Transplant Surgery

Outcomes of transplantation using organs from donors after medical assistance in dying

This systematic review included 19 studies, with 7 contributing to quantitative analysis of transplants from donors after medical assistance in dying (DCD-V). Across organs, graft survival for DCD-V was comparable to controlled donation after circulatory death grafts. Available data support DCD-V kidneys and lungs as providing acceptable posttransplant outcomes. Signals of concern were noted for liver transplantation, where outcomes appeared less favorable, warranting cautious donor and graft selection. Overall, DCD-V may safely expand the donor pool where legally available, but organ-specific protocols, especially for livers, are needed. 1

Clinically significant biliary complications after living donor hepatectomy remain uncommon but burdensome

Among 6532 living liver donors across 13 centers, 1.9% developed biliary complications requiring at least Clavien-Dindo IIIa interventions. Biliary leakage was most common, followed by strictures and combined lesions, managed mainly with percutaneous or endoscopic drainage. Redo surgery was required in 0.29% of all donors, including hepaticojejunostomy in a subset, underscoring the gravity of severe injuries. Minimally invasive hepatectomy had a significantly higher rate of major biliary complications than open surgery (2.9% vs 1.6%). Late biliary complications took substantially longer to resolve than early events, prolonging morbidity despite overall low incidence. 2

Coronary calcium progresses rapidly after heart transplantation, driven by donor heart age

In this single-center cohort of 116 heart transplant recipients, over half showed progression of coronary artery calcium (CAC) over long-term follow-up. Annual CAC progression corresponded to a 55% relative yearly increase in Ln(CAC + 1). The proportion of patients with higher cardiac allograft vasculopathy scores increased over time, paralleling CAC progression. Donor heart age was the only independent predictor of CAC progression in multivariable analysis. Younger donor and recipient age, male sex, and ischemic cardiomyopathy were associated with faster CAC progression, suggesting need for tailored surveillance and risk modification. 3

Imaging-based sarcopenia assessment in liver transplant candidates remains prognostically useful but poorly standardized

This systematic review synthesized 17 studies evaluating imaging-based sarcopenia in end-stage liver disease patients listed for liver transplantation. CT at the L3 level was most frequently applied and consistently predicted waitlist mortality, hospital stay, and post-transplant survival. MRI and dual-energy X-ray absorptiometry also showed prognostic value, but data were less extensive. Cutoff values and sarcopenia definitions varied widely, limiting comparability and clinical implementation. Emerging metrics of muscle quality, such as attenuation and fat infiltration, may refine risk stratification if incorporated into standardized criteria. 4