Journal of Liver Transplantation最新文献

{"title":"The evolution of liver transplant program in Pakistan and the challenges ahead","authors":"Imran Ali Syed ,&nbsp;Abdullah Khalid ,&nbsp;Bilal Ahmed Khan ,&nbsp;Usman Iqbal Aujla","doi":"10.1016/j.liver.2023.100187","DOIUrl":"https://doi.org/10.1016/j.liver.2023.100187","url":null,"abstract":"<div><h3>Background and aim</h3><p>The burden of Liver disease has significant implications on the healthcare infrastructure in Pakistan, with viral hepatitis being the leading etiology of end-stage liver disease. Liver transplant remains the only curative treatment option for end-stage liver disease. A decade ago, the liver transplant facility was almost non-existent for the Pakistani population, and the patients with end-stage liver disease had to travel overseas to receive liver transplantation. Gradually, during the last decade the country has progressed steeply and achieved various milestones in living donor liver transplantation. Various public and private sector hospitals are providing liver transplant services nationwide. The study aimed to describe the evolution and success of living donor liver transplant programs in Pakistan. We will also discuss the current practices involved in donor and recipient selection, factors related to non-existent deceased donor organ programs, and the introduction of innovative strategies to overcome the shortage of donor organ pools.</p></div><div><h3>Methods</h3><p>We retrospectively analyzed the data of the first 416 living donor liver transplants (LDLTs) performed at PKLI&amp;RC from March 2019 to April 2023. The stepwise approach for the donor and recipient selection process is described in detail, along with the survival outcomes of LDLT at our center.</p></div><div><h3>Results</h3><p>Among the 416 living donor liver transplants performed between March 2019 and April 2023. The Hepatitis C virus was the most common etiology (50.5 %) for chronic liver disease. Hepatocellular carcinoma (HCC) was present in 27.9 % of cases. Most donors were offspring of the recipients, with sons accounting for 23 % and daughters for 17.5 % of cases. Only a single (0.24 %) patient had a deceased donor transplant. The annual donor rejection rate was up to 68 % at our center. Nine SWAP transplants were performed to overcome the donor shortage. The Clavien Dindo classification system was used to grade the severity of complications after donor hepatectomy. No donor mortality (grade-5 complication) was observed in our cohort, whereas 1- and 3-year recipient survival rates were 89 % and 88 %, respectively.</p></div><div><h3>Conclusion</h3><p>Hepatitis C virus remains the most common etiology of chronic liver disease requiring liver transplantation. The major pool of living donations was from first-degree relatives. There was no donor mortality with acceptable 1- and 3-year recipient's survival rates. Living donor liver transplantation is a feasible and safe strategy in regions where cadaveric liver transplant program is limited.</p></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"12 ","pages":"Article 100187"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666967623000491/pdfft?md5=856009dad386d98a2e57fb98724e0dbc&pid=1-s2.0-S2666967623000491-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91964488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of patients with primary sclerosing cholangitis after liver transplantation in a predominantly living donor liver transplant center","authors":"Murat Harputluoglu ,&nbsp;Mehmet Zeki Calgin ,&nbsp;Engin Ataman ,&nbsp;Deniz Tikici ,&nbsp;Koray Kutluturk ,&nbsp;Ramazan Kutlu ,&nbsp;Cumali Savas Efe ,&nbsp;Sezai Yilmaz","doi":"10.1016/j.liver.2023.100186","DOIUrl":"https://doi.org/10.1016/j.liver.2023.100186","url":null,"abstract":"<div><h3>Background and aim</h3><p>The number of studies reporting in detail the complications that occur after liver transplantation in patients with primary sclerosing cholangitis (PSC), especially after living donor liver transplantation (LDLT), is limited. In this study we present the complications and outcomes of PSC patients after liver transplantation in a predominantly LDLT center.</p></div><div><h3>Materials and methods</h3><p>Adult and pediatric patients who underwent liver transplantation for PSC between February 2008 and October 2020 were included in the study. The demographic characteristics, presence of co-existing diseases, indications for transplantation, type of transplantation, and immunosuppressive treatments used were recorded. Patient survival, survival times, cause of death, recurrences, rejection, and biliary complications were recorded.</p></div><div><h3>Results</h3><p>Thirty patients who underwent liver transplantation for PSC were included in the study. Twenty-seven patients (90 %) were living donor transplants. The 1-, 3-, and 5-year survival rates after transplantation were 75.9 %, 74.9 %, and 74.9 %, respectively. Biliary complications occurred in 15 patients (50 %). All patients with biliary complications were successfully treated with endoscopic and percutaneous interventional treatments. Chronic rejection occurred in three patients (10 %) and acute rejection occurred in five patients (13.3 %). PSC recurrence developed in five patients (18.5 %).</p></div><div><h3>Conclusion</h3><p>Biliary complications are the most common complication after liver transplantation in patients with PSC in our center, where LDLT is used extensively and PSC patients are followed closely with respect to biliary complications after transplantation.</p></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"12 ","pages":"Article 100186"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266696762300048X/pdfft?md5=698eb5a6bef4939abe1bc5c064ff6ac6&pid=1-s2.0-S266696762300048X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91964487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early liver transplantation for severe alcohol-associated hepatitis: A single-center experience","authors":"A Asgharpour ,&nbsp;RK Sterling ,&nbsp;E Smirnova ,&nbsp;N Duong ,&nbsp;K Houston ,&nbsp;H Khan ,&nbsp;Keller Nicole ,&nbsp;S Matherly ,&nbsp;J Wedd ,&nbsp;H Lee ,&nbsp;MS Siddiqui ,&nbsp;V Patel ,&nbsp;S Bullock ,&nbsp;S Weinland ,&nbsp;V Kumaran ,&nbsp;S Lee ,&nbsp;A Sharma ,&nbsp;D Imai ,&nbsp;A Kahn ,&nbsp;M Levy ,&nbsp;D Bruno","doi":"10.1016/j.liver.2023.100184","DOIUrl":"https://doi.org/10.1016/j.liver.2023.100184","url":null,"abstract":"<div><p>Liver transplantation (LT) is life-saving for patients with alcohol-associated liver disease (ALD) and severe alcohol-associated hepatitis (SAH). In this retrospective analysis of deceased donor LT from 10/2018 to 4/2022, patients were subdivided into those with ALD with &lt;6 months (M) or &gt;6 M sobriety vs. non-ALD etiologies of liver disease. Patients with &lt;6 M sobriety were further stratified into those meeting the NIAAA criteria for SAH. Of the 367 LT, ALD comprised 171(47 %) of all LT; 85(50 %) had &lt;6 M sobriety. Comparing those with ALD with &lt;6 M to &gt;6 M sobriety and other non-ALD etiologies, those with &lt;6 M were younger (mean age 46 vs. 54 and 56 years; <em>p</em> &lt; .001), had higher MELD (36 vs. 26 and 23; <em>p</em> &lt; .001), and on the list fewer days (14 vs. 83 and 168; <em>p</em> &lt; .001) while there were no differences in gender or length of stay following LT. Of those with &lt;6 M sobriety, 41 met the NIAAA definition of SAH: mean age 43, 42 % female, 0 % AA, mean MELD of 37, mean days of abstinence 58d prior to LT with 29 % prior ALD rehabilitation, 58 % failed steroids, and were listed for 7 days prior to LT. The 1-year survival was similar in all groups with 90 % in SAH, 93 % in &lt;6 M, 93 % in &gt;6 M, and 94 % in those receiving LT for all other causes. While 24 % with SAH had an alcohol slip following LT, only 4 % had a return to harmful drinking. Our single center experience shows LT for those with AUD and &lt;6 M of sobriety and specifically SAH have excellent 1-yr survival similar to those with AUD &gt;6 M sobriety and other etiologies with a low rate of return to harmful drinking.</p></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"12 ","pages":"Article 100184"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50203088","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":"Layered Methodologies: Innovating Multimodal Qualitative Research in Liver Transplantation","authors":"Chloe Wong-Mersereau ,&nbsp;Fraser Allen Best ,&nbsp;Lia Tarachansky ,&nbsp;Shabnam Sukhdev ,&nbsp;Mary Bunch ,&nbsp;Alexandra Frankel ,&nbsp;Brad Necyk ,&nbsp;Kelly Fritsch ,&nbsp;Suze Berkhout","doi":"10.1016/j.liver.2023.100183","DOIUrl":"https://doi.org/10.1016/j.liver.2023.100183","url":null,"abstract":"<div><h3>Background</h3><p>There is a growing interest in qualitative methodologies for understanding complexities in the lived experience of liver transplantation. Frequently, such studies explore quality of life and offer insights for integrating patient-oriented outcomes into conventional research strategies. The scope of qualitative research in liver transplantation tends to be limited, however, with respect to engagement with critical theories, leaving certain aspects of lived experience unexamined.</p></div><div><h3>Methods</h3><p>The authors describe the process of layering multiple modes of critical qualitative research in liver transplantation, exploring how experiences in liver transplantation are structured discursively and what aspects of recipients’ stories are not easily spoken or shared. This study pairs a critical discourse analysis of patient manuals from a Canadian liver transplant program with digital storytelling with liver transplant recipients.</p></div><div><h3>Results</h3><p>A homogenous narrative emerges from patient manuals that does not adequately capture the complexity of lived experience of liver transplant survivors. Digital storytelling opens new narrative possibilities by layering sensory aspects of the transplant experience, which are often difficult to articulate through words. This complicates common ideas of survivorship, who is considered a “good” patient, and the cultural scripts that transplant stories frequently engage.</p></div><div><h3>Conclusion</h3><p>Critical qualitative research offers opportunities for understanding structures of power embedded within biomedical transplant narratives. Layering qualitative and arts-based methodologies within a framework of co-creation can shift knowledge/power relations while also intervening through material-discursive practices to offer novel insights and opportunities for critical reflection on transplant experiences for recipients, families, and healthcare providers.</p></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"12 ","pages":"Article 100183"},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50203086","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":"Incidental detection of a large atrial septal defect in liver donor: Addressing the unknown!","authors":"Ramneek Kaur ,&nbsp;Annu Sarin Jolly ,&nbsp;Sanjay Yadav ,&nbsp;Sanjay K Goja","doi":"10.1016/j.liver.2023.100182","DOIUrl":"https://doi.org/10.1016/j.liver.2023.100182","url":null,"abstract":"<div><p>Liver donation is an altruistic act wherein donor safety takes paramount importance. Donor selection is done after a meticulous evaluation to rule out any perioperative health risk. It is not unusual to find uncorrected congenital heart disease (CHD) in adults as a part of this detailed examination. This case reports a 34-year-old male liver transplant donor, with no known comorbidities, who was incidentally detected with a large atrial septal defect (ASD). We report the successful management of this case after ASD closure with the various therapeutic options available to us. The need for ASD closure for donor hepatectomy, and the unique preoperative and intraoperative challenges are elaborated in this report as limited literature is available to guide the course of action in this context. A multidisciplinary approach can facilitate safe perioperative management and prevent the exclusion of such donors from the scanty liver donor pool.</p><p><strong>Categories:</strong> Anesthesiology, Transplantation</p></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"12 ","pages":"Article 100182"},"PeriodicalIF":0.0,"publicationDate":"2023-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50203085","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":"Preexisting portal vein thrombosis and adult LDLT: A retrospective cohort analysis","authors":"Zubair Saeed ,&nbsp;Bilal Ahmed Khan ,&nbsp;Abdullah Khalid ,&nbsp;Ihsan-ul-Haq ,&nbsp;Muhammad Yasir Khan ,&nbsp;Sohail Rashid ,&nbsp;Faisal Saud Dar","doi":"10.1016/j.liver.2023.100180","DOIUrl":"https://doi.org/10.1016/j.liver.2023.100180","url":null,"abstract":"<div><h3>Background</h3><p>Portal Vein Thrombosis (PVT) is a common concern in cirrhotic patients awaiting liver transplantation (LT), with high morbidity and mortality rates. While preexisting PVT was traditionally considered a contraindication for the LT procedure, recent advances in surgical techniques have provided new possibilities for operating on these patients. This retrospective cohort study compared the surgical outcomes of adult living donor liver transplantation (LDLT) patients with and without preexisting PVT.</p></div><div><h3>Methods</h3><p>The study analyzed data from 416 liver transplant recipients and included 270 patients without PVT and 69 patients with PVT who underwent LDLT between March 2019 and March 2023. Preoperative imaging methods and intraoperative assessments were used to diagnose PVT and classify the extent of the thrombus using the Yerdel classification. Various surgical techniques were employed to remove the thrombus and establish a portal flow to the graft. Postoperatively, patients were monitored for complications and followed up regularly.</p></div><div><h3>Results</h3><p>There were no significant differences between the non-PVT and PVT groups regarding recipient age, gender, body mass index, primary disease leading to transplantation, Child-Pugh class, or Model for End-Stage Liver Disease (MELD) score. The operative variables, including graft type, duration of surgery, and cold and warm ischemia times, were also similar between the groups. The surgical procedures varied based on the Yerdel classification grade of PVT, with most patients undergoing partial or complete thrombectomy. The mean hospital stays, intensive care unit (ICU) stay duration, and reexploration rates were comparable between the non-PVT and PVT groups. However, the incidence of portal vein thrombosis was significantly higher in the PVT group (<em>p</em> &lt; 0.001). Other complications, such as portal vein stenosis and hepatic artery thrombosis, occurred in a small number of patients.</p></div><div><h3>Conclusion</h3><p>This retrospective cohort analysis demonstrates the feasibility of performing LDLT in patients with preexisting PVT using various surgical techniques. While the overall surgical outcomes and postoperative complications were comparable between patients with and without PVT, the incidence of portal vein thrombosis was higher in the PVT group. Further studies are needed to explore optimal management strategies for PVT in LDLT patients and improve outcomes in this population.</p></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"12 ","pages":"Article 100180"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50203082","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":"SPECT for risk stratification in patients with advanced liver disease","authors":"Jay Talati,&nbsp;David E. Winchester","doi":"10.1016/j.liver.2023.100181","DOIUrl":"https://doi.org/10.1016/j.liver.2023.100181","url":null,"abstract":"<div><h3>Background</h3><p>Patients with advanced liver disease (ALD) have unique hemodynamics including high resting cardiac output and low systemic vascular resistance which may reduce the sensitivity of pharmacological myocardial perfusion imaging (MPI). MPI is frequently ordered for patients with ALD if liver transplantation is being considered. Because of the limited data on effectiveness of MPI in the ALD population, we conducted this cohort study focused on cardiac outcomes after pharmacological MPI.</p></div><div><h3>Methods</h3><p>We conducted a cohort study comparing normal versus abnormal MPI among 454 patients with ALD between 1/1/2011 and 06/01/2021 at a single tertiarycare academic medical center. Abnormal MPI was defined as summed stress score &gt; 2 on LVEF &lt; 40 %. The primary outcome was to compare the frequency of major adverse cardiovascular events (MACEs) among ALD patients with and without abnormal MPI. Secondary outcome included individual components of MACE analyzed by chi square. Kaplan-Meier survival curves and a logistic-regression model of associations with MACE were also performed.</p></div><div><h3>Results</h3><p>In this cohort, 58 patients were observed to have an abnormal MPI. Baseline characteristics between the groups were similar, except prior coronary disease, which was more common among the abnormal MPI group (risk ratio 2.07, 95 % confidence interval 1.30–3.30, <em>P</em> = 0.003). MACE was more common in the group with abnormal MPI (<em>n</em> = 24, 41.4 % versus normal MPI <em>n</em> = 104, 26.3 %, <em>P</em> &lt; .001). No difference in MACE was observed when stratified by liver disease type. In the logistic regression model, diabetes mellitus, stage 3 chronic kidney disease, and summed stress score &gt;2 were retained as being associated with MACE.</p></div><div><h3>Conclusions</h3><p>Our data suggest that MPI remains an effective test for identifying ALD patients at higher risk of mortality and cardiac events. Further study is needed to understand whether a strategy of routine MPI for liver transplant candidates effectively improves long term survival.</p></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"12 ","pages":"Article 100181"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50203081","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":"A simple machine learning-derived rule to promote ERAS pathways in Liver Transplantation","authors":"Stefano Skurzak ,&nbsp;Alessandro Bonini ,&nbsp;Paolo Cerchiara ,&nbsp;Cristiana Laici ,&nbsp;Andrea De Gasperi ,&nbsp;Manlio Prosperi ,&nbsp;Matilde Perego ,&nbsp;Elena Augusta Guffanti ,&nbsp;Giovanni Chierego ,&nbsp;Gaetano Azan ,&nbsp;Roberto Balagna ,&nbsp;Antonio Siniscalchi ,&nbsp;Gianpaola Monti ,&nbsp;Martina Tosi ,&nbsp;Ciro Esposito ,&nbsp;Elisabetta Cerutti ,&nbsp;Stefano Finazzi ,&nbsp;GIVITI group","doi":"10.1016/j.liver.2023.100179","DOIUrl":"https://doi.org/10.1016/j.liver.2023.100179","url":null,"abstract":"<div><p>Enhanced recovery after surgery (ERAS) is a fascinating new approach to the perioperative care of liver transplantation (LT). Being an already established pathway in other surgical fields, ERAS in LT (ERALT) is moving its first steps into a complex scenario.</p></div><div><h3>Material and Methods</h3><p>In this study, using an Italian multicentre database dedicated to LT (Petalo Trapianto Fegato), we compared a group of patients who had a relatively short length of hospital stay (LHoS) after LT (12 days, 569 patients) vs a group that exceeded this LHoS (1017 patients). The main aim was to find a clinical rule to select patients who could afford safely and successfully an ERAS pathway. We used several machine learning techniques to find the best model to predict a short LHoS. We used logistic regression and Boruta random forest to select the most important features to be included in a prognostic score.</p></div><div><h3>Results</h3><p>According to our results, early after LT, an ERAS pathway might be confidently considered early after LT when the MELDNa is less than 10 or when the MELDNa is between 10 and 17 and the patient received ≤ 5 units of Packed Red Blood Cells intraoperatively (accuracy 72%, sensitivity 78%, specificity 66%, positive predictive value 78%).</p></div><div><h3>Conclusion</h3><p>This simple clinical rule is intended to be used as a screening tool in patient selection for centres approaching ERAS in LT focusing clinical safety and efficacy, physician confidence and patients’ satisfaction.</p></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"12 ","pages":"Article 100179"},"PeriodicalIF":0.0,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50203519","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":"Auxiliary partial orthotopic liver transplantation (APOLT) for Crigler-Najjar syndrome: A retrospective analysis","authors":"Zubair Saeed ,&nbsp;Bilal Ahmed Khan ,&nbsp;Abdullah Khalid ,&nbsp;Sohail Rashid ,&nbsp;Muhammad Yasir Khan ,&nbsp;Ihsan-ul Haq ,&nbsp;Faisal Saud Dar","doi":"10.1016/j.liver.2023.100178","DOIUrl":"https://doi.org/10.1016/j.liver.2023.100178","url":null,"abstract":"<div><h3>Background</h3><p>Crigler-Najjar syndrome is an ultra-rare hereditary disorder characterized by severe jaundice and risk of neurological complications. Current treatments, such as phototherapy, have limitations, and liver transplantation is often necessary. Auxiliary partial orthotopic liver transplantation (APOLT) is a potential treatment option. Still, its safety and efficacy in Pakistani patients with Crigler-Najjar syndrome Type I (CNS-I) have not been well established.</p></div><div><h3>Methods</h3><p>This retrospective study reviewed the outcomes of five pediatric patients with CNS-I who underwent APOLT at a tertiary care center in Pakistan. Patient demographics, surgical details, postoperative course, complications, and follow-up data were analyzed. The primary endpoint was the feasibility and safety of APOLT, while secondary endpoints included improvement in serum bilirubin levels, neurological symptoms, and survival rates.</p></div><div><h3>Results</h3><p>Among five patients diagnosed with CNS-I, APOLT was performed without intraoperative complications. During the median follow-up period of 6 months, there were no cases of relaparotomy, graft rejection, biliary complications, or portal venous thrombosis. One patient developed a portal venous stricture, but his symptoms were controlled with conservative measures. Postoperative liver function tests showed a significant improvement, with an average reduction of 90% in serum bilirubin levels. There was some improvement in neurological symptoms, and the overall patient and graft survival rate was 100%.</p></div><div><h3>Conclusion</h3><p>This study suggests that APOLT is a feasible and safe treatment option in patients with CNS-I. It improves liver function, bilirubin levels, and neurological symptoms. Further research with larger sample sizes is warranted to confirm these findings and evaluate the long-term outcomes of APOLT in this patient population.</p></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"12 ","pages":"Article 100178"},"PeriodicalIF":0.0,"publicationDate":"2023-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50203080","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":"Effectiveness of machine perfusion in liver transplantation: A meta-analysis of randomized controlled trials","authors":"Xiangfeng Yang,&nbsp;Yunlong Li,&nbsp;Qing Guo,&nbsp;Yuanzhe Li,&nbsp;Xiangyu Zhong","doi":"10.1016/j.liver.2023.100176","DOIUrl":"https://doi.org/10.1016/j.liver.2023.100176","url":null,"abstract":"<div><h3>Background</h3><p>In contemporary transplantation research, the utilization of machine perfusion to facilitate the perfusion, preservation, evaluation, and repair of donor livers has garnered considerable attention.In an effort to comprehensively assess the clinical outcomes of liver transplantation procedures incorporating machine perfusion, a meta-analysis of published randomized controlled trials (RCTs) was undertaken.</p></div><div><h3>Methods</h3><p>The relevant literature was obtained from PubMed, EMBASE, Web of Science, and other databases up until December 2022. Subsequently, the authors extracted the requisite data, conducted a meta-analysis, and arrived at a conclusion based on the findings derived from the analysis.</p></div><div><h3>Results</h3><p>A total of seven high-quality prospective RCTs, comprising 917 patients, were included in the analysis. Machine perfusion demonstrated significant superiority over cold storage in reducing the incidence of major postoperative complications (RR 0.55, 95% CI 0.42 to 0.73; <em>p</em> &lt; 0.0001) and early allograft dysfunction (RR 0.52, 95% CI 0.41 to 0.67; <em>p</em> &lt; 0.00001). Notably, postoperative aspartate aminotransferase peak, bilirubin levels, and post-reperfusion lactate were also found to decrease. However, no statistically significant differences were observed for other outcomes. Hypothermic oxygenation machine perfusion demonstrated a lower frequency of re-transplantation (RR 0.29, 95% CI 0.10 to 0.86; <em>p</em> = 0.03), rejection (RR 0.55, 95% CI 0.32 to 0.95; <em>p</em> = 0.03), and resulted in shorter hospital stays (Std, MD -0.30, 95% CI -0.52 to -0.07; <em>p</em> = 0.009).</p></div><div><h3>Conclusions</h3><p>The application of machine perfusion can yield significant improvements in the outcomes of liver transplantation.</p></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"12 ","pages":"Article 100176"},"PeriodicalIF":0.0,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50203106","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}