Kidney paired exchange (KPE) constitutes 12% of all living donor kidney transplantations (LDKTs) in the United States. The success of KPE programs has prompted many in the liver transplant community to consider the possibility of liver paired exchange (LPE). Though the idea seems promising, the application has been limited to a handful of centers in Asia. In this article, we consider the indications, logistical issues, and ethics for establishing a LPE program in the United States with reference to the principles and advances developed from experience with KPE. Liver Transplantation 24 677-686 2018 AASLD.

Extracellular vesicles (EVs) are small lipid bilayer-delimited particles that are naturally released from cells into body fluids, and therefore can travel and convey regulatory functions in the distal parts of the body. EVs can transmit paracrine signaling by carrying over cytokines, chemokines, growth factors, interleukins (ILs), transcription factors, and nucleic acids such as DNA, mRNAs, microRNAs, piRNAs, lncRNAs, sn/snoRNAs, mtRNAs and circRNAs; these EVs travel to predecided destinations to perform their functions. While mesenchymal stem cells (MSCs) have been shown to improve healing and facilitate treatments of various diseases, the allogenic use of these cells is often accompanied by serious adverse effects after transplantation. MSC-produced EVs are less immunogenic and can serve as an alternative to cellular therapies by transmitting signaling or delivering biomaterials to diseased areas of the body. This review article is focused on understanding the properties of EVs derived from different types of MSCs and MSC–EV-based therapeutic options. The potential of modern technologies such as 3D bioprinting to advance EV-based therapies is also discussed.

eduction mammaplasty is the seventh most common plastic surgical procedure performed worldwide, with over 600,000 cases performed in 2019. 1 Despite its prevalence, pain control following this procedure remains a challenge. 2,3 Preemptive analgesia commonly administered by means of a preoperative modified block of the pectoral nerves (PECS II) 4 or a serratus plane block using bupivacaine has been shown to greatly improve postoperative pain and decrease in-hospital narcotic use. 5 Bupivacaine (0.5%) is relatively cheap in bulk at $0.07/mL, 6 but its actions may Background: There are many approaches to pain control in reduction mammaplasty. Preoperative bupivacaine regional blocks control pain relatively inexpensively ($0.07/mL), but last only 8 hours. A liposomal bupivacaine formulation lasts 72 hours but can be costly ($17.21/mL). Orthopedic and thoracic operations have demonstrated that dexamethasone ($0.44/mL) plus bupivacaine can prolong analgesia. The authors conducted a double-blind, randomized, controlled trial to determine whether dexamethasone plus bupivacaine regional block improves postoperative pain control, reduces inpatient narcotic use, and improves patient satisfaction. Methods: Female patients were randomized into control and experimental groups. Both groups received preoperative modified block of the pectoral nerves: bupivacaine plus saline (control group) or bupivacaine plus dexamethasone (experimental group). Postoperative pain regimens were standardized. Vital signs, pain scores, narcotic consumption, and antiemetic use were recorded throughout the hospitalization. Quality-of-life surveys were distributed at the first postoperative visit.Results: Fifty-one patients completed the study: 25 control and 26 experimental group patients. The experimental group averaged lower pain scores, although there was no statistically significant difference overall or at each 4-hour interval. Postoperative narcotic use was significantly lower in the experimental group (mean, 23.2 oral morphine equivalents versus 36.6 oral morphine equivalents per patient; P = 0.026). There were no differences in 4-hour interval vital signs, antiemetic use, or length of stay. Survey results showed enhanced quality of life in the experimental group, but this was not statistically significant. Conclusions: The addition of dexamethasone to bupivacaine in the preoperative modified block of the pectoral nerves block before bilateral reduction mammaplasty resulted in significantly less narcotic consumption in the hospital. This can be a costeffective adjunct for postoperative pain control.

Arthroscopic superior capsular reconstruction has become a popular technique used to restore shoulder function in superior cuff deficiency. Passage of the graft via the portal sites is prone to entanglement with sutures and graft twisting. To make shuttling of the graft easier, and reduce the risk of suture entanglement, we developed a technique involving fabricating a suture management cannula from a simple sterile 10-mL syringe. The benefits of this technique are that it allows multiple sutures to be managed easily, avoiding entanglement of the graft during passage and attachment.

Purpose of Review: With the ongoing organ shortage, several mechanisms to facilitate organ exchanges and expand the scope of living kidney or liver donation have been proposed. Although each addresses at least one barrier to transplantation, these innovative programs raise important ethical, logistical, and regulatory considerations. Recent findings: This review addresses four recent proposals to expand living donor transplantation. For kidney transplantation, we discuss global paired exchange and advanced donation programs (“vouchers”) and for liver transplantation, liver paired exchange. Lastly, this review considers trans-organ exchange. We explore the conceptual framework of the exchange, current status, benefits, and concerns for implementation among each of these evolving pathways. Summary: Through highlighting these novel mechanisms in organ exchange, greater awareness, discussion or support can occur to create more avenues for transplantation.