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Au S, Bellato V, Carvas JM, Córdoba CD, Daudu D, Dziakova J, Eltarhoni K, El Feituri N, Fung ACH, Fysaraki C, Gallo G, Gultekin FA, Harbjerg JL, Hatem F, Ioannidis A, Jakobsen L, Clinch D, Kristensen HØ, Kuiper SZ, Kwok AMF, Kwok W, Millan M, Milto KM, Ng HJ, Pellino G, Picciariello A, Pronin S, van Ramshorst GH, Ramser M, Jiménez-Rodríguez RM, Sainz Hernandez JC, Samadov E, Sohrabi S, Uchiyama M, Wang JHS, Younis MU, Fleming S, Alhomoud S, Mayol J, Moeslein G, Smart NJ, Soreide K, Teh C, Verran D, Maeda Y. Global parental leave in surgical careers: differences according to gender, geographical regions and surgical career stages. Br J Surg 2021; 108:1315-1322. [PMID: 34467970 DOI: 10.1093/bjs/znab275] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/24/2021] [Accepted: 07/01/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND There is a lack of information regarding the provision of parental leave for surgical careers. This survey study aims to evaluate the experience of maternity/paternity leave and views on work-life balance globally. METHODS A 55-item online survey in 24 languages was distributed via social media as per CHERRIES guideline from February to March 2020. It explored parental leave entitlements, attitude towards leave taking, financial impact, time spent with children and compatibility of parenthood with surgical career. RESULTS Of the 1393 (male : female, 514 : 829) respondents from 65 countries, there were 479 medical students, 349 surgical trainees and 513 consultants. Consultants had less than the recommended duration of maternity leave (43.8 versus 29.1 per cent), no paid maternity (8.3 versus 3.2 per cent) or paternity leave (19.3 versus 11.0 per cent) compared with trainees. Females were less likely to have children than males (36.8 versus 45.6 per cent, P = 0.010) and were more often told surgery is incompatible with parenthood (80.2 versus 59.5 per cent, P < 0.001). Males spent less than 20 per cent of their salary on childcare and fewer than 30 hours/week with their children. More than half (59.2 per cent) of medical students did not believe a surgical career allowed work-life balance. CONCLUSION Surgeons across the globe had inadequate parental leave. Significant gender disparity was seen in multiple aspects.
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Affiliation(s)
- S Au
- NHS Education for Scotland, Edinburgh, UK
| | | | | | - C D Córdoba
- University of Lausanne, Lausanne, Switzerland
| | - D Daudu
- Faculty of Health and Medical Sciences, University of Western Australia, Australia
| | - J Dziakova
- Hospital Clinico San Carlos, IDISSC, Madrid, Spain
| | | | | | - A C H Fung
- Department of Surgery, The University of Hong Kong, Hong Kong SAR, China
| | - C Fysaraki
- Urology Department, Mid Yorkshire Hospitals NHS Trust, UK
| | - G Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - F Ayca Gultekin
- General Surgery Department, Zonguldak Bulent, Ecevit University School of Medicine, Zonguldak, Turkey
| | - J L Harbjerg
- Department of Surgery, Research Unit C119, Aarhus University Hospital, Palle Juul-Jensens, Aarhus N, Denmark
| | - F Hatem
- Glasgow Royal Infirmary, Glasgow, UK
| | | | - L Jakobsen
- UiT, The Arctic University of Norway, University Hospital of North Norway, Tromso, Norway
| | - D Clinch
- Department of General Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - H Ø Kristensen
- Department of Surgery, Research Unit C119, Aarhus University Hospital, Palle Juul-Jensens, Aarhus N, Denmark
| | - S Z Kuiper
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
| | | | - W Kwok
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | - M Millan
- Coloproctology Unit, Department of Surgery, La Fe University Hospital, Valencia, Spain
| | - K M Milto
- NHS Education for Scotland, Edinburgh, UK
| | - H J Ng
- Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, UK
| | - G Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - A Picciariello
- Department of Emergency and Organ Transplantation, University 'Aldo Moro' of Bari, Italy
| | - S Pronin
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | | | - M Ramser
- Department of Surgery, Solothurner Spitäler SoH, Bürgerspital Solothurn, Solothurn, Switzerland
| | | | - J C Sainz Hernandez
- Instituto Nacional de Ciencias Médicas y Nutrición 'Salvador Zubirán', Mexico City, Mexico
| | - E Samadov
- Surgical Department, LEYLA Medical Centre, Baku, Azerbaijan
| | | | - M Uchiyama
- Showa University School of Medicine, Tokyo, Japan
| | - J H-S Wang
- Australasian Students' Surgical Association, New Zealand
| | - M U Younis
- Mediclinic City Hospital, Dubai, United Arab Emirates
| | - S Fleming
- Barts and the London School of Medicine and Dentistry, London, UK
| | - S Alhomoud
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - J Mayol
- Hospital Clinico San Carlos, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain
| | - G Moeslein
- Ev. Bethesda Khs Duisburg, University of Witten, Herdecke, Germany
| | - N J Smart
- Royal Devon & Exeter Hospital & University of Exeter Medical School, Exeter, UK
| | - K Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - C Teh
- Department of Surgery, Makati Medical Centre, Makati, Philippines.,Department of General Surgery, National Kidney & Transplant Institute, Quezon City, Philippines
| | - D Verran
- Ramsey Health Care, Sydney, Australia
| | - Y Maeda
- Department of Colorectal Surgery, Western General Hospital and University of Edinburgh, Edinburgh, UK
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Sawant R, Hulse K, Sohrabi S, Yeo JCL, Pal K, Gibb FW, Adamson R, Nixon IJ. The impact of completion thyroidectomy. Eur J Surg Oncol 2019; 45:1171-1174. [PMID: 30910458 DOI: 10.1016/j.ejso.2019.03.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/01/2019] [Accepted: 03/11/2019] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The oncological benefit of completion thyroidectomy (CT) following thyroid lobectomy (TL) is presumed to be similar to that of upfront total thyroidectomy(TT), from a patient's perspective the risk and inconvenience of further surgery adds significantly to the impact of the overall treatment. The aim of this study is to assess the impact of CT in terms of the duration of admission and associated complications. METHODS A study of consecutive patients with DTC identified from prospective MDT records of South-East Scotland from 2009 to 2015. Surgical data was extracted from electronic medical record. RESULTS Of 361 patients diagnosed with DTC, 161 (45%) had CT. The median postoperative stay was 1 day (range 1-5days). In total 22 patients (14%)suffered complications. Four patients (3%) developed postoperative haematoma. Two (1%) had an identified permanent nerve palsy on the completion side. 13 patients (8%) remained on calcium supplementation for more than 6 months postoperatively and three patients (2%) developed wound complications. CONCLUSIONS Our study confirms that CT is regularly performed (45%). Recent changes in international guidelines recognize increasing number of patients as eligible for a conservative approach but recommend CT based on whether upfront TT would have been recommended if the TL pathology were known from the outset. Such an approach fails to consider the additional risk and inconvenience of CT on the overall patient experience. Due to a relatively high rate of complications, only those patients who are most likely to benefit from further surgery to facilitate adjuvant radioactive iodine should be offered additional surgery.
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Affiliation(s)
- R Sawant
- Department of Otolaryngology, Head and Neck Surgery, NHS Lothian, Edinburgh, UK.
| | - K Hulse
- Department of Otolaryngology, Head and Neck Surgery, NHS Lothian, Edinburgh, UK.
| | - S Sohrabi
- Department of Otolaryngology, Head and Neck Surgery, NHS Lothian, Edinburgh, UK.
| | - J C L Yeo
- Department of Otolaryngology, Head and Neck Surgery, Kirkaldy, NHS Fife, UK.
| | - K Pal
- Department of General Surgery, Borders General Hospital, UK.
| | - F W Gibb
- Department of Endocrinology, NHS Lothian, Edinburgh, UK.
| | - R Adamson
- Department of Otolaryngology, Head and Neck Surgery, NHS Lothian, Edinburgh, UK.
| | - I J Nixon
- Department of Otolaryngology, Head and Neck Surgery, NHS Lothian, Edinburgh, UK.
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Sohrabi S, Wheatcroft S, Barth JH, Bailey MA, Johnson A, Bridge K, Griffin K, Baxter PD, Scott DJA. Cardiovascular risk in patients with small and medium abdominal aortic aneurysms, and no history of cardiovascular disease. Br J Surg 2014; 101:1238-43. [DOI: 10.1002/bjs.9567] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 08/19/2013] [Accepted: 04/17/2014] [Indexed: 12/31/2022]
Abstract
Abstract
Background
Cardiovascular disease (CVD) is the main cause of death in people with abdominal aortic aneurysm (AAA). There is little evidence that screening for AAA reduces all-cause or cardiovascular mortality. The aim of the study was to assess whether subjects with a small or medium AAA (3·0–5·4 cm), without previous history of clinical CVD, had raised levels of CVD biomarkers or increased total mortality.
Methods
This prospective study included subjects with a small or medium AAA and controls, all without a history of clinical CVD. CVD biomarkers (high-sensitivity C-reactive protein, hs-CRP; heart-type fatty acid-binding protein, H-FABP) were measured, and survival was recorded.
Results
Of a total of 815 people, 476 with an AAA and 339 controls, a cohort of 86 with small or medium AAA (3–5·4 cm) and 158 controls, all with no clinical history of CVD, were identified. The groups were matched for age and sex. The AAA group had higher median (i.q.r.) levels of hs-CRP (2·8 (1·2–6·0) versus 1·3 (0·5–3·5) mg/l; P < 0·001) and H-FABP (4·6 (3·5–6·0) versus 4·0 (3·3–5·1) µg/l; P = 0·011) than controls. Smoking was more common in the AAA group; however, hs-CRP and H-FABP levels were not related to smoking. Mean survival was lower in the AAA group: 6·3 (95 per cent confidence interval (c·i.) 5·6 to 6·9) years versus 8·0 (7·6 to 8·1) years in controls (P < 0·001). Adjusted mortality was higher in the AAA group (hazard ratio 3·41, 95 per cent c·i. 2·11 to 9·19; P < 0·001).
Conclusion
People with small or medium AAA and no clinical symptoms of CVD have higher levels of hs-CRP and H-FABP, and higher mortality compared with controls. They should continue to receive secondary prevention against CVD.
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Affiliation(s)
- S Sohrabi
- Leeds Vascular Institute, Leeds, UK
- Leeds General Infirmary Teaching Hospital NHS Trust, Leeds, UK
- Institute for Genetics Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre (MCRC), Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - S Wheatcroft
- Institute for Genetics Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre (MCRC), Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - J H Barth
- Blood Sciences, Leeds General Infirmary, Leeds, UK
| | - M A Bailey
- Leeds Vascular Institute, Leeds, UK
- Leeds General Infirmary Teaching Hospital NHS Trust, Leeds, UK
- Institute for Genetics Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre (MCRC), Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - A Johnson
- Leeds Vascular Institute, Leeds, UK
- Leeds General Infirmary Teaching Hospital NHS Trust, Leeds, UK
- Institute for Genetics Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre (MCRC), Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - K Bridge
- Leeds Vascular Institute, Leeds, UK
- Leeds General Infirmary Teaching Hospital NHS Trust, Leeds, UK
- Institute for Genetics Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre (MCRC), Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - K Griffin
- Leeds Vascular Institute, Leeds, UK
- Leeds General Infirmary Teaching Hospital NHS Trust, Leeds, UK
- Institute for Genetics Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre (MCRC), Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - P D Baxter
- Leeds Centre for Epidemiology and Biostatistics, MCRC, University of Leeds, Leeds, UK
| | - D J A Scott
- Leeds Vascular Institute, Leeds, UK
- Leeds General Infirmary Teaching Hospital NHS Trust, Leeds, UK
- Institute for Genetics Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre (MCRC), Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
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Navarro AP, Asher J, Sohrabi S, Reddy M, Stamp S, Carter N, Talbot D. Peritoneal cooling may provide improved protection for uncontrolled donors after cardiac death: an exploratory porcine study. Am J Transplant 2009; 9:1317-23. [PMID: 19459821 DOI: 10.1111/j.1600-6143.2009.02633.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Uncontrolled donation after cardiac death (DCD) renal transplantation relies on rapid establishment of organ preservation interventions. We have developed a model of the uncontrolled DCD, comparing current in situ perfusion (ISP) techniques with additional peritoneal cooling (PC). Ten pigs were killed and subjected to a 2 h ischemia period. The ISP group modeled current DCD protocols. The PC group (PC) modeled current protocols plus PC. Two animals were used as controls and subjected to 2 h of warm ischemia. Core renal temperature and microdialysis markers of ischemia were measured. Preservation interventions began at 30 min, with rapid laparotomy and kidney recovery performed at 2 h, prior to machine perfusion viability testing. The final mean renal temperature achieved in the ISP group was 26.3 degrees C versus 16.9 degrees C in the PC group (p = 0.0001). A significant cryopreservation benefit was suggested by lower peak microdialysate lactate and glycerol levels (ISP vs. PC, p = 0.0003 and 0.0008), and the superiority of the PC group viability criteria (p = 0.0147). This pilot study has demonstrated significant temperature, ischemia protection and viability assessment benefits with the use of supplementary PC. The data suggests a need for further research to determine the potential for reductions in the rates of ischemia-related clinical phenomena for uncontrolled DCDs.
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Affiliation(s)
- A P Navarro
- Liver, Renal and Pancreatic Transplant Unit, Freeman Hospital, Newcastle-upon-Tyne, UK.
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Navarro A, Sohrabi S, Colechin E, Griffiths C, Talbot D, Soomro N. Evaluation of the Ischemic Protection Efficacy of a Laparoscopic Renal Cooling Device Using Renal Transplantation Viability Assessment Criteria in a Porcine Model. J Urol 2008; 179:1184-9. [DOI: 10.1016/j.juro.2007.10.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Indexed: 11/28/2022]
Affiliation(s)
- A.P. Navarro
- Liver and Renal Transplant Unit, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - S. Sohrabi
- Department of Medical Physics, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - E. Colechin
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - C. Griffiths
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - D. Talbot
- Liver and Renal Transplant Unit, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - N.A. Soomro
- Liver and Renal Transplant Unit, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
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Sanni AO, Wilson CH, Wyrley-Birch H, Vijayanand D, Navarro A, Gok MA, Sohrabi S, Jaques B, Rix D, Soomro N, Manas D, Talbot D. Non-heart-beating kidney transplantation: 6-year outcomes. Transplant Proc 2007; 38:3396-7. [PMID: 17175282 DOI: 10.1016/j.transproceed.2006.10.108] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Indexed: 10/23/2022]
Abstract
Non-heart-beating donor kidneys (NHBD) are being used to increase the donor pool due to the scarcity of cadaveric heart beating donors (HBD). We evaluated the long-term outcomes of renal transplantation using NHBD kidneys, comparing the first 100 NHBD kidneys transplanted at our facility to the next consecutive cadaveric HBD kidneys for graft survival, recipient survival, and quality of graft function. Recipient survival (P = .22) and graft survival (P = .19) at 6 years did not differ between recipients of NHBD (83%, 80%) and HBD (89%, 87%) kidneys. Quality of graft function using the mean glomular filtration rates were significantly lower in the NHBD group up to 3 months following discharge (41 +/- 2 vs 47 +/- 2, P = .007) but were then comparable up to 6 years following transplantation (43 +/- 5 vs 46 +/- 4, P = .55).
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Affiliation(s)
- A O Sanni
- Regional Liver/Renal Transplant Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
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Sohrabi S, Navarro A, Wilson C, Sanni A, Wyrley-Birch H, Anand V, Reddy M, Rix D, Jacques B, Manas D, Talbot D. Diabetic donors as a source of non-heart-beating renal transplants. Transplant Proc 2007; 38:3402-3. [PMID: 17175285 DOI: 10.1016/j.transproceed.2006.10.079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Indexed: 11/22/2022]
Abstract
Due to the organ shortage, many renal transplantation centers attempt to increase the donor pool by using non-heart-beating donors (NHBDs). These kidneys are generally regarded as "marginal" grafts. Many centers do not consider transplantation from an NHBD with a history of diabetes as it is a more suboptimal donor. We began our NHBD program in 1998 and have performed 5 renal transplants from diabetic NHBDs. Viability testing identified kidneys suitable for single or dual transplantation. Although kidneys from brain stem dead donors with diabetes have been used successfully, our data suggested that kidneys from diabetic NHBDs can also be used although we still need long-term results.
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Affiliation(s)
- S Sohrabi
- Liver and Renal Transplant Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
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Sanni A, Wilson CH, Wyrley-Birch H, Vijayanand D, Navarro A, Sohrabi S, Jaques B, Rix D, Soomro N, Manas D, Talbot D. Donor risk factors for renal graft thrombosis. Transplant Proc 2007; 39:138-9. [PMID: 17275491 DOI: 10.1016/j.transproceed.2006.10.228] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Indexed: 10/23/2022]
Abstract
Graft thrombosis is one of the most devastating complications of transplantation. In obtaining consent prior to transplant, it is useful to share potential risk factors with the recipient. In order to do this, we explored the impact of different risk factors that could contribute to this complication. Using multivariate analysis we found that neither multiple vessels nor vascular injury had a bearing on the risk of graft thrombosis but atheroma did (P < .02).
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Affiliation(s)
- A Sanni
- Regional Liver/Renal Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, UK
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Sohrabi S, Navarro AP, Wilson C, Sanni A, Wyrley-Birch H, Anand DV, Reddy M, Rix D, Jacques B, Manas D, Talbot D. Donation after cardiac death kidneys with low severity pre-arrest acute renal failure. Am J Transplant 2007; 7:571-5. [PMID: 17352711 DOI: 10.1111/j.1600-6143.2006.01639.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The widening gap between supply and demand for renal transplantation has prompted many centers to use donors after cardiac death. Some of these donors exhibit signs of acute renal failure (ARF) prior to cardiac arrest. Concern has been expressed about poor quality of graft function from such donors. In response to this perception, we reviewed 49 single renal transplant recipients from category III donors after cardiac death between 1998 and 2005, at our center. All kidneys but one had hypothermic machine perfusion and viability testing prior to transplantation. According to the RIFLE criteria, nine recipients had kidneys from donors with "low severity pre-arrest ARF". The remainder of the recipients were used as control group. There was no statistical significant difference in delayed graft function and rejection rates between these two groups. Recipients GFR at 12 months was 44.4 +/- 17.1 and 45.2 +/- 14.7 (mL/min/1.73m(2)) from donors with ARF and without ARF, respectively (p = 0.96). In conclusion, low severity ARF in kidneys from controlled after cardiac death donors can be a reversible condition after transplantation. Short-term results are comparable to the kidneys from same category donors without renal failure, providing that some form of viability assessment is implemented prior to transplantation.
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Affiliation(s)
- S Sohrabi
- Liver and Renal Transplant Unit, Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne, NE7 7DN, UK.
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Navarro AP, Sohrabi S, Wilson C, Sanni A, Wyrley-Birch H, Vijayanand D, Reddy M, Rix D, Manas D, Talbot D. Renal transplants from category III non-heart-beating donors with evidence of pre-arrest acute renal failure. Transplant Proc 2007; 38:2635-6. [PMID: 17098023 DOI: 10.1016/j.transproceed.2006.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Kidneys transplanted from non-heart-beating donors (NHBDs) have been exposed to varying degrees of ischemic damage after death. Category III donors have invariably been managed, treated, and investigated in a hospital setting prior to arrest and death. Some therefore exhibit evidence of renal dysfunction and even acute renal failure (ARF) before death. Many surgeons would regard a NHBD with pre-arrest evidence of ARF as too marginal for renal transplantation. This retrospective study examines five Maastricht category III NHBD donors with evidence of pre-arrest ARF. We compare 3- and 12-month GFR outcome data from the nine resulting transplants with 40 category III NHBD transplants with normal pre-arrest renal function. The mean GFR at 3 months was 45.4 and 43.8 for the ARF and normal group, respectively. At 12 months the GFR was 42.2 and 44.7 in the ARF and normal groups, respectively. Thus evidence of ARF pre-arrest does not preclude successful category III NHBD renal transplantation.
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Affiliation(s)
- A P Navarro
- Liver and Renal Transplant Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
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Navarro AP, Sohrabi S, Wyrley-Birch H, Vijayanand D, Wilson C, Sanni A, Reddy M, Manas D, Rix D, Talbot D. Dual renal transplantation for kidneys from marginal non-heart-beating donors. Transplant Proc 2007; 38:2633-4. [PMID: 17098022 DOI: 10.1016/j.transproceed.2006.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Kidneys transplanted from non-heart-beating donors (NHBD) are generally regarded as marginal or extended criteria grafts due to the associated period of warm ischemia. The most prolonged periods occurring in the category II (uncontrolled) donor. This potential for injury can adversely affect the glomular filtration rate (GFR), which in severe cases results in primary nonfunction. Viability testing can identify a group of kidneys that, although unsuitable for solitary transplantation, may be considered for dual transplant. This retrospective study examined a series of 11 dual renal transplants, comparing 3- and 12-month GFR outcome data with 81 single NHBD transplants. The mean GFR at 3 months in the dual group was 47.6 and at 12 months was 48.6. In the single group the GFR at 3 months was 40.6 and at 12 months was 41.9. Thus using viability testing to identify NHBD kidneys suitable for dual transplant appears reliable and predictable.
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Affiliation(s)
- A P Navarro
- Liver and Renal Transplant Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
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Sohrabi S, Navarro A, Asher J, Wilson C, Sanni A, Wyrley-Birch H, Anand V, Reddy M, Rix D, Jacques B, Manas D, Talbot D. Agonal period in potential non-heart-beating donors. Transplant Proc 2007; 38:2629-30. [PMID: 17098020 DOI: 10.1016/j.transproceed.2006.08.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The shortage of donor kidneys for renal transplantation is becoming more severe as the gap between the number of patients waiting for renal transplantation and the number of cadaveric organs available continues to widen. Therefore, many centres have started using non-heart-beating (NHB) donors. There was no clear plan for maximal duration of agonal period in Maastricht category NHB donors after withdrawal of treatment in Newcastle. This withdrawal has been audited in retrospect. Our current wait time is now a maximum of 5 hours; however, previously there have been some considerably longer periods. Concern has always been expressed about poor quality with protracted periods. Nonuse in this review of 58 kidneys can be expressed against time: 0 to 2 hours 13%, 2 to 5 hours 33%, and >5 hours 45%. Therefore, though the nonuse rate was significantly different between 0 to 2 hours and >5 hours (P < .05, chi-square), there were 16 transplants performed with kidneys >2 hours and 12 transplanted >5 hours. In conclusion, although good usable kidneys can still be used with protracted withdrawal, there are considerable logistical difficulties with our 5-hour cut-off, which means that one third of potential kidneys will not be utilized.
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Affiliation(s)
- S Sohrabi
- Liver and Renal Transplant Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
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Sohrabi S, Navarro A, Wilson C, Asher J, Sanni A, Wyrley-Birch H, Vijayanand D, Reddy M, Rix D, Jacques B, Manas D, Talbot D. Renal Graft Function After Prolonged Agonal Time in Non–Heart-Beating Donors. Transplant Proc 2006; 38:3400-1. [PMID: 17175284 DOI: 10.1016/j.transproceed.2006.10.080] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Indexed: 11/17/2022]
Abstract
To deal with the increasing gap between organ demand and supply for kidney transplantation, many centers have started to use non-heart-beating (NHB) donors. When we initiated our program to utilize kidneys from such donors in 1998, we had no protocol for the maximal agonal period. This however was audited in retrospect. Our current wait time is now a maximum of 5 hours. Concern has been expressed in the past about possible deterioration in the quality of the organs with a protracted agonal time. We aimed in this study to examine the effect of prolonging agonal period on the quality of kidneys retrieved from Maastricht category III donors: A total of 40 kidneys were transplanted from 29 category III donors between 1998 and 2004. Eleven kidneys had donor agonal times of >5 hours; the remainder, agonal times <5 hours. Both groups were matched for donor and recipient factors. The mean glomerular filtration rates at 12 months for <5 hours versus >5 hours agonal time were 43.8 +/- 4.4 versus 49.8 +/- 5.8, respectively (P = .24) and at 24 months, 46.83 +/- 8.99 versus 37.67 +/- 3.85, respectively (P = .24). In conclusion, intermediate graft function is comparable to ones with shorter agonal time, although we await long-term results.
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Affiliation(s)
- S Sohrabi
- Freeman Hospital, Liver and Renal Transplant Unit, Newcastle upon Tyne, UK.
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