BENJAMIN SAMSTEIN, MD

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This study developed a new scoring tool to predict which patients undergoing living donor liver transplantation are at the highest risk of losing their graft within 90 days. Using data from nearly 4,000 patients across 18 centers, the EAGLE-LDLT model—based on liver enzyme and clotting values in the first week after surgery—outperformed existing models and correctly identified 40% of high-risk patients. Surgeons can use this tool after transplant to flag patients who need closer monitoring or earlier intervention.

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Researchers studied whether liver transplantation using deceased donors is a viable treatment for patients with colorectal cancer that has spread to the liver and cannot be surgically removed. Among 35 patients who received transplants, two-year overall survival reached nearly 85%, and prior use of a hepatic artery pump did not affect outcomes. This confirms that deceased donor liver transplant is a legitimate option for selected colorectal liver metastasis patients, opening the door to centers without access to living donors.

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Researchers described 12 patients with a rare subtype of bile duct cancer driven by mutations in the IDH1 or IDH2 genes. These patients were predominantly older women, often had additional co-mutations, and some experienced long-lasting responses to targeted treatments. The report highlights that molecular testing is essential for these patients because specific mutations have both prognostic and treatment implications, with approved targeted drugs now available.

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Surgeons at one institution compared outcomes of open, laparoscopic, and robotic liver removal over seven years as their practice shifted almost entirely to robotic surgery. Robotic cases had 87% lower odds of needing conversion to open surgery compared to laparoscopic, shorter hospital stays, and fewer complications, even for complex cases. The results support a full transition to robotic liver surgery at experienced centers as the standard approach.

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This study created a pretransplant prediction model to estimate the risk of early graft dysfunction after living donor liver transplantation, using only information available before surgery. Three factors predicted poor graft function: higher disease severity score, being hospitalized at the time of transplant, and receiving a smaller graft. The model can help surgeons better match donors to recipients before the operation to reduce complications.

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A hospital implemented a structured fast-track recovery program for liver transplant patients that included lower steroid doses, earlier removal of tubes and drains, and coordinated physical therapy and nutrition care. Hospital stays dropped from 12 to 10 days and the rate of post-transplant delirium fell from 26% to 9%, with no increase in rejection or readmissions. The findings show that aggressive recovery protocols are safe in high-acuity liver transplant patients and meaningfully reduce complications.

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This 12-center North American study followed 360 patients who received a living donor liver transplant for liver cancer, including many whose tumors exceeded the standard size and number limits (Milan criteria). Ten-year survival exceeded 60% even for patients outside the criteria, and a newer scoring tool called the NYCA score correctly identified most of these "out-of-criteria" patients as low or acceptable risk. Living donor transplant offers good long-term outcomes for a broader group of liver cancer patients than current criteria allow.

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This large international study of 3,633 living donor liver transplant patients identified risk factors for the two most common surgical complications: bile leaks and narrowing of the bile duct connection. Multiple bile duct connections, a history of prior abdominal surgery, and blood type incompatibility were among the key risk factors, and both complications significantly shortened graft survival. Careful donor selection and surgical planning are critical to reducing these complications.

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Researchers analyzed two decades of national liver transplant data and found that while survival after transplant has steadily improved, survival from the time of waitlist listing has not. Over the same period, the rate of donated livers going unused rose significantly, as did the rate of patients dropping off the waitlist before receiving a transplant. This suggests that gains in post-transplant care are being offset by more patients dying while waiting, partly because usable organs are being declined.

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A single surgical center reviewed 260 patients who underwent liver removal and compared outcomes between those who had open versus minimally invasive surgery, with minimally invasive used as the preferred first approach for all patients. The minimally invasive group had shorter operative times, less blood loss, shorter hospital stays, and fewer major complications, with no difference in cancer clearance margins. The study supports making minimally invasive liver surgery the default approach rather than reserving it for select cases.

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Two patients with advanced bile duct cancer developed a dangerous drop in platelets shortly after receiving a liver-targeted radiation therapy called yttrium-90 while also on durvalumab immunotherapy. All other causes were ruled out, and both patients required steroids and immune-modulating treatments to recover; one had a recurrent episode requiring additional therapy. This case report alerts clinicians to watch platelet counts closely when combining durvalumab with yttrium-90 radiation.

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Using national mortality and transplant listing data from 2014 to 2018, researchers found that patients with alcohol-related liver disease have far lower rates of liver transplant listing relative to deaths than patients with other liver diseases—and within that group, Black patients and women face the greatest disadvantage. Black patients with alcohol-related liver disease were listed at half the rate of White patients. These findings call for targeted interventions to address compounded disparities in transplant access.

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Researchers surveyed 53 liver transplant programs in the U.S. to understand how they evaluate living liver donors. They found that, on average, about 33% of potential donors were accepted, with most centers agreeing on age limits and excluding donors with obesity. This study highlights differing practices across centers, emphasizing the need for clearer guidelines to ensure safe evaluations of living donors.

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Five high-volume centers compared robotic liver removal to traditional open surgery for liver cancer in 398 patients. Robotic patients had shorter hospital stays, fewer ICU admissions, and lower rates of post-operative liver failure, while cancer recurrence rates were equivalent. This is the largest Western study confirming that robotic liver resection for liver cancer is safe, reproducible, and oncologically effective.

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Researchers tested whether a painless ultrasound-based technique called vibration controlled transient elastography could reliably screen potential living donors for liver fat without requiring a biopsy. Among 79 donor candidates, the tool showed a meaningful correlation with MRI fat measurements and liver biopsy results, with acceptable sensitivity and specificity at defined score cutoffs. Integrating this screening step could reduce the number of invasive biopsies needed during donor evaluation.

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Researchers looked into the challenges and potential improvements in living donor liver transplants (LDLT) during a conference in October 2021. They found that issues like donor age, size, and blood type mismatches, along with a lack of awareness about the benefits of LDLT and a shortage of skilled surgeons, hinder its growth in the U.S. They recommend creating a national registry for better matching and improving surgical training to ensure more successful transplants, which could greatly increase the availability and effectiveness of these procedures.

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A national survey of 60 U.S. liver transplant programs examined how often and under what circumstances centers refer declined patients for a second opinion at another center. While all centers receive second-opinion referrals, only 25% frequently facilitate them for their own declined patients, and practices vary widely with no standardized process. Standardizing second-opinion pathways could improve equity for patients denied transplant listing.

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An international team of 15 high-volume liver transplant centers established reference benchmarks for living donor liver transplantation outcomes, similar to quality standards that exist for other surgical procedures. Living donor transplants matched or outperformed deceased donor transplants on most measures like graft loss and need for retransplantation, though bile leaks and hepatic artery clots remained higher. These benchmarks give transplant programs a concrete target for quality improvement and international comparison.

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Two patients with locally advanced colon and rectal cancer that typically does not respond to immunotherapy received a combination of two immune checkpoint drugs before surgery. Both had dramatic tumor responses with a distinctive inside-out pattern of immune cell attack not previously described, and molecular analysis revealed the drugs activated both innate and adaptive immune pathways. These cases suggest that this drug combination may overcome immunotherapy resistance in certain colorectal cancers and should be tested in clinical trials.

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This consensus guidance article reviews available evidence and draws on kidney donation experience to provide practical recommendations for evaluating anonymous living liver donors—people who donate to strangers rather than a specific recipient. The authors address donor selection criteria, allocation of nondirected grafts, and ethical considerations to ensure safe expansion of this practice. The guidance aims to standardize an emerging practice that could meaningfully increase the supply of living donor livers.

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A national survey of 99 liver transplant programs explored current use of nondirected living liver donation (where a stranger donates to an unknown recipient) and liver paired exchange (where incompatible donor-recipient pairs swap). Most programs accepting living donors allowed nondirected donation, but only 12% performed paired exchange, though 78% said they would participate if logistical barriers were resolved. Understanding these gaps can guide policy efforts to make more flexible forms of living donation routine.

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An online survey examined whether people who had previously donated blood were more likely to be registered as organ donors or to donate a living organ, and whether their motivations differed. Blood donation history did not predict organ donor registration or interest in living donation. The results suggest that different outreach strategies are needed for blood donation and organ donation recruitment.

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Researchers analyzed 20 years of national data on living liver donors and found that the demographic profile has changed very little: donors remain predominantly young, White, employed, and college-educated, with a recent rise in female donors. The narrow socioeconomic and racial profile of donors likely reflects structural barriers to donation rather than medical exclusions. Addressing financial and social obstacles to donation is essential to diversify the donor pool.

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A 10-year multicenter study of 2,645 liver transplant patients with liver cancer found that patients whose tumors were successfully shrunk to within transplant criteria before surgery had excellent long-term outcomes, similar to patients who always met criteria. Ten-year survival for the downstaged group was 52%, and patients whose cancer recurred after transplant lived longer if they were able to have surgical treatment of the recurrence. These data strongly support national policies allowing downstaged patients to receive liver transplants.

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Surgeons at five institutions reviewed their collective experience with a technically demanding procedure called ex vivo liver resection, in which the liver is removed from the body, the tumor is cut out on a back table, and the liver is then reimplanted. Among 35 patients with otherwise unresectable tumors, five-year survival reached 28%, and the required surgical skills overlap with those already used in partial liver transplant. The findings argue that more liver transplant centers should consider adding this technique to treat patients with no other surgical options.

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An international panel of experts in minimally invasive donor liver surgery developed 44 clinical practice guidelines to help transplant centers safely adopt laparoscopic and robotic techniques for living donor hepatectomy. The guidelines address patient selection, surgical technique, training, and safety monitoring and reached over 90% consensus among experts. This framework gives centers clear standards to follow as minimally invasive donor surgery becomes more widely available.

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Using national death and transplant registry data from 2014 to 2018, researchers found that Black patients with end-stage liver disease are placed on the transplant waiting list at a significantly lower rate relative to deaths than White patients, despite having similar transplant success rates once listed. This gap existed in every state analyzed and persisted after adjusting for other factors. The findings reveal a systemic barrier to transplant access for Black patients before they ever reach the waitlist.

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Researchers validated a new scoring tool for selecting liver transplant candidates with liver cancer by testing it on data from 2,236 patients across eight international centers. The New York/California (NYCA) score—which incorporates how a patient's AFP tumor marker changes over time—outperformed older size-based criteria and correctly reclassified most patients previously excluded under those criteria into acceptable-risk categories. This score offers transplant programs a more accurate, biology-based way to decide who benefits from liver transplantation.

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Five patients with rare subtypes of primary liver cancer—including combined liver-bile duct cancer, virus-associated carcinoma, and unusual cell-type variants—were described along with the treatments used when their cancers returned after surgery. Each case illustrates how the specific tumor subtype influenced treatment choices including chemotherapy, targeted therapy, and immunotherapy. Recognizing these rare variants matters because standard liver cancer treatment guidelines may not apply.

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This review outlines the innovations and policy changes most likely to expand living donor liver transplantation in the United States, where it remains a small fraction of all transplants. Promising developments include nondirected donation, paired exchange, ABO-incompatible transplants, laparoscopic and robotic donor surgery, and financial support for donors. The review provides a roadmap for transplant programs and policymakers to grow living donation safely and equitably.

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Among the first 90 solid organ transplant patients infected with COVID-19 in New York City, 30% had severe disease requiring ICU admission and 18% died—substantially higher than in the general population at the time. Most patients received hydroxychloroquine-based regimens, and immunosuppression was often reduced. This early report established the clinical baseline for transplant recipients with COVID-19 and shaped initial management approaches.

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Two cases are described in which a rare type of bile duct cancer closely mimicking a lymphoma led to missed or delayed diagnoses on initial tissue sampling. The tumor's dense immune cell infiltrate hid the underlying cancer on frozen section and biopsy, and the report offers specific microscopic and staining features to help pathologists recognize it. Awareness of this diagnostic pitfall can prevent misdiagnosis and treatment delays in this unusual cancer.

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This review summarizes the global experience with minimally invasive surgical techniques for removing part of a living donor's liver for transplantation, from early laparoscopic left lateral donor surgery to fully laparoscopic half-liver removal. The evidence supports laparoscopic left lateral liver removal as a standard of care for pediatric donation, and a growing number of experienced centers have extended the approach to larger donor operations. Expanding minimally invasive donor hepatectomy reduces recovery time and surgical burden for living donors.

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Researchers compared weekly organ donation and liver transplant activity during the first three months of the COVID-19 pandemic to the same period the prior year in the United States, United Kingdom, and India. Transplant volumes fell sharply in all three countries, dropping over 80% at peak in the UK and India, with early signs of recovery by the end of the study period. The study documents the pandemic's severe disruption to life-saving transplant services and the policy adaptations used to maintain some activity.

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A single center reported 11-year outcomes for 46 patients who underwent ex vivo surgery—removing abdominal organs, resecting the tumor off the operating table, and reimplanting the organs—for tumors that could not be removed by any other means. Overall five-year survival was 52%, with 91% of patients achieving complete tumor removal and an in-hospital mortality rate of about 4%. The results support selective use of this procedure at centers with transplant expertise for patients who have no other surgical option.

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Three liver specimens from patients with a rare bile duct condition caused by portal vein blockage—portal cavernoma cholangiopathy—were analyzed to describe its microscopic features, which have not been well characterized. Key findings included abnormal or absent portal veins within the liver and signs of bile duct obstruction that can closely resemble cholangiocarcinoma or cirrhosis. Recognizing these histologic patterns can prevent misdiagnosis, particularly when a biopsy is taken from a patient with known portal vein thrombosis.

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This commentary argues that the long-standing imbalance between the supply and demand for donor organs cannot be solved by redistribution policy changes alone, and that improving organ procurement organization performance is essential. Meaningful reform requires transparent performance metrics, partnership between transplant centers and procurement organizations, and patient-centered data. Geographic redistribution proposals risk oversimplifying a problem that requires systemic, collaborative solutions.

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This article examines whether liver transplant programs in the United States could establish a paired exchange program modeled on the successful kidney paired exchange system, where incompatible donor-recipient pairs swap to enable compatible transplants. The authors analyze the specific logistical, medical, and ethical challenges unique to liver donation that would need to be resolved. A liver paired exchange program could meaningfully expand living donor liver transplantation for patients who currently have no compatible donor.

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This ethics article explores the concept of trans-organ paired exchange, in which a person willing to donate a kidney could instead donate part of their liver to allow a liver recipient's willing donor to donate a kidney—crossing organ type boundaries to enable more transplants. The authors examine the ethical challenges including mismatched surgical risks between donor operations, the validity of informed consent when donation is indirect, and potential effects on deceased donor rates. The piece argues these challenges are addressable and that trans-organ exchange deserves serious consideration to expand access to both liver and kidney transplantation.

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Researchers developed the New York/California (NYCA) score, a new tool to select liver transplant candidates with liver cancer that goes beyond tumor size and count to include how the AFP blood marker changes over time before transplant. The score outperformed the standard Milan Criteria in predicting cancer-free survival and would allow 85% of patients currently excluded under Milan Criteria to safely receive a transplant. This model gives U.S. transplant programs a practical, evidence-based tool to expand liver cancer transplant eligibility.

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Surgeons reported their experience performing 51 fully laparoscopic liver removals for living donors, the first such large series from a US center, comparing outcomes to open donation. Laparoscopic donors had longer operations but similar complication rates, and graft survival in recipients was 94% at one year. The results support cautious expansion of fully laparoscopic living donor hepatectomy at centers with sufficient expertise.

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Children who receive livers from living donors—usually parents—have better long-term outcomes than those receiving deceased-donor organs, but living donor transplants remain rare in the U.S. This study found that living-donor recipients also showed immunological advantages, with lower rejection rates likely tied to the partial genetic match with a parent donor. The data make a strong case for expanding living donor programs for children.