A meta-analysis of perfusion parameters affecting weight gain in ex vivo perfusion.

BACKGROUND: Ex vivo machine perfusion (EVMP) has been established to extend viability of donor organs. However, EVMP protocols are inconsistent. We hypothesize that there is a significant relationship between specific parameters during EVMP and perfusion outcomes. METHODS: A meta-analysis of literature was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement. The search encompassed articles published before July 25, 2023. PubMed, Embase, and CENTRAL databases were screened using search terms "ex-vivo," "ex-situ," "machine," and "perfusion." Weight gain, an indicator of organ viability, was chosen to compare outcomes. Extracted variables included perfused organ, warm and cold ischemia time before perfusion, perfusion duration, perfusate flow, pressure, temperature, perfusate composition (presence of cellular or acellular oxygen carrier, colloids, and other supplements) and percent weight change. Data were analyzed using SPSS statistical software. RESULTS: Overall, 44 articles were included. Red blood cell-based perfusates resulted in significantly lower weight gain compared to acellular perfusates without oxygen carriers (11.3% vs. 27.0%, p < 0.001). Hemoglobin-based oxygen carriers resulted in significantly lower weight gain compared to acellular perfusates (16.5% vs. 27%, p = 0.006). Normothermic perfusion led to the least weight gain (14.6%), significantly different from hypothermic (24.3%) and subnormothermic (25.0%) conditions (p < 0.001), with no significant difference between hypothermic and subnormothermic groups (24.3% vs. 25.0%, p = 0.952). There was a positive correlation between flow rate and weight gain (ß = 13.1, R = 0.390, p < 0.001). CONCLUSIONS: Oxygen carriers, low flow rates, and normothermic perfusate temperature appear to improve outcomes in EVMP. These findings offer opportunities for improving organ transplantation outcomes.

Nonbinary and Transgender Male Patient Preferences for Gender-Affirming Top Surgery.

BACKGROUND: This study aimed to identify patient preferences and outcomes of chest masculinization surgery in patients identifying as nonbinary versus transgender (trans-) males. METHODS: Patients who underwent chest masculinization (2003-2022) were included. Demographics, medical comorbidities, surgical approaches, complications, secondary procedures, and BODY-Q chest module survey responses were compared between cohorts. RESULTS: Three hundred two patients were included. Thirteen percent identified as nonbinary and 87% as trans-male. The most common surgical approach in both groups was double incision with free nipple-areola graft (63% vs 71%, P = 0.33). Nonbinary patients more frequently opted for double incision without free nipple areola graft compared to trans-male patients (18% vs 2.7%, P < 0.001). Other unique surgical requests of nonbinary patients included nipple areola preservation and small breast mound preservation (5.2%) and balance between losing bulk and achieving a more androgynous appearance (5.3%). The survey response rate was 31% (93/302). Both groups reported improved quality of life postoperatively ( P = 0.16). Three nonbinary patients elected not to keep their nipple-areola complexes ( P = 0.005). Trans-male patients were more likely to report having a male chest as very important for their gender identity (82% vs 95%, P = 0.043). Nonbinary patients were less likely to prefer small nipples (82% vs 95%, P = 0.033) and 18% stated that they preferred no nipples (vs 2.7% trans-male patients, P < 0.001). CONCLUSIONS: Nonbinary patients have distinct surgical preferences regarding nipple-areola complexes. Chest masculinization planning can differ for this group of patients compared to their trans-male counterparts.

Secondary reduction mammaplasty techniques and outcomes: Cleveland Clinic experience.

BACKGROUND: Information on optimal techniques and outcomes following secondary reduction mammaplasty remains sparse, with only 280 patient cases reported in the literature to date. METHODS: A total of 7179 medical charts of patients who underwent nononcological breast reduction at the Cleveland Clinic Health System from January 2001 to October 2023 were screened to identify whether the procedure was a secondary reduction. Patient charts were then reviewed to extract demographic, surgical, and outcome data. Patients were also contacted through the electronic medical record to fill out the BREAST-Q V2 questionnaire about postoperative satisfaction. Surgical techniques and satisfaction were compared for patients with complications versus those without. RESULTS: One hundred and twenty-two (1.7%) patients underwent secondary breast reduction. An inferior pedicle was the most used for both primary (n = 59, 48.4%) and secondary (n = 64, 52.5%) surgeries. The primary pedicle was recreated in 62 of the 84 (73.8%) rereductions where a primary pedicle was known. A total of 15 patients (12.3%) completed the BREAST-Q questionnaire. Body mass index was significantly and negatively associated with satisfaction with outcome (R=-0.66, p = 0.01), sexual well-being (R=-0.58, p = 0.04), and physical well-being (R=-0.69, p = 0.006). No patients experienced nipple-areola complex (NAC) necrosis following secondary reduction. However, 21 (17.2%) of patients experienced complications or breast fat necrosis following rereduction. Unmatched secondary pedicles showed a trend toward higher complication rates than matched secondary pedicles (31.3% vs. 12.9%, p = 0.051). CONCLUSION: When known, the primary pedicle can be safely used for secondary reduction mammaplasty with minimal risk of NAC necrosis or complication.