Liver Transplantation最新文献

{"title":"PRO AI: AI-augmented allocation is in our future-We should invest the necessary resources today.","authors":"Jin Ge","doi":"10.1097/LVT.0000000000000625","DOIUrl":"10.1097/LVT.0000000000000625","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1303-1306"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007687","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":"To Err Is Robot-An analysis of complications following robotic donor hepatectomy.","authors":"Shweta Mallick, Krishnanunni Nair, Christi Titus Varghese, Binoj Sivasankara Pillai Thankamony Amma, Ramachandran N Menon, Dinesh Balakrishnan, Unnikrishnan Gopalakrishnan, Othiyil Vayoth Sudheer, Sudhindran Surendran","doi":"10.1097/LVT.0000000000000592","DOIUrl":"10.1097/LVT.0000000000000592","url":null,"abstract":"<p><p>Robotic donor hepatectomy (RDH) has been reported with lower morbidity than its open counterpart. Donor safety remains the primary concern, precluding its wide adoption. We aimed to evaluate donor complications following RDH and identify their predictive factors. Out of 348 live donor liver transplants performed between 2018 and 2021, the prospective data of 202 RDH were analyzed for complications by the modified Clavien-Dindo grading system. Multivariate analysis of donor and operative parameters was done to identify factors predicting complications, and CUSUM (cumulative sum) analysis was done to evaluate the effect of a learning curve. Out of 202 RDH (mean age: 37.5 [±10.4]; f [female]:m [male]-133:69; mean body mass index: 25.2±3.84), 196 (97%) were modified right lobe grafts. Conversion to open occurred in 7 (3.4%) (5-bleeding, 1-hepatic duct injury, and 1-portal vein kink). Postoperative complications occurred in 33 (16.3%), the most common being bile leak (5.9%) and bleeding (3.9%). Grades IIIa, IIIb, and IVa complications were seen in 3.4%, 3.4%, and 0.9% of patients, respectively. Reoperation was required in 3 cases for PVT, narrowing of IVC, and biliary peritonitis, respectively. At follow ups of 4 years, these patients are doing well. Although in univariate analysis, higher blood loss and body mass index appeared to be significant, multivariate analysis did not reveal any donor factor that could predict complications (biliary anatomy, portal anatomy, blood loss, body mass index, duration of surgery, or future liver remnant volume). The number of overall complications (21.7% vs. 9.9%; p =0.020; OR, 2.53) came down significantly in the second half. On RA-CUSUM (risk-adjusted CUSUM) analysis, we identified that it took around 130 cases for our unit to collectively overcome the learning curve. Although RDH appears to be safe, critical complications can occur in a minority of cases. Safety lies in flattening the learning curve.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1269-1276"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567582","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":"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 (SMI L3 ) is commonly used for assessment, the upper thigh skeletal muscle index (SMI UT ) 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, intensive care unit, 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. SMI UT demonstrated stronger associations with hospital days ( R2 =0.378) than SMI L3 ( R2 =0.302). High SMI UT correlated with improved survival ( p =0.02), unlike SMI L3 . Longitudinal analysis revealed a significant divergence in SMI UT between survivors and non-survivors, whereas SMI L3 showed no significant changes. The visceral fat index at L3 (VFI L3 ) increased continuously, highlighting potential metabolic risks. SMI UT showed a similar or even stronger association with LT outcomes than SMI L3 , effectively reflecting patient prognosis. SMI UT in the postoperative period also better reflected clinical status. Therefore, preoperative and postoperative SMI UT is helpful for patient assessment and ongoing management in LT patients.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1250-1257"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","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":"Metabolic issues in patients with metabolic dysfunction-associated steatohepatitis (MASH) and their impact on MASH recurrence following liver transplantation: A narrative review.","authors":"Lynna Alnimer, Diego Arellano, Elizabeth Brombosz, Mazen Noureddin","doi":"10.1097/LVT.0000000000000544","DOIUrl":"10.1097/LVT.0000000000000544","url":null,"abstract":"<p><p>Decompensated cirrhosis secondary to metabolic dysfunction-associated steatohepatitis (MASH) is not only a common indication for liver transplant (LT) but is becoming the leading cause of LT in postmenopausal women in the United States. Given the different complex mechanisms involved in the occurrence of MASH, it is being recognized as the hepatic manifestation of the metabolic syndrome. There are multiple metabolic issues associated with MASH, including obesity, DMT2, cardiovascular disease, and chronic kidney disease, which need to be addressed in the pretransplant and posttransplant setting for better patient outcomes. Recurrence of MASH following LT can occur due to many reasons including reversal of the catabolic state seen in cirrhosis, improvement in appetite, and the effect of certain post-LT medications on the graft; however, managing recurrence can be challenging and thus urges addressing these issues before transplant, in addition to recognizing, and treating them in the posttransplant setting. In this review, we discuss the various metabolic issues that face patients with MASH and the medical and surgical management options available to improve outcomes and reduce chances of recurrence.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1277-1285"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770502","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: Limitations of MRI-serum-based scoring in liver transplant rejection assessment.","authors":"Jelte Schaapman, Elizabeth Shumbayawonda, Hildo Lamb, Minneke Coenraad","doi":"10.1097/LVT.0000000000000639","DOIUrl":"10.1097/LVT.0000000000000639","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"E26-E27"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111145","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":"Exploring auxiliary liver transplantation in the era of transplant oncology-A proposal for a new liver splitting program (ALERT-50).","authors":"Enrico Gringeri, Alessandro Furlanetto, Marina Polacco, Luca Perin, Eleonora Nieddu, Eugenia Rosso, Clarissa De Nardi, Mattia Ballo, Tullia De Feo, Silvia Trapani, Patrizia Burra, Marco Spada, Michele Colledan, Andrea Lauterio, Renato Romagnoli, Massimo Cardillo, Giuseppe Feltrin, Luciano De Carlis, Umberto Cillo","doi":"10.1097/LVT.0000000000000574","DOIUrl":"10.1097/LVT.0000000000000574","url":null,"abstract":"<p><p>Total hepatectomy and liver transplantation have emerged as a game-changing strategy in the treatment of several liver-confined primary or metastatic tumors, opening a new era of transplant oncology. However, the expansion of indications is going to worsen the chronic scarcity of organs, and new strategies are needed to enlarge the donor pool. A possible source of organs could be developing split liver transplantation programs. We propose to refer donors aged 18-50 years unsuitable for pediatric patients and donors aged 50-60 years for split evaluation. This will generate new small left lateral grafts that can be used for resection and partial liver segment II-III transplantation with delayed total hepatectomy procedures, based on a national waiting list specifically for non-HCC oncologic patients. Centralized imaging review will streamline the donor-recipient matching process and address organizational challenges. Additionally, adopting an ex situ splitting technique during hypothermic oxygenated machine perfusion could further enhance logistical efficiency and improve graft viability. The proposed protocol (ALERT 50) will therefore promote the development of oncologic indications without affecting the standard waiting list and without competing with urgent or pediatric patients.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1176-1182"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007925","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":"Liver transplantation after ex vivo normothermic machine preservation without recooling the graft: A clinical series from a single center.","authors":"Salvatore Gruttadauria, Ivan Vella, Sergio Li Petri, Caterina Accardo, Pasquale Bonsignore, Alessandro Tropea, Sergio Calamia, Duilio Pagano, Gaetano Burgio, Rosalia Longo, Fabrizio di Francesco","doi":"10.1097/LVT.0000000000000564","DOIUrl":"10.1097/LVT.0000000000000564","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1190-1194"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950879","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":"\"You're hot then you're cold\" : Can we omit recooling after NMP?","authors":"Shennen A Mao, Kristopher P Croome","doi":"10.1097/LVT.0000000000000641","DOIUrl":"10.1097/LVT.0000000000000641","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1087-1088"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078993","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":"Utilization of fibrotic HCV-viremic grafts in liver transplantation: An emerging opportunity or a step too far?","authors":"Avesh J Thuluvath, Elizabeth C Verna","doi":"10.1097/LVT.0000000000000627","DOIUrl":"10.1097/LVT.0000000000000627","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1083-1084"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030175","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":"Hepatitis C-positive grafts for hepatitis C-negative recipients in liver transplantation: Buried treasure or depleting resource?","authors":"Toshihiro Nakayama, David T Krist, Miho Akabane, Yuki Imaoka, Carlos O Esquivel, Allison J Kwong, Paul Y Kwo, Marc L Melcher, Kazunari Sasaki","doi":"10.1097/LVT.0000000000000557","DOIUrl":"10.1097/LVT.0000000000000557","url":null,"abstract":"<p><p>Long-term outcomes of using HCV-positive donors in HCV-negative recipients in liver transplantation (LT) are not well established. Data from the United Network for Organ Sharing (UNOS) database between July 1, 2015, and December 31, 2023, were analyzed. The cohort included 44,447 HCV antibody-negative (Ab-) candidates who underwent deceased donor LT. Changes in case numbers and utilization rates of HCV-positive donors, divided into HCV-viremic (NAT+) or Ab+ nonviremic (Ab+/NAT-), were assessed. Kaplan-Meier analysis and propensity score matching were used to evaluate 5-year graft survival. The number of HCV-viremic donation after brain death (DBD) donors and their use in LT for HCV Ab- recipients peaked at 640 donors in 2019 and 289 LTs in 2022. In contrast, Ab+ nonviremic DBD donations are rising, with 536 donors and 284 LTs in 2023. The utilization rate of viremic DBD grafts has continuously decreased despite increased willingness by waitlist candidates to accept them. HCV-positive donation after circulatory death donors were seldom utilized in the study period. The 5-year graft survival rates for HCV-viremic, Ab+ nonviremic, and naïve donors were not significantly different in either DBD ( p = 0.56) or donation after circulatory death ( p = 0.52). Furthermore, Ishak stage 2 or 3 fibrotic DBD grafts had similar 5-year graft survival to nonfibrotic grafts. The findings suggest that the long-term outcome of using HCV-viremic DBD or donation after circulatory death grafts for HCV-negative recipients is comparable to that of other graft types and that fibrotic grafts have the potential to expand the DBD donor pool.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1154-1164"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829297","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}