Liver Transplantation最新文献

{"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":"Renal replacement therapy in liver transplant-ineligible patients.","authors":"Nagasri Shankar, Amy W Johnson, Muhammad Y Jan, Kavish R Patidar","doi":"10.1097/LVT.0000000000000654","DOIUrl":"10.1097/LVT.0000000000000654","url":null,"abstract":"<p><p>The decision to initiate renal replacement therapy in patients who are ineligible for liver transplantation can be challenging. Careful patient selection is required to identify those who may benefit from early renal replacement therapy as a pathway toward liver recovery or as a palliative plan of care. Emerging literature suggests that the etiology of kidney injury should play less of a role in clinical decision-making. Decisions around renal replacement therapy are often influenced by medical, ethical, and end-of-life factors and should be made in conjunction with patients and their caregivers.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234483","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":"Access to early liver transplantation is adversely impacted by social determinants of health: A retrospective cohort study.","authors":"James T Flanary, Po-Hung Chen, Sarah Shan, Jonathan Mitchell, Ahmet Gurakar, Alexandra T Strauss, Marie Diener-West, Michael R Desjardins, Sharon R Weeks, Kayleigh Herrick-Reynolds, Mayan Teles, Sumeyye Yilmaz, Daniel Warren, Elizabeth King, Andrew Cameron","doi":"10.1097/LVT.0000000000000653","DOIUrl":"10.1097/LVT.0000000000000653","url":null,"abstract":"<p><p>Early liver transplant (ELT) is the practice of liver transplant for those with severe alcohol-associated hepatitis or acute on chronic alcohol-associated liver disease, without requiring any minimum pre-transplant abstinence period. It is an increasingly adopted practice for alcohol-associated liver disease (ALD) capable of providing excellent outcomes, but there are concerns regarding equity in access to ELT. Our objectives were (1) to quantify the association between social determinants of health (SDoH) and progression from referral to listing, and (2) to identify geographic disparities in referrals for ELT. We included 501 ELT candidates and a comparison population of 165 standard liver transplantation (SLT) candidates referred from 2017 to 2023. Multivariable regression quantified the association between individual-level and neighborhood-level SDoH and progression from referral to listing, adjusting for sociodemographic characteristics and MELD. Negative binomial regression quantified the association between neighborhood-level SDoH and the number of ELT referrals within 150 Nmi of our institution, adjusting for relevant geographic confounders. ELT candidates with Medicaid insurance were less likely to progress from referral to evaluation than candidates with private insurance (RR 0.69, 95% CI 0.56-0.85). ELT candidates from census tracts with a high Social Vulnerability Index (SVI) were less likely to progress from evaluation to listing than candidates from low SVI census tracts in Modified Poisson Regression (RR 0.64, 95% CI 0.46-0.88), but not in Cox regression (HR 0.67, 95% CI 0.41-1.09). These findings were not significant among SLT candidates. High SVI census tracts were less likely to have individuals referred for ALD compared to tracts with low SVI (incidence rate ratio [IRR] 0.53, 95% CI 0.42-0.66). Both individual-level and neighborhood-level SDoH are important factors that ultimately influence who is eligible for transplant.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234481","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":"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 preoperative 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":"10.1097/LVT.0000000000000642","url":null,"abstract":"<p><p>Cardiovascular (CV) disease is a leading cause of postoperative mortality following liver transplantation (LT). The presence of abdominal aortic calcification (AAC) has been linked to CV events in the general population. We sought to investigate whether AAC on routine pre-transplant CT can improve the prediction of coronary artery disease, post-LT major adverse cardiovascular events (MACEs) or long-term mortality. Of 461 patients undergoing LT between 2010 and 2018, 318 were included in the analysis, among whom 81 had also undergone computed tomography coronary angiography. The extent of AAC was quantified with high AAC defined as a calcium score ≥500. High AAC was identified in 84/318 (26.4%) and demonstrated moderate correlation with coronary artery calcium score (CACS) ( 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 CT coronary angiography (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 CV 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 significantly improved model fit for predicting MACE outcomes ( p <0.01), while the absence of heavy AAC ruled out moderate-to-severe disease on CT coronary angiography with a negative predictive value of 97.0%. High AAC on routine CT scans was associated with a 3-fold increased risk of 30-day MACE post-LT and improved CV risk prediction compared to traditional indices. Quantification of AAC may offer a simple method of improving CV 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}

{"title":"Management of obesity in liver transplant candidates and recipients: Rethinking the false dichotomy between pharmacotherapy and surgical intervention.","authors":"Jessica P E Davis, Anesia Reticker, Hyosun Han, Babak J Orandi, Zachary Henry, Shirley M Tsunoda, Julie K Heimbach, Allison R Schulman, Monica A Tincopa","doi":"10.1097/LVT.0000000000000645","DOIUrl":"10.1097/LVT.0000000000000645","url":null,"abstract":"<p><p>The prevalence of comorbid metabolic dysfunction-associated steatotic liver disease (MASLD) and obesity has increased exponentially over the last several years, with current estimates demonstrating that up to 40% of adults in the United States have MASLD. Metabolic dysfunction-associated steatohepatitis is now a leading indication for liver transplantation, and rates of obesity and MASLD pre-transplant and post-transplant are on the rise. Our understanding of the physiology of obesity and metabolic disease and the availability of effective obesity treatments have evolved over the same time frame. With the availability of new anti-obesity medications, there has been a debate over the role of pharmacotherapy versus interventional approaches in the treatment of obesity and MASLD in the liver transplantation population. In October 2024, the American Society of Transplantation (AST) Liver and Intestinal Community of Practice held a virtual Controversies Conference on obesity and liver transplantation. Experts in the field presented the available data, and smaller working groups had interactive breakout sessions that identified knowledge gaps and developed recommendations. This perspective prepared on behalf of the participants of the AST Controversies Conference on obesity and liver transplant aims to summarize the available evidence for surgical and pharmaceutical treatment in the liver transplantation population.</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":"144208879","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":"Balancing abstinence and harm reduction across the continuum of care for liver transplantation in alcohol-associated liver disease.","authors":"Sue Hyon Kim, Sasha Deutsch-Link, Marina Serper","doi":"10.1097/LVT.0000000000000644","DOIUrl":"10.1097/LVT.0000000000000644","url":null,"abstract":"<p><p>Alcohol use following liver transplantation (LT) is associated with worse outcomes. Strategies for predicting, preventing, and managing alcohol consumption among candidates and recipients of LT with alcohol-associated liver disease (ALD) have historically emphasized complete abstinence. We propose a harm reduction approach as a possible complementary and realistic strategy for managing alcohol use in the context of LT for ALD. In this article, we outline the ethical and clinical foundations for applying harm reduction across the continuum of care for LT in ALD. Although complete alcohol abstinence prevents liver damage, harm reduction promotes shared decision-making that balances liver function with realistic patient circumstances and patient autonomy. Approaches grounded in harm reduction may allow us to improve outcomes across different alcohol consumption patterns and more effectively address health disparities in certain patient groups facing additional challenges in maintaining complete abstinence. Harm reduction strategies may also help prevent psychological distress in candidates and recipients of transplant with ALD and encourage early disclosure of alcohol use that enables timely interventions. Listing procedures and waitlist management for patients with ALD that incorporate principles of harm reduction may also broaden access to life-saving care while maintaining organ utility. Based on clinical evidence, we highlight the need to examine current LT selection processes, coordinate alcohol use disorder treatment for patients with ALD, and develop comprehensive markers of posttransplant success. Finally, we discuss potential challenges and considerations when applying the harm reduction approach to nuanced scenarios of candidates and recipients of LT with ALD.</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":"144199472","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":"Safety and efficacy of simultaneous liver transplantation and sleeve gastrectomy in morbid obese patients with end-stage liver disease: The LT-SG study.","authors":"Tommaso Maria Manzia, Bruno Sensi, Paolo Gentileschi, Claudia Quaranta, Luca Toti, Leonardo Baiocchi, Mario Dauri, Roberta Angelico, Giuseppe Tisone","doi":"10.1097/LVT.0000000000000522","DOIUrl":"10.1097/LVT.0000000000000522","url":null,"abstract":"<p><p>In obese patients, metabolic dysfunction-associated steatotic liver disease is becoming a leading etiology of end-stage liver disease and HCC. Simultaneous liver transplantation and sleeve gastrectomy (LT-SG) have been proposed in the United States, but the safety and efficacy of the procedure have not been widely explored in Europe. Between January 2016 and December 2022, morbidly obese patients listed for liver transplantation at Tor Vergata University were enrolled in the LT-SG study. Primary outcomes were (1) safety expressed as 30- and 90-day overall survival and (2) major postoperative complications (Clavien-Dindo >IIIa). The secondary outcome was efficacy expressed as a 3-year %excess body mass index (BMI) loss. Eleven patients were enrolled in the study. The median BMI at transplantation was 42 (IQR 38-48). Indications of LT-SG were HCC (63.6%) and cirrhosis (36.4%). In 54% of cases, donors had high-risk characteristics (eurotransplant donor risk index >1.6). The 30- and 90-day overall survival were 63.6% and 54.5%, respectively. All deaths occurred in patients with P-SOFT >15 or in patients who had at least 3 of the following characteristics: >60 years, BMI >45, metabolic syndrome, MELD >25 or eurotransplant donor risk index >1.6. The 6 months, 1, 2, and 3 years %excess BMI loss was 73%, 60%, 50%, and 43%, respectively. LT-SG is a complex procedure that may carry excess risk in an unselected population. It should be considered only in highly selected patients. Standard donors are recommended, and prioritization of severely obese patients on the waiting list should be considered.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"770-780"},"PeriodicalIF":4.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142503072","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 2024 ILTS-ILCA consensus recommendations for liver transplantation for HCC and intrahepatic cholangiocarcinoma.","authors":"Sudha Kodali, Laura Kulik, Antonio D'Allessio, Eleonora De Martin, Abdul Rahman Hakeem, Monica Lewinska, Stacie Lindsey, Ken Liu, Zorana Maravic, Madhukar S Patel, David Pinato, Ashwin Rammohan, Nicole Rich, Marco Sanduzzi Zamparelli, David W Victor, Carmen Vinaxia, Elizabeth W Brombosz, Augusto Villanueva, Tim Meyer, Nazia Selzner, Rafik Mark Ghobrial, Mohamed Rela, Gonzalo Sapisochin","doi":"10.1097/LVT.0000000000000589","DOIUrl":"10.1097/LVT.0000000000000589","url":null,"abstract":"<p><p>Liver transplantation (LT) provides the best long-term survival outcomes for patients with liver cancer. As a result, the field of transplant oncology has grown greatly over the past few decades, and many centers have expanded their criteria to allow increased access to LT for liver malignancies. Center-level guidelines and practices in transplant oncology significantly vary across the world, leading to debate regarding the best course of treatment for this patient population. An international consensus conference was convened by the International Liver Transplantation Society and the International Liver Cancer Association on February 1-2, 2024, in Valencia, Spain to establish a more universal consensus regarding LT for oncologic indications. The conference followed the Delphi process, followed by an external expert review. Consensus statements were accepted regarding patient assessment and waitlisting criteria, pretransplant treatment (including immunotherapy) and downstaging, living donor LT, post-LT patient management, and patient- and caregiver-related outcomes. The multidisciplinary participants in the consensus conference provided up-to-date recommendations regarding the selection and management of patients with liver cancer being considered for LT. Although participants deferred to center protocols in many cases, there was great interest in safely expanding access to LT for patients with larger tumor burden and biologically amenable lesions.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"815-831"},"PeriodicalIF":4.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515935","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}