Colorectal cancer is the third most common malignancy worldwide. Metastases are present at diagnosis in 15–30% of patients, and 20–50% develop them during treatment. The liver is the most frequent site of spread. Recently, liver transplantation has emerged as a novel option for selected patients with unresectable colorectal liver metastases. A 50-year-old man with stage IIIC rectal adenocarcinoma received neoadjuvant radiochemotherapy with capecitabine followed by abdominoperineal resection and adjuvant capecitabine. Despite treatment, imaging revealed liver metastases, which were resected laparoscopically. Pathology examination confirmed metastatic adenocarcinoma consistent morphologically with the primary tumor, with negative surgical margins. Between July 2021 and April 2022, new metastases were treated with thermal ablation, but shortly thereafter a new unresect­able lesion was found in segment VIII. The patient received FOLFIRI plus cetuximab, with partial response after six cycles. In May 2023, he underwent orthotopic liver transplantation from a deceased donor at the Department of General, Transplant, and Liver Surgery, Medical University of Warsaw. This was one of the first cases of liver transplantation for colorectal cancer metastases in Poland and the first one using a telemedicine platform during qualification. No recurrence has been observed since transplantation, and the patient remains in complete remission to date. Despite advances in induction therapies, most patients with unresectable liver metastases require palliative systemic treatment, the efficacy of which is limited. This case highlights the potential of liver transplantation as a breakthrough treatment option in selected patients. Further studies are needed to evaluate its efficacy in broader patient populations.

Background: Reliable intraoperative tools for donor liver assessment are needed, particularly in the context of steatotic and extended-criteria grafts. While histology remains the reference standard, it is limited by sampling variability and logistical constraints. Preservation fluid may provide a complementary, whole-organ source of biochemical information. Methods: In this single-center prospective exploratory pilot study, liver tissue and preservation fluid were collected from 30 donation-after-brain-death grafts during the back-table procedure. Biochemical parameters, including arginase activity, β-hydroxybutyrate (βHB), acetoacetate, and total protein, were measured using standard assays. Associations with histological steatosis on wedge biopsy were assessed using nonparametric correlation analyses, and paired preservation fluid samples were compared. Results: Most grafts demonstrated absent or mild steatosis; only two exhibited moderate steatosis, and none were severely steatotic. No preservation fluid biomarker showed a statistically significant association with histological steatosis. Weak, non-significant positive correlations were observed for βHB and arginase activity (Spearman r ≈ 0.33-0.35). Protein concentration and arginase activity decreased between start and end samples, whereas ketone body levels remained relatively stable. Conclusions: Preservation fluid biomarker measurement during routine graft preparation is feasible. Although no significant associations with histological steatosis were identified, the observed weak correlations suggest possible associations requiring validation in larger studies. Larger, adequately powered studies, including a broader spectrum of steatosis and clinically relevant outcomes, are required to determine potential clinical applicability.

Collagen is the major protein of the extracellular matrix that provides mechanical strength to the tissues. The relationship between the development of complications and the quality and quantity of collagen fibres has not been investigated in the literature, yet. This was a prospective study of 392 patients who underwent subcostal laparotomy for confirmed or suspected gastrointestinal malignancy. Prior to abdominal closure a sample of transversalis fascia was collected. The area covered by collagen (ACC) was measured as the mean area covered by Picosirius stained fibres in three areas of the fascia. The primary endpoint of the study was the occurrence of complications, graded according to the Clavien-Dindo over a 90-day follow-up period. 392 patients were included in the study. A transversalis fascia sample was obtained in 354 patients (90.3

Background/Objectives : Pleomorphic liposarcoma (PLS) is a rare and aggressive subtype that accounts for 5% of all liposarcomas, with a 5-year survival rate of only 55-65%. Although PLS can metastasize in 30-50% of cases, isolated liver metastasis is extremely rare (0.5%) phenomenon. Surgical resection with histologically negative margins is considered the gold standard treatment in solitary metastasis of PLS. We present the second case reported worldwide of solitary liver metastasis in extremity pleomorphic liposarcoma patient. Methods : A 39-year-old male presented with metastasis in liver segment IVa following surgical resection of a primary PLS in his right lower leg. On physical examination, the liver protruded 1.5 cm below the costal margin without tenderness on palpation. The patient underwent hepatic segment IV resection with cholecystectomy, achieving negative margins. Postoperative recovery was uneventful, but disease recurrence occurred rapidly, with new metastases detected in the vertebral column at three months, followed by progression to the bones, peritoneum, lungs, and eye. Results : Despite multiple chemotherapy regimens, the patient succumbed to the disease 14 months after hepatic resection. Conclusions : Complete surgical resection offers the lowest recurrence rate for PLS but is most effective when disease is diagnosed at an early stage. This case highlights the aggressive nature of PLS and its unpredictable metastatic pattern. Given the rarity and diverse clinical course of this malignancy, further research and standardized management guidelines are urgently needed to improve outcomes for patients with this challenging disease.

Background: Acute liver failure (ALF) remains a critical concern, accounting for about 8% of all liver transplants, with acetaminophen overdose contributing to nearly half of these cases. Besides synthetic toxins, natural toxins such as phallotoxin from Amanita phalloides mushrooms also lead to severe hepatocyte damage. This study investigates the outcomes of liver transplantation (LT) as a life-saving intervention in patients suffering from ALF due to acetaminophen and Amanita phalloides poisoning. Material/Methods: We conducted a retrospective analysis of 39 patients who underwent LT for ALF induced by acetaminophen (n=18) or A. phalloides (n=21) poisoning at the Medical University of Warsaw. Various statistical analyses, including logistic regression, Mann-Whitney-U, and chi-squared tests, were employed. Survival rates were determined using Kaplan-Meier analysis. Results: The cohort included 24 females and 15 males, with a median age of 41. The 90-day mortality rate was 22.2% for acetaminophen poisoning and 38.1% for A. phalloides poisoning (P=0.284), with an estimated 5-year survival rate of 59.6%. Key factors associated with increased 90-day mortality included the number of red blood cells transfused (OR 1.574 per unit; P=0.011), fresh frozen plasma units (OR 1.346 per unit; P=0.003), acute kidney failure requiring hemodialysis (OR 13.50; P=0.021), and days from listing to LT (OR 2.289 per day; P=0.013). Conclusions: Liver transplantation for ALF, though inherently high-risk, offers substantial survival benefits. Outcomes are largely influenced by the patient's condition at the time of transplant, organ availability, and intraoperative management. Despite significant mortality risks, LT remains a crucial intervention for ALF due to acetaminophen and Amanita phalloides toxicity.

BACKGROUND:Primary sclerosing cholangitis (PSC) is a chronic liver disease characterised by inflammation and fibrosis of the bile ducts, conferring an increased risk of cholangiocarcinoma (CCA). However, detecting CCA early in PSC patients remains challenging due to the limited sensitivity of conventional diagnostic methods, including imaging or bile duct brush cytology during endoscopic retrograde cholangiopancreatography (ERCP). This study aims to evaluate the potential of bile cell-free DNA (cfDNA) mutational analysis, termed the Bilemut assay, as a tool for CCA detection in PSC patients. METHODS:Sixty-three PSC patients undergoing ERCP due to biliary strictures were prospectively recruited. Bile samples were collected, and cfDNA was extracted and analysed using the Oncomine Pan-Cancer Cell-Free assay. Twenty healthy liver donors were included for comparison. Samples with a mutant allele frequency (MAF) ≥ 0.1% were considered positive. Correlations between mutational status and clinical characteristics were assessed. RESULTS:cfDNA mutational analysis was successful in all bile samples. Mutations predominantly in KRAS, GNAS, and TP53 were detected in 36.5% (23/63) of PSC patients, compared to 10% (2/20) of healthy donors (p = 0.0269). The clinical characteristics of Bilemut-positive and -negative patients were comparable, though there was a trend towards a lower prevalence of inflammatory bowel disease in the Bilemut-positive group. Among PSC patients diagnosed with CCA during follow-up, 75% were Bilemut-positive, suggesting an association between mutational status and malignancy risk. CONCLUSIONS:Mutational analysis of cfDNA obtained from bile collected from PSC patients undergoing ERCP is feasible. Implementing the Bilemut assay may help identify patients needing closer surveillance and further imaging studies.

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.

Background: Liver transplantation constitutes a well-established treatment for patients with end-stage liver disease and selected hepatic malignancies. The introduction of normothermic machine perfusion (NMP) offers a platform for both extracorporeal organ maintenance and viability assessment, especially for organs with suspicious malfunction. These organs, discarded by the majority of transplant centers (so-called ‘orphan livers’), may help to safely expand the donor pool thanks to pre-transplant appraisal; Methods: We identified all grafts undergoing normothermic ma-chine perfusions performed in the Department of General, Transplant, and Liver Surgery between December 2022 and August 2023. Their perfusion characteristics and immediate postoperative periods, as well as complications that occurred in the 90-day postoperative periods, were analyzed; Results: There were eight orphan liver grafts that underwent NMP in our Department. Postoperative complications occurring in patients receiving grafts after NMP did not seem associated with the procedure. One patient required laparotomy within the 90-day postoperative period due to biliary fistula and underwent bile duct stenting due to both fistula and nonanastomotic stricture. In one patient we observed the occurrence of anastomotic biliary stricture more than 90 days after LTx; Conclusions: NMP allows for the viability assessment of grafts with suspicious prepreservation malfunction. Some of these organs may help to expand the donor pool.

Liver resection and lymphadenectomy is a standard procedure in patients with incidental gallbladder cancer. Data regarding laparoscopic approach in this setting are scarce. The aim of this study was to compare laparoscopic and open approach in this population. This was a multicenter retrospective study including 177 patients. The primary outcome measure was overall survival (OS). The secondary outcomes measures were recurrence-free survival (RFS), lymph node yield, operative time, postoperative complications and length of hospital stay. Surgery was laparoscopic in 60 (33.9

Liver transplantation is the only curative option for end-stage liver disease and is necessary for an increasing number of patients with advanced primary or secondary liver cancer. Many patient groups can benefit from this treatment, however the shortage of liver grafts remains an unsolved problem. Liver bioengineering offers a promising method for expanding the donor pool through the production of acellular scaffolds that can be seeded with recipient cells. Decellularization protocols involve the removal of cells using various chemical, physical, and enzymatic steps to create a collagenous network that provides support for introduced cells and future vascular and biliary beds. However, the removal of the cells causes varying degrees of matrix damage, that can affect cell seeding and future organ performance. The main objective of this review is to present the existing techniques of producing decellularized livers, with an emphasis on the assessment and definition of acellularity. Decellularization agents are discussed, and the standard process of acellular matrix production is evaluated. We also introduce the concept of the stepwise assessment of the matrix during decellularization through decellularization cycles. This method may lead to shorter detergent exposure times and less scaffold damage. The introduction of apoptosis induction in the field of organ engineering may provide a valuable alternative to existing long perfusion protocols, which lead to significant matrix damage. A thorough understanding of the decellularization process and the action of the various factors influencing the final composition of the scaffold is essential to produce a biocompatible matrix, which can be the basis for further studies regarding recellularization and retransplantation.

INTRODUCTION:Liver transplantation (LT) is a well-established method applied for the treatment of various liver diseases, including primary and secondary malignancies, as well as acute liver failure triggered by different mechanisms. In turn, liver failure (PHLF) is the most severe complication observed after liver resection (LR). PHLF is an extremely rare indication for LT. The aim of the present study was to assess the results of LT in patients with PHLF. METHODS:Relevant cases were extracted from the prospectively collected database of all LTs performed in our center. All clinical variables, details of the perioperative course of each patient and long-term follow-up data were thoroughly assessed. RESULTS:Between January 2000 and August 2023, 2703 LTs were carried out. Among them, six patients underwent LT for PHLF, which accounted for 0.2% of all patients. The median age of the patients was 38 years (range 24-66 years). All patients underwent major liver resection before listing for LT. The 90-day mortality after LT was 66.7% (4 out of 6 patients), and all patients experienced complications in the posttransplant course. One patient required early retransplantation due to primary non-function (PNF). The last two transplanted patients are alive at 7 years and 12 months after LT, respectively. CONCLUSIONS:In an unselected population of patients with PHLF, LT is a very morbid procedure associated with high mortality but should be considered the only life-saving option in this group.

Introduction:The aim of the study was to assess prognostic factors associated with an increased risk of recurrence of hepatocellular carcinoma (HCC) after radical treatment. Materials and methods:This is a retrospective, single-center analysis of data on HCC recurrence in patients who underwent radical treatment. Molecular tumor characteristics, baseline laboratory results and hepatic viral status were analyzed. Results:Data from 111 patients were included in the analysis. The most important prognostic factors for recurrence were vascular microinvasion (HR 4.54; 95 % CI 1.769-11.681; p 0.001), baseline white blood count (HR 2.13; 95 % CI 1.261-3.567; p 0.004) and baseline alpha-fetoprotein (HR 1.00009; 95 % CI 1.000001-1.00002; p 0.034). Microvascular invasion was only prognostic factor which correlate significantly with the overall survival (HR 5.04, 95 % CI 2.352-12.413; p < 0.001). PD-L1 expression was confirmed in 4 patients and all of them developed a disease recurrence. However, there was no statistically significant assosciation with prognosis. The presence of CD68 tumor-associated macrophages was confirmed in 62 patients, ranging from 5 % to 40 %. Analysis showed that CD68 was not associated with the risk of recurrence of HCC. Conclusions:The results confirm that microvascular invasion is the most important factor associated with an increased risk of hepatocellular carcinoma recurrence and death, while PD-L1 and CD68 expression did not have an impact on patient prognosis.

Background:The outcomes of liver surgery worldwide remain unknown. The true population-based outcomes are likely different to those vastly reported that reflect the activity of highly specialized academic centers. The aim of this study was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes.Methods:LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach with a 3-month prospective, consecutive patient enrollment within January-December 2019. Each patient was followed up for 90 days postoperatively. All patients undergoing liver surgery at their respective centers were eligible for study inclusion. Basic demographics, patient and operation characteristics were collected. Morbidity was recorded according to the Clavien-Dindo Classification of Surgical Complications. Country-based and hospital-based data were collected, including the Human Development Index (HDI). (NCT03768141).Results:A total of 2159 patients were included from six continents. Surgery was performed for cancer in 1785 (83%) patients. Of all patients, 912 (42%) experienced a postoperative complication of any severity, while the major complication rate was 16% (341/2159). The overall 90-day mortality rate after liver surgery was 3.8% (82/2,159). The overall failure to rescue rate was 11% (82/ 722) ranging from 5 to 35% among the higher and lower HDI groups, respectively.Conclusions:This is the first to our knowledge global surgery study specifically designed and conducted for specialized liver surgery. The authors identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives.