Indication and assessment for liver transplantation

Southern, Paul B.; Davies, Mervyn H.

doi:10.7861/clinmedicine.2-4-313

Cited by 4 publications

(2 citation statements)

References 10 publications

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“…Advanced endstage liver disease is the principal indication for liver transplantation in the world 20. Worldwide the three most frequent disease indications for liver transplantation are chronic hepatitis B (HBV) particularly in the Middle East, Asia, and Southern Africa, and chronic hepatitis C (HCV) and alcoholic liver disease in Western Europe and the United States 20–23. HCC is a frequent late complication of advanced cirrhotic liver disease 1, 4, 5, 7, 10, 12, 13, 16.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, with the recent changes in the UNOS listing criteria for liver transplantation in the United States, individuals with small hepatic cancers such as those likely to be detected as a consequence of surveillance techniques are awarded additional points moving them up on the transplant list ahead of their peers with equivalently advanced liver disease but without an HCC 19–26. This change in UNOS listing criteria has increased the transplant rate for individuals with HCC 3.5 fold and has encouraged an interest in surveillance of individuals on liver transplant waiting lists for HCC at many centers 39–44…”

Section: Discussionmentioning

confidence: 99%

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The development ofde novohepatocellular carcinoma in patients on a liver transplant list: Frequency, size, and assessment of current screening methods

Thiel

Yong

et al. 2004

Liver Transpl

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Chronic end stage liver disease is the most frequent indication for liver transplantation. Individuals with end stage cirrhosis, and therefore individuals on liver transplant lists, are at increased risk of developing a hepatic cancer. Those individuals on liver transplant lists also may represent the best group available for evaluating the current methods for screening and surveillance for the development of hepatic cancer as an examination of the explant liver provides a gold standard for tumor assessment. Assuming that only tumor free individuals were screened at the onset of this study, the data obtained enables one to determine the frequency of new hepatic cancers since listing and evaluate the positive and negative predictive values of each assessment method over the surveillance interval. All patients listed for liver transplantation with end stage chronic liver disease, who did not have a hepatoma at the time of transplant listing, were followed and assessed for the development of a hepatic cancer while on the waiting list. The screening techniques utilized included quarterly ␣ fetoprotein (␣FP) determinations and ultrasound (US) studies as well as semi-annual triple phase computed tomography (CT) scans of the liver. ␣FP failed to identify any cases of de novo hepatic cancer in patients waiting for a liver transplant. In contrast, US and especially CT scanning with intravenous contrast identified new hepatic masses. The later method, which identified early enhancing mass lesions, was the more valuable method at identifying masses that subsequently were shown by pathologic examination of the explant liver to be hepatic cancers. However, only 14 of 20 individuals found to have a de novo tumor were identified by this method. Once identified however, the treatments utilized for hepatic tumor ablation while waiting for a transplant appear to be effective with a mean of 57.8؎8.3% necrosis of the treated masses being identified at the time of explant examination. In conclusion these data suggest that: T he major etiologic agents identified for the development of hepatocellular carcinoma (HCC) in the western world are chronic hepatitis C virus (HCV) infection and chronic alcohol abuse. 1 -16 Worldwide, particularly in Asia and Africa, the leading etiologic agent for the development of HCC is the presence of a chronic hepatitis B infection. 3,4,7,8,12,13 Chronic hepatitis C appears to be responsible for the recent increase in prevalence of HCC in the United States 5,6 and in other unique groups. 9 -11 HCC is also a well-recognized complication of cirrhosis in individuals with the various toxin exposures particularly alcohol but also other environmental toxins. 1,2,9,16,17 Finally, HCC occurs in cases of advanced endstage liver disease regardless of the etiology. 1,2,9,10,14,15 Thus, candidates for liver transplantation on a waiting list are a unique population at risk for the development of HCC. Despite this fact, the rate of de novo HCC development in liver transplant candidates listed for transplantation is cu...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The development ofde novohepatocellular carcinoma in patients on a liver transplant list: Frequency, size, and assessment of current screening methods

Thiel

Yong

et al. 2004

Liver Transpl

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Predictors and outcome of emergent Liver transplantation for patients with acute-on-chronic liver failure

Kim

Sinn

Choi

et al. 2021

Digestive and Liver Disease

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Background and aims: Controversy exists over whether emergent liver transplantation (LT) should be performed for patients with acute-on-chronic liver failure (ACLF), especially for patients with multiple organ failure. Methods: A total of 110 ACLF patients, defined by the European Association for the Study of the Liver (EASL) Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) criteria were analyzed. The primary outcome was overall survival after ACLF diagnosis. Results: During follow-up, 76 patients received LT (59 received deceased-donor LT and 17 patients received living-donor LT). The overall survival was better for patients who received LT than patients who did not (82.9% vs. 17.6%, P < 0. 001). Among the 76 patients who received LT, the overall survival was not different according to ACLF grade at diagnosis (70.0%, 85.3%, and 84.4% at one-year for ACLF grades 1, 2, and 3, respectively, P = 0.45 ). The baseline model for end-stage liver disease (MELD) score and progression of the ACLF grade during the pre-transplant period were independent factors for survival after LT. The one-year survival rate was 92.3% for patients with baseline MELD scores of ≤ 32 without ACLF grade progression, whereas it was 33.3% for those with baseline MELD scores of > 32 and ACLF grade progression. Conclusions: Emergent LT provided a significant survival benefit to ACLF patients, regardless of the baseline ACLF grade. Post-LT outcomes were associated with baseline MELD scores and ACLF progression during the pre-transplant period, which might be used in the emergent LT plan for patients presenting with ACLF.

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Síndrome de isquemia-reperfusión asociado al trasplante hepático: una visión actualizada

Casillas-Ramírez

Mosbah

Franco-Gou

et al. 2006

Gastroenterología y Hepatología

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Indication and assessment for liver transplantation

Cited by 4 publications

References 10 publications

The development ofde novohepatocellular carcinoma in patients on a liver transplant list: Frequency, size, and assessment of current screening methods

The development ofde novohepatocellular carcinoma in patients on a liver transplant list: Frequency, size, and assessment of current screening methods

Predictors and outcome of emergent Liver transplantation for patients with acute-on-chronic liver failure

Síndrome de isquemia-reperfusión asociado al trasplante hepático: una visión actualizada

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