Tomorrow’s challenge in liver transplantation: diminishing the imbalance between donor organ availability and need

Gut ◽  
1998 ◽  
Vol 43 (5) ◽  
pp. 728.8-728
Author(s):  
E M YOSHIDA ◽  
S W CHUNG
2018 ◽  
Vol 6 (2) ◽  
pp. 67-74
Author(s):  
Bharata Regmi ◽  
Manoj Kumar Shah

A liver transplantation (LT) is a surgical procedure that removes a liver that no longer functions properly and replaces it with a healthy liver from a living or deceased donor. It is a viable treatment option for end-stage liver disease and acute liver failure. The most commonly used technique is orthotopic transplantation or deceased donor liver transplantation (DDLT) in which the native liver is removed and replaced by the donor organ in the same anatomic location as the original liver. Ongoing challenges of LT include those concerning donor organ shortages, recipients with more advanced disease at transplant, growing need for transplantation, side effects associated with long-term immunosuppression, toxicities and obesity. Organ shortage has become the most vexing problem in LT, with 10–25% of patients dying while awaiting transplantation. Different ideas has been evolved like living donor liver transplantation (LDLT), marginal donor liver transplantation (MDLT) and  split liver transplantation (SLT) to overcome the growing problem of organ shortage. These techniques are becoming very important in an attempt to narrow the gap between demand and supply of organs. The advances in surgical and anaesthetic techniques, greater understanding of the physiological, haematological, biochemical, microbiological and immunological changes in liver disease and transplantation allowed a multidisciplinary approach that led to better outcomes. These changes, coupled with more effective immunosuppressive and anti-microbial agents and improvements in patient and donor selection, mean that now liver replacement is a routine procedure with excellent long term outcomes.Int. J. Appl. Sci. Biotechnol. Vol 6(2): 67-74 


2015 ◽  
Vol 28 (4) ◽  
pp. 448-454 ◽  
Author(s):  
Katrin S. Umgelter ◽  
Moritz Tobiasch ◽  
Aida Anetsberger ◽  
Manfred Blobner ◽  
Stefan Thorban ◽  
...  

Infection ◽  
2008 ◽  
Vol 36 (3) ◽  
pp. 207-212 ◽  
Author(s):  
F. Mattner ◽  
A. Kola ◽  
S. Fischer ◽  
T. Becker ◽  
A. Haverich ◽  
...  

2014 ◽  
Vol 98 ◽  
pp. 728-729
Author(s):  
N. Parikh ◽  
D. Hutton ◽  
K. Sangani ◽  
Y. Xu ◽  
M. Lavieri

HPB ◽  
2018 ◽  
Vol 20 ◽  
pp. S800
Author(s):  
J. van Grafhorst ◽  
M. Nijboer ◽  
V. de Meijer ◽  
M. de Boer ◽  
W. Polak ◽  
...  

2019 ◽  
Vol 28 (1) ◽  
pp. 53-61
Author(s):  
Anca Zimmermann ◽  
Felix Darstein ◽  
Maria Hoppe-Lotichius ◽  
Gerrit Toenges ◽  
Anja Lautem ◽  
...  

Background & Aims: Fibrosis progression (FP) after liver transplantation (LT) increases morbidity and mortality. Biomarkers are needed for early prediction of FP. A recipient’s seven-gene cirrhosis risk score (CRS) has been associated with FP, especially in non-transplant cohorts. A broader validation of CRS, including the genotype of the donor-organ and HCV-negative patients is lacking. We therefore analyzed the impact of donor- and recipient-specific genotypes on FP after LT in a large cohort of HCV-positive and -negative patients.Method: Genotyping from liver biopsies (n=201 donors) and peripheral blood (n=442 recipients) was performed. Cirrhosis risk score was correlated with FP at 1 and 5 years after LT.Results: Fibrosis ≥F2 was documented in 26.5% of the recipients’ CRS group (R-CRS) (defined by recipient’s genotype) and in 23.4% of the donors’ CRS- group (D-CRS) (defined by donor’s genotype). Cumulative incidence for fibrosis ≥F2 was higher in patients with D-CRS >0.7 (p=0.03). While the R-CRS showed no prognostic relevance, D-CRS >0.7 was associated with higher hazard ratios (HRs) for fibrosis ≥F2 (HR=2.04; p=0.01), especially in HCV-negative patients (HR=2.59, p=0.03). Donors’ CRS >0.7 was associated with higher risk for ≥F2 in 1-year protocol biopsies (p<0.001). Among the patients in whom both the recipient’s and donor’s CRS were available, fibrosis ≥F2 was encountered more frequently in patients with a D-CRS >0.7, in combination with any R-CRS, compared to patients with D-CRS scores ≤0.7 (p=0.034). Donors’ AZIN1, STXBP5L, TRPM5 genotypes carried a higher risk for fibrosis ≥F2 in subgroups.Conclusion: High D-CRS >0.7 predicted early FP after LT, especially in HCV negative patients.


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