Citations 2
Variations in liver allocation systems across continents with a focus on MELD exceptions
Tanaka, Tomohiro , Polak, Wojciech G. , Vinaixa, Carmen , Russo, Francesco Paolo, Kabaçam, Gökhan , Chaudhury, Prosanto , Pillai, Anjana , Selzner, Nazia, Russo, Francesco Paolo , Polak, Wojciech G , Kabacam, Gökhan , Heimbach, Julie K , Hakeem, Abdul , Chadha, Ryan , Francoz, Claire , Russo, Francesco Paolo , Line, Pål‐Dag , Liu, Ken , Contreras, Alan G. , Selzner, Nazia , Heimbach, Julie K.
Liver Transplantation | October 16, 2025 | Volume: 32 | Issue: 5 | Pages: 748-764
Variations in liver allocation systems worldwide are presented, with a specific focus on regional differences and their potential impact on outcomes, with the goal of serving as a reference for future policy development. Summaries of liver allocation across multiple European, Scandinavian, and Asian systems, as well as the combined allocation system of Australia plus Canada, the United States, and the systems in Central America, South America, and the Caribbean are reviewed. A comprehensive comparison of how different regions address MELD exceptions, primarily focusing on hepatocellular carcinoma, along with the most common etiologies of liver disease requiring transplantation is presented. In addition, the adoption of living donation and donation after circulatory death is discussed. The study involves contributions from a diverse group of world experts in liver transplantation and may serve as an essential resource to foster international dialogue as countries strive to optimize organ allocation policies, including MELD exceptions.
Adequate versus deep response to ursodeoxycholic acid in primary biliary cholangitis: To what extent and under what conditions is normal alkaline phosphatase level associated with complication-free survival gain?
Lemoinne, Sara , Soret, Pierre‐Antoine , Gulamhusein, Aliya , Lytvyak, Ellina , Olivas, Ignasi , Eaton, John E. , Sebode, Marcial , Lohse, Ansgar W. , Nevens, Frederik , Cazzagon, Nora , Zago, Alessandra , Russo, Francesco Paolo , Floreani, Annarosa , Abbas, Nadir , Thorburn, Douglas , Delamarre, Adèle , Sobenko, Natalia , Villamil, Alejandra , Patwardhan, Vilas , Rigamonti, Cristina , Meer, Adriaan van der , Veer, Rozanne de, Zigmond, Ehud , Yehezkel, Eyal , Bruns, Tony , Große, Karsten , Wetten, Aaron , Jones, David , Dumortier, Jérôme , Pageaux, Georges‐Philippe , Lédinghen, Victor de , Chazouillères, Olivier , Groups, the Global & ERN Rare-Liver PBC Study, Osman, Karim T. , Bruns, Tony , Patwardhan, Vilas R , Lytvyak, Ellina , Corpechot, Christophe , Hansen, Bettina E. , Hirschfield, Gideon M. , Montaño‐Loza, Aldo J. , Parés, Albert , Schramm, Christoph , Dalekos, George Ν. , Gatselis, Nikolaos , Abbas, Nadir , Trivedi, Palak Jitendrakumar , Saffioti, Francesca , Barkai, László , Roccarina, Davide , Calvaruso, Vincenza , Fichera, Anna, Villamil, Alejandra , Medina‐Morales, Esli , Bonder, Alan , Carbone, Marco , Invernizzi, Pietro , Cristoferi, Laura , Kremer, Andreas E. , Deibel, Ansgar , Dyson, Jessica Katharine , Carrat, Fabrice , Groups, the Global & ERN Rare-Liver PBC Study
Hepatology | September 21, 2023 | Volume: 79 | Issue: 1 | Pages: 39-48
Background and Aims: Normal alkaline phosphatase (ALP) levels in ursodeoxycholic acid (UDCA)-treated patients with primary biliary cholangitis (PBC) are associated with better long-term outcome. However, second-line therapies are currently recommended only when ALP levels remain above 1.5 times the upper limit of normal (×ULN) after 12-month UDCA. We assessed whether, in patients considered good responders to UDCA, normal ALP levels were associated with significant survival gains. Approach and Results: We performed a retrospective cohort study of 1047 patients with PBC who attained an adequate response to UDCA according to Paris-2 criteria. Time to liver-related complications, liver transplantation, or death was assessed using adjusted restricted mean survival time (RMST) analysis. The overall incidence rate of events was 17.0 (95% CI: 13.7–21.1) per 1000 out of 4763.2 patient-years. On the whole population, normal serum ALP values (but not normal gamma-glutamyl transpeptidase (GGT), alanine aminotransferase (ALT), or aspartate aminotransferase (AST); or total bilirubin < 0.6 ×ULN) were associated with a significant absolute complication-free survival gain at 10 years (mean 7.6 months, 95% CI: 2.7 - 12.6 mo.; p = 0.003). In subgroup analysis, this association was significant in patients with a liver stiffness measurement ≥ 10 kPa and/or age ≤ 62 years, with a 10-year absolute complication-free survival gain of 52.8 months (95% CI: 45.7–59.9, p < 0.001) when these 2 conditions were met. Conclusions: PBC patients with an adequate response to UDCA and persistent ALP elevation between 1.1 and 1.5 ×ULN, particularly those with advanced fibrosis and/or who are sufficiently young, remain at risk of poor outcome. Further therapeutic efforts should be considered for these patients.