Ian S Jaffe

Plain English
Current cardiac arrest guidelines recommend 10 breaths per minute for patients on breathing tubes, based mainly on animal studies. In a review of 222 in-hospital cardiac arrest patients, those ventilated at more than 12 breaths per minute were almost twice as likely to have their hearts restart compared to those given fewer breaths. This raises the possibility that current ventilation targets during CPR may be too conservative, though the findings need confirmation in prospective trials.

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A gene-edited pig kidney was transplanted into a brain-dead human and kept functioning for a planned 61-day study using only standard approved anti-rejection drugs. The kidney maintained stable electrolyte balance and eliminated the need for dialysis, but antibody-mediated rejection emerged on day 33 and was reversed with plasma exchange and complement inhibition. The study shows a minimally modified pig kidney can sustain human-equivalent kidney function and identifies pre-existing immune cells reactive to pig tissue as a key obstacle to long-term success.

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Tacrolimus has been the backbone drug for preventing organ rejection after transplantation for over 40 years, but its narrow safe dosing range requires constant monitoring. Extended-release formulations have reduced side effects like kidney damage and improved how consistently patients take their medication. The review examines the next wave of very-extended release versions that could further smooth out drug level swings and reduce the number of pills patients need daily.

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A small but growing number of living organ donors choose to donate a second time years after their first donation. Among 220 repeat donors identified in national registry data from 1994 to 2023, short-term outcomes for both donors and recipients were comparable to those of first-time donors. The practice appears safe in carefully selected individuals in the short term, and recipients of repeat-donor organs had similar graft survival rates to recipients from standard donors.

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This study looked at the long-term results of using a drug called imlifidase to help people with kidney transplants when their body was likely to reject the new kidney due to pre-existing antibodies. After five years, most participants were doing well: 7 out of 8 were alive, and although a few experienced issues related to their antibodies early on, these were effectively managed. This matters because it shows that using imlifidase allows for successful kidney transplants in difficult cases, and even though some antibodies returned, they were weaker and didn't cause significant problems in the long term.

Plain English
Pig organ transplantation into humans has advanced rapidly from animal studies to a handful of compassionate-use cases, with early results revealing key obstacles including antibody-mediated rejection, dangerous drops in platelet counts, and unknown long-term immune responses. As formal clinical trials approach, major decisions remain unresolved: which pig genetic modifications to use, how to suppress the immune system without leaving patients vulnerable to infection, and which patients are appropriate candidates. Addressing these challenges through coordinated, multidisciplinary work will determine whether xenotransplantation can realistically close the gap between organ supply and demand.

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Children awaiting liver transplants often have physical, cognitive, and developmental impairments, and this study examined whether those impairments predict transplant failure over up to 14 years. Motor delays, inability to attend school, and lower functional status before transplant each significantly raised the risk of graft failure, while cognitive delays alone did not. Screening for these functional deficits at transplant can identify children who need targeted rehabilitation to improve their chances of long-term graft survival.

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Clinical research draws large volumes of blood from study subjects, but most blood collected for routine clinical tests goes unused and is discarded after analysis. In a 61-day xenotransplant experiment, researchers collected leftover clinical samples from the hospital lab twice weekly, recovering enough plasma to supply 62% of all research plasma needs without taking additional blood from the subject. This recycling approach can meaningfully reduce unnecessary blood loss in patients enrolled in intensive research studies.

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This study looked at how a new policy, which requires kidney biopsies for certain donors, impacted kidney donation practices in the U.S. After the policy was introduced, the rate of biopsies for required kidneys increased significantly, while the rate for optional biopsies decreased. Overall, the number of kidneys not used for transplant slightly rose from 27.2% to 28.7%, but the policy did not negatively affect this trend. The findings show that the new rules have made biopsy practices more consistent without harming the availability of kidneys for transplant.

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The study looked at Americans who received organ transplants in other countries and were removed from the US transplant waiting list. Between 2010 and 2023, 818 people went abroad for transplants, with most (92%) getting kidney transplants, predominantly in countries like the Philippines and India. This information is important because it highlights trends in international transplant travel and the need for better post-surgery care for those patients.

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This pilot study tested whether a 14-day course of the hepatitis C drug combination glecaprevir/pibrentasvir, started just before transplant, could safely prevent or clear hepatitis C transmitted from infected donor kidneys. All 20 recipients achieved a sustained virus-free response with no relapses at one year, and 35% never developed detectable virus at all. The results support using a two-week prophylactic course as a safe and effective strategy that expands the pool of usable donor kidneys.

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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.

Plain English
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 looked at how well two advanced computer programs, ChatGPT and LlaMA-2, can find and report results from cognitive exams like the MMSE and CDR in a large collection of clinical notes. They analyzed 34,465 notes and found that ChatGPT was more accurate, correctly identifying scores and dates 83% of the time for MMSE, compared to LlaMA-2's 66.4%. This is important because it shows that using ChatGPT can help doctors better identify dementia patients who may need treatment or could participate in clinical trials. Who this helps: Patients with dementia and their healthcare providers.

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A technique called thoracoabdominal normothermic regional perfusion (TA-NRP) restores blood flow to organs in donors who die after cardiac arrest before the organs are removed, potentially improving their quality. In 22 such donors at a single center, organ use rates were high across all organ types, and kidney recipients had a lower rate of delayed graft function compared to standard cardiac-death donors. The results support TA-NRP as a promising procurement method, with comparable recipient outcomes to traditional donation approaches.

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ChatGPT was tested on 12 complex kidney transplant case questions from nephrology fellowship exams, and its performance was compared to doctors and trainees. The most advanced version, GPT-4V, answered 10 of 12 questions correctly — on par with nephrology fellows and training program directors — while older versions performed worse. AI models show real promise as educational and decision-support tools in specialized medicine, but should complement rather than replace clinical expertise.

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Clinicians spend significant time manually searching through medical records for cognitive test scores needed for dementia research and care. This study tested whether ChatGPT (GPT-4) and LlaMA-2 could accurately extract scores and dates for standard memory tests from over 34,000 clinical notes. ChatGPT achieved 83% accuracy and far fewer errors than LlaMA-2, indicating that well-validated AI tools could substantially speed up the identification of dementia patients eligible for treatment or clinical trials.

Plain English
Researchers studied the immune responses and cellular changes in two human patients who received heart transplants from genetically modified pigs. They found significant immune activity and organ dysfunction in one patient, while the other had only minor changes after the surgery. Understanding these differences helps in developing better treatments to manage immune reactions and improve recovery after such transplants.

Plain English
Standard organ matching based on a small set of immune markers misses much of the biological complexity that drives long-term transplant failure. Higher-resolution molecular matching tools that account for specific protein shapes recognized by the immune system predict rejection more accurately than traditional methods. The review outlines where molecular matching is already ready to use in practice — such as for living donors and kidney exchange programs — and what barriers remain for applying it to deceased donor allocation.

Plain English
This study looked at transplanting genetically modified pig hearts into two recently deceased human patients to see how well they would function. Both pig hearts worked well right after the transplant, but one heart eventually had problems due to being too large for the recipient. Importantly, there were no signs that the human bodies rejected the hearts or that any diseases were passed from pigs to humans, which is a significant step forward in addressing the shortage of human organs for transplant.

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Doctors frequently cannot tell from symptoms alone whether a patient's infection is bacterial or viral, leading to overuse of antibiotics. A blood test that reads the activity of the patient's own immune genes correctly classified bacterial versus viral infection with 83% accuracy — better balanced than standard clinical judgment, which was biased toward diagnosing bacterial infections and drove a 33% rate of inappropriate antibiotic prescriptions. More accurate infection typing tools could meaningfully reduce unnecessary antibiotic use and slow the growth of antibiotic resistance.

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Researchers analyzed 10 years of infectious disease clinical trials registered on ClinicalTrials.gov (2007–2017), covering over 13,700 trials. HIV/AIDS and hepatitis C were heavily overrepresented relative to their global disease burden, while lower respiratory infections — a leading cause of death worldwide — had far fewer trials. The analysis reveals a mismatch between where clinical research effort is directed and where the greatest medical need exists, offering a roadmap for prioritizing future investment.