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Current Opinion in Organ Transplantation最新文献

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Optimizing cardiac status in the preliver transplant candidate. 优化肝脏移植候选者的心脏状态。
IF 2.2 4区 医学
Current Opinion in Organ Transplantation Pub Date : 2024-02-01 Epub Date: 2023-11-14 DOI: 10.1097/MOT.0000000000001119
Maxine W Stachel, Eugene C DePasquale
{"title":"Optimizing cardiac status in the preliver transplant candidate.","authors":"Maxine W Stachel, Eugene C DePasquale","doi":"10.1097/MOT.0000000000001119","DOIUrl":"10.1097/MOT.0000000000001119","url":null,"abstract":"<p><strong>Purpose of review: </strong>Liver transplant is a widely accepted therapy for end-stage liver disease. With advances in our understanding of transplant, candidates are increasingly older with more cardiac comorbidities. Cardiovascular disease also represents a leading cause of morbidity and mortality posttransplant.</p><p><strong>Recent findings: </strong>Preoperative cardiac risk stratification and treatment may improve short-term and long-term outcomes after liver transplant. Importantly, the appropriate frequency of surveillance has not been defined. Optimal timing of cardiac intervention in end-stage liver disease is likewise uncertain.</p><p><strong>Summary: </strong>The approach to risk stratification of cardiovascular disease in end-stage liver disease is outlined, incorporating the AHA/ACC scientific statement on evaluation of cardiac disease in transplant candidates and more recent expert consensus documents. Further study is needed to clarify the ideal timing and approach for cardiovascular interventions.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"50-55"},"PeriodicalIF":2.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138290600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Treating rare tumors with liver transplantation. 肝移植治疗罕见肿瘤。
IF 2.2 4区 医学
Current Opinion in Organ Transplantation Pub Date : 2024-02-01 Epub Date: 2023-10-18 DOI: 10.1097/MOT.0000000000001118
Andrew Melehy, Vatche Agopian
{"title":"Treating rare tumors with liver transplantation.","authors":"Andrew Melehy, Vatche Agopian","doi":"10.1097/MOT.0000000000001118","DOIUrl":"10.1097/MOT.0000000000001118","url":null,"abstract":"<p><strong>Purpose of review: </strong>The success of liver transplantation (LT) in treating unresectable hepatocellular carcinoma (HCC) has resulted in interest in LT for other oncologic conditions. Here, we discuss the role of LT for rare oncologic indications including metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs), hepatic epitheliod hemangioendothelioma (HEHE), fibrolamellar hepatocellular carcinoma (FLC), and hepatic angiosarcoma (HAS).</p><p><strong>Recent findings: </strong>Conditions reviewed have been documented indications for LT in the available literature. We summarize the experience of LT for these indications and proposed management guidelines.</p><p><strong>Summary: </strong>GEP-NETs with isolated metastases to the liver can be treated with LT with excellent long-term outcomes (10-year survival 88%) if strict selection criteria are used (low-intermediate grade, Ki-67% < 20%, complete resection of primary tumor, stable disease for 6 months, <50% hepatic involvement). HEHE is a rare hepatic tumor for which LT can be performed with reported 10-year survival around 70%. FLC is a distinct clinical entity to HCC and is optimally treated with surgical resection though experience with LT is described in observational series (5-year survival 50%, recurrence in 10%). HAS is a rapidly progressive tumor with a dismal prognosis with or without treatment, including LT.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"30-36"},"PeriodicalIF":2.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41233124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Innovative surgical techniques in the intestine and multivisceral transplant. 创新的肠道和多器官移植手术技术。
IF 2.2 4区 医学
Current Opinion in Organ Transplantation Pub Date : 2024-02-01 Epub Date: 2023-10-30 DOI: 10.1097/MOT.0000000000001098
Phillipe Abreu, Joao Manzi, Rodrigo Vianna
{"title":"Innovative surgical techniques in the intestine and multivisceral transplant.","authors":"Phillipe Abreu, Joao Manzi, Rodrigo Vianna","doi":"10.1097/MOT.0000000000001098","DOIUrl":"10.1097/MOT.0000000000001098","url":null,"abstract":"<p><strong>Purpose of review: </strong>This timely review delves into the evolution of multivisceral transplantation (MVT) over the past six decades underscoring how advancements in surgical techniques and immunosuppression have driven transformation, to provide insight into the historical development of MVT, shedding light on its journey from experimentation to a valuable clinical approach.</p><p><strong>Recent findings: </strong>The review presents contemporary enhancements in surgical methods within the context of intestinal transplantation. The versatility of MVT is emphasized, accommodating diverse organ combinations and techniques. Both isolated intestinal transplantation (IIT) and MVT have seen expanded indications, driven by improved parenteral nutrition, transplantation outcomes, and surgical innovations. Surgical techniques are tailored based on graft type, with various approaches for isolated transplantation. Preservation strategies and ostomy techniques are also covered, along with graft assessment advancements involving donor-specific antibodies.</p><p><strong>Summary: </strong>This review's findings underscore the remarkable evolution of MVT from experimental origins to a comprehensive clinical practice. The progress in surgical techniques and immunosuppression has broadened the spectrum of patients who can benefit from intestinal transplant, including both IIT and MVT. The expansion of indications offers hope to patients with complex gastrointestinal disorders. The detection of donor-specific antibodies in graft assessment advances diagnostic accuracy, ultimately improving patient outcomes.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"88-96"},"PeriodicalIF":2.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71411062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hemodynamic monitoring in liver transplantation 'the hemodynamic system'. 肝移植血流动力学监测“血流动力学系统”。
IF 2.2 4区 医学
Current Opinion in Organ Transplantation Pub Date : 2024-02-01 Epub Date: 2023-11-30 DOI: 10.1097/MOT.0000000000001125
Sherif Kandil, Ashraf Sedra
{"title":"Hemodynamic monitoring in liver transplantation 'the hemodynamic system'.","authors":"Sherif Kandil, Ashraf Sedra","doi":"10.1097/MOT.0000000000001125","DOIUrl":"10.1097/MOT.0000000000001125","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this article is to provide a comprehensive review of hemodynamic monitoring in liver transplantation.</p><p><strong>Recent findings: </strong>Radial arterial blood pressure monitoring underestimates the aortic root arterial blood pressure and causes excessive vasopressor and worse outcomes. Brachial and femoral artery monitoring is well tolerated and should be considered in critically ill patients expected to be on high dose pressors. The pulmonary artery catheter is the gold standard of hemodynamic monitoring and is still widely used in liver transplantation; however, it is a highly invasive monitor with potential for serious complications and most of its data can be obtained by other less invasive monitors. Rescue transesophageal echocardiography relies on few simple views and should be available as a standby to manage sudden hemodynamic instability. Risk of esophageal bleeding from transesophageal echocardiography in liver transplantation is the same as in other patient populations. The arterial pulse waveform analysis based cardiac output devices are minimally invasive and have the advantage of real-time beat to beat monitoring of cardiac output. No hemodynamic monitor can improve clinical outcomes unless integrated into a goal-directed hemodynamic therapy. The hemodynamic monitoring technique should be tailored to the patient's medical status, surgical technique, and the anesthesiologist's level of expertise.</p><p><strong>Summary: </strong>The current article provides a review of the current hemodynamic monitoring systems and their integration in goal-directed hemodynamic therapy.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"72-81"},"PeriodicalIF":2.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138458475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pushing the limits of treatment for hepatocellular carcinoma. 推动肝细胞癌治疗的极限。
IF 2.2 4区 医学
Current Opinion in Organ Transplantation Pub Date : 2024-02-01 Epub Date: 2023-11-30 DOI: 10.1097/MOT.0000000000001123
Michelle Jones-Pauley, David W Victor, Sudha Kodali
{"title":"Pushing the limits of treatment for hepatocellular carcinoma.","authors":"Michelle Jones-Pauley, David W Victor, Sudha Kodali","doi":"10.1097/MOT.0000000000001123","DOIUrl":"10.1097/MOT.0000000000001123","url":null,"abstract":"<p><strong>Purpose of review: </strong>We review existing and newer strategies for treatment and surveillance of hepatocellular carcinoma (HCC) both pre and postliver transplantation.</p><p><strong>Summary: </strong>HCC is rising in incidence and patients are often diagnosed at later stages. Consequently, there is a need for treatment strategies which include collaboration of multiple specialties. Combinations of locoregional, systemic, and surgical therapies are yielding better postliver transplantation (post-LT) outcomes for patients with HCC than previously seen. Tumor biology (tumor size, number, location, serum markers, response to therapy) can help identify patients who are at high risk for HCC recurrence posttransplantation and may expand transplant eligibility for some patients.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"3-9"},"PeriodicalIF":2.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138458477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Molecular profiling in the management of hepatocellular carcinoma. 分子分析在肝细胞癌治疗中的应用。
IF 2.2 4区 医学
Current Opinion in Organ Transplantation Pub Date : 2024-02-01 Epub Date: 2023-12-01 DOI: 10.1097/MOT.0000000000001124
Nadine Soliman, Ashish Saharia, Maen Abdelrahim, Ashton A Connor
{"title":"Molecular profiling in the management of hepatocellular carcinoma.","authors":"Nadine Soliman, Ashish Saharia, Maen Abdelrahim, Ashton A Connor","doi":"10.1097/MOT.0000000000001124","DOIUrl":"10.1097/MOT.0000000000001124","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this review is to both summarize the current knowledge of hepatocellular carcinoma molecular biology and to suggest a framework in which to prospectively translate this knowledge into patient care. This is timely as recent guidelines recommend increased use of these technologies to advance personalized liver cancer care.</p><p><strong>Recent findings: </strong>The main themes covered here address germline and somatic genetic alterations recently discovered in hepatocellular carcinoma, largely owing to next generation sequencing technologies, and nascent efforts to translate these into contemporary practice.</p><p><strong>Summary: </strong>Early efforts of translating molecular profiling to hepatocellular carcinoma care demonstrate a growing number of potentially actionable alterations. Still lacking are a consensus on what biomarkers and technologies to adopt, at what scale and cost, and how to integrate them most effectively into care.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"10-22"},"PeriodicalIF":2.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138458476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Optimizing the prelung transplant candidate. 优化肺移植前候选者。
IF 2.2 4区 医学
Current Opinion in Organ Transplantation Pub Date : 2024-02-01 Epub Date: 2023-11-07 DOI: 10.1097/MOT.0000000000001116
John Pagteilan, Scott Atay
{"title":"Optimizing the prelung transplant candidate.","authors":"John Pagteilan, Scott Atay","doi":"10.1097/MOT.0000000000001116","DOIUrl":"10.1097/MOT.0000000000001116","url":null,"abstract":"<p><strong>Purpose of review: </strong>Lung transplant outcomes are impacted by multiple modifiable risk factors. Candidate deterioration on the wait list remains problematic. Innovative technology and strategies to identify and impact pretransplant morbidity have improved short- and long-term outcomes. We focus our review on recent advances in pretransplant recipient assessment and optimization.</p><p><strong>Recent findings: </strong>Advancements in recipient management have focused on risk factor identification for adverse outcomes and the development of a lung transplant specific frailty assessment. Early surgical correction of gastroesophageal reflux disease (GERD), including the use of partial fundoplication in the setting of esophageal dysmotility, leads to improvements in graft function/longevity. New evidence supports expanding criteria for extracorporeal life support as a bridge to transplant.</p><p><strong>Summary: </strong>Candidate optimization requires early intervention to limit functional deterioration potentially contributing to adverse outcomes. Frailty can be identified with a transplant specific frailty assessment, and positively impacted with dedicated rehabilitation. Pretransplant frailty is reversible following transplant and should be considered in the context of overall fitness at the time of candidate selection. Invasive support modes including extracorporeal membrane oxygenation (ECMO) are appropriate to preserve strength and mobility, with awake, ambulatory ECMO preferred. The deleterious effect of GERD on graft function can be managed with early fundoplication over medical management alone.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"37-42"},"PeriodicalIF":2.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71479206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ethical issues in solid organ transplantation: transfusion-free transplantation in Jehovah's witness patients. 实体器官移植的伦理问题：耶和华见证人患者的无输血移植。
IF 2.2 4区 医学
Current Opinion in Organ Transplantation Pub Date : 2024-02-01 Epub Date: 2023-12-06 DOI: 10.1097/MOT.0000000000001128
Rick Selby, Taylor Selby-Medical, Michael Richman
{"title":"Ethical issues in solid organ transplantation: transfusion-free transplantation in Jehovah's witness patients.","authors":"Rick Selby, Taylor Selby-Medical, Michael Richman","doi":"10.1097/MOT.0000000000001128","DOIUrl":"10.1097/MOT.0000000000001128","url":null,"abstract":"<p><strong>Purpose of review: </strong>Jehovah's Witnesses do not accept transfusion of major allogeneic blood fractions. Successful solid organ transplantation is challenging for Jehovah's Witnesses when anemia, coagulation disturbances, and difficult technical aspects co-exist, and key blood bank resources cannot be utilized. Organ availability for transplantation is limited and demand exceeds supply for all organ types. Historically, the likelihood of poor outcomes in Jehovah's Witnesses patients placed ethical limitations on transplant candidacy for this population violating the precept of maximal utilization of a limited resource. The review's purpose is to describe advancements and strategies that make Jehovah's Witnesses transplant outcomes comparable to transfusion-eligible patients and allay the ethical concerns of their candidacy.</p><p><strong>Recent findings: </strong>Immunomodulation from allogeneic transfusion is a cause of significant postop morbidity. Blood conservation strategies have led to improved outcomes across different medical and surgical cohorts and set the stage for expanded utility in Jehovah's Witnesses with organ insufficiency.Published single-center series with descriptions of specific peri-operative strategies describe the path to major blood product avoidance.</p><p><strong>Summary: </strong>Comparable outcomes in solid organ transplantation for Jehovah's Witnesses without allogeneic transfusion are possible when inclusion-exclusion criteria are respected, and blood conservation strategies employed.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"82-87"},"PeriodicalIF":2.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138486947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Transplantation for colorectal liver metastasis. 大肠癌肝转移的移植治疗。
IF 2.2 4区 医学
Current Opinion in Organ Transplantation Pub Date : 2024-02-01 Epub Date: 2023-11-23 DOI: 10.1097/MOT.0000000000001126
Pål-Dag Line, Svein Dueland
{"title":"Transplantation for colorectal liver metastasis.","authors":"Pål-Dag Line, Svein Dueland","doi":"10.1097/MOT.0000000000001126","DOIUrl":"10.1097/MOT.0000000000001126","url":null,"abstract":"<p><strong>Purpose of review: </strong>Liver transplantation has emerged as a possible treatment for selected patients with nonresectable colorectal liver metastasis, but controversy still exists regarding optimal selection criteria and acceptable outcomes.</p><p><strong>Recent findings: </strong>Univariate analysis in the largest cohorts confirms that metachronous disease, Oslo score = 0-1, metabolic tumor volume (MTV) less than 70 cm 3 , and tumor burden score less than 9 are positive predictive factors for good overall survival outcomes. Some recent trials might suggest that technical resectability is not a valid exclusion criterion for patients with high tumor load and favorable prognostic scores in the transplant evaluation. Recent developments in circulation DNA technology and liquid biopsy may play a future role in the selection and monitoring of patients.</p><p><strong>Summary: </strong>Evaluation for transplant needs multidisciplinary involvement and should not be delayed until the failure of conventional oncological therapy. Larger data sets are needed to refine the selection criteria for liver transplantation in colorectal liver metastasis (CRLM).</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"23-29"},"PeriodicalIF":2.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10763714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138298616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Enhanced recovery after surgery for liver transplantation: a review of recent literature. 肝移植术后恢复增强：近期文献综述。
IF 2.2 4区 医学
Current Opinion in Organ Transplantation Pub Date : 2024-02-01 Epub Date: 2023-11-08 DOI: 10.1097/MOT.0000000000001117
Cara E Crouch, Erin Stewart, Adrian Hendrickse
{"title":"Enhanced recovery after surgery for liver transplantation: a review of recent literature.","authors":"Cara E Crouch, Erin Stewart, Adrian Hendrickse","doi":"10.1097/MOT.0000000000001117","DOIUrl":"10.1097/MOT.0000000000001117","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review was created to highlight important articles from the past year related to the evolving field of enhanced recovery after surgery (ERAS) in liver transplantation that are relevant to the transplant anesthesiologist.</p><p><strong>Recent findings: </strong>The International Liver Transplantation Society (ILTS) recently completed a landmark project, the ERAS4OLT.org project, which culminated in 80 recommendations for ERAS in liver transplantation. These recommendations encompass management for deceased donor recipients, living donor recipients and living donors. This review highlights selected articles relevant to the perioperative management of deceased donor liver transplant recipients.</p><p><strong>Summary: </strong>Though, there are now published internationally agreed upon recommendations for ERAS topics specific to liver transplantation, there is an obvious need for further investigation into this area to provide high quality evidence to support these recommendations. It is reasonable to utilize these recommendations in ERAS protocols for individual institutions; however, more evidence is needed in several areas to confirm the effects of these protocols on short-term outcomes.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"64-71"},"PeriodicalIF":2.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71479205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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