Transplant Surgery

REUP enables adult DCD heart transplantation without reanimation and with excellent early outcomes

This single-center case series describes 24 adult DCD heart transplants using rapid extended ultraoxygenated preservation (REUP) without donor heart reanimation or machine perfusion. Donors were relatively older (mean age 32 years; 38% older than 40 years), and 60% of grafts had ischemic times beyond 4 hours. Despite these conditions, 30-day survival was 96%, with severe primary graft dysfunction in 4% and secondary graft dysfunction in another 4%. Initial endomyocardial biopsy showed only one case of 2R acute cellular rejection and no antibody-mediated rejection. 1

TARE reduces waitlist dropout versus TACE in HCC liver transplant candidates

This UNOS-based study included 5,677 liver transplant candidates with HCC receiving first-line locoregional therapy with either TARE or TACE. Compared with TACE, TARE patients more often required only a single LRT (80.6% vs 57.8%) and achieved complete necrosis on explant (35.3% vs 20.2%). In inverse probability–weighted competing-risk models, TARE was associated with a 22% lower hazard of waitlist dropout (HR 0.78, 95% CI 0.69-0.89). Cumulative dropout incidence with TARE remained lower at 1, 2, and 3 years after adjustment for tumor and liver disease characteristics. 2

Cost-effectiveness modeling favors broader deceased donor kidney use in candidates ≥65 years

This economic evaluation used a microsimulation model of 100,000 synthetic kidney transplant candidates aged 65 years or older. Scenarios increased deceased donor transplantation rates by up to 25% using acceptable-quality kidneys of lower quality than current practice. A 25% increase in transplantation was estimated to prevent 141 waiting list deaths per 10,000 candidates and cost about $8,100 per QALY gained. From health care sector perspectives, this strategy was often cost saving and always preferred at willingness-to-pay thresholds ≥$40,000 per QALY. 3