Journal of Liver Transplantation最新文献_第2页

Validation of Prognostic Accuracy of the RETREAT Score in Hepatocellular carcinoma recurrence after liver transplantation in an Egyptian cohort 在一个埃及队列中肝移植后肝细胞癌复发的撤退评分预后准确性的验证

Journal of Liver Transplantation

Pub Date : 2025-12-04 DOI: 10.1016/j.liver.2025.100312

Reham Ashour , Hazem Mohamed Zakaria , Hossam Soliman , Mona Saeed Tantawy , Sally Waheed Elkhadry , Ahmed Hamdy , Yasmin AbdelRahman Muhammed omar

Background

The Risk Estimation of Tumor Recurrence After Transplant (RETREAT) score has been previously validated as a prognostic model for post-transplant recurrence. Our objective was to establish the validity of the RETREAT score in an Egyptian cohort.

Methods

The study included 113 patients who underwent living donor liver transplantation (LDLT) for Hepatocellular carcinoma (HCC) between 2004 and 2023. RETREAT score effectiveness was investigated following stratification of patients according to Milan criteria (MC) status on the explant pathology. Recurrence risks were assessed using the Kaplan–Meier analysis and differences were calculated with log-rank test.

Results

Over a median follow-up duration of 37 months, the cumulative HCC recurrence rates were 15.4 %, 24.8 %, and 29.5 % at 2, 5, and 10 years, respectively. A strong correlation was demonstrated between higher RETREAT scores and increased recurrence risk. Patients with a RETREAT score ≥ 3 (n = 48) experienced significantly higher recurrence rates at 2, 5, and 10 years than those with a RETREAT score ≤ 2 (n = 65) (35.4 %, 58.8 %, and 70.6 % vs 2.2 % (p < 0.0001)). Based on explant, 74 patients were identified as meeting the MC. The most favorable outcomes were observed in patients who were both within MC and had a low RETREAT score (n = 51), with no HCC recurrence risk being observed at 2, 5, or 10 years.

Conclusion

We validated the predictive accuracy of RETREAT score in HCC recurrence post LT. Patients with low RETREAT scores demonstrated a low risk of HCC recurrence, especially those confirmed to be within MC on explant analysis.

移植后肿瘤复发风险评估（RETREAT）评分先前已被证实为移植后复发的预后模型。我们的目的是在埃及队列中建立RETREAT评分的有效性。方法本研究纳入2004年至2023年间113例肝细胞癌（HCC）患者接受活体肝移植（LDLT）治疗。根据米兰标准（MC）外植体病理状态对患者进行分层后，研究了撤退评分的有效性。复发风险评估采用Kaplan-Meier分析，差异计算采用log-rank检验。结果在37个月的中位随访中，2年、5年和10年的累积HCC复发率分别为15.4%、24.8%和29.5%。较高的撤退评分与复发风险增加之间存在很强的相关性。退却评分≥3的患者（n = 48）在2年、5年和10年的复发率明显高于退却评分≤2的患者（n = 65）（35.4%、58.8%和70.6% vs 2.2% (p < 0.0001)）。基于外植体，74例患者被确定为符合MC。在MC范围内且撤退评分较低的患者（n = 51）中观察到最有利的结果，在2年，5年或10年没有观察到HCC复发风险。结论：我们验证了RETREAT评分对lt后HCC复发的预测准确性。低RETREAT评分的患者HCC复发风险低，尤其是外植体分析证实在MC范围内的患者。

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引用次数: 0

Expanding the donor pool: Outcomes of liver transplantation using grafts with ≥50% macrosteatosis 扩大供体池：大脂肪变性≥50%的肝移植的结果

Journal of Liver Transplantation

Pub Date : 2025-12-04 DOI: 10.1016/j.liver.2025.100311

Kasra Shirini, Shani S. Kamberi, Srinivasan Muthukrishnan, Omar Alattar, Ruchin Patel, Francheska Nieves, Massimo Arcerito, Josue Alvarez-Casas, Saad Malik, Kirti Shetty, Daniel G. Maluf, Chandra Bhati, Raphael P.H. Meier

Liver grafts with over 50% macrosteatosis are often deemed marginal, but organ shortages necessitate exploring their use. We conducted five transplants with deceased donor grafts containing 50%–90% macrosteatosis, ensuring donor age <55 years, CIT ≤6 hours, and recipient laboratory MELD score ≤30. Two patients required reoperations due to thrombotic complications (acute HAT and PVT), and hospital stay ranged from 6 to 26 days. All patients survived beyond one year with functioning grafts. These findings suggest the feasibility of using high-macrosteatosis grafts in intermediate- to low-laboratory-MELD recipients, albeit with potential thrombotic risks.

大脂肪变性超过50%的肝移植通常被认为是边缘性的，但器官短缺需要探索其应用。我们进行了5例移植，死者供体移植中含有50%-90%的大脂肪变性，确保供体年龄55岁，CIT≤6小时，受体实验室MELD评分≤30。2例患者因血栓并发症（急性HAT和PVT）需要再次手术，住院时间从6天到26天不等。所有患者在移植物功能正常的情况下存活超过一年。这些发现表明，尽管存在潜在的血栓风险，但在中低实验室meld受体中使用高大脂肪变性移植物是可行的。

引用次数: 0

A pilot pathway for penicillin allergy delabelling in liver transplant recipients 肝移植受者青霉素过敏去标签的试点途径

Journal of Liver Transplantation

Pub Date : 2025-11-29 DOI: 10.1016/j.liver.2025.100308

Shashank Ramakrishnan , Jeremy S Nayagam , Hannah Kershaw , Marisa Lanzman , Brian J Hogan , Indran Balakrishnan , Alex J Kew , Rachel H Westbrook

Antibiotic allergy labels (AAL), particularly to penicillin, are common among liver transplant (LT) recipients and can compromise antimicrobial stewardship and increase the risk of multidrug-resistant infection. We retrospectively reviewed adult LT recipients over 12 months to determine the prevalence of AAL and antibiotic use, and piloted a pharmacist- and microbiologist-led delabelling pathway for low-risk patients. Among 83 LT recipients, AAL prevalence was 20%, with 12% reporting penicillin allergy and no prior delabelling attempts identified. Patients were screened weekly on a 31-bed hepatopancreaticobiliary ward, and 14 patients (age 35–83 years) were safely delabelled, including nine with liver disease (five of whom were transplant patients). All drug provocation tests were negative and no adverse events occurred. This pilot demonstrates the feasibility and safety of a microbiologist-led penicillin delabelling pathway within a ward based liver transplant programme. To our knowledge, this is the first UK example of such a protocol integrated within a transplant hepatology service, complementing emerging international data supporting antibiotic allergy delabelling in transplant and immunocompromised populations.

抗生素过敏标签（AAL），特别是对青霉素的过敏标签，在肝移植（LT）受者中很常见，可能损害抗菌药物管理并增加耐多药感染的风险。我们回顾性地回顾了12个月以上的成人肾移植受者，以确定AAL和抗生素使用的患病率，并试点了一种由药剂师和微生物学家主导的低风险患者去标签途径。83例肝移植受者中，AAL患病率为20%，其中12%报告青霉素过敏，且未发现先前的撕标签尝试。患者每周在31个床位的肝胆胰病房进行筛查，14名患者（年龄35-83岁）被安全地去标签，包括9名肝病患者（其中5名是移植患者）。所有药物激发试验均为阴性，未发生不良事件。该试验证明了微生物学家主导的青霉素去标签途径在病房肝移植项目中的可行性和安全性。据我们所知，这是英国首例将此类方案整合到移植肝病学服务中的案例，补充了支持移植和免疫功能低下人群中抗生素过敏去标签的新兴国际数据。

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引用次数: 0

A retrospective study of enteral nutrition utilization and clinical outcomes in patients with cirrhosis diagnosed with severe malnutrition 肝硬化合并严重营养不良患者肠内营养利用及临床结果的回顾性研究

Journal of Liver Transplantation

Pub Date : 2025-11-28 DOI: 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.

背景/目的：我们评估了诊断为严重蛋白质热量营养不良的肝硬化住院患者肠内喂养的使用情况和临床结果。方法对2019-2023年住院肝硬化患者进行单中心回顾性分析。ICD-10-CM代码E43用于识别诊断为严重蛋白质热量营养不良的患者。比较的研究组为住院期间有无肠内营养支持的患者。使用Wilcoxon秩和和和两个样本t检验来检验连续变量平均值的差异，使用卡方检验和Fisher精确检验来研究分类变量的差异。结果96例肝硬化合并严重蛋白热量营养不良患者中，31例（32%）接受肠内营养。入院至开始肠内营养平均时间为7天，平均总肠内营养持续时间为10天。对比分析显示，肠内营养组患者的住院时间、重症监护需求、菌血症、胃肠道出血、出院MELD 3.0评分及院内死亡率均显著增加（p≤0.05）。结论：不到50%的肝硬化住院患者接受了肠内营养，尽管他们被诊断为严重的蛋白质卡路里营养不良。发现肠内营养的开始平均延迟一周，在入院后。住院时间的延长和较高的住院死亡率表明，在住院过程中较晚开始肠内营养缺乏益处。

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引用次数: 0

Postoperative AKI after combined heart–liver transplantation: Keep an eye on the lesser evil 心肝联合移植术后AKI：防患于未然

Journal of Liver Transplantation

Pub Date : 2025-11-27 DOI: 10.1016/j.liver.2025.100306

Rodolpho Augusto de Moura Pedro

引用次数: 0

“I’ll give all my money for a liver”: Caring for the undocumented patient with end-stage liver disease “我愿意用我所有的钱买一个肝脏”：照顾无证终末期肝病患者

Journal of Liver Transplantation

Pub Date : 2025-11-26 DOI: 10.1016/j.liver.2025.100307

Sarah Samaranayake MS , Alexandra Arges MD , Emily Pinto Taylor MD

引用次数: 0

Combined heart-liver transplantation and Acute Kidney Injury: Risk factors and outcomes from CARDHEPAT registry 联合心肝移植和急性肾损伤：来自CARDHEPAT登记的危险因素和结果

Journal of Liver Transplantation

Pub Date : 2025-11-12 DOI: 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.

背景：心肝联合移植（CHLT）为没有其他治疗选择的患者提供了新的可能性，但它仍然是一种罕见且复杂的手术。尽管近年来其应用有所增加，但数据仍然很少，并且该手术的许多方面尚未完全了解，特别是其重要围手术期发病率的原因，如急性肾损伤。CARDHEPAT研究首次对法国区域性CHLT患者队列进行了描述。方法回顾性分析2002年1月1日至2022年1月1日在巴黎公共援助医院Hôpitaux （APHP）进行的30例chlt患者的CARDHEPAT队列。本研究的目的是强调术后KDIGO3急性肾损伤（AKI）对受体预后的影响及其演变。结果在50%的病例中观察到skdigo3 AKI，并且与CHLT患者的高死亡率相关。在第30天和第90天，KDIGO3 AKI患者的生存率分别为67%和53%，而无KDIGO3 AKI患者的生存率分别为100%和93% （p = 0.04和p = 0.03）。此外，我们发现术中几个与术后KDIGO3 AKI发生相关的因素，包括体外循环时间、主动脉夹持时间、术中酸中毒水平以及术前白蛋白血症。结论CHLT后KDIGO3 AKI发生率高，似乎与死亡率增加有关，结果表明术中阶段对其发生至关重要。

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引用次数: 0

Coronary artery calcium score on chest computed tomography in liver transplant candidates: A retrospective study of diagnostic performance and risk stratification 肝移植候选者的胸部计算机断层扫描冠状动脉钙评分：诊断表现和风险分层的回顾性研究

Journal of Liver Transplantation

Pub Date : 2025-11-12 DOI: 10.1016/j.liver.2025.100301

Matthanja Bieze , Eduarda Schutz Martinelli , Jônatas Fávero Prietto dos Santos , Selene Perez Martinez , Cristopher Araya , Stella Wang , Carla Luzzi , Elmar Jaeckel , Cheryl Borosz , Elsie T Nguyen , Stuart A McCluskey

Introduction

Cardiac risk assessment in liver transplantation (LT) candidates is challenging as non-invasive tests have low sensitivity for detecting significant coronary artery disease (CAD), often necessitating coronary angiography (CAG). This study examined less invasive qualitative coronary artery calcium (CAC) scoring, major adverse cardiac events (MACE), coronary angiography findings, and health system outcomes after LT.

Methods

We conducted a retrospective cohort study of adult LT recipients. Two radiologists independently classified CAC on chest CT as absent (0), mild (1), moderate (2), or severe (3). The primary endpoint was MACE (myocardial infarction, cardiac arrest, cardiac death). Secondary endpoints included CAD severity on CAG, and health system outcomes. Logistic regression and log-transformed linear regression were used.

Results

Among 982 LT patients, 477 underwent chest CT and 394 CAG. Median age was 61 years; MELDNa 15. CAC distribution was CAC0 185 (38.8 %), CAC1 110 (23.1 %), CAC2 96 (20.1 %), CAC3 86 (18.0 %). CAC correlated with CAG (sensitivity 91 %, specificity 64 %). MACE occurred in 8 (1.7 %). CAC severity was not associated with MACE or health system outcomes.

Conclusion

In LT candidates, low CAC indicated low CAD risk. However, MACE occurred without CAD, underscoring multifactorial perioperative cardiac risk and the potential value of chest CT in comprehensive pre-transplant evaluation.

肝移植（LT）候选人的心脏风险评估具有挑战性，因为非侵入性检查对检测显著冠状动脉疾病（CAD）的敏感性较低，通常需要冠状动脉造影（CAG）。本研究检查了低创定性冠状动脉钙（CAC）评分、主要心脏不良事件（MACE）、冠状动脉造影结果和肝移植后的健康系统结果。方法我们对成人肝移植受者进行了回顾性队列研究。两名放射科医生独立将胸部CT上的CAC分为未见(0)、轻度(1)、中度(2)和重度(3)。主要终点为MACE（心肌梗死、心脏骤停、心源性死亡）。次要终点包括CAD对CAG的严重程度和卫生系统结果。采用逻辑回归和对数变换线性回归。结果982例LT患者中，477例行胸部CT， 394例行CAG。中位年龄61岁；MELDNa 15。CAC分布为：cac185（38.8%）、cac110（23.1%）、cac96（20.1%）、cac386（18.0%）。CAC与CAG相关（敏感性91%，特异性64%）。MACE发生8例（1.7%）。CAC严重程度与MACE或卫生系统结果无关。结论在肝移植患者中，低CAC意味着低的冠心病风险。然而，MACE在无CAD的情况下发生，强调了多因素围手术期心脏风险和胸部CT在移植前综合评估中的潜在价值。

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引用次数: 0

Evaluating current efficiency of normothermic machine perfusion in donation after circulatory death liver transplantation amidst widespread utilization 在循环死亡肝移植广泛应用的情况下，常温机器灌注在肝移植捐献中的有效性评价

Journal of Liver Transplantation

Pub Date : 2025-11-07 DOI: 10.1016/j.liver.2025.100304

Daniel M Kaufman , Philip B Vutien , James D Perkins , Lena Sibulesky

Background

Normothermic machine perfusion (NMP) has shown promise in improving outcomes for donation after circulatory death (DCD) liver transplants, but published data is dominated by clinical and single center trials. As US transplantation community gains widespread experience with NMP, it is imperative to continuously evaluated NMP efficiency over static cold storage (SCS).

Methods

We conducted a retrospective review of DCD liver transplants from 2016 to 2023, dividing data into two eras: pre-2023 and 2023. Demographic data revealed the change in donor and recipient selection over these two time periods. Cox proportional hazards models on propensity score data analyzed the current benefit of NMP over SCS.

Results

In the later era, grafts selected for NMP were increased risk donors with increased agonal time. Despite using high-risk grafts in the later era, NMP still had significantly improved graft survival and there was a lower incidence of diffuse cholangiopathy but not significantly improved patient survival over SCS.

Conclusions

As transplant programs’ NMP utilization increases by expanding the selection criteria and increasing the agonal time of donors, NMP still has significantly better graft survival than SCS. Continued evaluation of NMP is essential to determine its efficiency over SCS and a first step in accurate cost-effectiveness studies.

常温机器灌注（NMP）已显示出改善循环死亡（DCD）肝移植后捐献结果的希望，但已发表的数据主要是临床和单中心试验。随着美国移植界在NMP方面获得广泛的经验，持续评估NMP相对于静态冷藏（SCS）的效率是必要的。方法回顾性分析2016 -2023年DCD肝移植病例，将数据分为2023年前和2023年两个时期。人口统计数据揭示了这两个时期供体和受体选择的变化。基于倾向评分数据的Cox比例风险模型分析了NMP相对于SCS的当前获益。结果随着时间的延长，后期选择NMP的供体是风险增加的供体。尽管在后期使用了高风险的移植物，NMP仍然显著提高了移植物的存活率，弥漫性胆管病的发生率较低，但没有显著提高SCS患者的生存率。结论通过扩大供体的选择标准和延长供体的死亡时间，增加了移植项目对NMP的利用，但NMP仍具有明显优于SCS的移植物存活率。对NMP的持续评估对于确定其对SCS的有效性至关重要，也是进行准确成本效益研究的第一步。

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引用次数: 0

Evaluation of hepatitis B recurrence in liver transplant recipients in Vietnam 越南肝移植受者乙型肝炎复发的评估

Journal of Liver Transplantation

Pub Date : 2025-11-06 DOI: 10.1016/j.liver.2025.100300

Van Quang Vu, Cam Linh Le, Van Thanh Le, Van Linh Ho, Hoang Ngoc Anh Nguyen

Introduction

: Hepatitis B virus (HBV) is a global public health challenge and a leading cause of end – stage liver disease requiring transplantation. However, HBV recurrence after transplantation can significantly compromise graft function and patient survival. In the context of limited healthcare resources, evaluating the recurrence rate and the current status of prophylactic strategies is essential.

Methods

: A cross-sectional descriptive study was conducted at the 108 Military Central Hospital (Vietnam) involving 126 patients who underwent LT due to HBV-related liver diseases. Data collected included pre- and post-transplant laboratory results (HBsAg, HBeAg, Anti-HBs, Anti-HBc IgG/IgM, and HBV-DNA) and information regarding prophylactic regimens (use of Hepatitis B Immunoglobulin [HBIG] and nucleos(t)ide analog [NA]).

Results

: Male patients accounted for 89.7 %, with a mean age of 54.2 ± 10.8 years. The average follow-up duration after transplantation was 34.4 ± 20.1 months. HCC was the most common indication for LT (48.4 %). The HBV recurrence rate was 11.1 %. Short-term HBIG prophylaxis following transplantation, in combination with long-term NA therapy, has demonstrated effectiveness in preventing HBV recurrence in this patient population. Notably, only 25.4 % of patients were Anti-HBs positive, raising concerns about long-term immunological protection. The use of appropriately dosed HBIG in combination therapy, tailored according to high- and low-risk HBV recurrence groups, should be considered to optimize antibody levels in this patient population, as maintaining HBIG therapy remains a major challenge due to financial burden and supply shortages in Vietnam.

Conclusion

: Oral NA therapy remains an effective prophylactic approach for preventing HBV recurrence after LT, particularly in the context of significant challenges associated with HBIG availability in Vietnam. Strategies to enhance post-transplant Anti-HBs titers – such as selective dosing of HBIG administration – should be considered in long-term post-transplant care.

乙型肝炎病毒（HBV）是一个全球性的公共卫生挑战和终末期肝脏疾病需要移植的主要原因。然而，移植后HBV复发可显著损害移植物功能和患者生存。在医疗资源有限的情况下，评估复发率和预防策略的现状至关重要。方法：在越南108军事中心医院进行了一项横断面描述性研究，涉及126例因hbv相关肝病接受肝移植的患者。收集的数据包括移植前和移植后的实验室结果（HBsAg、HBeAg、Anti-HBs、Anti-HBc IgG/IgM和HBV-DNA）和有关预防方案的信息（使用乙型肝炎免疫球蛋白[HBIG]和核苷类似物[NA]）。结果：男性患者占89.7%，平均年龄54.2±10.8岁。移植后平均随访34.4±20.1个月。肝细胞癌是肝移植最常见的适应症（48.4%）。HBV复发率为11.1%。移植后短期HBIG预防与长期NA治疗相结合，已证明可有效预防该患者群体的HBV复发。值得注意的是，只有25.4%的患者呈抗- hbs阳性，这引起了对长期免疫保护的关注。应考虑在联合治疗中使用适当剂量的HBIG，根据高风险和低风险HBV复发组量身定制，以优化该患者人群的抗体水平，因为由于越南的经济负担和供应短缺，维持HBIG治疗仍然是一个主要挑战。结论：口服NA治疗仍然是预防肝移植后HBV复发的有效方法，特别是在越南HBIG可用性面临重大挑战的背景下。在移植后的长期护理中应考虑提高移植后抗乙肝抗体滴度的策略，如选择性给药HBIG。

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引用次数: 0