Association of organ procurement organization volume with Centers for Medicare and Medicaid Services performance evaluations.

Under 2020 Centers for Medicare and Medicaid Services (CMS) conditions of coverage, Organ Procurement Organizations (OPOs) will be decertified if their 95% upper confidence limit for donation or transplant rate falls below the previous year's median (tier 3) and must recompete if either is below the 75th percentile (tier 2). This study aimed to examine the associations of CMS metrics with OPO volume and evaluate an alternate observed-to-expected tiering system using simulation analysis and CMS's OPO public report. In 2021, CMS tier 3 and 2 OPOs had significantly larger volumes than tier 1 OPOs (median = 2042 vs 2124 vs 1003; P = .

Area-Level Social Deprivation and Cytomegalovirus Seropositivity at the Time of Solid Organ Transplant.

Importance: Cytomegalovirus (CMV) is associated with significant morbidity and mortality in solid organ transplant (SOT) recipients. The risk factors for CMV seropositivity in SOT recipients, including area-level social deprivation in the US, have not been fully characterized.

Objective: To (1) evaluate CMV seroprevalence, (2) assess the recipient characteristics associated with CMV seropositivity, and (3) assess the association of area-level social deprivation index (SDI) scores with pretransplant CMV serostatus.

Marked variation in disease acuity and outcomes on the liver transplant waiting list by sociodemographic characteristics.

Understanding the association of social determinants of health with liver transplant listing and waitlist outcomes can inform health care policy and interventions aimed at improving access to care. We analyzed the Scientific Registry of Transplant Recipients database merged with the Social Deprivation Index (SDI) to evaluate if the area of residence is associated with the Model for End-Stage Liver Disease incorporating sodium (MELD-Na) at the time of waitlist placement and outcomes following waitlisting, and if this varied based on sociodemographic variables. Compared to candidates residing in areas of low SDI, those residing in areas of high SDI (most socioeconomic disadvantage) had 11% higher adjusted likelihood (aOR [95% CI] = 1.

Renal autotransplant as a definitive treatment for nutcracker syndrome: A multicenter retrospective study.

Objective: Nutcracker syndrome is a rare condition that involves mechanical compression of the left renal vein, leading to chronic and debilitating left flank pain. The etiology of the pain is misdiagnosed frequently, and patients usually require long-term opioid use to manage their pain. Multiple therapeutic options for nutcracker syndrome have been described in the literature but the reports are limited by small numbers of patients, and the lack of convincing data demonstrating consistently improved outcomes.

Virtual Nephron: Evaluation of a Novel Virtual Reality Educational Tool.

Introduction: Recent technological advancements allowed the development of engaging technological tools. Using ASN funding from the ASN, we developed a 3D Virtual Reality (VR) physiology course entitled DiAL-Neph (Diuretic Action and eLectrolyte transport in the Nephron). We hereby present its evaluation.

DNA N-gram analysis framework (DNAnamer): A generalized N-gram frequency analysis framework for the supervised classification of DNA sequences.

In 1948, Claude Shannon published a mathematical system describing the probabilistic relationships between the letters of a natural language and their subsequent order or syntax structure. By counting unique, reoccurring sequences of letters called N-grams, this language model was used to generate recognizable English sentences from N-gram frequency probability tables. More recently, N-gram analysis methodologies have been successfully applied to address many complex problems in a variety of domains, from language processing to genomics.

Crossing national borders for transplantation: A focused evaluation of deceased donor lung exports from the United States.

Organ transplantation is a life-saving treatment for end-stage organ failure patients, but the United States (US) faces a shortage of available organs. US policies incentivize identifying recipients for all recovered organs. Technological advancements have extended donor organ viability, creating new opportunities for long-distance transport and international sharing.

Phase I clinical trial of the feasibility and safety of direct peritoneal resuscitation in liver transplantation.

Background: Direct peritoneal resuscitation (DPR) is associated with improved outcomes in trauma. Animal models suggest DPR has favorable effects on the liver. We sought to evaluate its safety and assess for improved outcomes in liver transplantation (LT).

An evaluation of the organ procurement and transplantation network's expanded post-transplant performance metrics.

On July 14, 2022, the Organ Procurement and Transplantation Network's (OPTN) Membership and Professional Standards Committee (MPSC) approved bylaws including two new post-transplant performance evaluation metrics, the 90-day (90D) and 1-year conditional on the 90-day (1YC90D) graft survival hazard ratio (HR). These metrics have replaced the previous 1-year (1Y) unconditional, post-transplant graft survival HR and are used to nationally rank and identify programs for MPSC review. The MPSC's policies have major implications for all transplant programs, providers, and patients across the United States.

Survival following liver transplantation: A population-based nested case-control study.

Background: Liver transplantation is the gold standard treatment for end-stage liver disease. This study evaluates post-transplantation survival compared with the general population by quantifying standardized mortality ratios in a nested case-control study.

Methods: Controls were noninstitutionalized United States inhabitants from the National Longitudinal Mortality Study.

Retransplantation in Living Donor Liver Transplantation.

The need for retransplantation after living donor liver transplantation can occur early, mainly because of technical difficulties such as hepatic artery thrombosis or as a result of early allograft dysfunction as a symptom of small-for-size syndrome. Patients with autoimmune diseases may develop progressive graft failure from recurrent disease. The ethics of retransplantation can be complicated by the cause of the initial liver disease, which may be self-inflicted or the outcome of malignancy.

Socioeconomic deprivation is associated with worse patient and graft survival following adult liver transplantation.

The impact of social determinants of health on adult liver transplant recipient outcomes is not clear at a national level. Further understanding of the impact of social determinants of health on patient outcomes can inform effective, equitable health care delivery. Unadjusted and multivariable models were used to analyze the Scientific Registry of Transplant Recipients to evaluate the association between the Social Deprivation Index (SDI) based on the liver transplant recipient's residential location and patient and graft survival.

A Mediterranean diet plan in lactating women with obesity reduces maternal energy intake and modulates human milk composition - a feasibility study.

Introduction: Maternal obesity is associated with increased concentrations of human milk (HM) obesogenic hormones, pro-inflammatory cytokines, and oligosaccharides (HMOs) that have been associated with infant growth and adiposity. The objective of this pilot study was to determine if adherence to a Mediterranean meal plan during lactation modulates macronutrients and bioactive molecules in human milk from mothers with obesity.

Methods: Sixteen healthy, exclusively breastfeeding women with obesity (body mass index ≥30 kg/m) enrolled between 4 and 5 months postpartum.

Cannabis use in liver transplant candidates and recipients.

The increasing legality and acceptance of cannabis sale and consumption across the United States has led to a measurable increase in cannabis use nationwide, including in liver transplant (LT) candidates and recipients. With over 75% of liver transplant recipients transplanted in states with legalized use of medicinal and/or recreational cannabis, liver transplant clinicians must have expertise in the assessment of cannabis use given its potential impact on clinical care. In this review, the authors provide an understanding of nomenclature and tools to assess cannabis use, highlight essential components to guide clinical policy development and implementation, and discuss the potential impacts of cannabis use on patients' transplant course.

Patient years lost due to cytomegalovirus serostatus mismatching in the scientific registry of transplant recipients.

Background: The cytomegalovirus (CMV) mismatch rate in deceased donor kidney transplant (DDKT) recipients in the US remains above 40%. Since CMV mismatching is common in DDKT recipients, the cumulative effects may be significant in the context of overall patient and graft survival. Our primary objective was to describe the short- and long-term risks associated with high-risk CMV donor positive/recipient negative (D+/R-) mismatching among DDKT recipients with the explicit goal of deriving a mathematical mismatching penalty.

The American Society of Transplant Surgeons Consensus Statement on Normothermic Regional Perfusion.

On June 3, 2023, the American Society of Transplant Surgeons convened a meeting in San Diego, California to (1) develop a consensus statement with supporting data on the ethical tenets of thoracoabdominal normothermic regional perfusion (NRP) and abdominal NRP; (2) provide guidelines for the standards of practice that should govern thoracoabdominal NRP and abdominal NRP; and (3) develop and implement a central database for the collection of NRP donor and recipient data in the United States. National and international leaders in the fields of neuroscience, transplantation, critical care, NRP, Organ Procurement Organizations, transplant centers, and donor families participated. The conference was designed to focus on the controversial issues of neurological flow and function in donation after circulatory death donors during NRP and propose technical standards necessary to ensure that this procedure is performed safely and effectively.

Differential in Kidney Graft Years on the Basis of Solitary Kidney, Simultaneous Liver-Kidney, and Kidney-after-Liver Transplants.

Background: The number of simultaneous liver-kidney (SLK) transplants has significantly increased in the United States. There has also been an increase in kidney-after-liver transplants associated with 2017 policy revisions aimed to fairly allocate kidneys after livers. SLK and kidney-after-liver candidates are prioritized in allocation policy for kidney offers ahead of kidney-alone candidates.

Living Donor Liver Transplantation: Left Lobe or Right Lobe.

Living Donor Liver Transplantation (LDLT) has seen great advancements since its inception in 1988. Herein, the nuances of LDLT are discussed spanning from donor evaluation to the recipient operation. Special attention is given to donor anatomy and graft optimization techniques in the recipient.