Article of the Month

October’s Article of the Month, with commentary from Dr. Cale Kassel, analyzes SRTR registry data from March 2020 through August 2021 — the first 18 months of the pandemic — to evaluate how SARS-CoV-2-positive deceased donors were used (or not used) across U.S. solid organ transplantation. Despite comparable post-transplant graft survival for kidney, liver, and heart recipients regardless of donor SARS-CoV-2 status, COVID-positive organs were recovered and transplanted at significantly lower rates — suggesting an opportunity to safely expand the donor pool.

September’s Article of the Month, with commentary from Dr. Scott Byram, examines a 250-patient retrospective study identifying risk factors for postreperfusion syndrome (PRS) in living donor liver transplantation. While most prior PRS literature has focused on DBD recipients, this analysis pinpoints five independent associations specific to LDLT — including two modifiable intraoperative factors (ionized calcium and mean pulmonary artery pressure) that may give anesthesiologists levers to reduce PRS risk before portal vein reperfusion.

July’s Article of the Month, with commentary from Dr. Cale Kassel, is a narrative review on hyponatremia in liver transplantation — one of the most common electrolyte challenges anesthesiologists face perioperatively, and the source of the rare but devastating osmotic demyelination syndrome (ODS). The review consolidates the evidence on outcomes, walks through pre-, intra-, and postoperative management strategies, and offers practical guidance — including a reference table for diluting standard fluids and blood products with D5W to control sodium delivery.

June’s Article of the Month, with commentary from Dr. Scott Byram, examines the OCS Liver PROTECT trial — the first multicenter randomized clinical trial comparing portable normothermic machine perfusion (NMP) to standard ischemic cold storage (ICS) for liver preservation. Across 20 U.S. transplant programs and 293 recipients, NMP using the Organ Care System reduced early allograft dysfunction, lowered ischemic biliary complications at 6 and 12 months, and enabled greater use of marginal donor organs — particularly DCD livers.

May’s Article of the Month, with commentary from Dr. Cara Crouch, examines a 9-year single-center retrospective from Mount Sinai on intracardiac thrombus (ICT) during liver transplantation — comparing incidence and outcomes before and after routine intraoperative TEE became standard practice. The findings make a strong case for TEE standardization: ICT was detected nearly twice as often in the TEE era, but 30-day mortality dropped substantially as earlier detection enabled treatment before hemodynamic collapse.

April’s Article of the Month, with commentary from Dr. Cale Kassel, examines a 117-patient observational cohort study from Spain comparing liver transplant outcomes between DCD donors recovered with normothermic regional perfusion (NRP) and DBD donors. Despite earlier concerns about biliary complications limiting DCD utility, the data suggest that NRP-recovered DCD organs deliver short- and medium-term outcomes comparable to DBD grafts — adding to the growing case for machine perfusion as a tool to expand the donor pool.

January’s Article of the Month, with commentary from Dr. Cara Crouch, examines a 15-year, 1,021-patient retrospective from Mount Sinai analyzing postreperfusion syndrome (PRS) during DBD liver transplantation. The authors identify four donor-side risk factors for PRS — donor age, donor BMI, moderate macrosteatosis, and cold ischemia time — and propose a PRS risk score that, combined with recipient MELD, may help optimize donor-to-recipient matching.