Evolving Frequency and Outcomes of Liver Transplantation Based on Etiology of Liver Disease

Singal, Ashwani K.; Guturu, Praveen; Hmoud, Bashar; Kuo, Yong Fang; Salameh, Habeeb; Wiesner, Russell H.

doi:10.1097/tp.0b013e31827afb3a

Cited by 263 publications

(195 citation statements)

References 30 publications

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“…Based on preoperative imaging studies, 62% were within the Milan criteria and 38% were beyond the Milan criteria, with 5-year recurrence-free survival rates of 90% and 61%, respectively (P < 0.001). These findings do not differ much from those obtained in the DDLT database of the United States and Europe [24][25][26][27] , and may validate the use of LDLT for HCC patients.…”

Section: Studies Reporting a Comparable Outcomesupporting

confidence: 48%

Living-donorvsdeceased-donor liver transplantation for patients with hepatocellular carcinoma

Akamatsu

Sugawara

Kokudo

2014

WJH

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With the increasing prevalence of living-donor liver transplantation (LDLT) for patients with hepatocellular carcinoma (HCC), some authors have reported a potential increase in the HCC recurrence rates among LDLT recipients compared to deceased-donor liver transplantation (DDLT) recipients. The aim of this review is to encompass current opinions and clinical reports regarding differences in the outcome, especially the recurrence of HCC, between LDLT and DDLT. While some studies report impaired recurrence -free survival and increased recurrence rates among LDLT recipients, others, including large database studies, report comparable recurrence -free survival and recurrence rates between LDLT and DDLT. Studies supporting the increased recurrence in LDLT have linked graft regeneration to tumor progression, but we found no association between graft regeneration/initial graft volume and tumor recurrence among our 125 consecutive LDLTs for HCC cases. In the absence of a prospective study regarding the use of LDLT vs DDLT for HCC patients, there is no evidence to support the higher HCC recurrence after LDLT than DDLT, and LDLT remains a reasonable treatment option for HCC patients with cirrhosis.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Deceased donor liver transplantation; Hepatocellular carcinoma; Living donors; Living-donor liver transplantation; RecurrenceCore tip: The current opinions and clinical reports regarding differences in the recurrence of hepatocellular carcinoma (HCC) between living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT) were reviewed. In the absence of a prospective study regarding the use of LDLT vs DDLT for HCC patients, only with some retrospective studies with conflicting results, there is no evidence to support the higher HCC recurrence after LDLT than DDLT, and LDLT remains a reasonable treatment option for HCC patients with cirrhosis.Akamatsu N, Sugawara Y, Kokudo N. Living-donor vs deceaseddonor liver transplantation for patients with hepatocellular carcinoma. World J Hepatol 2014; 6(9): 626-631 Available from:

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Section: Studies Reporting a Comparable Outcomesupporting

confidence: 48%

Living-donorvsdeceased-donor liver transplantation for patients with hepatocellular carcinoma

Akamatsu

Sugawara

Kokudo

2014

WJH

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“…1,2 Both diseases share similar pathogenesis and histology despite their different phenotypes and risk factors. Because in it was first established as a distinct category for liver transplant in 2000, the number of liver transplants for patients with NASH has increased, accounting for approximately 8% to 10% of all liver transplants in 2009, 2,3 especially among recipients > 65 years old and with more performed in Southeastern and Midwestern regions of the United States. 4 Patients with metabolic syndrome because of concomitant comorbidities such as diabetes, hypertension, obesity, and dyslipidemia are more likely to present with atherosclerosis and its complications and have an increased risk for cardiovascular and all-cause mortality.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Piazza

Singal²

2016

Exp Clin Transplant

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Objectives: Frequency of liver transplants because of nonalcoholic steatohepatitis is increasing. Data are conflicting on nonalcoholic steatohepatitis as a risk factor for cardiovascular events after transplant. Materials and Methods:We reviewed medical records of liver transplant recipients (between years 2005 and 2010) for alcoholic cirrhosis or nonalcoholic steatohepatitis for cardiovascular events (arrhythmia, congestive heart failure, coronary disease, pulmonary hypertension, or stroke) and patient survival within 3 years. Results: Compared with the 65 transplant recipients for alcoholic cirrhosis, the 78 transplant recipients for nonalcoholic steatohepatitis were significantly (P < .0001 for all) more likely to be female (46% vs 8%), have a larger mean body mass index (34 ± 7 vs 29 ± 5), more likely to have diabetes (58% vs 26%), less likely to be hepatitis C virus-positive (3% vs 29%), and less likely to smoke (29% vs 69%). Eleven patients with nonalcoholic steatohepatitis and 9 patients with nonalcoholic steatohepatitis had cardiovascular events; however, these groups were not significantly different 1 year (7.7% vs 6.1%; P = .45) or 3 years (14.1% vs 13.8%; P = .9) after liver transplant. The odds of having a cardiovascular event were about 9-fold greater for patients with concomitant hepatitis C virus and 3-fold greater for men. Eighteen patients died, with patients with cardiovascular events having greater than 4-fold increased mortality (mean 4.1-fold; range, 1.2-fold to 13.9-fold). Conclusions: Cardiovascular events occurred with similar frequency in transplant recipients for nonalcoholic steatohepatitis or alcoholic cirrhosis. Patient survival was affected in both groups, but male patients with concomitant hepatitis C virus infection remained at higher risk for a cardiovascular event after liver transplant. Development of a cardiac evaluation protocol for liver transplant recipients could help monitor these patients.

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“…Alcoholic liver disease (ALD) is a common indication for liver transplantation (LT) (Singal et al, 2013b). Most transplant centers require minimum 6 months of abstinence prior to evaluating for LT. About 10-60% of transplant recipients for ALD use alcohol after LT (Singal et al, 2013a).…”

Section: Introductionmentioning

confidence: 99%

Alcohol Use after Liver Transplantation is Independent of Liver Disease Etiology

Russ

Chen

Kamath

et al. 2016

Alcohol and Alcoholism

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Aim: To assess alcohol use after liver transplantation (LT) and compare liver transplant recipients for alcoholic liver disease (ALD) with recipients for non-ALD causes. Methods: National Institute of Diabetes and Digestive and Kidney Diseases liver transplant database stratified to ALD and non-ALD causes. Results: Among 488 LT recipients reporting pre-transplant alcohol use (147 ALD), proportion of LT recipients reporting alcohol use was similar comparing ALD and non-ALD transplants (25.4% vs. 27.2%; P = 0.56). Among ALD transplants, of 31 with alcohol use, 23 (74%) relapsed at ≥2 year, 25 (80%) reported intermittent drinking and 4 (13%) reported heavy drinking. Among Non-ALD recipients, alcohol use was equally distributed to within 2, 2-5 and after 5 years of LT with 82% reporting intermittent drinking and 9% heavy drinking. Patients with pre-transplant drinking of >20 years and abstinence duration of <2 years were over 2.5-fold likely to report post-transplant alcohol use compared to drinking of >20 years and abstinence of >2 years, 2.56 [95% CI: 1.41-4.67]. Etiology (ALD vs. non-ALD) did not predict post-transplant alcohol use. Of 139 ALD patients with follow-up biopsy data, 13 (7 with post-transplant alcohol use) had steatohepatitis. Histology on 319 non-ALD recipients showed recurrent disease in 91, none due to alcohol. Overall survival was similar between drinkers and abstainers (71% vs. 66%; P = 0.35). Recurrent ALD was cause of death in one ALD and none of non-ALD patients. Conclusion: Alcohol use after LT is independent of LT indication. Patients with non-ALD etiology should be carefully screened for alcohol use prior to LT to identify those at risk for post-LT alcohol use.

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Evolving Frequency and Outcomes of Liver Transplantation Based on Etiology of Liver Disease

Cited by 263 publications

References 30 publications

Living-donorvsdeceased-donor liver transplantation for patients with hepatocellular carcinoma

Living-donorvsdeceased-donor liver transplantation for patients with hepatocellular carcinoma

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Alcohol Use after Liver Transplantation is Independent of Liver Disease Etiology

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