This study sought to identify the short- and long-term changes in left ventricular ejection fraction (LVEF) after mitral valve repair (MVr) in patients with chronic primary mitral regurgitation according to preoperative LVEF (pre-LVEF) and preoperative left ventricular end-systolic diameter (pre-LVESD). This study evaluated 461 patients. Restricted cubic spline regression models were constructed to demonstrate the long-term changes in postoperative LVEF (post-LVEF). The patients were divided into four groups according to pre-LVEF (<50%, 50–60%, 60–70%, and ≥70%). The higher the pre-LVEF was, the greater was the decrease in LVEF immediately after MVr. In the same pre-LVEF range, immediate post-LVEF was lower in patients with pre-LVESD ≥ 40 mm than in those with pre-LVESD < 40 mm. The patterns of long-term changes in post-LVEF differed according to pre-LVEF (p for interaction < 0.001). The long-term post-LVEF reached a plateau of approximately 60% when the pre-LVEF was ≥50%, but it seemed to show a downward trend after reaching a peak at approximately 3–4 years after MVr when the pre-LVEF was ≥70%. The patterns of short- and long-term changes in post-LVEF differed according to pre-LVEF and pre-LVESD values in patients with chronic primary mitral regurgitation after MVr.

Post-reperfusion syndrome (PRS) remains a critical complication in living donor liver transplantation (LDLT). While sevoflurane is recognized for its organ-protective properties, the impact of the donor’s anesthetic choice on recipient outcomes has not been clearly established. This study evaluated whether donor sevoflurane anesthesia reduces the incidence of PRS in recipients compared to desflurane. We retrospectively analyzed 5006 adult LDLT recipients whose donors received either sevoflurane or desflurane. Propensity score matching was employed to minimize selection bias, resulting in 941 matched pairs. The incidence of PRS was significantly lower in the sevoflurane group (64.0%) compared to the desflurane group (71.8%; p < 0.001). Multivariable logistic regression identified donor sevoflurane as an independent protective factor against PRS (odds ratio 0.47; 95% confidence interval 0.41–0.55; p < 0.001). Furthermore, recipients in the sevoflurane group exhibited significantly lower rates of prolonged intensive care unit stay, along with superior recovery of liver enzymes and inflammatory markers. Our findings suggest a potential association between donor sevoflurane anesthesia and more favorable early recipient outcomes, including a reduced incidence of PRS and enhanced recovery.

Background and Objectives: While liver transplantation (LT) is a definitive treatment for hepatocellular carcinoma (HCC), tumor recurrence remains a major clinical concern. Although volatile anesthetics influence oncological outcomes, direct comparison between sevoflurane and desflurane remains scarce. This study aimed to investigate the impact of the recipient’s volatile anesthetic choice (sevoflurane vs. desflurane) on HCC recurrence following living donor liver transplantation (LDLT). Materials and Methods: This retrospective cohort study included adult patients who underwent LDLT for HCC. Patients were then divided into sevoflurane and desflurane groups, and propensity score matching (PSM) was used to balance baseline variables. The primary outcome was HCC recurrence, and the secondary outcomes were overall survival (OS) and postoperative C-reactive protein (CRP) levels as a marker for the postoperative systemic inflammatory response. Results: After PSM, 373 matched pairs (n = 746) were analyzed. HCC recurrence was significantly higher in the sevoflurane group compared to the desflurane group (19.6% vs. 13.1%, p = 0.023). Kaplan–Meier analysis also demonstrated that cumulative recurrence of HCC was significantly higher in recipients who received sevoflurane anesthesia than in those who received desflurane (log-rank p = 0.0018). In multivariate Cox proportional hazards regression analysis, the use of sevoflurane for anesthesia maintenance was an independent risk factor forHCC recurrence (Hazard Ratio, 1.66; 95% Confidence Interval, 1.15–2.39; p = 0.007). Regarding OS, no significant difference was observed between the two groups (log-rank p = 0.1123). Postoperative CRP levels were significantly higher in the sevoflurane group compared to the desflurane group, suggesting a more intense systemic inflammatory response associated with sevoflurane maintenance. Conclusions: For HCC patients undergoing LDLT, anesthesia maintenance with desflurane is associated with a reduced risk of tumor recurrence compared to sevoflurane, without a significant impact on overall survival.

Background/Objectives: Sarcopenia adversely affects outcomes after liver transplantation. The CT-based skeletal muscle index (SMI) is a validated prognostic measure but requires dedicated image analysis. We evaluated the diagnostic performance of creatinine/cystatin C-based serum muscle indices for identifying CT-defined sarcopenia and their prognostic value for graft failure in living donor liver transplantation (LDLT) recipients. Methods: We retrospectively analyzed 802 LDLT recipients (January 2023–April 2026). Using serum creatinine- and cystatin C-based equations, we calculated total body muscle mass (TBMM), appendicular skeletal muscle mass (ASM), and predicted SMI, and derived height-squared-normalized indices (TBMMI, ASMI); the creatinine-to-cystatin C ratio served as a non-equation-based comparator. CT-defined sarcopenia was classified using sex-specific reference cutoffs (males < 39.9, females < 28.9 cm²/m²). Diagnostic accuracy was assessed with sex-stratified ROC curves and DeLong test. The primary outcome was graft failure (recipient death or re-transplantation); its association with the best-performing index at 180 days, 1 year, and 3 years was evaluated using multivariable Cox models. Results: TBMMI showed the strongest correlation with SMI (r = 0.75). TBMMI discriminated CT-defined sarcopenia well (AUC 0.845 in males, 0.828 in females). After multivariable adjustment, each 1 kg/m² decrease in TBMMI was independently associated with graft failure at 180 days (adjusted hazard ratio [HR] 1.42, 95% CI, 1.14–1.78), 1 year (HR 1.28, 1.05–1.56), and 3 years (HR 1.20, 1.02–1.40) (all p < 0.05). Conclusions: TBMMI is an accessible, non-imaging surrogate for SMI in LDLT recipients, and a lower TBMMI is independently associated with postoperative graft failure.