Artificial organs最新文献

{"title":"Identification of Coagulation Phenotypes Using Viscoelastic and Conventional Assays During Veno-Venous Extracorporeal Membrane Oxygenation: A Hierarchical Clustering Analysis","authors":"Daisuke Irimada,&nbsp;Yudai Iwasaki,&nbsp;Yusuke Takei,&nbsp;Moe Oyama,&nbsp;Ami Tanaka,&nbsp;Shinichi Yamaguchi,&nbsp;Naoya Kobayashi,&nbsp;Daisuke Konno,&nbsp;Takuya Shiga,&nbsp;Masanori Yamauchi","doi":"10.1111/aor.70153","DOIUrl":"10.1111/aor.70153","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is essential for managing severe respiratory failure; however, hemorrhagic and thrombotic complications remain major challenges. Conventional activated partial thromboplastin time (APTT) monitoring may inadequately reflect the complex coagulation changes during ECMO. Although viscoelastic hemostatic assays (VHAs) provide a comprehensive assessment, discrepancy patterns between VHAs and conventional tests in V-V ECMO patients remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to identify distinct coagulation phenotypes in patients receiving V-V ECMO using hierarchical clustering of VHA and conventional coagulation parameters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational study was conducted at a tertiary university hospital in Japan. Patients receiving V-V ECMO between November 2020 and June 2023 who underwent VHA and conventional coagulation testing were included. Coagulation profiles were clustered using hierarchical analysis of five variables. Cluster validity was assessed, and results were visualized using principal component analysis and generalized additive models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 19 patients and 110 VHA measurements were analyzed. Three distinct coagulation phenotypes were identified. Cluster 1 demonstrated concordant prolongation of APTT and citrated kaolin reaction time (CK-R). Clusters 2 and 3 exhibited disproportionately prolonged CK-R relative to APTT, with Cluster 3 further characterized by elevated fibrinogen and platelet counts. Anticoagulant use, laboratory markers, and clinical outcomes, including thrombotic and bleeding events, were evaluated. Complication rates did not differ significantly among clusters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Hierarchical clustering identified three distinct coagulation profiles among V-V ECMO patients, highlighting the heterogeneity of ECMO-related coagulopathy. Thromboelastography-derived CK-R may complement APTT monitoring to inform more tailored anticoagulation strategies in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":"50 8","pages":"1170-1181"},"PeriodicalIF":2.2,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aor.70153","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticoagulation Strategies in Adults Undergoing Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis","authors":"Vincenz Scharner,&nbsp;Karoline Lenz,&nbsp;Harald Herkner,&nbsp;Nina Buchtele,&nbsp;Thomas Staudinger,&nbsp;Eva Schaden,&nbsp;Marion Wiegele,&nbsp;Johannes Gratz","doi":"10.1111/aor.70162","DOIUrl":"10.1111/aor.70162","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention for patients with severe cardiac or respiratory failure, but it is associated with a high risk of thrombotic and bleeding complications. Unfractionated heparin (UFH) remains the most frequently used anticoagulant, largely due to historical practice and longstanding clinical familiarity, despite the absence of robust evidence from randomized controlled trials. Alternative strategies—including direct thrombin inhibitors (DTIs), low-molecular-weight heparins (LMWHs), nafamostat mesylate (NM), and no anticoagulation—are increasingly being explored. However, a comprehensive and contemporary comparison of these approaches has been lacking.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We conducted a comprehensive search of PubMed/MEDLINE, EMBASE, and CENTRAL through March 2025, supplemented by manual searches of reference lists. We included randomized controlled trials and observational studies including patients 16 years or older receiving ECMO for ≥ 24 h that compared any anticoagulation strategy with another or with no anticoagulation. The primary outcome was thromboembolic events; secondary outcomes included bleeding and mortality. Risk of bias was assessed using validated tools. Meta-analyses were performed using a multivariable random-effects model, with prespecified subgroup analyses by ECMO modality (venoarterial [VA], venovenous [VV], or mixed) and subsequent sensitivity analyses.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Twenty-one observational studies involving 2 775 adult ECMO patients were included, with UFH serving as the comparator in all studies. DTIs showed reduced thromboembolism (OR 0.73; 95% CI: 0.53–0.99) and were associated with significantly lower bleeding (OR 0.51; 95% CI: 0.39–0.67) and mortality (OR 0.70; 95% CI: 0.52–0.94), confirmed in a sensitivity analysis. LMWH was associated with significantly reduced odds of thromboembolic events (OR 0.26; 95% CI: 0.13–0.55), as well as showing a favorable bleeding profile (OR 0.46; 95% CI: 0.25–0.87), yet no significant difference in mortality (OR 0.80; 95% CI: 0.30–2.14). While no anticoagulation reduced the odds for bleeding (OR 0.17; 95% CI: 0.07–0.38) and NM showed no significant differences, both had wide confidence intervals, limiting interpretation. Heterogeneity for LMWH was low for efficacy and bleeding, yet substantial for mortality; for DTI, low to moderate; for no anticoagulation, low; and for NM, substantial to high on all comparisons.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 ","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":"50 8","pages":"1103-1117"},"PeriodicalIF":2.2,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aor.70162","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147969780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Right Ventricular Failure in Animal Models: Evidence, Limitations, and Future Directions.","authors":"Paolo Manca, Vincenzo Nuzzi, Antonella Peccianti, Lisa Prahl Wittberg, Maximilian Valentin Malfertheiner, Lars Mikael Broman, Mirko Belliato, Johannes Heinze, Lorenzo Grazioli, Matthias Raes, Matteo Di Nardo, Dirk W Donker, Leen Vercaemst, Jutta Arens, Calogera Pisano, Giuseppe Maria Raffa, Manlio Cipriani, Roberto Lorusso","doi":"10.1111/aor.70212","DOIUrl":"https://doi.org/10.1111/aor.70212","url":null,"abstract":"<p><p>Acute right ventricular failure (ARVF) is a life-threatening condition commonly encountered in the intensive care unit. The treatment of ARVF profoundly changed in the last years, with a growing number of mechanical circulatory support (MCS) devices that have been deployed in clinical practice to support patients with severe forms of ARVF. However, comparative clinical data addressing the superiority of the different MCS strategies are lacking. Several animal models addressing ARVF have been proposed in the literature, and they have been crucial to increase the knowledge on right ventricular (RV) pathophysiology and response to different stressors. Nevertheless, models that reliably mimic acute RV severe failure, ventricular-pulmonary artery uncoupling, and cardiogenic shock are comparatively scarce. Furthermore, only a limited number of experimental studies have incorporated MCS devices in this setting, and direct head-to-head comparisons between different support strategies are largely lacking. This gap in preclinical experiences significantly limits the development of evidence-based algorithms for right-sided MCS deployment. In this review, we summarize currently available animal models of ARVF, critically highlighting their methodological strengths and limitations, and examining the evidence supporting the use of MCS within these frameworks. By highlighting the translational limitations of the existing preclinical experiences, we underscore the urgent need for standardized, reproducible, and clinically relevant ARVF models. Such efforts are essential to improve the current treatment of ARVF, and they could be particularly relevant in developing and optimizing MCS devices and their selection, ultimately enhancing outcomes in patients with ARVF.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683161","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":"Efficacy of Antimicrobial Silver-Plated Dressings Compared to Usual Care in Preventing Left Ventricular Assist Device Driveline Infections.","authors":"Barbara Veiter, Martina Socha, Christiane Marko, Nesibe Seyda Colak, Alexandra Kuhn, Hebe Al Asadi, Julia Riebandt, Roxana Moayedifar, Daniel Zimpfer, Thomas Schlöglhofer","doi":"10.1111/aor.70214","DOIUrl":"https://doi.org/10.1111/aor.70214","url":null,"abstract":"<p><strong>Background: </strong>Left ventricular assist device (LVAD) driveline infections (DLIs) represent one of the most common adverse events in LVAD patients. This study investigates the effectiveness of a silver-plated antimicrobial dressing (Silverlon, Bravida Medical) in addition to usual driveline wound care for DLI-prevention. The primary outcome was six-months freedom from DLI. Secondary outcomes included independent risk factors for DLI, freedom from DLI-related hospital readmission, freedom from negative pressure wound therapy (NPWT) and temporal changes in DESTINE wound staging.</p><p><strong>Methods: </strong>This single center cohort study included 61 patients implanted with a HeartMate 3 LVAD between 2022 and 2025 (8.2% female; median age 61 (55; 67 IQR) years; BMI 27.2 (±4.42 STD) kg/m²). Starting with the first follow-up visit (FFUV) after hospital discharge, 39 patients received usual wound care, while 22 patients additionally received Silverlon.</p><p><strong>Results: </strong>The Silverlon group demonstrated a significantly greater freedom from DLI (100% vs. 71.8%; p = 0.017). No independent predictors of DLI were identified due to the complete absence of DLIs in the Silverlon group (0 vs. 11 events); multivariable Cox regression effect could not be mathematically estimated. The Silverlon group showed 100% freedom from DLI-related readmission and NPWT therapy (vs. 97.4%; p = 0.45). DESTINE stages 0-1 predominated within the Silverlon group; severe stages (3, 4) occurred exclusively within the usual care group (p > 0.22).</p><p><strong>Conclusion: </strong>Given the substantial burden of DLI, integrating silver-plated wound dressings into standard LVAD wound care appears to be a safe and effective strategy, associated with enhanced wound healing and a reduction in DLI incidence.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676731","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":"Determinants of Baseline Membrane Lung Resistance in Extracorporeal Membrane Oxygenation.","authors":"Giancarlo Sabetta, Xiaoyue Zhang, Jie Yang, Saleem Zaidi, Jonathon Schwartz","doi":"10.1111/aor.70210","DOIUrl":"https://doi.org/10.1111/aor.70210","url":null,"abstract":"<p><strong>Background: </strong>Membrane lung (ML) resistance is commonly monitored during extracorporeal membrane oxygenation (ECMO) to forewarn of circuit obstruction, but differences in device design and patient hemorheological factors may complicate interpretation. We sought to determine whether a stable baseline resistance exists shortly after ECMO initiation and to identify factors associated with baseline variability.</p><p><strong>Methods: </strong>We conducted a single-center retrospective cohort study of adult patients receiving veno-arterial or veno-venous ECMO between 2011 and 2023. Baseline resistance was calculated as the mean inlet-outlet pressure difference normalized to flow during the first 2 and 3 h after initiation. Descriptive statistics and linear regression evaluated associations between patient and device characteristics and baseline resistance.</p><p><strong>Results: </strong>Among 170 patients, 33 (19.4%) used the Sorin EOS ML and 135 (79.4%) used the Quadrox-i Small Adult ML, and 2 (1.2%) used other ML models that were excluded from model-specific analysis. Resistance stabilized within 2-3 h post-initiation. Baseline resistance varied by ML model: median 31.7 mmHg·min/L for Sorin versus 5.5 mmHg·min/L for Quadrox (p < 0.0001). Each 1 unit increase in hematocrit increased baseline resistance by 0.54 (95% CI: 0.13 to 0.95) for Sorin, and by 0.05 (95% CI: 0.02 to 0.09) for Quadrox. Female sex was associated with lower resistance compared to male sex (Sorin: -6.92 mmHg·min/L, 95% CI -11.28 to -2.56; Quadrox: -0.63 mmHg·min/L, 95% CI -1.06 to -0.20). Additional associations varied by device model.</p><p><strong>Conclusions: </strong>Baseline ML resistance reflects device design and patient hemorheology. Early resistance provides a stable baseline reference, though patient hemorheology may confound resistance deviations attributed to true ML obstruction. Device-specific and physiologically adjusted interpretation may personalize detection of ML obstruction.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618276","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":"Initiation of Neurohormonal Blockade and Clinical Outcomes in HeartMate 3 LVAD Recipients During Index Implantation","authors":"Flavia Tejada Frisancho,&nbsp;Richa Gupta,&nbsp;Zhi Li,&nbsp;Liza Shaban,&nbsp;Ajay Kadakkal,&nbsp;Miguel Pinilla-Vera,&nbsp;Michael Hockstein,&nbsp;Ezequiel J. Molina,&nbsp;Keki Balsara,&nbsp;Farooq H. Sheikh,&nbsp;Phillip H. Lam","doi":"10.1111/aor.70140","DOIUrl":"10.1111/aor.70140","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The use of neurohormonal blockade (NB), including beta-blockers, mineralocorticoid receptor antagonists, and renin angiotensin system inhibitors, in patients after left ventricular assist device (LVAD) implantation is associated with improved clinical outcomes. However, its use during and soon after index LVAD implant discharge, a period of potential hemodynamic and laboratory vulnerability, and impact on outcomes in HeartMate 3 (HM3) recipients remain undefined and is the aim of the current study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A single-center retrospective analysis was performed of patients undergoing HM3 LVAD implantation and discharged from index implant from January 2015 to December 2021. To align with contemporary management, we included sodium-glucose cotransporter 2 inhibitors in the NB cohort. Patients on and not on any NB after index discharge were compared. Cox proportional hazards modeling was performed to investigate the association between the presence of NB with survival and heart failure (HF) readmission.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 273 patients underwent HM3 LVAD implantation during the study period. The average implant age was 58 years, 75% were men, and 78% were Black patients. Of the 273 patients, 138 (50%) had a prescription of at least one NB agent after index discharge. Predictors of NB use included a history of stroke, perioperative renal replacement therapy, and index discharge creatinine level. An index discharge prescription for NB was associated with a lower risk of all-cause mortality at a median follow-up of 3.8 years (age-sex-race adjusted HR 0.63; 95% CI, 0.41–0.98; <i>p</i> = 0.042). The association was attenuated with additional adjustment for the predictors (HR 0.68; 95% CI, 0.43–1.08; <i>p</i> = 0.100). A discharge prescription for NB was not associated with HF readmission.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While early initiation of NB therapy in HM3 LVAD recipients was associated with a lower risk of mortality, its clinical impact was attenuated after accounting for baseline and perioperative factors. These findings suggest that NB prescription may reflect underlying clinical stability and accordingly, results should be considered hypothesis-generating and warrant prospective evaluation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":"50 7","pages":"1052-1059"},"PeriodicalIF":2.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760991","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":"Incidence and Management of Access Site Infection Following Trans-Axillary Implant of a Microaxial Left Ventricular Assist Device","authors":"Junichi Shimamura,&nbsp;Nolberto Jaramillo,&nbsp;Gabrielle Amar,&nbsp;Igor Laskowski,&nbsp;Sateesh Babu,&nbsp;Romeo Mateo,&nbsp;Arun Goyal,&nbsp;Steven Lansman,&nbsp;Avi Levine,&nbsp;Abhay Dhand,&nbsp;David Spielvogel,&nbsp;Suguru Ohira","doi":"10.1111/aor.70146","DOIUrl":"10.1111/aor.70146","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Impella 5.5 is microaxial left ventricular assist device (LVAD) implanted most commonly into the axillary artery (AxA). This study aims to investigate the incidence and management of vascular graft infection (VGI) following circulatory support with the Impella 5.5.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a single-center retrospective analysis of 92 patients who were supported by Impella 5.5 between June 2020 and August 2024. Since November 2023, Dacron graft has been tunneled through the pectoralis major muscle via a separate incision in patients expected to require prolonged support. The graft was trimmed and buried beneath the pectoralis major muscle during explant. Support period was classified as short (≤ 14 days, Group SS) or extended (&gt; 14 days, Group ES).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 92 patients, 26 (28.3%) died while on support, Impella was explanted in 66 patients (71.7%): Bridge-to-recovery in 36 (39.1%), bridge-to-durable LVAD in 8 (8.7%), and bridge-to-transplant in 22 (23.4%) including 5 heart and kidney transplant (HKT). Median support duration was 7 [5, 8] days in Group SS (<i>N</i> = 54) and 27.5 [18, 38] days in Group ES (<i>N</i> = 38). No infections were reported in Group SS. Four patients in Group ES who underwent HKT experienced VGI following 39, 47, 51, and 85 days of support. Two patients with tunneled grafts required patch repair of AxA, while the remaining two patients with non-tunneled grafts required extensive extra-anatomical bypass.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Approximately 10% of patients requiring extended support developed VGI. Heart transplant recipients with a high risk of infection such as extended support or HKT will benefit from a comprehensive approach for early diagnosis and therapeutic intervention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":"50 7","pages":"1067-1076"},"PeriodicalIF":2.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147721421","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":"A Novel Chitosan-Modified PLA Doped n-HA Bone Scaffold","authors":"Jie Zhang,&nbsp;Yudi Chu,&nbsp;Ying Zhang,&nbsp;Da Zhang,&nbsp;Chengyang Shi,&nbsp;Wei Zhao,&nbsp;Mingzhong Wu","doi":"10.1111/aor.70160","DOIUrl":"10.1111/aor.70160","url":null,"abstract":"<div>\u0000 \u0000 <p>Based on the principles of bionics, the hydrophilicity, bacteriostasis, and alkalinity of chitosan (CS) have been utilized to enhance the hydrophilic and antibacterial properties of a polylactic acid (PLA) bone scaffold. They also neutralize the acidity generated by its degradation. The incorporation of nano-hydroxyapatite (n-HA) effectively improves the osteogenic properties of PLA. The PLA-CS graft was first synthesized by grafting CS onto PLA using ferulic acid (FA), resulting in a CS-modified, PLA-doped n-HA (PLA-CS/n-HA) bone scaffold. The prepared PLA-CS/n-HA bone scaffold facilitated the formation of new bone and tissue attachment. More importantly, the acidity from PLA degradation in the PLA-CS/n-HA scaffold was alleviated to a certain extent. Its hydrophilicity and compressive strength were enhanced compared to the PLA bone scaffold, and its antibacterial activity was stronger against <i>Staphylococcus aureus</i> than against <i>Escherichia coli</i>. After a 12 h co-culture with the PLA-CS/n-HA bone scaffold, the relative adhesion rate of MC3T3-E1 cells was 118.95%. After 14 days of inducing MC3T3-E1 cells on the PLA-CS/n-HA bone scaffold, the MC3T3-E1 cells exhibited preliminary differentiation and alkaline phosphatase activity reached 1.23. The PLA-CS/n-HA bone scaffold received a cytotoxicity grade of class 0, indicating no cytotoxicity.</p>\u0000 </div>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":"50 7","pages":"971-987"},"PeriodicalIF":2.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147939953","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":"An In Vitro System for Studying Toxin Transport Across Hemodialysis Membranes","authors":"M. Torrents-Yeste,&nbsp;D. Ramada,&nbsp;O. E. M. ter Beek,&nbsp;F. Pel,&nbsp;J. de Vries,&nbsp;B. H. Lentferink,&nbsp;K. G. F. Gerritsen,&nbsp;D. Stamatialis","doi":"10.1111/aor.70139","DOIUrl":"10.1111/aor.70139","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Healthy kidneys regulate acid–base balance and electrolytes, produce hormones, and clear excess fluids and uremic toxins. Progressive kidney function loss in chronic kidney disease leads to end-stage kidney disease (ESRD), where fluid and toxin accumulation causes severe complications and can be fatal. ESRD requires renal replacement therapy; kidney transplantation is preferred; however, limited availability of donor organs makes hemodialysis (HD) the most used treatment option. In the last years, many studies had focused on development of new membranes with improved toxin removal, however, these studies implement various experimental conditions making direct comparison between membranes challenging. Here, we develop an in vitro system for evaluating various membranes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed toxin transport studies using commercially available hollow fiber membranes (FX1000, Fresenius) as well as newly developed mixed matrix membrane (MMM) hollow fibers, both assembled in a mini dialyzer. Creatinine (Cr), hippuric acid (HA) and indoxyl sulfate (IS) were used as model uremic toxins and their removal by the membranes from human plasma and full human blood under a range of experimental conditions was studied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We mainly implemented dialysate recirculation, which allowed for monitoring of the mass balance of toxins inside the mini dialyzer and for obtaining better understanding about the membrane fouling and concentration polarization phenomena. Dialysance normalized by membrane effective area was used as a key parameter for assessing the performance of the membranes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings are in good agreement to various literature studies for small and larger scale dialyzers suggesting that the proposed in vitro system can be used for comparison of membranes for HD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":"50 7","pages":"988-1006"},"PeriodicalIF":2.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aor.70139","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pushing the Limit for Marginal Grafts in the Era of Machine Perfusion: A Tale of HOPE From a Leading Italian Institution","authors":"Gerti Dajti,&nbsp;Giuliana Germinario,&nbsp;Enrico Prosperi,&nbsp;Guido Fallani,&nbsp;Chiara Bonatti,&nbsp;Edoardo Prosperi,&nbsp;Antonio Siniscalchi,&nbsp;Maria Cristina Morelli,&nbsp;Antonietta D’ Errico,&nbsp;Matteo Serenari,&nbsp;Massimo Del Gaudio,&nbsp;Chiara Zanfi,&nbsp;Federica Odaldi,&nbsp;Lorenzo Maroni,&nbsp;Andrea Laurenzi,&nbsp;Matteo Cescon,&nbsp;Matteo Ravaioli","doi":"10.1111/aor.70137","DOIUrl":"10.1111/aor.70137","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The advent of machine perfusion (MP) has significantly improved post-liver transplantation (post-LT) outcomes, potentially enabling the use of increasingly marginal grafts and expanding the organ donor pool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We present a retrospective cohort study of consecutive adult patients who underwent LT between 2018 and 2023 at a leading Italian institution. The objective was to evaluate outcomes following the use of hypothermic oxygenated perfusion (HOPE) in high-risk grafts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 507 patients were included in the final analysis, of whom 420 (83%) received extended criteria donor (ECD) grafts. Among ECD grafts, 62 (15%) were from donation after circulatory death (DCD) donors, and 64 (15%) were previously discarded by other centers. HOPE was applied in 248 (49%) cases. Recipients in the HOPE group experienced significantly lower rates of early allograft dysfunction (EAD) (20% vs. 32%, <i>p</i> = 0.007), primary nonfunction (2% vs. 7%, <i>p</i> = 0.017), and severe postoperative complications (Clavien–Dindo grade ≥ 3b) (19% vs. 28%, <i>p</i> = 0.026). Notably, marginal grafts treated with HOPE achieved survival outcomes comparable to those of standard risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>HOPE is associated with improved outcomes in LT using ECD grafts and can enable the safe use of higher-risk organs with acceptable results when performed in experienced centers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":"50 7","pages":"1027-1036"},"PeriodicalIF":2.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aor.70137","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}