Journal of Clinical Medicine

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Dear Colleagues,

Liver transplantation is one of the main treatments for end-stage liver disease and has made significant progress in recent years. The introduction of new surgical techniques, immunosuppressive drugs, and organ preservation methods has improved the success and survival rates of liver transplantation. However, the problem of donor shortage still exists, and the long-term use of immunosuppressive drugs may lead to side effects and complications. In addition, postoperative care and complication management are critical to patient recovery and survival. This Special Issue will summarize improvements in liver transplantation techniques, donor shortage issues, immunosuppression and rejection, and postoperative care and complication management.

This Special Issue aims to promote scholarly communication and provide valuable information to physicians, researchers, and patients. We invite researchers working in the field of liver transplantation and related areas to submit their findings as original articles or reviews to this Special Issue.

Dr. Paolo De Simone
Guest Editor

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Keywords

liver transplantation
end-stage liver disease
organ preservation
transplant rejection
post-transplantation
immunotolerance
perioperative care

Published Papers (2 papers)

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14 pages, 1845 KiB

Open AccessCase Report

Utilization of Immunotherapy as a Neoadjuvant Therapy for Liver Transplant Recipients with Hepatocellular Carcinoma

by Maen Abdelrahim, Abdullah Esmail, Mukul K. Divatia, Jiaqiong Xu, Sudha Kodali, David W. Victor, Elizabeth Brombosz, Ashton A. Connor, Ashish Saharia, Ahmed Elaileh, Ahmed O. Kaseb and Rafik Mark Ghobrial

J. Clin. Med. 2024, 13(11), 3068; https://doi.org/10.3390/jcm13113068 - 24 May 2024

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Abstract

Background: Hepatocellular carcinoma (HCC) is widely recognized as the predominant type of primary liver malignancy. Orthotopic liver transplantation (OLT) has emerged as a highly effective treatment option for unresectable HCC. Immunotherapies as neoadjuvant options are now being actively investigated in the transplant oncology era to enhance outcomes in patients with HCC. Here, we report our experience with patients with HCC who had received Immune Checkpoint Inhibitors (ICPI) prior to curative OLT. Methods: This was a retrospective cohort that included patients with HCC who received ICPI prior to OLT at a single institution from January 2019 to August 2023. Graft rejection was assessed and reported along with the type of ICPI, malignancy treated, and the timing of ICPI in association with OLT. Results: During this cohort period, six patients with HCC underwent OLT after neoadjuvant ICPI. All patients were male with a median age of 61 (interquartile range: 59–64) years at OLT. Etiology associated with HCC was viral (N = 4) or Non-alcoholic steatohepatitis, NASH (N = 2). Tumor focality was multifocal (N = 4) and unifocal (N = 2). Lymphovascular invasion was identified in four patients. No perineural invasion was identified in any of the patients. All patients received ICPI including atezolizumab/bevacizumab (N = 4), nivolumab/ipilimumab (N = 1), and nivolumab as monotherapy (N = 1). All patients received either single or combined liver-directed/locoregional therapy, including transarterial chemoembolization (TACE), Yttrium-90 (Y90), stereotactic body radiotherapy (SBRT), and radiofrequency ablation (RFA). The median washout period was 5 months. All patients responded to ICPI and achieved a safe and successful OLT. All patients received tacrolimus plus mycophenolate as immunosuppressant (IS) therapy post-OLT and one patient received prednisone as additional IS. No patient had clinical evidence of rejection. Conclusions: This cohort emphasizes the success of tumor downstaging by ICPI for OLT when employed as the neoadjuvant therapy strategy. In addition, this study illustrated the importance of timing for the administration of ICPI before OLT. Given the lack of conclusive evidence in this therapeutic area, we believe that our study lays the groundwork for prospective trials to further examine the impact of ICPI prior to OLT. Full article

(This article belongs to the Special Issue Developments and Challenges in Liver Transplantation)

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11 pages, 1133 KiB

Open AccessCase Report

Blood Purification in Hepatic Dysfunction after Liver Transplant or Extensive Hepatectomy: Far from the Best-Case Scenarios

by Rita Gaspari, Paola Aceto, Giorgia Spinazzola, Edoardo Piervincenzi, Maurizio Chioffi, Felice Giuliante, Massimo Antonelli and Alfonso Wolfango Avolio

J. Clin. Med. 2024, 13(10), 2853; https://doi.org/10.3390/jcm13102853 - 12 May 2024

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Abstract

Background: Hepatic dysfunction (HD) after liver transplantation (LT) or extended hepatic resection (EHR) is associated with graft failure and high short-term mortality. We evaluated the safety and depurative efficacy of CytoSorb® in these settings. The primary endpoint was the change in serum total bilirubin at the end of the treatment compared to the baseline value. The secondary endpoint was to evaluate the trend of serum total bilirubin and coagulation parameters up to 72 h after discontinuation of CytoSorb®. The effects of CytoSorb® therapy on the degree of hepatic encephalopathy (HE), Sequential Organ Failure Assessment (SOFA), and Model for End-Stage Liver Disease (MELD) scores as well as the hemodynamic status compared to baseline were also assessed. Methods: Adult patients with a serum total bilirubin level > 10 mg/dL admitted to the Intensive Care Unit were included. Exclusion criteria were hemodynamic instability, postoperative bleeding and platelet count < 20,000/mm3. Results: Seven patients were treated. Serum total bilirubin was significantly reduced at the end of treatment. However, seventy-two hours after the discontinuation of extracorporeal therapy, bilirubin levels returned to baseline levels in four patients. A decrease in platelet count was found during therapy, and platelet transfusion was required in six cases. A significant increase in D-dimer at the end of treatment was detected. HE degree, SOFA and MELD scores remained stable, while a deterioration in hemodynamic status was observed in two cases. Conclusions: Our preliminary findings did not show the possible benefits of CytoSorb^® in rebalancing clinical and laboratory parameters in patients with HD after LT or EHR. Full article

(This article belongs to the Special Issue Developments and Challenges in Liver Transplantation)

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