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":"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}

{"title":"Geographic variation in utilization of deceased donor livers in the United States in the era of advanced perfusion.","authors":"Maggie E Jones-Carr, Hiren Dayala, M Chandler McLeod, Paul MacLennan, Saulat Sheikh, M Umaid Rabbani, Marcos E Pozo, Sergio A Acuna, Juliet Emamaullee, David Goldberg, Robert M Cannon","doi":"10.1097/LVT.0000000000000687","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000687","url":null,"abstract":"<p><p>Understanding the geographic variation in deceased donor liver utilization can guide allocation policy and technology implementation. Using US transplant registry data, we evaluated geographic differences in utilization by donor quality, policy era, and uptake of advanced perfusion (AP). This retrospective cohort included all liver donors and waitlisted patients from 2010 to Sept. 2024. Donors were aggregated by Hospital Referral Region (HRR) and stratified by quality using the liver discard risk index (DSRI). Exposures included allocation policy era and increased use of AP technology (July 2022-onward). Observed to expected (O:E) ratios of liver non-utilization were calculated by HRR and modeled to reveal geographically contiguous Low Utilization Clusters (LUCs). The proportion of HRRs within LUCs increased from 24% in Share 15 (S15), to 25% in Share 35 (S35), 32% in Acuity Circles (AC), then decreased to 21% in the AP era ( p =0.01). There were 7 distinct LUCs in S15 (median non-utilization=33%), 7 LUCs in S35 (non-utilization=32%), 7 LUCs in AC (non-utilization=41%), and 3 LUCs in the AP era (non-utilization=46%). Donor quality by HRR decreased over time, with a median DSRI of 2.56 (IQR: 1.25-5.79) in S15 to 5.69 (2.01-35.30) in AP ( p <0.001). Accounting for DSRI, odds of non-utilization were highest in AC ( ref. Share 35 , OR=1.27, p <0.001), which decreased in AP (OR=1.06, p =0.001). Utilization of normothermic machine perfusion was associated with a markedly lower odds of discard (OR=0.03, 0.03-0.04; p <0.001). Livers originating from LUCs traveled shorter distances in each era other than S35. The number of net exporter HRRs in LUCs was equivalent to non-LUCs in each era other than AP, where LUCs contained fewer net exporter HRRs (2 [3.2%] vs. 42 [17.4%], p =0.004). On adjusted analysis, candidates in LUCs had lower likelihood of transplant (HR=0.88, p <0.001) but also lower waitlist mortality (HR=0.95, p <0.001). The advent of advanced perfusion was associated with utilization of otherwise marginal liver allografts and ameliorating geographic imbalances in discard seen with successive allocation policy eras.</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":"144639516","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":"Prognostic communication, Psychological distress, and caregiving burden among caregivers of patients with decompensated cirrhosis.","authors":"Lucinda Li, John Donlan, Lina Nurhussien, Nora Horick, Chengbo Zeng, Teresa Indriolo, Malia E Armstrong, Grace Bizup, Anushka Dalvi, Enya Zhu, Michelle S Diop, Nancy Mason, Kirsten G Engel, Michaela Rowland, Sara Kenimer, Karen O'Brien, Annie Liu, Hermioni L Amonoo, Deborah Forst, Lara Traeger, Jamie M Jacobs, Vicki Jackson, Raymond T Chung, Areej El-Jawahri, Nneka N Ufere","doi":"10.1097/LVT.0000000000000683","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000683","url":null,"abstract":"<p><p>Caregivers play a critical role in supporting patients with decompensated cirrhosis (DC) while often also enduring psychological distress themselves. Despite caregivers' essential role in medical decision-making, no studies have examined the associations of caregiver-hepatologist prognostic communication with caregivers' psychological outcomes. In this cross-sectional study, we examined associations of caregivers' self-reported frequency, adequacy, and quality of prognostic communication from the patients' hepatologist (Prognosis and Treatment Preferences Questionnaire) with their anxiety and depression symptoms (Hospital Anxiety and Depression Scale, HADS) and caregiving burden (Zarit Burden Index-12, ZBI-12) using linear regression adjusted for caregiver age, gender, and relationship to the patient. Between 8/2018-9/2022, we enrolled 127/162 (78%) adult caregivers of patients with DC (median age 59 years old, 62% female, 63% spouses). In total, 52% and 35% of caregivers reported clinically significant anxiety and depression symptoms (HADS subscale ≥8), and 27% reported high caregiving burden (ZBI-12 >20). Over 85% had never participated in prognostic communication about the patients' end-of-life care preferences with their hepatologist. Higher frequency of prognostic communication with the hepatologist was associated with lower caregiving burden (β=-4.82, p=0.01). Receipt of adequate information about the patient's prognosis was associated with lower caregiving burden (β=-4.21, p=0.02). Lastly, rating the prognostic communication from the patient's hepatologist as high-quality was associated with lower caregiver anxiety symptoms (β=-2.31, p=0.03). Frequency and adequacy of prognostic communication were not significantly associated with caregivers' anxiety and depression symptoms. Quality of prognostic communication was not significantly associated with caregiving burden or depression symptoms. These findings emphasize the substantial psychological distress and burden experienced by caregivers of patients with DC and highlight prognostic understanding as a potential modifiable target for improving their psychological 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":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602806","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":"Selective splenectomy centered on graft-to-spleen volume ratio is a practical option in living donor liver transplantation to prevent early allograft dysfunction: A Prospective validation study.","authors":"Siyuan Yao, Masaaki Hirata, Takashi Ito, Hikaru Aoki, Ryuji Uozumi, Shinya Okumura, Yuuki Masano, Etsuro Hatano","doi":"10.1097/LVT.0000000000000678","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000678","url":null,"abstract":"<p><strong>Background: </strong>While simultaneous splenectomy (SPX) is an option in selected cases of living donor liver transplantation (LDLT) to protect graft function, graft-to-spleen volume ratio (GSVR) may serve as a new determinant of SPX. A prospective validation study was conducted to test our institutional strategy of SPX based mainly on GSVR, which has been employed since 2019.</p><p><strong>Methods: </strong>This prospective study enrolled 141 LDLT recipients from 2019 to 2024. The indication for SPX was GSVR ≤0.70 and high-risk patients (ABO-incompatibility or donor age ≥45 y) with a final portal venous pressure >15 mmHg. Surgical outcomes related to graft function were evaluated and compared between the group with SPX (n=51), the group without SPX (n=90), and the historical control group without SPX despite GSVR of ≤0.70 (from 2007 to 2018, n=33). The risk factors for early allograft dysfunction (EAD) in the modern era were also investigated.</p><p><strong>Results: </strong>Low GSVR indicated 88.2% (45 out of 51) of SPX in the prospective cohort. The historical group (no-SPX despite GSVR ≤0.70) showed an increased incidence of EAD with post-transplant thrombocytopenia, cholestasis, coagulopathy, and massive ascites. In contrast, these adverse events decreased significantly after introducing the new selective SPX protocol, with comparable results between the SPX and no-SPX groups in the prospective cohort. The Model for End-stage Liver Disease (MELD) score was the only indicator of EAD in the multivariable analysis after 2019.</p><p><strong>Conclusions: </strong>Selective SPX centered on GSVR is a feasible and practical option in LDLT to screen out high-risk recipients and improve their graft function for EAD prevention.</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":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602807","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":"Building bridges: The power of near-peer mentorship in hepatology.","authors":"Sarah Uttal, Elizabeth S Aby, Atoosa Rabiee, Adam Winters, Pratima Sharma, Jessica P E Davis","doi":"10.1097/LVT.0000000000000679","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000679","url":null,"abstract":"<p><p>Mentorship is paramount for success in academic medicine, impacting personal and professional growth. Traditional mentorship forms the backbone of mentorship in academic medicine and has many benefits including perspective and sponsorship opportunities. Traditional mentorship, however, has some limitations, especially for individuals at smaller institutions or those traditionally underrepresented in medicine. Lateral mentorship with near peers is a potential adjunctive form of mentorship that can help fill these gaps. In this review, we provide a background on this non-traditional form of mentorship and highlight its distinct benefits and associated challenges. We also provide a case study of our experience with a dedicated group of near-peer mentors in hepatology. By sharing our perspective on near-peer mentorship we hope to expand the uptake and support of lateral mentorship programs within our field.</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":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593788","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":"CON: A multi-vendor organ procurement and transplantation network (OPTN) will not improve liver procurement and use.","authors":"Sidharth Sharma, David C Mulligan","doi":"10.1097/LVT.0000000000000681","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000681","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":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593789","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":"PRO: A multi-vendor organ procurement and transplantation network (OPTN) will improve liver procurement and use.","authors":"David Goldberg","doi":"10.1097/LVT.0000000000000677","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000677","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":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593790","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":"Seeing Through the Machine: Ultrasound Assessment of Hepatic Artery Integrity During Normothermic Machine Perfusion.","authors":"Nihal Aykun, Qimeng Gao, Isaac S Alderete, Mohamed M Diab, Andrew S Barbas","doi":"10.1097/LVT.0000000000000680","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000680","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":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586193","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}