Liver Transplantation最新文献

{"title":"Safety and efficacy of continuous infusion terlipressin (BIV201): A phase 2 trial in patients with decompensated cirrhosis and refractory ascites.","authors":"Jasmohan S Bajaj, Ethan M Weinberg, K Rajender Reddy, Andrew P Keaveny, Michael K Porayko, David Koch, Paul J Thuluvath, Douglas A Simonetto, Paolo Angeli, Sujit V Janardhan, Eric S Orman, Jeffrey Zhang, Susan Clausen, Elisa Dauphinée, Joseph M Palumbo, Penelope Markham","doi":"10.1097/LVT.0000000000000623","DOIUrl":"10.1097/LVT.0000000000000623","url":null,"abstract":"<p><p>Refractory ascites often requires therapeutic paracentesis, which is associated with potential risks and diminished quality of life. Terlipressin is a vasopressin analog that is indicated for i.v. bolus injection for hepatorenal syndrome, with the potential to reduce large-volume ascites and its complications. Continuous infusion of terlipressin is associated with fewer adverse effects than bolus dosing. The efficacy and safety of continuous infusion of a novel liquid formulation of terlipressin acetate (BIV201) were evaluated in this open-label phase 2 study. Patients with cirrhosis and refractory ascites were randomly assigned (2:1) to receive two 28-day cycles of continuous infusion BIV201 plus standard of care (SOC) separated by a ≤56-day washout (n=10), or SOC alone (n=5). Data analysis was limited by the small sample size and confounded by a potential interaction with gabapentinoids in the BIV201+SOC group. Nonetheless, there were differences in favor of BIV201+SOC versus SOC in the coprimary efficacy endpoints and several quality of life assessments. The beneficial effects of BIV201 on liver complications (mean: 90% CI; BIV201-completers=2.87: 1.51; 5.46 vs. SOC=2.38: 1.20; 4.73) and the change in cumulative ascites (mean: 90% CI; BIV201-completers=-10.76: -26.51; 5.00 vs. SOC=-4.99: -21.95; 11.97) were more pronounced versus SOC in the 5 BIV201+SOC patients who completed both treatment cycles. There were also greater improvements in exploratory quality of life assessments and the percent change in therapeutic paracenteses with BIV201+SOC (-27.94±41.80) versus SOC (-16.67±45.64). Despite the high rate of hyponatremia in the BIV201+SOC group (4/10 patients), the safety profile suggested that continuous BIV201 infusion was well tolerated. These findings support further development of BIV201 in confirmatory trials.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1202-1214"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12445179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017921","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":"Outcomes of the kidney after liver transplantation by induction type, inter-transplant interval, and immunologic risk: A UNOS analysis.","authors":"Gabriel Cojuc-Konigsberg, Stalin Cañizares, Belen Rivera, Kalathil K Sureshkumar, Devin Eckhoff, Martha Pavlakis, Bhavna Chopra","doi":"10.1097/LVT.0000000000000633","DOIUrl":"10.1097/LVT.0000000000000633","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1307-1311"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033731","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":"Geospatial analysis of liver donation after death by drug intoxication.","authors":"Haaris Kadri, Thomas J Handley, Toshihiro Nakayama, Kazunari Sasaki, Marc L Melcher","doi":"10.1097/LVT.0000000000000618","DOIUrl":"10.1097/LVT.0000000000000618","url":null,"abstract":"<p><p>Increases in deaths from drug intoxication in the United States could be contributing to more liver donations. This study investigates regional variation in liver donation following death by drug intoxication over a decade. The number of drug intoxication-related deaths in the continental United States (2011-2020) was collected from CDC WONDER. Reports from UNOS provided the number of liver donors who died of drug intoxication over the decade. County-level ratios of liver donors after drug intoxication to the total number of drug intoxication-related deaths were calculated. Missed donation opportunities were quantified by comparing the actual number of donors to the hypothetical number if all counties achieved the efficiency of counties in the 90th and 50th percentiles. Regression analysis was used to assess the relationship between missed opportunities for liver donation per drug intoxication-related death and county-level variables. County-level proportions of liver donors after drug intoxication to all eligible drug intoxications ranged from 0 to 0.600. If every county matched the efficiency of the 90th and 50th percentile county, the liver donor pool could grow by 7572 or 1550 donors over the decade, respectively. The national rate of missed opportunities for a liver donation per death by drug intoxication was 0.114 or 0.022, depending on whether the 90th or 50th percentile donation ratio was used in the calculation. The number of missed donations per drug intoxication increased with higher social vulnerability, distance from a trauma center, and rural county status. Conversely, it decreased as the rate of deaths by drug intoxication rose. Assessing liver donation following drug intoxication allows for targeted efforts to increase donations in regions with the greatest potential for improvement.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1215-1225"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753463","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 MELD: MELD is the best method of prioritization for liver transplantation.","authors":"Vivek Charu, W Ray Kim, Allison J Kwong","doi":"10.1097/LVT.0000000000000626","DOIUrl":"10.1097/LVT.0000000000000626","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1298-1302"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024470","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":"Sinusoidal obstruction syndrome after liver transplantation: A multicenter observational study: Erratum.","authors":"","doi":"10.1097/LVT.0000000000000124","DOIUrl":"10.1097/LVT.0000000000000124","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"E25"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10112375","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":"Implementation of intraoperative distal splenic artery ligation for portal inflow modulation in adult living donor liver transplantation.","authors":"Rekha Subramaniyam, Imtiakum Jamir, Niteen Kumar, Nitesh Agrawal, Gaurav Sood, Aditya Shriya, Anish Gupta, Abhideep Chaudhary","doi":"10.1097/LVT.0000000000000635","DOIUrl":"10.1097/LVT.0000000000000635","url":null,"abstract":"<p><p>In living donor liver transplant, graft hyperperfusion can lead to early allograft dysfunction, graft loss, and even mortality. Portal inflow modulation is advocated to prevent hyperperfusion injury. We implemented intraoperative distal splenic artery ligation (SAL) since January 2021 in recipients with one or more of the indications: graft to recipient weight ratio <0.8, graft to spleen volume ratio ≤1, high post-reperfusion portal venous flow (≥250 mL/min/100 g of graft weight), low hepatic artery peak systolic velocity (≤20 cm/s), and/or high post-reperfusion portal venous pressure (≥15 mm Hg). This group was compared with a retrospective splenic artery ligation-not done (non-SAL) group, during July 2019-December 2020, who met any one or more of the above criteria, but had not undergone SAL. Out of 426 patients who underwent living donor liver transplant during the study period, 90 and 42 right lobe adult recipients were included in the SAL and non-SAL groups, respectively. The SAL group had a significant reduction in post-reperfusion portal flow and pressure and also improved hepatic arterial peak systolic velocity compared to the non-SAL group ( p <0.01). Significant reduction in serum total bilirubin and ascitic fluid was observed on post-operative days 1, 3, 5, 7, and 14 in the SAL group ( p <0.01). There was a significant reduction in the incidence of early allograft dysfunction in the SAL group compared to the non-SAL group (8.8% vs. 26.2%, p <0.01). There was a decreased incidence of small for size syndrome (SFSS) ( p <0.05) with no incidence of grade-C SFSS and lower 90-day mortality in the SAL group ( p <0.01). Intraoperative distal SAL significantly reduces portal hyperperfusion, thereby reducing early allograft dysfunction, small for size syndrome, morbidity, and improving 1-year survival.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1238-1249"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000744","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":"Combining radiomics and imaging biomarkers with clinical variables for the prediction of HCC recurrence after liver transplantation.","authors":"Philipp Schindler, Philippa von Beauvais, Emily Hoffmann, Haluk Morgül, Nikolaus Börner, Max Masthoff, Najib Ben Khaled, Florian Rennebaum, Christian M Lange, Jonel Trebicka, Michael Ingrisch, Michael Köhler, Jens Ricke, Andreas Pascher, Max Seidensticker, Markus Guba, Osman Öcal, Moritz Wildgruber","doi":"10.1097/LVT.0000000000000603","DOIUrl":"10.1097/LVT.0000000000000603","url":null,"abstract":"<p><p>To develop and validate an integrated model that combines CT-based radiomics and imaging biomarkers with clinical variables to predict recurrence and recurrence-free survival in patients with HCC following liver transplantation (LT), this 2-center retrospective study includes 123 patients with HCC who underwent LT between 2007 and 2021. Radiomic features (RFs) were extracted from baseline CT liver tumor volume. Feature selection was performed using the Least Absolute Shrinkage and Selection Operator (LASSO) regression method with 10-fold cross-validation in the training cohort (n=48) to build a predictive radiomics signature for HCC recurrence. Combined diagnostic models were built based on the radiomics signature supplemented with imaging features beyond the Milan criteria, the AFP (alpha-fetoprotein) model, and Metroticket 2.0 before LT using multivariate logistic regression. Receiver operating characteristic analyses were performed in both internal (n=22) and external (n=53) validation cohorts, and patients were stratified into either high-risk or low-risk groups for HCC recurrence. Kaplan-Meier analysis was performed to analyze recurrence-free survival. LASSO and multivariate regression analysis revealed 4 independent predictors associated with an increased risk of HCC recurrence: radiomics signature of 5 RF, peritumoral enhancement, satellite nodules, and no bridging therapies. For the prediction of tumor recurrence, the highest AUC of the final integrated models combining clinical variables, non-radiomics imaging features, and radiomics was 0.990 and 0.900 for the internal and external validation sets, respectively, outperforming the Milan and clinical stand-alone models. In all integrated models, the high-risk groups had a shorter recurrence-free survival than the corresponding low-risk group. CT-based radiomics and imaging parameters beyond the Milan criteria representing aggressive behavior, along with the history of bridging therapies, show potential for predicting HCC recurrence after LT.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1226-1237"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657647","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":"Management of obesity in liver transplant candidates and recipients: Rethinking the false dichotomy between pharmacotherapy and surgical intervention.","authors":"Jessica P E Davis, Anesia Reticker, Hyosun Han, Babak J Orandi, Zachary Henry, Shirley M Tsunoda, Julie K Heimbach, Allison R Schulman, Monica A Tincopa","doi":"10.1097/LVT.0000000000000645","DOIUrl":"10.1097/LVT.0000000000000645","url":null,"abstract":"<p><p>The prevalence of comorbid metabolic dysfunction-associated steatotic liver disease (MASLD) and obesity has increased exponentially over the last several years, with current estimates demonstrating that up to 40% of adults in the United States have MASLD. Metabolic dysfunction-associated steatohepatitis is now a leading indication for liver transplantation, and rates of obesity and MASLD pre-transplant and post-transplant are on the rise. Our understanding of the physiology of obesity and metabolic disease and the availability of effective obesity treatments have evolved over the same time frame. With the availability of new anti-obesity medications, there has been a debate over the role of pharmacotherapy versus interventional approaches in the treatment of obesity and MASLD in the liver transplantation population. In October 2024, the American Society of Transplantation (AST) Liver and Intestinal Community of Practice held a virtual Controversies Conference on obesity and liver transplantation. Experts in the field presented the available data, and smaller working groups had interactive breakout sessions that identified knowledge gaps and developed recommendations. This perspective prepared on behalf of the participants of the AST Controversies Conference on obesity and liver transplant aims to summarize the available evidence for surgical and pharmaceutical treatment in the liver transplantation population.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1286-1297"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208879","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":"Lower Child Opportunity Index is associated with increased health care utilization following pediatric liver transplantation.","authors":"Aaron D Bennett, Knashawn H Morales, Yuan-Shung V Huang, Vicky Tam, Amit Shah, Kathleen M Loomes, Marina Serper, Therese Bittermann","doi":"10.1097/LVT.0000000000000586","DOIUrl":"10.1097/LVT.0000000000000586","url":null,"abstract":"<p><p>Social determinants of health are known to lead to adverse health outcomes, including high acute care utilization. The mechanisms underlying health care disparities among children who have undergone liver transplantation (LT) are poorly understood. To elucidate the relationship between social determinants of health and health care utilization among children (<18 y old at the time of LT) who have undergone LT, we performed a retrospective study merging data from the Organ Procurement and Transplantation Network (OPTN) and the Pediatric Health Information System (PHIS) database. Children with lower Child Opportunity Index (COI) scores, a composite measure of social determinants of health, were admitted for 28% more days in the first year and 29% more days over the first 2 years after LT, as compared to children with higher COI. We also observed that in the second year after LT, children with a lower COI were more often admitted with a complication of LT (23%) than those with a higher COI (18%). COI may be a useful composite screening instrument for clinical teams to target resources and limit acute care use after LT.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1258-1268"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458558","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":"Robotic living donor hepatectomy: Redefining global standards in living donor liver transplant.","authors":"Adeel S Khan, Phillipe Abreu","doi":"10.1097/LVT.0000000000000620","DOIUrl":"10.1097/LVT.0000000000000620","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1200-1201"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764336","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}