Liver Transplantation Program
Liver Transplantation Program
News Article | May 26, 2017
Patients with hepatitis C who suffer from advanced stages of liver disease have renewed hope, thanks to findings by researchers who have discovered that a new drug significantly reduces their risk of death and need for transplantation. The research team, led by clinical researchers at Intermountain Healthcare's Intermountain Medical Center in Salt Lake City, studied nearly 1,900 hep C patients and found that the number of patients needing transplants was reduced by 40 percent after they were given a regimen of the drug, sofosbuvir. Results of the study will be presented at the 2017 International Joint Congress of ILTS, ELITA & LICAGE in Prague, Czech Republic, on Friday, May 26, 2017. About 3.3 million people in the United States have chronic hepatitis C infection, which causes inflammation of the liver and eventually leads to serious liver problems like cirrhosis, which is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism. Researchers studied longitudinal data to learn the impact sofosbuvir had in treating patients with advanced stages of cirrhosis. They compared the outcomes of 1,857 patients prior to the United States Food and Drug Administration's approval of sofosbuvir in Dec. 2013 with 623 similar patients who were treated with sofosbuvir after approval of the drug. "Prior to FDA approval of sofosbuvir, patients with the most advanced stages of cirrhosis either died from their disease or ended up receiving a transplant," said Michael Charlton, MD, lead researcher from Intermountain Healthcare's Intermountain Medical Center Transplant Program, and current president of the International Liver Transplantation Society. "We found that by treating those patients, who were on the verge of needing a transplant, with sofosbuvir-based therapies, we greatly reduced the liver transplant and mortality rates." Only three percent of patients on sofosbuvir ended up needing a transplant, compared to ovder 40% of untreated patients. Data used in the study included an integrated database of four separate, prospective, multicenter, multinational randomized controlled clinical trials of sofosbuvir-based therapies in patients with advanced stages of cirrhosis, and compared them with patients who were on the United Network for Organ Sharing (UNOS) waitlist for a liver transplant between 2008-2013. "We found the sicker a patient was, the more benefit they experienced by using sofosbuvir," said Dr. Charlton. "However, many people around the world who might benefit most from this therapy don't have access to it because the regulatory authorities haven't felt it safe for use in patients with advanced stages of liver disease due to hepatitis C. Our research shows the benefits of this drug include significantly improving the health of even the sickest patients, allowing them to return to their normal life sooner." Study authors conclude the study by recommending that treatment of the hepatitis C virus using sofosbuvir should be considered in all patients with cirrhosis, even those in advanced stages of the liver disease. Members of the Intermountain Medical Center Liver Transplantation Program involved in the study include Li Dong; Michael Leise; Richard Gilroy, MD; Jake Krong; Anu Osinusi; Michael P. Curry; Michael Manns; Nezam Afdhal; Diana M. Brainard; and Michael Charlton, MD.
Lin C.-H.,Kaohsiung Chang Gung Memorial Hospital |
Chen C.-L.,Liver Transplantation Program |
Chen C.-L.,Chang Gung University |
Lin T.-K.,Kaohsiung Chang Gung Memorial Hospital |
And 6 more authors.
Medicine (United States) | Year: 2015
After liver transplantation, patients may develop seizures or epilepsy due to a variety of etiologies. The ideal antiepileptic drugs for these patients are those with fewer drug interactions and less hepatic toxicity. In this study, we present patients using levetiracetam to control seizures after liver transplantation. We retrospectively enrolled patients who received levetiracetam for seizure control after liver transplantation. We analyzed the etiology of liver failure that required liver transplantation, etiology of the seizures, outcomes of seizure control, and the condition of the patient after follow-up at the outpatient department. Hematological and biochemical data before and after the use of levetiracetam were also collected. Fifteen patients who received intravenous or oral levetiracetam monotherapy for seizure control after liver transplantation were enrolled into this study. All of the patients remained seizure-free during levetiracetam treatment. Two patients died during the follow-up, and the other 13 patients were alive at the end of the study period and all were seizurefree without neurological sequelae that interfered with their daily activities. No patients experienced liver failure or rejection of the donor liver due to ineffective immunosuppressant medications. The dosage of immunosuppressants did not change before and after levetiracetam treatment, and there were no changes in hematological and biochemical data before and after treatment. Levetiracetam may be a suitable antiepileptic drug for patients who undergo liver transplantation due to fewer drug interactions and a favorable safety profile. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Flamm S.L.,Liver Transplantation Program
The Journal of family practice | Year: 2017
Cirrhosis has become the focus of greater attention in recent years largely because of the increasing prevalence of 2 of its most common causes: chronic viral hepatitis and steatohepatitis (a subset of nonalcoholic fatty liver disease [NAFLD]). Cirrhosis is the result of progressive destruction and regeneration of the liver parenchyma due to chronic liver disease (CLD).
News Article | December 14, 2016
There's new hope for patients with liver disease who are waiting for a donor liver to become available for transplantation. Doctors at Intermountain Medical Center in Salt Lake City have found a way to safely use a damaged liver to replace a dying liver, then cure the damaged liver of its disease. Intermountain Medical Center is the first transplant center in the nation to use a revolutionary approach for saving the life of patients who are on death's door. This year over 13,000 people will be added to the liver transplant waiting list of around 17,000 people; however only 7,000 received a transplant in 2016. This creates an enormous supply -- demand mismatch and results in about 1,500 people dying each year while waiting and another 1,700 being removed for getting too sick before they see their opportunity. "We're excited about the possibilities this opens when it comes to providing life-saving treatment to some of the sickest patients waiting for a liver transplant," said Richard Gilroy, MD, medical director of the Liver Transplantation Program at Intermountain Medical Center. "We are able to make what were felt damaged goods work and sometimes far better than we ever thought we could. This outcome means more people can be saved before they get too sick and allows them to move back to an active life sooner." During the procedure, the patient's dying liver is removed and a liver with hepatitis C virus infection is transplanted into the recipient. Following the transplant surgery, the patient begins undergoing treatment to cure them from the hepatitis C virus that was carried over from the organ donor via the liver. Once treatment is complete, the patient is cured of hepatitis C and their new liver functions properly. What is ironic about this is the fact that hepatitis C is the most common indication for a liver transplant nationally. Because of this, multiple methods are in place to assure that the patient receives a "safe" hepatitis C liver. Earlier this year, Lorenzo Swank's health was quickly declining. In 2010, he was diagnosed with Primary Sclerosing Cholangitis, or PSC, which slowly damages the bile ducts in his liver, causing bile to build up in the liver and damage liver cells. There is no cure for PSC. In 2013, Swank was added to the liver transplant waiting list and went almost three years with no major issues. But in May 2016, his health was declining yet again. "Getting a transplant was the only solution that would allow me to overcome PSC," said Lorenzo Swank, recipient of a hepatitis C positive liver who has since been cured of the virus. "If I had not received the hepatitis C positive liver, I was weeks, if not days away from dying. Now my doctors are telling me I can get back to my regularly scheduled life."? Following Swank's transplant, he began treatment for the disease that was carried over from the liver donor -- hepatitis C. Following the treatment for the disease, which was developed by a research team led by Intermountain Medical Center transplant physician Michael Charlton, MD, late last year, Swank has been deemed hepatitis C free. One other patient underwent the same transplant procedure using a hepatitis C positive liver and is currently undergoing the treatment regimen for hepatitis C. "Giving a curable disease to a patient is a lot better than letting them die from an incurable disease," said Dr. Gilroy. "We feel this new method will save many more lives by increasing the number of available donor livers to those on the liver transplant wait list."
Flamm S.L.,Liver Transplantation Program
Clinics in Liver Disease | Year: 2015
Covert hepatic encephalopathy is a common problem in cirrhosis, affecting up to 80% of patients. It is defined as test-dependent brain dysfunction with clinical consequences in the setting of cirrhosis in patients who are not disoriented. Because it is not apparent clinically, and diagnostic testing has not been standardized, the issue has often been ignored in clinical practice. Yet, the clinical consequences are notable, including impaired quality of life, diminished work productivity, and poor driving skills. © 2015 Elsevier Inc.
PubMed | Liver Transplantation Program
Type: Journal Article | Journal: Transplantation proceedings | Year: 2010
Orthotopic liver transplantation (OLT) is currently an established therapy for small, early-stage hepatocellular carcinoma (HCC) within the Milan criteria. Long waiting times due to the shortage of donor organs can result in tumor progression and drop-out from OLT candidacy. Therefore a wide variety of procedures are necessary before OLT. The aim of this retrospective study was to review our experience in relation to bridge therapy prior to OLT for HCC.This was a retrospective database review of all of the patient who underwent transplantation in our institutions between January 1993 and June 2009. We analyzed patients with a diagnosis of HCC in the explant.Among 29 patients, including 12 who were diagnosed by the explant and 17 prior to transplantation, 88% underwent bridge therapy during a mean waiting time to OLT of 12 months. Among the 23 procedures, namely 1.5 procedures per patient, included most frequently chemoembolization (48%), alcohol ablation (30%), radiofrequency ablation (13%), and surgery (9%). Thirty-three percent of the explants contained lesions within the Milan criteria. In our series the 5-year survival rate for patients transplanted for HCC was 86%; in the bridge therapy group, it was 73%.The incidence of patients who underwent bridge therapy (52%) was similar to other reported experiences, but the fulfillment of Milan criteria in the explants was lower. Among the bridge therapy group, the survival was slightly lower, probably because this group displayed more advanced disease.