Abstracts of the International Society of Liver Surgeons, 6th Congress of International Advanced HBP Surgery 2025 (ISLS 2025)

October 22-25, 2025, Toronto, Canada Abstract #: SESS-133 Topic: Basic/Others Title: Mechanisms Of Histopathological Vascular Damage Caused By Pancreatic Juice Leakage Authors:Yusuke Seki, The University of Tokyo; Takeaki Ishizawa, Department of Hepatobiliary-Pancreatic Surgery, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan; Genki Watanabe, Department of Hepatobiliary-Pancreatic Surgery, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan; Yujiro Nishioka, Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan; Akihiko Ichida, Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan; Takeshi Takamoto, Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan; Yoshikuni kawaguchi, Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan; Nobuhisa Akamatsu, Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan; Kiyoshi Hasegawa, Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan Introduction: To investigate the enzymatic interactions that cause histological changes in the vascular wall to help prevent bleeding complications after pancreatic surgery. During pancreatic surgery, severe hemorrhage can result from the accumulation of pancreatic juice and digestive fluids around vascular stumps. However, the specific digestive enzymes and their interactions that cause histological damage to vascular walls remain unclear. Methods: Histopathological changes in porcine arterial and venous walls were examined 48 h after exposure to enzymatic solutions and human pancreatic juice, with or without a mixture of other digestive fluids obtained from four patients undergoing pancreatoduodenectomy. Moreover, the protective effect of a protease inhibitor added to active pancreatic juice against histopathological damage was evaluated. Results: Thinning of the arterial walls, with degeneration of smooth muscle nuclei and muscle/collagen fibers in the media, was significant after exposure to trypsin or chymotrypsin, and, among human digestive fluids, only after exposure to pancreatic juice mixed with intestinal fluid. Venous walls were more vulnerable to proteases and digestive fluids. Histopathological changes in the arterial wall were prevented when 10 units of nafamostat mesylate (protease inhibitor) were added to the pancreatic juice mixed with intestinal fluid. Conclusion: The activation of pancreatic proteases through mixing with intestinal fluids is a major factor causing histological damage to the arterial media, leading to aneurysm formation and rupture of the vascular wall. Developing methods for the localized and continuous administration of protease inhibitors around vascular stumps could reduce life-threatening bleeding complications after pancreatic surgery. Abstract #: SESS-18 Topic: Basic/Others Title: Value-Based Surgical Outcome Score for Comprehensive Healthcare Assessment: Novel Metric for Prioritizing Patient-Centered Care Authors:Dimitri Raptis, King Faisal Specialist Hospital and Research Center, Riyadh,; Dimitri A. Raptis, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh; Milo A. Puhan, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Elizabeth A, Pomfret, Division of Transplant Surgery, Department of Surgery, University of Colorado Health, Denver, Colorado; Pierre-Alain Clavien, Wyss Translational Center, University of Zurich, Zurich, Switzerland; Dieter C. Broering, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh Introduction: Rising healthcare costs demand a strategic reallocation of resources and the development of metrics that evaluate financial, patient-reported, and clinical outcomes comprehensively. Traditional surgical metrics often overlook cost and patient experiences. The novel Value-Based Surgical Outcome Score (VBS) integrates these aspects to enhance resource allocation and patient care across surgical disciplines. Methods: The VBS Score combines patient satisfaction, quality of life (QoL), cost, and traditional surgical outcomes into a unified metric. It categorizes surgical disciplines and procedures into high, middle, and low priorities to guide resource distribution. This study utilizes simulation data of 5200 cases generated through Python, and surgical expertise to replicate real-world clinical scenarios. Data analysis was conducted using R. Results: The VBS Score using simulation data ranked for example Cardiac, HPB Surgery, and Organ Transplantation as top priorities, with scores of 70, 69, and 69 respectively, indicating high patient satisfaction and QoL impacts. Lower-priority disciplines like Maxillofacial and Plastic/Reconstructive Surgery scored 53 and 51, respectively, showing lesser patient satisfaction and QoL. Statistical analysis revealed patient satisfaction and QoL as the most influential factors in the VBS Score (r=0.81&r=0.80). Conclusion: The VBS Score effectively demonstrates the importance of integrating patient satisfaction, QoL, and cost into surgical prioritization. This framework aids in optimizing resource allocation and enhancing patient outcomes. By focusing on patient-centered care, healthcare institutions can improve clinical outcomes and potentially receive more funding and support. The VBS Score offers a comprehensive tool for assessing and prioritizing surgical care, promoting a value-driven approach in healthcare. Abstract #: SESS-264 Topic: Basic/Others Title: Effect of Hepatic Steatosis on Immune Profile of Perfused Livers Authors:Joshua Badshah, Stanford University; Greta Cywinska, Stanford University, Surgery; Shuling Han, Stanford University, Surgery; Tetsuya Tajima, Stanford University, Surgery; Olivia Martinez, Stanford University, Surgery; Sheri Krams, Stanford University, Surgery; Marc Melcher, Stanford University, Surgery; Varvara Kirchner, Stanford University, Surgery Introduction: The shortage of high quality donor organs in liver transplantation has prompted the need to use marginal grafts like steatotic livers, despite higher risks. Normothermic machine perfusion (NMP) has emerged as a promising strategy to improve outcomes of marginal grafts by enabling functional assessment before transplantation and facilitating therapeutic interventions. However, its effects on the hepatic immune landscape remain unclear. This study uses whole-genome RNA sequencing to profile immune responses in viable and nonviable lean and steatotic human livers during NMP. Methods: Lean (n = 6) and steatotic (n = 5) human livers underwent 12 hours (h) of NMP. Viability was assessed based on lactate levels, pH, flow rates, glucose metabolism, bile production, and perfusion homogeneity. Bulk RNA sequencing was performed on liver biopsies collected at 0 and 3 h. Immune deconvolution was conducted using CIBERSORT, and molecular pathways were analyzed via Gene Set Enrichment Analysis (GSEA). Results: Viability assessment classified 3 lean and 2 steatotic livers as viable, and 3 lean and 3 steatotic as nonviable. Immune deconvolution of 22 cell types revealed baseline (0 h) enrichment of CD8+ T cells in steatotic nonviable livers and plasma cells in lean nonviable livers. After 3 hours of NMP, steatotic nonviable livers showed increased CD8+ T cells, activated NK cells, and M2 macrophages, with reduced Tregs—changes absent in lean grafts. Gene Set Enrichment Analysis (GSEA) at 3 hours revealed that steatotic nonviable livers had significant upregulation of immune-related pathways. In contrast, lean nonviable livers lacked immune pathway enrichment and instead showed downregulation of IL-17 and NF-κB signaling—key mediators of inflammatory cytokine production and immune cell recruitment. Conclusion: Our findings demonstrate that NMP affects the hepatic immune cell repertoire differently in steatotic and lean livers. Therefore, tailoring immune modulation strategies to graft type may optimize the preservation and recovery of grafts. Abstract #: SESS-273 Topic: Basic/Others Title: Gender Representation in Liver Transplantation and Hepatobiliary Surgery: A Cross-Sectional Bibliometric and Institutional Analysis of Leadership and Recognition Authors:Kacylia Roy Proulx, McGill University; Cami Sotomayor, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Gender Equity Initiative in Global Surgery; Kacylia Roy Proulx, Faculty of Medicine and Health Sciences, McGill University, Gender Equity Initiative in Global Surgery; Brenda Feres, Medical Faculty, Kursk State Medical University, Gender Equity Initiative in Global Surgery; Patricia Rebolledo, Department of Digestive Surgery, Pontificia Universidad Católica de Chile Introduction: Despite progress in gender equity in surgery, women remain underrepresented in academic and leadership roles, particularly in high-acuity fields like liver transplantation (LT) and hepatobiliary (HPB). Although EDI initiatives have gained traction, their impact remains unclear. Existing literature focuses on general surgery and isolated metrics, limiting understanding of how gender disparities manifest across the academic continuum. This study addresses that gap through a longitudinal, analysis of in academic and Methods: A analysis was were from the top in using gender was via and at Data on and were collected from and and leadership were assessed using and Results: A of and for and HPB surgery, for of and of in and of and of in academic analyzed across four major were to of in HPB and data on leadership and and across academic and leadership Conclusion: remain underrepresented in and leadership across and HPB surgery. disparities the need for to gender equity and academic and for is to a more and in these high-acuity surgical Abstract #: Topic: Basic/Others Title: Liver and Normothermic A Of The University Hospital of Department of Hepatobiliary Surgery and Liver de Research and de of and Department of and de Research and de de Research and de de de Department of Medical Liver de Department of de Department of and de Department of and de Department of Hepatobiliary Surgery and Liver de Research and de de Introduction: liver more to and to outcomes and often Normothermic machine perfusion (NMP) therapeutic like may by de enhancing to a lesser through pathway This study a for of steatotic grafts. Methods: A with and was for liver In on steatotic human and liver assessed and The was in a in perfusion of porcine and human livers. pathway and of were evaluated. Results: A was with and In reduced by in and respectively, without In livers, in and with hepatic of via of In steatotic human livers, a in without histological of Gene analysis by revealed upregulation of with and downregulation of in de the of Conclusion: This study the for liver in and human livers. the of a strategy using and the for clinical Abstract #: Topic: Basic/Others Title: Surgical in a A on and Medical Center, University School of Department of Surgery, Medical Center, University School of Medicine Introduction: Surgical their can patient may improve of their impact on preservation is in This study the impact of on the and quality of surgical in focusing on liver across Methods: liver were collected and using was assessed using and was based on and quality was analyzed across four and and a were to for and Results: the from to and the from to and However, quality analysis showed a in scores before and scores before The significant in = and = in Despite analysis that the as and Conclusion: surgical enhance may aspects of particularly in findings the need for a approach that and patient and and across and healthcare Abstract #: Topic: Title: The in Hospital Hospital Hospital Hospital Hospital Hospital Hospital Hospital Hospital Hospital Introduction: is particularly in or is often may surgical and outcomes. a novel and evaluate its impact on and Methods: analyzed patients underwent was and classified into four or wall wall or and wall and Results: patients had cases showed increased and higher and patients had and higher higher Conclusion: in is with increased surgical and outcomes. Our and with and of of the surgical strategy in This is the study to and a tool to guide Abstract #: Topic: Title: of the of University Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Medical Center Introduction: of is more as the of is Although have the clinical of the or of is study on the clinical of the of the of the Methods: The of was as the of the of a on the of the surgical the outcomes surgery on the and on the patients with after surgery. 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This study the bile liver and the of in patients undergoing for Methods: study at a in and bile and liver biopsies were Statistical Results: Of patients with underwent was (n = The was (n = in (n = bile was with = were in (n = The of and the of or production was with increased of surgical = and = was with development = Conclusion: bile for understanding outcomes. and liver the of and Abstract #: Topic: Title: outcomes after surgical in a study Division of Surgery, Department of Surgery, Hospital de de Division of Hepatobiliary and Surgery, Department of Surgery, University Division of Surgery, Department of Surgery, Hospital de de Division of Surgery, Department of Surgery, Hospital de de Division of Surgery, Department of Surgery, Hospital de de Division of Surgery, Department of Surgery, Hospital de de Division of Surgery, Department of Surgery, Hospital Division of Surgery, Department of Surgery, Hospital de de Division of Surgery, Department of Surgery, Hospital de de Introduction: of the bile increased of and In the surgical has as a in the of The in the literature is based on the as was by in However, in with surgical procedures and can or Methods: performed a analysis of patients that underwent surgery for in Hospital de and to The was on the or and the were Results: for and for were the was in the and in the in complications were of was 12 in the and in the After of of patients and in 3 patients for with surgery and 2 with for for was and Conclusion: Surgical for is and and outcomes and Abstract #: Topic: Title: of to Surgery in with A Center University University Department of and Transplant Surgery; University Department of and Transplant Surgery; University Department of and Transplant Surgery; University Department of and Transplant Surgery; University Department of and Transplant Surgery Introduction: is a with and Surgical remains the remains unclear. This study to investigate impact of to surgery on and outcomes in patients underwent surgery for at Methods: This study patients underwent surgical for and was as the and surgery. analysis was to the for were into and Outcome and Results: Of underwent surgical To reduce only major were and cases with or of the liver were the study of patients was was with a of was = analysis as the was in of with a significant in of the significant were in or Conclusion: Despite the and in surgical were with these findings in the and to to Abstract #: Topic: Liver Title: of the Liver in Liver University Liver Institute, University of Medicine, of Medicine, University, of Medicine, State University, Center for and University; Department of Medicine, Medical Center, University of of Medicine, University; Division of Surgery, Department of Surgery, University Division of and Department of Surgery, University Division of and Department of Surgery, University Division of Surgery, Department of Surgery, University Department of Surgery, Medical Center, University School of Medicine, Department of Surgery, Medical Center, University School of Medicine, Introduction: liver remains a and is for surgical outcomes. This study to investigate the of the liver for Methods: A analysis was conducted on patients underwent and and were and factors for Results: Of the patients with showed the as of = The analysis revealed of for with of of and of Conclusion: The is a significant of into may improve and guide surgical Abstract #: Topic: Liver Title: of a and a Hepatobiliary in the of A University of University Hospital University of University HPB Surgery University HPB Surgery University of University HPB Surgery University of University HPB Surgery University HPB Surgery University HPB Surgery Department Introduction: The of on of clinical and as in healthcare. This study to from a with for Methods: A of patients with to hepatobiliary at from to were were and to were using a and specific The were as as Results: patients were Liver was classified as A in in and in was a for of patients a for the The with in of cases and in strategies liver in in care in and in cases the for more by Conclusion: This study the and in may of in clinical to when with Abstract #: Topic: Liver Title: of the from the Liver Surgery University University HPB Dimitri Raptis, King Faisal Specialist University Hospital Medical Department of Surgery; University Hospital Medical Center, Transplant University HPB Division Introduction: liver surgery is a for patients with or This study to evaluate patient surgical and in a undergoing liver surgery. Methods: A analysis was conducted on patients underwent liver surgery. analysis was performed on R. Results: The of the was with a gender distribution. patients were from the and of liver and of the were the most was to of The underwent liver with without with a of and of complications in of with major complications in was The was with of at and at 10 Conclusion: liver surgery is with significant and high rates, outcomes can in the importance of and patient to optimize outcomes in surgical Abstract #: Topic: Liver Title: Hepatic A University Organ Transplantation Center, University Organ Transplantation Center, University Organ Transplantation Center, University Organ Transplantation Center, University Organ Transplantation Center, University Organ Transplantation Center, University Introduction: with hepatic a surgical particularly when liver preservation is hepatic is a viable a a to optimize approach for a Methods: A with with revealed a 10 in and the a Liver was without or were and analysis showed a liver of with of the and was Results: Liver was performed using a The was the and the by a the and After the the was using The and liver The with of 3 with and The patient had with liver on and was on 10 with A bile the liver with and Conclusion: and using a is a and approach for the This Abstract #: Topic: Liver Title: with Liver Hospital de Hospital de Hospital de Hospital de Hospital de Hospital de Hospital de Hospital de Introduction: of liver on liver as and its to surgical the of a patient with liver with a with of A strategy using and liver was The and Methods: the of a patient with liver with a with of A and liver was Results: The and To the has in a of cases in The with is a of 10 patients with liver and is that a of with of the of the In the was The and liver the of in with patient is Conclusion: demonstrates the of and that is to replicate surgical strategies in with the of surgery. Abstract #: Topic: Liver Title: In The Department of Surgery, Department of Surgery, Department of Surgery, Introduction: vascular of the liver the flow with perfusion and is a for the hepatic to their with the It the of and the of the and by Liver is performed using Methods: The patient was a women a with a and a localized in to the hepatic and the its in the A to was performed the flow with in perfusion of the liver using perfusion Results: 2 of were The in the was 10 and flow was at Liver was at The was and were was with at after surgery. Conclusion: The use of perfusion machine is in In with the obtained in liver transplantation on marginal could reduce of the the of liver and improve Abstract #: Topic: Liver Title: assessment for Leakage After Liver University of University of of Surgical Division of and Hepatobiliary Surgery; University of of Surgical Division of and Hepatobiliary Surgery; University of of Surgical Division of and Hepatobiliary Surgery; University of of Surgical Division of and Hepatobiliary Surgery; University of of Surgical Division of and Hepatobiliary Surgery; University of of Surgical Division of and Hepatobiliary Surgery; University of of Surgical Division of and Hepatobiliary Surgery; University of of Surgical Division of and Hepatobiliary Surgery Introduction: is a significant of liver to increased of surgical and healthcare of patients could improve and outcomes. offers a promising approach by interactions among that traditional methods may This study to and a to the of bile Methods: This study patients underwent liver at the Hepatobiliary Surgery of The was into and were and was assessed using the the The was based on was Results: bile A The of these patients had and underwent major surgery or hepatic exposure and and in was The the Of the the 10 via by bile surgical and Conclusion: can surgical and the of to and of bile Abstract #: Topic: Liver Title: Analysis Of The In To The Hospital A Center University of Department of Surgery; Department of Surgery; University of Department of Surgery; Department of Surgery; Department of Surgery; Department of Surgery Introduction: Of Of To After The To Of The Surgical Of A Of In Methods: Cross-Sectional Of A Of Our After Results: A Surgical To The Surgery Our The Of

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