Complementary Roles of Cadaveric and Living Donor Liver Transplantation in Acute Liver Failure

Özden, İlgin; Yavru, Hacer Ayşen; Durmaz, Özlem; Orhun, Günseli; Salmaslıoğlu, Artür; Güllüoğlu, Mine; Alper, Aydın; İbiş, Cem; Serin, Kürşat Rahmi; Önal, Zerrin; Özcan, Perihan Ergin; Poyanlı, Arzu; Törün, Selda Hançerli; Çağatay, Atahan; Cantez, Sema; Kaymakoğlu, Sabahattin

doi:10.1007/s11605-021-04932-3

Cited by 6 publications

(5 citation statements)

References 53 publications

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“…In addition to logistic difficulties, urgent living donor liver transplantation inevitably carries ethical problems because the time interval available for an informed decision is very short [29]. It is a ‘necessity’ [29] that ‘complements’ cadaveric liver transplantation in some countries [30,31] or practically replaces it in others [32,33].…”

Section: Discussionmentioning

confidence: 99%

Successful results of early nucleos(t)ide analogue treatment for liver transplantation candidates with severe acute hepatitis B infection

Özden,

Kinaci,

Ocak

et al. 2024

European Journal of Gastroenterology &Amp; Hepatology

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Background Early treatment of severe acute hepatitis B virus (HBV) infection with nucleos(t)ide analogues may prevent progression to acute liver failure (ALF). Patients and methods The charts of 24 patients who were treated for severe acute HBV infection (either INR ≥ 1.5 or INR≥ 1.4 and total bilirubin ≥ 20 mg/dL at the referring institution or after admission) between April 2021 and May 2023 (inclusive) were evaluated retrospectively. Twelve patients were women; median [range] age: 48 [35–68]. Entecavir (0.5 mg/day) (n = 16) or tenofovir disoproxil fumarate (245 mg/day) (n =8) were used depending on availability. Results Two patients required liver transplant which was performed successfully in one (no suitable donor for the other). Deterioration to ALF was prevented in 22 of the 24 cases (92%); these patients could be discharged after median (range) 12 (5–24) days following initiation of the antiviral drug. There was no significant difference in efficacy between the two antiviral agents. The anti-HBsAg antibody became positive in 16 patients (73%); one other patient became HBsAg negative at 1 month after discharge but was lost to follow up. Five patients (23%) are still HBsAg positive but all except one have started treatment in the last 6 months. One of the recently treated 4 patients stopped taking the antiviral drug at his own will and one has become anti-HIV antibody positive during follow up. Conclusion Early treatment of severe acute HBV infection with entecavir or tenofovir disoproxil fumarate prevents the need for liver transplant and consideration of living donors.

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Section: Discussionmentioning

confidence: 99%

Successful results of early nucleos(t)ide analogue treatment for liver transplantation candidates with severe acute hepatitis B infection

Özden,

Kinaci,

Ocak

et al. 2024

European Journal of Gastroenterology &Amp; Hepatology

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“…Finally, it has been reported that living donor evaluation and preparation can take approximately 36–40 h, which can limit the number of eligible living liver donors [ 4 ]. Such time-line requirements and lack of institutional protocols and experience required to serve the rapid evaluation process of donors may further limit the usage of LDLT as an option for adult patients with ALF.…”

Section: Discussionmentioning

confidence: 99%

“…Acute liver failure (ALF) is a life-threatening condition defined by the development of hepatic encephalopathy and coagulopathy that is characterized by an international normalized ratio (INR) ≥ 1.5 and often the development of multi-organ failure leading to death in a patient with no pre-existing liver disease [ 1 , 2 ]. Despite improvements in survival rates due to more sophisticated supportive care methods in the intensive care unit, emergent liver transplantation (LT) remains the only treatment for patients who do not improve [ 3 , 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Recipient Survival among Living Donor vs. Deceased Donor Liver Transplants for Acute Liver Failure in the United States

Moughames,

Gurakar,

Khan

et al. 2024

JCM

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Objectives: Acute liver failure (ALF) is associated with high morbidity and mortality. Timely liver transplantation (LT) is the only universally accepted therapy for ALF that is non-responsive to medical therapy. Data regarding the use of living donor LT (LDLT) for this indication in the US is scarce. Materials and Methods: United Network of Organ Sharing/Organ Procurement and Transplantation Network (UNOS/OPTN) data from January 2002 to December 2020 were reviewed. Adult and pediatric recipients listed as status 1 were included. Demographics, clinical and laboratory data, and post-LT survival rates were compared for LDLT vs. DDLT recipients. Results: There were 180 LDLT (3.6%) and 4779 DDLT (96.4%) recipients with a diagnosis of ALF. The majority of recipients in the LDLT group were pediatric (n = 164, 91%) compared to the DDLT group (n = 1455, 30%), p < 0.001. In the pediatric-only group, post-LT survival was comparable between LDLT and DDLT recipients (p = 0.15). Five-year post-LT survival was higher for pediatric recipients compared to adults in the LDLT group (84.2% vs. 62.5%, respectively, p < 0.001) and the DDLT group (82.8% vs. 78.7%, respectively, p < 0.001). Adults had a higher hazard of death compared to pediatric recipients in the LDLT group (HR = 3.560, 95% CI 1.612–7.844, p = 0.002) and the DDLT group (HR = 1.472, 95% CI 1.290–1.679, p < 0.001). In multivariate analysis results, the type of LT and age group were not associated with higher post-LT mortality. Conclusions: In the US, LDLT constitutes 3.6% of LTs for ALF. In the pediatric-only group, post-LT survival was comparable between LDLT and DDLT recipients. Overall, there were superior post-LT outcomes for pediatric recipients compared to adults for LDLT and DDLT.

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“…Currently, another milestone in LT introduced in 1990-LDLT-has evolved from initially providing left lateral grafts to paediatric recipients to being able to offer right lobe grafts to adult recipients. [89][90][91][92] With the gradual improvement of techniques and experience, as well as the continuous refinement of donor and recipient selection criteria, SLT has the potential to complement LDLT and further expand the pool of adult donors, 93 while maximizing the utilization of deceased donor livers. 94 It should receive attention and development from transplant centres worldwide.…”

Section: Full-right/full-left Splittingmentioning

confidence: 99%

Split liver transplantation: Current status and future trend

Zhao,

Zheng

2024

Surgical Practice

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Liver transplantation (LT) remains the most effective treatment for end‐stage liver disease. However, there continues to be a severe shortage of liver donors worldwide, resulting in a significant disparity between the number of patients on the liver transplant waiting list and the available donor organs. Split liver transplantation (SLT) enables a single whole liver graft to be divided into two partial grafts, which can then be transplanted into two recipients. This approach expands the pool of available liver donors and reduces the waiting time for LT. Since its inception, SLT has undergone continuous development and research. As a complex variant of LT, SLT requires a high level of surgical expertise, and many aspects of SLT have not yet reached a consensus or clear definition within the transplantation community. In addition, it represents a smaller proportion among all LT techniques, which hampers the further development of SLT technology. This review concludes recent developments in SLT, offering a comprehensive summary of current practices regarding donor selection criteria, surgical techniques, and clinical outcomes. Its purpose is to serve as a reference for real clinical scenarios and explore potential future trends in SLT.

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Complementary Roles of Cadaveric and Living Donor Liver Transplantation in Acute Liver Failure

Cited by 6 publications

References 53 publications

Successful results of early nucleos(t)ide analogue treatment for liver transplantation candidates with severe acute hepatitis B infection

Successful results of early nucleos(t)ide analogue treatment for liver transplantation candidates with severe acute hepatitis B infection

Recipient Survival among Living Donor vs. Deceased Donor Liver Transplants for Acute Liver Failure in the United States

Split liver transplantation: Current status and future trend

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