What we’re reading…

This month's key articles selected by Ryan Chadha, Marit Kalisvaart, Tomohiro Tanaka, Michael Spiro, and Prashant Bhangui.

Transplantation

Mortality rates in transplant recipients and transplantation candidates in a high prevalence COVID-19 environment

The risk of COVID-19 infection in transplant recipients is unknown. Patients on dialysis may be exposed to greater risk of infection due to an inability to isolate. Consideration of these competing risks is important before restarting suspended transplant programs. This study compared outcomes in kidney and kidney/pancreas transplant recipients with those on the waiting list, following admission with COVID-19 in a high prevalence region. Read more.

 

American Journal of Transplantation

Inpatient COVID‐19 Outcomes in Solid Organ Transplant Recipients Compared to Non‐Solid Organ Transplant Patients: A Retrospective Cohort

Immunosuppression and comorbidities might place solid organ transplant (SOT) recipients at higher risk from COVID‐19, as suggested by recent case series. We compared 45 SOT vs 2427 non‐SOT patients who were admitted with COVID‐19 to our health‐care system (3/1/20‐8/21/20), evaluating hospital length‐of‐stay and inpatient mortality using competing risks regression. Read more.

 

Gastroenterology

Protective role of tacrolimus, deleterious role of age and comorbidities in liver transplant recipients with Covid-19: results from the ELITA/ELTR multi-center European study

Despite concerns that liver transplant (LT) recipients may be at increased risk of unfavorable outcomes from COVID-19 due the high prevalence of co-morbidities, immunosuppression and ageing, a detailed analysis of their effects in large studies is lacking METHODS: Data from adult LT recipients with laboratory confirmed SARS-CoV2 infection were collected across Europe. Read more.

 

Transplantation Proceedings

Risk Factors and Outcomes of Intracardiac Thrombosis During Orthotopic Liver Transplantation

Intracardiac thrombosis incidence during orthotopic liver transplantation is estimated at 0.36% to 6.2% with mortality up to 68%. We aimed to evaluate risk factors and outcomes related to intracardiac thrombosis during orthotopic liver transplantation. Read more.

 

World Journal of Transplantation

Intraoperative thromboelastography as a tool to predict postoperative thrombosis during liver transplantation

Thromboembolic complications are relatively common causes of increased morbidity and mortality in the perioperative period in liver transplant patients. Early postoperative portal vein thrombosis (PVT, incidence 2%-2.6%) and early hepatic artery thrombosis (HAT, incidence 3%-5%) have a poor prognosis in transplant patients, having impacts on graft and patient survival. In the present study, we attempted to identify the predictive factors of these complications for early detection and therefore monitor more closely the patients most at risk of thrombotic complications. Read more.

 

International Journal of Surgery

Enhanced recovery after low- and medium-risk liver transplantation: A single-center prospective observational cohort study

Few studies have fully applied an enhanced recovery after surgery (ERAS) protocol to liver transplantation (LT). Our aim was to assess the effects of a comprehensive ERAS protocol in our cohort of low- and medium-risk LT patients. Read more.

 

Transplantation

Sex-Based Disparities in Hepatocellular Carcinoma Recurrence After Liver Transplantation

Women with chronic liver disease have lower rates of hepatocellular carcinoma (HCC) as compared to men; it is unknown if there are sex-based differences in HCC recurrence post-liver transplant . Read more.

 

Hepatology

Refitting the Model for End‐stage Liver Disease for the Eurotransplant region

The UNOS‐MELD score is the basis of liver allocation in the Eurotransplant region. It was constructed 20 years ago in a small US cohort and has remained unchanged ever since. The best boundaries and coefficients were never calculated for any region outside the US. Therefore, this study refits MELD (reMELD) for the Eurotransplant region. Read more.

 

Clinical Gastroenterology and Hepatology

Patterns of Alcohol Use After Early Liver Transplantation for Alcoholic Hepatitis

Early liver transplantation (LT) for alcoholic hepatitis (AH) is lifesaving but concerns regarding return to harmful alcohol use remain. We sought to identify distinct patterns of alcohol use post-LT to inform pre-LT candidate selection and post-LT addiction care. Read more.

 

Liver Transplantation

Incorporating tumour biology to predict HCC recurrence in patients undergoing LDLT using expanded selection criteria

Conventional selection criteria for liver transplantation in patients with hepatocellular carcinoma (HCC) based on tumour size and number alone, do not consider vital surrogates of tumor biology like alpha‐fetoprotein (AFP) and tumour FDG‐18 PET avidity. We follow an expanded selection criteria for living donor liver transplantation (LDLT) in patients with cirrhosis and HCC (HCC‐cirr): no extrahepatic disease, no major vascular invasion, irrespective of tumour size and number. Read more.

 

Liver Transplantation

Hypothermic oxygenated perfusion(HOPE) improves ECD liver graft function and reduces duration of hospitalisation without extra cost: The PERPHO Study

Few studies have evaluated the efficacy or the cost of Hypothermic Oxygenated Perfusion( HOPE) in the conservation of extended criteria donor (ECD) grafts from brain-dead donors (DBD) during liver transplantation(LT). The PERPHO Study (NCT03376074) is a prospective, monocentric, study designed to evaluate the interest of HOPE for ECD-DBD grafts. Read more.

 

Transplantation

Outcomes of Highly Selected Live Donors With a Future Liver Remnant Less Than or Equal to 30%

The main concern with live donor liver transplantation (LDLT) is the risk to the donor. Given the potential risk of liver insufficiency, most centers will only accept candidates with future liver remnants (FLR) >30%. We aimed to compare postoperative outcomes of donors who underwent LDLT with FLR ≤30% and >30%. Read more.