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Clinical Advances and Challenges in Liver Transplantation: 2nd Edition
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Clinical Advances and Challenges in Liver Transplantation: 2nd Edition

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (25 December 2024) | Viewed by 5502

Special Issue Editors

Dr. Paola Aceto

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Guest Editor
1. Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
2. Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
Interests: geriatric anaesthesia; perioperative medicine; neuroscience (pain mechanisms; cognition) postoperative cognitive disorders; monitoring of anaesthesia depth; anaesthesia for robotic surgery; tranplantation; hemodynamic monitoring
Special Issues, Collections and Topics in MDPI journals
Dr. Dario Lorenzin

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Guest Editor
Liver-Kidney Transplant Unit, Department of Medicine, University of Udine, 33100 Udine, Italy
Interests: liver transplantation; transplantation surgery; liver transplant surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue is the 2nd edition of "Clinical Advances and Challenges in Liver Transplantation" (https://www.mdpi.com/journal/jcm/special_issues/Advances_LT).

In recent years, in deceased donor liver transplantation (DDLT), the inclusion criteria for donation have progressively been expanded. Older donors, those with multiple comorbidities, donors after circulatory death (DCD), or grafts with significant steatosis have increasingly been accepted. This trend has been determined by the increasing organ demand of liver transplantation (LT) candidates, who, in turn, have been listed with progressively worse clinical conditions. However, low-quality graft and high-risk recipients are associated with an greater inherent risk of post-transplant morbidity, such as early allograft dysfunction and vascular and biliary complications. Furthermore, a new trend in the selection criteria of hepatocellular carcinoma (HCC) patients for LT has been developing, aiming to integrate morphological parameters, such as tumor number and size, with more precise markers of tumor biology and patient immune functions.

On the other hand, researchers have developed several new diagnostic or therapeutic tools, such as immune therapy, radiomics analysis, genomic tests, and machine perfusion, with a potentially revolutionary impact on clinical practice.

Therefore, the transplant community must now address new clinical challenges and integrate LT management with new technology advances in a multidisciplinary approach. The present Special Issue aims to consider these crucial clinical issues.

Dr. Paola Aceto
Dr. Dario Lorenzin
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • liver transplantation (LT)
  • deceased donor liver transplantation (DDLT)
  • donors after circulatory death (DCD)

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Published Papers (4 papers)

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Research

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16 pages, 1702 KiB  
Article
Organ Utilization Rates from Non-Ideal Donors for Solid Organ Transplant in the United States
by Steven A. Wisel, Daniel Borja-Cacho, Dominick Megna, Michie Adjei, Irene K. Kim and Justin A. Steggerda
J. Clin. Med. 2024, 13(11), 3271; https://doi.org/10.3390/jcm13113271 - 31 May 2024
Cited by 1 | Viewed by 1476
Abstract
Background: Non-ideal donors provide acceptable allografts and may expand the donor pool. This study evaluates donor utilization across solid organs over 15-years in the United States. Methods: We analyzed the OPTN STAR database to identify potential donors across three donor eras: 2005–2009, 2010–2014, [...] Read more.
Background: Non-ideal donors provide acceptable allografts and may expand the donor pool. This study evaluates donor utilization across solid organs over 15-years in the United States. Methods: We analyzed the OPTN STAR database to identify potential donors across three donor eras: 2005–2009, 2010–2014, and 2015–2019. Donors were analyzed by a composite Donor Utilization Score (DUS), comprised of donor age and comorbidities. Outcomes of interest were overall and organ-specific donor utilization. Descriptive analyses and multivariable logistic regression modeling were performed. p-values < 0.01 considered significant. Results: Of 132,465 donors, 32,710 (24.7%) were identified as non-ideal donors (NID), based on a DUS ≥ 3. Compared to ideal donors (ID), NID were older (median 56 years, IQR 51–64 years vs. 35 years, 22–48 years, p < 0.001) and more frequently female (44.3% vs. 39.1%, p < 0.001), Black (22.1% vs. 14.6%, p < 0.001) and obese (60.7% vs. 19.6%, p < 0.001). The likelihood of overall DBD utilization from NID increased from Era 1 to Era 2 (OR 1.227, 95% CI 1.123–1.341, p < 0.001) and Era 3 (OR 1.504, 1.376–1.643, p < 0.001), while DCD donor utilization in NID was not statistically different across Eras. Compared to Era 1, the likelihood of DBD utilization from NID for kidney transplantation was lower in Era 2 (OR 0.882, 0.822–0.946) and Era 3 (OR 0.938, 0.876–1.004, p = 0.002). The likelihood of NID utilization increased in Era 3 compared to Era 1 for livers (OR 1.511, 1.411–1.618, p < 0.001), hearts (OR 1.623, 1.415–1.862, p < 0.001), and lungs (OR 2.251, 2.011–2.520, p < 0.001). Conclusions: Using a universal definition of NID across organs, NID donor utilization is increasing; however, use of DUS may improve resource utilization in identifying donors at highest likelihood for multi-organ donation. Full article
(This article belongs to the Special Issue Clinical Advances and Challenges in Liver Transplantation: 2nd Edition)
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12 pages, 476 KiB  
Article
Aging with a Liver Graft: Analysis of Very Long-Term Survivors after Liver Transplantation
by Paolo De Simone, Jessica Bronzoni, Caterina Martinelli, Juri Ducci, Daniela Campani, Stefano Gitto, Piero Marchetti and Giandomenico Biancofiore
J. Clin. Med. 2024, 13(4), 1087; https://doi.org/10.3390/jcm13041087 - 14 Feb 2024
Cited by 4 | Viewed by 1641
Abstract
Background: In Italy, data on long-term survivors after liver transplantation are lacking. Materials and Methods: We conducted a hybrid design study on a cohort of 359 adult recipients who received transplants between 1996 and 2002 to identify predictors of survival and the prevalence [...] Read more.
Background: In Italy, data on long-term survivors after liver transplantation are lacking. Materials and Methods: We conducted a hybrid design study on a cohort of 359 adult recipients who received transplants between 1996 and 2002 to identify predictors of survival and the prevalence of co-morbidities among long-term survivors. Results: The actuarial (95% CI) patient survival was 96% (94.6–98.3%), 69% (64.2–73.6%), 55% (49.8–59.9%), 42.8% (37.6–47.8%), and 34% (29.2–38.9%) at 1, 5, 10, 15, and 20 years, respectively. The leading causes of death were hepatitis C virus recurrence (24.6%), extrahepatic malignancies (16.9%), infection (14.4%), and hepatocellular carcinoma recurrence (14.4%). The factors associated with the survival probability were younger donor and recipient ages (p = 0.001 and 0.004, respectively), female recipient sex (p < 0.001), absence of HCV (p < 0.01), absence of HCC (p = 0.001), and absence of diabetes mellitus at one year (p < 0.01). At the latest follow-up, the leading comorbidities were hypertension (53.6%), obesity (18.7%), diabetes mellitus (17.1%), hyperlipidemia (14.7%), chronic kidney dysfunction (14.7%), and extrahepatic malignancies (13.8%), with 73.9% of patients having more than one complication. Conclusions: Aging with a liver graft is associated with an increased risk of complications and requires ongoing care to reduce the long-term attrition rate resulting from chronic immunosuppression. Full article
(This article belongs to the Special Issue Clinical Advances and Challenges in Liver Transplantation: 2nd Edition)
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Review

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12 pages, 1193 KiB  
Review
Intensive Care Unit-Acquired Weakness after Liver Transplantation: Analysis of Seven Cases and a Literature Review
by Rita Gaspari, Giorgia Spinazzola, Paola Aceto, Alfonso Wolfango Avolio, Manuel Delli Compagni, Stefania Postorino, Teresa Michi, Daniele Cosimo Fachechi, Anna Modoni and Massimo Antonelli
J. Clin. Med. 2023, 12(24), 7529; https://doi.org/10.3390/jcm12247529 - 6 Dec 2023
Cited by 3 | Viewed by 1766
Abstract
Intensive Care Unit (ICU)-Acquired Weakness (ICU-AW) is a generalized muscle weakness that is clinically detected in critical patients and has no plausible etiology other than critical illness. ICU-AW is uncommon in patients undergoing orthotopic liver transplantation (OLT). Our report sheds light on the [...] Read more.
Intensive Care Unit (ICU)-Acquired Weakness (ICU-AW) is a generalized muscle weakness that is clinically detected in critical patients and has no plausible etiology other than critical illness. ICU-AW is uncommon in patients undergoing orthotopic liver transplantation (OLT). Our report sheds light on the highest number of ICU-AW cases observed in a single center on OLT patients with early allograft dysfunction. Out of 282 patients who underwent OLT from January 2015 to June 2023, 7 (2.5%) developed generalized muscle weakness in the ICU and underwent neurophysiological investigations. The neurologic examination showed preserved extraocular, flaccid quadriplegia with the absence of deep tendon reflexes in all patients. Neurophysiological studies, including electromyography and nerve conduction studies, showed abnormalities with fibrillation potentials and the rapid recruitment of small polyphasic motor units in the examined muscles, as well as a reduced amplitude of the compound muscle action potential and sensory nerve action potential, with an absence of demyelinating features. Pre-transplant clinical status was critical in all patients. During ICU stay, early allograft dysfunction, acute kidney injury, prolonged mechanical ventilation, sepsis, hyperglycemia, and high blood transfusions were observed in all patients. Two patients were retransplanted. Five patients were alive at 90 days; two patients died. In non-cooperative OLT patients, neurophysiological investigations are essential for the diagnosis of ICU-AW. In this setting, the high number of red blood cell transfusions is a potential risk factor for ICU-AW. Full article
(This article belongs to the Special Issue Clinical Advances and Challenges in Liver Transplantation: 2nd Edition)
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Other

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9 pages, 1326 KiB  
Opinion
Living Donor Liver Transplant Programs in the United States Need to Be Carefully Nurtured Amidst Expanding Use of Perfusion Technology
by Sorabh Kapoor and Chirag S. Desai
J. Clin. Med. 2025, 14(7), 2259; https://doi.org/10.3390/jcm14072259 - 26 Mar 2025
Viewed by 126
Abstract
Living donor transplantation constitutes a small portion of total transplants in the United States as compared Southeast Asia and Middle East. Recent consensus meeting has identified reluctance on the part of transplant providers and donor financial concerns as the major hindrance in increasing [...] Read more.
Living donor transplantation constitutes a small portion of total transplants in the United States as compared Southeast Asia and Middle East. Recent consensus meeting has identified reluctance on the part of transplant providers and donor financial concerns as the major hindrance in increasing the Living donor liver transplants in US. There is a need to carefully analyze the recent outcome data from across the globe and from large volume North American centers that clearly establishes the benefit of Living donor transplants for both adults and children and reducing wait list mortality. LDLT also provides an opportunity for expanding the indications to offer transplant for indications like colorectal metastasis and intrahepatic cholangiocarcinoma without reducing the number of livers available for traditional indications. Recent expansion of perfusion technology has demonstrated significant increase in utilization of Non heart beating donor livers over the last few years. However, with simultaneous increase in patients being added to the wait list, the wait list mortality and dropouts have been persistently high. In this opinion piece, the authors have looked at the transplant trends in the US in the last few years and advocate for adopting a complementary rather than a singular approach for expansion of LDLT along with new perfusion technologies for increasing the number of liver transplants in the US. Full article
(This article belongs to the Special Issue Clinical Advances and Challenges in Liver Transplantation: 2nd Edition)
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