Liver Transplantation最新文献

{"title":"Characterizing practice variations in the care of hospitalized patients with cirrhosis across the University of California Health.","authors":"Jin Ge, Albert Lee, Oksana Gologorskaya, Aryana T Far, Asal Bastani, Chiung-Yu Huang, Mark J Pletcher, Jennifer C Lai","doi":"10.1097/LVT.0000000000000630","DOIUrl":"10.1097/LVT.0000000000000630","url":null,"abstract":"<p><p>Despite publicly available practice guidelines, in-hospital cirrhosis care remains highly variable. Prior studies of cirrhosis guideline adherence have been limited by administrative claims data. We aimed to overcome these limitations by using a novel multicenter electronic health record (EHR) database, the University of California Health Data Warehouse (UCHDW), to compare guideline adherence in the 5 medical centers of the University of California Health (UCH). We identified adult patients with cirrhosis hospitalized from 2013 to 2022. We evaluated adherence to 5 care quality measures applicable to inpatients. We used t tests to compare pairwise differences between individual UCH sites. We assessed the impact of patient-level and center-level factors (transplant services) through multivariate logistic regressions. We identified 17,249 patients with cirrhosis with 31,512 admissions: 39% women, 43% White, 31% Hispanic/Latino, 11% Asian, 7% Black/African-American, and 8% Unknown/Other. In pairwise comparisons, we found differences in adherence rates across all measures except for antibiotics for gastrointestinal bleeding. In multivariate modeling, we found positive associations between care at transplant centers and receiving paracenteses for those admitted for ascites or HE, albumin/antibiotics for those admitted for spontaneous bacterial peritonitis, endoscopy for those admitted for gastrointestinal bleeding, and lactulose for those admitted for HE. In addition, we observed negative associations between Black/African-American race and guideline adherence for receiving paracenteses for ascites or HE. Through our analyses of high-dimensional EHR data, we found significant differences in care associated with admissions at the transplant center and race/ethnicity. Our use of high-dimensional EHR data indicates that there is still significant room for improvement in the provision of high-quality cirrhosis care.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990156","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":"Safety and efficacy of continuous infusion terlipressin (BIV201): A phase 2 trial in patients with decompensated cirrhosis and refractory ascites.","authors":"Jasmohan S Bajaj, Ethan M Weinberg, K Rajender Reddy, Andrew P Keaveny, Michael K Porayko, David Koch, Paul J Thuluvath, Douglas A Simonetto, Paolo Angeli, Sujit V Janardhan, Eric S Orman, Jeffrey Zhang, Susan Clausen, Elisa Dauphinée, Joseph Palumbo, Penelope Markham","doi":"10.1097/LVT.0000000000000623","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000623","url":null,"abstract":"<p><p>Refractory ascites often requires therapeutic paracentesis (TP), which is associated with potential risks and diminished quality of life (QoL). Terlipressin is a vasopressin analog that is indicated as an IV bolus injection for hepatorenal syndrome, with the potential to reduce large-volume ascites and its complications. Continuous infusion of terlipressin is associated with fewer adverse effects than bolus dosing. The efficacy and safety of continuous infusion of a novel liquid formulation of terlipressin acetate (BIV201) were evaluated in this open-label phase 2 study. Patients with cirrhosis and refractory ascites were randomly assigned (2:1) to receive two 28-day cycles of continuous infusion BIV201 plus standard of care (SOC) separated by a ≤56-day washout (n=10), or SOC alone (n=5). Data analysis was limited by the small sample size and confounded by a potential interaction with gabapentinoids in the BIV201+SOC group. Nonetheless, there were differences in favor of BIV201+SOC versus SOC in the coprimary efficacy endpoints and several QoL assessments. The beneficial effects of BIV201 on liver complications (mean: 90% CI; BIV201-completers=2.87: 1.51; 5.46 vs. SOC=2.38: 1.20; 4.73) and the change in cumulative ascites (mean; 90% CI; BIV201-completers=-10.76: -26.51; 5.00 vs. SOC=-4.99: -21.95; 11.97) were more pronounced versus SOC in the 5 BIV201+SOC patients who completed both treatment cycles. There were also greater improvements in exploratory QoL assessments and the percent change in TPs with BIV201+SOC (-27.94±41.80) versus SOC (-16.67±45.64). Despite the high rate of hyponatremia in the BIV201+SOC group (4/10 patients), the safety profile suggested that continuous BIV201 infusion was well tolerated. These findings support further development of BIV201 in confirmatory trials.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017921","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":"Living-donor availability improves pediatric patient survival in a large North American center: An intention-to-treat analysis.","authors":"Zhihao Li, Owen Jones, Fernanda Takamatsu, Jennifer Stunguris, Christian T J Magyar, Nazia Selzner, Binita Kamath, Yaron Avitzur, Simon Ling, Nicola Jones, Robert H J Bandsma, Mar Miserachs, Gonzalo Sapisochin, Mark Cattral, Anand Ghanekar, Asad Siddiqui, Vicky L Ng, Blayne A Sayed","doi":"10.1097/LVT.0000000000000629","DOIUrl":"10.1097/LVT.0000000000000629","url":null,"abstract":"<p><p>Although living-donor liver transplantation (LDLT) is increasingly adopted for pediatric liver transplantation, there is limited data on whether live donation extends benefits to patients from the time of listing. This study investigated the benefits of pediatric LDLT through an intention-to-treat analysis. Pediatric candidates listed between 2001 and 2023 at a single Canadian center were categorized as pLDLT (with a potential live donor) or pDDLT (without a live donor). The primary endpoint was overall survival from the time of listing. The secondary endpoint involved the waitlist outcomes described by the probabilities of receiving liver transplantation or waitlist dropout. Among 474 candidates, 219 (46.2%) had potential live donors. The pLDLT group had a higher likelihood of receiving a liver transplantation (adjusted HR: 1.38, 95% CI: 1.16-1.64) and a lower risk of dying without a transplant (adjusted HR: 0.11, 95% CI: 0.01-0.82) compared to the pDDLT group. Survival rates from the time of listing were significantly better in the pLDLT group at 1-(98.6% vs. 87.6%), 5-(96.6% vs. 84.4%), and 10-(96.6% vs. 83.1%) years. Having a potential live donor was linked to a 72% reduction in mortality risk (adjusted HR: 0.28, 95% CI: 0.12-0.64). Although the number of patients listed annually increased over the study period, the waiting time for deceased donation shortened. This correlated with increased LDLT utilization, suggesting LDLT not only improved outcomes but also shortened wait times even for pDDLT patients. Having a potential live donor is associated with substantial survival benefit. Pediatric programs offering LDLT can expand the donor pool and decrease the waiting time for DDLT, supporting the argument for making LDLT a standard for pediatric candidates.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021364","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":"https://doi.org/10.1097/LVT.0000000000000628","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-22","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":"PRO MELD: MELD is the best method of prioritization for liver transplantation.","authors":"Vivek Charu, W Ray Kim, Allison J Kwong","doi":"10.1097/LVT.0000000000000626","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000626","url":null,"abstract":"<p><p>■■■■.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024470","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":"PRO AI: AI-augmented allocation is in our future-We should invest the necessary resources today.","authors":"Jin Ge","doi":"10.1097/LVT.0000000000000625","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000625","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007687","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":"NT-proBNP predicts the development of acute-on-chronic liver failure and mortality in patients with cirrhosis listed for liver transplantation.","authors":"Juan Manuel Diaz, Rocio Blanco, Lorena Savluk, María Nelly Gutierrez-Acevedo, Agustina Martinez Garmendia, Carlos de la Peña-Ramirez, Sebastián Marciano, Juan Carlos Spina, Ignacio Bluro, Adrián Gadano, Diego Giunta, Joan Clària, Javier Fernandez, Ezequiel Mauro","doi":"10.1097/LVT.0000000000000624","DOIUrl":"10.1097/LVT.0000000000000624","url":null,"abstract":"<p><p>Acute-on-chronic liver failure (ACLF) is a major clinical event in cirrhosis that is characterized by high mortality rates and a short window for liver transplantation. N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been suggested as a prognostic biomarker in cirrhosis. However, its accuracy in predicting the development of ACLF or mortality in candidates for liver transplantation remains unknown. This observational, retrospective, single-center study included 277 consecutive patients with cirrhosis who were listed for liver transplantation between 2014 and 2020 in Hospital Italiano, Buenos Aires, Argentina. Clinical data, including sarcopenia, serum cystatin C (CysC), and NT-proBNP levels, were collected at listing. The median MELD-Na and NT-proBNP levels at the time of listing were 16 points (13-22) and 123 (58-257) pg/mL, respectively. High NT-proBNP levels (≥125 pg/mL) were associated with the development of ACLF (subhazard ratio: 4.00, 95% CI: 1.76-9.10; p <0.001) and mortality (subhazard ratio: 3.89, 95% CI: 1.28-11.79, p =0.02) after adjusting for MELD-Na and CysC. Patients with NT-proBNP ≥125 pg/mL showed a significantly higher incidence of ACLF at 3 months (28.5% vs. 3.6%; p <0.001) and 12 months (49.2% vs. 6.1%; p <0.001). Mortality in the waiting list at 1 year was also significantly higher in patients with NT-proBNP ≥125 pg/mL (22.3% vs. 4%; p <0.001). Serum NT-proBNP emerges as a promising prognostic biomarker for ACLF development and mortality in patients with cirrhosis on the waiting list. Its integration into clinical practice could facilitate preventive interventions and improve prioritization on the waiting list.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027502","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":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-21","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":"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":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-08","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}

{"title":"Robotic living donor hepatectomy: Redefining global standards in living donor liver transplant.","authors":"Adeel S Khan, Phillipe Abreu","doi":"10.1097/LVT.0000000000000620","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000620","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764336","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}