What we´re reading… May 2023
The May issue of Transplantation, the official Journal of ILTS and the Transplantation Society is out now.
A must-read for anyone working in the field of liver transplantation.
Article selections by Ryan Chadha, Abdul Rahman Hakeem, Alexandra Shingina, Sadhana Shankar, Madhukar Patel.
Journal of Hepatology
TIPS prevents further decompensation and improves survival in patients with cirrhosis and portal hypertension in an individual patient data meta-analysis
Background and Aims: Further decompensation represents a prognostic stage of cirrhosis associated with higher mortality than first decompensation. A transjugular intrahepatic portosystemic shunt (TIPS) is indicated to prevent variceal rebleeding and for refractory ascites, but its overall efficacy to prevent further decompensations is unknown. This study aimed to assess (i) the incidence of further decompensation and (ii) mortality after TIPS vs. standard of care (SOC). More
AFP-L3 and DCP are superior to AFP in predicting waitlist dropout in hepatocellular carcinoma patients: results of a prospective study
In patients with HCC awaiting liver transplantation (LT), there is a need to identify biomarkers that are superior to AFP in predicting prognosis. AFP-L3 and des-gamma-carboxyprothrombin (DCP) play a role in HCC detection, but their ability to predict waitlist dropout is unknown. More
Impact of living donor liver transplantation on long-term cardiometabolic and graft outcomes in cirrhosis due to nonalcoholic steatohepatitis
Background and aim: Non-alcoholic steatohepatitis (NASH) is a leading indication for liver transplantation (LT). This study aimed to determine whether living donor LT (LDLT) recipients experienced less recurrent NASH, cirrhosis, and cardiometabolic complications compared to deceased donor LT (DDLT). More
Journal of the American Colleges of Surgeons
Liver Transplantation vs Partial Hepatectomy for Stage T2 Multifocal Hepatocellular Carcinoma <3 cm without Vascular Invasion: A Propensity-Score Matched Survival.
Background: Multifocal hepatocellular carcinoma (HCC) differs biologically and immunologically from single-nodule HCC. Asian and European guidelines consider liver transplantation (LT) and partial hepatectomy (PH)) as effective for T2 multifocal HCC, with preference towards LT, but few US studies compare these treatments directly. This propensity-score based observational study uses an established national cancer outcomes registry to compare overall survival in patients undergoing PH and LT for multifocal HCC. More
CT Volumetry Can Be Used for Monitoring Liver Function Recovery in Auxiliary Partial Orthotopic Liver Transplantation
Background: Scintigraphy with a 99mTC-trimethyl-Br-IDA tracer (TBIDA) is used to monitor liver function regeneration after auxiliary partial orthotopic liver transplantation (APOLT) for acute liver failure (ALF). As computed tomography (CT) is also regularly performed during patient follow-up, CT volumetry could be used as an alternative to monitor native liver recovery after APOLT for ALF. More
Oxygen saturation during donor warm ischemia time and outcome of donation after circulatory death (DCD) liver transplantation with static cold storage: a review of 1114 cases.
The donor operation and the hemodynamics during declaration resulting in donor warm ischemia time (DWIT) have been linked to the outcomes in donation after circulatory death (DCD) liver transplantation (LT). Scrutiny of the donor hemodynamics at the time of withdrawal of life support (WLS) concluded that a functional donor warm ischemia time (fDWIT) may be associated with LT graft failure. Unfortunately, the definition for fDWIT has not reached consensus – but has almost always incorporated time spent in a hypoxic state. More
ANESTHESIOLOGY AND CRITICAL CARE
International Journal of Surgery
Prophylactic terlipressin infusion for severe postreperfusion syndrome in patients undergoing deceased donor liver transplantation. The TIPS-DDLT randomized controlled trial
Background: Severe postreperfusion syndrome (PRS) is a critical and potentially catastrophic event during deceased donor liver transplantation (LT). Terlipressin has been widely used as a renoprotective agent during the perioperative period of LT. This study was designed to evaluate whether prophylactic terlipressin would reduce the occurrence of severe PRS in deceased donor LT. More
American Journal of Transplantation
Intracardiac Thrombosis and Pulmonary Thromboembolism during Liver Transplantation: A Systematic Review and Meta-analysis
Intracardiac thrombosis and/or pulmonary embolism (ICT/PE) is a rare but devastating complication during liver transplantation. Its pathophysiology remains poorly understood and successful treatment remains a challenge. This systematic review summarizes the available published clinical data regarding ICT/PE during liver transplantation. More
Journal of Cardiology
Cirrhotic cardiomyopathy: Predictors of major adverse cardiac events and assessment of reversibility after liver transplant
Background: Major adverse cardiac events (MACE) are a leading cause of morbidity and mortality after orthotopic liver transplantation (OLT). Cirrhotic cardiomyopathy (CCM), initially described in 2005 and revised in 2019, is a source of MACE in patients after OLT. We sought to identify CCM-related predictors of MACE at one-year follow-up after OLT and assess for reversibility of CCM post-OLT. More