ABSTRACT
INTRODUCTION AND OBJECTIVES: Fatty liver disease (FLD) may develop in liver transplant recipients. We investigated the recipient and donor risk factors for FLD development after liver transplantation (LT). METHODS: A total of 108 liver transplant recipients (54 men [50.0%]; median age, 52 [20-68] years) treated from 2011-2020 was enrolled. Three recipients died at < 3 months as a result of infection or blood flow impairment, and were excluded from the long-term FLD study. On evaluation of 88 prospective living donors, fatty liver was observed in 21. The prevalence and risk factors for FLD and survival were evaluated. RESULTS: After LT, 28 of 105 recipients (26.7%) developed FLD. FLD was more common in patients with a high body mass index (BMI) and dyslipidemia (both p < 0.01), primary nonalcoholic steatohepatitis (p = 0.02), after living-donor LT (p = 0.03) and everolimus (EVL) use (p = 0.08). Factors predictive of FLD included EVL use and a high BMI (hazard ratios = 3.00 and 1.34; p = 0.05 and p < 0.01, respectively). Sixteen donors lost 6.5 kg (range: 2.0-16.0 kg) of body weight prior to LT. However, there were no cases of primary non-function, which did not affect the FLD prevalence. Development of FLD did not have a negative impact on LT outcome; the 5-year survival rate was 92.6%. CONCLUSIONS: Recipient factors were more important than donor factors for FLD onset after LT.
Subject(s)
Liver Transplantation , Non-alcoholic Fatty Liver Disease , Female , Humans , Liver Transplantation/adverse effects , Living Donors , Male , Middle Aged , Non-alcoholic Fatty Liver Disease/diagnosis , Non-alcoholic Fatty Liver Disease/epidemiology , Non-alcoholic Fatty Liver Disease/etiology , Prevalence , Prospective Studies , Retrospective Studies , Risk Factors , Tissue Donors , Treatment OutcomeABSTRACT
BACKGROUND/PURPOSE: Graft survival is affected by various factors, such as preoperative state and the ages of the recipient and donor, as well as graft size. The objective of this study was to analyze the risk factors for graft survival. METHODS: From September 1997 to July 2005, 24 patients who had undergone living-donor liver transplantation (LDLT) were retrospectively analyzed. Sixteen patients survived and the eight graft-loss cases were classified into two groups according to the cause of graft loss: graft dysfunction without major post-transplantation complications (graft dysfunction group; n = 3), and graft dysfunction with such complications (secondary graft dysfunction group; n = 5). Various factors were compared between these groups and the survival group. RESULTS: Mean donor age was 31.9 years in the survival group and 49.2 years in the secondary graft dysfunction group (P = 0.024). Graft weight/recipient standard liver volume ratios (G/SLVs) were 36.7% in the survival group, and 26.2% in the graft dysfunction group (P = 0.037). The postoperative mean PT% for 1 week was 48.6% in the survival group and 38.1% in the secondary graft dysfunction group (P = 0.05). CONCLUSIONS: Our surgical results demonstrated that G/SLV and donor age were independent factors that affected graft survival rates.
Subject(s)
Graft Survival , Hepatectomy/methods , Liver Transplantation , Living Donors , Adult , Age Factors , Aged , Chi-Square Distribution , Graft Rejection , Humans , Middle Aged , Postoperative Care , Postoperative Complications , Prognosis , Proportional Hazards Models , Retrospective Studies , Risk Factors , Treatment OutcomeABSTRACT
A 53-year-old woman presented with a diagnosis of advanced gallbladder cancer at our hospital. She was evaluated with CT scan and given a diagnosis of Stage IVb due to the multiple lymph nodes metastases and significant invasion to the artery. However, we underwent simple cholecystectomy followed by immunotherapy that was the hope of herself and her family. The serum level of DUPAN-2 was gradually elevated to 6,800 U/mL, and the metastases to the liver were detected. After we started the dendritic cell vaccine pulsed with autologous tumor-lysate with S-1, DUPAN-2 decreased to 980 U/ mL. The CT scan showed complete response (CR) in the liver metastases and partial response (PR) in the lymph node metastases. However, the serum level of CEA elevated since the MUC-1 peptide was used instead of autologous tumor- lysate, even DUPAN-2 did not. The liver metastases were in control, but the lymph nodes metastases had progressed. She died of the progressed lesion later in approximately one year from the operation. This case demonstrated a possibility of the tumor escape mechanism by changing their tumor-associated antigens.