Annals of surgery
October 15, 2026 · via Europe PMC
SETI-The Semi-Elective Transplant Initiative: A Systems-Based Approach to Expanding Kidney Transplant Access Through Operational Redesign.
Kaltenmeier C, Hanish SI, Nagaraju S, +11 more, Scalea J.
AI summary — for doctors, generated from the abstract only
A Semi-Elective Transplant Initiative combining preservation strategy with predictable morning operating room access shifted kidney transplantation toward planned timing and more logistics-sensitive grafts, though the abstract is cut off before most outcome results.
What was studied
Retrospective evaluation of a prospectively implemented operational redesign for deceased-donor kidney transplantation (January 2022 to June 2025), comparing pre-SETI, SETI-1 (expanded machine perfusion) and SETI-2 (morning OR access) periods, with a contemporaneous SRTR cohort (N=12,302) as comparator.
Key findings
- Among 936 transplants, mean cold ischemia time rose after SETI (20.2 to 21.9 h; P=0.0039)
- Donation after circulatory death kidneys with cold ischemia over 30 hours increased from 0.5% pre-SETI to 7.7% after full implementation
- The authors state the design does not support causal inference, and that net organ utilization was not established
Clinical relevance
Transplant programs may be able to convert urgent, night-time mobilization into more predictable scheduling using perfusion and OR access, and still transplant grafts with longer ischemia times. Clinical benefit is not demonstrated here.
Who should care
Limitations
The abstract is truncated mid-results, so comparator results and early clinical outcomes cannot be reported. Single-program, before-and-after retrospective design without causal inference.
The redesign enabled more logistically sensitive grafts to be transplanted, but effects on outcomes and overall organ use remain unproven and the abstract is incomplete.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Objective
To evaluate whether formal integration of preservation strategy with predictable operating room access was associated with measurable changes in transplant timing, preservation practice, the logistical profile of transplanted grafts, and early clinical outcomes.
Summary background data
Deceased donor kidney transplantation remains a reactive process requiring urgent mobilization of hospital resources. As volumes increase and hospitals operate near capacity, this creates operational barriers that limit organ utilization. We report a retrospective evaluation of a prospectively implemented operational redesign; the design does not support causal inference.
Methods
Adult deceased-donor kidney transplants (January 2022-June 2025) were grouped into pre-SETI, SETI-1 (expanded machine perfusion), and SETI-2 (morning operating room access). A contemporaneous SRTR cohort (N=12,302) served as the comparator.
Results
Among 936 transplants, mean cold ischemia time (CIT) increased after SETI (20.2→21.9 h, P=0.0039). Donation after circulatory death (DCD) kidneys with CIT >30 hours increased from 0.5% pre-SETI to 7.7% after full implementation (P<0.0001). Overnight perfusion increased more than 3-fold, and operative starts shifted toward 8-10 AM. Kidney Donor Profile Index rose across eras (median: 29→33→43, P<0.001). No significant differences were observed in DGF (41.4→38.2%, P=0.071) or graft failure (5.4→3.2%, P=0.34); these comparisons were underpowered and do not establish equivalence. Donor hypertension predicted graft failure, whereas CIT, DCD status, and SETI era did not.
Conclusions
Systems-based operational redesign transformed reactive deceased-donor kidney transplantation into a proactive model, enabling transplantation of a greater proportion of logistics-sensitive grafts, including DCD kidneys and organs with prolonged CIT, within existing healthcare resources. Whether this increases net organ utilization was not established by these data.
DOI
10.1097/sla.0000000000007235
PMID
42875848
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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