Liver Transplantation最新文献

Donor hepatectomy time exceeding 60 minutes is associated with poor liver transplant outcomes. A nationwide audit in 2018 showed that this critical time limit was frequently exceeded in Dutch procurement teams, particularly by those teams that were not affiliated with a liver transplant center. To reduce donor hepatectomy times, a nationwide intervention program was conducted, focusing on creating awareness and passing knowledge, mandatory training, and the introduction of simultaneous procurement of the lungs and liver in all procedures. In this retrospective study, we describe the effects of this intervention program on donor hepatectomy time in the Netherlands. A total of 1788 liver procurements performed between January 2013 and December 2022 were analyzed, divided into 873 before and 915 procedures after the intervention. Donor hepatectomy time decreased significantly from 55 [41-70] to 35 [28-43] minutes ( p <0.001), with virtually no difference between all procurement teams. After the introduction of simultaneous procurement, the difference in donor hepatectomy time between liver-only and liver-lung disappeared (34 [28-42] vs. 35 [29-43] minutes, p =0.73). Importantly, the decrease in hepatectomy time did not result in an increase in severe surgical injury leading to graft loss ( p =0.11). In conclusion, a significant and relevant reduction in hepatectomy time was achieved with this intervention program. We advocate a similar procurement intervention plan in any organ donation program, independent of their context.

In the last few decades, collaboration between international pediatric oncology groups has resulted in significant improvement in survival after liver transplantation (LT) for pediatric liver tumors, and LT has become the accepted standard of care for unresectable pediatric liver tumors-either living donor liver transplantation or deceased donor liver transplantation. Hepatoblastoma and HCC are the common pediatric liver malignancies treated by LT, and LT is now the accepted treatment modality for unresectable nonmetastatic cases. The long-term survival rate is more than 80% in hepatoblastoma transplants. Furthermore, with the advent of living donor liver transplantation, the waitlist mortality, availability of a better graft quality with shorter ischemic times, and performance of LT with the appropriate timing between chemotherapy have all improved. Up to 80% of pediatric HCCs are unresectable, and studies have shown that LT for pediatric HCC has better outcomes than liver resection. Furthermore, LT has also shown better results than liver resection for cases of HCC not meeting Milan criteria. Given the rarity of pediatric liver malignancies and challenges in optimal management, a multidisciplinary treatment approach, research models building on what is already known, and consideration of newer treatment modalities are required for further improving the treatment of pediatric liver malignancies.

Pediatric liver retransplantation (rLT) has historically shown poorer outcomes compared to primary liver transplantation (pLT). Comprehensive studies assessing outcomes for pediatric candidates for rLT under the modern allocation policy are lacking. Organ Procurement and Transplantation Network data from January 1, 2010, to December 31, 2022, were obtained; exclusion criteria included candidates ≥18 years of age and those listed or transplanted for multiple organs. A total of 7645 children met the inclusion criteria, including 7162 candidates for pLT and 483 candidates for rLT. The candidates for rLT, despite a shorter median waitlist time to transplant (6.5 vs. 54 d for pLT), had significantly higher waitlist dropout rates and worse posttransplant outcomes. Vascular complications were the most common reason for primary graft failure. The small size of the recipient was a significant risk factor. Among those retransplanted, the timing of relisting was significantly associated with outcomes, with those relisted within 30 days from the pLT demonstrating considerably worse outcomes. Our findings emphasize the importance of a center's surgical expertise in performing transplants on small recipients to minimize postoperative complications leading to primary graft failure. Once relisted, the timing of suitable organ availability was vital. The opportunity for technical variant grafts is crucial to capture every potential transplant opportunity that could ultimately decide between life and death.

Basic and translational research (B&TR) in liver transplantation (LT) underwent considerable changes and shifts over the past decade. To capture the current landscape and future potential of B&TR in LT, we conducted an online survey within the International Liver Transplantation Society (ILTS) community. The survey aimed to collect comprehensive data on the respondents' characteristics, qualifications, experiences, and research activities, providing the present state and future directions of B&TR in LT. Between October 2023 and January 2024, an online survey consisting of 35 key items was distributed to the ILTS community through newsletters and social media channels. Data were analyzed using a combination of quantitative and qualitative methods. The survey gathered 153 valid responses, with 79% of respondents possessing relevant experience in B&TR and 76% reporting concurrent clinical duties. Some 62% hold faculty positions, with 34% identifying as MDs and 44% holding combined MD/PhD degrees. About 71% of scientists with clinical duties reported challenges in conducting B&TR, with 57% citing a lack of time and 41% pointing to insufficient funding. Nevertheless, 69% of respondents currently receive research funding, with 58% supported by government or public sources. Among early career researchers, 57% reported receiving average or poor mentoring, and 30% indicated insufficient protected time for research. Looking ahead, advancing technologies, machine learning/artificial intelligence, multi-omics, xenotransplantation, and machine perfusion were highlighted as areas with the potential to significantly shift the paradigm in the near future. Our survey captured insights from B&TR scientists within the ILTS, identifying both challenges and opportunities for future developments and aiding in the strategic direction of the society's initiatives.

Recipient and donor risk factors impacting adult liver retransplantation remain inadequately described in the modern era of liver transplantation. Our study aimed to develop a risk model for 3-month recipient survival following liver retransplantation using data from the Organ Procurement and Transplantation Network's (OPTN) liver transplantation database. We conducted univariate and multivariable analyses on 6660 adult patients who underwent liver retransplantation between 2002 and 2023. Multiple imputation was also conducted to account for missing variables. From our analysis, we identified 14 recipient factors, 1 donor factor (age), and 1 operative factor (cold ischemia time) that significantly impacted 3-month patient survival. Among the most significant risk factors were a functional status, measured by the Karnofsky Score, of 10% at retransplantation (OR: 1.80, 95% CI: 1.44-2.24) and recipient albumin of <1.5 (OR: 1.76, CI: 1.12-2.77). The most significant protective factors included a functional status of 90% (OR: 0.22, CI: 0.07-0.70) and recipients with a history of HCC (OR: 0.10, CI: 0.01-0.79). The reSOFT score was developed by assigning points to these factors proportional to their hazard ratios and divided into high-, moderate-, and low-risk groups that accurately predict 3-month survival post-retransplant. With a C-statistic of 0.73 (CI: 0.71-0.75), this tool may serve to guide clinicians in identifying and better caring for high-risk retransplant recipients.

The use of the so-called extended criteria donors increases the number of grafts available for transplantation. Many studies reported their good outcomes but their use is debated due to increased risk of complications. Ex situ liver perfusion has reduced graft discard rate and helped to test their function before implantation. Cytokines are known to be involved in ischemia-reperfusion injury, but their potential to predict liver function during normothermic machine perfusion (NMP) has not been fully investigated. The aim of this study was to compare cytokines levels during NMP in 3 different types of donors (donation after brain death, donation after circulatory death [DCD]-II, DCD-III) and correlate these data to postoperative clinical and biochemical outcomes. All donations after brain deaths older than 70 years and DCDs transplanted after NMP were included. IL-6, IL-10, and TNF-α were measured during NMP and correlated with clinical outcomes. Thirty liver grafts were transplanted after NMP: 16 donations after brain deaths, 7 DCD-II, and 7 DCD-III. There were 6 cases of early allograft dysfunction (20.0%), 10 of post-reperfusion syndrome (33.3%), and 11 cases of acute kidney injury (36.7%), with no major differences among groups. A positive correlation was found between perfusate IL-6 levels and the bilirubin peak within 7 days after liver transplantation, while IL-10 was associated with the intensive care unit stay and TNF-α to the international normalized ratio peak within 7 days. IL-6 was negatively associated with postoperative ALT levels and IL-10 to bilirubin peak. A correlation between higher IL-6 levels at 2 hours and graft loss was found. This is the first study to compare cytokines profile during NMP in 3 different types of donors and correlate it to clinical outcomes. A correlation between IL-6 concentration and graft failure was found. The role and significance of inflammatory markers in machine perfusion perfusate and their potential to assess graft viability and the risk of post-liver transplantation complications have to be further addressed.