but does not have an impact on long-term post-transplant survival. Bariatric surgery may be a feasible option in select patients before, during, or after liver transplantation. Use of weight loss drugs and/or endoscopic therapies for obesity management ultimately may play a ...
Source: Clinics in Liver Disease - October 12, 2020 Category: Gastroenterology Authors: Danielle Brandman Source Type: research
Beyond Ice and the Cooler
Machine perfusion (MP) has emerged as a promising preservation technique to reduce the risks associated with transplant of high risk (steatotic, elderly, and donation after circulatory death) hepatic allografts. Multiple strategies for MP are under investigation. MP facilitates assessment of organ viability and enables liver-directed therapy before transplant. Clinical trials suggest MP may improve the use of hepatic allografts, mitigate ischemia-reperfusion injury, and reduce the incidences of early allograft dysfunction, biliary complications, and ischemic cholangiopathy. As MP sees more widespread use outside of trial s...
Source: Clinics in Liver Disease - October 12, 2020 Category: Gastroenterology Authors: David D. Aufhauser, David P. Foley Source Type: research
Frailty and Sarcopenia in Patients Pre – and Post–Liver Transplant
Greater than half of patients with decompensated liver disease suffer from frailty and/or sarcopenia, which can lead to increased pre – and post–liver transplant morbidity and mortality. Although frailty and sarcopenia can impact patients with end-stage liver disease in similar ways, they are unique clinical entities with differing underlying etiologies. Early assessment and identification of frailty and sarcopenia in patients is critical to guide clinical decision-making regarding transplantation and to implement nutritional and exercise-based treatment regiments. Nonetheless, accurate diagnosis and, in particular, pr...
Source: Clinics in Liver Disease - October 6, 2020 Category: Gastroenterology Authors: Yedidya Saiman, Marina Serper Source Type: research
