Medicina

Background and Objectives: Donor acute kidney injury (AKI) is increasingly recognized in deceased-donor kidney transplantation, but its association with long-term graft outcomes remains controversial. We examined the association between donor AKI and death-censored graft failure (DCGF) while accounting for confounding and competing risks. Materials and Methods: We conducted a retrospective cohort study of 258 adult deceased-donor kidney transplant recipients (144 with AKI donors, 114 with non-AKI donors); all exposure, outcome, and follow-up data were verified against the primary registry before analysis. Propensity score matching (1:1, caliper 0.2 SD of the logit) created 100 matched pairs, with robust variance estimation clustered on pairs. DCGF was analyzed with Fine–Gray competing-risk regression, treating death with a functioning graft as a competing event: a primary donor-level model in the matched cohort and an exploratory post-transplant event model in the full cohort, with biopsy-proven acute rejection as a time-dependent covariate. Results: DGF occurred in 49.0% of recipients of kidneys from donors with AKI and in 33.0% of matched controls (p = 0.031), and lasted longer after donor AKI (median 10 vs. 7.5 days, p = 0.039); DGF frequency rose steeply with AKI Stages 2–3 (63.0% and 80.8%), whereas Stage 1 was comparable to the non-AKI group (23.4% vs. 33.0%). Donor AKI was not significantly associated with DCGF (sHR 1.91, 95% CI 0.95–3.86, p = 0.07; 5-year cumulative incidence 23.1% vs. 13.8%, Gray p = 0.064). In the exploratory post-transplant event model, DGF >14 days was associated with DCGF (sHR 3.29, 95% CI 1.53–7.07, p = 0.002), and time-dependent acute rejection was independently associated with DCGF (sHR 2.71, 95% CI 1.16–6.33, p = 0.021). Conclusions: Donor AKI was associated with a higher incidence and, in particular, a longer duration of DGF, but not significantly with long-term DCGF, and a clinically relevant association cannot be excluded. Prolonged DGF (>14 days) remained associated with DCGF after multivariable adjustment in the exploratory model. Kidneys from donors with AKI may be considered for transplantation within an appropriate clinical context, with particular attention to the early post-transplant course.

Background and Objectives: Hepatocellular carcinoma (HCC) is a major indication for liver transplantation (LT); however, longitudinal musculoskeletal changes detectable by computed tomography (CT) during the first postoperative year remain insufficiently characterized. The aim of this study is to compare baseline CT-derived bone and muscle parameters between patients undergoing LT for HCC and controls and to evaluate longitudinal changes during the first postoperative year. Materials and Methods: This retrospective study included 64 patients who underwent LT for HCC and had technically adequate non-contrast abdominal CT examinations at baseline, postoperative day 180 (POD180), and postoperative day 365 (POD365). The control group comprised 64 patients undergoing non-contrast abdominal CT for urinary stone evaluation. CT-derived measures included L1–L4 vertebral trabecular attenuation, psoas muscle area (PMA), the psoas muscle index (PMI), and psoas muscle density (PMD). Repeated-measures analyses and adjusted linear mixed-effects models evaluated longitudinal changes within the HCC cohort. Results: At baseline, vertebral trabecular attenuation was higher in the HCC group than in controls (151 ± 36 vs. 137 ± 39, p = 0.037), whereas crude PMI, PMA, and PMD did not differ significantly. In hierarchical multivariable analysis, the between-group difference in vertebral attenuation was attenuated after adjustment, while age and baseline PMI remained independently associated with L1–L4 attenuation. In adjusted multivariate analysis, baseline PMD was higher in the HCC group than in controls (51.5 vs. 44.4, p < 0.001). Longitudinally, L1–L4 attenuation declined from baseline to POD180 and remained low at POD365 (overall p < 0.001), with no difference between POD180 and POD365. PMD also decreased over time (overall p < 0.001), whereas PMI and PMA showed no significant change. Adjusted mixed-effects analyses showed that these postoperative reductions persisted after adjustment for age, BMI, albumin, calcium, and ALP. The adjusted PMD model showed an additional decrease between POD180 and POD365 (mean difference, 1.411 HU; 95% CI, 0.065–2.757; Bonferroni-adjusted p = 0.037). Older age remained independently associated with lower vertebral attenuation and PMD. Conclusions: During the first year after LT for HCC, CT-derived vertebral trabecular attenuation and PMD showed significant longitudinal decreases, while psoas muscle quantity remained relatively stable. Muscle quality and vertebral attenuation may therefore provide earlier imaging signals of post-transplant musculoskeletal deterioration than area-based muscle-quantity measures.

Background and Objectives: Preoperative prediction of difficult laparoscopic cholecystectomy (LC) has expanded from point-based scores to regression, nomogram, machine-learning, and quantitative imaging approaches. We examined whether this diversification was accompanied by stronger validation and clinical translation. Materials and Methods: Following a registered Open Science Framework protocol, we conducted a scoping review using Joanna Briggs Institute methodology and PRISMA-ScR. PubMed/MEDLINE, Scopus, and Web of Science were searched on 8 August 2026 for English-language publications from 1 January 2010 through 31 July 2026. Eligible studies evaluated structured multivariable tools using exclusively preoperative inputs. Screening and data charting were performed independently and in duplicate. Results: Searches identified 893 records; removal of 55 records outside the publication window and 372 duplicates left 466 for screening. Sixty reports were assessed as full text, and 59 were included; 47 (79.7%) were published from 2020 onward. Point-based scores predominated (45/59, 76.3%), followed by nomograms (5/59, 8.5%), regression-based probability models (4/59, 6.8%), machine-learning models (4/59, 6.8%), and one quantitative imaging tool (1/59, 1.7%). Four model-development publications (6.8%) included a geographic external validation component, including one with mixed temporal and geographic validation. Calibration was reported in nine publications (15.3%), decision-curve analysis in seven (11.9%), and SHAP-based explainability in two (3.4%). Two publications evaluated scores during clinical use; no controlled clinical-impact study was identified. Conclusions: Evidence of transportability and clinical impact remains limited. Future studies should prioritize standardized prediction targets, complete model specification, calibration, independent validation, and controlled evaluation of model-guided care.