Table of Contents
Liver transplant teams recognize that surgery is just one step in a patient’s long journey. University of Florida researchers play an important role in fostering an environment that brings together sensitivity and science in the search for answers to difficult questions about transplantation.
goal
UF Health researchers aim to identify improved treatments for liver transplant patients and move them from the lab to the bedside. Primary focus includes clinical and basic science research related to the pathogenesis and related treatments of viral hepatitis.
hepatitis c virus
End-stage liver disease secondary to hepatitis C virus is the primary indication for liver transplantation in the United States. Unfortunately, viral recurrence is common after liver transplantation, and hepatitis C recurrence causes allograft failure, with more than 10% of recipients dying or graft failure by 5 years after surgery. leading to loss. These observations suggest that HCV-induced disease is more progressive in chronically immunosuppressed patients than in immunocompetent patients. Understanding the mechanisms of disease damage in this setting may improve organ allocation and patient management. As the shortage of cadaveric donor organs becomes increasingly acute, the need to optimize outcomes after liver transplantation for hepatitis C has become one of the most pressing issues facing the transplant community. UF Health’s Liver Transplant Program is actively engaged in multiple research projects focused on understanding how HCV causes liver disease and strategies to improve outcomes.
- New antiviral strategies: We are currently evaluating the efficacy of pegylated interferons, immunomodulators, and virus-specific molecules to eradicate hepatitis C virus.
- Prevention of graft reinfection : We are evaluating the ability of hepatitis C virus immune globulin to protect donor livers from reinfection with hepatitis C virus during transplantation.
- Development of antifibrotic drugs : We are participating in a large multicenter trial to evaluate drugs that have the potential to reverse fibrosis within the liver. Subjects with very advanced disease are being enrolled with the ultimate goal of avoiding the need for a liver transplant.
- immunopathogenicity : Multiple basic science efforts are underway to better understand the factors that lead to recurrence of hepatitis C virus disease after liver transplantation.
hepatitis B virus
Before the introduction of effective immunoprophylaxis, hepatitis B virus recurrence after liver transplantation was common and caused significant graft loss and patient death. Fortunately, the influence of pretransplant hepatitis B virus replication levels and the recent recognition of the protective effects of high doses of hepatitis B immune globulin (HBIG) make it possible to effectively prevent graft reinfection with HBV. Countermeasures have been established.
UF Health is currently actively participating in research evaluating the role of nucleoside analogs in the treatment of active disease and optimal use of HBIG. These strategies have enabled routine successful transplantation for hepatitis B patients.
- Prevention of disease recurrence
- Treatment of active disease
Immunosuppression strategies
Immunosuppression strategies in liver transplantation are divided into three periods: initial (induction), maintenance, and acute and chronic rejection. Many immunosuppressive drugs are used during these periods after liver transplantation, each with its own pharmacology, side effects, and toxicity. UF Health’s transplant team works to tailor the immunosuppressive treatment that best fits each patient’s individual needs. Current research focuses on the following efforts:
liver cancer
Many advances have been achieved in the management of liver cancer patients over the past decade. Improvements in imaging techniques and increased knowledge of the biology of this neoplasm have facilitated the establishment of useful criteria for selecting patients for transplantation. If strict selection policies are followed (solitary tumors <5 cm or up to three lesions each <3 cm), liver cancer patients may achieve the same survival rates as non-neoplastic subjects. The main question now is how to reduce the risk of tumor progression while waiting for the liver to recover. Ongoing research at UF Health is exploring new treatment options that can successfully prevent disease progression and improve patient outcomes.
- process : A multidisciplinary team is working to provide “anti-tumor” care to liver cancer patients. Treatment strategies range from radical resection to radiofrequency ablation to chemoembolization of the tumor. Ultimately, liver transplantation remains the final treatment option.
- Prevention of recurrence after transplantation : We are currently evaluating the use of new immunosuppressive agents that may inhibit tumor growth and reduce the risk of tumor recurrence after transplantation.
Quality of life
Clinical and health psychologists at the University of California are evaluating the impact of liver transplantation on quality of life. Results showed dramatic improvements in physical and social function, degree of physical discomfort, and vitality after surgery. These changes became noticeable just 6 months after transplantation. Additionally, current research interests also focus on stress levels in families and children of transplant recipients.
