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Ashwin A, Cherukuri SD, Rammohan A. The psychology, legality, ethics and medical aspects of organ donation by minors. Transplant Rev (Orlando) 2024; 38:100832. [PMID: 38340552 DOI: 10.1016/j.trre.2024.100832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/12/2024]
Abstract
Any individual who has not attained the chronological age of legal majority as per national law is termed a minor. The concept of living donation (LD) has always been a subject of ethical debate and further compounding the controversy is the question of LD by minors. The decision for a minor to donate poses a special challenge as it involves a close family unit of parent-child relationship. Such an emotionally loaded situation wherein questions of attachment, perceived duties, moral obligation are likely to cloud a truly informed consent on the part of the minor to donation, who may find themselves in a vulnerable position. Furthermore, a minor's cognitive ability to comprehend the gravity of LD and when required defy parental coercion need to be elucidates before a minor is accepted for LD. Experts have set out stringent conditions which need to be met prior to the exceptional circumstance that a minor is considered for organ donation. Such donations should require parental permission, child's assent and the involvement of a paediatric-trained donor advocacy team. This article debates the question of minors acting as live donors from ethical, medical, psychosocial and legal viewpoints with an aim to present internationally defined circumstances when a minor may morally participate as a LD, thereby laying the foundation for future deliberations in this regard using traditional metrics to juxtapose divergent courses of action.
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Affiliation(s)
- A Ashwin
- Wellington School, Wellington, UK
| | | | - A Rammohan
- The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India.
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Seda Neto J, Costa CM, Pugliese R, Vincenzi R, Benavides MR, Travassos NPR, de Oliveira CMV, Roda K, Fernandes DP, Kondo M, Fonseca EA. Living Donor Whole and Partial Liver Grafts, Deceased Donor Whole Liver and SPLIT: Outcome Comparison. J Pediatr Surg 2024:S0022-3468(24)00092-7. [PMID: 38413259 DOI: 10.1016/j.jpedsurg.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/02/2024] [Accepted: 02/14/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Currently, graft options for pediatric liver transplantation (PLT) include whole (WL) and partial (P) grafts, in the form of either deceased donor transplantation (DD) or living donor liver transplantation (LD). WL transplants from LD are commonly referred to as domino LT. The objective of this manuscript is to compare the outcomes of PLT performed with each of the available graft options. METHODS Retrospective cohort study from Jan. 2010 to Dec. 2022. The variables included data on the recipients' preoperative clinical status, intraoperative technical aspects, post-operative complications, and survival studies. There were 4 groups: SPLIT (17), DD-WL (55), LD-WL (824), and LD-P (22). RESULTS The median age and BW of the recipients was smaller in SPLIT, LD-P, and LD-WL compared to DDT-WL groups. HVOO (HR 15.87, 95% CI 1.89-133.06, P = 0.01), retransplantation (HR 7.94, 95% CI 2.63-24.02, P < 0.01), and malignancies (HR 3.08, 95% CI 1.29-7.37, P = 0.01) were independently associated with decreased patient survival. HAT (HR 27.54, 95% CI 10.44-72.68, P < 0.01) and malignancies (HR 2.42, 95% CI 1.10-5.34, P = 0.03) increased the risk of graft loss. The overall survival in this series was 91.4% (mean follow-up of 74.3 months). Patient and graft survival were not different among groups. CONCLUSION HAT and malignancies were associated with reduced graft survival. Whole liver from living donors with MSUD presented 100% patient survival at 120 months. Even without statistical differences in survival among the studied groups, LD-P and LD-WL recipients presented a trend towards better outcomes. LEVEL OF EVIDENCE LEVEL III.
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Affiliation(s)
- João Seda Neto
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil.
| | - Carolina M Costa
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Renata Pugliese
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Rodrigo Vincenzi
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Marcel R Benavides
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Nathália P R Travassos
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Caio M V de Oliveira
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Karina Roda
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Debora P Fernandes
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Mário Kondo
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Eduardo A Fonseca
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
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Mesnard B, Branchereau J. Arterial ligation in the context of living donor nephrectomy: Which device to employ? Experience feedback on an automatic vascular clamp. Fr J Urol 2024; 34:102586. [PMID: 38364678 DOI: 10.1016/j.fjurol.2024.102586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/18/2024]
Abstract
The choice of arterial ligation modality in the context of nephrectomies for living kidney donation poses a significant challenge. Due to the contraindication of Hem-O-Lock™ clips for this indication and the discontinuation of certain commercially available ligature devices suitable for this purpose, this issue remains particularly relevant. We report a serious adverse event with an arterial ligation device (Signia™ Stapling System, Medtronic, Dublin, Ireland). We observed intraoperative dislodgement of clips from the stump of the renal artery, resulting in significant bleeding and necessitating an emergency conversion to a subcostal approach. The experiential insights from each transplantation team regarding ligation modalities and the rigorous evaluation of medical devices are crucial imperative to ensure the donor's safety.
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Affiliation(s)
- Benoît Mesnard
- Clinique urologique, Hôpital Hôtel-Dieu, CHU de Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie CRTI Inserm, CHU de Nantes, Nantes, France
| | - Julien Branchereau
- Clinique urologique, Hôpital Hôtel-Dieu, CHU de Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie CRTI Inserm, CHU de Nantes, Nantes, France.
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Olumba FC, Vachharajani N, Yu J, Scherer M, Matson S, Hill AL, Kiani A, Lin Y, Doyle MMB, Chapman WC, Wellen JR, Khan AS. Robotic donor nephrectomy: optimizing outcomes beyond the limitations of laparoscopy. Surg Endosc 2023; 37:7511-7519. [PMID: 37415014 DOI: 10.1007/s00464-023-10246-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Robotic donor nephrectomy (RDN) has emerged as a safe alternate to laparoscopic donor nephrectomy (LDN), offering improved visualization, instrument dexterity and ergonomics. There is still concern about how to safely transition from LDN to RDN. METHODS We performed a retrospective review of 150 consecutive living donor operations (75 LDN and 75 RDN) at our center, comparing the first 75 RDN's with the last 75 LDN's performed prior to the initiation of the robotic transplant program. Operative times and complications were used as surrogates of efficiency and safety, respectively, to estimate the learning curve with RDN. RESULTS RDN was associated with a longer total operative time (RDN 182 vs LDN 144 min; P < 0.0001) but a significantly shorter post-operative length of stay (RDN 1.8 vs LDN 2.1 days; P = 0.0213). Donor complications and recipient outcomes were the same between both groups. Learning curve of RDN was estimated to be about 30 cases. CONCLUSIONS RDN is a safe alternate to LDN with acceptable donor morbidity and no negative impact on recipient outcomes even during the early part of the RDN learning curve. Surgeon preferences for the robotic approach compared to traditional laparoscopy will require further scrutiny to improve ergonomics and operative efficiency.
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Affiliation(s)
- Franklin C Olumba
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Neeta Vachharajani
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Jennifer Yu
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Meranda Scherer
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Sarah Matson
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Angela L Hill
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Amen Kiani
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Yiing Lin
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Majella M B Doyle
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - William C Chapman
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Jason R Wellen
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Adeel S Khan
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA.
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Kakos CD, Papanikolaou A, Ziogas IA, Tsoulfas G. Global dissemination of minimally invasive living donor hepatectomy: What are the barriers? World J Gastrointest Surg 2023; 15:776-787. [PMID: 37342850 PMCID: PMC10277954 DOI: 10.4240/wjgs.v15.i5.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/16/2023] [Accepted: 03/16/2023] [Indexed: 05/26/2023] Open
Abstract
Minimally invasive donor hepatectomy (MIDH) is a relatively novel procedure that can potentially increase donor safety and contribute to faster rehabilitation of donors. After an initial period in which donor safety was not effectively validated, MIDH currently seems to provide improved results, provided that it is conducted by experienced surgeons. Appropriate selection criteria are crucial to achieve better outcomes in terms of complications, blood loss, operative time, and hospital stay. Beyond a pure laparoscopic technique, various approaches have been recommended such as hand-assisted, laparoscopic-assisted, and robotic donation. The latter has shown equal outcomes compared to open and laparoscopic approaches. A steep learning curve seems to exist in MIDH, mainly due to the fragility of the liver parenchyma and the experience needed for adequate control of bleeding. This review investigated the challenges and the opportunities of MIDH and the barriers to its global dissemination. Surgeons need expertise in liver transplantation, hepatobiliary surgery, and minimally invasive techniques to perform MIDH. Barriers can be categorized into surgeon-related, institutional-related, and accessibility. More robust data and the creation of international registries are needed for further evaluation of the technique and the acceptance from more centers worldwide.
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Affiliation(s)
- Christos Dimitrios Kakos
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Department of Transplant Surgery, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54622, Greece
| | - Angelos Papanikolaou
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Ioannis A Ziogas
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Georgios Tsoulfas
- Department of Transplant Surgery, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54622, Greece
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Caliskan Y, Safak S, Oto OA, Velioglu A, Yelken B, Mirioglu S, Dirim AB, Yildiz A, Guller N, Yazici H, Ersoy A, Turkmen A, Lentine KL. Propensity score-matched analysis of long-term outcomes for living kidney donation in alternative complement pathway diseases: a pilot study. J Nephrol 2023; 36:979-986. [PMID: 36808609 DOI: 10.1007/s40620-023-01588-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/15/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Atypical hemolytic syndrome (aHUS) and C3 glomerulopathy (C3G) are complement-mediated rare diseases with excessive activation of the alternative pathway. Data to guide the evaluation of living-donor candidates for aHUS and C3G are very limited. The outcomes of living donors to recipients with aHUS and C3G (Complement disease-living donor group) were compared with a control group to improve our understanding of the clinical course and outcomes of living donation in this context. METHODS Complement disease-living donor group [n = 28; aHUS(53.6%), C3G(46.4%)] and propensity score-matched control-living donor group (n = 28) were retrospectively identified from 4 centers (2003-2021) and followed for major cardiac events (MACE), de novo hypertension, thrombotic microangiopathy (TMA), cancer, death, estimated glomerular filtration rate (eGFR) and proteinuria after donation. RESULTS None of the donors for recipients with complement-related kidney diseases experienced MACE or TMA whereas two donors in the control group developed MACE (7.1%) after 8 (IQR, 2.6-12.8) years (p = 0.15). New-onset hypertension was similar between complement disease and control donor groups (21.4% vs 25%, respectively, p = 0.75). There were no differences between study groups regarding last eGFR and proteinuria levels (p = 0.11 and p = 0.70, respectively). One related donor for a recipient with complement-related kidney disease developed gastric cancer and another related donor developed a brain tumor and died in the 4th year after donation (2, 7.1% vs none, p = 0.15). No recipient had donor-specific human leukocyte antigen antibodies at the time of transplantation. Median follow-up period of transplant recipients was 5 years (IQR, 3-7). Eleven (39.3%) recipients [aHUS (n = 3) and C3G (n = 8)] lost their allografts during the follow-up period. Causes of allograft loss were chronic antibody-mediated rejection in 6 recipients and recurrence of C3G in 5. Last serum creatinine and last eGFR of the remaining patients on follow up were 1.03 ± 038 mg/dL and 73.2 ± 19.9 m/min/1.73 m2 for aHUS patients and 1.30 ± 0.23 mg/dL and 56.4 ± 5.5 m/min/1.73 m2 for C3G patients. CONCLUSION The present study highlights the importance and complexity of living related-donor kidney transplant for patients with complement-related kidney disorders and motivates the need for further research to determine the optimal risk-assessment for living donor candidates to recipients with aHUS and C3G.
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Affiliation(s)
- Yasar Caliskan
- Saint Louis University Transplant Center, SSM-Saint Louis University Hospital, 1201 S. Grand Blvd., St. Louis, MO, 63104, USA. .,Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey.
| | - Seda Safak
- Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Ozgur Akin Oto
- Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Arzu Velioglu
- Division of Nephrology, Marmara University School of Medicine, Istanbul, Turkey
| | - Berna Yelken
- Organ Transplantation Center, Koc University Hospital, Istanbul, Turkey
| | - Safak Mirioglu
- Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey.,Division of Nephrology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Ahmet Burak Dirim
- Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Abdulmecit Yildiz
- Division of Nephrology, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Nurana Guller
- Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Halil Yazici
- Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Alparslan Ersoy
- Division of Nephrology, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Krista L Lentine
- Saint Louis University Transplant Center, SSM-Saint Louis University Hospital, 1201 S. Grand Blvd., St. Louis, MO, 63104, USA
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Neto JS, Chapchap P, Feier FH, Pugliese R, Vincenzi R, Benavides MR, Roda K, Kondo M, Fonseca EA. The impact of low recipient weight [≤ 7kg] on long-term outcomes in 1078 pediatric living donor liver transplantations. J Pediatr Surg 2022; 57:955-961. [PMID: 35697543 DOI: 10.1016/j.jpedsurg.2022.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND infants who require liver transplantation represent a treatment challenge because chronic liver disease at this early age affects the child's growth and development during a critical phase. The aim is to compare demographics, operative data, and long-term outcomes according to recipient weight at the time of LDLT. METHODS This retrospective study included primary LDLT analyzed in 2 groups: BW ≤ 7 kg (n = 322) and BW > 7 kg (n = 756). A historical comparison between periods was also investigated. RESULTS BW ≤ 7 kg had significantly lower height/age and weight/age z-scores, with median PELD score of 19. Transfusion rates were higher in the BW ≤ 7 kg group (30.9 ml/kg versus 15.5 ml/kg, P < 0.001). Higher frequencies of PV complications were seen in the BW ≤ 7 kg cohort. HAT and retransplantation rates were similar. Those with BW ≤ 7 kg required longer ICU and hospital stays. Patient and graft survival were similar. Patient survival in BW≤ 7 kg was significantly better in the most recent period. CONCLUSION Malnutrition and advanced liver disease were more frequent in BW ≤ 7 kg. Despite increased rates of PVT and longer hospital stay, patient and graft long-term survival were similar between groups.
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Affiliation(s)
- João Seda Neto
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil; Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brazil.
| | - Paulo Chapchap
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil
| | - Flavia H Feier
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Renata Pugliese
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil; Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brazil
| | - Rodrigo Vincenzi
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil; Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brazil
| | - Marcel R Benavides
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil; Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brazil
| | - Karina Roda
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil; Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brazil
| | - Mário Kondo
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil
| | - Eduardo A Fonseca
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil; Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brazil
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Reine PK, Feier F, da Fonseca EA, Hernandes RG, Seda-Neto J. Quality of life, depression and anxiety in potential living liver donors for pediatric recipients: A retrospective single center experience. World J Hepatol 2022; 14:1899-1906. [PMID: 36340749 PMCID: PMC9627440 DOI: 10.4254/wjh.v14.i10.1899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/21/2022] [Accepted: 09/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Living donor liver transplantation is a safe alternative for patients on a liver transplant list. Donor evaluation goes beyond physical variables to include social, emotional, and ethical aspects. The role of pre-donation sociopsychological evaluation of the donor candidate is as important to the success of the procedure as is the medical assessment. Success implies recovery from the operation and prompt engagement in pre-transplant professional and social activities, without leading to psychological or physical distress. Psychological profiling of potential living liver donors (PLLD) and evaluation of quality of life (QOL) can influence outcomes.
AIM To evaluate the socio-demographics and psychological aspects (QOL, depression, and anxiety) of PLLD for pediatric liver transplantation in a cohort of 250 patients.
METHODS This was a retrospective cohort study of 250 PLLD who underwent psychological pre-donation evaluation between 2015 and 2019. All the recipients were children. The Beck anxiety inventory, Beck depression inventory, and 36-item short-form health survey (SF-36) scores were used to evaluate anxiety (Beck anxiety inventory), depression (Beck depression inventory), and QOL, respectively.
RESULTS A total of 250 PLLD were evaluated. Most of them were women (54.4%), and the mean age was 29.2 ± 7.2 years. A total of 120 (48.8%) PLLD were employed at the time of evaluation for donation; however, most had low income (57% earned < 2 times the minimum wage). A total of 110 patients (44%) did not finish the donation process, and 247 PLLD answered a questionnaire to evaluate depression, anxiety, and QOL (SF-36). Prevalence of depression was of 5.2% and anxiety 3.6%. Although most of the PLLD were optimistic regarding the donation process and never had doubts about becoming a donor, some traces of ambivalence were observed: 46% of the respondents said they would feel relieved if a deceased donor became available.
CONCLUSION PLLD had a low prevalence of anxiety and depression. The foundation for effective and satisfactory results can be found in the pre-transplantation process, during which evaluations must follow rigorous criteria to mitigate potential harm in the future. Pre-donation psychological evaluation plays a predictive role in post-donation emotional responses and mental health issues. The impact of such findings on the donation process and outcomes needs to be further investigated.
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Affiliation(s)
- Paula K Reine
- Department of Psychology, Hospital Sírio-Libanês, São Paulo 01308901, Brazil
| | - Flavia Feier
- Department ofLiver Transplantation, Santa Casa de Porto Alegre, Porto Alegre 90020090, Brazil
| | | | - Rosely G Hernandes
- Department of Psychology, Hospital Sírio-Libanês, São Paulo 01308901, Brazil
| | - Joao Seda-Neto
- Department of Liver Transplantation, Hospital Sírio-Libanês, São Paulo 01308901, Brazil
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Harris DD, Fleishman A, Pavlakis M, Pollak MR, Baliga PK, Rohan V, Kayler LK, Rodrigue JR. Apolipoprotein L1 Opinions of African American Living Kidney Donors, Kidney Transplant Patients, and Nonpatients. J Surg Res 2022; 277:116-124. [PMID: 35489216 DOI: 10.1016/j.jss.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/29/2021] [Revised: 02/03/2022] [Accepted: 04/06/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The discovery of apolipoprotein L1 (ApoL1) has raised important ethical and clinical questions about genetic testing in the context of living and deceased kidney donation. Largely missing from this discussion are the perspectives of those African Americans (AA) most likely to be impacted by ApoL1 testing. METHODS We surveyed 331 AA potential and former living kidney donors (LKDs), kidney transplant candidates and recipients, and nonpatients at three United States transplant programs about their ApoL1 testing attitudes. RESULTS Overall, 72% felt that transplant programs should offer ApoL1 testing to AA potential LKDs. If a potential LKD has the high-risk genotype, 79% felt that the LKD should be allowed to make their own donation decision or participate in shared decision-making with transplant doctors. More than half of the potential LKDs (58%) would undergo ApoL1 testing and 81% of former LKDs would take the test now if offered. Most transplant candidates expressed a low likelihood of accepting a kidney from a LKD (79%) or a deceased donor (67%) with the high-risk genotype. CONCLUSIONS There is strong support among LKDs and transplant patients for ApoL1 testing when evaluating potential kidney donors of African ancestry. Inclusion of AA stakeholders in developing guidelines and educational programs for ApoL1 testing is critical.
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Affiliation(s)
- Dwight D Harris
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Aaron Fleishman
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Martha Pavlakis
- Department of Surgery, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Martin R Pollak
- Department of Surgery, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Prabhakar K Baliga
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Vinayak Rohan
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Liise K Kayler
- Department of Surgery, University at Buffalo (SUNY) Jacobs School of Medicine & Biomedical Sciences and Erie County Medical Center, Buffalo, New York
| | - James R Rodrigue
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Medical University of South Carolina, Charleston, South Carolina.
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10
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Valentín MO, Pérez Blanco A, Marazuela R, Domínguez-Gil B. [Legislaction, ethics and kidney transplantation.]. ARCH ESP UROL 2021; 74:910-921. [PMID: 34851306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Kidney transplantation (KT) is the best therapeutic option for patients with end-stage renal disease in terms of survival, quality of life and cost-effectiveness. The fundamental difference of KT with respect to other therapies is that the process depends on the availability of organs for clinical use, availability that is insufficient to cover the increasing transplantation needs of the population. Another relevant feature of transplantation is that it entails a risk of transmission of diseases from donor to recipient, a risk that can be minimized, but not completely eliminated. Due to its characteristics and its unique nature (the human being), KT requires a specific regulation that guarantees the protection of all those who participate in the process: donors and their families, patients in need of a transplant, recipients of organs and healthcareprofessionals involved. In this article, we reviewthe ethical-legal standards that regulate the practice of kidney donation and transplantation at the international level and analyze the ethical-legal framework that is applicable in Spain.
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Vaz O, Asderakis A, Sharma V, Moinuddin Z, Shanmugam M, Tavakoli A, van Dellen D, Augustine T. Laterality in laparoscopic hand assisted donor nephrectomy - Does it matter anymore? Outcomes of a large retrospective series. Surgeon 2021; 20:e273-e281. [PMID: 34844890 DOI: 10.1016/j.surge.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/14/2021] [Revised: 08/30/2021] [Accepted: 09/28/2021] [Indexed: 12/18/2022]
Abstract
This retrospective study was performed to analyse if laterality of the retrieved living donor kidney had any effect on donor and recipient outcomes after hand assisted laparoscopic donor nephrectomy (HALDN). 739 donors who underwent HALDN between January 2006 and January 2018 at a large tertiary transplant centre in the United Kingdom were included. Donor outcomes in individuals undergoing right versus left HALDN were compared with respect to conversion rates, morbidity, warm and cold ischaemia times and recipient failure rates, vascular and ureteric complications. 604 (81.7%) underwent left HALDN and 135 (18.3%) underwent right HALDN, mean age was 47.1 years and 46.8 years respectively with comparable gender distribution. The operative time was shorter for the left side (p = 0.003) and improved during the study for the left but not the right side. In recipients who received left kidneys there were more early technical failures observed (8 versus 1) though not statistically significant. Most centres prefer performing a left nephrectomy and recipient surgeons prefer a left kidney for transplantation primarily because of having a longer vein. This large study provides reassurance that right HALDN nephrectomy is a safe procedure with similar outcomes to left HALDN.
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Affiliation(s)
- Osborne Vaz
- Manchester Centre for Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK; Department of Hepatobiliary Surgery, Royal Blackburn Hospitals, Blackburn, Lancashire, BB2 3 HQ, UK.
| | - Argiris Asderakis
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff, CF14 4XW, UK; Cardiff University, School of Medicine, Division of Infection and Immunity, Cardiff CF14 4XN, UK
| | - Videha Sharma
- Manchester Centre for Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK; University of Manchester Faculty of Biology, Medicine and Health, Division of Informatics, Imaging and Data Science, Manchester, Greater Manchester, M13 9PT, UK
| | - Zia Moinuddin
- Manchester Centre for Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK; University of Manchester Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, Manchester, Greater Manchester, M13 9PT, UK
| | - Mohan Shanmugam
- Department of Anaesthetics, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre Manchester, Greater Manchester, M13 9WL, UK
| | - Afshin Tavakoli
- Manchester Centre for Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK
| | - David van Dellen
- Manchester Centre for Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK; University of Manchester Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, Manchester, Greater Manchester, M13 9PT, UK
| | - Titus Augustine
- Manchester Centre for Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK; University of Manchester Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, Manchester, Greater Manchester, M13 9PT, UK
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12
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Hori S, Tanaka N, Yoneda T, Nishimura N, Tomizawa M, Nakahama T, Nakai Y, Miyake M, Torimoto K, Minamiguchi K, Fujimoto K. Remnant renal volume can predict prognosis of remnant renal function in kidney transplantation donors: a prospective observational study. BMC Nephrol 2021; 22:367. [PMID: 34742246 PMCID: PMC8572493 DOI: 10.1186/s12882-021-02568-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background Safety and survival during and after donor nephrectomy (DN) are one of the main concerns in living kidney donors (LKDs). Therefore, kidney (left/right) to be procured should be determined after considering the difficulty of DN, as well as the preservation of remnant renal function (RRF). In this prospective study, we investigated the roles of computed tomography volumetry (CTV) in split renal function (SRF) and established a predictive model for RRF in LKDs. Methods We assessed 103 LKDs who underwent DN at our institute. The Volume Analyzer SYNAPSE VINCENT image analysis system were used as CTV. RRF was defined as the estimated glomerular filtration rate (eGFR) 12 months after DN. The association between various factors measured by CTV and RRF were investigated, and a role of CTV on prediction for RRF was assessed. Results The median age and the preoperative eGFR were 58 years and 80.7 mL/min/1.73m2, respectively. Each factor measured by CTV showed an association with RRF. The ratio of remnant renal volume to body surface area (RRV/BSA) could predict RRF. In addition, RRV/BSA could predict RRF more accurately when used together with age and 24-h creatinine clearance (CrCl). Conclusions Our findings suggest that RRV/BSA measured by CTV can play an important role in predicting RRF, and a comprehensive assessment including age and CrCl is important to determine the kidney to be procured. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02568-8.
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Affiliation(s)
- Shunta Hori
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Tatsuo Yoneda
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Nobutaka Nishimura
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Mitsuru Tomizawa
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Tomonori Nakahama
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Kiyoyuki Minamiguchi
- Department of Radiology and Nuclear Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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Theil G, Weigand K, Fischer K, Bialek J, Fornara P. Organ-Specific Monitoring of Solitary Kidney after Living Donation by Using Markers of Glomerular Filtration Rate and Urinary Proteins. Urol Int 2021; 105:1061-1067. [PMID: 34175841 DOI: 10.1159/000515674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/11/2020] [Accepted: 03/01/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Effective follow-up after living kidney donation is important for maintaining the renal function of the donor. We investigated whether the estimated glomerular filtration rate (eGFR) and urinary protein and enzyme levels can provide important information regarding the state of the remaining kidney after donor nephrectomy. METHODS Seventy-five living donations were included (prospective/retrospective) in the study. The following parameters were measured up to 1 year after donor nephrectomy: serum creatinine and cystatin C as markers of the GFR; the high-molecular-weight urinary proteins as markers of glomerular injury; and the low-molecular-weight urinary proteins and urinary enzymes as markers of tubular function. RESULTS One year after kidney donation, the creatinine and cystatin C values were 1.38-fold increased than their initial values, while the eGFR was 32% lower. At that time, 38% of donors had a moderate or high risk of CKD progression. The biochemical urinary glomerular and tubular kidney markers examined showed different behaviors. After a transient increase, the glomerular proteins normalized. Conversely, the detection of low-molecular-weight urinary proteins and enzymes reflected mild tubular damage at the end of the study period. CONCLUSIONS Our findings suggest that for the evaluation of mild tubular damage, low-molecular-weight marker proteins should be included in the urine diagnostic of a personalized living kidney donor follow-up.
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Affiliation(s)
- Gerit Theil
- Medical Faculty of Martin Luther University Halle-Wittenberg, University Clinic and Outpatient Clinic for Urology, Halle/Saale, Germany
| | - Karl Weigand
- Medical Faculty of Martin Luther University Halle-Wittenberg, University Clinic and Outpatient Clinic for Urology, Halle/Saale, Germany
| | - Kersten Fischer
- Medical Faculty of Martin Luther University Halle-Wittenberg, University Clinic and Outpatient Clinic for Urology, Halle/Saale, Germany
| | - Joanna Bialek
- Medical Faculty of Martin Luther University Halle-Wittenberg, University Clinic and Outpatient Clinic for Urology, Halle/Saale, Germany
| | - Paolo Fornara
- Medical Faculty of Martin Luther University Halle-Wittenberg, University Clinic and Outpatient Clinic for Urology, Halle/Saale, Germany
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Siraj MS. The Human Organ Transplantation Act in Bangladesh: Towards Proper Family-Based Ethics and Law. Asian Bioeth Rev 2021; 13:283-296. [PMID: 33868489 PMCID: PMC8035595 DOI: 10.1007/s41649-021-00170-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 11/28/2022] Open
Abstract
The Human Organ Transplantation Act came into officially force in Bangladesh on April 13, 1999, allowing organ donations from both living and brain-dead donors. The Act was amended by the Parliament on January 8, 2018, with the changes coming into effect shortly afterwards on January 28. The Act was revised to extend a living donor pool from close relatives (e.g., parents, adult sons and daughters, adult brothers and sisters, uncles and aunts from both the paternal and maternal sides, and spouses) to include certain other relatives such as grandparents, grandchildren, and first cousins (Section 2:4). The Act was also revised to allow individuals to prioritize family members in receiving their organs after their death (Section 7c:3). The aim of this paper is not to carry out an ethical analysis of the Act as a whole but only to focus on aspects relating to priority access for family members to organs. Despite Islam encouraging Muslims to be sympathetic, and to save the life of any member of humankind (Quran 5:32), saving the life of a relative through organ donation is even more highly valued. The collective and extended structure of the family impacts on the provisions of the Act that only allows Bangladeshis to legally donate their organs to save the lives of relatives and allows individuals to prioritize family members. Recent progress in the practice of organ transplantation raises a number of ethical dilemmas around the allocation of available organs in the context of organ scarcity. A key purpose of introducing incentive into the system of organ allocation is to increase the number of donations from living relatives and initiation of vital organ donations from brain-dead donors. However, allocation criteria based on a living organ donation incentive system would appear to be unethical because there is no provision in the Act with regard to financial compensation for a distant relative donor’s post-operative care in the absence of healthcare coverage. Receiving organs from a distant relative without giving financial compensation for post-operative care places them in a grave health condition and violates the biomedical principle of non-maleficence. An incentive system around brain-dead donors would appear to be ethical as the amended Act allows individuals to prioritize relatives in receiving their organs after death. This provision is intended to initiate the transplantation of vital organs (e.g., kidney, liver, heart, pancreas, bone marrow) from brain-dead donors as families might bear the cost of keeping the organs alive for transplantation. Regular reassessment of the impact of the Act is necessary to maximize the donation rate of transplantable organs using ethical means.
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Affiliation(s)
- Md Sanwar Siraj
- Department of Government and Politics, Jahangirnagar University, Dhaka, Bangladesh
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15
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Smeulders B, Mankowski MA, van de Klundert J. Kidney Exchange Program Reporting Standards: Evidence-Based Consensus From Europe. Front Public Health 2021; 9:623966. [PMID: 33681134 PMCID: PMC7928410 DOI: 10.3389/fpubh.2021.623966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/15/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Kidney Exchange Programs can play an important role to increase access to the life saving and most cost-effective treatment for End Stage Renal Disease. The rise of national KEPs in Europe brings a need for standardized performance reporting to facilitate the development of an international evidence base on program practices. Methods: We systematically searched and reviewed the literature to extract kidney exchange program performance measures. Reported measures were initially categorized as structure, process, and outcome measures. Expert feedback was used to redefine categories and extend the set of measures to be considered. Using the Delphi method and a panel of 10 experts, the resulting measures were subsequently classified as mandatory (Base set), optional (Extended set), or deleted. Results: Out of the initial 1,668 articles identified by systematic literature search, 21 European publications on kidney exchange programs were included to collect performance measures, accompanied by three national program reports. The final measurement categories were Context, Population, Enrollment, Matching, Transplantation, and Outcomes. The set of performance measures resulting from the literature review was modified and classified as mandatory or optional. The resulting Base set and Extended set form the kidney exchange program reporting standard. Conclusions: The evidence-based and consensus-based kidney exchange program reporting standard can harmonize practical and scientific reporting on kidney exchange programs, thus facilitating the advancement of national programs. In addition, the kidney exchange program reporting standard can promote and align cross-national programs.
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Affiliation(s)
- Bart Smeulders
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Michal A Mankowski
- Computer, Electrical, and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
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16
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Abstract
Hintergrund Durch strukturierte (Langzeit‑)Nachsorge nach Nierentransplantation und Nierenlebendspende können Risikofaktoren für Transplantatüberleben und Nierenfunktion und für die physische wie psychische Morbidität unterschiedlichster Genese detektiert und gebessert werden. Neben den klassischen kardiovaskulären Risikofaktoren zählen hierzu eine mangelnde Adhärenz des Patienten, Wissensdefizite im Hinblick auf Verhaltensregeln nach Transplantation und Lebendspende, Bewegungsmangel, mangelnde Coping-Strategien oder auch arbeitsmedizinische und sozialrechtliche Belange. Ziel der Arbeit Es soll dargestellt werden, wie Rehabilitationsmaßnahmen die Nachsorge nach Nierentransplantation und Lebendspende optimieren können, worauf sich der Rehabilitationsbedarf begründet, welche Ziele verfolgt werden und welche multidisziplinären Therapiemodule sich etabliert haben. Material und Methoden Hierfür dienen neben einer Literaturrecherche die Erfahrungen einer Rehabilitationsklinik, die seit dem Jahr 2000 Rehabilitationen nach Nierentransplantation und nach Lebendspende anbietet und etwa 600 Patienten pro Jahr behandelt. Ergebnisse Spezialisierte Rehamaßnahmen mit nephrologischem und transplantationsmedizinischem Schwerpunkt können die ambulante Nachsorge nach Nierentransplantation und Nierenlebendspende sinnvoll ergänzen, wenn die Rehabilitationsklinik konzeptionelle, personelle und strukturelle Qualitätsanforderungen erfüllt. Eine enge Kooperation der Rehaklinik mit dem Transplantationszentrum und den behandelnden Nephrologen ist essenziell. Diskussion Kontrollierte Studien zur Langzeitnachsorge unter Einbeziehung der stationären Rehabilitation sind anzustreben. Auch Prärehabilitation sollte in diesen Kontext einbezogen werden.
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Affiliation(s)
- Doris Gerbig
- Fachklinik Bad Heilbrunn, Innere Medizin - Nephrologie/Transplantationsnachsorge, m&i - Fachklinik Bad Heilbrunn, Wörnerweg 30, 83670 Bad Heilbrunn, Deutschland
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17
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Waterman AD, Gleason J, Lerminiaux L, Wood EH, Berrios A, Meacham LA, Osuji A, Pines R, Peipert JD. Amplifying the Patient Voice: Key Priorities and Opportunities for Improved Transplant and Living Donor Advocacy and Outcomes During COVID-19 and Beyond. Curr Transplant Rep 2020; 7:301-310. [PMID: 32904875 PMCID: PMC7462355 DOI: 10.1007/s40472-020-00295-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose of Review To define patient advocacy and engagement for modern transplant and living donation care, particularly in light of the COVID-19 pandemic, describe the patient experience when transplant advocacy and engagement are optimized, and recommend opportunities for advocacy within three key areas: (1) including the patient voice in healthcare decisions and drug development, (2) access to the best evidence-based treatments and informed decision-making, and (3) present and future care innovations and policies. Recent Findings There are many avenues for transplant and living donation advocacy and engagement at the patient, provider, family, system, community, and policy levels. Key recommendations include the following: (1) simplifying education to be health literate, written at the appropriate reading level, culturally sensitive, and available in multiple languages and across many delivery platforms, (2) inviting transplant patients and donors to the conversation through advisory panels, consensus conferences, and new mediums like digital storytelling and patient-reported outcomes (PROs), (3) training all members of the health team to understand their role as advocates, and (4) advancing policies and programs that support the financial neutrality of living donation, and support recipients with the cost of immunosuppressive drugs. Key recommendations specific to the COVID-19 pandemic include providing up-to-date, health literate, concise information about preventing COVID-19 and accessing care including telehealth. Summary Enhancing advocacy and engagement for transplant patients and donors along the pre-to-post transplant/donation continuum can improve clinical outcomes and quality of life generally, and more so, in light of the COVID-19 pandemic.
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Affiliation(s)
- Amy D. Waterman
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
- Terasaki Institute for Biomedical Innovation, University of California Los Angeles, Los Angeles, CA USA
| | - Jim Gleason
- Transplant Recipients International, Beverly, NJ USA
| | - Louise Lerminiaux
- Transplant Diagnostics, Thermo Fisher Scientific, Los Angeles, CA USA
| | - Emily H. Wood
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
| | - Alexander Berrios
- Terasaki Institute for Biomedical Innovation, University of California Los Angeles, Los Angeles, CA USA
| | - Laurie A. Meacham
- Terasaki Institute for Biomedical Innovation, University of California Los Angeles, Los Angeles, CA USA
| | - Anne Osuji
- Terasaki Institute for Biomedical Innovation, University of California Los Angeles, Los Angeles, CA USA
| | - Rachyl Pines
- Terasaki Institute for Biomedical Innovation, University of California Los Angeles, Los Angeles, CA USA
| | - John D. Peipert
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University Transplant Outcomes Research Collaborative, Chicago, IL USA
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18
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Garg AX, Levey AS, Kasiske BL, Cheung M, Lentine KL. Application of the 2017 KDIGO Guideline for the Evaluation and Care of Living Kidney Donors to Clinical Practice. Clin J Am Soc Nephrol 2020; 15:896-905. [PMID: 32276946 PMCID: PMC7274294 DOI: 10.2215/cjn.12141019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The Kidney Disease: Improving Global Outcomes (KDIGO) 2017 "Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors" was developed to assist medical professionals who evaluate living kidney donor candidates and provide care before, during, and after donation. This guideline Work Group concluded that a comprehensive approach to donor candidate risk assessment should replace eligibility decisions on the basis of assessments of single risk factors in isolation. To address all issues important to living donors in a pragmatic and comprehensive guideline, many of the guideline recommendations were on the basis of expert consensus opinion even when no direct evidence was available. To advance available evidence, original data analyses were also undertaken to produce a "proof-of-concept" risk projection model for kidney failure. This was done to illustrate how the community can advance a new quantitative framework of risk that considers each candidate's profile of demographic and health characteristics. A public review by stakeholders and subject matter experts as well as industry and professional organizations informed the final formulation of the guideline. This review highlights the guideline framework, key concepts, and recommendations, and uses five patient scenarios and 12 guideline statements to illustrate how the guideline can be applied to support living donor evaluation and care in clinical practice.
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Affiliation(s)
- Amit X Garg
- Division of Nephrology, Western University, London, Ontario, Canada
| | - Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Bertram L Kasiske
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Michael Cheung
- Kidney Disease: Improving Global Outcomes, Brussels, Belgium
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19
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Brown T, Magill F, Beckett N, Kanabar S, Monserez J, McDaid J, Veitch P, Magowan H, Kerr K, Courtney AE. Introduction of an enhanced recovery protocol into a laparoscopic living donor nephrectomy programme. Ann R Coll Surg Engl 2020; 102:204-208. [PMID: 31850804 PMCID: PMC7027413 DOI: 10.1308/rcsann.2019.0172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Living-donor renal transplantation is the optimal treatment for patients with end-stage renal disease. The rate of living donation in the UK is sub-optimal, and potential donor concerns regarding postoperative recovery may be contributory. Enhanced recovery programmes are well described for a number of surgical procedures, but experience in living-donor surgery is sparse. This study reports the impact of introducing an enhanced recovery protocol into a living-donor renal transplant programme. MATERIALS AND METHODS All consecutive patients undergoing laparoscopic living-donor nephrectomy over a 25-month period were included. The principles of enhanced recovery were fluid restriction, morphine sparing and expectation management. Outcome measures were postoperative pain scores and complications for donor and recipients. RESULTS Standard care was provided for 24 (30%) patients and 57 (70%) followed an enhanced recovery pathway. The latter group received significantly less preoperative intravenous fluid (0ml vs 841ml p < 000.1) and opiate medication (14.83mg vs 23.85mg p = 0.001). Pain scores, postoperative complications and recipient transplant outcomes were comparable in both groups. CONCLUSIONS Enhanced recovery for living-donor nephrectomy is a safe approach for donors and recipients. Application of these techniques and further refinement should be pursued to enhance the experience of living donors.
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Affiliation(s)
- T Brown
- Belfast City Hospital, Belfast, UK
| | - F Magill
- Belfast City Hospital, Belfast, UK
| | | | | | | | - J McDaid
- Belfast City Hospital, Belfast, UK
| | - P Veitch
- Belfast City Hospital, Belfast, UK
| | | | - K Kerr
- Belfast City Hospital, Belfast, UK
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20
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Schönburg S, Fornara P. [Current political aspects of transplantation medicine in Germany: Organ donation in contradiction?]. Urologe A 2019; 59:21-26. [PMID: 31822923 DOI: 10.1007/s00120-019-01084-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/25/2022]
Abstract
Despite the claimed high organ donation willingness in Germany, the real numbers for organ donation are far below the international average. About 8000 patients in Germany are waiting for a transplant kidney, of which only a fraction, after years of waiting, can be treated with a suitable transplant. Further changes to the transplantation law to improve organ donation in Germany were recently adopted. However, it remains the demand for a reorganization of organ donation towards the opting out solution. The political decision on this is at the time of delivery of the article.
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Affiliation(s)
- S Schönburg
- Universitätsklinik für Urologie und Nierentransplantation, Martin-Luther-Universität Halle/Saale, Ernst-Grube-Straße 40, 06120, Halle/Saale, Deutschland.
| | - P Fornara
- Universitätsklinik für Urologie und Nierentransplantation, Martin-Luther-Universität Halle/Saale, Ernst-Grube-Straße 40, 06120, Halle/Saale, Deutschland
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21
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Duvoux C. Anonymous living donation in liver transplantation: Squaring the circle or condemned to vanish? J Hepatol 2019; 71:864-6. [PMID: 31561912 DOI: 10.1016/j.jhep.2019.08.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 01/31/2023]
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Gambaro G, Naticchia A, Ferraro PM, Spagnoletti G, Romagnoli J, Salerno MP, Citterio F. Living Kidney Donation in a Type 1 Dent's Disease Patient from His Mother. Kidney Blood Press Res 2019; 44:1306-1312. [PMID: 31597132 DOI: 10.1159/000503301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/17/2019] [Accepted: 09/10/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Dent's disease is a rare X-linked recessive disorder that manifests in childhood or early adulthood and can lead to end-stage renal disease (ESRD). It occurs in males, who are hemizygous. In patients who develop ESRD, a deceased donor kidney transplant cures the disease. Females are obligate carriers of the mutated gene, and some show a mild Dent's disease phenotype. There may be reason for concern when considering a female obligate carrier (i.e., the mother) for kidney donation because of the risk of kidney function deterioration. CASE PRESENTATION We describe the first successful kidney transplantation involving a patient with type 1 Dent's disease and ESRD given a kidney by an obligate carrier of the gene mutation, his mother. CONCLUSIONS After careful assessment of the female obligate carriers, intrafamilial kidney donation in Dent's disease type 1 is feasible. No deteriorating renal function in the donor was observed.
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Affiliation(s)
- Giovanni Gambaro
- Nephrology Unit, University Hospital A. Gemelli IRCCS, Rome, Italy, .,Catholic University of the Sacred Heart, Rome, Italy,
| | - Alessandro Naticchia
- Nephrology Unit, University Hospital A. Gemelli IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | - Pietro Manuel Ferraro
- Nephrology Unit, University Hospital A. Gemelli IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | - Gionata Spagnoletti
- Kidney Transplantation Unit, University Hospital A. Gemelli IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | - Jacopo Romagnoli
- Kidney Transplantation Unit, University Hospital A. Gemelli IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | - Maria Paola Salerno
- Kidney Transplantation Unit, University Hospital A. Gemelli IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | - Franco Citterio
- Kidney Transplantation Unit, University Hospital A. Gemelli IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
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Koch M, Kroencke S, Li J, Wiessner C, Nashan B. Structured introduction of retroperitoneoscopic donor nephrectomy provides a high level of safety and reduces the physical burden for the donor compared to an anterior mini incision: A cohort study. Int J Surg 2019; 69:139-145. [PMID: 31400503 DOI: 10.1016/j.ijsu.2019.07.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/11/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 12/29/2022]
Abstract
INTRODUCTION A major goal in living donor kidney transplantation is to reduce the physical burden for the donor. Key-hole surgery for donor nephrectomy is a safe procedure, but concerns regarding donor safety during the learning phase might be the reason for surgeons' reluctance to change to a minimal invasive approach. MATERIAL AND METHODS We analyzed the first 100 retroperitoneoscopic donor nephrectomies (RPDN) performed at our institution and compared the results to the last 50 mini incision donor nephrectomies (MIDN) regarding donor and recipient outcome, and analyzed the learning curves of RPDN. RESULTS The learning phase of RPDN was very short with significantly shorter operative times compared to MIDN (118 vs. 175 min, p < 0.001) and significantly fewer surgical complications (p = 0.03). RPDN patients rated the physical burden (p = 0.01) as lower, and they felt less bothered by the surgical scar (p = 0.03). CONCLUSION Introducing RPDN is safe, even during the learning phase of the surgeons. Changing surgical technique from MIDN to RPDN reduces the surgical burden of the procedure. Our study might encourage more transplant centres to adopt a minimally invasive approach.
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Affiliation(s)
- Martina Koch
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Germany; Department of General, Visceral and Transplant Surgery, Universitätsmedizin Mainz, Germany.
| | - Sylvia Kroencke
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany
| | - Jun Li
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Germany
| | - Christian Wiessner
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Björn Nashan
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Germany; Clinic for HPB Surgery and Transplantation Center, First Affiliated Hospital, University of Science and Technology of China, Anhui, China
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Abstract
In the past decade, there have been increasing efforts to better define and quantify the short- and long-term risks of living kidney donation. Recent studies have expanded upon the previous literature by focusing on outcomes that are important to potential and previous donors, applying unique databases and/or registries to follow large cohorts of donors for longer periods of time, and comparing outcomes with healthy nondonor controls to estimate attributable risks of donation. Leading outcomes important to living kidney donors include kidney health, surgical risks, and psychosocial effects of donation. Recent data support that living donors may experience a small increased risk of severe CKD and ESKD compared with healthy nondonors. For most donors, the 15-year risk of kidney failure is <1%, but for certain populations, such as young, black men, this risk may be higher. New risk prediction tools that combine the effects of demographic and health factors, and innovations in genetic risk markers are improving kidney risk stratification. Minor perioperative complications occur in 10%-20% of donor nephrectomy cases, but major complications occur in <3%, and the risk of perioperative death is <0.03%. Generally, living kidney donors have similar or improved psychosocial outcomes, such as quality of life, after donation compared with before donation and compared with nondonors. Although the donation process should be financially neutral, living kidney donors may experience out-of-pocket expenses and lost wages that may or may not be completely covered through regional or national reimbursement programs, and may face difficulties arranging subsequent life and health insurance. Living kidney donors should be fully informed of the perioperative and long-term risks before making their decision to donate. Follow-up care allows for preventative care measures to mitigate risk and ongoing surveillance and reporting of donor outcomes to inform prior and future living kidney donors.
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Affiliation(s)
- Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri; .,Department of Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Ngan N Lam
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada; and
| | - Dorry L Segev
- Department of Surgery and .,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
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Gambaro G, Zaza G, Citterio F, Naticchia A, Ferraro PM. Living kidney donation from people at risk of nephrolithiasis, with a focus on the genetic forms. Urolithiasis 2018; 47:115-123. [PMID: 30470867 DOI: 10.1007/s00240-018-1092-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/17/2018] [Accepted: 11/08/2018] [Indexed: 02/03/2023]
Abstract
Deciding whether to accept a donor with nephrolithiasis is a multifaceted task because of the challenge of finding enough suitable donors while at the same time ensuring the safety of both donors and recipients. Until not long ago, donors with a history of renal stones or with stones emerging during screening on imaging were not considered ideal, but recent guidelines have adopted less stringent criteria for potential donors at risk of stones. This review goes through the problems that need to be approached to arrive at a wise clinical decision, balancing the safety of donors and recipients with the need to expand the organ pool. The risk of declining renal function and worsening stone formation is examined. Documents (consensus statements, guidelines, etc.) on this issue released by the most important medical societies and organizations are discussed and compared. Specific problems of living kidney donation associated with certain systemic (chronic hypercalcemia due to CYP24A1 gene mutations, primary hyperoxaluria, APRT deficiency) and renal (medullary sponge kidney, cystinuria, distal renal tubular acidosis, Dent's disease, Bartter syndrome, familial hypomagnesemia with hypercalciuria and nephrocalcinosis) Mendelian disorders that cause nephrolithiasis are also addressed.
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Affiliation(s)
- Giovanni Gambaro
- UOC Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. .,Renal Unit, Department of Medicine, University Hospital of Verona, Verona, Italy. .,Università Cattolica del Sacro Cuore, Via G. Moscati 31, 00168, Rome, Italy.
| | - G Zaza
- Renal Unit, Department of Medicine, University Hospital of Verona, Verona, Italy
| | - F Citterio
- UOSA Trapianto di rene, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Via G. Moscati 31, 00168, Rome, Italy
| | - A Naticchia
- UOC Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Via G. Moscati 31, 00168, Rome, Italy
| | - P M Ferraro
- UOC Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Via G. Moscati 31, 00168, Rome, Italy
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Saunders MR, Josephson MA. Donor Outcomes: Why We Need to Listen. Clin J Am Soc Nephrol 2018; 13:831-832. [PMID: 29853615 PMCID: PMC5989681 DOI: 10.2215/cjn.05000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Milda R. Saunders
- Section of General Internal Medicine, University of Chicago Medicine, Chicago, Illinois; and
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Rodrigue JR, Fleishman A, Carroll M, Evenson AR, Pavlakis M, Mandelbrot DA, Baliga P, Howard DH, Schold JD. The Living Donor Lost Wages Trial: Study Rationale and Protocol. Curr Transplant Rep 2018; 5:45-54. [PMID: 29805957 PMCID: PMC5967265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE OF REVIEW This paper describes the background, rationale, and design of an NIH-funded, single-center study to test the impact of offering reimbursement for donor lost wages incurred during the post-nephrectomy recovery period on the live donor kidney transplant (LDKT) rate in newly evaluated kidney transplant candidates, to examine whether offering reimbursement for donor lost wages reduces racial disparity in LDKT rates, and to determine whether higher reimbursement amounts lead to higher LDKT rates. RECENT FINDINGS LDKT is the optimal treatment for renal failure. However, living kidney donation has declined in the past decade, particularly among men, younger adults, blacks, and low-income adults. There is evidence that donation-related costs may deter both transplant candidates and potential donors from considering LDKT. Lost wages is a major source of financial loss for some living donors and, unlike travel and lodging expenses, is not reimbursed by financial assistance programs. SUMMARY The study addresses the transplant community's call to reduce the financial burden of living donation and examine its impact on LDKT rates. Findings have the potential to influence policy, clinical practice, LDKT access, and income-related and racial disparities in LDKT and living donation.
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Affiliation(s)
- James R. Rodrigue
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Aaron Fleishman
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
| | - Michaela Carroll
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
| | - Amy R. Evenson
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Martha Pavlakis
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Prabhakar Baliga
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - David H. Howard
- Department of Health Policy and Management, Emory University, Atlanta, GA
| | - Jesse D. Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
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Sieverdes JC, Price M, Ruggiero KJ, Baliga PK, Chavin KD, Brunner-Jackson B, Patel S, Treiber FA. Design and approach of the Living Organ Video Educated Donors (LOVED) program to promote living kidney donation in African Americans. Contemp Clin Trials 2017; 61:55-62. [PMID: 28687348 DOI: 10.1016/j.cct.2017.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 03/06/2017] [Revised: 07/03/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To describe the rationale, methodology, design, and interventional approach of a mobile health education program designed for African Americans with end stage renal disease (ESRD) to increase knowledge and self-efficacy to approach others about their need for a living donor kidney transplant (LDKT). METHODS The Living Organ Video Educated Donors (LOVED) program is a theory-guided iterative designed, mixed methods study incorporating three phases: 1) a formative evaluation using focus groups to develop program content and approach; 2) a 2-month proof of concept trial (n=27) to primarily investigate acceptability, tolerability and investigate increases of LDKT knowledge and self-efficacy; and 3) a 6-month, 2-arm, 60-person feasibility randomized control trial (RCT) to primarily investigate increases in LDKT knowledge and self-efficacy, and secondarily, to increase the number of living donor inquiries, medical evaluations, and LDKTs. The 8-week LOVED program includes an interactive web-based app delivered on 10″ tablet computer incorporating weekly interactive video education modules, weekly group video chat sessions with an African American navigator who has had LDKT and other group interactions for support and improve strategies to promote their need for a kidney. RESULTS Phase 1 and 2 have been completed and the program is currently enrolling for the feasibility RCT. Phase 2 experienced 100% retention rates with 91% adherence completing the video modules and 88% minimum adherence to the video chat sessions. CONCLUSIONS We are in the early stages of an RCT to evaluate the LOVED program; to date, we have found high tolerability reported from Phase 2.
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Affiliation(s)
- John C Sieverdes
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., Charleston, SC 29425-1600, USA.
| | - Matthew Price
- University of Vermont, College of Arts and Sciences, Department of Psychological Science, John Dewey Hall, Rm 248 2 Colchester Avenue, Burlington, VT 05405-0134, USA.
| | - Kenneth J Ruggiero
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., Charleston, SC 29425-1600, USA.
| | - Prabhakar K Baliga
- Medical University of South Carolina, College of Medicine, 96 Jonathan Lucas St., Charleston, SC 29425-1600, USA.
| | - Kenneth D Chavin
- Medical University of South Carolina, College of Medicine, 96 Jonathan Lucas St., Charleston, SC 29425-1600, USA; Case Western Reserve University School of Medicine, Department of Surgery-Transplant, 11100 Euclid Ave, Cleveland, OH 44106, USA.
| | - Brenda Brunner-Jackson
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., Charleston, SC 29425-1600, USA.
| | - Sachin Patel
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., Charleston, SC 29425-1600, USA.
| | - Frank A Treiber
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., Charleston, SC 29425-1600, USA; Medical University of South Carolina, College of Medicine, 96 Jonathan Lucas St., Charleston, SC 29425-1600, USA.
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29
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Gordon EJ, Shand J, Black A. Google analytics of a pilot mass and social media campaign targeting Hispanics about living kidney donation. Internet Interv 2016; 6:40-49. [PMID: 30135813 PMCID: PMC6096307 DOI: 10.1016/j.invent.2016.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 09/08/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The number of patients waiting for a kidney transplant surpasses available organs. Living donor kidney transplantation (LDKT) can expand the organ pool. However, Hispanics have lower rates of LDKT than non-Hispanic whites, largely due to a lack of awareness and knowledge about LDKT as a treatment option. To reduce this disparity about LDKT, Northwestern University faculty in partnership with the National Kidney Foundation of Illinois, developed a website culturally targeted to Hispanics about LDKT, called Infórmate. OBJECTIVE This paper describes a pilot mass media campaign about LDKT which leveraged Infórmate to provide additional education about LDKT targeting the Hispanic public in Chicago, IL. We report the impact of the campaign on visits to Infórmate. METHODS The mass media campaign was conducted in Chicago, IL from July 16, 2015 to January 17, 2016 in two waves. The campaign used traditional media, online media, and community-based venues. The campaign's bilingual (Spanish and English) messaging addressed key topics about kidney disease and LDKT, and included a call to action to visit Infórmate to learn more. Google Analytics was used to evaluate the effectiveness of the campaign's call to action by measuring the number of visits to Infórmate, visit duration, bounce rate, number of pages visited, pages most often visited, user demographics, and media channel. RESULTS Infórmate received an average of 1466 sessions per month during the entire campaign period, with a 16.7% return rate. Sessions and visitors increased during the entire campaign period compared to the pre- and post- campaign periods. Visits lasted an average of 1:26 min, with a bounce rate of 73.9% per session. Users visited an average of 1.93 pages, and the pages with the most views were Immigrant Issues and Financial Issues. Most sessions during this period occurred in the USA (69.57%) out of 100 countries, and in the city of Chicago (13.37%). Sessions were mostly conducted by men (54.1%) and people ages 18-34 (61%). Visitors accessed Infórmate primarily through their desktop computer (53.1%), and by typing the website address directly into their browser (32.78%). CONCLUSIONS Our findings suggest that our pilot mass media campaign's call to action was effective in increasing the Hispanic public's traffic to Infórmate. Google Analytics data can help to strategize future campaign messages and outlets. Future research should assess whether a theoretically-driven mass media campaign increases the Hispanic public's knowledge about LDKT, and increases rates of LDKT.
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Affiliation(s)
- Elisa J. Gordon
- Center for Healthcare Studies, Comprehensive Transplant Center, Center for Bioethics and Medical Humanities, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Corresponding author at: Center for Healthcare Studies, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, 633 N. St. Clair, 20th Floor, Chicago, IL 60611-3152, United States.
| | - Jennifer Shand
- National Kidney Foundation of Illinois, Chicago, IL 60654, USA
| | - Anne Black
- National Kidney Foundation of Illinois, Chicago, IL 60654, USA
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Rodrigue JR, Paek MJ, Schold JD, Pavlakis M, Mandelbrot DA. Predictors and Moderators of Educational Interventions to Increase the Likelihood of Potential Living Donors for Black Patients Awaiting Kidney Transplantation. J Racial Ethn Health Disparities 2016; 4:10.1007/s40615-016-0286-0. [PMID: 27631380 PMCID: PMC5342956 DOI: 10.1007/s40615-016-0286-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 08/19/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
Abstract
Our aim was to identify predictors and moderators of the effects of a house calls (HC) educational intervention, relative to a group-based (GB) intervention and to individual counseling (IC), in a randomized controlled trial to increase the likelihood of having living donor (LD) evaluations initiated and live donor kidney transplantation (LDKT). Black adults wait listed for kidney transplantation (N = 152) were randomized into one of the three educational conditions. We examined demographic, clinical, psychosocial, and socio-contextual baseline characteristics as predictors and moderators of having a potential LD initiate evaluation. HC assignment (OR = 2.024.7311.05, P = 0.001), younger age (OR = 0.910.940.98, P = 0.001), more willingness to discuss donation with others (OR = 1.081.371.75, P = 0.01), and larger social network (OR = 1.011.091.18, P = 0.04) were significant multivariable predictors of having ≥1 LD initiate evaluation. Age (P = 0.03) and social network size (P = 0.02) moderated the effect of HC relative to IC and GB, but not GB relative to IC, on LD evaluation initiation. Our findings suggest that HC is most effective for patients <60 years old and those with average or large social network size.
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Affiliation(s)
- James R Rodrigue
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, 110 Francis Street, 7th Floor, Boston, MA, 02215, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Matthew J Paek
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, 110 Francis Street, 7th Floor, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Jesse D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Martha Pavlakis
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, 110 Francis Street, 7th Floor, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Didier A Mandelbrot
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, 110 Francis Street, 7th Floor, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, University of Wisconsin, Madison, WI, USA
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Rodrigue JR, Vishnevsky T, Fleishman A, Brann T, Evenson AR, Pavlakis M, Mandelbrot DA. Patient-Reported Outcomes Following Living Kidney Donation: A Single Center Experience. J Clin Psychol Med Settings 2015; 22:160-8. [PMID: 26123551 DOI: 10.1007/s10880-015-9424-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article describes the development and implementation of an initiative at one transplant center to annually assess psychosocial outcomes of living kidney donors. The current analysis focuses on a cohort of adults (n = 208) who donated a kidney at BIDMC between September 2005 and August 2012, in which two post-donation annual assessments could be examined. One and two year post-donation surveys were returned by 59 % (n = 123) and 47 % (n = 98) of LKDs, respectively. Those who did not complete any survey were more likely to be younger (p = 0.001), minority race/ethnicity (p < 0.001), and uninsured at the time of donation (p = 0.01) compared to those who returned at least one of the two annual surveys. The majority of donors reported no adverse physical or psychosocial consequences of donation, high satisfaction with the donation experience, and no donation decision regret. However, a sizable minority of donors felt more pain intensity than expected and recovery time was much slower than expected, and experienced a clinically significant decline in vitality. We describe how these outcomes are used to inform clinical practice at our transplant center as well as highlight challenges in donor surveillance over time.
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Giacomoni A, Di Sandro S, Lauterio A, Concone G, Buscemi V, Rossetti O, De Carlis L. Robotic nephrectomy for living donation: surgical technique and literature systematic review. Am J Surg. 2016;211:1135-1142. [PMID: 26499052 DOI: 10.1016/j.amjsurg.2015.08.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 07/29/2015] [Accepted: 08/14/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND As compared with traditional laparoscopy, robotic-assisted surgery provides better EndoWrist instruments and three-dimensional visualization of the operative field. Studies published so far indicate that living donor nephrectomy using the robot-assisted technique is safe, feasible, and provides remarkable advantages for the patients. METHODS From 5 papers reporting detailed descriptions of surgical technique for robotic assisted nephrectomy (RAN) in living donor kidney transplantation, we have gathered information about the surgical techniques as well as about patients' intra- and postoperative outcome. Data from these articles were analyzed together with the data from our own experience (33 cases) so that the total number of analyzed cases was 292. RESULTS In the analyzed populations, no case of donor death occurred, and no case developed complication above grade 2 of Clavien score. Perioperative complications occurred in 37 of the 292 patients (12.6%). Accidental acute hemorrhage occurred in 5 of the 292 cases (1.7%). The average overall intraoperative blood loss was 67.8 mL (range 10 to 1,500). The average warm ischemia time was 3.5 minutes (range .58 to 7.6). Conversion to the open technique occurred in only 4 cases (1.3%). The average overall operative time was 192 minutes (range 60 to 400). The average length of the hospital stay was 2.7 days (range 1 to 10). CONCLUSIONS Safety and feasibility of RAN are pointed out in all the reviewed article, both as hand-assisted and as totally robotic technique. RAN appears to be significantly easier for the surgeons and the results are comparable with the ones obtained with the pure laparoscopic technique.
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Cauchy F, Schwarz L, Scatton O, Soubrane O. Laparoscopic liver resection for living donation: Where do we stand? World J Gastroenterol 2014; 20:15590-15598. [PMID: 25400442 PMCID: PMC4229523 DOI: 10.3748/wjg.v20.i42.15590] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/21/2014] [Accepted: 09/05/2014] [Indexed: 02/07/2023] Open
Abstract
In Western countries, living donor liver transplantation (LDLT) may represent a valuable alternative to deceased donor liver transplantation. Yet, after an initial peak of enthusiasm, reports of high rates of complications and of fatalities have led to a certain degree of reluctance towards this procedure especially in Western countries. As for living donor kidney transplantation, the laparoscopic approach could improve patient’s tolerance in order to rehabilitate this strategy and reverse the current trend. In this setting however, initial concerns regarding patient’s safety and graft integrity, need for acquiring surgical expertise in both laparoscopic liver surgery and living donor transplantation and lack of evidence supporting the benefits of laparoscopy have delayed the development of this approach. Similarly to what is performed in classical resectional liver surgery, initial experiences of laparoscopy have therefore begun with left lateral sectionectomy, which is performed for adult to child living donation. In this setting, the laparoscopic technique is now well standardized, is associated with decreased donor blood loss and hospital stays and provides graft of similar quality compared to the open approach. On the other hand laparoscopic major right or left hepatectomies for adult-adult LDLT currently lack standardization and various techniques such as the full laparoscopic approach, the hand assisted approach and the hybrid approach have been reported. Hence, even-though several reports highlight the feasibility of these procedures, the true benefits of laparoscopy over laparotomy remain to be fully assessed. This could be achieved through standardization of the procedures and creation of international registries especially in Eastern countries where LDLT keeps on flourishing.
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Kwekkeboom J, van der Laan LJW, Betjes MGH, Manintveld OC, Hoek RAS, Cransberg K, de Bruin RWF, Dor FJMF, de Jonge J, Boor PPC, van Gent R, van Besouw NM, Boer K, Litjens NHR, Hesselink DA, Hoogduijn MJ, Massey E, Rowshani AT, van de Wetering J, de Jong H, Hendriks RW, Metselaar HJ, van Gelder T, Weimar W, IJzermans JNM, Baan CC. Rotterdam: main port for organ transplantation research in the Netherlands. Transpl Immunol 2014; 31:200-6. [PMID: 25240732 DOI: 10.1016/j.trim.2014.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/01/2014] [Accepted: 09/08/2014] [Indexed: 12/25/2022]
Abstract
This overview describes the full spectrum of current pre-clinical and clinical kidney-, liver-, heart- and lung transplantation research performed in Erasmus MC - University Medical Centre in Rotterdam, The Netherlands. An update is provided on the development of a large living donor kidney transplantation program and on optimization of kidney allocation, including the implementation of a domino kidney-donation program. Our current research efforts to optimize immunosuppressive regimens and find novel targets for immunosuppressive therapy, our recent studies on prevention of ischemia-reperfusion-induced graft injury, our newest findings on stimulation of tissue regeneration, our novel approaches to prevent rejection and viral infection, and our latest insights in the regulation of allograft rejection, are summarized.
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Affiliation(s)
- Jaap Kwekkeboom
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands.
| | - Luc J W van der Laan
- Department of Surgery, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Michiel G H Betjes
- Department of Internal Medicine, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Rogier A S Hoek
- Department of Pulmonary Diseases, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Karlien Cransberg
- Department of Pediatric Nephrology, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Ron W F de Bruin
- Department of Surgery, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Frank J M F Dor
- Department of Surgery, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Jeroen de Jonge
- Department of Surgery, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Patrick P C Boor
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Rogier van Gent
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Nicole M van Besouw
- Department of Internal Medicine, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Karin Boer
- Department of Internal Medicine, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Nicolle H R Litjens
- Department of Internal Medicine, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Dennis A Hesselink
- Department of Internal Medicine, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Martin J Hoogduijn
- Department of Internal Medicine, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Emma Massey
- Department of Internal Medicine, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Ajda T Rowshani
- Department of Internal Medicine, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | | | - Huib de Jong
- Department of Pediatric Nephrology, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Rudi W Hendriks
- Department of Pulmonary Diseases, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Herold J Metselaar
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Teun van Gelder
- Department of Internal Medicine, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands; Department of Clinical Pharmacology, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Willem Weimar
- Department of Internal Medicine, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Jan N M IJzermans
- Department of Surgery, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Carla C Baan
- Department of Internal Medicine, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
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Traino HM. Communication self-efficacy, perceived conversational difficulty, and renal patients' discussions about transplantation. Patient Educ Couns 2014; 94:180-186. [PMID: 24280037 DOI: 10.1016/j.pec.2013.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 10/12/2013] [Accepted: 10/26/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Many patients with chronic and end-stage renal disease (ESRD) have reported difficulties initiating and managing discussions about kidney transplantation, particularly live donor transplantation (LDT). Limited communication has demonstrable impact on patients' access to transplantation, the duration of dialysis treatments, and the length of time awaiting a transplantable kidney. This formative study sought to identify the specific communicative and conversational elements impeding ESRD patients' discussions about transplantation to inform the design of an educational program facilitating transplant-related discussions. METHODS From March to July 2012, semi-structured telephone interviews (n=63) were conducted with ESRD patients waitlisted for kidney transplantation at one mid-Atlantic transplant center. RESULTS Although 85.7% (n=54) of patients reported holding discussions about transplantation, qualitative analyses of open-ended responses revealed that the majority (66.7%) had limited conversations. Patients reported difficulties managing a variety of logistical and content-related aspects of LDT discussions. Moderate levels of communication self-efficacy were also found (mean=19.2 out of 28); self-efficacy was highest among respondents having held discussions and was significantly related to perceived magnitude of difficulty handling conversational aspects. CONCLUSION Results support comprehensive communication skills training for ESRD patients awaiting kidney transplantation. PRACTICE IMPLICATIONS Potential topics to be included in such training are discussed.
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Affiliation(s)
- Heather M Traino
- Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, USA.
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