Pål Dag Line

• Dueland, Svein; Smedman, Tor Magnus; Syversveen, Trygve; Khan, Ammar; Grut, Harald & Line, Pål Dag (2026). Liver Transplantation for Nonresectable Colorectal Liver Metastases: Ten-year Follow-up and Assessment of Curative Rate in the SECA-II Study. Annals of Surgery. ISSN 0003-4932. doi: 10.1097/SLA.0000000000007200. Full text in Research Archive Show summary

  Objective: To determine if stringent selection criteria could result long-term overall survival and to determine the proportion of patients that most likely were cured by the transplantation. Summary Background Data: Liver transplantation is a potentially curative option for patients with nonresectable colorectal liver metastases, but optimal patient selection criteria remain undefined. Methods: SECA-II study is a prospective controlled cohort study of liver transplantation for patients with nonresectable liver-only metastases included from April 2012 to November 2023 at Oslo University Hospital. The primary endpoint was overall survival, with secondary endpoints; disease-free survival and survival after relapse. Final analysis is reported on January 1st, 2025. Results: Twenty-five patients were included. Median post-transplant observation time for patients still alive was 97.2 months. Median relapse-free survival, overall and postrecurrence survival was 24.3, 128.2, and 62.9 months, respectively. Twelve patients (48%) had a relapse and the primary site of relapse was pulmonary metastases in 6 patients. Twelve patients have no relapse after median 74 months (range: 13–122 mo) with 10 patients observed for more than 4 years. Four of these 12 patients have been observed for 10 years or more, with 4 others for more than 5 years, without relapse. Three patients have no evidence of disease for 93, 36, and 7 months after surgical treatment of a relapse. A maximum of 15 of the 25 liver-transplanted patients might obtain cure by the liver transplant. Conclusions: Selected colorectal cancer patients with nonresectable liver-only metastases may obtain long-term survival after liver transplantation. Liver transplantation for highly selected patients with nonresectable liver metastases might in some patients be a curative treatment even after a relapse.

• Smedman, Tor Magnus; Fretland, Åsmund Avdem; Dueland, Svein; Solheim, Jon Magnus Aarstrand; Hagness, Morten & Lassen, Kristoffer [Show all 8 contributors for this article] (2026). Liver Transplantation for Unresectable Colorectal Liver Metastases: Evidence, Patient Selection, and Clinical Implementation. Cancers. 18(14). doi: 10.3390/cancers18142306. Full text in Research Archive Show summary

  Liver transplantation (LT) has re-emerged as a potentially curative treatment for carefully selected patients with unresectable, liver-only colorectal liver metastases (CRLM). Prospective trials (SECA-I/II) demonstrated 5-year overall survival (OS) rates of 60–83% in selected patients, findings recently corroborated by the randomized TransMet trial, which showed superior 5-year OS with LT compared with chemotherapy alone. Favorable outcomes depend on rigorous patient selection integrating clinical risk stratification (Oslo Score), tumor burden assessed by metabolic tumor volume on FDG-PET-CT, and molecular profiling, while excluding high-risk features such as BRAF V600E and RAS/TP53 co-mutations. Broader implementation raises ethical challenges related to organ allocation, driving interest in alternative strategies including living-donor LT and innovative procedures such as RAPID. This narrative review summarizes evolving evidence supporting LT for CRLM, current approaches to patient selection, oncological outcomes, and practical considerations for implementing LT into contemporary HPB and transplant practice.

• Breder, Sigurd; Wang, Benny; Villard, Christina; Båve, Aiva; Lindström-Älgå, Lina & Eide, Emma [Show all 15 contributors for this article] (2026). Liver transplantation in primary sclerosing cholangitis with hepatobiliary neoplasia: survival outcomes and impact of diagnostic uncertainty. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. p. 1–12. doi: 10.1080/00365521.2026.2709611. Full text in Research Archive
• Stern, Nadide Mutlukoca; Dueland, Svein; Line, Pål Dag; Syversveen, Trygve & Grut, Harald (2026). Sex-related differences in survival based on [¹⁸F]FDG PET/CT metabolic tumor volume after liver transplantation for colorectal liver metastases. Transplant International. ISSN 0934-0874. 39, p. 16406–16406. doi: 10.3389/ti.2026.16406. Full text in Research Archive Show summary

  [18F]FDG PET/CT-derived metabolic tumor volume (MTV) is a strong prognostic biomarker in patients undergoing liver transplantation (LT) for non-resectable colorectal liver metastases (nCRLM). This study aimed to evaluate whether MTV-based survival outcomes after LT for nCRLM differ between males and females. Patients who underwent LT for nCRLM between 2006 and 2022 were included (n = 45). Baseline characteristics were compared using the Mann–Whitney U test and Fisher’s exact test. Overall survival (OS), disease-free survival (DFS), and survival after relapse (SAR) were estimated using Kaplan–Meier analysis with the log-rank test. Cox regression analyses including sex, dichotomized MTV, and an interaction term between sex and MTV were performed. Female patients had significantly shorter OS compared with male patients (median 58 vs. 92 months, p = 0.047). Low MTV was associated with significantly longer OS, DFS and SAR in both sexes. Among patients with high MTV, females had significantly shorter OS than males (median 25 vs. 59 months, p < 0.001). Females had more non-pulmonary recurrences than males (p = 0.006) and shorter median SAR than males (17 vs. 46 months, p < 0.001) with high MTV. A significant interaction between sex and MTV was observed, indicating a particularly adverse prognostic impact of high MTV in female patients.

• Stern, Nadide Mutlukoca; Dueland, Svein; Line, Pål Dag; Syversveen, Trygve & Grut, Harald (2026). Survival of patients with complete metabolic response on [18F]FDG PET/CT after chemotherapy prior to transplantation for colorectal liver metastases. Scandinavian Journal of Surgery. ISSN 1457-4969. doi: 10.1177/14574969261438696. Full text in Research Archive
• Cillo, Umberto; Vitale, Alessandro; Lanari, Jacopo; Rovetta, Alessandro; Mansournia, Mohammad Ali & Lonardi, Sara [Show all 13 contributors for this article] (2026). Benchmarking the real-world transplant benefit in unresectable colorectal liver metastases: A preliminary external validity assessment of the TransMet trial. Liver transplantation. ISSN 1527-6465. Publish Ahead of Print. doi: 10.1097/LVT.0000000000000818. Full text in Research Archive
• Jenssen, Håvard Bjørke; Dueland, Svein; Smedman, Tor Magnus; Grut, Harald; Abildgaard, Andreas & Line, Pål Dag [Show all 7 contributors for this article] (2026). Prognostic role of tumour volume and downstaging response on outcome after liver transplantation for colorectal liver metastases: retrospective study. BJS Open. 10(1). doi: 10.1093/bjsopen/zraf170. Full text in Research Archive Show summary

  Abstract Background The incidence of colorectal cancer is increasing, and the liver remains the predominant site for metastases. Whereas liver resection is the standard treatment for colorectal liver metastases (CRLMs), liver transplantation (LT) has re-emerged as a viable option for selected patients. The aim of this study was to investigate whether tumour volume and changes in tumour volume during chemotherapy before transplantation predict overall survival. Methods Patients who underwent LT for CRLMs between November 2006 and August 2020 were included. Tumour volumes were measured via manual segmentation on computerized tomography scans at baseline, at maximum tumour volume, and immediately before LT. Response to chemotherapy was assessed using Response Evaluation Criteria in Solid Tumours (RECIST) criteria, and the heterogeneous response was noted to investigate whether this subgroup performs differently. Receiver operating characteristic analysis was conducted to determine a tumour volume cut-off value for predicting overall survival. Overall survival between groups was compared using Kaplan–Meier curves and log rank test. Results Fifty-nine patients who underwent LT for CRLMs were analysed retrospectively. Receiver operating characteristic analysis revealed that final tumour volume at time of LT was a strong predictor of 5-year overall survival (area under the curve= 0.789), with a 35 mL cut-off providing optimal clinical discrimination. Patients achieving a final tumour volume below 35 mL, either consistently or via downstaging, demonstrated significantly improved survival compared with those with persistently high tumour volumes (4.54 years versus 2.17 years; P &lt; 0.001). Heterogeneous responses to chemotherapy were associated with poorer prognosis with no patients surviving beyond 2.16 years (P &lt; 0.001). Conclusion Dynamic tumour assessment, particularly measuring tumour volume to below 35 mL, is an important prognostic marker in LT for CRLMs.

• Ahmed, Ahmed F. Sayed; Wehrle, Chase J; Jr, Timothy Ring; Wu, Jerry; Hong, Hanna & Nadeem, Muhammad A [Show all 22 contributors for this article] (2025). Liver transplantation for colorectal metastasis – selection criteria, outcomes, and management recurrence: a systematic review and meta-analysis. International Journal of Surgery (IJS). ISSN 1743-9191. 112(2), p. 5155–5171. doi: 10.1097/js9.0000000000004018. Full text in Research Archive Show summary

  Background: Despite advances in systemic therapies, the prognosis for non-resectable colorectal liver metastases (nCRLMs) remains poor, with a 5-year survival rate of only 10%. Liver transplantation (LT) has emerged as a potential curative option for select patients. This study evaluated survival outcomes, recurrence rates, prognostic factors, and quality of life (QoL) following LT for nCRLM. Methods: A comprehensive search was performed through PubMed, Scopus, and the Cochrane Library for studies available up to 4 October 2024. Eligible studies reported survival, recurrence, or QoL following LT for nCRLM. Risk of bias was evaluated using the Risk of Bias in Nonrandomized Studies of Interventions and the Risk of Bias Tool for Randomized Trials/the Cochrane Risk of Bias Assessment Tool 2. A random-effects model pooled overall survival (OS), disease-free survival (DFS), and recurrence rates. Heterogeneity and publication bias were examined using Cochran’s Q and Egger tests. Result: Out of 549 patients, 20 studies with 377 unique patients were selected. OS at 1, 3, and 5 years were 91%, 67%, and 54%, respectively, and DFS at 65%, 38%, and 16%, respectively. Recurrence occurred in 52%. Favorable pretransplant factors were linked to better OS. QoL varied, with fatigue, pain, and dyspnea reported posttransplantation. Conclusion: LT offers strong survival benefits in nCRLM. However, high recurrence rates highlight the need for strict selection using Oslo score and metabolic tumor volume.

• Vitale, Alessandro; Lanari, Jacopo; Cillo, Umberto; Billato, Ilaria; Rovetta, Alessandro & Mansournia, Mohammad Ali [Show all 19 contributors for this article] (2025). Sex-based differences in survival after liver transplantation for colorectal cancer liver metastases: A multivariable analysis. JHEP Reports. 7(10). doi: 10.1016/j.jhepr.2025.101505. Full text in Research Archive
• Kodali, Sudha; Kulik, Laura; D'Allessio, Antonio; Martin, Eleonora De; Hakeem, Abdul Rahman & Lewinska, Monica [Show all 67 contributors for this article] (2025). The 2024 ILTS-ILCA consensus recommendations for liver transplantation for HCC and intrahepatic cholangiocarcinoma. Liver transplantation. ISSN 1527-6465. 31(6), p. 815–831. doi: 10.1097/LVT.0000000000000589. Full text in Research Archive
• Hunter, James; Hosgood, Sarah; Moers, Cyril; Leuvenink, Henri; Rabelink, Ton J. & Ploeg, Rutger [Show all 50 contributors for this article] (2025). Improving outcomes in kidney transplantation through advances in donor organ perfusion. Nature Reviews Nephrology. ISSN 1759-5061. 21(12), p. 818–832. doi: 10.1038/s41581-025-00993-8. Full text in Research Archive
• Tanaka, Tomohiro; Hakeem, Abdul Rahman; Chadha, Ryan; Polak, Wojciech G.; Francoz, Claire & Vinaixa, Carmen [Show all 15 contributors for this article] (2025). Variations in liver allocation systems across continents with a focus on MELD exceptions. Liver transplantation. ISSN 1527-6465. Publish Ahead of Print(2S1). doi: 10.1097/LVT.0000000000000751. Full text in Research Archive
• Østensen, Inger Anniken Bjørnstad; Jensen, Unn; Skarbø, Anne-Britt; Line, Pål Dag & Almaas, Runar (2025). Lasting reduced motor function affecting quality of life after liver transplantation in children and adolescents. Journal of Pediatric Gastroenterology and Nutrition - JPGN. ISSN 0277-2116. 81(4), p. 943–951. doi: 10.1002/jpn3.70183. Full text in Research Archive
• Yaqub, Sheraz; Brudvik, Kristoffer Watten; Smedman, Tor Magnus; Syversveen, Trygve; Line, Pål Dag & Dueland, Svein (2025). Liver transplantation for colorectal metastases following hepatic resection. British Journal of Surgery. ISSN 0007-1323. 112(9). doi: 10.1093/bjs/znaf193. Full text in Research Archive
• Hessheimer, Amelia J.; Hartog, Hermien; Marcon, Francesca; Schlegel, Andrea; Adam, René & Alwayn, Ian [Show all 52 contributors for this article] (2025). Deceased donor liver utilisation and assessment: Consensus guidelines from the European Liver and Intestine Transplant Association. Journal of Hepatology. ISSN 0168-8278. 82(6), p. 1089–1109. doi: 10.1016/j.jhep.2025.01.042. Full text in Research Archive
• Serenari, Matteo; Lanari, Jacopo; Dueland, Svein; Ettorre, Giuseppe Maria; Aldrighetti, Luca & Vivarelli, Marco [Show all 34 contributors for this article] (2025). LIVER TRANSPLANTATION VERSUS ALPPS FOR COLORECTAL LIVER METASTASES: AN ENTROPY BALANCED RETROSPECTIVE ANALYSIS. Annals of Surgery. ISSN 0003-4932. doi: 10.1097/SLA.0000000000006899. Full text in Research Archive
• Line, Pål Dag; Yaqub, Sheraz; Lassen, Kristoffer; Wiencke, Kristine; Khan, Ammar & Fosby, Bjarte [Show all 9 contributors for this article] (2025). A novel transplant approach for locally advanced unresectable perihilar cholangiocarcinoma: the SURE-LT concept. Annals of Surgery. ISSN 0003-4932. p. 1–9. doi: 10.1097/SLA.0000000000006892. Full text in Research Archive
• Breder, Sigurd; Villard, Christina; Eide, Emma; Wang, Benny; Engesæter, Lise Katrine & Reims, Henrik Mikael [Show all 15 contributors for this article] (2025). A retrospective evaluation of preemptive liver transplantation for bile duct dysplasia in primary sclerosing cholangitis: Balancing risks and benefits. JHEP Reports. 7(12), p. 1–11. doi: 10.1016/j.jhepr.2025.101598. Full text in Research Archive Show summary

  Background & Aims Liver transplantation (LT) to prevent cholangiocarcinoma (CCA) in individuals with primary sclerosing cholangitis (PSC) and bile duct dysplasia was introduced in Norway and Sweden in the early 2000s. We aimed to evaluate this practice to potentially improve future selection of candidates for LT. Methods We conducted a retrospective study of 512 adults with PSC who underwent first-time LT between 2000–2021 at Oslo and Karolinska University Hospitals. Pre-LT findings in bile duct brush cytology and/or biopsy of low-grade dysplasia (LGD) and high-grade dysplasia (HGD) were compared with histological findings in the explanted livers and survival rates were assessed. Results Bile duct dysplasia, low-grade (LGD) or high-grade (HGD), was the primary LT indication in 17% (88/512). Among individuals transplanted for LGD, only 10% (3/29) had HGD or CCA in the explant, compared to 48% (28/59) in the HGD group. No neoplasia was found in 42% (12/29) of LGD and 24% (14/59) of HGD cases, meaning nearly one-third of patients transplanted for suspected bile duct dysplasia had no histological evidence of neoplasia in the explant. Five-year post-transplant survival according to the explant histology was 95% for no neoplasia, 89% for LGD, 85% for HGD, decreasing to 33% in those with CCA in the explant. Conclusions While favorable survival in confirmed dysplasia supports the role of preemptive LT, the absence of neoplasia in a substantial proportion of explants, particularly in suspected LGD, calls for a cautious, individualized approach. LT appears more clearly justified in accurately diagnosed HGD, given its strong association with early malignancy and the poor prognosis of advanced CCA. Impact and implications Individuals with primary sclerosing cholangitis (PSC) are at increased risk of developing bile duct cancer. In precancerous stages (bile duct dysplasia), liver transplantation (LT) may prevent progression to advanced, incurable cancer. In our evaluation of 512 patients with PSC who underwent LT, we found that the low diagnostic accuracy and unpredictable detection of mild dysplasia support a cautious, individualized approach to LT in precancerous stages of PSC, while more advanced dysplasia remains a valid indication for LT.

• Færden, Ida Høy; Bliksøen, Marte; Liavåg, Olav Magnus Ivar; Hou, Jie; Majeed, Waleed Mohammed & Torp, May-Kristin [Show all 14 contributors for this article] (2025). Organ monitoring and identification of ischemic liver injury during ex situ porcine liver machine perfusion—A randomized controlled study. Liver transplantation. ISSN 1527-6465. 32(2), p. 153–165. doi: 10.1097/lvt.0000000000000752. Full text in Research Archive Show summary

  The global shortage of donor livers has led to an increased reliance on extended-criteria donor livers, including those from donors after circulatory death. Utilizing marginal livers necessitates distinguishing between injured but recoverable livers and those that are irreversibly damaged. Bile duct injury, prevalent in these grafts, poses significant risks, as ischemic injuries can be challenging to assess and may lead to recipient bile duct strictures and ultimately graft failure. This study aimed to identify objective measurements that enhance existing viability criteria and facilitate the diagnosis of ischemic injuries. We employed ex situ machine perfusion (MP) to monitor porcine livers subjected to standardized biliary injury (BileINJ), standardized global liver injury (GlobalINJ), and no injury (CTRL, total n=23). Using microdialysis catheters and pCO 2 sensors, we analyzed liver tissue, hilar plate, and bile duct, in addition to standard viability assessments, collecting data on 77 variables. Principal component analysis indicated distinct clustering of the GlobalINJ and partially the BileINJ group away from the CTRL group during MP. Feature extraction models highlighted microdialysate lactate, lactate/pyruvate ratio, glycerol, tissue pCO 2 , and blood gas hematocrit as critical indicators for classifying liver state. Histopathological evaluations confirmed group-specific liver and bile injuries. We identified unique metabolic patterns that differentiate ischemically injured from non-injured porcine livers and were able to distinguish liver and biliary injury. Real-time monitoring of livers using microdialysis and tissue pCO 2 during MP is feasible and clinically available. Measurements taken in the hilar plate show the ability to identify bile duct damage while not introducing measurement devices to the vulnerable bile duct itself. Our findings enable more objective and timely selection of transplantable livers and warrant further investigation in clinical studies.

• Farnes, Ingvild; Verbeke, Caroline Sophie; Kleive, Dyre; Waage, Anne; Tholfsen, Tore & Hagen, Milada [Show all 9 contributors for this article] (2025). Surgical, Histopathological, and Quality of Life Outcomes Following Neoadjuvant Chemotherapy and Pancreatectomy for Borderline Resectable and Locally Advanced Pancreatic Cancer. Cancers. 17(15), p. 1–17. doi: 10.3390/cancers17152505. Full text in Research Archive Show summary

  Background/Objectives: Treatment of borderline resectable (BRPC) and locally advanced (LAPC) pancreatic cancer involves neoadjuvant chemotherapy followed by complex surgery, posing significant risks of toxicity, complications, and changes in quality of life (QoL). This study aims to investigate the impact of neoadjuvant chemotherapy followed by resection on overall survival (OS) and QoL. Methods: Consecutive patients with BRPC and LAPC included in a population-based study (NORPACT-2) from January 2018 to December 2020 were reviewed. Results: A total of 54 patients (BRPC; n = 43, LAPC; n = 11) underwent neoadjuvant chemotherapy followed by pancreatectomy. The majority (66.7%) received (m)FOLFIRINOX. Forty-six (85.2%) patients underwent pancreatoduodenectomy. Vascular resection was performed in 32 (59.3%) patients. Fourteen (25.9%) patients experienced major complications. The majority of the resected specimens demonstrated T2 (63%), N+ (79.6%), and R1 (85.2%) status. Median OS was 31 (CI 24.7–37.3) months. In multivariate analysis, only CAP 3 (p = 0.035) predicted worse survival. Forty (74.1%) patients experienced recurrence. Global QoL (p = 0.031), social and role functioning (p = 0.024, p = 0.031), improved three months after surgery. Pain (p = 0.042), dyspnea (p = 0.004), appetite loss (p = 0.028), and diarrhea (p = 0.007) improved post-resection. Conclusions: Patients with BRPC and LAPC undergoing neoadjuvant chemotherapy and resection have survival comparable to primary resectable pancreatic cancer. Postoperative morbidity was acceptable, and QoL recovered post-surgery. CAP grade was the only independent negative prognostic factor.

• Smedman, Tor Magnus; Line, Pål Dag & Dueland, Svein (2025). Assessing the attitudes of next of kin toward living donor liver transplantation for patients with colorectal liver metastases. Scandinavian Journal of Surgery. ISSN 1457-4969. 114(2), p. 123–125. doi: 10.1177/14574969251335467. Full text in Research Archive
• Shi, Jihua; Line, Pål Dag; Zhang, Shui-Jun & Guo, Wen-Zhi (2025). Experimental Liver Surgery for Liver Research: Update, Choice and Translation. Journal of Inflammation Research. 18, p. 4497–4508. doi: 10.2147/JIR.S506737. Full text in Research Archive Show summary

  Experimental animal models of liver surgery are crucial for understanding human liver physiology and pathogenesis and identifying novel therapeutic modalities for liver disease. Herein, we update the brief summary of the most widely used experimental models and concepts in hepatic surgery, including hepatic ischemia/reperfusion, partial hepatectomy, liver transplantation, techniques and parameters of vascular perfusion of the liver, and using bile duct ligation as a model of cholestasis for the development of liver fibrosis. We focus on surgical aspects of available models for the study of various forms of liver disease. Furthermore, we summarize the translation of experimental liver surgery by highlighting surgical innovations, exploring key molecular mechanisms, and employing emerging treatment strategies.

• Ghotbi, Mohammad Jacob; Farnes, Ingvild; Kleive, Dyre; Verbeke, Caroline Sophie; Issa-Epe, Aart Imran & Fosby, Bjarte [Show all 8 contributors for this article] (2025). Anatomical Classification and Staging Systems of Borderline Resectable and Locally Advanced Pancreatic Cancer—A Subgroup Analysis of the NORPACT-2 Trial. Annals of Surgical Oncology. ISSN 1068-9265. 32(12), p. 8856–8869. doi: 10.1245/s10434-025-17527-y. Full text in Research Archive Show summary

  Background This study aims to provide a detailed understanding of resectability and prognosis within anatomical subgroups of borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) on the basis of established classification systems. Patients and Methods Patients with BRPC/LAPC, defined by National Comprehensive Cancer Network (NCCN) criteria, were prospectively included from 2018 to 2020. BRPC was subcategorized by vascular involvement and LAPC by the Louisville (Lv) classification system, and both cohorts were reclassified according to the Dutch (DPCG) criteria. NCCN-defined primary resectable pancreatic cancer (PC) cases that met DPCG-BRPC criteria were included in the analysis. Results In total, 228 patients (96 NCCN-BRPC, 92 NCCN-LAPC, and 40 reclassified from NNCN primary resectable PC to DPCG-BRPC) were included. NCCN-BRPC exhibiting both venous and arterial involvement had a lower resection rate (odds ratio (OR) 0.22, p = 0.038). Isolated vein involvement and baseline cancer antigen (CA)19–9 levels < 500 kU/L predicted resectability (OR 5.99, p = 0.005) and survival (hazard ratio (HR) 0.47, p = 0.024). DPCG-BRPC demonstrated higher resectability rates (67.4% versus 46.9%, p = 0.004) and fewer vascular resections (37% versus 58%, p = 0.031) compared with NCCN-BRPC. While the NCCN only predicted resectability, DPCG also predicted survival. No patients with Lv type IIIc2–4 (nonreconstructable invasion of the portomesenteric vein combined with arterial involvement) underwent resection, and this subgroup had worse survival (HR 2.08, p = 0.021). Conclusions Variations within established classification systems for BRPC/LAPC impact prediction of survival and resectability. A more detailed understanding of the anatomical subgroups in BRPC and LAPC, alongside CA19–9 levels, could enhance patient stratification regarding tumor resectability and neoadjuvant strategies.

• Yaqub, Sheraz; Longva, Anne Madsi; Angelsen, Jon-Helge; Brudvik, Kristoffer Watten; Carling, Johan Ulrik & Edwin, Bjørn von Gohren [Show all 15 contributors for this article] (2025). Multimodal treatment for colorectal liver metastases: A toolbox for clinicians. Scandinavian Journal of Surgery. ISSN 1457-4969. 114(2), p. 126–134. doi: 10.1177/14574969251333524. Full text in Research Archive Show summary

  Colorectal cancer is the second most common cause of cancer-related death worldwide, and liver metastases are the leading cause of mortality in these patients. Surgical innovations combined with modern systemic chemotherapy have improved 5-year overall survival rates. This review aims to equip non-hepatobiliary surgeons with a comprehensive toolbox for the diagnosis and management of colorectal liver metastases. It covers the current landscape of diagnostic workup, including imaging modalities and biomarkers, and reviews the surgical and nonsurgical treatment options. This guide attempts to enhance multidisciplinary care for patients with colorectal liver metastases by integrating evidence-based practices with innovative strategies, which can improve outcomes and survival.

• Moosavi, Hossein; Kryeziu, Kushtrim; Eilertsen, Ina; Nunes, Luis; Hektoen, Merete & Niederdorfer, Barbara [Show all 13 contributors for this article] (2025). Molecular prognostic factors for liver transplantation of unresectable metastatic colorectal cancer. British Journal of Surgery. ISSN 0007-1323. 112(4). doi: 10.1093/bjs/znaf072. Full text in Research Archive
• Molinaro, Antonio; Engesæter, Lise Katrine; Jorns, Carl; Nordin, Arno; Rasmussen, Allan & Line, Pål Dag [Show all 11 contributors for this article] (2025). Outcome of Liver Retransplantation in Patients With Primary Sclerosing Cholangitis. Liver international (Print). ISSN 1478-3223. 45(1). doi: 10.1111/liv.16214. Full text in Research Archive Show summary

  Background and Aims Primary sclerosing cholangitis (PSC) is among the most common indications for liver transplantation in the Nordic countries and with an increasing trend in Europe and North America. Due to post-transplant complications and high prevalence of disease recurrence this group is at risk of requiring retransplantation (re-LTX). Results from re-LTX for PSC are not extensively studied and there is a lack of knowledge regarding prognosis after re-LTX in this population. Methods Graft and patient survival after re-LTX for patients with PSC and a comparable comparison group from the Nordic liver transplant registry were analysed. One-hundred and eighty-five patients with PSC and 208 patients in the comparison group were included. Results The graft and patient survival were better for patients with PSC compared to the comparison group (p < 0.001). Re-LTX for recurrence of PSC (rPSC) compared to other aetiologies had similar and better outcomes for graft and patient survival (p = 0.093 and p = 0.023, respectively). Moreover, re-LTX for rPSC compared to the comparison group had a lower 30-day and 5-year mortality (p < 0.001 and p = 0.041, respectively). Conclusion Outcomes after retransplantation for PSC were similar or better compared to the comparison group. Retransplantation represents a treatment option with the potential for excellent outcomes in patients with PSC and should be considered in transplanted PSC patients with graft failure.

• Yaqub, Sheraz; Busund, Sondre; Smedman, Tor Magnus; Syversveen, Trygve; Khan, Ammar & Solheim, Jon Magnus Aarstrand [Show all 11 contributors for this article] (2025). Liver transplantation for locally advanced non-resectable intrahepatic cholangiocarcinoma treated with neoadjuvant therapy: early results from the TESLA trial. British Journal of Surgery. ISSN 0007-1323. 112(3). doi: 10.1093/bjs/znaf054. Full text in Research Archive
• Dasari, Bobby V.M.; Line, Pål Dag; Sapisochin, Gonzalo; Hibi, Taizo; Bhangui, Prashant & Halazun, Karim J. [Show all 11 contributors for this article] (2025). Liver transplantation as a treatment for cancer: comprehensive review. BJS Open. 9(3). doi: 10.1093/bjsopen/zraf034. Full text in Research Archive
• Cillo, Umberto; Furlanetto, Alessandro; Gringeri, Enrico; Bertacco, Alessandra; Marchini, Andrea & Rosso, Eugenia [Show all 9 contributors for this article] (2024). Advocating for a “shift-to-left” in transplant oncology: left grafts, RAPID and dual graft. Updates in Surgery (UPIS). ISSN 2038-131X. doi: 10.1007/s13304-024-01919-y. Full text in Research Archive
• Stern, Nadide Mutlukoca; Mikalsen, Lars Tore Gyland; Dueland, Svein; Schulz, Anselm; Line, Pål Dag & Stokke, Caroline [Show all 7 contributors for this article] (2024). The prognostic value of [18F]FDG PET/CT texture analysis prior to transplantation for unresectable colorectal liver metastases. Clinical Physiology and Functional Imaging. ISSN 1475-0961. 45(1). doi: 10.1111/cpf.12908. Full text in Research Archive Show summary

  Introduction To determine whether heterogeneity in colorectal liver metastases (CRLM) 18F fluorodeoxyglucose [18F]FDG distribution is predictive of disease-free survival (DFS) and overall survival (OS) following liver transplantation (LT) for unresectable CRLM. Methods The preoperative [18F]FDG positron emission tomography/computed tomography examinations of all patients in the secondary cancer 1 and 2 studies were retrospectively assessed. Maximum standardized uptake value (SUVmax), metabolic tumour volume (MTV), and six texture heterogeneity parameters (joint entropyGLCM, dissimilarityGLCM, grey level varianceSZM, size zone varianceSZM, and zone percentageSZM, and morphological feature convex deficiency) were obtained. DFS and OS for patients over and under the median value for each of these parameters were compared by using the Kaplan Meier method and log rank test. Results Twenty-eight out of 40 patients who underwent LT for unresectable CRLM had liver metastases with uptake above liver background and were eligible for inclusion. Low MTV (p < 0.001) and dissimilarityGLCM (p = 0.016) were correlated to longer DFS. Low MTV (p < 0.001) and low values of the texture parameters dissimilarityGLCM (p = 0.038), joint entropyGLCM (p = 0.015) and zone percentageSZM (p = 0.037) were significantly correlated to longer OS. SUVmax was not correlated to DFS and OS. Conclusion Although some texture parameters were able to significantly predict DFS and OS, MTV seems to be superior to predict both DFS and OS following LT for unresectable CRLM.

• Wehrle, Chase J.; Chávez-Villa, Mariana; Byrne, Matthew; Kusakabe, Jiro; Gross, Abby & Mahajan, Paresh [Show all 21 contributors for this article] (2024). Pre-Transplant Metabolic Tumor Volume Predicts Recurrence Following Liver Transplantation for Colorectal Metastasis: A Multicenter Study. Liver transplantation. ISSN 1527-6465. doi: 10.1097/LVT.0000000000000535. Full text in Research Archive
• Chávez-Villa, Mariana; Ruffolo, Luis I.; Line, Pål Dag; Dueland, Svein; Tomiyama, Koji & Hernandez-Alejandro, Roberto (2024). Emerging Role of Liver Transplantation for Unresectable Colorectal Liver Metastases. Journal of Clinical Oncology. ISSN 0732-183X. 42(10), p. 1098–1101. doi: 10.1200/JCO.23.01781. Full text in Research Archive
• Waage, Anne; Khan, Ammar; Labori, Knut Jørgen; Birkeland, Kåre Inge; Scholz, Hanne & Jenssen, Trond [Show all 9 contributors for this article] (2024). Implementation of a nationwide program for total pancreatectomy and islet autotransplantation in chronic pancreatitis: A Scandinavian single-center observational study. Scandinavian Journal of Surgery. ISSN 1457-4969. doi: 10.1177/14574969241298985. Full text in Research Archive
• Sjule, Hanna Meidell; Vinter, Caroline Andrea; Dueland, Svein; Line, Pål Dag; Burger, Emily Annika & Bjørnelv, Gudrun Maria Waaler (2024). The Spillover Effects of Extending Liver Transplantation to Patients with Colorectal Liver Metastases: A Discrete Event Simulation Analysis. Medical decision making. ISSN 0272-989X. 44, p. 529–542. doi: 10.1177/0272989X241249154. Full text in Research Archive Show summary

  Background: Liver transplantation is an alternative treatment for patients with nonresectable colorectal cancer liver-only metastases (CRLM); however, the potential effects on wait-list time and life expectancy to other patients on the transplant waiting list have not been considered. We explored the potential effects of expanding liver transplantation eligibility to include patients with CRLM on wait-list time and life expectancy in Norway. Methods: We developed a discrete event simulation model to reflect the Norwegian liver transplantation waiting list process and included 2 groups: 1) patients currently eligible for liver transplantation and 2) CRLM patients. Under 2 alternative CRLM-patient transplant eligibility criteria, we simulated 2 strategies: 1) inclusion of only currently eligible patients (CRLM patients received standard-of-care palliative chemotherapy) and 2) expanding waiting list eligibility to include CRLM patients under 2 eligibility criteria. Model outcomes included median waiting list time, life expectancy, and total life-years. Results: For every additional CRLM patient listed per year, the overall median wait-list time, initially 52 d, increased by 8% to 11%. Adding 2 additional CRLM patients under the most restrictive eligibility criteria increased the CRLM patients’ average life expectancy by 10.64 y and decreased the average life expectancy for currently eligible patients by 0.05 y. Under these assumptions, there was a net gain of 149.61 life-years over a 10-y programmatic period, which continued to increase under scenarios of adding 10 CRLM patients to the wait-list. Health gains were lower under less restrictive CRLM eligibility criteria. For example, adding 4 additional CRLM patients under the less restrictive eligibility criteria increased the CRLM patients’ average life expectancy by 5.64 y and decreased the average life expectancy for currently eligible patients by 0.12 y. Under these assumptions, there was a net gain of 96.36 life-years over a 10-y programmatic period, which continued to increase up to 7 CRLM patients. Conclusions: Our model-based analysis enabled the consideration of the potential effects of enlisting Norwegian CRLM patients for liver transplantation on wait-list time and life expectancy. Enlisting CRLM patients is expected to increase the total health effects, which supports the implementation of liver transplantation for CRLM patients in Norway. Highlights: • Given the Norwegian donor liver availability, adding patients with nonresectable colorectal cancer liver-only metastases (CRLM) to the liver transplantation waiting list had an overall modest, but varying, impact on total waiting list time. • Survival gains for selected CRLM patients treated with liver transplantation would likely outweigh the losses incurred to patients listed currently. • To improve the total life-years gained in the population, Norway should consider expanding the treatment options for CRLM patients to include liver transplantation. • Other countries may also have an opportunity to gain total life-years by extending the waiting list eligibility criteria; however, country-specific analyses are required.

• Braadland, Peder Rustøen; Bergquist, Annika; Kummen, Martin; Bossen, Lars; Engesæter, Lise Katrine & Reims, Henrik Mikael [Show all 21 contributors for this article] (2023). Clinical and biochemical impact of vitamin B6 deficiency in primary sclerosing cholangitis before and after liver transplantation. Journal of Hepatology. ISSN 0168-8278. 79(4), p. 955–966. doi: 10.1016/j.jhep.2023.05.038. Full text in Research Archive Show summary

  Background and aims We previously demonstrated that people with primary sclerosing cholangitis (PSC) had reduced gut microbial capacity to produce active vitamin B6 (pyridoxal 5’-phosphate [PLP]), which corresponded to lower circulating PLP levels and poor outcomes. Here, we define the extent and biochemical and clinical impact of vitamin B6 deficiency in people with PSC from several centers before and after liver transplantation (LT). Methods We used targeted liquid chromatography-tandem mass spectrometry to measure B6 vitamers and B6-related metabolic changes in blood from geographically distinct cross-sectional cohorts totaling 373 people with PSC and 100 healthy controls to expand on our earlier findings. Furthermore, we included a longitudinal PSC cohort (n = 158) sampled prior to and serially after LT, and cohorts of people with inflammatory bowel disease (IBD) without PSC (n = 51) or with primary biliary cholangitis (PBC) (n = 100), as disease controls. We used Cox regression to measure the added value of PLP to predict outcomes before and after LT. Results In different cohorts, 17-38% of people with PSC had PLP levels below the biochemical definition of a vitamin B6 deficiency. The deficiency was more pronounced in PSC than in IBD without PSC and PBC. Reduced PLP was associated with dysregulation of PLP-dependent pathways. The low B6 status largely persisted after LT. Low PLP independently predicted reduced LT-free survival in both non-transplanted people with PSC and in transplant recipients with recurrent disease. Conclusions Low vitamin B6 status with associated metabolic dysregulation is a persistent feature of PSC. PLP was a strong prognostic biomarker for LT-free survival both in PSC and recurrent disease. Our findings suggest that vitamin B6 deficiency modifies the disease and provides a rationale for assessing B6 status and testing supplementation. Impact and implications We previously found that people with PSC had reduced gut microbial potential to produce essential nutrients. Across several cohorts, we find that the majority of people with PSC are either vitamin B6 deficient or have a marginal deficiency, which remains prevalent even after liver transplantation. Low vitamin B6 levels strongly associate with reduced liver transplantation-free survival as well as deficits in biochemical pathways dependent on vitamin B6, suggesting that the deficiency has a clinical impact on the disease. The results provide a rationale for measuring vitamin B6 and to investigate whether vitamin B6 supplementation or modification of the gut microbial community can help improve outcomes for people with PSC.

• Line, Pål Dag & Dueland, Svein (2023). Transplantation for colorectal liver metastasis. Current Opinion in Organ Transplantation. ISSN 1087-2418. 29(1), p. 23–29. doi: 10.1097/MOT.0000000000001126. Full text in Research Archive Show summary

  Purpose of review Liver transplantation has emerged as a possible treatment for selected patients with nonresectable colorectal liver metastasis, but controversy still exists regarding optimal selection criteria and acceptable outcomes. Recent findings Univariate analysis in the largest cohorts confirms that metachronous disease, Oslo score = 0–1, metabolic tumor volume (MTV) less than 70 cm3, and tumor burden score less than 9 are positive predictive factors for good overall survival outcomes. Some recent trials might suggest that technical resectability is not a valid exclusion criterion for patients with high tumor load and favorable prognostic scores in the transplant evaluation. Recent developments in circulation DNA technology and liquid biopsy may play a future role in the selection and monitoring of patients. Summary Evaluation for transplant needs multidisciplinary involvement and should not be delayed until the failure of conventional oncological therapy. Larger data sets are needed to refine the selection criteria for liver transplantation in colorectal liver metastasis (CRLM).

• Fernandes, Eduardo de Souza Martins; Souza, Gabrielle Oliveira de; Braga, Eduardo Pinho; Furtado, Rodrigo Lopes Leite; Corrêa, Raphael Rodrigues & Queiroz, Camila Tobias [Show all 10 contributors for this article] (2023). AN EXPERIENCE ON LIVING DONOR LIVER TRANSPLANTATION FOR COLORECTAL LIVER METASTASIS IN SOUTH AMERICA: A NEW ERA IN TRANSPLANT ONCOLOGY. Arquivos Brasileiros de Cirurgia Digestiva (ABCD). ISSN 0102-6720. 36. doi: 10.1590/0102-672020230046e1764. Full text in Research Archive
• Åberg, Fredrik; Sallinen, Ville; Tuominen, Samuli; Adam, René; Karam, Vincent & Mirza, Darius [Show all 18 contributors for this article] (2023). Cyclosporine vs. tacrolimus after liver transplantation for primary sclerosing cholangitis – a propensity score-matched intention-to-treat analysis. Journal of Hepatology. ISSN 0168-8278. doi: 10.1016/j.jhep.2023.08.031. Full text in Research Archive Show summary

  Background & Aims There is controversy regarding the optimal calcineurin inhibitor type after liver transplant(ation) (LT) for primary sclerosing cholangitis (PSC). We compared tacrolimus with cyclosporine in a propensity score-matched intention-to-treat analysis based on registries representing nearly all LTs in Europe and the US. Methods From the European Liver Transplant Registry (ELTR) and Scientific Registry of Transplant Recipients (SRTR), we included adult patients with PSC undergoing a primary LT between 2000-2020. Patients initially treated with cyclosporine were propensity score-matched 1:3 with those initially treated with tacrolimus. The primary outcomes were patient and graft survival rates. Results The propensity score-matched sample comprised 399 cyclosporine-treated and 1,197 tacrolimus-treated patients with PSC. During a median follow-up of 7.4 years (IQR 2.3-12.8, 12,579.2 person-years), there were 480 deaths and 231 re-LTs. The initial tacrolimus treatment was superior to cyclosporine in terms of patient and graft survival, with 10-year patient survival estimates of 72.8% for tacrolimus and 65.2% for cyclosporine (p <0.001) and 10-year graft survival estimates of 62.4% and 53.8% (p <0.001), respectively. These findings were consistent in the subgroups according to age, sex, registry (ELTR vs. SRTR), time period of LT, MELD score, and diabetes status. The acute rejection rates were similar between groups. In the multivariable Cox regression analysis, tacrolimus (hazard ratio 0.72, p <0.001) and mycophenolate use (hazard ratio 0.82, p = 0.03) were associated with a reduced risk of graft loss or death, whereas steroid use was not significant. Conclusions Tacrolimus is associated with better patient and graft survival rates than cyclosporine and should be the standard calcineurin inhibitor used after LT for patients with PSC. Impact and implications The optimal calcineurin inhibitor to use after liver transplantation in patients with primary sclerosing cholangitis has yet to be firmly established. Since randomized trials with long follow-up are unlikely to be performed, multicontinental long-term registry data are essential in informing clinical practices. Our study supports the practice of using tacrolimus instead of cyclosporine in the initial immunosuppressive regimen after liver transplantation for patients with primary sclerosing cholangitis. The retrospective registry-based design is a limitation.

• Farnes, Ingvild; Kleive, Dyre; Verbeke, Caroline Sophie; Aabakken, Lars; Issa-Epe, Aart Imran & Småstuen, Milada Cvancarova [Show all 10 contributors for this article] (2023). Resection rates and intention-to-treat outcomes in borderline and locally advanced pancreatic cancer: real-world data from a population-based, prospective cohort study (NORPACT-2). BJS Open. 7:zrad137(6), p. 1–10. doi: 10.1093/bjsopen/zrad137. Full text in Research Archive Show summary

  Background: Systemic chemotherapy is the initial treatment strategy for borderline resectable and locally advanced pancreatic cancer to facilitate curative resection. The aim of this study was to investigate the resection rates and overall survival in patients with borderline resectable pancreatic cancer and locally advanced pancreatic cancer. Methods: Consecutive patients with borderline resectable pancreatic cancer/locally advanced pancreatic cancer discussed by Oslo University Hospital multidisciplinary team between 2018 and 2020, serving a population of 3.1 million within a geographically defined area in south-eastern Norway, were included in this prospective Norwegian Pancreatic Cancer Trial-2 study, according to intention-to-treat principles. The total number of patients with pancreatic cancer was sought from the Cancer Registry of Norway. Results: A total of 1178 patients were diagnosed with pancreatic cancer, of whom 618 were referred to Oslo University Hospital. After multidisciplinary team evaluation, 230 patients were considered to have borderline resectable pancreatic cancer/locally advanced pancreatic cancer. The final study group consisted of 188 patients (borderline resectable pancreatic cancer n = 96, locally advanced pancreatic cancer n = 92) who were fit to receive primary chemotherapy. Resection rates were 46.9% (45 of 96) for borderline resectable pancreatic cancer and 13% (12 of 92) for locally advanced pancreatic cancer (P <0.001). Median overall survival was 14.6 months (borderline resectable pancreatic cancer 16.4 months; locally advanced pancreatic cancer 13.7 months, (P = 0.2)). Adjusted for immortal time bias, median overall survival for patients undergoing resection versus only chemotherapy was 24.4 months versus 10.1 months (P <0.001) for borderline resectable pancreatic cancer and 28.4 months versus 12.6 months for locally advanced pancreatic cancer (P = 0.001). Conclusion: Resection rates and survival in patients with borderline resectable pancreatic cancer and locally advanced pancreatic cancer treated at a high-volume centre in a universal healthcare system compare well with those treated at international expert centres.

• Shi, Jihua; Cheng, Nuo; Zhang, Wen; Jin, Qiang; Guo, Wen-Zhi & Ge, Guang-Bo [Show all 9 contributors for this article] (2023). Air-ventilated normothermic machine perfusion alleviates hepatic injury from DCD rat through CYP1A2. Heliyon. 9(8). doi: 10.1016/j.heliyon.2023.e19150. Full text in Research Archive Show summary

  Background. Normothermic machine perfusion (NMP) could provide protection to organs from donation after circulatory death (DCD) before transplantation, and its molecular mechanism remains unclear. Our previous study discovered that the air-ventilated NMP confers a better DCD liver recovery than oxygen-ventilated NMP. The purpose in the current study was to investigate the protective mechanism of air-ventilated NMP in a rat model of DCD liver by metabolomics, and to select biomarker to predict liver function recovery. Materials and Methods. Peroxisome proliferator activator receptor-α (PPARα) agonist or antagonist was administered via the perfusion circuit in the air-ventilated NMP. Perfusate samples were taken for measurements of aminotransferases using standard biochemical methods, tumor necrosis factor-alpha and interleukin-6. Liver biopsies were allocated for detection of metabolomics, PPARα and cytochrome P450 1A2 (CYP1A2). Results. Metabolomics analysis revealed the significant increased γ-linolenic acid and decreased adrenic acid during the air-ventilated NMP, indicating linoleic acid metabolism pathway was associated with a better DCD liver recovery; as a major enzyme involved in linolenic acid metabolism, CYP1A2 was found correlated with a less inflammation and better liver function with the air-ventilated NMP; PPARα agonist could increase CYP1A2 expression and activity, decrease inflammation response, and improve liver function with the air-ventilated NMP, while PPARα antagonist played the opposite. Conclusion. Air-ventilated NMP confers a better liver recovery from DCD rats through the activated linoleic acid metabolism and CYP1A2 upregulation; CYP1A2 expression and activity might function as biomarker to predict DCD liver function recovery with NMP.

• Andersen, Ina Marie; Reims, Henrik Mikael; Grzyb, Krzysztof; Fevang, Børre; Melum, Espen & Aukrust, Pål [Show all 10 contributors for this article] (2023). Long-term survival after liver transplantation in patients with common variable immunodeficiency. Liver transplantation. ISSN 1527-6465. 29(8), p. 894–899. doi: 10.1097/LVT.0000000000000130. Full text in Research Archive
• Khan, Ammar; Fosby, Bjarte; Labori, Knut Jørgen; Lanari, Jacopo; Dorenberg, Eric & Line, Pål Dag (2023). Management of Coeliac and Hepatic Artery Aneurysms: A Single Institution Experience of 84 Cases. European Journal of Vascular and Endovascular Surgery. ISSN 1078-5884. 66(6), p. 814–820. doi: 10.1016/j.ejvs.2023.09.032. Full text in Research Archive Show summary

  Objective To report outcomes following open or endovascular treatment of true hepatic and coeliac artery aneurysms at a single referral centre. Methods This was a retrospective cohort study of consecutive patients treated for true hepatic and coeliac artery aneurysms between May 2002 and December 2021. Outcome measures included complications, graft patency, and survival rate. Results Overall, 84 patients were included with a median age of 63 years (interquartile range 55, 79). The majority (76%) of the patients were men. Frequent comorbidities included a history of tobacco (69%), hypertension (65%), hyperlipidaemia (32%), and diabetes (15%). Multiple synchronous aneurysms were detected in 22 patients (26%). There were 33 (39%) symptomatic aneurysms (abdominal pain without rupture [n = 18], rupture [n = 10], and sepsis [n = 5]). Seventeen patients (20%) had mycotic aetiology. Fifty patients (60%) underwent endovascular treatment with either covered stent placement (n = 29) or coil embolisation (n = 21), and 34 patients (40%) were treated with open surgery using allogenic iliac artery (n = 15), autologous saphenous vein (n = 15), GoreTex graft (n = 2), or ligation (n = 2). The complication rate was 32% in the open group and 18% in the endovascular group (p = .048). The overall 90 day post-operative mortality rate was 1.2%, five year primary patency was 90.0%, five year survival rate was 81.2%, and mean follow up was 6.9 ± 4.2 years. Conclusion Endovascular treatment is the preferred approach whenever technically possible. Despite higher post-operative morbidity, an open approach with vascular reconstruction using autologous or allogenic vascular grafts yields acceptable long term results.

• Carbone, M.; Penna, Penna Della; Mazzarelli, C.; Martin, Martin De; Villard, C. & Bergquist, A. [Show all 20 contributors for this article] (2023). Liver Transplantation for Primary Sclerosing Cholangitis (PSC) With or Without Inflammatory Bowel Disease (IBD)—A European Society of Organ Transplantation (ESOT) Consensus Statement. Transplant International. ISSN 0934-0874. 36. doi: 10.3389/ti.2023.11729. Full text in Research Archive Show summary

  Primary sclerosing cholangitis (PSC) is the classical hepatobiliary manifestation of inflammatory bowel disease (IBD) and a lead indication for liver transplantation (LT) in the western world. In this article, we present a Consensus Statement on LT practice, developed by a dedicated Guidelines’ Taskforce of the European Society of Organ Transplantation (ESOT). The overarching goal is to provide practical guidance on commonly debated topics, including indications and timing of LT, management of bile duct stenosis in patients on the transplant waiting list, technical aspects of transplantation, immunosuppressive strategies post-transplant, timing and extension of intestinal resection and futility criteria for re-transplantation.

• Rydenfelt, Kristina Elisabeth; Kjøsen, Gisle; Horneland, Rune; Ludviksen, Judith K; Jenssen, Trond & Line, Pål Dag [Show all 10 contributors for this article] (2023). Local Postoperative Graft Inflammation in Pancreas Transplant Patients With Early Graft Thrombosis. Transplantation direct. 10(1), p. E1567–E1567. doi: 10.1097/TXD.0000000000001567. Full text in Research Archive Show summary

  Background. Graft thrombosis is the main cause of early graft loss following pancreas transplantation, and is more frequent in pancreas transplant alone (PTA) compared with simultaneous pancreas-kidney (SPK) recipients. Ischemia-reperfusion injury during transplantation triggers a local thromboinflammatory response. We aimed to evaluate local graft inflammation and its potential association with early graft thrombosis. Methods. In this observational study, we monitored 67 pancreas-transplanted patients using microdialysis catheters placed on the pancreatic surface during the first postoperative week. We analyzed 6 cytokines, interleukin-1 receptor antagonist (IL-1ra), IL-6, IL-8, interferon gamma-induced protein 10 (IP-10), macrophage inflammatory protein 1β (MIP-1β), IL-10, and the complement activation product complement activation product 5a (C5a) in microdialysis fluid. We compared the dynamic courses between patients with pancreas graft thrombosis and patients without early complications (event-free) and between PTA and SPK recipients. Levels of the local inflammatory markers, and plasma markers C-reactive protein, pancreas amylase, and lipase were evaluated on the day of thrombosis diagnosis compared with the first week in event-free patients. Results. IL-10 and C5a were not detectable. Patients with no early complications (n = 34) demonstrated high IL-1ra, IL-6, IL-8, IP-10, and MIP-1β concentrations immediately after surgery, which decreased to steady low levels during the first 2 postoperative days (PODs). Patients with early graft thrombosis (n = 17) demonstrated elevated IL-6 (P = 0.003) concentrations from POD 1 and elevated IL-8 (P = 0.027) concentrations from POD 2 and throughout the first postoperative week compared with patients without complications. IL-6 (P < 0.001) and IL-8 (P = 0.003) were higher on the day of thrombosis diagnosis compared with patients without early complications. No differences between PTA (n = 35) and SPK (n = 32) recipients were detected. Conclusions. Local pancreas graft inflammation was increased in patients experiencing graft thrombosis, with elevated postoperative IL-6 and IL-8 concentrations, but did not differ between PTA and SPK recipients. Investigating the relationship between the local cytokine response and the formation of graft thrombosis warrants further research.

• Grut, Harald; Line, Pål Dag; Syversveen, Trygve & Dueland, Svein (2023). Metabolic Tumor Volume from ¹⁸F-FDG PET/CT in Combination with Radiologic Measurements to Predict Long-Term Survival Following Transplantation for Colorectal Liver Metastases. Cancers. 16(1). doi: 10.3390/cancers16010019. Full text in Research Archive
• Dueland, Svein; Smedman, Tor Magnus; Syversveen, Trygve; Grut, Harald; Hagness, Morten & Line, Pål Dag (2023). Long-Term Survival, Prognostic Factors, and Selection of Patients with Colorectal Cancer for Liver Transplant: A Nonrandomized Controlled Trial. JAMA Surgery. ISSN 2168-6254. 158(9). doi: 10.1001/jamasurg.2023.2932. Full text in Research Archive
• Rydenfelt, Kristina Elisabeth; Kjøsen, Gisle; Horneland, Rune; Ludviksen, Judith K; Jenssen, Trond & Line, Pål Dag [Show all 10 contributors for this article] (2023). Thromboinflammatory response is increased in pancreas transplant alone versus simultaneous pancreas-kidney transplantation and early pancreas graft thrombosis is associated with complement activation. Frontiers in Immunology. 14. doi: 10.3389/fimmu.2023.1044444. Full text in Research Archive Show summary

  Background: Pancreas transplant alone (PTA) recipients are more affected by pancreas graft thrombosis, and graft loss compared to simultaneous pancreas-kidney (SPK) recipients. The pathophysiology is unknown, but an increased immune response has been suggested in the PTA recipients. In this observational study, we compared perioperative thromboinflammation between PTA (n=32) and SPK (n=35) recipients, and between PTA recipients with (n=14) versus without (n=18) early graft thrombosis. Methods: We measured C-reactive protein (CRP), plasma markers of activated coagulation and complement, and cytokines preoperatively and daily during the first postoperative week. Results: Preoperatively, coagulation and complement activation markers were comparable between PTA and SPK recipients, while cytokine concentrations were higher in SPK recipients (TNF, IL-8, IP-10, MCP-1, MIP-1α; all p<0.05). On the first postoperative day, PTA recipients had higher coagulation activation, measured as thrombin-antithrombin complex (TAT), than SPK recipients (p=0.008). In the first postoperative week, PTA recipients showed higher relative cytokine release (IL-6, IL-8, G-CSF, IP-10, MCP-1, and MIP-1α; all p<0.05) while SPK recipients showed higher absolute cytokine concentrations (TNF, IL-1ra, IL-8, MIP-1α, and IL-4; all p<0.05). PTA and SPK recipients showed similar terminal complement complex (TCC, sC5b-9) activation. On the first postoperative day, TCC (OR 1.2 [95% CI 1.0-1.5] for 0.1 CAU/ml increase, p=0.02) and CRP (OR 1.2 [95% CI 1.0-1.3] for 10 mg/L increase, p=0.04) were associated with an increased risk of early graft thrombosis. TCC was specific for graft thrombosis, while CRP increased with several complications. PTA recipients with compared to those without graft thrombosis had higher TCC pre- (p=0.04) and postoperatively (p=0.03). Conclusion: The relative increase in postoperative thromboinflammatory response was more pronounced in PTA recipients. Complement activation was associated with an increased risk of graft thrombosis. This study indicates that innate immune activation rather than elevated levels may affect early postoperative pancreas graft thrombosis. Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT01957696, identifier NCT01957696

• Bergsmark, Thomas; Engesæter, Lise Katrine; Rasmussen, Allan; Bennet, William; Nordin, Arno & Pall, Virge [Show all 9 contributors for this article] (2023). Long-term survival after liver transplantation for alcohol-related liver disease in the Nordic countries. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 58(8), p. 923–930. doi: 10.1080/00365521.2023.2184193. Full text in Research Archive
• Bjørnelv, Gudrun Maria Waaler; Zolic-Karlsson, Zinajda; Dueland, Svein; Line, Pål Dag & Aas, Eline (2022). Cost-effectiveness of liver transplantation versus last-resort systemic therapy for colorectal liver metastases. British Journal of Surgery. ISSN 0007-1323. 109(6), p. 483–485. doi: 10.1093/bjs/znac022. Full text in Research Archive Show summary

  Approximately 50 per cent of patients with colorectal cancer have metastases at the time of diagnosis or subsequently develop metastases. The most frequent metastatic site is the liver1–3. Palliative chemotherapy is the treatment option for most patients with colorectal liver metastases (CRLMs). Regorafenib and TAS-102 have recently been approved by the European Medicines Agency and US Food and Drug Administration for patients with CRLMs who have progressed from second- or third-line treatments4–6. In randomized studies, regorafenib and TAS-102 prolonged median overall survival by 1.4–1.8 months compared with best supportive care (BSC)7,8. The authors have previously shown that deceased-donor liver transplantation (LT) is a cost-effective treatment alternative for patients with CRLMs compared with chemotherapy alone, particularly for selected low-risk patients (those with a low Oslo Score)9,10. LT may also be an option for patients with advanced liver-only CRLMs11. In the present study, a previously validated model was used to evaluate the cost-effectiveness of LT in patients with progressive disease, for whom the only available treatment options were TAS-102, regorafenib or BSC9.

• Solheim, Jon Magnus Aarstrand; Dueland, Svein; Line, Pål Dag & Hagness, Morten (2022). Transplantation for Nonresectable Colorectal Liver Metastases: Long-Term Follow-Up of the First Prospective Pilot Study. Annals of Surgery. ISSN 0003-4932. 278(2), p. 239–245. doi: 10.1097/SLA.0000000000005703. Full text in Research Archive
• Eshmuminov, Dilmurodjon; Studer, Debora J; Lopez, Victor Lopez; Schneider, Marcel Andre; Lerut, Jan & Lo, Mary [Show all 35 contributors for this article] (2022). Controversy Over Liver Transplantation or Resection for Neuroendocrine Liver Metastasis: Tumor Biology Cuts the Deal. Annals of Surgery. ISSN 0003-4932. 277(5). doi: 10.1097/SLA.0000000000005663. Full text in Research Archive
• Settmacher, Utz; Ali-Deeb, Aladdin; Coubeau, Laurent; Cillo, Umberto; Line, Pål Dag & Guba, Markus [Show all 8 contributors for this article] (2022). Auxilliary Liver Transplantation According to the RAPID Procedure in Noncirrhotic Patients Technical Aspects and Early Outcomes. Annals of Surgery. ISSN 0003-4932. 277(2), p. 305–312. doi: 10.1097/SLA.0000000000005726. Full text in Research Archive
• Østensen, Inger Anniken Bjørnstad; Skarbø, Anne-Britt; Sanengen, Truls; Line, Pål Dag & Almaas, Runar (2022). Impaired Neurocognitive Performance in Children After Liver Transplantation. Journal of Pediatrics. ISSN 0022-3476. doi: 10.1016/j.jpeds.2021.12.033. Full text in Research Archive Show summary

  Objectives To assess longitudinal neurocognitive development after liver transplantation and evaluate factors associated with neurocognitive performance. Study design Data from neurocognitive testing of 65 children (aged <18 years) who underwent liver transplantation at Oslo University Hospital between 1995 and 2018 were collected from the testing program after transplantation. The parent-reported version of the Behavior Rating Inventory of Executive Function was used to assess executive function. Results A total of 104 neurocognitive tests were conducted on 65 patients. At the first test, conducted at a median of 4.1 years (IQR, 1.5-5.3 years) after transplantation and at a median age of 6.7 years (IQR, 5.4-10.5 years), the mean full-scale IQ (FSIQ) was 91.7 ± 14, and the mean verbal comprehension index was 92.0 ± 14.5. In the 30 patients tested more than once, there was no significant difference in FSIQ between the first test at a median age of 5.8 years (IQR, 5.2-8.5 years) and the last test at a median age of 10.8 years (IQR, 9.8-12.9 years) (87.4 ± 12.9 vs 88.5 ± 13.2; P = .58). Compared with the patients who underwent transplantation a age >1 year (n = 35), those who did so at age <1 year (n = 30) had a lower FSIQ (87.1 ± 12.6 vs 96.6 ± 13.8; P = .005) and lower verbal comprehension index (87.3 ± 13.8 vs 95.4 ± 13.0; P = .020). Age at transplantation (P = .005; adjusted for cholestasis: P = .038) and transfusion of >80 mL/kg (P = .004; adjusted for age at transplantation: P = .046) were associated with FSIQ. Conclusions Young age at transplantation and large blood transfusions during transplantation are risk factors for poor neurocognitive performance later in life. Children who undergo transplantation before 1 year of age have significantly lower neurocognitive performance compared with those who do so later in childhood. Cognitive performance did not improve over time after transplantation.

• Dueland, Svein; Smedman, Tor Magnus; Grut, Harald; Syversveen, Trygve; Jørgensen, Lars Hilmar & Line, Pål Dag (2022). PET-Uptake in Liver Metastases as Method to Predict Tumor Biological Behavior in Patients Transplanted for Colorectal Liver Metastases Developing Lung Recurrence. Cancers. 14(20). doi: 10.3390/cancers14205042. Full text in Research Archive Show summary

  The objective of the study was to determine the impact of PET uptake on liver metastases on overall survival (OS) after resection of pulmonary metastases in patients who had received liver transplantation (LT) due to unresectable colorectal liver-only metastases. Resection of pulmonary colorectal metastases is controversial. Some hospitals offer this treatment to selected patients, whereas other hospitals do not perform the procedure in colorectal cancer patients who develop pulmonary metastases. All patients included in the LT studies who developed pulmonary metastases as first site of relapse, and had resection of these as first treatment, were included in this report. Metabolic tumor volume (MTV) in liver was derived from the pre-transplant PET examinations. OS from time of resection was calculated by the Kaplan–Meier method. Patients with low MTV (&lt;70 cm3) had significantly longer OS from time of resection of pulmonary metastases compared to patients with high MTV (&gt;70 cm3). Patients with low MTV in the liver had 10-year OS from time of pulmonary resections of 86%. Liver MTV values from pre-transplant PET examinations may predict long OS in colorectal cancer patients with a resection of pulmonary metastases developing after LT. Thus, in selected colorectal cancer patients developing pulmonary metastases resection of these metastases should be the treatment of choice.

• Hou, Jie; Liavåg, Olav Magnus Ivar; Færden, Ida Høy; Martinsen, Ørjan Grøttem; Tønnessen, Tor Inge & Line, Pål Dag [Show all 10 contributors for this article] (2022). Utilization of dielectric properties for assessment of liver ischemia-reperfusion injury in vivo and during machine perfusion. Scientific Reports. 12(1). doi: 10.1038/s41598-022-14817-3. Full text in Research Archive Show summary

  Abstract There is a shortage of donor livers and patients consequently die on waiting lists worldwide. Livers are discarded if they are clinically judged to have a high risk of non-function following transplantation. With the aim of extending the pool of available donor livers, we assessed the condition of porcine livers by monitoring the microwave dielectric properties. A total of 21 livers were divided into three groups: control with no injury (CON), biliary injury by hepatic artery occlusion (AHEP), and overall hepatic injury by static cold storage (SCS). All were monitored for four hours in vivo, followed by ex vivo plurithermic machine perfusion (PMP). Permittivity data was modeled with a two-pole Cole–Cole equation, and dielectric properties from one-hour intervals were analyzed during in vivo and normothermic machine perfusion (NMP). A clear increasing trend in the conductivity was observed in vivo in the AHEP livers compared to the control livers. After four hours of NMP, separations in the conductivity were observed between the three groups. Our results indicate that dielectric relaxation spectroscopy (DRS) can be used to detect and differentiate liver injuries, opening for a standardized and reliable point of evaluation for livers prior to transplantation.

• Haflidadottir, Svanhildur; Østensen, Inger Anniken Bjørnstad; Matthews, Iren; Line, Pål Dag & Almaas, Runar (2022). Mycophenolate mofetil use is associated with reduced incidence of food allergy in liver transplanted children. Journal of Pediatric Gastroenterology and Nutrition - JPGN. ISSN 0277-2116. 75(2), p. 138–144. doi: 10.1097/MPG.0000000000003509. Full text in Research Archive
• Salcedo, Magdalena; Vinaixa, Carmen; Javle, Milind; Trapero-Marugan, Maria; Bustamante, Javier & Line, Pål Dag (2022). Evaluation and Management of Liver Transplant Candidates With Prior Nonhepatic Cancer: Guidelines From the ILTS/SETH Consensus Conference. Transplantation. ISSN 0041-1337. 106(1), p. e3–e11. doi: 10.1097/TP.0000000000003997. Full text in Research Archive
• Fodor, Margot; Zoller, Heinz; Oberhuber, Rupert; Sucher, Robert; Seehofer, Daniel & Cillo, Umberto [Show all 9 contributors for this article] (2022). The need to update endpoints and outcome analysis in the rapidly changing field of liver transplantation. Transplantation. ISSN 0041-1337. 106(5), p. 938–949. doi: 10.1097/TP.0000000000003973. Full text in Research Archive
• Grut, Harald; Line, Pål Dag; Syversveen, Trygve & Dueland, Svein (2022). Metabolic tumor volume predicts long-term survival after transplantation for unresectable colorectal liver metastases: 15 years of experience from the SECA study. Annals of Nuclear Medicine. ISSN 0914-7187. 36(12), p. 1073–1081. doi: 10.1007/s12149-022-01796-8. Full text in Research Archive Show summary

  Abstract Objective To report 15 years of experience with metabolic tumor volume (MTV) of liver metastases from the preoperative 18 F-FDG PET/CT to predict long-term survival after liver transplantation (LT) for unresectable colorectal liver metastases (CRLM). Methods The preoperative 18 F-FDG PET/CT from all SECA 1 and 2 patients was evaluated. MTV was obtained from all liver metastases. The patients were divided into one group with low MTV (&lt; 70 cm 3 ) and one group with high MTV (&gt; 70 cm 3 ) based on a receiver operating characteristic analysis. Overall survival (OS), disease-free survival (DFS) and post recurrence survival (PRS) for patients with low versus high MTV were compared using the Kaplan–Meier method and log rank test. Clinopathological features between the two groups were compared by a nonparametric Mann–Whitney U test for continuous and Fishers exact test for categorical data. Results At total of 40 patients were included. Patients with low MTV had significantly longer OS ( p  &lt; 0.001), DFS ( p  &lt; 0.001) and PRS ( p  = 0.006) compared to patients with high values. The patients with high MTV had higher CEA levels, number of liver metastases, size of the largest liver metastasis, N-stage, number of chemotherapy lines and more frequently progression of disease at LT compared to the patients with low MTV. Conclusion MTV of liver metastases is highly predictive of long-term OS, DFS and PRS after LT for unresectable CRLM and should be implemented in risk stratification prior to LT.

• Kjøsen, Gisle; Horneland, Rune; Nordheim, Espen; Aandahl, Einar Martin; Line, Pål Dag & Rydenfelt, Kristina Elisabeth [Show all 9 contributors for this article] (2022). Validating the US pancreas donor risk index in a Norwegian population, a retrospective observational study. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 57(3), p. 345–351. doi: 10.1080/00365521.2021.2012590. Full text in Research Archive Show summary

  OBJECTIVES Despite advances in immunosuppression and surgical technique, pancreas transplantation is still associated with a significant graft loss rate. The Pancreas Donor Risk Index (PDRI) is a pre-transplant scoring tool derived from a US population. We sought to validate the PDRI in a Norwegian population. METHODS We retrospectively retrieved donor data for 344 pancreas transplants undertaken in Norway between 2000 and 2019, utilising the Scandiatransplant database, and matched these to the respective recipients. The PDRI score was calculated for each transplanted pancreas, these were then stratified into quintiles. The association between the PDRI quintiles and 1-year graft survival was calculated, and this was repeated for the different types of pancreas transplantation. The association between PDRI as a continuous variable, and graft survival was determined. Donor and recipient data were compared to the original US population. RESULTS The overall 1-year graft survival was 82.7%. There were no significant differences in survival between the different PDRI quintiles. When viewed as a continuous variable, increased PDRI score was not associated with decreased graft survival. Significant differences between the Norwegian and US populations were found. CONCLUSIONS When applied to a Norwegian population, the PDRI score was unable to predict 1-year graft survival.

• Line, Pål Dag (2022). Liver transplantation for colorectal secondaries: on the way to validation. Current Opinion in Organ Transplantation. ISSN 1087-2418. 27(4), p. 329–336. doi: 10.1097/MOT.0000000000000977. Full text in Research Archive Show summary

  Purpose of review Liver transplantation for nonresectable colorectal liver metastases (CRLMs) is an emerging field within transplant oncology. This review summarizes recent developments within this field. Recent findings More stringent selection criteria can yield 5-year survival rates that are similar to conventional indications for liver transplantation. Response to chemotherapy, low carcinoembryonic antigen levels, limited tumor volume and stable disease with observation time exceeding 12 months are fundamental requirements in this context. Radiomic analysis of pre transplant PET/computed tomography scans to determine metabolic tumor volume (MTV) in the liver seems particularly promising with regards to prediction of a favorable tumor biology. MTV values below 70 cm3 are associated with excellent long-term survival after transplantation, whereas the MTV threshold for liver resection seem far smaller. Recent studies put into question whether technical nonresectability per se is a valid inclusion criterion for liver transplantation. In patients with high hepatic tumor burden, but otherwise favorable prognostic features as assessed by the Oslo score, liver transplantation could possibly give a clinically relevant survival benefit compared with liver resection. Summary Liver transplantation is feasible treatment option in highly selected patients with nonresectable CRLMs. Robust and stringent selection criteria should be applied according to international consensus guidelines.

• Smedman, Tor Magnus; Guren, Tormod Kyrre; Tveit, Magne Kjell; Thomsen, Maria; Andersen, Marit Helen & Line, Pål Dag [Show all 7 contributors for this article] (2022). Health-Related Quality of Life in Colorectal Cancer Patients Treated With Liver Transplantation Compared to Chemotherapy. Transplant International. ISSN 0934-0874. 35. doi: 10.3389/ti.2022.10404. Full text in Research Archive Show summary

  Liver transplantation (LT) for patients with non-resectable colorectal liver metastases (CRLM) offers improved survival and has gained increased interest internationally the last years. The aim of this study was to describe the health-related quality of life (HRQoL) in patients with non-resectable CRLM receiving LT and how baseline HRQoL factors affect overall survival (OS). HRQoL data in the SECA (SEcondary CAncer) LT cohort was compared to data obtained from colorectal cancer patients starting first-line chemotherapy for metastatic disease in a clinical trial and data from a Norwegian normal population. HRQoL data from the QLQ-C30 questionnaire used in the SECA LT study and the NORDIC- VII study were reported. The relationship between patient-reported symptom burden at baseline and OS was investigated. In the SECA study longitudinal HRQoL assessment was used to describe the time until definitive deterioration as well as mean values at different time points. Patients in the SECA and NORDIC-VII studies reported similar baseline HRQoL. The median time until definitive deterioration in the transplanted patients was estimated to 36 months. In the SECA study appetite loss and pain at baseline had negative impact on OS (25.3 versus 71.7 months, p = 0.002 and 39.7 versus 71.7 months, p = 0.038, respectively). Despite a relapse in most of the LT patients the Global Health Score (GHS) remained good. Pain, and especially appetite loss at time of transplantation is associated with poor outcome after LT.

• Sparrelid, Ernesto; Thorsen, Trygve; Sauter, Christina; Jorns, Carl; Stål, Per & Nordin, Arno [Show all 14 contributors for this article] (2022). Liver transplantation in patients with post-hepatectomy liver failure – A Northern European multicenter cohort study. HPB. ISSN 1365-182X. doi: 10.1016/j.hpb.2021.12.005. Full text in Research Archive Show summary

  Background Liver transplantation (LTX) has been described as a rescue treatment option in severe, intractable post-hepatectomy liver failure (PHLF), but is not considered to be indicated for this condition by many hepatobiliary and transplant surgeons. In this article we describe the clinical experience of five northern European tertiary centers in using LTX to treat selected patients with severe PHLF. Methods All patients subjected to LTX due to PHLF at the participating centers were identified from prospective clinical databases. Preoperative variables, surgical outcome (both resection surgery and LTX) and follow-up data were assessed. Results A total of 10 patients treated with LTX due to severe PHLF from September 2008 to May 2020 were identified and included in the study. All patients but one were male and the median age was 70 years (range 49–72). In all patients the indication for liver resection was suspected malignancy, but in six patients post-resection pathology revealed benign or pre-malignant disease. There was no 90-day mortality after LTX. Patients were followed for a median of 49 months (13–153) and eight patients were alive without recurrence at last follow-up. Discussion In selected patients with PHLF LTX can be a life-saving procedure with low short-term risk.

• Dueland, Svein; Yaqub, Sheraz; Syversveen, Trygve; Carling, Johan Ulrik; Hagness, Morten & Brudvik, Kristoffer Watten [Show all 7 contributors for this article] (2021). Survival Outcomes after Portal Vein Embolization and Liver Resection Compared with Liver Transplant for Patients with Extensive Colorectal Cancer Liver Metastases. JAMA Surgery. ISSN 2168-6254. 156(6), p. 550–557. doi: 10.1001/jamasurg.2021.0267. Full text in Research Archive
• Mueller, Matteo; Breuer, Eva; Mizuno, Takashi; Bartsch, Fabian; Ratti, Francesca & Benzing, Christian [Show all 63 contributors for this article] (2021). Perihilar Cholangiocarcinoma - Novel Benchmark Values for Surgical and Oncological Outcomes From 24 Expert Centers. Annals of Surgery. ISSN 0003-4932. 274(5), p. 780–788. doi: 10.1097/SLA.0000000000005103. Full text in Research Archive
• Grut, Harald; Line, Pål Dag; Labori, Knut Jørgen; Schulz, Anselm & Dueland, Svein (2021). Survival after liver resection and liver transplantation for colorectal liver metastases: a comparative analysis stratified by metabolic tumor volume assessed by 18F-FDG PET/CT. HPB. ISSN 1365-182X. doi: 10.1016/j.hpb.2021.11.015. Full text in Research Archive
• Hausken, John; Haugaa, Håkon; Hagness, Morten; Line, Pål-Dag; Melum, Espen & Tønnessen, Tor Inge (2021). Thoracic Epidural Analgesia for Postoperative Pain Management in Liver Transplantation: A 10-year Study on 685 Liver Transplant Recipients. Transplantation direct. 7(2), p. 1–6. doi: 10.1097/TXD.0000000000001101. Full text in Research Archive Show summary

  Background. Thoracic epidural analgesia (TEA) is not widely used for postoperative pain management in liver transplantation due to hepatic coagulopathy-related increased risk of inducing an epidural hematoma. However, an increasing number of patients are transplanted for other indications than the end-stage liver disease and without coagulopathy allowing insertion of an epidural catheter. Methods. This study is a retrospective observational single-center study of all adult patients undergoing first-time liver transplantation at Oslo University Hospital between January 1, 2008, and December 31, 2017. Data regarding patient characteristics were obtained from the Nordic liver transplant registry, medical records, and pain registration forms. Patients without coagulopathy (international normalized ratio <1.5 and platelets >100 × 109/L) were eligible for TEA. Results. Out of 685 first-time liver transplantations in a 10-year period, 327 received TEA, and 358 did not. The median Model of End-stage Liver Disease score was lower in the TEA group than in the non-TEA-group (9 versus 17, P < 0.001), and fewer patients were hospitalized preoperatively (16 versus 127, P < 0.001). The median international normalized ratio (1.1 versus 1.6, P < 0.001) and platelet count (190 versus 78, P < 0.001) were different between the TEA and non-TEA groups. There were no serious complications related to insertion or removal of the TEA catheters. Patients in the TEA group had less pain with a mean numeric rating scale at postoperative days 0–5 of 1.4 versus 1.8 (P = 0.008). Nearly 50% of the patients were prescribed opioids when discharged from hospital (non-TEA 154 versus TEA 158, P = 0.23), and there was no difference after 1 year (P = 0.718). Conclusions. Our report revealed very good pain control with both TEA and the non-TEA modality. TEA was without any serious complications like epidural hematoma or infection/abscess in selected liver transplant recipients without severe coagulopathy. Opioid prescription at hospital discharge and by 1-year follow-up did not differ between the groups.

• Bonney, Glenn K.; Chew, Claire Alexandra; Lodge, Peter; Hubbard, Joleen; Halazun, Karim J. & Trunecka, Pavel [Show all 27 contributors for this article] (2021). Liver transplantation for non-resectable colorectal liver metastases: the International Hepato-Pancreato-Biliary Association consensus guidelines. The Lancet Gastroenterology and Hepatology. ISSN 2468-1253. 6(11), p. 933–946. doi: 10.1016/S2468-1253(21)00219-3. Full text in Research Archive
• Dueland, Svein; Syversveen, Trygve; Hagness, Morten; Grut, Harald & Line, Pål Dag (2021). Liver transplantation for advanced liver-only colorectal metastases. British Journal of Surgery. ISSN 0007-1323. 108(12), p. 1402–1405. doi: 10.1093/bjs/znab196. Full text in Research Archive
• Berenguer, Marina; Maira, Tommaso Di; Baumann, Ulrich; Mirza, Darius F.; Heneghan, Michael A. & Klempnauer, Jurgen L. [Show all 16 contributors for this article] (2021). Characteristics, Trends, and Outcomes of Liver Transplantation for Primary Sclerosing Cholangitis in Female Versus Male Patients: An Analysis from the European Liver Transplant Registry. Transplantation. ISSN 0041-1337. p. 2255–2262. doi: 10.1097/TP.0000000000003542. Full text in Research Archive
• Dueland, Svein; Smedman, Tor M.; Røsok, Bård Ingvald; Grut, Harald; Syversveen, Trygve & Jørgensen, Lars Hilmar [Show all 7 contributors for this article] (2021). Treatment of relapse and survival outcomes after liver transplantation in patients with colorectal liver metastases. Transplant International. ISSN 0934-0874. 34(11), p. 2205–2213. doi: 10.1111/tri.13995. Full text in Research Archive
• Lindholm, Espen; Bergmann, Gisli Björn; Haugaa, Håkon; Labori, Knut Jørgen; Yaqub, Sheraz & Bjørnbeth, Bjørn Atle [Show all 11 contributors for this article] (2021). Early detection of anastomotic leakage after pancreatoduodenectomy with microdialysis catheters: an observational Study. HPB. ISSN 1365-182X. 24(6), p. 901–909. doi: 10.1016/j.hpb.2021.10.020. Full text in Research Archive Show summary

  Background Microdialysis catheters can detect focal inflammation and ischemia, and thereby have a potential for early detection of anastomotic leakages after pancreatoduodenectomy. The aim was to investigate whether microdialysis catheters placed near the pancreaticojejunostomy can detect leakage earlier than the current standard of care. Methods Thirty-five patients with a median age 69 years were included. Two microdialysis catheters were placed at the end of surgery; one at the pancreaticojejunostomy, and one at the hepaticojejunostomy. Concentrations of glucose, lactate, pyruvate, and glycerol were analyzed hourly in the microdialysate during the first 24 h, and every 2–4 h thereafter. Results Seven patients with postoperative pancreatic fistulae (POPF) had significantly higher glycerol levels (P < 0.01) in the microdialysate already in the first postoperative samples. Glycerol concentrations >400 μmol/L during the first 12 postoperative hours detected patients with POPF with a sensitivity of 100% and a specificity of 93% (P < 0.001). After 24 h, lactate and lactate-to-pyruvate ratio were significantly higher (P < 0.05) and glucose was significantly lower (P < 0.05) in patients with POPF. Conclusion High levels of glycerol in microdialysate was an early detector of POPF. The subsequent inflammation was detected as increase in lactate and lactate-to-pyruvate ratio and a decrease in glucose (NCT03627559).

• Kjøsen, Gisle; Rydenfelt, Kristina Elisabeth; Horneland, Rune; Aandahl, Einar Martin; Line, Pål Dag & Dorenberg, Eric Jürgen [Show all 15 contributors for this article] (2021). Early detection of complications in pancreas transplants by microdialysis catheters, an observational feasibility study. PLOS ONE. 16(3), p. 1–16. doi: 10.1371/journal.pone.0247615. Full text in Research Archive Show summary

  Background Despite advances in immunosuppression and surgical technique, pancreas transplantation is encumbered with a high rate of complication and graft losses. Particularly, venous graft thrombi occur relatively frequently and are rarely detected before the transplant is irreversibly damaged. Methods To detect complications early, when the grafts are potentially salvageable, we placed microdialysis catheters anteriorly and posteriorly to the graft in a cohort of 34 consecutive patients. Glucose, lactate, pyruvate, and glycerol were measured at the bedside every 1–2 hours. Results Nine patients with graft venous thrombosis had significant lactate and lactate–to-pyruvate-ratio increases without concomitant rise in blood glucose or clinical symptoms. The median lactate in these patients was significantly higher in both catheters compared to non-events (n = 15). Out of the nine thrombi, four grafts underwent successful angiographic extraction, one did not require intervention and four grafts were irreversibly damaged and explanted. Four patients with enteric anastomosis leakages had significantly higher glycerol measurements compared to non-events. As with the venous thrombi, lactate and lactate-to-pyruvate ratio were also increased in six patients with graft surrounding hematomas. Conclusions Bedside monitoring with microdialysis catheters is a promising surveillance modality of pancreatic grafts, but differentiating between the various pathologies proves challenging.

• Lanari, Jacopo; Hagness, Morten; Sartori, Alessandra; Rosso, Eugenia; Gringeri, Enrico & Dueland, Svein [Show all 8 contributors for this article] (2021). Liver transplantation versus liver resection for colorectal liver metastasis: a survival benefit analysis in patients stratified according to tumor burden score. Transplant International. ISSN 0934-0874. doi: 10.1111/tri.13981. Full text in Research Archive Show summary

  Liver transplantation (LT) for colorectal liver metastasis (CRLM) may provide excellent survival rates in patients with unresectable disease. High tumor load is a risk factor for recurrence and low overall survival (OS) after liver resection (LR). We tested the hypothesis that LT could offer better survival than LR in patients with high tumor load. LR performed at Padua University Hospital for CRLM was compared with LT for unresectable CRLM performed both at Oslo and Padua. High tumor load was defined as tumor burden score (TBS) ≥ 9, and inclusion criteria were as in the SECA-I transplant study. 184 patients were eligible: 128 LRs and 56 LTs. 5-year OS after LR and LT was 40.5% and 54.7% (P = 0.102). In the high TBS cohort, 5-year OS after LR and LT was 22.7% and 52.2% (P = 0.055). In patients with Oslo score ≤ 2 and TBS ≥ 9 (13 LR; 24 LT) the 5-year OS after LR and LT was 14.6% and 69.1% (P = 0.002). The corresponding disease-free survival (DFS) was 0% and 22.9% (P = 0.005). Selected CRLM patients with low Oslo score and high TBS could benefit from LT with survival outcomes that are far better than what is achieved by LR.

• Bjerre, Anna Kristina; Mjøen, Geir; Line, Pål Dag; Naper, Christian; Reisæter, Anna Varberg & Åsberg, Anders (2020). Five decades with grandparent donors: The Norwegian strategy and experience. Pediatric Transplantation. ISSN 1397-3142. 24(6). doi: 10.1111/petr.13751. Full text in Research Archive Show summary

  Living donors (LDs) are preferred over DDs for renal transplantation in children due to superior GS. Oslo University Hospital has never restricted living donation by upper age. The aim of this study was to investigate long‐term outcomes using grandparents (GPLD) compared to PLD. Retrospective nationwide review in the period 1970‐2017. First renal graft recipients using a GPLD were compared to PLD kidney recipients for long‐term renal function and GS. 278 children (≤18 years) received a first renal transplant: 27/251 recipients with a GPLD/PLD. GPLD (median 59 (42‐74) years) were significantly older than PLD (median 41 (23‐65) years, (P < .001). Median DRAD was 52 (38‐70) vs 28 (17‐48) years, respectively. GS from GPLD and PLD had a 1‐, 5‐, and 10‐year survival of 100%, 100%, and 90% vs 93%, 82%, and 72%, respectively (P = .6). In a multivariate Cox regression analysis adjusted for gender, donor age, recipient age, and year of transplant, this finding was similar (HR 0.98; 95% CI 0.34‐2.84, P = .97). Five‐year eGFR was 47.3 and 59.5 mL/min/1.73 m2 in the GPLD and PLD groups (P = .028), respectively. In this nationwide retrospective analysis, GS for pediatric renal recipients using GPLD was comparable to PLD. Renal function assessed as eGFR was lower in the GPLD group. The GPLD group was significantly older than the PLD group, but overall this did not impact transplant outcome. Based on these findings, older age alone should not exclude grandparent donations.

• Dueland, Svein; Syversveen, Trygve; Solheim, Jon Magnus Aarstrand; Solberg, Steinar; Grut, Harald & Bjørnbeth, Bjørn Atle [Show all 8 contributors for this article] (2020). Survival following liver transplantation for patients with nonresectable liver-only colorectal metastases. Annals of Surgery. ISSN 0003-4932. 271(2), p. 212–218. doi: 10.1097/SLA.0000000000003404. Full text in Research Archive
• Shi, Jihua; Yan, X.; Zhang, S.J. & Line, Pål Dag (2020). Simulated model of RAPID concept: highlighting innate inflammation and liver regeneration. BJS Open. 4(5), p. 893–903. doi: 10.1002/bjs5.50322. Full text in Research Archive Show summary

  Background The resection and partial liver segment II/III transplantation with delayed total hepatectomy (RAPID) concept is a novel transplantation technique for removal of non‐resectable liver tumours. The aim of this study was to establish a simulated RAPID model to explore the mechanism involved in the liver regeneration. Methods A RAPID model was created in rats involving cold ischaemia and reperfusion of the selected future liver remnant (FLR), portal vein ligation, followed by resection of the deportalized lobes in a second step. Histology, liver regeneration and inflammatory markers in RAPID‐treated rats were compared with those in controls that underwent 70 per cent hepatectomy with the same FLR size. The effects of interleukin (IL) 6 and macrophage polarization on hepatocyte viability were evaluated in an in vitro co‐culture system of macrophages and BRL hepatocytes. Results The survival rate in RAPID and control hepatectomy groups was 100 per cent. The regeneration rate was higher in the RAPID‐treated rats, with higher levels of IL‐6 and M1 macrophage polarization (P < 0·050). BRL hepatocytes co‐cultured with M1 macrophages showed a higher proliferation rate through activation of the IL‐6/signal transducer and activator of transcription 3/extracellular signal‐regulated kinase pathway. This enhancement of proliferation was inhibited by tocilizumab or gadolinium trichloride (P < 0·050). Conclusion The surgical model provides a simulation of RAPID that can be used to study the liver regeneration profile.

• Lanari, Jacopo; Dueland, Svein & Line, Pål Dag (2020). Liver Transplantation for Colorectal Liver Metastasis. Current Transplantation Reports. 7(4), p. 311–316. doi: 10.1007/s40472-020-00298-8. Full text in Research Archive
• Smedman, Tor Magnus; Line, Pål Dag; Hagness, Morten; Syversveen, Trygve; Grut, Harald & Dueland, Svein (2020). Liver transplantation for unresectable colorectal liver metastases in patients and donors with extended criteria (SECA-II arm D study). BJS Open. 4(3), p. 467–477. doi: 10.1002/bjs5.50278. Full text in Research Archive Show summary

  Background Patients with metastatic colorectal cancer receiving palliative chemotherapy have a 5-year survival rate of approximately 10 per cent. Liver transplantation using strict selection criteria in patients with colorectal cancer and unresectable liver-only disease will result in a 5-year survival rate of 56–83 per cent. The aim of this study was to evaluate survival of patients with colorectal liver metastases (CRLM) after liver transplantation using extended criteria for both patients and donors. Methods This was a prospective single-arm study. Patients with synchronous unresectable CRLM who were not suitable for arms A, B or C of the SEcondary CAncer (SECA) II study who had undergone radical resection of the primary tumour and received chemotherapy were included; they underwent liver transplantation with extended criteria donor grafts. Patients who had resectable pulmonary metastases were eligible for inclusion. The main exclusion criteria were BMI above 30 kg/m2 and liver metastases larger than 10 cm. Survival was estimated using Kaplan–Meier analysis. Results Ten patients (median age 54 years; 3 women) were included. They had an extensive liver tumour load with a median of 20 (range 1–45) lesions; the median size of the largest lesion was 59 (range 15–94) mm. Eight patients had (y)pN2 disease, six had poorly differentiated or signet ring cell-differentiated primary tumours, and five had primary tumour in the ascending colon. The median Fong clinical risk score was 3 (range 2–5) and the median Oslo score was 1 (range 1–4). The median plasma carcinoembryonic antigen level was 4·3 (range 2–4346) μg/l. Median disease-free and overall survival was 4 and 18 months respectively. Conclusion Patients with unresectable liver-only CRLM undergoing liver transplantation with extended patient and donor criteria have relatively short overall survival.

• Khan, Ammar; Kleive, Dyre; Aandahl, Einar Martin; Fosby, Bjarte; Line, Pål Dag & Dorenberg, Eric Jürgen [Show all 8 contributors for this article] (2020). Portal vein stent placement after hepatobiliary and pancreatic surgery. Langenbeck's Archives of Surgery. ISSN 1435-2443. 405, p. 657–664. doi: 10.1007/s00423-020-01917-9. Full text in Research Archive Show summary

  Purpose To evaluate the long-term outcomes of percutaneous transhepatic stent placement for portal vein (PV) stenosis after liver transplantation (LT) and hepato-pancreato-biliary (HPB) surgery. Methods Retrospective study of 455 patients who underwent LT and 522 patients who underwent resection of the pancreatic head between June 2011 and February 2016. Technical success, clinical success, patency, and complications were evaluated for both groups. Results A total of 23 patients were confirmed to have postoperative PV stenosis and were treated with percutaneous transhepatic PV stent placement. The technical success rate was 100%, the clinical success rate was 80%, and the long-term stent patency was 91.3% for the entire study population. Two procedure-related hemorrhages and two early stent thromboses occurred in the HPB group while no complications occurred in the LT group. A literature review of selected studies reporting PV stent placement for the treatment of PV stenosis after HPB surgery and LT showed a technical success rate of 78–100%, a clinical success rate of 72–100%, and a long-term patency of 57–100%, whereas the procedure-related complication rate varied from 0–33.3%. Conclusions Percutaneous transhepatic PV stent is a safe and effective treatment for postoperative PV stenosis/occlusion in patients undergoing LT regardless of symptoms. Due to increased risk of complications, the indication for percutaneous PV stent placement after HPB surgery should be limited to patients with clinical symptoms after an individual assessment.

• Hibi, Taizo; Rela, Mohamed; Eason, James D.; Line, Pål Dag; Fung, John & Sakamoto, Seisuke [Show all 10 contributors for this article] (2020). Liver Transplantation for Colorectal and Neuroendocrine Liver Metastases and Hepatoblastoma. Working Group Report from the ILTS Transplant Oncology Consensus Conference. Transplantation. ISSN 0041-1337. p. 1131–1135. doi: 10.1097/TP.0000000000003118. Full text in Research Archive Show summary

  Liver transplantation (LT) for unresectable colorectal liver metastases has long been abandoned because of dismal prognoses. After the dark ages, advances in chemotherapy and diagnostic imaging have enabled strict patient selection, and the pioneering study from the Oslo group has contributed to the substantial progress in this field. For unresectable neuroendocrine liver metastases, LT for patients who met the Milan criteria was able to achieve excellent long-term outcomes. The guidelines further adopted in the United States and Europe were based on these criteria. For hepatoblastoma, patients with unresectable and borderline-resectable disease are considered good candidates for LT; however, the indications are yet to be defined. In the budding era of transplant oncology, it is critically important to recognize the current status and unsolved questions for each disease entity. These guidelines were developed to serve as a beacon of light for optimal patient selection for LT and set the stage for future basic and clinical studies.

• Golse, Nicolas; Joly, Florian; Nicolas, Quentin; Vibert, Eric; Line, Pål Dag & Clementel, Irene Vignon (2020). Partial orthotopic liver transplantation in combination with two-stage hepatectomy: A proof-of-concept explained by mathematical modeling. Clinical Biomechanics. ISSN 0268-0033. 73, p. 195–200. doi: 10.1016/j.clinbiomech.2020.01.020. Full text in Research Archive

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• Gunstad, Per Ole Flaten; Foss, Stein; Khan, Ammar; Lundesgaard, Kristoffer; SØRENSEN, DAG WENDELBO & Fosby, Bjarte [Show all 7 contributors for this article] (2025). 405.1: Unintended resuscitation during controlled donation after circulatory death with abdominal normothermic regional perfusion: A case of probable pathological collateral circulation. Transplantation. ISSN 0041-1337. 109(12S), p. S96–S97. doi: 10.1097/01.tp.0001175312.71437.a8. Full text in Research Archive
• Kjeseth, Trond; Line, Pål Dag; Khan, Ammar; Solheim, Jon Magnus Aarstrand; Björk, Ida Gabriella & Sundal, Jon [Show all 8 contributors for this article] (2024). Ex-situ liver resection for complex Echinococcus multilocularis infection: a case report. Journal of Surgical Case Reports (JSCR). 2024(6). doi: 10.1093/jscr/rjae410. Full text in Research Archive
• Dueland, Svein; Syversveen, Trygve & Line, Pål Dag (2024). In Reply. JAMA Surgery. ISSN 2168-6254. doi: 10.1001/jamasurg.2023.5800. Full text in Research Archive
• Chávez-Villa, Mariana; Ruffolo, Luis I.; Byrne, Matthew; Line, Pål Dag; Dueland, Svein & Tomiyama, Koji [Show all 7 contributors for this article] (2024). Reply to A. Jain et al. Journal of Clinical Oncology. ISSN 0732-183X. 42(26), p. 3165–3166. doi: 10.1200/JCO.24.00922. Full text in Research Archive
• Yakub, Sheraz; Edwin, Bjørn von Gohren; Hammoud, Zane; Herrera-Almario, Gabriel; Jabir, Buthaina & Lassen, Kristoffer [Show all 23 contributors for this article] (2024). Gaza War: Too many citizens being killed. British Journal of Surgery. ISSN 0007-1323. 111(4). doi: 10.1093/bjs/znae094. Full text in Research Archive
• Siriwardena, Ajith K.; Serrablo, Alejandro; Fretland, Åsmund Avdem; Wigmore, Stephen J.; Ramia-Angel, Jose M. & Malik, Hassan Z. [Show all 95 contributors for this article] (2023). The multi-societal European consensus on the terminology, diagnosis and management of patients with synchronous colorectal cancer and liver metastases: an E-AHPBA consensus in partnership with ESSO, ESCP, ESGAR, and CIRSE. HPB. ISSN 1365-182X. 25(9), p. 985–999. doi: 10.1016/j.hpb.2023.05.360. Full text in Research Archive
• Menon, Krishna; Vijayashanker, Aarathi; Murphy, Jamie; Line, Pål Dag; Isaac, John & Adair, Anya [Show all 19 contributors for this article] (2023). Liver transplantation for isolated unresectable colorectal liver metastases - Protocol for a service evaluation in the United Kingdom - UKCoMET study. HPB. ISSN 1365-182X. 25(6), p. 684–692. doi: 10.1016/j.hpb.2023.02.011. Full text in Research Archive
• Wehrle, Chase J.; Fujiki, Masato; Schlegel, Andrea; Linganna, Maureen Whitsett; Pita, Alejandro & Kim, Jae-Keun [Show all 15 contributors for this article] (2023). Update to ‘A Contemporary Systematic Review on Liver Transplantation for Unresectable Liver Metastasis of Colorectal Cancer’. Annals of Surgical Oncology. ISSN 1068-9265. doi: 10.1245/s10434-023-14611-z. Full text in Research Archive
• Hernandez-Alejandro, Roberto; Chávez-Villa, Mariana; Line, Pål Dag & Sapisochin, Gonzalo (2023). Festina lente—to advance we need to make haste slowly. Living donor liver transplant for colorectal cancer liver metastases. American Journal of Transplantation. ISSN 1600-6135. doi: 10.1016/j.ajt.2023.09.015. Full text in Research Archive
• Skauby, Morten Heier; Heldal, Kristian; Line, Pål Dag; SØRENSEN, DAG WENDELBO; Fiane, Arnt Eltvedt & Hagness, Morten (2023). Lengre ventelister for organtransplantasjon. 143(9). doi: 10.4045/tidsskr.22.0777. Full text in Research Archive
• Line, Pål Dag (2022). Selection criteria in liver transplantation for hepatocellular carcinoma: an ongoing evolution. BJS Open. 6(1). doi: 10.1093/bjsopen/zrac024. Full text in Research Archive
• Dueland, Svein; Yaqub, Sheraz & Line, Pål Dag (2022). No Strong Evidence on Liver Transplant for Colorectal Cancer Liver Metastasis Over Portal Vein Embolization Associated With Liver Resection-Reply. JAMA Surgery. ISSN 2168-6254. doi: 10.1001/jamasurg.2021.5127. Full text in Research Archive
• Line, Pål Dag; Nadalin, Silvio & Balci, Deniz (2021). Auxiliary two-staged partial resection liver transplantation. BMC Surgery. 21(1). doi: 10.1186/s12893-021-01265-5. Full text in Research Archive Show summary

  A case report of two patients who underwent auxiliary liver transplantation and two staged hepatectomy was recently published in BMC Surgery. The surgical technique utilised is described as novel but has been published previously also in the setting of chronic liver disease. A new name for this surgical approach therefore seems redundant. The importance of careful hemodynamic monitoring of pressure and flow in the portal vein and artery of the auxiliary graft as well as optimizing venous outflow is paramount to ensure graft regeneration and avoid small for size syndrome. The relevant surgical considerations to ensure optimal safety has also been reported in previous literature. This brief letter to the editor of BMC Surgery gives an overview that put the article content in context with published literature on this transplant surgical technique.

• Dueland, Svein; Yaqub, Sheraz & Line, Pål Dag (2021). No Strong Evidence on Liver Transplant for Colorectal Cancer Liver Metastasis over Portal Vein Embolization Associated with Liver Resection-Reply. JAMA Surgery. ISSN 2168-6254. doi: 10.1001/jamasurg.2021.5127. Full text in Research Archive
• Line, Pål-Dag (2021). Contemporary outcome of liver transplantation for bilobar multiple colorectal liver metastasis. Surgery. ISSN 0039-6060. doi: 10.14701/ahbps.LV-SY-3-4. Full text in Research Archive
• Dueland, Svein & Line, Pål Dag (2021). Response to the Comment on "Survival Following Liver Transplantation for Patients With Nonresectable Liver-only Colorectal Metastases". Annals of Surgery. ISSN 0003-4932. 274(6), p. e721–e722. doi: 10.1097/SLA.0000000000003953. Full text in Research Archive
• Rammohan, Ashwin; Reddy, Mettu S.; Line, Pål Dag & Rela, Mohamed (2021). Heterotopic liver transplantation: Temporary solution, permanent problem? American Journal of Transplantation. ISSN 1600-6135. 21(2), p. 903–904. doi: 10.1111/ajt.16271. Full text in Research Archive
• Bjørlykke, Kristin Hammersbøen; Eftang, Lars Lohne; Grzyb, Krzysztof; Line, Pål Dag; Lassen, Kristoffer & Jahnsen, Jørgen (2020). A man in his fifties with abdominal pain, itching and weight loss. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. doi: 10.4045/tidsskr.19.0390. Full text in Research Archive

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