Seth A Waits

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A 58-year-old man with hemophilia A and a factor VIII inhibitor — which causes dangerous uncontrolled bleeding — successfully underwent living donor liver transplantation after the inhibitor was eliminated with rituximab before surgery. The inhibitor did not return after transplant, and the patient recovered well. This case provides a practical model for managing one of the rarest and most challenging coagulopathy scenarios in transplant surgery.

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Researchers examined whether cardiac PET scans could predict heart complications in 84 patients who underwent liver transplant, finding that nearly 1 in 5 experienced a major cardiac event within the first year. Reduced global myocardial flow reserve and lower left ventricular ejection fraction on the pre-transplant PET scan independently predicted these events, with a one-year survival of only 54% among those who had cardiac complications versus 98% in those who did not. Pre-transplant PET imaging identifies liver transplant candidates at high cardiac risk who may need more intensive monitoring or intervention.

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This study evaluated a curriculum for teaching advanced open surgical skills — including deep suture tying and continuous suturing — using a 3D-printed model and a microskills teaching approach. Experienced surgeons outperformed second-year residents on all tasks, and the difficulty of specific techniques was clearly tied to identifiable skill gaps, providing a roadmap for targeted instruction. The curriculum offers a structured, evidence-based path for teaching open surgical skills that have been lost as minimally invasive procedures have become dominant.

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This study analyzed 105,387 deceased organ donors to determine whether transplant teams were less likely to accept organs from donors who had just crossed a decade birthday — a phenomenon called left digit bias. At ages 60 and 70, there were significant drops in organ acceptance rates, with donors entering their 70s having a 5.4% lower chance of any organ placement and 0.25 fewer organs used. Awareness of this cognitive bias could prevent the unnecessary discard of viable organs from donors who are 60 or 70 years old.

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This project created 24 short surgical training videos covering steps of transplant operations, posted them to YouTube, and used Twitter to distribute them and spark discussion between learners and experts in 37 countries. The videos averaged about two minutes each and accumulated over 4,000 views and 127 hours of watch time in six months, with engagement from faculty, residents, fellows, and medical students worldwide. The results show that microlearning combined with social media can deliver surgical education globally at low cost.

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This national analysis compared 7-year graft survival and segment discard rates between split-liver transplants (one donor liver used for two recipients) and reduced-size transplants (one liver, one recipient with the rest discarded) in the US from 2008-2018. Long-term graft survival was identical between approaches, but reduced-size procedures had far higher segment discard rates (50% vs. 9%), mostly involving the right lobe. The data support prioritizing split-liver over reduced-size transplantation whenever technically feasible to maximize organ utilization.

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Using national kidney disease registry data on over one million patients with end-stage kidney disease from 2008-2016, researchers found that the obese group was the largest and fastest-growing demographic — rising from 37% to 40% over the period. Geographic variation was substantial, with state-level obesity rates in this population ranging from 32% to 45%, and transplant rates among obese patients varying nearly twofold by state. The findings underscore that obesity is the dominant unmet challenge in kidney disease management and access to transplantation.

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This study assessed US kidney transplant center websites for readability and availability of content in languages other than English, finding significant gaps in accessibility for non-English-speaking patients. The results highlight structural barriers to transplant access that exist even before a patient makes their first phone call to a program. Improving website readability and language access could meaningfully reduce disparities in who pursues kidney transplant evaluation.

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This cross-sectional study examined national trends in liver transplant waiting list additions and completed transplants for alcoholic hepatitis before and during the COVID-19 pandemic. The pandemic period was associated with notable shifts in both listing patterns and transplant rates for this indication. The findings provide context for understanding how the pandemic disrupted access to transplant for patients with alcohol-related liver disease.

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This study examined whether US liver transplant programs that perform well on recipient survival also tend to perform well on other quality measures — organ utilization and waitlist mortality — finding essentially no correlation. Only 2% of programs ranked in the top quartile on all three measures, meaning excellence in one domain provides no signal about performance in another. Current oversight that focuses narrowly on one-year survival may leave major quality gaps undetected.

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This study used a regression discontinuity design to test whether dialysis centers that received financial penalties under a federal quality program subsequently improved their scores. Penalized centers, which were disproportionately located in lower-income, non-white communities, showed no improvement in total performance scores or individual quality measures over two years. Pay-for-performance penalties are not an effective lever for quality improvement in dialysis care and may worsen health equity.

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This study evaluated a standardized opioid-restrictive pain management protocol after kidney transplant, comparing patients before and after its February 2018 implementation. After the protocol was adopted, the median number of opioid tablets prescribed at discharge dropped from 60 to 4, and total opioid use within 30 days fell by 87%, without increases in readmissions or pain-related phone calls. A structured, multimodal pain protocol can safely and dramatically reduce opioid prescribing after kidney transplantation.

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This cohort study examined the effects of a 2017 liver allocation policy change on how many donated livers were used and how far they traveled for transplant. The new policy altered both utilization patterns and organ transport distances, with implications for organ quality and equity in access across geographic regions. The findings inform ongoing policy debates about how to distribute scarce livers fairly while minimizing ischemia time.

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This report describes the Transplant Research, Education, and Engagement (TREE) group at the University of Michigan, a research collaborative that involves undergraduate students, medical students, residents, fellows, and faculty in transplant surgery research. The model deliberately gives junior members active roles and mentorship responsibilities, and within three years had over 30 members working on multiple projects. TREE demonstrates a scalable approach to building research skills and enthusiasm for transplant surgery across the full educational pipeline.

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This propensity-matched study compared 30-day surgical outcomes for chronic kidney disease patients who underwent Roux-en-Y gastric bypass versus sleeve gastrectomy using a national bariatric registry. The only statistically significant difference was a higher rate of acute kidney injury with gastric bypass (4.9% vs. 2.7%), but the effect size was small and could be explained by unmeasured confounders. The perception that gastric bypass is prohibitively risky in CKD patients is not supported by this data, and surgical selection should be individualized.

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This report introduces the best-case/worst-case communication framework as a tool for transplant providers discussing high-risk donor organ offers with patients. The framework structures the conversation around the patient's values and goals, then walks through the best, worst, and most likely outcomes to support a shared, personalized decision. It addresses a real need, since Public Health Service increased-risk donor kidneys are discarded 50% more often than standard kidneys despite comparable outcomes.

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This national cohort study of 1,597 obese patients with end-stage kidney disease who underwent bariatric surgery found that surgery was associated with 31% lower all-cause mortality at five years compared to a matched nonsurgical group, driven largely by fewer cardiovascular deaths. Bariatric surgery was also associated with an 80% higher rate of kidney transplant within five years. The one-year post-surgery period carried elevated risk, but the long-term benefits strongly favor offering bariatric surgery to eligible patients on the kidney transplant waitlist.

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Surgical residents at the University of Michigan used a low-cost 3D-printed model simulating the pelvic anatomy to practice kidney transplant vascular anastomoses, and all 12 participants reported a better understanding of the procedure and found the model effective. The model was derived from a de-identified CT scan and designed with computer-aided software, making it inexpensive and reproducible. 3D-printed simulation offers a practical, low-barrier solution for teaching transplant surgical technique.

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Using a national bariatric surgery database of over 320,000 procedures, this study found that patients with a prior solid organ transplant had higher rates of readmissions, surgical complications, and medical complications after bariatric surgery than non-transplant patients, but no higher risk of death. Baseline kidney function strongly moderated risk, with the lowest kidney function driving the most complications. The overall complication profile should not categorically exclude transplant recipients from bariatric surgery, given the substantial long-term benefits.

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This study evaluated the safety of bariatric surgery specifically in obese patients with end-stage renal disease, a population that is typically excluded or discouraged from these procedures. The findings characterize perioperative risks and provide data to inform transplant programs and bariatric surgeons who manage this growing patient group. The study supports individualized risk-benefit assessment rather than blanket exclusion of ESKD patients from bariatric intervention.

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This analysis of Medicare data found that bariatric surgery in patients with end-stage kidney disease increased ninefold between 2006 and 2016, with sleeve gastrectomy replacing gastric bypass as the dominant procedure (rising from under 1% to 84% of cases). Sleeve gastrectomy complication rates were similar to non-ESKD patients, though readmission rates were modestly higher. These national trends confirm that the field has shifted toward a safer surgical approach for this high-risk population.

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This study analyzed whether the volume of intravenous fluids given during laparoscopic donor kidney removal affected outcomes for both the donor and the recipient. Aggressive fluid management lowered recipient creatinine on day one after transplant but did not improve creatinine at six months, and donors who received aggressive fluids had significantly more complications. Standard, moderate fluid management is the appropriate approach during living donor nephrectomy.

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This commentary addresses a growing clinical dilemma: as obesity rates rise among potential living kidney donors, transplant programs are increasingly asked whether obese candidates should be offered bariatric surgery before donation. The authors review evidence that obese living donors have worse health outcomes than lean donors, discuss prior weight-loss approaches, and argue for prospective data collection on bariatric surgery as a pathway to safe donation for otherwise excluded candidates.

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This pilot study tested whether giving fourth-year surgical students structured video-based coaching — watching their own performance with a faculty mentor — improved their suturing skills compared to uncoached peers. Students who received coaching reported greater subjective improvement across all skill domains and overwhelmingly endorsed the experience. The study establishes proof-of-concept for video review as a scalable, efficient feedback tool to prepare students for surgical residency.

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This study applied the failure-to-rescue metric — measuring how often patients die after a major complication — to pediatric liver transplant data from 21 centers. Centers with the lowest mortality had both fewer complications and lower failure-to-rescue rates, suggesting that post-complication care quality is a key driver of outcomes variation. Standardizing perioperative protocols to reduce failure-to-rescue could close the three-fold gap in outcomes between high- and low-performing centers.

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Using CT imaging to measure abdominal fat and muscle mass in 348 liver transplant recipients, this study found that high visceral fat was associated with significantly worse post-transplant survival, especially in patients who also had small trunk muscles. At five years, patients with low muscle mass and high visceral fat had only 37% survival versus 58% in the low-fat group within the same muscle category. Body composition imaging before transplant could identify patients who need prehabilitation to improve their odds of survival.

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This prospective observational study evaluated whether a Twitter account delivering three surgical facts per day during a medical school clerkship enhanced student education. Most students (73%) used the tool and over half found it positively influenced their experience, but it had no measurable effect on shelf exam scores. Twitter can supplement a surgery clerkship without displacing it, but social media alone is unlikely to improve knowledge acquisition on standardized tests.

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This study found that sarcopenic liver transplant recipients — those with the smallest trunk muscle mass — had 2.8 times the failure-to-rescue rate of the most muscular group after complications, explaining why low muscle patients die more often after transplant. The mechanism appears to be that when complications occur, frail patients lack the physiological reserve to survive them rather than experiencing more complications in the first place. Early identification of sarcopenic transplant candidates could enable targeted rehabilitation before surgery.

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This single-center study implemented an enhanced recovery protocol for living kidney donors that included nerve blocks, preoperative carbohydrate loading, and opioid-free pain management. After implementation, median hospital stay dropped from two days to one, and opioid use decreased by nearly 50% without any change in pain scores. Enhanced recovery protocols offer a practical, evidence-based way to reduce recovery time and medication burden for living kidney donors.

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This analysis of national Medicare data found that laparoscopic colectomy for colon cancer was used in 33% of patients overall but varied from 0% to 67% across different regions, despite no differences in patient characteristics or access to laparoscopic technology between high and low-use areas. The wide geographic variation suggests that surgical training and local culture, not patient factors, determine whether patients receive the less invasive approach. Reducing this variation would require targeted training programs and better patient education.

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This analysis of ostomy surgery in 34 Michigan hospitals found high overall morbidity (44%) and mortality (11%), with risk-adjusted complication rates varying more than twofold between hospitals — from 31% to 61%. The variation was not explained by case volume, laparoscopic use, or operative time, suggesting differences in perioperative care quality. Ostomy surgery is common, morbid, and highly variable in outcomes, making it an important target for quality improvement efforts.