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Transplantology
Special Issues
Liver Transplantation: Current Status and Future Challenges
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Liver Transplantation: Current Status and Future Challenges

A special issue of Transplantology (ISSN 2673-3943). This special issue belongs to the section "Solid Organ Transplantation".

Deadline for manuscript submissions: closed (20 February 2022) | Viewed by 19834

Special Issue Editors

Dr. Alessandro Parente

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Guest Editor
1. Department of Hepatobiliary Surgery and Transplant Unit, Tor Vergata Hospital, Tor Vergata University of Rome, 81, Viale Oxford, 00133 Rome, Italy
2. Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
Interests: liver transplantation; organ machine perfusion; immunosuppression; HPB surgery; liver resection
Dr. Vincenzo Ronca

E-Mail Website
Guest Editor
1. Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TH, UK
2. Division of Gastroenterology, Centre for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
3. European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, 20900 Monza, Italy
Interests: liver transplantation; liver immunology; autoimmune liver disease; organ machine perfusion
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Liver transplantation is the only recognized effective treatment for end-stage liver disease and acute fulminant liver failure. In the last few decades, improvements in organ preservation techniques, clinical management and immunosuppression drugs have led to the achievement of a good survival rate of >90% and >75% at one year and five years, respectively. However, waiting list mortality due to organ shortage is still the main challenge for the transplant community worldwide. Utilization of marginal grafts, donation after cardiac death and novel preservation techniques have been pursued during the last twenty years in order to expand the donor pool. On top of this, there is an increased demand for organs as the indications for transplantation have been constantly broadened, especially with the recent advances in transplant oncology.

In the near future, transplant physicians will need to maximize organ utilization and revise allocation systems in order to decrease waiting list mortality whilst maintaining the current excellent outcomes of liver transplantation. 

Dr. Alessandro Parente
Dr. Vincenzo Ronca
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Transplantology is an international peer-reviewed open access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1000 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Liver transplantation
  • Donation after cardiac death (DCD)
  • Liver Machine perfusion
  • Liver transplantation for neuroendocrine tumor metastasis (NET)
  • Liver transplantation for colorectal liver metastasis (CRLM)
  • Marginal donors
  • Immunosuppression tapering
  • Transplant oncology

Published Papers (7 papers)

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Editorial

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2 pages, 156 KiB  
Editorial
Moving Forward to New Trends in Liver Transplantation
by Alessandro Parente and Vincenzo Ronca
Transplantology 2021, 2(3), 294-295; https://doi.org/10.3390/transplantology2030029 - 18 Aug 2021
Viewed by 1932
Abstract
Liver transplantation (LT) is the only recognized effective treatment for end-stage liver disease (ESLD) and acute fulminant liver failure [...] Full article
(This article belongs to the Special Issue Liver Transplantation: Current Status and Future Challenges)

Research

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8 pages, 593 KiB  
Article
Usefulness of T-Tube in Liver Transplantation: Still Effective or Outmoded Strategy?
by Niccolò Incarbone, Riccardo De Carlis, Leonardo Centonze, Livia Palmieri, Giuseppe Cordaro, Alberto Ficarelli, Ivan Vella, Vincenzo Buscemi, Andrea Lauterio and Luciano De Carlis
Transplantology 2021, 2(4), 379-386; https://doi.org/10.3390/transplantology2040036 - 24 Sep 2021
Cited by 2 | Viewed by 2547
Abstract
Introduction: T-tube placement during liver transplantation (LT) is still debated. We performed a retrospective study to evaluate the usefulness of T-tube after LT in two cohorts differing in post-transplant risk. Methods: A total of 327 LTs performed between 2015 and 2018 were included [...] Read more.
Introduction: T-tube placement during liver transplantation (LT) is still debated. We performed a retrospective study to evaluate the usefulness of T-tube after LT in two cohorts differing in post-transplant risk. Methods: A total of 327 LTs performed between 2015 and 2018 were included in the analysis. LTs from donation after circulatory death and living donation, split-liver transplants, and LTs with hepaticojejunostomy were excluded. T-tube was reserved for marginal grafts, high-risk recipients, and bile duct size discrepancy. A balance of risk (BAR) score of ≤9 defined the low-risk cohort (232 patients, 68 with and 164 without T-tube), while a BAR score of >9 defined the high-risk cohort (95 patients, 43 with and 52 without T-tube). Postoperative complications were estimated with the comprehensive complication index (CCI). Postoperative biliary complications were classified in anastomotic stricture (AS), non-anastomotic stricture (NAS), and biliary leakage (BL). Results: In the low-risk cohort, LTs with and without T-tube had similar rates of NAS (0 vs. 2.9%, p = 0.36), AS (2.9 vs. 2.4%, p = 0.83), and BL (1.4 vs. 2.4%, p = 0.64). Analogous outcomes were found in the high-risk cohort: NAS (0 vs. 0), AS (0 vs. 5.7%, p = 0.11), and BL (0 vs. 1.3%, p = 0.27). There were more postoperative complications among patients with T-tube, in both the low-risk (CCI 29 vs. 21, p < 0.001) and high-risk (CCI 51 vs. 29, p < 0.001) cohort. No differences in primary non-function, hepatic artery thrombosis, and mortality were observed. Conclusions: T-tube placement did not influence postoperative biliary complications. Although the two cohorts were normalized for post-transplant risk, LT recipients with T-tube had a more complicated course. Full article
(This article belongs to the Special Issue Liver Transplantation: Current Status and Future Challenges)
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Review

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12 pages, 589 KiB  
Review
Donation after Circulatory Death Liver Transplantation in Paediatric Recipients
by Alessandro Parente, Fabio Tirotta, Vincenzo Ronca, Andrea Schlegel and Paolo Muiesan
Transplantology 2022, 3(1), 91-102; https://doi.org/10.3390/transplantology3010009 - 4 Mar 2022
Cited by 2 | Viewed by 2327
Abstract
Waiting list mortality together, with limited availability of organs, are one of the major challenges in liver transplantation (LT). Especially in the paediatric population, another limiting factor is the scarcity of transplantable liver grafts due to additional concerns regarding graft size matching. In [...] Read more.
Waiting list mortality together, with limited availability of organs, are one of the major challenges in liver transplantation (LT). Especially in the paediatric population, another limiting factor is the scarcity of transplantable liver grafts due to additional concerns regarding graft size matching. In adults, donation after circulatory death (DCD) liver grafts have been used to expand the donor pool with satisfactory results. Although several studies suggest that DCD livers could also be used in paediatric recipients with good outcomes, their utilisation in children is still limited to a small number of reports. Novel organ perfusion strategies could be used to improve organ quality and help to increase the number of DCD grafts utilised for children. With the current manuscript, we present the available literature of LT using DCD grafts in paediatric recipients, discussing current challenges with the use of these livers in children and how machine perfusion technologies could be of impact in the future. Full article
(This article belongs to the Special Issue Liver Transplantation: Current Status and Future Challenges)
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14 pages, 1551 KiB  
Review
Strategies to Improve Immune Suppression Post-Liver Transplantation: A Review
by Islam B Mohamed, Fuad Z Aloor and Prasun K Jalal
Transplantology 2021, 2(4), 441-454; https://doi.org/10.3390/transplantology2040042 - 2 Nov 2021
Cited by 2 | Viewed by 3729
Abstract
Since the first liver transplantation operation (LT) in 1967 by Thomas Starzl, efforts to increase survival and prevent rejection have taken place. The development of calcineurin inhibitors (CNIs) in the 1980s led to a surge in survival post-transplantation, and since then, strategies to [...] Read more.
Since the first liver transplantation operation (LT) in 1967 by Thomas Starzl, efforts to increase survival and prevent rejection have taken place. The development of calcineurin inhibitors (CNIs) in the 1980s led to a surge in survival post-transplantation, and since then, strategies to prevent graft loss and preserve long-term graft function have been prioritized. Allograft rejection is mediated by the host immune response to donor antigens. Prevention of rejection can be achieved through either immunosuppression or induction of tolerance. This leads to a clinical dilemma, as the choice of an immunosuppressive agent is not an easy task, with considerable patient and graft-related morbidities. On the other hand, the induction of graft tolerance remains a challenge. Despite the fact that the liver exhibits less rejection than any other transplanted organs, spontaneous graft tolerance is rare. Most immunosuppressive medications have been incriminated in renal, cardiovascular, and neurological complications, relapse of viral hepatitis, and recurrence of HCC and other cancers. Efforts to minimize immunosuppression are directed toward decreasing medication side effects, increasing cost effectiveness, and decreasing economic burden without increasing the risk of rejection. In this article, we will discuss recent advances in strategies for improving immunosuppression following liver transplantation. Full article
(This article belongs to the Special Issue Liver Transplantation: Current Status and Future Challenges)
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10 pages, 1534 KiB  
Review
The Underutilization, Adverse Reactions and Efficacy of Statins after Liver Transplant: A Meta-Analysis and Systematic Review
by Yeung Jek Ho, Audrey Su-Min Koh, Zhi Hao Ong, Cheng Han Ng, Gwyneth Kong, Nicholas W.S. Chew, Hui Ning Lim, M. Shadab Siddiqui and Mark Dhinesh Muthiah
Transplantology 2021, 2(3), 264-273; https://doi.org/10.3390/transplantology2030025 - 3 Jul 2021
Cited by 2 | Viewed by 2806
Abstract
(1) Background: Treatment of dyslipidemia via statin therapy in the non-liver transplant (LT) population is associated with a mortality benefit; however, the impact of statin therapy in post-LT population is not well-defined. This meta-analysis seeks to investigate the safety and efficacy of statin [...] Read more.
(1) Background: Treatment of dyslipidemia via statin therapy in the non-liver transplant (LT) population is associated with a mortality benefit; however, the impact of statin therapy in post-LT population is not well-defined. This meta-analysis seeks to investigate the safety and efficacy of statin therapy in post-LT patients. (2) Methods: A systematic literature search on Medline and EMBASE database was conducted. A single-arm proportional meta-analysis and conventional pair-wise meta-analysis were performed to compare different outcomes with a random effects model. (3) Results: A total of 11 studies were included in this study, with 697 LT recipients identified to be on statin therapy. Statins were underutilized with only 32% (95% CI: 0.15–0.52) of 1094 post-LT patients on therapy. The incidence of adverse events of 14% (95% CI: 0.05–0.25) related to statin therapy was low. A significant mortality benefit was noted in patients on statin therapy with HR = 0.282 (95% CI: 0.154–0.517, p < 0.001), and improved lipid profiles post LT. The use of statins also significantly decreased odds of graft rejection (OR = 0.33; 95% CI: 0.15–0.73) and hepatocellular carcinoma (HCC) recurrence (HR = 0.32, 95% CI: 0.11–0.89). (4) Conclusions: Statin therapy is safe and efficacious in post-LT patients. Future studies to evaluate the effects of interactions between statins and immunosuppressant therapy are warranted. Full article
(This article belongs to the Special Issue Liver Transplantation: Current Status and Future Challenges)
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21 pages, 1311 KiB  
Review
Management of Autoimmune Liver Diseases after Liver Transplantation
by Romelia Barba Bernal, Esli Medina-Morales, Daniela Goyes, Vilas Patwardhan and Alan Bonder
Transplantology 2021, 2(2), 162-182; https://doi.org/10.3390/transplantology2020016 - 13 May 2021
Cited by 5 | Viewed by 3707
Abstract
Autoimmune liver diseases are characterized by immune-mediated inflammation and eventual destruction of the hepatocytes and the biliary epithelial cells. They can progress to irreversible liver damage requiring liver transplantation. The post-liver transplant goals of treatment include improving the recipient’s survival, preventing liver graft-failure, [...] Read more.
Autoimmune liver diseases are characterized by immune-mediated inflammation and eventual destruction of the hepatocytes and the biliary epithelial cells. They can progress to irreversible liver damage requiring liver transplantation. The post-liver transplant goals of treatment include improving the recipient’s survival, preventing liver graft-failure, and decreasing the recurrence of the disease. The keystone in post-liver transplant management for autoimmune liver diseases relies on identifying which would be the most appropriate immunosuppressive maintenance therapy. The combination of a steroid and a calcineurin inhibitor is the current immunosuppressive regimen of choice for autoimmune hepatitis. A gradual withdrawal of glucocorticoids is also recommended. On the other hand, ursodeoxycholic acid should be initiated soon after liver transplant to prevent recurrence and improve graft and patient survival in primary biliary cholangitis recipients. Unlike the previously mentioned autoimmune diseases, there are not immunosuppressive or disease-modifying agents available for patients with primary sclerosing cholangitis. However, colectomy and annual colonoscopy are key components during the post-liver transplant period. Full article
(This article belongs to the Special Issue Liver Transplantation: Current Status and Future Challenges)
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Other

4 pages, 184 KiB  
Case Report
One Step at a Time: A Pediatric Case of Primary Two Staged Liver Transplantation in a Child with ESLD
by Eberhard Lurz, Elisabeth Klucker, Karl Reiter, Robert Dalla Pozza, Jens Werner, Markus Guba and Michael Berger
Transplantology 2022, 3(2), 152-155; https://doi.org/10.3390/transplantology3020016 - 27 Apr 2022
Viewed by 1471
Abstract
Toxic liver syndrome is a rare condition with multiorgan failure in end-stage liver disease (ESLD), and a two-stage LT following hepatectomy with a prolonged anhepatic phase is an accepted approach to bridge to transplant. This primary approach has not been described for toxic [...] Read more.
Toxic liver syndrome is a rare condition with multiorgan failure in end-stage liver disease (ESLD), and a two-stage LT following hepatectomy with a prolonged anhepatic phase is an accepted approach to bridge to transplant. This primary approach has not been described for toxic liver syndrome in children with ESLD. We report a 6-year-old boy who developed toxic liver syndrome with multiorgan failure while awaiting LT for ESLD from biliary atresia and failed Kasai at the age of 2 years. Deemed too sick to transplant, he underwent full hepatectomy and portocaval shunt placement. The child was then transplanted hemodynamically stable after an anhepatic phase of 10 h and 30 min. Although his initial graft showed primary liver dysfunction and he needed re-transplantation after 14 days, he was able to leave the hospital 4 months following 2nd LT and is well with a fully working graft 5 years later. Primary two stage LT is feasible in children in dire situations. Full article
(This article belongs to the Special Issue Liver Transplantation: Current Status and Future Challenges)
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