Transplantation Procedures Research Articles

The impact of perioperative synbiotics treatment in living-donor liver transplantation after induction of early enteral nutrition.

Infectious complications, particularly post-transplant sepsis, have a critical impact on postoperative outcomes. This study examined the effects of perioperative synbiotic treatment on postoperative outcomes in patients receiving early enteral nutrition. We reviewed 210 living-donor liver transplantation procedures and retrospectively analyzed the postoperative outcomes with and without perioperative synbiotic treatment (live lactic acid bacteria, bifidobacteria, and oligosaccharides) 5days before and after living-donor liver transplantation. The synbiotic group (n = 34) had significantly fewer male donors (38.2% vs. 61.9%, p = 0.011) and a higher proportion of ABO-incompatible grafts (52.9% vs. 25.6%, p = 0.021) than the non-synbiotic group (n = 176). The incidence of sepsis was significantly lower in the synbiotic group than in the non-synbiotic group (0% vs. 7.4%, p = 0.029), with a lower incidence rate of sepsis due to bacteremia with intestinal bacteria (0% vs. 4.6%, p = 0.089). There were no significant differences in the proportions of acute rejection, small-for-size graft syndrome, or postoperative liver function between the two groups. Furthermore, there was no significant difference in the graft survival rates after LDLT between two groups. (p = 0.24). Perioperative synbiotic treatment prevents post-transplant sepsis, even with early enteral nutrition.

Abstract Tu145: Exploring Naltrindole’s hypercontracture attenuating effects during myocardial ischemia via a novel mechanism that produces cardioprotective effects in myocardial ischemia/reperfusion injury

Introduction: Previously, naltrindole (NTI) produced robust cardioprotective effects (e.g.~80% reduction of infarct size) in both ex-vivo (2.5-5µM) and in-vivo (3.75-7.5 mg/kg) rat myocardial ischemia-reperfusion (MIR) injury models. Additionally, we recently showed that NTI 100-200µM attenuated phorbol 12-myristate 13-acetate (PMA) induced polymorphonuclear leukocytes (PMNs) superoxide (SO) release by a novel mechanism of action (MOA) devoid of opioid receptors. Hypothesis: We hypothesize NTI’s novel MOA is a reduction of intracellular calcium (Ca 2+ ). Testing this hypothesis, we conducted isolated perfused MIR assays using KB-R7943(KB). KB is known to reduce intracellular Ca 2+ via inhibition of reverse mode Na + /Ca 2+ exchanger and, therefore, should attenuate myocardial ischemic hypercontracture, infarct size, and left ventricular end diastolic pressure (LVEDP). We predict that both NTI and KB will improve LVEDP and decrease infarct size compared to vehicle (dH 2 O) control and naloxone (NX) used as a negative control. Methods: Hearts were isolated from anesthetized male Sprague Dawley (SD) rats (~300g). We then infused NTI 1.25-5µM, KB 10-20µM, or NX 10µM for 5 min into perfused hearts, just prior to global I(30min)/R(45min). Cardiac left ventricular function was measured via a pressure transducer and infarct size using 1% triphenyltetrazolium chloride staining in the MIR assay. Data were analyzed using ANOVA and Fishers post-hoc analysis, with p<0.05 considered statistically significant. Results: MIR assay: NTI 5µM, 2.5µM, 1.25µM and KB 20 µM reduced infarct size (4.8±3%, n=5, p<0.05), (6.8±0.8%, n=6, p<0.05), (12.2±3%, n=5), and (2.9±2%, n=5, p<0.05) respectively compared to vehicle (14.1±2%, n=9) and NX 10µM controls (18±3%, n=3). NTI 5 µM and KB 20 µM had significantly improved LVEDP to (32.4±11%, n=5, p<0.05) and (22.8±4%, n=5, p<0.05) respectively compared to vehicle control (72.4±6%, n=9) and NX 10µM controls (54.2±8%, n=3) Conclusion: Both NTI (2.5µM, 5µM) and KB (20µM) reduced infarct size and improved LVEDP. The novel MOA of NTI may be mediated via a reduction in intracellular Ca 2+ during myocardial ischemia. The infarct reducing effect of NTI can benefit patients undergoing elective PCI, CABG, and transplant procedures.

Extended survival of 9- and 10-gene-edited pig heart xenografts with ischemia minimization and CD154 costimulation blockade-based immunosuppression

BackgroundXenotransplantation has made significant advances recently using pigs genetically engineered to remove carbohydrate antigens, either alone or with addition of various human complement, coagulation, and anti-inflammatory ‘transgenes’. Here we evaluated results associated with gene-edited (GE) pig hearts transplanted in baboons using an established costimulation-based immunosuppressive regimen and a cold-perfused graft preservation technique. MethodsEight baboons received heterotopic abdominal heart transplants from 3-GE (GalKO.β4GalNT2KO.hCD55, n=3), 9-GE (GalKO.β4GalNT2KO.GHRKO.hCD46.hCD55. TBM.EPCR.hCD47.HO-1, n=3) or 10-G (9-GE+CMAHKO, n=2) pigs using Steen’s cold continuous perfusion for ischemia minimization. Immunosuppression (IS) included induction with anti-thymocyte globulin and αCD20, ongoing αCD154, MMF, and tapered corticosteroid. ResultsAll three 3-GE grafts functioned well initially, but failed within 5 days. One 9-GE graft was lost intraoperatively due to a technical issue and another was lost at POD 13 due to antibody mediated rejection (AMR) in a baboon with a strongly positive pre-operative cross-match. One 10-GE heart failed at POD113 with combined cellular and antibody mediated rejection. One 9-GE and one 10-GE hearts had preserved graft function with normal myocardium on protocol biopsies, but exhibited slowly progressive graft hypertrophy until elective necropsy at POD393 and 243 respectively. Elevated levels of IL-6, MCP-1, C-reactive protein, and human thrombomodulin were variably associated with conditioning, the transplant procedure, and clinically significant postoperative events. ConclusionRelative to reference genetics without thrombo-regulatory and anti-inflammatory gene expression, 9- or 10-GE pig hearts exhibit promising performance in the context of a clinically applicable regimen including ischemia minimization and αCD154-based IS, justifying further evaluation in an orthotopic model.

Revision of antifungal strategies definitions for invasive fungal infections (proven/probable/possible) in 461 patients with haematological malignancies (REDEFI-SEIFEM).

Invasive fungal infections (IFI) are a relevant cause of morbidity and mortality among patients with haematological neoplasms (HMs). Since 2002, a classification of IFI based on host factors, clinical and radiological features and mycological tests was published for research purpose. These criteria are widely used in clinical practice to identify patients at risk for IFI. The aim of the study was to evaluate the clinical applicability of EORTC/MSG 2008 criteria for the diagnosis of IFI in daily practice. This multicentre, non-interventional, observational, prospective study gathered all consecutive inpatients with HMs in which an intravenous antifungal treatment was started. Exclusion criteria were a previous or concomitant transplant procedure, outpatient status and oral antifungal therapy. EORTC/MSG 2008 criteria were used to classify patients at the beginning of antifungal therapy and at 30 days. An independent board reviewed the classification of IFI given by local clinicians at T0 and T30. The highest percentage of agreement was found for possible IFI (96%), while a lower agreement was reported for proven IFI (74%), and the highest variability was observed for probable IFI (56%). At T30, the board re-evaluation confirmed a strict agreement for possible IFI only (98%). Among 306 patients classified as possible, 156 (51%) patients showed non-typical radiological findings and 45 (15%) patients presented host factors only. In real life, the EORTC/MSG criteria can be applicable only for possible IFI. As non-typical radiological findings are reported in possible IFI, introducing a new IFI category should be considered.

Moral injury: An unspoken burden of transplant surgery

Moral injury in health care is characterized as the lasting psychological, biological, and social impact on providers that occurs following an adverse patient outcome. Moral injury can contribute to second victim syndrome and lasting psychological harm. Although many surgeons face moral injury due to patient acuity and the potential for intraoperative or postoperative complications, the transplant ecosystem compounds the impact of moral injury. Institutional blame placed on the transplant surgeon following a posttransplant death or graft loss is magnified by public reporting. Centers whose outcomes fall below threshold levels are subject to regulatory citation and financial loss. Moral injury can also result in risk aversion, limiting access to transplants for higher-risk candidates and reducing acceptance of marginal organs hurting donor families. Strategies to increase resilience, reduce accusation and blame, and focus on system quality improvement are vital to mitigate the impact of moral injury on transplant professionals. The transplant community must proactively work to reduce moral injury to protect surgeons, ensure access to life-saving transplant procedures, and avoid unnecessary organ offer declines.

Decreasing Incidence of Partial Meniscectomy, and Increasing Incidence of Meniscus Preservation Surgery from 2010-2020 in the United States

The aim of the present study was to characterize the incidence of meniscus surgery from 2010 to 2020 in the United States, using the metrics of age, sex, type of meniscus surgery, and Charlson Comorbidity Index (CCI). A retrospective analysis was performed using the PearlDiver national insurance claims database from 2010-2020. Meniscus surgeries were identified using Current Procedural Terminology codes. Patients were stratified by procedure type, age, biological sex, and Charlson Comorbidity Index (CCI) scores. Compound annual growth rate (CAGR) analysis and analysis of variance (ANOVA) were performed to analyze the trends and demographic variables between cohorts. Of 2,053,884 meniscus surgeries, 94.7% were meniscectomies, 0.3% were open repairs, 4.9% were arthroscopic repairs, and 0.1% were meniscal transplantations. CAGR analysis displayed a 4.0% decrease per year in total meniscus surgery. For individual procedure types, the largest decrease was in meniscectomy, and the largest increase was in open repair. Patients undergoing meniscal transplantation were youngest, with the lowest CCI. Meniscectomy patients were oldest, and open repair patients had the highest average CCI. Most procedures were performed on female patients (52.4%), and patients in the 50-59-year age group (30.4%). There was a sustained decrease in the incidence of total meniscus surgeries from 2010-2020. Meniscectomy was the procedure with the highest incidence, however, it showed the most significant decline in usage over the study period. Conversely, meniscal repair and transplantation procedures increased during the study period.

A Rare Representation of Kidney Vasculature – Cadaveric Case Report

Understanding the nuances of renal vascular anatomy is paramount in the context of retroperitoneal surgeries and kidney transplant procedures. This case report describes the unique vascular variations observed in the right kidney of an adult male cadaver during dissection. The right kidney was supplied by three renal arteries: two through the hilum and an extra hilar superior polar branch, and one through the lower pole. Three renal veins emerged independently from the hilum, each opening separately into the inferior vena cava. Two of these veins emerged anterior to the renal pelvis, while the third emerged posterior to it. Notably, two veins terminated into the lateral aspect of the inferior vena cava, while one terminated into its posterior aspect.

COVID-19 seropositive donors yield comparable post-lung transplant outcomes.

Recent reports have suggested that coronavirus disease 2019 (COVID-19) infection can cause pneumonitis even in the absence of clinical symptoms and COVID-19 associated pulmonary inflammation can persist resulting in long-term fibrosis. This single-center study utilized standardized immunological testing to determine whether lungs from COVID-19 seropositive donors, indicative of past COVID-19 infection, can be safely used for clinical transplantation. The study included 90 consecutive lung transplant procedures incorporating donor serological testing for past COVID-19 infection. Donors were negative for active COVID-19 infection and met institutional criteria to be used for lung transplantation. The outcomes of lung transplant recipients were compared between donors with and without serological evidence of past COVID-19 infection. No significant difference was found in post-transplant survival rates between recipients of lungs obtained from donors with serological evidence compared to those without. Additionally, there were no significant differences in primary graft dysfunction grade 3 rates or other post-transplant clinical parameters, such as operative time, ischemic time, extracorporeal membrane oxygenation use, intensive care unit stay, and hospital stay. Our findings suggest that lungs from COVID-19 seropositive donors, but not active COVID-19 infection are safe and feasible for transplantation, yielding comparable post-transplant outcomes to donors who are negative COVID-19 antibodies. This study supports the utilization of lungs from donors with historic COVID-19 infection as long as they meet current transplant criteria, potentially addressing the concerns related to the use of such organs.

Host circuit engagement of human cortical organoids transplanted in rodents.

Human neural organoids represent promising models for studying neural function; however, organoids grown in vitro lack certain microenvironments and sensory inputs that are thought to be essential for maturation. The transplantation of patient-derived neural organoids into animal hosts helps overcome some of these limitations and offers an approach for neural organoid maturation and circuit integration. Here, we describe a method for transplanting human stem cell-derived cortical organoids (hCOs) into the somatosensory cortex of newborn rats. The differentiation of human induced pluripotent stem cells into hCOs occurs over 30-60 days, and the transplantation procedure itself requires ~0.5-1 hours per animal. The use of neonatal hosts provides a developmentally appropriate stage for circuit integration and allows the generation and experimental manipulation of a unit of human neural tissue within the cortex of a living animal host. After transplantation, animals can be maintained for hundreds of days, and transplanted hCO growth can be monitored by using brain magnetic resonance imaging. We describe the assessment of human neural circuit function in vivo by monitoring genetically encoded calcium responses and extracellular activity. To demonstrate human neuron-host functional integration, we also describe a procedure for engaging host neural circuits and for modulating animal behavior by using an optogenetic behavioral training paradigm. The transplanted human neurons can then undergo ex vivo characterization across modalities including dendritic morphology reconstruction, single-nucleus transcriptomics, optogenetic manipulation and electrophysiology. This approach may enable the discovery of cellular phenotypes from patient-derived cells and uncover mechanisms that contribute to human brain evolution from previously inaccessible developmental stages.

Revolutionizing Organ Transplantation with Robotic Surgery.

To evaluate the impact of robotic techniques on organ transplantation outcomes. The evolution of organ transplantation is becoming influenced by the adoption of minimally invasive techniques, transitioning from laparoscopic to robotic methods. Robotic surgery has emerged as a significant advancement, providing superior precision and outcomes compared to traditional approaches. This perspective includes a systematic review of the literature, original data from a high-volume center, as well as an international survey focusing on perceptions related to robotic versus laparoscopic and open approaches. The systematic review and meta-analysis revealed lower morbidity with robotic donor nephrectomy, recipient kidney transplant and donor hepatectomy. Our center's experience, with over 3,000 minimally invasive transplant procedures (kidney, liver, donor, and recipient), supports the superiority of Robotic Transplant Surgery (RTS). The global survey confirms this shift, revealing a preference for robotic approaches due to their reduced morbidity, despite challenges such as access to the robotic system and cost. This comprehensive overview including a systematic review, original data, and perceptions derived from the international survey demonstrate the superiority of Robotic Transplant Surgery (RTS) across a range of organ transplantations, for both donors and recipients. The future of RTS depends on the efforts of the surgical community in addressing challenges such as economic implications, the need for specialized surgical training for numerous surgeons, as well as wide access to robotic systems worldwide.

An efficient and successful outcome after haematopoietic stem cell transplantation in a patient with an LPS-responsive beige-like anchor gene mutation.

Lipopolysaccharide (LPS)-responsive beige ankyrin (LRBA) gene mutations were first reported as the cause of immunodeficiency syndromes and autoimmunity in 2012. The majority of LRBA patients have multiple organ system involvement and a complex clinical phenotype. Herein we present a comprehensive account on the disease progression and transplantation procedure in a patient with LRBA deficiency who exhibited progressive autoimmune disease symptoms along with recurrent pulmonary infections since the age of 6 years old. Despite receiving abatacept therapy and immunoglobulin replacement treatments to manage the symptoms, but the symptoms still progressed. Therefore, nine years after disease onset, patients were treated with allogeneic haematopoietic stem cell transplantation (allo-HSCT). The patient experienced acute and chronic graft-versus-host disease (GVHD) and recurrent infections after transplantation. During one and a half years of follow-up, we found that allogeneic haematopoietic stem cell transplantation can relieve the symptoms of autoimmune disease in patients with LRBA deficiency, and marked clinical improvement and recovery of immune function were observed following stem cell transplantation.

Ticlopidine protects hepatic ischemia-reperfusion injury via suppressing ferroptosis

Hepatic ischemia-reperfusion injury (IRI) is a major cause of liver damage during hepatic resection, transplantation, and other surgical procedures, often leading to graft failure and liver dysfunction. Recent studies have identified ferroptosis, a form of regulated cell death characterized by iron-dependent lipid peroxidation, as a key contributor to IRI. In this study, we investigated the protective effects of Ticlopidine, a thienopyridine compound and platelet aggregation inhibitor, on hepatic IRI. Using a C57BL/6J mouse model, we demonstrated that prophylactic Ticlopidine treatment significantly reduced necrotic and fibrotic areas in liver tissues, as well as serum levels of alanine transaminase (ALT) and aspartate aminotransferase (AST). Prussian Blue staining revealed that Ticlopidine pretreatment decreased iron accumulation in hepatic tissues, whereas markers of lipid peroxidation (malondialdehyde and 4-hydroxynonenal) and ferroptosis (PTGS2) were significantly downregulated. Additionally, Ticlopidine ameliorated inflammatory infiltration as indicated by reduced Gr-1 staining. In vitro, Ticlopidine dose-dependently inhibited ferroptosis induced by various inducers in liver cancer cell lines HUH7 and fibrosarcoma cells HT1080. The protective effects involved partial rescue of lipid peroxidation, significant reduction of ferrous iron levels, and strong protection against mitochondrial damage. These findings suggested that Ticlopidine acts as a broad-spectrum ferroptosis inhibitor, offering a promising therapeutic approach for protecting the liver against IRI.

Technological Checklist for Kidney and Liver Transplantation in a Multidisciplinary Hospital. Clinical Protocol

This clinical protocol delineates the technological requirements for performing kidney and liver transplantation procedures in a multidisciplinary hospital setting. The protocol has been developed based on clinical guidelines from leading international societies and has been approved by the Samara Regional Branch of the Interregional Public Organization "Society of Transplantologists" (Protocol No. 11 dated July 1, 2024). It is recommended for use in assessing a hospital's readiness to implement transplantation programs. The technologies specified in the protocol may be implemented either through the hospital's own resources or via agreements with other healthcare institutions or through outsourcing arrangements.

Recent solid-phase microextraction-based analytical approaches for the profiling of biliary bile acids in pre-transplant assessments of liver grafts subjected to normothermic ex vivo liver perfusion

BackgroundLiver transplantation is the definitive treatment for end-stage liver failure, but the scarcity of donor organs remains a significant challenge. Leveraging organs from extended criteria donors (ECD) offers a potential avenue to address worldwide shortages, though these organs are more susceptible to post-reperfusion injury. This study explores the use of normothermic ex vivo liver perfusion (NEVLP) as a method for organ preservation – an approach that sustains liver metabolism and facilitates pre-transplant assessments of organ viability via bile analysis. The focal point of this study revolves on the development of analytical methods for determining the bile acid profile throughout the peritransplantation period as a potential indicator of liver function and viability. ResultsThe study optimized and validated a high-throughput analytical method to quantify selected bile acids in bile samples using a thin-film microextraction-liquid chromatography-mass spectrometry (TFME-LC-MS) platform. Furthermore, it introduced a solid-phase microextraction-microfluidic open interface-mass spectrometry (SPME-MOI-MS) method for rapid direct analysis of bile acid isobar groups. In the animal study, discernible variations in the concentrations of specific bile acids were observed between donors after circulatory death (DCD) and heart-beating donors (HBD), particularly following normothermic perfusion and reperfusion. Noteworthy fluctuations in individual bile acid concentrations were observed throughout the entire organ transplantation process, with taurocholic acid (TCA), glycocholic acid (GCA), and glycochenodeoxycholic acid (GCDCA) emerging as promising indicators of organ quality. The efficacy of the SPME-MOI-MS platform in corroborating these trends highlights its potential for real-time bile acid analysis during liver transplantation procedures. SignificanceOur findings underscore the efficacy of NEVLP in tandem with advanced bile acid analysis methods as a reliable strategy for pre-transplant assessments of organ viability, potentially increasing the use of ECD organs and reducing organ shortages. The ability to monitor bile acid profiles in real-time provides crucial insights into liver function and ischemic injury, making significant strides in improving transplant outcomes and patient survival rates.

Reduction of Recipient Spleen Size after Living Donor Liver Transplantation: A Retrospective Study

Abstract Background Liver transplantation is considered an important solution to patients with end stage liver disease and a glimpse of hope for some patients with terrible quality of life due to the morbidity of such disease. Living donor liver transplantation procedures has now become widely done worldwide and many studies have been done to improve its outcome and improve the quality of the patients’ lives. Objective to help identify the factors that affects the size of spleen after living donor liver transplantation and promotes the reduction in its size which greatly affects the patients’ and graft survival rate. Patients and Methods This is a retrospective study including patients underwent living donor liver transplantation to be conducted in Ain Shams university hospitals to determine the factors promoting reduction of spleen size after living donor liver transplantation. This study was conducted at Ain-Shams University Hospitals, in the period from January 2008 to June 2021. Approval of the Ethical Committee and written informed consent from all participants were obtained. Results In our study we found that from 100 patients who had splenomegaly before transplantation, 54% of patients had persistent splenomegaly after liver transplantation, while 46% of patients had normal spleen size after transplantation within 1 year. The spleen size decreased significantly after transplantation in general, from a range of 13.3- 25 cm with a mean of 18.06 cm +/- 7 pre-op, to a range of 9-18 cm with a mean of 14.1 cm +/- 2.65. By analyzing this data and dividing it into two groups, it has been found that the group with persistent splenomegaly (54% of patients) had higher range of spleen size before transplantation with a range of 16.7-25 cm with a mean of 19.75 cm +/- 2.169, while the group of normal spleen size after transplantation ranged from 13.3-17 cm with a mean of 15.3 +/- 1.018 before transplantation. Also patients with dilated portal vein and portal vein thrombosis have higher chances of persistent splenomegaly post-operative. It has been found that in 93.4% of patients (43 patients)with reduced spleen size after transplantation had patent portal vein with average diameter, while only 6.5% (3 patients) had dilated portal vein and 0 patients with attenuated portal vein. On the other hand, 44.4% of patients with persistent splenomegaly had dilated portal vein, 38.9% had patent portal vein, and 16.67% had attenuated portal vein pre-op. Our study also showed the effect of spleen after transplantation on platelets levels and liver function. The normal spleen size was associated with better recovery of platelets number, in the group of patients with normal spleen size it ranged from 32 -189 10∧3/uL with a mean of 80 10∧3/uL pre-op, it increased to a mean of 163.95 10∧3/uL post op. While in the splenomegaly group the mean platelets count pre-op was 75.27 10∧3/uL in increased to 156.88 10∧3/uL post op. It has also been found that the decrease in spleen size greatly affects the liver functions, where in aspartate aminotransferase AST and Alanine transaminase ALT levels pre- operative in patients with normal spleen with a mean of 38.37 and 57.8 respectively. It decreased to a mean of 27 and 29.7 and difference of 11.2 and 28.1 respectively. Conclusion The spleen size after living donor liver transplantation is affected by the size of the spleen before transplantation and by the diameter portal vein before transplantation. Also the reduction in spleen size after living donor liver transplantation greatly affects the patient and graft survival platelets count and liver functions such as liver enzymes, albumin and coagulation profile.

Bone remodeling in survivors of pediatric hematopoietic stem cell transplantation: Impact of heavy resistance training.

Early-onset osteoporosis is a frequent late effect after pediatric hematopoietic stem cell transplantation (HSCT). It remains unknown if physical training can improve bone formation in these patients, as the transplantation procedure may cause sustained dysregulation of the bone-forming osteoblast progenitor cells. We aimed to explore the effect of resistance training on bone remodeling in long-term survivors of pediatric HSCT. In this prospective, controlled intervention study, we included seven HSCT survivors and 15 age- and sex-matched healthy controls. The participants completed a 12-week heavy load, lower extremity resistance training intervention with three weekly sessions. We measured fasting serum levels of the bone formation marker "N-terminal propeptide of type I procollagen" (P1NP), and the bone resorption marker "C-terminal telopeptide of type I collagen" (CTX). The hypothesis was planned before data collection began. The trial was registered at Clinicaltrials.gov before including the first participant, with trial registration no. NCT04922970. Resistance training led to significantly increased levels of fasting P1NP in both patients (from 57.62 to 114.99ng/mL, p=.03) and controls (from 66.02 to 104.62ng/mL, p<.001). No significant changes in fasting CTX levels were observed. Despite previous high-dose cytotoxic therapy, long-term survivors of pediatric HSCT respond to resistance training with improvement of bone formation, comparable to that of healthy controls. This suggests that resistance training might be a promising non-pharmacological approach to prevent the early decline in bone mass, and should be considered as part of a follow-up program to counteract long-term sequela after pediatric HSCT.

Cross-circulation combined with rapidly deployable veno-venous bypass grafts for multi-organ biosystemic support in liver failure: Experimental studies.

Liver failure remains a critical clinical challenge with limited treatment options. Cross-circulation, the establishment of vascular connections between individuals, has historically been explored as a potential supportive therapy but with limited success. This study investigated the feasibility of combining cross-circulation with a rapidly deployable veno-venous bypass (VVB) graft for multi-organ support in a rat model of total hepatectomy, representing the most severe form of liver failure. A Y-shaped VVB graft was fabricated using coaxial electrospinning of PLCL/heparin nanofibers and magnetic rings for rapid anastomosis. After total hepatectomy in rats, the VVB graft was implanted to divert blood flow. Cross-circulation was then established between anhepatic and normal host rats. Hemodynamics, biochemical parameters, blood gases, and survival were analyzed across three groups: hepatectomy with blocked vessels (block group), hepatectomy with VVB only (VVB group), and hepatectomy with VVB and cross-circulation (VVB/cross-circulation group). The VVB graft exhibited suitable mechanical properties and hemocompatibility. VVB rapidly restored hemodynamic stability and mitigated abdominal congestion post-hepatectomy. Cross-circulation further ameliorated liver dysfunction, metabolic derangements, and coagulation disorders in anhepatic rats, significantly prolonging survival compared to the VVB group (mean 6.56±0.58 vs 4.05±0.51h, P<0.05) and the block group (mean 1.01±0.05h, P<0.05). Combining cross-circulation with a rapidly deployed VVB graft provided effective multi-organ biosystemic support in a rat model of total hepatectomy, substantially improving the biochemical status and survival time. This approach holds promise for novel liver failure therapies and could facilitate liver transplantation procedures.

Recurrent treatment of refractory acute cellular rejection with alemtuzumab after lung transplantation

We present an exceptional case of a lung transplant recipient successfully treated by multiple courses of alemtuzumab for refractory acute cellular rejection.The patient experienced multiple episodes of acute cellular rejection following the transplantation procedure. Alemtuzumab was initiated as third-line rejection treatment and was repeated six times. Each treatment course resulted in complete recovery of the pulmonary function and depletion of T- and B-lymphocytes and NK cells. The onset of rejection was consistently preceded by the recovery of NK cells, while T- and B-lymphocytes remained depleted. This suggests a rejection process mediated by NK cells.This case contributes to recent research findings suggesting that NK cells play a significant role in acute cellular rejection in lung transplant recipients and stresses the importance to further investigate the role of NK cells in rejection. Furthermore, it demonstrates that acute cellular rejection following lung transplantation can be repeatedly managed by treatment with alemtuzumab. Data availability statementThe authors confirm that the data supporting the findings of this study are available within the article.

Pre-transplant experiences: A phenomenological study with hemodialysis patients awaiting transplantation

This study delves into the lived experiences of hemodialysis patients in anticipation of a transplant, with a particular focus on the transplant event. The present investigation is a qualitative research study employing a phenomenological framework. The sampling process was conducted using a purposive sampling technique, and the study included fourteen hemodialysis patients who were on the kidney transplant waiting list. The analysis of the interviews was performed utilizing the Colizzi method. This theme encompasses five sub-themes and five units of meaning: "the experience of distances" (concerns about financial assistance requests, concerns about requesting a kidney donation), "social embarrassment" (lack of genuine consent in living donors, the spiritual ownership the living donors, cognitive and civil ownership of living donors), "unfamiliar organ inside me", "the scent of death", and "excitement for an ambiguous future". The process of awaiting an organ transplant, with its inherent challenges, immerses patients in a complex cycle of varied emotions, beliefs, and life experiences during the kidney transplant waiting period. This phase is characterized by anxiety and mental apprehensions about the transplant procedure, the receipt of an organ from a living or deceased donor, and contemplations about life post-transplant with a new organ. Therefore, a comprehensive understanding of patients' lived experiences during this waiting period can equip relevant organizations and healthcare providers with the necessary insights to effectively manage the complexities of this life stage and deliver more professional and personalized care.

Donor procedure of lobar lung transplantation in the mouse.

Donor procedure of lobar lung transplantation in the mouse.