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Ex) Article Title, Author, Keywords

Review Article

Liver transplantation in Wilson’s disease: A systematic review

Wilson’s disease (WD) is a rare genetic disorder affecting the metabolism of copper that may present with neurological symptoms. In cases leading to hepatic failure, liver transplantation (LT) may be necessary. The aim of this paper is to examine the literature on LT cases related to WD in terms of disease characteristics, the neurological conditions of patients and survival rates. The keywords “Wilson and transplant*” were used to perform a title and abstract search across three databases...
Review Article

Impact of COVID-19 on the number of deceased donors and organ transplantation in Western countries

The severe acute respiratory syndrome coronavirus 2 disease 2019 (COVID-19) pandemic has an impact on all facets of our health care system, including life-saving procedures. The COVID-19 in 2020 has a substantial impact on the transplant community. This study aimed to assess the impact of COVID-19 on the number of deceased donors and organ transplantation in Western countries by analyzing literature review. In Spain, the COVID-19 pandemic has posed significant challenges to the Spanish donation ...
Original Article

Analysis of nationwide volume of liver transplantation in Korea during 2020 shows no definitive decrease during COVID-19 outbreak

Background: Recent outbreak of Coronavirus disease 2019 (COVID-19) has discouraged organ donation. To determine its impact on liver transplantation (LT) at Korean transplant centers, it is necessary to analyze the incidence and type of LT in each center. Methods: The number of deceased donor LT (DDLT) and living donor LT (LDLT) operations performed during the year 2020 were analyzed using the Korean Network for Organ Sharing (KONOS) database. Results: During the 21-year period from 2000 to 2020,...
How-I-Do-It

Minimal-incision donor right hepatectomy for living donor liver transplantation

For living donors, the second most important concern after the donor safety is the cosmetic aspect of abdominal incision. The present study aimed to present the technical details of minimal-incision laparotomy (MIL) in a case of living donor right hepatectomy with an eight minutes video clip. The recipient was a 57-year-old patient with alcoholic liver cirrhosis and the donor was his 28-year-old daughter of the recipient. The epigastrium area was narrow and the subcostal cartilages were elongate...

Current Issue Vol.2 No.1, May, 2022

  • Review Article

    Ann Liver Transplant 2022; 2(1): 1-7

    https://doi.org/10.52604/alt.22.0003

    Abstract : Marked development has led to significant improvements in the outcomes of organ transplantation. With the development of surgical techniques and immunosuppression, organ transplantation has become the ultimate treatment for patients with end-stage organ failure. Although the short-term transplant results have been improved, long-term outcomes of organ transplantation seem to have reached its limit. Posttransplant immunosuppression is directed toward optimization of the immunosuppressive regimens with conventional immunosuppressive agents for better control of antibodies while avoiding calcineurin inhibitor toxicity and by biological therapeutics including co-stimulation blockade agents that provide effective control of antibodies along with a reduction in the use or avoidance of available immunosuppressive agents. Tolerance induction through transplantation of donor hematopoietic stem cells or infusion of regulatory cells using various sources of immune cells is also a promising strategy because it can lead to avoidance of immunosuppressant-associated complications. Recent results of new immunosuppressants obtained from non-human study models provide valuable information on the optimization of immunosuppressive regimens. The recent initial success of human xenotransplantation using pig kidneys and hearts will give a new insight toward xenotransplantation. All new immunosuppressants and regimens should be validated under the considerations for risk-benefit balance in various clinical conditions. Future immunosuppressive therapy strategies are needed to effectively control antibodies and antibody-mediated rejection while avoiding calcineurin inhibitor-associated complications.

  • Review Article

    Ann Liver Transplant 2022; 2(1): 8-14

    https://doi.org/10.52604/alt.22.0011

    Abstract : Institutional case volume of liver transplantation (LT) is reported to be not associated with post-transplant survival in the United States, but their association was presented in several Korea-nationwide studies. Considering that the majority of LT centers in Korea are classified as low-volume centers, it is necessary to evaluate the effect of institutional LT case volume on post-transplant outcomes through a meta-analysis. This meta-analysis included four Korea-nationwide cohort studies using the database of Korean National Healthcare Insurance Service (NHIS) that focused on adult deceased donor liver transplantation (DDLT), adult living donor liver transplantation (LDLT), pediatric LT, and liver re-transplantation. A total of 1,616 LT cases were performed in 56 centers in the year 2020. DDLT and LDLT were performed in 46 and 51 centers, respectively. A total of 2,648 adult DDLTs were performed at 54 centers. Centers were divided into high (>30 LTs/year)-, medium (10–30)-, and low (50)-, medium (10-50)-, and low (10)-, medium (1–10)-, and low (

  • Original Article

    Ann Liver Transplant 2022; 2(1): 15-20

    https://doi.org/10.52604/alt.22.0002

    Abstract : Background: Coronavirus disease 2019 (COVID-19) pandemic had serious effects on the healthcare system and has led to decrease in organ transplantation. Since the prevalence of COVID-19 in Korea was much lower than in Western countries, we analyzed the influence of COVID-19 on organ donation and transplantation in Korea. Methods: The annual number of kidney transplantation (KT) and liver transplantation (LT) in 2020–2021 were compared with those in 2019 using data from Korean Network for Organ Sharing database. Results: The number of deceased donors (DD) was 450 in 2019, 478 in 2020 and 442 in 2021; their average monthly number was 37.5±5.9 in 2019, 39.8±4.4 in 2020, and 36.8±6.4 in 2021 (p≥0.284). The annual case number of DDLT was 391 in 2019, 395 in 2020 and 357 in 2021; their monthly case number was 32.6±5.7, 32.9±4.7, and 29.8±3.6, respectively (p≥0.161). The annual case number of DDKT was 794, 848, and 747, respectively; their average monthly case number was 66.1±10.4, 70.7±9.8, and 62.3±12.2, respectively (p≥0.285). The annual case number of LDLT was 1,577, 1,146, and 1,126, respectively; their average monthly case number was 131.4±18.1, 95.5±8.0, and 93.8±8.9, respectively (p

  • Original Article

    Very high serum soluble PD-1 is closely associated with hepatocellular carcinoma recurrence after liver transplantation

    Cheon-Soo Park1 , Yun Kyu Kim2 , Eunyoung Tak2 , Kyung Jin Lee2 , Shin Hwang3

    Ann Liver Transplant 2022; 2(1): 21-27

    https://doi.org/10.52604/alt.22.0008

    Abstract : Background: Programmed death protein 1 (PD-1) pathway is one of the most critical mechanisms in tumor biology of hepatocellular carcinoma (HCC). The aim of this study was to assess the prognostic influence of very high pretransplant serum soluble PD-1 (sPD-1) in patients undergoing liver transplantation (LT) for treatment of HCC. Methods: Twelve LT recipients showing very high sPD-1 (>318.9 ng/mL, upper 5 percentiles) were selected. Stored serum samples were used to measure sPD-1 concentrations. Results: The mean age was 51.8±5.1 years. There were 11 males(91.7%). All patients had hepatitis B virus-associated liver cirrhosis. The mean model for end-stage liver disease score was 13.5±8.8. Six (50.0%) patients met the Milan criteria. The cumulative tumor recurrence rate was 14.7% at 1 year, 75.0% at 3 years, and 75.0% at 5 years. Overall patient survival rate was 83.3% at 1 year, 66.7% at 3 years, 50.0% at 5 years, and 33.3% at 10 years. The median value of sPD-1 concentration was 365.7 ng/mL. Receiver operating characteristic curve analysis of serum sPD-1 concentration for tumor recurrence showed that the area under the curve was 0.556 (p=0.824). The Youden index J was 0.333 at sPD-1 cutoff of 444.8 ng/mL. Application of sPD-1 cutoff of 444.8 ng/mL showed no significant difference in tumor recurrence (p=0.756) or patient survival (p=0.486). Both Milan criteria and ADV score with a cutoff of 5 log showed no prognostic difference (p≥0.377). Conclusion: Results of the present study revealed that high pretransplant serum sPD-1 over 318.9 ng/mL appeared to be an important risk factor that could surpass the prognostic influences of the Milan criteria and ADV score. Therefore, eligibility of LT should be carefully evaluated for patients showing very high serum sPD-1.

  • Original Article

    Comparison of skeletal muscle index and body surface area-based formulae for estimation of standard liver volume

    Amro H. Ageel1,4 , Jeong-Ik Park2 , Yong-Kyu Chung3 , Dong-Hwan Jung4 , Shin Hwang4

    Ann Liver Transplant 2022; 2(1): 28-33

    https://doi.org/10.52604/alt.22.0014

    Abstract : Background: Formula-derived standard liver volume (SLV) has been clinically used for living donor liver transplantation and hepatic resection. The majority of currently available SLV formulae are based on the body surface area (BSA). However, they often show a wide range of error. Skeletal muscle index measured at the third lumbar vertebra level (L3SMI) appears to reflect the lean body mass. The objective of this study was to compare the accuracy of L3SMI-based formula and BSA-based formula for calculating SLV. Methods: The study cohort included 100 living liver donors who underwent surgery between January 2020 and December 2020. Computed tomography images were used for liver volumetry and skeletal muscle area measurement. Results: The study cohort included 62 male and 38 female donors. Their age, BSA, L3SMI, and body mass index were 35.6±6.9 years, 1.79±0.19 m2, 51.9±9.6 cm2/m2, and 23.3±3.1 kg/m2, respectively. The L3SMI-based SLV formula was as follows: SLV (mL)=19.7×L3SMI (cm2/m2) +428.4 (R2=0.375, p

  • Original Article

    Ann Liver Transplant 2022; 2(1): 34-42

    https://doi.org/10.52604/alt.22.0012

    Abstract : Background: This study analyzed the expression and diagnostic values of alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) in patients who underwent living donor liver transplantation. Methods: The number of patients with and without hepatocellular carcinoma (HCC) was 1,297 and 719 in hepatitis B virus (HBV) group; 128 and 90 in hepatitis C virus (HCV) group; 109 and 381 in alcoholic liver disease (ALD) group; and 61 and 306 in other disease group, respectively. Results: In all patients, the median AFP and PIVKA-II were 9.0 ng/mL and 25 mAU/ mL in HCC patients and 4.0 ng/mL and 23 mAU/mL in non-HCC patients (p

  • Original Article

    Liver transplantation for young adult patients with post-Kasai portoenterostomy biliary atresia: Analysis of Korean Organ Transplantation Registry database

    Woo-Hyoung Kang1 , Shin Hwang1 , Myoung Soo Kim2 , Jae Geun Lee2 , Nam-Joon Yi3 , YoungRok Choi3 , Dong-Sik Kim4 , Yang-Won Nah5 , Jong Man Kim6

    Ann Liver Transplant 2022; 2(1): 43-47

    https://doi.org/10.52604/alt.21.0033

    Abstract : Background: Some young adults with native liver after Kasai portoenterostomy (KPE) for biliary atresia (BA) have a long survival period. However, a considerable number of them finally require liver transplantation (LT) due to various BA-associated complications. This study aimed to analyze the outcomes of LT in adult patients with post-KPE BA using Korea Organ Transplantation Registry (KOTRY) database. Methods: This study was a retrospective analysis of multi-center data using KOTRY database, including 14 adult patients who underwent LT in six institutions during a 7-year period from January 2014 to December 2020. Results: All 14 patients underwent KPE at around 1 year of age. The mean ages at LT were 25.0±5.9 years. The mean model for end-stage liver disease score was 13.5±4.6. The main reasons for LT were advanced liver cirrhosis in nine and intractable cholangitis in five. All patients received living-donor LT. The mean graft-to-recipient body weight ratio was 1.21%±0.31%. All 14 patients are currently alive during the mean follow-up period of 32.3±17.1 months. Adult BA patients were being cared for by pediatric gastroenterologists in 3 institutions, by adult gastroenterologists in 1 institution, and undetermined in 2 institutions. Conclusion: Young adult patients with BA are a unique group of patients requiring specialist care during the transition from pediatric to adult services. Living donor LT has been the main type of LT for these patients because of donor shortage in Korea. Similar to our previous single-center study, in the present study, LT outcomes in young adult BA patients were excellent. Therefore, LT should be considered in patients showing serious BA-associated complications.

  • How-I-Do-It

    Ann Liver Transplant 2022; 2(1): 48-55

    https://doi.org/10.52604/alt.22.0009

    Abstract : The great saphenous vein (GSV) is the longest vein in the human body. Because of the small diameter of the GSV, the clinical use of homologous GSV allografts has yet not been reported worldwide. In the present study, we present our early experience with the employment of cryopreserved homologous GSV allografts in hepatobiliary-pancreatic surgery and liver transplantation. Recently, the Korea Public Tissue Bank (KPTB) initiated harvesting of GSV allografts from deceased donors, thereby making cryopreserved GSVs available for clinical practice. The cryopreserved GSVs can be used in three forms. First, it can be enlarged through parallel paneling, in which the paneled GSV patch can be used for patch venoplasty of portal vein reconstruction during hepatobiliary-pancreatic surgery. Second, spiral winding or the GSV can make a large-caliber conduit, which can be used for interposition venoplasty of portal vein reconstruction during hepatobiliary-pancreatic surgery. The third is the use of a short GSV segment per se for hepatic vein venoplasty during living donor liver transplantation. To the best of our knowledge, this study is the first report on the clinical use of cryopreserved homologous GSV allografts in the field of hepatobiliary- pancreatic surgery and liver transplantation. In conclusion, cryopreserved GSV allografts are proposed as useful vascular materials that can be employed for hepatobiliary-pancreatic surgery and living donor liver transplantation in the forms of GSV segment itself, paneled vein patch, and spirally winded vein conduit.

  • How-I-Do-It

    Clinical applicability of autologous great saphenous vein for living donor liver transplantation

    Tae-Yong Ha , Shin Hwang , Chul-Soo Ahn , Deok-Bog Moon , Gi-Won Song , Dong-Hwan Jung , Gil-Chun Park

    Ann Liver Transplant 2022; 2(1): 56-63

    https://doi.org/10.52604/alt.22.0010

    Abstract : The great saphenous vein (GSV) is the longest vein in the human body. Because the GSV has a small diameter, the clinical use of an autologous GSV has been limited. In the field of living donor liver transplantation (LDLT), it has been used frequently because of a shortage of vessel allograft supply. In this study, we present our experience of autologous GSV used in adult LDLT. In our initial experience of LDLT using a modified right liver graft, we used the hydraulically dilated GSV conduit as an interposition graft for middle hepatic vein reconstruction, but it was no longer used. An autologous GSV has been frequently used as a patch for right hepatic vein venoplasty and for unification of inferior right hepatic-vein orifices. A GSV segment can be attached to a figure of 8-shaped graft portal vein orifice to facilitate portal vein reconstruction. A stack of two ring-shaped GSV segments can provide additional length to the recipient portal vein after excision of the damaged proximal portal vein stump. Two separate graft portal veins can be unified by means of unification patch venoplasty using GSV patches. A new Y-shaped vein graft can be made by means of a stack of multiple ring-shaped SGV segments. It is feasible to make a paneled patch or spirally wound conduit using a GSV. A GSV was also used as an interposition conduit for hepatic artery reconstruction. In conclusion, the autologous GSV is a useful vascular material for LDLT in the forms of a vein segment itself, a paneled vein patch, and a ring-shaped or spirally winded vein conduit.

  • Case Report

    Inferior vena cava stenting for middle hepatic vein deprivation-induced graft outflow vein obstruction in a patient who underwent living donor live transplantation: A case report with 22-year follow-up

    Tae-Yong Ha1 , Shin Hwang1 , Gi-Young Ko2 , Chul-Soo Ahn1 , Deok-Bog Moon1 , Gi-Won Song1 , Dong-Hwan Jung1 , Gil-Chun Park1 , Sung-Gyu Lee1

    Ann Liver Transplant 2022; 2(1): 64-68

    https://doi.org/10.52604/alt.21.0032

    Abstract : Inferior vena cava (IVC) stenting is known to be effective for treating IVC stenosis following liver transplantation (LT). We present the 22-year posttransplant course of a recipient of adult living donor LT (LDLT) who survived after IVC stenting. The patient was a 48-year-old male with hepatitis B virus-associated liver cirrhosis. The recipient underwent LDLT using a right liver graft without middle hepatic trunk or reconstruction. He was 170 cm in height and 65 kg in body weight. The model for endstage liver disease score and graft-to-recipient ratio were 26 and 1.54%, respectively. Early computed tomography (CT) scan showed massive congestion of the right anterior section. Massive ascites was drained through abdominal drains and drainage volume was increased to 14 L/day at 30 days after LT. Simulative analysis of serial CT images revealed that excessive regeneration of the right posterior section compressed the IVC, which induced outflow occlusion of the inferior right hepatic vein. A self-made wall stent was inserted to relieve the IVC occlusion at 38 days after LT, which resulted in disappearance of pressure gradients within the retrohepatic IVC. Soon after stenting of this IVC, the amount of ascites was progressively decreased. The abdominal drain was successfully removed at 102 days after LT, and the patient was discharged at 106 days after LT. For 22 years after LDLT, the patient has been doing well without any noticeable complications. In conclusion, we believe that IVC stenting seems to be an effective treatment to cope with IVC stenosis due to various causes following LT.

  • Case Report

    Living donor liver transplantation with proximal splenic vein ligation in a pediatric patient with congenital absence of the portal vein

    Jung-Man Namgoong1 , Shin Hwang1 , Gil-Chun Park1 , Suhyeon Ha1 , Kyung Mo Kim2 , Seak Hee Oh2

    Ann Liver Transplant 2022; 2(1): 69-77

    https://doi.org/10.52604/alt.22.0015

    Abstract : Congenital absence of the portal vein (CAPV) is a rare venous malformation in which the mesenteric venous blood drains directly into the systemic circulation. We report a case of pediatric living donor liver transplantation (LDLT) for CAPV with prominent splenorenal shunt. A 6-year-old boy was diagnosed with CAPV at the age of 1 year. Portal hypertension with splenomegaly was progressed, therefore, we decided to perform LDLT. The graft was a left liver graft from the 31-year-old mother of the patient. The recipient hepatectomy was performed according to the standard procedures of pediatric LDLT. Portal vein reconstruction was performed using the interposition of an iliac vein homograft conduit to the enlarged collateral vein at the common bile duct wall. The proximal splenic vein was securely ligated to control the splenorenal shunt. The patient recovered uneventfully from the LDLT operation. The reconstructed portal vein was well maintained without any hemodynamic abnormalities. In conclusion, because CAPV patients can have several vascular anomalies, such combined vascular anomalies should be thoroughly assessed before and during the liver transplantation operation. Individualized portal vein reconstruction with homograft vein interposition combined with intraoperative cine-portogram is an effective technique with satisfactory results.

  • Case Report

    Ann Liver Transplant 2022; 2(1): 78-85

    https://doi.org/10.52604/alt.22.0006

    Abstract : We present a case report of successful right trisectionectomy with en bloc portal vein (PV) resection for perihilar cholangiocarcinoma after endovascular stenting of the PV combined with sequential embolization of the right PV and hepatic vein. The case was a 74-year-old female patient with Bismuth-Corlette type IV perihilar cholangiocarcinoma with invasion of the left PV, right anterior PV, and right hepatic artery. Preoperative right portal vein embolization (PVE) was considered for future remnant liver regeneration. During right PVE, a wall stent was inserted to restore the left portal blood flow. One week later, right hepatic vein embolization was sequentially performed. At four weeks after PVE, right trisectionectomy with caudate lobectomy, bile duct resection, PV segmental resection with removal of endovascular stent and end-to-end anastomosis, and Roux-en-Y hepaticojejunostomy were uneventfully performed. The PV was segmentally resected with inclusion of a wall stent. PV defect was repaired through end-to-end anastomosis. Pathology report showed that all resection margins were tumor-negative. The patient recovered uneventfully. She has been doing well for one year with no evidence of tumor recurrence. Preoperative PV stenting might have benefited the patient because it enabled us to perform major hepatectomy successfully. Our experience could help surgical planning for hepatobiliary malignancy patients with PV invasion.

  • Case Report

    Ann Liver Transplant 2022; 2(1): 86-94

    https://doi.org/10.52604/alt.22.0001

    Abstract : Hepatolithiasis is a known risk factor for intrahepatic cholangiocarcinoma. We present a case of a patient with perihilar cholangiocarcinoma that arose from the remnant hilar bile duct at 29 years after the initial hepatectomy for left-sided hepatolithiasis and at 16 years after completion left hepatectomy. A 66-year-old female patient was diagnosed with 4 cm-sized perihilar cholangiocarcinoma at follow-up studies. The tumor appeared to be confined at the right first-order hepatic duct without gross vascular invasion, thus surgical resection was performed with a curative intent. The tumor-containing right first-order hepatic duct was meticulously resected with concurrent removal of the caudate lobe. Cluster hepaticojejunostomy was performed to reconstruct the 4 cm-wide figure of 8-shaped intrahepatic bile duct openings. Significant bile leak occurred at the hepaticojejunostomy site, which was resolved with percutaneous pigtail drainage and percutaneous transhepatic biliary drainage. The patient was discharged from the hospital at 26 days after operation. The patient has been doing well for 12 months. She is currently undergoing scheduled adjuvant chemotherapy. The experience of our present case suggests that there is risk of de novo hepatobiliary malignancy after hepatic resection for hepatolithiasis. Thus, it is necessary to perform life-long follow-up studies for patients who have undergone hepatic resection for hepatolithiasis.

  • Case Report

    Ann Liver Transplant 2022; 2(1): 95-101

    https://doi.org/10.52604/alt.22.0007

    Abstract : Intraductal papillary neoplasm of bile duct (IPNB) is a rare variant of bile duct tumor with a wide range of histology from low-grade dysplasia to invasive carcinoma. A high-grade IPNB can be regarded as a malignant lesion because of potential tumor recurrence after curative resection. We herein report a case of IPNB recurrence at seven years after curative resection of IPNB with a high-grade dysplasia. A 63-year-old male patient underwent right anterior sectionectomy for IPNB with a high-grade dysplasia after close observation for four years. Postoperatively, recurrent IPNB lesion in the distal bile duct was diagnosed at postoperative seven years. Because the mass was localized without metastasis, pylorus-preserving pancreaticoduodenectomy was performed for the recurrent IPNB. The patient recovered uneventfully without specific complications. He has been doing well for one year without any evidence of recurrence. The recurrent IPNB lesion was a low-grade dysplasia, which was slightly different from the initial IPNB. Immunohistochemical status of MUC1/MUC2 stain was identical, indicating that the IPNB at the distal common bile duct was a recurrent lesion of the initial intrahepatic IPNB. The present case indicates that long-term follow-up is necessary for patients after undergoing curative resection for IPNB of low- or high-grade dysplasia, although the risk of tumor recurrence is not high. Aggressive surgical treatment for recurrent IPNB lesion is a viable option to achieve long-term survival after prudent consideration of postoperative recurrence pattern.

  • Case Report

    Ann Liver Transplant 2022; 2(1): 102-106

    https://doi.org/10.52604/alt.22.0013

    Abstract : Cryopreserved iliac vein allografts are suitable for middle hepatic vein reconstruction during living-donor liver transplantation, but their supply is often limited. Cryopreserved aorta allografts (CAG) are now one of the reliable resources, and those patency rates are comparable with polytetrafluoroethylene (PTFE) grafts. However, PTFE grafts have drawbacks of accidental gastric penetration and non-degradable foreign body. A similar complication can occur because the CAG has a similar property to PTFE, like elastic force against the pressure around organs. In this case, the patient was admitted to the ICU in hypovolemic shock due to internal bleeding. The fistula formation of the duodenum with the CAG was the reason. The patient recovered without complications after the operation, gastrojejunostomy, and feeding jejunostomy, but we did not excise the CAG. After fistulectomy, both CAG and the duodenum openings were closed with 5-0 prolene. Our experience with this case suggests that the CAG can cause problems to the adjacent organ because of its hard nature.

The Korean Liver Transplantation Society

Vol.2 No.1
May, 2022

pISSN 2765-5121
eISSN 2765-6098

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Aims and Scope

Annals of Liver Transplantation (Ann Liver Transplant), the official publication of the Korean Liver Transplantation Society, is an international, peer-reviewed open access journal. The journal pursues its advancement through original articles, reviews, case reports, editorials, and letter to editor. The journal is concerned with clinicians and scientists in liver transplantation and also with those in other fields who are interested in liver transplantation. The aim of the journal is to make contribution to saving lives of patients undergoing liver transplantation through active communication and exchange of study information on liver transplantation and provision of education and training on the diseases. The Ann Liver Transplant serves as a platform for debate and reassessment, a trigger of innovation, and a major pedestal for promoting understanding, improving outcomes, and advancing knowledge and technique in liver transplantation.

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