Introduction Acute kidney injury (AKI) in liver transplant patients is associated with increased morbidity, mortality, and reduced graft survival. However, the impact of the timing of dialysis initiation—before versus after transplantation—remains unclear. Objectives To characterize liver transplant recipients with Kidney Disease: Improving Global Outcomes (KDIGO) Stage 3 AKI–requiring dialysis (AKI‐D) according to the timing of kidney replacement therapy (KRT) initiation (pre‐ versus posttransplant) and to evaluate 90‐day mortality. Secondary objectives included identifying independent predictors of dialysis dependence and assessing liver graft function at 90 days. Methods This retrospective, single‐center cohort study included all consecutive adult liver transplant recipients who received dialysis in a Brazilian intensive care unit (ICU) between 1999 and 2015. The study was approved by the Research Ethics Committee of the Federal University of Sao Paulo (UNIFESP), with a waiver of informed consent. Patients were grouped according to the timing of dialysis initiation: pre‐ or postliver transplantation. Multiple logistic regression was used to identify predictors of 90‐day mortality and dialysis dependence. Ninety‐day liver graft survival was analyzed using a multivariate Cox model. Results A total of 356 liver transplant patients with AKI‐D were included. Of these, 109 (30.6%) initiated dialysis within 4 weeks before transplantation and 247 (69.4%) within 4 weeks after transplantation. The timing of dialysis initiation was not associated with 90‐day mortality or dialysis dependence. Independent predictors of 90‐day mortality included graft dysfunction and use of continuous KRT as the initial modality. Impaired pretransplant renal function and a history of diabetes mellitus were predictors of 90‐day dialysis dependence. Posttransplant dialysis was associated with a twofold increased risk of liver graft failure. Conclusion The timing of dialysis initiation (pre‐ versus posttransplantation) was not associated with 90‐day mortality or dialysis dependence. However, initiation of dialysis after transplantation was associated with an increased risk of liver graft dysfunction.
Background The physiological relevance of postoperative perfusion distribution after single lung transplantation (SLT) remains poorly defined, as asymmetric blood flow toward the graft is often regarded as an inherent consequence of the remaining native lung. This study aimed to determine whether the graft‐directed perfusion ratio assessed by quantitative lung perfusion scintigraphy (QLPS) in the early postoperative period serves as an early physiological marker after SLT. Methods We retrospectively analyzed SLT recipients who underwent surgery at Okayama University Hospital between 1998 and 2021 and completed QLPS approximately 3 months posttransplant. The graft perfusion ratio (graft flow/total pulmonary flow × 100%) was quantified, and recipients were classified into high (≥ 80%) and low (< 80%) perfusion groups. CLAD‐free survival, overall survival, and longitudinal perfusion changes were compared using Kaplan–Meier analysis and repeated‐measures ANOVA. Results Recipients with higher graft perfusion demonstrated significantly better CLAD‐free survival ( p = 0.027). Overall survival was higher in the high‐perfusion group, although the difference did not reach statistical significance ( p = 0.075). Repeated‐measures ANOVA revealed a significant group‐by‐time interaction ( p = 0.019): recipients who developed CLAD had lower graft perfusion as early as 3 months after transplantation, followed by a progressive decline, whereas those who did not develop CLAD maintained stable perfusion. In the multivariable Cox analysis, higher graft perfusion was associated with a lower hazard of reaching the composite CLAD‐free survival endpoint. Conclusions Early postoperative graft perfusion assessed by QLPS may serve as a noninvasive physiological marker after SLT. Higher graft‐directed perfusion was associated with a lower hazard of reaching the composite CLAD‐free survival endpoint and may aid early risk stratification and posttransplant surveillance.
Background Lung transplantation requires meticulous preoperative assessment. Recipients with Group 3 pulmonary hypertension can be at higher risk of mortality and primary graft dysfunction (PGD). We conducted a study to determine whether the right ventricular stroke work index (RVSWI), a right‐heart catheterisation haemodynamic indicator assessing right ventricle function, could predict 1‐year survival in this setting. Methods Monocentric, retrospective, observational cohort study approved by our local ethics review board, between January 2013 and December 2023. We included lung transplant recipients who underwent preprocedural right‐heart catheterisation assessment and presented with Group 3 pulmonary hypertension. We first determined a clinically relevant RVSWI threshold. The primary endpoint was mortality at 1 year amongst two groups of patients according to this threshold. Results 66 patients (age 57.0 ± 11.4 years, male 56%) were included amongst a study population of 699 patients. Double‐lung transplantations represented most of the procedures (91%). In univariate analysis, RVSWI was statistically associated with PGD Grade 3 at Day 3 and intraoperative veno‐arterial extracorporeal membrane oxygenation (ECMO) at a threshold of RVSWI = 13.5. Mortality at 1 year did not differ between the groups RVSWI ≤ 13.5 (6 patients, 14.6%) and RVSWI > 13.5 (6 patients, 24%) even after accounting for potential confounding factors. Conclusions In our lung transplant population with Group 3 pulmonary hypertension, RVSWI was not associated with mortality at 1 year. A higher RVSWI seemed associated with significant events such as intraoperative ECMO and PGD Grade 3. Further studies are needed to assess RVSWI’s prognostic value in this setting.
Living donor liver transplantation offers significant benefits to recipients, yet risks to donors remain incompletely characterized. We examined short- and intermediate-term outcomes associated with living liver donation using the Scientific Registry of Transplant Recipients. This retrospective cohort study included 8619 donors aged 18–65 years who donated between 1989 and 2023, of whom 8314 had follow-up data for secondary outcomes. Donors were categorized by era: early (1989–2006) and contemporary (2007–2023). Primary outcomes were 90-day and 2-year mortality; secondary outcomes were changes in physical capacity, functional status, and employment. Mean donor age was 36 years, and 53% were female. Eight donors (0.1%) died within 90 days and 18 (0.2%) within 2 years. Mortality was lower in the contemporary era at both 90 days (HR: 0.14, 95% CI: 0.03–0.70) and 2 years (HR: 0.06, 95% CI: 0.02–0.18). Reduced physical capacity at 6 months was more common among contemporary-era donors (aOR: 3.25, 95% CI: 1.32–8.00) and Hispanic donors (aOR: 2.07, 95% CI: 1.29–3.32). Reduced employment was more common among non-White donors at 6 months and 1 year (aOR: 2.04, 95% CI: 1.40–2.97 at 1 year), and among female donors at all timepoints (aOR: 1.71, 95% CI: 1.29–2.25 at 1 year). Living liver donor mortality has declined over the past three decades, and long-term physical impairments are uncommon. Reduced employment following donation is disproportionately reported by female and non-White donors. These findings provide a benchmark for center-level assessment of donor outcomes and may inform donor counseling that addresses occupational circumstances alongside surgical risk.
Background Thoracoabdominal normothermic regional perfusion (TA‐NRP) and hypothermic machine perfusion (HMP) reduce ischemia–reperfusion injury after donation after circulatory death (DCD) kidney transplantation, but their combined effects remain unclear. Methods Adult DCD kidney‐only recipients undergoing pretransplant dialysis in the OPTN registry (2020–2025) were stratified by TA‐NRP and HMP. The primary outcome was delayed graft function (DGF). Multivariable logistic regression included a TA‐NRP × HMP interaction and adjusted for recipient and donor factors. Death‐censored graft survival (DCGS) was evaluated by Kaplan–Meier analysis. Results Among 3502 recipients, DGF differed by preservation strategy. In the non‐TA‐NRP cohort, HMP significantly reduced DGF compared with static cold storage (SCS) (44.2% vs 53.8%; p = 0.001) and remained independently protective (adjusted OR 0.56; 95% CI 0.44–0.71; p < 0.001). In the TA‐NRP cohort, DGF rates were similar between HMP and SCS (26.7% vs 27.0%; p = 0.98), with no independent association after adjustment (adjusted OR 0.82; 95% CI 0.62–1.08; p = 0.16). A significant TA‐NRP × HMP interaction was observed ( p = 0.039). In the absence of HMP, TA‐NRP was strongly protective against DGF (adjusted OR 0.30; 95% CI 0.22–0.42; p < 0.001). At 3 years, DCGS was 93.9% (95% CI 91.5–96.4) for TA‐NRP‐HMP, 94.3% (90.9–97.9) for TA‐NRP‐SCS, 93.5% (91.5–95.6) for non‐TA‐NRP‐HMP, and 92.7% (89.1–96.6) for non‐TA‐NRP‐SCS, with no difference between groups (log‐rank p = 0.73). Conclusion TA‐NRP was associated with lower DGF than conventional DCD procurement. Within the TA‐NRP cohort, HMP was not associated with additional reductions in DGF. These findings should be interpreted in light of the surrogate definition used to identify TA‐NRP in the OPTN registry and warrant prospective validation.
