Pub Date : 2025-02-01DOI: 10.1016/j.liver.2024.100257
Elizaveta Makarova , Xuanjia Fan , Iman Farooqi , Katrina Bakhl , Terrence E. Murphy , Elizabeth S. Stonesifer , Alison Faust
Trans arterial chemoembolization (TACE) is the most frequently utilized locoregional therapy for patients with hepatocellular carcinoma (HCC). The reported evidence has been mixed regarding outcomes in patients with decompensated cirrhosis who undergo TACE. The aim of our study was to evaluate the clinical outcomes of patients with cirrhosis and HCC that underwent TACE procedures while awaiting liver transplantation. This was a retrospective cohort study of patients listed for transplant between February 2018 and April 2022. We analyzed 74 patients that had a total of 171 TACE procedures, and defined outcomes within 90 days of TACE in four categorical levels as follows: clinical stability/improvement (1), worsening of liver functioning (2), hospitalization (3), and death or delisting (4). The primary statistical analysis was based on multinomial modeling of this categorical outcome. Patients with decompensated liver function at the time of TACE had odds of being hospitalized within 90 days of the TACE procedure that were 8 times higher than those with compensated liver function (p=0.007). Patients with albumin <3 g/dL or bilirubin >3mg/dL were more likely to experience poor outcomes within 90 days following TACE. There was no statistically significant difference in death and delisting after TACE between patients with compensated and decompensated liver function, though the sample size in this outcome was small.
{"title":"Worse clinical outcomes of TACE when liver function is decompensated in a cohort of patients with cirrhosis and HCC waiting for liver transplantation","authors":"Elizaveta Makarova , Xuanjia Fan , Iman Farooqi , Katrina Bakhl , Terrence E. Murphy , Elizabeth S. Stonesifer , Alison Faust","doi":"10.1016/j.liver.2024.100257","DOIUrl":"10.1016/j.liver.2024.100257","url":null,"abstract":"<div><div>Trans arterial chemoembolization (TACE) is the most frequently utilized locoregional therapy for patients with hepatocellular carcinoma (HCC). The reported evidence has been mixed regarding outcomes in patients with decompensated cirrhosis who undergo TACE. The aim of our study was to evaluate the clinical outcomes of patients with cirrhosis and HCC that underwent TACE procedures while awaiting liver transplantation. This was a retrospective cohort study of patients listed for transplant between February 2018 and April 2022. We analyzed 74 patients that had a total of 171 TACE procedures, and defined outcomes within 90 days of TACE in four categorical levels as follows: clinical stability/improvement (1), worsening of liver functioning (2), hospitalization (3), and death or delisting (4). The primary statistical analysis was based on multinomial modeling of this categorical outcome. Patients with decompensated liver function at the time of TACE had odds of being hospitalized within 90 days of the TACE procedure that were 8 times higher than those with compensated liver function (p=0.007). Patients with albumin <3 g/dL or bilirubin >3mg/dL were more likely to experience poor outcomes within 90 days following TACE. There was no statistically significant difference in death and delisting after TACE between patients with compensated and decompensated liver function, though the sample size in this outcome was small.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"17 ","pages":"Article 100257"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143177366","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 : 2025-02-01DOI: 10.1016/j.liver.2024.100255
Kymentie Ferdinande , Anne Hoorens , Christine Sempoux , Simon Meganck , Hasan Eker , Michael Saerens , Siebe Loontiens , Joni Van Der Meulen , Sarah Raevens , Xavier Verhelst , Anja Geerts , Helena Degroote , Hans Van Vlierberghe
A 32-year-old female patient presented with a liver mass of unknown origin. The alpha-fetoprotein was markedly elevated up to 142 300 µg/L. MRI of the liver documented a bulky lobulated lesion in the right liver lobe with diameters of 11.7 × 12 × 12.6 cm with multiple satellite lesions. Staging revealed no extrahepatic metastases. Histological examination was consistent with a hepatocellular carcinoma (HCC) with stem cell features, a rare but distinct subtype of HCC with gene expression pattern similar to fetal hepatoblasts. Because of overlapping features with hepatoblastoma she was treated according to the Pediatric Hepatic Malignancy International Therapeutic Trial protocol and received induction chemotherapy with cisplatin and doxorubicin. Due to persistent involvement of the portal vein, surgical R0 resection was impossible after 6 cycles of chemotherapy, despite radiological downstaging. After multidisciplinary consultation our patient underwent a liver transplantation. Nine months after liver transplantation, a solitary pulmonary metastasis was observed necessitating wedge resection. However, >2 years after liver transplantation, the patient remains recurrence-free according to the latest available data.
This is the first report of an adult patient treated for HCC with stem cell features with a liver transplant beyond the Milan criteria. This case demonstrates that early liver transplantation should be considered in adult patients with highly aggressive subtypes of HCC.
{"title":"Liver transplantation for hepatocellular carcinoma with stem cell features in an adult patient","authors":"Kymentie Ferdinande , Anne Hoorens , Christine Sempoux , Simon Meganck , Hasan Eker , Michael Saerens , Siebe Loontiens , Joni Van Der Meulen , Sarah Raevens , Xavier Verhelst , Anja Geerts , Helena Degroote , Hans Van Vlierberghe","doi":"10.1016/j.liver.2024.100255","DOIUrl":"10.1016/j.liver.2024.100255","url":null,"abstract":"<div><div>A 32-year-old female patient presented with a liver mass of unknown origin. The alpha-fetoprotein was markedly elevated up to 142 300 µg/L. MRI of the liver documented a bulky lobulated lesion in the right liver lobe with diameters of 11.7 × 12 × 12.6 cm with multiple satellite lesions. Staging revealed no extrahepatic metastases. Histological examination was consistent with a hepatocellular carcinoma (HCC) with stem cell features, a rare but distinct subtype of HCC with gene expression pattern similar to fetal hepatoblasts. Because of overlapping features with hepatoblastoma she was treated according to the Pediatric Hepatic Malignancy International Therapeutic Trial protocol and received induction chemotherapy with cisplatin and doxorubicin. Due to persistent involvement of the portal vein, surgical R0 resection was impossible after 6 cycles of chemotherapy, despite radiological downstaging. After multidisciplinary consultation our patient underwent a liver transplantation. Nine months after liver transplantation, a solitary pulmonary metastasis was observed necessitating wedge resection. However, >2 years after liver transplantation, the patient remains recurrence-free according to the latest available data.</div><div>This is the first report of an adult patient treated for HCC with stem cell features with a liver transplant beyond the Milan criteria. This case demonstrates that early liver transplantation should be considered in adult patients with highly aggressive subtypes of HCC.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"17 ","pages":"Article 100255"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143177332","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}
In current guidelines, liver transplantation (LT) should be considered in patients with early-stage hepatocellular carcinoma (HCC) because of their lower risk of recurrence and excellent long-term overall survival (OS). To broaden curative opportunities in intermediate and advanced HCC, downstaging strategies are emerging and associated with similar OS compared to patients initially meeting LT criteria. These strategies may however expose these patients to higher HCC recurrence risk. HCC recurrence post LT is essentially metastatic and extrahepatic, and these patients’ prognosis is very poor. The treatments used in this case are tyrosine kinase inhibitors (TKIs) with a low response rate and bad tolerance. If immunotherapy is the new standard of care for advanced and metastatic HCC, scarce data about their administration in liver transplanted recipients in case of HCC recurrence are available. As immunosuppressive (IS) treatment and immunotherapy agents share common targets, utilization of immunotherapy in liver recipients remains complex and exposes patients to acute cellular rejection (ACR). We would like to share in this letter our center experience with eight patients that received immunotherapy post LT as long as a standardized specific IS regimen that aims to lower ACR risk and allow immunotherapy to be effective.
{"title":"Standardized immunosuppressive protocol to prevent rejection under immunotherapy for post liver transplantation HCC recurrence: A French center's experience","authors":"Héloïse Giudicelli , Filomena Conti , Olivier Scatton , Dominique Thabut , Manon Allaire","doi":"10.1016/j.liver.2024.100252","DOIUrl":"10.1016/j.liver.2024.100252","url":null,"abstract":"<div><div>In current guidelines, liver transplantation (LT) should be considered in patients with early-stage hepatocellular carcinoma (HCC) because of their lower risk of recurrence and excellent long-term overall survival (OS). To broaden curative opportunities in intermediate and advanced HCC, downstaging strategies are emerging and associated with similar OS compared to patients initially meeting LT criteria. These strategies may however expose these patients to higher HCC recurrence risk. HCC recurrence post LT is essentially metastatic and extrahepatic, and these patients’ prognosis is very poor. The treatments used in this case are tyrosine kinase inhibitors (TKIs) with a low response rate and bad tolerance. If immunotherapy is the new standard of care for advanced and metastatic HCC, scarce data about their administration in liver transplanted recipients in case of HCC recurrence are available. As immunosuppressive (IS) treatment and immunotherapy agents share common targets, utilization of immunotherapy in liver recipients remains complex and exposes patients to acute cellular rejection (ACR). We would like to share in this letter our center experience with eight patients that received immunotherapy post LT as long as a standardized specific IS regimen that aims to lower ACR risk and allow immunotherapy to be effective.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"17 ","pages":"Article 100252"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143177363","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}
Liver transplantation is critical for end-stage liver disease, but limited donor availability necessitates prioritizing patients on waiting lists. Predictive models like the Model for End-stage Liver Disease (MELD) are used for organ allocation and survival probabilities, but MELD's effectiveness is debated. This study aimed to develop machine learning models to predict postoperative survival at 1-month, 3-month, and 1-year intervals using preoperative data.
Methods
The dataset, after excluding missing or invalid data, comprised 454 patients with 52 features each. Leave-One-Out cross-validation was used to address data imbalance. K-Nearest Neighbor imputation handled missing values, ensuring robustness. Feature selection was performed using Decision Trees (DT) and Random Forests (RF), incorporating both clinically used and new features.
Various algorithms were evaluated, including DT, RF, Logistic Regression, Gaussian Naive Bayes (GuassianNB), and Linear Discriminant (LD) Analysis, to predict survival outcomes.
Results
indicated that DT outperformed other feature selection methods, while GuassianNB excelled in predicting 1-year survival with an area under the curve of 0.61, a sensitivity of 0.98, and an F1-score of 0.89, demonstrating superior discrimination power. The LD model combined with RF feature selection was superior for 1-month and 3-month predictions. Additionally, a performance comparison of models for 1-year survival using MELD features and various selection methods was analyzed.
Conclusion
The study demonstrates that advanced machine learning models, particularly GuassianNB and LD Analysis with robust feature selection methods, can improve the prediction of postoperative survival in liver transplant patients. These findings could lead to better patient prioritization and outcomes in liver transplantation.
{"title":"Predictive models for post-liver transplant survival using machine learning techniques in three critical time intervals","authors":"Aref Abdollahzade , Hoda Rahimi , Amir Mahmoud Ahmadzade , Farnaz Khoshrounejad , Atefeh Rahimi , Hossein Jamalirad , Saeid Eslami , Mohsen Aliakbarian , Rozita Khodashahi","doi":"10.1016/j.liver.2024.100253","DOIUrl":"10.1016/j.liver.2024.100253","url":null,"abstract":"<div><h3>Background</h3><div>Liver transplantation is critical for end-stage liver disease, but limited donor availability necessitates prioritizing patients on waiting lists. Predictive models like the Model for End-stage Liver Disease (MELD) are used for organ allocation and survival probabilities, but MELD's effectiveness is debated. This study aimed to develop machine learning models to predict postoperative survival at 1-month, 3-month, and 1-year intervals using preoperative data.</div></div><div><h3>Methods</h3><div>The dataset, after excluding missing or invalid data, comprised 454 patients with 52 features each. Leave-One-Out cross-validation was used to address data imbalance. K-Nearest Neighbor imputation handled missing values, ensuring robustness. Feature selection was performed using Decision Trees (DT) and Random Forests (RF), incorporating both clinically used and new features.</div><div>Various algorithms were evaluated, including DT, RF, Logistic Regression, Gaussian Naive Bayes (GuassianNB), and Linear Discriminant (LD) Analysis, to predict survival outcomes.</div></div><div><h3>Results</h3><div>indicated that DT outperformed other feature selection methods, while GuassianNB excelled in predicting 1-year survival with an area under the curve of 0.61, a sensitivity of 0.98, and an F1-score of 0.89, demonstrating superior discrimination power. The LD model combined with RF feature selection was superior for 1-month and 3-month predictions. Additionally, a performance comparison of models for 1-year survival using MELD features and various selection methods was analyzed.</div></div><div><h3>Conclusion</h3><div>The study demonstrates that advanced machine learning models, particularly GuassianNB and LD Analysis with robust feature selection methods, can improve the prediction of postoperative survival in liver transplant patients. These findings could lead to better patient prioritization and outcomes in liver transplantation.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"17 ","pages":"Article 100253"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143177364","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 : 2025-02-01DOI: 10.1016/j.liver.2024.100254
Julie Giannini , Stephanie Hamel , Jenna Lawson , Kimberly Bone , Jinyuan Liu , Manhal Izzy , Seth Karp , Martin Montenovo , Alexandra Shingina
Our objective was to examine the outcomes of transplanting Hepatitis B Virus nucleic acid test positive organs (HBV NAT+) and HBcAb+ NAT negative (HBV NAT-) organs into HBV seronegative(HBV-) recipients. We chose to evaluate NAT+ organs since NAT is highly sensitive and specific for viral nucleic acid, amplifying a targeted region of viral ribonucleic acid (RNA) or deoxyribonucleic acid (DNA) and detecting HBV earlier than other screening methods. This study is a retrospective review of patients who were HBV- recipients of HBV NAT+ or HBcAb+ NAT- organs. Primary outcomes include patient and graft survival. Secondary outcomes were manifestations of HBV, including HBV viremia and viral clearance. There were 15 HBV NAT+ recipients and 68 HBcAb+ NAT- recipients who were evaluated for a mean period of 2.6 years and 4.2 years, respectively. Patient survival rates of the HBV NAT+ and HBcAb+ NAT- groups were 92.9 %/92.6 % at 6 months and 1 year (p = 0.97) and 85.7 %/90.7 % at 3 years (p = 0.64). Graft survival rates were 85.7 %/92.6 % at 6 months and 1 year (p = 0.52), and 78.6 %/90.7 % at 3 years (p = 0.33). None of the patient deaths or graft failures were related to HBV. HBV viremia developed in 43 %/19 % recipients (p = 0.12) but viral clearance was observed in 67 %/60 % patients (p = 0.81). There was no statistically significant difference in patient and graft survival when comparing outcomes of HBV NAT+ and HBcAb+ NAT- LT. It may be safe to use these grafts for transplantation into HBV- recipients.
{"title":"The use of Hepatitis B Core Antibody and nucleic acid testing positive organs in safe and effective in Hepatitis B naïve liver transplant recipients","authors":"Julie Giannini , Stephanie Hamel , Jenna Lawson , Kimberly Bone , Jinyuan Liu , Manhal Izzy , Seth Karp , Martin Montenovo , Alexandra Shingina","doi":"10.1016/j.liver.2024.100254","DOIUrl":"10.1016/j.liver.2024.100254","url":null,"abstract":"<div><div>Our objective was to examine the outcomes of transplanting Hepatitis B Virus nucleic acid test positive organs (HBV NAT+) and HBcAb+ NAT negative (HBV NAT-) organs into HBV seronegative(HBV-) recipients. We chose to evaluate NAT+ organs since NAT is highly sensitive and specific for viral nucleic acid, amplifying a targeted region of viral ribonucleic acid (RNA) or deoxyribonucleic acid (DNA) and detecting HBV earlier than other screening methods. This study is a retrospective review of patients who were HBV- recipients of HBV NAT+ or HBcAb+ NAT- organs. Primary outcomes include patient and graft survival. Secondary outcomes were manifestations of HBV, including HBV viremia and viral clearance. There were 15 HBV NAT+ recipients and 68 HBcAb+ NAT- recipients who were evaluated for a mean period of 2.6 years and 4.2 years, respectively. Patient survival rates of the HBV NAT+ and HBcAb+ NAT- groups were 92.9 %/92.6 % at 6 months and 1 year (<em>p</em> = 0.97) and 85.7 %/90.7 % at 3 years (<em>p</em> = 0.64). Graft survival rates were 85.7 %/92.6 % at 6 months and 1 year (<em>p</em> = 0.52), and 78.6 %/90.7 % at 3 years (<em>p</em> = 0.33). None of the patient deaths or graft failures were related to HBV. HBV viremia developed in 43 %/19 % recipients (<em>p</em> = 0.12) but viral clearance was observed in 67 %/60 % patients (<em>p</em> = 0.81). There was no statistically significant difference in patient and graft survival when comparing outcomes of HBV NAT+ and HBcAb+ NAT- LT. It may be safe to use these grafts for transplantation into HBV- recipients.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"17 ","pages":"Article 100254"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143177365","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 : 2025-02-01DOI: 10.1016/j.liver.2024.100249
Patrick B. McGeoghegan , John J. Miggins , Megan Crawford , Evert Sugarbaker , Abbas Rana
<div><h3>Background</h3><div>It has been shown that recipients receiving grafts from both undersized and oversized donors have worse clinical outcomes. However, donor-recipient size (DR) mismatch is an understudied metric in pediatric whole-liver deceased donor liver transplantation (DDLT). Here, we analyzed the utility of both DR weight ratio (WR) and body surface area ratio (BSAR) in predicting outcomes among all pediatric whole-liver DDLT recipients. We also performed subgroup analyses for patients with biliary atresia (BA) as well as for other diagnoses with ascites to evaluate these ratios’ utility among patients with increased abdominal domain.</div></div><div><h3>Methods</h3><div>We evaluated all pediatric patients undergoing primary whole-liver DDLT within the UNOS database from 3/1/2002–1/23/2023. We identified 5286 patients <18 years old and divided them into five groups based on increasing DR weight ratios (WRs) and body surface area ratios (BSARs) (<10th percentile, 10th–20th percentile, 20th–80th percentile [reference], 80th–90th percentile, and >90th percentile). Subgroup analyses were performed for patients with BA and other diagnoses with ascites. Chi-square tests were also used to compare patients with and without BA. A Cox proportional hazards model adjusted for both donor and recipient factors was used to identify associations between WR and BSAR percentiles and graft survival, patient survival, and length of stay (LOS). Kaplan–Meier curves and log-rank test were used to compare each of the time-to-event outcomes among the percentiles.</div></div><div><h3>Results</h3><div>In multivariable analysis, both WR and BSAR impacted clinical outcomes. However, WR remains to be explored in pediatric transplant and is easier to calculate. We therefore focused our analysis on WR.</div><div>The <10th WR percentile (WR ≤ 0.70) and >90th WR percentile (WR > 2.0) were associated with increased hazard of graft failure and death. The <10th percentile WR hazard ratio (HR) for graft survival was 1.45 (95 % confidence interval [CI] 1.12, 1.87, <em>p =</em> 0.004). The >90th percentile WR for graft survival was 1.61 (95 % CI 1.22, 2.13, <em>p =</em> 0.001). Bottom 10th WR percentile for patient survival was 1.46 (95 % CI 1.14, 1.88, <em>p =</em> 0.01), while the >90th WR for patient survival was 1.54 (95 % CI 1.28, 2.23, <em>p</em> < 0.001). Only the >90th percentile WR (HR 0.86, 95 % CI 0.77, 0.96, <em>p =</em> 0.007) was associated with increased LOS.</div><div>The relationship between WR and outcomes did not hold in patients with BA or in other diagnoses with ascites (<em>p</em> > 0.05).</div></div><div><h3>Conclusions</h3><div>DR WR is a significant predictor of adverse outcomes in pediatric whole-liver DDLT recipients, and WR is a superior metric to BSAR. The utility of size-matching metrics is decreased in patients with BA or significant ascites. Transplant surgeons should exercise caution if they encounter
研究表明，接受过小量和过大量供体移植的受者临床结果更差。然而，在儿童全肝死亡供肝移植（DDLT）中，供体-受体大小（DR）不匹配是一个尚未得到充分研究的指标。在这里，我们分析了DR体重比（WR）和体表面积比（BSAR）在预测所有儿童全肝DDLT接受者预后中的效用。我们还对胆道闭锁（BA）患者以及其他腹水诊断患者进行了亚组分析，以评估这些比率在腹部面积增加患者中的效用。方法：我们评估了2002年3月1日至2023年1月23日在UNOS数据库中接受原发性全肝DDLT的所有儿童患者。我们选取了5286例18岁的患者，并根据DR体重比（WRs）和体表面积比（bsar）的增加情况（第10百分位、第10 - 20百分位、第20 - 80百分位[文献]、第80 - 90百分位和第90百分位）将其分为5组。对BA和其他诊断为腹水的患者进行亚组分析。卡方检验也用于比较有和没有BA的患者。采用校正供体和受体因素的Cox比例风险模型来确定WR和BSAR百分位数与移植物存活、患者存活和住院时间（LOS）之间的关系。采用Kaplan-Meier曲线和log-rank检验比较各百分位数间的时间到事件结果。结果在多变量分析中，WR和BSAR对临床结果均有影响。然而，在儿科移植中，WR仍有待探索，并且更容易计算。因此，我们将分析重点放在WR上。第10个WR百分位数（WR≤0.70）和第90个WR百分位数(WR >；2.0)与移植物衰竭和死亡风险增加相关。第10百分位WR风险比（HR）为1.45（95%可信区间[CI] 1.12, 1.87, p = 0.004）。移植瘤存活的第90百分位WR为1.61 （95% CI 1.22, 2.13, p = 0.001）。患者生存的第10个WR百分位数为1.46 (95% CI 1.14, 1.88, p = 0.01)，而患者生存的第90个WR百分位数为1.54 (95% CI 1.28, 2.23, p <；0.001)。只有第90百分位WR （HR 0.86, 95% CI 0.77, 0.96, p = 0.007）与LOS增加相关。在BA患者或其他诊断为腹水的患者中，WR与预后之间的关系不成立(p >；0.05)。结论WR是儿童全肝DDLT受者不良结局的重要预测指标，WR优于BSAR。在BA或严重腹水患者中，尺寸匹配指标的效用降低。如果移植外科医生在儿童全肝DDLT中遇到WR≤0.70或>；2.0，则应谨慎行事。
{"title":"The impact of donor-recipient weight ratios on outcomes after pediatric deceased donor whole-liver transplantation","authors":"Patrick B. McGeoghegan , John J. Miggins , Megan Crawford , Evert Sugarbaker , Abbas Rana","doi":"10.1016/j.liver.2024.100249","DOIUrl":"10.1016/j.liver.2024.100249","url":null,"abstract":"<div><h3>Background</h3><div>It has been shown that recipients receiving grafts from both undersized and oversized donors have worse clinical outcomes. However, donor-recipient size (DR) mismatch is an understudied metric in pediatric whole-liver deceased donor liver transplantation (DDLT). Here, we analyzed the utility of both DR weight ratio (WR) and body surface area ratio (BSAR) in predicting outcomes among all pediatric whole-liver DDLT recipients. We also performed subgroup analyses for patients with biliary atresia (BA) as well as for other diagnoses with ascites to evaluate these ratios’ utility among patients with increased abdominal domain.</div></div><div><h3>Methods</h3><div>We evaluated all pediatric patients undergoing primary whole-liver DDLT within the UNOS database from 3/1/2002–1/23/2023. We identified 5286 patients <18 years old and divided them into five groups based on increasing DR weight ratios (WRs) and body surface area ratios (BSARs) (<10th percentile, 10th–20th percentile, 20th–80th percentile [reference], 80th–90th percentile, and >90th percentile). Subgroup analyses were performed for patients with BA and other diagnoses with ascites. Chi-square tests were also used to compare patients with and without BA. A Cox proportional hazards model adjusted for both donor and recipient factors was used to identify associations between WR and BSAR percentiles and graft survival, patient survival, and length of stay (LOS). Kaplan–Meier curves and log-rank test were used to compare each of the time-to-event outcomes among the percentiles.</div></div><div><h3>Results</h3><div>In multivariable analysis, both WR and BSAR impacted clinical outcomes. However, WR remains to be explored in pediatric transplant and is easier to calculate. We therefore focused our analysis on WR.</div><div>The <10th WR percentile (WR ≤ 0.70) and >90th WR percentile (WR > 2.0) were associated with increased hazard of graft failure and death. The <10th percentile WR hazard ratio (HR) for graft survival was 1.45 (95 % confidence interval [CI] 1.12, 1.87, <em>p =</em> 0.004). The >90th percentile WR for graft survival was 1.61 (95 % CI 1.22, 2.13, <em>p =</em> 0.001). Bottom 10th WR percentile for patient survival was 1.46 (95 % CI 1.14, 1.88, <em>p =</em> 0.01), while the >90th WR for patient survival was 1.54 (95 % CI 1.28, 2.23, <em>p</em> < 0.001). Only the >90th percentile WR (HR 0.86, 95 % CI 0.77, 0.96, <em>p =</em> 0.007) was associated with increased LOS.</div><div>The relationship between WR and outcomes did not hold in patients with BA or in other diagnoses with ascites (<em>p</em> > 0.05).</div></div><div><h3>Conclusions</h3><div>DR WR is a significant predictor of adverse outcomes in pediatric whole-liver DDLT recipients, and WR is a superior metric to BSAR. The utility of size-matching metrics is decreased in patients with BA or significant ascites. Transplant surgeons should exercise caution if they encounter ","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"17 ","pages":"Article 100249"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143177361","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 : 2025-02-01DOI: 10.1016/j.liver.2024.100251
Gowda N Yashaswini , R.V. Manjunath , B Shubha , Punya Prabha , N Aishwarya , H M Manu
Segmenting the liver and tumors from computed tomography (CT) scans is crucial for medical studies utilizing machine and deep learning techniques. Semantic segmentation, a critical step in this process, is accomplished effectively using fully convolutional neural networks (CNNs). Most Popular networks like UNet and ResUNet leverage diverse resolution features through meticulous planning of convolutional layers and skip connections. This study introduces an automated system employing different convolutional layers that automatically extract features and preserve the spatial information of each feature. In this study, we employed both UNet and a modified Residual UNet on the 3Dircadb (3D Image Reconstruction for computer Assisted Diagnosis database) dataset to segment the liver and tumor. The ResUNet model achieved remarkable results with a Dice Similarity Coefficient of 91.44% for liver segmentation and 75.84% for tumor segmentation on 128 × 128 pixel images. These findings validate the effectiveness of the developed models. Notably both models exhibited excellent performance in tumor segmentation. The primary goal of this paper is to utilize deep learning algorithms for liver and tumor segmentation, assessing the model using metrics such as the Dice Similarity Coefficient, accuracy, and precision.
{"title":"Deep learning technique for automatic liver and liver tumor segmentation in CT images","authors":"Gowda N Yashaswini , R.V. Manjunath , B Shubha , Punya Prabha , N Aishwarya , H M Manu","doi":"10.1016/j.liver.2024.100251","DOIUrl":"10.1016/j.liver.2024.100251","url":null,"abstract":"<div><div>Segmenting the liver and tumors from computed tomography (CT) scans is crucial for medical studies utilizing machine and deep learning techniques. Semantic segmentation, a critical step in this process, is accomplished effectively using fully convolutional neural networks (CNNs). Most Popular networks like UNet and ResUNet leverage diverse resolution features through meticulous planning of convolutional layers and skip connections. This study introduces an automated system employing different convolutional layers that automatically extract features and preserve the spatial information of each feature. In this study, we employed both UNet and a modified Residual UNet on the 3Dircadb (3D Image Reconstruction for computer Assisted Diagnosis database) dataset to segment the liver and tumor. The ResUNet model achieved remarkable results with a Dice Similarity Coefficient of <strong>91.44%</strong> for liver segmentation and <strong>75.84%</strong> for tumor segmentation on 128 × 128 pixel images. These findings validate the effectiveness of the developed models. Notably both models exhibited excellent performance in tumor segmentation. The primary goal of this paper is to utilize deep learning algorithms for liver and tumor segmentation, assessing the model using metrics such as the Dice Similarity Coefficient, accuracy, and precision.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"17 ","pages":"Article 100251"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143177362","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 : 2025-02-01DOI: 10.1016/j.liver.2025.100259
Tomazo Franzini , Eduardo G.H. De Moura , Andres Cardenas , Adam Slivka , Jan-Werner Poley , Georgios I. Papachristou , Mordechai Rabinovitz , Marco Bruno , Joyce A. Peetermans , Matthew J. Rousseau , Wellington Andraus , Jean C. Emond , Amrita Sethi
Background
Biliary strictures are a common complication of living and deceased donor liver transplantation. Peroral cholangioscopy (POCS) with POCS-guided biliary tract biopsies may improve diagnostic accuracy compared to endoscopic retrograde cholangiopancreatography (ERCP) with biopsy, but the role and clinical impact of adding POCS to ERCP in management of post-liver-transplantation biliary adverse events remains unknown.
Methods
In a multicenter prospective study, patients ≥1 month post-liver transplantation with abnormal imaging and/or liver tests, without prior treatment of a biliary stricture, and referred for ERCP evaluation of a suspected biliary stricture underwent POCS immediately following the initial diagnostic portion of the ERCP. Outcomes were POCS visual impression of the stricture, impact on patient management and diagnosis, and related serious adverse events (SAEs).
Results
Forty-one patients (88 % cadaveric donors, mean 28 ± 44 months since liver transplantation) underwent POCS (mean POCS procedure time 25.7 ± 19.5 min). Stricture was confirmed by POCS in 38 patients (93 %) treated with balloon dilation (2), biliary stent(s) (7) or both (28), or with percutaneous drainage (1). Three patients without POCS-confirmed stricture had an angulated duct (2) or a cast (1). POCS influenced patient management in 26 (63 %), and diagnosis in 19 patients (46 %). POCS-guided selective guidewire placement was achieved in 12 cases (29 %) that failed during ERCP. No POCS-related SAEs were reported.
Conclusions
When added to standard-of-care ERCP, POCS showed diagnostic value and helped change patient management in over 60 % of patients, with no POCS-related adverse events. The greatest impact was in visual enhancement and facilitating guidewire access to the donor ducts.
{"title":"The role of peroral cholangioscopy in liver transplant recipients: A prospective, international series","authors":"Tomazo Franzini , Eduardo G.H. De Moura , Andres Cardenas , Adam Slivka , Jan-Werner Poley , Georgios I. Papachristou , Mordechai Rabinovitz , Marco Bruno , Joyce A. Peetermans , Matthew J. Rousseau , Wellington Andraus , Jean C. Emond , Amrita Sethi","doi":"10.1016/j.liver.2025.100259","DOIUrl":"10.1016/j.liver.2025.100259","url":null,"abstract":"<div><h3>Background</h3><div>Biliary strictures are a common complication of living and deceased donor liver transplantation. Peroral cholangioscopy (POCS) with POCS-guided biliary tract biopsies may improve diagnostic accuracy compared to endoscopic retrograde cholangiopancreatography (ERCP) with biopsy, but the role and clinical impact of adding POCS to ERCP in management of post-liver-transplantation biliary adverse events remains unknown.</div></div><div><h3>Methods</h3><div>In a multicenter prospective study, patients ≥1 month post-liver transplantation with abnormal imaging and/or liver tests, without prior treatment of a biliary stricture, and referred for ERCP evaluation of a suspected biliary stricture underwent POCS immediately following the initial diagnostic portion of the ERCP. Outcomes were POCS visual impression of the stricture, impact on patient management and diagnosis, and related serious adverse events (SAEs).</div></div><div><h3>Results</h3><div>Forty-one patients (88 % cadaveric donors, mean 28 ± 44 months since liver transplantation) underwent POCS (mean POCS procedure time 25.7 ± 19.5 min). Stricture was confirmed by POCS in 38 patients (93 %) treated with balloon dilation (2), biliary stent(s) (7) or both (28), or with percutaneous drainage (1). Three patients without POCS-confirmed stricture had an angulated duct (2) or a cast (1). POCS influenced patient management in 26 (63 %), and diagnosis in 19 patients (46 %). POCS-guided selective guidewire placement was achieved in 12 cases (29 %) that failed during ERCP. No POCS-related SAEs were reported.</div></div><div><h3>Conclusions</h3><div>When added to standard-of-care ERCP, POCS showed diagnostic value and helped change patient management in over 60 % of patients, with no POCS-related adverse events. The greatest impact was in visual enhancement and facilitating guidewire access to the donor ducts.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"17 ","pages":"Article 100259"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143177331","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 : 2025-02-01DOI: 10.1016/j.liver.2024.100256
Miho Akabane , Yuki Imaoka , Jun Kawashima , Austin Schenk , Timothy M. Pawlik
Immunotherapy has emerged as an important approach in the treatment of hepatocellular carcinoma (HCC), particularly through the use of immune checkpoint inhibitors (ICIs) targeting the PD-1/PD-L1 and CTLA-4 pathways. While this therapy offers new hope for patients, it presents unique challenges when integrated with liver transplantation (LT), the definitive treatment for early-stage HCC. Despite LT's curative potential, post-transplant tumor recurrence remains a concern, partly due to the immunosuppressive regimens necessary to prevent graft rejection, which can impair immune surveillance and increase the risk of HCC recurrence and de novo malignancies. Incorporating immunotherapy offers a strategy to enhance antitumor immunity but raises concerns about triggering graft rejection due to immune activation. Nevertheless, the use of ICIs as neoadjuvant therapy before LT has demonstrated promise in downstaging tumors and reducing waitlist dropout rates; however, careful patient selection, optimal timing between ICI administration and LT, and tailored immunosuppressive management are crucial to mitigate the risk of acute graft rejection. In the post-LT setting, ICIs have been examined for treating recurrent HCC, with some data demonstrating promising antitumor responses. Nonetheless, the risk of severe rejection unresponsive to standard immunosuppressive therapies necessitates cautious application and close monitoring. Furthermore, emerging immuno-cell therapies, such as natural killer (NK) cell-based treatments, offer robust antitumor activity with potentially fewer adverse effects compared with T-cell-based therapies. These innovative approaches are under investigation for their ability to enhance immune surveillance and reduce HCC recurrence post-LT. Integrating immunotherapy into the management of HCC among LT recipients holds promise but requires a delicate balance between maximizing antitumor efficacy and minimizing the risk of graft rejection. Future research should focus on establishing standardized protocols for the safe incorporation of immunotherapy in LT patients, optimizing immunosuppressive regimens, and further exploring the potential of immuno-cell therapies to improve long-term outcomes for HCC patients undergoing LT.
{"title":"Immunotherapy in liver transplantation for hepatocellular carcinoma: A comprehensive review","authors":"Miho Akabane , Yuki Imaoka , Jun Kawashima , Austin Schenk , Timothy M. Pawlik","doi":"10.1016/j.liver.2024.100256","DOIUrl":"10.1016/j.liver.2024.100256","url":null,"abstract":"<div><div>Immunotherapy has emerged as an important approach in the treatment of hepatocellular carcinoma (HCC), particularly through the use of immune checkpoint inhibitors (ICIs) targeting the PD-1/PD-L1 and CTLA-4 pathways. While this therapy offers new hope for patients, it presents unique challenges when integrated with liver transplantation (LT), the definitive treatment for early-stage HCC. Despite LT's curative potential, post-transplant tumor recurrence remains a concern, partly due to the immunosuppressive regimens necessary to prevent graft rejection, which can impair immune surveillance and increase the risk of HCC recurrence and de novo malignancies. Incorporating immunotherapy offers a strategy to enhance antitumor immunity but raises concerns about triggering graft rejection due to immune activation. Nevertheless, the use of ICIs as neoadjuvant therapy before LT has demonstrated promise in downstaging tumors and reducing waitlist dropout rates; however, careful patient selection, optimal timing between ICI administration and LT, and tailored immunosuppressive management are crucial to mitigate the risk of acute graft rejection. In the post-LT setting, ICIs have been examined for treating recurrent HCC, with some data demonstrating promising antitumor responses. Nonetheless, the risk of severe rejection unresponsive to standard immunosuppressive therapies necessitates cautious application and close monitoring. Furthermore, emerging immuno-cell therapies, such as natural killer (NK) cell-based treatments, offer robust antitumor activity with potentially fewer adverse effects compared with T-cell-based therapies. These innovative approaches are under investigation for their ability to enhance immune surveillance and reduce HCC recurrence post-LT. Integrating immunotherapy into the management of HCC among LT recipients holds promise but requires a delicate balance between maximizing antitumor efficacy and minimizing the risk of graft rejection. Future research should focus on establishing standardized protocols for the safe incorporation of immunotherapy in LT patients, optimizing immunosuppressive regimens, and further exploring the potential of immuno-cell therapies to improve long-term outcomes for HCC patients undergoing LT.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"17 ","pages":"Article 100256"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143176433","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}
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