Liver Transplantation最新文献

{"title":"Policy corner: The evolution of continuous distribution in liver transplantation.","authors":"Yeshika Sharma, Conner Fishbach, Shivang Mehta","doi":"10.1097/LVT.0000000000000643","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000643","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-28","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":"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":"https://doi.org/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 2016-2020. Univariate and multivariate Cox regression was performed to determine factors associated with evaluation and listing for LT. 472 safety-net patients were referred. 76% completed an evaluation out of which 58% were listed. In adjusted models, MASLD vs 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 vs. 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 probability of listing. Social determinants of health were key to successful evaluation and listing for LT among referred SNH patients and provide targets for intervention.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-22","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}

{"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":"https://doi.org/10.1097/LVT.0000000000000639","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-21","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":"\"You're hot then you're cold\": Can we omit recooling after NMP?","authors":"Shennen Mao, Kristopher P Croome","doi":"10.1097/LVT.0000000000000641","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000641","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-19","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":"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":"https://doi.org/10.1097/LVT.0000000000000640","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical significance of occult hepatocellular carcinoma (HCC) identified on explant pathology in liver transplantation (LT).</p><p><strong>Background: </strong>Among LT recipients, discordance between pre-LT radiographic assessment of HCC and explant tumor burden is common. Data regarding the association of incidental HCC (iHCC, no pre-LT radiographic diagnosis) and occult multifocal HCC (omHCC, pre-LT radiology underestimates number of explant tumors) with outcomes are scarce.</p><p><strong>Design/methods: </strong>Post-LT recurrence and survival were compared among LT recipients (n=919, 2002-2019) with iHCC (n=129), omHCC (n=349) and non-omHCC (n=437). Multivariable analysis identified independent predictors of omHCC in the subset of patients with known HCC (kHCC).</p><p><strong>Results: </strong>Compared to kHCC, iHCC had similar 5-yr 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 loco-regional treatments (p<0.001) but similar maximum and pre-LT alphafetoprotein compared to non-omHCC. Compared to kHCC without omHCC, omHCC patients 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-year 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 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).</p><p><strong>Conclusion: </strong>In patients with known HCC prior to LT, presence of omHCC is common and associated with inferior post-LT survival and higher recurrence rates. The development of improved radiographic and serum biomarkers which more accurately reflect explant tumor burden may improve patient selection and post-LT outcomes.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-16","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":"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":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-13","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":"From embedded interprofessional clinics to expanded alcohol-associated liver disease programs.","authors":"Gerald Scott Winder, Juan Pablo Arab, Arpita Goswami Banerjee, Kelly Bryce, David C Fipps, Filza Hussain, Gene Im, Lesley Omary, Arpan A Patel, Shivali Patel, Susan Rubman, Marina Serper, Akhil Shenoy, Joji Suzuki, Paula Zimbrean, Kimberly Brown, Marwan Abouljoud, Jessica L Mellinger","doi":"10.1097/LVT.0000000000000638","DOIUrl":"10.1097/LVT.0000000000000638","url":null,"abstract":"<p><p>Hazardous alcohol use remains a major contributor to acute and chronic liver disease, while alcohol-associated liver disease (ALD) is a leading indication for liver transplantation. In recent years, embedded, interprofessional ALD clinics have improved access to alcohol use disorder care within hepatology and liver transplantation, but more work is needed to meet this challenge. The literature is lacking regarding scaling procedures to provide services for increasingly large ill patient populations. This article begins to fill this gap by describing \"expanded ALD care\": broad, innovative, longitudinal, interprofessional care delivery strategies surpassing standalone clinics. Drawing from analogous patient populations served by collaborative models in primary care and comprehensive eating disorder treatment, the expanded ALD care framework proposes practical strategies toward specific innovations: equipoise between biomedical and psychosocial care elements, increased clinician number and reach, long-term patient relationships, harm reduction and palliative care, outreach to external agencies and clinicians, and enhanced support for patients and families. The article also defines attributes of innovative healthcare systems that support expanded ALD care.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032332","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":"Outcomes of kidney after liver transplantation by induction type, Inter-Transplant interval, and immunologic risk: A UNOS analysis.","authors":"Gabriel Cojuc-Konigsberg, Stalin Cañizares, Belen Rivera, Kalathil K Sureshkumar, Devin Eckhoff, Martha Pavlakis, Bhavna Chopra","doi":"10.1097/LVT.0000000000000633","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000633","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033731","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":"Implementation of intra-operative distal splenic artery ligation for portal inflow modulation in adult living donor Liver Transplantation.","authors":"Rekha Subramaniyam, Imtiakum Jamir, Niteen Kumar, Nitesh Agrawal, Gaurav Sood, Aditya Shriya, Anish Gupta, Abhideep Chaudhary","doi":"10.1097/LVT.0000000000000635","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000635","url":null,"abstract":"<p><p>In living donor liver transplant (LDLT), graft hyperperfusion can lead to early allograft dysfunction (EAD), graft loss and even mortality. Portal inflow modulation is advocated to prevent hyperperfusion injury. We implemented intra-operative distal splenic artery ligation (SAL) since Jan 2021 in recipients with one or more of the indications: graft to recipient weight ratio <0.8, graft to spleen volume ratio ≤1, high post re-perfusion portal vein flow (≥250 mL/min/100 gm of graft-weight), low hepatic artery peak systolic velocity (≤20 cm/s) and/or high post re-perfusion portal vein pressure (≥15 mmHg). This group was compared with a retrospective non-SAL group, during Jul 2019 to Dec 2020, who met any one or more of the above criteria, but had not undergone SAL. Out of 426 patients who underwent LDLT during the study period, 90 and 42 right lobe adult recipients were included in SAL and non-SAL groups respectively. The SAL group had significant reduction in post re-perfusion portal flow and pressure and also improved hepatic arterial peak systolic velocity compared to the non-SAL group (p<0.01). Significant reduction in serum total bilirubin and ascitic fluid was observed on post-operative days 1, 3, 5, 7 and 14 in the SAL group (p<0.01). There was significant reduction in the incidence of EAD in the SAL group compared to the non-SAL group (8.8% vs. 26.2%, p<0.01). There was decreased incidence of small for size syndrome (SFSS) (p<0.05) with no incidence of grade-C SFSS and lower 90 day-mortality in the SAL group (p<0.01). Intra-operative distal SAL significantly reduces portal hyper-perfusion, thereby reducing early allograft dysfunction, small for size syndrome, morbidity and improved one year survival.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000744","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 and pathological spectrum of disease severity among patients with acute liver failure (ALF) undergoing deceased donor liver transplantation.","authors":"Shannan R Tujios, Jody A Rule, Norman Sussman, Jorge L Rakela, Daniel Ganger, Nathan Bass, Adrian Reuben, R Todd Stravitz, David Kleiner, Hanlin Wang, Eun-Young K Choi, Lan Peng, Matthew Yeh, Bryce Hatfield, Guang-Yu Yang, Ryan Gill, Robert J Fontana, William M Lee","doi":"10.1097/LVT.0000000000000634","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000634","url":null,"abstract":"<p><strong>Background: </strong>Listing and transplanting patients with acute liver failure (ALF) is challenging, requiring rapid assessment of the likelihood of recovery. The availability of a large number of ALF liver explants, along with their clinical data, afforded an opportunity to retrospectively evaluate liver transplantation (LT) decision-making. We hypothesized that, with the benefit of hindsight, a small number of patients might have recovered without LT.</p><p><strong>Methods: </strong>Three hundred liver explants from ALF patients of varying etiologies who had undergone liver transplantation over 22 years in the Acute Liver Failure Study Group registry were reviewed for histopathological features and degree of necrosis by a committee of eight hepato-pathologists. A second committee of eight experienced transplant hepatologists independently reviewed clinical data on these same 300 patients and retrospectively scored the likelihood that each patient required transplantation.</p><p><strong>Results: </strong>Only three (1%) of those reviewed by the Clinical Committee were considered to 'Definitely' not require liver grafting while an additional 10 (3.3%) were deemed to possibly not require transplantation (Not Likely Group, N=13). There was no difference in the degree of necrosis in explants in these groups, when compared to the remaining Likely Group, N=287 (95.6%), except in acetaminophen (APAP)-associated ALF where the degree of necrosis was more uniformly graded as severe, correlating with need for transplantation.</p><p><strong>Conclusion: </strong>Virtually every patient undergoing liver transplantation for ALF retrospectively appeared to need their transplant, based on expert clinical consensus review. Overall, there was poor correlation between clinical severity and apparent degree of necrosis seen in the 300 liver explants, except perhaps for APAP subjects.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003138","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}