Liver Transplant Recipients Research Articles

Safety and Efficacy of Primary Stent Placement for Hepatic Artery Kinks in Liver Transplant Recipients.

To evaluate the long-term outcomes of primary stent placement for hepatic artery kinks in liver transplant recipients. After institutional review board approval, all patients undergoing liver transplantation between February 2001 and February 2024 at a single institution who underwent primary stent placement were reviewed. Patients who had hepatic artery thrombosis or underwent balloon angioplasty alone were excluded. Patients who underwent stent placement for hepatic artery kink were included. Hepatic artery kinks were defined by an acute arterial bend with coaptation of the arterial wall which is typically due to redundancy of the transplant hepatic artery. Hepatic arterial patency was evaluated at 1, 3, and 5 years. Kaplan-Meier analysis was performed for primary patency. Fifty-six patients underwent hepatic artery stent placement. Further stratification resulted in 15/56 patients undergoing stent placement for hepatic artery kink. Primary patency rates for hepatic artery kink patients (n = 15) at 1, 3, and 5 years were 92%, 92%, and 92%, respectively. Primary-assisted patency for stent placement for hepatic artery kink was 100% at 1, 3, and 5 years. One patient had mid-stent kinking which was categorized as a technical failure and required re-intervention (n = 1/15). No patients had kink propagation or arterial rupture. In conclusion, primary stent placement for hepatic artery kink has excellent long-term patency.

2016-LB: Implementing rtCGM in Early Postoperative Intensive Care of Liver Transplant Recipients Treated with Insulin Comprehensively Improves Glycemic Control

Introduction and Objective: Glycemia management early after liver transplantation (LTx) is challenging due to patients' critical state and corticoid therapy. We evaluated the impact of actively used real-time continuous glucose monitoring (CGM) on glycemic control in LTx recipients at postoperative ICU in a prospective randomized trial (clinicaltrials.gov NCT05585801). Methods: LTx recipients were randomized to wearing an open-labelled or blinded CGM (Dexcom G6) added to standard care, placed in the infraclavicular region immediately after surgery. Data from the open-labelled CGM were used to adjust insulin therapy; blinded CGM data served as controls. Primary endpoint was > 7.5% difference in time in the target range 6-10 mmol/l. Results: We included 154 patients, 12 were excluded due to technical failures (6 from each arm), 142 patients were evaluated (active CGM n=82, control n=60), 28% with diabetes. All required vasopressors, mechanical ventilation and intravenous insulin therapy after transplantation. Patients with actively used CGM spent significantly more time in the target range compared to the control group (68.5% vs. 60.3%, p=0.003), meeting the primary endpoint, and significantly less time in level 1 hyperglycemia, see Table 1. Conclusion: Active use of CGM added to standard therapy significantly improved glycemic control in patients in critical state early after liver transplantation. Disclosure B. Hagerf (Voglová): None. M. Protus: None. L. Nemetova: None. M. Mraz: None. P. Girman: Speaker's Bureau; Neovii. M. Haluzik: Research Support; Sanofi. Advisory Panel; Eli Lilly and Company. Speaker's Bureau; Novo Nordisk, Abbott. Advisory Panel; AstraZeneca. Speaker's Bureau; GlaxoSmithKline plc, Amgen Inc. Advisory Panel; Bausch Health. J. Franekova: None. A. Jabor: None. E. Kieslichova: None. Funding CarDia (Programme EXCELES, Project No. LX22NPO5104); Funded by the European Union; Next Generation EUCooperatio Program, Charles University in Prague

Post-reperfusion syndrome in liver transplant recipients: What is new in prevention and management?

Post-reperfusion syndrome (PRS) in liver transplant recipients remains one of the most dreaded complications in liver transplant surgery. PRS can impact the short-term and long-term patient and graft outcomes. The definition of PRS has evolved over the years, from changes in arterial blood pressures and heart and/or decreases in the systemic vascular resistance and cardiac output to including the fibrinolysis and grading the severity of PRS. However, all that did not reflect on the management of PRS or its impact on the outcomes. In recent years, new scientific techniques and new technology have been in the pipeline to better understand, manage and maybe prevent PRS. These new methods and techniques are still in the infancy, and they have to be proven not in prevention and management of PRS but their effects in the patient and graft outcomes. In this article, we will review the long history of PRS, its definition, etiology, management and most importantly the new advances in science and technology to prevent and properly manage PRS.

Therapeutic vancomycin monitoring: a comparative analysis of high-performance liquid chromatography and chemiluminescent microparticle immunoassay methods in liver transplant recipients.

Vancomycin is a glycopeptide antibiotic of choice for treating serious Gram-positive bacterial infections, including methicillin-resistant Staphylococcus aureus (MRSA). However, its therapeutic efficacy and risk of nephrotoxicity are closely related to maintaining specific serum concentration levels. Liver transplant recipients (LTRs) require precise therapeutic drug monitoring (TDM) due to altered pharmacokinetics. This study compares the accuracy and precision of two vancomycin measurement methods-chemiluminescent microparticle immunoassay (CMIA) and high-performance liquid chromatography (HPLC) in LTRs. The cross-sectional study was conducted over 11months at the Abu-Ali Sina Solid Organ Transplant Hospital in Shiraz, Iran. The study included 34 adult LTRs on vancomycin treatment, excluding those with hypersensitivity, chronic kidney disease, burn injuries, or receiving phenytoin. Blood samples were collected at different intervals post-vancomycin administration and analyzed using both CMIA and HPLC methods. HPLC demonstrated superior accuracy and precision in measuring vancomycin concentrations, particularly in identifying patients with vancomycin-induced nephrotoxicity. Significantly higher trough (p-value: 0.026) and intermediate (p-value: 0.49) concentrations were detected by HPLC in patients experiencing nephrotoxicity, whereas CMIA did not show significant differences between groups. Pharmacokinetic variables such as half-life (p-value: 0.024) and AUC (p-value:0.037), measured by HPLC, were significantly different between LTRs with and without nephrotoxicity, which was not observed with CMIA. HPLC is more sensitive and reliable than CMIA for measuring vancomycin levels in LTRs, which is critical for optimizing vancomycin therapy and preventing adverse effects. The research suggests that HPLC should be the preferred method for vancomycin TDM in LTRs and further multicenter studies are recommended to validate these results.

Outcomes in liver transplant recipients with and without obesity: A propensity-matched analysis using the TriNetX database.

e23096 Background: Obesity is a growing concern among liver transplant recipients and has been linked to adverse post-transplant outcomes. This study aims to shed light on the impact of obesity on liver transplant outcomes. Methods: This retrospective cohort study leveraged the TriNetX database to evaluate the impact of obesity on outcomes in liver transplant recipients. Propensity score matching was applied to control for confounding demographic and clinical variables such as age, gender, and comorbidities, ensuring balanced comparison groups for analysis. Results: After 1:1 propensity score matching, a total of 18323 patients were identified in the Liver Transplant without obesity group and 18308 patients in the Liver Transplant with obesity group. Before propensity matching, significant differences were observed between the 2 groups. Obese recipients were older (61.5 years vs. 58.2 years, p < 0.001) and more likely to have comorbidities, such as hypertensive diseases (67.6% vs. 24.8%, p < 0.001), ischemic heart diseases (28.3% vs. 9.3%, p < 0.001), and asthma (11.2% vs. 3.2%, p < 0.001). Additionally, the obese group included more females (40.6% vs. 37.2%, p < 0.001). After matching, baseline characteristics were well-balanced between the groups. Mean age was 61.0 years (obese) and 61.2 years (non-obese, p = 0.199), and gender distribution was nearly identical (39.1% female in the obese group vs. 38.4% in the non-obese group, p = 0.210). Comorbidities such as hypertensive diseases (61.3% vs. 61.2%, p = 0.882) and ischemic heart disease (23.3% vs. 22.5%, p = 0.065) were also comparable. Obese recipients demonstrated significantly higher odds of adverse outcomes. Liver transplant rejection was more likely in obese recipients (OR 1.191, CI 1.127–1.258, p < 0.001), as were transplant failure (OR 1.149, CI 1.074–1.229, p < 0.001) and transplant-related infection (OR 1.220, CI 1.070–1.391, p = 0.003). Additionally, obesity was associated with increased odds of heart failure (OR 1.459, CI 1.379–1.545, p < 0.001) and acute kidney injury (OR 1.234, CI 1.183–1.286, p < 0.001). Conclusions: Obesity significantly increases the risks of rejection, failure, infection, heart failure, and acute kidney injury in liver transplant recipients, even after controlling for baseline differences through propensity matching. These findings underscore the importance of targeted interventions and close monitoring of obese recipients to optimize transplant outcomes. This analysis highlights the value of propensity score matching in isolating the impact of obesity on liver transplant results. Condition Odds Ratio CI Lower Bound CI Upper Bound p-value Liver Transplant Rejection 1.191 1.127 1.258 0.000 Liver Transplant Failure 1.149 1.074 1.229 0.000 Liver Transplant Infection 1.220 1.070 1.391 0.003 Heart Failure 1.459 1.379 1.545 0.000 Acute Kidney Injury 1.234 1.183 1.286 0.000

Lung transplantation and bone health: A narrative review.

Lung transplantation and bone health: A narrative review.

Meaningful differences in patient-reported outcome measurement scores in liver disease.

Patient-reported outcome measures (PROMs) are being used more often in chronic liver disease (CLD) clinical care and research. Their interpretability can be greatly enhanced by establishing the smallest meaningful score difference (MSD). We report scores of commonly used PROMs and their MSDs in patients at different stages of liver disease. Patient-Reported Outcomes Measurement Information System (PROMIS)-29 Profile, Chronic Liver Disease Questionnaire (CLDQ), and Short Form-36 (SF-36) v1.0 scores were aggregated from 2442 adults with CLD at 4 different stages: inpatients with decompensated cirrhosis (n=1146) and outpatients with cirrhosis (n=677) or CLD (n=128) or recipients of liver transplant (LT, n=490) between June 2014 and April 2023 from 3 academic centers. MSDs were estimated using distribution and anchor-based methods. The study sample's median age was 60.0 (IQR: 51.0-66.0); 55% were male, 17% Hispanic, 84% White, and 49% college educated. The etiology of CLD was alcohol in 36%, metabolic dysfunction-associated steatohepatitis (MASH) in 31%, and viral hepatitis B/C in 26%. Median PROMIS domain scores were generally lowest in inpatients and highest after transplant. For PROMIS, distribution-based and anchor-based MSDs ranged from 3 to 4 for individual domains and 4 to 6 for summary scores. Distribution-based MSDs were 1 for CLDQ and ranged from 7 to 11 for individual SF-36 domains, except role limitations domains, which ranged from 15 to 18, and component scores, which were 3. When compared across stages of liver disease, PROMIS MSDs were generally similar, although they tended to be 0.5-1.0 points smaller in the decompensated population compared to the stable populations. This study provides data-driven recommendations for MSDs, enhancing the interpretability of commonly used PROMs in liver disease and facilitating the integration of PROMs in various clinical and research settings.

Incidence and outcomes of rejection in solid organ transplant recipients treated with immune checkpoint inhibitors: A systematic review and meta-analysis.

11068 Background: Immune checkpoint inhibitors (ICIs) are a cornerstone in the treatment of many solid tumors; however, their use in cancer patients with solid organ transplants (SOTs) poses unique challenges due to the risk of allograft rejection. We conducted a systematic review and meta-analysis of retrospective studies to determine the incidence of rejection and associated outcomes in SOT patients treated with ICIs. Methods: We searched PubMed, Embase, and Scopus to identify retrospective studies examining ICI therapy in SOT patients with cancer. Primary endpoints were the incidence of rejection and its clinical outcomes. Statistical analyses were performed using the "meta" package in R. Results: Seventeen studies encompassing 587 patients were included. The most frequent malignancies were hepatocellular carcinoma (HCC), melanoma, and cutaneous squamous cell carcinoma (cSCC). The overall rejection incidence was 16% (95% CI: 9%-24%), with variation across cancer types: multiple cancers (18%, 95% CI: 5%-36%), HCC (22%, 95% CI: 15%-29%), and cSCC (4%, 95% CI: 0%-21%). Rejection incidence was higher among liver transplant recipients (18%, 95% CI: 10%-26%) compared to kidney recipients (16%, 95% CI: 5%-32%). Geographic differences were observed, with rejection rates of 15% (95% CI: 1%-37%) in U.S.-based studies, 25% (95% CI: 18%-33%) in China, and 9% (95% CI: 0%-25%) in Korea. Pre-transplant ICI exposure was associated with a higher rejection rate (18%, 95% CI: 9%-28%) compared to post-transplant exposure (15%, 95% CI: 7%-26%). Outcomes of rejection varied, with 44% (95% CI: 24%-65%) achieving stabilization or resolution. Liver transplant recipients demonstrated higher resolution rates (67%, 95% CI: 46%-85%) compared to kidney recipients (27%, 95% CI: 7%-52%). Regional differences in resolution were notable, with higher rates reported in China (65%, 95% CI: 45%-83%) compared to the U.S. (26%, 95% CI: 13%-42%). Conclusions: This meta-analysis reveals a 16% overall rejection rate in SOT recipients treated with ICIs, higher in liver allografts and HCC, with regional disparities. Nearly half of patients who experienced rejection improved or stabilized, especially liver recipients. These findings underscore the need for personalized approaches to balance oncologic efficacy and graft survival in this complex population. Category Rate (% [95% CI]) Overall Rejection Rate 16 [9-24] Rejection by Cancer Type Multiple: 18 [5-36], HCC: 22 [15-29], cSCC: 4 [0-21] Rejection by Transplant Type Liver: 18 [10-26], Kidney: 16 [5-32] Rejection by Geography USA: 15 [1-37], China: 25 [18-33], Korea: 9 [0-25] Rejection by Timing Pre-Transplant: 18 [9-28], Post-Transplant: 15 [7-26] Overall Reversibility 44 [24-65] Reversibility by Transplant Type Liver: 67 [46-85], Kidney: 27 [7-52] Reversibility by Geography China: 65 [45-83], USA: 26 [13-42]

Transoral incisionless fundoplication as rescue therapy for gastroesophageal reflux in a lung transplant recipient.

Transoral incisionless fundoplication as rescue therapy for gastroesophageal reflux in a lung transplant recipient.

Scoliosis progression after lung transplantation.

Scoliosis progression after lung transplantation.

Calcineurin Inhibitor Replacement With Mammalian Target of Rapamycin (mTOR) Inhibitor Following Lung Transplantation.

Calcineurin inhibitors (CNIs) are the cornerstone of lung transplant immunosuppression but are associated with nephrotoxicity and other adverse effects. Although dose reduction and combination with Sirolimus, a mammalian target of rapamycin inhibitor (mTORi), have been explored, full conversion to Sirolimus remains uncommon. This study describes the characteristics and outcomes of lung transplant recipients who underwent complete CNI withdrawal and conversion to Sirolimus. This retrospective case series included 52 lung transplant recipients transitioned to Sirolimus-based immunosuppression between 2010 and 2021. Data on demographics, transplant characteristics, immunosuppression, and outcomes were collected from electronic medical records. The cohort included 31 males (59.6%) with a median age of 58.4 years (IQR 52.3-63.5). The primary indication for CNI withdrawal was renal dysfunction (73.1%). Sirolimus discontinuation occurred in 69.2%, most commonly due to edema (25.0%), lung toxicity (19.4%), rejection (19.4%), and surgical needs (22.2%). Clinically significant rejection occurred in 13.5%, with four patients progressing to chronic lung allograft dysfunction (CLAD) and two deaths. Sixteen patients (30.8%) tolerated CNI withdrawal for over a year. Full conversion from CNI to Sirolimus is poorly tolerated due to side effects and has a high incidence of rejection. Further studies are needed to optimize patient selection and risk mitigation strategies.

Development and validation of a prognostic risk score for hepatocellular carcinoma recurrence post–liver transplant: Insights from the UNOS database.

4125 Background: For over two decades, the criteria for liver transplantation (LT) in hepatocellular carcinoma (HCC) have been well-established, yet recurrence remains a major clinical challenge. This recurrence contributes to inferior post-LT survival in HCC patients compared to those without HCC. Prognostic index could serve as a valuable tool to identify patients who may benefit from adjuvant therapies and guide standardized post-LT HCC surveillance, which currently varies across transplant centers. Methods: We developed and validated a predictive model using the United Network for Organ Sharing (UNOS) database, analyzing adult liver transplant recipients with hepatocellular carcinoma (HCC) from 2009 to 2024, including 4,970 patients. Univariable analysis identified variables associated with 1-year, 3-year, and 5-year post-transplant HCC recurrence, applying a strict p-value threshold ( < 0.01). Significant variables were selected for multivariable logistic regression to build the model. Internal validation was performed for each time point using Receiver Operating Characteristic (ROC) curve analysis and confusion matrix evaluation, with the best-performing model selected based on these metrics. Results: The most significant model was derived using 3-year recurrence as the outcome. The final model included the pre-transplant Model for End-Stage Liver Disease (MELD) score (p = 0.02), worst tumor histology grade (p < 0.001), and total tumor diameter (p = 0.03). The final logistic regression equation is as follows: log(1-p/p) = −3.9630 − 0.0621 × Initial MELD score + 0.7657 × Worst tumor histology grade + 0.1084 × Total tumor diameter. Internal validation results showed an AUC of 0.761 (95% CI: 0.718 - 0.804), accuracy of 0.769 (95% CI: 0.757 - 0.7807), sensitivity of 77.2%, and specificity of 65.0% for 1-year recurrence. For 3-year recurrence, the model demonstrated an AUC of 0.733 (95% CI: 0.702 - 0.763), accuracy of 0.6696 (95% CI: 0.6563 - 0.6827), sensitivity of 66.7%, and specificity of 70.9%. For 5-year recurrence, the AUC was 0.714 (95% CI: 0.685 - 0.743), with accuracy of 0.655 (95% CI: 0.641 - 0.668), sensitivity of 65.2%, and specificity of 68.6%. Conclusions: We have developed and validated a predictive model for HCC recurrence following LT using UNOS data. This model shows promising performance, particularly for predicting 1-year recurrence, and may potentially serve as a useful tool for guiding post-transplant management and surveillance strategies.

Phosphatidylethanol clearance after packed red blood cell transfusion.

Phosphatidylethanol clearance after packed red blood cell transfusion.

Health-Related Quality of Life After Pediatric Lung Transplantation.

Pediatric lung transplantation is a therapeutic option for children and adolescents with end-stage lung disease. While it offers a chance to extend survival and improve physical health, the impact on health-related quality of life (HRQOL) remains understudied. This observational study aimed to assess HRQOL in pediatric lung transplant recipients using the EuroQol questionnaire and additional self-designed questions about school, employment, and housing situations. We compared the results to those in children and adolescents with end-stage lung disease and investigated possible influencing determinants. Patients were included during routine clinical visits, starting at least 2 months post-transplant. Data collection was from November 2016 to January 2023. The study included 29 pediatric lung transplant recipients aged between 4 and 17 years at the time of first transplantation. Our findings show a good HRQOL after pediatric lung transplantation with a median EuroQol-Score of 1.0, representing the best possible EuroQol-Score, and a median visual analog scale (VAS) score of 93 out of 100. Most patients were engaged in employment or education, and they typically lived with their parents. HRQOL was superior to that of pre-transplant patients with end-stage lung disease, suggesting a quality of life improvement by lung transplantation. The presence of chronic lung allograft dysfunction (CLAD), a lower age at transplantation, and a longer time since transplantation were associated with lower HRQOL scores. This study underscores the generally favorable HRQOL experienced by pediatric lung transplant recipients.

GraftIQ: Hybrid multi-class neural network integrating clinical insight for multi-outcome prediction in liver transplant recipients

Liver transplant recipients (LTRs) are at risk of graft injury, leading to cirrhosis and reduced survival. Liver biopsy, the diagnostic gold standard, is invasive and risky. We developed a hybrid multi-class neural network (NN) model, ‘GraftIQ,’ integrating clinician expertise for non-invasive graft pathology diagnosis. Biopsies from LTRs (1992–2020) were classified into six categories using demographic, clinical, and lab data from 30 days pre-biopsy. The dataset (5217 biopsies) was split 70/30 for training/testing, with external validation at Mayo Clinic, Hannover Medical School, and NUHS Singapore. Bayesian fusion was used to combine clinician-derived probabilities with NN predictions, improving performance. Here we show that GraftIQ (MulticlassNN+clinical insight) achieved an AUC of 0.902 (95% CI:0.884–0.919), up from 0.885 with NN alone. Internal and external validation demonstrated 10–16% higher AUC than conventional ML models. GraftIQ demonstrates high accuracy in identifying graft etiologies and offers a valuable clinical decision support tool for LTRs.

Glucagon-like peptide-1 receptor agonists in liver transplant recipients with diabetes: changes in glucose control and cardiometabolic risk factors

IntroductionData about efficacy and safety of GLP1 receptor agonists in liver-transplanted patients are lacking.MethodsAmong a population of liver-transplanted individuals with diabetes, we evaluated 68 patients before, 6, 12 and 18 months after starting a GLP1RA-based therapy, as add on to metformin or insulin. We assessed glycemic control, body weight and composition (with bio-impedance analysis), liver fibrosis and steatosis (with transient elastography). Amylase, lipase levels and concomitant therapies were recorded at basal and follow up evaluations. Patients had an e-mail contact to report any adverse events.ResultsWe observed a significant decrease in fasting plasma glucose, HbA1c, weight, BMI, waist circumference. We demonstrated a reduction in total and LDL cholesterol. Liver stiffness decreased during the first 6 months. The rate of adverse events was low and the symptoms reported didn’t require any medical measures: 26.9% reported mild nausea, only 3 patients (7.69%) discontinued the drug dose due to gastrointestinal intolerance. No pancreatitis episodes were detected, amylase and lipase levels didn’t increase (despite concomitant calcineurin inhibitors). No adjustments in immunosuppressant therapy were reported. Among the 45 patients requiring insulin when a GLP1RA therapy was added on, 20 (33.2%) and 31 (45.5%) could suspend insulin therapy at, respectively, 6 and 18 months.DiscussionIn conclusion, GLP1RA-based therapy can be considered safe and effective in a short-term follow up in liver-transplanted patients. Further studies are needed to assess the effects of this drugs on long term complications, such as renal impairment, cardiovascular events and all-cause mortality.

Diagnoses and Timelines in Pediatric Liver Transplant Recipients With Suspected Acute Infections

Infections are a leading cause of morbidity after pediatric liver transplantation (LT), yet data beyond 3 months post-LT are limited. Among 315 LT recipients, 135 (42.9%) accounted for 342 unscheduled visits for suspected acute infections. Common diagnoses included viral respiratory (33.9%), enteric (29.8%) and skin (8.2%) infections. Some visits were due to noninfectious mimics such as rejection or ileus.

Complications Associated with Immunosuppressive Agents in Solid Organ Transplant Recipients: A Nationwide Analysis.

Background: Immunosuppressive therapies are vital for solid organ transplant (SOT) recipients to ensure graft survival, but long-term use can lead to complications. This study aimed to comprehensively evaluate the complications associated with immunosuppressive agents across different types of major SOTs. Methods: In a retrospective cohort study using a national claims database, we analyzed adult SOT recipients who began immunosuppressive therapy from 2007 to 2018. We identified complications such as infections, acute kidney injury, hypertensive emergencies, chronic kidney disease, hypertension, diabetes, dyslipidemia, and osteoporosis. These outcomes were determined through diagnostic codes, medication usage data, and hospital or emergency department visits. Results: Among 30,997 transplants with three-year follow up, complication rates varied by transplant type. Pancreatic transplant recipients had the lowest complication rate (225.9 per 1000 patient-years), while lung transplant recipients experienced the highest rate (823.9 per 1000 patient-years). Serious infections and chronic kidney disease were most common 2 to 6 months post transplant. Other complications, like acute kidney injury, hypertensive emergencies, hypertension, diabetes, dyslipidemia, and osteoporosis, were predominantly observed in the first month. Opportunistic infections peaked between 7 months and 1 year after transplantation. Conclusions: This study emphasizes the varied complications related to immunosuppressive therapy among different SOT recipients, delineating specific timeframes for each complication and maintenance regimen.

An Integrative Review of Frailty, Patient Mortality and Graft Failure in Solid Organ Transplant

Introduction Characteristics and the impact of frailty on adult solid organ transplant recipients have not been clearly described. The purpose of this integrative review was to identify characteristics of frailty and associations between frailty and patient mortality and graft failure in adult solid organ transplant recipients. Methods An integrative literature review was performed using Cooper's integrative methodology. PubMed, Excerpta Medica, and the Cumulative Index of Nursing and Allied Health Literature databases were searched using the terms frailty and transplant. Inclusion criteria were primary research reports, written in English, focusing on adult solid organ transplant recipients, and including graft or patient survival outcomes. Results The review included 35 articles, were largely retrospective, and published between 2015 and 2023 in 11 different countries. Most studies were single-center studies that were not theory-based, and liver transplant recipients were highly represented. Males outnumbered females in the majority of studies and White race was represented in half of the studies. Most studies used one strategy to measure frailty, and modified versions of the Physical Frailty Phenotype were the measurement used most often. Of the 35 articles that investigated the association of frailty with patient mortality, 44 measures were used, and of those, 32 showed a significant association. For graft failure, of the 10 studies included, half showed a significant association between frailty and graft failure. Conclusion This integrative review offers insights into the characteristics and the association between frailty, patient mortality, and graft failure.

Oncological Complications of Liver Transplantation: A Narrative Review on De Novo and Donor-Transmitted Cancers

Liver transplantation (LT) has deeply transformed the treatment of end-stage liver disease and hepatocellular carcinoma, offering the most effective therapy for many liver conditions. However, LT carries inherent risks, including the development of cancers, which can arise from the transmission of neoplastic cells from the donor, the recurrence of pre-existing cancers, or as a long-term effect of the transplant, originating from the recipient’s own cells. The development of cancer in LT recipients is influenced by a variety of factors, such as age, gender, race, the underlying cause of liver disease, lifestyle factors (like alcohol use and smoking), and the use of immunosuppressive therapy. These combined factors increase the susceptibility of LT recipients to several types of cancer, including skin cancers, gastrointestinal malignancies, and lymphoproliferative disorders. While long-term survival after LT has significantly improved, there has been a notable increase in the incidence of de novo malignancies, which underscores the importance of diligent cancer screening and monitoring in transplant recipients, especially as they age. To manage this increased risk, various screening programs are recommended, including annual skin exams, colonoscopies for patients with primary sclerosing cholangitis (PSC) or inflammatory bowel disease (IBD), and lung cancer screening with low-dose CT for former smokers. When cancer is detected in LT recipients, reducing immunosuppression is a crucial strategy. Decreasing calcineurin inhibitors (CNIs) and integrating mTOR inhibitors (mTORis) provide promising avenues for balancing immunological control with oncological risk. Understanding these risk factors and adjusting immunosuppression appropriately is vital for improving cancer outcomes in LT recipients. Although evidence from LT-specific studies remains limited, insights from other solid organ transplant (SOT) settings, especially kidney transplants, offer valuable guidance in managing cancer risks in LT recipients. This narrative review focuses on the prevention and management of de novo and donor-transmitted malignancies.