Journal of Liver Transplantation最新文献

{"title":"A pilot pathway for penicillin allergy delabelling in liver transplant recipients","authors":"Shashank Ramakrishnan ,&nbsp;Jeremy S Nayagam ,&nbsp;Hannah Kershaw ,&nbsp;Marisa Lanzman ,&nbsp;Brian J Hogan ,&nbsp;Indran Balakrishnan ,&nbsp;Alex J Kew ,&nbsp;Rachel H Westbrook","doi":"10.1016/j.liver.2025.100308","DOIUrl":"10.1016/j.liver.2025.100308","url":null,"abstract":"<div><div>Antibiotic allergy labels (AAL), particularly to penicillin, are common among liver transplant (LT) recipients and can compromise antimicrobial stewardship and increase the risk of multidrug-resistant infection. We retrospectively reviewed adult LT recipients over 12 months to determine the prevalence of AAL and antibiotic use, and piloted a pharmacist- and microbiologist-led delabelling pathway for low-risk patients. Among 83 LT recipients, AAL prevalence was 20%, with 12% reporting penicillin allergy and no prior delabelling attempts identified. Patients were screened weekly on a 31-bed hepatopancreaticobiliary ward, and 14 patients (age 35–83 years) were safely delabelled, including nine with liver disease (five of whom were transplant patients). All drug provocation tests were negative and no adverse events occurred. This pilot demonstrates the feasibility and safety of a microbiologist-led penicillin delabelling pathway within a ward based liver transplant programme. To our knowledge, this is the first UK example of such a protocol integrated within a transplant hepatology service, complementing emerging international data supporting antibiotic allergy delabelling in transplant and immunocompromised populations.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"21 ","pages":"Article 100308"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating current efficiency of normothermic machine perfusion in donation after circulatory death liver transplantation amidst widespread utilization","authors":"Daniel M Kaufman ,&nbsp;Philip B Vutien ,&nbsp;James D Perkins ,&nbsp;Lena Sibulesky","doi":"10.1016/j.liver.2025.100304","DOIUrl":"10.1016/j.liver.2025.100304","url":null,"abstract":"<div><h3>Background</h3><div>Normothermic machine perfusion (NMP) has shown promise in improving outcomes for donation after circulatory death (DCD) liver transplants, but published data is dominated by clinical and single center trials. As US transplantation community gains widespread experience with NMP, it is imperative to continuously evaluated NMP efficiency over static cold storage (SCS).</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of DCD liver transplants from 2016 to 2023, dividing data into two eras: pre-2023 and 2023. Demographic data revealed the change in donor and recipient selection over these two time periods. Cox proportional hazards models on propensity score data analyzed the current benefit of NMP over SCS.</div></div><div><h3>Results</h3><div>In the later era, grafts selected for NMP were increased risk donors with increased agonal time. Despite using high-risk grafts in the later era, NMP still had significantly improved graft survival and there was a lower incidence of diffuse cholangiopathy but not significantly improved patient survival over SCS.</div></div><div><h3>Conclusions</h3><div>As transplant programs’ NMP utilization increases by expanding the selection criteria and increasing the agonal time of donors, NMP still has significantly better graft survival than SCS. Continued evaluation of NMP is essential to determine its efficiency over SCS and a first step in accurate cost-effectiveness studies.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"21 ","pages":"Article 100304"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145529486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep learning for non-invasive NAFLD detection and staging: A comprehensive review","authors":"Priyanka Sengar,&nbsp;Jagendra Singh,&nbsp;Abhay Bansal","doi":"10.1016/j.liver.2026.100318","DOIUrl":"10.1016/j.liver.2026.100318","url":null,"abstract":"<div><div>Non-alcoholic fatty liver disease (NAFLD), a prevalent chronic liver condition, demands accurate, non-invasive diagnostics to replace invasive liver biopsies for staging steatosis, non-alcoholic steatohepatitis (NASH), and fibrosis. Deep learning (DL) has demonstrated transformative potential in enhancing diagnostic accuracy and efficiency by leveraging ultrasound (US) imaging, elastography, and clinical/serological data. This systematic review analyzes 64 studies from 2015 to 2025, retrieved from multiple scholarly databases, to evaluate DL models for NAFLD detection and quantification. The reviewed models, primarily leveraging convolutional neural networks (CNNs) and multimodal data integration, achieve high diagnostic accuracy (AUC &gt; 0.90) and generalizability in detecting and staging NAFLD. Ablation studies highlight the critical role of multimodal inputs and advanced architectures in improving performance. However, gaps such as limited diverse datasets, scarce prospective validations, and poor model explainability persist. Opportunities include developing explainable AI (XAI), federated learning for multi-institutional collaboration, and integration with telemedicine for scalable diagnostics. These findings suggest that DL-based systems can significantly reduce biopsy dependency, enhance early detection, and improve clinical outcomes, provided interdisciplinary efforts address existing challenges.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"21 ","pages":"Article 100318"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of hepatitis B recurrence in liver transplant recipients in Vietnam","authors":"Van Quang Vu,&nbsp;Cam Linh Le,&nbsp;Van Thanh Le,&nbsp;Van Linh Ho,&nbsp;Hoang Ngoc Anh Nguyen","doi":"10.1016/j.liver.2025.100300","DOIUrl":"10.1016/j.liver.2025.100300","url":null,"abstract":"<div><h3>Introduction</h3><div><strong>:</strong> Hepatitis B virus (HBV) is a global public health challenge and a leading cause of end – stage liver disease requiring transplantation. However, HBV recurrence after transplantation can significantly compromise graft function and patient survival. In the context of limited healthcare resources, evaluating the recurrence rate and the current status of prophylactic strategies is essential.</div></div><div><h3>Methods</h3><div><strong>:</strong> A cross-sectional descriptive study was conducted at the 108 Military Central Hospital (Vietnam) involving 126 patients who underwent LT due to HBV-related liver diseases. Data collected included pre- and post-transplant laboratory results (HBsAg, HBeAg, Anti-HBs, Anti-HBc IgG/IgM, and HBV-DNA) and information regarding prophylactic regimens (use of Hepatitis B Immunoglobulin [HBIG] and nucleos(t)ide analog [NA]).</div></div><div><h3>Results</h3><div><strong>:</strong> Male patients accounted for 89.7 %, with a mean age of 54.2 ± 10.8 years. The average follow-up duration after transplantation was 34.4 ± 20.1 months. HCC was the most common indication for LT (48.4 %). The HBV recurrence rate was 11.1 %. Short-term HBIG prophylaxis following transplantation, in combination with long-term NA therapy, has demonstrated effectiveness in preventing HBV recurrence in this patient population. Notably, only 25.4 % of patients were Anti-HBs positive, raising concerns about long-term immunological protection. The use of appropriately dosed HBIG in combination therapy, tailored according to high- and low-risk HBV recurrence groups, should be considered to optimize antibody levels in this patient population, as maintaining HBIG therapy remains a major challenge due to financial burden and supply shortages in Vietnam.</div></div><div><h3>Conclusion</h3><div><strong>:</strong> Oral NA therapy remains an effective prophylactic approach for preventing HBV recurrence after LT, particularly in the context of significant challenges associated with HBIG availability in Vietnam. Strategies to enhance post-transplant Anti-HBs titers – such as selective dosing of HBIG administration – should be considered in long-term post-transplant care.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"21 ","pages":"Article 100300"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145529488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding the donor pool: Outcomes of liver transplantation using grafts with ≥50% macrosteatosis","authors":"Kasra Shirini,&nbsp;Shani S. Kamberi,&nbsp;Srinivasan Muthukrishnan,&nbsp;Omar Alattar,&nbsp;Ruchin Patel,&nbsp;Francheska Nieves,&nbsp;Massimo Arcerito,&nbsp;Josue Alvarez-Casas,&nbsp;Saad Malik,&nbsp;Kirti Shetty,&nbsp;Daniel G. Maluf,&nbsp;Chandra Bhati,&nbsp;Raphael P.H. Meier","doi":"10.1016/j.liver.2025.100311","DOIUrl":"10.1016/j.liver.2025.100311","url":null,"abstract":"<div><div>Liver grafts with over 50% macrosteatosis are often deemed marginal, but organ shortages necessitate exploring their use. We conducted five transplants with deceased donor grafts containing 50%–90% macrosteatosis, ensuring donor age &lt;55 years, CIT ≤6 hours, and recipient laboratory MELD score ≤30. Two patients required reoperations due to thrombotic complications (acute HAT and PVT), and hospital stay ranged from 6 to 26 days. All patients survived beyond one year with functioning grafts. These findings suggest the feasibility of using high-macrosteatosis grafts in intermediate- to low-laboratory-MELD recipients, albeit with potential thrombotic risks.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"21 ","pages":"Article 100311"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145749993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autologous liver cells mini liver implant for liver cirrhosis treatment: A phase II single center controlled trial","authors":"Hans Ulrich Baer ,&nbsp;Andri Sanityoso Sulaiman ,&nbsp;Nunuk Tri Wahyuni ,&nbsp;Barlian Sutedja ,&nbsp;Peter Ian Limas ,&nbsp;Olivia Marcelina ,&nbsp;Jennifer Lheman ,&nbsp;Nuraeni ,&nbsp;Clement Drew ,&nbsp;Siufui Hendrawan","doi":"10.1016/j.liver.2025.100314","DOIUrl":"10.1016/j.liver.2025.100314","url":null,"abstract":"<div><h3>Background</h3><div>Liver cirrhosis represents a major healthcare burden, with its prevalence continuing to rise. While orthotopic liver transplantation (OLT) remains to be the only treatment, persistent shortage of donor organ contributes to significant waitlist mortality. Hepatocyte transplantation offers a regenerative approach as a bridging therapy to OLT. However, transplantation through portal vein infusion often ends with poor cell engraftment and allogeneic rejection. Herein, we designed a mini liver implant, composed of a 3-dimensional biodegradable poly-<span>l</span>-lactic acid matrix carrying autologous hepatocyte and islets.</div></div><div><h3>Methods</h3><div>A phase II clinical trial was conducted in patients with liver cirrhosis to receive either a mini liver implant or standard treatment (control group). Liver stiffness and steatosis were measured by FibroScan® at baseline, 6-, and 12-months after implantation. Child-Pugh score, MELD (Model for End-stage Liver Disease) score, serum albumin, and other biochemical parameters were assessed at baseline, 2-, 4-, 6-, and 12-months.</div></div><div><h3>Results</h3><div>The implant group demonstrated a progressive reduction in liver stiffness from 19.23 kPa at baseline to 15.33 kPa at 12 months (20.28 % decrease), although not statistically significant. The control group showed worsen liver stiffness from 25.92 kPa to 62.22 kPa (140.05 % increase). Other hepatic parameters, including steatosis, albumin, and liver enzymes, showed no significant differences between groups. The implant was well tolerated with only mild adverse events reported. Overall survival was comparable between both groups.</div></div><div><h3>Conclusions</h3><div>While larger studies are required to confirm efficacy, autologous mini liver implantation shows promise as a regenerative therapy that could delay or complement liver transplantation.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"21 ","pages":"Article 100314"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary artery calcium score on chest computed tomography in liver transplant candidates: A retrospective study of diagnostic performance and risk stratification","authors":"Matthanja Bieze ,&nbsp;Eduarda Schutz Martinelli ,&nbsp;Jônatas Fávero Prietto dos Santos ,&nbsp;Selene Perez Martinez ,&nbsp;Cristopher Araya ,&nbsp;Stella Wang ,&nbsp;Carla Luzzi ,&nbsp;Elmar Jaeckel ,&nbsp;Cheryl Borosz ,&nbsp;Elsie T Nguyen ,&nbsp;Stuart A McCluskey","doi":"10.1016/j.liver.2025.100301","DOIUrl":"10.1016/j.liver.2025.100301","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiac risk assessment in liver transplantation (LT) candidates is challenging as non-invasive tests have low sensitivity for detecting significant coronary artery disease (CAD), often necessitating coronary angiography (CAG). This study examined less invasive qualitative coronary artery calcium (CAC) scoring, major adverse cardiac events (MACE), coronary angiography findings, and health system outcomes after LT.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of adult LT recipients. Two radiologists independently classified CAC on chest CT as absent (0), mild (1), moderate (2), or severe (3). The primary endpoint was MACE (myocardial infarction, cardiac arrest, cardiac death). Secondary endpoints included CAD severity on CAG, and health system outcomes. Logistic regression and log-transformed linear regression were used.</div></div><div><h3>Results</h3><div>Among 982 LT patients, 477 underwent chest CT and 394 CAG. Median age was 61 years; MELDNa 15. CAC distribution was CAC0 185 (38.8 %), CAC1 110 (23.1 %), CAC2 96 (20.1 %), CAC3 86 (18.0 %). CAC correlated with CAG (sensitivity 91 %, specificity 64 %). MACE occurred in 8 (1.7 %). CAC severity was not associated with MACE or health system outcomes.</div></div><div><h3>Conclusion</h3><div>In LT candidates, low CAC indicated low CAD risk. However, MACE occurred without CAD, underscoring multifactorial perioperative cardiac risk and the potential value of chest CT in comprehensive pre-transplant evaluation.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"21 ","pages":"Article 100301"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145580410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subclinical right ventricular dysfunction in NASH does not impact post-liver transplant survival: Insights from echocardiographic strain imaging","authors":"Tanvi Nayak ,&nbsp;Nausheen Akhter ,&nbsp;Bernadette Puleo ,&nbsp;Inga Vaitenas ,&nbsp;Abigail Baldridge ,&nbsp;Kameswari Maganti","doi":"10.1016/j.liver.2025.100294","DOIUrl":"10.1016/j.liver.2025.100294","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular complications are a leading cause of morbidity following liver transplantation (LT), especially in patients with non-alcoholic steatohepatitis (NASH). We assessed changes in cardiac mechanics pre- and post-LT and evaluated the association between NASH etiology, myocardial strain, and long-term survival.</div></div><div><h3>Methods</h3><div>We retrospectively studied 50 consecutive adult LT recipients from 2009 to 2012 at a single academic center. Of these, 27 patients had high-quality transthoracic echocardiograms before and one year after LT. We assessed electrocardiographic and echocardiographic parameters, including left ventricular (LV) ejection fraction (EF), global longitudinal strain (GLS), and right ventricular (RV) free wall strain. Associations were evaluated using <em>t</em>-tests, linear regression, and Kaplan-Meier survival analysis.</div></div><div><h3>Results</h3><div>1 year following LT, QRS duration, mitral E velocity, tissue Doppler velocities (septal and lateral e′), and septal s′ were significantly reduced, indicating a decline in diastolic and longitudinal systolic function. LV GLS decreased from 19.2 % to 16.2 % (<em>p</em> = 0.0002), and RV free wall strain declined from 20.5 % to 19.0 % (<em>p</em> = 0.02). Amongst the various etiologies leading to LT, NASH was associated with significantly reduced RV free wall strain (β: -5.23 %; 95 % CI: -9.85 to -0.62), but not with other cardiac parameters or post-LT survival. No differences in 10-year survival were observed based on NASH status or baseline strain.</div></div><div><h3>Conclusion</h3><div>Cardiac mechanics demonstrate a reduction in biventricular function despite a normal LV ejection fraction and RV fractional area change at 1 year following LT. NASH cirrhosis is associated with subclinical RV dysfunction, but this does not appear to affect long-term post-LT survival. Larger studies are warranted to clarify the prognostic role of myocardial strain in liver transplantation.</div></div><div><h3>Impact and implications</h3><div>As NASH is now a leading indication for liver LT, there is a critical need to understand its cardiovascular impact, particularly in the context of post-transplant outcomes. This study demonstrates that while NASH is associated with subclinical RV dysfunction as evaluated by strain imaging, these abnormalities do not significantly impact long-term survival following LT. These findings are important for transplant physicians and cardiologists evaluating LT candidates. Incorporating echocardiographic strain imaging into pre- and post-LT assessments could enhance cardiovascular risk stratification and enable patient-centric monitoring; however, further prospective studies in larger, diverse cohorts are warranted before widespread adoption.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"20 ","pages":"Article 100294"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Portopulmonary hypertension in liver transplant candidates: Echocardiographic screening, prevalence, and long-term outcomes","authors":"Ömer Bedir ,&nbsp;Halit Ziya Dündar ,&nbsp;Ekrem Kaya ,&nbsp;Murat Kıyıcı ,&nbsp;Dilek Yeşilbursa","doi":"10.1016/j.liver.2025.100296","DOIUrl":"10.1016/j.liver.2025.100296","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction and Objectives&lt;/h3&gt;&lt;div&gt;Portopulmonary hypertension (PoPH) represents a significant pulmonary vascular complication in patients with portal hypertension, substantially increasing perioperative mortality during liver transplantation (LT). While systematic transthoracic echocardiographic (TTE) screening has become standard practice, optimal diagnostic thresholds and prevalence data across diverse populations remain incompletely characterized. This investigation sought to determine the prevalence of PoPH among LT candidates at a tertiary hepatology center, comprehensively characterize the clinical and hemodynamic profiles of affected patients, and evaluate the diagnostic efficacy of TTE screening protocols.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients or Materials and Methods&lt;/h3&gt;&lt;div&gt;We conducted a comprehensive retrospective analysis of 422 consecutive LT candidates with portal hypertension evaluated at our tertiary center between 2007–2017. All patients underwent systematic TTE, with right heart catheterization (RHC) performed when right ventricular systolic pressure (RVSP) exceeded 40 mmHg or when indirect pulmonary hypertension indicators were present. PoPH was defined according to currently established hemodynamic criteria: mean pulmonary arterial pressure &gt;20 mmHg, pulmonary vascular resistance &gt;2 Wood units, and pulmonary arterial wedge pressure ≤15 mmHg.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 422 patients (mean age 52.9 ± 12.3 years, 67.5 % male), chronic hepatitis B predominated (35.1 %). Fifty-two patients underwent RHC, with twenty (4.74 % of total cohort) receiving definitive PoPH diagnosis. PoPH patients demonstrated significantly higher pulmonary vascular resistance (3.51 ± 1.90 vs 1.25 ± 1.02 Wood units, &lt;em&gt;p&lt;/em&gt; &lt; 0.001), and transpulmonary gradient (18.05 ± 9.28 vs 9.56 ± 8.43 mmHg, &lt;em&gt;p&lt;/em&gt; = 0.001), while reduced pulmonary arterial wedge pressure (9.45 ± 1.73 vs 13.53 ± 4.81 mmHg, &lt;em&gt;p&lt;/em&gt; &lt; 0.001), cardiac output (5.21 ± 0.95 vs 7.57 ± 1.38 L/min, &lt;em&gt;p&lt;/em&gt; &lt; 0.001), and cardiac index (2.97 ± 0.98 vs 4.15 ± 0.85 L/min/m², &lt;em&gt;p&lt;/em&gt; = 0.023) compared to non-PoPH patients. Targeted pulmonary vasodilator therapy was initiated in three patients with mean pulmonary arterial pressure ≥35 mmHg, with two severe cases successfully bridged to LT following demonstrable hemodynamic improvement. The 40 mmHg TTE threshold demonstrated robust diagnostic performance characteristics: 95.0 % sensitivity, 93.5 % specificity, 42.2 % positive predictive value, 99.7 % negative predictive value, with positive and negative likelihood ratios of 14.7 and 0.05, respectively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;PoPH affects 4.74 % of LT candidates with portal hypertension using contemporary diagnostic criteria. Systematic TTE screening employing a 40 mmHg threshold for RVSP effectively identifies patients requiring further hemodynamic assessment, with exceptional negative predictive value enabling confident exclusion o","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"20 ","pages":"Article 100296"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145106683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The current status of CMV prophylaxis and treatment in liver transplant recipients: A single center study","authors":"W. Gaya Shivega ,&nbsp;Ali Olyaei ,&nbsp;Madelaine A. Hack ,&nbsp;Pushpa Neppala ,&nbsp;George Zak ,&nbsp;Alexandra Bolognese ,&nbsp;C. Kristian Enestvedt ,&nbsp;Erin Maynard ,&nbsp;Willscott E. Naugler ,&nbsp;David L. Scott ,&nbsp;Oren Shaked ,&nbsp;Elizabeth Swanson ,&nbsp;Lynne Srasfeld ,&nbsp;David C. Woodland ,&nbsp;Christopher R. Connelly","doi":"10.1016/j.liver.2025.100299","DOIUrl":"10.1016/j.liver.2025.100299","url":null,"abstract":"<div><h3>Study Purpose</h3><div>Cytomegalovirus (CMV) is a common opportunistic viral infection among liver transplant (LT) recipients. This study evaluated the status of current CMV prophylaxis, treatment and associated antiviral side effects in LT patients.</div></div><div><h3>Procedures</h3><div>This single-center, retrospective study of 570 adult LT recipients from January 1, 2013, to December 31, 2023 compared CMV infection, disease, antiviral side effects and survival among high- (<em>D</em>+/R-, <em>n</em> = 157), intermediate- (D-/<em>R</em>+, <em>D</em>+/<em>R</em>+, <em>n</em> = 341), and low-CMV risk patients (D-/R-, <em>n</em> = 72). Maintenance immunosuppression was tacrolimus, mycophenolate or azathioprine (Imuran), and prednisone. High-risk patients received valganciclovir 900 mg daily for 6 months, and intermediate-risk patients received valganciclovir 450 mg daily for 3 months. Low-risk recipients received acyclovir 400 mg BID for 3 months.</div></div><div><h3>Findings</h3><div>Overall, 92 (16 %) patients developed CMV infection, and 64 (11 %) developed CMV disease. The high-risk group had the highest rates of CMV infection (50.3 % vs. 3.2 % vs. 2.8 %; <em>p</em> &lt; 0.001) and disease (37.6 % vs. 1.2 % vs. 1.4 %; <em>p</em> &lt; 0.001) compared to intermediate- and low-risk groups. Of those with CMV disease, 90.6 % received antiviral treatment, while 9.4 % resolved their disease without treatment. During prophylaxis, the high-risk group experienced higher rates of leukopenia (65.6 % vs. 45.7 % vs. 18.1 %; <em>p</em> &lt; 0.001), antiviral-associated neutropenia (AAN; 48.4 % vs. 16.1 % vs. 8.3 %; <em>p</em> &lt; 0.001), and uptrend in AAN requiring G-CSF (28.0 % vs. 8.7 % vs. 2.8 %; <em>p</em> = 0.802). Notably, more intermediate-risk recipients developed AAN requiring G-CSF during prophylaxis than developed CMV disease (8.7 % vs. 1.2 %).</div></div><div><h3>Conclusion</h3><div>This study demonstrates the need for revised antiviral prophylactic and treatment algorithms that effectively manage CMV disease while minimizing antiviral side effects such as AAN.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"20 ","pages":"Article 100299"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145424782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}