Dear colleagues and friends,
The ILTS 2020 Consensus Conference held in Venice on January 31 highlighted the latest research in machine perfusion and DCD liver transplantation. An eminent international faculty outlined key challenges and opportunities in the field, and joined delegates in topic-focused working groups to agree consensus positions on current knowledge and priorities for future research. These efforts will culminate in an ILTS Consensus Statement, to be presented at the 2020 Annual Congress in Istanbul.
ILTS Elections took place during the ILTS Winter Council Meeting in early February. Congratulations to Mohamed Rela, future President-Elect, and new Council members James Findlay and Nazia Selzner!
The ILTS 2020 Annual Congress is just around the corner! 59 late-breaking abstracts have been submitted, bringing the abstract total to 789. The high quality of these abstracts, and the broad international participation they reflect, will guarantee a superb scientific and networking event. Join us in Istanbul!
Again in this month’s newsletter, you will find exciting ILTS initiatives, opportunities for career development, and must-read scientific publications in liver transplantation.
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Claus U. Niemann n
ILTS President
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Help us bring the Liver Transplant community together:
Forward this newsletter to your colleagues!
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ILTS 2020 - Late Breaking Abstract Submission
ILTS is pleased to announce that 59 late breaking abstracts have been submitted and are currently under review.
Check out the scientific program for all sessions and topics here!
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ILTS 2020: Novel Coronavirus (COVID-19) Update
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There is understandably considerable concern regarding the spread of the Novel Coronavirus (COVID-19). The health and safety of our attendees is our highest priority. Please be assured that we are monitoring the situation very closely and are in regular contact with the health authorities in Turkey. At present, there are no plans to cancel ILTS 2020 Annual Congress this May in Istanbul. We will communicate any changes that may affect the annual meeting in a timely manner.
We encourage you to follow the World Health Organization’s Situation Reports, which provide updates concerning COVID-19.
Claus U. Niemann n
ILTS President
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ILTS 2020 - Promotional Kit
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Help us spread the word about #ILTS2020 by using your networks to bolster interest in the Congress. The digital promotion kit includes: Flyer, E-Banner, PowerPoint Slides, General Info Text, Congress Logo.
Social media is another key component of our outreach. Help us reach experts in our field by adding the website link https://2020.ilts.org/ and the Congress banner to your Twitter, LinkedIn or Facebook feed. If you tweet about the Congress, please add the hashtag #ILTS2020 to ensure that everyone following the Congress reads it.
Download the ILTS 2020 digital promotion kit below with materials you can use to promote the Congress!
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2020 ILTS Perioperative Care in Liver Transplantation Meeting
The ILTS Perioperative Care Meeting 2020 is all about preoperative evaluation, intraoperative management, and postoperative care. A special pro/con session will focus on intraoperative monitoring and perioperative serum sodium management. Anesthesiologists, critical care specialists, and everyone involved in the care of these challenging patients are welcome to take part!
Join us on October 2, 2020 in Washington D.C., USA. Save the date and stay tuned for more information here!
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Highlights of ILTS Consensus Conference 2020
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The Consensus Conference on DCD, Liver Preservation & Machine Perfusion was a great success! Convened by Amelia J. Hessheimer, Marit Kalisvaart and colleagues in the ILTS Special Interest Group, the program attracted more than 150 specialists and researchers in the field. Six topic-based working groups developed consensus statements, which will feature in a formal Consensus Conference presentation at the ILTS Annual Congress in Istanbul.
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Dr. Mohamed Rela was voted President-Elect 2020-21 by the ILTS Council in Venice earlier this month. As council member and chair of the ILTS Pediatric Committee, Dr. Rela spearheaded work on the ILTS Pediatric Liver Transplant Registry, which aims to provide a better picture of pediatric liver transplant activity worldwide, especially from regions that lack formal national or regional registries.
"My experience working in major centers in the UK and India has given me a good understanding of issues concerning this field in both Western and Eastern worlds", Dr. Rela stated. The main objectives of his presidency will be as follows:
- Provide opportunities for Eastern centers to showcase their work on the world stage
- Build bridges of knowledge and collaboration between ILTS and Eastern LT communities
- Travel extensively as a representative of the ILTS mentor programs
- Improve membership by providing ILTS enormous visibility within the liver transplant community in South Asia
Congratulations Dr. Rela!
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International Day of Women and Girls in Science
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The International Day of Women and Girls in Science was celebrated on February 11th according to the United Nations General Assembly Resolution A/RES/70/212, adopted to achieve full and equal access to science for women and girls since less than 30 percent of researchers worldwide are women.
ILTS would like to congratulate again all of the outstanding women who are contributing to global health advancements in their daily work. To promote gender equality in science and in liver transplantation, ILTS has established the Equality, Diversity and Inclusion Committee.
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COVID-19 Statement from the Infectious Diseases and Liver Transplantation SIG
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The concern for global spread of the coronavirus strain, Covid-19, initially found in Wuhan, China must be recognized by the organ transplant community. To our knowledge, Covid-19 has not been described in blood, tissue or organ transplant recipients. However, as with SARS and MERS infections that were reported in transplant recipients during their outbreaks, it is likely just a matter of time.1,2 Prior experience suggests that there will be a spectrum from asymptomatic to severe illness and that viral shedding (and risk of transmission to others) may be prolonged in organ recipients.
The risk of a recipient obtaining the virus from a donor is low, however it is important to note that 15% (6/41) of people admitted with confirmed Covid-19 had viral RNA identified in the plasma. The risk of contracting the virus from an organ of an infected donor is real, but unknown. Human-to-human spread occurs primarily through respiratory droplets, but the virus is also present in other bodily secretions with an undetermined duration of viremia and shedding.3 As there are no readily available screening tools or therapies, the community must rely upon general concepts. The Transplantation Society and the US Organ Procurement and Transplant Network (OPTN/UNOS) have released guidelines regarding Covid-19.4,5
General consensus has led to the following recommendations:
- Organ donation: Be cognizant of respiratory symptoms in donors and query for fever or acute illness symptoms. Avoid deceased and living organs retrieved from donors within endemic/high prevalence areas. If a live donor has been within an endemic area, wait at least 14 days (presumed incubation period) for symptom development prior to proceeding with donation.
- Candidate: Avoid transplanting and immunosuppressing someone with developing or active disease. The recommendation of waiting 14 days if the candidate traveled through an endemic area is current, but subject to change. Clinical prudence is paramount.
- Recipient: Respiratory viruses in transplant recipients can be severe. It is unclear whether the transplant recipient is more susceptible to acquiring acute infection. The uninfected recipient should take respiratory precautions and wash hands frequently and thoroughly. Respiratory isolation and supportive therapy is the first line treatment for people who contract Covid-19. This is true for transplant recipients as well. While there is no proven effective antiviral treatment, the field is rapidly evolving.
- Healthcare team and uninfected individuals: There is a proven risk of patient-to-provider disease transmission. It is incumbent that all organ donor teams, transplant providers and support staff are aware of the risks and take appropriate respiratory contact precautions. Frequent hand washings (at least 20 seconds with soap) and frequent disinfection of surfaces is recommended. Avoid hand-face contact as much as possible. Avoid close contact with coughing or sneezing individuals that may have viral infections. If contact is unavoidable, use of a N95 mask and eye cover is recommended.
Updates of recommendations should be followed on the CDC or WHO information web pages.
Timothy Pruett & Varvara Kirchner
Infectious Diseases and Liver Transplantation SIG Topic Coordinators
- Kumar D., Tellier R., Draker R. et al., Severe Acute Respiratory Syndrome (SARS) in a Liver Transplant Recipient and Guidelines for Donor SARS Screening. Am J Transplant. 2003 Aug;3(8):977-81.
- AlGhamdi M., Mushtaq F, Awn N., et al., MERS CoV Infection in Two Renal Transplant Recipients: Case Report. Am J Transplant. 2015 Apr; 15(4):1101-4.
- CDC: https://www.cdc.gov/coronavirus/2019-ncov/index.html
- TTS:https://tts.org/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-.%20%20
- OPTN/UNOS:https://optn.transplant.hrsa.gov/news/information-for-transplant-programs-and-opos-regarding-2019-novel-coronavirus/
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International Transplantation Science Mentee-Mentor Awards - Call for Applications!
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The Transplantation Society in collaboration with ILTS acknowledges the contribution of basic science to the field of transplantation by offering Mentee-Mentor awards.
The International Transplantation Science Mentee-Mentor Awards encourage young investigators to submit their research to TTS 2020 and will help cover expenses to attend the Congress in Seoul. You can download the award flyer here.
Applications are due by March 23, 2020.
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The February issue of Transplantation, the official Journal of the International Liver Transplantation Society and the Transplantation Society, is out now.
A must read for anyone working in the field of liver transplantation.
Free access for ILTS members!
Nature Biotechnology
An integrated perfusion machine preserves injured human livers for 1 week
The ability to preserve metabolically active livers ex vivo for 1 week or more could allow repair of poor-quality livers that would otherwise be declined for transplantation. Current approaches for normothermic perfusion can preserve human livers for only 24 h. Here we report a liver perfusion machine that integrates multiple core physiological functions, including automated management of glucose levels and oxygenation, waste-product removal and hematocrit control. Read more.
See Commentary by Amelia Judith Hessheimer.
Transplantation (FREE TO ILTS MEMBERS)
Do Social Determinants Define “Too Sick” to Transplant in Patients with End-stage Liver Disease?
Delisting for being "too sick" to be transplanted is subjective. Previous work has demonstrated that the mortality of patients delisted for "too sick" is unexpectedly low. Transplant centers use their best clinical judgment for determining "too sick," but it is unclear how social determinants influence decisions to delist for "too sick." We hypothesized that social determinants and Donor Service Area (DSA) characteristics may be associated with determination of "too sick" to transplant. Read more.
See Commentary by Isabel Campos Varela.
Transplantation (FREE TO ILTS MEMBERS)
Prevalence and patterns of opioid use before and after liver transplantation
Opioid use in liver transplantation is poorly understood and has potential associated morbidity. Using a national dataset of employer-based insurance claims, we identified 1257 adults who underwent liver transplantation between 12/2009-2/2015. We calculated risk-adjusted prevalence of peritransplant opioid fills, assessed changes in opioid use after transplant, and identified correlates of persistent or increased opioid use posttransplant. Read more. See commentary by Michael Spiro.
Transplantation (FREE TO ILTS MEMBERS)
Incidence, Predictors, and Impact on Survival of Long-term Cardiovascular Events After Liver Transplantation
Information on the risk factors, particularly kidney function, and impact of long-term cardiovascular events (CVE) after liver transplantation (LT) remains scarce.
This is a retrospective, single-center study that included consecutive LT recipients between 2007 and 2017. The incidence of CVE, their risk factors, and their impact on patient survival were investigated. Read more.
See Commentary by Isabel Campos Varela.
Digestive Diseases and Sciences
Home-Based Physical Activity and Diet Intervention to Improve Physical Function in Advanced Liver Disease: A Randomized Pilot Trial
A decline in physical function is highly prevalent and a poor prognostic factor in cirrhosis. We assessed the benefits of a home-based physical activity program (HB-PAP) in patients with cirrhosis with a randomized pilot trial. Read more.
See commentary by Michael Spiro.
Transplantation (FREE TO ILTS MEMBERS)
New Evidence Supporting Increased Use of Split Liver Transplantation
Young children and small-statured candidates are dying on liver candidate waitlists. The Organ Procurement and Transplantation Network and United Network for Organ Sharing have proposed a split liver (SL) variance encouraging transplant programs to split more livers to aid these smaller statured candidates.
We evaluated the US experience of splitting donor livers during 2002-2016. The results of our analysis provide new evidence to support this variance.
Usage of "large-for-size" left lateral segment (LLS) liver grafts in children with high graft to recipient weight ratio (GRWR) is controversial due to concerns about increased recipient complications. During the study period, 77 pediatric living donor liver transplantations (LDLTs) with LLS grafts were performed. We compared recipients with GRWR ≥2.5% (GR-High = 50) vs GRWR <2.5% (GR-Low = 27). Read more.
Hyperammonemia is a key contributing factor for cerebral edema in acute liver failure. Continuous renal replacement therapy may help reduce ammonia levels. However, the optimal timing, mode, intensity, and duration of continuous renal replacement therapy in this setting are unknown. We aimed to study continuous renal replacement therapy use in acute liver failure patients and to assess its impact on hyperammonemia. Read more.
See commentary by Michael Spiro.
Liver Transplantation
Changing Etiologies and Prognostic Factors in Pediatric Acute Liver Failure
After the implementation of universal hepatitis A virus vaccination in Argentina, the outcome of pediatric acute liver failure (PALF) remains unknown. We aimed to identify variables associated with the risk of liver transplantation (LT) or death and to determine the causes and short-term outcomes of PALF in Argentina.
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Last Month (January, 2020)
1. Preoperative Assessment of Muscle Mass Using Computerized Tomography Scans to Predict Outcomes Following Orthotopic Liver Transplantation. (link)
2. A Randomized Control Trial of Thromboelastography-Guided Transfusion in Cirrhosis for High-Risk Invasive Liver-Related Procedures. (link)
3. Area Under Trough Concentrations of Tacrolimus as a Predictor of Progressive Renal Impairment After Liver Transplantation. (link)
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2019
1. Recipient age and mortality after liver transplantation: A population-based cohort study (link)
2. Immune-mediated graft dysfunction in liver transplant recipients with hepatitis C virus treated with direct-acting antiviral therapy (link)
3. ILTS consensus statement on end-stage liver disease due to nonalcoholic steatohepatitis and liver transplantation (link)
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