Liver Transplantation最新文献

{"title":"Ex-situ machine perfusion in clinical liver transplantation: Current practices and future directions.","authors":"Michelle C Nguyen, Xingjie Li, Natalia Linares, Caroline Jadlowiec, Adyr Moss, Kunam S Reddy, Amit K Mathur","doi":"10.1097/LVT.0000000000000428","DOIUrl":"10.1097/LVT.0000000000000428","url":null,"abstract":"<p><p>Ex-situ machine perfusion of the liver has surmounted traditional limitations associated with static cold storage in the context of organ preservation. This innovative technology has changed the landscape of liver transplantation by mitigating ischemia perfusion injury, offering a platform for continuous assessment of organ quality, and providing an avenue for optimizing the use of traditionally marginal allografts. This review summarizes the contemporary clinical applications of machine perfusion devices and discusses potential future strategies for real-time viability assessment, therapeutic interventions, and modulation of organ function after recovery.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"531-544"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141534760","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":"CON: All patients should not receive a palliative care consult during LT evaluation.","authors":"Seren M Gedallovich, Claudio R Tombazzi, Nneka N Ufere","doi":"10.1097/LVT.0000000000000540","DOIUrl":"10.1097/LVT.0000000000000540","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"552-555"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739742","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 history of transplant oncology-The story of Steve Jobs.","authors":"Rahul Sandella, Anjana Pillai","doi":"10.1097/LVT.0000000000000547","DOIUrl":"10.1097/LVT.0000000000000547","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"545-547"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770481","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":"Preservation of coagulation function by normothermic machine perfusion in liver transplant as evidenced by thromboelastography parameters.","authors":"Leon L Su, Daniel T Secor, Alyssa K McGary, Michelle C Nguyen, Caroline C Jadlowiec, Lance A Williams, Theresa N Kinard, Jill Adamski, Alex D Stoker, Peter E Frasco","doi":"10.1097/LVT.0000000000000507","DOIUrl":"10.1097/LVT.0000000000000507","url":null,"abstract":"<p><p>The use of normothermic machine perfusion (NMP) over static cold storage in liver transplantation has been shown to reduce posttransplant risks of early allograft dysfunction, primary nonfunction, and ischemic cholangiopathy, and its increasing use has played a role in the expanded utilization of marginal livers. While studies have demonstrated improved clinical outcomes using NMP over static cold storage preservation, real-time intraoperative data reflecting the quality and viability of NMP livers is limited. This retrospective, single-center study compared NMP versus static cold storage livers in first-time recipients of liver transplants through the evaluation of synthetic coagulation function as measured by thromboelastography and conventional coagulation testing. Secondarily, transfusion utilization between the 2 cohorts was reviewed. One hundred eighty-six recipients of liver transplants receiving allografts from donors after circulatory death were included in the study, of which 99 (53%) allografts were preserved in static cold storage, and 87 (47%) allografts were placed on the TransMedics Organ Care System. Study findings showed NMP livers supported with the TransMedics Organ Care System were associated with increased synthetic coagulation function and less excess fibrinolysis in the postreperfusion period compared to static cold storage livers, and that these findings were better reflected in real-time with thromboelastography monitoring versus conventional coagulation testing. Following reperfusion, there was a significant decrease in the transfusion of blood products in the NMP group compared with that in the static cold storage group. Overall, we determined that the use of intraoperative thromboelastography can provide real-time data to assess one aspect of reperfusion liver quality and viability.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"464-475"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786015","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":"Validation of mitochondrial FMN as a predictor for early allograft dysfunction and patient survival measured during hypothermic oxygenated perfusion.","authors":"Jule Dingfelder, Dagmar Kollmann, Laurin Rauter, David Pereyra, Sertac Kacar, Anna M Weijler, Tina Saffarian Zadeh, Chiara Tortopis, Gerd Silberhumer, Andreas Salat, Thomas Soliman, Gabriela Berlakovich, Georg P Györi","doi":"10.1097/LVT.0000000000000512","DOIUrl":"10.1097/LVT.0000000000000512","url":null,"abstract":"<p><p>Hypothermic oxygenated machine perfusion (HOPE) preconditions liver grafts before transplantation. While beneficial effects on patient outcomes were demonstrated, biomarkers for viability assessment during HOPE are scarce and lack validation. This study aims to validate the predictive potential of perfusate flavin mononucleotide (FMN) during HOPE to enable the implementation of FMN-based assessment into clinical routine and to identify safe organ acceptance thresholds. FMN was measured in perfusate samples of 50 liver grafts at multiple time points. After transplantation, patients were followed up for development of early allograft dysfunction (EAD), transplantation, and 1-year survival. FMN concentrations were significantly higher for grafts that developed EAD at 5 and 60 minutes into HOPE ( p = 0.008, p = 0.026). The strongest predictive potential of FMN for EAD was observed at 5 minutes of HOPE with an AUC of 0.744. Similarly, 5-minute FMN was predictive for 1-year mortality ( p < 0.001), reaching a remarkable AUC of 0.890. Cutoffs for prediction of EAD (10.6 ng/mL) and early mortality (23.5 ng/mL) were determined and allowed risk stratification of grafts. Particularly, patients receiving low-risk grafts developed EAD in 9% of cases, while all patients survived the first postoperative year. In contrast, high-risk organs developed an incidence of EAD at 62%, accompanied by the necessity of retransplantation in 38% of cases. One-year mortality in the high-risk cohort was 62%. Evaluation of FMN as early as 5 minutes during HOPE allows for risk stratification of liver grafts. Low-risk grafts, according to FMN, display a negligible risk for patients. Yet, high-risk grafts are associated with increased risk for EAD, transplantation, and early mortality and should not be used for transplantation without further assessment.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"476-488"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950878","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":"Geospatial analysis of liver donation after death by drug intoxication.","authors":"Haaris Kadri, Thomas J Handley, Toshihiro Nakayama, Kazunari Sasaki, Marc L Melcher","doi":"10.1097/LVT.0000000000000618","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000618","url":null,"abstract":"<p><strong>Background: </strong>Increases in deaths from drug intoxication in the United States could be contributing to more liver donations. This study investigates regional variation in liver donation following death by drug intoxication over a decade.</p><p><strong>Methods: </strong>The number of drug intoxication-related deaths in the continental United States (2011-2020) was collected from CDC WONDER. Reports from UNOS provided the number of liver donors who died of drug intoxication over the decade. County-level ratios of liver donors after drug intoxication to the total number of drug intoxication-related deaths were calculated. Missed donation opportunities were quantified by comparing the actual number of donors to the hypothetical number if all counties achieved the efficiency of counties in the 90th and 50th percentiles. Regression analysis was used to assess the relationship between missed opportunities for liver donation per drug intoxication-related death and county-level variables.</p><p><strong>Results: </strong>County-level proportions of liver donors after drug intoxication to all eligible drug intoxications ranged from 0 to 0.600. If every county matched the efficiency of the 90th and 50th percentile county, the liver donor pool could grow by 7572 or 1550 donors over the decade, respectively. The national rate of missed opportunities for liver donation per death by drug intoxication was 0.114 or 0.022 depending on whether the 90th or 50th percentile donation ratio was used in calculation. The number of missed donations per drug intoxication increased with higher social vulnerability, distance from a trauma center, and rural county status. Conversely, it decreased as the rate of deaths by drug intoxication rose.</p><p><strong>Conclusion: </strong>Assessing liver donation following drug intoxication allows for targeted efforts to increase donations in regions with the greatest potential for improvement.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753463","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":"Prediction of portal venous pressure in living donor liver transplantation: A retrospective study.","authors":"Takeshi Kurihara, Shinji Itoh, Takeo Toshima, Katsuya Toshida, Takahiro Tomiyama, Yukiko Kosai, Takahiro Tomino, Shohei Yoshiya, Yoshihiro Nagao, Kazutoyo Morita, Mizuki Ninomiya, Noboru Harada, Tomoharu Yoshizumi","doi":"10.1097/LVT.0000000000000433","DOIUrl":"10.1097/LVT.0000000000000433","url":null,"abstract":"<p><p>Liver transplantation is the definitive treatment for advanced liver cirrhosis with portal hypertension. In Japan, the scarcity of deceased donors leads to reliance on living donors, often resulting in smaller grafts. Managing portal venous pressure (PVP) is critical to prevent fatal posttransplant complications. This study explored the possibility of predicting intraoperative PVP. We analyzed 475 living donor liver transplant cases from 2006 to 2023, excluding those with acute liver failure or prior splenectomy or splenic artery embolization. Patients were divided into a training group (n = 425) and a test group (n = 50). We evaluated the correlation between preoperative factors and PVP at laparotomy to predict PVP at laparotomy and closure. The predictive model was validated with the test group data. PVP at laparotomy could be predicted using correlated preoperative factors: prothrombin time ( p < 0.001), predicted splenic volume ( p < 0.001), and presence of a portosystemic shunt ( p = 0.002), as follows: predicted PVP at laparotomy (mm Hg)=25.818 - 0.077 × (prothrombin time [%]) + 0.004 × (predicted splenic volume [mL]) - 2.067 × (1: with a portosystemic shunt) ( p < 0.001; R = 0.346). In addition, PVP at closure could be predicted using correlated operative factors, including measured PVP at laparotomy, as follows: predicted PVP at closure (mm Hg)=14.268 + 0.149 × (measured PVP at laparotomy [mm Hg]) - 0.040 × (GV/SLV [%]) - 0.862 × (1: splenectomy [if yes]) - 3.511 × (1: splenic artery ligation without splenectomy [if yes]) ( p < 0.001; R = 0.339). This study demonstrated the feasibility of predicting intraoperative PVP using preoperative factors in patients with decompensated cirrhosis undergoing liver transplant. This predictive approach could refine surgical planning, potentially improving patient outcomes.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"428-437"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141590689","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":"Split liver transplantation and allocation policy: an uncertain connection.","authors":"Angela M Chen, Jean C Emond","doi":"10.1097/LVT.0000000000000615","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000615","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753466","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":"Long-term maternal outcomes of pregnancy after orthotopic liver transplantation in the Netherlands: A retrospective multicenter cohort study.","authors":"Jildau R Meinderts, Herold J Metselaar, Bart van Hoek, Caroline M den Hoed, Douwe Rijntjes, Mariette Groenewout, Frederike G I van Vilsteren, Henk Groen, Stefan P Berger, Jelmer R Prins, Margriet F C de Jong","doi":"10.1097/LVT.0000000000000477","DOIUrl":"10.1097/LVT.0000000000000477","url":null,"abstract":"<p><p>Pregnancy after orthotopic liver transplantation (OLT) puts the mother, child, and transplanted organ at risk. Little is known about long-term outcomes. We performed a nationwide retrospective cohort study to evaluate short-term and long-term outcomes of post-OLT pregnancies. The secondary aim was to assess predictors for adverse pregnancy outcomes. A composite outcome of preeclampsia, preterm birth, low birth weight, and neonatal intensive care unit admission was made. Survival of women who received a transplant at <50 years of age with and without pregnancy after OLT were compared (Dutch Organ Transplantation Registry data). Descriptive statistics, regression analysis, Kaplan-Meier and log-rank analysis, and generalized estimating equation analysis were used. Among the included 70 women with 113 pregnancies >20 weeks of gestation, hypertension occurred in 20% and preeclampsia in 12%. The live birth rate was 87%; 33% were preterm, and 23% had low birth weight. Long-term follow-up (median 10 y [IQR: = 4-14]) showed small changes in serum creatinine and bilirubin ( p < 0.001). Sixteen mothers (23%) died during follow-up (median 8 y [IQR: = 4-12]), with all their children aged <18 years. No difference in survival was found when comparing women with and without pregnancy after OLT. The composite outcome occurred in 43/98 of pregnancies. Higher body mass index (BMI) and maternal age at conception increased the composite outcome risk (OR: 1.24, p < 0.01, and OR: 1.25, p = 0.01, respectively). To conclude, pregnancy after OLT does not seem to influence long-term outcomes of graft, kidney function, or patient survival in most cases. However, although pregnancy does not seem to impact survival after OLT, we do show that a substantial number of children will lose their mothers early in life. We believe this is important for pregnancy couseling of patients with an OLT and their partners.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"508-520"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154488","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":"Three Problems, Two Viruses, and One Man with a Vision and Voice: Larry Kramer, Medical Activist.","authors":"Lorna M Dove","doi":"10.1097/LVT.0000000000000619","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000619","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753469","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}