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Knaak M, Goldaracena N, Doyle A, Cattral MS, Greig PD, Lilly L, McGilvray ID, Levy GA, Ghanekar A, Renner EL, Grant DR, Selzner M, Selzner N. Donor BMI >30 Is Not a Contraindication for Live Liver Donation. Am J Transplant 2017; 17:754-760. [PMID: 27545327 DOI: 10.1111/ajt.14019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 08/10/2016] [Accepted: 08/13/2016] [Indexed: 01/25/2023]
Abstract
The increased prevalence of obesity worldwide threatens the pool of living liver donors. Although the negative effects of graft steatosis on liver donation and transplantation are well known, the impact of obesity in the absence of hepatic steatosis on outcome of living donor liver transplantation (LDLT) is unknown. Consequently, we compared the outcome of LDLT using donors with BMI <30 versus donors with BMI ≥30. Between April 2000 and May 2014, 105 patients received a right-lobe liver graft from donors with BMI ≥30, whereas 364 recipients were transplanted with grafts from donors with BMI <30. Liver steatosis >10% was excluded in all donors with BMI >30 by imaging and liver biopsies. None of the donors had any other comorbidity. Donors with BMI <30 versus ≥30 had similar postoperative complication rates (Dindo-Clavien ≥3b: 2% vs. 3%; p = 0.71) and lengths of hospital stay (6 vs. 6 days; p = 0.13). Recipient graft function, assessed by posttransplant peak serum bilirubin and international normalized ratio was identical. Furthermore, no difference was observed in recipient complication rates (Dindo-Clavien ≥3b: 25% vs. 20%; p = 0.3) or lengths of hospital stay between groups. We concluded that donors with BMI ≥30, in the absence of graft steatosis, are not contraindicated for LDLT.
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Affiliation(s)
- M Knaak
- Department of Surgery, Multi Organ Transplant Program, Toronto General Hospital, Toronto, ON, Canada.,General-, Visceral- and Transplantation Surgery, University Hospital of Frankfurt am Main, Frankfurt, Germany
| | - N Goldaracena
- Department of Surgery, Multi Organ Transplant Program, Toronto General Hospital, Toronto, ON, Canada
| | - A Doyle
- Department of Medicine, Multi Organ Transplant Program, Toronto General Hospital, Toronto, ON, Canada
| | - M S Cattral
- Department of Surgery, Multi Organ Transplant Program, Toronto General Hospital, Toronto, ON, Canada
| | - P D Greig
- Department of Surgery, Multi Organ Transplant Program, Toronto General Hospital, Toronto, ON, Canada
| | - L Lilly
- Department of Medicine, Multi Organ Transplant Program, Toronto General Hospital, Toronto, ON, Canada
| | - I D McGilvray
- Department of Surgery, Multi Organ Transplant Program, Toronto General Hospital, Toronto, ON, Canada
| | - G A Levy
- Department of Medicine, Multi Organ Transplant Program, Toronto General Hospital, Toronto, ON, Canada
| | - A Ghanekar
- Department of Surgery, Multi Organ Transplant Program, Toronto General Hospital, Toronto, ON, Canada
| | - E L Renner
- Department of Medicine, Multi Organ Transplant Program, Toronto General Hospital, Toronto, ON, Canada
| | - D R Grant
- Department of Surgery, Multi Organ Transplant Program, Toronto General Hospital, Toronto, ON, Canada
| | - M Selzner
- Department of Surgery, Multi Organ Transplant Program, Toronto General Hospital, Toronto, ON, Canada
| | - N Selzner
- Department of Medicine, Multi Organ Transplant Program, Toronto General Hospital, Toronto, ON, Canada
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Zimmermann T, Otto C, Hoppe-Lotichius M, Biesterfeld S, Lautem A, Knaak M, Zimmermann A, Barreiros A, Heise M, Schattenberg J, Sprinzl M, Galle P, Otto G, Schuchmann M. Risk Factors in Patients With Rapid Recurrent Hepatitis C Virus–Related Cirrhosis Within 1 Year After Liver Transplantation. Transplant Proc 2009; 41:2549-56. [DOI: 10.1016/j.transproceed.2009.06.120] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Moench C, Heimann A, Foltys D, Schneider B, Minouchehr S, Schwandt E, Knaak M, Kempski O, Otto G. Flow and Pressure during Liver Preservation under ex situ and in situ Perfusion with University of Wisconsin Solution and Histidine-Tryptophan-Ketoglutarate Solution. Eur Surg Res 2007; 39:175-81. [PMID: 17351323 DOI: 10.1159/000100800] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Accepted: 12/19/2006] [Indexed: 12/14/2022]
Abstract
Effective preservation of liver grafts is the first essential step for successful liver transplantation. Insufficient perfusion leads to ischemic-type biliary lesions after transplantation. Perfusion of the graft can be performed either in situ or ex situ, with gravity flow or pressure-controlled. Mainly University of Wisconsin (UW) and histidine-tryptophan-ketoglutarate (HTK) solutions are used widespread in clinical liver transplantation. Due to a persistent lack of data, we performed this systematic investigation of in situ and ex situ perfusion of liver grafts with HTK (low-viscous) and UW (high-viscous) solutions at different pressure steps on the perfusion solution (gravity flow, 50, 100, 150, and 200 mm Hg). End points were perfusion flow and pressure in the hepatic artery. A pig model was used with n = 8 pigs randomized to each (HTK and UW) group. In situ perfusion was ineffective for both solutions at any pressure on the perfusate bag. Ex situ perfusion showed significantly improved flow and pressure in the hepatic artery and, therefore, was highly effective. No major differences between HTK and UW solutions could be detected. Therefore, an additional ex situ perfusion of the hepatic artery should be mandatory in every liver procurement.
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Affiliation(s)
- C Moench
- Department of Transplantation and Hepatobiliarypancreatic Surgery, Johannes Gutenberg University, Mainz, Germany.
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So S, Najarian J, Nevins T, Fryd D, Knaak M, Chavers B, Mauer S, Simmons R. Low-Bose Cyclosporine Therapy Combined With Standard Immunosuppression in Pediatric Renal Transplantation. J Urol 1988. [DOI: 10.1016/s0022-5347(17)42943-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S.K.S. So
- Departments of Surgery and Pediatrics, University of Minnesota, Health Sciences Center, Minneapolis, Minnesota
| | - J.S. Najarian
- Departments of Surgery and Pediatrics, University of Minnesota, Health Sciences Center, Minneapolis, Minnesota
| | - T.E. Nevins
- Departments of Surgery and Pediatrics, University of Minnesota, Health Sciences Center, Minneapolis, Minnesota
| | - D.S. Fryd
- Departments of Surgery and Pediatrics, University of Minnesota, Health Sciences Center, Minneapolis, Minnesota
| | - M. Knaak
- Departments of Surgery and Pediatrics, University of Minnesota, Health Sciences Center, Minneapolis, Minnesota
| | - B. Chavers
- Departments of Surgery and Pediatrics, University of Minnesota, Health Sciences Center, Minneapolis, Minnesota
| | - S. Mauer
- Departments of Surgery and Pediatrics, University of Minnesota, Health Sciences Center, Minneapolis, Minnesota
| | - R.L. Simmons
- Departments of Surgery and Pediatrics, University of Minnesota, Health Sciences Center, Minneapolis, Minnesota
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So SK, Najarian JS, Nevins TE, Fryd DS, Knaak M, Chavers B, Mauer SM, Simmons RL. Low-dose cyclosporine therapy combined with standard immunosuppression in pediatric renal transplantation. J Pediatr 1987; 111:1017-21. [PMID: 3316573 DOI: 10.1016/s0022-3476(87)80048-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A new immunosuppressive regimen combining anti-lymphocyte globulin, azathioprine, prednisone, and low doses of cyclosporine was used in 28 children aged 9 months to 17 years (mean 5.8 years) who received primary renal allografts between July 1, 1984, and September 25, 1986. After a mean follow-up of 17.3 months, the patient and graft survival is 100% (18 of 18) for mismatched related kidneys, and 90% (nine of 10) for cadaver kidneys. The single graft failure was the result of a death from technical complications. Serum creatinine concentration after transplantation ranged from 0.3 to 1.7 mg/dL (mean 0.85 mg/dL). The probability of a rejection episode in the first year was 45% and 60% for mismatched-related and cadaver kidneys, respectively. Cyclosporine nephrotoxicity was recognized in only one (3.7%) of 27 children, and was rapidly reversed after cyclosporine was discontinued. An initial group of nine children was weaned from cyclosporine therapy 6 to 12 months after transplantation, but two (22%) had rejection episodes. Our preliminary experience suggests that the use of a quadruple immunosuppressive regimen for both living related and cadaver renal transplants in children is associated with an improved graft function rate and a low incidence of complications.
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Affiliation(s)
- S K So
- Department of Surgery, University of Minnesota Health Sciences Center, Minneapolis
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