1. Donor‐derived disease transmission occurs in less than 1% of all transplants.
2. Early recognition and screening of the donor are essential to prevent transmission. Nucleic acid testing, though costly, is more sensitive and accurate than serological testing, and when it is used appropriately, it can effectively identify high‐risk donors.
3. Prompt and aggressive treatment of any recipient...
1. Most liver transplant allograft recipients require long‐term immunosuppression, and the most popular therapeutic regimen includes induction therapy, calcineurin inhibitors, corticosteroids, and mycophenolate.
2. Tailoring currently available drugs to the individual may allow better graft outcomes with less toxicity.
3. Many new agents are being evaluated in clinical studies. Among these,...
1. Hepatoblastoma (HB) is the most common primary pediatric liver malignancy. The majority of children with HB are resection candidates. Determining which children should undergo resection or primary liver transplantation is essential to the prognosis.
2. Hepatocellular carcinoma (HCC) is the second most common pediatric primary liver malignancy. Most children with HCC are not resection...
1. Cytomegalovirus (CMV) is a common infection after liver transplantation and manifests as an asymptomatic infection or clinically as CMV syndrome (fever and myelosuppression) or tissue‐invasive CMV disease.
2. The most common risk factor for CMV disease is donor positivity and recipient negativity for CMV, and severe impairment in immunity, especially with a pathogen‐specific immune response,...
(1) In cirrhosis, acute kidney injury (AKI) is mainly due to prerenal factors [including type 1 hepatorenal syndrome (HRS)] and ischemic acute tubular necrosis (ATN).
(2) IN cirrhosis, chronic kidney disease (CKD) may be due to type 2 HRS, immunoglobulin A (IgA) nephropathy, or membranoproliferative glomerulonephritis. Some patients have acute‐on‐chronic kidney injury.
(3) In patients with...
1. Hepatitis C virus reinfection is almost universal in patients who are polymerase chain reaction–positive at the time of transplantation, and it significantly impairs patient and graft survival.
2. The virus infects the graft a few hours after transplantation and leads within weeks to a viral load higher than the pretransplant levels; this is associated with an accelerated progression...
1. Hepatic epithelioid hemangioendothelioma is a rare disease with a variable natural history; current data support liver transplantation for unresectable disease.
2. Anti–vascular endothelial cell growth factor therapy may change the approach to hepatic epithelioid hemangioendothelioma in the future.
3. The role of liver transplantation in the treatment of neuroendocrine tumors remains...
(1) No therapies for the treatment of Epstein‐Barr virus (EBV)–associated posttransplant lymphoproliferative disorder (PTLD) are based on data from randomized clinical trials.
(2) Published clinical experience suggests that implementation of a systematic, stepwise approach to the treatment of EBV‐associated PTLD can result in improved outcomes.
(3) Several new second‐line therapies, including...
1. The insufficient supply of deceased donor livers for transplantation has motivated the expansion of acceptance criteria; such organs are captured by the terms marginal and expanded criteria livers.
2. This context of aggressive liver utilization motivated the derivation of the donor risk index, a quantitative, objective, and continuous metric of liver quality based on factors known or...
1. Transplantation for HBV‐related HCC is increasing in the West, whilst HBV‐relate liver failure is decreasing.
2. Combination lamivudine plus HBIG reduces the risk of HBV recurrence to less than 5%.
3. Low‐dose IM HBIG ihas similar efficacy and better cost effectiveness than high‐dose IV HBIG when combined with oral nucleos(t)ide therapy.
4. HBIG may be discontinued in low risk recipients...
(1) Liver allografts exhibit intrinsic tolerogenic properties that result in their spontaneous acceptance in many experimental animal models.
(2) In clinical transplantation, liver allografts require milder immunosuppression (IS) regimens than other organs, are remarkably resistant to antibody‐mediated rejection, and only very rarely are lost because of immunological insults.
(3) A fraction...
1. The body mass index is not an adequate measure of obesity in patients with cirrhosis. It is necessary to account for the contributions of ascites and fluid overload in addition to the distribution of adipose tissue. The interpretation of the literature on the effects of the body mass index on posttransplant outcomes is difficult if adjustments are not made for these factors.
The expression of interleukin 7 receptor alphahigh (IL‐7Rαhigh) discriminates between activated CD25+CD45RO+CD4+ T cells [IL‐7Rαhigh and forkhead box P3–negative (FoxP3−)] and regulatory T cells (IL‐7Rαlow and FoxP3+). The IL‐7RαhighCD25+CD45RO+CD4+FoxP3− T cell population has been shown to be expanded in the blood and tissues of patients after kidney transplantation and to contain alloreactive T...
The number of liver donors has not measurably increased since 2004 and has begun to decrease. Although many waitlisted patients may be suitable candidates to receive a living donor graft, they are often reticent to discuss living donation with close friends and family, partly because of a lack of knowledge about donor health and quality of life outcomes after donation. The objective of this study...
Alcoholic liver disease (ALD) is a leading indication for liver transplantation. Our center has randomly checked blood alcohol levels (BALs) in ALD patients on the waiting list since 2004. We aimed to identify the incidence and predictors of inactivation on the transplant list due to alcohol use and to determine the utility of BAL‐screening in this process. We conducted a retrospective review of patients...
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