Preservation injury patterns in liver transplantation associated with poor prognosis

Lee, Y.-M; O’Brien, Christopher B.; Yamashiki, Noriyo; Behro, Mariana; Weppler, D.; Tzakis, Andreas G.; Schiff, E.

doi:10.1016/j.transproceed.2003.10.084

Cited by 15 publications

(13 citation statements)

References 9 publications

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“…[12] However, our results are similar to the study by Killackey et al where a correlation could not be found between PI and the frequency and timing of histologic HCV recurrence. Their study also showed that the severity of PI did not impact patient survival.…”

Section: Discussionsupporting

confidence: 89%

Hepatic Preservation Injury: Severity of Hepatitis C Recurrence and Survival After Liver Transplantation

et al. 2013

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Background Preservation injury in the HCV liver transplant population has been reported to correlate with poorer survival outcomes compared to preservation injury in the non-HCV liver transplant population. However, determinants of progression to cirrhosis in HCV infection remain poorly defined in this population. Aim This study aimed to determine if presence and severity of preservation injury impact the acceleration of HCV recurrence and survival after liver transplant. Methods We retrospectively reviewed liver transplant HCV patients over a 10-year period. Biopsies from POD 7 were assessed for preservation injury and 4 and 12-month biopsies were assessed for fibrosis. Patients with Ishak fibrosis > 0.8 units/year were considered rapid fibrosers. Results Our study group consisted of 255 patients. The mean age was 49.3 years old, 180 (70.6%) were male and 221 (86.7%) were Caucasian. The incidence of preservation injury on the 7-day biopsy was 69.0%. A strong correlation between postoperative peak AST within the first week and preservation injury was found. The overall prevalence of rapid fibrosers at 4-months, 1-year and 2-years was 47.4%, 75.2%, and 58.9%, respectively. The prevalence of rapid fibrosers at 4 months, 1 and 2 years between patients with or without preservation injury was not statistically significant (p=0.39, p=0.46, and p=0.53, respectively). No differences were seen between patients with and without PI in terms of patient and graft survival. Conclusion In this study, the presence and severity of preservation injury were not associated with development of rapid HCV recurrence or worsening in survival.

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Section: Discussionsupporting

confidence: 89%

Hepatic Preservation Injury: Severity of Hepatitis C Recurrence and Survival After Liver Transplantation

et al. 2013

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“…Mild PI is defined as neutrophilic infiltrate, hepatocyte necrosis, cytoaggregation, and pyknosis, as well as microvesicular steatosis involving <30% of hepatocytes. Progression to more severe injury was defined as centrilobular or zonal necrosis, hepatocyte ballooning, sinusoidal dilation, cholestasis, and fibrosis 1, 2. Severity was only analyzed in the multivariate analysis.…”

Section: Methodsmentioning

confidence: 99%

“…Preservation injury (PI), otherwise known as transport injury, harvesting injury, or reperfusion injury, occurs not infrequently in liver transplantation. It has been reported to occur in approximately 17% of cases, but rates as high as 50% have been reported 1, 2. It usually is suspected with abnormal liver enzymes in the early posttransplant period, but requires histological confirmation with a liver biopsy 2.…”

Section: Introductionmentioning

confidence: 99%

“…It has been reported to occur in approximately 17% of cases, but rates as high as 50% have been reported 1, 2. It usually is suspected with abnormal liver enzymes in the early posttransplant period, but requires histological confirmation with a liver biopsy 2. Histological findings of neutrophilic infiltration, microvesicular steatosis, and hepatocyte cytoaggregation occur early and progress to centrilobular necrosis, while hepatocyte swelling and cholestasis occur later in the process.…”

Section: Introductionmentioning

confidence: 99%

“…Histological findings of neutrophilic infiltration, microvesicular steatosis, and hepatocyte cytoaggregation occur early and progress to centrilobular necrosis, while hepatocyte swelling and cholestasis occur later in the process. Mild cases resolve spontaneously, but more severe cases may have residual damage 2…”

Section: Introductionmentioning

confidence: 99%

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Recurrent hepatitis C posttransplant: Early preservation injury may predict poor outcome

et al. 2005

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Organ cold/warm ischemia is thought to be a risk factor for increased severity of recurrence of hepatitis C (HCV) post liver transplantation. We had noted some HCV patients with preservation injury (PI) to have particularly poor outcomes. Our goal was to determine if PI on biopsy in HCV patients is associated with earlier, more rapidly progressive recurrence or graft and patient survival. Sixty-nine patients from the University of Nebraska transplant database were included: 23 HCV patients with PI (group ϭ 1), 23 non-HCV patients with PI (group ϭ 2), and 23 HCV patients without PI (group ϭ 3). Patient groups were matched for gender, age, immunosuppression, and time of transplantation for analysis. No difference in time to recurrence was noted between HCV groups (256 vs. 316 days posttransplant). More patients in group 1 had progression to stage 3 or 4 fibrosis, compared to group 3 (43 vs. 9%, P ϭ 0.02). One-year survival for groups 1, 2, and 3 was 78, 82, and 100% respectively, whereas 3-yr survival was 59, 82, and 88% (group 1 vs. group 2 or 3 respectively, P ϭ 0.0055). There was no difference in survival between groups 2 and 3. Patients in group 1 that received antiviral treatment had improved survival, compared to those who did not (P ϭ 0.012). Risk factors for poor survival on univariate analysis included severity of PI (Relative Risk ϭ 2.78, P Ͻ 0.001) and donor age of Ͼ55 (P ϭ 0.014). Multivariate analysis shows HCV is the most important factor. In conclusion, HCV transplant patients with evidence of early PI on biopsy have poorer survival outcomes than non-HCV transplant patients with PI or HCV transplant patients without PI. Consideration for antiviral therapy early in the posttransplant course may be warranted in this subset of patients. Liver Transpl 12: 134 -139, 2006.

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Implications of a positive crossmatch in liver transplantation: A 20-year review

et al. 2012

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Whether a positive crossmatch result has any relevance to liver transplantation (LT) outcomes remains controversial. We assessed the impact of a positive crossmatch result on patient and graft survival and posttransplant complications. During a 20-year period, 2723 LT procedures with crossmatch results were identified: 2479 primary transplants and 244 retransplants. The rates of positive B cell and T cell crossmatches were 10.1% and 7.4%, respectively, for primary transplants and 14.6% and 6.4%, respectively, for retransplants (P = 0.049 for a B cell crossmatch). Across all primary transplants, females (P < 0.001) and patients with autoimmune hepatitis (P < 0.001) had greater frequencies of positive crossmatches. There was no effect from race or age. For both primary transplants and retransplants, patient survival and graft survival were not affected by the presence of a positive crossmatch. With respect to posttransplant complications, there were no differences in rejection episodes (hyperacute, acute, or chronic) or technical complications (biliary and vascular) between negative and positive crossmatch groups. However, there were significant differences in the pathological findings of preservation injury (PI) on liver biopsy samples taken at the time of transplantation and within the first week of transplantation (P = 0.003 for B cells and P = 0.03 for T cells). In summary, a positive crossmatch had no significant impact on patient survival or graft outcomes. However, there was a significantly higher incidence of PI in primary LT recipients with a positive crossmatch. This finding is important for a broader understanding of PI, which may include a significant immunological component.

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Preservation injury patterns in liver transplantation associated with poor prognosis

Cited by 15 publications

References 9 publications

Hepatic Preservation Injury: Severity of Hepatitis C Recurrence and Survival After Liver Transplantation

Hepatic Preservation Injury: Severity of Hepatitis C Recurrence and Survival After Liver Transplantation

Recurrent hepatitis C posttransplant: Early preservation injury may predict poor outcome

Implications of a positive crossmatch in liver transplantation: A 20-year review

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