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New Perspectives in Liver Transplantation and Biliary Complications
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New Perspectives in Liver Transplantation and Biliary Complications

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: 28 September 2025 | Viewed by 2709

Special Issue Editors

Dr. Marco Maria Pascale

E-Mail Website
Guest Editor
General Surgery and Liver Transplant Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
Interests: liver transplant; hepatocarcinoma; cholangiocarcinoma; benign hepatic diseases
Special Issues, Collections and Topics in MDPI journals
Dr. Francesco Frongillo

E-Mail Website
Guest Editor
Head of Multiorgan Procurement Program, General Surgery and Liver Transplant Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
Interests: liver transplant; multi-organ procurement; machine perfusion; hepatocarcinoma; cholangiocarcinoma; benign hepatic diseases

Special Issue Information

Dear Colleagues,

We are pleased to invite you to contribute your valuable articles to our medical journal, focusing on the theme “New Perspectives in Liver Transplantation and Biliary Complications”. This highly relevant medical topic requires in-depth scientific and clinical exploration, and your contribution could make a significant difference in improving medical practices and patient outcomes.

Liver transplantation represents one of the most complex and delicate surgical procedures, and biliary complications are among the most common and challenging issues that can arise post-operatively. The organ shortage imposes the use of increasingly marginal donors, both among dead brain donors (DBD) and among dead cardiocirculatory donors (DCD). The acceptance of expanded criteria grafts results in increased rates of cholangiopathy driven by ischemia/reperfusion injury (IRI). The adoption of innovative protocols before and after liver transplant has demonstrated encouraging results in reducing cholangiopathy rates. Machine perfusions allow better preservation of liver grafts or a more accurate ex vivo assessment of the expression of IRI. Furthermore, medications on the graft, both in the pre- and post-implantation phases, can further reduce the injury expressed by the liver graft.

Articles exploring new surgical techniques, pre- and post-operative management protocols, and innovative studies are particularly welcomed.

We invite you to share your clinical experiences, original research, and literature reviews that can contribute to a better understanding of the biliary complications in the context of liver transplantation. Each article will undergo rigorous peer review to ensure the highest scientific quality.

We are confident that your expertise and dedication will provide valuable insights to the medical community and improve the management of patients undergoing liver transplantation.

We are available to provide any further information and clarification.

Dr. Marco Maria Pascale
Dr. Francesco Frongillo
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • liver transplant
  • cholangiopathy
  • ischemia/reperfusion injury
  • machine perfusion
  • extended-criteria donors

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Published Papers (3 papers)

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Research

10 pages, 819 KiB  
Article
Endoscopic Management of Recurrent Anastomotic Biliary Stricture Following Deceased Orthotopic Liver Transplantation
by Esteban Fuentes-Valenzuela, Marina De Benito Sanz, Irene Peñas-Herrero, Félix García-Pajares, Carmen Alonso-Martín, Carolina Almohalla Álvarez, Antonio Martínez-Ortega, Ramon Sanchez-Ocana, Carlos de la Serna-Higuera, Gloria Sánchez-Antolín and Manuel Perez-Miranda
J. Clin. Med. 2025, 14(7), 2198; https://doi.org/10.3390/jcm14072198 - 24 Mar 2025
Viewed by 387
Abstract
Background/Objectives: Data on the natural history and endoscopic treatment outcomes of recurrent anastomotic biliary stricture (RABS) after orthotopic liver transplantation (OLT) are limited. This study aimed to evaluate the incidence and outcomes of RABS after OLT. Methods: A retrospective single-center study on OLT [...] Read more.
Background/Objectives: Data on the natural history and endoscopic treatment outcomes of recurrent anastomotic biliary stricture (RABS) after orthotopic liver transplantation (OLT) are limited. This study aimed to evaluate the incidence and outcomes of RABS after OLT. Methods: A retrospective single-center study on OLT patients who underwent successful endoscopic treatment of ABS was conducted. The incidence of RABS, risk factors for recurrence, and outcomes of repeat endoscopic therapy were recorded. Results: A total of 131 OLT patients with ABS underwent endoscopic treatment, of which 119 successfully completed an endoscopic treatment course. After a median follow-up of 51.5 months (IQR 18.5–86.25) from ABS resolution, 26/119 patients (22.7%) developed RABS. All patients with RABS underwent a second endoscopic treatment course; 24 patients received self-expandable metal stents and 2 received plastic stents. Re-treatment was successful in 21 patients (80.8%) after a median of 8.5 months (IQR 5.25–14.50) and a total of 62 ERCPs. Adverse events occurred in two patients (7.4%)—one bacteremia and one suprastenotic biliary stricture. After a median follow-up of 65.5 months (IQR 20.75–125.5) from stent removal, only one patient had a second recurrence, which was treated with a Roux-en-Y hepaticojejunostomy. Multivariate analysis showed that older age at ABS diagnosis (OR 1.1; 95% CI: 1.1–1.2 p = 0.04) was the only independent risk factor for recurrence. Conclusions: RABS affects more than 20% of patients after successful endoscopic treatment. A second endoscopic therapy with covered self-expandable metal stents is a safe and effective option and should be considered before more invasive options. Full article
(This article belongs to the Special Issue New Perspectives in Liver Transplantation and Biliary Complications)
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17 pages, 3415 KiB  
Article
Real-Time Biomarkers of Liver Graft Quality in Hypothermic Oxygenated Machine Perfusion
by Andriy Zhylko, Marcin Morawski, Paweł Rykowski, Maciej Krasnodębski, Anya Wyporski, Jan Borkowski, Dmytro Zhylko, Konrad Kobryń, Rafał Stankiewicz, Jan Stypułkowski, Wacław Hołówko, Waldemar Patkowski, Tadeusz Wróblewski, Benedykt Szczepankiewicz, Barbara Górnicka, Magdalena Mielczarek-Puta, Marta Struga, Marek Krawczyk and Michał Grąt
J. Clin. Med. 2025, 14(2), 471; https://doi.org/10.3390/jcm14020471 - 13 Jan 2025
Viewed by 891
Abstract
Background: Hypothermic oxygenated machine perfusion has emerged as a strategy to alleviate ischemic-reperfusion injury in liver grafts. Nevertheless, there is limited data on the effectiveness of hypothermic liver perfusion in evaluating organ quality. This study aimed to introduce a readily accessible real-time [...] Read more.
Background: Hypothermic oxygenated machine perfusion has emerged as a strategy to alleviate ischemic-reperfusion injury in liver grafts. Nevertheless, there is limited data on the effectiveness of hypothermic liver perfusion in evaluating organ quality. This study aimed to introduce a readily accessible real-time predictive biomarker measured in machine perfusate for post-transplant liver graft function. Methods: The study evaluated perfusate analytes over a 90-day postoperative period in 26 patients randomly assigned to receive a liver graft following dual hypothermic machine perfusion in a prospective randomized controlled trial. Machine perfusion was consistently conducted end-ischemically for at least 120 min, with real-time perfusate assessment at 30-min intervals. Graft functionality was assessed using established metrics, including Early Allograft Dysfunction (EAD). Results: Perfusate lactate concentration after 120 min of machine perfusion demonstrated significant predictive value for EAD (AUC ROC: 0.841, p = 0.009). Additionally, it correlated with post-transplant peak transaminase levels and extended hospital stays. Subgroup analysis revealed significantly higher lactate accumulation in livers with post-transplant EAD. Conclusions: Liver graft quality can be effectively assessed during hypothermic machine perfusion using simple perfusate lactate measurements. The reliability and accessibility of this evaluation support its potential integration into diverse transplant centers. Full article
(This article belongs to the Special Issue New Perspectives in Liver Transplantation and Biliary Complications)
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10 pages, 1918 KiB  
Article
Impact of Hypothermic Oxygenated Machine Perfusion on Immune Cell Clearance in Liver Transplantation: Enhancing Graft Function and Post-Transplant Outcomes
by Dominik Thomas Koch, Malte Schirren, Severin Jacobi, Hanno Nieß, Bernhard Willibald Renz, Jens Werner, Markus Otto Guba and Dionysios Koliogiannis
J. Clin. Med. 2025, 14(1), 127; https://doi.org/10.3390/jcm14010127 - 29 Dec 2024
Viewed by 967
Abstract
Background: Hypothermic oxygenated machine perfusion (HOPE) has emerged as a critical innovation in liver transplantation (LTx), offering significant protection against ischemia-reperfusion injury (IRI). This study focuses on quantifying and characterizing immune cells flushed out during HOPE to explore its effects on graft function [...] Read more.
Background: Hypothermic oxygenated machine perfusion (HOPE) has emerged as a critical innovation in liver transplantation (LTx), offering significant protection against ischemia-reperfusion injury (IRI). This study focuses on quantifying and characterizing immune cells flushed out during HOPE to explore its effects on graft function and post-transplant outcomes. Materials and Methods: Fifty liver grafts underwent end-ischemic HOPE. Perfusate samples were collected at three time points: at the start of perfusion, after 10 min, and at the end of perfusion. The samples were analyzed to quantify and characterize immune cells, assessing the effectiveness of HOPE in reducing cellular debris and its impact on graft quality. Results: The primary perfusate contained significant concentrations of immune cells, mainly segmented neutrophils, lymphocytes, and monocytes. After 10 min of perfusion, outflow cell concentration decreased by over 95%, and by the end of perfusion, a more than 99% reduction was observed. Conclusions: HOPE effectively reduces immune cell concentrations in liver grafts, suggesting a mechanism for improved graft function and reduced post-transplant complications. These findings support the continued use and optimization of HOPE in LTx. Full article
(This article belongs to the Special Issue New Perspectives in Liver Transplantation and Biliary Complications)
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