Transplantation Procedures Research Articles

Acute kidney injury during transplantation and the role of inflammasomes: A brief review.

The increasing demand for an effective therapeutic modality in the form of organ transplantation leads to the need to improve the long-term outcomes of the process. Ischemia/reperfusion injuries (IRI) are an integral part of the kidney transplantation process, contributing to inflammation, oxidative stress and activation of the immune system. Inflammasomes, as a component of the immune response, in the form of inflammatory mediators during infection or tissue damage, initiate cell death called pyroptosis. In this context, we have defined the process of inflammasome activation in response to IRI, which is a potential cause of early kidney rejection due to increased susceptibility of the kidneys to ischemia. This review focuses on analyzing the modulation of inflammasome activity in kidney transplants and the activation of the NLRP3 inflammasome as a crucial element of kidney injury during the transplantation procedure, which could be a potential target for future preventive/therapeutic strategies.

Life-long functional regeneration of in vivo airway epithelium by the engraftment of airway basal stem cells.

Durable and functional regeneration of the airway epithelium in vivo with transplanted stem cells has the potential to reconstitute healthy tissue in diseased airways, such as in cystic fibrosis or primary ciliary dyskinesia. Here, we present detailed protocols for the preparation and culture expansion of murine primary and induced pluripotent stem cell-derived airway basal stem cells (iBCs) and methods for their intra-airway transplantation into polidocanol-conditioned murine recipients to achieve durable in vivo airway regeneration. Reconstitution of the airway tissue resident epithelial stem cell compartment of immunocompetent mice with syngeneic donor cells leverages the extensive self-renewal and multipotent differentiation properties of basal stem cells (BCs) to durably generate a broad diversity of mature airway epithelial lineages in vivo. Engrafted donor-derived cells re-establish planar cell polarity as well as functional ciliary transport. By using this same approach, human primary BCs or iBCs transplanted into NOD-SCID gamma recipient mice similarly display engraftment and multilineage airway epithelial differentiation in vivo. The time to generate mouse or human iBCs takes ~60 d, which can be reduced to ~20 d if previously differentiated cells are thawed from cryopreserved iBC archives. The tracheal conditioning regimen and cell transplantation procedure is completed in 1 d. A competent graduate student or postdoctoral trainee should be able to perform the procedures listed in this protocol.

Sustained Repigmentation in Vitiligo and Leukodermas Using Melanocyte-Keratinocyte Transplantation: 7 Years of Data.

The autologous non-cultured melanocyte-keratinocyte transplantation procedure (MKTP) has emerged as an effective treatment for various types of vitiligo and leukodermas. However, there is limited data on the long-term outcomes of the MKTP, especially in Thai patients. To assess the long-term efficacy and safety of the MKTP in patients with vitiligo and other leukodermas. This retrospective observational study analyzed data from 23 patients who underwent the MKTP for vitiligo and other leukodermas at the Siriraj MKTP Clinic, Thailand, and had a follow-up period exceeding 12 months. Clinical characteristics and MKTP specifics were evaluated. Repigmentation outcomes were assessed using the Vitiligo Area Scoring Index (VASI). Of the 23 patients (24 treated lesions), 78.3% had segmental vitiligo, while the others had nevus depigmentosus, nonsegmental vitiligo, or piebaldism. Most lesions (70.8%) were located on the face. At the 12-month follow-up, repigmentation showed an 80.8% ± 19.3% VASI improvement, which was sustained over 84 months with an 80%-90% VASI improvement. There was no statistically significant difference in repigmentation outcomes between facial and non-facial lesions. The MKTP demonstrated long-term efficacy and safety in treating vitiligo and other leukodermas, with sustained repigmentation over 84 months. These findings support the use of the MKTP as an effective treatment option for patients with refractory vitiligo and leukodermas, particularly within Thai populations.

Robot-assisted kidney transplantation: initial experience from a tertiary hospital in China

Abstract Background Robot-assisted kidney transplantation (RAKT) has currently become an effective alternative to open kidney transplantation (OKT), which has long been considered the gold standard for kidney transplant surgery. This study aimed to summarize our initial experience with RAKT and explore its safety and feasibility. Materials and methods Ten cases of RAKT, including 8 cases of deceased-donor kidney transplantation and 2 cases of living-donor kidney transplantation, were performed at our center from March 2023 to November 2023. Perioperative clinical data and follow-up results of patients were collected and statistically analyzed. Results All RAKT surgeries were performed successfully with no complications. The average operative time was 297.90 ± 65.59 minutes, and the median estimated blood loss was 100 mL. The average serum creatinine level decreased from 918.14 ± 166.63 μmol/L preoperatively to 109.89 ± 29.89 μmol/L at discharge. The postoperative outcomes of RAKT from both deceased and living donors were satisfactory during the follow-up period. Conclusions RAKT is an effective alternative to OKT and is suitable for both deceased- and living-donor kidney transplantations. The postoperative outcomes were satisfactory, and the postoperative complications were acceptable. RAKT appears to be a safe and feasible procedure for transplantation teams skilled in OKT and robot-assisted surgery.

Developing endoscopic cell sheet delivery device using a beating human heart simulator and a pig model for minimally invasive cardiac regenerative therapy

Abstract Introduction Recently, clinical trials have commenced for cardiac regenerative therapy utilizing stem cells in patients with heart failure. Among the various transplantation approaches, there is a growing demand for less invasive methods to transplant sheet/patch-shaped cell products onto the heart surface, rather than resorting to conventional open surgery. This is particularly important considering the need for immunosuppressants due to allogeneic cell transplantation. Objective This study aims to develop a device for endoscopic transplantation of cell sheets onto the beating heart surface. Methods Prototype devices, initially developed in our prior study using a static heart model (Regenerative Therapy, 2020), were refined to better suit the cell sheet transplantation procedure onto a beating heart. We constructed a three-dimensional (3D) model of a beating heart located inside a thoracic cavity model, based on human computed tomography data and a 3D printer dedicated to simulating endoscopic surgical procedures. Human mesenchymal stromal cell (MSC)-derived cell sheets were prepared using temperature-responsive culture dishes and transferred onto a beating heart model pulsating at 80 beats per minute. We assessed the technical feasibility (N=8). Furthermore, skeletal muscle tissue was harvested from the thigh of the Clawn miniature pigs, and skeletal myoblasts were cultured from enzymatically digested tissue to create a cell sheet for autologous transplantation (8.0×10⁶ cells/sheet). Subsequently, the cell sheets labeled with Hoechst 33342 were endoscopically transplanted onto the pig heart surface (N=2). The pigs were sacrificed one week later, and the engraftment of the cell sheet was histologically evaluated. Results Successful deployment of MSC sheets onto the beating heart model was achieved in all procedures with one trial (100% success rate). The procedure duration from device insertion to the completion of cell sheet transplantation averaged 142±19 seconds. In experiments on autologous transplantation of myoblast cell sheets, two cases were successfully accomplished, with the transplanted cell sheet positive for Hoechst 33342 observed on the heart surface. Conclusion We have developed an endoscopic cell sheet delivery device using a pulsating heart model and a pig model, which holds promise for minimally invasive cardiac regenerative therapy in the future. Further investigations into the safety of the procedure are warranted for the clinical application of this system.

Islet Transplantation: Current Limitations and Challenges for Successful Outcomes.

Islet transplantation is a promising approach for treating patients with unstable T1DM. However, it is confronted with numerous obstacles throughout the various stages of the transplantation procedure. Significant progress has been made over the last 25 years in understanding the mechanisms behind the loss of functional islet mass and in developing protective strategies. Nevertheless, at present, two to three pancreases are still needed to treat a single patient, which limits the maximal number of patients who can benefit from islet transplantation. Thus, this publication provides an overview of recent scientific findings on the various issues affecting islet transplantation. Specifically, we will focus on the understanding of the mechanisms involved and the strategies developed to alleviate these problems from the isolation stage to the post-transplantation phase. Finally, we hope that this review will highlight new avenues of action, enabling us to propose pancreatic islet transplantation to a maximum number of patients with T1DM.

Cost-effectiveness of Dual Hypothermic Oxygenated Machine Perfusion Versus Static Cold Storage in DCD Liver Transplantation.

Ex situ machine perfusion of the donor liver, such as dual hypothermic oxygenated machine perfusion (DHOPE), is increasingly used in liver transplantation. Although DHOPE reduces ischemia/reperfusion-related complications after liver transplantation, data on cost-effectiveness are lacking. Our objective was to evaluate the cost-effectiveness of DHOPE in donation after circulatory death (DCD) liver transplantation. We performed an economic evaluation of DHOPE versus static cold storage (SCS) based on a multicenter randomized controlled trial in DCD liver transplantation (DHOPE-DCD trial; ClinicalTrials.gov number, NCT02584283). All patients enrolled in the 3 participating centers in the Netherlands were included. Costs related to the transplant procedure, hospital stay, readmissions, and outpatients treatments up to 1 y posttransplant were calculated. The cost for machine perfusion was calculated using 3 scenarios: (1) costs for machine perfusion, (2) machine perfusion costs plus costs for personnel, and (3) scenario 2 plus depreciation expenses for a dedicated organ perfusion room. Of 119 patients, 60 received a liver after DHOPE and 59 received a liver after SCS alone. The mean total cost per patient up to 1 y posttransplant was €126 221 for the SCS group and €110 794 for the DHOPE group. The most significant reduction occurred in intensive care costs (28.4%), followed by nonsurgical interventions (24.3%). In cost scenario 1, DHOPE was cost-effective after 1 procedure. In scenarios 2 and 3, cost-effectiveness was achieved after 25 and 30 procedures per year, respectively. Compared with conventional SCS, machine perfusion using DHOPE is cost-effective in DCD liver transplantation, reducing the total medical costs up to 1 y posttransplant.

Global perspectives on donor-derived infections: Brazil and Argentina.

Brazil and Argentina are two of the South American countries that perform the highest number of solid organ transplant procedures globally each year. These procedures are not exempt from risks for the recipient, and there is a risk of donor-derived infections. Risk mitigation measures for disease transmission from donor to recipient are essential, and biovigilance systems play a crucial role to inform authorities and provide data for the definition of screening procedures and prevention of donor-derived infections. We herein describe the biovigilance systems in Brazil and Argentina and provide some data regarding potential and effective donors.

Gastric Bleeding in Stem Cell Transplantation: A Focus on Gastric Vascular Ectasia Under Post-Transplant Cyclophosphamide, Sirolimus, and Mycophenolate Mofetil Prophylaxis

Gastrointestinal bleeding (GIB) is a serious complication following allogeneic hematopoietic stem cell transplantation (HSCT), with limited data on its incidence and characteristics, particularly for upper gastrointestinal bleeding (UGIB) of gastric origin. We aimed to evaluate the incidence, clinical, endoscopic, and histopathologic features, and outcomes of UGIB, with a focus on gastric vascular ectasias (GVEs) in patients undergoing HSCT with graft-versus-host disease (GVHD) prophylaxis using post-transplant cyclophosphamide (PTCY), sirolimus or calcineurin inhibitors, and mycophenolate mofetil. This retrospective, single-center study included all adult patients who underwent allogeneic HSCT at a single institution between January 2017 and December 2023. Data were collected on transplant procedures, complications, and GIB incidents, with UGIB cases undergoing endoscopic and histologic examination. Out of 559 patients, 38 (6.6%) experienced UGIB, with 27 cases (70%) attributed to GVE. GVE typically presented as melena or hematemesis at a median time of 68 days (range, 29-125) after transplant. Endoscopy revealed diffuse oozing from gastric antral mucosa without distinct lesions, while histology showed vascular congestion and mild foveolar hyperplasia. The 6-month cumulative incidence of GVE was 5.1%. Older age (≥60 years) and diagnosis of myelodysplastic/myeloproliferative neoplasm were significant risk factors. All cases resolved with no attributable mortality with supportive measures including transfusions, proton-pump inhibitors, and sirolimus withdrawal in some cases. GVE is a notable cause of UGIB in HSCT recipients on PTCY-based GVHD prophylaxis, presenting significant morbidity but favorable outcomes with appropriate management. The potential role of sirolimus and conditioning agents in GVE pathogenesis warrants further investigation.

Drug Acute Liver Failure in Children Caused by Anthelmintic Agents (Albendazole): Treatment Strategy.

Drug-induced liver injury accounts for numerous clinically significant events each year and can cause severe injury, resulting in a need for liver transplant or fatality. Liver injury triggered by albendazole is relatively common, resulting in mild to moderate changes in liver enzymes and affecting ~16% of patients who use this medication. Albendazole-induced liver injury and jaundice have been previously documented, but a case of fulminant hepatic failure requiring liver transplant has not yet been described. Acute liver failure is a clinical syndrome that is potentially reversible. About 2% of liver transplants are performed because of acute liver failure. We reviewed drug-induced fulminant and subfulminant hepatic failures among pediatric patients transferred to the Batumi Center for Liver Diseases and Transplantation in Georgia. The 6 cases were children aged 2 to 14 years who were diagnosed in Georgia between 2018 and 2023. Of 6 children, patients N1 and N2 had reversible acute liver failure and treatment ended with recovery, patients N3 and N4 had successful transplant procedures performed at the peak of disease development, and patients N5 and N6 did not receive transplant procedures because of presence of irreversible brain damage. Although the Model for End-Stage Liver Disease Score (the model score for patients with end-stage liver disease) is useful for patients with chronic hepatocytic failure, the score does not apply for patients with acute liver failure. On the basis of our study, at the first signs of disease development, patients should be referred to the transplant center and the preparation of a living donor should be started immediately, so that organ transplant can be performed without a long elapse of time.

Cardiac Evaluation in Children With Chronic Renal Failure and Effect of Kidney Transplant.

Cardiovascular diseases are an important cause of mortality and morbidity in children with chronic renal failure. Cardiac evaluation and followup are crucial for these patients before and after renal transplant. Echocardiography is a noninvasive imaging modality that allows for the assessment of cardiac structure and function. We retrospectively investigated pretransplant and posttransplant echocardiography findings for 55 pediatric patients who had underwent kidney transplant. We recorded patient characteristics before and after transplant, including age, sex, follow-up period, etiology of renal failure, left ventricular systolic and diastolic diameters and the associated z scores, left ventricular mass indexes and z scores, ejection fraction and fractional shortening, aortic valve and atrioventricular valve insufficiencies, presence of pulmonary hypertension, and pericardial effusion (if any) in echocardiography. All participants underwent echocardiography at baseline and after 6 months following the transplant procedure. Posttransplant echocardiography evaluations showed that the z scores of left ventricular systolic and diastolic diameters decreased significantly, mitral regurgitation decreased, and left ventricular systolic functions and left ventricular mass index increased. Our study revealed that kidney transplant has a beneficial effect on the cardiovascular status of patients with end-stage renal disease, as shown by improvements in both structural and functional echocardiographic features. Cardiac functions must be monitored regularly before and after transplant. Transplantation is the optimal treatment option for preservation and improvement of cardiovascular functions.

Comparative Effects of Fedratinib and Upadacitinib on Renal Ischemia-Reperfusion Injury in Rat Models

Renal ischemia-reperfusion injury (RIRI) is a severe condition that frequently occurs following kidney transplantation or surgical procedures affecting renal blood flow. Inflammatory responses, oxidative stress, and apoptotic pathways significantly contribute to RIRI. This study aimed to compare the renoprotective effects of Fedratinib, a JAK2 inhibitor, and Upadacitinib, a JAK1 inhibitor, in rat models of RIRI. Both inhibitors were administered one hour prior to ischemia induction, and the effects on renal function, inflammation, and cell death pathways were assessed. The findings revealed that both Fedratinib and Upadacitinib significantly reduced serum creatinine and urea levels, inflammatory cytokines (TNF-α, IL-6), and markers of apoptosis (BCL2/BAX) by suppressing the JAK/STAT signaling pathways. Histopathological analysis showed substantial reduction in renal tissue damage in the treated groups compared to controls. The study concludes that JAK inhibition by either drug provides significant renoprotection in RIRI, though with some differences in the degree of pathway inhibition and clinical implications.

Trends in knee cartilage repair procedures in the United States, 2010 to 2020

IntroductionSurgical intervention of knee articular cartilage injuries may prevent degeneration in symptomatic patients. ObjectiveThis study aims to analyze trends, demographics, and yearly incidence of four different knee cartilage repair procedures in the U.S. from 2010 to 2020. MethodsThe PearlDiver database was queried for patients who underwent knee microfracture, autologous chondrocyte implantation (ACI), osteochondral autograft transfer (OAT) and osteochondral allograft transplantation (OCA) procedures from 2010 to 2020. Student t and χ-square tests were used for statistical comparisons and analysis of data trends. Regression models and Compound Annual Growth Rates (CAGR) further assessed trends of each procedure. Results220,674 patients from 2010 to 2020 were included in this study. Microfracture incurred a 62.4% decrease in occurrence (P < 0.001). Incidence of OCA trended upwards (37.7%; P = 0.065) whilst OAT procedures significantly decline (53.9%; P < 0.001). ACI procedure numbers remained relatively stable (11.2% increase; P = 0.847). ConclusionsThe incidence of microfracture significantly decreased in the United States from 2010 to 2020. There was a positive trend in the incidence of OCA cases, whilst the number of OAT cases decreased significantly. The number of ACI cases performed per year did not change significantly over the study period with the exception of an increase from 2017-2019. Microfracture procedures were performed in an older patient population than the other cartilage procedures. Males were more likely to undergo the four cartilage preservation surgeries compared to females. Similar studies should be carried out in other large health databases to confirm the external validity of these trends across the United States.

The Proportion of Catagen and Telogen Hair Follicles in Occipital Scalp of Male Androgenetic Alopecia Patients: Challenging the Established Dogma.

The hair follicle can cycle throughout a lifetime, undergoing periods of growth (anagen), regression (catagen) and relative quiescence (telogen). The time that a hair follicle spends in each of these stages is crucial to determine the length of hair fibre that it produces. Perturbations in this regard can manifest in various hair diseases such as anagen effluvium, or acute and chronic telogen effluvium. The established 'dogma' when considering how many hair follicles there are in each stage has long been that the majority are in anagen (85%-90%), followed by telogen (10%-15%) and catagen (1%-2%). These values are based on various studies using different methodologies such as hair plucking, phototrichograms and histology. However, these methods have flaws when it comes to differentiating between catagen and telogen follicles. We sought to determine the catagen: telogen ratio through the exvivo stereomicroscopic examination of hundreds of hair follicles removed from the occipital scalp of 14 Caucasian males during routine hair transplantation procedures. Using this methodology, and in agreement with a similar observation by another research group, we found that the percentage of catagen hair follicles was higher (7.5%) than telogen (3.5%) in all patients assessed. Consequently, we believe that the percentage of catagen follicles is clearly underestimated and therefore challenge the current established dogma.

A novel two-stage network data envelopment analysis model for kidney allocation problem under medical and logistical uncertainty: a real case study.

Organ transplantation is one of the most complicated and challenging treatments in healthcare systems. Despite the significant medical advancements, many patients die while waiting for organ transplants because of the noticeable differences between organ supply and demand. In the organ transplantation supply chain, organ allocation is the most significant decision during the organ transplantation procedure, and kidney is the most widely transplanted organ. This research presents a novel method for assessing the efficiency and ranking of qualified organ-patient pairs as decision-making units (DMUs) for kidney allocation problem in the existence of COVID-19 pandemic and uncertain medical and logistical data. To achieve this goal, two-stage network data envelopment analysis (DEA) and credibility-based chance constraint programming (CCP) are utilized to develop a novel two-stage fuzzy network data envelopment analysis (TSFNDEA) method. The main benefits of the developed method can be summarized as follows: considering internal structures in kidney allocation system, investigating both medical and logistical aspects of the problem, the capability of expanding to other network structures, and unique efficiency decomposition under uncertainty. Moreover, in order to evaluate the validity and applicability of the proposed approach, a validation algorithm utilizing a real case study and different confidence levels is used. Finally, the numerical results indicate that the developed approach outperforms the existing kidney allocation system.

Transplantation for type 1 diabetes: radiologist's primer on islet, pancreas and pancreas-kidney transplantation imaging.

Whole-organ pancreas, pancreatic-kidney and islet transplantation are surgical therapeutic options for the treatment of type 1 diabetes. They can enable effective glycemic control, improve quality of life and delay/reduce the secondary complications of type 1 diabetes mellitus. Radiologists are integral members of the multidisciplinary transplantation team involved in these procedures, with multimodality imaging serving as the mainstay for early recognition and management of transplant related complications. This review highlights the transplantation procedures available for patients with type 1 Diabetes Mellitus with a focus on the imaging appearance of transplantation-related complications.

Training in Transplantation and Cellular Therapy in Latin America: A Cross-Sectional Study of the LABMT

Hematopoietic cell transplantation (HCT) is a complex and resource-intensive procedure that has become a critical treatment for certain hematologic conditions. However, in Latin America, access to HCT is limited compared to high-income countries, in part due to a lack of standardized training programs for HCT professionals. To address this gap, the Latin-American Bone Marrow Transplantation Group conducted a cross-sectional study to assess the current state of training programs in HCT and cellular therapy across the region. This study aimed to describe and analyze the availability, characteristics, and challenges of HCT training programs in Latin America, with a focus on identifying barriers and proposing solutions for improvement. A cross-sectional survey was sent to 127 recognized HCT centers across 14 Latin-American countries in December 2022. The survey collected data on institutional characteristics, training program structure, costs, and barriers to program development. Descriptive statistics were used to summarize the data, and comparative analyses were performed using Chi-square and Mann-Whitney tests. Of the 127 centers surveyed, 50 (39%) responded, with the majority located in Brazil (34%) and Mexico (30%). Among the respondents, 64% (n = 32) offered formal training programs lasting 6 months or longer. The most significant barriers reported were lack of funding (n = 21), limited number of transplant procedures (n = 15), and a shortage of qualified professors (n = 11). Proposed solutions included increasing student mobility opportunities (n = 28), enhancing program quality (n = 27), and improving access to funding (n = 15). Only 6% of programs offered exposure to CAR-T therapy, and fewer than half of the centers provided international rotations. This study highlights significant disparities in HCT training programs across Latin America, with most countries lacking access to formalized training. While Brazil and Mexico serve as regional hubs, other nations have limited or no training opportunities. Addressing these gaps through increased funding, international collaborations, and standardized curricula is essential to improving HCT training and ultimately patient care in the region.

Survival After Extracorporeal Membrane Oxygenation Bridge to Lung Retransplantation

BackgroundExtracorporeal membrane oxygenation (ECMO) is increasingly used as a bridge to lung transplantation. Despite success in select populations, candidates requiring ECMO bridge to retransplantation have historically had poor 1-year survival. This study aimed to examine the characteristics of the recipient, donor, and transplant procedure type to guide selection of candidates for ECMO bridge to retransplantation. MethodsThis was a retrospective cohort study of all US adult lung retransplant recipients between May 5, 2005, and December 31, 2022. We evaluated 1-year survival of ECMO-bridged retransplant patients, stratified by time from initial transplant, procedure type (single or bilateral retransplant), and ECMO era (2005-2017 vs 2018-2022). ResultsIn this national cohort, 111 of 1296 (8.6%) retransplant recipients underwent ECMO bridge. One-year survival was worse for ECMO bridge retransplant recipients (52.2% vs 74.0%; P < .001) and has worsened in the contemporary era (2018-2022) of ECMO bridge to retransplantation compared with prior years (P = .03). Time from initial transplantation and use of bilateral retransplant after an initial bilateral transplant were most strongly associated with improved 1-year survival of ECMO-bridged retransplant recipients. Of bilateral recipients bridged to bilateral transplant more than 1 year after primary transplantation, survival was 65.9% in ECMO-bridged patients as opposed to 77.2% in nonbridged patients. ConclusionsCareful selection of candidates and surgical procedure type remains essential in determining candidacy for ECMO bridge to retransplantation.

Enhancing Hematopoietic Stem Cell Transplantation Success: The Crucial Role of Architectural Design in Transplant Units and Hematology Departments

Aim: This paper aims to explore the critical role of architectural design in Hematopoietic Stem Cell Transplantation (HSCT) procedures, focusing on how various aspects of design influence patient outcomes, staff efficiency, infection control, and overall safety. The study seeks to understand how the physical environment impacts both the immediate and long-term recovery of patients undergoing HSCT and to advocate for design principles that enhance patient and caregiver experiences. Discussion: Hematopoietic Stem Cell Transplantation (HSCT) has emerged as a vital therapeutic modality for a diverse spectrum of hematological disorders and malignancies. As medical and technological advancements continue to evolve, the significance of the physical environment in which HSCT procedures are conducted becomes increasingly evident. This paper delves into how architectural design affects patient well-being, staff efficiency, and infection control, emphasizing the importance of creating environments that support psychological well-being. It examines the impact of design on infection prevention, safety during emergencies, and the overall efficiency of healthcare delivery. The discussion also highlights the role of sustainability and green design principles in minimizing the environmental footprint while promoting patient recovery. Conclusions: The paper concludes that architectural design plays a transformative role in enhancing patient experiences and healthcare outcomes in HSCT settings. It underscores the need for a patient-centric approach to design that integrates wellness-focused elements and advanced technology. The study advocates for a collaborative effort among healthcare institutions, architects, designers, and policymakers to create supportive, efficient, and sustainable healthcare environments. By prioritizing these design considerations, healthcare environments can significantly improve the HSCT journey and contribute to the broader realm of healthcare excellence.

Progranulin enhances the engraftment of transplanted human iPS cell-derived cerebral neurons.

Cerebral organoids (COs) in cell replacement therapy offer a viable approach to reconstructing neural circuits for individuals suffering from stroke or traumatic brain injuries. Successful transplantation relies on effective engraftment and neurite extension from the grafts. Earlier research has validated the effectiveness of delaying the transplantation procedure by 1 week. Here, we hypothesized that brain tissues 1 week following a traumatic brain injury possess a more favorable environment for cell transplantation when compared to immediately after injury. We performed a transcriptomic comparison to differentiate gene expression between these 2 temporal states. In controlled in vitro conditions, recombinant human progranulin (rhPGRN) bolstered the survival rate of dissociated neurons sourced from human induced pluripotent stem cell-derived COs (hiPSC-COs) under conditions of enhanced oxidative stress. This increase in viability was attributable to a reduction in apoptosis via Akt phosphorylation. In addition, rhPGRN pretreatment before in vivo transplantation experiments augmented the engraftment efficiency of hiPSC-COs considerably and facilitated neurite elongation along the host brain's corticospinal tracts. Subsequent histological assessments at 3 months post-transplantation revealed an elevated presence of graft-derived subcerebral projection neurons-crucial elements for reconstituting neural circuits-in the rhPGRN-treated group. These outcomes highlight the potential of PGRN as a neurotrophic factor suitable for incorporation into hiPSC-CO-based cell therapies.