Moral K, Harputluoğlu M, Özkumur GF
… +38 more, Gavcar D, Erbay E, Eren F, Göktuğ MR, Nazari A, Acar S, Ari D, Gökçe DT, Ellik ZM, Işik E, Yağli MA, Akin A, Yilmaz N, Ordu B, Gencdal G, Yüksekyayla O, Gürbüz B, Kekilli M, Cindoruk M, Karakan T, Yilmaz S, Dayangac M, Adanir H, Daniş N, Uyanikoğlu A, Adali G, Gökcan H, Turan I, Kiyici M, Keskin O, Akyildiz M, Kayhan MA, Akarsu M, Kaymakoğlu S, Günşar F, Karasu Z, Idilman R, Kabaçam G
The Model for End-stage Liver Disease Sodium (MELD-Na) score predicts mortality in liver transplant candidates. MELD 3.0 has been proposed as an improved model for estimating mortality risk. This study evaluated MELD 3.0...The Model for End-stage Liver Disease Sodium (MELD-Na) score predicts mortality in liver transplant candidates. MELD 3.0 has been proposed as an improved model for estimating mortality risk. This study evaluated MELD 3.0's predictive accuracy for short-term mortality among Turkish liver transplant candidates and compared its performance with MELD and MELD-Na scores. Patients listed both for deceased donor transplants and living donor transplants were analyzed in the study. The discriminative abilities of MELD, MELD-Na, and MELD 3.0 scores were assessed using the area under the receiver operating characteristic curve (AUROC). Comparisons between AUROC values used the DeLong test. The most predictive cutoff for MELD 3.0 was determined using the Youden index. Transplant-free survival was analyzed using the Kaplan-Meier method, with survival curves compared using the log-rank test. A total of 1689 patients were included in this nationwide, multicenter study. Hepatitis B was the leading cause of cirrhosis (29%, n=491), followed by metabolic dysfunction-associated steatohepatitis (20%, n=335). For 3-month mortality, MELD 3.0 had the highest AUROC (0.753), followed by MELD-Na (0.747) and MELD (0.725). The most predictive cutoff values were 18 for MELD and 21 for MELD-Na and MELD 3.0. Both MELD-Na and MELD 3.0 outperformed MELD ( p <0.001), but showed no significant difference between them ( p =0.17). MELD 3.0 and MELD-Na demonstrated superior performance to MELD in predicting 3-month mortality among Turkish liver transplant candidates, though their predictive accuracy was comparable. Further refinements are needed to enhance MELD 3.0's clinical utility.
Biliary cast syndrome (BCS) remains a significant concern that can lead to graft failure and mortality. Data on the etiology and outcomes are limited, particularly with regard to the differences in the risk of occurrence...Biliary cast syndrome (BCS) remains a significant concern that can lead to graft failure and mortality. Data on the etiology and outcomes are limited, particularly with regard to the differences in the risk of occurrence of BCS between living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT). This study was aimed at identifying the risk factors for BCS and analyzing the impact of BCS on the long-term outcomes in recipients of liver transplantation. We retrospectively reviewed the data of 469 adults who underwent liver transplantation at the University of Tokyo between 2010 and 2023. The risk factors for BCS were analyzed by logistic regression analysis, and the survival outcomes were evaluated by the Kaplan-Meier method. Of the 469 liver transplant recipients included in this study, 31 (6.6%) developed BCS. DDLT was significantly more common in the BCS group (58.1% vs. 11.9%; p <0.01). Multivariate analysis identified DDLT [odds ratio (OR) 10.5; p <0.01], biliary stricture (OR 9.5; p <0.01), hepatic arterial complications (OR 5.0; p =0.04), and older donor age (OR 1.04; p =0.03) as significant risk factors for the development of BCS. No significant difference in the overall survival (OS) was observed between the BCS and non-BCS groups (81.5% vs. 85.6% at 5 y, p =0.79). DDLT was a significant risk factor for the development of BCS, independent of the presence of biliary stricture. When appropriately managed by endoscopic interventions, BCS did not affect the long-term graft or OS. These findings suggest that even in liver transplant recipients developing BCS, timely intervention can ensure favorable long-term outcomes.
Cotter TG, Anouti A, VanWagner LB
… +10 more, Verna EC, Goldberg DS, Keyes KM, Schaefer N, Lee M, Fernandez A, Rady ED, Mitchell MC, Mellinger JL, INTEGRATE Collaborative
Wolfe S, Nadimpalli S, Imai D
… +11 more, Sambommatsu Y, Datta M, Hallesy J, Navarrete S, Khan A, Saeed M, Sharma A, Kumaran V, Cotterell A, Bruno D, Lee SD
Music has long been used to motivate athletes and soldiers, yet transplant patients-who face some of life's most profound physical and emotional battles-rarely choose positive anthems to motivate themselves. As a liver t...Music has long been used to motivate athletes and soldiers, yet transplant patients-who face some of life's most profound physical and emotional battles-rarely choose positive anthems to motivate themselves. As a liver transplant recipient and peer-support facilitator with the Transplant Recipients International Organization (TRIO), I have witnessed how personal "fight songs" help patients reclaim strength, identity, and hope during recovery. Drawing from the experiences of 10 transplant recipients who shared their fight songs and the meanings behind them, we explored how music fosters resilience and coping throughout the transplant journey. Patients described their songs as lifelines during isolation, dialysis, or recovery-reminders that they were "still breathing," "still standing," and "still fighting." A word-cloud analysis of recurring lyrics revealed shared themes of survival, gratitude, and renewal. These songs were not about illness, but about transcendence. Incorporating discussions of music and meaning into transplant care may humanize the medical experience and strengthen emotional recovery. Selecting a fight song can be another tool that healthcare providers recommend to empower transplant patients.
Vionnet J, Ferrari-Lacraz S, Hoessly LD
… +34 more, Mancarella A, Müller YD, Schaub S, Nilsson J, Wirthmüller U, Stampf S, Koller M, Mueller NJ, Amrari M, Manuel O, Golshayan D, Fraga M, Moradpour D, Goossens N, Magini G, Compagnon P, McLin V, Rock N, Wildhaber B, Kremer AE, Oberholzer J, Sousa Da Silva RX, Tinguely P, Kavaliukaite L, Berzigotti A, Banz V, Bernsmeier C, Dutkowski P, Semela D, Niemann M, Pantaleo G, Pascual M, Villard J, and the Swiss Transplant Cohort Study (STCS)
Liver Transpl
· 2026 Jul · PMID 41894252
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Full text
The impact of preformed donor-specific antibodies (DSA) in liver transplantation (LT) remains controversial despite evidence linking their presence to an increased risk of early allograft damage, as well as antibody- and...The impact of preformed donor-specific antibodies (DSA) in liver transplantation (LT) remains controversial despite evidence linking their presence to an increased risk of early allograft damage, as well as antibody- and T-cell-mediated rejection. In this nationwide analysis, preformed DSA were assessed using single-antigen bead assays [positive if mean fluorescence intensity (MFI) ≥1000]. This study included all LT recipients enrolled in the Swiss Transplant Cohort Study (STCS) who underwent LT between 2014 and 2016. One-year post-LT outcomes, including cumulative allograft and patient survival, as well as the incidence of biliary, vascular, and infectious complications, were compared between DSA-positive (DSA+) and DSA-negative (DSA-) individuals. Among 321 LT performed in 306 patients, preformed DSA were detected in 92 (28.7%) and more frequently observed in patients with a history of prior transplantation ( p =0.008) or autoimmune liver disease ( p =0.036). Class I and II DSA were present in 48.9% and 71.1% of DSA+ cases, with concomitant class I and II DSA in 20.7%. The median (IQR) cumulative MFI (cMFI) of the preformed DSA was 3768 (1875-10,537), and 52.2% of DSA+ patients harbored multiple DSA. While overall patient survival did not differ between DSA+ and DSA- individuals, DSA+ patients with cMFI ≥5000 exhibited a higher incidence of allograft failure and biopsy-proven rejection. Multivariate analysis revealed that the presence of preformed DSA was independently associated with biliary complications (HR 2.26, 95% CI 1.17-4.37, p =0.02) but not with vascular or infectious complications. In summary, preformed DSA were associated with biliary complications, increased rejection, and reduced allograft survival. These findings suggest pre-transplant immunological risk assessment and the need for tailored immunosuppressive strategies in LT.
Liver transplantation outcomes have improved. However, immunosuppression also raises infection susceptibility. Potential differences in infections between donation after circulatory death (DCD) and donation after brain d...Liver transplantation outcomes have improved. However, immunosuppression also raises infection susceptibility. Potential differences in infections between donation after circulatory death (DCD) and donation after brain death (DBD) recipients remain unclear. This study analyzed postoperative infections and compared their incidence between DCD and DBD recipients. Patients undergoing liver transplantation from January 1, 2016, to December 31, 2022, were included. DCD and marginal DBD liver grafts underwent hypothermic oxygenated machine perfusion (HOPE). Bacterial, viral, and fungal infections were identified using standardized definitions. Infections were categorized into periods: 0-2 weeks (period 1), 3-4 weeks (period 2), 1-6 months (period 3), and beyond 6 months (period 4). The primary outcome was the occurrence of infection within the first post-transplant year, including pathogen spectrum, timing, and infection site. The secondary outcome was the assessment of infection risk factors investigated with Poisson regression. A total of 300 liver transplants were included. In all, 42.8% of DBD recipients and 44.3% of DCD recipients suffered from at least 1 infection. In total, 298 relevant infections occurred, with bacteria accounting for 73.2% in DBD and 86.4% in DCD recipients. Bacterial infections predominated in all periods. In periods 1 and 2, bloodstream infections, abdominal and surgical site infections were most frequent, while liver-related infections, especially in DCD, and bloodstream infections dominated in periods 3 and 4. Viral and fungal infections were less frequent. One-year survival was 87.1% for DBD and 87.7% for DCD recipients. Poisson regression identified DCD recipients (IRR 1.99, 95% CI 1.37-2.92, p <0.001) and younger age (IRR 0.98, 95% CI 0.97-0.99, p <0.001) as more likely to develop infections. DCD liver recipients experienced more infections in the first post-transplant year. While mortality was not different, the increased infection rates in DCD recipients highlight the need for infection prevention and surveillance.
Acute kidney injury (AKI) is a frequent and severe complication in patients with cirrhosis. Identifying patients at high risk for AKI progression and in-hospital complications could enable timely targeted interventions....Acute kidney injury (AKI) is a frequent and severe complication in patients with cirrhosis. Identifying patients at high risk for AKI progression and in-hospital complications could enable timely targeted interventions. Given the central role of inflammation in AKI and cirrhosis, we investigated whether inflammatory biomarkers could provide prognostic insights. In this multicenter, prospective cohort study, we enrolled 188 patients with cirrhosis and AKI from 4 tertiary care centers. Urine and plasma samples were analyzed for 4 biomarkers: urine monocyte chemoattractant protein-1 (MCP-1), urine YKL-40, and plasma tumor necrosis factor receptors 1 and 2 (TNFR-1, TNFR-2). Biomarkers were assessed for their associations with AKI progression, mortality, and in-hospital complications using multivariate analyses adjusted for demographics, baseline kidney function, and MELD score. Urine MCP-1, plasma TNFR-1, and plasma TNFR-2 were each associated with increased odds of AKI progression and mortality: urine MCP-1 had odds ratio (OR) 2.35 (95% CI, 1.26-5.65), plasma TNFR-1 OR 6.90 (95% CI, 2.45-25.50), and plasma TNFR-2 OR 2.69 (95% CI, 1.34-6.17) per standard deviation (SD) higher biomarker level. Plasma TNFR-1 had the strongest associations with in-hospital complications. Each SD higher plasma TNFR-1 was associated with developing hepatic encephalopathy (OR 2.53; 95% CI, 1.37-5.06), developing spontaneous bacterial peritonitis (OR 2.20; 95% CI, 1.14-4.47), variceal bleeding during admission (OR 3.47; 95% CI, 1.05-14.46), and requiring dialysis (OR 2.81; 95% CI, 1.39-6.23). Inflammatory biomarkers effectively identify high-risk patients with AKI and cirrhosis. Incorporating these biomarkers into clinical decision-making has the potential to guide treatment.