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":"External validation of the SALT-M score in living donor liver transplantation for acute-on-chronic liver failure.","authors":"Bandar M Aljudaibi, Dimitri A Raptis, Lama Alshehri, Kris Ann H Marquez, Dieter C Broering, Khalid I Bzeizi","doi":"10.1097/LVT.0000000000001017","DOIUrl":"https://doi.org/10.1097/LVT.0000000000001017","url":null,"abstract":"<p><strong>Background & aims: </strong>The Sundaram Acute-on-Chronic Liver Failure-Liver Transplant Mortality (SALT-M) score predicts 1-year post-transplant mortality in patients with severe ACLF undergoing deceased donor liver transplantation (DDLT). Its performance in living donor liver transplantation (LDLT) is unknown.</p><p><strong>Methods: </strong>We externally validated SALT-M in two independent ACLF-LDLT cohorts: King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh (n=121), and a global International LDLT Registry cohort (n=57). Discrimination (AUROC with 95% CI), calibration (observed-to-expected [O:E] ratio, calibration slope and intercept), and association with observed outcomes were assessed overall and, in the KFSHRC cohort, separately in ACLF grade 1 and severe ACLF (grades 2-3).</p><p><strong>Results: </strong>In the KFSHRC cohort, ACLF grade was 1 in 47.9%, 2 in 43.0%, and 3 in 9.1%; 1-year mortality was 14.9% (global cohort 21.1%). SALT-M predicted ≤30% mortality in 95.9% of the KFSHRC and 98.2% of the global cohort. Discrimination was limited and statistically inconclusive: AUROC 0.56 (95% CI 0.40-0.72) overall, 0.62 (0.42-0.81) in severe ACLF, and 0.51 (0.25-0.76) in ACLF-1. Calibration-in-the-large was acceptable (O:E 1.18, 95% CI 0.74-1.87) but the calibration slope was shallow (0.16). None of the five SALT-M components was associated with 1-year mortality; white blood cell count (OR 1.14, p=0.03) and female sex (OR 3.49, p=0.02) were. MELD-Na and MELD 3.0 were higher in non-survivors in the global cohort (p=0.03 and p=0.02).</p><p><strong>Conclusions: </strong>In LDLT-dominant ACLF cohorts - evaluated largely outside the severe-ACLF population for which SALT-M was derived - discrimination could not be confirmed, reflecting profound spectrum restriction and few outcome events rather than demonstrated model failure. SALT-M should be applied cautiously as an adjunctive risk-stratification tool, not as a universal threshold for transplant candidacy.</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":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140360","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":"Robotic recipient surgery in living donor liver transplantation: A single-center consecutive case series.","authors":"Su Young Hong, YoungRok Choi, Kwang-Woong Lee, Gayoung Kim, Min Kyoung Kim, Sang Hyuk Park, Minseob Kim, Jae-Yoon Kim, Suk Kyun Hong","doi":"10.1097/LVT.0000000000001016","DOIUrl":"https://doi.org/10.1097/LVT.0000000000001016","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":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140355","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":"Vasoconstrictor therapy for HRS-AKI in patients listed for liver transplantation: Translating evidence to the pretransplant setting.","authors":"Nazli Begum Ozturk, Konstantinos Ouranos, Rohan Garg, Ahila Manivannan, Pratima Sharma, Kavish R Patidar","doi":"10.1097/LVT.0000000000001012","DOIUrl":"10.1097/LVT.0000000000001012","url":null,"abstract":"<p><p>Hepatorenal syndrome-acute kidney injury (HRS-AKI) is a life-threatening complication of decompensated cirrhosis and carries significant implications for liver transplantation (LT) candidacy and outcomes. Terlipressin, a synthetic vasopressin analog, has emerged as a first-line pharmacologic therapy for HRS-AKI. We conducted a systematic review of practice guidelines and studies published between 2020 and 2025 evaluating the role of terlipressin in adult patients with HRS-AKI, with a focus on those undergoing evaluation or listed for LT. Databases including PubMed, MEDLINE, and Scopus were included, and 127 studies met the inclusion criteria. Current evidence supports early initiation of terlipressin in appropriately selected patients with HRS-AKI who do not respond to volume resuscitation, with concurrent albumin administration. However, heterogeneity exists across professional society guidelines regarding diagnostic criteria, albumin use, and timing of therapy. In candidates undergoing LT, additional complexities arise due to the impact of HRS-AKI reversal on MELD prioritization. Adjunctive tools such as point-of-care ultrasound and emerging biomarkers may improve diagnostic accuracy and guide individualized management. Terlipressin therapy, as compared to placebo and other vasoconstrictors, is associated with higher rates of HRS reversal, reduced need for renal replacement therapy, and improved short-term outcomes, including patients awaiting LT. However, careful patient selection and monitoring are essential due to the risks of ischemic and cardiopulmonary complications. This systematic review provides literature-based considerations to guide the management of HRS-AKI with terlipressin in candidates undergoing LT, emphasizing individualized care, early intervention, and integration with LT planning.</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":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122957","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":"Fellows' Corner.","authors":"Nazli Begum Ozturk","doi":"10.1097/LVT.0000000000000971","DOIUrl":"https://doi.org/10.1097/LVT.0000000000000971","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":"32 10","pages":"1349-1351"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984619","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: Silent graft injury after pediatric liver transplantation: Beyond protocol biopsy?","authors":"Jesús Quintero-Bernabeu, Maria Teresa Salcedo-Allende, Javier Juamperez-Goñi, Maria Mercadal-Hally, Cristina Padrós-Fornieles, Mauricio Larrarte-King, Paula Muyo-Hernández, José Andrés Molino-Gahete, Ana Coma-Muñoz, Antonio Moreno-Galdo","doi":"10.1097/LVT.0000000000000916","DOIUrl":"10.1097/LVT.0000000000000916","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":"E88-E89"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148020526","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":"Does stigma reduce hazardous health behaviors contributing to steatotic liver disease?","authors":"Gerald Scott Winder, Shivali Patel, David C Fipps, Jessica L Mellinger","doi":"10.1097/LVT.0000000000000854","DOIUrl":"10.1097/LVT.0000000000000854","url":null,"abstract":"<p><p>Hazardous health behaviors increasingly contribute to end-stage liver diseases. To address surges in alcohol-associated liver disease and metabolic dysfunction-associated steatotic liver disease, clinicians in hepatology and liver transplantation must increasingly understand factors that influence eating and alcohol behaviors and consider ways to therapeutically influence patients' health choices. Stigma is a prominent influence on patient behavior, but is overused as a sweeping explanatory factor as to why difficulties arise, behavior change does not occur, or when outcomes are suboptimal. With more awareness of behavioral influences, clinicians may wonder if, for all its adverse effects, stigma exerts some therapeutic effects on patients considering altering habits. While stigma is less likely to yield desired outcomes, other co-occurring systemic, social, and interpersonal influences can favorably affect health choices (ie, structural nudging, social norms and consequences, and motivational interviewing, respectively). In this article, we analyze these related yet distinct constructs in ways pertinent to liver disease and transplantation, indicating where they might be applied and further studied.</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":"1437-1445"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147358548","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":"Effect of MELD exception point policy changes on application and waitlist outcomes in primary sclerosing cholangitis-A retrospective cohort study.","authors":"Isaac J Benque, Melinda Wang, Jennifer C Lai, Michael Li","doi":"10.1097/LVT.0000000000000864","DOIUrl":"10.1097/LVT.0000000000000864","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":"1446-1450"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635678","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: Choledochoduodenostomy in pediatric liver transplantation-Technical feasibility versus long-term safety.","authors":"Rani Kassir","doi":"10.1097/LVT.0000000000000918","DOIUrl":"10.1097/LVT.0000000000000918","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":"E77-E78"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148153071","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: Choledochoduodenostomy in pediatric liver transplantation-Technical feasibility versus long-term safety.","authors":"Amanda R Jensen, Carlos O Esquivel","doi":"10.1097/LVT.0000000000000926","DOIUrl":"10.1097/LVT.0000000000000926","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":"E79-E80"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148153039","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":"Predicting severe liver dysfunction following locoregional therapy for early- and intermediate-stage hepatocellular carcinoma.","authors":"Jordyn Agins, Catherine Blandon, David E Kaplan, Binu John, Nadim Mahmud, David S Goldberg","doi":"10.1097/LVT.0000000000000901","DOIUrl":"10.1097/LVT.0000000000000901","url":null,"abstract":"<p><p>Predicting short-term liver dysfunction after locoregional therapy (LRT) for hepatocellular carcinoma (HCC) remains challenging, and the relative prognostic value of liver function, tumor diameter, and patient characteristics is not well defined. Improved risk stratification may inform patient selection and peri-procedural decision-making. We performed a retrospective cohort study of patients with HCC undergoing LRT in the Veterans Health Administration. Clinical, laboratory, and tumor-related variables were evaluated for their ability to predict 30-day and 90-day outcomes of liver dysfunction. Model discrimination was assessed in the test dataset using the area under the receiver operating characteristic curve (AUC) with 95% confidence intervals, and calibration was evaluated using calibration plots and Brier scores. Among 1183 patients with early- to intermediate-stage HCC, liver function-based scores consistently showed the strongest predictive performance. For 30-day outcomes, the Model for End-stage Liver Disease (MELD) score demonstrated the highest discrimination, followed by MELD-Na and serum bilirubin. Similar patterns were observed for 90-day outcomes. In contrast, total tumor diameter measures and demographic variables exhibited limited discriminatory ability. Overall model calibration was acceptable across risk strata. In patients undergoing LRT for HCC, measures of liver function outperform tumor-related and demographic variables in predicting liver failure. These findings underscore the central role of hepatic reserve in peri-procedural risk assessment and support prioritizing liver severity metrics when evaluating candidates for LRT.</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":"1352-1362"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147937265","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}