Liver transplantation prognosis: Difference between revisions

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* The incidence of complications in the donor varies from 9 to 67%.<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>
* The incidence of complications in the donor varies from 9 to 67%.<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>
* The modified Clavien classification is commonly used to describe, report, and compare 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>
* The modified Clavien classification is commonly used to describe, report, and compare 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, does not result in residual disability, and does not require a therapeutic invasive intervention  
**Grade I—a complication that is not life-threatening, does not result in residual disability, 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 IV—a complication with residual or lasting disability or which leads to Living-donor Liver Transplantation 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>
Grade III—a complication that is potentially lifethreatening and that requires a therapeutic invasive intervention
 
Grade IV—a complication with residual or lasting disability or which leads to Living-donor Liver Transplantation 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 ==
Line 31: Line 28:
* Combination therapy may be peginterferon or standard interferon and ribavirin, monotherapy may be peginterferon, standard interferon, or ribavirin, and anti-HCV immune globulin.
* 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''' 
* '''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>  
**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 in 28 of 40 patients (70 percent).  
**Treatment resulted in persistently undetectable HCV ribonucleic acid (RNA) 12 weeks after stopping treatment in 28 of 40 patients (70 percent).  
* All of the cases of virologic failure were due to relapse. As a result, sofosbuvir is usually now given in combination with one of several additional direct-acting antivirals (ledipasvir, simeprevir, and daclatasvir), with or without ribavirin.<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>
**All of the cases of virologic failure were due to relapse. As a result, sofosbuvir is usually now given in combination with one of several additional direct-acting antivirals (ledipasvir, simeprevir, and daclatasvir), with or without ribavirin.<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 ====

Revision as of 23:43, 17 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

Home

Patient Information

Overview

Historical Perspective

Indications

Pre-surgical management

Choice of donor

Epidemiology and Demographics

Techniques

Complications

Acute rejection

Immune therapy

Post-surgical infection

Prognosis

Overview

Liver transplantation prognosis

  • Prognosis is quite good. 1-year survival (in Finland) is 83%, 5-year survival is 76% and 10-year survival is 66%.
  • Majority of deaths happen during the first three months after transplantation.
  • Mortality rates in donors are 0.2% in the USA and vary fro, 0.1 to 1.0% worldwide.
  • Overall mortality rate is of the order of 0.2–0.5%.
  • 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%.[1]
  • The modified Clavien classification is commonly used to describe, report, and compare donor morbidity:[2]
    • Grade I—a complication that is not life-threatening, does not result in residual disability, 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 Living-donor Liver Transplantation 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 preemptive 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 in 28 of 40 patients (70 percent).
    • All of the cases of virologic failure were due to relapse. As a result, sofosbuvir is usually now given in combination with one of several additional direct-acting antivirals (ledipasvir, simeprevir, and daclatasvir), with or without ribavirin.[6]

Hepatocellular Carcinoma

  • Resection remains the standard with which alternative treatment methods must be compared. [4,14-16]:

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, coexistent IBD, presence of an intact colon after transplantation, cytomegalovirus (CMV) infection, recurrent acute cellular rejection, steroid-resistant cellular rejection, use of OKT3.

References

  1. ↑ 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.
  2. ↑ Surman OS (2002). "The ethics of partial-liver donation". N Engl J Med. 346 (14): 1038. doi:10.1056/NEJM200204043461402. PMID 11932469.
  3. ↑ 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.
  4. ↑ Smith B (1969). "Segmental liver transplantation from a living donor". J Pediatr Surg. 4 (1): 126–32. PMID 4976215.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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.
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