Liver Transplantation最新文献

{"title":"Optimizing liver transplant candidacy in patients with cirrhosis and obesity.","authors":"Nghiem B Ha, Julie K Heimbach, Bilal Hameed","doi":"10.1097/LVT.0000000000000609","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000609","url":null,"abstract":"<p><p>The epidemic of obesity in the United States has led to a significant increase in the prevalence of obesity the liver transplant population, with metabolic dysfunction-associated steatotic liver disease (MASLD) becoming one of the most common indications for liver transplantation. Despite this rise in obesity, the optimal management strategies in the pretransplant, peri-transplant, and post-transplant phases of care have not yet been determined. In the current review, we will present and discuss the available evidence for the surgical management of obesity, including the optimal timing, as well as a review of the novel medical therapies and how these strategies may best be utilized to provide ideal long-term outcomes for liver transplant patients with obesity.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700825","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":"Assessing hepatic arterial injuries in the setting of normothermic machine perfusion in liver transplantation: A non-invasive approach.","authors":"Adam S Bodzin, Malcolm P MacConmara, Magdy Attia, Dana K Perry, Ashesh P Shah","doi":"10.1097/LVT.0000000000000610","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000610","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700819","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":"Decompensated cirrhosis but low MELD - should we wait or refer for liver transplantation?","authors":"Noreen Singh, Yu Jun Wong, Patrizia Burra, Nazia Selzner, Aldo J Montano-Loza","doi":"10.1097/LVT.0000000000000608","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000608","url":null,"abstract":"<p><p>Cirrhosis constitutes a significant global health burden with decompensation characterized by ascites, hepatic encephalopathy, as well as variceal hemorrhage. These decompensation features are independent predictors of mortality. Liver transplantation remains the definitive treatment for patients with cirrhosis. However, given that this is a limited resource, thus its allocation, using the MELD score, has to be judicious despite decompensation features affecting the patient's quality of life. Patients with grade three ascites or overt hepatic encephalopathy have significant mortality, therefore, in some instances, these decompensation features should be considered indications for liver transplantation despite low MELD. The majority of patients listed for liver transplantation have low MELD scores (≤15 points); and approximately half will die due to liver-related complications. Current evidence demonstrates a mortality reduction of approximately 40% with LT in those patients with a low MELD. Furthermore, new scores have been developed such as the MELD 3.0 that incorporates female sex, albumin, and all the MELD-Na components (bilirubin, creatinine, INR, and sodium), and the Gender-Equity Model for liver Allocation (GEMA), that includes bilirubin, INR and the Royal Free Hospital glomerular filtration rate, which have demonstrated improved discrimination. Lastly, to address the limited resource, living-donor liver transplant has demonstrated a significant survival benefit in patients even at MELD-Na scores as low as 11, suggesting that life-years gained are similar to deceased-donor transplant. In this review, our goal is to present the frequency of patients listed for transplant with low MELD, and the limitation of using MELD in patients for liver transplantation. We will provide practical guidance on the management of common complications of cirrhosis and early consideration for liver transplant referral in patients with clinical decompensation and low MELD.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700824","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":"Building a better mouse trap in liver retransplantation risk prediction: Is resoft the end or the beginning?","authors":"Michelle C Nguyen, Amit K Mathur","doi":"10.1097/LVT.0000000000000607","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000607","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657646","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 screening to action: Social determinants and early outcomes in pediatric liver transplant recipients.","authors":"Tiange P Zhang, Kali Zhou","doi":"10.1097/LVT.0000000000000605","DOIUrl":"10.1097/LVT.0000000000000605","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657648","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":"Portal vein interposition in pediatric living donor liver transplantation: Which vein graft type is best?","authors":"Dor Yoeli, Megan Adams","doi":"10.1097/LVT.0000000000000606","DOIUrl":"10.1097/LVT.0000000000000606","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657649","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":"https://doi.org/10.1097/LVT.0000000000000603","url":null,"abstract":"<p><strong>Background & aims: </strong>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 (RFS) in patients with HCC following liver transplantation (LT).</p><p><strong>Methods: </strong>This two-center retrospective study includes 123 patients with HCC who underwent LT between 2007 and 2021. Radiomic features (RF) 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 model and Metroticket 2.0 before LT using multivariate logistic regression. ROC analyses were performed in both internal (n=22) and external (n=53) validation cohorts and patients were stratified into either high- or low-risk group for HCC recurrence. Kaplan-Meier analysis was performed to analyze RFS.</p><p><strong>Results: </strong>LASSO and multivariate regression analysis revealed four independent predictors associated with an increased risk of HCC recurrence: radiomics signature of five RF, peritumoral enhancement, satellite nodules and no bridging therapies. For 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 RFS than the corresponding low-risk group.</p><p><strong>Conclusions: </strong>CT-based radiomics and imaging parameters beyond the Milan criteria representing aggressive behavior, along with history of bridging therapies, show potential for predicting HCC recurrence after LT.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-19","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":"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":"https://doi.org/10.1097/LVT.0000000000000604","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-19","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":"Achieving transplant equity: A feasible solution for uninsured patients.","authors":"Saulat S Sheikh","doi":"10.1097/LVT.0000000000000602","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000602","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657645","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":"International liver transplantation society practice guideline update on portopulmonary hypertension.","authors":"Hilary M DuBrock, Laurent Savale, Olivier Sitbon, Sarah Raevens, Steven M Kawut, Michael B Fallon, Julie K Heimbach, Ryan M Chadha, Gonzalo Crespo, Michael Ae Ramsay, Michael J Krowka","doi":"10.1097/LVT.0000000000000600","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000600","url":null,"abstract":"<p><p>Portopulmonary hypertension (POPH), pulmonary artery hypertension (PAH) that develops in the setting of portal hypertension, has long been of significant interest to the pulmonary, cardiology and hepatology communities. Optimal management of POPH has been challenging to define due to lack of evidence from clinical trials regarding PAH therapies and uncertainty regarding the role of liver transplantation (LT). Initially, the high risk of intraoperative and early post-transplant death in predominantly untreated patients with POPH tempered consideration of LT. More recently, the observation that POPH can improve, and sometimes even resolve, following LT, has led to reconsideration of the role of LT in selected patients. The first International Liver Transplantation Society (ILTS) POPH and hepatopulmonary syndrome practice guideline was a multidisciplinary consensus of expert opinions based on available evidence. Since that publication, hemodynamic definitions, management approaches and POPH Model for End Stage Liver Disease exception criteria have evolved and there have been new randomized controlled trials in POPH as well as studies regarding long-term outcomes. In order to ensure the guidelines remained current and reflected recent evidence, the original writing committee of the 2016 guidelines, leaders of the ILTS Cardiovascular Special Interest Group and colleagues active in POPH research were invited to participate in the writing committee. In this document, approved for publication by the ILTS executive council, we provide an update to the prior guidelines with expert recommendations to guide and advance POPH management. Recommendations in these guidelines are based on expert opinion and available evidence and were agreed upon by consensus.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649680","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}