The endothelial glycocalyx is a thin layer consisting of proteoglycans, glycoproteins and glycosaminoglycans that lines the luminal side of vascular endothelial cells. It acts as a barrier and contributes to the maintenance of vascular homeostasis and microperfusion. During solid organ transplantation, the endothelial glycocalyx of the graft is damaged as part of Ischemia Reperfusion Injury (IRI), which is associated with impaired organ function. Although several substances are known to mitigate glycocalyx damage, it has not been possible to use these substances during graft storage on ice. Normothermic machine perfusion (NMP) emerges as an alternative technology for organ preservation and allows for organ evaluation, but also offers the possibility to treat and thus improve organ quality during storage. This review highlights the current knowledge on glycocalyx injury during organ transplantation, presents ways to protect the endothelial glycocalyx and discusses potential glycocalyx protection strategies during normothermic machine perfusion.

Background. Normothermic machine perfusion (NMP) of liver grafts has been shown to reduce intraoperative catecholamine consumption and the need for allogenic blood products after reperfusion compared with organs undergoing classical static cold storage (SCS). This study aimed to investigate the effects of an NMP phase after SCS (NMP after SCS) of liver grafts in terms of postreperfusion hemodynamics and transfusion requirements. Methods. Eighteen recipients of NMP after SCS grafts were matched according to recipient age, donor age, and model for end-stage liver disease score in a 1:2 ratio with recipients of an SCS graft. Postreperfusion hemodynamics and the need for catecholamines, blood products, and clotting factors were compared. Results. After reperfusion of the organ, patients in the NMP after SCS group showed significantly reduced transfusion requirements for packed red blood cells and platelet concentrates compared with patients of the SCS group (P < 0.001 and P = 0.018, respectively). In addition, patients in the NMP after SCS group received less fibrinogen concentrate (NMP after SCS group 0 [0–1.5] g versus SCS group 2 [0–4] g; P = 0.0163). No differences in postreperfusion hemodynamics could be detected between groups. Conclusions. This retrospective analysis shows that NMP reduces postreperfusion requirements of red blood cells, platelet concentrates, and fibrinogen concentrate even if installed after a phase of organ SCS, because it may be practiced on most centers where NMP is available.

Summary: Background: Video-assisted thoracoscopic surgery (VATS) is widely used for anatomical lung resections. Despite available enhanced recovery after surgery (ERAS) recommendations, perioperative management may vary between institutions. This survey assessed current perioperative practice for VATS procedures in Austria. Methods: A structured questionnaire comprising 19 items was distributed to all anesthesia departments performing thoracic surgery in Austria ( n = 13) in February 2024. The survey addressed institutional characteristics, airway management, intraoperative anesthesia strategies, monitoring practices and perioperative analgesia. Data were analyzed descriptively. Results: A total of 10 centers responded (response rate 76.7%) but 1 center did not perform VATS procedures and was excluded from the practice-based analysis; therefore, 9 centers performing VATS were analyzed. Annual VATS case volume ranged from 48–800 procedures. An established ERAS program was reported by three centers (33.3%), while implementation was planned in two centers (22.2%). Airway management varied, with direct laryngoscopy, video laryngoscopy and user-dependent intubation strategies reported. Conventional double-lumen tubes were used as the primary device in six centers (66.7%), whereas camera-assisted double-lumen tubes were used in three centers (33.3%). Routine invasive arterial monitoring was reported by six centers (66.7%) and immediate extubation in the operating room was routine in eight centers (88.9%). Regional anesthesia techniques varied considerably, whereas systemic analgesia was applied more consistently. Conclusion: This national survey demonstrates substantial intercenter variability in perioperative management of VATS procedures in Austria, particularly regarding ERAS implementation, airway management and regional analgesia strategies. The clinical impact of this variability remains unknown because patient outcomes were not assessed.