Liver Transplantation最新文献

{"title":"To Err Is Robot - an analysis of complications following robotic donor hepatectomy.","authors":"Shweta Mallick, Krishnanunni Nair, Christi Titus Varghese, Binoj Sivasankara Pillai Thankamony Amma, Ramachandran N Menon, Dinesh Balakrishnan, Unnikrishnan Gopalakrishnan, Sudheer Othiyil Vayoth, S Sudhindran","doi":"10.1097/LVT.0000000000000592","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000592","url":null,"abstract":"<p><strong>Background: </strong>Robotic donor hepatectomy (RDH) has been reported with lower morbidity than its open counterpart. Donor safety remains the primary concern precluding its wide adaption. We aimed to evaluate donor complications following RDH and identify their predictive factors.</p><p><strong>Study design: </strong>Out of 348 live donor liver transplants performed between 2018-2021, the prospective data of 202 RDH were analyzed for complications by modified Clavien-Dindo grading system. Multivariate analysis of donor and operative parameters was done to identify factors predicting complications and CUSUM analysis was done to evaluate the effect of learning curve.</p><p><strong>Results: </strong>Out of 202 RDH [mean age: 37.5(±10.4); f:m-133:69; mean BMI: 25.2±3.84], 196 (97%) were modified right lobe grafts. Conversion to open occurred in 7(3.4%) [5-bleeding, 1-hepatic duct injury & 1-portal vein kink]. Post-operative complications occurred in 33(16.3%), the most common being bile leak (5.9%) and bleeding(3.9%). Grade IIIa, IIIb & Iva complications were seen in 3.4%, 3.4% and 0.9% of patients respectively. Re-operation was required in 3 cases for portal vein thrombosis, narrowing of inferior vena cava and biliary peritonitis respectively. At a follow up of 4 year period, these patients are doing well. Although in univariate analysis, higher blood loss and basal metabolic index appeared to be significant, a multivariate analysis did not reveal any donor factor that could predict complications (biliary anatomy, portal anatomy, blood loss, BMI, duration of surgery or FLR volume). The number of overall complications (21.7% vs. 9.9%; p= 0.020; OR 2.53) came down significantly in the second half. On RA-CUSUM analysis we identified that it took around 130 cases for our unit to collectively overcome the learning curve.</p><p><strong>Conclusion: </strong>Although RDH appears to be safe, critical complications can occur in a minority of cases. Safety lies in flattening the learning curve.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567582","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 long and winding road to maximize the benefit of Liver Transplantation.","authors":"Ji Jade King, Oliver D Tavabie","doi":"10.1097/LVT.0000000000000591","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000591","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542473","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 2024 ILTS-ILCA consensus recommendations for liver transplantation for hepatocellular carcinoma and intrahepatic cholangiocarcinoma.","authors":"Sudha Kodali, Laura Kulik, Antonio D'Allessio, Eleonora De Martin, Abdul Rahman Hakeem, Monica Lewinska, Stacie Lindsey, Ken Liu, Zorana Maravic, Madhukar S Patel, David Pinato, Ashwin Rammohan, Nicole Rich, Marco Sanduzzi Zamparelli, David W Victor, Carmen Vinaxia, Elizabeth W Brombosz, Augusto Villanueva, Tim Meyer, Nazia Selzner, R Mark Ghobrial, Mohamed Rela, Gonzalo Sapisochin","doi":"10.1097/LVT.0000000000000589","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000589","url":null,"abstract":"<p><strong>Background: </strong>Liver transplantation (LT) provides the best long-term survival outcomes for patients with liver cancer. As a result, the field of transplant oncology has grown greatly over the past few decades, and many centers have expanded their criteria to allow increased access to LT for liver malignancies. Center-level guidelines and practices in transplant oncology significantly vary across the world, leading to debate regarding the best course of treatment for this patient population.</p><p><strong>Methods: </strong>An international consensus conference was convened by the International Liver Transplantation Society and the International Liver Cancer Association on February 1-2, 2024, in Valencia, Spain to establish a more universal consensus regarding LT for oncologic indications. The conference followed the Delphi process, followed by external expert review.</p><p><strong>Results: </strong>Consensus statements were accepted regarding patient assessment and waitlisting criteria, pre-transplant treatment (including immunotherapy) and downstaging, living donor liver transplantation, post-LT patient management, and patient- and caregiver-related outcomes.</p><p><strong>Conclusion: </strong>The multidisciplinary participants in the consensus conference provided up-to-date recommendations regarding the selection and management of patients with liver cancer being considered for LT. Although participants deferred to center protocols in many cases, there was great interest in safely expanding access to LT for patients with larger tumor burden and biologically amenable lesions.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515935","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":"No RETREAT: Moving forward in post-transplant HCC recurrence prediction.","authors":"Andrew M Moon, Oren K Fix","doi":"10.1097/LVT.0000000000000590","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000590","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515932","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":"A holistic approach is needed for the treatment of alcohol use disorder.","authors":"Victoria T Kronsten, Ashwin Dhanda","doi":"10.1097/LVT.0000000000000588","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000588","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501860","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":"Letter to the Editor: Induction therapy in pediatric liver transplants affects outcomes.","authors":"Laura M Cogua, Connor J Tupper, Meng-Hao Li, Naoru Koizumi, Jorge Ortiz","doi":"10.1097/LVT.0000000000000587","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000587","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501863","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":"Cannabis and liver transplant in the era of legalization: Effects of pre-transplant cannabis use on postoperative opioid use and transplant outcomes.","authors":"Ava Runge, Becca Loeb, Amy M Shui, Cynthia Fenton, Jennifer Lai, Jessica Rubin","doi":"10.1097/LVT.0000000000000585","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000585","url":null,"abstract":"<p><strong>Background: </strong>Cannabis use is increasing in the United States, including among liver transplant candidates. Although the anesthesia literature suggests an association between cannabis use and increased post-operative pain, the impact of cannabis use on post-liver transplant (LT) opioid use remains unknown. This study investigates changes in cannabis use at a transplant center over time, as well as the impact of cannabis use on post-LT opioid use, healthcare utilization, and mortality.</p><p><strong>Methods: </strong>We included 4,236 patients evaluated for LT at our institution between January 2013 and July 2023. Our primary risk factor was cannabis use, defined as urine toxicology (UTox) positive for cannabis within 90 days of LT evaluation. Our primary outcome was post-LT opioid use, including oral morphine equivalents (OME) received during the LT hospitalization and discharge opioid prescriptions. We used multivariable logistic and quantile regression to compare post-LT opioid use, healthcare utilization outcomes, and mortality between cannabis users and nonusers.</p><p><strong>Results: </strong>Cannabis use was associated with higher OME use in the 48 hours post-LT (p=0.04). There were no statistically significant differences between groups in 72-hour (p=0.07) or 7-day cumulative OME (p=0.33), opioid prescriptions on discharge (p=0.25), hospital length of stay (LOS, p=0.69), intensive care unit LOS (p=0.94), 90-day readmission (p=0.66), or 90-day mortality (p=0.96).</p><p><strong>Conclusions: </strong>While cannabis use pre-LT was associated with significantly higher opioid use in the immediate postoperative period, this did not translate to differences in opioid use beyond 48 hours post-LT, or short-term healthcare utilization or clinical outcomes. These findings should help set provider expectations for immediate post-LT pain control. Our findings support the growing body of literature that fails to identify an association between pre-LT cannabis use and post-LT outcomes.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458615","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":"Co-producing a health advocate intervention for pediatric liver transplant recipients using human-centered design.","authors":"Telly Cheung, James E Squires, Bethany Bautista, Cynthia Milionis, Jonathan Prugh, Evelyn Hsu, Noelle H Ebel, Kathleen Campbell, Jennifer Vittorio, John C Bucuvalas, Laura M Gottlieb, Courtney R Lyles, Jennifer C Lai, Sharad I Wadhwani","doi":"10.1097/LVT.0000000000000584","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000584","url":null,"abstract":"<p><p>Pediatric healthcare delivery systems are increasingly employing navigators, community health workers, and social workers to improve child and household access to healthcare and social services, with the goal of decreasing healthcare inequities. However, navigation strategies are understudied in pediatric liver transplantation. We used human-centered design methods, eliciting the perspectives of caregivers and transplant team members, to design a navigator role for pediatric liver transplantation. We enrolled 10 caregivers reporting household social risks and 6 transplant practitioners from 7 U.S. transplant centers. We conducted 8 virtual focus groups between 9/12/2023-1/31/2024 to define gaps in care and ideate on how lay navigators could mitigate those challenges. We utilized design tools to elicit stakeholders' values and preferences. We recorded the focus groups and qualitatively analyzed audio transcripts to thematically identify essential job functions. Most caregivers reported earning an annual household income <$59,000 (70.0%), living below the federal poverty line (55.6%), and experiencing financial strain (80.0%). Caregivers wanted navigators to help them (1) access community-based resources, (2) build longitudinal relationships with the healthcare team, (3) prepare them for appointments, (4) communicate with their child's school, and (5) address cultural differences between families and transplant practitioners. The transplant team wanted navigators to help caregivers (1) address families' socioeconomic resource needs, (2) coordinate appointment scheduling, and (3) facilitate cultural and language-concordant care. Using structured design methodology, we designed a prototype navigator role for pediatric liver transplant care teams. Future studies should test the effectiveness of this navigator role in improving post-transplant outcomes.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458554","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 healthcare 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":"https://doi.org/10.1097/LVT.0000000000000586","url":null,"abstract":"<p><p>Social determinants of health (SDOH) are known to lead to adverse health outcomes, including high acute care utilization. The mechanisms underlying healthcare disparities among children who have undergone liver transplantation (LT) are poorly understood. To elucidate the relationship between SDOH and healthcare utilization among children (<18 y old at 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 Hospital Information System (PHIS) database. Children with lower Child Opportunity Index (COI) scores, a composite measure of SDOH, were admitted for 28% more days in the first year and 29% more days over the first two years post-LT, as compared to children with higher COI. We also observed that in the second year post-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 post-LT.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-21","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":"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":"https://doi.org/10.1097/LVT.0000000000000583","url":null,"abstract":"<p><strong>Background: </strong>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 (DBD, DCD II, DCD III) and correlate these data to postoperative clinical and biochemical outcomes.</p><p><strong>Methods: </strong>All DBDs 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.</p><p><strong>Results: </strong>Thirty liver grafts were transplanted after NMP: 16 DBD, 7 DCD-II and 7 DCD-III. There were 6 cases of EAD (20.0%), 10 of PRS (33.3%) and 11 cases of AKI (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 LT while IL-10 was associated with the ICU stay and TNF-α to the INR peak within 7 days. IL-6 was negatively associated to post-operative ALT levels, IL-10 to bilirubin peak. A correlation between higher IL-6 levels at 2h and graft loss was found.</p><p><strong>Conclusions: </strong>This is the first study to compare cytokines profile during NMP in three different types of donors and correlate it to clinical outcomes. A correlation between IL-6 concentration and graft failure was found. The role and the significate of inflammatory markers in MP perfusate and their potential to assess graft viability and the risk of post-LT complications has to be further addressed.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-11","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}