Liver Transplantation最新文献

{"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":"https://doi.org/10.1097/LVT.0000000000000620","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-03","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}

{"title":"Can we safely scale RAPID in transplant oncology?","authors":"Matthew M Byrne, Cristina Jimenez-Soto, Abigail Loszko, Roberto Hernandez-Alejandro","doi":"10.1097/LVT.0000000000000621","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000621","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764327","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":"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":"https://doi.org/10.1097/LVT.0000000000000617","url":null,"abstract":"<p><strong>Introduction: </strong>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. In order to reduce donor hepatectomy times, a nationwide intervention program was conducted, focusing on creating awareness and passing knowledge, mandatory training and introduction of simultaneous procurement of lung- and liver in all procedures.</p><p><strong>Methods: </strong>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 in 873 before and 915 procedures after the intervention. Results Donor hepatectomy time decreased significantly from 55 [41-70] to 35 [28-43] minutes (p<0.001), with virtually no more difference between all procurement teams. After 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).</p><p><strong>Discussion: </strong>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":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-02","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":"Center-Level variations are associated with disparate waitlist mortality and probability of liver transplant in MELD 35 and greater patients.","authors":"Andrew Melehy, Dominic Amara, Shreya Gumate, Samer Ebaid, Fady M Kaldas, Douglas G Farmer, Alex A T Bui, Vatche G Agopian","doi":"10.1097/LVT.0000000000000616","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000616","url":null,"abstract":"<p><p>Liver transplant (LT) centers may have variations in their approach to high-acuity (MELD ≥35) candidates for listing and transplantation. We investigated center-specific differences in waitlist outcomes, probability of LT, and post-LT survival in MELD ≥35 patients. Adult LT candidates (MELD ≥35) were identified from the Scientific Registry of Transplant Recipients between 01/01/10-04/01/22. Waitlist mortality was modelled with center as a random effect. Centers were grouped based on the random effect coefficient, with the highest tertile representing the highest risk group (comprised of centers with the highest risk of waitlist mortality attributable to center). Cumulative incidence of death/delisting, probability of LT, and 1-year post-LT survival were compared, with patients stratified by a listing MELD ≥35 or increase to MELD ≥35 after listing. In patients who increased to MELD ≥35, the 1-year cumulative incidence of death/delisting was highest (50%) and probability of transplant lowest (46%) in the high-risk group, compared to the low-risk group (37% and 55%, p<0.001 for both comparisons). For patients receiving an LT, post-transplant survival did not differ among the groups, though high-risk centers transplanted far less high-acuity patients. These variations may indicate that certain centers are associated with substantially decreased waitlist mortality for the highest acuity patients without corresponding decreases in post-transplant survival.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764329","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 normothermic machine perfusion and acuity circles on waitlist time, mortality, and cost in liver transplantation: A multicenter experience.","authors":"Chase J Wehrle, Hanna Hong, Abby Gross, Qiang Liu, Khaled Ali, Beatrice Cazzaniga, Yuki Miyazaki, Munkhbold Tuul, Jamak Modaresi Esfeh, Mazhar Khalil, Alejandro Pita, Eduardo Fernandes, Jaekeun Kim, Teresa Diago-Uso, Federico Aucejo, David C H Kwon, Masato Fujiki, Cristiano Quintini, Andrea Schlegel, Antonio Pinna, Charles Miller, Koji Hashimoto","doi":"10.1097/LVT.0000000000000412","DOIUrl":"10.1097/LVT.0000000000000412","url":null,"abstract":"<p><p>Ex situ normothermic machine perfusion (NMP) helps increase the use of extended criteria donor livers. However, the impact of an NMP program on waitlist times and mortality has not been evaluated. Adult patients listed for liver transplant (LT) at 2 academic centers from January 1, 2015, to September 1, 2023, were included (n=2773) to allow all patients ≥6 months follow-up from listing. Routine NMP was implemented on October 14, 2022. Waitlist outcomes were compared from pre-NMP pre-acuity circles (n=1460), pre-NMP with acuity circles (n=842), and with NMP (n=381). Median waitlist time was 79 days (IQR: 20-232 d) at baseline, 49 days (7-182) with acuity circles, and 14 days (5-56) with NMP ( p <0.001). The rate of transplant-per-100-person-years improved from 61-per-100-person-years to 99-per-100-person-years with acuity circles and 194-per-100-person-years with NMP ( p <0.001). Crude mortality without transplant decreased from 18.3% (n=268/1460) to 13.3% (n=112/843), to 6.3% (n=24/381) ( p <0.001) with NMP. The incidence of mortality without LT was 15-per-100-person-years before acuity circles, 19-per-100 with acuity circles, and 9-per-100-person-years after NMP ( p <0.001). Median Model for End-Stage Liver Disease at LT was lowest with NMP, but Model for End-Stage Liver Disease at listing was highest in this era ( p <0.0001). The median donor risk index of transplanted livers at baseline was 1.54 (1.27-1.82), 1.66 (1.42-2.16) with acuity circles, and 2.06 (1.63-2.46) with NMP ( p <0.001). Six-month post-LT survival was not different between eras ( p =0.322). The total cost of health care while waitlisted was lowest in the NMP era ($53,683 vs. $32,687 vs. $23,688, p <0.001); cost-per-day did not differ between eras ( p =0.152). The implementation of a routine NMP program was associated with reduced waitlist time and mortality without compromising short-term survival after liver transplant despite increased use of riskier grafts. Routine NMP use enables better waitlist management with reduced health care costs.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"438-449"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141237589","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":"Analysis of treatment benefits and prognostic factors for posttransplant HCC recurrence in a large Euro-American-Asian cohort.","authors":"Zhihao Li, Itsuko Chih-Yi Chen, Leonardo Centonze, Christian T J Magyar, Woo Jin Choi, Sachin Shah, Grainne M O'Kane, Arndt Vogel, Luciano De Carlis, Jan Lerut, Quirino Lai, Neil Mehta, Chao-Long Chen, Gonzalo Sapisochin","doi":"10.1097/LVT.0000000000000501","DOIUrl":"10.1097/LVT.0000000000000501","url":null,"abstract":"<p><p>Posttransplant HCC recurrence significantly impacts survival, yet its management is challenging due to limited evidence. With recent advancements in HCC treatment, updated data on managing recurrent diseases are needed. In this retrospective study across 6 centers (2000-2022), we employed Cox proportional-hazards regression and log-rank tests to assess survival differences. A prognostic score model was developed to categorize patient survival. The efficacy of tyrosine kinase inhibitors was evaluated through propensity score matching. In our study, 431 of 3349 (14%) patients with HCC who underwent transplantation developed recurrence within a median interval of 18 (IQR: 9-32) months. One hundred forty-seven (34%) underwent curative-intent treatments, 207 (48%) received palliative treatments, and 77 (18%) were given best-supportive care. Patients undergoing curative-intent treatments had better survival from the time of recurrence with a median survival of 45 (95% CI: 36-63) months and 1/3/5-year survival of 90%/56%/43% compared to those receiving noncurative treatments (median: 11 [95% CI: 10-13] mo, 1/3/5-y survival of 46%/10%/7%, log-rank p < 0.001). Patients with recurrence diagnosed in the era 2018-2022 showed improved survival over the previous era (HR 0.64 [95% CI: 0.47-0.86]). Multivariable analysis identified 5 prognostic factors: ineligibility for curative-intent treatment (HR: 3.5 [95% CI: 2.7-4.6]), recurrence within 1 year (HR: 1.7 [95% CI: 1.3-2.1]), poor tumor differentiation (HR: 1.5 [95% CI: 1.1-1.9]), RETREAT score ≥3 (HR: 1.4 [95% CI: 1.1-1.8]), and alpha-fetoprotein at recurrence ≥400 ng/mL (HR: 1.4 [95% CI: 1.1-1.9]). These factors contributed to a prognostic scoring system (0-9) that stratified patients into 3 prognosis groups. Both propensity score-matched analysis and multivariable regression indicated that lenvatinib was not statistically superior to sorafenib in terms of efficacy. Curative-intent treatments should be advocated for patients with posttransplant recurrence whenever possible. Prognostic factors linked to aggressive tumor biology significantly influence survival. Advancements in HCC management have improved survival outcomes over the past 5 years.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"450-463"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361739","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: All patients should receive a palliative care consult during LT evaluation.","authors":"Alan Noll, Shari Rogal","doi":"10.1097/LVT.0000000000000541","DOIUrl":"10.1097/LVT.0000000000000541","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"548-551"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729749","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 clinical relevance of the new criteria for cirrhotic cardiomyopathy and future directions.","authors":"Sarah Myers, Deepak K Gupta, Manhal Izzy","doi":"10.1097/LVT.0000000000000458","DOIUrl":"10.1097/LVT.0000000000000458","url":null,"abstract":"<p><p>Cardiac dysfunction in patients with liver disease has been recognized since the 1950s. Initially attributed to shared risk factors, it is now evident that cardiac dysfunction in patients with cirrhosis can occur in the absence of known cardiac, that is, coronary artery and valvular heart disease, and across all etiologies for cirrhosis. In 1996, this myocardial dysfunction was termed cirrhotic cardiomyopathy (CCM). The pathophysiologic mechanisms underlying CCM include impaired beta-adrenergic membrane function and circulating proinflammatory and cardiotoxic substances. In 2005, the first diagnostic criteria for CCM were introduced enabling greater sensitivity and accuracy of diagnosis. Since 2005, advancements in echocardiographic methods and a better understanding of the pathophysiology of cardiac dysfunction in patients with cirrhosis necessitated a revision of CCM criteria. Changes in CCM criteria included the removal of blunted contractile or heart rate response on stress testing and the addition of global longitudinal systolic strain. The refinement of criteria for diastolic dysfunction was also incorporated into the new diagnostic approach. Since 2020, the prevalence of the disorder and clinical considerations for pretransplant, peritransplant, and posttransplant patients with cirrhosis have been further evaluated, and CCM was found to adversely impact clinical outcomes during all 3 phases of care. Future research considerations should address the timing of universal echocardiographic screening for patients with cirrhosis, the utility of biomarkers in aiding CCM diagnosis, the impact of CCM on right heart function, and the role of anti-remodeling agents after liver transplant.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"521-530"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055996","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":"Sociodemographic disparities in downstaging to liver transplant for hepatocellular carcinoma.","authors":"Kali Zhou, Lauren Nguyen, Parissa Tabrizian, Neil Mehta","doi":"10.1097/LVT.0000000000000532","DOIUrl":"10.1097/LVT.0000000000000532","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"556-559"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605018","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":"Incremental impact of organ allocation changes and machine perfusion technology on liver transplant waitlist and volumes.","authors":"Vijay Subramanian, Kiran Dhanireddy","doi":"10.1097/LVT.0000000000000515","DOIUrl":"10.1097/LVT.0000000000000515","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"417-420"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950877","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}