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Health-related Quality of Life in Liver Transplantation: Another Step Forward
No full textIn the field of liver transplantation (LT), satisfactory results have been achieved in recent years in terms of graft and patient survival, but improving patients' health-related quality of life (HRQoL) remains an issue. It is well known that the HRQoL of patients with end-stage liver disease is impaired due to the life-threatening complications of portal hypertension, frequent hospitalizations, and limitations on their social life. This article is protected by copyright. All rights reserved
Letter: Addressing Gaps in Hospital-Based Hepatitis C Screening-Insights and Recommendations. Authors' Reply'
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Liver transplantation for Wilson disease: Current knowledge and future perspectives
No full textLiver transplantation currently represents a therapeutic option for patients with Wilson disease presenting with end-stage liver disease or acute liver failure. Indeed, it has been associated with excellent postoperative survival curves in view of young age at transplant and absence of recurrence. Attention has shifted over the past decades to a wise expansion of indications for liver transplantation. Evidence has emerged supporting the transplantation of carefully selected patients with primarily neuropsychiatric symptoms and compensated cirrhosis. The rationale behind this approach is the potential for surgery to improve copper homeostasis and consequently ameliorate neuropsychiatric symptoms. However, several questions remain unanswered, such as how to establish thresholds for assessing pretransplant neuropsychiatric impairment, how to standardize preoperative neurological assessments, and how to define postoperative outcomes for patients meeting these specific criteria. Furthermore, a disease-specific approach will be proposed both for the liver transplant evaluation of candidates with Wilson disease and for patient care during the transplant waiting period, highlighting the peculiarities of this systemic disease
Quality of life and adherence in liver transplant recipients
No full textThe assessment of Quality of Life (QoL) after transplantation represents an ancillary tool to evaluate the efficacy of solid organ transplantation, in addition to graft and patient survival rates and complication. The global assessment of QoL after transplantation usually confirms the improvement when compared to pre-transplant setting. However, whereas significant improvement in physical activity has been widely reported, several studies have demonstrated that social domain and cognitive function do not reach the level of general population after surgery. Post-transplant adherence depends on several factors, including patient personality, level of education, understanding of disease, complexity of medical prescriptions, family support. The evaluation of post-transplant adherence includes adherence to medical prescriptions, in particular to immunosuppressive regimens. QoL and adherence represent crucial issues in the long-term management of liver transplant recipients. Therefore, the transplant professionals should be able to identify risk factors of poor adherence and limited quality of life, in adult and paediatric liver transplant recipients
Pre-liver Transplant Functional Status: Refining Assessment and Outcomes for MASLD Patients
No full textHepatitis B and liver transplantation
No full textLiver transplantation (LT) is the only effective treatment for hepatitis B-virus (HBV) related end stage liver disease, even if the outcome of these patients, has significantly improved after introduction of effective and well tolerated nucleos/tide analogues (NUC). Pre-transplant therapy has been initially based on lamivudine, but entecavir and tenofovir represent the currently recommended first-line therapeutic option in patients with HBV decompensated cirrhosis. After LT, the development of hepatitis B immunoglobulin (HBIG) in the early 1990s change dramatically the prognosis of these patients by reducing the incidence of HBV recurrence and increasing survival rate. Combination of HBIG and NUC is now considered as the standard of care for prophylaxis against HBV recurrence, however personalized therapeutic algorithms based on pre and post-transplant viral and host factors have been proposed. Finally, liver grafts from hepatitis B core antibody (anti-HBc) positive donors and from hepatitis B antigens (HBsAg) positive donors can be safely used in selected patients
Recent advances in understanding and managing liver transplantation
Full text linkLiver transplantation (LT) has been established as the most effective treatment modality for end-stage liver disease over the last few decades. Currently, patient and graft survival after LT are excellent, with 1- and 5-year survival of 90% and 80%, respectively. However, the timing of referral to LT is crucial for improving survival benefit and outcome. The current shortage of donors and the increasing demand for LT currently lengthen the waiting time. Thus, waiting list mortality is about 10-15%, according to the geographical area. For this reason, over the last several years, alternatives to deceased donor LT and new options for prioritizing patients on the waiting list have been proposed
Therapeutic approaches for portal biliopathy: A systematic review
Full text linkPortal biliopathy (PB) is defined as the presence of biliary abnormalities in patients with non-cirrhotic/non-neoplastic extrahepatic portal vein obstruction (EHPVO) and portal cavernoma (PC). The pathogenesis of PB is due to ab extrinseco compression of bile ducts by PC and/or to ischemic damage secondary to an altered biliary vascularization in EHPVO and PC. Although asymptomatic biliary abnormalities can be frequently seen by magnetic resonance cholangiopancreatography in patients with PC (77%-100%), only a part of these (5%-38%) are symptomatic. Clinical presentation includes jaundice, cholangitis, cholecystitis, abdominal pain, and cholelithiasis. In this subset of patients is required a specific treatment. Different therapeutic approaches aimed to diminish portal hypertension and treat biliary strictures are available. In order to decompress PC, surgical porto-systemic shunt or transjugular intrahepatic porto-systemic shunt can be performed, and treatment on the biliary stenosis includes endoscopic (Endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy, balloon dilation, stone extraction, stent placement) and surgical (bilioenteric anastomosis, cholecystectomy) approaches. Definitive treatment of PB often requires multiple and combined interventions both on vascular and biliary system. Liver transplantation can be considered in patients with secondary biliary cirrhosis, recurrent cholangitis or unsuccessful control of portal hypertension
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