The role of interventional radiology in the pre-liver transplant patient
- PDF / 1,407,798 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 46 Downloads / 161 Views
SPECIAL SECTION: LIVER TRANSPLANTATION
The role of interventional radiology in the pre‑liver transplant patient Paula M. Novelli1 · Philip D. Orons1 Received: 11 October 2019 / Revised: 11 January 2020 / Accepted: 8 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Each year approximately 8500 patients undergo liver transplantation in the USA for acute and chronic liver failure. Over the years, the success of liver transplantation has led to more clinical indications for liver transplantation. These expanded indications, without a proportionate increase in donors, result in increased competition for the limited pool of transplantable whole or partial grafts. The likelihood of receiving a deceased donor graft depends on many clinical variables, including the acute and chronic fitness of the candidate aligning with the timing of donor organ availability. Several types of patients are candidates for transplant: patients with acute fulminant hepatic failure who will die without a transplant, patients with decompensated cirrhosis, and patients with HCC and compensated cirrhosis. Interventional radiology can preserve equity between these subgroups and reduce patient dropout by increasing the physiologic and anatomic fitness of the candidate before and after formal listing. The primary determinants of candidacy fitness and dropout are the severity of clinical symptoms related to portal hypertension and the presence of hepatocellular cancer. There is a subgroup of patients whose disease severity is not accurately reflected by the Model for End-stage Liver Disease (MELD), such as patients with chronic cholestasis that also may benefit from IR management. Keywords Cirrhosis · Liver transplantation · Hepatocellular carcinoma · Portal hypertension
Introduction Data from the Organ Procurement and Transplant Network (OPTN) showed approximately 13,000 patients listed for liver transplant in the USA in 2018. 1174 patients died while waiting, and an additional 1304 patients were removed from the waitlist for being too sick for transplant [1]. Bridging therapies are used to reduce pre-transplant waiting period morbidity and mortality and to downstage patients for waitlist candidacy. The ability to list a patient for liver transplant is standardized to indication, social support, and controlled co-morbidities. The actual fitness or waitlist worthiness of a transplant candidate is dynamic and for many patients’ statuses can be modified to be suitable for listing, or suitable to maintain listing. Portal vein interventions, locoregional cancer therapies, and percutaneous interventions for cholestatic liver disease are the most frequent interventions performed in the liver transplant candidate for pre-transplant fitness. * Paula M. Novelli [email protected] 1
Department of Radiology, UPMC, 200 Lothrop St, Pittsburgh, PA 15213, USA
This review aims to show the role of these interventions in pre-transplant patients as an essential component of a successful liver transplantation program.
Data Loading...
