The imbalance between organ supply and demand continues to limit the broader benefits of organ transplantation. Machine perfusion (MP) may increase the supply of donor livers by expanding the use of extended criteria donors (ECDs). Using the UNOS/OPTN STAR dataset we reviewed the effect of MP implementation on the behavior of transplant centers. We identified 15 high-utilizing MP centers that were matched to suitable controls based on volume and geographical proximity. We conducted a Differences-in-Differences analysis using linear regression to estimate the impact of MP adoption on the transplant centers' donor utilization. We found a significant increase in cold ischemia time and organs with donor warm ischemia time (DWIT) over 30 minutes (p < 0.05). After removing one outlier center, the analysis showed that these centers through MP accepted overall more DCD donors, DCD donors over 50 years old, donors with macrovesicular steatosis greater than 30% on liver biopsy and with DWIT over 30 minutes (p < 0.05). MP has allowed centers to expand their use of ECDs beyond traditional cutoffs and to increase patient access to liver transplantation.

Hepatocellular carcinoma (HCC) is a leading cause of cancer death, with liver transplantation (LT) offering a curative option for early-stage patients who cannot undergo resection. Although LT provides good long-term outcomes within standard criteria, recurrence occurs in approximately 8–20% of recipients and often leads to poor survival. Traditionally, LT eligibility relied on strict criteria like the Milan criteria, which are effective in selecting patients with low recurrence but may exclude patients who could benefit from transplantation. In response, new expanded criteria and models using tumor biology have been developed for better risk stratification, allowing more personalized selection and management. Despite these advances, recurrence remains a major clinical challenge, with no consensus on optimal imaging timing or frequency post-LT. Treatment depends on the recurrence’s extent and location, including surgical resection and locoregional therapies. Systemic treatments are promising, especially for unresectable or extrahepatic recurrence, though most evidence comes from small retrospective studies, limiting the development of standardized protocols. Future research should focus on addressing these gaps and guiding evidence-based post-transplant care. This is a narrative review summarizing recent advances in HCC recurrence.

Key Points: Female overrepresentation in living kidney donation stems from higher self-referral rates, not differences in approval or follow-through. Male volunteers are not more likely to be declined as donors due to medical contraindications, contrary to common assumptions. Engaging more male volunteers in living donation could expand access to kidney transplantation and reduce waitlist times. Background: Multiple studies have shown that female volunteers are living donors (LDs) for kidney transplantation at higher rates than male volunteers. However, the underlying reasons for this observation are not well understood. We examined the LD evaluation process to determine the point at which sex imbalance arises. On the basis of a previous study, we hypothesized that both sexes are equally likely to become approved as LDs, but female volunteers are more likely to follow through with donation. Methods: This is a single-institution retrospective chart review of self-referrals for LD evaluation between January 2009 and December 2022. Self-referrals were identified using the Organ Transplant Tracking Record database and cross-referenced with billing data. Exclusion at each stage of evaluation was recorded and compared between sexes using log binomial regression; unadjusted and adjusted (for donor age, race, ethnicity, relationship to recipient, and recipient sex) risk ratios with 95% confidence interval were determined. Results: One thousand eight hundred sixty-one self-referrals were reviewed, including 1214 female (65.2%) and 647 male (34.8%) volunteers, resulting in 146 approvals and 125 donations (76/125, 60.8% female, 49/125, 39.2% male). Adjusted risk ratios indicated no significant differences between sexes in completing medical and/or psychosocial workup, having medical and/or psychosocial contraindications, being approved for donation, and proceeding with donation. The top medical contraindications for both sexes were obesity, hypertension, and nephrolithiasis. Conclusions: Female overrepresentation among LDs is likely due to the 1.9 times higher rate of self-referral for evaluation. After this point, both sexes were equally likely to complete workup, be approved, and follow through with donation. Increased efforts to engage male volunteers at the initial self-referral stage has the potential to expand access to LD kidney transplantation. Podcast: This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/K360/2024_12_26_KID0000000581.mp3