Artificial organs最新文献

{"title":"Economic Evaluation of Prolonged Hypothermic Oxygenated Machine Perfusion Enabling Daytime Liver Transplantation.","authors":"Linda C Woltjes, Marijke I Bonnema, Isabel M A Brüggenwirth, Veerle A Lantinga, Christian S van der Hilst, Vincent E de Meijer","doi":"10.1111/aor.70267","DOIUrl":"https://doi.org/10.1111/aor.70267","url":null,"abstract":"<p><strong>Background: </strong>Short-duration (1-2 h) dual hypothermic oxygenated machine perfusion (DHOPE) reduces ischemia-reperfusion injury-related complications. Prolonged DHOPE preservation (DHOPE-PRO) may facilitate logistics. We assessed the economic impact of DHOPE-PRO versus conventional short-duration DHOPE, hypothesizing that DHOPE-PRO would not be associated with increased one-year transplantation-related costs.</p><p><strong>Methods: </strong>This post hoc economic evaluation of the prospective DHOPE-PRO trial (NL8740) included adult recipients of livers donated after brain death. All transplantation-related medical expenses up to one year post-transplant were collected. The cost of resource use was calculated using 2022 full hospital prices indexed to 2024. Time-driven variable costing was applied to perfusion, surgery, and intensive care costs. The primary outcome was total one-year transplantation-related cost.</p><p><strong>Results: </strong>Of 24 patients, 12 received a liver after DHOPE and 12 after DHOPE-PRO. Median one-year total costs were €83 583 [interquartile range (IQR) 78 400-104 158] for DHOPE and €78 582 [IQR 73123-92 855] for DHOPE-PRO (p = 0.347). Perfusion costs were higher with DHOPE-PRO (€23 926 [IQR 22711-24 697] versus €17 306 [IQR 16928-17 594]; p < 0.001), while surgery costs were lower (€18 560 [IQR 17806-20 747] versus €21 303 [IQR 19535-25 418]; p = 0.033). Costs related to other medical activities did not differ between groups.</p><p><strong>Conclusion: </strong>In this exploratory single-center economic evaluation, DHOPE-PRO enabled daytime liver transplantation without evidence of increased one-year transplantation-related costs compared with short-duration DHOPE. Higher perfusion-related costs were accompanied by lower surgery-related costs in this cohort. These findings warrant confirmation in larger studies.</p><p><strong>Trial registration: </strong>Netherlands Trial Registry number: NL8740.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physiological Effects and Clinical Limitations of Impella-Bridge Strategy for Post-Infarction Ventricular Septal Rupture.","authors":"Toshihide Izumida, Teruhiko Imamura, Makiko Nakamura, Masaki Nakagaito, Shigeki Yokoyama, Saori Nagura, Toshio Doi, Koichiro Kinugawa","doi":"10.1111/aor.70252","DOIUrl":"https://doi.org/10.1111/aor.70252","url":null,"abstract":"<p><strong>Background: </strong>Post-infarction ventricular septal rupture (VSR) remains a life-threatening mechanical complication of acute myocardial infarction. We evaluated the feasibility of an Impella-bridge strategy for scheduled VSR repair.</p><p><strong>Methods: </strong>We retrospectively analyzed 10 consecutive patients with post-infarction VSR who were transferred to our institution and managed with Impella support. Outcomes included achievement of scheduled repair and serial changes in hemodynamic parameters and organ dysfunction during the bridging period.</p><p><strong>Results: </strong>The median age was 74 years. All patients received Impella 2.5 or CP support after transfer; veno-arterial extracorporeal life support was added in four patients, and Impella support was upgraded in one patient. The median duration from Impella initiation to VSR repair was 8 (7, 10) days. Scheduled repair was achieved in nine patients (90%). Mean pulmonary artery pressure, central venous pressure, plasma B-type natriuretic peptide levels, and lactate decreased over time before repair, whereas non-CNS SOFA scores increased during bridging.</p><p><strong>Conclusions: </strong>In patients with post-infarction VSR, an Impella-bridge strategy may help achieve scheduled VSR repair with improved hemodynamic stabilization; however, SOFA-defined abnormalities, organ support requirements, and device-related complications were observed during the bridging period. Further studies are needed to define patient selection, management strategies, and the optimal timing of repair for this strategy.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abdominal Normothermic Regional Perfusion Versus Normothermic Machine Perfusion of DCD Kidneys Aged 50 Years or Older: A Propensity Score Matched Analysis.","authors":"J S Slagter, E F van de Geijn, F H C de Goeij, P C Groen, I J Schurink, I P J Alwyn, R J Porte, V A L Huurman, J de Jonge, R C Minnee","doi":"10.1111/aor.70234","DOIUrl":"https://doi.org/10.1111/aor.70234","url":null,"abstract":"<p><strong>Introduction: </strong>The use of donor kidneys from older donation after circulatory death (DCD) donors is limited due to increased susceptibility to ischemia-reperfusion injury, resulting in delayed graft function (DGF) and graft loss. While hypothermic machine perfusion (HMP) with oxygen (HMPO₂) offers some benefit, clinical outcomes remain suboptimal. Emerging normothermic preservation techniques, such as abdominal normothermic regional perfusion (aNRP) and normothermic machine perfusion (NMP), may enhance graft viability in high-risk transplants. This study compares post-transplant outcomes of aNRP versus NMP in DCD donors over 50 years of age.</p><p><strong>Materials and methods: </strong>Data were collected from two clinical trials (NMP group) and a national registry (aNRP group). The primary outcome was the incidence of DGF. Secondary outcomes included primary non-function (PNF), acute rejection, death-censored graft and patient survival, and longitudinal kidney function (eGFR) until three years after transplantation.</p><p><strong>Results: </strong>The outcomes of 85 kidneys that underwent aNRP were compared to 29 kidneys that underwent NMP. No significant difference was observed in the incidence of DGF (aNRP: 46% vs. NMP: 52%, p = 0.82), PNF (aNRP: 8% vs. NMP: 7%, p = 0.87) or acute rejection (25% vs. 31%, p = 0.67). Death-censored graft and patient survival was similar in the aNRP and NMP group. At three years post-transplant, median eGFR was 38 (±2.1) mL/min/1.73 m² in the aNRP group and 33 (±3.8) mL/min/1.73 m² in the NMP group.</p><p><strong>Conclusion: </strong>The findings of this study demonstrate that both aNRP and NMP provide similar graft outcomes in older DCD kidney transplantation, potentially increasing the acceptance of high-risk donor kidneys by transplant centers. The interpretation of the results of this study is limited by its non-randomized design and small sample size.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Neural Network-Driven Early Recognition in Cardiopulmonary Failure: A Paradigm Shift Underway in Temporary Mechanical Circulatory Support?","authors":"Monika Tukacs, Elena Giovanna Bignami, Patrick M Wieruszewski, Jacopo D'Andria Ursoleo, Justyna Swol","doi":"10.1111/aor.70265","DOIUrl":"https://doi.org/10.1111/aor.70265","url":null,"abstract":"<p><p>The contemporary intensive care unit generates an overwhelming magnitude of high-frequency, granular physiological data. However, conventional decision-making for patients requiring temporary mechanical circulatory support (tMCS) remains tethered to reactive, threshold-driven manual adjustments, underutilizing continuous data streams and failing to optimize the complex patient-machine interaction. This review examines the integration of deep neural networks (DNNs) as a candidate strategy for advanced clinical decision support. By identifying a continuous \"digital phenotype,\" hierarchical deep learning architectures signal a shift toward real-time trajectory recognition in tMCS. We establish a four-tier functional taxonomy-prognosticative, descriptive, predictive, and prescriptive-to categorize translational milestones from automated pump-speed optimization to closed-loop homeostatic regulation. Operational challenges are analyzed through the TEIP (Transparency, Explainability, Interpretability, and Performance) Core-Lens Framework, navigating the dynamic equilibrium between computational density and clinical explainability. We further evaluate the evolving global regulatory landscape, advocating for a foundation on verified empirical safety and rigorous clinical trial validation over absolute mathematical transparency in high-density architectures. Implementing a strategic roadmap including context-specific validation, multimodal integration, and human-centered design is quintessential to safely transform passive hardware into intelligent systems. As the field evolves, DNN technology offers a consequential opportunity to advance early cardiopulmonary failure recognition into a clinical reality.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to \"Effects of Medium Cut-Off Dialyzers on Fat Tissue and Muscle Mass Indices\".","authors":"","doi":"10.1111/aor.70264","DOIUrl":"https://doi.org/10.1111/aor.70264","url":null,"abstract":"","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to \"Early and Late Effects of Medium Cutoff Dialyzer on Arterial Stiffness in Maintenance Hemodialysis Patients\".","authors":"","doi":"10.1111/aor.70262","DOIUrl":"https://doi.org/10.1111/aor.70262","url":null,"abstract":"","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporary Right Ventricular Mechanical Circulatory Support Devices in Acute Right Ventricular Failure and Cardiogenic Shock: A Cross-Device Systematic Review and Single-Arm Meta-Analysis.","authors":"Hussein Elghazaly, Omar Naeim, Anna Collins, Mohamed Abouegla, Omar Elsiraffy, Syed Yusuf Maududi","doi":"10.1111/aor.70256","DOIUrl":"https://doi.org/10.1111/aor.70256","url":null,"abstract":"<p><strong>Background: </strong>Evidence for temporary right ventricular assist devices (tRVADs) is fragmented. We characterized outcomes among adults receiving temporary support for acute right ventricular (RV) failure or RV-predominant cardiogenic shock.</p><p><strong>Methods: </strong>MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov were searched from inception to June 2026. Arm-level outcome proportions were pooled on the logit scale using three-level random-effects models, with arms nested within studies. Device-stratified estimates, meta-regression, and sensitivity analyses were examined.</p><p><strong>Results: </strong>We included 106 studies (119 device arms; 4653 patients), including 57 conference-abstract studies (53.8%). Concurrent left-sided support was reported in 85.8% of patients with available data; post-LVAD RV failure predominated in 47.5% of arms. Separately pooled survival to discharge was 60.4% (95% CI 56.0-64.7; 63 arms), successful weaning 60.6% (54.8-66.2; 68 arms), and 30-day mortality 30.1% (24.1-36.9; 31 arms). The survival prediction interval was wide (34.4%-81.6%). Pooled bleeding, renal complications (acute kidney injury and/or renal replacement therapy, as reported), and stroke were 36.5%, 46.6%, and 14.5%, respectively. Device-stratified estimates were vulnerable to confounding. No meta-regression association remained significant after multiplicity correction.</p><p><strong>Conclusions: </strong>These descriptive estimates characterize selected, heterogeneous treated cohorts, predominantly receiving left-sided or biventricular support; they do not establish treatment benefit or comparative device effectiveness. Complication rates were high. Applicability to isolated primary RV shock is limited. Standardized prospective data are needed to inform patient selection, timing, and device strategy.</p><p><strong>Trial registration: </strong>PROSPERO registration number: CRD420261406088.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surrogate-Assisted Multi-Objective Optimization of an Axial-Flow Ventricular Assist Device Rotor Using CFD, Hybrid Surrogates, Sobol Analysis, and MOPSO.","authors":"Mohamed Bounouib, Reda Lakraimi, Hamza Isksioui, Mourad Taha-Janan, Wajih Maazouzi","doi":"10.1111/aor.70266","DOIUrl":"https://doi.org/10.1111/aor.70266","url":null,"abstract":"<p><strong>Background: </strong>This study presents a surrogate-assisted workflow for multi-objective optimization of an axial-flow ventricular assist device (VAD) rotor using 4809 steady-state CFD simulations spanning six geometric variables.</p><p><strong>Methods: </strong>Repeated learning-curve analysis and blade-count-stratified Gaussian-process regression (GPR) assessed data efficiency and complemented tree-based surrogate models. Final selection retained GPR for pressure rise, torque, hemolysis index, platelet activation, and exposure time, and HistGradientBoosting for hydraulic efficiency and the low-shear fraction S < 50 Pa, with held-out R² values of 0.968-1.000. Because hydraulic efficiency is derived from pressure rise and torque at the fixed operating condition, the primary MOPSO formulation used six objectives: maximizing pressure rise and S < 50 Pa while minimizing torque, hemolysis index, platelet activation, and exposure time; efficiency was retained as a secondary engineering metric. Ten independent MOPSO runs were pooled to characterize Pareto trade-offs, and five representative Pareto designs were re-evaluated by direct CFD.</p><p><strong>Results: </strong>The balanced compromise used a 53.58° inlet blade angle, 20.93° outlet blade angle, three blades, a 0.222 mm clearance gap, 0.796 mm blade thickness, and a 20.00 mm rotor length. For the balanced compromise, mean surrogate-to-CFD relative error was 4.0%, with all individual errors below 10%. Relative to baseline, direct CFD confirmed reductions of 17.2% in torque, 55.6% in hemolysis index, 46.9% in platelet activation, and 27.0% in exposure time, together with a 4.5% increase in S < 50 Pa; pressure rise decreased by 22.4% and hydraulic efficiency changed by +0.7%.</p><p><strong>Conclusions: </strong>The workflow supports design-space screening, trade-off identification, and targeted CFD confirmation of candidate geometries.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Race Mismatch in Ex Vivo Lung Perfusion Is Not Associated With Worse Survival After Lung Transplantation.","authors":"Neelesh Bagrodia, Ervin Y Cui, Divyaam Satija, Casey T Walk, Ahmed Aly, Aaron Guo, Ammu Alvarez, Kukbin Choi, Matthew C Henn, Asvin M Ganapathi, Doug A Gouchoe, Bryan A Whitson","doi":"10.1111/aor.70220","DOIUrl":"https://doi.org/10.1111/aor.70220","url":null,"abstract":"<p><strong>Objective: </strong>To meet the growing demand of donor lungs, ex vivo lung perfusion (EVLP) is being used to further assess higher risk donor lungs. This study aims to identify the association of race mismatch between donor and recipient on survival in lung transplantation with EVLP.</p><p><strong>Methods: </strong>The UNOS database was queried for all lung transplants evaluated with EVLP from 2/2018 to 3/2025. Recipients with age < 18, multi-organ transplants, re-transplants, or missing data were excluded. Transplants were stratified into those with race concordance (RC) and mismatch (RM) between recipients and donors. Kaplan-Meier methods with log-rank tests were used to assess survival differences. A multivariable cox regression model was created using select variables.</p><p><strong>Results: </strong>1246 lung transplant recipients were identified: 638 in the RC group, 608 in the RM group. RC recipients were predominantly White (92.2% vs. 55.9%), had higher incidence of former smoking history (63.2% vs. 54.3%), and lower lung allocation scores. RC donors were more frequently White (92.2% vs. 31.6%) and DCD (38.6% vs. 29.9%). Post-operative outcomes were similar between both RC and RM groups, only treated rejection in the first year was significantly higher in the former (p = 0.005). Unadjusted survival did not differ between the groups (p = 0.27). On multivariate cox-proportional hazard modeling, RM was not independently predictive of mortality (HR 1.16 95% CI: 0.92-1.46) while recipient ECMO was the strongest predictor of mortality (HR 2.68, 95% CI: 1.71-4.20).</p><p><strong>Conclusions: </strong>For recipients who underwent lung transplantation following EVLP, race mismatch was not independently associated with mortality on adjusted analysis.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial V-A ECMO Flow-Index and Its Association With Inflammation, Organ Failure, and Outcomes.","authors":"Kostiantyn Kozakov, Zdenek Provaznik, Alois Philipp, Maik Foltan, Christian Schach, Sergey Vasin, Andreas Keyser, Leopold Rupprecht, Christof Schmid, Simon Schopka","doi":"10.1111/aor.70257","DOIUrl":"https://doi.org/10.1111/aor.70257","url":null,"abstract":"<p><strong>Background: </strong>Refractory cardiogenic shock remains associated with high mortality despite macrocirculatory stabilization with V-A ECMO. We investigated the association between initial ECMO flow-index, organ dysfunction, inflammatory activation, hemolysis, and clinical outcome.</p><p><strong>Methods: </strong>In this retrospective single-center study, 553 patients receiving V-A ECMO between 2014 and 2024 were divided into low-flow (< 1.63 L/min/m², n = 269) and high-flow (≥ 1.63 L/min/m², n = 284) groups. Patients were additionally stratified according to eCPR status. Multivariable logistic regression was used to assess factors associated with multi-organ failure (MOF), and exploratory mediation analyses evaluated day-1 free hemoglobin and IL-6 as potential mediators.</p><p><strong>Results: </strong>High-flow patients were more hemodynamically compromised, with higher lactate, vasoactive-inotropic support, inflammatory markers, and early hemolysis. After exclusion of cerebral death, MOF occurred more frequently in the high-flow group (32.7% vs. 23.0%, p = 0.028). Initial flow-index remained independently associated with MOF in the overall cohort (OR 1.102 per 0.1 L/min/m², 95% CI 1.001-1.214, p = 0.048) and in the eCPR subgroup (OR 1.117, 95% CI 1.028-1.214, p = 0.008). Day-1 free hemoglobin was independently associated with MOF, and mediation analysis demonstrated a significant indirect effect through early hemolysis. No significant indirect effect through IL-6 was observed. Higher flow index was also associated with worse neurological outcome and reduced survival.</p><p><strong>Conclusions: </strong>Higher initial V-A ECMO flow-index is associated with greater shock severity and multi-organ failure. Early hemolysis may partly contribute to this association, particularly in eCPR patients. These findings support individualized flow management with close monitoring of hemolysis and evolving organ dysfunction.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}