Summary Background The importance of primary biliary cholangitis as an indication for liver transplantation has probably been influenced by the introduction of therapies, and changes in selection criteria and disease epidemiology. Aims To assess the time trends in liver transplantation for primary biliary cholangitis and to evaluate the characteristics of the patient population during the past three decades. Methods Patients undergoing liver transplantation from 1986 to 2015 in centres reporting to the European Liver Transplantation Registry were included. We excluded combined organ transplantations and patients <18 years. Trends were assessed using linear regression models. Results We included 112 874 patients, of whom 6029 (5.3%) had primary biliary cholangitis. After an initial increase in the first decade, the annual number of liver transplantation for primary biliary cholangitis remained stable at around 200. The proportion of liver transplantations for primary biliary cholangitis decreased from 20% in 1986 to 4% in 2015 ( P < 0.001). Primary biliary cholangitis was the only indication showing a consistent proportional decrease throughout all decades. From the first to the third decade, the age at liver transplantation increased from 54 (IQR 47‐59) to 56 years (IQR 48‐62) and the proportion of males increased from 11% to 15% (both P < 0.001). Conclusions We have found a proportional decrease in primary biliary cholangitis as indication for liver transplantation. However, despite treatment with ursodeoxycholic acid and improved disease awareness, the absolute annual number of liver transplantations has stabilised.

Ursodeoxycholic acid

Primary Biliary Cirrhosis

Primary Sclerosing Cholangitis

Liver disease

10.1111/apt.15060

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CORRELATION BETWEEN INTRAOPERATIVE RBC, FFP, PLATELET AND RECOMBINANT ACTIVATED FACTOR VII TRANSFUSION AND SURVIVAL AFTER LIVER TRANSPLANTATION

Transplantation (2008)

Waldemar Patkowski Krzysztof Zieniewicz P Nyckowski Marek Krawczyk

Platelet Transfusion

10.1097/01.tp.0000330755.60157.5e

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Liver transplantation for patients with acute-on-chronic liver failure (ACLF) in Europe: Results of the ELITA/EF-CLIF collaborative study (ECLIS)

Journal of Hepatology (2021)

L Belli Christophe Duvoux Thierry Artzner William Bernal Sara Conti

Renal replacement therapy

10.1016/j.jhep.2021.03.030

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Citations (137)

Next-generation sequencing of bile cell-free DNA for the early detection of patients with malignant biliary strictures

Gut (2021)

María Arechederra María Rullán Irene Amat Daniel Oyón Lucía Zabalza

Objective Despite significant progresses in imaging and pathological evaluation, early differentiation between benign and malignant biliary strictures remains challenging. Endoscopic retrograde cholangiopancreatography (ERCP) is used to investigate biliary strictures, enabling the collection of bile. We tested the diagnostic potential of next-generation sequencing (NGS) mutational analysis of bile cell-free DNA (cfDNA). Design A prospective cohort of patients with suspicious biliary strictures (n=68) was studied. The performance of initial pathological diagnosis was compared with that of the mutational analysis of bile cfDNA collected at the time of first ERCP using an NGS panel open to clinical laboratory implementation, the Oncomine Pan-Cancer Cell-Free assay. Results An initial pathological diagnosis classified these strictures as of benign (n=26), indeterminate (n=9) or malignant (n=33) origin. Sensitivity and specificity of this diagnosis were 60% and 100%, respectively, as on follow-up 14 of the 26 and eight of the nine initially benign or indeterminate strictures resulted malignant. Sensitivity and specificity for malignancy of our NGS assay, herein named Bilemut, were 96.4% and 69.2%, respectively. Importantly, one of the four Bilemut false positives developed pancreatic cancer after extended follow-up. Remarkably, the sensitivity for malignancy of Bilemut was 100% in patients with an initial diagnosis of benign or indeterminate strictures. Analysis of 30 paired bile and tissue samples also demonstrated the superior performance of Bilemut. Conclusion Implementation of Bilemut at the initial diagnostic stage for biliary strictures can significantly improve detection of malignancy, reduce delays in the clinical management of patients and assist in selecting patients for targeted therapies.

Cell-free fetal DNA

10.1136/gutjnl-2021-325178

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Citations (58)

P1704POST-TRANSPLANTATION LYPMHOPROLIFERATIVE DISORDER (PTLD) RISK AND PROGNOSTIC FACTORS IN KIDNEY AND LIVER TRANSPLANT RECIPIENTS

Nephrology Dialysis Transplantation (2020)

Rafał Staros Bartosz Foroncewicz Krzysztof Zieniewicz Maciej Kosieradzki Sławomir Nazarewski

Abstract Background and Aims Post-transplantation lymphoprolipherative disorder [PTLD] is a serious, potentially fatal complication of transplantation [Tx], pathogenesis of which remains to be fully understood. Due to the intrinsic difficulty of assembling a large cohort of rare disease patients, most research papers have investigated PTLD in the general graft recipient population. They report however, that the relative risk of disease development significantly varies in relation to the type of transplanted organ, with multiorgan and intestinal graft recipients possessing the highest risk (RR=239.5), liver (RR=29.9) and the lowest for kidney transplant recipients (RR=12.6). The aim of this study was to investigate the factors contributing to the development, course, treatment and outcomes of PTLD and compare their impact on the populations of liver [LTR] and kidney [KTR] transplant recipients. Method In this retrospective cohort study we have included all KTRs and LTRs diagnosed with PTLD at our centres between 2002 and 2017. The following data were collected from the patients’ medical records: immunosuppression (IS), viral infections, PTLD type, treatment and outcomes. Mann-Whitney U-test was used to assess the differences in group composition, and the Log-rank test was used to compare Kaplan-Meier curves. Statistical analysis was performed in R version 3.2.3., p-values below .05 were considered statistically significant. Results We have identified 23 LTR and 16 KTR who matched our inclusion criteria. The mean age was 40.69 years. 61.5% of the patients were male, 38.5% female. Analysis of Kaplan-Meier curves revealed that PTLD occurred earlier in: LTRs (p<.001); patients above the median age of 45 years at Tx (p=.002); patients whose IS regimens at the time of PTLD diagnosis contained tacrolimus [TAC] (p<.001) or did not contain cyclosporin [CsA]. Among KTRs PTLD was diagnosed earlier in males (p<0.05), patients over 45 years at Tx (p<0.05), and those receiving TAC-containing IS regimens at PTLD diagnosis (p<0.05). These factors were not statistically significant for LTRs, among whom PTLD development was affected by the presence of MMF in IS regimens at diagnosis (p<0.05). Survival time was longer for patients receiving MMF-containing IS regimens (p<0.05). LTRs were more likely than KTRs to achieve complete remission in response to treatment (p<0.05). Conclusion Our results indicate, that in comparable KTR and LTR populations, the course of PLTD and response to treatment vary significantly. Factors such as patients’ age at transplantation, sex, type of maintenance IS have a different impact depending on graft type. In our opinion these findings, when applied to further research, could enhance our ability to identify patients at risk and potentially lead to the formation of more personalised guidelines to the diagnosis and treatment of PTLD.

Immunosuppression

10.1093/ndt/gfaa142.p1704

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Viruses in transplantology

Polskie Archiwum Medycyny Wewnętrznej (2019)

Krzysztof Mucha Bartosz Foroncewicz Alicja Dębska‐Ślizień Magdalena Durlik Ryszard Grenda

The 3 leading causes of death in patients after solid organ transplantation (SOT) include cardiovascular diseases, malignancies, and infections. According to our current understanding, the latter play the key role in the pathogenesis of atherosclerosis. Similarly, infections (mainly viral) are implicated in the pathogenesis of at least 20% of known neoplasms. In other words, the implications of acute and chronic infectious diseases in modern medicine, not only transplantology, are significant and ever‑increasing. Immunosuppressive treatment impairs the immune function, which renders the patient more susceptible to infections. Furthermore, treatment of infections in immunocompromised patients poses a challenge and SOT. The current publication provides a brief summary of the key information provided in 20 lectures on viral infections in patients after SOT delivered during the 9th Practical Transplantology Course in Warsaw, Poland on September 15-16, 2017.

Pathogenesis

10.20452/pamw.15012

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Citations (1)