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":"Delisting for clinical improvement as a proxy for recompensated cirrhosis on the U.S. liver transplant waitlist: A retrospective cohort study.","authors":"Alexandra A McCullough, Nadim Mahmud, K Rajender Reddy, Therese Bittermann","doi":"10.1097/LVT.0000000000000885","DOIUrl":"10.1097/LVT.0000000000000885","url":null,"abstract":"<p><p>Recompensation is emerging as a concrete outcome for patients with effective disease-modifying treatments for cirrhosis. Delisting due to clinical improvement (DCI) from the liver transplant (LT) waitlist may serve as a proxy for recompensation. This study investigated factors associated with time on the waitlist and risk of relisting. This was a retrospective cohort study of patients listed for LT between January 1, 2005, and December 12, 2024, using the Organ Procurement and Transplantation Network (OPTN) database. Timing of DCI was categorized as: <1 year, 1-3 years, and ≥3 years. Of 127,168 patients, 6.9% achieved DCI. The proportion of patients experiencing DCI was highest for hepatitis B virus (9.9%), alcohol-associated liver disease (8.3%), and autoimmune hepatitis (8.2%). Median time to DCI was 2.5 years: 19% were delisted in <1 year, 39% in 1-3 years, and 42% in ≥3 years. Among patients waitlisted as Child-Turcotte-Pugh (CTP) class B or C, only 40.6% improved to CTP A at DCI. Relisting after DCI occurred in 9.6%, with 33% of these driven by hepatocellular carcinoma. In multivariable analysis, only patients with both MELD score improvement ≥3 points and CTP class improvement had significantly lower relisting risk after DCI (adjusted HR 0.52; p <0.001), but not those meeting either criterion individually. Additional relisting predictors included albumin <3.5 g/dL at DCI, male sex, and cirrhosis etiology (all p <0.001). The occurrence of DCI is variable across disease etiologies. Achieving combined improvement in MELD and CTP class may better identify durable clinical improvement and guide safe waitlist removal decisions.</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":"1512-1522"},"PeriodicalIF":3.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147795366","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: Anonymous living donation in pediatric liver transplantation-A tool for equity.","authors":"Rani Kassir, Grégoire Schneider, Rémi Dubois, Guillaume Rossignol","doi":"10.1097/LVT.0000000000000931","DOIUrl":"10.1097/LVT.0000000000000931","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":"E97-E98"},"PeriodicalIF":3.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267907","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-derived clinical phenotypes of ascites in cirrhosis: A multi-center latent class analysis with external validation.","authors":"Giuseppe Cullaro, Jennifer C Lai, Taryn Liu, Miguel E Gomez, Douglas A Simonetto, Sean Lee, Brian P Lee, Andrew S Allegretti, Nikhilesh R Mazumder, Kavish R Patidar, Elizabeth C Verna","doi":"10.1097/LVT.0000000000000942","DOIUrl":"10.1097/LVT.0000000000000942","url":null,"abstract":"<p><p>Ascites development in cirrhosis reduces 5-year survival from 80% to 30%, yet substantial heterogeneity exists among patients with comparable ascites severity. This multicenter retrospective cohort study included adult liver transplant candidates with ascites at 4 United States centers (2015-2024). Latent class analysis was performed using 7 clinical variables: ascites grade, bilirubin, albumin, platelet count, estimated glomerular filtration rate, systolic blood pressure, and portal vein thrombosis. The derivation cohort (n=625) from the University of California San Francisco and Columbia University was randomly split 80/20 for model development and internal validation. External validation was performed at the University of Southern California (n=59) and Mayo Clinic (n=93). Primary outcomes were acute kidney injury (AKI) and waitlist mortality over 365 days. Three phenotypes emerged: \"CKD-Metabolic\" (30.4%, lowest eGFR 76.5 mL/min/1.73 m 2 ), \"Vasodilatory-Synthetic Dysfunction\" (38.9%, highest bilirubin 7.03 mg/dL, lowest blood pressure 117.5 mmHg), and \"PVT-Intermediate\" (30.7%, severe thrombocytopenia 68.1×10 3 /μL, 24.0% PVT). In validation cohorts (n=305), phenotypes demonstrated robust classification (mean posterior probability 0.823-0.855). Vasodilatory-Synthetic Dysfunction showed increased AKI risk versus CKD-Metabolic in derivation (MELD 3.0-adjusted HR 2.95, 95% CI 2.07-4.22, p <0.001) and validation cohorts (HR 3.39, 95% CI 1.93-5.94, p <0.001). Competing risk analysis revealed no mortality differences, but Vasodilatory-Synthetic Dysfunction was associated with higher transplantation rates (validation: HR 1.63, 95% CI 1.19-2.22, p =0.002). Three reproducible clinical phenotypes of ascites were identified with distinct risk profiles. The Vasodilatory-Synthetic Dysfunction phenotype was associated with a 3-fold increase in the risk of AKI that persisted after adjustment for MELD 3.0. No differences in waitlist mortality were observed, likely reflecting effective MELD-based transplant allocation that preferentially removes the highest-acuity patients from the waitlist.</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":"1465-1478"},"PeriodicalIF":3.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148682098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can FMN even the playing field? Mitochondrial FMN during hypothermic oxygenated perfusion to guide liver utilization.","authors":"Adam S Bodzin, James V Guarrera","doi":"10.1097/LVT.0000000000000949","DOIUrl":"10.1097/LVT.0000000000000949","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":"1463-1464"},"PeriodicalIF":3.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371755","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":"Frailty 1 year after liver transplant is associated with long-term mortality: From the Functional Assessment in Liver Transplantation (FrAILT) Study.","authors":"Melinda Wang, Matthew R Kappus, Amy M Shui, Andres Duarte-Rojo, Elizabeth C Verna, Robert Rahimi, Elizabeth A King, Meredith Pearson, Marwan Ghabril, Daniela P Ladner, Daniel Ganger, Jennifer C Lai","doi":"10.1097/LVT.0000000000000910","DOIUrl":"10.1097/LVT.0000000000000910","url":null,"abstract":"<p><p>Frailty before liver transplantation (LT) is a critical determinant of outcomes after LT. While frailty often improves after LT, it persists-and even worsens-in some. The extent to which post-LT frailty impacts longer-term outcomes has not been characterized. Adults with cirrhosis who underwent LT between 2013 and 2023 from 9 centers with an ambulatory frailty assessment [by Liver Frailty Index (LFI)] 12 months (±6 mo) post-LT were included. Kaplan-Meier methods were used to estimate post-LT survival beyond 1 year (1y) post-LT. Associations between 1y post-LT frailty and subsequent mortality were assessed using Cox regression. Linear regression was used to explore the association between 1y post-LT frailty and health-related quality of life (HrQoL) using the 36-Item Short Form Survey. Among 1097 LT recipients, 144 (13%) patients were frail 1y post-LT. Those who were frail 1y post-LT were more often women (47% vs. 33%), had MASLD (40% vs. 19%), diabetes (44% vs. 30%), stroke (3.5% vs. 0.6%), and pre-LT frailty (37% vs. 16%) (all p ≤0.001). At 3, 5, and 7 years after the 1y post-LT assessment, mortality was higher among those who were frail versus not frail 1y post-LT (13% vs. 6%, 24% vs. 10%, and 32% vs. 16%). After multivariate adjustment, 1y post-LT frailty was associated with a 2.0 times increased risk of post-LT mortality (95% CI 1.2-3.4, p =0.01) and worse physical HrQoL (estimate -9.99, 95% CI -12.5 to -7.5, p <0.001). Patients who were frail 1y after LT experienced >2-fold increased risk of long-term mortality and poorer physical HrQoL. Patients who transitioned from not frail pre-LT to frail 1y post-LT had a 2.5-fold increased risk of post-LT mortality (95% CI 1.3-4.8, p =0.005) compared with patients who remained not frail. These findings suggest the 1y period after LT may be a critical window for evaluating whether targeted frailty mitigation strategies may improve long-term survival among LT recipients.</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":"1492-1499"},"PeriodicalIF":3.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148039089","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":"Long-term renal benefit of a biopsy-guided personalized calcineurin inhibitor-sparing regimen late after liver transplantation.","authors":"Alisa Kielkowski, Alejandro Campos-Murguia, Emily A Bosselmann, Sophia Heinrich, Björn Hartleben, Heiner Wedemeyer, Bastian Engel, Elmar Jaeckel, Richard Taubert","doi":"10.1097/LVT.0000000000000950","DOIUrl":"10.1097/LVT.0000000000000950","url":null,"abstract":"<p><p>Long-term success after liver transplantation (LT) is often hindered by side effects from lifelong immunosuppression (IS). Standard liver enzyme tests are poor indicators of graft inflammation or fibrosis. To address this, a program of surveillance liver biopsy (svLbx)-guided personalized IS has been implemented to inform decisions on IS minimization. This study, spanning from 2018 to 2024, extends previous short-term observations to assess the long-term impact of biopsy-guided calcineurin inhibitor (CNI) reduction in recipients of LT, including follow-up biopsies. Patients' IS was adjusted based on svLbx findings, donor-specific antibodies, liver function, and comorbidities. Analyzing 242 recipients of LT, the study compared outcomes in those whose CNI dosage was reduced (n=89) versus those whose dosage was maintained or increased (n=83). CNI reduction proved safe, with no increase in rejection, graft loss, or death. Crucially, it significantly preserved kidney function (ΔeGFR [estimated glomerular filtration rate]: +0.5 vs. -6.5 mL/min) over a median follow-up of 47 months, even when controlling for baseline kidney function, CNI score, graft injury, and time after LT. Sequential biopsies revealed no worsening of fibrosis or inflammation, and noninvasive measures corroborated these findings. In conclusion, svLbx-guided CNI reduction safely maintains kidney function and prevents graft injury late after LT, making it a viable strategy for long-term IS minimization.</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":"1500-1511"},"PeriodicalIF":3.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148379324","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":"Outcomes in pediatric recipients of ABO-incompatible liver transplants: An analysis of the SPLIT Registry.","authors":"Sarah M Bedoyan, Bridget A Whitehead, Krupa R Mysore, Sarah G Anderson, Jeffery Mitchell, Ravinder Anand, James E Squires, Catherine A Chapin","doi":"10.1097/LVT.0000000000000887","DOIUrl":"10.1097/LVT.0000000000000887","url":null,"abstract":"<p><p>Liver transplantation (LT) is the standard of care for children with end-stage liver disease, but waitlist mortality remains high, especially among infants. ABO-incompatible (ABO-I) LT offers a strategy to expand the donor pool, though concerns over antibody-mediated rejection have limited widespread use. We analyzed outcomes of recipients of ABO-I LT using the Society of Pediatric Liver Transplantation (SPLIT) registry from 2011 to 2022, a prospective, multicenter database capturing over 75% of pediatric LTs in the United States and Canada. Clinical characteristics, posttransplant complications, and graft and patient survival were compared between matched ABO-I and ABO-compatible (ABO-C) recipients. Recipients of ABO-I transplant were matched 1:5 with recipients of ABO-C using year of transplant, age, and clinical status at the time of transplant. A center-level survey assessed institutional practices regarding ABO-I LT. Among 3372 pediatric recipients of LT, 155 received ABO-I grafts and were matched to 775 recipients of ABO-C grafts. Recipients of ABO-I had higher rates of ventilator support, parenteral nutrition, and ICU care at the time of transplant compared with recipients of ABO-C. There was no statistically significant difference in 3-year graft (87.8% vs. 92.6%, p =0.06) or patient survival (93.9% vs. 96.6%, p =0.11) between ABO-I and ABO-C groups. In children ≤2 years of age, there was a higher incidence of early portal venous thrombosis in the ABO-I group (8.5% vs. 3.7%, p =0.025). Survey responses revealed substantial variability in center ABO-I eligibility criteria, desensitization protocols, and immunosuppressive strategies. Outcomes for pediatric recipients of ABO-I and ABO-C LT within the SPLIT registry are comparable, supporting broader implementation of ABO-I LT to reduce pediatric waitlist mortality. Variability in institutional practices underscores the need for prospective studies to inform standardized protocols and optimize outcomes.</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":"1523-1533"},"PeriodicalIF":3.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147826231","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":"Multi-modal machine learning highlights recipient genetic and clinical factors as primary drivers of post-transplant MASLD: A two-center study.","authors":"Soumita Ghosh, Khairunnadiya Prayitno, Saba Maleki, Amirhossein Azhie, Lila González Hodár, Bima J Hasjim, Shlok Panchal, Jason M Vanatta, Quynh T Tran, Sanjaya K Satapathy, Yaron Rotman, Mamatha Bhat","doi":"10.1097/LVT.0000000000000881","DOIUrl":"10.1097/LVT.0000000000000881","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":"1604-1609"},"PeriodicalIF":3.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147795544","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":"From donor to recipient: Interpretable machine learning refocuses the prediction of post-transplant MASLD.","authors":"Joseph C Ahn","doi":"10.1097/LVT.0000000000000935","DOIUrl":"10.1097/LVT.0000000000000935","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":"1459-1460"},"PeriodicalIF":3.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280791","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":"Reply: Anonymous living donation in pediatric liver transplantation-A tool for equity.","authors":"Toshifumi Yodoshi","doi":"10.1097/LVT.0000000000000932","DOIUrl":"10.1097/LVT.0000000000000932","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":"E99"},"PeriodicalIF":3.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267834","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}