Post-Transplant Management and Complications of Autoimmune Hepatitis, Primary Biliary Cholangitis, and Primary Sclerosing Cholangitis including Disease Recurrence

Henson, Jacqueline B.; King, Lindsay Y.

doi:10.1016/j.cld.2023.07.009

Cited by 4 publications

(2 citation statements)

References 112 publications

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“…Also, while the literature suggests a relationship between rejection and the etiology of recipient liver failure, the exact causative factors for this association are unknown [22–24]. Interestingly, similar to patient 2, at least 22 of the 50 7DS cases reported in the literature were recipients with previous autoimmune or autoimmune like liver disease.…”

Section: Discussionmentioning

confidence: 99%

Early Graft Loss With Suspected Seventh‐Day Syndrome Following Pediatric Liver Transplantation

Hartjes,

Koo,

Al‐Ibraheemi

et al. 2024

Pediatric Transplantation

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IntroductionAllograft dysfunction within the first week posttransplant is an uncommon but known complication following liver transplantation. Seventh‐Day Syndrome (7DS) is a rare complication of allograft dysfunction following liver transplantation characterized by the rapid clinical deterioration of a formerly well‐functioning allograft within the first week posttransplant. The etiology of 7DS is unknown, and treatment options remain limited. While cases of graft survival have been reported, the risk of mortality remains exceedingly high without urgent retransplantation.MethodsPatient data was retrospectively analyzed and a literature review performed.ResultsWe present a unique case of split liver transplantation into two pediatric recipients in which one recipient developed rapidly progressive graft failure approximately 1 week postoperatively requiring urgent retransplantation while the other recipient had an unremarkable postoperative course. Upon clinical manifestation of progressive graft failure, the patient was treated with thymoglobulin, rituximab, intravenous immunoglobulin, and plasmapheresis. Despite this, the patient's clinical status continued to decline and she underwent retransplantation 11 days following her initial liver transplant.ConclusionSeventh‐Day Syndrome is a rare complication following liver transplantation that is associated with a high risk of morbidity and mortality. Our case adds to the limited literature on 7DS in children and is the first to report a comparative posttransplant clinical course in two recipients who received split grafts from the same donor.

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Section: Discussionmentioning

confidence: 99%

Early Graft Loss With Suspected Seventh‐Day Syndrome Following Pediatric Liver Transplantation

Hartjes,

Koo,

Al‐Ibraheemi

et al. 2024

Pediatric Transplantation

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“…86 87 The increased risk of recurrence and thereby retransplantation stresses the importance of adequately diagnosing dysplasia and malignancy. 88…”

Section: Open Accessmentioning

confidence: 99%

Treatment of cholangiocarcinoma in patients with primary sclerosing cholangitis: a comprehensive review

Villard,

Jorns,

Bergquist

2024

egastro

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Primary sclerosing cholangitis (PSC) is a rare cholestatic liver disease, characterised by persistent biliary inflammation resulting in fibrosis and multifocal strictures of the biliary tree. The course of disease is highly variable, ranging from asymptomatic disease to the development of end-stage biliary cirrhosis and an increased risk of biliary tract cancer (BTC), particularly cholangiocarcinoma (CCA).PSC is the most important risk factor for CCA in younger people, with a reported lifetime prevalence ranging from 6% to 13%. Perihilar CCA (pCCA), involving the hepatic duct bifurcation, is the most common CCA amounting to approximately 50% of all cases, whereas intrahepatic CCA (iCCA), located within the hepatic parenchyma, represents less than 10%.CCA is an aggressive tumour, and only a minority of patients are amenable to surgical resection with curative intent. Radical liver resection and liver transplantation are potentially curative therapeutic options in patients with PSC in the absence of metastatic or locally advanced disease. Liver transplantation with neoadjuvant chemoradiation could be considered in selected patients with unresectable pCCA and without pretreatment in patients with PSC with bile duct high-grade dysplasia. Recent reports demonstrating favourable outcomes in transplanted patients with small iCCA and patients with locally advanced disease following neoadjuvant therapy have challenged the previously described poor outcome in transplanted patients with iCCA.Treatment for CCA is challenged by the inherent difficulties in enabling an early diagnosis and thereby preventing an otherwise dismal prognosis. This comprehensive review aims to describe therapeutic considerations and challenges in patients with PSC-CCA.

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Impact of Intrapatient Immunosuppression Variability in Liver Transplantation Outcomes: A Systematic Review and Meta-analysis

Lattimore,

Chambers,

Angeli-Pahim

et al. 2024

Transplantation Direct

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Background. To investigate the impact of intrapatient variability (IPV) in the levels of immunosuppressant drugs on health outcomes after liver transplantation. Methods. A comprehensive systematic review and meta-analysis were conducted, examining literature from MEDLINE/PubMed, Embase, Web of Science, Cochrane Reviews, and Cochrane CENTRAL. Results. The analysis focused on acute rejection, graft survival, acute kidney injury, and cancer risk as health outcomes. Of 2901 articles screened, 10 met the inclusion criteria. The results indicate a 19% reduction in the risk of acute rejection in patients with lower IPV (RR = 0.81; 95% confidence interval, 0.66-0.99), although 6 studies found no significant association between high IPV and acute rejection. Contrasting results were observed for graft survival, with 1 study indicating worse outcomes for high IPV, whereas another reported no significant difference. High IPV was consistently associated with acute kidney injury across 3 studies. One study suggested a link between high IPV and hepatocellular carcinoma, although a meta-analysis for these outcomes was not feasible. Conclusions. These findings point to a marginal but statistically significant association between high IPV and an increased risk of acute rejection, highlighting the importance of precise management of immunosuppressive drugs in liver transplant recipients to enhance patient outcomes.

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Post-Transplant Management and Complications of Autoimmune Hepatitis, Primary Biliary Cholangitis, and Primary Sclerosing Cholangitis including Disease Recurrence

Cited by 4 publications

References 112 publications

Early Graft Loss With Suspected Seventh‐Day Syndrome Following Pediatric Liver Transplantation

Early Graft Loss With Suspected Seventh‐Day Syndrome Following Pediatric Liver Transplantation

Treatment of cholangiocarcinoma in patients with primary sclerosing cholangitis: a comprehensive review

Impact of Intrapatient Immunosuppression Variability in Liver Transplantation Outcomes: A Systematic Review and Meta-analysis

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