Liver transplantation prognosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
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Liver trasnsplantation Microchapters |
Overview
Liver transplantation prognosis
- Prognosis is quite good. 1-year survival (in Finland) is 83%, 5-year survival is 76% and 10-year survival is 66%.
- Majority of deaths happen during the first three months after transplantation.
- Mortality rates in donors are 0.2% in the USA and vary fro, 0.1 to 1.0% worldwide.
- Overall mortality rate is of the order of 0.2–0.5%.
- The risk associated with left-lobe donation may be lower than that with right-lobe donation.
- The incidence of complications in the donor varies from 9 to 67%.[1]
- The modified Clavien classification is commonly used to describe, report, and compare donor morbidity:[2]
- Grade I—a complication that is not life-threatening, does not result in residual disability, and does not require a therapeutic invasive intervention
- Grade II—a complication that is potentially life-threatening and that requires the use of drug therapy or foreign blood units
- Grade III—a complication that is potentially life-threatening and that requires a therapeutic invasive intervention
- Grade IV—a complication with residual or lasting disability or which leads to Living-donor Liver Transplantation death.[3]
Recurrence
Hepatitis B virus
- Recurrence of HBV after liver transplantation can be prevented by administering hepatitis B immune globulin at the time of transplantation and at regular intervals thereafter in combination with antivirals such as tenofovir or entecavir.
Hepatitis C virus
- There is no established role for prophylactic or preemptive therapy following transplantation.[4]
- No effective immunoglobulin prophylaxis exists for HCV.
- Treatment is initiated within six weeks of the transplantation. Theapy may be combined or monotherapy.
- Combination therapy may be peginterferon or standard interferon and ribavirin, monotherapy may be peginterferon, standard interferon, or ribavirin, and anti-HCV immune globulin.
- Direct-acting antiviral agents
- Sofosbuvir is an NS5B nucleotide analog used for the treatment of HCV.[5]
- Treatment resulted in persistently undetectable HCV ribonucleic acid (RNA) 12 weeks after stopping treatment in 28 of 40 patients (70 percent).
- All of the cases of virologic failure were due to relapse. As a result, sofosbuvir is usually now given in combination with one of several additional direct-acting antivirals (ledipasvir, simeprevir, and daclatasvir), with or without ribavirin.[6]
Hepatocellular Carcinoma
- Resection remains the standard with which alternative treatment methods must be compared. [4,14-16]:
Alcoholic liver disease
- Patient survival rates following liver transplantation for alcoholic liver disease are similar to rates following transplantation for non-alcohol related diagnoses.
- Five-year patient and graft survival rates 72 and 66 percent. Five-year survival without liver transplantation is 23 percent.
Primary biliary cirrhosis
- A precise estimate of the recurrence rate is uncertain.[7]
- Methods to prevent recurrence may include immunosuppression using cyclosporine rather than tacrolimus and giving ursodeoxycholic acid (UDCA) following liver transplantation.
Primary sclerosing cholangitis (PSC)
- Recurrent PSC following liver transplantation in 14 to 20 percent of patients.[8]
- Risk factors for recurrence include age, sex mismatch, male sex, coexistent IBD, presence of an intact colon after transplantation, cytomegalovirus (CMV) infection, recurrent acute cellular rejection, steroid-resistant cellular rejection, use of OKT3.
References
- ↑ Ghobrial RM, Freise CE, Trotter JF, Tong L, Ojo AO, Fair JH; et al. (2008). "Donor morbidity after living donation for liver transplantation". Gastroenterology. 135 (2): 468–76. doi:10.1053/j.gastro.2008.04.018. PMC 3731061. PMID 18505689.
- ↑ Surman OS (2002). "The ethics of partial-liver donation". N Engl J Med. 346 (14): 1038. doi:10.1056/NEJM200204043461402. PMID 11932469.
- ↑ Salvalaggio PR, Baker TB, Koffron AJ, Fryer JP, Clark L, Superina RA; et al. (2004). "Comparative analysis of live liver donation risk using a comprehensive grading system for severity". Transplantation. 77 (11): 1765–7. PMID 15201680.
- ↑ Smith B (1969). "Segmental liver transplantation from a living donor". J Pediatr Surg. 4 (1): 126–32. PMID 4976215.
- ↑ Charlton M, Gane E, Manns MP, Brown RS, Curry MP, Kwo PY; et al. (2015). "Sofosbuvir and ribavirin for treatment of compensated recurrent hepatitis C virus infection after liver transplantation". Gastroenterology. 148 (1): 108–17. doi:10.1053/j.gastro.2014.10.001. PMID 25304641.
- ↑ Fontana RJ, Hughes EA, Bifano M, Appelman H, Dimitrova D, Hindes R; et al. (2013). "Sofosbuvir and daclatasvir combination therapy in a liver transplant recipient with severe recurrent cholestatic hepatitis C." Am J Transplant. 13 (6): 1601–5. doi:10.1111/ajt.12209. PMID 23593993.
- ↑ Liermann Garcia RF, Evangelista Garcia C, McMaster P, Neuberger J (2001). "Transplantation for primary biliary cirrhosis: retrospective analysis of 400 patients in a single center". Hepatology. 33 (1): 22–7. doi:10.1053/jhep.2001.20894. PMID 11124816.
- ↑ Harrison RF, Davies MH, Neuberger JM, Hubscher SG (1994). "Fibrous and obliterative cholangitis in liver allografts: evidence of recurrent primary sclerosing cholangitis?". Hepatology. 20 (2): 356–61. PMID 8045496.