Digestive and Liver Disease最新文献

{"title":"A Comparative Outcome and Safety Analysis of Lenvatinib Versus Sorafenib in Hepatocellular Carcinoma recurring after Liver Transplantation","authors":"M. Sagasta ,&nbsp;E. Alimenti ,&nbsp;C. Mazzarelli ,&nbsp;M. De Giorgio ,&nbsp;F. Villa ,&nbsp;C. Dibenedetto ,&nbsp;D. Costantino ,&nbsp;F. Tosi ,&nbsp;M. Orlando ,&nbsp;L. Cesarini ,&nbsp;S. Fagiuoli ,&nbsp;M. Iavarone ,&nbsp;P. Lampertico","doi":"10.1016/j.dld.2025.08.053","DOIUrl":"10.1016/j.dld.2025.08.053","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) is approximately 17%. We aimed to retrospectively compare the outcomes of patients who received systemic treatment with different tyrosine kinase inhibitors (TKIs) for recurrent HCC post-LT.</div></div><div><h3>Methods</h3><div>Patients with recurrent HCC post-LT between 2002 and 2025 were included in a multicenter study involving three liver transplant centers in Northern Italy. The impact of first line sorafenib or lenvatinib treatment for recurrent HCC was evaluated in terms of safety (adverse events, AEs) and effectiveness, using survival analysis and stratifying patients according to significantly different baseline variables.</div></div><div><h3>Results</h3><div>Ninety-seven patients developed HCC recurrence post-LT and received TKIs: sorafenib (SOR-group, n=50) or lenvatinib (LEN-group, n=47). At recurrence, patients treated with sorafenib were younger (median age 56 vs. 65 years, p=0.001). In both groups patients were mainly males (80% vs. 89%, p=0.20) and recurrence was mostly intra- and extra-hepatic (52% vs. 53% p=0.51), with AFP values similar between the two groups (median value 11 µg/L in SOR-group vs. 7 µg/L in LEN-group, p=0.94). No significant differences were observed between groups in terms of proportion of patients receiving surgery or locoregional treatment before TKI (50% vs. 68%; p=0.07) as well as the time between LT and TKI start (median time 23 vs. 29 months p=0.56). During a median follow-up of 13 months of TKI therapy, 69 (71%) patients died [43 (86%) SOR-group and 26 (55%) LEN-group]. Median treatment duration was similar in the two groups (6.5 months in SOR-group vs. 5 months in LEN-group, p=0.45). The most frequently reported grade &gt; 3 AEs in the SOR-treated group were hand-foot syndrome [18 (36%) patients vs. 1 (2%) patient in the LEN group], fatigue [15 (30%) patients vs. 5 (10%) patients], and diarrhea [13 (26%) patients vs. 1 (2%) patient]. In the LEN-treated group, the main grade &gt; 3 AE was proteinuria [6 (12%) patients, vs 0 in the SOR-group]. Overall, patients experiencing at least one grade ≥3 AEs were more frequent in SOR-group compared to LEN-group [31 (62%) vs. 13 (28%), p=0.001)]. Only one patient treated with sorafenib died due to grade-5 AE (GI bleeding). Response to treatment was similar in the two groups, with an overall response rate of 15% in sorafenib and 18% (p=0.67) and a disease control rate of 59% and 57%, (p=0.79) and a similar median overall survival: 17 months [95% confidence interval (CI), 6-32] in SOR-group vs. 18 months (95% CI 11-34) in LEN-group, p=0.71.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that lenvatinib is a safer option as compared to sorafenib for patients with HCC recurrence after LT, granting a comparable survival with a lower risk of severe adverse events.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S341"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183659","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":"Evaluation of coronary artery disease risk in liver transplant candidates using a modified CAD-LT algorithm integrated with coronary artery calcium score and coronary CT angiography","authors":"M. Cucco ,&nbsp;F. Bolis ,&nbsp;G. Perricone ,&nbsp;R. Viganò ,&nbsp;C. Mazzarelli ,&nbsp;C. Becchetti ,&nbsp;G. Dispinzieri ,&nbsp;A. Palermo ,&nbsp;G. Masciocco ,&nbsp;J.A. Oreglia ,&nbsp;S. Santambrogio ,&nbsp;G. Monti ,&nbsp;A. Vanzulli ,&nbsp;A. Lauterio ,&nbsp;L.S. Belli","doi":"10.1016/j.dld.2025.08.057","DOIUrl":"10.1016/j.dld.2025.08.057","url":null,"abstract":"<div><h3>Background</h3><div>Epidemiological changes in liver transplant (LT) candidates have increased the prevalence of coronary artery disease (CAD) risk factors. The CAD-LT algorithm, validated in the U.S. to guide cardiac evaluation in LT candidates, is limited by its reliance on invasive tests such as invasive coronary angiography (ICA). In the general population, coronary artery calcium scoring (CACS) and coronary computed tomography angiography (CCTA) have demonstrated high negative predictive value for clinically significant CAD. This study evaluates a modified CAD-LT (mCAD-LT) algorithm incorporating CACS and CCTA.</div></div><div><h3>Methods</h3><div>This prospective, single-center study enrolled LT candidates between August 2022 and January 2025. The mCAD-LT score added obesity and metabolic dysfunction-associated steatotic liver disease (MASLD) as risk factors and redefines cardiovascular risk categories as low (&lt;7), intermediate (7–10), and high (&gt;10).Low-risk patients (mCAD-LT &lt;7) with CACS &lt;100 required no further evaluation. Patients at low risk with CACS ≥100 or those with mCAD-LT ≥7 and CACS &lt;400 underwent CCTA. If CACS ≥400, subsequent testing was determined by the mCAD-LT score: patients at intermediate risk (mCAD-LT 7-10) underwent stress echocardiography, while those at high risk (mCAD-LT &gt;10) were referred directly to ICA (Fig. 1).</div></div><div><h3>Results</h3><div>Among 205 LT candidates (mean age 59 ± 7 years; 73.6% male), MASLD and alcohol-related liver disease were the predominant etiologies. Obesity was present in 21.4% (mean BMI 26.4 ± 3.6 kg/m²), and only 14.4% had no cardiovascular risk factors. Thirty-five patients (17%) were classified as low-risk (mCAD-LT &lt;7 and CACS &lt;100) and did not require further testing. CCTA was performed in 126 patients who either had a low mCAD-LT score with a CACS ≥100, or an intermediate/high-risk mCAD-LT score (≥7) with a CACS &lt;400.Among 44 intermediate/high-risk patients with CACS ≥400, 18 underwent stress echocardiography and 26 were referred directly to ICA (Fig. 1). Overall, 46 ICAs (22%) were performed, detecting significant coronary stenosis in 9 cases. Seven patients underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES); two were excluded from LT due to dual antiplatelet therapy (DAPT) contraindications. One post-LT acute myocardial infarction (&lt;1%) occurred, successfully managed with repeat PCI.</div></div><div><h3>Conclusions</h3><div>The mCAD-LT algorithm significantly reduced ICA use by more than 50% compared to estimates using the original CAD-LT algorithm, while maintaining a low (&lt;1%) incidence of post-transplant cardiac events. These results support mCAD-LT as a safe, effective, and less invasive strategy for CAD risk stratification in LT candidates.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S343"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183663","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":"Alterations in body mass composition are not predictive of post-transplant outcomes in patients with cirrhosis and hepatocellular carcinoma undergoing liver transplantation.","authors":"F. D'Arcangelo ,&nbsp;M. Marchiori ,&nbsp;L. Marta Vivian ,&nbsp;J. Lanari ,&nbsp;A. Ferrarese ,&nbsp;M. Gambato ,&nbsp;S. Piano ,&nbsp;G. Germani ,&nbsp;F.P. Russo ,&nbsp;M. Senzolo ,&nbsp;P. Angeli ,&nbsp;U. Cillo ,&nbsp;P. Burra ,&nbsp;A. Zanetto","doi":"10.1016/j.dld.2025.08.030","DOIUrl":"10.1016/j.dld.2025.08.030","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Changes in skeletal muscle mass (sarcopenia) and adipose tissue distribution may serve as predictor reduced survival both while awaiting liver transplantation (LT) and after the procedure. Nonetheless, how body composition evolves before and after LT and its correlation with patient outcomes remains poorly understood.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Aim&lt;/h3&gt;&lt;div&gt;To assess body mass composition (skeletal muscle, visceral and subcutaneous adipose tissue) in patients with cirrhosis and HCC awaiting LT and their potential association with post-transplant survival.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This retrospective study included adult patients diagnosed with hepatocellular carcinoma (HCC) who underwent LT at Padua University Hospital between January 2015 and March 2022. Body composition was assessed using CT imaging within six months before LT and again at 3, 6, and 12 months after transplantation. Skeletal Muscle Index (SMI), Visceral Adipose Tissue Index (VATI), and Subcutaneous Adipose Tissue Index (SATI) were calculated. Univariate and multivariate Cox regression analyses were used to evaluate associations with clinical outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 164 patients (85.3% male; median age: 62 years) were analyzed. Hepatitis C virus (HCV) was the leading cause of liver disease, followed by alcohol-related cirrhosis (20%). HCC was the primary LT indication in 69% of patients. Sarcopenia was observed in 45% of the cohort (median SMI: 50 cm³/m²; IQR: 56.43–45.03), while abnormalities in VAT and SAT were identified in 22.4% and 49.4% of patients, respectively. Sarcopenia prevalence increased from 45.1% before LT to 56.1% at 12 months post-LT. VAT alterations increased steadily (40.6% pre-LT to 60% at 12 months), whereas SAT changes remained relatively unchanged. Pre-LT alterations in body composition were not significantly associated with survival at 1, 3, or 5 years (sarcopenia: p=0.21; VATI: p=0.20; SATI: p=0.28). Likewise, no significant association were found between post-LT changes in body composition and survival (sarcopenia: p=0.43; VATI: p=0.50; SATI: p=0.43). In multivariate analysis, only HCC recurrence (HR: 2.77; 95% CI: 1.05–7.31; p=0.038) and chronic kidney disease (CKD) (HR: 3.85; 95% CI: 1.06–13.92; p=0.039) emerged as independent predictors of survival. Among HCC patients, no correlation was found between body composition or its progression and the risk of cancer recurrence.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Sarcopenia and fat distribution abnormalities are common in patients with cirrhosis and HCC undergoing LT; however, these do not appear to influence post-transplant survival or complications. Although significant shifts in body composition occur within the first year following LT, these changes lack prognostic value. Therefore, routine evaluation of body composition may not be necessary for LT candidacy assessment or early post-LT risk stratification in patients with compensat","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Pages S329-S330"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183437","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":"Transjugular Intrahepatic Portosystemic Shunt (TIPS) as possible therapeutic strategy for refractory ascites with early-onset after liver transplantation","authors":"F. BOLIS ,&nbsp;C. BECCHETTI ,&nbsp;G. PERRICONE ,&nbsp;R. VIGANO' ,&nbsp;C. MAZZARELLI ,&nbsp;M. CUCCO ,&nbsp;E. MOTTO ,&nbsp;F. BARBOSA ,&nbsp;A. ALFONSI ,&nbsp;F. MORELLI ,&nbsp;P.M. BRAMBILLASCA ,&nbsp;C. ANDRIULO ,&nbsp;A. RAMPOLDI ,&nbsp;A. LAUTERIO ,&nbsp;L.S. BELLI ,&nbsp;M. SOLCIA ,&nbsp;A. AIROLDI","doi":"10.1016/j.dld.2025.08.055","DOIUrl":"10.1016/j.dld.2025.08.055","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Early-onset ascites after liver transplantation (LT) is an uncommon complication, affecting approximately 6% of LT recipients. It is primarily associated with vascular complications, acute cellular rejection, and, historically, with early hepatitis C recurrence. The incidence and natural history of post-LT ascites in the modern era remain poorly characterized, and current diagnostic and therapeutic approaches are not well defined. While transjugular intrahepatic portosystemic shunt (TIPS) is a standard therapy for refractory ascites in cirrhosis, its role in the post-LT setting is less well established.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Aim&lt;/h3&gt;&lt;div&gt;To evaluate the clinical characteristics and outcomes of LT recipients treated with TIPS for early post-LT ascites.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a retrospective, descriptive study of adult LT recipients who developed early-onset ascites, defined as ascites requiring paracentesis and persisting beyond 6 months, and subsequently underwent TIPS placement at our center between January 2016 and May 2025. Data collected included pre-LT characteristics, surgical details, etiology of ascites based on histological and hemodynamic findings, and TIPS procedural information. Clinical outcomes included periprocedural complication, ascites resolution within 3 months post-TIPS placement and graft and patient survival.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;During the study period 1080 patients received LT and a total of 10 (0,9%) patients underwent TIPS placement for early-onset ascites post-LT (6, [60%] male with median age 60 [IQR 50-62]). Main indication to LT was hepatocellular carcinoma (6, 60%) with a median Model of End Stage Liver Disease (MELD)-Na of 10 (IQR 8-22). Only two (20%) patients had ascites pre-LT. They mostly received donation after brain death donors (6, 60%) and all underwent caval anastomosis through piggy-back technique. Hemodynamic study and transjugular liver biopsy were performed in all the patients. Mean hepatic venous pressure gradient was 11 (IQR 6-16) mmHg, whereas a pathological gradient between hepatic vein and right atrium was found in 8 (80%) cases. Consistently, liver biopsy revealed features of hepatic venous outflow obstruction in 6 patients (60%), and signs of acute rejection in 6 (60%) as well, with overlapping findings in some cases. Mean interval time between LT and TIPS was 72 (IQR 47-88) days with mean portal pressure gradient of 7 (IQR 5-8) mmHg. All the procedure were technically feasible. Three patients (30%) showed a transient elevation in bilirubin and transaminases, of whom only one patient showed radiological feature of ischemic hepatitis. Other minor complications included a case of acute kidney injury and indirect hyperbilirubinemia due to intra-shunt hemolysis. All the condition were self-limiting. Early clinical success in resolving ascites was achieved in 8 out of 10 patients (80%). After a median follow-up of 25 (IQR 5-53) mon","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S342"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183661","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":"En bloc technique for Combined Heart-Liver Transplantation: A cumbersome strategy","authors":"S. Strona ,&nbsp;M. Saracco ,&nbsp;C. Manuli ,&nbsp;R. Romagnoli ,&nbsp;M. Rinaldi ,&nbsp;M. Boffini ,&nbsp;C. Pace Napoleone ,&nbsp;G.A. Annoni ,&nbsp;A.C. Trompeo ,&nbsp;R. Balagna ,&nbsp;L. Brazzi ,&nbsp;E. Simonato ,&nbsp;M. Marro ,&nbsp;G. Rizza ,&nbsp;P. Strignano ,&nbsp;S. Martini","doi":"10.1016/j.dld.2025.08.050","DOIUrl":"10.1016/j.dld.2025.08.050","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Patients (pts) surviving after palliative Fontan-like surgery for univentricular heart are arising. Long-term hemodynamic changes often lead to Fontan-associated liver disease (FALD), which develops in almost all pts. These pts are at increased risk for hepatocellular carcinoma (HCC), or less commonly, for severe decompensated FALD requiring liver transplantation (LT). If required, sequential heart-liver transplant (CHLT) is the most common approach, however, according to scanty scientific data, en bloc technique offers surgical advantages, including shorter organ ischemic time and procedural simplification. We aim to describe the first two en bloc CHLT performed at our Center.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;In 2024, in our Center two pts were listed for CHLT due to FALD and cardiac failure. We collected data about pre-LT management, surgical characteristics and post-transplant follow-up (f/u).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Case 1: 38-years-old (yo) woman (blood group A) with congenitally corrected transposition of great arteries, left ventricular hypoplasia, pulmonary stenosis, sinus node dysfunction, right ventricle double outlet. Glenn and Fontan with extracardiac conduit surgeries were performed at age 1 and 7, respectively (total sternotomies 3). At the age of 17, epicardial pacemaker was implanted. At the age of 38, monofocal HCC was diagnosed (AFP 1042 ng/mL) and treated with stereotactic body radiotherapy (SABR), with partial response (CT scan after 3 and 6 months, AFP →82→14 ng/mL). 195 days (d) after SABR, she was listed for CHLT. She underwent en bloc CHLT 46 d after listing. Donor age 27-yo. Surgery lasted 12 hours (h), and 8 surgeons were involved; total ischemia time was 3.37 h. The cardiac portion of the procedure was carried out under cardiopulmonary bypass (CBP). Infrahepatic vena cava, common portal vein, hepatic artery, and common bile duct reconstruction included end-to-end anastomoses between graft and recipient.Transfusion requirement: blood units: 6, plasma: 600 ml. Pt was extubated on post-operative day (POD) 2 and weaned inotropes off by POD 6. The total length of hospital stay was 26 d. After 10 months she is alive, without HCC recurrence, and no signs of rejection on protocol biopsies. Case 2: a 34-yo man (blood group 0) with hypoplastic right ventricle and atrial septal defect (ASD). Glenn procedure and percutaneous ASD closure were performed at 9 and 15 years, respectively (total sternotomy 1). Cirrhosis was histologically diagnosed at 24-yo, later he experienced variceal bleeding, ascites and hepatic encephalopathy. He was listed for CHLT with NaMELD 20 and MELD XI 22 and after 274 d of listing, he underwent en bloc CHLT with NaMELD 24 and MELD XI 23. Donor age 28-yo. Surgery lasted 14 h and 8 surgeons were involved. CBP lasted 225 min and upgraded to ECMO due to acute right heart failure (+adrenaline, noradrenaline, iNO). Hepatic vascular and biliary reconstruction included ","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Pages S339-S340"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183656","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":"Evaluating Post-Transplant Outcomes in Elderly Liver Recipients: A Comparative Study of Patients Aged Over 70","authors":"E. Prosperi ,&nbsp;C. Bonatti ,&nbsp;E. Prosperi ,&nbsp;F. Odaldi ,&nbsp;G. Fallani ,&nbsp;A. Stocco ,&nbsp;G. Radi ,&nbsp;M. Serenari ,&nbsp;L. Maroni ,&nbsp;A. Laurenzi ,&nbsp;C. Zanfi ,&nbsp;M. Del Gaudio ,&nbsp;V.R. Bertuzzo ,&nbsp;M. Ravaioli ,&nbsp;M.C. Morelli ,&nbsp;M. Cescon","doi":"10.1016/j.dld.2025.08.042","DOIUrl":"10.1016/j.dld.2025.08.042","url":null,"abstract":"<div><h3>Background</h3><div>The increasing average age of the population has led to a higher percentage of elderly patients awaiting liver transplantation (LT). However, advanced age has been considered an independent risk factor for candidates. This study aims to evaluate post-transplant outcomes in patients over 70 years, traditionally viewed as an age limit for LT.</div></div><div><h3>Methods</h3><div>We performed a prospective analysis of 584 liver transplant recipients at our center between January 2018 to November 2023, dividing them into two groups: under 70 years (n=548) and over 70 years (n=36). Categorical variables were reported as numbers and percentages, while continuous variables were expressed as medians and interquartile ranges (IQR). The two groups differed significantly only in MELD and cirrhosis etiology. To reduce selection bias, we performed propensity score matching (PSM) at a 3:1 ratio, without replacement, based on MELD and cirrhosis etiology.</div></div><div><h3>Results</h3><div>The median age was 58 years (IQR 52-63) in the younger group and 71 years (IQR 70-72) for the older group (p&lt;0.001). Viral cirrhosis was more frequent in younger group patients (36.1% vs 13.1 %), while MASLD was more common in those over 70 (13.1% vs 25 %) (p=0.013). The MELD scores were lower in patients over 70 (13, IQR 9-17) compared to the young group (15, IQR 10-23) (p=0.032). Both groups were homogeneous in sex and BMI (p&gt;0.05). No significant differences were observed in cirrhosis-related complications (ascites, encephalopathy, portal hypertension, jaundice, coagulopathy, varices, hepatocellular carcinoma; p&gt;0.05) or donor characteristics. Postoperative complications, including early allograft dysfunction, hepatic artery thrombosis, and biliary or cardiological complications, were also similar (p&gt;0.05). The Comprehensive Complication Index was comparable (30.2, IQR 20.9–48.3 in &lt;70 vs. 29.6, IQR 21–38.35 in ≥70; p=0.519), as was the 90-day readmission rate (p&gt;0.05). After PSM, MELD scores and cirrhosis etiology were balanced between groups. No significant differences were shown in preoperative, donor, and postoperative characteristics.</div></div><div><h3>Conclusions</h3><div>With careful selection, patients over 70 years of age can achieve post-liver transplant outcomes comparable to younger patients. These findings suggest that advanced age alone should not be considered an absolute contraindication. Instead, a comprehensive, multidimensional assessment is essential to identify suitable candidates.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Pages S335-S336"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183772","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":"Long-Term Outcomes and Transition to Adult Care After Pediatric Liver Transplantation: A 30-Year Experience from Padua University Hospital","authors":"A. Ferrarese,&nbsp;M. Cananzi,&nbsp;L. Bosa,&nbsp;A. Dolcet,&nbsp;M. Senzolo,&nbsp;F.P. Russo,&nbsp;G. Germani,&nbsp;M. Gambato,&nbsp;A. Zanetto,&nbsp;E. Gringeri,&nbsp;C. Mescoli,&nbsp;U. Cillo,&nbsp;P. Burra","doi":"10.1016/j.dld.2025.08.017","DOIUrl":"10.1016/j.dld.2025.08.017","url":null,"abstract":"<div><h3>Introduction</h3><div>Pediatric liver transplantation (pLT) offers excellent survival rates, enabling many patients to reach adulthood and transition to the adult healthcare service (AHS).</div></div><div><h3>AIM</h3><div>To describe the short- and long-term outcomes of patients who underwent pLT at Padua University Hospital, focusing on the achievement of ideal outcome after transitioning to AHS.</div></div><div><h3>Materials and Methods</h3><div>All patients who underwent pLT between 1993 and 2022 were included. Short- (i.e., 6 months) and long-term (i.e., ≥20 years) outcomes were assessed. For those who transitioned to AHS, the rate of achieving an ideal outcome—defined as a combination of perfect graft function, no immunosuppression side effects, and no late reLT—was evaluated.</div></div><div><h3>Results</h3><div>197 pLTs were performed in 167 children (90 males [53.8%], median age at transplant 4 years). Biliary atresia was the most common underlying condition (31%), while oncological indications accounted for 16% cases. Patient and graft survival rates at 1, 5, 10, and 20 years were 87%, 84%, 80%, and 76%, and 76%, 75%, 70%, and 63%, respectively. Nineteen (11%) patients did not survive beyond 6 months after their first pLT, with the need for urgent re-LT identified as the only independent predictor of survival in multivariate analysis (p = 0.05). Among 27 patients who, at the time of analysis, had survived ≥20 years after pLT, all but one were still receiving immunosuppression; 7(26%) developed at least one major medical complication, 1(3.7%) underwent re-LT due to chronic rejection, and 1(3.7%) died of sepsis. Of the 48 patients who transitioned to AHS, an ideal outcome was achieved in 47%, 44%, and 45% of patients at 12, 36, and 60 months after transition, respectively.</div></div><div><h3>Conclusions</h3><div>Medical complications, whether related or unrelated to the graft, during the long-term follow-up of patients undergoing pLT significantly impact global health and the achievement of an ideal outcome.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S326"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183811","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":"Impact of GLP1-receptor agonists on diabetes after liver transplantation - A single-center experience.","authors":"C. Sicuro ,&nbsp;P. Magistri ,&nbsp;C. Giglio ,&nbsp;M. Scoppettuolo ,&nbsp;M. Montanari ,&nbsp;L. Di Marco ,&nbsp;A. Colecchia ,&nbsp;F. Di Benedetto ,&nbsp;N. De Maria","doi":"10.1016/j.dld.2025.08.020","DOIUrl":"10.1016/j.dld.2025.08.020","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Metabolic syndrome can be observed in nearly 50% of patients undergoing liver transplantation (LT), determining a higher risk for cardiovascular disease and accelerated graft damage. One or more of its components (obesity, insulin resistance or diabetes, hypertension and dyslipidemia) may be already present at the time of LT or may develop in the post-transplant setting, contributing to the recurrence or de novo development of metabolic dysfunction-associated steatotic liver disease (MASLD). Post-transplant MASLD can be observed in up to 50% of patients 1 year after LT. Immunosuppression related side effects play a non-negligible role in the development of insulin resistance, diabetes, hypertension, dyslipidemia and weight gain in the post-transplant setting. Nearly 30% of liver transplant recipients develop new-onset diabetes mellitus after LT and up to 40% of LT recipients are obese 3 years after LT. It seems therefore of pivotal importance the need for an early intervention in the management of the above-mentioned risk factors, to reduce recurrence or de novo development of metabolic syndrome and MASLD, cardiovascular risk and graft damage.GLP-1 receptor agonists (GLP1-RAs) therapy has achieved optimal results in the treatment of adults with type 2 diabetes in terms of reduction of HbA1c and weight, with only mild to moderate adverse effects (mainly nausea, diarrhea, vomiting, abdominal discomfort). They have also been approved for reducing the risk of cardiovascular events in patients with diabetes and cardiovascular disease. A reduction in body weight has also been observed in overweight and obese individuals without diabetes. Following these results, some small retrospective studies have been performed in LTR with diabetes, showing the efficacy of GLP-1RAs in achieving better glycemic control and a reduction in body weight. AIMOur study aimed to assess the efficacy and safety of weekly GLP1-RAs injection in a cohort of LTR with diabetes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Material and Methods&lt;/h3&gt;&lt;div&gt;We retrospectively evaluated, between 2014 and 2023, all patients who underwent LT at our center and were treated with a GLP1-RA (semaglutide, liraglutide or dulaglutide) for diabetes. Body weight, body mass index, Hb1Ac values, ALT and AST values, adverse events and drug discontinuation were recorded at each follow-up visit. Results were expressed as mean ± SD, paired t-test was used when needed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 24 patients were included in the study. The characteristics of our population are shown in Table 1. The mean age was 59.0 (± 6.76) years, 29,2% were female. Alcohol was the main etiology of cirrhosis, and 13 patients had HCC.As shown in Table 2, after 6 months of treatment, there was a significant reduction in body weight and BMI (88.1 ± 17.7, p = 0.015; 29.1 ± 4.6, p = 0.026, respectively). The reduction was even more pronounced after 12 months (84.6 ± 16.7, p = 0.003; 28.4 ± 4.4, p = 0.0","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Pages S322-S323"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183814","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":"Comment on \"Population stratification using MASLD polygenic risk score improves severe liver disease prediction by clinical fibrosis scores\".","authors":"Zhiyao Shi, Kai Feng, Xiaokun Yang, Yu Gao, Xixing Wang","doi":"10.1016/j.dld.2025.08.079","DOIUrl":"https://doi.org/10.1016/j.dld.2025.08.079","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946616","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":"Comment on \"Diagnostic delay at diagnosis and time-to-treatment influence overall survival of pancreatic cancer patients\".","authors":"Yangyuxiao Lu, Mengqi Fang, Xuan Huang","doi":"10.1016/j.dld.2025.08.077","DOIUrl":"https://doi.org/10.1016/j.dld.2025.08.077","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946636","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}