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Abstract
There are few, if any, technological advancements in the field of medicine that have been able to transform a life-threatening condition, in this case, end-stage renal failure, from a certain and horrible death, just some 100 years ago, to a condition manageable within the confines of one’s home. This refresher course, by no means a comprehensive text on peritoneal or haemodialysis, aims to provide the reader (a pre-part one FCA candidate) with the following brief overview:
* A short history of dialysis
* The basic physiology of fluid and solute exchange employed in renal replacement therapy (RRT)
* The physical principals of RRT
* Modality
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Botha J, Ströbele B, Loveland J, Rambarran S, Britz R, Etheredge H, Maher H, Bolon S, Eager M, Beeton A, Brannigan L, Mononyane R, Bannan S, Smith O, Fabian J. Living donor liver transplantation in South Africa: the donor experience. S AFR J SURG 2019; 57:11-16. [PMID: 31392859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Living donor liver transplantation (LDLT) plays a crucial role in liver transplant programmes, particularly in regions with a scarcity of deceased donor organs and especially for paediatric recipients. LDLT is a complex and demanding procedure which places a healthy living donor in harm's way. Donor safety is therefore the overriding concern. This study aimed to report our standardised approach to the evaluation, technical aspects and outcomes of LDLT donor hepatectomy at Wits Donald Gordon Medical Centre. METHOD The study population consisted of all patients undergoing LDLT donor hepatectomy since the inception of the programme in March 2013 until 2018. Sixty five living donor hepatectomies were performed. Primary outcome measures included donor demographics, operative time, peak bilirubin, aspartate and alanine transaminase levels postoperatively, length of hospital stay and postoperative complications using the Clavien-Dindo classification. RESULTS The majority of the donors were female, most were parents with mothers being the donor almost 85% of the time. The median operative time was 374 minutes with a downward trend over time as experience was gained. The median length of hospital stay was 7 days. There was no mortality and the complication rate was 30% with the majority being minor (Grade 1). CONCLUSION Living donor liver transplant from adult-to-child has been successfully initiated in South Africa. Living donor hepatectomy can be safely performed with acceptable outcomes for the donor. Wait-list mortality however remains unacceptably high. Expansion of LDLT as well as real change in deceased donor policy is required to address this issue.
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Affiliation(s)
- J Botha
- Wits Donald Gordon Medical Centre, Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - B Ströbele
- Wits Donald Gordon Medical Centre, Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - J Loveland
- Wits Donald Gordon Medical Centre, Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - S Rambarran
- Wits Donald Gordon Medical Centre, Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - R Britz
- Wits Donald Gordon Medical Centre, Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - H Etheredge
- Wits Donald Gordon Medical Centre and Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - H Maher
- Wits Donald Gordon Medical Centre and Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S Bolon
- Department of Anaesthesia and Critical Care, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, South Africa
| | - M Eager
- Wits Donald Gordon Medical Centre Transplant Anaesthesia, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - A Beeton
- Wits Donald Gordon Medical Centre Transplant Anaesthesia, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - L Brannigan
- Wits Donald Gordon Medical Centre Transplant Anaesthesia, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - R Mononyane
- Wits Donald Gordon Medical Centre Transplant Anaesthesia, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - S Bannan
- Wits Donald Gordon Medical Centre Transplant Anaesthesia, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - O Smith
- Department of Anaesthesia and Critical Care, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, South Africa
| | - J Fabian
- Wits Donald Gordon Medical Centre and Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Botha J, Ströbele B, Loveland J, Rambarran S, Britz R, Etheredge H, Maher H, Bolon S, Eagar M, Beeton A, Brannigan L, Mononyane R, Bannan S, Morford M, Smith O, Fabian J. Living donor liver transplantation in South Africa: the donor experience. S AFR J SURG 2019. [DOI: 10.17159/2078-5151/2019/v57n3a2998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Fabian J, Loveland J, Maher H, Gaylard P, Etheredge H, Bouter C, Cantrell J, Sanyika C, Britz R, Strobele B, Rambarran S, van der Schyff F, Brannigan L, Demopoulos D, Campbell Lang A, Archibald-Durham L, Beretta M, Bobat B, Mahomed A, Terblanche A, Botha J. Wits Transplant Annual Data Report 2018 Adult and Paediatric Liver Transplantation. ACTA ACUST UNITED AC 2019. [DOI: 10.18772/26180197.2019.v1n3a2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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