Liver Transplantation最新文献

{"title":"Survival outcomes following liver retransplantation (reSOFT) score: A model predicting survival after adult liver retransplantation.","authors":"Vivian Terry, Caroline Christmann, Spoorthi Kamepalli, Ashley Montgomery, John Goss, Abbas Rana","doi":"10.1097/LVT.0000000000000549","DOIUrl":"10.1097/LVT.0000000000000549","url":null,"abstract":"<p><p>Recipient and donor risk factors impacting adult liver retransplantation remain inadequately described in the modern era of liver transplantation. Our study aimed to develop a risk model for 3-month recipient survival following liver retransplantation using data from the Organ Procurement and Transplantation Network's (OPTN) liver transplantation database. We conducted univariate and multivariable analyses on 6660 adult patients who underwent liver retransplantation between 2002 and 2023. Multiple imputation was also conducted to account for missing variables. From our analysis, we identified 14 recipient factors, 1 donor factor (age), and 1 operative factor (cold ischemia time) that significantly impacted 3-month patient survival. Among the most significant risk factors were a functional status, measured by the Karnofsky Score, of 10% at retransplantation (OR: 1.80, 95% CI: 1.44-2.24) and recipient albumin of <1.5 (OR: 1.76, CI: 1.12-2.77). The most significant protective factors included a functional status of 90% (OR: 0.22, CI: 0.07-0.70) and recipients with a history of HCC (OR: 0.10, CI: 0.01-0.79). The reSOFT score was developed by assigning points to these factors proportional to their hazard ratios and divided into high-, moderate-, and low-risk groups that accurately predict 3-month survival post-retransplant. With a C-statistic of 0.73 (CI: 0.71-0.75), this tool may serve to guide clinicians in identifying and better caring for high-risk retransplant recipients.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"906-915"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829300","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":"Outcomes following the use of HBsAg-positive liver allografts in HBsAg-negative recipients.","authors":"Adam S Myer, Drake A Seccurro, Kenneth E Sherman, Yeshika Sharma","doi":"10.1097/LVT.0000000000000533","DOIUrl":"10.1097/LVT.0000000000000533","url":null,"abstract":"<p><p>The use of positive HBsAg (HBsAg+) liver allografts has been increasing globally and is gaining wider acceptance within the United States. However, most of the data supporting the use of HBsAg+ organs has been in the setting of recipients with chronic hepatitis B. We aim to describe our institutional experience using HBsAg+ liver donors in HBsAg-negative recipients through case series. Between 2019 and 2021, 10 HBsAg-negative recipients received an HBsAg+ liver transplant. Kaplan-Meier survival analysis showed no difference in survival when compared to all other liver transplants performed at the institution during the same period ( p = 0.5, HR = 1.6, CI = 0.4-6.5). Based on these findings, the use of HBsAg+ liver donors appears to be safe; however, continued follow-up is required to understand further risks associated with the use of HBsAg+ liver allografts.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"870-876"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605017","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":"Association of perfusate cytokine concentrations during liver graft ex situ normothermic perfusion to donor type and postoperative outcomes.","authors":"Daniele Pezzati, Francesco Torri, Maria Franzini, Emanuele Balzano, Gabriele Catalano, Giovanni Tincani, Jessica Bronzoni, Caterina Martinelli, Arianna Trizzino, Lorenzo Petagna, Paola Carrai, Stefania Petruccelli, Matilde Masini, Maria Isabella Rotondo, Serena Babboni, Serena Del Turco, Riccardo Morganti, Vincenzo De Tata, Giandomenico Biancofiore, Adriano Peris, Chiara Lazzeri, Giuseppina Basta, Aldo Paolicchi, Davide Ghinolfi","doi":"10.1097/LVT.0000000000000583","DOIUrl":"10.1097/LVT.0000000000000583","url":null,"abstract":"<p><p>The use of the so-called extended criteria donors increases the number of grafts available for transplantation. Many studies reported their good outcomes but their use is debated due to increased risk of complications. Ex situ liver perfusion has reduced graft discard rate and helped to test their function before implantation. Cytokines are known to be involved in ischemia-reperfusion injury, but their potential to predict liver function during normothermic machine perfusion (NMP) has not been fully investigated. The aim of this study was to compare cytokines levels during NMP in 3 different types of donors (donation after brain death, donation after circulatory death [DCD]-II, DCD-III) and correlate these data to postoperative clinical and biochemical outcomes. All donations after brain deaths older than 70 years and DCDs transplanted after NMP were included. IL-6, IL-10, and TNF-α were measured during NMP and correlated with clinical outcomes. Thirty liver grafts were transplanted after NMP: 16 donations after brain deaths, 7 DCD-II, and 7 DCD-III. There were 6 cases of early allograft dysfunction (20.0%), 10 of post-reperfusion syndrome (33.3%), and 11 cases of acute kidney injury (36.7%), with no major differences among groups. A positive correlation was found between perfusate IL-6 levels and the bilirubin peak within 7 days after liver transplantation, while IL-10 was associated with the intensive care unit stay and TNF-α to the international normalized ratio peak within 7 days. IL-6 was negatively associated with postoperative ALT levels and IL-10 to bilirubin peak. A correlation between higher IL-6 levels at 2 hours and graft loss was found. This is the first study to compare cytokines profile during NMP in 3 different types of donors and correlate it to clinical outcomes. A correlation between IL-6 concentration and graft failure was found. The role and significance of inflammatory markers in machine perfusion perfusate and their potential to assess graft viability and the risk of post-liver transplantation complications have to be further addressed.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"877-889"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382744","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":"Building a better mouse trap in liver retransplantation risk prediction: Is reSOFT the end or the beginning?","authors":"Michelle C Nguyen, Amit K Mathur","doi":"10.1097/LVT.0000000000000607","DOIUrl":"10.1097/LVT.0000000000000607","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"853-854"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657646","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":"Informatics-driven solutions for optimal care delivery in liver transplantation.","authors":"Ashley Spann, Jeremy Louissaint, Manhal Izzy","doi":"10.1097/LVT.0000000000000471","DOIUrl":"10.1097/LVT.0000000000000471","url":null,"abstract":"<p><p>Clinical informatics, which combines health information technology and clinical expertise, aims to improve health care delivery and outcomes. For candidates and recipients of liver transplants, the complexities of their management are vast. Care often involves significant volumes of data from various sources and multiple health care settings and health care systems. Informatics represents an opportunity to support the care of these patients through this process; however, it has been underutilized to date. Preliminary examples of informatics use exist for this patient population, such as clinical decision support to link patients to hepatology providers, utilization of digital health technologies to track responses to medical therapy, and artificial intelligence to characterize organ donor compatibility. Further deployment of these tools can optimize care delivery for patients with cirrhosis and across the transplant cascade. In this review, we explore the utility of various techniques of clinical informatics mainly within the transplant care cascade, barriers to implementation, and highlight opportunities for future investigation and optimized use. Although barriers to widespread adoption remain such as interoperability, data access and availability, and structured implementation strategies, the integration of informatics and clinical decision support/artificial intelligence-based tools into routine care for liver transplantation represents an opportunity for marked enhancement in how we deliver care to these patients.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"935-944"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142036249","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":"Evaluating allograft risk models in organ transplantation: Understanding and balancing model discrimination and calibration.","authors":"David Goldberg, Hemant Ishwaran, Vishnu Potluri, Michael Harhay, Emily Vail, Peter Abt, Sarah J Ratcliffe, Peter P Reese","doi":"10.1097/LVT.0000000000000575","DOIUrl":"10.1097/LVT.0000000000000575","url":null,"abstract":"<p><p>In the field of organ transplantation, the accurate assessment of donor organ quality is necessary for efficient organ allocation and informed consent for recipients. A common approach to organ quality assessment is the development of statistical models that accurately predict posttransplant survival by integrating multiple characteristics of the donor and allograft. Despite the proliferation of predictive models across many domains of medicine, many physicians may have limited familiarity with how these models are built, the assessment of how well models function in their population, and the risks of a poorly performing model. Our goal in this perspective is to offer advice to transplant professionals about how to evaluate a prediction model, focusing on the key aspects of discrimination and calibration. We use liver allograft assessment as a paradigm example, but the lessons pertain to other scenarios too.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"956-963"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066521","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":"Pediatric living donor liver transplantation for small infants with biliary atresia using interposition portal vein grafts: A multicenter cohort study.","authors":"Daniel Zamora-Valdés, Ryuji Komine, Wei Gao, Masaki Honda, Yusuke Yanagi, Pilar Leal-Leyte, Nam Joon Yi, Toru Ikegami, Mureo Kasahara","doi":"10.1097/LVT.0000000000000596","DOIUrl":"10.1097/LVT.0000000000000596","url":null,"abstract":"<p><p>Despite multiple techniques, portal vein (PV) inflow reconstruction during living donor liver transplantation (LDLT) for patients with biliary atresia (BA) and small-diameter PV remains a challenge. The use of PV interposition grafts has emerged as a promising therapeutic strategy to mitigate complications and reinterventions. We conducted a retrospective multicenter cohort study of patients under 3 years of age (n=85) undergoing LDLT for BA using PV interposition grafts. Our primary outcome was PV complications after LDLT, and secondary outcomes included long-term PV patency and death-censored graft survival. LDLT was performed on 85 patients. The PV diameter was 4.0±0.6 mm. Cold-stored venous allografts were used in 26 cases, donor-derived grafts in 53, and autologous in 6. The portal inflow was the PV in 38 cases, splenomesenteric confluence in 33, superior mesenteric vein in 3, and coronary vein in 1. The intraoperative PV thrombosis rate was 22.4%, and the overall PV complication rate after LDLT was 23.5% (16 PV stenoses and 4 thromboses). Multivariate analysis revealed that the use of cold-stored venous allografts predicted PV complications (53.8% vs. 10.2%; relative risk, 15.9; 95% CI: 2.9-86.2; p =0.001). Eleven patients underwent PV stent placement after LDLT with primary patency rates of 81.8% and secondary patency rates of 90.9%. The long-term patency, death-censored graft survival, and patient survival rates were 96.5%, 96.5%, and 97.6%, respectively. Portal inflow reconstruction using interposition grafts during LDLT for BA achieves favorable long-term patency and patient and graft survival outcomes. This approach has the potential to mitigate morbidity and mortality in pediatric patients with BA undergoing LDLT. Longer cold-stored venous allografts are associated with a higher risk of PV complications after LDLT.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"890-896"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605665","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":"Trends in surgical volume and mortality by surgery type among patients with cirrhosis: A Veterans Affairs study.","authors":"Helen Tang, David E Kaplan, Nadim Mahmud","doi":"10.1097/LVT.0000000000000576","DOIUrl":"10.1097/LVT.0000000000000576","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"964-967"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12178816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047149","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":"Acceptable outcomes of liver transplantation in uninsured patients under the coverage of a state assistance program.","authors":"Flavio Paterno, Grace S Lee-Riddle, Raquel Olivo, Arpit N Amin, Baburao Koneru, Nikolaos T Pyrsopoulos, Keri E Lunsford, James V Guarrera","doi":"10.1097/LVT.0000000000000495","DOIUrl":"10.1097/LVT.0000000000000495","url":null,"abstract":"<p><p>The lack of health insurance is a major barrier to access to health care, even in the case of life-saving procedures such as liver transplantation (LT). Concerns about worse outcomes in uninsured patients have also discouraged the evaluation and transplantation of patients without adequate health insurance coverage. The aim of this study is to evaluate outcomes from the largest cohort of uninsured patients who underwent LT with the support of a state payment assistance program (also called charity care). This study included all consecutive patients who underwent LT at a single center from 2002 to 2020. Demographic, clinical, and social variables and outcome metrics were collected and compared between insured and uninsured patients. Among a total of 978 LT recipients, 594 had private insurance, 324 government insurance (Medicare/Medicaid), and 60 were uninsured and covered under a state charity care program. In the charity care group, there was a higher proportion of Hispanic subjects, single marital status, younger age, and high-MELD score patients. The 1- and 3-year patient survival rates were 89.0% and 81.8% in private insurance patients, 88.8% and 80.1% in government insurance recipients, and 93.3% and 79.6% in those with charity care ( p =0.49). There was no difference in graft survival between insured and uninsured patients ( p =0.62). The 3 insurance groups presented similar hospital length-of-stay and 30-day readmission rates. In both univariate and multivariate analysis, uninsured status (charity care) was not associated with worse patient survival (HR: 1.23, 95% CI: 0.84-1.80, p =0.29) or graft survival (HR: 1.22, 95% CI: 0.84-1.78, p =0.29). In conclusion, there was no difference in outcomes after LT between insured and uninsured patients. A charity care program may be an effective tool to mitigate socioeconomic disparities in both outcomes and access to LT.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"924-934"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349432","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 core to surface: Expanding the donor pool with HBsAg-positive liver allografts.","authors":"Matthew Dukewich, Pratima Sharma","doi":"10.1097/LVT.0000000000000580","DOIUrl":"10.1097/LVT.0000000000000580","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"849-850"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066526","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}