Liver Transplantation最新文献

{"title":"Cystatin C in decompensated cirrhosis: Shedding the excess baggage in clinical practice.","authors":"Erin F Barreto, Olivia C Walker, Sumeet K Asrani","doi":"10.1097/LVT.0000000000000516","DOIUrl":"10.1097/LVT.0000000000000516","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469073","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: Improved outcomes of ABO incompatible living donor liver transplant with biologically related donor.","authors":"Priya Ranjan, Nishant Pathak, Subhash Gupta, Shaleen Agarwal","doi":"10.1097/LVT.0000000000000519","DOIUrl":"10.1097/LVT.0000000000000519","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469076","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":"Does the introduction of acuity circle policy change split liver transplantation practice?","authors":"Toshihiro Nakayama, Miho Akabane, Yuki Imaoka, Carlos O Esquivel, Marc L Melcher, Kazunari Sasaki","doi":"10.1097/LVT.0000000000000513","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000513","url":null,"abstract":"<p><p>With the Acuity Circles (AC) policy aiming to reduce disparities in liver transplantation (LT) access, the allocation of high-quality grafts has shifted, potentially affecting the use and outcomes of split LT. Data from the United Network for Organ Sharing (UNOS) database (February 4, 2016, to February 3, 2024) were analyzed, including 1,470 candidates who underwent deceased donor split LT, with 681 adult and 789 pediatric cases. The study periods were divided into pre-AC (February 4, 2016, to February 3, 2020) and post-AC (February 4, 2020, to February 3, 2024). The study assessed changes in split LT volumes and examined the impact of center practices. Both adult and pediatric split LTs decreased in the initial three years post-policy change, followed by an increase in the final year, with an overall 11.9% and 13.9% decrease between the eras. Adult female split LT cases remained consistent, ensuring access for smaller recipients. High-quality \"splittable\" livers were increasingly allocated to high MELD patients (MELD-Na ≥30). Despite the overall decrease in case volume, adult split LT volume increased in newly active LDLT centers, with six centers increasing LDLT volume by over 50.0%. Pediatric split LT volumes decreased despite additional priorities for pediatric candidates. The number of split LTs decreased in the initial period after the AC policy introduction, but there was a consistent need for small female candidates. In the adult population, LDLT and split LT demonstrated a synergistic effect in boosting center transplant volumes, potentially improving access for female candidates who need small grafts.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469074","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":"Where your liver lives matters: How neighborhoods shape transplant outcomes.","authors":"Valerie L Thompson, Alexandra T Strauss","doi":"10.1097/LVT.0000000000000510","DOIUrl":"10.1097/LVT.0000000000000510","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400687","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: Does the utilization of machine perfusion require a boundary for livers donated after circulatory death?","authors":"Emil Bluhme, Carl Jorns","doi":"10.1097/LVT.0000000000000506","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000506","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576351","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":"Role of mentorship in the learning curve of robotic right lobe donor hepatectomy.","authors":"Roberto Ivan Troisi","doi":"10.1097/LVT.0000000000000511","DOIUrl":"10.1097/LVT.0000000000000511","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400686","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":"Analysis of treatment benefits and prognostic factors for posttransplant HCC recurrence in a large Euro-American-Asian cohort.","authors":"Zhihao Li, Itsuko Chih-Yi Chen, Leonardo Centonze, Christian T J Magyar, Woo Jin Choi, Sachin Shah, Grainne M O'Kane, Arndt Vogel, Luciano De Carlis, Jan Lerut, Quirino Lai, Neil Mehta, Chao-Long Chen, Gonzalo Sapisochin","doi":"10.1097/LVT.0000000000000501","DOIUrl":"10.1097/LVT.0000000000000501","url":null,"abstract":"<p><p>Posttransplant HCC recurrence significantly impacts survival, yet its management is challenging due to limited evidence. With recent advancements in HCC treatment, updated data on managing recurrent diseases are needed. In this retrospective study across 6 centers (2000-2022), we employed Cox proportional-hazards regression and log-rank tests to assess survival differences. A prognostic score model was developed to categorize patient survival. The efficacy of tyrosine kinase inhibitors was evaluated through propensity score matching. In our study, 431 of 3349 (14%) patients with HCC who underwent transplantation developed recurrence within a median interval of 18 (IQR: 9-32) months. One hundred forty-seven (34%) underwent curative-intent treatments, 207 (48%) received palliative treatments, and 77 (18%) were given best-supportive care. Patients undergoing curative-intent treatments had better survival from the time of recurrence with a median survival of 45 (95% CI: 36-63) months and 1/3/5-year survival of 90%/56%/43% compared to those receiving noncurative treatments (median: 11 [95% CI: 10-13] mo, 1/3/5-y survival of 46%/10%/7%, log-rank p < 0.001). Patients with recurrence diagnosed in the era 2018-2022 showed improved survival over the previous era (HR 0.64 [95% CI: 0.47-0.86]). Multivariable analysis identified 5 prognostic factors: ineligibility for curative-intent treatment (HR: 3.5 [95% CI: 2.7-4.6]), recurrence within 1 year (HR: 1.7 [95% CI: 1.3-2.1]), poor tumor differentiation (HR: 1.5 [95% CI: 1.1-1.9]), RETREAT score ≥3 (HR: 1.4 [95% CI: 1.1-1.8]), and alpha-fetoprotein at recurrence ≥400 ng/mL (HR: 1.4 [95% CI: 1.1-1.9]). These factors contributed to a prognostic scoring system (0-9) that stratified patients into 3 prognosis groups. Both propensity score-matched analysis and multivariable regression indicated that lenvatinib was not statistically superior to sorafenib in terms of efficacy. Curative-intent treatments should be advocated for patients with posttransplant recurrence whenever possible. Prognostic factors linked to aggressive tumor biology significantly influence survival. Advancements in HCC management have improved survival outcomes over the past 5 years.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361739","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":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-10-03","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":"Marked variation in disease acuity and outcomes on the liver transplant waiting list by sociodemographic characteristics.","authors":"Whitney E Jackson, Rocio Lopez, Lisa M Forman, Susana Arrigain, Jesse D Schold","doi":"10.1097/LVT.0000000000000502","DOIUrl":"10.1097/LVT.0000000000000502","url":null,"abstract":"<p><p>Understanding the association of social determinants of health with liver transplant listing and waitlist outcomes can inform health care policy and interventions aimed at improving access to care. We analyzed the Scientific Registry of Transplant Recipients database merged with the Social Deprivation Index (SDI) to evaluate if the area of residence is associated with the Model for End-Stage Liver Disease incorporating sodium (MELD-Na) at the time of waitlist placement and outcomes following waitlisting, and if this varied based on sociodemographic variables. Compared to candidates residing in areas of low SDI, those residing in areas of high SDI (most socioeconomic disadvantage) had 11% higher adjusted likelihood (aOR [95% CI] = 1.11 [CI 1.05,1.17]) of being listed for transplant with a MELD-Na score ≥30; this was not statistically significant when also adjusted for race/ethnicity (aOR = 1.02 [0.97,1.08]). When stratified by race/ethnicity, residing in an area of high SDI was associated with a MELD-Na score ≥30 at the time of waitlisting among Hispanic White candidates (aOR = 1.24, 95% CI: 1.04, 1.49). Candidates residing in areas of high SDI had an 8% lower chance (adjusted hazard ratio [aHR] = 0.92 [0.88,0.96]) of undergoing a liver transplant, a 6% higher risk of death (aHR = 1.06 [1.002,1.13]), and a 20% higher risk (aHR = 1.20 [1.13,1.28]) of removal on the waitlist independent of race, ethnicity, insurance status, or sex. In the United States, residence in areas of high socioeconomic disadvantage is significantly associated with higher MELD-Na at the time of waitlisting among Hispanic White candidates. In addition, residence in areas of high socioeconomic disadvantage was associated with a higher risk of death or removal from the waitlist and lower chances of receiving a liver transplant after waitlist placement, particularly among Non-Hispanic White candidates and older candidates.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361740","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":"Value of Factor V in the diagnosis of early graft dysfunction after liver transplantation: Internal validation.","authors":"Claudia Sanchez-Gonzalez, José L Fernández Aguilar, Belinda Sánchez Pérez, Julio Santoyo Santoyo","doi":"10.1097/LVT.0000000000000500","DOIUrl":"10.1097/LVT.0000000000000500","url":null,"abstract":"<p><p>Primary graft dysfunction is a major early complication following liver transplantation, potentially leading to retransplantation or patient death. Coagulation Factor V (FV) and ALT have emerged as important biomarkers in assessing liver function, yet their role as early predictors of graft loss has not been fully validated. The aim of this study is to conduct an internal validation of published results on the applicability of FV and ALT for diagnosing graft dysfunction and its predictive ability for graft loss within the first 90 days. We conducted a retrospective cohort study including 513 adult recipients from 2012 to 2023 at the Regional University Hospital of Málaga. FV and ALT levels were measured on postoperative day 2, and patients were categorized based on FV <37.5 and ALT >1539. The association with 90-day graft loss was analyzed. Graft loss occurred in 43 patients (8.4%) within the first 90 days. The combination of FV <37.5 and ALT >1539 on postoperative day 2 demonstrated a specificity of 99% and a test efficiency of 94% in predicting graft loss. Patients meeting both criteria had a 74-fold increased risk of graft loss, with most losses occurring within the first week, and a median survival of 4 days. These findings suggest that FV and ALT on postoperative day 2 are reliable early markers for predicting graft loss, enabling risk stratification and guiding critical decisions regarding early retransplantation in the immediate postoperative period.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349438","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}