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":"Total intravenous versus volatile anesthesia in living donor hepatectomy: A global prospective cohort study from the international LDLT registry.","authors":"Toby Lewis, Dimitri A Raptis, Ilya Kantsedikas, Enrico Prosperi, Meera Raja, Thomas Ma Fernandez, Michael Spiro","doi":"10.1097/LVT.0000000000000981","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000981","url":null,"abstract":"<p><p>The choice between total intravenous anesthesia (TIVA) and volatile anesthesia for living donor hepatectomy remains controversial, with limited evidence comparing their impact on donor and recipient outcomes. This study evaluates the association between anesthetic technique and early postoperative outcomes using global prospective data. 1,466 donor-recipient pairs (September 2023-February 2025) from the International LDLT Registry (LDLTregistry.org) were analyzed. Donors were stratified by anesthetic technique (TIVA vs. volatile). Primary outcome was donor morbidity assessed by the Comprehensive Complication Index® (CCI®). Secondary outcomes included complication incidence (grouped by Clavien-Dindo grade), intraoperative blood loss, transfusion requirements, and biochemical markers. Multivariable regression analysis was adjusted for Human Development Index, surgical approach, and graft type. A linear mixed-effects model with a random intercept for transplant center, to account for outcome differences related to individual transplant center practices, was used to evaluate the association between anesthetic technique and donor CCI. TIVA was used for most donor hepatectomies (82.8%) but there was significant regional variation in its use (p<0.001). All seven centers contributing more than 50 cases (50.3% of the total cohort) used TIVA exclusively or predominantly. Use of volatile anesthesia was independently associated with higher donor CCI® scores (regression coefficient 1.69, 95% CI 0.29-3.09, p=0.018), more major complications (6.3% vs. 1.2%, p<0.001), and greater median blood loss (250 mL vs. 100 mL, p<0.001). TIVA was associated with lower transfusion rates (6.0% vs. 11.6%, p=0.002) and fewer biliary complications (2.5% vs. 8.3%, p<0.001). Recipient outcomes, including graft function and biochemical recovery, were comparable between groups. Our findings suggest an association between TIVA use and improved outcomes in living liver donors, with reduced morbidity in multivariable analysis accounting for transplant center and socioeconomic status of the countries where data originated. Further evaluation of this association with large scale international multicenter randomized trials is warranted.</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":3.9,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149003299","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":"Beyond graft survival: Health literacy is associated with patient-reported health after liver transplantation.","authors":"Dominic Denk, Lucia Alcober-Boquet, Alexander Queck","doi":"10.1097/LVT.0000000000001001","DOIUrl":"10.1097/LVT.0000000000001001","url":null,"abstract":"<p><p>Current liver transplantation (LT) guidelines recognize perceived health-related quality of life as an important outcome of long-term care, yet it remains unclear whether posttransplantation health literacy plays a role in patient-reported physical and mental health. We conducted a large-scale cross-sectional analysis using data from the US. All of Us Research Program of adults with documented LT before completing the \"Overall Health\" survey (n=1042). Health literacy was assessed using the 3-item Brief Health Literacy Screen (BHLS; range: 3-15), and physical and mental health were assessed using Patient-Reported Outcomes Measurement Information System Global Health T-scores. The multivariable linear regression model was adjusted for age, sex at birth, race and ethnicity, and education. Associations were compared with those in adults with cirrhosis without LT (n=5290) and the general All of Us comparator population. Among 747,029 participants, 1042 recipients of LT had evaluable BHLS scores. Marginal health literacy (BHLS ≤12) was present in 372 recipients (35.7%), including 131 (12.6%) with low health literacy (BHLS ≤9). Patients who underwent LT displayed lower health literacy compared with the general population (mean BHLS 12.8 vs. 13.4), but higher than adults with cirrhosis (12.4; all p <0.001). Each 3-point increase in the BHLS score was associated with a 3.22-point higher Physical Health T-score (95% CI: 2.52-3.92) and a 2.85-point higher Mental Health T-score (95% CI: 2.09-3.60) after adjustment (both p <0.001). The strength of the association did not differ significantly between recipients and either comparator group. Recipients ​​​​of transplant displayed reduced health literacy, and posttransplant health literacy was strongly associated with better patient-reported physical and mental health. These findings identify health literacy as a modifiable dimension of long-term transplant survivorship and support its assessment in posttransplant care.</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":3.9,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149003241","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":"Cirrhotic cardiomyopathy is independently associated with peritransplant acute kidney injury in biliary atresia: A hepato-cardio-renal link.","authors":"Divya G Sabapathy, Auda P Gonzalez, Christin Silos, Sanjiv Harpavat, John A Goss, Manpreet K Virk, Poyyapakkam Srivaths, Moreshwar S Desai, Ayse Akcan-Arikan","doi":"10.1097/LVT.0000000000000989","DOIUrl":"10.1097/LVT.0000000000000989","url":null,"abstract":"<p><p>Hepatorenal syndrome (HRS-AKI) confers significant morbidity and mortality in patients with cirrhosis. Cirrhotic cardiomyopathy (CCM), a prevalent comorbidity in adults with growing recognition in children, leads to hemodynamic perturbations that may compound the maladaptive physiology resulting in HRS-AKI. We aimed to explore a hepato-cardio-renal link in pediatric cirrhosis by examining peritransplant AKI, with a focus on CCM and Major Adverse Kidney Events at 28 days (MAKE28) in patients undergoing liver transplant (LT). This is a single-center, retrospective study of pediatric LT for biliary atresia (BA) from 2014 to 2020. Peri-LT AKI was defined as AKI within 7 days of LT. CCM was defined as left ventricular mass index to height of ≥95 g/m 2.7 , and/or relative wall thickness ≥0.42. Of 62 patients with BA (age 1.1 y [IQR: 0.8-2.4]), 29% had AKI, 61% had CCM, and 40% fulfilled MAKE28. Patients with AKI had higher blood product and vasoactive requirements, and lower ventilator-free days, compared with patients without AKI. The median length of stay was 133 (IQR: 54-121) versus 19.5 (IQR: 8.5-41) days for patients with AKI and without AKI, respectively ( p <0.001). CCM was more prevalent in those with peri-LT AKI (OR: 6.6, CI: 1.7-23, p =0.005). CCM remained significant after adjusting for age, markers of liver disease severity, and intraoperative events. Patients with BA face high morbidity peri-LT in the setting of prevalent AKI. The association between pediatric CCM and AKI suggests that cardiac dysfunction may be an independent risk factor for HRS-AKI. While studies are needed to further define the relationship between CCM and renal injury, pre-LT echocardiogram has the potential to facilitate timely identification and management of children at risk for HRS-AKI, and thereby promote renal recovery.</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":3.9,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149003259","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":"Why the SRTR metric \"Survival on the Waitlist\" is still useful in the age of short liver transplant waiting times.","authors":"Grace R Lyden, Nicholas L Wood, Maria Masotti, Kyle R Jackson, William F Parker, Jon J Snyder","doi":"10.1097/LVT.0000000000001002","DOIUrl":"10.1097/LVT.0000000000001002","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":3.9,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149003294","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":"Biliary complications in pediatric living donor liver transplantation: An international multicenter analysis of risk and prognostic factors.","authors":"Kaihang Wang, Omid Madadi-Sanjani, Yuan Liu, Dimitri A Raptis, Vasanthakumar Gunasekaran, Ashwin Rammohan, Seisuke Sakamoto, Hajime Uchida, Piotr Kaliciński, Nicolas Goldaracena, Cornelius J van Beekum, Felix J Krendl, Itsuko Chih-Yi Chen, Bryanna N Domenick, Alfred Kow, Yuji Soejima, Katryn N Furuya, George V Mazariegos, Vidyadhar Padmakar Mali, Stephen Dunn, Kim Olthoff, Samir Abu-Gazala, Elizabeth B Rand, Ian Leipnitz, Chao-Long Chen, Deniz Balci, Elvan Onur Kirimker, Silvio Nadalin, Stefan Schneeberger, Debra L Sudan, Moritz Schmelzle, Uta Herden, Lutz Fischer, Blayne A Sayed, Vicky L Ng, Grzegorz Kowalewski, Mureo Kasahara, Mohamed Rela, Dieter C Broering, Qiang Xia, Pierre-Alain Clavien, Zhihao Li","doi":"10.1097/LVT.0000000000000998","DOIUrl":"10.1097/LVT.0000000000000998","url":null,"abstract":"<p><p>Biliary reconstruction is often considered the Achilles' heel of liver transplantation, yet risk factors and outcomes remain poorly defined, particularly in pediatric living donor liver transplantation (LDLT). This international multicenter study aims to identify predictors of biliary complications and evaluate their impact on long-term outcomes. The study included 2665 pediatric patients who underwent LDLT between January 2019 and December 2023 across 19 centers. Multivariable logistic regression was performed to identify risk factors, while time-dependent Cox models were used to assess the impact on survival. The median recipient age was 11 months (IQR: 6.3-34.6), and biliary atresia was the most common diagnosis (59.7%). Bile leak and anastomotic stricture occurred in 3.6% (n=97) and 1.9% (n=51) of patients, respectively. For bile leak, higher donor BMI was an independent predictor (OR 1.09 per kg/m 2 , 95% CI: 1.02-1.17). For anastomotic strictures, longer cold ischemia time was a significant predictor (OR 1.36 per hour, 95% CI: 1.03-1.79). Bile leak (aHR 4.39, 95% CI: 1.04-18.60) and biliary stricture (aHR 6.26, 95% CI: 1.58-24.80) were associated with worse graft survival. Patient survival was not significantly impacted by bile leak and stricture. Early complications more often required surgery, but survival and failure-to-rescue rates were similar regardless of treatment approach. Ultimately, bile leak and anastomotic stricture remain significant threats to graft survival. The identified risk factors offer insights for risk stratification and prevention strategies aimed at improving outcomes in children undergoing LDLT.</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":3.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148973005","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":"TIVA and the living liver donor: Is this a clear signal for change of practice?","authors":"Bhangui Pooja, Awc Kow","doi":"10.1097/LVT.0000000000000995","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000995","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":3.9,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972263","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":"Social determinants of health and access to liver transplantation in patients with hepatocellular carcinoma within a universal healthcare system: A retrospective cohort study.","authors":"Carlos Moctezuma-Velazquez, Kinjal Patel, Anita Sharifi, Godolfino Miranda-Zazueta, Noreen Singh, Rahima A Bhanji, Aldo Montano-Loza, Juan G Abraldes","doi":"10.1097/LVT.0000000000000996","DOIUrl":"10.1097/LVT.0000000000000996","url":null,"abstract":"<p><p>Hepatocellular carcinoma (HCC) remains a major contributor to cancer-related illness and death globally. For eligible patients, liver transplantation (LT) represents a potentially curative option. Social determinants of health (SDOH) impact HCC outcomes, but their influence across the multi-step LT continuum remains poorly defined. We evaluated how SDOH measured through the Canadian Index of Multiple Deprivation (CIMD) and census metrics relate to LT access and tumor burden among HCC-referred patients. We analyzed a retrospective cohort of 576 patients with HCC referred for LT (2003-2021). Multivariable multinomial, linear, and competing risks regression examined relationships between SDOH and outcomes across the LT pathway. High residential instability was associated with presenting beyond Milan criteria at referral ( ptrend =0.02), and higher odds of non-listing due to psychosocial factors (quintile 5, RRR 4.74, p =0.02). Among waitlisted patients, higher residential instability scores predicted prolonged time-to-listing (β=0.08, p =0.04), whereas higher area-level marriage (β=-0.01, p =0.03) and private vehicle commuting rates (β=-0.01, p =0.002) predicted faster listing. In competing risks analysis (death/delisting as competitors), area-level CIMD dimensions did not influence LT probability once listed, and only a higher vehicle commuting rate remained significantly associated with transplantation (SHR 1.01, p =0.05). Ethnocultural quintile 2 was uniquely protective against psychosocial non-listing (RRR 0.14, p =0.01). SDOH inequities primarily restrict the pre-listing stages of the LT continuum, influencing tumor burden at referral, listing eligibility, and evaluation velocity, rather than post-listing organ allocation. Targeted interventions to ensure equitable transplantation access should focus on early social work navigation and logistical transportation support.</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":3.9,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972973","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":"Artificial intelligence in liver transplant allocation: Promise, pitfalls, and ethical safeguards.","authors":"Sreeya Reddy, Sarah R Lieber, Ashley Spann, Alexandra T Strauss, Mark Pedersen, Madhukar S Patel, Arjmand Mufti, Lisa B VanWagner","doi":"10.1097/LVT.0000000000000997","DOIUrl":"10.1097/LVT.0000000000000997","url":null,"abstract":"<p><p>Liver transplantation (LT) is an ethically complex procedure that involves allocating a limited, life-saving resource. For over 20 years, the Model for End-Stage Liver Disease (MELD) score and its variations have implemented a sickest-first ethical approach, enhancing waitlist survival rates and adding objectivity to the process. Nonetheless, ongoing disparities based on sex, race, and other structural factors reveal the shortcomings of relying on simplified, static models of disease severity. As LT progresses into an era increasingly shaped by artificial intelligence (AI) and machine learning (ML), these algorithms offer better predictions of waitlist mortality, post-transplant outcomes, and donor-recipient matching. However, higher predictive accuracy does not automatically lead to more ethical distribution. In this Perspective, we explore AI-assisted deceased donor liver allocation through the ethical principles of justice, respect for persons, and humanism. We review emerging AI/ML models proposed for LT, highlighting their potential advantages and risks, including amplification of historical inequities embedded in training data, lack of transparency, erosion of informed consent, and overreliance on algorithmic outputs at the expense of clinical judgment. We contend that AI should serve as decision support rather than a decision-maker, and that ethical implementation requires deliberate safeguards. We suggest a framework for responsibly integrating AI into liver allocation focused on fairness monitoring, transparency, explainability, human oversight, and multi-stakeholder governance. When applied properly, AI can potentially enhance both utility and equity in liver transplantation-but only if its use is guided by clear ethical principles and ongoing evaluation in real-world clinical settings.</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":3.9,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148973057","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: The liver transplant that saved thousands of lives.","authors":"Reg Green","doi":"10.1097/LVT.0000000000000999","DOIUrl":"10.1097/LVT.0000000000000999","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":3.9,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972986","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":"Evaluation of available scoring systems in liver transplantation for severe acute-on-chronic liver failure (ACLF).","authors":"Sébastien L'Hermite, Isaure Breteau, Sébastien Halter, Nicolas Jacquinot, Valentin Coirier, José Ursic-Bedoya, Giovanni Perricone, Laure Elkrief, Philippe Ichai, Audrey Coilly, Sophie-Caroline Sacleux, Pauline Houssel-Debry, Baptiste Giguet, Line-Carolle Ntandja-Wandji, Alexandre Louvet, Filomena Conti, Edouard Bardou-Jacquet, Georges-Philippe Pageaux, Antoine Monsel, Eric Levesque, Constantine J Karvellas, Jean-François Morcet, William Bernal, Florent Artru","doi":"10.1097/LVT.0000000000000987","DOIUrl":"10.1097/LVT.0000000000000987","url":null,"abstract":"<p><p>The Transplantation for ACLF-3 Model (TAM) and Sundaram ACLF-LT-Mortality score (SALT-M) have been proposed to help select liver transplantation (LT) candidates with acute-on-chronic liver failure (ACLF) to optimize post-LT outcomes. We assessed the performance and clinical utility of these scores and their components on a large retrospective international multicenter study. All patients transplanted in the context of ACLF grade 3 (n=336) from 9 international cohorts (2008-2024) were included in the study. The primary endpoint was 1-year post-LT survival. Score discrimination, calibration, and clinical utility using decision-curve (net benefit) analysis were assessed. The 1-year post-LT survival rate was 75.3%. Both TAM (OR 1.91, p =0.0001) and SALT-M (OR 1.09, p <0.0001) were associated with 1-year mortality but showed only modest discriminative performance (AUROC 0.61 and 0.64, respectively). Clinically relevant candidate high-risk thresholds were identified: TAM ≥3 (1-year survival 42.9% vs. 79.0%) and SALT-M >25 (46.9% vs. 78.7%). Respiratory failure (PaO 2 /FiO 2 ≤200) was associated with 1-year post-LT mortality, whereas other variables included in the original scores, diabetes, BMI, and leukocyte count, did not demonstrate significant prognostic value in this cohort. In this large multicenter study, TAM and SALT-M were associated with post-LT mortality but demonstrated limited discriminative accuracy. Candidate high-risk thresholds (TAM ≥3, SALT-M >25) may help identify a small subset of patients with markedly poor post-LT outcomes. However, given their modest performance, these scores should support, not replace, multidisciplinary decision-making, and their applicability should be evaluated in a prospective fashion.</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":3.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148973013","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}