Pub Date : 2025-04-10DOI: 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.
{"title":"Outcomes of living donor liver transplant in elevated body mass index over a decade in the United States","authors":"Marie L Jacobs , Matthew Byrne , Xueya Cai , Shan Gao , John Martens , Luis I Ruffolo , Ana Paula Cupertino , Karen Pineda-Solis","doi":"10.1016/j.liver.2025.100274","DOIUrl":"10.1016/j.liver.2025.100274","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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/m<sup>2</sup>; Overweight: 25 to <30 kg/m<sup>2</sup>, Class 1 Obesity: 30 to <35 kg/m<sup>2</sup>, and Class 2/3 Obesity: ≥35 kg/m<sup>2</sup>. Recipient and donor characteristics, and post-transplant graft failure and mortality were compared.</div></div><div><h3>Results</h3><div>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 (<em>p</em> < 0.0001 and <em>p</em> < 0.0001). At 5-years, graft failure (GF) in each group was 7.7 %, 5.2 %, 4.2 %, and 3.5 %, respectively (<em>p</em> = 0.0091). At 5 years, rate of death in each group was 11.2 %, 12.5 %, 10.7 %, and 10.4 %, respectively (<em>p</em> = 0.61). After controlling for patient demographics, clinical characteristics, and donor age, weight was no longer associated with graft failure or death.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"18 ","pages":"Article 100274"},"PeriodicalIF":0.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143824176","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 : 2025-04-08DOI: 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
{"title":"Single organ transplant for transposition of the great arteries","authors":"Tripti Gupta , Kayla Buttafuoco , Kara Siegrist , Kelly Mishra , Benjamin Byrd , Frank Fish , Angela Weingarten , Benjamin Frischhertz , Roman Perri , Martin Montenovo , Jonathan Menachem","doi":"10.1016/j.liver.2025.100273","DOIUrl":"10.1016/j.liver.2025.100273","url":null,"abstract":"","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"18 ","pages":"Article 100273"},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143821428","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 : 2025-03-29DOI: 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。
{"title":"The impact of donor anemia on post-liver transplant outcomes: A stratified analysis by cold ischemia time","authors":"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","doi":"10.1016/j.liver.2025.100270","DOIUrl":"10.1016/j.liver.2025.100270","url":null,"abstract":"<div><h3>Background & Aims</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"18 ","pages":"Article 100270"},"PeriodicalIF":0.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776722","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}
Pub Date : 2025-03-28DOI: 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.
{"title":"Dual hypothermic oxygenated machine perfusion (DHOPE) improves extended allocation graft function in liver transplantation","authors":"J Arend, A Bollensdorf, F Stelter, M Rahimli, RS Croner, M Franz","doi":"10.1016/j.liver.2025.100271","DOIUrl":"10.1016/j.liver.2025.100271","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Materials and Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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, <em>p</em> = 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, <em>p</em> = 0.010). The Donor Risk Index was higher with DHOPE (1.903 vs. 1.889, <em>p</em> = 0.869). The rate of <em>Re</em>-LTx was 0 % vs 7.0 % with and without DHOPE (<em>p</em> = 0.299). The rate of EAD and primary non-function DHOPE vs. non-MP was 23.5 % vs. 27.8 % (<em>p</em> = 0.485) and 0.0 % vs. 5.3 % (<em>p</em> = 0.427). DHOPE significantly increased the rate of extended or rescue allocation from 26.3 % to 61.1 % (<em>p</em> = 0.003). With DHOPE, the donor age was higher (64.5 vs. 58.3 years, <em>p</em> = 0.0.073). The postoperative ICU time was significantly shorter after DHOPE (7.2 vs. 13.6 days, <em>p</em> = 0.044). The hospitalisation time after LTx was not significant, but it tended to be shorter at 28.7 vs 39.3 days (<em>p</em> = 0.097). The 1-year survival rate with and without DHOPE was 88,9 % vs. 80,3 % (<em>p</em> = 0593).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"18 ","pages":"Article 100271"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747777","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}
Pub Date : 2025-03-23DOI: 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.
{"title":"The role of recipient sex in the post-liver transplant prognosis of acute-on-chronic liver failure","authors":"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","doi":"10.1016/j.liver.2025.100267","DOIUrl":"10.1016/j.liver.2025.100267","url":null,"abstract":"<div><h3>Background & 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}
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 , Audrey Dieu , Loïc Benoit , Arnaud Steyaert , Virginie Montiel , Aude Vanbuggenhout , Lancelot Marique , 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}
Pub Date : 2025-02-18DOI: 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 , Hsao-Hsun Hsu , Hui-Ling Chen , Po-Huang Lee , 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}
Pub Date : 2025-02-18DOI: 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.
{"title":"Tacrolimus-induced psychosis in liver transplant recipients: A systematic review of all published cases","authors":"Pooja Belur , Komal Dani , 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}
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.
{"title":"Incidental hepatocellular carcinoma in explanted livers: Prevalence, prognosis and features","authors":"Emilie Kerstens , Samuele Iesari , Eliano Bonaccorsi , Laurent Coubeau , Géraldine Dahlqvist , Coralie Hamoir , Olga Ciccarelli , Bénédicte Delire","doi":"10.1016/j.liver.2025.100264","DOIUrl":"10.1016/j.liver.2025.100264","url":null,"abstract":"<div><h3>Background and aims</h3><div>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).</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 268 cirrhotic patients who underwent LT at our center between 2010 and 2020<em>.</em> 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.</div></div><div><h3>Results</h3><div>The prevalence of iHCC was 12 %. Alcohol-related liver disease was more frequent in iHCC LTRs than in the other groups (<em>p</em> = 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; <em>p</em> = 0.04). Five-year overall survival of iHCC LTRs was significantly reduced compared to the survival of Ci LTRs (44 % vs. 87 %, <em>p</em> = 0.028).</div></div><div><h3>Conclusions</h3><div>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.</div></div><div><h3>Summary</h3><div>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.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"18 ","pages":"Article 100264"},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386321","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}