Liver Transplantation Questions & Answers

1. United Network for Organ Sharing (UNOS). Data. UNOS Web site. Available at https://unos.org/data/. Accessed: April 19, 2022.

2. Kwong AJ, Ebel NH, Kim WR, Lake JR, Smith JM, Schladt DP, et al. OPTN/SRTR 2020 Annual Data Report: Liver. Am J Transplant. 2022 Mar. 22 Suppl 2:204-309. [QxMD MEDLINE Link]. [Full Text].

3. Patel YA, Berg CL, Moylan CA. Nonalcoholic Fatty Liver Disease: Key Considerations Before and After Liver Transplantation. Dig Dis Sci. 2016 May. 61 (5):1406-16. [QxMD MEDLINE Link]. [Full Text].

4. Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018 Jan. 67 (1):123-133. [QxMD MEDLINE Link]. [Full Text].

5. Saab S, Han SH, Martin P. Liver transplantation. Selection, listing criteria, and preoperative management. Clin Liver Dis. 2000 Aug. 4(3):513-32. [QxMD MEDLINE Link].

6. [Guideline] American Association for the Study of Liver Diseases. Clinical Best Practice Advice for Hepatology and Liver Transplant Providers During the COVID-19 Pandemic: AASLD Expert Panel Consensus Statement. v.10.0. Available at https://www.aasld.org/sites/default/files/2021-11/AASLD%20COVID-19%20Expert%20Panel%20Consensus%20Statement%20Update%2011.02.2021.pdf. November 1, 2021; Accessed: December 15, 2021.

7. United Network for Organ Sharing. About MELD and PELD. UNOS. Available at https://optn.transplant.hrsa.gov/resources/allocation-calculators/about-meld-and-peld/. Accessed: March 21, 2018.

8. Kanwal F, Dulai GS, Spiegel BM, Yee HF, Gralnek IM. A comparison of liver transplantation outcomes in the pre- vs. post-MELD eras. Aliment Pharmacol Ther. 2005 Jan 15. 21(2):169-77. [QxMD MEDLINE Link].

9. QuickStats: Death Rates* for Chronic Liver Disease and Cirrhosis,^† by Sex and Age Group - National Vital Statistics System, United States, 2000 and 2015. MMWR Morb Mortal Wkly Rep. 2017 Sep 29. 66 (38):1031. [QxMD MEDLINE Link]. [Full Text].

10. Torres HA, Shigle TL, Hammoudi N, Link JT, Samaniego F, Kaseb A, et al. The oncologic burden of hepatitis C virus infection: A clinical perspective. CA Cancer J Clin. 2017 Sep. 67 (5):411-431. [QxMD MEDLINE Link]. [Full Text].

11. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016 Jul. 64 (1):73-84. [QxMD MEDLINE Link]. [Full Text].

12. [Guideline] Organ Procurement and Transplantation Network. OPTN Policy 9: Allocation of livers and liver-intestines. OPTN. Available at https://optn.transplant.hrsa.gov/media/1200/optn_policies.pdf. October 7, 2021; Accessed: December 16, 2021.

13. Yang JD, Larson JJ, Watt KD, Allen AM, Wiesner RH, Gores GJ, et al. Hepatocellular Carcinoma Is the Most Common Indication for Liver Transplantation and Placement on the Waitlist in the United States. Clin Gastroenterol Hepatol. 2017 May. 15 (5):767-775.e3. [QxMD MEDLINE Link]. [Full Text].

14. Achord JL. Malnutrition and the role of nutritional support in alcoholic liver disease. Am J Gastroenterol. 1987 Jan. 82(1):1-7. [QxMD MEDLINE Link].

15. Kim SJ, Kim DG, Park JH, Moon IS, Lee MD, Kim JI, et al. Clinical analysis of living donor liver transplantation in patients with portal vein thrombosis. Clin Transplant. 2011 Jan. 25(1):111-8. [QxMD MEDLINE Link].

16. Olthoff KM, Smith AR, Abecassis M, Baker T, Emond JC, Berg CL, et al. Defining long-term outcomes with living donor liver transplantation in North America. Ann Surg. 2015 Sep. 262 (3):465-75; discussion 473-5. [QxMD MEDLINE Link]. [Full Text].

17. Faure S, Herrero A, Jung B, Duny Y, Daures JP, Mura T, et al. Excessive alcohol consumption after liver transplantation impacts on long-term survival, whatever the primary indication. J Hepatol. 2012 Aug. 57(2):306-12. [QxMD MEDLINE Link].

18. Gonwa TA, McBride MA, Anderson K, Mai ML, Wadei H, Ahsan N. Continued influence of preoperative renal function on outcome of orthotopic liver transplant (OLTX) in the US: where will MELD lead us?. Am J Transplant. 2006 Nov. 6(11):2651-9. [QxMD MEDLINE Link].

19. Sun HY, Cacciarelli TV, Wagener MM, Singh N. Impact of duration of posttransplant renal replacement therapy on bacterial infections in liver transplant recipients. Liver Transpl. 2011 Jul 8. [QxMD MEDLINE Link].

20. Jacob M, Copley LP, Lewsey JD, et al. Pretransplant MELD score and post liver transplantation survival in the UK and Ireland. Liver Transpl. 2004 Jul. 10(7):903-7. [QxMD MEDLINE Link].

21. Onaca NN, Levy MF, Sanchez EQ, et al. A correlation between the pretransplantation MELD score and mortality in the first two years after liver transplantation. Liver Transpl. 2003 Feb. 9(2):117-23. [QxMD MEDLINE Link].

22. Haydon GH, Hiltunen Y, Lucey MR, et al. Self-organizing maps can determine outcome and match recipients and donors at orthotopic liver transplantation. Transplantation. 2005 Jan 27. 79(2):213-8. [QxMD MEDLINE Link].

23. Aberg F, Höckerstedt K, Roine RP, Sintonen H, Isoniemi H. Influence of liver-disease etiology on long-term quality of life and employment after liver transplantation. Clin Transplant. 2012 Mar 8. [QxMD MEDLINE Link].

24. Volk ML, Biggins SW, Huang MA, Argo CK, Fontana RJ, Anspach RR. Decision making in liver transplant selection committees: a multicenter study. Ann Intern Med. 2011 Oct 18. 155(8):503-8. [QxMD MEDLINE Link]. [Full Text].

25. Park MS, Kim S, Patel J, Hajdu CH, Do RK, Mannelli L, et al. Hepatocellular carcinoma: Detection with diffusion-weighted vs. contrast-enhanced MRI in pre-transplant patients. Hepatology. 2012 Feb 28. [QxMD MEDLINE Link].

26. Azoulay D, Bhangui P, Andreani P, Salloum C, Karam V, Hoti E, et al. Short- and long-term donor morbidity in right lobe living donor liver transplantation: 91 consecutive cases in a European Center. Am J Transplant. 2011 Jan. 11(1):101-10. [QxMD MEDLINE Link].

27. van Beekum CJ, Vilz TO, Glowka TR, von Websky MW, Kalff JC, Manekeller S. Normothermic Machine Perfusion (NMP) of the Liver - Current Status and Future Perspectives. Ann Transplant. 2021 Aug 24. 26:e931664. [QxMD MEDLINE Link]. [Full Text].

28. Mergental H, Laing RW, Kirkham AJ, et al. Transplantation of discarded livers following viability testing with normothermic machine perfusion. Nat Commun. 2020 Jun 16. 11 (1):2939. [QxMD MEDLINE Link]. [Full Text].

29. Clarke G, Mergental H, Hann A, Perera MTPR, Afford SC, Mirza DF. How Machine Perfusion Ameliorates Hepatic Ischaemia Reperfusion Injury. Int J Mol Sci. 2021 Jul 14. 22 (14):[QxMD MEDLINE Link]. [Full Text].

30. Broering DC, Wilms C, Bok P, Fischer L, Mueller L, Hillert C, et al. Evolution of donor morbidity in living related liver transplantation: a single-center analysis of 165 cases. Ann Surg. 2004 Dec. 240 (6):1013-24; discussions 1024-6. [QxMD MEDLINE Link].

31. Cimino FM, Snyder KA. Primary Care of the Solid Organ Transplant Recipient. Am Fam Physician. 2016 Feb 1. 93 (3):203-10. [QxMD MEDLINE Link]. [Full Text].

32. Ertel AE, Wima K, Chang AL, Hoehn RS, Hohmann SF, Edwards MJ, et al. Risk of Reoperation Within 90 Days of Liver Transplantation: A Necessary Evil?. J Am Coll Surg. 2016 Apr. 222 (4):419-28. [QxMD MEDLINE Link].

33. Ikegami T, Shirabe K, Yoshizumi T, Aishima S, Taketomi YA, Soejima Y, et al. Primary Graft Dysfunction After Living Donor Liver Transplantation Is Characterized by Delayed Functional Hyperbilirubinemia. Am J Transplant. 2012 Apr 11. [QxMD MEDLINE Link].

34. Warner P, Fusai G, Glantzounis GK, Sabin CA, Rolando N, Patch D, et al. Risk factors associated with early hepatic artery thrombosis after orthotopic liver transplantation - univariable and multivariable analysis. Transpl Int. 2011 Apr. 24(4):401-8. [QxMD MEDLINE Link].

35. Afessa B, Gay PC, Plevak DJ, et al. Pulmonary complications of orthotopic liver transplantation. Mayo Clin Proc. 1993 May. 68(5):427-34. [QxMD MEDLINE Link].

36. Slifkin M, Doron S, Snydman DR. Viral prophylaxis in organ transplant patients. Drugs. 2004. 64(24):2763-92. [QxMD MEDLINE Link].

37. Aberg F, Mäkisalo H, Höckerstedt K, Isoniemi H. Infectious complications more than 1 year after liver transplantation: a 3-decade nationwide experience. Am J Transplant. 2011 Feb. 11(2):287-95. [QxMD MEDLINE Link].

38. Rath PM, Saner F, Paul A, Lehmann N, Steinmann E, Buer J, et al. Multiplex PCR for rapid and improved diagnosis of bloodstream infections in liver transplant recipients. J Clin Microbiol. 2012 Jun. 50(6):2069-71. [QxMD MEDLINE Link].

39. Munoz SJ, Rothstein KD, Reich D, Manzarbeitia C. Long-term care of the liver transplant recipient. Clin Liver Dis. 2000 Aug. 4(3):691-710. [QxMD MEDLINE Link].

40. Martínez-Saldivar B, Prieto J, Berenguer M, de la Mata M, Pons JA, Serrano T, et al. Control of Blood Pressure in Liver Transplant Recipients. Transplantation. 2012 Mar 9. [QxMD MEDLINE Link].

41. Ojo AO, Held PJ, Port FK, et al. Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med. 2003 Sep 4. 349(10):931-40. [QxMD MEDLINE Link].

42. Pawarode A, Fine DM, Thuluvath PJ. Independent risk factors and natural history of renal dysfunction in liver transplant recipients. Liver Transpl. 2003 Jul. 9(7):741-7. [QxMD MEDLINE Link].

43. Cohen AJ, Stegall MD, Rosen CB, Wiesner RH, Leung N, Kremers WK, et al. Chronic renal dysfunction late after liver transplantation. Liver Transpl. 2002 Oct. 8(10):916-21. [QxMD MEDLINE Link].

44. Neau-Cransac M, Morel D, Bernard PH, et al. Renal failure after liver transplantation: outcome after calcineurin inhibitor withdrawal. Clin Transplant. 2002 Oct. 16(5):368-73. [QxMD MEDLINE Link].

45. Lucey MR, Abdelmalek MF, Gagliardi R, et al. A comparison of tacrolimus and cyclosporine in liver transplantation: effects on renal function and cardiovascular risk status. Am J Transplant. 2005 May. 5(5):1111-9. [QxMD MEDLINE Link].

46. Marik PE, Wood K, Starzl TE. The course of type 1 hepato-renal syndrome post liver transplantation. Nephrol Dial Transplant. 2006 Feb. 21(2):478-82. [QxMD MEDLINE Link].

47. Terrault NA. Treatment of recurrent hepatitis C in liver transplant recipients. Clin Gastroenterol Hepatol. 2005 Oct. 3(10 Suppl 2):S125-31. [QxMD MEDLINE Link].

48. Beckebaum S, Cicinnati VR, Klein CG, et al. Impact of combined mycophenolate mofetil and low-dose calcineurin inhibitor therapy on renal function, cardiovascular risk factors, and graft function in liver transplant patients: preliminary results of an open prospective study. Transplant Proc. 2004 Nov. 36(9):2671-4. [QxMD MEDLINE Link].

49. Kornberg A, Kupper B, Hommann M, Scheele J. Introduction of MMF in conjunction with stepwise reduction of calcineurin inhibitor in stable liver transplant patients with renal dysfunction. Int Immunopharmacol. 2005 Jan. 5(1):141-6. [QxMD MEDLINE Link].

50. Raimondo ML, Dagher L, Papatheodoridis GV, et al. Long-term mycophenolate mofetil monotherapy in combination with calcineurin inhibitors for chronic renal dysfunction after liver transplantation. Transplantation. 2003 Jan 27. 75(2):186-90. [QxMD MEDLINE Link].

51. Cantarovich M, Tzimas GN, Barkun J, Deschenes M, Alpert E, Tchervenkov J. Efficacy of mycophenolate mofetil combined with very low-dose cyclosporine microemulsion in long-term liver-transplant patients with renal dysfunction. Transplantation. 2003 Jul 15. 76(1):98-102. [QxMD MEDLINE Link].

52. Yoshida EM, Marotta PJ, Greig PD, et al. Evaluation of renal function in liver transplant recipients receiving daclizumab (Zenapax), mycophenolate mofetil, and a delayed, low-dose tacrolimus regimen vs. a standard-dose tacrolimus and mycophenolate mofetil regimen: a multicenter randomized clinical trial. Liver Transpl. 2005 Sep. 11(9):1064-72. [QxMD MEDLINE Link].

53. Herrero JI, Quiroga J, Sangro B, et al. Conversion of liver transplant recipients on cyclosporine with renal impairment to mycophenolate mofetil. Liver Transpl Surg. 1999 Sep. 5(5):414-20. [QxMD MEDLINE Link].

54. Barkmann A, Nashan B, Schmidt HH, et al. Improvement of acute and chronic renal dysfunction in liver transplant patients after substitution of calcineurin inhibitors by mycophenolate mofetil. Transplantation. 2000 May 15. 69(9):1886-90. [QxMD MEDLINE Link].

55. Stewart SF, Hudson M, Talbot D, Manas D, Day CP. Mycophenolate mofetil monotherapy in liver transplantation. Lancet. 2001 Feb 24. 357(9256):609-10. [QxMD MEDLINE Link].

56. Hirose R, Roberts JP, Quan D, et al. Experience with daclizumab in liver transplantation: renal transplant dosing without calcineurin inhibitors is insufficient to prevent acute rejection in liver transplantation. Transplantation. 2000 Jan 27. 69(2):307-11. [QxMD MEDLINE Link].

57. Ziolkowski J, Paczek L, Senatorski G, et al. Renal function after liver transplantation: calcineurin inhibitor nephrotoxicity. Transplant Proc. 2003 Sep. 35(6):2307-9. [QxMD MEDLINE Link].

58. Nair S, Eason J, Loss G. Sirolimus monotherapy in nephrotoxicity due to calcineurin inhibitors in liver transplant recipients. Liver Transpl. 2003 Feb. 9(2):126-9. [QxMD MEDLINE Link].

59. Bahirwani R, Shaked O, Bewtra M, Forde K, Reddy KR. Acute-on-Chronic Liver Failure Before Liver Transplantation: Impact on Posttransplant Outcomes. Transplantation. 2011 Oct 27. 92(8):952-7. [QxMD MEDLINE Link].

60. Egawa H, Ueda Y, Ichida T, Teramukai S, Nakanuma Y, Onishi S, et al. Risk Factors for Recurrence of Primary Sclerosing Cholangitis after Living Donor Liver Transplantation in Japanese Registry. Am J Transplant. 2011 Mar. 11(3):518-527. [QxMD MEDLINE Link].

61. Yao FY, Ferrell L, Bass NM, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology. 2001 Jun. 33(6):1394-403. [QxMD MEDLINE Link].

62. Decaens T, Roudot-Thoraval F, Hadni-Bresson S, et al. Impact of UCSF criteria according to pre- and post-OLT tumor features: analysis of 479 patients listed for HCC with a short waiting time. Liver Transpl. 2006 Dec. 12(12):1761-9. [QxMD MEDLINE Link].

63. Lesurtel M, Mullhaupt B, Pestalozzi BC, Pfammatter T, Clavien PA. Transarterial chemoembolization as a bridge to liver transplantation for hepatocellular carcinoma: an evidence-based analysis. Am J Transplant. 2006 Nov. 6(11):2644-50. [QxMD MEDLINE Link].

64. Kim do Y, Choi MS, Lee JH, et al. Milan criteria are useful predictors for favorable outcomes in hepatocellular carcinoma patients undergoing liver transplantation after transarterial chemoembolization. World J Gastroenterol. 2006 Nov 21. 12(43):6992-7. [QxMD MEDLINE Link].

65. Millonig G, Graziadei IW, Freund MC, et al. Response to preoperative chemoembolization correlates with outcome after liver transplantation in patients with hepatocellular carcinoma. Liver Transpl. 2007 Feb. 13(2):272-9. [QxMD MEDLINE Link].

66. Yao FY, Mehta N, Flemming J, Dodge J, Hameed B, Fix O, et al. Downstaging of hepatocellular cancer before liver transplant: long-term outcome compared to tumors within Milan criteria. Hepatology. 2015 Jun. 61 (6):1968-77. [QxMD MEDLINE Link]. [Full Text].

67. Ishaque T, Massie AB, Bowring MG, Haugen CE, Ruck JM, Halpern SE, et al. Liver Transplantation and Waitlist Mortality for HCC and Non-HCC Candidates Following the 2015 HCC Exception Policy Change. Am J Transplant. 2018 Oct 12. [QxMD MEDLINE Link].

68. Ragni MV, Belle SH, Im K, Neff G, Roland M, Stock P, et al. Survival of human immunodeficiency virus-infected liver transplant recipients. J Infect Dis. 2003 Nov 15. 188(10):1412-20. [QxMD MEDLINE Link].

69. Stock PG, Roland ME, Carlson L, et al. Kidney and liver transplantation in human immunodeficiency virus-infected patients: a pilot safety and efficacy study. Transplantation. 2003 Jul 27. 76(2):370-5. [QxMD MEDLINE Link].

70. HIV positive and HIV negative patients have similar survival rates following liver transplant. Presented April 24, 2009 at the Annual Meeting of the European Association for the Study of the Liver. [Full Text].

71. Roland ME, Barin B, Carlson L, Frassetto LA, Terrault NA, Hirose R. HIV-infected liver and kidney transplant recipients: 1- and 3-year outcomes. Am J Transplant. 2008 Feb. 8(2):355-65. [QxMD MEDLINE Link].

72. de Vera ME, Dvorchik I, Tom K, et al. Survival of liver transplant patients coinfected with HIV and HCV is adversely impacted by recurrent hepatitis C. Am J Transplant. 2006 Dec. 6(12):2983-93. [QxMD MEDLINE Link].

73. Duclos-Vallee JC, Feray C, Sebagh M, Teicher E, Roque-Afonso AM, Roche B. Survival and recurrence of hepatitis C after liver transplantation in patients coinfected with human immunodeficiency virus and hepatitis C virus. Hepatology. 2008 Feb. 47(2):407-17. [QxMD MEDLINE Link].

Cosme Manzarbeitia, MD, FACS Director of Abdominal Transplant and Hepatobiliary Surgery, South Florida Transplant Center, Broward Health

Cosme Manzarbeitia, MD, FACS is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Surgeons, Americas Hepato-Pancreato-Biliary Association, American Society of Transplant Surgeons, International Liver Transplantation Society

Disclosure: Nothing to disclose.

Antonios Arvelakis, MD, MPH Associate Professor of Surgery (Transplantation), Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center

Antonios Arvelakis, MD, MPH is a member of the following medical societies: American Society of Transplant Surgeons, American Society of Transplantation, Americas Hepato-Pancreato-Biliary Association, International Liver Transplantation Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Vinay K Kapoor, MBBS, MS, FRCSEd, FICS, FAMS Professor of HPB Surgery, Mahatma Gandhi Medical College and Hospital (MGMCH), Jaipur, India

Vinay K Kapoor, MBBS, MS, FRCSEd, FICS, FAMS is a member of the following medical societies: Association of Surgeons of India, Indian Association of Surgical Gastroenterology, Indian Society of Gastroenterology, Medical Council of India, National Academy of Medical Sciences (India), Royal College of Surgeons of Edinburgh

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Pfizer Sanofi.

Tushar Patel, MB, ChB Professor of Medicine, Ohio State University Medical Center

Tushar Patel, MB, ChB is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association

Disclosure: Nothing to disclose.

Youmin Wu, MD Professor, Department of Surgery, Transplantation Division, University of Arkansas for Medical Sciences

Youmin Wu, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

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