Journal of Clinical and Experimental Hepatology最新文献

{"title":"Epidemiological Dynamics of Burden and Health Inequalities in Metabolic Dysfunction-associated Steatotic Liver Disease in Adolescents at Global, Regional, and National Levels, 1990–2021","authors":"Xiaohui Sui ,&nbsp;Junde Zhao ,&nbsp;Yuxin Yang ,&nbsp;Yikun Yang ,&nbsp;Kaifeng Li ,&nbsp;Zuocheng Wang ,&nbsp;Ziqi Liu ,&nbsp;Ruining Lu ,&nbsp;Guiju Zhang","doi":"10.1016/j.jceh.2025.102537","DOIUrl":"10.1016/j.jceh.2025.102537","url":null,"abstract":"<div><h3>Background</h3><div>Metabolic dysfunction-associated steatotic liver disease (MASLD) has become one of the major causes of chronic liver disease among adolescents. However, epidemiological studies on MASLD in adolescents are still insufficient. In this study, we aim to investigate the global burden and the trend of MASLD in adolescents from 1990 to 2021.</div></div><div><h3>Methods</h3><div>The age-standardized incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of MASLD were calculated based on the Global Burden of Disease (GBD) 2021 study and stratified by sex, socio-demographic index (SDI), GBD regions, and countries. The temporal trends were examined using the average annual percentage change (AAPC) and joinpoint regression.</div></div><div><h3>Results</h3><div>From 1990 to 2021, the global trends of age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) of MASLD show notable increase, and the male is significantly higher than the female in adolescents. According to the incidence and prevalence, nations with low SDI confront a higher burden of MASLD. Besides, the inequality of incidence and prevalence between different SDI regions have shrunk in 2021, but the inequality of DALYs and mortality are still exacerbated. Decomposition analysis revealed that population growth and epidemiological changes were the main reasons for the increase in the incidence of MASLD.</div></div><div><h3>Conclusion</h3><div>From 1990 to 2021, there is a significant upward trend in the incidence of MASLD among adolescents worldwide. Of particular note are male adolescents, East Asian regions, and groups living in high SDI countries.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102537"},"PeriodicalIF":3.3,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143682850","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":"Factors Associated With Advanced Liver Fibrosis in a Population With Type 2 Diabetes: A Multicentric Study in Mexico City","authors":"Froylan D. Martínez-Sánchez ,&nbsp;Maria J. Corredor-Nassar ,&nbsp;Sandra M. Feria-Agudelo ,&nbsp;Victor M. Paz-Zarza ,&nbsp;Carolina Martinez-Perez ,&nbsp;Alejandra Diaz-Jarquin ,&nbsp;Fátima Manzo-Santana ,&nbsp;Victor A. Sánchez-Gómez ,&nbsp;Alondra Rosales-Padron ,&nbsp;Mónica Baca-García ,&nbsp;Jessica Mejía-Ramírez ,&nbsp;Ignacio García-Juárez ,&nbsp;Fatima Higuera-de la Tijera ,&nbsp;Jose L. Pérez-Hernandez ,&nbsp;Beatriz Barranco-Fragoso ,&nbsp;Nahum Méndez-Sánchez ,&nbsp;Jacqueline Córdova-Gallardo","doi":"10.1016/j.jceh.2025.102536","DOIUrl":"10.1016/j.jceh.2025.102536","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major cause of chronic liver disease, primarily due to insulin resistance and type 2 diabetes (T2D). Despite the strong link between T2D and MASLD, identifying and treating liver fibrosis in T2D patients is still poor. This study aimed to identify the factors related to advanced liver fibrosis in T2D patients.</div></div><div><h3>Methods</h3><div>This retrospective observational study used medical records from four centers in Mexico City from 2018 to 2023. The study included 2000 patients with T2D. Liver fibrosis was evaluated using the Fibrosis-4 (FIB-4) index, and insulin resistance was assessed using the estimated glucose disposal rate (eGDR).</div></div><div><h3>Results</h3><div>The mean age of the patients was 58.9 years, with 63.7% being women. The median duration of T2D was 7 years, and the mean HbA1c was 7.63%. Overall, 20.4% had advanced liver fibrosis. The multivariate logistic regression analysis showed that diabetes duration &gt;10 years {odds ratio (OR) = 2.105 (95% confidence interval [CI] 1.321–3.355)}, fasting glucose &gt;126 mg/dL (OR = 1.568 [95% CI 1.085–2.265]), and microalbuminuria &gt;300 mg/24 h (OR = 2.007 [95% CI 1.134–3.552]) were associated with advanced liver fibrosis. Conversely, the eGDR (OR = 0.805 [95% CI 0.703–0.888]), statins (OR = 0.111 [95% CI 0.073–0.168]), and pioglitazone (OR = 0.082 [95% CI 0.010–0.672]) were inversely associated.</div></div><div><h3>Conclusion</h3><div>Longer diabetes duration, insulin resistance, and microalbuminuria are independently linked to advanced liver fibrosis in T2D patients. Statins and pioglitazone may protect against liver fibrosis. Enhanced screening and management strategies targeting these factors could slow fibrosis progression and reduce the global burden of MASLD.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102536"},"PeriodicalIF":3.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143682849","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":"Left Lateral Sectionectomy With Intrahepatic Cholangiojejunostomy for Portal Cavernoma Cholangiopathy (PCC)—A Novel Approach","authors":"Yajnadatta Sarangi,&nbsp;Anu Behari,&nbsp;Somanath Malage,&nbsp;Ashok Kumar II,&nbsp;Rajneesh K. Singh","doi":"10.1016/j.jceh.2025.102535","DOIUrl":"10.1016/j.jceh.2025.102535","url":null,"abstract":"<div><div>The development of portal cavernoma cholangiopathy (PCC) in cases of extrahepatic portal vein obstruction (EHPVO) presents significant management challenges. Strictures, stones, and extensive collaterals at the porta hepatis contribute to considerable surgical complexity. The traditional surgical approach for such patients involves a portosystemic shunt, followed by hepaticojejunostomy when indicated. In carefully selected cases, left lateral sectionectomy combined with intrahepatic cholangiojejunostomy (Longmire’s procedure) offers a viable and durable long-term solution. We present two cases where this approach was successfully employed. Both the patients had sub-hilar strictures, and a large stone burden localized to the left lateral section of the liver. Conventional hepaticojejunostomy was contraindicated due to a heavily collateralized hilum, which precluded a safe landing zone. In these two cases, left lateral sectionectomy was performed to clear the large intrahepatic stone burden, with intrahepatic cholangiojejunostomy providing effective biliary drainage while avoiding the heavily collateralized hilar and pericholedochal regions.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102535"},"PeriodicalIF":3.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143714270","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 Direct Oral Anticoagulants Compared to Vitamin K Antagonists for Atrial Fibrillation in Patients With Liver Cirrhosis: An Update Systematic Review and Meta-analysis","authors":"Maria C.R. Miranda ,&nbsp;Charles K.M. Santos ,&nbsp;Gabriel A. Barbosa ,&nbsp;Antônio da Silva Menezes Júnior","doi":"10.1016/j.jceh.2025.102534","DOIUrl":"10.1016/j.jceh.2025.102534","url":null,"abstract":"<div><h3>Background</h3><div>This meta-analysis aimed to compare the efficacy and safety of direct oral anticoagulants (DOACs) with vitamin K antagonists (VKAs) in patients with concomitant atrial fibrillation (AF) and liver cirrhosis (LC).</div></div><div><h3>Methods</h3><div>PubMed, Cochrane Library, Embase, Scopus, Web of Science, and China National Knowledge Infrastructure (CNKI) databases were searched for randomized clinical trials (RCTs) and non-RCTs comparing DOACs and VKAs in patients with AF and LC. Analyses were performed in R software. A random-effects model was employed to calculate the pooled hazard ratio (HR).</div></div><div><h3>Results</h3><div>Eleven studies encompassing 19,617 patients were included, with 9379 receiving DOACs and 10,238 receiving VKAs. DOACs were associated with a significant reduction in the incidence of major bleeding (HR 0.70; 95% CI: 0.61–0.81; <em>P</em> &lt; 0.001; I² = 0%), all-cause mortality (HR 0.87; 95% CI: 0.78–0.98; <em>P</em> = 0.022; I² = 41%), and gastrointestinal bleeding (HR 0.75; 95% CI: 0.67–0.84; <em>P</em> &lt; 0.001; I² = 4%). No significant difference was observed for thromboembolic events (HR 0.86; 95% CI: 0.69–1.06; <em>P</em> = 0.153; I² = 0%).</div></div><div><h3>Conclusion</h3><div>DOACs may be a feasible option for patients with AF and LC, demonstrating similar effectiveness to VKAs while exhibiting a better safety profile. These findings await validation by prospective studies.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102534"},"PeriodicalIF":3.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791061","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":"Challenges and Recent Advances in Diagnosing Wilson Disease","authors":"Hani S. Aboalam ,&nbsp;Marwa K. Hassan ,&nbsp;Nada El-domiaty ,&nbsp;Nagat F. Ibrahim ,&nbsp;Anwar M. Ali ,&nbsp;Wesam Hassan ,&nbsp;Esam G. Abu El Wafa ,&nbsp;Ashraf Elsaghier ,&nbsp;Helal F. Hetta ,&nbsp;Mohamed Elbadry ,&nbsp;Mohamed El-Kassas","doi":"10.1016/j.jceh.2025.102531","DOIUrl":"10.1016/j.jceh.2025.102531","url":null,"abstract":"<div><div>Wilson disease (WD) is a rare autosomal recessive disorder caused by ATP7B gene mutations, leading to pathological copper accumulation that primarily affects the liver, brain, and eyes. Diagnosing WD remains a significant challenge due to its highly variable clinical presentation, which ranges from asymptomatic biochemical abnormalities to acute liver failure and severe neuropsychiatric manifestations. Traditional diagnostic markers, such as serum ceruloplasmin, urinary copper excretion, and liver biopsy, lack sufficient specificity and sensitivity, often leading to delays in diagnosis and misclassification. Additionally, the absence of a single gold-standard test and the overlap with other hepatic and neurological disorders further complicate early detection.</div><div>Recent advances in diagnostic techniques offer promising solutions to overcome these limitations. Novel biomarkers, including relative exchangeable copper (REC) and ATP7B protein quantification in dried blood spots have demonstrated improved accuracy in distinguishing WD from other conditions. Advanced imaging modalities, such as anterior segment optical coherence tomography (AS-OCT), quantitative susceptibility mapping (QSM), and copper-64 positron emission tomography imaging provide noninvasive tools for detecting early disease-related changes. Furthermore, next-generation sequencing (NGS) enhances genetic screening, facilitating earlier diagnosis, and family screening.</div><div>A comprehensive approach integrating conventional and emerging diagnostic methodologies is essential for improving early detection and patient outcomes. Greater awareness of the limitations of traditional tests and the incorporation of novel biomarkers and imaging techniques into clinical practice can help refine diagnostic accuracy, reduce delays, and optimize treatment strategies for WD.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102531"},"PeriodicalIF":3.3,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628519","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":"Hepatic Infarct: Uncommon Causes of an Uncommon Vascular Complication Revealed at Nontransplant Medical Autopsies","authors":"Dipanwita Biswas ,&nbsp;Suvradeep Mitra ,&nbsp;Ritambhra Nada ,&nbsp;Ashish Bhalla ,&nbsp;Saroj K. Sinha ,&nbsp;Vanita Suri ,&nbsp;Ajay Duseja","doi":"10.1016/j.jceh.2025.102533","DOIUrl":"10.1016/j.jceh.2025.102533","url":null,"abstract":"<div><h3>Background and aims</h3><div>Hepatic infarcts are uncommon vascular lesions due to dual vascular supply of the liver characterized by the peripherally-located wedge-shaped large zones of necrosis in the hepatic parenchyma. They are commonly seen as a complication of liver transplant.</div></div><div><h3>Material and methods</h3><div>The cases of hepatic infarcts of the native liver detected in medical autopsies were searched in the archives and their clinical, biochemical, gross, and histomorphological details were retrieved.</div></div><div><h3>Results</h3><div>Three cases of hepatic infarct of the native liver were detected from among 1865 consecutive cases of adult and pediatric autopsies (0.2%). These cases were caused by hornet stings, acute pancreatitis, and hemolysis, elevated liver enzymes, low platelet syndrome (HELLP) in a 24-year-old male, 19-year-old male, and a 28-year-old postpartum female, respectively. The first two cases showed 50–150 times elevated transaminases and conjugated hyperbilirubinemia. All cases showed hyperemic to pale subcapsular infarcts. The HELLP syndrome case showed intrasinusoidal fibrin-rich microthrombi, while the other two cases showed the presence of fibrin-rich/organized microthrombi involving variable-sized portal and central venous radicles. Two of these cases (hornet sting and HELLP syndrome) did not show any macroscopic thrombi in the portal vein, hepatic artery, or hepatic veins.</div></div><div><h3>Conclusion</h3><div>Hepatic infarcts are rare vascular lesions found in the nontransplant liver. The gross and histomorphology of these lesions depend on the age of these lesions. They can occur in the presence of vascular microthrombi in the absence of any documented macroscopic thrombus.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102533"},"PeriodicalIF":3.3,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628520","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":"Minimally Invasive Liver Transplantation: The Recipient Operation","authors":"Rajesh Rajalingam,&nbsp;Ashwin Rammohan,&nbsp;Ramkiran Cherukuru,&nbsp;Mohamed Rela","doi":"10.1016/j.jceh.2025.102532","DOIUrl":"10.1016/j.jceh.2025.102532","url":null,"abstract":"<div><div>The introduction of minimally invasive donor hepatectomy (MIDH) operation saw the initiation and incorporation of minimal access surgery into the field of liver transplantation (LT). Several studies, meta-analyses, and consensus guidelines have demonstrated the undisputed advantages of the MIDH operation. Given these positive trends, and the increasing acceptance and acknowledgment of the safety of MIDH among the transplant community, there has been an intuitive thrust to further push the boundaries of what was initially considered unfeasible – to that of the minimally invasive liver transplant recipient surgery (MIRS). Given its extremely steep learning curve and undefined safety profile, the MIRS procedure remains limited to less than a handful of LT units across the world. It does, however, appear inevitable that the MIRS is likely to be performed widely in the future. Nonetheless, embarking on such a project needs not only just a gifted and trained surgeon, but a focussed and united effort of the whole team. This article reviews the current evidence, debates the early trade-offs involved in the introduction of the operation, and importantly, presents a safe and structured algorithm for teams interested in embarking on this very complex, yet exciting new realm of LT.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102532"},"PeriodicalIF":3.3,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143642732","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":"Minimally Invasive Donor Hepatectomy","authors":"Guhan Venkatakrishnan,&nbsp;Krishnanunni Nair,&nbsp;Binoj S. Pillai Thankamony Amma,&nbsp;Christi T. Varghese,&nbsp;Shweta Mallick,&nbsp;Sudhindran Surendran","doi":"10.1016/j.jceh.2025.102516","DOIUrl":"10.1016/j.jceh.2025.102516","url":null,"abstract":"<div><div>Minimally invasive donor hepatectomy (MIDH) involves either laparoscopic or robot-assisted technique, with the graft being retrieved through a remote incision. Current evidence reports faster recovery and better quality of life following MIDH than open donor hepatectomy, although these are limited to a handful of high-volume transplant centers. Nonetheless, grafts obtained by MIDH have a slight disadvantage of having shorter vein lengths than its open counterpart. Additionally, biliary complications are more prevalent in recipients of grafts retrieved by laparoscopic technique, while those obtained by the robotic platform demonstrate biliary complication rates comparable to, or even better than, those from open donor hepatectomy. Widespread application of MIDH has still not occurred across the world. This narrative review explores the challenges faced by the transplant surgeons when transitioning from open donor hepatectomy to MIDH, standard technique of robotic donor hepatectomy and suggests strategies to overcome the learning curve. It compares laparoscopic and robotic donor hepatectomies, detailing the advantages and disadvantages of each approach, as well as their outcomes.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102516"},"PeriodicalIF":3.3,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609502","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":"Demystifying the Heart Before Liver Transplant (LT)","authors":"Shweta A. Singh,&nbsp;Kamal Kajal,&nbsp;Kelika Prakash","doi":"10.1016/j.jceh.2025.102517","DOIUrl":"10.1016/j.jceh.2025.102517","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102517"},"PeriodicalIF":3.3,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143562583","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":"Combined Living Donor Liver Transplantation With Coronary Artery Bypass Grafting: Possible but not Without a Struggle","authors":"Vijay Vohra ,&nbsp;Pooja Bhangui ,&nbsp;Prashant Bhangui ,&nbsp;Nishant Sharma ,&nbsp;Nikunj Gupta ,&nbsp;Manish Bansal ,&nbsp;Arvinder Singh Soin","doi":"10.1016/j.jceh.2025.102515","DOIUrl":"10.1016/j.jceh.2025.102515","url":null,"abstract":"<div><h3>Background</h3><div>A combined liver transplant (LT) and coronary artery bypass grafting (CABG) may sometimes be needed for patients with decompensated cirrhosis who also have significant coronary artery disease (CAD). However, such a procedure is associated with significant morbidity and mortality.</div></div><div><h3>Methods</h3><div>From May 2012 to August 2020, eight patients with significant coronary artery disease (CAD) underwent combined off pump CABG (OPCAB) and living donor liver transplantation (LDLT) at our center. We analyzed patient demographics, preoperative clinical findings, operative details, and postoperative outcomes.</div></div><div><h3>Results</h3><div>Mean recipient age and body mass index were 59 ± 6 years and 26 ± 3kg/m², respectively. The model for end-stage liver disease (MELD) score was 20. Four patients each had hypertension and diabetes. Mean total duration of the surgery was 982 ± 117 min, with 598 ± 89 min for living donor liver transplantation (LDLT). The mean volume of packed red blood cell transfusion was 2500ml. The duration of the ventilatory support (median 49 h post-surgery), and the median intensive care unit and hospital stay (8 and 18 days, respectively). Two patients died during the postoperative period due to sepsis with multiorgan failure No recipient had evidence of acute coronary syndrome, stress cardiomyopathy; none required interventional hemodynamic support. Four patients developed atrial arrhythmia's in the post-operative period, all were managed successfully with medical management.</div></div><div><h3>Conclusion</h3><div>Combined CABG and LDLT is feasible but poses significant challenges. Careful preprocedure planning, and meticulous intra- and post-operative management involving a multidisciplinary team of LT Surgeons and anesthetists, hepatologists, cardiologists, and cardiac surgeons is required to ensure optimal outcomes in these patients.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102515"},"PeriodicalIF":3.3,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579655","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}