المؤلفون: Flemming, Jennifer A, Vagefi, Parsia A, Freise, Chris E, Yao, Francis Y, Terrault, Norah A

المصدر: Liver Transplantation. 20(10)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Digestive Diseases, Infectious Diseases, Hepatitis - C, Chronic Liver Disease and Cirrhosis, Emerging Infectious Diseases, Liver Disease, Clinical Research, Organ Transplantation, Transplantation, Hepatitis, Good Health and Well Being, Adult, Age Factors, California, Disease Progression, Female, Follow-Up Studies, Hepatitis C, Chronic, Humans, Liver Transplantation, Male, Middle Aged, Patient Dropouts, Prognosis, Retrospective Studies, Survival Rate, Time Factors, Tissue Donors, Transplant Recipients, Waiting Lists, Young Adult, Surgery, Clinical sciences

الوصف: Older donor age is associated with lower graft and patient survival among all recipients of liver transplantation (LT). Among patients with hepatitis C virus (HCV), donor age is one of the strongest predictors of fibrosis severity and graft loss. We evaluated the implementation of a donor age restriction policy for LT patients with HCV at a single center and the effects that this policy had on wait-list (WL) and post-LT outcomes for HCV and non-HCV patients. This was a cohort study of 2388 WL patients and 1015 LT recipients between March 2002 and January 2013 and reflected 3 different eras of donor age policies. With the donor age restriction, the median donor age was reduced in LT recipients with HCV versus LT recipients without HCV (30 versus 48 years, P

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/62q21176Test

المؤلفون: Goel, Aparna, Mehta, Neil, Guy, Jennifer, Fidelman, Nicholas, Yao, Francis, Roberts, John, Terrault, Norah

المصدر: Liver Transplantation. 20(10)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Transplantation, Rare Diseases, Liver Cancer, Clinical Research, Cancer, Chronic Liver Disease and Cirrhosis, Liver Disease, Digestive Diseases, Organ Transplantation, Evaluation of treatments and therapeutic interventions, 6.4 Surgery, Oral and gastrointestinal, Good Health and Well Being, Adult, Aged, Biliary Tract, California, Carcinoma, Hepatocellular, Chemoembolization, Therapeutic, Constriction, Pathologic, Female, Follow-Up Studies, Forecasting, Hepatic Artery, Humans, Liver Neoplasms, Liver Transplantation, Male, Middle Aged, Preoperative Care, Retrospective Studies, Risk Factors, Survival Rate, Surgery, Clinical sciences

الوصف: Liver transplantation (LT) is the treatment of choice for patients with cirrhosis and hepatocellular carcinoma (HCC) not amenable to resection. Locoregional therapies for HCC are often used to reduce tumor burden, bridge patients to LT, and down-stage HCC so that patients are eligible for LT. We hypothesized that prior endovascular antitumor therapy may increase the risk of hepatic artery (HA) and biliary complications after LT. The aim of this study was to compare HA and biliary complications in LT recipients with HCC who received transarterial chemoembolization (TACE) before LT with complications in LT recipients with HCC who did not receive TACE before LT. This was a retrospective cohort study of HCC patients at two transplant centers. The prevalence of HA complications (HA thrombosis, stenosis, or pseudoaneurysm) and biliary complications (nonanastomotic stricture, bile leak, and diffuse injury) were compared between patients treated with or without TACE. There were 456 HCC patients with a median age of 61 years (77% were male, and 63% had hepatitis C virus), and 328 (72%) received TACE before LT. The overall prevalence of HA complications was 4.7% in the no-TACE group and 7.9% in the TACE group (P = 0.22). All HA stenosis complications (n = 14) occurred in the TACE group (P = 0.018 versus the no-TACE group). An older donor age and a lower albumin level significantly increased the odds of HA complications. There was a nonstatistically significant increased odds of HA complications in the TACE group versus the no-TACE group according to an adjusted analysis (odds ratio = 2.02, 95% confidence interval = 0.79-5.16, P = 0.14). The overall prevalence of biliary complications was 16.4% in the no-TACE group and 19.8% in the TACE group (P = 0.40). In conclusion, a lower pre-LT albumin level and an older donor age were significantly associated with higher odds of HA complications after LT. TACE was not associated with higher odds of overall HA complications but was associated with a higher prevalence of HA stenosis. Further studies are warranted to confirm the HA stenosis findings and elucidate the pathogenesis.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/6qc9d4v5Test