Liver Transplantation最新文献

{"title":"The impact of recipient hypernatremia on pediatric liver transplantation outcomes.","authors":"Zhi Mei Sonia He, Gabriel Reyes, Tommy Liu, Malcolm McDonald, Spoorthi Kamepalli, John A Goss, Nhu Thao Nguyen Galvan, Abbas Rana","doi":"10.1097/LVT.0000000000000528","DOIUrl":"10.1097/LVT.0000000000000528","url":null,"abstract":"<p><p>In pediatric liver transplants, dysnatremias have been found to have an impact on pretransplant and posttransplant outcomes. However, much of the current literature has focused on waitlist survival, secondary organ damage, and dysnatremia in donors rather than in recipients. To understand the effect of recipient immediate pretransplant hypernatremia on posttransplant mortality, we conducted a multivariable retrospective review analyzing data from 8011 pediatric patients undergoing liver transplantation provided by the United Network for Organ Sharing (UNOS). Multivariable analysis of hypernatremia showed an increased risk of mortality (OR: 2.49, 95% CI: 1.75, 3.54 for a serum sodium between 150 and 155 mEq/L), while hyponatremia did not show a significant increase in relative risk for mortality (HR: 1.11, 95% CI: 0.75, 1.63 for a serum sodium between 125 and 130 mEq/L). Kaplan-Meier curves stratified by sodium level showed statistically significant differences in outcomes with progressively increasing mortality associated with increasing serum sodium levels. In particular, there is a statistically significant increase in 90-day mortality with serum sodium levels above 150 mEq/L. Hyponatremia had a moderate impact on mortality but was not statistically significant. Our analysis of immediate pretransplantation resolution of hypernatremia also showed improved survival outcomes with a decreased mortality compared to transplant patients with unresolved hypernatremia. In conclusion, immediate pretransplant recipient hypernatremia has a substantial impact on pediatric post-liver transplantation survival. Corrected hypernatremia resulted in decreased mortality compared to uncorrected hypernatremia. Recipient hypernatremia is an important indicator of disease processes and a predictor of poor posttransplantation mortality outcomes.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"648-657"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605021","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":"Less salt and more water for children-not just dietary, but transplant management too.","authors":"M Kyle Jensen, Juan F Gallegos-Orozco","doi":"10.1097/LVT.0000000000000577","DOIUrl":"10.1097/LVT.0000000000000577","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"569-570"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047145","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":"Comparative outcomes of living donor liver transplantation in elderly recipients: A study on morbidity and survival in 1018 recipients.","authors":"Fuat H Saner, Dimitri A Raptis, Leen Alchibi, Sami A Kareem, Kris Ann H Marquez, Yasser Elsheikh, Yasir Alnemary, Saleh Alabbad, Markus U Boehnert, Massimo Malago, Dieter C Broering","doi":"10.1097/LVT.0000000000000518","DOIUrl":"10.1097/LVT.0000000000000518","url":null,"abstract":"<p><p>Given the increasing demand of patients requiring liver transplants who are 70 years or older and may have health conditions, this study aimed to assess the outcomes of recipients of living donor liver transplants (LDLTs) in this age group. We conducted an analysis using a prospective registry that included all recipients of LDLT from January 2011 to May 2023. Patients were divided into 2 age groups, 18-69 years and 70 years or older, and their short-term and long-term outcomes were compared. We considered complications as major if they were grade ≥3a (Dindo-Clavien). Among 1018 recipients of LDLT, 71 (7%) were aged 70 years or older. The rates of posttransplant complications of any severity were comparable between the younger and older age groups (46.7% vs. 46%, p = 0.983), as were the rates of major complications (25% vs. 25%, p = 0.995) and in-hospital mortality (6% vs. 7%, p = 0.800). The 1-, 3-, and 5-year graft survival rates were 94%, 86%, and 81% in the younger group and 92%, 87%, and 65% in the older group ( p = 0.090). Similarly, the overall 1-, 3-, and 5-year recipient survival rates were 90%, 85%, and 86% in the younger group and 88%, 86%, and 65% in the older group ( p = 0.100). This study suggests that carefully selected elderly patients can undergo LDLT and achieve comparable short-term outcomes to their younger counterparts.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"630-636"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142503168","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":"Jehovah's Witnesses: Challenges in liver disease management and in liver transplantation.","authors":"Jordan S Sack, Sander S Florman, Thomas D Schiano","doi":"10.1097/LVT.0000000000000514","DOIUrl":"10.1097/LVT.0000000000000514","url":null,"abstract":"<p><p>Patients of Jehovah's Witnesses faith who are in need of liver transplantation pose unique challenges. These patients should be seen at transplant centers with experience in caring for Jehovah's Witnesses to formulate careful preoperative, intraoperative, and postoperative strategies on an individualized basis with multidisciplinary input to mitigate the risk of bleeding complications and to prepare for potentially catastrophic scenarios. In-depth and individualized conversations about what constitutes acceptable bloodless transfusion strategies both for the patient and for the transplant center should begin as early as possible with an experienced coordinator or church liaison. A therapeutic physician-patient relationship is vital to formulating a safe care plan and to understanding the spectrum of beliefs among Jehovah's Witnesses. There remains a paucity of data on disparities in liver care and outcomes in patients of the Jehovah's Witnesses faith. Future research on liver diseases and liver transplantation in Jehovah's Witnesses should focus on creating registries of patient outcomes and centers with experience.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"682-693"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682151","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":"Letter to the Editor: Plasma exchange for alcohol-associated liver disease as a bridge to liver transplantation-A call to expand its adaptation in Japan.","authors":"Takeru Yoshimoto, Daisuke Katagiri, Yasuo Tanaka","doi":"10.1097/LVT.0000000000000553","DOIUrl":"10.1097/LVT.0000000000000553","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"E20-E21"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801367","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 caveat of biliary pH as biomarker of bile duct viability during normothermic machine perfusion of donor livers.","authors":"Bianca Lascaris, Puck C Groen, Silke B Bodewes, Roberto Broere, Otto B van Leeuwen, Jeroen de Jonge, Vincent E de Meijer, Robert J Porte","doi":"10.1097/LVT.0000000000000538","DOIUrl":"10.1097/LVT.0000000000000538","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"694-697"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11999090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818549","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":"Prospective evaluation of cystatin C in the assessment of kidney dysfunction and survival in liver transplant candidates.","authors":"Stevan A Gonzalez, Nagasri Shankar, Ashwini Mehta, Mauricio Garcia-Saenz-de-Sicilia, Goran B Klintmalm, James F Trotter, Sumeet K Asrani, Bernard V Fischbach, Andres Duarte-Rojo","doi":"10.1097/LVT.0000000000000492","DOIUrl":"10.1097/LVT.0000000000000492","url":null,"abstract":"<p><p>Kidney dysfunction is associated with decreased survival in liver transplant (LT) candidates, yet serum creatinine (sCr) is a poor surrogate for glomerular filtration rate (GFR) in this population. Serum cystatin C (CysC) may provide a more accurate assessment of kidney function and predict outcomes. We performed a multicenter prospective cohort study of consecutive candidates for LT. CysC was obtained at LT evaluation (n = 244), and a subset underwent simultaneous I 125 -iothalamate clearance for measured GFR (mGFR) assessment (n = 137). Patients were followed to assess the need for pre-LT renal replacement therapy, simultaneous liver and kidney transplant, and survival. Estimated GFR (eGFR) based on MDRD-4, GRAIL, Royal Free Hospital Cirrhosis GFR, and the CKD-EPI equations was assessed for bias, precision, and accuracy in reference to mGFR. Receiver operator characteristic (AUROC) and competing risk survival analyses were performed. CysC more accurately discriminated mGFR than sCr at thresholds of ≤60 and ≤30 mL/min/1.73 m 2 with AUROC 0.92 ( p = 0.005) and 0.96 ( p =0.01), respectively. All eGFR equations overestimated GFR, especially among females ( p < 0.05). The GRAIL equation demonstrated the least bias, while CKD-EPI-cystatin C was associated with the greatest precision and lowest frequency of GFR overestimation. Among 165 recipients of LT, CysC discriminated pre-LT renal replacement therapy and the need for simultaneous liver and kidney transplant with AUROC of 0.70 and 0.85, respectively. Cumulative incidence of death, accounting for LT as a competing event, increased with CysC ( p = 0.002) but was not observed with sCr overall or among subgroups ( p = NS). CysC more accurately predicts thresholds of mGFR than sCr in candidates for LT. Elevated CysC discriminates pre-LT renal replacement therapy and simultaneous liver and kidney transplant and is strongly associated with survival in contrast with sCr. CysC is a promising tool to improve prognostication among candidates for LT.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"571-583"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290409","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":"Takotsubo cardiomyopathy following liver transplantation: A multicenter cohort study.","authors":"Abraham J Matar, James Keiler, Alexandra C Bolognese, Arielle Cimeno, Colin Whitmore, Chase J Wehrle, Federico Aucejo, Ekaterina Fedorova, David Aufhauser, Ram Subramanian, Marwan M Kazimi, Valmiki Maharaj, Elizabeth S Aby, Joseph Magliocca, Steven C Kim","doi":"10.1097/LVT.0000000000000503","DOIUrl":"10.1097/LVT.0000000000000503","url":null,"abstract":"<p><p>Takotsubo cardiomyopathy (TCM) is an acute, stress-mediated, reversible cardiomyopathy that occurs in the absence of hemodynamically significant coronary artery disease. We aimed to investigate the characteristics and outcomes of patients who developed TCM following liver transplantation (LT) in a multicenter study. Adult patients from 6 centers across the United States who developed TCM according to Mayo Clinic criteria following LT between 2008 and 2023 were included. Demographics, perioperative and long-term outcomes, and treatment modalities were assessed. Fifty-five patients were included. The center incidence of TCM ranged from 0.1% to 0.5%. The majority were female (54.5%) and Caucasian (87.2%), and the median age at transplant was 59 years. The primary etiologies for LT were alcohol-associated cirrhosis (49.1%) and metabolic dysfunction-associated steatotic liver disease cirrhosis (21.8%). The median time from LT to TCM diagnosis was 4 days. TCM was associated with a 60.9% reduction in left ventricular ejection fraction (LVEF) from a pretransplant median LVEF of 64.0%-25.0%. The most common treatment for TCM was diuretics (67.3%) and afterload reduction (54.5%), with only 27.3% of patients requiring vasopressor support. At a median follow-up of 31.5 months, 1-year and 3-year overall survivals (OSs) were 86.3% and 69.4%, respectively. A repeat echocardiogram performed at a median of 84 days demonstrated that 45/55 patients (81.8%) had recovered LVEF ≥50%. Patients with LVEF recovery to ≥50% had significantly improved OS compared to those without LVEF recovery >50% (106.4 vs. 12.2 mo, p = 0.001). TCM following LT is associated with a significant reduction in LVEF; however, the majority of patients recover LVEF to >50% with minimal perioperative mortality. Importantly, follow-up assessment of LVEF has significant implications as lack of recovery is associated with worse OS.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"623-629"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361741","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":"Machine perfusion strategies in liver transplantation: A systematic review, pairwise, and network meta-analysis of randomized controlled trials.","authors":"Fouad Jaber, Mohamed Abuelazm, Youssef Soliman, Mahmoud Madi, Husam Abusuilik, Ahmed Mazen Amin, Abdallah Saeed, Ibrahim Gowaily, Basel Abdelazeem, Abbas Rana, Kamran Qureshi, Tzu-Hao Lee, George Cholankeril","doi":"10.1097/LVT.0000000000000567","DOIUrl":"10.1097/LVT.0000000000000567","url":null,"abstract":"<p><p>Machine perfusion (MP), including hypothermic oxygenated machine perfusion (HOPE), dual HOPE, normothermic machine perfusion (NMP), NMP ischemia-free liver transplantation (NMP-ILT), and controlled oxygenated rewarming (COR), is increasingly being investigated to improve liver graft quality from extended criteria donors and donors after circulatory death and expand the donor pool. This network meta-analysis investigates the comparative efficacy and safety of various liver MP strategies versus traditional static cold storage (SCS). We searched PubMed, Scopus, Web of Science, and Cochrane Controlled Register of Trials for randomized controlled trials comparing liver transplantation outcomes between SCS and MP techniques. The primary outcome was the incidence of early allograft dysfunction. Secondary endpoints included 1-year graft survival, the incidence of graft failure/loss, post-reperfusion syndrome, biliary complications, the need for renal replacement therapy, graft-related patient mortality, and the length of intensive care unit and hospital stay. R-software was used to conduct a network meta-analysis using a frequentist framework (PROSPERO ID: CRD42024549254). We included 12 randomized controlled trials involving 1628 patients undergoing liver transplantation (801 in the liver MP groups and 832 in the SCS group). Compared to SCS, HOPE/dHOPE, but not other MP strategies, was associated with a significantly lower risk of early allograft dysfunction (RR: 0.53, 95% CI [0.37, 0.74], p =0.0002), improved 1-year graft survival rate (RR: 1.07, 95% CI [1.01, 1.14], p =0.02), decreased graft failure/loss (RR: 0.38, 95% CI [0.16, 0.90], p =0.03), and reduced the risk of biliary complications (RR: 0.52, 95% CI [0.43, 0.75], p < 0.0001). Compared to SCS, NMP (RR: 0.49, 95% CI [0.24, 0.96]) and NMP-ILT (RR: 0.15, 95% CI [0.04, 0.57]), both significantly reduced the risk of postperfusion syndrome. There is no difference between SCS and MP groups in the risk of renal replacement therapy, graft-related patient mortality, and intensive care unit and hospital stay length. Our meta-analysis showed that HOPE/dual-HOPE is a promising alternative to SCS for donor liver preservation. These new techniques can help expand the donor pool with similar or even better post-liver transplantation outcomes.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"596-615"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047147","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":"Prolonged time from cross-clamp until normothermic machine perfusion start is associated with an increased risk of early allograft dysfunction following DCD liver transplant.","authors":"Charles Lee, Amit K Mathur, Shennen Mao, Julie K Heimbach, C Burcin Taner, Bashar Aqel, Kristopher P Croome","doi":"10.1097/LVT.0000000000000548","DOIUrl":"10.1097/LVT.0000000000000548","url":null,"abstract":"<p><p>There is a paucity of data on the impact of cold ischemia time before the initiation of normothermic machine perfusion (NMP), particularly in more susceptible organs such as livers from donation after circulatory death (DCD) donors. The present analysis aimed to investigate the impact of prolonged time from cross-clamp until NMP start on early allograft dysfunction and other peri-liver transplant (LT) outcomes. All DCD LT performed and placed on NMP at Mayo Clinic Arizona, Florida, and Rochester from January 2022 to March 2024 were included. The decision was made a priori to divide the population into 2 groups based on terciles: typical cross-clamp to on-pump time (lower 2 terciles) versus prolonged cross-clamp to on-pump time (upper tercile; >2 h 45.6 min). Three hundred eighty-four DCD LT undergoing NMP met the inclusion criteria. The rate of early allograft dysfunction was significantly higher in the prolonged cross-clamp to on-pump group (51.2%) compared to the typical cross-clamp to on-pump group (37.6%) ( p = 0.01). The prolonged cross-clamp to on-pump group also had higher rates of acute kidney injury and the number of packed red blood cells transfused during LT. No significant difference in ischemic cholangiopathy (2.4% vs. 3.1%; p = 0.68) or graft survival at 12 months was seen between the prolonged cross-clamp to on-pump and typical cross-clamp to on-pump group, respectively. Following cross-clamp, DCD liver grafts should be placed on the NMP pump as quickly as is safely and logistically possible. In cases where delays are unavoidable, such as waiting for biopsy results or liver reallocation with another center, acceptable results can still be achieved, and therefore, livers with prolonged times should still be used.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"616-622"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801389","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}