Left ventricular diastolic dysfunction (DD) is a common cardiac abnormality in patients with liver cirrhosis (LC), associated with adverse peri-and posttransplant outcomes. We aimed to develop a simple clinical risk score incorporating magnetic resonance elastography (MRE) and biomarkers to identify DD and improve prediction of post-liver transplantation (LT) major adverse cardiac events (MACE). This retrospective study analyzed 114 LC patients who underwent pre-LT MRE and transthoracic echocardiography (TTE) between 2019 and 2025. Patients with structural heart disease or confounding comorbidities were excluded. Clinical, laboratory, and imaging parameters were analyzed. Independent predictors of DD were identified using logistic regression, and a composite DD risk score was developed. Predictive ability for 1-year post-LT MACE was assessed with and without reclassification of indeterminate cases. The prevalence of DD by TTE was 14.0%. Higher NT-proBNP and liver stiffness on MRE were independent predictors of DD. A composite risk score was derived as (NT-proBNP/50) + (4 × MRE stiffness). Using a cutoff ≥61 points, the score achieved 92% specificity. Among patients with indeterminate DD (35.9% of the cohort), 12.2% were classified as DD using the risk score, raising the prevalence to 18.4%. Incorporating the score improved discrimination of 1-year post-LT MACE (p < 0.001). DD classified by TTE plus risk score was independently associated with MACE (odds ratio [OR], 5.77, p = 0.002). A simple risk score integrating MRE-derived liver stiffness and NT-proBNP improved DD identification and prognostication of post-LT MACE, and may serve as a complementary tool in patients equivocal for DD on echocardiography.

Metastatic spread of cancer to transplanted organs is rare, with no prior systematic review. As both the number of transplant recipients and their long term survival increase, such cases may become more common. This systematic review seeks to synthesize all existing case studies describing metastases in transplanted organs. A systematic search of EMBASE and PUBMED was conducted following PRISMA guidelines (PROSPERO: CRD420251119412). Eligible studies described cancer originating from the graft recipient metastasizing to a transplant organ. Studies were summarized across six key domains: patient characteristics, primary tumor types, transplant history, imaging, metastatic cancer treatment, and complications and mortality. Of the 643 studies identified and screened, 12 met the inclusion criteria. The mean patient age was 58 years (±11 years). Affected organs included the liver (n = 7), kidney (n = 4), and lung (n = 1). The most common primary cancer was colorectal cancer. Immunosuppression regimens most often included tacrolimus or cyclosporine. Most studies used CT (n = 6) as the imaging modality to detect metastases. Due to the high prevalence of colorectal cancers, the most common therapy administered was chemotherapy consisting of 5-fluorouracil, oxaliplatin, and folinic acid. Three studies reported complications and seven reported patients passing away. Metastatic spread to transplanted organs is extremely rare and/or under-reported. Further research may help reveal more about the process of metastatic spread, guide screening, and standardize reporting.

There is a lack of data reviewing the role of predicted cardiac mass ratio (PCMR) in transplant recipients with pulmonary hypertension (PH). In particular, the right ventricular (RV) mass ratio (RVMR) is a component of PCMR not yet studied separately for this purpose. We aimed to review the relationship of PCMR and RVMR with PH in terms of post-transplant overall survival. The United Network for Organ-Sharing (UNOS) database was queried for primary heart transplant (HTx) patients from 2004 to 2023. Predicted RVMR was calculated for donors and recipients. A parsimonious multivariable model Cox model was formed for risk adjustment. Covariates with statistically significant relationships to the outcomes were further evaluated with tensor product spline models. A total of 37904 patients were identified. After risk adjustment, diastolic pulmonary artery pressure (dPAP) was protective (HR 0.993 [0.989-0.997], p = 0.001), whereas increasing systolic pulmonary artery pressures (sPAPs) (HR 1.007 [1.005-1.009], p < 0.001) and diastolic pulmonary gradient (DPG) (HR 1.011 [1.007-1.015], p < 0.001) were associated with increased overall mortality. Increasing RV mass ratio (RVMR) was protective (OR 0.663 [0.589-0.747], p < 0.001)). This was appreciated in a restricted cubic spline analysis as a nonlinear relation was evident with any RVMR less than 1 (p < 0.001). Subsequent tensor product spline models evaluating the complex relationship between RVMR and pulmonary pressures demonstrated increasing relative hazards in patients with PH and smaller RVMR (p < 0.001). In HTx patients with PH, RVMR ≥ 1 is significantly associated with a reduced hazard of overall mortality. This indicates RV undersizing may be harmful in the population.

Arterial conduits are effective when normal graft arterialization is not feasible in liver transplantation (LT), but long-term outcomes for both patient and graft survival are variable across studies. Most studies combine primary and re-transplant recipients, are limited by small sample sizes, and do not include propensity-matched controls. We included adults undergoing primary LT at a quaternary academic center between 1/1998 and 8/2025 with iliac artery conduits. Conduit patients were propensity matched using a full matching approach. Kaplan-Meier and Cox regression evaluated the effect of arterial conduits on post-transplant patient and graft survival and hepatic artery thrombosis (HAT). Compared with controls (n=2695), LT recipients with iliac artery conduits (n=100) had similar patient and graft survival at 20years post-transplant. However, conduit recipients had a greater risk of early (HR 6.07, 95% CI 2.09-17.57, p=0.001) and late HAT (HR 4.34, 95% CI 1.45-13.05, p=0.009). Even following re-transplantation for HAT, iliac artery conduit recipients had decreased 5-year survival compared with controls. Conduit length, placement, and reasons for graft use were not predictive of overall HAT incidence, death, or graft failure. Compared with matched controls, patients with iliac artery conduits have comparable 20-year graft and patient survival. Although conduit use may not increase mortality risk, it may identify patients with vascular susceptibility, who face high risk of HAT in both the early post-transplant period and across long-term follow-up. For patients with iliac artery conduits, long-term survival may be optimized through routine, extended follow-up with vascular imaging to detect and manage late HAT.

Normothermic machine perfusion (NMP) maintains physiological metabolism ex situ and enables functional assessment of liver grafts. However, the clinical performance of predefined viability criteria in liver transplantation from brain-death donors (DBD) remains uncertain. This single-center study, an ancillary of the OVERNIGHT NMP program (Rennes University Hospital, 2021-2023), evaluated predefined viability thresholds applied during prolonged end-ischemic NMP. All adult DBD grafts retrieved between 16:00 and 00:00 underwent NMP until scheduled transplantation the following morning. Grafts meeting predefined viability criteria were transplanted. Outcomes were compared with 1:3 propensity-matched controls preserved by static cold storage (SCS) in exploratory, hypothesis-generating analyses. The primary endpoint was early allograft dysfunction (EAD); a modified definition (mEAD, excluding transaminase criteria) was used as a sensitivity analysis. Secondary endpoints included primary non-function (PNF), biliary and vascular complications, and death-censored graft survival. Among 382 liver transplants, 18 NMP and 54 matched SCS recipients were analyzed. All 18 NMP grafts fulfilling predefined thresholds were transplanted, while two non-viable grafts were discarded. No PNF occurred. EAD and mEAD rates were comparable between NMP and SCS (44.4%vs. 26.0%, p = 0.204; 17%vs. 24%, p = 0.550). Biliary complications, requiring endoscopic or surgical intervention, were similar (43.8%vs. 36.6%, p = 0.684). Death-censored graft survival at 24 months did not differ (88.5%vs. 96.0%, p = 0.584). Predefined viability criteria applied during NMP allowed safe identification of transplantable DBD grafts. However, functional assessment based solely on hepatocellular markers was insufficient to anticipate biliary complications, underscoring the need for integrative viability algorithms incorporating cholangiocellular or molecular indicators.

Patients presenting for kidney transplantation on antithrombotic therapy may face an increased risk of bleeding and surgery-related morbidity. How to best optimize pre-operative antithrombotic therapies to decrease the risk for allograft complications has not been fully elucidated. This was a single-center, retrospective study of adult patients undergoing kidney transplantation between 2018-2024. Patients taking oral anticoagulants or antiplatelet therapies at the time of organ offer were compared to control patients not on antithrombotics. A subgroup analysis was also performed, comparing patients on warfarin versus apixaban. The primary endpoint was combined patient and allograft survival at 6 months post-transplant. Key secondary endpoints included the incidence of delayed allograft function, blood product requirements and re-operation, and estimated glomerular filtration rate. 27 patients on anticoagulants and 26 patients on antiplatelet therapies were compared to 227 controls. No significant differences were observed in allograft survival between anticoagulant (96.3%), antiplatelet (88.5%), and control (93.4%) groups. Patients on anticoagulants exhibited a higher incidence of bleeding complications including increased blood product requirements (2.0 vs. 0.6; p < 0.01) and re-operation (14.8% vs. 4.4%; p = 0.04) relative to controls, although this did not impact allograft function. No differences were observed in survival or bleeding endpoints between patients on warfarin and apixaban. Use of anticoagulant but not antiplatelet therapy prior to transplantation was associated with an increased risk of bleeding complications, without adversely affecting short-term allograft function. These results suggest that anticoagulant and antiplatelet therapies may be continued until the time of organ offer in select patients, and apixaban may be a suitable alternative to warfarin for patients on the transplant waiting list.

Preserving health and quality of life are priorities of care for living liver donors (LLDs) due to their altruistic contribution to recipients. No study has examined the role of multimodal prehabilitation for living donor liver transplantation (LDLT). Prior to determining the efficacy of prehabilitation in LLDs, a feasibility study is required. The objective of this feasibility randomized controlled trial (RCT) was to assess the feasibility of conducting a large-scale RCT of prehabilitation prior to LDLT. Thirty LLDs at Toronto General Hospital were randomized 2:1 to receive multimodal prehabilitation or usual care, respectively. The prehabilitation intervention comprised: (1) exercise, (2) nutrition support, (3) psychological counselling, and (4) LLD peer mentor sessions. The primary outcome was feasibility via rates of recruitment, retention, adverse events, adherence, and healthcare provider engagement. Clinical, patient-reported, and physical fitness outcomes were collected at baseline, preoperatively, and at 4 and 12 weeks postoperatively. Qualitative interviews were used to assess feasibility and satisfaction with the intervention. Sixty-three patients were eligible and 30 enrolled (48%). Participants' mean age was 42 ± 8 and 67% were female. There were no intervention-related adverse events. Attrition was 33% and adherence across each of the components of prehabilitation was ≥75%. Interviews demonstrated satisfaction with the prehabilitation intervention and areas for improvement for a Phase III RCT. This study demonstrates a Phase III RCT of prehabilitation versus usual care may be feasible in LLDs. The Phase III trial will confirm the preliminary and exploratory physical and psychosocial benefit reported in this study. ClinicalTrials.gov identifier: NCT0543136.

As survival following solid organ transplantation (SOT) improves, attention has shifted to survivorship and quality of life (QoL) outcomes. Sexual function is an important component of women's health in transplant recipients. In the general population, sexual distress affects approximately 10%-15% of midlife women. Female SOT recipients may experience additional risk for sexual dysfunction related to surgery, body image, and immunosuppression. However, sexual health in this population remains understudied. This study assessed sexual function and its impact on QoL among female SOT recipients by menopausal status. A cross-sectional study of female SOT recipients aged ≥ 18 years was conducted at a single tertiary transplant center from 2018 to 2023. Participants were within five years of kidney, liver, or pancreas transplantation. Validated questionnaires included female sexual function index (FSFI), female sexual distress scale (FSDS), menopause rating scale (MRS), linear analog scale assessment (LASA). Respondents were categorized as premenopausal or peri/postmenopausal. Sexual function, distress, and QoL were compared between groups, with exploratory analyses stratified by current sexual activity status. The survey response rate was approximately 30%. Among 277 respondents, peri/postmenopausal patients were less likely to be sexually active (48.9%vs 69.4%, p = 0.002). They reported lower desire, arousal, and lubrication scores, and higher sexual distress than premenopausal SOT recipients. While overall QoL was rated highly across both groups, sexual distress negatively correlated with QoL across menopausal groups. Among the entire cohort, most women (≈74%) had not been asked about sexual health by any provider in the past year. Sexual dysfunction is common among female SOT recipients and is associated with menopausal status, with higher rates observed than those reported in the general population. These findings highlight the importance of integrating sexual health into posttransplant survivorship care.

ABSTRACTIntroductionDual kidney transplantation (DKT), an uncommonly performed procedure, provides a unique opportunity to transplant nonstandard kidneys that might otherwise not be utilized. We compared perioperative and five‐year posttransplant outcomes between DKT, and single kidney transplants (SKT) performed at our institution.MethodsWe analyzed all adult deceased donor kidney‐alone transplant recipients at our center between 2001 and 2020. Recipients of pediatric en bloc kidney transplants were excluded. Perioperative outcomes of interest included delayed graft function (DGF), posttransplant length of stay (LOS), rehospitalization, and reoperation. Five‐year outcomes included biopsy‐proven acute rejection (AR), death‐censored graft failure (DCGF), uncensored graft failure (UCGF), and death with functioning graft (DWFG).ResultsA total of 100 DKT and 3125 SKT recipients were included. DKT recipients were older (p < 0.001), more often male (68%), and more often underwent early steroid withdrawal (p = 0.04). In comparison to SKT, after adjustment for multiple variables, DKT was not independently associated with DGF (aOR: 1.25; 95% CI 0.76–2.08); prolonged LOS (linear coefficient 0.42; −0.9–1.7); reoperation (aOR: 0.73; 95% CI: 0.21–2.51) or rehospitalization (aOR 0.98; 95% CI: 0.55–1.74). However, within five years, DKT had a lower adjusted incidence rate ratio (aIRR) for AR (aIRR: 0.28; CI 0.12–0.64); DCGF (aIRR: 0.30; 95% CI 0.13–0.68), and UCGF (aIRR: 0.53; 95% CI: 0.33–0.86), without statistically significant differences in DWFG (aIRR: 0.83; 95% CI: 0.46–1.53).ConclusionIn selected recipients, DKT offered superior medium‐term outcomes compared to SKT without compromising perioperative outcomes. DKT can mitigate concerns associated with medically complex donor kidneys, increase organ utilization, and increase access to transplantation.