8 updates on liver transplantation outcomes for 2017

Liver transplantation is a necessity for many chronic liver diseases, including hepatocellular carcinoma, chronic hepatitis C, and alcoholic liver disease. Over the past year, researchers and physicians have reported changes among the leading indications on the liver waitlist and improvements in transplantation outcomes.

Below, Healio.com/Hepatology presents recent reports on waitlist mortality risks, improved pediatric liver transplantation outcomes, and the positive effects of HCV treatment on transplant and waitlist outcomes.

HCC liver transplant outcomes better in children with inherited liver disease

Children with inherited liver disease who underwent liver transplantation for hepatocellular carcinoma had superior long-term survival compared with children without inherited liver disease and adults with inherited liver disease, according to a recently published study.

“It has been suggested that HCCs arising in patients with inherited disease form a distinct clinical entity given that the pathophysiology behind these tumors differs considerably from other HCC types; evidence to support this hypothesis is, however, scarce,” Ulrich Baumann, MD, from the Hannover Medical School, Hannover, Germany, and colleagues wrote. “In this study we investigated the hypothesis that children transplanted for HCC with associated inherited liver disease show better LT outcomes than other HCC patients.” Read more

Low skeletal muscle mass increases risk for liver waitlist mortality

Patients with sarcopenia on the liver transplant waitlist had increased mortality rates and more liver-related complications before waitlist placement, according to a recently published study. The researchers also validated the previously published MELD-Sarcopenia score as a predictive measure for waitlist mortality, although it had limited added value compared with standard MELD score.

“Low skeletal muscle mass (ie, sarcopenia) is an independent risk factor for mortality in a national Dutch cohort of cirrhosis patients listed for liver transplantation. The best model to predict waiting list mortality included both the MELD score and sarcopenia. However, its performance, as expressed in the concordance index, was not significantly better compared with the MELD score on its own,” Jeroen Laurens Ad van Vugt, MD, from the Erasmus MC University Medical Center, the Netherlands, and colleagues wrote. “An explanation could be that both prioritization and allocation on the one hand and waiting list mortality on the other hand are strongly associated with the MELD score, leading to a self-fulfilling prophecy in studies such as ours.” Read more

HCV nucleic acid test offers ‘opportunity’ to increase liver transplant pool

Using hepatitis C antibody-positive but nucleic acid test-negative liver donors for HCV-negative liver transplant recipients opens up liver transplant options, allowing for the use of livers available due to drug overdose, according to experts.

“Now that we have [nucleic acid testing (NAT)] available, that should be considered in labeling the donors rather than hepatitis C-positive or not,” Khurram Bari, MD, from the University of Cincinnati, told Healio Gastroenterology and Liver Disease. “NAT testing is a better indicator of hepatitis C positivity or negativity in donors, not just antibody. The antibody test can be nonspecific; it can be positive, but if the NAT is negative there is a much lower risk for hepatitis C transmission.” Read more

Alcoholic liver disease overtakes HCV as leading indication on liver waitlist

An analysis of the liver waitlist revealed that as the total number of liver transplantations in the U.S. has increased each year, alcoholic liver disease has become the leading indication over hepatitis C.

“Data through 2015 demonstrated a decline in the number of HCV-related LT waitlist registrations and LT surgeries following the introduction of [direct-acting antiviral]-based regimens. Despite the downtrend, primary diagnosis of HCV remained the most common etiology for liver transplantation in the U.S. until the end of 2015,” George Cholankeril, MD, and Aijaz Ahmed, MD, from Stanford University School of Medicine, wrote. “In 2016, ALD became the leading indication for LT waitlist additions in the U.S. by surpassing HCV.” Read more

Intra-platelet serotonin affects tumor recurrence, morbidity after liver resection

High perioperative levels of intra-platelet serotonin correlated with early disease recurrence after liver resection, while low levels increased the risk for postoperative morbidity, according to a recently published study.

“During the process of liver regeneration, a microenvironment containing various growth factors is generated. These factors may not only accelerate repair processes but also enhance tumor development and progression by promoting angiogenesis, tumor cell viability and migration,” Robin Padickakudy, from the University of Vienna, and colleagues wrote. “We found ... that a platelet stored growth factor seems to affect both liver regeneration and tumor recurrence, thereby confirming the human relevance of previous experimental studies.” Read more

Expanding liver transplant criteria offers comparable survival

Select patients with hepatocellular carcinoma who surpassed traditional indications for living donor liver transplantation exceeded survival expectations, with rates comparable to patients within the Milan criteria, according to results of a prospective study.

“Despite some efforts to expand indications of transplant for HCC patients beyond Milan criteria — based on tumor size and number of nodules or successful down-staging after preoperative therapies — clinical practice guidelines have not adopted such extended criteria and the vast majority of transplant centers are still excluding this type of patients from liver transplantation with cadaveric grafts,” Josep M. Llovet, MD, from the Barcelona-Clínic Liver Cancer Group, Spain, and colleagues wrote. Read more

Liver tumor program launched to ‘work in a fashion of teamwork’

The Perlmutter Cancer Center at NYU Langone Health launched a new liver tumor program, designed to provide multidisciplinary care for patients with primary and secondary liver and bile duct cancers, according to a press release.

“What we’ve seen in the past — because these are patients with tough problems and care depends on familiarity with these diseases — and what we don’t want to see is a patient bouncing around for 6 weeks, waiting on various studies and biopsies and things of that nature,” Theodore H. Welling, MD, from the director of the liver tumor program at Perlmutter Cancer Center, told Healio Gastroenterology and Liver Disease. “Our experts can get to a disease-management plan much more quickly and I think that saves a lot of angst for the patient.” Read more

Liver waitlist outcomes for patients with HCV improving in recent years

In recent years, mortality rates and progression of disease severity has decreased among patients with hepatitis C on the liver transplant waitlist, according to recently published data.

“The improvement in survival and disease progression in this population could be attributed to improvement in the management of cirrhosis complications, advances in the quality of medical care in general, access to LT, or perhaps a difference in the selection of patients referred and listed for LT; however, the difference between HCV and non-HCV patients points to factors that are specific to HCV,” Allison Kwong, MD, from the Stanford University School of Medicine, California, and colleagues wrote. Read more