Liver Transplantation最新文献

{"title":"Abdominal aortic calcification on routine preoperative 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":"10.1097/LVT.0000000000000642","url":null,"abstract":"<p><p>Cardiovascular (CV) disease is a leading cause of postoperative mortality following liver transplantation (LT). The presence of abdominal aortic calcification (AAC) has been linked to CV events in the general population. We sought to investigate whether AAC on routine pre-transplant CT can improve the prediction of coronary artery disease, post-LT major adverse cardiovascular events (MACEs) or long-term mortality. Of 461 patients undergoing LT between 2010 and 2018, 318 were included in the analysis, among whom 81 had also undergone computed tomography coronary angiography. The extent of AAC was quantified with high AAC defined as a calcium score ≥500. High AAC was identified in 84/318 (26.4%) and demonstrated moderate correlation with coronary artery calcium score (CACS) ( 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 CT coronary angiography (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 CV 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 significantly improved model fit for predicting MACE outcomes ( p <0.01), while the absence of heavy AAC ruled out moderate-to-severe disease on CT coronary angiography with a negative predictive value of 97.0%. High AAC on routine CT scans was associated with a 3-fold increased risk of 30-day MACE post-LT and improved CV risk prediction compared to traditional indices. Quantification of AAC may offer a simple method of improving CV risk assessment in these patients.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1522-1532"},"PeriodicalIF":3.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12617310/pdf/","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":"OA","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":"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 candidates and recipients of LT 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 candidates and recipients of transplant with ALD and encourage early disclosure of alcohol use that enables timely interventions. Listing procedures and waitlist management for patients with ALD that incorporate principles of harm reduction may also broaden 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 posttransplant success. Finally, we discuss potential challenges and considerations when applying the harm reduction approach to nuanced scenarios of candidates and recipients of LT with ALD.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1558-1566"},"PeriodicalIF":3.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12354219/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From embedded interprofessional clinics to expanded alcohol-associated liver disease programs.","authors":"Gerald Scott Winder, Juan Pablo Arab, Arpita Goswami Banerjee, Kelly Bryce, David C Fipps, Filza Hussain, Gene Im, Lesley Omary, Arpan A Patel, Shivali Patel, Susan Rubman, Marina Serper, Akhil Shenoy, Joji Suzuki, Paula Zimbrean, Kimberly Brown, Marwan Abouljoud, Jessica L Mellinger","doi":"10.1097/LVT.0000000000000638","DOIUrl":"10.1097/LVT.0000000000000638","url":null,"abstract":"<p><p>Hazardous alcohol use remains a major contributor to acute and chronic liver disease, while alcohol-associated liver disease (ALD) is a leading indication for liver transplantation. In recent years, embedded, interprofessional ALD clinics have improved access to alcohol use disorder care within hepatology and liver transplantation, but more work is needed to meet this challenge. The literature is lacking regarding scaling procedures to provide services for increasingly large ill patient populations. This article begins to fill this gap by describing \"expanded ALD care\": broad, innovative, longitudinal, interprofessional care delivery strategies surpassing standalone clinics. Drawing from analogous patient populations served by collaborative models in primary care and comprehensive eating disorder treatment, the expanded ALD care framework proposes practical strategies toward specific innovations: equipoise between biomedical and psychosocial care elements, increased clinician number and reach, long-term patient relationships, harm reduction and palliative care, outreach to external agencies and clinicians, and enhanced support for patients and families. The article also defines attributes of innovative healthcare systems that support expanded ALD care.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1567-1580"},"PeriodicalIF":3.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032332","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":"Living-donor availability improves pediatric patient survival in a large North American center: An intention-to-treat analysis.","authors":"Zhihao Li, Owen Jones, Fernanda Takamatsu, Jennifer Stunguris, Christian T J Magyar, Nazia Selzner, Binita Kamath, Yaron Avitzur, Simon Ling, Nicola Jones, Robert H J Bandsma, Mar Miserachs, Gonzalo Sapisochin, Mark Cattral, Anand Ghanekar, Asad Siddiqui, Vicky L Ng, Blayne A Sayed","doi":"10.1097/LVT.0000000000000629","DOIUrl":"10.1097/LVT.0000000000000629","url":null,"abstract":"<p><p>Although living-donor liver transplantation (LDLT) is increasingly adopted for pediatric liver transplantation, there is limited data on whether live donation extends benefits to patients from the time of listing. This study investigated the benefits of pediatric LDLT through an intention-to-treat analysis. Pediatric candidates listed between 2001 and 2023 at a single Canadian center were categorized as pLDLT (with a potential live donor) or pDDLT (without a live donor). The primary endpoint was overall survival from the time of listing. The secondary endpoint involved the waitlist outcomes described by the probabilities of receiving liver transplantation or waitlist dropout. Among 474 candidates, 219 (46.2%) had potential live donors. The pLDLT group had a higher likelihood of receiving a liver transplantation (adjusted HR: 1.38, 95% CI: 1.16-1.64) and a lower risk of dying without a transplant (adjusted HR: 0.11, 95% CI: 0.01-0.82) compared to the pDDLT group. Survival rates from the time of listing were significantly better in the pLDLT group at 1-(98.6% vs. 87.6%), 5-(96.6% vs. 84.4%), and 10-(96.6% vs. 83.1%) years. Having a potential live donor was linked to a 72% reduction in mortality risk (adjusted HR: 0.28, 95% CI: 0.12-0.64). Although the number of patients listed annually increased over the study period, the waiting time for deceased donation shortened. This correlated with increased LDLT utilization, suggesting LDLT not only improved outcomes but also shortened wait times even for pDDLT patients. Having a potential live donor is associated with substantial survival benefit. Pediatric programs offering LDLT can expand the donor pool and decrease the waiting time for DDLT, supporting the argument for making LDLT a standard for pediatric candidates.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1337-1348"},"PeriodicalIF":3.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021364","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":"NT-proBNP predicts the development of acute-on-chronic liver failure and mortality in patients with cirrhosis listed for liver transplantation.","authors":"Juan Manuel Diaz, Rocio Blanco, Lorena Savluk, María Nelly Gutierrez-Acevedo, Agustina Martinez Garmendia, Carlos de la Peña-Ramirez, Sebastián Marciano, Juan Carlos Spina, Ignacio Bluro, Adrián Gadano, Diego Giunta, Joan Clària, Javier Fernandez, Ezequiel Mauro","doi":"10.1097/LVT.0000000000000624","DOIUrl":"10.1097/LVT.0000000000000624","url":null,"abstract":"<p><p>Acute-on-chronic liver failure (ACLF) is a major clinical event in cirrhosis that is characterized by high mortality rates and a short window for liver transplantation. N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been suggested as a prognostic biomarker in cirrhosis. However, its accuracy in predicting the development of ACLF or mortality in candidates for liver transplantation remains unknown. This observational, retrospective, single-center study included 277 consecutive patients with cirrhosis who were listed for liver transplantation between 2014 and 2020 in Hospital Italiano, Buenos Aires, Argentina. Clinical data, including sarcopenia, serum cystatin C (CysC), and NT-proBNP levels, were collected at listing. The median MELD-Na and NT-proBNP levels at the time of listing were 16 points (13-22) and 123 (58-257) pg/mL, respectively. High NT-proBNP levels (≥125 pg/mL) were associated with the development of ACLF (subhazard ratio: 4.00, 95% CI: 1.76-9.10; p <0.001) and mortality (subhazard ratio: 3.89, 95% CI: 1.28-11.79, p =0.02) after adjusting for MELD-Na and CysC. Patients with NT-proBNP ≥125 pg/mL showed a significantly higher incidence of ACLF at 3 months (28.5% vs. 3.6%; p <0.001) and 12 months (49.2% vs. 6.1%; p <0.001). Mortality in the waiting list at 1 year was also significantly higher in patients with NT-proBNP ≥125 pg/mL (22.3% vs. 4%; p <0.001). Serum NT-proBNP emerges as a promising prognostic biomarker for ACLF development and mortality in patients with cirrhosis on the waiting list. Its integration into clinical practice could facilitate preventive interventions and improve prioritization on the waiting list.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1324-1336"},"PeriodicalIF":3.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027502","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 pretransplant 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":"10.1097/LVT.0000000000000585","url":null,"abstract":"<p><p>Cannabis use is increasing in the United States, including among candidates for liver transplants (LTs). Although the anesthesia literature suggests an association between cannabis use and increased postoperative pain, the impact of cannabis use on post-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, health care utilization, and mortality. We included 4236 patients evaluated for LT at our institution between January 2013 and July 2023. Our primary risk factor was cannabis use, defined as urine toxicology positive for cannabis within 90 days of LT evaluation. Our primary outcome was post-LT opioid use, including oral morphine equivalents received during the LT hospitalization and discharge opioid prescriptions. We used multivariable logistic and quantile regression to compare post-LT opioid use, health care utilization outcomes, and mortality between cannabis users and nonusers. Cannabis use was associated with higher oral morphine equivalent use in the 48 hours after LT ( p =0.04). There were no statistically significant differences between groups in 72-hour ( p =0.07) or 7-day cumulative oral morphine equivalent ( p =0.33), opioid prescriptions on discharge ( p =0.25), hospital length of stay ( p =0.69), intensive care unit length of stay ( p =0.94), 90-day readmission ( p =0.66), or 90-day mortality ( p =0.96). While cannabis use before 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 after LT, or short-term health care 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":"1398-1410"},"PeriodicalIF":3.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353119/pdf/","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":"OA","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":"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 in the liver transplant population, with metabolic dysfunction-associated steatotic liver disease becoming one of the most common indications for liver transplantation. Despite this rise in obesity, the optimal management strategies in the pretransplant, peritransplant, and posttransplant 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":"1411-1422"},"PeriodicalIF":3.9,"publicationDate":"2025-11-01","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":"Reply: Methodological considerations for predicting HCC recurrence after liver transplantation.","authors":"Philipp Schindler, Osman Öcal, Moritz Wildgruber","doi":"10.1097/LVT.0000000000000648","DOIUrl":"10.1097/LVT.0000000000000648","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"E35-E36"},"PeriodicalIF":3.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174346","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 noninvasive approach.","authors":"Adam S Bodzin, Malcolm P MacConmara, Magdy Attia, Dana K Perry, Ashesh P Shah","doi":"10.1097/LVT.0000000000000610","DOIUrl":"10.1097/LVT.0000000000000610","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1436-1439"},"PeriodicalIF":3.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12517725/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and pathological spectrum of disease severity among patients with acute liver failure (ALF) undergoing deceased donor liver transplantation.","authors":"Shannan R Tujios, Jody A Rule, Norman Sussman, Jorge L Rakela, Daniel Ganger, Nathan Bass, Adrian Reuben, R Todd Stravitz, David Kleiner, Hanlin Wang, Eun-Young K Choi, Lan Peng, Matthew Yeh, Bryce Hatfield, Guang-Yu Yang, Ryan Gill, Robert J Fontana, William M Lee","doi":"10.1097/LVT.0000000000000634","DOIUrl":"10.1097/LVT.0000000000000634","url":null,"abstract":"<p><p>Listing and transplanting patients with acute liver failure (ALF) is challenging, requiring rapid assessment of the likelihood of recovery. The availability of a large number of ALF liver explants, along with their clinical data, afforded an opportunity to retrospectively evaluate liver transplantation (LT) decision-making. We hypothesized that, with the benefit of hindsight, a small number of patients might have recovered without LT. Three hundred liver explants from ALF patients of varying etiologies who had undergone LT over 22 years in the Acute Liver Failure Study Group registry were reviewed for histopathological features and degree of necrosis by a committee of 8 hepatopathologists. A second committee of 8 experienced transplant hepatologists independently reviewed clinical data on these same 300 patients and retrospectively scored the likelihood that each patient required transplantation. Only 3 (1%) of those reviewed by the Clinical Committee were considered to \"Definitely\" not require liver grafting, while an additional 10 (3.3%) were deemed to \"Possibly\" not require transplantation (Not Likely Group, N=13). There was no difference in the degree of necrosis in explants in these groups, when compared to the remaining Likely Group, N=287 (95.6%), except in acetaminophen (APAP)-associated ALF, where the degree of necrosis was more uniformly graded as severe, correlating with the need for transplantation. Virtually every patient undergoing LT for ALF retrospectively appeared to need their transplant, based on expert clinical consensus review. Overall, there was poor correlation between clinical severity and apparent degree of necrosis seen in the 300 liver explants, except perhaps for APAP subjects.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1368-1378"},"PeriodicalIF":3.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003138","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}