Predicting prognosis: 6 reports on improving liver transplant outcomes

Liver transplantation can significantly improve the survival rates and overall life quality among patients with end-stage liver disease and other chronic conditions. Predicting outcomes is necessary for appropriate allocation of donor resources and follow-up for patients at risk for adverse events.

Healio Gastroenterology and Liver Disease presents the following reports on live donor liver offers, cardiovascular event risks posttransplant, curing hepatitis C after transplantation with an infected organ, and discard rates of older donor livers.

Live donor liver offers improve transplant survival in patients with HCC

Patients with hepatocellular carcinoma who had a potential live donor at listing for liver transplantation had a significantly lower risk for mortality compared with those who waited for a deceased donor graft, according to recently published data.

According to Nicolas Goldaracena, MD, from the University of Toronto in Canada, and colleagues, the benefits derived from live donor liver transplantation (LDLT) related to a lower dropout rate and shorter waiting period. Read more

Small dense LDL cholesterol predicts CVD events post-liver transplant

According to a study published in Hepatology, small dense LDL cholesterol independently predicted cardiovascular disease events among liver transplant recipients.

“The present study employs detailed lipoprotein sub-particles to link specific proteins with CVD outcomes using a prospective cohort and provides valuable information that can be readily incorporated into clinical practice to hopefully improve clinical outcomes,” Mohammad B. Siddiqui, MD, from the Virginia Commonwealth University, and colleagues wrote. “The generation of the atherogenic [small dense LDL cholesterol (sdLDL-C)] likely results from insulin resistance, exposure to chronic immunosuppression and fatty liver after LT.” Read more

Sovaldi cures recurrent HCV after liver transplantation in 12 weeks

Twelve weeks of combination Sovaldi and NS5A inhibitors without ribavirin was a reliable therapy with high rates of sustained virologic response for recurrent hepatitis C after liver transplantation, according to a study published in Hepatology.

“Liver recipients with HCV recurrence have always been considered as a difficult-to-treat population,” Pauline Houssel-Debry, MD, from the Pontchaillou University Hospital in France, and colleagues wrote. “Previous HCV treatment post-LT, progression of fibrosis on the graft, a high HCV viral load, and the immunosuppressive therapy implemented had originally prompted clinicians to choose treatment for 24 weeks with [ribavirin] in order to improve SVR12 rates. However, the availability of [direct-acting antivirals] should change these dogmas.” Read more

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Anastomotic biliary complications post-LT linked to 7 comorbid factors

Researchers identified seven significant risk factors for the development of anastomotic biliary complications following liver transplantation in high-acuity patients, including vascular comorbidities and use of nonabsorbable suture materials in biliary reconstruction, according to a recently published study.

“The ever-increasing acuity among LT recipients limits their ability to tolerate significant postoperative morbidity and emphasizes the importance of identifying factors contributing to biliary complications in these patients,” Fady M. Kaldas, MD, from the David Geffen School of Medicine in California, and colleagues wrote. Read more

Older donor livers still discarded despite improving mortality outcomes

Between 2003 and 2016, liver graft loss and mortality rates among recipients of grafts from older donors improved; however, discard rates of older donor grafts continued to increase and use of older donor grafts decreased, according to a study published in JAMA Surgery.

“Our findings of improved posttransplant mortality and all-cause graft loss may be associated with several factors, including patient care, surgical technique, or improved donor to recipient matching,” Christine E. Haugen, MD, from the Johns Hopkins University School of Medicine in Baltimore, Maryland, and colleagues wrote. “Exclusion of a potential organ donor should not be based on age alone, but donor age should be evaluated with donor to recipient matching and consideration of potential cold ischemia time.” Read more

Liver transplantations for alcohol-associated liver disease increase

Over the past 15 years, there was a 12.5% increase in the number of liver transplantations for patients with alcohol-associated liver disease, according to findings published in JAMA Internal Medicine.

“Alcohol-associated liver disease has emerged as the most common indication for liver transplant in the United States, but data on the reasons for this increase and long-term post-liver transplant outcomes among liver transplant recipients are sparse,” Brian P. Lee, MD, medical director of the Living Kidney Donor Program at the University of California, San Francisco, and colleagues wrote. Read more