Liver Transplantation最新文献

{"title":"Development of a collaborative learning health system data mart in pediatric liver transplantation.","authors":"James E Squires, Emily R Perito, Alexander Garza, Read Urban, Kyle A Soltys, Eric Pahl, Cassandra Krise-Confair, George V Mazariegos","doi":"10.1097/LVT.0000000000000552","DOIUrl":"10.1097/LVT.0000000000000552","url":null,"abstract":"<p><p>Pediatric liver transplant is a lifesaving intervention for children with disparate pathology ranging from single-gene defects to global liver dysfunction and complications from progressive cirrhosis and portal hypertension. The Starzl Network for Excellence in Pediatric Transplantation (SNEPT), a novel learning health system dedicated to pediatric liver transplant, has previously identified practice variability, waitlist mortality, perioperative complications, and inadequate quality initiative implementation as critical barriers that deserve prioritization in the field. This project was a novel partnership between SNEPT and the United Network for Organ Sharing to co-design a pediatric transplant-specific data mart and web portal to systematically map an approach to understanding these barriers and deliver strategies to combat them. We combined transplant-specific data from center Standard Transplant Analysis and Research files with project specific metrics identified by SNEPT to develop a web-based application to display progress and disseminate results. Customized, dynamic visualizations were built to display project data for center-level review and network-wide benchmarking, quality assurance, and performance improvement. Our DataMart platform represents a successful, scalable, systems-level approach to data management that can be adopted by other transplant communities to ensure transplant-specific learning health system development, growth, and expansion.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"897-905"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813657","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":"Portal vein interposition in pediatric living donor liver transplantation: Which vein graft type is best?","authors":"Dor Yoeli, Megan Adams","doi":"10.1097/LVT.0000000000000606","DOIUrl":"10.1097/LVT.0000000000000606","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"851-852"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657649","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":"Achieving transplant equity: A feasible solution for uninsured patients.","authors":"Saulat S Sheikh","doi":"10.1097/LVT.0000000000000602","DOIUrl":"10.1097/LVT.0000000000000602","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"855-856"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657645","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":"Clinical outcomes in patients with unintended pregnancy after liver transplantation: A multicenter registry cohort study.","authors":"Anjali Walia, Ophelia Yin, Lisa Coscia, Yalda Afshar, Roxanna Irani, Serban Constantinescu, Michael Moritz, Monika Sarkar","doi":"10.1097/LVT.0000000000000524","DOIUrl":"10.1097/LVT.0000000000000524","url":null,"abstract":"<p><p>The consequences of unintended pregnancy in recipients of liver transplants (LTs), a growing part of the high-risk obstetric population, remain unknown. To fill this gap, we conducted a retrospective registry cohort study to describe the risk factors, obstetric and neonatal morbidity, and graft outcomes associated with unintended pregnancy after LT. This study utilized the Transplant Pregnancy Registry International and included 565 pregnancies of recipients of LT between 1967 and 2019 from 289 hospitals, primarily in North America. The primary outcome of acute cellular rejection and secondary outcomes of graft loss, severe maternal morbidity, and neonatal composite morbidity were compared by pregnancy intention. The study population included 60.9% with intended pregnancies and 39.1% with unintended pregnancies. Recipients with unintended pregnancy were more likely to self-report as Black race, to be younger, nulliparous, and to have exposure to teratogenic immunosuppression. Acute cellular rejection was more common with unintended pregnancy (3.7% vs. 1.2%, p =0.047). Unintended pregnancies had lower median birth weight (2806.6 vs. 2948.4 g, p =0.033). Unintended pregnancy was not associated with increased neonatal morbidity or severe maternal morbidity. These findings underscore the importance of family planning counseling, access to safe and effective contraceptive options, as well as multidisciplinary prenatal care in the growing population of recipients of reproductive-aged LT.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"916-923"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142503167","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 liver transplant access vary within and across transplant referral regions.","authors":"Arrey-Takor Ayuk-Arrey, Lauren Nephew, Juan Carlos Caicedo, Katherine Ross-Driscoll","doi":"10.1097/LVT.0000000000000561","DOIUrl":"10.1097/LVT.0000000000000561","url":null,"abstract":"<p><p>Prior studies have demonstrated racial disparities in access to liver transplantation, but the determinants of these disparities remain poorly understood. We used geographic catchment areas for transplant centers (transplant referral regions, TRRs) to characterize transplant environment contributors to racial and ethnic disparities in liver transplant access. Data were obtained from the Scientific Registry for Transplant Recipients and the National Center for Health Statistics from 2015 to 2021. The primary outcome was the difference in the listing-to-end-stage liver disease death ratio between Black, Hispanic, and non-Hispanic White patients for each TRR. We accounted for demographics, socioeconomic status, health care access, organ availability, and transplant center competition using multivariable linear regression. We examined intra-TRR differences in waitlist composition using Levene's test of variance. Across the 66 included TRRs, Black patients had lower listing-to-end-stage liver disease death ratios than White patients in 80% of TRRs, while Hispanic patients had equal or higher listing-to-end-stage liver disease death ratios compared to White patients in 56% of TRRs. The majority of variation in racial disparities across TRRs remained unexplained by multivariable models. Disparities were attenuated after excluding patients with HCC-associated mortality. Among the 27 TRRs that contained more than one transplant center, variance across TRRs was statistically significant for Black and Hispanic waitlist composition. We observed substantial geographic variation in the magnitude of racial disparities in liver transplant access across the United States. Findings highlight the need for targeted health equity interventions in regions with high disparities and the development of disparity-sensitive access metrics for transplant centers.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"857-869"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971418","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":"Proceedings of the 29th Annual Congress of the International Liver Transplantation Society.","authors":"Madhukar S Patel, Sadhana Shankar, Marta Tejedor, Andrew S Barbas, Joohyun Kim, Shennen Mao, Tommy Ivanics, Johns Shaji Mathew, Alexandra Shingina, Mohammad Qasim Khan, Elizabeth A Wilson, Nicholas Syn, Felipe Alconchel, Dhupal Patel, Jiang Liu, David Nasralla, Alessandra Mazzola, Tomohiro Tanaka, David W Victor, Young-In Yoon, Carmen Vinaixa, A Mi Mi Kyaw, Antonio Galante, Paolo Magistri, Manikandan Kathirvel, Daniel Aliseda, Kenan Moral, Tommaso Di Maira, Eleonora De Martin, Ryan Chadha, Abdul Rahman Hakeem, Eliano Bonaccorsi-Riani, Ashwin Rammohan","doi":"10.1097/LVT.0000000000000593","DOIUrl":"10.1097/LVT.0000000000000593","url":null,"abstract":"<p><p>The 2024 Annual Congress of the International Liver Transplantation Society (ILTS) was from May 1-4 in Houston, Texas, USA, under the theme \"Liver Disease and Transplantation: Breaking Barriers and Exploring New Frontiers.\" In addition to a robust scientific program, the congress also hosted a hands-on cadaveric robotic liver surgery course, a machine perfusion workshop, and a transesophageal echocardiography course. In this report, the ILTS Vanguard and Basic Sciences Committees present a summary of the congress proceedings.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"945-955"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586164","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":"Preoperative assessment of body composition and sarcopenia in candidates for multivisceral transplant.","authors":"Ruy J Cruz, Hao Liu, Ajai Khanna, Colin Powers, Vikraman Gunabushanam, Andrea DiMartini","doi":"10.1097/LVT.0000000000000565","DOIUrl":"10.1097/LVT.0000000000000565","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"968-971"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950882","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":"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, and future directions.","authors":"Daljeet Chahal, Laura Hornby, Jordan D Bird, Samuel S Lee, Thomas D Schiano, Mypinder S Sekhon","doi":"10.1097/LVT.0000000000000647","DOIUrl":"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 from 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. We then discuss physiologic mechanisms of hepatic blood flow and oxygenation, and how these are relevant to donor warm ischemic time 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}