Liver Transplantation最新文献

{"title":"Treatment algorithm for the management of concomitant splenic artery aneurysms in adult liver transplant recipients.","authors":"Ho-Jung Park, Young-In Yoon, Gi-Young Ko, Jung Bok Lee, Deok-Bog Moon, Yong-Pil Cho, Sung-Gyu Lee","doi":"10.1097/LVT.0000000000000604","DOIUrl":"10.1097/LVT.0000000000000604","url":null,"abstract":"<p><p>The rupture of splenic artery aneurysms (SAAs) is a life-threatening complication with a high mortality rate, occurring mainly in patients with cirrhosis and portal hypertension. This study aimed to describe the clinical characteristics of concomitant SAAs in adult liver transplantation (LT) recipients and to report long-term outcomes of SAAs managed by our treatment algorithm. Between January 2016 and December 2020, this single-center, retrospective, observational study included 2316 adult LT recipients. A total of 88 LT recipients (3.8%) with concomitant 130 SAAs were managed based on our treatment algorithm, which applied a more aggressive therapeutic option-surgical or endovascular treatment-mainly based on the location, number, and accessibility of SAAs. Clinical characteristics of SAAs and their long-term outcomes were analyzed. The most common SAA location was the splenic hilum (59.2%), and 65.9% of patients had single SAAs. Surgical ligation of the splenic artery and endovascular embolization of SAAs were performed in 51 (58.0%) and 37 (42.0%) patients, respectively. A high incidence of splenic infarction after SAA treatment (75.0%) was observed, which did not require additional invasive treatment. The incidence of splenic infarctions was significantly lower in patients receiving surgical ligation than in those receiving endovascular embolization ( p <0.01). During the mean follow-up of 53 months, no case of SAA sac expansion and SAA-related or treatment-related mortality was observed. Despite a high incidence of post-treatment splenic infarction, our treatment algorithm was safe and effective as an adjunctive treatment to prevent SAA-related mortality in adult LT recipients.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1135-1142"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657650","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":"Letter to the Editor: Limitations of MRI-serum-based scoring in liver transplant rejection assessment.","authors":"Ibrahim Nagmeldin Hassan, Mohamed Ibrahim","doi":"10.1097/LVT.0000000000000637","DOIUrl":"10.1097/LVT.0000000000000637","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"E25"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971260","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":"Occult multifocal and incidental hepatocellular carcinoma: An analysis of long-term survival and risk factors at a single liver transplant center.","authors":"Dominic Amara, Wethit Dumronggittigule, Andrew Melehy, Daniela Markovic, Lynn Nguyen, Shannon Nesbit, David S Lu, Samer Ebaid, Fady M Kaldas, Douglas G Farmer, Ronald W Busuttil, Vatche G Agopian","doi":"10.1097/LVT.0000000000000640","DOIUrl":"10.1097/LVT.0000000000000640","url":null,"abstract":"<p><p>The clinical significance of occult HCC identified on explant pathology in liver transplantation (LT) remains unclear. Among recipients of LT, discordance between pre-LT radiographic assessment of HCC and explant tumor burden is common. Data regarding the association of incidental HCC (no pre-LT radiographic diagnosis) and occult multifocal hepatocellular carcinoma (omHCC, pre-LT radiology underestimates a number of explant tumors) with outcomes are scarce. Post-LT recurrence and survival were compared among recipients of LT (n=919, 2002-2019) with incidental HCC (n=129), omHCC (n=349), and non-omHCC (n=437). Multivariable analysis identified independent predictors of omHCC in the subset of patients with kHCC. Compared to kHCC, incidental HCC had similar 5-year overall (OS) and recurrence-free survival (RFS), lower post-LT recurrence (6.9% vs. 16.2%, p =0.0019), but higher non-HCC-related mortality (38.4% vs. 23.7%, p =0.0042). Of 790 kHCC, 349 (44.1%) had omHCC, who demonstrated greater radiographic number of lesions ( p =0.049) and locoregional treatments ( p <0.001) but similar maximum and pre-LT alphafetoprotein compared to non-omHCC. Compared to kHCC without omHCC, patients with omHCC had inferior 5-year OS (60.4% vs. 70.9%, p =0.010) and RFS (56.8% vs. 69.7%, p <0.001), higher recurrence (23.8% vs. 9.2%, p <0.001), and similar non-HCC-related mortality. These observations remained true within patients who remained within Milan throughout preoperative imaging (5-y OS: 62.1% vs. 72.6%, p =0.027; RFS: 58.6% vs. 71.7%, p =0.010; recurrence: 21.7% vs. 7.6%, p <0.001). Multivariable predictors of omHCC tumor included a number of pre-LT locoregional therapies (OR 1.62 for 2 treatments, 95% CI 1.15-2.28, p =0.005; OR 1.98 for 3+ treatments, 1.36-2.88, p <0.001). In patients with kHCC prior to LT, the presence of omHCC is common and associated with inferior post-LT survival and higher recurrence rates. The development of improved radiographic and serum biomarkers that more accurately reflect explant tumor burden may improve patient selection and post-LT outcomes.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1111-1122"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078996","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 survey of national practice patterns of HCC surveillance for patients with Fontan-associated liver disease: A call to action.","authors":"Matthew R Kappus, Dempsey Hughes, Daniel R Ganger, Yuli Kim, Mustafa Bashir, Julie Bonn, Amir Borhani, David Fetzer, Ryan Fischer, Helena Gabriel, Maha Guindi, Elizabeth Hecht, Maarouf Hoteit, Geetika Khanna, Richard Krasuski, Sara Lewis, Alisha Mavis, Frank Miller, Cara Morin, Thomas Schiano, Gary Schooler, Alexandra Shingina, Claude Sirlin, Amit Singal, Bachir Taouli, Rose Tompkins, Ali Zaidi, Lisa VanWagner, Takeshi Yokoo","doi":"10.1097/LVT.0000000000000622","DOIUrl":"10.1097/LVT.0000000000000622","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1185-1189"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795816","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":"Can we safely scale RAPID in transplant oncology?","authors":"Matthew M Byrne, Cristina Jimenez-Soto, Abigail Loszko, Roberto Hernandez-Alejandro","doi":"10.1097/LVT.0000000000000621","DOIUrl":"10.1097/LVT.0000000000000621","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1085-1086"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764327","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":"Center-level variations are associated with disparate waitlist mortality and probability of liver transplant in MELD 35 and greater patients.","authors":"Andrew Melehy, Dominic Amara, Shreya Gumate, Samer Ebaid, Fady M Kaldas, Douglas G Farmer, Alex A T Bui, Vatche G Agopian","doi":"10.1097/LVT.0000000000000616","DOIUrl":"10.1097/LVT.0000000000000616","url":null,"abstract":"<p><p>Liver transplant (LT) centers may have variations in their approach to high-acuity (MELD ≥35) candidates for listing and transplantation. We investigated center-specific differences in waitlist outcomes, probability of LT, and post-LT survival in MELD ≥35 patients. Adult candidates of LT (MELD ≥35) were identified from the Scientific Registry of Transplant Recipients between January 1, 2010, and April 1, 2022. Waitlist mortality was modeled with the center as a random effect. Centers were grouped based on the random effect coefficient, with the highest tertile representing the highest risk group (comprises centers with the highest risk of waitlist mortality attributable to the center). Cumulative incidence of death/delisting, probability of LT, and 1-year post-LT survival were compared, with patients stratified by a listing MELD ≥35 or increase to MELD ≥35 after listing. In patients who increased to MELD ≥35, the 1-year cumulative incidence of death/delisting was highest (50%) and the probability of transplant lowest (46%) in the high-risk group, compared to the low-risk group (37% and 55%, p <0.001 for both comparisons). For patients receiving an LT, post-transplant survival did not differ among the groups, though high-risk centers transplanted far less high-acuity patients. These variations may indicate that certain centers are associated with substantially decreased waitlist mortality for the highest acuity patients without corresponding decreases in post-transplant survival.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1100-1110"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764329","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 rising cost of liver transplantation in the United States.","authors":"Alyson Kaplan, Adam Winters, Sharon Klarman, Michael Kriss, Dempsey Hughes, Pratima Sharma, Sumeet Asrani, Alan Hutchison, Paul Myoung, Asad Zaman, Laura Butler, James Pomposelli, Fredric Gordon, Andres Duarte-Rojo, Deepika Devuni, Brett Fortune","doi":"10.1097/LVT.0000000000000493","DOIUrl":"10.1097/LVT.0000000000000493","url":null,"abstract":"<p><p>Liver transplantation (LT) is the only curative treatment for end-stage liver disease and significantly improves patient outcomes. However, LT is resource-intensive and costly, with expenditures rising dramatically in recent years. Factors contributing to this increase in cost include expanded transplant criteria, utilization of marginal organs, and broader organ distribution, resulting in significant logistical expenses. Advanced technologies like organ perfusion devices, while promising better outcomes, further inflate costs due to their high price and market monopolization. Moreover, living donor liver transplant and utilization of donation after cardiac death organs introduce higher initial expenditures yet potential long-term savings. Despite rising costs, reimbursement has remained largely stagnant, putting financial strain on transplant programs, and threatening their sustainability. This review examines the multifaceted drivers of rising costs in LT, focusing on recent policy changes, the role of organ procurement organizations, and the impact of new technologies. We also propose comprehensive solutions at national, organ procurement organization, and local levels, including optimizing resource allocation, leveraging regional collaborations, and advocating for revised reimbursement models to curb escalating costs. Addressing these challenges is critical to ensuring the continued viability of LT programs and maintaining patient access to this life-saving intervention.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1165-1175"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308067","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":"Policy Corner: The evolution of continuous distribution in liver transplantation.","authors":"Yeshika Sharma, Conner Fishbach, Shivang Mehta","doi":"10.1097/LVT.0000000000000643","DOIUrl":"10.1097/LVT.0000000000000643","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1183-1184"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150986","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":"1123-1134"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12363319/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social determinants of health are associated with liver transplant evaluation and listing in a safety-net referral cohort.","authors":"Saroja Bangaru, Mark C Wang, Matt Sumethasorn, Sarah Wang, Christopher Wong, Sabrina Omer, Nicole Kim, Sachin Shah, Mignote Yilma, Michele Tana, Neil Mehta, Jihane N Benhammou, Kali Zhou","doi":"10.1097/LVT.0000000000000632","DOIUrl":"10.1097/LVT.0000000000000632","url":null,"abstract":"<p><p>Among safety-net hospital (SNH) patients, little is known about the care cascade to liver transplantation (LT) and the clinical and psychosocial factors that impact evaluation and listing. We obtained clinical and psychosocial data on all patients referred for LT at our SNH from 2016 to 2020. Univariate and multivariate Cox regression were performed to determine factors associated with evaluation and listing for LT. A total of 472 safety-net patients were referred. Seventy-six percent completed an evaluation, out of which 58% were listed. In adjusted models, metabolic-associated steatotic liver disease versus alcohol-associated liver disease as etiology increased odds of evaluation (OR: 6.89, 95% CI: 2.17-21.89) while lack of stable housing (0.30, 0.13-0.71) and <6 months of abstinence (0.22, 0.10-0.46) reduced odds of evaluation. Living in a house rather than rental (2.05, 1.19-3.52); having ample versus limited or no social support (7.86, 3.93-15.73); and having a MELD >25 (vs. ≤25) (3.71, 1.44-9.51) were associated with increased odds of listing while history of polysubstance abuse reduced odds of listing (0.40, 0.19-0.83). A sensitivity analysis including an existing multicenter cohort re-demonstrated the significance of residence, adequacy of social support, and MELD score in the probability of listing. Social determinants of health were key to successful evaluation and listing for LT among referred SNH patients and provided targets for intervention.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1089-1099"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111161","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}