Liver Transplantation最新文献

{"title":"Does the introduction of the acuity circle policy change split liver transplantation practice?","authors":"Toshihiro Nakayama, Miho Akabane, Yuki Imaoka, Carlos O Esquivel, Marc L Melcher, Kazunari Sasaki","doi":"10.1097/LVT.0000000000000513","DOIUrl":"10.1097/LVT.0000000000000513","url":null,"abstract":"<p><p>With the acuity circles (AC) policy aiming to reduce disparities in liver transplantation (LT) access, the allocation of high-quality grafts has shifted, potentially affecting the use and outcomes of split LT. Data from the United Network for Organ Sharing (UNOS) database (February 4, 2016, to February 3, 2024) were analyzed, including 1470 candidates who underwent deceased donor split LT, with 681 adult and 789 pediatric cases. The study periods were divided into pre-AC (February 4, 2016, to February 3, 2020) and post-AC (February 4, 2020, to February 3, 2024). The study assessed changes in split LT volumes and examined the impact of center practices. Both adult and pediatric split LTs decreased in the initial 3 years after the policy change, followed by an increase in the final year, with an overall 11.9% and 13.9% decrease between the eras. Adult female split LT cases remained consistent, ensuring access for smaller recipients. High-quality \"splittable\" livers were increasingly allocated to high MELD patients (MELD-Na ≥30). Despite the overall decrease in case volume, adult split LT volume increased in newly active living donor liver transplantation centers, with 6 centers increasing living donor liver transplantation volume by over 50.0%. Pediatric split LT volumes decreased despite additional priorities for pediatric candidates. The number of split LTs decreased in the initial period after the AC policy introduction, but there was a consistent need for small female candidates. In the adult population, living donor liver transplantation and split LT demonstrated a synergistic effect in boosting center transplant volumes, potentially improving access for female candidates who need small grafts.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"989-997"},"PeriodicalIF":4.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fellows' Corner.","authors":"Matthew Dukewich","doi":"10.1097/LVT.0000000000000628","DOIUrl":"10.1097/LVT.0000000000000628","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"973-974"},"PeriodicalIF":4.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CON: It's time for new strategies to optimize liver transplant immunosuppression.","authors":"Michael Dybala, Nivetha Saravanan, Josh Levitsky","doi":"10.1097/LVT.0000000000000572","DOIUrl":"10.1097/LVT.0000000000000572","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1070-1075"},"PeriodicalIF":4.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Material economic hardships are associated with adverse 1-year outcomes after pediatric liver transplantation: Prospective cohort results from the multicenter SOCIAL-Tx Study.","authors":"Sharad I Wadhwani, James E Squires, Evelyn Hsu, Nitika Gupta, Kathleen Campbell, Shannon Zielsdorf, Jennifer Vittorio, Dev M Desai, Noelle H Ebel, Amy M Shui, John C Bucuvalas, Laura M Gottlieb, Courtney R Lyles, Jennifer C Lai","doi":"10.1097/LVT.0000000000000554","DOIUrl":"10.1097/LVT.0000000000000554","url":null,"abstract":"<p><p>Pediatric liver transplant outcomes exhibit disparities, necessitating the identification of modifiable risk factors to develop targeted interventions. We characterized associations between household material economic hardship (eg, financial barriers to housing or food) and pediatric liver transplant outcomes. We recruited pediatric recipients of liver transplants <18 years at the time of transplant across 8 US centers. Our primary exposure was ≥1 household material economic hardship (ie, food insecurity, housing instability, transportation challenges, or utility concerns), measured using the Accountable Healthcare Communities screening tool. Outcomes included 90-day and 1-year (1) total inpatient bed-days, and (2) episodes of T-cell-mediated rejection. Of the 77 participants (36% female), 34% reported household material economic hardship. Such hardship was associated with increased total inpatient bed-days within 90 days (ratio estimate: 1.45, 95% CI: 1.08, 1.96); the association persisted after adjusting for health literacy, insurance, and transplant center (ratio estimate: 1.37, 95% CI: 1.02, 1.84). Household material economic hardship was associated with total inpatient bed-days within 1 year after transplant (ratio estimate: 3.2, 95% CI: 1.1, 10.1); associations diminished in multivariable analyses (ratio estimate: 2.2, 95% CI: 0.7, 6.9). Household material economic hardship was associated with increased risk of T-cell-mediated rejection within 1 year of transplant (relative risk: 2.1, 95% CI: 1.1, 4.2); the association diminished in propensity-score matched analyses (relative risk: 1.4, 95% CI: 0.9, 2.3). Our findings highlight the adverse influence of household material economic hardship on pediatric liver transplant outcomes within the first year. Targeted social risk assistance and adjustment strategies offer actionable avenues to mitigate these challenges and enhance outcomes in pediatric recipients of liver transplants.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1042-1052"},"PeriodicalIF":4.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12167753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Failure to rescue in acute liver failure: A multicenter cohort study.","authors":"Filipe S Cardoso, William M Lee, Constantine J Karvellas","doi":"10.1097/LVT.0000000000000594","DOIUrl":"10.1097/LVT.0000000000000594","url":null,"abstract":"<p><p>The concept of failure to rescue has been used to measure the quality of care for complications developed following surgery. The concept of failure to rescue has been poorly studied in patients with primary medical diseases, such as sepsis or acute liver failure (ALF). We performed a retrospective multicenter cohort study including consecutive patients with ALF within the United States ALF Study Group (USALFSG) prospective registry from 2010-2016. The failure to rescue rate for 12 medical complications in the registry was calculated as the mortality events up to 21 days after inclusion divided by the complication events registered on the first day after inclusion. The association between these complications and 21-day transplant-free mortality was studied. Among 665 patients with ALF, 478 (71.9%) were females, and the median (IQR) age was 42 (30-55) years. Acetaminophen intoxication was observed in 322 (48.4%) patients. Overall, 461 (69.3%) patients had at least one medical complication on the first day after inclusion (median [IQR] number of 1 [0-3]). The failure to rescue rate for the 12 complications was 32.8%. The complications with the higher failure-to-rescue rates were gastrointestinal bleed (63.6%), non-gastrointestinal bleed (53.9%), requirement for vasopressors (52.5%), and acute respiratory distress syndrome (48.1%). After adjusting for age, sex, etiology, and international normalized ratio, per each added complication present on day 1, the odds of 21-day transplant-free mortality increased by 38% (adjusted OR [95% CI] of 1.38 [1.24-1.54]; c-statistic [95% CI] of 0.77 [0.73-0.81]). In patients with ALF, the concept of failure to rescue highlights the need to improve prevention, early detection, and timely management of medical complications developing early in the hospital stay.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"982-988"},"PeriodicalIF":4.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From screening to action: Social determinants and early outcomes in pediatric liver transplant recipients.","authors":"Tiange P Zhang, Kali Zhou","doi":"10.1097/LVT.0000000000000605","DOIUrl":"10.1097/LVT.0000000000000605","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"979-981"},"PeriodicalIF":4.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12279453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduction of hepatectomy times in Dutch organ procurement teams.","authors":"Isabelle J C Dielwart, Hanne C R Verberght, Kirsten M de Vries, Aline C Hemke, Stephan J L Bakker, Steven W M Olde Damink, Marcel C G van de Poll, Robert A Pol, Jeroen de Jonge","doi":"10.1097/LVT.0000000000000617","DOIUrl":"10.1097/LVT.0000000000000617","url":null,"abstract":"<p><p>Donor hepatectomy time exceeding 60 minutes is associated with poor liver transplant outcomes. A nationwide audit in 2018 showed that this critical time limit was frequently exceeded in Dutch procurement teams, particularly by those teams that were not affiliated with a liver transplant center. To reduce donor hepatectomy times, a nationwide intervention program was conducted, focusing on creating awareness and passing knowledge, mandatory training, and the introduction of simultaneous procurement of the lungs and liver in all procedures. In this retrospective study, we describe the effects of this intervention program on donor hepatectomy time in the Netherlands. A total of 1788 liver procurements performed between January 2013 and December 2022 were analyzed, divided into 873 before and 915 procedures after the intervention. Donor hepatectomy time decreased significantly from 55 [41-70] to 35 [28-43] minutes ( p <0.001), with virtually no difference between all procurement teams. After the introduction of simultaneous procurement, the difference in donor hepatectomy time between liver-only and liver-lung disappeared (34 [28-42] vs. 35 [29-43] minutes, p =0.73). Importantly, the decrease in hepatectomy time did not result in an increase in severe surgical injury leading to graft loss ( p =0.11). In conclusion, a significant and relevant reduction in hepatectomy time was achieved with this intervention program. We advocate a similar procurement intervention plan in any organ donation program, independent of their context.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"998-1006"},"PeriodicalIF":4.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PRO: Liver transplantation immunosuppression can be optimized with current tools.","authors":"Karen Khalil, Jacqueline I Kim, Adam Griesemer","doi":"10.1097/LVT.0000000000000573","DOIUrl":"10.1097/LVT.0000000000000573","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1064-1069"},"PeriodicalIF":4.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of alcohol-associated liver disease on famous athletes who received liver transplants.","authors":"Olivia Greenham, Rajeshwar P Mookerjee","doi":"10.1097/LVT.0000000000000598","DOIUrl":"10.1097/LVT.0000000000000598","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1076-1078"},"PeriodicalIF":4.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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 and allocation policy: An uncertain connection.","authors":"Angela M Chen, Jean C Emond","doi":"10.1097/LVT.0000000000000615","DOIUrl":"10.1097/LVT.0000000000000615","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"975-976"},"PeriodicalIF":4.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}