Liver Transplantation最新文献

{"title":"Exploring auxiliary liver transplantation in the era of transplant oncology-A proposal for a new liver splitting program (ALERT-50).","authors":"Enrico Gringeri, Alessandro Furlanetto, Marina Polacco, Luca Perin, Eleonora Nieddu, Eugenia Rosso, Clarissa De Nardi, Mattia Ballo, Tullia De Feo, Silvia Trapani, Patrizia Burra, Marco Spada, Michele Colledan, Andrea Lauterio, Renato Romagnoli, Massimo Cardillo, Giuseppe Feltrin, Luciano De Carlis, Umberto Cillo","doi":"10.1097/LVT.0000000000000574","DOIUrl":"10.1097/LVT.0000000000000574","url":null,"abstract":"<p><p>Total hepatectomy and liver transplantation have emerged as a game-changing strategy in the treatment of several liver-confined primary or metastatic tumors, opening a new era of transplant oncology. However, the expansion of indications is going to worsen the chronic scarcity of organs, and new strategies are needed to enlarge the donor pool. A possible source of organs could be developing split liver transplantation programs. We propose to refer donors aged 18-50 years unsuitable for pediatric patients and donors aged 50-60 years for split evaluation. This will generate new small left lateral grafts that can be used for resection and partial liver segment II-III transplantation with delayed total hepatectomy procedures, based on a national waiting list specifically for non-HCC oncologic patients. Centralized imaging review will streamline the donor-recipient matching process and address organizational challenges. Additionally, adopting an ex situ splitting technique during hypothermic oxygenated machine perfusion could further enhance logistical efficiency and improve graft viability. The proposed protocol (ALERT 50) will therefore promote the development of oncologic indications without affecting the standard waiting list and without competing with urgent or pediatric patients.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1176-1182"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007925","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":"Liver transplantation after ex vivo normothermic machine preservation without recooling the graft: A clinical series from a single center.","authors":"Salvatore Gruttadauria, Ivan Vella, Sergio Li Petri, Caterina Accardo, Pasquale Bonsignore, Alessandro Tropea, Sergio Calamia, Duilio Pagano, Gaetano Burgio, Rosalia Longo, Fabrizio di Francesco","doi":"10.1097/LVT.0000000000000564","DOIUrl":"10.1097/LVT.0000000000000564","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1190-1194"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950879","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":"\"You're hot then you're cold\" : Can we omit recooling after NMP?","authors":"Shennen A Mao, Kristopher P Croome","doi":"10.1097/LVT.0000000000000641","DOIUrl":"10.1097/LVT.0000000000000641","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1087-1088"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078993","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":"Utilization of fibrotic HCV-viremic grafts in liver transplantation: An emerging opportunity or a step too far?","authors":"Avesh J Thuluvath, Elizabeth C Verna","doi":"10.1097/LVT.0000000000000627","DOIUrl":"10.1097/LVT.0000000000000627","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1083-1084"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030175","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":"Hepatitis C-positive grafts for hepatitis C-negative recipients in liver transplantation: Buried treasure or depleting resource?","authors":"Toshihiro Nakayama, David T Krist, Miho Akabane, Yuki Imaoka, Carlos O Esquivel, Allison J Kwong, Paul Y Kwo, Marc L Melcher, Kazunari Sasaki","doi":"10.1097/LVT.0000000000000557","DOIUrl":"10.1097/LVT.0000000000000557","url":null,"abstract":"<p><p>Long-term outcomes of using HCV-positive donors in HCV-negative recipients in liver transplantation (LT) are not well established. Data from the United Network for Organ Sharing (UNOS) database between July 1, 2015, and December 31, 2023, were analyzed. The cohort included 44,447 HCV antibody-negative (Ab-) candidates who underwent deceased donor LT. Changes in case numbers and utilization rates of HCV-positive donors, divided into HCV-viremic (NAT+) or Ab+ nonviremic (Ab+/NAT-), were assessed. Kaplan-Meier analysis and propensity score matching were used to evaluate 5-year graft survival. The number of HCV-viremic donation after brain death (DBD) donors and their use in LT for HCV Ab- recipients peaked at 640 donors in 2019 and 289 LTs in 2022. In contrast, Ab+ nonviremic DBD donations are rising, with 536 donors and 284 LTs in 2023. The utilization rate of viremic DBD grafts has continuously decreased despite increased willingness by waitlist candidates to accept them. HCV-positive donation after circulatory death donors were seldom utilized in the study period. The 5-year graft survival rates for HCV-viremic, Ab+ nonviremic, and naïve donors were not significantly different in either DBD ( p = 0.56) or donation after circulatory death ( p = 0.52). Furthermore, Ishak stage 2 or 3 fibrotic DBD grafts had similar 5-year graft survival to nonfibrotic grafts. The findings suggest that the long-term outcome of using HCV-viremic DBD or donation after circulatory death grafts for HCV-negative recipients is comparable to that of other graft types and that fibrotic grafts have the potential to expand the DBD donor pool.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1154-1164"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829297","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":"10.1097/LVT.0000000000000604","url":null,"abstract":"<p><p>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. 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. 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. 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":"1135-1142"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","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":"Occult multifocal and incidental hepatocellular carcinoma: An analysis of long-term survival and risk factors at a single liver transplant center.","authors":"Dominic Amara, Wethit Dumronggittigule, Andrew Melehy, Daniela Markovic, Lynn Nguyen, Shannon Nesbit, David S Lu, Samer Ebaid, Fady M Kaldas, Douglas G Farmer, Ronald W Busuttil, Vatche G Agopian","doi":"10.1097/LVT.0000000000000640","DOIUrl":"10.1097/LVT.0000000000000640","url":null,"abstract":"<p><p>The clinical significance of occult HCC identified on explant pathology in liver transplantation (LT) remains unclear. Among recipients of LT, discordance between pre-LT radiographic assessment of HCC and explant tumor burden is common. Data regarding the association of incidental HCC (no pre-LT radiographic diagnosis) and occult multifocal hepatocellular carcinoma (omHCC, pre-LT radiology underestimates a number of explant tumors) with outcomes are scarce. Post-LT recurrence and survival were compared among recipients of LT (n=919, 2002-2019) with incidental HCC (n=129), omHCC (n=349), and non-omHCC (n=437). Multivariable analysis identified independent predictors of omHCC in the subset of patients with kHCC. Compared to kHCC, incidental HCC had similar 5-year overall (OS) and recurrence-free survival (RFS), lower post-LT recurrence (6.9% vs. 16.2%, p =0.0019), but higher non-HCC-related mortality (38.4% vs. 23.7%, p =0.0042). Of 790 kHCC, 349 (44.1%) had omHCC, who demonstrated greater radiographic number of lesions ( p =0.049) and locoregional treatments ( p <0.001) but similar maximum and pre-LT alphafetoprotein compared to non-omHCC. Compared to kHCC without omHCC, patients with omHCC had inferior 5-year OS (60.4% vs. 70.9%, p =0.010) and RFS (56.8% vs. 69.7%, p <0.001), higher recurrence (23.8% vs. 9.2%, p <0.001), and similar non-HCC-related mortality. These observations remained true within patients who remained within Milan throughout preoperative imaging (5-y OS: 62.1% vs. 72.6%, p =0.027; RFS: 58.6% vs. 71.7%, p =0.010; recurrence: 21.7% vs. 7.6%, p <0.001). Multivariable predictors of omHCC tumor included a number of pre-LT locoregional therapies (OR 1.62 for 2 treatments, 95% CI 1.15-2.28, p =0.005; OR 1.98 for 3+ treatments, 1.36-2.88, p <0.001). In patients with kHCC prior to LT, the presence of omHCC is common and associated with inferior post-LT survival and higher recurrence rates. The development of improved radiographic and serum biomarkers that more accurately reflect explant tumor burden may improve patient selection and post-LT outcomes.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1111-1122"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078996","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: Limitations of MRI-serum-based scoring in liver transplant rejection assessment.","authors":"Ibrahim Nagmeldin Hassan, Mohamed Ibrahim","doi":"10.1097/LVT.0000000000000637","DOIUrl":"10.1097/LVT.0000000000000637","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"E25"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971260","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 rising cost of liver transplantation in the United States.","authors":"Alyson Kaplan, Adam Winters, Sharon Klarman, Michael Kriss, Dempsey Hughes, Pratima Sharma, Sumeet Asrani, Alan Hutchison, Paul Myoung, Asad Zaman, Laura Butler, James Pomposelli, Fredric Gordon, Andres Duarte-Rojo, Deepika Devuni, Brett Fortune","doi":"10.1097/LVT.0000000000000493","DOIUrl":"10.1097/LVT.0000000000000493","url":null,"abstract":"<p><p>Liver transplantation (LT) is the only curative treatment for end-stage liver disease and significantly improves patient outcomes. However, LT is resource-intensive and costly, with expenditures rising dramatically in recent years. Factors contributing to this increase in cost include expanded transplant criteria, utilization of marginal organs, and broader organ distribution, resulting in significant logistical expenses. Advanced technologies like organ perfusion devices, while promising better outcomes, further inflate costs due to their high price and market monopolization. Moreover, living donor liver transplant and utilization of donation after cardiac death organs introduce higher initial expenditures yet potential long-term savings. Despite rising costs, reimbursement has remained largely stagnant, putting financial strain on transplant programs, and threatening their sustainability. This review examines the multifaceted drivers of rising costs in LT, focusing on recent policy changes, the role of organ procurement organizations, and the impact of new technologies. We also propose comprehensive solutions at national, organ procurement organization, and local levels, including optimizing resource allocation, leveraging regional collaborations, and advocating for revised reimbursement models to curb escalating costs. Addressing these challenges is critical to ensuring the continued viability of LT programs and maintaining patient access to this life-saving intervention.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1165-1175"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308067","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":"A survey of national practice patterns of HCC surveillance for patients with Fontan-associated liver disease: A call to action.","authors":"Matthew R Kappus, Dempsey Hughes, Daniel R Ganger, Yuli Kim, Mustafa Bashir, Julie Bonn, Amir Borhani, David Fetzer, Ryan Fischer, Helena Gabriel, Maha Guindi, Elizabeth Hecht, Maarouf Hoteit, Geetika Khanna, Richard Krasuski, Sara Lewis, Alisha Mavis, Frank Miller, Cara Morin, Thomas Schiano, Gary Schooler, Alexandra Shingina, Claude Sirlin, Amit Singal, Bachir Taouli, Rose Tompkins, Ali Zaidi, Lisa VanWagner, Takeshi Yokoo","doi":"10.1097/LVT.0000000000000622","DOIUrl":"10.1097/LVT.0000000000000622","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1185-1189"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795816","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}