Transplant Surgery

Pretransplant immune frailty index strongly stratifies early mortality after liver transplantation

This prospective cohort identified pretransplant plasma immune biomarkers associated with 1-year mortality after deceased donor liver transplantation. Fractalkine and MMP3 emerged as independent predictors and were combined into the Liver Immune Frailty Index (LIFI). LIFI stratified patients into low, moderate, and high-risk groups with markedly different 1-year mortality rates (1.9%, 10.3%, and 63.6%). Higher LIFI scores were also associated with worse graft survival, more infections, and poorer 24‑month survival. These data suggest immune frailty assessment could complement MELD-based selection and guide intensified perioperative monitoring for high-risk candidates. 1

Genetically modified pig livers provide effective xenogeneic support in human decedent cross-circulation

Four brain-dead human decedents underwent extracorporeal liver cross-circulation using extensively genetically modified pig livers. Triple glycan knockout, seven human transgenes, and pig endogenous retrovirus inactivation were combined with methylprednisolone-only immunosuppression. Pig livers maintained preserved architecture, mild immune infiltration, and ongoing bile production throughout 48–84 hours of support. In one decedent after hepatectomy, xenogeneic liver-only support sustained stable hemodynamics, acid-base balance, ammonia, INR, and metabolic function. These findings demonstrate technical feasibility and short-term functional support, informing future development of xenogeneic liver assist or bridge-to-transplant platforms. 2

World Transplant Congress 2025 kidney updates: perfusion, desensitization, and precision immunosuppression

This review summarizes major kidney transplantation advances presented at the World Transplant Congress 2025. Machine perfusion, including the Central Preservation and Assessment Service trial, demonstrated utility rescuing discarded kidneys and enabling ex vivo repair strategies. For highly sensitized patients, desensitization regimens using new proteasome inhibitors and anti-CD38 antibodies lowered donor-specific antibodies and enabled transplantation. Anti-CD38 antibodies and early costimulatory blockade trials suggested options for treating antibody-mediated rejection and safely reducing tacrolimus exposure. AI tools integrating multiomics and novel biomarkers emerged as promising predictors of graft outcomes, supporting movement toward precision immunosuppression. 3