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Life
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New Scenarios in Liver Transplantation
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New Scenarios in Liver Transplantation

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Medical Research".

Deadline for manuscript submissions: closed (28 February 2023) | Viewed by 8069

Special Issue Editors

Prof. Dr. Laura Crocetti

E-Mail Website
Guest Editor
1. Division of Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
2. Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
Interests: interventional oncology; liver; ablation; intra-arterial; solid tumors
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Paolo De Simone

E-Mail Website
Guest Editor
Division of Hepatic Surgery and Liver Transplantation, University of Pisa Medical School Hospital, 56126 Pisa, Italy
Interests: liver transplantation; hepatocellular carcinoma; immunosuppression; hepatobiliary surgery; liver diseases; liver cancer
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Liver transplantation is the ideal clinical setting in which multiple disciplines meet: hepatologists, surgeons, diagnostic radiologists, interventional radiologists, immunologists, oncologists, anesthesiologists—to mention only some of the multiple actors that can contribute in this fascinating setting. The transplantation landscape is in continuous development, and many issues may find different answers as time pass by. This is the case, for example, for the best imaging approach for pre-transplant evaluation, or the possibility to perform immunotherapy before or after liver transplantation.

In this Special Issue of Life, a multidisciplinary panel of experts will explore multiple new scenarios in liver transplantation and will open further questions for future research.

Prof. Dr. Laura Crocetti
Prof. Dr. Paolo De Simone
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Life is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • liver transplantation
  • hepatocellular carcinoma
  • liver tumours
  • immunotherapy
  • interventional radiology

Published Papers (6 papers)

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Review

18 pages, 1988 KiB  
Review
Hepatocellular Carcinoma: Optimal Radiological Evaluation before Liver Transplantation
by Marco Dioguardi Burgio, Lorenzo Garzelli, Roberto Cannella, Maxime Ronot and Valérie Vilgrain
Life 2023, 13(12), 2267; https://doi.org/10.3390/life13122267 - 27 Nov 2023
Cited by 1 | Viewed by 1049
Abstract
Liver transplantation (LT) is the recommended curative-intent treatment for patients with early or intermediate-stage hepatocellular carcinoma (HCC) who are ineligible for resection. Imaging plays a central role in staging and for selecting the best LT candidates. This review will discuss recent developments in [...] Read more.
Liver transplantation (LT) is the recommended curative-intent treatment for patients with early or intermediate-stage hepatocellular carcinoma (HCC) who are ineligible for resection. Imaging plays a central role in staging and for selecting the best LT candidates. This review will discuss recent developments in pre-LT imaging assessment, in particular LT eligibility criteria on imaging, the technical requirements and the diagnostic performance of imaging for the pre-LT diagnosis of HCC including the recent Liver Imaging Reporting and Data System (LI-RADS) criteria, the evaluation of the response to locoregional therapy, as well as the non-invasive prediction of HCC aggressiveness and its impact on the outcome of LT. We will also briefly discuss the role of nuclear medicine in the pre-LT evaluation and the emerging role of artificial intelligence models in patients with HCC. Full article
(This article belongs to the Special Issue New Scenarios in Liver Transplantation)
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15 pages, 1706 KiB  
Review
Liver Transplantation in People Living with HIV: Still an Experimental Procedure or Standard of Care?
by Erica Nicola Lynch and Francesco Paolo Russo
Life 2023, 13(10), 1975; https://doi.org/10.3390/life13101975 - 27 Sep 2023
Viewed by 1222
Abstract
Liver transplantation (LT) is the only curative treatment for various liver diseases, including acute liver failure, end-stage liver disease, and selected unresectable liver malignancies. Combination antiretroviral therapy has improved outcomes for people living with HIV (PLWH), transforming the status of acquired immune deficiency [...] Read more.
Liver transplantation (LT) is the only curative treatment for various liver diseases, including acute liver failure, end-stage liver disease, and selected unresectable liver malignancies. Combination antiretroviral therapy has improved outcomes for people living with HIV (PLWH), transforming the status of acquired immune deficiency syndrome from a fatal disease to a chronic and manageable condition. These powerful antiviral therapies have not only increased the number of HIV+ enlisted patients by improving their survival but also made the use of HIV+ organs a viable option. In this review, we summarise current knowledge on the peculiarities of liver transplantation in PLWH. In particular, we focus on the indications, contraindications, specific considerations for treatment, and outcomes of LT in PLWH. Finally, we present available preliminary data on the use of HIV+ liver allografts. Full article
(This article belongs to the Special Issue New Scenarios in Liver Transplantation)
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16 pages, 1791 KiB  
Review
Advances and Controversies in Acute Alcohol-Related Hepatitis: From Medical Therapy to Liver Transplantation
by Giacomo Germani, Francesca D’Arcangelo, Marco Grasso and Patrizia Burra
Life 2023, 13(9), 1802; https://doi.org/10.3390/life13091802 - 24 Aug 2023
Cited by 2 | Viewed by 1060
Abstract
Alcohol-related hepatitis (AH) is a clinical syndrome characterized by recent-onset jaundice in the context of alcohol consumption. In patients with severe AH “unresponsive” to steroid therapy, mortality rates exceed 70% within six months. According to European and American guidelines, liver transplantation (LT) may [...] Read more.
Alcohol-related hepatitis (AH) is a clinical syndrome characterized by recent-onset jaundice in the context of alcohol consumption. In patients with severe AH “unresponsive” to steroid therapy, mortality rates exceed 70% within six months. According to European and American guidelines, liver transplantation (LT) may be considered in highly selected patients who do not respond to medical therapy. The aim of this narrative review is to summarize current knowledge from medical therapy to liver transplantation in acute alcohol-related hepatitis. Due to the impossibility to guarantee six-month abstinence, LT for AH is controversial. Principal concerns are related to organ scarcity in the subset of stigma of “alcohol use disorder” (AUD) and the risk of relapse to alcohol use after LT. Return to alcohol use after LT is a complex issue that cannot be assessed as a yes/no variable with heterogeneous results among studies. In conclusion, present data indicate that well-selected patients have excellent outcomes, with survival rates of up to 100% at 24 and 36 months after LT. Behavioral therapy, ongoing psychological support, and strong family support seem essential to improve long-term outcomes after LT and reduce the risk in relapse of alcohol use. Full article
(This article belongs to the Special Issue New Scenarios in Liver Transplantation)
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21 pages, 378 KiB  
Review
Evolving Landscape in Liver Transplantation for Hepatocellular Carcinoma: From Stage Migration to Immunotherapy Revolution
by Silvia Cesario, Virginia Genovesi, Francesca Salani, Enrico Vasile, Lorenzo Fornaro, Caterina Vivaldi and Gianluca Masi
Life 2023, 13(7), 1562; https://doi.org/10.3390/life13071562 - 14 Jul 2023
Cited by 1 | Viewed by 1361
Abstract
Liver transplantation (LT) represents the primary curative option for HCC. Despite the extension of transplantation criteria and conversion with down-staging loco-regional treatments, transplantation is not always possible. The introduction of new standards of care in advanced HCC including a combination of immune checkpoint [...] Read more.
Liver transplantation (LT) represents the primary curative option for HCC. Despite the extension of transplantation criteria and conversion with down-staging loco-regional treatments, transplantation is not always possible. The introduction of new standards of care in advanced HCC including a combination of immune checkpoint inhibitor-based therapies led to an improvement in response rates and could represent a promising strategy for down-staging the tumor burden. In this review, we identify reports and series, comprising a total of 43 patients who received immune checkpoint inhibitors as bridging or down-staging therapies prior to LT. Overall, treated patients registered an objective response rate of 21%, and 14 patients were reduced within the Milan criteria. Graft rejection was reported in seven patients, resulting in the death of four patients; in the remaining cases, LT was performed safely after immunotherapy. Further investigations are required to define the duration of immune checkpoint inhibitors, their minimum washout period and the LT long-term safety of this strategy. Some randomized clinical trials including immunotherapy combinations, loco-regional treatment and/or tyrosine kinase inhibitors are ongoing and will likely determine the appropriateness of immune checkpoint inhibitors’ administration before LT. Full article
(This article belongs to the Special Issue New Scenarios in Liver Transplantation)
12 pages, 1227 KiB  
Review
Interventional Approach to Portal Vein Thrombosis and Liver Transplantation: State of the Art
by Vijay Ramalingam, Lauren M. Yang, Colin J. McCarthy and Muneeb Ahmed
Life 2023, 13(6), 1262; https://doi.org/10.3390/life13061262 - 26 May 2023
Cited by 1 | Viewed by 1152
Abstract
Porto-mesenteric vein thrombosis (PVT) is a well-recognized but uncommon disease entity in patients with and without cirrhosis. Given the complexity of these patients, there are many differing treatment algorithms depending on the individual circumstances of a given patient. The focus of this review [...] Read more.
Porto-mesenteric vein thrombosis (PVT) is a well-recognized but uncommon disease entity in patients with and without cirrhosis. Given the complexity of these patients, there are many differing treatment algorithms depending on the individual circumstances of a given patient. The focus of this review is primarily patients with cirrhosis, with an emphasis on liver transplantation considerations. The presence of cirrhosis substantially affects work-up, prognosis, and management of these patients and will substantially affect the patient treatment and have additional implications for prognosis and long-term outcomes. Here, we review the incidence of portal vein thrombosis in known cirrhotic patients, medical and interventional treatment options that are currently used, and, in particular, how to approach cirrhotic patients with PVT who are awaiting liver transplantation. Full article
(This article belongs to the Special Issue New Scenarios in Liver Transplantation)
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10 pages, 1238 KiB  
Review
How to Optimize the Results of Liver Transplantation for Acute-on-Chronic Liver Failure
by Sophie-Caroline Sacleux and Faouzi Saliba
Life 2023, 13(5), 1152; https://doi.org/10.3390/life13051152 - 10 May 2023
Cited by 1 | Viewed by 1685
Abstract
Cirrhotic patients who developed a decompensation episode requiring an admission to an intensive care unit are not equal in term of prognosis. This led to the definition of a syndrome, acute-on-chronic liver failure (ACLF), marked by the severity of systemic inflammation, the development [...] Read more.
Cirrhotic patients who developed a decompensation episode requiring an admission to an intensive care unit are not equal in term of prognosis. This led to the definition of a syndrome, acute-on-chronic liver failure (ACLF), marked by the severity of systemic inflammation, the development of organ failures and a high short-term mortality. The most common underlying liver etiology is related to acute alcohol hepatitis in western countries and to HBV or HCV cirrhosis in eastern countries. Twenty-eight and 90-days high mortality rates are well linked to the number of organ failure and defined, merely ten years ago, by a modified SOFA score. ACLF is a dynamic syndrome and grading can vary from hospital admission. ACLF grading between day 3–7 of admission is more accurate for determining outcome. ACLF-3 patients with ≥3 organ failures remain very challenging with >75% mortality rate. Despite recent advances in the medical management of critically ill cirrhotic patients, the prognosis of these patients remains poor. Currently, the main effective treatment is an urgent liver transplantation (LT) which is performed in a very selected patients eligible to transplant given the limited availability of organ donors and the low post-transplant survival rates reported in earlier studies. Recently, large retrospective multicenter studies and registries showed an improved 1-year post-transplant survival rate >83% in several transplant centers. Nevertheless, only few proportions of the ACLF-2 and ACLF-3 patients are transplanted representing 0–10% of most liver transplant programs. A careful selection of these patients (excluding major comorbidities i.e., older age, addictology criteria, severe malnutrition…) and optimal timing for transplant (infection control, hemodynamic stability, low oxygen and vasopressor requirements) are associated with excellent post-transplant survival rate. Full article
(This article belongs to the Special Issue New Scenarios in Liver Transplantation)
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