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1.
Urologe A ; 59(1): 32-39, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31915888

RESUMO

BACKGROUND: In the context of living donation, the protection of the donor and the outcome are very important aspects. However, the side selection of the donor nephrectomy is also decisive. In this work, the basics of side selection and the question of whether there are differences regarding the left-sided or right-sided donor nephrectomy are considered. MATERIALS AND METHODS: Living kidney donation data of our center between December 2004 and July 2019 were evaluated in terms of withdrawal side, complications and outcome, as well as the current literature in PubMed. Finally, the results from our center are compared with the current literature. RESULTS: During the investigation period, 152 live donations were carried out in our center. In these cases 66 patients had a left-sided and in 86 cases a right-sided donor nephrectomy. One transplant vein thrombosis occurred in each group. Complications and outcome were similar for the recipient in both groups. It was noticed in the current literature that generally more left-sided donor nephrectomies are performed, most likely due to the preference of the surgeon. Although a low significantly increased risk of transplant vein thrombosis after right-sided donor nephrectomy is described, all authors agree that right-sided donor nephrectomy is a safe procedure with good outcome. CONCLUSIONS: Our own results and the current literature show that the right-sided donor nephrectomy is a safe procedure with only a slightly increased risk of complications compared to the left side and therefore can be recommended. It is clearly safe for the donor and organ, with an equivalent outcome for the recipient. The results are also dependent on the experience of the surgeon.


Assuntos
Transplante de Rim , Doadores Vivos , Nefrectomia/métodos , Coleta de Tecidos e Órgãos/efeitos adversos , Humanos , Laparoscopia , Nefrectomia/efeitos adversos , Coleta de Tecidos e Órgãos/métodos
2.
Medicine (Baltimore) ; 99(4): e18677, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977857

RESUMO

To investigate whether postoperative hepatic hemodynamics have an impact on graft function.Using a retrospective cohort with 262 adult living donor liver transplantation (LDLT) recipients, we discussed the relationship between postoperative hepatic hemodynamics and patient outcomes.According to the definition of early allograft dysfunction (EAD), the patients were classified into the EAD group (43 patients) and the non-EAD group (219 patients). In terms of postoperative hemodynamic parameters, there was no significant differences between these 2 groups regarding hepatic artery flow (HAF), hepatic artery velocity (HAV), portal vein flow (PVF), and portal vein velocity (PVV), except for the hepatic artery resistance index (HARI) which was somewhat higher in the EAD group on postoperative day 3 (POD3) (0.70 vs 0.61, P < .05). According to these results, we used a ROC curve and found that a HARI of 0.68 was the cutoff point (with 73.8% sensitivity and 58.3% specificity) for predicting EAD after LDLT. In addition, multivariate analysis showed that fulminant hepatic failure, pretransplant hepatorenal syndrome, and HARI ≥ 0.68 on POD3 were independent risk factors for postoperative EAD.Our results showed that postoperative hemodynamics might influence graft function by altering hepatic artery flow.


Assuntos
Sobrevivência de Enxerto/fisiologia , Artéria Hepática/patologia , Transplante de Fígado/efeitos adversos , Doadores Vivos , Resistência Vascular/fisiologia , Adolescente , Idoso , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Veia Porta/patologia , Prognóstico , Estudos Retrospectivos , Adulto Jovem
3.
Urologe A ; 59(1): 3-9, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31832746

RESUMO

BACKGROUND: Robot-assisted surgery has become widely adopted in urology due to advantages in comparison with laparoscopic or open approaches. Robot-assisted living kidney transplantation is one of the most challenging procedures in urology regarding technical, but also psychological and ethical aspects, and is currently routinely performed in two German departments. OBJECTIVES: The goal was to analyze and compare current evidence and experiences of robot-assisted living kidney transplantation in Europe and in Germany. MATERIALS AND METHODS: A systematic search was performed to identify relevant publications. They were compared with latest results from two German academic centers (Halle and Homburg/Saar). RESULTS: In 2015, robot-assisted living kidney transplantation was performed for the first time in Europe. Since then, 8 academic centers have established this procedure. Until today, more than 180 robot-assisted kidney transplantations have been performed. Short- and mid-term results have proven to be excellent with low complication rates. Apart from 3 transplant losses because of arterial thrombosis and 5 surgical re-explorations due to hematoma, no other noteworthy complications occurred. There was only 1 lymphocele. The median blood loss was 150 ml and kidney function after 1 year was unchanged in comparison with postoperative day 30. CONCLUSIONS: Robot-assisted living kidney transplantation is not inferior to the open approach. Even superiority is not unlikely because problematic situations such as obese patients or complex vascular anatomy can be handled safely. In particular, the development of lymphocele and wound healing disorders appear to be significantly decreased compared to conventional surgery.


Assuntos
Transplante de Rim/métodos , Doadores Vivos , Procedimentos Cirúrgicos Robóticos , Europa (Continente) , Alemanha , Humanos , Laparoscopia
4.
Georgian Med News ; (295): 132-137, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31804215

RESUMO

Patients with refractory cardiac arrest, who have undergone Extracorporeal Life Support (ECLS) for resuscitation, but have not achieved cardiac recovery, can be considered as potential donors (Cardiac Death Donors). In such cases, it takes time to notify and obtain the principle consent of the relatives and finalize the clinical and legal documents. During this time, prior to obtaining consent for the removal of organs, ECLS can be extended. In this case, the extracorporeal circulation implies organ preservation "in situ" until the ethical, religious and organizational problems should be decided. Correspondingly, the identification of safe time terms during which the donor organs do not suffer by the changes not compatible with transplantation is extremely important. We aimed to study the morphological changes in the liver after 8 hours of extracorporeal circulation in experiments. The investigation was performed on 6 sheep with simulated cardiac arrest and undergone 8-hours extracorporeal circulation with own blood by using of new portable perfusion apparatus, made on the basis of a universal volumetric blood pump of our own design. The device was connected to the body through the femoral artery and vein with special cannulas. The biopsy of the liver was performed before the starting of perfusion, and on 4 and 8 hours of the experiment. The histological slices were stained by H&E and were assessed by standard criteria: level of steatosis (large-droplet macrovesicular steatosis [ld-MaS] and/or small-droplet macrovesicular steatosis [sd-MaS]); mononuclear portal inflammatory cell infiltrates; bile ductular proliferation; cholestasis; venous congestion; hepatocellular necrosis. Before the perfusion, no venous congestion, hepatocellular necrosis or ld-MaS were observed; Less than 3% of cells were suffered by sd-MaS; mononuclear portal inflammatory cell infiltrates were found only in several areas. Mild mixed ld-MaS and sd-MaS was found in less than 5 % and 10% of the cells accordingly on the 4 and 8 hours after in vivo Machine perfusion. Similarly the mild venous congestion was present in 1 out of 6 livers after 4-hours perfusion and in 2 out of 6 livers after 8-hours Perfusion. The number of necrotic hepatocytes and portal triads infiltrated with mononuclear cells did not exceed 10% and 15% accordingly. However, there were no differences in the degree of biliary damage - cholestasis or ductular proliferation - correlating with the terms of the experiment. Taking into the consideration all internationally accepted criteria of donor liver histological assessment, 8-hour in vivo perfusion of the liver in Cardiac Death Donors by using of the machine of own design providing the pulsatile blood flow guarantees the satisfactory preservation of liver making it useful for successful transplantation.


Assuntos
Transplante de Fígado , Fígado , Preservação de Órgãos , Perfusão , Animais , Morte , Modelos Animais de Doenças , Humanos , Fígado/fisiologia , Doadores Vivos , Ovinos
5.
Actas urol. esp ; 43(10): 536-542, dic. 2019. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185259

RESUMO

Objetivos: El objetivo de este estudio es describir nuestros resultados de nefrectomía laparoscópica derecha de donante vivo (NLDDV) y los factores asociados con la longitud de la vena renal derecha de los donantes. Material y métodos: Se evaluaron 60 donantes (48 hombres y 12 mujeres) desde enero de 2016 hasta diciembre de 2017. Se llevó a cabo una revisión retrospectiva de pacientes que se sometieron consecutivamente a nefrectomía laparoscópica de donante vivo de riñón derecho con abordaje transperitoneal en nuestro servicio. Resultados: Los procedimientos de NLDDV fueron realizados por los mismos cirujanos, obteniendo éxito quirúrgico en todos los casos. De los 60 casos, 47 donantes tenían arteria y vena renal única, 2 casos tenían una arteria y 2 venas, y 5 donantes tenían 2 arterias y una vena. El resto tenía 2-3 arterias con 1-3 venas. El tiempo quirúrgico fue de 142,60 ± 33,73 min. El tiempo de isquemia caliente fue de 2,64 ± 0,76 min. La estancia hospitalaria media fue de 6,69 ± 0,63 días. La longitud media de la vena renal derecha fue de 1,92 ± 0,41 cm. Todos los riñones trasplantados presentaron función inmediata. No se registraron pérdidas del injerto. Con excepción del IMC y el tiempo de isquemia caliente, se encontraron pocas diferencias relacionadas con el sexo de los pacientes en las variables del estudio. Las mujeres presentaron un IMC más alto y un tiempo de isquemia caliente más corto frente a los donantes masculinos. Un análisis adicional señaló una correlación negativa entre el IMC y el vena renal derecha (r = -0,282, p < 0,05), pero una correlación positiva entre el tiempo quirúrgico y la pérdida de sangre estimada (r = 0,37, p < 0,01). Conclusiones: La NLDDV es un procedimiento seguro y viable, con un enfoque menos traumático, que proporciona buenos resultados a los receptores. Notablemente, el IMC más alto de todo el grupo de estudio se asoció con un procedimiento de NLDDV y trasplante de riñón más complicados


Aims: The aim of this study was to describe outcomes of laparoscopic living donor right nephrectomy (LLDRN) and study factors affecting the length of right renal vein from the donors. Material and methods: This study was conducted in 60 donors (48 males and 12 females) from January 2016 to December 2017. We performed a retrospective review of consecutive patients who underwent transperitoneal right laparoscopic living donor nephrectomy at our unit. Results: LLDRN was successfully performed in all subjects by the same surgeons. Among 60 cases, 47 donors had single renal artery and vein, 2 cases had one artery and 2 veins, and 5 donors had 2 arteries and one vein, and the rest had 2-3 arteries with 1-3 veins. Operative time was 142.60 ± 33.73 min. Warm ischemic time was 2.64 ± 0.76 min. The mean hospital stay was 6.69 ± 0.63 days. The median length of right renal vein was 1.92 ± 0.41cm. All transplanted kidneys showed immediate function. No graft losses were recorded. Almost no gender differences were found in study variables except BMI and warm ischemic time, that was higher BMI but shorter warm ischemic time in female versus male donors. Further analysis showed a negative correlation between BMI and right renal vein (r = -0.282, P < 0.05), but a positive correlation between operative time and estimate blood loss (r = 0.37, P < 0.01). Conclusions: LLDRN is a feasible safe procedure, less traumatic approach, and provides good outcomes kidney for recipients. Notably, in the study group the higher BMI was associated with resulting more difficult LLDRN and kidney transplantation


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Nefrectomia/métodos , Doadores Vivos , Veias Renais/anatomia & histologia , Transplante de Rim , Laparoscopia , Veias Renais/cirurgia , Estudos Retrospectivos , Tempo de Internação , Taxa de Filtração Glomerular , Índice de Massa Corporal
6.
Transplant Proc ; 51(9): 3059-3066, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31711584

RESUMO

BACKGROUND: There are limited data on predictors of growth after pediatric liver transplantation. METHODS: We reviewed the impact of graft type, ethnicity, and biliary complications (BC) on growth after pediatric liver transplantation (LT). We compared preoperative and 6-, 12-, and 24-month weight, height, and body mass index (BMI) percentiles between living donor (LD), deceased donor full-size (DD-full), and deceased donor split (DD-split) graft recipients. We also compared length of stay (LOS) between groups. RESULTS: We had 98 patients (DD-split: 32; DD-full: 43, LD: 23). The Median Pediatric End-stage Liver Disease (PELD) scores, exception points, albumin, bilirubin, failure to thrive, and presence of ascites were similar among groups. The DD-full group had the lowest preoperative percentiles in all categories and exceeded these at 24 months. The DD-split group was at preoperative percentiles at 24 months. The LD group had parallel weight curves compared to the DD-full group and exceeded only the preoperative weight percentile at 24 months. Black patients had the lowest percentiles in all categories (P < .01). The BC group caught up weight and BMI percentile at 24 months but had persistent decrease in height percentiles. Patients without BC exceeded preoperative height percentiles. The longer LOS group had lower height and BMI percentiles at 24 months; however, there was no statistical difference. CONCLUSION: DD-full and black patients seem to benefit the most from LT in terms of growth. BC seems to affect height percentiles. Patients with longer LOS had lower height and BMI percentiles (P>.05). Longer follow up and larger cohorts are necessary to improve the power of these findings.


Assuntos
Crescimento , Transplante de Fígado , Adolescente , Criança , Doença Hepática Terminal/cirurgia , Feminino , Humanos , Doadores Vivos , Masculino
7.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(5): 760-764, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31762248

RESUMO

OBJECTIVE: To analyze of the minimum graft-to-recipient weight ratio (GRWR) required for living donor liver transplantation (LDLT) without middle hepatic vein branch (MHVT) reconstruction. METHODS: We retrospectively collected the clinical data and outcomes of 303 LDLT patients over 16 years from 2001 to 2017. The minimum GRWR of non-middle hepatic vein reconstruction was analyzed by propensity score (PSM). RESULTS: With PSM analysis, no significant differences were observed in postoperative complications, SFSS, inpatient time, liver function, and coagulation function, but significant differences in 1-year, 3-year and 5-year survival between MHVT reconstruction and non-reconstruction group. The patients with MHVT reconstruction had better short-term and long-term survival than those without reconstruction. CONCLUSION: For LDLT patients without HMVT reconstruction, GRWR should be greater than 0.86%; for patients with HMVT reconstruction, GRWR is acceptable between 0.5% and 0.6%.


Assuntos
Veias Hepáticas/cirurgia , Transplante de Fígado , Fígado/anatomia & histologia , Doadores Vivos , Sobrevivência de Enxerto , Humanos , Tamanho do Órgão , Pontuação de Propensão , Estudos Retrospectivos , Taxa de Sobrevida
10.
BMC Surg ; 19(1): 149, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640624

RESUMO

BACKGROUND: Living donor liver transplantation (LDLT) has emerged as an equally viable option to deceased donor liver transplant for treating end stage liver disease patients. Optimising the recipient outcome without compromising donor safety is the primary goal of LDLT. Achieving the adequate graft to recipient weight ratio (GRWR) is important to prevent small for size syndrome which is an uncommon but potentially lethal complication of LDLT. CASE PRESENTATION: Here we describe a case of successful dual lobe liver transplant for a 32 years old patient with ethanol related end stage liver disease. A right lobe graft without middle hepatic vein and another left lateral sector graft were transplanted successfully. Recipient and both donors recovered uneventfully. CONCLUSION: Dual lobe liver transplant is a feasible strategy to achieve adequate GRWR without compromising donor safety.


Assuntos
Doença Hepática Terminal/reabilitação , Transplante de Fígado/métodos , Doadores Vivos , Adulto , Veias Hepáticas , Humanos , Fígado/cirurgia , Masculino , Resultado do Tratamento
11.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(9): 1137-1142, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31657340

RESUMO

OBJECTIVE: To investigate the protective effect of bone marrow mesenchymal stem cells (BMMSC) combined with normothermic mechanical perfusion (NMP) on biliary epithelial cells (BEC) in rats receiving donation after cardiac death (DCD) donor liver transplantation. METHODS: The BMMSC were isolated from male Sprague-Dawley (SD) rats aged 2-3 weeks and weighing 40-60 g, and then cultured, identified and expanded to the third generation in vitro. Male SD rats aged 6-8 weeks and weighing 200-220 g were divided into sham-operated group (Sham group), static cold storage (SCS group), simple NMP group (NMP group) and BMMSC combined with NMP group (BMMSC+NMP group) by random number table method with 44 rats in each group. The DCD donor liver transplantation models in rats were reproduced with 30-minute warm ischemic time. While the rats in Sham group merely received perihepatic ligaments-separation, which did not affect their liver blood supply, and then their incisions were sutured after 30 minutes. The DCD donor grafts in SCS group were preserved in the University of Wisconsin (UW) cold storage solution for 4 hours. While the DCD donor grafts in the NMP group and the BMMSC+NMP group were perfused with the DMEM/F12-based culture solution or combined with BMMSC for 4 hours through the established ex vivo NMP system. The orthotopic liver transplantation model was reproduced, and the survival rate of the recipients was observed at 0, 1, 7 and 14 days after liver transplantation. The biochemical liver function of rats in different groups was determined at each time point after operation. The morphological changes in bile ducts of liver grafts were observed by hematoxylin-eosin (HE) staining, and the expression of cytokeratin 19 (CK19) was determined qualitatively by immunohistochemistry and quantitatively by Western Blot after protein extraction from BEC in liver samples. RESULTS: The morphology, differentiation function and phenotypic identification of BMMSC confirmed that the stem cells used in this experiment were standard BMMSC. The survival rates of rats in the NMP group and the BMMSC+NMP group were significantly higher than that in the SCS group at 0, 1, 7 and 14 days after operation. The increase was more significant in the BMMSC+NMP group, with 100% on postoperative day (POD) 0, and the 14-day survival rate was still significantly higher than that in the SCS group and the NMP group [80.0% (16/20) vs. 20.0% (4/20), 70.0% (14/20), both P < 0.05]. As the time after liver transplantation prolonged, the liver function parameters of rats in the SCS group were deteriorated gradually, which reached the peak at 1-7 days after operation. The damage of biliary tissue increased gradually under the microscope, and the injury was most serious on POD 7 in the SCS group, showing a lot of balloon-like changes in hepatocytes, with obvious bile duct dilatation accompanied by large area inflammatory cell infiltration. Immunohistochemistry and Western Blot showed that the expression of CK19 in BEC cytoplasm was decreased gradually in the SCS group, reached the lowest on POD 7, and then gradually increased. The BMMSC+NMP group and the NMP group were significantly better than the SCS group in terms of liver function, pathological injury of biliary tract and CK19 expression in BEC, and the improvement was more significant in the BMMSC+NMP group. These results suggested that the protective effects of BMMSC combined with NMP on BEC was significantly better than that of the SCS and NMP. CONCLUSIONS: Preservation of rat DCD donor liver by BMMSC combined with NMP can reduce the BEC injury after liver transplantation significantly, thus improving both the prognosis and the survival rate after transplantation.


Assuntos
Transplante de Fígado , Células-Tronco Mesenquimais , Animais , Humanos , Doadores Vivos , Masculino , Preservação de Órgãos , Perfusão , Ratos , Ratos Sprague-Dawley
12.
Transplant Proc ; 51(9): 3178-3180, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31619344

RESUMO

We describe a unique case of a 53-year-old woman who underwent a nonrelated living donor kidney transplant 9 years after a previous small bowel transplant from her sister. The patient had suffered from short bowel syndrome secondary to volvulus after undergoing bariatric surgery for morbid obesity. Her entire small bowel had to be resected emergently, but she also developed acute kidney failure at the time. This initial kidney injury associated with long-term exposure to calcineurin-inhibitor medication eventually led to end-stage renal disease. A successful kidney transplant from a different, nonrelated adult donor was performed. Of note, the unrelated kidney donor matched exactly the 2 HLA-A and HLA-B antigens that the recipient had not matched with her sister. We discuss the unique HLA configuration between the patient and her 2 living donors, the absence of posttransplant rejection and posttransplant immunosuppressive therapy. To our knowledge this is the first published report of a successful kidney after a previous bowel transplant using (2 different) living donors.


Assuntos
Intestino Delgado/transplante , Falência Renal Crônica/cirurgia , Transplante de Rim/métodos , Doadores Vivos , Cirurgia Bariátrica/efeitos adversos , Feminino , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Imunossupressão/métodos , Volvo Intestinal/etiologia , Volvo Intestinal/cirurgia , Falência Renal Crônica/complicações , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Síndrome do Intestino Curto/etiologia , Síndrome do Intestino Curto/cirurgia
13.
J Laparoendosc Adv Surg Tech A ; 29(11): 1427-1430, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31621492

RESUMO

Background: The incidence of morbidity and readmission rate after hand-assisted laparoscopic donor nephrectomy (HALDN) is not clear. Aims: Our study aims to review our experience with HALDN, mainly the reasons for patient readmissions. Methods: Prospectively collected data on all patients undergoing HALDNs between August 2007 and June 2015 were retrieved. The primary outcome was 30-day readmission rate. Secondary outcomes were complications and readmission etiology. Results: There were 161 nephrectomies with a median age of 51 years, 72 (44.7%) men, and 114 (70.8%) left-sided operations. Twenty-one (13%) individuals were readmitted within 30 days. There were total 25 (15.5%) readmissions during the study period. The characteristics of patients readmitted and patients not readmitted were broadly similar. Nine of 21 (43%) individuals readmitted had nonspecific findings (nonspecific findings on imaging, negative blood cultures, and raised inflammatory markers). The reasons for readmission were unrelated to nephrectomy in 24% and 19% required surgery for complications unrelated to nephrectomy. Conclusion: We observed a high readmission rate after HALDN. A significant proportion of readmissions were due to nonspecific abdominal pain associated with raised inflammatory markers and no obvious source of sepsis. Living donors should be fully informed about the risks including the possibility of complications unrelated to HALDN.


Assuntos
Laparoscopia Assistida com a Mão/efeitos adversos , Nefrectomia/efeitos adversos , Nefrectomia/métodos , Readmissão do Paciente , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Transplante de Rim , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Coleta de Tecidos e Órgãos/efeitos adversos , Coleta de Tecidos e Órgãos/métodos , Adulto Jovem
14.
Transplant Proc ; 51(9): 3092-3098, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31623898

RESUMO

Gastrointestinal bleeding after kidney transplantation is a complication that can occur from immunosuppressant use. We present a case of refractory small bowel bleeding treated successfully with thalidomide after multiple failed attempts of conventional treatment. A 65-year-old male patient with diabetic nephropathy underwent living donor kidney transplantation. The surgery was uneventful, however, he developed immunosuppressant-induced melena with unstable vital signs 11 days later. There were a total of 4 bleeding episodes until the 90th postoperative day, and he received a total of 290 units of red blood cell transfusion during this period. Endoscopic clipping, transarterial embolization, and 2 surgical interventions failed to stop the bleeding. A trial of thalidomide 100 mg per day finally stopped the bleeding and the patient was discharged on the 110th postoperative day with a functioning renal graft. This case shows that thalidomide can be a safe option to treat immunosuppressant-induced refractory gastrointestinal bleeding in the setting of kidney transplantation. Additionally, this is the first case that reports the survival of a renal graft after more than 3000 mL of transfusion.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Hemorragia Gastrointestinal/tratamento farmacológico , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/tratamento farmacológico , Talidomida/uso terapêutico , Idoso , Humanos , Imunossupressores/efeitos adversos , Doadores Vivos , Masculino , Melena/imunologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Tacrolimo/efeitos adversos
15.
Transplant Proc ; 51(9): 2910-2913, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31606181

RESUMO

INTRODUCTION: Laparoscopic living donor nephrectomy (LLDN) has become the standard procedure for living kidney transplantation. Enhanced recovery after surgery (ERAS) is a multimodal perioperative management aimed at facilitating rapid patient recovery after major surgery by modifying the response to stress induced by exposure to surgery. This association can further reduce hospital stay, surgical stress, and perioperative morbidity of living kidney donors. MATERIAL AND METHODS: In this retrospective analysis conducted at our institute, we compared the first 21 patients who underwent LLDN enrolled with the ERAS protocol with 55 patients who underwent LLDN with the fast-track protocol in the 5 years prior to ERAS protocol implementation. RESULTS: We evaluated 76 consecutive patients. After ERAS protocol implementation, elderly living donors had a shorter hospital stay and a faster return to normal life compared with the same age group of patients in the previous period. There were no major differences in median postoperative hospital stay and no meaningful differences in the percentage of complications after surgery and hospital readmissions. CONCLUSIONS: The introduction of the ERAS protocol for patients undergoing LLDN compared with the traditional protocol led to a reduction in postoperative hospitalization in elder donors, without determining a raise in the number of hospital complications and readmissions.


Assuntos
Transplante de Rim , Doadores Vivos , Nefrectomia/métodos , Recuperação de Função Fisiológica , Coleta de Tecidos e Órgãos/métodos , Adulto , Idoso , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Coleta de Tecidos e Órgãos/efeitos adversos
16.
BMC Health Serv Res ; 19(1): 755, 2019 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-31655578

RESUMO

BACKGROUND: No studies using a valid, standardized method to measure post-donation satisfaction levels among living kidney donors (LKDs) have been published. METHODS: Donor satisfaction levels were measured using the Japanese version of the Client Satisfaction Questionnaire-8 (CSQ-8), a validated, self-report questionnaire. To identify factors related to post-donation satisfaction levels, we compared donors' sociodemographic and psychological characteristics and health-related quality of life (HRQoL), using the Short Form-36 Health Survey (SF-36), as well as recipients' clinical characteristics and SF-36 scores between donors with and without low satisfaction. In addition, donors' perceptions of the donation results and transplant procedure were assessed using measures that we developed. RESULTS: The mean (standard deviation [SD]) CSQ-8 score for the 195 participants was 26.9 (3.4). Twenty-nine (14.9%) respondents with total scores < 1 SD below the mean CSQ-8 score were placed into the low satisfaction group. Multiple logistic regression analysis demonstrated that lower perceptions of receiving adequate information prior to transplantation (odds ratio [OR] = 0.17; 95% confidence interval [CI] = 0.079-0.379; p < 0.001), lower optimism according to the Life Orientation Test (OR = 1.24; 95% CI = 1.045-1.470; p = 0.014), and increased serum creatinine levels in the paired recipient (OR = 0.05; 95% CI = 0.250-1.011; p = 0.054) independently increased the odds of having less satisfaction with donation. CONCLUSIONS: Our findings suggest that careful pre-donation education and more detailed informed consent may be needed, especially in LKDs with low constitutional optimism.


Assuntos
Transplante de Rim , Doadores Vivos/psicologia , Satisfação Pessoal , Idoso , Feminino , Humanos , Japão , Doadores Vivos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
17.
Transplant Proc ; 51(9): 3111-3115, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31611113

RESUMO

Extensive portosplenomesenteric thrombosis is regarded as a relative contraindication to liver transplantation because of the complexity of the surgical procedure. This report describes a case of living-donor liver transplantation (LDLT) for a patient with extensive portosplenomesenteric thrombosis, in whom portal flow was successfully restored by intraoperative transplenic portal vein and superior mesenteric vein stenting after surgical thrombectomy. The patient's liver function remained normal with a patent portal vein stent 6 months after LDLT, and Doppler ultrasonography demonstrated a normal wave form for portal flow. To the best of our knowledge, this is the world's first case of endovascular management of the portal vein via percutaneous transsplenic access during LDLT, demonstrating that transsplenic access can be an alternative approach without liver graft injury when the superior mesenteric vein branch and inferior mesenteric vein cannot be used as access routes.


Assuntos
Procedimentos Endovasculares/métodos , Transplante de Fígado/métodos , Veia Porta/cirurgia , Veia Esplênica/cirurgia , Trombose Venosa/cirurgia , Humanos , Fígado/irrigação sanguínea , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Trombose Venosa/complicações
18.
Transplant Proc ; 51(9): 3136-3139, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31611115

RESUMO

Graft-vs-host disease (GVHD) after liver transplantation is a rare complication with a high mortality rate. A complex interplay between donor and recipient immunity plays a role in the development of GVHD. Infection following liver transplantation is one of the most common complications in a recipient of an organ transplant who is immunosuppressed. On clinical signs of infection, the immune reaction of the recipient can be reconstituted by withdrawal of immunosuppression in order to help combat infection. However, the discontinuation of immunosuppression could restore the donor's immune activity rather than that of the recipient. There is little information available as to whether the discontinuation of immunosuppression for severe infection could contribute to the development of GVHD in a patient who underwent ABO-incompatible (ABO-I) living donor liver transplantation (LDLT). Herein, we present a unique case of GVHD following ABO-I LDLT, for which the cessation of immunosuppression could be responsible.


Assuntos
Doença Enxerto-Hospedeiro/imunologia , Imunossupressão , Transplante de Fígado , Sistema do Grupo Sanguíneo ABO/imunologia , Incompatibilidade de Grupos Sanguíneos , Humanos , Doadores Vivos , Masculino , Pessoa de Meia-Idade
19.
Transplant Proc ; 51(9): 3120-3123, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31611118

RESUMO

BACKGROUND: In living-donor liver transplantation (LDLT), successful microsurgical arterial reconstruction is essential but quite challenging. Dissection of the hepatic artery extending to the celiac trunk is a rare complication during liver transplantation. Kazakhstan is an area in which deceased donor grafts are not sufficient for several reasons, and the availability of graft vessels is limited. METHODS: We herein report the case of a 65-year-old patient who underwent LDLT due to hepatitis B + D virus-coinfected liver cirrhosis complicated by hepatic artery dissection extending to the celiac trunk. Because of massive gastric collateral varices, direct anastomosis to the supraceliac aorta was not possible. Therefore, extra-anatomic jump graft reconstruction was performed from the right iliac artery to the graft's hepatic artery using an autologous graft vein (great saphenous vein). RESULTS: The patient's postoperative period was uneventful. The patient was discharged at 27 days post-transplantation. At the time of writing, the follow-up period is 8 months after transplantation, and the recipient maintains a normal liver function. CONCLUSION: When there is no other option for arterial reconstruction, this method is a feasible option for performing extra-anatomic jump graft reconstruction.


Assuntos
Transplante de Fígado/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Veia Safena/transplante , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Aneurisma Dissecante/cirurgia , Feminino , Artéria Hepática/patologia , Humanos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Transplante Autólogo/métodos
20.
Transplant Proc ; 51(9): 3131-3135, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31611120

RESUMO

Liver cirrhosis can cause splenic artery aneurysms (SAA) that pose a threat to patients undergoing liver transplantation. However, liver transplantation with multiple visceral artery aneurysms including giant SAA caused by arterial fragility has never been reported. We describe a 36-year-old man with decompensated liver cirrhosis due to Wilson disease that was complicated by giant SAA and multiple aneurysms in the bilateral renal arteries caused by fibromuscular dysplasia (FMD). The maximal diameter of the triple snowball-shaped SAA was 11 cm. We planned a 2-stage strategy consisting of a splenectomy with distal pancreatectomy to treat the SAA and subsequent living donor liver transplantation (LDLT) to address the liver cirrhosis. This strategy was selected to prevent fatal postoperative infectious complications caused by the potential development of pancreatic fistula during simultaneous procedures and to histopathologically diagnose the arterial lesion before LDLT to promote safe hepatic artery reconstruction. However, a postoperative pancreatic fistula did not develop after a splenectomy with distal pancreatectomy, and the pathologic findings of the artery indicated FMD. The patient underwent ABO-identical LDLT with a right lobe graft donated by his brother. Other than postoperative rupture of the aneurysm in the left renal artery requiring emergency interventional radiology, the patient has remained free of any other arterial complications and continues to do well at 2 years after LDLT.


Assuntos
Aneurisma/etiologia , Displasia Fibromuscular/complicações , Degeneração Hepatolenticular/complicações , Transplante de Fígado , Artéria Esplênica/patologia , Adulto , Aneurisma/cirurgia , Humanos , Cirrose Hepática/etiologia , Cirrose Hepática/cirurgia , Doadores Vivos , Masculino , Pancreatectomia/efeitos adversos , Pancreatectomia/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Artéria Renal/patologia , Esplenectomia/efeitos adversos , Esplenectomia/métodos , Artéria Esplênica/cirurgia
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