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Liver transplantation highlights from The Liver Meeting 2018

This year at The Liver Meeting, data presented on liver transplantation focused on comorbid complications, such as alcohol misuse and obesity, and their correlated outcomes.

Healio Gastroenterology and Liver Disease has compiled the following reports which include presentations on a predictive score for alcohol relapse posttransplant, mortality rates related to obesity and high steatosis in patients who received liver grafts, steady prescription opioid use both before and after transplant, as well as data on negative-to-positive hepatitis C heart transplant.

Preemptive DAA therapy improves outcomes of negative-to-positive HCV heart transplant

Preemptive administration of pangenotypic direct-acting antiviral therapy resulted in rapid viral suppression of hepatitis C in patients without HCV who received a heart transplantation with an HCV-positive organ, according to data presented at The Liver Meeting 2018.

“With the rising number of HCV-positive donors, there is a time-sensitive and critical need to document both the efficacy and detailed implementation strategies surrounding successful use of HCV-positive organs,” Emily Bethea, MD, Massachusetts General Hospital, said in her presentation. Read more

VIDEO: Opioid use pre vs. post liver transplant largely remains steady

In this exclusive video perspective from The Liver Meeting 2018, Monica Konerman, MD, director of the Michigan Medicine NAFLD Clinic, discusses the varying prevalence of opioid use among liver transplant candidates before and after transplantation.

“We know that pain is a very common chronic symptom among individuals who are being evaluated for live transplantation, but we don’t have very good data on what is the prevalence of use among patients who are listed for transplant and how that use changes after they undergo liver transplantation,” Konerman told Healio Gastroenterology and Liver Disease. “By and large, the vast majority of people did not change their pattern of use ... if they were chronic users before transplant, they tended to continue to be chronic users after transplant.” Read more

Scoring methods inaccurately predict who will relapse to alcohol post LT

Current methods for predicting harmful alcohol relapse after liver transplantation accurately predict who will not relapse but have low positive predictive values, according to data presented at The Liver Meeting 2018.

“Cirrhosis due to alcohol is increasing in incidence and alcoholic hepatitis is an increasingly common indication for transplant,” Michael D. Voigt, MD, from the University of Iowa School of Medicine, said in his presentation. “Standard approach to selecting patients with alcohol use disorder for transplant is to use predictive factors to stratify the risk of alcohol relapse following transplant and then exclude those at the highest risk. Our aim was to evaluate the accuracy of clinical and objective scoring systems in predicting this relapse to harmful drinking.” Read more

Alcohol relapse score predicts early liver transplant eligibility

A novel prognostic score using four objective pretransplant variables identified patients with alcoholic hepatitis who were candidates for early liver transplantation with a low risk for sustained alcohol use posttransplant, according to data presented at The Liver Meeting 2018.

“Severe alcoholic hepatitis portends high mortality and there’s still no effective therapy for long-term survival,” Brian Lee, MD, from University of California in San Francisco, said in his presentation. “Early liver transplant, meaning without minimum curative abstinence, can be life-saving.” Read more

High steatosis liver grafts linked to mortality in patients with obesity

Liver grafts with high macrosteatosis correlated with a higher posttransplant mortality in patients with obesity compared with patients with normal BMI, according to data presented at The Liver Meeting 2018.

“The obesity epidemic in the U.S. has changed both liver recipient and liver donor characteristics,” Patrick G. Northup, MD, from the University of Virginia, said in his presentation. “Many transplants in the high MELD era of these modern days now involve very sick recipients and more risky donors by nature of the system we have. It was the aim of this study to assess the influence of recipient obesity combined with and without these high graft macrosteatosis organs.” Read more