Transplantation Direct最新文献

{"title":"Improved Survival From Graft-versus-host Disease Following Pediatric Small Intestinal Transplantation Through Reduction in Systemic Immunosuppression Altering T-cell Chimerism Dynamics.","authors":"Sandeep Potluri, Sarah Lawson, Shyla Kishore, Malobi Ogboli, Jane Hartley, Arun Alfred, Yvonne Wilson, Darius F Mirza, Khalid Sharif, Girish Gupte","doi":"10.1097/TXD.0000000000001830","DOIUrl":"10.1097/TXD.0000000000001830","url":null,"abstract":"<p><strong>Background: </strong>Graft-versus-host-disease (GvHD) is an infrequent but serious complication of small intestinal transplantation in children, which is associated with a very poor prognosis. This study evaluated a novel strategy of managing GvHD in these patients through a reduction in immunosuppression.</p><p><strong>Methods: </strong>We conducted a retrospective review 108 consecutive pediatric patients at our center between 2005 and 2021, who had small intestinal transplantation. We assessed clinical features and outcomes as well as laboratory chimerism studies in cohorts of patients before and following a change in treatment strategy for GvHD from intensification to reduction in immunosuppression.</p><p><strong>Results: </strong>Fourteen percent of pediatric patients developed GvHD after small intestinal transplantation. A change in treatment strategy to a reduction in immunosuppression led to significantly improved overall survival (log rank <i>P</i> = 0.015). This improved survival correlated biologically with altered T-cell chimerism dynamics in blood; in patients who had a reduction in immunosuppression, there was abrogation of the rise in donor T-cell chimerism over time seen in the blood of patients who instead had intensification of their immunosuppression. This may be because of permitting recipient lymphocytes to have a host-versus-graft effect and outcompete donor-derived lymphocytes.</p><p><strong>Conclusions: </strong>Our results demonstrate that that altering the immunosuppressive therapy strategy, following clinical manifestations of GvHD such as a typical skin rash, from intensification to a reduction in immunosuppression led to significantly improved survival.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 7","pages":"e1830"},"PeriodicalIF":1.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seven Cases of Living Parental Small Bowel Transplantation Donors: Perioperative Care in 3D Laparoscopic Live Donor Ileal Resection.","authors":"Dongling Shao, Qunmin Wang, Shuting Sun, Chaoxu Liu, Ge Sun","doi":"10.1097/TXD.0000000000001783","DOIUrl":"10.1097/TXD.0000000000001783","url":null,"abstract":"<p><strong>Background: </strong>Although small bowel transplantation is generally a highly effective treatment for patients with irreversible intestinal failure, and it is the only viable recourse for the restoration of intestinal function, the quantity of individuals awaiting a transplant surpasses that of accessible donors. With the advent of living donor small bowel transplantation, the small bowel transplant donor pool has been expanded to include parental donors. However, its global implementation is constrained by concerns regarding remaining donor safety and long-term prognoses. To help the donor recover better in the future, we have used 3-dimensional (3D) laparoscopic live donor ileal resection.</p><p><strong>Methods: </strong>This study reviews 7 cases at our hospital involving living parental donors for small bowel transplantation. Each donor, being a close relative of the recipient, voluntarily provided a portion of their intestine. We used 3D laparoscopic ileal resection under general anesthesia to enable minimally invasive procedures, reduce surgical trauma, and expedite recovery. Comprehensive preoperative evaluations included psychological counseling to ensure informed consent, whereas postoperative care focused on tailored rehabilitation, nutritional support, bowel function monitoring, and psychological health.</p><p><strong>Results: </strong>All donors recovered successfully without severe perioperative complications. At 6 mo postsurgery, all donors had normal bowel function and reported no issues with malabsorption or gastrointestinal health. Psychological assessments indicated good mental health and high satisfaction with their decision to donate.</p><p><strong>Conclusions: </strong>Three-dimensional laparoscopic ileal resection for living parental donors is both feasible and safe, offering a minimally invasive approach with favorable donor outcomes. One-year follow-ups confirm that this technique provides high-quality grafts for recipients while preserving donor health and well-being. These findings support the potential for broader adoption of 3D laparoscopic ileal resection in living donor small bowel transplantation, with larger cohort studies recommended to validate these outcomes and refine donor care practices.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 7","pages":"e1783"},"PeriodicalIF":1.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Center Experience Is Associated With Improved Survival in Liver Transplantation for Hilar Cholangiocarcinoma: A Retrospective Study.","authors":"Omar Bushara, Yash Kadakia, Katharine Krupp, Jessica Friedman, Maarouf A Hoteit, Therese Bittermann, Tarek Araji, Matthew H Levine","doi":"10.1097/TXD.0000000000001822","DOIUrl":"10.1097/TXD.0000000000001822","url":null,"abstract":"<p><strong>Background: </strong>Hilar cholangiocarcinoma has limited treatments, with transplantation emerging as a curative option. During the era of regional patient review, it was suggested that transplant centers performing a higher volume of transplants for cholangiocarcinoma had improved outcomes. However, it is unknown whether this association persists since the national standardization of guidelines in May 2019.</p><p><strong>Methods: </strong>Transplant candidates listed in the United Network of Organ Sharing database using cholangiocarcinoma exception points from May 2019 to December 2022 were included. Experienced centers were defined as performing at least 10 transplants during the time period. Recipient and donor characteristics, graft and patient survival, and hospital length of stay were compared between more and less experienced centers. The Wilcoxon rank-sum test, Fisher exact test, Kaplan-Meier curves, log-rank tests, and Cox hazards analyses were used where appropriate.</p><p><strong>Results: </strong>Between May 2019 and December 2022, 166 transplants for cholangiocarcinoma were performed at 37 centers, with \"more experienced\" centers accounting for 59% (n = 98). Unadjusted graft survival (<i>P</i> = 0.03) and patient survival (<i>P</i> = 0.047) were lower at less experienced centers. In addition to center experience, univariable Cox analyses recipient age (0.02), diabetes (0.18), and donor age (0.08) had a <i>P</i> value of ≤0.2. In a covariate-adjusted model, more experienced centers were associated with a 70% lower hazard of graft failure (hazard ratio, 0.29; 95% confidence interval, 0.12-0.70; <i>P</i> = 0.006) and 72% lower hazard of mortality (hazard ratio, 0.27; confidence interval, 0.11-0.69; <i>P</i> = 0.007).</p><p><strong>Conclusions: </strong>These data suggest that experienced centers have improved posttransplant survival. Variations in selection and postoperative care not captured by this study may underlie this association. More granular studies are warranted to elucidate the impact of center experience on outcomes in transplantation for cholangiocarcinoma.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 7","pages":"e1822"},"PeriodicalIF":1.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustained Molecular Allograft Injury After Episodes of Acute Rejection and Organizing Pneumonia Increases the Risk of Lung Allograft Failure.","authors":"Michael B Keller, Allison Y Lin, Moon Kyoo Jang, Hyesik Kong, Ananth Charya, Gerald J Berry, Charles C Marboe, Ileana L Ponor, Shambhu Aryal, Jonathan B Orens, Pali D Shah, Steven D Nathan, Xin Tian, Sean Agbor-Enoh","doi":"10.1097/TXD.0000000000001828","DOIUrl":"10.1097/TXD.0000000000001828","url":null,"abstract":"<p><strong>Background: </strong>Despite treatment of major risk factors such as acute rejection (AR) and organizing pneumonia (OP) in lung transplant recipients, chronic lung allograft dysfunction (CLAD) still develops at high rates, suggesting that traditional methods of assessing response to treatment and resolution remain inadequate. It is unknown whether the degree of molecular allograft injury after treatment of AR/OP modulates the risk of CLAD and death.</p><p><strong>Methods: </strong>To evaluate the association of molecular allograft injury after AR/OP with the incidence of CLAD/death, we conducted a multicenter prospective cohort study that included 93 patients who underwent lung transplantation between 2015 and 2022. The degree of molecular allograft injury after AR/OP was quantified by the mean area under the curve of longitudinal measures of plasma donor-derived cell-free DNA (dd-cfDNA).</p><p><strong>Results: </strong>Over a median follow-up of 5 y, patients who developed CLAD/death had persistently higher levels of dd-cfDNA in the months after AR/OP. In multivariable Cox regression analysis adjusting for patient and transplant risk factors, mean dd-cfDNA levels after AR/OP were independently associated with an increased risk of CLAD/death (adjusted hazard ratio, 2.84; 95% confidence interval, 1.67-4.83; <i>P</i> < 0.001) and remained consistent when accounting for changes in pulmonary function after AR/OP events (hazard ratio, 2.62; 95% confidence interval, 1.53-4.47; <i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>The degree of allograft injury on the molecular level after AR/OP events in lung transplant recipients is associated with the risk of developing CLAD or death. This study demonstrates the potential of dd-cfDNA for improving risk stratification and monitoring the resolution and treatment responses of lung allograft injury.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 7","pages":"e1828"},"PeriodicalIF":1.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Molecular Mechanisms of Autophagy-related Genes in Hepatic Ischemia/Reperfusion Injury Using Bioinformatics.","authors":"Qi Xiao, Xiaoxiao Hu, Qiong Chen, WenYu Wang, JianSheng Xiao, Biqi Fu","doi":"10.1097/TXD.0000000000001829","DOIUrl":"10.1097/TXD.0000000000001829","url":null,"abstract":"<p><strong>Background: </strong>Autophagy is a highly conserved cellular process. In the context of hepatic ischemia/reperfusion injury (HIRI), dysregulation of autophagy may lead to hepatocyte dysfunction. Therefore, we conducted a comprehensive transcriptomics analysis to investigate the biomolecular mechanisms underlying autophagy in HIRI.</p><p><strong>Methods: </strong>Bioinformatics were used to analyze the GSE112713 data set, with the objective of identifying the differential expression of autophagy-related genes (DEARGs). The expression and diagnostic potential of DEARGs were validated using in vitro models and receiver operating characteristic curves. Additionally, potential therapeutic drugs targeting DEARGs were predicted.</p><p><strong>Results: </strong>Transcriptome bioinformatics analysis revealed widespread dysregulation of autophagy in HIRI. Seven DEARGs (<i>IL6</i>, <i>JUN</i>, <i>HSPA1A</i>, <i>PPP1R15A</i>, <i>ERN1</i>, <i>DNAJB1</i>, and <i>HSPA1B</i>) were confirmed in vitro. Based on these findings, we predicted potential drugs that may mitigate HIRI by modulating autophagy.</p><p><strong>Conclusions: </strong>The present study identified 7 DEARGs (<i>IL6</i>, <i>JUN</i>, <i>HSPA1A</i>, <i>PPP1R15A</i>, <i>ERN1</i>, <i>DNAJB1</i>, and <i>HSPA1B</i>) in HIRI, which provides a reliable therapeutic target for HIRI.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 7","pages":"e1829"},"PeriodicalIF":1.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the Composite Allocation Score on Lung Transplant Waitlist and Posttransplant Outcomes.","authors":"Ye In Christopher Kwon, Holly Caboti-Jones, Michael Keller, Andrew Min-Gi Park, Alan Lai, Rachit D Shah, Zachary Fitch, Vigneshwar Kasirajan, Vipul Patel, Zubair A Hashmi","doi":"10.1097/TXD.0000000000001836","DOIUrl":"10.1097/TXD.0000000000001836","url":null,"abstract":"<p><strong>Background: </strong>On March 9, 2023, the Composite Allocation Score (CAS) was introduced for all lung transplantation (LT) candidates. We analyzed waitlist and posttransplant outcomes after CAS implementation.</p><p><strong>Methods: </strong>Using the United Network for Organ Sharing registry (2022-2024), adult patients listed for isolated LT were divided into 2 eras: era 1 (pre-CAS: March 1, 2022-March 8, 2023) and era 2 (post-CAS: March 9, 2023-September 30, 2024). Competing risk regression analyzed waitlist events. Recipient/donor characteristics and mortality risk factors were assessed with Cox models. Survival was evaluated with Kaplan-Meier analysis.</p><p><strong>Results: </strong>Among 6398 LTs, 2598 (40.6%) occurred in era 2. More Black patients (16.9% versus 15%, <i>P</i> = 0.04) and those with a high school education (35.4% versus 33.4%, <i>P</i> = 0.0003) were transplanted. ABO type O patients were less likely to undergo LT (42.5% versus 46.6%, <i>P</i> = 0.04). Era 2 had longer transport distances (231 versus 202 miles, <i>P</i> < 0.0001), ischemic times (5.1 versus 4.9 h, <i>P</i> < 0.0001), and increased use of flights (79.1% versus 72.8%, <i>P</i> < 0.0001). Donation after circulatory death (9.4% versus 6.2%, <i>P</i> < 0.0001) and normothermic regional perfusion (2.2% versus 1.2%, <i>P</i> = 0.02) usage rose. Waitlist times decreased (29 versus 31 d, <i>P</i> = 0.009), with improved outcomes (sub-hazard ratio, 0.70; <i>P</i> < 0.0001). Era 2 showed superior 6-mo and 1-y survival (<i>P</i> < 0.0001) and reduced rejection treatment (2.6% versus 14.5%, <i>P</i> < 0.0001).</p><p><strong>Conclusions: </strong>The implementation of CAS was associated with reduced waitlist mortality, improved access for marginalized groups, and enhanced survival. Lungs were procured from greater distances with an increased use of donation after circulatory death with normothermic regional perfusion or ex vivo perfusion. Disparities remain for ABO type O patients, warranting closer follow-up.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 7","pages":"e1836"},"PeriodicalIF":1.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of High Kidney Donor Profile Index Hepatitis C Nucleic Acid Testing Positive Kidneys are Equivalent to Matched Hepatitis C Nucleic Acid Testing Negative Kidneys.","authors":"Shengliang He, Christie P Thomas, Alan E Gunderson, Patrick Ten Eyck, Alan I Reed","doi":"10.1097/TXD.0000000000001827","DOIUrl":"10.1097/TXD.0000000000001827","url":null,"abstract":"<p><strong>Background: </strong>A recent Organ Procurement and Transplant Network policy change removes hepatitis C virus (HCV) status and race from the Kidney Donor Profile Index (KDPI) calculation, thereby lowering the KDPI of HCV nucleic acid testing positive (NAT⁺) kidneys and increasing their allocation priority. However, even in the era of direct-acting antivirals, high KDPI HCV NAT⁺ kidneys exhibited higher discard rates compared with their HCV NAT^- counterparts, and outcome data for this \"high-risk\" group remain limited. This study aims to address this knowledge gap by providing comprehensive outcome data to better inform organ allocation and selection decisions under the new KDPI framework.</p><p><strong>Methods: </strong>Using national transplant data from 2015 to 2023, we analyzed adult deceased donor kidney transplants stratified by KDPI and HCV NAT status. An exact matching model was used to identify the matched HCV NAT^- group.</p><p><strong>Results: </strong>No significant differences were observed in delayed graft function, rejection, or patient and graft survival between high KDPI HCV NAT⁺ and matched HCV NAT^- recipients. High KDPI HCV NAT⁺ kidneys were more often allocated regionally or nationally, with 67.6% occurring in 4 regions. Their recipients were more likely to have a high school education and shorter wait times. After the policy change, >90% of prior high KDPI HCV NAT⁺ kidneys will no longer be classified as high KDPI.</p><p><strong>Conclusions: </strong>Our findings support the safe utilization of previously high KDPI HCV NAT⁺ kidneys after a policy change. Although the revised KDPI may assist clinicians in identifying higher-quality organs, its impact on existing sociodemographic disparities and overall organ utilization rate remains uncertain.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 7","pages":"e1827"},"PeriodicalIF":1.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Narrow Anvil Stapler on Graft Vein Length in Right-sided Living-donor Nephrectomy.","authors":"Hiroshi Noguchi, Yu Sato, Yu Hisadome, Shinsuke Kubo, Keizo Kaku, Yuki Nakafusa, Yoshifumi Miura, Masafumi Nakamura","doi":"10.1097/TXD.0000000000001837","DOIUrl":"10.1097/TXD.0000000000001837","url":null,"abstract":"<p><strong>Background: </strong>Right-sided living donor nephrectomy presents a challenge because of the shorter renal vein length, which may complicate vascular anastomosis during transplantation. We hypothesized that the use of a narrow anvil stapler could optimize vein preservation by allowing safer and more effective transection closer to the inferior vena cava. This study aimed to compare the effectiveness of the Signia Small Diameter Reload Short with Curved Tip (SDR) and the Tri-Staple 2.0 Reload (TSR) in preserving renal vein length and to evaluate their impact on donor and recipient outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective observational cohort study of 39 right-sided donor nephrectomies performed at 2 institutions between May 2019 and December 2024. Patients were divided into 2 groups based on the stapler used: TSR (n = 16) and SDR (n = 23). Inverse probability of treatment weighting was applied to adjust for baseline differences, resulting in a final analysis of 11 TSR and 23 SDR cases. We evaluated renal vein length and overall surgical outcomes.</p><p><strong>Results: </strong>The SDR group had significantly longer renal vein lengths than the TSR group (23.0 ± 4.0 versus 17.5 ± 3.9 mm, <i>P</i> < 0.001). However, there were no significant differences in operative time, estimated blood loss, or perioperative complications in both donors and recipients. Warm ischemia time, rewarming time, and total ischemia time were also comparable between groups. Early postoperative serum creatinine levels did not differ significantly between recipient groups.</p><p><strong>Conclusions: </strong>The SDR stapler provided a significant technical advantage in preserving renal vein length in right-sided donor nephrectomy. However, this did not translate into improved recipient outcomes, suggesting that surgical precision and vascular adaptation play a more critical role in transplantation success than vein length alone. Nonetheless, the ability to preserve greater vein length remains a potential advantage, particularly in challenging cases.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 7","pages":"e1837"},"PeriodicalIF":1.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allogeneic Liver Transplantation in Nonhuman Primates: Surgical Technique With Stable Postoperative Outcomes.","authors":"Katsuhiro Tomofuji, Daniel J Cloonan, Taylor M Coe, Olivia Bourgeois, Rudy Matheson, Ahmad Karadagi, Anil Kharga, Toshihide Tomosugi, James F Markmann, Shoko Kimura","doi":"10.1097/TXD.0000000000001832","DOIUrl":"10.1097/TXD.0000000000001832","url":null,"abstract":"<p><strong>Background: </strong>Nonhuman primate models are essential in preclinical transplantation studies. Although many advances in medical and surgical therapies have been achieved in liver transplantation research using rodent models, nonhuman primate models have not been widely used because of their technical complexity. As scientific inquiries into tolerance-free and ischemia-free models of transplantation continue to progress, it is vital to establish a standard nonhuman primate model. We attempted to establish a feasible and stable nonhuman primate model for orthotopic liver transplantation using baboons.</p><p><strong>Methods: </strong>Orthotopic allogeneic liver transplantations were performed in 3 cynomolgus macaques and 5 baboons. Portocaval shunts and extracorporeal bypasses were performed as previously described for cynomolgus macaques. In baboon models, minimization of the anhepatic time was attempted without the bypass technique. Survival, postoperative clinical course, histopathology, and liver enzyme levels were assessed.</p><p><strong>Results: </strong>The first 2 macaques were euthanized because of gastric necrosis and pneumonia. The third had bypass failure of circulation and developed coagulopathy, which occurred at the end of the study during surgery. In baboons, all 5 recipients survived for >2 mo. The first 3 recipients, whose bile ducts were reconstructed with choledocholedochostomy (duct-to-duct), showed elevated liver function and bile duct enzymes. Therefore, choledochojejunostomy was performed in the other 2 cases, revealing normal liver function postoperatively.</p><p><strong>Conclusions: </strong>We report successful and consistently stable outcomes of nonhuman primate liver transplantation in baboons. In addition to existing cynomolgus macaque models, our method offers a promising approach and contributes to further clinical adaptation of translational studies.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 7","pages":"e1832"},"PeriodicalIF":1.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survey of Early Practices and Perceptions of Liver Machine Perfusion Among US Liver Transplant Surgeons.","authors":"Michelle C Nguyen, Xingjie Li, Chi Zhang, Stephanie Ohara, Mehrdad Motamed, Caroline C Jadlowiec, Adyr A Moss, Kunam S Reddy, Amit K Mathur","doi":"10.1097/TXD.0000000000001841","DOIUrl":"10.1097/TXD.0000000000001841","url":null,"abstract":"<p><strong>Background: </strong>Ex vivo machine perfusion (MP) has transformed organ preservation, offering significant benefits in liver transplantation (LT), particularly with high-risk donor grafts. However, adoption in the United States has been limited. We aimed to examine early adoption trends, surgeon perceptions, and barriers to implementing MP in the United States after Food and Drug Administration approval of MP platforms.</p><p><strong>Methods: </strong>A 23-question electronic survey was distributed to members of the American Society of Transplant Surgeons between October and November 2022, capturing attitudes and practices related to MP adoption. Responses from 96 surgeons representing 77 LT centers across 11 Organ Procurement and Transplantation Network regions were analyzed.</p><p><strong>Results: </strong>Forty-four respondents (48%) reported having an MP program at their institution. Adoption of MP was significantly more common in high-volume centers and those performing ≥20 donation after circulatory death (DCD) transplants annually (<i>P</i> < 0.001). MP utilization received strong support, with 88% endorsing its use for DCD liver allografts and 82% for donation after brain death allografts. Respondents cited MP's ability to reduce ischemic cholangiopathy, enable graft repair, and facilitate viability assessment as key benefits. Normothermic MP was preferred for high-risk donor profiles, including DCD grafts, older donors, and steatotic livers, and was associated with an increased willingness to accept medically complex grafts compared with static cold storage. Barriers to MP utilization included program costs, personnel demands, and logistical complexities. Centers with higher proportions of privately insured patients were more likely to adopt MP. Despite these challenges, 84% of respondents expressed interest in future MP adoption.</p><p><strong>Conclusions: </strong>MP enhances graft utilization and outcomes, particularly for complex and high-risk donor livers, but widespread US adoption requires addressing financial and logistical barriers. Future efforts should focus on refining cost-effectiveness analyses, collaboration with organ procurement organizations and device companies, and developing standardized training to optimize MP integration and maximize its clinical impact on LT.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 7","pages":"e1841"},"PeriodicalIF":1.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}