Liver Transplantation最新文献_第3页

Pediatric living donor liver transplantation for small infants with biliary atresia using interposition portal vein grafts: A multicenter cohort study. 小儿活体供肝移植治疗胆道闭锁小婴儿门静脉间置移植，多中心队列研究。

IF 4.7 2区医学

Liver Transplantation Pub Date : 2025-07-01 Epub Date: 2025-03-13 DOI: 10.1097/LVT.0000000000000596

Daniel Zamora-Valdés, Ryuji Komine, Wei Gao, Masaki Honda, Yusuke Yanagi, Pilar Leal-Leyte, Nam Joon Yi, Toru Ikegami, Mureo Kasahara

{"title":"Pediatric living donor liver transplantation for small infants with biliary atresia using interposition portal vein grafts: A multicenter cohort study.","authors":"Daniel Zamora-Valdés, Ryuji Komine, Wei Gao, Masaki Honda, Yusuke Yanagi, Pilar Leal-Leyte, Nam Joon Yi, Toru Ikegami, Mureo Kasahara","doi":"10.1097/LVT.0000000000000596","DOIUrl":"10.1097/LVT.0000000000000596","url":null,"abstract":"Despite multiple techniques, portal vein (PV) inflow reconstruction during living donor liver transplantation (LDLT) for patients with biliary atresia (BA) and small-diameter PV remains a challenge. The use of PV interposition grafts has emerged as a promising therapeutic strategy to mitigate complications and reinterventions. We conducted a retrospective multicenter cohort study of patients under 3 years of age (n=85) undergoing LDLT for BA using PV interposition grafts. Our primary outcome was PV complications after LDLT, and secondary outcomes included long-term PV patency and death-censored graft survival. LDLT was performed on 85 patients. The PV diameter was 4.0±0.6 mm. Cold-stored venous allografts were used in 26 cases, donor-derived grafts in 53, and autologous in 6. The portal inflow was the PV in 38 cases, splenomesenteric confluence in 33, superior mesenteric vein in 3, and coronary vein in 1. The intraoperative PV thrombosis rate was 22.4%, and the overall PV complication rate after LDLT was 23.5% (16 PV stenoses and 4 thromboses). Multivariate analysis revealed that the use of cold-stored venous allografts predicted PV complications (53.8% vs. 10.2%; relative risk, 15.9; 95% CI: 2.9-86.2; p =0.001). Eleven patients underwent PV stent placement after LDLT with primary patency rates of 81.8% and secondary patency rates of 90.9%. The long-term patency, death-censored graft survival, and patient survival rates were 96.5%, 96.5%, and 97.6%, respectively. Portal inflow reconstruction using interposition grafts during LDLT for BA achieves favorable long-term patency and patient and graft survival outcomes. This approach has the potential to mitigate morbidity and mortality in pediatric patients with BA undergoing LDLT. Longer cold-stored venous allografts are associated with a higher risk of PV complications after LDLT.","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"890-896"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605665","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}

引用次数: 0

Trends in surgical volume and mortality by surgery type among patients with cirrhosis: A Veterans Affairs study. 按手术类型划分的肝硬化患者手术量和死亡率趋势：一项退伍军人事务研究。

IF 4.7 2区医学

Liver Transplantation Pub Date : 2025-07-01 Epub Date: 2025-01-28 DOI: 10.1097/LVT.0000000000000576

Helen Tang, David E Kaplan, Nadim Mahmud

引用次数: 0

Acceptable outcomes of liver transplantation in uninsured patients under the coverage of a state assistance program. 在州援助计划覆盖范围内，无保险患者接受肝脏移植手术的可接受结果。

IF 4.7 2区医学

Liver Transplantation Pub Date : 2025-07-01 Epub Date: 2024-09-27 DOI: 10.1097/LVT.0000000000000495

Flavio Paterno, Grace S Lee-Riddle, Raquel Olivo, Arpit N Amin, Baburao Koneru, Nikolaos T Pyrsopoulos, Keri E Lunsford, James V Guarrera

{"title":"Acceptable outcomes of liver transplantation in uninsured patients under the coverage of a state assistance program.","authors":"Flavio Paterno, Grace S Lee-Riddle, Raquel Olivo, Arpit N Amin, Baburao Koneru, Nikolaos T Pyrsopoulos, Keri E Lunsford, James V Guarrera","doi":"10.1097/LVT.0000000000000495","DOIUrl":"10.1097/LVT.0000000000000495","url":null,"abstract":"The lack of health insurance is a major barrier to access to health care, even in the case of life-saving procedures such as liver transplantation (LT). Concerns about worse outcomes in uninsured patients have also discouraged the evaluation and transplantation of patients without adequate health insurance coverage. The aim of this study is to evaluate outcomes from the largest cohort of uninsured patients who underwent LT with the support of a state payment assistance program (also called charity care). This study included all consecutive patients who underwent LT at a single center from 2002 to 2020. Demographic, clinical, and social variables and outcome metrics were collected and compared between insured and uninsured patients. Among a total of 978 LT recipients, 594 had private insurance, 324 government insurance (Medicare/Medicaid), and 60 were uninsured and covered under a state charity care program. In the charity care group, there was a higher proportion of Hispanic subjects, single marital status, younger age, and high-MELD score patients. The 1- and 3-year patient survival rates were 89.0% and 81.8% in private insurance patients, 88.8% and 80.1% in government insurance recipients, and 93.3% and 79.6% in those with charity care ( p =0.49). There was no difference in graft survival between insured and uninsured patients ( p =0.62). The 3 insurance groups presented similar hospital length-of-stay and 30-day readmission rates. In both univariate and multivariate analysis, uninsured status (charity care) was not associated with worse patient survival (HR: 1.23, 95% CI: 0.84-1.80, p =0.29) or graft survival (HR: 1.22, 95% CI: 0.84-1.78, p =0.29). In conclusion, there was no difference in outcomes after LT between insured and uninsured patients. A charity care program may be an effective tool to mitigate socioeconomic disparities in both outcomes and access to LT.","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"924-934"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349432","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}

引用次数: 0

From core to surface: Expanding the donor pool with HBsAg-positive liver allografts. 从核心到表面：用乙型肝炎表面抗原阳性的同种异体肝移植扩大供体池。

IF 4.7 2区医学

Liver Transplantation Pub Date : 2025-07-01 Epub Date: 2025-01-31 DOI: 10.1097/LVT.0000000000000580

Matthew Dukewich, Pratima Sharma

引用次数: 0

Development of a collaborative learning health system data mart in pediatric liver transplantation. 儿童肝移植协同学习卫生系统数据集市的开发。

IF 4.7 2区医学

Liver Transplantation Pub Date : 2025-07-01 Epub Date: 2024-12-10 DOI: 10.1097/LVT.0000000000000552

James E Squires, Emily R Perito, Alexander Garza, Read Urban, Kyle A Soltys, Eric Pahl, Cassandra Krise-Confair, George V Mazariegos

{"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":"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.","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}

引用次数: 0

Portal vein interposition in pediatric living donor liver transplantation: Which vein graft type is best? 门静脉介入儿童活体肝移植：哪种静脉移植类型最好？

IF 4.7 2区医学

Liver Transplantation Pub Date : 2025-07-01 Epub Date: 2025-03-20 DOI: 10.1097/LVT.0000000000000606

Dor Yoeli, Megan Adams

引用次数: 0

Achieving transplant equity: A feasible solution for uninsured patients. 实现移植公平：一个可行的解决方案，为没有保险的病人。

IF 4.7 2区医学

Liver Transplantation Pub Date : 2025-07-01 Epub Date: 2025-03-18 DOI: 10.1097/LVT.0000000000000602

Saulat S Sheikh

引用次数: 0

Clinical outcomes in patients with unintended pregnancy after liver transplantation: A multicenter registry cohort study. 肝移植术后意外怀孕患者的临床结局：一项多中心登记队列研究。

IF 4.7 2区医学

Liver Transplantation Pub Date : 2025-07-01 Epub Date: 2024-10-28 DOI: 10.1097/LVT.0000000000000524

Anjali Walia, Ophelia Yin, Lisa Coscia, Yalda Afshar, Roxanna Irani, Serban Constantinescu, Michael Moritz, Monika Sarkar

{"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":"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.","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}

引用次数: 0

Racial and ethnic disparities in liver transplant access vary within and across transplant referral regions. 肝移植可及性的种族和民族差异在移植转诊地区内部和不同地区有所不同。

IF 4.7 2区医学

Liver Transplantation Pub Date : 2025-07-01 Epub Date: 2025-01-14 DOI: 10.1097/LVT.0000000000000561

Arrey-Takor Ayuk-Arrey, Lauren Nephew, Juan Carlos Caicedo, Katherine Ross-Driscoll

{"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":"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.","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}

引用次数: 0

Proceedings of the 29th Annual Congress of the International Liver Transplantation Society. 第29届国际肝移植学会年会论文集。

IF 4.7 2区医学

Liver Transplantation Pub Date : 2025-07-01 Epub Date: 2025-03-11 DOI: 10.1097/LVT.0000000000000593

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

引用次数: 0