Outcomes of liver transplantation for end-stage biliary disease: A comparative study with end-stage liver disease

Lai, Yanhua; Duan, Weidong; Yu, Qiang; Ye, Sheng; Xiao, Nian-Jun; Zhang, Dongxin; Huang, Zhiqiang; Yang, Zhanyu; Dong, Jiahong

doi:10.3748/wjg.v21.i20.6296

Cited by 6 publications

(4 citation statements)

References 26 publications

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“…Hepatocyte transplantation has also been foreseen as a useful therapeutic approach for bridging patients to LT and is indicated for providing metabolic support during ALF and ACLF in which the only hope for survival for most patients is either LT, or facilitating liver regeneration of the native organ (93) (Table 1). Additionally, some patients suffering from ESLD, but with preserved liver function and no indication of LT could benefit from HLCs transplantation because cell therapy could delay disease progression and associated complications (95). Recently, the use of this strategy has been proposed to reverse the inflammation and fibrosis in non-alcoholic fatty liver disease, one of the commonest chronic liver diseases (96).…”

Section: Other Liver Diseasesmentioning

confidence: 99%

Induced pluripotent stem cells for the treatment of liver diseases: challenges and perspectives from a clinical viewpoint

Pareja¹,

Gómez-Lechón²,

Tolosa³

2020

Ann Transl Med

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The only curative treatment for severe end-stage liver disease (ESLD) is liver transplantation (LT) but it is limited by the shortage of organ donors. The increase of the incidence of liver disease has led to develop new therapeutic approaches such as liver cell transplantation. Current challenges that limit a wider application of this therapy include a limited cell source and the poor engraftment in the host liver of cryopreserved hepatocytes after thawing. Induced pluripotent stem cells (iPSCs) that can be differentiated into hepatocyte-like cells (HLCs) are being widely explored as an alternative to human hepatocytes because of their unlimited proliferation capacity and their potential ability to avoid the immune system. Their largescale production could provide a new tool to produce enough HLCs for treating patients with metabolic diseases, acute liver failure (ALF), those with ESLD or patients not considered for organ transplantation.In this review we discuss current challenges for generating differentiated cells compatible with human application as well as in-depth safety evaluation. This analysis highlights the uncertainties and deficiencies that should be addressed before their clinical use but also points out the potential benefits that will produce a great impact in the field of hepatology.

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Section: Other Liver Diseasesmentioning

confidence: 99%

Induced pluripotent stem cells for the treatment of liver diseases: challenges and perspectives from a clinical viewpoint

Pareja¹,

Gómez-Lechón²,

Tolosa³

2020

Ann Transl Med

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“…A very similar finding was reported for the adult transplant programme of our hospital . However, results from adult patients cannot be translated easily to paediatric patients, as neither the indications for transplantation nor the baseline pathologies or the levels of pro‐ and anti‐coagulation factors are comparable between the two populations .…”

Section: Discussionmentioning

confidence: 99%

Trends in transfusion practice over 20 years in paediatric liver transplant programme

et al. 2019

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Background We investigated changes to transfusion practices over time in paediatric liver transplant centre and evaluated the effect of transfusion practice to mortality.Methods A pilot retrospective study included two cohorts each with 101 sequential paediatric LT recipients: an Early group (1994)(1995)(1996)(1997)(1998) and a Recent group (2009)(2010)(2011)(2012)(2013). Demographic characteristics and data on the intraoperative transfusion of red blood cells (RBC), fresh-frozen plasma (FFP), platelets and cryoprecipitate were collected. Postoperative laboratory results were also obtained, together with donor and data regarding 1-and 5-year survival. Appropriate intergroup comparisons, univariate and multivariate analysis were made and P ≤ 0Á05 was considered statistically significant.Results There were no significant group differences in demographic data (except patient height). Despite the fact that median total blood loss did not differ between groups (111 ml/kg in both groups), the Early group had greater levels of intraoperative RBC transfusion (75 vs. 59 ml/kg, respectively, P = 0Á04) and less use of FFP (53 vs. 62 ml/kg, respectively, P = 0Á01). Overall we noted a lower 1and 5-year survival in the Early group (88Á2% vs. 96%, P = 0Á04 and 82Á4% vs. 89Á1%, P = 0Á01, respectively). Univariate, but not multivariate regression analyses demonstrated that higher PELD score, RBC and FFP transfusion, and inclusion in the Early group were contributing factors to 1-year higher mortality.Conclusions This retrospective analysis of blood loss and replacement in paediatric LT patients demonstrates that the majority of our patients suffer major haemorrhage and require large-volume RBC and FFP replacements. In our pilot study, large volume of RBC and FFP replacement did not contribute to mortality. Paediatric LT involves a number of multidisciplinary teams. Thus, all care-related factors and combinations thereof that may contribute to outcome and should be evaluated in the future.

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“…Nos casos de transplante hepático, é importante observar que o escore MELD não é uma boa ferramenta, pois ele avalia a função hepática e tem sua aplicação bem estabelecida para pacientes com cirrose hepática. No caso da cirrose biliar secundária por LIVB, não há ainda uma ferramenta que funcione de forma análoga ao MELD para avaliar esses pacientes 29 .…”

Section: Tratamentounclassified

Lesões iatrogênicas das vias biliares: diagnóstico e manejo

Neto

Perez

Lopes

2023

Rev. Med. (São Paulo)

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A lesão iatrogênica das vias biliares (LIVB) se configura em uma grave complicação relacionada a abordagens cirúrgicas do trato gastrointestinal e mesmo em centros de referência taxas de 0,2% a 1,5% ainda são registradas. A taxa de LIVB varia se a cirurgia inicial foi realizada por meio de técnica aberta ou videolaparoscópica, e a sua gravidade se dá pelo grande espectro de complicações que podem ser causadas e que apresentam forte impacto negativo na qualidade de vida do paciente. A primeira classificação de LIVB se deu em 1982 com Bismuth e, com o advento da videolaparoscopia, várias outras foram feitas, sendo a de Strasberg uma das mais utilizadas até hoje. A suspeição diagnóstica pode ser feita com auxílio de exames laboratoriais e principalmente com exames de imagem, como a colangiorressonância. O tratamento se constitui em um verdadeiro desafio para a equipe cirúrgica e pode ser realizado por meio de técnicas percutâneas endoscópicas e também cirúrgicas, sendo mais comumente realizada por meio de hepaticojejunostomia em Y de Roux. No paciente com doença hepática em estágio terminal por cirrose biliar secundária, pode ser realizado o transplante hepático. O paciente sempre que possível deve ser acompanhado por uma equipe multidisciplinar e é de suma importância que seja rapidamente encaminhado para um centro especializado.

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Outcomes of liver transplantation for end-stage biliary disease: A comparative study with end-stage liver disease

Abstract: MELD/PELD criteria do not adequately measure the clinical characteristics and staging of ESBD. The allocation system based on MELD/PELD criteria should be re-evaluated for patients with ESBD.

Cited by 6 publications

References 26 publications

Induced pluripotent stem cells for the treatment of liver diseases: challenges and perspectives from a clinical viewpoint

Induced pluripotent stem cells for the treatment of liver diseases: challenges and perspectives from a clinical viewpoint

Trends in transfusion practice over 20 years in paediatric liver transplant programme

Lesões iatrogênicas das vias biliares: diagnóstico e manejo

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