Transplantation proceedings最新文献

{"title":"Impact of Family-Based Care on the Outcome of Brain Death and Humanization in the Process of Multiple Organ Donation: Case Report","authors":"Joyce Lopes de Lima,&nbsp;Thiago Telles Bellini Ceruti,&nbsp;Claudia Mara Santos de Oliveira,&nbsp;Davi de Paula Brito,&nbsp;Alessandra Gilioti Temporin,&nbsp;Matheus Gonzaga Feitosa,&nbsp;Marcelo Moock,&nbsp;Rosa Goldstein Alheira","doi":"10.1016/j.transproceed.2026.06.005","DOIUrl":"10.1016/j.transproceed.2026.06.005","url":null,"abstract":"<div><div>In the care of this 29-year-old male patient, a victim of traumatic brain injury with brain death outcome, the multidisciplinary team played a fundamental role in an integrated, ethical, transparent and humanized way. Particularly important was the work of the nursing team, which provided humane and empathetic care and established a bond of trust with family members; the medical team, which managed the case with respect and clarity, guaranteeing the family's right to witness the diagnostic process and understand it at all stages; and psychology, which provided shelter and support for grieving. The family meetings, conducted by the horizontal attendant with the support of psychologists and nurses, provided a safe space for clarifying doubts and expressing emotions. This environment of listening and empathy strengthened the bond between the team and the family, acting as a protective factor in coping with grief. Empathetic and respectful communication about the outcome directly influenced the positive decision for organ donation. On day 7 after the patient’s death, the team made telephone contact with the family members, offering continuity of emotional support and grief assistance—a gesture of commitment and care from the multidisciplinary team.</div></div><div>In the care of this 29-year-old male patient, a victim of traumatic brain injury with brain death outcome, the multidisciplinary team played a fundamental role in an integrated, ethical, transparent and humanized way. Particularly important was the work of the nursing team, which provided humane and empathetic care and established a bond of trust with family members; the medical team, which managed the case with respect and clarity, guaranteeing the family's right to witness the diagnostic process and understand it at all stages; and psychology, which provided shelter and support for grieving. The family meetings, conducted by the horizontal attendant with the support of psychologists and nurses, provided a safe space for clarifying doubts and expressing emotions. This environment of listening and empathy strengthened the bond between the team and the family, acting as a protective factor in coping with grief. Empathetic and respectful communication about the outcome directly influenced the positive decision for organ donation. On day 7 after the patient’s death, the team made telephone contact with the family members, offering continuity of emotional support and grief assistance—a gesture of commitment and care from the multidisciplinary team.</div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1374-1376"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148335357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrence of ANCA-Associated Vasculitis After Kidney Transplantation in a Patient With Pulmonary Tuberculosis: A Case Report","authors":"Phillipe Guilherme do Rego Silva,&nbsp;Marclebio Manuel Coelho Dourado,&nbsp;Maria Ruth Padilha de Medeiros,&nbsp;Lia Bastos Lopes,&nbsp;Larissa Guedes da Fonte Andrade,&nbsp;Joaquim de Oliveira Borba Junior,&nbsp;Guilherme Gouveia Danzi,&nbsp;Diogo Buarque Cordeiro Cabral,&nbsp;Victor Hugo de Souza Galvão,&nbsp;Maria Esilene Valença Batista","doi":"10.1016/j.transproceed.2026.07.009","DOIUrl":"10.1016/j.transproceed.2026.07.009","url":null,"abstract":"<div><div>Recurrence of antineutrophil cytoplasmic antibody–associated vasculitis (AAV) after kidney transplantation is uncommon and has become less frequent with modern immunosuppressive strategies. However, infections and modulation of immunosuppression may act as potential triggers for disease reactivation. We report the case of a 28-year-old male kidney transplant recipient with end-stage renal disease secondary to granulomatosis with polyangiitis (GPA). One year prior to transplantation, he had a low-titer C-ANCA positivity, with no subsequent ANCA measurements until the current admission. Six years after transplantation, the patient developed pulmonary tuberculosis and required antituberculous therapy, during which tacrolimus serum concentrations decreased significantly. Despite partial clinical improvement, he presented with persistent fever, progressive allograft dysfunction, hematuria, proteinuria, and elevated serum C-ANCA. Kidney allograft biopsy revealed pauci-immune crescentic glomerulonephritis, consistent with recurrent GPA. Immunosuppressive intensification with corticosteroids and cyclophosphamide, followed by rituximab, resulted in improvement of renal function without infectious deterioration, while antituberculous therapy was successfully completed. This case highlights that recurrence of AAV should be considered in the evaluation of kidney allograft dysfunction, particularly in the context of infection and immunosuppressive modulation. With careful monitoring and individualized management, vasculitis recurrence can be effectively treated even in the presence of active tuberculosis.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1384-1387"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Graft Survival in Kidney Transplant Recipients During the 2024 Floods in Rio Grande do Sul: A Retrospective Cohort Study","authors":"Maria Antônia Peres Saldanha,&nbsp;Amanda Seus Paz,&nbsp;Anita Schweig,&nbsp;Beatriz Paganin Gonçalves,&nbsp;Carolina Andrade Bissani,&nbsp;Laura Fortes Ruhling,&nbsp;Luana Colares dos Santos da Costa,&nbsp;Thiago Bonatto Arlaque,&nbsp;Leonardo Viliano Kroth","doi":"10.1016/j.transproceed.2026.06.023","DOIUrl":"10.1016/j.transproceed.2026.06.023","url":null,"abstract":"<div><h3>Background</h3><div>The floods that devastated southern Brazil in 2024 constituted a humanitarian crisis of historic proportions and significantly restricted access to transplant care services. This study evaluated the impact of this event on renal function and survival among kidney transplant recipients.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study including kidney transplant recipients with scheduled outpatient visits between May 3 and May 30, 2024. Patients were categorized as having attended appointments, had at least one visit rescheduled, or received remote care. Renal function was assessed using serum creatinine and estimated glomerular filtration rate (eGFR) calculated by the CKD-EPI equation. Acute rejection episodes, hospitalizations, and patient and graft survival were recorded.</div></div><div><h3>Results</h3><div>Sixty kidney transplant recipients were included. Mean serum creatinine improved 6 months after the floods compared with the pre-flood period (1.57 ± 0.65 vs 1.68 ± 0.67 mg/dL; <em>p</em> = .025), as did eGFR (56.8 ± 24.2 vs 52.6 ± 22.0 mL/min; <em>p</em> = .019). Fifty patients had appointments rescheduled (mean delay 3.9 ± 2.1 months), and 6 received teleconsultations. Over 1 year, 5 acute rejection episodes, one graft loss due to rejection, and one death due to neoplasia were observed. Follow-up interval was not correlated with changes in renal function at 6 months (r = −0.108; <em>p</em> = .41).</div></div><div><h3>Conclusion</h3><div>Despite restricted healthcare access during the floods, kidney transplant recipients did not experience deterioration in renal function. Coordinated multidisciplinary care and proactive patient outreach may have contributed to these outcomes.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1270-1273"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148498610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombotic Microangiopathy After Kidney Transplantation Associated With Rifampicin: A Case Report","authors":"Agatha Prado de Lima,&nbsp;Diogo Buarque Cordeiro Cabral,&nbsp;Alexandre de Holanda Cavalcanti Pinto,&nbsp;Tatiana Cristina Manzi Sena,&nbsp;Joaquim de Oliveira Borba Junior,&nbsp;Maria Carolina Romeiro Figueirôa Benício Coelho,&nbsp;Renata Amorim Brandão,&nbsp;Tiago Luiz Lagedo Ferraz,&nbsp;Frederico Castelo Branco Cavalcanti","doi":"10.1016/j.transproceed.2026.07.011","DOIUrl":"10.1016/j.transproceed.2026.07.011","url":null,"abstract":"<div><div>Thrombotic microangiopathy (TMA) is a severe complication, particularly after kidney transplantation (KT), and is associated with significant morbidity, mortality and graft loss. Rifampicin (RIF), although rarely reported, has relevant interactions and may act as an additional trigger capable of precipitating TMA in susceptible patients. Diagnosis requires a high index of suspicion, exclusion of alternative causes and thorough investigation. Considering its prognostic impact on both graft and patient outcomes, identifying RIF as a potential causative agent is essential to guide clinical management, with immediate drug withdrawal being the most appropriate intervention. This case report aims to describe a case of TMA after KT associated with RIF use, given its clinical relevance and the scarcity of available reports.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1377-1380"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary Sternal Closure With Titanium Plate Fixation After Bilateral Lung Transplantation","authors":"Flávia Fiuza de Andrade Vale,&nbsp;Samuel Lucas dos Santos,&nbsp;Flavio Pola dos Reis,&nbsp;Lucas Matos Fernandes,&nbsp;Luis Gustavo Abdalla,&nbsp;Silvia Vidal Campos,&nbsp;Paulo Manuel Pêgo Fernandes","doi":"10.1016/j.transproceed.2026.07.002","DOIUrl":"10.1016/j.transproceed.2026.07.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Transverse thoracosternotomy (clamshell incision) provides wide exposure of thoracic anatomical structures and is commonly used in bilateral lung transplantation. However, it is associated with a significant risk of mechanical sternal complications. Conventional closure with stainless steel wires has reported complication rates of 20%-40%, prompting the development of alternative sternal closure strategies.</div></div><div><h3>Methods</h3><div>This retrospective, single-center study included patients who underwent bilateral lung transplantation between January 2020 and December 2024. A total of 131 transplants were performed, 7 patients required reoperation for sternal complications. In all cases, surgical access was obtained via a clamshell incision with transverse sternotomy. Primary sternal closure was performed using 3 interrupted stainless steel wire sutures. In cases of sternal complications, secondary closure was achieved using a rigid titanium fixation system. Demographic data, clinical characteristics, perioperative variables, and outcomes were analyzed</div></div><div><h3>Results</h3><div>Only 1 patient had pre-transplant colonization. All donor cultures were positive, with Staphylococcus aureus isolated in 6 cases. 3 patients required extracorporeal support, 2 of whom were listed under high-urgency status; 1 required intensive care with an open chest on ECMO. Four patients were reoperated on for sternal osteomyelitis, and 3 for mechanical instability or persistent pain. All patients achieved successful sternal realignment and symptom resolution, with no fixation-related complications.</div></div><div><h3>Conclusion</h3><div>Rigid titanium plate fixation is a safe and effective option for secondary sternal closure after bilateral lung transplantation and represents a promising strategy to reduce clamshell-related sternal complications.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1367-1370"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Profile of Patients Undergoing Liver Transplantation for Hepatocellular Carcinoma at a Brazilian High-Complexity Referral Center: Tumor Biology as a Predictor of Post-Transplant Recurrence","authors":"Pedro Marin-Castro,&nbsp;Rafael Soares Pinheiro,&nbsp;Daniel Reis Waisberg,&nbsp;Rubens Macedo Arantes,&nbsp;Vinicius Rocha Santos,&nbsp;Rodrigo Bronze Martino,&nbsp;Liliana Ducatti,&nbsp;Luciana Bertocco Haddad,&nbsp;Alice Tung Song,&nbsp;Andre Dong Lee,&nbsp;Joao Paulo Costa Santos,&nbsp;Joel Avancini Rocha,&nbsp;Regis Otaviano Franca Bezerra,&nbsp;Manoel Souza Rocha,&nbsp;Wellington Andraus","doi":"10.1016/j.transproceed.2026.07.012","DOIUrl":"10.1016/j.transproceed.2026.07.012","url":null,"abstract":"<div><h3>Introduction</h3><div>Liver transplantation (LT) is considered the optimal curative therapeutic option for most patients with hepatocellular carcinoma (HCC), with 5-year survival rates exceeding 70%. The objective of this study was to analyze the clinical profile of patients undergoing LT for HCC in Brazil and identify prognostic factors associated with survival and recurrence.</div></div><div><h3>Methods</h3><div>Retrospective study analyzing patients who underwent LT for HCC between January/2015 and December/2024 at a quaternary referral center in Brazil.</div></div><div><h3>Results</h3><div>Among 1321 LT, 423 (32.02%) were performed for HCC. The median recipient age was 61 years, 73% were male, and hepatitis C virus infection was the predominant underlying etiology of cirrhosis. Median physiologic MELD score was 13 and 95.74% of patients were granted MELD exception points. At diagnosis, most patients were within Milan-Brazil criteria (76.59%). Locoregional therapy was performed in 85.10% of patients, mostly as a bridging therapy (65.48%), but also as downstaging procedure (19.62%). From 414 patients within Milan-Criteria before LT, only 255 remained within these criteria on explant pathology. During follow-up, HCC recurrence occurred in 34 patients (8.03%), and the 5-year overall survival rate was 74.6%. Vascular invasion was the strongest predictor of post-transplant recurrence, while microsatellite nodules, poor tumor differentiation, and increasing pre-transplant serum alpha-fetoprotein levels were also associated with recurrence. Overall post-transplant survival was independently associated with recipient age, donor risk index, intraoperative blood transfusion, and prolonged intensive care unit stay.</div></div><div><h3>Conclusions</h3><div>HCC is a major indication for LT in Brazil. Tumor biology was the principal determinant of post-transplant recurrence, whereas recipient-, donor-, and perioperative-related factors predominantly influenced overall survival.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1311-1321"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148650139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum HLA-G Levels in Kidney Transplant Recipients and Association With Clinical Outcomes: A Single-Center Cross-Sectional Study","authors":"Silvia Marçal Botelho,&nbsp;Geovana Maria Nunes Arantes Chaves,&nbsp;Isabela Jubé Wastowski,&nbsp;Antônio Menezes da Silva Júnior","doi":"10.1016/j.transproceed.2026.04.015","DOIUrl":"10.1016/j.transproceed.2026.04.015","url":null,"abstract":"<div><h3>Background</h3><div>HLA-G is a non-classical HLA class I molecule with immunomodulatory properties and has been proposed as a biomarker of immune tolerance in kidney transplantation. However, the clinical meaning of circulating HLA-G remains controversial.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional, single-center study including kidney transplant recipients with available clinical data and serum samples. Soluble HLA-G levels were quantified by enzyme-linked immunosorbent assay. We tested associations between HLA-G levels and immunosuppressive regimen, acute rejection episodes, cytomegalovirus (CMV) infection, and early post-transplant need for hemodialysis. Statistical significance was defined as <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>A total of 114 kidney transplant recipients were analyzed. Use of a regimen including corticosteroids, a calcineurin inhibitor, and azathioprine was associated with lower HLA-G levels (<em>P</em> &lt; .001). Lower HLA-G levels were also associated with acute rejection (<em>P</em> &lt; .001) and CMV infection (<em>P</em> = .006). In contrast, recipients requiring 6–10 hemodialysis sessions in the early post-transplant period showed higher HLA-G levels (<em>P</em> = .02).</div></div><div><h3>Conclusions</h3><div>Serum HLA-G levels were significantly associated with clinically relevant outcomes after kidney transplantation. Lower HLA-G levels were linked to acute rejection and CMV infection, whereas higher HLA-G levels were observed among recipients requiring more hemodialysis early after transplantation. These findings support further evaluation of HLA-G as a prognostic biomarker.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1251-1252"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147990579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invasive Candidiasis in Liver Transplant Recipients Undergoing Antifungal Prophylaxis","authors":"Luiz Felipe de Abreu Guimarães,&nbsp;Larissa de Oliveira Pereira,&nbsp;Tainara Moreira Curcio,&nbsp;Claudia Cristina Tavares de Sousa,&nbsp;Samanta Teixeira Basto,&nbsp;Damares Szrajbman,&nbsp;Eduardo de Souza Martins Fernandes,&nbsp;Guilherme Santoro-Lopes","doi":"10.1016/j.transproceed.2026.05.006","DOIUrl":"10.1016/j.transproceed.2026.05.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Invasive candidiasis (IC) is the most frequent invasive fungal infection (IFI) affecting liver transplant (LT) recipients. Antifungal prophylaxis (AP) effectively reduces the incidence IFI after LT. However, a considerable proportion of LT recipients undergoing AP are still affected by IC.</div></div><div><h3>Objectives</h3><div>To assess the incidence and factors associated with IC in high-risk LT recipients undergoing AP.</div></div><div><h3>Patients and Methods</h3><div>Retrospective single-center study including high-risk LT recipients undergoing AP between 2015 and 2020. The primary outcome was the occurrence of IC within the first 90 days after LT. Secondary outcomes included mortality within 30 days of diagnosis of IC and the occurrence of other IFI within 90 days after LT. The basic prophylactic regimen was fluconazole 200 mg/d, with micafungin being an alternative option.</div></div><div><h3>Results</h3><div>There were 10 cases (5.8%) of IC among 171 high-risk recipients who started AP. Most cases were caused by non-albicans <em>Candida</em> spp. The 30-day mortality rate was 40%. Only 1 case (0.6%) of another IFI (disseminated cryptococcosis) was diagnosed during the study period. IC was more frequent among Black patients (p=0.02), after reoperation (<em>p</em> = .036), and in recipients with a higher count of risk factors for IFI (<em>p</em> = .061). Oppositely, IC was less frequent in patients with a pre-transplant diagnosis of hepatocellular carcinoma (<em>p</em> = .065).</div></div><div><h3>Conclusion</h3><div>IC occurred in 5.8% of LT recipients undergoing AP and was associated with high mortality. The predictive factors for IC identified in this study may inform the decision to start empirical antifungal therapy in high-risk LT recipients undergoing AP.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1300-1304"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148255230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treacherous Pitfalls in Liver Transplantation for Budd-Chiari Syndrome: When the Devil Hides in the Shadows-A Case Report","authors":"Isabela Couto Mendonça,&nbsp;Daniel Reis Waisberg,&nbsp;Maciana Santos Silva,&nbsp;Rafael Soares Pinheiro,&nbsp;Vinicius Rocha-Santos,&nbsp;Rubens Macedo Arantes,&nbsp;Liliana Ducatti,&nbsp;Luciana Bertocco Haddad,&nbsp;Flávio Henrique Galvão,&nbsp;Andre Dong Lee,&nbsp;Alice Tung Song,&nbsp;Rodrigo Bronze Martino,&nbsp;Wellington Andraus","doi":"10.1016/j.transproceed.2026.05.009","DOIUrl":"10.1016/j.transproceed.2026.05.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Budd–Chiari syndrome (BCS) is a rare vascular liver disorder characterized by obstruction of the hepatic venous outflow, involving the hepatic veins and/or the inferior vena cava (IVC). Etiology varies geographically, with thrombophilic conditions and myeloproliferative disorders predominating in Western countries, and membranous IVC obstruction being more frequent in Eastern countries. Liver transplantation (LT) remains the definitive treatment for patients with acute liver failure or advanced disease refractory to medical and interventional therapies, but it presents unique surgical challenges due to hepatomegaly, retroperitoneal fibrosis, and potential IVC stenosis or thrombosis.</div></div><div><h3>Case Report</h3><div>We report a 33-year-old male with BCS who underwent deceased-donor LT using the piggyback technique. Intraoperatively, the retrohepatic IVC was fibrotic and narrowed; a diamond-shaped side-to-side cavocaval anastomosis was performed to optimize venous outflow. Despite an initially well-perfused graft, the patient developed primary graft nonfunction on the first postoperative day. Urgent retransplantation revealed severe venous outflow obstruction caused by an unrecognized stenosis of the native suprahepatic IVC near the right atrium. The first graft exhibited extensive congestion and coagulative necrosis. Retransplantation was successfully performed using conventional technique without veno-venous bypass, completely removing the recipient's IVC.</div></div><div><h3>Conclusion</h3><div>This case illustrates the potential for subtle anatomical anomalies, such as suprahepatic IVC stenosis, to cause acute post-transplant hepatic venous outflow obstruction in BCS. Awareness of these “Budd–Chiari pitfalls” is critical for surgical planning and intraoperative decision-making. LT remains a safe and effective therapy for carefully selected BCS patients, provided that meticulous attention is paid to venous anatomy and possible intraoperative challenges.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1398-1401"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sequential or Simultaneous Portal-Arterial Reperfusion During Liver Transplantation: A Retrospective Study","authors":"Wilson Júnior Pereira da Silva,&nbsp;Elizandra Letícia Vieira Terra,&nbsp;Fernanda De Sousa Rodrigues,&nbsp;Mateus Silva Feijó,&nbsp;Alexandre Corrente de Oliveira,&nbsp;Catarina Marcos Moldão,&nbsp;João Pedro Soares Costa,&nbsp;Ana Virginia Figueira,&nbsp;Tiago Morato,&nbsp;Silas Gustavo Barboza Romeres,&nbsp;Danielle Sacchi Bitencourt,&nbsp;Henrique Rocha,&nbsp;Natália de Carvalho Trevizoli,&nbsp;Luiz Gustavo Diaz,&nbsp;Priscila Brizolla de Campos,&nbsp;Gabriel Cajá,&nbsp;Raquel Francine Bundchen Ullmann,&nbsp;Fernando Jorge,&nbsp;André Luís Conde Watanabe","doi":"10.1016/j.transproceed.2026.06.026","DOIUrl":"10.1016/j.transproceed.2026.06.026","url":null,"abstract":"<div><h3>Background</h3><div>Ischemia–reperfusion injury is a relevant complication in liver transplantation. Sequential (SeqR) and simultaneous reperfusion (SimR) techniques are the most commonly used strategies to reduce this injury; however, there is still no consensus regarding which technique provides better outcomes. This study compares these techniques in terms of graft recovery, complications, and patient survival.</div></div><div><h3>Materials and Methods</h3><div>This retrospective study included 872 patients who underwent liver transplantation, divided into 2 groups according to the reperfusion technique used. Patient characteristics, intraoperative and postoperative outcomes, as well as recipient and graft mortality and survival, were analyzed. Continuous variables were analyzed using Student’s t-test, and categorical variables using Pearson’s chi-square test, with a significance level of 5%.</div></div><div><h3>Results</h3><div>A total of 520 transplants were performed using SimR and 352 using SeqR. SimR was associated with shorter operative time (<em>P</em> &lt; .001) and longer total ischemia time (<em>P</em> &lt; .001). It was also associated with a higher incidence of biliary stricture (<em>P</em> = .032) and a lower rate of graft rejection (95% CI: 0.342–0.754; OR: 0.508; <em>P</em> &lt; .001). Overall recipient survival was significantly higher in the SimR group (<em>P</em> = .002).</div></div><div><h3>Discussion and Conclusions</h3><div>In this study, the SimR technique was significantly associated with improved overall recipient survival, despite being associated with longer total ischemia time. SimR was also correlated with a higher incidence of biliary strictures but demonstrated a protective effect against graft rejection. These findings should be confirmed in prospective, randomized studies.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1293-1299"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148475145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}