Di Lu

Skeletal muscle is an established determinant of outcome after liver transplantation (LT), yet conventional CT assessment reduces the trunk musculature to a single scalar measure. Here, automated three-dimensional segmentation quantified volume and CT attenuation in 20 side-specific muscles from 617 male LT recipients with hepatocellular carcinoma. Unsupervised integration identified three anatomical phenotypes that were indistinguishable by conventional L3 measures but differed in survival, circulating metabolism and peri-transplant muscle response. Phenotype 3 had the poorest overall and recurrence-free survival relative to Phenotype 1 (HR, 2.83 and 2.46, respectively), whereas liver dysfunction was greatest in Phenotype 2, excluding a simple severity continuum. Targeted metabolomics linked Phenotypes 1 and 3 to opposing carbon–nitrogen profiles, with Phenotype 2 showing a transition-like reorganization. In 341 recipients with paired CT, median post-LT muscle-volume changes were −0.6%, −7.4% and −13.6% across Phenotypes 1–3. The phenotype architecture was reproduced in an independent HCC cohort and broadly across four additional cancer cohorts. These findings redefine muscle status as a spatially organized host phenotype that captures systemic biology, response to transplant stress and clinical heterogeneity beyond aggregate measurements.

Background: Serum metabolic features associated with microvascular invasion (MVI) and recurrence after liver transplantation (LT) for hepatocellular carcinoma (HCC) remain unclear. We examined MVI-associated serum metabolic changes and the association of a glutaminolysis index with post-transplant recurrence. Methods: We analysed pre-transplant serum from 151 HCC recipients undergoing LT, including 61 MVI-positive and 90 MVI-negative recipients, using a targeted panel of 209 metabolites. The index was calculated as z(glutamate) − z(glutamine) + z(alpha-ketoglutarate) and evaluated by receiver operating characteristic (ROC), Kaplan-Meier, and Cox analyses. Results: MVI-positive recipients had a higher recurrence rate and shorter median recurrence-free survival (RFS) than MVI-negative recipients (47.5% vs. 21.1%, Pvs. 51.2 months, PConclusions: MVI-positive recipients showed a serum glutaminolysis profile before LT. The glutaminolysis index may be a biomarker for recurrence after LT, particularly in MVI-positive recipients. The purine/energy-charge pattern in MVI-negative recipients requires further validation.

Laparoscopic surgery typically requires stable tissue retraction for optimal visualization of the operative field; however, conventional mechanical retractors often inflict substantial tissue injury during prolonged procedures. Moreover, existing vacuum-assisted retraction devices are still limited by insufficient suction stability and elevated risks of tissue barotrauma. To address these challenges, we developed an octopus-sucker-inspired biomimetic retraction device with adjustable negative-pressure actuation, featuring a surface-coated double-network hydrogel (PSBMA/WAN) composed of poly(sulfobetaine methacrylate) (PSBMA) and a wet-adhesive network (WAN). The finite element model demonstrated that the hydrogel coating acts as a biomechanical buffer, reducing the peak tensile stress in liver tissue by over 50% and maintaining stable sealing contact up to a vertical retraction of s = 6.0, whereas the uncoated device detached prematurely at s = 4.75. Ex vivo porcine liver experiments demonstrated that this biomimetic device stably retracted a 0.7 kg left hepatic lobe for over 2 h under -0.04 MPa. Furthermore, in an in vivo porcine liver model, the PSBMA/WAN-coated device markedly improved retraction stability while significantly mitigating tissue injury compared to conventional vacuum-assisted and suture suspension methods. Collectively, this biomimetic device holds great promise as a safe and effective organ retractor for minimally invasive laparoscopic procedures.

Background: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer‐related deaths worldwide. For eligible patients, liver transplantation is a curative treatment option, but recurrence after transplantation can severely affect long‐term survival rates. Reliable biomarkers are urgently needed to optimise the entire transplantation process. Aims: This review aims to summarize the role of traditional and emerging biomarkers in the treatment of HCC with liver transplantation, discuss the current challenges, and explore the direction of development in precision medicine. Method: We conducted a review of recent literature on protein biomarkers, genomic feature profiles, transcriptomic and proteomic markers, as well as the application of liquid biopsies in HCC liver transplantation. Results: Traditional biomarkers (including alpha‐fetoprotein, its fucosylated variant AFP‐L3, and protein induced by vitamin K absence or antagonism II) are widely used for recipient screening, staging, and recurrence prediction. Emerging multi‐omics markers and liquid biopsy markers provide deeper molecular insights and enable non‐invasive real‐time monitoring. They assist in pre‐transplant risk stratification, downstaging response assessment, early recurrence detection, and guidance of personalised immunosuppression and adjuvant therapy. Conclusion: Biomarkers are the core tools for precision medicine in liver transplantation for HCC. Despite challenges in standardization and clinical application, combining traditional biomarkers with multi‐omics and liquid biopsy technologies holds promise for further improving patient prognosis.

Supplementary Fig S6. PGE2 released by tumor cells under immune attack promotes CX3CR1 upregulation on macrophages

Supplementary Figure S3. The effect of CX3CR1 neutralizing antibody on macrophages