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As part of the TLJ2.0 organised by the European Society of Organ Transplantation (ESOT) our working group surveyed transplant professionals' attitudes towards expanding the donor pool, barriers and interventions to overcome these. The survey was posted for three weeks in July-August 2020 via the ESOT's social media platforms.

Infections are a major complication of solid organ transplants (SOTs). This study aimed to describe recipients’ characteristics, and the frequency and etiology of infections and transplant outcome in liver and lung SOTs, and to investigate exposures associated to infection and death in liver transplant recipients. The study population included recipients of SOTs performed in Italy during a 1-year period in ten Italian lung transplant units and eight liver transplant units. Data on comorbidities, infections, retransplantation, and death were prospectively collected using a web-based system, with a 6-month follow-up. The cumulative incidence of infection was 31.7% and 47.8% in liver and lung transplants, respectively, with most infections occurring within the first month after transplantation. Gram-negatives, which were primarily multidrug-resistant, were the most frequent cause of infection. Death rates were 0.42 per 1000 recipient-days in liver transplants and 1.41 per 1000 recipient-days in lung transplants. Infection after SOT in adult liver recipients is associated to an increased risk of death (OR = 13.25; p-value < 0.001). Given the frequency of infection caused by multidrug-resistant microorganisms in SOT recipients in Italy and the heavy impact of infections on the transplant outcome, the reinforcement of surveillance and control activities to prevent the transmission of multidrug-resistant microorganisms in SOT recipients represents a priority. The implementation of the study protocol in liver and lung transplant units and the sharing of results have increased the awareness about the threat due to antimicrobial resistance in the country.

Abnormally high myocardial performance index (MPI) is a Doppler-derived marker of combined systolic and diastolic left ventricular (LV) dysfunction. To identify early stage allograft dysfunction by MPI, we studied 154 long-term heart transplantation (HT) recipients (131 male, aged 51 +/- 13 years at HT, mean follow up 8.4 +/- 3.5 years), with normal left ventricular ejection fraction (LVEF) and free from acute rejection (AR), and 25 normals (13 male, aged 39 +/- 16 years). Rejection score (RS) on endomyocardial biopsy was calculated in the first year. MPI was prolonged (0.45 +/- 0.18 vs. 0.28 +/- 0.10, P = 0.0001) in patients and directly related with mean time from HT (P = 0.001), higher cumulative dosages of cyclosporine at 3 months (P = 0.01), 6 months (P = 0.03), 1 year (P = 0.02), 3 years (P = 0.04) and with cumulative dosage of methylprednisolone at 1 year (P = 0.002). The index was inversely related with mean age at HT (P = 0.002) and tended to be directly related with RS at 1 year (P = 0.05). Thus, MPI is abnormal in long-term HT recipients with normal LVEF. Its direct relation with time from HT as well as immunosuppressive load suggests an early stage of graft dysfunction because of chronic rejection. Extended prospective studies are warranted to clarify its potential role as a negative prognostic marker in HT.

After attending this presentation, attendees will have novel information on the role of Micro-CT analysis of gunshot wounds for estimating the firing range. This presentation will impact the forensic science community by adding new data on the estimation of the firing distance of intermediate-range gunshot wounds in clothed victims, through a micro-CT analysis of the gunshot residue. Estimation of the firing range is often critical for reconstructing gunshot fatalities, where the main measurable evidence consists of the gunshot residue (GSR). Several techniques and methods have already been used for characterizing GSR, such as Atomic Absorption Spectroscopy, Neutron Activation Analysis, Autoradiography, Routine- CT, Scanning Electron Microscopy, and Histochemistry. Recently, a novel approach, based on the use of Micro-CT, proved to be an objective, reliable, rapid, and inexpensive tool for estimating the firing range in intermediate-range shots. Aim of the Study: It is well known that the presence of clothes covering the body heavily affects the distribution of GSR on the entrance wound, hindering the estimation of the firing range on the basis of the sole macroscopic inspection. The goal of the present study was to evaluate the differential distribution of GSR, with regard to the different kinds of textiles covering the skin, by means of micro-CT analysis, with the final purpose of reconstructing the firing distance. Materials and methods: Human legs, surgically amputated, were cleaned of dried blood and any other contaminants, and cut into sections of approximately 6 cm in length. A total of 60 sections were selected; each section was covered with a single type of textile, chosen among cotton fabric (n = 15), jeans (n = 15), leather (n = 15), and waterproof synthetic fabric (n = 15). Bare skin sections were used as controls (n = 15). Firing was carried out perpendicularly at distances of 5, 15, and 30 cm, using a .32 pistol loaded with full-jacketed bullets. A total of 75 shots were performed (five replicates for each distance). After each firing test, the gunshot wounds were photographed and formalin fixed. The skin specimens, comprising the epidermis, dermis, and subcutaneous fat, were cut into parallelepipeds (height 1 cm, side 1 cm) with a lancet. Samples were scanned following standard processing procedures, using a high resolution scanner. The acquired raw data were reconstructed with reconciliation software, which uses the back-projection algorithm to reconstruct axial subsequent images saved as bitmap format. The bitmap images were analyzed by a CT analysis software: the selected volume of interest. (VOI side of 1 cm and height of 3.8 mm) was focused in the centre of the specimen in order to have the entire entry wound positioned in the middle, All the samples were binarized using the same parameters. The percentage of GSR deposit was calculated analyzing all particles with a density higher than 1000 Hu (particles with a density lower than 1000 Hu were excluded to reduce iron artefacts). The 3D images were reconstructed through a Ct-Vox Software. Results: The visual inspection of the skin did not allow the estimation of the firing distance for the covered gunshot-wounds; the morphological features of the entrance wounds (blackening and tattooing) were, indeed, not discernible. The micro-CT analysis revealed that: - GSR particles were less represented in cases compared to controls; - In cases GSR particles were distributed inside the cavity and the fatty tissue of the entrance wound, while in controls they were present mainly on the skin around the hole; and, - Increasing the firing range, the radiological detection of GSR progressively decreased in both cases and controls, allowing a good discrimination of the firing distances tested in the present study. Conclusions: Micro-CT analysis might be useful for the forensic assessment of the firing range, particularly when the morphological features of intermediate-range wounds are not visually discernible (i.e., black people or clothed victims).