Transplant Surgery

Normothermic regional perfusion improves outcomes in US DCD kidney transplantation

In 21,010 adult DCD kidney transplants, normothermic regional perfusion (NRP) markedly reduced delayed graft function versus non-NRP (30.3% vs 49.7%). NRP was associated with shorter post-transplant length of stay (median 4 vs 5 days). Overall graft and patient survival, including three-year outcomes, were significantly better with NRP. Short versus long NRP durations showed no difference in overall graft survival. NRP benefits were greatest in elderly donors or recipients, high donor BMI, higher KDPI, and prolonged pretransplant dialysis. 1

Roux-en-Y biliary reconstruction improves survival in PSC liver transplantation

This meta-analysis pooled 12 studies with 1418 PSC liver transplant recipients comparing duct-to-duct (DD) and Roux-en-Y (RY) reconstruction. Rates of biliary strictures and leaks did not differ significantly between DD and RY. DD reconstruction lowered cholangitis risk, but RY conferred superior patient survival (HR 0.69 favoring RY). Graft survival was also better with RY (HR 1.38 indicating higher failure risk with DD). Other outcomes, including cholangiocarcinoma, recurrent PSC, hepatic artery thrombosis, and retransplantation, were similar. RY may represent the safer default reconstruction strategy in PSC despite more cholangitis. 2

Early MACE after liver transplantation are uncommon but prognostically important

Among 10,213 English liver transplants, first-year major adverse cardiovascular events (MACE) occurred in 2.6% of recipients. MACE-related mortality within one year was very low at 0.1%, largely due to nonfatal events. Stroke was the most frequent MACE, followed by myocardial infarction. First-year MACE independently predicted worse long-term all-cause mortality (HR 1.37). Risk of MACE increased with older age, male sex, diabetes, and higher Charlson comorbidity scores. 3

Sex disparities persist across the transplant continuum

This review synthesizes evidence on sex differences in kidney, heart, liver, and lung transplantation. Women, especially older women, have reduced access to referral, waitlisting, activation, and transplantation compared with men. Sex differences in graft loss and mortality vary by donor sex and recipient age, reflecting biologic and selection effects. Provider bias, access to bridge therapies, and gendered health behaviors may contribute to observed disparities. The authors call for mechanistic research and explicit equity efforts within transplant programs to address sex disparities. 4