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Hiramitsu T, Himeno T, Hasegawa Y, Futamura K, Okada M, Matsuoka Y, Goto N, Ichimori T, Narumi S, Takeda A, Kobayashi T, Uchida K, Watarai Y. Impact of Age 70 years or Older on Donors for Living-Donor Kidney Transplantation. Kidney Int Rep 2024; 9:1321-1332. [PMID: 38707796 PMCID: PMC11069014 DOI: 10.1016/j.ekir.2024.01.043] [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] [Received: 09/17/2023] [Revised: 12/12/2023] [Accepted: 01/22/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Kidney transplantation (KT) involving elderly living kidney donors (LKDs) is becoming more frequent because of a profound organ shortage. The efficacy of KT involving grafts obtained from LKDs aged 70 years or older has been reported. However, the safety of donor nephrectomy in LKDs aged 70 years or older, including that associated with changes in the estimated glomerular filtration rate (eGFR), has not been investigated. This study investigated the outcomes of LKDs aged 70 years or older after donor nephrectomy. Methods This single-center, retrospective cohort study included 1226 LKDs who underwent donor nephrectomy between January 2008 and December 2020. LKDs were stratified into the following age groups: 30 to 49 years (244 LKDs), 50 to 69 years (803 LKDs), and 70 to 89 years (179 LKDs). Surgical outcomes, postoperative eGFR changes, end-stage renal disease (ESRD) rates, and mortality rates were compared among these groups. Results No significant difference in surgical outcomes was identified among the groups. LKDs aged 70 to 89 years experienced the lowest eGFR changes at all time points and the lowest eGFR improvement; however, ESRD was not identified in any group during the observation period. Mortality was the highest among LKDs aged 70 to 89 years compared to the other age groups. Conclusion Surgical outcomes, eGFR changes, and ESRD incidences can support the safety of donor nephrectomy in LKDs aged 70 years or older. Considering the advanced age, the high mortality rates in LKDs aged 70 years or older could be considered acceptable.
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Affiliation(s)
- Takahisa Hiramitsu
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| | - Tomoki Himeno
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| | - Yuki Hasegawa
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| | - Kenta Futamura
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| | - Manabu Okada
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| | - Yutaka Matsuoka
- Department of Renal Transplant Surgery, Masuko Memorial Hospital, Nagoya, Aichi, Japan
| | - Norihiko Goto
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| | - Toshihiro Ichimori
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| | - Shunji Narumi
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| | - Asami Takeda
- Department of Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Kazuharu Uchida
- Department of Renal Transplant Surgery, Masuko Memorial Hospital, Nagoya, Aichi, Japan
| | - Yoshihiko Watarai
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
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Dhalla A, Ravani P, Quinn RR, Garg AX, Clarke A, Al-Wahsh H, Lentine KL, Klarenbach S, Hemmelgarn BR, Wang C, Lam NN. Risk Factors for Developing Low Estimated Glomerular Filtration Rate and Albuminuria in Living Kidney Donors. Kidney Med 2024; 6:100767. [PMID: 38313807 PMCID: PMC10837092 DOI: 10.1016/j.xkme.2023.100767] [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: 02/06/2024] Open
Abstract
Rationale & Objective Chronic kidney disease is associated with significant morbidity and mortality in the general population, but little is known about the incidence and risk factors associated with developing low estimated glomerular filtration rate (eGFR) and moderate-severe albuminuria in living kidney donors following nephrectomy. Study Design Retrospective, population-based cohort study. Setting & Participants Kidney donors in Alberta, Canada. Exposure Donor nephrectomy between May 2001 and December 2017. Outcome Two eGFR measurements <45 mL/min/1.73 m2 or 2 measurements of moderate or severe albuminuria from 1-year postdonation onwards that were at least 90 days apart. Analytical Approach Associations between potential risk factors and the primary outcome were assessed using Cox proportional hazard regression analyses. Results Over a median follow-up period of 8.6 years (IQR, 4.7-12.6 years), 47 of 590 donors (8.0%) developed sustained low eGFR or moderate-severe albuminuria with an incidence rate of 9.2 per 1,000 person-years (95% confidence interval, 6.6-11.8). The median time for development of this outcome beyond the first year after nephrectomy was 2.9 years (IQR, 1.4-8.0 years). Within the first 4 years of follow-up, a 5 mL/min/1.73 m2 lower predonation eGFR increased the hazard of developing postdonation low eGFR or moderate-severe albuminuria by 26% (adjusted HR, 1.26; 95% CI, 1.10-1.44). Furthermore, donors were at higher risk of developing low eGFR or albuminuria if they had evidence of predonation hypertension (adjusted HR, 2.52; 95% CI, 1.28-4.96) or postdonation diabetes (adjusted HR, 4.72; 95% CI, 1.54-14.50). Limitations We lacked data on certain donor characteristics that may affect long-term kidney function, such as race, smoking history, and transplant-related characteristics. Conclusions A proportion of kidney donors at an incidence rate of 9.2 per 1,000 person-years will develop low eGFR or albuminuria after donation. Donors with lower predonation eGFR, predonation hypertension, and postdonation diabetes are at increased risk of developing this outcome.
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Affiliation(s)
- Anisha Dhalla
- Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Pietro Ravani
- Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Robert R Quinn
- Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Amit X Garg
- Department of Medicine, Division of Nephrology, Western University, London, ON, Canada
| | - Alix Clarke
- Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Huda Al-Wahsh
- Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University Hospital, St. Louis, MO
| | - Scott Klarenbach
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, AB, Canada
| | - Brenda R Hemmelgarn
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, AB, Canada
| | - Carol Wang
- Department of Medicine, Division of Nephrology, Western University, London, ON, Canada
| | - Ngan N Lam
- Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, AB, Canada
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3
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Shaikh FB, Ganpule AP. Retroperitoneal approach for robot living donor nephrectomy: A step-by-step description of technical nuances. J Minim Access Surg 2024; 20:115-120. [PMID: 37706411 PMCID: PMC10898627 DOI: 10.4103/jmas.jmas_29_23] [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: 01/26/2023] [Accepted: 03/22/2023] [Indexed: 09/15/2023] Open
Abstract
Open, pure or hand-assisted laparoscopic, natural orifice transluminal endoscopic surgical (NOTES) and robotic approaches (Transperitoneal or retroperitoneal) are the described approaches for living donor nephrectomy. We describe the procedural steps of a robotic living donor nephrectomy (RLDN) retroperitoneal (RRLDN) technique using a da Vinci X surgical system and three robotic arms. This is the first reported case with the retroperitoneal robotic approach. The procedure in brief is as follows. First, with the patient placed in full flank position, the camera port is placed at the level of the Petit's triangle apex. Retroperitoneal space is created by turning the index finger in a 180° movement through this port and a gloves balloon. The second 8mm port was inserted, 8 cm far from the first port, The peritoneum is reflected medially and downward off of the transversus abdominis muscle laparoscopically, respectively along the anterior and posterior axillary line; 3-5 cm caudally to the last one, a 12 mm AirSeal® assistant port is placed in the same manner. Only then, the port is placed under direct vision. The robotic ports placement will result in a caudally convex arc. This technique, due to the extensive use of the surgeon index, implies fast access to the retroperitoneum, protects the underlying anatomical structures from damage, and, due to the trocar positioning along an arc, lowers the arm conflict risk.
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Affiliation(s)
- Forqan Babu Shaikh
- Department of General and Renal Transplant, NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Arvind P. Ganpule
- Department of Urology, Muljibhai patel Urological Hospital, Nadiad, Gujarat, India
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4
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Keleş A, Kaya C. A comparison of pre- and post-operative outcomes in living donors undergoing transperitoneal laparoscopic nephrectomy and open nephrectomy: a retrospective single-center study. SAO PAULO MED J 2023; 142:e2022488. [PMID: 38088685 PMCID: PMC10708893 DOI: 10.1590/1516-3180.2022.0488.r1.070723] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/05/2023] [Accepted: 07/07/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Kidney transplantation is often regarded as the preferred therapy for end-stage renal disease. Several surgical procedures have been developed to reduce postoperative donor complications, while maintaining kidney quality. OBJECTIVE This study aimed to compare the preoperative and postoperative outcomes of living kidney donors who underwent either transperitoneal laparoscopic nephrectomy or open nephrectomy. DESIGN AND SETTING Retrospective study conducted in Istanbul, Turkey. METHODS Fifty-five living-related kidney donors underwent nephrectomy and were retrospectively divided into two groups: 21 donors who underwent open nephrectomy (Group 1) and 34 donors who underwent transperitoneal laparoscopic nephrectomy (Group 2). RESULTS In comparison to the donors who underwent open nephrectomy, those who underwent transperitoneal laparoscopic nephrectomy had significantly shorter postoperative hospital stays (2.3 ± 0.2 versus 3.8 ± 0.8 days, P = 0.003), duration of urinary catheterization (1.2 ± 0.8 days versus 2.0 ± 0.7 days, P = 0.0001), operating times (210 ± 27 minutes versus 185 ± 24 minutes, P = 0.02), and less blood loss (86 ml versus 142 ml, P = 0.048). There was no statistically significant difference between the two groups with regard to the estimated blood transfusion and warm ischemia time. The preoperative week, first postoperative week, and 1-month postoperative serum creatinine levels were comparable between the groups. CONCLUSIONS Laparoscopic donor nephrectomy can be safely performed at centers with expertise in laparoscopic surgery. Laparoscopic donor nephrectomy has better outcomes than open donor nephrectomy in terms of length of hospital stay, duration of urinary catheterization, operating time, and blood loss.
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Affiliation(s)
- Ahmet Keleş
- MD. Urologist, Department of Urology, School of Medicine,
Istanbul Medeniyet University, Uskudar, Turkey
| | - Cevdet Kaya
- MD. Professor of Urology, Department of Urology, School of
Medicine, Marmara University, Istanbul, Turkey
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5
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Buksh O, Almalki AM, Jar A, Alzahrani H, Bitar H, Al-Akraa M. Chylous Ascites Following Laparoscopic Donor Nephrectomy: A Case Report. Cureus 2023; 15:e38416. [PMID: 37273336 PMCID: PMC10233342 DOI: 10.7759/cureus.38416] [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] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Chylous ascites is a form of peritoneal fluid accumulation that can arise from trauma or lymphatic obstruction. In this report, we present the first case of chylous ascites following laparoscopic donor nephrectomy in our high-volume kidney transplant center. The patient presented to the emergency department three weeks post-procedure with complaints of abdominal distention and discomfort, accompanied by constipation and nausea. Radiological confirmation of ascites was followed by paracentesis, which yielded 20 mL of milky fluid that was analyzed and confirmed as chylous ascites. A subsequent pigtail drain was inserted, resulting in a total drainage of 4 L of fluid. Chylous ascites is a rare complication of abdominal surgeries, with higher body mass index and the American Society of Anesthesiologists physical status score system being significant risk factors. Conservative management involving diet modification is the initial therapy, with percutaneous drainage or more aggressive surgical interventions considered if conservative measures are not effective, with high success rates reported for these interventions. Here, we report a case of chylous ascites following donor nephrectomy as the first case reported from our region.
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Affiliation(s)
- Omar Buksh
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Abdullah M Almalki
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Anfal Jar
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Hani Alzahrani
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Hussam Bitar
- Department of General Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Mahmoud Al-Akraa
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
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6
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Jackson S, Combes A, Latif E, Tran M, Lam S, Gore N, Utsiwegota M, Mawson J, Smith L, Palma C, Laurence J, Crawford M, Pulitano C, Wyburn K, Chadban S, Leslie S, Vasilaras A. Laparoscopic donor nephrectomy-Technique and peri-operative outcomes in an Australian transplant center. Clin Transplant 2023; 37:e14945. [PMID: 36807636 DOI: 10.1111/ctr.14945] [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: 01/19/2023] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 02/21/2023]
Abstract
INTRODUCTION Demand for donor kidneys far exceeds the availability of organs from deceased donors. Living donor kidneys are an important part of addressing this shortfall, and laparoscopic nephrectomy is an important strategy to reduce donor morbidity and increase the acceptability of living donation. AIM To retrospectively review the intraoperative and postoperative safety, technique, and outcomes of patients undergoing donor nephrectomy at a single tertiary hospital in Sydney, Australia. METHOD Retrospective capture and analysis of clinical, demographic, and operative data for all living donor nephrectomies performed between 2007 and 2022 at a single University Hospital in Sydney, Australia. RESULTS Four hundred and seventy-two donor nephrectomies were performed: 471 were laparoscopic, two of which were converted from laparoscopic to open and hand-assisted nephrectomy, respectively, and one (.2%) underwent primary open nephrectomy. The mean warm ischemia time was 2.8 min (±1.3 SD, median 3 min, range 2-8 min) and the mean length of stay (LOS) was 4.1 days (±1.0 SD). The mean renal function on discharge was 103 μmol/L (±23.0 SD). Seventy-seven (16%) patients had a complication with no Clavien Dindo IV or V complications seen. Outcomes demonstrated no impact of donor age, gender, kidney side, relationship to the recipient, vascular complexity; or surgeon experience, on complication rate or LOS. CONCLUSION Laparoscopic donor nephrectomy is a safe and effective procedure with minimal morbidity and no mortality in this series.
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Affiliation(s)
- Stuart Jackson
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Alexander Combes
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Edward Latif
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Minh Tran
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Susanna Lam
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Neel Gore
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Mike Utsiwegota
- Department of Renal Medicine and Transplantation, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Jane Mawson
- Department of Renal Medicine and Transplantation, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Laura Smith
- Department of Renal Medicine and Transplantation, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Catalina Palma
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Jerome Laurence
- Department of Surgical Transplantation, Royal Prince Alfred Hospital, Camperdown, Australia.,RPA Institute of Academic Surgery, Camperdown, Australia.,The University of Sydney, Camperdown, Australia.,Chris O'Brien Lifehouse, Sydney, Australia
| | - Michael Crawford
- Department of Surgical Transplantation, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Carlo Pulitano
- Department of Surgical Transplantation, Royal Prince Alfred Hospital, Camperdown, Australia.,RPA Institute of Academic Surgery, Camperdown, Australia.,The University of Sydney, Camperdown, Australia.,Chris O'Brien Lifehouse, Sydney, Australia
| | - Kate Wyburn
- Department of Renal Medicine and Transplantation, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Steve Chadban
- Department of Renal Medicine and Transplantation, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Scott Leslie
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia.,RPA Institute of Academic Surgery, Camperdown, Australia.,The University of Sydney, Camperdown, Australia.,Chris O'Brien Lifehouse, Sydney, Australia
| | - Arthur Vasilaras
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia.,Chris O'Brien Lifehouse, Sydney, Australia
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7
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Pippias M, Skinner L, Noordzij M, Reisæter AV, Abramowicz D, Stel VS, Jager KJ. Pregnancy after living kidney donation, a systematic review of the available evidence, and a review of the current guidance. Am J Transplant 2022; 22:2360-2380. [PMID: 35716049 PMCID: PMC9804926 DOI: 10.1111/ajt.17122] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/18/2022] [Accepted: 06/09/2022] [Indexed: 01/25/2023]
Abstract
Understanding and communicating the risk of pregnancy complications post-living kidney donation is imperative as the majority of living kidney donors (LKD) are women of childbearing age. We aimed to identify all original research articles examining complications in post-donation pregnancies and compared the quality and consistency of related guidelines. We searched Embase, MEDLINE, PubMed, society webpages, and guideline registries for English-language publications published up until December 18, 2020. Ninety-three articles were screened from which 16 studies were identified, with a total of 1399 post-donation pregnancies. The outcome of interest, post-donation pregnancy complications, was not calculable, and only a narrative synthesis of the evidence was possible. The absolute risk of pre-eclampsia increased from ~1%-3% pre-donation (lower than the general population) to ~4%-10% post-donation (comparable to the general population). The risks of adverse fetal and neonatal outcomes were no different between post-donation and pre-donation pregnancies. Guidelines and consensus statements were consistent in stating the need to inform LKDs of their post-donation pregnancy risk, however, the depth and scope of this guidance were variable. While the absolute risk of pregnancy complications remains low post-donation, a concerted effort is required to better identify and individualize risk in these women, such that consent to donation is truly informed.
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Affiliation(s)
- Maria Pippias
- Bristol Medical School: Population Health SciencesUniversity of BristolBristolUK,North Bristol NHS Trust, Renal UnitBristolUK
| | - Laura Skinner
- North Bristol NHS Trust, Renal UnitBristolUK,Bristol Medical School: Translational Health SciencesUniversity of BristolBristolUK
| | - Marlies Noordzij
- Department of Internal MedicineUniversity Medical Center GroningenGroningenThe Netherlands
| | | | | | - Vianda S. Stel
- ERA Registry, Department of Medical InformaticsAmsterdam Public Health Research Institute, Amsterdam UMC‐Location AMC, University of AmsterdamAmsterdamThe Netherlands
| | - Kitty J. Jager
- ERA Registry, Department of Medical InformaticsAmsterdam Public Health Research Institute, Amsterdam UMC‐Location AMC, University of AmsterdamAmsterdamThe Netherlands
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8
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Al Harakeh H, Emmanuel B, Hughes C, Tevar A, Steel JL, DiMartini A, Ganesh S, Sood P, Humar A. Sequential liver and kidney living donors: Making the ultimate gift twice. Clin Transplant 2022; 36:e14750. [PMID: 35695890 DOI: 10.1111/ctr.14750] [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: 10/12/2021] [Revised: 05/01/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
There are nearly 150 living donors in the United States who donated more than one solid organ. Using our divisional database, we found 20 individuals who donated a liver and a kidney at different times. We performed a retrospective chart review of these donors, studying their motivating factors, complications and outcomes. The donors included 11 (55%) males and nine females. Thirteen (65%) donated the kidney before the liver. Fourteen (70%) were nondirected donors at the first donation, and four of the six directed donors in the first donation became nondirected in the second donation. Seventeen (85%) were nondirected at the second donation. Common reasons for donating the second time were a good experience with the first donation and knowing that one can donate again. Outcomes and the incidence of early complications were not significantly different after the 2nd versus the 1st donation. All donors recovered and currently are doing well. Our results show a significant number of dual organ donors are nondirected and motivated by their strong desire to help. A positive experience with the 1st donation often was the driving factor for the 2nd. A history of previous organ donation did not negatively impact the 2nd donation.
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Affiliation(s)
- Hasan Al Harakeh
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Bishoy Emmanuel
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Amit Tevar
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Andrea DiMartini
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Swaytha Ganesh
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Puneet Sood
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Abhinav Humar
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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9
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Heylen L, Pirenne J, Naesens M, Sprangers B, Jochmans I. "Time is tissue"-A minireview on the importance of donor nephrectomy, donor hepatectomy, and implantation times in kidney and liver transplantation. Am J Transplant 2021; 21:2653-2661. [PMID: 33759371 DOI: 10.1111/ajt.16580] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/12/2021] [Accepted: 03/19/2021] [Indexed: 01/25/2023]
Abstract
Donor organs are exposed to sequential temperature changes during the transplantation process. The role of donor warm ischemia and cold ischemia times on post-transplant outcomes has been extensively studied. Much less attention has been paid to the transient ischemia occurring during donor organ removal and implantation. Recently, it has become clear that prolonged donor nephrectomy and implantation time are independently associated with delayed graft function after kidney transplantation. In addition, implantation time correlates with post-transplant kidney graft function, histology, and survival. Similar detrimental associations of donor hepatectomy and implantation time with early allograft dysfunction, ischemic cholangiopathy, and graft and patient survival after liver transplantation have been demonstrated. This review details kidney and liver temperature changes occurring during procurement and transplantation. It summarizes the effects of the ischemia the kidney and liver sustain during these phases on short- and long-term post-transplant outcomes, advocating the standardized reporting of donor hepatectomy, donor nephrectomy, and implantation times in (inter)national registries. The review also explores strategies to protect the graft from this ischemic injury.
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Affiliation(s)
- Line Heylen
- Nephrology and Renal Transplantation Research Group, Department of Immunology, Microbiology, and Transplantation, K.U. Leuven, Leuven, Belgium.,Department of Nephrology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Jacques Pirenne
- Transplantation Research Group, Department of Immunology, Microbiology, and Transplantation, K.U. Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Maarten Naesens
- Nephrology and Renal Transplantation Research Group, Department of Immunology, Microbiology, and Transplantation, K.U. Leuven, Leuven, Belgium.,Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Ben Sprangers
- Department of Nephrology, University Hospitals Leuven, Leuven, Belgium.,Immunity and Inflammation Research Group, Department of Immunology, Microbiology, and Transplantation, K.U. Leuven, Leuven, Belgium
| | - Ina Jochmans
- Transplantation Research Group, Department of Immunology, Microbiology, and Transplantation, K.U. Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
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10
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Gritsch HA, Osbun N, Grogan T, Fero KE, Partownavid P, Stockman J, Sadoughi N, Park E, Miller E, Blumberg J, McDonald M, Cowan N, Shah N, Rahman S. Randomized controlled trial of a quadratus lumborum block with liposomal bupivacaine for postoperative analgesia in laparoscopic donor nephrectomy. Clin Transplant 2021; 35:e14403. [PMID: 34184312 PMCID: PMC8596399 DOI: 10.1111/ctr.14403] [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] [Received: 05/06/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 11/29/2022]
Abstract
Perioperative pain management is an important consideration in early recovery and patient satisfaction following laparoscopic donor nephrectomy. Transmuscular quadratus lumborum block has been described to reduce pain and opioid usage following several abdominal surgeries. In this prospective single‐blind randomized controlled trial, we compared 52 patients who adhered to our institutional donor nephrectomy Early Recovery After Surgery pathway, which includes a laparoscopic‐guided transversus abdominus plane block, to 40 patients who additionally received a transmuscular quadratus lumborum block with liposomal bupivacaine. Compared to control patients, those who received the block spent longer in the operating room prior to the surgical start (65.4 vs. 51.6 min, P < .001). Both groups had similar total hospital length of stay (33.3 h vs. 34.4 h, P = .61). Pain scores from postoperative days 0–30, number of patients requiring opioids, postoperative nausea, and pain management satisfaction were similar between both groups. Patients who received the block consumed less opioid on postoperative day 1 compared to controls (P = .006). No complications were attributable to the block. The quadratus lumborum block provides a safe pain management adjunct for some patients, and may reduce opioid use in the early postoperative period when combined with our standard institutional protocol for kidney donors.
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Affiliation(s)
- Hans Albin Gritsch
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Nathan Osbun
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Tristan Grogan
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Katherine E Fero
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Parisa Partownavid
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Joel Stockman
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Namjeh Sadoughi
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Edward Park
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Eric Miller
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jeremy Blumberg
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Michelle McDonald
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Nicholas Cowan
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Nikhil Shah
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Siamak Rahman
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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11
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Byrne MHV, Mehmood A, Summers DM, Hosgood SA, Nicholson ML. A systematic review of living kidney donor enhanced recovery after surgery. Clin Transplant 2021; 35:e14384. [PMID: 34101263 DOI: 10.1111/ctr.14384] [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: 11/24/2020] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 12/20/2022]
Abstract
Enhanced recovery after surgery (ERAS) reduces complications and shortens hospital stay without increasing readmission or mortality. However, its role in living donor nephrectomy (LDN) has not yet been defined. Medline, Embase, CINAHL, PsycINFO, and Cochrane Central were searched prior to 08/01/21 for all randomized controlled and cohort studies comparing ERAS to standard of care in LDN. The study was registered on PROSPERO (CRD: CRD42019141706). One thousand, three hundred seventy-seven patients were identified from 14 studies (698 patients with ERAS and 679 patients without). There were considerable differences in the protocols used, and compliance with general ERAS recommendations was poor. Meta-analysis of laparoscopic procedures (including hand- and robot-assisted) revealed that duration of stay was significantly reduced by 0.98 days with ERAS (95% CI = 0.36-1.60, P = .002) and opiate requirement by 32.4 mg (95% CI = 1.1-63.7, P = .04). There was no significant difference n readmission rates or complications. Quality of evidence was low to moderate assessed using the GRADE tool. This review suggests there is a positive benefit of ERAS in laparoscopic LDN. However, there was considerable variation in ERAS protocols used, and the quality of evidence was low; as such, a guideline for ERAS in LDN should be developed and validated.
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Affiliation(s)
- Matthew H V Byrne
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Ahmed Mehmood
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Dominic M Summers
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Sarah A Hosgood
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Michael L Nicholson
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
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12
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Waterman AD, Peipert JD, Cui Y, Beaumont JL, Paiva A, Lipsey AF, Anderson CS, Robbins ML. Your Path to Transplant: A randomized controlled trial of a tailored expert system intervention to increase knowledge, attitudes, and pursuit of kidney transplant. Am J Transplant 2021; 21:1186-1196. [PMID: 33245618 PMCID: PMC7882639 DOI: 10.1111/ajt.16262] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 10/13/2019] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 01/25/2023]
Abstract
Individually tailoring education over time may help more patients, especially racial/ethnic minorities, get waitlisted and pursue deceased and living donor kidney transplant (DDKT and LDKT, respectively). We enrolled 802 patients pursuing transplant evaluation at the University of California, Los Angeles Transplant Program into a randomized education trial. We compared the effectiveness of Your Path to Transplant (YPT), an individually tailored coaching and education program delivered at 4 time points, with standard of care (SOC) education on improving readiness to pursue DDKT and LDKT, transplant knowledge, taking 15 small transplant-related actions, and pursuing transplant (waitlisting or LDKT rates) over 8 months. Survey outcomes were collected prior to evaluation and at 4 and 8 months. Time to waitlisting or LDKT was assessed with at least 18 months of follow-up. At 8 months, compared to SOC, the YPT group demonstrated increased LDKT readiness (47% vs 33%, P = .003) and transplant knowledge (effect size [ES] = 0.41, P < .001). Transplant pursuit was higher in the YPT group (hazard ratio: 1.44, 95% confidence interval: 1.15-1.79, P = .002). A focused, coordinated education effort can improve transplant-seeking behaviors and waitlisting rates. ClinicalTrials.gov registration: NCT02181114.
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Affiliation(s)
- Amy D. Waterman
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California,Terasaki Institute of Biomedical Innovation, Los Angeles, California
| | - John D. Peipert
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University,Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, IL
| | - Yujie Cui
- Terasaki Institute of Biomedical Innovation, Los Angeles, California
| | | | - Andrea Paiva
- Department of Psychology, The University of Rhode Island, Kingston, RI
| | - Amanda F. Lipsey
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California,Terasaki Institute of Biomedical Innovation, Los Angeles, California
| | - Crystal S. Anderson
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Mark L. Robbins
- Department of Psychology, The University of Rhode Island, Kingston, RI
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13
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Akin EB, Soykan Barlas I, Dayangac M. Hand-assisted retroperitoneoscopic donor nephrectomy offers more liberal use of right kidneys: lessons learned from 565 cases - a retrospective single-center study. Transpl Int 2021; 34:445-454. [PMID: 33340167 DOI: 10.1111/tri.13806] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/08/2020] [Accepted: 12/15/2020] [Indexed: 01/19/2023]
Abstract
The introduction of laparoscopic donor nephrectomy caused a shift toward' left donor nephrectomy. Some centers report a significantly low rate of endoscopic right donor nephrectomy. Hand-assisted retroperitoneoscopic donor nephrectomy (HARP-DN) was introduced as a novel surgical technique, which aims to avoid intra-abdominal complications. It was also reported to provide technical advantages for right-sided DN. In this retrospective single-center study, we evaluated the impact of HARP-DN technique on utilization of right-sided DNs. After the implementation of HARP-DN on February 2009, a total of 565 DNs were performed until December 2015. The introduction of HARP-DN technique resulted in an immediate increase in the utilization of right kidneys from 6.1% to an average of 19.6% annually. The donors 'outcome was similar to the left-sided and right-sided DN groups, excluding the increased incidence of incisional hernias in left kidney donors. None of the donors developed intra-abdominal complications. In conclusion, the implementation of HARP technique significantly increased the use of right-sided DNs, which enables a more liberal use of donors in LDKT.
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Affiliation(s)
- Emin Baris Akin
- Department of General Surgery, Division of Transplantation, Demiroglu Bilim University, Istanbul, Turkey
| | - Ilhami Soykan Barlas
- Department of General Surgery, Division of Transplantation, Demiroglu Bilim University, Istanbul, Turkey
| | - Murat Dayangac
- Center for Organ Transplantation, Medipol University, Istanbul, Turkey
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14
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Ammary FA, Yu Y, Ferzola A, Motter JD, Massie AB, Yu S, Thomas AG, Crews DC, Segev DL, Muzaale AD, Henderson ML. The first increase in live kidney donation in the United States in 15 years. Am J Transplant 2020; 20:3590-3598. [PMID: 32524764 PMCID: PMC8717834 DOI: 10.1111/ajt.16136] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 04/22/2020] [Revised: 05/26/2020] [Accepted: 06/01/2020] [Indexed: 01/25/2023]
Abstract
The first sustained increase in live kidney donation in the United States in 15 years was observed from 2017 to 2019. To help sustain this surge, we studied 35 900 donors (70.3% white, 14.5% Hispanic, 9.3% black, 4.4% Asian) to understand the increase in 2017-2019 vs 2014-2016 using Poisson regression. Among biologically related donors aged <35, 35-49, and ≥50 years, the number of donors did not change across race/ethnicity but increased by 38% and 29% for Hispanic and black ≥50. Among unrelated donors <35, 35-49, and ≥50, white donors increased by 18%, 14%, and 27%; Hispanic donors <35 did not change but increased by 22% and 35% for 35-49 and ≥50; black donors <35 declined by 23% and did not change for 35-49 and ≥50; Asian donors did not change. Among kidney paired donors <35, 35-49, and ≥50, white donors increased by 42%, 50%, and 68%; Hispanic donors <35 and 35-49 increased by 36% and 55% and did not change for ≥50; black donors did not change; Asian donors <35 did not change but increased by 107% and 82% for 35-49 and ≥50. The increase in donation was driven predominantly by unrelated and paired white donors. Donation among unrelated black individuals should be promoted.
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Affiliation(s)
- Fawaz Al Ammary
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yifan Yu
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Alexander Ferzola
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer D. Motter
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allan B. Massie
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sile Yu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alvin G. Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
| | - Deidra C. Crews
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Scientific Registry of Transplant Recipients, Minneapolis, MN
| | - Abimereki D. Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Macey L. Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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15
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Altheaby A, Almukhlifi A, Aldoukhi A, Alfaleh A, Aboalsamah G, Alshareef A, Alruwaymi M, Bin Saad K, Arabi Z. Why Living Kidney Donor Candidates Are Turned Down? A Single-Center Cohort Study. Cureus 2020; 12:e9877. [PMID: 32963917 PMCID: PMC7500709 DOI: 10.7759/cureus.9877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/19/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction Living donor kidney transplantation is the best replacement therapy for patients with end-stage renal disease. It offers more benefits than deceased donor transplantation. However, living kidney donors (LKDs) undergo an extensive evaluation to ensure their suitability for donation, and this can result in rejection of many potential donors. Aim The aim of this study was to recognize the reasons for declining LKDs in our Organ Transplant Center at King Abdulaziz Medical City. Settings and Design This was a retrospective study to determine the various reasons to reject an LKD at the Organ Transplant Center. Methods and Material All the LKDs from January 2016 to December 2019 were included. Declined donors were reviewed and data were obtained from the electronic database and transplant nephrology shared files. Statistical analysis We performed data analysis using SPSS version 24.0 (IBM Corp., Armonk, NY, USA). Data for continuous variables were presented as mean ± standard deviation and were compared using t-test. Categorical variables were presented as frequencies and percentages; chi-square test was used to test for main association and then Bonferroni adjustment was used for post-hoc testing. Statistical significance was considered if a two-tailed p-value of <0.05 was achieved. Results A total of 410 potential LKDs were evaluated, of whom 241 (58.8%) successfully underwent donor nephrectomy and 169 (41.2%) were unable to proceed for kidney donation. The most common reasons for rejection of LKDs were medical (47.9%) followed by immunological reasons mainly blood group incompatibility (19.5%). Other reasons were donor withdrawal (15.4%), recipient-related reasons (7.1%), surgically unfit to proceed for nephrectomy (4.7%), or psychological reasons (2.3%). Conclusions A significant proportion of potential LKDs did not complete the kidney donation process due to medical, immunological, and surgical reasons. In addition, a proportion of LKDs decided to withdraw at some point during the evaluation process. Investing in donors' educational programs and implementing a standardized evaluation process are essential to increase LKDs pool.
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Affiliation(s)
- Abdulrahman Altheaby
- Organ Transplant Center and Hepatobiliary Sciences Department, King Abdulaziz Medical City, Riyadh, SAU
| | - Ahmed Almukhlifi
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | - Abdullah Alfaleh
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Ghaleb Aboalsamah
- Organ Transplant Center and Hepatobiliary Sciences Department, King Abdulaziz Medical City, Riyadh, SAU
| | - Ala Alshareef
- Organ Transplant Center and Hepatobiliary Sciences Department, King Abdulaziz Medical City, Riyadh, SAU
| | - Mohamed Alruwaymi
- Organ Transplant Center and Hepatobiliary Sciences Department, King Abdulaziz Medical City, Riyadh, SAU
| | - Khaled Bin Saad
- Organ Transplant Center and Hepatobiliary Sciences Department, King Abdulaziz Medical City, Riyadh, SAU
| | - Ziad Arabi
- Organ Transplant Center and Hepatobiliary Sciences Department, King Abulaziz Medical City, Riyadh, SAU
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16
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O'Neill DC, Murphy B, Carmody E, Trench L, Dunne R, Lee MJ, Little D, Morrin MM. Assessment of renal vascular anatomy on multi-detector computed tomography in living renal donors. J Med Imaging Radiat Oncol 2020; 64:484-489. [PMID: 32441449 DOI: 10.1111/1754-9485.13050] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 04/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prospective renal donors are a select population of healthy individuals who have been thoroughly screened for significant comorbidities before they undergo multi-detector computed tomography angiography and urography (MDCT). PURPOSE The aim of this study is to describe the anatomy of potential living renal donor subjects using MDCT over a 2-year period. The primary objective is to identify the renal arterial anatomy variations, with a secondary objective of identifying venous and collecting system/ureteric variations. MATERIALS AND METHODS A prospective study was performed of prospective living kidney transplant donors at a national kidney transplant centre. Study inclusion criteria were all potential kidney donors who underwent MDCT during the living-donor assessment process over a 2-year period. RESULTS Our cohort included 160 potential living donors who had MDCT; mean age was 45.6 years (range, 21-71). Two renal arteries were identified on the left in 40 subjects (25%) and on the right in 42 subjects (26.3%). A total of 3 or more renal arteries were identified on the left in 7 subjects (4.4%) and on the right in 7 subjects (4.4%). On the left, the distances between multiple arteries ranged from 1 mm to 43 mm, and on the right, they were 1 mm to 84 mm. CONCLUSIONS Conventionally described anatomy was only seen on the left side in 70.6% and 69.4% on the right side of subjects. Single renal arteries are seen in 54.4% showing that conventional anatomy has a relatively low incidence.
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Affiliation(s)
| | | | - Emma Carmody
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Luke Trench
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Ruth Dunne
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Michael J Lee
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Dilly Little
- Department of Urology and Transplant, Beaumont Hospital, Dublin, Ireland
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17
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Schwartz FR, Shaw BI, Lerebours R, Vernuccio F, Rigiroli F, Gonzalez F, Luo S, Rege AS, Vikraman D, Hurwitz-Koweek L, Marin D, Ravindra K. Correlation of preoperative imaging characteristics with donor outcomes and operative difficulty in laparoscopic donor nephrectomy. Am J Transplant 2020; 20:752-760. [PMID: 31553125 PMCID: PMC7042043 DOI: 10.1111/ajt.15608] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/20/2019] [Accepted: 09/09/2019] [Indexed: 01/25/2023]
Abstract
This study aimed to understand the relationship of preoperative measurements and risk factors on operative time and outcomes of laparoscopic donor nephrectomy. Two hundred forty-two kidney donors between 2010 and 2017 were identified. Patients' demographic, anthropomorphic, and operative characteristics were abstracted from the electronic medical record. Glomerular filtration rates (GFR) were documented before surgery, within 24 hours, 6, 12, and 24 months after surgery. Standard radiological measures and kidney volumes, and subcutaneous and perinephric fat thicknesses were assessed by three radiologists. Data were analyzed using standard statistical measures. There was significant correlation between cranio-caudal and latero-lateral diameters (P < .0001) and kidney volume. The left kidney was transplanted in 92.6% of cases and the larger kidney in 69.2%. Kidney choice (smaller vs. larger) had no statistically significant impact on the rate of change of donor kidney function over time adjusting for age, sex and race (P = .61). Perinephric fat thickness (+4.08 minutes) and surgery after 2011 were significantly correlated with operative time (P ≤ .01). In conclusion, cranio-caudal diameters can be used as a surrogate measure for volume in the majority of donors. Size may not be a decisive factor for long-term donor kidney function. Perinephric fat around the donor kidney should be reported to facilitate operative planning.
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Affiliation(s)
| | - Brian I Shaw
- Department of Surgery, Duke University, Durham, NC
| | - Reginald Lerebours
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Federica Vernuccio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Italy
| | | | - Fernando Gonzalez
- Department of Radiology, Clinica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - Sheng Luo
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | | | | | | | - Daniele Marin
- Department of Radiology, Duke University, Durham, NC
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18
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Rodrigue JR, Fleishman A, Schold JD, Morrissey P, Whiting J, Vella J, Kayler LK, Katz DA, Jones J, Kaplan B, Pavlakis M, Mandelbrot DA. Patterns and predictors of fatigue following living donor nephrectomy: Findings from the KDOC Study. Am J Transplant 2020; 20:181-189. [PMID: 31265199 DOI: 10.1111/ajt.15519] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/23/2019] [Accepted: 06/11/2019] [Indexed: 01/25/2023]
Abstract
This study sought to identify the prevalence, pattern, and predictors of clinical fatigue in 193 living kidney donors (LKDs) and 20 healthy controls (HCs) assessed at predonation and 1, 6, 12, and 24 months postdonation. Relative to HCs, LKDs had significantly higher fatigue severity (P = .01), interference (P = .03), frequency (P = .002), and intensity (P = .01), and lower vitality (P < .001), at 1-month postdonation. Using published criteria, significantly more LKDs experienced clinical fatigue at 1 month postdonation, compared to HCs, on both the Fatigue Symptom Inventory (60% vs. 37%, P < .001) and SF-36 Vitality scale (67% vs. 16%, P < .001). No differences in fatigue scores or clinical prevalence were observed at other time points. Nearly half (47%) reported persistent clinical fatigue from 1 to 6 months postdonation. Multivariable analyses demonstrated that LKDs presenting for evaluation with a history of affective disorder and low vitality, those with clinical mood disturbance and anxiety about future kidney failure after donation, and those with less physical activity engagement were at highest risk for persistent clinical fatigue 6 months postdonation. Findings confirm inclusion of fatigue risk in existing OPTN informed consent requirements, have important clinical implications in the care of LKDs, and underscore the need for further scientific examination in this population.
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Affiliation(s)
- James R Rodrigue
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Aaron Fleishman
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jesse D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Paul Morrissey
- Transplant Center, Rhode Island Hospital, Providence, Rhode Island
| | - James Whiting
- Maine Transplant Center, Maine Medical Center, Portland, Maine
| | - John Vella
- Maine Transplant Center, Maine Medical Center, Portland, Maine
| | - Liise K Kayler
- Montefiore Einstein Center for Transplantation, Bronx, New York.,Regional Center of Excellence for Transplantation & Kidney Care, Erie County Medical Center, University of Buffalo, Buffalo, New York
| | - Daniel A Katz
- Organ Transplantation Program, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Jody Jones
- Organ Transplantation Program, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Bruce Kaplan
- Department of Medicine, University of Arizona, Tucson, Arizona.,School for the Science of Health Care Delivery, Arizona State University, Phoenix, Arizona
| | - Martha Pavlakis
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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19
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Dale LA, Silva MV, Sandoval PR, Decastro J, Campenot ES, Ratner LE. Therapeutic living donor nephrectomy. Clin Transplant 2019; 33:e13715. [PMID: 31541580 DOI: 10.1111/ctr.13715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/25/2019] [Revised: 08/25/2019] [Accepted: 09/14/2019] [Indexed: 01/20/2023]
Abstract
Therapeutic living donor nephrectomy is defined as a nephrectomy that is performed as therapy for an underlying medical condition. The patient directly benefits from having their kidney removed, but the kidney is deemed transplantable. The kidney is subsequently used as an allograft for an individual with advanced renal disease. Therapeutic donor nephrectomy can be successfully utilized for a heterogenous cohort of disease processes as both treatment for the donor and to increase the number of suitable organs available for transplantation. We describe four cases of therapeutic donor nephrectomy that were performed at our institution. Of the four cases, two patients elected to undergo therapeutic donor nephrectomy as treatment for loin pain hematuria syndrome; one after blunt abdominal trauma that resulted in complete proximal ureteral avulsion; and the fourth after being diagnosed with a small renal mass. Based on our data presented to the United Network for Organ Sharing Board of Directors (UNOS) in December 2015, living donor evaluation has been made simpler for patients electing to undergo therapeutic donor nephrectomy. UNOS eliminated the requirement for a psychosocial evaluation for these patients. As the organ shortage continues to limit transplantation, therapeutic donor nephrectomy should be considered when appropriate.
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Affiliation(s)
- Leigh-Anne Dale
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Mark V Silva
- Department of Urology, NYU Langone - Brooklyn, Brooklyn, New York
| | | | - Joel Decastro
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Eric S Campenot
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Lloyd E Ratner
- Department of Surgery, Columbia University Medical Center, New York, New York
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20
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Ammary FA, Bowring MG, Massie AB, Yu S, Waldram MM, Garonzik-Wang J, Thomas AG, Holscher CM, Qadi MA, Henderson ML, Wiseman A, Gralla J, Brennan DC, Segev DL, Muzaale AD. The changing landscape of live kidney donation in the United States from 2005 to 2017. Am J Transplant 2019; 19:2614-2621. [PMID: 30903733 PMCID: PMC6711793 DOI: 10.1111/ajt.15368] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 10/22/2018] [Revised: 03/12/2019] [Accepted: 03/15/2019] [Indexed: 01/25/2023]
Abstract
The number of live kidney donors has declined since 2005. This decline parallels the evolving knowledge of risk for biologically related, black, and younger donors. To responsibly promote donation, we sought to identify declining low-risk donor subgroups that might serve as targets for future interventions. We analyzed a national registry of 77 427 donors and quantified the change in number of donors per 5-year increment from 2005 to 2017 using Poisson regression stratified by donor-recipient relationship and race/ethnicity. Among related donors aged <35, 35 to 49, and ≥50 years, white donors declined by 21%, 29%, and 3%; black donors declined by 30%, 31%, and 12%; Hispanic donors aged <35 and 35 to 49 years declined by 18% and 15%, and those aged ≥50 increased by 10%. Conversely, among unrelated donors aged <35, 35 to 49, and ≥50 years, white donors increased by 12%, 4%, and 24%; black donors aged <35 and 35 to 49 years did not change but those aged ≥50 years increased by 34%; Hispanic donors increased by 16%, 21%, and 46%. Unlike unrelated donors, related donors were less likely to donate in recent years across race/ethnicity. Although this decline might be understandable for related younger donors, it is less understandable for lower-risk related older donors (≥50 years). Biologically related older individuals are potential targets for interventions to promote donation.
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Affiliation(s)
- Fawaz Al Ammary
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Grace Bowring
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Sile Yu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Madeleine M. Waldram
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Alvin G. Thomas
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Courtenay M. Holscher
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mohamud A. Qadi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Macey L. Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexander Wiseman
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Jane Gralla
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel C. Brennan
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
| | - Abimereki D. Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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21
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Keys DO, Jackson S, Berglund D, Matas AJ. Kidney donor outcomes ≥ 50 years after donation. Clin Transplant 2019; 33:e13657. [PMID: 31283043 DOI: 10.1111/ctr.13657] [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: 06/13/2019] [Accepted: 07/01/2019] [Indexed: 01/10/2023]
Abstract
Many living kidney donors (LDs) are young at donation; yet there are little data on long-term LD follow-up. We report on 66 LDs who donated ≥50 years ago: 22 (33.3%) are still alive (current age, 78.5 ± 7.25 years); 39 (59%) died (mean age at death, 74.2 ± 12.3 years); and 5 are lost to follow-up (mean age at last contact, 68.7 ± 4.6 years). Those who died were older at donation (P < .001). Causes of death included 12 (30.8% of deaths) cardiovascular diseases, 9 (23.0%) respiratory failures, 5 (12.8%) malignancies and 4 (10.3%) infections, and 9 (23%) were unknown or miscellaneous. Forty-nine living donors (74%) developed hypertension at a mean age of 59.9 ± 14.0 years; 12 (18%) developed diabetes at a mean age of 62 ± 19.4 years; and 11 (16.7%) developed proteinuria at a mean age of 60.6 ± 18.2 years-each at a similar incidence as seen in the age-matched general population. At last follow-up, the eGFR by CKD-EPI (mean ± SD) for donors currently alive was 60.2 ± 13.4 mL/min/1.73 m2 ; for those that died, 54.0 ± 21.5 mL/min/1.73 m2 ; for those lost to follow-up, 55.6 ± 7.5 mL/min/1.73 m2 . ESRD developed in 2 (3.3%). SF-36 quality of life health survey scores (n = 21) were similar to the age-matched general population.
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Affiliation(s)
- Daniel O Keys
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Scott Jackson
- Informatics Services for Researching & Reporting, Fairview, Minneapolis, Minnesota
| | - Danielle Berglund
- Informatics Services for Researching & Reporting, Fairview, Minneapolis, Minnesota
| | - Arthur J Matas
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
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22
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Deshmukh CS, Ganpule AP, Sudharsan SB, Singh AG, Sabnis RB, Desai MR. Iliac fossa vs Pfannenstiel retrieval incision in laparoscopic donor nephrectomy: A critical analysis. Arab J Urol 2019; 17:318-325. [PMID: 31723450 PMCID: PMC6830294 DOI: 10.1080/2090598x.2019.1637069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/15/2019] [Indexed: 11/24/2022] Open
Abstract
Objective: To compare two retrieval incisions, Pfannenstiel vs iliac fossa incision, in terms of operative technique-related variables and variables related to patient satisfaction postoperatively, in patients undergoing laparoscopic donor nephrectomy (LDN). Patients and methods: This prospective randomised study was conducted between May 2016 and April 2017. All the voluntary kidney donors aged 18–60 years were randomised into two groups. Group 1, comprised patients undergoing graft retrieval via an iliac fossa incision, and Group 2 comprised those undergoing graft retrieval via a Pfannenstiel incision. Intraoperative assessment of the incision by the surgeon was done using a Likert scale-based questionnaire. Other variables studied were the operative time, retrieval time, warm ischaemia time, and length of incision. Postoperatively, visual analogue scale pain scores, analgesia consumption, and hospital stay were compared. During follow-up cosmetic outcome was compared. Results: In all, 108 patients were enrolled in the study with 54 patients in each group. The mean operative time was shorter in Pfannenstiel-incision group, at 155.2 vs 171.67 min (P = 0.01). The retrieval incision length was significantly less in the Pfannenstiel arm, at 9.29 vs 9.85 cm (P < 0.001). In the surgeon Likert scale-based questionnaire, the Pfannenstiel incision scored better than the iliac fossa incision for ease of specimen retrieval (P = 0.015), ease of immediate check laparoscopy (P = 0.002), and ease of incision closure (P < 0.001). The Pfannenstiel-incision group required less postoperative analgesia, at a mean (SD) of 7.03 (8.82) vs 15.55 (11.1) mg nalbuphine (P < 0.001). During follow-up the Manchester Scar Scores were lesser in the Pfannenstiel-incision group (P < 0.001). Conclusion: The Pfannenstiel incision was considered preferable during the critical steps of the LDN and had a smaller retrieval incision, lesser operative time and postoperative analgesia requirement, and better cosmesis than the iliac fossa incision. Abbreviations: BMI: body mass index; LDN: laparoscopic donor nephrectomy; VAS: visual analogue scale; WIT, warm ischaemia time
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Affiliation(s)
| | - Arvind P Ganpule
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - S Balaji Sudharsan
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Abhishek G Singh
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Ravindra B Sabnis
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Mahesh R Desai
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
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23
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Tabrizian P, Giacca M, Prigoff J, Tran B, Holzner ML, Chin E, Palese M, Herron D, Arvelakis A, Rudow DL, Florman S, Shapiro R. Renal Safety of Intravenous Ketorolac Use After Donor Nephrectomy. Prog Transplant 2019; 29:283-286. [PMID: 31185805 DOI: 10.1177/1526924819855360] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The benefit and short-term safety of ketorolac have been established in previous studies however, the risk of bleeding and long-term renal impairment in patients undergoing donor nephrectomy remain unclear. We report our experience at a high-volume transplant center. METHOD Between January 1996 and January 2014, 862 consecutive patients underwent laparoscopic donor nephrectomy. Exclusion criteria included nonsteroidal anti-inflammatory drug allergy, asthma, bleeding disorders, long-term opioid use, intraoperative blood loss >700 mL, peptic ulcer disease, bleeding diathesis, and baseline creatinine greater than 1.9 mg/dL. Intravenous ketorolac was administered within 30 minutes following the surgical procedure at a dose of 15 to 30 mg every 6 hours. Patients were categorized into 2 groups according to the administration of ketorolac after surgery. Differences between the groups were analyzed. Primary outcomes were changes in serum creatinine and hemoglobin levels. Poor outcome was defined as postsurgical complications. RESULTS During this time, 469 (55.3%) received ketorolac. The mean donor age was 39 years, and 360 (42.5%) were male. Left kidneys were procured in 82%. Operative time averaged 210 minutes and warm ischemia time117 seconds. Baseline demographic and operative outcomes were comparable in both groups. No statistically significant differences were found between the ketorolac group and the nonketorolac group in preoperative and postoperative hemoglobin levels and serum creatinine at 1 week, 1 year, and 5 years (P = .6). Ketorolac use was not associated with increased perioperative morbidity (P = NS). CONCLUSION The use of intravenous ketorolac in patients undergoing donor nephrectomy was not associated with an increased risk of bleeding or renal impairment.
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Affiliation(s)
- Parissa Tabrizian
- 1 Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Massimo Giacca
- 1 Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jake Prigoff
- 1 Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benjamin Tran
- 1 Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew L Holzner
- 1 Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Edward Chin
- 2 Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Palese
- 2 Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Herron
- 2 Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Antonios Arvelakis
- 1 Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dianne LaPointe Rudow
- 1 Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sander Florman
- 1 Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ron Shapiro
- 1 Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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24
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Kumar A, Gupta P, Kumar S, Yadav S, Prasanth YM, Tyagi V, Prasad V, Saurav K. A prospective evaluation of donor and graft outcomes of 3-D laparoscopic donor nephrectomy: a single centre experience. Cent European J Urol 2019; 72:72. [PMID: 31011446 PMCID: PMC6469007 DOI: 10.5173/ceju.2019.1850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 01/27/2019] [Accepted: 02/12/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Anup Kumar
- Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India
| | - Pankaj Gupta
- Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India
| | - Sandeep Kumar
- Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India
| | - Siddharth Yadav
- Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India
| | - Y M Prasanth
- Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India
| | - Vijay Tyagi
- Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India
| | - Vishnu Prasad
- Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India
| | - Kumar Saurav
- Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India
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25
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Yoon YE, Lee HH, Na JC, Han WK. Prospective assessment of urinary neutrophil gelatinase-associated lipoprotein in living kidney donors: toward understanding differences between chronic kidney diseases of surgical and medical origin. BJU Int 2018; 123:869-876. [PMID: 30347133 DOI: 10.1111/bju.14592] [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: 11/30/2022]
Abstract
OBJECTIVES To evaluate the clinical implications of postoperative urinary neutrophil gelatinase-associated lipoprotein (NGAL) changes and the association between urinary NGAL (uNGAL) and renal function in living kidney donors. SUBJECTS, PATIENTS AND METHODS We included 76 healthy adults who underwent donor nephrectomy between December 2013 and November 2014. Perioperative serum creatinine (sCr), uNGAL, serum NGAL (sNGAL), and urinary microalbumin were prospectively measured until 6 months postoperatively. Patients with chronic kidney disease (CKD) due to medical disorders who visited our outpatient clinic during the same period were included for comparison. RESULTS The mean (SD) preoperative uNGAL of donors was 5 (5.17) ng/mL. uNGAL (corrected for urinary creatinine) was maximal at 1-2 days postoperatively, decreased on postoperative day 3, and stabilised by 7 days after surgery. Postoperative uNGAL was not associated with sex, age, or preoperative renal function. When corrected for sNGAL to compensate for the systemic increase in NGAL with major surgery, uNGAL on days 1-3 postoperatively was negatively correlated with sCr. Postoperatively, donor uNGAL remained higher than preoperatively for up to 6 months but was significantly lower than in patients with medical CKD with similar glomerular filtration rates. CONCLUSION Acute kidney injury due to hyperfiltration of remnant kidney after donor nephrectomy was maximal within 1-2 days postoperatively. The rise in uNGAL during this period in donors was negatively correlated with postoperative sCr levels. Decreased renal function after nephrectomy differs from that of medical CKD.
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Affiliation(s)
- Young Eun Yoon
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | - Hyung Ho Lee
- Department of Urology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Joon Chae Na
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Kyu Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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26
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Matas AJ, Berglund DM, Vock DM, Ibrahim HN. Causes and timing of end-stage renal disease after living kidney donation. Am J Transplant 2018; 18:1140-1150. [PMID: 29369517 DOI: 10.1111/ajt.14671] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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: 10/06/2017] [Revised: 12/14/2017] [Accepted: 01/04/2018] [Indexed: 01/25/2023]
Abstract
End-stage renal disease (ESRD) is a risk after kidney donation. We sought, in a large cohort of kidney donors, to determine the causes of donor ESRD, the interval from donation to ESRD, the role of the donor/recipient relationship, and the trajectory of the estimated GFR (eGFR) from donation to ESRD. From 1/1/1963 thru 12/31/2015, 4030 individuals underwent living donor nephrectomy at our center, as well as ascertainment of ESRD status. Of these, 39 developed ESRD (mean age ± standard deviation [SD] at ESRD, 62.4 ± 14.1 years; mean interval between donation and ESRD, 27.1 ± 9.8 years). Donors developing ESRD were more likely to be male, as well as smokers, and younger at donation, and to have donated to a first-degree relative. Of donors with a known cause of ESRD (n = 25), 48% was due to diabetes and/or hypertension; only 2 from a disease that would have affected 1 kidney (cancer). Of those 25 with an ascertainable ESRD cause, 4 shared a similar etiology of ESRD with their recipient. Almost universally, thechange of eGFR over time was stable, until new-onset disease (kidney or systemic). Knowledge of factors contributing to ESRD after living kidney donation can improve donor selection and counseling, as well as long-term postdonation care.
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Affiliation(s)
- Arthur J Matas
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Danielle M Berglund
- Informatics Services for Research and Reporting, Fairview, Minneapolis, MN, USA
| | - David M Vock
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Hassan N Ibrahim
- Division of Renal Diseases and Hypertension, Houston Methodist Hospital, Houston, TX, USA
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27
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Samstein B, de Melo-Martin I, Kapur S, Ratner L, Emond J. A liver for a kidney: Ethics of trans-organ paired exchange. Am J Transplant 2018; 18:1077-1082. [PMID: 29442420 DOI: 10.1111/ajt.14690] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 02/01/2018] [Accepted: 02/04/2018] [Indexed: 01/25/2023]
Abstract
Living donation provides important access to organ transplantation, which is the optimal therapy for patients with end-stage liver or kidney failure. Paired exchanges have facilitated thousands of kidney transplants and enable transplantation when the donor and recipient are incompatible. However, frequently willing and otherwise healthy donors have contraindications to the donation of the organ that their recipient needs. Trans-organ paired exchanges would enable a donor associated with a kidney recipient to donate a lobe of liver and a donor associated with a liver recipient to donate a kidney. This article explores some of the ethical concerns that trans-organ exchange might encounter including unbalanced donor risks, the validity of informed consent, and effects on deceased organ donation.
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Affiliation(s)
| | | | - Sandip Kapur
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Lloyd Ratner
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Jean Emond
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
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28
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Kumar S, Witt RG, Tullius SG, Malek SK. Hand-assisted laparoscopic retroperitoneal donor nephrectomy: A single-institution experience of over 500 cases-Operative technique and clinical outcomes. Clin Transplant 2018; 32:e13261. [PMID: 29663498 DOI: 10.1111/ctr.13261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Although there are several variations of laparoscopic living-donor nephrectomies, there is no consensus as to the best technique. Our objective was to describe our technique and assess the outcomes of our approach to hand-assisted laparoscopic retroperitoneal donor nephrectomies. METHODS From July 2001 to October 2015, 507 consecutive hand-assisted laparoscopic retroperitoneal donor nephrectomies were performed. Their clinical information was retrospectively reviewed including warm ischemia time, skin incision to kidney ready time, estimated blood loss, adverse intraoperative events, and postoperative complications. RESULTS Mean incision time to kidney removal was 135 minutes (55-260), mean warm ischemia time was 125 seconds (30-390), and mean blood loss was 83 mL (20-500). Average length of stay was 3 days (1-6). There were no significant differences between left and right kidney donors based on demographics, length of hospital stay, or warm ischemia time. There were no conversions to open surgery. Complications occurred in 4.9% of patients (25/507), including 4 cases of perioperative bleeding. CONCLUSIONS This is a single-center series describing the safety and efficacy of the hand-assisted laparoscopic retroperitoneal donor nephrectomy for both right and left sides. It does not require intraperitoneal manipulation and allows for safe extraction of either kidney with minimal warm ischemia time.
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Affiliation(s)
- Sanjaya Kumar
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Russell G Witt
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Stefan G Tullius
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Sayeed K Malek
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
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29
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Park JS, Ahn HK, Na J, Lee HH, Yoon YE, Yoon MG, Han WK. Cumulative sum analysis of the learning curve for video-assisted minilaparotomy donor nephrectomy in healthy kidney donors. Medicine (Baltimore) 2018; 97:e0560. [PMID: 29703043 PMCID: PMC5944565 DOI: 10.1097/md.0000000000010560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 04/04/2018] [Indexed: 11/26/2022] Open
Abstract
Video-assisted minilaparotomy surgery (VAMS) is a hybrid of open and laparoscopic surgical techniques, so has advantages of both approaches. Here, we examined the learning curve for this procedure.We retrospectively evaluated 50 consecutive patients who underwent VAMS donor nephrectomy performed by a single surgeon (YEY) between March 2015 and March 2016. The learning curve was evaluated using the cumulative sum (CUSUM) method. Measures of surgical performance included total operation time, warm ischemic time, and estimated blood loss.The mean patient age, body mass index, and body surface area were 43.5 years, 23.8 kg/m, and 1.7 m, respectively. The mean operation time and warm ischemic time were 160.0 minutes and 124.4 seconds. The learning curve of total operation time was best modeled as a second-order polynomial with equation CUSUMOT (minutes) = -0.3802 × case number + 20.315 × case number - 41.333 (R = 0.7707). The curve included 3 unique phases: phase 1 (the initial 17 cases), which is the initial learning curve; phase 2 (the middle 23 cases), expert competence, and phase 3 (the subsequent cases), mastery. In terms of warm ischemic time and estimated blood loss, the initial learning was achieved after 16 cases and after 9 to 10 cases, one could achieve competency.The VAMS donor nephrectomy learning curve is shorter than for laparoscopic or robotic hand-assisted donor nephrectomy. Surgeons can become familiar with the procedure and perform it without complications after approximately 16 to 17 operations.
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Affiliation(s)
- Jee Soo Park
- Department of Urology, Urological Science Institute, Yonsei
University College of Medicine
| | - Hyun Kyu Ahn
- Department of Urology, Urological Science Institute, Yonsei
University College of Medicine
| | - Joonchae Na
- Department of Urology, Urological Science Institute, Yonsei
University College of Medicine
| | - Hyung Ho Lee
- Department of Urology, National Health Insurance Service
Ilsan Hospital, Goyang, Gyeonggi-do
| | - Young Eun Yoon
- Department of Urology, Hanyang University College of
Medicine
| | - Min Gee Yoon
- Department of Urology, Urological Science Institute, Yonsei
University College of Medicine
| | - Woong Kyu Han
- Department of Urology, Urological Science Institute, Yonsei
University College of Medicine
- Brain Korea 21 PLUS Project for Medical Science, Department
of Urology, Yonsei University, Seoul, Republic of Korea
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30
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Yalin SF, Trabulus S, Seyahi N, Cengiz M, Cicik ME, Altiparmak MR. Ambulatory blood pressure monitoring in living kidney donors: What changes in 10 years? Clin Transplant 2018; 32:e13224. [PMID: 29457269 DOI: 10.1111/ctr.13224] [Citation(s) in RCA: 4] [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] [Accepted: 02/11/2018] [Indexed: 11/30/2022]
Abstract
In renal transplantation, living donations have more significant benefits compared to cadaveric donations. However, a probable increase in blood pressure following donation should also be kept in mind. In this study, we investigated the long-term changes in blood pressure in living kidney donors using ambulatory blood pressure monitoring and we explored the e-GFR and albuminuria/proteinuria measurements at 3 time points. Twenty-eight living kidney donors and 39 healthy individuals were evaluated and compared at the baseline and later at the 10th year. At the 10th year, creatinine levels were higher and eGFR levels were lower in the donors, whereas the systolic and diastolic measurements of the donors and controls and the prevalence of nondipping in the donors and controls were similar. Our study may be underpowered due to its small population size. However, our results at the 10th year follow-up indicated that the risk of hypertension might not seem to have increased in the well-selected donors. In addition, the majority of our donors had preserved their GFR values. Therefore, we can suggest that living kidney donation appears to be safe in well-selected patients over a 10-year time frame.
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Affiliation(s)
- Serkan Feyyaz Yalin
- Department of Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sinan Trabulus
- Department of Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nurhan Seyahi
- Department of Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mahir Cengiz
- Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Erdogan Cicik
- Department of Ophthalmology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Riza Altiparmak
- Department of Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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31
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Ruck JM, Holscher CM, Purnell TS, Massie AB, Henderson ML, Segev DL. Factors associated with perceived donation-related financial burden among living kidney donors. Am J Transplant 2018; 18:715-719. [PMID: 29068176 PMCID: PMC5863761 DOI: 10.1111/ajt.14548] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/18/2017] [Accepted: 10/12/2017] [Indexed: 01/25/2023]
Abstract
The perception of living kidney donation-related financial burden affects willingness to donate and the experience of donation, yet no existing tools identify donors who are at higher risk of perceived financial burden. We sought to identify characteristics that predicted higher risk of perceived financial burden. We surveyed 51 living kidney donors (LKDs) who donated from 01/2015 to 3/2016 about socioeconomic characteristics, predonation cost concerns, and perceived financial burden. We tested associations between both self-reported and ZIP code-level characteristics and perceived burden using Fisher's exact test and bivariate modified Poisson regression. Donors who perceived donation-related financial burden were less likely to have an income above their ZIP code median (14% vs. 72%, P = .006); however, they were more likely than donors who did not perceive burden to rent their home (57% vs. 16%, P = .03), have an income <$60 000 (86% vs. 20%, P = .002), or have had predonation cost concerns (43% vs. 7%, P = .03). Perceived financial burden was 3.6-fold as likely among those with predonation cost concerns and 10.6-fold as likely for those with incomes <$60 000. Collecting socioeconomic characteristics and asking about donation-related cost concerns prior to donation might allow transplant centers to target financial support interventions toward potential donors at higher risk of perceiving donation-related financial burden.
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Affiliation(s)
- Jessica M. Ruck
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Tanjala S. Purnell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD,Department of Health, Behavior, and Society, Johns Hopkins School of Public Health, Baltimore, MD
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Macey L. Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Johns Hopkins University School of Nursing, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD,Johns Hopkins University School of Nursing, Baltimore, MD
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32
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LaMattina JC, Powell JM, Costa NA, Leeser DB, Niederhaus SV, Bromberg JS, Alvarez-Casas J, Phelan MS, Barth RN. Surgical complications of laparoendoscopic single-site donor nephrectomy: a retrospective study. Transpl Int 2017; 30:1132-1139. [PMID: 28672056 DOI: 10.1111/tri.13005] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/13/2017] [Accepted: 06/26/2017] [Indexed: 01/29/2023]
Abstract
The single-port approach has been associated with an unacceptably high rate of umbilical port hernias in large series of patients undergoing single-port cholecystectomy and colectomy and with additional surgical risks thought secondary to technical and ergonomic limitations. A retrospective review of 378 consecutive laparoendoscopic single-site(LESS) donor nephrectomies performed between 04/15/2009 and 04/09/2014 was conducted. Twelve patients (3%) developed an umbilical hernia. Eleven (92%) were female and eight (73%) of these patients had a prior pregnancy. Hernias were reported 13.5 ± 6.9 months after donation, and the mean size was 5.1 ± 3.7 cm. Seven additional cases (1.9%) required a return to the operating room for internal hernia (2), evisceration (1), bleeding (1), enterotomy (1), and wound infection (2). The original incision was utilized for reexploration. One patient required emergent conversion to an open procedure for bleeding during the initial donation. There were no mortalities. Recipient patient and graft survival were 99% and 99% at 1 year, respectively. Although reports associated with earlier experiences with single-site procedures suggested an unacceptably high rate of hernias at the surgical site, this does not seem to be the case at our center. This technique is a reliable surgical technique for left donor nephrectomy at this institution.
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Affiliation(s)
- John C LaMattina
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jessica M Powell
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nadiesda A Costa
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David B Leeser
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Silke V Niederhaus
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jonathan S Bromberg
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Josue Alvarez-Casas
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael S Phelan
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rolf N Barth
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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Bang JY, Kim SO, Kim SG, Song JG, Hwang GS. Cystatin-C is associated with partial recovery of kidney function and progression to chronic kidney disease in living kidney donors: Observational study. Medicine (Baltimore) 2017; 96:e6037. [PMID: 28151912 PMCID: PMC5293475 DOI: 10.1097/md.0000000000006037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 01/04/2017] [Accepted: 01/09/2017] [Indexed: 01/28/2023] Open
Abstract
Donor nephrectomy in living-donor kidney transplantation may result in hyperfiltration injury in remnant kidney; however, its clinical implication in partial recovery of kidney function (PRKF) in remnant kidney and chronic kidney disease (CKD) progression remains unclear. Thus, we investigated the effect of PRKF on CKD development in the residual kidney and the utility of cystatin-C (Cys-C) in evaluating renal function in living-donor kidney transplantation donors.The electronic medical records and laboratory results of 1648 kidney transplant (KT) donors and 13,834 healthy nondonors between January 2006 and November 2014 were reviewed. The predictors of PRKF and CKD diagnosed by Kidney Disease: Improving Global Outcomes (KDIGO) criteria were evaluated by multivariate analysis. CKD risk was compared between KT donors and healthy nondonors using Cox proportional hazard regression analysis following propensity score matching (PSM).The incidence of PRKF for KT donors was 49.3% (813). CKD incidence was 24.8% (408) in KT donors and 2.0% (277) in healthy nondonors. The predictors of PRKF were, male sex (odds ratio [OR], 17.32; 95% confidence interval [CI] 9.16-32.77), age (OR, 1.02; 95% CI, 1.00-1.04; P < 0.001), Cys-C concentration (OR, 1.02; 95% CI, 1.00-1.04; P = 0.02), and preoperative albumin level (OR, 0.49; 95% CI, 0.27-0.89; P = 0.02). The predictors of CKD were age (hazards ratio [HR], 1.04; 95% CI, 1.02-1.05; P < 0.001), Cys-C concentration (HR, 1.024; 95% CI, 1.012-1.037; P < 0.001), and PRKF (HR, 1.41; 95% CI, 1.04-1.92; P = 0.03). After PSM, the risk of progression to CKD was higher in KT donors than in healthy nondonors (HR, 58.4; 95% CI, 34.2-99.8; P < 0.001).Donor nephrectomy is associated with PRKF and progression to CKD. Cys-C is a useful early marker for detecting PRKF and CKD.
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Affiliation(s)
- Ji-Yeon Bang
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics
| | - Seon-Ok Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sae-Gyul Kim
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics
| | - Jun-Gol Song
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics
| | - Gyu Sam Hwang
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics
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Ong Sio LCL, dela Cruz RGC, Bautista AF. A comparison of renal responses to sevoflurane and isoflurane in patients undergoing donor nephrectomy: a randomized controlled trial. Med Gas Res 2017; 7:19-27. [PMID: 28480028 PMCID: PMC5402343 DOI: 10.4103/2045-9912.202906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Sevoflurane and isoflurane are volatile halogenated ether widely used in anesthesia. Both have comparable potency and easy titratability but sevoflurane has lower pungency and results in faster patient recovery. Isoflurane, however, is more affordable. The nephrotoxicity of sevoflurane is undisputed but studies on isoflurane nephrotoxicity are lacking. The objective of this paper is to determine the overall nephrotoxicity profile of sevoflurane and isoflurane in donor nephrectomy patients using the renal function markers - nuclear glomerular filtration rate (GFR), serum creatinine, urine protein-to-creatinine ratio, proteinuria, and glucosuria. A randomized comparative study of postoperative renal functions in donor nephrectomy patients who had received either low-flow (< 1 L/min) sevoflurane or isoflurane were analyzed. The renal parameters were repeated 72 hours post anesthesia. Forty-seven subjects (46%) were randomized to receive isoflurane while fifty-five received sevoflurane (54%). Between the two anesthetic groups, there was no significant difference in terms of serum creatinine, total GFR, or nuclear GFR. There was a statistically higher proportion of patients with urine protein-to-creatinine ratios of 0.2 and above in the isoflurane group (64% vs. 38%), while more patients in the sevoflurane group had ratios above 0.2 (62% vs. 36%, P < 0.05). The type of anesthetic agent was not an independent predictor of increasing serum creatinine, total GFR and urine protein-to-creatinine ratio and nuclear GFR. In conclusion, the overall nephrotoxicity profile of sevoflurane and isoflurane-treated donor nephrectomy patients is minimal.
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Affiliation(s)
| | | | - Alexander F. Bautista
- Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Zwang NA, Shetty A, Sustento-Reodica N, Gordon EJ, Leventhal J, Gallon L, Friedewald JJ. APOL1-Associated End-Stage Renal Disease in a Living Kidney Transplant Donor. Am J Transplant 2016; 16:3568-3572. [PMID: 27588375 DOI: 10.1111/ajt.14035] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 06/28/2016] [Revised: 08/09/2016] [Accepted: 08/27/2016] [Indexed: 01/25/2023]
Abstract
Homozygosity for apolipoprotein-L1 (APOL1) risk variants has emerged as an important predictor of renal disease in individuals of African descent over the past several years. Additionally, these risk variants may be important predictors of renal allograft failure when present in a living or deceased donor. Currently, there is no universal recommendation for screening of potential donors. We present a case of end-stage renal disease with focal segmental glomerulosclerosis in a living donor 7 years following donor nephrectomy. Genetic assessment revealed homozygosity for the G1 high-risk APOL1 variant.
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Affiliation(s)
- N A Zwang
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL.,McGaw Medical Center of Northwestern University, Chicago, IL
| | - A Shetty
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - N Sustento-Reodica
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - E J Gordon
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL.,Center for Healthcare Studies, and Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - J Leventhal
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - L Gallon
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - J J Friedewald
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
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36
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Janki S, Klop KWJ, Dooper IMM, Weimar W, Ijzermans JNM, Kok NFM. More than a decade after live donor nephrectomy: a prospective cohort study. Transpl Int 2016; 28:1268-75. [PMID: 25865340 DOI: 10.1111/tri.12589] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 01/16/2015] [Revised: 02/19/2015] [Accepted: 04/07/2015] [Indexed: 01/10/2023]
Abstract
Previously reported short-term results after live kidney donation show no negative consequences for the donor. The incidence of new-onset morbidity takes years to emerge, making it highly likely that this will be missed during short-term follow-up. Therefore, evidence on long-term outcome is essential. A 10-year follow-up on renal function, hypertension, quality of life (QOL), fatigue, and survival was performed of a prospective cohort of 100 donors. After a median follow-up time of 10 years, clinical data were available for 97 donors and QOL data for 74 donors. Nine donors died during follow-up of unrelated causes to donation, and one donor was lost to follow-up. There was a significant decrease in kidney function of 12.9 ml/min (P < 0.001) at follow-up. QOL showed significant clinically relevant decreases of 10-year follow-up scores in SF-36 dimensions of physical function (P < 0.001), bodily pain (P = 0.001), and general health (P < 0.001). MFI-20 scores were significantly higher for general fatigue (P < 0.001), physical fatigue (P < 0.001), reduced activity (P = 0.019), and reduced motivation (P = 0.030). New-onset hypertension was present in 25.6% of the donors. Donor outcomes are excellent 10 years post-donation. Kidney function appears stable, and hypertension does not seem to occur more frequently compared to the general population.
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Affiliation(s)
- Shiromani Janki
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Karel W J Klop
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Ine M M Dooper
- Department of Internal Medicine, Division of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willem Weimar
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jan N M Ijzermans
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Niels F M Kok
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Abstract
We present the first case report of chylous ascites following total robot-assisted donor nephrectomy. A 39-year-old female underwent a transperitoneal left-sided total robot-assisted donor nephrectomy. The procedure was uneventful and the patient was discharged without any symptoms. At postoperative Day 29, the patient presented with abdominal pain, nausea and a distended, painful abdomen with shifting dullness. She was diagnosed with chylous ascites by ultrasonography and puncture analysis, and treated with therapeutic drainage and dietary restriction. After 4 weeks, she was free of symptoms. The occurrence of this complication is rare after donor nephrectomy. Fortunately, the complication can be successfully treated within a few weeks with minimal discomfort for the patient as demonstrated in this case. It is of utmost importance to minimize the risks and limit discomfort for live kidney donors who willingly undergo major surgery to improve the well-being of another individual.
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Affiliation(s)
- Shiromani Janki
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Türkan Terkivatan
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Hendrikus J A N Kimenai
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jan N M IJzermans
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - T C Khé Tran
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Rodrigue JR, Schold JD, Morrissey P, Whiting J, Vella J, Kayler LK, Katz D, Jones J, Kaplan B, Fleishman A, Pavlakis M, Mandelbrot DA. Predonation Direct and Indirect Costs Incurred by Adults Who Donated a Kidney: Findings From the KDOC Study. Am J Transplant 2015; 15:2387-93. [PMID: 25943721 PMCID: PMC5097875 DOI: 10.1111/ajt.13286] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/22/2015] [Accepted: 02/26/2015] [Indexed: 01/25/2023]
Abstract
Limited information exists on the predonation costs incurred by eventual living kidney donors (LKDs). Expenses related to completion of the donation evaluation were collected from 194 LKDs participating in the multi-center, prospective Kidney Donor Outcomes Cohort (KDOC) Study. Most LKDs (n = 187, 96%) reported one or more direct costs, including ground transportation (80%), healthcare (24%), lodging (17%) and air transportation (14%), totaling $101 484 (USD; mean = $523 ± 942). Excluding paid vacation or sick leave, donor and companion lost wages totaled $35 918 (mean = $187 ± 556) and $14 378 (mean = $76 ± 311), respectively. One-third of LKDs used paid vacation or sick leave to avoid incurring lost wages. Few LKDs reported receiving financial support from the transplant candidate (6%), transplant candidate's family (3%), a nonprofit organization (3%), the National Living Donor Assistance Center (7%), or transplant center (3%). Higher total costs were significantly associated with longer distance traveled to the transplant center (p < 0.001); however, total costs were not associated with age, sex, race/ethnicity, household income, marital status, insurance status, or transplant center. Moderate predonation direct and indirect costs are common for adults who complete the donation evaluation. Potential LKDs should be advised of these possible costs, and the transplant community should examine additional strategies to reimburse donors for them.
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Affiliation(s)
- J. R. Rodrigue
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA,Harvard Medical School, Boston, MA,Corresponding author: James R. Rodrigue,
| | - J. D. Schold
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - P. Morrissey
- Transplant Center, Rhode Island Hospital, Providence, RI
| | - J. Whiting
- Maine Transplant Center, Maine Medical Center, Portland, ME
| | - J. Vella
- Maine Transplant Center, Maine Medical Center, Portland, ME
| | - L. K. Kayler
- Montefiore Einstein Center for Transplantation, Bronx, NY
| | - D. Katz
- Organ Transplantation Program, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - J. Jones
- Organ Transplantation Program, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - B. Kaplan
- Division of Internal Medicine, University of Kansas Medical Center, Kansas City, KS,Department of Medicine, University of Arizona, Tucson, AZ
| | - A. Fleishman
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA,Harvard Medical School, Boston, MA
| | - M. Pavlakis
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA,Harvard Medical School, Boston, MA
| | - D. A. Mandelbrot
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA,Department of Medicine, University of Wisconsin, Madison, WI
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Janki S, Verver D, Klop KWJ, Friedman AL, Peters TG, Ratner LE, Ijzermans JNM, Dor FJMF. Vascular management during live donor nephrectomy: an online survey among transplant surgeons. Am J Transplant 2015; 15:1701-7. [PMID: 25833120 DOI: 10.1111/ajt.13142] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 11/30/2014] [Accepted: 11/30/2014] [Indexed: 01/25/2023]
Abstract
In 2006, a survey from the American Society of Transplant Surgeons disclosed significant and sometimes fatal hemorrhagic events in live donor nephrectomies (LDN) related to failure of clips, leading to the contraindication of the Weck® Hem-o-lok® clip for control of the renal artery during LDN. A survey regarding vascular control techniques, their perceived safety ratings and their failures was sent to 645 European Society for Organ Transplantation members who profiled their profession as "surgeon" and selected "kidney" as organ type. Two hundred forty-three (41%) members responded, of whom 171 (63.3%) independently perform LDN. Their responses were analyzed. For arterial and venous vascular control, the GIA™ and TA™stapler are used most frequently, and were rated the safest. Of the 121 reported hemorrhagic events, slippage and dislodgement of clips occurred at least 58 times, while stapler malfunction occurred at least 40 times. One donor death from hemorrhage related to clip dysfunction was reported. Hemorrhagic complications of LDN with fatal and non-fatal outcomes still occur. Strikingly, many surgeons do not use the vascular closing technique that they consider most safe. Failure of non-transfixion techniques is associated with greater risks for the donor. Control of major vessels in LDN must employ transfixion techniques for optimal donor safety.
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Affiliation(s)
- S Janki
- Division of HPB & Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - D Verver
- Division of HPB & Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - K W J Klop
- Division of HPB & Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - T G Peters
- Department of Surgery, University of Florida Health Sciences Center, Jacksonville, FL
| | - L E Ratner
- Department of Surgery, Columbia University, New York, NY
| | - J N M Ijzermans
- Division of HPB & Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - F J M F Dor
- Division of HPB & Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Tiong HY, Goel RK, White WM, Goldfarb DA, Kaouk JH. Chylous ascites after laparoscopic donor nephrectomy. Asian J Endosc Surg 2015; 8:34-9. [PMID: 25384614 DOI: 10.1111/ases.12144] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 05/15/2014] [Revised: 08/07/2014] [Accepted: 08/08/2014] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The aim of this study was to determine the incidence, presentation, management, and outcomes of chylous ascites following laparoscopic donor nephrectomy. METHODS An Internet-based, multi-institutional survey was performed using http://www.surveymonkey.com. An email invitation to the voluntary survey was sent to 30 transplant centers and posted on CenterSpan, an email forum for transplant surgeons. The number of living donor transplantations and the number of cases of chylous ascites with clinical information, treatment and outcomes were sought from the questionnaire. RESULTS A total of 12 centers responded and reported 7683 cases of live donor nephrectomy. The reported incidence of postoperative chylous ascites was 0.013% (n = 12). Six centers reported 10 cases of chylous ascites following laparoscopic donor nephrectomy and 2 cases after open donor nephrectomy. Among the eight patients who developed chylous ascites following laparoscopic donor nephrectomy, presentation was typically 2 weeks after the date of initial surgery. Conservative therapy was successful in 50% of cases. Refractory ascites managed secondarily with surgical intervention had a success rate of 100%. CONCLUSION Chylous ascites is a rare complication following laparoscopic donor nephrectomy. Initial treatment should be conservative, with surgical therapy reserved for refractory cases.
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Affiliation(s)
- Ho Yee Tiong
- The Transplant Center, Glickman Kidney and Urological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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41
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Hoogendijk-van den Akker JM, Warlé MC, van Zuilen AD, Kloke HJ, Wever KE, d'Ancona FCH, Ӧzdemir DMD, Wetzels JFM, Hoitsma AJ. Urinary biomarkers after donor nephrectomy. Transpl Int 2015; 28:544-52. [PMID: 25581388 DOI: 10.1111/tri.12523] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 04/04/2014] [Accepted: 01/04/2015] [Indexed: 11/27/2022]
Abstract
As the beginning of living-donor kidney transplantation, physicians have expressed concern about the possibility that unilateral nephrectomy can be harmful to a healthy individual. To investigate whether the elevated intra-abdominal pressure (IAP) during laparoscopic donor nephrectomy causes early damage to the remaining kidney, we evaluated urine biomarkers after laparoscopic donor nephrectomy. We measured albumin and alpha-1-microglobulin (α-1-MGB) in urine samples collected during and after open and laparoscopic donor nephrectomy and laparoscopic cholecystectomy and colectomy. Additionally, kidney injury molecule 1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) were measured in urine samples collected during and after laparoscopic donor nephrectomy and colectomy. The same biomarkers were studied in patients randomly assigned to standard or low IAP during laparoscopic donor nephrectomy. We observed a peak in urinary albumin excretion during all procedures. Urine α-1-MGB rose in the postoperative period with a peak on the third postoperative day after donor nephrectomy. Urine α-1-MGB did not increase after laparoscopic cholecystectomy and colectomy. After laparoscopic nephrectomy, we observed slight increases in urine KIM-1 during surgery and in urine NGAL at day 2-3 after the procedure. After laparoscopic colectomy, both KIM-1 and NGAL were increased in the postoperative period. There were no differences between the high- and low-pressure procedure. Elevated urinary α-1-MGB suggests kidney damage after donor nephrectomy, occurring irrespective of IAP during the laparoscopic procedure.
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Affiliation(s)
- Judith M Hoogendijk-van den Akker
- Department of Nephrology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands; Department of Nephrology, Isala Zwolle, Zwolle, The Netherlands
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42
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Abstract
Laparoscopic donor nephrectomy is a routine practice but still requires an intense level of attention to prevent complications. We report a rare case of gross hematuria in postoperative period after an uneventful laparoscopic donor nephrectomy.
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Affiliation(s)
- G Gaurav
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
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43
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Giorgakis E, Fernandez-Diaz S. Diffuse subcutaneous emphysema after transperitoneal laparoscopic donor nephrectomy. Hippokratia 2013; 17:94. [PMID: 23935356 PMCID: PMC3738291] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- E Giorgakis
- Division of Surgery & Interventional Science, University College London, UK ; Department of Renal Transplantation, Royal London Hospital, UK
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44
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Abstract
Chylous ascites as a result of laparoscopic donor nephrectomy (LDN) is a rare complication that carries significant morbidity, including severe protein-calorie malnutrition and an associated immunocompromised state. We report a patient who underwent hand-assisted left LDN and subsequently developed chylous ascites. He failed conservative therapy including low-fat diet with medium-chain triglycerides (LFD/MCT) and oral protein supplementation as well as strict NPO status with intravenous (IV) total parenteral nutrition (TPN) and subcutaneous (SQ) somatostatin analogue administration. Laparoscopic re-exploration and intracorporeal suture ligation and clipping of leaking lymph channels successfully sealed the chyle leak. We review the literature to date including diagnosis, incidence, management options, psychosocial aspects and clinical outcomes of chylous ascites after LDN.
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Affiliation(s)
- J Aerts
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
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45
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Mitre AI, Dénes FT, Nahas WC, Simões FA, Colombo JR, Piovesan AC, Chambô JL, Arap S, Srougi M. Comparative and prospective analysis of three different approaches for live- donor nephrectomy. Clinics (Sao Paulo) 2009; 64:23-8. [PMID: 19142547 PMCID: PMC2671972 DOI: 10.1590/s1807-59322009000100005] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Accepted: 09/17/2008] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Living donor nephrectomy is usually performed by a retroperitoneal flank incision. Due to the significant morbidity and long recovery time for a flank incision, anterior extra peritoneal sub-costal and transperitoneal video-laparoscopic methods have been described for donor nephrectomy. We prospectively compare the long-term results of donors as well as functional recipients submitted to these three approaches. MATERIALS AND METHODS A total of 107 live donor renal transplantations were prospectively evaluated from May 2001 to January 2004. Donors were compared with regard to operative and warm ischemia time, postoperative pain, analgesic requirements, and complications. Recipients were compared with regard to graft function, acute cellular rejection, surgical complications, and graft and recipient survival. RESULTS The mean operative and warm ischemia times were longer in the video-laparoscopic group (p<0.001), whereas patients of the flank incision group presented more postoperative pain (p=0.035), required more analgesics (p<0.001), had longer hospital stays (p<0.001), and suffered more pain on the 90th day after surgery (p=0.006). In the sub-costal and flank incision groups, there was a larger number of paraesthesias and abdominal wall asymmetries (p<0.001). Recipient groups were demographically comparable and presented similar acute tubular necrosis incidence and delayed graft function. The incidence of acute cellular rejection was higher in the video-laparoscopic and flank incision groups (p=0.013). There was no difference in serum creatinine levels, surgical complications, or recipient or graft survival between groups. CONCLUSIONS The video-laparoscopic and sub-costal approaches proved to be safe, and to provide donor advantages relative to the flank incision approach. Among recipients, the complication rate, graft survival, and recipient survival were similar in all groups.
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Affiliation(s)
- Anuar Ibrahim Mitre
- Department of Urology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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46
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Abstract
Of the various options for patients with end stage renal disease, kidney transplantation is the treatment of choice for a suitable patient. The kidney for transplantation is retrieved from either a cadaver or a live donor. Living donor nephrectomy has been developed as a method to address the shortfall in cadaveric kidneys available for transplantation. Laparoscopic living donor nephrectomy (LLDN), by reducing postoperative pain, shortening convalescence, and improving the cosmetic outcome of the donor nephrectomy, has shown the potential to increase the number of living kidney donations further by removing some of the disincentives inherent to donation itself. The technique of LLDN has undergone evolution at different transplant centers and many modifications have been done to improve donor safety and recipient outcome. Virtually all donors eligible for an open surgical procedure may also undergo the laparoscopic operation. Various earlier contraindications to LDN, such as right donor kidney, multiple vessels, anomalous vasculature and obesity have been overcome with increasing experience. Laparoscopic live donor nephrectomy can be done transperitoneally or retroperitoneally on either side. The approach is most commonly transperitoneal, which allows adequate working space and easy dissection. A review of literature and our experience with regards to standard approach and the modifications is presented including a cost saving model for the developing countries. An assessment has been made, of the impact of LDN on the outcome of donor and the recipient.
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Affiliation(s)
- Nitin Gupta
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pamposh Raina
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anant Kumar
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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