Digestive and Liver Disease最新文献

{"title":"Personalized Infection Risk Stratification After Liver Transplantation: Integration of Immune Function and Tacrolimus Monitoring","authors":"S. Costantini ,&nbsp;M. Bassi ,&nbsp;E. Magrini ,&nbsp;P. Selva ,&nbsp;S. Ramirez ,&nbsp;R. Mancini ,&nbsp;M. Cescon ,&nbsp;M. Ravaioli ,&nbsp;P. Pianta ,&nbsp;G. Vitale ,&nbsp;M.C. Morelli","doi":"10.1016/j.dld.2025.08.049","DOIUrl":"10.1016/j.dld.2025.08.049","url":null,"abstract":"<div><div>Liver transplantation, while life-saving, presents ongoing challenges related to immune management and infection risk. Traditional laboratory tests inadequately reflect immune function, underscoring the need for more precise monitoring tools. The ImmuKnow assay, which quantifies adenosine triphosphate (ATP) released by activated T lymphocytes, has shown potential in assessing immune reserve but exhibits inconsistent predictive capacity for infections when used alone. This study evaluates the utility of a multivariate model combining ATP levels by blood CD4+ lymphocytes, indicative of immune function, and Tacrolimus doses, which reflect the level of immunosuppressive therapy during the third week post-transplantation, demonstrating high predictive accuracy for infection risk (AUC = 0.9242). Logistic regression revealed that the interaction between ATP and Tacrolimus levels significantly correlates with infection susceptibility, allowed effective risk stratification into high- and low-risk categories, achieving a sensitivity of 100% and specificity of 75%. The integration of these parameters into an interactive, patient-specific risk assessment algorithm facilitates dynamic adjustments of immunosuppressive therapy, aiming to optimize individual patient outcomes. These findings highlight the importance of combined immunopharmacological monitoring for advancing personalized post-transplant management strategies.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S339"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183655","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":"How the use of loco-regional endovascular treatment before Liver Transplantation impacts on post-transplant arterial complications","authors":"G. Radi,&nbsp;A. Laurenzi,&nbsp;A. Stocco,&nbsp;C. Bonatti,&nbsp;E. Prosperi,&nbsp;G. Fallani,&nbsp;M. Serenari,&nbsp;F. Odaldi,&nbsp;M.C. Morelli,&nbsp;M. Ravaioli,&nbsp;M. Cescon","doi":"10.1016/j.dld.2025.08.051","DOIUrl":"10.1016/j.dld.2025.08.051","url":null,"abstract":"<div><h3>Introduction</h3><div>Liver transplantation (LT) for hepatocellular carcinoma accounts for 35% of indications. Due to the limited availability of organs, to access the transplant list, hepatocellular carcinoma has to satisfy specific criteria. To avoid disease progression, endovascular treatments (LRT) such as TACE and TARE can be used. These treatments are also used as downstaging. Endovascular treatments may damage the hepatic artery, increasing the risk of arterial complications (stenosis, pseudoaneurysm, and thrombosis) in the postoperative period, with a need for re-transplantation up to 50%. The aim of this study is to evaluate vascular and biliary complications in patients undergoing LT who already received LRT compared to patients with no pre-transplant treatments.</div></div><div><h3>Methodology</h3><div>A retrospective observational single-center study was conducted on all patients who underwent LT for hepatocellular carcinoma between 2010 and 2020.</div></div><div><h3>Results</h3><div>During this period, 315 LTs were performed for hepatocellular carcinoma, of which 181 (57.4%) underwent LRT (LT-LRT) and 134 (42.6%) did not undergo LRT (LT-noLRT). The two populations had homogeneous characteristics. Arterial complications occurred in 1.9% of the total (n=6), of which n=3 in the LT-LRT group (1.66%) and n=3 in the LT-noLRT group (2.24%) (p value = ns). The most frequent complication was thrombosis (n=4). Biliary complications occurred in 9.84% (n=31), of which 15 in the LT-noLRT group and 16 in the LT-LRT group (p=ns). The most frequent complication was stenosis (n=17), mainly treated endoscopically. Late biliary complications (&gt; 6 months) were also evaluated, which developed in 12.7%, of which 13 in the LT-noLRT group (10%) and 16 in the LT-LRT group (8.84%) (p=ns). Arterial and biliary complications occurred more frequently in patients with a greater number of arterial anastomoses and LRT. Additionally, the number of treatments affects the development of complications in general, without impacting arterial and biliary complications.</div></div><div><h3>Conclusions</h3><div>In our series, pre-LT LRTs do not affect arterial and biliary complications, although these treatments affect the total number of complications. The number of arterial anastomoses and treatments could be a risk factor with a possible synergistic effect. Prospective and multicentric studies could help to identify possible risk factor in these patients.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S340"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183657","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":"Tolerability and Short-term Effectiveness of Novel Antidiabetic Agents and Metformin in Liver Transplant Recipients with Type 2 Diabetes: Insights from the DiaBoLT2021 Study","authors":"M. Stecchi ,&nbsp;C. Montroni ,&nbsp;G. Vitale ,&nbsp;L. Vizioli ,&nbsp;M.C. Morelli ,&nbsp;M. Ravaioli ,&nbsp;M. Cescon ,&nbsp;P. Pianta ,&nbsp;L. Brodosi","doi":"10.1016/j.dld.2025.08.056","DOIUrl":"10.1016/j.dld.2025.08.056","url":null,"abstract":"<div><h3>Background and Aim</h3><div>Type 2 diabetes mellitus (T2DM) affects up to one-third of liver transplant recipients and is associated with increased morbidity and reduced graft and patient survival. Post-transplant diabetes mellitus (PTDM) may emerge de novo or represent a persistence of pre-existing T2DM. Its management is complex due to potential interactions with immunosuppressive therapy, and insulin is often continued despite suboptimal outcomes, owing to its perceived safety and simplicity. Notably, data on the safety and effectiveness of novel glucose-lowering agents and metformin in this population remain limited. This study aims to evaluate the short-term tolerability and metabolic impact of novel antidiabetic drugs (GLP-1 receptor agonists, DPP-4 inhibitors, SGLT2 inhibitors) and metformin in adult liver transplant recipients with pre-existing or post-transplant T2DM.</div></div><div><h3>Methods</h3><div>A monocentric, observational study (DiaBoLT2021) was conducted, including 132 adult recipients of liver transplantation with T2DM, followed from December 2021 to December 2024 at a Clinical Nutrition and Metabolism Unit. Data were extracted from electronic medical records and evaluated at 6-month follow-up. Study endpoints included: (1) treatment tolerability; (2) changes in HbA1c, weight/BMI, and insulin requirements.</div></div><div><h3>Results</h3><div>Metformin was prescribed in 126 out of 132 patients; 5 discontinued due to gastrointestinal side effects. Among GLP-1 receptor agonist users (n=55), 4 discontinued due to nausea or vomiting. SGLT2 inhibitors were prescribed in 52 patients, with 1 discontinuation due to a genitourinary infection. No discontinuations occurred with DPP-4 inhibitors. All adverse events were mild and promptly resolved after discontinuation. Importantly, gastrointestinal side effects did not require any modification of immunosuppressive regimens. At 6 months, significant improvements in glycemic control and body weight were observed (p&lt;0.05). Insulin therapy was discontinued in 28% of patients, while others reduced dosage or transitioned to simpler regimens.</div></div><div><h3>Conclusions</h3><div>In liver transplant recipients with T2DM, both metformin and novel antidiabetic agents appear safe and metabolically effective in the short term. These findings support a paradigm shift toward a safer and more personalized management of diabetes in this population, with the potential to reduce insulin burden, enhance metabolic outcomes, and harness the cardio-renal protective benefits offered by selected novel therapies.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Pages S342-S343"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183662","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 stiffness measurement in the early post-liver transplant phase predicts acute allograft rejection","authors":"A. Liguori ,&nbsp;A. Amodeo ,&nbsp;M. Pascale ,&nbsp;L. Tomasello ,&nbsp;M. Biolato ,&nbsp;G. Marrone ,&nbsp;R. Gaspari ,&nbsp;A.W. Avolio ,&nbsp;S. Agnes ,&nbsp;A. Gasbarrini ,&nbsp;A. Grieco ,&nbsp;M. Pompili ,&nbsp;L. Miele","doi":"10.1016/j.dld.2025.08.022","DOIUrl":"10.1016/j.dld.2025.08.022","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Acute allograft rejection (ACR) continues to be a significant complication following liver transplantation (LT). Currently, diagnosis depends on laboratory tests and histopathological criteria, which do not always enable prompt diagnosis and early treatment initiation. Liver stiffness measurement (LSM) is known to be an accurate method for estimating liver fibrosis; however, many other conditions have been shown to impact it, including necro-inflammatory liver damage. Thus, the inflammatory process related to ACR could also impact on LSM.The present study aims to explore the potential prognostic role of LSM in predicting the development of ACR after LT.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This study included all adult consecutive patients who underwent orthotopic LT between 1 September 2021 and 31 December 2023 at Policlinico Universitario A. Gemelli, IRCCS. We excluded patients who underwent LT for acute liver failure and patients who develop an early vascular or surgical complication. During the first 14 days after LT, complete blood counts and liver function tests were performed daily. Diagnosis of ACR was based on validated histological criteria (Banff RAI). LSM was performed on post-operative day (POD) 1st, 3rd, and 7th with Fibroscan (Echosense, France) after a fasting period of at least 6 hours.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Seventy patients were enrolled. The analysis involved 65 patients, as 5 patients met exclusion criteria. The median age was 62 years (IQR 56-66), and 80% of the patients were male. Fifteen patients (23%) developed ACR within the first 4 weeks after LT (median at 9 POD - IQR 7-10). At POD 1, LSM was not significantly different between patients who developed ACR and those who did not (15.0 [IQR 10.5–21.7] vs 17.7 kPa [IQR 12.3–22.4], respectively). AST and bilirubin levels, but not eosinophil count, on POD 3 and 7 were significantly higher in patients who were subsequently diagnosed with ACR compared to those who did not develop ACR. During the first week post-transplant, patients who developed ACR showed a progressive worsening of LSM, which was significantly different compared to patients who did not on POD 3 (19.2 [IQR 14.7–27.8] vs 13.7 [IQR 9.9–18.9], p&lt;0.01, respectively) and POD 7 (26.6 [IQR 19.7–31.6] vs 10.5 [IQR 8.8–14.9], p&lt;0.01, respectively). Consequently, the relative change over time in LSM was significantly different between patients who developed ACR and those who did not (delta% LSM POD3–1: 28.8% [IQR 1.4–63.1] vs -15.1% [IQR -30.3 to -5.8], p&lt;0.01; delta% LSM POD7–1: 53.7% [IQR 10.9–101.1] vs -25.2% [IQR -48.1 to -15.8], p&lt;0.01).At logistic regression analysis delta% LSM POD3–1 and delta% LSM POD7–1 were significantly associated with ACR development independently from delta% AST and delta%eosinophil count at same timepoints (OR 1.06; CI 1.03-1.10; p&lt;0.01 and OR 1.07; CI 1.03-1.12; p&lt;0.01, respectively).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;We","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Pages S323-S324"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183768","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":"Hepatitis B immunoglobulins withdrawal in Hepatitis B Virus mono-infected liver transplant recipients: an Italian multicenter prospective study","authors":"R. Viganò ,&nbsp;A. Loglio ,&nbsp;C. Di Benedetto ,&nbsp;P. Carrai ,&nbsp;S. Martini ,&nbsp;I. Lenci ,&nbsp;B. Magro ,&nbsp;S. Conti ,&nbsp;P. Cortesi ,&nbsp;C. Mazzarelli ,&nbsp;C. Becchetti ,&nbsp;G. Perricone ,&nbsp;M. Cucco ,&nbsp;D. Cocchis ,&nbsp;L. Pasulo ,&nbsp;M. Viganò ,&nbsp;M. Sagasta ,&nbsp;D. Ghinolfi ,&nbsp;P. Lampertico ,&nbsp;S. Fagiuoli ,&nbsp;L.S. Belli","doi":"10.1016/j.dld.2025.08.028","DOIUrl":"10.1016/j.dld.2025.08.028","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background &amp; Aims&lt;/h3&gt;&lt;div&gt;Despite recommendations from scientific societies that Hepatitis B Immunoglobulin (HBIG) can be safely discontinued, centers across Europe continue to use the combination nucleoside analogues (NAs) plus HBIG for long-term prophylaxis against Hepatitis B virus (HBV) recurrence after liver transplant (LT). Aim of this study was to evaluate the safety of HBIG withdrawal in a cohort of LT recipients on long-term HBIG+NAs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;All patients under third-generation NAs+HBIG and who adhered to the INSIGHT-B protocol were followed-up after HBIG withdrawal, in a multicentre, prospective, Italian cohort study, to evaluate the risk of HBV reactivation. Patients transplanted between January 1st, 1991 and December 31st, 2022 were considered for HBIG withdrawal on occasion of the scheduled follow-up visit in the clinic at each site. (Milano-Niguarda, Milano-Policlinico, Bergamo-ASST Papa San Giovanni XXXIII; Pisa-Cisanello; Roma-Umberto I; Torino-Molinette; and Palermo-ISMETT). Informed consent was obtained from all patients before HBIG discontinuation. The probability of HBsAg reappearance after HBIG withdrawal, stratified by presence of HCC at LT, was estimated through Kaplan-Meier curves, and Log-rank tests.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Between February 2021 and January 2024, 222 liver transplant (LT) recipients withdrew HBIG 11.6 (IQR 6.7-17.0) years after LT, and were followed up for a median time of 24 months(&lt;strong&gt;fig 1)&lt;/strong&gt; At LT, 43 (19%) patients were HBV DNA positive. 22% of donors were anti-HBc positive. HBIG were stopped after a median time from LT of 11.6 years (range 1-31 years). After HBIG withdrawal, Hepatitis B surface antigen (HBsAg) reappearance was observed in 12 patients (5.4%) with a cumulative 1-, 2-, and 3-year recurrence rate of 4.08%, 5.36% and 6.89%, respectively &lt;strong&gt;(fig. 2).&lt;/strong&gt; The median time of HBsAg reappearance from HBIG discontinuation was 9 (IQR 4.5–15) months and HBsAg serum levels remained very low over the entire period of observation (median 9 months, range 3-20), and in 4 cases fluctuated around the detectability threshold (tab 1). 10 out of 12 patients experiencing HBsAg reappearance, were continued on hgbNA alone, while 2 were restarted on HBIG (in 1 case for patient preference, in the other on clinician advise). Both patients were restarted on the same HBIG dose they were taking before withdrawal, and both became HBsAg negativeIn all cases HBV-DNA persisted undetectable, liver function tests (LFTs) remained within the normal range and neither HBV-related hepatitis or HCC were observed. 77 patients (27 %) were on LAM at the time of HBIG withdrawal and were switched either to ETV (49%) or to TDF/TAF (51%). 24/77 patients with eGFR &lt; 60ml/min/1.73m2 at the time of HBIG discontinuation were switched to TAF. No significant worsening in renal function was observed during the follow-upNo baseline patients’ features were found ","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Pages S328-S329"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183769","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":"Biliary Atresia and Liver Transplantation: new liver, extended life","authors":"F. Leonardi ,&nbsp;L. Pasulo ,&nbsp;P. Stroppa ,&nbsp;V. Casotti ,&nbsp;S. Camagni ,&nbsp;D. Pinelli ,&nbsp;L. D'Antiga ,&nbsp;S. Fagiuoli","doi":"10.1016/j.dld.2025.08.035","DOIUrl":"10.1016/j.dld.2025.08.035","url":null,"abstract":"<div><h3>Background</h3><div>Biliary Atresia (BA) is actually the most common indication for Pediatric Liver Transplantation (PLT), accounting for at least 50% of the total PLT worldwide. This is a retrospective single Center study aimed at evaluating the long term outcomes of these patients.</div></div><div><h3>Methods</h3><div>Consecutive patients receiving PLT for BA were included. Clinical characteristics of the patients and vascular, biliary and neoplastic complications after PLT were reported. Patients’ follow up was until death or May 31st 2025.</div></div><div><h3>Results</h3><div>Between October 1997 and December 2005, 265 patients underwent PLT in our Referral Transplant Centre, 150 patients for a BA indication (56.6%). The study population (150 pts) consisted predominantly of female patients (51.3%), with a median age at LT of 10.5 months (range 3.7-204.1). Split-grafts were used in 122 patients (81.3%) and whole-liver grafts in 28 patients (18.3%). During the follow up, 53 patients (35.3%) presented at least one vascular complication (64.2% portal thrombosis, 20.8% hepatic artery thrombosis). Biliary complications occurred in 39 patients (26%), primarily biliary anastomotic strictures (37/39 pts). Sixty-three patients (42%) presented at least one acute rejection episode, 56 patients (37.3%) showed histological signs of chronic rejection in at least one liver biopsy. Twenty patients (13.3%) developed a Post-Transplant Lymphoproliferative Disorder after PLT. Twenty-nine patients underwent liver re-transplantation (19.3%). At the end of follow up, 71 patients were alive, 22 had died (6 pts in the first 10 days after PLT), and 57 were lost to follow-up as they were being followed at other Centers. Graft- and Patient-survival rates at 1, 5, 10, 20 and 25 years after LT, were 84.0%, 81.3%, 78.4%, 66.3% and 63.6% and 92.0%, 90.0%, 89.0%, 83.5% and 80.8% respectively. Hepatic artery thrombosis was the only complication associated with a statistically significant impact on survival-rate (p&lt;0.05).</div></div><div><h3>Conclusions</h3><div>Pediatric Liver Transplantation for Biliary Atresia shows excellent very long-term patient-survival rates.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Pages S331-S332"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183442","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":"Reintegration into working life after Liver Transplantation: are there predictors of unemployment?","authors":"M. Saracco ,&nbsp;S. Strona ,&nbsp;C. Manuli ,&nbsp;A. Godono ,&nbsp;M. Maci ,&nbsp;A.C. Surra ,&nbsp;G. Curoso ,&nbsp;F. Angelino ,&nbsp;C. Arnone ,&nbsp;B. Papaleo ,&nbsp;M.V. Picciaiola ,&nbsp;P. Boffetta ,&nbsp;C. Frascheri ,&nbsp;E. Pira ,&nbsp;A. Ottobrelli ,&nbsp;D. Cocchis ,&nbsp;G.M. Saracco ,&nbsp;R. Romagnoli ,&nbsp;S. Martini","doi":"10.1016/j.dld.2025.08.040","DOIUrl":"10.1016/j.dld.2025.08.040","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The reintegration of liver transplant (LT) recipients into the workforce remains a key objective, yet specific recommendations to guide this process are still lacking. The BRIC-2022-ID25 project explores how liver disease and transplantation affect employability, analyzing the interplay of clinical, social, and occupational variables before and after LT, with the goal of improving return-to-work outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;In collaboration with the occupational medicine department, we enrolled all patients who underwent LT at our center between 2018 and 2023, aged 18 to 68 years, who were not retired prior to LT. Participants completed the WHODAS 2.0 (World Health Organization Disability Assessment Schedule) and Work Ability Index (WAI) questionnaires, with results merged with clinical and occupational data from both pre- and post-LT follow-up. Patients were interviewed between January and December 2024. Univariate and multivariate analysis were performed following 3 outcomes: 1) Return to work, 2) Current work ability (WAS) and total WAI, 3) Disability score (WHODAS).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;From 2018 to 2023 918 LT were performed; 163/918 (18%) were excluded for age, 77/918 (8%) because they died before the study, 161/918 (17%) already retired before transplant, 55/918 (6%) because never worked before and after LT for personal choice; 181/918 (20%) refused to participate or were excluded for other reasons. 281/918 (31%) agreed to participated. The 83% of partecipants had cirrhosis (viral 40%; alcoholic 15%; 42% with hepatocellular carcinoma – HCC), 11% hepatic/hepatorenal polycistosis, 6.4% other indication to LT. 8% received a combined LT (mostly kidney). The mean age at interview was 55 years (range 24-68), with 65% males and an average of 44 months between LT and the interview. Notably, 55% had a middle-school education, while 25% had a university degree. 90% were Italian; 72% lived in the same region of the transplant center. 66% identified as caregiver his/her partner, 30% another relative/parents. Outcome 1: the overall return-to-work rate was 0.36 (95% CI: 0.30–0.41) at 6 months, reaching a maximum of 0.64 (95% CI: 0.57–0.70) at 36 months. Men return to work more rapidly and in a greater proportion than women (Log-Rank test, p-value &lt; 0.001). Post-LT, 39% were unemployed, with 64% indicating health issues as a barrier to their job search. At univariate analysis, significant correlations were found between unemployment and factors such as age &gt;59 years (p=0.049), having a caregiver outside the household (p=0.01), middle-school education (p=0.04), a longer waiting list time (p=0.02). At multivariate analysis, male sex (OR 3.6, p=0.001), Age &gt; 59 y (OR 0.015, p=0.01), university degree (OR 5.6, P=0.006), caregiver outside the household (OR 0.3, p=0.001) were independent predictor for return-to-work.Outcome 2: low self-assessment of work ability (WAS) correlated with age &","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S334"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183544","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 evaluation in a patient with Chanarin-Dorfman Syndrome: A Case Report","authors":"S. Demma ,&nbsp;M. Valiante ,&nbsp;V. Giannelli ,&nbsp;C. Telesca ,&nbsp;S. Ferrari ,&nbsp;D. Cartoni ,&nbsp;D. Formicola ,&nbsp;L. Celli ,&nbsp;P. Grammatico ,&nbsp;G.M. Ettorre ,&nbsp;A. Pellicelli","doi":"10.1016/j.dld.2025.08.052","DOIUrl":"10.1016/j.dld.2025.08.052","url":null,"abstract":"<div><h3>Introduction</h3><div>Chanarin-Dorfman Syndrome (CDS) is a rare autosomal recessive neutral lipid storage disease characterized by ichthyosis, hepatic steatosis, and multisystem involvement. CDS should be considered in cases of cryptogenic cirrhosis with dermatological and systemic findings to ensure timely diagnosis and management.</div></div><div><h3>Methods</h3><div>We present the case of a 49-year-old male with decompensated cryptogenic cirrhosis referred for liver transplantation evaluation. The patient had lifelong ichthyosis, cataracts, sensorineural hearing loss, and a family history of severe ichthyosis in a sibling with parental consanguinity. Laboratory tests and advanced imaging including CT, MRI, and cardiac MRI were performed. A peripheral blood smear was evaluated, and a genetic consultation was obtained.</div></div><div><h3>Results</h3><div>Laboratory tests revealed hyperbilirubinemia, elevated transaminases, thrombocytopenia, and a MELD-Na score of 19. Imaging confirmed cirrhosis with portal hypertension and ascites. Cardiac MRI demonstrated intramyocardial fibrosis and lipid deposition consistent with CDS. Peripheral blood smear revealed Jordans' anomaly, supporting the suspicion of CDS. Genetic consultation led to urgent molecular analysis for ABHD5 gene mutations, with the patient proceeding through pre-transplant evaluation.</div></div><div><h3>Conclusion</h3><div>This case highlights the importance of considering rare metabolic disorders such as CDS in the differential diagnosis of cryptogenic cirrhosis, particularly in the presence of dermatological and systemic findings. Early identification enables multidisciplinary management, genetic counseling, and tailored transplant evaluation, improving patient outcomes in advanced liver disease of unclear etiology.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S340"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183658","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":"Social and welfare needs in transplant patient: a new way to handle","authors":"M. Valente ,&nbsp;F. Mirici Cappa ,&nbsp;I. Costa ,&nbsp;L. Golfieri ,&nbsp;S. Vezzani ,&nbsp;A. Nanni Costa ,&nbsp;P. Pianta ,&nbsp;L. Potena ,&nbsp;M.C. Morelli","doi":"10.1016/j.dld.2025.08.060","DOIUrl":"10.1016/j.dld.2025.08.060","url":null,"abstract":"<div><h3>Background</h3><div>With the increasing number of patients in need of solid organ transplantation and the ethnographic, anthropological, and social changes in the patient population, it has become necessary to analyze the social needs of the patients during a pre-transplant screening. These needs may include the lack of a caregiver, unstable and unsuitable housing, missing identification documents, challenges with health bureaucracy, transportation and insufficient financial resources. Thus, in February 2024, thanks to the collaboration with the Sant'Orsola Foundation, the first welfare desk within a hospital dedicated to the psychosocial needs of transplant patients was inaugurated.</div></div><div><h3>Methods</h3><div>The retrospective research will concern the analysis of the requests collected during 2024 from the Welfare for Transplant patients (WELT). The current project envisions the establishment of a dedicated service within the hospital to support patients during their transplant journey. The social support desk is integrated into the transplant care pathways of the IRCCS-Azienda Ospedaliero-Universitaria in Bologna and will involve the S.S. Service of Clinical Hospital Psychology, the operative units of Internal Medicine for the Treatment of Serious Organ Failure, Hepatobiliary Surgery and Transplantation, the S.S.D. Heart Failure and Transplantation, the Lung Transplantation Program and the Complex Structure of Nephrology, Dialysis and Transplantation.</div></div><div><h3>Results</h3><div>This research is in the start-up phase. The enrollment will include the analysis of approximately 120 patients to define the social needs and the options for solving them.</div></div><div><h3>Conclusions</h3><div>The anticipated effects of the social support desk within the hospital include: a prompt and effective management of patients' social requirements by skilled professionals; improved accessibility and decreased duration of the transplant process; a more comprehensive psychological assessment; the implementation of services without burdening the patients; a beneficial influence on the physical and psychological well-being of patients before and after transplantation.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Pages S344-S345"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183715","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":"Early HBV and HDV kinetics in patients undergoing liver transplantation","authors":"S. Battistella ,&nbsp;A. Pocurull ,&nbsp;T. Leonel ,&nbsp;S. Rodríguez-Tajes ,&nbsp;Y. Fundora ,&nbsp;L. Shekhtman ,&nbsp;L. Hershkovich ,&nbsp;S. Cotler ,&nbsp;H. Dahari ,&nbsp;T. Fortney ,&nbsp;M. Anderson ,&nbsp;G. Cloherty ,&nbsp;J.C. Hurtado ,&nbsp;S. Lens ,&nbsp;S. Pérez-del-Pulgar ,&nbsp;X. Forns","doi":"10.1016/j.dld.2025.08.014","DOIUrl":"10.1016/j.dld.2025.08.014","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Hepatitis B virus (HBV) graft infection occurs after liver transplantation (LT) despite viral source removal and prophylactic treatment. We aimed to elucidate mechanisms and timing of HBV/hepatitis delta virus (HDV) reinfection by analysing early viral kinetics in serum and tissue.</div></div><div><h3>Methods</h3><div>Serial serum and liver samples were prospectively collected peri- and post-transplant in 12 HBV (5 HDV coinfected) LT recipients. Kinetics of different viral markers were analysed.</div></div><div><h3>Results</h3><div>HBV-DNA, HDV-RNA, HBsAg and HDAg were detected in all liver explants, while cccDNA was only detectable in HBV monoinfected patients. Residual serum HBV-DNA was detectable before LT in 5 patients but became undetectable a few hours after the anhepatic phase. HBsAg levels were low (&lt;3logIU/mL) in HBV monoinfected patients and cleared fast (within 5 days) in those receiving hepatitis B immune globulin (HBIG) compared to those who did not (within 6 months). In HDV coinfected patients (all receiving HBIG), HBsAg clearance was fast (within 12 hours) if baseline HBsAg &lt;3logIU/mL and slow (within 6 months) if baseline HBsAg &gt;3logIU/ml. HDV-RNA kinetics paralleled that of HBsAg. Post-transplant biopsies, obtained at reperfusion, 3 and 12 months after LT, tested negative for all viral markers (including cccDNA), except for one patient with detectable intrahepatic HDV-RNA and HDAg at 3 months post-LT with undetectable HBV and HDV serum markers.</div></div><div><h3>Conclusion</h3><div>Despite varying kinetics of HBsAg clearance following LT, we did not detect intrahepatic HBV markers at different time points following transplantation. In contrast, HDV could be sporadically detected in the liver graft, highlighting the need to evaluate new prophylactic strategies in HDV coinfected patients awaiting LT.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S319"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183725","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}