Journal of Clinical and Experimental Hepatology最新文献

{"title":"Safety and Outcomes of an On-Demand Transfusion Strategy Versus Prophylactic Transfusion of Platelets in Patients With Liver Cirrhosis and Severe Thrombocytopenia Undergoing High-Risk Procedures: A Post Hoc Analysis of Two Randomized Controlled Trials","authors":"Sagnik Biswas ,&nbsp;Sanchita Gupta ,&nbsp;Shubham Mehta ,&nbsp;Shekhar Swaroop ,&nbsp;Arnav Aggarwal ,&nbsp;Ayush Agarwal ,&nbsp;Sarthak Saxena ,&nbsp;Tushar Sehgal ,&nbsp;Samagra Aggarwal ,&nbsp;Deepak Gunjan ,&nbsp;Baibaswata Nayak ,&nbsp;Shivanand Gamanagatti ,&nbsp;Shalimar","doi":"10.1016/j.jceh.2024.102467","DOIUrl":"10.1016/j.jceh.2024.102467","url":null,"abstract":"<div><h3>Background</h3><div>There are limited studies assessing whether prophylactic platelet transfusions prior to high-risk procedures reduce the risk of bleeding in patients with liver cirrhosis.</div></div><div><h3>Methods</h3><div>We performed a <em>post hoc</em> analysis of two prior randomized clinical trials (CTRI/2017/12/010822 and CTRI/2021/05/033464), which compared thromboelastography-guided prophylactic platelet transfusion to standard-of-care (empirical prophylactic transfusion for all patients prior to the procedure) or on-demand transfusion (no prophylactic transfusions). We aimed to assess the risk of major procedure-related bleeding or mortality among patients who had received prophylactic platelet transfusions versus those who did not (on-demand transfusions).</div></div><div><h3>Results</h3><div>A total of 118 patients were included in the analysis, with baseline demographics well matched between groups. The leading etiologies of cirrhosis were cryptogenic (42, 35.6%) and autoimmune liver disease (30, 25.4%). The most common procedures performed were percutaneous liver biopsy (73, 61.8%), followed by transjugular intrahepatic portosystemic shunt (14, 11.9%) and transarterial chemoembolization (14, 11.9%). No episode of major bleeding or procedure-related mortality occurred in either group, though minor bleeding occurred in 5 patients. A significantly lower number of patients in the on-demand group required platelet transfusions than those receiving empirical transfusions as part of standard care.</div></div><div><h3>Conclusion</h3><div>Procedure-related bleeding rates were not significantly higher among patients with liver cirrhosis undergoing high-risk procedures without prophylactic platelet transfusions than in those who received them. Larger randomized trials are required to validate these findings from our <em>post hoc</em> analysis.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102467"},"PeriodicalIF":3.3,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Transaminitis and Metabolic Dysfunction-Associated Steatotic Liver Disease Among Young Indian Adults—A Population-Based Study","authors":"Abilash Nair ,&nbsp;Jabbar Puthiyaveettil Khadar ,&nbsp;Archana Mohan Preetha ,&nbsp;Jayakumari Chellamma ,&nbsp;Krishnadas Devadas ,&nbsp;Tanvir Kaur Gandhi ,&nbsp;Bipin K. Gopal ,&nbsp;Sreejith Babu U.S. ,&nbsp;Amal Kingsley ,&nbsp;Anish Thekkumkara Surendran Nair ,&nbsp;Ramesh Gomez ,&nbsp;Praveen G ,&nbsp;Ajosh Thambi T.S. ,&nbsp;Sumitha N.","doi":"10.1016/j.jceh.2024.102466","DOIUrl":"10.1016/j.jceh.2024.102466","url":null,"abstract":"<div><h3>Background</h3><div>Metabolic dysfunction-associated steatotic liver disease (MASLD) with onset in youth may be more consequential for adverse outcomes than that detected later in adulthood. Transaminitis in the general population is a marker of the prevalence of MASLD. There are no previous community-based studies in Indian youth assessing the prevalence of transaminitis. The purpose of this study was to find out the prevalence of transaminitis, MASLD and elevated Fibrosis-4 (FIB-4) index among young South Indian adults.</div></div><div><h3>Methods</h3><div>This was a cross-sectional study done over a period of 1 year from January 2022 among adults aged 18–30 years. Multistage sampling was used to recruit participants with body mass index (BMI) &lt; 30 kg/m² and without moderate to heavy alcohol consumption from four different sociogeographic regions. Detailed history, physical examination and investigations including liver enzymes (alanine aminotransferase [ALT] and aspartate aminotransferase [AST]), platelet count, and metabolic workup were carried out. FIB-4 index and Nonalcoholic fatty liver disease-liver fat score (NAFLD-LFS) were calculated. LFS ≥ −0.64 was used to rule in MASLD.</div></div><div><h3>Results</h3><div>A total of 2373 (1170 males) participants with a mean age of 24 ± 3.5 years were included. Transaminitis (AST or ALT≥35 IU/L) was seen in 25.9% of the cohort. MASLD by NAFLD-LFS was present in 27.4% of the population. FIB-4 index ≥1.3 was found in 54 (2.27%) participants. Neck circumference and Trivandrum Medical College adiposity index were associated with transaminitis, MASLD, and elevated FIB-4. Blood pressure, triglycerides, and low-density lipoprotein cholesterol were higher, and high-density lipoprotein cholesterol was lower among participants with transaminitis, but they were not different among those with elevated FIB-4 index. BMI and waist-hip ratio were not different among participants with and those without transaminitis or MASLD.</div></div><div><h3>Conclusion</h3><div>There is a high prevalence of transaminitis and MASLD in community-dwelling young adult Indians. We recommend screening all young adult Indians for MASLD and transaminitis.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102466"},"PeriodicalIF":3.3,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver Explantation in Difficult Scenarios","authors":"Rajesh Dey,&nbsp;Shaleen Agarwal,&nbsp;Subash Gupta","doi":"10.1016/j.jceh.2024.102461","DOIUrl":"10.1016/j.jceh.2024.102461","url":null,"abstract":"<div><div>Recipient hepatectomy is considered as the most difficult part of a liver transplant operation. This article describes techniques to deal with scenarios like massive caudate lobe, a recipient with a transjugular intrahepatic portosystemic shunt (TIPS) shunt <em>in situ</em>, a recipient with hepatocellular carcinoma, acute liver failure and a history of previous abdominal surgery.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 2","pages":"Article 102461"},"PeriodicalIF":3.3,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tofacitinib-induced Hepatitis and Tuberculosis: A Case of Two Rare Adverse Events in a Single Patient","authors":"Kamlesh Taori,&nbsp;Sanjay Kumar,&nbsp;Mayankbhushan Pateriya,&nbsp;Naveen TMU","doi":"10.1016/j.jceh.2024.102457","DOIUrl":"10.1016/j.jceh.2024.102457","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 2","pages":"Article 102457"},"PeriodicalIF":3.3,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body Composition in Cholangiocarcinoma Affects Immune Cell Populations in the Tumor and Normal Liver Parenchyma","authors":"Guanwu Wang ,&nbsp;Dong Liu ,&nbsp;Tarick M. Al-Masri ,&nbsp;Carlos C. Otto ,&nbsp;Jens Siveke ,&nbsp;Sven A. Lang ,&nbsp;Tom F. Ulmer ,&nbsp;Steven WM Olde Damink ,&nbsp;Tom Luedde ,&nbsp;Edgar Dahl ,&nbsp;Ulf P. Neumann ,&nbsp;Lara R. Heij ,&nbsp;Jan Bednarsch","doi":"10.1016/j.jceh.2024.102460","DOIUrl":"10.1016/j.jceh.2024.102460","url":null,"abstract":"<div><h3>Background</h3><div>Due to malnutrition and tumor cachexia, body composition (BC) is frequently altered and known to adversely affect short- and long-term results in patients with cholangiocarcinoma (CCA). Here, we explored immune cell populations in the tumor and liver of CCA patients with respect to BC.</div></div><div><h3>Methods</h3><div>A cohort of 96 patients who underwent surgery for CCA was investigated by multiplexed immunofluorescence (MIF) techniques with computer-based analysis on whole-tissue slide scans to quantify and characterize immune cells in normal liver and tumor regions. BC was characterized by obesity, sarcopenia, myosteatosis, visceral obesity and sarcopenic obesity. Associations between BC and immune cell populations were determined by univariate and multivariable binary logistic regressions.</div></div><div><h3>Results</h3><div>BC was frequently altered in intrahepatic CCA (iCCA, n = 48), with 47.9% of the patients showing obesity, 70.8% sarcopenia, 18.8% sarcopenic obesity, 58.3% myosteatosis and 54.2% visceral obesity as well as in perihilar CCA (pCCA, n = 48) with 45.8% of the patients showing obesity, 54.0 sarcopenia, 14.6% sarcopenic obesity, 47.9% myosteatosis and 56.3% visceral obesity. From an immune cell perspective, independent associations within the tumor compartment were observed for iCCA (myosteatosis: TIM-3+CD8+cells; obesity: PD-1+TIM-3+CD4+cells) and for pCCA (myosteatosis: PD-L2+CD68-cells and CD4+cells). Further, independent associations were observed within the normal liver parenchyma for iCCA (visceral obesity: PD-1+PD-L1+PD-L2+CD68+cells) and for pCCA (sarcopenia: CD68+cells and TIM-3+CD8+cells; visceral obesity: ICOS+-TIGIT+CD8+cells and sarcopenic obesity: PD-1+PD-L1+PD-L2+CD8+cells).</div></div><div><h3>Conclusion</h3><div>This is the first systematic analysis of the association of BC and immune cells in cholangiocarcinoma showing a strong association between BC and distinct immune cell populations within the tumor itself as well as within the normal parenchyma.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 2","pages":"Article 102460"},"PeriodicalIF":3.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11697564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Measured Glomerular Filtration Rate Versus Estimated Glomerular Filtration Rate in Indian Cirrhotic Patients: Report of a Pilot Study","authors":"Smita Divyaveer ,&nbsp;Madhuri Kashyap ,&nbsp;Kushal Kekan ,&nbsp;Ashok K. Yadav ,&nbsp;Jaskiran Kaur ,&nbsp;Madhumita Premkumar ,&nbsp;Akash Gandotra ,&nbsp;Kanchan Prajapati ,&nbsp;Arka De ,&nbsp;Ajay K. Duseja ,&nbsp;Nipun Verma ,&nbsp;Radhika Aggarwal ,&nbsp;Vaishnavi Venkatasubramanian ,&nbsp;Vaibhav Tiwari ,&nbsp;Vishnuvardhan Bagur ,&nbsp;Amol N. Patil ,&nbsp;Nusrat Safiq ,&nbsp;Harbir S. Kohli","doi":"10.1016/j.jceh.2024.102464","DOIUrl":"10.1016/j.jceh.2024.102464","url":null,"abstract":"<div><h3>Background</h3><div>Renal impairment significantly affects morbidity and mortality rates of cirrhosis patients. Studies on glomerular filtration rate (eGFR) estimation did not include cirrhosis patients. These equations are erroneous and unreliable in cirrhosis due to sarcopenia. Further, the accuracy of eGFR equations varies across different ethnic groups. Measurement of GFR by iohexol clearance is a gold standard method of accurate determination of GFR. There is scarce data on iohexol GFR in cirrhosis and none in Indian population.</div></div><div><h3>Methodology</h3><div>This was prospective observational study. Consecutive adult patients with cirrhosis with stable renal function for prior 1 month were included. Iohexol weight-based dosage was given and timed blood samples were taken to measure iohexol clearance. Plasma iohexol levels was measured by high performance liquid chromatography (HPLC) and Cystatin-C was measured by ELISA in plasma samples.</div></div><div><h3>Results</h3><div>Thirty-five patients were enrolled in the study. Hepatitis B (n = 5), hepatitis C (n = 4); alcoholic liver disease (n = 20), metabolic dysfunctional associated steatotic liver disease (n = 2), others/overlap (n = 3). The average eGFR by MDRD4, MDRD6, CKD-EPI Creat, CKD EPI Cys C, CKD EPI Creat-Cys C, RFHand GRAIL formulae were 105.24(24.2),104.75(23.5),102.14(15.9),68.91(16.5),82.91(15.21), 67.27 (14.08) and 112.9 (19.5) ml/min ml/min/1.73m², respectively. The average mGFR measured by iohexol method was 73.44 (16.8)ml/min/1.73 m². 30% agreement with mGFR was found with eGFR by MDRD4 in 38.2% (n = 13), MDRD6 38.2% ((n = 13), CKD-EPI Creat in 35.2% (n = 12), CKD EPI Cys C in 79.41% (n = 27), CKD EPI Creat-Cys C in 76.42% (n = 26), RFH 76.4% (n = 26) and GRAIL 20.5% (n = 7).</div></div><div><h3>Conclusion</h3><div>The eGFR equations using creatinine are imprecise and less accurate in Indian patients with cirrhosis. All equations overestimate GFR. Equations especially developed for cirrhosis patients like MDRD6 are also not precise. Cystatin C based equations are better than creatinine-based equations. Further studies with large sample size are needed to establish an accurate method of GFR assessment in Indian patients with cirrhosis.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 2","pages":"Article 102464"},"PeriodicalIF":3.3,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Ileal Bile Acid Transport Inhibitors in Inherited Cholestatic Liver Disorders: A Meta-analysis of Randomized Controlled Trials","authors":"Muhammad Imran ,&nbsp;Ahmed B. Elsnhory ,&nbsp;Ahmed A. Ibrahim ,&nbsp;Mohamed Elnaggar ,&nbsp;Muhammad S. Tariq ,&nbsp;Areeba M. Mehmood ,&nbsp;Shujaat Ali ,&nbsp;Saba Khalil ,&nbsp;Sheharyar H. Khan ,&nbsp;Mansab Ali ,&nbsp;Mohamed Abuelazm","doi":"10.1016/j.jceh.2024.102462","DOIUrl":"10.1016/j.jceh.2024.102462","url":null,"abstract":"<div><h3>Background</h3><div>Inherited cholestatic liver disorders such as progressive familial intrahepatic cholestasis (PFIC) and Alagille syndrome result in significant pruritus and increased serum bile acids, necessitating liver transplantation. This study aims to evaluate the efficacy and safety of Ileal bile acid transport inhibitors (IBATIs) in children with PFIC and Alagille syndrome.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive search across the databases to identify relevant randomized controlled trials (RCTs), and Covidence was used to screen eligible articles. All outcomes data were synthesized using risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs) in RevMan 5.4. PROSPERO: <span><span>CRD42024564270</span><svg><path></path></svg></span>.</div></div><div><h3>Results</h3><div>Four multicenter RCTs involving 215 patients were included. IBATIs were associated with a significant reduction in Itch Observer Reported Outcome (Itch (ObsRo)) score (MD: −0.90, 95% CI [−1.17, −0.63], <em>P</em> &lt; 0.01), serum bile acids (MD: −119.06, 95% CI [-152.37, −85.74], <em>P</em> &lt; 0.01), total bilirubin (MD: −0.73, 95% CI [-1.32, −0.15], <em>P</em> = 0.01), and increased proportion of patients achieving ≥1 score reduction in Itch (ObsRo) score (RR: 2.54, 95% CI [3.83, 1.69], <em>P</em> &lt; 0.01) and bile acid responders (RR: 8.76, 95% CI [2.46, 31.23], <em>P</em> &lt; 0.01) compared with placebo. No differences were observed in any treatment-emergent adverse events (TEAs) (RR: 1.02, 95% CI [1.12, 0.93], <em>P</em> = 0.71), TEAs leading to drug discontinuation (1.03, 95% CI [5.56, 0.19], any serious TEAs, or liver-related TEAs.</div></div><div><h3>Conclusion</h3><div>IBATIs showed significant improvement in various cholestatic parameters with tolerable safety profile; however, future research on optimal dosage and long-term outcomes is needed.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102462"},"PeriodicalIF":3.3,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Hormone: A Potential Target at Treating Female Metabolic Dysfunction-Associated Steatotic Liver Disease?","authors":"Huiyan Duan ,&nbsp;Minmin Gong ,&nbsp;Gang Yuan ,&nbsp;Zhi Wang","doi":"10.1016/j.jceh.2024.102459","DOIUrl":"10.1016/j.jceh.2024.102459","url":null,"abstract":"<div><div>The global prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is rising due to rapid lifestyle changes. Although females may be less prone to MASLD than males, specific studies on MASLD in females should still be conducted. Previous research has shown that sex hormone levels are strongly linked to MASLD in females. By reviewing a large number of experimental and clinical studies, we summarized the pathophysiological mechanisms of estrogen, androgen, sex hormone-binding globulin, follicle-stimulating hormone, and prolactin involved in the development of MASLD. We also analyzed the role of these hormones in female MASLD patients with polycystic ovarian syndrome or menopause, and explored the potential of targeting sex hormones for the treatment of MASLD. We hope this will provide a reference for further exploration of mechanisms and treatments for female MASLD from the perspective of sex hormones.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 2","pages":"Article 102459"},"PeriodicalIF":3.3,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling Toxicity: A Case Report of Complications Following Henna Leaf Consumption","authors":"Kamlesh Taori,&nbsp;Sanjay Kumar,&nbsp;Mayankbhushan Pateriya,&nbsp;Naveen Tmu","doi":"10.1016/j.jceh.2024.102456","DOIUrl":"10.1016/j.jceh.2024.102456","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 2","pages":"Article 102456"},"PeriodicalIF":3.3,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Small for Size Syndrome in Living Donor Liver Transplantation- Prevention and Management","authors":"Mettu Srinivas Reddy ,&nbsp;Prasanna V. Gopal","doi":"10.1016/j.jceh.2024.102458","DOIUrl":"10.1016/j.jceh.2024.102458","url":null,"abstract":"<div><div>Small-for-size syndrome is a clinical syndrome of early allograft dysfunction usually following living donor liver transplantation due to a mismatch between recipient metabolic and functional requirements and the graft's functional capacity. While graft size relative to the recipient size is the most commonly used parameter to predict risk, small-for-size syndrome is multifactorial and its development depends on a number of inter-dependant factors only some of which are modifiable. Intra-operative monitoring of portal haemodynamics and portal flow modulation is widely recommended though there is wide variation in clinical practice. Management of established small-for-size syndrome centres around meticulous patient care, infection prevention, fluid management and identifying correctable technical complications. However, retransplantation is the only treatment in severe cases. While small-for-size syndrome <em>per se</em> is associated with increased peri-operative mortality, the contribution of non-hepatic organ failure in determining patient outcomes needs further studies.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 2","pages":"Article 102458"},"PeriodicalIF":3.3,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}