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Wu TW, Hou TY, Yang JCS, Wang CC. First report of successful liver transplantation following supermicrosurgical lymphaticovenous anastomoses for lymphorrhea with intractable infection: A case report. World J Transplant 2025; 15:101496. [DOI: 10.5500/wjt.v15.i3.101496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Revised: 12/30/2024] [Accepted: 02/06/2025] [Indexed: 04/18/2025] Open
Abstract
BACKGROUND Liver transplant (LT) candidates face a heightened risk of infection both pre- and post-transplant, owing to immunosuppressive therapy and complications from chronic liver disease. Infections during the pre-transplant period, such as lymphorrhea-induced cellulitis, can cause significant delays in transplantation and increase mortality while on the waiting list. Lymphorrhea, characterized by substantial lymphatic leakage and recurrent skin infections, presents a significant challenge in managing patients who are already immunocompromised. Effective preoperative infection control is critical to enhancing the prospects for a successful liver transplantation.
CASE SUMMARY We report the case of a 50-year-old female diagnosed with Hepatitis C virus-related cirrhosis (Child-Pugh C) and recurrent cellulitis due to lymphorrhea in her left lower leg. She suffered repeated episodes of cellulitis over five years, which prevented her from undergoing LT. Initial conservative treatments were unsuccessful in managing the lymphatic leakage and accompanying infections. In February 2019, she underwent supermicrosurgical lymphaticovenous anastomoses (LVA) to address her lymphorrhea. This procedure, which created multiple lymphatic-venous connections in the lower limb, led to significant improvements in her condition. After the LVA, she experienced no further episodes of cellulitis. Eighteen months later, she successfully underwent a deceased donor liver transplantation. Postoperative complications, including a wound hematoma, were effectively managed, and she was discharged 3 months post-operation. At her 3-year follow-up, her liver function was stable, with no recurrence of cellulitis.
CONCLUSION Despite numerous challenges, the patient achieved a successful recovery with satisfactory graft function and was free from lymphorrhea/lymphedema in her left lower limb 3 years post-transplantation. This case underscores the importance of robust infection control during both the pre- and post-transplantation phases and highlights the potential of LVA as a treatment option for managing lymphorrhea and infections in patients with liver cirrhosis.
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Affiliation(s)
- Tse-Wei Wu
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan
| | - Teng-Yuan Hou
- Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833401, Taiwan
| | - Johnson Chia-Shen Yang
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833401, Taiwan
| | - Chih-Chi Wang
- Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833401, Taiwan
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Arora A, Sharma P, Kumar A, Acharya S, Sarin SK, Duseja A, Puri P, Shah S, Chawla Y, Rao P, Saraya A, Mohanka R, Singh S, Saighal S, Rela M, Vij V, Asthana S, Shukla A, Bhangui P, Saraf N, Maiwall R, Mandot A, Saraswat V, Madan K, Shalimar, Kapoor D, Anand AC, Gupta S, Varghese J, Mehta N. Indian National Association for the Study of Liver (INASL) Guidance Statements for Determining Futility in Liver Transplantation. J Clin Exp Hepatol 2025; 15:102539. [PMID: 40343081 PMCID: PMC12056968 DOI: 10.1016/j.jceh.2025.102539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 02/24/2025] [Indexed: 05/10/2025] Open
Abstract
Liver transplantation (LT) is a life-saving procedure for patients with end-stage liver disease; however, with the growing shortage of organ donors, the need to identify futile transplants has become increasingly urgent. Futility in liver transplantation refers to situations where the expected post-transplant survival or quality of life is poor, making the procedure unlikely to yield a meaningful benefit. Various definitions of futility are used across different countries and transplant centers, with criteria often based on clinical factors such as age, comorbidities, MELD score, and functional status. For hepatologists and transplant surgeons, clearer guidelines are essential to make informed decisions and avoid unnecessary transplants that may place patients at risk without improving their prognosis. While some studies have proposed futility scores, there is currently no universal consensus on a standardized definition or set of criteria. This highlights the need for further prospective trials to evaluate the predictors of futility in liver transplantation, aiming to refine decision-making processes, optimize organ allocation, and improve patient outcomes. Future research should focus on the development of universally accepted futility criteria and explore interventions to mitigate the factors contributing to transplant futility.
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Affiliation(s)
- Anil Arora
- Institute of Liver Gastroenterology & Pancreatico Biliary Sciences. Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110060, India
| | - Praveen Sharma
- Institute of Liver Gastroenterology & Pancreatico Biliary Sciences. Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110060, India
| | - Ashish Kumar
- Institute of Liver Gastroenterology & Pancreatico Biliary Sciences. Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110060, India
| | - S.K. Acharya
- Kalinga Institute of Medical Sciences (KIMS), Kushabhadra Campus (KIIT Campus-5), Patia, Bhubaneswar, 751024, Odisha, India
| | - Shiv K. Sarin
- Institute of Liver and Biliary Sciences, Delhi, India
| | - Ajay Duseja
- Post Institute of Medical Sciences, Chandigarh, India
| | | | - Samir Shah
- Institute of Liver Disease, HPB Surgery and Transplant, Global Hospitals, Dr E Borges Road, Parel, Mumbai, 400012, India
| | - Y.K. Chawla
- Kalinga Institute of Medical Sciences (KIMS), Kushabhadra Campus (KIIT Campus-5), Patia, Bhubaneswar, 751024, Odisha, India
| | - P.N. Rao
- Asian Institute of Gsstroenterology, Hyderabad, India
| | - Anoop Saraya
- All India Institute of Medical Sciences, New Delhi, India
| | - Ravi Mohanka
- Sir HN Reliance Foundation Hospital, Mumbai, India
| | | | | | - Mohamed Rela
- Dr. Rela Institute & Medical Centre, #7, CLC Works Road, Chromepet, Chennai, 600044, India
| | - Vivek Vij
- Fortis Hospital, Noida, Delhi, India
| | - Sonal Asthana
- Aster CMI Bangalore, Aster RV Bangalore, Aster Whitefield, Bangalore, India
| | - Akash Shukla
- Reliance Foundation Hospital and Research Centre, Mumbai, India
- Seth GSMC & KEM Hospital, Mumbai, 400022, India
| | | | | | - Rakhi Maiwall
- Institute of Liver and Biliary Sciences, Delhi, India
| | - Amit Mandot
- Institute of Liver Disease, HPB Surgery and Transplant, Global Hospitals, Dr E Borges Road, Parel, Mumbai, 400012, India
| | | | | | - Shalimar
- All India Institute of Medical Sciences, New Delhi, India
| | - Dharmesh Kapoor
- Mahatma Gandhi Medical College and Hospital, RIICO Institutional Area, Sitapura, Tonk Road, Jaipur, 302022, Rajasthan, India
- Yashoda Hospital, Hyderabad, India
| | - Anil C. Anand
- Kalinga Institute of Medical Sciences (KIMS), Kushabhadra Campus (KIIT Campus-5), Patia, Bhubaneswar, 751024, Odisha, India
| | | | - Joy Varghese
- Gleneagles Global Health City, 439, Cheran Nagar, Perumbakkam, Chennai, Tamil Nadu, 600100, India
| | - Naimish Mehta
- Institute of Liver Gastroenterology & Pancreatico Biliary Sciences. Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110060, India
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3
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Jothimani D, Kumar Marannan N, Jain K, Krishna A, Rela M. Cardiac Evaluation in Liver Transplant Candidates. J Clin Exp Hepatol 2025; 15:102554. [PMID: 40415922 PMCID: PMC12099453 DOI: 10.1016/j.jceh.2025.102554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/18/2025] [Indexed: 05/27/2025] Open
Abstract
Liver transplantation (LT) is the only cure for patients with end-stage liver disease. With an increase in the prevalence of obesity and associated metabolic risk factors cardiovascular disease, in particular coronary artery disease is increasingly recognised in patients with liver cirrhosis. Identification and management of these cardiovascular risk factors may influence post-transplant clinical outcomes. A detailed assessment of patients' cardiovascular status is therefore crucial in the decision-making of patients for LT. Identification of patients with CAD requires risk stratification around perioperative and long term post-operative period. Advanced age, male sex, smoking diabetes mellitus, hypertension, obesity and metabolic-associated steatohepatitis (MASH) cirrhosis significantly increase the risk of coronary artery disease (CAD). Patients with these high-risk factors should undergo cardiac investigations with higher sensitivity to identify CAD. Patients with low-risk factors for CAD may undergo cardiac investigations with high specificity. Patients with cirrhosis may also suffer from conditions directly related to liver disease such as cirrhotic cardiomyopathy and porto-pulmonary hypertension, and conditions unrelated to liver disease such as arrhythmias. Rarely, valvular heart disease may be identified during transplant evaluation. Clinicians managing patients for liver transplantation should carefully evaluate cardiovascular risk and treat it appropriately prior to the surgery, to minimise post-transplant complication. A multidisciplinary approach involving transplant physicians, anaesthetists, cardiologists and transplant surgeons is strongly recommended.
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Affiliation(s)
- Dinesh Jothimani
- Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chennai, India
| | - Navin Kumar Marannan
- Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chennai, India
| | - Karan Jain
- Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chennai, India
| | - Aswin Krishna
- Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chennai, India
| | - Mohamed Rela
- Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chennai, India
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Saha T, Mehrotra S, Gupta P, Kumar A. Exosomal miRNA combined with anti-inflammatory hyaluronic acid-based 3D bioprinted hepatic patch promotes metabolic reprogramming in NAFLD-mediated fibrosis. Biomaterials 2025; 318:123140. [PMID: 39892017 DOI: 10.1016/j.biomaterials.2025.123140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 01/03/2025] [Accepted: 01/23/2025] [Indexed: 02/03/2025]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a complex metabolic disorder, where the underlying molecular mechanisms are mostly not well-understood and therefore, warrants the need for therapeutic interventions targeting several metabolic pathways as a unified response. Of late, promising outcomes have been observed with mesenchymal stem cell-derived exosomes. However, reduced bioavailability due to systemic delivery and the need for repeated fresh isolation hinders their feasibility for clinical applications. In this regard, an 'off-the-shelf' 3D bioprinted hyaluronic acid-based hepatic patch to deliver encapsulated exosomes alone/or with hepatocytes (as dual-therapy) is developed as a holistic approach for ameliorating the disease condition and promoting tissue regeneration. The bioprinted hepatic patch demonstrated sustained and localized release of exosomes (∼82 % in 21 days), and healthy liver tissue-like mechanical properties while being biocompatible and biodegradable. Assessment in NAFLD rat models displayed alleviation of the altered biochemical parameters such as fat deposition, deranged liver functions, disrupted lipid, glucose, and insulin metabolism along with a reduction in localized inflammation, and associated liver fibrosis. The study suggests that a synergistic effect between the miRNA population of released exosomes, cell therapy, and the bioprinted matrix materials is crucial in targeting multiple complex metabolic pathways associated with the severity of the disease.
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Affiliation(s)
- Triya Saha
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur, 208016, UP, India
| | - Shreya Mehrotra
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur, 208016, UP, India; Centre for Environmental Science and Engineering, Indian Institute of Technology Kanpur, Kanpur, 208016, UP, India.
| | - Purva Gupta
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur, 208016, UP, India
| | - Ashok Kumar
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur, 208016, UP, India; Centre for Environmental Science and Engineering, Indian Institute of Technology Kanpur, Kanpur, 208016, UP, India; The Mehta Family Centre for Engineering in Medicine, Indian Institute of Technology Kanpur, Kanpur, 208016, UP, India; Centre for Nanosciences, Indian Institute of Technology Kanpur, Kanpur, 208016, UP, India; Centre of Excellence for Materials in Medicine, Gangwal School of Medical Sciences and Technology, Indian Institute of Technology Kanpur, Kanpur, 208016, UP, India.
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Biolato M, Miele L, Avolio AW, Marrone G, Liguori A, Galati F, Petti A, Tomasello L, Pedicino D, Lombardo A, D'Aiello A, Pompili M, Agnes S, Gasbarrini A, Grieco A. Diagnostic accuracy and cost-effectiveness of the CAR-OLT score in predicting cardiac risk for liver transplantation. World J Transplant 2025; 15. [DOI: 10.5500/wjt.v15.i2.99208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 12/13/2024] [Accepted: 01/14/2025] [Indexed: 02/21/2025] Open
Abstract
BACKGROUND
The CAR-OLT score predicts major adverse cardiovascular events 1 year after liver transplant (LT).
AIM
To test the hypothesis that the CAR-OLT score may help avoid cardiac stress tests in LT candidates.
METHODS
This retrospective single-center cohort study included all adult patients undergoing elective evaluation for first cadaveric donor orthotopic LT for liver cirrhosis with or without hepatocellular carcinoma at Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricerca e Cura a Carattere Scientifico in Rome, Italy. Cardiac contraindications for LT listing were defined after a center-specific cardiac workup, which included cardiac stress tests for most patients. The diagnostic accuracy of the CAR-OLT score was evaluated using the area under the receiver operating characteristic (AUROC) method.
RESULTS
A total of 342 LT candidates were evaluated between 2015 and 2019, with a moderate cardiovascular risk profile (37% diabetes, 34% hypertension, 22% obesity). Of these, 80 (23%) candidates underwent coronary angiography. Twenty-one (6%) candidates were given cardiac contraindications to LT listing, 48% of which were due to coronary artery disease. The CAR-OLT score predicted cardiac contraindications to LT listing with an AUROC of 0.81. The optimal cut-off for sensitivity was a CAR-OLT score ≤ 23, which showed a 99% negative predictive value for cardiac contraindications to LT listing. A total of 84 (25%) LT candidates with a CAR-OLT score ≤ 23 underwent 87 non-invasive cardiac tests and 13 coronary angiographies pre-listing, with estimated costs of approximately 48000€. The estimated savings per patient was €574.70 for the Italian National Health System.
CONCLUSION
A CAR-OLT score ≤ 23 can identify LT candidates who can be safely listed without the need for cardiac stress tests, providing time and cost savings. These findings require external validation.
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Affiliation(s)
- Marco Biolato
- Department of Medical and Surgical Sciences, Centro Malattie Apparato Digerente (CEMAD), Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
| | - Luca Miele
- Department of Medical and Surgical Sciences, Centro Malattie Apparato Digerente (CEMAD), Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
| | - Alfonso W Avolio
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
- General Surgery and Liver Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
| | - Giuseppe Marrone
- Department of Medical and Surgical Sciences, Centro Malattie Apparato Digerente (CEMAD), Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
| | - Antonio Liguori
- Department of Medical and Surgical Sciences, Centro Malattie Apparato Digerente (CEMAD), Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
| | - Francesco Galati
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
| | - Anna Petti
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
| | - Lidia Tomasello
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
| | - Daniela Pedicino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
| | - Antonella Lombardo
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
| | - Alessia D'Aiello
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
| | - Maurizio Pompili
- Department of Medical and Surgical Sciences, Centro Malattie Apparato Digerente (CEMAD), Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
| | - Salvatore Agnes
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
- General Surgery and Liver Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
| | - Antonio Gasbarrini
- Department of Medical and Surgical Sciences, Centro Malattie Apparato Digerente (CEMAD), Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
| | - Antonio Grieco
- Department of Medical and Surgical Sciences, Centro Malattie Apparato Digerente (CEMAD), Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
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Manzia TM, Sensi B, Gentileschi P, Quaranta C, Toti L, Baiocchi L, Dauri M, Angelico R, Tisone G. Safety and efficacy of simultaneous liver transplantation and sleeve gastrectomy in morbid obese patients with end-stage liver disease: The LT-SG study. Liver Transpl 2025; 31:770-780. [PMID: 39451118 DOI: 10.1097/lvt.0000000000000522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 09/30/2024] [Indexed: 10/26/2024]
Abstract
In obese patients, metabolic dysfunction-associated steatotic liver disease is becoming a leading etiology of end-stage liver disease and HCC. Simultaneous liver transplantation and sleeve gastrectomy (LT-SG) have been proposed in the United States, but the safety and efficacy of the procedure have not been widely explored in Europe. Between January 2016 and December 2022, morbidly obese patients listed for liver transplantation at Tor Vergata University were enrolled in the LT-SG study. Primary outcomes were (1) safety expressed as 30- and 90-day overall survival and (2) major postoperative complications (Clavien-Dindo >IIIa). The secondary outcome was efficacy expressed as a 3-year %excess body mass index (BMI) loss. Eleven patients were enrolled in the study. The median BMI at transplantation was 42 (IQR 38-48). Indications of LT-SG were HCC (63.6%) and cirrhosis (36.4%). In 54% of cases, donors had high-risk characteristics (eurotransplant donor risk index >1.6). The 30- and 90-day overall survival were 63.6% and 54.5%, respectively. All deaths occurred in patients with P-SOFT >15 or in patients who had at least 3 of the following characteristics: >60 years, BMI >45, metabolic syndrome, MELD >25 or eurotransplant donor risk index >1.6. The 6 months, 1, 2, and 3 years %excess BMI loss was 73%, 60%, 50%, and 43%, respectively. LT-SG is a complex procedure that may carry excess risk in an unselected population. It should be considered only in highly selected patients. Standard donors are recommended, and prioritization of severely obese patients on the waiting list should be considered.
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Affiliation(s)
- Tommaso Maria Manzia
- Department of Surgical Science, HPB and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Bruno Sensi
- Department of Surgical Science, HPB and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Paolo Gentileschi
- Department of Surgical Science, HPB and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
- Department of Surgery, Bariatric and Metabolic Surgery Unit, Maria Cecilia Hospital, Cotignola, Italy
| | - Claudia Quaranta
- Department of Surgical Science, HPB and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Luca Toti
- Department of Surgical Science, HPB and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Leonardo Baiocchi
- Department of Medical Sciences, Hepatology Unit, University of Rome Tor Vergata, Rome, Italy
| | - Mario Dauri
- Department of Surgical Science, HPB and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Roberta Angelico
- Department of Surgical Science, HPB and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Tisone
- Department of Surgical Science, HPB and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
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Dutta S, Khan AS, Ukeje CC, Chapman WC, Doyle MB, Scherer M, Benzinger GR, Kangrga IM, Zoller JK. Anesthetic Considerations for Robotic Liver Transplantation. J Cardiothorac Vasc Anesth 2025; 39:1571-1582. [PMID: 40113456 DOI: 10.1053/j.jvca.2025.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Revised: 02/19/2025] [Accepted: 02/26/2025] [Indexed: 03/22/2025]
Abstract
Liver transplantation has traditionally been performed through a large, bilateral subcostal incision. Recently, liver transplant programs across the world, including our own, have reported successful liver transplants via total robotic approaches on recipients with low Model for End-stage Liver Disease scores and preexisting abdominal wall laxity. This review discusses the unique anesthetic considerations of robotic liver transplantation based on our group's initial experience with this novel surgical approach. Robotic liver transplantation presents a unique set of considerations and challenges for the anesthesiologist, and a thorough understanding of liver disease, liver transplant surgery, venovenous bypass, and the various implications of robotic surgery is essential to ensure optimal patient outcomes. Specific management topics discussed here include appropriate patient selection, preoperative assessment, and intraoperative management. We also discuss certain theoretical and actual challenges that our group has experienced.
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Affiliation(s)
- Shourik Dutta
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO
| | - Adeel S Khan
- Department of Surgery, Washington University in St. Louis, St. Louis, MO
| | - Chideraa C Ukeje
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO
| | - William C Chapman
- Department of Surgery, Washington University in St. Louis, St. Louis, MO
| | - Majella B Doyle
- Department of Surgery, Washington University in St. Louis, St. Louis, MO
| | - Meranda Scherer
- Department of Surgery, Washington University in St. Louis, St. Louis, MO
| | - G Richard Benzinger
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO
| | - Ivan M Kangrga
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO
| | - Jonathan K Zoller
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO.
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8
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Haselwanter P, Fairfield S, Riedl-Wewalka M, Schmid M, Stättermayer AF, Reiberger T, Trauner M, Zauner C, Schneeweiss-Gleixner M. Acute liver failure in patients admitted to the intensive care unit-a Viennese retrospective single-center analysis. Wien Klin Wochenschr 2025:10.1007/s00508-025-02539-1. [PMID: 40419847 DOI: 10.1007/s00508-025-02539-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Accepted: 04/05/2025] [Indexed: 05/28/2025]
Abstract
BACKGROUND Acute liver failure (ALF) is characterized by a rapid deterioration of liver function and a high mortality without transplantation depending on etiology and onset. Immediate transfer to a dedicated intensive care unit (ICU) and evaluation for high-urgency liver transplantation (HU-LTx) is recommended to maximize chances of survival. Data on ALF epidemiology are limited, particularly for Central Europe. METHODS This retrospective single-center study included all ALF patients admitted to the ICU of the Department of Gastroenterology and Hepatology at the Vienna General Hospital between 2012 and 2024. RESULTS Overall, 31 patients (median age of 44 [interquartile range, IQR 32-56] years, 20 [65%] female) were included. The primary causes of ALF were viral infections (n = 8; 26%), autoimmune hepatitis (n = 5; 16%), drug-induced liver injury (DILI; n = 3; 10%), and Wilson's disease (n = 4; 13%), while in 8 patients (26%) no cause was identified. Median length of ICU stay was 12 (IQR 4-21) days, with mean sequential organ failure assessment (SOFA) and simplified acute physiology score II (SAPS II) scores of 10.55 ± 4.56 and 40.97 ± 14.84. Overall ICU survival was 61% (n = 19). Non-HU-LTx patients (n = 18) had an ICU survival of 44%. HU-LTx was performed in 13 patients (42%), with 12 patients (92%) surviving 28 days. The 6‑month overall survival of HU-LTx patients was 85%. CONCLUSION The diverse causes of ALF in Central Europe include most commonly viral infections, autoimmune hepatitis, and DILI. HU-LTx was required and performed in almost half of patients and was associated with favorable survival rates, underscoring the importance of ICU management and early transfer to liver transplantation centers in the management of ALF.
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Affiliation(s)
- Patrick Haselwanter
- Department of Medicine III, Division of Gastroenterology and Hepatology, Intensive Care Unit 13H1, Medical University of Vienna, Vienna, Austria
| | - Seanna Fairfield
- Department of Medicine III, Division of Gastroenterology and Hepatology, Intensive Care Unit 13H1, Medical University of Vienna, Vienna, Austria
| | - Marlene Riedl-Wewalka
- Department of Medicine III, Division of Gastroenterology and Hepatology, Intensive Care Unit 13H1, Medical University of Vienna, Vienna, Austria
| | - Monika Schmid
- Department of Medicine III, Division of Gastroenterology and Hepatology, Intensive Care Unit 13H1, Medical University of Vienna, Vienna, Austria
| | - Albert Friedrich Stättermayer
- Department of Medicine III, Division of Gastroenterology and Hepatology, Intensive Care Unit 13H1, Medical University of Vienna, Vienna, Austria
| | - Thomas Reiberger
- Department of Medicine III, Division of Gastroenterology and Hepatology, Intensive Care Unit 13H1, Medical University of Vienna, Vienna, Austria
| | - Michael Trauner
- Department of Medicine III, Division of Gastroenterology and Hepatology, Intensive Care Unit 13H1, Medical University of Vienna, Vienna, Austria
| | - Christian Zauner
- Department of Medicine III, Division of Gastroenterology and Hepatology, Intensive Care Unit 13H1, Medical University of Vienna, Vienna, Austria
| | - Mathias Schneeweiss-Gleixner
- Department of Medicine III, Division of Gastroenterology and Hepatology, Intensive Care Unit 13H1, Medical University of Vienna, Vienna, Austria.
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9
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Del Carlo C, Santoni L, Fabiani I, Coceani M, Arzilli C, Passino C, Carrai P, Ghinolfi D, Biancofiore GL, Emdin M. Ischemic Heart Disease in Liver Transplant Candidates With High Bleeding Risk: Any Way Out? JACC Case Rep 2025; 30:103303. [PMID: 40409854 DOI: 10.1016/j.jaccas.2025.103303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Accepted: 12/16/2024] [Indexed: 05/25/2025]
Abstract
Coronary artery disease in candidates for liver transplantation is a real challenge because of the need to balance the risks of bleeding and thrombosis. Antiplatelet therapy, essential to prevent thrombotic events, may increase the risk of hemorrhagic complications, especially in the context of hepatic surgery. A 71-year-old woman with end-stage liver disease (ESLD) presented for a pretransplantation evaluation. She received a diagnosis of significant coronary artery disease (CAD), and a multidisciplinary discussion resulted in the option for an invasive treatment with several precautions to minimize her bleeding risk. Because of the intricacy of underlying comorbidities and the elevated perioperative risk, managing CAD in patients with ESLD is particularly challenging. More research and evidence are needed on treating CAD in this patient group. Patients with ESLD who are waiting for liver transplantation should have CAD actively screened. Multidisciplinary treatment is crucial to maximizing the results.
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Affiliation(s)
- Chiara Del Carlo
- Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - Lorenza Santoni
- Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - Iacopo Fabiani
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Michele Coceani
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Chiara Arzilli
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Claudio Passino
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Paola Carrai
- Hepatobiliary Surgery and Liver Transplantation Unit, University of Pisa, Medical School and Hospital, Pisa, Italy
| | - Davide Ghinolfi
- Hepatobiliary Surgery and Liver Transplantation Unit, University of Pisa, Medical School and Hospital, Pisa, Italy
| | | | - Michele Emdin
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
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10
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Ang SP, Chia JE, Iglesias J, Krittanawong C. Trends, Clinical Characteristics, and Outcomes of Percutaneous Coronary Intervention in Liver Transplant Recipients. Clin Transplant 2025; 39:e70181. [PMID: 40373057 PMCID: PMC12080875 DOI: 10.1111/ctr.70181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2025] [Revised: 04/12/2025] [Accepted: 04/26/2025] [Indexed: 05/17/2025]
Abstract
BACKGROUND Coronary artery disease (CAD) poses a significant challenge for liver transplant recipients (LTRs) who face higher cardiovascular risks due to immunosuppressive therapies and metabolic changes. While extensive research has focused on CAD management in patients awaiting liver transplantation, data on the outcomes of percutaneous coronary intervention (PCI) in the post-transplant population remain limited. METHODS This retrospective cohort study used the National Inpatient Sample database (2016-2021) to evaluate PCI hospitalizations involving LTR and non-transplant patients. Propensity score matching (1:3) was applied to balance the covariates between the LTRs and non-transplant patients. The primary outcome was in-hospital mortality. RESULTS Among the 2 681 545 PCI hospitalizations, LTRs accounted for 0.1% (n = 2675). LTRs were more likely to have diabetes (60.56% vs. 41.36%) and chronic kidney disease (60.93% vs. 21.06%) but less likely to have hyperlipidemia (58.32% vs. 72.65%; all p < 0.001). The crude rates of AKI (32.34% vs. 16.07%; p < 0.001) and blood transfusion (5.61% vs. 2.76%; p = 0.0001) were higher in the LTRs. After matching, the LTRs were associated with lower odds of in-hospital mortality (OR, 0.55; 95% CI, 0.30-1.00; p = 0.05) and cardiogenic shock (OR, 0.46; 95% CI, 0.29-0.74; p = 0.001). PCI hospitalizations among LTRs increased over time, peaking in 2019 (116.6/100 000). CONCLUSION Despite higher comorbidities and complication rates, LTRs undergoing PCI exhibited lower in-hospital mortality than non-transplant patients, likely reflecting survivor bias, rigorous pre- and post-transplant care, and specialized management. These preliminary findings highlight the need for further studies with detailed clinical data to validate the current findings.
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Affiliation(s)
- Song Peng Ang
- Department of MedicineRutgers Health/Community Medical CenterToms RiverNew JerseyUSA
| | - Jia Ee Chia
- Department of MedicineTexas Tech University Health Science CenterEl PasoTexasUSA
| | - Jose Iglesias
- Department of MedicineRutgers Health/Community Medical CenterToms RiverNew JerseyUSA
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11
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Kulkarni AV, Wall A, Reddy KR, Bittermann T. Early living donor liver transplantation for alcohol-associated hepatitis: Status in the era of increasing demand, unmet needs, and future considerations. Liver Transpl 2025; 31:668-681. [PMID: 39073609 DOI: 10.1097/lvt.0000000000000448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/23/2024] [Indexed: 07/30/2024]
Abstract
Hazardous alcohol consumption is the leading cause of liver disease worldwide. Alcohol-associated hepatitis (AH) is an acute and serious presentation of alcohol-associated liver disease that is associated with high short-term mortality. Medical management remains limited to corticosteroid therapy and intensive nutrition but improves survival in <50% of individuals. Liver transplantation (LT) is increasingly recognized as a treatment option for many patients with AH and may lead to greater survival benefits than medical management alone. The rate of waitlistings and LTs for AH has doubled in recent years, especially in the United States. Several studies from the West have reported early LT for AH to be successful, where deceased donor LT is the norm. The challenges of LT in living donor centers, particularly for those with AH, are unique and have previously not been discussed in depth. In this review, we aim to discuss the challenges unique to LDLT with respect to candidate and donor selection, ethical considerations, disparities in LDLT, post-LT alcohol relapse, and measures to prevent them while also addressing the definitions and outcomes of early-living donor liver LT for AH.
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Affiliation(s)
- Anand V Kulkarni
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Anji Wall
- Division of Abdominal Transplantation, Baylor University Medical Center, Dallas, Texas, USA
| | - K Rajender Reddy
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Therese Bittermann
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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12
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Abstract
Alcohol-associated liver disease (ALD) is the foremost cause of liver-related mortality in the United States comprising a spectrum of conditions from simple hepatic steatosis to more severe alcohol-associated cirrhosis and alcohol-associated hepatitis. There has been growing acceptance and application of early liver transplantation (eLT) for ALD. There is robust evidence for excellent patient and graft survival rates for eLT for ALD. Nevertheless, recidivism remains a major concern. This article aims to explore the recent trends in liver transplantation for ALD, as well as the advances in practice and outcomes, with focus on eLT and emerging challenges in this field.
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Affiliation(s)
- Elias D Rady
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ahmad Anouti
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Thomas G Cotter
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA.
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13
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Ocak I, Colak M, Bilici BN. Comparative Analysis of Plasmapheresis Versus Plasmapheresis Combined With Continuous Renal Replacement Therapy in Adult Liver Failure: A Retrospective Observational Study. Transplant Proc 2025; 57:598-605. [PMID: 40102129 DOI: 10.1016/j.transproceed.2025.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2024] [Revised: 10/09/2024] [Accepted: 02/26/2025] [Indexed: 03/20/2025]
Abstract
BACKGROUND Liver failure constitutes a critical medical condition marked by the rapid decline in hepatic functions. Novel therapeutic approaches, including therapeutic plasma exchange (TPE) and continuous venovenous hemodiafiltration (CVVHDF), have emerged as promising modalities for mitigating the effects of this condition by facilitating detoxification and enhancing liver function. The efficacy of these interventions, whether administered individually or in combination, is a prominent area of investigation in the management of liver failure among adult populations. This study aims to evaluate the role and effectiveness of TPE, both as a standalone treatment and in conjunction with CVVHDF, in the management of liver failure in adult patients. METHODS This retrospective study was conducted in a Liver Transplant Intensive Care Unit (LTICU), focusing on the medical records of adult patients aged 35 to 62 years. The patient cohort consisted of individuals admitted between January 1, 2021, and June 1, 2024, due to acute liver failure or acute-on-chronic liver failure. The analysis specifically included patients who underwent therapeutic plasma exchange (TPE) or those who received continuous renal replacement therapy in conjunction with TPE. For the statistical analysis, a P-value of less than .05 was deemed indicative of statistical significance. The study encompassed a total of 47 patients with liver failure, comprising 23 males and 24 females. Among these patients, 25 (53.2%) received only TPE, while 22 (46.8%) were treated with a combination of TPE and continuous venovenous hemodiafiltration (CVVHDF). RESULTS In the cohort of patients who received only therapeutic plasma exchange (TPE), the median International Normalized Ratio (INR) improved significantly, decreasing from 2 (1.6-2.6) to 1.3 (1.1-1.7). Similarly, alanine aminotransferase levels reduced from 351 (66-1482) to 166 (71-367), while aspartate aminotransferase levels decreased from 259 (132-1392) to 86 (35-160). In the group receiving a combination of TPE and continuous venovenous hemodiafiltration (CVVHDF), notable reductions were also observed: INR decreased from 3 (2.4-4.7) to 1.5 (1.3-2.4), alanine aminotransferase levels dropped from 691 (59-2397) to 162 (70-1060), and aspartate aminotransferase levels fell from 916 (134-1828) to 69 (45-503). These changes were statistically significant, with P-values of less than .05 for each parameter in both treatment groups. Overall, 21 patients achieved survival without requiring a liver transplant, while 7 patients underwent liver transplantation, resulting in a transplant-free survival rate of 44.7%. CONCLUSION The findings from our study on the management of liver failure in adults demonstrate that both therapeutic plasma exchange (TPE) administered alone and in conjunction with continuous venovenous hemodiafiltration (CVVHDF) are effective treatment modalities, particularly as a bridging strategy to liver transplantation. The observed transplant-free survival rate of 44.7% underscores the significant clinical advantages of these therapies. However, to enhance the validity of these results and their applicability in broader clinical contexts, additional multicenter studies are essential for further exploration of these treatment approaches in liver failure management.
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Affiliation(s)
- Ilhan Ocak
- Liver Transplant Intensive Care Unit, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
| | - Mustafa Colak
- Liver Transplant Intensive Care Unit, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Bilge Nur Bilici
- Liver Transplant Intensive Care Unit, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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14
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Kyriakoulis I, Kumar SS, Lianos GD, Schizas D, Kokkinidis DG. Coronary Computed Angiography and Coronary Artery Calcium Score for Preoperative Cardiovascular Risk Stratification in Patients Undergoing Noncardiac Surgery. J Cardiovasc Dev Dis 2025; 12:159. [PMID: 40278217 PMCID: PMC12027494 DOI: 10.3390/jcdd12040159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2025] [Revised: 04/09/2025] [Accepted: 04/15/2025] [Indexed: 04/26/2025] Open
Abstract
Perioperative and long-term postoperative major adverse cardiovascular events (MACE) are a leading cause of morbidity and mortality in patients undergoing noncardiac surgery. In selected high-risk patients, when information about cardiovascular status may influence surgical decisions, preoperative risk stratification is reasonable, with stress imaging being the preferred method. Coronary computed angiography (CCTA) and coronary artery calcium score (CACS) offer direct anatomical assessment of atherosclerotic coronary arteries and help gauge the extent and severity of coronary artery disease. Strong evidence supports that CCTA and CACS, either alone or in combination, are reliable methods for assessing the risk of both perioperative and long-term postoperative MACE, often demonstrating equal or superior prognostic performance compared to traditional imaging tools. Moreover, integrating CCTA or CACS into standard preoperative imaging protocols further enhances perioperative risk prediction and improves the ability to accurately stratify patients. Future research is needed to better define the role of CCTA and CACS in preoperative cardiovascular risk evaluation of patients undergoing noncardiac surgery.
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Affiliation(s)
- Ioannis Kyriakoulis
- Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100 Larissa, Greece;
| | - Sriram S. Kumar
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY 10461, USA;
| | - Georgios D. Lianos
- Department of Surgery, University Hospital of Ioannina, 45110 Ioannina, Greece;
| | - Dimitrios Schizas
- Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece;
| | - Damianos G. Kokkinidis
- Heart and Vascular Institute, Yale New Haven Health, Lawrence and Memorial Hospital, New London, CT 06320, USA
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15
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Capiro N, Chalfant JS. Breast Cancer Screening and Solid Organ Transplantation. JOURNAL OF BREAST IMAGING 2025:wbaf016. [PMID: 40222033 DOI: 10.1093/jbi/wbaf016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2024] [Indexed: 04/15/2025]
Abstract
Solid organ transplantation volumes in the United States have been steadily increasing over the past decade. Rigorous evaluation of potential transplant recipients must be performed to ensure appropriate allocation of solid organs for transplant. Because active malignancy is a contraindication for most solid organ transplantations, appropriate cancer screening should be included as part of the pretransplant assessment for both potential transplant recipients and donors. This article provides a summary of the current state of solid organ transplant-related breast cancer screening in the United States.
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Affiliation(s)
- Nina Capiro
- Department of Radiological Sciences, David Geffen School of Medicine at the University of California, Los Angeles, CA, Los Angeles, CA, USA
| | - James S Chalfant
- Department of Radiological Sciences, David Geffen School of Medicine at the University of California, Los Angeles, CA, Los Angeles, CA, USA
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16
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Goldberg D, Blandon C, Delgado C, John B, Emanuel E, Kaplan D, Reese P. Simulating the impact of survival benefit-based liver transplant organ allocation. Hepatology 2025:01515467-990000000-01232. [PMID: 40194301 DOI: 10.1097/hep.0000000000001338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2025] [Accepted: 03/26/2025] [Indexed: 04/09/2025]
Abstract
BACKGROUND AND AIMS In the United States and much of the world, prioritization for a deceased donor liver transplant focuses on sickest-first, based on allocating organs using the MELD score. There have been calls to instead allocate organs based on transplant survival benefit, but the impact of such a system on the broader waitlist population is unknown. APPROACH AND RESULTS We performed a simulation study using the Liver Simulated Allocation Model to compare the current US system of liver allocation to the one using different time horizons, focused on pretransplant survival only, posttransplant survival only, and survival benefit (difference of posttransplant survival and pretransplant survival). Changing liver allocation to a survival benefit-based system was simulated to lead to a small improvement in average patient-level posttransplant survival (mean survival over a 5-year time horizon of 4.24 y vs. 4.19 y in the current system). However, this small improvement was associated with a simulated decrease in transplants and an increase in waitlist mortality of 400 deaths per year. The resulting net benefit overall (pretransplant deaths and posttransplant survival) was negligible under a survival benefit-based allocation approach. CONCLUSIONS Our simulations predicted that survival benefit-based allocation would only increase posttransplant survival by an average of 18 days per recipient at the expense of a simulated increase in waitlist mortality of 400 deaths per year. In the current practice of liver transplantation, with the sickest-first allocation operating in a system where transplant physicians ration organs to maximize outcomes, the overall survival benefit is maintained and not compromised.
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Affiliation(s)
- David Goldberg
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Catherine Blandon
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Cindy Delgado
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Binu John
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Medicine, Bruce Carter VA Medical Center, Miami, Florida, USA
| | - Ezekiel Emanuel
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - David Kaplan
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Peter Reese
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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17
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Devauchelle P, Bignon A, Breteau I, Defaye M, Degravi L, Despres C, Godon A, Guérin R, Lavayssiere L, Lebas B, Maurice A, Monet C, Monsel A, Reydellet L, Roullet S, Rozier R, Guichon C, Weiss E. Perioperative Management During Liver Transplantation: A National Survey From the French Special Interest Group in "Liver Anesthesiology and Intensive Care". Transplantation 2025; 109:671-680. [PMID: 40071909 DOI: 10.1097/tp.0000000000005264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2025]
Abstract
BACKGROUND Perioperative management practices in liver transplantation (LT) evolve very quickly. There are few specific recommendations, often based on a low level of evidence, resulting in wide heterogeneity of practices. METHODS We performed a survey in all 16 French centers in 2021 by focusing on center organization, preoperative cardiovascular assessment, antimicrobial prophylaxis, hemostasis management, intraoperative use of hemodynamic monitoring and renal replacement therapy, immunosuppression, and postoperative prevention of arterial complications and compared it with current recommendations. RESULTS The organization of perioperative LT care involved 1 single team throughout the perioperative LT process in 7 centers (43.7%). The coronary evaluation was systematic in one-third of the centers and guided by risk factors in the other centers. Antibiotic prophylaxis was strictly intraoperative in only 7 centers (44%). Antifungal prophylaxis targeting high-risk LT recipients was administered in 15 centers (93%). Intraoperative coagulation assessment was based on standard coagulation tests in 8 centers (50%), on viscoelastic assays in 4 centers (25%), and both methods in 4 centers (25%). Hemodynamic monitoring practices greatly varied between centers.Concerning immunosuppression, molecules and dosages were heterogeneous. Aspirin was systematically administered in one-third of cases (6 centers; 37.5%). Of the 21 recommendations tested, the concordance rate was 100% for 3 recommendations and <50% for 7 recommendations. CONCLUSIONS Our study precisely describes French practices regarding LT in perioperative care and highlights the paucity of data in this setting, leading to very weak recommendations that are poorly followed in LT centers.
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Affiliation(s)
- Pauline Devauchelle
- Department of Anaesthesiology and Critical Care, Hôpital Beaujon, AP-HP, Clichy, France
| | - Anne Bignon
- CHU Lille, Surgical Critical Care and Hepatic Transplant Unit, Department of Anesthesia Critical Care and Perioperative Medicine, Lille, France
| | - Isaure Breteau
- Department of Anesthesia and Surgical Intensive Care Unit, Tours University Hospital, Tours, France
| | - Mylène Defaye
- Department of Anaesthesia and Intensive Care, Bordeaux University Hospital, Pessac, France
| | - Laurianne Degravi
- Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, Montpellier, France
| | - Cyrielle Despres
- Department of Anaesthesia and Intensive Care, Minjoz Hospital, Besançon University Hospital, Besançon, France
| | - Alexandre Godon
- Department of Anaesthesia and Intensive Care, University of Grenoble Alpes, Grenoble Alpes University Hospital, Grenoble, France
| | - Renaud Guérin
- Service De Réanimation Adultes, Unité de Soins Continus et Unité de Transplantation Hépatique, pôle MPO, CHU Estaing, Clermont-Ferrand, France
| | - Laurence Lavayssiere
- Intensive Care Unit, Department of Transplantation, Rangueil University Hospital, Toulouse, France
| | - Benjamin Lebas
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - Axelle Maurice
- Département d'Anesthésie réanimation chirurgicale, CHU Pontchaillou, Rennes, France
| | - Clément Monet
- Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, Montpellier, France
| | - Antoine Monsel
- Sorbonne Université-INSERM UMRS_959, Immunology-Immunopathology-Immunotherapy, Paris, France
- Biotherapy (CIC-BTi), La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Paris, France
- UMRS-938, Research Center of Saint-Antoine (CRSA), Sorbonne University, Paris, France
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Laurent Reydellet
- Service d'Anesthésie-Réanimation, Réanimation Polyvalente et Pathologie du Foie, APHM, C.H.U. Timone, Marseille, France
| | - Stéphanie Roullet
- Département d'Anesthésie Réanimation, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
- Université Paris-Saclay, INSERM, Hémostase Inflammation Thrombose HITH U1176, Le Kremlin-Bicêtre, France
| | - Romain Rozier
- Department of Anesthesia and Intensive Care, University of Cöte d'Azur, University Hospital Archer 2, Nice, France
| | - Céline Guichon
- Service d'Anesthésie-Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Emmanuel Weiss
- Department of Anaesthesiology and Critical Care, Université de Paris, Hôpital Beaujon, AP-HP, Clichy, France
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18
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Allen JL, Sterling RK. Palliative care & management of symptoms in advanced liver disease: an expert review. Expert Rev Gastroenterol Hepatol 2025; 19:515-526. [PMID: 40200429 DOI: 10.1080/17474124.2025.2491529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2025] [Revised: 03/07/2025] [Accepted: 04/07/2025] [Indexed: 04/10/2025]
Abstract
INTRODUCTION Chronic liver disease (CLD) is a leading cause of death worldwide. End-stage liver disease (ESLD) causes a rapid and progressive decline in health and quality of life (QOL) and creates significant suffering and burdens for patients, families, and health systems alike. These patients have significant physical, psychological, and complex social needs that benefit from the support of an interdisciplinary palliative care (PC) team. AREAS COVERED This review of the English literature analyzes general palliative care principles for the CLD and ESLD populations including factors affecting QOL and review of symptom management per AASLD and AGA Guidelines. We have also reviewed the impacts of palliative support on QOL, caregiver burden, and healthcare-related outcomes. EXPERT OPINION ESLD causes significant suffering and burdens for patients, families, and healthcare systems. PC is an essential component of ESLD care; it improves QOL, reduces caregiver burdens, and shows benefits of reduced healthcare costs and aggressive care at end of life. Provider and community misunderstanding or inexperience of PC is often a barrier to PC involvement. There is a clear lack of standardization in medical training and lack of clear guidelines on when to involve PC in the ESLD population that must be addressed.
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Affiliation(s)
- Jessica L Allen
- Division of Hematology, Oncology & Palliative Care, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Richard K Sterling
- Division of Gastroenterology, Hepatology & Nutrition, Virginia Commonwealth University Health System, Richmond, VA, USA
- Stravitz-Sanyal Institute for Liver Disease and Metabolic Health, Virginia Commonwealth University Health System, Richmond, VA, USA
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19
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Burger CD, Saunders H, Hodge DO, Safford RE, Helgeson SA, Moss JE, DuBrock HM, Cartin-Ceba R, Cajigas HR, Krowka MJ. Echocardiography Screening of Consecutive Patients With Portal Hypertension Referred to Mayo Clinic for Liver Transplant Evaluation. Mayo Clin Proc 2025; 100:668-679. [PMID: 39520417 DOI: 10.1016/j.mayocp.2024.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 07/12/2024] [Accepted: 08/07/2024] [Indexed: 11/16/2024]
Abstract
OBJECTIVE To determine the prevalence of portopulmonary hypertension in patients referred for liver transplant evaluation. METHODS Medical records were reviewed for 986 consecutive patients referred for liver transplant evaluation who were screened for pulmonary hypertension with echocardiography from February 1, 2021, to January 31, 2022, across 3 liver transplant centers. RESULTS Of 934 patients eligible for analysis, mean (SD) age was 57 (11) years, 558 (59.7%) were men, and 859 (92.0%) were White. Alcoholic cirrhosis and nonalcoholic steatohepatitis represented 640 (68.5%) of the liver diseases. Right ventricular systolic pressure estimated by echocardiography was 35 mm Hg or greater in 147 (15.7%) and less than 35 mm Hg in 475 (50.9%; unable to estimate in 312 [33.4%]). Right-sided heart catheterization was performed in 42 (4.5%) patients; hemodynamic profiles revealed that 12 (28.6%) did not have pulmonary hypertension, 15 (35.7%) had postcapillary venous pulmonary hypertension, 7 (16.7%) had portopulmonary hypertension, 6 (14.3%) had unclassifiable pulmonary hypertension, and 2 (4.8%) had combined pre- and postcapillary pulmonary hypertension. CONCLUSION The percentage of portopulmonary hypertension in patients referred for liver transplant was considerably lower, 7 of 934 (0.7%), than in previous studies, but the reason was unclear.
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Affiliation(s)
- Charles D Burger
- Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic, Jacksonville, FL.
| | - Hollie Saunders
- Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, FL
| | - David O Hodge
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL
| | - Robert E Safford
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Scott A Helgeson
- Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic, Jacksonville, FL
| | - John E Moss
- Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic, Jacksonville, FL
| | - Hilary M DuBrock
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | - Hector R Cajigas
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Michael J Krowka
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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20
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Wehrle CJ, Hong H, Gross A, Liu Q, Ali K, Cazzaniga B, Miyazaki Y, Tuul M, Modaresi Esfeh J, Khalil M, Pita A, Fernandes E, Kim J, Diago-Uso T, Aucejo F, Kwon DCH, Fujiki M, Quintini C, Schlegel A, Pinna A, Miller C, Hashimoto K. The impact of normothermic machine perfusion and acuity circles on waitlist time, mortality, and cost in liver transplantation: A multicenter experience. Liver Transpl 2025; 31:438-449. [PMID: 38833290 DOI: 10.1097/lvt.0000000000000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 05/13/2024] [Indexed: 06/06/2024]
Abstract
Ex situ normothermic machine perfusion (NMP) helps increase the use of extended criteria donor livers. However, the impact of an NMP program on waitlist times and mortality has not been evaluated. Adult patients listed for liver transplant (LT) at 2 academic centers from January 1, 2015, to September 1, 2023, were included (n=2773) to allow all patients ≥6 months follow-up from listing. Routine NMP was implemented on October 14, 2022. Waitlist outcomes were compared from pre-NMP pre-acuity circles (n=1460), pre-NMP with acuity circles (n=842), and with NMP (n=381). Median waitlist time was 79 days (IQR: 20-232 d) at baseline, 49 days (7-182) with acuity circles, and 14 days (5-56) with NMP ( p <0.001). The rate of transplant-per-100-person-years improved from 61-per-100-person-years to 99-per-100-person-years with acuity circles and 194-per-100-person-years with NMP ( p <0.001). Crude mortality without transplant decreased from 18.3% (n=268/1460) to 13.3% (n=112/843), to 6.3% (n=24/381) ( p <0.001) with NMP. The incidence of mortality without LT was 15-per-100-person-years before acuity circles, 19-per-100 with acuity circles, and 9-per-100-person-years after NMP ( p <0.001). Median Model for End-Stage Liver Disease at LT was lowest with NMP, but Model for End-Stage Liver Disease at listing was highest in this era ( p <0.0001). The median donor risk index of transplanted livers at baseline was 1.54 (1.27-1.82), 1.66 (1.42-2.16) with acuity circles, and 2.06 (1.63-2.46) with NMP ( p <0.001). Six-month post-LT survival was not different between eras ( p =0.322). The total cost of health care while waitlisted was lowest in the NMP era ($53,683 vs. $32,687 vs. $23,688, p <0.001); cost-per-day did not differ between eras ( p =0.152). The implementation of a routine NMP program was associated with reduced waitlist time and mortality without compromising short-term survival after liver transplant despite increased use of riskier grafts. Routine NMP use enables better waitlist management with reduced health care costs.
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Affiliation(s)
- Chase J Wehrle
- Department of General Surgery, Cleveland Clinic, Digestive Disease & Surgery Institute, Cleveland, Ohio, USA
| | - Hanna Hong
- Department of General Surgery, Cleveland Clinic, Digestive Disease & Surgery Institute, Cleveland, Ohio, USA
| | - Abby Gross
- Department of General Surgery, Cleveland Clinic, Digestive Disease & Surgery Institute, Cleveland, Ohio, USA
| | - Qiang Liu
- Department of General Surgery, Cleveland Clinic, Digestive Disease & Surgery Institute, Cleveland, Ohio, USA
| | - Khaled Ali
- Department of General Surgery, Cleveland Clinic, Digestive Disease & Surgery Institute, Cleveland, Ohio, USA
| | - Beatrice Cazzaniga
- Department of General Surgery, Cleveland Clinic, Digestive Disease & Surgery Institute, Cleveland, Ohio, USA
| | - Yuki Miyazaki
- Department of General Surgery, Cleveland Clinic, Digestive Disease & Surgery Institute, Cleveland, Ohio, USA
| | - Munkhbold Tuul
- Department of General Surgery, Cleveland Clinic, Digestive Disease & Surgery Institute, Cleveland, Ohio, USA
| | - Jamak Modaresi Esfeh
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mazhar Khalil
- Department of General Surgery, Cleveland Clinic, Digestive Disease & Surgery Institute, Cleveland, Ohio, USA
| | - Alejandro Pita
- Department of General Surgery, Cleveland Clinic, Digestive Disease & Surgery Institute, Cleveland, Ohio, USA
| | - Eduardo Fernandes
- Cleveland Clinic Florida, Abdominal Transplant Center, Weston, Florida, USA
| | - Jaekeun Kim
- Department of General Surgery, Cleveland Clinic, Digestive Disease & Surgery Institute, Cleveland, Ohio, USA
| | - Teresa Diago-Uso
- Cleveland Clinic Abu Dhabi, Digestive Disease Institute, Abu Dhabi, United Arab Emirates
| | - Federico Aucejo
- Department of General Surgery, Cleveland Clinic, Digestive Disease & Surgery Institute, Cleveland, Ohio, USA
| | - David C H Kwon
- Department of General Surgery, Cleveland Clinic, Digestive Disease & Surgery Institute, Cleveland, Ohio, USA
| | - Masato Fujiki
- Department of General Surgery, Cleveland Clinic, Digestive Disease & Surgery Institute, Cleveland, Ohio, USA
| | - Cristiano Quintini
- Cleveland Clinic Abu Dhabi, Digestive Disease Institute, Abu Dhabi, United Arab Emirates
| | - Andrea Schlegel
- Department of General Surgery, Cleveland Clinic, Digestive Disease & Surgery Institute, Cleveland, Ohio, USA
| | - Antonio Pinna
- Cleveland Clinic Abu Dhabi, Digestive Disease Institute, Abu Dhabi, United Arab Emirates
| | - Charles Miller
- Department of General Surgery, Cleveland Clinic, Digestive Disease & Surgery Institute, Cleveland, Ohio, USA
| | - Koji Hashimoto
- Department of General Surgery, Cleveland Clinic, Digestive Disease & Surgery Institute, Cleveland, Ohio, USA
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21
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Sabry A, Zakaria H, Maher D, Seddik RM, Nada A. Ischemia-Reperfusion Injury at Time-Zero Biopsy as a Prognostic Factor in Predicting Liver Graft Outcome in Egyptian Living Donor Liver Transplanted Patients. Int J Hepatol 2025; 2025:9113107. [PMID: 40224292 PMCID: PMC11991779 DOI: 10.1155/ijh/9113107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Accepted: 02/07/2025] [Indexed: 04/15/2025] Open
Abstract
Background and Aims: Ischemia-reperfusion injury (IRI) is believed to contribute to the early dysfunction of the graft as well as the survival of the patients following liver transplantation (LT). This study is aimed at ascertaining the role of time-zero biopsies in predicting early graft dysfunction and 5-year patient survival after living donor liver transplantation (LDLT). Patients and Methods: From February 2012 to August 2017, time-zero biopsies were obtained from 60 patients. Histological grading of time-zero biopsies was performed to identify the severity of IRI. Patients were divided into two groups: no or minimal to mild IRI versus moderate to severe IRI. Results: Time-zero biopsies of 60 liver allografts revealed no or minimal to mild IRI (n = 38, 63.3%) (Group 1) versus moderate to severe IRI (n = 22, 36.7%) (Group 2). Group 2 recipients indicated a significant increase in serum bilirubin and a higher incidence of early graft dysfunction. There were significant survival differences between the two groups (p = 0.033), and the rate of death was higher in the moderate to severe IRI group. Recipient age, steatosis, and longer CIT were identified as independent predictors of moderate to severe IRI. Conclusion: Time-zero biopsies with moderate to severe IRI upon biopsy can predict adverse clinical outcomes following LT.
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Affiliation(s)
- Aliaa Sabry
- Department of Hepatology & Gastroenterology, Menoufia University, National Liver Institute, Shebin El-Kom, Menoufia, Egypt
| | - Hazem Zakaria
- Department of Hepatobiliary Surgery, Menoufia University, National Liver Institute, Shebin El-Kom, Menoufia, Egypt
| | - Doha Maher
- Department of Pathology, Menoufia University, National Liver Institute, Shebin El-Kom, Menoufia, Egypt
| | - Randa Mohamed Seddik
- Department of Tropical Medicine, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Ali Nada
- Department of Hepatology & Gastroenterology, Menoufia University, National Liver Institute, Shebin El-Kom, Menoufia, Egypt
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22
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Poyekar S, Kapoor D. Pre-Liver Transplant Cardiac Evaluation-Demystifying the Heart Under Stress or Unclogging the Coronaries? J Clin Exp Hepatol 2025; 15:102448. [PMID: 40177698 PMCID: PMC11959372 DOI: 10.1016/j.jceh.2024.102448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Accepted: 10/21/2024] [Indexed: 04/05/2025] Open
Affiliation(s)
- Samriddhi Poyekar
- Associate Consultant, Transplant Medicine, Yashoda Hospital, Secunderabad, India
| | - Dharmesh Kapoor
- Senior Consultant- Hepatologist, Yashoda Hospital, Secunderabad, India
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23
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Engels EA, Mandal S, Corley DA, Blosser CD, Hart A, Lynch CF, Qiao B, Pawlish KS, Haber G, Yu KJ, Pfeiffer RM. Cure models, survival probabilities, and solid organ transplantation for patients with colorectal cancer. Am J Transplant 2025; 25:545-555. [PMID: 39182612 PMCID: PMC11842210 DOI: 10.1016/j.ajt.2024.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 08/15/2024] [Accepted: 08/19/2024] [Indexed: 08/27/2024]
Abstract
A previous cancer diagnosis can preclude patients from consideration for solid organ transplantation. Statistical models may improve candidate selection. We fitted statistical cure models and estimated 5-year cancer-specific survival (5yCSS) for colorectal cancer patients in the United States using registry data. The median cure probability at cancer diagnosis for patients in the general population was 0.67. Among 956 colorectal cancer patients who underwent solid organ transplantation, the median time since diagnosis was 6.3 years and the median 5yCSS at transplantation was 0.96. Patients with a 5yCSS below 0.90 had increased posttransplant cancer-specific mortality (hazard ratio 3.31, 95% CI 1.52-7.21). Compared with recently published guidelines, our models suggested shorter wait times for some groups of colorectal cancer patients (eg, stage IIA cancers) and longer wait times for others (stages IIB, IIIB, IIIC, IV). In conclusion, colorectal cancer patients undergoing solid organ transplantation had excellent prognoses, reflecting selection incorporating existing guidelines and clinical judgment. Nonetheless, 5yCSS probabilities estimated from cure models offer additional prognostic information for patients considered for transplantation and identify situations where current guidelines might be revised. We developed a web-based tool for clinicians to calculate 5yCSS probabilities for use in transplant evaluation for individual colorectal cancer patients (https://dceg.cancer.gov/tools/risk-assessment/calculator-of-colorectal-cancer-survival-probability).
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Affiliation(s)
- Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA.
| | - Soutrik Mandal
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA; Department of Population Health, New York University, New York, New York, USA
| | - Douglas A Corley
- Division of Research, Kaiser Permanente, Oakland, California, USA
| | - Christopher D Blosser
- Department of Medicine, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Allyson Hart
- Scientific Registry of Transplant Recipients and Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Charles F Lynch
- Department of Epidemiology, The University of Iowa, Iowa City, Iowa, USA
| | - Baozhen Qiao
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Karen S Pawlish
- Cancer Epidemiology Services, New Jersey Department of Health, Trenton, New Jersey, USA
| | - Gregory Haber
- National Institute of Standards and Technology, Gaithersburg, Maryland, USA
| | - Kelly J Yu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
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24
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Singh SA, Prakash K, Kajal K, Loganathan S, K N, Subramanian R, Singh A, Choudhary NS, Mukherjee A, Viswanathan Premkumar G, Sindwani G, Ranade S, Malleeswaran SK, Raghu A, Mathiyazhagan R, Venkatachalapathy S, Pant D, Srivastava P, Kumar L, Vohra V, Rajkumar A, Narsimhan G, Goel A, Aggarwal V, Kumar A, Panackel C. LTSI Consensus Guidelines: Preoperative Cardiac Evaluation in Adult Liver Transplant Recipients. J Clin Exp Hepatol 2025; 15:102419. [PMID: 40177699 PMCID: PMC11959373 DOI: 10.1016/j.jceh.2024.102419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 09/27/2024] [Indexed: 01/03/2025] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among LT candidates and accounts for up to 40% of the overall mortality within one month. It is influenced by traditional and nontraditional risk factors related to end-stage liver disease. A large proportion of CLD patients have underlying cardiovascular disease (CVD) especially if the etiology is metabolic associated steatohepatitis. Despite the large number of liver transplantations being conducted in India, there is a lack of an evidence-based guidelines for screening of CVD in this patient population. This consensus statement from Liver Transplant Society of India (LTSI) is the first attempt for developing an evidence-based document on preoperative cardiac evaluation from India. A task force consisting of transplant-anesthesiologists, transplant hepatologists, liver transplant surgeon and cardiologists from high volume centres was formed which reviewed the existing evidence and literature and formulated graded recommendations. The document focuses on identification of underlying cardiac pathologies, risk stratification and optimisation of modifiable cardiac diseases. Implementation of best practices and optimal strategies should be encouraged to improve cardiovascular outcomes in these populations.
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Affiliation(s)
- Shweta A. Singh
- Department of Anaesthesia and Critical Care - Center for Liver & Biliary Sciences (CLBS), Max Super Speciality Hospital (MSSH), Saket, New Delhi, India
| | - Kelika Prakash
- Department of Anaesthesiology, Pain Medicine & Critical Care AIIMS, New Delhi, India
| | - Kamal Kajal
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sekar Loganathan
- Department of Anesthesiology, All India Institute of Medical Sciences Kalyani, West Bengal, India
| | - Nandakumar K
- GI/Liver/Renal Intensive Care, Liver & Renal Intensive Care, Apollo Main Hospitals, Chennai, India
| | | | - Anil Singh
- Liver Transplant Anaesthesia & Critical Care, Nanavati Max Super Speciality Hospital, Mumbai, India
| | - Narendra S Choudhary
- Institute of Liver Transplantation & Regenerative Medicine, Medanta the Medicity, Gurugram, India
| | | | | | | | - Sharmila Ranade
- Liver Transplant Anaesthesia, Kokilaben Dhirubhai Ambani Hospital & Medical Research Centre, Andheri East Mumbai, India
| | - Selva K. Malleeswaran
- Department of Liver Anesthesia and Critical Care, Gleneagles Hospitals, Chennai, India
| | - Arun Raghu
- Anaesthesia & Transplant Anaesthesia, Gleneagles BGS Hospital, Bengaluru, India
| | | | | | - Deepanjali Pant
- Institute of Anaesthesiology, Pain & Perioperative Medicine, Sir Ganga Ram Hospital New Delhi, India
| | - Piyush Srivastava
- Department of Liver Transplant Anaesthesia & Critical Care, Fortis Hospiital, Noida, India
| | - Lakshmi Kumar
- Department of Anaesthesiology & Critical Care, Amrita Institute of Medical Sciences, Kochi, India
| | - Vijay Vohra
- Liver Transplant, GI Anaesthesia & Intensive Care, Medanta The Medicity, Gurugram, Haryana, India
| | - Akila Rajkumar
- Liver Intensive Care and Anaesthesia, Dr.Rela Institute & Medical Center, Chennai, India
| | | | - Anupam Goel
- Max Super Speciality Hospital (MSSH) Saket, New Delhi, India
| | - Vinayak Aggarwal
- Clinical Cardiology & Advance Cardiac Imaging, Fortis Memorial Research Institute(FMRI), Gurgaon, India
| | - Ashok Kumar
- Intereventional Cardiologist Advance Heart Failure Specialist, Dr.Rela Institute & Medical Center, Chennai, India
| | - Charles Panackel
- Hepatology & Liver Transplsant, Aster Integrated Liver Care, Kochi, India
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25
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del Valle KT, Kay D, Krowka MJ, Runo JR, Sadd C, Heimbach JK, Cartin-Ceba R, Cajigas HR, Burger CD, Moss JE, DuBrock HM. The Utility of Follow-up Transthoracic Echocardiogram to Screen for Severe Portopulmonary Hypertension (POPH) in Patients Granted POPH Model for End-stage Liver Disease (MELD) Exceptions. Transplant Direct 2025; 11:e1757. [PMID: 39936134 PMCID: PMC11810002 DOI: 10.1097/txd.0000000000001757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Accepted: 10/28/2024] [Indexed: 02/13/2025] Open
Abstract
Background The current model for end-stage liver disease (MELD) exception policies for portopulmonary hypertension (POPH) require serial right heart catheterizations (RHCs) every 3 mo to maintain exception points. RHC is necessary for the initial diagnosis of POPH, but the utility of serial catheterizations has not been studied. In patients with POPH MELD exceptions, we sought to compare noninvasive and invasive hemodynamics and determine the sensitivity of echocardiography for the detection of hemodynamically severe POPH that would preclude liver transplant. Methods We performed a single-center retrospective cohort study of patients with POPH MELD exceptions who underwent liver transplant from December 2008 to January 2024. Results were validated at an external center. Echocardiograms and RHCs performed within 1 mo were compared. Pearson correlation coefficient and Bland-Altman plots assessed the association between echocardiogram and RHC variables. We examined varied echocardiographic parameters to optimize sensitivity for the detection of hemodynamically severe POPH. Results Twenty-two individuals underwent 60 follow-up RHCs with paired echocardiograms. Right ventricular systolic pressure (RVSP) and cardiac index estimated with echocardiogram were not strongly correlated with RHC measurements at follow-up (RVSP and RHC pulmonary artery systolic pressure: R = 0.30, P = 0.02; cardiac index: R = 0.17, P = 0.21). However, echocardiograms with RVSP ≥48 mm Hg had 100% sensitivity for detecting hemodynamically severe POPH, with 100% negative predictive value. In external validation of 13 paired echocardiograms and RHCs, our algorithm had 64% specificity and 100% negative predictive value. Conclusions Although echocardiogram and RHC hemodynamic estimates were not strongly correlated, these results could potentially negate the current requirement for repeat RHC every 3 mo to maintain POPH MELD exception.
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Affiliation(s)
| | - Dana Kay
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati, Cincinnati, OH
| | - Michael J. Krowka
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - James R. Runo
- Division of Pulmonary and Critical Care Medicine, University of Wisconsin, Madison, WI
| | - Corey Sadd
- Division of Pulmonary and Critical Care Medicine, University of Wisconsin, Madison, WI
| | | | - Rodrigo Cartin-Ceba
- Division of Pulmonary and Sleep Medicine, Department of Critical Care Medicine, Mayo Clinic, Phoenix, AZ
| | - Hector R. Cajigas
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Charles D. Burger
- Division of Pulmonary and Critical Care, Mayo Clinic, Jacksonville, FL
| | - John E. Moss
- Division of Pulmonary and Critical Care, Mayo Clinic, Jacksonville, FL
| | - Hilary M. DuBrock
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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26
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Wehrle CJ, de Goeij FHC, Zhang M, Abbassi F, Satish S, Jiao C, Sun K, Pinna AD, Hashimoto K, Miller C, Polak WG, Clavien PA, De Jonge J, Schlegel A. Core outcome sets and benchmarking complications: Defining best practices for standardized outcome reporting in liver transplantation. Liver Transpl 2025; 31:395-409. [PMID: 39311852 DOI: 10.1097/lvt.0000000000000494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 09/05/2024] [Indexed: 12/06/2024]
Abstract
The comparison of outcomes in liver transplantation (LT) is hampered by using clinically nonrelevant surrogate endpoints and considerable variability in reported relevant posttransplant outcomes. Such variability stems from nonstandard outcome measures across studies, variable definitions of the same complication, and different timing of reporting. The Clavien-Dindo classification was established to improve the rigor of outcome reporting but is nonspecific to an intervention, and there are unsolved dilemmas specifically related to LT. Core outcome sets (COSs) have been used in other specialties to standardize outcomes research, but have not been defined for LT. Thus, we use the 5 major benchmarking studies published to date to define a 10-measure COS for LT using previously validated metrics. We further provide standard definitions for each of the 10 measures that may be used in international research on the topic. These definitions also include standard time points for recording to facilitate between-study comparisons and future meta-analysis. These 10 outcomes are paired with 3 validated, procedure-independent metrics, including the Clavien-Dindo Classification and the Comprehensive Complications Index. The Clavien scale and Comprehensive Complications Index are specifically reviewed to enhance their utility in LT, and their use, along with the COS, is explored. We encourage future studies to employ this COS along with the Clavien-Dindo grading system and Comprehensive Complications Index to improve the reproducibility and generalizability of research concerning LT.
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Affiliation(s)
- Chase J Wehrle
- Transplant Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Femke H C de Goeij
- Department of Surgery, Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mingyi Zhang
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Fariba Abbassi
- Department of Surgery & Transplantation, University of Zurich, Zurich, Switzerland
| | | | - Chunbao Jiao
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Keyue Sun
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Antonio D Pinna
- Transplant Center, Cleveland Clinic Florida, Weston, Florida, USA
| | - Koji Hashimoto
- Transplant Center, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Charles Miller
- Transplant Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Wojciech G Polak
- Department of Surgery, Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Pierre-Alain Clavien
- Transplant Center, Wyss Translational Center, ETH Zurich and University of Zurich, Zurich, Switzerland
| | - Jeroen De Jonge
- Department of Surgery, Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Andrea Schlegel
- Transplant Center, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
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27
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Romero-Cristóbal M, Salcedo Plaza M, Bañares R. Why your doctor is not an algorithm: Exploring logical principles of different clinical inference methods using liver transplantation as a model. GASTROENTEROLOGIA Y HEPATOLOGIA 2025; 48:502215. [PMID: 38852780 DOI: 10.1016/j.gastrohep.2024.502215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/11/2024]
Abstract
The development of machine learning (ML) tools in many different medical settings is largely increasing. However, the use of the resulting algorithms in daily medical practice is still an unsolved challenge. We propose an epistemological approach (i.e., based on logical principles) to the application of computational tools in clinical practice. We rely on the classification of scientific inference into deductive, inductive, and abductive comparing the characteristics of ML tools with those derived from evidence-based medicine [EBM] and experience-based medicine, as paradigms of well-known methods for generation of knowledge. While we illustrate our arguments using liver transplantation as an example, this approach can be applied to other aspects of the specialty. Regarding EBM, it generates general knowledge that clinicians apply deductively, but the certainty of its conclusions is not guaranteed. In contrast, automatic algorithms primarily rely on inductive reasoning. Their design enables the integration of vast datasets and mitigates the emotional biases inherent in human induction. However, its poor capacity for abductive inference (a logical mechanism inherent to human clinical experience) constrains its performance in clinical settings characterized by uncertainty, where data are heterogeneous, results are highly influenced by context, or where prognostic factors can change rapidly.
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Affiliation(s)
- Mario Romero-Cristóbal
- Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España; CIBEREHD, Instituto de Salud Carlos III, Madrid, España
| | - Magdalena Salcedo Plaza
- Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España; CIBEREHD, Instituto de Salud Carlos III, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Rafael Bañares
- Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España; CIBEREHD, Instituto de Salud Carlos III, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.
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28
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Moein M, Baio S, Contento R, Essop T, Bahreini A, Abedini M, Abedini M, Shahri MM, Jamshidi A, Saidi R. Understanding the Impact of Obesity on Liver Transplant Outcomes: A Comprehensive Analysis. World J Surg 2025; 49:734-742. [PMID: 39856025 DOI: 10.1002/wjs.12489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 12/19/2024] [Accepted: 12/29/2024] [Indexed: 01/27/2025]
Abstract
BACKGROUND The purpose of this investigation is to assess how effective it is to exclude individuals from the liver transplant (LT) using the body mass index (BMI) as a criterion. METHODS AND MATERIALS A retrospective longitudinal analysis of patients with liver transplant outcomes from January 2001 to May 2020 was conducted using the United Network for Organ Sharing (UNOS) database. RESULTS A total of 118,486 LT cases included in the study. Based on their BMI, patients were split into three groups: a BMI < 35 kg/m2, a 35 ≤ BMI < 40 kg/m2, and a BMI ≥ 40 kg/m2. The data analysis revealed a significant improvement in 10-year graft survival in the 2011-2020 group compared to the 2001-2010 group (mean 70% vs. 53% and P < 0.001). Interestingly, a BMI above 35 kg/m2 did not have a significant effect on the graft survival, and in both time frames, there was no clinically significant difference between the recipients of the different BMI spectrum. The patient's survival was also characterized by the same pattern. Primary graft failure was the most significant cause of allograft transplant failure in all the BMI spectrum, except recipients with a BMI < 35 kg/m2, in 2011-2020 group. CONCLUSION The outcomes of LT in patients requiring a LT are not significantly affected using the BMI, considering the advancements in surgical techniques and postoperation improvements, and excluding obese patients based on the BMI alone would be inappropriate.
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Affiliation(s)
- Mahmoudreza Moein
- Division of Transplant Services, Department of Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Stephen Baio
- Division of Transplant Services, Department of Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Robert Contento
- Division of Transplant Services, Department of Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Tasiyah Essop
- Division of Transplant Services, Department of Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Amin Bahreini
- Division of Transplant Services, Department of Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Mahsa Abedini
- Department of Medical and Serological Sciences, University of Bologna, Bologna, Italy
| | - Marjan Abedini
- Division of Transplant Services, Department of Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Matin Moallem Shahri
- Division of Transplant Services, Department of Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Abolfazl Jamshidi
- Division of Transplant Services, Department of Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Reza Saidi
- Division of Transplant Services, Department of Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
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Feng X, Fu B, Yang Q, Zeng K, Yi H, Yi S, Yang Y. An 82-year-old recipient of split liver transplantation worldwide: A case report. LIVER RESEARCH (BEIJING, CHINA) 2025; 9:74-78. [PMID: 40206436 PMCID: PMC11977115 DOI: 10.1016/j.livres.2024.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 10/08/2024] [Accepted: 12/31/2024] [Indexed: 04/11/2025]
Abstract
Split liver transplantation (SLT) has become an indispensable method for expanding the donor liver pool. However, advanced age in recipients can have significant adverse effects on prognosis. We report the case of an 82-year-old man with chronic liver failure and polycystic liver disease who underwent in vivo split right triple lobe donor liver transplantation on October 29, 2021. The patient made a remarkable recovery and was discharged 1 month after surgery. To date, he has been followed up for 32 months, with favorable laboratory and imaging test results, and no significant abnormalities or complications. Currently, this patient may be the oldest SLT recipient in the world. With comprehensive preoperative evaluation, optimized surgical techniques, and individually tailored postoperative care, older adults can safely undergo SLT. Therefore, advanced age should not be considered an absolute contraindication for this procedure.
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Affiliation(s)
- Xiao Feng
- Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Binsheng Fu
- Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qing Yang
- Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Kaining Zeng
- Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Huimin Yi
- Surgical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shuhong Yi
- Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yang Yang
- Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
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30
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Bitzer M, Groß S, Albert J, Blödt S, Boda-Heggemann J, Borucki K, Brunner T, Caspari R, Dombrowski F, Evert M, Follmann M, Freudenberger P, Gani C, Gebert J, Geier A, Gkika E, Götz M, Helmberger T, Hoffmann RT, Huppert P, Krug D, La Fougère C, Lang H, Langer T, Lenz P, Lüdde T, Mahnken A, Nadalin S, Nguyen HHP, Nothacker M, Ockenga J, Oldhafer K, Ott J, Paprottka P, Pereira P, Persigehl T, Plentz R, Pohl J, Recken H, Reimer P, Riemer J, Ringe K, Roeb E, Rüssel J, Schellhaas B, Schirmacher P, Schlitt HJ, Schmid I, Schütte K, Schuler A, Seehofer D, Sinn M, Stengel A, Steubesand N, Stoll C, Tannapfel A, Taubert A, Trojan J, van Thiel I, Utzig M, Vogel A, Vogl T, Wacker F, Waidmann O, Wedemeyer H, Wege H, Wenzel G, Wildner D, Wörns MA, Galle P, Malek N. [Not Available]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2025; 63:e159-e260. [PMID: 40064172 DOI: 10.1055/a-2460-6298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2025]
Affiliation(s)
- Michael Bitzer
- Abteilung für Gastroenterologie, Gastrointestinale Onkologie, Hepatologie, Infektiologie und Geriatrie, Eberhard-Karls Universität, Tübingen
| | - Sabrina Groß
- Abteilung für Gastroenterologie, Gastrointestinale Onkologie, Hepatologie, Infektiologie und Geriatrie, Eberhard-Karls Universität, Tübingen
| | - Jörg Albert
- Katharinenhospital, Klinik für Allgemeine Innere Medizin, Gastroenterologie, Hepatologie, Infektiologie und Pneumologie, Stuttgart
| | - Susanne Blödt
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF), Berlin
| | | | - Katrin Borucki
- Otto-von-Guericke-Universität Magdeburg, Medizinische Fakultät, Institut für Klinische Chemie und Pathobiochemie
| | - Thomas Brunner
- Universitätsklinik für Strahlentherapie-Radioonkologie, Medizinische Universität Graz
| | - Reiner Caspari
- Klinik Niederrhein Erkrankungen des Stoffwechsels der Verdauungsorgane und Tumorerkrankungen, Bad Neuenahr-Ahrweiler
| | | | | | - Markus Follmann
- Office des Leitlinienprogrammes Onkologie, Deutsche Krebsgesellschaft e.V., Berlin
| | | | - Cihan Gani
- Klinik für Radioonkologie, Universitätsklinikum Tübingen
| | - Jamila Gebert
- Abteilung für Gastroenterologie, Gastrointestinale Onkologie, Hepatologie, Infektiologie und Geriatrie, Eberhard-Karls Universität, Tübingen
| | - Andreas Geier
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg
| | - Eleni Gkika
- Klinik für Strahlenheilkunde, Department für Radiologische Diagnostik und Therapie, Universitätsklinikum Freiburg
| | - Martin Götz
- Medizinische Klinik IV - Gastroenterologie/Onkologie, Klinikverbund Südwest, Böblingen
| | - Thomas Helmberger
- Institut für Radiologie, Neuroradiologie und minimal invasive Therapie, München Klinik Bogenhausen
| | - Ralf-Thorsten Hoffmann
- Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Dresden
| | - Peter Huppert
- Radiologisches Zentrum, Max Grundig Klinik, Bühlerhöhe
| | - David Krug
- Strahlentherapie Campus Kiel, Universitätsklinikum Schleswig-Holstein
| | - Christian La Fougère
- Nuklearmedizin und Klinische Molekulare Bildgebung, Eberhard-Karls Universität, Tübingen
| | - Hauke Lang
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Johannes Gutenberg-Universität, Mainz
| | - Thomas Langer
- Office des Leitlinienprogrammes Onkologie, Deutsche Krebsgesellschaft e.V., Berlin
| | - Philipp Lenz
- Zentrale Einrichtung Palliativmedizin, Universitätsklinikum Münster
| | - Tom Lüdde
- Medizinische Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf
| | - Andreas Mahnken
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Marburg
| | - Silvio Nadalin
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Eberhard-Karls Universität, Tübingen
| | | | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF), Berlin
| | - Johann Ockenga
- Medizinische Klinik II, Gesundheit Nord, Klinikverbund Bremen
| | - Karl Oldhafer
- Klinik für Leber-, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek
| | - Julia Ott
- Abteilung für Gastroenterologie, Gastrointestinale Onkologie, Hepatologie, Infektiologie und Geriatrie, Eberhard-Karls Universität, Tübingen
| | - Philipp Paprottka
- Sektion für Interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München
| | - Philippe Pereira
- Zentrum für Radiologie, Minimal-invasive Therapien und Nuklearmedizin, SLK-Klinken Heilbronn
| | - Thorsten Persigehl
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln
| | - Ruben Plentz
- Digestive Diseases and Nutrition, Gastroenterology, University of Kentucky
| | - Jürgen Pohl
- Abteilung für Gastroenterologie, Asklepios Klinik Altona
| | | | - Peter Reimer
- Institut für Diagnostische und Interventionelle Radiologie, Städtisches Klinikum Karlsruhe
| | | | - Kristina Ringe
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover
| | - Elke Roeb
- Medizinische Klinik II Pneumologie, Nephrologie und Gastroenterologie, Universitätsklinikum Gießen
| | - Jörn Rüssel
- Medizinische Klinik IV Hämatologie und Onkologie, Universitätsklinikum Halle (Saale)
| | - Barbara Schellhaas
- Medizinische Klinik I Gastroenterologie, Pneumologie und Endokrinologie, Friedrich-Alexander-Universität, Erlangen
| | - Peter Schirmacher
- Allgemeine Pathologie und pathologische Anatomie, Universitätsklinikum Heidelberg
| | | | - Irene Schmid
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, LMU München
| | - Kerstin Schütte
- Klinik für Innere Medizin und Gastroenterologie, Niels-Stensen-Kliniken, Marienhospital Osnabrück
| | - Andreas Schuler
- Medizinische Klinik, Gastroenterologie, Alb-Fils-Kliniken, Geislingen an der Steige
| | - Daniel Seehofer
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig
| | - Marianne Sinn
- II. Medizinische Klinik und Poliklinik (Onkologie, Hämatologie, Knochenmarktransplantation mit Abteilung für Pneumologie), Universitätsklinikum Hamburg-Eppendorf
| | - Andreas Stengel
- Innere Medizin VI - Psychosomatische Medizin und Psychotherapie, Eberhard-Karls Universität, Tübingen
| | | | | | | | - Anne Taubert
- Klinische Sozialarbeit, Universitätsklinikum Heidelberg
| | - Jörg Trojan
- Medizinische Klinik 1: Gastroenterologie und Hepatologie, Pneumologie und Allergologie, Endokrinologie und Diabetologie sowie Ernährungsmedizin, Goethe-Universität, Frankfurt
| | | | - Martin Utzig
- Abteilung Zertifizierung, Deutsche Krebsgesellschaft e.V., Berlin
| | - Arndt Vogel
- Institute of Medical Science, University of Toronto
| | - Thomas Vogl
- Institut für Diagnostische und Interventionelle Radiologie, Goethe-Universität, Frankfurt
| | - Frank Wacker
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover
| | | | - Heiner Wedemeyer
- Klinik für Gastroenterologie, Hepatologie, Infektiologie und Endokrinologie, Medizinische Hochschule Hannover
| | - Henning Wege
- Klinik für Allgemeine Innere Medizin, Onkologie/Hämatologie, Gastroenterologie und Infektiologie, Klinikum Esslingen
| | - Gregor Wenzel
- Office des Leitlinienprogrammes Onkologie, Deutsche Krebsgesellschaft e.V., Berlin
| | - Dane Wildner
- Innere Medizin, Krankenhäuser Nürnberger Land GmbH, Standort Lauf
| | - Marcus-Alexander Wörns
- Klinik für Gastroenterologie, Hämatologie und internistische Onkologie und Endokrinologie, Klinikum Dortmund
| | - Peter Galle
- 1. Medizinische Klinik und Poliklinik, Gastroenterologie, Hepatologie, Nephrologie, Rheumatologie, Infektiologie, Johannes Gutenberg-Universität, Mainz
| | - Nisar Malek
- Abteilung für Gastroenterologie, Gastrointestinale Onkologie, Hepatologie, Infektiologie und Geriatrie, Eberhard-Karls Universität, Tübingen
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Gabrielli F, Bernasconi E, Toscano A, Avossa A, Cavicchioli A, Andreone P, Gitto S. Side Effects of Immunosuppressant Drugs After Liver Transplant. Pharmaceuticals (Basel) 2025; 18:342. [PMID: 40143120 PMCID: PMC11946649 DOI: 10.3390/ph18030342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Revised: 02/18/2025] [Accepted: 02/26/2025] [Indexed: 03/28/2025] Open
Abstract
Liver transplantation (LT) is the standard of care for both end-stage liver failure and hepatocellular carcinoma (HCC). Side effects of the main used immunosuppressive drugs have a noteworthy impact on the long-term outcome of LT recipients. Consequently, to achieve a balance between optimal immunosuppression and minimal side effects is a cornerstone of the post-LT period. Today, there are no validated markers for overimmunosuppression and underimmunosuppression, only a few drugs have therapeutic drug monitoring, and immunosuppression regimens vary from center to center and from country to country. Currently, there are many drugs with different efficacy and safety profiles. Using different agents permits a decrease in the dosage and minimizes the toxicities. A small subset of recipients achieves immunotolerance with the chance to stop immunosuppressive therapy. This article focuses on the side effects of immunosuppressive drugs, which significantly impact long-term outcomes for LT recipients. The primary aim is to highlight the balance between achieving effective immunosuppression and minimizing adverse effects, emphasizing the role of personalized therapeutic strategies. Moreover, this review evaluates the mechanisms of action and specific complications associated with immunosuppressive agents. Finally, special attention is given to strategies for reducing immunosuppressive burdens, improving patient quality of life, and identifying immunotolerant individuals.
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Affiliation(s)
- Filippo Gabrielli
- Internal and Metabolic Medicine, Department of Medical and Surgical Sciences for Children & Adults, AOU of Modena, University of Modena and Reggio Emilia, 41126 Modena, Italy
| | - Elisa Bernasconi
- Postgraduate School of Internal Medicine, University of Modena and Reggio Emilia, 41126 Modena, Italy
| | - Arianna Toscano
- Division of Internal Medicine, University Hospital of Policlinico G. Martino, 98124 Messina, Italy
| | - Alessandra Avossa
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Alessia Cavicchioli
- Internal and Metabolic Medicine, Department of Medical and Surgical Sciences for Children & Adults, AOU of Modena, University of Modena and Reggio Emilia, 41126 Modena, Italy
| | - Pietro Andreone
- Internal and Metabolic Medicine, Department of Medical and Surgical Sciences for Children & Adults, AOU of Modena, University of Modena and Reggio Emilia, 41126 Modena, Italy
- Postgraduate School of Allergology and Clinical Immunology, University of Modena and Reggio Emilia, 41126 Modena, Italy
| | - Stefano Gitto
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
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32
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Abate EG, McKenna A, Yang L, Ball CT, Kearns AE. Five-year evaluation of bone health in liver transplant patients: developing a risk score for predicting bone fragility progression beyond the first year. Front Endocrinol (Lausanne) 2025; 16:1467825. [PMID: 40052155 PMCID: PMC11882866 DOI: 10.3389/fendo.2025.1467825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Accepted: 01/02/2025] [Indexed: 03/09/2025] Open
Abstract
Introduction Liver transplant (LT) recipients have a substantial risk of bone loss and fracture. An individual's risk is highest before and within the first year after transplantation and returns to baseline in some patients but not all. We aim to identify risk factors for bone loss and fracture beyond the first year LT and to create a risk-scoring tool to aid clinicians in identifying those at high risk for bone loss and fracture. Methods We conducted a retrospective review of 264 liver transplant recipients between 2011 and 2014, who were followed in our transplant clinic for an additional five years. Clinical records were evaluated at the one-year post-LT visit and subsequently on an annual basis for up to five years. Results Over a median follow-up of 3.6 years post-liver transplantation, 40 out of 264 patients experienced disease progression, defined as worsening bone mineral density (BMD), initiation of osteoporosis treatment, or a new fracture. Factors associated with BMD progression included female sex, Caucasian race, new fractures, number of acute rejection events requiring treatment, and lower dual energy X-ray absorptiometry (DXA) scores after the first year post-LT. A risk model was developed using multivariable analysis, with a risk score based on BMD categories. The concordance index was 0.771, indicating good discrimination between those who progressed and those who did not. Risk categories were defined as low (0-4 points), medium (5 points), and high (6-9 points) based on model coefficients. The probability of progression-free survival at two years post-LT was 96.7% for low-risk, 83.1% for medium-risk, and 59.1% for high-risk groups. Conclusion We developed a simple, clinically applicable risk score that predicts bone disease progression beyond the first year after LT. This tool may help guide appropriate bone health follow-up, although prospective validation is necessary.
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Affiliation(s)
| | - Amanda McKenna
- Division of Endocrinology, Mayo Clinic, Jacksonville, FL, United States
| | - Liu Yang
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, United States
| | - Colleen T. Ball
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL, United States
| | - Ann E. Kearns
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, United States
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Choudhury A, Kulkarni AV, Arora V, Soin AS, Dokmeci AK, Chowdhury A, Koshy A, Duseja A, Kumar A, Mishra AK, Patwa AK, Sood A, Roy A, Shukla A, Chan A, Krag A, Mukund A, Mandot A, Goel A, Butt AS, Sahney A, Shrestha A, Cárdenas A, Di Giorgio A, Arora A, Anand AC, Dhawan A, Jindal A, Saraya A, Srivastava A, Kumar A, Kaewdech A, Pande A, Rastogi A, Valsan A, Goel A, Kumar A, Singal AK, Tanaka A, Coilly A, Singh A, Meena BL, Jagadisan B, Sharma BC, Lal BB, Eapen CE, Yaghi C, Kedarisetty CK, Kim CW, Panackel C, Yu C, Kalal CR, Bihari C, Huang CH, Vasishtha C, Jansen C, Strassburg C, Lin CY, Karvellas CJ, Lesmana CRA, Philips CA, Shawcross D, Kapoor D, Agrawal D, Payawal DA, Praharaj DL, Jothimani D, Song DS, Kim DJ, Kim DS, Zhongping D, Karim F, Durand F, Shiha GE, D’Amico G, Lau GK, Pati GK, Narro GEC, Lee GH, Adali G, Dhakal GP, Szabo G, Lin HC, Li H, Nair HK, Devarbhavi H, Tevethia H, Ghazinian H, Ilango H, Yu HL, Hasan I, Fernandez J, George J, Behari J, Fung J, Bajaj J, Benjamin J, Lai JC, Jia J, Hu JH, et alChoudhury A, Kulkarni AV, Arora V, Soin AS, Dokmeci AK, Chowdhury A, Koshy A, Duseja A, Kumar A, Mishra AK, Patwa AK, Sood A, Roy A, Shukla A, Chan A, Krag A, Mukund A, Mandot A, Goel A, Butt AS, Sahney A, Shrestha A, Cárdenas A, Di Giorgio A, Arora A, Anand AC, Dhawan A, Jindal A, Saraya A, Srivastava A, Kumar A, Kaewdech A, Pande A, Rastogi A, Valsan A, Goel A, Kumar A, Singal AK, Tanaka A, Coilly A, Singh A, Meena BL, Jagadisan B, Sharma BC, Lal BB, Eapen CE, Yaghi C, Kedarisetty CK, Kim CW, Panackel C, Yu C, Kalal CR, Bihari C, Huang CH, Vasishtha C, Jansen C, Strassburg C, Lin CY, Karvellas CJ, Lesmana CRA, Philips CA, Shawcross D, Kapoor D, Agrawal D, Payawal DA, Praharaj DL, Jothimani D, Song DS, Kim DJ, Kim DS, Zhongping D, Karim F, Durand F, Shiha GE, D’Amico G, Lau GK, Pati GK, Narro GEC, Lee GH, Adali G, Dhakal GP, Szabo G, Lin HC, Li H, Nair HK, Devarbhavi H, Tevethia H, Ghazinian H, Ilango H, Yu HL, Hasan I, Fernandez J, George J, Behari J, Fung J, Bajaj J, Benjamin J, Lai JC, Jia J, Hu JH, Chen JJ, Hou JL, Yang JM, Chang J, Trebicka J, Kalf JC, Sollano JD, Varghese J, Arab JP, Li J, Reddy KR, Raja K, Panda K, Kajal K, Kumar K, Madan K, Kalista KF, Thanapirom K, Win KM, Suk KT, Devadas K, Lesmana LA, Kamani L, Premkumar M, Niriella MA, Al Mahtab M, Yuen MF, Sayed MHE, Alla M, Wadhawan M, Sharma MK, Sahu M, Prasad M, Muthiah MD, Schulz M, Bajpai M, Reddy MS, Praktiknjo M, Yu ML, Prasad M, Sharma M, Elbasiony M, Eslam M, Azam MG, Rela M, Desai MS, Vij M, Mahmud N, Choudhary NS, Marannan NK, Ormeci N, Saraf N, Verma N, Nakayama N, Kawada N, Oidov Baatarkhuu, Goyal O, Yokosuka O, Rao PN, Angeli P, Parikh P, Kamath PS, Thuluvath PJ, Lingohr P, Ranjan P, Bhangui P, Rathi P, Sakhuja P, Puri P, Ning Q, Dhiman RK, Kumar R, Vijayaraghavan R, Khanna R, Maiwall R, Mohanka R, Moreau R, Gani RA, Loomba R, Mehtani R, Rajaram RB, Hamid SS, Palnitkar S, Lal S, Biswas S, Chirapongsathorn S, Agarwal S, Sachdeva S, Saigal S, Kumar SE, Violeta S, Singh SP, Mochida S, Mukewar S, Alam S, Lim SG, Alam S, Shalimar, Venishetty S, Sundaram SS, Shetty S, Bhatia S, Singh SA, Kottilil S, Strasser S, Shasthry SM, Maung ST, Tan SS, Treeprasertsuk S, Asthana S, Manekeller S, Gupta S, Acharya SK, K.C. S, Maharshi S, Asrani S, Dadhich S, Taneja S, Giri S, Singh S, Chen T, Gupta T, Kanda T, Tanwandee T, Piratvishuth T, Spengler U, Prasad VGM, Midha V, Rakhmetova V, Arroyo V, Sood V, BR VK, Wong VWS, Pamecha V, Singh V, Dayal VM, Saraswat VA, Kim WR, Jafri W, Gu W, Jun WY, Qi X, Chawla YK, Kim YJ, Shi Y, Abbas Z, Kumar G, Shiina S, Wei L, Omata M, Sarin SK, APASL-ACLF Research Consortium (AARC) for APASL-ACLF working party. Acute-on-chronic liver failure (ACLF): the ‘Kyoto Consensus’—steps from Asia. Hepatol Int 2025; 19:1-69. [DOI: https:/doi.org/10.1007/s12072-024-10773-4] [Show More Authors] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2024] [Accepted: 12/29/2024] [Indexed: 04/16/2025]
Abstract
Abstract
Acute-on-chronic liver failure (ACLF) is a condition associated with high mortality in the absence of liver transplantation. There have been various definitions proposed worldwide. The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set in 2004 on ACLF was published in 2009, and the “APASL ACLF Research Consortium (AARC)” was formed in 2012. The AARC database has prospectively collected nearly 10,500 cases of ACLF from various countries in the Asia–Pacific region. This database has been instrumental in developing the AARC score and grade of ACLF, the concept of the ‘Golden Therapeutic Window’, the ‘transplant window’, and plasmapheresis as a treatment modality. Also, the data has been key to identifying pediatric ACLF. The European Association for the Study of Liver-Chronic Liver Failure (EASL CLIF) and the North American Association for the Study of the End Stage Liver Disease (NACSELD) from the West added the concepts of organ failure and infection as precipitants for the development of ACLF and CLIF-Sequential Organ Failure Assessment (SOFA) and NACSELD scores for prognostication. The Chinese Group on the Study of Severe Hepatitis B (COSSH) added COSSH-ACLF criteria to manage hepatitis b virus-ACLF with and without cirrhosis. The literature supports these definitions to be equally effective in their respective cohorts in identifying patients with high mortality. To overcome the differences and to develop a global consensus, APASL took the initiative and invited the global stakeholders, including opinion leaders from Asia, EASL and AASLD, and other researchers in the field of ACLF to identify the key issues and develop an evidence-based consensus document. The consensus document was presented in a hybrid format at the APASL annual meeting in Kyoto in March 2024. The ‘Kyoto APASL Consensus’ presented below carries the final recommendations along with the relevant background information and areas requiring future studies.
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Groß S, Bitzer M, Albert J, Blödt S, Boda-Heggemann J, Borucki K, Brunner T, Caspari R, Dombrowski F, Evert M, Follmann M, Freudenberger P, Gani C, Gebert J, Geier A, Gkika E, Götz M, Helmberger T, Hoffmann RT, Huppert P, Krug D, Fougère CL, Lang H, Langer T, Lenz P, Lüdde T, Mahnken A, Nadalin S, Nguyen HHP, Nothacker M, Ockenga J, Oldhafer K, Ott J, Paprottka P, Pereira P, Persigehl T, Plentz R, Pohl J, Recken H, Reimer P, Riemer J, Ringe K, Roeb E, Rüssel J, Schellhaas B, Schirmacher P, Schlitt HJ, Schmid I, Schütte K, Schuler A, Seehofer D, Sinn M, Stengel A, Steubesand N, Stoll C, Tannapfel A, Taubert A, Trojan J, van Thiel I, Utzig M, Vogel A, Vogl T, Wacker F, Waidmann O, Wedemeyer H, Wege H, Wenzel G, Wildner D, Wörns MA, Galle P, Malek N. [Not Available]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2025; 63:e82-e158. [PMID: 39919781 DOI: 10.1055/a-2460-6347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2025]
Affiliation(s)
- Sabrina Groß
- Abteilung für Gastroenterologie, Gastrointestinale Onkologie, Hepatologie, Infektiologie und Geriatrie, Eberhard-Karls Universität, Tübingen
| | - Michael Bitzer
- Abteilung für Gastroenterologie, Gastrointestinale Onkologie, Hepatologie, Infektiologie und Geriatrie, Eberhard-Karls Universität, Tübingen
| | - Jörg Albert
- Katharinenhospital, Klinik für Allgemeine Innere Medizin, Gastroenterologie, Hepatologie, Infektiologie und Pneumologie, Stuttgart
| | - Susanne Blödt
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF), Berlin
| | | | - Katrin Borucki
- Otto-von-Guericke-Universität Magdeburg, Medizinische Fakultät, Institut für Klinische Chemie und Pathobiochemie
| | - Thomas Brunner
- Universitätsklinik für Strahlentherapie-Radioonkologie, Medizinische Universität Graz
| | - Reiner Caspari
- Klinik Niederrhein Erkrankungen des Stoffwechsels der Verdauungsorgane und Tumorerkrankungen, Bad Neuenahr-Ahrweiler
| | | | | | - Markus Follmann
- Office des Leitlinienprogrammes Onkologie, Deutsche Krebsgesellschaft e.V., Berlin
| | | | - Cihan Gani
- Klinik für Radioonkologie, Universitätsklinikum Tübingen
| | - Jamila Gebert
- Abteilung für Gastroenterologie, Gastrointestinale Onkologie, Hepatologie, Infektiologie und Geriatrie, Eberhard-Karls Universität, Tübingen
| | - Andreas Geier
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg
| | - Eleni Gkika
- Klinik für Strahlenheilkunde, Department für Radiologische Diagnostik und Therapie, Universitätsklinikum Freiburg
| | - Martin Götz
- Medizinische Klinik IV - Gastroenterologie/Onkologie, Klinikverbund Südwest, Böblingen
| | - Thomas Helmberger
- Institut für Radiologie, Neuroradiologie und minimal invasive Therapie, München Klinik Bogenhausen
| | - Ralf-Thorsten Hoffmann
- Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Dresden
| | - Peter Huppert
- Radiologisches Zentrum, Max Grundig Klinik, Bühlerhöhe
| | - David Krug
- Strahlentherapie Campus Kiel, Universitätsklinikum Schleswig-Holstein
| | - Christian La Fougère
- Nuklearmedizin und Klinische Molekulare Bildgebung, Eberhard-Karls Universität, Tübingen
| | - Hauke Lang
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Johannes Gutenberg-Universität, Mainz
| | - Thomas Langer
- Office des Leitlinienprogrammes Onkologie, Deutsche Krebsgesellschaft e.V., Berlin
| | - Philipp Lenz
- Zentrale Einrichtung Palliativmedizin, Universitätsklinikum Münster
| | - Tom Lüdde
- Medizinische Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf
| | - Andreas Mahnken
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Marburg
| | - Silvio Nadalin
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Eberhard-Karls Universität, Tübingen
| | | | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF), Berlin
| | - Johann Ockenga
- Medizinische Klinik II, Gesundheit Nord, Klinikverbund Bremen
| | - Karl Oldhafer
- Klinik für Leber-, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek
| | - Julia Ott
- Abteilung für Gastroenterologie, Gastrointestinale Onkologie, Hepatologie, Infektiologie und Geriatrie, Eberhard-Karls Universität, Tübingen
| | - Philipp Paprottka
- Sektion für Interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München
| | - Philippe Pereira
- Zentrum für Radiologie, Minimal-invasive Therapien und Nuklearmedizin, SLK-Klinken Heilbronn
| | - Thorsten Persigehl
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln
| | - Ruben Plentz
- Digestive Diseases and Nutrition, Gastroenterology, University of Kentucky
| | - Jürgen Pohl
- Abteilung für Gastroenterologie, Asklepios Klinik Altona
| | | | - Peter Reimer
- Institut für Diagnostische und Interventionelle Radiologie, Städtisches Klinikum Karlsruhe
| | | | - Kristina Ringe
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover
| | - Elke Roeb
- Medizinische Klinik II Pneumologie, Nephrologie und Gastroenterologie, Universitätsklinikum Gießen
| | - Jörn Rüssel
- Medizinische Klinik IV Hämatologie und Onkologie, Universitätsklinikum Halle (Saale)
| | - Barbara Schellhaas
- Medizinische Klinik I Gastroenterologie, Pneumologie und Endokrinologie, Friedrich-Alexander-Universität, Erlangen
| | - Peter Schirmacher
- Allgemeine Pathologie und pathologische Anatomie, Universitätsklinikum Heidelberg
| | | | - Irene Schmid
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, LMU München
| | - Kerstin Schütte
- Klinik für Innere Medizin und Gastroenterologie, Niels-Stensen-Kliniken, Marienhospital Osnabrück
| | - Andreas Schuler
- Medizinische Klinik, Gastroenterologie, Alb-Fils-Kliniken, Geislingen an der Steige
| | - Daniel Seehofer
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig
| | - Marianne Sinn
- II. Medizinische Klinik und Poliklinik (Onkologie, Hämatologie, Knochenmarktransplantation mit Abteilung für Pneumologie), Universitätsklinikum Hamburg-Eppendorf
| | - Andreas Stengel
- Innere Medizin VI - Psychosomatische Medizin und Psychotherapie, Eberhard-Karls Universität, Tübingen
| | | | | | | | - Anne Taubert
- Klinische Sozialarbeit, Universitätsklinikum Heidelberg
| | - Jörg Trojan
- Medizinische Klinik 1: Gastroenterologie und Hepatologie, Pneumologie und Allergologie, Endokrinologie und Diabetologie sowie Ernährungsmedizin, Goethe-Universität, Frankfurt
| | | | - Martin Utzig
- Abteilung Zertifizierung, Deutsche Krebsgesellschaft e.V., Berlin
| | - Arndt Vogel
- Institute of Medical Science, University of Toronto
| | - Thomas Vogl
- Institut für Diagnostische und Interventionelle Radiologie, Goethe-Universität, Frankfurt
| | - Frank Wacker
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover
| | | | - Heiner Wedemeyer
- Klinik für Gastroenterologie, Hepatologie, Infektiologie und Endokrinologie, Medizinische Hochschule Hannover
| | - Henning Wege
- Klinik für Allgemeine Innere Medizin, Onkologie/Hämatologie, Gastroenterologie und Infektiologie, Klinikum Esslingen
| | - Gregor Wenzel
- Office des Leitlinienprogrammes Onkologie, Deutsche Krebsgesellschaft e.V., Berlin
| | - Dane Wildner
- Innere Medizin, Krankenhäuser Nürnberger Land GmbH, Standort Lauf
| | - Marcus-Alexander Wörns
- Klinik für Gastroenterologie, Hämatologie und internistische Onkologie und Endokrinologie, Klinikum Dortmund
| | - Peter Galle
- 1. Medizinische Klinik und Poliklinik, Gastroenterologie, Hepatologie, Nephrologie, Rheumatologie, Infektiologie, Johannes Gutenberg-Universität, Mainz
| | - Nisar Malek
- Abteilung für Gastroenterologie, Gastrointestinale Onkologie, Hepatologie, Infektiologie und Geriatrie, Eberhard-Karls Universität, Tübingen
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Kakish H, Drigotas C, Loftus AW, Boutros CS, Doh SJ, Ammori JB, Rothermel LD, Hoehn RS. Reasons for Surgical Attrition Among Nonmetastatic Upper Gastrointestinal Cancer Patients: A Single Institutional Experience. J Surg Oncol 2025; 131:197-203. [PMID: 39257297 DOI: 10.1002/jso.27865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/20/2024] [Accepted: 08/21/2024] [Indexed: 09/12/2024]
Abstract
INTRODUCTION Upper gastrointestinal (UGI) cancers require multidisciplinary treatment, but surgery provides the only potentially curative option. We sought to understand reasons for attrition before surgery within our regional hospital network. METHODS We performed chart reviews of patients (age 18-80) with stage I-III UGI cancers (gastroesophageal junction, gastric, and hepatopancreatobiliary adenocarcinomas) in our multihospital cancer registry from 2015 to 2021. Our primary outcome was reasons for surgical attrition. Univariable analysis identified factors related to surgical attrition and the Kaplan-Meier method estimated overall survival based on surgery receipt. RESULTS Seven hundred and ninety-two patients were included in our analysis, of whom 107 (13.5%) did not undergo curative surgery. Reasons for not undergoing surgery included medical comorbidities (30.8%), patient preference/nonmedical barriers (24.3%, which included: not interested without further explanation, worried about complications, nonadherence to appointments, insurance issues, did not wish for blood transfusion, lack of social support, preferring home care, and worried about recurrence), psychosocial (5.6%), progression while on neoadjuvant therapy or waiting for transplant (15.0% and 7.5%), poor performance status (3.7%), side effects of neoadjuvant therapy (3.7%), and death unrelated to treatment or unknown cause (9.4%). Nonsurgical management was not associated with race, socioeconomic status, or distance traveled for care. Survival was greatly improved for patients who underwent surgery (158 vs. 63 weeks, p < 0.05). CONCLUSION Nearly one in seven patients (18-80 years old) with UGI cancers evaluated at our academic cancer center did not undergo surgical resection. Reasons for surgical attrition included potentially modifiable issues, and addressing these barriers could help overcome inequities in cancer treatment and survival.
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Affiliation(s)
- Hanna Kakish
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Claire Drigotas
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Alexander W Loftus
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Christina S Boutros
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Susan J Doh
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - John B Ammori
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Luke D Rothermel
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Richard S Hoehn
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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36
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Choudhury A, Kulkarni AV, Arora V, Soin AS, Dokmeci AK, Chowdhury A, Koshy A, Duseja A, Kumar A, Mishra AK, Patwa AK, Sood A, Roy A, Shukla A, Chan A, Krag A, Mukund A, Mandot A, Goel A, Butt AS, Sahney A, Shrestha A, Cárdenas A, Di Giorgio A, Arora A, Anand AC, Dhawan A, Jindal A, Saraya A, Srivastava A, Kumar A, Kaewdech A, Pande A, Rastogi A, Valsan A, Goel A, Kumar A, Singal AK, Tanaka A, Coilly A, Singh A, Meena BL, Jagadisan B, Sharma BC, Lal BB, Eapen CE, Yaghi C, Kedarisetty CK, Kim CW, Panackel C, Yu C, Kalal CR, Bihari C, Huang CH, Vasishtha C, Jansen C, Strassburg C, Lin CY, Karvellas CJ, Lesmana CRA, Philips CA, Shawcross D, Kapoor D, Agrawal D, Payawal DA, Praharaj DL, Jothimani D, Song DS, Kim DJ, Kim DS, Zhongping D, Karim F, Durand F, Shiha GE, D'Amico G, Lau GK, Pati GK, Narro GEC, Lee GH, Adali G, Dhakal GP, Szabo G, Lin HC, Li H, Nair HK, Devarbhavi H, Tevethia H, Ghazinian H, Ilango H, Yu HL, Hasan I, Fernandez J, George J, Behari J, Fung J, Bajaj J, Benjamin J, Lai JC, Jia J, Hu JH, et alChoudhury A, Kulkarni AV, Arora V, Soin AS, Dokmeci AK, Chowdhury A, Koshy A, Duseja A, Kumar A, Mishra AK, Patwa AK, Sood A, Roy A, Shukla A, Chan A, Krag A, Mukund A, Mandot A, Goel A, Butt AS, Sahney A, Shrestha A, Cárdenas A, Di Giorgio A, Arora A, Anand AC, Dhawan A, Jindal A, Saraya A, Srivastava A, Kumar A, Kaewdech A, Pande A, Rastogi A, Valsan A, Goel A, Kumar A, Singal AK, Tanaka A, Coilly A, Singh A, Meena BL, Jagadisan B, Sharma BC, Lal BB, Eapen CE, Yaghi C, Kedarisetty CK, Kim CW, Panackel C, Yu C, Kalal CR, Bihari C, Huang CH, Vasishtha C, Jansen C, Strassburg C, Lin CY, Karvellas CJ, Lesmana CRA, Philips CA, Shawcross D, Kapoor D, Agrawal D, Payawal DA, Praharaj DL, Jothimani D, Song DS, Kim DJ, Kim DS, Zhongping D, Karim F, Durand F, Shiha GE, D'Amico G, Lau GK, Pati GK, Narro GEC, Lee GH, Adali G, Dhakal GP, Szabo G, Lin HC, Li H, Nair HK, Devarbhavi H, Tevethia H, Ghazinian H, Ilango H, Yu HL, Hasan I, Fernandez J, George J, Behari J, Fung J, Bajaj J, Benjamin J, Lai JC, Jia J, Hu JH, Chen JJ, Hou JL, Yang JM, Chang J, Trebicka J, Kalf JC, Sollano JD, Varghese J, Arab JP, Li J, Reddy KR, Raja K, Panda K, Kajal K, Kumar K, Madan K, Kalista KF, Thanapirom K, Win KM, Suk KT, Devadas K, Lesmana LA, Kamani L, Premkumar M, Niriella MA, Al Mahtab M, Yuen MF, Sayed MHE, Alla M, Wadhawan M, Sharma MK, Sahu M, Prasad M, Muthiah MD, Schulz M, Bajpai M, Reddy MS, Praktiknjo M, Yu ML, Prasad M, Sharma M, Elbasiony M, Eslam M, Azam MG, Rela M, Desai MS, Vij M, Mahmud N, Choudhary NS, Marannan NK, Ormeci N, Saraf N, Verma N, Nakayama N, Kawada N, Oidov Baatarkhuu, Goyal O, Yokosuka O, Rao PN, Angeli P, Parikh P, Kamath PS, Thuluvath PJ, Lingohr P, Ranjan P, Bhangui P, Rathi P, Sakhuja P, Puri P, Ning Q, Dhiman RK, Kumar R, Vijayaraghavan R, Khanna R, Maiwall R, Mohanka R, Moreau R, Gani RA, Loomba R, Mehtani R, Rajaram RB, Hamid SS, Palnitkar S, Lal S, Biswas S, Chirapongsathorn S, Agarwal S, Sachdeva S, Saigal S, Kumar SE, Violeta S, Singh SP, Mochida S, Mukewar S, Alam S, Lim SG, Alam S, Shalimar, Venishetty S, Sundaram SS, Shetty S, Bhatia S, Singh SA, Kottilil S, Strasser S, Shasthry SM, Maung ST, Tan SS, Treeprasertsuk S, Asthana S, Manekeller S, Gupta S, Acharya SK, K C S, Maharshi S, Asrani S, Dadhich S, Taneja S, Giri S, Singh S, Chen T, Gupta T, Kanda T, Tanwandee T, Piratvishuth T, Spengler U, Prasad VGM, Midha V, Rakhmetova V, Arroyo V, Sood V, Br VK, Wong VWS, Pamecha V, Singh V, Dayal VM, Saraswat VA, Kim WR, Jafri W, Gu W, Jun WY, Qi X, Chawla YK, Kim YJ, Shi Y, Abbas Z, Kumar G, Shiina S, Wei L, Omata M, Sarin SK. Acute-on-chronic liver failure (ACLF): the 'Kyoto Consensus'-steps from Asia. Hepatol Int 2025; 19:1-69. [PMID: 39961976 PMCID: PMC11846769 DOI: 10.1007/s12072-024-10773-4] [Show More Authors] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2024] [Accepted: 12/29/2024] [Indexed: 02/23/2025]
Abstract
Acute-on-chronic liver failure (ACLF) is a condition associated with high mortality in the absence of liver transplantation. There have been various definitions proposed worldwide. The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set in 2004 on ACLF was published in 2009, and the "APASL ACLF Research Consortium (AARC)" was formed in 2012. The AARC database has prospectively collected nearly 10,500 cases of ACLF from various countries in the Asia-Pacific region. This database has been instrumental in developing the AARC score and grade of ACLF, the concept of the 'Golden Therapeutic Window', the 'transplant window', and plasmapheresis as a treatment modality. Also, the data has been key to identifying pediatric ACLF. The European Association for the Study of Liver-Chronic Liver Failure (EASL CLIF) and the North American Association for the Study of the End Stage Liver Disease (NACSELD) from the West added the concepts of organ failure and infection as precipitants for the development of ACLF and CLIF-Sequential Organ Failure Assessment (SOFA) and NACSELD scores for prognostication. The Chinese Group on the Study of Severe Hepatitis B (COSSH) added COSSH-ACLF criteria to manage hepatitis b virus-ACLF with and without cirrhosis. The literature supports these definitions to be equally effective in their respective cohorts in identifying patients with high mortality. To overcome the differences and to develop a global consensus, APASL took the initiative and invited the global stakeholders, including opinion leaders from Asia, EASL and AASLD, and other researchers in the field of ACLF to identify the key issues and develop an evidence-based consensus document. The consensus document was presented in a hybrid format at the APASL annual meeting in Kyoto in March 2024. The 'Kyoto APASL Consensus' presented below carries the final recommendations along with the relevant background information and areas requiring future studies.
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Affiliation(s)
- Ashok Choudhury
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | | | - Vinod Arora
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - A S Soin
- Medanta-The Medicity Hospital, Gurugram, Haryana, India
| | | | - Abhijeet Chowdhury
- Institute of Post-Graduate Medical Education and Research (IPGMER), Kolkata, West Bengal, India
| | - Abraham Koshy
- VPS Lakeshore Hospital and Research Center Ltd, Kochi, Kerala, India
| | - Ajay Duseja
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ajay Kumar
- Govind Ballabh Pant Hospital, New Delhi, India
| | - Ajay Kumar Mishra
- Sanjay Gandhi Post Graduate Institute (SGPGI), Lucknow, Uttar Pradesh, India
| | | | - Ajit Sood
- Dayanand Medical College, Ludhiana, India
| | - Akash Roy
- Apollo Multispeciality Hospital, Kolkata, India
| | - Akash Shukla
- Seth G S Medical College and K E M Hospital, Mumbai, Maharashtra, India
- Sir HN Reliance Foundation Hospital, Girgaon, Mumbai, Maharashtra, India
| | - Albert Chan
- Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | | | - Amar Mukund
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | | | - Amit Goel
- Sanjay Gandhi Post Graduate Institute (SGPGI), Lucknow, Uttar Pradesh, India
| | | | | | | | - Andrés Cárdenas
- Univerity of Barcelona Institut d'Investigacions Biomèdiques August Pi-Sunyer, Barcelona, Spain
| | | | - Anil Arora
- Sir Ganga Ram Hospital, Rajender Nagar, New Delhi, India
| | - Anil Chandra Anand
- Kalinga Institute of Medical Sciences (KIMS), Bhubaneshwar, Orissa, India
| | | | - Ankur Jindal
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Anoop Saraya
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Anshu Srivastava
- Sanjay Gandhi Post Graduate Institute (SGPGI), Lucknow, Uttar Pradesh, India
| | - Anupam Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | | | - Apurva Pande
- Fortis Hospital, Greater Noida, Uttar Pradesh, India
| | - Archana Rastogi
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Arun Valsan
- Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Ashish Goel
- Christian Medical College (CMC), Vellore, India
| | - Ashish Kumar
- Sir Ganga Ram Hospital, Rajender Nagar, New Delhi, India
| | - Ashwani K Singal
- University of Louisville School of Medicine, Trager Transplant Center and Jewish Hospital, Louisville, KY, USA
| | | | - Audrey Coilly
- Centre Hepato-Biliaire, Paul Brousse Hospital, Paris-Saclay University, Villejuif, France
| | - Ayaskanta Singh
- IMS and SUM Hospital, SOA University, Bhubaneswar, Odisha, India
| | - Babu Lal Meena
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | | | | | - Bikrant Bihari Lal
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - C E Eapen
- Christian Medical College (CMC), Vellore, India
| | - Cesar Yaghi
- Saint Joseph University, Hôtel-Dieu de France University Medical Center, Beirut, Lebanon
| | | | | | | | - Chen Yu
- Capital Medical University, Beijing, China
| | - Chetan R Kalal
- Nanavati Max Super Specialty Hospital, Mumbai, Maharashtra, India
| | - Chhagan Bihari
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | | | - Chitranshu Vasishtha
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Christian Jansen
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | | | - Chun Yen Lin
- Linkou Medical Centre, Chang Gung Memorial Hospital, Keelung, Taiwan
| | | | - Cosmas Rinaldi Adithya Lesmana
- Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta, Indonesia
- Medistra Hospital, Jakarta, Indonesia
| | | | | | | | | | | | | | | | | | | | - Dong-Sik Kim
- Korea University College of Medicine, Seoul, Republic of Korea
| | | | - Fazal Karim
- Sir Salimullah Medical College, Mitford Hospital, Dhaka, Bangladesh
| | - Francois Durand
- Université de Paris, AP-HP, C, DMU DIGEST, Centre de Référence Des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Centre de Recherche Sur L'inflammation, Inserm, Paris, France
| | | | - Gennaro D'Amico
- Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
- Clinica La Maddalena, Palermo, Italy
| | - George K Lau
- Humanity and Health Medical Center, Hongkong, SAR, China
| | | | - Graciela Elia Castro Narro
- Hospital Médica Sur, Mexico City, Mexico
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubiran",, Mexico City, Mexico
- Latin-American Association for the Study of the Liver (ALEH), Santiago de Chile, Chile
| | - Guan-Huei Lee
- National University Hospital, National University of Singapore, Singapore, Singapore
| | - Gupse Adali
- University of Health Sciences, Ümraniye, Istanbul, Turkey
| | | | - Gyongyi Szabo
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - H C Lin
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hai Li
- School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hari Kumar Nair
- Ernakulam Medical Center (EMC), Kinder Multispeciality Hospital, Kochi, Kerala, India
| | | | - Harshvardhan Tevethia
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | | | | | | | - Irsan Hasan
- Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta, Indonesia
| | - J Fernandez
- University of Barcelona, IDIBAPS and CIBEREHD, Barcelona, Spain
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, NSW, Australia
| | - Jaideep Behari
- Pittsburgh Liver Research Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James Fung
- Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | | | - Jaya Benjamin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Jennifer C Lai
- University of California, San Francisco, San Francisco, CA, USA
| | - Jidong Jia
- Capital Medical University, Beijing, China
| | - Jin Hua Hu
- The Fifth Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Jin Jun Chen
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jin Lin Hou
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jin Mo Yang
- The Catholic University of Korea, Seoul, Korea
| | - Johannes Chang
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Jonel Trebicka
- Medizinische Klinik B, Universitätsklinikum Münster, Münster, Germany
| | - Jörg C Kalf
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Jose D Sollano
- Department of Medicine, Cardinal Santos Medical Center, Manila, Philippines
| | - Joy Varghese
- Gleneagles Global Hospital, Chennai, Tamil Nadu, India
| | - Juan Pablo Arab
- Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Schulich School of Medicine, Western University, London, ON, Canada
| | - Jun Li
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | | | - Kaiser Raja
- King's College Hospital London, Dubai, United Arab Emirates
| | - Kalpana Panda
- IMS and SUM Hospital, SOA University, Bhubaneswar, Odisha, India
| | - Kamal Kajal
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Karan Kumar
- Mahatma Gandhi Medical College, Jaipur, Rajasthan, India
| | - Kaushal Madan
- Max Super Specialty Hospital Saket, New Delhi, India
| | - Kemal Fariz Kalista
- Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta, Indonesia
| | | | - Khin Maung Win
- University of Medicine, Yangon Ministry of Health, Yangon, Myanmar
| | - Ki Tae Suk
- Hallym University, Chuncheon, Republic of Korea
| | | | | | - Lubna Kamani
- Liaquat National Hospital, Karachi, Sindh, Pakistan
| | - Madhumita Premkumar
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Mamun Al Mahtab
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Man Fung Yuen
- Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | | | - Manasa Alla
- Asian Institute of Gastroenterology Hospitals, Hyderabad, India
| | | | - Manoj Kumar Sharma
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Manoj Sahu
- IMS and SUM Hospital, SOA University, Bhubaneswar, Odisha, India
| | - Manya Prasad
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Mark Dhinesh Muthiah
- National University Hospital, National University of Singapore, Singapore, Singapore
| | - Martin Schulz
- Goethe University Clinic Frankfurt, Frankfurt, Germany
| | - Meenu Bajpai
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | | | | | - Ming Lung Yu
- Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- College of Medicine, National Sun Yet-Sen University, Kaohsiung, Taiwan
| | | | - Mithun Sharma
- Asian Institute of Gastroenterology Hospitals, Hyderabad, India
| | | | - Mohammed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, NSW, Australia
| | - Mohd Golam Azam
- Endocrine and Metabolic Disorder (BIRDEM) Shahbad, Bangladesh Institute of Research and Rehabilitation in Diabetes, Dhaka, Bangladesh
| | - Mohd Rela
- Dr. Rela Institute and Medical Centre, Chennai, India
| | - Moreshwar S Desai
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Mukul Vij
- Dr. Rela Institute and Medical Centre, Chennai, India
| | - Nadim Mahmud
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Necati Ormeci
- İstanbul Health and Technology University, Istanbul, Turkey
| | - Neeraj Saraf
- Medanta-The Medicity Hospital, Gurugram, Haryana, India
| | - Nipun Verma
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Norifumi Kawada
- Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Oidov Baatarkhuu
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | - Osamu Yokosuka
- Graduate School of Medicine, Chiba University, Chuo-Ku, Chiba, Japan
| | - P N Rao
- Asian Institute of Gastroenterology Hospitals, Hyderabad, India
| | - Paolo Angeli
- Department of Medicine (DIMED), University of Padova, Padua, Italy
| | | | | | | | - Philipp Lingohr
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Piyush Ranjan
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Pravin Rathi
- Topi Wala National (TN) Medical College and BYL Nair Charitable Hospital, Mumbai, India
| | | | - Puneet Puri
- Virginia Commonwealth University, Richmond, VA, USA
| | - Qin Ning
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - R K Dhiman
- Sanjay Gandhi Post Graduate Institute (SGPGI), Lucknow, Uttar Pradesh, India
| | - Rahul Kumar
- Changi General Hospital, Singapore, Singapore
| | - Rajan Vijayaraghavan
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Rajeev Khanna
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Rakhi Maiwall
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Ravi Mohanka
- Sir HN Reliance Foundation Hospital, Girgaon, Mumbai, Maharashtra, India
| | - Richard Moreau
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), Barcelona, Spain
- Centre de Recherche Sur L'Inflammation (CRI), INSERM and Université Paris-Cité, Paris, France
- Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Beaujon, Service d'Hépatologie, Clichy, France
| | - Rino Alvani Gani
- Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta, Indonesia
| | - Rohit Loomba
- University of California, San Diego, La Jolla, CA, USA
| | - Rohit Mehtani
- Amrita Institute of Medical Sciences and Research Centre, Faridabad, Haryana, India
| | | | - S S Hamid
- Aga Khan University Hospital, Karachi, Pakistan
| | | | - Sadhna Lal
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sagnik Biswas
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Samagra Agarwal
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Sanjiv Saigal
- Max Super Specialty Hospital Saket, New Delhi, India
| | | | | | - Satender Pal Singh
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | | | - Saurabh Mukewar
- Midas Multispeciality Hospital Pvt. Ltd, Nagpur, Maharashtra, India
| | - Seema Alam
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Seng Gee Lim
- National University Hospital, National University of Singapore, Singapore, Singapore
| | - Shahinul Alam
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Shalimar
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | | | - Shiran Shetty
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shobna Bhatia
- National Institute of Medical Sciences, Jaipur, India
| | | | - Shyam Kottilil
- University of Maryland School of Medicine, Baltimore, USA
| | | | - S M Shasthry
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | | | - Soek Siam Tan
- Selayang Hospital, University of Malaysia, Batu Caves, Selangor, Malaysia
| | | | | | | | - Subhash Gupta
- Max Super Specialty Hospital Saket, New Delhi, India
| | | | - Sudhamshu K C
- Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Sudhir Maharshi
- Sawai Man Singh (SMS) Medical College and Hospital, Jaipur, Rajasthan, India
| | - Sumeet Asrani
- Baylor Simmons Transplant Institute, Dallas, TX, USA
| | - Sunil Dadhich
- Dr Sampuranand Medical College (SNMC), Jodhpur, Rajasthan, India
| | - Sunil Taneja
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Suprabhat Giri
- Kalinga Institute of Medical Sciences (KIMS), Bhubaneshwar, Orissa, India
| | - Surender Singh
- Sanjay Gandhi Post Graduate Institute (SGPGI), Lucknow, Uttar Pradesh, India
| | - Tao Chen
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tarana Gupta
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Tatsuo Kanda
- Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | | | | | - Ulrich Spengler
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - V G Mohan Prasad
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | | | | | - Vicente Arroyo
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), Barcelona, Spain
| | - Vikrant Sood
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Vinay Kumar Br
- Mazumdar Shaw Medical Centre, Bangalore, Karnataka, India
| | | | - Viniyendra Pamecha
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Virendra Singh
- Punjab Institute of Liver and Biliary Sciences, Mohali, Punjab, India
| | - Vishwa Mohan Dayal
- Indira Gandhi Institute of Medical Sciences, (IGIMS), Bely Road Patna, Bihar, India
| | | | - WRay Kim
- Stanford University, Stanford, CA, USA
| | - Wasim Jafri
- Aga Khan University Hospital, Karachi, Pakistan
| | - Wenyi Gu
- Goethe University Clinic Frankfurt, Frankfurt, Germany
| | - Wong Yu Jun
- Changi General Hospital, Singapore, Singapore
| | - Xiaolong Qi
- Medical School, Zhongda Hospital, Southeast University, Nanjing, China
| | - Yogesh K Chawla
- Kalinga Institute of Medical Sciences (KIMS), Bhubaneshwar, Orissa, India
| | - Yoon Jun Kim
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yu Shi
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Zaigham Abbas
- Ziauddin University Hospital Karachi, Karachi, Pakistan
| | - Guresh Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | | | - Lai Wei
- Changgung Hospital, Tsinghua University, Beijing, China
| | - Masao Omata
- Yamanashi Central Hospital, Yamanashi, Japan
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
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Satre DD, Dasarathy D, Batki SL, Ostacher MJ, Snyder HR, Hua W, Parekh P, Shui AM, Cheung R, Monto A, Wong RJ, Chen JY, Liao M, Tana M, Chen PH, Haight CG, Fakadej T, Khalili M. Factors Associated With Motivation to Reduce Alcohol Use Among Patients With Chronic Liver Disease. Aliment Pharmacol Ther 2025; 61:481-490. [PMID: 39523996 PMCID: PMC11710982 DOI: 10.1111/apt.18387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Revised: 09/25/2024] [Accepted: 10/25/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND AND AIMS Alcohol use is prevalent among hepatology clinic patients with chronic liver disease (CLD). We explored factors associated with the importance and confidence dimensions of motivation to reduce drinking. METHODS Participants (N = 121) with unhealthy alcohol use (i.e., over NIH guidelines) receiving care in hepatology clinics from a safety-net hospital (SN, N = 54) and two Veterans Affairs Healthcare Systems (VA, N = 67) were enrolled in an alcohol intervention trial from March 2022 through October 2023. Baseline assessments included Generalised Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-8), Alcohol Use Disorders Identification Test (AUDIT), COVID-19 stress; and measures of importance and confidence to decrease alcohol use (readiness rulers, scales of 1-10). Liver disease aetiology and severity were extracted from electronic health records. We performed multivariable linear regression models with forward selection to assess pre-specified variables' associations with importance and confidence. RESULTS The sample was 84% male, 40% Latino, 31% White, 18% Black and 11% other races; median age was 61 years. Median (Q1-Q3) AUDIT score was 16 (12-24), importance was 9 (6-10) and confidence was 8 (5-9). On multivariable analysis, VA site (vs. SN) participants had a 0.97-point lower importance score (p = 0.02); higher symptoms of depression (PHQ-8 score ≥ 10 vs. < 10) and AUDIT scores (for each point increase) were associated with higher importance score (estimates 1.2 and 0.08, p < 0.05, respectively). Liver disease aetiology and severity were not significantly associated with outcomes. CONCLUSIONS Depression, alcohol problem severity and treatment site may influence motivation to reduce alcohol use and could inform future hepatology-based interventions.
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Affiliation(s)
- Derek D. Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA USA
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA USA
| | | | - Steven L. Batki
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA USA
- Mental Health Service, Veterans Affairs San Francisco Health Care System, San Francisco, CA USA
| | - Michael J. Ostacher
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA USA
- Department of Psychiatry, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA USA
| | - Hannah R. Snyder
- Department of Family and Community Medicine, University of California, San Francisco, CA USA. University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, San Francisco, CA USA
| | - William Hua
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA USA
- Mental Health Service, Veterans Affairs San Francisco Health Care System, San Francisco, CA USA
| | - Priti Parekh
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA USA
| | - Amy M. Shui
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA USA
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA USA
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA USA
| | - Alexander Monto
- Division of Gastroenterology and Hepatology, Veterans Affairs San Francisco Health Care System, San Francisco, CA USA
| | - Robert J. Wong
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA USA
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA USA
| | - Jennifer Y. Chen
- Division of Gastroenterology and Hepatology, Zuckerberg San Francisco General, San Francisco, CA USA
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Francisco, CA USA
| | - Meimei Liao
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA USA
| | - Michele Tana
- Division of Gastroenterology and Hepatology, Zuckerberg San Francisco General, San Francisco, CA USA
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Francisco, CA USA
- University of California San Francisco Liver Center, San Francisco, CA USA
| | - Po-Hung Chen
- Division of Gastroenterology & Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Christina G. Haight
- Division of Gastroenterology and Hepatology, Veterans Affairs San Francisco Health Care System, San Francisco, CA USA
| | - Taylor Fakadej
- Division of Gastroenterology and Hepatology, Zuckerberg San Francisco General, San Francisco, CA USA
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Francisco, CA USA
| | - Mandana Khalili
- Division of Gastroenterology and Hepatology, Zuckerberg San Francisco General, San Francisco, CA USA
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Francisco, CA USA
- University of California San Francisco Liver Center, San Francisco, CA USA
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Maegawa FB, Stetler J, Patel D, Patel S, Serrot FJ, Lin E, Patel AD. Robotic compared with laparoscopic cholecystectomy: A National Surgical Quality Improvement Program comparative analysis. Surgery 2025; 178:108772. [PMID: 39277483 DOI: 10.1016/j.surg.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 08/05/2024] [Accepted: 08/09/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND Data demonstrating the clinical benefit of robotic cholecystectomy over the laparoscopic approach are lacking. Herein, we aim to evaluate whether robotic cholecystectomy is associated with improved surgical outcomes compared with laparoscopic cholecystectomy. STUDY DESIGN This is a retrospective cohort study that used the American College of Surgeons National Surgical Quality Improvement Program to compare the outcomes of patients who underwent robotic or laparoscopic cholecystectomy for benign indications in 2022. RESULTS Of the 59,216 patients identified, 53,746 underwent laparoscopic cholecystectomy and 5,470 robotic. Compared with the robotic cohort, the patients in the laparoscopic cholecystectomy group were older (50.4 vs 49.7 years), were of the male sex (32.7% vs 29.7%), and comprised a greater percentage of other races than White, African American, and Asian (28.6% vs 14.8%). Multivariable logistic regression revealed that robotic cholecystectomy compared with the laparoscopic approach was independently associated with a lower risk of Clavien-Dindo complications grade 3 or 4 (odds ratio, 0.82; 95% confidence interval, 0.69-0.98), a lower rate of conversion to open (odds ratio, 0.44; 95% confidence interval, 0.32-0.61), and lower odds of requiring hospitalization ≥24 hours (odds ratio, 0.76; 95% confidence interval, 0.71-0.81). There were no significant differences between the 2 approaches in terms of reoperation (odds ratio, 0.69; 95% confidence interval, 0.47-1.00) and readmission (odds ratio, 0.94; 95% confidence interval, 0.82-1.10). CONCLUSION Robotic cholecystectomy was independently associated with a lower risk of serious complications, lower rate conversion to open, and hospitalization ≥24 hours compared with laparoscopic cholecystectomy. These findings suggest that new technologies might enhance the safety of minimally invasive surgery.
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Affiliation(s)
- Felipe B Maegawa
- Division of General & GI Surgery, Department of Surgery, Emory University, Atlanta, GA.
| | - Jamil Stetler
- Division of General & GI Surgery, Department of Surgery, Emory University, Atlanta, GA
| | - Dipan Patel
- Division of General & GI Surgery, Department of Surgery, Emory University, Atlanta, GA
| | - Snehal Patel
- Division of General & GI Surgery, Department of Surgery, Emory University, Atlanta, GA
| | - Federico J Serrot
- Department of Surgery, Cleveland Clinic Florida, Weston, FL. https://twitter.com/FedeSerrotMD
| | - Edward Lin
- Division of General & GI Surgery, Department of Surgery, Emory University, Atlanta, GA. https://twitter.com/EdLinEmory
| | - Ankit D Patel
- Division of General & GI Surgery, Department of Surgery, Emory University, Atlanta, GA. https://twitter.com/AnkitPatelMD
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De Gasperi A, Petrò L, Cerutti E. Liver Transplantation and the Older Adults Candidate: Perioperative Considerations. Clin Geriatr Med 2025; 41:65-81. [PMID: 39551542 DOI: 10.1016/j.cger.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2024]
Abstract
Pioneered by Thomas Starzl in the early 1970s, liver transplant (LT) is nowadays often considered a final intervention and standard of care to cure many forms of acute and chronic end-stage liver diseases. Started in recipients younger than 60 years old, LT indications are now much broader, and at least, one-fifth of the candidates are older than 65 years. Problems associated with ageing and frailty in LT recipients and their impact on the entire perioperative course are discussed according to a modern anesthesiological perspective and the anesthesiologist covering the role of the perioperative (transplant) physician.
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Affiliation(s)
| | - Laura Petrò
- ANRI1 - Emergency and Intensive Care, ASST Ospedale Giovanni XXIII, Bergamo, Italy; ASST Papa Giovanni XXII, Piazza MSO 1, 24100 Bergamo, Italy
| | - Elisabetta Cerutti
- Anestesia e Rianimazione dei Trapianti e Chirurgia Maggiore, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60020, Ancona, Italy; Azienda Ospedaliero Universitaria "Ospedali Riuniti", Via Conca 71, 60020, Ancona, Italy
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40
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Kramer AH, Couillard PL, Doig CJ, Kromm JA. Neuroimaging Augments DCD-N Score in Predicting Time from Withdrawal of Life-Sustaining Measures to Death Among Potential Organ Donors. Neurocrit Care 2025:10.1007/s12028-024-02204-x. [PMID: 39776350 DOI: 10.1007/s12028-024-02204-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Accepted: 12/20/2024] [Indexed: 01/11/2025]
Abstract
BACKGROUND Controlled donation after circulatory determination of death (DCD) is feasible only if circulatory arrest occurs soon after withdrawal of life-sustaining measures (WLSM). When organ recovery cannot proceed because this time interval is too long, there are potential negative implications, including perceptions of "secondary loss" for patients' families and significant resource consumption. The DCD-N score is a validated clinical tool for predicting rapid death following WLSM. We hypothesized that neuroimaging evidence of effaced perimesencephalic cisterns improves prediction of time to death compared with the DCD-N score alone. METHODS In a retrospective population-based cohort study, DCD-N scores were prospectively determined in patients for whom consent for DCD had been obtained. Perimesencephalic cisterns on last available neuroimaging were assessed in duplicate and classified as normal, partially effaced, or completely effaced. Multivariable logistic regression assessed the capacity of DCD-N score and effaced cisterns to predict death within 1, 2, or 3 h of WLSM. RESULTS Of 164 consecutive patients, 49 (30%) progressed to death by neurologic criteria and were excluded. Of the remaining 115 patients, 81 (70%) died within 2 h of WLSM. When perimesencephalic cisterns were patent, this occurred in 48% of patients, compared with 88% and 93%, respectively, of patients with partially and completely effaced cisterns (p < 0.0001). In multivariable analysis, the odds ratio for prediction of death within 2 h was 7.2 (2.8-18.3) for each incremental DCD-N score and 15.4 (4.1-58.1) for the presence of either partially or completely effaced cisterns (c = 0.92 vs. 0.75-0.84 for univariate models). Results were comparable for prediction of death within 1 or 3 h. With patent cisterns, median time to death was 132.5 (21-420) minutes, compared with 23.5 (16-32) and 22 (19-30) minutes, respectively, with partially and completely effaced cisterns (p = 0.0002). CONCLUSIONS Cerebral edema with effaced perimesencephalic cisterns predicts rapid death following WLSM in potential DCD organ donors and improves on performance of the DCD-N score alone. Although originally validated for the prediction of death within 1 h, the DCD-N score remains predictive up to 3 h following WLSM.
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Affiliation(s)
- Andreas H Kramer
- Departments of Critical Care Medicine and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
| | - Philippe L Couillard
- Departments of Critical Care Medicine and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Christopher J Doig
- Departments of Critical Care Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Julie A Kromm
- Departments of Critical Care Medicine and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Give Life Alberta South Zone, Calgary, AB, Canada
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Ang SP, Chia JE, Iglesias J, Usman MH, Krittanawong C. Coronary Intervention Outcomes in Patients with Liver Cirrhosis. Curr Cardiol Rep 2025; 27:2. [PMID: 39754700 PMCID: PMC11700054 DOI: 10.1007/s11886-024-02163-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2024] [Indexed: 01/06/2025]
Abstract
PURPOSE OF REVIEW This review assesses the outcomes of coronary interventions in patients with liver cirrhosis and coronary artery disease (CAD), focusing on the clinical challenges posed by cirrhosis-related hemodynamic and coagulopathic changes. It highlights essential considerations for managing these patients, who have an increased risk of adverse events during coronary procedures. RECENT FINDINGS Recent studies have shown that patients with liver cirrhosis undergoing PCI experience significantly higher mortality rates compared to non-cirrhotic patients, particularly in the context of STEMI and NSTEMI. Coagulopathy and thrombocytopenia increase the risk of bleeding and vascular complications during interventions. Radial access has been suggested as a safer alternative to femoral access in these patients due to reduced bleeding complications. Additionally, contrast-induced nephropathy (CIN) is a prevalent risk, with cirrhotic patients demonstrating higher rates of acute kidney injury post-PCI. Preventive strategies such as minimizing contrast exposure and utilizing intravascular ultrasound (IVUS) are recommended. Managing CAD in cirrhotic patients requires careful consideration of their unique pathophysiological state. Higher in-hospital mortality, bleeding risks, and vascular complications necessitate tailored procedural strategies, such as radial access and contrast minimization. The balance between thrombotic and bleeding risks is critical in decision-making, with IVUS and hydration strategies being promising approaches. Further research is required to optimize treatment protocols and improve long-term outcomes for this high-risk population.
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Affiliation(s)
- Song Peng Ang
- Department of Medicine, Rutgers Health/Community Medical Center, Toms River, NJ, USA.
| | - Jia Ee Chia
- Department of Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Jose Iglesias
- Department of Medicine, Rutgers Health/Community Medical Center, Toms River, NJ, USA
- Department of Medicine, Hackensack Meridian School of Medicine, Nutley, NJ, USA
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Yi K, Avery V, McCall J, Giles H, Lindsay H, Gane E, Orr D, Barbier L. Liver Transplantation in Well-Selected Class III Obese Recipients Yields Good Outcomes. Clin Transplant 2025; 39:e70060. [PMID: 39803816 DOI: 10.1111/ctr.70060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 11/11/2024] [Accepted: 12/08/2024] [Indexed: 05/02/2025]
Abstract
INTRODUCTION Previous guidelines considered body mass index (BMI) over 40 kg/m2 a relative contra-indication to liver transplantation (LT). The aims were to examine the selection process and study outcomes of patients with Class I-III obesity. METHODS Retrospective analysis of outcomes of obese patients assessed for LT at our center between 2010 and 2023, divided into three groups: Class I (BMI30-34.9 kg/m2), Class II (BMI35-39.9 kg/m2), and Class III (BMI>40 kg/m2). Survival of non-obese adult patients was used for comparison. RESULTS Three hundred fifteen patients with BMI ≥30 kg/m2 were assessed for LT. Seventeen (5.4%) were not wait-listed due to comorbidities. One hundred sixty-eight patients were transplanted: 100 Class I, 43 Class II, and 25 Class III. There were no differences in postoperative complications (Clavien-Dindo Grade 3 or more; 41%, 42%, 48% for Class I-III obesity respectively) or patient and graft survival (5-y rates 84.4% and 82.7%, respectively, for the whole cohort) according to the different classes of obesity. Furthermore, patient and graft survival was not different between non-obese and obese patients (p = 0.932). CONCLUSION With a rigorous selection process, short-term outcomes after LT for patients with Class III obesity were comparable to patients with Class I-II obesity. Long-term survival was identical for obese and non-obese patients.
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Affiliation(s)
- Kevin Yi
- New Zealand Liver Transplant Unit, Auckland City Hospital, Te Toka Tumai, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Vicki Avery
- New Zealand Liver Transplant Unit, Auckland City Hospital, Te Toka Tumai, Auckland, New Zealand
| | - John McCall
- New Zealand Liver Transplant Unit, Auckland City Hospital, Te Toka Tumai, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Hannah Giles
- New Zealand Liver Transplant Unit, Auckland City Hospital, Te Toka Tumai, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Helen Lindsay
- Anesthesia and Peri-Operative Care, Auckland City Hospital, Te Toka Tumai, Auckland, New Zealand
| | - Ed Gane
- New Zealand Liver Transplant Unit, Auckland City Hospital, Te Toka Tumai, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - David Orr
- New Zealand Liver Transplant Unit, Auckland City Hospital, Te Toka Tumai, Auckland, New Zealand
| | - Louise Barbier
- New Zealand Liver Transplant Unit, Auckland City Hospital, Te Toka Tumai, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
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Katbamna B, Wu L, Rodriguez M, King P, Schilling J, Mahar J, Nair AP, Jneid H, Klings ES, Weinhouse GL, Mazimba S, Simon MA, Strauss M, Krittanawong C. The uses of right heart catheterization in cardio-pulmonary disease: State-of-the-art. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2025; 49:100488. [PMID: 39760109 PMCID: PMC11699050 DOI: 10.1016/j.ahjo.2024.100488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 10/27/2024] [Accepted: 12/03/2024] [Indexed: 01/07/2025]
Abstract
The right heart catheterization (RHC) remains an important diagnostic tool for a spectrum of cardiovascular disease processes including pulmonary hypertension (PH), shock, valvular heart disease, and unexplained dyspnea. While it gained widespread utilization after its introduction, the role of the RHC has evolved to provide valuable information for the management of advanced therapies in heart failure (HF) and cardiogenic shock (CS) to name a few. In this review, we provide a comprehensive overview on the indications, utilization, complications, interpretation, and calculations associated with RHC.
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Affiliation(s)
- Bhavesh Katbamna
- Division of Cardiovascular Disease, Section of Advanced Heart Failure and Transplant Cardiology, Barnes-Jewish Hospital, Washington University in St. Louis School of Medicine, USA
| | - Lingling Wu
- Cardiovascular Division, the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mario Rodriguez
- Division of Cardiovascular Disease, Section of Advanced Heart Failure and Transplant Cardiology, Barnes-Jewish Hospital, Washington University in St. Louis School of Medicine, USA
| | - Phillip King
- Division of Cardiovascular Disease, Section of Advanced Heart Failure and Transplant Cardiology, Barnes-Jewish Hospital, Washington University in St. Louis School of Medicine, USA
| | - Joel Schilling
- Division of Cardiovascular Disease, Section of Advanced Heart Failure and Transplant Cardiology, Barnes-Jewish Hospital, Washington University in St. Louis School of Medicine, USA
| | - Jamal Mahar
- Section of Cardiology, Texas Heart Institute, Baylor College of Medicine, Houston, TX, USA
| | - Ajith P. Nair
- Section of Cardiology, Texas Heart Institute, Baylor College of Medicine, Houston, TX, USA
| | - Hani Jneid
- John Sealey Centennial Chair in Cardiology, Chief of Cardiology, The University of Texas Medical Branch, TX, USA
| | | | - Gerald L. Weinhouse
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sula Mazimba
- Department of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, USA
| | - Marc A. Simon
- Pulmonary Vascular Disease, a PHA Center of Comprehensive Care, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Markus Strauss
- Department of Cardiology, Sector Preventive Medicine, Health Promotion, Faculty of Health, School of Medicine, University Witten/Herdecke, 58095 Hagen, Germany
- Department of Cardiology I- Coronary and Periphal Vascular Disease, Heart Failure Medicine, University Hospital Muenster, Cardiol, 48149 Muenster, Germany
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Robinson BL, Ciobanu C, Brown RS, Russo MW. A tale of 2 diseases: ALD and MASLD requirements and monitoring for liver transplantation. Liver Transpl 2025; 31:117-121. [PMID: 39133045 DOI: 10.1097/lvt.0000000000000455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 08/06/2024] [Indexed: 08/13/2024]
Abstract
The requirements for eligibility and monitoring before and after liver transplantation for alcohol-associated liver disease (ALD) and metabolic dysfunction-associated steatotic liver disease (MASLD) are different and not as well defined for MASLD as they are for ALD. Two groups of patients with ALD considered for liver transplant (LT) include those with decompensated cirrhosis from alcohol and those with severe alcohol-associated hepatitis. Both groups are required to commit to lifelong abstinence from alcohol. Pretransplant eligibility criteria for LT in those with ALD varies between transplant centers, but generally, a period of alcohol abstinence with or without counseling is required to be considered for an LT, or the candidate must meet specific requirements. In contrast to ALD, the pre-LT requirements for patients with MASLD, such as weight loss goals or control of metabolic diseases, are not as well defined. Reviews and consensus statements on MASLD and LT discuss risk stratification and management for conditions associated with MASLD, but there are no consensus recommendations regarding obesity and metabolic disease goals before and after transplant. Candidates and recipients of LT may be held to more stringent requirements and monitoring for alcohol use compared to weight loss goals and metabolic parameters advised for patients with MASLD. Because of the disparities in requirements between ALD and MASLD, consensus recommendations should be developed for pre-LT and post-LT monitoring and requirements for candidates and recipients with MASLD.
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Affiliation(s)
- Benjamin L Robinson
- Division of Hepatology, Department of Medicine, Atrium Health Wake Forest, Charlotte, North Carolina, USA
| | - Camelia Ciobanu
- Division of Hepatology, Department of Medicine, Atrium Health Wake Forest, Charlotte, North Carolina, USA
| | - Robert S Brown
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Mark W Russo
- Division of Hepatology, Department of Medicine, Atrium Health Wake Forest, Charlotte, North Carolina, USA
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Depauw L, Townsend A, Karapetis C, Roy A, Wigg A, Tebbutt NC, Chen J, Brooke-Smith M, Price T. Role of locoregional therapy including liver transplantation in liver-only metastatic colorectal cancer: a review paper. Expert Rev Anticancer Ther 2025; 25:41-53. [PMID: 39718339 DOI: 10.1080/14737140.2024.2447360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Revised: 12/21/2024] [Accepted: 12/23/2024] [Indexed: 12/25/2024]
Abstract
INTRODUCTION Resection of primary tumor and liver metastases is the gold standard for colorectal cancer with liver-only metastases (CRLM). Although treatment options have expanded to enable conversion of unresectable to resectable CRLM, about 40% of patients will have definitively unresectable disease. Major advances in surgical techniques, immunosuppressive protocols and patient selection criteria for liver transplantation have resulted in improved outcomes. AREAS COVERED A literature search has been conducted in Pubmed for articles published between 2014 and 2024. This review paper comments on current liver-directed treatment options for CRLM: resection, percutaneous ablation, conversion-chemotherapy, TACE, SIRT, and SABR. We explore evidence for liver transplantation in patients with unresectable CRLM, comment on possible limitations for implementation in clinical practice and give an overview of the current guidelines on liver transplantation in the USA, Europe, the United Kingdom, and Australia/New Zealand. EXPERT OPINION The recent randomized TRANSMET trial, investigating liver transplantation versus chemotherapy in unresectable CRLM, shows promising 5-year OS reaching similar values as for other accepted liver transplantation indications. Further investigations with RCTs to investigate reproducibility and feasibility in clinical practice are needed. Before liver transplantation can be implemented as a standard treatment option, reorganizations at federal, regional and hospital levels would be required.
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Affiliation(s)
- Laura Depauw
- Department of Medical Oncology, The Queen Elizabeth Hospital, Woodville, SA, Australia
| | - Amanda Townsend
- Department of Medical Oncology, The Queen Elizabeth Hospital, Woodville, SA, Australia
| | - Christos Karapetis
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Amitesh Roy
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Alan Wigg
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- South Australian Liver Transplant Unit, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Niall C Tebbutt
- Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, VIC, Australia
- Department of Surgery, University of Melbourne, Parkville, VIC, Australia
| | - John Chen
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Mark Brooke-Smith
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Timothy Price
- Department of Medical Oncology, The Queen Elizabeth Hospital, Woodville, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
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Hudson D, Ayares G, Taboun Z, Malhi G, Idalsoaga F, Mortuza R, Souyet M, Ramirez-Cadiz C, Díaz LA, Arrese M, Arab JP. Periodontal disease and cirrhosis: current concepts and future prospects. EGASTROENTEROLOGY 2025; 3:e100140. [PMID: 40160254 PMCID: PMC11950965 DOI: 10.1136/egastro-2024-100140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Accepted: 02/05/2025] [Indexed: 04/02/2025]
Abstract
Periodontal diseases are prevalent among the general population and are associated with several systemic conditions, such as chronic kidney disease and type 2 diabetes mellitus. Chronic liver disease and cirrhosis have also been linked with periodontal disease, an association with complex underlying mechanisms, and with potential prognostic implications. Multiple factors can explain this relevant association, including nutritional factors, alcohol consumption, disruption of the oral-gut-liver axis and associated dysbiosis. Additionally, patients with liver disease have been observed to exhibit poorer oral hygiene practices compared with the general population, potentially predisposing them to the development of periodontal disease. Therefore, it is recommended that all patients with liver disease undergo screening and subsequent treatment for periodontal disease. Treatment of periodontal disease in patients with cirrhosis may help reduce liver-derived inflammatory damage, with recent research indicating a potential benefit in terms of reduced mortality. However, further studies on periodontal disease treatment in patients with liver disease are still warranted to determine optimal management strategies. This narrative review describes current concepts on the association between periodontal disease and chronic liver disease.
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Affiliation(s)
- David Hudson
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada
| | - Gustavo Ayares
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Zahra Taboun
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Gurpreet Malhi
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada
| | - Francisco Idalsoaga
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rokhsana Mortuza
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada
| | - Maite Souyet
- Escuela de Odontología, Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Santiago, Chile
- Escuela de Odontología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carolina Ramirez-Cadiz
- Department of Anesthesiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Luis Antonio Díaz
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- MASLD Research Center, Division of Gastroenterology and Hepatology, University of California San Diego, San Diego, California, USA
| | - Marco Arrese
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Pablo Arab
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Luk JW, Ha N, Shui AM, Snyder HR, Batki SL, Ostacher MJ, Monto A, Wong RJ, Cheung R, Parekh P, Hua W, Tompkins DA, Fakadej T, Haight CG, Liao M, Khalili M, Satre DD. Demographic and clinical characteristics associated with utilization of alcohol use disorder treatment in a multicenter study of patients with alcohol-associated cirrhosis. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2025; 49:244-255. [PMID: 39632077 PMCID: PMC11747812 DOI: 10.1111/acer.15500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Accepted: 11/05/2024] [Indexed: 12/07/2024]
Abstract
BACKGROUND Alcohol use disorder (AUD) treatment can help improve clinical outcomes among patients with alcohol-associated cirrhosis but is underutilized. Among socioeconomically disadvantaged patients with alcohol-associated cirrhosis, we examined rates of lifetime and past 12-month AUD treatment utilization and associated demographic and clinical characteristics. METHODS Racial/ethnically diverse patients with alcohol-associated cirrhosis who had at least one hepatology clinic visit in the prior 6 months were recruited from three Northern California medical centers serving veterans and safety-net populations. Participants self-reported their AUD treatment utilization, liver disease quality of life (LDQoL), history and current symptoms of anxiety and depression, and problematic drinking as measured by the Alcohol Use Disorders Identification Test (AUDIT). Clinical measures including liver disease severity were captured from medical records. RESULTS Among 196 participants, the majority were male (88%) with a mean age of 62 years. Two-thirds of participants (67%) reported ever utilizing AUD treatment and 32% reported utilizing AUD treatment in the past 12 months. Compared with those who did not utilize AUD treatment, participants who utilized lifetime or past 12-month AUD treatment were younger, had lower LDQoL scores, and had higher scores on current symptoms of anxiety, depression, and problematic drinking. In multivariable analyses, the odds of ever utilizing pharmacological treatment alone or both behavioral and pharmacological treatment (vs. none) were lower with older age or higher LDQoL, and higher among those with a history of anxiety/depressive disorder. For past 12-month treatment utilization, odds were lower with older age, and higher among those with current clinically significant anxiety/depression or problematic drinking. CONCLUSIONS Patients with alcohol-associated cirrhosis who were younger or had anxiety/depression and problematic drinking were more likely to utilize AUD treatment. To improve AUD treatment utilization, targeted outreach to patients less likely to receive care and the provision of integrated ALD and AUD treatment is warranted.
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Affiliation(s)
- Jeremy W. Luk
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Nghiem Ha
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Amy M. Shui
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Liver Center, University of California, San Francisco, San Francisco, CA, USA
| | - Hannah R. Snyder
- Department of Family and Community Medicine, University of California, San Francisco, CA, USA
| | - Steven L. Batki
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- Mental Health Service, Veterans Affairs San Francisco Health Care System, San Francisco, CA, USA
| | - Michael J. Ostacher
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Department of Psychiatry, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Alexander Monto
- Division of Gastroenterology and Hepatology, Veterans Affairs San Francisco Health Care System, San Francisco, CA, USA
| | - Robert J. Wong
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
- Gastroenterology Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
- Gastroenterology Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Priti Parekh
- Department of Psychiatry, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - William Hua
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- Mental Health Service, Veterans Affairs San Francisco Health Care System, San Francisco, CA, USA
| | - D. Andrew Tompkins
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Taylor Fakadej
- Division of Gastroenterology and Hepatology, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Christina G. Haight
- Division of Gastroenterology and Hepatology, Veterans Affairs San Francisco Health Care System, San Francisco, CA, USA
| | - Meimei Liao
- Gastroenterology Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Mandana Khalili
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, CA, USA
- Liver Center, University of California, San Francisco, San Francisco, CA, USA
- Division of Gastroenterology and Hepatology, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Derek D. Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA, USA
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Singal AK, Panneerselvam D, Arab JP, Im G, Kuo YF. Delisting From Liver Transplant List for Improvement and Recompensation Among Decompensated Patients at One Year. Am J Gastroenterol 2024:00000434-990000000-01494. [PMID: 39714037 DOI: 10.14309/ajg.0000000000003259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 10/03/2024] [Indexed: 12/24/2024]
Abstract
INTRODUCTION Data are limited regarding etiology-specific trends for delisting and recompensation for liver disease improvement among liver transplantation (LT)-listed candidates in the United States. METHODS AND RESULTS A retrospective cohort (2002-2022) using United Network of Organ Sharing database examined etiology-specific trends for delisting and recompensation due to liver disease improvement among candidates listed for LT. Of 120,451 listings in adults, 34,444 (2002-2008), 38,296 (2009-2015), 47,711 (2016-2022) were analyzed. A total of 7,196 (6.2%) were delisted for liver disease improvement, with 5.6%, 7.2%, and 5.3% in 3 respective time periods, Armitage trend P < 0.001. Delisting for improvement of liver disease was 8.1%, 5.8%, 4.0%, 3.9%, and 3.1% among listings for alcohol-associated liver disease (ALD n = 41,647), hepatitis C virus infection (HCV n = 38,797), autoimmune (n = 12,131), metabolic-associated steatohepatitis (MASH n = 22,162), hepatitis B virus infection (HBV n = 3,027), and metabolic liver disease (MLD n = 2,687), respectively. One thousand one hundred twenty-two (15.6% or 0.9%) were delisted for improvement at 1 year with cumulative incidence competing for waitlist mortality and receipt of LT of 1.18, 1.17, 0.64, 0.59, 0.50, and 0.34 for ALD, HBV, HCV, MASH, MLD, and autoimmune, respectively. In a fine and gray model, compared with metabolic, subhazard ratio (95% confidence interval) on delisting at 1 year was 3.47 (31.6-3.81) and 3.44 (2.96-3.99), P < 0.001, for ALD and for HBV, respectively. Of 7,196 delisting for improvement, 567 of 5,750 (9.9%) decompensated at listing had recompensation, 19.5% for HBV, 16.6% for MLD and autoimmune, 9.9% ALD, 8.6% for HCV, and 6.9% for MASH. In a logistic regression model among delisted candidates for improved liver disease, HBV vs MASH etiology was associated with recompensation, 2.37 (1.40-4.03), P < 0.001. DISCUSSION ALD and HBV are most frequent etiologies for delisting due to liver disease improvement. About 10% of delisted patients develop recompensation, with HBV etiology most likely to recompensate. Models and biomarkers are needed to identify these candidates for optimal use of deceased donor livers.
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Affiliation(s)
- Ashwani K Singal
- Department of Medicine, University of Louisville Health Sciences Center, Louisville, Kentucky, USA
- Department of Medicine, Trager Transplant Center at Jewish Hospital, Louisville, Kentucky, USA
- Department of Medicine, KRobley Rex VA Medical Center, Louisville, Kentucky, USA
| | - Deepan Panneerselvam
- Department of Medicine, University of South Dakota, Sioux Falls, South Dakota, USA
| | - Juan P Arab
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada
| | - Gene Im
- Department of Medicine, Mount Sinai School of Medicine, New York, New York, USA
| | - Yong-Fang Kuo
- Department of Biostatistics, University of Texas Medical Branch, Galveston, Texas, USA
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Sato-Espinoza K, Chotiprasidhi P, Liza E, Placido-Damian Z, Diaz-Ferrer J. Evolution of liver transplantation in the metabolic dysfunction-associated steatotic liver disease era: Tracking impact through time. World J Transplant 2024; 14:98718. [PMID: 39697455 PMCID: PMC11438936 DOI: 10.5500/wjt.v14.i4.98718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 08/19/2024] [Accepted: 08/23/2024] [Indexed: 09/20/2024] Open
Abstract
Liver transplantation (LT) for metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing globally due to rising rates of obesity and metabolic syndrome, posing significant challenges. MASLD patients typically present with advanced age, higher body mass index (BMI), and metabolic comorbidities such as diabetes, hypertension, and dyslipidemia. Comprehensive pre-transplant evaluations are crucial for assessing surgical risks and preparing patients for transplantation. MASLD patients with higher BMI may experience longer operative times, potentially affecting intraoperative outcomes. In the months following LT, MASLD recipients face persistent challenges, including a higher incidence of metabolic syndrome and cardiovascular events compared to non-MASLD recipients. However, survival rates at 1-, 3-, and 5-years post-LT do not markedly differ from other etiologies, indicating comparable surgical outcomes. Optimizing outcomes in MASLD patients undergoing LT demands a multidisciplinary approach from pre-transplant assessment to post-transplant care. Strategies must address metabolic comorbidities, manage cardiovascular health, and monitor steatosis recurrence, which can be exacerbated by obesity and diabetes. This approach aims to mitigate long-term graft complications and mortality risks, ultimately enhancing transplant success and patient well-being. Continued research is essential to refine these approaches and meet the evolving challenges posed by MASLD as a leading indication for LT worldwide.
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Affiliation(s)
- Karina Sato-Espinoza
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55902, United States
| | - Perapa Chotiprasidhi
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55902, United States
| | - Estefanía Liza
- Hepatology Service, Department of Digestive Diseases, Hospital Nacional Edgardo Rebagliati Martins, Lima 15072, Peru
| | - Zuly Placido-Damian
- Hepatology Service, Department of Digestive Diseases, Hospital Nacional Edgardo Rebagliati Martins, Lima 15072, Peru
| | - Javier Diaz-Ferrer
- Hepatology Service, Department of Digestive Diseases, Hospital Nacional Edgardo Rebagliati Martins, Lima 15072, Peru
- Medicine Faculty, Universidad San Martin de Porres, Lima 02002, Peru
- Gastroenterology Service, Clinica Internacional, Lima 02002, Peru
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50
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Zhu XF, Ding RR, Wang BY, Yang YH, Ta FX, Wang Y, Gao QM, Zhang Q, Xia R, Luo XG, Wang X, Zheng JM, Zhu HQ. Iodine-131 Combined With Plasma Exchange Treatment in Graves' Hyperthyroidism Patients With Severe Liver Injury Whose Average Model for End-Stage Liver Disease Scores >20. GASTRO HEP ADVANCES 2024; 4:100600. [PMID: 39996246 PMCID: PMC11849068 DOI: 10.1016/j.gastha.2024.100600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Accepted: 12/11/2024] [Indexed: 02/26/2025]
Abstract
Background and Aims The purpose of this retrospective study is to describe the Graves' hyperthyroidism patients with severe liver injury treated by iodine-131 combined with plasma exchange (PE). Methods The patients who had hyperthyroidism caused by Graves' disease, with severe liver injury (The level of total bilirubin ≥12 mg/dL), and after 1 week of liver protective medication treatment, the patient's liver function did not improve, were enrolled in this study. All patients were treated with iodine-131 and PE. The patients' laboratory data after 3 months of isotope therapy were collected. Results In this study, there were 8 patients included, the average model for end-stage liver disease (MELD) scores were greater than 20 (ranges from 19 to 30) at baseline. The levels of hemoglobin, platelet count, alanine aminotransferase, aspartate aminotransferase, total bilirubin, direct bilirubin, alkaline phosphatase, glutamyl transpeptidase, MELD scores, free triiodothyronine, free thyroxine, antithyroid peroxidase autoantibody and serum thyrotropin receptor antibodies after PE treatment were significantly lower than before PE treatment (P < .05). The level of total bilirubin at 3 months post-131I treatment was significantly lower than pre-131I treatment (P = .0200), the same was the level of direct bilirubin (P = .0200). Conclusion Our study enrolled Graves' hyperthyroidism patients with severe liver injury whose average MELD scores were greater than 20, and shows that liver function test can recover on about 3 months treated iodine-131 combined with PE therapy.
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Affiliation(s)
- Xin-Fang Zhu
- Department of Transfusion, Huashan Hospital, Fudan University, Shanghai, China
| | - Rong-Rong Ding
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Bing-Yao Wang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
- Liver Diseases Center, Huashan Hospital, Fudan University, Shanghai, China
- National Medical Center for Infectious Diseases, Shanghai, China
- Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, China
| | - Yun-hui Yang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Fu-Xia Ta
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
- Liver Diseases Center, Huashan Hospital, Fudan University, Shanghai, China
- National Medical Center for Infectious Diseases, Shanghai, China
- Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuan Wang
- Department of Transfusion, Huashan Hospital, Fudan University, Shanghai, China
| | - Qing-Mei Gao
- Department of Transfusion, Huashan Hospital, Fudan University, Shanghai, China
| | - Qi Zhang
- Department of Transfusion, Huashan Hospital, Fudan University, Shanghai, China
| | - Rong Xia
- Department of Transfusion, Huashan Hospital, Fudan University, Shanghai, China
| | - Xing-Guang Luo
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut
| | - Xuan Wang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
- Liver Diseases Center, Huashan Hospital, Fudan University, Shanghai, China
- National Medical Center for Infectious Diseases, Shanghai, China
- Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, China
| | - Jian-Ming Zheng
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
- Liver Diseases Center, Huashan Hospital, Fudan University, Shanghai, China
- National Medical Center for Infectious Diseases, Shanghai, China
- Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, China
| | - Hui-Qing Zhu
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China
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