Liver transplantation as an alternative for the treatment of non-resectable liver colorectal cancer: Advancing the therapeutic algorithm

Colorectal cancer is a leading cause of cancer-related mortality, with nearly half of the affected patients developing liver metastases. For three decades, liver resection (LR) has been the primary curative strategy, yet its applicability is limited to about 20% of cases. Liver transplantation (LT) for unresectable metastases was attempted unsuccessfully in the 1990s, with high rates of perioperative death and recurrence. There is now more interest in this strategy due to improvements in systemic therapies and surgical techniques. A significant study conducted by the Oslo group showed that patients receiving liver transplants had a 60% chance of survival after five years. Significantly better results have been achieved by using advanced imaging for risk stratification and further refining selection criteria, especially in the Norvegian SECA trials. This review carefully charts the development and history of LT as a treatment option for colorectal cancer liver metastases. The revolutionary path from the early days of exploratory surgery to the current situation of cautious optimism is traced, highlighting the critical clinical developments and improved patient selection standards that have made LT a potentially curative treatment for such challenging very well selected cases.

Addressing Kidney Transplant Shortage: The Potential of Kidney Paired Exchanges in Jordan

Jordan performed the Middle East's first living-donor kidney transplant in 1972. In 1977, the country became one of the first Arab countries to regulate organ donation and transplantation. Despite these early advances in living donor transplantation, Jordan's organ donation after brain death program remains inactive, making it challenging to meet organ demand and placing many patients on long transplant waiting lists. As of 2020, only 14.2% of the patients with end-stage kidney disease have access to a living donor. The scarcity of compatible living donors exacerbates Jordan's organ shortage, leaving patients with extended waits and uncertain transplant prospects. Due to the lack of living donors and the inactive brain death donation program, additional options are needed to meet organ demand. Kidney paired exchange (KPE), emerges as a potential solution to the problem of donor shortage and donor-recipient incompatibility. By allowing living donors to direct their donated organs to different compatible recipients, KPE offers the promise of expanding transplant opportunities for patients without suitable living donors. However, the current Jordanian law restricting living kidney donation to fifth-degree relatives further limits the pool of potential donors, aggravating the organ shortage situation. This article explores the feasibility of implementing KPE in Jordan and proposes an approach to implementing KPE in Jordan, considering ethical and legal aspects to substantially increase kidney transplants.

Global research productivity of post-transplant lymphoproliferative disorder: a bibliometric study

Background

Post-transplant lymphoproliferative diseases (PTLD) are a heterogeneous collection of neoplasms that occur after solid organ transplants (SOT). In the past 20 years, there has been a rise in PTLD research. This study aims to investigate the global research output and interest regarding PTLD using a bibliometric approach.

Material and methods

On 28 November 2022, the Web of Science Core Collection documents on PTLD published between 2000 and 2022 were collected and analyzed using bibliometric techniques. The VOSviewer application was utilized to visualize the annual number of publications, authors, organizations, countries, published journals, citations, and most occurring keywords.

Results

A total of 2814 documents were retrieved, and a screening process included 1809 documents. The total number of citations was 45 239, and the average number per item was 25. Most articles (n = 747) and citations (n = 25 740) were produced in the United States. Based on citations, most of the top 10 institutions that contributed were in the United States of America. The University of Pittsburgh topped the list with 2700 citations and 64 articles. The vast majority of articles were published in Pediatric Transplantation (n = 147), Transplantation (n = 124), and the American Journal of Transplantation (n = 98). Transplantation has received the most citations, 6499, followed by the American Journal of Transplantation with 5958 citations and Blood with 4107 citations.

Conclusion

With ongoing debates over optimal classification, Epstein-Bar virus involvement, and treatment, this topic has received significant interest from researchers in recent years. Our results can be used as a guide for future research in the field and as a framework for a more in-depth look at the scientific progress of PTLD.

A Global Overview on the Evolution, Debate, and Research Output on Liver Transplant Perfusion Machines

OBJECTIVES

Machine perfusion of liver grafts has gained popularity for its abilities to preserve liver grafts,reduce cold storage damage, and evaluate graft viability before transplant. However, debate persists regarding the optimal solutions, logistics, and biomarkers for assessing graft quality. To shed light on the lengthy debates surrounding the use of machine perfusion in liver graft preservation,this study utilized bibliometric analysis to evaluate the status and development trends of main research areas.

MATERIALS AND METHODS

On December 10th, 2022, we conducted a literature search using the Web of Science database to identify articles related to liver machine perfusion. The search included only original studies and reviews and excluded meeting abstracts, letters, notes, editorials, short surveys, book chapters, and errata. We identified the number of citations and encompassed various aspects, such as annual trends, countries, institutions, authors, journals, and key words. We used VOSviewer version 1.6.18 to generate tables and figures.

RESULTS

After manually removing irrelevant papers, we included 264 articles (89 reviews; remaining were original studies). The articles were cited 5743 times, averaging 21.92 per article. We found that the United Kingdom (n = 76) was the country that produced the most articles,followed by theUnited States (66 articles). Most papers in our search were published in Liver Transplantation (n = 31) and Transplantation (n = 16).

CONCLUSIONS

Bibliometric analysis provided insights into debates and advancements in liver graft preservation using machine perfusion. The analysis showed leading countries and key research areas in the field. This overview serves as a valuable resource for researchers, offering a foundation for further exploration and guiding future investigations in the field of machine perfusion for liver graft preservation.

Unveiling transplantation research productivity of United States: A bibliometric analysis

BACKGROUND

The United States has witnessed significant advancements in the field of organ transplantation over the course of the last five decades, as demonstrated by a notable increase in the quantity of academic research. The presence of a highly dynamic research environment necessitates continuous evaluations to maintain the integrity and progress of the field.

AIM

To evaluate the total output and thematic emphasis of transplant research conducted in the United States.

METHODS

On January 10, 2023, we conducted a bibliometric search of United States research output in transplantation journals from the Web of Science database's Science Citation Index Expanded. We excluded editorials, meeting abstracts, and other non-article types. We analyzed annual trends, authors, institutions, articles, keywords, and countries collaborating with the United States, using VOSviewer 1.6.18 to create figures and tables.

RESULTS

The United States published 25956 papers (3078 reviews and 22878 articles) representing 37.7% of the world's scientific output. Canada emerged as the top collaborator with the United States, co-authoring 1263 articles. Leading institutions in United States transplantation research were the University of Pittsburgh (1749 articles), Mayo Clinic (1605 articles), Harvard Medical School (1549 articles), and Johns Hopkins University (1280 articles). The top three keywords with over 2000 occurrences were "recipients," "survival," and "outcomes," indicating a focus on graft and recipient outcome markers by United States researchers.

CONCLUSION

Our findings demonstrate the United States leadership in organ transplantation research, contributing significantly to the global scientific output in this field. However, opportunities exist for fostering expansive partnerships, particularly with developing countries. This study provides valuable insights into the transplantation research landscape in the United States, emphasizing the importance of ongoing evaluations to maintain and propel advancements in this critical medical discipline. The results may facilitate future collaborations, knowledge exchange, and the pursuit of innovative solutions in the realm of organ transplantation.

Application of robotics in abdominal organ transplantation: A bibliometric analysis

BACKGROUND

Robotic transplant surgery has garnered worldwide attention since 2002. Discussions on this issue have led to more publications over the past decade. This study assessed global robotic organ transplantation studies using bibliometric analysis.

METHOD

The study sample was robotic technique use in organ transplantation publications from 2002 to 2021 in the Web of Science database. We analysed top-cited authors, countries, institutions, journals, and keywords. Citations were used to visualise and analyse target literature in VOSviewer.

RESULTS

160 articles were included in the bibliometric study. Among the nations that are presently involved in the use of robotics in organ transplantation research, the United States of America leads robotic organ transplantation studies. The American Journal of Transplantation published the most articles overall.

CONCLUSION

Based on publication and citation numbers, robotic organ transplantation techniques are becoming more global attention. This robotic abdominal organ transplant surgery bibliometric analysis review covers research output and hotspots.

The Leading Transplantation Journals: A Trend Analysis, 2011-2021

Background

As the field of transplantation has expanded, so have the quantity and variety of articles published on the topic. Evaluation of publications and journals is crucial to the expansion of transplant research. This study investigated the research output and journal metrics of the leading solid organ transplant journals published between 2011 and 2021 based on estimations of the trends in the category CiteScore from the Scopus database.

Materials and Methods

We obtained data on the listed journals from the Scopus Source List. We then filtered the list for "Transplantation" journals. Only the top quartiles or quartile 1 (Q1) journals were placed in this category. This study focused specifically on transplantation journals and did not include other journals related to diseases of transplanted organs such as the kidney, liver, heart, and lungs.

Results

The number of transplantation journals increased by 42.8% in the last ten years, from 28 in 2011 to 40 in 2021. Between 2011 and 2021, nine transplantation journals ranked in the highest quartile (Q1). The American Journal of Transplantation was the top journal in both years, with a 150% increase in citations and an 11.2% increase in articles published. Open access (OA) transplant journals rose from 3 in 2011 to 10 in 2021. In 2021, OA journals earned 8,555 citations, a 125% increase from 2011. Despite this increase, non-OA journals received more citations than OA in 2021 (p value 0.026).

Conclusion

Solid organ transplantation advances lead to more publications and citations. Regular journals and publications evaluation benefits academics and policymakers by promoting the growth of research. This study examined solid organ transplantation journals and gave a global perspective on transplant journal rankings and compared their status in 2011 and 2021.

ChatGPT and Artificial Intelligence in Transplantation Research: Is It Always Correct?

INTRODUCTION

ChatGPT (OpenAI, San Francisco, California, United States) is a chatbot powered by language-based artificial intelligence (AI). It generates text based on the information provided by users. It is currently being evaluated in medical research, publishing, and healthcare. However, there has been no prior study on the evaluation of its ability to help in kidney transplant research. This feasibility study aimed to evaluate the application and accuracy of ChatGPT in the field of kidney transplantation.

METHODS

On two separate dates, February 21 and March 2, 2023, ChatGPT 3.5 was questioned regarding the medical treatment of kidney transplants and related scientific facts. The responses provided by the chatbot were compiled, and a panel of two specialists reviewed the correctness of each answer.

RESULTS

We demonstrated that ChatGPT possessed substantial general knowledge of kidney transplantation; however, they lacked sufficient information and had inaccurate information that necessitates a deeper understanding of the topic. Moreover, ChatGPT failed to provide references for any of the scientific data it provided regarding kidney transplants, and when requested for references, it provided inaccurate ones.

CONCLUSION

The results of this short feasibility study indicate that ChatGPT may have the ability to assist in data collecting when a particular query is posed. However, caution should be exercised and it should not be used in isolation as a supplement to research or decisions regarding healthcare because there are still challenges with data accuracy and missing information.

A Bibliometric Analysis of the Most Cited Journal Articles in Kidney Transplantation

Citation analysis uses the number of times an author, article, or publication has been cited to determine its relative importance or effect. To provide an overview and identify the articles that have gotten the most attention in the field of kidney transplantation, this bibliometric analysis was conducted to analyze the top 100 most cited articles in the Scopus database. The search terms "kidney" and "renal" and transplant-related words such as "transplant," "donor," "recipient," and "procurement" were used to search the Scopus database. Articles up to the query date of December 21, 2022, were included, and all document types including articles, reviews, conference papers, editorials, book chapters, and meeting abstracts were analyzed. The analysis focused on authors, annual trends, journals, and countries. A total of 68,271 articles related to kidney transplantation were published in the Scopus database up to the search date of December 21, 2022. The top 100 cited papers had a total of 76,029 citations, with a mean citation count of 760.3 ± 284.6. The most cited article was a clinical practice guideline paper published by the Kidney Disease: Improving Global Outcomes (KDIGO) Work Group. The top cited journals were the New England Journal of Medicine, Transplantation, and the American Journal of Transplantation. The most productive authors were primarily based in the United States, with the most frequently cited first author being Kasiske B.L. The greatest number of articles and citations were published between 2000 and 2005. This bibliometric analysis provides a comprehensive overview of the top cited articles in the field of kidney transplantation. The results highlight the most influential and impactful research, as well as the most productive authors, journals, and countries. These findings can be used to guide future research and support decision-making in funding and policy.

Laparoscopic Cholecystectomy in a Patient with Situs Inversus Totalis and a Double Superior Vena Cava

BACKGROUND Situs inversus totalis (SIT) is an uncommon condition characterized as a congenital disorder in which the visceral organs are inverted relative to their typical anatomical position. SIT with double superior vena cava (SVC) is an even rarer presentation. Due to the underlying anatomical difference, the diagnosis and treatment of gallbladder stones in patients with SIT are challenging. CASE REPORT We report the case of a 24-year-old male patient who presented with an intermittent history of epigastric pain for 2 weeks. Clinical assessment and radiological investigations confirmed gall bladder stones with evidence of SIT and double superior vena cava (SVC). The patient underwent elective laparoscopic cholecystectomy (LC) with an inverted laparoscopic approach. The recovery from the operation went smoothly, the patient was discharged from the hospital the following day, and the drain was removed on the third postoperative day. CONCLUSIONS Because anatomical variations in the SIT can affect localization of symptoms in patients with complicated gallbladder stones, the diagnosis of patients who have abdominal pain and SIT necessitates both a high index of suspicion and a thorough assessment. Although LC is considered to be a technically challenging surgery and calls for modification of the standard protocol, it is nevertheless feasible to perform the procedure effectively. To the best of our knowledge, this is the first time that LC has been documented in a patient who has SIT and double SVC.

Impact of COVID-19 on abdominal organ transplantation: A bibliometric analysis

BACKGROUND

Abdominal solid organ transplant (SOT) programs have been hit hard by the COVID-19 pandemic, which was officially declared as such on March 11, 2020. Over two years, the tightening and softening of limitations in response to the "waves" of infection and COVID-19 fluctuations have provided distinct issues for waitlisted patients, transplant recipients, and transplant organizations.

METHOD

We searched Scopus using the terms "transplant" and "transplantation," and organ-related phrases like "intestin*," "liver," "kidney," "hepatic," "renal," and "pancrea*," as well as COVID-19 terms such as "COVID-19," "coronavirus," and "SARS-CoV-2." We included articles, reviews, conference papers, letters, notes, editorials, brief surveys, book chapters, and errata and studied nations, institutions, authors, journals, keywords, and articles. VOSviewer 1.6.18 and Excel were used to create tables and figures.

RESULTS

We included 1,251 of 1,256 studies. Among them, 289 (23.1%), 489 (39.1%), and 473 (37.8%) papers were published in 2020, 2021, and 2022, with mean (SD) citations of 30.3 (53.3), 14.3 (26.8), and 4.79 (6.38), respectively. Compared to other abdominal organs, the field of kidney transplants had the highest number of articles describing the impact of COVID-19. The United States contributed the most articles, and the American Journal of Transplantation published the most articles.

CONCLUSION

To our knowledge, this is the first bibliometric investigation of the impact of COVID-19 on SOT. This report provides an overview of the research conducted on SOT and COVID-19. There is potential for this bibliometric analysis to serve as a beneficial and practical resource for ongoing and future research.

Retroperitoneal lipoma and bilateral renal cell carcinoma in a rare co-existence

Introduction

Giant retroperitoneal lipomas are rarely observed clinically, and a retroperitoneal lipoma accompanied by renal cell carcinoma is even more unusual. We present a case of a large retroperitoneal lipoma with bilateral renal cell carcinoma that was definitively diagnosed after resection.

Case presentation

A huge retroperitoneal mass was incidentally discovered in a 58-year-old male with end stage renal disease being evaluated for a kidney transplant. Imaging studies revealed a mixed solid and fat-containing mass displacing the left kidney. Repeat imaging discovered concurrent unilateral renal cell carcinoma and interval enlargement of the mass. Histopathology showed benign adipose tissue, bland spindle cells, and mixed inflammatory infiltrate that was negative for MDM2 amplification. Resection of the mass and bilateral nephrectomy was performed. Final histopathological examination was consistent with bilateral renal cell carcinoma and a large benign retroperitoneal lipoma.

Discussion

The presented case provides a prime example of the diagnostic challenges encountered with retroperitoneal tumors, The final diagnosis of lipoma in this case was only made after review of the resected specimen in its entirety. Retroperitoneal lipomas can present differently based on tumor size and involvement of adjacent organs. The concomitant occurrence of a renal cell carcinoma and retroperitoneal lipoma is extremely rare, and this is the first report published in the literature.

Conclusion

We document a rare case of retroperitoneal lipoma with concurrent bilateral renal cell carcinoma and illustrate frequently encountered challenges during the evaluation of retroperitoneal masses.

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This retroperitoneal lipoma with bilateral renal cell carcinoma is the first case to be reported in the medical literature.

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This case provides a prime example of the diagnostic challenges encountered with retroperitoneal tumors.

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We illustrated frequently encountered challenges during the evaluation of retroperitoneal masses.

Robot-assisted kidney transplantation is a safe alternative approach for morbidly obese patients with end-stage renal disease

BACKGROUND

Many centres deny obese patients with a body mass index (BMI) >35 access to kidney transplantation due to increased intraoperative and postoperative complications.

METHODS

From August 2017 to December 2019, 73 consecutive cases of kidney transplantation in morbidly obese patients were enrolled at a single university at the initiation of a robotic transplant surgery program. Outcomes of patients who underwent robotic assisted kidney transplant (RAKT) were compared to frequency-matched patients undergoing open kidney transplant (OKT).

RESULTS

A total of 24 morbidly obese patients successfully underwent RAKT, and 49 obese patients received an OKT. The RAKT group developed fewer surgical site infections (SSI) than the OKT group. Graft function, creatinine, and glomerular filtration rate (GFR) were similar between groups 1 year after surgery. Graft and patient survival were 100% for both groups.

CONCLUSIONS

RAKT offers a safe alternative for morbidly obese patients, who may otherwise be denied access to OKT.

Transplant of a Kidney from a Hepatitis C Viremic Donor to a Naïve Recipient without Viral Transmission: A Case Report

Patient: Male, 49-year-old

Final Diagnosis: HCV infection

Symptoms: Haematuria

Medication:—

Clinical Procedure: —

Specialty: Transplantology

Hepatic Artery Thrombosis and Takotsubo Syndrome After Liver Transplantation - Which Came First?

BACKGROUND Takotsubo syndrome is a transient, reversible, stress-induced cardiomyopathy that affects only 1.4% of liver transplant patients and can cause complications, including cardiogenic shock, arrhythmia, and thromboembolism. Hepatic artery thrombosis is also rare, affecting just 2-4% of these patients, but can have disastrous consequences. Here, we describe a case of concurrent takotsubo syndrome and hepatic artery thrombosis in a postoperative liver transplant recipient. CASE REPORT The patient was a 66-year-old man who underwent living donor liver transplantation for non-alcoholic steatohepatitis. On postoperative day 3, he became lethargic and tachycardic to the 120 s. Work-up, including EKG, troponin I, BNP, and transthoracic echocardiogram, was characteristic for takotsubo syndrome. His LVEF of 15-20% was markedly reduced compared to his baseline of 50-55% from 6 months prior. Hepatic ultrasonography showed no hepatic arterial flow, prompting emergent return to the OR, where intraoperative evaluation revealed hepatic artery thrombosis. The graft was salvaged after hepatic artery thrombectomy and arterial anastomosis revision. We are unable to determine which event caused the other in this case, as both takotsubo syndrome and hepatic artery thrombosis manifested within the same time frame. CONCLUSIONS It is important to recognize takotsubo syndrome as a potential cause of cardiac dysfunction and hepatic artery thrombosis in liver transplant patients, and also be aware that hepatic artery thrombosis can precipitate takotsubo syndrome.

Bileaflet Foldoplasty in Barlow’s Disease

Mitral valve repair is a feasible and preferable option for the treatment of Barlow's disease. Complex valve repair techniques, in contrast, often lead to increased cross-clamp times and low cardiac output syndrome. A simple, fast, and reproducible foldoplasty technique to reduce anterior and posterior mitral leaflet heights may improve coaptation and reduce mitral regurgitation. Accordingly, herein are described minimally invasive, successful trans-septal and robotic approaches for a bileaflet foldoplasty technique in two patients with Barlow's disease.

Unicentric Castleman's disease presenting as a pulmonary mass: a diagnostic dilemma

Patient: Female, 16

Final Diagnosis: Castleman’s Disease

Symptoms: Chest pain • cough non-productive

Medication: —

Clinical Procedure: —

Specialty: Oncology

A rare case of extracranial meningioma in parapharyngeal space presented as a neck mass

BACKGROUND

Meningiomas are the most common intracranial tumor, but rarely, they can develop extracranially, usually in the neck. There are very few cases of parapharyngeal meningioma reported in literature and little is known about their biological behavior and operative management. We present a patient with a primary parapharyngeal meningioma that presented as an anterior neck mass.

CASE PRESENTATION

The patient is a 55-year-old female who presented with neck mass. A CT scan and MRI revealed a large, well defined, mildly enhancing soft tissue mass located in the right carotid sheath extended from the level of the thyroid gland into the skull base jugular foramen superiorly. Cervical exploration with partial excision of the mass was performed. Histological examination revealed meningiothelial cells with intranuclear inclusions, arranged in a syncytial pattern. Mutiple psamoma bodies these findings are consistent with the diagnosis of meningioma.

CONCLUSION

Extracranial meningiomas are quite rare. The diagnosis of these types of tumors is challenging due to the non specific nature of the symptoms. The anatomic complexity of the region of parapharyngeal space also makes their detection difficult. Imaging modalities can aid in the diagnosis, but pathological examinations are essential in confirming a definite diagnosis.

Unilateral robotic hybrid mini-maze: a novel experimental approach

BACKGROUND

A complete Cox maze IV procedure is difficult to accomplish using current endoscopic and minimally invasive techniques. These techniques are hampered by inability to adequately dissect the posterior structures of the heart and place all necessary lesions. We present a novel approach, using robotic technology, that achieves placement of all the lesions of the complete maze procedure.

METHODS

In three cadaveric human models, the technical feasibility of using robotic instruments through the right chest to dissect the posterior structures of the heart and place all Cox maze lesions was performed.

RESULTS

The entire posterior aspect of the heart was dissected in the cadaveric model facilitating successful placement of all Cox maze IV lesions with robotic assistance through minimally invasive incisions.

CONCLUSION

The robotic Cox maze IV procedure through the novel right thoracic approach is feasible. This obviates the need for sternotomy and avoids the associated morbidity of the conventional Cox-maze procedure.

Unusual presentation of a giant benign inflammatory polyp in the upper esophagus

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This case report highlights a rare type of esophageal polyps (inflammatory fibroid polyp).

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This case report presents a giant esophageal inflammatory fibroid polyp.

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This case report represents the second reported case for giant inflammatory fibroid polyps that is originated from the upper esophagus.

Introduction

Benign inflammatory fibroid polyps (IFP) are rare submucosal tumors of the upper gastrointestinal tract. Rarely, they can develop in the esophagus, usually in the lower third. There are only 12 cases of giant IFP of the esophagus reported in literature and little is known about their origin, biological behavior and operative management. We present a patient with a giant benign IFP of the esophagus that originated from the upper esophagus.

Case presentation

The patient is a 59-year-old male who presented with dysphagia. Upper endoscopy and esophagram revealed a giant intraluminal esophageal mass with a pedicle in the upper esophagus. Resection of this mass was performed through a left cervical esophagotomy. Pathology confirmed IFP, On 2 year follow up, there was no recurrence of the mass.

Discussion

A giant IFP is defined as an IFP greater than 4 cm, commonly present in the distal esophagus. Pathology usually reveals vascularized fibrous stroma with elements of inflammatory infiltrate. This mass is slow-growing and asymptomatic until it grows to a large size. Common diagnostic studies include barium esophagram, upper endoscopy, and CT imaging. A key pre-operative work-up is to identify the location of the pedicle to plan out surgical approach and to avoid injuring the rich blood supply thus preventing a life threatening hemorrhage during the operation.

Conclusion

Giant IFPs are infrequent in clinical practice. Resection is indicated and usually performed by a surgical intervention or endoscopic removal. The pathogenesis of these polyps remains poorly understood due to the rarity of these lesions.