世界移植杂志最新文献

{"title":"Current concepts and recent trends in endothelial keratoplasty.","authors":"Prateek Nishant, Bharat Gurnani, Prabhakar Singh, Sony Sinha, Kirandeep Kaur, Ashish Kumar, Ranjeet Kumar Sinha","doi":"10.5500/wjt.v15.i2.102507","DOIUrl":"10.5500/wjt.v15.i2.102507","url":null,"abstract":"<p><p>Endothelial keratoplasty (EK) is defined as an umbrella term comprising methods for selective surgical replacement of corneal endothelium and adjacent corneal tissue, which retains healthy portions of a patient's cornea while replacing diseased innermost corneal layer(s) with healthy donor tissue, to achieve corneal dehydration and transparency before the onset of irreversible stromal edema and permanent loss of corneal clarity. Recently, the pathophysiology of corneal decompensation is increasingly being researched upon. Consequent improvement in pharmacotherapy is progressively leading to reduction in the indications of EK. In addition, EK techniques have progressed towards using thinner tissue, optimizing visual outcomes. Improvements have enabled better donor tissue formulation, usage, and attachment, and surgical modifications have enhanced the tissue utilization in difficult clinical scenarios lowering failure and rejection. However, challenges are encountered in various complex clinical scenarios including eyes with prior intraocular surgery, complex anterior chamber anatomy, glaucoma, ocular surface disease <i>etc.</i> These complexities demand tailored surgical strategies, including modifications in graft handling, instrumentation, and postoperative management to ensure success. Attention to these details and addressing patient-specific factors can help improve outcomes in these difficult cases. The choice of procedure depends on multiple factors, including the surgeon's experience, patient's ocular anatomy, and the specific clinical scenario. This review article encompasses the recent developments in this field presenting a comprehensive picture of our modern understanding of the indications, contraindications, surgical techniques, clinical situations, community aspects and future directions pertaining to EK.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"15 2","pages":"102507"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327862","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":"Effect of frailty as measured by functional impairment on long-term outcomes in liver transplantation in the United States.","authors":"Julius Balogh, Talha Mubashir, Yuan Li, Biai D Digbeu, Nikita Hegde, Fatemeh Movaghari Pour, Mohsen Rezapour, Hong-Yin Lai, Kelly West, Rabail A Chaudhry, George W Williams, Vahed Maroufy","doi":"10.5500/wjt.v15.i2.98228","DOIUrl":"10.5500/wjt.v15.i2.98228","url":null,"abstract":"<p><strong>Background: </strong>In patients with chronic liver disease or hepatic dysfunction with sarcopenia, there is an increased risk of frailty as measured by functional impairment, making frailty a vital predictor of post-transplant mortality.</p><p><strong>Aim: </strong>To investigate the effects of frailty on mortality after liver transplantation.</p><p><strong>Methods: </strong>A retrospective review of post-transplant outcomes in liver transplant recipients assessed frailty using Karnofsky Performance Score. Data from the Scientific Registry of Transplant Recipients database for 37427 liver transplant recipients was used.</p><p><strong>Results: </strong>Of 82.7% frail patients, 42.7% were severely frail and 40% were moderately frail (<i>P</i> < 0.001) at the time of transplantation. Compared with non-frail patients, post-transplant mortality in frail patients was significantly higher at 12 months [odds ratio (OR) = 1.94, <i>P</i> = 0.02)]. Secondary analysis of the data revealed that liver grafts from donation after circulatory death (DCD) were more likely to be associated with frail patients at transplant (OR = 1.86, <i>P</i> < 0.001). Furthermore, a donor history of hypertension was associated with a lower likelihood of frailty in the recipient at the time of transplant (OR = 0.65, <i>P</i> = 0.03).</p><p><strong>Conclusion: </strong>Recipient frailty is associated with increased mortality at 12 months following liver transplantation, and liver transplants from donors with DCD are associated with increased frailty of the liver transplant recipient.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"15 2","pages":"98228"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327876","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":"Ischemic colitis with small-vessel occlusion, simultaneous total colectomy and liver transplantation: A case report.","authors":"Leonardo Yuri Kasputis Zanini, Fabiana Roberto Lima, Michel Ribeiro Fernandes, Paola Sofia Espinoza Alvarez, Marcello de Souza Silva, Antônio Paulo Ramos Martins Filho, Tomazo Antonio Prince Franzini, Lucas Souto Nacif","doi":"10.5500/wjt.v15.i2.98620","DOIUrl":"10.5500/wjt.v15.i2.98620","url":null,"abstract":"<p><strong>Background: </strong>The colon is the hollow viscera that proportionally has the lowest vascular supply and is more predisposed to ischemic colitis. In the context of end-stage liver disease, various components may explain this group's greater predisposition to colonic ischemic events. Furthermore, portal hypertension generates a process of coagulopathy, impairing local vascularization. This case report describes a case of ischemic colitis with small-vessel occlusion found during liver transplantation in a patient with decompensated end-stage liver disease.</p><p><strong>Case summary: </strong>A 64-year-old man with liver cirrhosis due to non-alcoholic steatohepatitis and hepatocellular carcinoma. The patient underwent liver transplantation due to hepatic decompensation. The donor was a 53-year-old man who had died of a hemorrhagic stroke. Cavitary examination revealed diffuse ischemic colitis with significant distention and necrosis. Due to the condition of the colon, a subtotal colectomy was performed. Liver transplantation with warm ischemia time of 35 minutes, cold ischemia of 6 hours 30 minutes and total ischemia time of 7 hours 5 minutes. The patient improved clinically with oral tract function and physiotherapy, but unfortunately, he developed a bloodstream infection, a new septic shock and died six months after surgery.</p><p><strong>Conclusion: </strong>Simultaneous total colectomy and orthotopic liver transplantation represent a rare situation. Ischemic events have a high mortality rate in the general population and are particularly important in cirrhotic patients.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"15 2","pages":"98620"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327879","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":"Rise in deaths from drug overdose and firearm injury during coronavirus disease 2019 pandemic and its impact on organ transplantation.","authors":"Roshan Dhand, Kenji Okumura, Seigo Nishida, Abhay Dhand","doi":"10.5500/wjt.v15.i2.101986","DOIUrl":"10.5500/wjt.v15.i2.101986","url":null,"abstract":"<p><strong>Background: </strong>The coronavirus disease 2019 (COVID-19) pandemic had a profound societal impact in the United States which was associated with a decrease in overall life expectancy and an increase in substance abuse and firearm injury. Our understanding of changes in mortality trends during the pandemic and its effect on organ availability for transplantation is limited.</p><p><strong>Aim: </strong>To examine the trends of substance abuse and firearm injury fatalities during COVID-19 and a potential correlation with organ transplantation.</p><p><strong>Methods: </strong>Crude rates of population-based deaths among adults (18-75 years) from firearm injury and substance abuse from the period of 2014-2021 were obtained from centers of disease control wide-ranging online data for epidemiologic research database. Crude rates of causes of donor (18-75 years) deaths from 2014-2021 were obtained from the united network for organ sharing database.</p><p><strong>Results: </strong>Average annual percentage change (AAPC) deaths among the United States population were 16.4% from substance abuse and 3.4% from firearm injury. AAPC in cause of death among organ donors was 10.9% from drug intoxication and 2.1% from firearm injury. There was a significant (<i>P</i> < 0.001) and progressive increase in mortality from both causes during the pandemic (2020-2021) and significant correlation (<i>P</i> < 0.001) between population and donor causes of death. COVID-19 exacerbated trends in substance abuse and firearm mortality with a consequent increase in organ donation from donors who died from these two causes.</p><p><strong>Conclusion: </strong>Identifying the socioeconomic and regional disparities associated with increase in deaths from substance abuse and firearms can help guide post-pandemic healthcare policies and mitigate their impact on organ transplantation.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"15 2","pages":"101986"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327920","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":"Development and validation of a decision algorithm for eyelid reconstruction following oncological resection.","authors":"Giovanni Miotti, Davide Quaglia, Federico Cesare Novati, Pier Camillo Parodi, Martina Grando, Carlo Salati, Leopoldo Spadea, Caterina Gagliano, Mutali Musa, Marco Zeppieri","doi":"10.5500/wjt.v15.i2.97571","DOIUrl":"10.5500/wjt.v15.i2.97571","url":null,"abstract":"<p><strong>Background: </strong>Eyelid reconstruction is an intricate process, addressing both aesthetic and functional aspects post-trauma or oncological surgery. Aesthetic concerns and oncological radicality guide personalized approaches. The complex anatomy, involving anterior and posterior lamellae, requires tailored reconstruction for optimal functionality.</p><p><strong>Aim: </strong>To formulate an eyelid reconstruction algorithm through an extensive literature review and to validate it by juxtaposing surgical outcomes from Cattinara Hospital with established findings.</p><p><strong>Methods: </strong>The algorithm was formulated by analyzing 1538 articles, which were subsequently refined to 113 according to quality standards, and then implemented in surgical cases at Cattinara Hospital. Complication rates were examined for validity.</p><p><strong>Results: </strong>The decision algorithm was employed to apply reconstructive techniques customized to the characteristics of the eyelid defect, including its depth and location. The results exhibited a minimal complication rate, consistent with established guidelines. Validation confirmed the algorithm's efficacy in reducing post-operative problems.</p><p><strong>Conclusion: </strong>This algorithm functions as an essential decision-making instrument for eyelid reconstruction, enhancing outcomes by minimizing complications in clinical practice.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"15 2","pages":"97571"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327863","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":"Diagnostic value of ultrasonography for post-liver transplant hepatic vein complications.","authors":"Ning-Bo Zhao, Zi Luo, Ying Li, Rui Xia, Yu Zhang, Yi-Jun Li, Dong Zhao","doi":"10.5500/wjt.v15.i2.100373","DOIUrl":"10.5500/wjt.v15.i2.100373","url":null,"abstract":"<p><p>Liver transplantation (LT) is the most effective treatment for patients with end-stage liver disease, and maintaining vascular patency of the transplanted liver is one of the crucial prerequisites for surgical success. Despite hepatic vein complications following LT occurring at a relatively low frequency, ranging between 2% to 11%, delayed diagnosis and treatment may lead to graft dysfunction and even patient mortality. Clinical manifestations of hepatic vein complications are often subtle and nonspecific, posing challenges for early diagnosis. Signs may initially present as mild abnormalities in liver function, delayed recovery of liver function, unexplained ascites, lower limb edema, and perineal edema. Prolonged duration of these complications can lead to hepatic sinusoidal dilatation and eventual liver failure due to prolonged hepatic congestion. Ultrasonography has become the preferred imaging modality for post-liver transplant evaluation due to its convenience and non-invasiveness. Although hepatic vein complications may manifest as disappearance or flattening of the hepatic vein spectrum on routine ultrasound imaging, these findings lack specificity. Contrast-enhanced ultrasound that visualizes the filling of contrast agent in the hepatic veins and dynamically displays blood flow perfusion information in the drainage area can, however, significantly improve diagnostic confidence and provide additional information beyond routine ultrasound examination.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"15 2","pages":"100373"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327874","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":"Donor-specific antibodies against HLA-C, HLA-DP and HLA-DQ and their implications in kidney transplantation.","authors":"Muhammad Abdul Mabood Khalil, Nihal Mohammed Sadagah, Ishida Hediki, Jackson Tan, Salem H Al-Qurashi","doi":"10.5500/wjt.v15.i2.99952","DOIUrl":"10.5500/wjt.v15.i2.99952","url":null,"abstract":"<p><p>HLA-C, HLA-DP and HLA-DQ are thought to be benign due to low expression and few initial negative studies. Historically, most allocation programs used HLA-A, HLA-B and HLA-DR antigens for matching. With the advent and use of single-bead antigen assays, more was learned about donor-specific antibodies (DSAs) against these antigens. Interest in these antigens and antibodies grew when cases of acute antibody-mediated rejection (AMR), mixed rejections, chronic AMR, and reduced graft survival were reported with DSAs against these antigens. Although the deleterious effects of these DSAs are more pronounced in retransplants, harmful effects have also been observed in first-time recipients. DSAs against each of these antigens can trigger rejection alone. Their combination with DSAs against HLA-A, HLA-B and HLA-DR can cause more damage. It has been shown that strategies that reduce mismatches for these antigen lead to fewer rejections and better graft survival. There is a need for greater consensus on the universal typing of these antigens prior to transplantation for better patient and graft outcomes. This review focuses on the interaction of these antigens with lymphocytes and killer immunoglobulin receptors, arguments for not typing them, detailed analyses of the literature about their harmful effects, potential strategies moving forward, and recommendations for the future.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"15 2","pages":"99952"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327875","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":"C3 glomerulopathy post kidney transplantation: A single center experience.","authors":"Jonathan Zuckerman, Phuong-Thu Pham, Meena Parakkal, Alexis F Velazquez, Mrinalini Sarkar, Michael A Pablos, Suphamai Bunnapradist, Erik L Lum","doi":"10.5500/wjt.v15.i2.101517","DOIUrl":"10.5500/wjt.v15.i2.101517","url":null,"abstract":"<p><strong>Background: </strong>C3 glomerulopathies (C3G) are a rare cause of kidney failure resulting from complement dysregulation. Small studies demonstrate a high rate of recurrence and poor outcomes in kidney transplantation. Treatment efficacy in this setting with eculizumab, a terminal complement inhibitor, is largely unknown.</p><p><strong>Aim: </strong>To determine the outcomes of kidney transplantation in patients with C3G and the potential impact of eculizumab.</p><p><strong>Methods: </strong>We retrospectively studied kidney transplant recipients who underwent a post-transplant biopsy confirming C3G between January 1, 1993 and December 31, 2023 at a single center. Only the first episode of kidney transplant was reviewed. The electronic medical records were reviewed for post-transplant allograft function, indication for biopsy, time to biopsy from transplant, time to allograft failure from transplantation, post-C3G treatment, complement laboratory testing, and concurrent malignancy/infection. Reports, and when available slides and immunofluorescence/electron microscopic images, were re-reviewed by a renal pathologist.</p><p><strong>Results: </strong>A total of fifteen patients were included in this study. Fourteen patients had suspected recurrent disease, with a pre-transplant native kidney report of C3G. One patient developed <i>de novo</i> C3G. Median post kidney transplant clinical follow up time was 91 months. Median time to recurrence was 7 months with median graft survival of 48 months post kidney transplantation. The most common index biopsy pattern of injury was endocapillary proliferative glomerulonephritis (often with exudative features) with or without mesangial hypercellularity (56%) followed by membranoproliferative glomerulonephritis (25%). Most patients developed membranoproliferative glomerulonephritis pattern of injury on follow up biopsies (63%). Seven patients with recurrent disease received treatment with eculizumab with a median graft survival of 73 months, with five functioning grafts by the end of the study period. Seven patients with recurrent disease did not receive therapy, and all lost their graft with a median graft survival of 22 months (<i>P</i> = 0.003).</p><p><strong>Conclusion: </strong>C3G following kidney transplantation is mostly a recurrent disorder with a poor prognosis in untreated patients. Untreated recurrence has a poor prognosis with median allograft survival < 2 years. Early treatment with eculizumab may improve transplant outcomes in patients with recurrent C3G.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"15 2","pages":"101517"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327816","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":"Clinical events and healthcare resource utilization associated with neutropenia and leukopenia among adult kidney transplant recipients receiving valganciclovir.","authors":"Andrew P Beyer, Pamela A Moise, Michael Wong, Wei Gao, Cheryl Xiang, Pangsibo Shen, Martha Pavlakis, Flavio Vincenti, Weijia Wang","doi":"10.5500/wjt.v15.i2.102671","DOIUrl":"10.5500/wjt.v15.i2.102671","url":null,"abstract":"<p><strong>Background: </strong>Cytomegalovirus (CMV) prophylaxis with valganciclovir and ganciclovir is associated with elevated neutropenia and leukopenia risk in kidney transplant recipients, although the impact of these events on healthcare resource utilization (HCRU) and clinical outcomes is unclear.</p><p><strong>Aim: </strong>To quantify clinical events and HCRU associated with neutropenia and leukopenia among adults receiving valganciclovir and/or ganciclovir post-kidney transplantation.</p><p><strong>Methods: </strong>Adult kidney transplant recipients receiving valganciclovir and/or ganciclovir prophylaxis were identified in the TriNetX database from 2012 to 2021. Patient characteristics were evaluated in the 1-year period pre-first transplant. HCRU and adjusted event rates per person-year were evaluated in follow-up year 1 and years 2-5 after first kidney transplantation among cohorts with <i>vs</i> without neutropenia and/or leukopenia.</p><p><strong>Results: </strong>Of 15398 identified patients, the average age was 52.39 years and 58.70% were male. Patients with neutropenia and/or leukopenia had greater risk of clinical events for CMV-related events, opportunistic infections, use of granulocyte colony stimulating factor, and hospitalizations (relative risk > 1 in year 1 and years 2-5). Patients with <i>vs</i> without neutropenia and/or leukopenia had higher HCRU in year 1 and years 2-5 post kidney transplantation, including the mean number of inpatient admissions (year 1: 3.47 <i>vs</i> 2.76; years 2-5: 2.70 <i>vs</i> 2.29) and outpatient visits (48.97 <i>vs</i> 34.42; 31.73 <i>vs</i> 15.59, respectively), as well as the mean number of labs (1654.55 <i>vs</i> 1182.27; 622.37 <i>vs</i> 327.89).</p><p><strong>Conclusion: </strong>Adults receiving valganciclovir and/or ganciclovir prophylaxis post-kidney transplantation had greater risk of neutropenia and/or leukopenia, which were associated with higher clinical event rates and HCRU up to 5 years post-transplantation. These findings suggest the need for alternative prophylaxis options with lower myelosuppressive effects to improve patient outcomes.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"15 2","pages":"102671"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327860","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":"Diagnostic accuracy and cost-effectiveness of the CAR-OLT score in predicting cardiac risk for liver transplantation.","authors":"Marco Biolato, Luca Miele, Alfonso W Avolio, Giuseppe Marrone, Antonio Liguori, Francesco Galati, Anna Petti, Lidia Tomasello, Daniela Pedicino, Antonella Lombardo, Alessia D'Aiello, Maurizio Pompili, Salvatore Agnes, Antonio Gasbarrini, Antonio Grieco","doi":"10.5500/wjt.v15.i2.99208","DOIUrl":"10.5500/wjt.v15.i2.99208","url":null,"abstract":"<p><strong>Background: </strong>The CAR-OLT score predicts major adverse cardiovascular events 1 year after liver transplant (LT).</p><p><strong>Aim: </strong>To test the hypothesis that the CAR-OLT score may help avoid cardiac stress tests in LT candidates.</p><p><strong>Methods: </strong>This retrospective single-center cohort study included all adult patients undergoing elective evaluation for first cadaveric donor orthotopic LT for liver cirrhosis with or without hepatocellular carcinoma at Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricerca e Cura a Carattere Scientifico in Rome, Italy. Cardiac contraindications for LT listing were defined after a center-specific cardiac workup, which included cardiac stress tests for most patients. The diagnostic accuracy of the CAR-OLT score was evaluated using the area under the receiver operating characteristic (AUROC) method.</p><p><strong>Results: </strong>A total of 342 LT candidates were evaluated between 2015 and 2019, with a moderate cardiovascular risk profile (37% diabetes, 34% hypertension, 22% obesity). Of these, 80 (23%) candidates underwent coronary angiography. Twenty-one (6%) candidates were given cardiac contraindications to LT listing, 48% of which were due to coronary artery disease. The CAR-OLT score predicted cardiac contraindications to LT listing with an AUROC of 0.81. The optimal cut-off for sensitivity was a CAR-OLT score ≤ 23, which showed a 99% negative predictive value for cardiac contraindications to LT listing. A total of 84 (25%) LT candidates with a CAR-OLT score ≤ 23 underwent 87 non-invasive cardiac tests and 13 coronary angiographies pre-listing, with estimated costs of approximately 48000€. The estimated savings per patient was €574.70 for the Italian National Health System.</p><p><strong>Conclusion: </strong>A CAR-OLT score ≤ 23 can identify LT candidates who can be safely listed without the need for cardiac stress tests, providing time and cost savings. These findings require external validation.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"15 2","pages":"99208"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327864","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}