A D Griesemer

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Researchers transplanted a pig kidney-thymus combination into a deceased human and tracked the immune response over 61 days. T cells from the recipient infiltrated the organ and specific clones expanded in blood, tissue, and lymph nodes around rejection events. This reveals that T cell-driven rejection of pig organs in humans closely mirrors what happens with human-to-human transplants, informing how future immunosuppression strategies must be designed.

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This study tracked how donor-reactive immune cells behaved during a 61-day pig-to-human decedent kidney transplant. Specific T cell clones that attack pig tissue were detected expanding in blood and the organ, and innate immune cells also contributed to rejection. The findings clarify the combined immune barriers that must be overcome before pig-to-human transplants can succeed in living patients.

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The first two living recipients of pig hearts died within two months, raising questions about whether animal studies predict human outcomes. This paper argues that transplanting pig organs into recently deceased humans provides a more realistic testing ground before attempting risky trials in living patients. The decedent model could serve as a critical safety checkpoint between animal experiments and human clinical trials.

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Livers stored on ice before transplant suffer ischemia damage that worsens outcomes. This randomized trial tested a portable device that keeps the liver oxygenated and perfused during transport, compared to standard cold storage. The results support that hypothermic oxygenated machine perfusion reduces injury and could become a new standard for liver preservation in the U.S.

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Living donor liver transplantation can reduce deaths on the waitlist, but its use in the U.S. remains low. This consensus conference report from the American Society of Transplantation identified barriers to wider adoption and outlined best practices for selecting candidates and engaging potential donors. The goal is to increase access to living donor transplants across more transplant centers.

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Using national transplant registry data, researchers examined how often pediatric liver transplant centers use partial or living-donor grafts, and what effect this has on outcomes. Centers that more aggressively used these technical variant grafts had lower waitlist mortality for children. The findings argue for broader adoption of split and living-donor livers at pediatric transplant programs.

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Pigs engineered to remove the main immune trigger for human rejection are now considered viable organ sources for people with end-stage kidney disease. This review covers the physiologic challenges unique to pig kidneys functioning in a human body—including differences in hormone, protein, and filtration compatibility. Solving these physiology mismatches is essential before xenotransplantation can become a clinical reality.

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A teenager with liver cancer received immune checkpoint inhibitor therapy (anti-PD1) to shrink the tumor before a liver transplant. Despite concerns that this drug could trigger severe rejection after transplant, the graft remained stable and the patient did well. This case offers early evidence that checkpoint inhibitors may be safely bridged to transplantation in carefully selected pediatric patients.

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Liver removal surgery in children carries real risks, but population-level data on complications are limited. Using a national pediatric surgical database, researchers identified which factors—including wound class and operative time—predict unplanned readmission within 30 days of hepatectomy. These benchmarks help hospitals identify high-risk patients and plan better follow-up care.

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Transplant tolerance—where the recipient's immune system accepts a donor organ without lifelong drugs—has been achieved for kidneys in primates but not for livers. This study tested whether creating temporary mixed bone marrow chimerism could induce tolerance to a transplanted liver in nonhuman primates. It did not, suggesting liver tolerance requires a fundamentally different approach than kidney tolerance.

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Most donated lungs are never used because injury makes them too risky for transplant. Researchers connected damaged human lungs to a living pig's circulation as an extended support system and showed the lungs could recover function over multiple days. This xenogeneic cross-circulation approach could dramatically increase the number of usable donor lungs.

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An infant who received a living-donor liver transplant developed COVID-19 hepatitis when the donor later tested positive for the virus. Liver function deteriorated but the patient recovered without losing the graft. This early case documented that COVID-19 can affect transplanted liver allografts and prompted questions about donor screening protocols.

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Medical students who assisted with organ procurements reported the experience was meaningful but lacked any formal educational structure. A survey of students who participated over several years found strong interest in surgery and donation but gaps in knowledge and guidance. The authors call for a standardized curriculum to make procurement education consistent and impactful.

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This review summarizes efforts to make transplanted organs permanently accepted by the recipient's immune system—without lifelong immunosuppression—by first transplanting donor bone marrow. Clinical trials at Massachusetts General Hospital have achieved durable tolerance in kidney transplant patients who received haploidentical donor marrow. The same approach is being tested in nonhuman primates with the goal of broadening its use.

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Bile duct strictures are a common complication after pediatric liver transplant, often requiring repeated procedures. This study tested a structured three-session dilation protocol and found it reduced total drainage time and improved outcomes compared to less systematic approaches. A standardized biliary dilation protocol can spare children multiple interventions.

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Planning surgery for living liver donors requires detailed imaging to map blood vessels and bile ducts, but no standard protocol exists across transplant centers. This article describes imaging workflows and anatomy variants from multiple institutions to lay the groundwork for consensus guidelines. Standardized radiology reporting would improve donor safety and surgical planning.

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Living donor liver transplantation relies on accurate preoperative imaging, yet imaging protocols vary widely and no agreed guidelines exist. This overview describes how radiologists assess potential donors, including the surgical techniques used downstream. Better imaging standardization could improve outcomes for both donors and recipients.

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A 12-year-old who had received a liver transplant as an infant presented acutely with fever and abdominal pain. Imaging revealed a large stone in the bowel loop connected to the bile duct reconstruction, causing obstruction and tissue death. This case illustrates a rare but serious late complication of pediatric liver transplantation requiring urgent surgical intervention.

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In patients without cirrhosis, portal vein blockage can cause parts of the liver to shrink while others compensate. This study examined liver atrophy patterns in such patients and found that surgical shunts to relieve portal hypertension allowed meaningful liver regeneration. These findings support surgical intervention rather than watchful waiting in non-cirrhotic portal vein thrombosis.

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Children who receive livers from living donors—usually parents—have better long-term outcomes than those receiving deceased-donor organs, but living donor transplants remain rare in the U.S. This study found that living-donor recipients also showed immunological advantages, with lower rejection rates likely tied to the partial genetic match with a parent donor. The data make a strong case for expanding living donor programs for children.

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Donor livers from people over 70 are almost never used, even though studies show they can work well. Analysis of national data found that older grafts are systematically excluded by Medicare eligibility rules and center bias, not just medical evidence. Reconsidering these policies could meaningfully expand the organ supply.

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Deceased organ donors represent a rare opportunity to study human immune cells directly from tissues rather than just blood. This paper shows that clinical factors during the donor's hospitalization—such as cause of death, infection, and time in the ICU—significantly alter immune cell profiles in organs and blood. These variations must be accounted for when using donor tissues for immunology research.

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A 21-year-old patient had a large ganglioneuroma wrapped around major abdominal structures, making standard surgery too risky. A novel robotic-assisted technique allowed complete removal of the tumor while protecting surrounding vessels and nerves. This case expands the options for surgeons managing difficult retroperitoneal tumors.

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Liver transplant experiments in cynomolgus monkeys are hampered by the animals' poor tolerance of portal vein clamping during surgery. This study developed and tested an H-shaped vein bypass to maintain blood flow during the critical no-liver phase, dramatically improving surgical survival. The technique enables more reliable primate liver transplant models for future research.

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Using marginal donor livers—from older, obese, or otherwise imperfect donors—is controversial because of concerns about worse outcomes. A single-institution analysis of over 2,000 transplants found that marginal livers performed acceptably when carefully selected and managed. High-volume centers can safely use marginal organs to transplant more patients without sacrificing survival.

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The Milan criteria determine which liver cancer patients qualify for a transplant, but they don't capture tumor biology. This study built the MORAL score, combining AFP, neutrophil-to-lymphocyte ratio, and tumor size, to better predict which patients will have cancer recurrence after transplant. The model outperforms Milan criteria alone and could guide fairer organ allocation.

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Most adult living-donor liver transplants use the larger right lobe because of worries that the smaller left lobe won't provide enough liver mass to the recipient. This largest North American report on left lobe adult-to-adult living donor transplants showed comparable outcomes to right lobe grafts when donors and recipients were well selected. Left lobe donation is safer for donors and more feasible than commonly assumed.

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After a living donor gives part of their liver, delayed stomach emptying is a recognized but poorly understood complication. This study characterized the incidence, risk factors, and management—including the need for endoscopy or reoperation—after living donor hepatectomy. Awareness of this complication can guide post-operative monitoring and earlier intervention.

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Patients with liver cancer receive transplant priority points under MELD exception rules, but the benefit varies by geographic region depending on organ availability. Comparing regions with long versus short wait times, this study found that priority allocation for hepatocellular carcinoma led to similar survival outcomes regardless of waiting time, with some regional disparities. The findings informed ongoing debates about how to fairly prioritize cancer patients for transplant.

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The thymus shrinks with age, which is a barrier to inducing transplant tolerance using thymus-based protocols in older animals. This study tested whether an LHRH agonist—a hormone-blocking drug—could reverse thymic shrinkage in miniature pigs. The drug successfully rejuvenated the aging thymus, raising the possibility of extending tolerance induction protocols to older transplant recipients.

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The thymus is the organ where immune cells learn to distinguish self from foreign, and it plays a central role in transplant tolerance. This review explains positive and negative thymic selection and describes how regulatory T cells arising from the thymus suppress immune attacks on self-tissues. Understanding thymic biology is the foundation for any strategy aimed at inducing tolerance to a transplanted organ.

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Intestinal transplantation has the highest rejection rates of all solid organ transplants, partly because of the massive immune cell load carried in the gut. In miniature swine, researchers showed that intestinal transplants can induce lasting tolerance and peripheral chimerism—a state where donor and recipient immune cells coexist—without chronic immunosuppression. This proof of concept opens a path toward tolerance strategies for human intestinal transplant.

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John Jones was the first professor of surgery in the Americas and a founder of Columbia University's medical school. This historical piece traces his training in Europe, his role during the Revolutionary War, and his influence on the development of American surgical education. Recognizing early surgical pioneers contextualizes the evolution of modern surgical training and ethics.

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Pig organs engineered to lack the alpha-1,3-galactosyltransferase gene avoid the immediate antibody-mediated rejection seen in standard xenografts. This study transplanted these knockout pig kidney-thymus units into nonhuman primates and found that while hyperacute rejection was prevented, other immune mechanisms still caused organ failure. The results defined the next barriers to xenotransplantation beyond the Gal antigen.

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Some kidney transplants survive long-term despite the recipient producing antibodies against the donor—a phenomenon called accommodation. This study used GalT-knockout pigs, which naturally make anti-Gal antibodies, to model accommodation and found that a complement-inhibiting protein called CD59 was upregulated in surviving kidneys. CD59 upregulation may be a key protective mechanism that the immune system uses to accommodate mismatched grafts.

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Transplant tolerance to kidneys across full genetic mismatches has been achieved in pigs using a short course of immunosuppression. This study tested whether a second, partially mismatched kidney could survive in animals that had already accepted a fully mismatched kidney, suggesting that tolerance spreads via a linked suppression mechanism. The finding supports the idea that regulatory T cells generated against one donor can protect other grafts sharing some donor antigens.

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Traditional assays for measuring T cell responses to transplant antigens require radioactive materials, limiting their use. This paper describes non-radioactive methods using fluorescent dyes (CFSE and PKH-26) to measure both T cell proliferation and killing activity in pigs. These safer, flow cytometry-based assays can be broadly adopted in transplant immunology labs.

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Kidney transplant tolerance induced by a short course of cyclosporine depends on the ongoing presence of donor tissue and on how the immune system recognizes donor antigens. Removing the donor kidney caused tolerance to fade over time, and switching antigen recognition pathways shifted the mechanism of tolerance maintenance. These findings reveal that tolerance is an active, antigen-dependent process rather than a permanent state.

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Nonspecific colonic ulcers are rare lesions with no identified cause, diagnosed by ruling out infection, inflammation, and malignancy under the microscope. They can cause bleeding, perforation, or bowel obstruction and may be mistaken for other conditions on imaging. Early colonoscopy is essential for diagnosis and to guide treatment before serious complications develop.