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: Liver transplantation in AH-ACLF-Which condition drives post-transplant outcomes?","authors":"Victoria E Kusztos, Tiffany Wu, Blake Kassmeyer, Ruben Hernaez, Constantine Karvellas, Saro Khemichian, Lance Stein, Kirti Shetty, Christina C Lindenmeyer, Justin Boike, Robert Rahimi, Jalal Prasun, Manhal Izzy, Michael Kriss, Gene Y Im, Ming V Lin, Janice H Jou, Brett E Fortune, George T Cholankeril, Alexander Kuo, Douglas A Simonetto","doi":"10.1097/LVT.0000000000000937","DOIUrl":"10.1097/LVT.0000000000000937","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":"E85-E86"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280758","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":"MELD exception in primary sclerosing cholangitis: A policy in search of evidence.","authors":"Aaron Hakim, Alan Bonder","doi":"10.1097/LVT.0000000000000923","DOIUrl":"10.1097/LVT.0000000000000923","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":"1347-1348"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148153113","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":"Comparative analysis of early post-transplant infections after DCD with hypothermic oxygenated liver perfusion and DBD liver transplantation: A retrospective cohort study.","authors":"Stephanie Klinzing, Olivia J Kotoun, Linard D Hoessly, Andreas E Kremer, Nicolas J Mueller, Philipp Dutkowski, Rea Andermatt, Peter W Schreiber, Daniel A Hofmaenner","doi":"10.1097/LVT.0000000000000868","DOIUrl":"10.1097/LVT.0000000000000868","url":null,"abstract":"<p><p>Liver transplantation outcomes have improved. However, immunosuppression also raises infection susceptibility. Potential differences in infections between donation after circulatory death (DCD) and donation after brain death (DBD) recipients remain unclear. This study analyzed postoperative infections and compared their incidence between DCD and DBD recipients. Patients undergoing liver transplantation from January 1, 2016, to December 31, 2022, were included. DCD and marginal DBD liver grafts underwent hypothermic oxygenated machine perfusion (HOPE). Bacterial, viral, and fungal infections were identified using standardized definitions. Infections were categorized into periods: 0-2 weeks (period 1), 3-4 weeks (period 2), 1-6 months (period 3), and beyond 6 months (period 4). The primary outcome was the occurrence of infection within the first post-transplant year, including pathogen spectrum, timing, and infection site. The secondary outcome was the assessment of infection risk factors investigated with Poisson regression. A total of 300 liver transplants were included. In all, 42.8% of DBD recipients and 44.3% of DCD recipients suffered from at least 1 infection. In total, 298 relevant infections occurred, with bacteria accounting for 73.2% in DBD and 86.4% in DCD recipients. Bacterial infections predominated in all periods. In periods 1 and 2, bloodstream infections, abdominal and surgical site infections were most frequent, while liver-related infections, especially in DCD, and bloodstream infections dominated in periods 3 and 4. Viral and fungal infections were less frequent. One-year survival was 87.1% for DBD and 87.7% for DCD recipients. Poisson regression identified DCD recipients (IRR 1.99, 95% CI 1.37-2.92, p <0.001) and younger age (IRR 0.98, 95% CI 0.97-0.99, p <0.001) as more likely to develop infections. DCD liver recipients experienced more infections in the first post-transplant year. While mortality was not different, the increased infection rates in DCD recipients highlight the need for infection prevention and surveillance.</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":"1378-1387"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147535391","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":"Pre-transplant cardiac evaluation in liver transplant recipients.","authors":"Michael P Dybala, Jacob K Sterling, Lisa B VanWagner, Daniel R Schimmel, Richard L Weinberg, Joshua Herborn, Sathish S Kumar, Dempsey L Hughes","doi":"10.1097/LVT.0000000000000922","DOIUrl":"10.1097/LVT.0000000000000922","url":null,"abstract":"<p><p>Liver transplantation (LT) remains the ultimate curative treatment for decompensated cirrhosis and specific hepatobiliary cancers. Adverse cardiac events significantly contribute to post-LT morbidity and mortality, and the prevalence of cardiovascular comorbidities is rising in this new era of steatotic-predominant liver disease. Therefore, successful LT recipient selection requires accurate and timely assessment of pre-LT cardiac risk. This review provides updated data on the prevalence of certain cardiac pathologies in the LT candidate population, examines how these conditions affect waitlist survival and post-LT outcomes, explores advances in screening diagnostics for better cardiac risk stratification, and discusses initial clinical management strategies to mitigate cardiac risk.</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":"1424-1436"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148153069","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":"Redefining liver transplant priority: Waitlist outcomes for HCC after MMaT-3 donor hospital-based allocation reform.","authors":"Esli Medina-Morales, Yash Shah, Anastasia Xynogala, Hirsh D Trivedi, Pedro Ochoa-Allemant, Behnam Saberi, Alan Bonder, Zaid Tafesh, Arpit Amin, Vivek Lingiah, Mumtaz Niazi, Paul J Gaglio, Flavio Paterno, Keri E Lunsford","doi":"10.1097/LVT.0000000000000888","DOIUrl":"10.1097/LVT.0000000000000888","url":null,"abstract":"<p><p>In 2022, the United Network for Organ Sharing (UNOS) revised the liver transplant allocation policy to calculate the median MELD at Transplant minus 3 points (MMaT-3) around the donor hospital instead of the transplant center, aiming to reduce disparities among MELD exception candidates. We evaluated the impact of this revised policy on waitlist outcomes in patients with or without hepatocellular carcinoma (HCC). Using the OPTN/UNOS registry, we identified all adult transplant candidates between October 8, 2015, and March 31, 2024, and stratified by policy eras: Pre-MMaT-3 (n=25,580), MMaT-3 Recipient (n=13,311), and MMaT-3 Donor (n=10,027). Fine-Gray competing risk models were performed to estimate waitlist removal due to dropout (death or removal due to clinical deterioration), due to clinical improvement, or transplantation by HCC status. During Pre-MMaT-3, candidates with HCC had a significantly higher probability of transplant than those without HCC [adjusted subdistribution hazard ratio (aSHR) 2.03, 95% CI: 1.95-2.12, p <0.001]. This advantage declined in the MMaT-3 Recipient era (aSHR 1.39, 95% CI: 1.31-1.47, p <0.001) and disappeared in the MMaT-3 Donor era (aSHR 0.98, 95% CI: 0.88-1.09, p =0.73). Waitlist dropout, initially similar for HCC candidates than non-HCC (aSHR 0.93, 95% CI: 0.86-1.01, p =0.08), increased following MMaT-3 Recipient (aSHR 1.21, 95% CI: 1.07-1.36, p =0.01) and Donor (aSHR 2.06, 95% CI: 1.64-2.60, p <0.001) eras. Importantly, within-HCC cohort, waitlist mortality analysis improved after the MMaT-3 Donor era ( aSHR 0.79, p =0.01), while maintaining reduced wait times and stable transplant rates. The MMaT-3 Donor policy effectively deprioritized HCC for transplantation, while improving waitlist mortality within the HCC group. Ongoing evaluation is essential to guide equitable liver allocation.</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":"1363-1377"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147795569","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: Optimizing prognostic utility of ROTEM-assessed low fibrinolytic activity in liver transplantation-Key methodological adjustments.","authors":"Zhong Dai, Lei Yao, Lei Pu","doi":"10.1097/LVT.0000000000000924","DOIUrl":"10.1097/LVT.0000000000000924","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":"E90-E91"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148153101","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: Prophylactic tranexamic acid in liver transplantation-looking beyond the primary endpoint.","authors":"Diana Elizabeth Díaz Arizmendi, Rafael Paulino Leal Villalpando, Mariana Rebeca Baéz Lima","doi":"10.1097/LVT.0000000000001013","DOIUrl":"https://doi.org/10.1097/LVT.0000000000001013","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":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122926","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: Outcome definition, class enumeration, and transportability of machine learning-derived ascites phenotypes.","authors":"Imen Ben Ismail","doi":"10.1097/LVT.0000000000001009","DOIUrl":"10.1097/LVT.0000000000001009","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":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083544","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":"Definitive surgical outcomes in children with advanced hepatoblastoma (PRETEXT III-IV): A retrospective single-center Canadian experience.","authors":"Sagar Mehta, Blayne Amir Sayed, Furqan Shaikh, Fernanda Takamatsu, Eveline Lapidus-Krol, Or Steg Saban, Jennifer Stunguris, Maria De Angelis, Krista Van Roestel, Julia Hensley, Yaron Avitzur, Robert H J Bandsma, Nicola Jones, Binita M Kamath, Justin T Gerstle, Anand Ghanekar, Mark Cattral, Vicky L Ng, Nicolas Goldaracena","doi":"10.1097/LVT.0000000000001006","DOIUrl":"10.1097/LVT.0000000000001006","url":null,"abstract":"<p><p>Children with advanced hepatoblastoma (PRETEXT III-IV) often require complex surgical decision-making; however, contemporary data describing long-term outcomes and recurrence patterns across the full spectrum of definitive surgery remain limited. We included 68 patients with PRETEXT III and IV who underwent definitive liver resection (LR, n=41) or liver transplantation (LT, n=27). The primary objective of this study was to characterize survival and recurrence patterns after surgical clearance of primary liver disease. The median age at diagnosis was 18 months (IQR, 9-36). All the patients received neoadjuvant chemotherapy. With a median follow-up of 62 months (IQR, 25-146), 5-year overall survival was 79% (95% CI: 65%-97%) after LT and 88% (95% CI 78%-100%) after LR. After LT, recurrence occurred in 6 of the 27 (22%) patients, including isolated lung metastases (n=4), combined lung-graft involvement (n=1), and isolated graft relapse (n=1). Recurrence occurred in 6 of the 41 patients (15%) after LR, involving the liver (n=2), lung (n=2), combined liver and pulmonary disease progression (n=1), and unspecified site (n=1). Among LR patients with residual pulmonary nodules at surgery (n=8), progression occurred in 3, 2 of whom died. The majority of events occurred within the first postoperative year after LR or LT. All deaths (n=10, 15%) were attributable to tumor recurrence or progression of known lung metastasis, including all post-LT recurrences. There were no perioperative or graft-related deaths. Univariate analysis showed that a serum alpha-fetoprotein decline of <95% and distant metastasis at diagnosis were associated with poor prognosis after LT and LR. Mortality in this cohort was entirely disease-related, occurring after recurrence or progression of residual metastases rather than from surgical modality. Incorporating AFP trend, pulmonary response, and detailed imaging into preoperative assessment may help identify high-risk patients and support more informed surgical decision-making.</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":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083517","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: Reconsidering the temporal dynamics of sarcopenia in MELD-based allocation bias-A clinical perspective.","authors":"Shivangi Gupta, Angus W Jeffrey, Zhengyi Wang, Leon A Adams, George Garas, Gerry MacQuillan, Michael Wallace, Briohny Smith, Wai H Lim, Ros Francis, Christopher J Welman, Gary P Jeffrey","doi":"10.1097/LVT.0000000000001008","DOIUrl":"10.1097/LVT.0000000000001008","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":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083656","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}