Dynamic Lactate Clearance Patterns During Normothermic Machine Perfusion Predict Posttransplant Biliary Complications in Donation After Circulatory Death Liver Transplantation.

Background: Normothermic machine perfusion (NMP) enables real-time assessment of liver graft viability through various biomarkers. Although lactate clearance during NMP has been associated with graft outcomes, its dynamic patterns and relationship with posttransplant biliary complications (PTBCs) remain poorly understood. We sought to evaluate whether dynamic lactate clearance patterns during NMP could predict PTBCs in both donations after circulatory death (DCD) and brain death (DBD) liver transplantation (LT).

Impact of portal vein thrombosis grade and donor characteristics on biliary complications after liver transplantation: A risk stratification framework.

Background: Portal vein thrombosis in liver transplant recipients presents a significant challenge, with potential implications for posttransplant biliary complications. This study investigated the relationship between portal vein thrombosis and posttransplant biliary complications, aiming to identify risk factors and establish a stratification framework.

Methods: We conducted a single-center retrospective study of 914 adult liver transplant recipients from 2016 to 2023.

Pretransplant Midodrine Use-A Risk Factor for Graft Loss at 1 Year in Kidney Transplant Recipients?

Introduction: Hypotension is a frequent complication of patients who are on chronic maintenance hemodialysis. Midodrine is an alpha-1 adrenergic agonist used to treat patients on hemodialysis who have chronic hypotensiom. The aim of our study was to evaluate if patients who required midodrine for hypotension had inferior outcomes compared to those who did not require midodrine.

Kidney Allograft Torsion After Simultaneous Pancreas Kidney Transplantation: Case Report and Review of Literature.

Kidney allograft torsion (KAT) is a rare but critical complication of kidney transplantation that can lead to graft loss due to acute ischemia. This report presents a case of KAT resulting in graft loss 9 months following intraperitoneal simultaneous pancreas and kidney (SPK) transplant and reviews previous reports to identify potential high-risk features. A 38-year-old female with end-stage renal disease secondary to Type 1 diabetes mellitus underwent an intraperitoneal enteric drained SPK transplant.

Does Weekend Discharge Affect Readmission and Survival in Liver Transplant Patients? Insights From a Cohort Study.

Background: Weekend hospital discharges are often associated with reduced staffing, potentially impacting the quality of patient care. We studied the effects of weekend discharge after liver transplantation (LT) on early readmission rates, overall survival (OS), and graft survival (GS).

Method: We analyzed data from the Ohio State University Wexner Medical Center database (January 2016 to December 2023).

Determinants of Long Waiting Time to Kidney Transplantation.

Background: Disparity in waiting time to kidney transplantation led to new policy (KAS250). Our aims were to identify variables associated with long wait time (LWT); assess the impact of KAS250 on WT; and analyze modifiable transplant center behaviors correlated with WT.

Methods: SRTR data for adult deceased donor kidney transplants were analyzed.

Outcomes of Liver Transplantation From Hepatitis C Virus-positive DCD Donors and Its Utilization Among Centers in the United States.

Background: Donation after circulatory death (DCD) or hepatitis C virus (HCV + ) liver grafts are underused among transplant centers in the United States. The study aimed to evaluate organ utilization and outcomes of liver grafts from DCD donors with HCV infection.

Methods: National registry and local center data of all deceased donor liver transplants performed between November 2016 and December 2021 were analyzed.

Outcomes After Deceased Donor Kidney Transplantation Using Kidney Allografts With Marginal Perfusion Parameters.

Background: This study examines outcomes of deceased donor kidney transplantation (DDKT) in recipients of kidney allografts with marginal perfusion parameters.

Methods: Allografts with marginal perfusion parameters (resistance index [RI] >0.4 and pump flow rate [F] <70 mL/min; MP group) were compared with those with good parameters (RI <0.

Postoperative and Recurrent Hematuria after Pretransplant Core Needle Biopsy in Living Donor Kidney Transplant.

Background: Core needle and wedge biopsies are the two main pathologic ways to determine the suitability of a kidney allograft and to have a baseline allograft biopsy in case of future rejection. . A 57-year-old patient developed a renal arteriovenous fistula causing postoperative and recurrent hematuria after allograft pretransplant renal core needle biopsy and treated with selective Interventional radiology coil embolization.

Orthotopic Kidney Transplant as a Fifth Intra-Abdominal Organ after Two Previous Kidney and Two Previous Pancreas Transplants.

Background: Patients with more than two prior kidney transplant procedures pose unique surgical challenges. Once both the right and left retroperitoneal spaces have been dissected, intra-abdominal implantation is usually necessary. If the external iliac arteries have been used previously, it is sometimes necessary to use the aorta and vena cava for implantation.

Spinal Stroke following Kidney Transplant.

Complications are a part of surgery. Spinal infarctions are a dreaded complication of aortic surgery. We present a patient who developed a spinal infarct after a kidney transplant.

Safely Expanding the Liver Donor Pool by Utilization of Organs from Donation after Circulatory Death with Comparable Results to Donation After Brain Death, a Large Single-Center Experience.

Background: Use of livers donated after circulatory death (DCD) is one way to expand the donor pool. Our center has aggressively incorporated use of DCD liver grafts into practice. We examined our center and national outcomes as well as national DCD liver utilization.

Early United States experience with liver donation after circulatory determination of death using thoraco-abdominal normothermic regional perfusion: A multi-institutional observational study.

Mortality on the liver waitlist remains unacceptably high. Donation after circulatory determination of death (DCD) donors are considered marginal but are a potentially underutilized resource. Thoraco-abdominal normothermic perfusion (TA-NRP) in DCD donors might result in higher quality livers and offset waitlist mortality.

Donation After Circulatory Death Yields Survival Rates Similar to Donation After Brain Death Liver Transplant, Which Effectively Expands the Donor Pool.

Objectives: Liver allograft shortage has necessitated greater use of donations after circulatory death. Limited data are available to compare recipients' health care utilization for donation after circulatory death versus brain death.

Materials And Methods: Liver transplant data for our center from November 2016 until May 2019 were obtained (208 donations after brain death and 39 after circulatory death).

Liver Transplant for Management of Hepatic Complications of Dyskeratosis Congenita: A Case Report.

Dyskeratosis congenita, a rare genetic disorder typified by progressive bone marrow failure, is classically characterized by the triad of abnormal skin pigmentation, nail dystrophy, and oral leukoplakia; however, it is a multisystem disease. Although hepatic involvement occurs in about 7% of patients with dyskeratosis congenita, end-stage liver disease is rare. Treatment of dyskeratosis congenita generally involves hematopoietic stem cell transplant.

Rescue Hepatectomy and Anhepatic Phase Management After Primary Nonfunction in a Liver Transplant.

Primary nonfunction is a rare but lethal complication that occurs in a small number of liver transplants. When primary nonfunction occurs, the only definite treatment is retransplant; however, another liver might not be readily available at that time. Hence, a surgeon should be aware of the various options available at hand for patient care during the time interval between the primary nonfunction and retransplant.

Hepatic Resection and Transplant in Glycogen Storage Diseases.

Patients with glycogen storage diseases pose unique management challenges to clinicians.These challenges are exacerbated wheneverthey undergo surgery as the basic anomaly in their glycogen storage pathways make them susceptible to organic acidosis, which may in turn complicate their preoperative, intraoperative, and postoperative course. Because of the rarity of these diseases, clinicians may not be aware of the specific management concerns.

Left Renal Vein Ligation for Spontaneous Splenorenal Shunts During Deceased-Donor Orthotopic Liver Transplant Is Safe and Can Mitigate Complications from Portal Steal: A Case Series.

Objectives: Large spontaneous splenorenal shunts can result in portal vein steal syndrome and is a risk factor for portal vein thrombosis after orthotopic liver transplant. Disconnection of these shunts by left renal vein ligation has been suggested as a potential technique for improving portal venous flow and mitigating risk of portal vein thrombus, thus improving graft perfusion. We present a series of 6 patients who underwent left renal vein ligation for spontaneous splenorenal shunts and their outcomes.