Liver Transplantation最新文献

{"title":"Can we safely scale RAPID in transplant oncology?","authors":"Matthew M Byrne, Cristina Jimenez-Soto, Abigail Loszko, Roberto Hernandez-Alejandro","doi":"10.1097/LVT.0000000000000621","DOIUrl":"10.1097/LVT.0000000000000621","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1085-1086"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764327","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":"Center-level variations are associated with disparate waitlist mortality and probability of liver transplant in MELD 35 and greater patients.","authors":"Andrew Melehy, Dominic Amara, Shreya Gumate, Samer Ebaid, Fady M Kaldas, Douglas G Farmer, Alex A T Bui, Vatche G Agopian","doi":"10.1097/LVT.0000000000000616","DOIUrl":"10.1097/LVT.0000000000000616","url":null,"abstract":"<p><p>Liver transplant (LT) centers may have variations in their approach to high-acuity (MELD ≥35) candidates for listing and transplantation. We investigated center-specific differences in waitlist outcomes, probability of LT, and post-LT survival in MELD ≥35 patients. Adult candidates of LT (MELD ≥35) were identified from the Scientific Registry of Transplant Recipients between January 1, 2010, and April 1, 2022. Waitlist mortality was modeled with the center as a random effect. Centers were grouped based on the random effect coefficient, with the highest tertile representing the highest risk group (comprises centers with the highest risk of waitlist mortality attributable to the center). Cumulative incidence of death/delisting, probability of LT, and 1-year post-LT survival were compared, with patients stratified by a listing MELD ≥35 or increase to MELD ≥35 after listing. In patients who increased to MELD ≥35, the 1-year cumulative incidence of death/delisting was highest (50%) and the probability of transplant lowest (46%) in the high-risk group, compared to the low-risk group (37% and 55%, p <0.001 for both comparisons). For patients receiving an LT, post-transplant survival did not differ among the groups, though high-risk centers transplanted far less high-acuity patients. These variations may indicate that certain centers are associated with substantially decreased waitlist mortality for the highest acuity patients without corresponding decreases in post-transplant survival.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1100-1110"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764329","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: The evolution of continuous distribution in liver transplantation.","authors":"Yeshika Sharma, Conner Fishbach, Shivang Mehta","doi":"10.1097/LVT.0000000000000643","DOIUrl":"10.1097/LVT.0000000000000643","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1183-1184"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150986","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":"Optimizing the mouse orthotopic liver transplantation model: Learning curve, technical enhancements, and keys to success.","authors":"Zipei Wang, Linrui Dai, Daqiang Zhao, Peixiang Lan, Yuanyuan Zhao, Lai Wei, Dong Chen, Bo Zhang, Dunfeng Du, Zhishui Chen","doi":"10.1097/LVT.0000000000000612","DOIUrl":"10.1097/LVT.0000000000000612","url":null,"abstract":"<p><p>Due to the easier availability of transgenic mice and reagents, the mouse orthotopic liver transplantation model offers significant advantages in liver transplantation research. However, technical challenges have limited its broader application. The most challenging steps of the procedure include manual anastomosis of the suprahepatic vena cava, cuff anastomosis of the portal vein, and maintaining the anhepatic phase within 20 minutes. This study aims to provide detailed solutions to overcome these bottlenecks and introduces a modified magnetic device to facilitate safer and more efficient cuff anastomosis. We also describe the learning curve for beginners to achieve a 30-day survival rate exceeding 90% in mouse orthotopic liver transplantation. We demonstrate that mouse orthotopic liver transplantation can be mastered within 8 months of continuous practice, with 7-day and 30-day survival rates improving from 0% to 96.7% and 0% to 93.3%, respectively. The entire procedure can be completed within 80 minutes. We believe these technical improvements will provide more practical guidance for mouse liver transplantation.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1123-1134"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12363319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700826","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":"Social determinants of health are associated with liver transplant evaluation and listing in a safety-net referral cohort.","authors":"Saroja Bangaru, Mark C Wang, Matt Sumethasorn, Sarah Wang, Christopher Wong, Sabrina Omer, Nicole Kim, Sachin Shah, Mignote Yilma, Michele Tana, Neil Mehta, Jihane N Benhammou, Kali Zhou","doi":"10.1097/LVT.0000000000000632","DOIUrl":"10.1097/LVT.0000000000000632","url":null,"abstract":"<p><p>Among safety-net hospital (SNH) patients, little is known about the care cascade to liver transplantation (LT) and the clinical and psychosocial factors that impact evaluation and listing. We obtained clinical and psychosocial data on all patients referred for LT at our SNH from 2016 to 2020. Univariate and multivariate Cox regression were performed to determine factors associated with evaluation and listing for LT. A total of 472 safety-net patients were referred. Seventy-six percent completed an evaluation, out of which 58% were listed. In adjusted models, metabolic-associated steatotic liver disease versus alcohol-associated liver disease as etiology increased odds of evaluation (OR: 6.89, 95% CI: 2.17-21.89) while lack of stable housing (0.30, 0.13-0.71) and <6 months of abstinence (0.22, 0.10-0.46) reduced odds of evaluation. Living in a house rather than rental (2.05, 1.19-3.52); having ample versus limited or no social support (7.86, 3.93-15.73); and having a MELD >25 (vs. ≤25) (3.71, 1.44-9.51) were associated with increased odds of listing while history of polysubstance abuse reduced odds of listing (0.40, 0.19-0.83). A sensitivity analysis including an existing multicenter cohort re-demonstrated the significance of residence, adequacy of social support, and MELD score in the probability of listing. Social determinants of health were key to successful evaluation and listing for LT among referred SNH patients and provided targets for intervention.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1089-1099"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111161","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 the 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":"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 1470 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 3 years after the 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 living donor liver transplantation centers, with 6 centers increasing living donor liver transplantation 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, living donor liver transplantation 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":" ","pages":"989-997"},"PeriodicalIF":4.7,"publicationDate":"2025-08-01","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":"Material economic hardships are associated with adverse 1-year outcomes after pediatric liver transplantation: Prospective cohort results from the multicenter SOCIAL-Tx Study.","authors":"Sharad I Wadhwani, James E Squires, Evelyn Hsu, Nitika Gupta, Kathleen Campbell, Shannon Zielsdorf, Jennifer Vittorio, Dev M Desai, Noelle H Ebel, Amy M Shui, John C Bucuvalas, Laura M Gottlieb, Courtney R Lyles, Jennifer C Lai","doi":"10.1097/LVT.0000000000000554","DOIUrl":"10.1097/LVT.0000000000000554","url":null,"abstract":"<p><p>Pediatric liver transplant outcomes exhibit disparities, necessitating the identification of modifiable risk factors to develop targeted interventions. We characterized associations between household material economic hardship (eg, financial barriers to housing or food) and pediatric liver transplant outcomes. We recruited pediatric recipients of liver transplants <18 years at the time of transplant across 8 US centers. Our primary exposure was ≥1 household material economic hardship (ie, food insecurity, housing instability, transportation challenges, or utility concerns), measured using the Accountable Healthcare Communities screening tool. Outcomes included 90-day and 1-year (1) total inpatient bed-days, and (2) episodes of T-cell-mediated rejection. Of the 77 participants (36% female), 34% reported household material economic hardship. Such hardship was associated with increased total inpatient bed-days within 90 days (ratio estimate: 1.45, 95% CI: 1.08, 1.96); the association persisted after adjusting for health literacy, insurance, and transplant center (ratio estimate: 1.37, 95% CI: 1.02, 1.84). Household material economic hardship was associated with total inpatient bed-days within 1 year after transplant (ratio estimate: 3.2, 95% CI: 1.1, 10.1); associations diminished in multivariable analyses (ratio estimate: 2.2, 95% CI: 0.7, 6.9). Household material economic hardship was associated with increased risk of T-cell-mediated rejection within 1 year of transplant (relative risk: 2.1, 95% CI: 1.1, 4.2); the association diminished in propensity-score matched analyses (relative risk: 1.4, 95% CI: 0.9, 2.3). Our findings highlight the adverse influence of household material economic hardship on pediatric liver transplant outcomes within the first year. Targeted social risk assistance and adjustment strategies offer actionable avenues to mitigate these challenges and enhance outcomes in pediatric recipients of liver transplants.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1042-1052"},"PeriodicalIF":3.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12167753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847006","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":"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":"10.1097/LVT.0000000000000594","url":null,"abstract":"<p><p>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). We performed a retrospective multicenter cohort study including consecutive patients with ALF within the United States ALF Study Group (USALFSG) prospective registry from 2010-2016. The failure to rescue rate for 12 medical complications in the registry was calculated as the mortality events up to 21 days after inclusion divided by the complication events registered on the first day after inclusion. The association between these complications and 21-day transplant-free mortality was studied. Among 665 patients with ALF, 478 (71.9%) were females, and the 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 after 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 gastrointestinal bleed (63.6%), non-gastrointestinal bleed (53.9%), requirement for vasopressors (52.5%), and acute respiratory distress syndrome (48.1%). After adjusting for age, sex, etiology, and international normalized ratio, per each added complication present on day 1, the odds of 21-day transplant-free mortality increased by 38% (adjusted OR [95% CI] of 1.38 [1.24-1.54]; c-statistic [95% CI] of 0.77 [0.73-0.81]). 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":"982-988"},"PeriodicalIF":3.9,"publicationDate":"2025-08-01","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":"Fellows' Corner.","authors":"Matthew Dukewich","doi":"10.1097/LVT.0000000000000628","DOIUrl":"10.1097/LVT.0000000000000628","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"973-974"},"PeriodicalIF":3.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990161","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":"CON: It's time for new strategies to optimize liver transplant immunosuppression.","authors":"Michael Dybala, Nivetha Saravanan, Josh Levitsky","doi":"10.1097/LVT.0000000000000572","DOIUrl":"10.1097/LVT.0000000000000572","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"1070-1075"},"PeriodicalIF":4.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007884","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}