Entering our fourth decade: The next chapter of Liver Transplantation by @acv69cardenas @timucin_taner
journals.lww.com/lt/citation…
🌍 Can mentorship meet global demand in liver transplantation?
The ILTS program drew 114 applicants from 36 countries, with 35 professional achievements reported. Yet mentor shortages and expertise mismatches remain.
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Does portal vein stenosis threaten long-term survival after pediatric LT?
🌍 In 239 patients from 21 centers, 10-year graft and patient survival were 90% and 96%. PVS diagnosed ≤7 days after LT showed the poorest 1-year outcomes.
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#LiverX #LiverFellows
Frailty 1 year after LT predicts long-term mortality. Can we change that?
🇯🇵 Kobayashi et al. explore whether shorter LDLT waits, prehabilitation and nutrition could reduce post-LT frailty and thereby improve long-term outcomes for high-risk recipients.
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Choledocholithiasis & cholangitis are more frequent after LT in patients with prior sphincterotomy.
Beyond reflux & bacterial translocation, could biliary anatomy play a role? Letter & reply discuss anastomotic geometry and MRCP.
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Are smaller grafts necessarily riskier?
🌍 In 1,944 LDLTs (55 centers), small-for-size syndrome rose 33%→63% as graft size fell. GRWR <0.6% had 47.6% grade B/C SFSS. Yet size did not independently predict major complications; 90-day mortality was <5%.
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Does IBD predict PSC recurrence after LT?
🇪🇺 Across 14 centers (n=143), rPSC occurred in 19.6%. IBD was independently associated with recurrence (HR 4.26). rPSC impaired graft survival and increased retransplantation, without affecting patient survival.
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Donor BMI rises, liver biopsy use in LDLT is plummeting.
🇺🇸 In 7,942 LDLTs (2000–2024), donor BMI rose 24.6→27.6, while biopsy use fell ~50%→6%. Higher BMI was not linked to worse recipient outcomes.
Time to standardize steatosis assessment?
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#LiverX
🫀 How mild is “mild” tricuspid regurgitation before liver transplantation?
Among recipients with MELD ≥20, ≥mild TR was associated with higher 1-year mortality (12.7% vs 3.8%; HR 3.46) and postoperative heart failure.
doi.org/10.1097/LVT.00000000…
#LiverX #CardioHepatology
Protect the kidneys. Check the liver.
🇩🇪 In 172 LT recipients, biopsy-guided CNI reduction late after LT preserved eGFR (+0.5 vs −6.5 mL/min over 47 months), while repeat liver biopsies showed no excess inflammation or fibrosis.
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📑MOC Opportunity
Pre-transplant cardiac evaluation in liver transplant recipients
journals.lww.com/lt/fulltext…
#LiverTransplantation #CardiacRisk #CardioHepatology #TransplantCardiology
EDITORIAL 📧
Are synbiotics ineffective after LT or was the trial set up to fail?
A new RCT found no reduction in infections (38.5% vs 33.3%). But low event rates and differential nonadherence complicate interpretation.
Too early to dismiss synbiotics?
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Can robotic LDLT close the warm ischemia gap?
🇰🇷 In 10 consecutive robotic recipient cases, anastomotic WIT fell 64→32 min and operative time 850→584 min (first vs last 5). No conversions.
Will workflow optimization make robotic LT widely feasible?
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Can a deceased donor–derived predictor guide decisions in living donor LT for ACLF? 🧐
In 178 LDLT recipients, SALT-M showed limited discrimination (AUROC 0.56).
Model failure or simply a different patient population? Use with caution ☝️
🔗 doi.org/10.1097/LVT.00000000…
🤖 Robotic liver transplantation: Ready for prime time?
~100 published cases from 5 centers. Early results are promising, but patient selection, technical pitfalls & surgical expertise remain key.
Khan et al. review the evidence, with operative videos 👇
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A neutral primary endpoint does not equal a neutral clinical signal.
In LT, prophylactic use of TXA did not significantly reduce major bleeding, but RBC transfusion was lower.
Are our bleeding endpoints measuring what matters?
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Does response to terlipressin in LT candidates matter beyond HRS-AKI itself? This review examines when its use helps, when it may harm, and how treatment response may affect MELD-based prioritization.
@KavishPatidar11 @Pummy92 @NBegumOzturkMD @Ouranos_Kon
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Can area-level deprivation capture a patient's social risk?
In HCC referred for LT, Aby and Ufere argue area indices miss individual barriers, and that social risk phenotypes, not cumulative counts, better flag patients lost in the care pathway.
doi.org/10.1097/LVT.00000000…
#LiverX
Does one CT scan capture how muscle mass distorts MELD?
Zheng et al. argue muscle loss in cirrhosis is dynamic and needs serial measures. Gupta et al. agree, and find no residual sex effect once muscle mass is considered.
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#LiverX
Is portal vein thrombosis more than a clot?
In CLEARED, PVT carried higher 30-day mortality despite lower MELD-Na. This editorial argues PVT reflects structural disease of the portal vein, which may explain why anticoagulation often disappoints.
doi.org/10.1097/LVT.00000000…
#LiverX
Are livers from SARS-CoV-2-positive donors a thrombotic risk?
In 102 recipients, HAT occurred in 4.9% and no donor or procurement factor predicted thrombosis. 1-year patient and graft survival were 96.1% and 94.1%, with no COVID-related deaths.
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