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Bratu B, Kuntz S, Caillard S, Chakfe N, Lejay A. A Tubular Vena Cava Conduit Used to Lengthen a Kidney Transplant Renal Artery Injured During Organ Procurement. EJVES Vasc Forum 2024; 61:51-53. [PMID: 38328688 PMCID: PMC10847879 DOI: 10.1016/j.ejvsvf.2024.01.052] [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: 07/24/2023] [Revised: 12/11/2023] [Accepted: 01/12/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction Organ transplantation is limited by the supply of transplantable organs, and the supply of organs cannot meet the needs of patients on the waiting list. Ensuring transplantation of any procured organ is therefore mandatory. Organ injury, mostly to the organ's vasculature, can occur during multi-organ procurement, preventing subsequent transplantation. In such a context, vascular reconstructions of arterial or venous organ injuries can be useful. Report This report describes the case of an obese 64 year old female with a history of diabetic nephropathy who underwent a cadaveric kidney transplant (right kidney with one main renal artery, one inferior polar artery, one vein, and one ureter). The ex situ preparation of the graft revealed that the main renal artery was injured and cut close to the renal hilum (0.8 cm length, 6 mm diameter), not allowing graft implantation. In order to increase the length of the main renal artery, the donor inferior vena cava was used to create a tubular conduit, allowing subsequent graft implantation. Cold and warm ischaemic times were respectively 12 hours and 36 minutes, with immediate graft function. The patient was discharged on day 8 (serum creatinine level was 95 μmol/L). Twelve month follow up was uneventful (serum creatinine level was 108 μmol/L and duplex ultrasonography showed homogeneous blood flow throughout the graft). Discussion This case report highlights the possibility of overcoming an injured kidney graft artery by creating a tubular vena cava conduit in order to allow subsequent transplantation. Vascular reconstructions of organs injured during procurement should be considered.
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Affiliation(s)
- Bogdan Bratu
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
- GEPROMED, Strasbourg, France
| | - Salomé Kuntz
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
- GEPROMED, Strasbourg, France
| | - Sophie Caillard
- Department of Nephrology and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Nabil Chakfe
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
- GEPROMED, Strasbourg, France
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
- GEPROMED, Strasbourg, France
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Siddique A, Parekh KR, Huddleston SJ, Shults A, Locke JE, Keshavamurthy S, Schwartz G, Hartwig MG, Whitson BA. A call to action in thoracic transplant surgical training. J Heart Lung Transplant 2023; 42:1627-1631. [PMID: 37268052 DOI: 10.1016/j.healun.2023.05.017] [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: 12/12/2022] [Revised: 05/19/2023] [Accepted: 05/30/2023] [Indexed: 06/04/2023] Open
Abstract
Thoracic organ recovery and implantation is increasing in complexity. Simultaneously the logistic burden and associated cost is rising. An electronic survey distributed to the surgical directors of thoracic transplant programs in the United States indicated dissatisfaction amongst 72% of respondents with current procurement training and 85% of respondents favored a process for certification in thoracic organ transplantation. These responses highlight concerns for the current paradigm of training in thoracic transplantation. We discuss the implications of advancements in organ retrieval and implant for surgical training and propose that the thoracic transplant community might address the need through formalized training in procurement and certification in thoracic transplantation.
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Affiliation(s)
- A Siddique
- University of Nebraska Medical Center, Department of Surgery, Division of Cardiothoracic Surgery, Omaha, Nebraska.
| | - K R Parekh
- University of Iowa Hospitals and Clinics, Department of Cardiothoracic Surgery, Carver College of Medicine, Iowa City, Iowa
| | - S J Huddleston
- University of Minnesota, Department of Surgery, Division of Cardiothoracic Surgery
| | - A Shults
- American Society of Thoracic Surgeons, Arlington, Virginia
| | - J E Locke
- University of Alabama at Birmingham, Department of Surgery, Division of Transplantation, Birmingham, Alabama
| | - S Keshavamurthy
- University of Kentucky College of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Lexington, Kentucky
| | - G Schwartz
- Baylor University Medical Center, Department of Thoracic Surgery, Dallas, Texas
| | - M G Hartwig
- Duke University Health System, Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Durham, North Carolina
| | - B A Whitson
- The Ohio State University Wexner Medical Center, Department of Surgery, Division of Cardiac Surgery, Columbus, Ohio
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Taber-Hight E, Paramesh A, Neidlinger N, Lebovitz DJ, Souter M, Taber T. The Impact of Organ Procurement Injury on Transplant Organ Availability. Transplant Proc 2022; 54:2075-2081. [DOI: 10.1016/j.transproceed.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/10/2022] [Accepted: 06/16/2022] [Indexed: 11/09/2022]
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Walcott J, Fink M, Ealing I, Christophi C, Muralidharan V. Procurement-related liver injury for transplantation: an analysis of the risk factors and consequences in an Australian transplant centre. ANZ J Surg 2021; 91:2669-2674. [PMID: 34723420 DOI: 10.1111/ans.17285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 09/28/2021] [Accepted: 10/05/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Liver transplantation is an established treatment for liver failure, and its success relies on the quality of the donated organ amongst other factors. Studies on procurement-related liver injury (PRLI) are few and some may not apply to modern-day practice. This is the first Australian study examining risk factors and consequences of PRLI. METHOD The Victorian Liver Transplant Unit database was examined for deceased liver donors from 2010 to 2017. Information regarding the donor, retrieval and subsequent transplantation was obtained. PRLI details were sought from the 'organ retrieval report form'. PRLI risk factors and their complications were analysed. RESULTS A total of 420 transplants were included, with 45 injuries in 44 livers (10%), and significant injuries were observed in 4%. Variant anatomy was associated with an increased risk of PRLI (11% vs. 2%, p < 0.001). Complication rates were not significantly different between livers with and without PRLI however a reduction in early graft survival was observed. CONCLUSION This study shows that PRLI is common, and that variant anatomy is associated with an increased risk of injury. Appropriate feedback and benchmarking are important to maintain a high quality in donor surgery.
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Affiliation(s)
- James Walcott
- Department of Surgery, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia.,Hepato-Pancreato-Biliary & Transplant Surgery Unit, Austin Health, Melbourne, Victoria, Australia
| | - Michael Fink
- Department of Surgery, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia.,Hepato-Pancreato-Biliary & Transplant Surgery Unit, Austin Health, Melbourne, Victoria, Australia.,Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Isaac Ealing
- Royal Prince Alfred Hospital, UGI, Sydney, New South Wales, Australia
| | - Christopher Christophi
- Department of Surgery, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia.,Hepato-Pancreato-Biliary & Transplant Surgery Unit, Austin Health, Melbourne, Victoria, Australia.,Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Vijayaragavan Muralidharan
- Department of Surgery, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia.,Hepato-Pancreato-Biliary & Transplant Surgery Unit, Austin Health, Melbourne, Victoria, Australia.,Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
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Knechtle SJ, Niedfeldt D, Sudan D, Jackson A, Jamieson I, Hartwig M, Milano C. Another Step Toward Becoming a Transplant Community. Ann Surg 2021; 273:e149-e150. [PMID: 33086314 DOI: 10.1097/sla.0000000000004472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Stuart J Knechtle
- Duke Transplant Center, Duke University School of Medicine, Durham, North Carolina
| | | | - Debra Sudan
- Duke Transplant Center, Duke University School of Medicine, Durham, North Carolina
| | - Annette Jackson
- Duke Transplant Center, Duke University School of Medicine, Durham, North Carolina
| | - Ian Jamieson
- Duke Transplant Center, Duke University School of Medicine, Durham, North Carolina
| | - Matthew Hartwig
- Duke Transplant Center, Duke University School of Medicine, Durham, North Carolina
| | - Carmelo Milano
- Duke Transplant Center, Duke University School of Medicine, Durham, North Carolina
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Rofaiel G, Allam SR, Ali M, Martinez E, Brower CT, Fayek SA. Successful Transplantation of Pediatric Kidneys Despite Vascular Injuries. Cureus 2018; 10:e3073. [PMID: 30280068 PMCID: PMC6166908 DOI: 10.7759/cureus.3073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The gap between the kidney transplant recipient list and the number of organs available for transplantation continues to grow. Pediatric donors help fill a small and valuable portion of that gap. Normally these organs are transplanted en-bloc by closing the proximal vascular caps and using the distal aorta and distal inferior vena cava (IVC) for inflow. They are however commonly injured during the donor operation making the standard operation for pediatric en-bloc transplantation not possible. This case report presents two cases in which injured small pediatric kidneys were transplanted successfully in adult patients. We are presenting two examples of common vascular injuries to small pediatric kidneys, one venous and one arterial. In both scenarios, the kidneys were transplanted using a modification to the standard technique. The two kidneys were separated and the technique of implantation was modified to allow safe transplantation. This way we were able to transplant both kidneys successfully and using a reproducible methodology. Both recipients were young adults. There were no surgical complications.
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Affiliation(s)
- George Rofaiel
- Surgery, University of Utah School of Medicine/Huntsman Cancer Institute, Salt Lake City, USA
| | - Sridhar R Allam
- Transplantation Surgery, Medical City Fort Worth, Fort Worth, USA
| | - Mohammed Ali
- Surgery, Medical City Fort Worth, Fort Worth, USA
| | | | - Chase T Brower
- Transplant Surgery, University of Utah, Salt Lake City, USA
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