Liver Transplantation最新文献

{"title":"A snapshot of challenges and opportunities faced by the scientific workforce in liver transplantation - a survey of the International Liver Transplantation Society (ILTS).","authors":"Zoltan Czigany, Aghnia J Putri, Decan Jiang, Raphael Meier, Juliet Emamaullee, David P Al-Adra, Li Pang, Joohyun Kim, Felix J Krendl, Monique Verstegen, Franziska A Meister, Georg Lurje, Valeria R Mas, Mamatha Bhat, Eliano Bonaccorsi-Riani, Paulo N Martins","doi":"10.1097/LVT.0000000000000599","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000599","url":null,"abstract":"<p><p>Basic & translational research (B&TR) in liver transplantation (LT) underwent considerable changes and shifts over the past decade. To capture the current landscape and future potential of B&TR in LT, we conducted an online survey within the International Liver Transplantation Society (ILTS) community. The survey aimed to collect comprehensive data on the respondents' characteristics, qualifications, experiences, and research activities, providing the present state and future directions of B&TR in LT. Between October 2023 and January 2024, an online survey consisting of 35 key items was distributed to the ILTS community through newsletters and social media channels. Data were analyzed using a combination of quantitative and qualitative methods. The survey gathered 153 valid responses, with 79% of respondents possessing relevant experience in B&TR and 76% reporting concurrent clinical duties. Some 62% hold faculty positions, with 34% identifying as MDs and 44% holding combined MD/PhD degrees. About 71% of scientists with clinical duties reported challenges in conducting B&TR, with 57% citing a lack of time and 41% pointing to insufficient funding. Nevertheless, 69% of respondents currently receive research funding, with 58% supported by government or public sources. Among early career researchers, 57% reported receiving average or poor mentoring, and 30% indicated an insufficient protected time for research. Looking ahead, advancing technologies, machine learning/artificial intelligence, multi-omics, xenotransplantation, and machine perfusion were highlighted as areas with potential to significantly shift the paradigm in the near future. Our survey captured insights from B&TR scientists within the ILTS, identifying both challenges and opportunities for future developments and aiding in the strategic direction of the society's initiatives.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625405","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":"Pediatric living donor liver transplantation for small infants with biliary atresia using interposition portal vein grafts, multi-center cohort study.","authors":"Daniel Zamora-Valdés, Ryuji Komine, Wei Gao, Masaki Honda, Yusuke Yanagi, Pilar Leal-Leyte, Nam Joon Yi, Toru Ikegami, Mureo Kasahara","doi":"10.1097/LVT.0000000000000596","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000596","url":null,"abstract":"<p><strong>Background: </strong>Despite multiple techniques, portal vein (PV) inflow reconstruction during living donor liver transplantation (LDLT) for patients with biliary atresia (BA) and small-diameter PV remains a challenge. The use of PV interposition grafts has emerged as a promising therapeutic strategy to mitigate complications and reinterventions.</p><p><strong>Methods: </strong>We conducted a retrospective multi-center cohort study of patients under 3 years of age (n=85) undergoing LDLT for biliary atresia using PV interposition grafts. Our primary outcome was PV complications after LDLT, and secondary outcomes included long-term PV patency and death-censored graft survival.</p><p><strong>Results: </strong>LDLT was performed on 85 patients. The PV diameter was 4.0±0.6 mm. Cold-stored venous allografts were used in 26 cases, donor-derived grafts in 53, and autologous in six. The portal inflow was the PV in 38 cases, splenomesenteric confluence in 33, superior mesenteric vein in 3, and coronary vein in 1. The intraoperative PV thrombosis rate was 22.4% and the overall PV complication rate after LDLT was 23.5% (16 PV stenoses and 4 thromboses). Multivariate analysis revealed that the use of cold-stored venous allografts predicted PV complications (53.8% vs. 10.2%; RR, 15.9; 95%CI 2.9-86.2; p=0.001). Eleven patients underwent PV stent placement after LDLT with primary patency rates of 81.8% and secondary patency rates of 90.9%. The Long-term patency, death-censored graft survival, and patient survival rates were 96.5%, 96.5%, and 97.6%, respectively.</p><p><strong>Conclusions: </strong>Portal inflow reconstruction using interposition grafts during LDLT for biliary atresia achieves favorable long-term patency and patient and graft survival outcomes. This approach has the potential to mitigate morbidity and mortality in pediatric BA patients undergoing LDLT. Longer cold-stored venous allografts are associated with a higher risk of PV complications after LDLT.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605665","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 impact of alcohol-associated liver disease on famous athletes who received Liver Transplants.","authors":"Olivia Greenham, Rajeshwar P Mookerjee","doi":"10.1097/LVT.0000000000000598","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000598","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605667","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":"Policy Corner: Transplant oncology, colorectal liver metastases MELD nonstandard exception.","authors":"Ahmad Moussawi, Shivang Mehta, Craig Rosenstengle","doi":"10.1097/LVT.0000000000000597","DOIUrl":"10.1097/LVT.0000000000000597","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605666","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":"Failure to rescue in acute liver failure: A multicenter cohort study.","authors":"Filipe S Cardoso, William M Lee, Constantine J Karvellas","doi":"10.1097/LVT.0000000000000594","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000594","url":null,"abstract":"<p><strong>Introduction: </strong>The concept of failure to rescue has been used to measure the quality of care for complications developed following surgery. The concept of failure to rescue has been poorly studied in patients with primary medical diseases, such as sepsis or acute liver failure (ALF).</p><p><strong>Methods: </strong>Retrospective multicenter cohort including consecutive patients with ALF within the United States ALF Study Group (USALFSG) prospective registry from 2010 to 2016. The failure to rescue rate for 12 medical complications in the registry was calculated as the mortality events up to 21 days post inclusion divided by the complication events registered on the first day post inclusion. The association between these complications and 21-day transplant-free mortality was studied.</p><p><strong>Results: </strong>Among 665 patients with ALF, 478 (71.9%) were females and median (IQR) age was 42 (30-55) years. Acetaminophen intoxication was observed in 322 (48.4%) patients. Overall, 461 (69.3%) patients had at least one medical complication on the first day post inclusion (median (IQR) number of 1 (0-3)). The failure to rescue rate for the 12 complications was 32.8%. The complications with the higher failure to rescue rates were gastro-intestinal bleed (63.6%), non-gastro-intestinal bleed (53.9%), requirement for vasopressors (52.5%), and acute respiratory distress syndrome (48.1%). After adjusting for age, sex, etiology, and INR, per each added complication present on day one, the odds of 21-day transplant-free mortality increased 38% (aOR (95%CI) of 1.38 (1.24-1.54); c-statistic (95%CI) of 0.77 (0.73-0.81)).</p><p><strong>Conclusions: </strong>In patients with ALF, the concept of failure to rescue highlights the need to improve prevention, early detection, and timely management of medical complications developing early in the hospital stay.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586161","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":"Proceedings of the 29th Annual Congress of the International Liver Transplantation Society.","authors":"Madhukar S Patel, Sadhana Shankar, Marta Tejedor, Andrew S Barbas, Joohyun Kim, Shennen Mao, Tommy Ivanics, Johns Shaji Mathew, Alexandra Shingina, Mohammad Qasim Khan, Elizabeth A Wilson, Nicholas Syn, Felipe Alconchel, Dhupal Patel, Jiang Liu, David Nasralla, Alessandra Mazzola, Tomohiro Tanaka, David W Victor, Young-In Yoon, Carmen Vinaixa, A Mi Mi Kyaw, Antonio Galante, Paolo Magistri, Manikandan Kathirvel, Daniel Aliseda, Kennen Moral, Tommaso Di Maira, Eleonora De Martin, Ryan Chadha, Abdul Rahman Hakeem, Eliano Bonaccorsi-Riani, Ashwin Rammohan","doi":"10.1097/LVT.0000000000000593","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000593","url":null,"abstract":"<p><p>The 2024 Annual Congress of the International Liver Transplantation Society (ILTS) was from May 1-4th in Houston, Texas, USA, under the theme \"Liver Disease and Transplantation: Breaking Barriers and Exploring New Frontiers\". In addition to a robust scientific program, the congress also hosted a hands-on cadaveric robotic liver surgery course, a machine perfusion workshop, and a transesophageal echocardiography course. In this report, the ILTS Vanguard and Basic Sciences Committees present a summary of the congress proceedings.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586164","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":"Normothermic liver perfusion: Is the juice worth the squeeze?","authors":"Omar Alomar, William C Chapman","doi":"10.1097/LVT.0000000000000595","DOIUrl":"10.1097/LVT.0000000000000595","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573409","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, Sudheer Othiyil Vayoth, S Sudhindran","doi":"10.1097/LVT.0000000000000592","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000592","url":null,"abstract":"<p><strong>Background: </strong>Robotic donor hepatectomy (RDH) has been reported with lower morbidity than its open counterpart. Donor safety remains the primary concern precluding its wide adaption. We aimed to evaluate donor complications following RDH and identify their predictive factors.</p><p><strong>Study design: </strong>Out of 348 live donor liver transplants performed between 2018-2021, the prospective data of 202 RDH were analyzed for complications by modified Clavien-Dindo grading system. Multivariate analysis of donor and operative parameters was done to identify factors predicting complications and CUSUM analysis was done to evaluate the effect of learning curve.</p><p><strong>Results: </strong>Out of 202 RDH [mean age: 37.5(±10.4); f:m-133:69; mean BMI: 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 & 1-portal vein kink]. Post-operative complications occurred in 33(16.3%), the most common being bile leak (5.9%) and bleeding(3.9%). Grade IIIa, IIIb & Iva complications were seen in 3.4%, 3.4% and 0.9% of patients respectively. Re-operation was required in 3 cases for portal vein thrombosis, narrowing of inferior vena cava and biliary peritonitis respectively. At a follow up of 4 year period, these patients are doing well. Although in univariate analysis, higher blood loss and basal metabolic index appeared to be significant, a multivariate analysis did not reveal any donor factor that could predict complications (biliary anatomy, portal anatomy, blood loss, BMI, duration of surgery or FLR 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 analysis we identified that it took around 130 cases for our unit to collectively overcome the learning curve.</p><p><strong>Conclusion: </strong>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":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-07","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":"The long and winding road to maximize the benefit of liver transplantation.","authors":"Ji Jade King, Oliver D Tavabie","doi":"10.1097/LVT.0000000000000591","DOIUrl":"10.1097/LVT.0000000000000591","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542473","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 hepatocellular carcinoma 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, R Mark Ghobrial, Mohamed Rela, Gonzalo Sapisochin","doi":"10.1097/LVT.0000000000000589","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000589","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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 external expert review.</p><p><strong>Results: </strong>Consensus statements were accepted regarding patient assessment and waitlisting criteria, pre-transplant treatment (including immunotherapy) and downstaging, living donor liver transplantation, post-LT patient management, and patient- and caregiver-related outcomes.</p><p><strong>Conclusion: </strong>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":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-28","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}