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Book Details
Abstract
Cirrhosis from hepatitis C (HCV) is now the most common indication for liver transplant (LT) in the U.S., but between 2004 and 2013, new LT listings for NASH increased by 170%. Unfortunately, fibrosis progression leading to cirrhosis, liver cancer, and liver decompensation continues to occur after transplantation. Once cirrhosis and decompensation are evident, patient survival is poor and repeat LT is considered to improve outcomes. Therefore, the never-ending thirst for new approaches in the management of patients pre- and post-transplant has led to a very promising future in transplantation, thought there is much to learn to achieve better patient outcomes. This issue of Clinics in Liver Disease addresses the core areas to achieve better patient outcomes, with articles devoted to coagulopathy before liver transplant, challenges in renal failure before LT, LT for acute alcoholic hepatitis, LT in the pregnant patient, bariatric surgery and LT,and MELD Scores in prioritization of LT, to name a few. Readers will place a high value on the current state of liver transplantation in this issue.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Liver Transplantation\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| CONSULTING EDITOR | iii | ||
| EDITOR | iii | ||
| AUTHORS | iii | ||
| Contents | vii | ||
| Preface: Liver Transplantation in the Twenty-First Century | vii | ||
| Liver Transplantation and Bariatric Surgery: Best Approach | vii | ||
| Treatment Options in Patients Awaiting Liver Transplantation with Hepatocellular Carcinoma and Cholangiocarcinoma | vii | ||
| Coagulopathy Before and After Liver Transplantation: From the Hepatic to the Systemic Circulatory Systems | vii | ||
| Model for End-Stage Liver Disease–Sodium Score: The Evolution in the Prioritization of Liver Transplantation | viii | ||
| Extended Criteria Donors in Liver Transplantation | viii | ||
| Challenges in Renal Failure Treatment Before Liver Transplant | viii | ||
| De Novo and Recurrence of Nonalcoholic Steatohepatitis After Liver Transplantation | viii | ||
| Management of Immunosuppression in Liver Transplantation | ix | ||
| Liver Transplantation in Alpha-1 Antitrypsin Deficiency | ix | ||
| Predictors of Cardiovascular Events After Liver Transplantation | ix | ||
| Autoimmune Hepatitis in the Liver Transplant Graft | ix | ||
| Cholestatic Liver Diseases After Liver Transplant | x | ||
| The New Era of Hepatitis C: Therapy in Liver Transplant Recipients | x | ||
| Liver Retransplantation: How Much Is Too Much?\r | x | ||
| CLINICS IN LIVER DISEASE\r | xi | ||
| FORTHCOMING ISSUES | xi | ||
| August 2017 | xi | ||
| November 2017 | xi | ||
| February 2018 | xi | ||
| RECENT ISSUES | xi | ||
| February 2017 | xi | ||
| November 2016 | xi | ||
| August 2016 | xi | ||
| Erratum | xiii | ||
| Preface:\rLiver Transplantation in the Twenty-First Century | xv | ||
| Liver Transplantation and Bariatric Surgery | 215 | ||
| Key points | 215 | ||
| INTRODUCTION | 215 | ||
| IMPACT OF OBESITY IN LIVER TRANSPLANT | 216 | ||
| NONSURGICAL INTERVENTIONS FOR OBESITY | 218 | ||
| TYPES OF BARIATRIC SURGERY | 218 | ||
| BARIATRIC SURGERY IN PATIENTS WITH LIVER DISEASE | 222 | ||
| BARIATRIC SURGERY AND LIVER TRANSPLANT | 222 | ||
| BARIATRIC SURGERY BEFORE LIVER TRANSPLANTATION | 223 | ||
| BARIATRIC SURGERY DURING TRANSPLANTATION | 223 | ||
| BARIATRIC SURGERY AFTER TRANSPLANTATION | 224 | ||
| SUMMARY | 224 | ||
| REFERENCES | 224 | ||
| Treatment Options in Patients Awaiting Liver Transplantation with Hepatocellular Carcinoma and Cholangiocarcinoma | 231 | ||
| Key points | 231 | ||
| INTRODUCTION | 232 | ||
| PATIENT EVALUATION OVERVIEW | 233 | ||
| LOCOREGIONAL THERAPIES | 233 | ||
| ABLATION TREATMENTS | 234 | ||
| TRANSCATHETER ARTERIAL TREATMENTS | 235 | ||
| Transarterial Chemoembolization | 235 | ||
| Transarterial Radioembolization | 236 | ||
| COMBINATION THERAPIES | 239 | ||
| Transarterial Chemoembolization Plus Radiofrequency Ablation | 239 | ||
| Locoregional Therapies with Sorafenib | 239 | ||
| EMERGING THERAPIES | 239 | ||
| Stereotactic Body Radiation Therapy | 239 | ||
| SURGICAL TREATMENT OPTIONS | 241 | ||
| EVALUATION OF OUTCOME AND RECOMMENDATIONS FOR TREATMENT OF HEPATOCELLULAR CARCINOMA | 241 | ||
| PERIHILAR CHOLANGIOCARCINOMA | 244 | ||
| SUMMARY | 245 | ||
| REFERENCES | 245 | ||
| Coagulopathy Before and After Liver Transplantation | 253 | ||
| Key points | 253 | ||
| INTRODUCTION | 253 | ||
| PITFALLS AND CAVEATS OF DIAGNOSTIC TESTING: PREDICTING THROMBOTIC AND BLEEDING RISK | 255 | ||
| PRETRANSPLANT VENOUS THROMBOEMBOLIC DISEASE | 256 | ||
| PRETRANSPLANT PORTAL VEIN THROMBOSIS IN PATIENTS WITH CIRRHOSIS | 257 | ||
| NONALCOHOLIC STEATOHEPATITIS | 259 | ||
| THERAPEUTIC ANTICOAGULATION IN CIRRHOSIS | 260 | ||
| INTRAOPERATIVE AND POST–LIVER TRANSPLANTATION THROMBOSIS | 264 | ||
| Intraoperative Thromboembolic Events | 264 | ||
| Venous Thromboembolic Disease | 264 | ||
| Portal Vein Thrombosis | 265 | ||
| Hepatic Artery Thrombosis | 265 | ||
| SUMMARY | 266 | ||
| REFERENCES | 266 | ||
| Model for End-Stage Liver Disease–Sodium Score | 275 | ||
| Key points | 275 | ||
| HISTORICAL PERSPECTIVE: STARTING TO REGULATE LIVER TRANSPLANTATION | 275 | ||
| THE FIRST IMPROVEMENT: CREATION OF THE UNOS STATUS CLASSIFICATION | 276 | ||
| REDEFINING PRIORITY FOR TRANSPLANTATION: THE FINAL RULE | 277 | ||
| A MATHEMATICAL FORMULA HELP SOLVING THE LIVER ALLOCATION PROBLEM | 278 | ||
| LIVER ORGAN ALLOCATION IMPROVES WITH THE MELD IMPLEMENTATION | 279 | ||
| IMPROVING THE PREDICTION OF SURVIVAL WITH ADDING SODIUM TO THE CALCULATION | 279 | ||
| ADDRESSING GEOGRAPHIC DISPARITIES: DISTRIBUTION OF ORGANS | 281 | ||
| MODEL FOR END-STAGE LIVER DISEASE EXCEPTIONS: THE CASE FOR HEPATOCELLULAR CARCINOMA | 282 | ||
| MODEL FOR END-STAGE LIVER DISEASE EXCEPTION: PULMONARY COMPLICATIONS OF CIRRHOSIS | 282 | ||
| OTHER MODEL FOR END-STAGE LIVER DISEASE EXCEPTIONS | 283 | ||
| SUMMARY | 283 | ||
| REFERENCES | 284 | ||
| Extended Criteria Donors in Liver Transplantation | 289 | ||
| Key points | 289 | ||
| INTRODUCTION | 289 | ||
| DONOR AGE | 290 | ||
| DONOR STEATOSIS | 291 | ||
| DONORS AFTER CARDIAC DEATH | 292 | ||
| CENTERS FOR DISEASE CONTROL AND PREVENTION HIGH-RISK DONORS | 293 | ||
| VIRAL HEPATITIS C | 294 | ||
| VIRAL HEPATITIS B | 294 | ||
| Hepatitis B Core Antibody–Positive Donors | 294 | ||
| Hepatitis B Surface Antigen–Positive Donors | 295 | ||
| HUMAN IMMUNODEFICIENCY VIRUS | 295 | ||
| SUMMARY | 296 | ||
| REFERENCES | 296 | ||
| Challenges in Renal Failure Treatment Before Liver Transplant | 303 | ||
| Key points | 303 | ||
| INTRODUCTION | 303 | ||
| RENAL FAILURE IN CIRRHOSIS: EPIDEMIOLOGY AND OUTCOME | 304 | ||
| HISTORICAL PERSPECTIVE | 304 | ||
| HEPATORENAL SYNDROME: CLINICAL PICTURE | 305 | ||
| HEPATORENAL SYNDROME: PATHOPHYSIOLOGY | 306 | ||
| HEPATORENAL SYNDROME: DIAGNOSIS | 307 | ||
| OUTCOME OF PATIENTS WITH HEPATORENAL SYNDROME AND LIVER TRANSPLANT | 309 | ||
| PHARMACOLOGIC TREATMENT OF HEPATORENAL SYNDROME | 309 | ||
| RATIONALE OF THERAPY FOR HEPATORENAL SYNDROME | 309 | ||
| THERAPY FOR HEPATORENAL SYNDROME: VASOCONSTRICTORS (OBSERVATIONAL STUDIES) | 310 | ||
| THERAPY FOR HEPATORENAL SYNDROME: VASOCONSTRICTORS (RANDOMIZED, CONTROLLED TRIALS) | 311 | ||
| THERAPY FOR HEPATORENAL SYNDROME: ARTERIAL BLOOD PRESSURE AND VASOCONSTRICTORS | 311 | ||
| THERAPY FOR HEPATORENAL SYNDROME: TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT | 312 | ||
| THERAPY FOR HEPATORENAL SYNDROME: RENAL REPLACEMENT THERAPY | 313 | ||
| SUMMARY | 314 | ||
| REFERENCES | 314 | ||
| De Novo and Recurrence of Nonalcoholic Steatohepatitis After Liver Transplantation | 321 | ||
| Key points | 321 | ||
| INTRODUCTION | 321 | ||
| DONOR FACTORS: RISK FOR DE NOVO NONALCOHOLIC FATTY LIVER DISEASE POST LIVER TRANSPLANT | 322 | ||
| RECIPIENT-SPECIFIC FACTORS FOR DE NOVO AND RECURRENT NONALCOHOLIC FATTY LIVER DISEASE AGE | 323 | ||
| Ethnic Risk Factors | 323 | ||
| Gender | 324 | ||
| Genetic Factors | 324 | ||
| Rapid Weight Gain After Transplantation | 325 | ||
| Comorbid Metabolic Syndrome | 326 | ||
| Pretransplant Alcoholic Liver Disease | 326 | ||
| TRANSPLANT-SPECIFIC FACTORS | 326 | ||
| Corticosteroids | 326 | ||
| Calcineurin Inhibitors | 327 | ||
| Sirolimus | 328 | ||
| MANAGEMENT OF DE NOVO NONALCOHOLIC FATTY LIVER DISEASE | 328 | ||
| SUMMARY | 329 | ||
| REFERENCES | 329 | ||
| Management of Immunosuppression in Liver Transplantation | 337 | ||
| Key points | 337 | ||
| INTRODUCTION | 337 | ||
| PATHOPHYSIOLOGY OF IMMUNE RESPONSE AFTER LIVER TRANSPLANTATION | 338 | ||
| MAJOR CLASSES OF IMMUNOSUPPRESSIVE DRUGS | 339 | ||
| Corticosteroids | 339 | ||
| Mechanism of action | 339 | ||
| Dose and protocol | 339 | ||
| Adverse effects | 339 | ||
| Calcineurin Inhibitors | 339 | ||
| Liver Transplantation in Alpha-1 Antitrypsin Deficiency | 355 | ||
| Key points | 355 | ||
| INTRODUCTION | 355 | ||
| EPIDEMIOLOGY AND GENETICS | 355 | ||
| PATHOGENESIS | 356 | ||
| ALPHA-1 ANTITRYPSIN DEFICIENCY AND LIVER DISEASE IN CHILDREN | 356 | ||
| LIVER DISEASE IN ADULTS | 357 | ||
| Risk of Cirrhosis in PI*ZZ Adults | 357 | ||
| Risk of Cirrhosis in PI*MZ Adults | 357 | ||
| EARLY EXPERIENCE IN LIVER TRANSPLANTATION AND ALPHA-1 ANTITRYPSIN DEFICIENCY | 357 | ||
| LIVER TRANSPLANTATION FOR ALPHA-1 ANTITRYPSIN DEFICIENCY IN CHILDREN | 358 | ||
| LIVER TRANSPLANTATION FOR ALPHA-1 ANTITRYPSIN DEFICIENCY IN ADULTS | 359 | ||
| HEPATOCELLULAR CARCINOMA AND ALPHA-1 ANTITRYPSIN DEFICIENCY | 361 | ||
| GENOTYPE/PHENOTYPE MISMATCH AND OTHER DONOR ISSUES | 361 | ||
| CONSIDERATIONS OF LUNG FUNCTION PARTICULAR TO ALPHA-1 ANTITRYPSIN DEFICIENCY | 361 | ||
| SUMMARY | 362 | ||
| REFERENCES | 362 | ||
| Predictors of Cardiovascular Events After Liver Transplantation | 367 | ||
| Key points | 367 | ||
| INTRODUCTION | 367 | ||
| CARDIOVASCULAR COMPLICATIONS AFTER LIVER TRANSPLANTATION | 368 | ||
| PREOPERATIVE CARDIOVASCULAR EVALUATION IN LIVER TRANSPLANT CANDIDATES | 370 | ||
| PREDICTORS OF POSTTRANSPLANT CARDIOVASCULAR COMPLICATIONS | 372 | ||
| PORTOPULMONARY HYPERTENSION | 375 | ||
| SUMMARY | 375 | ||
| REFERENCES | 375 | ||
| Autoimmune Hepatitis in the Liver Transplant Graft | 381 | ||
| Key points | 381 | ||
| RECURRENT AND DE NOVO AUTOIMMUNE HEPATITIS AFTER LIVER TRANSPLANTATION | 381 | ||
| RECURRENT AUTOIMMUNE HEPATITIS AFTER LIVER TRANSPLANTATION | 381 | ||
| Incidence and Timing of Recurrent Autoimmune Hepatitis | 382 | ||
| Risk Factors for and Pathogenesis of Recurrent Autoimmune Hepatitis | 382 | ||
| Diagnosis of Recurrent Autoimmune Hepatitis | 384 | ||
| Monitoring for Recurrence | 385 | ||
| Management of Recurrent Autoimmune Hepatitis | 386 | ||
| Outcomes of Recurrent Autoimmune Hepatitis | 386 | ||
| DE NOVO AUTOIMMUNE HEPATITIS AFTER LIVER TRANSPLANTATION | 386 | ||
| Incidence of De Novo Autoimmune Hepatitis | 387 | ||
| Histology | 387 | ||
| Presence of Antibodies in De Novo Autoimmune Hepatitis | 392 | ||
| Risk Factors for the Development of De Novo Autoimmune Hepatitis | 393 | ||
| Outcomes | 395 | ||
| Treatment | 396 | ||
| SUMMARY | 396 | ||
| REFERENCES | 396 | ||
| Cholestatic Liver Diseases After Liver Transplant | 403 | ||
| Key points | 403 | ||
| INTRODUCTION | 403 | ||
| PRIMARY SCLEROSING CHOLANGITIS | 404 | ||
| Indication and Timing of Liver Transplant | 404 | ||
| Transplant Trends | 404 | ||
| Survival After Liver Transplant | 405 | ||
| Disease Recurrence | 407 | ||
| Diagnosis | 407 | ||
| Cholangiographic findings | 407 | ||
| Histologic findings | 408 | ||
| Incidence of recurrent primary sclerosing cholangitis | 408 | ||
| Risk factors for recurrent primary sclerosing cholangitis | 408 | ||
| Treatment of recurrent primary sclerosing cholangitis | 409 | ||
| Rejection | 409 | ||
| Importance of Acute Cellular Rejection After Liver Transplant for Primary Sclerosing Cholangitis | 410 | ||
| Retransplant | 410 | ||
| Inflammatory Bowel Disease Activity After Liver Transplant | 410 | ||
| Bone Mineral Density | 411 | ||
| PRIMARY BILIARY CHOLANGITIS | 411 | ||
| Indication and Timing of Liver Transplant | 411 | ||
| Transplant Trends | 412 | ||
| Survival After Liver Transplant | 412 | ||
| Disease Recurrence | 412 | ||
| Diagnosis | 412 | ||
| Incidence of recurrent primary biliary cholangitis | 413 | ||
| Risk factors for recurrent primary biliary cholangitis | 413 | ||
| Treatment of Recurrent Primary Biliary Cholangitis | 414 | ||
| Prevention of Recurrent Primary Biliary Cholangitis | 414 | ||
| Clinical Impact of Recurrent Primary Biliary Cholangitis | 415 | ||
| Rejection | 415 | ||
| SUMMARY | 415 | ||
| REFERENCES | 415 | ||
| The New Era of Hepatitis C | 421 | ||
| Key points | 421 | ||
| INTRODUCTION | 421 | ||
| WHEN TO TREAT HEPATITIS C VIRUS IN PATIENTS WHO NEED LIVER TRANSPLANT | 422 | ||
| HOW TO TREAT HEPATITIS C VIRUS IN PATIENTS LISTED FOR LIVER TRANSPLANT | 426 | ||
| Treatment of Patients with Cirrhosis | 426 | ||
| Treatment of Hepatitis C Virus After Liver Transplant | 426 | ||
| AVAILABLE TREATMENT REGIMENS | 427 | ||
| Sofosbuvir and Ribavirin | 427 | ||
| Sofosbuvir and Ledipasvir | 427 | ||
| Sofosbuvir and Simeprevir | 428 | ||
| Sofosbuvir and Daclatasvir | 428 | ||
| Paritaprevir, Ritonavir, Ombitasvir, and Ribavirin | 429 | ||
| Other Combinations | 429 | ||
| FIBROSING CHOLESTATIC HEPATITIS | 429 | ||
| RESISTANCE-ASSOCIATED VARIANTS | 430 | ||
| SUMMARY | 430 | ||
| REFERENCES | 430 | ||
| Liver Retransplantation | 435 | ||
| Key points | 435 | ||
| INTRODUCTION | 435 | ||
| TECHNICAL CONSIDERATIONS | 436 | ||
| FACTORS AFFECTING OUTCOMES | 437 | ||
| RETRANSPLANT FOR HEPATITIS C OR HUMAN IMMUNODEFICIENCY VIRUS | 439 | ||
| MODELS TO PREDICT OUTCOMES | 440 | ||
| MULTIPLE RETRANSPLANTS | 442 | ||
| SUMMARY | 443 | ||
| REFERENCES | 444 |