This month’s key articles were selected by Ryan Chadha, Jiang Liu, Alessandra Mazzola, Johns Matthew, and Eleonora DeMartin.

HEPATOLOGY

Transplantation
Relatively Poor Long-term Outcomes Following Liver Transplantation for NASH in the United States
Background: Nonalcoholic steatohepatitis (NASH) continues to increase in frequency as an indication for liver transplantation (LT). Data on long-term outcomes for these patients are limited. We aimed to compare long-term patient and graft survival in patients undergoing LT for NASH in the United States to other indications. More

Journal of Hepatology
Liver stiffness measurement by vibration-controlled transient elastography improves outcome prediction in primary biliary cholangitis
Background & aims: Liver stiffness measurement (LSM) by vibration-controlled transient elastography (VCTE) was shown to predict outcomes of primary biliary cholangitis (PBC) in small-size studies. We aimed to validate the prognostic value of LSM in a large cohort study.
Methods: We performed an international, multicentre, retrospective follow-up study of 3985 patients with PBC seen at 23 centres in 12 countries. Eligibility criteria included at least one reliable LSM by VCTE and a follow-up ≥ 1 year. Independent derivation (n=2740) and validation (n=568) cohorts were built. The primary endpoint was time to poor clinical outcomes defined as liver-related complications, liver transplantation, or death. Hazard ratios (HRs) with confidence intervals (CIs) were determined using a time-dependent multivariable Cox regression analysis. More.

Liver Transplantation
Low-dose aspirin confers protection against acute cellular allograft rejection after primary liver transplantationBackground: The use of low-dose aspirin after LT is practiced by many transplant centers to minimize the risk of hepatic artery thrombosis HAT, although solid recommendations do not exist. However, aspirin also possesses potent anti-inflammatory properties and might mitigate inflammatory processes after LT, such as rejection. Therefore, we hypothesized that the use of aspirin after liver transplantation has a protective effect against ACR. More.

SURGERY

Transplantation
Paired Exchange Living Donor Liver Transplantation: A Nine-year Experience From North India
Background: Paired exchange liver transplantation is an evolving strategy to overcome ABO blood group incompatibility and other barriers such as inadequate graft-to-recipient weight ratio and low remnant liver volume in donors. However, for the transplant team to carry 4 major operations simultaneously is a Herculean effort. We analyzed our experience with liver paired exchange (LPE) program over the past 9 years. More.

Liver Transplantation
Portal vein complications and outcomes following pediatric liver transplantation: Data from the Society of Pediatric Liver Transplantation
Children who undergo liver transplantation are at risk for portal vein complications (PVCs) including thrombosis (PVT) and stenosis (PVS). Using multicenter data from the Society of Pediatric Liver Transplantation, we analyzed the prevalence, timing, and risk factors for PVC following a first liver transplantation, and assessed the potential impact of PVC on patient outcomes. More.

Journal of Hepatobiliary Pancreatic Sciences
A randomized, double-blinded, placebo-controlled trial analyzing the effect of synbiotics on infectious complications following living donor liver transplant-PREPRO trial
Background: Following liver transplantation (LT), bacterial infections occur in over 70% of recipients leading to significant morbidity and mortality. While synbiotics have been reported to decrease infectious complications in various surgical procedures, the evidence of their benefits following LT remains limited. More.

ANESTHESIOLOGY AND CRITICAL CARE

Transplantation
Four Decades of Clinical Liver Transplantation Research: Results of a Comprehensive Bibliometric Analysis
Background: Nearly 40 y have passed since the 1983 National Institutes of Health Consensus-Development-Conference, which has turned liver transplantation (LT) from a clinical experiment into a routine therapeutic modality. Since’ clinical LT has changed substantially. We aimed to comprehensively analyze the publication trends in the most-cited top-notch literature in LT science over a 4-decade period. More.

European Radiology
Diagnostic accuracy of coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) in patients before liver transplantation using CT-FFR machine learning algorithm
Objectives: Liver transplantation (LT) is associated with high stress on the cardiovascular system. Ruling out coronary artery disease (CAD) is an important part of evaluation for LT. The aim of our study was to assess whether CT-derived fractional flow reserve (CT-FFR) allows for differentiation of hemodynamically significant and non-significant coronary stenosis in patients evaluated for LT. More.

Journal of Cardiothoracic and Vascular Anesthesia
Calcium Chloride Requirement and Postreperfusion Rebound During Massive Transfusion in Liver Transplantation
Objectives: The administration of citrated blood products during massive transfusion requires calcium salt administration to prevent citrate toxicity and to maintain ionized calcium values. The literature does not provide adequate guidance for the amount of calcium required during massive transfusions during liver transplantation. This study was conducted to provide guidance on calcium salt replacement during a massive transfusion in liver transplant patients, with a focus on the phase of transplantation during which citrate metabolism was minimal. More.