Current Issue : July-September Volume : 2026 Issue Number : 3 Articles : 5 Articles
Background/Objectives: Intraoperative bleeding remains one of the major challenges in pediatric liver transplantation (PLT), contributing significantly to perioperative morbidity, transfusion-related complications, and prolonged recovery. Although viscoelastic testing has improved intraoperative hemostatic management, there are currently no validated preoperative tools capable of predicting bleeding risk in this vulnerable population. Methods: We conducted a prospective, single-center observational study including 43 consecutive pediatric patients who underwent orthotopic liver transplantation between May 2008 and August 2009. A comprehensive dataset encompassing demographic, clinical, biochemical, and surgical variables was collected. A multivariable linear regression model was developed to predict intraoperative blood loss (IBL). Variable selection was guided by Mallows’ Cp criterion to ensure optimal model fit and clinical interpretability. Model performance was assessed using adjusted R2, diagnostic residual analysis, and internal validation to verify regression assumptions. Results: Six independent predictors of IBL were identified: presence of ascites, prior abdominal surgery, operative time, baseline fibrinogen concentration, platelet count, and recipient weight. The final model explained 35.2% of IBL variance (adjusted R2 = 0.352; F = 7.68; p < 0.001). Model diagnostics confirmed linearity, normal distribution of residuals, and homoscedasticity, supporting its robustness and reliability. Conclusions: This multivariable model provides an interpretable, clinically applicable framework for individualized preoperative estimation of blood loss in PLT. It may assist in planning perioperative patient blood management strategies and serve as a foundation for future decision-support systems. Limitations include the singlecenter design and modest sample size; however, internal validation supported the stability and reliability of the model....
Introduction: Cardiothoracic transplant surgery represents a critical intervention for patients with end-stage heart and/or lung failure. While advancements in surgical techniques and perioperative management have enhanced survival rates, these procedures remain associated with significant morbidity, extended hospitalizations, and complex recovery trajectories. Background/Objectives: Enhanced Recovery After Surgery (ERAS) protocols, originally developed for colorectal surgery, have shown promise in optimizing perioperative care across various surgical disciplines. However, their application in cardiac and thoracic transplantation is still emerging. This article evaluates recent advancements in ERAS protocols tailored to cardiac and thoracic transplant patients, focusing on preoperative, intraoperative, and postoperative interventions. Results: Evidence highlights the potential of ERAS to reduce complications, shorten hospital stays, and improve longterm outcomes. Key strategies include preoperative optimization through nutritional and psychosocial prehabilitation, intraoperative adoption of minimally invasive techniques and refined anesthesia practices, and postoperative protocols emphasizing opioid-sparing pain management, early mobilization, and nutritional recovery. Conclusions: This review identifies gaps in current research and offers recommendations for the broader implementation and standardization of ERAS protocols in cardiothoracic surgery, with emphasis on cardiothoracic transplantation, aiming to improve outcomes for this high-risk population....
Background: Obesity is increasingly prevalent among kidney transplant candidates; however, its impact on graft outcomes in Asian populations is not well characterized. We evaluated the association between preoperative obesity and living-donor kidney transplantation outcomes in Japan. Methods: We analyzed 623 living-donor kidney transplants performed from 1998 to 2021 at six centers in northern Japan. Recipients were categorized by body mass index (BMI) at transplant, and multivariable Cox regression was employed for assessing graft outcomes. Results: Obesity (BMI, ≥30 kg/m2; n = 27 [4.3%]) was the strongest graft failure predictor (hazard ratio, 4.62) compared with normal-weight recipients. Moreover, overweight status (BMI, 25–29.9 kg/m2), acute rejection, and older donor age were independent risk factors. Despite similar rejection rates across the BMI groups, recipients with obesity exhibited persistently impaired kidney function from 1-week posttransplant to the 5-year follow-up. Patient survival was comparable across BMI groups; however, underweight status (BMI < 18.5 kg/m2) was associated with higher mortality. Conclusions: Preoperative obesity and overweight status were significant risk factors for graft failure in Japanese living-donor kidney transplant recipients. Meanwhile, the mortality rate was significantly higher in the patients with underweight status at transplant. Pre-transplant weight optimization and shared decision-making with candidates warrant consideration....
Post-transplant diabetes mellitus (PTDM) is a common complication after liver transplantation. Trimethylamine N-oxide (TMAO), a microbiota-derived metabolite, has been linked to insulin resistance, but epidemiological findings on type 2 diabetes remain inconsistent. The Lipoprotein Insulin Resistance (LP-IR) score is a nuclear magnetic resonance (NMR)-derived marker of insulin resistance, yet its role in PTDM and interaction with TMAO are unknown. Three hundred sixty-seven (367) liver transplant recipients (LTRs) from the TransplantLines cohort were studied. Baseline TMAO and LP-IR score were quantified by NMR spectroscopy. Incident PTDM was defined by international criteria. Associations were tested using logistic regression and Cox proportional regression analysis. Effect modification was tested with interaction terms. Thirty-one out of 246 LTRs at risk developed PTDM after a median follow-up of 7.1 years. Higher TMAO (OR 2.14, p = 0.015) and LP-IR score (OR 1.66, p = 0.015) were associated with increased PTDM risk after adjustment for eGFR and immunosuppressant use. A positive interaction was present (p = 0.029) with risk amplification when both biomarkers were elevated. TMAO’s association with PTDM was strongest at high LP-IR (90th percentile; OR 3.20, p = 0.005), and LP-IR’s association was strongest at high TMAO (90th percentile; OR 2.56, p = 0.002). Time-to-event analysis confirmed these findings. The independent and positive interaction of TMAO and LP-IR with PTDM in LTRs would suggest a pro-diabetic action of TMAO that depends on insulin resistance....
Background/Objectives: Chronic lung allograft dysfunction (CLAD) remains the leading cause of late graft failure after lung transplantation (LuTX). De novo donor-specific anti-HLA antibodies (dnDSA), especially HLA-DQ, have been implicated; we assessed associations between dnDSA (class and specificity) and CLAD after LuTX. Methods: We retrospectively analyzed all LuTX recipients transplanted from 2005–2018 at a single center (n = 585). dnDSA were measured by Luminex single-antigen bead assays (MFI > 1000) at 1, 3, 6, and 12 months and at least annually thereafter. CLAD was defined by ISHLT criteria; time-to-event comparisons used log-rank testing. Results: dnDSA developed in 151/585 recipients (25.8%), predominantly class II (129/585; 22.1%); class I dnDSA occurred in 52/585 (8.9%). CLAD occurred more frequently in dnDSA-positive than dnDSA-negative recipients (64/151; 42.4% vs. 109/434; 25.1%; p < 0.0001). Rejection-attributed death was higher in dnDSA-positive recipients (19/151; 11.3% vs. 25/434; 5.3%; p = 0.01). Both class I and class II dnDSA were associated with higher CLAD rates (log-rank p < 0.001 each). Locus-specific analyses identified HLA-DQ dnDSA as strongly associated with CLAD (p < 0.0001); DQ7 was the most frequent specificity (n = 44) and showed the strongest association (p < 0.0001). Conclusions: dnDSA after LuTX were associated with increased CLAD incidence and rejection-attributed mortality, with a prominent association for HLADQ— particularly DQ7....
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