The ongoing global deficit of donor organs remains a significant obstacle for transplantation programs, with more than 100000 individuals currently listed for transplantation in the United States and an estimated 13 patients dying each day before receiving a suitable organ. This commentary integrates current evidence regarding public knowledge, perceptions, and barriers to organ donation, and connects these factors to the anticipated acceptance of emerging transplantation and regenerative medicine innovations. Despite widespread support for organ donation-reported among nearly 90% of United States adults-actual enrollment in donor registries remains disproportionately low, underscoring a persistent disconnect between positive attitudes and real-world participation. Recent findings from the United Arab Emirates, including the study by Al-Sharbatti et al , reveal notable gaps in understanding and fear of medical procedures as key deterrents to donor enrollment, trends similarly reported in regions such as Kazakhstan. These insights reaffirm that inadequate awareness and distrust of healthcare systems continue to impede donor registration, even in highly educated communities. Enhancing public education, promoting transparency, and fostering trust are crucial steps toward improving donation rates. As transplantation advances through innovations such as xenotransplantation, stem cell–derived tissues, and bioengineered organs, societal confidence will be pivotal in shaping their acceptance. Addressing current knowledge deficits and proactively engaging with ethical and societal considerations will be essential to fully realizing the potential of both conventional and next-generation transplantation therapies.
Artificial intelligence (AI) and machine learning (ML) are increasingly applied across the transplantation pathway, offering advances in preoperative planning, perioperative management, and postoperative recovery. In preoperative care, deep learning algorithms improve anatomical assessment, volumetry, and graft weight estimation, while ML-based functional status evaluation and urgency scoring refine candidate selection. Predictive models incorporating metabolic and physiological data further support surgical eligibility and targeted prehabilitation strategies. Perioperatively, ML models outperform conventional approaches in predicting massive transfusion, intraoperative haemorrhage, and acute kidney injury, with explainable outputs enhancing interpretability and clinical trust. Robotic and AI-assisted surgical platforms demonstrate functional equivalence or superiority to conventional methods, reducing intraoperative complications and accelerating recovery, particularly in high-risk cohorts. Postoperatively, ML-driven models enable early prediction of sepsis, pneumonia, and graft dysfunction, while longitudinal markers such as the recipient-to-donor estimated glomerular filtration rate ratio and novel imaging or biomarker-based approaches inform long-term graft monitoring. Optimised perioperative strategies, including analgesic regimens and fluid management, further enhance donor recovery and rehabilitation outcomes. Cross-cutting innovations include imaging-based AI applications such as hyperspectral imaging for real-time graft viability assessment and deep learning for automated histopathological evaluation, which improve diagnostic speed, accuracy, and reproducibility. Multimodal models integrating electronic health records, intraoperative signals, ultrasound, and histology provide dynamic, system-wide insights into graft function and rejection risk, bridging diagnostic, prognostic, and therapeutic decision-making. AI and ML thus hold substantial potential to personalise transplant care and improve outcomes. Their translation into practice, however, requires rigorous validation, dataset diversity, and strong ethical and regulatory governance.
In this article, we comment on the article by Sessa et al published in the recent issue of the World Journal of Transplantation , who revisit the three-decade single centre cohort of Muñoz-Serrano et al and conclude that chronic kidney disease (CKD) after liver transplantation (LT) is a modifiable determinant of long-term survival rather than an unavoidable consequence of calcineurin inhibitor exposure. We share their central position and welcome the weight they give to perioperative acute kidney injury (AKI), to calcineurin inhibitor minimisation through basiliximab induction and mycophenolate, and to the disciplined control of hypertension and metabolic disease. Our intention is to carry the argument one step further, because three problems lie beneath the literature they assemble and constrain what any inventory of risk factors can deliver. The first is metrological. Almost every reported association, including the signal attached to female sex, and the reported incidence itself, which varies according to the definition of CKD applied, the time point of ascertainment and whether creatinine-based or measured filtration is used, derive from creatinine-based estimates of glomerular filtration, a measure the same authors concede performs poorly in patients who are sarcopenic, oedematous and metabolically deranged. The second concerns timing, since the most powerful and most modifiable determinant of chronic injury is the passage from early AKI to fixed nephropathy, a transition that draws surveillance away from isolated tacrolimus trough concentrations, which did not predict one year disease in the index cohort, towards intrapatient variability and time within the therapeutic range. The third is therapeutic, because the prevailing synthesis omits the sodium glucose cotransporter 2 inhibitors, agents with established renal benefit in non-transplant CKD populations that deserve formal evaluation after LT. Measured accurately, protected early and evaluated pharmacologically, the kidney of the liver transplant recipient is more defensible than current practice assumes.
BACKGROUND Pretransplant donor-specific antibodies (DSA) are frequently encountered in kidney transplant recipients, but their combined effect with human leukocyte antigen (HLA) mismatches on post-transplant outcomes is as yet not fully understood, particularly in Middle Eastern populations. AIM To evaluate the effect of pretransplant DSA, HLA mismatches, and early graft function on acute rejection, graft loss, and patient survival, using detailed immunologic profiling and longitudinal follow-up to inform transplant management strategies. METHODS We conducted a retrospective study of 260 kidney transplant recipients with available pretransplant HLA typing and DSA assessment. Patients were followed for graft function, acute rejection, graft loss, and mortality. Multivariable logistic regression was used to identify predictors of preformed DSA and acute rejection, and Cox proportional hazards models were applied to evaluate factors associated with a composite outcome of acute rejection, graft loss, or death. Event-free survival was assessed using Kaplan-Meier analysis. RESULTS Acute rejection occurred in 10 patients (3.8%). In exploratory multivariable analyses, a higher HLA mismatch burden and suboptimal early graft function at 4 months post-transplant were associated with acute rejection; however, these findings should be interpreted cautiously because of the limited number of events. Pretransplant DSA was present in a subset of patients but was not independently associated with outcomes after adjustment for HLA mismatch and early graft function. A mismatch burden ≥ 7, reduced early graft function, and a history of sensitizing events were associated with a higher risk of the composite outcome. Kaplan-Meier analysis showed significantly lower event-free survival among patients with ≥ 7 HLA mismatches, while reduced early graft function further improved risk discrimination over time. CONCLUSION Pretransplant DSA and HLA mismatch burden were both associated with post-transplant outcomes; however, the prognostic signal was largely driven by HLA mismatch and early graft function rather than DSA alone. A mismatch burden ≥ 7 was associated with reduced event-free survival, and early graft function further stratified risk. Induction therapy with antithymocyte globulin may have reduced the clinical impact of preformed DSA in sensitized recipients.
Post-transplant atrial tachyarrhythmias - including atrial fibrillation (AF), atrial flutter, and organized atrial tachycardias - occur after solid-organ transplantation and follow distinct time- and organ-dependent patterns. Early arrhythmias are mainly postoperative, resulting from inflammatory and autonomic stress, hemodynamic and metabolic shifts, and atrial injury. Thoracic transplantation bears the highest burden: Early postoperative AF is frequent, while late arrhythmias typically present as macroreentrant tachycardias at anastomotic or incisional sites. These late arrhythmias can signal graft pathology or atrial remodeling. In heart transplantation, late atrial tachyarrhythmias depend on surgical technique and often coincide with rejection or cardiac allograft vasculopathy. In abdominal transplantation, AF is less common but remains relevant. In liver transplantation, AF links closely to advanced disease and perioperative instability, with poorer outcomes. Across organs, post-transplant AF leads to longer hospitalization and higher risks of thromboembolism, mortality, and graft loss, emphasizing its significance beyond a brief postoperative event. Management is complex and multidisciplinary, requiring careful evaluation for reversible causes, patient-specific rate-control or rhythm-control, and attention to interactions among antiarrhythmics, anticoagulants, and immunosuppressive agents. Rhythm control is increasingly mechanism-driven. Catheter ablation, at experienced centers, is effective for late organized tachyarrhythmias, achieving high acute and durable success in recent single-center series. Stroke prevention remains difficult due to changing bleeding risk, organ function, and limited relevant trial evidence. Anticoagulation requires ongoing reassessment. Left atrial appendage occlusion is an emerging alternative for patients ineligible for long-term anticoagulation. Evidence, mainly from registry data and small series, suggests potentially higher vascular complication rates. This review summarizes current knowledge, clarifies knowns and unknowns, and describes future goals, including standardized definitions, phenotyping, surveillance windows, transplant-specific risk stratification, and comparative studies of anticoagulation, ablation, and appendage-closure strategies to improve outcomes.
Paediatric kidney transplantation substantially improves survival and quality of life in children with end-stage kidney disease. However, impaired linear growth and broader developmental challenges remain common after transplantation. This article provides an evidence-based narrative review of the mechanisms, clinical determinants, monitoring strategies, and management options for post-transplant growth and development in paediatric kidney recipients, with particular emphasis on the growth hormone (GH)-insulin-like growth factor 1 axis, graft function, immunosuppression, nutrition, GH therapy, and long-term follow-up. Current evidence indicates that post-transplant growth is influenced by age at transplantation, pretransplant growth status, graft function, cumulative corticosteroid exposure, nutritional and metabolic status, and the selective use of recombinant human GH. Younger age at transplantation and steroid-sparing strategies are consistently associated with better height outcomes, whereas chronic graft dysfunction, persistent inflammation, and metabolic complications may attenuate catch-up growth. Emerging biomarkers and precision-medicine tools are promising, but most remain insufficiently validated for routine growth-focused decision-making. Optimising growth after paediatric kidney transplantation requires early transplantation when feasible, preservation of graft function, careful balancing of rejection prevention against growth toxicity, multidisciplinary nutritional and endocrine support, and structured long-term follow-up. The evidence base is expanding, but high-quality multicentre longitudinal studies are still needed.
Early allograft dysfunction (EAD) is a significant complication of liver transplantation (LT). LT remains the sole curative treatment for patients with end-stage liver disease. EAD is correlated with heightened morbidity, extended stays in intensive care units, and decreased graft survival rates. Within the clinical practice, EAD presents a substantial challenge, necessitating vigilant monitoring, heightened clinical awareness, and prompt multidisciplinary intervention to prevent progression to primary graft nonfunction and multiorgan failure. Multiple forms of programmed cell death, including necrosis, apoptosis, necroptosis, pyroptosis, ferroptosis, autophagy, PANoptosis, and NETosis, have been implicated in graft injury. Apoptosis facilitates the regulated elimination of damaged or senescent hepatocytes via caspase-dependent pathways, whereas necroptosis and other necrotic mechanisms exacerbate caspase-independent tissue injury through membrane disruption and the release of inflammatory mediators. Pyroptosis, driven by inflammasome activation and gasdermin-mediated pore formation, further amplifies inflammatory signaling within the graft. Moreover, ferroptosis, characterized by iron-dependent lipid peroxidation, has emerged as a pivotal contributor to hepatocellular injury during hepatic ischemia–reperfusion events. Failure of hepatocellular protective mechanisms to adequately counteract energy depletion and oxidative stress during ischemia results in cell death, which subsequently activates immune and contributing to acute graft rejection.
BACKGROUND Living donor liver transplantation (LDLT) has become an essential strategy to address the shortage of deceased donor organs in Malaysia. Universiti Malaya Medical Centre (UMMC), the second public institution in the country to establish a liver transplantation program, initiated its adult LDLT program in 2017 and became the first center in the country to successfully perform a living-related adult right lobe LDLT. However, data on donor outcomes from emerging LDLT programs remain limited. AIM To evaluate donor outcomes and perioperative results of an emerging LDLT program in Malaysia. METHODS This retrospective cohort study included all living donor hepatectomies performed at UMMC from January 2017 to June 2025. Data on donor selection, perioperative management, morbidity, and mortality were analyzed. RESULTS A total of 30 living donor hepatectomies were performed using right lobe, left lobe, and left lateral segment grafts. No donor mortality was observed. Complications included superficial wound infection (n = 4, 13.3%), anesthetic complications (n = 2, 6.7%), pulmonary atelectasis (n = 2, 6.7%), bile leak (n = 1, 3.3%), and gastrointestinal bleeding (n = 1, 3.3%). The median intraoperative blood loss was 500 mL (interquartile range: 400-800 mL), with a transfusion rate of 6.7%. The median length of hospital stay was 10 days. All donors achieved full functional recovery during follow-up. CONCLUSION As an emerging liver transplantation program, UMMC demonstrated favorable donor safety outcomes consistent with published reports from established LDLT centers. Continued refinement of surgical techniques, multidisciplinary perioperative care, and public awareness initiatives will be essential for the sustainable expansion of liver transplantation in Malaysia.
BACKGROUND In Egypt, living donor liver transplantation is currently the only option for patients with end-stage liver disease. Although efforts to establish a national deceased organ transplantation programme are currently ongoing, implementation of the organ transplantation law faces challenges in terms of executive regulations and cultural barriers. Continuous medical education is must for promoting organ donation successfully. AIM To evaluate awareness of and attitudes towards organ donation programmes among Egyptian physicians. METHODS This online cross-sectional survey was conducted at Ain Shams University Hospitals for more than 1 month (August 2024). A questionnaire covering demographics, knowledge, and attitudes towards organ donation was distributed through an online platform. RESULTS A total of 391 physicians participated (42.9% MD holders, 35.9% master’s degree holders, and 21.2% residents). Most participants (79.6%) represented medical specialties. Satisfactory general knowledge of organ transplantation was reported by only 20% of the participants, whereas 50% were aware of the Egyptian organ transplantation law. With respect to attitudes, 42% accepted being a living donor, and 38% would donate to a relative. With respect to deceased donations, 40% agreed to be donors, whereas 28% remained undecided. CONCLUSION Despite limited specific knowledge of organ donation and transplantation laws, Egyptian physicians demonstrate a generally positive attitude towards becoming organ donors. Continuous medical education is essential to promote organ donation successfully.
BACKGROUND Organ transplantation is the definitive treatment for end-stage organ failure, and the gap between organ demand and donation is still a major challenge to overcome. Several countries, including Greece, have reformed their transplant framework to increase organ donation, but the long waiting times and low donor rates point to limited public awareness and engagement. Medical students, as future physicians, have a critical role within transplantation systems, as their knowledge, attitudes and engagement will affect donor identification, the consent processes and how donation is communicated to the public. AIM To assess Greek medical students’ knowledge and attitudes in order to inform strategies for strengthening organ donation nationally and internationally. METHODS A cross-sectional online survey was conducted between July 2025 and September 2025 across all medical schools in Greece. A 38-item questionnaire covered baseline demographics, knowledge and attitudes toward organ donation and transplantation. Responses were summarized with descriptive statistics, and seven multivariable logistic regression models were used to identify predictors of key outcomes (significance at adjusted P < 0.05). RESULTS Among 562 respondents (mean age 21.5 years, 68.3% female), only 13.0% correctly identified all organs transplantable from deceased donors, compared with 62.0% for living donors. Misconceptions were common, and awareness of the Hellenic Transplant Organization (HTO) was limited (22.8%). While 63.4% were willing to donate posthumously, only 8.2% were registered donors. Willingness to donate during lifetime was high (95.0%) but conditional. Prior discussion with family or friends increased the likelihood of willingness for posthumous donation [odds ratio (OR) = 2.38, adjusted P < 0.001]. A preference for surgical specialties predicted the perception of living donor grafts as superior (OR = 2.15, adjusted P = 0.027), while awareness of the HTO was a strong predictor of donor card possession (OR = 6.60, adjusted P < 0.001). CONCLUSION Medical students in Greece exhibit strong intentions but limited engagement and mixed knowledge of organ donation. Strengthening transplant education, raising the visibility of national structures and fostering student-led advocacy are essential to converting willingness into action and building public trust.
Obesity is a challenging complication that many liver transplant recipients face. Liver transplantation is the sole life-saving procedure in many end-stage liver diseases, but the underlying pathology, in addition to some immunosuppressive regimens, may worsen the metabolic status of many patients. A comprehensive management plan to prevent further metabolic complications, like metabolic dysfunction-associated steatotic liver disease, chronic renal dysfunction, and diabetes, is essential to obtain a favourable prognosis and a better quality of life. glucagon-like peptide-1 (GLP-1) and GLP-1/glucose-dependent insulinotropic polypeptide receptor agonists have been approved for long-term weight management by the United States Food and Drug Administration and other regulatory authorities. While this pharmacotherapeutic intervention revolutionised obesity management, it comes with many limitations. Their long-term safety profile, optimal dosing, duration of treatment and outcomes are still insufficiently studied, specifically in the transplant recipient population. This review aims to explore the pathophysiology, risk factors, clinical presentation, and burden of metabolic complications in liver transplant recipients and to review available data on the potential use of GLP-1 and GLP-1/glucose-dependent insulinotropic polypeptide receptor agonists in mitigating these complications among this vulnerable population.
BACKGROUND Early allograft dysfunction (EAD) contributes to significant morbidity and mortality. Although EAD can occur after any preservation method, the risk is higher with static cold storage (SCS) - still the predominant modality worldwide - given its longer ischemia time. We hypothesize specific peri-implantation alterations in serum cytokine and transcription factor levels are associated with EAD in recipients of allografts preserved using SCS. AIM To identify peri-implantation predictive biomarkers of EAD in SCS recipients. METHODS We conducted a prospective single-center pilot study of adult deceased donor SCS-preserved liver transplant recipients from August 2023 to July 2024. EAD was defined by the Olthoff criteria. Arterial serum was obtained pre-implantation (timepoint, T1) and 2 (T2) and 48 hours (T3) post-implantation to measure biomarker levels by multiplex immunoassay. Biomarker levels between non-EAD and EAD groups, and their associations with clinical outcomes, were compared using Mann-Whitney U , χ 2 or Fisher’s exact, Friedman, Wilcoxon Z , and Spearman correlation tests. RESULTS EAD occurred in 8 of 24 SCS recipients (33.3%). Compared with non-EAD recipients, those with EAD had lower interleukin-6 (IL-6) levels at T1 [6.3 pg/mL interquartile ranges (IQR): 3.7, 12.9 vs 15.4 pg/mL IQR: 8.7, 24.9, P = 0.0433], greater peri-implantation increases in induced protein 10 (IP-10) (T2-T1) [386.7 pg/mL (IQR: -26.7, 1280.7) vs -181.5 pg/mL (IQR: -452.4, 145.9), P = 0.02], and higher 48-hour post-implantation hypoxia inducible factor-1 alpha (HIF-1α) levels at T3 [611.2 pg/mL (IQR: 384.7, 869.9) vs 157.9 pg/mL (IQR: 110, 273), P = 0.0095]. Discriminatory performance was moderate-to-strong for pre-implantation IL-6 [area under the curve (AUC) = 0.7578], peri-implantation IP-10 (AUC = 0.7969), and 48-hour post-implantation HIF-1α (AUC = 0.8889). CONCLUSION When integrated with established risk factors and pending external validation, these biomarkers may predict EAD and enhance early risk stratification in SCS recipients.
BACKGROUND Complement dysregulation is a key mechanism underlying atypical hemolytic uremic syndrome and complement-mediated thrombotic microangiopathy in kidney transplantation, and is associated with post-transplant recurrence, graft dysfunction, and graft loss. Although Western cohort data are well established, integrated transplant outcome data combining genetic analysis, anti-factor H (AFH) antibody profiling, and individualized therapy from Indian and other South Asian populations remain limited, despite a distinct biologic profile in this region. AIM To evaluate clinical characteristics, complement biologic profile, post-transplant recurrence, and graft outcomes in kidney transplant recipients with complement dysregulation managed at a tertiary transplant center in Central India, with particular emphasis on genotype-phenotype correlation and outcomes in a resource-constrained setting. METHODS This single-center retrospective cohort study included kidney transplant recipients with evidence of complement dysregulation identified from January 2018 to March 2025 at a tertiary transplant center in Central India. Complement dysregulation was defined as the presence of a pathogenic or likely pathogenic complement gene variant, AFH antibody positivity, or both. Genetic testing was performed using multiplex ligation-dependent probe amplification and/or clinical exome sequencing covering the alternative complement pathway gene panel, and AFH antibodies were measured using enzyme-linked immunosorbent assay. All patients underwent comprehensive evaluation including hematological, biochemical, and complement (C3, C4) profiling, with kidney biopsy when clinically feasible. The primary outcome was post-transplant recurrence of thrombotic microangiopathy; secondary outcomes included graft loss, patient survival, renal function, and treatment response. Median post-transplant follow-up was approximately 12 months. RESULTS Of the 335 patients evaluated for complement abnormalities, 136 had complement dysregulation, of whom 38 underwent kidney transplantation and constituted the study cohort. Mean age was 36.3 ± 9.3 years, 84.2% were male, and 97.4% had hypertension; 73.7% were on maintenance hemodialysis at diagnosis. Complement genetic abnormalities were identified in 34/38 recipients (89.5%), with CFHR1-CFHR3 structural variants predominating (78.9%) and complement factor H abnormalities in 18.4%; no pathogenic variants were detected in CFI , C3 , CD46 , THBD , or DGKE . AFH antibodies were detected in 15 patients (39.5%), with 11 having concomitant genetic abnormalities. Pre-transplant immunomodulation with plasma exchange and rituximab reduced mean AFH antibody levels from 179.9 AU/mL to 59.7 AU/mL (approximately 67% reduction). Post-transplant recurrence occurred in 7/38 recipients (18.4%), all biopsy-confirmed, donor-specific antibody and C4d-negative, and clustered within 1-3 weeks of transplantation; recurrence occurred exclusively in patients with complement genetic abnormalities, and not in those with isolated AFH antibody positivity. All 7 recipients with recurrence maintained functioning grafts after disease-directed therapy. Overall patient survival was 94.7%; two deaths (5.3%) were attributable to severe infections, and one graft loss followed invasive mucormycosis unrelated to recurrent disease. CONCLUSION In this Indian transplant cohort with complement dysregulation, CFHR1-CFHR3 structural variants and AFH antibody positivity defined the predominant biologic substrate, post-transplant recurrence clustered within the early weeks after transplantation, and disease-directed therapy with plasma exchange, rituximab, and selective eculizumab achieved durable graft preservation despite limited access to long-term complement inhibition. Comprehensive pre-transplant complement evaluation and biologic risk stratification are essential for safe transplantation in complement-mediated kidney disease, particularly in resource-limited settings.
BACKGROUND This study evaluated the joint and modifying effects of obesity and income on access to kidney transplantation, stratified by race/ethnicity. AIM To investigate whether income modifies the association between body mass index (BMI) and the likelihood of deceased donor kidney transplantation (DDKT) and living donor kidney transplantation (LDKT). METHODS We conducted a retrospective cohort study of 54891 adult kidney-only candidates added to the United States waiting list in 2020 and 2022, using data from the Organ Procurement and Transplantation Network and LexisNexis. RESULTS Overall, 47% of candidates were obese (BMI ≥ 30 kg/m2). In multivariable models, BMI 30- < 35 was associated with a lower likelihood of DDKT for non-Hispanic White and non-Hispanic Black candidates [sub-distribution hazard ratio (sHR): 0.93 for both]. BMI ≥ 35 was associated with an 18% lower likelihood to DDKT for non-Hispanic White candidates only. Low income was associated with higher likelihood of DDKT among non-Hispanic White (sHR: 1.34) and Hispanic/Latino (sHR: 1.20) candidates but was not associated with DDKT among non-Hispanic Black candidates. In interaction models, income-related differences in DDKT were most consistently observed among nonobese nonHispanic White and Hispanic/Latino candidates. For LDKT, both BMI ≥ 35 and low income were associated with lower likelihood of transplantation across all racial and ethnic groups; low income was also associated with reduced likelihood of LDKT among non-obese candidates in interaction models. CONCLUSION Obesity and income are differentially associated with access to transplantation by racial/ethnicity and transplant modality, highlighting the importance of jointly considering clinical and social risk factors in transplantation.
Therapeutic penetrating keratoplasty (TPK) is a surgical procedure for salvaging medically refractory infectious keratitis. By replacing diseased, infected host corneal tissue with a full-thickness donor cornea, TPK aims to eliminate infection, preserves globe integrity and maintain vision. However, recurrence of infection in the graft remains a significant concern, particularly in cases caused by resistant organisms such as Acanthamoeba , Pythium , microsporidia, and certain bacterial and fungal pathogens. Although often curative, TPK carries a higher risk of endothelial rejection, reduced graft survival, and increased complications due to its open-sky approach. Lamellar keratoplasty, particularly deep anterior lamellar keratoplasty, has emerged as a promising surgical alternative in cases where the infection has spared the deeper corneal layers. Compared with full-thickness therapeutic keratoplasty, it offers advantages including improved graft survival, lower rejection rates and fewer postoperative complications. Nevertheless, recurrence may still occur in deep or extensive infections, and advanced cases with descemetocele, perforation, or limbal or scleral involvement often still require TPK. This article on TPK summarizes peer-reviewed literature from the past decade, incorporating recent advances in corneal surgery while placing the modern-day application of classically described techniques into perspective to strengthen surgical decision-making. Emphasis is placed on resistant pathogens, surgical indications, preoperative evaluation, anesthesia considerations, operative techniques, prognostic factors, and postoperative management strategies. Through this review, ophthalmic surgeons are expected to gain practical guidance for optimizing outcomes in complex corneal infections while addressing the challenges posed by resistant and atypical pathogens across diverse clinical scenarios.
In this editorial, we comment on the study by Christou et al recently published in World Journal of Transplantation , which presents a matched comparative analysis evaluating robot-assisted vs hand-assisted laparoscopic donor nephrectomy within a contemporary United Kingdom living-donor programme. Their work directly addresses a central question in the current evolution of minimally invasive donor surgery - the robotic platforms offer incremental advantages in precision, operative consistency, or ergonomic sustainability without compromising donor safety or graft function. The authors demonstrate that both techniques achieve comparable perioperative recovery, complication profiles, and early allograft outcomes. Although modest variations were observed in warm ischaemia time, postoperative stay, and workflow dynamics, these differences lacked clinical significance and did not influence donor or graft results. Importantly, the progressive reduction in console time with accumulating experience reflects the characteristic learning-curve trajectory seen across early robotic adoption, underscoring how proficiency stabilises as teams internalise the platform’s ergonomics and procedural choreography. Beyond the procedural metrics themselves, the study offers practical insight into how robotics may be integrated into mature donor programmes: As a complementary modality that supports technical reproducibility, preserves donor safety, and potentially enhances surgeon ergonomics. These findings therefore provide timely guidance for centres evaluating whether robotics can be incorporated alongside established laparoscopic pathways, balancing performance, training requirements, institutional resources, and long-term programme sustainability.
Kidney transplantation continues to be the kidney replacement therapy of choice for patients with end stage kidney disease (ESKD) associated with a survival benefit over remaining on dialysis. Patients living with both ESKD and human immunodeficiency virus (HIV) have traditionally faced barriers accessing the kidney transplant (KT) waiting list given need for special considerations in addition to general listing requirements for KT candidates. The HIV Organ Policy Equity (HOPE) Act in 2013 and HOPE Act Variance in 2015 restricted HIV positive donor (+D) to HIV positive recipient (+R) transplants to research protocols or Institutional Review Board approved programs. Federal regulatory changes in 2024-2025 removed the above restrictions making HIV +D to HIV +R KTs standard of care practice for approved centers. Removal of the research criteria requirements in alignment with federal regulatory changes will likely expand access so that more individuals living with HIV can obtain a KT. Herein we will provide a narrative review of the available literature in the PubMed database on studies completed under the HOPE act as well as the special considerations in evaluating HIV positive renal transplant candidates and their subsequent post-transplant care to help ensure clinician and patient comfort in this era.
BACKGROUND While the model for end-stage liver disease excluding international normalized ratio (MELD-XI) is known to be associated with adverse outcomes following cardiac surgery and heart transplantation, its predictive value in outcomes of simultaneous heart–kidney transplant (SHKT) remains unclear. To identify a reliable pre-transplant risk marker for graft and patient survival among SHKT recipients, we hypothesized that higher MELD-XI scores are linked to worse post-transplant outcomes. AIM To determine the association between MELD-XI and post-transplant outcomes in SHKT recipients. METHODS We performed a retrospective cohort study in adult SHKT recipients using the United Network for Organ Sharing database from 2014 to 2023. MELD-XI was calculated and categorized into tertiles (high, medium and low). Multivariable Cox proportional hazards models and generalized additive models were used to evaluate the association between MELD-XI and patient mortality and kidney graft failure. RESULTS Among the cohort of 2148 SHKT recipients the MELD-XI tertile distribution was: High (11%), medium (56%), and low (36%). Statistically significant differences among recipients in the highest tertile were seen and they were younger, more frequently female, had higher rates of dialysis, and shorter waitlist times. Recipients in the higher MELD-XI tertile also had significant increase in the delayed kidney graft function and longer hospital stays after transplantation. On multivariable analysis, MELD-XI independently predicted increase in 90-day graft failure, and 1-year graft failure and mortality. CONCLUSION Higher MELD-XI is associated with increased early mortality and kidney graft failure in SHKT recipients. MELD-XI can provide an objective risk-stratification tool to help identify candidates who should undergo SHKT vs kidney-after-heart transplantation.
