Kidney transplantation is the treatment of choice for patients with end-stage renal disease. Kidneys with complex vascular anatomy are prevalent in donors, and due to donor shortage, the acceptance of these kidneys for transplantation has increased over time. Donor kidneys with both complex vascular and urological anatomy are rare and using it in a recipient for second kidney transplantation with successful outcome is very rare. We report a case managed at our facility. A 40-year-old male presented at the urology clinic, Zenith Medical and Kidney Center, Abuja, Nigeria, as a potential kidney donor for a 62-year-old male with end-stage kidney disease (ESKD) secondary to human immunodeficiency virus-associated nephropathy (HIVAN). Donor renal angiogram revealed 3 left renal arteries and 2 right renal arteries, with bilateral duplex ureters. The donor had a left open donor nephrectomy that yielded a kidney with 3 renal arteries, 1 renal vein, and 2 ureters. This was used for the recipient surgery, which was a second kidney transplant with a successful outcome. The need for more donors for kidney transplantation has led to the use of donor kidneys with both complex vascular and urological anatomy. The outcome following these surgeries was successful for both the donor and recipient, with immediate graft function after kidney transplant.
Outcomes in liver transplantation remain constrained by challenges in donor selection, organ allocation, and long-term graft survival, and traditional scoring systems such as MELD, SOFT, and the Donor Risk Index have well-recognized limitations in capturing the nonlinear complexity of transplant data. Artificial intelligence (AI), including machine learning (ML) and deep learning (DL), offers analytical methods capable of processing high-dimensional data beyond conventional regression, but the maturity and clinical readiness of this evidence base across the liver transplant continuum have not been comprehensively characterized. A narrative review was conducted via systematic search of PubMed, MEDLINE, and the Cochrane Library (January 1991-June 2025) using combinations of terms including “artificial intelligence,” “machine learning,” “deep learning,” “liver transplant,” “organ allocation,” and “graft failure.” Of 754 records identified, 45 studies met inclusion criteria following independent dual-reviewer screening. Each study was classified by evidence level as exploratory (internal validation only), externally validated, or implementation-oriented, and organized according to the pre-transplant and post-transplant continuum. AI applications span transplant candidacy assessment, organ allocation and waitlist prioritization, donor-recipient matching, graft quality assessment, and post-transplant prediction of acute kidney injury, sepsis, cardiovascular events, graft dysfunction, biliary complications, hepatocellular carcinoma (HCC) recurrence, immunosuppression dosing, and mortality. Performance varied widely (AUC/C-index 0.63-0.99), with the most methodologically mature evidence found for HCC recurrence prediction (C-index 0.75-0.839, including one internationally validated model) and waitlist mortality modeling. Notably, logistic regression outperformed several ML algorithms in the largest donor-recipient matching registry analyzed (n > 39,000), and cross-national validation of mortality models revealed substantial performance degradation (AUROC 0.70-0.74) when applied across healthcare systems. Fewer than half of included studies used explainability methods such as SHAP, and only two models explicitly incorporated equity considerations into their design. AI is increasingly applied across the liver transplant continuum and shows particular promise for HCC recurrence prediction and waitlist risk stratification. However, the field is limited by a predominance of single-center exploratory studies with internal validation only, inadequate attention to algorithmic fairness and bias, and an absence of prospective evaluation or regulatory engagement-no AI model in liver transplantation has yet received regulatory approval for clinical use. Future progress will require standardized data frameworks, multicenter prospective validation, formal reporting guidelines, and equity auditing before AI tools can be considered genuinely practice-changing.
Kidney transplantation is the preferred therapy for end-stage kidney disease (ESKD), but long-term success is greatly influenced by the selection and safety of immunosuppressants. Local data on prescribing patterns and the incidence of drug side effects in Indonesia are still limited. Therefore, this study aims to evaluate induction therapy patterns, immunosuppressant maintenance, and the incidence of drug-related side effects among kidney transplant recipients at a tertiary hospital in Yogyakarta, Indonesia. Materials and methods: This was a retrospective cohort study of recipients aged ≥18 years who underwent outpatient follow-up between January 2017 and July 2024. Complete medical records were analyzed descriptively, with variables including recipient and donor characteristics, induction and maintenance immunosuppressive regimens, and adverse drug reactions such as infections and non-infections during the 12 months post-transplantation. A total of 57 among the 87 recipients met the inclusion criteria, comprising 70.2% male, 56.1% aged 18-39 years, 98.2% with a history of dialysis, 77.2% with hypertension, and all living donors. Basiliximab induction was administered to all recipients (100%) in combination with triple therapy of tacrolimus, mycophenolate sodium (MPS) or mycophenolate mofetil (MMF) and steroids. Maintenance therapy was predominantly tacrolimus, MPS, steroids 43/57 (75.4%), and tacrolimus, MMF, steroids 14/57 (24.6%). The most common adverse drug events were urinary tract infections (31.6%), followed by cytomegalovirus (CMV, 5.3%) and herpes zoster (3.5%). Non-infectious events included diarrhea (7%), tremor (3.5%), dyslipidemia (3.5%), and new-onset diabetes after transplantation (NODAT) (3.5%). Basiliximab induction and tacrolimus-mycophenolate-steroid maintenance therapy were the predominant immunosuppressive regimens and were associated with an acceptable first-year safety profile. Close monitoring for opportunistic infections, optimization of tacrolimus levels, and structured pharmacovigilance are required to maintain graft function.
Subcutaneous transplantation of islets into small-pore macroencapsulation devices that prevent immune cell passage can inhibit allorejection in rodents. However, there are no reports of euglycemia in humans using this technology. This report further develops these macroencapsulation devices. We compared the ability of macroencapsulation transplant devices containing transformed mouse islet cells (MIN-6) with varying polymer membranes, pore sizes, and hydrophilicity to inhibit allorejection and maintain glycemic control in diabetic mice. We found that 10 μm pore planar polytetrafluoroethylene (PTFE) devices do not inhibit allorejection; 1-2 μm pore devices allow only partial protection; and 0.4 μm devices prevent long-term allorejection. A more hydrophilic PTFE membrane (PTFE-HP) improves device function. Devices constructed with nylon and, secondly, PTFE-HP membranes serve as transplant devices better than those constructed with polyvinylidene fluoride (PVDF), fluorinated ethylene propylene (FEP), ethylenetetrafluoroethylene (ETFE), or polyethersulfone (PES), and result in a lower fibrotic response. Allo-presensitized mice are equally protected from allorejection with 0.4 μm pore PTFE-HP transplant devices as non-presensitized mice. Our layered membrane macroencapsulation device is as effective as a single planar device in inhibiting allorejection. Nylon and, secondly, hydrophilic PTFE macroencapsulation transplant devices with 0.4 μm pores robustly prevent allotransplant rejection compared with all membranes tested and induce the least fibrosis. Future studies with nylon membranes are warranted. A multilayered device is described that reduces the skin surface requirement and increases potential islet load. A transplant model using MIN-6 cells is feasible for studying such devices to prevent allorejection.
Aseptic femoral shaft nonunion represents a biologically compromised state in which impaired osteogenesis, insufficient vascularity, and inadequate mechanical stability prevent healing. Although mechanical revision is essential, achieving union often requires effective autologous bone tissue transplantation and biologic stimulation. This study evaluated a multimodal revision strategy integrating structural and cancellous autografts with mechanical reconstruction to restore both biological viability and stability at the nonunion site. Fifty-four patients with aseptic femoral shaft nonunion were retrospectively reviewed. Revision procedures included exchange nailing, augmentation plating with retained nail, plate replacement, or dynamization. All biologic strategies were based on autologous bone transplantation, including iliac crest cancellous bone grafting, cortical onlay strut grafts harvested from the iliac crest, and Judet osteoperiosteal decortication to enhance local vascularity. Union was assessed based on clinical and radiographic criteria during follow-up. The overall union rate was 96.3% (52/54). Hypertrophic and oligotrophic nonunions achieved 100% union, whereas atrophic nonunions achieved 83.3%. Both exchange nailing and augmentation plating resulted in 100% healing. The most favorable outcomes were observed in patients receiving combined autologous bone grafting (cancellous autograft ± cortical strut graft) together with Judet decortication, underscoring the importance of restoring osteogenic potential and biological activity in addition to mechanical rigidity. Multimodal revision combining stable fixation with autologous bone graft transplantation and biologic enhancement provides an effective treatment option for aseptic femoral shaft nonunion. These findings reinforce the principle that addressing biological insufficiency—through cancellous autografting, cortical strut transplantation, and decortication—is essential to achieving successful bone regeneration, particularly in atrophic nonunion.
