Decision-Making in Transplant Candidate Selection Committees: Frameworks and Other Considerations.

Organ transplant selection committees are tasked with deciding whether patients seeking a transplant are medically and psychosocially appropriate to be placed on the waitlist. The selection process is obscure to patients and those outside of the institution. Currently, very limited standards exist for decision-making in selection committees, which could exacerbate inequities and disparities in the transplant process, a major concern among patients.

Development of the Perihilar Cholangiocarcinoma Risk Estimation of Tumor Recurrence After Transplant (PRETREAT) Score.

Objective: To develop and validate a risk score for predicting post-transplant recurrence in perihilar cholangiocarcinoma (pCCA) patients.

Background: pCCA is an aggressive malignancy with a poor prognosis. Although neoadjuvant chemoradiation (CRT) followed by liver transplantation (LT) offers a potential cure for patients with unresectable, early-stage de novo or primary sclerosing cholangitis (PSC)-associated pCCA, post-transplant recurrence negatively impacts survival.

New Perspectives and Approaches to Transplant Selection Committee.

The transplant selection process for solid organ recipients relies on committee review and is susceptible to human nature and bias. The current model of selection committees has been under-examined and untested. Few studies exist on transplant selection committees.

Guiding ethical principles in transplant candidate selection committees: A scoping review protocol.

Objective: The goal of this scoping review is to examine the published literature regarding ethical principles that guide solid-organ transplant candidate selection committees. The review will identify the available research and provide recommendations to selection committees.

Introduction: Transplantation is a field where ethics is involved with almost every juncture of treatment.

Impact of Sleeve Gastrectomy on Kidney Function and Preemptive Transplant in Kidney Transplant Candidates With Obesity.

Objective: To compare the impact of sleeve gastrectomy (SG) on kidney function, comorbidities, and kidney transplant (KT) rates in KT candidates with obesity with a nonsurgical cohort.

Methods: Twenty-one KT candidates with body mass index (BMI) above 35 kg/m underwent SG between February 26, 2021, and October 27, 2023, and were compared with 19 who did not have SG. The secondary endpoints included changes in BMI, requirements for antihyperglycemic and antihypertension medications, and preemptive KT rates.

Simultaneous liver transplant and sleeve gastrectomy provides durable weight loss, improves metabolic syndrome and reduces allograft steatosis.

Background And Aims: The prevalence of obesity and metabolic syndrome is rising among liver transplant (LT) candidates, many of whom have metabolic dysfunction-associated steatotic liver disease (MASLD). We aimed to determine the long-term impact of simultaneous LT and sleeve gastrectomy (LTSG) in patients with obesity transplanted for MASLD.

Methods: We analyzed patients undergoing LTSG using a single clinical protocol (n = 72), and patients with BMI >30 who underwent LT alone for MASLD (n = 185) in a multicenter retrospective cohort study.

Benefits of Glucagon-like Peptide-1 Receptor Agonists After Kidney Transplantation.

Objective: Benefits of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in kidney transplant (KT) recipients have not been adequately studied.

Methods: We retrospectively examined the effects of GLP-1 RA on mortality, kidney outcomes and metabolic parameters in KT recipients with type 2 diabetes mellitus (T2DM) treated versus not treated with GLP-1 RA. A reference group of KT recipients not treated with GLP-1 RA was used for comparison.

Impact of immunosuppression medication management on short-term complications following sleeve gastrectomy.

Background: Sleeve gastrectomy (SG) is the most performed bariatric procedure in the United States due to its favorable safety profile. However, managing patients on chronic immunosuppressive therapy (CIT) during bariatric surgery poses challenges, particularly in balancing surgical outcomes with the risks associated with CIT interruption. This study aims to compare the short-term outcomes of SG in patients who temporarily discontinued CIT versus those who continued it perioperatively.

Moral Inequity in Organ Donation: An Examination of Age-Based Denial.

The decision to donate an organ is often the decision to save a loved one's life. Frequently recognized as an ultimate act of altruism, a person's choice to donate is embedded in their right to make decisions about their own body and well-being, free of coercion. To ensure donors are truly acting out of altruism, transplant professionals will not allow someone to donate if there are concerns of duress or inability to consent.

Mesangial Expansion by Morphometry at 5 y After Kidney Transplantation: Incidence, Risk Factors, and Association With Graft Loss.

Background: Mesangial expansion (ME) is an understudied histologic lesion in renal allografts. The current Banff score is not reproducible and may miss important ME features. The study aimed to improve the quantification of ME using morphometry, assess changes over time, and determine its association with allograft loss.

Bariatric surgery and the diseased kidney: a 5-year assessment of safety and postoperative renal outcomes.

Background: Obesity and its related medical conditions are well-established contributors to the development of chronic kidney disease (CKD). Metabolic and bariatric surgery (MBS), including procedures such as sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), is a potential intervention for these individuals. However, the heightened risk of postoperative complications casts doubts on the suitability of MBS in this population.

Outcomes of bariatric surgery in the setting of compensated advanced chronic liver disease associated with clinically significant portal hypertension: a multicenter, retrospective, cohort study on feasibility and safety.

Background: The obesity epidemic has led to an increase in the proportion of patients with chronic liver disease due to metabolic associated steatosic liver disease and in the prevalence of obesity in patients with cirrhosis. Metabolic and bariatric surgery (MBS) has been proven to determine weight loss, obesity-related medical problems remission, and liver steatosis, inflammation, and fibrosis improvement. However, cirrhosis and portal hypertension are well-known risk factors for increased morbidity and mortality after surgery.

Revitalizing pancreas transplantation: creation of a hands-on training course for pancreas allograft procurement, backbench preparation, and transplantation.

Despite a steady increase in the number of organs available for transplant in the United States, over the last two decades there has been a precipitous decrease in the annual number of pancreas transplants performed. One overlooked consequence of this decline in pancreas transplant volume has been a decrease in experience in proper pancreas procurement and transplantation techniques for transplant surgeons as well as fewer trained abdominal transplant fellows entering the workforce certified for pancreas procurement and transplantation, with those achieving certification having less-developed judgment, skills, and experience. To augment current fellowship training and provide a concentrated experience in pancreas procurement and transplantation, the ASTS developed a hands-on surgical skills workshop focused on proper techniques for pancreas allograft procurement and backbench preparation.

Obesity management for the hepatologist-What to do, how to do it and why?

Obesity is highly prevalent in hepatology clinics and has a significant impact on chronic liver disease and patient management. Hepatologists and gastroenterologists need to be actively engaged in the management of obesity. This review provides a detailed approach to this challenging comorbidity.

Bariatric surgery and left ventricular assist device in patients with heart failure: A systematic review and meta-analysis.

Background: The role of metabolic and bariatric surgery (MBS), in synergy with left ventricular assist device (LVAD) implantation, in the scope of end-stage heart failure management for patients with severe obesity is not well elucidated.

Methods: We conducted a meta-analysis using Cochrane, Embase, PubMed, and Scopus databases to include articles from their inception to November 2022.

Results: A total of 271 patients who underwent MBS during or after the LVAD implantation were included from eleven separate studies.

Outcomes of Kidney Transplantation in Patients That Underwent Bariatric Surgery: A Systematic Review and Meta-analysis.

The impact of bariatric surgery (BS) on kidney transplantation (KT) outcomes in patients with obesity remains controversial. We systematically searched MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials for studies reporting outcomes of KT recipients that underwent prior BS. Common/random effects meta-analyses were performed to obtain summary ratios of the postoperative outcomes.

Impact of side-to-side cavocavostomy versus traditional piggyback implantation in liver transplantation.

Background: Traditional piggyback implantation has often been used in liver transplant; however, this technique may be hindered by difficult visualization and postoperative incidences of outflow obstruction. Side-to-side cavocavostomy is an alternative approach, but perioperative outcomes associated with this technique remain largely unknown.

Methods: In July 2017, side-to-side cavocavostomy was adopted as the standard implantation technique at our institution by all surgeons (n = 4).