- MeSH
- Fatal Outcome MeSH
- Carcinoma, Hepatocellular etiology MeSH
- Clinical Studies as Topic MeSH
- Middle Aged MeSH
- Humans MeSH
- Non-alcoholic Fatty Liver Disease * diagnosis epidemiology complications therapy MeSH
- Risk Factors MeSH
- Failure to Rescue, Health Care MeSH
- Severity of Illness Index MeSH
- Terminology as Topic MeSH
- Liver Transplantation statistics & numerical data MeSH
- Health Status Indicators MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
- Newspaper Article MeSH
BACKGROUND AND AIMS: Management of Budd-Chiari syndrome (BCS) has improved over the last decades. The main aim was to evaluate the contemporary post-liver transplant (post-LT) outcomes in Europe. APPROACH AND RESULTS: Data from all patients who underwent transplantation from 1976 to 2020 was obtained from the European Liver Transplant Registry (ELTR). Patients < 16 years, with secondary BCS or HCC were excluded. Patient survival (PS) and graft survival (GS) before and after 2000 were compared. Multivariate Cox regression analysis identified predictors of PS and GS after 2000. Supplemental data was requested from all ELTR-affiliated centers and received from 44. In all, 808 patients underwent transplantation between 2000 and 2020. One-, 5- and 10-year PS was 84%, 77%, and 68%, and GS was 79%, 70%, and 62%, respectively. Both significantly improved compared to outcomes before 2000 ( p < 0.001). Median follow-up was 50 months and retransplantation rate was 12%. Recipient age (aHR:1.04,95%CI:1.02-1.06) and MELD score (aHR:1.04,95%CI:1.01-1.06), especially above 30, were associated with worse PS, while male sex had better outcomes (aHR:0.63,95%CI:0.41-0.96). Donor age was associated with worse PS (aHR:1.01,95%CI:1.00-1.03) and GS (aHR:1.02,95%CI:1.01-1.03). In 353 patients (44%) with supplemental data, 33% had myeloproliferative neoplasm, 20% underwent TIPS pre-LT, and 85% used anticoagulation post-LT. Post-LT anticoagulation was associated with improved PS (aHR:0.29,95%CI:0.16-0.54) and GS (aHR:0.48,95%CI:0.29-0.81). Hepatic artery thrombosis and portal vein thrombosis (PVT) occurred in 9% and 7%, while recurrent BCS was rare (3%). CONCLUSIONS: LT for BCS results in excellent patient- and graft-survival. Older recipient or donor age and higher MELD are associated with poorer outcomes, while long-term anticoagulation improves both patient and graft outcomes.
- MeSH
- Budd-Chiari Syndrome * surgery MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Graft Survival * MeSH
- Registries * statistics & numerical data MeSH
- Retrospective Studies MeSH
- Liver Transplantation * statistics & numerical data MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Geographicals
- Europe MeSH
Úvod: Slovensko je krajinou s najvyššou prevalenciou cirhózy pečene na svete, spolu s najvyšším podielom rómskeho etnika. Existuje však len málo dôkazov o zastúpení rómskeho etnika v národných kohortách pacientov s cirhózou. Ciele: 1. určiť prevalenciu rómskej etnickej príslušnosti v našich registroch cirhózy pečene a transplantácií pečene (LT); porovnať ich 2. základné charakteristiky a 3. finálne výsledky s pacientmi z väčšinovej populácie. Metodika a pacienti: Retrospektívna štúdia; údaje sme získali z 1. Registra cirhóz RH7; 2. Registra transplantácií pečene: a) pacienti vedení ako aktívni na čakacej listine na LT; b) pacienti, ktorí podstúpili prvú LT. Prvý zdroj – Register cirhóz RH7 (NCT 04767945; RH7 zaznamenáva po sebe idúcich pacientov s cirhózou pečene prijatých do nemocnice od r. 2014). Etnická príslušnosť bola do roku 2021 zaznamenaná ako tzv. pripísané etnikum. Druhý zdroj – register LT (od r. 2008); spôsob určenia etnickej príslušnosti bol identický s RH7. Okrem etnicity boli u všetkých pacientov analyzované: demografia, klinické premenné charakterizujúce cirhózu pečene, ako je etiológia a MELD skóre, ako aj základné premenné pre LT, ako je dĺžka čakacej doby a mortalita. Výsledky: Prezentujeme výsledky rómskeho etnika z troch kohort z dvoch registrov, tj. zo 1 515 pacientov z RH7, 464 pacientov zaradených do zoznamu čakateľov z LT registra a 302 transplantovaných pacientov z LT registra. Zastúpenie rómskeho etnika v týchto kohortách bolo 2 %, 4 % a 4 %. U rómskeho etnika z registra cirhóz boli zistené signifikantné rozdiely vo veku a pohlaví: 46 oproti 55 rokom (p = 0,001) a ženskom pohlaví 25 % oproti 39 % (p = 0,042). Z kandidátov prvýkrát zaradených na čakaciu listinu na LT boli rómski pacienti rovnako mladší – 42,6 oproti 51,5 rokom; u Rómov bola v nižšom počte zastúpená etiológia alkoholovej choroby pečene (ALD) a vo vyššom počte bola zastúpená autoimunitná etiológia. Nakoniec, pacienti po prvej LT, kde Rómovia boli opäť mladší – 40,2 oproti 51,6 rokom, opäť s nižším podielom etiológie ALD – 15 % oproti 47 % a vyšším podielom autoimunitnej etiológie – 39 % oproti 23 %. Finálne výsledky rómskeho etnika zo všetkých kohort boli v rámci terciárnej starostlivosti porovnateľné. Záver: 1. zastúpenie rómskeho etnika v rámci terciárnej starostlivosti je nižšie, ako sme očakávali, z neznámych dôvodov; 2. vek Rómov pri vstupe do zariadenia terciárnej starostlivosti je približne o desať rokov nižší; 3. finálne výsledky Rómov odoslaných do zariadenia terciárnej starostlivosti sú porovnateľné.
Introduction: Slovakia is a country with the highest prevalence of liver cirrhosis in the world and a country with the highest proportion of Roma ethnicity at the same time. However, there is only little evidence of Roma representation in national cohorts with cirrhosis. Aims: 1. To determine the prevalence of Roma ethnicity in our cirrhosis and liver transplant registers; to compare their 2. fundamental characteristics and 3. final results with patients from the majority population. Patients and methods: A retrospective study; we acquired data from 1. Cirrhosis registry RH7; 2. Liver transplant registry: a) patients listed active on the liver-transplant waiting list; b) patients underwent first LT. The first source – the cirrhosis registry RH7 (NCT 04767945; since 2014, RH7 has been listing consecutive patients admitted to hospital with liver cirrhosis). Up to 2021, the mode of the ethnicity determination was so-called “ascribed ethnicity”. The second source – the Liver transplant registry (since 2008); the mode of ethnicity determination was identical to the one of RH7. Apart from the ethnicity, the following points were recorded and analyzed in all patients: demographics, elementary cirrhosis-relevant clinical variables such as etiology and MELD score, as well as an elementary LT-relevant variables, such as waiting time and mortality. Results: We present the results on Roma ethnic group in three cohorts from two datasets, i.e. on 1,515 patients from RH7, on 464 waitlisted patients from LT registry and on 302 transplanted patients from LT registry, respectively. The representation of Roma ethnicity in these cohorts were 2%, 4%, and 4%, respectively. Significant differences in age and gender were detected in Roma cirrhotic patients: 46 vs. 55 years (P = 0.001) and female gender 25% vs. 39% (P = 0.042). Of the first time waitlisted candidates for LT, Roma patients were also significantly younger – 42.6 vs. 51.5 years; in addition, Romas had a less prevalent alcohol-associated etiology (ALD) and a more prevalent autoimmune etiology. Finally, Roma patients after first LT were younger – 40.2 vs. 51.6 years, again with lower etiology of ALD – 15% vs. 47% and more autoimmune etiology – 39% vs. 23%. The results of Romas from all cohorts in tertiary care were comparable. Conclusion: 1. the admission of Romas to a tertiary liver care is lower than expected, for unknown reasons; 2. the age of Romas entering tertiary care is approximately ten years lower; 3. the results of Romas in tertiary care is comparable to the majority population.
There are scarce data on the impact of COVID-19 pandemic on liver transplantation (LT) in Europe. The aim of this study was to obtain a preliminary data on incidence, management, and outcome of COVID-19 in liver transplant recipients and candidates in Europe. An Internet-based survey was sent to the centers affiliated with European Liver Transplant Registry (ELTR). One hundred nine out of 149 (73%) of ELTR centers located in 28 European countries (93%) responded. Ninety-four (86%) of the centers tested all donors, and 75 (69%) centers tested all LT recipients for SARS-CoV-2. Seventy-three (67%) centers selected recipients for LT in the COVID-19 pandemic, whereas 33% did not. Eighty-eight centers reported COVID-19 infection in 57 LT candidates and in 272 LT recipients. Overall crude incidence of COVID-19 among LT candidates and recipients was estimated 1.05% (range 0.5-20%) and 0.34% (range 0.1-4.8%), respectively, and it was significantly higher among candidates (P < 0.001). Crude rate of death was 18% (10/57) among candidates and 15% (36/244) among recipients. This first large-scale European snapshot study clearly shows that both LT candidates and recipients are at a high risk for COVID-19. These results plead for an early and pro-active screening of COVID-19 symptoms in these populations.
- MeSH
- Early Diagnosis MeSH
- COVID-19 diagnosis epidemiology MeSH
- Tissue Donors statistics & numerical data MeSH
- Immunocompromised Host MeSH
- Incidence MeSH
- Comorbidity MeSH
- Humans MeSH
- Liver Diseases epidemiology surgery MeSH
- Pandemics * MeSH
- Mass Screening MeSH
- Postoperative Complications epidemiology MeSH
- Transplant Recipients statistics & numerical data MeSH
- Health Care Surveys MeSH
- Registries MeSH
- Risk MeSH
- SARS-CoV-2 * MeSH
- COVID-19 Testing MeSH
- Liver Transplantation statistics & numerical data MeSH
- Donor Selection standards MeSH
- Procedures and Techniques Utilization MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Europe MeSH
- MeSH
- Adult MeSH
- Humans MeSH
- Liver Transplantation * history statistics & numerical data MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
- Newspaper Article MeSH
The purpose of this registry study was to provide an overview of trends and results of liver transplantation (LT) in Europe from 1968 to 2016. These data on LT were collected prospectively from 169 centers from 32 countries, in the European Liver Transplant Registry (ELTR) beginning in 1968. This overview provides epidemiological data, as well as information on evolution of techniques, and outcomes in LT in Europe over more than five decades; something that cannot be obtained from only a single center experience.
- MeSH
- Time-to-Treatment MeSH
- Tissue Donors MeSH
- Child MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Liver Neoplasms surgery MeSH
- Liver Diseases surgery MeSH
- Graft Survival MeSH
- Prospective Studies MeSH
- Surveys and Questionnaires MeSH
- Registries * MeSH
- Reoperation MeSH
- Aged MeSH
- Liver Transplantation statistics & numerical data MeSH
- Geography MeSH
- Check Tag
- Child MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Europe MeSH
- MeSH
- Liver Failure, Acute MeSH
- Survival Analysis MeSH
- Tissue Donors MeSH
- Child MeSH
- Immunosuppression Therapy methods MeSH
- Humans MeSH
- Postoperative Complications MeSH
- Waiting Lists MeSH
- Liver Transplantation * history methods statistics & numerical data MeSH
- Patient Selection MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Geographicals
- Czech Republic MeSH
The aim of this study was to collect data from patients who underwent liver transplantation (LT) for adenomatosis; to analyze the symptoms, the characteristics of the disease, and the recipient outcomes; and to better define the role of LT in this rare indication. This retrospective multicenter study, based on data from the European Liver Transplant Registry, encompassed patients who underwent LT for adenomatosis between January 1, 1986, and July 15, 2013, in Europe. Patients with glycogen storage disease (GSD) type IA were not excluded. This study included 49 patients. Sixteen patients had GSD, and 7 had liver vascular abnormalities. The main indications for transplantation were either a suspicion of hepatocellular carcinoma (HCC; 15 patients) or a histologically proven HCC (16 patients), but only 17 had actual malignant transformation (MT) of adenomas. GSD status was similar for the 2 groups, except for age and the presence of HCC on explants (P = 0.030). Three patients with HCC on explant developed recurrence after transplantation. We obtained and studied the pathomolecular characteristics for 23 patients. In conclusion, LT should remain an extremely rare treatment for adenomatosis. Indications for transplantation primarily concern the MT of adenomas. The decision should rely on morphological data and histological evidence of MT. Additional indications should be discussed on a case-by-case basis. In this report, we propose a simplified approach to this decision-making process.
- MeSH
- Adult MeSH
- Glycogen Storage Disease Type I surgery MeSH
- Adenoma, Liver Cell pathology surgery MeSH
- Carcinoma, Hepatocellular pathology surgery MeSH
- Clinical Decision-Making methods MeSH
- Cohort Studies MeSH
- Humans MeSH
- Liver Neoplasms pathology surgery MeSH
- Registries statistics & numerical data MeSH
- Retrospective Studies MeSH
- Liver Transplantation statistics & numerical data MeSH
- Treatment Outcome MeSH
- Rare Diseases surgery MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Geographicals
- Europe epidemiology MeSH
Transplantace jater je po tři desetiletí standardním léčebným postupem u pacientů s chronickým i akutním selháním jater, vrozenými vadami metabolismu vázanými na játra a některými tumory, především hepatocelulárním karcinomem. Metoda došla značného rozšíření a ve vyspělých státech včetně České republiky je prováděna v počtu 10–20 výkonů na milión obyvatel ročně. Poslední roky přinesly významné změny v postupech týkajících se nemocných s infekcí virem hepatitidy C, potransplantační rekurentní hepatitida se stala dobře léčitelným onemocněním, a to včetně fibrotizující cholestatické formy. V uvedeném přehledu je více prostoru věnováno problémovým indikacím, především alkoholové chorobě jater včetně alkoholické hepatitidy a hepatocelulárnímu karcinomu, kde byl v poslední dekádě zaznamenán zřetelný posun k rozšíření indikací. Rovněž se mění postupy u nemocných s akutním selháním jater, zejména nově charakterizovaná jednotka selhání jater akutní na chronickém si žádá nový přístup. Se zlepšením péče o nemocné se mění postupy u některých komplikací jaterní cirhózy, zejména u hepatopulmonálního syndromu a portopulmonální hypertenze. Zvláštní zřetel je třeba věnovat onkologicky nemocným.
Liver transplantation has been the standard therapeutic procedure for patients with both acute and chronic liver failure, congenital metabolic liver-centred disorders and some tumours, especially hepatocellular carcinoma. This method has spread far and wide, and in the developed world, including the Czech Republic, it is being performed at rates of roughly 10-20 procedures per million inhabitants per year. Recent years have brought significant changes in the procedures involving patients with viral hepatitis C, post-transplant recurrent hepatitis has become well treatable, including fibrotic cholestatic forms. This review devotes more space to problematic indications, especially alcohol-related liver diseases, including alcoholic hepatitis and hepatocellular carcinoma, which have recently seen a push towards widening the indication. Procedures for patients with acute liver failure are changing as well, especially the newly characterised unit of acute-on-chronic liver failure, which demands a new approach. With improved patient care, the rules are also changing for some cirrhosis complications, especially hepatopulmonary syndrome and portopulmonary hypertension. Oncologic patients need to be treated with extra care.
- MeSH
- Liver Failure, Acute surgery MeSH
- Liver Diseases, Alcoholic surgery MeSH
- Child MeSH
- Adult MeSH
- Carcinoma, Hepatocellular surgery MeSH
- Humans MeSH
- Surgical Clearance MeSH
- Disease-Free Survival MeSH
- Transplant Recipients MeSH
- Liver Transplantation * history standards statistics & numerical data trends MeSH
- Patient Selection MeSH
- Check Tag
- Child MeSH
- Adult MeSH
- Humans MeSH
- Publication type
- Review MeSH
