Hpb最新文献

{"title":"The impact of vascular injuries on the management of bile duct injury following laparoscopic cholecystectomy- insights from a prospective study","authors":"Rohith Kodali ,&nbsp;Utpal Anand ,&nbsp;Kunal Parasar ,&nbsp;Rajeev N. Priyadarshi ,&nbsp;Ramesh Kumar ,&nbsp;Basant N. Singh ,&nbsp;Kislay Kant","doi":"10.1016/j.hpb.2024.12.022","DOIUrl":"10.1016/j.hpb.2024.12.022","url":null,"abstract":"<div><h3>Background</h3><div>Our study aimed to compare the clinical presentation and outcomes of post-cholecystectomy bile duct injuries (BDI) with and without arterial injuries.</div></div><div><h3>Methods</h3><div>A prospective analysis of 123 patients with post-cholecystectomy BDI between July 2018 and January 2022 was performed. Multivariate logistic regression analysis was used to assess the impact of vascular injuries on perioperative complications and long-term outcomes after delayed repair.</div></div><div><h3>Results</h3><div>Of 123 patients, 42 (34%) had associated vascular injuries, predominantly right hepatic artery disruptions. These patients experienced significantly higher perioperative complications after the index surgery (Cholangiolar abscess- 83.3% vs 32.1% ( p&lt;0.001), recurrent cholangitis- 66.67 % vs 14.81 % ( p&lt;0.001), blood transfusions ³2 - 89.74 % vs 28.57 % ( p&lt;0.001), hospital admissions ³3 – 3.88 ± 1.99 vs 2.49 ± 0.74 ( p&lt;0.001). Delayed Hepp-Couinaud biliary repair was performed in 112 patients. After a median follow-up, of 2 years, 85 (51.43 % vs. 88.16 % ), 12 (25.71 % vs. 3.89 %), 6 (11.43 % vs. 2.59 %), and 9 (11.43 % vs. 6.49 %) patients had excellent, good, fair, and poor outcomes.</div></div><div><h3>Conclusion</h3><div>Concomitant vasculobiliary injuries were associated with increased morbidity after index surgery; however, the long-term outcomes following definitive biliary repair remained comparable.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 544-552"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004813","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":"Laparoscopic versus open resection for hepatocellular carcinoma according to the procedure’s complexity: real-world weighted data from a national register","authors":"Simone Famularo ,&nbsp;Flavio Milana ,&nbsp;Francesco Ardito ,&nbsp;Federica Cipriani ,&nbsp;Alessandro Vitale ,&nbsp;Andrea Lauterio ,&nbsp;Matteo Serenari ,&nbsp;Andrea Fontana ,&nbsp;Daniele Nicolini ,&nbsp;Mario Giuffrida ,&nbsp;Mattia Garancini ,&nbsp;Tommaso Dominioni ,&nbsp;Matteo Zanello ,&nbsp;Pasquale Perri ,&nbsp;Quirino Lai ,&nbsp;Simone Conci ,&nbsp;Sarah Molfino ,&nbsp;Mariano Giglio ,&nbsp;Giuliano LaBarba ,&nbsp;Cecilia Ferrari ,&nbsp;Guido Mantovani","doi":"10.1016/j.hpb.2024.12.017","DOIUrl":"10.1016/j.hpb.2024.12.017","url":null,"abstract":"<div><h3>Background</h3><div>Minimal access liver surgery (MALS) is considered superior to open liver resection (OLR) in reducing the perioperative risk in patients affected by hepatocellular carcinoma (HCC). No national-level comparisons exist based on procedure complexity. This study aims to compare postoperative complications, postoperative ascites (POA), and major complications (MC) between MALS and OLR.</div></div><div><h3>Methods</h3><div>Data were retrieved from the Italian HE. RC.O.LE.S. registry. Patients were categorized into OLR or MALS groups and stratified by complexity grade (CP1, CP2, CP3). An inverse probability weighting (IPW) was performed to ensure balanced comparisons.</div></div><div><h3>Results</h3><div>From 2008 to 2021, 4738 patients were included: 1596 (33.7 %) underwent MALS, and 3142 (66.3 %) underwent OLR. CP1 procedures were conducted in 2522 cases (53.2 %), CP2 in 974 cases (20.5 %), and CP3 in 1242 cases (26.2 %). For CP1, MALS was associated with reduced POA (OR 0.356, 95%CI:0.29–0.43, <em>p</em> &lt; 0.001), and MC (OR 0.738, 95%CI:0.59–0.91, <em>p</em>: 0.006). In CP2, MALS showed association with MC (OR 0.557, 95%CI:0.37–0.82, p:0.004), but not with POA. For CP3, MALS was associated with increased MC risk (OR 1.441, 95%CI:1.10–1.88, p:0.008). Low-volume centers had significantly higher MC risks after CP2 and CP3 procedures than medium or high-volume centers.</div></div><div><h3>Conclusion</h3><div>In CP1 and CP2 procedures, MALS was proven advantageous in reducing POA and MC. Among CP3, MALS increased the risk of MC, but not among high-volume centres.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 511-522"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970671","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":"Ideal outcome after pancreatic resection for neuroendocrine tumors: a nationwide study","authors":"Jeffrey W. Chen ,&nbsp;Simone A. Augustinus ,&nbsp;Bert A. Bonsing ,&nbsp;Stefan A.W. Bouwense ,&nbsp;Ignace H.J.T. De Hingh ,&nbsp;Casper H. Van Eijck ,&nbsp;Bas Groot Koerkamp ,&nbsp;Tessa E. Hendriks ,&nbsp;Anton F. Engelsman ,&nbsp;Marc G. Besselink ,&nbsp;Els J.M. Nieveen van Dijkum ,&nbsp;Dutch Pancreatic Cancer Group","doi":"10.1016/j.hpb.2024.12.024","DOIUrl":"10.1016/j.hpb.2024.12.024","url":null,"abstract":"<div><h3>Background</h3><div>Pancreatic resections for pancreatic neuroendocrine tumors (pNET) may experience a higher complication rate than for pancreatic ductal adenocarcinoma (PDAC). This study aimed to determine the rate of the novel composite “Ideal Outcome” measure after resection for pNET, using PDAC as reference.</div></div><div><h3>Methods</h3><div>This observational cohort study included all consecutive patients after pancreatic resection for pNET and PDAC using the nationwide Dutch Pancreatic Cancer Audit (2014–2021). The primary outcome was Ideal Outcome; absence of postoperative mortality, postoperative pancreatic fistulas (POPF) grade B/C, other major complications, prolonged length of stay, reoperations and readmissions.</div></div><div><h3>Results</h3><div>In total, 524 pNET and 2851 PDAC resections were included. The rate of Ideal Outcome was lower after resection for pNET (47.7% <em>versus</em> 55.7%; <em>P</em>&lt;0.001) as compared to PDAC. This difference was driven by a lower rate of Ideal Outcome after pancreatoduodenectomy for pNET (37.7% <em>versus</em> 56.3%; <em>P</em>&lt;0.001), with no difference after left pancreatectomy (54.5% <em>versus</em> 52.5%; <em>P</em>=0.598). Among the individual components of Ideal Outcome after pancreatoduodenectomy, the largest difference was a four times higher rate of POPF (32.1% <em>versus</em> 7.9%; <em>P</em>&lt;0.001) after resection of pNET.</div></div><div><h3>Conclusion</h3><div>Patients undergoing pancreatoduodenectomy for pNET have a reduced Ideal Outcome rate compared to patients with PDAC, related to a fourfold increased risk of POPF. This highlights the value of pNET-specific patient counseling and the need for effective POPF mitigation strategies.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 562-571"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisiting the place of surgical portal decompression for adults with noncirrhotic portal hypertension due to chronic extrahepatic portal vein obstruction: a scoping review","authors":"Chetana Lim ,&nbsp;Faouzi Saliba ,&nbsp;Chady Salloum ,&nbsp;Daniel Azoulay","doi":"10.1016/j.hpb.2025.01.005","DOIUrl":"10.1016/j.hpb.2025.01.005","url":null,"abstract":"<div><h3>Background</h3><div>Liver cirrhosis accounts for more than 90 % of portal hypertension cases, and the other cases are due to noncirrhotic portal hypertension (NCPH). Variceal bleeding is the most life-threatening complication of portal hypertension and its primary treatment is medical according to the Baveno VII guidelines. This review discusses the evidence on surgical portal decompression for adult patients with NCPH secondary to chronic extrahepatic portal vein obstruction (EHPVO).</div></div><div><h3>Methods</h3><div>This is a scoping review of the evidence for the feasibility and effectiveness of surgical portal decompression in adults with NCPH secondary to EHPVO.</div></div><div><h3>Results</h3><div>This scoping review yielded 17 studies, including a total of 110 patients. Patient age(s) ranged from 19 to 68 years, with the majority undergoing nonphysiological (i.e., portosystemic shunts) shunts (N = 84, 76.4 %), mostly for variceal bleeding refractory to medical and endoscopic treatments. Physiological shunts (i.e., Rex shunts) had a potential advantage over nonphysiological shunts in postoperative rebleeding (5 % vs. 10 %) and hepatic encephalopathy rates (0 % vs. 13 %). Conversely, nonphysiological shunts had a potential advantage over physiological shunts in postoperative shunt thrombosis (8 % vs. 22 %).</div></div><div><h3>Discussion</h3><div>This scoping review reported that surgical portal decompression is feasible in adults with NCPH due to EHPVO with favorable outcomes and long-term patency.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 434-444"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143038187","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":"Highlights in this issue","authors":"","doi":"10.1016/S1365-182X(25)00529-5","DOIUrl":"10.1016/S1365-182X(25)00529-5","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Page iii"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143740035","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":"Machine learning based prediction model for bile leak following hepatectomy for liver cancer","authors":"Abdullah Altaf ,&nbsp;Muhammad M. Munir ,&nbsp;Muhammad Muntazir M. Khan ,&nbsp;Zayed Rashid ,&nbsp;Mujtaba Khalil ,&nbsp;Alfredo Guglielmi ,&nbsp;Francesca Ratti ,&nbsp;Luca Aldrighetti ,&nbsp;Todd W. Bauer ,&nbsp;Hugo P. Marques ,&nbsp;Guillaume Martel ,&nbsp;Sorin Alexandrescu ,&nbsp;Matthew J. Weiss ,&nbsp;Minoru Kitago ,&nbsp;George Poultsides ,&nbsp;Shishir K. Maithel ,&nbsp;Carlo Pulitano ,&nbsp;Vincent Lam ,&nbsp;Irinel Popescu ,&nbsp;Ana Gleisner ,&nbsp;Timothy M. Pawlik","doi":"10.1016/j.hpb.2024.12.015","DOIUrl":"10.1016/j.hpb.2024.12.015","url":null,"abstract":"<div><h3>Objective</h3><div>We sought to develop a machine learning (ML) preoperative model to predict bile leak following hepatectomy for primary and secondary liver cancer.</div></div><div><h3>Methods</h3><div>An eXtreme Gradient Boosting (XGBoost) model was developed to predict post-hepatectomy bile leak using data from the ACS-NSQIP database. The model was externally validated using data from hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) multi-institutional databases.</div></div><div><h3>Results</h3><div>Overall, 20,570 and 2253 patients were identified from the ACS-NSQIP and multi-institutional databases, respectively. The incidence rates of bile leak were 7.0 %, 6.3 % and 10.2 % in the ACS-NSQIP, HCC and ICC databases, respectively. The XGBoost model achieved areas under receiver operating characteristic curves (AUROC) of 0.748, 0.719 and 0.711 in the training, testing and external validation cohorts, respectively. The SHAP algorithm demonstrated that the factors most strongly predictive of postoperative bile leak were serum alkaline phosphatase, surgical approach and cancer diagnosis. An online tool was developed for ease-of-use and clinical applicability (<span><span>https://altaf-pawlik-bileleak-calculator.streamlit.app/</span><svg><path></path></svg></span>).</div></div><div><h3>Conclusion</h3><div>A novel ML model demonstrated strong discrimination power to preoperatively identify patients at high risk of developing bile leak post-hepatectomy. The online calculator may be used as a clinical tool to inform preoperative surgical planning, intraoperative decision-making, and postoperative recovery protocols for patients undergoing hepatectomy.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 489-501"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927241","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":"Risk factors associated with venous thromboembolism after hepatectomy in oncology patients","authors":"Brianna Greenberg ,&nbsp;Alexandra W. Acher ,&nbsp;Alejandro Branes ,&nbsp;Rachel Roke ,&nbsp;Grace Xu ,&nbsp;Myriam Lafreniere-Roula ,&nbsp;Kevin Thorpe ,&nbsp;Keying Xu ,&nbsp;Paul J. Karanicolas ,&nbsp;HPB CONCEPT Team","doi":"10.1016/j.hpb.2024.12.021","DOIUrl":"10.1016/j.hpb.2024.12.021","url":null,"abstract":"<div><h3>Background</h3><div>Liver resection increases venous thromboembolism (VTE) risk due to malignancy-related hyper-coagulopathy and surgical inflammation. Current guidelines recommend early post-operative and extended pharmacologic prophylaxis for all patients but lack stratification by patient or surgical factors. Despite these guidelines, surgeon preferences influence prophylaxis practices. This study aimed to identify clinical factors associated with VTE following liver resection.</div></div><div><h3>Methods</h3><div>Using data from the Hemorrhage During Liver Resection (HeLiX) trial, a randomized clinical trial of patients undergoing liver resection for cancer, univariate comparisons and logistic regression were performed.</div></div><div><h3>Results</h3><div>Study cohort VTE incidence was 4.1 %. Multivariable analysis identified major liver resection (odds ratio (OR) 2.59, 95 % confidence interval (CI) 1.38–5.03) and higher estimated blood loss (EBL) (OR 1.14 per 500 mL increase, 95 % CI 1.03–1.26) as associated with increased risk. Surgical duration (OR 1.14 per hour increase, 95 % CI 0.95–1.34) and use of tranexamic acid (OR 1.77, 95 % CI 0.98–3.27) did not reach statistical significance. VTE rate was highly dependent on extent of resection (1–2 segments, 1.7 %; 3–4 segments, 5.4 %; &gt;4 segments, 6.7 %).</div></div><div><h3>Conclusion</h3><div>Major resection and increased EBL are associated with higher risk of VTE. These patients may warrant more intensive prophylax compared to those having minor resections with minimal blood loss.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 538-543"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Somatostatin analogues do not reduce the risk of clinically relevant post-operative fistula rates in patients undergoing pancreatic surgery\", a systematic review and meta-analysis.","authors":"Carolyn Cullinane, Michael Devine, Mohammed Alazzawi, Criostoir O Suilleabhain, Adrian O Sullivan","doi":"10.1016/j.hpb.2025.03.003","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.03.003","url":null,"abstract":"<p><strong>Background: </strong>The impact of Somatostatin Analogues (SSA) on Post-Operative Pancreatic Fistula (POPF) risk reduction lacks clarity and reports are conflicting. The aim of this study was to perform a systematic review and meta-analysis to explore the effect of SSA on POPF rates.</p><p><strong>Methods: </strong>A systematic review was performed for studies reporting POPF in relation to SSA use following the consensus by the International Study Group of Pancreatic Fistula (ISGPF) to re-define what constitutes a clinically significant POPF in 2015. The primary outcome was the incidence of clinically relevant POPF among patients who received SSA peri-operatively.</p><p><strong>Results: </strong>Twenty studies, including 6947 patients, were eligible for inclusion. Overall, SSA use did not significantly lower the risk of developing a POPF(OR 0.89, 95 % CI 0.66-1.20, P = 0.44, I² = 73 %). Subgroup analysis was performed to determine whether SSA could reduce POPF in high-risk cohorts (soft pancreas, duct <5 mm). SSA did not significantly reduce POPF in the five studies reporting on high-risk cohorts (OR 1.42, 95 % CI 0.60-3.37, P = 0.43, I² = 73 %). Furthermore, subgroup analysis of both grade B and grade C POPF's did not show any benefit of SSA.</p><p><strong>Conclusion: </strong>SSA prophylaxis does not reduce the incidence of clinically relevant POPR and should not be routinely administered for pancreatic resections.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779886","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":"International multidisciplinary consensus recommendations on clinical application of three-dimensional visualization in precision surgery for pediatric liver tumors.","authors":"Qian Dong, Wenli Xiu, Benjie Tang, Eiso Hiyama, Mary T Austin, Yeming Wu, Xiaojun Yuan, Chengzhan Zhu, Chengli Liu, Hiroki Ishibashi, Karthik K Tappa, Huanmin Wang, Chuandong Sun, YunTao Ma, Hongwei Xi, Jian Wang, Jianghua Zhan, Kyong Ihn, Mitsuo Shimada, Mingman Zhang, Mary E Brindle, Patrick B Thomas, Shigehisa Fumino, Tao Liu, Thom Lobe, Udo Rolle, Shan Wang, Xiaowen Zhai, Yoshinori Koga, Yoshiaki Kinoshita, Yuzuo Bai, Zhaozhu Li, Zhe Wen, Weikang Pan, Krysta M Sutyak, Pier C Giulianotti","doi":"10.1016/j.hpb.2025.03.007","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.03.007","url":null,"abstract":"<p><strong>Background: </strong>Pediatric liver tumors are predominantly primary malignant tumors, and complete tumor resection with sufficient preservation of liver tissue is crucial for improving prognosis. However, due to the delicate anatomical structure of the pediatric liver and the relatively large size of the tumors, especially in difficult cases, the surgical challenges are substantial. While precision liver surgery are widely applied in clinical practice, pediatric cases require more customized approaches. The application of three-dimensional (3D) visualization technology is crucial for enhancing surgical accuracy, allowing for precise preoperative planning and intraoperative guidance.</p><p><strong>Methods: </strong>This consensus was collaboratively developed by 36 experts from eight countries, using the Glaser's state-of-the-art method to review and refine the draft.</p><p><strong>Results: </strong>The final consensus resulted in 15 international multidisciplinary consensus recommendations on clinical application of 3D visualization in precision surgery for pediatric liver tumors.</p><p><strong>Conclusion: </strong>This consensus will standardize the application of 3D visualization technology in precision surgery for pediatric liver tumors to improve outcomes and reduce risks.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709702","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":"Split liver transplantation in high MELD score adult recipients: a reappraisal.","authors":"Lucia Paiano, Daniel Azoulay, Frédérique Blandin, Marc-Antoine Allard, Daniel Pietrasz, Oriana Ciacio, Gabriella Pittau, Chady Salloum, Eleonora De Martin, Antonio Sa Cunha, René Adam, Daniel Cherqui, Eric Vibert, Nicolas Golse","doi":"10.1016/j.hpb.2025.03.004","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.03.004","url":null,"abstract":"<p><strong>Background: </strong>Split liver transplantation (SLT) from deceased donors is a potential solution to the global organ shortage. While effective in patients with mild disease, outcomes in high MELD score recipients remain uncertain and conflicting. This study compares survival in high vs. low MELD score recipients.</p><p><strong>Methods: </strong>This retrospective single-centre study included all consecutive patients transplanted with a split liver graft between 2010 and 2022. Two groups of recipients with MELD<25 and ≥ 25 at LT were compared.</p><p><strong>Results: </strong>The study population included 119 patients (n = 98 with MELD<25, n = 21 with MELD≥25) with an average follow-up of 55 months. Both groups were comparable in terms of indication for transplantation and donor characteristics. The high MELD group required more blood transfusions (7 vs. 3 units; p < 0.001) during LT and had a longer stay in intensive care unit (7 vs. 5 days; p = 0.011). Biliary, arterial, and venous complications were similar between groups, as well as graft survival (5 years: 75 % vs. 61 %, p = 0.35) and long-term overall survival (5 years: 83 % vs. 75 %, p = 0.17).</p><p><strong>Discussion: </strong>Our results indicate that SLT for patients with MELD≥25 improves access to grafts, is feasible and safe, without significant increased risk of severe complications or decreased long-term overall patient or graft survivals.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709707","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}