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Outcomes of living donor liver transplant in elevated body mass index over a decade in the United States 美国十多年来体重指数升高的活体肝移植的结果
Pub Date : 2025-04-10 DOI: 10.1016/j.liver.2025.100274
Marie L Jacobs , Matthew Byrne , Xueya Cai , Shan Gao , John Martens , Luis I Ruffolo , Ana Paula Cupertino , Karen Pineda-Solis

Introduction

Living donor liver transplant (LDLT) is a treatment option for end stage liver disease (ESLD). This study assesses the impact of recipient BMI on LDLT outcomes.

Methods

The United Network for Organ Sharing (UNOS) database was reviewed for adult LDLTs between January 2010 and December 2020. Recipients were stratified by BMI: Normal: < 25 kg/m2; Overweight: 25 to <30 kg/m2, Class 1 Obesity: 30 to <35 kg/m2, and Class 2/3 Obesity: ≥35 kg/m2. Recipient and donor characteristics, and post-transplant graft failure and mortality were compared.

Results

3068 patients were included. The mean age was 53 ± 13 years. The prevalence of diabetes and MASH cirrhosis was positively correlated with higher BMI groups (p < 0.0001 and p < 0.0001). At 5-years, graft failure (GF) in each group was 7.7 %, 5.2 %, 4.2 %, and 3.5 %, respectively (p = 0.0091). At 5 years, rate of death in each group was 11.2 %, 12.5 %, 10.7 %, and 10.4 %, respectively (p = 0.61). After controlling for patient demographics, clinical characteristics, and donor age, weight was no longer associated with graft failure or death.

Conclusion

In this retrospective analysis, recipient BMI did not correlate with death, and obesity is associated with lower rates of graft failure. Obesity alone should not preclude candidacy for LDLT.
导言活体肝移植(LDLT)是终末期肝病(ESLD)的一种治疗方法。本研究评估了受者体重指数对 LDLT 治疗效果的影响。方法对器官共享联合网络(UNOS)数据库中 2010 年 1 月至 2020 年 12 月期间的成人 LDLT 进行了审查。受者按体重指数分层:正常:25 kg/m2;超重:25 至 30 kg/m2,1 级肥胖:30至35 kg/m2,2/3级肥胖:≥35 kg/m2。比较了受者和供者的特征、移植后的失败率和死亡率。平均年龄为 53 ± 13 岁。糖尿病和 MASH 肝硬化的发病率与体重指数较高的组别呈正相关(p < 0.0001 和 p < 0.0001)。5年后,各组的移植失败率(GF)分别为7.7%、5.2%、4.2%和3.5%(p = 0.0091)。5 年后,各组的死亡率分别为 11.2%、12.5%、10.7% 和 10.4%(P = 0.61)。在控制了患者人口统计学特征、临床特征和供体年龄后,体重与移植物失败或死亡不再相关。肥胖本身不应排除 LDLT 的候选资格。
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引用次数: 0
Single organ transplant for transposition of the great arteries 大动脉转位单器官移植
Pub Date : 2025-04-08 DOI: 10.1016/j.liver.2025.100273
Tripti Gupta , Kayla Buttafuoco , Kara Siegrist , Kelly Mishra , Benjamin Byrd , Frank Fish , Angela Weingarten , Benjamin Frischhertz , Roman Perri , Martin Montenovo , Jonathan Menachem
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引用次数: 0
The impact of donor anemia on post-liver transplant outcomes: A stratified analysis by cold ischemia time 供体贫血对肝移植术后结果的影响:冷缺血时间分层分析
Pub Date : 2025-03-29 DOI: 10.1016/j.liver.2025.100270
David Uihwan Lee , Mohammed Rifat Shaik , Kuntal Bhowmick , Youngjae Cha , Ki Jung Lee , Nishat Anjum Shaik , Gregory Hongyuan Fan , Miranda Tsang , Eddie Kwon , Hannah Chou , Harrison Chou , Raza Malik

Background & Aims

Cold ischemia time (CIT) has long been correlated with liver transplant (LT) graft viability. Donor anemia, leading to suboptimal oxygen delivery to the liver, may theoretically worsen the ischemia-reperfusion injury associated with CIT. In this study, we stratify CIT by tertiles and investigate the potential relationship between donor anemia, CIT, and LT-recipient prognosis by varying donor hematocrit (Hct) thresholds.

Methods

The United Network for Organ Sharing (UNOS) Standard Transplant Analysis and Research (STAR) Database was used to study LT patients between 2005 and 2019. Patients were categorized into tertiles by donor Hct thresholds of < 27.6, 27.6-32.3, and > 32.3, and compared amongst all CIT and set thresholds. Primary outcomes assessed were all-cause mortality and graft failure.

Results

All study results are reported in comparison to LT recipients with donor Hct below 27.6. In the composite population encompassing all CIT thresholds, LT recipients experienced higher all-cause mortality (aHR 1.04; 95% CI 1.00-1.08, p=0.05), as well as graft failure (aHR 1.10; 95% CI 1.01-1.20, p=0.02) with donor Hct above 32.3. There were no significant differences in primary outcomes within the first CIT tertile. Recipients within the 2nd CIT tertile experienced higher rates of graft failure with Hct above 32.3 (aHR 1.17; 95% CI 1.01-1.37, p=0.04). Higher all-cause mortality was observed in recipients with donor Hct above 32.3 (aHR 1.07; 95% CI 1.00-1.14, p=0.04) within the 3rd tertile of CIT.

Conclusion

Normal donor Hct and mild donor anemia were associated with worse LT-recipient outcomes when compared to moderate-to-severe donor anemia. This may potentially represent a local adaptation in the donor graft from chronic anemia or a multifactorial, organization-based process. These associations warrant further investigation.
背景,缺血时间(CIT)长期以来一直与肝移植(LT)移植物存活有关。供体贫血导致肝脏供氧不足,理论上可能会加重CIT相关的缺血再灌注损伤。在本研究中,我们对CIT进行了分类,并通过不同的供体红细胞压积(Hct)阈值来研究供体贫血、CIT和lt受体预后之间的潜在关系。方法采用联合器官共享网络(UNOS)标准移植分析与研究(STAR)数据库对2005 - 2019年肝移植患者进行研究。根据供体Hct阈值<;27.6, 27.6-32.3和>;32.3,并在所有CIT和设定阈值之间进行比较。评估的主要结果是全因死亡率和移植物衰竭。所有的研究结果都是与供体Hct低于27.6的肝移植受体进行比较。在包含所有CIT阈值的复合人群中,肝移植受者的全因死亡率更高(aHR 1.04;95% CI 1.00-1.08, p=0.05),以及移植物衰竭(aHR 1.10;95% CI 1.01-1.20, p=0.02),供体Hct高于32.3。在第一个CIT组中,主要结局没有显著差异。第二CIT组的受者Hct高于32.3时移植物失败率更高(aHR 1.17;95% CI 1.01-1.37, p=0.04)。供体Hct高于32.3的受者全因死亡率较高(aHR 1.07;95% CI 1.00-1.14, p=0.04)。结论与中度至重度供体贫血相比,正常供体Hct和轻度供体贫血与较差的受体结果相关。这可能潜在地代表供体移植物从慢性贫血或多因素的局部适应,组织为基础的过程。这些关联值得进一步调查。
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引用次数: 0
Dual hypothermic oxygenated machine perfusion (DHOPE) improves extended allocation graft function in liver transplantation 双低温氧机灌注(DHOPE)改善肝移植中延长分配移植物功能
Pub Date : 2025-03-28 DOI: 10.1016/j.liver.2025.100271
J Arend, A Bollensdorf, F Stelter, M Rahimli, RS Croner, M Franz

Background

Patients with end-stage liver disease or liver tumours can only be treated curatively with liver transplantation (LTx). The glaring organ shortage and the increasing allocation of marginal donor organs is an international challenge. These organs can be accepted and transplanted with good results through preconditioning using machine perfusion (MP). This makes it possible to shorten the waiting list time and thus reduce the dropout rate from the waiting list, especially for patients with hepatocellular carcinoma.

Materials and Methods

The Magdeburg Liver Surgery Register/ Study was screened for the last 132 liver transplant patients. Of these, 18 were transplanted with Dual Hypothermic Oxygenated Machine (DHOPE) perfusion and 114 without (non-MP). Recipient demographic, perioperative and follow-up data were retrospectively collected and analysed. Donor data and risk factors were evaluated.

Results

The mean recipient age with DHOPE was 57.4 years vs. non-MP 55.9 years. The mean donor age was higher in the DHOPE Group (64.5 vs. 58.3 years, p = 0.073). The mean DHOPE time was 371.0 (57–945) minutes. The DHOPE reduced the cold ischemic time significant (7.1 vs. 8.4 h, p = 0.010). The Donor Risk Index was higher with DHOPE (1.903 vs. 1.889, p = 0.869). The rate of Re-LTx was 0 % vs 7.0 % with and without DHOPE (p = 0.299). The rate of EAD and primary non-function DHOPE vs. non-MP was 23.5 % vs. 27.8 % (p = 0.485) and 0.0 % vs. 5.3 % (p = 0.427). DHOPE significantly increased the rate of extended or rescue allocation from 26.3 % to 61.1 % (p = 0.003). With DHOPE, the donor age was higher (64.5 vs. 58.3 years, p = 0.0.073). The postoperative ICU time was significantly shorter after DHOPE (7.2 vs. 13.6 days, p = 0.044). The hospitalisation time after LTx was not significant, but it tended to be shorter at 28.7 vs 39.3 days (p = 0.097). The 1-year survival rate with and without DHOPE was 88,9 % vs. 80,3 % (p = 0593).

Conclusion

The increasing proportion of marginal donor organs requires optimisation of organ reconditioning, as is possible with Dual Hypothermic Oxygenated Machine Perfusion. Reduction of reperfusion damage leads to better postoperative graft function and thus faster convalescence. As the data show, marginal organs can be transplanted safely and with a good result using DHOPE.
背景:终末期肝病或肝脏肿瘤患者只能通过肝移植(LTx)进行治愈性治疗。明显的器官短缺和日益增加的边缘供体器官分配是一项国际挑战。通过机器灌注预处理,这些器官可以接受并移植,效果良好。这使得缩短等候名单时间成为可能,从而减少等候名单的辍学率,特别是对于肝细胞癌患者。材料与方法筛选马格德堡肝脏外科登记/研究的132例肝移植患者。其中18例采用双低温充氧机(DHOPE)灌注,114例不采用(非mp)灌注。接受者人口统计学、围手术期和随访资料回顾性收集和分析。评估供体资料和危险因素。结果DHOPE患者的平均年龄为57.4岁,非mp患者的平均年龄为55.9岁。DHOPE组的平均供者年龄更高(64.5岁比58.3岁,p = 0.073)。平均DHOPE时间为371.0(57 ~ 945)分钟。DHOPE显著缩短冷缺血时间(7.1 h vs. 8.4 h, p = 0.010)。DHOPE的供者风险指数较高(1.903比1.889,p = 0.869)。有DHOPE和无DHOPE的Re-LTx率分别为0%和7.0% (p = 0.299)。EAD和原发性无功能DHOPE与非mp的比率分别为23.5%对27.8% (p = 0.485)和0.0%对5.3% (p = 0.427)。DHOPE将延长或抢救分配率从26.3%显著提高至61.1% (p = 0.003)。与DHOPE相比,供者年龄更高(64.5比58.3岁,p = 0.0.073)。DHOPE术后ICU时间明显缩短(7.2天比13.6天,p = 0.044)。LTx术后住院时间无显著性差异,但有缩短趋势,分别为28.7天和39.3天(p = 0.097)。合并和不合并DHOPE的1年生存率分别为88.9%和803% (p = 0593)。结论边缘供器官比例的增加需要优化器官修复,双低温充氧机灌注是可能的。减少再灌注损伤,术后移植物功能更好,康复更快。数据表明,使用DHOPE可以安全、有效地移植边缘器官。
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引用次数: 0
The role of recipient sex in the post-liver transplant prognosis of acute-on-chronic liver failure 受体性别在急性慢性肝衰竭患者肝移植后预后中的作用
Pub Date : 2025-03-23 DOI: 10.1016/j.liver.2025.100267
David Uihwan Lee , Mohammed Rifat Shaik , Sharmitha Yerneni , Ashton Harmacinski , Nishat Anjum Shaik , Katie Evey , Kuntal Bhowmick , Zainab Mujahid , Youngjae Cha , Hannah Chou , Andrew Yi , Kijung Lee , Gregory Hongyuan Fan , Raza Malik

Background & aims

Limited data exists on the impact of recipient sex on the post-liver transplant (LT) outcomes in patients with acute-on-chronic liver failure (ACLF). This study aims to utilize a national transplant registry to evaluate the relationship between recipient sex and post-transplant outcomes, stratified by ACLF severity.

Methods

The United Network for Organ Sharing Standard Transplant Analysis and Research (UNOS-STAR) database was queried to collect health information on 47,447 patients who underwent liver transplantation between 1987 and 2019. The cohort was stratified by biological sex, and further subdivided into groups based on ACLF severity: Grade 0 (without ACLF) and Grade 1–3 in increasing severity. The primary outcomes assessed were all-cause mortality and graft failure while secondary outcomes included specific causes of death.

Results

No sex-based disparities were observed in the primary outcomes of all-cause mortality and graft failure across all grades of ACLF. However, females without ACLF exhibited a higher risk of mortality from recurrent graft disease compared to males. Time-point analyses revealed higher 180-day and 360-day mortality rates in females without ACLF. Among patients with ACLF Grade 1, females demonstrated higher 30-day mortality, but no significant differences were found at 90-, 180- or 360-days. Among patients with ACLF Grades 2 and 3, however, no sex-based differences in 30-day to 360-day mortality were identified.

Conclusion

Factors other than sex appear to play a more critical role in determining the long-term transplant outcomes in ACLF. The increased short-term mortality observed in females with ACLF grade 1 warrants further investigation to elucidate potential contributing factors.
背景,目的:关于受体性别对急性慢性肝衰竭(ACLF)患者肝移植后(LT)预后影响的数据有限。本研究旨在利用国家移植登记来评估接受者性别与移植后结果之间的关系,并按ACLF严重程度分层。方法查询美国器官共享标准移植分析与研究网络(UNOS-STAR)数据库,收集1987年至2019年接受肝移植的47447例患者的健康信息。该队列按生理性别分层,并根据ACLF严重程度进一步细分为0级(无ACLF)和加重程度1-3级。评估的主要结局是全因死亡率和移植物衰竭,而次要结局包括具体的死亡原因。结果:在所有级别ACLF的全因死亡率和移植物衰竭的主要结局中,没有观察到基于性别的差异。然而,与男性相比,没有ACLF的女性因复发性移植物疾病而死亡的风险更高。时间点分析显示,没有ACLF的女性180天和360天的死亡率更高。在1级ACLF患者中,女性患者的30天死亡率较高,但在90天、180天或360天时没有发现显著差异。然而,在ACLF 2级和3级患者中,未发现30天和360天死亡率的性别差异。结论性别以外的因素在ACLF患者的长期移植预后中起着更重要的作用。在女性1级ACLF患者中观察到的短期死亡率增加值得进一步调查以阐明潜在的影响因素。
{"title":"The role of recipient sex in the post-liver transplant prognosis of acute-on-chronic liver failure","authors":"David Uihwan Lee ,&nbsp;Mohammed Rifat Shaik ,&nbsp;Sharmitha Yerneni ,&nbsp;Ashton Harmacinski ,&nbsp;Nishat Anjum Shaik ,&nbsp;Katie Evey ,&nbsp;Kuntal Bhowmick ,&nbsp;Zainab Mujahid ,&nbsp;Youngjae Cha ,&nbsp;Hannah Chou ,&nbsp;Andrew Yi ,&nbsp;Kijung Lee ,&nbsp;Gregory Hongyuan Fan ,&nbsp;Raza Malik","doi":"10.1016/j.liver.2025.100267","DOIUrl":"10.1016/j.liver.2025.100267","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Limited data exists on the impact of recipient sex on the post-liver transplant (LT) outcomes in patients with acute-on-chronic liver failure (ACLF). This study aims to utilize a national transplant registry to evaluate the relationship between recipient sex and post-transplant outcomes, stratified by ACLF severity.</div></div><div><h3>Methods</h3><div>The United Network for Organ Sharing Standard Transplant Analysis and Research (UNOS-STAR) database was queried to collect health information on 47,447 patients who underwent liver transplantation between 1987 and 2019. The cohort was stratified by biological sex, and further subdivided into groups based on ACLF severity: Grade 0 (without ACLF) and Grade 1–3 in increasing severity. The primary outcomes assessed were all-cause mortality and graft failure while secondary outcomes included specific causes of death.</div></div><div><h3>Results</h3><div>No sex-based disparities were observed in the primary outcomes of all-cause mortality and graft failure across all grades of ACLF. However, females without ACLF exhibited a higher risk of mortality from recurrent graft disease compared to males. Time-point analyses revealed higher 180-day and 360-day mortality rates in females without ACLF. Among patients with ACLF Grade 1, females demonstrated higher 30-day mortality, but no significant differences were found at 90-, 180- or 360-days. Among patients with ACLF Grades 2 and 3, however, no sex-based differences in 30-day to 360-day mortality were identified.</div></div><div><h3>Conclusion</h3><div>Factors other than sex appear to play a more critical role in determining the long-term transplant outcomes in ACLF. The increased short-term mortality observed in females with ACLF grade 1 warrants further investigation to elucidate potential contributing factors.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"18 ","pages":"Article 100267"},"PeriodicalIF":0.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738369","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}
引用次数: 0
De novo shrimp allergy in an adult liver transplant recipient 一名成年肝移植受者对虾过敏
Pub Date : 2025-03-15 DOI: 10.1016/j.liver.2025.100269
Jaimie Chang, Aryanna Sousa, Steven Flamm, Lloyd Brown, Edie Chan, Nathalie Sela
{"title":"De novo shrimp allergy in an adult liver transplant recipient","authors":"Jaimie Chang,&nbsp;Aryanna Sousa,&nbsp;Steven Flamm,&nbsp;Lloyd Brown,&nbsp;Edie Chan,&nbsp;Nathalie Sela","doi":"10.1016/j.liver.2025.100269","DOIUrl":"10.1016/j.liver.2025.100269","url":null,"abstract":"","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"18 ","pages":"Article 100269"},"PeriodicalIF":0.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686988","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}
引用次数: 0
Preliminary experience in anesthetic management of patients undergoing auxiliary liver transplant according to the RAPID procedure 辅助肝移植手术的麻醉管理初步体会
Pub Date : 2025-02-20 DOI: 10.1016/j.liver.2025.100268
Marie-Hélène Lagios , Audrey Dieu , Loïc Benoit , Arnaud Steyaert , Virginie Montiel , Aude Vanbuggenhout , Lancelot Marique , Laurent Coubeau

Background

RAPID (Resection And Partial Liver Transplantation With Delayed Total Hepatectomy) is a novel two-stage surgical procedure, with only 23 reported cases, involving partial liver resection and transplantation of a left lobe (stage 1) followed by a delayed total hepatectomy (stage 2). The perioperative anesthetic management of these recipients presents unique challenges and has never been described so far.

Materials and methods

We report on ten patients with unresectable liver metastases who underwent this procedure from a living donor in our center between May 2020 and April 2024. Retrospectively, we collected preoperative, graft-related, and intraoperative management data during stage 1 (S1) and stage 2 (S2), and postoperative outcomes.

Results and discussion

Recipients’ median age was 53 (50–57), median graft-to-recipient weight ratio 0.43 % (0.41–0.45), total ischemia time 82 min (75–105). No patients experienced postreperfusion syndrome. Median intensive care unit (ICU) stay was 36 h (27–48) after S1, 24 h (24–48) after S2. Median INR on POD 3 was 1.20 (1.13–1.29) after S1, 1.29 (1.16–1.70) after S2. Complications after S1 included portal thrombosis in one patient, and three required revision surgery. After S2, one patient required revision for hemostasis, and another developed acute kidney injury. This patient died on day 12 from bleeding post-thoracocentesis for pleural effusion. Six-month survival rate was 90 %.

Conclusions

These preliminary data, as a first step in developing perioperative management protocols for this innovative surgery, show good hemodynamic tolerance, no postreperfusion syndrome, and preserved liver function throughout the process. These results highlight the RAPID procedure's safety during surgery and postoperative course.
apid(切除和部分肝移植伴延迟全肝切除术)是一种新的两阶段手术,仅有23例报道,包括部分肝切除和左叶移植(1期),然后是延迟全肝切除术(2期)。这些接受者的围手术期麻醉管理提出了独特的挑战,迄今为止从未被描述过。材料和方法我们报告了2020年5月至2024年4月期间在我们中心接受活体供体肝转移手术的10例不可切除肝转移患者。回顾性地,我们收集了1期(S1)和2期(S2)的术前、移植物相关和术中处理数据以及术后结果。结果与讨论受者中位年龄53岁(50-57岁),中位移植物与受者体重比0.43%(0.41-0.45),总缺血时间82 min(75-105)。无患者出现灌注后综合征。S1术后ICU住院时间中位数为36 h (27-48), S2术后24 h(24 - 48)。S1后,POD 3的中位INR为1.20 (1.13-1.29),S2后为1.29(1.16-1.70)。S1术后并发症包括1例门静脉血栓形成,3例需要翻修手术。S2后,1例患者需要翻修止血,另1例发生急性肾损伤。该患者于第12天死于胸腔积液穿刺后出血。6个月存活率为90%。结论:这些初步数据作为制定该创新手术围手术期管理方案的第一步,显示了良好的血流动力学耐受性,无灌注后综合征,并在整个过程中保持了肝功能。这些结果强调了RAPID手术在手术和术后过程中的安全性。
{"title":"Preliminary experience in anesthetic management of patients undergoing auxiliary liver transplant according to the RAPID procedure","authors":"Marie-Hélène Lagios ,&nbsp;Audrey Dieu ,&nbsp;Loïc Benoit ,&nbsp;Arnaud Steyaert ,&nbsp;Virginie Montiel ,&nbsp;Aude Vanbuggenhout ,&nbsp;Lancelot Marique ,&nbsp;Laurent Coubeau","doi":"10.1016/j.liver.2025.100268","DOIUrl":"10.1016/j.liver.2025.100268","url":null,"abstract":"<div><h3>Background</h3><div>RAPID (Resection And Partial Liver Transplantation With Delayed Total Hepatectomy) is a novel two-stage surgical procedure, with only 23 reported cases, involving partial liver resection and transplantation of a left lobe (stage 1) followed by a delayed total hepatectomy (stage 2). The perioperative anesthetic management of these recipients presents unique challenges and has never been described so far.</div></div><div><h3>Materials and methods</h3><div>We report on ten patients with unresectable liver metastases who underwent this procedure from a living donor in our center between May 2020 and April 2024. Retrospectively, we collected preoperative, graft-related, and intraoperative management data during stage 1 (S1) and stage 2 (S2), and postoperative outcomes.</div></div><div><h3>Results and discussion</h3><div>Recipients’ median age was 53 (50–57), median graft-to-recipient weight ratio 0.43 % (0.41–0.45), total ischemia time 82 min (75–105). No patients experienced postreperfusion syndrome. Median intensive care unit (ICU) stay was 36 h (27–48) after S1, 24 h (24–48) after S2. Median INR on POD 3 was 1.20 (1.13–1.29) after S1, 1.29 (1.16–1.70) after S2. Complications after S1 included portal thrombosis in one patient, and three required revision surgery. After S2, one patient required revision for hemostasis, and another developed acute kidney injury. This patient died on day 12 from bleeding post-thoracocentesis for pleural effusion. Six-month survival rate was 90 %.</div></div><div><h3>Conclusions</h3><div>These preliminary data, as a first step in developing perioperative management protocols for this innovative surgery, show good hemodynamic tolerance, no postreperfusion syndrome, and preserved liver function throughout the process. These results highlight the RAPID procedure's safety during surgery and postoperative course.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"18 ","pages":"Article 100268"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509120","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}
引用次数: 0
Molecular evidence of solitary lung metastasis as the initial recurrence of hepatocellular carcinoma a decade more after liver transplantation 肝移植后10多年肝细胞癌初始复发为单发肺转移的分子证据
Pub Date : 2025-02-18 DOI: 10.1016/j.liver.2025.100266
Cheng-Maw Ho , Hsao-Hsun Hsu , Hui-Ling Chen , Po-Huang Lee , Rey-Heng Hu
{"title":"Molecular evidence of solitary lung metastasis as the initial recurrence of hepatocellular carcinoma a decade more after liver transplantation","authors":"Cheng-Maw Ho ,&nbsp;Hsao-Hsun Hsu ,&nbsp;Hui-Ling Chen ,&nbsp;Po-Huang Lee ,&nbsp;Rey-Heng Hu","doi":"10.1016/j.liver.2025.100266","DOIUrl":"10.1016/j.liver.2025.100266","url":null,"abstract":"","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"18 ","pages":"Article 100266"},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465449","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}
引用次数: 0
Tacrolimus-induced psychosis in liver transplant recipients: A systematic review of all published cases 肝移植受者他克莫司诱发的精神病:对所有已发表病例的系统回顾
Pub Date : 2025-02-18 DOI: 10.1016/j.liver.2025.100265
Pooja Belur , Komal Dani , Stephanie H. Cho

Objective

This systematic review aims to better characterize the clinical patterns, potential protective and risk factors, prognosis, and management of tacrolimus-induced psychosis in liver transplant recipients.

Method

We reviewed all published cases of severe psychiatric complications associated with tacrolimus in liver transplant recipients from 1998 to 2024. In total, 17 case reports, 1 case-control study, 3 retrospective studies, and 2 prospective studies were identified.

Results

Tacrolimus-induced psychosis presented with a wide range of symptoms, including tremor, speech difficulties, seizures, delusions, and paranoia. Of the 17 case reports, only 10 documented symptoms aligning with a clinical, DSM-based definition of psychosis. Affected patients varied in age, and a significant proportion had no prior psychiatric history. Symptom onset after tacrolimus initiation varied, though 15 of 17 cases developed psychosis within the first 6 months of treatment. Of these cases, 13 saw resolution of symptoms within one month of stopping tacrolimus. We differentiated cases by a strict, DSM-based definition of psychosis versus a broader categorization. The 10 cases fitting the classic definition showed a higher rate of symptom resolution within the first month.

Conclusion

Presentation of tacrolimus-induced psychosis varied considerably across reviewed studies, with rapid resolution upon drug discontinuation in most cases. However, a standardized approach to balancing risks of drug withdrawal against the need for immunosuppression remains absent. This review underscores the need for standardized diagnostic criteria.
目的探讨肝移植受者他克莫司致精神病的临床特点、潜在的保护和危险因素、预后和处理。方法回顾1998年至2024年所有发表的肝移植受者与他克莫司相关的严重精神并发症病例。共纳入17份病例报告、1份病例对照研究、3份回顾性研究和2份前瞻性研究。结果司他莫司致精神病表现为震颤、言语困难、癫痫发作、妄想、偏执等多种症状。在17个病例报告中,只有10个记录的症状符合临床的、基于dsm的精神病定义。受影响的患者年龄各不相同,很大一部分患者之前没有精神病史。他克莫司开始使用后,症状的发作各不相同,尽管17例中有15例在治疗的前6个月内出现精神病。在这些病例中,13例在停用他克莫司一个月内症状得到缓解。我们通过严格的、基于dsm的精神病定义与更广泛的分类来区分病例。符合经典定义的10例患者在第一个月内表现出较高的症状缓解率。结论:在回顾的研究中,他克莫司诱发的精神病的表现差异很大,在大多数情况下,停药后迅速消退。然而,平衡药物停药风险和免疫抑制需求的标准化方法仍然缺乏。本综述强调了标准化诊断标准的必要性。
{"title":"Tacrolimus-induced psychosis in liver transplant recipients: A systematic review of all published cases","authors":"Pooja Belur ,&nbsp;Komal Dani ,&nbsp;Stephanie H. Cho","doi":"10.1016/j.liver.2025.100265","DOIUrl":"10.1016/j.liver.2025.100265","url":null,"abstract":"<div><h3>Objective</h3><div>This systematic review aims to better characterize the clinical patterns, potential protective and risk factors, prognosis, and management of tacrolimus-induced psychosis in liver transplant recipients.</div></div><div><h3>Method</h3><div>We reviewed all published cases of severe psychiatric complications associated with tacrolimus in liver transplant recipients from 1998 to 2024. In total, 17 case reports, 1 case-control study, 3 retrospective studies, and 2 prospective studies were identified.</div></div><div><h3>Results</h3><div>Tacrolimus-induced psychosis presented with a wide range of symptoms, including tremor, speech difficulties, seizures, delusions, and paranoia. Of the 17 case reports, only 10 documented symptoms aligning with a clinical, DSM-based definition of psychosis. Affected patients varied in age, and a significant proportion had no prior psychiatric history. Symptom onset after tacrolimus initiation varied, though 15 of 17 cases developed psychosis within the first 6 months of treatment. Of these cases, 13 saw resolution of symptoms within one month of stopping tacrolimus. We differentiated cases by a strict, DSM-based definition of psychosis versus a broader categorization. The 10 cases fitting the classic definition showed a higher rate of symptom resolution within the first month.</div></div><div><h3>Conclusion</h3><div>Presentation of tacrolimus-induced psychosis varied considerably across reviewed studies, with rapid resolution upon drug discontinuation in most cases. However, a standardized approach to balancing risks of drug withdrawal against the need for immunosuppression remains absent. This review underscores the need for standardized diagnostic criteria.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"18 ","pages":"Article 100265"},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143474677","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}
引用次数: 0
Incidental hepatocellular carcinoma in explanted livers: Prevalence, prognosis and features 外植肝偶发性肝细胞癌:患病率、预后及特征
Pub Date : 2025-02-05 DOI: 10.1016/j.liver.2025.100264
Emilie Kerstens , Samuele Iesari , Eliano Bonaccorsi , Laurent Coubeau , Géraldine Dahlqvist , Coralie Hamoir , Olga Ciccarelli , Bénédicte Delire

Background and aims

Incidental hepatocellular carcinoma (iHCC) on cirrhotic liver specimens is not rare. The aim of this study was to evaluate prevalence and outcomes of liver transplant recipients (LTRs) with iHCC. We compared this group to cirrhotic patients who underwent liver transplantation (LT) for previously known hepatocellular carcinoma (pkHCC) or tumor-free end-stage liver disease (ESLD).

Methods

We retrospectively reviewed 268 cirrhotic patients who underwent LT at our center between 2010 and 2020. Patient selection was made according to the indication for LT and histopathological analyses of surgical specimens (tumor-free ESLD, hepatocellular carcinoma (HCC)). Results were compared using Fisher's exact or Mann-Whitney U tests as appropriate. We used the Kaplan-Meier method to analyze the rate of death and log-rank tests to compare survival curves.

Results

The prevalence of iHCC was 12 %. Alcohol-related liver disease was more frequent in iHCC LTRs than in the other groups (p = 0.046). iHCC patients spent more time on the waiting list than patients with tumor-free ESLD cirrhosis (Ci) (12.2 months vs. 3.5 months; p = 0.04). Five-year overall survival of iHCC LTRs was significantly reduced compared to the survival of Ci LTRs (44 % vs. 87 %, p = 0.028).

Conclusions

The prevalence of iHCC within LT candidates is significant. iHCC LTRs show a lower survival rate than Ci LTRs, but a reduced rate of tumor recurrence compared to pkHCC LTRs. HCC screening protocol of ESLD LT candidates might include a larger use of high-resolution imaging techniques and iHCC LTRs should be approached as pkHCC LTRs with regards to postoperative imaging follow-up.

Summary

Prevalence of incidental hepatocellular carcinoma is considerable among LT candidates. These patients have a lower survival rate than recipients with tumor-free ESLD cirrhosis. Optimizing screening methods for hepatocellular carcinoma in cirrhotic patients awaiting liver transplantation could improve their prognosis.
背景与目的肝硬化标本中偶发肝细胞癌(iHCC)并不罕见。本研究的目的是评估肝移植受者(LTRs) iHCC的患病率和预后。我们将这一组与因先前已知的肝细胞癌(pkHCC)或无肿瘤终末期肝病(ESLD)而接受肝移植(LT)的肝硬化患者进行比较。方法我们回顾性分析了2010年至2020年间在本中心接受肝移植的268例肝硬化患者。根据肝移植的适应症和手术标本的组织病理学分析(无肿瘤ESLD、肝细胞癌)选择患者。采用Fisher精确检验或Mann-Whitney U检验对结果进行比较。我们用Kaplan-Meier法分析死亡率,用log-rank检验比较生存曲线。结果iHCC患病率为12%。酒精相关性肝病在iHCC ltr中的发生率高于其他组(p = 0.046)。iHCC患者比无肿瘤ESLD肝硬化患者的等待时间更长(Ci)(12.2个月vs 3.5个月;P = 0.04)。与Ci ltr相比,iHCC ltr的5年总生存率显著降低(44%对87%,p = 0.028)。结论肝移植候选者中iHCC的患病率显著。iHCC LTRs的生存率低于Ci LTRs,但与pkHCC LTRs相比,肿瘤复发率降低。ESLD肝移植候选者的HCC筛查方案可能包括更多地使用高分辨率成像技术,在术后影像学随访方面,iHCC肝移植应被视为pkHCC肝移植。在肝移植候选者中,偶发肝细胞癌的发生率相当高。这些患者的生存率低于无肿瘤ESLD肝硬化患者。优化等待肝移植的肝硬化患者肝细胞癌筛查方法可改善其预后。
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引用次数: 0
期刊
Journal of Liver Transplantation
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