Olthoff, Kim M
Mayo Clinic
Department of Surgery, Penn Transplant Institute, University of Pennsylvania, Philadelphia, PA 19104, USA.
Citations 2
The Association of Flavin Mononucleotide and Lactate During Normothermic Regional Perfusion with Post-Transplant Liver Outcomes: An Exploratory Study
Fischer, R , Cywes, Claire , Ong, Olivia , Muñoz, Nicolás , Din, Sardar, Ibeabuchi, Tobenna , Brown‐Soler, Isabela , Mahmud, Nadim , Cederquist, K., Smith, Georgeine, Benko, Stephanie , Wehrle, Chase J. , Sonnenberg, Elizabeth M. , Gazala, Samir Abu , Markmann, James F. , Olthoff, Kim M. , Shaked, Abraham , Vyas, Frederick, Sellers, Marty T. , Jonge, Jeroen de , Sun, Keyue , Schlegel, Andrea , Abt, Peter L. , Fischer, Raphaël M J , Levine, Matthew H , Abu-Gazala, Samir , Markmann, James F , Olthoff, Kim M , Shaked, Abraham , Sellers, Marty , de Jonge, Jeroen , Sun, Keyue , Schlegel, Andrea , Abt, Peter L , Ong, Olivia , Din, Sardar Wali , Vyas, Frederick
Medicina | August 24, 2026 | Volume: 62 | Issue: 9 | Pages: 1622
Background and Objectives: Normothermic regional perfusion (NRP) is an effective technique to improve recipient outcomes. However, no valid methods for determining liver viability exist. Identifying relevant biological markers with clinical correlation to liver viability and recipient clinical outcomes is imperative to improve decision-making. Materials and Methods: Fifty-four donors undergoing NRP and their recipients were included. FMN was measured at the start, 1 h, and end of NRP. Lactate was measured at the start, 30, 60, and 90 min of NRP. Primary outcomes were early allograft function using the early allograft dysfunction (EAD) criteria and the model for early allograft function (MEAF). Secondary outcomes included the association with donor warm ischemia time (DWIT), stratified by 30 min. Spearman’s rho assessed correlations. Results: Forty (74%) livers were transplanted, with 5 (12.5%) recipients developing EAD and the mean MEAF score was 3.13 (1.49). FMN at all time points was significantly greater in the EAD group compared to the non-EAD group and was significantly correlated with the MEAF score (Peak FMN: rho = 0.507, p = 0.001). FMN during perfusion did not differ between DWIT < and ≥30 min. Lactate levels were similar across all groups and did not discriminate for adverse allograft outcomes. However, lactate levels during perfusion were higher in the DWIT ≥ 30 min group. Conclusions: These findings suggest that during NRP, elevated FMN, but not lactate, is associated with early allograft function.
Early graft failure after adult living donor liver transplantation: A multicenter risk analysis and development of the early allograft failure in living donor liver transplantation (EAGLE-LDLT) model
Li, Zhihao, Centonze, Leonardo , Raptis, Dimitri , Marquez, Kris Ann Hervera , Rammohan, Ashwin, Gunasekaran, Vasanthakumar , Hong, Suyoung , Chen, I Lun, KIM, Jongman , Hsu, Shih-Chao , Akamatsu, Nobuhisa, Shaked, Oren, Genedy, Lara, Dutkowski, Philipp , Nadalin, Silvio, Boehnert, Markus U, Mathur, Abhishek, Emond, J., Testa, Giuliano, Olthoff, Kim, Taner, Timucin, Wong, Tiffany CL, Hasegawa, Kiyoshi, Balci, D., Cattral, Mark, Sapisochin, G., Selzner, Nazia, Jeng, Long-Bin, Chen, Chao-Long, Suh, Kyung-Suk, Rela, Mohamed, Broering, Dieter, Clavien, Pierre-Alain, Kim, Jong Man , Raptis, Dimitri Aristotle , Li, Zhihao , Hong, Su young , Chen, I. , Centonze, Leonardo , Li, Zhihao , Rammohan, Ashwin , Chen, Itsuko Chih-Yi , Kirimker, Elvan Onur , Akamatsu, Nobuhisa , Shaked, Oren , Finotti, Michele , Yeow, Marcus , Nadalin, Silvio , Boehnert, Markus U , Polak, Wojciech G , Bonney, Glenn K , Samstein, Benjamin , Emond, Jean C , Testa, Giuliano , Olthoff, Kim M , Heimbach, Julie K , Taner, Timucin , Wong, Tiffany C L , Balci, Deniz , Cattral, Mark , Sapisochin, Gonzalo , Selzner, Nazia , Jeng, Long-Bin , Joh, Jae-Won , Chen, Chao-Long , Suh, Kyung-Suk , Di Sandro, Stefano , Rela, Mohamed , Broering, Dieter , Clavien, Pierre-Alain , Akamatsu, Nobuhisa , Shaked, Oren , Boehnert, Markus , Polak, Wojciech G. , Mathur, Abhishek , Samstein, Benjamin , Emond, Jean C. , Testa, Giuliano , Heimbach, Julie K. , Taner, Timuçin , Wong, Tiffany , Hasegawa, Kiyoshi , Cattral, Mark S. , Sapisochín, Gonzalo , Selzner, Nazia , Joh, Jae‐Won , Rela, Mohamed , Bröering, Dieter C. , Clavien, Pierre‐Alain
Liver Transplantation | January 21, 2026 | Volume: 32 | Issue: 7 | Pages: 1027-1039
Early allograft failure (EAF) after living donor liver transplantation (LDLT) remains a clinical challenge. Existing prediction models developed for deceased donor transplantation poorly apply to LDLT due to distinct surgical and physiological factors. This study identifies clinical determinants of EAF and develops an LDLT-specific prediction model. We conducted a multicenter retrospective cohort study from 17 high-volume LDLT centers (January 2016–December 2020) with external validation at a tertiary center in Saudi Arabia (January 2015–December 2022). The primary outcome was EAF (graft loss or patient death ≤90 d). Multivariable mixed-effects logistic regression identified preoperative/intraoperative risk factors. The EAGLE-LDLT model was constructed using postoperative laboratory values. Performance was compared against established models (EAD, MEAF, A2ALL) using ROC analysis and decision curve analysis. The development cohort included 2944 adult LDLT recipients (67.7% male; median age 55 y; median MELD 14) with a 5.5% EAF rate. External validation included 1020 recipients (median MELD 21, 6.7% EAF). Independent risk factors for EAF were MELD (OR 1.06, 95% CI 1.04–1.08), donor BMI (OR 1.05, 95% CI 1.00–1.10), portal vein thrombosis (OR 1.73, 95% CI 1.13–2.63), and hepaticojejunostomy (OR 1.58, 95% CI 1.06–2.36). The EAGLE-LDLT model incorporating peak ALT (>468 U/L), peak INR (>1.9), and bilirubin (>3.5 mg/dL) and INR (>1.3) at POD7, demonstrated superior discrimination (AUC=0.81) compared with MEAF (AUC=0.77, p =0.004), EAD (AUC=0.67, p <0.001), and A2ALL (AUC=0.65, p <0.001). EAGLE-LDLT achieved balanced sensitivity (75.0%) and specificity (73.7%), effectively stratifying patients into high-risk (15% of patients; 40.4% EAF incidence) and low-risk groups. Preoperative and intraoperative clinical factors predict EAF in LDLT. The EAGLE-LDLT model accurately identifies LDLT recipients at the highest risk for EAF postoperatively.