30-Second Takeaway
- Sequential NRP+NMP safely rescues many DCD livers that initially fail NRP criteria, with acceptable medium-term outcomes.
- Simple clinical metrics at CLAD onset and post-HT AF patterns meaningfully stratify thoracic graft loss risk.
- RETREAT scoring and pre-LT FDG PET/CT refine HCC recurrence risk beyond morphology, informing listing and surveillance strategies.
Week ending February 28, 2026
Perfusion advances, refined risk scores, and emerging biology reshaping transplant decision-making
Sequential NRP+NMP safely recovers DCD livers with marginal NRP parameters
This single-center retrospective series evaluated 70 controlled DCD livers undergoing sequential in situ NRP followed by ex situ NMP. Transplantation occurred in 65% of donor-indicated NMP cases and 85% of recipient/logistical NMP cases. Many grafts not meeting NRP lactate or ALT criteria, including some with ALT >1000 U/L, were transplanted after favorable NMP performance. Among livers failing both lactate and ALT criteria, NRP+NMP enabled successful use of most grafts.
Spirometry-defined features at CLAD onset predict lung graft loss
This multicenter LTOG analysis studied 2386 adult lung recipients to identify routine metrics at CLAD onset predicting graft loss. Probable CLAD developed in 59% of recipients, most with stage 1 disease but frequent early-onset CLAD and FVC loss. Higher CLAD stage, early-onset CLAD, and FVC loss each independently increased hazards of death or retransplantation. In contrast, an FEV1/FVC ratio <0.7 was associated with reduced graft loss risk after adjustment.
Post–heart-transplant AF associates with late mortality but not stroke
In 1072 adult heart transplant recipients, atrial fibrillation occurred in 11%, more often as late or recurrent AF. Early AF was predicted by donor age, post-transplant extracorporeal membrane oxygenation, and pericardial effusion. Late AF was associated with prior rejection, cardiac allograft vasculopathy, and early AF. Stroke occurred in 9% and was independently linked to pre-transplant mechanical circulatory support and ischemic time, but not to post-transplant AF.
RETREAT score stratifies long-term post-LT HCC recurrence and survival
This retrospective single-center study applied the RETREAT score to 298 adults transplanted for hepatocellular carcinoma. During a median 64-month follow-up, 19% developed HCC recurrence, typically about 31 months post-transplant. Five-year recurrence-free survival was 93% in low-, 78% in medium-, and 58% in high-risk RETREAT groups. Medium- and high-risk groups had substantially higher hazards of recurrence than low-risk patients.
References
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Additional Reads
Optional additional studies from this edition.