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Gitto L, Favi E, Giorgakis E, Cacciola R. Editorial: Assessing the value and cost of Organ Donation and Transplantation (ODT). Front Public Health 2024; 12:1388317. [PMID: 38566788 PMCID: PMC10985343 DOI: 10.3389/fpubh.2024.1388317] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Affiliation(s)
- Lara Gitto
- Dipartimento di Economia, Università Degli Studi di Messina, Messina, Italy
| | - Evaldo Favi
- General Surgery and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Clinical Sciences and Community Health, Università Degli Studi di Milano, Milan, Italy
| | - Emmanouil Giorgakis
- Division of Solid Organ Transplantation, Department of Surgery, UAMS Medical Center, Little Rock, AR, United States
| | - Roberto Cacciola
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy
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2
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Samstein B, Cherqui D. Pure laparoscopic donor hepatectomy: A nearly finished product. Am J Transplant 2024; 24:160-161. [PMID: 37619921 DOI: 10.1016/j.ajt.2023.08.013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Benjamin Samstein
- Department of Surgery, Weill Cornell Medicine, New York, New York, USA.
| | - Daniel Cherqui
- Hepatobiliary Center-Paul Brousse Hospital, APHP-Université Paris Saclay, Villejuif, France
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Verbesey J, Thomas AG, Waterman AD, Karhadkar S, Cassell VR, Segev DL, Hogan J, Cooper M. Unrecognized opportunities: The landscape of pediatric kidney-paired donation in the United States. Pediatr Transplant 2024; 28:e14657. [PMID: 38317337 PMCID: PMC10857737 DOI: 10.1111/petr.14657] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/31/2023] [Accepted: 11/13/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Pediatric (age < 18 years) kidney transplant (KT) candidates face increasingly complex choices. The 2014 kidney allocation system nearly doubled wait times for pediatric recipients. Given longer wait times and new ways to optimize compatibility, more pediatric candidates may consider kidney-paired donation (KPD). Motivated by this shift and the potential impact of innovations in KPD practice, we studied pediatric KPD procedures in the US from 2008 to 2021. METHODS We describe the characteristics and outcomes of pediatric KPD recipients with comparison to pediatric non-KPD living donor kidney transplants (LDKT), pediatric LDKT recipients, and pediatric deceased donor (DDKT) recipients. RESULTS Our study cohort includes 4987 pediatric DDKTs, 3447 pediatric non-KPD LDKTs, and 258 pediatric KPD transplants. Fewer centers conducted at least one pediatric KPD procedure compared to those that conducted at least one pediatric LDKT or DDKT procedure (67, 136, and 155 centers, respectively). Five centers performed 31% of the pediatric KPD transplants. After adjustment, there were no differences in graft failure or mortality comparing KPD recipients to non-KPD LDKT, LDKT, or DDKT recipients. DISCUSSION We did not observe differences in transplant outcomes comparing pediatric KPD recipients to controls. Considering these results, KPD may be underutilized for pediatric recipients. Pediatric KT centers should consider including KPD in KT candidate education. Further research will be necessary to develop tools that could aid clinicians and families considering the time horizon for future KT procedures, candidate disease and histocompatibility characteristics, and other factors including logistics and donor protections.
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Affiliation(s)
| | - Alvin G Thomas
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Surgery, New York University Langone Health, New York, New York, USA
| | - Amy D Waterman
- Department of Surgery, Houston Methodist, Houston, Texas, USA
| | - Sunil Karhadkar
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | | | - Dorry L Segev
- Department of Surgery, New York University Langone Health, New York, New York, USA
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota, USA
| | - Julien Hogan
- Université Paris Cité, INSERM, UMR-S970, PARCC, Paris Translational Research Center for Organ Transplantation, Paris, France
- Pediatric Nephrology Department, Robert Debré Hospital, APHP, Paris, France
| | - Matt Cooper
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Emmons BR, Adler JT, Sandoval PR, King KL, Yu M, Cron DC, Mohan S, Ratner LE, Husain SA. Association between donor kidney cysts and donor and recipient outcomes after living donor kidney transplantation. Clin Transplant 2024; 38:e15242. [PMID: 38289895 DOI: 10.1111/ctr.15242] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/08/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Incidental kidneys cysts are typically considered benign, but the presence of cysts is more frequent in individuals with other early markers of kidney disease. We studied the association of donor kidney cysts with donor and recipient outcomes after living donor kidney transplantation. METHODS We retrospective identified 860 living donor transplants at our center (1/1/2011-7/31/2022) without missing data. Donor cysts were identified by review of pre-donation CT scan reports. We used linear regression to study the association between donor cysts and 6-month single-kidney estimated glomerular filtration rate (eGFR) increase, and time-to-event analyses to study the association between donor cysts and recipient death-censored graft failure. RESULTS Among donors, 77% donors had no kidney cysts, 13% had ≥1 cyst on the kidney not donated, and 11% only had cysts on the donated kidney. In adjusted linear regression, cysts on the donated kidney and kidney not donated were not significantly associated with 6-month single-kidney eGFR increase. Among transplants, 17% used a transplanted kidney with a cyst and 6% were from donors with cysts only on the kidney not transplanted. There was no association between donor cyst group and post-transplant death-censored graft survival. Results were similar in sensitivity analyses comparing transplants using kidneys with no cysts versus 1-2 cysts versus ≥3 cysts. CONCLUSIONS Kidney cysts in living kidney donors were not associated with donor kidney recovery or recipient allograft longevity, suggesting incidental kidney cysts need not be taken into account when determining living donor candidate suitability or the laterality of planned donor nephrectomy.
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Affiliation(s)
- Brendan R Emmons
- Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians & Surgeons, New York, New York, USA
- Columbia University Renal Epidemiology Group, New York, New York, USA
| | - Joel T Adler
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Pedro Rodrigo Sandoval
- Department of Surgery, Columbia University Vagelos College of Physicians & Surgeons, New York, New York, USA
| | - Kristen L King
- Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians & Surgeons, New York, New York, USA
- Columbia University Renal Epidemiology Group, New York, New York, USA
| | - Miko Yu
- Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians & Surgeons, New York, New York, USA
- Columbia University Renal Epidemiology Group, New York, New York, USA
| | - David C Cron
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians & Surgeons, New York, New York, USA
- Columbia University Renal Epidemiology Group, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Lloyd E Ratner
- Department of Surgery, Columbia University Vagelos College of Physicians & Surgeons, New York, New York, USA
| | - Syed Ali Husain
- Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians & Surgeons, New York, New York, USA
- Columbia University Renal Epidemiology Group, New York, New York, USA
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5
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Cacciola R, Leonardis F, Gitto L, Favi E, Gruttadauria S, Clancy M, Veroux M, Angelico R, Pagano D, Mazzeo C, Cacciola I, Santoro D, Toti L, Tisone G, Cucinotta E. Health economics aspects of kidney transplantation in Sicily: a benchmark analysis on activity and estimated savings. Front Public Health 2023; 11:1222069. [PMID: 38162608 PMCID: PMC10757609 DOI: 10.3389/fpubh.2023.1222069] [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: 05/13/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024] Open
Abstract
Background International and national registries consistently report substantial differences in kidney transplant (KT) activity despite demonstrable clinical and financial benefits. The study aims to estimate the financial resources gained by KT and produce a benchmark analysis that would inform adequate strategies for the growth of the service. Methods We analyzed the KT activity in our region between 2017 and 2019. The benchmark analysis was conducted with programs identified from national and international registries. The estimate of financial resources was obtained by applying the kidney transplant coefficient of value; subsequently, we compared the different activity levels and savings generated by the three KT programs. Findings The KT activity in the region progressively declined in the study years, producing a parallel reduction of the estimated savings. Such savings were substantially inferior when compared to those generated by benchmark programs (range €18-22 million less). Interpretation The factors influencing the reduced KT activity in the study period with the related "foregone savings" are multiple, as well as interdependent. Organ donation, access to the transplant waiting list, and KT from living donors appear to be the most prominent determinants of the observed different levels of activities. International experience suggests that a comprehensive strategy in the form of a "task force" may successfully address the critical areas of the service reversing the observed trend. The financial impact of a progressively reduced KT activity may be as critical as its clinical implications, jeopardizing the actual sustainability of services for patients with end-stage kidney disease.
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Affiliation(s)
- Roberto Cacciola
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy
| | - Francesca Leonardis
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy
- Intensive Care Unit, Organ and Tissue Procurement Policlinico Tor Vergata, Rome, Italy
| | - Lara Gitto
- Dipartimento di Economia, Università Degli Studi di Messina, Messina, Italy
| | - Evaldo Favi
- General Surgery and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Clinical Sciences and Community Health, Università Degli Studi di Milano, Milan, Italy
| | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, University of Istituto di Ricovero e Cura a Carattere Scientifico – Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center Italy, Palermo, Italy
- Department of Surgery and Surgical and Medical Specialties, University of Catania, Catania, Italy
| | - Marc Clancy
- Institute of Cardiovascular and Molecular Sciences, Glasgow University, Glasgow, United Kingdom
| | - Massimiliano Veroux
- General Surgery Unit, Organ Transplant Unit, University Hospital of Catania, Catania, Italy
| | - Roberta Angelico
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy
| | - Duilio Pagano
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, University of Istituto di Ricovero e Cura a Carattere Scientifico – Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center Italy, Palermo, Italy
| | - Carmelo Mazzeo
- Department of Human Pathology, Emergency Surgery Unit, Università Degli Studi di Messina, Messina, Italy
| | - Irene Cacciola
- Department of Clinical and Experimental Medicine, Medicine and Hepatology Unit, Università Degli Studi di Messina, Messina, Italy
| | - Domenico Santoro
- Department of Clinical and Experimental Medicine, Nephrology and Dialysis Unit, Università Degli Studi di Messina, Messina, Italy
| | - Luca Toti
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy
| | - Giuseppe Tisone
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy
| | - Eugenio Cucinotta
- General Surgery Unit, Organ Transplant Unit, University Hospital of Catania, Catania, Italy
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6
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de Assis A, de Carvalho Melo JA, Kawakami WY, Moreira AM, Carnevale FC, Massami H, Hirschfeld APM, Pugliese RPS, Foronda FK, Paulino RG, de Araújo AA, Fonseca EA, Seda Neto J. Life-threatening variceal bleeding after liver transplantation and extensive portal vein thrombosis: Desperate times call for desperate measures. Pediatr Transplant 2023; 27:e14555. [PMID: 37291909 DOI: 10.1111/petr.14555] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/08/2023] [Accepted: 05/22/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND The management of complex, intra- and extrahepatic portal vein thrombosis (PVT) after liver transplantation (LT) is challenging. Although most of the patients remain asymptomatic or oligosymptomatic in the chronic setting, some of them may develop severe portal hypertension and related complications, notably gastrointestinal (GI) bleeding. In the emergency scenario, clinical and endoscopic treatments as well as intensive support constitute the bases of conservative management, while more definitive treatment options such as surgical shunting and retransplantation are related to high morbidity rates. Transjugular intrahepatic portosystemic shunt (TIPS) was largely considered of limited role due to technical difficulties arising from extensive PVT. Recently, however, new minimally invasive image-guided techniques emerged, allowing portal vein recanalization and TIPS creation simultaneously (TIPS-PVR), even in complex PVT pretransplant patients. METHODS Herein, we describe a novel indication for TIPS-PVR in a post-LT adolescent presenting with life-threatening, refractory GI bleeding. RESULTS The patient presented with complete resolution of the hemorrhagic condition after the procedure, with no deterioration of hepatic function or hepatic encephalopathy. Follow-up Doppler ultrasound after TIPS-PVR showed normal hepatopetal venous flow within the stents, and no evidence of complications, including intraperitoneal or peri splenic bleeding. CONCLUSIONS This report describes the feasibility of TIPS-PVR in the post-LT scenario complicated by extensive PVT. In this case, a complete resolution of the life-threatening GI bleeding was achieved, with no major complications. Other patients with complex chronic PVT might benefit from the use of the described technique, but further studies are required to determine the correct timing and indications of the procedure, eventually before the occurrence of life-threatening complications.
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Affiliation(s)
| | | | | | | | | | - Hayashi Massami
- Pediatric Intensive Care Unit, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | | | | | | | | | | | | | - João Seda Neto
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
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Ceulemans LJ, Dubois A, Clarysse M, Canovai E, Venick R, Mazariegos G, Vanuytsel T, Hibi T, Avitzur Y, Hind J, Horslen S, Gondolesi G, Benedetti E, Gruessner R, Pirenne J. Outcome After Intestinal Transplantation From Living Versus Deceased Donors: A Propensity-matched Cohort Analysis of the International Intestinal Transplant Registry. Ann Surg 2023; 278:807-814. [PMID: 37497671 PMCID: PMC10549910 DOI: 10.1097/sla.0000000000006045] [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: 07/28/2023]
Abstract
OBJECTIVE To describe the worldwide experience with living donation (LD) in intestinal transplantation (ITx) and compare short-term and long-term outcomes to a propensity-matched cohort of deceased donors. BACKGROUND ITx is a rare life-saving procedure for patients with complicated intestinal failure (IF). Living donation (LD)-ITx has been performed with success, but no direct comparison with deceased donation (DD) has been performed. The Intestinal Transplant Registry (ITR) was created in 1985 by the Intestinal Transplant Association to capture the worldwide activity and promote center's collaborations. METHODS Based on the ITR, 4156 ITx were performed between January 1987 and April 2019, of which 76 (1.8%) were LD, including 5 combined liver-ITx, 7 ITx-colon, and 64 isolated ITx. They were matched with 186 DD-ITx for recipient age/sex, weight, region, IF-cause, retransplant, pretransplant status, ABO compatibility, immunosuppression, and transplant date. Primary endpoints were acute rejection and 1-/5-year patient/graft survival. RESULTS Most LDs were performed in North America (61%), followed by Asia (29%). The mean recipient age was: 22 years; body mass index: 19kg/m²; and female/male ratio: 1/1.4. Volvulus (N=17) and ischemia (N=17) were the most frequent IF-causes. Fifty-two percent of patients were at home at the time of transplant. One-/5-year patient survival for LD and DD was 74.2/49.8% versus 80.3/48.1%, respectively ( P =0.826). One-/5-year graft survival was 60.3/40.6% versus 69.2/36.1%, respectively ( P =0.956). Acute rejection was diagnosed in 47% of LD versus 51% of DD ( P =0.723). CONCLUSION Worldwide, LD-ITx has been rarely performed. This retrospective matched ITR analysis revealed no difference in rejection and in patient/graft survival between LD and DD-ITx.
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Affiliation(s)
- Laurens J. Ceulemans
- Leuven Intestinal Failure and Transplantation (LIFT), University Hospitals Leuven, Leuven, Belgium
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Antoine Dubois
- Leuven Intestinal Failure and Transplantation (LIFT), University Hospitals Leuven, Leuven, Belgium
- Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Experimental Surgery and Transplantation (CHEX), University Hospital Saint-Luc, Brussels, Belgium
| | - Mathias Clarysse
- Leuven Intestinal Failure and Transplantation (LIFT), University Hospitals Leuven, Leuven, Belgium
- Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Emilio Canovai
- Leuven Intestinal Failure and Transplantation (LIFT), University Hospitals Leuven, Leuven, Belgium
- Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Robert Venick
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Mattel Children’s Hospital at UCLA Medical Center, Los Angeles, CA
| | - George Mazariegos
- Hillman Center for Pediatric Transplantation, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States of America
| | - Tim Vanuytsel
- Leuven Intestinal Failure and Transplantation (LIFT), University Hospitals Leuven, Leuven, Belgium
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Yaron Avitzur
- Department Gastroenterology, Hepatology, and Nutrition, SickKids Hospital, Toronto, Canada
| | - Jonathan Hind
- Department of Paediatric Liver, Gastrointestinal and Nutrition Centre, King’s College Hospital, London
| | - Simon Horslen
- Department of Gastroenterology, Hepatology, and Nutrition, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - Gabriel Gondolesi
- Department of General Surgery, Nutritional Support Unit, Liver, Pancreas, and Intestinal Transplant Unit, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Enrico Benedetti
- Department of Surgery, University of Illinois Hospital, Chicago, IL
| | - Rainer Gruessner
- Department of Surgery, SUNY Downstate Health Sciences University, New York City, NY
| | - Jacques Pirenne
- Leuven Intestinal Failure and Transplantation (LIFT), University Hospitals Leuven, Leuven, Belgium
- Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
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8
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Selzler AM, Davoodi PM, Klarenbach S, Lam NN, Smith T, Ackroyd A, Wiebe N, Corradetti B, Ferdinand S, Iyekekpolor D, Smith G, Verdin N, Bello AK, Wen K, Shojai S. Multidisciplinary Support To Access living donor Kidney Transplant (MuST AKT): A Clinical Research Protocol for a Pilot Randomized Controlled Trial to Increase Living Kidney Donation. Can J Kidney Health Dis 2023; 10:20543581231205340. [PMID: 37920779 PMCID: PMC10619336 DOI: 10.1177/20543581231205340] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/07/2023] [Indexed: 11/04/2023] Open
Abstract
Background Living donor kidney transplantation (LDKT) is the optimal treatment for eligible patients with kidney failure, although it is underutilized. Contextually tailored patient- and family-centered interventions may be effective to increase LDKT. Objective We outline a protocol to test the feasibility of the Multidisciplinary Support To Access living donor Kidney Transplant (MuST AKT) intervention designed to increase LDKT. Design Non-blinded single-center pilot randomized controlled trial with a qualitative interview component. Setting Academic transplant referral center in Northern Alberta Region with a population of more than 2 million in its catchment area. Patients English-speaking patients of the age range 18 to 75 years who are referred for kidney transplantation are eligible to participate. Measurements Feasibility will be assessed by indicators of recruitment, retention, and completion rates, treatment fidelity, adherence to intervention, engagement in intervention, and acceptability. Methods Participants will be randomly assigned 1:1 to either standard care (control) or the experimental group who receive standard care plus the MuST AKT intervention, a person-centered program designed to assist and enable the kidney transplant candidate to achieve what is required to receive an LDKT. The intervention consists of an introductory session and 4 intervention sessions delivered in-person or virtually. Limitations Inferences cannot be drawn regarding the efficacy/effectiveness of the MuST AKT intervention. This study is non-blinded. Conclusions This pilot study is the first step in our broader initiative to increase LDKT in our health care jurisdiction. The results of this study will be used to inform the development of a future definitive randomized controlled trial. Trial registration number NCT04666545.
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Affiliation(s)
- Anne-Marie Selzler
- Kidney Health Section, Medicine Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | | | - Scott Klarenbach
- Kidney Health Section, Medicine Strategic Clinical Network, Alberta Health Services, Alberta, Canada
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ngan N. Lam
- Division of Nephrology, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Terry Smith
- Kidney Health Section, Medicine Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - Abigail Ackroyd
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Natasha Wiebe
- Kidney Health Research Group, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Bonnie Corradetti
- Kidney Health Section, Medicine Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - Sharron Ferdinand
- Social Work—Transplant Services, University of Alberta Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Dorothy Iyekekpolor
- Social Work—Transplant Services, University of Alberta Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Gordon Smith
- Social Work—Alberta Kidney Care North, Grey Nuns Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Nancy Verdin
- Kidney Health Section, Medicine Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - Aminu K. Bello
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kevin Wen
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Soroush Shojai
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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9
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Paessler A, Stojanovic J. Considering ABO Incompatible Living Donor Kidney Transplantation Before Deceased Donor Kidney Transplantation in Children: A Letter to the Editor. Transpl Int 2023; 36:11613. [PMID: 37789915 PMCID: PMC10542673 DOI: 10.3389/ti.2023.11613] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/01/2023] [Indexed: 10/05/2023]
Affiliation(s)
- Alicia Paessler
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Jelena Stojanovic
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- Institute for Child Health, University College London, London, United Kingdom
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10
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Seda Neto J, Magalhães Costa C, Pereira FP, Pugliese R, Travassos NP, Oliveira CM, Vincenzi R, Benavides MR, Roda K, Kondo M, Fonseca EA. Anterior hepatic resection: A simple and safe technique for reducing the antero-posterior diameter of the liver graft for small pediatric recipients. Pediatr Transplant 2023; 27:e14518. [PMID: 36973639 DOI: 10.1111/petr.14518] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND The techniques involved in neonatal and infantile transplantation require approaches that can sculpt a left lateral segment (LLS) to the right shape and size and avoid large-for-size syndrome. The aim of this article is to describe the anterior hepatic resection (AHR) of the LLS in pediatric LDLT. METHODS A retrospective anatomical study of preoperative image studies, description of the technique for AHR, and short-term results. RESULTS The AHR was performed in eight cases. All donors were male, with average age, BW, and BMI of 28.3 ± 5.9 years, 74.2 ± 9.3 kg, and 24.3 ± 2.6 kg/m2, respectively. Donors were discharged at an average of 3.6 ± 0.8 days. The median recipient age and BW at transplantation were 6.9 (2.7 to 11) months and 5.9 (3.9 to 8) kg, respectively, and the recipient-to-donor body weight ratio (RDBW) was <0.1 in all but one case. The mean percentage reduction in graft weight and in the antero-posterior diameter were 33.2% ± 5.5% and 38.3% ± 12.6%, respectively. The average (SD) GRWR was 4.8% ± 1.7% before all the resections and 3.5% ± 1.0% after the procedures. Seven patients were primarily closed. CONCLUSION After LLS resection, a nonanatomical anterior resection of the LLS was accomplished without hilar vascular dissection to segments II/III. The final liver graft allowed primary abdominal wall closure in all but one patient, with meaningful adjustments in GRWR. AHR proved to be simple, safe, reproducible, and effective in the presented case series.
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Affiliation(s)
- João Seda Neto
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
| | | | | | - Renata Pugliese
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
| | | | - Caio M Oliveira
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Rodrigo Vincenzi
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Marcel R Benavides
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Karina Roda
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Mário Kondo
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Eduardo A Fonseca
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
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11
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Husain SA, Lentine KL. Policy Strategies to Reduce Financial Risks for Living Donors. Kidney360 2023; 4:987-989. [PMID: 37211639 PMCID: PMC10371270 DOI: 10.34067/kid.0000000000000157] [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] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Syed Ali Husain
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Krista L. Lentine
- Saint Louis University Transplant Center, SSM-Saint Louis University Hospital, St. Louis, Missouri
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12
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Bambha K, Kim NJ, Sturdevant M, Perkins JD, Kling C, Bakthavatsalam R, Healey P, Dick A, Reyes JD, Biggins SW. Maximizing utility of nondirected living liver donor grafts using machine learning. Front Immunol 2023; 14:1194338. [PMID: 37457719 PMCID: PMC10344453 DOI: 10.3389/fimmu.2023.1194338] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Objective There is an unmet need for optimizing hepatic allograft allocation from nondirected living liver donors (ND-LLD). Materials and method Using OPTN living donor liver transplant (LDLT) data (1/1/2000-12/31/2019), we identified 6328 LDLTs (4621 right, 644 left, 1063 left-lateral grafts). Random forest survival models were constructed to predict 10-year graft survival for each of the 3 graft types. Results Donor-to-recipient body surface area ratio was an important predictor in all 3 models. Other predictors in all 3 models were: malignant diagnosis, medical location at LDLT (inpatient/ICU), and moderate ascites. Biliary atresia was important in left and left-lateral graft models. Re-transplant was important in right graft models. C-index for 10-year graft survival predictions for the 3 models were: 0.70 (left-lateral); 0.63 (left); 0.61 (right). Similar C-indices were found for 1-, 3-, and 5-year graft survivals. Comparison of model predictions to actual 10-year graft survivals demonstrated that the predicted upper quartile survival group in each model had significantly better actual 10-year graft survival compared to the lower quartiles (p<0.005). Conclusion When applied in clinical context, our models assist with the identification and stratification of potential recipients for hepatic grafts from ND-LLD based on predicted graft survivals, while accounting for complex donor-recipient interactions. These analyses highlight the unmet need for granular data collection and machine learning modeling to identify potential recipients who have the best predicted transplant outcomes with ND-LLD grafts.
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Affiliation(s)
- Kiran Bambha
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Washington, Seattle, WA, United States
- Center for Liver Investigation Fostering discovery (C-LIFE), University of Washington, Seattle, WA, United States
- Clinical and Bio-Analytics Transplant Laboratory (C-BATL), University of Washington, Seattle, WA, United States
| | - Nicole J. Kim
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Washington, Seattle, WA, United States
- Center for Liver Investigation Fostering discovery (C-LIFE), University of Washington, Seattle, WA, United States
| | - Mark Sturdevant
- Clinical and Bio-Analytics Transplant Laboratory (C-BATL), University of Washington, Seattle, WA, United States
- Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
| | - James D. Perkins
- Clinical and Bio-Analytics Transplant Laboratory (C-BATL), University of Washington, Seattle, WA, United States
- Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
| | - Catherine Kling
- Clinical and Bio-Analytics Transplant Laboratory (C-BATL), University of Washington, Seattle, WA, United States
- Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
| | - Ramasamy Bakthavatsalam
- Clinical and Bio-Analytics Transplant Laboratory (C-BATL), University of Washington, Seattle, WA, United States
- Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
| | - Patrick Healey
- Clinical and Bio-Analytics Transplant Laboratory (C-BATL), University of Washington, Seattle, WA, United States
- Pediatric Transplant Surgery Division, Department of Surgery, Seattle Children’s Hospital, Seattle, WA, United States
| | - Andre Dick
- Clinical and Bio-Analytics Transplant Laboratory (C-BATL), University of Washington, Seattle, WA, United States
- Pediatric Transplant Surgery Division, Department of Surgery, Seattle Children’s Hospital, Seattle, WA, United States
| | - Jorge D. Reyes
- Clinical and Bio-Analytics Transplant Laboratory (C-BATL), University of Washington, Seattle, WA, United States
- Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
- Pediatric Transplant Surgery Division, Department of Surgery, Seattle Children’s Hospital, Seattle, WA, United States
| | - Scott W. Biggins
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Washington, Seattle, WA, United States
- Center for Liver Investigation Fostering discovery (C-LIFE), University of Washington, Seattle, WA, United States
- Clinical and Bio-Analytics Transplant Laboratory (C-BATL), University of Washington, Seattle, WA, United States
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13
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Gillespie A, Daw J, Brown R, Cappiello J, Lee BE, Fink EL, Gardiner HM, Reese PP, Gadegbeku CA, Obradovic Z. Dialysis Patients' Social Networks and Living Donation Offers. Kidney Med 2023; 5:100640. [PMID: 37235041 PMCID: PMC10206208 DOI: 10.1016/j.xkme.2023.100640] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Rationale & Objective Most living kidney donors are members of a hemodialysis patient's social network. Network members are divided into core members, those strongly connected to the patient and other members; and peripheral members, those weakly connected to the patient and other members. We identify how many hemodialysis patients' network members offered to become kidney donors, whether these offers were from core or peripheral network members, and whose offers the patients accepted. Study Design A cross-sectional interviewer-administered hemodialysis patient social network survey. Setting & Participants Prevalent hemodialysis patients in 2 facilities. Predictors Network size and constraint, a donation from a peripheral network member. Outcomes Number of living donor offers, accepting an offer. Analytical Approach We performed egocentric network analyses for all participants. Poisson regression models evaluated associations between network measures and number of offers. Logistic regression models determined the associations between network factors and accepting a donation offer. Results The mean age of the 106 participants was 60 years. Forty-five percent were female, and 75% self-identified as Black. Fifty-two percent of participants received at least one living donor offer (range 1-6); 42% of the offers were from peripheral members. Participants with larger networks received more offers (incident rate ratio [IRR], 1.26; 95% CI, 1.12-1.42; P = 0.001), including networks with more peripheral members (constraint, IRR, 0.97; 95% CI, 0.96-0.98; P < 0.001). Participants who received a peripheral member offer had 3.6 times greater odds of accepting an offer (OR, 3.56; 95% CI, 1.15-10.8; P = 0.02) than those who did not receive a peripheral member offer. Limitations A small sample of only hemodialysis patients. Conclusions Most participants received at least one living donor offer, often from peripheral network members. Future living donor interventions should focus on both core and peripheral network members.
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Affiliation(s)
- Avrum Gillespie
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Jonathan Daw
- Department of Sociology and Demography, College of Liberal Arts, Penn State, Philadelphia, Pennsylvania
| | - Riley Brown
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Jamie Cappiello
- Department of Social & Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Briana Eugene Lee
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Edward L. Fink
- Department of Communication and Social Influence, Klein College of Media and Communication, Temple University, Philadelphia, Pennsylvania
| | - Heather M. Gardiner
- Department of Social & Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Peter P. Reese
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Zoran Obradovic
- Center for Data Analytics and Biomedical Informatics, Temple University, Philadelphia, Pennsylvania
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14
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Mariat C, Gaillard F, Fournier T, Rabate C, Pincon É, Bacchetta J, Aurelle M, Bouquegneau A. A call for promoting living kidney donation in France in 2023. Nephrol Ther 2023; 19:83-88. [PMID: 37098713 DOI: 10.1684/ndt.2023.20] [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] [Indexed: 04/27/2023]
Abstract
Kidney transplantation from living donors is particularly under-developed in France in comparison with the US and most European countries. Among others, the lack of a proactive and evidence-based communication from French health providers is a potential cause that has been overlooked thus far. With this as a backdrop, the SFNDT Commission of transplantation has elaborated a 10 points-call for promoting living kidney transplantation in France in 2023 with the aims at (1) providing the entire nephrology community with a scientific rationale and (2) strenghtening the conviction of health providers, patients, and their relatives regarding the relevance of this modality of kidney transplantation.
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Affiliation(s)
- Christophe Mariat
- Hôpital Nord, Centre hospitalier universitaire de Saint-Étienne, service de néphrologie, dialyse et transplantation rénale, Université Jean Monnet, 42055 Saint-Étienne Cedex 2, France
- Au nom de la commission Transplantation de la SFNDT
| | - François Gaillard
- Hôpital Édouard Herriot, service de transplantation, néphrologie et immunologie clinique, Université Claude Bernard, Lyon, France
- Au nom de la commission Transplantation de la SFNDT
| | - Thomas Fournier
- Médipôle Lyon-Villeurbanne, Hôpital privé, service de néphrologie, Lyon, France
- Au nom de la commission Transplantation de la SFNDT
| | - Clémentine Rabate
- Diaverum Paris, service de néphrologie et dialyse, Hôpital Necker, service de transplantation rénale adulte, Paris
- Au nom de la commission Transplantation de la SFNDT
| | - Émilie Pincon
- Fondation AUB-Santé, Rennes, France
- Au nom de la commission Transplantation de la SFNDT
| | - Justine Bacchetta
- Hôpital Mère-Enfant, service de néphrologie-rhumatologie-dermatologie pédiatriques, Lyon, France
| | - Manon Aurelle
- Hôpital Mère-Enfant, service de néphrologie-rhumatologie-dermatologie pédiatriques, Lyon, France
| | - Antoine Bouquegneau
- CHU Sart Tilman, service de néphrologie, dialyse, transplantation, Université de Liège, Liège, Belgique
- Au nom de la commission Transplantation de la SFNDT
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15
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Marinaki S, Vallianou K, Darema M, Mantios E, Kapsia E, Melexopoulou C, Filiopoulos V, Liapis G, Boletis IN. Τhe Impact of Pre-Transplant Kidney Biopsy on the Evaluation of Prospective Living Kidney Donors. J Clin Med 2023; 12:jcm12072685. [PMID: 37048768 PMCID: PMC10095397 DOI: 10.3390/jcm12072685] [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: 02/15/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
Living kidney donation contributes to increasing the donor pool. Since safety and excellent outcomes of living kidney donors (LKD) are essential, renal biopsy must be part of the pre-transplant evaluation in donors with isolated urine abnormalities or other risk factors. We retrospectively collected data on potential living donors evaluated in the pre-transplant outpatient clinic of Laiko General Hospital of Athens between 2007 and 2022, who underwent a pre-transplant biopsy. Biopsy indications included microscopic hematuria, borderline proteinuria and comorbidities suggestive of chronicity. Those with glomerular diseases or chronic lesions were excluded from donation. We identified 59 potential living donors who underwent renal biopsy. Of these, 10 (16.9%) were male. Median age was 58 (IQR 51-63) years, while 23 (39%) were older than 60 years. 49 out of 59 (83%) had glomerular hematuria, 10 (16.7%) had proteinuria (150-300 mg/d). Out of the 59 donors, 21 (35.6%) were hypertensive, three (5.1%) had impaired glucose tolerance and seven (11.9%) had a BMI > 30 kg/m2. A total of 32 (54.2%) potential donors were accepted for donation. Eight (13.6%) had IgA nephropathy, 10 (16.9%) TBMD and nine (15.3%) had increased chronicity including secondary FSGS. When compared with a control group of donors who did not need a pre-transplant biopsy, those 32 who donated were more frequently hypertensive (p = 0.003), but had similar eGFR [61.3 (±10.4) vs. 61.9 (±13.8), p = 0.866] after a follow-up of 79 (36-114) months. Renal biopsy is a useful tool in the evaluation of prospective LKD. Thorough assessment of donors with isolated urine abnormalities and marginal donors is critical to ensure good post-donation outcomes.
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Affiliation(s)
- Smaragdi Marinaki
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, 11527 Athens, Greece
| | - Kalliopi Vallianou
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, 11527 Athens, Greece
| | - Maria Darema
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, 11527 Athens, Greece
| | - Evangelos Mantios
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, 11527 Athens, Greece
| | - Eleni Kapsia
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, 11527 Athens, Greece
| | - Christina Melexopoulou
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, 11527 Athens, Greece
| | - Vassilis Filiopoulos
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, 11527 Athens, Greece
| | - George Liapis
- 1st Department of Pathology, Medical School of Athens, National and Kapodistrian University, 11527 Athens, Greece
| | - Ioannis N Boletis
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, 11527 Athens, Greece
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16
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Liapakis A, Agbim U, Bittermann T, Dew MA, Deng Y, Gan G, Emre S, Hunt HF, Olthoff KM, Locke JE, Jesse MT, Kumar V, Pillai A, Verna E, Lentine KL. A survey of transplant providers regarding attitudes, barriers, and facilitators to living donor liver transplantation in the United States. Clin Transplant 2023:e14967. [PMID: 36938716 DOI: 10.1111/ctr.14967] [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: 01/03/2023] [Revised: 02/24/2023] [Accepted: 03/05/2023] [Indexed: 03/21/2023]
Abstract
INTRODUCTION A successful living donor liver transplant (LDLT) is the culmination of a multifaceted process coordinated among key stakeholders. METHODS We conducted an electronic survey of US liver transplant (LT) centers (August 26, 2021-October 10, 2021) regarding attitudes, barriers, and facilitators of LDLT to learn how to expand LDLT safely and effectively in preparation for the American Society of Transplantation Living Donor Liver Transplant Consensus Conference. RESULTS Responses were received from staff at 58 programs (40.1% of US LT centers). There is interest in broadening LDLT (100% of LDLT centers, 66.7% of non-LDLT centers) with high level of agreement that LDLT mitigates donor shortage (93.3% of respondents) and that it should be offered to all suitable candidates (87.5% of respondents), though LDLT was less often endorsed as the best first option (29.5% of respondents). Key barriers at non-LDLT centers were institutional factors and surgical expertise, whereas those at LDLT centers focused on waitlist candidate and donor factors. Heterogeneity in candidate selection for LDLT, candidate reluctance to pursue LDLT, high donor exclusion rate, and disparities in access were important barriers. CONCLUSION Findings from this study may help guide current and future expansion of LDLT more efficiently in the US. These efforts require clear and cohesive messaging regarding LDLT benefits, engagement of the public community, and dedicated resources to equitably increase LDLT access.
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Affiliation(s)
- AnnMarie Liapakis
- Department of Medicine, Yale University, New Haven, Connecticut, USA
| | - Uchenna Agbim
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri, USA
| | | | | | - Yanhong Deng
- Yale Center for Analytical Sciences, New Haven, Connecticut, USA
| | - Geliang Gan
- Yale Center for Analytical Sciences, New Haven, Connecticut, USA
| | - Sukru Emre
- Ege University School of Medicine, Izmir, Turkey
| | - Heather F Hunt
- United Network for Organ Sharing, Richmond, Virginia, USA
| | - Kim M Olthoff
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | - Anjana Pillai
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Elizabeth Verna
- Center for Liver Disease and Transplantation, Columbia University, New York, New York, USA
| | - Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri, USA
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17
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Hobson O, Lumsdaine J, Sherif A, Oniscu GC. A Home Education Service to Increase Knowledge of Treatment Options and Improve Attitudes to Living Donor Kidney Transplantation. Prog Transplant 2023; 33:95-99. [PMID: 36562149 DOI: 10.1177/15269248221145041] [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: 12/24/2022]
Abstract
Introduction: Lack of knowledge about living donor kidney transplant and difficulties in approaching potential donors constitute barriers for many patients and may contribute to inequality of access. Project Aims: Renal Education and Choices at Home was a UK single-centre pilot of home education; an initiative aiming to overcome barriers by increasing knowledge among patients and support networks and by facilitating living donation discussion in the patient's home. Design: This was a pre-post comparison of knowledge, attitude, and ability to communicate about transplant. Pre-visit knowledge about treatment options and attitudes towards transplant were measured using a validated questionnaire, repeated 4-6 weeks post-visit, to assess the session's impact, along with an evaluation survey, to determine how patients perceived the session. Results: From November 2018 to February 2020, a nurse specialist delivered living donor transplant education sessions in the homes of 86 patients, attended by 141 additional invitees. Home visits led to a significant improvement in knowledge about renal therapies, including living donor transplantation. The evaluation of the home visits by patients and invitees was overwhelmingly positive. Of the 86 patients visited, 46 (53%) had at least one potential donor initiating the assessment process following the visit. Overall, 78 potential donors initiated the assessment process. Conclusion: Home education contributed to addressing recognised barriers, in a way that was well received by patients and was novel in our health system. Home education may be particularly beneficial for patients affected by known barriers to living donor transplantation such as socio-economic deprivation.
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Affiliation(s)
- Orla Hobson
- Edinburgh Transplant Centre, 59843Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Jen Lumsdaine
- Edinburgh Transplant Centre, 59843Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ahmed Sherif
- Edinburgh Transplant Centre, 59843Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Clinical Surgery, University of Edinburgh, 59843Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Gabriel C Oniscu
- Edinburgh Transplant Centre, 59843Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Clinical Surgery, University of Edinburgh, 59843Royal Infirmary of Edinburgh, Edinburgh, UK
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18
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Rasmussen LV, Agrawal AH, Botsford P, Powers A, Schnoebelen J, Xinos S, Harper G, Thanner J, McCabe S, Moore S, Wicklund CA, Duquette D, Gordon EJ. Challenges of Integrating APOL1 Genetic Test Results into the Electronic Health Record. Appl Clin Inform 2023; 14:321-325. [PMID: 37186083 PMCID: PMC10132929 DOI: 10.1055/s-0043-1767680] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/12/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES Integrating genetic test results into the electronic health record (EHR) is essential for integrating genetic testing into clinical practice. This article describes the organizational challenges of integrating discrete apolipoprotein L1 (APOL1) genetic test results into the EHR for a research study on culturally sensitive genetic counseling for living kidney donors. METHODS We convened a multidisciplinary team across three institutions (Northwestern University, Northwestern Memorial HealthCare [NMHC], and OHSU Knight Diagnostic Laboratories [KDL]), including researchers, physicians, clinical information technology, and project management. Through a series of meetings over a year between the team and the genetic testing laboratory, we explored and adjusted our EHR integration plan based on regulatory and budgetary constraints. RESULTS Our original proposal was to transmit results from KDL to NMHC as structured data sent via Health Level Seven (HL7) v2 message. This was ultimately deemed infeasible given the time and resources required to establish the interface, and the low number of samples to be processed for the study (n = 316). We next explored the use of Epic's Care Everywhere interoperability platform, but learned it was not possible as a laboratory test ordered for a research study; even though our intent was to study the APOL1 genetic test result's clinical use and impact, test results were still considered "research results." Faced with two remaining options-downloading a PDF from the KDL laboratory portal or scanning a faxed result from KDL-only a PDF of the APOL1 test result could be integrated into the EHR, reinforcing the status quo. CONCLUSION Even with early and ongoing stakeholder engagement, dedicated project management, and funding, unanticipated implementation challenges-especially for research projects-can result in drastic design tradeoffs.
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Affiliation(s)
- Luke V. Rasmussen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Akansha H. Agrawal
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Paul Botsford
- Information Services, Digital Solutions, Northwestern Medicine, Chicago, Illinois, United States
| | - Andrew Powers
- Information Services, Clinical Applications, Northwestern Medicine, Chicago, Illinois, United States
| | - Jeffrey Schnoebelen
- Information Services, Business Relationship Management, Northwestern Medicine, Chicago, Illinois, United States
| | - Stavroula Xinos
- Information Services, Digital Administration, Northwestern Medicine, Chicago, Illinois, United States
| | - Gail Harper
- Business Development and Strategic Outreach, Knight Diagnostic Laboratories, Oregon Health & Science University, Portland, Oregon, United States
| | - Jane Thanner
- Information Technology Group, Oregon Health & Science University, Portland, Oregon, United States
| | - Sarah McCabe
- Knight Diagnostic Laboratories, Oregon Health & Science University, Portland, Oregon, United States
| | - Stephen Moore
- Knight Diagnostic Laboratories, Oregon Health & Science University, Portland, Oregon, United States
| | - Catherine A. Wicklund
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Debra Duquette
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Elisa J. Gordon
- Department of Surgery, Section of Surgical Sciences, and Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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19
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Lentine KL, Tanaka T, Xiao H, Bittermann T, Dew MA, Schnitzler MA, Olthoff KM, Locke JE, Emre S, Hunt HF, Liapakis A, Axelrod DA. Variation in adult living donor liver transplantation in the United States: Identifying opportunities for increased utilization. Clin Transplant 2023:e14924. [PMID: 36733213 DOI: 10.1111/ctr.14924] [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: 11/13/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023]
Abstract
In the United States, living donor liver transplantation (LDLT) is limited to transplant centers with specific experience. However, the impact of recipient characteristics on procedure selection (LDLT vs. deceased donor liver transplant [DDLT]) within these centers has not been described. Transplant registry data for centers that performed ≥1 LDLT in 2002-2019 were analyzed using hierarchal regression modeling to quantify the impact of patient and center factors on the adjusted odds ratio (aOR) of LDLT (vs DDLT). Among 73,681 adult recipients, only 4% underwent LDLT, varying from <1% to >60% of total liver transplants. After risk adjustment, the likelihood of receiving an LDLT rose by 73% in recent years (aOR 1.73 for 2014-2019 vs. 2002-2007) but remained lower for older adults, men, racial and ethnic minorities, and obese patients. LDLT was less commonly used in patients with hepatocellular carcinoma or alcoholic cirrhosis, and more frequently in those with hepatitis C and with lower severity of illness (Model for End-Stage Liver Disease (MELD) score < 15). Patients with public insurance, lower educational achievement, and residence in the Northwest and Southeast had decreased access. While some differences in access to LDLT reflect clinical factors, further exploration into disparities in LDLT utilization based on center practice and socioeconomic determinants of health is needed.
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Affiliation(s)
- Krista L Lentine
- Saint Louis University Transplant Center, SSM-Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Tomohiro Tanaka
- Organ Transplant Center, University of Iowa, Iowa City, Iowa, USA
| | - Huiling Xiao
- Saint Louis University Transplant Center, SSM-Saint Louis University Hospital, St. Louis, Missouri, USA
| | | | | | - Mark A Schnitzler
- Saint Louis University Transplant Center, SSM-Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Kim M Olthoff
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Sukru Emre
- Ege University School of Medicine, Izmir, Turkey
| | - Heather F Hunt
- United Network for Organ Sharing, Richmond, Virginia, USA
| | | | - David A Axelrod
- Organ Transplant Center, University of Iowa, Iowa City, Iowa, USA
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20
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Shadnoush M, Latifi M, Rahban H, Pourhosein E, Shadnoush A, Jafarian A, Dehghani S. Trends in organ donation and transplantation over the past eighteen years in Iran. Clin Transplant 2023; 37:e14889. [PMID: 36545788 DOI: 10.1111/ctr.14889] [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: 03/07/2022] [Revised: 12/06/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND This article will review the trends in organ donation over the past 18 years in Iran. MATERIAL AND METHODS All donation and transplantation statistics were extracted by reviewing the Organ Procurement and Transplantation database of the Ministry of Health of Iran from 2002 to 2019. RESULTS Iran's national deceased donation rate from 2002 to 2019 increased 19.06-fold from .75 to 14.3 per million population (PMP). After the beginning of the COVID-19 pandemic, the rate of organ donation in Iran decreased significantly. Although 1 year after the onset of the pandemic, due to the widespread adoption of COVID19 vaccination, the rate of organ donation began to increase again, this system is still under performing. During the years under examination, the rate of deceased kidney donation increased significantly compared to living kidney donation and reached up to 2001 kidney transplantations in 2021. From 2002 to 2019, the rate of liver transplants increased to 12.8. Likewise, the rate of heart transplants increased 8.4-fold, from 15 to 126 cases during the same time. CONCLUSSION Although a personal choice, the process of organ donation involves medical, legal, ethical, organizational, and social aspects. The trend in increasing donation rates over the past years can be attributed to multiple influences, which include rigorous team efforts in the organ donation and transplantation systems, in addition to creating a donation culture and promoting donation through media platforms. Moreover, we can say that the rising rates of deceased donor transplantation also can drive down rates of commercial living donor transplantation.
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Affiliation(s)
- Mahdi Shadnoush
- Faculty of Nutrition & Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Latifi
- Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Habib Rahban
- Cardiovascular Research Foundation of Southern California, Beverly Hills, California, USA.,Southern California Medical Education Consortium, Temecula Valley Hospital, Universal Health System, Temecula, California, USA
| | - Elahe Pourhosein
- Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Shadnoush
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Arefeh Jafarian
- Iranian Tissue Bank & Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanaz Dehghani
- Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Iranian Tissue Bank & Research Center, Tehran University of Medical Sciences, Tehran, Iran
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21
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de Rougemont O, Deng Y, Frischknecht L, Wehmeier C, Villard J, Ferrari-Lacraz S, Golshayan D, Gannagé M, Binet I, Wirthmueller U, Sidler D, Schachtner T, Schaub S, Nilsson J. Donation type and the effect of pre-transplant donor specific antibodies - Data from the Swiss Transplant Cohort Study. Front Immunol 2023; 14:1104371. [PMID: 36875145 PMCID: PMC9974644 DOI: 10.3389/fimmu.2023.1104371] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/30/2023] [Indexed: 02/19/2023] Open
Abstract
Introduction The type of donation may affect how susceptible a donor kidney is to injury from pre-existing alloimmunity. Many centers are, therefore, reluctant to perform donor specific antibody (DSA) positive transplantations in the setting of donation after circulatory death (DCD). There are, however, no large studies comparing the impact of pre-transplant DSA stratified on donation type in a cohort with a complete virtual cross-match and long-term follow-up of transplant outcome. Methods We investigated the effect of pre-transplant DSA on the risk of rejection, graft loss, and the rate of eGFR decline in 1282 donation after brain death (DBD) transplants and compared it to 130 (DCD) and 803 living donor (LD) transplants. Results There was a significant worse outcome associated with pre-transplant DSA in all of the studied donation types. DSA directed against Class II HLA antigens as well as a high cumulative mean fluorescent intensity (MFI) of the detected DSA showed the strongest association with worse transplant outcome. We could not detect a significant additive negative effect of DSA in DCD transplantations in our cohort. Conversely, DSA positive DCD transplants appeared to have a slightly better outcome, possibly in part due to the lower mean fluorescent intensity (MFI) of the pre-transplant DSA. Indeed when DCD transplants were compared to DBD transplants with similar MFI (<6.5k), graft survival was not significantly different. Discussion Our results suggest that the negative impact of pre-transplant DSA on graft outcome could be similar between all donation types. This suggests that immunological risk assessment could be performed in a similar way regardless of the type of donor kidney transplantation.
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Affiliation(s)
- Olivier de Rougemont
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Yun Deng
- Department of Immunology, University Hospital Zurich (USZ), Zurich, Switzerland
| | - Lukas Frischknecht
- Department of Immunology, University Hospital Zurich (USZ), Zurich, Switzerland
| | - Caroline Wehmeier
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Jean Villard
- Transplantation Immunology Unit and National Reference Laboratory for Histocompatibility, Department of Diagnostic, Geneva University Hospitals, Geneva, Switzerland
| | - Sylvie Ferrari-Lacraz
- Transplantation Immunology Unit and National Reference Laboratory for Histocompatibility, Department of Diagnostic, Geneva University Hospitals, Geneva, Switzerland
| | - Déla Golshayan
- Transplantation Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Monique Gannagé
- Service of Immunology and Allergy, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Isabelle Binet
- Nephrology & Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Urs Wirthmueller
- Department of Laboratory Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Daniel Sidler
- Department of Nephrology and Hypertension, Inselspital, Berne University Hospital and University of Berne, Berne, Switzerland
| | - Thomas Schachtner
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Stefan Schaub
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Jakob Nilsson
- Department of Immunology, University Hospital Zurich (USZ), Zurich, Switzerland
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22
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Wu G, Liu C, Zhou X, Zhao L, Zhang W, Wang M, Zhao Q, Liang T. Short- and long-term complications after living donor ileal resection. Am J Transplant 2022; 22:3053-3060. [PMID: 36066568 DOI: 10.1111/ajt.17193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 01/25/2023]
Abstract
Intestinal transplantation from deceased donors is the established procedure for patients with irreversible intestinal failure. However, a living-donor intestinal transplant has not been routinely performed yet because of undefined surgical risks to the donor. In this report, we reviewed our experience with living-donor ileal resection from May 1999 to December 2021. A total of 40 living-donor ileal resections were performed for 40 intestinal transplant recipients. Clinical data were prospectively collected and analyzed for postoperative complications after ileal procurement. None of the donors experienced life-threatening complications or mortality. Six (15%) of 40 donors experienced minor operative complications. Transit intestinal graft inadequacy including weight loss, diarrhea, and vitamin B12 deficiency was common early following surgery, but was manageable and disappeared in most cases within a year. All donors had significant reductions in total plasma cholesterol and low-density lipoprotein cholesterol concentrations after donation as compared with the baseline levels. With an average follow-up of 67.8 months, bilateral kidney stones occurred in one donor and gallstones in the other. All the donors have regained their normal capacity for work. Living-donor ileal resection is associated with minimal short- and long-term morbidity and remains an attractive alternative for potential recipients when suitable deceased donors are unavailable.
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Affiliation(s)
- Guosheng Wu
- Intestinal Transplant Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chaoxu Liu
- Intestinal Transplant Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xile Zhou
- Intestinal Transplant Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Long Zhao
- Intestinal Transplant Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wentong Zhang
- Intestinal Transplant Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mian Wang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, the Fourth Military Medical University, Xi'an, China
| | - Qingchuan Zhao
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, the Fourth Military Medical University, Xi'an, China
| | - Tingbo Liang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang Provincial Key Laboratory of Pancreatic Disease, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Cancer Center, Zhejiang University, Hangzhou, China
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23
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Visser A, Alma MA, Bakker SJL, Bemelman FJ, Berger SP, van der Boog PJM, Brouwer S, Hilbrands LB, Standaar DSM, Stewart RE, Gansevoort RT. Employment and ability to work after kidney transplantation in the Netherlands: The impact of preemptive versus non-preemptive kidney transplantation. Clin Transplant 2022; 36:e14757. [PMID: 35716362 PMCID: PMC9788192 DOI: 10.1111/ctr.14757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/01/2021] [Revised: 02/14/2022] [Accepted: 06/11/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Work can have a major positive impact on health and wellbeing. Employment of kidney transplant recipients (KTR) of working age is much lower than in the general population. The first aim of this study was to examine the impact of a preemptive kidney transplantation (PKT) on employment, in addition to other possible influencing factors. The second aim was to explore differences in work ability, absenteeism and work performance among employed KTR with different types of transplantations. METHODS A cross-sectional survey study was conducted between 2018 and 2019 in nine Dutch hospitals. PKT as potential predictor of employment was examined. Furthermore, work ability, absenteeism and loss of work performance were compared between employed preemptive recipients with a living donor (L-PKT) and non-preemptive recipients with a living donor (L-nPKT) and with a deceased donor (D-nPKT). RESULTS Two hundred and twenty four KTR participated; 71% reported having paid work. Paid work was more common among PKT recipients (82% vs. 65% in L-nPKT and 55% in D-nPKT) and recipients who were younger (OR .950, 95%CI .913-.989), had no comorbidities (1 comorbidity: OR .397, 95%CI .167-.942; 2 comorbidities: OR .347, 95%CI .142-.844), had less fatigue (OR .974, 95%CI .962-.987) and had mentally demanding work tasks (only in comparison with physically demanding tasks, OR .342, 95%CI .145-.806). If recipients were employed, D-nPKT recipients worked fewer hours (mean 24.6±11.3 vs. PKT 31.1±9.6, L-nPKT 30.1±9.5) and D-nPKT and L-nPKT recipients received more often supplemental disability benefits (32 and 33.3%, respectively) compared to PKT recipients (9.9%). No differences were found for self-reported ability to work, sick leave (absenteeism) and loss of work performance with the exception of limitations in functioning at work. CONCLUSIONS Preemptive kidney transplantation recipients with a kidney from a living donor are employed more often, work more hours per week (only in comparison with D-nPKT) and have a partial disability benefit less often than nPKT recipients. More knowledge regarding treatments supporting sustainable participation in the labor force is needed as work has a positive impact on recipients' health and wellbeing and is also beneficial for society as a whole.
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Affiliation(s)
- Annemieke Visser
- Department of Applied Health ResearchHealth SciencesUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Manna A. Alma
- Department of Applied Health ResearchHealth SciencesUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Stephan J. L. Bakker
- Department of NephrologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Frederike J. Bemelman
- Department of NephrologyUniversity of Amsterdam's Faculty of MedicineAmsterdamThe Netherlands
| | - Stefan P. Berger
- Department of NephrologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | | | - Sandra Brouwer
- Department of Health Sciences, Community and Occupational MedicineUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Luuk B. Hilbrands
- Department of NephrologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Dorien S. M. Standaar
- Department of NephrologyUniversity of Amsterdam's Faculty of MedicineAmsterdamThe Netherlands
| | - Roy E. Stewart
- Department of Health Sciences, Community and Occupational MedicineUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Ron T. Gansevoort
- Department of NephrologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
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24
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Emamaullee J, Heimbach JK, Olthoff KM, Pomfret EA, Roberts JP, Selzner N. Assessment of long-term outcomes post living liver donation highlights the importance of scientific integrity when presenting transplant registry data. Am J Transplant 2022; 22:1519-1522. [PMID: 35352461 PMCID: PMC9177716 DOI: 10.1111/ajt.17045] [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] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/14/2022] [Accepted: 03/26/2022] [Indexed: 01/25/2023]
Abstract
Living donor liver transplantation has expanded in recent years, particularly in North America. As experience with this procedure has matured over the last 25 years, centers are increasingly faced with potential living donors who are more medically complex. As donors move through the evaluation process, completing the informed consent process continues to be challenged by a paucity of granular data demonstrating long-term outcomes and overall safety specifically in the otherwise "healthy" living liver donor population. Two recently published studies examined long-term outcomes post-living liver donation using Korean registry data and reported similar results, with excellent overall survival when compared to appropriately matched controls. However, the authors of these studies were presented differently, with one reporting an alarmist view based on one aspect of a suboptimal analysis approach using an inappropriate comparator group. Herein, the North American Living Liver Donor Innovation Group (NALLDIG) consortium discusses these two studies and their potential impact on living liver donation in North America, ultimately highlighting the importance of scientific integrity in data presentation and dissemination when using transplant registry data.
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Affiliation(s)
- Juliet Emamaullee
- Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA,Department of SurgeryUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Kim M. Olthoff
- Department of SurgeryUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Elizabeth A. Pomfret
- Department of SurgeryUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - John P. Roberts
- Department of SurgeryUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Nazia Selzner
- Department of MedicineAjmera Transplant CenterUniversity of TorontoTorontoOntarioCanada
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25
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Seda Neto J, M Costa C, Fonseca EA, Vincenzi R, Pugliese R, Rocha JIX, Roda K, Benavidez MR, Oliveira CMV, Pereira FP, Assis AM, Feier FH, Chapchap P. Intestinal complications are common in patients with acquired diaphragmatic hernia after pediatric living donor liver transplantation. Pediatr Transplant 2022; 26:e14203. [PMID: 34881487 DOI: 10.1111/petr.14203] [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: 08/17/2021] [Accepted: 11/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acquired diaphragmatic hernia (DH) following liver transplantation (LT) is usually considered a surgical emergency. Interplay of contributing elements determines its occurrence but, in children, LT with partial liver grafts seems to be the most important causative factor. METHODS This retrospective study describes the clinical scenario and outcomes of 11 patients with acquired DH following LDLT. RESULTS During the study period, 1109 primary pediatric LDLT were performed (0.8% DH). The median age and BW of the recipients with DH at transplantation were 17 months and 11.1 kg, respectively; 63.7% of the cases had a weight/age Z-score of less than -2 at transplantation. The median interval between transplantation and diagnosis of DH was 114 days (32-538 days). A total of 6 (54.5%) of the patients had bowel obstruction due to bowel migration into the hemithorax. Ten defects were right-sided. Three patients required enterectomy and enterorrhaphy. Two patients required a new bilioenteric anastomosis, and one of them had complete necrosis of the Roux-in-Y limb. The patient with left-side DH presented gastroesophageal perforation. CONCLUSION Most defects necessitate primary closure as the first treatment, and recurrence is rare. The associated problems encountered, especially related to intestinal complications, can determine increased morbidity following DH repair. Early diagnosis and intervention are required for achieving better outcomes.
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Affiliation(s)
- João Seda Neto
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hepatology and Liver Transplantation, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Carolina M Costa
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hepatology and Liver Transplantation, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Eduardo A Fonseca
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hepatology and Liver Transplantation, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Rodrigo Vincenzi
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hepatology and Liver Transplantation, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Renata Pugliese
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hepatology and Liver Transplantation, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - João Ivo X Rocha
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hepatology and Liver Transplantation, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Karina Roda
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hepatology and Liver Transplantation, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Marcel R Benavidez
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hepatology and Liver Transplantation, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Caio Márcio V Oliveira
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hepatology and Liver Transplantation, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | | | - André Moreira Assis
- Intervention Radiology Department, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Flavia H Feier
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Paulo Chapchap
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
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26
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Spoon EQW, Kortram K, Ismail SY, Nieboer D, d’Ancona FCH, Christiaans MHL, Dam RE, Hofker HS, Hoksbergen AWJ, van der Pant KA, Toorop RJ, van de Wetering J, Ijzermans JNM, Dor FJMF. Living Kidney Donor Knowledge of Provided Information and Informed Consent: The PRINCE Study. J Clin Med 2022; 11:jcm11030698. [PMID: 35160147 PMCID: PMC8837079 DOI: 10.3390/jcm11030698] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 12/12/2021] [Revised: 01/12/2022] [Accepted: 01/21/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Informed consent for living kidney donation is paramount, as donors are healthy individuals undergoing surgery for the benefit of others. The informed consent process for living kidney donors is heterogenous, and the question concerns how well they are actually informed. Knowledge assessments, before and after donor education, can form the basis for a standardized informed consent procedure for live kidney donation. Methods: In this prospective, a multicenter national cohort study conducted in all eight kidney transplant centers in The Netherlands, we assessed the current status of the informed consent practice for live donor nephrectomy. All of the potential living kidney donors in the participating centers were invited to participate. They completed a pop quiz during their first outpatient appointment (Cohort A). Living kidney donors completed the same pop quiz upon admission for donor nephrectomy (Cohort B). Results: In total, 656 pop quizzes were completed (417 in Cohort A, and 239 in Cohort B). The average donor knowledge score was 7.0/25.0 (±3.9, range 0–18) in Cohort A, and 10.5/25.0 (±2.8, range 0–17.5) in Cohort B. Cohort B scored significantly higher on overall knowledge, preparedness, and the individual item scores (p < 0.0001), except for the long-term complications (p = 0.91). Conclusions: Donor knowledge generally improves during the live donor workup, but it is still quite disappointing. Long-term complications, especially, deserve more attention during living kidney donor education.
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Affiliation(s)
- Emerentia Q. W. Spoon
- Erasmus MC University Medical Centre, Department of Surgery, 3015 GD Rotterdam, The Netherlands; (E.Q.W.S.); (K.K.); (J.N.M.I.)
| | - Kirsten Kortram
- Erasmus MC University Medical Centre, Department of Surgery, 3015 GD Rotterdam, The Netherlands; (E.Q.W.S.); (K.K.); (J.N.M.I.)
| | - Sohal Y. Ismail
- Erasmus MC University Medical Centre, Department of Psychiatry, 3015 GD Rotterdam, The Netherlands;
| | - Daan Nieboer
- Erasmus MC University Medical Centre, Department of Public Health, 3015 GD Rotterdam, The Netherlands;
| | - Frank C. H. d’Ancona
- Radboud University Medical Centre, Department of Urology, 6525 GA Nijmegen, The Netherlands;
| | - Maarten H. L. Christiaans
- Maastricht University Medical Centre, Department of Internal Medicine, 6229 HX Maastricht, The Netherlands;
| | - Ruth E. Dam
- Leiden University Medical Centre, Department of Nephrology, 2333 ZA Leiden, The Netherlands;
| | - Hendrik Sijbrand Hofker
- University Medical Centre Groningen, Department of Surgery, 9713 GZ Groningen, The Netherlands;
| | | | - Karlijn Ami van der Pant
- Amsterdam University Medical Centre, Renal Transplant Unit, Department of Internal Medicine, 1105 AZ Amsterdam, The Netherlands;
- Amsterdam University Medical Centre, Renal Transplant Unit, Department of Nephrology, 1105 AZ Amsterdam, The Netherlands
| | - Raechel J. Toorop
- Utrecht University Medical Centre, Department of Surgery, 3584 CX Utrecht, The Netherlands;
| | | | - Jan N. M. Ijzermans
- Erasmus MC University Medical Centre, Department of Surgery, 3015 GD Rotterdam, The Netherlands; (E.Q.W.S.); (K.K.); (J.N.M.I.)
| | - Frank J. M. F. Dor
- Erasmus MC University Medical Centre, Department of Surgery, 3015 GD Rotterdam, The Netherlands; (E.Q.W.S.); (K.K.); (J.N.M.I.)
- Department of Surgery and Cancer, Imperial College, London SW7 2AZ, UK
- Correspondence:
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27
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Bellini MI, Nozdrin M, Pengel L, Knight S, Papalois V. The Impact of Recipient Demographics on Outcomes from Living Donor Kidneys: Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10235556. [PMID: 34884257 PMCID: PMC8658296 DOI: 10.3390/jcm10235556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/16/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 11/21/2022] Open
Abstract
Background and Aims: Recipient demographics affect outcomes after kidney transplantation. The aim of this study was to assess, for kidneys retrieved from living donors, the effect of recipient sex, ethnicity, and body mass index (BMI) on delayed graft function (DGF) and one-year graft function, incidence of acute rejection (AR), and recipient and graft survivals. Methods: A systematic review and meta-analysis was performed. EMBASE and MEDLINE databases were searched using algorithms through Ovid. Web of Science collection, BIOSIS, CABI, Korean Journal database, Russian Science Citation Index, and SciELO were searched through Web of Science. Cochrane database was also searched. Risk of bias was assessed using the NHBLI tools. Data analysis was performed using Revman 5.4. Mean difference (MD) and risk ratio (RR) were used in analysis. Results: A total of 5129 studies were identified; 24 studies met the inclusion criteria and were analysed. Female recipients were found to have a significantly lower serum creatinine 1-year-post renal transplantation (MD: −0.24 mg/dL 95%CI: −0.18 to −0.29 p < 0.01) compared to male recipients. No significant difference in survival between male and female recipients nor between Caucasians and Africans was observed (p = 0.08). However, Caucasian recipients had a higher 1-year graft survival compared to African recipients (95% CI 0.52−0.98) with also a lower incidence of DGF (RR = 0.63 p < 0.01) and AR (RR = 0.55 p < 0.01). Recipient obesity (BMI > 30) was found to have no effect on 1-year recipient (p = 0.28) and graft survival (p = 0.93) compared to non-obese recipients although non-obese recipients had a lower rate of DGF (RR = 0.65 p < 0.01) and AR (RR = 0.81 p < 0.01) compared to obese recipients. Conclusions: Gender mismatch between male recipients and female donors has negative impact on graft survival. African ethnicity and obesity do not to influence recipient and graft survival but negatively affect DGF and AR rates.
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Affiliation(s)
- Maria Irene Bellini
- Department of Emergency Medicine and Surgery, Azienda Ospedaliera San Camillo Forlanini, 00152 Rome, Italy
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy
- Correspondence:
| | | | - Liset Pengel
- Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX3 7HE, UK; (L.P.); (S.K.)
| | - Simon Knight
- Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX3 7HE, UK; (L.P.); (S.K.)
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28
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Ibrahim HN, Murad DN, Hebert SA, Adrogue HE, Nguyen H, Nguyen DT, Matas AJ, Graviss EA. Intermediate Renal Outcomes, Kidney Failure, and Mortality in Obese Kidney Donors. J Am Soc Nephrol 2021; 32:2933-2947. [PMID: 34675059 PMCID: PMC8806092 DOI: 10.1681/asn.2021040548] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/04/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Obesity is associated with the two archetypal kidney disease risk factors: hypertension and diabetes. Concerns that the effects of diabetes and hypertension in obese kidney donors might be magnified in their remaining kidney have led to the exclusion of many obese candidates from kidney donation. METHODS We compared mortality, diabetes, hypertension, proteinuria, reduced eGFR and its trajectory, and the development of kidney failure in 8583 kidney donors, according to body mass index (BMI). The study included 6822 individuals with a BMI of <30 kg/m2, 1338 with a BMI of 30-34.9 kg/m2, and 423 with a BMI of ≥35 kg/m2. We used Cox regression models, adjusting for baseline covariates only, and models adjusting for postdonation diabetes, hypertension, and kidney failure as time-varying covariates. RESULTS Obese donors were more likely than nonobese donors to develop diabetes, hypertension, and proteinuria. The increase in eGFR in obese versus nonobese donors was significantly higher in the first 10 years (3.5 ml/min per 1.73m2 per year versus 2.4 ml/min per 1.73m2 per year; P<0.001), but comparable thereafter. At a mean±SD follow-up of 19.3±10.3 years after donation, 31 (0.5%) nonobese and 12 (0.7%) obese donors developed ESKD. Of the 12 patients with ESKD in obese donors, 10 occurred in 1445 White donors who were related to the recipient (0.9%). Risk of death in obese donors was not significantly increased compared with nonobese donors. CONCLUSIONS Obesity in kidney donors, as in nondonors, is associated with increased risk of developing diabetes and hypertension. The absolute risk of ESKD is small and the risk of death is comparable to that of nonobese donors.
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Affiliation(s)
| | - Dina N. Murad
- Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Sean A. Hebert
- Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | | | - Hana Nguyen
- Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Duc T. Nguyen
- Department of Pathology and Genomic Medicine, Institute for Academic Medicine, Houston Methodist Research Institute, Houston, Texas
| | - Arthur J. Matas
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Edward A. Graviss
- Department of Pathology and Genomic Medicine, Institute for Academic Medicine, Houston Methodist Research Institute, Houston, Texas
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
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Maldonado RA, Bisigniano L. Global Perspective on Kidney Transplantation: Argentina. Kidney360 2021; 3:368-371. [PMID: 35373116 PMCID: PMC8967651 DOI: 10.34067/kid.0002632021] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 09/10/2021] [Indexed: 01/10/2023]
Affiliation(s)
- Rafael Alberto Maldonado
- Clínica Privada Vélez Sarsfield, Córdoba, Argentina,Postgraduate School of Nephrology, National University of Córdoba, Córdoba, Argentina
| | - Liliana Bisigniano
- Instituto Nacional Central Único Coordinador de Ablación e Implante, Buenos Aires, Argentina
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30
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Turine Neto P, Seda Neto J, da Fonseca EA, Porta G, Pugliese R, Benavides MAR, Vincenzi R, Roda KMO, Danesi VLB, Hirschfeld APM, Feier FH, Chapchap P, Miura IK. Impact of hypoxemia on pediatric liver transplantation for hepatopulmonary syndrome. Pediatr Transplant 2021; 25:e13968. [PMID: 33590638 DOI: 10.1111/petr.13968] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/20/2020] [Accepted: 12/27/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND The treatment of choice for patients with cirrhosis and HPS is LT. The clinical manifestations associated with hypoxemia result in limitations and a poor health-related quality of life of affected patients. The present report aims to study the differences in outcomes between patients with PaO2 < 50 mm Hg and those with PaO2 ≥ 50 mm Hg. METHODS This was a retrospective study of 21 patients under 18 years of age conducted from 2001 to 2018; the patients were divided into 2 groups: G1-PaO2 ≥ 50 mm Hg, 11 patients, and G2-PaO2 < 50 mm Hg, 10 patients. Demographic, clinical, laboratory, and perioperative data; outcome variables; and post-transplant survival were compared between the groups. RESULTS In total, 2/11 (18.2%) patients in G1 and 8/10 (80%) patients in G2 required supplemental oxygen therapy at home (P = .005). Patients in G2 required prolonged MV (median 8.5 days in G2 vs 1 day in G1, P = .015) and prolonged ICU and hospital stays (P = .002 and P = .001, respectively). Oxygen weaning time was longer in G2 (median 127.5 days) than in G1 (median 3 days; P = .004). One (9.1%) patient in G1 and three (30%) patients in G2 died (P = .22). The survival at 90 months was 90.9% in G1 and 70% in G2 (P = .22). CONCLUSION The survival between groups was similar. Patients with very severe HPS required a longer MV time, longer ICU and hospital stays, and a longer O2 weaning time than those with mild, moderate, or severe HPS.
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Affiliation(s)
- Plínio Turine Neto
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - João Seda Neto
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Eduardo Antunes da Fonseca
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Gilda Porta
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Renata Pugliese
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Marcel Albeiro Ruiz Benavides
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Rodrigo Vincenzi
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Karina Moreira Oliveira Roda
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Vera Lúcia Baggio Danesi
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Adriana Porta Miche Hirschfeld
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Flavia Heinz Feier
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Paulo Chapchap
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Irene Kazue Miura
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
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31
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Lentine KL, Pastan S, Mohan S, Reese PP, Leichtman A, Delmonico FL, Danovitch GM, Larsen CP, Harshman L, Wiseman A, Kramer HJ, Vassalotti J, Joseph J, Longino K, Cooper M, Axelrod DA. A Roadmap for Innovation to Advance Transplant Access and Outcomes: A Position Statement From the National Kidney Foundation. Am J Kidney Dis 2021; 78:319-332. [PMID: 34330526 DOI: 10.1053/j.ajkd.2021.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 04/17/2021] [Accepted: 05/01/2021] [Indexed: 02/07/2023]
Abstract
Over the past 65 years, kidney transplantation has evolved into the optimal treatment for patients with kidney failure, dramatically reducing suffering through improved survival and quality of life. However, access to transplant is still limited by organ supply, opportunities for transplant are inequitably distributed, and lifelong transplant survival remains elusive. To address these persistent needs, the National Kidney Foundation convened an expert panel to define an agenda for future research. The key priorities identified by the panel center on the needs to develop and evaluate strategies to expand living donation, improve waitlist management and transplant readiness, maximize use of available deceased donor organs, and extend allograft longevity. Strategies targeting the critical goal of decreasing organ discard that warrant research investment include educating patients and clinicians about potential benefits of accepting nonstandard organs, use of novel organ assessment technologies and real-time decision support, and approaches to preserve and resuscitate allografts before implantation. The development of personalized strategies to reduce the burden of lifelong immunosuppression and support "one transplant for life" was also identified as a vital priority. The panel noted the specific goal of improving transplant access and graft survival for children with kidney failure. This ambitious agenda will focus research investment to promote greater equity and efficiency in access to transplantation, and help sustain long-term benefits of the gift of life for more patients in need.
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Affiliation(s)
- Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, St Louis, MO.
| | - Stephen Pastan
- Department of Medicine, Emory Transplant Center, Atlanta, GA
| | - Sumit Mohan
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Peter P Reese
- Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA
| | - Alan Leichtman
- Department of Medicine, University of Michigan, Ann Arbor, MI
| | | | | | | | - Lyndsay Harshman
- Department of Pediatrics, University of Iowa Transplant Institute, Iowa City, IA
| | - Alexander Wiseman
- Department of Medicine, Centura Health-Porter Adventist Hospital, Aurora, CO
| | | | - Joseph Vassalotti
- National Kidney Foundation, New York, NY; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Matthew Cooper
- Department of Surgery, Medstar Georgetown Transplant Institute, Washington, DC
| | - David A Axelrod
- Department of Surgery, University of Iowa Transplant Institute, Iowa City, IA
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32
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Sung PS, Han JW, Seo C, Ahn J, Lee SK, Nam HC, Choi HJ, You YK, Jang JW, Choi JY, Yoon SK. Real-Life Experience of mTOR Inhibitors in Liver Transplant Recipients in a Region Where Living Donation Is Predominant. Front Pharmacol 2021; 12:685176. [PMID: 34326770 PMCID: PMC8314303 DOI: 10.3389/fphar.2021.685176] [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: 03/24/2021] [Accepted: 06/30/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Mammalian target of rapamycin (mTOR) inhibitors, such as everolimus and sirolimus, may be efficacious in preserving renal function in liver transplantation (LT) recipients while preventing hepatocellular carcinoma (HCC) recurrence. Materials and Methods: In this study, we retrospectively evaluated the safety, efficacy, and renoprotective effects of mTOR inhibitors in LT recipients. Among the 84 patients enrolled, mTOR inhibitor was commenced during the first year after LT. Renal function was measured by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease equation. Results: Regarding the type of mTOR inhibitor, everolimus was used in 71 patients and sirolimus in 13 patients. Concomitant tacrolimus was used in 63 patients (75.0%). For total enrolled patients, kidney function did not significantly change during 12 months after initiation of mTOR inhibitors, although tacrolimus-withdrawn patients (n = 21) showed better kidney function compared to tacrolimus-minimized patients (n = 63) after conversion. However, a significant improvement in kidney function was observed in the eGFR <60 ml/min/1.73 m2 group (n = 19) 12 months after initiation of mTOR inhibitors, for both patient groups with early + mid starters (n = 7, stating within 1 year after LT) and late starters (n = 12, starting over 1 year after LT). mTOR inhibitors were safely administered without serious adverse events that led to drug discontinuation. Conclusion: We demonstrated that patients with renal impairment showed significant improvement in renal function regardless of the timing of mTOR inhibitor start, suggesting that switch to mTOR inhibitors may be beneficial when renal function declines.
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Affiliation(s)
- Pil Soo Sung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.,The Catholic Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Won Han
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.,The Catholic Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Changho Seo
- Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Joseph Ahn
- Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Soon Kyu Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.,The Catholic Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hee Chul Nam
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.,The Catholic Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho Joong Choi
- Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Young Kyoung You
- Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jeong Won Jang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.,The Catholic Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Young Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.,The Catholic Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Kew Yoon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.,The Catholic Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
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33
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Thomas R, Consolo H, Oniscu GC. Have we reached the limits in altruistic kidney donation? Transpl Int 2021; 34:1187-1197. [PMID: 34008872 DOI: 10.1111/tri.13921] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 04/18/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 01/05/2023]
Abstract
Altruistic donation (unspecified donation) is an important aspect of living donor kidney transplantation. Although donation to a stranger is lawful and supported in many countries, it remains uncommon and not actively promoted. Herein, we ask the question if we have reached the limit in altruistic donation. In doing so, we examine important ethical questions that define the limits of unspecified donation, such as the appropriate balance between autonomous decision-making and paternalistic protection of the donor, the extent of outcome uncertainty and risk-benefit analyses that donors should be allowed to accept. We also consider the scrutiny and acceptance of donor motives, the potential for commercialization, donation to particular categories of recipients (including those encountered through social media) and the ethical boundaries of active promotion of unspecified kidney donation. We conclude that there is scope to increase the number of living donation kidney transplants further by optimizing existing practices to support and promote unspecified donation. A number of strategies including optimization of the assessment process, innovative approaches to reach potential donors together with reimbursement of expenses and a more specific recognition of unspecified donation are likely to lead to a meaningful increase in this type of donation.
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Affiliation(s)
- Rachel Thomas
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK
| | | | - Gabriel C Oniscu
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.,Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
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34
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Vernadakis S, Marinaki S, Darema M, Soukouli I, Michelakis IE, Beletsioti C, Zavvos G, Bokos I, Boletis IN. The Evolution of Living Donor Nephrectomy Program at A Hellenic Transplant Center. Laparoscopic vs. Open Donor Nephrectomy: Single-Center Experience. J Clin Med 2021; 10:1195. [PMID: 33809339 DOI: 10.3390/jcm10061195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/27/2021] [Accepted: 03/05/2021] [Indexed: 01/11/2023] Open
Abstract
Since its introduction in 1995, laparoscopic nephrectomy has emerged as the preferred surgical approach for living donor nephrectomy. Given the ubiquity of the surgical procedure and the need for favorable outcomes, as it is an elective operation on otherwise healthy individuals, it is imperative to ensure appropriate preoperative risk stratification and anticipate intraoperative challenges. The aim of the present study was to compare peri-and postoperative outcomes of living kidney donors (LD), who had undergone laparoscopic nephrectomy (LDN), with a control group of those who had undergone open nephrectomy (ODN). Health-related quality of life (QoL) was also assessed using the validated SF-36 questionnaire. Data from 252 LD from a single transplant center from March 2015 to December 2020 were analyzed retrospectively. In total, 117 donors in the LDN and 135 in the ODN groups were assessed. Demographics, type of transplantation, BMI, duration of surgery, length of hospital stay, peri- and postoperative complications, renal function at discharge and QoL were recorded and compared between the two groups using Stata 13.0 software. There was no difference in baseline characteristics, nor in the prevalence of peri-and postoperative complications, with a total complication rate of 16% (mostly minor, Clavien–Dindo grade II) in both groups, while a different pattern of surgical complications was noticed between them. Duration of surgery was significantly longer in the ODN group (median 240 min vs. 160 min in LDN, p < 0.01), warm ischemia time was longer in the LDN group (median 6 min vs.2 min in ODN, p < 0.01) and length of hospital stay shorter in the LDN group (median 3 days vs. 7 days in ODN). Conversion rate from laparoscopic to open surgery was 2.5%. There was a drop in estimated glomerular filtration rate (eGFR) at discharge of 36 mL/min in the LDN and 32 mL/min in the ODN groups, respectively (p = 0.03). No death, readmission or reoperation were recorded. There was a significant difference in favor of LDN group for each one of the eight items of the questionnaire (SF1–SF8). As for the two summary scores, while the total physical component summary (PCS) score was comparable between the two groups (57.87 in the LDN group and 57.07 in the ODN group), the mental component summary (MCS) score was significantly higher (62.14 vs. 45.22, p < 0.001) in the LDN group. This study provides evidence that minimally invasive surgery can be performed safely, with very good short-term outcomes, providing several benefits for the living kidney donor, thereby contributing to expanding the living donor pool, which is essential, especially in countries with deceased-donor organ shortage.
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35
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Bugeja A, Hae R, Rajda E, Clark EG, Akbari A, Fairhead T, Arianne Buchan C. A living donor kidney transplant recipient with mycobacterium senegalense bacteremia: A case report. Transpl Infect Dis 2021; 23:e13596. [PMID: 33655620 DOI: 10.1111/tid.13596] [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: 02/13/2020] [Revised: 02/03/2021] [Accepted: 02/21/2021] [Indexed: 11/27/2022]
Abstract
Mycobacterium senegalense is primarily known in sub-Saharan Africa to cause bovine farcy, a chronic granulomatous inflammation of the skin and lymphatics in cows. Reports of M. senegalense are rare among humans. We report a unique case of M. senegalense bloodstream infection in a living donor kidney transplant recipient with multiple possible sources of infection.
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Affiliation(s)
- Ann Bugeja
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - Richard Hae
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - Ewa Rajda
- Division of Infectious Diseases, Department of Medical Microbiology, McGill University Health Centre and McGill University, Montreal, Canada
| | - Edward G Clark
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - Ayub Akbari
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - Todd Fairhead
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - C Arianne Buchan
- Division of Infectious Diseases, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
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36
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Westenberg LB, van Londen M, Sotomayor CG, Moers C, Minnee RC, Bakker SJL, Pol RA. The Association between Body Composition Measurements and Surgical Complications after Living Kidney Donation. J Clin Med 2021; 10:E155. [PMID: 33466272 DOI: 10.3390/jcm10010155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 11/16/2022] Open
Abstract
Obesity is considered a risk factor for peri- and postoperative complications. Little is known about this risk in overweight living kidney donors. The aim of this study was to assess if anthropometric body measures and/or surgical determinants are associated with an increased incidence of peri- and postoperative complications after nephrectomy. We included 776 living kidney donors who donated between 2008 and 2018 at the University Medical Center Groningen. Prenephrectomy measures of body composition were body mass index (BMI), body surface area (BSA), waist circumference, weight, and waist–hip ratio. Incidence and severity of peri- and postoperative complications were assessed using the Comprehensive Complication Index. Mean donor age was 53 ± 11 years; 382 (49%) were male, and mean BMI at donor screening was 26.2 ± 3.41 kg/m2. In total, 77 donors (10%) experienced peri- and postoperative complications following donor nephrectomy. Male sex was significantly associated with fewer surgical complications (OR 0.59, 0.37–0.96 95%CI, p = 0.03) in binomial logistic regression analyses. Older age (OR: 1.03, 1.01–1.05 95%CI, p = 0.02) and a longer duration of surgery (OR: 1.01, 1.00–1.01 95%CI, p = 0.02) were significantly associated with more surgical complications in binomial logistic regression analyses. Multinomial logistic regression analyses did not identify any prenephrectomy measure of body composition associated with a higher risk of surgical complications. This study shows that higher prenephrectomy BMI and other anthropometric measures of body composition are not significantly associated with peri- and postoperative complications following living donor nephrectomy.
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37
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Turgeon NA. Deceased donor chains-It is time for debate and consensus. Am J Transplant 2021; 21:5-6. [PMID: 33080097 DOI: 10.1111/ajt.16362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Nicole A Turgeon
- Department of Surgery, University of Texas Dell Medical School, Austin, TX, USA
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38
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DuBray BJ, Shawar SH, Rega SA, Smith KM, Centanni KM, Warmke K, Concepcion BP, Edwards GC, Schaefer HM, Feurer ID, Forbes RC. Impact of Social Media on Self-Referral Patterns for Living Kidney Donation. Kidney360 2020; 1:1419-1425. [PMID: 35372891 DOI: 10.34067/kid.0003212020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/16/2020] [Indexed: 01/10/2023]
Abstract
Background As the organ-shortage crisis continues to worsen, many patients in need of a kidney transplant have turned to social media to find a living donor. The effect of social media on living kidney donation is not known. The goal of this study is to investigate the influence of social media on those interested in donating a kidney. Methods Self-referrals for living kidney donation from December 2016 to March 2019 were retrospectively reviewed. Age, sex, race, and relationship of individuals petitioned through social media (SM) were compared with those petitioned through verbal communication (VC). Data were analyzed using chi-squared tests, with z tests of column proportions, and multivariable logistic regression. Results A total of 7817 individuals (53% SM, 36% VC, and 10% other) were self-referred for living kidney donation. The analysis sample included 6737 adults petitioned through SM (n=3999) or VC (n=2738). Half (n=3933) of the individuals reported an altruistic relationship, and 94% of these respondents were petitioned through SM. Although univariate analyses indicated that SM respondents were younger, more likely female, more likely White, and more likely to have directed altruistic intent than those petitioned through VC (all P<0.05), multivariable logistic regression demonstrated that only decreased age, female sex, and relationship were significantly related to likelihood of SM use (all P<0.001). Conclusions The use of SM to petition living kidney donors is prevalent and accounts for a greater proportion of respondents compared with VC. SM respondents tend to be younger, female, and altruistic compared with VC. Directed altruistic interest in kidney donation is almost exclusively generated through SM.
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Affiliation(s)
- Bernard J DuBray
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Saed H Shawar
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott A Rega
- Vanderbilt Transplant Center, Nashville, Tennessee
| | | | | | - Kara Warmke
- Vanderbilt Transplant Center, Nashville, Tennessee
| | - Beatrice P Concepcion
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gretchen C Edwards
- Division of General Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Heidi M Schaefer
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Irene D Feurer
- Departments of Surgery and Biostatistics, Vanderbilt University Medical Center, Vanderbilt Transplant Center, Nashville, Tennessee
| | - Rachel C Forbes
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Abd ElHafeez S, Noordzij M, Kramer A, Bell S, Savoye E, Abad Diez JM, Lundgren T, Reisaeter AV, Kerschbaum J, Santiuste de Pablos C, Ortiz F, Collart F, Palsson R, Arici M, Heaf JG, Massy ZA, Jager KJ. The association of living donor source with patient and graft survival among kidney transplant recipients in the ERA-EDTA Registry - a retrospective study. Transpl Int 2020; 34:76-86. [PMID: 33022814 PMCID: PMC7821376 DOI: 10.1111/tri.13759] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/21/2020] [Accepted: 09/28/2020] [Indexed: 11/28/2022]
Abstract
In this study we aimed to compare patient and graft survival of kidney transplant recipients who received a kidney from a living‐related donor (LRD) or living‐unrelated donor (LUD). Adult patients in the ERA‐EDTA Registry who received their first kidney transplant in 1998–2017 were included. Ten‐year patient and graft survival were compared between LRD and LUD transplants using Cox regression analysis. In total, 14 370 patients received a kidney from a living donor. Of those, 9212 (64.1%) grafts were from a LRD, 5063 (35.2%) from a LUD and for 95 (0.7%), the donor type was unknown. Unadjusted five‐year risks of death and graft failure (including death as event) were lower for LRD transplants than for LUD grafts: 4.2% (95% confidence interval [CI]: 3.7–4.6) and 10.8% (95% CI: 10.1–11.5) versus 6.5% (95% CI: 5.7–7.4) and 12.2% (95% CI: 11.2–13.3), respectively. However, after adjusting for potential confounders, associations disappeared with hazard ratios of 0.99 (95% CI: 0.87–1.13) for patient survival and 1.03 (95% CI: 0.94–1.14) for graft survival. Unadjusted risk of death‐censored graft failure was similar, but after adjustment, it was higher for LUD transplants (1.19; 95% CI: 1.04–1.35). In conclusion, patient and graft survival of LRD and LUD kidney transplant recipients was similar, whereas death‐censored graft failure was higher in LUD. These findings confirm the importance of both living kidney donor types.
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Affiliation(s)
- Samar Abd ElHafeez
- Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Marlies Noordzij
- Department of Medical Informatics, ERA-EDTA Registry, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Anneke Kramer
- Department of Medical Informatics, ERA-EDTA Registry, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Samira Bell
- Scottish Renal Registry, Meridian Court, Information Services Division Scotland, Glasgow, UK.,Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Emilie Savoye
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | | | - Torbjörn Lundgren
- Division of Transplantation Surgery, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Varberg Reisaeter
- Department of Transplantation Medicine, Oslo University hospital, Rikshospitalet, Norway
| | - Julia Kerschbaum
- Austrian Dialysis and Transplant Registry, Department for Internal Medicine IV - Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Carmen Santiuste de Pablos
- Murcia Renal Registry, Department of Epidemiology, Murcia Regional Health Authority, IMIB-Arrixaca, Murcia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Fernanda Ortiz
- Abdominal Center Unit, HUS Helsinki University Hospital, Helsinki, Finland
| | | | - Runolfur Palsson
- Division of Nephrology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Mustafa Arici
- Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - James G Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, Paris, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Unit 1018 team5, Research Centre in Epidemiology and Population Health (CESP), University of Paris Ouest-Versailles-St Quentin-en-Yveline, Villejuif, France
| | - Kitty J Jager
- Department of Medical Informatics, ERA-EDTA Registry, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
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Nicholson ML, Hoff M, Leighton P, Mohamed I, Hosgood SA. Pre-emptive immunosuppression using tacrolimus monotherapy does not reduce the rate of early acute rejection in renal transplantation from live donors: a comparative cohort study. Transpl Int 2020; 33:1754-1761. [PMID: 32964465 DOI: 10.1111/tri.13747] [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: 07/01/2020] [Revised: 08/04/2020] [Accepted: 09/14/2020] [Indexed: 11/29/2022]
Abstract
The planned nature of live donor kidney transplantation allows for immunosuppression to be initiated in the pretransplant period. The aim of this study was to determine the effect of pre-emptive immunosuppression on acute rejection rates after live donor kidney transplantation. In two consecutive cohorts of live donor kidneys transplants, 99 patients received pre-emptive immunosuppression with tacrolimus monotherapy for 2 weeks prior to transplantation (PET group - first era) and 100 patients received tacrolimus-based immunosuppression commencing on the day of transplantation (control group - second era). The main outcome measure was the incidence of biopsy-proven acute rejection (BPAR) in the first 3 months post-transplantation. Tacrolimus levels were significantly higher in the PET group at day 4 post-transplant (PET 9.08 ± 4.57 vs. control 5.92 ± 3.64 ng/ml; P < 0.0001), but there were no significant differences in tacrolimus levels at day 7 (PET 8.22 ± 3.58 vs. control 7.63 ± 3.56 ng/ml; P = 0.2452). BPAR was numerically higher in the PET group, but this difference did not reach statistical significance (PET 13/99 vs. control 6/100; P = 0.097). There were no differences in allograft function measured by serum creatinine at 1 year (PET 130 ± 36 vs. control 142 ± 69 μmol/l; P = 0.6829). Graft survival at 1 year was equivalent in both groups (PET 96.9 vs. control 97.0%; P = 0.9915). This study suggests that there is little role for the use of pre-emptive tacrolimus monotherapy in ABO blood group and HLA-compatible live donor kidney transplantation in patients on triple maintenance immunosuppression.
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Affiliation(s)
- Michael L Nicholson
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.,Leicester General Hospital, University of Leicester, Leicester, UK
| | - Mekhola Hoff
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Philippa Leighton
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Ismail Mohamed
- Leicester General Hospital, University of Leicester, Leicester, UK
| | - Sarah A Hosgood
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
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Waterman AD, Wood EH, Ranasinghe ON, Faye Lipsey A, Anderson C, Balliet W, Holland-Carter L, Maurer S, Aurora Posadas Salas M. A Digital Library for Increasing Awareness About Living Donor Kidney Transplants: Formative Study. JMIR Form Res 2020; 4:e17441. [PMID: 32480362 PMCID: PMC7404010 DOI: 10.2196/17441] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 12/12/2019] [Revised: 05/08/2020] [Accepted: 05/14/2020] [Indexed: 12/15/2022] Open
Abstract
Background It is not common for people to come across a living kidney donor, let alone consider whether they would ever donate a kidney themselves while they are alive. Narrative storytelling, the sharing of first-person narratives based on lived experience, may be an important way to improve education about living donor kidney transplants (LDKTs). Developing ways to easily standardize and disseminate diverse living donor stories using digital technology could inspire more people to consider becoming living donors and reduce the kidney shortage nationally. Objective This paper aimed to describe the development of the Living Donation Storytelling Project, a web-based digital library of living donation narratives from multiple audiences using video capture technology. Specifically, we aimed to describe the theoretical foundation and development of the library, a protocol to capture diverse storytellers, the characteristics and experiences of participating storytellers, and the frequency with which any ethical concerns about the content being shared emerged. Methods This study invited kidney transplant recipients who had received LDKTs, living donors, family members, and patients seeking LDKTs to record personal stories using video capture technology by answering a series of guided prompts on their computer or smartphone and answering questions about their filming experience. The digital software automatically spliced responses to open-ended prompts, creating a seamless story available for uploading to a web-based library and posting to social media. Each story was reviewed by a transplant professional for the disclosure of protected health information (PHI), pressuring others to donate, and medical inaccuracies. Disclosures were edited. Results This study recruited diverse storytellers through social media, support groups, churches, and transplant programs. Of the 137 storytellers who completed the postsurvey, 105/137 (76.6%) were white and 99/137 (72.2%) were female. They spent 62.5 min, on average, recording their story, with a final median story length of 10 min (00:46 seconds to 32:16 min). A total of 94.8% (130/137) of storytellers were motivated by a desire to educate the public; 78.1% (107/137) were motivated to help more people become living donors; and 75.9% (104/137) were motivated to dispel myths. The ease of using the technology and telling their story varied, with the fear of being on film, emotional difficulty talking about their experiences, and some technological barriers being reported. PHI, most commonly surnames and transplant center names, was present in 62.9% (85/135) of stories and was edited out. Conclusions With appropriate sensitivity to ensure diverse recruitment, ethical review of content, and support for storytellers, web-based storytelling platforms may be a cost-effective and convenient way to further engage patients and increase the curiosity of the public in learning more about the possibility of becoming living donors.
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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, United States.,Terasaki Research Institute, Los Angeles, CA, United States
| | - Emily H Wood
- Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Omesh N Ranasinghe
- Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Crystal Anderson
- Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Wendy Balliet
- Medical University of South Carolina, Charleston, SC, United States
| | | | - Stacey Maurer
- Medical University of South Carolina, Charleston, SC, United States
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Bellini MI, Courtney AE, McCaughan JA. Living Donor Kidney Transplantation Improves Graft and Recipient Survival in Patients with Multiple Kidney Transplants. J Clin Med 2020; 9:jcm9072118. [PMID: 32635614 PMCID: PMC7408952 DOI: 10.3390/jcm9072118] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 06/03/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Failed kidney transplant recipients benefit from a new graft as the general incident dialysis population, although additional challenges in the management of these patients are often limiting the long-term outcomes. Previously failed grafts, a long history of comorbidities, side effects of long-term immunosuppression and previous surgical interventions are common characteristics in the repeated kidney transplantation population, leading to significant complex immunological and technical aspects and often compromising the short- and long-term results. Although recipients’ factors are acknowledged to represent one of the main determinants for graft and patient survival, there is increasing interest in expanding the donor’s pool safely, particularly for high-risk candidates. The role of living kidney donation in this peculiar context of repeated kidney transplantation has not been assessed thoroughly. The aim of the present study is to analyse the effects of a high-quality graft, such as the one retrieved from living kidney donors, in the repeated kidney transplant population context. Methods: Retrospective analysis of the outcomes of the repeated kidney transplant population at our institution from 1968 to 2019. Data were extracted from a prospectively maintained database and stratified according to the number of transplants: 1st, 2nd or 3rd+. The main outcomes were graft and patient survivals, recorded from time of transplant to graft failure (return to dialysis) and censored at patient death with a functioning graft. Duration of renal replacement therapy was expressed as cumulative time per month. A multivariate analysis considering death-censored graft survival, decade of transplantation, recipient age, donor age, living donor, transplant number, ischaemic time, time on renal replacement therapy prior to transplant and HLA mismatch at HLA-A, -B and -DR was conducted. In the multivariate analysis of recipient survival, diabetic nephropathy as primary renal disease was also included. Results: A total of 2395 kidney transplant recipients were analysed: 2062 (83.8%) with the 1st kidney transplant, 279 (11.3%) with the 2nd graft, 46 (2.2%) with the 3rd+. Mean age of 1st kidney transplant recipients was 43.6 ± 16.3 years, versus 39.9 ± 14.4 for 2nd and 41.4 ± 11.5 for 3rd+ (p < 0.001). Aside from being younger, repeated kidney transplant patients were also more often males (p = 0.006), with a longer time spent on renal replacement therapy (p < 0.0001) and a higher degree of sensitisation, expressed as calculated reaction frequency (p < 0.001). There was also an association between multiple kidney transplants and better HLA match at transplantation (p < 0.0001). A difference in death-censored graft survival by number of transplants was seen, with a median graft survival of 328 months for recipients of the 1st transplant, 209 months for the 2nd and 150 months for the 3rd+ (p = 0.038). The same difference was seen in deceased donor kidneys (p = 0.048), but not in grafts from living donors (p = 0.2). Patient survival was comparable between the three groups (p = 0.59). Conclusions: In the attempt to expand the organ donor pool, particular attention should be reserved to high complex recipients, such as the repeated kidney transplant population. In this peculiar context, the quality of the donor has been shown to represent a main determinant for graft survival—in fact, kidney retrieved from living donors provide comparable outcomes to those from single-graft recipients.
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Sharma V, Roy R, Piscoran O, Summers A, van Dellen D, Augustine T. Living donor kidney transplantation: Let's talk about it. Clin Med (Lond) 2020; 20:346-348. [PMID: 32414729 DOI: 10.7861/clinmed.2020-0047] [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: 11/27/2022]
Abstract
Transplantation is the preferred treatment option for end-stage renal disease as it offers superior results and patient reported outcomes in comparison to dialysis. Patients treated with a transplant live longer, healthier and more independent lives. Transplantation is also more cost-effective, reducing the overall burden of renal disease. Despite the rising incidence of renal failure, the uptake of living donor kidney transplantation has been static across the UK for several years. Among transplantation, living donation offers a number of advantages compared with deceased donor transplantation. The procedure is more likely to be performed pre-dialysis and the elective nature allows for better perioperative planning. Awareness for living donation processes among healthcare professionals, patients and the public appears to be poor. Sharing information regarding the process will help educate colleagues, dispel myths and, crucially, allow patients the opportunity to talk about this treatment option with their hospital doctor.
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Affiliation(s)
- Videha Sharma
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK and University of Manchester, Manchester, UK
| | - Reuben Roy
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Oana Piscoran
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK and University of Manchester, Manchester, UK
| | - Angela Summers
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK and University of Manchester, Manchester, UK
| | - David van Dellen
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK and University of Manchester, Manchester, UK
| | - Titus Augustine
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK and University of Manchester, Manchester, UK
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Jehn U, Schütte-Nütgen K, Henke U, Bautz J, Pavenstädt H, Suwelack B, Reuter S. Prognostic Value of Growth Differentiation Factor 15 in Kidney Donors and Recipients. J Clin Med 2020; 9:E1333. [PMID: 32375259 DOI: 10.3390/jcm9051333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/23/2020] [Accepted: 05/01/2020] [Indexed: 12/13/2022] Open
Abstract
Growth differentiation factor-15 (GDF15) is associated with inflammatory conditions, chronic kidney disease, cardiovascular disease and mortality. There is very limited data on GDF15 after kidney donation and transplantation. We analyzed serum samples of patients who donated a kidney (54 living donors) or who underwent kidney transplantation (104 recipients) at the University Hospital of Münster (Germany) between 2013 and 2015, for GDF15 levels immediately prior and one year after surgery. GDF15 levels were significantly elevated in end-stage renal disease patients compared to healthy individuals (2844 (IQR 2087, 3361) pg/ml vs. 384 (IQR 307, 487) pg/ml, p < 0.001). GDF15 was strongly associated with the dialysis vintage. While kidney transplantation led to a significant decrease of GDF15 (913 (IQR 674, 1453) pg/ml, p < 0.001), kidney donation caused a moderate increase of GDF15 (510 (IQR 420, 626), p < 0.001) one year after surgery. GDF15 levels remained significantly higher in recipients and kidney donors than in healthy controls (735 (IQR 536, 1202) pg/ml vs. 384 (IQR 307, 487) pg/ml, p < 0.001). GDF15 is increased in patients with kidney disease and is associated with dialysis vintage. Given its decrease after transplantation and its increase after uni-nephrectomy, GDF15 might be a marker of kidney function. However, since it correlates only to the eGFR in transplanted patients it may indicate chronic kidney disease.
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Ambagtsheer F, Haase-Kromwijk B, Dor FJMF, Moorlock G, Citterio F, Berney T, Massey EK. Global Kidney Exchange: opportunity or exploitation? An ELPAT/ESOT appraisal. Transpl Int 2020; 33:989-998. [PMID: 32349176 PMCID: PMC7540591 DOI: 10.1111/tri.13630] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/11/2020] [Accepted: 04/24/2020] [Indexed: 12/20/2022]
Abstract
This paper addresses ethical, legal, and psychosocial aspects of Global Kidney Exchange (GKE). Concerns have been raised that GKE violates the nonpayment principle, exploits donors in low- and middle-income countries, and detracts from the aim of self-sufficiency. We review the arguments for and against GKE. We argue that while some concerns about GKE are justified based on the available evidence, others are speculative and do not apply exclusively to GKE but to living donation more generally. We posit that concerns can be mitigated by implementing safeguards, by developing minimum quality criteria and by establishing an international committee that independently monitors and evaluates GKE's procedures and outcomes. Several questions remain however that warrant further clarification. What are the experiences and views of recipients and donors participating in GKE? Who manages the escrow funds that have been put in place for donor and recipients? What procedures and safeguards have been put in place to prevent corruption of these funds? What are the inclusion criteria for participating GKE centers? GKE provides opportunity to promote access to donation and transplantation but can only be conducted with the appropriate safeguards. Patients' and donors' voices are missing in this debate.
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Affiliation(s)
- Frederike Ambagtsheer
- Department of Internal Medicine, Nephrology & Transplantation, Erasmus MC, Rotterdam, The Netherlands
| | | | - Frank J M F Dor
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Greg Moorlock
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Franco Citterio
- Renal Transplantation Unit, Fondazione Policlinico Universitario, A. Gemelli, Rome, Italy
| | - Thierry Berney
- Division of Transplantation, University of Geneva Hospitals, Geneva, Switzerland
| | - Emma K Massey
- Department of Internal Medicine, Nephrology & Transplantation, Erasmus MC, Rotterdam, The Netherlands
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Contento MN, Vercillo RN, Malaga-Dieguez L, Pehrson LJ, Wang Y, Liu M, Stewart Z, Montgomery R, Trachtman H. Center Volume and Kidney Transplant Outcomes in Pediatric Patients. Kidney Med 2020; 2:297-306. [PMID: 32734249 PMCID: PMC7380383 DOI: 10.1016/j.xkme.2020.01.008] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Rationale & Objectives Recent data demonstrate that center volume is not a factor in the outcomes of adult kidney transplant recipients. This study assessed whether center volume affects graft survival in pediatric patients who received a kidney transplant. Study Design Case-cohort study. Setting & Participants Kidney transplantation centers, recipients younger than 18 years. Results Data were retrieved from the Scientific Registry of Transplant Recipients for transplantations performed July 1, 2010, to June 30, 2015, and the Organ Procurement and Transplantation Network for transplantations performed January 1, 2010, to December 30, 2015. Center volume was divided into 3 groups: low (<4 per year), intermediate (4-8 per year), and high (>8 per year). The primary outcome was 3-year graft survival rate. Outcomes were reviewed in 115 centers that performed 3,762 transplantations. There were no substantive differences in sex, age, ethnicity, diagnosis, and kidney donor profile index score in the 3 transplantation center volume categories. During the 5-year period (July 1, 2010, to June 30, 2015), 3-year graft survival in centers with low, intermediate, and high volumes were 88.4%, 90.3%, and 92.1%, respectively; P = 0.02. Although outcomes for deceased donor kidney recipients were similar in the 3 volume categories, outcomes in patients who received a living kidney donation were better in the high-volume centers. Low household income was associated with poorer outcomes. However, 3-year graft survival was similar in the 3 center volume categories in high and low mean household income states. Limitations Lack of information for complications and individual family household income of recipients. Conclusions Transplantation outcomes are worse in pediatric patients treated at lower-volume centers. The difference was more pronounced for patients receiving living versus deceased donor kidneys. The distribution of household income in pediatric transplant recipients may also be a factor that contributes to lower 3-year graft survival in low-volume centers.
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Affiliation(s)
- Marissa N Contento
- Division of Nephrology, Department of Pediatrics, NYU Langone Health, New York, NY
| | - Rachel N Vercillo
- Division of Nephrology, Department of Pediatrics, NYU Langone Health, New York, NY
| | - Laura Malaga-Dieguez
- Division of Nephrology, Department of Pediatrics, NYU Langone Health, New York, NY
| | - Laura Jane Pehrson
- Division of Nephrology, Department of Pediatrics, NYU Langone Health, New York, NY
| | - Yuyan Wang
- Division of Biostatistics, Department of Population Health, NYU Langone Health, New York, NY
| | - Mengling Liu
- Division of Biostatistics, Department of Population Health, NYU Langone Health, New York, NY
| | - Zoe Stewart
- Division of Transplantation, Department of Surgery, NYU Langone Health, New York, NY
| | - Robert Montgomery
- Division of Transplantation, Department of Surgery, NYU Langone Health, New York, NY
| | - Howard Trachtman
- Division of Nephrology, Department of Pediatrics, NYU Langone Health, New York, NY
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Jehn U, Schütte-Nütgen K, Bautz J, Pavenstädt H, Suwelack B, Thölking G, Heinzow H, Reuter S. Cytomegalovirus Viremia after Living and Deceased Donation in Kidney Transplantation. J Clin Med 2020; 9:jcm9010252. [PMID: 31963515 PMCID: PMC7019428 DOI: 10.3390/jcm9010252] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 12/22/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 12/14/2022] Open
Abstract
Despite screening, effective anti-viral drugs and risk-balanced prophylaxis, cytomegalovirus (CMV) remains a major cause of morbidity in transplant patients. The objective of this study was to retrospectively analyze the risk factors associated with CMV viremia after kidney transplantation in a large European cohort with standardized valganciclovir prophylaxis in the present era. A special focus was placed on the comparison of living and postmortal donation. We conducted a longitudinal observational study involving 723 adult patients with a total of 3292 patient-years who were transplanted at our center between 2007 and 2015. Valganciclovir prophylaxis was administered over 100 days for CMV+ donors (D) or recipients (R), over 200 days for D+/R−, and none in D−/R−. A CMV+ donor, rejection episodes, and deceased donor transplantation were identified to be associated with increased incidences of CMV viremia. Although we did not find a reduced overall survival rate for patients with CMV viremia, it was associated with worse graft function. Since we observed a relevant number of CMV infections despite prescribing valganciclovir prophylaxis, a pre-emptive strategy in patients with (suspected) adherence restrictions could be favored. Our data can help transplant physicians educate their patients about their individual CMV risk and choose the most appropriate CMV treatment approach.
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Affiliation(s)
- Ulrich Jehn
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Muenster, 48149 Muenster, Germany; (U.J.); (K.S.-N.); (J.B.); (H.P.); (B.S.); (G.T.)
| | - Katharina Schütte-Nütgen
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Muenster, 48149 Muenster, Germany; (U.J.); (K.S.-N.); (J.B.); (H.P.); (B.S.); (G.T.)
| | - Joachim Bautz
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Muenster, 48149 Muenster, Germany; (U.J.); (K.S.-N.); (J.B.); (H.P.); (B.S.); (G.T.)
| | - Hermann Pavenstädt
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Muenster, 48149 Muenster, Germany; (U.J.); (K.S.-N.); (J.B.); (H.P.); (B.S.); (G.T.)
| | - Barbara Suwelack
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Muenster, 48149 Muenster, Germany; (U.J.); (K.S.-N.); (J.B.); (H.P.); (B.S.); (G.T.)
| | - Gerold Thölking
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Muenster, 48149 Muenster, Germany; (U.J.); (K.S.-N.); (J.B.); (H.P.); (B.S.); (G.T.)
| | - Hauke Heinzow
- Department of Medicine B, Division of Gastroenterology and Hepatology, University Hospital of Muenster, 48149 Muenster, Germany;
| | - Stefan Reuter
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Muenster, 48149 Muenster, Germany; (U.J.); (K.S.-N.); (J.B.); (H.P.); (B.S.); (G.T.)
- Correspondence: ; Tel.: +49-251-83-47540; Fax: +49-251-83-56973
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Lentine KL, Koraishy FM, Sarabu N, Naik AS, Lam NN, Garg AX, Axelrod D, Zhang Z, Hess GP, Kasiske BL, Segev DL, Henderson ML, Massie AB, Holscher CM, Schnitzler MA. Associations of obesity with antidiabetic medication use after living kidney donation: An analysis of linked national registry and pharmacy fill records. Clin Transplant 2019; 33:e13696. [PMID: 31421057 PMCID: PMC7153560 DOI: 10.1111/ctr.13696] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/23/2019] [Accepted: 08/05/2019] [Indexed: 12/19/2022]
Abstract
We examined a novel linkage of national US donor registry data with records from a pharmacy claims warehouse (2007-2016) to examine associations (adjusted hazard ratio, LCL aHRUCL ) of post-donation fills of antidiabetic medications (ADM, insulin or non-insulin agents) with body mass index (BMI) at donation and other demographic and clinical factors. In 28 515 living kidney donors (LKDs), incidence of ADM use at 9 years rose in a graded manner with higher baseline BMI: underweight, 0.9%; normal weight, 2.1%; overweight, 3.5%; obese, 8.5%. Obesity was associated with higher risk of ADM use compared with normal BMI (aHR, 3.36 4.596.27 ). Metformin was the most commonly used ADM and was filled more often by obese than by normal weight donors (9-year incidence, 6.87% vs 1.85%, aHR, 3.55 5.007.04 ). Insulin use was uncommon and did not differ significantly by BMI. Among a subgroup with BMI data at the 1-year post-donation anniversary (n = 19 528), compared with stable BMI, BMI increase >0.5 kg/m2 by year 1 was associated with increased risk of subsequent ADM use (aHR, 1.03 1.482.14, P = .04). While this study did not assess the impact of donation on the development of obesity, these data support that among LKD, obesity is a strong correlate of ADM use.
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Affiliation(s)
- Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Farrukh M Koraishy
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Nagaraju Sarabu
- Division of Nephrology, Department of Medicine, University Hospitals Cleveland Medical center, Cleveland, OH, USA
| | - Abhijit S Naik
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ngan N Lam
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Amit X Garg
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
| | - David Axelrod
- University of Iowa Transplant Institute, University of Iowa School of Medicine, Iowa City, IA, USA
| | - Zidong Zhang
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Gregory P Hess
- Drexel College of Medicine, Drexel University, Philadelphia, PA, USA
| | - Bertram L Kasiske
- Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Dorry L Segev
- Division of Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Macey L Henderson
- Division of Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Allan B Massie
- Division of Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Courtenay M Holscher
- Division of Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Mark A Schnitzler
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
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Abstract
PURPOSE OF REVIEW The safety of living donor nephrectomy is essential to the continued success, growth, and sustainability of the clinical practice of living donor kidney transplantation. This review summarizes recent advances in our understanding of the perioperative and long-term risks faced by living kidney donors. RECENT FINDINGS Although adverse perioperative complications are extremely rare, donors particularly men, Black, or obese, frequently experience minor complications that result in delayed return to normal duties at home and work. Similarly, although long-term complications such as end-stage renal disease (ESRD) are rare, recent studies suggest a relative increase in risk of ESRD that is attributable to donation. Several risk calculators have been developed to help donors and their care providers quantify the baseline and postdonation risk of ESRD based on demographic and health characteristics. Thresholds of risk may help define what is an acceptable level of risk to the donor and the transplant center. SUMMARY Individualized risk calculators now allow care providers and potential donors to objectively and transparently participate in shared decision-making about the safety of living kidney donation.
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Affiliation(s)
- Luckmini Liyanage
- Department of Surgery, Division of Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Abimerki Muzaale
- Department of Surgery, Division of Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Macey Henderson
- Department of Surgery, Division of Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD, USA
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Alhalel N, Francone NO, Salazar AM, Primeaux S, Ruiz R, Caicedo JC, Gordon EJ. Patients' perceptions of a culturally targeted Hispanic Kidney Transplant Program: A mixed methods study. Clin Transplant 2019; 33:e13577. [PMID: 31034642 DOI: 10.1111/ctr.13577] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/29/2019] [Revised: 04/11/2019] [Accepted: 04/22/2019] [Indexed: 11/29/2022]
Abstract
Disproportionately fewer waitlisted Hispanics receive living donor kidney transplants (LDKTs) compared to non-Hispanic whites. Northwestern Medicine's® culturally targeted Hispanic Kidney Transplant Program (HKTP) is associated with a significant increase in LDKTs among Hispanics. This multisite study assessed potential kidney recipients' and donors' and/or family members' perceptions of the HKTP's cultural components through semi-structured interviews and validated surveys. Qualitative thematic analysis and descriptive statistics were performed. Thirty-six individuals participated (62% participation rate) comprising 21 potential recipients and 15 potential donors/family (mean age: 51 years, 50% female, 72% preferred Spanish). Participants felt confident about the educational information because a transplant physician delivered the education and viewed the group format as effective. Participants felt that education sessions addressed myths about transplantation shared by Hispanics. Primary use of Spanish enhanced participants' understanding of transplantation. While few knew about living donation before attending the HKTP, most were "more in favor of" kidney transplantation (97%) and living donation (97%) afterward. Few reported learning about the HKTP from outreach staff and suggested leveraging community leaders to promote HKTP awareness. Our findings suggest the HKTP's cultural components were viewed favorably and positively influenced perceptions of kidney transplantation and living donation, which may help reduce transplant disparities in Hispanics. (Clinicaltrial.gov registration # NCT03276390, date of registration: 9-7-17, retrospectively registered).
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Affiliation(s)
- Nathan Alhalel
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Alice M Salazar
- Abdominal Transplant Research, Baylor Scott & White Research Institute, Dallas, Texas.,Baylor Scott & White Research Institute, Dallas, Texas
| | | | - Richard Ruiz
- Baylor Simmons Transplant Institute, Dallas, Texas
| | - Juan Carlos Caicedo
- Comprehensive Transplant Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Elisa J Gordon
- Comprehensive Transplant Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Center for Bioethics and Medical Humanities, Department of Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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