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Achkar KA, Abdelnour LM, Abu Jawdeh BG, Tantisattamoa E, Al Ammary F. Evaluation and Long-Term Follow-Up of Living Kidney Donors. ADVANCES IN KIDNEY DISEASE AND HEALTH 2024; 31:400-407. [PMID: 39232610 DOI: 10.1053/j.akdh.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 03/21/2024] [Accepted: 04/10/2024] [Indexed: 09/06/2024]
Abstract
The evaluation of living kidney donor candidates is a complex and lengthy process. Donor candidates face geographic and socioeconomic barriers to completing donor evaluation. Inequities in access to living donations persist. With a growing demand for kidney transplants and a shortage of living donors, transplant centers are more permissive of accepting less-than-ideal donor candidates. Donors have an increased lifetime risk of kidney failure, but the absolute risk increase is small. Efforts are needed to support donor candidates to complete donor nephrectomy safely and efficiently and receive optimal follow-up care to prevent risk factors for kidney disease and detect complications early. In this article, the authors address key elements of donor kidney evaluation, including current living donation policy requirements and transplant center practices. The authors present a simplified comprehensive practical approach to help guide providers in completing donor evaluation and follow-up care with best outcomes possible.
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Affiliation(s)
| | - Lama M Abdelnour
- Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | | | | | - Fawaz Al Ammary
- Department of Medicine, University of California Irvine, Orange, CA.
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Kao YN, Huang ST, Wang IK, Chuang YW, Lin CL, Lee BK, Li CY, Yu TM. Risk of new onset hyperuricemia and chronic kidney disease after living kidney donation through propensity score matching analysis. Sci Rep 2024; 14:20015. [PMID: 39198621 PMCID: PMC11358382 DOI: 10.1038/s41598-024-70760-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 08/21/2024] [Indexed: 09/01/2024] Open
Abstract
Living kidney donors have been regarded as those people having earned the healthiest status level after having undergone scrutiny. Although one's post-donation GFR is expected to fall to 50% of their pre-donation value, it is well documented that there is a compensatory increase in GFR which subsequently reaches approximately 60-70% of the donor's pre-donation value. Data regarding gout/hyperuricemia in living kidney donors has remained scarce until now. This study involved kidney donors enrolled within the years 2000 to 2017, where those who were selected to be matched to those in group of case cohort by age, year of index date, gender and co-morbidity were considered as the control cohort. During the 17-year study period 2,716 participants were enrolled. Results revealed that kidney donors experienced a risk of new onset gout/ hyperuricemia (adjusted HR = 1.73; 95%CI = 1.27, 2.36), and new onset CKD (adjusted HR = 6.7; 95% CI = 4.4, 10.21) were found to be higher in kidney donors. Our findings suggest that people after kidney donation are significantly associated with a higher risk of new onset gout/hyperuricemia. Clinical professionals therefore need to be cautious of new onset gouy/hyperuricemia after donation surgery.
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Affiliation(s)
- Yu-Nong Kao
- Division of Nephrology, Taichung Veterans General Hospital, Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Shih-Ting Huang
- Division of Nephrology, Taichung Veterans General Hospital, Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - I-Kuan Wang
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Ya-Wen Chuang
- Division of Nephrology, Taichung Veterans General Hospital, Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Cheng-Li Lin
- College of Medicine, China Medical University, Taichung, Taiwan
- Management Office for Health Data, Clinical Trial Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Brian K Lee
- University of Texas, Austin, Dell Seton Medical Center, Austin, USA
| | - Chi-Yuan Li
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Tung-Min Yu
- Division of Nephrology, Taichung Veterans General Hospital, Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.
- College of Medicine, China Medical University, Taichung, Taiwan.
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
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Garg AX, Arnold JB, Cuerden MS, Dipchand C, Feldman LS, Gill JS, Karpinski M, Klarenbach S, Knoll G, Lok CE, Miller M, Monroy-Cuadros M, Nguan C, Prasad GVR, Sontrop JM, Storsley L, Boudville N. Hypertension and Kidney Function After Living Kidney Donation. JAMA 2024; 332:287-299. [PMID: 38780499 PMCID: PMC11117152 DOI: 10.1001/jama.2024.8523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 04/22/2024] [Indexed: 05/25/2024]
Abstract
Importance Recent guidelines call for better evidence on health outcomes after living kidney donation. Objective To determine the risk of hypertension in normotensive adults who donated a kidney compared with nondonors of similar baseline health. Their rates of estimated glomerular filtration rate (eGFR) decline and risk of albuminuria were also compared. Design, Setting, and Participants Prospective cohort study of 924 standard-criteria living kidney donors enrolled before surgery and a concurrent sample of 396 nondonors. Recruitment occurred from 2004 to 2014 from 17 transplant centers (12 in Canada and 5 in Australia); follow-up occurred until November 2021. Donors and nondonors had the same annual schedule of follow-up assessments. Inverse probability of treatment weighting on a propensity score was used to balance donors and nondonors on baseline characteristics. Exposure Living kidney donation. Main Outcomes and Measures Hypertension (systolic blood pressure [SBP] ≥140 mm Hg, diastolic blood pressure [DBP] ≥90 mm Hg, or antihypertensive medication), annualized change in eGFR (starting 12 months after donation/simulated donation date in nondonors), and albuminuria (albumin to creatinine ratio ≥3 mg/mmol [≥30 mg/g]). Results Among the 924 donors, 66% were female; they had a mean age of 47 years and a mean eGFR of 100 mL/min/1.73 m2. Donors were more likely than nondonors to have a family history of kidney failure (464/922 [50%] vs 89/394 [23%], respectively). After statistical weighting, the sample of nondonors increased to 928 and baseline characteristics were similar between the 2 groups. During a median follow-up of 7.3 years (IQR, 6.0-9.0), in weighted analysis, hypertension occurred in 161 of 924 donors (17%) and 158 of 928 nondonors (17%) (weighted hazard ratio, 1.11 [95% CI, 0.75-1.66]). The longitudinal change in mean blood pressure was similar in donors and nondonors. After the initial drop in donors' eGFR after nephrectomy (mean, 32 mL/min/1.73 m2), donors had a 1.4-mL/min/1.73 m2 (95% CI, 1.2-1.5) per year lesser decline in eGFR than nondonors. However, more donors than nondonors had an eGFR between 30 and 60 mL/min/1.73 m2 at least once in follow-up (438/924 [47%] vs 49/928 [5%]). Albuminuria occurred in 132 of 905 donors (15%) and 95 of 904 nondonors (11%) (weighted hazard ratio, 1.46 [95% CI, 0.97-2.21]); the weighted between-group difference in the albumin to creatinine ratio was 1.02 (95% CI, 0.88-1.19). Conclusions and Relevance In this cohort study of living kidney donors and nondonors with the same follow-up schedule, the risks of hypertension and albuminuria were not significantly different. After the initial drop in eGFR from nephrectomy, donors had a slower mean rate of eGFR decline than nondonors but were more likely to have an eGFR between 30 and 60 mL/min/1.73 m2 at least once in follow-up. Trial Registration ClinicalTrials.gov Identifier: NCT00936078.
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Affiliation(s)
- Amit X. Garg
- Lawson Health Research Institute and London Health Sciences, London, Ontario, Canada
- ICES, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Research Methods, Evidence and Uptake, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
| | - Jennifer B. Arnold
- Lawson Health Research Institute and London Health Sciences, London, Ontario, Canada
| | - Meaghan S. Cuerden
- Lawson Health Research Institute and London Health Sciences, London, Ontario, Canada
| | - Christine Dipchand
- Department of Medicine (Nephrology), Queen Elizabeth II Health Sciences Centre and Dalhousie University Halifax, Nova Scotia, Canada
| | - Liane S. Feldman
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - John S. Gill
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Greg Knoll
- Department of Medicine (Nephrology), the Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | | | | | | | | | - G. V. Ramesh Prasad
- St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Jessica M. Sontrop
- Lawson Health Research Institute and London Health Sciences, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Neil Boudville
- Medical School, The University of Western Australia, Nedlands, Western Australia, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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Ogata M, Osako K, Terashita M, Miyauchi T, Sakurai Y, Shinoda K, Sasaki H, Shibagaki Y, Yazawa M. Consequences of kidney donation by age in Japanese living kidney donors: a single-center study. Clin Exp Nephrol 2024; 28:664-673. [PMID: 38436901 DOI: 10.1007/s10157-024-02476-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/10/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Elderly living kidney donors (LKDs) are becoming increasingly important in countries with a high prevalence of living-donor kidney transplants and an aging society. This study explored the features of elderly LKDs, focusing on their subsequent outcomes. METHODS This single-center, retrospective, observational study included eligible LKDs who donated their kidneys between April 2008 and July 2022. LKDs were categorized into an elderly (≥70 years at donation) or a non-elderly group (<70 years). We examined pre-operative characteristics and post-operative outcomes, such as kidney function, complications, development of end-stage kidney disease (ESKD), and mortality. RESULTS Of the 188 LKDs observed for a median of 5.7 years, 31 were in the elderly group (16.5%) and 157 (83.5%) were in the non-elderly group (mean age 72.5 ± 2.7 and 58.2 ± 7.3 years, respectively). No significant differences were observed in hospital stay length or peri-operative complications between groups. Both groups experienced a similar decline in post-donation estimated glomerular filtration rate (eGFR)-approximately 37%. In the elderly group, four LKDs died, and one progressed to ESKD. In the non-elderly group, two LKDs died, and none progressed to ESKD. The cause of death was not strongly suspected to be associated with the donation. CONCLUSIONS eGFR was maintained even in elderly LKDs post-donation. Prioritizing LKDs' safety is paramount; however, donations from elderly people would be acceptable, considering their life expectancy. This can expand the pool of living kidney donors and address the growing demand for kidney transplants.
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Affiliation(s)
- Masatomo Ogata
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Kiyomi Osako
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Maho Terashita
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Takamasa Miyauchi
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Yuko Sakurai
- Department of Pharmacy, St Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-Ku, Kawasaki, Kanagawa, Japan
| | - Kazunobu Shinoda
- Department of Urology, St Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-Ku, Kawasaki, Kanagawa, Japan
| | - Hideo Sasaki
- Department of Urology, St Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-Ku, Kawasaki, Kanagawa, Japan
- Sasaki Urology Clinic, 2566-1, Noborito, Tama-Ku, Kawasaki, Kanagawa, Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Masahiko Yazawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan.
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Ng AP, Chervu N, Branche C, Bakhtiyar SS, Marzban M, Toste PA, Benharash P. National clinical and financial outcomes associated with acute kidney injury following esophagectomy for cancer. PLoS One 2024; 19:e0300876. [PMID: 38547215 PMCID: PMC10977786 DOI: 10.1371/journal.pone.0300876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/06/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Esophagectomy is a complex oncologic operation associated with high rates of postoperative complications. While respiratory and septic complications have been well-defined, the implications of acute kidney injury (AKI) remain unclear. Using a nationally representative database, we aimed to characterize the association of AKI with mortality, resource use, and 30-day readmission. METHODS All adults undergoing elective esophagectomy with a diagnosis of esophageal or gastric cancer were identified in the 2010-2019 Nationwide Readmissions Database. Study cohorts were stratified based on presence of AKI. Multivariable regressions and Royston-Parmar survival analysis were used to evaluate the independent association between AKI and outcomes of interest. RESULTS Of an estimated 40,438 patients, 3,210 (7.9%) developed AKI. Over the 10-year study period, the incidence of AKI increased from 6.4% to 9.7%. Prior radiation/chemotherapy and minimally invasive operations were associated with reduced odds of AKI, whereas public insurance coverage and concurrent infectious and respiratory complications had greater risk of AKI. After risk adjustment, AKI remained independently associated with greater odds of in-hospital mortality (AOR: 4.59, 95% CI: 3.62-5.83) and had significantly increased attributable costs ($112,000 vs $54,000) and length of stay (25.7 vs 13.3 days) compared to patients without AKI. Furthermore, AKI demonstrated significantly increased hazard of 30-day readmission (hazard ratio: 1.16, 95% CI: 1.01-1.32). CONCLUSIONS AKI after esophagectomy is associated with greater risk of mortality, hospitalization costs, and 30-day readmission. Given the significant adverse consequences of AKI, careful perioperative management to mitigate this complication may improve quality of esophageal surgical care at the national level.
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Affiliation(s)
- Ayesha P. Ng
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Corynn Branche
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Syed Shahyan Bakhtiyar
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado, United States of America
| | - Mehrab Marzban
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Paul A. Toste
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
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Ng AP, Cho NY, Kim S, Ali K, Mallick S, Lee H, Benharash P. National analysis of racial disparities in emergent surgery for colorectal cancer. Surg Open Sci 2024; 18:35-41. [PMID: 38318320 PMCID: PMC10838942 DOI: 10.1016/j.sopen.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 02/07/2024] Open
Abstract
Background Racial disparities in access to preoperative evaluation for colorectal cancer remain unclear. Emergent admission may indicate lack of access to timely care. The present work aimed to evaluate the association of admission type with race among patients undergoing colorectal cancer surgery. Methods All adults undergoing resection for colorectal cancer in 2011-2020 National Inpatient Sample were identified. Multivariable regression models were developed to examine the association of admission type with race. Primary outcome was major adverse events (MAE), including mortality and complications. Secondary outcomes included costs and length of stay (LOS). Interaction terms between year, admission type, and race were used to analyze trends. Results Of 722,736 patients, 67.6 % had Elective and 32.4 % Emergent admission. Black (AOR 1.38 [95 % CI 1.33-1.44]), Hispanic (1.45 [1.38-1.53]), and Asian/Pacific Islander or Native American (1.25 [1.18-1.32]) race were associated with significantly increased odds of Emergent operation relative to White. Over the study period, non-White patients consistently comprised over 5 % greater proportion of the Emergent cohort compared to Elective. Furthermore, Emergent admission was associated with 3-fold increase in mortality and complications, 5-day increment in LOS, and $10,100 increase in costs. MAE rates among Emergent patients remained greater than Elective with a widening gap over time. Non-White patients experienced significantly increased MAE regardless of admission type. Conclusion Non-White race was associated with increased odds of emergent colorectal cancer resection. Given the persistent disparity over the past decade, systematic approaches to alleviate racial inequities in colorectal cancer screening and improve access to timely surgical treatment are warranted.
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Affiliation(s)
- Ayesha P. Ng
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Nam Yong Cho
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Shineui Kim
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Konmal Ali
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Saad Mallick
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Hanjoo Lee
- Division of Colon and Rectal Surgery, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Dhalla A, Ravani P, Quinn RR, Garg AX, Clarke A, Al-Wahsh H, Lentine KL, Klarenbach S, Hemmelgarn BR, Wang C, Lam NN. Risk Factors for Developing Low Estimated Glomerular Filtration Rate and Albuminuria in Living Kidney Donors. Kidney Med 2024; 6:100767. [PMID: 38313807 PMCID: PMC10837092 DOI: 10.1016/j.xkme.2023.100767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Rationale & Objective Chronic kidney disease is associated with significant morbidity and mortality in the general population, but little is known about the incidence and risk factors associated with developing low estimated glomerular filtration rate (eGFR) and moderate-severe albuminuria in living kidney donors following nephrectomy. Study Design Retrospective, population-based cohort study. Setting & Participants Kidney donors in Alberta, Canada. Exposure Donor nephrectomy between May 2001 and December 2017. Outcome Two eGFR measurements <45 mL/min/1.73 m2 or 2 measurements of moderate or severe albuminuria from 1-year postdonation onwards that were at least 90 days apart. Analytical Approach Associations between potential risk factors and the primary outcome were assessed using Cox proportional hazard regression analyses. Results Over a median follow-up period of 8.6 years (IQR, 4.7-12.6 years), 47 of 590 donors (8.0%) developed sustained low eGFR or moderate-severe albuminuria with an incidence rate of 9.2 per 1,000 person-years (95% confidence interval, 6.6-11.8). The median time for development of this outcome beyond the first year after nephrectomy was 2.9 years (IQR, 1.4-8.0 years). Within the first 4 years of follow-up, a 5 mL/min/1.73 m2 lower predonation eGFR increased the hazard of developing postdonation low eGFR or moderate-severe albuminuria by 26% (adjusted HR, 1.26; 95% CI, 1.10-1.44). Furthermore, donors were at higher risk of developing low eGFR or albuminuria if they had evidence of predonation hypertension (adjusted HR, 2.52; 95% CI, 1.28-4.96) or postdonation diabetes (adjusted HR, 4.72; 95% CI, 1.54-14.50). Limitations We lacked data on certain donor characteristics that may affect long-term kidney function, such as race, smoking history, and transplant-related characteristics. Conclusions A proportion of kidney donors at an incidence rate of 9.2 per 1,000 person-years will develop low eGFR or albuminuria after donation. Donors with lower predonation eGFR, predonation hypertension, and postdonation diabetes are at increased risk of developing this outcome.
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Affiliation(s)
- Anisha Dhalla
- Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Pietro Ravani
- Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Robert R Quinn
- Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Amit X Garg
- Department of Medicine, Division of Nephrology, Western University, London, ON, Canada
| | - Alix Clarke
- Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Huda Al-Wahsh
- Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University Hospital, St. Louis, MO
| | - Scott Klarenbach
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, AB, Canada
| | - Brenda R Hemmelgarn
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, AB, Canada
| | - Carol Wang
- Department of Medicine, Division of Nephrology, Western University, London, ON, Canada
| | - Ngan N Lam
- Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, AB, Canada
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Correia J, Madanelo M, Silva-Ramos M. Renal Artery Thrombosis After Laparoscopic Living-Donor Nephrectomy: A Case Report. Transplant Proc 2023; 55:1903-1905. [PMID: 37422375 DOI: 10.1016/j.transproceed.2023.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/22/2023] [Accepted: 04/14/2023] [Indexed: 07/10/2023]
Abstract
Renal transplantation is the most successful treatment for end-stage renal disease, and the number of living-donor nephrectomies has been rising over the years due to the advantages it offers over deceased donors. Although this surgery is considered safe, it can be associated with complications amplified by the fact that it is performed on a healthy individual. Renal artery thrombosis is a rare disease that needs prompt diagnosis and treatment to avoid renal function deterioration, which becomes even more important in cases of solitary kidneys. We report the first case of renal artery thrombosis after laparoscopic living-donor nephrectomy treated with catheter-directed thrombolysis.
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Affiliation(s)
- Jorge Correia
- Department of Urology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
| | - Mariana Madanelo
- Department of Urology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Miguel Silva-Ramos
- Department of Urology, Centro Hospitalar Universitário do Porto, Porto, Portugal
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9
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Ruch B, Tsering D, Bhati C, Kumar D, Saeed M, Lee SD, Khan A, Imai D, Bruno D, Levy M, Cotterell A, Sharma A. Right versus left fully robotic live donor nephrectomy and open kidney transplantation: Does the laterality of the donor kidney really matter? Asian J Urol 2023; 10:453-460. [PMID: 38024427 PMCID: PMC10659977 DOI: 10.1016/j.ajur.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/21/2023] [Accepted: 08/16/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Robotic-assisted live donor nephrectomy (LDN) is being gradually adopted across transplant centers. The left donor kidney is preferred over right due to anatomical factors and ease of procurement. We aimed to study donor and recipient outcomes after robotic procurement and subsequent open implantation of right and left kidneys. Methods All fully robotic LDNs and their corresponding open kidney transplants performed at our center between February 2016 and December 2021 were retrospectively analyzed. Results Out of 196 robotic LDN (49 [right] vs. 147 [left]), 10 (5.1%) donors had intra-operative events (6.1% [right] vs. 4.8% [left], p=0.71). None of the LDN required conversion to open surgery. The operative times were comparable for the two groups. Nausea (13.3%) was the most common post-operative complication. There was no mortality in either LDN group. Herein, we report our outcomes on 156 recipients (39 right and 117 left allografts) excluding robotic implants, exports, and pediatric recipients. There were no significant differences between right and left kidney recipients with respect to 1-year post-transplant patient survival (100.0% vs. 98.1%, p=0.45) or graft survival (93.9% vs. 97.1%, p=0.11), or delayed graft function (7.7% vs. 5.1%, p=0.55). Conclusion Non-hand-assisted robotic live donor nephrectomies can be safely performed with excellent outcomes. Right LDN was not associated with higher incidence of complications compared to left LDN. Open implantation of robotically procured right renal allografts was not associated with higher risk of recipient complications.
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Affiliation(s)
- Brianna Ruch
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Deki Tsering
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Chandra Bhati
- Division of Transplant Surgery, University of Maryland, Baltimore, MD, USA
| | - Dhiren Kumar
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Muhammad Saeed
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Seung Duk Lee
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Aamir Khan
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Daisuke Imai
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - David Bruno
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Marlon Levy
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Adrian Cotterell
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Amit Sharma
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
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10
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Centonze L, Di Bella C, Giacomoni A, Silvestre C, De Carlis R, Frassoni S, Franchin B, Angrisani M, Tuci F, Di Bello M, Bagnardi V, Lauterio A, Furian L, De Carlis L. Robotic Versus Laparoscopic Donor Nephrectomy: A Retrospective Bicentric Comparison of Learning Curves and Surgical Outcomes From 2 High-volume European Centers. Transplantation 2023; 107:2009-2017. [PMID: 37195281 DOI: 10.1097/tp.0000000000004618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Although laparoscopic donor nephrectomy (LDN) represents the gold-standard technique for kidney living donation, robotic donor nephrectomy (RDN) settled as another appealing minimally invasive technique over the past decades. A comparison between LDN and RDN outcomes was performed. METHODS RDN and LDN outcomes were compared, focusing on operative time and perioperative risk factors affecting surgery duration. Learning curves for both techniques were compared through spline regression and cumulative sum models. RESULTS The study analyzed 512 procedures (154 RDN and 358 LDN procedures) performed between 2010 and 2021 in 2 different high-volume transplant centers. The RDN group presented a higher prevalence of arterial variations (36.2 versus 22.4%; P = 0.001) compared with the LDN cohort. No open conversions occurred; operative time (210 versus 195 min; P = 0.011) and warm ischemia time (WIT; 230 versus 180 s; P < 0.001) were longer in RDN. Postoperative complication rate was similar (8.4% versus 11.5%; P = 0.49); the RDN group showed shorter hospital stay (4 versus 5 d; P < 0.001). Spline regression models depicted a faster learning curve in the RDN group ( P = 0.0002). Accordingly, cumulative sum analysis highlighted a turning point after about 50 procedures among the RDN cohort and after about 100 procedures among the LDN group.Higher body mass index resulted as an independent risk factor for longer operative time for both techniques; multiple arteries significantly prolonged operative time in LDN, whereas RDN was longer in right kidney procurements; both procedures were equally shortened by growing surgical experience. CONCLUSIONS RDN grants a faster learning curve and improves multiple vessel handling. Incidence of postoperative complications was low for both techniques.
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Affiliation(s)
- Leonardo Centonze
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Caterina Di Bella
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padua, Padua, Italy
| | - Alessandro Giacomoni
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Cristina Silvestre
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padua, Padua, Italy
| | - Riccardo De Carlis
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
- PhD Course in Clinical and Experimental Sciences, University of Padua, Padua, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Barbara Franchin
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padua, Padua, Italy
| | - Marco Angrisani
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Francesco Tuci
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padua, Padua, Italy
| | - Marianna Di Bello
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padua, Padua, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Andrea Lauterio
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Lucrezia Furian
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padua, Padua, Italy
| | - Luciano De Carlis
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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11
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Burgan CM, Summerlin D, Lockhart ME. Renal Transplantation: Pretransplant Workup, Surgical Techniques, and Surgical Anatomy. Radiol Clin North Am 2023; 61:797-808. [PMID: 37495288 DOI: 10.1016/j.rcl.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
End-stage renal disease continues to grow worldwide, and renal transplantation remains the primary and most effective treatment to handle this burden. Living-donor transplantation is the ideal mechanism for transplant recipients to have a successful allograft but carries both medical and surgical risks. Cadaveric kidneys have their own risks and can have a high rate of success as well. Multimodality imaging is crucial and has improved greatly during the last 20 years. Finally, a robust understanding of current surgical techniques can facilitate better postoperative imaging when early complications are a consideration.
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Affiliation(s)
- Constantine M Burgan
- Department of Radiology, University of Alabama-Birmingham, 625 19th Street South JT N316, Birmingham, AL 35233, USA.
| | - David Summerlin
- Department of Radiology, University of Alabama-Birmingham, 625 19th Street South JT N370A, Birmingham, AL 35233, USA
| | - Mark E Lockhart
- Department of Radiology, University of Alabama-Birmingham, 619 19th Street South JTN 344, Birmingham, AL 35233, USA
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12
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Bielopolski D, Yemini R, Gravetz A, Yoskovitch O, Keidar A, Carmeli I, Mor E, Rahamimov R, Rozen-Zvi B, Nesher E. Bariatric Surgery in Severely Obese Kidney Donors Before Kidney Transplantation: A Retrospective Study. Transplantation 2023; 107:2018-2027. [PMID: 37291708 DOI: 10.1097/tp.0000000000004645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Bariatric surgery (BS) is the optimal approach for sustained weight loss and may alter donation candidacy in potential donors with obesity. We evaluated the long-term effects of nephrectomy after BS on metabolic profile, including body mass index, serum lipids and diabetes, and kidney function of donors. METHODS This was a single-center retrospective study. Live kidney donors who underwent BS before nephrectomy were matched for age, gender, and body mass index with patients who underwent BS alone and with donors who underwent nephrectomy alone. Estimated glomerular filtration rate (eGFR) was calculated according to Chronic Kidney Disease Epidemiology Collaboration and adjusted to individual body surface area to create absolute eGFR. RESULTS Twenty-three patients who underwent BS before kidney donation were matched to 46 controls who underwent BS alone. At the last follow-up, the study group showed significantly worse lipid profile with low-density lipoprotein of 115 ± 25 mg/dL versus the control group with low-density lipoprotein of 99 ± 29 mg/dL ( P = 0.036) and mean total cholesterol of 191 ± 32 versus 174 ± 33 mg/dL ( P = 0.046). The second control group of matched nonobese kidney donors (n = 72) had similar serum creatinine, eGFR, and absolute eGFR as the study group before nephrectomy and 1 y after the procedure. At the end of follow-up, the study group had significantly higher absolute eGFR compared with the control group (86 ± 21 versus 76 ± 18 mL/min; P = 0.02) and similar serum creatinine and eGFR. CONCLUSIONS BS before live kidney donation is a safe procedure that could increase the donor pool and improve their health in the long run. Donors should be encouraged to maintain their weight and avoid adverse lipid profile and hyperfiltration.
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Affiliation(s)
- Dana Bielopolski
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva, Israel
- Department of Medicine, Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Renana Yemini
- Department of Surgery, Assuta Medical Center Ashdod, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Aviad Gravetz
- Department of Medicine, Medical School, Tel-Aviv University, Tel-Aviv, Israel
- Department of Transplant Surgery, Rabin Medical Center, Petach-Tikva, Israel
| | - Oz Yoskovitch
- Department of Transplant Surgery, Rabin Medical Center, Petach-Tikva, Israel
| | - Andrei Keidar
- Department of Surgery, Assuta Medical Center Ashdod, Israel
| | - Idan Carmeli
- Department of Surgery, Assuta Medical Center Ashdod, Israel
| | - Eytan Mor
- Department of Surgery B, Transplant Center, Sheba Medical Center, Ramat-Gan, Israel
| | - Ruth Rahamimov
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva, Israel
- Department of Medicine, Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Benaya Rozen-Zvi
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva, Israel
- Department of Medicine, Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Eviatar Nesher
- Department of Medicine, Medical School, Tel-Aviv University, Tel-Aviv, Israel
- Department of Transplant Surgery, Rabin Medical Center, Petach-Tikva, Israel
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13
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Nguyen NTQ, Courtney AE, Nguyen HQ, Quinn M, Maxwell AP, O'Neill C. Early clinical and economic outcomes of expanded criteria living kidney donors in the United States. J Nephrol 2023; 36:957-968. [PMID: 36592302 DOI: 10.1007/s40620-022-01541-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/20/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND The donation of what might be termed expanded criteria kidneys has become an increasingly common practice. This study aimed to assign expanded criteria and non-expanded criteria donation status and examine early clinical and economic outcomes among expanded criteria and non-expanded criteria living kidney donor (LKD) hospitalizations in the US. METHODS Healthcare cost and Utilization Project-National (Nationwide) Inpatient Sample (HCUP-NIS) data (Jan 2008-Dec 2019, N = 12,020) were used. Expanded criteria LKDs were identified as admitted patients aged ≥ 60 years, or 50-59 years with any comorbidity that historically precluded donation. The Clavien-Dindo system was applied to classify surgical complications as grade I-IV/V. RESULTS The number of LKD admissions decreased by 31% over the study period, although this trend fluctuated over time. Compared to non-expanded criteria LKD admissions, expanded criteria LKD admissions had comparable surgical complication rates in Grade I (aOR 1.0, 0.8-1.3), but significantly higher surgical complication rates in Grade II (aOR 1.5, 1.1-2.2) and Grade III (aOR 1.4, 1.0-2.0). The two groups had comparable hospital length of stay and cost in the adjusted models. Notably, Grade II complications were significantly higher in private, for-profit hospitals (15%) compared to government hospitals (2.9%). CONCLUSIONS Expanded criteria LKDs had comparable early outcomes compared to non-expanded criteria LKDs, but the trends evident in LKDs over time and the variation in complication records warrant further research.
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Affiliation(s)
- Nga T Q Nguyen
- Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, 41-43 Dinh Tien Hoang Street, Ben Nghe Ward, District 1, Ho Chi Minh City, Vietnam.
| | - Aisling E Courtney
- Regional Nephrology and Transplant Unit, Belfast City Hospital, Belfast, UK
| | - Hoa Q Nguyen
- Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, 41-43 Dinh Tien Hoang Street, Ben Nghe Ward, District 1, Ho Chi Minh City, Vietnam
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Michael Quinn
- Regional Nephrology and Transplant Unit, Belfast City Hospital, Belfast, UK
| | - Alexander P Maxwell
- Belfast City Hospital, Belfast, UK
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Ciaran O'Neill
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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14
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Di Bella C, Capovilla G, Rosso E, Di Bello M, Tuci F, Contarini E, Simioni A, Baldan N, Silvestre C, Rigotti P, Furian L. How Long Does It Take to Acquire Mastery of Performance in Laparoscopic Living Donor Nephrectomy? A Center-Based and Surgeon-Based Operative Time CUSUM Analysis. Transplant Proc 2023; 55:554-561. [PMID: 36948957 DOI: 10.1016/j.transproceed.2023.02.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/18/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND The safety of laparoscopic donor nephrectomy (LDN) has been widely documented, but its challenging learning curve (LC) requires an insightful assessment to expand its application. The aim of this study was to evaluate LC of LDN in a high-volume transplant center. METHODS Three hundred forty-three LDNs performed from 2001 to 2018 were evaluated. CUSUM analysis based on the operative time was used to assess the number of cases required to reach mastery in the technique for both the entire surgical team and for the 3 main surgeons considered separately. Analysis of association between demographics, perioperative characteristics, and complications within the different LC phases was conducted. RESULTS Mean operative time was 228.9 minutes. Mean length of stay was 3.8 days and mean warm ischemia time (WIT) was 170.8 seconds. Surgical and medical complication rates were 7.3% and 6.4%, respectively. The CUSUM-LC showed a requirement of 157 cases (for surgical team) and 75 cases (for single surgeons) to reach competence in the procedure. Patient baseline characteristic showed no differences among the LC phases. Compared with the initial LC phase, hospital stay was significantly lower at the end of the LC whereas WIT results were longer in the LC descendent phase. CONCLUSIONS This study confirms the safety and efficacy of LDN, with a low rate of complications. This analysis suggests that about 75 procedures are required to reach competence and 93 cases to achieve mastery level of skill for a single surgeon. It can be hypothesized that, in a high-volume transplant enter, the time to guarantee training in LDN is compatible with the duration of a clinical fellowship.
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Affiliation(s)
- Caterina Di Bella
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy.
| | - Giovanni Capovilla
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Eugenia Rosso
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Marianna Di Bello
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Francesco Tuci
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | | | - Andrea Simioni
- Transplantation Center, Department of Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Nicola Baldan
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Cristina Silvestre
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Paolo Rigotti
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Lucrezia Furian
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
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15
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Dhalla A, Lloyd A, Lentine KL, Garg AX, Quinn RR, Ravani P, Klarenbach SW, Hemmelgarn BR, Ibelo U, Lam NN. Long-Term Outcomes for Living Kidney Donors With Early Guideline-Concordant Follow-up Care: A Retrospective Cohort Study. Can J Kidney Health Dis 2023; 10:20543581231158067. [PMID: 36875057 PMCID: PMC9983079 DOI: 10.1177/20543581231158067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/18/2023] [Indexed: 03/06/2023] Open
Abstract
Background Current guidelines recommend that living kidney donors receive lifelong annual follow-up care to monitor kidney health. In the United States, the reporting of complete clinical and laboratory data for kidney donors has been mandated for the first 2 years post-donation; however, the long-term impact of early guideline-concordant care remains unclear. Objective The primary objective of this study was to compare long-term post-donation follow-up care and clinical outcomes of living kidney donors with and without early guideline-concordant follow-up care. Design Retrospective, population-based cohort study. Setting Linked health care databases were used to identify kidney donors in Alberta, Canada. Patients Four hundred sixty living kidney donors who underwent nephrectomy between 2002 and 2013. Measurements The primary outcome was continued annual follow-up at 5 and 10 years (adjusted odds ratio with 95% confidence interval, LCLaORUCL). Secondary outcomes included mean change in estimated glomerular filtration rate (eGFR) over time and rates of all-cause hospitalization. Methods We compared long-term follow-up and clinical outcomes for donors with and without early guideline-concordant care, defined as annual physician visit and serum creatinine and albuminuria measurement for the first 2 years post-donation. Results Of the 460 donors included in this study, 187 (41%) had clinical and laboratory evidence of guideline-concordant follow-up care throughout the first 2 years post-donation. The odds of receiving annual follow-up for donors without early guideline-concordant care were 76% lower at 5 years (aOR 0.180.240.32) and 68% lower at 10 years (aOR 0.230.320.46) compared with donors with early care. The odds of continuing follow-up remained stable over time for both groups. Early guideline-concordant follow-up care did not appear to substantially influence eGFR or hospitalization rates over the longer term. Limitations We were unable to confirm whether the lack of physician visits or laboratory data in certain donors was due to physician or patient decisions. Conclusions Although policies directed toward improving early donor follow-up may encourage continued follow-up, additional strategies may be necessary to mitigate long-term donor risks.
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Affiliation(s)
- Anisha Dhalla
- Division of Nephrology, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Anita Lloyd
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University, MO, USA
| | - Amit X Garg
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
| | - Robert R Quinn
- Division of Nephrology, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Pietro Ravani
- Division of Nephrology, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Scott W Klarenbach
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Brenda R Hemmelgarn
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Uchenna Ibelo
- Division of Nephrology, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Ngan N Lam
- Division of Nephrology, Cumming School of Medicine, University of Calgary, AB, Canada
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16
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Wu G, Liu C, Zhou X, Zhao L, Zhang W, Wang M, Zhao Q, Liang T. Short- and long-term complications after living donor ileal resection. Am J Transplant 2022; 22:3053-3060. [PMID: 36066568 DOI: 10.1111/ajt.17193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 01/25/2023]
Abstract
Intestinal transplantation from deceased donors is the established procedure for patients with irreversible intestinal failure. However, a living-donor intestinal transplant has not been routinely performed yet because of undefined surgical risks to the donor. In this report, we reviewed our experience with living-donor ileal resection from May 1999 to December 2021. A total of 40 living-donor ileal resections were performed for 40 intestinal transplant recipients. Clinical data were prospectively collected and analyzed for postoperative complications after ileal procurement. None of the donors experienced life-threatening complications or mortality. Six (15%) of 40 donors experienced minor operative complications. Transit intestinal graft inadequacy including weight loss, diarrhea, and vitamin B12 deficiency was common early following surgery, but was manageable and disappeared in most cases within a year. All donors had significant reductions in total plasma cholesterol and low-density lipoprotein cholesterol concentrations after donation as compared with the baseline levels. With an average follow-up of 67.8 months, bilateral kidney stones occurred in one donor and gallstones in the other. All the donors have regained their normal capacity for work. Living-donor ileal resection is associated with minimal short- and long-term morbidity and remains an attractive alternative for potential recipients when suitable deceased donors are unavailable.
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Affiliation(s)
- Guosheng Wu
- Intestinal Transplant Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chaoxu Liu
- Intestinal Transplant Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xile Zhou
- Intestinal Transplant Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Long Zhao
- Intestinal Transplant Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wentong Zhang
- Intestinal Transplant Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mian Wang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, the Fourth Military Medical University, Xi'an, China
| | - Qingchuan Zhao
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, the Fourth Military Medical University, Xi'an, China
| | - Tingbo Liang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang Provincial Key Laboratory of Pancreatic Disease, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Cancer Center, Zhejiang University, Hangzhou, China
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17
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Frutos MÁ, Crespo M, Valentín MDLO, Alonso-Melgar Á, Alonso J, Fernández C, García-Erauzkin G, González E, González-Rinne AM, Guirado L, Gutiérrez-Dalmau A, Huguet J, Moral JLLD, Musquera M, Paredes D, Redondo D, Revuelta I, Hofstadt CJVD, Alcaraz A, Alonso-Hernández Á, Alonso M, Bernabeu P, Bernal G, Breda A, Cabello M, Caro-Oleas JL, Cid J, Diekmann F, Espinosa L, Facundo C, García M, Gil-Vernet S, Lozano M, Mahillo B, Martínez MJ, Miranda B, Oppenheimer F, Palou E, Pérez-Saez MJ, Peri L, Rodríguez O, Santiago C, Tabernero G, Hernández D, Domínguez-Gil B, Pascual J. Recommendations for living donor kidney transplantation. Nefrologia 2022; 42 Suppl 2:5-132. [PMID: 36503720 DOI: 10.1016/j.nefroe.2022.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/26/2021] [Indexed: 06/17/2023] Open
Abstract
This Guide for Living Donor Kidney Transplantation (LDKT) has been prepared with the sponsorship of the Spanish Society of Nephrology (SEN), the Spanish Transplant Society (SET), and the Spanish National Transplant Organization (ONT). It updates evidence to offer the best chronic renal failure treatment when a potential living donor is available. The core aim of this Guide is to supply clinicians who evaluate living donors and transplant recipients with the best decision-making tools, to optimise their outcomes. Moreover, the role of living donors in the current KT context should recover the level of importance it had until recently. To this end the new forms of incompatible HLA and/or ABO donation, as well as the paired donation which is possible in several hospitals with experience in LDKT, offer additional ways to treat renal patients with an incompatible donor. Good results in terms of patient and graft survival have expanded the range of circumstances under which living renal donors are accepted. Older donors are now accepted, as are others with factors that affect the decision, such as a borderline clinical history or alterations, which when evaluated may lead to an additional number of transplantations. This Guide does not forget that LDKT may lead to risk for the donor. Pre-donation evaluation has to centre on the problems which may arise over the short or long-term, and these have to be described to the potential donor so that they are able take them into account. Experience over recent years has led to progress in risk analysis, to protect donors' health. This aspect always has to be taken into account by LDKT programmes when evaluating potential donors. Finally, this Guide has been designed to aid decision-making, with recommendations and suggestions when uncertainties arise in pre-donation studies. Its overarching aim is to ensure that informed consent is based on high quality studies and information supplied to donors and recipients, offering the strongest possible guarantees.
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Affiliation(s)
| | - Marta Crespo
- Nephrology Department, Hospital del Mar, Barcelona, Spain
| | | | | | - Juana Alonso
- Nephrology Department, Hospital Regional Universitario de Málaga, Spain
| | | | | | - Esther González
- Nephrology Department, Hospital Universitario 12 Octubre, Spain
| | | | - Lluis Guirado
- Nephrology Department, Fundacio Puigvert, Barcelona, Spain
| | | | - Jorge Huguet
- RT Surgical Team, Fundació Puigvert, Barcelona, Spain
| | | | - Mireia Musquera
- Urology Department, Hospital Clinic Universitari, Barcelona, Spain
| | - David Paredes
- Donation and Transplantation Coordination Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | - Ignacio Revuelta
- Nephrology and RT Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | - Antonio Alcaraz
- Urology Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | - Manuel Alonso
- Regional Transplantation Coordination, Seville, Spain
| | | | - Gabriel Bernal
- Nephrology Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Alberto Breda
- RT Surgical Team, Fundació Puigvert, Barcelona, Spain
| | - Mercedes Cabello
- Nephrology Department, Hospital Regional Universitario de Málaga, Spain
| | | | - Joan Cid
- Apheresis and Cell Therapy Unit, Haemotherapy and Haemostasis Department, Hospital Clinic Universitari, Barcelona, Spain
| | - Fritz Diekmann
- Nephrology and RT Department, Hospital Clinic Universitari, Barcelona, Spain
| | - Laura Espinosa
- Paediatric Nephrology Department, Hospital La Paz, Madrid, Spain
| | - Carme Facundo
- Nephrology Department, Fundacio Puigvert, Barcelona, Spain
| | | | | | - Miquel Lozano
- Apheresis and Cell Therapy Unit, Haemotherapy and Haemostasis Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | | | | | | | - Eduard Palou
- Immunology Department, Hospital Clinic i Universitari, Barcelona, Spain
| | | | - Lluis Peri
- Urology Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | | | | | - Domingo Hernández
- Nephrology Department, Hospital Regional Universitario de Málaga, Spain
| | | | - Julio Pascual
- Nephrology Department, Hospital del Mar, Barcelona, Spain.
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18
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Ethical and medical dilemmas in paid living kidney donor transplantation. Transplant Rev (Orlando) 2022; 36:100726. [PMID: 36113305 DOI: 10.1016/j.trre.2022.100726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/02/2022] [Indexed: 11/20/2022]
Abstract
Due to the shortage of deceased and genetically- or emotionally-related living donors, living unrelated paid donor (LURpD) kidney transplantation has been considered; however, this practice may result in medical, ethical and social dilemmas, induce organ trading (commodification), and even criminal activities. Commodification also risks undermining public trust in the transplant system and impeding the development of proper altruistic or deceased donor programs by ignoring altruism, volunteerism, and dignity. However, despite many objections by authoritative organizations, black market practices are involved in up to 10% of all transplants worldwide. The authors strongly discourage any payment or rewards for organ donation, and instead urge the governments of all countries to provide adequate and accessible kidney health care. However, it is an undeniable fact that paid-living donor transplantation is increasing despite all objections, disapprovals and regulations. We feel it as our responsibility not to ignore this uncertain and undesirable practice, but rather to underline the necessity for strict rules and prohibitions to minimize unacceptable medical, social and ethical risks as long as it exists. Furthermore, economic profit, be it direct or indirect, must not be the goal of those involved, and the employment of intermediaries must be avoided entirely. Additionally, the donor should be in a position where not donating has no detrimental effect on his/her future in any way (free agency). In our view, every country has the obligation and responsibility to provide adaequate kidney health care and to make kidney transplantation accessible to those in need. This provision is key to stop transplant tourism and commercialization of kidney transplantation. The nephrology community has a duty to establish structures that optimize organ availability within strict ethical limits. The legal position of LURpD varies considerably worldwide. Strictly respecting each country's legislation and local values is mandatory to minimize medical and ethical risks and controversies.
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Bhurtyal N, Paudel K, Shah S, Paudel S, Kafle MP, Shah DS. Anxiety and depression among living kidney donors in tertiary care hospital of low resource country setting Nepal. Ann Med Surg (Lond) 2022; 80:104119. [PMID: 36045759 PMCID: PMC9422055 DOI: 10.1016/j.amsu.2022.104119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/28/2022] [Accepted: 07/01/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Kidneys accounted for the majority of transplanted organs worldwide in 2018, according to the Global Observatory on Donation and Transplantation. Living kidney donors continue to have negative psychosocial effects after donation. We aimed to assess anxiety and depression among Nepalese living kidney donors. Methods This was an observational, cross-sectional study conducted from May 2020 to January 2021. All patients who had undergone donor nephrectomy and had completed 6 months of post-donation period were included in the study. Anxiety and depression was assessed using the Hospital Anxiety and Depression Scale (HADS). Fischer exact and chi-square test was used to determine the association between variables and the level of significance was maintained at 5% with p < 0.05 considered statistically significant. Results A total of 147 kidney donors undergoing nephrectomies were included in the study. Among them 69.4% of participants were female and 55.8% of participants were aged 50 years or more. The prevalence of anxiety and depression among kidney donors was 27.9% and 6.2% respectively. Gender, earner, parental relations, occupation, and educational status were related to symptoms of anxiety among the living kidney donors. Similarly, earner was associated with symptoms of depression. Conclusion In addition to physical health measures, routine evaluations of kidney donors should include assessments of depression and other emotional disorders. The actual issue is to come up with effective treatments for depressive symptoms and to improve health outcomes following kidney donation. The prevalence of anxiety and depression among live kidney donors were 27.9% and 6.2% respectively. Gender, parental relations, occupation, and educational status were related with symptoms of anxiety. Routine evaluations of kidney donors should include assessments of depression and other emotional disorders.
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Lauridsen MB, Skov K, Øzbay LA. Short-term Outcome of Danish Kidney Donors: Postoperative Complications and Labor Affiliation. Transplant Proc 2022; 54:1763-1767. [PMID: 35868874 DOI: 10.1016/j.transproceed.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Living kidney donation is safe and effective, but disincentives to donation include risk of short- and long-term complications, which need to be addressed in order to ensure care of live kidney donors. METHODS From January 1, 2016 to December 31, 2019, 123 living kidney donors (LKDs) underwent LKD nephrectomy at Aarhus University Hospital, Aarhus, Denmark. Data from The Scandiatransplant registry and patient records were reviewed in order to identify short-term postoperative complications within 90 days after donation, as well as affiliation to the labor market and health data at follow-up. The Clavien-Dindo classification of surgical complications with modifications by Kocak et al was used to categorize minor and major complications. RESULTS There were available data for 119 of 123 LKDs. Of these, 25 (21%) developed minor complications and 4 (3%) developed major complications. Ninety LKDs (76%) had an uneventful course without any complications. The most common complications were pain and nausea that required additional medical treatment. Seventy-two of the 82 LKDs working before donation had returned to work within 3 months after donor nephrectomy. No one retired or became disabled as a result of being a live kidney donor. CONCLUSIONS Short-term follow up of the LKDs showed that most donors experienced an uneventful course and that the frequency of major complications was low. Donation did not seem to impact the ability to resume work. At the 90-day follow-up the majority of donors with both minor and major complications resumed work and reported full convalescence at the same level as donors without any complications. Nine of the LKDs (8%), all women, were out of work for >3 months with the main reason being fatigue.
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Affiliation(s)
| | - Karin Skov
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lara Aygen Øzbay
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.
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Alvarado F, Cervantes CE, Crews DC, Blanck J, Al Ammary F, Ng DK, Purnell TS. Examining post-donation outcomes in Hispanic/Latinx living kidney donors in the United States: A systematic review. Am J Transplant 2022; 22:1737-1753. [PMID: 35258164 PMCID: PMC9546009 DOI: 10.1111/ajt.17017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 02/18/2022] [Accepted: 02/19/2022] [Indexed: 01/25/2023]
Abstract
We conducted a systematic review to assess outcomes in Hispanic donors and explore how Hispanic ethnicity was characterized. We searched PubMed, EMBASE, and Scopus through October 2021. Two reviewers independently screened study titles, abstracts, and full texts; they also qualitatively synthesized results and independently assessed quality of included studies. Eighteen studies met our inclusion criteria. Study sample sizes ranged from 4007 to 143,750 donors and mean age ranged from 37 to 54 years. Maximum follow-up time of studies varied from a perioperative donor nephrectomy period to 30 years post-donation. Hispanic donors ranged between 6% and 21% of the donor populations across studies. Most studies reported Hispanic ethnicity under race or a combined race and ethnicity category. Compared to non-Hispanic White donors, Hispanic donors were not at increased risk for post-donation mortality, end-stage kidney disease, cardiovascular disease, non-pregnancy-related hospitalizations, or overall perioperative surgical complications. Compared to non-Hispanic White donors, most studies showed Hispanic donors were at higher risk for diabetes mellitus following nephrectomy; however, mixed findings were seen regarding the risk for post-donation chronic kidney disease and hypertension. Future studies should evaluate cultural, socioeconomic, and geographic differences within the heterogeneous Hispanic donor population, which may further explain variation in health outcomes.
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Affiliation(s)
- Flor Alvarado
- Section of Nephrology and HypertensionDepartment of MedicineTulane UniversityNew OrleansLouisinaUSA
| | - Carmen Elena Cervantes
- Division of NephrologyDepartment of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Deidra C. Crews
- Division of NephrologyDepartment of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
- Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Jamie Blanck
- Johns Hopkins Welch Medical LibraryJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Fawaz Al Ammary
- Division of NephrologyDepartment of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
- Division of TransplantationDepartment of SurgeryJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Derek K. Ng
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Tanjala S. Purnell
- Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins UniversityBaltimoreMarylandUSA
- Division of TransplantationDepartment of SurgeryJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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22
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Saunders M, Simpson D. “Can i donate a kidney?” Common questions and simplified answers to the prospective kidney donor. J Natl Med Assoc 2022; 114:S56-S61. [DOI: 10.1016/j.jnma.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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23
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Benavides X, Rogers RT, Tan EK, Merzkani MA, Thirunavukkarasu S, Yigitbilek F, Smith BH, Rule AD, Kukla A, Chow GK, Heimbach JK, Taner T, Dean PG, Prieto M, Stegall MD. Complications After Hand-Assisted Laparoscopic Living Donor Nephrectomy. Mayo Clin Proc 2022; 97:894-904. [PMID: 35483987 DOI: 10.1016/j.mayocp.2021.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/12/2021] [Accepted: 11/03/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To study the complications of hand-assisted laparoscopic living donor nephrectomy (HALLDN) with an emphasis on complications occurring early after hospital discharge up to 120 days after surgery. PATIENTS AND METHODS We retrospectively categorized complications using the Clavien-Dindo classification in 3002 HALLDNs performed at 1 center from January 1, 2000, through December 31, 2019. In addition to overall summaries, modeling was used to identify correlates of complications before and after living donation. RESULTS Of these donors, 87% were White, 59% were female, the mean age was 45 years (range, 18-77 years), 30.3% had a body mass index of at least 30, and 36.3% had previous abdominopelvic surgery. There were no deaths related to the surgery. The incidence of major complications (intraoperative complications plus Clavien-Dindo grade ≥III postoperatively) was 2.5% (n=74). The overall complication rate was 12.4% (n=371), including 15 intraoperative, 76 postoperative before discharge, and 280 after discharge to 120 days. Reoperation was required in 1.8% of patients (n=54), and all but 1 of these were incision-related problems. Seventy-six percent of all complications occurred after discharge, including 85% of the reoperations. For major complications, no risk factor was found. Risk factors for any complication included paramedian incision (hazard ratio [HR], 2.54; 95% CI, 1.49 to 4.34; P<.001); a history of abdominopelvic surgery (HR, 1.37; 95% CI, 1.07 to 1.76; P=.01), male sex (HR, 1.37; 95% CI, 1.07 to 1.76; P=.01), non-White race (HR, 1.40; 95% CI, 1.05 to 1.88; P=.02), and early era of the experience. CONCLUSION Most major complications of HALLDN occur after discharge, suggesting that close follow-up is warranted and that the current literature may underestimate the true incidence.
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Affiliation(s)
- Xiomara Benavides
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Richard T Rogers
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Ek Khoon Tan
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN; Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Massini A Merzkani
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | | - Furkan Yigitbilek
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Byron H Smith
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Aleksandra Kukla
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | | - Julie K Heimbach
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN; Division of Transplantation Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Timucin Taner
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN; Division of Transplantation Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Patrick G Dean
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN; Division of Transplantation Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Mikel Prieto
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN; Division of Transplantation Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Mark D Stegall
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN; Division of Transplantation Surgery, Department of Surgery, Mayo Clinic, Rochester, MN.
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Recomendaciones para el trasplante renal de donante vivo. Nefrologia 2022. [DOI: 10.1016/j.nefro.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Zhuang J, Guidry A. A Content Analysis of Living Organ Donation Materials from Certified Transplant Centers. HEALTH COMMUNICATION 2021; 36:2002-2009. [PMID: 32847410 DOI: 10.1080/10410236.2020.1813392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Despite the fact that living organ donation has the great potential to reduce the shortage of transplantable organs, it is still surrounded by many misconceptions, ethical concerns, and myths. Research conducted to understand factors contributing to public misconceptions related to living organ donation is rare. This research takes a content analytic approach to uncover how living organ donation is portrayed in materials developed and delivered by transplant centers across 11 regions. A total of 332 unique materials were analyzed. The results revealed that living kidney donation dominated the corpus of data whereas other living organ donations were largely overlooked. Benefits and risks associated with living organ donation were relatively evenly presented; however, social support necessary to donors and recipients and available resources to obtain social support were not sufficiently addressed. Embedded in these materials were 46 personal narrative stories. Analysis of these stories showed a focus on undirected living organ donation and revealed a wide range of emotional experiences. Significant regional differences were found in several themes, such as benefits and risks, and social support. Inconsistent information regarding living organ donation was present. Practical implications are discussed.
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Affiliation(s)
- Jie Zhuang
- Department of Communication Studies, Bob Schieffer College of Communication, Texas Christian University
| | - Ashley Guidry
- Department of Communication Studies, Bob Schieffer College of Communication, Texas Christian University
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Kaplan A, Rosenblatt R, Samstein B, Brown RS. Can Living Donor Liver Transplantation in the United States Reach Its Potential? Liver Transpl 2021; 27:1644-1652. [PMID: 34174025 DOI: 10.1002/lt.26220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 12/12/2022]
Abstract
Living donor liver transplantation (LDLT) is a vital tool to address the growing organ shortage in the United States caused by increasing numbers of patients diagnosed with end-stage liver disease. LDLT still only makes up a very small proportion of all liver transplantations performed each year, but there are many innovations taking place in the field that may increase its acceptance among both transplant programs and patients. These innovations include ways to improve access to LDLT, such as through nondirected donation, paired exchange, transplant chains, transplant of ABO-incompatible donors, and transplants in patients with high Model for End-Stage Liver Disease scores. Surgical innovations, such as laparoscopic donor hepatectomy, robotic hepatectomy, and portal flow modulation, are also increasingly being implemented. Policy changes, including decreasing the financial burden associated with LDLT, may make it a more feasible option for a wider range of patients. Lastly, center-level behavior, such as ensuring surgical expertise and providing culturally competent education, will help toward LDLT expansion. Although it is challenging to know which of these innovations will take hold, we are already seeing LDLT numbers improve within the past 2 years.
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Affiliation(s)
- Alyson Kaplan
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell School of Medicine, New York Presbyterian, New York, NY
| | - Russell Rosenblatt
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell School of Medicine, New York Presbyterian, New York, NY
| | - Benjamin Samstein
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Weill Cornell School of Medicine, New York Presbyterian, New York, NY
| | - Robert S Brown
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell School of Medicine, New York Presbyterian, New York, NY
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Arabi Z, Bukhari M, Hamad A, Altheaby A, Kaysi S. Practice Patterns in the Acceptance of Medically Complex Living Kidney Donors with Obesity, Hypertension, Family History of Kidney Disease, or Donor-Recipient Age Discrepancy. Avicenna J Med 2021; 11:172-184. [PMID: 34881200 PMCID: PMC8648409 DOI: 10.1055/s-0041-1736541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background To assess the practice patterns of the acceptance of medically complex living kidney donors (MCLKDs). Methods We distributed a survey to nephrologists and transplant surgeons (TS) across the world through major international transplant societies. The survey contained questions regarding obesity, abnormal blood glucose profile, mild hypertension, donor-recipient age discrepancy, or family history of kidney disease of unknown etiology. Results In total, 239 respondents from 29 countries (42% were nephrologists and 58% were TS). Most respondents would allow donations from obese donors, especially if they intended to lose weight but would be cautious if these donors had abnormal blood glucose or family history of diabetes mellitus. In hypertensive donors, future pregnancy plans mattered in decisions regarding the acceptance of female donors. Most respondents would allow young donors but would be more cautious if they had a future risk of hypertension or a family history of kidney disease of unknown etiology. They would also allow donations from an older person if prolonged waiting time was anticipated. We found multiple areas of consensus of practice among the diverse members of international transplant societies, with some interesting variations among nephrologists and TS. Conclusions This survey highlights the practice patterns of the acceptance of MCLKDs among the international community. In the absence of clear guidelines, this survey provides additional information to counsel kidney donors with these conditions.
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Affiliation(s)
- Ziad Arabi
- Department of the Organ Transplant Center, Division of Adult Transplant Nephrology, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Muhammad Bukhari
- Department of Medicine, Division of Adult Nephrology, Taif University, Taif, Saudi Arabia
| | - Abdullah Hamad
- Department of Medicine, Division of Nephrology, Regional Medical Center of Orangeburg and Calhoun Counties, Orangeburg, South Carolina, United States
| | - Abdulrahman Altheaby
- Department of the Organ Transplant Center, Division of Adult Transplant Nephrology, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Saleh Kaysi
- Department of Medicine, Division of Nephrology, CHU, Clermont-Ferrand, France
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Garcia-Ochoa C, Feldman LS, Nguan C, Monroy-Caudros M, Arnold JB, Barnieh L, Boudville N, Cuerden MS, Dipchand C, Gill JS, Karpinski M, Klarenbach S, Knoll G, Lok CE, Miller M, Prasad GVR, Sontrop JM, Storsley L, Garg AX. Impact of Perioperative Complications on Living Kidney Donor Health-Related Quality of Life and Mental Health: Results From a Prospective Cohort Study. Can J Kidney Health Dis 2021; 8:20543581211037429. [PMID: 34394947 PMCID: PMC8361543 DOI: 10.1177/20543581211037429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Although living kidney donation is safe, some donors experience perioperative complications. Objective: This study explored how perioperative complications affected donor-reported health-related quality of life, depression, and anxiety. Design: This research was a conducted as a prospective cohort study. Setting: Twelve transplant centers across Canada. Patients: A total of 912 living kidney donors were included in this study. Measurements: Short Form 36 health survey, Beck Depression Inventory and Beck Anxiety Inventory. Methods: Living kidney donors were prospectively enrolled predonation between 2009 to 2014. Donor perioperative complications were graded using the Clavien-Dindo classification system. Mental and physical health-related quality of life was assessed with the 3 measurements; measurements were taken predonation and at 3- and 12-months postdonation. Results: Seventy-four donors (8%) experienced a perioperative complication; most were minor (n = 67 [91%]), and all minor complications resolved before hospital discharge. The presence (versus absence) of a perioperative complication was associated with lower mental health-related quality of life and higher depression symptoms 3-month postdonation; neither of these differences persisted at 12-month. Perioperative complications were not associated with any changes in physical health-related quality of life or anxiety 3-month postdonation. Limitations: Minor complications may have been missed and information on complications postdischarge were not collected. No minimal clinically significant change has been defined for kidney donors across the 3 measurements. Conclusions: These findings highlight a potential opportunity to better support the psychosocial needs of donors who experience perioperative complications in the months following donation. Trial registration: NCT00319579 and NCT00936078.
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Affiliation(s)
| | - Liane S Feldman
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Chris Nguan
- The University of British Columbia, Vancouver, Canada
| | | | | | | | - Neil Boudville
- Medical School, Department of Renal Medicine, Sir Charles Gairdner Hospital, The University of Western Australia, Perth, Australia
| | | | | | - John S Gill
- The University of British Columbia, Vancouver, Canada
| | | | | | - Greg Knoll
- Division of Nephrology, Department of Medicine, University of Ottawa, ON, Canada
| | | | - Matthew Miller
- Division of Nephrology and Transplantation, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
| | | | - Jessica M Sontrop
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada
| | | | - Amit X Garg
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.,Department of Medicine, Western University, London, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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Development and Preliminary Evaluation of a Patient-facing Educational Video About Live Kidney Donor Surgical Complications. Transplant Direct 2021; 7:e744. [PMID: 34386581 PMCID: PMC8352607 DOI: 10.1097/txd.0000000000001194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background. Living kidney donation (LKD) improves transplant access; however, its use is compromised, in part, by individuals’ unaddressed concerns about perioperative complications. Methods. We developed an animated, patient-centered educational video about LKD surgical complications, with input from experts in transplantation, communication, and anthropology, 35 patients/care partners (5 LKD candidates, 5 prior LKDs, 10 kidney transplant recipients, 10 kidney transplant candidates, 5 care partners), and 1 community advocate. We then conducted an online pre-post study with 24 potential kidney donors and recipients to measure the video’s acceptability and feasibility to improve donation complication knowledge and concerns. Results. Knowledge of LKD surgical complications increased 23% (mean 5.7 to 7.0, P < 0.01) from pre- to post- animation viewing. Large knowledge effect size increases were observed for different levels of age, race, health literacy, and technology access. The frequency of positive responses about donation safety increased from 88% preanimation to 96% postanimation. Concerns about surgical complications remained at 17% before and after exposure. After viewing the animation, over 90% indicated positive ratings on ease of watching, understanding, and engaging. Conclusions. An animated educational video about LKD surgical complications was developed in collaboration with multiple stakeholders. The video was well received and promised to positively impact individuals’ knowledge and concerns.
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Raza MH, Jackson WE, Dell A, Ding L, Shapiro J, Pomfret EA, Genyk Y, Sher L, Emamaullee J. Health-related quality of life after anonymous nondirected living liver donation: A multicenter collaboration. Am J Transplant 2021; 21:1056-1067. [PMID: 32741102 PMCID: PMC8351218 DOI: 10.1111/ajt.16229] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 01/25/2023]
Abstract
Literature on living nondirected liver donation is sparse. The purpose of this study was to assess health-related quality of life (HR-QOL) in anonymous nondirected living liver donors (ND-LLDs). ND-LLDs at 3 centers: University of Alberta (n = 12), University of Colorado (n = 12), and University of Southern California (n = 12), were surveyed. Thirty donors (83%) responded to the Donor Quality of Life (USC DQLS) and Short-Form 36 (SF-36). Most respondents (n = 15, 50%) donated their left lateral segment, 27% right lobe, and 23% left lobe. The majority were female (67%) and mean age was 38.9 ± 11.2 years at donation. Median follow-up was 1.1 (interquartile range 0.4-3.3) years. Approximately 37% had previously donated a kidney. Eleven experienced ≥1 postoperative complication, with only 1 Clavien-Dindo IIIb. Most reported minimal impact on school or work performance, all felt positive or neutral about their overall health since donation, and none expressed postdonation regrets. No donor reported impacts on health insurability, and 3 of 4 respondents attempting to purchase life insurance postdonation were successful. ND-LLD SF-36 outcomes were similar to US population norms. Overall, ND-LLDs demonstrated acceptable HR-QOL after donation and are appropriate candidates for partial liver donation. Based on evaluation of donation impact, consideration should be given to postdonation support strategies.
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Affiliation(s)
- Muhammad H. Raza
- Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Whitney E. Jackson
- Department of Gastroenterology and Hepatology, University of Colorado, Aurora, CO USA
| | - Angela Dell
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Li Ding
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA USA
| | - James Shapiro
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | | | - Yuri Genyk
- Keck School of Medicine, University of Southern California, Los Angeles, CA USA,Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA USA
| | - Linda Sher
- Keck School of Medicine, University of Southern California, Los Angeles, CA USA,Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA USA
| | - Juliet Emamaullee
- Keck School of Medicine, University of Southern California, Los Angeles, CA USA,Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA USA
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Luo X, Zhang J, Zou S, Wang X, Chen G, Li Z, Li K, Wang M, Chen Z, Ming C, Zhu X, Gong N. Bone Fragment Co-transplantation Alongside Bone Marrow Aspirate Infusion Protects Kidney Transplant Recipients. Front Immunol 2021; 12:630710. [PMID: 33643315 PMCID: PMC7904687 DOI: 10.3389/fimmu.2021.630710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/22/2021] [Indexed: 12/20/2022] Open
Abstract
Integration of non-vascularized bone grafting and bone marrow aspirate infusion in transplantation may provide clinical benefit. Here we have incorporated bone fragment co-transplantation and bone marrow aspirate infusion (BF-BM) into living kidney transplantation (LKT). Twenty LKT recipients receiving bone fragments and bone marrow aspirates donated from their corresponding donors were enrolled into a retrospective study. A contemporaneous control group was formed of 38 out of 128 conventional LKT recipients, selected using propensity score matching by a 1:2 Greedy algorithm. Ultrasonography, contrast-enhanced ultrasonography (US/CEUS) and SPECT/CT showed that the co-transplanted bone fragments remained viable for 6 months, subsequently shrank, and finally degenerated 10 months post-transplantation. BF-BM resulted in earlier kidney recovery and more robust long-term kidney function. Throughout 5 years of follow-up, BF-BM had regulatory effects on dendritic cells (DCs), T helper (Th1/Th2) cells and regulatory T cells (Tregs). Both alloantigen-specific lymphocyte proliferation and panel reactive antibody levels were negative in all recipients with or without BF-BM. In addition, the BF-BM group experienced few complications during the 5-year follow-up (as did the donors)—this was not different from the controls. In conclusion, BF-BM is safe and benefits recipients by protecting the kidney and regulating the immune response.
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Affiliation(s)
- Xianzhang Luo
- Key Laboratory of the National Health Commission, Institute of Organ Transplantation, Tongji Medical College, The Ministry of Education and Chinese Academy of Medical Sciences, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory for Biorheological Science and Technology of Ministry of Education, Chongqing University Cancer Hospital, Chongqing, China
| | - Ji Zhang
- Key Laboratory of the National Health Commission, Institute of Organ Transplantation, Tongji Medical College, The Ministry of Education and Chinese Academy of Medical Sciences, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Sijuan Zou
- Department of Nuclear Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xinqiang Wang
- Key Laboratory of the National Health Commission, Institute of Organ Transplantation, Tongji Medical College, The Ministry of Education and Chinese Academy of Medical Sciences, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Gen Chen
- Department of Radiology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Li
- Department of Radiology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Kaiyan Li
- Department of Medical Ultrasound, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Mengqing Wang
- Key Laboratory of the National Health Commission, Institute of Organ Transplantation, Tongji Medical College, The Ministry of Education and Chinese Academy of Medical Sciences, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhishui Chen
- Key Laboratory of the National Health Commission, Institute of Organ Transplantation, Tongji Medical College, The Ministry of Education and Chinese Academy of Medical Sciences, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Changshen Ming
- Key Laboratory of the National Health Commission, Institute of Organ Transplantation, Tongji Medical College, The Ministry of Education and Chinese Academy of Medical Sciences, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaohua Zhu
- Department of Nuclear Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Nianqiao Gong
- Key Laboratory of the National Health Commission, Institute of Organ Transplantation, Tongji Medical College, The Ministry of Education and Chinese Academy of Medical Sciences, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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Xie L, O'Leary M, Jefferson FA, Karani R, Limfueco L, Parkhomenko E, Sung JM, Patel RM, Ichii H, Dafoe D, Clayman RV, Landman J. Interactive Virtual Reality Renal Models as an Educational and Preoperative Planning Tool for Laparoscopic Donor Nephrectomy. Urology 2021; 153:192-198. [PMID: 33556447 DOI: 10.1016/j.urology.2020.12.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/13/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the efficacy of interactive virtual reality (iVR) in providing a three-dimensional (3D) experience with the donor's anatomy for surgeons and patients, we present a retrospective, case-controlled study assessing the impact of iVR renal models prior to LDN on both surgical outcomes and patients' understanding of the procedure. MATERIALS AND METHODS Twenty patients undergoing LDN were prospectively recruited; their contrast-enhanced CT scans were transformed into iVR models. An iVR platform allowed the surgeons to rotate and deconstruct the renal anatomy; patients could also view their anatomy as the procedure was explained to them. Questionnaires assessed surgeons' understanding of renal anatomy after CT alone and after CT+iVR. Surgeons also commented on whether iVR impacted their preoperative plan. Patients assessed their anatomical understanding and anxiety level before and after iVR. Surgical outcomes for the iVR cohort were compared to a retrospectively matched, non-iVR cohort of LDN patients. RESULTS Surgeons altered their preoperative plan in 18 of 20 LDNs after viewing iVR models. Patients reported better understanding of their anatomy (5/5) and noted decreased preoperative anxiety (5/5) after viewing iVR. When compared to the non-iVR group, the iVR group had a 25% reduction in median operative time (P < .001). In terms of surgical outcomes, patients in the iVR group had a 40% lower median relative change in postoperative creatinine (P < .001). CONCLUSION Preoperative viewing of iVR models altered the operative approach, decreased the operative time, and improved donor patient outcomes. iVR models also reduced patients' preoperative anxiety.
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Affiliation(s)
- Lillian Xie
- Department of Urology, University of California, Irvine, Orange CA.
| | - Mitchell O'Leary
- Department of Urology, University of California, Irvine, Orange CA
| | | | - Rajiv Karani
- Department of Urology, University of California, Irvine, Orange CA
| | - Luke Limfueco
- Department of Urology, University of California, Irvine, Orange CA
| | | | - John M Sung
- Department of Urology, University of California, Irvine, Orange CA
| | - Roshan M Patel
- Department of Urology, University of California, Irvine, Orange CA
| | - Hirohito Ichii
- Department of Surgery, University of California, Irvine, Orange CA
| | - Donald Dafoe
- Department of Surgery, University of California, Irvine, Orange CA
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, Orange CA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange CA.
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One size does not fit all: understanding individual living kidney donor risk. Pediatr Nephrol 2021; 36:259-269. [PMID: 31897715 PMCID: PMC7815560 DOI: 10.1007/s00467-019-04456-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/25/2019] [Accepted: 12/13/2019] [Indexed: 01/06/2023]
Abstract
Living donor kidney transplantation is the optimal treatment for end-stage kidney disease (ESKD) but confers a risk upon the donor, both in the short term and many years after donation. While perioperative mortality is low and longevity does not appear to be adversely affected, there are small increases in the risk of other important morbidities. The overall risk of ESKD among donors is low but appears to be three- to five-fold higher than among healthy non-donors, and this relative risk is even higher among donors of African ancestry. For these individuals, apolipoprotein L1 genotyping may be helpful. Kidney donors also have an increased risk of developing hypertension post-donation and a modestly increased risk of developing gout. Living kidney donation also increases the risk of gestational hypertension and preeclampsia while not affecting other important pregnancy outcomes. As our understanding of donor risk grows, it is important to counsel prospective donors according to their individual risk and so obtain better informed donor consent. As knowledge advances, it is also important that all clinicians who manage kidney transplant candidates have an up to date understanding of donor risk to inform shared decision making.
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Favi E, Iesari S, Catarsini N, Sivaprakasam R, Cucinotta E, Manzia T, Puliatti C, Cacciola R. Outcomes and surgical complications following living-donor renal transplantation using kidneys retrieved with trans-peritoneal or retro-peritoneal hand-assisted laparoscopic nephrectomy. Clin Transplant 2020; 34:e14113. [PMID: 33051895 DOI: 10.1111/ctr.14113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 01/06/2023]
Abstract
The best minimally invasive procedure for living-donor kidney retrieval remains debated. Our objective was to assess trans-peritoneal (TP) and retro-peritoneal (RP) hand-assisted laparoscopic donor nephrectomy (HALDN). In this single-center retrospective study, we analyzed results from 317 living-donor renal transplants (RT) performed between 2008 and 2016. Donor and recipient outcomes were compared between TP-HALDN (n = 235) and RP-HALDN (n = 82). Conversion to open nephrectomy (0.4% vs 0%; P = 1.000), intra-operative complications (1.7% vs 1.2%; P = 1.000), and 1-year overall post-operative complications (11.9% vs 17.1%; P = .258) rates were similar in TP-HALDN and RP-HALDN. Overall surgical site infections were higher in RP-HALDN (6.1% vs 1.7%; P = .053), whereas incisional hernias were only recorded following TP-HALDN (3.4% vs 0%; P = .118). The duration of the procedure was 11-minute shorter for TP-HALDN than RP-HALDN (P < .001) but extraction time was equivalent (2, IQR 1.5-2.5 minutes; P = 1.000). RT following TP-HALDN and RP-HALDN showed comparable one-year death-censored allograft survival (97% vs 98.8%; P = .685), primary non-function (0.4% vs 0%; P = .290), delayed graft function (1.3% vs 4.9%; P = .077), and urological complications (2.6% vs 4.9%; P = .290) rates. In our series, donor and recipient outcomes were not substantially affected by the approach used for donor nephrectomy. TP-HALDN and RP-HALDN were both safe and effective.
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Affiliation(s)
- Evaldo Favi
- Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Samuele Iesari
- Pôle de Chirurgie Expérimentale et Transplantation, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Nivia Catarsini
- General Surgery, Azienda Ospedaliera Universitaria Policlinico G. Martino, Messina, Italy
| | - Rajesh Sivaprakasam
- Renal Transplantation, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Eugenio Cucinotta
- General Surgery, Azienda Ospedaliera Universitaria Policlinico G. Martino, Messina, Italy
| | - Tommaso Manzia
- HPB Surgery and Transplantation, Fondazione PTV, Rome, Italy
| | | | - Roberto Cacciola
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.,HPB Surgery and Transplantation, Fondazione PTV, Rome, Italy
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Celasin H, Kocaay AF, Cimen SG, Çelik SU, Ohri N, Şengül Ş, Keven K, Tüzüner A. Surgical Drains After Laparoscopic Donor Nephrectomy: Needed or Not? Ann Transplant 2020; 25:e926422. [PMID: 32989211 PMCID: PMC7532696 DOI: 10.12659/aot.926422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Routine placement of prophylactic drains after laparoscopic donor nephrectomy has been suggested and has become common practice in some centers. However, there is a lack of evidence proving the surgical benefits of routine drain placement in laparoscopic donor nephrectomy. Here, we assessed the effect of surgical drain placement on recovery, length of hospital stay, and complication rates of live kidney donors. MATERIAL AND METHODS This retrospective study included all live donor nephrectomies performed at a single institution from January 2010 to January 2017. Surgeries were performed by 2 surgeons; one routinely placed a closed suction drain after LDN whereas the other did not. Patients operated on by these 2 surgeons were enrolled in either the drain or no drain group. Demographic data, preoperative and postoperative creatinine levels, estimated blood loss (EBL), surgical time, surgical complications, and length of hospital stay were compared. RESULTS The study included 272 patients. Three were converted to open donor nephrectomy and were excluded (1.1%). Among the 269 patients, 156 (57.9%) had surgical drains and 113 (42.1%) did not. Mean surgical time, estimated blood loss, and duration of hospital stay did not significantly differ between groups. Postoperative complications were encountered in 17 of the patients, but the overall complication rate did not differ between patients with vs. those without surgical drains. CONCLUSIONS There was no significant difference between the drain and no drain groups in terms of length of hospital stay, complication rates, or postoperative creatinine levels. Thus, placement of a surgical drain in the setting of an LDN is not justified based on our single-center experience.
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Affiliation(s)
- Haydar Celasin
- Department of General Surgery, Faculty of Medicine, Lokman Hekim University, Ankara, Turkey
| | - Akın Fırat Kocaay
- Department of General Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Sanem Guler Cimen
- Department of General Surgery, Health Sciences University, Ankara, Turkey
| | - Suleyman Utku Çelik
- Department of General Surgery, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Nurian Ohri
- Department of General Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Şule Şengül
- Department of Nephrology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Kenan Keven
- Department of Nephrology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Acar Tüzüner
- Department of General Surgery, Faculty of Medicine, Lokman Hekim University, Ankara, Turkey
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Fleishman A, Khwaja K, Schold JD, Comer CD, Morrissey P, Whiting J, Vella J, Kayler LK, Katz D, Jones J, Kaplan B, Pavlakis M, Mandelbrot DA, Rodrigue JR. Pain expectancy, prevalence, severity, and patterns following donor nephrectomy: Findings from the KDOC Study. Am J Transplant 2020; 20:2522-2529. [PMID: 32185880 PMCID: PMC7483675 DOI: 10.1111/ajt.15861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/14/2020] [Accepted: 03/03/2020] [Indexed: 01/25/2023]
Abstract
Postoperative pain is an outcome of importance to potential living kidney donors (LKDs). We prospectively characterized the prevalence, severity, and patterns of acute or chronic postoperative pain in 193 LKDs at six transplant programs. Three pain measurements were obtained from donors on postoperative Day (POD) 1, 3, 7, 14, 21, 28, 35, 41, 49, and 56. The median pain rating total was highest on POD1 and declined from each assessment to the next until reaching a median pain-free score of 0 on POD49. In generalized linear mixed-model analysis, the mean pain score decreased at each pain assessment compared to the POD3 assessment. Pre-donation history of mood disorder (adjusted ratio of means [95% confidence interval (CI)]: 1.40 [0.99, 1.98]), reporting "severe" on any POD1 pain descriptors (adjusted ratio of means [95% CI]: 1.47 [1.12, 1.93]) and open nephrectomy (adjusted ratio of means [95% CI]: 2.61 [1.03, 6.62]) were associated with higher pain scores across time. Of the 179 LKDs who completed the final pain assessment, 74 (41%) met criteria for chronic postsurgical pain (CPSP), that is, any donation-related pain on POD56. Study findings have potential implications for LKD education, surgical consent, postdonation care, and outcome measurements.
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Affiliation(s)
- A Fleishman
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA,Harvard Medical School, Boston, MA
| | - K Khwaja
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA,Harvard Medical School, Boston, MA
| | - JD Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - CD Comer
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
| | - P Morrissey
- Transplant Center, Rhode Island Hospital, Providence, RI
| | - J Whiting
- Maine Transplant Center, Maine Medical Center, Portland, ME
| | - J Vella
- Maine Transplant Center, Maine Medical Center, Portland, ME
| | - LK Kayler
- Montefiore Einstein Center for Transplantation, Bronx, NY,Regional Center of Excellence for Transplantation & Kidney Care, Erie County Medical Center, University of Buffalo, Buffalo, NY
| | - D Katz
- Organ Transplantation Program, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - J Jones
- Organ Transplantation Program, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - B Kaplan
- Baylor Scott and White Health, Temple, TX
| | - M Pavlakis
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA,Harvard Medical School, Boston, MA
| | - DA Mandelbrot
- Department of Medicine, University of Wisconsin, Madison, WI
| | - JR Rodrigue
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA,Harvard Medical School, Boston, MA
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Bailey PK, Wong K, Robb M, Burnapp L, Rogers A, Courtney A, Wroe C. Has the UK living kidney donor population changed over time? A cross-sectional descriptive analysis of the UK living donor registry between 2006 and 2017. BMJ Open 2020; 10:e033906. [PMID: 32546487 PMCID: PMC7299046 DOI: 10.1136/bmjopen-2019-033906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND A living-donor kidney transplant is the best treatment for most people with kidney failure. Population cohort studies have shown that lifetime living kidney donor risk is modified by sex, age, ethnicity, body mass index (BMI), comorbidity and relationship to the recipient. OBJECTIVES We investigated whether the UK population of living kidney donors has changed over time, investigating changes in donor demographics. DESIGN We undertook a cross-sectional analysis of the UK living kidney donor registry between January 2006 to December 2017. Data were available on living donor sex, age, ethnicity, BMI, hypertension and relationship to recipient. SETTING UK living donor registry. PARTICIPANTS 11 651 consecutive living kidney donors from January 2006 to December 2017. OUTCOME MEASURES Living kidney donor demographic characteristics (sex, age, ethnicity, BMI and relationship to the transplant recipient) were compared across years of donation activity. Donor characteristics were also compared across different ethnic groups. RESULTS Over the study period, the mean age of donors increased (from 45.8 to 48.7 years, p<0.001), but this change appears to have been limited to the White population of donors. Black donors were younger than White donors, and a greater proportion were siblings of their intended recipient and male. The proportion of non-genetically related non-partner donations increased over the 12-year period of analysis (p value for linear trend=0.002). CONCLUSIONS The increasing age of white living kidney donors in the UK has implications for recipient and donor outcomes. Despite an increase in the number of black, Asian and minority ethnic individuals waitlisted for a kidney transplant, there has been no increase in the ethnic diversity of UK living kidney donors. Black donors in the UK may be at a much greater risk of developing kidney failure due to accumulated risks: whether these risks are being communicated needs to be investigated.
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Affiliation(s)
- Phillippa K Bailey
- Population Health Sciences, Bristol Medical School, Bristol, UK
- Renal Department, North Bristol NHS Trust, Bristol, UK
| | - Katie Wong
- Population Health Sciences, Bristol Medical School, Bristol, UK
- Renal Department, North Bristol NHS Trust, Bristol, UK
| | - Matthew Robb
- Statistics and Clinical Studies Department, NHS Blood and Transplant, Bristol, UK
| | - Lisa Burnapp
- NHS Blood and Transplant Clinical Lead for Living Donation, Renal Department, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
| | - Alistair Rogers
- Urology Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Aisling Courtney
- Renal Department, Belfast Health and Social Care Trust, Belfast, UK
| | - Caroline Wroe
- Renal Department, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
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Melkonian V, Nguyen MTJP. Managing the Obese Living Kidney Donor. CURRENT TRANSPLANTATION REPORTS 2020. [DOI: 10.1007/s40472-020-00279-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lam NN, Lloyd A, Lentine KL, Quinn RR, Ravani P, Hemmelgarn BR, Klarenbach S, Garg AX. Changes in kidney function follow living donor nephrectomy. Kidney Int 2020; 98:176-186. [PMID: 32571482 DOI: 10.1016/j.kint.2020.03.034] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/10/2020] [Accepted: 03/13/2020] [Indexed: 01/28/2023]
Abstract
Better understanding of kidney function after living donor nephrectomy and how it differs by donor characteristics can inform patient selection, counselling, and follow-up care. To evaluate this, we conducted a retrospective matched cohort study of living kidney donors in Alberta, Canada between 2002-2016, using linked healthcare administrative databases. We matched 604 donors to 2,414 healthy non-donors from the general population based on age, sex, year of cohort entry, urban residence and the estimated glomerular filtration rate (eGFR) before cohort entry (nephrectomy date for donors and randomly assigned date for non-donors). The primary outcome was the rate of eGFR change over time (median follow-up seven years; maximum 15 years). The median age of the cohort was 43 years, 64% women, and the baseline (pre-donation) eGFR was 100 mL/min/1.73 m2. Overall, from six weeks onwards, the eGFR increased by +0.35 mL/min/1.73 m2 per year (95% confidence interval +0.21 to +0.48) in donors and significantly decreased by -0.85 mL/min/1.73 m2 per year (-0.94 to -0.75) in the matched healthy non-donors. The change in eGFR between six weeks to two years, two to five years, and over five years among donors was +1.06, +0.64, and -0.06 mL/min/1.73 m2 per year, respectively. In contrast to the steady age-related decline in kidney function in non-donors, post-donation kidney function on average initially increased by 1 mL/min/1.73 m2 per year attributable to glomerular hyperfiltration, which began to plateau by five years post-donation. Thus, the average change in eGFR over time is significantly different between donors and non-donors.
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Affiliation(s)
- Ngan N Lam
- Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Anita Lloyd
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Krista L Lentine
- Department of Medicine, Center for Abdominal Transplantation, Saint Louis University, St. Louis, Missouri, USA
| | - Robert R Quinn
- Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Pietro Ravani
- Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Brenda R Hemmelgarn
- Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Scott Klarenbach
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Amit X Garg
- Department of Medicine, Division of Nephrology, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences (ICES), Ontario, Canada
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40
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Use of Telehealth to Expand Living Kidney Donation and Living Kidney Donor Transplantation. CURRENT TRANSPLANTATION REPORTS 2020. [DOI: 10.1007/s40472-020-00276-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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41
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Long-term Surgical Outcome and Risk Factors in Living Kidney Donors. Transplant Proc 2020; 52:722-730. [PMID: 32143866 DOI: 10.1016/j.transproceed.2019.12.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/25/2019] [Accepted: 12/15/2019] [Indexed: 11/21/2022]
Abstract
CONTEXT Studies on the surgical outcome in living kidney donors mainly report perioperative complications with short follow-up. OBJECTIVE The objectives of this study are to evaluate the long-term surgical outcome in living kidney donors and to identify donors with an increased risk for a complicated postoperative course. BASIC PROCEDURES A prospectively collected database of 496 living kidney donors at the Department of General, Visceral, and Transplantation Surgery of the Ruprecht Karls University Heidelberg was retrospectively analyzed in a retrospective, observational single-center study. RESULTS The median follow-up time was 37 months. The perioperative severe complication (Clavien-Dindo IIIb) rate was 2.8%, the early postoperative (PO) severe complication rate (1-3 months post operation) was 0.7%, and the late PO severe complication rate (> 3 months post operation) was 8.4%. In multivariate analyses, male sex was associated with higher overall perioperative complication rate (odds ratio [OR], 1.930; P = .005) as well as higher rate of late PO complications (OR, 2.243; P = .014). An increased body mass index was associated with a higher late and severe (Clavien-Dindo ≥ IIIb) PO complication rate (OR, 1.107; P = .009 and OR, 1.105; P = .008, respectively). CONCLUSIONS AND RELEVANCE Long-term surgery-associated severe complications occur in 8.4% of kidney donors. Older age is associated with an increased operative time, greater intraoperative blood loss, and longer PO hospital stay. Male donors and donors with an increased body mass index have a higher risk for a complicated PO course after kidney donation. Within a shared decision-making process before living kidney donation, special awareness should be brought to these facts.
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Aditianingsih D, Mochtar CA, Lydia A, Siregar NC, Margyaningsih NI, Madjid AS, Suwarto S. Effects of low versus standard pressure pneumoperitoneum on renal syndecan-1 shedding and VEGF receptor-2 expression in living-donor nephrectomy: a randomized controlled study. BMC Anesthesiol 2020; 20:37. [PMID: 32019488 PMCID: PMC7001365 DOI: 10.1186/s12871-020-0956-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 01/27/2020] [Indexed: 12/20/2022] Open
Abstract
Background Laparoscopic nephrectomy is a preferred technique for living kidney donation. However, positive-pressure pneumoperitoneum may have an unfavorable effect on the remaining kidney and other distant organs due to inflamed vascular endothelium and renal tubular cell injury in response to increased systemic inflammation. Early detection of vascular endothelial and renal tubular response is needed to prevent further kidney injury due to increased intraabdominal pressure induced by pneumoperitoneum. Transperitoneal laparoscopic living donor nephrectomy represented a human model of mild increasing intraabdominal pressure. This study aimed to assess the effect of increased intraabdominal pressure on vascular endothelium and renal tubular cells by comparing the effects of low and standard pressure pneumoperitoneum on vascular endothelial growth factor receptor-2 (VEGFR-2) expression and the shedding of syndecan-1 as the early markers to a systemic inflammation. Methods We conducted a prospective randomized study on 44 patients undergoing laparoscopic donor nephrectomy. Subjects were assigned to standard (12 mmHg) or low pressure (8 mmHg) groups. Baseline, intraoperative, and postoperative plasma interleukin-6, syndecan-1, and sVEGFR-2 were quantified by ELISA. Syndecan-1 and VEGFR-2 expression were assessed immunohistochemically in renal cortex tissue. Renal tubule and peritubular capillary ultrastructures were examined using electron microscopy. Perioperative hemodynamic changes, end-tidal CO2, serum creatinine, blood urea nitrogen, and urinary KIM-1 were recorded. Results The low pressure group showed lower intra- and postoperative heart rate, intraoperative plasma IL-6, sVEGFR-2 levels and plasma syndecan-1 than standard pressure group. Proximal tubule syndecan-1 expression was higher in the low pressure group. Proximal-distal tubules and peritubular capillary endothelium VEGFR-2 expression were lower in low pressure group. The low pressure group showed renal tubule and peritubular capillary ultrastructure with intact cell membranes, clear cell boundaries, and intact brush borders, while standard pressure group showed swollen nuclei, tenuous cell membrane, distant boundaries, vacuolizations, and detached brush borders. Conclusion The low pressure pneumoperitoneum attenuated the inflammatory response and resulted in reduction of syndecan-1 shedding and VEGFR-2 expression as the renal tubular and vascular endothelial proinflammatory markers to injury due to a systemic inflammation in laparoscopic nephrectomy. Trial registration ClinicalTrials.gov NCT:03219398, prospectively registered on July 17th, 2017.
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Affiliation(s)
- Dita Aditianingsih
- Department of Anesthesiology and Intensive Care, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia. .,Department of Anesthesiology, Cipto Mangunkusumo Hospital, Salemba Raya 6th, Jakarta, 10430, Indonesia.
| | - Chaidir Arif Mochtar
- Department of Urology, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Aida Lydia
- Department of Internal Medicine, Division of Nephrology and Hypertension, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Nuryati Chairani Siregar
- Department of Anatomical Pathology, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia.,Eijkman Institute of Molecular Biology, Jakarta, Indonesia
| | | | - Amir Sjarifuddin Madjid
- Department of Anesthesiology and Intensive Care, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Suhendro Suwarto
- Department of Internal Medicine, Division of Tropical and Infectious Disease, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
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Blood Pressure and Living Kidney Donors: A Clinical Perspective. Transplant Direct 2019; 5:e488. [PMID: 31723583 PMCID: PMC6791603 DOI: 10.1097/txd.0000000000000939] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 08/09/2019] [Indexed: 01/13/2023] Open
Abstract
Elevated blood pressure (BP), or “hypertension,” has been one of the main exclusion criteria for living kidney donation, as it is a risk factor for renal and cardiovascular disease. The effect of elevated BP in living kidney donors is not well studied or understood. The most current living kidney donation guidelines state that donors with a BP >140/90 mm Hg with 1–2 antihypertensive medications or evidence of end-organ damage should be excluded from living kidney donation. Yet, the definitions of “hypertension” have changed with the release of the American Heart Association (AHA)/American College of Cardiology (ACC) clinical practice guidelines suggesting that 120–129 mm Hg is elevated BP and Stage 1 hypertension is 130 mm Hg. However, the kidney function (in terms of estimated GFR) of “hypertensive” living kidney donors does not fare significantly worse postdonation compared with that of “normotensive” donors. In addition, even though living kidney donation itself is not considered to be a risk factor for developing hypertension, there exist certain risk factors (African American or Hispanic descent, obesity, age) that may increase the risk of living kidney donors developing elevated BP postdonation. The choice of BP targets and medications needs to be carefully individualized. In general, a BP <130/80 mm Hg is needed, along with lifestyle modifications.
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Tokaç M, Eren E, Özçelik Ü, Şahin T, Dinçkan A. Renal Hilus Ligation With Single Stapler in Laparoscopic Donor Nephrectomy. Transplant Proc 2019; 51:2225-2227. [DOI: 10.1016/j.transproceed.2019.02.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/25/2019] [Accepted: 02/03/2019] [Indexed: 11/30/2022]
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Torres AM, Wong F, Pearson S, Weinberg S, Roberts JP, Ascher NL, Freise CE, Lee BK. Bi-organ paired exchange-Sentinel case of a liver-kidney swap. Am J Transplant 2019; 19:2646-2649. [PMID: 30977579 DOI: 10.1111/ajt.15386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/10/2019] [Accepted: 04/01/2019] [Indexed: 01/25/2023]
Abstract
Organ transplantation is the optimal treatment for patients with end stage liver disease and end stage renal disease. However, due to the imbalance in the demand and supply of deceased organs, most transplant centers worldwide have consciously pursued a strategy for living donation. Paired exchanges were introduced as a means to bypass various biologic incompatibilities (blood- and tissue-typing), while expanding the living donor pool. This shift in paradigm has introduced new ethical concerns that have hitherto been unaddressed, especially with nondirected, altruistic living donors. So far, transplant communities have focused efforts on separate liver- and kidney-paired exchanges, whereas the concept of a transorgan paired exchange has been theorized and could potentially facilitate a greater number of transplants. We describe the performance of the first successful liver-kidney swap.
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Affiliation(s)
- Ana-Marie Torres
- Connie Frank Transplant Center, Division of Abdominal Transplantation, University of California, San Francisco, California
| | - Finesse Wong
- Connie Frank Transplant Center, Division of Abdominal Transplantation, University of California, San Francisco, California
| | - Sophie Pearson
- Connie Frank Transplant Center, Division of Abdominal Transplantation, University of California, San Francisco, California
| | - Sandy Weinberg
- Connie Frank Transplant Center, Division of Abdominal Transplantation, University of California, San Francisco, California
| | - John P Roberts
- Department of Surgery, University of California, San Francisco, California
| | - Nancy L Ascher
- Department of Surgery, University of California, San Francisco, California
| | - Chris E Freise
- Department of Surgery, University of California, San Francisco, California
| | - Brian K Lee
- Connie Frank Transplant Center, Division of Nephrology and Hypertension, Department of Medicine, University of California, San Francisco, California
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Donation approval among obese living kidney donor candidates: The impact of metabolic syndrome. Surgery 2019; 166:940-946. [PMID: 31444005 DOI: 10.1016/j.surg.2019.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 07/02/2019] [Accepted: 07/07/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND The scarcity of organs available for transplantation has increased attempts to augment transplantation by utilizing obese living kidney donors. The literature has suggested that these donors have increased risks postdonation. Not surprising, the threshold for living kidney donor approval among obese persons is typically higher and the process more costly. Therefore, a screening tool to predict the likelihood of approval among obese living kidney donor candidates was created. METHODS A single-center retrospective study was performed among obese (body mass index ≥ 30 kg/m2) living kidney donor candidates evaluated in clinic (January 1, 2012, to December 31, 2017). Approved candidates were compared with those not approved using multivariable logistic regression, and a prediction tool was generated. RESULTS Among 389 obese living kidney donor candidates, there were no significant differences in sex or race and ethnicity by approval status. However, nonapproved candidates had a higher prevalence of metabolic syndrome. In the prediction model, glucose impairment and hypertension were most predictive of nonapproval. CONCLUSION Among obese living kidney donor candidates, several metabolic syndrome components were associated with decreased odds of approval. This tool may serve as a useful initial screening for obese living kidney donor candidates, permitting more cost-effective evaluation processes. The tool could also be used to promote expeditious interventions in the preclinical setting, including weight management programs, to improve the likelihood of donation and postdonation outcomes.
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Abstract
PURPOSE OF REVIEW The safety of living donor nephrectomy is essential to the continued success, growth, and sustainability of the clinical practice of living donor kidney transplantation. This review summarizes recent advances in our understanding of the perioperative and long-term risks faced by living kidney donors. RECENT FINDINGS Although adverse perioperative complications are extremely rare, donors particularly men, Black, or obese, frequently experience minor complications that result in delayed return to normal duties at home and work. Similarly, although long-term complications such as end-stage renal disease (ESRD) are rare, recent studies suggest a relative increase in risk of ESRD that is attributable to donation. Several risk calculators have been developed to help donors and their care providers quantify the baseline and postdonation risk of ESRD based on demographic and health characteristics. Thresholds of risk may help define what is an acceptable level of risk to the donor and the transplant center. SUMMARY Individualized risk calculators now allow care providers and potential donors to objectively and transparently participate in shared decision-making about the safety of living kidney donation.
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Affiliation(s)
- Luckmini Liyanage
- Department of Surgery, Division of Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Abimerki Muzaale
- Department of Surgery, Division of Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Macey Henderson
- Department of Surgery, Division of Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD, USA
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McCormick F, Held PJ, Chertow GM, Peters TG, Roberts JP. Removing Disincentives to Kidney Donation: A Quantitative Analysis. J Am Soc Nephrol 2019; 30:1349-1357. [PMID: 31345987 DOI: 10.1681/asn.2019030242] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
| | - Philip J Held
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Glenn M Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Thomas G Peters
- Department of Surgery, University of Florida, Jacksonville, Florida; and
| | - John P Roberts
- Department of Surgery, University of California, San Francisco, San Francisco, California
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Garcia-Ochoa C, Feldman LS, Nguan C, Monroy-Cuadros M, Arnold J, Boudville N, Cuerden M, Dipchand C, Eng M, Gill J, Gourlay W, Karpinski M, Klarenbach S, Knoll G, Lentine KL, Lok CE, Luke P, Prasad GVR, Sener A, Sontrop JM, Storsley L, Treleaven D, Garg AX. Perioperative Complications During Living Donor Nephrectomy: Results From a Multicenter Cohort Study. Can J Kidney Health Dis 2019; 6:2054358119857718. [PMID: 31367455 PMCID: PMC6643179 DOI: 10.1177/2054358119857718] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/30/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND While living kidney donation is considered safe in healthy individuals, perioperative complications can occur due to several factors. OBJECTIVE We explored associations between the incidence of perioperative complications and donor characteristics, surgical technique, and surgeon's experience in a large contemporary cohort of living kidney donors. DESIGN Living kidney donors enrolled prospectively in a multicenter cohort study with some data collected retrospectively after enrollment was complete (eg, surgeon characteristics). SETTING Living kidney donor centers in Canada (n = 12) and Australia (n = 5). PATIENTS Living kidney donors who donated between 2004 and 2014 and the surgeons who performed the living kidney donor nephrectomies. MEASUREMENTS Operative and hospital discharge medical notes were collected prospectively, with data on perioperative (intraoperative and postoperative) information abstracted from notes after enrollment was complete. Complications were graded using the Clavien-Dindo system and further classified into minor and major. In 2016, surgeons who performed the nephrectomies were invited to fill an online survey on their training and experience. METHODS Multivariable logistic regression models with generalized estimating equations were used to compare perioperative complication rates between different groups of donors. The effect of surgeon characteristics on the complication rate was explored using a similar approach. Poisson regression was used to test rates of overall perioperative complications between high- and low-volume centers. RESULTS Of the 1421 living kidney donor candidates, 1042 individuals proceeded with donation, where 134 (13% [95% confidence interval (CI): 11%-15%]) experienced 142 perioperative complications (55 intraoperative; 87 postoperative). The most common intraoperative complication was organ injury and the most common postoperative complication was ileus. No donors died in the perioperative period. Most complications were minor (90% of 142 complications [95% CI: 86%-96%]); however, 12 donors (1% of 1042 [95% CI: 1%-2%]) experienced a major complication. No statistically significant differences were observed between donor groups and the rate of complications. A total of 43 of 48 eligible surgeons (90%) completed the online survey. Perioperative complication rates did not vary significantly by surgeon characteristics or by high- versus low-volume centers. LIMITATIONS Operative and discharge reporting is not standardized and varies among surgeons. It is possible that some complications were missed. The online survey for surgeons was completed retrospectively, was based on self-report, and has not been validated. We had adequate statistical power only to detect large effects for factors associated with a higher risk of perioperative complications. CONCLUSIONS This study confirms the safety of living kidney donation as evidenced by the low rate of major perioperative complications. We did not identify any donor or surgeon characteristics associated with a higher risk of perioperative complications. TRIAL REGISTRATIONS NCT00319579: A Prospective Study of Living Kidney Donation (https://clinicaltrials.gov/ct2/show/NCT00319579)NCT00936078: Living Kidney Donor Study (https://clinicaltrials.gov/ct2/show/NCT00936078).
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Affiliation(s)
- Carlos Garcia-Ochoa
- Division of Nephrology, Department of
Medicine, Western University, London, ON, Canada
| | | | - Christopher Nguan
- Department of Urologic Sciences, The
University of British Columbia, Vancouver, Canada
| | | | - Jennifer Arnold
- Division of Nephrology, Department of
Medicine, Western University, London, ON, Canada
| | - Neil Boudville
- Medical School, The University of
Western Australia, Perth, Australia
| | - Meaghan Cuerden
- Division of Nephrology, Department of
Medicine, Western University, London, ON, Canada
| | - Christine Dipchand
- Division of Nephrology, Department of
Medicine, Dalhousie University, Halifax, NS, Canada
| | - Michael Eng
- Department of Urologic Sciences, The
University of British Columbia, Vancouver, Canada
| | - John Gill
- Division of Nephrology, The University
of British Columbia, Vancouver, Canada
| | - William Gourlay
- Department of Urologic Sciences, The
University of British Columbia, Vancouver, Canada
| | - Martin Karpinski
- Department of Medicine, University of
Manitoba, Winnipeg, Canada
| | | | - Greg Knoll
- Division of Nephrology, Department of
Medicine, Ottawa Hospital Research Institute, ON, Canada
| | - Krista L. Lentine
- Centre for Abdominal Transplantation,
Saint Louis University School of Medicine, MO, USA
| | | | - Patrick Luke
- Department of Urology, Western
University, London, ON, Canada
| | - G. V. Ramesh Prasad
- Division of Nephrology, Department of
Medicine, University of Toronto, ON, Canada
| | - Alp Sener
- Department of Urology, Western
University, London, ON, Canada
| | - Jessica M. Sontrop
- Department of Epidemiology &
Biostatistics, Western University, London, ON, Canada
| | - Leroy Storsley
- Department of Internal Medicine,
University of Manitoba, Winnipeg, Canada
| | - Darin Treleaven
- Division of Nephrology, Department of
Medicine, McMaster University, Hamilton, ON, Canada
| | - Amit X. Garg
- Division of Nephrology, Department of
Medicine, Western University, London, ON, Canada
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