Journal of Liver Transplantation最新文献

{"title":"A statistical model to determine the optimal bone mineral density (BMD) screening schedule in liver transplant recipients","authors":"Harish Reddy Koyya ,&nbsp;Elijah Meredith ,&nbsp;Farid Gharehmohammadi ,&nbsp;Mahmoud Elmahdy ,&nbsp;Ronnie Sebro","doi":"10.1016/j.liver.2025.100295","DOIUrl":"10.1016/j.liver.2025.100295","url":null,"abstract":"<div><h3>Background</h3><div>The American Association for the Study of Liver Diseases (AASLD) and the American Society of Transplantation (AST) 2012 practice guidelines based on expert opinion provide surveillance frequency guidelines for dual-energy X-ray absorptiometry (DXA) bone mineral density (BMD) scans after liver transplant (LT). Since then, post-transplant immunosuppression has changed. This study aims to use statistical models to identify the optimal DXA surveillance frequency after LT.</div></div><div><h3>Materials and Methods</h3><div>This study retrospectively evaluated 402 LT recipients followed for up to 8 years post-LT, each with at least one pre-LT and two post-LT DXA scans. Linear mixed-effects (LME) models using random slopes and intercepts were used to identify whether BMD decline was linear or non-linear (quadratic) in time. Multivariate LME models were used to model the decline in femoral neck (FN), total hip (TH), and L1-L4 BMD decline after LT adjusting for demographic and clinical variables.</div></div><div><h3>Results</h3><div>Males had higher pre-LT BMD than females (P&lt;0.001 at all sites). The rate of BMD loss was fastest at the FN, and faster in patients with normal pre-LT BMD than in patients with low pre-LT BMD (osteopenia/osteoporosis). The model predicted that there would be a significant FN BMD decrease in patients with normal pre-LT BMD after approximately 481 days post-LT (1 year, 3 months).</div></div><div><h3>Conclusion</h3><div>LT recipients with normal pre-LT BMD should have DXA scans ∼481 days post-LT. LT recipients with low BMD pre-LT who were more likely to be treated with bisphosphonates did not need annual DXA screening.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"20 ","pages":"Article 100295"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145106682","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":"Renal resistive index as a predictor of acute kidney injury in patients undergoing living donor liver transplantation—a prospective observational study","authors":"Gangaiah K ,&nbsp;Balasubramanian B ,&nbsp;Anand U S ,&nbsp;Kutnikar J V ,&nbsp;Sam A F ,&nbsp;Rajakumar A ,&nbsp;Rela M","doi":"10.1016/j.liver.2025.100293","DOIUrl":"10.1016/j.liver.2025.100293","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of acute kidney injury (AKI) following liver transplantation ranges from 40 % to 60 %. Early prediction or diagnosis of AKI could significantly enhance patient outcomes. Our study aimed to determine the role of the Renal Resistive Index (RRI) via ultrasound-Doppler imaging in predicting AKI and identifying other potential factors associated with it.</div></div><div><h3>Methodology</h3><div>We conducted a single-center, prospective study involving 78 subjects who underwent adult living donor liver transplantation (LDLT) between March 2023 and December 2023. Ultrasound Doppler RRI was measured preoperatively and then daily until postoperative day (POD) 5.</div></div><div><h3>Results</h3><div>Patients who developed AKI within the first 5 POD showed an increasing RRI on POD1, while others experienced a gradual decline in RRI following LT. In our study, preoperative RRI predicted AKI on POD1 with an area under the curve (AUC) of 0.67 at a cut-off of ≥0.68. Moreover, POD2 RRI predicted AKI on POD3 with a superior AUC of 0.87 at the same cut-off. Given the proximity of the median to the optimal cutoff point, we explored expressing the values as relative renal resistance and calculated the ratio between RRI and the Hepatic artery resistive index, referred to as the RH ratio. Our findings indicate that the POD2 RH ratio predicted AKI on POD3 with an AUC of 0.71 at a cut-off of ≥0.90. The incidence of AKI on POD3 was 41.7 % when the POD2 RRI was ≥0.68 and 27.5 % when the POD2 RH ratio was ≥0.9. When both the RH ratio and RRI exceeded their respective cutoff values on POD2, the incidence of POD3 AKI was 52.9 %.</div></div><div><h3>Conclusion</h3><div>RRI measurement via Doppler is a noninvasive, simple bedside procedure that can predict AKI in the immediate postoperative period after LDLT.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"20 ","pages":"Article 100293"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989923","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":"Endovascular management of venous complications post liver transplantation: a retrospective analysis of technical and clinical success","authors":"Kheng Song Leow ,&nbsp;Sebastian Mafeld ,&nbsp;Abdul Aziz Qazi ,&nbsp;Arash Jaberi ,&nbsp;Kong Teng Tan","doi":"10.1016/j.liver.2025.100298","DOIUrl":"10.1016/j.liver.2025.100298","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the technical and clinical success of percutaneous endovascular management of venous complications post liver transplantation (LT).</div></div><div><h3>Materials and methods</h3><div>This single-center retrospective study analyzed 16 patients who underwent endovascular treatment for post-LT venous complications at a quaternary referral center between January 2019 and December 2023. The analysis evaluated technical success (&lt;30 % residual stenosis), clinical success (symptom resolution or improvement), target vessel patency and organ preservation (Olthoff criteria) at 6 and 12 months.</div></div><div><h3>Results</h3><div>The cohort included 16 patients (male:female ratio 9:7, median age 50 years), including 12 recipients from deceased donors and 4 from living donors. Technical success was achieved in 100 % (16/16) of cases, with clinical success in 87.5 % (14/16). Target vessel patency was maintained in 81.3 % (13/16) at both 6 and 12 months. Organ preservation was achieved in 93.8 % (15/16) at both 6 and 12 months. Procedure-related complications occurred in two patients: one managed endovascularly and one conservatively. One non-procedure-related complication was successfully managed endovascularly.</div></div><div><h3>Conclusion</h3><div>Percutaneous endovascular treatment is a relatively safe and effective approach for post-LT venous complications, demonstrating high technical success rates and favorable clinical outcomes.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"20 ","pages":"Article 100298"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145332269","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 impact of temperature ranges on liver machine perfusion and development of combined perfusion protocols","authors":"Sophie Ann Kupiec-Weglinski,&nbsp;Juan C. Reyna,&nbsp;Tammy T. Chang","doi":"10.1016/j.liver.2025.100297","DOIUrl":"10.1016/j.liver.2025.100297","url":null,"abstract":"<div><div>Liver machine perfusion is being rapidly adopted in many parts of the world to improve transplant outcomes and increase the pool of donor grafts. Machine perfusion appears to be particularly effective in expanding the use of extended criteria donor grafts by reducing and/or assessing the impact of ischemia-reperfusion injury on post-transplant graft function. There are 3 main temperature categories for liver machine perfusion: normothermic (37 °C), hypothermic (2–10 °C), and subnormothermic (20–25 °C). Each mode has advantages, disadvantages, and distinct beneficial effects on liver graft function. It is currently unknown which temperature range of perfusion is most effective with respect to improving extended criteria donor graft performance. Because periods of static cold storage (0–4 °C) may still be required, it is also unclear how to transition liver grafts through these perfusion temperature zones in a way that minimizes ischemia-reperfusion injury related to abrupt shifts in temperature. Moreover, perfusate requirements differ for each perfusion modality and temperature range. In this review, we discuss evidence that gradual temperature transitions that combine perfusion approaches may further improve outcomes for extended criteria liver grafts. We highlight unique considerations at each temperature range, approaches to transition between temperature zones, and temperature-dependent perfusate constraints. We propose that as liver machine perfusion gains widespread clinical implementation, the next phase of machine perfusion development will entail the optimization of combined perfusion protocols that efficiently traverse temperature ranges.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"20 ","pages":"Article 100297"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158380","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 the demographics of patients transplanted for alcohol-related liver disease: A retrospective and prospective longitudinal cohort study","authors":"Ella M Shanahan,&nbsp;Trana Hussaini,&nbsp;Benjamin Cox,&nbsp;Daljeet Chahal,&nbsp;Vladimir Marquez","doi":"10.1016/j.liver.2025.100288","DOIUrl":"10.1016/j.liver.2025.100288","url":null,"abstract":"&lt;div&gt;&lt;div&gt;Alcohol-related liver disease (ALD) is among the top three indications for orthotopic liver transplantation (OLT). A period of abstinence of 6 months was previously required in British Columbia (BC) before being considered for listing for liver transplantation. The liver transplant program in BC abandoned this rule in 2019. We aimed to evaluate if there was a change in characteristics of patients referred for liver transplant following removal of an mandatory abstinence period. We conducted a longitudinal cohort study with both retrospective and prospective arms on data obtained from the BC transplant database. Outcomes of interest included transplant, discharge or death and documented alcohol relapse. We compared the 5 years prior to the change in criteria to the following 5 years. From January 2014 to May 2024 there were 1005 referrals. Changes were noted in the mean age of referral (57 vs 52), proportion of women (32 % pre change vs 40 % post change) and First Nations patients referred (4.6 % vs 13.8 %). Relapse proportions were similar pre and post change but the median time to relapse was shorter post-change. Removing a mandatory sixth month abstinence period improved referrals for First Nations patients, women and younger patients with similar outcomes demonstrated.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Alcohol-related liver disease (ALD) is among the top three indications for orthotopic liver transplantation (OLT) in British Columbia (BC). A period of abstinence of 6 months was previously required before being considered for listing for liver transplantation. The liver transplant program in BC opted in May 2019 to abandon the six month rule, and to base their decision on a multidisciplinary evaluation of the risk of alcohol relapse.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Aims&lt;/h3&gt;&lt;div&gt;The purpose of this study is to evaluate if there has been a change in characteristics of patients referred for liver transplant for alcohol related liver disease in British Columbia following removal of a six month period of abstinence.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Method&lt;/h3&gt;&lt;div&gt;We conducted a longitudinal cohort study with both retrospective and prospective arms on data obtained from the BC transplant database. Patients of any age referred for liver transplant evaluation for alcohol related liver disease were included. Outcomes of interest included transplant, discharge or death and documented alcohol relapse. We compared the 5 years prior to the change in criteria to the following 5 years.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;From January 2014 to May 2024 there were 1005 referrals. The mean age at referral pre-change was 57 vs 52 post-change. 32 % of referrals were female pre- whilst 40 % were female post-change. The proportion of First Nations patients referred for assessment was 4.6 % pre 2019 and 13.8 % post 2019. No differences in proportion of women transplanted or mean age at transplant was found. There was a clinically significant increase in the proportion of Fi","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"19 ","pages":"Article 100288"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652989","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":"Alpha-1 antitrypsin deficiency-associated liver disease: A review focusing on new assessment tools and therapies","authors":"Luca Marzi ,&nbsp;Ilaria Ferrarotti ,&nbsp;Federica Benini ,&nbsp;Andrea Mega ,&nbsp;Luisa Siciliani","doi":"10.1016/j.liver.2025.100287","DOIUrl":"10.1016/j.liver.2025.100287","url":null,"abstract":"<div><div>Alpha-1-antitrypsin deficiency (AATD) is an autosomal codominant genetic disorder, often going undiagnosed. AATD results from malformed or deficient AAT proteins, which predispose individuals to obstructive pulmonary disease and liver disease. The PI*ZZ genotype is the most common and severe, but even milder genotypes like PI*SZ and PI*MZ can lead to lung and liver disease, particularly when combined with metabolic disfunction. The rate ranges of ZZ liver-related mortality are 10 to 40 %. Despite ongoing clinical trials, there is currently no approved therapy for AATD-associated liver disease (AATD-LD), and liver transplantation remains the only curative option. AATD-LD can progress slowly for decades, with contributing factors such as metabolic dysfunction-associated steatotic liver disease, alcohol use, and hepatitis accelerating disease progression. Moreover, these factors complicate the accurate diagnosis of AATD-LD. To date, data on blood markers or non-invasive markers for monitoring and predicting the evolution of AATD-LD are few and not as numerous as for other liver diseases. Moreover, a correct staging of the patient is important not only for the follow-up of the patient but also to evaluate the inclusion of the patient in experimental protocols. This review aims to evaluate non-invasive techniques for monitoring the AATD-LD.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"19 ","pages":"Article 100287"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144588297","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":"Psychological screening and follow-up care for living liver donors: 5-year prospective cohort data from a single academic center","authors":"Leonieke Kranenburg ,&nbsp;Alicia Chorley ,&nbsp;Emma Massey ,&nbsp;Hayo ter Burg ,&nbsp;Robert Minnee ,&nbsp;Markus Boehnert","doi":"10.1016/j.liver.2025.100281","DOIUrl":"10.1016/j.liver.2025.100281","url":null,"abstract":"<div><h3>Aim</h3><div>This study reports on the outcomes of psychological screening and care for all living donor candidates who entered our center’s program since the start in 2018, and is the first study to evaluate the use of the ELPAT Psychosocial Assessment Tool (EPAT) for this population.</div></div><div><h3>Methods</h3><div>All donor candidates were screened using the ELPAT Psychosocial Assessment Tool (EPAT), consisting of a structured interview with set topics and a combination of validated questionnaires. Reports of the interviews were retrieved form the medical records and analysed per topic. Data from the questionnaires were analysed with existing cut-off scores. An independent samples <em>t</em>-test was used to compare means of related versus unrelated donors. Data on additional pre- or post donation psychological treatment was retrieved from the medical records.</div></div><div><h3>Results</h3><div>137 donor candidates underwent psychology screening for living liver donation. Over half of them had sought professional mental health support and/or used psychotropic drugs in the past. However, the average scores for current anxiety and depression as measures by the questionnaires were low. Unrelated donor candidates had statistically significant lower scores on emotional support and anxiety. Of all candidates, 2 were declined for psychological reasons; 53 eventually donated part of their liver, and of these, 15 received additional psychological treatment.</div></div><div><h3>Discussion</h3><div>The EPAT is a useful tool for living liver donor screening, covering all important psychological domains. Providing psychological treatment on indication proved to be a feasible way for this group to deal with potential psychological complaints during the process.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"19 ","pages":"Article 100281"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144098523","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":"Graft versus host disease after liver transplantation: A single center case series","authors":"Erin Horsfall ,&nbsp;Peter Browett ,&nbsp;Amanda Charlton ,&nbsp;Edward Gane","doi":"10.1016/j.liver.2025.100282","DOIUrl":"10.1016/j.liver.2025.100282","url":null,"abstract":"<div><h3>Background</h3><div>Graft-versus-host disease (GVHD) after liver transplantation (LT) is a rare and usually fatal complication. Recent advances in diagnosis and treatment have improved outcomes. Understanding pre and post-transplant risk factors, early clinical features, and targeted treatment strategies are vital for optimal management.</div></div><div><h3>Methods</h3><div>We conducted a retrospective case series of GVHD after LT in the New Zealand Liver Transplant Unit (NZLTU). Patients were identified from a prospectively maintained database and clinical data were analyzed to assess risk factors, clinical presentations, treatments, and outcomes.</div></div><div><h3>Results</h3><div>Among the 873 LT recipients, six (0.7 %) developed GVHD. The median time of GVHD was 37 days post transplantation, usually presenting with skin and gastrointestinal involvement. Initial management involved immunosuppression reduction and corticosteroid therapy, with refractory cases being treated with ruxolitinib or basiliximab. The overall mortality rate was 66 %. Liver re-transplantation was pursued in one case following GVHD remission, which was complicated by GVHD recurrence after liver re-transplantation, a first-ever reported clinical case.</div></div><div><h3>Conclusions</h3><div>GVHD after LT is associated with significant morbidity and mortality. Prompt recognition, early intervention, and close monitoring are crucial to improve patient outcomes. Early treatment with ruxolitinib should be considered in the treatment of GVHD after LT.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"19 ","pages":"Article 100282"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144071613","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":"Outcomes of SARS-CoV-2 infection in liver transplant recipients of a large volume transplant center in Latin America","authors":"Camila Sotomayor ,&nbsp;Daniel García ,&nbsp;María Elvira Balcells ,&nbsp;Felipe Muñoz ,&nbsp;Karen Muñoz ,&nbsp;María Pilar Domínguez ,&nbsp;Alejandra Cancino ,&nbsp;Rodrigo Wolff ,&nbsp;Francisco Barrera ,&nbsp;Carlos Benítez ,&nbsp;Luis Díaz ,&nbsp;Eduardo Briceño ,&nbsp;Eduardo Viñuela ,&nbsp;Pablo Achurra ,&nbsp;Patricia Rebolledo ,&nbsp;Nicolas Jarufe ,&nbsp;María Magdalena Vera ,&nbsp;Martin Dib ,&nbsp;Jorge A. Martínez","doi":"10.1016/j.liver.2025.100284","DOIUrl":"10.1016/j.liver.2025.100284","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>The COVID-19 pandemic significantly affected liver transplantation (LT) worldwide, with higher mortality observed in patients with chronic diseases. However, the impact of COVID-19 on transplant recipients, particularly those on immunosuppressive therapy, has been variably reported.</div><div>Our center’s historical 90-day LT mortality is 8%, and with waiting list mortality exceeding 35%, we kept our program operational, pausing elective Living Donor Liver Transplant (LDLT) for three months to minimize donor risk.</div><div>This study evaluates LT outcomes during the pandemic, particularly SARS-CoV-2 infection-related mortality, in 104 patients transplanted during the first COVID-19 wave.</div></div><div><h3>Materials and Methods</h3><div>We conducted a retrospective review of patients who underwent LT between January 1, 2020, and December 31, 2021, at our center in Santiago, Chile. All recipients tested negative for SARS-CoV-2 pre-transplant, and COVID-19 cases were tracked postoperatively.</div></div><div><h3>Results</h3><div>Among 104 adult patients, 84% were elective cases, 15% emergency, and 1% re-transplant. The mean age was 56.2 ±12.5; 56% male. The most frequent indications were NAFLD (41%), hepatocarcinoma (23%), autoimmune hepatitis (16%), and alcoholic liver disease (14%). Deceased donors provided 79.8% of the grafts, while living donors accounted for 20.2%. The mean MELD score was 22.5± 9.5. Nineteen recipients (18.3%) acquired postoperative RT-PCR-confirmed SARS-CoV-2 infection; 73.6% were symptomatic, and 26.3 % had early infections. Most had mild symptoms of COVID-19, requiring only symptomatic treatment (10/19; 52.6%). One patient required non-invasive mechanical ventilation (5.3%), and 3 required invasive mechanical ventilation (3/19;15.8%), with mortality in all of them. The overall 90-day post-transplant mortality rate in the cohort was 7.7%. Among non-infected patients, it was 5.9%, while in recipients with SARS-CoV-2 infection, it reached 15.8%. In early infected patients, mortality was 40% (2/5).</div></div><div><h3>Conclusions</h3><div>In conclusion, while SARS-CoV-2 infection significantly affected LT recipients, the post-transplant mortality in infected patients remained lower than waiting list mortality.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"19 ","pages":"Article 100284"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144501650","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 impact of functional status on post-liver transplant outcomes in acute-on-chronic liver failure","authors":"David Uihwan Lee ,&nbsp;Youngjae Cha ,&nbsp;Mohammed Rifat Shaik ,&nbsp;Kuntal Bhowmick ,&nbsp;Andrew Yi ,&nbsp;Andrew Chan ,&nbsp;Nishat Anjum Shaik ,&nbsp;Zainab Mujahid ,&nbsp;Gregory Hongyuan Fan ,&nbsp;Keeseok Lee ,&nbsp;Sindhura Kolachana ,&nbsp;Mohamed Refaat ,&nbsp;Raffi Karagozian","doi":"10.1016/j.liver.2025.100286","DOIUrl":"10.1016/j.liver.2025.100286","url":null,"abstract":"<div><h3>Background and aims</h3><div>Acute-on-Chronic Liver Failure (ACLF) is a severe condition where liver transplantation is often the only definitive treatment. Previous studies have shown an influence of functional status on post-transplant outcomes in patients with advanced chronic liver disease. However, the impact of functional status on outcomes in an ACLF cohort is largely unknown.</div></div><div><h3>Methods</h3><div>The United Network for Organ Sharing (UNOS) Standard Transplant Analysis and Research (STAR) Database was utilized to study LT patients between 1987 and 2019. Patients were categorized by ACLF grades and further divided within each grade based on their level of assistance—no, some, or total—using KPS scores. The primary outcomes assessed were graft failure and all-cause mortality post-transplant. The secondary outcomes assessed were mortality secondary to specific organ system failures.</div></div><div><h3>Results</h3><div>Patients without ACLF requiring some (aHR 1.10, 95 %CI 1.04–1.17, <em>p</em> = 0.002) or total assistance (aHR 1.32, 95 %CI 1.22–1.43, <em>p</em> &lt; 0.001) showed increased risk of all-cause mortality. Those needing total assistance also faced a higher risk of graft failure (aHR 1.34, 95 %CI 1.13–1.58, <em>p</em> &lt; 0.001). However, functional status did not significantly impact post-transplant outcomes across all ACLF grades.</div></div><div><h3>Conclusion</h3><div>Functional status was not a significant predictor of post-transplant outcomes in ACLF patients, regardless of ACLF severity. <em>Poor functional scores in multi-organ failure likely reflect acute critical illness rather than baseline frailty.</em></div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"19 ","pages":"Article 100286"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144596636","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}