BACKGROUND Acute lung injury (ALI) after liver transplantation (LT) is a critical complication negatively affecting transplant outcomes and patient survival. However, effective biomarkers for early diagnosis remain unidentified. This study aimed to identify hub biomarkers and signaling pathways involved in post-LT ALI through integrated bioinformatics and machine-learning analyses and to validate their diagnostic potential. MATERIAL AND METHODS Differential gene expression analysis identified 27 differentially expressed genes (DEGs). Functional enrichment analyses revealed significant involvement in cytokine-mediated signaling, particularly within the NF-kB and TNF pathways. Single-sample gene set enrichment analysis (ssGSEA) evaluated immune infiltration. Machine-learning algorithms identified crucial biomarkers for ALI prediction. Transcription factor-hub gene and competitive endogenous RNA (ceRNA) networks were constructed. Single-cell RNA sequencing (scRNA-seq) and enzyme-linked immunosorbent assay (ELISA) analyses validated biomarker expression patterns in relation to ALI. RESULTS Hub biomarkers identified included CXCL3, CD48, and IRAK3. ssGSEA revealed prominent macrophage and neutrophil infiltration associated with ALI. Machine-learning models confirmed CXCL3, CD48, and IRAK3 as reliable predictive biomarkers, which were incorporated into a robust diagnostic nomogram. scRNA-seq analysis showed cell-type-specific expression patterns for CXCL3, CD48, and IRAK3, with heterogeneous associations across datasets. ELISA validated significantly altered protein levels of CXCL3, CD48, and IRAK3 in post-transplant ALI cases compared with controls. CONCLUSIONS CXCL3, CD48, and IRAK3 are novel and promising diagnostic biomarkers for predicting post-LT ALI. These findings provide foundational insights that could support improved diagnosis, prevention strategies, and targeted therapeutic interventions, ultimately enhancing patient outcomes after liver transplantation.

BackgroundLiver transplantation (LT) involves substantial intraoperative blood loss and postoperative complications, yet the relationship between these factors remains incompletely defined. This study aimed to evaluate the impact of excessive intraoperative blood loss (EIBL) on postoperative complication rates.Material/MethodsWe enrolled adult patients who underwent liver transplantation at 5 centers from January 2015 to June 2024. Patients were categorized into EIBL (blood loss ≥1000 mL) and non-EIBL groups. Univariate and multivariate logistic regression analyses were performed to identify EIBL risk factors and to assess its effect on postoperative complications, with adjustment for confounders such as age, sex, and comorbidities. Risk factors for specific complications were also examined.ResultsIn total, 822 patients were included. Univariate and multivariate logistic regression analyses indicated that benign disease, previous major abdominal surgery, pre-LT intensive care unit stay, and preoperative albumin below 38 g/L were independent risk factors for EIBL. EIBL was significantly associated with postoperative biliary complications and severe complications (Clavien-Dindo grade ≥3). Further regression confirmed EIBL as an independent risk factor for biliary complications (P=0.034) and Clavien-Dindo grade 3 or higher complications (P=0.042). Kaplan-Meier analysis showed that the 5-year survival rate was significantly lower in the EIBL group than in the non-EIBL group (P=0.010).ConclusionsComprehensive preoperative assessment and meticulous surgical practice can reduce EIBL risk, thereby decreasing postoperative complications after LT and improving long-term survival.

BACKGROUND Complete pathological response (CPR) after transcatheter arterial chemoembolization (TACE) is associated with improved posttransplant outcomes in patients with hepatocellular carcinoma (HCC). This study evaluated the prognostic significance of TACE-induced CPR in patients with HCC who underwent liver transplantation (LT). MATERIAL AND METHODS The records of 2238 patients who underwent primary LT for HCC between January 2006 and December 2020 were retrospectively reviewed; of these, 253 achieved explant pathology-confirmed TACE-induced CPR. Their clinical outcomes were analyzed. RESULTS These 253 patients underwent an average of 2.2±2.3 TACE sessions. The median number of non-viable tumors was 1, and the median maximal tumor size was 1.6 cm. At 1, 3, 5, 10, and 15 years, cumulative post-LT recurrence rates were 1.2%, 3.3%, 3.3%, 5.6%, and 5.6%, respectively; overall patient survival rates were 96.0%, 93.7%, 92.4%, 91.3%, and 82.1%, respectively. Larger tumors (>2 cm) and multiple non-viable tumors were independently associated with higher recurrence and reduced survival rates (P≤0.036). Cluster analysis identified patients with multiple non-viable tumors larger than 2 cm as a high-risk group; others comprised a low-risk group. Recurrence (P<0.001) and survival (P=0.018) rates were significantly lower in the high-risk group than in the low-risk group. CONCLUSIONS TACE-induced CPR is a strong prognostic indicator of favorable long-term outcomes after LT in patients with HCC. Stratification based on non-viable tumor size and number can identify high-risk patients with CPR who require closer surveillance. Less intensive follow-up may be sufficient for low-risk patients.

BACKGROUND Coronary vasculopathy is one of the most serious late complications after heart transplantation (Htx). The aim of this study was to assess the utility and safety of the invasive assessment of coronary physiology and investigate the occurrence of coronary microvascular dysfunction (CMD) and its association with clinical characteristics of recipients and donors. MATERIAL AND METHODS Coronary microcirculation was assessed during routine coronary angiography, performed prospectively between December 1, 2020, and July 24, 2023, by using index of microcirculatory resistance (IMR) and coronary flow reserve (CFR). Values of IMR ³25 or CFR <2.0 confirmed CMD. RESULTS Thirty-three patients aged 49±14 years were included; 21 (64%) were men. CMD was found in 8 (24%) patients. There were no complications, and examination was performed in all patients. The median values for IMR and CFR were 13 [IQR: 10-20] and 3.6 [IQR: 2.2-4.9], respectively. CMD was more common in younger patients: 40±16 vs 51±13 years (P=0.045), and those with lower BMI: 22±4 vs 26±4 kg/m² (P=0.016). Patients with CMD were more likely to require pacemaker implantation, with 3 (38%) vs 1 (4%) in the post-transplant period (P=0.012). The median time since Htx was 2 [IQR: 2-10] years and was higher in the CMD group: 9.5 [IQR: 6-16] vs 2 [IQR: 1-8] years, (P=0.042). There were no significant differences in other recipient and donor characteristics. CONCLUSIONS Invasive assessment of coronary physiology was safe and effective and diagnosed CMD in nearly one-fourth of heart transplant recipients. CMD is related to age, time since transplantation, and chronotropic graft dysfunction.

BACKGROUND Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare primary liver tumor with poor prognosis. This retrospective study aimed to evaluate the outcomes and prognostic factors of 40 patients who underwent liver transplantation (LT) for cHCC-CC using data from the Korean Organ Transplant Registry (KOTRY). MATERIAL AND METHODS A cohort of 40 LT recipients diagnosed with cHCC-CC was selected from the KOTRY database between 2014 and 2019. Survival analyses were performed according to key clinicopathological variables, and risk factor analyses were conducted for overall survival (OS) and recurrence-free survival (RFS). RESULTS During a median follow-up of 21.4 months, 10 patients (25.0%) died and 9 patients (22.5%) experienced tumor recurrence. The 1-, 2-, and 3-year OS rates were 91.8%, 76.2%, and 59.3%, respectively, and the corresponding RFS rates were 88.8%, 70.5%, and 50.2%. Patients with a MELD score <20 (P=0.017) and a single tumor <3 cm (P=0.046) showed significantly better OS. On multivariate analysis, MELD score ≥20 (P=0.04), perineural invasion (P=0.04), and portal vein tumor thrombosis (P=0.005) were independent risk factors for poor OS, whereas microvascular invasion (P=0.01) was an independent risk factor for poor RFS. CONCLUSIONS LT can be a feasible treatment option for patients with early-stage cHCC-CC, providing favorable long-term survival. As most prognostic factors identified were pathology-related, further studies are needed to refine the selection criteria for LT candidates in this population.

BackgroundPost-transplant outcomes were analyzed in adult patients with primary extrahepatic malignancies (EHM) who underwent living donor liver transplantation (LDLT). Few studies to date have analyzed post-transplant outcomes in adult patients with primary extrahepatic malignancies (EHM) who underwent LDLT.Material/MethodsThe study cohort included 109 patients who were treated for EHM more than 6 months before LDLT between January 2000 and December 2022. The clinicopathological characteristics of EHMs and outcomes of LDLT, including EHM recurrence and patient survival, were analyzed.ResultsThe most common primary EHM was stomach cancer (27.5%), followed by thyroid (11.0%), breast (11.0%), colorectal (10.1%), and kidney (10.1%) cancer. The mean and median intervals between final EHM treatment and LT were 84.9±78.0 months and 27 months (range: 6-336 months), respectively. During mean follow-up period of 84.9±78.0 months, 15 patients died. The 1-, 5-, 10-, and 20-year patient survival rates were 96.3%, 88.5%, 85.0%, and 70.8%, respectively. Five patients (4.6%) experienced post-transplant EHM recurrence, with 4 dying due to sepsis during EHM treatment (n=2), progression of EHM recurrence (n=1), and pneumonia (n=1). The mean and median intervals between LT and recurrence of pretransplant EHM were 71.6±82.8 months and 25 months (range: 19–213 months), respectively. The cumulative 1-, 5-, 10-, and 20-year EHM recurrence rates were 0%, 3.1%, 4.6%, and 18.3%, respectively.ConclusionsPatients with previously treated EHMs may be considered for LDLT following careful multidisciplinary evaluation and implementation of individualized post-transplant surveillance strategies.

BACKGROUND Chronotropic incompetence often prolongs dobutamine stress echocardiography (DSE) and provokes adverse events in liver-transplant (LT) candidates. We evaluated whether administering atropine 1 stage earlier than conventionally recommended improves test efficiency and tolerability. MATERIAL AND METHODS In this retrospective single-center study, 69 end-stage liver disease patients were assigned to 3 cohorts according to the protocol used: Group 1 - high-dose dobutamine alone (n=24); Group 2 - "late" atropine (1 mg at 40 µg/kg/min; n=22); Group 3 - "early" atropine (at 30 µg/kg/min; n=23). Primary endpoints were target heart rate (HR) achievement, procedure time, hypotension, and ventricular extrasystole (VES). RESULTS Target HR was reached in 83%, 86%, and 95% of Groups 1-3, respectively (P<0.001). Mean procedure duration fell from 27.82±2.06 min with late atropine to 18.48±0.95 min with early atropine (-33.6%). Hypotension dropped from 50.0% to 8.7% (relative reduction≈83%) and VES decreased from 59.1% to 13.0% (≈78%). Cumulative dobutamine exposure was halved (≈1 113→≈554 µg/kg). No early-atropine patients experienced test-terminating complications. CONCLUSIONS Introducing atropine at the preceding dobutamine stage offers a simple, cost-neutral modification that accelerates DSE, halves drug exposure, and substantially improves hemodynamic and arrhythmic safety in LT candidates. Prospective trials should confirm whether this streamlined protocol can be adopted as the new standard for chronotropically challenging patients.

BackgroundKidney transplantation is the best therapeutic option for patients with end-stage kidney disease. Despite advances in surgical techniques, the surgical procedure itself is associated with a risk of postoperative complications, with an incidence rate of 5–25%. The aim of this retrospective analysis was to identify risk factors for surgical complications after kidney transplantation.Material/MethodsThe study included 283 patients who underwent kidney transplantation at our center over an 11-year period (2013–2023). Baseline characteristics of the recipients (age, sex, and type of donor) and factors influencing the development of surgical complications (type of induction therapy, diabetes mellitus, BK positivity) were recorded. Patients who developed a surgical complication (bleeding, lymphocele, ureteral stenosis) were identified and analyzed in relation to potential independent risk factors.ResultsSurgical complications occurred in 15.8% of patients (n=45), with ureteral stenosis comprising 60% of all surgical complications. The average time to surgical complication onset ranged from 5.4 to 8.6 months. By using Cox proportional-hazard regression multivariate analysis, none of the parameters that were looked at were found to be independent risk factors for the development of surgical complications (endpoints: surgical complications itself, bleeding, ureteral stenosis, lymphocele/lymphorrhea).ConclusionsKidney transplantation significantly improves quality of life and survival in patients with end-stage kidney disease. Surgical complications remain a significant post-transplant challenge, with urological, vascular, and parietal complications being most common. While we found no independent risk factors among the parameters studied, minimizing these complications is essential to reduce the need for reinterventions and to improve outcomes.

BackgroundLiver transplant (LT) recipients have an increased risk for the development of postoperative atrial fibrillation (POAF). POAF has been associated with serious long-term outcomes such as thromboembolic events, stroke, heart failure, and even graft instability.Material/MethodsWe assessed potential clinical, biochemical, and ECG predictors of POAF in LT recipients between 2012 and 2024. The patients were divided into 2 groups: POAF and non-POAF (34.5%, n: 38 and 65.4, n: 72, respectively).ResultsBasal characteristics and comorbidities of the 2 groups were similar. Patients in the POAF group had significantly higher heart rates (81.16±18.62 bpm vs 65.11±12.47 bpm, P<0.01) and longer maximal P-wave durations (169.47±20.41ms vs 145.06±33.99 ms, P<0.01). Maximal P-wave duration, PR interval, P-wave peak time in lead II (PWPT-II), QRS duration, and QTc interval were also significantly longer in the POAF group compared to the non-POAF group. With these consistent findings, we may consider that changes or abnormalities in P-wave indices are significant indicators of atrial conduction delay, even before the development of LA enlargement.ConclusionsOur results are valuable in providing the prediction of POAF, which may be associated with major adverse outcomes such as mortality in LT recipients, using a simple and inexpensive tool like ECG. Such risks can be minimized by strategies such as optimization of beta-blocker therapy, fluid and electrolyte balance, and intraoperative temperature regulation.

BACKGROUND Living donor liver transplantation (LDLT) has been shown to be safe in the curative treatment of liver cirrhosis. Portal flow modulation techniques, such as splenic artery ligation (SAL), have been used to avoid complications like small-for-size syndrome (SFSS). However, the effects of SAL on portal flow, splenic function, and hematologic outcomes remain underexplored. MATERIAL AND METHODS This retrospective study analyzed 60 LDLT recipients treated at a single center from January 2023 to December 2024. Thirty patients underwent SAL (SAL+) while 30 did not undergo SAL (SAL-). Data on demographic and clinical characteristics, portal flow dynamics, spleen volume, hematologic parameters, and postoperative complications were collected and analyzed using IBM SPSS 20.0. Statistical significance was set at P<0.05. RESULTS SAL significantly reduced portal flow from 3148±989 mL/min to 1949±830 mL/min (P<0.001), optimizing the portal flow/graft weight ratio. SAL also decreased splenic volume by 21% and alleviated thrombocytopenia, with postoperative platelet counts increasing 3.8-fold compared to preoperative levels (P<0.001). There were fewer complications in the SAL+ group, with significant reductions in biliary complications and improved graft function. No severe ischemic splenic changes or thromboembolic events were observed in the SAL+ group. CONCLUSIONS SAL is an effective strategy for portal flow modulation in LDLT, significantly reducing portal flow to optimal levels and improving hematologic outcomes. By preserving splenic function and minimizing complications, SAL is a safe and beneficial approach to managing SFSS and improving graft performance in LDLT patients.