Transplant Surgeons Research Articles

Standardization of the Side-to-Side Cavo-Caval Anastomosis in Orthotopic Liver Transplantation Based on the Causal Analysis of Outflow Obstruction

Although liver transplantation is widely accepted as the therapeutic strategy for end-stage liver failure, complication of hepatic venous outflow obstruction remains lethal. Currently, ensuring a single wide orifice in both the graft and recipient inferior vena cava has been proposed to avoid hepatic venous outflow obstruction with no theoretical concept. We herein report a standardization technique for the reconstruction of the hepatic vein based on the causal analysis. During the put-in process, the graft must be positioned in contact with the recipient diaphragm and slightly pushed to the cranial direction to simulate the state after abdominal closure. Because there is no extra space between the graft and diaphragm, the graft could not rotate about the anastomotic site of the inferior vena cava toward the diaphragm after abdominal closure as the intestinal pressure increases, and accordingly hepatic venous outflow obstruction does not develop. With this concept, all transplant surgeons can successfully and easily perform hepatic vein reconstruction without total clamping of the inferior vena cava and without outflow block.

Single-Center Experience with Hepatic Artery Reconstruction During Living Donor Liver Transplantation: Microscope Versus Surgical Loupe.

BackgroundHepatic artery reconstruction during living donor liver transplantation is a critical step. To perform this risky procedure, a microscope has been used. However, it takes a long time to complete the procedure and it has a long and steep learning curve. Recently, some transplant surgeons have performed the procedure using a surgical loupe. We conducted this study to compare the outcomes after hepatic artery reconstruction using a microscope versus using a surgical loupe.Material/MethodsWe retrospectively reviewed the outcomes of 300 patients at our institution from April 2014 to July 2020. From April 2014 to September 2017 (era 1), hepatic artery reconstruction was performed using a microscope by an experienced plastic surgeon. From September 2017 to the end date (era 2), it was performed using a loupe (×5.0) by an experienced transplantation surgeon.ResultsThere was no difference in most perioperative outcomes between the 2 groups, including the major postoperative complications of hepatic artery complications (2/150 versus 2/150, P=1.000), postoperative bleeding (10/150 versus 5/150, P=0.185), and biliary leakage (18/150 versus 13/150, P=0.343). There was a statistically significant difference between the 2 groups in anastomosis time (42.4±11.8 versus 24.2±7.8, P<0.001) and the entire operation time (436.6±83.9 versus 415.3±68.5, P=0.035).ConclusionsWe suggest that when the surgeon is familiar with a loupe and vascular anastomosis, hepatic artery reconstruction using a surgical loupe is a safe and feasible method with a shorter operation time.

Practice Patterns for the Acceptance of Medically Complex Living Kidney Donors with Hematuria, Sickle Cell Trait, Smoking, Illegal Drug Use, or Urological Issues: A Multinational Survey.

Background To review the practice patterns for the acceptance of medically complex living kidney donors (MCLKD) among the transplant providers of the international transplant community. Methods We distributed a survey globally, through major international transplantation societies, among nephrologists and transplant surgeons (TS). The survey contained questions regarding potential donors with microscopic hematuria, sickle cell trait, renal cysts, kidney stones, smoking, or illegal drug use. Results There were 239 respondents from 29 countries, including nephrologists (42%) and TS (58%). Although most respondents would investigate microscopic hematuria, one-third of them indicated they would decline these potential donors without investigation. Interestingly, most respondents accepted heavy smokers, intermittent illegal drug users (with advice to quit), and those with incidentally identified kidney stones, remote history of renal colic or simple renal cysts. We found multiple areas of consensus in practice with some interesting differences between nephrologists and TS. Conclusions This survey highlights the practice patterns of the acceptance of MCLKDs among the international community. In the absence of clear guidelines, this survey provides additional information to counsel kidney donors with microscopic hematuria, sickle cell trait, renal cysts, kidney stones, heavy smoking, or illegal drug use.

Editorial introductions.

Current Opinion in Organ Transplantation was launched in 1996. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of organ transplantation is divided into 18 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Linda S. SherLinda S. SherDr Linda S. Sher is Professor of Clinical Surgery and Director of Clinical Research in the Division of Hepatobiliary Surgery and Abdominal Organ Transplantation at Keck School of Medicine, University of Southern California (USC), USA. After completing her medical school education and surgical residency at Mount Sinai School of Medicine in New York, USA, Dr Sher undertook her fellowship training in Liver and Kidney Transplantation at the University of Pittsburgh, USA. After completing her fellowship in 1988, Dr Sher was involved in the establishment of two liver transplant programs in Los Angeles prior to joining the USC program in 2001. Dr Sher has participated in and overseen over 50 research projects and is currently very active in the development of the clinical and basic science research components of the USC Abdominal Organ Transplantation Program. She has numerous publications on immunosuppression, chronic rejection, disease recurrence, infection, and hepatobiliary surgery. Dr Sher is one of the original editors of Current Opinion in Organ Transplantation and has endeavored over the years to provide the reader with an up to date overview of the entire field of organ transplantation. Paulo N. MartinsPaulo N. MartinsDr Paulo N. Martins MD, PhD, FAST, FEBS, FACS is a transplant surgeon (Associate Professor of Surgery) and has a transplant lab focused on liver preservation at University of Massachusetts, USA. He graduated from medical school in Brazil, where he ranked first. He finished his PhD in transplant immunology at the University of Berlin-Germany in 2005 with “Summa cum Laude” and worked clinically in Berlin, Germany (Charite’-Virchow Klinikum) for over a year. He completed a post-doc research fellowship at the Brigham and Women Hospital and Massachusetts General Hospital at Harvard University, in Boston-USA, and later did a clinical hepatobiliary and Transplant Fellowship at the New York Medical School, followed by other clinical transplant fellowship at Massachusetts General Hospital, Harvard University, followed by one year as clinical instructor in the same institution. Since 2013, Dr. Martins has been working as a transplant Surgeon at the University of Massachusetts. During his career he has obtained several research awards (including the ILTS rising star award, ASTS vanguard award, ASTS rising star award, AST basic science award, an AASLD grant, and the Portuguese-American Scientific leadership award) and grants. He is the vice-chair of the ILTS Basic and Translational Science committee, associate editor of the journal "Artificial Organs, an editorial board member/reviewer of 15 scientific journals, and member of several transplant societies including (ILTS, ESOT, AST, ASTS, DTG, AASLD). Dr. Martins has published 107 peer-reviewed articles (with over 3,500 citations), one textbook, 16 book chapters, and over 100 abstracts in scientific meeting and medical journals. He has been part of Diversity committee at his institution, he is co-chair of the ASTS diversity committee, and chair of the UNOS/OPTN Minority Affairs Committee. He has been part of several initiatives to increase equity in transplantation access (e.g. policies to collect socio-economic data and to eliminate the black race coefficient for eGFR calculation, adjustments/provisions in organ allocation policies, guidelines about listing of patients with cognitive impairment among others). He is also part of the bold against racism task-force in the ASTS that aims to increase representation and equity for the transplant workforce, to build inclusive work environments, and provide culturally sensitive training. He published several articles in this field and this year he was nominated by the University of Massachusetts to the Alpha Omega Alpha honor society.

Integrating APOL1 Kidney-risk Variant Testing in Live Kidney Donor Evaluation: An Expert Panel Opinion.

Integrating APOL1 Kidney-risk Variant Testing in Live Kidney Donor Evaluation: An Expert Panel Opinion.

Practice Patterns in the Acceptance of Medically Complex Living Kidney Donors with Obesity, Hypertension, Family History of Kidney Disease, or Donor-Recipient Age Discrepancy.

Background To assess the practice patterns of the acceptance of medically complex living kidney donors (MCLKDs). Methods We distributed a survey to nephrologists and transplant surgeons (TS) across the world through major international transplant societies. The survey contained questions regarding obesity, abnormal blood glucose profile, mild hypertension, donor-recipient age discrepancy, or family history of kidney disease of unknown etiology. Results In total, 239 respondents from 29 countries (42% were nephrologists and 58% were TS). Most respondents would allow donations from obese donors, especially if they intended to lose weight but would be cautious if these donors had abnormal blood glucose or family history of diabetes mellitus. In hypertensive donors, future pregnancy plans mattered in decisions regarding the acceptance of female donors. Most respondents would allow young donors but would be more cautious if they had a future risk of hypertension or a family history of kidney disease of unknown etiology. They would also allow donations from an older person if prolonged waiting time was anticipated. We found multiple areas of consensus of practice among the diverse members of international transplant societies, with some interesting variations among nephrologists and TS.Conclusions This survey highlights the practice patterns of the acceptance of MCLKDs among the international community. In the absence of clear guidelines, this survey provides additional information to counsel kidney donors with these conditions.

Psychology of Hair Loss Patients and Importance of Counseling.

Androgenetic alopecia (AGA) is highly prevalent in society, affecting both men and women. More than the sociological meaning of hair loss, it has become a very important part of self-identity or “body image.” A psychological concept of body image refers to one's thoughts, feelings, perceptions, and behavioral changes related to one's physical looks. In spite of alopecia's common occurrence, it often leads to psychological disturbance and distress. Hair thinning and perceived hair loss also has a very important negative impact on the psyche of the individual. The common emotional aspects associated are self-consciousness, embarrassment, frustration, and jealousy. Knowledge of these effects among the clinicians managing hair loss patients is beneficial. The clinician must make an active effort to identify the borderline group of patients with body dysmorphic syndrome so as to manage them with psychotherapeutic medication for their hair loss prior to hair transplantation. This article aims to provide important information and an understanding of how the psychology gets affected due to hair loss, particularly AGA and its management to the practicing hair transplant surgeons.

Beware of the Impostors-Scalp Pathology Primer for the Hair Transplant Surgeon.

Histopathological features are important for the practicing hair transplant surgeon to ensure proper case selection, diagnosis, choice of proper treatment, and successful outcome. While the primary focus of the hair transplant surgeon is androgenetic alopecia (AGA), it is important to be aware of other conditions that can mimic AGA, whose treatment may be different. This article outlines some of these conditions such as scarring alopecias, alopecia areata, etc., and how to distinguish them. Proper identification will ensure proper treatment and avoid potential missteps in management.

Women Physicians Pay High Price—Again

Back to table of contents Previous article Next article ProfessionalFull AccessWomen Physicians Pay High Price—AgainMaureen Sayres Van Niel, M.D.Maureen Sayres Van NielSearch for more papers by this author, M.D.Published Online:1 Oct 2021https://doi.org/10.1176/appi.pn.2021.11.32AbstractWomen physicians have significantly higher rates of infertility, pregnancy loss, and pregnancy complications.Two recent New York Times articles on health documented the increased incidence of infertility, pregnancy loss, and pregnancy complications among studied groups of women physicians. Here is a small sample of the recent papers on this topic.In a study published in the October 2016 in the Journal of Women’s Health, a random sample of 327 women physicians, 24% (more than twice the rate of the general population) had been diagnosed with infertility at a mean age of 33.7 years. Among those with infertility, 29.3% reported diminished ovarian reserve, and 21.3% never conceived. Faced with this infertility, many respondents would have tried to conceive earlier, chosen a different specialty, or pursued oocyte cryopreservation.A study posted July 28 in JAMA Surgery surveyed 692 female surgeons and 158 nonphysician female partners of male surgeons, who were used as controls. Female surgeons had fewer children and delayed childbearing. Nearly 25% of women surgeons had infertility necessitating in vitro fertilization. The survey also found that 42% of women surgeons had experienced a pregnancy loss, more than twice the rate of the general population, following which most of them had taken no time off. Female surgeons had significantly higher rates of major pregnancy complications such as perinatal depression, hypertensive and placental disease, and intrauterine growth restriction. More than half (56%) of the pregnant women surgeons surveyed worked more than 60 hours a week, and those working 12 or more hours a week in the operating room (OR) during the last trimester were subject to a higher complication rate. A woman surgeon featured in one of the Times articles had a small stroke after developing severe preeclampsia at 34 weeks after working long hours in the OR.A January 2015 study in Journal of Obstetrics and Gynaecology Canada of 3,767 medical and surgical residents found that residents have higher rates of pregnancy loss and pregnancy complications than the general population and that the rate of pregnancy complications was five times higher for those working more than 8 hours a week in the OR.These are sobering findings despite the fact that we do not yet have a prospective, randomized, controlled study that would provide more accurate data. Women physicians can likely anticipate double the infertility and pregnancy loss of other women and will have significantly more pregnancy complications, especially when they work long hours. Authors of the articles cited have proposed solutions to these problems that include providing residents and medical students with more education on infertility and cryopreservation, offering built-in support for women who undergo a pregnancy loss, and anticipating that the problem will likely self-correct because the percentage of female medical students has now surpassed men, giving women more agency in the system.One cannot help but think when reading this: Have we in medicine lost our minds? Have the institutions of medicine become so intransigent that they would rather see their women physicians suffer infertility, pregnancy complications, and loss than recognize the fact that, for example, women surgeons who are in their third trimester should not be required to stand in surgery for more than 12 hours a week—period? And why can’t residency programs that train future heart transplant surgeons solve the logistics of creating a residency system with built-in redundancy to accommodate the predictable number of women who will become pregnant during residency?The same women physicians who have already possibly endured unequal pay and sexual harassment and who have hidden in bathrooms to pump their breast milk to conform to present expectations are now suffering painful intrusions into their ability to get pregnant, carry their baby to term, and have a pregnancy freer of complications. Academic medicine has not autocorrected over the years to accommodate the beautiful biology of so many of its contributing members. If we had not already reached the limit, we have reached it now. We don’t need small adjustments to the current system; we need a wholesale change. Medical institutions, all physicians, and especially we as psychiatrists must rise up immediately to enact solutions to this intolerable reality. ■“A Medical Career, at a Cost: Infertility” is posted at here.“Surgeons at Greater Risk of Pregnancy Loss, Study Finds” is posted here.“Fertility and Childbearing Among American Female Physicians” is posted here.“Incidence of Infertility and Pregnancy Complications in US Female Surgeons” is posted here.“Obstetrical Complications in Pregnant Medical and Surgical Residents” is posted here.Maureen Sayres Van Niel, M.D., is the immediate past president of the APA Caucus of Women Psychiatrists. She is a reproductive psychiatrist and private consultant in Cambridge, Mass. ISSUES NewArchived

Patient Counselling and Medicolegal Aspects of Hair Transplant Surgery.

Hair transplantation being an elective aesthetic surgery, the importance of informed consent cannot be overstated. Explaining the condition of hair loss, the causes, progress, prognosis, and all available treatment options is a part of this process. Providing conflict-free information, ensuring that the patient comprehends this information, and allowing him/her to make the decision to authorize the surgeon to perform the procedure is the moral obligation of the hair transplant surgeon. The benefits of this approach are noticeable and one of the most effective ways to have a satisfied patient and reduce the possibility of claims.

Screening, Management, and Acceptance of Patients with Aorto-Iliac Vascular Disease for Kidney Transplantation: A Survey among 161 Transplant Surgeons

Introduction: Aorto-iliac vascular disease (AVD) is frequently found during the workup for kidney transplantation. However, recommendations on screening and management are lacking. We aimed to assess differences in screening, management, and acceptance of these patients for transplantation by performing a survey among transplant surgeons. Second, we aimed to identify center- and surgeon-related factors associated with decline or acceptance of kidney transplant candidates with AVD. Methods: A survey was sent to transplant surgeons and urologists. The survey contained general questions (part I) and 2 patient-based cases (part II) with Trans-Atlantic Inter-Society Consensus (TASC) D and B AVD supported with videos of their CT scans. Results: One hundred ninety-one (20.3%) participants responded; 171 were currently involved in kidney transplantation: 161 (94.2%) completed part I and 145 (84.8%) part II. Screening for AVD was often (38.5%) restricted to high-risk patients. The majority of respondents (67.7%) rated “technical problems” as the most important concern in case of AVD, followed by “increased mortality risk because of cardiovascular comorbidity” (29.8%). Pretransplant vascular interventions to facilitate transplantation were infrequently performed (71.4% mentioned <10 per year). Ninety (64.3%) respondents answered that an open vascular procedure should preferably be performed prior to kidney transplantation while 42 (30.0%) respondents preferred a simultaneous open vascular procedure. The decline rate was higher in the TASC D case compared to the TASC B case (26.9% and 9.7%, respectively). Respondents from centers with expertise in pretransplant vascular interventions were more likely to accept both patients with TASC D and B for transplantation. Conclusion: There is no uniformity in the screening, management, and acceptance of patients with AVD for transplantation. If a center declines a patient with AVD because of technical concerns, the patient should be referred for a second opinion to a tertiary center with expertise in pretransplant vascular interventions. Multidisciplinary meetings including a vascular surgeon and a cardiologist could help optimize these patients for transplantation.

A Case Report of Posttransplant Lymphoproliferative Disorder After AstraZeneca Coronavirus Disease 2019 Vaccine in a Heart Transplant Recipient

We report a case of a heart transplant recipient who presented with a rapidly growing Epstein-Barr virus (EBV)–positive, diffuse large B-cell lymphoma 7 days after receiving the first dose of the ChAdOx1 nCoV-19 vaccine. Because of the atypical radiologic presentation, the initial tentative diagnosis was a mediastinal abscess. This observation indicates a potential risk of EBV reactivation after coronavirus disease 2019 (COVID-19) vaccination, which might lead to or aggravate the presentation of posttransplant lymphoproliferative disorder in transplantation patients. Transplant surgeons should be aware of the potential immunomodulatory effects of the COVID-19 vaccination.

Re-appropriation of a right anterior thoracotomy approach to portal-systemic bypass for liver transplantation in a patient with complete superior vena cava occlusion

The utilization of venovenous bypass in liver transplantation (LT) has become less frequent and more center dependent over time. Unfortunately, this has left many transplant surgeons, particularly younger trainees, unfamiliar with the techniques and indications for its utilization. We present a case of LT in a patient with complete superior vena cava (SVC) occlusion prohibiting direct vascular access. A multi-disciplinary approach involving interventional radiology, anesthesiology, cardiac surgery, and transplant surgery, was used to diagnose, evaluate, and develop an operative plan for successful LT. In doing so, a novel approach to portosystemic bypass was utilized involving a right mini-thoracotomy with direct cannulation of the right atrium to gain central venous access and optimize venous return during LT. As a center that does not routinely use venovenous bypass, this multidisciplinary approach was crucial identifying the need for a rarely used technique for vascular access and performance of a successful LT.

SPECIFICITY OF PERFORMING KIDNEY TRANSPLANTATION AFTER CHRONIC KIDNEY DISEASE

Kidney transplantation is one of the first disciplines of transplant medicine to be established clinically as the standard of care for patients with end-stage renal disease. The significant advantages of kidney transplantation over hemodialysis in terms of life expectancy and quality, as well as in economic terms, make it the method of choice, especially in relatively young patients. Indications for kidney transplantation are determined jointly by a transplant surgeon and a nephrologist or urologist (or / and a pediatrician). These patients are usually chronic dialysis patients.

Diversity in American Society of Transplant Surgeons Governance: Equitable but Unequal.

The diversity in the governance of the American Society of Transplant Surgeons has not been described. We aimed to quantify the present state of its leadership as a baseline to inform future research. Lists of leaders on the American Society of Transplant Surgeons Council, the COVID-19 Strike Force, and 20 different American Society of Transplant Surgeons committees were obtained from the Society's website. Demographic and training information for the members were compiled through internet searches and analyzed. The American Society of Transplant Surgeons Council included 15 members, with 20% women. It was 93.3% non-Hispanic White. The COVID-19 Strike Force included 12 surgeons, 16.7% of whom were female, with 75% non-Hispanic White. Of the 198 committee members, 23.7% were women, 68.7% were nonHispanic White, 16.6% were Asian, 8.1% were Hispanic, and 6.6% were Black. Among female committee members, underrepresented minorities comprised 23.6%. Committee chairs included 23% women, 23% underrepresented minorities, and 2.3% minority women. International medical graduates were more likely men (P = .02). Representation of women in the American Society of Transplant Surgeons leadership has kept pace with their membership in the transplant surgery workforce. There is a deficiency of female under - represented minorities in leadership positions at the Society. Further interventions are required to recruit underrepresented minorities to transplant surgery, catalog their footprint in the workforce, and champion their role as leaders within the American Society of Transplant Surgeons.

Notes from the Editor Emeritus, 1996–1998

![Figure][1]</img> It is almost 15 years since I retired as a full-time hair transplant (HT) surgeon. My friends ask if I miss my work of nearly 50 years. The answer is that I miss my faithful staff and patients but seldom think or dream about the actual work. I have moved on to a different phase

One-Month Trial of HOCl: An Observational Pilot Study

The search for a clearly superior aid to wound healing that meets the unique needs of the hair transplant surgeon has been fraught with frustration and littered with failed attempts.^1,2 Hydrogen peroxide, chlorhexidine, isopropyl alcohol, and betadine have been used for their antibacterial properties.^2,3 Copper peptide, silicone, hydrocolloid, and others have been used for their accelerative healing properties with mixed results. As of 2007 hypochlorous acid (HOCl), which has both antibacterial and wound healing properties, had never been used as a pharmaceutical drug, and as of 2021, it has not been described in the literature specific to hair transplant procedures. We investigated the use of medical grade HOCl as a routine component of both intra-operative hair transplant procedures (both linear excision and follicular unit excision) and as a post-operative wound healing aid.

A world-wide survey on kidney transplantation practices in breast cancer survivors: The need for new management guidelines

Kidney transplantation reduces mortality in patients with end stage renal disease (ESRD). Decisions about performing kidney transplantation in the setting of a prior cancer are challenging, as cancer recurrence in the setting of immunosuppression can result in poor outcomes. For cancer of the breast, rapid advances in molecular characterization have allowed improved prognostication, which is not reflected in current guidelines. We developed a 19-question survey to determine transplant surgeons' knowledge, practice, and attitudes regarding guidelines for kidney transplantation in women with breast cancer. Of the 129 respondents from 32 states and 14 countries, 74.8% felt that current guidelines are inadequate. Surgeons outside the United States (US) were more likely to consider transplantation in a breast cancer patient without a waiting period (p=.017). Within the US, 29.2% of surgeons in the Western region would consider transplantation without a waiting period, versus 3.6% of surgeons in the East (p=.004). Encouragingly, 90.4% of providers surveyed would consider eliminating wait-times for women with a low risk of cancer recurrence based on the accurate prediction of molecular assays. These findings support the need for new guidelines incorporating individualized recurrence risk to improve care of ESRD patients with breast cancer.

Gender and racial disparities in the transplant surgery workforce.

This review explores trends in the United States (US) transplant surgery workforce with a focus on historical demographics, post-fellowship job market, and quality of life reported by transplant surgeons. Ongoing efforts to improve women and racial/ethnic minority representation in transplant surgery are highlighted. Future directions to create a transplant workforce that reflects the diversity of the US population are discussed. Representation of women and racial and ethnic minorities among transplant surgeons is minimal. Although recent data shows an improvement in the number of Black transplant surgeons from 2% to 5.5% and an increase in women to 12%, the White to Non-White transplant workforce ratio has increased 35% from 2000 to 2013. Transplant surgeons report an average of 4.3 call nights per week and less than five leisure days a month. Transplant ranks 1st among surgical sub-specialties in the prevalence of three well-studied facets of burnout. Concerns about lifestyle may contribute to the decreasing demand for advanced training in abdominal transplantation by US graduates. Minimal improvements have been made in transplant surgery workforce diversity. Sustained and intentional recruitment and promotion efforts are needed to improve the representation of women and minority physicians and advanced practice providers in the field.

Extrusion, meniscal signal change, loss of shape, synovitis and bone marrow oedema are reliable scoring parameters to assess MRI appearance post meniscal transplant.

Meniscal allograft transplantation (MAT) has shown good promise in restoring normal knee joint biomechanics in a meniscal deficient patient. However, MRI appearance of the meniscal allograft is often questioned and raises concerns of its viability and function. This paper aims to introduce and validate a new scoring system for MAT MRI appearance at 12months [MRI appearance in Meniscal Transplant Score (MIMS)], using key changes such as extrusion, meniscal signal change, loss of shape, synovitis and bone marrow oedema. A retrospective analysis of 10 patients from a single surgeon series was conducted. All MAT were performed with soft tissue fixation technique. MRI was performed at 12months post-transplant with two independent consultant musculoskeletal radiologists and one experienced meniscal transplant surgeon scoring the images obtained. Interobserver agreement and intraclass correlation were measured. Interobserver agreement between examiners on individual features of the MIMS was superior for tibial bone oedema, substantial for meniscal extrusion and femoral bone oedema, moderate for meniscal shape and synovitis, and fair for meniscal signal changes. Absolute agreement between raters found good reliability (ICC = 0.774; 95% 0.359, 0.960) for single measures and excellent reliability (ICC = 0.911; 95% 0.627, 0.986) for average measures. MIMS is a reliable method of evaluating the meniscal allograft transplant 12months post-transplant. Further research with larger MAT cohort groups and patient reported outcome measures may be helpful to correlate its clinical significance and guide further management. Level III.