8 reports on liver transplantation survival rates, improved techniques

Recent research in the field of liver transplantation has revealed key predictive measures to determine survival rates, and innovative techniques have improved graft function and survival.

The following reports include data on how metabolomic profiling and n-glycan levels can predict graft function posttransplant, how normothermic machine perfusion improves both graft and patient survival, and updated statistics on patient survival rates after transplantation in pediatric patients and posttransplantation with organs donated after drug overdose.

Organs donated after drug overdose safe for transplantation

Considering the ongoing opioid epidemic in the United States, researchers confirmed that survival rates among transplantation recipients who received organs from patients who died of drug overdose were similar to survival among recipients from donors who died of other causes.

Josef Stehlik, MD, MPH, medical director of the Heart Transplant Program at the University of Utah Health, told Healio Gastroenterology and Liver Disease that because donations from drug overdose cases often occur in hospitals that are not transplant centers, there may be bias against their use. Read more

Normothermic machine perfusion for liver storage improves graft, patient survival

Normothermic machine perfusion for donated livers had a 50% lower rate of graft injury and no significant difference in bile duct complications, graft survival or patient survival compared with conventional static cold storage, according to a recently published study.

“Despite many advances in liver transplantation, the method of organ preservation has changed very little in almost 30 years. In recent years, interest has developed in perfusion at physiological temperature,” David Nasralla, MRCS, from the University of Oxford, United Kingdom, and colleagues wrote. “During [normothermic machine perfusion (NMP)], the liver is perfused with oxygenated blood, medications and nutrients at normal body temperature to maintain a physiological milieu.” Read more

Metabolomic profiling predicts graft function after liver transplantation

Researchers found that lactate and choline-derived metabolites predicted poor graft function in both native livers and liver grafts, according to a recently published study.

High-resolution magic-angle-spinning nuclear magnetic resonance (HR-MAS-NMR) appeared to be a valid technique for evaluating graft quality and the consequences of cold ischemia on grafts. Read more

N-glycan levels in liver grafts predict primary nonfunction after transplantation

NGA2F glycan levels present on perfusate proteins of liver grafts correlated with the development of primary nonfunction in patients who underwent liver transplantation, according to recently published data.

“A particular problem associated with the use of ... low-quality grafts is primary nonfunction (PNF),” Xavier Verhelst, MD, PhD, from the Ghent University Hospital in Belgium, and colleagues wrote. “The results of the present study ... provide a strong proof of concept that the analysis of N-glycans in preservation fluid can predict the appearance of PNF after liver transplantation.” Read more

Renal function predicts preterm birth in liver transplant recipients

Preconception renal function predicted preterm birth in pregnant women who underwent prior liver transplantation, according to a recently published study.

“Our results show that the number of live births is increasing in parallel to the number of women of reproductive age undergoing LT. Moreover, the live birth rate has also increased significantly over the last three decades,” Tiong Y. Lim, MD, from King's College Hospital, London, and colleagues wrote. “There are currently limited prognostic markers predicting outcomes in LT recipients wishing to get pregnant. We have shown ... that preconception renal function is a useful marker to prognosticate pregnancy outcomes in women following LT.” Read more

DAAs for HCV do not increase liver cancer recurrence after local-regional therapy

Recently published data showed no association between direct-acting antiviral therapy and an increased risk for hepatocellular carcinoma recurrence among liver transplantation candidates with hepatitis C who experienced initial complete response to local-regional therapy.

“The majority of recent publications reveal no increased risk of liver cancer in patients treated with DAAs — both in terms of de novo HCC and recurrence after complete response to HCC treatment,” Norah Terrault, MD, from the University of California, San Francisco, told HCV Next. “These studies highlight the limitations of earlier studies that were uncontrolled and thus unable to account for differences in the patients in the current DAA era (older, more advanced cirrhosis) and prior pegylated-interferon era.” Read more

Center-level variances affect pediatric liver transplant offer acceptance

Researchers observed significant variability in liver offer acceptance rates for pediatric transplant candidates within individual centers that were not explained by donor or recipient factors, according to recently published data.

“We observed an almost threefold difference in center-level liver offer acceptance for pediatric patients,” Ellen Mitchell, MD, from the Children’s Hospital of Pittsburgh at the University of Pittsburgh Medical Center, and colleagues wrote. “Being listed at a center with a low acceptance rate considerably increases a child’s probability of dying prior to receiving a transplant. While it would be infeasible to discuss every offer with the patient or family, there should be shared decision making when possible.” Read more

Recent research in the field of liver transplantation has revealed key predictive measures to determine survival rates, and innovative techniques have improved graft function and survival.

The following reports include data on how metabolomic profiling and n-glycan levels can predict graft function posttransplant, how normothermic machine perfusion improves both graft and patient survival, and updated statistics on patient survival rates after transplantation in pediatric patients and posttransplantation with organs donated after drug overdose.

Organs donated after drug overdose safe for transplantation

Considering the ongoing opioid epidemic in the United States, researchers confirmed that survival rates among transplantation recipients who received organs from patients who died of drug overdose were similar to survival among recipients from donors who died of other causes.

Josef Stehlik, MD, MPH, medical director of the Heart Transplant Program at the University of Utah Health, told Healio Gastroenterology and Liver Disease that because donations from drug overdose cases often occur in hospitals that are not transplant centers, there may be bias against their use. Read more

Normothermic machine perfusion for liver storage improves graft, patient survival

Normothermic machine perfusion for donated livers had a 50% lower rate of graft injury and no significant difference in bile duct complications, graft survival or patient survival compared with conventional static cold storage, according to a recently published study.

“Despite many advances in liver transplantation, the method of organ preservation has changed very little in almost 30 years. In recent years, interest has developed in perfusion at physiological temperature,” David Nasralla, MRCS, from the University of Oxford, United Kingdom, and colleagues wrote. “During [normothermic machine perfusion (NMP)], the liver is perfused with oxygenated blood, medications and nutrients at normal body temperature to maintain a physiological milieu.” Read more

Metabolomic profiling predicts graft function after liver transplantation

Researchers found that lactate and choline-derived metabolites predicted poor graft function in both native livers and liver grafts, according to a recently published study.

High-resolution magic-angle-spinning nuclear magnetic resonance (HR-MAS-NMR) appeared to be a valid technique for evaluating graft quality and the consequences of cold ischemia on grafts. Read more

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N-glycan levels in liver grafts predict primary nonfunction after transplantation

NGA2F glycan levels present on perfusate proteins of liver grafts correlated with the development of primary nonfunction in patients who underwent liver transplantation, according to recently published data.

“A particular problem associated with the use of ... low-quality grafts is primary nonfunction (PNF),” Xavier Verhelst, MD, PhD, from the Ghent University Hospital in Belgium, and colleagues wrote. “The results of the present study ... provide a strong proof of concept that the analysis of N-glycans in preservation fluid can predict the appearance of PNF after liver transplantation.” Read more

Renal function predicts preterm birth in liver transplant recipients

Preconception renal function predicted preterm birth in pregnant women who underwent prior liver transplantation, according to a recently published study.

“Our results show that the number of live births is increasing in parallel to the number of women of reproductive age undergoing LT. Moreover, the live birth rate has also increased significantly over the last three decades,” Tiong Y. Lim, MD, from King's College Hospital, London, and colleagues wrote. “There are currently limited prognostic markers predicting outcomes in LT recipients wishing to get pregnant. We have shown ... that preconception renal function is a useful marker to prognosticate pregnancy outcomes in women following LT.” Read more

DAAs for HCV do not increase liver cancer recurrence after local-regional therapy

Recently published data showed no association between direct-acting antiviral therapy and an increased risk for hepatocellular carcinoma recurrence among liver transplantation candidates with hepatitis C who experienced initial complete response to local-regional therapy.

“The majority of recent publications reveal no increased risk of liver cancer in patients treated with DAAs — both in terms of de novo HCC and recurrence after complete response to HCC treatment,” Norah Terrault, MD, from the University of California, San Francisco, told HCV Next. “These studies highlight the limitations of earlier studies that were uncontrolled and thus unable to account for differences in the patients in the current DAA era (older, more advanced cirrhosis) and prior pegylated-interferon era.” Read more

Center-level variances affect pediatric liver transplant offer acceptance

Researchers observed significant variability in liver offer acceptance rates for pediatric transplant candidates within individual centers that were not explained by donor or recipient factors, according to recently published data.

“We observed an almost threefold difference in center-level liver offer acceptance for pediatric patients,” Ellen Mitchell, MD, from the Children’s Hospital of Pittsburgh at the University of Pittsburgh Medical Center, and colleagues wrote. “Being listed at a center with a low acceptance rate considerably increases a child’s probability of dying prior to receiving a transplant. While it would be infeasible to discuss every offer with the patient or family, there should be shared decision making when possible.” Read more