Liver Transplantation最新文献

{"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":" ","pages":"623-629"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","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":"Machine perfusion strategies in liver transplantation: A systematic review, pairwise, and network meta-analysis of randomized controlled trials.","authors":"Fouad Jaber, Mohamed Abuelazm, Youssef Soliman, Mahmoud Madi, Husam Abusuilik, Ahmed Mazen Amin, Abdallah Saeed, Ibrahim Gowaily, Basel Abdelazeem, Abbas Rana, Kamran Qureshi, Tzu-Hao Lee, George Cholankeril","doi":"10.1097/LVT.0000000000000567","DOIUrl":"10.1097/LVT.0000000000000567","url":null,"abstract":"<p><p>Machine perfusion (MP), including hypothermic oxygenated machine perfusion (HOPE), dual HOPE, normothermic machine perfusion (NMP), NMP ischemia-free liver transplantation (NMP-ILT), and controlled oxygenated rewarming (COR), is increasingly being investigated to improve liver graft quality from extended criteria donors and donors after circulatory death and expand the donor pool. This network meta-analysis investigates the comparative efficacy and safety of various liver MP strategies versus traditional static cold storage (SCS). We searched PubMed, Scopus, Web of Science, and Cochrane Controlled Register of Trials for randomized controlled trials comparing liver transplantation outcomes between SCS and MP techniques. The primary outcome was the incidence of early allograft dysfunction. Secondary endpoints included 1-year graft survival, the incidence of graft failure/loss, post-reperfusion syndrome, biliary complications, the need for renal replacement therapy, graft-related patient mortality, and the length of intensive care unit and hospital stay. R-software was used to conduct a network meta-analysis using a frequentist framework (PROSPERO ID: CRD42024549254). We included 12 randomized controlled trials involving 1628 patients undergoing liver transplantation (801 in the liver MP groups and 832 in the SCS group). Compared to SCS, HOPE/dHOPE, but not other MP strategies, was associated with a significantly lower risk of early allograft dysfunction (RR: 0.53, 95% CI [0.37, 0.74], p =0.0002), improved 1-year graft survival rate (RR: 1.07, 95% CI [1.01, 1.14], p =0.02), decreased graft failure/loss (RR: 0.38, 95% CI [0.16, 0.90], p =0.03), and reduced the risk of biliary complications (RR: 0.52, 95% CI [0.43, 0.75], p < 0.0001). Compared to SCS, NMP (RR: 0.49, 95% CI [0.24, 0.96]) and NMP-ILT (RR: 0.15, 95% CI [0.04, 0.57]), both significantly reduced the risk of postperfusion syndrome. There is no difference between SCS and MP groups in the risk of renal replacement therapy, graft-related patient mortality, and intensive care unit and hospital stay length. Our meta-analysis showed that HOPE/dual-HOPE is a promising alternative to SCS for donor liver preservation. These new techniques can help expand the donor pool with similar or even better post-liver transplantation outcomes.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"596-615"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047147","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":"Prolonged time from cross-clamp until normothermic machine perfusion start is associated with an increased risk of early allograft dysfunction following DCD liver transplant.","authors":"Charles Lee, Amit K Mathur, Shennen Mao, Julie K Heimbach, C Burcin Taner, Bashar Aqel, Kristopher P Croome","doi":"10.1097/LVT.0000000000000548","DOIUrl":"10.1097/LVT.0000000000000548","url":null,"abstract":"<p><p>There is a paucity of data on the impact of cold ischemia time before the initiation of normothermic machine perfusion (NMP), particularly in more susceptible organs such as livers from donation after circulatory death (DCD) donors. The present analysis aimed to investigate the impact of prolonged time from cross-clamp until NMP start on early allograft dysfunction and other peri-liver transplant (LT) outcomes. All DCD LT performed and placed on NMP at Mayo Clinic Arizona, Florida, and Rochester from January 2022 to March 2024 were included. The decision was made a priori to divide the population into 2 groups based on terciles: typical cross-clamp to on-pump time (lower 2 terciles) versus prolonged cross-clamp to on-pump time (upper tercile; >2 h 45.6 min). Three hundred eighty-four DCD LT undergoing NMP met the inclusion criteria. The rate of early allograft dysfunction was significantly higher in the prolonged cross-clamp to on-pump group (51.2%) compared to the typical cross-clamp to on-pump group (37.6%) ( p = 0.01). The prolonged cross-clamp to on-pump group also had higher rates of acute kidney injury and the number of packed red blood cells transfused during LT. No significant difference in ischemic cholangiopathy (2.4% vs. 3.1%; p = 0.68) or graft survival at 12 months was seen between the prolonged cross-clamp to on-pump and typical cross-clamp to on-pump group, respectively. Following cross-clamp, DCD liver grafts should be placed on the NMP pump as quickly as is safely and logistically possible. In cases where delays are unavoidable, such as waiting for biopsy results or liver reallocation with another center, acceptable results can still be achieved, and therefore, livers with prolonged times should still be used.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"616-622"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801389","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":"Postoperative heartbreak: Takotsubo cardiomyopathy following liver transplantation.","authors":"Devang R Amin, Patricia P Bloom, Nicole M Bhave","doi":"10.1097/LVT.0000000000000562","DOIUrl":"10.1097/LVT.0000000000000562","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"567-568"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886002","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":"Development of posttransplant diabetes mellitus in US recipients of liver transplant is influenced by OPTN region.","authors":"Mohammad Qasim Khan, Kymberly D Watt, Chloe Teasdale","doi":"10.1097/LVT.0000000000000508","DOIUrl":"10.1097/LVT.0000000000000508","url":null,"abstract":"<p><p>Posttransplant diabetes mellitus (PTDM) is associated with significant morbidity and mortality in liver transplant recipients (LTRs). We used the Organ Procurement and Transplantation Network (OPTN) database to compare the incidence of developing PTDM across the United States and develop a risk prediction model for new-onset PTDM using OPTN region as well as donor-related, recipient-related, and transplant-related factors. All US adult, primary, deceased donor, LTRs between January 1, 2007, and December 31, 2016, with no prior history of diabetes noted , were identified. Kaplan-Meier estimators were used to calculate the cumulative incidence of PTDM, stratified by OPTN region. Multivariable Cox proportional hazards models were fitted to estimate hazards of PTDM in each OPTN region and build a risk prediction model, through backward selection. Cumulative incidence of PTDM at 1 year, 3 years, and 5 years after transplant was 12.0%, 16.1%, and 18.9%, respectively. Region 3, followed by regions 8, 2, and 9, had the highest adjusted hazards of developing PTDM. Inclusion of OPTN region in a risk prediction model for PTDM in LTRs (including recipient age, sex, race, education, insurance coverage, body mass index, primary liver disease, cold ischemia time, and donor history of diabetes) modestly improved performance (C-statistic = 0.60). In patients without pre-existing, confirmed diabetes mellitus, the incidence of PTDM in LTRs varied across OPTN regions, with the highest hazards in region 3, followed by regions 8, 2, and 9. The performance of a novel risk prediction model for PTDM in LTRs has improved performance with the inclusion of the OPTN region. Vigilance is recommended to centers in high-risk regions to identify PTDM and mitigate its development.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"637-647"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895855","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":" ","pages":"584-595"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","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":"Early living donor liver transplantation for alcohol-associated hepatitis: Status in the era of increasing demand, unmet needs, and future considerations.","authors":"Anand V Kulkarni, Anji Wall, K Rajender Reddy, Therese Bittermann","doi":"10.1097/LVT.0000000000000448","DOIUrl":"10.1097/LVT.0000000000000448","url":null,"abstract":"<p><p>Hazardous alcohol consumption is the leading cause of liver disease worldwide. Alcohol-associated hepatitis (AH) is an acute and serious presentation of alcohol-associated liver disease that is associated with high short-term mortality. Medical management remains limited to corticosteroid therapy and intensive nutrition but improves survival in <50% of individuals. Liver transplantation (LT) is increasingly recognized as a treatment option for many patients with AH and may lead to greater survival benefits than medical management alone. The rate of waitlistings and LTs for AH has doubled in recent years, especially in the United States. Several studies from the West have reported early LT for AH to be successful, where deceased donor LT is the norm. The challenges of LT in living donor centers, particularly for those with AH, are unique and have previously not been discussed in depth. In this review, we aim to discuss the challenges unique to LDLT with respect to candidate and donor selection, ethical considerations, disparities in LDLT, post-LT alcohol relapse, and measures to prevent them while also addressing the definitions and outcomes of early-living donor liver LT for AH.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"668-681"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788569","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":"Noninvasive assessment of renal dysfunction in patients with end-stage liver disease: New solutions for old problems?","authors":"Simone Incicco, Carmine Gambino","doi":"10.1097/LVT.0000000000000566","DOIUrl":"10.1097/LVT.0000000000000566","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"563-564"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950881","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: Normothermic regional perfusion in controlled DCD liver procurement: Comparable outcomes to DBD liver transplantation in 3 different European countries.","authors":"Mikel Gastaca, Patricia Ruiz, Javier Bustamante, Alberto Ventoso","doi":"10.1097/LVT.0000000000000555","DOIUrl":"10.1097/LVT.0000000000000555","url":null,"abstract":"","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"E18-E19"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829298","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":"Incidence and risk factors for chronic rejection in pediatric liver transplantation.","authors":"Peace N Dike, Deborah Schady, Ryan Himes, John A Goss, Danielle Guffey, Dana Cerminara, Krupa R Mysore","doi":"10.1097/LVT.0000000000000488","DOIUrl":"10.1097/LVT.0000000000000488","url":null,"abstract":"<p><p>Chronic rejection (CR) is a progressive immunological injury that frequently leads to long-term liver allograft dysfunction and loss. Although CR remains an important indication for retransplantation, as transplant immunosuppression has evolved, its prevalence in adults undergoing liver transplantation (LT) has declined. However, the incidence and factors that lead to CR in pediatric LT are poorly defined. Therefore, we sought to systematically measure CR's incidence and assess both the risk factors for developing CR and outcomes in a large cohort of pediatric recipients of LT. In this single-center study, we retrospectively analyzed and compared relevant recipient characteristics, surgical details, immunosuppression, graft, and patient survival in the CR and control groups over a 17-year period. After a median time of 1.9 years after LT, 19/356 recipients of LT (5.3%) developed CR in our cohort. Posttransplant lymphoproliferative disorder ( p = 0.01), infections ( p = 0.02), autoimmune liver diseases (HR = 7.3, p = <0.01), Black race (HR = 11.5, p = 0.01), and 2 or more episodes of T cell mediated rejection (HR = 5.1, p = <0.01) were associated with CR development. The retransplantation rate among CR cases was 15.8% at a median follow-up time of 4.1 years. Overall, patient survival was lower in the CR group (78.9%) versus controls (91.1%). While CR incidence in our pediatric cohort was lower than previously reported rates of >12%, the CR group had a higher graft failure rate that required retransplantation and lower overall patient survival. Thus, identifying risk factors may warrant specialized immunosuppression protocols and closer posttransplantation monitoring to reduce the risk of morbidity and mortality from CR.</p>","PeriodicalId":18072,"journal":{"name":"Liver Transplantation","volume":" ","pages":"658-667"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290406","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}