Warm Ischemia Research Articles

Transperitoneal robot-assisted partial nephrectomy: a comparison of operative and oncological outcomes between posterior and anterolateral tumours.

To compare operative and oncological outcomes, as well as the risk of postoperative complications in patients who underwent transperitoneal robot-assisted partial nephrectomy (RAPN) for renal tumours located either posteriorly or anterolaterally. Retrospective, consecutive study including 451 patients who underwent transperitoneal RAPN for non-metastatic, localised renal tumours from May 2016 to April 2023. Operative data included duration of the procedure, warm ischaemia time, and blood loss; oncological data included surgical margins and recurrence; and 90-day postoperative complications were classified according to the Clavien-Dindo classification. In total, 140 (31%) patients had tumours with a posterior location. The median follow-up was 3.3 (IQR 1.8-5.0) years. There were no differences in operative outcomes or length of hospital stay between the two groups. Positive surgical margins were recorded in 9% of the patients with posterior tumours compared to 7% of patients with anterolateral tumours, p = 0.60. The estimated probability of recurrence-free survival at 5years was 95.2% (95% CI 87.4-98.2) for patients with posterior tumours and 96.7% (95% CI 92.3-98.6) for patients with anterolateral tumours, p = 0.4. Patients with posterior tumours had a similar risk of any complication (OR 1.24 [95% CI 0.80-1.91]) and CD ≥ III (OR 0.73 [95% CI 0.28-1.67]) compared to patients with anterolateral tumours. This study found that patients with posterior tumours had longer operating times and hospital stays following transperitoneal RAPN compared to those with anterolateral tumours but without increased complications or poorer oncological outcomes.

Can parenchymal volume analysis replace nuclear renal scans for split renal function before and after partial nephrectomy with warm ischemia?

The assessment of split renal function (SRF) before and after partial nephrectomy (PN) is crucial. While nuclear renal scan (NRS) is a traditional method for evaluating SRF, its extensive use is hindered by concerns regarding radioactivity. Parenchymal volume analysis (PVA) has been employed to assess SRF for kidney donors. Nonetheless, the efficacy of PVA in evaluating SRF in kidneys with renal masses before and after PN with warm ischemia remains uncertain. The current study probed into the potential of PVA as a substitute for NRS in assessing SRF before and after PN with warm ischemia. This study included 318 patients who underwent unilateral PN with warm ischemia at Sun Yat-Sen University Cancer Center (SYSUCC) and had a functional contralateral kidney. All patients underwent PVA and NRS assessments both pre-PN and at 1-12 months post-PN. PVA was analyzed using Mimics software in the venous phase. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 equation. The correlation between ipsilateral eGFR values derived from SRF assessed via PVA and NRS was examined using Pearson correlation. Concordance between different methods of SRF estimation was analyzed using the Friedman test, Bland-Altman plots, and Kendall's consistency coefficient. Similar study was conducted on a comparable cohort from Sun Yat-Sen Memorial Hospital. The median tumor size was 3.5cm, and the median warm ischemia time was 25min. Preoperatively, ipsilateral SRF values based on PVA were notably consistent with those derived from NRS (49.4% vs 50.0%, P = .501). A strong correlation was observed between preoperative ipsilateral eGFR based on SRF from PVA and NRS (r = 0.89, P < .0001). Bland-Altman plots indicated minimal bias (-0.36%) between PVA and NRS in assessing SRF. However, post-PN, the median ipsilateral SRF based on PVA was slightly higher than that based on NRS (45.6% vs. 43.6%, P < .0001). Although there was still a strong correlation between post-PN ipsilateral eGFR based on SRF from PVA and NRS (r = 0.87, P < .0001), Bland-Altman plots revealed a non-negligible bias between the 2 methods (2.19 %). External study supported our findings. PVA shows promise as a substitute for NRS in assessing SRF before PN with warm ischemia. However, this substitution may result in an overestimation of ipsilateral renal function in the post-PN phase.

Association analysis of T and B-cell epitopes with humoral alloimmunisation in kidney transplantation: A Tunisian cohort study.

HLA matching is critical for successful kidney transplantation. This study aimed to investigate the impact of eplet mismatches and Predicted Indirectly Recognizable HLA Epitopes (PIRCHE-II) scores on the development of de novo donor-specific antibodies (dnDSA) and graft survival in a Tunisian cohort, characterized by a high prevalence of living donors and significant genetic diversity in HLA profiles. This retrospective study included 112 adult kidney transplant recipients who underwent transplantation between 2012 and 2018. Donor and recipient HLA typing was performed using One Lambda Labtype PCR-SSO and PCR-SSP kits, with high-resolution typing inferred using validated tools and reference datasets. Luminex DSA screening (One Lambda) was conducted at transplantation, during follow-up for graft dysfunction or proteinuria, and at the study's conclusion. Eplet mismatches and PIRCHE-II scores were calculated using EpVix and PIRCHE-II software. Nineteen patients (17%) developed dnDSA, predominantly targeting HLA-DQ, with a median detection timeframe of 50months (range: 11-106months) post-transplantation. Male donor sex was negatively associated with dnDSA development, while prolonged cold ischemia time was a significant risk factor. Molecular HLA-DQ mismatches and high PIRCHE-II scores were significantly associated with dnDSA. Factors independently associated with reduced death-censored graft survival included history of transfusion after transplantation, allelic DRB1 mismatch, dnDSA development, and elevated PIRCHE-II score. Our findings highlight the critical role of HLA-DQ compatibility in kidney transplantation and suggest that molecular HLA-DQ matching should be considered in kidney allocation strategies to minimise alloimmune responses and improve long-term graft outcomes.

Impact of Hypothermic Perfusion on Immune Responses and Sterile Inflammation in a Preclinical Model of Pancreatic Transplantation.

In organ transplantation, cold ischemia is associated with sterile inflammation that subsequently conditions adaptive immunity directed against the grafts during revascularization. This inflammation is responsible for venous thrombosis, which is the main postoperative complication affecting graft function. Our aim was to investigate the modulation of immune responses and endothelial function of pancreatic grafts during cold ischemia using different preservation modalities. According to a preclinical porcine model of controlled donation after circulatory death, pancreatic grafts were preserved under hypothermic conditions for 24 h according to 4 modalities: static cold storage, hypothermic machine perfusion, hypothermic oxygenated perfusion at 21%, and 100%. Biopsies of the head and tail of the pancreas were performed during preservation. The first step involved a broad screening of the gene expression profile (84 genes) during preservation on a limited number of grafts. In the second step, a confirmation test was performed in all 4 groups. Vascular endothelial growth factor gene expression showed a decrease during preservation in the hypothermic oxygenated perfusion 21% and 100% groups compared with the static cold storage group. In contrast, thrombomodulin gene expression showed an increase during preservation in the hypothermic oxygenated perfusion 21% and 100% groups compared with the static cold storage and hypothermic machine perfusion groups. We demonstrated that compared with static cold storage, hypothermic oxygenated perfusion is an effective modality for modulating endothelial function by increasing thrombomodulin expression and decreasing ischemia and vascular endothelial growth factor expression.

The role of hyperaccuracy CT three-dimensional reconstruction technology in partial nephrectomy for completely endophytic renal cell carcinoma: A retrospective propensity-matched cohort study.

To compare the clinicopathological, perioperative, functional, and oncological outcomes of completely endophytic renal cell carcinoma (RCC) patients who underwent partial nephrectomy (PN) with or without preoperative hyperaccuracy CT three-dimensional (HACT3D) reconstruction. A retrospective cohort study was conducted on 154 completely endophytic RCC patients treated with PN at our medical center from January 2018 to December 2023. Patients were divided into two groups based on whether they received preoperative HACT3D reconstruction. To control for selection bias, we implemented 1:1 propensity score matching based on baseline characteristics. In the original cohort, 47 patients in the HACT3D group had higher RENAL scores (P=0.014) and PADUA scores (P=0.012). After matching, each group contained 47 RCC patients with no significant baseline differences (P>0.05). In the matched cohort, patients in the HACT3D group had significantly shorter warm ischemia time (WIT) (22.3 vs. 26.7min, p<0.001), shorter total length of hospital stay (LOS) (10.0 vs. 11.6 days, p=0.012), shorter postoperative LOS (5.8 vs. 7.3 days, p=0.003), and higher trifecta achievement rate (83.0% vs. 36.2%, p<0.001). Among functional variables, patients in the HACT3D group exhibited a smaller increase in postoperative serum creatinine (SCR) (7.5 vs. 16.5μmol/L, p=0.012), and a smaller decrease in postoperative estimated Glomerular Filtration Rate (eGFR) (-6.9 vs. -14.1mL/min/1.73m2, p=0.011). No significant differences were found in pathological outcomes and prognosis between the two groups (p>0.05). For completely endophytic RCC patients, HACT3D reconstruction can assist clinicians in performing precise parameter measurements, designing personalized surgical approaches, and providing intraoperative image guidance.

Impact of Normothermic Machine Perfusion on Patient Survival Following Deceased Donor Liver Transplant Compared to Short Cold Ischemia Time Alone

Impact of Normothermic Machine Perfusion on Patient Survival Following Deceased Donor Liver Transplant Compared to Short Cold Ischemia Time Alone

A Novel Machine Perfusion System for Enhancing Hepatic Microcirculation Perfusion

ABSTRACTBackgroundMachine perfusion is a promising strategy for safeguarding liver transplants donated after cardiac death (DCD). In this study, we developed and validated a novel machine perfusion approach for mitigating risk factors and salvaging severe DCD livers.MethodsA novel hypothermic oxygenated perfusion (HOPE) system was developed, incorporating two pumps and an elastic water sac to emulate the functionality of the cardiac cycle. Compared to conventional systems (HOPE S1 and S2), the novel HOPE system (HOPE S3) was evaluated in rats, utilizing healthy livers perfused with methylene blue diluted using Histidine‐tryptophan‐ketoglutarate (HTK) solution or DCD livers subjected to 60 min of warm ischemia without heparin administration. Liver perfusion outcomes were assessed through macroscopic and microscopic evaluations, molecular analyses, and orthotopic liver transplantation (OLT).ResultsDCD livers subjected to HOPE systems' perfusion exhibited decreased injury and enhanced survival rates compared to static cold storage following 60 min of warm ischemia (DCD + SCS). The 4‐week post‐transplantation survival rates were 0%, 20%, and 33% in the DCD + SCS, HOPE S1, and HOPE S2 groups, respectively. HOPE S3 conferred protection against hepatocyte and non‐parenchymal cell injury, resulting in a 67% animal survival rate following 60 min of warm donor ischemia (HOPE S3). Assessments of hepatic sinusoidal microcirculation, morphological changes, and molecular alterations in preserved livers further confirmed these findings.ConclusionsThe newly devised machine perfusion system can enhance and uniform liver perfusion and may become a promising tool for revitalizing DCD liver grafts afflicted with severe warm ischemic injuries.

Disposable intravenous infusion sets as a temporary intravascular shunt for major limb replantation: a retrospective study

ObjectiveThe key to increasing the success rate of limb preservation lies in timely restoration of the blood supply to the severed limb, This study examines the clinical effect of a disposable intravenous infusion device as a temporary vascular shunt device which can quickly restore blood circulation in the replantation of severed limbs.MethodsA retrospective review of all amputated major limbs in our department from May 2005 to May 2022. Patients treated with intravenous infusion tubes as temporary vascular shunt devices were included in group A(shunt group ) and those who could not use temporary intravascular shunt devices were included in group B (no shunt group). The durations of temporary vascular shunt placement and continuous placement during the operation were recorded, and the rates of limb survival and complications ( thrombosis and osteofascial compartment syndrome, infection) were evaluated after the operation. A comparison of complications, the postoperative function between the two groups was also performed. Results: A total of 67 patients were included: group A (shunt group, n = 35) and group B (no shunt group, n = 32), The average duration of temporary vascular shunt placement in all patients was 10 ± 1.5 min. The rate of amputation and the incidence of thrombus compartment syndrome and infection were statistically different between the two groups (P < 0.05), There was no significant difference in thrombosis rate between the two groups. All patients were followed up for a mean of 32.5 (8–60) months. The DASH scores of group A and group B at the last follow-up were 65 ± 8.5 points and 85 ± 6.5 points respectively and The Maryland foot scores of group A and group B at the last follow-up were 58 ± 4.5 points and 35 ± 5.5 points respectively, There were statistical differences in function between the two groups(P < 0.05).ConclusionA disposable intravenous infusion device as a temporary vascular shunt device can be effectively and practically used for reducing the warm ischemia time and significantly improving the successful limb replantation rate and is therefore worthy of clinical application.

Impact of platelet-lymphocyte ratio after robot-assisted partial nephrectomy with renorrhaphy

Renorrhaphy is often performed after tumor resection during robotic-assisted laparoscopic partial nephrectomy (RAPN). This study aimed to investigate the association between renorrhaphy performance and inflammatory markers. A retrospective cohort study was conducted including patients with renal cell carcinoma who underwent RAPN at eight institutions in Japan between April 2016 and November 2023. The primary endpoint was the association between the renorrhaphy performance in RAPN and the postoperative inflammatory markers. The secondary endpoints were perioperative outcomes in patients with and without renorrhaphy. The patients were divided into two groups at the time of RAPN: those who underwent renorrhaphy (renorrhaphy group) and those who did not (omitted group). In total, 934 patients were enrolled in this study. After propensity score matching, the rate of change in C-reactive protein and neutrophil-lymphocyte ratio on postoperative day 28 were not significant difference between the two groups. In contrast, the rate of change in platelet-lymphocyte ratio (PLR) on postoperative day 28 was significantly higher in renorrhaphy group than omitted group. Regarding surgical outcomes, the renorrhaphy group had a significantly longer hospital stay, operative time, and warm ischemia time (P = 0.038, P = 0.022, and P = 0.009, respectively) than the omitted group did. Furthermore, the omitted group had a significantly higher rate of Trifecta achievement than the renorrhaphy group did. This study demonstrated that renorrhaphy performance in RAPN was significantly associated with the higher value of postoperative PLR.

Long-Term Results of Kidney Transplantation in Patients Aged 60 Years and Older.

Background/Objectives: The results of kidney transplantation (KTx) in elderly patients are deteriorated by more frequent use of organs procured from older or extended criteria donors (ECDs). To eliminate the influence of donor factors on the transplantation results, the pair analysis method was applied. The study aimed to assess the survival, during long-term follow-up after transplantation, of recipients and transplanted kidneys, graft function, and factors influencing survival in recipients aged 60 years and older (≥60) compared to recipients aged less than 60 years (<60) who received a kidney from the same brain death donor (DBD). Methods: The study group consisted of 213 consecutive patients ≥60 who received a kidney procured from a DBD from whom the second procured kidney was transplanted to a patient <60 (control group). Results: The survival rates in the 10-year follow-up period were lower in those recipients ≥60 than in the control group (p < 0.01). The survival rates of the transplanted kidneys were comparable in both groups, while the death-censored graft survival was higher in those patients ≥60 than in the control group (p < 0.05). The estimated glomerular filtration rate levels were similar in the follow-up in patients ≥60 compared to those recipients <60. Transplantation of kidneys procured from ECD, longer duration of dialysis treatment, and longer duration of cold ischemia time (CIT) affected the recipient and graft survival in the ≥60 patients. Death-censored kidney graft survival was influenced by transplantation of a kidney procured from ECD, longer CIT, and the need for reoperation in the early postoperative period. Conclusions: Despite the higher mortality in the kidney recipients ≥60, the long-term results of KTx after the elimination of donor-dependent factors are similar or better compared to the recipients <60. The factors influencing the results of KTx in elderly recipients differ from those observed in the entire cohort and younger patients.

Evaluation of surgical outcomes of nephron-sparing surgery in a leading hospital of an advanced nation

Objectives: To assess the efficacy of renal score grading in guiding therapy decisions, predicting perioperative outcomes, and characterising tumours following partial nephrectomy. Methods: The retrospective, single-centre study was conducted at the University College Hospital Galway, Ireland, and comprised data from January 11, 2012, to June 17, 2016, of all patients aged &gt;18 years who underwent partial nephrectomy as part of treatment for kidney cancer. Data was analysed using SPSS 20. Results: Of the 76 patients, 52(68.4%) were males and 24(31.6%) were females. The median age of patients was 58 years (IQR: 16). Tumours were predominantly on the right side 44(57.9%) and lower pole 36(47.4%), with a median tumour size of 2.35 cm (IQR: 1.0 cm), and renal score had a median of 5.00 (IQR: 2). Of the total, 70(92.1%) patients underwent open surgery, with complications in 6(7.9%), which were associated significantly with higher body mass index, American Society of Anaesthesiologists classification score, warm ischemia time and tumour size (p&lt;0.05). Recurrence correlated with tumour size and positive margins (p&lt;0.05). Survival analysis showed a median disease-free survival (DFS) of 30 months (IQR: 6 months). However, due to the absence of events, the median overall survival (OS) and survival estimates could not be fully calculated. The longest follow-up time was 36 months, with no recorded mortality in the cohort. Conclusion: For individuals with comparatively small localised renal tumours, the selection of partial nephrectomy was found to be a suitable alternative, showcasing exceptional results regarding the complication profile, recurrence-free survival and overall survival. Key Words: Nephron Sparing surgery, Partial nephrectomy, Small renal masses, Renal score, Perioperative outcomes.

Dynamic Preservation of Donation After Circulatory Death Liver Grafts From Donors Aged 60 y and Older.

Donor livers from older donation after circulatory death (DCD) donors are frequently discarded for transplantation because of the high risk of graft failure. It is unknown whether DCD livers from older donors benefit from dynamic preservation. In a multicenter study, we retrospectively compared graft and patient outcomes after transplantation of livers from DCD donors older than 60 y, preserved with either static cold storage (SCS), ex situ sequential dual hypothermic perfusion, controlled oxygenated rewarming, and normothermic perfusion (DHOPE-COR-NMP), or in situ abdominal normothermic regional perfusion (aNRP). Fifty-six liver transplants were included in the SCS cohort, 33 in the DHOPE-COR-NMP cohort, and 27 in the aNRP cohort. Donor warm ischemia time was significantly shorter in the SCS group than in DHOPE-COR-NMP (P < 0.001) and aNRP (P < 0.001) groups. Cold ischemia times were similar. One-year incidence of nonanastomotic biliary strictures was lower after DHOPE-COR-NMP (3%, P = 0.03) or aNRP (7%, P = 0.13), compared with SCS alone (21%). Anastomotic strictures were less frequent in aNRP (19%) compared with DHOPE-COR-NMP (52%; P = 0.015). One-year graft and patient survival were similar. Dynamic preservation allows safe transplantation of livers from DCD donors aged 60 y or older. The risk of nonanastomotic strictures was significantly lower after DHOPE-COR-NMP than after SCS, despite longer donor warm ischemia times.

Subnormothermic Machine Perfusion of Neonatal and Small-Sized Pediatric Donor Hearts.

Donor heart machine perfusion enables avoidance of prolonged cold ischemia, however the optimal temperature is yet to be elucidated. Given that maintenance of temperature beyond ambient levels demands significant energy, we sought to determine the suitability of room-temperature perfusion preservation of neonatal/pediatric-sized (5-20 kg) piglet donor hearts. A custom device was fabricated suitable for this purpose, with continuous readout of perfusion pressure, flow rate, temperature, and oxygen saturation. Oxygen delivery was automated to keep saturation above 90%. The perfusate consisted of a 1:1 mix of donor whole blood and modified Krebs-Henseleit solution with albumin. Donor hearts were procured from 5 kg (n = 5), 10 kg (n = 3), and 20 kg (n = 5) piglets, and perfused for 10 hours. Subsequently, 20 kg piglet hearts were transplanted. Hemodynamic stability and echocardiographic measurement of donor heart function were evaluated posttransplant. Perfusate parameters were stable through the perfusion interval. Temperature was consistently 23.8 ± 1.6°C. pH (7.35 ± 0.09) and pO2 (102 ± 29 mm Hg) were steady throughout. Glucose (5.9 ± 1.8 mmol/L) and lactate (2.4 ± 1.5 mmol/L) were metabolized by the heart over the course of perfusion. Transplanted hearts displayed durable hemodynamics and good biventricular function. We conclude that neonatal and pediatric hearts can be safely perfused for extended periods at subnormothermic conditions using blood-based perfusate.

Risk scores for allograft failure: Are they still useful in liver recipients from donation after circulatory death?

Liver grafts from donation after circulatory death (DCD) are associated with a higher risk of early graft dysfunction, determined by the warm ischemia and cold ischemia times. It is essential to have precise criteria to identify this complication in order to guide therapeutic strategies. To validate different graft and recipient survival scores in patients undergoing liver transplantation (LT) with DCD grafts. A retrospective and observational unicentric study was conducted on 65 LT patients with grafts obtained from controlled DCD donors from November 2013 to November 2022. The United Kingdom (UK) risk score, early allograft dysfunction (EAD) Olthoff score, and model for early allograft function (MEAF) score were used to evaluate the risk of graft and recipient survival post-transplant. For survival analysis purposes, we used the Kaplan-Meier method, and the differences between subgroups were compared using the log-rank (Mantel-Cox) test. Sixty-five patients were included in the study. The UK risk score did not demonstrate predictive capacity for recipient or graft survival. However, in donors aged over 70 years old (18.4%), it significantly predicted graft survival (P < 0.05). According to Kaplan-Meier survival curves, graft survival rates at 6 months, 2 years, and 5 years in the futility group dramatically decreased to 50% compared to the other groups (log-rank 8.806, P < 0.05). The EAD Olthoff and MEAF scores did not demonstrate predictive capacity for recipient or graft survival. Based on Kaplan-Meier survival curves, patients with a MEAF score ≥ 7 had a lower graft survival rate at 6 months, 2 years, and 5 years compared to patients with a lower MEAF score (log-rank 4.667, P < 0.05). In our series, both UK DCD risk score and MEAF score showed predictive capability for graft survival.

Analyzing the temporal trends of kidney transplantation surgeries and their impact on warm and cold ischemia time in a Canadian setting.

The effect of weekend admission and surgery on patient morbidity and mortality has been studied in many settings and has been shown to lead to worse outcomes. Several studies have sought to determine whether there is a weekend effect in kidney transplantation specifically, but a clear effect on outcomes and graft survival has not been established. We analyzed data from all deceased-donor organ procurements and cadaveric kidney transplants occurring during the 5-year period between Apr. 1, 2013, and Dec. 31, 2017, included in the database of the Trillium Gift of Life Network, Ontario's organ and tissue donation agency. A total of 1116 deceased donor nephrectomies (DNs) and 1858 recipient procedures were performed in Ontario during the study period. The overall rate of after-hours DNs on weekdays was significantly greater than during working hours (23.1/30 d v. 15.4/30 d, p < 0.001). Donations after neurological determination of death were more frequent during weekday working hours (22.8/30 d) than after hours on weekdays (17.3/30 d, p < 0.001) or weekends (16.3/30 d, p < 0.001), whereas donations after cardiac death were significantly more frequent after hours on weekdays than during working hours (10.3/30 d v. 7.7/30 d, p = 0.021). On weekdays, mean warm ischemia time (WIT) was significantly longer after hours than during working hours (40.75 ± 12.26 min v. 38.52 ± 11.92 min, p = 0.017). Similarly, mean WIT was longer after hours than during working hours on weekends (40.23 ± 12.48 min v. 38.59 ± 11.91 min, p = 0.015). Kidney transplantations occurred more frequently after hours and were associated with increased WIT. Further study is needed across multiple Canadian centres to better understand the temporal patterns of kidney transplantation and implications for patients, providers, and health care systems.

Robot-assisted partial nephrectomy in complex renal tumors using the Versius platform: An initial but promising experience

ABSTRACT Background and objectives The widespread utilization of robotic surgeries in urology encouraged several teams to explore the option of performing robot-assisted partial nephrectomy (RAPN), taking advantage of its magnified stereoscopic vision and the articulating instruments that facilitate tumor resection and the reconstructive steps of hemostasis and renorrhaphy. The implementation of the CMR Versius system in RAPN, especially in complex masses, has not been explored yet. Herein, we present our initial experience in performing RAPN in complex renal masses using this novel platform. Methods Between July 2022 and November 2023, thirty patients who had complex renal masses and were candidates for RAPN were enrolled in this study. Tumor complexity was assessed using the preoperative aspects of the dimension used for anatomic (PADUA) nephrometry scores. Perioperative data were prospectively collected and analyzed. ‘TRIFECTA’ was defined as free surgical margins, warm ischemia time (WIT)< 30 minutes, and no major complications (>Clavien-Dindo II). Results All cases were successfully completed with no conversion to radical, open, or laparoscopic surgery. The median PADUA score was 9.5 (8–11). The mean docking time, console time, and total operative time were 9.17 ± 0.91, 149 ± 14.27, and 177.17 ± 29.53 minutes, respectively. The mean WIT was 26.67 ± 3.66 minutes. Surgical margins were free in all cases. TRIFECTA was fulfilled in 25/30 patients (83.33%). Five patients (16.66%) did not fulfill TRIFECTA; two patients had prolonged WIT > 30 minutes, two had prolonged WIT with prolonged urine leakage necessitating DJ stent insertion, and the fifth patient had only prolonged urine leakage and DJ insertion. None of the patients developed tumor recurrence or acute kidney injury during follow-up. Conclusion Performing RAPN with the CMR Versius platform is a feasible option in complex renal masses with slightly increased but accepted WIT and total operative time. It should be wisely restricted to well-experienced teams.

Survival outcomes following liver retransplantation (reSOFT) score: A model predicting survival after adult liver retransplantation.

Recipient and donor risk factors impacting adult liver retransplantation remain inadequately described in the modern era of liver transplantation. Our study aimed to develop a risk model for 3-month recipient survival following liver retransplantation using data from the Organ Procurement and Transplantation Network's (OPTN) liver transplantation database. We conducted univariate and multivariable analyses on 6,660 adult patients who underwent liver retransplantation between 2002 and 2023. Multiple imputation was also conducted to account for missing variables. From our analysis, we identified 14 recipient factors, 1 donor factor (age), and 1 operative factor (cold ischemia time) that significantly impacted 3-month patient survival. Among the most significant risk factors was a functional status, measured by the Karnofsky Score, of 10% at retransplantation (OR 1.80, 95% CI: 1.44-2.24) and recipient albumin of less than 1.5 (OR: 1.76, CI: 1.12-2.77). The most significant protective factors included a functional status of 90% (OR 0.22, CI: 0.07-0.70) and recipients with a history of hepatocellular carcinoma (OR 0.10, CI: 0.01-0.79). The reSOFT score was developed by assigning points to these factors proportional to their hazard ratios and divided into high-, moderate-, and low-risk groups that accurately predict 3-month survival post-retransplant. With a C-statistic of 0.73 (CI 0.71-0.75), this tool may serve to guide clinicians in identifying and better caring for high-risk re-transplant recipients.

Uterine Transplant Optimization From a Preclinical Donor Model With Controlled Cardiocirculatory Arrest.

Uterus transplantation from deceased donors offers a promising solution to the organ shortage, but optimal preservation methods are crucial for successful outcomes. Our primary objective is to conduct an initial assessment of the contribution of oxygenated hypothermic perfusion in uterine transplantation. We performed a preclinical study on a porcine model of controlled donation after circulatory death (60 min warm ischemia). Ten uterus grafts were preserved for 12 h using static cold storage or hypothermic machine perfusion (VitaSmart device, perfusion pressure at 15 mm Hg). Subsequently, they were reperfused using ex vivo normothermic machine perfusion (Liverassist, perfusion pressure at 30 mm Hg) with oxygenated autologous blood to assess early ischemia/reperfusion injury. Not only resistance index assessment and oxygenation evaluation but also immunochemistry and gene expression analysis were performed. This study demonstrates the feasibility of using hypothermic machine perfusion for uterine graft preservation, showing improvements in reperfusion capacity (decrease of resistance indexes; P < 0.0001) and tissue oxygenation (higher oxygen level) compared with static cold storage. These findings provide valuable insights for further research and refinement of uterine transplantation procedures.

Prolonged time from cross clamp until normothermic machine perfusion start is associated with increased risk of early allograft dysfunction following DCD liver transplant.

There is a paucity of data on the impact of cold ischemia time prior to the initiation of normothermic machine perfusion (NMP), particularly in more susceptible organs such livers from DCD donors. The present analysis aimed to investigate the impact of prolonged time from cross clamp until NMP start on early allograft dysfunction (EAD) and other peri-liver transplant (LT) outcomes. All DCD LT performed and placed on NMP at Mayo Clinic Arizona, Florida and Rochester from January 2022-March 2024 were included. The decision was made a priori to divide the population into 2 groups based on terciles: Typical Cross-clamp to On-pump time (lower 2 terciles) versus Prolonged Cross-clamp to On-pump Time (upper tercile; >2h 45.6min). 384 DCD LT undergoing NMP met the inclusion criteria. The rate of EAD was significantly higher in the Prolonged Cross-clamp to On-pump group (51.2%) compared to the Typical Cross-clamp to On-pump group (37.6%) (P=0.01). The Prolonged Cross-clamp to On-pump group also had higher rates of AKI and number of pRBCs transfused during LT. No significant difference in IC (2.0% vs. 1.5%;P=0.77) or graft survival at 12 months was seen between the Prolonged Cross-clamp to On-pump and Typical Cross-clamp to On-pump group, respectively. Following cross clamp, DCD liver grafts should be placed on the NMP pump as quickly as is safely and logistically possible. In cases where delays are unavoidable such as waiting for biopsy results or liver reallocation with another center, acceptable results can still be achieved and therefore livers with prolonged times should still be utilized.

Integrating Clinical and Histopathological Data to Predict Delayed Graft Function in Kidney Transplant Recipients Using Machine Learning Techniques.

Background: Given the significant impact of delayed graft function (DGF) on transplant outcomes, the aim of this study was to develop and validate machine learning (ML) models capable of predicting the risk of DGF in deceased-donor kidney transplantation (DDKT). Methods: This retrospective cohort study was conducted using clinical and histopathological data collected between 2018 and 2022 at Ramathibodi Hospital from DDKT donors, recipients, and post-implantation time-zero kidney biopsy samples to develop predictive models. The performance of three ML models (neural network, random forest, and extreme gradient boosting [XGBoost]) and traditional logistic regression on an independent test data set was evaluated using the area under the receiver operating characteristic curve (AUROC) and Brier score calibration. Results: Among 354 DDKT recipients, 64 (18.1%) experienced DGF. The key contributing factors included a donor body mass index > 23 kg/m2, donor diabetes mellitus, a prolonged cold ischemia time, a male recipient, and an interstitial fibrosis/tubular atrophy score of 2-3 in the time-zero kidney biopsy sample. The random forest model had a specificity of 99.96% and an AUROC of 0.9323, the neural network model had a specificity of 97.43% and an AUROC of 0.844, and the XGBoost model had a specificity of 99.81% and an AUROC of 0.989. A traditional statistical model had a specificity of 84.4% and an AUROC of 0.769. Conclusions: Predictive models, especially XGBoost models, have potential as tools for assessing DGF risk post-DDKT, guiding acceptance decisions, and avoiding risky biopsy, and they may be crucial in resource-limited settings.