{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:42:41Z","timestamp":1790743361724,"version":"4.1.0"},"reference-count":70,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T00:00:00Z","timestamp":1736121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Transplant."],"abstract":"<jats:sec><jats:title>Background and aims<\/jats:title><jats:p>There is growing interest in the environmental impact of surgical procedures, yet more information is needed specifically regarding liver transplantation. This study aims to quantify the total greenhouse gas emissions, or carbon footprint, associated with adult whole-size liver transplantation from donors after brain death, including the relevant back-table graft preparation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The carbon footprint was calculated retrospectively using a bottom-up approach. This approach sums the volumes of energy consumption (kWh), volatile anesthetics (ml), solid waste (kg), and units of blood products transfused for each transplant. These consumption values were converted using validated conversion factors to the equivalent mass of carbon dioxide released into the environment (kg CO2e).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 147 patients with a mean age of 55 years (male, 78.9%) who underwent liver transplants between 2021 and 2022 were analyzed, resulting in 45.5 tons CO2e. The mean (SD) carbon footprint for each procedure was 309.8 (33.2) kg CO2e [95% CI: 304.4; 315.3]. Total energy power consumption was 96.5\u2005MW, contributing 65.4% of greenhouse emissions (29.8 tons CO2e), while volatile anesthetics, solid waste, and blood product transfusions contributed 8.0% (3.64 tons CO2e), 5.9% (2.7 tons CO2e), and 20.6% (9.4 tons CO2e), respectively. The duration of surgery (<jats:italic>t<\/jats:italic>\u2009=\u200929.0; <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), transfused red blood cells (<jats:italic>t<\/jats:italic>\u2009=\u200913.1; <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), fresh frozen plasma (<jats:italic>t<\/jats:italic>\u2009=\u200911.1; <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), platelets (<jats:italic>t<\/jats:italic>\u2009=\u20098.9; <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), and the use of an extracorporeal pump machine (<jats:italic>t<\/jats:italic>\u2009=\u20093.6; <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001) had the greatest effects on greenhouse gas emissions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Liver transplantation requires significant energy and is associated with considerable greenhouse gas emissions, particularly during longer procedures. Transplant clinicians, hospital administrators, policymakers, and patients should be aware of the environmental impact of liver transplantation and collaborate to adopt sustainable energy practices.<\/jats:p><\/jats:sec>","DOI":"10.3389\/frtra.2024.1441928","type":"journal-article","created":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T07:06:03Z","timestamp":1736147163000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["The carbon footprint and energy consumption of liver transplantation"],"prefix":"10.3389","volume":"3","author":[{"given":"Paolo","family":"De Simone","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quirino","family":"Lai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juri","family":"Ducci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Campani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giandomenico","family":"Biancofiore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,1,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1016\/S0140-6736(09)60935-1","article-title":"Managing the health effects of climate change: lancet and university college London institute for global health commission","volume":"373","author":"Costello","year":"2009","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1861","DOI":"10.1016\/S0140-6736(15)60854-6","article-title":"Health and climate change: policy responses to protect public health","volume":"386","author":"Watts","year":"2015","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e538","DOI":"10.1016\/S2542-5196(20)30247-3","article-title":"Climate change: challenges and opportunities to scale up surgical, obstetric, and anaesthesia care globally","volume":"4","author":"Roa","year":"2020","journal-title":"Lancet Planet Health"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e381","DOI":"10.1016\/S2542-5196(17)30162-6","article-title":"The impact of surgery on global climate: a carbon footprinting study of operating theatres in three health systems","volume":"1","author":"MacNeill","year":"2017","journal-title":"Lancet Planet Health"},{"key":"B5","doi-asserted-by":"publisher","first-page":"3775","DOI":"10.3390\/en12193775","article-title":"Energy consumption analysis and characterization of healthcare facilities in the United States","volume":"12","author":"Bawaneh","year":"2019","journal-title":"Energies"},{"key":"B6","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1002\/rcs.1640","article-title":"Carbon footprint of robotically-assisted laparoscopy, laparoscopy and laparotomy: a comparison","volume":"11","author":"Woods","year":"2015","journal-title":"Int J Med Robot"},{"key":"B7","article-title":"What is a carbon footprint","year":""},{"key":"B8","doi-asserted-by":"publisher","first-page":"2830","DOI":"10.1111\/jan.15671","article-title":"The carbon footprint of healthcare settings: a systematic review","volume":"79","author":"Rodr\u00edguez-Jim\u00e9nez","year":"2023","journal-title":"J Adv Nurs"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s40472-023-00424-2","article-title":"The carbon footprint of organ transplantation in the USA","volume":"11","author":"Wall","year":"2024","journal-title":"Curr Transplant Rep"},{"key":"B10","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/s12940-021-00814-y","article-title":"What is the carbon footprint of primary care practices? 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