Lulic I, Lulic D, Durekovic I, Pavicic Saric J, Bacak Kocman I, Sarec Z, Rogic D. YKL-40: Revolutionizing cardiac risk prediction and therapy in liver transplantation. World J Transplant 2025; 15(4): 105621 [DOI: 10.5500/wjt.v15.i4.105621]
Corresponding Author of This Article
Ileana Lulic, MD, Postdoctoral Fellow, Department of Anesthesiology, Intensive Care and Pain Medicine, Clinical Hospital Merkur, Zajceva 19, Zagreb 10000, Croatia. ileanalulic@gmail.com
Research Domain of This Article
Transplantation
Article-Type of This Article
Editorial
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 18, 2025 (publication date) through Nov 19, 2025
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Journal Information of This Article
Publication Name
World Journal of Transplantation
ISSN
2220-3230
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Lulic I, Lulic D, Durekovic I, Pavicic Saric J, Bacak Kocman I, Sarec Z, Rogic D. YKL-40: Revolutionizing cardiac risk prediction and therapy in liver transplantation. World J Transplant 2025; 15(4): 105621 [DOI: 10.5500/wjt.v15.i4.105621]
Ileana Lulic, Ivan Durekovic, Jadranka Pavicic Saric, Iva Bacak Kocman, Zrinka Sarec, Department of Anesthesiology, Intensive Care and Pain Medicine, Clinical Hospital Merkur, Zagreb 10000, Croatia
Ileana Lulic, Dinka Lulic, Dunja Rogic, Department of Medical Biochemistry and Hematology, Faculty of Pharmacy and Biochemistry, Zagreb 10000, Croatia
Dinka Lulic, Immediate Medical Care Unit, Saint James Hospital, Sliema SLM-1030, Malta
Dunja Rogic, Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Author contributions: Lulic I, Lulic D, and Rogic D participated in the conceptualization of this manuscript; Lulic I, Lulic D, Durekovic I, Pavicic Saric J, Bacak Kocman I, and Rogic D performed the literature review and data analysis; Lulic I, Lulic D, and Durekovic I designed the manuscript's original draft; Pavicic Saric J, Bacak Kocman I, Sarec Z, and Rogic D reviewed and edited the manuscript original draft; Lulic I, Lulic D, and Rogic D performed manuscript supervision and project administration; all of the authors approved the final version of the manuscript to be published.
Conflict-of-interest statement: There are no conflicts of interest to this manuscript.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ileana Lulic, MD, Postdoctoral Fellow, Department of Anesthesiology, Intensive Care and Pain Medicine, Clinical Hospital Merkur, Zajceva 19, Zagreb 10000, Croatia. ileanalulic@gmail.com
Received: February 2, 2025 Revised: March 25, 2025 Accepted: April 15, 2025 Published online: December 18, 2025 Processing time: 292 Days and 9.7 Hours
Abstract
Cardiovascular complications remain a leading cause of morbidity and mortality in liver transplantation (LT), exposing the limitations of current risk assessment strategies. YKL-40, a glycoprotein involved in inflammation, endothelial dysfunction, and fibrotic remodeling, has emerged as a biomarker associated with adverse cardiovascular outcomes and liver disease severity. Its inclusion in structured cardiovascular assessment frameworks may improve transplant-specific risk scores and support earlier identification of high-risk LT recipients. Mechanistically, YKL-40 contributes to vascular injury and myocardial dysfunction via nuclear factor-κB and STAT3 signaling, and is under investigation as a biomarker in preclinical studies aimed at cardiovascular risk modulation in LT. Integration of YKL-40 into predictive models, particularly those supported by artificial intelligence, may enhance individualized perioperative decision-making. This editorial outlines translational directions for integrating YKL-40 into cardiovascular risk models and therapeutic research, supporting its clinical adoption in precision-guided LT care.
Core Tip: YKL-40 is a biomarker of cardiovascular dysfunction in liver transplant (LT) recipients, reflecting underlying inflammation, endothelial activation, and fibrosis. Its integration into cardiovascular risk models may improve perioperative stratification, complement existing screening tools, and support early identification of high-risk patients. Mechanistic insights and artificial intelligence–driven analytics support its future role in targeted risk reduction, while clinical adoption will require prospective validation, actionable thresholds, and structured incorporation into multimodal assessment frameworks to improve outcomes in LT recipients.
