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Purpose: Musculoskeletal strength can be impaired in pediatric solid organ transplant recipients. Exercise training programs can be beneficial but in-person delivery can be challenging; virtual exercise programs can alleviate some of these challenges. This feasibility study aimed to deliver an 8-week virtual exercise program in pediatric solid organ transplant recipients. Method: Program delivery occurred 3 times per week for 30 minutes. An exercise stress test was completed prior to program start. The Bruininks-Oseretsky Test of Motor Proficiency strength subtest and self-report surveys were used to assess musculoskeletal strength, quality of life, fatigue, and physical activity. Contact was maintained through a text messaging platform. Z scores were calculated using standardized normative data. Medians (interquartile range) are reported for all other data. Results: Eleven participants completed the program (2 liver, 5 kidney, 4 heart; 58% females; median age = 11.5 [10.3–13.8] y). Six participants attended ≥60% of classes, 5 participants attended <50% of classes. After 8 weeks, strength scores improved (Z score, Pre: −1.0 [−1.65 to −0.60] to Post: −0.2 [−1.30 to 0.40]; P =.007) with no change in other outcome measures. Conclusion: The virtual exercise program was delivered without technical issues and received positive participant feedback. Engagement and costs need to be considered. [ABSTRACT FROM AUTHOR]

Dental implants are commonly used to replace missing single teeth. However, esthetic rehabilitation of an adjacent tooth may also be required due to diastemas, crowding, or existing large direct restorations to improve the final esthetic outcome. With the advancements in ceramics and bonding techniques, minimally invasive esthetic approaches have become viable for compromised spacing issues. This case report describes a dental technique for the esthetic rehabilitation of compromised anterior spacing with a customized zirconia implant abutment at a maxillary central incisor site and a partial ceramic veneer bonded to the adjacent central incisor. [ABSTRACT FROM AUTHOR]

The aim of this report is to describe a new sling suturing method with papillary anchorage that is clinically applicable within the available conventional root-coverage tunneling procedures. Although caution is advised to not increase excessive tension on the fragile papilla tips, as they provide coronal and palatal suspension, the tension used with this method ascertains a firm and stable connection for the entire buccogingival graft complex into the horizontal and vertical dimensions of both single and multiple recession defects. This technical note describes the "trapezoidal sling suture" technique, which allows fixation and stabilization for the graft and flap around both natural teeth and implants. [ABSTRACT FROM AUTHOR]

Multiple adjacent gingival recessions (MAGRs) are commonly treated with autogenous grafts. However, several intra- and postsurgical complications have been described following autogenous grafts, leading clinicians to explore the use of different biomaterials to treat these conditions. The aim of the present study was to evaluate the root coverage outcomes of a novel porcine-derived acellular dermal matrix (PADM) in combination with the tunneled coronally advanced flap (TCAF) for the treatment of MAGRs. Ten patients with 33 type 1 recession defects (RT1s) were treated with PADM + TCAF. The outcomes of interest included the mean root coverage (mRC), the frequency of complete root coverage (CRC), changes in keratinized tissue width, volumetric gain at the treated sites (assessed with digital intraoral scanning), and patient-reported outcome measures. All treated sites healed uneventfully, and no complications were noted throughout the study. At 6 months, a statistically significant reduction in recession was noted at the treated sites, exhibiting an overall mRC of 89.14% ± 19.15% and a CRC of 72.7%. The average volume gain after 6 months was 26.28 ± 11.71 mm3, and the mean distance between the surface/mean thickness of the reconstructed volume (DD) was 0.63 ± 0.28 mm. The region-specific volumetric analysis revealed an overall higher linear dimensional gain at the midroot aspect (range: 0.72 to 0.78 mm, assessed 1 to 4 mm apical to the cementoenamel junction) compared to the other regions. The present study presents the clinical and volumetric outcomes of PADM + TCAF for the treatment of MAGRs. A significant amount of volumetric gain was also observed at 6 months as a result of the treatment, along with satisfactory esthetic and patient-reported outcomes. [ABSTRACT FROM AUTHOR]

Objectives: This study compared the effects of leukocyte platelet-rich fibrin (L-PRF) and advanced platelet-rich fibrin (A-PRF) on patients' quality of life and the healing of palatal wounds after free gingival graft harvesting. Method and materials: After free gingival graft harvesting, palatal donor sites of 36 patients were assigned to one of three groups: L-PRF group, A-PRF group, or palatal stent + periodontal pack group (control group). Wound healing was evaluated by H2O2 test. Pain was evaluated by visual analog scale and number of analgesics consumed. For patient quality of life, the Oral Health Impact Profile-14 (OHIP-14) questionnaire was utilized. Results: Complete epithelialization was higher in the control group on day 7 than in the test groups (P < .05). Complete epithelialization was achieved in all groups 14 days postoperatively. Visual analog scale scores for pain and the number of analgesic tablets consumed were similar in all groups (P > .05). OHIP-14 total scores were similar in all study groups at 7 days postoperatively (P > .05). OHIP-14 total and physical pain score was lower in the L-PRF group than the A-PRF group at 14 days postoperatively (P < .05). Conclusion: Aside from the slight superiority of L-PRF over A-PRF, it can be concluded that both PRF procedures have similar effects on palatal wound healing and quality of life. [ABSTRACT FROM AUTHOR]

Peripheral giant cell granulomas (PGCGs) are benign oral cavity tumors, reactive in nature, caused by local trauma or irritation. A 51-year-old woman presented with a soft tissue lesion related to an implant at site 36 (FDI numbering system). An excisional biopsy was completed, and the soft tissue mass was diagnosed as a PGCG. The biopsy led to a lack of keratinized tissue and vestibular depth around the implant site. After the initial healing phase, a free gingival graft was completed. Then, following soft tissue maturation, the cement-retained implant-supported prosthesis was converted into a screwretained implant-supported prosthesis that was easily accessible. With a combined periodontal and restorative approach, the KT increased, adequate vestibular depth was achieved, and there was no recurrence of the PGCG. [ABSTRACT FROM AUTHOR]

The anterior mandible is the most challenging anatomical site for performing periodontal plastic surgeries. Increased demands for optimal root coverage and esthetic outcomes contribute to the development of pedicle flap-based surgical solutions, in contrast to the predominantly used free gingival graft. The aims of this study were to (1) summarize the current literature to identify the most-used techniques, indications, and their efficacy, and (2) provide a decision table for surgeons to navigate through the selection of appropriate techniques. Four main approaches were identified: free gingival graft, lateral sliding, tunneling, and coronally advanced flap. The flap approaches are mostly combined with a connective tissue graft. The decision table considers the patient's chief complaint, local anatomical factors, and technique sensitivity. The table provides a framework for supporting an evidence-based selection of surgical techniques and for studying novel methods to achieve predictable root coverage in the anterior mandible. [ABSTRACT FROM AUTHOR]

Objective: Mucogingival surgery involving tissue grafts is commonly employed for cosmetic procedures like root coverage, and is increasingly applied in implant therapy to modulate peri-implant soft tissues and enhance implant survival. These procedures involve harvesting autologous connective or epithelial connective tissue, often from the palate or tuber maxillae. However, this can cause patient morbidity due to postoperative pain. Substitute materials, including animal-derived and xenografts, have been developed but lack qualities of autologous grafts. Method and materials: To address postoperative discomfort, a novel technique, named "palatal shield," using composite resin stabilized on adjacent teeth's palatal surface is proposed as an aid to donor site healing after mucogingival procedures. Two cases are reported where this technique was successfully applied. The first case involves a 53-year-old woman undergoing free gingival graft surgery for peri-implant treatment. The second case features a 58-year-old man receiving subepithelial connective tissue graft surgery for root sensitivity. Results: Ten days post surgery, both patients reported excellent postoperative comfort. The technique's effectiveness is highlighted in these cases, demonstrating its applicability in various surgical cases involving free gingival graft or connective tissue graft harvesting. Conclusion: The proposed "palatal shield" technique offers several advantages, including enhanced patient comfort, ease of application, and cost-effectiveness, making it a promising addition to mucogingival surgical procedures. [ABSTRACT FROM AUTHOR]

This randomized controlled trial aimed to determine the clinical efficacy of xenogeneic collagen membrane (XCM) derived from porcine peritoneum in combination with a coronally advanced flap (CAF) in the management of gingival recession defects and to compare the outcomes to those of connective tissue grafts (CTGs). A total of 12 systemically healthy individuals presenting with 30 isolated/multiple Cairo RT 1/2 gingival recession defects in maxillary canines and premolars were randomly treated either with CAF + XCM or CAF + CTG. Recession height (RH), gingival biotype (GB), gingival thickness (GT), width of keratinized gingiva (WKG), and width of attached gingiva (WAG) were recorded at baseline and at 3, 6, and 12 months. Patient perceptions of pain and esthetics and the modified root coverage esthetic score (MRES) were also documented. From baseline to 12 months, both groups showed a significant reduction in mean RH (CAF + CTG: 2.73 ± 0.79 mm to 0.33 ± 0.61 mm; CAF + XCM: 2.73 ± 0.88 mm to 1.20 ± 0.77 mm). At 12 months, CAF + CTG sites had a mean root coverage percentage (MRC%) of 85.60% ± 28.74%, whereas CAF + XCM sites had an MRC% of 55.13% ± 31.22%. CAF + CTG-treated sites had significantly better outcomes, with a greater number of sites achieving complete root coverage (n = 11) and higher MRES scores than the porcine peritoneal membrane group (P < .05). [ABSTRACT FROM AUTHOR]

The biggest challenge during periodontal regeneration in the anterior region is the prevention of soft tissue recession. Minimally invasive surgeries, particularly papilla preservation techniques and soft tissue augmentation, may significantly reduce such postoperative soft tissue recession. This article presents the vestibular incision subperiosteal tunnel access (VISTA) approach for periodontal regeneration in the anterior region. A subperiosteal tunnel prepared from a single vertical vestibular incision adjacent to the defect is used for debridement, application of enamel matrix derivative, defect grafting with corticocancellous tuberosity bone, and insertion of the connective tissue graft. Evaluation of six cases with up to 6 years of follow-up showed improvements in all clinical parameters. The probing pocket depth improved from 8.2 ± 0.75 mm initially to 2.7 ± 0.52 mm at follow-up, clinical attachment level improved from 8.5 ± 0.83 mm initially to 2.7 ± 0.52 mm at follow-up, and midfacial gingival recession of 1 mm at two sites was corrected. The papillae were stable at all sites, with an average distance of 4.8 mm from the incisal edge to the papilla tip. This technique seems to be a promising approach for achieving both esthetic and functional goals of periodontal regenerative surgery. However, experience in performing microsurgeries and harvesting tuberosity tissues may be a limitation. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion Adenovirus (ADV) infection can lead to significant morbidity and mortality in immunocompromised patients, particularly in those with hematopoietic stem cells or solid organ transplants. The incidence of ADV infection in kidney transplant (KT) is not well‐defined as ADV is often asymptomatic and not routinely checked.This retrospective case‐series study included KT and simultaneous pancreas‐KT (SPKT) recipients from January 1, 2008, to January 31, 2024, across three Mayo Clinic sites (Arizona, Florida, and Minnesota) with symptomatic adenovirus polymerase chain reaction cases. The primary outcomes were allograft function at various intervals post‐ADV infection, allograft, and patient survival.We report one of the largest multi‐site case series regarding outcomes of ADV in KT with 17 patients. The median time to ADV infection was 30 weeks (5–74). Five patients (29%) developed disseminated infection. Nine patients (53%) of the entire cohort experienced graft loss within a median of 35 (4–168) weeks, with four (44%) of graft loss attributed to ADV. Nine patients (53%) developed rejections post‐ADV infection with a median of 4 (2–8) weeks after resolution. One patient died from acute hypoxic respiratory failure from ADV infection.ADV should be considered in KT/SPKT patients with renal dysfunction, hematuria, and with or without fever. Despite the low mortality rate, there is a significant risk of graft loss and rejection after ADV infection. It is crucial to screen for ADV and develop intervention strategies for treatment. Further multicenter studies are needed to better define, stage, and manage ADV infection. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusions Outcomes after bebtelovimab treatment for COVID‐19 were favorable for most but not all solid organ transplant recipients (SOTRs) during the era of Omicron BA.2 to BA.5, but effects of timing of bebtelovimab administration on these outcomes are unknown. We sought to compare outcomes of SOTR who received early bebtelovimab (“EBT”, given ≤ 2 days from diagnosis) versus late bebtelovimab (“LBT”, given between Days 3 and 7), versus no bebtelovimab (NBT).This was a retrospective cohort study of SOTRs with mild‐to‐moderate COVID‐19, with endpoint of 30‐day COVID‐19‐related hospitalization. Multivariable logistic regression was performed to determine variables associated with receiving EBT, and to assess impact of EBT on hospitalization. A propensity score (PS) was calculated for EBT versus NBT.Of 297 SOTRs, 162 (58.1%) received EBT, 46 (16.5%) LBT, and 71 (25.4%) NBT. Early bebtelovimab treatment was associated with a lower risk of 30‐day COVID‐19‐related hospitalization compared to NBT (OR, 0.112 [95% CI, 0.018–0.686]; p = 0.018). There was no significant difference in hospitalization risk between LBT and NBT, suggesting that delayed administration may not confer additional benefits over no treatment.Early bebtelovimab treatment in outpatient SOTRs was associated with a lower risk of hospitalization compared to no treatment, while late administration did not show a significant advantage over no treatment. Although bebtelovimab is no longer authorized, these findings suggest that the timing of COVID therapies for SOTRs may be important to optimize outcomes. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa (HS) is a chronic inflammatory disease that affects intertriginous skin areas, clinically characterized by recurrent inflamed nodules, abscesses, sinus tracts, and severe scars. Systemic treatments may provide temporary relief, while wide surgical excision offers prolonged disease‐free periods. We evaluated the most efficient wound closure methods following wide excision of HS lesions in terms of recurrence, functionality, and quality of life. A systematic literature search was conducted in PubMed, Embase, Cochrane, and ClinicalTrials.gov, adhering to the PRISMA 2020 criteria. We included original studies published until February 2024, focusing on wound closure methods post‐wide excision for HS. Data from 121 papers were analyzed using network and direct meta‐analysis methods to compare recurrence and postoperative complication rates. From 1181 articles, 121 were included in the meta‐analysis after removing duplicates and excluding publications that did not meet the inclusion criteria. Recurrence rates were associated with the type of reconstruction technique as follows: primary closure, 25% (95% confidence interval [CI], 20–30%); skin grafts, 18% (95% CI, 14–22%), and flaps, 12% (95% CI, 9–15%). Secondary intention healing showed a recurrence rate of 28% (95% CI, 23–33%). Flaps were associated with the lowest recurrence rates compared to other surgery techniques. [ABSTRACT FROM AUTHOR]

The main purpose of our research highlights a lack of awareness about donor laws, inadequate implementation, and critical challenges that require legal reform, enhanced support for donors, and better training for healthcare professionals. The legislative framework for organ transplantation varies widely across Asian countries, reflecting differences in cultural, ethical, and legal perspectives. Organ transplantation involves transferring organs, tissues, or cells from donors to recipients, with a significant global demand surpassing the available supply. Biomedical ethics, as outlined by Beauchamp and Childress, and further examined by Veatch and Harris, provide a framework for addressing the moral dilemmas associated with transplantation. In Mongolia, the organ transplantation framework is guided by international standards, though there are gaps in legislation, social welfare, and insurance coverage, which impact the effectiveness of the transplant system. [ABSTRACT FROM AUTHOR]

Purpose: This study compares the efficacy of two different ranges of parathyroid transplantation weights with the aim of determining a preferable range for transplantation weight. Methods: From May 2018 to June 2023, 79 patients underwent total parathyroidectomy with autotransplantation. Demographic data, symptoms, and pre- or postoperative biochemical indicators were compared between two different ranges of parathyroid transplantation weights. Results: All 79 surgeries were successful, with a total of 316 parathyroid glands reported among the patients. The patients were diagnosed with parathyroid hyperplasia. Postoperatively, itching, bone pain, and muscle weakness disappeared, while serum parathyroid hormone and phosphate levels significantly decreased. With an average follow-up of 12 months, no transplant-dependent recurrence was observed. Conclusion: Parathyroid transplantation with a weight of 30–50 mg is a feasible, safe, and effective surgical approach. [ABSTRACT FROM AUTHOR]

De novo or viral reactivation cancers are a major cause of morbidity and mortality in the solid organ transplant (SOT) population. Primary sclerosing cholangitis (PSC) is an aggressive disease which can lead to cholestatic liver damage and cirrhosis. PSC often cooccurs with inflammatory bowel disease (IBD). Here, we describe the case of a 28‐year‐old male with PSC along with poorly controlled IBD who underwent a liver transplant and developed colonic Kaposi sarcoma (KS). Our case highlights the importance of adequate pretransplant screening for endemic viruses, high clinical suspicion for KS in the setting of difficult‐to‐control colitis, and early multidisciplinary involvement. [ABSTRACT FROM AUTHOR]

Background: Pancreatic transplantation is the only definitive surgical treatment for diabetes mellitus. Currently, most transplant centers use enteric exocrine drainage of pancreatic secretions; however, experts disagree on which part of the gastrointestinal tract is preferable for enteric anastomosis. We analyzed the outcomes of retroperitoneal pancreatic transplantation with enteric drainage of pancreatic secretions. Materials and methods: We evaluated the outcomes of 60 simultaneous retroperitoneal pancreas-kidney transplantations. Based on the type of enteric anastomosis, the patients were divided into two groups: the study group consisted of 10 patients who underwent enteric drainage via Roux-en-Y duodenojejunostomy, and the control group included 50 patients who underwent exocrine drainage via duodenoduodenal anastomosis. No statistically significant differences were observed between the groups in terms of the main parameters. Results: The rate of surgical complications did not differ significantly between the groups (p > 0.05). Clavien IVb complications occurred only in the control group (n = 4.8%). The in-hospital pancreatic graft survival rate in both groups was 80%, whereas the recipient survival rates were 90% and 84%, in the study and control groups, respectively (p < 0.05). Conclusion: Retroperitoneal pancreatic transplantation with exocrine drainage via a Roux-en-Y duodenojejunostomy is an effective alternative technique that reduces the rate of severe surgical complications. [ABSTRACT FROM AUTHOR]

Recent advances in machine perfusion have revolutionised the field of transplantation by prolonging preservation, permitting evaluation of viability prior to implant and rescue of discarded organs. Long-term perfusion for days-to-weeks provides time to modify these organs prior to transplantation. By using long-term normothermic machine perfusion to facilitate liver splitting and subsequent perfusion of both partial organs, possibilities even outside the clinical arena become possible. This model remains in its infancy but in the future, could allow for detailed study of liver injury and regeneration, and ex-situ treatment strategies such as defatting, genetic modulation and stem-cell therapies. Here we provide insight into this new model for research and highlight its great potential and current limitations. Long-term machine perfusion holds great promise in the field of liver transplantation, potentially allowing for extended viability checks as well as treatment of marginal discarded organs. Here, the authors discuss the advances in machine perfusion techniques for liver transplants as well as future potential clinical avenues that it will open up including potential splitting of livers. [ABSTRACT FROM AUTHOR]

Background: Many clinical variables might impact the pharmacokinetics of calcineurin inhibitors (CIs). Different alleles of cytochromes P450 (CYP)3A4/5 and drug transporter P-glycoprotein are the main variables. Other variables include relocated type, treatment duration after transplantation, age, sex, dietary consumption, medications used and renal or hepatic impairment. Tacrolimus and cyclosporine are two main CIs extensively used in organ transplantation. Both drugs are metabolized by CYP3A4 and CYP3A5 isoforms, and single-nucleotide polymorphisms in these genes have been displayed to influence CIs pharmacokinetics. Another important gene is the pregnane X receptor (PXR), which manages the statement of a variety of genes including CYP3A4 genes. PXR has a clinical significance in CIs metabolism. The liver is the essential site for CIs metabolism. A decreased clearance with a prolonged CIs half-life was occurred in patients with impaired liver compared with patients with normal liver function. The presence of different genetic and clinical factors that may affect calcineurin inhibitors trough levels will consequently affect their immunosuppressant effect after liver transplantation. Purpose: This study aims to determine the effect of different genetic polymorphisms in CYP3A4 1B rs2740574 and PXR A7635G rs6785049 and other clinical factors that may affect calcineurin inhibitors pharmacokinetics after liver transplantation. Results: The presence of T allele in CYP3A4 gene was associated with elevated DATLs with P values of 0.00, 0.00, 0.007 and 0.00 after tacrolimus doses 4, 30, 60 and 90, respectively. Regarding PXR gene, the presence of G allele was associated with elevated DATLs in cyclosporine. About 432 correlations were tested in both drugs. In CYP3A4 genotype CC, male sex was associated with elevated DATLs interpreted by strong positive correlations and statistically significant difference in all DATLs, except DATL 60 (P value 0.374). No strong association was found between low hemoglobin levels and DATLs in almost all the follow-up periods. There were many positive relations between increased total and direct bilirubin and increased DATLs. Conclusions: Studying the various genetics and clinical factors that may affect calcineurin inhibitors serum concentrations is very essential for successful treatment plans after organ transplantation. These different factors may interact with each other and these complicated interactions may complicate the patient's conditions post-transplantation. Considering all these complicated interactions is very crucial in monitoring treatment plans, especially in the presence of other comorbidities or chronic diseases. More studies with large number of patients should be conducted to explore more consequences of these interacting variables of treatment plans of these patients and all studied parameters in this study should be considered while monitoring patients after transplantation. [ABSTRACT FROM AUTHOR]

AbstractIn bone grafting surgery, autograft, allograft, xenograft, and synthetic graft are the choices of materials used to fill the voids. Because of the risk of infection cautioned during bone grafting surgery, the bone harvested from patient’s own body is widely used to fill the damaged/diseased bone-site. In this study, the voids created post harvesting the bones from iliac-crest of a 40-years-old male patient was considered in-silico. Bone harvested in different geometric patterns by window and trapdoor techniques are considered, and a series of finite element analyses was conducted to evaluate the pelvis status pre and post extraction of bone graft under a single-leg stance loading condition. The results of the study revealed that the maximum of 20 cm3 volume of cortico-cancellous bone in the form of circular pattern harvested from the iliac-crest using a trapdoor technique as the best. To validate the result, the displacements obtained post the extraction of different volumes of cortico-cancellous bone was analyzed, and found that 20 cm3 volume of cortico-cancellous bone harvested using a circular trapdoor technique was ideal choice, considering the pelvis fragility as a major concern. The outcomes of the study can be used to noninvasively predict the pelvis status before harvesting the bone. [ABSTRACT FROM AUTHOR]

Metabolic syndrome is a significant risk factor for poor graft outcomes in kidney transplant (KT) patients. However, the effects of variability in metabolic parameters on graft outcomes in KT patients have not been completely elucidated. A total of 852 KT patients were included from the Korean Organ Transplantation Registry. The study exposure was variability in body mass index (BMI) or other metabolic parameters measured at 6 months, 1 year, and 2 years after KT. Patients were classified into tertiles according to the degree of variability. The primary outcome was a composite of adverse kidney outcomes, such as death-censored graft loss or ≥ 30% decline in estimated glomerular filtration rate. The adverse kidney outcomes occurred in 73 (8.6%) participants. The high-BMI variability group had a higher risk for adverse kidney outcomes compared to the low-variability group. High variabilities in triglyceride, fasting blood glucose, and systolic blood pressure were also associated with adverse kidney outcomes. Furthermore, high variability in metabolic syndrome-related composite indices, such as the triglyceride and glucose index and metabolic variability scores, showed a higher risk for adverse kidney outcomes. In conclusion, high variability in metabolic parameters could be associated with an increased risk of adverse kidney outcome in KT patients. [ABSTRACT FROM AUTHOR]

Transplantable ready-made microvessels have therapeutic potential for tissue regeneration and cell replacement therapy. Inspired by the natural rapid angiogenic sprouting of microvessels in vivo, engineered injectable 3D microvessel networks are created using thermoplastic elastomer (TPE) microfluidic devices. The TPE material used here is flexible, optically transparent, and can be robustly yet reversibly bonded to a variety of plastic substrates, making it a versatile choice for microfluidic device fabrication because it overcomes the weak self-adhesion properties and limited manufacturing options of poly(dimethylsiloxane) (PDMS). By leveraging the reversible bonding characteristics of TPE material templates, we present their utility as an organ-on-a-chip platform for forming and handling microvessel networks, and demonstrate their potential for animal-free tissue generation and transplantation in clinical applications. We first show that TPE-based devices have nearly 6-fold higher bonding strength during the cell culture step compared to PDMS-based devices while simultaneously maintaining a full reversible bond to (PS) culture plates, which are widely used for biological cell studies. We also demonstrate the successful generation of perfusable and interconnected 3D microvessel networks using TPE–PS microfluidic devices on both single and multi-vessel loading platforms. Importantly, after removing the TPE slab, microvessel networks remain intact on the PS substrate without any structural damage and can be effectively harvested following gel digestion. The TPE-based organ-on-a-chip platform offers substantial advantages by facilitating the harvesting procedure and maintaining the integrity of microfluidic-engineered microvessels for transplant. To the best of our knowledge, our TPE-based reversible bonding approach marks the first confirmation of successful retrieval of organ-specific vessel segments from the reversibly-bonded TPE microfluidic platform. We anticipate that the method will find applications in organ-on-a-chip and microphysiological system research, particularly in tissue analysis and vessel engraftment, where flexible and reversible bonding can be utilized. [ABSTRACT FROM AUTHOR]

Short-term preoperative methionine restriction (MetR) is a promising translatable strategy to mitigate surgical injury response. However, its application to improve post-interventional vascular remodeling remains underexplored. Here we find that MetR protects from arterial intimal hyperplasia in a focal stenosis model and pathologic vascular remodeling following vein graft surgery in male mice. RNA sequencing reveals that MetR enhances browning in arterial (thoracic aorta) perivascular adipose tissue (PVAT) and induces it in venous (caval vein) PVAT. Specifically, Ppara is highly upregulated in PVAT-adipocytes upon MetR. Furthermore, MetR dampens the postoperative pro-inflammatory response to surgery in PVAT-macrophages in vivo and in vitro. This study shows that the detrimental effects of dysfunctional PVAT on vascular remodeling can be reversed by MetR, and identifies pathways involved in MetR-induced browning of PVAT. Furthermore, we demonstrate the potential of short-term preoperative MetR as a simple intervention to ameliorate vascular remodeling after vascular surgery. Utilizing short-term dietary interventions for surgical preconditioning stands as an emerging approach to enhance surgical outcomes. Here, the authors show the potential of short-term preoperative methionine restriction as a simple intervention to ameliorate postinterventional vascular remodelling. [ABSTRACT FROM AUTHOR]

Purpose: The main aim of this study was to determine the short- and long-term outcomes of the non-operative management of acute left-sided complicated diverticulitis (ALCD) in severely immunocompromised patients (IMS group) and compare them with immunocompetent patients (IC group). The secondary aim was to assess the necessity of an elective surgery following a successful prior non-operative management in the IMS group after a non-operative management of the first episode of ALCD. Methods: Patients presented with their first episode of ALCD between 2012 and 2018 were retrospectively reviewed. Only severely immunosuppressed patients were considered for the analysis, including the following: long-term oral or intravenous steroid intake, current malignancy undergoing chemotherapy, chronic kidney disease on hemodialysis, or solid organ transplant with immunosuppressive medication. For each group, demographic data, severity of the episode, management decisions (conservative or operative), and short- and long-term outcomes were recorded and compared. A sub-analysis of patients with ALCD associating and abscess (modified Hinchey classification Ib/II) was performed. Results: A total of 290 patients were included in the study: 50 among the IMS and 240 among the IC group. The rate of emergent surgery was higher in the IMS group (50.0% vs. 22.5%, p < 0.001) and was associated with increased morbidity (72.4% vs. 50.0%, p = 0.041) and mortality (24.1% vs. 4.3%, p = 0.003). The duration of the hospital stay was significantly longer in the IMS group (15 vs. 8 days, p < 0.001). The final stoma rate was significantly higher in the IMS group (82.1% vs. 22.9, p < 0.001), with a median follow-up of 51.4 months. A total of 141 patients presented ALCD with an abscess; 25 in the IMS and 116 in the IC group. There was a higher rate of surgical intervention among the IMS group as the initial treatment approach (24.0% vs. 5.2%, p = 0.002), even though the conservative treatment had a similar rate of success (81.3% vs. 92.0%, p = 0.178). The recurrence rate following a non-operative approach was similar (IMS: 31.2% vs. 35.4% in the IC group, p = 0.169). Furthermore, 81.2% of non-operatively managed IMS patients (13 out of 16) did not require a surgical intervention at the end of the follow-up, with similar findings in the IC group (78/96, 81.2%, p = 0.148). Conclusion: Medical treatment of immunosuppressed patients during their first ALCD episode associated with an abscess is feasible, with a high success rate and results comparable with the IC group. Moreover, taking into account the readmission rates, the need for emergent surgery of the recurrence, and the perioperative mortality and morbidity in the IMS group, conservative management with no differed scheduled surgery seems to be a safe option in this subgroup of patients. [ABSTRACT FROM AUTHOR]

Liver transplantation has evolved into a mature clinical field, but scarcity of usable organs poses a unique challenge. Expanding the donor pool requires novel approaches for protecting hepatic physiology and cellular homeostasis. Here we define hepatocellular injury during transplantation, with an emphasis on modifiable cell death pathways as future therapeutics. [ABSTRACT FROM AUTHOR]

Background: Steroids are widely used in maintenance immunosuppression treatment in kidney transplant recipients. Older individuals undergo age-related immunosenescence that consequently decreases their ability to process and evoke a response to foreign antigens. Thus, steroids may not be necessary in preventing allograft rejection and may consequently increase older recipients' risk of long-term steroid-related adverse effects. Objective: The objective of this study was to analyze the adverse outcomes of long-term steroid immunosuppression in older kidney transplant recipients using real-world electronic medical record data. Methods: The TriNetX database "US Collaborative Network" was utilized to perform a propensity score-matched case-control study comparing 1-year, 3-year, and 5-year adverse effects of steroid immunosuppression in older adults (aged ≥ 65 years) kidney transplant recipients who underwent either an early-steroid withdrawal (ESW) maintenance regimen or a steroid continuous immunosuppression (SCI) regimen between 31 December, 2010 and 31 December, 2020. Early-steroid withdrawal was defined as tacrolimus plus mycophenolate mofetil maintenance with no prednisone after the seventh day post-transplant. Steroid continuous immunosuppression was defined as tacrolimus plus mycophenolate mofetil plus prednisone maintenance. Cohorts were matched on age, race/ethnicity, and risk factors for adverse steroid-related outcomes and rejection. Outcomes included post-transplant diabetes mellitus, dyslipidemia osteoporosis/fractures, myocardial infarction, glaucoma/cataract, stroke, pulmonary embolism, and malignancy. Secondary outcomes analyzed incidences of infection-related outcomes, graft-related outcomes, and recipient mortality. Results: After matching, there were 304 recipients in each group (ESW, SCI). Mean age at the time of transplant was 69.2 ± 3.7 years (ESW) and 69.2 ± 3.4 years (SCI, p = 0.96). The Kaplan–Meier analysis showed recipients who underwent SCI had increased incidences of post-transplant diabetes mellitus at 1 year (22.36% vs 30.37%, p = 0.01) and 3 years (34.89% vs 44.29%, p = 0.01), but this became non-significant at 5 years post-transplant (41.97% vs 42.6%, p = 0.34). Incidences of acute pancreatitis were higher for the SCI cohort at 3 years (p = 0.02) as well as incidences of acute myocardial infarction at 5 years post-kidney transplant (6.75% vs 14.39%, p < 0.01). No difference was found for other adverse outcomes. Early-steroid withdrawal recipients experienced significantly fewer infection-related outcomes, such as cytomegalovirus, BK virus, sepsis/bacteremia, and fungal infections, compared with SCI recipients. Last, recipients who underwent ESW experienced fewer incidences of rejection and death-censored graft failure at 5 years post-transplant. Conclusions: There is currently no standard maintenance immunosuppression protocol for older kidney transplant recipients. Death-censored graft survival, rejection, and patient survival were improved with ESW. Steroid minimization may be beneficial in this population given that it lowers the risk of drug-induced adverse effects. [ABSTRACT FROM AUTHOR]

Objectives: Transplantation is a form of treatment that requires long-term pharmacotherapy. After transplantation, patients may have difficulty adapting to medication use for various reasons, and this may result in rejection. The aim of this study is to determine participants' medication compliance and the factors affecting it. Methods: The research was conducted with a sequential explanatory mixed method. In the study, quantitative data were collected using the Turkish Immunosuppressive Medication Adherence Scale, and qualitative data were collected using the In-Depth Individual Interview Guide. Quantitative data were analyzed using statistical methods, and qualitative data were examined according to Braun and Clarke's thematic analysis framework. Results: In this study, 62.3% of the participants were male, 37.0% were 50 years old and over, 71.3% lived with their spouse, 54.0% had primary and secondary school education, and 42.0% could not work due to their current health condition. From a clinical perspective, it was determined that 78% of the transplants were kidney transplants, and 41.3% were more than 4 years after transplantation. 74.3% of the transplants were from living donors. The mean score of the immunosuppressive medication compliance scale was determined to be 40.91±4.09. In the qualitative data analysis of the study, factors affecting medication adherence were examined and the themes of "individual factors", "complexity of the regimen" and "social support resources" were obtained. The sub-themes of the individual factors theme are reluctance, hopelessness and addiction; Sub-themes of the complexity of the regimen theme are drug side effects and polypharmacy; The sub-themes of the social support resources theme are loneliness and family pressure. Conclusions: The factors influencing medication adherence among organ transplant recipients have been investigated, revealing that adherence levels vary significantly depending on various factors. These findings underscore the importance of tailored care strategies and individualized support approaches. [ABSTRACT FROM AUTHOR]

Metabolomics enables the analysis of metabolites within an organism, which offers the closest direct measurement of the physiological activity of the organism, and has advanced efforts to characterize metabolic states, identify biomarkers, and investigate metabolic pathways. A high degree of innovation in analytical techniques has promoted the application of metabolomics, especially in the study of clinical surgery. Metabolomics can be employed as a clinical testing method to maximize therapeutic outcomes, and has been applied in rapid diagnosis of diseases, timely postoperative monitoring, prognostic assessment, and personalized medicine. This review focuses on the use of mass spectrometry and nuclear magnetic resonance-based metabolomics in clinical surgery, including identifying metabolic changes before and after surgery, finding disease-associated biomarkers, and exploring the potential of personalized therapy. Challenges and opportunities of metabolomics in organ transplantation are also discussed, with a particular emphasis on metabolomics in donor organ evaluation and protection, prognostic outcome prediction, as well as postoperative adverse reaction monitoring. In the end, current limitations of metabolomics in clinical surgery and future research directions are presented. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Frailty is a good predictor of adverse outcomes among older patients, especially those who have undergone surgery. The prevalence of frailty among kidney transplant candidates is higher than the general population. This study aimed to explore the predictive value of frailty on post-transplant adverse outcomes among kidney recipients. METHODS: A systematic review was performed for relevant studies until May 20, 2022, using four databases (Embase, Medline, Cochrane, and PsycINFO) for prospective design studies (PROSPERP: CRD42022331022). Random-effect meta-analysis modeling was undertaken in RevMan 5.3 to estimate the predictive value of frailty on adverse outcomes after kidney transplant. RESULTS: This systematic review included 14 studies, eight of which were suitable for metaanalysis. Frailty increased the risk of mortality (pooled hazard ratio [HR] 1.98, 95% confidence interval [CI] 1.48-2.64), surgical complications (risk ratio [RR] 2.14, 95% CI 1.01-4.54), deathcensored graft failure (DCGF) (pooled HR 3.31, 95% CI 1.27-8.62), length of stay (LOS) (pooled RR 1.59, 95% CI 1.05-2.39), length of stay =2 weeks (pooled odds ratio [OR] 1.72, 95% CI 1.26-2.35), and other common adverse outcomes among kidney transplant recipients. CONCLUSIONS: Frailty is associated with adverse outcomes after kidney transplant. This systematic review suggests the importance of assessing frailty among kidney transplant candidates prior to transplantation. Further research focusing on pre-transplant assessment combined with frailty is warranted to improve kidney transplant management. [ABSTRACT FROM AUTHOR]

The outcome of kidneys transplanted following organ donation after euthanasia (ODE) remains unclear. This study analyzed all kidney transplantations in the Netherlands from January 2012 to December 2021, comparing the outcomes following ODE, donation after circulatory death (DCD-III), and donation after brain death (DBD). 9,208 kidney transplantations were performed: 148 ODE, 2118 DCD-III, and 1845 DBD. Initial graft function was compared between these categories. Immediate graft function, delayed graft function and primary nonfunction in ODE kidney recipients were 76%, 22%, and 2%, respectively, 47%, 50% and 3% in DCD-III kidney recipients and 73%, 25%, and 2% in DBD kidney recipients (overall p-value: p < 0.001). The number of kidneys transplanted over a median follow-up period of 4.0 years (IQR 2.0-6.6), was 1810, including 72 ODE, 958 DCD-III and 780 DBD kidneys. In this period, 213 grafts (11.8%) failed [7 grafts (9.7%) from ODE donors, 93 grafts (9.7%) from DCD-III donors, and 113 grafts (14.5%) from DBD donors]. Kidneys transplanted after euthanasia have a good immediate graft function, a comparable longitudinal 10 years eGFR, and similar graft failure hazard to kidneys from DCD-III and DBD. Kidney transplantation following ODE is a valuable and safe contribution to the donor pool. [ABSTRACT FROM AUTHOR]

Tacrolimus, a calcineurin inhibitor, is a highly effective immunosuppressant used in solid organ transplantation (SOT). However, it is characterized by a narrow therapeutic range and high inter‐patient variability in pharmacokinetics. Standard weight‐based dosing followed by empiric dose titration is suboptimal in controlling drug concentrations, increasing risk of rejection or toxicity, particularly in the initial months post transplantation. This review explores the potential of combined pre‐transplant genotyping and pharmacokinetic (PK) modelling to improve tacrolimus dosing in paediatric SOT recipients. A systematic search of Medline, Embase and Cochrane databases identified studies published between March 2013 and March 2023 that investigated genotype‐ and PK model‐informed tacrolimus dosing in children post‐SOT. The Newcastle‐Ottawa Scale assessed study quality. Seven studies encompassing paediatric kidney, heart, liver and lung transplants reported using genotype and model‐informed dosing. A combination of clinical and genetic factors significantly impacts tacrolimus clearance and thus initial dose recommendation. Body size, transplant organ and co‐medications were consistently important, while either time post‐transplant or haematocrit emerged in some studies. Several models were identified, however, with limitations evident in some and with absence of evidence for their effectiveness in optimizing initial and subsequent dosing. This review highlights the development of PK models in paediatric SOT that integrate genotype and clinical covariates to personalize early tacrolimus dosing. While promising, prospective studies are needed to validate and confirm their effectiveness in improving time to therapeutic concentrations and reducing under‐ or overexposure. This approach has the potential to optimize tacrolimus therapy in paediatric SOT, thereby improving outcomes. [ABSTRACT FROM AUTHOR]

Our hypothesis is that the peroneus longus (PL) is a great option for ligament reconstruction in the knee, and therefore the objective of the study is to determine if the use of this graft is safe and does not cause secondary damage to the harvested area. A prospective study was conducted between April 2019 and September 2022. Patients who underwent any type of knee ligament reconstruction using the PL or just the anterior half (AHPL) as grafts were followed up. These patients were evaluated according to the Tegner–Lysholm score and the International Knee Documentation Committee (IKDC) guidelines for functional evaluation of the knee and the American Orthopedic Foot and Ankle Score (AOFAS) and the Foot and Ankle Disability Index (FADI) for the functional evaluation of the ankle. Most patients had an increase in the IKDC score, Tegner–Lysholm score, AOFAS and FADI regardless of the graft used in the surgical procedure, with mean values at the 24-month follow-up of, respectively, 99.02± 0.02, 98.69± 0.08, 99.92± 0.07, and 99.92± 0.07 for those with PL grafts and 99.31± 0.54, 98.88± 0.95, 100± 0.00, and 100± 0.00 for those with AHPL grafts. The differences in the scores between the two graft groups during each of the follow-up periods were significant (P = 0.001). The use of the peroneus longus tendon as a graft in knee surgeries was shown to be adequate for achieving good knee functional results. [ABSTRACT FROM AUTHOR]

Background: Although adult transplant centers are successfully transplanting organs from hepatitis C virus (HCV)‐infected donors with detectable viral load by nucleic acid testing (NAT+) into HCV‐negative recipients, this practice has not yet been adopted widely by the pediatric heart transplant community. Methods: We present a case series of four patients who received heart transplants from HCV NAT+ donors at a pediatric transplant center, including two pediatric patients < 18 years of age. Results: All recipients tolerated a 12‐week course of glecaprevir/pibrentasvir and achieved a sustained virologic response with no HCV or liver complications with over 1 year of follow‐up (range 1.4–2.5 years). All four have had good post‐heart transplant outcomes with normal graft function and good functional status without rejection or cardiac allograft vasculopathy at time of last follow‐up. Conclusions: This case series details the successful multidisciplinary implementation of a protocol to accept cardiac allografts from HCV NAT+ donors for transplantation into HCV negative recipients at our pediatric transplant center. With the limited donor pool in pediatrics and the morbidity associated with prolonged durations on the transplant waitlist, pediatric centers should consider utilizing organs from HCV NAT+ donors to broaden the donor pool. Future work should evaluate other organs beyond heart and optimal timing and duration of direct acting antiviral therapy. [ABSTRACT FROM AUTHOR]

Background: Vaccinating pediatric solid organ transplant candidates against measles and varicella is crucial due to the risk of severe disease in immunosuppressed recipients and general avoidance of live virus vaccines post‐transplantation. The world saw a resurgence of measles starting 2012 prompting the American Society of Transplantation in 2015 to release guidelines on recognition, prevention, and post‐exposure prophylaxis of this disease in solid transplant recipients. This study aims to assess the extent of incomplete immunity to these viruses in candidates and the approach to immunity optimization during a period of heightened awareness. Methods: A cross‐sectional study from 2012 to 2016 at Cleveland Clinic Children's included pediatric solid organ transplant candidates. Data on vaccination history, serology, and demographics were collected. Incomplete immunity was defined by incomplete vaccination or seronegativity. Results: Among 91 candidates, 54.9% had complete varicella vaccination. Serological varicella immunity among patients tested varied by age: < 7 years, 50.0% positive in patients with complete schedules, none in the incomplete; ≥ 7 years, 50.0% positive in patients with complete schedules, 65.5% in the incomplete. For measles, 69.2% had complete vaccination, with immunity varying by age among those tested: < 7 years, 84.6% positive in patients with complete schedules, 42.9% in the incomplete; ≥ 7 years, 81.0% with complete, 62.5% with incomplete. Only 31.1% of those who qualified for a varicella additional dose and 28% who qualified for an additional measles dose received it, respectively. Conclusions: Incomplete immunity to varicella and measles was prevalent in pediatric solid organ transplant candidates at our center during the study period. Despite an increase in global measles activity, our efforts to optimize immunity through additional vaccine doses were only partially successful. Future research should focus on addressing strategies and understanding barriers to ensure timely vaccination for this vulnerable population prior to transplant, especially during periods of increased viral activity. [ABSTRACT FROM AUTHOR]

Background: Although acute hepatitis caused by varicella zoster virus mostly develops in immunocompromised patients, hyperacute liver failure is very rare. To our knowledge, there are no previous reports on liver transplant patients. Methods: We report the first case of fatal hyperacute liver failure due to varicella zoster virus immediately after living‐donor liver transplantation without cutaneous lesions and review the literature. Result: The present case exhibited rapid development and progression of acute liver failure from postoperative days 11–13, despite being seropositive for varicella zoster virus but unvaccinated and on immunosuppression before transplantation. Especially in solid organ transplantation, only six cases of severe acute liver failure that included hepatic encephalopathy and/or impaired consciousness and sudden extremely high (> 4000 U/L) serum aspartate aminotransferase levels have been reported in heart, lung, and kidney transplant patients. Conclusions: Early diagnosis of hyperacute liver failure due to varicella zoster virus is challenging because the disease progresses rapidly and skin lesions are absent. [ABSTRACT FROM AUTHOR]

Background: Life with end‐stage organ failure is accompanied by an accumulation of traumatic medical or surgical experiences. Despite recovery after solid organ transplantation (SOT), many children and adolescents develop post‐traumatic stress symptoms (PTSS). PTSS remain underappreciated as a major comorbidity in SOT programs, despite their association with decreased quality of life. Methods: We conducted a retrospective, cross‐sectional study of 86 pediatric SOT recipients (17 heart, 44 kidney, and 25 liver) to evaluate potential determinants of PTSS. Trauma symptoms were measured by the Child Trauma Screening Questionnaire (CTSQ). Demographic, baseline, and contemporaneous factors were tested for independent association with CTSQ scores. Results: The median post‐transplant CTSQ score was 2 (IQR 1–4), and 22% were identified as high risk (score ≥5) for PTSD. Higher CTSQ scores were independently associated with the number of ICU days within the previous 12 months, the number of medications (complexity), and involvement with foster care in the primary model (R2 [adj.] = 0.26). The addition of the Family Impact Module improved the overall model (R2 [adj.] = 0.33), wherein higher family functioning was independently associated with lower CTSQ scores. An exploratory analysis of pre‐transplant patients (n = 34) found a median pre‐transplant CTSQ of 2 (IQR 1–6), suggesting that PTSS are onset before transplant and persist afterward. Conclusions: PTSS are highly prevalent in the SOT population. Risk factors include recent adverse medical experiences and complexity, whereas family stability may be protective. Additional research is needed to improve early ascertainment and support for patients at high risk of developing PTSS throughout their transplant journey. [ABSTRACT FROM AUTHOR]

Background: Heart transplantation is often limited by the availability of transplantable donor heart and understanding of donor aspects that would influence transplant outcomes becomes important. In this study, donor characteristics and their impact on the outcomes of pediatric heart transplantations performed in South Korea were investigated. Methods: We reviewed the medical records of patients less than 18 years old who received heart transplantation between 2002 and 2022 in three tertiary hospitals located in South Korea. Results: A total of 139 cases were enrolled. One‐year mortality was 10.4% and total mortality was 33.8%. Forty‐nine recipients (35.3%) showed biopsy‐proven rejections and 20 (14.4%) showed cardiac allograft vasculopathy during mean follow‐up of 6.4 ± 4.9 years. Six recipients (4.5%) showed left ventricle ejection fraction of less than 55% post‐transplantation. The mean age of the donors was 23.0 ± 15.4 years. The most common cause of death of the donors was unspecified illness (46.4%). Donors with a history of diabetes, hypertension, smoking, and alcohol consumption were 0%, 3.1%, 32.1%, and 34.4%, respectively. Mean total ischemic time was 191.6 ± 72.7 min, while total ischemic time was over 4 h in 37 patients (26.6%). There were no significant relationship between donor factors and survival. However, donor's history of drinking or cardiopulmonary resuscitation was significantly associated with acute rejection and donor's age with cardiac allograft vasculopathy. Conclusion: Donor factors did not show significant impact on post‐transplant survival but some factors were predictive of post‐transplant rejection and cardiac allograft vasculopathy. [ABSTRACT FROM AUTHOR]

Primary graft dysfunction (PGD) is a complication of lung transplantation that continues to cause significant morbidity. The Th2 immune response has been shown to counteract tissue-damaging inflammation. We hypothesized that Th2 cytokines/chemokines in blood would be associated with protection from PGD. Utilizing pretransplant sera from the multicenter clinical trials in organ transplantation study, we evaluated Th2 cytokines/chemokines in 211 patients. Increased concentrations of Th2 cytokines were associated with freedom from PGD, namely IL-4 (odds ratio [OR] 0.66 [95% confidence interval {CI} 0.45-0.99], p = 0.043), IL-9 (OR 0.68 [95% CI 0.49-0.94], p = 0.019), IL-13 (OR 0.73 [95% CI 0.55-0.96], p = 0.023), and IL-6 (OR 0.74 [95% CI 0.56-0.98], p = 0.036). Multivariable regression performed for each cytokine, including clinically relevant covariables, confirmed these associations and additionally demonstrated association with IL-5 (OR 0.57 [95% CI 0.36-0.89], p = 0.014) and IL-10 (OR 0.55 [95% CI 0.32-0.96], p = 0.035). Higher levels of Th2 immune response before lung transplant appear to have a protective effect against PGD, which parallels the Th2 role in resolving inflammation and tissue injury. Pretransplant cytokine assessments could be utilized for recipient risk stratification. [ABSTRACT FROM AUTHOR]

Objective: This review sought to answer the following research question: What are the characteristics of pediatric necrotizing otitis externa (NOE)? Moreover, we wanted to highlight the clinical importance of the current limitations in the literature. Methods: A scoping review was performed to determine what is known about NOE in the pediatric population. Four databases (COCHRANE Library, CINAHL, PubMed, and Scopus) were queried for articles published in English between 1976 to 2022. Variables extracted included comorbidities, demographics, outcomes, and treatment. Results: A total of 20 studies (N = 439) reported sufficient measures to be included in the review. Patients with NOE had a mean age of 10.0 years (range 2 months to 14 years) with a male-to-female gender ratio of 1.1:1. Mean length of hospital stay was 2.9 days (95%CI: 2.7-3.0). Demographics included 45.4% Caucasian, 6.0% African American, and 2.7% Asian/Pacific Islander. Less than 5% of patients had diabetes, while other reported comorbidities included neutropenia (n = 6), anemia (n = 5), dehydration/malnutrition (n = 4), Stevens Johnson Syndrome (n = 2), some form of immunosuppression/organ transplantation (n = 2), thrombocytopenia (n = 2), and leukopenia (n = 2). There have been no reported deaths from NOE in children. Conclusions: In the adult population NOE most commonly affects patients with diabetes, but our review reveals that diabetes does not appear to play as big a role in children. The disease seems to commonly affect patients with immunosuppression or severe health conditions. Complications such as cranial nerve palsies appear to be more common in the pediatric population. Specifically, the role of biopsy and culture in the treatment of pediatric NOE is stressed as they are important in treatment decisions. [ABSTRACT FROM AUTHOR]

Ovarian tissue cryopreservation and transplantation (OTCT) offers hope for preserving fertility and endocrine functions in patients undergoing gonadotoxic treatments. Advancements in techniques for the procedure have transformed OTCT from an experimental procedure into a viable option. There is a growing interest in utilizing OTCT to delay menopause and alleviate associated health issues. Menopausal transition affects women globally, leading to symptoms and long- term health risks. OTCT has the potential to restore endocrine functions, reducing menopause-related symptoms while mitigating health consequences such as osteoporosis and cardiovascular diseases. Although the use of OTCT for delaying menopause is not clinically proven, the discussion around shows potential for future utilization. In essence, the remarkable advancements in OTCT have bestowed upon us the ability to safeguard fertility and sustain the delicate endocrine functions of the ovaries. However, it is the tantalizing prospect of utilizing this technique to postpone menopause and alleviate its associated symptoms that truly captivates the imagination. Further research is imperative to substantiate the clinical efficacy of OTCT; nonetheless, its potential in menopausal therapy is both promising and warrants comprehensive exploration. This review highlights advancements and the feasibility of OTCT to postpone menopause as an alternative approach to currently used conventional menopause therapy methods. [ABSTRACT FROM AUTHOR]

Purpose: In recent years, fat grafting has gained importance as a valuable technique in breast surgery. As a breast center that has embraced this approach, we aimed to investigate the indications and complications of fat grafting. Methods: In this retrospective study, we examined a total of 263 lipofilling treatments on 121 patients. Five groups were identified: the reconstruction group (72.7%), consisting of 24.8% autologous and 38% implant-based reconstructions after cancer, and correction of the tuberous breasts (10.7%). An almost equivalent group (10.7%), consisted of patients treated for cosmetic reasons. Patients after breast-conserving therapy amounted to 16.5%. Twenty patients (16.5%) were treated to alleviate pain. Results: No major complications, and no cancer recurrence or metastasis were observed. One case of infection occurred at the injection site (infection rate: 0.38%). ANOVA showed statistically significant results for age (p < 0.001) and mean fat volume (p = 0.001). Posthoc analysis showed that the mean age of the tuberous group (21 years) was significantly smaller compared to all other categories (p < 0.001). Post-hoc analysis for fat volume indicated that the mean value for the cosmetic category (447.08 cc) was significantly greater than that of the breast-conserving and implant reconstruction categories (p = 0.009 and p = 0.030, respectively), while not significantly different from the tuberous and autologous reconstruction categories (p = 0.928 and p = 0.648, respectively). Conclusions: Lipofilling has proven a valuable adjunct in reconstructive and aesthetic breast surgery with a low complication profile. The versatility of this low-cost technique and the low rate of complications make it a powerful asset of modern breast centers. [ABSTRACT FROM AUTHOR]

Background: Liver transplantation is used for treating end‐stage liver disease, fulminant hepatitis, and oncological malignancies and organ shortage is a major limiting factor worldwide. The use of grafts based on extended donor criteria have become internationally accepted. Oxygenated machine perfusion technologies are the most recent advances in organ transplantation; however, it is only applied after a period of cold ischemia. Due to its high cost, we aimed to use a novel device, OxyFlush®, based on oxygenation of the preservation solution, applied during liver procurement targeting the maintenance of ATP during static cold storage (SCS). Methods: Twenty patients were randomly assigned to the OxyFlush or control group based on a 1:1 ratio. In the OxyFlush group, the perfusion solution was oxygenated with OxyFlush® device while the control group received a non‐oxygenated solution. Liver and the common bile duct (CBD) biopsies were obtained at three different time points. The first was at the beginning of the procedure, the second during organ preparation, and the third after total liver reperfusion. Biopsies were analyzed, and adenosine triphosphate (ATP) levels and histological scores of the liver parenchyma and CBD were assessed. Postoperative laboratory tests were performed. Results: OxyFlush® was able to maintain ATP levels during SCS and improved the damage caused by the lack of oxygen in the CBD. However, OxyFlush® did not affect laboratory test results and histological findings of the parenchyma. Conclusion: We present a novel low‐cost device that is feasible and could represent a valuable tool in organ preservation during SCS. [ABSTRACT FROM AUTHOR]

Noninvasive monitoring of allograft rejection is beneficial for the prognosis of patients with organ transplantation. Recently, IL-27/IL-27R α was proved in close relation with inflammatory diseases, and 125I-anti-IL-27R α mAb our group developed demonstrated high accumulation in the rejection of the allograft. However, antibody imaging has limitations in the imaging background due to its large molecular weight. Therefore, we developed a novel radiotracer (iodine-125-labeled recombinant IL-27) to evaluate the advantage in the targeting and imaging of allograft rejection. In vitro specific binding of 125I-rIL-27 was determined by saturation and competitive assay. Blood clearance, biodistribution, phosphor autoradioimaging, and IL-27R α expression were studied on day 10 after transplantation (top period of allorejection). Our results indicated that 125I-rIL-27 could bind with IL-27R α specifically and selectively in vitro. The blood clearance assay demonstrated fast blood clearance with 13.20 μ l/h of 125I-rIL-27 staying in the blood after 24 h. The whole-body phosphor autoradiography and biodistribution assay indicated a higher specific uptake of 125I-rIL-27 and a clear radioimage in allograft than in syngraft at 24 h, while a similar result was obtained at 48 h in the group of 125I-anti-IL-27R α mAb injection. Meanwhile, a higher expression of IL-27R α was found in the allograft by Western blot. The accumulation of radioactivity of 125I-rIL-27 was highly correlated with the expression of IL-27R α in the allograft. In conclusion, 125I-rIL-27 could be a promising probe for acutely monitoring allograft rejection with high specific binding towards IL-27R α on allograft and low imaging background. [ABSTRACT FROM AUTHOR]

Objectives: Studies suggest that transplant patients are at a higher risk of developing chronic rhinosinusitis (CRS). However, there is a dearth of studies describing the factors that may be linked to the development of CRS in this population. Our objective is to identify the risk factors associated with the development of CRS in transplant recipients. Study design: Retrospective cohort. Setting: Tertiary care center. Methods: This cohort included 3347 transplant recipients seen between 2017 and 2022. Of these, 2128 patients met the inclusion criteria and were grouped according to whether they were diagnosed with CRS during the post-transplant period. The analysis included both univariate and multivariate analysis to ascertain the odds ratio (OR) and predictive factors. Results: Of the 2128 patients, 649/2128 (30.4%) had CRS. CRS patients had an increased prevalence of previous endoscopic sinus surgery, allergic rhinitis, and recurrent acute rhinosinusitis in the pre-transplant period compared to the non-CRS group. According to the multivariate analysis, patients with primary immunodeficiency and additional transplant were 1.9 and 3.1 times more likely to develop CRS during the posttransplant period (95% CI: 1.3–2.6, p <.0001), (95% CI: 1.3 −7.3, p =.01), respectively. Sirolimus use was also associated with the development of CRS (OR = 1.4, 95% CI: 1.1–1.9, p =.01). Conclusion: This study is the largest cohort aimed at determining the predictive factors associated with the development of CRS. Patients with pretransplant rhinologic conditions, hematologic deficiencies, and the utilization of specific immunosuppressants were found to have a higher likelihood of developing CRS following transplantation. [ABSTRACT FROM AUTHOR]

This study aimed to synthesize the existing evidence on perinatal outcomes after autologous cryopreserved ovarian tissue transplantation, concurrently identifying key factors influencing these outcomes. A comprehensive search was performed on MEDLINE, Embase, and Cochrane Library databases to identify relevant studies on the effect of autologous cryopreserved ovarian tissue transplantation on perinatal outcomes from inception to October 22, 2023. Where there was missing information, the authors were contacted for updated data. Observational studies, such as cohort studies, case series, and case reports that reported a live birth after autologous cryopreserved ovarian tissue transplantation, were considered eligible. Studies lacking data on women's demographic characteristics, autologous cryopreserved ovarian tissue transplantation procedure details, or perinatal outcomes were excluded. In addition, cases involving fresh or nonautologous transplantations and those addressing primary ovarian insufficiency were excluded. Two reviewers (M.E. and E.U.) independently performed the study selection, data extraction, and risk of bias assessment, and the results were then reviewed together. The PRISMA guidelines were followed, and the protocol was registered on PROSPERO (CRD42023469296). This review included 58 studies composed of 122 women with 162 deliveries (154 singletons and 8 twins) after autologous cryopreserved ovarian tissue transplantation, resulting in 170 newborns. Of note, 83.6% of the women had a malignant disease. Moreover, most of these women (51.0%) were exposed to some form of chemotherapy before ovarian tissue cryopreservation. Of the 162 childbirths, 108 (66.7%) were conceived naturally, and 54 (33.3%) were conceived through assisted reproductive techniques. The birthweight of 88.5% of newborns was appropriate for gestational age, whereas 8.3% and 3.1% were small for gestational age and large for gestational age, respectively. The preterm birth rate was 9.4%, with the remaining being term deliveries. Hypertensive disorders of pregnancy were noted in 18.9% of women, including pregnancy-induced hypertension in 7.6%, preeclampsia in 9.4%, and hemolysis, elevated liver enzymes, and low platelet count in 1.9%. The incidences of gestational diabetes mellitus and preterm premature rupture of membranes were 3.8% for each condition. Neonatal anomalies were reported in 3 transplant recipients with 4 newborns: arthrogryposis, congenital cataract, and diaphragmatic hernia in a twin. Finally, among the recipients' characteristics, not receiving chemotherapy before ovarian tissue cryopreservation (odds ratio, 0.23; 95% confidence interval, 0.07–0.72; P =.012) and natural conception (odds ratio, 0.29; 95% confidence interval, 0.09–0.92; P =.035) were associated with a lower perinatal complication rate. On the basis of low certainty evidence from observational studies, perinatal complication rates did not increase after autologous cryopreserved ovarian tissue transplantation compared with the general pregnant population, except for preeclampsia. This could be due to chemotherapy exposure, underlying medical conditions, and the common use of assisted reproductive techniques. Further larger studies are needed to explore the causes of increased preeclampsia incidence in autologous cryopreserved ovarian tissue transplantation pregnancies. [ABSTRACT FROM AUTHOR]

Ascertaining the presence of weakly positive anti‐HLA donor‐specific antibodies (DSA) in organ transplantation with multiplex single antigen beads assays may be challenging despite their high sensitivity due to technical variability issues. Through extensive datasets of Next‐Generation Sequencing HLA typings and single antigen analyses, we reassessed the mean fluorescence intensity (MFI) positivity threshold of the assay to enhance accuracy. By showing that some beads were more prone to false positivity than others, we propose a nuanced approach that accounts for nonspecific intrinsic reactivities at the HLA antigen level, that is, on a bead‐by‐bead basis, as it enhances assay precision and reliability. This is substantiated by a comprehensive statistical analysis of MFI values and the implementation of the determination of a "Quantile Adjusted Threshold 500" (QAT500) value for each bead. Applied to DSA detection during patients' follow‐up, this approach discriminated better and earlier low‐strength DSA that would later raise their MFI above the clinically relevant threshold of 3000. Moving from a subjective interpretation to a more objective and precise methodology allows for standardizing HLA antibody and DSA detection. The study emphasizes the need for further research with real clinical data to validate and refine this approach. [ABSTRACT FROM AUTHOR]

Background: Post-transplant diabetes mellitus (PTDM) is a well-known complication of kidney transplantation that significantly impacts recipient morbidity and mortality. Over the recent years, the incidence of PTDM has increased considerably worldwide. Therefore, the primary purpose of this study was to evaluate the incidence and risk factors for PTDM in living donor kidney transplantation patients in Riyadh, Saudi Arabia. Methods: A retrospective cohort study was conducted at a tertiary transplant center in Riyadh, Saudi Arabia, and data were extracted between February 2016 and March 2022. Patients aged ≥ 18 years who underwent renal transplant with at least one year of post-transplant follow-up were included in the analysis, and their medical records were comprehensively reviewed. Patients < 18 years of age, history of diabetes mellitus, other organ transplants, or those who underwent transplantation outside the Kingdom of Saudi Arabia were excluded from the study. Results: The study included 247 living donor kidney transplant patients, with a mean age of 39.5 ± 14.6 years. 17.0% of the patients were diagnosed with PTDM. Patient age and fasting glucose levels at 6-months and 12-months after transplantation were found to be significant risk factors for the development of PTDM. Conclusion: An increased occurrence of PTDM emphasizes the importance of identifying high-risk patients prior to transplantation and implementing early interventions to prevent potential complications that could affect graft and patient survival. [ABSTRACT FROM AUTHOR]

We conduct a lab experiment that shows that current rules regulating transplant centers (TCs) and organ-procurement organizations (OPOs) create perverse incentives that inefficiently reduce both organ recovery and beneficial transplantations. We model the decision environment with a two-player multiround game between an OPO and a TC. In the condition that simulates current rules, OPOs recover only the highest-quality kidneys and forgo valuable recovery opportunities, and TCs decline some beneficial transplants. Alternative regulations that reward TCs and OPOs together for health outcomes in their entire patient pool lead to behaviors that increase organ recovery and appropriate transplants. [ABSTRACT FROM AUTHOR]

Objective: The article reviews the safety and efficacy of treatments for cytomegalovirus (CMV) in solid organ transplantation. Data Sources: A literature review was conducted in PubMed, MEDLINE, and Clinicaltrials.gov from database inception through January 2024, using terms CMV, therapy, and solid organ transplantation. Study Selection and Data Extraction: Clinical trials, meta-analyses, cohort studies, case reports, and guidelines were included. Letters to the editor, reviews, and commentaries were excluded. Data Synthesis: After abstract screening and full-text review of 728 citations for eligibility, 53 were included. Valganciclovir and intravenous ganciclovir are drugs of choice for CMV management and, until recently, the availability of alternative options has been restricted due to toxicity. For instance, foscarnet and cidofovir serve as second-line agents due to potential bone marrow and renal toxicity. In patients with refractory or resistant CMV, maribavir, a novel oral agent, has proven efficacy and a lower adverse effect profile. However, in refractory or resistant CMV, foscarnet and cidofovir are preferred in invasive disease (CMV gastritis, CMV retinitis, and CMV encephalitis), high viral loads, and inability to tolerate oral preparations. Relevance to Patient Care and Clinical Practice: Consensus guidelines have not been revised since approval of novel antivirals in solid organ transplantation. Valganciclovir and ganciclovir remain drugs of choice for initial CMV therapy. Foscarnet, cidofovir, and maribavir are treatments for refractory or resistant-CMV. Conclusions: Selection of CMV antiviral treatment should be determined by patient-specific factors, including severity of illness, resistant or refractory disease, dose-limiting adverse effects, and the preferred route of administration. [ABSTRACT FROM AUTHOR]