The effect of Liver Transplantation on the quality of life of the recipient's main caregiver - a systematic review

Introduction: Liver transplantation (LT) is a transformative, life-saving procedure with life-long sequale for patients and their caregivers. The impact of LT on the patient's main caregiver can be underestimated. We carried out a systematic review of the impact of LT on the Health Related Quality of Life (HRQL) of LT patients’ main caregivers. Methods: We searched 13 medical databases from 1996 to 2015. We included studies with HRQL data on caregivers of patients following LT then quality assessed and narratively synthesized the findings from these studies. Results: Of 7076 initial hits, only five studies fell within the scope of this study. In general, they showed caregiver burden persisted in the early period following LT. One study showed improvements, however the other four showed caregiver's levels of stress, anxiety and depression, remained similar or got worse post-LT and remained above that of the normal population. It was suggested that HRQL of the patient impacted on the caregiver and vice versa and may be linked to patient outcomes. No data was available investigating which groups were at particular risk of low HRQL following LT or if any interventions could improve this. Conclusion: The current information about LT caregivers’ needs and factors that impact on their HRQL are not adequately defined. Large studies are needed to examine the effects of LT on the patients’ family and caregivers in order to understand the importance of caregiver support to maximise outcomes of LT for the patient and their caregivers

The immune reponse following small bowel transplantation: an unusual pattern of cytokine expression

Acute cell mediated graft rejection is frequently associated with an immune response dominated by cytokines like IL-2 and IFNγ. While small bowel grafts are rejected acutely, there is little information on the type of immune response generated following transplantation and, in particular, whether the cytokine profile resembles that seen during the rejection of other solid organ grafts. In this paper we compare the expression of cytokines in isolated gut tissue following experimental small bowel transplantation with that in heart grafts. Heterotopic small bowel (n=32) and cardiac (n=32) transplants were performed using the following rat strain combinations: syngeneic Lewis (Lew) > Lew (n=8), blood group D Agouti (DA) > DA (n=8) and allogeneic Lew > DA (n=8), DA > Lew (n=8). Two rats from each group were sacrificed at 1, 3, 5, or 7 days after transplantation. RNA was prepared separately from gut wall, after removing the Peyer's patches (PPs) and mesenteric lymph nodes (MLNs) and from heart. Cytokine (IL-1α, IL-2, IL- 4, IL-6, IL-10 and IFNγ) transcripts were analyzed using semiquantitative RT-PCR. Most notably, transcripts of only a single cytokine, IFNγ, became progressively elevated with time in the rejecting small bowel grafts. This is in marked contrast to the findings presented here for rat cardiac grafts in which transcripts of all cytokines tested show an increase with rejection. This significant and steady increase in IFNγ expression occurred before there was any clinical or histological evidence of rejection. These data demonstrate that the mechanisms of rejection in small bowel and other solid organ grafts are likely to be different. Further, the unique rise in IFNγ expression in the gut wall may be a valuable and early indicator of graft rejection.link_to_subscribed_fulltex

The Immune Response Following Small Bowel Transplantation: Ii: A Very Early Cytokine Response In The Gut-Associated Lymphoid Tissue

The Small Bowel Has A Unique Amount Of Closely Associated Lymphoid Tissue In The Form Of Mesenteric Lymph Nodes (Mlns) And Peyer's Patches (Pps). It Is Rather Unclear How This May Affect The Immune Response To Transplants Involving Small Bowel. It Is Clear, However, That Host-Derived Leukocytes Infiltrate This Lymphoid Tissue Very Rapidly After Transplantation Of Small Bowel, Which Suggests The Possibility Of An Early Immune Response Within This Compartment. To Investigate This Possibility, We Analyzed, Using A Semiquantitative Reverse Transcriptase-Polymerase Chain Reaction, The Level Of Cytokine Transcripts Within Isolated Mlns And Pps For The First 7 Days After Small Bowel Transplantation. Heterotopic Small Bowel (N=32) Transplants Were Performed Using The Following Rat Strain Combinations: Syngeneic Lewis (Lew→Lew (N=8), Blood Group D Agouti (Da)→Da (N=8), Allogeneic Lew→Da (N=8), And Allogeneic Da →Lew (N=8). Two Rats From Each Group Were Killed At 1, 3, 5, And 7 Days After Transplantation. Rna Was Prepared Separately From Pps And Mlns Before Analysis Of Transcripts For Interleukin (Il) 2, Il-4, Il- 10, Il-6, Il-1Α, And Interferon (Ifn) Γ. No Increase In Transcripts For Il- 2 Or Il-10 Was Observed In Either Pps Or Mlns Of Syngeneic Grafts. A Small Rise In Il-6, Il-Α, And Ifn-Γ Transcripts Was Seen In Mlns And Ifn-Γ Transcripts In Pps Of Syngeneic Grafts. In Contrast, In Allografts An Extremely Early Increase In Cytokine Transcripts Was Observed; All Cytokine Transcripts Tested Were Elevated Within The First 24 Hr After Transplantation. Indeed, The Peak Response Of Both Il-2 And Il-10 Occurred Within 1 To 3 Days After Grafting. His Early Immune Response In The Lymphoid Tissue May Not Be Controlled By Immunosuppression Delivered Only At The Time Of Transplantation, And Therefore May He Responsible For The Difficulty In Achieving Adequate Immunosuppression In Small Bowel Transplantation.link_to_subscribed_fulltex