Main factors influencing long-term outcomes of liver transplantation in 2022

Fuochi, Elisa; Anastasio, Lorenzo; Lynch, Erica Nicola; Campani, Claudia; Dragoni, Gabriele; Milani, Stefano; Galli, Andrea; Innocenti, Tommaso

doi:10.4254/wjh.v15.i3.321

Cited by 8 publications

(5 citation statements)

References 309 publications

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“…With long-term survival now commonplace following LT, there is an increasing need to improve non-hepatic health to avoid complications including metabolic derangements, renal impairment and de novo malignancy. De novo PTM accounts for approximately 16.4% of late deaths following LT[ 12 , 52 ]. Although immunosuppression exposure is a well-known contributor of PTM risk, there remains uncertainty regarding the carcinogenic effect of specific immunosuppression drugs, alone or in combination.…”

Section: Discussionmentioning

confidence: 99%

Relative carcinogenicity of tacrolimus vs mycophenolate after solid organ transplantation and its implications for liver transplant care

Liu,

Youssef,

Grace

et al. 2024

World J Hepatol

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BACKGROUND De novo malignancy is a leading cause of late morbidity and mortality in liver transplant recipients. Cumulative immunosuppression has been shown to contribute to post-transplant malignancy (PTM) risk. There is emerging evidence on the differential carcinogenic risk profile of individual immunosuppressive drugs, independent of the net effect of immunosuppression. Calcineurin inhibitors such as tacrolimus may promote tumourigenesis, whereas mycophenolic acid (MPA), the active metabolite of mycophenolate mofetil, may limit tumour progression. Liver transplantation (LT) is relatively unique among solid organ transplantation in that immunosuppression monotherapy with either tacrolimus or MPA is often achievable, which makes careful consideration of the risk-benefit profile of these immunosuppression agents particularly relevant for this cohort. However, there is limited clinical data on this subject in both LT and other solid organ transplant recipients. AIM To investigate the relative carcinogenicity of tacrolimus and MPA in solid organ transplantation. METHODS A literature search was conducted using MEDLINE and Embase databases using the key terms “solid organ transplantation”, “tacrolimus”, “mycophenolic acid”, and “carcinogenicity”, in order to identify relevant articles published in English between 1st January 2002 to 11th August 2022. Related terms, synonyms and explosion of MeSH terms, Boolean operators and truncations were also utilised in the search. Reference lists of retrieved articles were also reviewed to identify any additional articles. Excluding duplicates, abstracts from 1230 records were screened by a single reviewer, whereby 31 records were reviewed in detail. Full-text articles were assessed for eligibility based on pre-specified inclusion and exclusion criteria. RESULTS A total of 6 studies were included in this review. All studies were large population registries or cohort studies, which varied in transplant era, type of organ transplanted and immunosuppression protocol used. Overall, there was no clear difference demonstrated between tacrolimus and MPA in de novo PTM risk following solid organ transplantation. Furthermore, no study provided a direct comparison of carcinogenic risk between tacrolimus and MPA monotherapy in solid organ transplantation recipients. CONCLUSION The contrasting carcinogenic risk profiles of tacrolimus and MPA demonstrated in previous experimental studies, and its application in solid organ transplantation, is yet to be confirmed in clinical studies. Thus, the optimal choice of immunosuppression drug to use as maintenance monotherapy in LT recipients is not supported by a strong evidence base and remains unclear.

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Section: Discussionmentioning

confidence: 99%

Relative carcinogenicity of tacrolimus vs mycophenolate after solid organ transplantation and its implications for liver transplant care

Liu,

Youssef,

Grace

et al. 2024

World J Hepatol

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“…They may be in great uncertainty due to their symptom distress and in need of targeted interventions with symptom management support, where a primary contact nurse could establish a continuous person centered caring relationship to enable personalized follow-up. As short-term survival after LT has improved extensively over recent decades, we need to focus on the long-term outcome ( Fuochi et al, 2023 ). Even though LT is a lifesaving treatment it is a chronic condition where one moves from end-stage disease to hopefully better health and well-being.…”

Section: Discussionmentioning

confidence: 99%

Self-reported symptom occurrence and distress, and psychological well-being after liver transplantation – a descriptive cross-sectional study of Danish recipients

Dengsø,

Knudsen,

Møller

et al. 2024

Front. Psychol.

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IntroductionSymptom distress and impaired psychological well-being after liver transplantation may lead to limitations in everyday activities and lowered health-related quality of life. The aim of this nationwide, descriptive, and cross-sectional study was to explore self-reported symptom occurrence and distress, among Danish liver transplant recipients, and their association with self-reported psychological well-being as well as demographic, and clinical characteristics.MethodsLiver transplant recipients transplanted from 1990 to 2022 were included. All recipients were asked to complete the Organ Transplant Symptom and Wellbeing instruments consisting of two instruments measuring self-reported symptom occurrence and distress, respectively, as well as self-reported psychological well-being by the Psychological General well-being instrument.ResultsOf 511 invited recipients 238 responded: 116 women and 122 men with a median post-transplant follow-up of 7.5 years (IQR 3.6–14.2 years). The most common single symptoms reported were decreased libido (18%), diarrhea (10%), and headache (8%). Sleep problems were the most common transplant-specific domain. 41% of the recipients reported poor psychological well-being, especially those who had undergone transplantation within the last 5 years, women, and younger recipients.DiscussionIn the interest of equity, the fact that women reported a higher level of symptom distress than men requires attention. Research on symptom management support is warranted with interventions focusing on how to alleviate symptom distress, which might increase long-term survival, which has not improved in recent decades.

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“…Reduced adherence to lifestyle recommendations can be linked to social deprivation, a third area that needs to be explored. Along with constant medical care, the active participation of patients in their healthcare plan and adherence to lifestyle recommendations are crucial for improving the outcomes of LT ( 75 ). To reduce the rate of chronic attrition after a transplant, it is important to address pre-existing health conditions and complications that may arise from immunosuppressive drugs ( 76 ).…”

Section: A Theoretical Background Model To Explain the Impact Of Soci...mentioning

confidence: 99%

The impact of socioeconomic deprivation on liver transplantation

De Simone,

Germani,

Lai

et al. 2024

Front. Transplant.

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Despite global expansion, social disparities impact all phases of liver transplantation, from patient referral to post-transplant care. In pediatric populations, socioeconomic deprivation is associated with delayed referral, higher waitlist mortality, and reduced access to living donor transplantation. Children from socially deprived communities are twice as much less adherent to immunosuppression and have up to a 32% increased incidence of graft failure. Similarly, adult patients from deprived areas and racial minorities have a higher risk of not initiating the transplant evaluation, lower rates of waitlisting, and a 6% higher risk of not being transplanted. Social deprivation is racially segregated, and Black recipients have an increased risk of post-transplant mortality by up to 21%. The mechanisms linking social deprivation to inferior outcomes are not entirely elucidated, and powered studies are still lacking. We offer a review of the most recent evidence linking social deprivation and post-liver transplant outcomes in pediatric and adult populations, as well as a literature-derived theoretical background model for future research on this topic.

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Main factors influencing long-term outcomes of liver transplantation in 2022

Cited by 8 publications

References 309 publications

Relative carcinogenicity of tacrolimus vs mycophenolate after solid organ transplantation and its implications for liver transplant care

Relative carcinogenicity of tacrolimus vs mycophenolate after solid organ transplantation and its implications for liver transplant care

Self-reported symptom occurrence and distress, and psychological well-being after liver transplantation – a descriptive cross-sectional study of Danish recipients

The impact of socioeconomic deprivation on liver transplantation

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