Background:Abdominal normothermic regional perfusion (A-NRP) is postmortem perfusion of organs in the abdominal cavity and can be performed using multiple approaches, including femoral, intra-abdominal, and thoracic. Our program began with surgeons performing intra-abdominal cannulations with mechanical or balloon occlusion of the descending thoracic aorta for A-NRP procedures. Recently, we developed a novel technique using the descending thoracic aorta for arterial cannulation with right atrial venous drainage. Methods:All A-NRP cases performed by Regional Perfusion Services from July 1, 2024, to June 30, 2025, were retrospectively reviewed. Intraoperative parameters were collected for comparison. Results:During the study period, 28 intra-abdominal normothermic regional perfusion (IA-NRP) cannulations and 47 descending thoracic normothermic regional perfusion (DT-NRP) cannulations were performed by 16 surgeons. Median cannulation time was shorter in the DT-NRP cohort (8.5 versus 10.0 min; P = 0.016). Median time on NRP was shorter in the IA-NRP cohort (61.5 versus 91.0 min; P = 0.006). The median decrease in lactate was larger in the DT-NRP cohort (2.9 versus 2.3 mmol/dL; P = 0.024). The median number of transfusions used was higher in the IA-NRP cohort (3.0 versus 0.0; P < 0.001). The learning curves show a quicker descent in time and a lower nadir for the DT-NRP cases, indicating this technique may have a quicker learning curve and be a more efficient approach to cannulation. Conclusions:DT-NRP cannulation can be implemented for A-NRP with a quick learning curve, providing an additional cannulation option to the IA-NRP approach.
Background. Although robotic kidney transplantation (RKT) is an emerging minimally invasive surgical technique, graft anatomical variations such as multiple renal arteries (MRAs) remain a perceived limitation to its broader dissemination. This study evaluates the feasibility and short-term outcomes of RKT in grafts with MRAs compared with single renal artery (SRA) grafts. Methods. We conducted a retrospective review of RKT procedures performed at a single center from November 2021 to January 2026. Perioperative and postoperative outcomes were compared between MRA and SRA cohorts. A subanalysis was performed within the MRA group to assess the impact of single versus multiple arterial anastomoses. All RKTs were performed using the Da Vinci Xi system. Results. In the assessed period, 126 robotic-assisted kidney transplants were performed: 94 with SRA (74.6%) and 32 with MRAs (25.4%). Across the overall cohort, 1 patient (0.8%) had their operation converted to an open procedure. Total operative time had a median duration of 257 min (interquartile range [IQR], 213.0–309.8) in the SRA cohort compared with 303 min (IQR, 269.2–355.2) in the MRA cohort ( P = 0.004). Warm ischemia time was measured at 34 min (IQR, 29.0–42.0) in the SRA group and at 40 min (IQR, 33.0–45.2) in the MRA group ( P = 0.013). Within the MRA cohort, 9 grafts (28.1%) required a single arterial anastomosis (SAA) and 23 (71.9%) required multiple arterial anastomoses (MAA). The median operative time was 270 min (IQR, 210.0–305.0; SAA) versus 313 min (IQR, 283.5–392.5; MAA, P = 0.033). Warm ischemia time, anastomosis time, blood loss, length of stay, delayed graft function, serum creatinine at 1 mo, and graft survival did not differ between SAA and MAA cohorts. Conclusions. RKT using grafts with MRAs is technically feasible and yields perioperative and short-term outcomes comparable with those of SRA grafts. The presence of MRAs should not be considered a contraindication to robotic transplantation.
Background:Tacrolimus (TAC) trough-level variability has been associated with patient outcomes and renal graft survival. However, its relationship with posttransplant diabetes mellitus (PTDM) remains unclear. This study aims to evaluate the association between the coefficient of variation (CV) of TAC (TAC-CV) and the incidence of PTDM within the first year after kidney transplantation (KT). Methods:A multicenter retrospective study was conducted on 516 Thai KT patients who received TAC-based immunosuppressive regimens from 2011 to 2020, with a 1-y post-KT follow-up period. TAC-CV was calculated for the 0-12 mo post-KT period, and optimal cutoff values were determined using receiver operating characteristic analysis. Results:Of the 516 patients, 208 (40.31%) developed PTDM, whereas 308 (59.69%) did not during the first year post-KT. Significant associations were found between TAC-CV and PTDM throughout the study period (P < 0.001). The optimal CV cutoff values were identified as 36% (at 0-3 and 0-6 mo), 23% (at 6-12 mo), and 33% (at 0-12 mo) post-KT. High TAC-CV was strongly associated with an increased risk of PTDM during the first year post-KT. Conclusions:These findings suggest that TAC-CV may serve as a valuable marker for identifying patients at high risk of PTDM and may aid in its prevention and effective management in KT recipients.
Background:There are limited data on the impact of azole antifungal use on the appropriate dose conversion strategy from immediate-release tacrolimus (IR-Tac) to once-daily extended-release tacrolimus (LCP-Tacro tablets [LCPT]). The purpose of this study was to determine whether the initial IR-Tac-to-LCPT conversion ratio is affected by azole antifungal use. Methods:This single-center, retrospective cohort study included adult non-kidney transplant recipients who were converted from IR-Tac to LCPT between 2015 and 2022. Patients were grouped by azole antifungal use. The primary outcome was the IR-Tac-to-LCPT conversion ratio for those at goal tacrolimus trough, stratified by azole antifungal use. Secondary outcomes included conversion indications, acute kidney injury, neurological adverse effects, and rejection. Results:A total of 113 transplant recipients were included (liver 23 [20.4%], heart 70 [61.9%], lung 9 [8.0%], and multiorgan 11 [9.8%]). Twenty-two patients (19.5%) were on azole antifungals. A larger proportion of lung transplant recipients were on azole therapy compared with non-lung allograft recipients (27.3% versus 3.3%, P = 0.004). Conversion ratios were significantly higher for patients on azoles at 7 d (P = 0.031), 30 d (P = 0.038), and 90 d (P = 0.001). Azole use was associated with lower LCPT doses at 7 d. There was no difference in patients at goal concentration or in the incidence of acute kidney injury between cohorts. Neurologic adverse effects related to IR-Tac prompted conversion in 55 patients, with 79.3% reporting improvement on LCPT. Conclusions:LCPT may be safely used in non-kidney transplant recipients regardless of azole antifungal use. Patients converting from IR-Tac to LCPT taking azole antifungals may warrant a higher dose conversion ratio, closer to 1, to achieve comparable tacrolimus trough concentrations.
