OBJECTIVE Compare TEG parameters between clopidogrel-resistant and clopidogrel-non-resistant groups. SUMMARY BACKGROUND DATA Graft or stent thrombosis affects 1 in 5 patients within six months post-revascularization and is a leading cause of amputation in the elderly. Clopidogrel resistance occurs in 5-44% of patients. METHODS This prospective observational study evaluated patients with PAD undergoing

ImportanceTracheobronchial replacement remains a surgical and biological challenge despite several decades of experimental and clinical research.ObjectiveTo compile a comprehensive state-of-the-science review examining the current indications, techniques, and outcomes of tracheobronchial replacement in human patients.Evidence ReviewA systematic review of the literature was conducted on July 1, 2024

ImportanceSurgical mortality remains a critical public health issue in resource-limited settings. Hospital ownership type may influence surgical outcomes, yet this relationship is not well understood in East, Central, and Southern Africa, where a diverse mix of public, private, and faith-based hospitals provides care.ObjectiveTo determine whether hospital ownership type (public, private, or faith-based)

ImportanceThe surgeon-anesthesiologist teamwork is a core component of performance in the operating room, which can influence patient outcomes.ObjectiveTo examine the association between surgeon-anesthesiologist dyad familiarity (as dyad volume, the number of procedures done together) with 90-day postoperative major morbidity for high-risk elective surgery.Design, Setting, and ParticipantsThis population-based

OBJECTIVE We sought to determine how kidney transplant center volume impacts waitlisted candidate access to transplant. SUMMARY BACKGROUND DATA Over 90,000 candidates await a kidney transplant, of which we hypothesized that waitlist access is subject to significant program-level variation, potentially resulting in pseudo-access: a state where the waitlisted candidate does not achieve expected transplantation

OBJECTIVE This study examines the success of surgeon-scientists to non-surgeon physician-scientists in obtaining NIH funding after participation on a research training grant. SUMMARY BACKGROUND DATA Dedicated research time during postgraduate training for physician-scientists is advantageous for obtaining future independent funding from NIH. METHODS NIH Reporter was used to identify F32 and T32 grants

OBJECTIVE The primary aim was to compare the proportion of opioid-free discharges between two postoperative analgesia bundles distinguished by receipt of a single-block versus a second, "rescue" block. Secondary outcomes included differences in discharge prescription oral morphine equivalents (OME) and patient-reported outcomes. SUMMARY BACKGROUND After a preoperative quadratus lumborum (QL) block

OBJECTIVES This systematic review and meta-analysis compared the effectiveness and safety of lytic and non-lytic early thrombus removal strategies in addition to anticoagulation versus anticoagulation alone. SUMMARY BACKGROUND DATA Early thrombus removal strategies have been developed to prevent post-thrombotic syndrome (PTS) following acute iliofemoral deep vein thrombosis (DVT). METHODS This review

The benefits of bilateral lung transplantation (BLT) versus single lung transplantation (SLT) are still debated. One impediment to clinical recommendations is that BLT vs. SLT advantages may vary based on underlying disease. Since both options are clinically tenable in patients with emphysema, we conducted a comprehensive assessment of lung allograft survival in this population. Using U.S. registry

Group 2 innate lymphoid cells (ILC2s) that produce IL-10 (IL-10+ILC2s) have demonstrated regulatory and tissue-protective properties in murine studies, but preclinical studies are lacking that explore the potential of human IL-10+ILC2s as a tolerance-promoting cell therapy for transplantation or autoimmunity. Here, we investigated whether human IL-10+ILC2s could enhance islet function and prevent allograft

OBJECTIVE To explore surgeons' perspectives on and priorities for communicating about non-curative operations for patients with advanced cancers, which aim to improve longevity or quality of life without possibility of cure. SUMMARY BACKGROUND DATA Describing the potential benefits of non-curative surgery is important so that treatment decisions are based on an accurate understanding of what surgery

ImportanceThe use of robotic-assisted cholecystectomy in acute care surgery is increasing, but its safety and efficacy compared with laparoscopic cholecystectomy remain unclear.ObjectiveTo compare clinical outcomes and bile duct injury rates between robotic-assisted cholecystectomy and laparoscopic cholecystectomy in acute care surgery.Design, Setting, and ParticipantsThis was a retrospective cohort

ImportancePostinduction hemodynamic instability is a frequent complication among patients with severe aortic stenosis (AS). Using cipepofol as the anesthesia agent may reduce the incidence and severity of hemodynamic instability.ObjectiveTo assess whether cipepofol outperforms propofol in maintaining postinduction hemodynamic stability in patients with AS.Design, Setting, and ParticipantsThis single-center

In 2020, the Centers for Medicare and Medicaid Services (CMS) updated the Organ Procurement Organization (OPO) Conditions for Coverage, redefining deceased donor potential (DDP) as all inpatient deaths among patients 75 or younger with a primary cause of death consistent with organ donation, also called CALC (Cause, Age, and Location Consistent with donation). This study evaluates CALC performance

OBJECTIVE To assess the efficacy and safety of hypovolemic phlebotomy (HP) versus conventional management (control group) in achieving low central venous pressure (CVP) to reduce blood loss during open liver resections. BACKGROUND Excessive blood loss increases perioperative complications and worsen patient outcomes. HP is used to reduce blood loss and the need for allogenic transfusions. This study

OBJECTIVE To assess the feasibility of integrating environmental sustainability into clinical guidelines for operating rooms (ORs) and provide evidence-based recommendations. SUMMARY BACKGROUND DATA Surgical practices contribute significantly to healthcare's environmental impact. Incorporating sustainability into evidence-based clinical guidelines can support environmentally responsible decision-making

OBJECTIVE This study aimed to investigate whether microRNAs (miRNAs) quantified from primary pancreatic ductal adenocarcinoma (PDAC) samples could serve as potential biomarkers for identifying PDAC with occult liver metastasis. SUMMARY BACKGROUND DATA Undetectable occult liver metastasis impair the survival of PDAC. Novel biomarkers are immediately required to detect occult liver metastasis in PDAC

OBJECTIVE Use a new patient registry to characterize and predict progression of lower-extremity chronic wounds to amputation and/or death, while considering infection history. BACKGROUND Chronic wounds are a common health issue causing amputation and death. The Regenstrief Chronic Wound Registry, created from one of the U.S.'s largest health information exchanges, can give insights into their epidemiology

OBJECTIVE Our objective was to assess outcomes for newborns with congenital diaphragmatic hernia (CDH) and congenital heart disease (CHD). SUMMARY BACKGROUND DATA CDH is a complex malformation often associated with CHD, yet limited data exist on outcomes for infants with both conditions. This study highlights factors associated with survival and how specific cardiac diagnoses shape patient outcomes

OBJECTIVE To establish benchmark cutoffs for robotic liver resection (R-LR), encompassing both major and minor resections, and to determine the impact of patient selection on outcomes. BACKGROUND R-LR is a key advancement in minimally invasive liver surgery but lacks standardized benchmarks, especially for minor resections. While guidelines endorse R-LR, its role in optimizing outcomes remains unclear

Tacrolimus (also known as FK506) is one of the most widely used immunosuppressive drugs in the postsurgery management of transplantation. To date, the cellular mechanism by which FK506 suppresses immune activation and elongates allograft survival remains largely unclear. Here, we employed a mouse model for corneal penetrating keratoplasty to interrogate this critical question. Administration of FK506

Cirrhotic cardiomyopathy (CCM) is an underrecognized risk factor for cardiac events in patients undergoing liver transplantation (LT). Blunted cardiac reserve (BCR) is an emerging indicator of CCM, although it has not been integrated into diagnostic guidelines. This study assesses posttransplant cardiac outcomes and mortality in patients with BCR compared with current CCM diagnostic guidelines, focusing

Lung transplantation is a cornerstone in treating patients with end-stage lung disease, yet ischemia-reperfusion injury poses significant complications in posttransplant recovery. This study aimed to understand the effects of donor type, cold ischemic time (CIT), and reperfusion on metabolic changes in lung grafts. Porcine donor lungs underwent different CITs on ice: minimal time (control), 6 hours

Pediatric liver transplant (LT) waitlist mortality remains unacceptably high. In 2020, the Organ Procurement and Transplantation Network implemented acuity circle (AC)-based liver distribution and national pediatric prioritization for pediatric donor livers. Using Organ Procurement and Transplantation Network data, waitlist outcomes for pediatric LT candidates listed between February 4, 2016, and February

Respiratory viral infections, including human metapneumovirus (hMPV), are increasingly recognized as a significant cause of morbidity and mortality in lung transplant recipients (LTRs). We present a case of hMPV pneumonia in a bilateral LTR, likely transmitted by the donor, resulting in severe acute respiratory distress syndrome and leading to death. Next-generation sequencing of hPMV genomes was performed

OBJECTIVE The purpose of this study is to estimate differences in the supply of general surgeons by age group and rurality and model potential impending shortages, with an emphasis on surgeons reaching and above the traditional retirement age. SUMMARY BACKGROUND DATA The healthcare workforce at large is experiencing shortages and impending retirements, which are especially prominent in rural communities

OBJECTIVE To longitudinally compare trends in quality of care for common surgical conditions at CAHs compared to non-CAHs. SUMMARY BACKGROUND DATA Critical access hospitals (CAH) simultaneously face challenges of preserving access and ensuring quality. Data have identified concerns of quality over time for medical conditions, but less is understood about surgical care. DESIGN, SETTING, PARTICIPANTS

BACKGROUND Human leukocyte antigen (HLA) sensitization is a significant barrier to transplantation for many patients. Daratumumab has proven safety and tolerability in multiple myeloma. We hypothesized that daratumumab monotherapy could be an effective and safe desensitization strategy in highly sensitized patients awaiting cardiac transplantation. OBJECTIVES The primary end-point of this trial was

BACKGROUND This study evaluates the impact of pretransplant HeartMate III (HM3) left ventricular assist device (LVAD) support duration on post-transplant survival in a contemporary cohort. METHODS A retrospective review of the United Network for Organ Sharing database was conducted for adult heart transplant recipients from January 2019 to December 2023 who were bridged with an HM3 LVAD. We utilized

ImportanceApproximately 2 million individuals are incarcerated in the US. Surgical needs increase with age, and an aging prison population means an increasing need for surgical care for incarcerated individuals. Challenges in logistics, privacy, communication, and comorbidities put people in law enforcement custody at risk for suboptimal care and outcomes. Little guidance exists for surgeons seeking

ImportanceAntibiotics are thought to decelerate inflammation progression and reduce complications in acute uncomplicated appendicitis. The evidence of their effectiveness is insufficient, and treatment practices vary widely.ObjectiveTo investigate the effect of preoperatively started antibiotic treatment on the rate of appendiceal perforation.Design, Setting, and ParticipantsThis multicenter, noninferiority

This Viewpoint outlines the problems with the failure rates for nonoperative treatment of uncomplicated appendicitis (NOTA) reported in several major trials and discusses why NOTA may be preferable to appendectomy.

CD95L is a transmembrane cytokine mainly expressed by activated T and natural killer cells to contract the immune response through cell-cell contact. Conversely, after cleavage by metalloproteases, this ligand releases a soluble CD95L (sCD95L) that stimulates the immune response and its antitumor activity. In posttransplant lymphoproliferative disorders (PTLDs), we hypothesized that the concentration

Early experimental investigations of alloimmunity demonstrated that the T cell response against allogeneic antigens is robust and results from a high precursor frequency of responding clones. Seminal studies using cell culture-based methods led to an overall model in which CD8+ T cells can recognize self-peptide complexed to an allogeneic peptide major histocompatibility complex (MHC), termed the direct

With the expansion of solid organ transplantation activities in the United States, there is a critical need for more transplant care providers and trainees to sustain and advance the field of transplantation. However, there has been a pending shortage of trainees pursuing transplant fellowship training in the United States in recent years. To address this issue, the American Society of Transplantation

OBJECTIVE To assess the accuracy of the ACS NSQIP Risk Calculator (RC) when applied to subsets of high-risk patients. BACKGROUND The RC plays an especially important role in surgical decision making in situations where probabilities for adverse events are high. However, the performance of the RC in these situations has not been studied in detail. Furthermore, past criticisms of the RC have evaluated

INTRODUCTION The introduction of donor-derived cell-free DNA (dd-cfDNA) and the Molecular Microscope (MMDx) is changing how we diagnose rejection following heart transplantation (HT). This study aims to assess the accuracy of dd-cfDNA in detecting rejection as identified by MMDx and histology, with a focus on determining an optimal dd-cfDNA threshold to improve diagnostic performance. METHODS Single-center

We report the results of 2 independent, concurrently performed studies evaluating the safety and efficacy of donor-derived mesenchymal stromal cell (MSC) infusions in inducing immune-tolerance in nonhuman primate (NHP) and human kidney transplant recipients treated with depletional induction and belatacept/sirolimus maintenance. Fifteen NHPs received rhesus ATG induction and were divided into 3 groups:

Short-statured lung transplant candidates experience longer waitlist times than taller ones. The new composite allocation score (CAS) includes height to enhance allocation equity. We assessed the impact of CAS on waitlist outcomes for different height groups. We queried a national transplant database for lung transplant candidates listed from 2021 to 2024, categorized into 4 height groups: ≤162 cm

People living with human immunodeficiency virus (HIV) (PWH) face limited access to organ transplantation despite higher rates of end-organ disease. The HIV Organ Policy Equity Act, enacted in 2015, allowed transplants from donors with HIV to recipients with HIV (HIV D+/R+) under research protocols. Studies have since demonstrated overall comparable outcomes between HIV D+/R+ and donors without HIV/R+

Ischemia-reperfusion injury commonly causes delayed graft function (DGF) after kidney transplantation and is associated with poorer graft function and lower allograft survival. Activation of the lectin complement pathway is one mediator of ischemia-reperfusion injury. In this randomized double-blind placebo-controlled pilot study, we tested whether preimplantation intragraft administration of C1 esterase