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Transplants

2009

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MELD Score and the Question of When I am Getting My Liver?


November / AASLD Updates


 
 
What Is the Optimal Timing of Hepatitis C Antiviral Therapy before and after Liver Transplantation? Presented at AASLD

http://www.docguide.com
By Cheryl Lathrop

BOSTON -- November 4, 2009 -- Treatment with pegylated interferon and ribavirin (PEG/RBV) therapy during compensated cirrhosis is the most cost-effective strategy for antiviral administration in the setting of advanced hepatitis C virus (HCV)-related liver disease, researchers noted here at the Liver Meeting 2009, the 60th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD).

This strategy yields the greatest survival benefit with the lowest associated cost; it reverses cirrhosis, and prevents decompensation, transplantation, hepatocellular carcinoma (HCC), and death. Sammy Saab, MD, MPH, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, and colleagues reported evidence from their study for treating HCV in patients with compensated cirrhosis before it progresses to more advanced liver disease. The poster presentation was held here on October 31.

Antiviral therapy for the treatment of HCV infection is used both before and after liver transplantation. The objective of this study was to determine the ideal timing for PEG/RBV therapy in patients with advanced liver disease infected with genotype 1 HCV.

The 4 treatment groups were as follows: (1) no antiviral treatment, (2) antiviral therapy in patients with compensated cirrhosis, (3) antiviral therapy in patients with decompensated cirrhosis, and (4) antiviral therapy in patients with recurrent HCV post transplant. A Markov model was constructed comparing treatment strategies. Outcomes of interest were total cost per patient, number of quality-adjusted life-years (QALYs) saved, number of deaths, number of HCCs, and number of transplants required. Each of the 4 treatment arms comprised 1,000 patients.

The total cost per patient for treatment during compensated cirrhosis was $331,425; the total cost per patient for each of the other 3 treatment groups was approximately $152,000 more. The life expectancy for treatment during compensated cirrhosis was almost 10 QALY; for the other 3 groups it was about 7 QALY.

In the 10-year outcome data, a total of approximately 250 patients died in the compensated cirrhosis treatment group; approximately 500 patients died in each of the other 3 groups. A total of approximately 175 patients had a transplant in the compensated cirrhosis treatment group; approximately 200 patients had a transplant in each of the other 3 groups. About 50 patients had regression of cirrhosis in the compensated-cirrhosis treatment group.

Treatment of patients with compensated cirrhosis was the most cost-effective strategy; it resulted in improved survival and decreased cost when compared with the other 3 strategies. Treatment after development of decompensated cirrhosis or post transplant was also cost-effective, but these patients derived less survival benefit at greater cost (when compared with patients treated during compensated cirrhosis). Patients who were allowed to develop more advanced disease had a considerably worse prognosis. All 3 treatment strategies appeared more cost-effective than "no treatment," which suggests that these patients may benefit from antiviral treatment.

"Given these results, we strongly recommend expeditious administration of antiviral therapy to patients with compensated cirrhosis before their disease advances," the authors stated.

These treatment strategies must be studied further, however, before they can be universally recommended, they advised.

[Presentation title: Timing of Hepatitis C Antiviral Therapy Pre and Post Liver Transplantation: A Decision Analysis Model. Abstract 503]

 

Patients who have undergone a liver transplant may have a significantly increased risk for developing cardiovascular risk factors. Researchers from New York Medical College assessed the incidence of new coronary risk factors and coronary artery disease in 200 patients (mean age, 58 years) after liver transplantation. All patients received prednisone for the first 3 months after transplantation. For the 2 years after transplantation, 36 patients were treated with cyclosporine plus mycophenolate, 154 with tacrolimus plus mycophenolate, and 10 with prednisone plus tacrolimus or cyclosporine plus mycophenolate. During 2 years after liver transplantation, the incidence of hypertension increased 36 percent, diabetes increased 17 percent, hypercholesterolemia increased 21 percent, and coronary artery disease increased 6 percent. Researchers attributed the increase in cardiovascular risk factors to the drugs used to prevent transplant rejection.

ACLS Training May Be Inadequate for Treatment of Cardiopulmonary Arrests
(#8685)

Advanced Cardiac Life Support (ACLS) certification may not adequately prepare health-care professionals for performing these certified skills in a clinical setting. Using patient simulations, a research team from Long Island Jewish Medical Center in New York tested 35 incoming medical house staff on chest compressions (CC) and initial airway management (IAM). Of the 35 house officers, 25 had received ACLS training (group 1) and 10 had not received this training (group 2) prior to testing. For CC, group 1 scored 3.16±1.95 and group 2 scored 4.40±1.65 out of the maximum possible score of 11. For IAM, group 1 scored 2.12±1.17 and group 2 scored 1.60±1 out of the maximum possible score of 12. Researchers conclude that ACLS certification had no impact on performance of the key tasks of CC and IAM during a simulated in-hospital cardiopulmonary arrest.

Asian Indians Experience Heart Attacks Earlier Than Caucasians
(#8071)

People of Indian origin experience heart attacks at a much earlier age than Caucasians. Researchers from Maimonides Medical Center in New York analyzed a total of 752 patients (55 years or younger) who had a myocardial infarction (MI) over a 14-year period. The two most predominant groups were people of Indian origin (group I, n=132) and Caucasian (group C, n=447). Results showed that group I presented with an MI at a significantly earlier age compared with group C (45±5.5 years vs. 48±5.8 years). Researchers speculate that the ethnic difference seen in MI presentation could be due to inadequate preventive care or unexplored genetic factors.

Source: Jennifer Stawarz
American College of Chest Physicians



 

AASLD: Survival Lower in HCV-Infected Women after Liver Transplant

www.medpagetoday.com

Nov 4

By John Gever, Senior Editor, MedPage Today

Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and

Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

 

BOSTON -- Women undergoing liver transplant as a result of hepatitis C virus (HCV) infection show poorer long-term survival rates and more frequent failure of the donor liver, compared with male recipients, a researcher said here.

 

Female gender was associated with a hazard ratio for five-year mortality of 1.46 (95% CI 1.04 to 2.03) in multivariate analysis of 195 female and 655 male liver recipients, reported Jennifer Lai, MD, of the University of California San Francisco.

 

Women were also at almost 40% higher risk for overall graft loss (HR 1.39, 95% CI 1.39 to 1.89), Lai said here at the annual meeting of the American Association for the Study of Liver Disease.

 

Action Points 

·        Explain to interested patients that the study suggested that HCV-infected women may have worse outcomes than men after liver transplantation, but the reasons were unknown.

·        Explain that there are few alternatives to transplantation for patients with advanced liver disease related to HCV infection.

·        Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered preliminary until published in a peer-reviewed journal.

 

"Further studies are needed to evaluate modifiable donor factors and post-transplant therapies that influence [women's] outcomes," she told attendees at a plenary presentation.

 

She said previous studies were equivocal on whether gender affects survival and graft loss rates in HCV-infected liver transplant recipients.

 

Moreover, the earlier research included patients whose transplants occurred before the current system for allocating donor livers, based on Model for End-Stage Liver Disease (MELD) scores, was instituted earlier in the decade.

 

The study conducted by Lai and her colleagues included all adult liver transplant recipients with HCV-related liver disease at a network of four major centers from March 2002 to December 2007.

 

A co-diagnosis of hepatocellular carcinoma was not an exclusion, but patients with HIV or who were negative for HCV RNA after transplant were excluded, as were those whose grafts failed within a month of transplant.

 

Overall, with median follow-up of 3.1 years, 22% of transplant recipients had died and 25% had sustained graft loss.

 

Graft loss with recurrent HCV infection occurred in 10% of patients. Advanced recurrent disease was seen in 26%.

 

Lai said that women were at substantially increased risk for these latter outcomes -- a 44% increased chance of advanced recurrent HCV and 84% higher rates of graft loss associated with recurrent infection.

 

In addition to female gender, factors significantly associated with outcomes included:

 

·        African-American race: HR for mortality 1.66 (95% CI 1.09 to 2.55); HR for graft loss 1.51 (95% CI 1.00 to 2.26)

·        Post-transplant antiviral treatment: HR for mortality 0.57 (95% CI 0.40 to 0.80); HR for graft loss 0.70 (95% CI 0.51 to 0.95)

·        Donor age, per year: HR for mortality 1.03 (95% CI 1.02 to 1.04); HR for graft loss 1.02 (95% CI 1.01 to 1.03)

 

Lai emphasized that these factors were adjusted for in the hazard ratios calculated for female gender.

 

She suggested several potential explanations for the higher risks that women appeared to run:

 

·        Differential effects of aging in women compared with men

·        Gender mismatch between donors and recipients -- these were more common with female versus male recipients in the study

·        Renal impairment prior to transplant, also more likely to occur with women than men in the sample

 

Gregory Everson, MD, a hepatologist at the University of Colorado in Denver, who was not involved in the study, said he was not entirely surprised by the findings.

 

He said one of the first studies to examine the role of gender in liver transplant outcomes had also found a disadvantage for women. "This kind of confirms the finding," Everson said.

 

He added that, at this point, there wasn't a clear clinical implication. Everson agreed with Lai that more research is needed to identify the factors underlying the gender differences and how they might be alleviated either prior to or after transplantation.

 

The study was supported by the National Institutes of Health.

 

Lai had no potential conflicts of interest. Other co-authors reported relationships with Salix, Gilead, GlaxoSmithKline, Novartis, Schering, Vertex, Roche, Siemens, Schering-Plough, SciClone, and Human Genome Sciences.

 

Everson reported relationships with Schering-Plough and Ortho Biotech.

 

Primary source: Hepatology

Lai J, et al "Hepatitis C virus (HCV) infected females are at higher risk of graft loss after liver transplantation (LT): A multicenter cohort study" Hepatology 2009; 50: S304A-305A.


 

Noninvasive Breath Test Predicts Survival in Patients with Viral Hepatitis

www.reuters.com

 Presented Monday, November 2, 2009 at 8:00 a.m. Eastern Time in Boston, MA

 

ALEXANDRIA, Va. and BOSTON, Nov. 2 /PRNewswire/ -- A methacetin breath test (MBT) that can be performed quickly and noninvasively has been proven to accurately predict survival in patients with viral hepatitis and may be used as an adjunctive tool to MELD. "The breath test has to be validated on a large cohort of patients," said Gadi Lalazar, MD, principal investigator on this study "but if it is validated, this non invasive liver function test will be able to identify liver impairment at all stages of liver disease - both acute and chronic."

 

MELD (Model for End-Stage Liver Disease) is a scoring system adopted by the United Network for Organ Sharing to assess liver disease severity and determining 3-month mortality. Viral hepatitis progresses at an unpredictable rate and the addition of another way of assessing disease progression can serve as an important adjunct to MELD.  

 

Researchers studied 395 patients with viral hepatitis. The MBT accurately predicted survival. Of those patients, 11 had died in the two years in which data were collected. MBT identified 9 of these 11 patients as being high risk. Whereas 6 of those 11 deaths occurred in patients with a MELD score less than 15 - patients who were considered at a low risk by the MELD scoring system. In addition, MBT accurately predicted survival in patients with a higher MELD score and, therefore, at increased risk as defined by MELD.

 

They concluded that MBT may increase physicians' ability to identify at-risk patients and allow those patients to be listed for liver transplantation earlier than using MELD alone to determine mortality. "We are now conducting large scale clinical trials to assess the role of the methacetin breath test for follow up and therapeutic decision making in patients with chronic hepatitis B and in non-alcoholic fatty liver disease," said Dr. Lalazar.

 

Abstract title:

The noninvasive 13C methacetin breath test accurately predicts long-term survival in patients with chronic viral hepatitis and may serve as an adjunctive tool to MELD: Results of a 395-patient clinical trial.


 

 

Viral Load Predicts Outcome of Liver Transplant Recipients with Hepatitis C: Presented at AASLD

http://www.docguide.com

By Cheryl Lathrop

BOSTON -- November 2, 2009 -- Viral load is an important factor and can predict the outcome of patients with hepatitis C virus (HCV) after liver transplantation, for both the development of the different types of recurrent HCV and patient survival, researchers stated here at the Liver Meeting 2009, the 60th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD).

 

Ivo Graziadei, Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria, and colleagues reported the findings from their study in a poster session here on October 31.

 

After liver transplant, recurrent HCV infection is ubiquitous and leads to graft loss and re-transplantation for 10% to 20% of liver transplant recipients. Donor, recipient, and viral parameters are the risk factors associated with HCV recurrence.

 

As there has been conflicting data reported about the viral load and the severity of recurrent HCV disease, the aim of this study was to analyse the impact of the viral load upon the severity of the recurrent HCV infection.

 

The study included data from 129 patients who received liver transplants due to HCV cirrhosis between 1980 and 2006 at the Medical University of Innsbruck and, who survived more than 6 months, and had histologically proven recurrent HCV infection.

 

Viral load was measured at week 2, and at months 3, 6, and 12 post-transplant (using the bDNA HCV RNA 3.0 assay by Bayer Diagnostics). There was a mean overall follow-up of 6.1 +- 3.6 years. Annual liver biopsies began in 2000; before that, biopsies were performed only in patients with elevated serum transaminases.

 

The majority of patients (81.4%) had no, or only mild to moderate HCV recurrence; 18.6% developed either a cholestatic type of recurrence (8.6%) or a rapid progression to advanced fibrosis/cirrhosis (9.1%).

 

Early viraemia (HCV RNA levels >6.0 log10 IU/mL) at week 2 were highly predictive for the cholestatic type of recurrence and poor patient survival. High viral loads (>6.5 log10 IU/mL) at month 3 were associated with recurrent cirrhosis of the liver allograft.

 

Presentation Title: Viral Load Predicts Outcome of Hepatitis C Patients After Liver Transplantation. Abstract 516


 

Post-transplant Prophylactic Antiviral Treatment Does Not Prevent Recurrent Hepatitis C: Presented at AASLD

Nov 1 09

 Cheryl Lathrop

BOSTON -- November 1, 2009 -- Post-transplant prophylactic antiviral treatment with pegylated interferon (PEG-IFN) alfa-2a plus ribavirin to prevent recurrent hepatitis C is associated with a low rate of sustained virologic response (SVR), adverse events (anaemia, neutropenia), and a high rate of discontinuation.

Natalie Bzowej, MD, California Pacific Medical Center, San Francisco, California, and colleagues presented the findings from the PEGASYS and COPEGUS Administered After Liver Transplantation for Hepatitis C (PHOENIX) study here on October 31 at the Liver Meeting 2009, the 60th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD).

Recurrent allograft hepatitis due to hepatitis C virus (HCV) can be aggressive and can result in graft loss. Prevention of allograft hepatitis C by post-transplant prophylaxis with antiviral treatment is desirable and PEG-IFN alfa-2a plus ribavirin is one strategy. However, data from large randomised controlled trials concerning the optimal timing of PEG-IFN alfa-2a/ribavirin was lacking.

The prospective, multicentre, open-label, randomised study compared prophylactic treatment with a low accelerating dose regimen of PEG-IFN alfa-2a/ribavirin versus initiating the same antiviral regimen only upon observation of histologically confirmed recurrent HCV infection. PHOENIX measured the efficacy, tolerability, and safety of prophylactic treatment at 10 to 26 weeks post-transplant.

Patients were aged >=18 years and had undergone orthotopic liver transplantation (OLT) due to liver disease from HCV infection. Patients were clinically stable and expected to be able to tolerate PEG-IFN alfa-2a/ribavirin therapy.

At 10 to 26 weeks post transplant, patients were randomised to either the prophylaxis arm (n = 55) which consisted of PEG-IFN alfa-2a 135 to 180 mcg/week plus ribavirin 400 to 1,200 mg/day for 48 weeks or to the observation arm (n = 60) in which patients were treated for 48 weeks after histologically confirmed HCV recurrence. The study lasted 120 weeks and all treated patients had 24 to 72 weeks of treatment-free follow-up.

The primary endpoint was the percentage of patients with histologically confirmed HCV recurrence at 120 weeks postrandomisation. Secondary endpoints included Histological Activity Index (HAI) grades and Fibrosis Score (FS) at weeks 48 and 120, virologic response rates defined by undetectable HCV RNA, and biopsy-proven acute allograft rejection, graft loss, or death (a combined endpoint).

There was no difference between the study arms in the primary endpoint of histologically confirmed HCV recurrence at 120 weeks. The distribution of HAI grades and FS scores at baseline and week 120 post randomisation was generally similar in both arms.

Virologic response rates were generally similar between the 2 arms. Three patients in each arm had biopsy-proven acute allograft rejection by week 120.

The frequency of adverse events was generally similar between the 2 arms.

"Given the significant toxicity associated with PEG-IFN alfa-2a plus ribavirin therapy in post-OLT patients, without a clear benefit in terms of HCV recurrence or SVR, this study does not provide sufficient evidence to support routine use of prophylactic therapy."

[Presentation Title: A Randomized Controlled Trial of the Efficacy, Tolerability, and Safety of Prophylactic Treatment With Peginterferon alfa-2a Plus Ribavirin After Orthotopic Liver Transplantation (OLT) for Hepatitis C: The PHOENIX Study. Abstract 506]

 

http://www.docguide.com/news/content.nsf/news/85257

 


Extending Treatment After Liver Transplant May Benefit Patients With Hepatitis C Recurrence

 

Extending hepatitis C treatment for liver transplant patients beyond current practice results in high rates of clearance of the hepatitis C virus from the blood, as well as a low rate of relapse, according to a Henry Ford Hospital study.

 

"We found that patients who achieved a sustained virological response were more likely to have had extended treatment," says Kimberly Brown, M.D., Division head of Gastroenterology at Henry Ford Hospital and senior author of the study.

"In addition, prolonging treatment for 52 weeks after patients were virus negative, resulted in a relapse rate of only 8 percent." This is in contrast to typical relapse rates of 30-35 percent in non transplant patients treated with standard therapy.

Study results will be presented during an oral presentation Oct. 31 at the American Association for the Study of Liver Diseases' Annual Meeting in Boston.

The study looked at 241 consecutive liver transplant patients from 1999-2006. Patients were offered treatment if they tested positive hepatitis C, had recurrent hepatitis C with at least Stage I fibrosis on biopsy, and stable immunosuppression for a minimum of three months. Patients received either non-pegylated interferon tiw or pegylated interferon weekly in combination with ribavirin.

Of the study patients with hepatitis C, 66 were eligible for treatment, and 22 achieved sustained virological response. Only two patients (8 percent) relapsed.

After week 24 of treatment, 35 percent of patients who achieved a sustained virologic response became virus negative.

"These results call into question previous studies which suggested 'stop rules' at weeks 12 and 24 when there is no response to inferferon and ribravirin," says Dr. Brown. "Our results suggest that even if patients are positive at week 24, there is still a 35 percent chance that they can achieve sustained viral clearance. We think this may be beneficial to extend treatment beyond the standard 48 weeks total."

According to the U.S. Department of Health & Human Services, more than 16,000 liver transplants were performed last year and there are currently almost 18,000 Americans on the liver transplant list.

African Americans Fare Worse After Undergoing Liver Transplantation Due to
Hepatitis C
Presented Monday, November 2, 2009 at 4:45 pm Eastern Time in Boston, MA




African Americans Fare Worse After Undergoing Liver Transplantation Due to Hepatitis C


ALEXANDRIA, Va. and BOSTON, Oct. 31 /PRNewswire/ -- Previous studies have
shown that hepatitis C virus (HCV) progresses slower prior to liver
transplantation in African Americans than in whites. However, researchers
demonstrate in this study, which will be presented at the annual meeting of
the American Association for the Study of Liver Diseases, that the opposite is
true after transplantation, in that recurrent HCV in the transplanted liver
progresses faster in African Americans than in whites. "I believe this study
highlights the need, in all patients, for early close clinical monitoring,
including the use of early protocol biopsies, to identify these patients that
have early disease progression post-transplantation," said Jennifer Layden,
MD, PhD, principal investigator on this study.

This retrospective multisite cohort study of 771 patients from 5 sites
evaluated patients who had a liver transplantation between 1999 and 2008. All
patients were transplanted due to liver failure caused by HCV. Data were
analyzed at 6 months, 1 year, and 2 years after transplantation.

The researchers found, based on an analysis of liver biopsies performed after
transplantation, that African Americans had more severe fibrosis progression
and histologic inflammation compared to whites following liver transplantation
for HCV.  While Hispanics demonstrated similar disease progression after liver
transplantation as whites, African Americans more often experienced graft
failure and required repeat liver transplantation compared to whites. In
addition, the hazard ratio for patient death for African Americans was 1.3,
indicating a 30% higher mortality for African Americans compared to whites.
The researchers concluded that African Americans who undergo liver
transplantation caused by HCV had more severe fibrosis progression and
histologic inflammation compared to whites undergoing the same procedure.

"While this study illustrates that HCV histologic progression occurs early and
is more aggressive in African Americans, it does not allow a careful analysis
of factors that may be contributing to these differences," concluded Dr.
Layden, "we are conducting a multi-site prospective study to not only confirm
these retrospective findings, but also examine both donor and host factors,
including psychosocial, virologic, genetic and immunologic that may contribute
to this important health disparity."


Abstract title:
Hepatitis C virus (HCV) progresses more rapidly after orthotopic liver
transplantation (OLT) in African-Americans (AA) compared to whites (W)

About the AASLD

AASLD is the leading medical society focused solely on advancing the science
and practice of hepatology and represents more than 3,300 practitioners,
researchers, and allied health professionals worldwide. Founded by physicians
in 1950, AASLD has upheld the standards of the profession and fostered
research that generates treatment options for the millions of patients with
liver diseases.

This year's Liver Meeting, held in Boston, Massachusetts, October 30 -
November 3, will bring together more than 7,000 researchers from 55 countries.
A pressroom will be available from October 31 at the annual meeting. For
copies of abstracts and press releases, or to arrange for pre-conference
research interviews contact Gregory Bologna at 703-299-9766. To pre-register,
call Ann Tracy at 703-299-9766.

Press releases, additional information for the media, and all abstracts are
available online at www.aasld.org.

    Media Contact: Gregory Bologna
    703/299-9766
    gbologna@aasld.org
    Press Room: October 31 - November 3, 2009
    Hynes Convention Center, Room 209
    Telephone: (617) 954-2827

    Researcher: Jennifer Layden, MD, PhD
    Email: jlayde1@uic.edu
    Phone: (312) 804-9087


This release was issued through The Xpress Press News Service, merging e-mail
and satellite distribution technologies to reach business analysts and media
outlets worldwide. For more information, visit http://www.XpressPress.com


SOURCE  American Association for the Study of Liver Diseases

Gregory Bologna, +1-703-299-9766, gbologna@aasld.org


Oct


Women Are At Greater Risk Than Men Of Graft Loss After Undergoing Liver Transplantation For Hepatitis C-related Liver Disease
 

30 October 2009

Although women with chronic hepatitis C virus (HCV) infection are at lower risk for developing cirrhosis, researchers who compared outcomes for men and women after having liver transplantation found that women have a...
[read article]

 

 

Alert Over Donor Organs Riddled with Cancer, Mad Cow Disease and Hepatitis

Identifying Early Graft Dysfunction Preoperatively

Small-for-size graft dysfunction (SFSGD) following living-related liver transplantation (LRLT) is characterized by early graft dysfunction (EGD) when the graft-to-recipient body weight ratio (GRBWR) is below 0.8%...
[read article]

19 October 2009


Maintenance ribavirin monotherapy delays fibrosis progression in liver transplant recipients with recurrent hepatitis C at high risk of progression

Oct 17  


 

Hepatitis C virus impacts survival after liver transplantation

 


 

Multivisceral Transplant Survival Rates Improve With New Treatment, Says Pittsburgh Study

Monitoring, aggressive treatment key for otitis media in transplant candidates

The natural history of hepatitis C cirrhosis after liver transplantation

Oct 07

Vital Therapies Initiates Liver Stabilization Trial

Oct 3 09

Keeping hepatitis C virus at bay after a liver transplant

Long Term Management of Liver Transplants By Primary Doctor

Hypertension And Diabetes Are Concern In Long-Term Care Of Liver Transplant Patients


Sept


"Acupuncture May Smooth Liver Transplant Recovery" Aug 09

Metabolic Bone Disease In Cirrhosis Patients


July


What I need to know about Liver Transplantation
http://www.foodconsumer.org

Steve Jobs, co-founder and CEO of Apple Inc. received a liver transplant in Tennessee about two months ago, Wall Street Journal reported Friday. Jobs has been on medical leave since January to treat a undisclosed medical condition. He has reportedly been recovering well and is expected to return to work soon.

Cited below is an article on liver transplant from a U.S. government website for those who might be interested in knowing more about the procedure.

What I need to know about Liver Transplantation
http://digestive.niddk.nih.gov/ddiseases
/pubs/livertransplant_ez/

 

Liberal selection criteria for liver transplantation forhepatocellular carcinoma

FYI...Artificial Liver For Drug Tests

Acetaminophen and Liver Injury: Q & A for Consumers

FDA Takes Action on Acetaminophen
 

Microproteinuria: Indicator To Monitor CNI-Related Nephrotoxicity In Liver Transplant Recipients?

 


June


FDA Alert Warns of Elevated Risk of Death in Liver Transplant Recipients Who Switch to Rapamune (Sirolimus)

For HCV-Positive Liver Transplant Recipients, Some Donor Factors Affect Outcomes



Strategies for Managing Acetaminophen-related Liver Disease and Acute Liver Failure

Report Predicts Costly Epidemic of Advanced Liver Disease among Baby Boomers with Chronic Hepatitis C


Liver disease: Better monitoring, better prognosis


High-Tech Artificial Liver Extends Lives

"More than 27,000 people die every year from liver disease while only 6,000 receive new livers. A new artificial liver may close this gap.


May


View the latest transplant news videos added to the internet and find links to the latest news stories!

How to use the Video Wall: To find out what each video is about hover your mouse pointer over the video preview you want to find out more about. After about a second, information about that video will appear below it. To watch a video story, click the preview to be taken to the viewing page for that particular video.
 


 


 

Predictors of psychological morbidity in liver transplant assessment candidates: is alcohol abuse or dependence a factor?

Acute Kidney Injury Common After Liver Transplantation

Pegylated Interferon alfa-2b (PegIntron) Maintenance Monotherapy May Reduce Esophageal Varices in Hepatitis C Patients with Cirrhosis

Ocera Therapeutics Presents Data On AST-120 In Patients With Hepatic Encephalopathy At The European Association For The Study Of Liver Disease

Survival Rates Following Liver Transplant Similar In HIV Positive And HIV Negative Patients

Diabetes, Obesity And Hypertension Increase Mortality In Hepatitis C Patients

Warning on Hydroxycut Products

Liver Cancer Drug Sorafenib (Nexavar) May Also Alleviate Complications Due to Cirrhosis


EASL: PegIntron Maintenance Therapy in Cirrhotic (METAVIR F4) HCV Patients Who Failed to Respond to Interferon/Ribavirin (IR) Therapy: Final Results of the EPIC3 Cirrhosis Maintenance Trial

EASL: Maintenance Therapy: we don't know if it provides benefit -

EASL: EPIC Study Shows Maintenance Therapy Provides Benefits -

Transplanted Liver Cells Function In Older Animals But Do Not Proliferate As Much As In Younger Ones


 

April-March


Genetically Mismatched Liver Transplants Predict HCV Recurrence, Progression

Preventing Bleeding Varices: A Liver Transplant Must

Licorice May Block Effectiveness Of Drug Widely Used By Transplant Patients

The Immune System's Role In Hepatitis C Recurrence After Liver Transplantation

The evaluation of liver dysfunction: When to suspect portal hypertension

4-01


MELD and other predictors of liver transplant survival

14 April 2009

This month’s issue of Clinical Transplantation investigates MELD and other predictors of survival after liver transplantation.
 
 

Dr Ajacio Brandão and colleagues from Brazil examined how reliable the pre-transplant model is for end-stage liver disease (MELD) score in predicting post-transplantation survival.

In addition, the research team analyzed variables associated with patient survival.

The team conducted a cohort study using receiver operating characteristic curve c-statistics to determine the ability of MELD score to predict mortality.

The Kaplan–Meier method was used to analyze survival as a function of time regarding the MELD score and Child-Turcotte-Pugh category.

The Cox model was employed to assess the association between baseline risk factors and mortality.

The researchers identified 436 transplants, and that recipients and donors were mostly male, with a mean age of 52 and 39 years, respectively.

The c-statistic values for three-month patient mortality were 0.60 and 0.61 for MELD score and Child-Turcotte-Pugh category, respectively.

Kaplan–Meier survival at 3, 6 and 12 months were lower in those who had a MELD score of 21 or were Child-Turcotte-Pugh category C.

Multivariate analysis revealed that recipient age 65 years, MELD score of 21, Child-Turcotte-Pugh C category, and a bilirubin level of 7 mg/dL were predictors of mortality.

Creatinine levels of 1.5 mg/dL, platelet transfusion, hepatocellular carcinoma, and non-white color donor skin were also predictors of mortality.

Dr Brandão’s team concluded, “Severe pre-transplant liver disease, age 65 years, non-white skin donor, and hepatocellular carcinoma are associated with poor outcome.”

Clin Transplant 2009: 23(2): 220-7
14 April 2009


 

Post-liver transplant survival in Hep C is improving

09 April 2009
Post-liver transplant survival in Hepatitis C patients is improving over time, finds the latest issue of Liver Transplantation.
 

Dr Jacqueline O'Leary and colleagues from Texas, USA found outcomes after orthotopic liver transplantation for chronic Hepatitis C have been reported to be worsening over the last 2 decades.

The team analyzed our center's experience over 15 years to identify trends in post-orthotopic liver transplantation survival in patients with and without Hepatitis C virus infection.

Patient survival and graft survival among 1901 adult primary orthotopic liver transplantation recipients who survived more than 90 days from 1991 to 2006 at the Baylor Regional Transplant Institute were evaluated by Kaplan-Meier analysis.
 
Those with or without Hepatitis C virus infection were analyzed by era.

Era 1 included 473 and spanned from 1991 to 1994, whereas era 2 had 421 patients and went from 1995 to 1998.

Era 3 spanned from 1999 to 2002 and included 498 patients, with 512 patients in Era 4 evaluated from 2003 to 2006.

The team assessed differences in eras with disparate survivals by univariate and multivariable analysis.

Overall, patient survival and graft survival were significantly lower among Hepatitis C virus infection recipients compared to those without Hepatitis C virus infection.

This difference was dependent on the era of transplantation, with progressive improvement in Hepatitis C virus patient  and graft survival in sequential eras.

The researchers found several factors accounted for this improvement, notably better selection of hepatocellular carcinoma patients and fewer late cytomegalovirus infections.

The team noted that improvement occurred despite an increase in the ages of both donors and recipients.

Dr O'Leary's team concluded, “Posttransplant survival after orthotopic liver transplantation for chronic Hepatitis C has improved significantly over the last 15 years.”

“Despite demographic changes in patients and grafts that have been previously shown to impair survival.”

“A major reason for this improvement is better selection of patients with concurrent hepatocellular carcinoma and fewer late cytomegalovirus infections, although other factors may play a role as well.”

http://www.gastrohep.com/news/news.asp?id=106420

Liver Transplant 2009: 15(4): 360-8
09 April 2009

Risk factors for early hepatic artery thrombosis after transplantation

31 March 2009

The most recent issue of the American Journal of Transplantation investigates the incidence and risk factors of early hepatic artery thrombosis after liver transplantation.
 
 

Dr Bekker and colleagues from the Netherlands conducted a systematic review to identify the incidence, risk factors and outcome of early hepatic artery thrombosis after liver transplantation.

The team searched studies identified from databases including MEDLINE, EMBASE, Science Citation Index, and references of identified studies.

The team identified 71 studies out of 999 screened abstracts as eligible for this systematic review.

The team found that the incidence of hepatic artery thrombosis was 4%.

In children, the incidence of hepatic artery thrombosis was 8%, and 3% in adults.

Doppler ultrasound screening  protocols varied from 'no routine' to 'three times a day.'

The median time to detection was at day 7.

The team noted that the overall retransplantation rate was 53%, and was higher in children than in adults.

The overall mortality rate of patients with hepatic artery thrombosis was 33%.

The researchers found that mortality in adults was higher than in children.

The reported risk factors for hepatic artery thrombosis included cytomegalovirus mismatch, and retransplantation.

Arterial conduits, prolonged operation time, low recipient weight, variant arterial anatomy, and low volume transplantation centers were also risk factors for hepatic artery thrombosis.

Hepatic artery thrombosis is associated with significant graft loss and mortality.

Dr Bekker’s team concluded, “Uniform definitions of hepatic artery thrombosis and uniform treatment modalities are obligatory to confirm these results and to obtain a better understanding of this disastrous complication.”

Am J Transplant 2009: 9(4): 746-57
31 March 2009

This study is currently recruiting participants.
Verified by Northwestern University, March 2009

 

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HCV Treatment after Liver Transplantation

Liver transplants succeed in many hepatitis C patients

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February-January



Hepatitis C Patients Should Avoid Fatty Liver Transplants.

 

Treatment of hepatitis C in liver transplant recipients

Transplant Experience

Liver Transplant Allocation

Statement On Liver Transplants - Royal Free Hampstead NHS Trust, England
In light of recent press reports about liver transplants at the Royal Free Hampstead NHS Trust, we would like to make the following points:- 1. There is no truth in the assertion that patients from outside the UK can 'buy'...

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Link Between Transplanted Fatty Livers And Worse Prognosis For Patients With HCV

ELAD(R) Liver Support System Study Initiated at Multiple U.S. Centers

Mayo Clinic Researchers Develop Improved Tool to Rank Sickest Patients Waiting for Liver Transplants

Transplant Links

AASLD New Approach Urged for Liver Transplant Allocation

 

Impact of donor graft steatosis on overall outcome and viral recurrence after liver transplantation for hepatitis C virus cirrhosis
The aim of this study was to determine the influence of donor graft steatosis on overall outcome, viral recurrence, and fibrosis progression in orthot...
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Cirrhosis of mixed etiology (hepatitis C virus and alcohol): Posttransplantation outcome-Comparison with hepatitis C virus-related cirrhosis and alcoholic-related cirrhosis
Hepatitis C virus (HCV)-related liver disease is enhanced by alcohol consumption. Of HCV-related liver transplantation (LT) recipients, 25% have a his...
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Long-term antiviral therapy for recurrent hepatitis C after liver transplantation in nonresponders: Biochemical, virological, and histological impact
More than 50% of patients with a recurrent posttransplant hepatitis C virus infection fail to respond to antiviral treatment. The aim of this study wa...
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‘Miracle man’ from Halifax survives three transplants

Molecular Events Involved In Liver Regeneration
The ability to regenerate after major tissue damage or surgical intervention is an important property of the liver. Since liver resection is an established therapeutic measure for severe liver diseases, it would be of...
[read article]

 

Liver transplants from elderly donors are safe
Posted on December 29th 2008
Advanced donor age, per se, does not adversely affect the transplant recipient or the survival of the organ after liver transplantation, according to a report in the
Journal of the American College of Surgeons.


 

Management of Hepatitis C in the Pre-Transplant Patient

 

 



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