世界移植杂志最新文献

{"title":"Islet dimension and its impact on transplant outcome: A systematic review.","authors":"Sipra Rout, Pravash R Mishra, Appakalai N Balamurugan, Praveen Kumar Ravi","doi":"10.5500/wjt.v15.i3.102383","DOIUrl":"10.5500/wjt.v15.i3.102383","url":null,"abstract":"<p><strong>Background: </strong>Not all islet transplants desirably achieve insulin independence. This can be attributed to the microarchitecture and function of the islets influenced by their dimensions. Large islets enhance insulin secretion through paracrine effects but are more susceptible to hypoxic injury post-transplant, while small islets offer better viability and insulin independence. <i>In vivo</i> studies suggest large islets are essential for maintaining euglycemia, though smaller islets are typically preferred in transplantation for better outcomes.</p><p><strong>Aim: </strong>To document the impact of islet dimension on clinical and preclinical transplant outcomes to optimize procedures.</p><p><strong>Methods: </strong>PubMed, Scopus and EMBASE platforms were searched for relevant literature up to 9 April 2024. Articles reported on either glucose-stimulated insulin-secreting (GSIS) capacity, islet viability and engraftment, or insulin independence based on the islet dimension were included. The risk of bias was measured using the Appraisal Tool for Cross-Sectional Studies. Extracted data was analyzed <i>via</i> a narrative synthesis.</p><p><strong>Results: </strong>Nineteen studies were included in the review. A total of sixteen studies reported the GSIS, of which nine documented the increased insulin secretion in the small islet, where the majority reported insulin secretion per islet equivalent (IEQ). Seven studies documented increased GSIS in large-sized islets that measure insulin secretion per cell or islet. All the articles that compared small and large islets reported poor viability and engraftment of large islets.</p><p><strong>Conclusion: </strong>Small islets with a diameter < 125 µm have desired transplantation outcomes due to their better survival following isolation. Large-sized islets receive blood supply directly from arterioles <i>in vivo</i> to meet their higher metabolic demands. The large islet undergoes central necrosis soon after the isolation (devascularization); failing to maintain the viability and glucose stimuli leads to a decline in GSIS and the overall function of the islet. Improved preservation of large islets after islet isolation, enhances the islet yield (IEQ), thereby reducing the likelihood of failed islet isolation and potentially improves transplant outcome.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"15 3","pages":"102383"},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12038580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980419","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 donor obesity on paediatric liver transplantation; current evidence and potentials for graft pool expansion.","authors":"Amr Alnagar, Ahmed Amgad, Tassos Grammatikopoulos, Eirini Kyrana","doi":"10.5500/wjt.v15.i3.103015","DOIUrl":"10.5500/wjt.v15.i3.103015","url":null,"abstract":"<p><p>Paediatric liver transplantation (PLT) is a life-saving procedure for children with advanced liver disease or hepatoblastoma. The number of available grafts is limited in relation to the number of children on PLT waiting list. This graft shortage has led transplant societies and healthcare organizations to explore ways to investigate possible options and expand the donor pool. The safe use of grafts from obese donors has always been a subject of debate among PLT specialists. Donors' obesity is strongly associated with hepatic steatosis which can affect graft function by impairing microcirculation and maximizing the potential of ischemia-reperfusion injury. Donor body mass index consideration should go hand in hand with the workup for hepatic steatosis which is an independent predictor for early graft dysfunction. New strategies to optimize the grafts before PLT such as normothermic regional perfusion and <i>ex vivo</i> liver perfusion can potentially mitigate the risk of using grafts from obese donors. This review summarizes the available evidence about the impact of donor obesity on PLT and highlights the current policies to widen the graft pool and suggest future research directions to improve donor selection and patient outcomes.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"15 3","pages":"103015"},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12038587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980436","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":"What about the caregivers? Rethinking chronic illness support in the age of transplantation.","authors":"Hirak Pahari, Shikhar Tripathi, Samiran Nundy","doi":"10.5500/wjt.v15.i3.104230","DOIUrl":"10.5500/wjt.v15.i3.104230","url":null,"abstract":"<p><p>Caregivers play an essential but often unacknowledged role in healthcare, particularly in chronic illness and post-transplantation scenarios. We highlight the profound emotional, physical, and logistical challenges caregivers face, as illuminated by recent studies, including the work of Virches <i>et al</i> about liver transplantation. Pre-transplant caregiving is marked by heightened stress, depression, and emotional strain, as caregivers navigate the unpredictability of conditions like cirrhosis. While liver transplantation significantly alleviates caregiver burden by stabilizing patient health, caregiving evolves rather than ends, requiring ongoing vigilance for post-transplant care, medication adherence, and lifestyle adjustments. We examine the disproportionate impact of caregiving on the family, due to entrenched cultural and gender norms and highlight how these disparities reinforce systemic neglect. Caregiving, often viewed as a familial duty, carries financial, mental, and physical health costs, perpetuating inequities and marginalization. We argue that caregivers are integral to healthcare outcomes and must be included in systemic frameworks to improve patient care. We also advocate for a paradigm shift from patient-centered to family-centered care, emphasizing caregiver inclusion as a core healthcare priority. Policy recommendations related to financial support, respite care, education, and mental health services should be tailored for caregivers. By addressing caregiver needs, healthcare systems can improve patient outcomes, reduce costs, and foster equity. This editorial underscores that caregivers are not ancillary but central to healthcare's success. Recognizing and supporting them is both an ethical responsibility and a practical necessity for sustainable healthcare.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"15 3","pages":"104230"},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12038586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980380","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":"Frailty as a determinant of liver transplant outcomes: A call for integrative strategies.","authors":"Hirak Pahari, Shikhar Tripathi, Samiran Nundy","doi":"10.5500/wjt.v15.i3.104500","DOIUrl":"10.5500/wjt.v15.i3.104500","url":null,"abstract":"<p><p>Frailty has emerged as a pivotal determinant of post-liver transplant (LT) outcomes, yet its integration into clinical practice remains inconsistent. Defined by functional impairments and reduced physiologic reserve, frailty transcends traditional metrics like the model for end-stage liver disease (MELD) score, demonstrating increasing predictive value for mortality beyond the immediate post-operative period. Recent findings suggest that frail recipients experience significantly higher mortality within the first 12 months following transplantation-a period when traditional monitoring often wanes. This raises critical questions about the adequacy of current assessment and follow-up protocols. The observed dissociation between MELD scores and long-term survival underscores the limitations of existing selection criteria. Frailty, as a dynamic and modifiable condition, represents an opportunity for targeted intervention. Prehabilitation programs focusing on nutritional optimization, physical rehabilitation, and psychosocial support could enhance resilience in transplant candidates, reducing their risk profile and improving post-transplant outcomes. Furthermore, these findings call for an expanded approach to post-transplant monitoring. Extending surveillance for frail recipients beyond standard timelines may facilitate early detection of complications, mitigating their impact on survival. Incorporating frailty into both pre- and post-transplant protocols could redefine how transplant centers evaluate and manage risk. This editorial advocates for a paradigm shift: Frailty must no longer be viewed as a secondary consideration but as a core element in LT care. By addressing frailty comprehensively, we can move toward more personalized, effective strategies that improve survival and quality of life for LT recipients.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"15 3","pages":"104500"},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12038599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980387","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":"Introducing hyperspectral imaging as a novel tool for assessing donor liver quality during machine perfusion: A case report.","authors":"Mohamed El-Mahrouk, Cord Langner, Robert Sucher, Daniela Kniepeiss","doi":"10.5500/wjt.v15.i3.102798","DOIUrl":"10.5500/wjt.v15.i3.102798","url":null,"abstract":"<p><strong>Background: </strong>Hyperspectral imaging (HSI) offers useful information on organ quality and has already been successfully used in kidney and liver transplantation to assess transplanted organs. Up to now, there is no case report in the literature describing HSI for quality assessment of a machine perfused donor liver. The allocated liver from a 49-year-old female donor (161 cm, 70 kg) was perfused with the OrganOx^® normothermic machine perfusion system in the recommended way. Organ quality assessment was performed based on laboratory values at defined time points. In addition, the final evaluation of the liver comprised macroscopic findings and HSI of each liver segment. After discarding the organ, biopsies were taken from each segment and correlated with the results of the HSI.</p><p><strong>Case summary: </strong>The donor liver's size (29 cm × 17 cm × 11 cm) and weight of 2180 g posed challenges for adequate placement within the organ container. Baseline biopsy of the liver revealed no evidence of fibrosis, steatosis or inflammation. An hour after perfusion start, measurements of the perfusate indicated a pH of 7.18, a glucose level of 404 mg/dL, and a lactate level of 1.7 mmol/L. Throughout perfusion, a significant decline in glucose levels began at the fourth hour, reaching a nadir of 20 mg/dL after eight hours. Concurrently, lactate levels steadily rose, peaking at 4.9 mmol/L after the total perfusion time of 12 hours. Macroscopic alterations (signs of congestion and reduced blood circulation) on the liver's surface were noted, particularly pronounced in segments 2, 3, and 8. HSI of these areas unveiled significant reduced oxygenation. Consequently, based on all these observations, the decision was made to discard the organ. Histological examination of the altered regions revealed congestion, necrotic changes, and dissociation of sinusoidal lining cells from liver cell cords. The histological findings correlated well with the HSI.</p><p><strong>Conclusion: </strong>This case report describes the integration of HSI in the decision making of the decline of a 49-year-old machine perfused donor liver. HSI offered useful information concerning the tissue morphology and graft viability and could therefore be a useful additional tool in assessing donor liver quality before transplantation.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"15 3","pages":"102798"},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12038598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980400","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":"Death after psychiatric contraindications to urgent liver transplant for paracetamol overdose.","authors":"Olivia R E Impey, Jennifer D Baker, Roger S Smyth, Stephen G Potts","doi":"10.5500/wjt.v15.i3.101865","DOIUrl":"10.5500/wjt.v15.i3.101865","url":null,"abstract":"<p><strong>Background: </strong>Paracetamol overdose (POD) is the most common cause of acute hepatic failure (AHF) in the United Kingdom. Without urgent orthotopic liver transplant (OLT), mortality is high. Psychiatric assessment for transplant is time-pressured and often undertaken by psychiatrists without transplant experience. Assessors may identify absolute psychiatric contraindications (APCIs) precluding transplant in otherwise medically suitable patients. It is unknown how often this occurs. The combination of high but unknown mortality, time pressure, and relative inexperience is likely to provoke anxiety in assessors. This study hypothesised that the proportion of POD patients assessed for OLT who die because psychiatric contraindications preclude transplant would be small but not negligible.</p><p><strong>Aim: </strong>To determine the proportion of patients with paracetamol-induced AHF, for whom psychiatric contraindications preclude transplantation, and the consequent mortality.</p><p><strong>Methods: </strong>This is an 18-year single-centre retrospective cohort study based in a national liver transplant centre. 524 participants were identified from a departmental database and included if they had AHF from suspected POD and received a psychiatric assessment for OLT. For those who died before discharge, records were reviewed for medical and psychiatric contraindications to transplant, alongside age, sex, and primary psychiatric diagnosis. We calculated the proportion of patients assessed for whom APCIs precluded transplant, resulting in death.</p><p><strong>Results: </strong>Among 524 patients undergoing psychiatric assessment for OLT, there were 102 in-episode deaths (19.5%). APCIs were identified in 46 patients who were otherwise medically suitable for transplant and went on to die. This statistic represents 8.8% of the number of persons evaluated and 45% of the number of deaths. Within this subgroup, 27 (59%) were female, with a mean age of 44.6 years (ranging from 19-72 years). The most common primary psychiatric diagnosis was alcohol dependence syndrome, which accounted for 67% (<i>n</i> = 31).</p><p><strong>Conclusion: </strong>8.8% of medically suitable patients with AHF following POD died with APCIs to transplant. This indicates a need for ongoing assessor training and support, and (inter) national comparisons of practice.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"15 3","pages":"101865"},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12038596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980404","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":"Increased reflux burden on pre-transplant reflux testing independently predicts significant pulmonary function decline after lung transplantation.","authors":"Wai-Kit Lo, Annel M Fernandez, Natan Feldman, Nirmal Sharma, Hilary J Goldberg, Walter W Chan","doi":"10.5500/wjt.v15.i3.100111","DOIUrl":"10.5500/wjt.v15.i3.100111","url":null,"abstract":"<p><strong>Background: </strong>Gastroesophageal reflux disease has been shown to contribute to allograft injury and rejection outcomes in lung transplantation through a proposed mechanism of aspiration, inflammation, and allograft injury. The value of pre-transplant reflux testing in predicting reduction in pulmonary function after lung transplantation is unclear. We hypothesized that increased reflux burden on pre-transplant reflux testing is associated with pulmonary function decline following lung transplant.</p><p><strong>Aim: </strong>To assess the relationship between pre-transplant measures of reflux and pulmonary function decline in lung transplant recipients.</p><p><strong>Methods: </strong>This was a retrospective cohort study of lung transplant recipients who underwent pre-transplant reflux testing with 24-hour pH-impedance off acid suppression at a tertiary center in 2007-2016. Patients with pre-transplant fundoplication were excluded. Time-to-event analysis was performed using Cox proportional hazards models to assess associations between reflux measures and reduction in forced expiratory volume in 1 second (FEV1) of ≥ 20% post-transplant. Patients not meeting endpoint were censored at time of post-transplant fundoplication, last clinic visit, or death, whichever was earliest.</p><p><strong>Results: </strong>Seventy subjects (58% men, mean age: 56 years) met the inclusion criteria. Interstitial lung disease represented the predominant pulmonary diagnosis (40%). Baseline demographics were similar between groups and were not associated with pulmonary decline. The clinical endpoint (≥ 20% FEV1 decline) was reached in 18 subjects (26%). In time-to-event univariate analysis, FEV1 decline was associated with increased acid exposure time (AET) [hazard ratio (HR) = 3.49, <i>P</i> = 0.03] and increased proximal acid reflux (HR = 3.34, <i>P</i> = 0.04) with confirmation on Kaplan-Meier analysis. Multivariate analysis showed persistent association between pulmonary decline and increased AET (HR = 3.37, <i>P</i> = 0.04) when controlling for potential confounders including age, body mass index, and sex. Sub-group analysis including only patients with FEV1 decline showed that all subjects with abnormal AET progressed to bronchiolitis obliterans syndrome.</p><p><strong>Conclusion: </strong>Increased reflux burden on pre-transplant testing was associated with significant pulmonary function decline post-transplant. Pre-transplant reflux assessment may provide clinically relevant information in the prognostication and management of transplant recipients.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"15 3","pages":"100111"},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12038592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980363","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":"Comparison of ChatGPT-3.5 and GPT-4 as potential tools in artificial intelligence-assisted clinical practice in renal and liver transplantation.","authors":"Chrysanthos D Christou, Olga Sitsiani, Panagiotis Boutos, Georgios Katsanos, Georgios Papadakis, Anastasios Tefas, Vassilios Papalois, Georgios Tsoulfas","doi":"10.5500/wjt.v15.i3.103536","DOIUrl":"10.5500/wjt.v15.i3.103536","url":null,"abstract":"<p><strong>Background: </strong>Kidney and liver transplantation are two sub-specialized medical disciplines, with transplant professionals spending decades in training. While artificial intelligence-based (AI-based) tools could potentially assist in everyday clinical practice, comparative assessment of their effectiveness in clinical decision-making remains limited.</p><p><strong>Aim: </strong>To compare the use of ChatGPT and GPT-4 as potential tools in AI-assisted clinical practice in these challenging disciplines.</p><p><strong>Methods: </strong>In total, 400 different questions tested ChatGPT's/GPT-4 knowledge and decision-making capacity in various renal and liver transplantation concepts. Specifically, 294 multiple-choice questions were derived from open-access sources, 63 questions were derived from published open-access case reports, and 43 from unpublished cases of patients treated at our department. The evaluation covered a plethora of topics, including clinical predictors, treatment options, and diagnostic criteria, among others.</p><p><strong>Results: </strong>ChatGPT correctly answered 50.3% of the 294 multiple-choice questions, while GPT-4 demonstrated a higher performance, answering 70.7% of questions (<i>P</i> < 0.001). Regarding the 63 questions from published cases, ChatGPT achieved an agreement rate of 50.79% and partial agreement of 17.46%, while GPT-4 demonstrated an agreement rate of 80.95% and partial agreement of 9.52% (<i>P</i> = 0.01). Regarding the 43 questions from unpublished cases, ChatGPT demonstrated an agreement rate of 53.49% and partial agreement of 23.26%, while GPT-4 demonstrated an agreement rate of 72.09% and partial agreement of 6.98% (<i>P</i> = 0.004). When factoring by the nature of the task for all cases, notably, GPT-4 demonstrated outstanding performance, providing a differential diagnosis that included the final diagnosis in 90% of the cases (<i>P</i> = 0.008), and successfully predicting the prognosis of the patient in 100% of related questions (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>GPT-4 consistently provided more accurate and reliable clinical recommendations with higher percentages of full agreements both in renal and liver transplantation compared with ChatGPT. Our findings support the potential utility of AI models like ChatGPT and GPT-4 in AI-assisted clinical practice as sources of accurate, individualized medical information and facilitating decision-making. The progression and refinement of such AI-based tools could reshape the future of clinical practice, making their early adoption and adaptation by physicians a necessity.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"15 3","pages":"103536"},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12038595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980353","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":"First report of successful liver transplantation following supermicrosurgical lymphaticovenous anastomoses for lymphorrhea with intractable infection: A case report.","authors":"Tse-Wei Wu, Teng-Yuan Hou, Johnson Chia-Shen Yang, Chih-Chi Wang","doi":"10.5500/wjt.v15.i3.101496","DOIUrl":"10.5500/wjt.v15.i3.101496","url":null,"abstract":"<p><strong>Background: </strong>Liver transplant (LT) candidates face a heightened risk of infection both pre- and post-transplant, owing to immunosuppressive therapy and complications from chronic liver disease. Infections during the pre-transplant period, such as lymphorrhea-induced cellulitis, can cause significant delays in transplantation and increase mortality while on the waiting list. Lymphorrhea, characterized by substantial lymphatic leakage and recurrent skin infections, presents a significant challenge in managing patients who are already immunocompromised. Effective preoperative infection control is critical to enhancing the prospects for a successful liver transplantation.</p><p><strong>Case summary: </strong>We report the case of a 50-year-old female diagnosed with Hepatitis C virus-related cirrhosis (Child-Pugh C) and recurrent cellulitis due to lymphorrhea in her left lower leg. She suffered repeated episodes of cellulitis over five years, which prevented her from undergoing LT. Initial conservative treatments were unsuccessful in managing the lymphatic leakage and accompanying infections. In February 2019, she underwent supermicrosurgical lymphaticovenous anastomoses (LVA) to address her lymphorrhea. This procedure, which created multiple lymphatic-venous connections in the lower limb, led to significant improvements in her condition. After the LVA, she experienced no further episodes of cellulitis. Eighteen months later, she successfully underwent a deceased donor liver transplantation. Postoperative complications, including a wound hematoma, were effectively managed, and she was discharged 3 months post-operation. At her 3-year follow-up, her liver function was stable, with no recurrence of cellulitis.</p><p><strong>Conclusion: </strong>Despite numerous challenges, the patient achieved a successful recovery with satisfactory graft function and was free from lymphorrhea/lymphedema in her left lower limb 3 years post-transplantation. This case underscores the importance of robust infection control during both the pre- and post-transplantation phases and highlights the potential of LVA as a treatment option for managing lymphorrhea and infections in patients with liver cirrhosis.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"15 3","pages":"101496"},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12038583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980355","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":"Comparison of a direct <i>vs</i> consultative advanced heart failure role in the outcomes of extracorporeal membrane oxygenation patients.","authors":"James Zhang, Todd Nagamine, Kimberly Vu, Mohammed Ali, Nath Limpruttidham, Maan Gozun, Jesus Pino Moreno, Dipanjan Banerjee","doi":"10.5500/wjt.v15.i3.102078","DOIUrl":"10.5500/wjt.v15.i3.102078","url":null,"abstract":"<p><strong>Background: </strong>Advanced heart failure and transplant (AHFTC) teams are crucial in the management of patients in cardiogenic shock. We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extracorporeal membrane oxygenation (ECMO) support.</p><p><strong>Aim: </strong>To determine whether outcomes differ in the care of ECMO patients when AHFTC physicians serve in a primary <i>vs</i> consultative role.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 51 patients placed on veno-venous (VV) and veno-arterial (VA) ECMO between January 2015 and February 2023 at our institution. We compared ECMO outcomes between teams managed primarily by intensivists <i>vs</i> teams where AHFTC physicians played a direct role in ECMO management, including patient selection. Our primary outcome measure was survival to 30 days post hospital discharge.</p><p><strong>Results: </strong>For combined VA and VV ECMO patients, survival to 30 days post discharge in the AHFTC cohort was significantly higher (67% <i>vs</i> 30%, <i>P</i> = 0.01), largely driven by a significantly increased 30-day post discharge survival in VA ECMO patients in the AHFTC group (64% <i>vs</i> 20%, <i>P</i> = 0.05).</p><p><strong>Conclusion: </strong>This study suggests that patients in shock requiring VA ECMO support may have improved survival 30 days after hospital discharge when an AHFTC team serves in a direct role in the selection and management of patients. Further studies are needed to validate this impact.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"15 3","pages":"102078"},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12038605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980365","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}