A significant proportion of patients presenting a primary sclerosing cholangitis (PSC) will require liver transplantation (LT). The present study aimed to investigate graft loss and patient death in a large cohort of patients. We conducted a nationwide multicenter retrospective study including all adult patients transplanted for PSC in France From 1985 to 2019. Were included 571 patients; median follow-up after LT was 89.0 months (IQR, 43.0-151.0). Patient survival at 5, 10 and 20 years after LT was 88.2%, 81.2% and 62.6%. After exclusion of patients who died during the first month after LT, 37 patients (6.6%) died during the first 2 years and the main cause was malignancies (n = 15, 40.5%, including 12 cases of recurrent cholangiocellular carcinoma). After 2 years, 90 patients (17.2%) died; the two main causes were malignancies (n = 36, 40.0%, including 13 cases of colorectal cancer) and sepsis (n = 23, 25.6%, of which 7 were related to recurrent PSC). Graft survival at 5, 10 and 20 years was 89.5%,78.7% and 62.7%. Independent factors associated with late patient death (after 2 years) were an older age at LT, a bilio-digestive anastomosis and the use of preventive UDCA; independent factors associated with late graft loss were recurrent PSC, cellular rejection, a younger age at LT, and the use of tacrolimus (protective). Our results emphasise that the prognosis after LT for PSC could be improved by better detection of cholangiocellular carcinoma before LT, and colorectal cancer after LT.

Pathological mechanisms of hepatic ischemia-reperfusion injury and stem cell-based therapeutic strategies: Mechanistic insights and translational perspectives.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading reason for liver transplantation (LT) worldwide. With limited donor availability and rising posttransplant morbidity due to chronic noncommunicable disease, preventive strategies are urgently needed. This review highlights the role of physical activity in MASLD before and after LT. Epidemiologic and interventional studies show that regular physical activity reduces liver fat, improves insulin sensitivity, and lowers aminotransferases, even without significant weight loss, in individuals with noncirrhotic MASLD. Physical activity also enhances muscle strength, physical performance, and quality of life. Although most research has focused on earlier disease stages, physical activity remains feasible and beneficial for patients with advanced chronic liver disease (advCLD) due to MASLD, improving performance, reducing frailty, and maintaining transplant candidacy. Following LT, preliminary studies suggest that regular physical activity may reduce cardiometabolic complications and improve functional recovery, though data on preventing recurrent MASLD or improving long-term outcomes is inconclusive. Physical activity should be integrated into clinical pathways before and after LT for individuals living with MASLD. Future studies should address the unmet needs in both the advCLD and post-LT populations where maintaining LT candidacy and optimizing survival, quality of life, and long-term outcomes remains of high public health significance.

Could taurine supplementation improve graft functions after liver transplantation? A randomized clinical trial among liver transplant recipients.

Use of aspirin for prevention of hepatic artery thrombosis after liver transplantation: A systematic review and meta-analysis.

Mucormycosis is a rapidly progressive and highly lethal fungal infection in liver transplant recipients, with early diagnosis remaining a major challenge. This study aimed to evaluate the clinical utility of metagenomic next-generation sequencing (mNGS) for early detection and management of perioperative mucormycosis in adult liver transplant patients. A retrospective analysis was conducted on 539 adult patients who underwent liver transplantation between June 2022 and August 2025 at a single tertiary center. Nine patients with clinically confirmed perioperative mucormycosis, in whom mNGS was the first positive diagnostic tool, were included. Clinical characteristics, diagnostic modalities, antifungal strategies, and outcomes were systematically reviewed. Mucormycosis was identified in 1.67% (9/539) of liver transplant recipients. All patients were male with a median age of 51 years. Pulmonary mucormycosis was the most common presentation (n = 5), followed by disseminated (n = 3) and cutaneous infection (n = 1). In all cases, mNGS provided the earliest microbiological evidence, preceding culture and histopathology. Species detected included Cunninghamella spp., Rhizopus microsporus, and Rhizomucor pusillus. The mortality rate of disseminated disease was 100%, whereas localized pulmonary and cutaneous infections had a combined cure or improvement rate of 66.7%. Early targeted antifungal therapy guided by mNGS (amphotericin B formulations combined with posaconazole or isavuconazole) was associated with improved outcomes in nondisseminated cases. mNGS enables earlier detection of perioperative mucormycosis compared to conventional diagnostic methods and supports timely initiation of targeted therapy. Rapid mNGS-guided intervention may prevent progression to disseminated disease and improve prognosis in liver transplant recipients. Integration of mNGS into the diagnostic workflow is recommended for high-risk patients with unexplained pulmonary or cutaneous lesions.

Ultrastructural configuration of porcine liver preserved by machine perfusion versus static cold storage donated cardiac after death.

Polycystic liver disease: Evidence-based management and critical gaps in surgical decision-making.

A machine learning-driven app for predicting the need for post-operative respiratory support in liver transplant recipients.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease globally. Menopause is associated with increased hepatic fat deposition and thus metabolic dysfunction, contributing to heightened risk of progressive liver and cardiovascular disease. Hormone replacement therapy (HRT), supported by pre-clinical data, may be associated with a lower risk. We performed a retrospective cohort study using the TriNetX global federated research network. Eligible participants were peri-menopausal women (ICD-10 codes N95/Z78.0, AND age 40-65 years) with pre-existing MASLD (based on ICD-10 codes K76.0/K75.81 or positive modified hepatic steatosis index plus ≥ 1 metabolic syndrome, MetS, trait). Patients initiating HRT (oestrogen ± progesterone) were compared with untreated controls using 1:1 propensity score matching for demographics, comorbidities, biochemistry and medications. The primary outcome was a composite of major adverse liver outcomes (MALO: portal hypertension, varices, ascites, spontaneous bacterial peritonitis, encephalopathy, hepatorenal/pulmonary syndromes, cirrhosis, decompensated liver disease, hepatocellular carcinoma, liver transplant). Secondary outcomes were individual MALO components, type 2 diabetes (T2D), major adverse cardiovascular events (MACE), breast and endometrial cancer, and venous thromboembolism (VTE). Cox regression generated hazard ratios (HRs) with 95% CIs over 5 years. Sensitivity analyses adjusted for geography, hormone type, and degree of obesity. After matching, 21 639 patients were included in each treatment arm. HRT was associated with a significantly reduced risk of MALO (HR 0.80; 0.71, 0.9), largely driven by reductions in ascites and SBP (0.78; 0.64, 0.95), and liver cirrhosis (0.75; 0.63, 0.90), and reduced risk of cardiometabolic outcomes: T2D (0.90; 0.84, 0.96), and MACE (0.90; 0.83, 0.98). HRT was not associated with increased risk of breast cancer or VTE, whilst endometrial cancer risk was reduced (0.49; 0.40, 0.61). Oestrogen was linked to greater benefits compared to progesterone, and patients with mild-moderate obesity experienced more significant risk reduction. Treatment of peri-menopausal symptoms with HRT, in patients with pre-existing MASLD, is associated with a lower 5-year risk of major liver and cardiometabolic disease. These findings support early basic science research and should prompt a closer examination through clinical trials.

Silencing OGFOD1 ameliorates hepatic ischemia-reperfusion injury through abrogating oxidative stress and apoptosis via downregulating SPARC.

Normothermic machine perfusion (NMP) has emerged as technology for organ preservation and assessment. While NMP has been widely adopted for liver, lung, and heart transplantation, kidney NMP has faced slower clinical integration. Normothermic perfusion may potentially improve kidney transplant through improved preservation, graft viability assessment, mitigation of ischemia reperfusion injury, and treatment prior to transplant. The purpose of this review is to highlight the applications of NMP in kidney transplantation. Kidney NMP has been proven well tolerated and feasible in multiple studies. Two recent randomized controlled trials did not demonstrate a benefit of NMP compared to cold storage. The use of NMP may increase utilization through improved logistics. Graft assessment during perfusion may allow for well tolerated transplantation of marginal kidneys. Successful long-term perfusion up to 4 days of discarded kidneys has been performed. Gene therapies and treatments, including immune modification, have been carried out during kidney NMP. Normothermic perfusion has several applications to kidney transplantation including preservation, assessment, and treatment. Perfusion protocols viability criteria need to be defined. A portable, commercially available device is needed to increase clinical use. Further studies are needed to compare NMP to current preservation methods.

Quantitative analysis of cyclosporine A in whole blood samples of liver transplant recipients using a stir bar-assisted magnetic dispersive solid phase extraction combined with HPLC-MS/MS.

Cardiometabolic risk factors (CMRF) are common in alcohol-associated liver disease (ALD), but their impact on clinical outcomes is unclear. We evaluated whether CMRF identifies a higher-risk phenotype among adults with ALD. We performed a multicenter retrospective cohort study within the TriNetX research network, including adults with ALD (ICD-10 K70) from 2010 to 2019. CMRFs were defined by overweight/obesity, dysglycemia, hypertension or dyslipidemia using the steatotic liver disease framework. Individuals with other liver diseases, cancer, prior liver transplantation or pregnancy were excluded. After 1:1 propensity score matching (PSM) on demographics, comorbidities, laboratory indices and medications, we compared ALD with versus without CMRF using Cox models, overall and stratified by cirrhosis. After matching, 2942 adults with ALD were included (ALD with CMRF, n = 1471; without CMRF, n = 1471). Five-year all-cause mortality was similar between groups (Hazard Ratio [HR]: 1.01, 95% CI 0.83-1.23). In contrast, ALD patients with CMRF had higher risks of alcohol-associated hepatitis (HR 2.12, 95% CI 1.62-2.79) and a numerically higher risk of major adverse liver outcomes (HR 1.14, 95% CI 0.98-1.32). Cardiovascular complications were markedly increased, including major adverse cardiovascular events (HR 3.07, 95% CI 2.14-4.39), arrhythmia (12.4% vs. 4.8%, HR 2.24, 95% CI 1.70-2.94) and heart failure (HR 3.70, 95% CI 2.11-6.47). Infectious events were also more frequent among CMRF patients, including sepsis, urinary tract infection and pneumonia. Associations were generally stronger among patients with cirrhosis. Among individuals with ALD, CMRF does not increase short- to intermediate-term mortality but identifies a phenotype with substantially higher liver, cardiovascular and infectious morbidity. Systematic detection and intensive management of CMRF should be integrated into ALD care pathways.

The spleen is a vital intra-abdominal organ that provides a role in hematopoietic and immunologic functions. It is highly vascular and is the most commonly injured organ in the setting of blunt trauma, potentially leading to life-threatening hemoperitoneum. Splenic artery embolization (SAE) serves as an alternative to operative management of patients with splenic trauma and has quickly become popular given the infectious risks associated with splenectomy. Since its inception, indications for SAE have evolved beyond the management of traumatic injury. The authors discuss splenic artery anatomy and the importance of maintaining critical collateral pathways when SAE is performed to preserve splenic and distal pancreatic arterial flow and minimize complication risks. An in-depth and evidence-based review of SAE in the setting of trauma is provided, including a comparison between proximal and distal embolization techniques. Nontraumatic indications for splenic embolization to induce splenic involution are covered, including for the treatment of hypersplenism, thrombocytopenia, portal hypertension, and complications of liver transplant such as the small-for-size syndrome and splenic artery steal syndrome. The use of SAE for the treatment of splenic aneurysms and upper gastrointestinal bleeding is also discussed. Periprocedural and intraprocedural technical considerations are covered, such as the routes of vascular access, type of embolic used, role of vaccination, preprocedural imaging, antibiotic therapy, and postprocedural management and complications. ©RSNA, 2026 Supplemental material is available for this article. See the invited commentary by Montgomery and Elliott in this issue.

Dengue virus infection is one of the most prevalent arboviral diseases worldwide, particularly affecting tropical and subtropical regions, and continues to pose a significant public health burden. Although hepatic involvement is a well-recognized manifestation of dengue infection, ranging from mild transaminase elevation to severe hepatitis, acute liver failure remains an uncommon but devastating complication associated with exceptionally high mortality. In many dengue endemic regions, access to liver transplantation is limited or nonexistent, underscoring the importance of identifying reliable predictors of transplant-free survival to guide timely clinical decision making. In this review, we comprehensively evaluate the existing literature, including observational studies and meta-analyses, to delineate key prognostic determinants and to propose evidence based therapeutic strategies aimed at improving patient outcomes and the survival.

BACKGROUND Incisional hernia (IH) is a common late complication following orthotopic liver transplantation, with reported incidences up to 46%. Incision type, particularly the use of the Mercedes incision, has been implicated as a modifiable risk factor due to its midline component and associated fascial disruption. AIM To determine whether the Mercedes incision increases the risk of IH compared with Chevron and J-shaped incisions in adult liver transplant recipients. METHODS We conducted a systematic review and meta-analysis in accordance with PRISMA 2020 guidelines (PROSPERO: CRD42020161632). PubMed, MEDLINE, EMBASE, Google Scholar, and Cochrane Library were searched up to June 2025 for studies reporting IH incidence stratified by incision type. Observational studies with ≥ 12 months follow-up in adults were included. Random-effects meta-analysis was performed to estimate pooled odds ratios (OR) with 95%CI. Heterogeneity was assessed using the I ² statistic. Exploratory subgroup analyses examined closure technique, incision closure approach, and suture material. RESULTS Eight observational studies (n = 2965) met the inclusion criteria. Pooled analysis showed the Mercedes incision was associated with a higher IH risk compared with Chevron or J-shaped incisions (OR = 1.93, 95%CI: 1.06–3.51; I ² = 76%). Sensitivity analysis excluding a zero-event study reduced the OR to 1.79 (95%CI: 0.99–3.25). Single-layer closure (OR = 3.75, 95%CI: 2.22–6.35) and absorbable sutures (OR = 3.06, 95%CI: 1.18–7.93) were associated with increased IH rates in exploratory analyses. CONCLUSION The Mercedes incision is likely associated with a higher risk of IH after liver transplantation compared with Chevron or J-shaped incisions. Surgical planning should consider incision type alongside patient and technical factors to reduce long-term abdominal wall morbidity.

This study aims to evaluate the safety and effectiveness of TIPS-PVR in patients with cirrhosis with acute PVT. A retrospective analysis of cirrhotic patients with acute PVT who underwent TIPS-PVR at a single academic institution. Patients were categorized by PVT etiology and thrombus extent according to AASLD criteria. Outcomes assessed included technical success, one-year patency of the TIPS and porto-mesenteric venous system, need for TIPS reintervention, symptom recurrence, and overall survival. Overall survival was defined as the time from TIPS-PVR to death or last follow-up. Fifty cirrhotic patients underwent TIPS-PVR for acute PVT. Technical success was 100%. Superior mesenteric vein (SMV) involvement was seen in 30/50 (60%), and splenic vein in 11/50 (22%). At one year, 32 patients had follow-up. Primary patency was 75% (24/32), primary-assisted patency 94% (30/32) for TIPS and 97% (31/32) for the portal vein. Patency rates improved at one year: Main portal vein from 18 to 97% (p < 0.001), SMV from 50 to 91% (p < 0.001), splenic vein from 78 to 100% (p = 0.0108). 9 patients underwent liver transplantation after TIPS-PVR. There were no grade 4 or grade 5 CIRSE adverse events. There were five Grade 6 events after the procedure. Overall survival was 78% at 12months, with 95% CI 64-87%. TIPS-PVR appears to be a safe and effective procedure for cirrhotic patients with acute PVT, offering a viable option for restoring portal venous flow.

Metabolic dysfunction-associated steatohepatitis (MASH)-cirrhosis represents a critical and growing global health burden due to its progression to hepatic decompensation, hepatocellular carcinoma (HCC), and liver-related mortality. A growing number of MASH-related HCCs contribute to the increasing need for liver transplantation. Under current regulatory guidance, Phase 3 trials in compensated MASH cirrhosis compare drug versus placebo on time to a composite endpoint for outcomes. Composite endpoints are major adverse liver outcomes (MALO)-hepatic decompensation (ascites requiring treatment, variceal hemorrhage, hepatic encephalopathy, MELD ≥ 15), liver transplantation-and all‑cause mortality. Future trial sample size hinges on the annual event rate and expected effect size. From prior studies, event rates are ~ 3-20% higher with risk features. Progression to large gastroesophageal varices is now an accepted endpoint and will typically add a 3-5% yearly event rate to the baseline MALO event rate. Effect sizes on hard outcomes in metabolic chronic diseases often range from 0.70-0.85. Trials should enroll high‑risk patients (defined as those with clinically significant portal hypertension [CSPH], Child Turcotte Pugh A cirrhosis, and magnetic resonance elastography measurements > 6.5 kPa), plan 3-5 years of follow‑up and enroll using noninvasive criteria. Accelerated approval based on histologic reversal of cirrhosis is potentially possible; the SYMMETRY Phase 2b trial achieved F4 regression within 96 weeks with efruxifermin. Levers to increase regression include an upper limit for liver stiffness measurement(LSM), a platelet threshold (> 110,000/µL), limiting CSPH, and prespecified proportions with FIB‑4 > 3.5 or enhanced liver fibrosis (ELF) > 11.3. Ongoing studies include but are not limited to survodutide, a glucagon/GLP-1 receptor dual agonist targeting metabolic drivers, efruxifermin, an FGF21 analog, and a conditionally approved drug resmetirom, which is a selective thyroid hormone receptor β agonist.

High-grade and relevant strictures have recently been introduced in clinical guidelines for primary sclerosing cholangitis (PSC). However, the definition of relevant strictures differs between the two liver associations (AASLD, EASL). We aim to assess the prevalence, the agreement of identification of extrahepatic, high-grade, and relevant strictures, and their association with outcomes in PSC. In this retrospective single-center study, three radiologists, independently and in consensus, assessed MRCPs of 170 PSC individuals for the presence of extrahepatic and high-grade strictures. Interreader agreement was calculated with Fleiss kappa. Association of extrahepatic, high-grade, and relevant strictures with outcomes (hepatobiliary malignancy, liver transplantation, liver-related death) was assessed with Cox-regression, and outcome-free survival estimates with Kaplan-Meier. Median age was 40 years, and 62% were males. One hundred-seven (63%) individuals had high-grade strictures, 49 (29%), and 53 (31%) had relevant strictures according to EASL and AASLD, respectively. During the median follow-up of 10.3 years, 50 individuals developed outcomes (liver transplantation = 37, liver-related death = 5, hepatobiliary malignancy = 8). Agreement for high-grade strictures was fair (k = 0.31). All strictures types were associated with worse prognosis in the univariate and multivariate analysis with extrahepatic strictures having hazard ratio (HR) = 3.34 (95% CI: 1.42-7.86), high-grade strictures HR = 2.00 (95% CI: 1.02-3.90), relevant strictures according to EASL and AASLD had HR = 2.43 (95% CI: 1.34-4.42) and HR = 2.89 (95% CI:1.57-5.32), respectively, after adjusting for Mayo Risk Score. Prevalence of high-grade strictures is high, but the agreement of their identification is unsatisfactory. High-grade and relevant strictures, regardless of their definition (EASL or AASLD), were associated with a worse prognosis. Question What is the prevalence and the interreader agreement of high-grade and relevant strictures? Are they associated with a worse prognosis in PSC? Findings High-grade and relevant strictures are relatively common in PSC and are associated with a worse prognosis; however, the agreement of their identification is unsatisfactory. Clinical relevance High-grade and relevant strictures have a role in clinical practice; however, the low interreader agreement of the interpretation of MRCP of individuals with PSC remains an unmet challenge.