Liver Transplantation最新文献

{"title":"Peri- and postoperative analgesic strategies in live donor hepatectomy: A national survey.","authors":"Peyton Crest, Sebastian Zeiner, Piper Stacey, Kate Kronish, Rachel Lin, John P Roberts, Dieter Adelmann","doi":"10.1097/LVT.0000000000000650","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000650","url":null,"abstract":"<p><strong>Introduction: </strong>Donor safety is of paramount importance in live donor hepatectomy, and acute pain is the most frequent complaint reported by donors. There are various approaches to managing peri- and postoperative pain following live donor hepatectomy. These include the administration of opioid and non-opioid analgesics and neuraxial-, regional- and local anesthesia. However, there is limited data on the practice patterns of pain management for live donor hepatectomy, particularly when comparing left and right lobe hepatectomies.</p><p><strong>Methods: </strong>A national electronic survey was administered to active live donor liver transplant centers in the United States, identified via the Organ Procurement and Transplantation Network directory. The Survey focused on demographics, peri- and postoperative pain management strategies, and differences in pain management practices based on left vs. right lobe hepatectomies and surgical approach.</p><p><strong>Results: </strong>We received responses from 37 centers (86%). The majority of centers (67.6%) performed both right and left live donor hepatectomies. Most centers had protocolized peri- (78.4%) and postoperative (83.8%) pain management guidelines. Perioperatively, most centers utilized a multimodal approach, based on intravenous fentanyl and/or hydromorphone combined with non-opioid adjuncts. Acetaminophen was the most common postoperative analgesic for both right (75.7%) and left (80%) lobe donors. Transversus abdominis plane blocks were the most frequently used regional anesthesia technique for both right (43.2%) and left (48%) lobe donors. Epidural catheters were placed more frequently in left (40%) than in right (32.4%) lobe donors.</p><p><strong>Conclusion: </strong>We observed a significant variation in peri- and postoperative pain management strategies after live donor hepatectomy between centers. Some centers adapt analgesic techniques based on the surgical technique (e.g., open vs. laparoscopic/robotic, and right vs left lobe hepatectomy).</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234482","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":"Hepatic hypoxia in donation after circulatory death: Physiology, clinical relevance, & future directions.","authors":"Daljeet Chahal, Laura Hornby, Jordan D Bird, S Lee Samuel, Thomas D Schiano, Mypinder S Sekhon","doi":"10.1097/LVT.0000000000000647","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000647","url":null,"abstract":"<p><p>Donation after circulatory death (DCD) has increased hepatic graft supply, but is plagued by complications that arise via hypoxic injury. There is a lack of understanding regarding donor physiology during DCD, and how this contributes to hepatic dysfunction in transplantation. Herein, we outline the current DCD process and the concept of donor warm ischemic time (dWIT). We then discuss physiologic mechanisms of hepatic blood flow and oxygenation, and how these are relevant to dWIT and DCD. We discuss the pathophysiology of hepatic ischemia-reperfusion injury, and relevant insights that can be derived from studies of other hepatic conditions. Lastly, we touch on emerging technologies such as machine perfusion. We hope that our review unites concepts of hepatic physiology with DCD practice and enlightens readers to envision novel areas of study in this field.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199473","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":"Abdominal aortic calcification on routine pre-operative computed tomography - a novel cardiovascular risk prediction tool in liver transplant patients.","authors":"Benjamin Cailes, Numan Kutaiba, Omar Farouque, Avik Majumdar, Thalys S Rodrigues, Anees Enayati, Layal Abdelganne, Shannon McNamara, Nikki Garrard, Ali Al-Fiadh, Terase Lancefield, Matias B Yudi, Mark Horrigan, Julian Yeoh, Laurence Weinberg, Adam Testro, Marie Sinclair, Ruth Lim, Paul Gow, Anoop N Koshy","doi":"10.1097/LVT.0000000000000642","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000642","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease is a leading cause of postoperative mortality following liver transplantation (LT). The presence of abdominal aortic calcification (AAC) has been linked to cardiovascular events in the general population. We sought to investigate whether AAC on routine pre-transplant computed tomography (CT) can improve prediction of coronary artery disease, post-LT Major Adverse Cardiovascular Events (MACE) or long-term mortality.</p><p><strong>Methods: </strong>Of 461 patients undergoing LT between 2010-2018, 318 were included in the analysis, among whom 81 had also undergone CT coronary angiography (CTCA). Extent of AAC was quantified with high AAC defined as a calcium score ≥500.</p><p><strong>Results: </strong>High AAC was identified in 84/318 (26.4%) and demonstrated moderate correlation with coronary artery calcium score (r=0.52, p<0.001). Thirty-two MACE events occurred in 28 patients (8.8%) within 30-days. High AAC was a strong independent predictor of moderate-to-severe coronary disease on CTCA (OR 12.6, 95% CI 1.5-103.0, p=0.02). It was also associated with a significantly increased risk of 30-day MACE (OR 2.34 (95%CI 1.08-5.05), p=0.03) and long-term mortality (HR 2.45 (95%CI 1.18-5.06, p=0.02). Following multivariate analysis adjusting for pertinent cardiovascular risk factors, high AAC remained a strong independent predictor of MACE (OR 3.10, 95% CI 1.27-7.60, p=0.02). Addition of AAC to the revised cardiac risk index (RCRI) significantly improved model fit for predicting MACE outcomes (p<0.01), while absence of heavy AAC ruled out moderate-to-severe disease on CTCA with a negative predictive value of 97.0%.</p><p><strong>Conclusions: </strong>High AAC on routine CT scans was associated with a 3-fold increased risk of 30-day MACE post-LT and improved cardiovascular risk prediction compared to traditional indices. Quantification of AAC may offer a simple method of improving cardiovascular risk assessment in these patients.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199471","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 & 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":"https://doi.org/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 associated steatohepatitis (MASH) is now a leading indication for liver transplantation and rates of obesity and MASLD pre- and post-transplant are on the rise. Our understanding of the physiology of obesity and metabolic disease and the availability of effective obesity treatments has evolved over the same time frame. With the availability of new anti-obesity medications (AOM), 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 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":""},"PeriodicalIF":4.7,"publicationDate":"2025-06-03","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":"Balancing abstinence and harm reduction across the continuum of care for liver transplantation in alcohol-associated liver disease.","authors":"Sue Hyon Kim, Sasha Deutsch-Link, Marina Serper","doi":"10.1097/LVT.0000000000000644","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000644","url":null,"abstract":"<p><p>Alcohol use following liver transplantation (LT) is associated with worse outcomes. Strategies for predicting, preventing, and managing alcohol consumption among LT candidates and recipients with alcohol-associated liver disease (ALD) have historically emphasized complete abstinence. We propose a harm reduction approach as a possible complementary and realistic strategy for managing alcohol use in the context of LT for ALD. In this article, we outline the ethical and clinical foundations for applying harm reduction across the continuum of care for LT in ALD. Although complete alcohol abstinence prevents liver damage, harm reduction promotes shared decision-making that balances liver function with realistic patient circumstances and patient autonomy. Approaches grounded in harm reduction may allow us to improve outcomes across different alcohol consumption patterns and more effectively address health disparities in certain patient groups facing additional challenges in maintaining complete abstinence. Harm reduction strategies may also help prevent psychological distress in transplant candidates and recipients with ALD and encourage early disclosure of alcohol use that enables timely interventions. Listing procedures and waitlist management for ALD patients that incorporate principles of harm reduction may also broaden the access to life-saving care while maintaining organ utility. Based on clinical evidence, we highlight the need to examine current LT selection processes, coordinate alcohol use disorder treatment for patients with ALD, and develop comprehensive markers of post-transplant success. Finally, we discuss potential challenges and considerations when applying the harm reduction approach to nuanced scenarios of LT candidates and recipients with ALD.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199472","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":"Safety and efficacy of simultaneous liver transplantation and sleeve gastrectomy in morbid obese patients with end-stage liver disease: The LT-SG study.","authors":"Tommaso Maria Manzia, Bruno Sensi, Paolo Gentileschi, Claudia Quaranta, Luca Toti, Leonardo Baiocchi, Mario Dauri, Roberta Angelico, Giuseppe Tisone","doi":"10.1097/LVT.0000000000000522","DOIUrl":"10.1097/LVT.0000000000000522","url":null,"abstract":"<p><p>In obese patients, metabolic dysfunction-associated steatotic liver disease is becoming a leading etiology of end-stage liver disease and HCC. Simultaneous liver transplantation and sleeve gastrectomy (LT-SG) have been proposed in the United States, but the safety and efficacy of the procedure have not been widely explored in Europe. Between January 2016 and December 2022, morbidly obese patients listed for liver transplantation at Tor Vergata University were enrolled in the LT-SG study. Primary outcomes were (1) safety expressed as 30- and 90-day overall survival and (2) major postoperative complications (Clavien-Dindo >IIIa). The secondary outcome was efficacy expressed as a 3-year %excess body mass index (BMI) loss. Eleven patients were enrolled in the study. The median BMI at transplantation was 42 (IQR 38-48). Indications of LT-SG were HCC (63.6%) and cirrhosis (36.4%). In 54% of cases, donors had high-risk characteristics (eurotransplant donor risk index >1.6). The 30- and 90-day overall survival were 63.6% and 54.5%, respectively. All deaths occurred in patients with P-SOFT >15 or in patients who had at least 3 of the following characteristics: >60 years, BMI >45, metabolic syndrome, MELD >25 or eurotransplant donor risk index >1.6. The 6 months, 1, 2, and 3 years %excess BMI loss was 73%, 60%, 50%, and 43%, respectively. LT-SG is a complex procedure that may carry excess risk in an unselected population. It should be considered only in highly selected patients. Standard donors are recommended, and prioritization of severely obese patients on the waiting list should be considered.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"770-780"},"PeriodicalIF":4.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142503072","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 HCC 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, Rafik Mark Ghobrial, Mohamed Rela, Gonzalo Sapisochin","doi":"10.1097/LVT.0000000000000589","DOIUrl":"10.1097/LVT.0000000000000589","url":null,"abstract":"<p><p>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. 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 an external expert review. Consensus statements were accepted regarding patient assessment and waitlisting criteria, pretransplant treatment (including immunotherapy) and downstaging, living donor LT, post-LT patient management, and patient- and caregiver-related outcomes. 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":"815-831"},"PeriodicalIF":4.7,"publicationDate":"2025-06-01","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":"Less is more: The use of single biodegradable stenting to treat biliary anastomotic strictures in pediatric liver transplantation.","authors":"Jesús Quintero Bernabeu, Javier Juamperez Goñi, Maria Mercadal Hally, Cristina Padrós Fornieles, Mauricio Larrarte King, José Andrés Molino Gahete, Anna Coma Muñoz, Iratxe Diez Miranda, Mercedes Pérez Lafuente, Ramon Charco Torra, Ernest Hidalgo Llompart","doi":"10.1097/LVT.0000000000000504","DOIUrl":"10.1097/LVT.0000000000000504","url":null,"abstract":"<p><p>This study reports our experience of using biodegradable biliary stents (BBSs) for anastomotic biliary strictures (ABSs) in pediatric patients undergoing liver transplants. It involves the analysis of a retrospective data collection from January 2014 to January 2023, including all pediatric recipients of liver transplants in our center treated for ABSs with BBSs. In phase 1 (2014-2019), there was an initial percutaneous transhepatic cholangiography with anastomotic dilatation followed 2 weeks after a second percutaneous transhepatic cholangiography with BBS insertion. In phase 2 (2019-2023), the BBS was placed shortly after ABS dilatation, requiring only 1 percutaneous transhepatic cholangiography. All patients were followed up with routine tests and ultrasound. Forty-six ABSs were diagnosed in 43 pediatric recipients of liver transplants with a median of 6.7 months after liver transplantation (0.1-246.8 mo). Eight out of 46 ABSs (17.4%) treated with BBSs relapsed (median recurrence time: 6.5 mo; 1.6-17.0 mo). Four resolved with further BBS placement; only 4 needed surgical revision (8.7%) after a median follow-up time of 43.9 months (0.3-106.3). There were no differences in ABS recurrence rate, time between stent placement and recurrence, or the presence of cholangitis based on whether the BBS was deployed in 1 or 2 steps. Patients with end-to-end anastomosis had a higher ABS recurrence (OR 10.8; 1.4-81.3, p = 0.008) than those with bilioenteric anastomosis. The use of biodegradable stents could be a good option for treating ABSs in pediatric patients undergoing liver transplants, with our series showing a success rate of over 90% and an average follow-up of 43.9 months.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"793-802"},"PeriodicalIF":4.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349434","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":"Why and when biodegradable biliary stents may be used in children? The emerging evidence may be starting to answer these questions.","authors":"Dimitri A Parra","doi":"10.1097/LVT.0000000000000563","DOIUrl":"10.1097/LVT.0000000000000563","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"707-708"},"PeriodicalIF":4.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886000","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":"Racial and ethnic disparities in extended criteria allograft use for liver transplantation.","authors":"Jeong W Han, George Cholankeril, Fadl A Zeineddine, Maria F Machicao, Nhu Thao Nguyen Galván, John A Goss, Hashem B El-Serag, Fasiha Kanwal, Abbas Rana, Tzu-Hao Lee","doi":"10.1097/LVT.0000000000000578","DOIUrl":"10.1097/LVT.0000000000000578","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"844-847"},"PeriodicalIF":4.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059826","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}