Current status of minimally invasive liver transplantation: a narrative review

Introduction

Liver transplantation (LT) is the optimal treatment for end-stage liver disease (1,2). During the past few decades, thanks to improvements in perioperative management and surgical technique, short-term outcomes after LT have markedly improved (3). However, most LTs to date have been performed via a large open upper abdominal incision, in stark contrast to minimally invasive surgery (MIS) being the main approach in most other general surgery procedures (4).

MIS started in 1985 when the first laparoscopic cholecystectomy was performed in Germany (5). This procedure rapidly disseminated worldwide. Robotic surgery also spread worldwide after the landmark Lindbergh operation in 2001 (6). The benefits of MIS compared to open surgery include cosmesis, reduced postoperative pain, shorter length of stay, lower rates of surgical site infection, and reduced blood loss because of pneumoperitoneum (7-9). Additionally, robotic platforms offer magnified three-dimensional visualization that can facilitate precise dissection (10). Until recently, LT recipients have been unable to realize these benefits.

This changed in 2021, when a group from South Korea reported the first case of laparoscopic LT (11). The same group also reported robotic LT (12). Initial reports of totally robotic cases were limited to living donor cases using the right lobe, but then, in 2024, the first case of total deceased donor LT was reported by Khan et al. in the United States (4). Living donor cases are no longer limited to the right lobe, and left lobe cases are reported from Saudi Arabia (13). Additionally, in 2025, improvements in perioperative outcomes using a robotic platform compared to open LT were reported from Saudi Arabia (14). Nevertheless, the practice is still limited to highly selected centers worldwide, and optimal indications for MIS have not been solidified. Prior reviews on MIS in LT have focused largely on donor hepatectomy or surgery for post-transplant complications (15). In this narrative review, we focus on recipient surgery, summarize the largest cumulative evidence reported to date, and discuss the optimal indication for LT using MIS, including both laparoscopic and robotic platforms and both hybrid and fully minimally invasive approaches. We present this article in accordance with the Narrative Review reporting checklist (available at https://ales.amegroups.com/article/view/10.21037/ales-2025-1-52/rc).

Methods

We conducted a comprehensive literature search on PubMed and Google Scholar to find relevant prospective or retrospective studies on LT performed using laparoscopy or robotic platforms. The search included articles published between January 2020 and November 2025. Boolean search strings are provided in Table 1. Only English-language studies were included. Given the rarity of the procedure, case reports were included as well as cohort studies. Literature on minimally invasive donor hepatectomies was not included. We included recipient minimally invasive LT (MI-LT) reports, including both pure MIS and hybrid approaches (MIS explant with open implantation). Further details regarding the search strategy and selection criteria are summarized in Table 1.

Results

After applying the inclusion and exclusion criteria, a total of 21 studies from 10 institutions published between January 2020 and November 2025 were deemed eligible for inclusion (4,11-14,16-31). The study and patient characteristics are reported in Tables 2,3. By adding the case volume of each center’s largest report, these 10 centers have at least completed 116 cases in total (54 at King Faisal Specialist Hospital, 16 at Samsung Medical Center, 10 at Seoul National University, 10 at University of Modena, 8 at Xi’an Jiaotong University, 6 at Washington University, 6 at Beaujon Hospital, 4 at Curry Cabral Hospital, 1 at Sun Yat-sen Memorial Hospital, and 1 at University of Lille). Thirteen studies came from four Asian centers, six from three European centers, and two from a North American center. All studies were single-center studies except for one. All included reports described adult recipients only; no pediatric recipient cases were identified. The youngest reported recipient was 24 years of age.

Donor selection

Seven centers reported deceased donor cases while three centers in Asia reported living donor cases. For living donors, a South Korean center reported ten right lobe grafts, while another South Korean center and a Saudi Arabian center reported both right and left grafts. For deceased donor grafts, three centers reported the use of normothermic or hypothermic machine perfusion devices. In the initial phase, living donor centers preferred right lobe grafts because they provide better exposure, grafts with graft-to-recipient weight ratio ≥0.8% to avoid size mismatch in portal vein anastomosis, and grafts with standard vascular and biliary anatomy that does not require multiple anastomoses (14,18,19,23). For deceased donor grafts, centers preferred smaller grafts (<1,600 or <2,000 grams) to avoid larger incisions and for easy exposure for anastomosis (4,25,29).

Equipment and surgical technique

For recipient native liver explant, four centers used laparoscopic technique, five centers used robotic platform, and one center used both laparoscopy and robotic platforms. For graft implantation, two centers reported a hybrid approach (MIS explant with open implantation), five reported a fully minimally invasive approach, and three reported both hybrid and fully minimally invasive approaches. For incision, seven centers only used a midline incision. The other three centers, both performing living donor cases, reported the use of a Pfannenstiel incision. For hypertrophied native livers, some centers have performed in situ size reductions such as left lateral sectionectomy (14,16). For deceased donor grafts, one European center reported the graft size reduction by resecting the left lateral segment and used the reduced right trisegment graft (16,17). Veno-veno bypass was used for safety in 3 out of 6 cases at Washington University in St. Louis. It was not used in one Seoul National University case report and the Portugal/Italy series (20,27), and was not stated in the remaining reports. Among studies that explicitly reported veno-veno bypass status, the overall usage rate was 3/13 recipients (23.1%).

Recipient indication

Seventeen out of 21 studies reported Model for End-Stage Liver Disease (MELD) scores for their recipients. The median MELD score for each study ranged from 8 to 22. Most centers stated that patients with ascites, thin abdominal walls, small native liver (<2,000 grams), and small caudate lobe were preferred because these features provide a larger intracorporeal surgical space (4,12,23,25,26,29). Three out of ten recipients in the paper from Seoul National University, 7 out of 10 recipients in the study from King Faisal Specialist Hospital, and 4 out of 4 recipients in the study from Curry Cabral Hospital had ascites. Many centers noted that obese patients might benefit from robotic procedures as they do in robotic kidney transplantation (32), but in the initial implementation phase some centers set the upper limit of recipient body mass index (BMI) as 27.5 to 35 kg/m² (4,25,29). Liver malignancies such as hepatocellular carcinoma (HCC) or metastases from neuroendocrine tumors (NETs) were the indication in all six cases from the French study, 15 out of 54 cases from a Saudi Arabian study, 5 out of 8 cases at Xi’an Jiaotong University, 8 out of 10 cases at University of Modena, and 8 out of 16 cases at Samsung Medical Center. Most centers preferred recipients with well-preserved liver function and set the upper limit of MELD as 25 or 30 (4,18,29), because hemostasis with robotic instruments can be difficult and MELD >30 patients might not fit early-discharge protocols and derive maximal benefit from smaller incisions. Portal hypertension can be harmful or helpful. Portal vein thrombus or inflammation around the hilum are not preferred due to technical difficulty, but varices or collaterals that do not require ligation are preferred because they help prevent bowel congestion while the portal vein is clamped (4,11,12,21,25,29). Lastly, in the initial phase, procedures can be longer, and some centers noted that they prefer patients with good functional status and no history of major upper abdominal surgery (19,23,25).

Perioperative outcomes

Four studies mentioned planned conversion. Among others, four studies mentioned there was at least one case of unplanned conversion. Across the included studies, no in-hospital mortality was reported among MI-LT recipients. Excluding case reports, median total operating room (OR) time ranged from 405 to 635 minutes, median hepatectomy time ranged from 150 to 279 minutes, median warm ischemia time ranged from 32 to 71.5 minutes, median estimated blood loss ranged from 525 to 4,350 ml, and median length of stay ranged from 5 to 25 days. Warm ischemia time was generally shorter in a hybrid approach (MIS explant with implantation via a midline incision) (30–40 minutes), compared to fully minimally invasive reconstruction (≥ 60 minutes), except for the studies from King Faisal Specialist Hospital (Table 3). There is one case control study that compared robotic versus open approach (14). They reported that the robotic approach was superior in estimated blood loss (650 vs. 2,000 ml, p<0.001), infections of any grade (9.3% vs. 42.8%, p<0.001), and postoperative pain (Numeric Pain Rating Scale on days 0 to 7: 0.18 vs. 1.12, p<0.001).

Discussion

This study aimed to summarize the currently available literature on MI-LT. Our review is distinct in several ways. First, ours is the first of its kind focusing on minimally invasive recipient liver transplants, accumulating the experience of at least 116 cases from 10 centers worldwide. Second, we focused on variation in practice including donor selection, recipient selection, and surgical technique. Donor and recipient criteria were very similar among centers. Most centers preferred stable patients with low MELD but with moderate portal hypertension, and grafts and native livers should preferably be small with normal anatomy. There is only one case control study comparing MIS and open approach, and the clinical benefit has not been solidified.

Donor and recipient selection

At present, most reports consist of fewer than ten cases and have primarily focused on safe implementation. Attention to body habitus appears to be a unique concern specific to MI-LT. Many reports noted that, at least during the initial phase, ideal candidates would be non-obese candidates with ascites whose native liver is shrunken and who receive small grafts. After this implementation phase, it remains to be determined which patient groups may benefit, and whether reduced infection rates in obese patients can be achieved, similar to what was observed in kidney or simultaneous kidney pancreas transplantation (32,33). Another key consideration during early adoption is prior major upper abdominal surgery, as dense adhesions can prolong total OR time and hemostasis can be more challenging in MI-LT.

For the recipient’s medical condition, to ensure safe implementation, candidates with comparatively low MELD scores and without portal vein thrombosis or coagulopathy are preferred. Historically, low-MELD candidates did not have good access to LT, but their numbers have increased in recent years thanks to aggressive utilization of extended criteria donors (34-40). In the United States, the adoption of normothermic machine perfusion has been accompanied by a dramatic rise in liver transplant volume, enabling transplantation at lower MELD scores, prior to progression of cirrhosis to the point of requiring intensive care unit (ICU) admission (41). For such patients, because of generally favorable functional status before transplant, the benefits of MIS, such as earlier return to normal activities, are likely to be substantial. Hypothermic machine perfusion is also widely used worldwide for extended criteria grafts, and was reported in several included studies (27-29). Transplant oncology is also expanding rapidly. LT has demonstrated superior survival for conditions such as HCC and colorectal liver metastases (CRLM) compared with resection or chemotherapy; if transplantation can be performed via MIS, an even faster return to daily life would further enhance the value of transplantation (42-46). Taken together, current indications for MI-LT are highly selected adult recipients with low-to-moderate MELD, favorable body habitus and abdominal domain (often with ascites and a small native liver), no history of major upper abdominal surgery, and standard vascular anatomy without portal vein thrombosis.

Challenges and learning curve

As described above, MI-LT imposes stringent requirements on patients and remains unsuitable for the general transplant population. Especially for minimally invasive implantation, many centers reported median warm ischemia time exceeding 60 minutes, suggesting that it demands exceptionally high levels of surgeon expertise and that the learning curve may be steep. Long warm ischemia time is a risk factor for graft survival in open LT (47-51), and this may also adversely affect recipient outcomes in MI-LT. Safe implementation also requires a highly experienced surgical team with specialized equipment and institutional support.

Future

While benefits seem likely for low MELD patients, will they extend to high MELD patients in the future? Currently, warm ischemia time and total OR time in MIS tend to be longer than the open approach, particularly when reconstruction is performed intracorporeally, and hemostasis can be more challenging in MI-LT. Port placement limits access, and even with an assistant port, the assistant cannot reach all areas as in open surgery. Moreover, the range of hemostatic devices available remains limited. As surgical technique stabilizes, we expect that high MELD patients may also derive benefit. For example, as several centers are attempting, if MI-LTs are performed with a Pfannenstiel incision instead of an upper midline incision, reductions in respiratory complications can be anticipated. Moreover, although patients with high MELD scores often have poor functional status pre-transplant and may not fit conventional enhanced recovery after surgery (ERAS) pathways, a US study showed that the median length of stay for patients with MELD ≥35 is 11–12 days (52). It is reasonable to expect that these patients will also benefit from smaller incisions and earlier discharge. However, robotic platforms require substantial investment, maintenance costs, and disposable instrument expenses. Therefore, future comparative studies should include formal cost-effectiveness analyses that weigh these costs against potential savings from reduced complications, shorter length of stay, and faster recovery.

Furthermore, robotic platforms offer enhanced dexterity, motion filtration, and magnified visualization, which may facilitate precise vascular anastomoses and potentially reduce vascular complications. It may also enable AI-driven analyses unique to this modality. At present, LT is performed via open surgery, so evaluation of trainee proficiency relies heavily on narrative assessments and surrogate metrics such as operative time (53,54). By contrast, in robotic surgery it is straightforward to capture granular data—such as counts and durations of instrument usage—and there are reports that assessment of instrument kinematics can predict postoperative complications (55). Because LT remains open, high-quality operative videos are relatively scarce, making it difficult to study techniques across centers. Conversely, for MIS procedures, sharing operative videos on various platforms is comparatively easy (56-58). Looking ahead, robotic transplantation could further standardize training and, ultimately, promote the broad dissemination and democratization of surgical technique.

Limitations

This study has several limitations. First, the available evidence is limited to retrospective single-center series and case reports with small sample sizes and relatively short follow-up. Although no in-hospital mortality was reported among MI-LT recipients in the included studies, this likely reflects highly selected candidates, implementation in expert centers, and potential publication bias, and therefore should not be interpreted as definitive evidence of equivalent or superior safety compared with open LT. Larger, multicenter studies are needed to more accurately define perioperative and longer-term mortality risks. Second, the heterogeneity in surgical platforms (laparoscopic vs. robotic), hybrid vs. fully minimally invasive approach, anastomotic methods, and intraoperative hemodynamic management strategies precluded pooled statistical analysis. Thirdly, only a limited number of studies compared MI-LT with open LT, which restricted our ability to delineate which benefits are attributable to the MIS approach itself versus center expertise.

Conclusions

LT using MIS has emerged, and at least 116 cases have been performed worldwide. Currently, MIS is applied to selected recipients with low MELD scores. Appropriate donor and recipient selection are particularly important for safe implementation of this novel procedure. Future research should focus on the clinical benefit of MI-LT compared to open approach.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the Narrative Review reporting checklist. Available at https://ales.amegroups.com/article/view/10.21037/ales-2025-1-52/rc

Peer Review File: Available at https://ales.amegroups.com/article/view/10.21037/ales-2025-1-52/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://ales.amegroups.com/article/view/10.21037/ales-2025-1-52/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Lucey MR, Furuya KN, Foley DP. Liver Transplantation. N Engl J Med 2023;389:1888-900. [Crossref] [PubMed]
2. Nakayama T, Akabane M, Imaoka Y, et al. Does the introduction of the acuity circle policy change split liver transplantation practice? Liver Transpl 2025;31:989-97. [Crossref] [PubMed]
3. Rana A, Ackah RL, Webb GJ, et al. No Gains in Long-term Survival After Liver Transplantation Over the Past Three Decades. Ann Surg 2019;269:20-7. [Crossref] [PubMed]
4. Khan AS, Scherer M, Panni R, et al. Total robotic liver transplant: the final frontier of minimally invasive surgery. Am J Transplant 2024;24:1467-72. [Crossref] [PubMed]
5. Reynolds W Jr. The first laparoscopic cholecystectomy. JSLS 2001;5:89-94.
6. Brower V. The cutting edge in surgery. Telesurgery has been shown to be feasible--now it has to be made economically viable. EMBO Rep 2002;3:300-1. [Crossref] [PubMed]
7. Keus F, de Jong JA, Gooszen HG, et al. Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev 2006;CD006231. [Crossref] [PubMed]
8. Madhok B, Nanayakkara K, Mahawar K. Safety considerations in laparoscopic surgery: A narrative review. World J Gastrointest Endosc 2022;14:1-16. [Crossref] [PubMed]
9. Vega EA, Salehi O, Loewenthal JV, et al. Strategic response to bleeding in laparoscopic hepato-pancreato-biliary surgery: an intraoperative checklist. HPB (Oxford) 2022;24:452-60. [Crossref] [PubMed]
10. Wong SW, Crowe P. Visualisation ergonomics and robotic surgery. J Robot Surg 2023;17:1873-8. [Crossref] [PubMed]
11. Suh KS, Hong SK, Lee S, et al. Pure laparoscopic living donor liver transplantation: Dreams come true. Am J Transplant 2022;22:260-5. [Crossref] [PubMed]
12. Lee KW, Choi Y, Lee S, et al. Total robot-assisted recipient's surgery in living donor liver transplantation: First step towards the future. J Hepatobiliary Pancreat Sci 2023;30:1198-200. [Crossref] [PubMed]
13. Broering DC, Raptis DA, Elsheikh Y. Fully robotic recipient left graft living donor liver transplantation. Am J Transplant 2025;25:1784-7. [Crossref] [PubMed]
14. Broering DC, Elsheikh Y, Alnemary Y, et al. Improved Short-Term Outcomes With Fully Robotic Recipient Adult Living Donor Liver Transplantation: A Comparative Study. Ann Surg 2025; Epub ahead of print. [Crossref]
15. López-López V, Martínez-Serrano MÁ, Ruiz-Manzanera JJ, et al. Minimally invasive surgery and liver transplantation: is it a safe, feasible, and effective approach? Updates Surg 2023;75:807-16. [Crossref] [PubMed]
16. Dokmak S, Cauchy F, Sepulveda A, et al. Laparoscopic Liver Transplantation: Dream or Reality? The First Step With Laparoscopic Explant Hepatectomy. Ann Surg 2020;272:889-93. [Crossref] [PubMed]
17. Dokmak S, Cauchy F, Aussilhou B, et al. Laparoscopic-assisted liver transplantation: A realistic perspective. Am J Transplant 2022;22:3069-77. [Crossref] [PubMed]
18. Suh KS, Hong SK, Hong K, et al. Minimally Invasive Living Donor Liver Transplantation: Pure Laparoscopic Explant Hepatectomy and Graft Implantation Using Upper Midline Incision. Liver Transpl 2021;27:1493-7. [Crossref] [PubMed]
19. Lee KW, Choi Y, Hong SK, et al. Laparoscopic donor and recipient hepatectomy followed by robot-assisted liver graft implantation in living donor liver transplantation. Am J Transplant 2022;22:1230-5. [Crossref] [PubMed]
20. Suh KS, Hong SK, Lee S, et al. Purely laparoscopic explant hepatectomy and hybrid laparoscopic/robotic graft implantation in living donor liver transplantation. Br J Surg 2022;109:162-4. [Crossref] [PubMed]
21. Kim JC, Hong SK, Lee KW, et al. Early experiences with developing techniques for pure laparoscopic explant hepatectomy in living donor liver transplantation. Liver Transpl 2023;29:377-87. [Crossref] [PubMed]
22. Broering DC, Raptis DA, Elsheikh Y. Pioneering fully robotic donor hepatectomy and robotic recipient liver graft implantation - a new horizon in liver transplantation. Int J Surg 2024;110:1333-6. [Crossref] [PubMed]
23. Broering DC, Elsheikh Y, Malago M, et al. Outcomes of Fully Robotic Recipient Living Donor Liver Transplant in Relation to the Open Approach. Transplantation 2024;108:2396-402. [Crossref] [PubMed]
24. Dutta S, Khan AS, Ukeje CC, et al. Anesthetic Considerations for Robotic Liver Transplantation. J Cardiothorac Vasc Anesth 2025;39:1571-82. [Crossref] [PubMed]
25. Liu XM, Li Y, Feng Z, et al. Laparoscopic-assisted full-sized liver transplantation with magnetically fast portal vein anastomosis: an initial cohort study. Int J Surg 2024;110:5483-8. [Crossref] [PubMed]
26. Wu WR, Xu LB, Zhang FP, et al. Pure laparoscopic full-size liver transplantation in adult. Hepatobiliary Pancreat Dis Int 2024;23:638-43. [Crossref] [PubMed]
27. Pinto-Marques H, Sobral M, Magistri P, et al. Full Robotic Whole Graft Liver Transplantation: A Step Into The Future. Ann Surg 2025;281:67-70. [Crossref] [PubMed]
28. Duarte A, Katerenchuk V, Poeira R, et al. Anesthesia management for total robotic liver transplantation: Inaugural case series in Europe. Ann Hepatobiliary Pancreat Surg 2025;29:88-94. [Crossref] [PubMed]
29. Magistri P, Odorizzi R, Catellani B, et al. Robotic liver transplantation: University of Modena experience. Liver Transpl 2026;32:35-45. [Crossref] [PubMed]
30. El Amrani M, Pecquenard F, Bignon A, et al. Full Robotic Whole Graft Liver Transplantation: A Novel Approach. Ann Surg Open 2025;6:e595. [Crossref] [PubMed]
31. Rhu J, Kim J, Oh N, et al. Long-term outcome of the initial cases with recipient-side minimal invasive liver transplantation: Single-center comparison study. Liver Transpl 2025; Epub ahead of print. [Crossref]
32. Spaggiari M, Petrochenkov E, Gruessner A, et al. Robotic kidney transplantation from deceased donors: A single-center experience. Am J Transplant 2023;23:642-8. [Crossref] [PubMed]
33. Spaggiari M, Martinino A, Petrochenkov E, et al. Single-center retrospective assessment of robotic-assisted simultaneous pancreas-kidney transplants: Exploring clinical utility. Am J Transplant 2024;24:1035-45. [Crossref] [PubMed]
34. Hornstein N, Levenson J, Nakayama T, et al. Liver-Directed Therapies in Colorectal Cancer: Old Hats and New Tricks. Am Soc Clin Oncol Educ Book 2025;45:e473598. [Crossref] [PubMed]
35. Nakayama T, Hall KA, Wehrle CJ, et al. Re-emergence of early liver transplant access for hepatocellular carcinoma in the era of normothermic machine perfusion. J Gastrointest Surg 2025;29:102142. [Crossref] [PubMed]
36. Yokota S, Nakayama T, Sasaki K. Shifting landscape of adult liver transplantation in the United States: Declining role of living donor transplants? Am J Transplant 2025;25:S124.
37. Bekki Y, Loszko A, Endo Y, et al. Embracing Liver Transplantation From Donation After Circulatory Death in the United States in the Era of Perfusion Technology. Transplantation 2025; Epub ahead of print. [Crossref]
38. Wehrle CJ, Gross A, Satish S, et al. Out of Sequence Allocation in Liver Transplantation: A Poorly Used Tool to Improve Organ Utilization. Ann Surg 2025; Epub ahead of print. [Crossref]
39. Nakayama T, Krist DT, Akabane M, et al. Hepatitis C-positive grafts for hepatitis C-negative recipients in liver transplantation: Buried treasure or depleting resource? Liver Transpl 2025;31:1154-64. [Crossref] [PubMed]
40. Nakayama T, Imaoka Y, Esquivel CO, et al. Listing for blood type A2 donors is highly variable and impacts waitlist outcomes among blood type O liver transplantation candidates in the United States. Am J Transplant 2025;25:1746-55. [Crossref] [PubMed]
41. Wehrle CJ, Zhang M, Khalil M, et al. Impact of Back-to-Base Normothermic Machine Perfusion on Complications and Costs: A Multicenter, Real-World Risk-Matched Analysis. Ann Surg 2024;280:300-10. [Crossref] [PubMed]
42. Adam R, Piedvache C, Chiche L, et al. Liver transplantation plus chemotherapy versus chemotherapy alone in patients with permanently unresectable colorectal liver metastases (TransMet): results from a multicentre, open-label, prospective, randomised controlled trial. Lancet 2024;404:1107-18. [Crossref] [PubMed]
43. Byrne MM, Chávez-Villa M, Ruffolo LI, et al. The Rochester Protocol for living donor liver transplantation of unresectable colorectal liver metastasis: A 5-year report on selection, approval, and outcomes. Am J Transplant 2025;25:780-92. [Crossref] [PubMed]
44. Wehrle CJ, Kusakabe J, Nakayama T, et al. Time to expand selection criteria for MELD exception points in liver transplantation for hepatocellular carcinoma. Transplantation 2025;109:1265-8. [Crossref] [PubMed]
45. Chávez-Villa M, Sasaki K, Nakayama T, et al. Optimizing liver transplant outcomes for colorectal liver metastases in the United States. Liver Transpl 2025; Epub ahead of print. [Crossref]
46. Nakayama T, Sasaki K, Margonis GA. Liver transplantation for unresectable colorectal liver metastases: a narrative review. Chin Clin Oncol 2025;14:44. [Crossref] [PubMed]
47. Rana A, Hardy MA, Halazun KJ, et al. Survival outcomes following liver transplantation (SOFT) score: a novel method to predict patient survival following liver transplantation. Am J Transplant 2008;8:2537-46. [Crossref] [PubMed]
48. Busuttil RW, Farmer DG, Yersiz H, et al. Analysis of long-term outcomes of 3200 liver transplantations over two decades: a single-center experience. Ann Surg 2005;241:905-16; discussion 916-8. [Crossref] [PubMed]
49. Buchholz BM, Gerlach UA, Chandrabalan VV, et al. Revascularization Time in Liver Transplantation: Independent Prediction of Inferior Short- and Long-term Outcomes by Prolonged Graft Implantation. Transplantation 2018;102:2038-55. [Crossref] [PubMed]
50. Jochmans I, Fieuws S, Tieken I, et al. The Impact of Implantation Time During Liver Transplantation on Outcome: A Eurotransplant Cohort Study. Transplant Direct 2018;4:e356. [Crossref] [PubMed]
51. Ito T, Naini BV, Markovic D, et al. Ischemia-reperfusion injury and its relationship with early allograft dysfunction in liver transplant patients. Am J Transplant 2021;21:614-25. [Crossref] [PubMed]
52. Meier RPH, Nunez M, Syed SM, et al. DCD liver transplant in patients with a MELD over 35. Front Immunol 2023;14:1246867. [Crossref] [PubMed]
53. Khan AS, Garcia-Aroz S, Vachharajani N, et al. The learning curve of deceased donor liver transplant during fellowship training. Am J Transplant 2021;21:3573-82. [Crossref] [PubMed]
54. Yu J, Vachharajani N, Ahmed O, et al. Novel Method of Evaluating Liver Transplant Surgery Fellows Using Objective Measures of Operative Efficiency and Surgical Outcomes. J Am Coll Surg 2021;233:111-8. [Crossref] [PubMed]
55. Heard JR, Ghaffar U, Ma R, et al. Surgical Performance Metrics for 1-Year Patient-Reported Outcomes After Radical Prostatectomy. JAMA Surg 2025;160:674-80. [Crossref] [PubMed]
56. Haberal HB, Piana A, Pecoraro A, et al. Decoding YouTube: An In-depth Analysis of Living Donor Kidney Transplantation Videos and Their Implications for Patient Education. Eur Urol Open Sci 2024;70:64-9. [Crossref] [PubMed]
57. El-Mahrouk M, Jaradat D, Eichler T, et al. "YouTube" for Surgical Training and Education in Donor Nephrectomy: Friend or Foe? J Med Educ Curric Dev 2025; Epub ahead of print. [Crossref]
58. Wakam GK, Palmon I, Kulick AA, et al. Adapting to the Times: Combining Microlearning Videos and Twitter to Teach Surgical Technique. J Surg Educ 2022;79:850-4. [Crossref] [PubMed]