Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 16.877
Filtrar
1.
World J Gastroenterol ; 27(39): 6701-6714, 2021 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-34754162

RESUMO

BACKGROUND: Standard liver weight (SLW) is frequently used in deceased donor liver transplantation to avoid size mismatches with the recipient. However, some deceased donors (DDs) have fatty liver (FL). A few studies have reported that FL could impact liver size. To the best of our knowledge, there are no relevant SLW models for predicting liver size. AIM: To demonstrate the relationship between FL and total liver weight (TLW) in detail and present a related SLW formula. METHODS: We prospectively enrolled 212 adult DDs from West China Hospital of Sichuan University from June 2019 to February 2021, recorded their basic information, such as sex, age, body height (BH) and body weight (BW), and performed abdominal ultrasound (US) and pathological biopsy (PB). The chi-square test and kappa consistency score were used to assess the consistency in terms of FL diagnosed by US relative to PB. Simple linear regression analysis was used to explore the variables related to TLW. Multiple linear regression analysis was used to formulate SLW models, and the root mean standard error and interclass correlation coefficient were used to test the fitting efficiency and accuracy of the model, respectively. Furthermore, the optimal formula was compared with previous formulas. RESULTS: Approximately 28.8% of DDs had FL. US had a high diagnostic ability (sensitivity and specificity were 86.2% and 92.9%, respectively; kappa value was 0.70, P < 0.001) for livers with more than a 5% fatty change. Simple linear regression analysis showed that sex (R2, 0.226; P < 0.001), BH (R2, 0.241; P < 0.001), BW (R2, 0.441; P < 0.001), BMI (R2, 0.224; P < 0.001), BSA (R2, 0.454; P < 0.001) and FL (R2, 0.130; P < 0.001) significantly impacted TLW. In addition, multiple linear regression analysis showed that there was no significant difference in liver weight between the DDs with no steatosis and those with steatosis within 5%. Furthermore, in the context of hepatic steatosis, TLW increased positively (non-linear); compared with the TLW of the non-FL group, the TLW of the groups with hepatic steatosis within 5%, between 5% and 20% and more than 20% increased by 0 g, 90 g, and 340 g, respectively. A novel formula, namely, -348.6 + (110.7 x Sex [0 = Female, 1 = Male]) + 958.0 x BSA + (179.8 x FLUS [0 = No, 1 = Yes]), where FL was diagnosed by US, was more convenient and accurate than any other formula for predicting SLW. CONCLUSION: FL is positively correlated with TLW. The novel formula deduced using sex, BSA and FLUS is the optimal formula for predicting SLW in adult DDs.


Assuntos
Fígado Gorduroso , Transplante de Fígado , Adulto , Fígado Gorduroso/diagnóstico por imagem , Feminino , Humanos , Fígado/diagnóstico por imagem , Doadores Vivos , Masculino , Tamanho do Órgão , Estudos Prospectivos
2.
Acad Radiol ; 28 Suppl 1: S112-S117, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34756817

RESUMO

PURPOSE: To evaluate the role of two-dimensional shear wave elastography (2D SWE) in assessing graft quality before liver transplantation and the relationship between donor liver stiffness (LS) and early allograft dysfunction (EAD) after transplantation. METHODS: Eighty-three donors from January 2018 to December 2018 were involved in this prospective study. Liver stiffness measurements (LSMs) were performed using 2D SWE. The differences in LS values between discarded and transplanted grafts were analyzed. The relationship of donor LS with recipient EAD was also evaluated. RESULTS: Our results suggest that the donor LS values were higher in discarded grafts than in transplanted grafts (24.0 ± 10.9 kPa vs 10.0 ± 2.6 kPa, p < 0.001). LSM failed in one donor. According to multivariate logistic regression analysis, the donor LS values ≥10.9 kPa (odds ratio [OR] 4.042, 95% confidence interval [CI] 1.133-14.421, p = 0.031), BMI (OR 1.287, 95% CI 1.025-1.616, p = 0.030) and INR (OR 6.703, 95% CI 1.338-33.589, p = 0.021) were independently associated with EAD. CONCLUSION: Donor LSM conducted by 2D SWE might represent an effective quantitative method to evaluate graft quality. Donor LS might predict recipient EAD after liver transplantation.


Assuntos
Técnicas de Imagem por Elasticidade , Transplante de Fígado , Aloenxertos , Encéfalo , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Cirrose Hepática/patologia , Doadores Vivos , Estudos Prospectivos
3.
Vertex ; XXXII(152): 29-34, 2021 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-34783793

RESUMO

OBJECTIVE: To describe the perceptions of renal transplant patients of the need for information about their donors and the potential influence of their donors' biological sex and age. MATERIALS AND METHODS: Analytical, observational, cross-sectional and prospective study. Kidney transplant patients over 18 years old who had been transplanted, at least, one year before were included. A semi-structured survey was conducted, and data were collected from medical records. RESULTS: 104 patients were analyzed, 58% (n=60) were women; median age: 47 years; and median post-transplantation period: 7 years. Seventy-six percent (n=79) expressed that they were interested in knowing their donors' biological sex and age (p < 0.001). When asked whether they would choose their donors' sex and age, only 13% (n=14) answered that they would (p < 0.001). When asked whether they felt that their donors' sex and age might have an influence on them, 78% (n=81) answered that they did not, while 22% answered that they did (p < 0.001). Of the 79 patients who expressed an interest in knowing their donors' biological sex and age, 62% (n=49) stated that appreciation was the reason for it (p=0.0025). CONCLUSION: The appreciation towards that person about whom only sex and age are known would allow patients to imaginarily construct their donors.


Assuntos
Transplante de Rim , Adolescente , Estudos Transversais , Feminino , Humanos , Doadores Vivos , Pessoa de Meia-Idade , Percepção , Estudos Prospectivos
4.
BMJ Case Rep ; 14(11)2021 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-34789527

RESUMO

Ex vivo normothermic perfusion (EVNP) is increasingly recognised as a viability tool to increase organ utilisation in deceased donor transplantation. We report the use of EVNP to assess graft perfusion quality following indication nephrectomy and back-bench arterial reconstruction in a case of renal artery stenosis, unamenable to endovascular treatment. Once explanted, it was not possible to effectively cold perfuse the graft through the main renal artery or collaterals. An arterial reconstruction was performed with patch angioplasty using the largest collateral creating a single common stem. EVNP was used to assess organ perfusion and, therefore, viability. Excellent global perfusion was evident alongside urine production, demonstrating that the arterial reconstruction was satisfactory. A patient with end-stage renal disease was consented with particular attention to the uncertainty of the underlying donor disease process and long-term outcome of the reconstruction. Primary function was achieved and recipient estimated glomerular filtration rate (eGFR) remains stable at 58 mL/min/1.73 m² at 6 months.


Assuntos
Transplante de Rim , Obstrução da Artéria Renal , Sobrevivência de Enxerto , Humanos , Rim/cirurgia , Doadores Vivos , Nefrectomia , Preservação de Órgãos , Perfusão , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/cirurgia
6.
BMC Surg ; 21(1): 401, 2021 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-34798847

RESUMO

BACKGROUND: The Milan criteria are the universal standard of liver transplantation for hepatocellular carcinoma (HCC). Numerous expanded criteria have shown outcomes as good as the Milan criteria. In Taiwan, living donor liver transplant (LDLT) accounts for the majority of transplantations due to organ shortages. METHODS: We retrospectively enrolled 155 patients who underwent LDLT for HCC from July 2005 to June 2017 and were followed up for at least 2 years. Patients beyond the Milan criteria (n = 78) were grouped as recurrent or nonrecurrent, and we established new expanded criteria based on these data. RESULTS: Patients beyond the Milan criteria with recurrence (n = 31) had a significantly larger maximal tumor diameter (4.13 ± 1.96 cm versus 6.10 ± 3.41 cm, p = 0.006) and total tumor diameter (7.19 ± 4.13 cm versus 10.21 ± 5.01 cm, p = 0.005). Therefore, we established expanded criteria involving maximal tumor diameter ≤ 6 cm and total tumor diameter < 10 cm. The 5-year survival rate of patients who met these criteria (n = 134) was 77.3%, and the 5-year recurrence rate was 20.5%; both showed no significant differences from those of the Milan criteria. Under the expanded criteria, the pool of eligible recipients was 35% larger than that of the Milan criteria. CONCLUSION: Currently, patients with HCC who undergo LDLT can achieve good outcomes even when they are beyond the Milan criteria. Under the new expanded criteria, patients can achieve outcomes as good as those with the Milan criteria and more patients can benefit.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Transplante de Fígado , Carcinoma Hepatocelular/cirurgia , Humanos , Neoplasias Hepáticas/cirurgia , Doadores Vivos , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
7.
Am J Case Rep ; 22: e933992, 2021 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-34799546

RESUMO

BACKGROUND Elizabethkingia meningoseptica is an emerging pathogen in hospital environments. Immunocompromised individuals have a high risk of infections caused by E. meningoseptica, especially after transplantation. E. meningoseptica is associated with prolonged hospital stays and high mortality. In addition, E. meningoseptica is commonly resistant to many antibiotics used for gram-negative bacterial infections. We introduce the first case of E. meningoseptica bacteremia in a recipient of a liver transplant in Vietnam. CASE REPORT A 55-year-old woman with end-stage liver disease due to biliary cirrhosis underwent living donor liver transplantation at the 108 Military Central Hospital. On day 3 after transplantation, the patient had an acute cellular rejection, and corticosteroid pulse therapy was used. On day 7 after transplantation, the patient had a fever and an increased white blood cell count and C-reactive protein level. Blood cultures were positive for E. meningoseptica. Intravenous levofloxacin was administered for 10 days. The patient showed an excellent treatment response to the antibiotic therapy and was discharged. CONCLUSIONS E. meningoseptica, a multidrug-resistant gram-negative bacteria, can be considered an emerging pathogen in the hospital environment, especially in patients receiving organ transplants. Early recognition helps physicians to improve patient outcomes.


Assuntos
Bacteriemia , Chryseobacterium , Infecções por Flavobacteriaceae , Transplante de Fígado , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Feminino , Infecções por Flavobacteriaceae/diagnóstico , Infecções por Flavobacteriaceae/tratamento farmacológico , Humanos , Transplante de Fígado/efeitos adversos , Doadores Vivos , Pessoa de Meia-Idade
8.
Nephrol Nurs J ; 48(5): 481-488, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34756002

RESUMO

Despite barriers and disincentives to living kidney donation, a record-setting number of living donor transplants (6,867) were performed in 2019. Additionally, there was a 24% increase in living donor kidney transplants from 2014-2019. These increases are welcome, yet the supply has not kept up with the demand, and the kidney transplant waiting list continues to grow. Innovative solutions are necessary to overcome disincentives to living kidney donation and increase the number of donors. The authors propose changing laws and rules to reimburse donors for all expenses related to donating a kidney; informing them of all the options of donation, including directed, non-directed, paired exchange, remote, and advanced donation; informing them of programs that transplant centers provide, including whether or not the center participates in the National Kidney Registry Donor Shield program; educating each donor about their personal risk; and dispelling misinformation they may have about living kidney donation. Implementing these measures will require a national, standard approach because there is variability between the states in relation to work leave and financial incentives for living donation.


Assuntos
Transplante de Rim , Obtenção de Tecidos e Órgãos , Humanos , Rim , Doadores Vivos , Motivação
9.
J Med Invest ; 68(3.4): 330-333, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34759154

RESUMO

Background : The aim of this study is to clarify the regeneration of the CL (caudate lobe) without any reconstructions of short hepatic veins (SHVr) after LDLT (living donor liver transplantation) and compare the regeneration of the CL after right hepatectomy (Rt. Hx), as the surrogate model of extended left lobe graft (Ex LLG) with complete SHVr. Methods : Eleven Ex LLGs with CL were included in this study. SHVr was not performed in all cases. The volumetry was performed before, one month and six months after LDLT. Seven patients who underwent Rt. Hx were also included in this study as the surrogate model. Results : In Ex LLGs with CL, the regeneration rate of the large CL (> 30 ml) was worse than that of small CL (< 30 ml). In the surrogate model, the regeneration rate of the CL was not worse than other segments. However, the regeneration rate of the large CL was also worse than that of small CL even in the presence of complete SHVr. Conclusions : The regeneration of the large CL was worse than that of the small CL regardless of the presence or absence of SHVr, indicating that SHVr in Ex LLG with CL might not be necessary. J. Med. Invest. 68 : 330-333, August, 2021.


Assuntos
Transplante de Fígado , Hepatectomia , Veias Hepáticas , Humanos , Fígado/cirurgia , Doadores Vivos
10.
Gesundheitswesen ; 83(S 01): S33-S38, 2021 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-34731891

RESUMO

The German living donor register Safety of the Living Kidney Donor - The German National Register (SOLKID-GNR) collects data of the medical and psychosocial outcome of living kidney donors. For the first time in Germany, a prospective data collection allows a scientifically based long-term analysis of how a living kidney donation influences the psychological and physical health of living kidney donors. This will contribute directly to improve the information and care of living kidney donors.


Assuntos
Transplante de Rim , Doadores Vivos , Coleta de Dados , Alemanha/epidemiologia , Serviços de Saúde , Humanos
11.
Ann Acad Med Singap ; 50(9): 679-685, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34625755

RESUMO

INTRODUCTION: Hepatic artery reconstruction is a critical aspect of liver transplantation. The microsurgeon faces several challenges when reconstructing the hepatic artery-the donor hepatic artery stalk is short and often a poor match for the usually hypertrophic recipient vessels. Previous inflammation impedes vessel dissection, and recipient vessels have a tendency to delaminate with manipulation. We review 51 consecutive liver transplantations to highlight these problems and propose strategies for a successful reconstruction of the hepatic artery. METHODS: A prospective study involving all adult patients undergoing liver transplantation at the Singapore General Hospital from January 2015 to December 2018 was undertaken. All hepatic artery anastomoses were performed by 2 microsurgeons at 10x magnification. Patients were started on a standard immunosuppressive regimen. Postoperative ultrasound scans on days 1, 3, 5, 7, 9 and 14 were used to confirm arterial patency. RESULTS: There were 51 patients who underwent liver transplantation during the study period. Of this number, 31 patients received deceased donor grafts and 20 received living donor grafts. A total of 61 anastomoses were performed (5 dual anastomosis, 4 radial artery interposition grafts) with 1 case of hepatic artery thrombosis that was successfully salvaged. The mean (range) postoperative resistive index and hepatic artery peak systolic velocity were 0.69 (0.68-0.69) and 1.0m/s (0.88-1.10m/s), respectively. CONCLUSION: Hepatic artery thrombosis after liver transplantation is poorly tolerated. The challenges of hepatic artery reconstruction in liver transplantation are related to vessel quality and length. The use of microsurgical technique, appropriate recipient vessel selection, minimisation of vessel manipulation with modified instruments, variation in anastomosis techniques, and use of radial artery interpositional grafts are useful strategies to maximise the chances of success.


Assuntos
Transplante de Fígado , Adulto , Anastomose Cirúrgica , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/cirurgia , Humanos , Doadores Vivos , Estudos Prospectivos
12.
Ann Transplant ; 26: e932994, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34593749

RESUMO

BACKGROUND There is no consensus about the long-term prognosis of pediatric patients with a variety of rare liver diseases but with inherited metabolic diseases (IMDs). We retrospectively reviewed the developmental outcomes of patients with IMDs undergoing living donor liver transplantation (LDLT). MATERIAL AND METHODS Between May 2001 and December 2020, of 314 pediatric patients who underwent LDLT, 44 (14%) had IMDs. The median age at LDLT was 3.0 years old (range 0-15.0 years). Associations between the post-transplant complications and graft survival rate in patients with IMDs and biliary atresia (BA) were calculated. We evaluated the safety of LDLT from heterozygous carrier donors, the prognosis of patients with IMDs who have metabolic defects expressed in other organs, and developmental outcomes of patients with IMDs. RESULTS The 10-year graft survival rates in patients with IMDs and BA were 87% and 94%, respectively (P=0.041), and the causes of graft failure included pneumocystis pneumonia, acute lung failure, hemophagocytic syndrome, hepatic vein thrombosis, portal vein thrombosis, and sepsis. The rate of post-transplant cytomegalovirus viremia in patients with IMDs was higher than that of patients with BA (P=0.039). Of 39 patients with IMDs, 15 patients (38%) had severe motor and intellectual disabilities in 4 patients, intellectual developmental disorders including epilepsy in 2, and attention-deficit hyperactivity disorder in 2. Of 28 patients with IMDs, 13 (46%) needed special education. CONCLUSIONS The long-term outcomes of LDLT in patients with IMDs are good. However, further long-term social and educational follow-up regarding intellectual developmental disorders is needed.


Assuntos
Transplante de Fígado , Doadores Vivos , Doenças Metabólicas , Adolescente , Criança , Pré-Escolar , Feminino , Sobrevivência de Enxerto , Humanos , Lactente , Recém-Nascido , Masculino , Doenças Metabólicas/complicações , Doenças Metabólicas/genética , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento
14.
Int J Surg ; 95: 106152, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34688930

RESUMO

BACKGROUND: Although minimally invasive technology has been widely used in hepatectomy, it remains controversial with regards to liver transplantation, especially in donors right hepatectomy. Herein, we compared the short-term safety and efficacy of minimally invasive donors right hepatectomy (MIDRH) with open donors right hepatectomy (ODRH). METHODS: A systematic literature search was carried out using PubMed, Embase, Web of Science and the Cochrane Library database in order to identify comparison studies of MIDRH and ODRH. Next, we obtained the relevant data, and carried out the meta-analysis. RESULTS: This meta-analysis included 12 studies, which included 1755 cases that underwent donors right hepatectomy. Compared to ODRH, patients that underwent MIDRH had less bleeding (SWD = -0.52, p<0.001), shorter hospital stays (SWD = -0.58, p < 0.001) and lower overall postoperative complications of donors (RR = 0.74, p = 0.008). However, MIDRH was found to be associated with prolonged operative times (SWD = 0.74, p < 0.001), as well as a higher rate of biliary complications in donors (RR = 2.26, p = 0.007) and recipients (RR = 1.69, p < 0.001). There were no statistically significant differences between MIDRH and ODRH in postoperative liver function, rate of major complications and vascular complications of both donors and recipients and overall postoperative complications. DISCUSSION: MIDRH is superior to ODRH with regards to intraoperative bleeding, postoperative hospital stay and overall donor complications. Although biliary-related complications are higher, it is feasible to develop MIDRH in experienced liver transplant centers. However, higher-quality research is still needed for corroboration.


Assuntos
Laparoscopia , Transplante de Fígado , Hepatectomia/efeitos adversos , Humanos , Tempo de Internação , Transplante de Fígado/efeitos adversos , Doadores Vivos , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Coleta de Tecidos e Órgãos
16.
Curr Opin Organ Transplant ; 26(6): 640-645, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34593704

RESUMO

PURPOSE OF REVIEW: Donor hysterectomy for live donor uterus transplantation was from the start performed by laparotomy, but minimal invasive surgery has entered the scene. In particular robotic-assisted laparoscopy is used since robotics is advantageous in the complex donor hysterectomy surgery in narrow space. This review covers the development and benefits of robotics and the published robotic donor hysterectomy experiences. RECENT FINDINGS: Robotic donor hysterectomy publications are scarce with eight cases in Sweden, five in USA, and one each in China and Spain. Robotics have been performed for either the entire donor hysterectomy or with conversion to laparotomy for the last steps of the surgical procedure. The total operative times are in line with open surgery, although a decrease is expected in the future. The estimated blood loss and hospital stays are less than at open surgery. The complication panorama includes hydronephrosis, ureteric fistula and pressure alopecia. Live births with healthy babies have been reported. SUMMARY: In uterus transplantation, robotic live donor hysterectomy has proven to be feasible, safe and associated with successful live births. The robotic donor hysterectomy is a low-volume procedure and an international registry to gather collective information is crucial for further evaluation and development.


Assuntos
Laparoscopia , Procedimentos Cirúrgicos Robóticos , Feminino , Humanos , Histerectomia/efeitos adversos , Laparoscopia/efeitos adversos , Laparotomia , Doadores Vivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos
17.
Curr Opin Organ Transplant ; 26(6): 664-668, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34636768

RESUMO

PURPOSE OF REVIEW: Uterus transplantation (Utx) offers women with absolute uterine factor infertility the opportunity to carry their own pregnancies. As Utx transitions from an experimental to standard clinical procedure, we review the status of the ethical issues applicable to the stakeholders involved. RECENT FINDINGS: With more than 65 Utx procedures reported to date, evidence is accruing that enables the chance of success - a live birth - for the recipient to be weighed against the risks the recipient incurs through the Utx process, as well as risks to living donors undergoing surgery, to children exposed in utero to immunosuppressants and the uterine graft environment, and to third parties related to uterus procurement from multiorgan deceased donors. Experience has also informed aspects of recipient and donor autonomy that must be safeguarded. SUMMARY: Clinical trial results provides a basis for weighing the interests of the stakeholders implicated in Utx, and so can inform transplant centers' and regulatory bodies' development of policies and protocols that will determine access to Utx and allocation of organs, together with other considerations of justice. Additional evidence, particularly on long-term outcomes, is needed, and new questions can be expected to arise as access to and indications for Utx broaden.


Assuntos
Infertilidade Feminina , Transplante de Órgãos , Criança , Feminino , Humanos , Infertilidade Feminina/cirurgia , Doadores Vivos , Transplante de Órgãos/efeitos adversos , Gravidez , Útero/transplante
18.
Curr Opin Organ Transplant ; 26(6): 675-680, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34653087

RESUMO

PURPOSE OF REVIEW: To assess the outcomes of split liver transplantation (SLT) in adults and children and evaluate its role in high-risk recipients with a high model for end-stage liver disease (MELD) score, an urgent indication or requiring retransplantation. RECENT FINDINGS: Split liver grafts in general have equivalent long-term survival outcomes to whole grafts despite an increase in biliary complications. Recent success and technical advances have encouraged use of these grafts in high-risk recipients. Split liver grafts can be used successfully in recipients with a high MELD score if there is adequate weight-matching. There are mixed results in urgent indication recipients and for retransplantation such that use in this group of patients remains controversial. SUMMARY: SLT addresses donor shortages by facilitating the transplant of two recipients from the same donor liver. By using careful donor and recipient selection criteria, SLT can achieve equivalent long-term outcomes to whole grafts. These grafts have been used successfully in recipients with a high MELD score, but should be used selectively in urgent indication recipients and for retransplantation.


Assuntos
Doença Hepática Terminal , Transplante de Fígado , Doença Hepática Terminal/cirurgia , Humanos , Transplante de Fígado/efeitos adversos , Doadores Vivos , Índice de Gravidade de Doença , Resultado do Tratamento
19.
Curr Opin Organ Transplant ; 26(6): 634-639, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34714790

RESUMO

PURPOSE OF REVIEW: Uterus transplantation (UTx) is transitioning from an experimental procedure to a clinical treatment for absolute uterine factor infertility (AUFI). Standardized protocols for the evaluation and selection of donors and recipients that maximize chances of success - a healthy live birth - are needed. RECENT FINDINGS: To date, recipient eligibility has been limited to otherwise healthy women with AUFI who are of childbearing age and are good candidates for in-vitro fertilization (IVF). For donors (living or deceased), selection criteria vary, apart from basic requirements of blood-type compatibility and freedom from critical infectious diseases, but generally require a term birth and a uterus free from uterine pathologies. The stepwise evaluation process for candidate recipients and living donors moves through health screening (medical and psychosocial); initial selection committee review; IVF (recipients only); and final selection committee review. This eliminates candidates with poor chances of success before exposure to unnecessary risks. SUMMARY: The currently stringent selection criteria for prospective recipients and donors will likely broaden, as UTx becomes more widely available. Continued research is needed to define the donor, recipient and uterine graft factors associated with successful outcomes, and to support the development of standardized selection criteria.


Assuntos
Infertilidade Feminina , Transplante de Órgãos , Feminino , Humanos , Infertilidade Feminina/cirurgia , Doadores Vivos , Transplante de Órgãos/efeitos adversos , Seleção de Pacientes , Útero/transplante
20.
Pan Afr Med J ; 39: 232, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34659605

RESUMO

The purpose of this study is to highlight the need and the obligation to combine living donation with deceased one, this later is an incomparable source of organ donation, a plea with a triple objective: 1) analyzing the contribution of living donations in terms of numbers, through two elements: the degree of involvement of our medico-surgical competencies and our regulations governing organ donations. 2) Showing that, even though optimized, living donations will always fall short of the needs of our patients and are only part of the solution. 3) The other part is deceased donors: a source of donation which can not be substituted by that of the living donors, and which concerns patients awaiting a vital organ with no possibility of another substitute treatment. Patients are sentenced to death if not transplanted in a few weeks. In this respect, only professionalism and full staff availability can rid us of prejudices which unjustly and systematically overwhelm our society with regard to this type of life-saving donations. In countries promoting and performing this source of donation, a national priority planning network has been developed. This program ensures reliable results, based on universal standards for ethics, recruitment, training and organization. For health authorities of these same countries, the sharing of these organs with others countries is irrational and unreasonable. As long as these organs remain the only life-saving for this type of seriously ill patients, and this source of grafts will be insufficient to meet the needs of all their patients.


Assuntos
Doadores Vivos/provisão & distribuição , Doadores de Tecidos/provisão & distribuição , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Argélia , Humanos , Transplante de Órgãos/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...