Digestive and Liver Disease最新文献

{"title":"Liver transplantation for acute liver failure due to HBV-related infection: A temporal snapshot from the North Italy Transplant Program","authors":"C. Scalamogna ,&nbsp;M.F. Donato ,&nbsp;T.M. De Feo ,&nbsp;E. Sguazzini ,&nbsp;R. Torelli ,&nbsp;A. Longobardi ,&nbsp;M. Cardillo","doi":"10.1016/j.dld.2025.08.054","DOIUrl":"10.1016/j.dld.2025.08.054","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>the global burden of viral-induced acute liver failure (ALF), as defined by international guidelines, remains unclear, with wide geographical variability and limited data on disease incidence. Despite the availability of effective vaccines for several decades, HBV-related ALF (HBV-ALF) still occurs. This study aims to estimate: 1) the burden of HBV-ALF-related liver transplant (LT) within the North Italy Transplant Program (NITp), and 2) the possible epidemiological changes following the introduction of mandatory neonatal vaccination in 1991 in Italy and the migratory flows from high-endemic regions.</div></div><div><h3>Methods</h3><div>we retrospectively analyzed all HBsAg-positive LT recipients transplanted for ALF within NITp area, from the program’s start in 1988 to 2024. ALF diagnosis was based on specific criteria defined by the National Super-Emergency Protocol (revised on May 15, 2024). Patients with HBV-related acute-on-chronic liver failure or ALF due to HBV reactivation were excluded.</div></div><div><h3>Results</h3><div>overall, 101 HBV-ALF out of 356 (28,4%) ALF-LT recipients of any etiology were studied (see Table); 45.5% were males, and median age was 42 years (range 16-69). Most of ALF-HBV recipients were transplanted in Lombardia (3 centers, 62,4%), followed by Veneto (2 centers 14.9%), Friuli-Venezia Giulia (8.9%), Marche (7.9%) and Liguria (5.9%). Dividing patients into three transplant decades, a progressive increase of recipient’s age (33 vs 47 years, p&lt;0.001) and a reduction in transplant need among younger subjects (51.6% vs 17.1%, p=0.006) were observed. Overall, most LT recipients were born in Italy (82.2%). However, temporal analysis revealed the emergence of foreign-born LT recipients starting from the 2001-2012 period, with HBV-ALF-related transplants in this group rising sharply over time (0 vs 40%, p=0.002).</div></div><div><h3>Conclusions</h3><div>HBV-related ALF remains an indication for liver transplantation despite universal vaccination. Over time, a progressive increase in recipient age and a reduction in transplants among younger individuals were observed, possibly reflecting the long-term impact of neonatal immunization. Conversely, the rise in foreign-born recipients underscores the influence of migratory flows from high-endemic areas on HBV epidemiology in Italy.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Pages S341-S342"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Left Atrial Dysfunction Using Speckle Tracking Echocardiography in Patients Awaiting Liver Transplant","authors":"N. Sperduti,&nbsp;A. Pellicelli,&nbsp;G.M. Ettorre,&nbsp;A. Pingitore,&nbsp;D. Cartoni,&nbsp;S. Demma,&nbsp;C. Telesca,&nbsp;V. Giannelli","doi":"10.1016/j.dld.2025.08.043","DOIUrl":"10.1016/j.dld.2025.08.043","url":null,"abstract":"<div><h3>Introduction</h3><div>Pre-transplant cardiac evaluation is crucial for identifying patients at risk of peri- and post-operative cardiovascular complications. Advanced echocardiography, particularly left atrial strain (LAS) analysis, offers a sensitive assessment of atrial function, which is not always detectable with conventional echocardiographic parameters. The aim of this study is to evaluate the clinical utility of advanced echocardiographic values, such as left atrial strain, in risk stratification and understanding cardiac pathophysiology in patients undergoing orthotopic liver transplant (OLT).</div></div><div><h3>Methods</h3><div>A retrospective observational study was conducted, including 41 consecutive patients awaiting OLT. The patient cohort had a mean age of 58 ± 10 years, with 14.6% being female. Regarding the etiology of liver disease, 36.6% had viral etiology, 29.3% had MASLD, and 39.0% had alcohol-related cirrhosis. 48.8% (20 patients) had HCC as an OLT indication. The median MELD score was 16 (IQR: 12), and the median MELD-Na score was 17 (IQR: 14). All patients underwent comprehensive echocardiographic evaluation, including assessment of left atrial longitudinal strain parameters using Speckle Tracking Echocardiography: LA-Strain Reservoir (LASr) 35.8% ± 10.3 (normal value &gt;39%), LA-Strain Conduit (LAScd) 19.6% ± 7.3 (normal value 15-25%), and LA-Strain Contractile (LASct) 16.5 ± 6.9 (normal value 17-19%). Follow-up data were also recorded during the first month post-transplant.</div></div><div><h3>Results</h3><div>Correlation analyses revealed significant relationships between left atrial strain and the severity of liver disease. In particular, LASct showed a strong, statistically significant negative correlation with the MELD score at the time of OLT evaluation (r = -0.832, p = 0.010) and with the Na-MELD score (r = -0.850, p = 0.008). These results indicate that higher MELD scores are associated with significant deterioration of left atrial contractile function. During the follow-up period, 4 patients (9.8%) developed early cardiovascular events (&lt;1 month post-OLT): 1 case of Tako-tsubo, 1 sudden cardiac death, 1 atrial fibrillation, and 1 acute myocardial infarction. In the comparative analysis between patients with events and those without events, LASr showed a statistically significant difference (p = 0.023) compared to patients without events.</div></div><div><h3>Conclusions</h3><div>These data suggest that LASct, an indicator of left atrial contractility, is closely correlated with the severity of advanced liver disease. Furthermore, LASr, an indicator of left atrial distensibility and filling, could be an early risk indicator for specific cardiovascular complications in this type of patient, thus having a prognostic role.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S336"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative TIPS and complications and in-hospital mortality in patients with liver cirrhosis undergoing liver transplantation","authors":"M. Biolato ,&nbsp;Q. Lai ,&nbsp;T. Galasso ,&nbsp;G. Marrone ,&nbsp;A. Liguori ,&nbsp;L. Monastero ,&nbsp;A. Contegiacomo ,&nbsp;R. Iezzi ,&nbsp;S. Agnes ,&nbsp;A. Gasbarrini ,&nbsp;L. Miele ,&nbsp;M. Pompili ,&nbsp;A. Avolio","doi":"10.1016/j.dld.2025.08.015","DOIUrl":"10.1016/j.dld.2025.08.015","url":null,"abstract":"<div><h3>Background</h3><div>A recent study suggested that preoperative transjugular intrahepatic portosystemic shunt (TIPS) placement in patients with cirrhosis is associated with a lower incidence of complications and in-hospital mortality following non-transplant surgery (JHEP Reports 2024;6:100914). This study aims to evaluate the impact of pre-transplant TIPS placement on postoperative complications and in-hospital mortality in patients with liver cirrhosis undergoing liver transplantation (LT).</div></div><div><h3>Methods</h3><div>This retrospective cohort study was conducted at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, and included all patients who underwent LT between 2015 and 2023. Major exclusion criteria were retransplantation, combined liver-kidney transplantation, and transplantation for indications other than liver cirrhosis. To adjust for baseline differences between patients who received pre-transplant TIPS and those who did not, inverse probability of treatment weighting (IPTW) based on a propensity score model was applied.</div></div><div><h3>Results</h3><div>The study cohort comprised 263 patients, with a median age of 57.0 ± 13.0 years and a median MELDNa score at LT of 25.0 ± 11.0. Among these, 23 patients (8.7%) underwent pre-transplant TIPS placement—15 for refractory or recurrent ascites and 8 for prevention of variceal bleeding. The median stent diameter was 8 ± 1 mm. Notably, TIPS migration was observed in 30.4% of patients at the time of LT. Patients with TIPS had a higher prevalence of esophageal/gastric varices (p=0.001), previous gastrointestinal bleeding (p &lt; 0.001), ascites (p=0.004), and hepatorenal syndrome (p = 0.04).In the IPTW-weighted pseudo-population, no significant differences were found between patients with and without pre-transplant TIPS regarding total post-transplant hospital stay (p = 0.246), ICU stay (p = 0.994), Comprehensive Complication Index (CCI) scores (p = 0.746), intraoperative mortality (p = 0.167), or in-hospital mortality (p = 0.893). However, the rate of reoperation was significantly higher in the TIPS group (17.4% vs. 8.0%, p = 0.003). In a parsimonious logistic regression model weighted by IPTW, preoperative TIPS presence was not associated with in-hospital mortality (p = 0.902).</div></div><div><h3>Conclusions</h3><div>Preoperative TIPS placement may enable patients with severe portal hypertension to achieve postoperative outcomes comparable to those without TIPS in terms of complications and in-hospital mortality. Nevertheless, preoperative TIPS does not appear to provide a survival advantage in patients on the transplant waiting list and should therefore be reserved for indications established by current guidelines.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Pages S319-S320"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of the complete genome of Human Pegivirus in a pediatric patient with acute hepatitis of unknown etiology through shotgun metagenomics: a case report","authors":"A. Gallo,&nbsp;R. Vazzana,&nbsp;A. Mularoni,&nbsp;C. Vaiana,&nbsp;A. Cona,&nbsp;G. Mulè,&nbsp;G. Ranucci,&nbsp;V. Agnese,&nbsp;N. Cuscino","doi":"10.1016/j.dld.2025.08.032","DOIUrl":"10.1016/j.dld.2025.08.032","url":null,"abstract":"<div><div>Human Pegivirus (HPgV) is a positive-sense single strand RNA virus belonging to the Flaviviridae family. Although not conclusively linked to a specific disease, an increasing number of studies are recently reporting as association between this virus and different human pathologies [1-4]. Here we describe the presence of HPgV, detected by metagenomic analysis, in a 6-months old female with severe acute hepatitis of unknown etiology. Serological and molecular biology tests for hepatotropic viruses, including Hepatitis B virus (HBV), Hepatitis A virus (HAV), Hepatitis C virus (HCV), Hepatitis E virus (HEV), Epstein-Barr Virus (EBV), Cytomegalovirus (CMV), Herpes Simplex Virus (HSV), enterovirus and adenovirus, were tested negative. Metagenomic Next Generation Sequencing (mNGS) showed the presence of the complete genome of human HPgV. This represents an important aspect to be taken in consideration and warrants a particular attention.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S330"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver transplantation for Acute Liver Failure: evaluation of Padua Transplant Center activity","authors":"R. Muzzupappa ,&nbsp;A. Ferrarese ,&nbsp;F.P. Russo ,&nbsp;M. Senzolo ,&nbsp;M. Gambato ,&nbsp;A. Zanetto ,&nbsp;F. d’Arcangelo ,&nbsp;L. Vivian ,&nbsp;P. Feltracco ,&nbsp;E. Gringeri ,&nbsp;U. Cillo ,&nbsp;P. Burra ,&nbsp;G. Germani","doi":"10.1016/j.dld.2025.08.036","DOIUrl":"10.1016/j.dld.2025.08.036","url":null,"abstract":"<div><h3>Background</h3><div>According to data from ELTR, Acute Liver Failure (ALF) accounts for 8% of all liver transplants (LT) in Europe. However, only 50% of patients hospitalized for ALF, who present with a high severity of disease, achieve LT. Among those undergoing LT, a significant improvement in patient survival was observed.</div></div><div><h3>Aims</h3><div>The aims of the study were: a) to assess the demographic and clinical variables of patients who underwent LT for ALF; b) to evaluate graft and patient survival and complications occurring after LT, identifying possible risk factors for poor outcome; c) to analyze trends in the collected variables across different time periods.</div></div><div><h3>Methods</h3><div>All patients who underwent LT for ALF at the Padua Transplant Centre between 1991 and 2025 were included in the study. Donor, graft and recipient variables were analyzed. Aetiologies and time periods (1991-2007 vs. 2008-2025) were compared. Then characteristics of deceased patients were compared with those of surviving patients and risk factors associated with death were investigated using univariate and multivariate analysis.</div></div><div><h3>Results</h3><div>58 patients (55,2% female, 19% pediatric) were included in the study. Most ALF cases had an undetermined etiology (32,8%) or were HBV-related (31%). This was followed by 5 cases of DILI and 4 cases due to mushroom poisoning. The mean MELD score at transplantation was 34,4 (SD: 5,0). Overall patient and graft survival at 1, 3 and 5 years was 76% and 67%, 76% and 67% and 74% and 65% respectively. The most common post-transplant complications were infections (40%), 2/3 of which were bacterial, followed by biliary anastomosis stenosis (18%), cardiovascular complications (16%). Additionally, 12,7% of patients underwent re-transplantation. The most frequent cause of death was infection (40,9%).</div></div><div><h3>Conclusions</h3><div>LT for ALF is associated with excellent survival rate, with most deaths occurring within the first year post-transplant. Infections are the most common post-transplant complication and the leading cause of death. The establishment of a national registry including all ALF cases is warranted, to allow the identification of true prognostic factors for a poor prognosis without LT.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S332"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver Transplantation for Unresectable Colorectal Liver Metastases: Worldwide Protocol Eligibility Criteria and Development of a Transplant-oriented patient-evaluation Tool (LT-CLEAR)","authors":"B. Sensi ,&nbsp;R. Angelico ,&nbsp;L. Toti ,&nbsp;M. Alessi ,&nbsp;G. D’arcangelo ,&nbsp;J. Bloino ,&nbsp;G. Tisone ,&nbsp;T.M. Manzia","doi":"10.1016/j.dld.2025.08.062","DOIUrl":"10.1016/j.dld.2025.08.062","url":null,"abstract":"<div><h3>Background</h3><div>Liver transplantation(LT) for unresectable colorectal liver metastases(uCLRM)showed good outcomes in terms of overall survival, and the field is exploding with several trials. We aimed to</div></div><div><h3>Methods</h3><div>A systematic review of the literature was performed to identify ongoing protocols of LT for uCRLM. All trials (both completed and/or with only published protocol) on LT for uCRLM published until May 1, 2025 were included in the analysis. The aims of the study were to identify the inclusion/exclusion criteria for LT in patients with uCRLM and to develop a practical on-line web tool to easy select patients with uCRLM eligible to LT.</div></div><div><h3>Results</h3><div>Out of 27 studies included, 23 (%) studies were still ongoing trials, while 8 (29.6%) trials had already published results. Selection criteria for LT elegibility for patienst with uCRLM were related to patient status, primary cancer, the extent of secondary liver disease, systemic therapy and disease trend. Radical surgery of the primary was required in 52%, while patients could be excluded for inadequate margins(11%), advanced T(22%) or N(19%) staging. Only few protocols excluded patients with primary rectal(7%) or right-colon(4%) locations. Primary cancer-related exclusion criterion were BRAF mutation (in 52% of protocols), microsatellite instability (22%), and RAS (7%). The dimension of hepatic lesions was considered as a selecting criteria in 33% of trials, while the number of hepatic lesions was considered only in 4%. Extrahepatic disease was not admissible in 67%, while 26% of trials accepted resectable lung-lesions. Systemic-therapy was mandatory in 93% of protocols, with stability(67%) or partial-response(11%)required by most. The LT-CLEAR, an on-line intuitive and easy tool was developed intended for consultation by clinicians to define whether patients with uCRLM can be eligible for LT according to the selecting criteria of published trials of LT for uCRLM.</div></div><div><h3>Conclusions</h3><div>YSelection criteria for patients with uCRLM eligible for LT are wildly variable. Due to the increasing number of LT protocols for uCRLM with heterogenous inclusion criteria, selecting patients with uCRLM eligible to LT may be bewildering for clinicians. The LT-CLEAR is a simple tool that help in selecting eligible LT candidate and may prove useful to encourage widespread consideration of LT as a therapy for uCRLM.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S345"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A journey from marginality to routine and beyond: single center experience with DCD utilization for liver transplantation in Italy","authors":"G. Fallani ,&nbsp;G. Radi ,&nbsp;A. Stocco ,&nbsp;B. Berti ,&nbsp;S. Togni ,&nbsp;E. Cordella ,&nbsp;M. Serenari ,&nbsp;E. Prosperi ,&nbsp;A. Laurenzi ,&nbsp;F. Odaldi ,&nbsp;C. Zanfi ,&nbsp;A. Siniscalchi ,&nbsp;M.C. Morelli ,&nbsp;M. Cescon ,&nbsp;M. Ravaioli","doi":"10.1016/j.dld.2025.08.023","DOIUrl":"10.1016/j.dld.2025.08.023","url":null,"abstract":"<div><h3>Background</h3><div>Donation after cardiovascular determination of death (DCD) has expanded the donor pool in liver transplantation but historically showed inferior outcomes due to prolonged donor warm ischemia time (DWIT). Despite improvements in donor management and transplant outcomes, Italy’s prolonged asystolic periods pose a higher transplant risk. This study evaluates trends in DCD liver transplantation at a high-volume Italian center, assessing donor and recipient profiles as well as reconditioning strategies over time.</div></div><div><h3>Methods</h3><div>This prospective study included adult recipients of DCD liver transplants from 2016 to 2023. Post-transplant outcomes, donor characteristics, and recipient profiles were compared between two periods (2016–2021 vs. 2022–2023).</div></div><div><h3>Results</h3><div>Seventy-five patients were included. Recipients in the later period had more severe liver disease (39.1% vs. 17.2% Child-Pugh C, p=0.045) and higher risk scores. Donors in the later period were older (median 72 vs. 62 years, p=0.022), more often characterized as extended criteria and had higher Donor Risk Index and EuroTransplant Donor Risk Index; additionally, transplants in the later period underwent longer HOPE and shorter ischemia times. Despite increasing donor- and recipient-related risk factors, rates of graft dysfunction, retransplantation, and survival remained stable. Donor- and recipient-related risk scores showed a linear correlation with time since DCD program’s inception; also HOPE duration increased and ischemia decreased linearly with time.</div></div><div><h3>Conclusions</h3><div>Donor and recipient risk profiles have increased over time with accumulated experience. With more extensive and effective reconditioning strategies, post-transplant outcomes remained stable demonstrating the feasibility of expanding DCD utilization even in the high-risk Italian setting.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Pages S324-S325"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune Dynamics of HHV-8 Infection After Liver Transplantation: From Viremia to KICS and Kaposi’s Sarcoma","authors":"R. Busà ,&nbsp;F. Timoneri ,&nbsp;M. Miele ,&nbsp;M. Di Bella ,&nbsp;A. Cona ,&nbsp;S. Castelbuono ,&nbsp;M.E. Ligotti ,&nbsp;A. Gallo ,&nbsp;F. Pecoraro ,&nbsp;G. Randazzo ,&nbsp;C. Amato ,&nbsp;C. Pipia ,&nbsp;G. Amico ,&nbsp;V. Agnese ,&nbsp;P.G. Conaldi ,&nbsp;M. Luppi ,&nbsp;A. Mularoni ,&nbsp;M. Bulati","doi":"10.1016/j.dld.2025.08.034","DOIUrl":"10.1016/j.dld.2025.08.034","url":null,"abstract":"<div><div>Liver transplant recipients are susceptible to the reactivation of latent viruses due to chronic immunosuppression. Among these, human herpesvirus 8 (HHV-8) poses a significant clinical threat, particularly in endemic areas, where seroprevalence remains high. Post-transplant HHV-8 reactivation may lead to a spectrum of manifestations ranging from asymptomatic viremia to Kaposi’s Sarcoma (KS) and, more severely, Kaposi’s Sarcoma Inflammatory Cytokine Syndrome (KICS), a condition associated with high morbidity and mortality. In our single-centre retrospective study, we examined 14 HHV-8-infected transplant patients, including several liver transplant recipients, and categorized them into three distinct clinical groups: asymptomatic viremia (n=5), classic or disseminated KS (n=4), and KICS (n=5). Comprehensive immuno-virological profiling was performed, including longitudinal monitoring of HHV-8 viral load, Specific T-cell response, and cytokine panels. Our findings underscore the critical importance of immune control in liver transplant recipients. Patients with asymptomatic viremia, including liver recipients, exhibited robust HHV-8-specific T-cell responses and preserved T-cell function, along with controlled cytokine levels. In contrast, those progressing to KS and especially KICS showed increasing T-cell exhaustion (notably elevated PD-1 expression), reduced HHV-8-specific reactivity, and marked elevations in inflammatory cytokines (IL-6, IL-10, IFN-α). Importantly, all KICS cases had undergone liver transplantation, and disease progression was preceded by rising HHV-8 viremia and a dysregulated inflammatory response. These results point to a unique vulnerability of liver transplant recipients to immune escape and cytokine-driven pathology in the context of HHV-8 primary infection or reactivation. This study highlights the need for early and tailored viro-immunological monitoring in liver transplant patients with HHV-8 infection. By identifying immune exhaustion markers and cytokine profiles early, clinicians may improve patient outcomes through timely immunosuppression adjustment and antiviral or immunomodulatory interventions. Further research is needed to define optimal strategies for surveillance and intervention in this high-risk population.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S331"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver transplantation for colorectal metastases: impact of a standardized protocol on transplant outcomes","authors":"A. Stocco ,&nbsp;L. Andrea ,&nbsp;M. Serenari ,&nbsp;E. Prosperi ,&nbsp;G. Fallani ,&nbsp;C. Bonatti ,&nbsp;G. Radi ,&nbsp;M. Prior ,&nbsp;F. Odaldi ,&nbsp;C. Zanfi ,&nbsp;F. Mirici Cappa ,&nbsp;A. Siniscalchi ,&nbsp;M.C. Morelli ,&nbsp;M. Ravaioli ,&nbsp;M. Cescon","doi":"10.1016/j.dld.2025.08.058","DOIUrl":"10.1016/j.dld.2025.08.058","url":null,"abstract":"<div><h3>Background</h3><div>Liver transplantation (LT) has recently re-emerged as a viable treatment option for selected patients with unresectable colorectal liver metastases (uCRLM), with promising survival outcomes demonstrated in prospective studies such as SECA II. Identification of the right patients, however, may be essential for long-term cancer control. In April 2021, we introduced the LITORALE protocol, a multidisciplinary selection algorithm aiming to define strict eligibility criteria for LT in this setting. This study evaluates the impact of the LITORALE protocol on clinical outcomes and patterns of recurrence in a single high-volume transplant center.</div></div><div><h3>Methods</h3><div>We conducted a prospective observational study including 21 patients who underwent LT for uCRLM between July 2015 and September 2024. Patients were stratified into two groups: pre-LITORALE (n = 8) and LITORALE (n = 13), based on the introduction of the protocol. Demographic, tumor, transplant, and post-transplant data were analyzed, with a particular focus on overall survival (OS) and recurrence patterns.</div></div><div><h3>Results</h3><div>Following introduction of the LITORALE protocol, transplanted patients showed significantly reduced tumor burden at the time of LT, with fewer metastases (median 4 vs. 17.5, p = 0.004) and a lower Tumor Burden Score (6.32 vs. 18.02, p = 0.002). Notably, one- and three-year OS in the LITORALE cohort were 100% and 83%, respectively, comparable to SECA II trial. While overall recurrence incidence was lower in the LITORALE group (46.2% vs. 87.5%), a significant shift in recurrence pattern was observed: multi-site relapses were drastically reduced (7.7% vs. 50%, p = 0.048), and lung-only recurrences became predominant (50% vs. 0%, p = 0.033). These lung-limited relapses are considered more favorable and manageable as described by Norwegian group.</div></div><div><h3>Conclusions</h3><div>The LITORALE protocol standardized and made the selection of candidates for LT more stringent. This was followed by comparable survival rates to those in SECA II and a trend towards more treatable recurrence patterns. Recurrences that are limited to the lungs are a best-case situation for treatment since they can be resected or addressed with other therapies. These results highlight the importance of careful, multidisciplinary-based evaluation to improve liver transplant outcomes in patients with uCRLM and validate the application of programs like LITORALE in cancer transplantation.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Pages S343-S344"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Full Title Page /Editorial Board","authors":"","doi":"10.1016/S1590-8658(25)01092-8","DOIUrl":"10.1016/S1590-8658(25)01092-8","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Pages i-ii"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}