Long-term outcome after living donor liver transplantation compared to donation after brain death in autoimmune liver diseases: Experience from the European Liver Transplant Registry

Heinemann, Melina; Liwinski, Timur; Adam, René; Berenguer, Marina; Mirza, Darius F.; Malekhosseini, Seyed Ali; Heneghan, Michael A.; Lodge, Peter; Pratschke, Johann; Boudjéma, Karim; Paul, Andreas; Zieniewicz, Krzysztof; Froněk, Jiří; Mehrabi, Arianeb; Tokat, Yaman; Çöker, Ahmet; Yılmaz, Sezai; Karam, Vincent; Duvoux, Christophe; Lohse, Ansgar W.; Schramm, Christoph

doi:10.1111/ajt.16864

Cited by 19 publications

(20 citation statements)

References 21 publications

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“…Our study is one of the largest available, based on individual data, and confirms an overall early good prognosis of AIH‐LT: 1‐year graft and patient survivals were respectively 84.3% and 88.0%, in agreement with previous studies 10,23 . We confirm the need to manage septic risk in the early post‐transplant period, as it represents the leading cause of early deaths.…”

Section: Discussionsupporting

confidence: 89%

Liver transplantation for autoimmune hepatitis: Pre‐transplant does not predict the early post‐transplant outcome

Chouik

Francoz

Martin

et al. 2023

Liver International

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Background and Aims: Autoimmune hepatitis (AIH) is a rare indication (<5%) for liver transplantation (LT). The aim of this study was to describe the early outcome after LT for AIH. Methods:A multicenter retrospective nationwide study including all patients aged ≥16 transplanted for AIH in France was conducted. Occurrences of biliary and vascular complications, rejection, sepsis, retransplantation and death were collected during the first year after LT.Results: A total of 344 patients (78.8% of women, 17.0% of (sub)fulminant hepatitis and 19.2% of chronic liver diseases transplanted in the context of acute-on-chronic liver failure [ACLF]) were included, with a median age at LT of 43.6 years. Acute rejection, sepsis, biliary and vascular complications occurred in respectively 23.5%, 44.2%, 25.3% and 17.4% of patients during the first year after LT. One-year graft and patient survivals were 84.3% and 88.0% respectively. The main cause of early death was sepsis. Pre-LT immunosuppression was not associated with an increased risk for early infections or surgical complications. Significant risk factors for septic events were LT

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Section: Discussionsupporting

confidence: 89%

Liver transplantation for autoimmune hepatitis: Pre‐transplant does not predict the early post‐transplant outcome

Chouik

Francoz

Martin

et al. 2023

Liver International

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“…Higher donor and recipient age and male donor have also been cited as risk factors for mortality after LDLT. [11][12][13] Mean donor and recipient age in our study was 33.7(± 9.5) and 42.5 (± 13.8) years, respectively. Larger prospective studies are needed to assess the effect of donor and recipients age on transplant outcome in PSC.…”

Section: Discussionmentioning

confidence: 67%

Good outcomes of living donor liver transplant in primary sclerosing cholangitis: an experience from North India

et al. 2022

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Background Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease. In the absence of effective medical therapy, liver transplant is the definitive treatment for advanced stage. However, recurrence of PSC after liver transplant is of concern which can lead to graft failure and may require retransplant. There are limited data on outcomes of living donor liver transplant (LDLT) in PSC. Also, in LDLT as donors are genetically related there can be an increased risk of recurrence. We conducted this retrospective study to analyze the outcomes of LDLT in PSC at a tertiary liver transplant center in north India. Methods We conducted a retrospective analysis of 3213 transplant recipients who underwent LDLT from January 2006 to May 2021. Of these 26 (0.80%) patients had PSC as indication for liver transplantation (PSC = 24, PSC-AIH overlap = 2). Data analysis was done to look for baseline demographics, clinical details, transplant outcomes, PSC recurrence, and survival. Results Mean age of study group was 42 (± 13.8) years and 19 patients (73.1%) were males. All patients had decompensated cirrhosis at the time of transplant. Mean CTP score and MELD score were 9.5 (± 1.8) and 18.9 (± 7.1), respectively. Sixteen patients received modified right lobe graft, seven extended right lobe graft and five patients received left lateral graft. Median graft weight and mean graft to recipient weight ratio (GRWR) were 633.5 ) grams and 1.23 (± 0.42), respectively. Most common biliary anastomosis was hepaticojejunostomy, done in 19 (73.1%) while duct to duct anastomosis was performed in 7 (26.9%) patients. Median follow-up was 96 (36-123) months. One patient had ulcerative colitis and none had cholangiocarcinoma. Two (7.7%) patients had bile leak during early post-transplant period. Three (11.1%) patients developed graft rejection and were managed successfully with steroid pulses. Three patients died during early post-transplant period while seven deaths occurred during long-term follow-up including one death due to COVID-19. Five (21.73%) patients had recurrence of PSC of which two patients had graft loss including one after retransplantation. The one year graft and patient survival rate was 88.5%. Conclusion LDLT can be performed in PSC with good long-term outcomes with a risk of PSC recurrence in about one-fifth patients.

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“…Of note, there is a significant increase in the incidence of biliary complications. 32 The possible concomitance of inflammatory bowel disease is a worse prognostic factor, as for other organ transplants. Unfortunately, no consensus on effective therapeutic management exists.…”

Section: Primary Sclerosing Cholangitismentioning

confidence: 99%

Pediatric Liver Transplantation: Long-Term Follow-Up Issues

Bellini¹,

Lauro²,

D’Andrea³

et al. 2022

Exp Clin Transplant

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Pediatric liver transplant is an established life-saving procedure for children with end-stage liver diseases, achieving excellent graft and patient survival but with effects on quality of life and psychological welfare in the long-term. With the natural increase in the number of pediatric transplant patients becoming adults, it is essential to successfully plan and manage issues affecting late outcomes in the vulnerable pediatric transplant population. This study offers an overview of the long-term surgical complications, the consequences of immunosuppression (such as posttransplant diabetes, hypertension, cardiovascular disease, and renal dysfunction), and the infection and malignancy risks. Finally, because quality of life is now an inclusive measurement of patient satisfaction, guidance on how to facilitate the transition to adulthood, empowering transplant recipients, is also provided.

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Long-term outcome after living donor liver transplantation compared to donation after brain death in autoimmune liver diseases: Experience from the European Liver Transplant Registry

Cited by 19 publications

References 21 publications

Liver transplantation for autoimmune hepatitis: Pre‐transplant does not predict the early post‐transplant outcome

Liver transplantation for autoimmune hepatitis: Pre‐transplant does not predict the early post‐transplant outcome

Good outcomes of living donor liver transplant in primary sclerosing cholangitis: an experience from North India

Pediatric Liver Transplantation: Long-Term Follow-Up Issues

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