Near-infrared (NIR) imaging with indocyanine green (ICG) has proven to be useful in general, visceral, and transplant surgery. However, most studies have performed only qualitative assessments. Therefore, a systematic overview of all studies performing quantitative indocyanine green evaluation in general, visceral, and transplant surgeries should be conducted. Free term and medical subject heading (MeSH) term searches were performed in the Medline and Cochrane databases until October 2022. The main categories of ICG quantification were esophageal surgery (24.6%), reconstructive surgery (24.6%), and colorectal surgery (21.3%). Concordantly, anastomotic leak (41%) was the main endpoint, followed by the assessment of flap perfusion (23%) and the identification of structures and organs (14.8%). Most studies examined open surgery (67.6%) or laparoscopic surgery (23.1%). The analysis was mainly carried out using manufacturer software (44.3%) and open-source software (15.6%). The most frequently analyzed parameter was intensity over time for blood flow assessment, followed by intensity alone or intensity-to-background ratios for structure and organ identification. Intraoperative ICG quantification could become more important with the increasing impact of robotic surgery and machine learning algorithms for image and video analysis.

Machine perfusion is an emerging technology in the field of liver transplantation. While machine perfusion has now been implemented in clinical routine throughout transplant centers around the world, a debate has arisen regarding its concurrent effect on the complex hepatic immune system during perfusion. Currently, our understanding of the perfusion-elicited processes involving innate immune cells remains incomplete. Hepatic macrophages (Kupffer cells) represent a special subset of hepatic immune cells with a dual pro-inflammatory, as well as a pro-resolving and anti-inflammatory, role in the sequence of ischemia–reperfusion injury. The purpose of this review is to provide an overview of the current data regarding the immunomodulatory role of machine perfusion and to emphasize the importance of macrophages for hepatic ischemia–reperfusion injury.

Introduction: The shortage of suitable donor organs represents an ongoing global challenge for organ transplantation. During the COVID-19 pandemic, the number of transplantable organs was especially limited. To date, the impact of recent coronavirus-19 (COVID-19) infection on liver and kidney transplant recipients has not been systematically analyzed, which is essential for the development of future transplant management. Methods: We conducted a systematic review and meta-analysis to assess the clinical outcomes of recent COVID-19 infection in the donor (1) or the recipient (2). A total of 17 studies were considered for systematic review, seven of these were included for meta-analysis. Results: Transplantation of COVID-19 positive donors did not result in an impaired graft survival for liver or kidney transplantation up to 180-days of follow up. Additionally, a positive COVID-19 donor status was not associated with decreased overall survival in kidney transplant recipients within 180 days of transplantation. Nevertheless, an association was found with decreased overall survival in liver transplant recipients within the 180-day follow-up period.Discussion: However, the heterogeneity of studies investigating COVID-19 infection of the recipient did not allow a classification of the significance of COVID-19 positive recipients. Conclusively, a COVID-19 positive donor status should not be considered as an exclusive factor for declining a suitable liver or kidney for transplantation.Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024562551.

Background To find a well-matched donor is crucial for a successful liver transplantation (LT). Several factors such as a matched size, age and type of donation might benefit survival after LT, but the role of donor and recipient gender mismatch (GM) was not yet fully elucidated. Methods This single centre retrospective cohort study included a total of 1146 patients receiving LT at Ajmera transplant centre Toronto from January 2016 to January 2022. We evaluated the influence of donor/recipient age, gender and type of donor on long term survival within a 10-year observation period after LT. Results Liver transplant recipients with gender mismatch (GM+) had a significantly higher 10-year survival rate compared to recipients without gender mismatch (GM-) (p = 0.018). GM significantly influenced survival of liver transplant recipients and favored increased patient survival of female recipients (p < 0.01). Additionally, male recipients of female donors exhibited a significant improved survival compared to those with male donors. Conclusion Donor and recipient GM might not represent a risk factor for an impaired long-term survival after LT. Moreover, the composition of favorable recipient and donor characteristics seem to be the main factors influencing long term survival. Especially, female donor gender was associated with an improved survival of male transplant recipients.

For carefully selected patients with peritoneal surface malignancies (PSMs), secondary cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) can provide similar oncological results as primary CRS/HIPEC. However, the mortality rate and the incidence of reoperations due to perioperative complications after secondary CRS/HIPEC remain understudied. A retrospective analysis was conducted using the StuDoQ|HIPEC registry, a prospectively maintained national German CRS/HIPEC database, to compare reoperation rates and 30-day mortality between patients undergoing primary and secondary CRS/HIPEC. The analysis included patients treated at 83 centers between 2011 and 2024. Propensity-score matching was performed to adjust for confounding factors prior to comparing outcomes between the matched cohorts. A comprehensive analysis of 5011 primary CRS/HIPEC cases and 236 secondary CRS/HIPEC cases showed no significant differences in reoperation rates (15 % vs. 12 %, p = 0.192) or 30-day mortality (2 % vs. 1 %, p = 0.240). After propensity-score matching to control for confounding factors, outcomes remained comparable, with identical reoperation rates of 12 % in both groups (p = 1.000) and similar 30-day mortality (2 % vs. 1 %, p = 0.685). Within the secondary CRS/HIPEC group, the male-to-female ratio was 1:3, and the median age was 55 years. The majority of these patients underwent secondary CRS/HIPEC primarily for appendiceal cancer (27 %), pseudomyxoma peritonei (21 %), or colorectal cancer (20 %), mesothelioma (12 %) and ovarian cancer (10 %). Secondary CRS/HIPEC can be performed safely in selected patients with PSMs, comparable to primary CRS/HIPEC. Reoperation rates and 30-day mortality rates were similar between groups, even after adjusting for confounding factors.