Current Issue : April-June Volume : 2026 Issue Number : 2 Articles : 5 Articles
A 56-year-old patient presented to our dermatology clinic with asymmetric hyperpigmentation on her lower lip, which had developed over the previous six to twelve months. Her medical history included kidney and pancreas transplants, requiring chronic immunosuppression, and two lip filler injections with hyaluronic acid (HA). Clinical examination revealed irregular pigmented macules limited strictly to the lower lip. Histological analysis showed epidermal melanosis, pigmentary incontinence, solar elastosis, and amorphous dermal HA deposits, without evidence of melanocytic hyperplasia or granulomatous inflammation....
Background/Objectives: The use of intraoperative venoarterial extracorporeal life support (VA ECLS) has traditionally been used to support unstable patients undergoing complex lung transplantation. More evidence is emerging that the use of intraoperative VA ECLS may be beneficial for all patients undergoing lung transplantation. The aim of this study was to report the safety and feasibility of lung transplantation with the routine use of central VA ECLS. Methods: In this single-center retrospective observational study, all consecutive patients undergoing lung transplantation from April 2021 until September 2025 were included. Early outcomes and the incidence of primary graft dysfunction were evaluated with the International Society for Heart and Lung Transplantation criteria at 72 h after transplantation. Survival and chronic lung allograft dysfunction (CLAD)-free survival were reported with Kaplan–Meier estimates and 95% confidence intervals (CIs). Results: During the study period, 35 patients were successfully transplanted with the aid of central VA ECLS. There were no complications associated with intraoperative ECLS. One revision surgery was performed for immediate postoperative bleeding, and one for bronchial anastomosis air leak. Operative mortality occurred in three patients (8.6%). The median in-hospital stay was 30 (25–43) days. Severe primary graft dysfunction at 72 h was observed in four (11.4%) patients. Survival and CLAD-free survival at 1-, 3-, and 5-years following surgery were 85% (95% CI [74–98]), 74% (95% CI [59–92]), 67% (95% CI [28–82]), and 82% (95% CI [70–96]), 52% (95% CI [37–74]), 36% (95% CI [11–59]), respectively. Conclusions: Lung transplantation can safely be performed with the aid of central VA ECLS, with a low rate of primary graft dysfunction and favorable long-term outcomes. Further follow-up studies and greater experience are needed to make inferences on the long-term outcomes. This technique is relatively recent and evolving, representing an innovative intersection of advanced supportive technology with transplant surgery, potentially broadening indications and improving success rates....
Background: Tacrolimus is a cornerstone immunosuppressant in kidney transplantation, but its narrow therapeutic index and marked inter-patient variability complicate dose optimization. Conventional therapeutic drug monitoring (TDM) relies on empirical adjustments that often overlook individual pharmacokinetics. Machine learning (ML) offers a precision dosing alternative by integrating diverse clinical and biochemical variables into predictive models. Methods: We retrospectively analyzed 1351 data points from 87 kidney transplant patients at Eunpyeong St. Mary’s Hospital (April 2019–November 2023). Clinical, demographic, and laboratory information, including tacrolimus trough levels and dosing history, were extracted from electronic medical records. Four predictive models—XGBoost, CatBoost, LightGBM, and a multilayer perceptron (MLP)—were trained to forecast next-day tacrolimus concentrations, and model serum creatinine level performance was evaluated using R-squared (R2), mean absolute error (MAE), and rootmean- squared error (RMSE). An ensemble model with weighted soft voting was applied to enhance predictive accuracy, and model interpretability was assessed using SHapley Additive exPlanations (SHAP). Results: The ensemble model achieved the best overall performance (R2 = 0.6297, MAE = 1.0181, RMSE = 1.2999), outperforming all individual models, whereas the MLP model showed superior predictive power among single models, reflecting the significance of nonlinear interactions in tacrolimus pharmacokinetics. SHAP analysis highlighted prior tacrolimus levels, cumulative dose, renal function markers (eGFR level, serum creatinine level), and albumin concentration as the most influential predictors. Conclusions: We present a robust ML-based algorithm for tacrolimus dose optimization in hospitalized kidney transplant recipients. By improving predictions of tacrolimus concentrations, the model may help reduce inter-patient dose variability and lower the risk of nephrotoxicity, supporting safer and more individualized immunosuppressive management. This approach advances AI-driven precision medicine in transplant care, offering a pathway to safer and more effective immunosuppression....
Background: Metabolic dysfunction-Associated Steatotic Liver Disease (MASLD) is becoming a leading indication for liver transplantation in the United States. In this growing recipient population, the combined eects of underlying liver disease etiology and associated comorbidities on the evaluation pathway to transplantation warrant closer examination of patient outcomes. Methods: We analyzed adult liver transplant referrals (n = 9981) from the California Liver Network, a multi-center retrospective cohort spanning six high-volume California transplant centers between 2018 and 2020. A total of 6709 patients who underwent formal evaluation were included. Patients were stratied by MASLD vs. non-MASLD etiology and compared for demographics, comorbidities, transplant evaluation timelines, listing rates, and outcomes. Results: MASLD patients (n = 1477) were older, had higher BMI, and had greater prevalence of metabolic comorbidities than non-MASLD patients (n = 5232; p < 0.001 for all). Compared to non- MASLD candidates, MASLD patients were more likely to be waitlisted (OR 1.52, 95% CI 1.33–1.74; p < 0.001). However, MASLD and non-MASLD patients had no statistically signicant dierence in the rate of transplant (p = 0.182), with clinically similar but statistically inferior post-transplant survival outcomes at 5 years post-transplant (88% vs. 83%; p = 0.014). Competing-risk analysis showed that MASLD candidates had higher cumulative incidence of death on the waitlist (p < 0.001), although MASLD was not independently associated with waitlist mortality when adjusting for covariates (p = 0.300). MASLD patients demonstrated increased mortality following waitlist removal (HR 1.64, 95% CI 1.14–2.35; p = 0.008), primarily among those removed for clinical deterioration (HR 1.50, 95% CI 1.01–2.23; p = 0.044). Conclusions: MASLD patients face unique challenges in liver transplant evaluation. MASLD patients are associated with higher comorbidities, increased incidence of waitlist mortality, and signicantly higher mortality rate following waitlist removal. However, transplantation provides signicant survival benet with comparable outcomes to non-MASLD recipients; thus, early access to transplant may optimize outcomes for MASLD liver transplant candidates....
Background: Simultaneous pancreas–kidney transplantation (SPKT) is an effective treatment for patients with type 1 diabetes (T1D) and end-stage kidney disease (ESKD). However, its long-term impact on diabetic retinopathy (DR) stability is not fully understood. This study evaluated DR severity, visual outcomes, and health-related quality of life (HRQoL) in patients with T1D post-SPKT. Methods: This quantitative longitudional study included 24 patients with T1D and ESKD who underwent SPKT between 2013 and 2020. Data included HbA1cand creatinine levels, comprehensive ophthalmic evaluations with fundus imaging, and HRQoL assessment using the 15D instrument. Results: Eighteen patients completed follow-up. The mean age at SPKT was 39 ± 7 years, with 67% male. Post- SPKT, HbA1c and creatinine improved significantly among all participants. The mean ETDRS letter gain was 5.2 letters (95% CI 0.03 to 10.29; p = 0.049). Cataract progression occurred in 39% of phakic eyes (p < 0.001), and seven patients had previous cataract surgery. Seventeen (89%) patients had proliferative DR (PDR) pre-SPKT, with 28% progressing to sight-threatening DR post-SPKT (p = 0.037). One patient (6%) was visually impaired. HRQoL scores were comparable to controls, though patients with PDR had lower visionrelated scores (p = 0.023). Conclusions: Despite metabolic improvements after SPKT, 28% of patients experienced DR progression to severe PDR, highlighting the need for long-term ophthalmic follow-up....
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