Liver Transplantation最新文献

{"title":"Sinusoidal obstruction syndrome after liver transplantation: A multicenter observational study: Erratum.","authors":"","doi":"10.1097/LVT.0000000000000124","DOIUrl":"10.1097/LVT.0000000000000124","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"E25"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10112375","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":"Combining radiomics and imaging biomarkers with clinical variables for the prediction of HCC recurrence after liver transplantation.","authors":"Philipp Schindler, Philippa von Beauvais, Emily Hoffmann, Haluk Morgül, Nikolaus Börner, Max Masthoff, Najib Ben Khaled, Florian Rennebaum, Christian M Lange, Jonel Trebicka, Michael Ingrisch, Michael Köhler, Jens Ricke, Andreas Pascher, Max Seidensticker, Markus Guba, Osman Öcal, Moritz Wildgruber","doi":"10.1097/LVT.0000000000000603","DOIUrl":"10.1097/LVT.0000000000000603","url":null,"abstract":"<p><p>To develop and validate an integrated model that combines CT-based radiomics and imaging biomarkers with clinical variables to predict recurrence and recurrence-free survival in patients with HCC following liver transplantation (LT), this 2-center retrospective study includes 123 patients with HCC who underwent LT between 2007 and 2021. Radiomic features (RFs) were extracted from baseline CT liver tumor volume. Feature selection was performed using the Least Absolute Shrinkage and Selection Operator (LASSO) regression method with 10-fold cross-validation in the training cohort (n=48) to build a predictive radiomics signature for HCC recurrence. Combined diagnostic models were built based on the radiomics signature supplemented with imaging features beyond the Milan criteria, the AFP (alpha-fetoprotein) model, and Metroticket 2.0 before LT using multivariate logistic regression. Receiver operating characteristic analyses were performed in both internal (n=22) and external (n=53) validation cohorts, and patients were stratified into either high-risk or low-risk groups for HCC recurrence. Kaplan-Meier analysis was performed to analyze recurrence-free survival. LASSO and multivariate regression analysis revealed 4 independent predictors associated with an increased risk of HCC recurrence: radiomics signature of 5 RF, peritumoral enhancement, satellite nodules, and no bridging therapies. For the prediction of tumor recurrence, the highest AUC of the final integrated models combining clinical variables, non-radiomics imaging features, and radiomics was 0.990 and 0.900 for the internal and external validation sets, respectively, outperforming the Milan and clinical stand-alone models. In all integrated models, the high-risk groups had a shorter recurrence-free survival than the corresponding low-risk group. CT-based radiomics and imaging parameters beyond the Milan criteria representing aggressive behavior, along with the history of bridging therapies, show potential for predicting HCC recurrence after LT.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1226-1237"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657647","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":"1286-1297"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","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":"Lower Child Opportunity Index is associated with increased health care utilization following pediatric liver transplantation.","authors":"Aaron D Bennett, Knashawn H Morales, Yuan-Shung V Huang, Vicky Tam, Amit Shah, Kathleen M Loomes, Marina Serper, Therese Bittermann","doi":"10.1097/LVT.0000000000000586","DOIUrl":"10.1097/LVT.0000000000000586","url":null,"abstract":"<p><p>Social determinants of health are known to lead to adverse health outcomes, including high acute care utilization. The mechanisms underlying health care disparities among children who have undergone liver transplantation (LT) are poorly understood. To elucidate the relationship between social determinants of health and health care utilization among children (<18 y old at the time of LT) who have undergone LT, we performed a retrospective study merging data from the Organ Procurement and Transplantation Network (OPTN) and the Pediatric Health Information System (PHIS) database. Children with lower Child Opportunity Index (COI) scores, a composite measure of social determinants of health, were admitted for 28% more days in the first year and 29% more days over the first 2 years after LT, as compared to children with higher COI. We also observed that in the second year after LT, children with a lower COI were more often admitted with a complication of LT (23%) than those with a higher COI (18%). COI may be a useful composite screening instrument for clinical teams to target resources and limit acute care use after LT.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1258-1268"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458558","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":"Robotic living donor hepatectomy: Redefining global standards in living donor liver transplant.","authors":"Adeel S Khan, Phillipe Abreu","doi":"10.1097/LVT.0000000000000620","DOIUrl":"10.1097/LVT.0000000000000620","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1200-1201"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764336","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":"To Err Is Robot-An analysis of complications following robotic donor hepatectomy.","authors":"Shweta Mallick, Krishnanunni Nair, Christi Titus Varghese, Binoj Sivasankara Pillai Thankamony Amma, Ramachandran N Menon, Dinesh Balakrishnan, Unnikrishnan Gopalakrishnan, Othiyil Vayoth Sudheer, Sudhindran Surendran","doi":"10.1097/LVT.0000000000000592","DOIUrl":"10.1097/LVT.0000000000000592","url":null,"abstract":"<p><p>Robotic donor hepatectomy (RDH) has been reported with lower morbidity than its open counterpart. Donor safety remains the primary concern, precluding its wide adoption. We aimed to evaluate donor complications following RDH and identify their predictive factors. Out of 348 live donor liver transplants performed between 2018 and 2021, the prospective data of 202 RDH were analyzed for complications by the modified Clavien-Dindo grading system. Multivariate analysis of donor and operative parameters was done to identify factors predicting complications, and CUSUM (cumulative sum) analysis was done to evaluate the effect of a learning curve. Out of 202 RDH (mean age: 37.5 [±10.4]; f [female]:m [male]-133:69; mean body mass index: 25.2±3.84), 196 (97%) were modified right lobe grafts. Conversion to open occurred in 7 (3.4%) (5-bleeding, 1-hepatic duct injury, and 1-portal vein kink). Postoperative complications occurred in 33 (16.3%), the most common being bile leak (5.9%) and bleeding (3.9%). Grades IIIa, IIIb, and IVa complications were seen in 3.4%, 3.4%, and 0.9% of patients, respectively. Reoperation was required in 3 cases for PVT, narrowing of IVC, and biliary peritonitis, respectively. At follow ups of 4 years, these patients are doing well. Although in univariate analysis, higher blood loss and body mass index appeared to be significant, multivariate analysis did not reveal any donor factor that could predict complications (biliary anatomy, portal anatomy, blood loss, body mass index, duration of surgery, or future liver remnant volume). The number of overall complications (21.7% vs. 9.9%; p =0.020; OR, 2.53) came down significantly in the second half. On RA-CUSUM (risk-adjusted CUSUM) analysis, we identified that it took around 130 cases for our unit to collectively overcome the learning curve. Although RDH appears to be safe, critical complications can occur in a minority of cases. Safety lies in flattening the learning curve.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1269-1276"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567582","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":"Thigh muscle index as a valuable prognostic marker in middle-aged male patients undergoing liver transplantation.","authors":"Woo Chul Son, Kyung-Won Kim, You-Sun Ko, Yoon Tae Jung, Dong-Hwan Jung, Won Kim","doi":"10.1097/LVT.0000000000000611","DOIUrl":"10.1097/LVT.0000000000000611","url":null,"abstract":"<p><p>In liver transplantation (LT), determining the optimal recipients is crucial, and the MELD score has been used for this purpose. However, the MELD score does not reflect functional status, leading to the evaluation of sarcopenia. While the L3 skeletal muscle index (SMI L3 ) is commonly used for assessment, the upper thigh skeletal muscle index (SMI UT ) may better represent functional capacity. This retrospective study included 246 male LT recipients aged 40-60 from 2013 to 2015. Preoperative and postoperative muscle and fat areas at the L3 and upper thigh levels were quantified using artificial intelligence software. Clinical outcomes, including ventilator, intensive care unit, and hospital days, were analyzed using logistic regression, while survival was evaluated using Cox regression and Kaplan-Meier curves. Longitudinal body composition changes were assessed over 5 years post-LT. SMI UT demonstrated stronger associations with hospital days ( R2 =0.378) than SMI L3 ( R2 =0.302). High SMI UT correlated with improved survival ( p =0.02), unlike SMI L3 . Longitudinal analysis revealed a significant divergence in SMI UT between survivors and non-survivors, whereas SMI L3 showed no significant changes. The visceral fat index at L3 (VFI L3 ) increased continuously, highlighting potential metabolic risks. SMI UT showed a similar or even stronger association with LT outcomes than SMI L3 , effectively reflecting patient prognosis. SMI UT in the postoperative period also better reflected clinical status. Therefore, preoperative and postoperative SMI UT is helpful for patient assessment and ongoing management in LT patients.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1250-1257"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700829","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":"PRO AI: AI-augmented allocation is in our future-We should invest the necessary resources today.","authors":"Jin Ge","doi":"10.1097/LVT.0000000000000625","DOIUrl":"10.1097/LVT.0000000000000625","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1303-1306"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007687","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":"Metabolic issues in patients with metabolic dysfunction-associated steatohepatitis (MASH) and their impact on MASH recurrence following liver transplantation: A narrative review.","authors":"Lynna Alnimer, Diego Arellano, Elizabeth Brombosz, Mazen Noureddin","doi":"10.1097/LVT.0000000000000544","DOIUrl":"10.1097/LVT.0000000000000544","url":null,"abstract":"<p><p>Decompensated cirrhosis secondary to metabolic dysfunction-associated steatohepatitis (MASH) is not only a common indication for liver transplant (LT) but is becoming the leading cause of LT in postmenopausal women in the United States. Given the different complex mechanisms involved in the occurrence of MASH, it is being recognized as the hepatic manifestation of the metabolic syndrome. There are multiple metabolic issues associated with MASH, including obesity, DMT2, cardiovascular disease, and chronic kidney disease, which need to be addressed in the pretransplant and posttransplant setting for better patient outcomes. Recurrence of MASH following LT can occur due to many reasons including reversal of the catabolic state seen in cirrhosis, improvement in appetite, and the effect of certain post-LT medications on the graft; however, managing recurrence can be challenging and thus urges addressing these issues before transplant, in addition to recognizing, and treating them in the posttransplant setting. In this review, we discuss the various metabolic issues that face patients with MASH and the medical and surgical management options available to improve outcomes and reduce chances of recurrence.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1277-1285"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770502","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":"10.1097/LVT.0000000000000639","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"E26-E27"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","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}