Digestive and Liver Disease最新文献

{"title":"Radiological–Histological Discrepancy in Hepatocellular Carcinoma and Post-Transplant Outcomes: A 23-Year Single-Centre Study from the University of Bologna","authors":"E. Prosperi ,&nbsp;M. Serenari ,&nbsp;L. Vinella ,&nbsp;C. Bonatti ,&nbsp;G. Fallani ,&nbsp;A. Stocco ,&nbsp;E. Prosperi ,&nbsp;L. Braccischi ,&nbsp;M. Taninokuchi ,&nbsp;B. Stefanini ,&nbsp;D. Malvi ,&nbsp;A. D'Errico ,&nbsp;F. Tovoli ,&nbsp;C. Mosconi ,&nbsp;F. Piscaglia ,&nbsp;P. Pianta ,&nbsp;M.C. Morelli ,&nbsp;M. Ravaioli ,&nbsp;M. Cescon","doi":"10.1016/j.dld.2025.08.016","DOIUrl":"10.1016/j.dld.2025.08.016","url":null,"abstract":"<div><h3>Introduction</h3><div>Accurate radiological staging of hepatocellular carcinoma (HCC) before liver transplantation (LT) is important for appropriate patient selection. This study aimed to evaluate the impact of radiological–histological discordance on recurrence-free survival (RFS) and overall survival (OS).</div></div><div><h3>Methods</h3><div>We performed a single-centre retrospective study of LTs for HCC performed between 2000 to 2023 after locoregional therapy. Only cases in which the number of nodules on explant histology was equal to or greater than that on the last pre-LT imaging were included. Patients were stratified into three groups: concordance (identical nodule count); discordance of 1–2 nodules; and discordance of ≥3 nodules. OS and RFS were analysed with multivariable Cox models.</div></div><div><h3>Results</h3><div>Among 499 LTs, 216 (43.3 %) showed concordance, 205 (41.1 %) had a discordance of 1–2 nodules, and 78 (15.6 %) had a discordance of ≥3 nodules. At diagnosis, 96 patients (19.4 %) were outside the Milan criteria (Milan-Out, MO); 28.9 % of MO patients exhibited a discordance of ≥3 nodules. Median post-LT follow-up was 7.1 years (95 % CI 7.0–8.2). At RFS analysis, discordance of 1–2 and ≥3 nodules was associated with an increased risk of recurrence (HR 2.97, 95 % CI 1.53–5.77, p = 0.001, and HR 6.84, 95 % CI 3.41–13.57, p &lt; 0.001, respectively). In OS analysis, only discordance ≥3 nodules increased mortality risk (HR 1.84, 95 % CI 1.16–2.93, p = 0.009). Multivariable analysis confirmed discordance ≥3 nodules as an independent risk factor for OS (HR 1.70, 95 % CI 1.10–2.60, p = 0.015).</div></div><div><h3>Conclusions</h3><div>Radiological–histological discordance significantly impacts both RFS and OS in patients undergoing LT for HCC. A discordance of ≥3 lesions is an independent predictor of recurrence and mortality.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Pages S325-S326"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183810","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":"Modeling liver regeneration using 3D human liver organoids to assess the impact of ischemia on hepatic regeneration during transplantation","authors":"M. Cimino ,&nbsp;R. Tinnirello ,&nbsp;R. Perriera ,&nbsp;A. Orlando ,&nbsp;P.G. Conaldi ,&nbsp;M. Pinzani ,&nbsp;D. Pagano ,&nbsp;G. Zito ,&nbsp;V. Miceli","doi":"10.1016/j.dld.2025.08.018","DOIUrl":"10.1016/j.dld.2025.08.018","url":null,"abstract":"<div><div>Liver transplantation is the treatment of choice for end-stage liver disease. However, its success is often compromised by ischemia-reperfusion injury (IRI), a major contributor to graft dysfunction. Liver regeneration is a crucial process that enables recovery following injury and transplantation, involving progenitor cell activation, tissue remodeling, and terminal differentiation. Understanding how ischemia affects this regenerative response is essential for developing strategies that improve post-transplant outcomes.In this study, we established a liver regeneration model using undifferentiated 3D human liver organoids (hLiOs). To model ischemic injury, undifferentiated hLiOs were subjected to cold storage at 4°C for 16 hours. Organoids subjected to ischemic preconditioning, as well as non-ischemic controls, were systematically analyzed at pre- and post-differentiation stages through high-resolution microscopy, gene expression analysis, and immunofluorescence.Undifferentiated hLiOs expressed higher levels of LGR5 and EpCAM but lower levels of albumin, HNF4A, and CYP3A4 compared to primary hepatocytes. Conversely, upon differentiation, hLiOs showed decreased LGR5 expression, increased albumin secretion, and high expression of CYP3A4 and HNF4A. We then evaluated the impact of cold ischemia on the differentiation capacity of hLiOs. Differentiated hLiOs showed increased expression of hepatic functional markers, such as HNF4A, CYP3A4, and albumin, with significantly higher levels observed in organoids that had been exposed to ischemia prior to differentiation. In contrast, alpha-fetoprotein, a marker of hepatic progenitor activation, was more highly expressed in non-ischemic organoids. This pattern suggests that ischemic preconditioning may have accelerated or enhanced terminal hepatic differentiation.While IRI can impair regeneration and lead to liver failure, regeneration also acts as a defense mechanism against ischemic damage. Understanding this interplay is critical for improving outcomes after liver transplantation. Our preliminary findings indicate that ischemic injury can modulate the regenerative trajectory of liver organoids, promoting a shift from progenitor activation toward functional maturation. These results support the utility of hLiOs as a relevant in vitro model to study the complex interplay between ischemia and liver regeneration. This platform may aid in identifying therapeutic strategies to manage IRI and enhance hepatic recovery following transplantation.This research was funded by the Italian Ministry of Health, Ricerca Corrente.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S321"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183812","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":"Post-TIPS paracentesis as a predictor of liver transplantation: a competing risks analysis","authors":"V. Calvaruso ,&nbsp;C. Celsa ,&nbsp;R. Miraglia ,&nbsp;G. Di Maria ,&nbsp;S. Petta ,&nbsp;D. Pagano ,&nbsp;G. Cabibbo ,&nbsp;G. Pennisi ,&nbsp;F. Simone ,&nbsp;V. Di Marco ,&nbsp;A. Galante ,&nbsp;S. Gruttadauria ,&nbsp;L. Maruzzelli ,&nbsp;C. Cammà","doi":"10.1016/j.dld.2025.08.021","DOIUrl":"10.1016/j.dld.2025.08.021","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&amp;Aims&lt;/h3&gt;&lt;div&gt;Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for portal hypertension complications in patients with cirrhosis. However, the relationship between TIPS placement and subsequent liver transplantation (LT) remains unexplored, particularly when considering death as a competing outcome. This study aimed to identify predictors of LT following controlled-expansion TIPS placement in patients with cirrhosis potentially eligible to LT.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a cohort study in patients with cirrhosis who underwent controlled-expansion TIPS placement for refractory ascites, variceal bleeding, or portal vein thrombosis from 2016 to 2023. Only transplant-eligible patients (age &lt;70 years, absence of severe extrahepatic comorbidities) were included. Follow-up started at TIPS placement date. Baseline variables related to liver disease severity, etiology, and clinical characteristics were assessed, along with post-TIPS clinical events including ascites requiring large-volume paracentesis (LVP), hepatic encephalopathy (HE), variceal bleeding episodes, and TIPS dysfunction. The primary outcome was LT, with death without LT as a competing event. A multivariable competing risk regression model was employed to identify independent predictors of LT.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Result&lt;/h3&gt;&lt;div&gt;The study cohort included 258 patients (mean age 57.2 years, male sex n=185, 71.7%) who placed TIPS for refractory ascites (n=178, 69.0%), variceal bleeding (n=62, 24.0%) or portal thrombosis (n=18, 7.0%). Mean MELD-Na before TIPS placement was 13.2+4.2. Most of patients (205, 79.5%) received a 8-mm diameter TIPS. During a median follow-up of 14 months (IQR 4.1-27.6), 52 patients (20.1%) underwent LT after a median time of 4.7 months from TIPS (range 0.1-62 months) and 49 (19.0%) died without LT. Cumulative incidence functions (CIFs) of LT were 19.3% (95%CI 14.3-25.0) at 12 months and 23.3% (95%CI 17.6-29.4%) at 24 months by competing risks analysis. CIFs of death were 14.8% (95%CI 10.3-20.0%) at 12 months and 21.2% (95%CI 15.6-27.4%) at 24 months. After TIPS placement, 92 patients (35.6%) developed HE (grade 3-4 in 23 patients, 8.9%), 73 patients (28.3%) developed ascites requiring LVP, 8 patients (3.1%) developed variceal bleeding and 26 patients (10.1%) developed TIPS dysfunction. Multivariable competing risk analysis identified three independent predictors of LT: TIPS indication for refractory ascites (HR 2.30, 95% CI 1.04-5.07, p=0.039), baseline MELD-Na score (HR 1.11 per point increase, 95% CI 1.05-1.17, p&lt;0.001), and post-TIPS ascites requiring paracentesis (HR 1.83, 95% CI 1.01-3.30, p=0.047).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Our findings demonstrate that both baseline disease severity and post-TIPS clinical events predict LT in TIPS recipients. Refractory ascites as TIPS indication and need for LVP after TIPS placement were independently associated with higher probabi","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S323"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183815","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":"Successful Management of HHV-8–Associated Primary Effusion Lymphoma and KICS in a Liver Transplant Recipient: A Case Report","authors":"C. Dibenedetto ,&nbsp;F.G. Rossi Dardanoni ,&nbsp;N. Rampi ,&nbsp;M. Sagasta ,&nbsp;B. Antonelli ,&nbsp;M.F. Donato ,&nbsp;C. Quintini ,&nbsp;F. Passamonti ,&nbsp;P. Lampertico","doi":"10.1016/j.dld.2025.08.027","DOIUrl":"10.1016/j.dld.2025.08.027","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Human herpesvirus 8 (HHV-8), also known as Kaposi sarcoma-associated herpesvirus (KSHV), is an oncogenic virus responsible for several rare lymphoproliferative disorders. While its impact in HIV-positive individuals is well documented, data regarding its behavior and clinical consequences in solid organ transplant (SOT) recipients remain scarce. Primary effusion lymphoma (PEL) and KSHV inflammatory cytokine syndrome (KICS) are particularly rare and often fatal complications in this setting.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Case Report&lt;/h3&gt;&lt;div&gt;A 56-year-old male underwent orthotopic liver transplantation (OLT) in February 2024 for alcoholic cirrhosis with refractory ascites, receiving a graft from a donor after circulatory death (DCD). Re-cipient HHV-8 serology was negative; donor serostatus was unknown. Immunosuppression included tacrolimus and steroids.In June 2024, the patient was admitted at our institution with fever, fatigue, jaundice, weight gain, and laboratory evidence of cholestasis, elevation of inflammatory markers, anemia, and hypo-natremia. Imaging (CT and MRI) revealed bilateral pulmonary infiltrates, ascites, and splenomegaly while biliary tract strictures were excluded. HHV-8 DNA was 32,156 copies/mL while EBV DNA was 739 cp/mL and CMV DNA was undetectable. A transjugular liver biopsy showed hemophago-cytic features; bone marrow biopsy ruled out HLH and lymphoproliferative disorders.Paracentesis revealed monoclonal plasmablasts positive for HHV-8 LANA-1, confirming a diagno-sis of PEL &lt;strong&gt;(Figure 1).&lt;/strong&gt; The patient met criteria for KICS. Tacrolimus was discontinued and replaced with everolimus. Rituximab monotherapy resulted in rapid clinical improvement and decline in HHV-8 viremia. Chemotherapy was initiated with CVP, later escalated to R-CHOP (reduced-dose doxorubicin for persistent jaundice) due to worsening clinical status.Hospital stay was complicated by CMV reactivation and a catheter-related bloodstream infection due to Pseudomonas putida, both successfully treated. The patient completed 6 cycles of R-CHOP, with full-dose doxorubicin in cycles II and III due to hepatic function improvement. Dose reduction was later required due to febrile neutropenia and neurotoxicity.At 10-month post-transplant, PET-CT and contrast-enhanced CT confirmed complete remission. HHV-8 DNA remained undetectable. A liver biopsy performed in March 2025 for persistent choles-tasis revealed drug-induced liver injury (DILI) and nodular regenerative hyperplasia, likely chemo-therapy-related. As of June 2025, the patient remains in stable remission.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;div&gt;PEL is a rare but potentially fatal post-transplant complication. Diagnosis is often delayed due to nonspecific clinical presentation and the need for invasive sampling. Literature on PEL in liver transplant recipients is limited to isolated case reports, with highly variable treatment approaches and outcomes. This case illustrates that earl","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Pages S327-S328"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183435","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":"Engineering a Human-Sized Common Bile Duct Prototype with Regenerative Potential: In Vitro Evaluation of Mechanics, Function, Degradation, and Immune Modulation","authors":"M. Pasqua ,&nbsp;M. Barbuto ,&nbsp;M. Calligaris ,&nbsp;R. Di Gesù ,&nbsp;D. Pagano ,&nbsp;R. Busà ,&nbsp;S. Gruttadauria ,&nbsp;S.D. Scilabra ,&nbsp;A. D'Amore ,&nbsp;M.G. Francipane","doi":"10.1016/j.dld.2025.08.031","DOIUrl":"10.1016/j.dld.2025.08.031","url":null,"abstract":"<div><div>Tissue engineering offers new hope for treating biliary defects. Several scaffolds have been proposed, but their properties have not been fully investigated. In this study, the design, fabrication, and characterization of a novel common bile duct (CBD)-like prototype are described. This prototype combines two biocompatible biomaterials, methacrylated type I collagen (CollMA) and poly(ε-caprolactone) (PCL), along with biliary epithelial cells. CollMA supports the organization of biliary epithelial cells into a functional biliary-like epithelium, as shown by histological, functional, and proteomic assays, while PCL provides mechanical strength. The biological and mechanical phases of the prototype are integrated into a multiphasic tubular scaffold using molding and electrospinning techniques. The final CBD-like prototype consists of three interpenetrating phases: from innermost to outermost, these are biliary epithelial cell-laden CollMA, PCL, and CollMA. This design overcomes challenges seen in multilayer constructs, such as interlayer delamination and lack of homogeneity. The prototype remains stable under physiological conditions, enables bile flow without leakage, and exhibits bile acid transport and modification activities, warranting future in vivo preclinical evaluation. In an ex vivo human blood assay, the acellular prototype elicited a favorable immune response, limiting inflammation and promoting sustained release of epidermal growth factor (EGF), indicating its potential to support regenerative processes.</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":"145183438","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":"Multidimensional frailty assessment of liver transplant recipients with long term follow-up (>20 years): preliminary results of the RESIST study an ELITA/ELTR project","authors":"R. Viganò ,&nbsp;C. Becchetti ,&nbsp;A. Ferrarese ,&nbsp;B. Francesco ,&nbsp;C. Dibenedetto ,&nbsp;D.P. Bernasconi ,&nbsp;L.M.A. Patetta ,&nbsp;C. Mazzarelli ,&nbsp;M. Cucco ,&nbsp;L. Pasulo ,&nbsp;M. Triolo ,&nbsp;M. Sagasta ,&nbsp;G. Vasta ,&nbsp;S. Iacob ,&nbsp;M. Cesari ,&nbsp;P. Lampertico ,&nbsp;S. Fagiuoli ,&nbsp;G. Germani ,&nbsp;L.S. Belli","doi":"10.1016/j.dld.2025.08.019","DOIUrl":"10.1016/j.dld.2025.08.019","url":null,"abstract":"<div><h3>Background</h3><div>chronic exposure to immunosuppressants may accelerate aging in ways not reflected by chronological age. Frailty may be considered a surrogate of biological age and can be assessed using a multidimensional frailty index which explores various deficits across liver function, functional status, cognition, comorbidities and physical performance.</div></div><div><h3>Aims</h3><div>to assess the multidimensional frailty of adult liver transplant (LT) recipients surviving longer than 20 years compared with the results obtained in the general population of similar age and gender, and to assess the impact of frailty on Quality of Life (QoL).</div></div><div><h3>Methods</h3><div>we conducted a multicenter, cross-sectional study comparing frailty and QoL of LT patients transplanted before 01/01/2005 and in regular follow-up at different LT Centers, with a control group of non-transplanted subjects of similar age, enrolled in geriatric or hepatological clinics. Frailty was assessed using an updated version of the Frailty Index (FI-39) and now called ELITA FI-35, which is calculated as the ratio of the number of health deficits present in a patient (presence=1, absence=0) with the total number of considered deficits, being 35. QoL was assessed though the auto-administered questionnaire the EQ-5D-5L.</div></div><div><h3>Results</h3><div>we included 99 LT long-survivor patients compared to 41 controls. Median (IQR) ELITA FI-35 in LT recipients was 0.26 (0.17-0.31) vs. 0.14 (0.11-0.20) in the control group (p &lt;0.001). A moderate correlation was found between age and ELITA FI-35 both for the LT and for the control group <strong>(Figure 1),</strong> showing a progressive worsening of the score in both group while age increase. The score was significantly different among age categories for the LT group (age&lt;65: 0.14 [0.11, 0.18]; 65&lt;age&lt;75: 0.26 [0.17, 0.31]; age&gt;75: 0.29 [0.23, 0.31], p&lt;0.001). Beyond liver function, the largest differences between cases and controls were observed in physical performance and cognitive domains, particularly: need for help with housekeeping (14% vs. 0%, p=0.03), balance disorders (20% vs. 5%, p=0.04), memory complaints (24% vs. 7%, p=0.4), and insomnia (32% vs. 12%, p=0.03). However, no significant differences were found in QoL measured by the EQ-5D-5L (median [IQR]: 78 [65–85] in LT patients vs. 75 [70–85] in controls, p=0.793), nor in emergency hospital admission rates (30% vs. 20%, p=0.272)</div></div><div><h3>Conclusion</h3><div>long-term LT recipients showed a higher frailty burden than controls, especially in physical and cognitive domains, with frailty increasing significantly with age. Nevertheless, similar QoL scores between groups suggest that LT recipients maintain a preserved perception of well-being.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Pages S321-S322"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183813","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":"Conversion to liver transplantation following atezolizumab-bevacizumab for HCC: the Bologna experience.","authors":"B. Stefanini ,&nbsp;E. Prosperi ,&nbsp;F. Tovoli ,&nbsp;S. Ascari ,&nbsp;G. Monaco ,&nbsp;C. Mosconi ,&nbsp;M.C. Morelli ,&nbsp;L. Lani ,&nbsp;P. Caraceni ,&nbsp;M. Serenari ,&nbsp;M. Cescon ,&nbsp;F. Piscaglia","doi":"10.1016/j.dld.2025.08.025","DOIUrl":"10.1016/j.dld.2025.08.025","url":null,"abstract":"<div><h3>Introduction</h3><div>The unprecedented response rates achieved with immune checkpoint inhibitors (ICIs) for hepatocellular carcinoma (HCC) paved the way for possible downstaging or conversion strategies. However, uncertainties remain regarding the optimal timing for ICI discontinuation before liver transplantation (LT) and the risk of graft rejection.</div></div><div><h3>Methods</h3><div>Post-hoc analysis of prospectively collected data from two hepatology centers in Bologna (2022-2025). Patients received atezolizumab-bevacizumab (AB) for unresectable HCC not suitable for loco-regional therapies. We report the proportion of patients who were successfully downstaged and their follow-up data. Eligibility for LT was discussed in a multidisciplinary team.</div></div><div><h3>Results</h3><div>Among 108 patients treated with AB (84.1 % were male, 44.8% had macrovascular invasion and 21.5% started with an AFP&gt;400), 35 (32.4%) achieved an objective response. Eight patients (7%) underwent LT after achieving a complete radiological response in 3 cases and a partial response in the remaining 5. When considering only the population &lt;75 year-old and without metastatic disease at the start of AB (n=49), the conversion rate to LT was 16.3%. Objective response was the only variable associated with conversion, while no baseline variable predicted this outcome. The median AB duration before LT was 17.6 months. The median time between atezolizumab discontinuation and LT was 111 days (range 56-134). No graft rejections were observed under standard immunosuppressive protocols After a median post-LT follow-up of 9.5 months, no HCC recurrences were observed.</div></div><div><h3>Conclusions</h3><div>Conversion to LT is feasible in a non-negligible part of patients receiving immunotherapy. No graft rejections were observed after a 2-months withdrawal of ICIs. Data on post-LT recurrence are still preliminary, yet encouraging.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Pages S320-S321"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183817","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":"Coronary CT scan for the screening of asymptomatic coronary disease in liver transplant candidates","authors":"L. Iogna Prat ,&nbsp;E. Fumolo ,&nbsp;D. Bitetto ,&nbsp;E. Fornasiere ,&nbsp;M. Puppato ,&nbsp;A. Vit ,&nbsp;M. Sponza ,&nbsp;P. Toniutto","doi":"10.1016/j.dld.2025.08.029","DOIUrl":"10.1016/j.dld.2025.08.029","url":null,"abstract":"<div><h3>Background</h3><div>Coronary artery disease (CAD) is the most frequent cause of non-graft related death among liver transplant (OLT) recipients. There is a lack of evidence supporting the systematic use of coronary CT scan (CCT) to evaluate the presence of CAD in OLT candidates with cardiovascular risk factors.</div></div><div><h3>Aims</h3><div>To assess: 1) the prevalence of asymptomatic CAD among OLT recipients with cardiovascular risk factors through systematic use of CCT. 2) the proportion of CCT positive patients in whom CAD was confirmed by means of coronary angiography and followed by coronary revascularization. 3) the drop out from transplantation list due to untreatable CAD. 4) 1-year post OLT cardiac death after coronary revascularization.</div></div><div><h3>Methods</h3><div>All OLT candidates referred to the Transplant Centre in Udine between 2020-2024 who underwent cardiovascular screening through CCT were enrolled. Clinical data regarding the first visit, listing, transplantation and follow-up until the last outpatient visit were retrospectively collected.</div></div><div><h3>Results</h3><div>37/120 OLT candidates with risk factors for CAD underwent CCT (mean age 60y, 75% male, mean MELD 13). CCT was abnormal in 10/37 (27%) and coronary angiography confirmed critical CAD in 3/10 (30%), all of whom underwent coronary revascularization. There were no cases of 1-year post OLT cardiac death and none dropped out from the list because of untreatable CAD.</div></div><div><h3>Conclusions</h3><div>CCT abnormalities were detected in near 30% of OLT candidates with risk factors for CAD. However, CCT overestimated the presence of clinically relevant CAD compared to coronary angiography. Coronary revascularization in patients presenting clinically relevant CAD does not preclude their access to OLT and was not associated with an increased 1-year post OLT mortality.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S329"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183436","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":"Clinical Determinants and Impact of Non-Tumoral Portal Vein Thrombosis among liver transplant candidates","authors":"S. Parisse ,&nbsp;F. Ferri ,&nbsp;M. Carlucci ,&nbsp;M. Corona ,&nbsp;A. De Santis ,&nbsp;P. Lucatelli ,&nbsp;F. Melandro ,&nbsp;G. Mennini ,&nbsp;M. Rossi ,&nbsp;S. Ginanni Corradini","doi":"10.1016/j.dld.2025.08.038","DOIUrl":"10.1016/j.dld.2025.08.038","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Portal vein thrombosis (PVT) is common among liver transplant (LT) candidates, and often associated with advanced cirrhosis. When severe, PVT may be a contraindication to LT. Metabolic syndrome features are increasingly prevalent in these patients and merit careful assessment. This study evaluates clinical factors associated with PVT in LT candidates and its effect on access to the LT waiting list (WL) and transplantation.</div></div><div><h3>Method</h3><div>711 consecutive patients assessed for LT (2008–2020) were retrospectively enrolled. Data included PVT presence and severity (Yerdel classification) and clinical variables. Reasons for listing exclusion and WL drop-out were also recorded. Multivariate binary logistic regression with backward selection and bootstrap was used, with PVT presence, WL access, and LT as dependent variables and clinically relevant factors as covariates.</div></div><div><h3>Results</h3><div>PVT was found in 11.6% of patients (n=83), with advanced PVT (Yerdel 3–4) in 28.6% of cases. 278 patients (39%) were listed, with 171 undergoing LT (61%). Obesity was the only independent factor associated with PVT (p=0.002, OR 2.619, 95% CI 1.577–4.352), adjusted for age, MELD, hepatocellular carcinoma, diabetes, hypertension, dyslipidemia. Patients with PVT were more often excluded from listing for clinical contraindications than those without PVT (26% vs 14%, p=0.04). However, multivariate analysis found no independent association between PVT and WL access or LT. Advanced PVT was more frequent in non-transplanted PVT patients than transplanted ones (40% vs 20%, p=0.04). No significant differences emerged in WL drop-out causes.</div></div><div><h3>Conclusion</h3><div>Among LT candidates, obesity is strongly associated with PVT, likely reflecting pro-inflammatory and pro-thrombotic gut-liver axis effects. Access to the WL and LT is probably affected by multiple factors, which can explain why PVT was not found to be significant. However, PVT is often observed in patients excluded from listing for clinical contraindications, likely associated with coexisting obesity, and, when advanced, reduces access to LT.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S333"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183540","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":"Implementation of a Regional Liver Transplant Network: The Tuscany Experience","authors":"P. Carrai ,&nbsp;S. Brillanti ,&nbsp;S. Petruccelli ,&nbsp;F. Marra ,&nbsp;E. Lorefice ,&nbsp;B. Cherubini ,&nbsp;D. Ghinolfi ,&nbsp;C. Lazzeri","doi":"10.1016/j.dld.2025.08.047","DOIUrl":"10.1016/j.dld.2025.08.047","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background and Aims&lt;/h3&gt;&lt;div&gt;The liver transplant scenario has significantly changed during the last decade due to the expansion of transplant indications and the increased availability of donor organs. In Tuscany, the number of liver transplants at the referral center in Pisa has increased significantly to 176 in 2024. For these reasons, the Tuscany Transplantation Organization (O.T.T.) has appointed a regional commission with the priority goal of implementing the network of health professionals connected to the pathway of patients with indication for liver transplantation to optimize the allocation of organs, with particular regard to the satisfaction of regional needs, and working on the timing and appropriateness of transplant indications. This project has been implemented over the past year to achieve a more comprehensive pre-transplant patient referral and evaluation and to optimize care for patients who have already undergone transplantation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The primary objective of this first year of work was, therefore, to verify the feasibility of establishing and implementing a territorial network for the referral and referral-back of Tuscan patients with terminal liver failure or liver neoplasms susceptible to organ replacement treatment (Transplant Oncology). A series of eight meetings was held, gathering representatives from the Tuscan divisions of Hepatology, Infectious Diseases, Gastroenterology, and Internal Medicine, and promoting specific training sessions on the following topics: pre-transplantation, post-transplantation, and transplant oncology. Additionally, three specific training courses were organized for nurses and physicians from the three major geographical areas of Tuscany. A pivotal element was the implementation of collaboration with the Association of Tuscan Hepatologists (ET), which involved planning and producing 15 short videos on indications for liver transplantation and communication with the transplant center. The goal is to disseminate informative and scientific material on the organization's institutional website, facilitating widespread distribution with a special focus on young professionals. Finally, a specific course involving General Practitioners (GPs) has been scheduled.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A first census of the territorial hospital divisions active in the transplantation pathway (pre- and post-phase or both) and of the living Tuscan patients was conducted, with a survey of more than 1,000 patients already in charge as of July 31, 2024. Data from the Tuscan Liver Transplant Network for the second half of 2024 show an increase in the number of patients proposed, with stable data on the proportion of regional transplant recipients (60%) and those from outside the region (40%). In 2024, 344 first liver transplant visits were performed: 250 from Tuscany (73%), of these, 107 patients were transplanted out of a total of 176 transplants (61%). In January 2025, ","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S338"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183549","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}