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Management of Liver Transplantation: Current Status and Future Direction
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Management of Liver Transplantation: Current Status and Future Direction

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

Deadline for manuscript submissions: closed (22 June 2022) | Viewed by 7582

Special Issue Editor

Dr. Giovanni Battista Levi Sandri

E-Mail Website
Guest Editor
Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy
Interests: minimally invasive surgery; hepatobiliary and pancreatic surgery; transplantation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The liver transplantation world is evolving rapidly. As a fixed point in our practice, liver donors' shortage is still the first limitation for enlargement criteria. Nevertheless, improvement of medical, surgical, and radiological treatments will upset the actual liver transplant indications. New indications are now understudies and will undoubtedly be part of the future practice. The surgical approach with minimally invasive technique, the further chemotherapy for metastatic diseases, and the recent increase of non-alcohol fatty liver are enlarging potential candidates for transplantation. Current practice achieves excellent results and is the aim to reach for the new ones.

With this Special Issue, we hope to focus on the current state and the future direction of liver transplantation.

Dr. Giovanni Battista Levi Sandri
Guest Editor

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Keywords

  • Downstaging and Bridge
  • NASH
  • Cholangiocarcinoma
  • Colorectal liver metastasis

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Published Papers (3 papers)

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Research

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11 pages, 841 KiB  
Article
Using Rotational Thromboelastometry to Identify Early Allograft Dysfunction after Living Donor Liver Transplantation
by Hao-Chien Hung, Chen-Fang Lee and Wei-Chen Lee
J. Clin. Med. 2021, 10(15), 3401; https://doi.org/10.3390/jcm10153401 - 30 Jul 2021
Cited by 3 | Viewed by 1671
Abstract
Background: Diagnostic tests for early allograft dysfunction (EAD) after living donor liver transplantation (LDLT) vary widely. We aimed to evaluate the predictive value of rotational thromboelastometry (ROTEM)-derived parameters in EAD. Materials and Methods: A total of 121 patients were reviewed. The definition of [...] Read more.
Background: Diagnostic tests for early allograft dysfunction (EAD) after living donor liver transplantation (LDLT) vary widely. We aimed to evaluate the predictive value of rotational thromboelastometry (ROTEM)-derived parameters in EAD. Materials and Methods: A total of 121 patients were reviewed. The definition of EAD proposed by Olthoff et al. included the presence of any of the following at postoperative day 7: bilirubin level ≥ 10 mg/dL, INR ≥ 1.6, or serum AST or ALT levels > 2000 IU/L. All patients underwent ROTEM assay, which consisted of an extrinsically activated thromboelastometric test (EXTEM) before and 24 h after LDLT. Results: The 1-year/2-year OS were 68.%8/64.5% and 94.4%/90.8% for the EAD and non-EAD groups, respectively (p = 0.001). Two independent risks were identified for EAD, the postoperative clotting time (CT, p = 0.026) and time to maximum clot firmness (maximum clot firmness (MCF)-t, p = 0.009) on the EXTEM. CT yielded a specificity of 82.0% and negative predictive value of 83.0%, and MCF-t displayed a specificity of 76.4% and negative predictive value of 81.9% in diagnosing EAD. The use of the 24 h post-LDLT ROTEM increased the effectiveness of predicting overall survival (OS) compared to using the Olthoff’s EAD criteria alone (p < 0.001). Conclusion: We conclude that CT and MCF on EXTEM were independent predictors of EAD. The 24 h post-LDLT ROTEM can be used with conventional laboratory tests to diagnose EAD. It increases the effectiveness of predicting OS. Full article
(This article belongs to the Special Issue Management of Liver Transplantation: Current Status and Future Direction)
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10 pages, 803 KiB  
Article
Developing a Novel Scoring System for Risk Stratification in Living Donor Liver Transplantation
by Hao-Chien Hung, Chen-Fang Lee, Ssu-Min Cheng and Wei-Chen Lee
J. Clin. Med. 2021, 10(9), 2014; https://doi.org/10.3390/jcm10092014 - 8 May 2021
Viewed by 1584
Abstract
Background: We aimed to develop a novel scoring system for risk stratification specific to living donor liver transplantation (LDLT) recipients, to improve the accuracy of predicting short-term outcomes. Methods: The sequential organ failure assessment (SOFA) score at postoperative day 7 was collected and [...] Read more.
Background: We aimed to develop a novel scoring system for risk stratification specific to living donor liver transplantation (LDLT) recipients, to improve the accuracy of predicting short-term outcomes. Methods: The sequential organ failure assessment (SOFA) score at postoperative day 7 was collected and simplified by dichotomization, and these categories and other clinical factors were subjected to univariate and multivariate logistic regression analyses to select independent risks in constructing a “graft-to-recipient weight ratio (GRWR)-SOFA” scoring system. Results: We enrolled 519 patients who underwent LDLT. The GRWR-SOFA score comprises a sum of six factors: cardiovascular (mean arterial pressure < 70 mmHg, scored 3), coagulation (serum platelet < 50 × 103/μL, scored 2), renal (creatinine > 1.2 mg/dL, scored 2), liver (serum total bilirubin > 5.9 mg/dL, scored 5), neurological (Glasgow coma scale < 15, scored 2), and GRWR < 0.8, scored 2. The GRWR-SOFA contained four classes: The early mortality rate at 3 months and 1 year after LDLT was 1.3% and 6.9% for class I (scores of 0–4), 9.1% and 16.7% for class II (scores of 5–8), 25.5% and 34% for class III (scores of 9–10), and 61.3% and 67.7% for class IV (scores ≥ 11), respectively. The area under the receiver operating characteristic curve of GRWR-SOFA in the 3-month mortality prediction was 0.881 (95% confidence interval (CI): 0.818–0.944). Conclusions: The GRWR-SOFA model demonstrates superior discriminatory power for predicting short-term mortality. It enables clinicians to identify the right level of care for distinct subgroups of patients receiving LDLT. Full article
(This article belongs to the Special Issue Management of Liver Transplantation: Current Status and Future Direction)
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Review

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17 pages, 946 KiB  
Review
The Edge of Unknown: Postoperative Critical Care in Liver Transplantation
by Fuat H. Saner, Dieter P. Hoyer, Matthias Hartmann, Knut M. Nowak and Dmitri Bezinover
J. Clin. Med. 2022, 11(14), 4036; https://doi.org/10.3390/jcm11144036 - 12 Jul 2022
Cited by 2 | Viewed by 3463
Abstract
Perioperative care of patients undergoing liver transplantation (LT) is very complex. Metabolic derangements, hypothermia, coagulopathy and thromboses, severe infections, and graft dysfunction can affect outcomes. In this manuscript, we discuss several perioperative problems that can be encountered in LT recipients. The authors present [...] Read more.
Perioperative care of patients undergoing liver transplantation (LT) is very complex. Metabolic derangements, hypothermia, coagulopathy and thromboses, severe infections, and graft dysfunction can affect outcomes. In this manuscript, we discuss several perioperative problems that can be encountered in LT recipients. The authors present the most up-to-date information regarding predicting and treating hemodynamic instability, coagulation monitoring and management, postoperative ventilation strategies and early extubation, management of infections, and ESLD-related pulmonary complications. In addition, early post-transplant allograft dysfunction will be discussed. Full article
(This article belongs to the Special Issue Management of Liver Transplantation: Current Status and Future Direction)
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