Abdominal Organ Transplantation Research Articles

What's New in Pediatric Abdominal Organ Transplantation?

What's New in Pediatric Abdominal Organ Transplantation?

Abdominal Organ Transplantation: Noteworthy Literature in 2023.

This review highlights noteworthy literature published in 2023 and pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. We feature 9 studies from 593 peer-reviewed papers on pancreatic transplantation, 3 from 194 on intestinal transplantation, and 28 from over 4513 on kidney transplantation. The liver transplantation section includes a special focus on 20 studies from 5666 clinical trial publications. We explore a broad range of topics, including donor management, perioperative recipient management, and innovative pharmacologic and mechanical interventions tested for the improvement of patient and graft outcomes and survival.

Accuracy and Feasibility of Real-time Continuous Glucose Monitoring in Critically Ill Patients After Abdominal Surgery and Solid Organ Transplantation.

Glycemia management in critical care is posing a challenge in frequent measuring and adequate insulin dose adjustment. In recent years, continuous glucose measurement has gained accuracy and reliability in outpatient and inpatient settings. The aim of this study was to assess the feasibility and accuracy of real-time continuous glucose monitoring (CGM) in ICU patients after major abdominal surgery. We included patients undergoing pancreatic surgery and solid organ transplantation (liver, pancreas, islets of Langerhans, kidney) requiring an ICU stay after surgery. We used a Dexcom G6 sensor, placed in the infraclavicular region, for real-time CGM. Arterial blood glucose measured by the amperometric principle (ABL 800; Radiometer, Copenhagen, Denmark) served as a reference value and for calibration. Blood glucose was also routinely monitored by a StatStrip bedside glucose meter. Sensor accuracy was assessed by mean absolute relative difference (MARD), bias, modified Bland-Altman plot, and surveillance error grid for paired samples of glucose values from CGM and acid-base analyzer (ABL). We analyzed data from 61 patients and obtained 1,546 paired glucose values from CGM and ABL. Active sensor use was 95.1%. MARD was 9.4%, relative bias was 1.4%, and 92.8% of values fell in zone A, 6.1% fell in zone B, and 1.2% fell in zone C of the surveillance error grid. Median time in range was 78%, with minimum (<1%) time spent in hypoglycemia. StatStrip glucose meter MARD compared with ABL was 5.8%. Our study shows clinically applicable accuracy and reliability of Dexcom G6 CGM in postoperative ICU patients and a feasible alternative sensor placement site.

Endovascular Treatment of a Multi-visceral Aortic Conduit Blowout With Parallel Stent Grafts and Coils.

Multi-visceral transplantation (MVT) is a complex surgical procedure involving the transplantation of multiple abdominal organs as a single unit, typically used as bailout treatment of patients with devastating abdominal pathologies. Due to the complexity of the procedure, major and even life-threatening complications can happen. Vascular complications, including anastomotic breakdowns or pseudoaneurysms due to infections, can be universally lethal. Open surgical repair is often not an option due to the hostile operative field. We report a case of endovascular salvage of multi-visceral aortic conduit blowout utilizing parallel stent grafts and coils without sacrifice of the transplanted viscera. This combination can successfully control bleeding and maintain graft perfusion in this rare but devastating complication.

Mesenchymal Stem Cell Extracellular Vesicles as a New Treatment Paradigm in Solid Abdominal Organ Transplantation: A Case Series.

Solid abdominal organ transplantation is fraught with variable rates of rejection and graft versus host disease (GVHD). We sought to determine the safety and efficacy of an advanced extracellular vesicle (EV) investigational product (IP) derived from mesenchymal stem cells (MSC) in the transplant patient population. Seven separate emergency investigational new drug (eNIDs) were filed with the Food and Drug Administration (FDA) for the emergency treatment of rejection of an isolated intestinal graft (n = 2), liver allograft graft (n = 2), modified multivisceral graft (n = 3), and GVHD in isolated intestinal transplant patients (n = 2). Fifteen milliliters of IP was administered intravenously on Day 0, 2, 4, and this treatment cycle was repeated up to four times in each patient depending on the treatment protocol allowed by the FDA. Safety (adverse event reporting) and efficacy (clinical status, serologies, and histopathology) were evaluated. There were no adverse events related to IP. All patients had improvement in clinical symptoms within 24 h, improved serologic laboratory evaluation, improved pulmonary symptoms and dermatologic manifestations of GVHD, and complete histologic resolution of graft inflammation/rejection within 7 days of IP administration. Systemic use of a MSC-derived EV IP was successful in achieving histological clearance of intestinal, liver, and multivisceral graft inflammation, and skin and pulmonary manifestations of GVHD.

Microdialysis in Abdominal Organ Transplantation and the Potential for Integration with Dynamic Preservation Platforms and Post Transplant Monitoring

The perpetual organ shortage crisis worldwide has meant a paradigm shift in global thinking with subsequent expansion of the accepted criteria for an organ donor to meet the demand. Robust pre-transplant organ viability assessment is the next great challenge in the field of transplantation today. Organ preservation in the nature of static cold storage has reached its limits, and machine perfusion both cold and warm offers theoretically superior preservation and the potential to assess organs. Microdialysis is a novel technique with proven ability to allow remote assessment of tissue biochemistry and metabolism. It has been used in various pre-clinical and clinical models of abdominal organ preservation and transplantation. This review focuses on the use of microdialysis in the assessment of the kidney, liver, and pancreas, and where this novel technology is heading in the context of the assessing organ viability prior to and after transplantation.

A Single-Center Case Series of Successful Abdominal Organ Transplan-tation from SARS-CoV-2-Infected Donors to Uninfected Recipients: Do We Need Rigorous Monitoring?

A Single-Center Case Series of Successful Abdominal Organ Transplan-tation from SARS-CoV-2-Infected Donors to Uninfected Recipients: Do We Need Rigorous Monitoring?

Management of incisional hernias in renal transplant patients

BackgroundIncisional hernia (IH) remains one of the most common complications following abdominal organ transplantation with no consensus on the optimal management. This study is a narrative review of the incidence, risk factors, diagnosis, and management of IH post-transplantation. MethodsA literature search using the EMBASE and MEDLINE from 1.1.2016 to 15.8.2002 was conducted. Included studies reported on IH after open abdominal organ transplantation. The outcomes included in our analysis were the incidence of IH, significant patient risk factors, the diagnostic approach used to detect IH, and proposed strategies for the management of IH. 54 publications that involved 9336 transplant patients who developed IH were included. ResultsThe incidence of IH ranged from 1.7 % to 43 % in liver transplant patients and was lower following kidney transplantation (1.1 %-7.0 %). Patient risk factors predisposing to IH were body mass index>30, age (>50), smoking history, previous open abdominal surgery, open surgical repair, a Mercedes or inverse T incision and surgical site infections. The most common diagnostic approach for IH is clinical examination, followed by US or CT imaging in cases of complex IH. Following IH repair, recurrence rates ranged from 0 to 76.9 %, and complication rates from 12 % - 52.9 %, the most common of which were surgical site occurrences (11.0–79.2 %) including infection (0 - 65.4 %) and seroma formation (0–8 %). Management of IH should include preoperative optimisation of patients through weight reduction, smoking cessation and adjustment of immunosuppression using a multidisciplinary (MDT) approach. Mesh repair, either open or laparoscopic, is the gold standard for the treatment of IH, resulting in a significantly lower recurrence rate than primary closure. There is no consensus on the type and positioning of mesh, and very limited studies have reported on other perioperative factors such as wound closure. ConclusionsPrehabilitation and MDT approach are important in ensuring good outcomes following IH repair. Further prospective studies and the establishment of a relevant registry are required to propose a consensus pathway for IH repair in the transplanted population.

Critical Care Length of Stay and Support Requirements for Patients Postpancreas Transplant.

Introduction: Pancreas transplant is one of the UK's less commonly done solid abdominal organ transplants. The transplant is reputed for its high-risk postsurgical complications due to multiple patients, procedures, and immunological factors. For this reason, patients are habitually admitted to the intensive care unit for postlaparotomy care, physiological support, and graft function monitoring during their immediate postoperative course. Project Aim: This program evaluation analyzed the trend in critical care length of stay and organ support requirements for patients following whole pancreas transplantation. The aim was to use these baseline data as performance metrics to enable a safer transition and Plan-Do-Study-Act (PDSA) cycles in improving the delivery of enhanced recovery service. Design: A retrospective chart review was performed using records from Phillips IntelliSpace Critical Care and Anaesthesia system to evaluate the institutional outcomes of patients < 18 years admitted to intensive care following pancreas transplantation between January 1, 2018, and December 31, 2021. Islet-cell transplant recipients were excluded as there is a different postoperative recovery. Results: The data suggested that although patients require a higher level of observations, blood pressure management, blood gas, and glucose monitoring during their first week of transplant, these patients did not routinely require the full range of critical care support. Conclusion: The present evaluation reported the organ support requirements for these transplant recipients. The results will generate further interest in enhanced recovery and service evaluation projects to streamline the postoperative care of these patients from the operating theatre back to the transplant wards.

Application of robotics in abdominal organ transplantation: A bibliometric analysis.

Robotic transplant surgery has garnered worldwide attention since 2002. Discussions on this issue have led to more publications over the past decade. This study assessed global robotic organ transplantation studies using bibliometric analysis. The study sample was robotic technique use in organ transplantation publications from 2002 to 2021 in the Web of Science database. We analysed top-cited authors, countries, institutions, journals, and keywords. Citations were used to visualise and analyse target literature in VOSviewer. 160 articles were included in the bibliometric study. Among the nations that are presently involved in the use of robotics in organ transplantation research, the United States of America leads robotic organ transplantation studies. The American Journal of Transplantation published the most articles overall. Based on publication and citation numbers, robotic organ transplantation techniques are becoming more global attention. This robotic abdominal organ transplant surgery bibliometric analysis review covers research output and hotspots.

Extracorporeal Photopheresis Suppresses Transplant Fibrosis by Inducing Decorin Expression in Alveolar Macrophages.

Extracorporeal Photopheresis Suppresses Transplant Fibrosis by Inducing Decorin Expression in Alveolar Macrophages.

Abdominal Organ Transplantation: Noteworthy Literature in 2022.

This review highlights noteworthy literature published in 2022 pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. We begin by exploring the impacts that the COVID-19 pandemic has had across the field of abdominal organ transplantation, including the successful use of grafts procured from COVID-19-infected donors. In pancreatic transplantation, we highlight several studies on dexmedetomidine and ischemia-reperfusion injury, equity in transplantation, and medical management, as well as studies comparing pancreatic transplantation to islet cell transplantation. In our section on intestinal transplantation, we explore donor selection. Kidney transplantation topics include cardiovascular risk management, obesity, and intraoperative management, including fluid resuscitation, dexmedetomidine, and sugammadex. The liver transplantation section focuses on clinical trials, systematic reviews, and meta-analyses published in 2022 and covers a wide range of topics, including machine perfusion, cardiovascular issues, renal issues, and coagulation/transfusion.

Does Physical Frailty and Pulmonary Function Affect the Number of Hospital Stay Among Liver Cirrhosis Patients? - A Retrospective Study

Background and need of research: Cirrhosis is permanent scarring(fibrosis) of liver and its major complication is frailty, defined as deterioration in physical and physiological function. Other complications such as Ascites, Hepatopulmonary syndrome, Respiratory muscles and generalized muscle weakness cause alteration in pulmonary function which is associated with frequent hospitalization and delisting from transplantation. The main aim of this study is to evaluate physical frailty and degree of pulmonary function abnormalities among cirrhotic patient using Short physical performance battery (SPPB) and pulmonary function using forced based spirometry pulmonary test (PFT) and to determine its relation with hospitalizations in cirrhotics. Methods: After approval from the institutional ethical committee, data of one hundred and thirty-three liver cirrhotic patients were retrieved from Physiotherapy department and Abdominal Organ Transplant between January’22-November’22. Data available like demographic and clinical parameters, severity of frailty assessed by Short Physical Performance Battery (SPPB) and Pulmonary Function Test (PFT) were evaluated. Statistical analysis was done using SPSS V.25(IBM). Result: Out of 133 subjects, 18(8%), 8(21%), 52(39%) were severely, moderate, and mildly frail respectively. In PFT findings, 15(11%), 43(32%), 16 (12%) had mild, moderate, and severe restriction. 4-meter gait speed test was weakly correlated with number of hospital admissions (r=0.199, p&lt;0.05). Sit to Stand test (STS) was moderately correlated with number of hospital admissions (r=0.24, p&lt;0.05). Comparison with categories of PFT and hospital admissions was not significant (Kruskal-Walli’s test, p&lt;0.53). Conclusion and Clinical Implications: SPPB (4m gait speed and Chair STS test) showed weak correlation with number of hospitalizations. However, PFT showed no correlation with number of hospitalizations. Findings of this study imply that assessment of frailty can be used to guide future rehabilitation for such patients. Keywords: Short Physical Performance Battery, Liver cirrhosis, Pulmonary function Test, Frailty, Retrospective study.

Which trial do we need? Culture of preservation fluid in abdominal organ transplant recipients

Which trial do we need? Culture of preservation fluid in abdominal organ transplant recipients

A Single-Center Case Series of Successful Abdominal Organ Transplantation From SARS-CoV-2-infected Donors to Uninfected Recipients-Do We Need Rigorous Monitoring?

We analyzed 16 recipients (7 liver, 9 kidney) transplanted from SARS-CoV-2 nucleic acid test+ deceased donors from December 25, 2021, to February 28, 2022, who were followed-up for at least 90 d. Primary outcomes included coronavirus disease 2019-positivity, allograft loss, and all-cause mortality. Secondary outcomes included biopsy-proven rejection (BPAR), donor-specific antibodies, delayed graft function, and opportunistic infections. Unlike previous studies, we followed the recipients clinically with the intent to treat if they developed SARS-CoV-2 symptoms. All donors were SARS-CoV-2 polymerase chain reaction-positive 72 h before donation. No recipients developed SARS-CoV-2 infection. The nadir serum creatinine and estimated glomerular filtration rate were 1.33 mg/dL and 64 mL/min/1.732 m2 for kidney transplantation (KTx) respectively. The median alanine transaminase was 14.5 IU/L, aspartate aminotransferase 13 IU/L, and alkaline phosphatase 74 IU/L. Two KTx patients lost allograft, and 1 liver transplantation patient died with a failed allograft. However, this was unrelated to their SARS-CoV-2-positive donor status. One BPAR in the liver transplantation was treated with steroids. No donor-specific antibodies or BPAR were reported in the KTx. Six KTx patients experienced delayed graft function, and 4 are off dialysis. Two KTx patients developed cytomegalovirus infection because of an error in reporting the cytomegalovirus serostatus by the donor center. We did not do serial testing for SARS-CoV-2 by polymerase chain reaction, imaging, or cycle threshold score pre- or posttransplant for donor/recipient and had comparable outcomes with previous studies. Because of the low risk of transmission, serial testing might not be necessary and, thus, could be reciprocated at small-volume transplant centers.

Liver Transplantation in Recipients With a Positive Crossmatch: A Retrospective Single-Center Match-Pair Analysis.

A positive crossmatch (XM+) is considered a contraindication to solid abdominal organ transplantation except liver transplantation (LT). Conflicting reports exist regarding the effects of XM+ on post-transplant outcomes. The goal of this retrospective single-center analysis is to evaluate the influence of XM+ on relevant outcome parameters such as survival, graft rejection, biliary and arterial complications. Forty-nine adult patients undergoing LT with a XM+ between 2002 and 2017 were included. XM+ LT recipients were matched 1:2 with crossmatch negative (XM-) LT recipients based on the balance of risk (BAR) score. Patient and graft survival were compared using Kaplan-Meier survival analysis and the log-rank test. Comparative analysis of clinical outcomes in XM+ and XM- groups were conducted. Patient and graft survival were similar in XM+ and XM- patients. Rejection episodes did not differ either. Recipients with a strong XM+ were more likely to develop a PCR+ CMV infection. A XM+ was not associated with a higher incidence of biliary or arterial complications. Donor age, cold ischemia time, PCR+ CMV infection and a rejection episode were associated with the occurrence of ischemic type biliary lesions. A XM+ has no effects on patient and graft survival or other relevant outcome parameters following LT.

The Effect of Language on Access to Timely COVID-19 Vaccination of Solid Abdominal Organ Transplant Recipients.

In dynamic healthcare environments including the COVID-19 pandemic, it is paramount to communicate health recommendations expediently and clearly. Research has shown social determinants of health affect the impact of COVID-19 on abdominal transplant recipients, but there has been less research on the effect of language proficiency. This is a cohort study of time to first COVID-19 vaccination among abdominal organ transplant recipients in an academic medical center in Boston, MA between 18 December 2020, and 15 February 2021. Cox proportional hazards analysis of time to vaccination by preferred language were adjusted for race, age group, insurance, and transplanted organ. Among 3001 patients, 53% were vaccinated during the study period. Language preference other than English was independently associated with delay to vaccination (0.64, p = 0.001), on adjusted analysis. In addition, Black, Hispanic and other race patients were less likely to be vaccinated than white patients (0.58, 0.67, 0.68 vs. reference, all p < 0.03). Language preference other than English is an independent barrier to solid abdominal organ transplant recipients' access to timely COVID-19 vaccination. Equity in care should be improved by providing targeted services to minority language speakers.

Impact of COVID-19 on abdominal organ transplantation: A bibliometric analysis.

Abdominal solid organ transplant (SOT) programs have been hit hard by the COVID-19 pandemic, which was officially declared as such on March 11, 2020. Over two years, the tightening and softening of limitations in response to the "waves" of infection and COVID-19 fluctuations have provided distinct issues for waitlisted patients, transplant recipients, and transplant organizations. We searched Scopus using the terms "transplant" and "transplantation," and organ-related phrases like "intestin*," "liver," "kidney," "hepatic," "renal," and "pancrea*," as well as COVID-19 terms such as "COVID-19," "coronavirus," and "SARS-CoV-2." We included articles, reviews, conference papers, letters, notes, editorials, brief surveys, book chapters, and errata and studied nations, institutions, authors, journals, keywords, and articles. VOSviewer 1.6.18 and Excel were used to create tables and figures. We included 1,251 of 1,256 studies. Among them, 289 (23.1%), 489 (39.1%), and 473 (37.8%) papers were published in 2020, 2021, and 2022, with mean (SD) citations of 30.3 (53.3), 14.3 (26.8), and 4.79 (6.38), respectively. Compared to other abdominal organs, the field of kidney transplants had the highest number of articles describing the impact of COVID-19. The United States contributed the most articles, and the American Journal of Transplantation published the most articles. To our knowledge, this is the first bibliometric investigation of the impact of COVID-19 on SOT. This report provides an overview of the research conducted on SOT and COVID-19. There is potential for this bibliometric analysis to serve as a beneficial and practical resource for ongoing and future research.

CAQ Corner: Evaluation and management of the living donor recipient.

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Recent advances in anaesthesia for abdominal solid organ transplantation.

Organ transplantation has undergone remarkable revolution in the last two decades and offers a scope for survival amongst patients with end-stage organ failure. Along with availability of advanced surgical equipment and haemodynamic monitors, minimally invasive surgical techniques have emerged as options for surgery both amongst the donors and recipients. Newer trends in haemodynamic monitoring and expertise in ultrasound guided fascial plane blocks have changed the management in both donors and recipients. The availability of factor concentrates and point-of-care tests for coagulation have allowed optimal and restrictive fluid management of patients. Newer immunosuppressive agents are useful in minimising rejection following transplantation. Concepts on enhanced recovery after surgery have allowed early extubation, feeding and shorter hospital stay. This review gives an overview of the recent progress in anaesthesia for organ transplantation.