Pub Date : 2025-07-04DOI: 10.1016/j.liver.2025.100287
Luca Marzi , Ilaria Ferrarotti , Federica Benini , Andrea Mega , Luisa Siciliani
Alpha-1-antitrypsin deficiency (AATD) is an autosomal codominant genetic disorder, often going undiagnosed. AATD results from malformed or deficient AAT proteins, which predispose individuals to obstructive pulmonary disease and liver disease. The PI*ZZ genotype is the most common and severe, but even milder genotypes like PI*SZ and PI*MZ can lead to lung and liver disease, particularly when combined with metabolic disfunction. The rate ranges of ZZ liver-related mortality are 10 to 40 %. Despite ongoing clinical trials, there is currently no approved therapy for AATD-associated liver disease (AATD-LD), and liver transplantation remains the only curative option. AATD-LD can progress slowly for decades, with contributing factors such as metabolic dysfunction-associated steatotic liver disease, alcohol use, and hepatitis accelerating disease progression. Moreover, these factors complicate the accurate diagnosis of AATD-LD. To date, data on blood markers or non-invasive markers for monitoring and predicting the evolution of AATD-LD are few and not as numerous as for other liver diseases. Moreover, a correct staging of the patient is important not only for the follow-up of the patient but also to evaluate the inclusion of the patient in experimental protocols. This review aims to evaluate non-invasive techniques for monitoring the AATD-LD.
{"title":"Alpha-1 antitrypsin deficiency-associated liver disease: A review focusing on new assessment tools and therapies","authors":"Luca Marzi , Ilaria Ferrarotti , Federica Benini , Andrea Mega , Luisa Siciliani","doi":"10.1016/j.liver.2025.100287","DOIUrl":"10.1016/j.liver.2025.100287","url":null,"abstract":"<div><div>Alpha-1-antitrypsin deficiency (AATD) is an autosomal codominant genetic disorder, often going undiagnosed. AATD results from malformed or deficient AAT proteins, which predispose individuals to obstructive pulmonary disease and liver disease. The PI*ZZ genotype is the most common and severe, but even milder genotypes like PI*SZ and PI*MZ can lead to lung and liver disease, particularly when combined with metabolic disfunction. The rate ranges of ZZ liver-related mortality are 10 to 40 %. Despite ongoing clinical trials, there is currently no approved therapy for AATD-associated liver disease (AATD-LD), and liver transplantation remains the only curative option. AATD-LD can progress slowly for decades, with contributing factors such as metabolic dysfunction-associated steatotic liver disease, alcohol use, and hepatitis accelerating disease progression. Moreover, these factors complicate the accurate diagnosis of AATD-LD. To date, data on blood markers or non-invasive markers for monitoring and predicting the evolution of AATD-LD are few and not as numerous as for other liver diseases. Moreover, a correct staging of the patient is important not only for the follow-up of the patient but also to evaluate the inclusion of the patient in experimental protocols. This review aims to evaluate non-invasive techniques for monitoring the AATD-LD.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"19 ","pages":"Article 100287"},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144588297","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 : 2025-06-29DOI: 10.1016/j.liver.2025.100286
David Uihwan Lee , Youngjae Cha , Mohammed Rifat Shaik , Kuntal Bhowmick , Andrew Yi , Andrew Chan , Nishat Anjum Shaik , Zainab Mujahid , Gregory Hongyuan Fan , Keeseok Lee , Sindhura Kolachana , Mohamed Refaat , Raffi Karagozian
Background and aims
Acute-on-Chronic Liver Failure (ACLF) is a severe condition where liver transplantation is often the only definitive treatment. Previous studies have shown an influence of functional status on post-transplant outcomes in patients with advanced chronic liver disease. However, the impact of functional status on outcomes in an ACLF cohort is largely unknown.
Methods
The United Network for Organ Sharing (UNOS) Standard Transplant Analysis and Research (STAR) Database was utilized to study LT patients between 1987 and 2019. Patients were categorized by ACLF grades and further divided within each grade based on their level of assistance—no, some, or total—using KPS scores. The primary outcomes assessed were graft failure and all-cause mortality post-transplant. The secondary outcomes assessed were mortality secondary to specific organ system failures.
Results
Patients without ACLF requiring some (aHR 1.10, 95 %CI 1.04–1.17, p = 0.002) or total assistance (aHR 1.32, 95 %CI 1.22–1.43, p < 0.001) showed increased risk of all-cause mortality. Those needing total assistance also faced a higher risk of graft failure (aHR 1.34, 95 %CI 1.13–1.58, p < 0.001). However, functional status did not significantly impact post-transplant outcomes across all ACLF grades.
Conclusion
Functional status was not a significant predictor of post-transplant outcomes in ACLF patients, regardless of ACLF severity. Poor functional scores in multi-organ failure likely reflect acute critical illness rather than baseline frailty.
背景和目的急性慢性肝衰竭（ACLF）是一种严重的疾病，肝移植通常是唯一的决定性治疗方法。先前的研究表明，功能状态对晚期慢性肝病患者移植后预后的影响。然而，功能状态对ACLF队列结果的影响在很大程度上是未知的。方法利用美国器官共享网络（UNOS）标准移植分析与研究（STAR）数据库对1987 - 2019年肝移植患者进行研究。根据ACLF分级对患者进行分类，并使用KPS评分根据患者的辅助水平（无、部分或全部）在每个等级内进一步划分。评估的主要结果是移植失败和移植后全因死亡率。评估的次要结局是特定器官系统衰竭继发的死亡率。结果无ACLF患者需要部分（aHR 1.10, 95% CI 1.04 ~ 1.17, p = 0.002）或全部辅助(aHR 1.32, 95% CI 1.22 ~ 1.43, p <；0.001)显示全因死亡风险增加。需要全面辅助的患者也面临更高的移植物衰竭风险(aHR 1.34, 95% CI 1.13-1.58, p <；0.001)。然而，在所有ACLF分级中，功能状态对移植后预后没有显著影响。结论无论ACLF严重程度如何，功能状态都不是ACLF患者移植后预后的重要预测因素。多器官衰竭的功能评分差可能反映了急性危重疾病，而不是基线虚弱。
{"title":"The impact of functional status on post-liver transplant outcomes in acute-on-chronic liver failure","authors":"David Uihwan Lee , Youngjae Cha , Mohammed Rifat Shaik , Kuntal Bhowmick , Andrew Yi , Andrew Chan , Nishat Anjum Shaik , Zainab Mujahid , Gregory Hongyuan Fan , Keeseok Lee , Sindhura Kolachana , Mohamed Refaat , Raffi Karagozian","doi":"10.1016/j.liver.2025.100286","DOIUrl":"10.1016/j.liver.2025.100286","url":null,"abstract":"<div><h3>Background and aims</h3><div>Acute-on-Chronic Liver Failure (ACLF) is a severe condition where liver transplantation is often the only definitive treatment. Previous studies have shown an influence of functional status on post-transplant outcomes in patients with advanced chronic liver disease. However, the impact of functional status on outcomes in an ACLF cohort is largely unknown.</div></div><div><h3>Methods</h3><div>The United Network for Organ Sharing (UNOS) Standard Transplant Analysis and Research (STAR) Database was utilized to study LT patients between 1987 and 2019. Patients were categorized by ACLF grades and further divided within each grade based on their level of assistance—no, some, or total—using KPS scores. The primary outcomes assessed were graft failure and all-cause mortality post-transplant. The secondary outcomes assessed were mortality secondary to specific organ system failures.</div></div><div><h3>Results</h3><div>Patients without ACLF requiring some (aHR 1.10, 95 %CI 1.04–1.17, <em>p</em> = 0.002) or total assistance (aHR 1.32, 95 %CI 1.22–1.43, <em>p</em> < 0.001) showed increased risk of all-cause mortality. Those needing total assistance also faced a higher risk of graft failure (aHR 1.34, 95 %CI 1.13–1.58, <em>p</em> < 0.001). However, functional status did not significantly impact post-transplant outcomes across all ACLF grades.</div></div><div><h3>Conclusion</h3><div>Functional status was not a significant predictor of post-transplant outcomes in ACLF patients, regardless of ACLF severity. <em>Poor functional scores in multi-organ failure likely reflect acute critical illness rather than baseline frailty.</em></div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"19 ","pages":"Article 100286"},"PeriodicalIF":0.0,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144596636","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 : 2025-06-24DOI: 10.1016/j.liver.2025.100284
Camila Sotomayor , Daniel García , María Elvira Balcells , Felipe Muñoz , Karen Muñoz , María Pilar Domínguez , Alejandra Cancino , Rodrigo Wolff , Francisco Barrera , Carlos Benítez , Luis Díaz , Eduardo Briceño , Eduardo Viñuela , Pablo Achurra , Patricia Rebolledo , Nicolas Jarufe , María Magdalena Vera , Martin Dib , Jorge A. Martínez
Introduction and Objectives
The COVID-19 pandemic significantly affected liver transplantation (LT) worldwide, with higher mortality observed in patients with chronic diseases. However, the impact of COVID-19 on transplant recipients, particularly those on immunosuppressive therapy, has been variably reported.
Our center’s historical 90-day LT mortality is 8%, and with waiting list mortality exceeding 35%, we kept our program operational, pausing elective Living Donor Liver Transplant (LDLT) for three months to minimize donor risk.
This study evaluates LT outcomes during the pandemic, particularly SARS-CoV-2 infection-related mortality, in 104 patients transplanted during the first COVID-19 wave.
Materials and Methods
We conducted a retrospective review of patients who underwent LT between January 1, 2020, and December 31, 2021, at our center in Santiago, Chile. All recipients tested negative for SARS-CoV-2 pre-transplant, and COVID-19 cases were tracked postoperatively.
Results
Among 104 adult patients, 84% were elective cases, 15% emergency, and 1% re-transplant. The mean age was 56.2 ±12.5; 56% male. The most frequent indications were NAFLD (41%), hepatocarcinoma (23%), autoimmune hepatitis (16%), and alcoholic liver disease (14%). Deceased donors provided 79.8% of the grafts, while living donors accounted for 20.2%. The mean MELD score was 22.5± 9.5. Nineteen recipients (18.3%) acquired postoperative RT-PCR-confirmed SARS-CoV-2 infection; 73.6% were symptomatic, and 26.3 % had early infections. Most had mild symptoms of COVID-19, requiring only symptomatic treatment (10/19; 52.6%). One patient required non-invasive mechanical ventilation (5.3%), and 3 required invasive mechanical ventilation (3/19;15.8%), with mortality in all of them. The overall 90-day post-transplant mortality rate in the cohort was 7.7%. Among non-infected patients, it was 5.9%, while in recipients with SARS-CoV-2 infection, it reached 15.8%. In early infected patients, mortality was 40% (2/5).
Conclusions
In conclusion, while SARS-CoV-2 infection significantly affected LT recipients, the post-transplant mortality in infected patients remained lower than waiting list mortality.
{"title":"Outcomes of SARS-CoV-2 infection in liver transplant recipients of a large volume transplant center in Latin America","authors":"Camila Sotomayor , Daniel García , María Elvira Balcells , Felipe Muñoz , Karen Muñoz , María Pilar Domínguez , Alejandra Cancino , Rodrigo Wolff , Francisco Barrera , Carlos Benítez , Luis Díaz , Eduardo Briceño , Eduardo Viñuela , Pablo Achurra , Patricia Rebolledo , Nicolas Jarufe , María Magdalena Vera , Martin Dib , Jorge A. Martínez","doi":"10.1016/j.liver.2025.100284","DOIUrl":"10.1016/j.liver.2025.100284","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>The COVID-19 pandemic significantly affected liver transplantation (LT) worldwide, with higher mortality observed in patients with chronic diseases. However, the impact of COVID-19 on transplant recipients, particularly those on immunosuppressive therapy, has been variably reported.</div><div>Our center’s historical 90-day LT mortality is 8%, and with waiting list mortality exceeding 35%, we kept our program operational, pausing elective Living Donor Liver Transplant (LDLT) for three months to minimize donor risk.</div><div>This study evaluates LT outcomes during the pandemic, particularly SARS-CoV-2 infection-related mortality, in 104 patients transplanted during the first COVID-19 wave.</div></div><div><h3>Materials and Methods</h3><div>We conducted a retrospective review of patients who underwent LT between January 1, 2020, and December 31, 2021, at our center in Santiago, Chile. All recipients tested negative for SARS-CoV-2 pre-transplant, and COVID-19 cases were tracked postoperatively.</div></div><div><h3>Results</h3><div>Among 104 adult patients, 84% were elective cases, 15% emergency, and 1% re-transplant. The mean age was 56.2 ±12.5; 56% male. The most frequent indications were NAFLD (41%), hepatocarcinoma (23%), autoimmune hepatitis (16%), and alcoholic liver disease (14%). Deceased donors provided 79.8% of the grafts, while living donors accounted for 20.2%. The mean MELD score was 22.5± 9.5. Nineteen recipients (18.3%) acquired postoperative RT-PCR-confirmed SARS-CoV-2 infection; 73.6% were symptomatic, and 26.3 % had early infections. Most had mild symptoms of COVID-19, requiring only symptomatic treatment (10/19; 52.6%). One patient required non-invasive mechanical ventilation (5.3%), and 3 required invasive mechanical ventilation (3/19;15.8%), with mortality in all of them. The overall 90-day post-transplant mortality rate in the cohort was 7.7%. Among non-infected patients, it was 5.9%, while in recipients with SARS-CoV-2 infection, it reached 15.8%. In early infected patients, mortality was 40% (2/5).</div></div><div><h3>Conclusions</h3><div>In conclusion, while SARS-CoV-2 infection significantly affected LT recipients, the post-transplant mortality in infected patients remained lower than waiting list mortality.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"19 ","pages":"Article 100284"},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144501650","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 : 2025-06-06DOI: 10.1016/j.liver.2025.100285
W. Gaya Shivega , Xin Wei Wang , Shay Behrens
Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA) are the two main liver cancers responsible for cancer deaths worldwide. Multiple etiologies exist driving these diseases; however, there are limited effective treatments to date. Recent studies have demonstrated improved outcomes in patients with advanced disease treated with immune checkpoint inhibition (ICI). Further, as these patients undergo liver transplantation, it’s critical to have an understanding of the impact of ICI on the immune system post-transplantation. In this review, we will provide an overview on ICI therapy in liver cancer, ICI utilization in the peri-transplantation setting, and discuss molecular predictions to immunotherapy response.
{"title":"Current knowledge about immunotherapy response after liver transplantation of patients with liver cancer","authors":"W. Gaya Shivega , Xin Wei Wang , Shay Behrens","doi":"10.1016/j.liver.2025.100285","DOIUrl":"10.1016/j.liver.2025.100285","url":null,"abstract":"<div><div>Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA) are the two main liver cancers responsible for cancer deaths worldwide. Multiple etiologies exist driving these diseases; however, there are limited effective treatments to date. Recent studies have demonstrated improved outcomes in patients with advanced disease treated with immune checkpoint inhibition (ICI). Further, as these patients undergo liver transplantation, it’s critical to have an understanding of the impact of ICI on the immune system post-transplantation. In this review, we will provide an overview on ICI therapy in liver cancer, ICI utilization in the peri-transplantation setting, and discuss molecular predictions to immunotherapy response.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"19 ","pages":"Article 100285"},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144307375","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 : 2025-05-13DOI: 10.1016/j.liver.2025.100281
Leonieke Kranenburg , Alicia Chorley , Emma Massey , Hayo ter Burg , Robert Minnee , Markus Boehnert
Aim
This study reports on the outcomes of psychological screening and care for all living donor candidates who entered our center’s program since the start in 2018, and is the first study to evaluate the use of the ELPAT Psychosocial Assessment Tool (EPAT) for this population.
Methods
All donor candidates were screened using the ELPAT Psychosocial Assessment Tool (EPAT), consisting of a structured interview with set topics and a combination of validated questionnaires. Reports of the interviews were retrieved form the medical records and analysed per topic. Data from the questionnaires were analysed with existing cut-off scores. An independent samples t-test was used to compare means of related versus unrelated donors. Data on additional pre- or post donation psychological treatment was retrieved from the medical records.
Results
137 donor candidates underwent psychology screening for living liver donation. Over half of them had sought professional mental health support and/or used psychotropic drugs in the past. However, the average scores for current anxiety and depression as measures by the questionnaires were low. Unrelated donor candidates had statistically significant lower scores on emotional support and anxiety. Of all candidates, 2 were declined for psychological reasons; 53 eventually donated part of their liver, and of these, 15 received additional psychological treatment.
Discussion
The EPAT is a useful tool for living liver donor screening, covering all important psychological domains. Providing psychological treatment on indication proved to be a feasible way for this group to deal with potential psychological complaints during the process.
{"title":"Psychological screening and follow-up care for living liver donors: 5-year prospective cohort data from a single academic center","authors":"Leonieke Kranenburg , Alicia Chorley , Emma Massey , Hayo ter Burg , Robert Minnee , Markus Boehnert","doi":"10.1016/j.liver.2025.100281","DOIUrl":"10.1016/j.liver.2025.100281","url":null,"abstract":"<div><h3>Aim</h3><div>This study reports on the outcomes of psychological screening and care for all living donor candidates who entered our center’s program since the start in 2018, and is the first study to evaluate the use of the ELPAT Psychosocial Assessment Tool (EPAT) for this population.</div></div><div><h3>Methods</h3><div>All donor candidates were screened using the ELPAT Psychosocial Assessment Tool (EPAT), consisting of a structured interview with set topics and a combination of validated questionnaires. Reports of the interviews were retrieved form the medical records and analysed per topic. Data from the questionnaires were analysed with existing cut-off scores. An independent samples <em>t</em>-test was used to compare means of related versus unrelated donors. Data on additional pre- or post donation psychological treatment was retrieved from the medical records.</div></div><div><h3>Results</h3><div>137 donor candidates underwent psychology screening for living liver donation. Over half of them had sought professional mental health support and/or used psychotropic drugs in the past. However, the average scores for current anxiety and depression as measures by the questionnaires were low. Unrelated donor candidates had statistically significant lower scores on emotional support and anxiety. Of all candidates, 2 were declined for psychological reasons; 53 eventually donated part of their liver, and of these, 15 received additional psychological treatment.</div></div><div><h3>Discussion</h3><div>The EPAT is a useful tool for living liver donor screening, covering all important psychological domains. Providing psychological treatment on indication proved to be a feasible way for this group to deal with potential psychological complaints during the process.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"19 ","pages":"Article 100281"},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144098523","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 : 2025-05-09DOI: 10.1016/j.liver.2025.100282
Erin Horsfall , Peter Browett , Amanda Charlton , Edward Gane
Background
Graft-versus-host disease (GVHD) after liver transplantation (LT) is a rare and usually fatal complication. Recent advances in diagnosis and treatment have improved outcomes. Understanding pre and post-transplant risk factors, early clinical features, and targeted treatment strategies are vital for optimal management.
Methods
We conducted a retrospective case series of GVHD after LT in the New Zealand Liver Transplant Unit (NZLTU). Patients were identified from a prospectively maintained database and clinical data were analyzed to assess risk factors, clinical presentations, treatments, and outcomes.
Results
Among the 873 LT recipients, six (0.7 %) developed GVHD. The median time of GVHD was 37 days post transplantation, usually presenting with skin and gastrointestinal involvement. Initial management involved immunosuppression reduction and corticosteroid therapy, with refractory cases being treated with ruxolitinib or basiliximab. The overall mortality rate was 66 %. Liver re-transplantation was pursued in one case following GVHD remission, which was complicated by GVHD recurrence after liver re-transplantation, a first-ever reported clinical case.
Conclusions
GVHD after LT is associated with significant morbidity and mortality. Prompt recognition, early intervention, and close monitoring are crucial to improve patient outcomes. Early treatment with ruxolitinib should be considered in the treatment of GVHD after LT.
{"title":"Graft versus host disease after liver transplantation: A single center case series","authors":"Erin Horsfall , Peter Browett , Amanda Charlton , Edward Gane","doi":"10.1016/j.liver.2025.100282","DOIUrl":"10.1016/j.liver.2025.100282","url":null,"abstract":"<div><h3>Background</h3><div>Graft-versus-host disease (GVHD) after liver transplantation (LT) is a rare and usually fatal complication. Recent advances in diagnosis and treatment have improved outcomes. Understanding pre and post-transplant risk factors, early clinical features, and targeted treatment strategies are vital for optimal management.</div></div><div><h3>Methods</h3><div>We conducted a retrospective case series of GVHD after LT in the New Zealand Liver Transplant Unit (NZLTU). Patients were identified from a prospectively maintained database and clinical data were analyzed to assess risk factors, clinical presentations, treatments, and outcomes.</div></div><div><h3>Results</h3><div>Among the 873 LT recipients, six (0.7 %) developed GVHD. The median time of GVHD was 37 days post transplantation, usually presenting with skin and gastrointestinal involvement. Initial management involved immunosuppression reduction and corticosteroid therapy, with refractory cases being treated with ruxolitinib or basiliximab. The overall mortality rate was 66 %. Liver re-transplantation was pursued in one case following GVHD remission, which was complicated by GVHD recurrence after liver re-transplantation, a first-ever reported clinical case.</div></div><div><h3>Conclusions</h3><div>GVHD after LT is associated with significant morbidity and mortality. Prompt recognition, early intervention, and close monitoring are crucial to improve patient outcomes. Early treatment with ruxolitinib should be considered in the treatment of GVHD after LT.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"19 ","pages":"Article 100282"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144071613","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 : 2025-04-28DOI: 10.1016/j.liver.2025.100275
D.U. Lee , K.J. Lee , Y.J. Cha , G.H. Fan , M.R. Shaik , K. Bhowmick , H. Chou , C. Sun , H. Chou , R. Malik
Background & Aims
Simultaneous liver and kidney transplant (SLKT) can be a life-saving procedure for those with liver failure and concomitant kidney disease. This study evaluates the post-transplant outcomes and prognosis based on the recipients’ age using the UNOS-STAR database.
Methods
Using the UNOS-STAR registry (2005–2019), patients who underwent SLKT were selected. They were stratified by the recipients’ each age cohort. Those under the age of 18, retransplantation, and with prior liver transplantation were excluded. Iterative Cox regression was performed on multiple mortality endpoints to assess the prognostic effects.
Results
From 5748 SLKT patients, there were five age groups of recipients: ages 18–39 (n = 371), quadragenarian (n = 759), quinquagenarian (n = 2112), sexagenarian (n = 2202), and septuagenarian (n = 183). The median follow-up time was 3.03 years (25–75 % IQR: 1.02–7.00). Assessing the primary endpoints, the sexagenarian recipients had a significantly lower incidence of graft failure compared to the controls (aHR 0.36, 95 % CI 0.19–0.68, p = 0.002). The septuagenarian recipients experienced a higher incidence of all-cause mortality compared to the controls (aHR 2.08, 95 % CI 1.34–3.21, p = 0.001). However, the quadragenarian and quinquagenarian recipients did not have significant differences in all-cause mortality and graft failure. Evaluating the end-organ outcomes, there were no significant differences obtained among the recipients with various age cohorts.
Conclusion
This study demonstrates the advanced age of transplant recipients with SLKT was associated with increased all-cause mortality. Therefore, certain groups of SLKT recipients had differential impacts based on the chronicle ages.
背景,目的：肝肾同步移植（SLKT）对于肝功能衰竭和伴随肾脏疾病的患者可能是一种挽救生命的手术。本研究使用UNOS-STAR数据库评估基于受者年龄的移植后结果和预后。方法使用UNOS-STAR注册表（2005-2019），选择接受SLKT的患者。他们按受助人的每个年龄段进行分层。排除年龄在18岁以下、再移植和既往肝移植的患者。对多个死亡率终点进行迭代Cox回归，以评估预后影响。结果5748例SLKT患者中，接受治疗的患者分为5个年龄组：18-39岁（371例）、四岁（759例）、五岁（2112例）、六十岁（2202例）和七十岁（183例）。中位随访时间为3.03年（25 - 75% IQR: 1.02-7.00）。评估主要终点，与对照组相比，60岁以上受体的移植物衰竭发生率显著降低（aHR 0.36, 95% CI 0.19-0.68, p = 0.002）。与对照组相比，70多岁的受体患者的全因死亡率更高（aHR 2.08, 95% CI 1.34-3.21, p = 0.001）。然而，四岁和五岁的受体在全因死亡率和移植物衰竭方面没有显著差异。在评估终末器官结果时，不同年龄组的受者之间没有显著差异。结论：该研究表明，SLKT移植受者的高龄与全因死亡率增加有关。因此，某些SLKT接受者群体的影响是不同的。
{"title":"The impact of recipient age on the post-liver transplant prognosis of simultaneous liver and kidney transplantation","authors":"D.U. Lee , K.J. Lee , Y.J. Cha , G.H. Fan , M.R. Shaik , K. Bhowmick , H. Chou , C. Sun , H. Chou , R. Malik","doi":"10.1016/j.liver.2025.100275","DOIUrl":"10.1016/j.liver.2025.100275","url":null,"abstract":"<div><h3>Background & Aims</h3><div>Simultaneous liver and kidney transplant (SLKT) can be a life-saving procedure for those with liver failure and concomitant kidney disease. This study evaluates the post-transplant outcomes and prognosis based on the recipients’ age using the UNOS-STAR database.</div></div><div><h3>Methods</h3><div>Using the UNOS-STAR registry (2005–2019), patients who underwent SLKT were selected. They were stratified by the recipients’ each age cohort. Those under the age of 18, retransplantation, and with prior liver transplantation were excluded. Iterative Cox regression was performed on multiple mortality endpoints to assess the prognostic effects.</div></div><div><h3>Results</h3><div>From 5748 SLKT patients, there were five age groups of recipients: ages 18–39 (<em>n</em> = 371), quadragenarian (<em>n</em> = 759), quinquagenarian (<em>n</em> = 2112), sexagenarian (<em>n</em> = 2202), and septuagenarian (<em>n</em> = 183). The median follow-up time was 3.03 years (25–75 % IQR: 1.02–7.00). Assessing the primary endpoints, the sexagenarian recipients had a significantly lower incidence of graft failure compared to the controls (aHR 0.36, 95 % CI 0.19–0.68, <em>p</em> = 0.002). The septuagenarian recipients experienced a higher incidence of all-cause mortality compared to the controls (aHR 2.08, 95 % CI 1.34–3.21, <em>p</em> = 0.001). However, the quadragenarian and quinquagenarian recipients did not have significant differences in all-cause mortality and graft failure. Evaluating the end-organ outcomes, there were no significant differences obtained among the recipients with various age cohorts.</div></div><div><h3>Conclusion</h3><div>This study demonstrates the advanced age of transplant recipients with SLKT was associated with increased all-cause mortality. Therefore, certain groups of SLKT recipients had differential impacts based on the chronicle ages.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"19 ","pages":"Article 100275"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144105912","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":"Initial hepatic artery reperfusion for complex portal vein thrombosis in living donor liver transplantation: A case report","authors":"Takako Yamada Fujii , Koichi Tanaka , Takuya Kimura","doi":"10.1016/j.liver.2025.100276","DOIUrl":"10.1016/j.liver.2025.100276","url":null,"abstract":"","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"18 ","pages":"Article 100276"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869762","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 : 2025-04-11DOI: 10.1016/j.liver.2025.100272
Darren W. Chua , Horng-ren Yang , Ping Chun Li , Sheng-Hsien Chen , Shih Chao Hsu , Te-Hong Chen , Hsueh-Chou Lai , Ching-Feng Wu , You-Cian Lin , Long-Bin Jeng
Background
Adult polycystic liver disease (PLD) is a rare genetic disorder. In instances of intractable symptoms from mass effect or recurrent cyst-related complications, liver transplant affords the best therapeutic solution.
Methods
This is a retrospective case series of patients who underwent isolated pure living donor liver transplantation (LDLT) for adult polycystic kidney disease (PCKD) associated PLD from 2012- 2022. Short-term peri‑operative outcomes including renal sequelae and long-term survival were analysed.
Results
From 2012–2022, a total of 9 patients underwent LDLT for PLD. The median explanted liver weight was 6950 g (IQR 5653–7700) with a median blood loss of was 5450mls (IQR 2400–9875). There was 1 mortality due to acute antibody-mediated rejection (11.1 %). Of the four patients with existing chronic kidney disease (CKD), 2 (50 %) developed end-stage renal failure and was renal replacement therapy (RRT) dependent at 3 months. The median overall survival in our series was 63.9 months with a 5-year survival of 88.9 %.
Conclusions
Despite its technical challenges, LDLT affords an excellent long-term prognosis with acceptable major morbidity. Pre-operative CKD appears to be a risk factor for early renal deterioration.
{"title":"Pure living donor liver transplant for liver and polycystic kidney disease, outcomes and experiences from an Asian transplant unit","authors":"Darren W. Chua , Horng-ren Yang , Ping Chun Li , Sheng-Hsien Chen , Shih Chao Hsu , Te-Hong Chen , Hsueh-Chou Lai , Ching-Feng Wu , You-Cian Lin , Long-Bin Jeng","doi":"10.1016/j.liver.2025.100272","DOIUrl":"10.1016/j.liver.2025.100272","url":null,"abstract":"<div><h3>Background</h3><div>Adult polycystic liver disease (PLD) is a rare genetic disorder. In instances of intractable symptoms from mass effect or recurrent cyst-related complications, liver transplant affords the best therapeutic solution.</div></div><div><h3>Methods</h3><div>This is a retrospective case series of patients who underwent isolated pure living donor liver transplantation (LDLT) for adult polycystic kidney disease (PCKD) associated PLD from 2012- 2022. Short-term peri‑operative outcomes including renal sequelae and long-term survival were analysed.</div></div><div><h3>Results</h3><div>From 2012–2022, a total of 9 patients underwent LDLT for PLD. The median explanted liver weight was 6950 g (IQR 5653–7700) with a median blood loss of was 5450mls (IQR 2400–9875). There was 1 mortality due to acute antibody-mediated rejection (11.1 %). Of the four patients with existing chronic kidney disease (CKD), 2 (50 %) developed end-stage renal failure and was renal replacement therapy (RRT) dependent at 3 months. The median overall survival in our series was 63.9 months with a 5-year survival of 88.9 %.</div></div><div><h3>Conclusions</h3><div>Despite its technical challenges, LDLT affords an excellent long-term prognosis with acceptable major morbidity. Pre-operative CKD appears to be a risk factor for early renal deterioration.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"18 ","pages":"Article 100272"},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864091","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}
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