Surgery:

Heart and lung transplantation remain the primary treatments for end-stage organ failure; yet organ shortages and ischemia-reperfusion injury (IRI) limit their success. Extended criteria donors (ECDs) have expanded the donor pool; however, prolonged cold ischemia times increase the risk of primary graft dysfunction (PGD). Static cold storage (SCS), the standard organ preservation method, is suboptimal, leading to mitochondrial dysfunction, ATP depletion, and oxidative stress. Recent advancements in organ storage show promise in maintaining graft viability. Mitochondria are key regulators of cellular homeostasis, and their dysfunction exacerbates IRI, contributing to inflammation and graft failure. Mitochondrial transplantation (MTx) has emerged as a novel therapeutic strategy to restore cellular bioenergetics, reduce oxidative stress, and improve graft function. Further research is needed to optimize MTx protocols and integrate them into current preservation techniques to enhance transplant success and long-term graft survival.

In solid organ transplantation, the alloimmune response is traditionally attributed to the action of alloreactive T cells that recognize mismatched human leukocyte antigens (HLA), and by antibody formation and antibody-mediated rejection. However, recent evidence indicates that these paradigms of involvement of the adaptive immune system in organ transplant rejection don't explain all cases of graft inflammation, and that innate cell allorecognition plays a role. This review, conducted by the innate team of the Sensitization in Transplantation Assessment of Risk (STAR) workgroup, summarizes the concepts and empirical evidence supporting innate allorecognition. The focus is on NK cell activation via missing self and monocyte activation through SIRPα-CD47 pathway and SIRPα gene polymorphisms. A consensus definition of genetic missing self is proposed, necessitating both donor and recipient HLA class I genotyping, and evaluation of recipient inhibitory killer-cell immunoglobulin-like receptor (KIR) genotype. While in vitro studies and preclinical validations corroborate the potential of innate allorecognition concepts, further research is required to establish clinical utility. This article delineates future research directions to bridge the gap between theoretical promise and practical application in clinical transplantation.

Simultaneous heart liver transplantation (SHLT) has expanded in recent years, bolstered by increases in congenital heart disease (CHD) indications and improvements in organ preservation. We performed a contemporary analysis of patients undergoing SHLT for CHD vs non-CHD, further exploring the impact of machine perfusion (MP). Patients undergoing SHLT between 2010-2024 were retrospectively identified using the UNOS database, assessing a primary outcome of patient survival and secondary outcome of MP utilization. 535 patients underwent SHLT, 224(41.9%) with CHD indication and 311(58.1%) non-CHD. CHD recipients had significantly lower one-(72.9% vs. 89.4%,p<0.01) and five-year survival (66.1% vs. 81.4%,p<0.01) compared to non-CHD recipients. CHD indication was independently associated with a two-fold increased mortality risk, compared to a non-CHD diagnosis (HR:2.31, 95%CI:[1.53,3.47]). Decision tree boosting demonstrated a 2.9% higher relative mortality likelihood after SHLT for recipients with CHD. From 2022-2024, SHLT MP utilization for CHD increased; among 111 patients, 18.0% received a MP liver, 8.1% a MP heart, and 10.8% MP heart and MP liver. In this analysis of modern SHLT cases, patients with CHD had suboptimal outcomes; several donor and recipient factors also impacted mortality. Awareness of these factors can guide pre-transplant optimization, donor/recipient matching, and strategic MP use to improve survival.

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OBJECTIVE: The aim of this study was to identify risk factors for conversion and assess its consequences on clinical outcomes after robotic distal pancreatectomy (RPD).

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Endoscopic bariatric and metabolic therapies (EBMTs) are increasingly recognized as valuable tools for managing obesity and related metabolic disorders. As the prevalence of obesity continues to rise globally, there is a growing demand for effective, safe, and less invasive treatment options. This review provides a comprehensive summary of the available EBMTs, including both stomach-targeted and small-bowel-targeted devices. The review details the various devices, outlines the techniques for their proper use, and discusses their indications. It also presents data on their efficacy and safety, and the management of adverse events and weight regain, as well as anticipated future developments. The paper emphasizes the necessity for additional high quality randomized controlled trials and long-term outcome data to better define the role of these therapies within obesity treatment protocols. Overall, this review serves as an authoritative resource for endoscopists, bariatric specialists, and the wider healthcare community involved in obesity care, promoting best practices and guiding the appropriate implementation of EBMTs in clinical settings.

OBJECTIVES: Sedation for endoscopic retrograde cholangiopancreatography (ERCP) is challenging owing to patient comorbidities and procedural complexity. Remimazolam, a novel benzodiazepine, has potential safety benefits. We aimed to systematically compare the efficacy and safety of remimazolam and propofol for ERCP sedation through a meta-analysis and trial sequential analysis (TSA).

CONCLUSIONS: ART pregnancies are associated with a higher risk of preterm births, hypertension during pregnancy, and cesarean delivery compared with naturally conceived pregnancies. The likelihood of live births and 2-y graft loss did not differ.

As the field of vascularized composite allograft (VCA) has matured, chronic rejection (CR) has emerged as the major cause of late graft loss, albeit occurring at a lower frequency than in many solid organ transplants. VCAs differ from conventional solid organ transplants in that they have multiple tissue targets and CR types. Exposure to environmental, physical, or thermal trauma has been shown to start or worsen both acute and CR in VCA recipients. This overview will cover the clinical presentation of CR in human and animal models, how that differs between VCA components such as skin, vessels, and adnexa, followed by a description of the pathologic presentation of CR, the resulting working pathologic classification of CR, and finally, a discussion of the pathophysiology and potential treatment or monitoring directions of CR in VCAs. These studies provide some exciting avenues where current and future research should be targeted to improve diagnosis and prognosis and find new treatment approaches, which include targeting complement and checkpoint inhibitors. The mechanisms of vasculopathy in disease states outside the field of transplantation, such as pulmonary arterial hypertension, are included, which may provide novel perspectives on CR in transplant recipients. Finally, we propose working points to summarize the current understanding of CR in VCAs and provide directions for future investigations, prevention, and possible treatment.

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BACKGROUND AND OBJECTIVES: Although axial neck pain and radicular arm pain are often associated with cervical spondylotic myelopathy (CSM), some patients present or are discovered to have CSM without pain. Little is known regarding the surgical outcomes in these patients. Our objective is to describe the outcomes of decompressive spine surgery in a cohort of patients treated for painless CSM.

CONCLUSIONS: Spanning fixation following pertrochanteric and intertrochanteric femoral fragility fractures mitigates the risk of a peri-implant fracture. However, the choice of fixation for a given patient requires that this risk be considered within the greater context of surgical decision-making.

IMPORTANCE: The incidence of HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) arising from the palatine tonsil and base of the tongue (BOT) is increasing among the older population. However, data on the prognostic impact of HPV status in patients 70 years and older who undergo up-front surgical treatment remain limited.

BACKGROUND: Portal vein thrombosis (PVT) complicates liver transplantation (LT) by hindering portal flow restoration. Some centers still consider PVT a contraindication for living-donor LT (LDLT) due to technical challenges compared to deceased-donor LT (DDLT).

BACKGROUND: There are repeated and ongoing failures in shared decision-making and informed consent for innovative surgical procedures. Governments and regulatory bodies internationally recommend establishing information standards to support safe and transparent surgical innovation. The aim of this study was to develop a core information set (CIS) for surgical innovation.

CONCLUSIONS: The incidence of POUR after lumbar decompression surgery was found to be 6.9%. A history of urinary retention, not having commercial (private) insurance, intraoperative Foley catheter usage, inpatient opioid consumption of >93 morphine milligram equivalents, and the administration of anticholinergic medication during hospitalization increased the risk of developing POUR. Furthermore, we constructed a preoperative predictive model with good performance metrics to help clinicians to identify patients at elevated risk for developing POUR.

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BACKGROUND: Long-term data on the prevalence of nutritional deficiencies after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in RCTs are lacking. The aim of this study was to compare nutritional deficiencies and adherence to vitamin supplements after LSG and LRYGB at 10 years.

IMPORTANCE: Fluorescence-guided surgery aims to improve intraoperative identification of vital structures. Rizedisben is a myelin-binding fluorophore that fluoresces in the blue light (370-425 nm) spectrum to improve intraoperative nerve identification.