Transplant Surgery

Portal-venous HOPE reduces early allograft dysfunction and shortens hospital stay.

In a 15-center randomized trial of 219 recipients of extended-criteria donor livers, portal-venous HOPE reduced early allograft dysfunction from 37.3% to 20.2%. HOPE improved MEAF scores (mean 4.28 vs 4.82) and shortened hospital length of stay (discharge HR 1.32). One-year patient and graft survival and NAS on imaging were similar between HOPE and standard static cold storage. These findings apply to accepted extended-criteria DBD and DCD livers after static cold storage and randomization at back-to-base. 1

Non-vascularized fibular grafts have high mechanical failure but acceptable long-term function.

In 24 intercalary reconstructions after malignant bone tumor resection, osteosynthesis failure occurred in 50%, pseudarthrosis in 47.6%, and graft fractures in 38.1%. Mechanical complications correlated with systemic therapy and larger defect size. Despite high complication rates, median functional scores were reasonable (MSTS ~74, TESS ~83) and quality of life approximated population norms. Use these data to counsel patients about high mechanical-risk but potential for acceptable long-term limb function. 2

FMT restores gut diversity better than probiotics in antibiotic-treated sepsis patients.

In this pilot RCT (n=40) of antibiotic-treated septic patients, fecal microbiota transplantation preserved alpha-diversity at 2 weeks versus control and probiotics (Chao1 p=0.0125). FMT increased Bacteroides, reduced Enterobacteriaceae, and lowered predicted pathogenic potential (BugBase p=0.021). Probiotics did not replicate these microbiome benefits in this cohort. Results are preliminary from a small single-center pilot and require larger trials before routine ICU adoption. 3