Liver transplantation prognosis: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
No edit summary |
||
| Line 1: | Line 1: | ||
__NOTOC__ | __NOTOC__ | ||
{{CMG}}; {{AE}} {{MAD}} | {{CMG}}; {{AE}} {{MAD}} | ||
{{Liver transplantation}} | {{Liver transplantation}} | ||
| Line 5: | Line 6: | ||
==Overview== | ==Overview== | ||
==Liver transplantation prognosis== | ==Liver transplantation prognosis== | ||
* Prognosis is | * Prognosis is good. One-year [[survival rates]] are 83%, 5-year survival is 76% and 10-year survival is 66%.<ref name="pmid18505689">{{cite journal| author=Ghobrial RM, Freise CE, Trotter JF, Tong L, Ojo AO, Fair JH et al.| title=Donor morbidity after living donation for liver transplantation. | journal=Gastroenterology | year= 2008 | volume= 135 | issue= 2 | pages= 468-76 | pmid=18505689 | doi=10.1053/j.gastro.2008.04.018 | pmc=3731061 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18505689 }}</ref> | ||
* Majority of deaths happen during the first three months after transplantation. | * Majority of deaths happen during the first three months after transplantation. | ||
* Mortality rates in donors are 0.2% in the USA and vary | * 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 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 incidence of complications in the donor varies from 9 to 67%. | ||
* The modified Clavien classification is commonly used to describe | * The modified Clavien classification is commonly used to describe donor morbidity:<ref name="pmid11932469">{{cite journal| author=Surman OS| title=The ethics of partial-liver donation. | journal=N Engl J Med | year= 2002 | volume= 346 | issue= 14 | pages= 1038 | pmid=11932469 | doi=10.1056/NEJM200204043461402 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11932469 }}</ref> | ||
**Grade I—a complication that is not life-threatening | **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 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 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 | **Grade IV—a complication with residual or lasting disability or which leads to death.<ref name="pmid15201680">{{cite journal| author=Salvalaggio PR, Baker TB, Koffron AJ, Fryer JP, Clark L, Superina RA et al.| title=Comparative analysis of live liver donation risk using a comprehensive grading system for severity. | journal=Transplantation | year= 2004 | volume= 77 | issue= 11 | pages= 1765-7 | pmid=15201680 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15201680 }}</ref> | ||
== Recurrence == | == Recurrence == | ||
==== Hepatitis B virus ==== | ==== Hepatitis B virus ==== | ||
* Recurrence of HBV after liver transplantation can be prevented by | * Recurrence of [[Hepatitis B virus|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 ==== | ==== Hepatitis C virus ==== | ||
* There is no established role for prophylactic or | * There is no established role for prophylactic or therapy following transplantation.<ref name="pmid4976215">{{cite journal| author=Smith B| title=Segmental liver transplantation from a living donor. | journal=J Pediatr Surg | year= 1969 | volume= 4 | issue= 1 | pages= 126-32 | pmid=4976215 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4976215 }}</ref> | ||
* No effective immunoglobulin prophylaxis exists for HCV. | * No effective [[immunoglobulin]] [[prophylaxis]] exists for [[HCV]]. | ||
* Treatment is initiated within six weeks of the transplantation. Theapy may be combined or monotherapy. | * Treatment is initiated within six weeks of the transplantation. Theapy may be combined or monotherapy. | ||
* Combination therapy may be peginterferon or standard interferon | * Combination therapy may be [[Peginterferon Beta-1a|peginterferon]] or standard interferon and [[ribavirin]], monotherapy may be [[Peginterferon Beta-1a|peginterferon]], standard [[Interferon|interferon,]] or [[ribavirin]], and anti-HCV [[immune globulin]]. | ||
* '''Direct-acting antiviral agents''' | * '''Direct-acting [[antiviral]] agents''' | ||
** | **[[Sofosbuvir]] is an NS5B nucleotide analog used for the treatment of [[HCV]].<ref name="pmid25304641">{{cite journal| author=Charlton M, Gane E, Manns MP, Brown RS, Curry MP, Kwo PY et al.| title=Sofosbuvir and ribavirin for treatment of compensated recurrent hepatitis C virus infection after liver transplantation. | journal=Gastroenterology | year= 2015 | volume= 148 | issue= 1 | pages= 108-17 | pmid=25304641 | doi=10.1053/j.gastro.2014.10.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25304641 }}</ref> | ||
**Treatment resulted in persistently undetectable HCV ribonucleic acid (RNA) 12 weeks after stopping treatment | **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.<ref name="pmid23593993">{{cite journal| author=Fontana RJ, Hughes EA, Bifano M, Appelman H, Dimitrova D, Hindes R et al.| title=Sofosbuvir and daclatasvir combination therapy in a liver transplant recipient with severe recurrent cholestatic hepatitis C. | journal=Am J Transplant | year= 2013 | volume= 13 | issue= 6 | pages= 1601-5 | pmid=23593993 | doi=10.1111/ajt.12209 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23593993 }}</ref> | ||
==== Hepatocellular Carcinoma ==== | ==== Hepatocellular Carcinoma ==== | ||
* Resection remains the standard with which alternative treatment methods must be compared. | * [[Resection]] remains the standard with which alternative treatment methods must be compared. | ||
==== Alcoholic liver disease ==== | ==== Alcoholic liver disease ==== | ||
* Patient survival rates following liver transplantation for alcoholic liver disease are similar to rates following transplantation for non-alcohol related diagnoses. | * 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. | * Five-year patient and graft [[survival rates]] 72 and 66 percent. | ||
* Five-year survival without liver transplantation is 23 percent. | |||
==== Primary biliary cirrhosis ==== | ==== Primary biliary cirrhosis ==== | ||
* A precise estimate of the recurrence rate is uncertain.<ref name="pmid11124816">{{cite journal| author=Liermann Garcia RF, Evangelista Garcia C, McMaster P, Neuberger J| title=Transplantation for primary biliary cirrhosis: retrospective analysis of 400 patients in a single center. | journal=Hepatology | year= 2001 | volume= 33 | issue= 1 | pages= 22-7 | pmid=11124816 | doi=10.1053/jhep.2001.20894 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11124816 }}</ref> | * A precise estimate of the recurrence rate is uncertain.<ref name="pmid11124816">{{cite journal| author=Liermann Garcia RF, Evangelista Garcia C, McMaster P, Neuberger J| title=Transplantation for primary biliary cirrhosis: retrospective analysis of 400 patients in a single center. | journal=Hepatology | year= 2001 | volume= 33 | issue= 1 | pages= 22-7 | pmid=11124816 | doi=10.1053/jhep.2001.20894 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11124816 }}</ref> | ||
* Methods to prevent recurrence may include immunosuppression | * Methods to prevent recurrence may include [[immunosuppression]] using [[cyclosporine]] rather than [[tacrolimus]] and giving [[ursodeoxycholic acid]] (UDCA) following liver transplantation. | ||
==== Primary sclerosing cholangitis (PSC) ==== | ==== Primary sclerosing cholangitis (PSC) ==== | ||
* Recurrent PSC following liver transplantation in 14 to 20 percent of patients.<ref name="pmid8045496">{{cite journal| author=Harrison RF, Davies MH, Neuberger JM, Hubscher SG| title=Fibrous and obliterative cholangitis in liver allografts: evidence of recurrent primary sclerosing cholangitis? | journal=Hepatology | year= 1994 | volume= 20 | issue= 2 | pages= 356-61 | pmid=8045496 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8045496 }}</ref> | * Recurrent PSC following liver transplantation in 14 to 20 percent of patients.<ref name="pmid8045496">{{cite journal| author=Harrison RF, Davies MH, Neuberger JM, Hubscher SG| title=Fibrous and obliterative cholangitis in liver allografts: evidence of recurrent primary sclerosing cholangitis? | journal=Hepatology | year= 1994 | volume= 20 | issue= 2 | pages= 356-61 | pmid=8045496 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8045496 }}</ref> | ||
* Risk factors for recurrence include age, sex mismatch, male sex | * 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== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 16:38, 19 December 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
|
Liver trasnsplantation Microchapters |
Overview
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.