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Trenches in Transplant Surgery

Sabin Subedi

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 comp... more

PublishesDailyEpisodes45Founded6 months ago
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MedicineHealth & Fitness

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Artwork for Trenches in Transplant Surgery

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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, o... more

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 allo... more

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-do... more

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 ... more

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 leukoc... more

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 ... more

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 clea... more

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 ... more

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