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BACKGROUND: Nearly 40 y have passed since the 1983 National Institutes of Health Consensus-Development-Conference, which has turned liver transplantation (LT) from a clinical experiment into a routine therapeutic modality. Since' clinical LT has changed substantially. We aimed to comprehensively analyze the publication trends in the most-cited top-notch literature in LT science over a 4-decade period.METHODS: A total of 106 523 items were identified between January 1981 and May 2021 from the Web of Science Core Collection. The top 100 articles published were selected using 2 distinct citation-based strategies to minimize bias. Various bibliometric tools were used for data synthesis and visualization.RESULTS: The citation count for the final dataset of the top 100 articles ranged from 251 to 4721. Most articles were published by US authors (n = 61). The most prolific institution was the University of Pittsburgh (n = 15). The highest number of articles was published in Annals of Surgery, Hepatology, and Transplantation; however, Hepatology publications resulted in the highest cumulative citation of 9668. Only 10% of the articles were classified as evidence level 1. Over 90% of first/last authors were male. Our data depict the evolution of research focus over 40 y. In part, a disproportional flow of citations was observed toward already well-cited articles. This might also project a slowed canonical progress, which was described in other fields of science.CONCLUSIONS: This study highlights key trends based on a large dataset of the most-cited articles over a 4-decade period. The present analysis not only provides an important cross-sectional and forward-looking guidance to clinicians, funding bodies, and researchers but also draws attention to important socio-academic or demographic aspects in LT.

Ischemic reperfusion injury is still remaining as a fundamental problem during organ transplantation. One key factor is the rapid rewarming during the time of vascular reconstruction. In this pilot study a new thermal isolation bag (TIB) for organ transplantation is to be tested to prevent organ rewarming. Isolation capacity, tissue compatibility, and usability were tested initially ex vivo on porcine kidneys (n=24) followed by first in vivo usage. 12 female German landrace pigs received a kidney auto-transplantation after 24h cold storage (4°C). During the implantation process the kidney was either isolated with the new TIB, or it was not thermos-protected at all. In this proof-of-concept study the usability (knife-to-skin-time) and the general thermal capacity (30 min. warm storage at 40°C ex vivo p