Organ allotransplantation remains the gold standard for treating end-stage organ failure, yet the chronic shortage of donor organs limits access to life-saving therapy. Xenotransplantation, particularly the use of genetically modified pigs as organ donors, has emerged as a viable alternative, supported by decades of preclinical research and recent breakthroughs in gene editing and immunosuppressive protocols. The current era of solid organ xenotransplantation began in 2021 with studies involving human recipients who were brain dead and has since progressed to the transplantation of porcine hearts, kidneys, and a liver into living patients. While initial cases were complicated by significant comorbidities and short-term survival, recent xenotransplants in carefully selected patients have yielded improved outcomes. Notably, one recipient of a porcine kidney recently passed the six-month post-transplant mark, an important milestone for the field. Regulatory momentum is also building. In 2025, the U.S. Food and Drug Administration approved clinical trials led by United Therapeutics and eGenesis targeting patients with end-stage kidney disease. The upcoming 18th Congress of the International Xenotransplantation Association, to be held in Geneva, Switzerland, from 30 September to 3 October 2025, underscores the global relevance of the current breakthrough. Geneva has historic ties to the field, having hosted key early policy discussions and managed the International Human Xenotransplantation Inventory for over a decade. As xenotransplantation moves into a new clinical era, continued collaboration as well as ethical and regulatory oversight will be essential to guide its safe and effective implementation.

Background: Small bowel obstruction (SBO) is a common hospital admission diagnosis. Identification of patients who will require a surgical resection because of a nonviable small bowel remains a challenge. Through a prospective cohort study, the authors aimed to validate risk factors and scores for intestinal resection, and to develop a practical clinical score designed to guide surgical versus conservative management. Patients and Methods: All patients admitted for an acute SBO between 2004 and 2016 in the center were included. Patients were divided in three categories depending on the management: conservative, surgical with bowel resection, and surgical without bowel resection. The outcome variable was small bowel necrosis. Logistic regression models were used to identify the best predictors. Results: Seven hundred and thirteen patients were included in this study, 492 in the development cohort and 221 in the validation cohort. Sixty-seven percent had surgery, of which 21% had small bowel resection. Thirty-three percent were treated conservatively. Eight variables were identified with a strong association with small bowel resection: age 70 years of age and above, first episode of SBO, no bowel movement for greater than or equal to 3 days, abdominal guarding, C-reactive protein greater than or equal to 50, and three abdominal computer tomography scanner signs: small bowel transition point, lack of small bowel contrast enhancement, and the presence of greater than 500 ml of intra-abdominal fluid. Sensitivity and specificity of this score were 65 and 88%, respectively, and the area under the curve was 0.84 (95% CI: 0.80–0.89). Conclusion: The authors developed and validated a practical clinical severity score designed to tailor management of patients presenting with an SBO.

Ongoing confinement for millions of urban citizens due to the Covid-19 pandemic has raised ecological consciousness, changed food habits and questioned the relationship urban dwellers have with nature. There is more interest in bringing plants into urban homes and in sustainable food sources, but no research have studied the relationships between food behaviours and plant-care activities. To address this gap and explore urban citizens' nature relatedness through the greening of private areas, we conducted a national survey of French, young urban citizens (n = 1000), who are more committed to 'edible' cities than older generations but have the lowest rate of plant purchasers. A quantitative approach reveals the prevalence of aesthetic/hedonistic expectations for plants in private housing but also demonstrates contrasting perceptions of tasks for plant maintaining and unequal valuation of social issues around plants. We discuss continuities between environmental awareness, commitment to sustainable food and natural/social uses of plants and argue that urban planning processes should address potential synergies for more integrative resilience. Community building around green areas, urban agriculture or collective gardens, in cities, can have ripple effects towards the greening of private housing. Lastly, the multidisciplinary approach bridging psychosociology and urban studies can inspire multi-scalar urban planning.

Background Achieving proficiency in a surgical procedure is a milestone in the career of a trainee. We introduced a competency assessment tool for laparoscopic cholecystectomy in our residency program. Our aim was to assess the inter-rater reliability of this tool. Methods We included all laparoscopic cholecystectomies performed by residents under the supervision of board certified surgeons. All residents were assessed at the end of the procedure by the supervising surgeon (live reviewer) using our competency assessment tool. Video records of the same procedure were analyzed by two independent reviewers (reviewer A and B), who were blinded to the performing trainee’s. The assessment had three parts: a laparoscopic cholecystectomy-specific assessment tool (LCAT), the objective structured assessment of technical skills (OSATS) and a 5-item visual analogue scale (VAS) to address the surgeon’s autonomy in each part of the cholecystectomy. We compared the assessment scores of the live supervising surgeon and the video reviewers. Results We included 15 junior residents who performed 42 laparoscopic cholecystectomies. Scoring results from live and video reviewer were comparable except for the OSATS and VAS part. The score for OSATS by the live reviewer and reviewer B were 3.68 vs. 4.26 respectively ( p = 0.04) and for VAS (5.17 vs. 4.63 respectively ( p = 0.03). The same difference was found between reviewers A and B with OSATS score (3.75 vs. 4.26 respectively ( p = 0.001)) and VAS (5.56 vs. 4.63 respectively; p = 0.004)). Conclusion Our competency assessment tool for the evaluation of surgical skills specific to laparoscopic cholecystectomy has been shown to be objective and comparable in-between raters during live procedure or on video material.

Abstract Objective Small bowel obstruction (SBO) is a common hospital admission diagnosis. Identification of patients who will require a surgical resection because of a non-viable small bowel remains a challenge. We aimed to identify risk factors for intestinal resection in patients with SBO and to develop a practical clinical score designed to guide surgical vs. conservative management. Methods We performed a prospective cohort study and included all patients admitted for an acute SBO between 2007 and 2016 in our center. Patients were divided in three categories: conservative management, surgical treatment with or without bowel resection. Clinical variables were assessed and compared between groups. Logistic regression models were used to identify the best predictors. Results 604 patients were included in this study. 438 (73%) had surgery of which 127 (21%) had small bowel resection. 166 (27%) patients were treated conservatively. Among 13 clinical variables, univariate and multivariate logistic regression models identified 8 variables with a strong association with small bowel resection: age ≥70 years, a first episode of SBO, absence of bowel movement for ≥3 days, abdominal guarding, C-reactive protein ≥50, and 3 signs on abdominal CT-scan, namely, small bowel transition point, lack of small bowel contrast enhancement, and the presence of > 500 mL of intra-abdominal fluid. Each variable was given one point. We observed that 71-100% of patients with ≥4 points required a surgical resection. Sensitivity and specificity of this score were 65% and 88%, respectively and the area under the curve (AUC) was 0.84 (95% CI 0.80-0.89). Additionally, we propose two variants of the 8-tem score: a 7-item score excluding the lack of contrast enhancement, specifically designed for patient with contrast allergies or renal insufficiency, and a simplified 4-item score leaving age, guarding, transition zone on CT-scan, and the presence of 500 mL of fluid on CT scan. Both scores showed similar performances compared to the 8-item score with an AUC of 0.83 and 0.80 for the 7- and 4-item scores, respectively. Conclusion We developed a practical clinical severity score designed to tailor management of patients presenting with a SBO. A score of ≥ 4 points indicates the need for surgical exploration given the high likelihood of small bowel ischemia in these patients.

Our objective was to describe the aetiologies of acute colitis and to identify patients who require diagnostic endoscopy. Patients with symptoms of gastrointestinal infection and colonic inflammation on computed tomography were prospectively included. Those immunosuppressed, with history of colorectal cancer or inflammatory bowel disease (IBD) were excluded. Stools were screened with BD-Max and BioFire FilmArray GI panel. Faecal calprotectin was determined. Patients with negative BD-Max underwent colonoscopy. The study was registered into clinicaltrials.gov (NCT02709213). One hundred and seventy-nine patients were included. BD-Max was positive in 93 patients (52%) and FilmArray in 108 patients (60.3%). Patients with infectious colitis (n = 103, 57.5%) were positive for Campylobacter spp (n = 57, 55.3%), Escherichia coli spp (n = 8, 7.8%), Clostridium difficile (n = 23, 22.3%), Salmonella spp (n = 9, 8.7%), viruses (n = 7, 6.8%), Shigella spp (n = 6, 5.8%), Entamoeba histolytica (n = 2, 1.9%) and others (n = 4, 3.9%). Eighty-six patients underwent colonoscopy, which was compatible with ischemic colitis in 18 patients (10.1%) and IBD in 4 patients (2.2%). Among patients with negative FilmArray, a faecal calprotectin >625μg/g allowed identifying patients with IBD with an area under ROC curve of 85.1%. Introduction of a diagnostic management algorithm including FilmArray and faecal calprotectin could allow decreasing unnecessary colonoscopies from 82 to 29 (corresponding to a decrease of 64.6%). Computed tomography-proven colitis was mostly of infectious aetiology. Diagnostic management of patients with acute colitis should include broad molecular testing of the stools and, in patients with a calprotectin concentration >625μg/g, colonoscopy to exclude IBD.

(1) Background: Platelets were postulated to constitute the trigger of liver regeneration. The aim of this study was to dissect the cellular interactions between the various liver cells involved in liver regeneration and to clarify the role of platelets. (2) Methods: Primary mouse liver sinusoidal endothelial cells (LSECs) were co-incubated with increasing numbers of resting platelets, activated platelets, or platelet releasates. Alterations in the secretion of growth factors were measured. The active fractions of platelet releasates were characterized and their effects on hepatocyte proliferation assessed. Finally, conditioned media of LSECs exposed to platelets were added to primary hepatic stellate cells (HSCs). Secretion of hepatocyte growth factor (HGF) and hepatocyte proliferation were measured. After partial hepatectomy in mice, platelet and liver sinusoidal endothelial cell (LSEC) interactions were analyzed in vivo by confocal microscopy, and interleukin-6 (IL-6) and HGF levels were determined. (3) Results: Co-incubation of increasing numbers of platelets with LSECs resulted in enhanced IL-6 secretion by LSECs. The effect was mediated by the platelet releasate, notably a thermolabile soluble factor with a molecular weight over 100 kDa. The conditioned medium of LSECs exposed to platelets did not increase proliferation of primary hepatocytes when compared to LSECs alone but stimulated hepatocyte growth factor (HGF) secretion by HSCs, which led to hepatocyte proliferation. Following partial hepatectomy, in vivo adhesion of platelets to LSECs was significantly increased when compared to sham-operated mice. Clopidogrel inhibited HGF secretion after partial hepatectomy. (4) Conclusion: Our findings indicate that platelets interact with LSECs after partial hepatectomy and activate them to release a large molecule of protein nature, which constitutes the initial trigger for liver regeneration.

Objective: The aim of this study was to develop and validate a prediction score for internal hernia (IH) after Roux-en-Y gastric bypass (RYGB). Summary Background Data: The clinical diagnosis of IH is challenging. A sensitivity of 63% to 92% was reported for computed tomography (CT). Methods: Consecutive patients admitted for abdominal pain after RYGB and undergoing CT and surgical exploration were included retrospectively. Potential clinical predictors and radiological signs of IH were entered in binary logistic regression analysis to determine a predictive score of surgically confirmed IH in the Geneva training set (January 2006–December 2014), and validated in 3 centers, Geneva (January 2015–December 2017) and Neuchâtel and Strasbourg (January 2012–December 2017). Results: Two hundred twenty-eight patients were included, 80 of whom (35.5%) had surgically confirmed IH, 38 (16.6%) had a negative laparoscopy, and 110 (48.2%) had an alternate diagnosis. In the training set of 61 patients, excess body weight loss >95% (odds ratio [OR] 6.73, 95% confidence interval [CI]: 1.13–39.96), swirl sign (OR 8.93, 95% CI: 2.30–34.70), and free liquid (OR 4.53, 95% CI: 1.08–19.0) were independent predictors of IH. Area under the curve (AUC) of the score was 0.799. In the validation set of 167 patients, AUC was 0.846. A score ≥2 was associated with an IH incidence of 60.7% (34/56), and 5.3% (3/56) had a negative laparoscopy. Conclusions: The score could be incorporated in the clinical setting. To reduce the risk of delayed IH diagnosis, emergency explorative laparoscopy in patients with a score ≥ 2 should be considered.

Robotic surgery has emerged as a promising minimally invasive surgical technique, with the ability to perform complex hepatobiliary surgeries and achieve outcomes similar to open surgery, but with the advantages of a minimally invasive approach. Recent advances in computer-assisted image-guided surgery are proposed to overcome some of the associated limitations of robotic surgery by preoperatively planning the surgical strategy with a patient-specific virtual resection plan, which can be directly transferred to the operating room in an augmented reality setup. Using new technologies, we could theoretically improve the preoperative planning, enhance the surgeon's skill, and simplify complex procedures. Specifically, using an optical tracking system, calibrated on the patient, we used images-overlay navigation for the location of the lesions during robotic liver resections. Based on our experience, we suggest that robotic image guidance can improve the surgeon's orientation during the operation, increasing the accuracy of tumor resection. The indications for robotic-assisted liver resection will increase in the coming years. This chapter reviews the recent development of robotic hepatic surgery, discussing its advantages and disadvantages in daily practice. The most common surgical procedures are described and, finally, the evolution of robotic surgery, one of the hottest fields in medical technology, is detailed.

The relevance of vitamin D for infections after kidney transplantation is poorly defined. 25‐OH vitamin D (25‐OHD) levels of 135 kidney transplant recipients, enrolled in the Swiss Transplant Cohort Study, were determined peri‐transplant and 6 months post‐transplant. Logistic regression was used to address the associations of 25‐OHD and overall infections and bacterial infections, respectively. For the first 6 months post‐transplant, 25‐OHD peri‐transplant, and for the second period (after 6 to 30 months post‐transplant), 25‐OHD at 6 months post‐transplant was considered. Vitamin D deficiency was common peri‐transplant and remained highly prevalent 6 months after transplantation despite frequent supplementation. Median 25‐OHD levels increased from 12.0 ng/mL (IQR 5.3‐19.5) peri‐transplant to 16.5 ng/mL (IQR 10.6‐22.6) 6 months post‐transplant (P = .005). We did not detect a significant association between 25‐OHD and overall infections (adjusted odds ratio (aOR) 1.05, 95% confidence interval (95%CI) 0.44‐2.51; aOR 0.67, 95%CI 0.31‐1.43) or bacterial infections (aOR 0.79, 95%CI 0.32‐1.96; aOR 0.79, 95%CI 0.35‐1.75) for the first and second period. To conclude, at both time points, vitamin D deficiency was observed in more than 50% of kidney recipients, albeit an increase in 25‐OHD in the longitudinal course was observed. No significant association between 25‐OHD and infections was detected.

Background: Surgical venous cutdown is a method for totally implantable venous access device (TIVAD) insertion. The main drawback of this technique is its higher failure rate when compared with the percutaneous approach, which is mostly related to anatomic variations of the cephalic vein. The aim of this study was to assess preoperative ultrasound imaging as a tool to predict cephalic vein cutdown failure for TIVAD insertion. Methods: Ultrasound and operative reports of a cohort of patients undergoing TIVAD insertion by cephalic vein cutdown were reviewed. Ultrasound venous (vein visibility, diameter, length, subcutaneous depth, vein path, and subclavian junction visibility) and patient variables were tested by logistic regression as predictors of TIVAD insertion failure. Results: One hundred sixty consecutive patients underwent cephalic vein cutdown for attempted TIVAD insertion. An inability to visualize the vein on the preoperative ultrasound examination (odds ratio, 4.39; 95% confidence interval, 1.57-12.30; P < .05) and depth of the vein (odds ratio, 1.07; 95% confidence interval, 1.00-1.15; P = .042) were predictors of failure of TIVAD insertion by cephalic vein cutdown. Conclusions: Preoperative ultrasound examination allows identifying patients at risk of failure of TIVAD insertion by cephalic vein cutdown. Preoperative ultrasound examination constitutes an efficient tool for choosing the most appropriate surgical approach and improving patient comfort.

Background: Patients with periampullary tumors frequently undergo endoscopic biliary investigations and biliary drainage (BD) prior to surgery. Recent literature shows a shift of the biliary microbiome toward more resistant bacteria in patients having BD. This study aimed to evaluate the local microbiome and changes induced by BD and related antibiotic exposure and to consider the choice of antibiotic for peri-operative prophylaxis. Methods: A single-center retrospective cohort study included patients operated on for periampullary tumors between January 2013 and November 2017. All patients had intra-operative bile samples taken for culture and peri-operative antibiotic use as well as documentation of complications according to the Dindo-Clavien classification. Results: A total of 37 patients were included. All received pre-operative endoscopy, and 29 (78%) had BD preceded by administration of ceftriaxone or metronidazole. Intra-operative antibiotic prophylaxis consisted of cefuroxime (92%) or ceftriaxone (13%) combined with metronidazole (100%). Bacterial contamination of bile samples was more common in the BD group than in the no biliary drainage (NBD) group (93% vs 38%; p < 0.01). A shift was observed from bile containing mainly Escherichia coli and Streptococcus spp. toward Enterococcus faecalis (0 in the NBD group versus 44.8% in the BD group; p < 0.01), Enterococcus faecium (0 versus 23%; p = 0.3), and Candida albicans (0 versus 34.5%; p = 0.08). Post-operative antibiotic modifications were common. No difference was found regarding Dindo-Clavien complications, post-operative stay, or antibiotic use in the two groups, although one patient in the NBD group who had pre-operative biliary endoscopy with antibiotic prophylaxis developed a fatal septic clot caused by Escherichia coli resistant to cefuroxime. Conclusions: We observed a significant change toward colonization by enterococci and fungi in the microbiome of patients who had pre-operative biliary investigations or drainage with antibiotic prophylaxis. These findings indicate that bile samples should be obtained systematically during surgery for periampullary tumors to guide any post-operative antibiotic therapy and peri-operative antibiotic prophylaxis and might need adaptation to target the modified microbiome.

Objective. Multiple Asian studies have proved the feasibility of laparoscopic approach for surgical treatment of gastric cancer. The difference between Asian and European patients could limit their application in Europe. We reviewed the literature for European studies comparing open gastrectomy with laparoscopic approach in the treatment of gastric cancer. Method . We searched the keywords gastric cancer and laparoscopy in MEDLINE and EMBASE. We included all studies published between 1990 and 2016 and conducted in Europe. Result . We found 1 randomized and 13 cohort studies which compared laparoscopic with open gastrectomy. We found no mean difference in the number of lymph nodes harvested between laparoscopic and open group (mean difference: -0.49; 95% CI: -2.42; 1.44, p=0.62) and no difference of short-term or long-term mortality (short-term odds ratio: 0.74, p=0.47; long-term odds ratio: 0.65, p=0.11). We found a longer operative time in the laparoscopic group (mean difference: 35.75 minutes, p<0.01) but lesser reoperation rate than the open group (odds ratio: 1.55 p=0.01). Conclusion . European based population studies found results comparable with their Asian counterpart. In the current state of evidence, minimally invasive surgery for gastric cancer is safe and can achieve the same oncological results.

Background: Interleukin-1 (IL-1)β and IL-1 receptor antagonist (IL-1Ra) have been proposed as important mediators during chronic liver diseases. We aimed to determine whether the modulation of IL-1β signaling with IL-1Ra impacts on liver fibrosis. Methods: We assessed the effects of IL-1β on human hepatic stellate cells (HSC) and in mouse models of liver fibrosis induced by bile duct ligation (BDL) or carbon tetrachloride treatment (CCl-4). Results: Human HSCs treated with IL-1β had increased IL-1β, IL-1Ra, and MMP-9 expressions in vitro. HSCs treated with IL-1β had reduced α-smooth muscle actin expression. These effects were all prevented by IL-1Ra treatment. In the BDL model, liver fibrosis and Kuppfer cell numbers were increased in IL-1Ra KO mice compared to wild type mice and wild type mice treated with IL-1Ra. In contrast, after CCl-4 treatment, fibrosis, HSC and Kupffer cell numbers were decreased in IL-1Ra KO mice compared to the other groups. IL-1Ra treatment provided a modest protective effect in the BDL model and was pro-fibrotic in the CCl-4 model. Conclusions: We demonstrated bivalent effects of IL-1Ra during liver fibrosis in mice. IL-1Ra was detrimental in the CCl-4 model, whereas it was protective in the BDL model. Altogether these data suggest that blocking IL-1-mediated inflammation may be beneficial only in selective liver fibrotic disease.

BACKGROUND: Enhanced recovery program is a multimodal, multidisciplinary-team, evidence-based care approach to reduce perioperative surgical stress, decrease morbidity and hospital stay, and improve recovery after surgery. This program may be most beneficial for elderly (≥70 y), but sparse series have investigated this question. OBJECTIVE: Feasibility and efficiency of a dedicated enhanced recovery program in the elderly as compared with standard care were studied. DESIGN: This was a nonblinded, randomized controlled study. SETTINGS: This study was conducted in a single high-volume university hospital. PATIENTS: A total of 150 eligible elderly patients undergoing elective colorectal surgery were included. INTERVENTIONS: Enhanced recovery after colorectal elective surgery in elderly patients was studied. MAIN OUTCOME MEASURES: The primary outcome was 30-day postoperative morbidity. Additional outcomes included hospital stay, readmission, postoperative pain, opioid consumption, independence preservation, and protocol compliance. RESULTS: An enhanced recovery program reduces postoperative morbidity according to Clavien-Dindo classification by 47% as compared with standard care (35% vs 65%; p = 0.0003), total number of complications (54 vs 118; p = 0.0003), and infectious complications (13 vs 29; p = 0.001). No anastomotic leak was recorded in the enhanced recovery group versus 5 for the standard group (p = 0.01). The enhanced recovery program resulted in shorter hospital stay (7 vs 12 d; p = 0.003) and better independence preservation (home discharge, 87% vs 67%; p = 0.005). A high protocol compliance of 77.2% could be achieved in this population. According to multivariate analysis, enhanced recovery program was strongly associated with reduced morbidity (OR = 0.23 (95% CI, 0.09–0.57); p = 0.001), less severe complications (OR = 0.36 (95% CI, 0.15–0.84); p = 0.02), and shorter hospital stay (OR = 2.07 (95% CI, 1.33–3.22); p = 0.001). LIMITATIONS: Limitations were a single-center recruitment and the impossibility of subject or healthcare professional blinding attributed to the nature of this multimodal program. CONCLUSIONS: Enhanced recovery program is safe and improves postoperative recovery in elderly patients with decreased morbidity, shorter hospital stay, and better maintenance of independence. It should therefore be considered as a standard of care for elective colorectal surgery in elderly patients. See Video Abstract at http://links.lww.com/DCR/A981. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01646190. ENSAYO CONTROLADO ALEATORIZADO DE UN PROGRAMA DE RECUPERACIÓN INTENSIFICADA DEDICADO A PACIENTES DE EDAD AVANZADA DESPUÉS DE CIRUGÍA COLORECTAL ANTECEDENTES: El Programa de Recuperación Intensificada es un enfoque de atención multimodal, multidisciplinaria y basada en evidencia para reducir el estrés quirúrgico perioperatorio, disminuir la morbilidad y la estancia hospitalaria, y mejorar la recuperación después de la cirugía. Este programa puede ser más beneficioso para las personas mayores (≥70 años), pero pocas series han investigado esta pregunta. OBJETIVO: Viabilidad y eficiencia del Programa de Recuperación Intensificada dedicado en personas de edad avanzada en comparación con la atención estándar. DISEÑO: Este fue un estudio controlado, aleatorizado, sin método ciego. ESCENARIO: Este estudio se realizó en un único hospital universitario de alto volumen. PACIENTES: Un total de 150 pacientes de edad avanzada elegibles sometidos a cirugía colorrectal electiva fueron incluidos. INTERVENCIONES: Recuperación Intensificada después de cirugía electiva colorrectal en pacientes de edad avanzada. PRINCIPALES MEDIDAS DE RESULTADO: El resultado primario fue la morbilidad postoperatoria a 30 días. Los resultados adicionales incluyeron estancia hospitalaria, reingreso, dolor postoperatorio, consumo de opioides, preservación de la independencia y cumplimiento del protocolo. RESULTADOS: El Programa de Recuperación Intensificada reduce la morbilidad postoperatoria según la clasificación de Clavien-Dindo en un 47% en comparación con la atención estándar (35% vs 65%; p = 0.0003), número total de complicaciones (54 vs 118; p = 0.0003) y complicaciones infecciosas (13 vs 29; p = 0.001). No se registró ninguna fuga anastomótica en el grupo de Recuperación Intensificada frente a 5 para el grupo estándar (p = 0.01). El Programa de Recuperación Intensificada dio como resultado una estancia hospitalaria más corta (7 contra 12 días; p = 0.003) y una mejor conservación de la independencia (alta hospitalaria: 87% vs 67%; p = 0.005). Se pudo lograr un alto cumplimiento del protocolo del 77.2% en esta población. De acuerdo con el análisis multivariable, el Programa de Recuperación Intensificada se asoció fuertemente con la reducción de morbilidad (OR = 0.23; IC 95%: 0.09–0.57; p = 0.001), menos complicaciones graves (OR = 0.36; IC 95%: 0.15–0.84; p = 0.02) y estancia hospitalaria más corta (OR = 2.07; IC 95%: 1.33–3.22; p = 0.001). LIMITACIONES: Las limitaciones fueron un centro único de reclutamiento y la imposibilidad de que los pacientes o el profesional de la salud tuvieran cegamiento debido a la naturaleza de este programa multimodal. CONCLUSIONES: El Programa de recuperación Intensificada es seguro y mejora la recuperación postoperatoria en pacientes de edad avanzada, con menor morbilidad, menor estancia hospitalaria y mejor mantenimiento de la independencia. Por lo tanto, debe considerarse como un estándar de atención para la cirugía colorrectal electiva en pacientes de edad avanzada. Vea el Resumen en video en http://links.lww.com/DCR/A981.

Fig. 1.Manhattan plot visualizing genome-wide association of 61 cutaneous squamous cell carcinoma (cSCC)-organ transplant recipients (OTRs) and 908 skin cancer negative-OTRs, showing -log10 p-value of SNPtest along chromosomes.Horizontal red line represents the significant threshold p-value of 5×10 -8 .Arrow indicates single nucleotide polymorphism rs34567942 with the most prominent p-value.

The lack of suitable kidney donor organs has led to rising numbers of patients with end stage renal disease waiting for kidney transplantation. Despite decades of clinical experience and research, no evaluation process that can reliably predict the outcome of an organ has yet been established. This review is an overview of current methods and emerging techniques in the field of donor kidney evaluation prior to transplantation. Established techniques like histological evaluation, clinical scores, and machine perfusion systems offer relatively reliable predictions of delayed graft function but are unable to consistently predict graft survival. Emerging techniques including molecular biomarkers, new imaging technologies, and normothermic machine perfusion offer innovative approaches toward a more global evaluation of an organ with better outcome prediction and possibly even identification of targets for therapeutic interventions prior to transplantation. These techniques should be studied in randomized controlled trials to determine whether they can be safely used in routine clinical practice to ultimately reduce the discard rate and improve graft outcomes.

In solid organ transplant recipients (sOTRs), 5 years after transplantation cancer is a relevant cause of death. We aimed to report cancer incidence in the Swiss Transplant Cohort Study (STCS) between 2008 and 2014 and conducted a prospective cohort study of kidney, heart, lung, pancreas and liver transplant recipients enrolled into the STCS by retrospective analysis of collected data. The STCS provided data on 2758 solid organ transplants. In total, 134 cases of cancer were observed (30 liver, 21 prostate, 18 lung, 13 kidney, 52 other cancers). Standardised incidence ratios (SIRs) were highest for liver cancer, kidney cancer, thyroid cancer, gastric cancer, bladder cancer, cancer of the oral cavity and the pharynx and for lung cancer. Cancer occurrence differed according to the transplanted organ. Cancers were mainly diagnosed at World Health Organisation (WHO) stages I and IV. Treatment received was mainly surgery and, in some cases, included also radiation and/or chemotherapy. Bladder, kidney, liver, lung and prostate cancer were detected at a younger age compared with the general population. Cumulative hazards for death were increased for transplant recipients with cancer. Solid organ transplant recipients show an organ specific increase of cancer compared with the general Swiss population. Clinical trial registration number: NCT02333279.

Beyond their role in hemostasis, platelets are proposed as key mediators of several physiological and pathophysiological processes of the liver, such as liver regeneration, toxic or viral acute liver injury, liver fibrosis, and carcinogenesis. The effects of platelets on the liver involve interactions with sinusoidal endothelial cells and the release of platelet‐contained molecules following platelet activation. Platelets are the major source of circulating extracellular vesicles, which are suggested to play key roles in platelet interactions with endothelial cells in several clinical disorders. In the present review, we discuss the implications of platelet‐derived extracellular vesicles in physiological and pathophysiological processes of the liver.