Ethical Issues in the Care of Patients Whose Personal, Religious, or Cultural Beliefs Impact Clinical Management Strategies.

Ethical principles regarding respect for patient autonomy in medical decision-making and the impact of religion, culture, and other issues on clinical care have been extensively reviewed in the medical literature. At the same time, despite physicians having an understanding of the underlying ethical principles in clinical decision-making, challenges arise when managing complicated clinical problems for which medical treatment is available, but not acceptable to the patient. For example, many anesthesiologists are challenged when caring for one of Jehohah's Witnesses who refuses to receive blood or blood products despite the potential consequences of doing so.

Use of HBsAg-positive donors in liver transplantation: An ILTS-EASL-AASLD multisociety survey.

The gap between organ supply and demand in liver transplantation remains large in most parts of the world. One strategy to increase the donor pool is to use grafts infected with HCV, HBV, and/or HIV viruses. We aimed to explore the current use of HBsAg-positive liver grafts worldwide.

A report of a prospective randomized trial of extended-release tacrolimus versus immediate release tacrolimus after liver transplantation with anti-thymocyte induction in a steroid free protocol.

Purpose: Our study hypothesis was that once daily dosing of extended-release tacrolimus (XRT) would be a safe and effective immunosuppression (IS) with the potential to decrease adverse events (AEs) associated with immediate release tacrolimus (IRT) after liver transplantation (LT).

Methods: All patients receiving LT at our center received rabbit anti-thymocyte globulin (RATG) induction therapy. Eligible patients were randomized in a 1:1 fashion to receive either XRT or IRT.

Preventing Rejection of the Kidney Transplant.

With increasing knowledge of immunologic factors and with the advent of potent immunosuppressive agents, the last several decades have seen significantly improved kidney allograft survival. However, despite overall improved short to medium-term allograft survival, long-term allograft outcomes remain unsatisfactory. A large body of literature implicates acute and chronic rejection as independent risk factors for graft loss.

Factors enabling transplant program participation in the Scientific Registry of Transplant Recipients (SRTR) Living Donor Collective: A national survey.

Background: The Scientific Registry of Transplant Recipients (SRTR) Living Donor Collective (LDC), the first effort to create a lifetime registry for living donor candidates in the United States, requires transplant programs to register donor candidates while the SRTR conducts follow-up.

Methods: To better understand facilitators and barriers to program participation, we conducted a brief electronic survey of U.S.

Design, Analysis, and Pitfalls of Clinical Trials Using Ex Situ Liver Machine Perfusion: The International Liver Transplantation Society Consensus Guidelines.

Background: Recent trials in liver machine perfusion (MP) have revealed unique challenges beyond those seen in most clinical studies. Correct trial design and interpretation of data are essential to avoid drawing conclusions that may compromise patient safety and increase costs.

Methods: The International Liver Transplantation Society, through the Special Interest Group "DCD, Preservation and Machine Perfusion," established a working group to write consensus statements and guidelines on how future clinical trials in liver perfusion should be designed, with particular focus on relevant clinical endpoints and how different techniques of liver perfusion should be compared.

Regulations and Procurement Surgery in DCD Liver Transplantation: Expert Consensus Guidance From the International Liver Transplantation Society.

Donation after circulatory death (DCD) donors are an increasingly more common source of livers for transplantation in many parts of the world. Events that occur during DCD liver recovery have a significant impact on the success of subsequent transplantation. This working group of the International Liver Transplantation Society evaluated current evidence as well as combined experience and created this guidance on DCD liver procurement.

Nutrition in Chronic Liver Disease.

Purpose Of Review: Malnutrition is a common finding in patients with chronic advanced liver disease (CLD) and is an important prognostic predictor for morbidity and mortality. This review aims to summarize the latest evidence-based guidelines and expert opinion regarding diagnosing malnutrition in patients with CLD and providing optimal solutions.

Recent Findings: In addition to diet, evidence demonstrates sarcopenia and frailty are emerging concepts critical to outcomes in those with CLD.

Glycated Hemoglobin Levels in Patients with Decompensated Cirrhosis.

. Aim of this study is to determine if HbA1c levels are a reliable predictor of glycemic control in patients with decompensated cirrhosis. .

Ethical issues in the care of Jehovah's Witnesses.

Purpose Of Review: To review the belief's of Jehovah's Witnesses regarding the use of blood and blood products, and how to ensure that those patients professing to be Jehovah's Witnesses are treated ethically.

Recent Findings: There are a number of blog sites that have reported that Jehovah's Witnesses have changed their position on transfusion, but communications with them have revealed these reports to be untrue. Most articles about the treatment of Jehovah's Witnesses focus on respect for personal autonomy and the right to refuse treatment.

Outcomes following renal transplantation in patients with chronic hepatitis C based on severity of fibrosis on pre-transplant liver biopsy.

Data regarding long-term outcomes following renal transplantation in patients with hepatitis C virus (HCV) infection have been controversial. Our aim was to determine whether there is a difference in outcomes between patients with HCV and more advanced fibrosis on pretransplant biopsy and those with minimal or no fibrosis. Patients were divided according to the severity of fibrosis and their outcomes (including acute rejection, chronic rejection, re-initiation of dialysis, progression of liver disease and mortality) were compared.

Costs and Outcomes of Privately-Insured Kidney Transplant Recipients by Body Mass Index.

Background: Obesity presents an additional challenge to the procedure of and recovery from kidney transplantation. As the prevalence of transplant candidates with an elevated body mass index (BMI) grows, researchers need to examine and quantify the increased risks and additional costs associated with the full spectrum of body composition.

Study Design: A retrospective cohort study design was used.

Spontaneous liver rupture associated with hydatidiform mole pregnancy.

Background: Spontaneous liver rupture is a rare occurrence during pregnancy.

Case: A young woman presented early in her pregnancy with severe abdominal pain, tachycardia, and hypotension. She was taken emergently to the operating room with a presumed diagnosis of ruptured ectopic pregnancy.

Proceedings of Consensus Conference on Simultaneous Liver Kidney Transplantation (SLK).

A consensus conference sponsored by the American Society of Transplant Surgeons (ASTS), American Society of Transplantation (AST), United Network for Organ Sharing (UNOS) and American Society of Nephrology (ASN) convened to examine simultaneous liver-kidney transplantation (SLK). Directors from the 25 largest liver transplant programs along with speakers with recognized expertise attended. The purposes of this conference were to propose indications for SLK, to establish a prospective data registry and, most importantly, to recommend standard listing criteria for these patients.