What We´re Reading… July 2023

The July issue of Transplantation, the official Journal of ILTS and the Transplantation Society, is out now.
A must-read for anyone working in the field of liver transplantation.

Free access for ILTS members!

Article selections by Sadhana Shankar, Alessandra Mazzola, Beth Wilson, Jiang Liu, Carmen Vinaixa and Abdul Hakeem.


A multi-society Delphi consensus statement on new fatty liver disease nomenclature
The principal limitations of the terms nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are the reliance on exclusionary confounder terms and the use of potentially stigmatising language. This study set out to determine if content experts and patient advocates were in favour of a change in nomenclature and/or definition. More

Liver Transplantation 
Development and validation of a REcurrent Liver cAncer Prediction ScorE (RELAPSE) following liver transplantation in patients with hepatocellular carcinoma: Analysis of the US Multicenter HCC Transplant Consortiumorld
HCC recurrence following liver transplantation (LT) is highly morbid and occurs despite strict patient selection criteria. Individualized prediction of post-LT HCC recurrence risk remains an important need. Clinico-radiologic and pathologic data of 4981 patients with HCC undergoing LT from the US Multicenter HCC Transplant Consortium (UMHTC) were analyzed to develop a REcurrent Liver cAncer Prediction ScorE (RELAPSE). Multivariable Fine and Gray competing risk analysis and machine learning algorithms (Random Survival Forest and Classification and Regression Tree models) identified variables to model HCC recurrence. RELAPSE was externally validated in 1160 HCC LT recipients from the European Hepatocellular Cancer Liver Transplant study group. More

Journal of Hepatology
Clinical and biochemical impact of vitamin B6 deficiency in primary sclerosing cholangitis before and after liver transplantation
Background and aims: We previously demonstrated that people with primary sclerosing cholangitis (PSC) had reduced gut microbial capacity to produce active vitamin B6 (pyridoxal 5′-phosphate [PLP]), which corresponded to lower circulating PLP levels and poor outcomes. Here, we define the extent and biochemical and clinical impact of vitamin B6 deficiency in people with PSC from several centers before and after liver transplantation (LT). More


Journal of Hepatology
Machine perfusion techniques for liver transplantation – A meta-analysis of the first seven randomized controlled trials
Background & aims: Machine perfusion is increasingly tested in clinical transplantation. Despite this success, the number of large prospective clinical trials remains limited. The aim of this study is therefore to compare the impact of machine perfusion on outcomes after liver transplantation versus static cold storage (SCS). More

Annals of Surgery
The Evolution of Redo Liver Transplantation Over 35 years: Analysis of 654 Consecutive Adult Liver Retransplants at a Single Center
Objective: Despite the durability of liver transplantation (LT), graft failure affects up to 40% of LT recipients. We examined liver retransplantation (ReLT) over 35-years at a single center. Methods: All adult, ReLTs from 1984-2021 were analyzed. Comparisons were made between ReLTs in the pre- vs. post- model for end-stage liver disease (MELD) eras and between ReLTs and primary-LTs in the modern era. Multivariate analysis was used for prognostic modeling. More

Sex-based Disparities in Access to Liver Transplantation for Waitlisted Patients With Model for end-stage Liver Disease Score of 40
Objective: To determine the association of sex with access to liver transplant among candidates with the highest possible model for end-stage liver disease score (MELD 40). Background: Women with end-stage liver disease are less likely than men to receive a liver transplant, due in part to MELD’s underestimation of renal dysfunction in women. The extent of the sex-based disparity among patients with high disease severity and equally high MELD scores is unclear. More


Clinical Transplantation
Intraoperative hypotension and the risk of acute kidney injury following liver transplantation
Background: Acute kidney injury (AKI) is a frequent adverse outcome following liver transplantation (LT) with a multifactorial etiology. It is critical to identify modifiable risk factors to mitigate the risk. One key area of interest is the role of intraoperative hypotension, which remains relatively unexplored in liver transplant cohorts. More

Korean Journal of Anesthesiology
Postoperative alterations in ventriculo-arterial coupling is an indicator of cardiovascular outcomes in liver transplant recipients
Background: Liver transplantation (LT) surgery increase the workload on the heart and vessels in patients with cirrhotic cardiomyopathy. While the interaction of the left ventricle (LV) with the arterial system (ventricular-arterial coupling, VAC) is a key determinant of cardiovascular performance, little has been known about the changes in VAC after LT. Therefore, we evaluated the relationship between the VAC after LT and cardiovascular outcomes. More

Liver Transplantation
A randomized, controlled, prehabilitation intervention to maximize early recovery (PRIMER) in liver transplantation
Background and aims: Frailty and impaired functional status are associated with adverse outcomes on the liver transplant (LT) waitlist and after transplantation. Prehabilitation prior to LT has rarely been tested. We conducted a two-arm patient randomized pilot trial to evaluate the feasibility and efficacy of a 14-week behavioral intervention to promote physical activity prior to LT. More