Josh Levitsky

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This study looked at patients with liver disease (cirrhosis) who needed kidney treatment (renal replacement therapy, RRT) because of kidney injury (acute kidney injury, or AKI). It found that the type of kidney injury (hepatorenal syndrome versus other causes) did not affect the chances of dying within 90 days. For example, 17.4% of the patients had hepatorenal syndrome, and their higher risk of death was not significantly greater than those with other types of kidney injury, suggesting that the specific cause of kidney injury may not be as important when deciding on treatment. Who this helps: This helps doctors by guiding treatment decisions for patients with liver disease and kidney injury.

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This study looked at a specific type of rejection called plasma cell-rich rejection (PCRR) that can occur after liver transplantation. Researchers reviewed various blood and tissue markers that could help quickly identify and manage PCRR, which is crucial because without timely treatment, patients risk severe liver damage or organ failure. They emphasized the importance of developing these biomarkers to improve patient outcomes. Who this helps: This benefits liver transplant patients by providing better tools for early diagnosis and treatment.

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This study looked at the outcomes of patients with liver cirrhosis who also had acute kidney injury, categorizing them into those with only acute kidney injury and those with acute kidney injury on top of chronic kidney disease. Researchers analyzed data from 2,057 patients and found that 39% of those with only acute kidney injury died within 90 days, compared to 30% of those with acute kidney injury combined with chronic kidney disease. This matters because it indicates that patients with chronic kidney disease might have better short-term survival when they also experience acute kidney injury, likely due to their better liver function. Who this helps: This information benefits doctors treating patients with liver cirrhosis and kidney issues, helping them make better decisions on care.

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This paper examines the lack of clinical trials aimed at treating chronic rejection, a major challenge for the long-term success of organ transplants. The authors found that there are significant obstacles preventing these trials from moving forward, despite the critical need for new treatments. They propose a strategic plan that brings together researchers and resources to tackle these challenges and advance care for patients facing chronic rejection. Who this helps: This benefits patients who receive organ transplants and are at risk of chronic rejection.

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This research studied liver transplant biopsies to identify a specific type of rejection called NK cell-enriched rejection-like (NKRL) state. They analyzed 765 biopsies and found that 13% showed this NKRL state, which is different from a more harmful rejection known as T cell-mediated rejection (TCMR) that was present in 16% of cases. The NKRL state appears to be less harmful, with no significant injury or biochemical abnormalities compared to TCMR, highlighting that some liver transplant rejections can be manageable and do not cause extensive damage to the liver. Who this helps: This benefits liver transplant patients and their doctors by providing insights into managing rejection types.

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This study explored how liver transplantation affects kidney function by examining the molecular differences between patients whose kidneys remained healthy and those who experienced kidney problems afterward. Researchers analyzed blood samples from nine transplant recipients and discovered 29 key metabolites and 45 proteins that were significantly different between the two groups. Understanding these differences is important because it can help identify patients at risk of kidney issues after transplant, leading to better care and outcomes. Who this helps: This research benefits patients undergoing liver transplantation by identifying those at risk for kidney dysfunction.

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This study looked at the shortage of doctors training to specialize in transplant medicine in the U.S. and found that increasing early exposure to transplant work, enhancing education about the field, offering more flexible training options, and improving work-life balance can help attract more trainees. The task force made specific recommendations to address these issues, aiming to boost interest in transplant fellowships and ensure enough qualified care providers as organ transplants become more common. Who this helps: This benefits patients needing organ transplants by ensuring more trained specialists are available for their care.

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This study focused on how well patients with hepatorenal syndrome (HRS) respond to terlipressin, a medication that helps improve kidney function. Researchers tested blood and urine samples from 115 patients and found that 31% experienced a reversal of HRS after treatment. They identified specific markers in the blood that were linked to successful treatment, which could help doctors choose the right patients for terlipressin therapy in the future. Who this helps: This benefits patients with hepatorenal syndrome by identifying who is most likely to respond to terlipressin treatment.

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This study looked at what information living liver donors need about the patients receiving their organs, especially in tough situations where recipients have serious health issues. Researchers surveyed 98 previous donors and found that while most were willing to donate (51% for patients with alcohol-related liver disease, 56% for acute liver failure, and 85% for liver cancer), a large majority (56% to 93%) wanted detailed information about the patients' health and expected outcomes before deciding. This matters because providing better information can help donors make more informed choices about their donations, ensuring they feel confident and supported in their decision. Who this helps: This helps living liver donors.

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This study looked at how effective a home-based exercise program could be for patients with liver disease awaiting a transplant. The program, which used exercise equipment, a smartphone app, and regular remote assessments, helped improve the frailty of these patients, as indicated by a decrease in their Liver Frailty Index score from 3.59 to 3.48 over about 259 days. In contrast, a similar group that did not participate in the exercise program showed no improvement, highlighting the program's potential benefits for patient health and survival. Who this helps: This helps patients with liver disease who are on the transplant waiting list.

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A prospective multicenter trial tested whether long-term liver transplant recipients could safely stop immunosuppression. Of 61 participants who attempted withdrawal, only 10 out of 17 who remained stable off drugs for a year were confirmed truly tolerant by biopsy. The study identified several biological signals in pre-withdrawal biopsies that may predict who can safely discontinue immunosuppression, a finding that could eventually reduce drug-related side effects for a small subset of patients.

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This study looked at how insulin levels after liver and heart transplants affect infection rates in patients. They found that patients who required the highest insulin drip rates—indicating severe insulin resistance—had fewer infections after liver transplants (42.3% compared to 60.0%) and heart transplants (19.1% compared to 53.9%) within six months. This is important because it suggests that how the body handles insulin may relate to better recovery outcomes, potentially guiding future treatments to reduce infections. Who this helps: This helps patients undergoing organ transplants.

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This study looked at a new method called proteoform reaction monitoring (PfRM) to measure specific protein forms in very small quantities. Researchers found that this method can accurately detect and quantify proteins at very low levels (down to the low femtomolar range) and can be used on complex samples, like blood from liver-transplanted patients. This is important because it could lead to better ways to identify protein biomarkers for diseases, helping with diagnostics and understanding how diseases develop. Who this helps: This helps doctors and researchers working on disease diagnosis and treatment.

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In September 2022, a group of experts in liver health met to discuss how to monitor and improve the long-term success of liver transplants. They emphasized the need for better tools to track liver health and suggested updating how we classify liver rejection to help doctors provide more personalized treatment. This matters because it can lead to improved survival rates for patients with liver transplants by ensuring they receive the right care tailored to their specific situations. Who this helps: Patients with liver transplants.

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This study examines the use of terlipressin, a medication recently approved in the U.S. for treating severe kidney issues related to liver disease, known as hepatorenal syndrome-acute kidney injury (HRS-AKI). Researchers discuss whether patients who respond well to terlipressin should have their eligibility for liver transplants protected under the MELD scoring system, which determines waitlist priority; they highlight that, while terlipressin might help some patients improve their chances, cost and availability pose serious challenges. It’s essential to ensure that all stakeholders, including healthcare providers and policymakers, work together to improve access to this treatment. Who this helps: This helps patients with severe liver disease and their doctors.

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This study looked at how kidney function changes after liver transplants, especially focusing on patients with kidney failure. Researchers found that patients with kidney failure had higher levels of proteins called OPN and TIMP-1 in their blood, which are linked to kidney recovery. The study suggests that inflammation plays a harmful role in kidney function, indicating that monitoring these levels before transplant could help predict and possibly improve kidney recovery after surgery. Who this helps: This helps patients undergoing liver transplants and their doctors in managing kidney health.

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This study looked at how well a short survey about physical ability (PROMIS) can identify frailty and predict hospitalizations in patients being evaluated for liver transplants. Researchers found that among 81 patients, 15% were considered frail, and they were hospitalized an average of 1.1 days each month. The findings indicate that using this quick survey can help estimate which patients may need more medical attention, making it easier for doctors to manage care. Who this helps: This helps patients waiting for liver transplants and their healthcare providers.

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This study looked at how well a simple questionnaire about cognitive function can identify people with cirrhosis who might experience confusion, a condition called hepatic encephalopathy (HE). Researchers found that patients who reported poorer cognitive abilities on the questionnaire had a significantly higher chance of being hospitalized: the rate of hospital admissions was about 1.6 days per month, and the survey could predict future hospital stays. This is important because it offers an easy way for doctors to identify at-risk patients and potentially prevent hospitalizations. Who this helps: This helps patients with cirrhosis and their doctors by providing a quick method to spot cognitive issues that could lead to hospital stays.

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This study looked at how a specific procedure called the modified Hutson loop access (MHLA) is used to treat complications in liver transplant patients, focusing on issues like bile duct blockages and leaks. Out of 201 procedures performed on 52 patients, the success rate was very high at 95%, with only 2% of procedures failing when using an endoscope, compared to 13% without it. These findings are important because they show that using the MHLA with endoscopy is a safe and effective way to manage post-transplant complications, which can lead to better patient outcomes and fewer additional procedures.

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This study looked at how much healthcare resources are used after liver transplantation in patients with a condition called acute-on-chronic liver failure (ACLF). Among 318 patients studied, those with ACLF had longer hospital stays, more time on dialysis, and a higher chance of needing rehabilitation compared to those without ACLF. For example, patients with the most severe form of ACLF (ACLF-3) stayed in the hospital for about 19 days longer than those without ACLF, and were more likely to face complications like infections. Who this helps: This information helps doctors understand the increased needs of patients with ACLF after liver transplant, which can improve patient care and resource planning.

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This study looked at how changing medications affects cancer risk in liver transplant patients. Researchers found that among 20 patients, those who successfully switched from one type of treatment (sirolimus) to another and then reduced their medication had lower signs of liver cancer, liver fat buildup, and liver scarring. Specifically, the study noted a significant decline in cancer-related genes after achieving medication tolerance, which is important because it suggests that these changes can lower cancer risks in liver transplant recipients. Who this helps: This helps liver transplant patients, especially those at a higher risk for cancer.

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This study looked at kidney transplant patients who received kidneys from donors infected with the hepatitis C virus (HCV) and were treated quickly with a medicine called glecaprevir/pibrentasvir (G/P). All patients treated within 2-5 days after their transplant were cured of HCV, and while some showed higher levels of certain inflammatory markers immediately after the surgery, these levels quickly returned to normal. This is important because it shows that even though these patients had a temporary infection, their immune system did not remain disturbed in the long term. Who this helps: This helps kidney transplant patients and doctors managing their care.

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The research studied how new biomarkers can help predict important outcomes after liver transplantation, like disease recurrence and chronic kidney disease. It highlighted that while liver transplantation has a high one-year survival rate of over 90%, issues like cancer return can still significantly affect patient health. The findings led to guidelines aimed at improving patient care by using these biomarkers for better management of immunosuppression. Who this helps: This benefits liver transplant patients and their doctors.

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This study focused on improving how organ transplant quality and outcomes can be assessed through sophisticated protein analysis methods. Researchers found that using "top-down" proteomics, which analyzes entire proteins rather than smaller fragments, can identify more accurate biomarkers related to organ rejection and dysfunction. This matters because better biomarkers can help doctors predict and address issues with transplanted organs, ultimately leading to improved patient survival rates. Who this helps: This helps patients receiving organ transplants and their doctors.

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Researchers studied the personality traits of 263 patients with cirrhosis who were being evaluated for liver transplants. They found that these patients were generally more open, extroverted, agreeable, and neurotic than the average person, but less conscientious. Importantly, those with higher conscientiousness were nearly three times more likely to receive a liver transplant, highlighting that personality can significantly affect treatment outcomes in liver disease.

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This review examines the current state of non-invasive biomarkers — genetic, protein, and immune signals — being developed to diagnose and predict complications after liver transplantation. Promising applications include detecting rejection earlier, guiding immunosuppression reduction, identifying fibrosis, and predicting kidney recovery, though most markers still lack the large-scale validation needed for routine clinical use. The authors frame this as a fast-moving field on the verge of changing how transplant patients are monitored and managed.

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Living donor liver transplantation can reduce deaths on the waitlist, but its use in the U.S. remains low. This consensus conference report from the American Society of Transplantation identified barriers to wider adoption and outlined best practices for selecting candidates and engaging potential donors. The goal is to increase access to living donor transplants across more transplant centers.

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This study focused on finding a blood test that could detect early signs of liver transplant rejection, which can help doctors manage immunosuppressive treatments more effectively. Researchers analyzed data from 61 liver transplant patients with rejection and 162 without, creating a system that accurately identifies rejection 72% of the time and correctly rules it out 86% of the time. This discovery is important because it allows for better, tailored treatment plans that could prevent damage to the transplanted liver. Who this helps: This helps liver transplant patients by improving their care and treatment outcomes.

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This study looked at how levels of donor-derived cell-free DNA (dd-cfDNA) in the blood can help predict and diagnose liver transplant problems. The researchers found that high levels of dd-cfDNA could identify cases of organ rejection with high accuracy: 87% of the time when comparing rejected grafts with healthy ones and 66.7% when distinguishing rejection from other types of dysfunction. Understanding these levels is important because it allows for early detection of graft injury, which can lead to better treatment decisions for liver transplant recipients. Who this helps: This helps doctors and liver transplant patients by providing a way to detect potential problems early.

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This study created a detailed map of nearly 30,000 unique protein forms found in human blood and bone marrow cells. Researchers discovered that these specific protein forms are better indicators of how cells differentiate and function than the proteins themselves, which are often present in many cell types. The findings can help improve monitoring after liver transplants by identifying signs that distinguish between normal organ function and problems like rejection. Who this helps: Patients receiving organ transplants and their doctors.

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The MYTHIC study looked at the results of transplanting kidneys from donors who have the hepatitis C virus (HCV) into patients who do not. It found that the chance of getting a kidney transplant was over three times higher for those who accepted these kidneys (68%) compared to patients who did not participate (19%). Additionally, all the patients who received HCV-infected kidneys were cured of the virus, and 93% of them survived for a year without major health issues. Who this helps: This benefits kidney transplant patients, especially those struggling to find suitable organs.

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This study looked at how well doctors follow guidelines for helping liver transplant patients quit smoking, as smoking increases the risk of heart problems after transplantation. Out of 572 patients, 56.8% had never smoked, while 9.8% were current smokers at the time of their transplant. It was found that only about 25% of current smokers received the recommended help to quit, and there was no significant difference in heart problems between those who received help and those who did not, highlighting missed opportunities for improving patient care. Who this helps: This research benefits liver transplant patients and healthcare providers.

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This research reviewed new ways to detect when a liver transplant is being rejected without needing a painful biopsy. It found that various blood tests measuring genetic materials and proteins can help predict rejection. These advancements could improve patient care by reducing the chance of complications and ensuring better outcomes after transplant. Who this helps: This benefits liver transplant patients and their doctors.

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This study explored whether a simple pulse oximeter-like device could help doctors determine fluid levels in patients with liver cirrhosis. Out of 26 patients, 9 (or 35%) had an excess of fluid in their blood vessels. The method using pulse oximeter waveforms was more accurate in predicting fluid overload than the current standard test, BNP, providing an 87% accuracy overall. Who this helps: This benefits doctors treating patients with cirrhosis, allowing for better management of fluid levels.

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This study looks at autoimmune hepatitis (AIH), a rare liver disease that can cause serious harm, including liver failure. Researchers explored new noninvasive biomarkers—like gene expressions and proteins—that could help doctors predict how patients will respond to treatment, identify those at higher risk of relapse, and improve how medications are managed. They found these biomarkers could significantly enhance how AIH is treated, which is important because current treatments often have side effects and aren’t tailored to individual needs. Who this helps: This benefits patients with autoimmune hepatitis and their doctors by offering better treatment strategies.

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This study examined liver tissue samples from patients who had undergone liver transplants to understand the role of specific genes related to stress in liver cells. Researchers found that patients with high bilirubin levels, which indicate liver problems, showed increased activity in genes related to the unfolded protein response (UPR), highlighting its role in liver damage. This matters because understanding these genetic responses could lead to better treatments for cholestatic liver diseases, which currently have limited effective options. Who this helps: This helps patients suffering from cholestatic liver diseases.

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This study looked at a new treatment method for patients who have received a liver transplant that could help them reduce their need for immunosuppressive drugs. Out of 10 patients who tried to stop their medication, only 5 received the treatment, and 2 of those successfully lowered their drug dosage by 75% while keeping their liver function stable. While this trial shows promise for reducing medication needs without harmful side effects, there weren't enough patients treated to draw strong conclusions about the therapy's effectiveness. Who this helps: This benefits liver transplant patients looking for options to lessen their reliance on immune-suppressing medications.

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The study examined the long-term health of children who received liver transplants, focusing on tracking their outcomes years after the surgery. Out of nearly 8,000 children who survived at least one year following their transplant, about 1 in 6 were not reachable for follow-up, which was more common for those transplanted in the 1990s. This lack of follow-up can lead to an inaccurate understanding of long-term success, as almost 10% needed another transplant and 8% faced organ failure later on, highlighting the need for better ongoing care and monitoring for these young patients.

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This research paper looks at the reasons why some people with severe liver problems also have kidney disease and how these issues affect the decision to perform a combined liver and kidney transplant. The authors explain the changes in guidelines for these types of transplants, detailing current rules and how they impact patient eligibility. Understanding these indications is crucial because it helps doctors make better decisions about who can receive these transplants, potentially improving outcomes for patients needing both organs. Who this helps: This benefits patients suffering from both liver and kidney diseases.

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This study looked at liver transplant recipients who also have chronic kidney disease (CKD) to see how working with kidney specialists (nephrologists) affects their risk of heart problems. It found that those receiving care from nephrologists had 43% fewer cardiovascular events compared to those who did not receive this specialized care. This is important because it shows that involving nephrologists can significantly improve heart health in these patients. Who this helps: This helps liver transplant recipients with chronic kidney disease and their doctors.

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This study focused on finding specific substances in the blood that can help identify patients with nonalcoholic fatty liver disease (NAFLD) after they have received a liver transplant. Researchers discovered 14 blood metabolites that were noticeably different in patients with recurrent NAFLD compared to those without liver disease and 19 that differed between NAFLD patients and those experiencing liver rejection. These findings matter because they offer a noninvasive way to detect and monitor NAFLD recurrence, which could improve patient management after liver transplants. Who this helps: This helps patients who have undergone liver transplants and may be at risk for recurrent liver diseases.

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This study looked at how living liver donation affects the quality of life (QOL) for donors. It found that about 9% of donors experienced a lasting drop in their physical health for at least two years after donating, while mental health scores usually improved. Many donors also faced financial strain, with 40% reporting it as a burden three months after the donation. Who this helps: This research benefits both living liver donors and healthcare providers by highlighting potential challenges donors might face.