Liver Transplantation Surgery Research Articles

The assessment of myopenia and muscle biopsy in pediatric patients with liver disease awaiting liver transplantation – A cross-sectional analysis

Little is known about the skeletal muscle characteristics (fibre type proportion and size, location of nuclei, presence of fat infiltration) in children with liver disease with radiologically determined myopenia (low muscle mass). During liver transplantation (LTx) surgery, biopsies from the rectus abdominis muscle were collected. Muscle fibre types (I, I/IIA, IIA, IIA/X, IIX) and CSA index (µm/m2) were determined using immunofluorescence staining. Triacylglycerol (TAG) and phospholipid content of muscle was determined using gas chromatography. Myopenia was defined using study-specific cut offs (skeletal muscle index <-2SD) from age-sex matched healthy control scans. Myopenia was prevalent in 41% of children. Children also had a high prevalence of high muscle adiposity (37%). Children with myopenia were older (8.4 vs. 0.7 yrs; p<0.001), had smaller total (median 595 vs. 844 µm/m2; p=0.04) and hybrid IIA/X (612±143 vs. 993±341 µm/m2; p=0.04) muscle fibre size index, lower prevalence of type I fibres (53 vs. 64%; p=0.01) and higher prevalence of type IIA/X hybrid fibres (median 7.5 vs. 0%; p=0.04). Children with myopenia also had a higher prevalence of elevated TAG content (>75 percentile) within the muscle compared to children without myopenia (36% vs 0%; p=0.009). Percent of muscle fibres with centralized nuclei were not different between groups. In conclusion, children with myopenia experience differences in skeletal muscle biological characteristics when compared to children without myopenia at LTx and these findings may have implications for dietary and exercise rehabilitation pre-and post-LTx.

Ultra-Small Copper-Based Multienzyme-Like Nanoparticles Protect Against Hepatic Ischemia-Reperfusion Injury Through Scavenging Reactive Oxygen Species in Mice.

Hepatic ischemia-reperfusion injury (IRI) is a severe complication that occurs in the process of liver transplantation, hepatectomy, and other end-stage liver disease surgery, often resulting in the failure of surgery operation and even patient death. Currently, there is no effective way to prevent hepatic IRI clinically. Here, it is reported that the ultra-small copper-based multienzyme-like nanoparticles with catalase-like (CAT-like) and superoxide dismutase-like (SOD-like) catalytic activities significantly scavenge the surge-generated endogenous reactive oxygen species (ROS) and effectively protects hepatic IRI. Density functional theory calculations confirm that the nanoparticles efficiently scavenge ROS through their synergistic effects of the ultra-small copper SOD-like activity and manganese dioxides CAT-like activity. Furthermore, the results show that the biocompatible CMP NPs significantly protected hepatocytes from IRI in vitro and in vivo. Importantly, their therapeutic effect is much stronger than that of N-acetylcysteamine acid (NAC), an FDA-approved antioxidative drug. Finally, it is demonstrated that the protective effects of CMP NPs on hepatic IRI are related to suppressing inflammation and hepatocytic apoptosis and maintaining endothelial functions through scavenging ROS in liver tissues. The study can provide insight into the development of next-generation nanomedicines for scavenging ROS.

A-355 Comparison of Arterial and Venous Whole Blood Samples Analyzed on the QuantraSystem With the QPlusand QStatCartridges

Abstract Background The Quantra Hemostasis System (HemoSonics, LLC) is a cartridge-based viscoelastic testing system used to monitor the coagulation status of whole blood samples. The clinical performance of the System with the QPlus and QStat Cartridges was demonstrated in patients undergoing surgical procedures using venous blood samples. However, depending on the nature of the surgical procedure, arterial or venous samples may be more accessible for testing. It is currently unknown if differences exist between the two samples for the Quantra System. This study compared QPlus and QStat parameters measurements in venous and arterial blood samples collected in parallel from patients undergoing cardiac or liver transplant surgery. Methods Two studies were conducted according to CLSI EP09. The cardiac study enrolled 50 adult patients undergoing cardiac surgery utilizing cardiopulmonary bypass to evaluate QPlus parameters. Matching arterial and venous samples were obtained at two time points: during bypass and post-protamine. The liver study enrolled 25 adult patients undergoing liver transplantation to evaluate QStat parameters. Matching arterial and venous samples from were obtained at three time points: baseline, anhepatic and reperfusion phases. All arterial samples were drawn from an existing arterial catheter whereas venous samples were drawn from the venous side of the bypass circuit or from the central venous catheter (proximal port to minimize infusion contamination). Linear regression analysis and means comparison (paired t-test) were used to assess whether the two sample types provided equivalent results, Results Table 1 provides the mean values for each parameter determined for venous and arterial samples. None of the parameters showed a significant difference between sample types (P > 0.05). Additionally, the linear regression analysis show strong correlation between the results for each parameter. Conclusions Both studies demonstrated that venous and arterial whole blood samples provide equivalent results on the Quantra System with the QPlus and QStat Cartridges.

Comparative Evaluation of 0.9% Normal Saline Versus Acetate-Gluconate-Based Balanced Solution on Acid-Base Status and Postoperative Liver Function in Donor Hepatectomy Patients.

Background Live donor liver transplantation, a widely practiced procedure, involves resecting a portion of a healthy donor's liver for transplantation. Despite advancements, it poses challenges like cardiovascular instability and electrolyte imbalances, with maintaining acid-base balance being critical. This study compares the effects of 0.9% normal saline and PlasmaLyte A® on acid-base status and postoperative liver function. Methodology This prospective observational study was conducted over one year among 40 healthy adults aged 18-60 years undergoing donor hepatectomy. Patients were alternately allocated to receive either 0.9% saline (Group 1; n = 20) or PlasmaLyte A® (Group 2; n = 20). Key parameters, including acid-base status, hemodynamic parameters, and postoperative liver function, were monitored at various intervals. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, NY, USA), with appropriate statistical tests. A p-value <0.05 was considered statistically significant. Results The study included 40 patients, with 20 in each group. No significant differences were observed between the groups concerning age, gender, weight, hemodynamic parameters, and urine output. However, significant differences were found in acid-base parameters. Group 2 showed better preservation of acid-base balance with higher pH and HCO₃ levels. Patients in Group 1 exhibited a significant decrease in HCO₃ levels during surgery, while those in Group 2 maintained a more stable metabolic profile. Furthermore, nine patients in Group 1 required sodium bicarbonate supplementation for metabolic acidosis, compared to only three in Group 2. Postoperative liver function tests revealed no significant differences between the two groups, although a trend toward better outcomes was observed in Group 2. Conclusions PlasmaLyte A® demonstrated superior preservation of acid-base balance compared to 0.9% normal saline, with less need for bicarbonate supplementation. While liver function outcomes were similar, the balanced solution showed a trend toward better metabolic stability, suggesting it may offer safer and more effective fluid management in liver transplantation surgery.

Transjugular intrahepatic portosystemic shunt for the patients on the liver transplant list

Patients with cirrhosis-associated and portal hypertension–associated complications may benefit from TIPS and/or liver transplantation. In many patients, the decision of whether or not TIPS should be placed prior to liver transplantation is fairly clear-cut. Nevertheless, there are some patients in whom the decision can be more complex. On one hand, TIPS is easily available in contrast to liver transplantation, and patients with TIPS may have clinical improvement. On the other hand, although TIPS may improve the situation of the patient, this improvement may not be sufficient to significantly improve the quality of life. Furthermore, TIPS malposition may be challenging for liver transplantation surgery. This review approaches the advantages and disadvantages of TIPS placement in patients who are candidates for liver transplantation and proposes decision pathways for patients with complications of portal hypertension on the liver transplant waiting list.

Dexmedetomidine use during orthotopic liver transplantation surgery on early allograft dysfunction: a randomized controlled trial.

Previous studies have shown a protective effect of dexmedetomidine use in kidney transplantation. In contrast, it is not known whether intraoperative administration of dexmedetomidine can reduce early allograft dysfunction (EAD) incidence following liver transplantation. To investigate the effect of dexmedetomidine use during surgery on EAD following orthotopic liver transplantation (OLT). This is a single-center, double-blinded, placebo-controlled randomized clinical trial. Three hundred thirty adult patients undergoing OLT were enrolled from 14th January 2019 to 22nd May 2022. Patients received dexmedetomidine or normal saline during surgery. One year follow-ups were recorded. Patients were randomized to two groups receiving either dexmedetomidine or normal saline intraoperatively. For patients in the dexmedetomidine group, a loading dose (1μg/kg over 10min) of dexmedetomidine was given after induction of anesthesia followed by a continuous infusion (0.5μg/kg /h) until the end of surgery. For patients in the normal saline group, an equal volume loading dose of 0.9% saline was given after the induction of anesthesia followed by an equal volume continuous infusion until the end of surgery. The primary outcome was EAD. Secondary outcomes included primary graft nonfunction, acute kidney injury, and acute lung injury/acute respiratory distress syndrome. Of 330 patients included in the intention-to-treat analysis, 165 were in the dexmedetomidine group [mean (SD) age, 49 (10) years; 117 (70.9%) men], and 165 were in the normal saline group [mean SD age, 49 (9) years; 118 (74%) men]. 39 (24.4%) patients in the dexmedetomidine group and 31 (19.4%) in normal saline group developed EAD and the difference was statistically insignificant ( P =0.28). Secondary outcomes including primary graft nonfunction and acute kidney injury was similar between the two groups. Intraoperative administration of dexmedetomidine did not reduce EAD rate after OLT.

Future of U.S. living donor liver transplant: Donor and recipient criteria, transplant indications, transplant oncology, liver paired exchange, and non-directed donor graft allocation.

In the United States, living donor liver transplant (LDLT), from both directed and nondirected living donors, has expanded over the past several years. LDLT is viewed as an important opportunity to expand the overall donor pool for liver transplantation (LT), shorten waiting times for a life-prolonging LT surgery, and reduce LT waitlist mortality. The LT community's focus on LDLT expansion in the United States is fostering discussions around future opportunities, which include the safe expansion of donor and recipient candidate eligibility criteria, broadening indications for LDLT including applications in transplant oncology, developing national initiatives around liver paired exchange, and maintaining vigilance to living donor and recipient candidate risk/benefit equipoise. Potential opportunities for expanding living liver donor and recipient candidate criteria include using donors with more than minimal hepatic steatosis, evaluating older donors, performing LDLT in older recipients to facilitate timely transplantation, and providing candidates who would benefit from an LT, but may otherwise have limited access (ie, lower MELD scores), an avenue to receive a life-prolonging organ. Expansion opportunities for LDLT are particularly robust in the transplant oncology realm, including leveraging LDLT for patients with advanced HCC beyond Milan, intrahepatic cholangiocarcinoma, and nonresectable colorectal cancer liver metastases. With ongoing investment in the deliberate growth of LDLT surgical expertise, experience, and technical advances in the United States, the LT community's future vision to increase transplant access to more patients with end-stage liver disease and selected oncology patients may be successfully realized.

The Effect of Fear of Covid-19 on Immunosuppressive Treatment Compliance in Patients with Liver Transplantation

Objective: In this study, we aimed to examine the effect of fear of Covid-19 on immunosuppressive treatment compliance in patients who underwent liver transplantation surgery. Method: This descriptive study was conducted at the liver transplant center of a university hospital with the participation of 169 patients. Data; It was collected face to face and online by researchers between February and March 2024. Data were collected using the Personal Information Form, Coronavirus (Covid-19) Fear Scale and Compliance with Immunosuppressive Medication Use scales. Data analysis was done with IBM SPSS (Statistical Package for the Social Sciences) Statistics 25 program. Results: 58.6% of the patients were male, 80.5% were married, 72% of the patients used tacrolimus as the immunosuppressive drug after the transplant, 63.3% did not catch Covid-19, 15.4% were diagnosed with Covid-19. It was determined that he lost a relative. Simple linear regression analysis was performed to determine the relationship between the scales used and no statistically significant relationship was found between the two scales (p&gt;0.05). Conclusion: It is recommended to create support programs that will include the normalization processes of liver transplant patients who are afraid of Covid-19 in order to become more compatible with their daily lives.

Comparison between the outcome of pancreaticogastrostomy and pancreaticojejunostomy after pancreaticoduodenectomy: a cross-sectional study

Background: Complications of pancreatic stump reconstruction after pancreaticoduodenectomy (PD) can lead to severe morbidity or even mortality. This study is taken to see the postoperative outcome of pancreatico-gastrostomy (PG) over pancreaticojejunostomy (PJ) after PD. Aim of the study was to compare the outcomes of PG and PJ following PD in a cross-sectional analysis. Methods: This comparative cross-sectional study was done in the department of hepatobiliary pancreatic and liver transplant surgery, BSMMU, Dhaka. A total of twenty-five patients (N=25), who underwent PD from July 2019 to June 2020, were included in this study. These patients were divided into two group, group A with PG (n=10) and group B with PJ (n=15). All patients were evaluated before and after surgery for assessing post-operative outcome by clinically, biochemically and radiologically. Results: This study showed no significant differences in demographic characteristics, co-morbidity and post-operative outcomes/complications between this two groups. However, PG demonstrated significantly shorter anastomosis time and required fewer sutures than PJ. Although a higher incidence of wound infections was observed in PJ compared to PG, these differences were not statistically significant. Peri-operative mortality did not significantly differ between the two techniques. Though postoperative hospital stay was shorter in the PG group compared to PJ but the difference was not statistically significant. Conclusions: PG can be considered as a safe and alternative procedure after PD.

Mid1 aggravates hepatic ischemia-reperfusion injury by inducing immune cell infiltration.

Hepatic ischemia-reperfusion injury (HIRI) represents a major risk factor in liver transplantation and resection surgeries. Kupffer cells (KCs) produce proinflammatory cytokines and lead to hepatic neutrophil infiltration in the liver, which is one of the leading causes of HIRI. Mid1 is involved in immune infiltration, but the role of Mid1 remains poorly understood. Herin, our study aimed to investigate the effect of Mid1 on HIRI progression. Male C57BL/6 mice aged 6 weeks were used for the HIRI model established. The function of Mid1 on liver injury and hepatic inflammation was evaluated. Invitro, KCs were used to investigate the function and mechanism of Mid1 in modulating KC inflammation upon lipopolysaccharide (LPS) stimulation. We found that Mid1 expression was up-regulated upon HIRI. Mid1 inhibition alleviated liver damage, as evidenced by neutrophil infiltration, intrahepatic inflammation, and hepatocyte apoptosis. Invitro experiments further revealed that Mid1 knockdown reduced the secretion of proinflammatory cytokines and chemokines in KCs. Moreover, silenced-Mid1 suppressed proinflammatory responses by the inhibition of NF-κB, JNK, and p38 signaling pathways. Taken together, Mid1 contributes to HIRI via regulating the proinflammatory response of KCs and inducing neutrophil infiltration. Targeting Mid1 may be a promising strategy to protect against HIRI.

Effectiveness of Nutritional Supplementation in Liver Transplant Recipients during Early Postoperative Course: A Systematic Review and Meta-Analysis

Abstract Background Nutrition is an integral part of health maintenance. The liver is the largest and most important metabolic organ, playing a pivotal role in integrating several biochemical pathways of carbohydrate, fat, protein, and vitamin metabolism. Malnutrition is a common complication of end- stage liver disease (ESLD). Progressive deterioration of nutritional status has been associated with poor outcome in cirrhotic patients. Liver transplantation (LT) revolutionized the management of liver disease. Nutritional therapy is an integral part of liver transplant care. Objective To identity the efficacy of different dietary nutritional supplements as zinc, vit D and immunonutrients (glutamine, omega 3, arginine and ribonucleic acid) for recipient at early post operative course. Material and Methods In this systematic review and meta-analysis we enrolled a total of 7 studies for assessing the clinical outcomes of ICU patients underwent liver transplantation surgery and supplied with dietary supplements during early postoperative period. The studies also assessed the laboratory assessment of patients postoperatively during ICU admission period. Results Regarding postoperative dietary supplementations with HMB, we found significant difference for appendicular skeletal muscle mass (ASMI) regarding the baseline and the postoperative ASMI in the intervention group with HMB. But we did not report significant difference regarding the baseline and the postoperative Fat-free mass index (FFMI) in both intervention and control group with HMB. Also we did not find significant difference between base line and postoperative in both groups for Mid-arm muscle-circumference (MAMC), Fat mass index (FMI), 6-minute walk test (6MWT), and Handgrip (HG). Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021. Conclusion BCAA as dietary supplementation showing a significant favorable effect regarding the baseline and the postoperative BTR levels, also for BCAA levels, Tyrosine levels, prealbumin levels, retinol binding protein and PTINR levels in both intervention and control groups. For HMB, we found significant difference for appendicular skeletal muscle mass (ASMI) regarding the baseline and the postoperative ASMI in the intervention group with HMB. But we did not report significant difference regarding the baseline and the postoperative Fat-free mass index (FFMI) in both intervention and control group with HMB.

A nomogram incorporating Psoas muscle index for predicting tumor recurrence after liver transplantation: A retrospective study in an Eastern Asian population

Background and aimsTumor recurrence significantly affects the prognostic outcomes for liver cancer patients following liver transplantation. However, existing predictive models often neglect the inclusion of body composition indicators. Hence, this research aimed to investigate the significance of the psoas muscle index (PMI) in evaluating the post-transplant prognosis of liver cancer. MethodsA retrospective analysis was conducted on liver cancer patients who underwent liver transplantation surgery. Imaging analysis was performed using CT data to calculate PMI based on the left and right psoas muscle areas. Subsequently, the patients were categorized into PMI-Low and PMI-High groups using the established cut-off values. Univariate and multivariate analyses were performed using Cox proportional hazards regression to assess the correlation between PMI and clinical outcomes, and a nomogram was constructed accordingly. ResultsAmong the 225 patients included in the analysis, the PMI-High group exhibited significantly improved overall survival (P < 0.001) and disease-free survival (DFS, P < 0.001) rates compared to the PMI-Low group. PMI exhibited a positive correlation with body mass index (R = 0.25, P < 0.001), but no significant correlations were observed. In the multivariate analysis, PMI (HR = 4.596, P < 0.001), MELD score (HR = 1.591, P = 0.038), and Hangzhou criteria (HR = 2.557, P < 0.001) emerged as significant predictors of DFS. The constructed nomogram, incorporating these predictors, demonstrated outstanding predictive performance. Decision curve analysis revealed the superiority of the nomogram over conventional methods. ConclusionsPMI serves as a valuable prognostic factor for tumor recurrence in liver cancer patients after liver transplantation. The established nomogram is pivotal in delivering personalized predictions of DFS.

The Efficiency of Volumetry in Graft Weight Assessment in Living Donor Liver Transplant

Abstract Background Liver transplantation is the treatment of choice for end-stage hepatic diseases. The most important factor responsible for the success of the transplant is the size of the graft and the remnant liver volume in the donor. A small graft may not meet the metabolic demands of the recipient resulting in impaired liver functions such as hyperbilirubinemia, prolonged prothrombin time (PT), ascites and portal hypertension. Patient and Methods This comparative study was conducted on manual contrast enhanced hepatic CT scans of 40 potential living liver donors (29) male and (11) female Age range from (18 to 50 ) in Ain shams specialized hospital and some private centers during the period from May 2021 till July 2022. The potential donors were investigated using 16 channel multi-detector row CT scanner (Alexion; Toshiba medical systems). All potential donors underwent 1st step laboratory investigations to enter the 2nd step investigations for living donor liver transplantation operations. All potential donors were of average weight and physically fit for operation with no history of any medical diseases. Results We correlated the results of CT volumetry of right lobe graft weight with the intra-operative weight of liver graft in patients undergoing Living Donor Liver Transplantation(LDLT). CT Volumetry is an efficient and a reliable tool for assessing potential donors undergoing liver transplant, and this information is essential for donor selection and pre operative surgical planning as well as it ensure that the liver remnant volume is at least 30 % which guarantee the safety of the donor. Conclusion The size of the right lobe graft for LDLT can be precisely calculated from pre-operative CT Volumetry with confidence and accuracy up to 95%.

Full Robotic Whole Graft Liver Transplantation: A Step Into The Future.

To report the first European series of full robotic whole liver transplantation (RLT) with technical details and future perspectives. Few cases of liver transplantation with a minimally invasive approach using partial grafts have been reported so far, and no cases of robotic whole liver transplantation have been reported in the scientific literature. The adopted technique was full robotic liver hepatectomy, followed by robotic implantation after graft introduction through a small midline incision. Patients presenting with Hepatocellular Carcinoma (HCC) in liver cirrhosis with a small caudate lobe, low degree of portal hypertension, no porto-mesenteric thrombosis, as well as low MELD patients have been considered ideal candidates. Six patients underwent RLT between February and March 2024 at Lisbon and Modena University Liver Transplant Centers. Warm ischemia time during RLT ranged between 55 and 90 min, with a total surgery duration between 440 and 710 min. The median total operative time was 595 (±111,3) minutes. Only one recipient had prolonged hyperbilirubinemia, which was safely treated. The median in-hospital stay was 7.5 days, (±4.8 days). RLT is a promising technique to further reduce the impact of liver transplantation thanks to smaller incision, gentle tissue manipulation, high magnification and precision for vascular and biliary anastomosis, and reduced postoperative pain. This is the first step toward the demonstration of the feasibility of minimally invasive surgery in liver transplantation, although further selection and technical refinements are needed to improve reproducibility.

Ramadan Fasting in Individuals with Metabolic Dysfunction-Associated Steatotic Liver Disease, Liver Transplant, and Bariatric Surgery: A Narrative Review.

Metabolic dysfunction-associated steatotic liver disease is a growing worldwide pandemic. A limited number of studies have investigated the potential effect of Ramadan fasting on metabolic dysfunction-associated steatotic liver disease (MASLD). There is no single medication for the treatment of MASLD. There is a growing interest in dietary intervention as potential treatment for metabolic diseases including MASLD. The aim of this study was to discuss the epidemiology, pathogenesis, and risk factors of MASLD and the potential effects of Ramadan fasting on MASLD, liver transplant, and bariatric surgery. We searched PubMed and SCOPUS databases using different search terms. The literature search was based on research studies published in English from the year 2000 to the 2024. Thirty-two studies were included in this review. Ramadan fasting reduced body weight and improved lipid profile, anthropometric indices, fasting plasma glucose, plasma insulin, and inflammatory cytokines. Ramadan fasting improved risk factors of nonalcoholic fatty liver disease and might improve MASLD through weight reduction. However, further studies are needed to assess the safety and effectiveness of Ramadan fasting in liver transplant recipients and bariatric surgery.

Impact of Albumin Infusion Compared With Crystalloid Infusion on Organ Function After Liver Transplantation in Adult Patients

ObjectivesTo compare the clinical benefit of using albumin versus crystalloids for volume resuscitation on organ function in adult patients after liver transplantation. DesignA retrospective cohort study SettingData from a tertiary care facility electronic medical record, (EMR) on liver transplantation patients admitted to the intensive care unit (ICU) PatientsAdults admitted to the ICU after liver transplantation InterventionsCrystalloid fluid resuscitation compared to albumin 5% in the immediate postoperative period after liver transplant. Measurements and main resultsAdults who underwent liver transplantation surgery and received a 5% albumin solution were compared with adults who received a crystalloid solution. Demographic, etiology, clinical variables, perioperative, and outcome variables were collected. The data were analyzed using a t-test, two-way ANOVA, and multivariate analysis. After applying all the exclusion criteria, a conservative population of 57 adult patients who underwent liver transplantation was included in this study. The crystalloid group had 27 patients (47.4%), while the albumin group had 30 patients (52.6%). The total mean age of the population was 52.2 years; males constituted most of the population (52.6%). Patients in the crystalloid group had similar characteristics to those in the albumin group. Daily SOFA scores gradually decreased during the postoperative period in both groups. The trend of the SOFA score was not different between the two groups. A two-way ANOVA shows no statistical difference in SOFA Score between the two groups postoperatively; the p-value is 0.84. A multivariate linear regression analysis shows that the MELD score was a predictor of the 7-day postoperative SOFA score in this population. ConclusionsIn our study, the use of albumin compared to crystalloids in patients undergoing liver transplantation appeared to have no significant difference in terms of the risk of organ dysfunction. However, further research is needed to confirm these findings and fully understand the potential benefits and risks of using either type of fluid.

Risk Factors for Unplanned Readmission in Adult Liver Transplant Patients: A Retrospective Study

IntroductionUnplanned readmission is an important indicator for evaluating medical care quality. Adult liver transplant patients have high risk for readmission, which seriously affects their recovery. As there is currently a lack of research on risk factors for unplanned readmission of adult liver transplant patients in China, the purpose of this study was to elucidate such risk factors. MethodsData for patients undergoing liver transplantation surgery at a tertiary hospital in Zhejiang Province from March 2018 to July 2022 were retrospectively collected. Patients were divided into readmission and nonreadmission groups based on whether unplanned readmission occurred within 90 days. Univariate analysis and logistic regression were used to analyze risk factors for unplanned readmission. ResultsIn total, 123 adult liver transplant patients were included; 38 had unplanned readmission, for a rate of 30.8%. There was a statistically significant difference between the groups in terms of age, educational level, operation time, intraoperative bleeding volume, number of complications, postoperative hospital stay, and hemoglobin (P < .05). Logistic regression analysis showed that age [OR = 1.085, 95% CI (1.022, 1.152)], operation time [OR = 1.010, 95% CI (1.001, 1.020)], postoperative hospital stay [OR = 1.124, 95% CI (1.023, 1.235)], and number of complications [OR = 4.487, 95% CI (1.234, 16.319)] were independent risk factors for unplanned readmission in adult liver transplant patients (P < .05). ConclusionsThe current situation of unplanned readmission for adult liver transplant patients cannot be ignored, indicating that staff should identify risk factors for unplanned readmission as soon as possible and take targeted personalized measures and health education to reduce readmission risk.

Evaluation of QT prolongation in children with cirrhosis and its association with the severity of liver diseases

Summary: Introduction: Prolongation of the QT interval in an electrocardiogram (ECG) is seen in more than 60% of adults with advanced cirrhosis. According to careful research, people with cirrhosis who have their QT intervals prolonged had worse survival rates, more severe disease symptoms, and faster development of their condition. Considering the importance of predicting complications of liver cirrhosis in children and the limited number of studies related to the relationship between prolonged QT and the severity of liver disease in children, in this study, prolonged QT in children with liver cirrhosis and its relationship with the severity of liver disease was investigated. Methods: In the present study, children under 18 years of age with liver cirrhosis were evaluated in the list of liver transplants referred to Abu Ali Sina Organ Transplantation Hospital in Shiraz between 2019 and 2021. QT was calculated based on two pediatric cardiologists‘ 12-lead ECG from liver transplant surgery. Results: In this study, 130 patients with liver cirrhosis with an average age of 7.05±5.34 years were evaluated. The average length of the QT segment was reported as 397±31milliseconds. Only 4 (3%) had a long QT segment in all the studied patients. The comparison of the Meld/ Peld criterion and Child criterion in the two groups of regular QT and prolonged QT showed that the mean of both criteria was signifi cantly longer in the standard QT group (P = 0.018, P = 0.038). Also, prolonged QT showed a signifi cant relationship with the cause of liver cirrhosis (P = 0.003). Conclusion: Our study is one of the fi rst to examine the relationship between QT and severity of cirrhosis in children. Based on the results of this study, prolonged QT is associated with severity of liver disease. Key words: liver – cirrhosis – children – long QT – fi brosis

Sarcopenia and Pleural Effusions: Exploring a Potential Link

Recent studies indicate a significant relationship between malnutrition, frailty, and pleural effusion (PE), highlighting the critical role of muscle mass in patient outcomes. This review investigates the association between sarcopenia—characterized by a decline in skeletal muscle mass and function—and PE, marked by fluid accumulation in the pleural space. The findings reveal that sarcopenia is prevalent in patients with PE and is linked to increased postoperative complications and mortality rates. In liver transplantation, esophagectomy, and lung cancer surgeries, sarcopenia exacerbates the risk of adverse outcomes. Notably, preoperative muscle mass assessment serves as a predictive tool for identifying patients at higher risk of complications. This review underscores the importance of early diagnosis and intervention for sarcopenia to improve clinical outcomes in PE patients. The therapeutic approach should include comprehensive nutritional evaluations and targeted muscle-strengthening interventions. By addressing sarcopenia, healthcare providers can significantly reduce PE-related complications, enhance patient recovery, and improve survival rates. This review provides a foundation for future research to develop effective strategies for the management and treatment of sarcopenia in the context of PEs, aiming to optimize patient care and quality of life.

Essential updates 2022/2023: A review of current topics in robotic hepatectomy.

The liver requires careful handling intra-operatively owing to its vital functions and complexity. Traditional open hepatectomy, while standard, is invasive and requires long recovery periods. Laparoscopic hepatectomy is a less invasive option, with its own challenges. The rise of robotic surgery, such as the da Vinci® system, improves precision and control, addressing the limitations of conventional methods, but brings new concerns, such as costs and training. This review focuses on the latest advancements in robotic hepatectomy from 2022/23 articles, delving into topics like "robotic surgery in liver transplantation," "robotic hepatectomy for hilar cholangiocarcinoma," "robotic vascular reconstruction following hepatectomy," "robotic repeat hepatectomy," and "prospective trials in robotic hepatectomy." To retrieve articles, a focused literature search was conducted using PubMed for articles from 2022/23 with a 5-year filter, excluding reviews. Initially, abstracts were screened, and relevant articles on robotic surgery were examined in full for inclusion in this review. Although all the above items are cutting-edge, and many of the references are necessarily at the level of case reports, recent articles are still accompanied by surgical videos, which are useful to readers, especially surgeons who are considering imitating the procedures. In summary, we examined the recent advancements in robotic liver resection. The inclusion of videos that present new techniques aids in knowledge transfer. We anticipate the continued growth of this field of research.