Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society最新文献

{"title":"Reply: True effect of splenic artery ligation warrants evaluation through robust statistical analyses.","authors":"Abhideep Chaudhary, Imtiakum Jamir, Niteen Kumar, Rekha Subramaniyam","doi":"10.1097/LVT.0000000000000694","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000694","url":null,"abstract":"","PeriodicalId":520704,"journal":{"name":"Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: True effect of splenic artery ligation warrants evaluation through robust statistical analyses.","authors":"Siyuan Yao, Takashi Ito","doi":"10.1097/LVT.0000000000000692","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000692","url":null,"abstract":"","PeriodicalId":520704,"journal":{"name":"Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional differences in changes in travel under the acuity circles policy for liver transplantation.","authors":"Allison E Marsh, David S Goldberg","doi":"10.1097/LVT.0000000000000693","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000693","url":null,"abstract":"","PeriodicalId":520704,"journal":{"name":"Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The cirrhosis-hospital frailty risk score predicts mortality in patients with chronic liver disease: Analysis of a nationally representative database.","authors":"Lucia Calthorpe, Jessica Rubin, Catherine Lee, Garrett Roll, Sandy Feng, Jennifer C Lai","doi":"10.1097/LVT.0000000000000691","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000691","url":null,"abstract":"<p><p>The prevalence of cirrhosis is increasing in the United States, coinciding with a demographic shift towards older and more medically complex patients. The Hospital Frailty Risk Score (HFRS) is widely used to measure comorbidity burden in administrative data. However, it is not specific to cirrhosis patients. Our group developed the cirrhosis-HFRS (cHFRS), a simplified tool that predicts in-hospital mortality among cirrhosis patients undergoing abdominal surgery. This study aims to externally validate the cHFRS in a broader cohort of hospitalized patients with chronic liver disease. Adult patients with cirrhosis were identified from the National Inpatient Sample, 2016-2018. The predictive performances of cHFRS and HFRS were compared by discrimination and calibration. Adjusted associations between cHFRS and in-hospital mortality were computed using logistic regression. Stratified analyses and formal tests for interaction assessed whether age, sex, and liver disease severity modified the association between cHFRS and mortality. Among 407,739 cirrhosis inpatients, cHFRS demonstrated superior predictive accuracy for in-hospital mortality (AUC=0.86 vs. 0.75 for HFRS, p<0.001). In adjusted models, a high cHFRS score (≥89th percentile) was associated with an increased risk of in-hospital mortality (OR=30.24, p<0.001). Interaction analysis demonstrated an increase in the magnitude of the association between cHFRS and mortality among younger patients compared to older patients (OR=41.95 for <65 years vs. OR=19.58 for ≥65 years, p<0.001). Among patients with cirrhosis, the cHFRS demonstrated superior prediction of in-hospital mortality, compared to the original HFRS score. These findings support the use of cHFRS rather than HFRS as a comorbidity index in future studies of cirrhosis patients utilizing administrative data.</p>","PeriodicalId":520704,"journal":{"name":"Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Steatotic liver disease is the dominant indication for liver transplantation in both europe and the United States: Trends and outcomes in the past two decades.","authors":"Zobair M Younossi, Giacomo Germani, Robert Wong, Maria Stepanova, Fatema Nader, Vincent Karam, Rene Adam, Saleh A Alqahtani, Linda Henry, Patrizia Burra","doi":"10.1097/LVT.0000000000000688","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000688","url":null,"abstract":"<p><strong>Background: </strong>Regional differences in liver transplantation (LT) may exist. We described liver transplant populations in the U.S. and European transplant centers over two decades.</p><p><strong>Methods: </strong>Data from two large LT registries: The United States Scientific Registry of Transplant Recipients (SRTR), and The European Liver Transplant Registry (ELTR), years 2000-2022 were compared.</p><p><strong>Results: </strong>There were 109,048 transplant recipients from ELTR (30 countries), 128,765 from SRTR with a higher proportion of hepatocellular carcinoma (HCC) in ELTR (29% vs. 20%). Chronic hepatitis B (CHB) (9% vs. 3%) and alcohol-associated liver disease (ALD) (30% vs. 23%) occurred more frequently among European transplant recipients; chronic hepatitis C (CHC) (18% vs. 27%) and NASH/MASH (7% vs. 19%) for the U.S. (all p<0.0001). The HCC proportion for both increased (SRTR peak 30% in 2015, SLTR 35% in 2016) then decreased. The most prominent trends for both were increases in ALD and decreases in CHC (trend p<0.0001). NASH/MASH also increased: SRTR 9% to 28%, ELTR 5% to 12%. From SRTR, NASH/MASH was the common etiology by 2022; ALD was the most common and fastest-growing in ELTR. In patients without HCC, the three most common etiologies were identical: ALD, NASH/MASH, primary sclerosing cholangitis. Predictors of higher post-transplant mortality included earlier calendar year, older recipient's age, male, higher MELD, grade III/IV encephalopathy, having CHC-HCC, older donor's age, small transplant center (all aHR>1.0, p<0.01), similar between ELTR and SRTR, in patients without and with HCC.</p><p><strong>Conclusions: </strong>ALD and NASH/MASH are now leading indications for liver transplantation in two large global regions.</p>","PeriodicalId":520704,"journal":{"name":"Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for in-hospital postoperative complications and 6-month graft survival after liver transplantation: A multicenter cohort study.","authors":"François M Carrier, Helen Trottier, Maxim Soucy-Proulx, Alexandre Joosten, Stuart A McCluskey, Carla Luzzi, Pritika Ghai, Kristi Papamihali, Constantine Karvellas, Sarah Larbi, Alexandre Sitbon, Antoine Monsel, Luis Eduardo Mendoza-Vasquez, Nelson Gonzalez-Valencia, Stanislas Kandelman, Abdulwahaab Nooh, Adrienne Carr, Éva Amzallag, Emmanuelle Fortin, Émilie Marceau, Jeanne-Marie Giard, Ève Simoneau, Emmanuelle Duceppe, Michaël Chassé","doi":"10.1097/LVT.0000000000000684","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000684","url":null,"abstract":"<p><p>Liver transplantation (LT) is a high-risk surgery requiring costly hospital resources. Robust multicenter data on the incidence of postoperative complications and their risk factors remains very limited. The objectives of this study were to describe the incidence and variability of postoperative complications in adult LT recipients and identify their determinants. We conducted a cohort study that included consecutive LT recipients over at least one year between January 2021 and May 2023 in eight LT centers in Canada and France. Our primary outcome was 7-day early allograft dysfunction or primary graft non-function. Our secondary outcomes included acute kidney injury (AKI) and severe complications. We measured the incidence and variability of these outcomes and their association with potential preoperative determinants using multivariable models. We reported incidences and risk ratios (RR) with 95% confidence intervals (CI). We included 852 patients. The incidence of our primary outcome, AKI and severe complications was respectively 28% [95% CI, 25% to 31%], 50% [95% CI, 47% to 54%] and 59% [95% CI, 55% to 62%]. Most outcomes were variable across centers. The primary outcome was mostly determined by donor age, body mass index, static cold ischemia time and type of donation (RR from 0.64 to 1.21). Model for End-Stage liver disease (MELD) 3.0 score and preoperative requirement for organ support were important determinants of transfusions, AKI and severe complications. The incidence of most outcomes was variable across centers. In conclusion, postoperative complications, such as graft dysfunction, AKI and severe complications, were frequent after LT. We identified risk factors, such as donor and graft characteristics, MELD 3.0 and preoperative requirement for organ support, that may inform transplant risk evaluation.</p>","PeriodicalId":520704,"journal":{"name":"Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survivorship interventions after liver transplantation (LT): A systematic review of interventions targeting physical and psychosocial wellbeing after LT.","authors":"Sarah R Lieber, Alex R Jones, Prajwal Gowda, Meena M Tadros, Olgert Bardhi, Shari S Rogal, Shannan Tujios, Arjmand R Mufti, Thomas A Kerr, Alvaro Noriega Ramirez, Lisa B VanWagner, Amit G Singal, Donna M Evon, Marina Serper","doi":"10.1097/LVT.0000000000000682","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000682","url":null,"abstract":"<p><strong>Background: </strong>Despite improved survival, liver transplantation (LT) recipients need interventions that promote survivorship including better quality of life. This scoping review describes the goals and quality of existing post-LT interventions to identify gaps in post-LT care.</p><p><strong>Methods: </strong>Published manuscripts and registered clinical trials were identified using MEDLINE, PsychINFO, Cochrane and Scopus from inception to January 1, 2024. Articles and trials were included if they described patient-facing interventions targeting health behaviors, patient-centered outcomes, or preventative health. Data extraction and intervention quality were assessed using applicable trial standards.</p><p><strong>Results: </strong>A total of 61 published manuscripts and 18 registered trials were identified in: 1) alcohol (n=14), 2) diet/nutrition (n=7), education (n=5), symptom management (n=11), preventative health (n=8), physical activity (n=19), and psychosocial issues (n=15). Most interventions were in the early phases of development or pilot testing and targeted the perioperative period up to 1-year post-LT, with fewer interventions targeting >1-year post-LT. There is good evidence to suggest that multidisciplinary programs with integrated psychiatric resources can reduce alcohol relapse post-LT; in-person multimodal interventions including individualized counseling, exercise prescriptions, and educational materials improved strength, body composition and quality of life. Multidisciplinary clinics integrating education, free resources, and clinical exams are beneficial in skin cancer prevention and cardiovascular risk modification. The best supported psychosocial interventions include support groups and in-person individualized counseling. Limited high-quality studies exist in diet/nutrition and education.</p><p><strong>Conclusion: </strong>For post-LT survivorship interventions, there is wide variation in intervention quality and limited investigation beyond 1-year post-LT. There is good evidence supporting multidisciplinary clinics/programs to prevent alcohol relapse, enhance physical activity, and facilitate cancer screening. There is limited data on promoting post-LT education, as well as social work and caregiver interventions. Future research should consider these areas for study; high quality interventions need to incorporate stakeholder input, target later LT survivorship stages, and apply consistent definitions of patient-centered outcomes using validated measures.</p>","PeriodicalId":520704,"journal":{"name":"Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: Low adherence on timely endoscopy among cirrhosis patients with acute variceal bleeding.","authors":"Margaret Teng, Yu Jun Wong","doi":"10.1097/LVT.0000000000000690","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000690","url":null,"abstract":"","PeriodicalId":520704,"journal":{"name":"Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning improves post-transplantation hepatocellular carcinoma recurrence prediction.","authors":"P Jonathan Li, Amir Ashraf Ganjouei, Shareef Syed, Neil Mehta, Adnan Alseidi, Mohamed A Adam","doi":"10.1097/LVT.0000000000000685","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000685","url":null,"abstract":"<p><strong>Background: </strong>To enhance post-transplantation hepatocellular carcinoma (HCC) recurrence prediction by evaluating additional novel risk factors and leveraging state-of-the-art machine learning (ML) algorithms.</p><p><strong>Methods: </strong>Using the UNOS database, we identified adult HCC patients who underwent liver transplantation (2015-2018) and considered >50 available clinical, radiographic, laboratory/biomarker, and explant pathology variables to predict post-transplantation recurrence free survival. The cohort was split 70:30 into training and test datasets. Recursive feature elimination was employed to select an optimal number of variables for each candidate ML model. Final model performance was compared to clinically used tools with the test dataset.</p><p><strong>Results: </strong>Of the 3106 patients identified, 7.2% developed post-transplantation HCC recurrence. The Gradient Boosting Survival algorithm performed best (C-index 0.73) and included 7 variables: explant tumor burden score (TBS), AFP at transplantation, maximum pre-transplantation TBS, pre-transplantation AFP slope, microvascular invasion on explant, poor tumor differentiation on explant, and change in pre-transplantation TBS normalized by the number of locoregional therapy received. This outperformed the RETREAT Score (C-Index 0.70). A Random Survival Forest model including only pre-operative variables (AFP at transplantation, pre-transplantation AFP Slope, change in AFP from listing to transplantation, maximum pre-transplantation TBS, and ALBI Grade change from listing to transplantation) was also able to predict post-LT HCC recurrence (C-Index 0.69).</p><p><strong>Conclusions: </strong>We developed a novel ML model that outperforms a widely used post-transplantation HCC recurrence risk score. This model may be used to better risk stratify patients following transplantation and tailor surveillance/adjuvant therapy. The pre-transplantation ML model may be used with the Milan Criteria to further risk stratify patients being considered for transplantation.</p>","PeriodicalId":520704,"journal":{"name":"Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding the indication of living donor liver transplantation to recipients with portal vein thrombosis: Clinical advances and ongoing challenges.","authors":"Deniz Balci, Concepción Gómez-Gavara, Amelia J Hessheimer","doi":"10.1097/LVT.0000000000000689","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000689","url":null,"abstract":"","PeriodicalId":520704,"journal":{"name":"Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}