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PODCAST

Trenches in Transplant Surgery

Step into the forefront of abdominal transplant surgery — where innovation meets ongoing complexity. Machine perfusion and normothermic regional perfusion (NRP) are reshaping organ preservation and donor utilization, with growing evidence that these technologies improve graft assessment and early outcomes. Yet reviews continue to highlight key challenges — ischemia–reperfusion injury, biliary complications in DCD grafts, and the logistical demands of perfusion platforms. Despite these hurdles,

health & fitness medicine

All Episodes

00:43:20

The Future of Transplant (Organ Transplantation in 2050)

Trenches in Transplant Surgery ·

2025/10/30

By 2050, organ transplantation will be radically transformed—from a scarce, donor-dependent therapy into a diverse ecosystem of biological and technological solutions. Patients will receive organs from genetically engineered pigs, bioprinting labs, or even their own regenerated cells, while many others may avoid transplantation altogether through regenerative medicine, gene editing, and artificial organ implants. Advances in AI-driven allocation, precision medicine, and opt-out donation policies

en

00:41:58

Regulatory T Cells in Organ Transplantation

Trenches in Transplant Surgery ·

2025/10/07

Regulatory T cells (Tregs)—discovered by Shimon Sakaguchi, Mary Brunkow, and Fred Ramsdell, who were awarded the 2025 Nobel Prize—are central to inducing immune tolerance and preventing organ transplant rejection. These CD4⁺FoxP3⁺ cells suppress alloimmune responses through multiple mechanisms (IL-10, TGF-β secretion; CTLA-4–mediated dendritic cell modulation; IL-2 consumption; cytotoxic effects on effector T cells). Clinically, higher Treg levels correlate with better graft survival and fewer

en

00:56:18

Desensitization and Pheresis in Kidney Transplant

Trenches in Transplant Surgery ·

2025/10/03

Desensitization has transformed kidney transplantation for patients with high immunologic risk by lowering or removing antibodies that would otherwise cause graft loss. Pre- and peri-transplant plasmapheresis (therapeutic plasma exchange) with low-dose intravenous immunoglobulin (IVIG), sometimes combined with B-cell depletion (rituximab) or newer agents (imlifidase, bortezomib, daratumumab), is standard for HLA- or ABO-incompatible living and deceased donor transplants. Plasmapheresis is also

en

00:39:12

Organ Offer Review - Kidney and Liver Transplant

Trenches in Transplant Surgery ·

2025/10/02

When a deceased-donor offer arrives, the on-call surgeon rapidly weighs donor organ quality, recipient need, and logistics within OPTN/UNOS policy. For kidneys, decisions hinge on KDPI, creatinine/AKI course, machine-pump metrics, procurement biopsy (e.g., glomerulosclerosis/arteriosclerosis), HLA antibodies/virtual or physical crossmatch, and the patient’s wait time/sensitization; kidneys tolerate longer cold ischemia and can be deferred a few hours if needed. For livers, the focus is MELD/urgency,

en

00:48:22

Chimerism and Solid Organ Transplantation

Trenches in Transplant Surgery ·

2025/10/01

Chimerism—the coexistence of donor and recipient hematopoietic cells—has become central to understanding and inducing immune tolerance in solid organ transplantation. Early work by Owen, Medawar, and later Starzl revealed that donor “passenger leukocytes” can persist as microchimerism in recipients, reshaping the once one-way host-versus-graft paradigm into a bidirectional model. Stable mixed chimerism can induce central and peripheral tolerance by deleting or regulating donor-reactive lymphocytes,

en

00:42:08

DCD vs DBD — Inside the Critical Step of Organ...

Trenches in Transplant Surgery ·

2025/09/28

Following a recent New York Times report that questioned the ethics and safety of donation after circulatory death (DCD), this episode clarifies how DCD and donation after brain death (DBD) actually work in U.S. organ procurement. We explain why DCD now accounts for ~43% of deceased donors (≈7,300 in 2024, 13,496 transplants) and how it complements the ~9,700 brain-dead donors who still provide most organs. We explore the surgical, ethical, and logistical safeguards that make procurement safe and

en

00:25:31

Red Flags in Normothermic Machine Perfusion

Trenches in Transplant Surgery ·

2025/08/25

During normothermic machine perfusion (NMP), several red flags may prompt declining a liver for transplantation. The most critical biochemical warning is failure to clear lactate to <2–2.5 mmol/L within 2–3 hours, or a rebound rise after initial clearance, indicating poor hepatocellular metabolism. Persistent metabolic acidosis despite heavy bicarbonate support and sharply rising ALT/AST (especially ALT >6000 IU/L) reflect ongoing hepatocellular injury. Perfusion parameters such as low hepatic

en

00:34:35

Domino Liver Transplantation

Trenches in Transplant Surgery ·

2025/08/16

Domino liver transplantation is a unique and innovative surgical strategy designed to expand the donor organ pool by utilizing the explanted liver from a patient with a non-cirrhotic metabolic liver disease—such as familial amyloid polyneuropathy or maple syrup urine disease—as a graft for a second recipient. While the donor liver carries a genetic or enzymatic defect, it remains structurally and functionally normal, and the recipient is carefully selected to minimize the risk or impact of the

en

00:22:03

Smarter Organ Allocation - AI, Policy, and KDPI...

Trenches in Transplant Surgery ·

2025/08/14

This episode of TTS Podcast explores “Smarter Organ Allocation: AI, Policy, and KDPI Optimization”, focusing on how recent U.S. policy reforms like continuous distribution, kidney expedited placement protocols, and updated scoring systems (KDPI, EPTS, MELD 3.0) are reshaping transplant equity and efficiency. It examines cutting-edge AI applications in donor-recipient matching, survival prediction, and real-time decision support, alongside integration with electronic health records and predictive

en

00:41:47

Vascular complications after liver transplantation –...

Trenches in Transplant Surgery ·

2025/08/11

Vascular complications after liver transplantation – HAT, HVOO, and PVT – though infrequent, demand a high index of suspicion and aggressive management. Early Doppler ultrasound monitoring and prompt imaging are essential to detect these complications in their nascent stages. Advances in surgical techniques and interventional radiology have significantly improved outcomes: for example, timely IR procedures now salvage many grafts that previously would have been lost. Multidisciplinary care,

en

00:25:06

Crossmatching in Abdominal Transplantation -...

Trenches in Transplant Surgery ·

2025/07/27

In this episode, we explore the science and clinical importance of crossmatching in abdominal organ transplantation—focusing on kidney and liver grafts. We delve into the key differences between T cell and B cell crossmatches, examining the roles of complement-dependent cytotoxicity (CDC) and flow cytometry in detecting donor-specific antibodies (DSAs). While a positive T cell crossmatch—particularly in kidney transplantation—often signifies a prohibitive immunologic risk due to class I HLA

en

00:28:18

Combining NRP and NMP vs NMP Alone in DCD Liver...

Trenches in Transplant Surgery ·

2025/07/25

Combining Normothermic Regional Perfusion (NRP) with Normothermic Machine Perfusion (NMP) in DCD liver transplantation offers synergistic benefits over NMP alone by providing both early in-situ resuscitation and ex-situ viability assessment. While NMP alone improves early graft function and logistics, it does not fully prevent ischemic cholangiopathy (IC); in contrast, NRP—by rapidly restoring oxygenated blood flow in the donor—virtually eliminates IC and significantly enhances biliary outcomes

en

00:17:25

Reactive vs. Preventative Care Burden in Abdominal...

Trenches in Transplant Surgery ·

2025/07/24

Reactive care for abdominal organ failure—through costly interventions like liver, kidney, pancreas, and multivisceral transplants—imposes a substantial healthcare burden in the U.S., with first-year costs ranging from $400,000 to over $2 million per case, plus significant long-term expenses and productivity losses. While transplantation improves survival and can be cost-effective (especially kidney vs. dialysis), it remains a late-stage solution. In contrast, preventative care—including chronic

en

00:18:39

Acute Alcoholic Hepatitis and Liver Transplantation

Trenches in Transplant Surgery ·

2025/07/20

Severe acute alcoholic hepatitis (AAH), characterized by high short-term mortality (exceeding 75% at 6 months) in patients failing corticosteroid therapy (Lille score >0.45), represents a paradigm shift in liver transplantation, moving from historical contraindication to a potentially life-saving intervention for highly selected candidates. Landmark studies, notably Mathurin et al. (2011), demonstrated dramatically improved survival (70-85% at 5 years) with early LT compared to medical management

en

00:20:09

Evolving Contraindications and Management Strategies...

Trenches in Transplant Surgery ·

2025/07/16

The critical organ shortage has driven a paradigm shift in utilizing deceased donors with infectious diseases, transforming many historical absolute contraindications into relative ones through advanced diagnostics and targeted therapies. While universally fatal or untreatable infections like active rabies, prion diseases, untreated disseminated fungal infections, or multidrug-resistant sepsis remain absolute contraindications, most infections now undergo rigorous risk-benefit analysis

en

00:16:18

Tele-Transplantation for Resource Limited Settings

Trenches in Transplant Surgery ·

2025/07/14

Tele-transplantation in RLS currently relies overwhelmingly on tele-mentoring (remote expert guidance via video link), as pure robotic telesurgery remains technologically and financially unfeasible due to prohibitive costs, unreliable ultra-low-latency connectivity, and lack of affordable robotic systems. Successful case studies, like kidney transplant mentoring between India and the UK or foundational surgical training in Malawi, demonstrate that tele-mentoring can effectively bridge expertise

en

00:22:07

Autonomous Perfusion - Where AI Meets Organ Viability

Trenches in Transplant Surgery ·

2025/07/13

Autonomous perfusion systems powered by machine learning represent a transformative advancement in organ preservation and tissue engineering. By integrating real-time sensor data with adaptive AI algorithms—such as reinforcement learning, Gaussian processes, and predictive modeling—these systems dynamically adjust perfusion parameters to optimize oxygenation, nutrient delivery, and waste removal. This closed-loop control enables precise, consistent, and prolonged ex vivo organ maintenance, reducing

en

00:18:26

Infrared Spectroscopy for Organ Viability Assessment

Trenches in Transplant Surgery ·

2025/07/11

Infrared spectroscopy, including both near-infrared (NIR) and mid-infrared (MIR) modalities, is emerging as a powerful, non-invasive tool for real-time organ viability assessment in transplantation. NIR spectroscopy has been applied to monitor perfusion and oxygenation in kidney and liver grafts during surgery and preservation, with studies showing strong correlations between spectral features and clinical viability markers such as Doppler indices or histological fibrosis. MIR techniques, like

en

00:24:25

Virtual Reality in Organ Transplant Training

Trenches in Transplant Surgery ·

2025/07/10

Immersive VR training modules for liver and kidney transplantation are emerging as powerful tools in surgical education, combining anatomical accuracy, procedural simulation, and collaborative learning. Academic institutions such as Lawrence Livermore National Lab and Otto-von-Guericke University have developed VR platforms that simulate complex procedures like laparoscopic liver resections and kidney transplants, incorporating haptic feedback, real-time team interaction, and patient-specific 3D

en

00:19:51

Wearable Biosensors for Transplant Care

Trenches in Transplant Surgery ·

2025/07/09

Wearable biosensors are emerging as transformative tools for real-time immunosuppression and graft monitoring in abdominal organ transplantation. These devices—ranging from sweat and interstitial fluid sensors to subcutaneous and implantable platforms—can detect key biomarkers such as tacrolimus levels, cytokines, CRP, creatinine, and tissue oxygenation. By integrating with mobile apps and cloud-based dashboards, they enable continuous, non-invasive monitoring that may help detect early rejection,

en

45 results

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