Systematic review with meta-analysis: the efficacy of faecal microbiota #transplantation for the treatment of recurrent and refractory #Clostridium difficile infection
http://onlinelibrary.wiley.com/doi/10.1111/apt.14201/abstract;jsessionid=F8304BE6332A57344642B0BBD9C57DFA.f03t02
Clostridium difficile infection (CDI) is the commonest nosocomial cause of diarrhoea. Faecal microbiota transplantation (FMT) is an approved treatment for recurrent or refractory CDI but there is uncertainty about its use.
FMT was more effective than vancomycin (RR: 0.23 95%CI 0.07-0.80) in resolving recurrent and refractory CDI. Clinical resolution across all studies was 92% (95%CI 89%-94%). A significant difference was observed between lower GI and upper GI delivery of FMT 95% (95%CI 92%-97%) vs 88% (95%CI 82%-94%) respectively (P=.02). There was no difference between fresh and frozen FMT 92% (95%CI 89%-95%) vs 93% (95%CI 87%-97%) respectively (P=.84). Administering consecutive courses of FMT following failure of first FMT resulted in an incremental effect.
Conclusion
Faecal microbiota transplantation is an effective treatment for recurrent and refractory Clostridium difficile infection, independent of preparation and route of delivery.
http://onlinelibrary.wiley.com/doi/10.1111/apt.14201/abstract;jsessionid=F8304BE6332A57344642B0BBD9C57DFA.f03t02
Clostridium difficile infection (CDI) is the commonest nosocomial cause of diarrhoea. Faecal microbiota transplantation (FMT) is an approved treatment for recurrent or refractory CDI but there is uncertainty about its use.
FMT was more effective than vancomycin (RR: 0.23 95%CI 0.07-0.80) in resolving recurrent and refractory CDI. Clinical resolution across all studies was 92% (95%CI 89%-94%). A significant difference was observed between lower GI and upper GI delivery of FMT 95% (95%CI 92%-97%) vs 88% (95%CI 82%-94%) respectively (P=.02). There was no difference between fresh and frozen FMT 92% (95%CI 89%-95%) vs 93% (95%CI 87%-97%) respectively (P=.84). Administering consecutive courses of FMT following failure of first FMT resulted in an incremental effect.
Conclusion
Faecal microbiota transplantation is an effective treatment for recurrent and refractory Clostridium difficile infection, independent of preparation and route of delivery.
Wiley
Systematic review with meta‐analysis: the efficacy of faecal microbiota transplantation for the treatment of recurrent and refractory…
Clostridium difficile infection (CDI) is the commonest nosocomial cause of diarrhoea. Faecal microbiota transplantation (FMT) is an approved treatment for recurrent or refractory CDI but there is uncertainty...
Can Viral Load be used as a Surrogate Marker in Clinical Studies of #Cytomegalovirus in Solid Organ #Transplantation: A Systematic Review and Meta-analysis
https://academic.oup.com/cid/article-abstract/doi/10.1093/cid/cix793/4104615/Can-Viral-Load-be-used-as-a-Surrogate-Marker-in?redirectedFrom=fulltext
We found several lines of evidence to support the validity of viral load as an appropriate surrogate end-point including 1)viral loads in CMV disease are significantly greater than in asymptomatic viremia (OR 9.3, 95%CI 4.6 to 19.3); 2)kinetics of viral replication are strongly associated with progression to disease; 3)pooled incidence of CMV viremia and disease is significantly lower during prophylaxis compared with the full patient followup period (viremia incidence: 3.2%vs.34.3%, p<0.001) (disease incidence: 1.1%vs.13.0%, p<0.001); 4)treatment of viremia prevented disease; and 5)viral load decline correlated with symptom resolution. Based on the analysis, we conclude that CMV viral load is an appropriate surrogate end-point for CMV trials in organ transplant recipients
https://academic.oup.com/cid/article-abstract/doi/10.1093/cid/cix793/4104615/Can-Viral-Load-be-used-as-a-Surrogate-Marker-in?redirectedFrom=fulltext
We found several lines of evidence to support the validity of viral load as an appropriate surrogate end-point including 1)viral loads in CMV disease are significantly greater than in asymptomatic viremia (OR 9.3, 95%CI 4.6 to 19.3); 2)kinetics of viral replication are strongly associated with progression to disease; 3)pooled incidence of CMV viremia and disease is significantly lower during prophylaxis compared with the full patient followup period (viremia incidence: 3.2%vs.34.3%, p<0.001) (disease incidence: 1.1%vs.13.0%, p<0.001); 4)treatment of viremia prevented disease; and 5)viral load decline correlated with symptom resolution. Based on the analysis, we conclude that CMV viral load is an appropriate surrogate end-point for CMV trials in organ transplant recipients
OUP Academic
Can Viral Load be used as a Surrogate Marker in Clinical Studies of Cytomegalovirus in Solid Organ Transplantation: A Systematic…
Symptomatic CMV disease has been the standard endpoint for clinical trials in organ transplant recipients. Viral load may be a more relevant endpoint due to low frequency of disease. We performed a meta-analysis and systematic review of the literature. We…
Survival of children after liver #transplantation for #hepatocellular carcinoma
http://onlinelibrary.wiley.com/doi/10.1002/lt.24994/full
Hepatocellular carcinoma (HCC) in childhood differs from adult HCC as it is often associated with inherited liver disease. Survival analyses demonstrated a superior long-term survival of children with inherited liver disease when compared to children with HCC without inherited liver disease (HR:0.29; 95%CI:0.10-0.90; p=0.03) and adults with HCC with inherited liver disease (HR:0.27; 95%CI:0.06-1.25;p=0.09). There was no survival difference between adults with and without inherited disease (HR:1.05; 95%CI:0.66-1.66; p=0.84).
Conclusion: The potential survival advantage of children with an HCC based on inherited disease should be acknowledged when considering transplantation and prioritization for these patients. Further prospective studies accounting for tumor size and extension at LT are necessary to fully interpret our findings
http://onlinelibrary.wiley.com/doi/10.1002/lt.24994/full
Hepatocellular carcinoma (HCC) in childhood differs from adult HCC as it is often associated with inherited liver disease. Survival analyses demonstrated a superior long-term survival of children with inherited liver disease when compared to children with HCC without inherited liver disease (HR:0.29; 95%CI:0.10-0.90; p=0.03) and adults with HCC with inherited liver disease (HR:0.27; 95%CI:0.06-1.25;p=0.09). There was no survival difference between adults with and without inherited disease (HR:1.05; 95%CI:0.66-1.66; p=0.84).
Conclusion: The potential survival advantage of children with an HCC based on inherited disease should be acknowledged when considering transplantation and prioritization for these patients. Further prospective studies accounting for tumor size and extension at LT are necessary to fully interpret our findings
Wiley
Survival of children after liver transplantation for hepatocellular carcinoma
Hepatocellular carcinoma (HCC) in childhood differs from adult HCC as it is often associated with inherited liver disease. It is, however, unclear whether liver transplantation (LT) for HCC in childhood...
Hypothermic oxygenated machine perfusion reduces #bile duct reperfusion injury after #transplantation of donation after circulatory death livers
http://onlinelibrary.wiley.com/doi/10.1002/lt.25023/abstract
Dual hypothermic oxygenated machine perfusion (DHOPE) of the liver has been advocated as a method to reduce ischemia-reperfusion injury. This study aimed to determine whether DHOPE reduces IR injury of the bile ducts in DCD liver transplantation Baseline characteristics and the degree of bile duct injury at baseline (end of SCS) were similar between both groups. In controls, degree of stroma necrosis (P=0.002) and injury of the deep peribiliary glands (P=0.02) increased after reperfusion, compared to baseline. In contrast, in DHOPE preserved livers the degree of bile duct injury did not increase after reperfusion. Moreover, there was less injury of deep peribiliary glands (P=0.04) after reperfusion in the DHOPE group, compared to controls.
Conclusion: This study suggests that DHOPE reduces ischemia-reperfusion injury of bile ducts after DCD liver transplantation
http://onlinelibrary.wiley.com/doi/10.1002/lt.25023/abstract
Dual hypothermic oxygenated machine perfusion (DHOPE) of the liver has been advocated as a method to reduce ischemia-reperfusion injury. This study aimed to determine whether DHOPE reduces IR injury of the bile ducts in DCD liver transplantation Baseline characteristics and the degree of bile duct injury at baseline (end of SCS) were similar between both groups. In controls, degree of stroma necrosis (P=0.002) and injury of the deep peribiliary glands (P=0.02) increased after reperfusion, compared to baseline. In contrast, in DHOPE preserved livers the degree of bile duct injury did not increase after reperfusion. Moreover, there was less injury of deep peribiliary glands (P=0.04) after reperfusion in the DHOPE group, compared to controls.
Conclusion: This study suggests that DHOPE reduces ischemia-reperfusion injury of bile ducts after DCD liver transplantation
Wiley
Hypothermic oxygenated machine perfusion reduces bile duct reperfusion injury after transplantation of donation after circulatory…
Introduction: Dual hypothermic oxygenated machine perfusion (DHOPE) of the liver has been advocated as a method to reduce ischemia‐reperfusion injury. This study aimed to determine whether DHOPE reduces...
Direct-Acting Antiviral Prophylaxis in Kidney #Transplantation From Hepatitis #C Virus–Infected Donors to Noninfected Recipients: An Open-Label Nonrandomized Trial
http://annals.org/aim/article-abstract/2674335/direct-acting-antiviral-prophylaxis-kidney-transplantation-from-hepatitis-c-virus
Transplantation of kidneys from deceased donors aged 13 to 50 years with positive HCV RNA and HCV antibody test results. All recipients received a dose of grazoprevir (GZR), 100 mg, and elbasvir (EBR), 50 mg, immediately before transplantation. Recipients of kidneys from donors with genotype 1 infection continued receiving GZR–EBR for 12 weeks after transplantation; those receiving organs from donors with genotype 2 or 3 infection had sofosbuvir, 400 mg, added to GZR–EBR for 12 weeks of triple therapy
Among 10 HCV D+/R− transplant recipients, no treatment-related adverse events occurred, and HCV RNA was not detected in any recipient 12 weeks after treatment.
Pre- and posttransplantation HCV treatment was safe and prevented chronic HCV infection in HCV D+/R– kidney transplant recipients. If confirmed in larger studies, this strategy should markedly expand organ options and reduce mortality for kidney transplant candidates without HCV infection
http://annals.org/aim/article-abstract/2674335/direct-acting-antiviral-prophylaxis-kidney-transplantation-from-hepatitis-c-virus
Transplantation of kidneys from deceased donors aged 13 to 50 years with positive HCV RNA and HCV antibody test results. All recipients received a dose of grazoprevir (GZR), 100 mg, and elbasvir (EBR), 50 mg, immediately before transplantation. Recipients of kidneys from donors with genotype 1 infection continued receiving GZR–EBR for 12 weeks after transplantation; those receiving organs from donors with genotype 2 or 3 infection had sofosbuvir, 400 mg, added to GZR–EBR for 12 weeks of triple therapy
Among 10 HCV D+/R− transplant recipients, no treatment-related adverse events occurred, and HCV RNA was not detected in any recipient 12 weeks after treatment.
Pre- and posttransplantation HCV treatment was safe and prevented chronic HCV infection in HCV D+/R– kidney transplant recipients. If confirmed in larger studies, this strategy should markedly expand organ options and reduce mortality for kidney transplant candidates without HCV infection
!!
Impact of #DAAs on liver #transplantation: major effects on the evolution of indications and results. An ELITA study based on the ELTR registry
https://www.journal-of-hepatology.eu/article/S0168-8278(18)32163-9/fulltext
Out of a total number of 60,527 LTs, 36,382 were performed in patients with HCV, HBV, ETOH and NASH. The percentage of LTs due to HCV-related liver disease varied significantly over time (p<0.0001), decreasing from 22.8% in IFN/RBV era to 17.4% in the DAA era, while those performed for NASH increased significantly (p<0.0001). In the DAA era, the percentage of LTs for HCV decreased significantly (p<0.0001) from 21.1% (first semester 2014) to 10.6% (first semester 2017). This decline was more evident in patients with DC (HCV-DC, -58.0%) than in those with HCC associated to HCV (HCV-HCC, -41.2%). Conversely, three-year survival of LT recipients with HCV related liver disease improved from 65.1% in the IFN/RBV era to 76.9% in the DAA era, being currently comparable to the survival of recipients with HBV infection (p=0.3807).
Conclusions
In Europe, the number of LTs due to HCV infection is rapidly declining for both HCV-DC and HCV-HCC indications and post-LT survival has dramatically improved over the last three years. This is the first comprehensive study of the overall impact of DAA treatment for HCV on liver transplantation in Europe.
Impact of #DAAs on liver #transplantation: major effects on the evolution of indications and results. An ELITA study based on the ELTR registry
https://www.journal-of-hepatology.eu/article/S0168-8278(18)32163-9/fulltext
Out of a total number of 60,527 LTs, 36,382 were performed in patients with HCV, HBV, ETOH and NASH. The percentage of LTs due to HCV-related liver disease varied significantly over time (p<0.0001), decreasing from 22.8% in IFN/RBV era to 17.4% in the DAA era, while those performed for NASH increased significantly (p<0.0001). In the DAA era, the percentage of LTs for HCV decreased significantly (p<0.0001) from 21.1% (first semester 2014) to 10.6% (first semester 2017). This decline was more evident in patients with DC (HCV-DC, -58.0%) than in those with HCC associated to HCV (HCV-HCC, -41.2%). Conversely, three-year survival of LT recipients with HCV related liver disease improved from 65.1% in the IFN/RBV era to 76.9% in the DAA era, being currently comparable to the survival of recipients with HBV infection (p=0.3807).
Conclusions
In Europe, the number of LTs due to HCV infection is rapidly declining for both HCV-DC and HCV-HCC indications and post-LT survival has dramatically improved over the last three years. This is the first comprehensive study of the overall impact of DAA treatment for HCV on liver transplantation in Europe.