Ischemia Time Research Articles

Development of posttransplant diabetes mellitus in US recipients of liver transplant is influenced by OPTN region

Posttransplant diabetes mellitus (PTDM) is associated with significant morbidity and mortality in liver transplant recipients (LTRs). We used the Organ Procurement and Transplantation Network (OPTN) database to compare the incidence of developing PTDM across the United States and develop a risk prediction model for new-onset PTDM using OPTN region as well as donor-related, recipient-related, and transplant-related factors. All US adult, primary, deceased donor, LTRs between January 1, 2007, and December 31, 2016, with no prior history of diabetes noted, were identified. Kaplan-Meier estimators were used to calculate the cumulative incidence of PTDM, stratified by OPTN region. Multivariable Cox proportional hazards models were fitted to estimate hazards of PTDM in each OPTN region and build a risk prediction model, through backward selection. Cumulative incidence of PTDM at 1 year, 3 years, and 5 years after transplant was 12.0%, 16.1%, and 18.9%, respectively. Region 3, followed by regions 8, 2, and 9, had the highest adjusted hazards of developing PTDM. Inclusion of OPTN region in a risk prediction model for PTDM in LTRs (including recipient age, sex, race, education, insurance coverage, body mass index, primary liver disease, cold ischemia time, and donor history of diabetes) modestly improved performance (C-statistic = 0.60). In patients without pre-existing, confirmed diabetes mellitus, the incidence of PTDM in LTRs varied across OPTN regions, with the highest hazards in region 3, followed by regions 8, 2, and 9. The performance of a novel risk prediction model for PTDM in LTRs has improved performance with the inclusion of the OPTN region. Vigilance is recommended to centers in high-risk regions to identify PTDM and mitigate its development.

Ten hour donor heart ischemic time with 10ºC static storage

Utilization of 10ºC static storage safely extended both ischemic time and travel radius in heart transplantation. A 57-year-old man with ischemic cardiomyopathy, a left ventricular assist device (LVAD), and end-stage renal disease was listed for combined heart-kidney transplant. The donor hospital in Anchorage, AK, was located approximately 2,700 nautical miles and 8 hours from the recipient center. The organ was transported in 10ºC static storage with over 10 hours of ischemic time and had superb early allograft function. Excellent outcomes with extended ischemic times can be achieved without machine perfusion, provided good recovery, storage, and implant techniques are followed.

Evaluating Predictive Factors for Lymphocele Formation Following Kidney Transplantation.

Lymphocele is a common complication post-kidney transplantation, influenced by various factors including surgical technique, graft vessel count, operator experience, body mass index, ischemia time, and immunotherapy regimens. The purpose of this study was to evaluate lymphocele risk factors, particularly focusing on the role of end-stage kidney disease. A retrospective study was conducted on renal transplant recipients from a single center (March 2020 to December 2022). Patients were categorized into those developing lymphocele and those without during the postoperative period. Data, including sociodemographic, personal history, graft-related variables, intervention, and postoperative outcomes, were collected from electronic medical records. Out of 291 renal transplant recipients, 57 (19.6%) developed postoperative lymphocele, with 15 (5.1%) being symptomatic. Patients with body mass index <24.9 kg/m2 have lower risk of developing lymphocele with an Odds Ratio of 0.538 (P=0.046). Higher lymphocele prevalence was noted in patients with chronic tubulointerstitial nephritis (46.2%; OR 3.815; P=0.024). Focal segmental glomerulosclerosis patients showed no lymphocele (0.0%; OR 0.123; P=0.048). Other factors, including autosomal dominant polycystic kidney disease, did not exhibit significant differences in lymphocele prevalence. The etiology of end-stage kidney disease can serve as a significant predictor of lymphocele development during the postoperative period following renal transplantation. Further larger prospective studies are required to comprehensively assess risk factors and explore end-stage kidney disease potential role in predicting lymphocele formation.

Study of related factors to vascular complications after pediatric liver transplantation

Objective: To explore the related factors of vascular complications after liver transplantation in children. Methods: This is a retrospective case-series research. The clinical data of 89 pediatric liver transplant patients admitted to the Organ Transplantation Center, the Affiliated Hospital of Qingdao University from January 2016 to March 2024 were collected retrospectively. This study included 44 males and 45 females,aged from 4 months to 17 years. The ratio of graft to recipient weight was 0.6% to 7.7%. The primary diseases included 48 cases of biliary atresia and 41 cases of non-biliary atresia. The t-test, Wilcoxon rank sum test, χ2 test, and Fisher's exact probability method were used for data analysis. Multivariate Logistic regression was used to analyze the related factors of vascular complications. Results: All 89 children with liver transplantation completed surgery successfully. There were 8 cases of arterial complications after surgery, including 6 cases of hepatic artery thrombosis and 2 cases of hepatic artery stenosis. There were 16 cases of portal vein complications after surgery, including 9 cases of portal vein stenosis and 7 cases of portal vein thrombosis. The results of univariate analysis showed that the age of the recipient ≤1 year was the relevant factor for hepatic arterial complications(χ2=4.772,P=0.029). The age of the recipient ≤1 year, the age of the donor, the hepatic phase, and the time of cold ischemia were the relevant factors for the occurrence of portal vein complications(χ2=7.270,Z=388.500,Z=838.000, Z=594.500;all P<0.05). The results of multivariate analysis showed that age(≤1 year vs. >1 year) and duration of cold ischemia(every additional 1 hour) were independent related factors for portal vein complications after liver transplantation in children(both P<0.05). Conclusion: Children aged ≤1 year and with prolonged cold ischemia are more likely to develop portal vein complications after liver transplantation.

Adoption of a Semi-elective Lung Transplantation Practice by Safely Extending Cold Ischemic Times

Lung transplantation is a complex surgical procedure performed by specialized teams. Practice changes to eliminate overnight lung transplants were implemented at our center and patient outcomes were evaluated. Patient and donor organ selection were performed in the standard fashion. All donors with a cross clamp after 6 PM matched to any of our listed recipients-independent of their surgical complexity or risk-were kept in a temperature-controlled iceless cooler from procurement to recipient implant. All recipients had a 7 AM in-room start. Data were prospectively collected and compared to a cohort of recipients from the previous fifteen months. 82 transplants were performed at a single academic institution between 7/1/22 and 1/7/24, 21% of which included allografts with extended ischemic times utilizing the iceless cooler (n=18) with a median average temperature of 6.81 degrees Celsius. Median ischemic times were 13.9 (12.5 - 15.6) hours, more than twice the length of ischemic times in the standard group (n=64, 6.8 (6.1 - 7.4) hours). Post-operative outcomes were similar between groups, including post-operative ICU duration (12 vs 9 days in the standard group), length of stay (24 vs 20 days), PGD3 (17% vs 20%), post-operative ECMO (22% vs 20%), and six-month survival (94% vs 91%). Donor lungs preserved in an iceless cooler were successfully transplanted after extended cold ischemic times. Adoption of a semi-elective transplant strategy can be successfully implemented without compromising patient outcomes. Additional advantages may be gleaned through daytime transplantation with standard transplant surgical teams rather than overnight, on call-teams.

Surgical Experience and Functional Outcomes after Laparoscopic and Robot-Assisted Partial Nephrectomy: Results from a Multi-Institutional Collaboration

Background: In patients treated with partial nephrectomy, prior evidence showed that peri-operative outcomes, such as complications and ischemia time, improved as a function of the surgical experience of the surgeon, but data on functional outcomes after surgery are still scarce. Methods: We retrospectively analyzed data of 4011 patients with a single, unilateral cT1a-b renal mass treated with laparoscopic or robot-assisted partial nephrectomy. The operations were performed by 119 surgeons at 22 participating institutions between 1997 and 2022. Multivariable models investigated the association between surgical experience (number of prior operations) and acute kidney injury (AKI) and recovery of at least 90% of baseline estimated glomerular filtration rate (eGFR) 1 yr after partial nephrectomy. The adjustment for case mix included age, Body Mass Index, preoperative serum creatinine, clinical T stage, PADUA score, warm ischemia time, pathologic tumor size, and year of surgery. Results: A total of 753 (19%) and 3258 (81%) patients underwent laparoscopic and robot-assisted partial nephrectomy, respectively. Overall, 37 (31%) and 55 (46%) surgeons contributed only to laparoscopic and robotic learning curves, respectively, whereas 27 (23%) contributed to the learning curves of both approaches. In the laparoscopic group, 8% and 55% of patients developed AKI and recovered at least 90% of their baseline eGFR, respectively. After adjusting for confounders, we did not find evidence of an association between surgical experience and AKI after laparoscopic partial nephrectomy (odds ratio [OR]: 0.9992; 95% confidence interval [CI]: 0.9963, 1.0022; p = 0.6). Similar results were found when 1-year renal function was the outcome of interest (OR: 0.9996; 95% CI: 0.9988, 1.0005; p = 0.5). Among patients who underwent robot-assisted partial nephrectomy, AKI occurred in 11% of patients, whereas 54% recovered at least 90% of their baseline eGFR. On multivariable analyses, the relationship between surgical experience and AKI after surgery was not statistically significant (OR: 1.0015; 95% CI: 0.9992, 1.0037; p = 0.2), with similar results when the outcome of interest was renal function one year after surgery (OR: 1.0001; 95% CI: 0.9980, 1.0022; p = 0.9). Virtually the same findings were found on sensitivity analyses. Conclusions: In patients treated with laparoscopic or robot-assisted partial nephrectomy, our data suggest that the surgical experience of the operating surgeon might not be a key determinant of functional recovery after surgery. This raises questions about the use of serum markers to assess functional recovery in patients with two kidneys and opens the discussion on what are the key steps of the procedure that allowed surgeons to achieve optimal outcomes since their initial cases.

Ultrasound-guided renal artery balloon catheter occluded hybrid partial nephrectomy (UBo-HPN) with branch renal artery occlusion: a single arm trial

BackgroundOne key focus of partial nephrectomy is preserving renal function. Segmental renal artery occlusion with microdissection at the renal hilum confines ischemia, effectively reducing warm ischemic injury. Ultrasound-Guided Renal Artery Balloon Catheter Occluded Hybrid Partial Nephrectomy (UBo-HPN) can achieve branch occlusion without the need for dissecting the renal hilum.ObjectiveTo investigate the feasibility and safety of UBo-HPN of branch renal artery occlusion in the treatment of localized renal tumors.Subject and methodsA prospective single-arm analysis involving 20 patients with renal localized tumors underwent robot assisted UBo-HPN with branch renal artery occlusion from August 2021 to July 2023, with an average follow-up of 12 months.ResultsAll patient was successfully operated on without conversion to conventional arterial clamping or radical nephrectomy. One case (5%) of minor complication occurred in the whole cohort, which was bruising around the puncture site. The mean total operative time was 95.8 min, with a mean operative time of 21.25 min for vascular intervention. The mean warm ischemia time was 20.35 min, and the median estimated blood loss was 50 ml. The median eGFR preservation percentage at postoperative 48 h, 30 days, and the latest follow-up were 87.52%, 91.47%, and 92.2%, respectively. After a median follow-up of 10.2 (2.3–19.2) months, no patients had radiological tumor recurrence or died from tumor-related causes.ConclusionsUBo-HPN with renal artery branch occlusion emerges as an efficient alternative to partial nephrectomy (PN), which achieved branch artery occlusion without dissecting the renal hilum. Long-term follow-up is expected for functional outcomes.

Assessing the reliability of rapid frozen tissue sections from pre-transplant kidney biopsies in DCD donors and correlations with clinico-pathological data: a pilot study.

Compared to donations after brain death, donations after circulatory death present a series of difficulties: the acquisition of the family's consent, the need for qualified personnel and specific resources, death assessment, assessment of the organ, and graft care (pre- and post-transplant). These are all time-related factors that negatively impact the organ, resulting in increased tubular, glomerular, and vascular damage. The evaluation of the organ, as per today's standards, requires three hours for the preparation and processing of formalin-fixed paraffin-embedded (FFPE) samples. An alternative to this is the use of the extemporaneous frozen biopsy. However, frozen samples are considered a second choice in the decision-making process. This retrospective study investigates the reliability of the frozen samples in identifying a series of morphological alterations compared to the more accepted results from FFPE samples. Additionally, two important clinical data, terminal serum creatinine levels and warm ischemia time, were correlated to the presence of some morphological alterations in an attempt to find effective and fast strategies to predict the kidney transplant outcome.

Robotic kidney transplant has superior outcomes compared to open kidney transplant: results of a propensity match analysis.

Several studies have demonstrated the feasibility of robotic kidney transplant (RKT) as a safe alternative to open kidney transplant (OKT). However, significant selection bias in RKT patient selection limits meaningful comparison between the two techniques. This is a single-center retrospective review of a prospectively maintained kidney transplant database (2021-2024). Outcomes after the first 50 "non-selected" RKTs are compared with a contemporary cohort of 100 OKTs after propensity score matching for age, gender, BMI and type of donation (living vs deceased). Data pertinent to recipient demographics, intraoperative parameters, and short-term post-operative outcomes were collected and compared. Both groups were well-matched for recipient age, gender, BMI, and donation type. RKT group had significantly longer total operative time (RKT 258min vs. OKT 183min; p < 0.0001) and warm ischemia time (RKT 37min vs. OKT 31min; p < 0.0001) but significantly less blood loss (OKT 155ml vs. RKT 93ml). Average length of hospital stay for both groups was 5days, with OKT group demonstrating significantly higher rates of post-operative complications (OKT 31% vs. RKT 14%; p = 0.028), return to OR (OKT 15% vs. RKT 2%; p = 0.021), hematoma (OKT 13% vs. RKT 2%; p = 0.0355), and lymphocele (OKT 25% vs. RKT 6%; p = 0.0039). OKT group also had higher 30-day readmission rate (OKT 31% vs. RKT 14%) and post-operative opioid requirement (OKT 93 MME vs. RKT 65; p = 0.0254). There were no differences in rates of wound infection, urine leaks, delayed graft function, acute rejection, graft loss, and patient death between the two groups. RKT is a safe and viable alternative to OKT as a first-choice procedure for all patients with ESRD. RKT offers many advantages over OKT which can lead to its wider adoption in the coming years as the new standard of care for ESRD patients.

Timeliness of reperfusion in ST-segment elevation myocardial infarction and outcomes in Kerala, India: results of the TRUST outcomes registry.

Transatlantic guidelines endorse quality metrics for timely reperfusion in patients with ST-elevation myocardial infarction (STEMI). Compliance in low- and middle-income countries (LMICs) is largely unknown. We prospectively evaluated 2928 STEMI patients in Kerala, India, across 16 PCI-capable hospitals who received reperfusion with either primary percutaneous coronary intervention (PPCI) or fibrinolysis. Primary endpoint was a major adverse cardiovascular event (MACE) composite of death, non-fatal myocardial infarction, stroke or readmission for heart failure at 1-year. Among reperfused STEMI patients, 320 (10.9%) received timely reperfusion with either PPCI or fibrinolysis, 1985 (67.8%) received delayed PPCI, and 623 (21.3%) received delayed fibrinolysis. Timely reperfusion had lower unadjusted MACE rates than delayed PCI or fibrinolysis (timely reperfusion: 11.9%, delayed PPCI: 13.6%, delayed fibrinolysis: 23.9%, P < 0.001). Mortality was lowest in the timely reperfusion group (timely reperfusion: 6.3%, delayed PPCI: 7.8%, delayed fibrinolysis 18.8%, P < 0.001). After multivariate analysis, delayed fibrinolysis had a higher MACE rate (HR 1.52 95% CI 1.04-2.21) and mortality (HR 1.97, 95% CI 1.18-3.25) compared to timely reperfusion. Total ischemic time > 3h and delayed first medical contact-to-needle time predicted MACE at 1 year. Among STEMI patients in Kerala, India, only one in 10 eligible patients received timely reperfusion. Longer total ischemic times and delayed fibrinolysis were associated with 1-year MACE. Improving timely reperfusion is critical to enhancing STEMI outcomes in LMICs. What is already known on this topic Given the established link between delay to reperfusion and worse major adverse cardiac events (MACE), global efforts have concentrated on minimizing different components of the total ischemic time to improve ST-elevation myocardial infarction (STEMI) outcomes. Compliance in low- and middle-income countries (LMICs) is largely unknown. What this study adds In this cohort of STEMI patients in Kerala, India, total ischemic time and first medical contact-to-needle time correlated with long-term MACE rates, whereas other timeliness indicators did not. How this study might affect research, practice or policy Our study highlights the significant barriers to accessing STEMI care that are prevalent in LMICs despite incremental growth in the number of PCI-capable hospitals. The pre-hospital phase within total ischemic time is the most important quality improvement metric of STEMI care in LMICs, especially for patients chosen for fibrinolysis.

Efectividad de las redes de atención al IAMCEST de diagnóstico extrahospitalario: revisión sistemática y metanálisis

Introduction and objectivesPrimary percutaneous coronary intervention (pPCI) is recommended for ST elevation myocardial infarction (STEMI). Countries have designed various STEMI network models to optimize out-of-hospital triage, timely treatment, and patient outcomes. The aim of this study was to evaluate the effectiveness of STEMI network implementation including out-of-hospital triage in improving STEMI case-fatality and long-term mortality, and its effect on the proportion of patients presenting with heart failure, their ischemia time, and time to pPCI. MethodsSystematic review and meta-analysis. Searches of PubMed, Scopus, and Web of Science databases covering January 2000 to December 2023, study selection, and data extraction were completed by 3 independent reviewers. ResultsA total of 32 articles were selected. STEMI network implementation with out-of-hospital triage was associated with reductions of 35% in case-fatality (95%CI, -23% to -45%), 27% in long-term mortality (95%CI, -22% to -32%), and in the proportion of patients with Killip III-IV at admission, ischemia, time and time to pPCI (-17%, 95%CI, -35% +6%; -19%, 95%CI, -6% to -31%; -33%, 95%CI, -16% to -47%, respectively). Networks based on emergency transport systems and those involving the entire health system, including primary care centers and hospitals without pPCI capabilities, showed similar effectiveness. Greater effectiveness was observed in urban vs rural areas and high-income vs middle- and low-income countries. ConclusionsThe implementation of out-of-hospital triage-based STEMI networks is effective in reducing STEMI case-fatality and long-term mortality, independently of the geographic and socioeconomic conditions of the region. Participation of the emergency transport system is the key element of successful networks.

The effects of underlying inflammatory bowel disease on the outcomes of primary sclerosing cholangitis liver transplant recipients

IntroductionInflammatory bowel disease (IBD) influences primary sclerosing cholangitis (PSC) severity, however, the impact of IBD on PSC liver transplantation (LT) outcomes is poorly understood. We aimed to elucidate the impact of IBD in modulating PSC LT outcomes. MethodsUsing UNOS data from 2010 through 2021, we identified PSC LT candidates with and without (±) IBD. We used adjusted competing-risk regression analysis to evaluate waitlist outcomes, Kaplan-Meier analysis to assess graft survival, and Cox proportional hazards modeling to identify factors associated with graft survival. ResultsOut of 5,586 PSC candidates added to the waitlist, 3,652 patients had IBD. Older age (SHR 1.01; 95 %CI 1.01–1.02) and initial MELD/PELD (SHR 1.03; 95 %CI 1.02–1.04) were associated with increased risk of waitlist mortality, while private insurance (SHR 0.00; 95 %CI 0.00–0.01) with reduced risk. PSC-IBD LT recipients had increased prevalence of cholangiocarcinoma (4.8 % vs 3.4 %, p=0.005). Longer donor cold ischemia times (HR 1.06; 95 %CI 1.03–1.09), presence of recipient diabetes (HR 1.52; 95 %CI 1.13–2.05), and employment (HR 0.75, 95 %CI 0.60–0.94) had an increased risk of graft failure among PSC patients with IBD, not seen in those without IBD. ConclusionRegardless of IBD, LT for PSC results in excellent outcomes. Certain clinicodemographic factors impacted waitlist and recipient mortality highlighting potential targets to enhance outcomes.

Laparoscopic Live Donor Nephrectomy: An Initial Moroccan Experience.

Introduction Laparoscopic nephrectomy is the gold standard for kidney removal in living donors, offering advantages such as reduced pain and quicker recovery. In Morocco, where end-stage renal disease (ESRD) is a growing concern, this approach could significantly impact the demand for kidney transplants. This study evaluates the safety and efficacy of laparoscopic live donor nephrectomy in the Moroccan healthcare system. Materials and methods Fifteen laparoscopic nephrectomies were analyzed, focusing on donor demographics, procedure details, and outcomes. Key parameters included donor age, BMI, operative time, warm ischemia time, and blood loss. Complications and graft outcomes were also assessed. Results The procedure was safe and effective, even in obese donors. Donors were predominantly female (80%), with an average age of 49.4 years. Obese donors had longer operative times (282 minutes vs. 220 minutes). Left kidney retrieval was preferred (95%). Warm ischemia averaged 6.27 minutesand blood loss was 207 mL. One donor had elevated creatinine postoperatively, while most maintained stable renal function. Eighteen complications, mostly minor, were reported. Conclusion Laparoscopic live donor nephrectomy is a safe and adaptable procedure in Morocco, offering low complication rates and favorable outcomes. It is effective for a diverse donor population, including older and obese individuals, and may help address the country's growing transplant needs.

Comparison of outcomes between single-port and multiport retroperitoneal robotic partial nephrectomy

IntroductionSingle-port (SP) robotic surgical system performs well in small anatomical spaces, which makes it suitable for retroperitoneal robotic partial nephrectomy (RPN). However, there is limited evidence comparing the safety and feasibility of SP RPN to multiport (MP) RPN. To address this gap in evidence, we sought to analyze and compare the safety of retroperitoneal RPN between SP and MP approaches. MethodsThis is a retrospective cohort study using data from the Single Port Advanced Research Consortium (SPARC) and a multicenter database of patients who underwent retroperitoneal RPN using either SP or MP between 2017 and 2023. Baseline, perioperative, and postoperative data were compared using t-tests, Mann-Whitney U test, χ2 test, and Fisher exact test. Multivariable analyses were conducted using robust and Poisson regressions. ResultsA total of 286 patients (SP RPN, n = 86 [30%]; MP RPN, n = 200 [70%]) underwent retroperitoneal RPN. R.E.N.A.L nephrometry score and tumor location were significantly different between the 2 groups. Notably, the ischemia time was significantly shorter in the MP group (16 vs. SP, 22 minutes, P < 0.001). Adjusting for baseline characteristics, the ischemia time was approximately 7.89 minutes longer for patients in the SP group compared to the MP group, on average (95% CI: 5.87, 9.92; P < 0.001). No significant differences were observed in operative time, EBL, blood transfusion, conversion rates, LOS, PSM, and overall 30-day postoperative complications between the 2 groups. ConclusionOur study shows that retroperitoneal SP and MP RPN have comparable perioperative and postoperative outcomes, except for the longer ischemia time in the SP platform. SP RPN is a safe and viable alternative; however, further research is needed to explore its potential benefits, cost-effectiveness, and long-term oncologic outcomes.

Intracoronary ECG ST-segment shift remission time during reactive myocardial hyperemia: a new method to assess hemodynamic coronary stenosis severity.

Fractional flow reserve (FFR) measurements are recommended for assessing hemodynamic coronary stenosis severity. Intracoronary ECG (icECG) is easily obtainable and highly sensitive in detecting myocardial ischemia due to its close vicinity to the myocardium. We hypothesized that the remission time of myocardial ischemia on icECG after a controlled coronary occlusion accurately detects hemodynamically relevant coronary stenosis. This retrospective, observational study included patients with chronic coronary syndrome undergoing hemodynamic coronary stenosis assessment immediately following a strictly 1-min proximal coronary artery balloon occlusion with simultaneous icECG recording. icECG was used for a beat-to-beat analysis of the ST-segment shift during reactive hyperemia immediately following balloon deflation. The time from coronary balloon deflation until the ST-segment shift reached 37% of its maximum level, i.e., icECG ST-segment shift remission time (τ-icECG in seconds), was obtained by an automatic algorithm. τ-icECG was tested against the simultaneously obtained reactive hyperemia FFR at a threshold of 0.80 as a reference parameter. From 120 patients, 139 icECGs (age, 68 ± 10 yr old) were analyzed. Receiver operating characteristic (ROC) analysis of τ-icECG for the detection of hemodynamically relevant coronary stenosis at an FFR of ≤0.80 was performed. The area under the ROC curve was equal to 0.621 (P = 0.0363) at an optimal τ-icECG threshold of 8 s (sensitivity, 61%; specificity, 67%). τ-icECG correlated inversely and linearly with FFR (P = 0.0327). This first proof-of-concept study demonstrates that τ-icECG, a measure of icECG ST segment-shift remission after a 1-min coronary artery balloon occlusion accurately detects hemodynamically relevant coronary artery stenosis according to FFR at a threshold of ≥8 s.NEW & NOTEWORTHY Invasive hemodynamic measurements are recommended by the current cardiology guidelines to guide percutaneous coronary interventions in the setting of chronic coronary syndrome. However, those pressure-derived indices demonstrate several theoretical and practical limitations. Thus, this study demonstrates the accuracy of a novel, pathophysiology-driven approach using intracoronary ECG for the identification of hemodynamically relevant coronary lesions by quantitatively assessing myocardial ischemia remission.

Impact of Ischemia Time on Kidney Function in Patients with Microcirculation Impairment during Partial Nephrectomy (PN) for Kidney Cancer

Impact of Ischemia Time on Kidney Function in Patients with Microcirculation Impairment during Partial Nephrectomy (PN) for Kidney Cancer

The effect of rewarming ischemia on tissue transcriptome and metabolome signatures: a clinical observational study in lung transplantation

BACKGROUND:In lung transplantation (LuTx), various ischemic phases exist, yet the rewarming ischemia time (RIT) during implantation has often been overlooked. During RIT, lungs are deflated and exposed to the body temperature in the recipient's chest cavity. Our prior clinical findings demonstrated that prolonged RIT increases the risk of primary graft dysfunction. However, the molecular mechanisms of rewarming ischemic injury in this context remain unexplored. We aimed to characterize the rewarming ischemia phase during LuTx by measuring organ temperature and comparing transcriptome and metabolome profiles in tissue obtained at the end versus the start of implantation. METHODSIn a clinical observational study, 34 double-LuTx with ice preservation were analyzed. Lung core and surface temperature (n=65 and 55 lungs) was measured during implantation. Biopsies (n=59 lungs) were wedged from right middle lobe and left lingula at start and end of implantation. Tissue transcriptomic and metabolomic profiling were performed. RESULTSTemperature increased rapidly during implantation, reaching core/surface temperatures of 21.5°C/25.4°C within 30min. Transcriptomics showed increased pro-inflammatory signaling and oxidative stress at the end of implantation. Upregulation of NLRP3 and NFKB1 correlated with RIT. Metabolomics indicated elevated levels of amino acids, hypoxanthine, uric acid, cysteineglutathione disulfide alongside decreased levels of glucose and carnitines. Arginine, tyrosine, and 1-carboxyethylleucine showed correlation with incremental RIT. CONCLUSIONSThe final rewarming ischemia phase in LuTx involves rapid organ rewarming, accompanied by transcriptomic and metabolomic changes indicating pro-inflammatory signaling and disturbed cell metabolism. Limiting implantation time and lung cooling represent potential interventions to alleviate rewarming ischemic injury.

Direct Procurement with Machine Perfusion and Normothermic Regional Perfusion in Donation after Circulatory Death Heart Transplantation

ObjectiveDonation after circulatory death (DCD) heart transplants have increased in US with DPP and TA-NRP techniques. There remains a paucity of data examining DPP and TA-NRP outcomes. The purpose of this study was to investigate the impact of DCD technique on post-transplant outcomes compared to DBD donors. MethodsAdult patients undergoing heart transplantation between December 1, 2019, and June 30, 2023 were identified in the UNOS registry. DPP and TA-NRP cohorts were detected using time of death to aortic cross-clamp of 30 minutes. Categorical variables were compared using chi-square or Fisher exact tests, while continuous variables were compared using Mann-Whitney U tests. Propensity score matching was performed using a 1:3 match. 1-year survival was analyzed using log-rank test and Cox proportional hazard regression model. ResultsDuring the study period, there were 7338 DBD and 419 DCD heart transplants. At 1-year, there was no difference in survival between unmatched (p=0.13) and matched (p=0.36) DBD and DCD recipients. There was an increase in acute rejection and rejection requiring treatment in DCD compared to DBD in the matched cohort. 134 TA-NRP and 242 DPP transplants occurred. 1-year survival and post-transplant outcomes were similar in DPP and TA-NRP. TA-NRP functional warm ischemia times increased significantly during the study period. ConclusionsIn a matched cohort, DCD heart recipients experience increased acute rejection, both treated and non-treated, compared to DBD. Despite differences in the techniques, and likely functional warm ischemic times, acute rejection, survival, and other secondary outcomes are similar between DPP and TA-NRP.

Prolonged Cold Ischemia Time in Pancreas Transplantation Yields Similar Outcomes Compared with Standard of Care Outcomes: Single-Center Experience, a Call to Action to Decrease Nonuse Rates

Prolonged Cold Ischemia Time in Pancreas Transplantation Yields Similar Outcomes Compared with Standard of Care Outcomes: Single-Center Experience, a Call to Action to Decrease Nonuse Rates

Impact of diabetes on epicardial reperfusion and mortality in a contemporary STEMI population undergoing mechanical reperfusion: insights from the ISACS STEMI COVID 19 Registry

Background and AimDiabetes has been shown in last decades to be associated with a significantly higher mortality among patients with ST‐segment elevation myocardial infarction (STEMI) treated with primary PCI (PPCI). Therefore, the aim of current study was to evaluate the impact of diabetes on times delays, reperfusion and mortality in a contemporary STEMI population undergoing PPCI, including treatment during the COVID pandemic. Methods and ResultsThe ISACS-STEMI COVID-19 is a large-scale retrospective multicenter registry involving PPCI centers from Europe, Latin America, South-East Asia and North-Africa, including patients treated from 1st of March until June 30, 2019 and 2020. Primary study endpoint of this analysis was in-hospital mortality. Secondary endpoints were postprocedural TIMI 0-2 flow and 30-day mortality. Our population is represented by 16083 STEMI patients. A total of 3812 (23,7%) patients suffered from diabetes. They were older, more often males as compared to non-diabetes. Diabetic patients were less often active smokers and had less often a positive family history of CAD, but they were more often affected by hypertension and hypercholesterolemia, with higher prevalence of previous STEMI and previous CABG. Diabetic patients had longer ischemia time, had more often anterior MI, cardiogenic shock, rescue PCI and multivessel disease. They had less often out-of-hospital cardiac arrest and in-stent thrombosis, received more often a mechanical support, received less often a coronary stent and DES. Diabetes was associated with a significantly impaired postprocedural TIMI flow (TIMI 0-2: 9.8% vs 7.2%, adjusted OR [95% CI] = 1.17 [1.02-1.38], p = 0.024) and higher mortality (in-hospital: 9.1% vs 4.8%, Adjusted OR [95% CI] =1.70 [1.43-2.02], p < 0.001); 30-day mortality (10.8% vs 6%, Adjusted HR [95% CI] =1.46 [1.26-1.68], p < 0.001) as compared to non-diabetes, particularly during the pandemic. ConclusionsOur study showed that in a contemporary STEMI population undergoing PPCI, diabetes is significantly associated with impaired epicardial reperfusion that translates into higher in-hospital and 30-day mortality, particularly during the pandemic.