From critical care to organ preservation: the potential role of hemadsorption in transplantation-a narrative review.

Background And Objective: Hemadsorption, a therapeutic modality traditionally used to mitigate cytokine storm in critically ill patients and is now being tested in other medical fields including organ transplantation, especially for organs from extended criteria donors. Such organs are susceptible to ischemia-reperfusion injury (IRI) during transplantation, which is known to release a cascade of innate immune mediators including damage-associated molecular patterns (DAMPs) and cytokines during reperfusion and ultimately leading to graft dysfunction based on the metabolic injury. To address this challenge, early studies have integrated hemadsorption filters into organ perfusion circuits, such as normothermic regional perfusion (NRP) in donors and machine perfusion (MP) of grafts, with the aim to reduce inflammation and improve organ viability.

Hypothermic Oxygenated Perfusion Versus Static Cold Storage in Transplantation of Extended Criteria Liver Grafts: A Systematic Review and Meta-Analysis.

Background: The use of extended criteria donor livers (ECD) is becoming more routine in many transplant centers. These organs have higher risks for complications; however, hypothermic-oxygenated perfusion (HOPE) was found to improve outcomes, including graft survival. We aim to assess the effect of HOPE on different types of ECD liver grafts.

Intracardiac thrombosis and its management during liver transplantation: international, multi-center, case-control study.

Background: Intracardiac thrombosis (ICT) during liver transplantation (LT) is a rare but life-threatening complication with limited data regarding its risk factors, management, and outcomes. This study aimed to identify factors associated with ICT development, define predictors of intraoperative outcomes and propose a novel classification and management algorithm for ICT.

Methods: A multicenter, international retrospective case-control study was conducted on liver transplant recipients from seven centers between January 2005 and December 2023.

A New Era of Decision-making in Liver Transplantation: A Prospective Validation and Cost-effectiveness Analysis of FMN-guided Liver Viability Assessment During Normothermic Machine Perfusion.

Objectives: Flavin mononucleotide (FMN), a marker of mitochondrial complex 1 injury, has not yet been validated for its predictive value of outcomes and economic impact.

Background: Normothermic machine perfusion (NMP) is the only ex situ perfusion technique currently approved for liver transplantation in the United States. Optimal graft viability assessment on this approach remains controversial.

Anatomic Feature and Preventive Strategy of Anterior Spinal Artery Occlusion in Endovascular Internal Trapping of Vertebral Artery Dissecting Aneurysms Distal to the Bifurcation of the Posterior Inferior Cerebellar Artery.

Background And Objectives: In endovascular internal trapping for intracranial vertebral artery dissecting aneurysms (VADAs) distal to the posterior inferior cerebellar artery bifurcation, anterior spinal artery (ASA) occlusion is a serious complication although it is relatively infrequent because of the presence of collateral blood vessels. In this article, we investigated the correlation between vascular anatomy and ischemic complications of the ASA.

Methods: We retrospectively evaluated 21 patients with ruptured PICA-distal type VADA treated by internal trapping at our affiliated institutions from 2008 to 2022.

Mechanisms and Management of Graft In- and Out-flow in Liver Transplantation: A Narrative Review of the Literature and Guide for Interventional Management.

Background And Aims: Management of the dual vascular supply of liver grafts in liver transplantation (LT) is increasingly recognized as crucial to achieving adequate graft function. We aim to review how the relationship between graft in-flow and out-flow affects graft function, and how surgeons can manage graft function within the context of liver hemodynamic autoregulation. This includes mechanisms of such autoregulation including the hepatic artery buffer response (HABR), and the impact of porto-systemic circulatory changes on graft inflow.

Circulating Tumor DNA in Primary and Secondary Liver Cancers: A Comprehensive Review.

Similar to many other cancer types, liver malignancies pose the common challenges of late detection of primary tumors and recurrences. Liquid biopsies, which assess the presence of circulating tumor DNA, have emerged as a novel, non-invasive clinical tool for diagnostic and surveillance purposes. This review represents an introductory and comprehensive overview of the current circulating tumor DNA (ctDNA) literature relevant to primary and secondary liver malignancies.

Potential of serum sulfatide levels as a marker for classification and disease activity in lupus nephritis.

Introduction: Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus, often leading to end-stage kidney disease. Serum sulfatide levels are linked to severe kidney vasculitis. This study aimed to assess serum sulfatide levels as a marker for classifying and evaluating disease activity in LN.

Quantifying Flavin mononucleotide: an internationally validated methodological approach for enhanced decision making in organ transplantation.

Background: Increasing donor risk, particularly in liver transplantation, where organs are often marginal, has made dynamic organ preservation techniques and viability assessment essential to safely improve organ quality and increase utilisation. However, existing viability parameters are based on routine clinical assessment in patients with acute liver failure, trauma, or liver resections. These parameters often do not correlate with clinically relevant post-transplant outcomes.

Multi-objective computational optimization of human 5' UTR sequences.

The computational design of messenger RNA (mRNA) sequences is a critical technology for both scientific research and industrial applications. Recent advances in prediction and optimization models have enabled the automatic scoring and optimization of $5^\prime $ UTR sequences, key upstream elements of mRNA. However, fully automated design of $5^\prime $ UTR sequences with more than two objective scores has not yet been explored.

Transforming Transplant Oversight: Enhancing Combined Cardiothoracic Surgery and Liver Transplantation With Normothermic Machine Perfusion.

Background: Simultaneous cardiothoracic surgery and liver transplantation (LT) is a high-risk procedure associated with high mortality and morbidity rates. The use of normothermic machine perfusion (NMP) allows graft quality enhancement, assessment of liver viability, and logistics optimization, expanding the donor pool and reducing organ discard rate. We share our institution's experience with simultaneous cardiothoracic surgery and LT, using NMP for liver graft preservation and viability assessment.

Out of Sequence Allocation in Liver Transplantation: A Poorly Used Tool to Improve Organ Utilization.

Significance: We evaluated the impact of OOS on organ utilization and also what factors impact the decision to employ OOS.

Background: Deceased donor liver allocation typically follows a ranked match-run of potential recipients. Organ procurement organizations (OPOs) may deviate from liver transplant standardized allocation using "out-of-sequence" (OOS) matches.

Clinical effects of combination therapy with continuous renal replacement therapy and continuous intravenous sodium infusion therapy.

Introduction: This single-center retrospective study investigated the clinical effects of combination therapy involving continuous renal replacement therapy (CRRT) and continuous intravenous sodium infusion therapy (cIVNa) in critically ill patients with prerenal acute kidney injury (AKI) who were expected to experience insufficient plasma refilling.

Method: The clinical data of 92 patients were analyzed. Clinical data from the control (CRRT, n = 49) and intervention (CRRT + cIVNa, n = 43) groups were compared statistically.

Elderly Ages in Liver Transplantation: Are Older Donors Really Higher Risk?

Background: There is currently a supply and demand mismatch in liver transplantation, with more patients needing transplants than grafts available. The use of older donors is one potential way of expanding access to viable grafts. No national study has yet reported on outcomes of liver transplants with donors ≥70 y.

Recipient 3-Hepatic Vein Technique with Graft Venoplasty to Maximize Venous Outflow in Left Lobe Living Donor Liver Transplantation.

Background: Augmentation of hepatic venous outflow is crucial in living donor liver transplantation (LDLT) to maximize functional graft size and prevent venous complications. We present details of our outflow augmentation technique for left lobe grafts (LLG) in adult LDLTs, which uses all recipient 3 hepatic veins and venoplasty of graft left and middle hepatic veins. This study examines the effectiveness of our technique in preventing outflow complications and the correlation between anatomical variations of the graft hepatic veins and surgical outcomes.

Intravenous Methylprednisolone for Acute Right Middle Cerebral Artery Occlusion in Granulomatosis Polyangiitis: A Case Report.

A 17-year-old Japanese woman diagnosed with granulomatosis with polyangiitis (GPA) and was treated with immunotherapy suddenly developed an impaired consciousness, left hemiplegia, and conjugate eye deviation to the right. Magnetic resonance imaging showed an acute cerebral infarction in the right striatum and right middle cerebral artery (MCA) occlusion. As her GPA had worsened recently, intravenous methylprednisolone (IVMP) was started.

The Impact of Liver Graft Preservation Method on Longitudinal Gut Microbiome Changes Following Liver Transplant: A Proof-of-concept Study.

Background And Aims: End-stage liver disease is associated with disruptions in gut microbiota composition and function, which may facilitate gut-to-liver bacterial translocation, impacting liver graft integrity and clinical outcomes following liver transplantation. This study aimed to assess the impact of two liver graft preservation methods on fecal microbiota and changes in fecal and breath organic acids following liver transplantation.

Methods: This single-center, non-randomized prospective pilot study enrolled liver transplant patients whose grafts were preserved using either static cold storage or ex situ normothermic machine perfusion (NMP).

Programmatic Normothermic Machine Perfusion and Association with Liver Transplant Waitlist Outcomes for Patients with Lower Model for End-Stage Liver Disease Score.

Background: Normothermic machine perfusion (NMP) may enhance the use of extended criteria donor livers which might impact waitlist outcomes. Its impact on patients with low Model for End-Stage Liver Disease (MELD) scores, who generally face longer waitlist times, has not been studied. This study aimed to assess the impact of NMP on waitlist and post liver transplantation (LT) outcomes accounting for MELD allocation preference.

Impact of prepared vascular access on mortality and medical expenses in elderly and non-elderly Japanese patients with chronic kidney disease stage G5: a retrospective cohort study.

Background: Patients with chronic kidney disease (CKD) stage 5 (CKDG5) have greater dialysis requirements that increase the risk of cardiovascular disease and mortality. The elevated costs associated with CKDG5 are a serious concern. The impact of prepared vascular access (VA) through planned VA creation on mortality and medical expenses remains unclear in Japanese patients with CKDG5.

Posterior Clinoidectomy in the Subtemporal Transtentorial Approach for a Basilar Bifurcation Aneurysm: Technical Note.

Background: Although the endovascular approach has emerged as the first-choice treatment for basilar bifurcation aneurysms, there are situations where direct surgery remains necessary. Among several surgical approaches, the subtemporal transtentorial approach can be adapted for low-positioned aneurysms projecting posteriorly. Because surgeons observe the aneurysm from a lateral perspective in this approach, the posterior clinoid process does not usually obstruct the surgical field, and posterior clinoidectomy in this approach has not been reported to date.

Expanding Indications in Transplant Oncology.

Liver transplantation is aptly described as the only curative treatment for cirrhosis and cirrhosis with co-morbid hepatocellular carcinoma (HCC). Its utility in the management of various other primary and secondary liver cancers is gaining traction rapidly, with more thorough assessments on broader populations continuing to emerge. Most prominently, this includes colorectal cancer liver metastasis (CRLM), cholangiocarcinoma (CCA), neuroendocrine tumors (NETs), and more.

Current Progress in Peritoneal Dialysis: A Narrative Review of Progress in Peritoneal Dialysis Fluid.

Peritoneal dialysis (PD) is a renal replacement therapy that removes solutes, electrolytes, and water via the infusion of dialysis fluid into the peritoneal cavity. However, the non-physiological composition of conventional PD fluids can cause peritoneal injury, leading to complications such as peritoneal fibrosis and encapsulating peritoneal sclerosis. This review highlights recent advancements in PD fluid formulations aimed at improving biocompatibility and reducing peritoneal damage.

Bridging therapy with histotripsy prior to liver transplantation for hepatocellular carcinoma: a first case report.

Background: Histotripsy is a novel, non-invasive, non-ionizing, and non-thermal ablation technique that disrupts tumors using acoustic cavitation. We report the first use of Histotripsy as bridging therapy prior to liver transplant for hepatocellular carcinoma (HCC) treated with histotripsy.

Case Presentation: A 59-year-old woman presented with Metabolic-Associated Steatotic Liver Disease (MASLD) cirrhosis (labMELD = 14), hepatic encephalopathy, and a single 2 cm OPTN V lesion in the left lateral segment consistent with HCC.