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Liver Transplantation for Acute and Chronic Liver Failure

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Liver Diseases

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Abstract

Liver transplantation is a life-saving surgical procedure for patients with acute and chronic liver diseases. In the United States, acute liver failure, chronic liver disease (alcoholic liver disease, PSC, PBC, viral hepatitis), hepatocellular carcinoma (HCC), and liver-based metabolic defects are the primary reasons for liver transplantation (O’Leary et al., Gastroenterology 134(6):1764–1776, 2008). In the United States in 2017, 8082 liver transplants were done, accounting for 23% of all solid organ transplantations (United Network for Organ Sharing (UNOS). Transplants by organ type—2017. Data: Transplant trends). The number of liver transplantations has increased by 24% since 2007, however due to a limited supply and increasing survival of patients on the transplantation waiting list, the number of organs available do not meet the needs of the population (https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/). Complex rules and regulations have been developed to best determine which candidates would benefit the most from receiving liver transplantation. This is a complicated matter that involves evaluation of the medical necessity, but also considers psychological and sociological factors, as patients are evaluated by liver transplant specialists.

This chapter will discuss general principles regarding liver transplantation, with a focus on liver transplantation for acute liver failure and chronic liver failure from cirrhosis.

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References

  1. O’Leary JG, Lepe R, Davis GL. Indications for liver transplantation. Gastroenterology. 2008;134(6):1764–76. https://doi.org/10.1053/j.gastro.2008.02.028. Review. PubMed PMID: 18471553.

    Article  PubMed  Google Scholar 

  2. United Network for Organ Sharing (UNOS). Transplants by organ type—2017. Data: Transplant trends. Richmond, VA: UNOS.

    Google Scholar 

  3. https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/. Accessed 15 Dec 2018.

  4. Martin P, DiMartini A, Feng S, Brown R Jr, Fallon M. Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Hepatology. 2014;59:1144–65.

    Article  PubMed  Google Scholar 

  5. Charlton MR, Burns JM, Pedersen RA, Watt KD, Heimbach JK, Dierkhising RA. Frequency and outcomes of liver transplantation for nonalcoholic steatohepatitis in the United States. Gastroenterology. 2011;141:1249–53.

    Article  PubMed  Google Scholar 

  6. Lopez P, Martin P. Update on liver transplantation: indications, organ allocation, and long-term care. Mt Sinai J Med. 2006;73:1056–66.

    PubMed  Google Scholar 

  7. Duffy JP, Kao K, Ko CY, Farmer DG, McDiarmid SV, Hong JC, et al. Long-term patient outcome and quality of life after liver transplantation: analysis of 20-year survivors. Ann Surg. 2010;252:652–61.

    PubMed  Google Scholar 

  8. Lucey MR, Brown KA, Everson GT, et al. Minimal criteria for placement of adults on the liver transplant waiting list: a report of a national conference organized by the American Society of Transplant Physicians and the American Association for the Study of Liver Diseases. Liver Transpl Surg. 1997;3:628–37.

    Article  CAS  PubMed  Google Scholar 

  9. Bernardi M, Gitto S, Biselli M. The MELD score in patients awaiting liver transplant: strengths and weaknesses. J Hepatol. 2011;54:1297–306.

    Article  PubMed  Google Scholar 

  10. Fede G, D’Amico G, Arvaniti V, Tsochatzis E, Germani G, Georgiadis D, et al. Renal failure and cirrhosis: a systematic review of mortality and prognosis. J Hepatol. 2012;56:810–8.

    Article  PubMed  Google Scholar 

  11. https://optn.transplant.hrsa.gov/resources/allocation-calculators/meld-calculator. Accessed 15 Dec 2018.

  12. Merion RM, Schaubel DE, et al. The survival benefit of liver transplantation. Am J Transplant. 2005;5:307–13.

    Article  PubMed  Google Scholar 

  13. Kim WR, Biggins SW, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359:1018–26.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. https://optn.transplant.hrsa.gov/media/1200/optn_policies.pdf. Accessed 15 Dec 2018.

  15. https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/cld.464. Accessed 15 Dec 2018.

  16. https://optn.transplant.hrsa.gov/media/1200/optn_policies.pdf#nameddest=Policy_09. Accessed 10 Jan 2019.

  17. Feldman M. Sleisenger and Fordtran’s gastrointestinal and liver disease. Philadelphia, PA: Saunders, Elsevier; 2016.

    Google Scholar 

  18. Siciliano M, Parlati L, Maldarelli F, Rossi M, Ginanni Corradini S. Liver transplantation in adults: choosing the appropriate timing. World J Gastrointest Pharmacol Ther. 2012;3(4):49–61.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Schilsky ML, Moini M. Advances in liver transplantation allocation systems. World J Gastroenterol. 2016;22(10):2922–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Kato T, Nery JR, Morcos JJ, et al. Successful living related liver transplantation in an adult with fulminant hepatic failure. Transplantation. 1997;64:415–7.

    Article  CAS  PubMed  Google Scholar 

  21. Muzaale AD, Dagher NN, Montgomery RA, et al. Estimates of early death, acute liver failure, and long-term mortality among live liver donors. Gastroenterology. 2012;142:273–80.

    Article  PubMed  Google Scholar 

  22. Tector A, Mangus R, Chestovich P, et al. Use of extended criteria livers decreases wait time for liver transplantation without adversely impacting posttransplant survival. Ann Surg. 2006;244:439–50.

    PubMed  PubMed Central  Google Scholar 

  23. O’Grady JG, Alexander GJ, Hayllar KM, et al. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology. 1989;97:439–45.

    Article  PubMed  Google Scholar 

  24. Bernal W, Hyyrylainen A, Gera A, et al. Lessons from look-back in acute liver failure? A single centre experience of 3300 patients. J Hepatol. 2013;59:74–80.

    Article  PubMed  Google Scholar 

  25. Freeman RB, Steffick DE, Guidinger MK, et al. Liver and intestine transplantation in the United States, 1997-2006. Am J Transplant. 2008;8:958–76.

    Article  PubMed  Google Scholar 

  26. Lipshutz GS, Hiatt J, Ghobrial RM, Farmer DG, Martinez MM, Yersiz H, et al. Outcome of liver transplantation in septuagenarians: a single-center experience. Arch Surg. 2007;142:775–81; discussion 81–84.

    Article  PubMed  Google Scholar 

  27. Watt KD. Reducing the load: the evolution and management of obesity and nonalcoholic steatohepatitis before liver transplantation. Liver Transpl. 2012;18(Suppl 2):S52–8.

    Article  PubMed  Google Scholar 

  28. McCaughan GW. Trekking new ground: overcoming medical and social impediments for extended criteria liver transplant recipients. Liver Transpl. 2012;18(Suppl 2):S39–46.

    Article  PubMed  Google Scholar 

  29. McAvoy NC, Kochar N, McKillop G, Newby DE, Hayes PC. Prevalence of coronary artery calcification in patients undergoing assessment for orthotopic liver transplantation. Liver Transpl. 2008;14:1725–31.

    Article  PubMed  Google Scholar 

  30. Azarbal B, Poommipanit P, Arbit B, Hage A, Patel J, Kittleson M, et al. Feasibility and safety of percutaneous coronary intervention in patients with end-stage liver disease referred for liver transplantation. Liver Transpl. 2011;17:809–13.

    Article  PubMed  Google Scholar 

  31. Safdar Z, Bartolome S, Sussman N. Portopulmonary hypertension: an update. Liver Transpl. 2012;18:881–91.

    Article  PubMed  Google Scholar 

  32. Kochar R, Nevah Rubin MI, Fallon MB. Pulmonary complications of cirrhosis. Curr Gastroenterol Rep. 2011;13:34–9.

    Article  PubMed  Google Scholar 

  33. Rodriguez-Roisin R, Krowka MJ. Hepatopulmonary syndrome—a liver-induced lung vascular disorder. N Engl J Med. 2008;358:2378–87.

    Article  CAS  PubMed  Google Scholar 

  34. Swanson KL, Wiesner RH, Krowka MJ. Natural history of hepatopulmonary syndrome: impact of liver transplantation. Hepatology. 2005;41:1122–9.

    Article  PubMed  Google Scholar 

  35. Arguedas MR, Singh H, Faulk DK, Fallon MB. Utility of pulse oximetry screening for hepatopulmonary syndrome. Clin Gastroenterol Hepatol. 2007;5:749–54.

    Article  PubMed  Google Scholar 

  36. Pungpapong S, Manzarbeitia C, Ortiz J, Reich DJ, Araya V, Rothstein KD, et al. Cigarette smoking is associated with an increased HEPATOLOGY, Vol. 59, No. 3, 2014 MARTIN ET AL. 1161 incidence of vascular complications after liver transplantation. Liver Transpl. 2002;8:582–7.

    Article  PubMed  Google Scholar 

  37. Mathurin P, et al. Early liver transplantation for severe alcoholic hepatitis. N Engl J Med. 2011;365(19):1790–800.

    Article  CAS  PubMed  Google Scholar 

  38. Duffy JP, Hong JC, Farmer DG, Ghobrial RM, Yersiz H, Hiatt JR, Busuttil RW. Vascular complications of orthotopic liver transplantation: experience in more than 4,200 patients. J Am Coll Surg. 2009;208(5):896–903.

    Article  PubMed  Google Scholar 

  39. Tannuri U, Tannuri AC. Postoperative care in pediatric liver transplantation. Clinics (Sao Paulo). 2014;69(Suppl 1):42–6.

    Article  Google Scholar 

  40. Chen XB, Xu MQ. Primary graft dysfunction after liver transplantation. Hepatobiliary Pancreat Dis Int. 2014;13(2):125–37.

    Article  CAS  PubMed  Google Scholar 

  41. Neves DB, Rusi MB, Diaz LG, Salvalaggio P. Primary graft dysfunction of the liver: definitions, diagnostic criteria and risk factors. Einstein (Sao Paulo). 2016;14(4):567–72.

    Article  Google Scholar 

  42. Pascher A, Neuhaus P. Bile duct complications after liver transplantation. Transpl Int. 2005;18(6):627–42.

    Article  PubMed  Google Scholar 

  43. Cheung A, Levitsky J. Follow-up of the post-liver transplantation patient. Clin Liver Dis. 2017;21(4):793–813.

    Article  PubMed  Google Scholar 

  44. Song AT, Avelino-Silva VI, Pecora RA, Pugliese V, D’Albuquerque LA, Abdala E. Liver transplantation: fifty years of experience. World J Gastroenterol. 2014;20(18):5363–74.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Levitsky J, Goldberg D, et al. Acute rejection increases risk of graft failure and death in recent liver transplant recipients. Clin Gastroenterol Hepatol. 2017;15(4):584–93.

    Article  PubMed  Google Scholar 

  46. Demetris AJ, Batts KP, Dhillon AP, et al. Banff Schema for grading liver allograft rejection: an international consensus document. Hepatology. 1997;25:658–63.

    Article  Google Scholar 

  47. Demetris AJ, Adeyi O, Bellamy CO, et al. Liver biopsy interpretation for causes of late liver allograft dysfunction. Hepatology. 2006;44:489–501.

    Article  PubMed  Google Scholar 

  48. Demetris AJ, Murase N, Lee RG, et al. Chronic rejection. A general overview of histopathology and pathophysiology with emphasis on liver, heart and intestinal allografts. Ann Transplant. 1997;2(2):27–44.

    CAS  PubMed  Google Scholar 

  49. Jain A, Demetris AJ, Kashyap R, et al. Does tacrolimus offer virtual freedom from chronic rejection after primary liver transplantation? Risk and prognostic factors in 1,048 liver transplantations with a mean follow-up of 6 years. Liver Transpl. 2001;7:623–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Kim WR, Lake JR, Smith JM, et al. OPTN/SRTR 2015 annual data report: liver. Am J Transplant. 2017;17:174–251.

    Article  PubMed  Google Scholar 

  51. Watt KD, Pedersen RA, Kremers WK, et al. Evolution of causes and risk factors for mortality post-liver transplant: results of the NIDDK long-term follow-up study. Am J Transplant. 2010;10:1420–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Kim WR, et al. OPTN/SRTR 2016 annual data report: liver. Am J Transplant. 2018;18(S1):172–253.

    Article  PubMed  Google Scholar 

  53. Ilyas JA, O’Mahony CA, Vierling JM. Liver transplantation in autoimmune liver diseases. Best Pract Res Clin Gastroenterol. 2011;25:765–82.

    Article  PubMed  Google Scholar 

  54. Montano-Loza AJ, Bhanji RA, et al. Systematic review: recurrent autoimmune liver diseases after liver transplantation. Aliment Pharmacol Ther. 2017;45(4):485–500.

    Article  CAS  PubMed  Google Scholar 

  55. Rowe IA, Webb K, Gunson BK, et al. The impact of disease recurrence on graft survival following liver transplantation: a single centre experience. Transpl Int. 2008;21:459–65.

    Article  PubMed  Google Scholar 

  56. Adil B, Fatih O, Volkan I, et al. Hepatitis B virus and Hepatitis D virus recurrence in patients undergoing liver transplantation for hepatitis B virus and hepatitis B virus plus hepatitis D virus. Transplant Proc. 2016;48:2119–23.

    Article  CAS  PubMed  Google Scholar 

  57. Garcia-Retortillo M, Forns X, Feliu A, et al. Hepatitis C virus kinetics during and immediately after liver transplantation. Hepatology. 2002;35:680–7.

    Article  PubMed  Google Scholar 

  58. Jain A, DiMartini A, Kashyap R, et al. Long-term follow-up after liver transplantation for alcoholic liver disease under tacrolimus. Transplantation. 2000;70:1335–42.

    Article  CAS  PubMed  Google Scholar 

  59. Dew MA, DiMartini AF, Steel J, et al. Meta-analysis of risk for relapse to substance use after transplantation of the liver or other solid organs. Liver Transpl. 2008;14:159–72.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Watt KD, Charlton MR. Metabolic syndrome and liver transplantation: a review and guide to management. J Hepatol. 2010;53:199–206.

    Article  PubMed  Google Scholar 

  61. Madhwal S, Atreja A, Albeldawi M, et al. Is liver transplantation a risk factor for cardiovascular disease? A meta-analysis of observational studies. Liver Transpl. 2012;18:1140–6.

    Article  PubMed  Google Scholar 

  62. Textor SC. De novo hypertension after liver transplantation. Hypertension. 1993;22:257–67.

    Article  CAS  PubMed  Google Scholar 

  63. Younossi ZM, Stepanova M, Saab S, et al. The impact of type 2 diabetes and obesity on the long-term outcomes of more than 85 000 liver transplant recipients in the US. Aliment Pharmacol Ther. 2014;40:686–94.

    Article  CAS  PubMed  Google Scholar 

  64. Desai S, Hong JC, Saab S. Cardiovascular risk factors following orthotopic liver transplantation: predisposing factors, incidence and management. Liver Int. 2010;30:948–57.

    Article  PubMed  Google Scholar 

  65. Ojo AO, Held PJ, Port FK, et al. Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med. 2003;349:931–40.

    Article  CAS  PubMed  Google Scholar 

  66. Zhou J, Hu Z, Zhang Q, et al. Spectrum of de novo cancers and predictors in liver transplantation: analysis of the scientific registry of transplant recipients database. PLoS One. 2016;11:e0155179.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  67. Garrett GL, Blanc PD, Boscardin J, et al. Incidence of and risk factors for skin cancer in organ transplant recipients in the United States. JAMA Dermatol. 2017;153:296–303.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Rutgers—New Jersey Medical School, Newark, NJ, USA

    Tehilla Apfel & Nikolaos T. Pyrsopoulos

Authors
  1. Tehilla Apfel
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  2. Nikolaos T. Pyrsopoulos
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Corresponding author

Correspondence to Nikolaos T. Pyrsopoulos .

Editor information

Editors and Affiliations

  1. Faculty of Medicine, “Titu Maiorescu” University, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Florentina Radu-Ionita

  2. New Jersey Medical School, Rutgers University New Jersey Medical School, Newark, NJ, USA

    Nikolaos T. Pyrsopoulos

  3. Carol Davila University of Medicine and Pharmacy, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Mariana Jinga

  4. Faculty of Medicine, “Titu Maiorescu” University, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Ion C. Tintoiu

  5. Medical Radiation Sciences, Curtin University, Perth, WA, Australia

    Zhonghua Sun

  6. “Prof. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania

    Ecaterina Bontas

Self Study

Self Study

1.1 Questions

  1. 1.

    Which statement is true?

    1. (a)

      All patients diagnosed with HCC are automatically assigned the status 1A designation.

    2. (b)

      Patients with hepatopulmonary syndrome are diagnosed with right heart catheterization and if the pulmonary vascular resistance is responsive to vasodilators the patient can be listed for liver transplantation.

    3. (c)

      Post-transplant lymphoproliferative disorder (PTLD) is a common malignancy in liver transplant recipients leads to death in 50% of cases

    4. (d)

      Liver transplantation is contraindicated in recipients who are over the age of 70.

  2. 2.

    A 55-year-old man with a PMH significant for well-compensated NASH cirrhosis presents to clinic for follow-up. She complains of dyspnea on exertion. She denies a history of smoking. On examination, she has finger clubbing, but a normal cardiac and respiratory exam. Vitals: T 37.2 °C HR 87 BP 112/60 SpO2 86% on room air. Labs reveal a PaO2 on ABG is 59 mmHg. Chest X-ray is significant for an enlarged mediastinum. Doppler of the lower extremities is negative for deep vein thrombosis.

    What is the next best test to evaluate the patient?

    1. (a)

      VQ scan

    2. (b)

      CT chest

    3. (c)

      Right heart catheterization.

    4. (d)

      Contrast echocardiogram

  3. 3.

    A 64 year old man received an orthotopic liver transplant 7 years ago for NASH cirrhosis. He is on tacrolimus for immunosuppression and takes medications for hypertension. On routine labs his creatinine is found to be 2.3 mg/dL and has been rising progressively over the last year. All his other labs values are normal and he has no other complaints.

    What do you consider doing next?

    1. (a)

      Plan for dialysis

    2. (b)

      Stop tacrolimus and start Basiliximab.

    3. (c)

      Stop tacrolimus and start sirolimus

    4. (d)

      Stop tacrolimus and start cyclosporine.

    5. (e)

      Start prednisone 20 mg.

1.2 Answers

  1. 1.

    Which statement is true?

    1. (a)

      All patients diagnosed with HCC are automatically assigned the status 1A designation

    2. (b)

      Patients with hepatopulmonary syndrome are diagnosed with right heart catheterization and if the pulmonary vascular resistance is responsive to vasodilators the patient can be listed for liver transplantation.

    3. (c)

      Posttransplant lymphoproliferative disorder (PTLD) is a common malignancy in liver transplant recipients leads to death in 50% of cases—CORRECT

    4. (d)

      Liver transplantation is contraindicated in recipients who are over the age of 70.

  2. 2.

    A 55-year-old man with a PMH significant for well-compensated NASH cirrhosis presents to clinic for follow-up. She complains of dyspnea on exertion. She denies a history of smoking. On examination, she has finger clubbing, but a normal cardiac and respiratory exam. Vitals: T 37.2 °C HR 87 BP 112/60 SpO2 86% on room air. Labs reveal a PaO2 on ABG is 59 mmHg. Chest X-ray is significant for an enlarged mediastinum. Doppler of the lower extremities is negative for deep vein thrombosis.

    What is the next best test to evaluate the patient?

    1. (a)

      VQ scan

    2. (b)

      CT chest

    3. (c)

      Right heart catheterization.

    4. (d)

      Contrast echocardiogram—CORRECT

  3. 3.

    A 64 year old man received an orthotopic liver transplant 7 years ago for NASH cirrhosis. He is on tacrolimus for immunosuppression and takes medications for hypertension. On routine labs his creatinine is found to be 2.3 mg/dL and has been rising progressively over the last year. All his other labs values are normal and he has no other complaints.

    What do you consider doing next?

    1. (a)

      Plan for dialysis

    2. (b)

      Stop tacrolimus and start Basiliximab.

    3. (c)

      Stop tacrolimus and start sirolimus—CORRECT

    4. (d)

      Stop tacrolimus and start cyclosporine.

    5. (e)

      Start prednisone 20 mg.

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Apfel, T., Pyrsopoulos, N.T. (2020). Liver Transplantation for Acute and Chronic Liver Failure. In: Radu-Ionita, F., Pyrsopoulos, N., Jinga, M., Tintoiu, I., Sun, Z., Bontas, E. (eds) Liver Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-24432-3_68

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  • DOI: https://doi.org/10.1007/978-3-030-24432-3_68

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  • Online ISBN: 978-3-030-24432-3

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