Liver transplantation prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
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Liver trasnsplantation Microchapters |
Overview
Prognosis is good. One-year survival rates are 83%, 5-year survival is 76% and 10-year survival is 66%. Mortality rates in donors are 0.2% in the USA and vary from 0.1 to 1.0% worldwide. The risk associated with left-lobe donation may be lower than that with right-lobe donation. Recurrence varies according to the cause; hepatitis B virus is the commonest cause of recurrence followed by hepatitis C virus. Recurrence of HBV after liver transplantation can be prevented by administering hepatitis B immune globulin at the time of transplantation. There is no established role for prophylactic or therapy following transplantation in HCV. Combination therapy for HCV may be peginterferon or standard interferon and ribavirin, monotherapy may be peginterferon, standard interferon, or ribavirin, and anti-HCV immune globulin.
Liver transplantation prognosis
- Prognosis is good. One-year survival rates are 83%, 5-year survival is 76% and 10-year survival is 66%.[1]
- Majority of deaths happen during the first three months after transplantation.
- Mortality rates in donors are 0.2% in the USA and vary from 0.1 to 1.0% worldwide.
- The risk associated with left-lobe donation may be lower than that with right-lobe donation.
- The incidence of complications in the donor varies from 9 to 67%.
- The modified Clavien classification is commonly used to describe donor morbidity:[2]
- Grade I—a complication that is not life-threatening and does not require a therapeutic invasive intervention.
- Grade II—a complication that is potentially life-threatening and that requires the use of drug therapy or foreign blood units.
- Grade III—a complication that is potentially life-threatening and that requires a therapeutic invasive intervention.
- Grade IV—a complication with residual or lasting disability or which leads to death.[3]
Recurrence
Hepatitis B virus
- Recurrence of HBV after liver transplantation can be prevented by administering hepatitis B immune globulin at the time of transplantation and at regular intervals thereafter in combination with antivirals such as tenofovir or entecavir.
Hepatitis C virus
- There is no established role for prophylactic or therapy following transplantation.[4]
- No effective immunoglobulin prophylaxis exists for HCV.
- Treatment is initiated within six weeks of the transplantation. Theapy may be combined or monotherapy.
- Combination therapy may be peginterferon or standard interferon and ribavirin, monotherapy may be peginterferon, standard interferon, or ribavirin, and anti-HCV immune globulin.
- Direct-acting antiviral agents
- Sofosbuvir is an NS5B nucleotide analog used for the treatment of HCV.[5]
- Treatment resulted in persistently undetectable HCV ribonucleic acid (RNA) 12 weeks after stopping treatment.
- Sofosbuvir is usually now given in combination with one of several additional direct-acting antivirals.[6]
Hepatocellular Carcinoma
- Resection remains the standard with which alternative treatment methods must be compared.
Alcoholic liver disease
- Patient survival rates following liver transplantation for alcoholic liver disease are similar to rates following transplantation for non-alcohol related diagnoses.
- Five-year patient and graft survival rates 72 and 66 percent.
- Five-year survival without liver transplantation is 23 percent.
Primary biliary cirrhosis
- A precise estimate of the recurrence rate is uncertain.[7]
- Methods to prevent recurrence may include immunosuppression using cyclosporine rather than tacrolimus and giving ursodeoxycholic acid (UDCA) following liver transplantation.
Primary sclerosing cholangitis (PSC)
- Recurrent PSC following liver transplantation in 14 to 20 percent of patients.[8]
- Risk factors for recurrence include age, sex mismatch, male sex, presence of an intact colon after transplantation, cytomegalovirus infection, recurrent acute cellular rejection, steroid-resistant cellular rejection, use of OKT3.
References
- ↑ Ghobrial RM, Freise CE, Trotter JF, Tong L, Ojo AO, Fair JH; et al. (2008). "Donor morbidity after living donation for liver transplantation". Gastroenterology. 135 (2): 468–76. doi:10.1053/j.gastro.2008.04.018. PMC 3731061. PMID 18505689.
- ↑ Surman OS (2002). "The ethics of partial-liver donation". N Engl J Med. 346 (14): 1038. doi:10.1056/NEJM200204043461402. PMID 11932469.
- ↑ Salvalaggio PR, Baker TB, Koffron AJ, Fryer JP, Clark L, Superina RA; et al. (2004). "Comparative analysis of live liver donation risk using a comprehensive grading system for severity". Transplantation. 77 (11): 1765–7. PMID 15201680.
- ↑ Smith B (1969). "Segmental liver transplantation from a living donor". J Pediatr Surg. 4 (1): 126–32. PMID 4976215.
- ↑ Charlton M, Gane E, Manns MP, Brown RS, Curry MP, Kwo PY; et al. (2015). "Sofosbuvir and ribavirin for treatment of compensated recurrent hepatitis C virus infection after liver transplantation". Gastroenterology. 148 (1): 108–17. doi:10.1053/j.gastro.2014.10.001. PMID 25304641.
- ↑ Fontana RJ, Hughes EA, Bifano M, Appelman H, Dimitrova D, Hindes R; et al. (2013). "Sofosbuvir and daclatasvir combination therapy in a liver transplant recipient with severe recurrent cholestatic hepatitis C." Am J Transplant. 13 (6): 1601–5. doi:10.1111/ajt.12209. PMID 23593993.
- ↑ Liermann Garcia RF, Evangelista Garcia C, McMaster P, Neuberger J (2001). "Transplantation for primary biliary cirrhosis: retrospective analysis of 400 patients in a single center". Hepatology. 33 (1): 22–7. doi:10.1053/jhep.2001.20894. PMID 11124816.
- ↑ Harrison RF, Davies MH, Neuberger JM, Hubscher SG (1994). "Fibrous and obliterative cholangitis in liver allografts: evidence of recurrent primary sclerosing cholangitis?". Hepatology. 20 (2): 356–61. PMID 8045496.