Pub Date : 2026-05-01Epub Date: 2026-02-02DOI: 10.1016/j.liver.2026.100322
Amal Francis Sam , Deepti Sachan , Velure Mohan Jyotsnaa Grace , Deepthi Krishna Gundrajukuppam , Koustav Jana , Akila Rajakumar , Mohamed Rela
In the post-liver transplant care unit, we observed several instances in which patients exhibited normal prothrombin time but disproportionately prolonged clotting time (CT), as measured by Rotational Thromboelastography (ROTEM). Hence, we conducted a case series in patients with reduced maximum clot firmness (MCF) in ROTEM. Platelets and fibrinogen concentrate were incrementally added to the blood samples in vitro in three tubes, with incremental doses from tubes 1 to 3, and ROTEM was repeated for each tube. Blood samples from six patients were analysed, with each patient undergoing one baseline ROTEM and three subsequent ROTEM tests following in vitro correction, resulting in a total of 24 observations (six baseline and 18 repeat ROTEM). Except for three instances, all repeat ROTEM values showed improvements in CT, along with Clot formation time (CFT) and MCF, from baseline to tube 3. Regression analysis of the 18 delta values suggested that for every 100-second increase in CFT, there was an associated 10-second increase in the CT. We conclude that a critically prolonged CFT and low MCF can result in falsely prolonged CT in ROTEM.
{"title":"In vitro evaluation of clotting time in rotational thromboelastometry after correction with platelet-rich plasma and fibrinogen in post–liver transplant patients: A case series","authors":"Amal Francis Sam , Deepti Sachan , Velure Mohan Jyotsnaa Grace , Deepthi Krishna Gundrajukuppam , Koustav Jana , Akila Rajakumar , Mohamed Rela","doi":"10.1016/j.liver.2026.100322","DOIUrl":"10.1016/j.liver.2026.100322","url":null,"abstract":"<div><div>In the post-liver transplant care unit, we observed several instances in which patients exhibited normal prothrombin time but disproportionately prolonged clotting time (CT), as measured by Rotational Thromboelastography (ROTEM). Hence, we conducted a case series in patients with reduced maximum clot firmness (MCF) in ROTEM. Platelets and fibrinogen concentrate were incrementally added to the blood samples in vitro in three tubes, with incremental doses from tubes 1 to 3, and ROTEM was repeated for each tube. Blood samples from six patients were analysed, with each patient undergoing one baseline ROTEM and three subsequent ROTEM tests following in vitro correction, resulting in a total of 24 observations (six baseline and 18 repeat ROTEM). Except for three instances, all repeat ROTEM values showed improvements in CT, along with Clot formation time (CFT) and MCF, from baseline to tube 3. Regression analysis of the 18 delta values suggested that for every 100-second increase in CFT, there was an associated 10-second increase in the CT. We conclude that a critically prolonged CFT and low MCF can result in falsely prolonged CT in ROTEM.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"22 ","pages":"Article 100322"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146174874","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}
Pub Date : 2026-05-01Epub Date: 2026-02-02DOI: 10.1016/j.liver.2026.100323
David Toapanta , Gonzalo Crespo , Annabel Blasi , Jordi Colmenero , Ernest Hidalgo , Javier Fernández
Acute pancreatitis in the context of acute-on-chronic liver failure (ACLF) is a rare but potentially severe complication that can jeopardize eligibility for liver transplantation (LT). We describe two ACLF patients listed for highly prioritized transplantation who developed acute pancreatitis during the late course of ACLF. In the first case, the patient developed necrosis of the pancreatic tail and a large pseudocyst; in the second, necrosis affected >50% of the pancreatic body and tail. Both patients were delisted and died. While necrotizing pancreatitis was considered an absolute contraindication for LT in these two cases, recent reports suggest that transplantation may be feasible in highly selected patients. A case-by-case multidisciplinary assessment remains essential for appropriate decision-making in this complex scenario. Early LT could contribute to prevent this feared complication.
{"title":"Severe acute pancreatitis in acute-on-chronic liver failure: An absolute contraindication for liver transplantation?","authors":"David Toapanta , Gonzalo Crespo , Annabel Blasi , Jordi Colmenero , Ernest Hidalgo , Javier Fernández","doi":"10.1016/j.liver.2026.100323","DOIUrl":"10.1016/j.liver.2026.100323","url":null,"abstract":"<div><div>Acute pancreatitis in the context of acute-on-chronic liver failure (ACLF) is a rare but potentially severe complication that can jeopardize eligibility for liver transplantation (LT). We describe two ACLF patients listed for highly prioritized transplantation who developed acute pancreatitis during the late course of ACLF. In the first case, the patient developed necrosis of the pancreatic tail and a large pseudocyst; in the second, necrosis affected >50% of the pancreatic body and tail. Both patients were delisted and died. While necrotizing pancreatitis was considered an absolute contraindication for LT in these two cases, recent reports suggest that transplantation may be feasible in highly selected patients. A case-by-case multidisciplinary assessment remains essential for appropriate decision-making in this complex scenario. Early LT could contribute to prevent this feared complication.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"22 ","pages":"Article 100323"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116511","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}
Pub Date : 2026-02-01Epub Date: 2025-12-30DOI: 10.1016/j.liver.2025.100317
Bozon-Rivière Pauline , Faure Stéphanie , Ursic Bedoya José , Meszaros Magdalena , Rivière Benjamin , Monet Clément , Moulis Lionel , Herrero Astrid , Guiu Boris , Pageaux Georges-Philippe , Meunier Lucy
Background & Aims
Liver biopsy (LB) is the gold standard for diagnosing post-liver transplantation (LT) complications. Currently, there is no data on the value of vibration-controlled-transient elastography (VCTE) for medium- and long-term follow-up after LT compared to protocol LB in asymptomatic patients. This study aims to evaluate the correlation between VCTE-derived liver stiffness measurements (LSM) and histological abnormalities observed in protocol LB 5 to 10 years after LT, to determine the potential role of VCTE in long-term graft monitoring.
Methods
A prospective study was conducted at a liver transplantation center in Montpellier, France, involving adult LT recipients who underwent both VCTE and LB within 6 months between January 2022 and January 2024. Protocol LB were performed in the absence of clinical or laboratory evidence of post-LT complications. The primary endpoint was to determine the LSM threshold for predicting abnormal LB. Receiver operating characteristic (ROC) curve analysis and the Youden index were used to identify the optimal cutoff.
Results
Among 90 patients, 32% had abnormal LB findings, including fibrosis ≥ F1 (by Ishak) in 58.6% of abnormal biopsies. The mean LSM was significantly higher in patients with abnormal LB (12.6 ± 13.9 kPa) compared to those with normal LB (5.9 ± 1.6 kPa), p < 0.001. LSM (area under the ROC curve [AUC]: 0.816) was the most accurate predictor of abnormal LB. The optimal LSM threshold to predict abnormal LB was 6.90 kPa (sensitivity [Se] = 0.69, specificity [Sp] = 0.84), while values ≤5.6 kPa and >12.9 kPa respectively ruled out and predicted an abnormal LB.
Conclusion
These results underscore the relevance of VCTE in long-term follow-up of LT recipients to determine the need for LB. VCTE effectively predicts abnormal histology and can guide selective use of protocol liver biopsies, potentially reducing unnecessary procedures. Multicenter studies are needed to validate these findings.
{"title":"Prospective evaluation of vibration-controlled transient elastography for guiding long-term protocol liver biopsies after liver transplantation","authors":"Bozon-Rivière Pauline , Faure Stéphanie , Ursic Bedoya José , Meszaros Magdalena , Rivière Benjamin , Monet Clément , Moulis Lionel , Herrero Astrid , Guiu Boris , Pageaux Georges-Philippe , Meunier Lucy","doi":"10.1016/j.liver.2025.100317","DOIUrl":"10.1016/j.liver.2025.100317","url":null,"abstract":"<div><h3>Background & Aims</h3><div>Liver biopsy (LB) is the gold standard for diagnosing post-liver transplantation (LT) complications. Currently, there is no data on the value of vibration-controlled-transient elastography (VCTE) for medium- and long-term follow-up after LT compared to protocol LB in asymptomatic patients. This study aims to evaluate the correlation between VCTE-derived liver stiffness measurements (LSM) and histological abnormalities observed in protocol LB 5 to 10 years after LT, to determine the potential role of VCTE in long-term graft monitoring.</div></div><div><h3>Methods</h3><div>A prospective study was conducted at a liver transplantation center in Montpellier, France, involving adult LT recipients who underwent both VCTE and LB within 6 months between January 2022 and January 2024. Protocol LB were performed in the absence of clinical or laboratory evidence of post-LT complications. The primary endpoint was to determine the LSM threshold for predicting abnormal LB. Receiver operating characteristic (ROC) curve analysis and the Youden index were used to identify the optimal cutoff.</div></div><div><h3>Results</h3><div>Among 90 patients, 32% had abnormal LB findings, including fibrosis ≥ F1 (by Ishak) in 58.6% of abnormal biopsies. The mean LSM was significantly higher in patients with abnormal LB (12.6 ± 13.9 kPa) compared to those with normal LB (5.9 ± 1.6 kPa), <em>p</em> < 0.001. LSM (area under the ROC curve [AUC]: 0.816) was the most accurate predictor of abnormal LB. The optimal LSM threshold to predict abnormal LB was 6.90 kPa (sensitivity [Se] = 0.69, specificity [Sp] = 0.84), while values ≤5.6 kPa and >12.9 kPa respectively ruled out and predicted an abnormal LB.</div></div><div><h3>Conclusion</h3><div>These results underscore the relevance of VCTE in long-term follow-up of LT recipients to determine the need for LB. VCTE effectively predicts abnormal histology and can guide selective use of protocol liver biopsies, potentially reducing unnecessary procedures. Multicenter studies are needed to validate these findings.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"21 ","pages":"Article 100317"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145938330","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}
Pub Date : 2026-02-01Epub Date: 2025-11-26DOI: 10.1016/j.liver.2025.100307
Sarah Samaranayake MS , Alexandra Arges MD , Emily Pinto Taylor MD
{"title":"“I’ll give all my money for a liver”: Caring for the undocumented patient with end-stage liver disease","authors":"Sarah Samaranayake MS , Alexandra Arges MD , Emily Pinto Taylor MD","doi":"10.1016/j.liver.2025.100307","DOIUrl":"10.1016/j.liver.2025.100307","url":null,"abstract":"","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"21 ","pages":"Article 100307"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693571","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}
Pub Date : 2026-02-01Epub Date: 2025-11-12DOI: 10.1016/j.liver.2025.100305
Andre Cordeiro , Pascal Lebray , Romain Guillemain , Samy Meriem , Fabiano Perdigao , Adrien Bougle , Olivier Scatton , Pascal Leprince , Shaida Varnouss , Eric Savier , Alain Combes , Geraldine Rousseau , Bernard Cholley , Bastien Genet , Benjamin Granger , Antoine Monsel , Daniel Eyraud
Background
Combined heart-liver transplantation (CHLT) offers new possibilities for patients with no other treatment options, yet it remains a rare and complex procedure. Despite an increase in its utilisation in recent years, data remain scarce, and many aspects of the procedure are not yet fully understood, particularly the causes of its significant perioperative morbidity, such as acute kidney injury. The CARDHEPAT study presents the first description of a French regional cohort of CHLT patients.
Methods
A retrospective analysis of the CARDHEPAT cohort examined 30 CHLTs performed at Assistance Publique - Hôpitaux de Paris (APHP) from January 1, 2002, to January 1, 2022. The aim of this study was to highlight the impact of postoperative KDIGO3 acute kidney injury (AKI) on recipient outcomes and its evolution.
Results
KDIGO3 AKI was observed in 50 % of cases and was associated with an excess mortality rate among patients undergoing CHLT. At Day-30 and -90, the survival rates with KDIGO3 AKI were 67 % and 53 %, respectively, compared to 100 % and 93 % in patients without (p = 0.04 and p = 0.03). Additionally, we found several intraoperative factors that were associated with the occurrence of postoperative KDIGO3 AKI, including durations of extracorporeal circulation and aortic clamping and level of intraoperative acidosis but also preoperative albuminemia
Conclusion
The incidence of KDIGO3 AKI is high after CHLT and seems to be associated with increased mortality, with results suggesting that the intraoperative phase is crucial for its occurrence.
{"title":"Combined heart-liver transplantation and Acute Kidney Injury: Risk factors and outcomes from CARDHEPAT registry","authors":"Andre Cordeiro , Pascal Lebray , Romain Guillemain , Samy Meriem , Fabiano Perdigao , Adrien Bougle , Olivier Scatton , Pascal Leprince , Shaida Varnouss , Eric Savier , Alain Combes , Geraldine Rousseau , Bernard Cholley , Bastien Genet , Benjamin Granger , Antoine Monsel , Daniel Eyraud","doi":"10.1016/j.liver.2025.100305","DOIUrl":"10.1016/j.liver.2025.100305","url":null,"abstract":"<div><h3>Background</h3><div>Combined heart-liver transplantation (CHLT) offers new possibilities for patients with no other treatment options, yet it remains a rare and complex procedure. Despite an increase in its utilisation in recent years, data remain scarce, and many aspects of the procedure are not yet fully understood, particularly the causes of its significant perioperative morbidity, such as acute kidney injury. The CARDHEPAT study presents the first description of a French regional cohort of CHLT patients.</div></div><div><h3>Methods</h3><div>A retrospective analysis of the CARDHEPAT cohort examined 30 CHLTs performed at Assistance Publique - Hôpitaux de Paris (APHP) from January 1, 2002, to January 1, 2022. The aim of this study was to highlight the impact of postoperative KDIGO3 acute kidney injury (AKI) on recipient outcomes and its evolution.</div></div><div><h3>Results</h3><div>KDIGO3 AKI was observed in 50 % of cases and was associated with an excess mortality rate among patients undergoing CHLT. At Day-30 and -90, the survival rates with KDIGO3 AKI were 67 % and 53 %, respectively, compared to 100 % and 93 % in patients without (<em>p</em> = 0.04 and <em>p</em> = 0.03). Additionally, we found several intraoperative factors that were associated with the occurrence of postoperative KDIGO3 AKI, including durations of extracorporeal circulation and aortic clamping and level of intraoperative acidosis but also preoperative albuminemia</div></div><div><h3>Conclusion</h3><div>The incidence of KDIGO3 AKI is high after CHLT and seems to be associated with increased mortality, with results suggesting that the intraoperative phase is crucial for its occurrence.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"21 ","pages":"Article 100305"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145580513","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}
Pub Date : 2026-02-01Epub Date: 2025-12-04DOI: 10.1016/j.liver.2025.100310
Amal F. Sam , Kavinandan Gangaiah , Stuti Kumari , Premchandar Velusamy , Akila Rajakumar , Dinesh Jothimani , Mohamed Rela
Background
: Albumin-Bilirubin score (ALBI) was primarily developed to quantify the liver function and to prognosticate the patients with hepatocellular carcinoma. Later, it was shown that the ALBI score could predict postoperative complications after liver resection and transplantation.
Methods
: A retrospective analysis was conducted to evaluate the preoperative ALBI score as a predictor of post-living donor liver transplant (LDLT) outcomes. This study included 190 patients from August 2019 to 2021. The predictive power of ALBI for post LDLT outcomes was assessed using Receiver Operating Characteristic (ROC) analysis.
Results
: In total, 190 LDLT recipients were included in this study. Twelve patients (6.3%) belonged to ALBI Grade 1, 82 patients (43.2%) belonged to ALBI Grade 2, and 96 patients (50.5%) belonged to ALBI Grade 3. Similar to the Model for End-stage Liver Disease (MELD), a high ALBI score implies poor liver function, and a low ALBI score implies a better-preserved state. The preoperative ALBI score predicted morbidity with an area under the curve (AUC) of 0.66, whereas the preoperative MELD score predicted morbidity with an AUC of 0.70. For 90-day mortality prediction, preoperative ALBI demonstrated an AUC of 0.60, whereas preoperative MELD showed an AUC of 0.63. ROC curve analysis revealed that the optimal ALBI score cutoff value for differentiating between survivors and non-survivors was -1.40. The discrimination ability of ALBI was higher in patients with high MELD scores (MELD ≥18).
Conclusion
: In predicting both morbidity and 90-day mortality, the performance of the ALBI score was comparable to that of the preoperative MELD. The discriminatory power of ALBI was higher in patients with high MELD scores.
{"title":"The value of albumin-bilirubin (ALBI) score in predicting outcomes following adult living donor liver transplantation","authors":"Amal F. Sam , Kavinandan Gangaiah , Stuti Kumari , Premchandar Velusamy , Akila Rajakumar , Dinesh Jothimani , Mohamed Rela","doi":"10.1016/j.liver.2025.100310","DOIUrl":"10.1016/j.liver.2025.100310","url":null,"abstract":"<div><h3>Background</h3><div><strong>:</strong> Albumin-Bilirubin score (ALBI) was primarily developed to quantify the liver function and to prognosticate the patients with hepatocellular carcinoma. Later, it was shown that the ALBI score could predict postoperative complications after liver resection and transplantation.</div></div><div><h3>Methods</h3><div><strong>:</strong> A retrospective analysis was conducted to evaluate the preoperative ALBI score as a predictor of post-living donor liver transplant (LDLT) outcomes. This study included 190 patients from August 2019 to 2021. The predictive power of ALBI for post LDLT outcomes was assessed using Receiver Operating Characteristic (ROC) analysis.</div></div><div><h3>Results</h3><div><strong>:</strong> In total, 190 LDLT recipients were included in this study. Twelve patients (6.3%) belonged to ALBI Grade 1, 82 patients (43.2%) belonged to ALBI Grade 2, and 96 patients (50.5%) belonged to ALBI Grade 3. Similar to the Model for End-stage Liver Disease (MELD), a high ALBI score implies poor liver function, and a low ALBI score implies a better-preserved state. The preoperative ALBI score predicted morbidity with an area under the curve (AUC) of 0.66, whereas the preoperative MELD score predicted morbidity with an AUC of 0.70. For 90-day mortality prediction, preoperative ALBI demonstrated an AUC of 0.60, whereas preoperative MELD showed an AUC of 0.63. ROC curve analysis revealed that the optimal ALBI score cutoff value for differentiating between survivors and non-survivors was -1.40. The discrimination ability of ALBI was higher in patients with high MELD scores (MELD ≥18).</div></div><div><h3>Conclusion</h3><div><strong>:</strong> In predicting both morbidity and 90-day mortality, the performance of the ALBI score was comparable to that of the preoperative MELD. The discriminatory power of ALBI was higher in patients with high MELD scores.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"21 ","pages":"Article 100310"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799763","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}
Pub Date : 2026-02-01Epub Date: 2025-11-27DOI: 10.1016/j.liver.2025.100306
Rodolpho Augusto de Moura Pedro
{"title":"Postoperative AKI after combined heart–liver transplantation: Keep an eye on the lesser evil","authors":"Rodolpho Augusto de Moura Pedro","doi":"10.1016/j.liver.2025.100306","DOIUrl":"10.1016/j.liver.2025.100306","url":null,"abstract":"","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"21 ","pages":"Article 100306"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693570","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}
Pub Date : 2026-02-01Epub Date: 2025-12-29DOI: 10.1016/j.liver.2025.100316
John Grady , Chad Spencer , Michael Idowu , Kevin Houston , Nikita Chadha , Nikki Duong , David Bruno , Joel Wedd , Richard K Sterling
Introduction: Early liver transplantation for severe alcohol-associated hepatitis has been increasingly utilized as a lifesaving treatment option in this population. Despite a more acute presentation, most of these patients have evidence of underlying chronic liver disease. However, detailed descriptions of histologic features in patients with severe alcohol-associated hepatitis undergoing liver transplant are lacking. The aim of this study is to characterize the histologic findings of explanted livers of patients who underwent liver transplantation for severe alcohol-associated hepatitis. Methods: This was a retrospective study of patients who underwent deceased donor liver transplant for severe alcohol-associated hepatitis between 2019–2022 at a single center. Clinical and laboratory data at the time of transplant listing were obtained from the electronic medical record. All explants were reviewed by an expert hepatic pathologist, and histology was assessed for fibrosis staging and microscopic features of alcohol-associated hepatitis. Results: Among 44 patients included in the study, the mean MELD-Na at the time of listing was 37 ± 6. On review of explant histology, 97.7 of patients had cirrhosis. Steatosis was present in 59.1 , Mallory bodies were found in 90.9 , hepatocyte ballooning in 84.1 , lobular inflammation in 95.5 , and megamitochondria in 25 . Portal inflammation was seen in 97.7 of liver explants. Discussion: In this study, all patients who underwent early liver transplant for severe alcohol-associated hepatitis had advanced chronic liver disease on review of explant histology. Although steatosis was only present in 59.1 of explants, most had other classic features of alcohol-associated hepatitis.
{"title":"The histologic features of severe alcohol-associated hepatitis undergoing liver transplantation: An explant study","authors":"John Grady , Chad Spencer , Michael Idowu , Kevin Houston , Nikita Chadha , Nikki Duong , David Bruno , Joel Wedd , Richard K Sterling","doi":"10.1016/j.liver.2025.100316","DOIUrl":"10.1016/j.liver.2025.100316","url":null,"abstract":"<div><div>Introduction: Early liver transplantation for severe alcohol-associated hepatitis has been increasingly utilized as a lifesaving treatment option in this population. Despite a more acute presentation, most of these patients have evidence of underlying chronic liver disease. However, detailed descriptions of histologic features in patients with severe alcohol-associated hepatitis undergoing liver transplant are lacking. The aim of this study is to characterize the histologic findings of explanted livers of patients who underwent liver transplantation for severe alcohol-associated hepatitis. Methods: This was a retrospective study of patients who underwent deceased donor liver transplant for severe alcohol-associated hepatitis between 2019–2022 at a single center. Clinical and laboratory data at the time of transplant listing were obtained from the electronic medical record. All explants were reviewed by an expert hepatic pathologist, and histology was assessed for fibrosis staging and microscopic features of alcohol-associated hepatitis. Results: Among 44 patients included in the study, the mean MELD-Na at the time of listing was 37 ± 6. On review of explant histology, 97.7 of patients had cirrhosis. Steatosis was present in 59.1 , Mallory bodies were found in 90.9 , hepatocyte ballooning in 84.1 , lobular inflammation in 95.5 , and megamitochondria in 25 . Portal inflammation was seen in 97.7 of liver explants. Discussion: In this study, all patients who underwent early liver transplant for severe alcohol-associated hepatitis had advanced chronic liver disease on review of explant histology. Although steatosis was only present in 59.1 of explants, most had other classic features of alcohol-associated hepatitis.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"21 ","pages":"Article 100316"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145938332","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}
Kaposi Sarcoma (KS) is a vascular malignancy driven by Human Herpes Virus 8 (HHV-8), commonly occurring in immunocompromised states. Hepatic involvement and development of Kaposi Sarcoma Herpesvirus Inflammatory Cytokine Syndrome (KICS) in post-liver transplant recipients is rare and hence not well described.
Case Presentation
A 59-year-old Caucasian woman developed cholestatic liver dysfunction six months following orthotopic liver transplantation for primary biliary cirrhosis. Initial imaging revealed a hilar and peribiliary soft tissue abnormality, with fine needle aspiration confirming Kaposi Sarcoma. Her clinical course was complicated by multidrug-resistant gram-negative septic encephalopathy, progressive hepatic failure, and acute kidney injury requiring continuous renal replacement therapy. High HHV-8 viral load and persistent systemic inflammation despite appropriate antimicrobial therapy raised suspicion for KICS. Despite immunosuppressive dose reduction and transition to sirolimus, she developed multi-organ failure, precluding standard chemotherapy with pegylated liposomal doxorubicin.
Discussion
This case highlights the aggressive nature of post-transplant hepatic KS and its potential evolution into KICS. The unique presentation of hilar involvement causing obstructive hepatopathy creates diagnostic challenges and severely limits therapeutic options. The development of refractory sepsis and multi-organ dysfunction associated with KICS necessitates novel treatment approaches beyond conventional immunosuppression reduction.
Conclusion
Clinicians should maintain high suspicion for KS and KICS in post-transplant patients presenting with unexplained systemic inflammation and hepatic dysfunction. Early recognition and development of alternative therapeutic strategies are crucial for improving outcomes in this challenging clinical scenario.
{"title":"Post-transplant Kaposi Sarcoma with Kaposi Sarcoma inflammatory cytokine syndrome: A case report with literature review","authors":"Pareekshith Hirenallur Lohithaswa , Qun Wang , Samir Parekh , Ram Subramanian , Sailaja Pisipati","doi":"10.1016/j.liver.2026.100319","DOIUrl":"10.1016/j.liver.2026.100319","url":null,"abstract":"<div><h3>Background</h3><div>Kaposi Sarcoma (KS) is a vascular malignancy driven by Human Herpes Virus 8 (HHV-8), commonly occurring in immunocompromised states. Hepatic involvement and development of Kaposi Sarcoma Herpesvirus Inflammatory Cytokine Syndrome (KICS) in post-liver transplant recipients is rare and hence not well described.</div></div><div><h3>Case Presentation</h3><div>A 59-year-old Caucasian woman developed cholestatic liver dysfunction six months following orthotopic liver transplantation for primary biliary cirrhosis. Initial imaging revealed a hilar and peribiliary soft tissue abnormality, with fine needle aspiration confirming Kaposi Sarcoma. Her clinical course was complicated by multidrug-resistant gram-negative septic encephalopathy, progressive hepatic failure, and acute kidney injury requiring continuous renal replacement therapy. High HHV-8 viral load and persistent systemic inflammation despite appropriate antimicrobial therapy raised suspicion for KICS. Despite immunosuppressive dose reduction and transition to sirolimus, she developed multi-organ failure, precluding standard chemotherapy with pegylated liposomal doxorubicin.</div></div><div><h3>Discussion</h3><div>This case highlights the aggressive nature of post-transplant hepatic KS and its potential evolution into KICS. The unique presentation of hilar involvement causing obstructive hepatopathy creates diagnostic challenges and severely limits therapeutic options. The development of refractory sepsis and multi-organ dysfunction associated with KICS necessitates novel treatment approaches beyond conventional immunosuppression reduction.</div></div><div><h3>Conclusion</h3><div>Clinicians should maintain high suspicion for KS and KICS in post-transplant patients presenting with unexplained systemic inflammation and hepatic dysfunction. Early recognition and development of alternative therapeutic strategies are crucial for improving outcomes in this challenging clinical scenario.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"21 ","pages":"Article 100319"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037163","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}
Pub Date : 2026-02-01Epub Date: 2025-11-28DOI: 10.1016/j.liver.2025.100309
Alexandra V Kimchy , Sophia L Dahmani , Sejal G Dave , Molly Good , Salam Sunna , Karen Strenger , Eshetu Tefera , Alex Montero , Rohit Satoskar
Backgrounds/Aims
We evaluated the utilization of enteral feeding and clinical outcomes in hospitalized patients with cirrhosis diagnosed with severe protein calorie malnutrition.
Methods
This was a single center retrospective review of hospitalized patients with cirrhosis from 2019-2023. ICD-10-CM code E43 was used to identity patients with a diagnosis of severe protein calorie malnutrition. Study groups for comparison were patients with and without enteral nutrition support during hospitalization. Wilcoxon rank sum and two sample t-tests were used to examine differences in the averages of continuous variables, and Chi-square and Fisher exact tests were used to investigate differences for categorical variables.
Results
Of the 96 patients with cirrhosis and severe protein calorie malnutrition, 31 patients (32%) received enteral nutrition. Time from admission to initiation of enteral feeding was on average 7 days with a mean total duration of enteral nutrition of 10 days. The comparative analysis showed a significant increase in length of stay, intensive care requirement, bacteremia, gastrointestinal bleeding, discharge MELD 3.0 score and in hospital mortality rates (p ≤ 0.05) among patients who received enteral nutrition.
Conclusions
Less than fifty percent of patients hospitalized with cirrhosis received enteral nutrition despite having a diagnosis of severe protein calorie malnutrition. Initiation of enteral nutrition was found to be delayed a week, on average, after hospital admission. Prolonged length of stay and higher in-hospital mortality rates suggest a lack of benefit of enteral nutrition when started late in the hospital course.
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