Transplant Surgery

Surgeon task-switching between organ types raises 1-year transplant mortality.

In 316,742 US transplants, switching organ types across consecutive surgeries increased 1-year mortality by 0.66 percentage points (95% CI 0.39–0.94). This represents a 14.8% relative increase versus baseline mortality in the cohort. Authors propose structured scheduling, longer intervals, and increased surgeon experience as potential mitigations. Findings derive from a natural experiment using quasi-random organ arrivals and apply to centers performing consecutive organ transplants. 1

Slow dose-adjusted tacrolimus phenotype associates with higher late mortality, infection, and malignancy.

In 5,965 kidney recipients, 23% had a slow C0/Dose phenotype with higher troughs despite lower doses and greater time above range. During years 2–6, the slow phenotype had higher adjusted risks of all-cause mortality (adjusted HR 1.616), serious infection (aHR 1.537), and malignancy (aHR 1.628). One-year graft and rejection outcomes did not differ after adjustment. Authors caution phenotype is a risk marker; whether dose changes improve outcomes requires prospective trials. 2

MySurgeryRisk generalizes across centers with high AUROCs for major postoperative events.

Across 508,097 major operations in 366,875 adults, MySurgeryRisk predicted ICU admission (AUROC 0.93), mechanical ventilation (0.94), AKI (0.92), and in-hospital mortality (0.95). Primary procedure code and clinician-specific factors were the strongest predictors. Model performance matched prior single-center results when applied multicenter, supporting broader clinical deployment for risk stratification. Implementation should pair prediction with actionable pathways to avoid alarm burden and inequitable care. 3