Asunto(s)
Trasplante de Hígado , Listas de Espera , Humanos , Trasplante de Hígado/estadística & datos numéricos , Trasplante de Hígado/normas , Listas de Espera/mortalidad , Masculino , Femenino , Persona de Mediana Edad , Enfermedad Hepática en Estado Terminal/cirugía , Enfermedad Hepática en Estado Terminal/mortalidad , Centros Médicos Académicos/estadística & datos numéricos , Centros Médicos Académicos/organización & administración , Selección de Paciente , Estudios Retrospectivos , Adulto , Instituciones de Atención Ambulatoria/organización & administración , Instituciones de Atención Ambulatoria/estadística & datos numéricos , AncianoAsunto(s)
Accesibilidad a los Servicios de Salud , Trasplante de Hígado , Trasplante de Hígado/normas , Trasplante de Hígado/métodos , Trasplante de Hígado/estadística & datos numéricos , Humanos , Accesibilidad a los Servicios de Salud/organización & administración , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Enfermedad Hepática en Estado Terminal/cirugía , Enfermedad Hepática en Estado Terminal/mortalidad , Instituciones de Atención Ambulatoria/organización & administración , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Instituciones de Atención Ambulatoria/normas , Comercialización de los Servicios de Salud/métodos , Comercialización de los Servicios de Salud/organización & administración , Listas de EsperaAsunto(s)
Accesibilidad a los Servicios de Salud , Trasplante de Hígado , Trasplante de Hígado/normas , Trasplante de Hígado/estadística & datos numéricos , Trasplante de Hígado/métodos , Humanos , Accesibilidad a los Servicios de Salud/organización & administración , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/normas , Instituciones de Atención Ambulatoria/organización & administración , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Instituciones de Atención Ambulatoria/normas , Enfermedad Hepática en Estado Terminal/cirugía , Enfermedad Hepática en Estado Terminal/mortalidad , Listas de Espera/mortalidadRESUMEN
OBJECTIVES: to evaluate the impact of educational intervention on understanding health recommendations after liver transplantation. METHODS: randomized and prospective clinical trial, with 68 liver transplant recipients in two institutions. The level of understanding was assessed using a statement agreement scale and the understanding score was classified. Chi-square test was used to compare groups. RESULTS: the level of understanding was reasonable in 77.9% of patients, 73.5% in the Control Group and 82.3% in the Intervention Group (p=0.399). For topics covered after educational action, there were more than 80% correct answers regarding nutrition, frequent hydration, usage and function of immunosuppressants. However, there were less than 10% correct answers regarding hand hygiene, contact with animals and crowds of people. The use of the patient's audio, visual and tactile resources led to improved understanding of skin care (p=0.014). CONCLUSIONS: the level of understanding acquired regarding health recommendations was only reasonable.
Asunto(s)
Trasplante de Hígado , Humanos , Trasplante de Hígado/métodos , Trasplante de Hígado/normas , Masculino , Femenino , Estudios Prospectivos , Persona de Mediana Edad , Adulto , Educación del Paciente como Asunto/métodos , Educación del Paciente como Asunto/normas , AncianoRESUMEN
Health care transition (HCT) is a vulnerable period that continues into adulthood, even after the transfer of care. Given the growing population of pediatric liver transplant recipients reaching young adulthood, the need for a standardized and multidisciplinary approach to transition that spans from pediatric to adult care is becoming more imperative. In this article, we review the unique challenges and barriers to successful HCT that adolescent and young adults (AYAs) who have undergone liver transplant face, highlight the gap in transition care in the adult setting, and present the Six Core Elements of Health Care Transition TM as a framework that can be used by adult providers to incorporate AYAs systematically and collaboratively into adult practice. Multidisciplinary HCT programs should be the standard of care for all AYAs with liver transplant, and while implementation is a necessary first step, ongoing efforts to increase awareness, funding, and research on HCTs into adulthood are needed.
Asunto(s)
Trasplante de Hígado , Transición a la Atención de Adultos , Humanos , Trasplante de Hígado/normas , Trasplante de Hígado/efectos adversos , Trasplante de Hígado/estadística & datos numéricos , Transición a la Atención de Adultos/organización & administración , Transición a la Atención de Adultos/normas , Adolescente , Adulto Joven , Receptores de Trasplantes/estadística & datos numéricos , Niño , Adulto , Factores de EdadAsunto(s)
Quistes , Enfermedad Hepática en Estado Terminal , Hepatopatías , Trasplante de Hígado , Humanos , Trasplante de Hígado/normas , Hepatopatías/terapia , Hepatopatías/diagnóstico , Quistes/diagnóstico , Quistes/terapia , Enfermedad Hepática en Estado Terminal/cirugía , Enfermedad Hepática en Estado Terminal/mortalidad , Enfermedad Hepática en Estado Terminal/diagnóstico , Índice de Severidad de la Enfermedad , Listas de Espera/mortalidad , Obtención de Tejidos y Órganos/normas , Obtención de Tejidos y Órganos/métodos , Obtención de Tejidos y Órganos/organización & administración , Estados Unidos/epidemiologíaRESUMEN
Transjugular intrahepatic portosystemic shunt (TIPS) has become essential in the treatment or prevention of portal hypertension-related complications. In the early 1990s, the primary indication was refractory bleeding. It is now proposed for the treatment of ascites for the prevention of bleeding and in patients with vascular diseases of the liver. Thus, there are a growing number of patients being treated with TIPS all over the world. The broadening of indications, the involvement of multiple stakeholders, the need for an accurate selection, the positioning in relation to transplantation and the lack of standardization in pre-therapeutic assessment, in the procedure itself and in the follow-up have led the board of the French Association for the Study of the Liver to establish recommendations.
Asunto(s)
Hipertensión Portal , Derivación Portosistémica Intrahepática Transyugular , Humanos , Hipertensión Portal/terapia , Hipertensión Portal/cirugía , Francia , Cirrosis Hepática/cirugía , Cirrosis Hepática/complicaciones , Ascitis/terapia , Ascitis/etiología , Várices Esofágicas y Gástricas/cirugía , Várices Esofágicas y Gástricas/etiología , Selección de Paciente , Hemorragia Gastrointestinal/prevención & control , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Trasplante de Hígado/normasAsunto(s)
Trasplante de Hígado , Trasplante de Hígado/tendencias , Trasplante de Hígado/estadística & datos numéricos , Trasplante de Hígado/normas , Humanos , Estados Unidos , Enfermedad Hepática en Estado Terminal/cirugía , Enfermedad Hepática en Estado Terminal/mortalidad , Obtención de Tejidos y Órganos/estadística & datos numéricos , Obtención de Tejidos y Órganos/tendencias , Obtención de Tejidos y Órganos/organización & administración , Optimismo , PredicciónRESUMEN
In the United States, the discrepancy between organ availability and need has persisted despite changes in allocation, innovations in preservation, and policy initiatives. Living donor liver transplant remains an underutilized means of improving access to timely liver transplantation and decreasing waitlist mortality. Liver paired exchange (LPE) represents an opportunity to overcome living donor liver transplant pair incompatibility due to size, anatomy, or blood type. LPE was adopted as a strategy to augment access to liver transplantation at our institution. Specific educational materials, consent forms, and selection processes were developed to facilitate LPE. From 2019 through October 2023, our center performed 11 LPEs, resulting in 23 living donor liver transplant pairs. The series included several types of LPE: those combining complementary incompatible pairs, the inclusion of compatible pairs to overcome incompatibility, and the use of altruistic nondirected donors to initiate chains. These exchanges facilitated transplantation for 23 recipients, including 1 pediatric patient. LPE improved access to liver transplantation at our institution. The ethical application of LPE includes tailored patient education, assessment and disclosure of exchange balance, mitigation of risk, and maximization of benefit for donors and recipients.
Asunto(s)
Trasplante de Hígado , Donadores Vivos , Listas de Espera , Humanos , Trasplante de Hígado/métodos , Trasplante de Hígado/normas , Donadores Vivos/provisión & distribución , Donadores Vivos/estadística & datos numéricos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Listas de Espera/mortalidad , Estados Unidos , Selección de Donante/organización & administración , Selección de Donante/normas , Selección de Donante/métodos , Obtención de Tejidos y Órganos/métodos , Obtención de Tejidos y Órganos/organización & administración , Obtención de Tejidos y Órganos/estadística & datos numéricos , Niño , Adolescente , Anciano , Adulto Joven , Enfermedad Hepática en Estado Terminal/cirugía , Enfermedad Hepática en Estado Terminal/mortalidadRESUMEN
The liver transplantation (LT) evaluation and waitlisting process is subject to variations in care that can impede quality. The American Association for the Study of Liver Diseases (AASLD) Practice Metrics Committee (PMC) developed quality measures and patient-reported experience measures along the continuum of pre-LT care to reduce care variation and guide patient-centered care. Following a systematic literature review, candidate pre-LT measures were grouped into 4 phases of care: referral, evaluation and waitlisting, waitlist management, and organ acceptance. A modified Delphi panel with content expertise in hepatology, transplant surgery, psychiatry, transplant infectious disease, palliative care, and social work selected the final set. Candidate patient-reported experience measures spanned domains of cognitive health, emotional health, social well-being, and understanding the LT process. Of the 71 candidate measures, 41 were selected: 9 for referral; 20 for evaluation and waitlisting; 7 for waitlist management; and 5 for organ acceptance. A total of 14 were related to structure, 17 were process measures, and 10 were outcome measures that focused on elements not typically measured in routine care. Among the patient-reported experience measures, candidates of LT rated items from understanding the LT process domain as the most important. The proposed pre-LT measures provide a framework for quality improvement and care standardization among candidates of LT. Select measures apply to various stakeholders such as referring practitioners in the community and LT centers. Clinically meaningful measures that are distinct from those used for regulatory transplant reporting may facilitate local quality improvement initiatives to improve access and quality of care.
Asunto(s)
Trasplante de Hígado , Listas de Espera , Humanos , Trasplante de Hígado/normas , Estados Unidos , Cuidados Preoperatorios/normas , Cuidados Preoperatorios/métodos , Técnica Delphi , Indicadores de Calidad de la Atención de SaludAsunto(s)
Enfermedad Hepática en Estado Terminal , Trasplante de Hígado , Índice de Severidad de la Enfermedad , Humanos , Trasplante de Hígado/normas , Enfermedad Hepática en Estado Terminal/cirugía , Enfermedad Hepática en Estado Terminal/mortalidad , Enfermedad Hepática en Estado Terminal/diagnóstico , Listas de Espera/mortalidadRESUMEN
Hepatorenal syndrome-acute kidney injury (HRS-AKI) is a severe complication of cirrhosis that carries a poor prognosis. The recent Food and Drug Administration approval of terlipressin has substantial implications for managing HRS-AKI and liver allocation in the United States. Terlipressin has been available in Europe for over a decade, and several countries have adapted policy changes such as Model for End-Stage Liver Disease (MELD) score "lock" for HRS-AKI. In this article, we outline the European experience with terlipressin use and explore the question of whether terlipressin treatment for HRS-AKI should qualify for the MELD score "lock" in the United States in those who respond to therapy. Arguments for the MELD lock include protecting waitlist priority for terlipressin responders or partial responders who may miss offers due to MELD reduction in the terlipressin treatment window. Arguments against MELD lock include the fact that terlipressin may produce a durable response and improve overall survival and that equitable access to terlipressin is not guaranteed due to cost and availability. We subsequently discuss the proposed next steps for studying terlipressin implementation in the United States. A successful approach will require the involvement of all major stakeholders and the mobilization of our transplant community to spearhead research in this area.
Asunto(s)
Lesión Renal Aguda , Síndrome Hepatorrenal , Trasplante de Hígado , Índice de Severidad de la Enfermedad , Terlipresina , Vasoconstrictores , Listas de Espera , Humanos , Terlipresina/uso terapéutico , Trasplante de Hígado/normas , Trasplante de Hígado/estadística & datos numéricos , Trasplante de Hígado/efectos adversos , Estados Unidos , Síndrome Hepatorrenal/etiología , Síndrome Hepatorrenal/diagnóstico , Listas de Espera/mortalidad , Vasoconstrictores/uso terapéutico , Lesión Renal Aguda/etiología , Lesión Renal Aguda/terapia , Enfermedad Hepática en Estado Terminal/cirugía , Enfermedad Hepática en Estado Terminal/mortalidad , Enfermedad Hepática en Estado Terminal/complicaciones , Cirrosis Hepática/complicaciones , Cirrosis Hepática/cirugía , Europa (Continente) , Selección de Paciente , Pronóstico , Resultado del TratamientoRESUMEN
Alcohol-associated liver disease poses a significant global health burden, with rising alcohol consumption and prevalence of alcohol use disorder (AUD) contributing to increased morbidity and mortality. This review examines the challenges and opportunities in the care of candidates and recipients of liver transplant (LT) with AUD. Despite advancements in posttransplant patient survival, the risk of disease recurrence and alcohol relapse remains substantial. Several challenges have been identified, including (1) rising disease burden of alcohol-associated liver disease, variable transplant practices, and systemic barriers; (2) disparities in mental health therapy access and the impact on transplant; (3) variable definitions, underdiagnosis, and stigma affecting access to care; and (4) post-LT relapse, its risk factors, and consequential harm. The review focuses on the opportunities to improve AUD care for candidates and recipients of LT through effective biochemical monitoring, behavioral and pharmacologic approaches, creating Centers of Excellence for post-LT AUD care, advocating for policy reforms, and ensuring insurance coverage for necessary services as essential steps toward improving patient outcomes. The review also highlights unmet needs, such as the scarcity of addiction specialists, and calls for further research on personalized behavioral treatments, digital health, and value-based care models to optimize AUD care in the LT setting.
Asunto(s)
Alcoholismo , Hepatopatías Alcohólicas , Trasplante de Hígado , Humanos , Trasplante de Hígado/efectos adversos , Trasplante de Hígado/normas , Hepatopatías Alcohólicas/cirugía , Hepatopatías Alcohólicas/terapia , Hepatopatías Alcohólicas/epidemiología , Hepatopatías Alcohólicas/diagnóstico , Hepatopatías Alcohólicas/etiología , Alcoholismo/complicaciones , Alcoholismo/terapia , Alcoholismo/epidemiología , Factores de Riesgo , Accesibilidad a los Servicios de Salud , Recurrencia , Disparidades en Atención de Salud , Prevalencia , Receptores de Trasplantes/estadística & datos numéricos , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/epidemiología , Enfermedad Hepática en Estado Terminal/cirugía , Enfermedad Hepática en Estado Terminal/diagnóstico , Enfermedad Hepática en Estado Terminal/terapia , Enfermedad Hepática en Estado Terminal/complicaciones , Enfermedad Hepática en Estado Terminal/mortalidadRESUMEN
Patients post liver transplant (LT) with progressive familial intrahepatic cholestasis type 1 (PFIC-1) often develop progressive graft steatohepatitis, intractable diarrhea, and growth failure. A total internal biliary diversion (TIBD) during an LT may prevent or reverse these adverse events. Children with PFIC-1 who underwent an LT at our institute were divided into 2 groups, A and B based on the timeline where we started offering a TIBD in association with LT. Pre-LT parameters, intraoperative details, and posttransplant complications like graft steatosis and diarrhea were also analyzed between the 2 groups, and their growth velocity was measured in the follow-up period. Of 550 pediatric LT performed between 2011 and 2022, 13 children underwent LT for PFIC-1. Group A had 7 patients (A1-A7) and group B had 6 (B1-B6). Patients A1, A4, B4, and B5 had a failed partial internal biliary diversion before offering them an LT. Patients A1, A2, and A6 in group A died in the post-LT period (2 early allograft dysfunction and 1 posttransplant lymphoproliferative disorder) whereas A3, A4, and A5 had graft steatosis in the follow-up period. A4 was offered a TIBD 4 years after LT following which the graft steatosis fully resolved. In group B, B1, B2, B5, and B6 underwent TIBD during LT, and B3 and B4 had it 24 and 5 months subsequently for intractable diarrhea and graft steatosis. None of the patients in group B demonstrated graft steatosis or diarrhea and had good growth catch-up during follow-up. We demonstrate that simultaneous TIBD in patients undergoing LT should be a standard practice as it helps dramatically improve outcomes in PFIC-1 as it prevents graft steatosis and/or fibrosis, diarrhea, and improves growth catch-up.