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Liver Transplantation: Current Management and Future Options
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Liver Transplantation: Current Management and Future Options

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: closed (28 February 2024) | Viewed by 6008

Special Issue Editors

Prof. Dr. Salvatore Agnes

E-Mail Website
Guest Editor
General Surgery and Organ Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy
Interests: liver transplantation; steato-hepatitis; hepatocellular carcinoma
Dr. Francesco Giovinazzo

E-Mail Website
Guest Editor
General Surgery and Organ Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy
Interests: carcinoma; hepatocellular; liver neoplasms; transplant oncology; neoadjuvant and adjuvant therapy; artificial intelligence; cholangiocarcinoma; colorectal and non-colorectal liver metastasis; pancreatic neoplasms
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Liver transplantation is a life-saving procedure for patients with end-stage liver disease and several malignancies. Over the years, significant advancements have been made in liver transplantation, leading to improved outcomes and expanded eligibility criteria. In terms of current management, the success of liver transplantation relies on several key factors. These include appropriate donor selection, meticulous surgical techniques, tailored immunosuppressive regimens, and comprehensive post-transplant care. Organ allocation systems have evolved to prioritize patients based on the severity of illness, ensuring the equitable distribution of available organs. Surgical approaches have become more refined, with advancements such as living donor liver transplantation and split liver transplantation expanding the donor pool and reducing waiting times. Improved immunosuppressive medications and protocols have improved long-term graft and patient survival rates. Moreover, multidisciplinary care teams comprising hepatologists, transplant surgeons, anesthesiologists, and other specialists work collaboratively to optimize pre-and post-transplant care, including managing complications. Several future options show promise for further enhancing liver transplantation. Advancements in organ preservation techniques, such as machine perfusion, may allow for longer preservation times, reducing organ shortages and improving outcomes. The development of artificial liver devices holds the potential to bridge the gap between transplantation and organ regeneration. Additionally, advances in genomics and precision medicine may enable personalized immunosuppressive strategies, minimizing complications and improving long-term graft survival. Gene-editing technologies, such as CRISPR-Cas9, can modify donor organs in order to mitigate immunological barriers and improve compatibility. Liver transplantion continues to evolve, with future options that hold the potential to further revolutionize the field. Continued research and innovation in liver transplantation are essential in order to overcome challenges, enhance patient care, and save more lives. Therefore, researchers in liver transplantation are encouraged to submit their findings as original articles or reviews to this Special Issue.

Prof. Dr. Salvatore Agnes
Dr. Francesco Giovinazzo
Guest Editors

Manuscript Submission Information

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Keywords

  • liver transplantation
  • immunosuppressive regimens
  • organ allocation and donor selection
  • living donor liver transplantation
  • split liver transplantation
  • multidisciplinary care
  • machine perfusion
  • artificial liver devices
  • gene-editing technologies

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Published Papers (4 papers)

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Research

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10 pages, 847 KiB  
Article
Evaluation of Humoral Response following SARS-CoV-2 mRNA-Based Vaccination in Liver Transplant Recipients Receiving Tailored Immunosuppressive Therapy
by Tommaso Maria Manzia, Bruno Sensi, Luigi Eduardo Conte, Leandro Siragusa, Roberta Angelico, Francesco Frongillo and Giuseppe Tisone
J. Clin. Med. 2023, 12(21), 6913; https://doi.org/10.3390/jcm12216913 - 3 Nov 2023
Cited by 2 | Viewed by 1055
Abstract
Background: The role of tailored immunosuppression (IS) in the development of the humoral response (HR) to SARS-CoV-2 mRNA-based vaccination in liver transplant (LT) recipients is unknown. Methods: This is a single-centre prospective study of patients who underwent LT between January 2015 [...] Read more.
Background: The role of tailored immunosuppression (IS) in the development of the humoral response (HR) to SARS-CoV-2 mRNA-based vaccination in liver transplant (LT) recipients is unknown. Methods: This is a single-centre prospective study of patients who underwent LT between January 2015 and December 2021 and who have received three doses of mRNA-based SARS-CoV-2 vaccination. Patients undergoing Tacrolimus-based immunosuppression (TAC-IS) were compared with those undergoing Everolimus-based immunosuppression (EVR-IS). Patients receiving the TAC-EVR combination were divided into two groups based on trough TAC concentrations, i.e., above or below 5 ng/mL. HR (analysed with ECLIA) was assessed at 30 to 135 days after vaccination. The primary outcome was the presence of a positive antibody titre (≥0.8 U/mL). Secondary outcomes were the presence of a highly protective antibody titre (≥142 U/mL), median antibody titre, and incidence of COVID-19. Results: Sixty-one participants were included. Twenty-four (40%) were receiving TAC-IS and thirty-seven (60%) were receiving EVR-IS. At the median follow-up of 116 (range: 89–154) days, there were no significant differences in positive antibody titre (95.8% vs. 94.6%; p = 0.8269), highly-protective antibody titre (83.3% vs. 81.1%; p = 0.8231), median antibody titre (2410 [IQ range 350–2500] vs. 1670 [IQ range 380–2500]; p = 0.9450), and COVID-19 incidence (0% vs. 5.4%; p = 0.5148). High serum creatinine and low estimated glomerular filtration rate were risk factors for a weak or absent HR. Conclusions: Three doses of mRNA-based SARS-CoV-2 vaccination yielded a highly protective HR in LT recipients. The use of TAC or EVR-based IS does not appear to influence HR or antibody titre, while renal disease is a risk factor for a weak or null HR. Full article
(This article belongs to the Special Issue Liver Transplantation: Current Management and Future Options)
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Review

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9 pages, 527 KiB  
Review
Use of Fluorescence Imaging in Liver Transplant Surgery
by Alvaro Ducas, Alessandro Martinino, Lorna Astrid Evans, Emiliano G. Manueli Laos, Francesco Giovinazzo and on behalf of the SMAGEICS Group
J. Clin. Med. 2024, 13(9), 2610; https://doi.org/10.3390/jcm13092610 - 29 Apr 2024
Cited by 1 | Viewed by 1063
Abstract
Liver transplant surgery is a complex procedure that demands high knowledge of surgical anatomy and the precise recognition and preservation of structures. To address this, the use of fluorescence imaging has facilitated the identification of anatomical structures such as biliary ducts, arteries, and [...] Read more.
Liver transplant surgery is a complex procedure that demands high knowledge of surgical anatomy and the precise recognition and preservation of structures. To address this, the use of fluorescence imaging has facilitated the identification of anatomical structures such as biliary ducts, arteries, and liver segmentation. Indocyanine green is among the most commonly utilized fluorescent agents, not just during surgery but also in the pre- and postoperative phases, where it is used to assess graft failure by measuring the plasma disappearance rate. New advancements such as artificial intelligence paired with fluorescence imaging have the potential to enhance patient outcomes. Additionally, technologies such as augmented reality and mixed reality could be integrated into surgical procedures, broadening the scope of possibilities for improving patient safety. Full article
(This article belongs to the Special Issue Liver Transplantation: Current Management and Future Options)
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22 pages, 2221 KiB  
Review
Cholangiocyte Organoids: The New Frontier in Regenerative Medicine for the Study and Treatment of Cholangiopathies
by Serena Babboni, Pier Giuseppe Vacca, Ludovica Simonini, Daniele Pezzati, Caterina Martinelli, Francesco Frongillo, Giuseppe Bianco, Emanuele Marciano, Giuseppina Basta, Davide Ghinolfi and Serena Del Turco
J. Clin. Med. 2024, 13(6), 1804; https://doi.org/10.3390/jcm13061804 - 21 Mar 2024
Cited by 2 | Viewed by 2266
Abstract
Cholangiopathies include a group of chronic progressive disorders, affecting the cholangiocytes, the epithelial cells that line the biliary tree, leading to liver parenchymal fibrosis and eventually end-stage liver disease necessitating transplantation. Experimental modeling of these multifactorial cholestatic diseases faces challenges due to the [...] Read more.
Cholangiopathies include a group of chronic progressive disorders, affecting the cholangiocytes, the epithelial cells that line the biliary tree, leading to liver parenchymal fibrosis and eventually end-stage liver disease necessitating transplantation. Experimental modeling of these multifactorial cholestatic diseases faces challenges due to the lack of adequate experimental in vitro and in vivo models. A novel approach employs three-dimensional organoid systems that offer several advantages for modeling disease and testing drug response in vitro. Organoids mimic intercellular communication, replicate the architecture of organs, and maintain the cell’s original phenotype. Cholangiocyte organoids provide an in vitro model to study the pathogenesis and pharmacotherapeutic treatment of cholangiopathies and show great promise for regenerative therapies. In particular, patient-derived organoids allow personalized medicine approaches and the study of individual disease characteristics. This review highlights the significance of cholangiocyte organoid models in advancing our understanding of cholangiopathies and driving advancements in regenerative medicine strategies. Full article
(This article belongs to the Special Issue Liver Transplantation: Current Management and Future Options)
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Other

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8 pages, 1807 KiB  
Case Report
Stapled Anastomosis for Side-to-Side Cavo-Cavostomy in Orthotopic Liver Transplantation
by Emilia Kruk, Piotr Kalinowski, Krzysztof Gibiński, Krzysztof Dudek, Michał Skalski, Marta Przybysz, Andriy Zhylko, Łukasz Nazarewski, Marcin Morawski and Michał Grąt
J. Clin. Med. 2023, 12(16), 5289; https://doi.org/10.3390/jcm12165289 - 14 Aug 2023
Cited by 2 | Viewed by 1137
Abstract
In liver transplantation, a side-to-side anastomosis is one of the commonly performed techniques of the inferior vena cava reconstruction. The authors report a case of an application of an endoscopic vascular linear stapler for a side-to-side caval anastomosis during deceased-donor liver transplantation. The [...] Read more.
In liver transplantation, a side-to-side anastomosis is one of the commonly performed techniques of the inferior vena cava reconstruction. The authors report a case of an application of an endoscopic vascular linear stapler for a side-to-side caval anastomosis during deceased-donor liver transplantation. The back table procedure was performed in a standard fashion for a side-to-side anastomosis. The linear vascular stapler was introduced during the temporary clamping of the recipient’s inferior vena cava and the anastomosis was created without problems. Suturing of the resulting defect completed the anastomosis. The use of the stapler resulted in a shortening of the anastomosis time. The staple line after the reperfusion of the graft was completely sealed. The patient’s postoperative course was uncomplicated and post-operative ultrasound and computed tomography confirmed the patency of the anastomosis. This case demonstrates a novel approach to a side-to-side caval reconstruction during liver transplantation that enables a shortening of the implantation time and may improve the quality of anastomoses. Full article
(This article belongs to the Special Issue Liver Transplantation: Current Management and Future Options)
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