Liver Transplantation最新文献

{"title":"Safety of acamprosate for alcohol use disorder after liver transplant: A pilot randomized controlled trial.","authors":"Divya Ayyala-Somayajula, Thomas Bottyan, Suhail Shaikh, Brian P Lee, Stephanie H Cho, Jennifer L Dodge, Norah A Terrault, Hyosun Han","doi":"10.1097/LVT.0000000000000475","DOIUrl":"10.1097/LVT.0000000000000475","url":null,"abstract":"<p><p>Acamprosate is a therapy for alcohol use disorder, but data on feasibility and safety in recipients of liver transplants are lacking. This was a single-center unblinded prospective pilot randomized controlled trial of adults (≥18 y) with liver transplant for alcohol-associated liver disease enrolled between 2021 and 2023, who were randomized 2:1 to the intervention of acamprosate (666 mg dose 3 times daily) or standard of care (SOC) over 14 weeks. Outcomes included safety (prevalence of adverse events [AEs]), feasibility (weekly survey response rate >60%), adherence (self-reported acamprosate use >60%), and efficacy (reduction in Penn Alcohol Craving Scale), and relapse-blood phosphatidylethanol (≥20 ng/mL/reported alcohol use) evaluated by standardized weekly surveys. The efficacy analysis was done in both the intention-to-treat (excluding withdrawals before medication administration) and per-protocol population (excluding withdrawals/<4 weeks participation). Of 78 participants who were approached, 30 enrolled (19 acamprosate and 11 SOC) with similar baseline characteristics. Eight participants withdrew (6 acamprosate before medication administration and 2 SOC). AEs were similar between acamprosate and SOC groups (92.3% vs. 90.0%, p > 0.99), including grade 3 AEs (53.9% vs. 60.0%, p > 0.99) with no reported grade 4/5 AEs. Survey response rates were similar in acamprosate versus SOC groups (61.0% vs. 76.0%, p = 0.19), and 69.0% were acamprosate adherents. Baseline Penn Alcohol Craving Scale values were low with no difference by the group in median absolute change in Penn Alcohol Craving Scale for intention-to-treat (0, IQR: -4 to 0 vs. 0, IQR: 0-0, p = 0.32), and per-protocol analyses (-1, IQR: -6 to 0 vs. 0, IQR: -0 to 0, p = 0.36). There was no reported or biochemical evidence of alcohol relapse. In this pilot study, preliminary data suggest that acamprosate may be safe and feasible. These data can inform larger studies and clinician efforts to address alcohol use disorder in post-liver transplant care (ClinicalTrials.gov, Number: NCT06471686).</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"498-507"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120199","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 on coagulation function and transfusion practice: Miracle machine or anticipatory bias.","authors":"Ritah R Chumdermpadetsuk, David D Lee","doi":"10.1097/LVT.0000000000000558","DOIUrl":"10.1097/LVT.0000000000000558","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"423-424"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828637","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":"Value of Factor V in the diagnosis of early graft dysfunction after liver transplantation: Internal validation.","authors":"Claudia Sanchez-Gonzalez, José L Fernández Aguilar, Belinda Sánchez Pérez, Julio Santoyo Santoyo","doi":"10.1097/LVT.0000000000000500","DOIUrl":"10.1097/LVT.0000000000000500","url":null,"abstract":"<p><p>Primary graft dysfunction is a major early complication following liver transplantation, potentially leading to retransplantation or patient death. Coagulation Factor V (FV) and ALT have emerged as important biomarkers in assessing liver function, yet their role as early predictors of graft loss has not been fully validated. The aim of this study is to conduct an internal validation of published results on the applicability of FV and ALT for diagnosing graft dysfunction and its predictive ability for graft loss within the first 90 days. We conducted a retrospective cohort study including 513 adult recipients from 2012 to 2023 at the Regional University Hospital of Málaga. FV and ALT levels were measured on postoperative day 2, and patients were categorized based on FV <37.5 and ALT >1539. The association with 90-day graft loss was analyzed. Graft loss occurred in 43 patients (8.4%) within the first 90 days. The combination of FV <37.5 and ALT >1539 on postoperative day 2 demonstrated a specificity of 99% and a test efficiency of 94% in predicting graft loss. Patients meeting both criteria had a 74-fold increased risk of graft loss, with most losses occurring within the first week, and a median survival of 4 days. These findings suggest that FV and ALT on postoperative day 2 are reliable early markers for predicting graft loss, enabling risk stratification and guiding critical decisions regarding early retransplantation in the immediate postoperative period.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"489-497"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349438","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":"Therapy of alcohol use disorder in liver transplant recipients.","authors":"Robert Weinrieb, Rituparna Medda, Michael R Lucey","doi":"10.1097/LVT.0000000000000546","DOIUrl":"10.1097/LVT.0000000000000546","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"425-427"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770516","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":"Optimizing the mouse orthotopic liver transplantation model: Learning curve, technical enhancements, and keys to success.","authors":"Zipei Wang, Linrui Dai, Daqiang Zhao, Peixiang Lan, Yuanyuan Zhao, Lai Wei, Dong Chen, Bo Zhang, Dunfeng Du, Zhishui Chen","doi":"10.1097/LVT.0000000000000612","DOIUrl":"10.1097/LVT.0000000000000612","url":null,"abstract":"<p><p>Due to the easier availability of transgenic mice and reagents, the mouse orthotopic liver transplantation model offers significant advantages in liver transplantation research. However, technical challenges have limited its broader application. The most challenging steps of the procedure include manual anastomosis of the suprahepatic vena cava, cuff anastomosis of the portal vein, and maintaining the anhepatic phase within 20 minutes. This study aims to provide detailed solutions to overcome these bottlenecks and introduces a modified magnetic device to facilitate safer and more efficient cuff anastomosis. We also describe the learning curve for beginners to achieve a 30-day survival rate exceeding 90% in mouse orthotopic liver transplantation. We demonstrate that mouse orthotopic liver transplantation can be mastered within 8 months of continuous practice, with 7-day and 30-day survival rates improving from 0% to 96.7% and 0% to 93.3%, respectively. The entire procedure can be completed within 80 minutes. We believe these technical improvements will provide more practical guidance for mouse liver transplantation.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700826","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":"Thigh muscle index as a valuable prognostic marker in middle-aged male patients undergoing liver transplantation.","authors":"Woo Chul Son, Kyung-Won Kim, You-Sun Ko, Yoon Tae Jung, Dong-Hwan Jung, Won Kim","doi":"10.1097/LVT.0000000000000611","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000611","url":null,"abstract":"<p><p>In liver transplantation (LT), determining the optimal recipients is crucial, and the MELD score has been used for this purpose. However, the MELD score does not reflect functional status, leading to the evaluation of sarcopenia. While the L3 skeletal muscle index (SMIL3) is commonly used for assessment, the upper thigh skeletal muscle index (SMIUT) may better represent functional capacity. This retrospective study included 246 male LT recipients aged 40-60 from 2013 to 2015. Preoperative and postoperative muscle and fat areas at the L3 and upper thigh levels were quantified using artificial intelligence software. Clinical outcomes, including ventilator, ICU, and hospital days, were analyzed using logistic regression, while survival was evaluated using Cox regression and Kaplan-Meier curves. Longitudinal body composition changes were assessed over 5 years post-LT. SMIUT demonstrated stronger associations with hospital days (R²=0.378) than SMIL3 (R²=0.302). High SMIUT correlated with improved survival (P=0.02), unlike SMIL3. Longitudinal analysis revealed a significant divergence in SMIUT between survivors and non-survivors, whereas SMIL3 showed no significant changes. The visceral fat index at L3 (VFIL3) increased continuously, highlighting potential metabolic risks. SMIUT showed a similar or even stronger association with LT outcomes than SMIL3, effectively reflecting patient prognosis. SMIUT in the postoperative period also better reflected clinical status. Therefore, pre- and postoperative SMIUT is helpful for patient assessment and ongoing management in LT patients.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700829","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":"Optimizing liver transplant candidacy in patients with cirrhosis and obesity.","authors":"Nghiem B Ha, Julie K Heimbach, Bilal Hameed","doi":"10.1097/LVT.0000000000000609","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000609","url":null,"abstract":"<p><p>The epidemic of obesity in the United States has led to a significant increase in the prevalence of obesity the liver transplant population, with metabolic dysfunction-associated steatotic liver disease (MASLD) becoming one of the most common indications for liver transplantation. Despite this rise in obesity, the optimal management strategies in the pretransplant, peri-transplant, and post-transplant phases of care have not yet been determined. In the current review, we will present and discuss the available evidence for the surgical management of obesity, including the optimal timing, as well as a review of the novel medical therapies and how these strategies may best be utilized to provide ideal long-term outcomes for liver transplant patients with obesity.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700825","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":"Assessing hepatic arterial injuries in the setting of normothermic machine perfusion in liver transplantation: A non-invasive approach.","authors":"Adam S Bodzin, Malcolm P MacConmara, Magdy Attia, Dana K Perry, Ashesh P Shah","doi":"10.1097/LVT.0000000000000610","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000610","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700819","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":"Decompensated cirrhosis but low MELD-Should we wait or refer for liver transplantation?","authors":"Noreen Singh, Yu Jun Wong, Patrizia Burra, Nazia Selzner, Aldo J Montano-Loza","doi":"10.1097/LVT.0000000000000608","DOIUrl":"10.1097/LVT.0000000000000608","url":null,"abstract":"<p><p>Cirrhosis constitutes a significant global health burden with decompensation characterized by ascites, hepatic encephalopathy, as well as variceal hemorrhage. These decompensation features are independent predictors of mortality. Liver transplantation remains the definitive treatment for patients with cirrhosis. However, given that this is a limited resource, thus its allocation, using the MELD score, has to be judicious despite decompensation features affecting the patient's quality of life. Patients with grade 3 ascites or overt hepatic encephalopathy have significant mortality; therefore, in some instances, these decompensation features should be considered indications for liver transplantation despite low MELD. The majority of patients listed for liver transplantation have low MELD scores (≤15 points); and approximately half will die due to liver-related complications. Current evidence demonstrates a mortality reduction of ~40% with LT in those patients with a low MELD. Furthermore, new scores have been developed, such as the MELD 3.0, which incorporates female sex, albumin, and all the MELD-Na components (bilirubin, creatinine, international normalized ratio, and sodium), and the Gender-Equity Model for Liver Allocation, that includes bilirubin, international normalized ratio, and the Royal Free Hospital glomerular filtration rate, which have demonstrated improved discrimination. Lastly, to address the limited resource, living donor liver transplant has demonstrated a significant survival benefit in patients even at MELD-Na scores as low as 11, suggesting that life-years gained are similar to deceased-donor transplant. In this review, our goal is to present the frequency of patients listed for transplant with low MELD, and the limitation of using MELD in patients for liver transplantation. We will provide practical guidance on the management of common complications of cirrhosis and early consideration for liver transplant referral in patients with clinical decompensation and low MELD.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700824","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 screening to action: Social determinants and early outcomes in pediatric liver transplant recipients.","authors":"Tiange P Zhang, Kali Zhou","doi":"10.1097/LVT.0000000000000605","DOIUrl":"10.1097/LVT.0000000000000605","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657648","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}