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1.
Turk J Med Sci ; 52(4): 1322-1328, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36326419

RESUMO

BACKGROUND: To evaluate hand-assisted laparoscopic donor nephrectomy (HALDN) in terms of intraoperative and postoperative results. METHODS: After institutional review board approval was obtained, a total of 1864 HALDN operations performed between March 2007 and January 2022 were retrospectively analyzed. Age, sex, body mass index (BMI), status of smoking and presence of previous abdominal surgery, laterality, operative time, transfusion requirement, port counts, length of extraction incision, time until mobilization, time until oral intake, donor serum creatinine levels before and one week after the surgery, length of postoperative hospital stay, intraoperative complications, and postoperative recovery and complications were recorded and statistically analyzed. Multiple renal arteries, BMI, right nephrectomy and male sex were also separately evaluated as risk factors for complications and operative time. RESULTS: A total of 825 (44.26%) male and 1039 (55.74%) female patients were enrolled in the study. The mean age of the patients was 45.79 ± 12.88 years. There were a total of 143 complications (7.67% of the total 1864 cases) consisting of 68 (3.65%) intraoperative and 75 (4.02%) postoperative complications. Open conversion was necessary for 10 patients (0.53%) to manage intraoperative complications. Reoperation was needed for 1 patient due to bleeding 6 h after the operation. Multiple renal arteries were a risk factor for intraoperative complications and prolonged operative time. Right nephrectomy and male sex were also related with longer operative times. DISCUSSION: HALDN is a safe procedure associated with low complication rates.


Assuntos
Laparoscopia Assistida com a Mão , Transplante de Rim , Laparoscopia , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Laparoscopia Assistida com a Mão/efeitos adversos , Laparoscopia Assistida com a Mão/métodos , Doadores Vivos , Estudos Retrospectivos , Nefrectomia/efeitos adversos , Nefrectomia/métodos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Intraoperatórias/etiologia
2.
Orv Hetil ; 163(45): 1798-1805, 2022 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-36335486

RESUMO

INTRODUCTION: Living donor transplantation is a more and more frequent medical intervention. Beyond the medical issues, living organ donation raises psychosocial questions about the donors and their motivation. OBJECTIVE: Our aim was to reveal the attitude, knowledge and beliefs regarding living kidney donation. Moreover to reveal the main determining factors of living donation willingness, such as relatedness to the recipient, personality traits, personal values, well-being and purpose in life. METHOD: The cross-sectional study included 571 Hungarian citizens. The online questionnaire included questions regarding the attitude, knowledge and beliefs, and the Schwartz Value Survey, the Big Five Inventory, the WHO-5 Well-Being Index and the Purpose in Life questionnaire. RESULTS: The majority of the participants would donate their kidney alive to relatives and friends, the fewest people would not donate at all, and 16.8% of the participants would donate even to a stranger. Most participants knew (71.8%) that kidney is the most often transplanted organ and also most often donated alive. Willingness to donate alive showed significant association with the relatedness (r = 0.187), personal values (Self-transcendence) (r = 0.208), and weak association with the knowledge (r = 0.104). The association was significant between knowledge and beliefs about the donors (r = -0.352, r = 0.136). Based on the multiple linear regression analysis, the personal value (Self-transcendence) (ß = 0.218) and the negative belief that donors have a worse state of health after donation (ß = -0.207), are weak, significant predictors of willingness to donate kidney alive. DISCUSSION: The intention to become a living kidney donor is associated with the beliefs, which are connected to the knowledge, and the knowledge is associated with the relatedness. Moreover the willingness to become a living donor is associated with the good intention, the desire to help others and social responsibility. CONCLUSION: The knowledge and the factors of personal values, such as good intention and social responsibility, play a main role in the intention to become a living donor. Orv Hetil. 2022; 163(45): 1798-1805.


Assuntos
Obtenção de Tecidos e Órgãos , Humanos , Estudos Transversais , Doadores Vivos , Atitude , Inquéritos e Questionários , Conhecimentos, Atitudes e Prática em Saúde
3.
Exp Clin Transplant ; 20(10): 908-916, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36409050

RESUMO

OBJECTIVES: Evidence on living donor kidney transplant procedures when both the donor and recipient have had a history of COVID-19 infection is scarce. MATERIALS AND METHODS: We retrospectively explored the protocol, outcomes, and follow-up of 64 donors and recipients of living donor kidney transplant who had recovered from COVID-19. This was a multicenter (n = 12) study from India that included transplants between October 29, 2020, and December 1, 2021. Induction and immunosuppression regimens forthose with different severities of COVID-19 were similar to standard practice. RESULTS: COVID-19 clinical severity ranged from asymptomatic/mild (not requiring oxygen therapy) in 49 recipients (77%) and 63 donors (95.4%) and moderate/severe (requiring oxygen therapy) in 15 recipients (23%) and 1 donor (4.6%). Mean wait time±SEM (SD)from firstdocumentednegative reverse transcriptase-polymerase chain reaction testto surgery for recipients and donors was 90.9 ± 9.27 (74.1) and 47 ± 4.5 (29.2) days, respectively. Six episodes (9.3%) of biopsy-proven acute rejection were reported at follow-up of 214 ± 14.8 (119) days and median of 227 (interquartile range, 109-309) days. The locally weighted scatter plot smoothing curve for creatinine during follow-up in donor-recipients pairs showed no trends of increased creatinine in the context of wait time from COVID-19 to transplant surgery. No graft loss, death, reactivation/reinfection, and complications related to surgery or COVID-19 were reported. CONCLUSIONS: Our report showed excellent outcomes and follow-up data of living donor kidney transplant in recovered donor-recipient pairs with the standard immunosuppression protocol. To our knowledge, this is the first and the largest study of donor-recipient living donor kidney transplant pairs when both donors and recipients had prior COVID-19.


Assuntos
COVID-19 , Transplante de Rim , Humanos , Transplante de Rim/efeitos adversos , Transplante de Rim/métodos , Doadores Vivos , Sobrevivência de Enxerto , Estudos Retrospectivos , Creatinina , Resultado do Tratamento , SARS-CoV-2 , Oxigênio
4.
Exp Clin Transplant ; 20(10): 917-924, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36409051

RESUMO

OBJECTIVES: Sarcopenia is a common entity in cirrhosis with significant morbidity and mortality. However,the effects of sarcopenia on the risk of complications and survival after liver transplant remain controversial.We aimed to evaluate the effect of sarcopenia on survival and complications after liver transplant. MATERIALS AND METHODS: Our study cohort included 61 adult patients with hepatitis C-related cirrhosis who underwent living donor liver transplant. Pretransplant clinical and anthropometric assessments included body mass index, hand grip, mid-arm circumference, triceps skin fold thickness, and gait speed. Sarcopenia was determined by computed tomography using the skeletal muscle index at the third lumbar vertebra cut-off value of <38.5 cm2/m2 for women and <52.4 cm2/m2 for men; these patients were then followed up for 6 months after transplant to determine survival and complications. RESULTS: At time of liver transplant, sarcopenia was present in 27/61 patients (44.3%). At follow-up after transplant, sarcopenia was found in 14 patients (30.4%) among 46 survivors; all patients who survived were male patients. Among patients with sarcopenia posttransplant, 12 had sarcopenia before transplant and 2 developed sarcopenia after transplant. Liver dysfunction, lower triceps skin fold thickness, recent infections, and sarcopenia pretransplant were associatedwithposttransplant complications, especially infection(42.8%) and prolonged intensive careunit stay. Age and pretransplant sarcopenia were found to be independent predictors of posttransplant mortality. CONCLUSIONS: Sarcopenia is a common entity in patients with cirrhosis who are on liver transplant wait lists and may continue after liver transplant. De novo sarcopenia after liver transplant is also a common finding. Sarcopenia can affect patient outcomes, including prolonged intensive care unit stay and poor short-term survival.


Assuntos
Transplante de Fígado , Sarcopenia , Humanos , Adulto , Masculino , Feminino , Sarcopenia/diagnóstico , Sarcopenia/diagnóstico por imagem , Transplante de Fígado/efeitos adversos , Força da Mão , Doadores Vivos , Resultado do Tratamento , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Cirrose Hepática/cirurgia
5.
Exp Clin Transplant ; 20(10): 959-964, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36409055

RESUMO

Nonvector transmission of dengue virus via organ transplantis rare.We report a probable case of dengue virus transmission via deceased donorlivertransplant. The donor was asymptomatic for dengue infection, and the liver recipient developed fever and thrombocytopenia 8 days after transplant. The recipient's testresults were positive forthe antigen for nonstructural protein 1 and for immunoglobulin M; however, donor serum samples were not available. Other transplant recipients (renal allograft) also showed dengue-positive test results during the same period, and these patients eventually died. Dengue illness in the liver recipient was severe and associated with shock and cardiomyopathy that required mechanical ventilation, intensive care, and cessation of immunosuppression; however, the patient subsequently improved and was discharged. This case highlights the importance of a high index of suspicion for dengue infection in the presence of graft dysfunction in dengue-endemic areas like India, as well as the importance of the test for the nonstructural protein 1 antigen during dengue outbreaks. These considerations should be included on the standard evaluation of solid-organ transplant donors.


Assuntos
Dengue , Transplante de Rim , Transplante de Fígado , Humanos , Transplante de Fígado/efeitos adversos , Doadores Vivos , Resultado do Tratamento , Fígado , Dengue/diagnóstico
6.
Curr Opin Organ Transplant ; 27(4): 346-350, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-36354261

RESUMO

PURPOSE OF REVIEW: Living donor liver transplantation (LT) has been increasingly recognized as an effective treatment modality with excellent patient survival. Indications for LT have evolved not only for cholestatic liver disease, but also metabolic liver diseases. Living donor selection, particularly for pediatric inherited disease, is essential to prevent morbidity, both in the donor and recipient. RECENT FINDINGS: Based on 30 years of experience in pediatric living donor LT in Japan, we could identify marginal parental living donors who have potential risks following LT, including heterozygous mothers with ornithine transcarbamylase deficiency, heterozygous protein C deficiency, heterozygous hypercholesterolemia, heterozygous protoporphyria, asymptomatic parental donors with paucity of intrahepatic bile duct, and human leukocyte antigen-homozygous parental donors. SUMMARY: Although these situations seem rare due to infrequency of the condition, careful living donor evaluation is required to optimize the outcomes for pediatric recipients. In the setting of an appropriate selection of a living donor, we should avoid any additional hazards, given that the procedure itself has risks for a healthy individual.


Assuntos
Hepatopatias , Transplante de Fígado , Doença da Deficiência de Ornitina Carbomoiltransferase , Criança , Humanos , Doadores Vivos , Transplante de Fígado/métodos , Pais
7.
Biomed Res Int ; 2022: 7647754, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36349313

RESUMO

Objectives: Tacrolimus is characterized by high pharmacokinetic variability in combination with a narrow therapeutic range. However, influence of donor CYP3A5 genotype and graft-to-recipient body weight ratio (GRWR) on tacrolimus' pharmacokinetics after pediatric living donor liver transplantation (LDLT) remains unclear. Methods: A total of 174 LDLT recipients (<6 y) were grouped according to donor CYP3A5 genotypes (nonexpressor (NEX) or expressor (EX)) and GRWR (<3.0% (SS, small-size) or ≥3.0% (LS, large-size)): SS/NEX (n = 40), SS/EX (n = 38), LS/NEX (n = 48), and LS/EX (n = 48). Pharmacokinetics of tacrolimus and clinical outcomes were analyzed. Results: The relationships between the concentration-dose ratio and donor CYP3A5 genotypes and graft size were examined 3, 7, 14, and 30 days after the transplantation. Tacrolimus C0 levels varied greatly among groups, although recipients started with the same initial dosage. LS/EX recipients had significantly lower C0 levels in comparison with those of other groups. The use of CYP3A5-EX-grafts and a greater GRWR both resulted in significantly higher TAC dose requirements and lower C/D ratios. However, the significance of GRWR no longer exists 3 months after transplantation. The multivariate generalized linear mixed model analysis showed that donor CYP3A5 genotypes (F = 11.876; P = 0.01) and GRWR (F = 4.631; P = 0.033) were independent impact factors for C/D ratios 3, 7, 14, and 30 days after transplantation. Donor CYP3A5-EX genotype was associated with significantly increasing risks of infectious complications and significantly lower Cylex ATP values. However, no significant difference was observed in acute rejections among 4 groups. Conclusions: Monitoring of C0 levels alone is not reliable to guide tacrolimus administration. Donor CYP3A5 and GRWR both significantly affect tacrolimus pharmacokinetics after pediatric LDLT. The use of Cylex ATP tests would be helpful to avoid overimmunosuppression.


Assuntos
Transplante de Fígado , Tacrolimo , Humanos , Criança , Tacrolimo/uso terapêutico , Citocromo P-450 CYP3A/genética , Doadores Vivos , Imunossupressores , Genótipo , Trifosfato de Adenosina , Polimorfismo de Nucleotídeo Único
8.
Sci Transl Med ; 14(669): eabo2628, 2022 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-36322627

RESUMO

Promoting immune tolerance to transplanted organs can minimize the amount of immunosuppressive drugs that patients need to take, reducing lifetime risks of mortality and morbidity. Regulatory T cells (Tregs) are essential for immune tolerance, and preclinical studies have shown their therapeutic efficacy in inducing transplantation tolerance. Here, we report the results of a phase 1/2 trial (ARTEMIS, NCT02474199) of autologous donor alloantigen-reactive Treg (darTreg) therapy in individuals 2 to 6 years after receiving a living donor liver transplant. The primary efficacy endpoint was calcineurin inhibitor dose reduction by 75% with stable liver function tests for at least 12 weeks. Among 10 individuals who initiated immunosuppression withdrawal, 1 experienced rejection before planned darTreg infusion, 5 received darTregs, and 4 were not infused because of failure to manufacture the minimal infusible dose of 100 × 106 cells. darTreg infusion was not associated with adverse events. Two darTreg-infused participants reached the primary endpoint, but an insufficient number of recipients were treated for assessing the efficacy of darTregs. Mechanistic studies revealed generalized Treg activation, senescence, and selective reduction of donor reactivity after liver transplantation. Overall, the ARTEMIS trial features a design concept for evaluating the efficacy of Treg therapy in transplantation. The mechanistic insight gained from the study may help guide the design of future trials.


Assuntos
Transplante de Fígado , Tolerância ao Transplante , Humanos , Transplante de Fígado/métodos , Linfócitos T Reguladores , Rejeição de Enxerto/prevenção & controle , Doadores Vivos
9.
Turk J Med Sci ; 52(4): 942-947, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36326422

RESUMO

BACKGROUND: Biliary fistula is one of the most important complications in liver transplantation. Complications can vary from simple local peritonitis to death, and various techniques have been described to prevent them. In this study, we compared two different stenting methods used in biliary tract anastomosis in living-donor liver transplantation. METHODS: We retrospectively analyzed data from 41 living-donor liver transplantations that were performed due to endstage liver failure between August 2019 and November 2020. Patients were grouped according to the stenting technique used in biliary anastomosis. Postoperative biliary tract complications were investigated. RESULTS: Biliary fistulas were observed in 2 (7.4%) patients in the internal stent group, while 4 (28.5) fistulas were observed in the external stent group. Biliary tract stricture was observed in 2 (7.4%) patients in the internal stent group, but there was no statistical difference in complications. The preoperative MELD score (p = 0.038*) was found to be statistically significant in regard to developing complications. DISCUSSION: Our study did not show the effect of stenting methods used during biliary anastomosis on the development of complications. However, larger randomized controlled studies are needed.


Assuntos
Transplante de Fígado , Doadores Vivos , Humanos , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Ductos Biliares/cirurgia , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Stents/efeitos adversos
10.
Am J Case Rep ; 23: e936921, 2022 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-36374795

RESUMO

BACKGROUND Delayed graft function (DGF) is defined as failure of the transplanted kidney to function in the early -post-transplant period. DGF is a rare complication after living donor kidney transplant and is most common after deceased donor kidney transplant, probably due to prolonged warm and cold ischemia times during retrieval. Most cases of DGF resolve spontaneously within days to weeks. There are very few reported cases in the literature of DGF lasting over 4 weeks. We present a case that resolved after 55 days. The recipient subsequently achieved normal renal function. CASE REPORT Our patient was a 52-year-old man with end-stage renal disease who underwent a second living donor renal transplant. The donor was his son, with whom he had 1 antigen mismatch. Postoperative day 1, the patient developed anuria and failed to improve with fluids and diuretics. Investigations ruled out common causes of renal dysfunction (rejection, ischemia), but failed to disclose the cause of this condition. After an extended period of watchful waiting, the graft function returned, reaching normal creatinine and urine output levels. CONCLUSIONS DGF after living donor kidney transplantation is rare, and few cases lasting more than a month have been reported. Before diagnosing DGF, other causes of renal dysfunction (rejection, ischemia, medication adverse effects) must be ruled out. In the absence of these, expectant management is appropriate and full graft recovery can be expected, even with anuria and hemodialysis.


Assuntos
Anuria , Função Retardada do Enxerto , Masculino , Humanos , Pessoa de Meia-Idade , Função Retardada do Enxerto/etiologia , Sobrevivência de Enxerto , Rejeição de Enxerto , Doadores Vivos , Anuria/complicações , Fatores de Tempo , Doadores de Tecidos , Rim/fisiologia , Fatores de Risco
11.
Narrat Inq Bioeth ; 12(2): 103-107, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36373519

RESUMO

This symposium includes thirteen personal narratives from people who have received at least one organ transplant from a living or deceased donor. These narratives foster better understanding of the experiences of life-saving organ recipients and their families, including post-transplant difficulties experienced-sometimes requiring multiple transplants. This issue also includes three commentaries by Macey L. Levan, Heather Lannon, and Vidya Fleetwood, Roslyn B. Mannon & Krista L. Lentine. Dr. Levan is a living kidney donor and associate professor of surgery and population health. She writes and teaches on organ transplant and has expertise and experience in governance at the federal level as a member of the board of directors for the U.S. Organ Procurement and Transplantation Network. Dr. Lannon is a social worker and transplant advocate. Her work and interest in the topic were inspired by her husband who needed a heart transplant. Dr. Fleetwood is a surgeon specializing in liver transplantation, pancreas transplantation, kidney transplantation, as well as living donor nephrectomy. Dr. Mannon is a nephrologist and professor of medicine, pathology and microbiology. Her work focuses on understanding and improving long-term kidney transplant outcomes for patients, donors, and caregivers. Dr. Lentine is a nephrologist specializing in treatment of adult patients with kidney disease. She is a researcher and co-chaired the international work group that developed guidelines for living donor kidney transplantation.


Assuntos
Transplante de Órgãos , Obtenção de Tecidos e Órgãos , Adulto , Feminino , Humanos , Sobrevivência de Enxerto , Doadores Vivos , Doadores de Tecidos , Frutanos
12.
Narrat Inq Bioeth ; 12(2): 147-152, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36373535

RESUMO

Transplantation affords recipients of a donated organ a second chance at life. However, the gift of life can incur impactful costs to the donor, the recipient, and their caregivers. In this collection of stories, thirteen authors explore their journey to transplantation and afterward-from physical pain and deconditioning; to navigating well-intentioned but rigid clinicians; to developing a greater appreciation of life, their community, and their abilities. We explore the recurring themes woven throughout the stories, including the solemn responsibility of accepting an organ, the challenges of living a new life with a body and mind changed by transplantation, the difficulty of preserving one's sense of self when one's clinicians are dominantly focused on the organ, and the spectrum of gifts that organ donation and transplantation provide.


Assuntos
Transplante de Órgãos , Obtenção de Tecidos e Órgãos , Humanos , Doadores Vivos , Pesquisa Qualitativa , Transplantados
14.
BMJ Open ; 12(11): e066128, 2022 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-36368749

RESUMO

INTRODUCTION: Donor-derived modified immune cells (MIC) induced long-term specific immunosuppression against the allogeneic donor in preclinical models of transplantation. In a phase I clinical trial (TOL-1 Study), MIC treatment resulted in a cellular phenotype that was directly and indirectly suppressive to the recipient's immune system allowing for reduction of conventional immunosuppressive therapy. Here, we describe a protocol for a randomised controlled, multicentre phase-IIb clinical trial of individualised immunosuppression with intravenously administered donor MIC compared with standard-of-care (SoC) in living donor kidney transplantation (TOL-2 Study). METHODS AND ANALYSIS: Sixty-three living donor kidney transplant recipients from six German transplant centres are randomised 2:1 to treatment with MIC (MIC group, N=42) or no treatment with MIC (control arm, N=21). MIC are manufactured from donor peripheral blood mononuclear cells under Good Manufacturing Practice conditions. The primary objective of this trial is to determine the efficacy of MIC treatment together with reduced conventional immunosuppressive therapy in terms of achieving an operational tolerance-like phenotype compared with SoC 12 months after MIC administration. Key secondary endpoints are the number of patient-relevant infections as well as a composite of biopsy-proven acute rejection, graft loss, graft dysfunction or death. Immunosuppressive therapy of MIC-treated patients is reduced during follow-up under an extended immunological monitoring including human leucocyte antigen-antibody testing, and determination of lymphocyte subsets, for example, regulatory B lymphocytes (Breg) and antidonor T cell response. A Data Safety Monitoring Board has been established to allow an independent assessment of safety and efficacy. ETHICS AND DISSEMINATION: Ethical approval has been provided by the Ethics Committee of the Medical Faculty of the University of Heidelberg, Heidelberg, Germany (AFmu-580/2021, 17 March 2022) and from the Federal Institute for Vaccines and Biomedicines, Paul-Ehrlich-Institute, Langen, Germany (Vorlage-Nr. 4586/02, 21 March 2022). Written informed consent will be obtained from all patients and respective donors prior to enrolment in the study. The results from the TOL-2 Study will be published in peer-reviewed medical journals and will be presented at symposia and scientific meetings. TRIAL REGISTRATION NUMBER: NCT05365672.


Assuntos
Transplante de Rim , Humanos , Transplante de Rim/efeitos adversos , Doadores Vivos , Padrão de Cuidado , Leucócitos Mononucleares , Terapia de Imunossupressão , Imunossupressores/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Multicêntricos como Assunto , Ensaios Clínicos Fase II como Assunto
15.
BMC Gastroenterol ; 22(1): 462, 2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36384451

RESUMO

OBJECTIVE: To explore the clinical application of a newly developed magnetic anchoring traction (MAT) system in the liver bench trimming and transplantation surgery. BACKGROUND: The conventionally limited space, vision, and exposure have always been a challenge for the quality of surgery in the liver bench trimming due to the fact that the exposure depends largely on the experience of surgeon. To deal with this problem, a MAT system is developed as an alternative support to enhance exposure. The preliminarily experiments on animals verified its feasibility and reliability in the practical use, and its clinical application and effects were examined in the present research. METHODS: A total of 20 DCD (donation of cardiac death) donor livers were collected and divided evenly between the magnetic anchor traction (MAT) assisted group (n = 10) and the manual assisted group (n = 10). The results and quality assessment from experts about the liver bench surgery performed by two groups were examined and compared. RESULTS: The MAT system can be employed effectively to compete and replace the manual assistance to achieve a better exposure in the liver bench trimming. No statistical difference was found regarding the baseline data between the MAT and the manual groups. In the inferior vena cava and hepatic artery trimming, the MAT group outperformed the manual group remarkably in many aspects. The surgery time for liver bench shortened considerably after a quick grasp of MAT skills by surgeons. CONCLUSION: The MAT system provides a more stable, reliable and qualified local exposure in the liver bench surgery, and can preferably be employed to replace the manual assistance in the procedures of liver transplantation.


Assuntos
Transplante de Fígado , Humanos , Transplante de Fígado/métodos , Tração , Reprodutibilidade dos Testes , Doadores Vivos , Fígado/cirurgia , Fenômenos Magnéticos
17.
PLoS One ; 17(11): e0276882, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36399462

RESUMO

BACKGROUND: Approval of living kidney donors (LKD) with end-stage kidney disease (ESKD) risk factors, such as obesity, has increased. While lifetime ESKD development data are lacking, the study of intermediate outcomes such as diabetes is critical for LKD safety. Donation-attributable diabetes risk among persons with obesity remains unknown. The purpose of this study was to evaluate 10-year diabetes-free survival among LKDs and non-donors with obesity. METHODS: This longitudinal cohort study identified adult, LKDs (1976-2020) from 42 US transplant centers and non-donors from the Coronary Artery Risk Development in Young Adults (1985-1986) and the Atherosclerosis Risk in Communities (1987-1989) studies with body mass index ≥30 kg/m2. LKDs were matched to non-donors on baseline characteristics (age, sex, race, body mass index, systolic and diastolic blood pressure) plus diabetes-specific risk factors (family history of diabetes, impaired fasting glucose, smoking history). Accelerated failure time models were utilized to evaluate 10-year diabetes-free survival. FINDINGS: Among 3464 participants, 1119 (32%) were LKDs and 2345 (68%) were non-donors. After matching on baseline characteristics plus diabetes-specific risk factors, 4% (7/165) LKDs and 9% (15/165) non-donors developed diabetes (median follow-up time 8.5 (IQR: 5.6-10.0) and 9.1 (IQR: 5.9-10.0) years, respectively). While not significant, LKDs were estimated to live diabetes-free 2 times longer than non-donors (estimate 1.91; 95% CI: 0.79-4.64, p = 0.15). CONCLUSIONS: LKDs with obesity trended toward living longer diabetes-free than non-donors with obesity, suggesting within the decade following donation there was no increased diabetes risk among LKDs. Further work is needed to evaluate donation-attributable diabetes risk long-term.


Assuntos
Diabetes Mellitus , Falência Renal Crônica , Transplante de Rim , Humanos , Adulto Jovem , Transplante de Rim/efeitos adversos , Estudos Longitudinais , Doadores Vivos , Estudos de Coortes , Obesidade/complicações , Obesidade/epidemiologia , Diabetes Mellitus/etiologia
19.
Comput Methods Programs Biomed ; 226: 107196, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36367484

RESUMO

BACKGROUND AND OBJECTIVE: Post-transplant refractory ascites (RA) is common in patients receiving living donor liver transplantation (LDLT) using a left hemi-liver graft than in those using a right hemi-liver graft. However, there is currently no clear mechanism explaining the effect of grafts on ascites drainage. The purpose of this study is to analyze the values of blood flow parameters in the portal vein under different grafts using computational fluid dynamics (CFD) to interpret the relationship between portal pressure values with ascites drainage. METHODS: In this work, ascites drainage was counted in 30 patients who underwent left-sided liver transplantation and 26 patients who underwent right-sided liver transplantation. The portal vein flow models of the transplanted liver under different flow rates were established based on computed tomography (CT) images and finite element theory. Ascites drainage and blood flow parameters were qualitatively compared. RESULTS: The results show that the ascites drained from patients who received LDLT with a left hemi-liver is three times as that with a right hemi-liver. The simulation results show that the coefficient of the pressure-velocity curve of the left-liver is 1.7 times of the right-liver under the same hydrodynamic conditions, which qualitatively agrees with the clinical data. Moreover, the streamline of the transplanted left liver shows more vortexes compared with the right liver, which is a major reason for the left liver's higher pressure value. CONCLUSION: This clinical phenomenon is reproduced and comprehensively explained by the hemodynamic parameters of the portal vein. This work establishes the relationship between portal pressure values and floating water drainage, and offers a new way for physicians to predict postoperative risks intuitively.


Assuntos
Transplante de Fígado , Humanos , Doadores Vivos , Ascite , Fígado/diagnóstico por imagem , Fígado/cirurgia , Fígado/irrigação sanguínea , Veia Porta/diagnóstico por imagem
20.
Prog Transplant ; 32(4): 274-282, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36367716

RESUMO

INTRODUCTION: The growing practice of living liver donation requires comprehensive understanding of the financial implications for living liver donors. While obtaining and maintaining insurance is important to financial health, little is known about the impact of liver donation on future insurability. RESEARCH QUESTIONS: The purpose of this study was to evaluate the donors' experiences with insurance following donation and identify the insurance provider-driven factors that contribute to donor insurability. DESIGN: A two center cohort of living donors with donation between January 2000 and December 2018 (N = 442) were surveyed about postdonation insurance experiences. To understand insurance provider practices towards liver donors, life (n = 11) and disability (n = 4) insurance underwriters were asked to provide policy quotes for a standardized living liver donor profile. RESULTS: Responses (N = 101) were received by August 2020 (response rate = 22.9%). Living liver donors reported owning life (58%), disability (35%), and medical (87%) insurance at rates comparable to the general population with low proportions reporting difficulty obtaining these insurance types (9%, 9%, 4%, respectively). Post-donation life insurance ownership was associated with post-donation employment (P = 0.01). Underwriter responses indicate life and disability insurability were adversely affected up to 12 months following donation. CONCLUSIONS: Living liver donors did not have difficulty maintaining insurance in the long-term but should be counseled to purchase insurance prior to surgery as short-term insurability may be affected. Perception of difficulty obtaining insurance following donation remains of significant concern among living donors. Further collaboration between the transplant community and insurance companies is warranted.


Assuntos
Transplante de Fígado , Doadores Vivos , Humanos , Inquéritos e Questionários , Emprego , Fígado
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