Shizuoka City Shimizu Hospital

The 2025 Annual Congress of the International Liver Transplantation Society (ILTS), themed " Advancing Liver Transplantation: Embracing Innovation for the Future ," was held from May 28 to 31 in Singapore. The meeting offered a comprehensive scientific program, featuring 92 sessions and 7 pre-congress workshops spanning living donor liver transplantation, advanced surgery, anesthesia and critical care, transplant oncology and immunology, basic science, pediatrics, and more. The program emphasized collaboration and innovation to advance patient outcomes in liver transplantation. In this report, the ILTS Vanguard Committee summarizes the key proceedings of the congress.

Abstract BACKGROUND In Japan, embolization of intracranial tumors is commonly performed as a preoperative adjunct to neurosurgical resection. The Japanese Registry of NeuroEndovascular Therapy (JR-NET), established in 2005, aims to identify factors influencing the outcomes of neuroendovascular procedures. JR-NET4, the latest phase of this registry, provides real-world data on the practice of intracranial tumor embolization across Japan. Patients and Methods JR-NET4 is a nationwide, multicenter, retrospective observational study that collected data from 166 neurosurgical centers between January 2015 and December 2019. Of 63,230 total registered cases, 2,664 patients (4.2%) underwent embolization for intracranial tumors. After excluding 61 cases with incomplete data, 2,603 patients were included in the analysis. Patient demographics, procedural details, and outcomes were evaluated. The primary endpoint was a modified Rankin Scale (mRS) score of 0–2 at 30 days post-procedure. Secondary endpoints included rates and types of procedure-related complications. RESULTS The final cohort included 2,603 patients (1,612 females; median age: 61 years, interquartile range 51–71). Favorable outcomes (mRS 0–2) at 30 days were observed in 86.9% of patients. The overall complication rate was 4.8%, including 1.8% hemorrhagic, 2.0% ischemic, and 1.0% other complications. Multivariate analysis revealed that general anesthesia and embolization of arteries other than the external carotid artery were significant risk factors for complications. Among tumor types, meningiomas had a 4.3% complication rate (3.5% major), while hemangioblastomas showed a higher complication rate of 14.9% (9.9% major). CONCLUSION JR-NET4 provides comprehensive, real-world evidence on intracranial tumor embolization in Japan. The findings underscore the safety and utility of the procedure while identifying key risk factors that may guide clinical decision-making in neuroendovascular therapy.

There is a paucity of data on safety of calcium channel blockers (CCB) in patients with severe aortic stenosis (AS) and hypertension. Among 2,460 patients with severe AS and hypertension receiving antihypertensive therapy in the CURRENT AS registry-2, we compared the clinical outcomes between patients taking antihypertensive therapy with CCB (CCB group) and without CCB (no CCB group). In the entire study population, CCB was prescribed in 1,763 patients (71.7%), which was the most commonly prescribed antihypertensive agents. The prescription rates of angiotensin converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers, and thiazides were 61.9%, 25.6%, and 7.3% in the CCB group, and 75.8%, 54.4%, and 6.0% in the no CCB group. In the propensity score matched cohort, the cumulative 3-year incidence of all-cause death or hospitalization for heart failure was not different between the CCB and no CCB groups (38.3% vs. 38.7%, log-rank P=0.65; HR, 0.94; 95%CI, 0.77-1.15; P=0.56). The cumulative 3-year incidence of syncope was low regardless of CCB prescription (1.1% vs. 1.0%, P=0.74). Among patients with severe AS and hypertension, CCB was the most commonly prescribed antihypertensive agents, and antihypertensive therapy with CCB was associated with comparable clinical outcomes to antihypertensive therapy without CCB. Syncope was rarely seen in patients with severe AS and hypertension receiving antihypertensive therapy regardless of CCB prescription.

The outcomes of carotid artery stenting (CAS) for asymptomatic patients aged ≥80 years remain unclear. This study aimed to investigate the procedural and functional outcomes of CAS in these patients. This was a post-hoc analysis of a nationwide retrospective registry of patients with asymptomatic carotid artery stenosis who underwent CAS. The primary outcome was a composite of ischemic stroke and all-cause death. The secondary outcomes were ischemic stroke, all-cause death, acute occlusion, and acute myocardial infarction. Functional outcomes were assessed using the modified Rankin Scale (mRS). The outcomes were assessed 30 days post-procedure and compared between patients aged ≥80 years and <80 years. Overall, 4549 patients were evaluated. Pre-procedural mRS and the prevalence of ≥80% stenosis were higher in the ≥80-year-old group. Calcified lesions and high risk for carotid endarterectomy were more common in the ≥80-year-old group. No significant between-group differences were found in primary and secondary outcomes. However, the functional outcomes were significantly worse in the ≥80-year-old group, with a higher proportion of patients with worse mRS score (ie, decreasing at least one point) at follow-up (11.2% vs 5.0%; adjusted OR 2.24 (95% CI 1.66 to 3.02)). CAS for asymptomatic carotid artery stenosis is associated with poorer 30-day functional outcomes in patients aged ≥80 years than in those aged <80 years, but the composite of ischemic stroke and all-cause death is not significantly different between the two age groups.

The EMPA-REG OUTCOME trial confirmed empagliflozin reduced mortality and heart failure hospitalization risk. These findings raised the possibility that empagliflozin may modulate cardiac autonomic function in patients with type 2 diabetes (T2D). The EMPYREAN study was a prospective randomized open-label assessor-blinded multicenter investigation of patients with T2D without prior antidiabetic therapy with sodium-glucose cotransporter 2 or dipeptidyl peptidase 4 inhibitors. Electrocardiographic monitoring was performed at study onset and after 12 and 24 weeks of treatment. Heart rate variability was analyzed using the MemCalc method. The primary endpoint was the change in the low frequency (LF; 0.04-0.15 Hz)/high frequency (HF; 0.15-0.4 Hz) ratio from baseline to 24 weeks. In all, 113 patients were randomized. The median age in the empagliflozin and sitagliptin groups was 60 and 63 years, respectively. There were no significant differences in serial changes in the LF/HF ratio (0.52, 95% confidence interval [CI] -0.15 to 1.19, P=0.126) or HF (16.13, 95% CI -11.58 to 43.84, P=0.251) between the 2 groups. In time domain analysis, serial changes in root mean square successive difference (1.90, 95% CI -0.56 to 4.38, P=0.12) and percent of difference between adjacent normal RR intervals >50 ms (1.04, 95% CI -0.32 to 2.41, P=0.13) were not significantly different. The effects of empagliflozin and sitagliptin on autonomic nerve activity did not differ significantly in patients with T2D.

ObjectiveThis study aimed to evaluate the feasibility and safety of neurointerventional procedures performed via transradial access (TRA) using a sheathless 8 Fr Optimo balloon guide catheter (BGC).MethodsWe retrospectively analyzed 100 consecutive neurointerventional procedures performed via TRA using a sheathless 8 Fr Optimo BGC at a single center. Technical success was defined as the successful delivery of the BGC to the target vessel without conversion to an alternative access site or catheter system, along with the completion of the planned procedure.ResultsA total of 100 procedures were performed in 95 patients (median age: 75 years; 63% male). The most common interventions were aneurysm coiling or flow diversion (45%) and carotid artery stenting (36%). Target vessels for BGC placement included the right carotid (59%), left carotid (31%), right vertebral (4%), and left vertebral (6%) arteries. The median BGC navigation time was 12 min (interquartile range: 7-20). Technical success was achieved in 95% of procedures. In five cases, conversion to transulnar, transbrachial, or transfemoral access was required; nevertheless, all planned procedures were completed successfully. Balloon inflation was utilized in 37% of procedures for distal embolic protection, rupture management, or device delivery support. No major access-related complications were observed. Symptomatic non-access-related periprocedural complications occurred in 3% of cases. The overall mortality rate was 2%.ConclusionsNeurointerventional procedures performed via TRA using a sheathless 8 Fr Optimo BGC appear to be feasible and safe, offering a high technical success rate and a low incidence of access-related complications.

Study DesignRetrospective multi-institutional study.ObjectivesAlthough previous studies have evaluated the surgical outcomes of laminoplasty in patients with cervical ossification of the posterior longitudinal ligament (OPLL), the long-term results remain unclear. The purpose of this study is to assess outcomes more than 10 years post-surgery and identify to identify factors that affect the long-term prognosis.MethodsEighty-four OPLL patients with more than a minimum of 10-year follow-up after surgery were divided into a good group with more than 50% improvement of the recovery rate of the cervical Japanese Orthopaedic Association (JOA) score, and a poor group with less than 50% improvement. The demographic data and radiographic parameters of cervical spinal alignment were compared, and significant poor prognostic factors were evaluated by multivariate logistic regression.ResultsFour preoperative factors showed significant differences between 2 groups: the presence of type 2 diabetes (P = 0.012), the baseline JOA scores (P = 0.001), the narrowest segment in the cervical (P < 0.001) and the presence of T2-weighted high signal on MRI (P = 0.030). Logistic regression analysis identified 3 of 4 factors were significantly associated with postoperative poor outcomes: the presence of type 2 diabetes (P = 0.011), the baseline JOA scores (P = 0.022), and the presence of T2-weighted high signal on MRI (P = 0.035).ConclusionThis study identified three risk factors associated with poor long-term surgical outcomes following laminoplasty for cervical OPLL. These findings could be significant indicators for predicting long-term outcomes in cervical OPLL patients.

IntroductionThe safety of discontinuing immune checkpoint inhibitors (ICIs) because of a durable response in patients with advanced NSCLC remains uncertain, and post-discontinuation survival outcomes based on the reason for cessation are not well defined.MethodsA pooled analysis was conducted using data from four prospective cohort studies involving 835 patients with advanced NSCLC who discontinued ICIs. Patients were categorized based on discontinuation reasons: durable response; immune-related adverse events (irAEs) (subcategorized by tumor response at discontinuation); non-irAE adverse events; disease progression; and other causes.ResultsDisease progression was the most common reason for ICI discontinuation (N = 528 [63.2%]), followed by irAEs (N = 187 [22.4%]) and tumor response (N = 23 [2.8%]). Regarding response status at ICI discontinuation due to irAEs, complete/partial response (CR/PR) was the most frequent (N = 85), followed by stable disease/not evaluable (SD/NE, N = 69) and disease progression (N = 33). After a median post-discontinuation follow-up of 15.8 months (interquartile range, 6.9–23.2), patients who discontinued because of a response had excellent outcomes, with no deaths and only three progression-free survival events. While post-discontinuation overall survival was comparable between the irAE-CR/PR and irAE-SD/NE groups, ICI therapy ≥12 months was associated with improved post-ICI discontinuation survival in the irAE-CR/PR group.ConclusionsDiscontinuation of ICIs because of a durable tumor response is rare in real-world settings but represents a feasible strategy for patients with advanced NSCLC. Patients in the irAE-CR/PR group had favorable post-ICI discontinuation survival if they received ICI therapy lasting ≥12 months.

Endovascular treatment (EVT) for intracranial atherosclerotic disease (ICAD)-related acute large vessel occlusion (LVO) has not been established in patients with posterior circulation occlusion. This study aimed to investigate the disparities in clinical outcomes after EVT between anterior and posterior circulation ICAD-related LVO. Using nationwide data from the retrospective multicenter registry, we conducted a post hoc analysis of 451 patients with acute ischemic stroke and ICAD-related LVO. Patients were categorized into the anterior (occlusion of the internal carotid artery or M1 or M2 segment of the middle cerebral artery) and posterior (occlusion of the basilar or intracranial vertebral arteries) groups. The primary outcome was a modified Rankin Scale score of 0 to 2 at 90 days. The posterior group exhibited a higher proportion of male patients, National Institute of Health Stroke Scale score, and prevalence of diabetes and hyperlipidemia. Although the onset-to-door and door-to-puncture times were comparable, the procedure time was significantly longer in the posterior group than in the anterior group (59 [33-99] vs 46 [29-72], P = .009). The use of stent retrievers was less frequent, and balloon angioplasty was more common in the posterior group. Adjusted analyses revealed that the posterior group had lower odds of achieving an modified Rankin Scale score of 0 to 2 at 90 days (adjusted odds ratio: 0.54, 95% CI: 0.31-0.95, P = .03) and a higher mortality rate (adjusted hazard ratio: 2.97, 95% CI: 1.27-6.95, P = .01) than the anterior group. Poorer clinical outcomes were associated with EVT for ICAD-related LVO in the posterior circulation. These findings emphasize the need to optimize treatment strategies for this patient population to improve overall prognosis.