Highlights d Human intestinal transplants were used to identify bona fide T RM cells d Single-cell RNA sequencing identifies two distinct CD8 + T RM subsets d CD103 + CD69 + and CD103 À CD69 + T RM cell subsets show distinct localization and function d b2-integrin is highly expressed on CD103 À T RM cells

Background Xenotransplantation has made tremendous progress over the last decade. Methods We discuss kidney and heart xenotransplantation, which are nearing initial clinical trials. Results Life sustaining genetically modified kidney xenografts can now last for approximately 500 days and orthotopic heart xenografts for 200 days in non‐human primates. Anti‐swine specific antibody screening, preemptive desensitization protocols, complement inhibition and targeted immunosuppression are currently being adapted to xenotransplantation with the hope to achieve better control of antibody‐mediated rejection (AMR) and improve xenograft longevity. These newest advances could probably facilitate future clinical trials, a significant step for the medical community, given that dialysis remains difficult for many patients and can have prohibitive costs. Performing a successful pig‐to‐human clinical kidney xenograft, that could last for more than a year after transplant, seems feasible but it still has significant potential hurdles to overcome. The risk/benefit balance is progressively reaching an acceptable equilibrium for future human recipients, e.g. those with a life expectancy inferior to two years. The ultimate question at this stage would be to determine if a “proof of concept” in humans is desirable, or whether further experimental/pre‐clinical advances are still needed to demonstrate longer xenograft survival in non‐human primates. Conclusion In this review, we discuss the most recent advances in kidney and heart xenotransplantation, with a focus on the prevention and treatment of AMR and on the recipient’s selection, two aspects that will likely be the major points of discussion in the first pig organ xenotransplantation clinical trials.

Primary hepatic gastrinoma is a very rare ectopic gastrinoma with less than 20 cases reported worldwide. We report the case of a patient with hypergastrinemia who was subjected to exhaustive preoperative and intraoperative imaging and also careful surgical exploration of the duodenum and pancreas which failed initially to identify the primary tumour. Eventually the patient was subjected to left liver lobectomy, as a small palpable lesion was noted intraoperatively. The diagnosis of gastrinoma requires a high index of clinical suspicion and the flawless cooperation of many specialties.

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Objective: To report our experience with the combination of radical surgical excision and intestinal transplantation in patients with recurrent pseudomyxoma peritonei (PMP) not amenable to further cytoreductive surgery (CRS). Background: CRS and heated intraoperative peritoneal chemotherapy are effective treatments for many patients with PMP. In patients with extensive small bowel involvement or nonresectable recurrence, disease progression results in small bowel obstruction, nutritional failure, and fistulation, with resulting abdominal wall failure. Methods: Between 2013 and 2022, patients with PMP who had a nutritional failure and were not suitable for further CRS underwent radical debulking and intestinal transplantation at our centre. Results: Fifteen patients underwent radical exenteration of affected intra-abdominal organs and transplantation adapted according to the individual case. Eight patients had isolated small bowel transplantation and 7 patients underwent modified multivisceral transplantation. In addition, in 7 patients with significant abdominal wall tumor involvement, a full-thickness vascularized abdominal wall transplant was performed. Two of the 15 patients died within 90 days due to surgically related complications. Actuarial 1-year and 5-year patient survivals were 79% and 55%, respectively. The majority of the patients had significant improvement in quality of life after transplantation. Progression/recurrence of disease was detected in 91% of patients followed up for more than 6 months. Conclusion: Intestinal/multivisceral transplantation enables a more radical approach to the management of PMP than can be achieved with conventional surgical methods and is suitable for patients for whom there is no conventional surgical option. This complex surgical intervention requires the combined skills of both peritoneal malignancy and transplant teams.

Aim -Background: Trends in the management of blunt splenic trauma have shifted over the years from splenectomy to splenic preservation. The Aim of the manuscript is to identify the factors that influence the choice of treatment for spleen trauma. Material-Method:We conducted a retrospective review of the medical records of patients admitted with blunt splenic injury to our regional hospital over a two-year period (2008)(2009)(2010). Haemodynamic status upon admission, computed tomography grade of splenic tear, presence and severity of associated injuries have been taken into account to determine the treatment of choice. Therapeutic options were classified into non-operative, operative salvage and splenectomy. Results: Fourteen patients (9 males 64.2%) were admitted with blunt splenic trauma. The most common mechanism of injury was motor vehicle accident (MVA) (64.2%). Splenectomy was undertaken in 7 (50%) patients, in 2 (14.3%) operative salvage was achieved and 5 (35.7%) were selected for nonoperative-management (NOM). Grade of splenic injury, concomitant injuries and haemodynamic stability were identified as significant determinants of the form of treatment provided. Conclusions: NOM can be successfully performed for haemodynamically stable patients with blunt splenic trauma. When surgery is indicated, intraoperative salvage should be considered to reduce the incidence of OPSI. Further research should be made into whether splenectomy is overused.

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