Objectives: Liver paired exchange (LPE) is an innovative strategy for expanding the living donor pool in liver transplantation, enabling compatible transplants between otherwise incompatible donor-recipient pairs. Despite its growing global adoption, the sociodemographic characteristics of LPE populations remain largely unreported. This study aimed to comprehensively characterize the sociodemographic profile of all recipients and donors who underwent crossover living donor liver transplantation at a single high-volume center and to contextualize the findings within a public health framework.
Methods: This was a retrospective, cross-sectional, descriptive epidemiological study. All 393 crossover living donor liver trans-plants performed at the İnönü University Liver Transplant Institute (IULTI), Malatya, Türkiye, between October 2021 and May 2026 through the Banu Bedestenci Sönmez Liver Paired Exchange (BBS-LPE) system were included. Variables analyzed included recipient and donor age, sex, blood group, primary diagnosis, exchange chain size (2-way through 7-way), geographic origin, MELD/PELD score, and graft weight. Descriptive and comparative statistical analyses were performed using IBM SPSS Statistics v27.0 (IBM Corp., Armonk, NY, USA). The Mann-Whitney U and Chi-square tests were used for between-group comparisons.
Results: A total of 393 recipient-donor pairs completed LPE through 132 exchange events ranging from 2-way to 7-way chains, the latter representing a world-first. Annual LPE volume increased from 2 transplants in 2021 to 155 in 2025 (R²=0.94, p<0.001). Recipients comprised 64.9% males (mean age: 44.7±20.1 years); 14.8% were pediatric. The leading indications were cryptogenic cirrhosis (24.2%), HBV-related cirrhosis (13.5%), and HBV-associated hepatocellular carcinoma (8.4%). Male recipients were significantly older than females (46.4±19.4 vs. 41.5±21.1 years; p=0.042). Donors had a mean age of 30.7±8.0 years; 52.4% were under 30. Female donors constituted 41.2% of the total and were significantly more likely to donate to male recipients (p=0.039). Recipients originated from 68 Turkish prov-inces and 13 foreign countries; the southeastern Anatolian region contributed 35.9% of all domestic referrals. Şanlıurfa (8.4%), Gaziantep (7.6%), and Diyarbakır (6.1%) were the leading provinces of origin. International patients comprised 8.9% of the cohort (13 countries), with Syria as the most common country of origin.
Conclusion: This is the largest single-center sociodemographic analysis of an LPE population reported to date. Our data reveal pro-nounced geographic disparities, a consistent male predominance among recipients, a young donor population with a notable female contribution, and a broad disease spectrum spanning adult and pediatric indications. These findings underscore the critical public health role of high-volume LPE programs and highlight the need for targeted policies to address inequities in access to this life-saving modality. Sociodemographic profiling of LPE populations should become a standard component of transplant program reporting globally.

Objectives: To develop and interpret machine learning (ML) models for predicting one-year survival in patients with hepatocellular carcinoma (HCC), and to characterize model behavior using an explainable artificial intelligence (XAI) framework combining global and local interpretability with calibration and clinical-utility analysis.
Methods: This was a secondary analysis of the publicly available, de-identified University of California, Irvine (UCI) HCC-Survival da-taset (165 patients; 49 features; outcome, one-year survival coded as 1 = alive and 0 = deceased). Missing data (10.2% overall) were handled with multivariate imputation by chained equations (MICE), and class imbalance (102 alive vs. 63 deceased) was addressed with the synthetic minority over-sampling technique combined with Tomek links (SMOTE-Tomek); all preprocessing was performed within cross-validation folds to prevent leakage. Seven ML algorithms-logistic regression, random forest, extreme gradient boost-ing (XGBoost), light gradient boosting machine (LightGBM), categorical boosting (CatBoost), support vector machine (SVM), and k-nearest neighbors (KNN)-were trained under 10-fold stratified cross-validation. SHapley Additive exPlanations (SHAP) provided global interpretability and Local Interpretable Model-Agnostic Explanations (LIME) provided local interpretability. Platt scaling was used for calibration and decision curve analysis (DCA) for clinical utility.
Results: Random forest achieved the best discrimination (area under the receiver operating characteristic curve [AUC] = 0.808 ± 0.083; accuracy = 0.746; F1 = 0.716; Brier score = 0.176; Matthews correlation coefficient [MCC] = 0.446), followed by XGBoost (AUC = 0.795) and LightGBM (AUC = 0.783). SHAP analysis identified alpha-fetoprotein (AFP), alkaline phosphatase (ALP), serum iron, performance status, and hemoglobin as the most influential predictors of one-year survival, consistent with prior findings on this cohort. LIME provided con-cordant patient-level explanations. DCA indicated a positive net clinical benefit across a clinically relevant range of risk thresholds.
Conclusion: On a small, single-center cohort, an explainable ML framework yielded moderate but robust discrimination and, more importantly, transparent and clinically coherent explanations. Rather than maximizing performance alone, the framework empha-sizes interpretability, calibration, and clinical utility, supporting its potential role as a transparent decision-support aid that warrants validation in larger, prospective cohorts.

Objectives: Pediatric liver transplant recipients may experience depression, anxiety, and post-traumatic stress symptoms despite favorable medical outcomes. This study aimed to evaluate depressive symptoms, anxiety symptoms, and post-traumatic stress symptoms among pediatric liver transplant recipients and to examine the relationships among these psychological outcomes.
Methods: This cross-sectional study was conducted with 50 pediatric liver transplant recipients aged 8–18 years who were followed at a liver transplant center. Data were collected using the Child Descriptive Information Form, the Children's Depression Inven-tory (CDI), the Screen for Child Anxiety Related Emotional Disorders (SCARED), and the Children's Revised Impact of Event Scale (CRIES-13). The data were analyzed using descriptive statistics, Mann–Whitney U tests, Spearman correlation analyses, and multiple linear regression analyses.
Results: A considerable number of participants exhibited clinically relevant psychological difficulties. Anxiety scores differed significantly according to sex. Recipients of deceased-donor transplants had significantly higher post-traumatic stress symptom scores than recipients of living-donor transplants. Emotional and psychological distress levels decreased as the time elapsed since transplantation increased. Correlation analyses indicated significant associations among the measured mental health outcomes. Furthermore, trauma-related symp-toms emerged as significant predictors of emotional difficulties after adjustment for age, sex, and post-transplant duration.
Conclusion: Psychological symptoms were observed among pediatric liver transplant recipients, and significant associations were identified among depression, anxiety, and trauma-related symptoms. These findings support the potential value of routine psycho-social assessment during post-transplant follow-up. Further longitudinal studies are needed to clarify the temporal relationships among these psychological outcomes.

Objectives: Pancreaticoduodenectomy is a technically demanding procedure with considerable morbidity and mortality where detailed knowledge of vascular anatomy is essential. Variations of the celiac trunk and hepatic artery are relatively common and may influence surgical strategy, lymph node dissection and perioperative outcomes. However, their impact on operative and onco-logical parameters remains controversial. This study aimed to evaluate the impact of celiac trunk and hepatic artery variations on operative time, lymph node yield and early postoperative liver function in patients undergoing pancreaticoduodenectomy.
Methods: A single-center retrospective study was conducted including 117 patients who underwent PD between January 2016 and March 2025. Preoperative contrast-enhanced computed tomography angiography was used to assess hepatic arterial anatomy according to the Michels classification. Patients were grouped as normal anatomy (Type I) and arterial variation (Types II–X). Clinical, operative and pathological parameters were compared.
Results: Arterial variations were identified in 32.5% of patients. Operative time was significantly longer in the variation group compared to normal anatomy (315 vs 240 minutes, p=0.002). Total lymph node yield was significantly lower in patients with arterial variation (12 vs 21, p<0.001) whereas malignant lymph node count and lymph node ratio were similar between groups. No signifi-cant differences were observed in postoperative liver function tests, including ALT and AST levels. Subgroup analysis demonstrated that left sided variations were associated with the longest operative times. Regression analysis confirmed arterial variation as an independent predictor of prolonged operative time (B=55.763, p=0.001).
Conclusion: Celiac trunk and hepatic artery variations significantly prolong operative time and are associated with reduced lymph node yield in pancreaticoduodenectomy without adversely affecting early postoperative liver function. Preoperative identification of these variations is crucial for optimal surgical planning and may have implications for oncological adequacy.

Objectives: Although liver transplantation is the most effective treatment for end-stage liver disease, many recipients still ex-perience impairments in physical performance, balance, cognitive function and fatigue, even after a successful transplant. While physiotherapy has been shown to be effective during the early postoperative period, evidence regarding its longer-term benefits is limited. This study investigated the long-term effects of routine physiotherapy and rehabilitation on physical performance, bal-ance, functional capacity, cognitive function and fatigue in liver transplant recipients approximately one year after transplantation.
Methods: This cross-sectional comparative study enrolled 106 adult liver transplant recipients who had undergone transplanta-tion at least one year previously. Participants were divided into two groups: a control group of 53 participants who had not par-ticipated in a postoperative physiotherapy programme, and a routine physiotherapy group of 53 participants who had completed the routine postoperative physiotherapy programme. Functional mobility was evaluated using the Timed Up and Go Test (TUG), static balance using the Single-Leg Stance Test (SLST), functional exercise capacity using the Six-Minute Walk Test (6MWT), cogni-tive function using the Montreal Cognitive Assessment (MoCA) and fatigue using the Fatigue Severity Scale (FSS). Between-group comparisons were performed using independent samples t-tests and chi-square tests, with statistical significance set at p<0.05.
Results: Baseline demographic and clinical characteristics were comparable between the groups (all p > 0.05). Recipients who had completed the routine physiotherapy programme demonstrated significantly better functional mobility (TUG, p=0.001), static balance (SLST, p=0.003), cognitive performance (MoCA, p=0.003) and lower fatigue levels (FSS, p=0.006) than the control group. No significant difference between the groups was observed in functional exercise capacity, as measured by the 6MWT (p=0.454).
Conclusion: Routine physiotherapy after liver transplantation was associated with improved functional mobility, balance, cognitive performance and reduced fatigue approximately one year after transplantation. While no significant improvement in functional exercise capacity was observed, these results suggest that the benefits of physiotherapy extend beyond the immediate postopera-tive period. Incorporating structured physiotherapy into long-term, multidisciplinary follow-up programmes could help to optimise functional recovery and improve overall patient outcomes after liver transplantation.

Objectives: The scissural vein is an independent venous structure arising from segment IV or the umbilical fissure and draining directly into the inferior vena cava (IVC) without joining the middle hepatic vein (MHV) or left hepatic vein (LHV). This study aimed to determine its prevalence in living liver donor candidates and evaluate its association with hepatic venous variants.
Methods: This single-center retrospective study included 248 consecutive adult living liver donor candidates evaluated between January 2020 and January 2026. Three-dimensional volumetric reconstructions from preoperative multiphase contrast-enhanced computed tomography (CT) were reviewed for surgically significant scissural veins (≥4 mm). The same ≥4 mm diameter threshold was applied to the inferior hepatic vein (IHV), V5, and V8, in accordance with institutional reconstruction practice and published literature. Associations between the scissural vein and demographic, volumetric, and venous variables were statistically analyzed.
Results: A scissural vein was identified in 70 of 248 candidates (28.2%). No significant differences were observed between candi-dates with and without a scissural vein regarding age, sex, BMI, hepatic steatosis, liver volumes, remnant liver percentage, GRWR, or the presence of an IHV ≥4 mm (OR 1.03; p=1.000). However, V5 and/or V8 ≥4 mm were significantly more frequent in the scis-sural vein-positive group (42.9% vs. 28.1%; OR 1.92, 95% CI 1.08–3.41; p=0.037), and this association remained significant after adjustment for age, BMI, and liver volume (adjusted OR 1.89, 95% CI 1.04–3.42; p=0.037). Hepatic steatosis was associated with BMI (p<0.001), but not with age (p=0.820).
Conclusion: A scissural vein was present in 28.2% of living donor candidates. It was not associated with liver volume, sex, or IHV presence but was independently associated with V5/V8. This finding may reflect a shared developmental pattern of the anterior/periscissural venous system and warrants further prospective investigation.

Although laparoscopic cholecystectomy is one of the most frequently performed operations in general surgery, its complications may be clinically serious. Management may range from minimally invasive interventional procedures to complex surgical strate-gies, including liver transplantation in selected cases. Correct management of these complications requires careful exclusion of an overlooked preoperative malignancy. In this case report, we present the clinical course of a patient with postcholecystectomy bili-ary complications accompanied by marked elevation of carbohydrate antigen 19-9 (CA 19-9).

Retroperitoneal liposarcoma is a difficult clinical entity it is usually diagnosed late, and it may reach very large sizes before being diagnosed. Therefore, recurrences are common and sometimes, they can be seen in very difficult places that require multiple organ resections and complex vascular reconstructions. In the present study we discuss our surgical approach in a 69-year-old male patient with recurrent retroperitoneal sarcoma treated with complete retroperitoneal dissection together with retrohepatic vena cava resection reconstruction.