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Sample records for adult living donor

  1. [Living donor liver transplantation in adults].

    Science.gov (United States)

    Neumann, U P; Neuhaus, P; Schmeding, M

    2010-09-01

    The worldwide shortage of adequate donor organs implies that living donor liver transplantation represents a valuable alternative to cadaveric transplantation. In addition to the complex surgical procedure the correct identification of eligible donors and recipients plays a decisive role in living donor liver transplantation. Donor safety must be of ultimate priority and overrules all other aspects involved. In contrast to the slightly receding numbers in Europe and North America, in recent years Asian programs have enjoyed constantly increasing living donor activity. The experience of the past 15 years has clearly demonstrated that technical challenges of both bile duct anastomosis and venous outflow of the graft significantly influence postoperative outcome. While short-term in-hospital morbidity remains increased compared to cadaveric transplantation, long-term survival of both graft and patient are comparable or even better than in deceased donor transplantation. Especially for patients expecting long waiting times under the MELD allocation system, living donor liver transplantation offers an excellent therapeutic alternative. Expanding the so-called "Milan criteria" for HCC patients with the option for living donor liver transplantation is currently being controversially debated.

  2. Successful adult-to-adult living donor liver transplantation using liver allograft after the resection of hemangioma: A suggestive case for a further expansion of living donor pool

    Directory of Open Access Journals (Sweden)

    Yasuharu Onishi

    2015-01-01

    Conclusion: We advocate that the use of liver allograft with hemangiomas in adult-to-adult LDLT settings can be remarkable strategy to reduce the problem of organ shortage without any unfavorable consequences in both living donor and recipient.

  3. Clinical study on safety of adult-to-adult living donor liver transplantation in both donors and recipients

    Institute of Scientific and Technical Information of China (English)

    Bin Liu; Ji-Chun Zhao; Yu-Kui Ma; Jiang-Wen Liu; Hong Wu; Lu-Nan Yan; Wen-Tao Wang; Bo Li; Yong Zeng; Tian-Fu Wen; Ming-Qing Xu; Jia-Yin Yang; Zhe-Yu Chen

    2007-01-01

    AIM: To investigate the safety of adult-to-adult living donor liver transplantation (A-A LDLT) in both donors and recipients.METHODS: From January 2002 to July 2006, 50 cases of A-A LDLT were performed at West China Hospital, Sichuan University, consisting of 47 cases using right lobe graft without middle hepatic vein (MHV), and 3 cases using dual grafts (one case using two left lobe, 2 using one right lobe and one left lobe). The most common diagnoses were hepatitis B liver cirrosis, 30 (60%) cases; and hepatocellular carcinoma, 15 (30%) cases in adult recipients. Among them, 10 cases had the model of end-stage liver disease (MELD) with a score of more than 25. Donor screening consisted of reconstruction of the hepatic blood vessels and biliary system with 3-dimension computed tomography and volumetry of whole liver and right liver volume. Various improved surgical techniques were adopted in the procedures for both donors and recipients .RESULTS: Forty-nine right lobes and 3 left lobes (2 left lobe grafts for 1 recipient, 1 left lobe graft for 1 recipient who had received right lobe graft donated by relative living donor) were obtained from 52 living donors. The 49 right lobe grafts, without MHV, weighed 400 g-850 g (media 550 g), and the ratio of graft volume to recipient standard liver volume (GV/SLV) ranged from 31.74% to 71.68% (mean 45.35%). All donors' remnant liver volume was over 35% of the whole liver volume. There was no donor mortality. With a follow-up of 2-52 mo (media 9 mo), among 50 adult recipients, complications occurred in 13 (26%) cases and 4 (8%) died postoperatively within 3 mo. Their 1-year actual survival rate was 92%.CONCLUSION: When preoperative CT volumetry shows volume of remnant liver is more than 35%, the ratio of right lobe graft to recipients standard liver volume exceeding 40%, A-A LDLT using right lobe graft without MHV should be a very safe procedure for both donors and recipients, otherwise dual grafts liver transplantation

  4. Donor safety in adult living donor liver transplantation using the right lobe:Single center experience in China

    Institute of Scientific and Technical Information of China (English)

    Fu-Gui Li; Lu-Nan Yan; Yong Zeng; Jia-Yin Yang; Qi-Yuan Lin; Xiao-Zhong Jiang; Bin Liu

    2007-01-01

    AIM: To evaluate the safety of donors in adult living donor liver transplantation (LDLT) using the right lobe in a single liver transplantation center in China.METHODS: We investigated retrospectively 52 living donor liver resections performed from October 2003 to July 2006. All patients were evaluated by blood tests and abdominal CT. The mean donor age was 28.2±7.4years. Residual liver volume was 42.1%±4.7%. Mean operative time was 420±76.2 min; mean ICU stay, less than 36 h; mean hospital stay, 16.4±8.6 d; and mean follow-up period, 6 mo.RESULTS: There was no mortality. The overall complication rate was 40% (21 donors). Major complications included biliary leak in two, and pneumonia in 2 donors. Minor complications included mild pleural effusion in 12 donors, transient ascites in 6, mild depression in 4, intra-abdominal collections in 2,and wound infections in 1 donor. Residual liver volume did not affect the complication rate. None required reoperation. Return to pre-donation activity occurred within 5-8 wk.CONCLUSION: Right hemi-hepatectomy can be performed safely with minimal risk in cases of careful donor selection. Major complications occurred in only 7.7% of our series.

  5. Recurrent primary sclerosing cholangitis in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study: Comparison of risk factors between living and deceased donor recipients.

    Science.gov (United States)

    Gordon, Fredric D; Goldberg, David S; Goodrich, Nathan P; Lok, Anna S F; Verna, Elizabeth C; Selzner, Nazia; Stravitz, R Todd; Merion, Robert M

    2016-09-01

    Primary sclerosing cholangitis (PSC) recurs in 15%-25% of patients transplanted for PSC. In the United States, PSC transplant patients are more likely to receive an organ from a living donor (LD) than patients without PSC. Our aims were to (1) compare risk of PSC recurrence in LD versus deceased donor recipients and (2) identify risk factors for PSC recurrence. There were 241 living donor liver transplantations (LDLTs) and 65 deceased donor liver transplantation (DDLT) patients transplanted between 1998 and 2013 enrolled in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study who were evaluated. PSC recurrence risk for LDLT and DDLT recipients was compared using Kaplan-Meier survival curves and log-rank tests. Cox models were used to evaluate PSC risk factors. Overall PSC recurrence probabilities were 8.7% and 22.4% at 5 and 10 years after liver transplantation (LT), respectively. The risk of PSC recurrence was not significantly different for DDLT versus LDLT recipients (P = 0.36). For DDLT versus LDLT recipients, unadjusted 5- and 10-year PSC recurrence was 9.4% versus 9.5% and 36.9% versus 21.1%. Higher laboratory Model for End-Stage Liver Disease (MELD) score at LT, onset of a biliary complication, cholangiocarcinoma, and higher donor age were associated with increased risks of PSC recurrence: for MELD (hazard ratio [HR] = 1.06; 95% confidence interval [CI] 1.02-1.10 per MELD point, P = 0.002); for biliary complication (HR, 2.82; 95% CI, 1.28-6.25; P = 0.01); for cholangiocarcinoma (HR, 3.98; 95% CI, 1.43-11.09; P = 0.008); for donor age (per 5-years donor age; HR, 1.17; 95% CI, 1.02-1.35; P = 0.02). Factors not significantly associated with PSC recurrence included the following: first-degree relative donor (P = 0.11), post-LT cytomegalovirus infection (P = 0.38), and acute rejection (P = 0.22). Risk of recurrent PSC was not significantly different for DDLT and LDLT recipients. Biliary complications

  6. Current status of adult-to-adult living donor liver transplantation: surgical techniques and innovations

    Institute of Scientific and Technical Information of China (English)

    YAN Lü-nan; WU Hong; CHEN Zhe-yu; LIN Yi-xin

    2009-01-01

    @@ In response to critical organ shortage, transplant surgeons have utilized living donors in an attempt to decrease the mortality rate associated with waiting on the liver transplant list. Although the surgical techniques were first utilized clinically 15 years ago, the application of living donor liver transplantation (LDLT) has been somewhat limited by the steep learning curve associated with developing a program.

  7. Outcomes of adult-to-adult living donor liver transplantation:a single center experience

    Institute of Scientific and Technical Information of China (English)

    FENG Xi; YUAN Ding; WEI Yong-gang; LI Fu-qiang; WEN Tian-fu; ZENG Yong; ZHAO Ji-chun; WANG Wen-tao; XU Ming-qing; YANG Jia-yin; MA Yu-kui; CHEN Zhe-yu; YE Hui; YAN Lü-nan; LI Bo

    2009-01-01

    Background Since January 2002,adult-to-adult living donor liver transplantation (AALDLT) has gained increasing popularity in China in response to the shortage of cadaveric donor livers.This study presents a detailed analysis of the outcomes of AALDLT in a single center.Methods A total of 70 patients underwent AALDLT at our center between January 2002 and January 2007.Among these,67 patients received a right lobe graft without the middle hepatic vein and 3 patients received dual grafts.Three-dimensional volumetric computed tomography,magnetic resonance imaging with angiography and cholangiography were performed preoperatively.Recipient operation time,intraoperative transfusion requirement,length of intensive care unit stay,length of hospital stay,liver function tests,coagulation tests and surgical outcomes were routinely investigated throughout this study.Results All donors survived the procedure with an overall complication rate of 15.3%.Overall recipient 1-year survival and complication rates were 87.1% and 34.2%,respectively.Among the 70 cases,average graft recipient weight ratio was 0.94% (0.72%-1.43%) and average graft volume/standard liver volume ratio was 46.42% (31.74%-71.68%).All residual liver volumes exceeded 35%.Liver function and coagulation recovered rapidly within the first 7 days after transplantation.Conclusions AALDLT is a safe procedure for the donors and an effective therapy for patients with end-stage liver disease.Patient selection and timely decision-making for transplantation are essential in achieving good outcomes.With accumulation of experience in surgery and clinical management,timely feedback and proper modification,we foresee better outcomes in the future.

  8. Adult-to-adult living donor liver transplantation for acute liver failure in China

    Institute of Scientific and Technical Information of China (English)

    Ding Yuan; Fei Liu; Yong-Gang Wei; Bo Li; Lv-Nan Yan; Tian-Fu Wen; Ji-Chun Zhao

    2012-01-01

    AIM:To investigate the long-term outcome of recipients and donors of adult-to-adult living-donor liver transplantation (AALDLT) for acute liver failure (ALF).METHODS:Between January 2005 and March 2010,170 living donor liver transplantations were performed at West China Hospital of Sichuan University.All living liver donor was voluntary and provided informed consent.Twenty ALF patients underwent AALDLT for rapid deterioration of liver function.ALF was defined based on the criteria of the American Association for the Study of Liver Diseases,including evidence of coagulation abnormality [international normalized ratio (INR) ≥ 1.5] and degree of mental alteration without pre-existing cirrhosis and with an illness of < 26 wk duration.We reviewed the clinical indications,operative procedure and prognosis of AALDTL performed on patients with ALF and corresponding living donors.The potential factors of recipient with ALF and corresponding donor outcome were respectively investigated using multivariate analysis.Survival rates after operation were analyzed using the Kaplan-Meier method.Receiver operator characteristic (ROC) curve analysis was undertaken to identify the threshold of potential risk factors.RESULTS:The causes of ALF were hepatitis B (n =18),drug-induced (n =1) and indeterminate (n =1).The score of the model for end-stage liver disease was 37.1 ± 8.6,and the waiting duration of recipients was 5 ± 4 d.The graft types included right lobe (n=17) and dual graft (n =3).The mean graft weight was 623.3 ± 111.3 g,which corresponded to graft-to-recipient weight ratio of 0.95% ± 0.14%.The segment Ⅴor Ⅷ hepatic vein was reconstructed in 11 right-lobe grafts.The 1-year and 3-year recipient's survival and graft survival rates were 65% (13 of 20).Postoperative results of total bilirubin,INR and creatinine showed obvious improvements in the survived patients.However,the creatinine level of the deaths was increased postoperatively and became more aggravated

  9. Problems in adult living donor liver transplantation using the right hepatic lobe

    Institute of Scientific and Technical Information of China (English)

    Guang-Dong Pan; Lu-Nan Yan

    2006-01-01

    BACKGROUND: Adult living donor liver transplantation (LDLT) is now widely applied to patients, children or adults, and the graft extends from the left hepatic lobe to the right hepatic lobe. Harvesting the right hepatic lobe would mean putting the donor at high risk. The congestion of a graft may cause small-for-size syndrome. The safety of the donor and its evaluation, which are related to the outcome for the recipient, play an important role in LDLT. How to decrease the congestion of the graft is another challenge to transplant experts. DATA SOURCES: A literature search from MEDLINE about adult LDLT in recent years was made to analyze the safety of the living donor and the innovation of surgical techniques for preventing small-for-size syndrome. RESULTS:The top priority for adult LDLT is donor safety. Preoperative donor evaluation consists of three stages:phase 1 for general evaluation, phase 2 for laboratory tests, and phase 3 for radiological evaluation of graft volume and vessel anatomy. The potential pathogenic mechanisms of small-for-size syndrome seem to be related to persistent portal hypertension and portal overperfusion. Improved surgical techniques for decreasing portal hypertension and preventing congestion of a graft may reduce the incidence of small-for-size syndrome. The improved techniques include reconstruction of the tributaries of the middle hepatic vein, end-to-side portocaval shunting, ligation of the splenic artery, dual-graft transplantation, and modiifed reconstruction of hepatic veins. CONCLUSION:With the careful preoperative assessment and the safety of the living donor, as well as improved surgical techniques, adult LDLT using the right lobe is safe.

  10. Major complications of adult right lobe living liver donors

    Institute of Scientific and Technical Information of China (English)

    Necdet Guler; Onur Yaprak; Yusuf Gunay; Murat Dayangac; Murat Akyildiz; Fisun Yuzer; Yildiray Yuzer and Yaman Tokat

    2015-01-01

    BACKGROUND: The right lobe of the liver is generally preferred for living donor liver transplantation in adult patients with end-stage liver disease. It is important to know the preoperative factors relating to the major postoperative complications. We therefore evaluated the possible risk factors for predicting post-operative complications in right lobe liver donors. METHODS: Data from 378 donors who had undergone right lobe hepatectomy at our center were evaluated retrospectively. The factors we evaluated included donor age, gender, body mass index (BMI), remnant liver volume, operation time, history of previous abdominal surgery, inclusion of the middle hepatic vein and variations in the portal and bile systems. RESULTS: Of the 378 donors, 219 were male and 159 female. None of the donors died, but 124 (32.8%) donors experienced complications including major complications (Clavien scores III and IV) in 27 (7.1%). Univariate analysis showed that complica-tions were signiifcantly associated with male gender and higher BMI (P0.05). Multivariate logistic regression analysis showed that major complications were signiifcantly associated with male gender (P=0.005) and higher BMI (P=0.029). Moreover, the Chi-square test showed that there were signiifcant relationships be-tween major complications and male gender (P=0.010, χ2=6.614, df=1) and BMI >25 kg/m2 (P=0.031, χ2=8.562, df=1). Of the 96 male donors with BMI >25 kg/m2, 14 (14.6%) with major com-plications had signiifcantly smaller mean remnant liver volume than those (82, 85.4%)

  11. Emergency adult living donor right lobe liver transplantation for fulminant hepatic failure

    Institute of Scientific and Technical Information of China (English)

    ZHANG Feng; LU Sheng; PU Liyong; LU Ling; WANG Xuehao; LI Xiangcheng; KONG Lianbao; SUN Beicheng; LI Guoqiang; QIAN Xiaofen; CHEN Feng; WANG Ke

    2007-01-01

    Fulminant hepatitis is fatal in most cases and timely liver transplantation is the only effective treatment.This study evaluates the survival outcomes of patients who underwent living-donor liver transplantation (LDLT)using right lobe liver grafts for fulminant liver failure due to hepatitis B infection.Nine cases of adult right lobe LDLT were performed in our department from September 2002 to August 2005 and the clinical and following-up data were reviewed.According to the pre-transplant Child-Pugh-Turcotte classification,the nine patients were classified as grade C.The model for end-stage liver disease (MELD) score of these patients ranged from 16 to 42.The principal complications before transplantation included abnormal renal function,hepatic coma of different degrees and alimentary tract hemorrhage.The main complications after transplantation included pulmonary infection in two cases,acute renal failure in three cases and transplantation-related encephalopathy in one case.No primary failure of vascular or biliary complications occurred.The one-year survival rate was 55.6%.There were no serious complications or deaths in donors.In general,it is extremely difficult to treat fulminant hepatitis by conservative regimen,particularly,in cases with rapid progresslon.Emergency adult living-donor liver transplantation is an effective treatment for fulminant hepatitis patients and is relatively safe for donors.

  12. Adult Living Donor Liver Transplantation with ABO-Incompatible Grafts: A German Single Center Experience

    Directory of Open Access Journals (Sweden)

    Armin D. Goralczyk

    2009-01-01

    Full Text Available Adult living donor liver transplantations (ALDLTs across the ABO blood group barrier have been reported in Asia, North Americas, and Europe, but not yet in Germany. Several strategies have been established to overcome the detrimental effects that are attached with such a disparity between donor and host, but no gold standard has yet emerged. Here, we present the first experiences with three ABO-incompatible adult living donor liver transplantations in Germany applying different immunosuppressive strategies. Four patient-donor couples were considered for ABO-incompatible ALDLT. In these patients, resident ABO blood group antibodies (isoagglutinins were depleted by plasmapheresis or immunoadsorption and replenishment was inhibited by splenectomy and/or B-cell-targeted immunosuppression. Despite different treatments ALDLT could safely be performed in three patients and all patients had good initial graft function without signs for antibody-mediated rejection (AMR. Two patients had long-term graft survival with stable graft function. We thus propose the feasibility of ABO-incompatible ALDLT with these protocols and advocate further expansion of ABO incompatible ALDLT in multicenter trials to improve efficacy and safety.

  13. Laparoscopic live donor nephrectomy.

    Science.gov (United States)

    Hasan, Waleed A; Al-Akraa, Mahmoud M

    2005-07-01

    With the number of patients presently awaiting renal transplantation exceeding the number of cadaveric organs available, there is an increasing reliance on live renal donation. Of the 11,869 renal transplants performed in 2002 in the US, 52.6% were living donors from the United Network for Organ Sharing Registry. Renal allografts from living donors provide: superior immediate long-term function; require less waiting time and are more cost-effective than those from cadaveric donors. However, anticipation of postoperative pain and temporary occupational disability may dissuade many potential donors. Additionally, some recipients hesitate to accept a living donor kidney due to suffering that would be endured by the donor. It is a unique medical situation when a young, completely healthy donor undergoes a major surgical procedure to provide an organ for transplantation. It is mandatory to offer a surgical technique, which is safe and with minimal complications. It is also obvious for any organ transplantation, that the integrity of the organ remain intact, thus, enabling its successful transplantation into the recipient. An acceptably short ischemia time and adequate lengths of ureter and renal vasculature are favored. Many centers are performing laparoscopic live donor nephrectomy in an effort to ease convalescence of renal donors. This may encourage the consideration of live donation by recipients and potential donors. PMID:16047050

  14. The usefulness of hepatobiliary scintigraphy in the diagnosis of complications after adult-to-adult living donor liver transplantation

    International Nuclear Information System (INIS)

    Living donor liver transplantation has become an accepted procedure to overcome the shortage of adult donor organs. The aim of this study was to evaluate the usefulness of hepatobiliary scintigraphy in the diagnosis of complications after adult-to-adult living donor liver transplantation. We analysed 82 hepatobiliary scintigraphy studies performed using technetium-99m DISIDA in 60 adult patients (44 males, 16 females) who had been transplanted with a living donor's hepatic lobe (right lobe, 32; left lobe, 28). Indications for hepatobiliary scintigraphy were abnormal symptoms and/or liver function tests (n=54) or suspected bile leak or biloma (n=28). Median interval between transplantation and scintigraphy was 69 days (9 days to 23 months). Scintigraphic findings were classified into hepatic parenchymal dysfunction, total biliary obstruction, segmental biliary obstruction, bile leak and normal graft. Scintigraphic findings were confirmed by liver biopsy in 17 cases, and by radiological and clinical follow-up in 65 cases. There were 29 events relating to biliary complications (six total biliary obstructions, eight segmental biliary obstructions and 15 bile leaks) and 19 relating to non-biliary complications (15 cases of rejection, two of infection and two of vascular compromise) in 38 patients. Hepatobiliary scintigraphy provided the correct diagnosis in all eight segmental and five of six total biliary obstructions, and in all 15 cases of bile leak. Of the 19 non-biliary complications, 16 showed parenchymal dysfunction regardless of the aetiology and three showed total biliary obstruction on scintigraphy. All but three of 34 normally functioning grafts were normal on scintigraphy. The diagnostic sensitivity and specificity of scintigraphy for biliary obstruction in the 54 patients with abnormal symptoms or liver function tests were 93% (100% for segmental, 83% for total) and 88% (35/40), respectively. The sensitivity and specificity were each 100% (15/15, 13/13) for

  15. The usefulness of hepatobiliary scintigraphy in the diagnosis of complications after adult-to-adult living donor liver transplantation

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    Kim, Jae Seung; Moon, Dae Hyuk; Lee, Hee Kyung [Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea); Lee, Sung Gyu; Lee, Young Joo; Park, Kwang Min; Hwang, Shin [Department of General Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea)

    2002-04-01

    Living donor liver transplantation has become an accepted procedure to overcome the shortage of adult donor organs. The aim of this study was to evaluate the usefulness of hepatobiliary scintigraphy in the diagnosis of complications after adult-to-adult living donor liver transplantation. We analysed 82 hepatobiliary scintigraphy studies performed using technetium-99m DISIDA in 60 adult patients (44 males, 16 females) who had been transplanted with a living donor's hepatic lobe (right lobe, 32; left lobe, 28). Indications for hepatobiliary scintigraphy were abnormal symptoms and/or liver function tests (n=54) or suspected bile leak or biloma (n=28). Median interval between transplantation and scintigraphy was 69 days (9 days to 23 months). Scintigraphic findings were classified into hepatic parenchymal dysfunction, total biliary obstruction, segmental biliary obstruction, bile leak and normal graft. Scintigraphic findings were confirmed by liver biopsy in 17 cases, and by radiological and clinical follow-up in 65 cases. There were 29 events relating to biliary complications (six total biliary obstructions, eight segmental biliary obstructions and 15 bile leaks) and 19 relating to non-biliary complications (15 cases of rejection, two of infection and two of vascular compromise) in 38 patients. Hepatobiliary scintigraphy provided the correct diagnosis in all eight segmental and five of six total biliary obstructions, and in all 15 cases of bile leak. Of the 19 non-biliary complications, 16 showed parenchymal dysfunction regardless of the aetiology and three showed total biliary obstruction on scintigraphy. All but three of 34 normally functioning grafts were normal on scintigraphy. The diagnostic sensitivity and specificity of scintigraphy for biliary obstruction in the 54 patients with abnormal symptoms or liver function tests were 93% (100% for segmental, 83% for total) and 88% (35/40), respectively. The sensitivity and specificity were each 100% (15/15, 13

  16. The usefulness of hepatobiliary scintigraphy in the diagnosis of complications after adult-to-adult living donor liver transplantation.

    Science.gov (United States)

    Kim, Jae Seung; Moon, Dae Hyuk; Lee, Sung Gyu; Lee, Young Joo; Park, Kwang Min; Hwang, Shin; Lee, Hee Kyung

    2002-04-01

    Living donor liver transplantation has become an accepted procedure to overcome the shortage of adult donor organs. The aim of this study was to evaluate the usefulness of hepatobiliary scintigraphy in the diagnosis of complications after adult-to-adult living donor liver transplantation. We analysed 82 hepatobiliary scintigraphy studies performed using technetium-99m DISIDA in 60 adult patients (44 males, 16 females) who had been transplanted with a living donor's hepatic lobe (right lobe, 32; left lobe, 28). Indications for hepatobiliary scintigraphy were abnormal symptoms and/or liver function tests ( n=54) or suspected bile leak or biloma ( n=28). Median interval between transplantation and scintigraphy was 69 days (9 days to 23 months). Scintigraphic findings were classified into hepatic parenchymal dysfunction, total biliary obstruction, segmental biliary obstruction, bile leak and normal graft. Scintigraphic findings were confirmed by liver biopsy in 17 cases, and by radiological and clinical follow-up in 65 cases. There were 29 events relating to biliary complications (six total biliary obstructions, eight segmental biliary obstructions and 15 bile leaks) and 19 relating to non-biliary complications (15 cases of rejection, two of infection and two of vascular compromise) in 38 patients. Hepatobiliary scintigraphy provided the correct diagnosis in all eight segmental and five of six total biliary obstructions, and in all 15 cases of bile leak. Of the 19 non-biliary complications, 16 showed parenchymal dysfunction regardless of the aetiology and three showed total biliary obstruction on scintigraphy. All but three of 34 normally functioning grafts were normal on scintigraphy. The diagnostic sensitivity and specificity of scintigraphy for biliary obstruction in the 54 patients with abnormal symptoms or liver function tests were 93% (100% for segmental, 83% for total) and 88% (35/40), respectively. The sensitivity and specificity were each 100% (15/15, 13

  17. Hepatic venous outflow reconstruction in adult right lobe living donor liver transplantation without middle hepatic vein

    Institute of Scientific and Technical Information of China (English)

    WU Hong; LU Qiang; CHEN Zhe-yu; MA Yu-kui; LI Jin; YANG Jia-yin; YAN Lü-nan; LI Bo; ZENG Yong; WEN Tian-fu; ZHAO Ji-chun; WANG Wen-tao; XU Ming-qing

    2007-01-01

    Background It is difficult and challenging to reconstruct hepatic venous outflow in adult right lobe living donor liver transplantation (LDLT) without the middle hepatic vein (MHV). Excessive perfusion of the portal vein and venous outflow obstruction will lead to acute congestion of the graft, ultimately resulting in primary nonfunction. Although various reconstruction patterns have been explored in many countries, there is currently no clear consensus. In this study we describe a technique to prevent "chocking" of the graft at the outflow anastomosis with the inferior vena cava (IVC) in LDLT using right lobe graft without the MHV.Methods A retrospective analysis was conducted on clinical data from 55 recipients undergoing LDLT using right lobe grafts without the MHV or reconstruction of hepatic venous outflow. The donor's right hepatic vein (RHV) was anastomosed with a triangular opening of the recipient IVC; the inferior right hepatic vein (IRHV), if large enough, was anastomosed directly to the IVC. The great saphenous vein (GSV) was used for reconstruction of significant MHV tributaries.Results No deaths occurred in any of the donors. Of the 55 recipients, complications occurred in 6, including hepaticvein stricture (1 case), small-for-size syndrome (1), hepatic artery thrombosis (1), intestinal bleeding (1), bile leakage (1),left subphrenic abscess and pulmonary infection (1). A total of three patients died, one from small-for-size syndrome and two from multiple system organ failure.Conclusions The multiple-opening vertical anastomosis was reconstructed with hepatic vein outflow. This technique alleviates surgical risk of living donors, ensures excellent venous drainage, and prevents vascular thromboses and primary nonfunction.

  18. Informed consent and decision-making about adult-to-adult living donor liver transplantation: a systematic review of empirical research.

    Science.gov (United States)

    Gordon, Elisa J; Daud, Amna; Caicedo, Juan Carlos; Cameron, Kenzie A; Jay, Colleen; Fryer, Jonathan; Beauvais, Nicole; Skaro, Anton; Baker, Talia

    2011-12-27

    Adult-to-adult living donor liver transplantation (LDLT) is a complex procedure that poses serious health risks to and provides no direct health benefit for the donor. Because of this uneven risk-benefit ratio, ensuring donor autonomy through informed consent is critical. To assess the current knowledge pertaining to informed consent for LDLT, we conducted a systematic review of the empirical literature on donors' decision-making process, comprehension about risks and outcomes, and information needs for LDLT. Of the 1423 identified articles, 24 met final review criteria, representing the perspective of approximately 2789 potential and actual donors. As donors' decisions to donate often occur before evaluation, they often make uninformed decisions. The review found that 88% to 95% of donors reported understanding information clinicians disclosed about risks and benefits. However, donors reported unmet information needs, knowledge gaps regarding risks, and unanticipated complications. Few donors reported feeling pressure to donate. Most studies were limited by cultural differences, small sample sizes, inconsistent measures, and poor methodological approaches. This systematic review suggests that informed consent for LDLT is sub-optimal as donors do not adequately appreciate disclosed information during the informed consent process, despite United Network for Organ Sharing/CMS regulations requiring formal psychological evaluation of donor candidates. Interventions are needed to improve donor-clinician communication during the LDLT informed consent process such as through the use of comprehension assessment tools and e-health educational tools that leverage adult learning theory to effectively convey LDLT outcome data. PMID:22143436

  19. Reconstruction of the middle hepatic vein tributary in adult right lobe living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Xiao-Min Shi; Yi-Feng Tao; Zhi-Ren Fu; Guo-Shan Ding; Zheng-Xin Wang; Liang Xiao

    2011-01-01

    BACKGROUND: In adult-to-adult living donor liver trans-plantation (LDLT), the use of a right lobe graft without the middle hepatic vein (MHV) can cause hepatic congestion and disturbance of venous drainage. To solve this problem, we successfully used cadaveric venous allografts preserved in 4 ℃ University of Wisconsin (UW) solution within 10 days as interposition veins for drainage of the paramedian portion of the right lobe in adult LDLT. METHODS: From June 2007 to January 2008, 11 adult LDLT patients received modified right liver grafts. The major MHV tributaries (greater than 5 mm in diameter) of 9 cases were preserved and reconstructed using cadaveric interposition vein allografts that had been stored for 1 to 10 days in 4 ℃ UW solution. The regeneration of the paramedian sector of the grafts and the patency of the interposition vein allografts were examined by Doppler ultrasonography after the operation. RESULTS: MHV tributaries were reconstructed in 9 recipients. Only 1 recipient died of renal failure and severe pulmonary infection on day 9 after transplantation without any hemiliver venous outflow obstruction. The other 8 recipients achieved long-term survival with a median follow-up of 30 months. The cumulative patency rates of the 8 recipients were 63.63% (7/11), 45.45% (5/11), 45.45% (5/11) and 36.36% (4/11) at 3, 6, 12 and 24 months, respectively. Regeneration of the paramedian sectors was equivalent. CONCLUSION: The cadaveric venous allograft preserved in 4 ℃ UW solution within 10 days serves as a useful alternative for interposition veins in facilitating implantation of a right lobe graft and guarantees outflow of the MHV.

  20. Live-donor nephrectomy.

    Science.gov (United States)

    Rocca, Juan P; Davis, Eric; Edye, Michael

    2012-01-01

    Six decades after its first implementation, kidney transplantation remains the optimal therapy for end-stage renal disease requiring dialysis. Despite the incontrovertible mortality reduction and cost-effectiveness of kidney transplantation, the greatest remaining barrier to treatment of end-stage renal disease is organ availability. Although the waiting list of patients who stand to benefit from kidney transplantation grows at a rate proportional to the overall population and proliferation of diabetes and hypertension, the pool of deceased-donor organs available for transplantation experiences minimal to no growth. Because the kidney is uniquely suited as a paired organ, the transplant community's answer to this shortage is living donation of a healthy volunteer's kidney to a recipient with end-stage renal disease. This review details the history and evolution of living-donor kidney transplantation in the United States as well as advances the next decade promises. Laparoscopic donor nephrectomy has overcome many of the obstacles to living donation in terms of donor morbidity and volunteerism. Known donor risks in terms of surgical and medical morbidity are reviewed, as well as the ongoing efforts to delineate and mitigate donor risk in the context of accumulating recipient morbidity while on the waiting list. PMID:22678857

  1. Preliminary experience in adult-to-adult living donor liver transplantation in a single center in China

    Institute of Scientific and Technical Information of China (English)

    YAN Lunan; CHEN Zheyu; LIU Jiangwen; WU Hong; LI Bo; ZENG Yong; WEN Tianfu; ZHAO Jichun; WANG Wentao; YANG Jiayin; XU Mingqing; MA Yukui

    2007-01-01

    The aim of this paper is to report the authors'experience in performing adult-to-adult living donor liver transplantation (LDLT)by using a modified technique in using grafts of the right lobe of the liver.From January 2002 to September 2006,56 adult patients underwent LDLT using right lobe grafts at the Wlest China Hospital.Sichuan University Medical School,China.All patients underwent a modified operation designed to improve the reconstruction of the right hepatic vein (RHV)and the tributariers of the middle hepatic vein(MHV)by interposing a vessel graft,and by anastomosing the hepatic arteries and bile ducts.There were no severe complications or deaths in all donors.Fifty-two (92.8%) recipients survived the operations.Among the 56 recipients,complications were seen in 15 recipients(26.8%),including hepatic vein stricture(one case),small-for-size syndrome(one case),hepatic artery thrombosis(two cases),intestinal bleeding (one case),bile leakage(two cases),left subphrenic abscess (one case),renal failure(two cases)and pulmonary infection (five cases).Within three months after transplantation,four recipients(7.1 4%)died due to smallfor-size syndrome(one case),renal failure(one case)and multiple organ failure(two cases).All patients underwent direct anastomoses of the RHV and the inferior vena cava (IVC),and in 23 cases,reconstruction of the right inferior hepatic vein was also done.In 24 patients,the reconstruction of the tributaries of the MHV was also done by interposing a vessel graft to provide sufficient venous outflow.Trifurcation of the portal vein was seen in nine cases.Thus,veno-plasty or separate anastomoses were performed.The graft and recipient body weight ratios(GRWR)were between 0.72%and 1.43%,and in three cases it was<0.8%.The graft weight to recipient standard liver volume ratios (GV/SLV) were between 31.86%and 71.68%.among which four cases had<40%.No "small-for-size syndrome"occurred.With modification of the surgical technique,especially in the

  2. Living Donor Liver Transplantation

    Science.gov (United States)

    ... What are Some Benefits of a Living-donor Liver Transplant? In the U.S., more than 17,500 patients ... 1,700 patients die each year while waiting. Liver transplants are given to patients on the basis of ...

  3. Liver graft regeneration in right lobe adult living donor liver transplantation.

    Science.gov (United States)

    Cheng, Y-F; Huang, T-L; Chen, T-Y; Tsang, L L-C; Ou, H-Y; Yu, C-Y; Concejero, A; Wang, C-C; Wang, S-H; Lin, T-S; Liu, Y-W; Yang, C-H; Yong, C-C; Chiu, K-W; Jawan, B; Eng, H-L; Chen, C-L

    2009-06-01

    Optimal portal flow is one of the essentials in adequate liver function, graft regeneration and outcome of the graft after right lobe adult living donor liver transplantation (ALDLT). The relations among factors that cause sufficient liver graft regeneration are still unclear. The aim of this study is to evaluate the potential predisposing factors that encourage liver graft regeneration after ALDLT. The study population consisted of right lobe ALDLT recipients from Chang Gung Memorial Hospital-Kaohsiung Medical Center, Taiwan. The records, preoperative images, postoperative Doppler ultrasound evaluation and computed tomography studies performed 6 months after transplant were reviewed. The volume of the graft 6 months after transplant divided by the standard liver volume was calculated as the regeneration ratio. The predisposing risk factors were compiled from statistical analyses and included age, recipient body weight, native liver disease, spleen size before transplant, patency of the hepatic venous graft, graft weight-to-recipient weight ratio (GRWR), posttransplant portal flow, vascular and biliary complications and rejection. One hundred forty-five recipients were enrolled in this study. The liver graft regeneration ratio was 91.2 +/- 12.6% (range, 58-151). The size of the spleen (p = 0.00015), total portal flow and GRWR (p = 0.005) were linearly correlated with the regeneration rate. Patency of the hepatic venous tributary reconstructed was positively correlated to graft regeneration and was statistically significant (p = 0.017). Splenic artery ligation was advantageous to promote liver regeneration in specific cases but splenectomy did not show any positive advantage. Spleen size is a major factor contributing to portal flow and may directly trigger regeneration after transplant. Control of sufficient portal flow and adequate hepatic outflow are important factors in graft regeneration.

  4. Risk factors and prevention of biliary anastomotic complications in adult living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Satoshi Yamamoto; Yoshinobu Sato; Hiroshi Oya; Hideki Nakatsuka; Takashi Kobayashi; Yoshiaki Hara; Takaoki Watanabe; Isao Kurosaki; Katsuyoshi Hatakeyama

    2007-01-01

    AIM: To evaluate risk factors of biliary anastomotic complications (BACs) and outcomes according to type of biliary reconstruction.METHODS: A total of 33 consecutive adult living donor liver transplantation (LDLF) were reviewed, 17 of which had undergone Duct-to-Duct anastomosis (D-D). The remaining16 patients received Roux-en-Y anastomosis (R-Y). The perioperative factors, such as the type of graft and the number of graft bile ducts, were analyzed retrospectively.RESULTS: The overall incidence of BACs was 39.4%.The incidence of BACs was significantly higher in the patients with than without neoadjuvant chemotherapy(71.4% vs 10%, P = 0.050). There was no significant difference in the incidence of biliary leakage in patients with D-D vs. those with R-Y. The incidence of biliary strictures following the healing of biliary leakage was significantly higher in D-D (60%) than in R-Y (0%)(P = 0.026). However, the incidence of BACs related bacteremia was significantly higher in R-Y than in D-D(71.4% vs 0%, P = 0.008). In D-D, use of T-tube stent remarkably reduced the incidence of BACs, compared with straight tube stent (0% vs 50%, P = 0.049).CONCLUSION: Our experience showed an increase of BACs related bacteremia in the patients with R-Y. Therefore, D-D might be a preferred biliary reconstruction. However, the surgical refinement of D-D should be required because of the high incidence of biliary strictures. Use of the T-tube stent might lead to a significant reduction of BACs in D-D.

  5. Changes in liver and spleen volumes after living liver donation: a report from the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL).

    Science.gov (United States)

    Emond, Jean C; Fisher, Robert A; Everson, Gregory; Samstein, Benjamin; Pomposelli, James J; Zhao, Binsheng; Forney, Sarah; Olthoff, Kim M; Baker, Talia B; Gillespie, Brenda W; Merion, Robert M

    2015-02-01

    Previous reports have drawn attention to persistently decreased platelet counts among liver donors. We hypothesized an etiologic association between altered platelet counts and postdonation splenomegaly and sought to explore this relationship. This study analyzed de-identified computed tomography/magnetic resonance scans of 388 donors from 9 Adult-to-Adult Living Donor Liver Transplantation Cohort Study centers read at a central computational image analysis laboratory. Resulting liver and spleen volumes were correlated with time-matched clinical laboratory values. Predonation liver volumes varied 2-fold in healthy subjects, even when they were normalized by the body surface area (BSA; range = 522-1887 cc/m(2) , n = 346). At month 3 (M3), postdonation liver volumes were, on average, 79% of predonation volumes [interquartile range (IQR) = 73%-86%, n = 165] and approached 88% at year 1 (Y1; IQR = 80%-93%, n = 75). The mean spleen volume before donation was 245 cc (n = 346). Spleen volumes greater than 100% of the predonation volume occurred in 92% of donors at M3 (n = 165) and in 88% at Y1 after donation (n = 75). We sought to develop a standard spleen volume (SSV) model to predict normal spleen volumes in donors before donation and found that decreased platelet counts, a younger age, a higher predonation liver volume, higher hemoglobin levels, and a higher BSA predicted a larger spleen volume (n = 344, R(2)  = 0.52). When this was applied to postdonation values, some large volumes were underpredicted by the SSV model. Models developed on the basis of the reduced sample of postdonation volumes yielded smaller underpredictions. These findings confirm previous observations of thrombocytopenia being associated with splenomegaly after donation. The results of the SSV model suggest that the biology of this phenomenon is complex. This merits further long-term mechanistic studies of liver donors with an investigation of the role of

  6. Changes in portal vein flow after adult living-donor liver transplantation: does it influence postoperative liver function?

    Science.gov (United States)

    García-Valdecasas, Juan C; Fuster, José; Charco, Ramon; Bombuy, Ernest; Fondevila, Constantino; Ferrer, Joana; Ayuso, Carmen; Taura, Pilar

    2003-06-01

    In adult living donor liver transplantation, using small grafts in cirrhotic patients with severe portal hypertension may have unpredictable consequences. The so-called small-for-size syndrome is present in most series worldwide. The goal of this study was to prospectively evaluate the influence of hemodynamic changes on postoperative liver function and on the percentage of liver volume increase, in the setting of living donor liver transplantation. Twenty-two consecutive adult living donor liver transplantations were performed at our institution in a 2-year period. We measured right portal flow and right hepatic arterial flow with an ultrasonic flow meter in the donor, and then in the recipient 1 hour after reperfusion. Postoperative liver function was measured by daily laboratory work. We also performed duplex ultrasounds on postoperative days 1, 2, and 7. Liver volume increase was estimated by magnetic resonance imaging graft volumetry at 2 months posttransplantation. We compared the blood flow results with the immediate liver function and its liver volume increase rate at 2 months. There was a significant increase in portal flow in the recipients compared with the donors (up to fourfold in some cases). Higher portal flow increase rates significantly correlated with faster prothrombin time normalization and faster liver volume increases. Median graft volume increase at 2 months was 44.9%. The increase in blood flow to the graft is well tolerated by the liver mass not affecting hepatocellular function as long as the graft-to body weight ratio is maintained (>0.8) and adequate outflow is provided. PMID:12783396

  7. Being a Living Donor: Risks

    Science.gov (United States)

    ... surgical risks and long term complications: Long-Term Organ Specific Donor Complications Kidney Hypertension Kidney failure Proteinuria Lung Intra- ... Vancouver Forum on the care of the live organ donor: lung, liver, pancreas, and intestine data and medical ...

  8. Bioethics of living donor liver transplantation

    OpenAIRE

    Chan, See-Ching; 陳詩正.

    2013-01-01

    Bioethics has been central to living donor liver transplantation (LDLT), which mandates a high recipient benefit and an acceptably low donor risk. The double equipoise imposes the contextual features of this already technically complex treatment. This research aimed at looking into key bioethical issues of LDLT in the light of the contemporary practice standards. In adult LDLT, in order to provide a partial graft of adequate size, donor right hepatectomy is often required. This procedure...

  9. Retroperitoneoscopic right living donor nephrectomy

    Institute of Scientific and Technical Information of China (English)

    GAO Zhen-li; WU Ji-tao; YANG Dian-dong; SHI Lei; MEN Chang-ping; WANG Lin

    2007-01-01

    @@ In the past, living donor nephrectomy required an open flank incision that results in postoperative morbidity and a prolonged hospital stay. Since its introduction in 1995, laparoscopic living donor nephrectomy has been shown to decrease postoperative pain and hospital stay,reduce blood loss, and improve cosmesis while hastening recovery of normal activities of donors.1 With decreased morbidity and favorable graft function, this procedure as a novel approach has been used to address the increasing disparity between organ need and availability.2 Better graft function and survival are noted in living-donor kidney transplantation than in cadaveric kidney transplantation. 1,2

  10. Downregulation of endothelin-1 by somatostatin improves liver function of recipients undergoing adult-to-adult living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    FENG Zhi-ying; XU Xiao; WU Ling-jiao; WU Jian; ZHU Sheng-mei; ZHENG Shu-sen

    2010-01-01

    Background The aim of this study was to investigate the possible effect of somatostatin on the liver function of recipients undergoing living donor liver transplantation.Methods Forty recipients were randomized into group A (n=20) and group B (n=20). Recipients in group A received no somatostatin whereas somatostatin was administrated for recipients in group B perioperatively. Liver function, the plasma concentration of endothelin-1 and nitric oxide, the intragraft expressions of endothelin-1 and inducible nitric oxide syntheses at 2 hours after declamping of the portal vein were compared between the two groups.Results Compared to group A, alanine transaminase values in group B were significantly reduced at 2 hours after portal vein declamping, at the end of the operation and postoperation day 1 (P <0.05), whereas aspartate aminotransferase values in group B decreased at 30 minutes after portal vein clamping, at 2 hours after portal vein declamping and at the end of the operation (P <0.05). Total bilirubin values in group B were reduced significantly at 2 hours after portal vein declamping and at the end of the operation when compared to group A (P <0.05). Intragraft expression of endothelin-1 was significantly downregulated at 2 hours after declamping of the portal vein accompanied with a reduction of plasma concentration of endothelin-1 in the peripheral blood (P <0.05).Conclusions Somatostatin had a protective effect on liver function during the early phase after declamping of portal vein for recipients undergoing living donor liver transplantation, and the possible mechanism might be partially attributed to the downregulation of endothelin-1.

  11. Recent advance in living donor liver transplantation.

    Science.gov (United States)

    Hashikura, Yasuhiko; Kawasaki, Seiji; Miyagawa, Shinichi; Terada, Masaru; Ikegami, Toshihiko; Nakazawa, Yuichi; Urata, Koichi; Chisuwa, Hisanao; Ogino, Shiro; Makuuchi, Masatoshi

    2002-02-01

    Living donor liver transplantation (LDLT)has been performed in more than 2000 cases around the world. This procedure is considered to have certain advantages over cadaveric liver transplantation, because detailed preoperative evaluation of the donor liver is possible and superior graft quality is available. The indication has recently been widened to include adult patients. The results of LDLT have been reported to be very good. In this article,several considerations on LDLT,including living donor selection and application to adult patients, are discussed. Between June 1990 and March 2001, 143 patients underwent LDLT at Shinshu University Hospital. During this period, 160 patients were determined to be candidates for liver transplantation in our institution, and 185 candidates were evaluated as potential donors for these patients. Thirty-eight of 185 donor candidates were excluded for reasons including liver dysfunction and withdrawal of consent. The recipients included 60 adults, 50 (83%) of whom are currently alive. Taking into account the worldwide shortage of cadaveric organ donation,the importance of LDLT will probably never diminish. This procedure should be established on the basis of profound consideration of donor safety as well as accumulated expertise of hepatobiliary surgery. PMID:11865355

  12. Living donor liver transplantation in Egypt.

    Science.gov (United States)

    Amer, Khaled E; Marwan, Ibrahim

    2016-04-01

    In Egypt there is no doubt that chronic liver diseases are a major health concern. Hepatitis C virus (HCV) prevalence among the 15-59 years age group is estimated to be 14.7%. The high prevalence of chronic liver diseases has led to increasing numbers of Egyptian patients suffering from end stage liver disease (ESLD), necessitating liver transplantation (LT). We reviewed the evolution of LT in Egypt and the current status. A single center was chosen as an example to review the survival and mortality rates. To date, deceased donor liver transplantation (DDLT) has not been implemented in any program though Egyptian Parliament approved the law in 2010. Living donor liver transplantation (LDLT) seemed to be the only logical choice to save many patients who are in desperate need for LT. By that time, there was increase in number of centers doing LDLT (13 centers) and increase in number of LDLT cases [2,400] with improvement of the results. Donor mortality rate is 1.66 per 1,000 donors; this comprised four donors in the Egyptian series. The exact recipient survival is not accurately known however, and the one-year, three-year and five-year survival were 73.17%, 70.83% and 64.16% respectively in the International Medical Center (IMC) in a series of 145 adult to adult living donor liver transplantation (AALDLT) cases. There was no donor mortality in this series. LDLT are now routinely and successfully performed in Egypt with reasonable donor and recipient outcomes. Organ shortage remains the biggest hurdle facing the increasing need for LT. Although LDLT had reasonable outcomes, it carries considerable risks to healthy donors. For example, it lacks cadaveric back up, and is not feasible for all patients. The initial success in LDLT should drive efforts to increase the people awareness about deceased organ donation in Egypt. PMID:27115003

  13. [Living donor transplantation. Surgical complications].

    Science.gov (United States)

    Karam, Georges

    2008-02-01

    Although nephrectomy by open surgery is the most used technique for the extraction of kidney transplants in the living donor, nephrectomy under laparaoscopy is increasingly practiced. Laparoscopic nephrectomy is less invasive and performed under videoscopy control, after insufflation of the peritoneal cavity. Three to four incisions are done in order to enter the surgical instruments. The kidney is extracted through a horizontal sus-pubic incision. The exposition is either exclusively transperitoneal, retroperitoneal or hand assisted. The advantages of laparoscopy are esthetical, financial due to a shorter hospitalisation and a quicker recovery, as well a confort for the donor. The disadvantages are a longer warm ischemia time and possibly a higher risk of delayed graft function. Randomised studies having compared laparoscopy and open surgery in the living donor have not find any significant difference regarding the per- and perioperative in the complications. PMID:18160357

  14. [Living donor transplantation. Surgical complications].

    Science.gov (United States)

    Karam, Georges

    2008-02-01

    Although nephrectomy by open surgery is the most used technique for the extraction of kidney transplants in the living donor, nephrectomy under laparaoscopy is increasingly practiced. Laparoscopic nephrectomy is less invasive and performed under videoscopy control, after insufflation of the peritoneal cavity. Three to four incisions are done in order to enter the surgical instruments. The kidney is extracted through a horizontal sus-pubic incision. The exposition is either exclusively transperitoneal, retroperitoneal or hand assisted. The advantages of laparoscopy are esthetical, financial due to a shorter hospitalisation and a quicker recovery, as well a confort for the donor. The disadvantages are a longer warm ischemia time and possibly a higher risk of delayed graft function. Randomised studies having compared laparoscopy and open surgery in the living donor have not find any significant difference regarding the per- and perioperative in the complications.

  15. Adult-to-adult right lobe living donor liver transplantation: Comparison of endoscopic retrograde cholangiography with standard T2-weighted magnetic resonance cholangiography for evaluation of donor biliary anatomy

    Institute of Scientific and Technical Information of China (English)

    Perdita Wietzke-Braun; Felix Braun; Dieter Müller; Thomas Lorf; Burckhardt Ringe; Giuliano Ramadori

    2006-01-01

    AIM: To compare the value of endoscopic retrograde cholangiography (ERC) and standard T2-weighted magnetic resonance cholangiography (MRC) in the evaluation process as adult-to-adult right lobe living donor liver transplantation (LDLTx) demands a successful outcome, and exact knowledge of the biliary tree is implicated to avoid biliary complications,postoperatively.METHODS: After starting the LDLTx program, 18 liver transplant candidates were selected for LDLTx by a stepwise evaluation process. ERC and standard T2-weighted MRC were performed to evaluate the biliary system of the donor liver. The anatomical findings of ERC and MRC mapping were compared usingthe Ohkubo classification.RESULTS: ERC allowed mapping of the whole biliary system in 15/15 (100%) cases, including 14/15 (93.3%)with biliary variants while routine MRC was only accurate in 2/13 (15.4%) cases. MRC was limited in depicting the biliary system proximal of the hepatic bifurcation.Postoperative biliary complications occurred in 2 donors and 8 recipients. Biliary complications were associated with Ohkubo type C, E or G in 6/8 recipients, and 2/3recipients with biliary leak received a graft with multiple (≥2) bile ducts.CONCLUSION: Pretransplant ERC is safe and superior over standard MRC for detection of biliary variations that occur with a high frequency. However, precise knowledge of biliary variants did not reduce the incidence of postoperative biliary complications.

  16. [Liver transplants from living donors].

    Science.gov (United States)

    Rogiers, X; Danninger, F; Malagó, M; Knoefel, W T; Gundlach, M; Bassas, A; Burdelski, M; Broelsch, C E

    1996-03-01

    In this article the authors discuss the advantages of Living Related Liver Transplantation (LRLT), criteria for the selection of donors and the standard operation technique. Among a total of 241 liver transplantation (LTx), 42 LRLT were performed at the University of Hamburg between October 1, 1991 and December 19, 1994. The body weight of recipients for LRLT ranged from 4,6 to 39 kg, with 64,2% having less than 10 kg. The volume of the donor left lateral liver lobe ranged from 100 cc to 350 cc. The average one year survival rate among electively operated patients-status 3-4 (UNOS 1995 classification) was 86.7%, two year survival rate 83.3%. The main advantages of LRLT are consired the following: 1. Absence of mortality on the waiting list, 2. Optimal timing of the transplantation (elective procedure, patient in a good condition), 3. Excellent organ (no primary non function), 4. A possible immunologic advantage, 5. Relief of the waiting list for cadaveric organs, 6. Psychological benefit for the family, 7. Cost effectiveness. Potential candidates for living donation with more than one cardiovascular risk factors were excluded. Social and psychological reasons leading to rejection of candidates were as follows: unstable family structure, expected professional or financial difficulties after living donation or withdrawal from consent. LRLT gives parents of a child with TLD a chance to avoid the risk of death on the waiting list or primary non function of the graft. LRLT has therefore established an important place in pediatric liver transplantation. PMID:8768973

  17. Initial experience in adult-to-adult living donor liver transplantation%成人活体肝移植的早期经验

    Institute of Scientific and Technical Information of China (English)

    董家鸿; 纪文斌; 段伟东; 史宪杰; 王彦斌; 冷建军; 王宏光; 黄志强

    2008-01-01

    目的 总结成人活体肝移植的早期经验,提高活体肝移植效果.方法 回顾性分析解放军总医院肝移植中心2006年6月至2008年2月31例成人活体肝移植资料.结果 31例中慢性乙型肝炎肝硬化失代偿期8例,急性肝功能衰竭7例,肝细胞肝癌12例,肝脏紫癜病2例,肝门部胆管癌1例和Wilson 病1例.含肝中静脉(middle hepatic vein,MHV)的右半肝移植25例,不含MHV的右半肝移植3例,双供肝为含MHV的右半肝+左外叶和含MHV的右半肝+左半肝各1例,左半肝辅助性原位肝移植1例.33例供者中5例发生并发症6例次.9例受者发生并发症11例次,其中胆道并发症4例,血管并发症3例,感染性并发症3例,切口延迟愈合1例.2例肺部感染和1例全身多处曲霉菌感染者死亡.结论 活体肝移植已成为拓展供肝来源的有效途径,合理的供、受者评估,手术方式和术后处理是关键.%Objective To summarize the initial experience in adult-to-adult living donor liver transplantation(ALDLT),so as to improve the efficacy of ALDLT.Methods The clinical data of 31 adult patients who undelwent ALDLT from June 2006 to February 2008 were retrospectively analyzed.Results Of all the patients,8 was with decompensated cirrhosis,7 with acute liver failure,12 with hepatocellular carcinoma,2 with purpura of liver,1 with hilar cholangiocarcinoma,and 1 with Wilson disease.The liver grafts included 25 right lobes with middle hepatic vein(MHV),3 right lobes without MHV,1 right lobe with MHV+left lateral lobe,1 right lobe with MHV+left lobe.The remaining 1 patient underwent auxiliary partial orthotopic liver transplantation with left lobe graft.Six post-transplantation complications occurred in 5 donors. Eleven post-transplantation complications occurred in 9 recipients,including 4 biliary complications,3 vascular complications,3 infection complications and 1 delayed healing of the incision.After ALDLT,2 recipients died of pulmonary infection and 1 of

  18. Renal Transplantation from Elderly Living Donors

    Directory of Open Access Journals (Sweden)

    Jacob A. Akoh

    2013-01-01

    Full Text Available Acceptance of elderly living kidney donors remains controversial due to the higher incidence of comorbidity and greater risk of postoperative complications. This is a review of publications in the English language between 2000 and 2013 about renal transplantation from elderly living donors to determine trends and effects of donation, and the outcomes of such transplantation. The last decade witnessed a 50% increase in living kidney donor transplants, with a disproportionate increase in donors >60 years. There is no accelerated loss of kidney function following donation, and the incidence of established renal failure (ERF and hypertension among donors is similar to that of the general population. The overall incidence of ERF in living donors is about 0.134 per 1000 years. Elderly donors require rigorous assessment and should have a predicted glomerular filtration rate of at least 37.5 mL/min/1.73 m2 at the age of 80. Though elderly donors had lower glomerular filtration rate before donation, proportionate decline after donation was similar in both young and elderly groups. The risks of delayed graft function, acute rejection, and graft failure in transplants from living donors >65 years are significantly higher than transplants from younger donors. A multicentred, long-term, and prospective database addressing the outcomes of kidneys from elderly living donors is recommended.

  19. Preoperative volume calculation of the hepatic venous draining areas with multi-detector row CT in adult living donor liver transplantation: impact on surgical procedure

    Energy Technology Data Exchange (ETDEWEB)

    Frericks, Bernd B.J. [Hanover Medical School, Departments of Radiology and Surgery, Hannover (Germany); University of Berlin, Department of Radiology, Berlin (Germany); Charite - University Medicine Berlin, Department of Radiology and Nuclear Medicine, Berlin (Germany); Kirchhoff, Timm D.; Shin, Hoen-Oh; Stamm, Georg; Merkesdal, Sonja; Abe, Takehiko; Galanski, Michael [Hanover Medical School, Departments of Radiology and Surgery, Hannover (Germany); Hanover Medical School, Department of Diagnostic Radiology, Hannover (Germany); Schenk, Andrea; Peitgen, Heinz-Otto [Hanover Medical School, Departments of Radiology and Surgery, Hannover (Germany); MeVis - Center for Medical Diagnostic Systems and Visualization, Bremen (Germany); Klempnauer, Juergen [Hanover Medical School, Departments of Radiology and Surgery, Hannover (Germany); Hanover Medical School, Department of Visceral- and Transplantation Surgery, Hannover (Germany); Nashan, Bjoern [Hanover Medical School, Departments of Radiology and Surgery, Hannover (Germany); Hanover Medical School, Department of Visceral- and Transplantation Surgery, Hannover (Germany); Dalhousie University, Multi Organ Transplant Program, Halifax, Nova Scotia (Canada)

    2006-12-15

    The purpose was to assess the volumes of the different hepatic territories and especially the drainage of the right paramedian sector in adult living donor liver transplantation (ALDLT). CT was performed in 40 potential donors of whom 28 underwent partial living donation. Data sets of all potential donors were postprocessed using dedicated software for segmentation, volumetric analysis and visualization of liver territories. During an initial period, volumes and shapes of liver parts were calculated based on the individual portal venous perfusion areas. After partial hepatic congestion occurring in three grafts, drainage territories with special regard to MHV tributaries from the right paramedian sector, and the IRHV were calculated additionally. Results were visualized three-dimensionally and compared to the intraoperative findings. Calculated graft volumes based on hepatic venous drainage and graft weights correlated significantly (r=0.86,P<0.001). Mean virtual graft volume was 930 ml and drained as follows: RHV: 680 ml, IRHV: 170 ml (n=11); segment 5 MHV tributaries: 100 ml (n=16); segment 8 MHV tributaries: 110 ml (n=20). When present, the mean aberrant venous drainage fraction of the right liver lobe was 28%. The evaluated protocol allowed a reliable calculation of the hepatic venous draining areas and led to a change in the hepatic venous reconstruction strategy at our institution. (orig.)

  20. Historical perspective of living donor liver transplantation

    OpenAIRE

    Chan, See Ching; Fan, Sheung Tat

    2008-01-01

    Living donor liver transplantation (LDLT) has gone through its formative years and established as a legitimate treatment when a deceased donor liver graft is not timely or simply not available at all. Nevertheless, LDLT is characterized by its technical complexity and ethical controversy. These are the consequences of a single organ having to serve two subjects, the donor and the recipient, instantaneously. The transplant community has a common ground on assuring donor safety while achieving ...

  1. Standardized surgical techniques for adult living donor liver transplantation using a modified right lobe graft: a video presentation from bench to reperfusion.

    Science.gov (United States)

    Hwang, Shin; Ha, Tae-Yong; Ahn, Chul-Soo; Moon, Deok-Bog; Kim, Ki-Hun; Song, Gi-Won; Jung, Dong-Hwan; Park, Gil-Chun; Lee, Sung-Gyu

    2016-08-01

    After having experienced more than 2,000 cases of adult living donor liver transplantation (LDLT), we established the concepts of right liver graft standardization. Right liver graft standardization intends to provide hemodynamics-based and regeneration-compliant reconstruction of vascular inflow and outflow. Right liver graft standardization consists of the following components: Right hepatic vein reconstruction includes a combination of caudal-side deep incision and patch venoplasty of the graft right hepatic vein to remove the acute angle between the graft right hepatic vein and the inferior vena cava; middle hepatic vein reconstruction includes interposition of a uniform-shaped conduit with large-sized homologous or prosthetic grafts; if the inferior right hepatic vein is present, its reconstruction includes funneling and unification venoplasty for multiple short hepatic veins; if donor portal vein anomaly is present, its reconstruction includes conjoined unification venoplasty for two or more portal vein orifices. This video clip that shows the surgical technique from bench to reperfusion was a case presentation of adult LDLT using a modified right liver graft from the patient's son. Our intention behind proposing the concept of right liver graft standardization is that it can be universally applicable and may guarantee nearly the same outcomes regardless of the surgeon's experience. We believe that this reconstruction model would be primarily applied to a majority of adult LDLT cases.

  2. Standardized surgical techniques for adult living donor liver transplantation using a modified right lobe graft: a video presentation from bench to reperfusion.

    Science.gov (United States)

    Hwang, Shin; Ha, Tae-Yong; Ahn, Chul-Soo; Moon, Deok-Bog; Kim, Ki-Hun; Song, Gi-Won; Jung, Dong-Hwan; Park, Gil-Chun; Lee, Sung-Gyu

    2016-08-01

    After having experienced more than 2,000 cases of adult living donor liver transplantation (LDLT), we established the concepts of right liver graft standardization. Right liver graft standardization intends to provide hemodynamics-based and regeneration-compliant reconstruction of vascular inflow and outflow. Right liver graft standardization consists of the following components: Right hepatic vein reconstruction includes a combination of caudal-side deep incision and patch venoplasty of the graft right hepatic vein to remove the acute angle between the graft right hepatic vein and the inferior vena cava; middle hepatic vein reconstruction includes interposition of a uniform-shaped conduit with large-sized homologous or prosthetic grafts; if the inferior right hepatic vein is present, its reconstruction includes funneling and unification venoplasty for multiple short hepatic veins; if donor portal vein anomaly is present, its reconstruction includes conjoined unification venoplasty for two or more portal vein orifices. This video clip that shows the surgical technique from bench to reperfusion was a case presentation of adult LDLT using a modified right liver graft from the patient's son. Our intention behind proposing the concept of right liver graft standardization is that it can be universally applicable and may guarantee nearly the same outcomes regardless of the surgeon's experience. We believe that this reconstruction model would be primarily applied to a majority of adult LDLT cases. PMID:27621745

  3. [Kidney transplant from living donors in children?].

    Science.gov (United States)

    Ginevri, Fabrizio; Dello Strologo, Luca; Guzzo, Isabella; Belingheri, Mirco; Ghio, Luciana

    2011-01-01

    A living-donor kidney transplant offers a child at the terminal stages of renal disease better functional recovery and quality of life than an organ from a deceased donor. Before starting the procedure for a living-donor transplant, however, it is necessary to establish if it is really safe. There are diseases, such as focal segmental glomerulosclerosis, atypical HUS and membranoproliferative glomerulonephritis with dense deposits, for which living donation is not recommended given the high incidence of recurrence of the disease but also the frequent loss of the graft. Regarding the selection of the donor, an increased risk of acute rejection has been reported for donors older than 60-65 years and a worsening of the renal outcome if the donor's weight is equal to or less than the recipient's. Finally, it is necessary to take into consideration that complications may arise in the donor both in the perioperative period and in the long term. In conclusion, kidney transplant from a living donor is a natural choice within the pediatric setting. The parents, usually young and highly motivated to donate, are the ideal donors. However, although the risks associated with donation are minimal, they are not totally absent, and consequently it is mandatory to follow standardized procedures according to the guidelines issued by the Centro Nazionale Trapianti. PMID:21341241

  4. Living-donor liver transplantation: current perspective.

    Science.gov (United States)

    Lobritto, Steven; Kato, Tomoaki; Emond, Jean

    2012-11-01

    The disparity between the number of available deceased liver donors and the number of patients awaiting transplantation continues to be an ongoing issue predisposing to death on the liver transplant waiting list. Deceased donor shortage strategies including the use of extended donor-criteria deceased donor grafts, split liver transplants, and organs harvested after cardiac death have fallen short of organ demand. Efforts to raise donor awareness are ongoing, but the course has been arduous to date. Living donor transplantation is a means to access an unlimited donor organ supply and offers potential advantages to deceased donation. Donor safety remains paramount demanding improvements and innovations in both the donor and recipient operations to ensure superior outcomes. The specialty operation is best preformed at centers with specific expertise and shuttling of select patients to these centers supported by third party payers is critical. Training future surgeons at centers with this specific experience can help disseminate this technology to improve local availability. Ongoing research in immunosuppression minimization, withdrawal and tolerance induction may make living donation a desired first-line operation rather than a necessary albeit less-desirable option. This chapter summarizes the progress of living liver donation and its potential applications. PMID:23397534

  5. Historical perspective of living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    See Ching Chan; Sheung Tat Fan

    2008-01-01

    Living donor liver transplantation (LDLT) has gone through its formative years and established as a legitimate treatment when a deceased donor liver graft is not timely or simply not available at all. Nevertheless,LDLT is characterized by its technical complexity and ethical controversy. These are the consequences of a single organ having to serve two subjects, the donor and the recipient, instantaneously. The transplant community has a common ground on assuring donor safety while achieving predictable recipient success. With this background, a reflection of the development of LDLT may be appropriate to direct future research and patient- care efforts on this life-saving treatment alternative.

  6. Hypophosphatemia after Right Hepatectomy for Living Donor Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Kelly W Burak

    2004-01-01

    Full Text Available Hypophosphatemia has been described in patients undergoing right hepatectomy for liver cancer and in living donors for liver transplantation who also received total parenteral nutrition. At the study centre, significant hypophosphatemia (0.36 mmol/L or less requiring intravenous replacement was seen in two of the first nine living donors for adult-to-adult liver transplantation. To determine the frequency of hypophosphatemia in living donors, the authors obtained phosphate levels on stored serum samples from postoperative days 0, 1, 3 and 7 in all nine patients, none of whom were on total parenteral nutrition. Within the first week, hypophosphatemia developed in 55.6% of patients and phosphate levels returned to normal by day 7 in all nine patients. One patient had normal phosphate levels during the first week, but had profound hypophosphatemia (0.32 mmol/L on day 14 when he presented with a Staphylococcus aureus infection of a bile collection and significant hypoxemia. The extent of hepatectomy and the rate of liver regeneration, estimated by baseline and postoperative day 7 volumetric computed tomography scans, did not correlate with the development of hypophosphatemia. In conclusion, hypophosphatemia is common in living donors undergoing right hepatectomy and may be associated with complications. All living donors should be monitored for the development of hypophosphatemia during the first two postoperative weeks.

  7. The value of living donor liver transplantation.

    Science.gov (United States)

    Yang, Xiaoli; Gong, Junhua; Gong, JianPing

    2012-12-31

    Living donor liver transplantation (LDLT) is a very successful procedure that develops liver resources in case of worldwide shortages. As the technology has developed so much in the past 2 decades, LDLT has the same good prognosis as DDLT. However, LDLT still has lots of ethical & technical problems. It causes great psychiatric, physical and psychosocial harm to donors. Also, it has some negative effects on society by providing a platform for organ trade. Therefore, there is much controversy about the social value of LDLT. After review of recent papers, we find much progress can be made in inspiring the public to become organ donors and creating donation model new to improve the consent rate for solid organ donation from deceased donors. That is the key strategy for increasing the liver supply. With this serious shortage of organs, liver donor transplantation still has its advantages, but we should not place all our hopes on LDLT to increase the liver supply. We all need to try our best to increase donor awareness and promote organ donor registration--when cadaver organs could meet the needs for liver transplantation, living donor liver transplants would not be necessary. PMID:23274332

  8. Dilemma over live-donor transplantation

    OpenAIRE

    Garwood, Paul

    2007-01-01

    Organ transplants save thousands of lives each year, but put many live donors at risk due to an unregulated organ trade that exploits the vulnerable in developing countries and complicates legitimate organ donation efforts. Countries face a dilemma: how they can increase the supply of organs in a manner that is ethical and humane.

  9. Successful living donor liver transplant in a very small child

    OpenAIRE

    Vijay Kumar; Raman Raina

    2010-01-01

    Liver transplantation in small children poses perioperative challenges that are different from those seen in adults. We present our successful anaesthetic experience in a 7-month-old infant who has been the youngest case of successful living donor liver transplant performed in our institution till the day this article was being prepared.

  10. Measures for increasing the safety of donors in living donor liver transplantation using right lobe grafts

    Institute of Scientific and Technical Information of China (English)

    Tian-Fu Wen; Ming-Qing Xu; Jiang-Wen Liu; Zhi-Gang Deng; Hong Wu; Zhe-Yu Chen; Lu-Nan Yan; Bo Li; Yong Zeng; Ji-Chun Zhao; Wen-Tao Wang; Jia-Yin Yang; Yu-Kui Ma

    2007-01-01

    BACKGROUND:The safety of donors in living donor liver transplantation (LDLT) should be the primary consideration. The aim of this study was to report our experience in increasing the safety of donors in LDLTs using right lobe grafts. METHODS:We retrospectively studied 37 living donors of right lobe grafts from January 2002 to March 2006. The measures for increasing the safety of donors in LDLT included carefully selected donors, preoperative evaluation by ultrasonography, angiography and computed tomography; and necessary intraoperative cholangiography and ultrasonography. Right lobe grafts were obtained using an ultrasonic dissector without inlfow vascular occlusion on the right side of the middle hepatic vein. The standard liver volume and the ratio of left lobe volume to standard liver volume were calculated. RESULTS:There was no donor mortality in our group. Postoperative complications only included bile leakage (1 donor), biliary stricture (1) and portal vein thrombosis (1). All donors recovered well and resumed their previous occupations. In recipients, complications included acute rejection (2 patients), hepatic artery thrombosis (1), bile leakage (1), intestinal bleeding (1), left subphrenic abscess (1) and pulmonary infection (1). The mortality rate of recipients was 5.4% (2/37); one recipient with pulmonary infection died from multiple organ failure and another from occurrence of primary disease. CONCLUSIONS:The ifrst consideration in adult-to-adult LDLT is the safety of donors. The donation of a right lobe graft is safe for adults if the remnant hepatic vasculature and bile duct are ensured, and the volume of the remnant liver exceeds 35% of the total liver volume.

  11. Living donor transplant: wider selection criteria.

    Science.gov (United States)

    Splendiani, G; Cipriani, S; Valeri, M; Torlone, N; Vega, A; Tullio, T; Condò, S; Dominijanni, S; Casciani, C U

    2004-04-01

    The availability of cadaveric donor organs is insufficient for actual needs. The organ demand increases by 20% per year. Living donor transplant (LDT) may be a valid therapeutical alternative provided one uses proper criteria. LDT provides many advantages, like improved patient and organ survival, short waiting time, and the possibility to carefully plan the procedure. Potential risks include perioperative mortality and renal dysfunction in the kidney donor. At present, kidney LDTs in Italy represent 8% of the total, with an organ survival rate of 97% after 1 year (vs 93% for cadaveric transplants) and donors mortality rate of almost null. Most LDTs are performed from kinsmen. Presently, law no. 458, 26 June 1967, is in force in Italy for kidney LDT and law no. 453, 16 December 1999, for liver LDT. The foundations of LDT are, of course, the recipient's condition, the donor's motivation, and the altruism of the donation. It is desirable that in the future an increasing number of LDT be performed, supported by a careful, widespread health education regarding organ donation from living subjects and by the possibility to obtain insurance for the donor, which has been considered but never provided by actual laws. PMID:15110560

  12. Living donor liver transplantation in the USA.

    Science.gov (United States)

    Kim, Peter T W; Testa, Giuliano

    2016-04-01

    Living donor liver transplant (LDLT) accounts for a small volume of the transplants in the USA. Due to the current liver allocation system based on the model for end-stage liver disease (MELD), LDLT has a unique role in providing life-saving transplantation for patients with low MELD scores and significant complications from portal hypertension, as well as select patients with hepatocellular carcinoma (HCC). Donor safety is paramount and has been a topic of much discussion in the transplant community as well as the general media. The donor risk appears to be low overall, with a favorable long-term quality of life. The latest trend has been a gradual shift from right-lobe grafts to left-lobe grafts to reduce donor risk, provided that the left lobe can provide adequate liver volume for the recipient. PMID:27115007

  13. Donor-Specific HLA Antibodies in Living Versus Deceased Donor Liver Transplant Recipients.

    Science.gov (United States)

    Levitsky, J; Kaneku, H; Jie, C; Walsh, R C; Abecassis, M; Tambur, A R

    2016-08-01

    With less ischemia, improved donor selection and controlled procedures, living donor liver transplantation (LDLT) might lead to less HLA donor-specific antibody (DSA) formation or fewer adverse outcomes than deceased donor liver transplantation (DDLT). Using the multicenter A2ALL (Adult-to-Adult Living Donor Liver Transplantation Cohort Study) biorepository, we compared the incidence and outcomes of preformed and de novo DSAs between LDLT and DDLT. In total, 129 LDLT and 66 DDLT recipients were identified as having serial samples. The prevalence of preformed and de novo DSAs was not different between DDLT and LDLT recipients (p = 0.93). There was no association between patient survival and the timing (preformed vs. de novo), class (I vs. II) and relative levels of DSA between the groups; however, preformed DSA was associated with higher graft failure only in DDLT recipients (p = 0.01). De novo DSA was associated with graft failure regardless of liver transplant type (p = 0.005) but with rejection only in DDLT (p = 0.0001). On multivariate analysis, DSA was an independent risk factor for graft failure regardless of liver transplant type (p = 0.017, preformed; p = 0.002, de novo). In conclusion, although similar in prevalence, DSA may have more impact in DDLT than LDLT recipients. Although our findings need further validation, future research should more robustly test the effect of donor type and strategies to mitigate the impact of DSA. PMID:26896194

  14. The Dutch Living Donor Kidney Exchange Program

    NARCIS (Netherlands)

    M. de Klerk (Marry)

    2010-01-01

    textabstractKidney transplantation is the optimal option for patients with an end-stage renal disease. The first successful transplantation with a living genetically related donor has been performed since 26 October 1954, when an identical twin transplant was performed in Boston. In the years that f

  15. Evaluation of the medically complex living kidney donor.

    Science.gov (United States)

    Caliskan, Yasar; Yildiz, Alaattin

    2012-01-01

    Due to organ shortage and difficulties for availability of cadaveric donors, living donor transplantation is an important choice for having allograft. Live donor surgery is elective and easier to organize prior to starting dialysis thereby permitting preemptive transplantation as compared to cadaveric transplantation. Because of superior results with living kidney transplantation, efforts including the usage of "Medically complex living donors" are made to increase the availability of organs for donation. The term "Complex living donor" is probably preferred for all suboptimal donors where decision-making is a problem due to lack of sound medical data or consensus guidelines. Donors with advanced age, obesity, asymptomatic microhematuria, proteinuria, hypertension, renal stone disease, history of malignancy and with chronic viral infections consist of this complex living donors. This medical complex living donors requires careful evaluation for future renal risk. In this review we would like to present the major issues in the evaluation process of medically complex living kidney donor. PMID:22655169

  16. Are live kidney donors at risk

    International Nuclear Information System (INIS)

    Objective: To share experience of live donor nephrectomy (including intraoperative variables, morbidity and ethical aspects) and to give an overview of surgical technique being practiced. Results: Majority of the donors (58.5%) were 31-50 years old and 70.6% were first-degree relatives. Left sided kidney was taken in 96.5% cases. Mean operative time was 145 minutes. Mean renal warm ischemia time from cross clamping of renal vessels to cold perfusion on the bench was 1.5 minutes per operation. Operative complications encountered were injury to lumbar veins in 5.1 % cases, slipping of satinsky clamp on vena cava stump in 1.7 % and accidental pleural damage in 5.1 % cases. Postoperative morbid complications found were urinary retention in 6.4 % cases, epididymo-orchitis in 1.7 %, prolonged lymph drain in 3.4 %, stitch infection in 1.7 % and prolonged wound discomfort in 5.1 % patients. Conclusions: Open live donor nepherectomy appears to be safe procedure for harvesting kidney. Related or emotionally related donors must be the choice in all cases. Non-related donors may be entertained in selected cases despite the probability of organ vending in our society. (author)

  17. Systemic Heparinisation in Laparoscopic Live Donor Nephrectomy

    Directory of Open Access Journals (Sweden)

    Charlotte Crotty

    2013-01-01

    Full Text Available Introduction. Systemic heparinisation is advocated during laparoscopic live donor nephrectomy (LDN as a preventative measure against renal vascular thrombosis during the warm ischaemic interval. This study compares the outcome with and without the administration of systemic heparinisation. Methods. A retrospective analysis was performed on 186 consecutive LDN patients between April 2008 and November 2012. Systemic heparin (2000–3000 IU was administered intravenously to donors (hep n=109. From January 2010, heparin was not used systemically in this group of LDN (no hep n=77. Outcome measures included donor and recipient complications, initial graft function, and 12 month graft survival. Results. The demographics of both heparinised and non-heparinised donors were similar. The warm ischaemic time (WIT was comparable in both groups (WIT; hep 5±3 versus no hep 5±3 minutes; P=1.000. There was no difference in complication rates, no episodes of graft thrombosis, and no incidences of primary nonfunction in either group. Delayed graft function occurred in 4/109 and 1/77 (3.6% versus 1.2%; P=0.405 and there was no significant difference in graft survival (P=0.650. Conclusion. Omitting systemic heparinisation during laparoscopic donor nephrectomy is a feasible and safe approach that does not compromise donor or recipient outcome.

  18. 儿童活体肝移植42例临床报告%Adult-to-children living donor liver transplantation: a report of 42 cases

    Institute of Scientific and Technical Information of China (English)

    唐丹; 邓玉华; 张明满; 严律南; 李英存; 戴小科; 蒲从伦; 康权; 郭春宝; 任志美

    2010-01-01

    目的 总结成人活体部分供肝儿童肝移植的临床疗效和经验.方法 42例儿童患者,年龄80 d至14岁.小于1岁者28例;体重3.08~45 kg,小于10kg者27例.移植前有不同程度的黄疸、腹水、营养不良和肝功能严重损害.其中父母供肝36例,祖母供肝4例.舅父和表兄供肝各1例.供肝类型包括:左外叶31例.Ⅱ段肝组织1例,左半肝8例.右半肝2例.对供肝的肝静脉、肝动脉和受者的肝动脉、肝静脉、门静脉进行成形.以便吻合;供肝动脉较短者,以供者大隐静脉搭桥.免疫抑制方案:采用环孢素A(CsA)+糖皮质激素21例,CsA+吗替麦考酚酯(MMF)+糖皮质激素8例,他克莫司(Tac)+糖皮质激素7例,Tac+MMF+糖皮质激素6例.术后随访时问2~43个月.结果 移植物与受者质量比为0.91%~5.71%,移植物与受者标准肝体积比为40.7%~137.1%.术后早期32例(76.2%,32/42)出现并发症,死亡5例,其中4例死于血管并发症;随访期9例出现并发症,死亡4例,其中3例死于血管并发症;意外死亡2例.其余31例(73.8%,31/42)健康存活.结论 成人活体部分供肝儿童肝移植是治疗儿童终末期肝病的有效方法,术后血管并发症是主要的死亡原因.预防和治疗血管并发症能明显提高手术成功率.%Objective To present our clinical outcomes of adult-to-children living donor liver transplantation(A-CLDLT) and summarize our experience. Methods The clinical data, preoperative assessment, surgical strategies and complications of 42 adult donors and children recipients who underwent A-CLDLT from April 2006 to December 2009 in Children's Hospital of Chongqing Medical University were retrospectively analyzed. These 42 recipients (21 boys and 21 girls) aged from 80 days to 14 years whose body weight at the time of operation was 3. 08 to 45. 00 kg. In all the children recipients, 28 cases suffered biliary atresia, 6 Wilson' s diseases, 4 glycogen storage diseases, 3 cavernous transformation of the

  19. Living-donor kidney transplantation: a review of the current practices for the live donor.

    Science.gov (United States)

    Davis, Connie L; Delmonico, Francis L

    2005-07-01

    The first successful living-donor kidney transplant was performed 50 yr ago. Since then, in a relatively brief period of medical history, living kidney transplantation has become the preferred treatment for those with ESRD. Organ replacement from either a live or a deceased donor is preferable to dialysis therapy because transplantation provides a better quality of life and improved survival. The advantages of live versus deceased donor transplantation now are readily apparent as it affords earlier transplantation and the best long-term survival. Live kidney donation has also been fostered by the technical advance of laparoscopic nephrectomy and immunologic maneuvers that can overcome biologic obstacles such as HLA disparity and ABO or cross-match incompatibility. Congressional legislation has provided an important model to remove financial disincentives to being a live donor. Federal employees now are afforded paid leave and coverage for travel expenses. Candidates for renal transplantation are aware of these developments, and they have become less hesitant to ask family members, spouses, or friends to become live kidney donors. Living donation as practiced for the past 50 yr has been safe with minimal immediate and long-term risk for the donor. However, the future experience may not be the same as our society is becoming increasingly obese and developing associated health problems. In this environment, predicting medical futures is less precise than in the past. Even so, isolated abnormalities such as obesity and in some instances hypertension are no longer considered absolute contraindications to donation. These and other medical risks bring additional responsibility in such circumstances to track the unknown consequences of a live-donor nephrectomy. PMID:15930096

  20. Living Donor Hepatectomy: Is it Safe?

    Science.gov (United States)

    Weiss, Anna; Tapia, Viridiana; Parina, Ralitza; Berumen, Jennifer; Hemming, Alan; Mekeel, Kristin

    2015-10-01

    Living donor hepatectomy (LDH) is high risk to a healthy donor and remains controversial. Living donor nephrectomy (LDN), conversely, is a common practice. The objective is to examine the outcomes of LDH and compare this risk profile to LDN. The Nationwide Inpatient Sample was queried for hepatectomies and nephrectomies from 1998 to 2011. LDH or LDN were identified by donor ICD-9 codes. Outcomes included in-hospital mortality and complications. Bivariate analysis compared nondonor hepatectomy or nondonor nephrectomy (NDN). Multivariate analyses adjusted for baseline organ disease, malignancy, or benign lesions. There were 430 LDH and 9211 nondonor hepatectomy. In-hospital mortality was 0 and 6 per cent, respectively (P LDN and 117,966 NDN. Mortality rates were 0.8 per cent LDN and 1.8 per cent NDN (P LDN had fewer complications [OR 0.06 (0.05-0.08)] and better survival [OR 0.32 (0.18-0.58)]. Complication rates were higher in LDH than LDN (4% vs 1%, P LDN. PMID:26463316

  1. 成人活体肝移植胆道并发症的防治%Prevention and treatment of biliary tract complications following adult living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    夏天; 马玉奎; 陈哲宇; 吴鸿; 严律南; 李波; 曾勇; 文天夫; 赵继春; 王文涛; 杨家印; 徐明清

    2008-01-01

    Objective To investigate the prevention and treatment of biliary tract complications following adult-adult living donor liver transplantation (A-A LDLT). Methods One hundred and eight patients, aged 38 (18 -63), underwent A-A LDLT, including transplantation of the right liver graft without middle hepatic vein (MHV) in 102 cases and dual graft transplantation in 6 cases (of left lobe from relative in 1 case, of right lobe + left lobe from relative in 3 cases, of right lobe from relative + cadaveric left lobe in 2 cases). Preoperative 3-dimensional computerized tomography (3D CT) and intra-operafive cholangiography were employed to reveal the state of the liver, caution was exercised to protect the peripheral vasculature of the right hepatic duct during resection. The bile duct was reconstructed by duct-to-duct (D-D) biliary anastomosis or Roux-en-Y anastomosis of the hepatic duct and jejunum (H-J). Results Twenty-four of the 108 patients (22. 2%) suffered from complications, including bile leakage (n = 4), cutting surface bile leakage (n = 1), and anastomotic biliary stricture (n=3), etc. Seven donors (6. 3%) suffered from complications too, including 2 cases of bile leakage from the remnant cut surface. All the biliary tract complications were properly managed with good outcomes, except for 1 case of recipient death. Conclusion Measures such as improvement of pre- and intra-surgical examinations and assessments, choice of appropriate approach of biliary tract reconstruction, employment of subtle operations of microscopic procedures, and timely detection and management of complications may reduce the incidence and mortality of biliary tract complications following A-A LDLT.%目的 探讨成人活体肝移植胆道并发症的防治策略.方法 回顾性分析2002年1月至2007年8月间108例成人活体肝移植胆道并发症的发生与处理,其中102例为不含肝中静脉(MHV)右半肝移植,6例双供肝移植(双亲属左半肝1

  2. Donor safety and remnant liver volume in living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Zheng-Rong Shi; Lu-Nan Yan; Cheng-You Du

    2012-01-01

    AIM:To evaluate the relationship between donor safety and remnant liver volume in right lobe living donor liver transplantation (LDLT).METHODS:From July 2001 to January 2009,our liver transplant centers carried out 197 LDLTs.The clinical data from 151 cases of adult right lobe living donors (not including the middle hepatic vein) were analyzed.The conditions of the three groups of donors were well matched in terms of the studied parameters.The donors' preoperative data,intraoperative and postoperative data were calculated for the three groups:Group 1 remnant liver volume (RLV) < 35%,group 2 RLV 36%-40%,and group 3 RLV > 40%.Comparisons included the different remnant liver volumes on postoperative liver function recovery and the impact of systemic conditions.Correlations between remnant liver volume and post-operative complications were also analyzed.RESULTS:The donors' anthroposomatology data,operation time,and preoperative donor blood test indicators were calculated for the three groups.No significant differences were observed between the donors' gender,age,height,weight,and operation time.According to the Chengdu standard liver volume formula,the total liver volume of group 1 was 1072.88 ± 131.06 mL,group 2 was 1043.84 ± 97.11 mL,and group 3 was 1065.33 ± 136.02 mL.The three groups showed no statistically significant differences.When the volume of the remnant liver was less than 35% of the total liver volume,the volume of the remnant had a significant effect on the recovery of liver function and intensive care unit time.In addition,the occurrence of complications was closely related to the remnant liver volume.When the volume of the remnant liver was more than 35% of the total liver volume,the remnant volume change had no significant effect on donor recovery.CONCLUSION:To ensure donor safety,the remnant liver volume should be greater than the standard liver volume (35%) in right lobe living donor liver transplantation.

  3. Exclusion Reasons of Living Kidney Donor Candidates: A Single-Center Experience

    Directory of Open Access Journals (Sweden)

    Ayşegül ORUÇ

    2014-05-01

    Full Text Available OBJECTIVE: Due to severe organ shortage, living kidney donors are important choices for transplantation. In Muslim countries, such as Turkey, living kidney donors are the main source of donor pool. In the literature, reasons for living donor exclusion are reported from several countries. However, there is no published study that focused on exclusion reasons of donor candidates in Turkey where living kidney transplantation rate is 73.4%. The goal of this retrospective study was to examine the exclusion reasons for donation among living kidney donor candidates at a single center in Turkey. MATERIAL and METHODS: A total 538 adults were evaluated as a living kidney donor candidate between December 1988 and January 2012. Evaluation outcome, exclusion reasons and demographic data were examined from electronic file system and immunology laboratory records. RESULTS: In this period 451 kidney transplantations (38.6% cadaveric, 61.4% living donor was performed. Overall 261 (48.5% donor candidates who underwent evaluation could not donate. We were able to find the precise cause of exclusion of 86 donors (33%. Among excluded donor candidates the most common exclusion reason was medical causes (64% such as diabetes mellitus, low glomerular filtration rate and hypertension. CONCLUSION: Our study suggests that medical causes are significant exclusion reasons for living kidney donation at our center.

  4. 成人间活体供肝移植中供肝的肝中静脉分配%Middle hepatic vein management in adult-to-adult living donor hepatectomy

    Institute of Scientific and Technical Information of China (English)

    张雅敏; 沈中阳; 朱志军; 蒋文涛; 侯建存; 蔡金贞; 淮明生; 魏林; 张海明; 王金山

    2009-01-01

    Objective To evaluate the donor safety and clinical outcomes in adult-to-adult living donor hepatectomy with or without middle hepatic vein.Methods From June 2007 to September 2008,78 consecutive cases of living donor hepatectomy were performed by the same surgical team.Seventy-six candidates donated their right lobe liver after thorough donor assessment and precise evaluation of blood vascular and biliary anatomy,and their middle hepatic vein was harvested.Donor demographic data,operative data and liver function after operation were compared.Results Donor remnant liver volume to total liver volume ratio which was calculated by computed tomography was 29.40%~50.99%,and graft weight to recipient body weight ratio was between 0.74 to 1.76.There was no significant difference in donor age,body mass index,operative time,blood loss and transfusion volume,abdominal drainage time and donor recipient survival rate between the middle hepatic vein-harvested group and non-middle hepatic vein-harvested group,and also the peak value of ALT,AST,T-bilirubin and D-bilirubin after operation.There was significant difference in graft weight.actual graft weight to recipient body weight ratio,graft cold preservation time,and the percentage of cases in which the donor's body weight was lower than the recipient's between the middle hepatic vein-harvested group and non-middle hepatic vein-harvested group.Conclusion It was safe to perform right lobe living donor hepatectomy with or without middle hepatic vein after thorough donor assessment and precise evaluation,and the clinical outcome was satisfactory.%目的 探讨成人间活体供肝移植中切取供者右半供肝(含或不含肝中静脉)的安全性及临床效果.方法 2007年6月至2008年9月,单小组实施成人间活体供肝切取手术78例;76例行右半供肝移植,其中供肝含肝中静脉30例(含肝中静脉组),不含肝中静脉46例(不含肝中静脉组).对两组供者的基本资料、手术相关资料以

  5. Exploring the Mental Health of Living Kidney Donors

    NARCIS (Netherlands)

    L. Timmerman (Lotte)

    2015-01-01

    markdownabstractAbstract Living donor kidney transplantation is the best option for extending and improving the lives of patients with end-stage renal disease. The benefits for the donor are less straightforward: a donor is a healthy person who undergoes a surgery in the first place for the benef

  6. Evaluation of the Medically Complex Living Kidney Donor

    OpenAIRE

    Yasar Caliskan; Alaattin Yildiz

    2012-01-01

    Due to organ shortage and difficulties for availability of cadaveric donors, living donor transplantation is an important choice for having allograft. Live donor surgery is elective and easier to organize prior to starting dialysis thereby permitting preemptive transplantation as compared to cadaveric transplantation. Because of superior results with living kidney transplantation, efforts including the usage of “Medically complex living donors” are made to increase the availability of organs ...

  7. Effect of donor GFR on early renal function of recipients with living donor transplantation

    Institute of Scientific and Technical Information of China (English)

    侯敬财

    2012-01-01

    Objective To study the influence of donor GFR on the early renal function in recipients undergoing living donor transplantation. Methods A total of 172 living donor transplant recipients in our kidney transplantation center from 2006 to 2011 were enrolled into this study. Among them,166 were genetically related

  8. Late-onset acute rejection after living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Nobuhisa Akamatsu; Yasuhiko Sugawara; Sumihito Tamura; Junichi Keneko; Yuichi Matsui; Kiyoshi Hasegawa; Masatoshi Makuuchi

    2006-01-01

    AIM: To investigate the incidence and risk factors of late-onset acute rejection (LAR) and to clarify the effectiveness of our immunosuppressive regime consisting of life-long administration of tacrolimus and steroids.METHODS: Adult living donor liver transplantation recipients (n = 204) who survived more than 6 mo after living donor liver transplantation were enrolled.Immunosuppression was achieved using tacrolimus and methylprednisolone. When adverse effects of tacrolimus were detected, the patient was switched to cyclosporine. Six months after transplantation,tacrolimus or cyclosporine was carefully maintained at a therapeutic level. The methylprednisolone dosage was maintained at 0.05 mg/kg per day by oral administration.Acute rejections that occurred more than 6 mo after the operation were defined as late-onset. The median followup period was 34 mo.RESULTS: LAR was observed in 15 cases (7%) and no chronic rejection was observed. The incidence of hyperlipidemia, chronic renal failure, new-onset posttransplantation diabetes, and deep fungal infection were 13%, 2%, 24%, and 17%, respectively. Conversion from tacrolimus to cyclosporine was required in 38 patients (19%). Multivariate analysis revealed that a cyclosporinebased regimen was significantly associated with LAR.CONCLUSION: Both LAR and drug-induced adverse events happen at a low incidence, supporting the safety and efficacy of the present immunosuppression regimen for living donor liver transplantation.

  9. 104例成人间活体肝移植肝动脉重建%Reconstruction of hepatic artery in adult to adult living donor liver transplantaiton in 104 patients

    Institute of Scientific and Technical Information of China (English)

    赵纪春; 陈哲宇; 严律南; 李波; 马玉奎; 曾勇; 文天夫; 王文涛; 杨家印; 徐明清

    2009-01-01

    Objective To report the experience of hepatic artery reconstruction with adult-to-adult living donor liver transplantation (ALDLT) using right lobe liver grafts. Methods From January 2002 to August 2007, 104 patients underwent ALDLT using right lobe grafts. Hepatic arteries of donors and recipients were assessed carefully with spiral CT angiography and DSA before ALDLT. All patients underwent reconstruction of hepatic artery between right lobe liver grafts of donor and recipient which included the anastomosis between right hepatic artery of donors and recipients; the reconstruction of right hepatic artery between donor grafts and left hepatic artery of recipients; interpositional bypass using autogenous saphenous vein and cryopreserved lilac artery between right hepatic artery of donors and hepatic artery, common hepatic artery and abdominal aorta of recipients. The microsurgical technique was employed under the magnification of 3.5 times and operative microscope of 5-10 times. Results In these series, HAT occurred in 2 recipients at Days 1 and 7 post-ALDLT (1.9%). Both were revascularizad with autogenous saphenous vein between right hepatic artery of donor and abdominal aorta of recipient. HAT occurred in 1 recipient at Days 90 post-ALDLT, but no symptom was presented. There was no severe complication and mortality related to hepatic artery reconstruction in recipients. No HAT, hepatic artery stenosis and aneurysm occurred during the follow-up period of 2-60 months. The 1,2 and 3-year survival rates were 89.3%, 76.0% and 69. 3% respectively. Conclusion Careful evaluation of hepatic artery condition and using microsurgical techniques are important for safer arterial reconstruction and a long-term patency of hepatic artery in living donor liver transplantation in adults using right lobe liver grafts.%目的 探讨成人间活体肝移植的肝动脉重建技术的经验.方法 自2002年1月至2007年8月,四川大学华西医院施行了104例成人间

  10. PREVENTION OF COMPLICATIONS AFTER HEPATIC ARTERY RECONSTRUCTION IN ADULT-TO-ADULT LIVING DONOR LIVER TRANSPLANTATION%成人间活体肝移植肝动脉重建并发症预防

    Institute of Scientific and Technical Information of China (English)

    武少辉; 赵纪春; 马玉奎; 严律南; 李波; 黄斌; 杨轶

    2011-01-01

    Objective To summarize the experience of the prevention of early arterial complications after hepatic artery (HA) reconstruction in adult-to-adult living donor liver transplantation (A-A LDLT).Methods Between January 2002 and March 2008, 127 patients underwent A-A LDLT.Of the 131 donors (127 cases of right lobe graft, 4 cases of left lobe graft),there were 69 males and 62 females with a mean age of 36.2 years (range, 19-65 years); in 127 recipients, there were 109 males and 18 females with a mean age of 41.9 years (range, 18-64 years).All patients underwent microsurgical reconstruction of HA between grafts and recipients.The artery of graft was anastomosed to the right HA in 62 cases, to the proper HA in 34 cases, to the left HA in 7 cases, to the common HA in 6 cases, and aberrant right HA rising from superior mesenteric artery in 8 cases.Interposition bypass using great saphenous vein (GSV) was performed between the donor right HA and recipient common HA in 5 cases.Bypass was performed between the donor right HA and recipient abdominal aorta using GSV in 2 cases, or using cryopreserved cadaveric iliac vessels in 3 cases.Results Of these 127 cases, hepatic artery thrombosis (HAT) occurred in 2 recipients (1.6%) at 1 day and 7 days following A-A LDLT, which were successfully revascularized with GSV between right HA of donor and abdominal aorta of recipient, HAT in 1 patient occurred on the 46th postoperative day with no symptom.No other arterial complication such as HA stenosis and aneurysm occurred in recipients.All patients were followed up 9-67 months.At 1, 2, and 3 years, actual survival rates were 82.2%, 64.7%, and 59.2%.No death was rehted to HA complication in peri-operative period.Condusion The anatomic structure and variation of HA, the pathological changes, as well as surgical technique in HA reconstruction, have direct impact on the risk of postoperative complications of HA reconstruction.%目的 总结成人间活体肝移植(adult-to-adult

  11. Insurability of living organ donors: a systematic review.

    Science.gov (United States)

    Yang, R C; Thiessen-Philbrook, H; Klarenbach, S; Vlaicu, S; Garg, A X

    2007-06-01

    Being an organ donor may affect one's ability to obtain life, disability and health insurance. We conducted a systematic review to determine if insurability is affected by living organ donation, and if concern about insurability affects donor decision making. We searched MEDLINE, EMBASE, SCI, EconLit and Cochrane databases for articles in any language, and reviewed reference lists from 1966 until June 2006. All studies discussing the insurability of living organ donors or its impact on donor decision making were included. Data were independently abstracted by two authors, and the methodological quality appraised. Twenty-three studies, from 1972 to 2006, provided data on 2067 living organ donors, 385 potential donors and 239 responses from insurance companies. Almost all companies would provide life and health insurance to living organ donors, usually with no higher premiums. However, concern about insurability was still expressed by 2%-14% of living organ donors in follow-up studies, and 3%-11% of donors actually encountered difficulties with their insurance. In one study, donors whose insurance premiums increased were less likely to reaffirm their decision to donate. Based on available evidence, some living organ donors had difficulties with insurance despite companies reporting otherwise. If better understood, this potential barrier to donation could be corrected through fair health and underwriting policies.

  12. NEOPTERIN IN PEDIATRIC LIVING-DONOR LIVER TRANSPLANT PATIENT

    Directory of Open Access Journals (Sweden)

    O. P. Shevchenko

    2011-01-01

    Full Text Available Neopterin (NP is a marker of macrophages activation and is used for monitoring rejection in patients after heart, renal transplantation. The aim of the study was to evaluate plasma levels of NP in children before and after living-donor liver transplantation (LDLT and its relationship with the postoperative course. The study included 72 children with end-stage liver disease (ESLD, aged 17 ± 11 (4–28 months before and after LDLT, 15 healthy children aged 9.9 ± 5.7 (3–21 months and 38 adult living-related liver donors, aged 37 ± 19 (18–56 years. In children with ESLD pre-transplant plasma levels of NP (25.2 ± 19.9 nmol/l was significantly higher than in healthy donors or healthy children (5.5 ± 3.4 and 6.3 ± 2.7 nmol/l, resp., p < 0.01. After LDLT plasma level of NP was higher in children, who had graft dysfunction at days 28–32 (61.9 ± 30.9 nmol/l after LDLT than in children who had no graft dysfunction (24.0 ± 5.6 nmol/l. The measurement of NP concentrations may be useful for monitoring of the postoperative course. 

  13. A Risk Index for Living Donor Kidney Transplantation.

    Science.gov (United States)

    Massie, A B; Leanza, J; Fahmy, L M; Chow, E K H; Desai, N M; Luo, X; King, E A; Bowring, M G; Segev, D L

    2016-07-01

    Choosing between multiple living kidney donors, or evaluating offers in kidney paired donation, can be challenging because no metric currently exists for living donor quality. Furthermore, some deceased donor (DD) kidneys can result in better outcomes than some living donor kidneys, yet there is no way to compare them on the same scale. To better inform clinical decision-making, we created a living kidney donor profile index (LKDPI) on the same scale as the DD KDPI, using Cox regression and adjusting for recipient characteristics. Donor age over 50 (hazard ratio [HR] per 10 years = 1.15 1.241.33 ), elevated BMI (HR per 10 units = 1.01 1.091.16 ), African-American race (HR = 1.15 1.251.37 ), cigarette use (HR = 1.09 1.161.23 ), as well as ABO incompatibility (HR = 1.03 1.271.58 ), HLA B (HR = 1.03 1.081.14 ) mismatches, and DR (HR = 1.04 1.091.15 ) mismatches were associated with greater risk of graft loss after living donor transplantation (all p DD kidney), and 4.4% of donors had LKDPI > 50 (more risk than the median DD kidney). The LKDPI is a useful tool for comparing living donor kidneys to each other and to deceased donor kidneys. PMID:26752290

  14. Hilar branching anatomy of living adult liver donors: comparison of T2-MR cholangiography and contrast enhanced T1-MR cholangiography in terms of diagnostic utility

    International Nuclear Information System (INIS)

    To compare T2-weighted MR cholangiography (T2-MRC) and contrast-enhanced T1-weighted MRC (enhanced T1-MRC) in the assessment of biliary anatomy in donor candidates for living related liver transplantation (LRLT). Thirty-three potential donors underwent MR examination for preoperative evaluation. Using the single-shot half-Fourier RARE sequence, T2-weighted single-section and coronal images were obtained, and enhanced T1-MRC was performed, using 3D GRE sequences after the administration of mangafodifir trisodium. To assess the hilar ductal branching pattern and determine diagnostic confidence, two reviewers first evaluated the unpaired T2-MRC and enhanced T1-MRC images, and then paired T2-MRC and enhanced T1-MRC images together. In particular, in 12 cases in which direct cholangiographys were performed, the feasibility of single duct-to-duct anastomosis was assessed using the unpaired and the paired sets sequentially. The reviewers, confidence tended to be higher for enhanced T1-MRC than T2-MRC, but the difference was not statistically significant. For both reviewers, confidence was significantly higher for the paired set than for T2- or enhanced T1-MRC alone (p<0.001). The types of biliary anatomy determined in the paired set matched the consensus reading in 33 (100%) and 30 cases(91%) assessed by reviewer 1 and 2, respectively. The separate interpretation of T2- and enhanced T1-MRC findings matched the consensus interpretation in 30 (91%) and 28 cases (85%), respectively, assessed by reviewer 1, and 26 (79%) and 28 cases (85%), respectively, assessed by reviewer 2. The possibility of single anastomosis was accurately predicted in 91.6% of cases in T2-MRC, and 100% at enhanced T1-MRC and the combined set. In the evaluation of the biliary anatomy of potential donors for LRLT, the combined use of T2-MRC and enhanced T1-MRC may improve diagnostic confidence and decrease the occurrence of a non diagnostic or equivocal interpretation at T2-MRC alone

  15. Low-pressure pneumoperitoneum during laparoscopic donor nephrectomy to optimize live donors' comfort

    NARCIS (Netherlands)

    Warle, M.C.; Berkers, A.W.; Langenhuijsen, J.F.; Jagt, M.F.P. van der; Dooper, P.M.M.; Kloke, H.J.; Pilzecker, D.; Renes, S.H.; Wever, K.E.; Hoitsma, A.J.; Vliet, J.A. van der; D'Ancona, F.C.H.

    2013-01-01

    Nowadays, laparoscopic donor nephrectomy (LDN) has become the gold standard to procure live donor kidneys. As the relationship between donor and recipient loosens, it becomes of even greater importance to optimize safety and comfort of the surgical procedure. Low-pressure pneumoperitoneum has been s

  16. Living donor liver hilar variations:surgical approaches and implications

    Institute of Scientific and Technical Information of China (English)

    Onur Yaprak; Tolga Demirbas; Cihan Duran; Murat Dayangac; Murat Akyildiz; Yaman Tokat; Yildiray Yuzer

    2011-01-01

    BACKGROUND: Varied vascular and biliary anatomies are common in the liver. Living donor hepatectomy requires precise recognition of the hilar anatomy. This study was undertaken to study donor vascular and biliary tract variations, surgical approaches and implications in living liver transplant patients. METHODS: Two hundred living donor liver transplantations were performed at our institution between 2004 and 2009. All donors were evaluated by volumetric computerized tomography (CT), CT angiography and magnetic resonance cholangiography in the preoperative period. Intraoperative ultrasonography and cholangiography were carried out. Arterial, portal and biliary anatomies were classified according to the Michels, Cheng and Huang criteria. RESULTS: Classical hepatic arterial anatomy was observed in 129 (64.5%) of the 200 donors. Fifteen percent of the donors had variation in the portal vein. Normal biliary anatomy was found in 126 (63%) donors, and biliary tract variation in 70% of donors with portal vein variations. In recipients with single duct biliary anastomosis, 16 (14.4%) developed biliary leak, and 9 (8.1%) developed biliary stricture; however more than one biliary anastomosis increased recipient biliary complications. Donor vascular variations did not increase recipient vascular complications. Variant anatomy was not associated with an increase in donor morbidity. CONCLUSIONS: Living donor liver transplantation provides information about variant hilar anatomy. The success of the procedure depends on a careful approach to anatomical variations. When the deceased donor supply is inadequate, living donor transplantation is a life-saving alternative and is safe for the donor and recipient, even if the donor has variant hilar anatomy.

  17. Living donor liver transplantation to patients with hepatitis C virus cirrhosis

    Institute of Scientific and Technical Information of China (English)

    Yasuhiko Sugawara; Masatoshi Makuuchi

    2006-01-01

    Living donor liver transplantation (LDLT) is an alternative therapeutic option for patients with end-stage hepatitis C virus (HCV) cirrhosis because of the cadaveric organ shortage. HCV infection is now a leading indication for LDLT among adults worldwide, and there is a worse prognosis with HCV recurrence. The antivirus strategy after transplantation, however, is currently under debate.Recent updates on the clinical and therapeutic aspects of living donor liver transplantation for HCV are discussed in the present review.

  18. Clostridium difficile-associated diarrhea after living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Masao Hashimoto; Yasuhiko Sugawara; Sumihito Tamura; Junichi Kaneko; Yuichi Matsui; Junichi Togashi; Masatoshi Makuuchi

    2007-01-01

    AIM: To assess the incidence and analyze the risk factors for Clostridium difficile-associated diarrhea (CDAD)after living donor liver transplantation (LDLT) in adult.METHODS: The micobiological data and medical records of 242 adult recipients that underwent LDLT at the Tokyo University Hospital were analyzed retrospectively. The independent risk factors for postoperative CDAD were identified.RESULTS: Postoperative CDAD occurred in 11 (5%)patients. Median onset of CDAD was postoperative d 19(range, 5-54). In the multivariate analyses, male gender (odds ratio, 4.56) and serum creatinine (≥ 1.5 mg/dL,odds ratio, 16.0) independently predicted postoperative CDAD.CONCLUSION: CDAD should be considered in the differential diagnosis of patients with postoperative diarrhea after LDLT.

  19. Imaging evaluation of potential donors in living-donor liver transplantation

    International Nuclear Information System (INIS)

    Liver transplants, originally obtained from deceased donors, can now be harvested from living donors as well. This technique, called living-donor liver transplantation (LDLT), provides an effective alternative means of liver transplantation and is a method of expanding the donor pool in light of the demand and supply imbalance for organ transplants. Imaging plays an important role in LDLT programmes by providing robust evaluation of potential donors to ensure that only anatomically suitable donors with no significant co-existing pathology are selected and that crucial information that allows detailed preoperative planning is available. Imaging evaluation helps to improve the outcome of LDLT for both donors and recipients, by improving the chances of graft survival and reducing the postoperative complication rate. In this review, we describe the history of LDLT and discuss in detail the application of imaging in donor assessment with emphasis on use of modern computed tomography (CT) and magnetic resonance imaging (MRI) techniques

  20. Imaging evaluation of potential donors in living-donor liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Low, G. [Department of Radiology and Diagnostic Imaging, University of Alberta Hospital (Canada)], E-mail: timgy@yahoo.com; Wiebe, E. [Department of Radiology and Diagnostic Imaging, University of Alberta Hospital (Canada); Walji, A.H. [Division of Anatomy, Faculty of Medicine, University of Alberta (Canada); Bigam, D.L. [Department of Surgery, University of Alberta Hospital (Canada)

    2008-02-15

    Liver transplants, originally obtained from deceased donors, can now be harvested from living donors as well. This technique, called living-donor liver transplantation (LDLT), provides an effective alternative means of liver transplantation and is a method of expanding the donor pool in light of the demand and supply imbalance for organ transplants. Imaging plays an important role in LDLT programmes by providing robust evaluation of potential donors to ensure that only anatomically suitable donors with no significant co-existing pathology are selected and that crucial information that allows detailed preoperative planning is available. Imaging evaluation helps to improve the outcome of LDLT for both donors and recipients, by improving the chances of graft survival and reducing the postoperative complication rate. In this review, we describe the history of LDLT and discuss in detail the application of imaging in donor assessment with emphasis on use of modern computed tomography (CT) and magnetic resonance imaging (MRI) techniques.

  1. Evaluation of the Medically Complex Living Kidney Donor

    Directory of Open Access Journals (Sweden)

    Yasar Caliskan

    2012-01-01

    Full Text Available Due to organ shortage and difficulties for availability of cadaveric donors, living donor transplantation is an important choice for having allograft. Live donor surgery is elective and easier to organize prior to starting dialysis thereby permitting preemptive transplantation as compared to cadaveric transplantation. Because of superior results with living kidney transplantation, efforts including the usage of “Medically complex living donors” are made to increase the availability of organs for donation. The term “Complex living donor” is probably preferred for all suboptimal donors where decision-making is a problem due to lack of sound medical data or consensus guidelines. Donors with advanced age, obesity, asymptomatic microhematuria, proteinuria, hypertension, renal stone disease, history of malignancy and with chronic viral infections consist of this complex living donors. This medical complex living donors requires careful evaluation for future renal risk. In this review we would like to present the major issues in the evaluation process of medically complex living kidney donor.

  2. Alternative donors: cord blood for adults.

    Science.gov (United States)

    Ruggeri, Annalisa

    2016-04-01

    Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative treatment for patients with hematological diseases. The probability of finding a human leukocyte antigen (HLA)- identical donor among family members is around 25% and 30% that of having a full matched unrelated donor in the registry. Patients in need may also benefit of a HLA-mismatched HSCT either from an haploidentical donors or from umbilical cord blood (UCB). Much has been learned about UCB transplant (UCBT) since the first human UCBT was performed back in 1988. Cord blood banks have been established worldwide for the collection, cryopreservation, and distribution of UCB for HSCT. Today, a global network of cord blood banks and transplant centers has been established with a large common inventory of more than 650,000 UCB units available, allowing for more than 40,000 UCBT worldwide in children and adults with severe hematological diseases. Several studies have been published on UCBT, assessing risk factors such as cell dose and HLA mismatch. Outcomes of several retrospective comparative studies showed similar results using other stem cell sources both in pediatric and adult setting. New strategies are ongoing to facilitate engraftment and reduce transplant-related mortality. In this issue, we review the current results of UCBT in adults with hematological malignancies and the clinical studies comparing UCBT with other transplant strategies. We provide guidelines for donor algorithm selection in UCBT setting.

  3. Stability of cirrhotic systemic hemodynamics ensures sufficient splanchnic blood flow after living-donor liver transplantation in adult recipients with liver cirrhosis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To investigate the correlation between systemic hemodynamics and splanchnic circulation in recipients with cirrhosis undergoing living-donor liver transplantation (LDLT), and to clarify how systemic hemodynamics impact on local graft circulation after LDLT.METHODS: Systemic hemodynamics, indocyanine green (ICG) elimination rate (KICG) and splanchnic circulation were simultaneously and non-invasively investigated by pulse dye densitometry (PDD) and ultrasound. Accurate estimators of optimal systemic hyperdynamics after LDLT [i.e., balance of cardiac output (CO) to blood volume (BV) and mean transit time (MTT), defined as the time required for half the administered ICG to pass through an attached PDD sensor in the first circulation] were also measured. Thirty recipients with cirrhosis were divided into two groups based on clinical outcomes corresponding to postoperative qraft function.RESULTS: Cirrhotic systemic hyperdynamics characterized by high CO, expanded BV and low total peripheral resistance (TPR) were observed before LDLT. TPR reflecting cirrhotic vascular alterations was slowly restored after LDLT in both groups. Although no significant temporal differences in TPR were detected between the two groups, CO/BV and MTT differed significantly. Recipients with good outcomes showed persistent cirrhotic systemic hyperdynamics after LDLT, whereas recipients with poor outcomes presented with unstable cirrhotic systemic hyperdynamics and severely decreased KICG. Systemic hyperdynamic disorders after LDLT impacted on portal venous flow but not hepatic arterial flow.CONCLUSION: We conclude that subtle systemic hyperdynamics disorders impact on splanchnic circulation, and that an imbalance between CO and BV decreases portal venous flow, which results in critical outcomes.

  4. LEFT LOBE LIVER TRANSPLANTATION FROM AB0-INCOMPATIBLE LIVING DONOR WITH SITUS INVERSUS

    Directory of Open Access Journals (Sweden)

    S. V. Gautier

    2014-01-01

    Full Text Available Situs inversus is a rare congenital abnormality that affects approximately 0.005% of all live births. Traditionally, this condition is considered as a contraindication for liver donation, primarily due to the peculiarities of the vascular anatomy and the diffi culties in graft placement in the abdominal cavity. Review of the world literature testifi es to fi ve cases of use of the whole liver from deceased donor with situs inversus in adult recipients, and to just one case of inverted right lobe transplantation from living donor to 53-year-old man. Thus, transplantation of an inverted left liver lobe from a living related donor in pediatric patients was performed for the fi rst time. The article presents a successful experience of liver transplantation in child with tyrosinemia type 1 from AB0-incompatible living donor with situs inversus.

  5. [Renal transplantation from living donor in Italy and Europe].

    Science.gov (United States)

    Frascà, Giovanni M; Gaffi, G; Taruscia, D; D'Arezzo, M; Benozzi, L; Sagripanti, S

    2009-01-01

    Renal transplantation from a living donor shows a better graft and patient survival when compared with cadaver donor grafts. Moreover, since surgery can be planned in advance when a living donor is available, the time spent on dialysis while awaiting transplantation can be greatly reduced and dialysis treatment can be completely avoided in some cases. Only few risks for the donor have been reported as a consequence of nephrectomy, both in the short and long term. Nevertheless, despite these advantages, the number of living donor renal transplants carried out in Europe each year varies greatly from country to country and is particularly low in Spain and Italy. Several factors account for these differences, mainly the effectiveness of the organ procurement system, which could make people reluctant to living donation, and doctors' and patients' limited knowledge about living donor transplants. Nephrologists have the responsibility to identify patients eligible for transplant early in the course of the disease, and to inform them and their relatives about living donor transplantation, enabling them to make informed choices among the various treatment options in end-stage renal disease. PMID:19644833

  6. Paid Living Donation and Growth of Deceased Donor Programs.

    Science.gov (United States)

    Ghahramani, Nasrollah

    2016-06-01

    Limited organ availability in all countries has stimulated discussion about incentives to increase donation. Since 1988, Iran has operated the only government-sponsored paid living donor (LD) kidney transplant program. This article reviews aspects of the Living Unrelated Donor program and development of deceased donation in Iran. Available evidence indicates that in the partially regulated Iranian Model, the direct negotiation between donors and recipients fosters direct monetary relationship with no safeguards against mutual exploitation. Brokers, the black market and transplant tourism exist, and the waiting list has not been eliminated. Through comparison between the large deceased donor program in Shiraz and other centers in Iran, this article explores the association between paid donation and the development of a deceased donor program. Shiraz progressively eliminated paid donor transplants such that by 2011, 85% of kidney transplants in Shiraz compared with 27% across the rest of Iran's other centers were from deceased donors. Among 26 centers, Shiraz undertakes the largest number of deceased donor kidney transplants, most liver transplants, and all pancreas transplants. In conclusion, although many patients with end stage renal disease have received transplants through the paid living donation, the Iranian Model now has serious flaws and is potentially inhibiting substantial growth in deceased donor organ transplants in Iran. PMID:27203584

  7. [What degree of freedom is there for living donors?].

    Science.gov (United States)

    Kinnaert, P; Abramowicz, D; De Pauw, L; Janssen, F; Hall, M; Wissing, M; Hooghe, L

    1999-09-01

    The shortage of cadaveric donors has induced a renewed interest in living kidney donation. This paper describes the legal, religious and ethical factors which ensure or restrict the autonomy of the potential donor. We conclude that it is possible with appropriate measures to protect his freedom of choice. PMID:10523905

  8. Living donor liver transplantation in Taiwan-challenges beyond surgery.

    Science.gov (United States)

    Pillai, Vinod G; Chen, Chao-Long

    2016-04-01

    Taiwan has a high prevalence of hepatitis B and C viral infections, and consequently a high burden of chronic liver diseases. Liver transplantation (LT) began in Taiwan in 1984, and living donor liver transplantation (LDLT) in 1994. Education and collaboration between physicians on a national and international scale were important factors in the development of transplantation in East Asia. Technical innovations in donor hepatectomy, vascular and biliary reconstruction, and interventional radiology, perioperative management of transplant patients and development of associated specialties have enabled achievement of excellent results after both adult and pediatric LDLT. The establishment of rigorous protocols to withstand strict medico-legal scrutiny, combined with technical excellence has contributed to excellent surgical outcomes. The socioeconomic development of Taiwan and the first nationwide hepatitis B vaccination program in the world have also contributed to the decrease in disease burden and improvement of quality of healthcare. This article examines the factors enabling the development of LT in Taiwan, the innovations that have contributed to excellent outcomes, and indicates the future prospects of LDLT in Taiwan. PMID:27115009

  9. Cost effectiveness of open versus laparoscopic living-donor nephrectomy

    DEFF Research Database (Denmark)

    Hamidi, Vida; Andersen, Marit Helen; Oyen, Ole;

    2009-01-01

    BACKGROUND: Kidney transplantation is an essential part of care for patients with end-stage renal disease. The introduction of laparoscopic living-donor nephrectomy (LLDN) has made live donation more advantageous because of less postoperative pain, earlier return to normal activities, and a conse......BACKGROUND: Kidney transplantation is an essential part of care for patients with end-stage renal disease. The introduction of laparoscopic living-donor nephrectomy (LLDN) has made live donation more advantageous because of less postoperative pain, earlier return to normal activities...

  10. 成人间右半肝活体肝移植的肝中静脉之争%Controversy of Middle Hepatic Vein in Adult Right - lobe Living Donor Liver Transplantation

    Institute of Scientific and Technical Information of China (English)

    陈虹; 徐光勋; 蒲朝煜; 沈中阳

    2011-01-01

    成人右半肝活体肝移植的开展在很大程度上解决了供肝短缺的问题,但随之也引发了右半肝移植物中是否带肝中静脉的技术与伦理之争.本文论述了肝中静脉的解剖,以及右半肝活体肝移植中带与不带肝中静脉的双方观点、理论依据和临床实践经验.%The development of adult right-lobe living donor liver transplantation had resolved the problem of deficiency of donor resource to a great extent, but it also initiated the cantroversy on technique and ethics that the issue of whether the middle hepatic vein(MHV)should or should not be taken with the graft. The article discussed anatomy of MHV, Views of both sides about whether in right-lobe graft with or without MHV, theory and clinic experiences.

  11. Preoperative CT evaluation of potential donors in living donor liver transplantation

    Directory of Open Access Journals (Sweden)

    Sandeep Vohra

    2014-01-01

    Full Text Available Living donor liver transplantation is an effective, life sustaining surgical treatment in patients with end-stage liver disease and a successful liver transplant requires a close working relationship between the radiologist and the transplant surgeon. There is extreme variability in hepatic vascular anatomy; therefore, preoperative imaging of potential liver donors is crucial not only in donor selection but also helps the surgeons in planning their surgical approach. In this article, we elaborate important aspects in evaluation of potential liver donors on multi-detector computed tomography (MDCT and the utility of MDCT in presurgical assessment of the hepatic parenchyma, relevant hepatic vascular anatomy and segmental liver volumes.

  12. Renal Function Recovery in Donors and Recipients after Live Donor Nephrectomy: Hand-Assisted Laparoscopic vs. Open Procedures

    OpenAIRE

    Kim, Bum Soo; Yoo, Eun Sang; Kim, Tae-Hwan; Kwon, Tae Gyun

    2010-01-01

    Purpose Laparoscopic donor nephrectomy is associated with less postoperative pain and faster recovery times in living kidney donors. However, pneumoperitoneum, which is required in laparoscopic donor nephrectomy, can result in adverse effects on renal function in donors and recipients. We compared renal function in donors and recipients after hand-assisted laparoscopic donor nephrectomy (HALDN) and open donor nephrectomy (ODN). Materials and Methods Between January 1997 and January 2008, 241 ...

  13. Small-for-size syndrome in adult-to-adult living-related liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Salvatore; Gruttadauria; Duilio; Pagano; Angelo; Luca; Bruno; Gridelli

    2010-01-01

    Small-for-size syndrome (SFSS) in adult-to-adult living-related donor liver transplantation (LRLT) remains the greatest limiting factor for the expansion of segmental liver transplantation from either cadaveric or living donors. Portal hyperperfusion, venous pathology, and the arterial buffer response signif icantly contribute to clinical and histopathological manifestations of SFSS. Here, we review the technical aspects of surgical and radiological procedures developed to treat SFSS in LRLT, along with the...

  14. [Use of related live donors in renal transplantation].

    Science.gov (United States)

    Broyer, M

    1996-06-01

    Collecting pertinent information is first step in assessing the use of living-related kidneys for transplantation. Current bioethics legislation in France limits kidney donation to first-degree family members and spouses in emergency situations. Severe penalties are inflicted for use of other donors or sale of organs. Further valuable information can be obtained from reports in the literature on complications in donors and on the advantages of living donor organs. The proportion of live donors in France is small (3.5% from 1984 through 1993) indicating that transplantation teams prefer cadaver organs except in pediatric cases. The proportion of live donor organs transplanted in northern Europe and North America is much higher. A quick survey of French teams show that opinions and practices vary. Questions still under debate include how to guarantee freedom to refuse or accept, a freedom directly related to correct information. Several propositions have been made in an attempt to harmonize management. First, an information sheet could be distributed during the early discussions, outlining the advantages and disadvantages of live organ donation. A list of complementary examinations could also be established to identify possible contraindications for nephrectomy and define exclusion criteria. A similar procedure adopted by all transplantation teams could be based on these propositions presented in the appendix. Potential donors could then benefit from uniform protection. PMID:8685149

  15. Expanding the live kidney donor pool: ethical considerations regarding altruistic donors, paired and pooled programs.

    Science.gov (United States)

    Patel, Shaneel Rajendra; Chadha, Priyanka; Papalois, Vassilios

    2011-06-01

    In renal transplant, there is a well-known deficiency in organ supply relative to demand. Live donation provides superior results when compared with deceased donation including a better rate of graft success and fewer immunologic complications. This deficiency in organs leads to significant morbidity and mortality rates. Alternative avenues have been extensively explored that may expand the live donor pool. They include altruistic donation as well as paired and pooled exchange programs. Altruistic donation is a truly selfless act from a donor unknown to the recipient. Kidney paired donation involves 2 incompatible donor-recipient pairs swapping donors to produce compatibility. Pooled donation involves at least 2 pairs, and can take the form of domino chains in which altruistic input sets up a chain of transplants, in which each recipient's incompatible donor makes a donation for the next recipient. Despite application of these various methods, there lie extensive ethical issues surrounding them. Misconceptions frequently occur; for instance, the perceived benefit that donating an organ to a loved one is greater for a related donor than for an altruistic one. Additionally, it is frequently believed that immunologic incompatibility offers coerced donors liberation from surgery, and that overcoming these barriers by introducing exchange programs provides vulnerable donors less protection. This article explores these and other complex ethical issues surrounding the various methods of expanding the donor pool. The authors offer opinions that challenge the ethical issues and attempt to overcome those views that hinder progress in the field. PMID:21649566

  16. Increasing the Supply of Kidneys for Transplantation by Making Living Donors the Preferred Source of Donor Kidneys

    OpenAIRE

    Testa, Giuliano; Siegler, Mark

    2014-01-01

    Abstract At the present time, increasing the use of living donors offers the best solution to the organ shortage problem. The clinical questions raised when the first living donor kidney transplant was performed, involving donor risk, informed consent, donor protection, and organ quality, have been largely answered. We strongly encourage a wider utilization of living donation and recommend that living donation, rather than deceased donation, become the first choice for kidney transplantation....

  17. Q-FISH measurement of hepatocyte telomere lengths in donor liver and graft after pediatric living-donor liver transplantation: donor age affects telomere length sustainability.

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    Youichi Kawano

    Full Text Available Along with the increasing need for living-donor liver transplantation (LDLT, the issue of organ shortage has become a serious problem. Therefore, the use of organs from elderly donors has been increasing. While the short-term results of LDLT have greatly improved, problems affecting the long-term outcome of transplant patients remain unsolved. Furthermore, since contradictory data have been reported with regard to the relationship between donor age and LT/LDLT outcome, the question of whether the use of elderly donors influences the long-term outcome of a graft after LT/LDLT remains unsettled. To address whether hepatocyte telomere length reflects the outcome of LDLT, we analyzed the telomere lengths of hepatocytes in informative biopsy samples from 12 paired donors and recipients (grafts of pediatric LDLT more than 5 years after adult-to-child LDLT because of primary biliary atresia, using quantitative fluorescence in situ hybridization (Q-FISH. The telomere lengths in the paired samples showed a robust relationship between the donor and grafted hepatocytes (r = 0.765, p = 0.0038, demonstrating the feasibility of our Q-FISH method for cell-specific evaluation. While 8 pairs showed no significant difference between the telomere lengths for the donor and the recipient, the other 4 pairs showed significantly shorter telomeres in the recipient than in the donor. Multiple regression analysis revealed that the donors in the latter group were older than those in the former (p = 0.001. Despite the small number of subjects, this pilot study indicates that donor age is a crucial factor affecting telomere length sustainability in hepatocytes after pediatric LDLT, and that the telomeres in grafted livers may be elongated somewhat longer when the grafts are immunologically well controlled.

  18. Donor safety in living donor liver transplantation: a single-center analysis of 300 cases.

    Directory of Open Access Journals (Sweden)

    Jianyong Lei

    Full Text Available AIM: To evaluate the safety to donors of living-donor liver transplantation. METHODS: This study included 300 consecutive living liver tissue donors who underwent operations at our center from July 2002 to December 2012. We evaluated the safety of donors with regard to three aspects complications were recorded prospectively and stratified by grade according to Clavien's classification, and the data were compared in two stages (the first 5 years' experience (pre-January 2008 and the latter 5 years' experience (post-January 2008; laboratory tests such as liver function and blood biochemistry were performed; and the health-related quality of life was evaluated. RESULTS: There was no donor mortality at our center, and the overall morbidity rate was 25.3%. Most of the complications of living donors were either grade I or II. There were significantly fewer complications in the latter period of our study than in the initial period (19.9% vs 32.6%, P<0.001, and biliary complications were the most common complications, with an incidence of 9%. All of the liver dysfunction was temporary; however, the post-operative suppression of platelet count lasted for years. Although within the normal range, eight years after operation, 22 donors showed lower platelet levels (189 × 10(9/L compared with the pre-operative levels (267 × 10(9/L (P<0.05. A total of 98.4% of donors had returned to their previous levels of social activity and work, and 99.2% of donors would donate again if it was required and feasible. With the exception of two donors who experienced grade III complications (whose recipients died and a few cases of abdominal discomfort, fatigue, chronic pain and scar itching, none of the living donors were affected by physical problems. CONCLUSION: With careful donor selection and specialized patient care, low morbidity rates and satisfactory long-term recovery can be achieved after hepatectomy for living-donor liver transplantation.

  19. Evaluation of 100 patients for living donor liver transplantation.

    Science.gov (United States)

    Trotter, J F; Wachs, M; Trouillot, T; Steinberg, T; Bak, T; Everson, G T; Kam, I

    2000-05-01

    The initial success of living donor liver transplantation (LDLT) in the United States has resulted in a growing interest in this procedure. The impact of LDLT on liver transplantation will depend in part on the proportion of patients considered medically suitable for LDLT and the identification of suitable donors. We report the outcome of our evaluation of the first 100 potential transplant recipients for LDLT at the University of Colorado Health Sciences Center (Denver, CO). All patients considered for LDLT had first been approved for conventional liver transplantation by the Liver Transplant Selection Committee and met the listing criteria of United Network for Organ Sharing status 1, 2A, or 2B. Once listed, those patients deemed suitable for LDLT were given the option to consider LDLT and approach potential donors. Donors were evaluated with a preliminary screening questionnaire, followed by formal evaluation. Of the 100 potential transplant recipients evaluated, 51 were initially rejected based on recipient characteristics that included imminent cadaveric transplantation (8 patients), refusal of evaluation (4 patients), lack of financial approval (6 patients), and medical, psychosocial, or surgical problems (33 patients). Of the remaining 49 patients, considered ideal candidates for LDLT, 24 patients were unable to identify a suitable donor for evaluation. Twenty-six donors were evaluated for the remaining 25 potential transplant recipients. Eleven donors were rejected: 9 donors for medical reasons and 2 donors who refused donation after being medically approved. The remaining 15 donor-recipient pairs underwent LDLT. Using our criteria for the selection of recipients and donors for LDLT gave the following results: (1) 51 of 100 potential transplant recipients (51%) were rejected for recipient issues, (2) only 15 of the remaining 49 potential transplant recipients (30%) were able to identify an acceptable donor, and (3) 15 of 100 potential living donor

  20. Changes in Surgical Site Infections after Living Donor Liver Transplantation

    Science.gov (United States)

    Yamamoto, Masaki; Takakura, Shunji; Iinuma, Yoshitsugu; Hotta, Go; Matsumura, Yasufumi; Matsushima, Aki; Nagao, Miki; Ogawa, Kohei; Fujimoto, Yasuhiro; Mori, Akira; Ogura, Yasuhiro; Kaido, Toshimi; Uemoto, Shinji; Ichiyama, Satoshi

    2015-01-01

    Surgical site infections (SSIs) are a major threat for liver transplant recipients. We prospectively studied SSIs after living donor liver transplantation (LDLT) at Kyoto University Hospital from April 2001 to March 2002 (1st period) and from January 2011 to June 2012 (2nd period). We investigated the epidemiology of SSIs after LDLT and determined the differences between the two periods. A total of 129 adult recipients (66 during the 1st period and 63 during the 2nd period) and 72 pediatric recipients (39 and 33) were included in this study. The SSI rates for each period were 30.3% (1st period) and 41.3% (2nd period) among the adult recipients and 25.6% and 30.3% among the pediatric recipients. The overall rates of 30-day mortality among adult transplant recipients with SSIs were 10.0% (1st period) and 3.9% (2nd period). No pediatric recipient died from SSIs after LDLT in either period. The incidence of Enterococcus faecium increased from 5.0% to 26.9% in the adults and from 10.0% to 40.0% in the pediatric patients. Extended-spectrum β-lactamase-producing Enterobacteriaceae were emerging important isolates during the 2nd period. For this period, a univariate analysis showed that ABO incompatibility (P = 0.02), total operation duration (P = 0.01), graft-to-recipient body weight ratio (GRWR [P = 0.04]), and Roux-en-Y biliary reconstruction (P<0.01) in the adults and age (P = 0.01) and NHSN risk index (P = 0.02) in the children were associated with SSI development. In a multivariate analysis, lower GRWR (P = 0.02) and Roux-en-Y biliary reconstruction (P<0.01) in the adults and older age (P = 0.01) in the children were independent risk factors for SSIs during the 2nd period. In conclusion, SSIs caused by antibiotic resistant bacteria may become a major concern. Lower GRWR and Roux-en-Y biliary reconstruction among adult LDLT recipients and older age among pediatric LDLT recipients increased the risk of developing SSIs after LDLT. PMID:26322891

  1. Changes in Surgical Site Infections after Living Donor Liver Transplantation.

    Directory of Open Access Journals (Sweden)

    Masaki Yamamoto

    Full Text Available Surgical site infections (SSIs are a major threat for liver transplant recipients. We prospectively studied SSIs after living donor liver transplantation (LDLT at Kyoto University Hospital from April 2001 to March 2002 (1st period and from January 2011 to June 2012 (2nd period. We investigated the epidemiology of SSIs after LDLT and determined the differences between the two periods. A total of 129 adult recipients (66 during the 1st period and 63 during the 2nd period and 72 pediatric recipients (39 and 33 were included in this study. The SSI rates for each period were 30.3% (1st period and 41.3% (2nd period among the adult recipients and 25.6% and 30.3% among the pediatric recipients. The overall rates of 30-day mortality among adult transplant recipients with SSIs were 10.0% (1st period and 3.9% (2nd period. No pediatric recipient died from SSIs after LDLT in either period. The incidence of Enterococcus faecium increased from 5.0% to 26.9% in the adults and from 10.0% to 40.0% in the pediatric patients. Extended-spectrum β-lactamase-producing Enterobacteriaceae were emerging important isolates during the 2nd period. For this period, a univariate analysis showed that ABO incompatibility (P = 0.02, total operation duration (P = 0.01, graft-to-recipient body weight ratio (GRWR [P = 0.04], and Roux-en-Y biliary reconstruction (P<0.01 in the adults and age (P = 0.01 and NHSN risk index (P = 0.02 in the children were associated with SSI development. In a multivariate analysis, lower GRWR (P = 0.02 and Roux-en-Y biliary reconstruction (P<0.01 in the adults and older age (P = 0.01 in the children were independent risk factors for SSIs during the 2nd period. In conclusion, SSIs caused by antibiotic resistant bacteria may become a major concern. Lower GRWR and Roux-en-Y biliary reconstruction among adult LDLT recipients and older age among pediatric LDLT recipients increased the risk of developing SSIs after LDLT.

  2. Organ Transplants from Living Donors – Halachic Aspects

    Directory of Open Access Journals (Sweden)

    Mordechai Halperin

    2011-04-01

    Full Text Available This manuscript is a survey of the halachic attitudes toward organ transplant procedures from a living donor which can be defined as life-saving procedures for the recipient or at least life-prolonging procedures. Three fundamental problems concerning the halachic aspects of such transplantation are discussed in detail: the danger to the donor, donation under coercion, and the sale of organs and tissues. The terms “halacha” and “Jewish law” are defined in the introduction.

  3. Ethical considerations on kidney transplantation from living donors.

    Science.gov (United States)

    Bruzzone, P; Pretagostini, R; Poli, L; Rossi, M; Berloco, P B

    2005-01-01

    Kidney transplantation from living donors is widely performed all over the world. Living nephrectomy for transplantation has no direct advantage for the donor other than increased self-esteem, but at least remains an extremely safe procedure, with a worldwide overall mortality rate of 0.03%. This theoretical risk to the donor seems to be justified by the socioeconomic advantages and increased quality of life of the recipient, especially in selected cases, such as pediatric patients, when living donor kidney transplantation can be performed in a preuremic phase, avoiding the psychological and physical stress of dialysis, which in children is not well tolerated and cannot prevent retarded growth. According to the Ethical Council of the Transplantation Society, commercialism must be prevented, not only for ethical but also medical reasons. The risks are too high not only for the donors, but also for the recipients, as a consequence of poor donor screening and evaluation with consequent transmission of human immunodeficiency virus or other infectious agents, as well as inappropriate medical and surgical management of donors and also of recipients, who are often discharged too early. Most public or private insurance companies are considering kidney donation a safe procedure without long-term impairment and, therefore, do not increase the premium, whereas recipient insurance of course should cover hospital fees for the donors. "Rewarded gifting" or other financial incentives to compensate for the inconvenience and loss of income related to the donation are not advisable, at least in our opinion. Our center does not perform anonymous living organ donation or "cross-over" transplantation. PMID:16182701

  4. Ethical aspects of renal transplantation from living donors.

    Science.gov (United States)

    Bruzzone, P; Berloco, P B

    2007-01-01

    Kidney transplantation from living donors is widely performed all over the world. Living nephrectomy for transplantation has no direct advantages for the donor other than increased self-esteem, but it at least remains an extremely safe procedure, with a worldwide overall mortality of 0.03%. This theoretical risk for the donor seems to be justified by the socioeconomic advantages and increased quality of life of the recipient, especially in selected cases, such as pediatric patients, when living donor kidney transplantation can be performed in a preuremic phase, avoiding the psychological and physical stress of dialysis, which in children is not well tolerated and cannot prevent retarded growth. According to the Ethical Council of the Transplantation Society, commercialism must be effectively prevented, not only for ethical but also medical reasons. The risks are too high, not only for the donors, but also for the recipients, as a consequence of poor donor screening and evaluation with consequent transmission of human immunodeficiency virus (HIV) or other infective agents, as well as of inappropriate medical and surgical management of donors and also recipients, who are often discharged too early. Most public or private insurance companies consider kidney donation a safe procedure without long-term impairment and therefore do not increase the premium, whereas recipient insurance of course should cover hospital fees for the donors. "Rewarded gifting" or other financial incentives to compensate for the inconvenience and loss of income related to the donation are not advisable, at least in our opinion. Our Center does not perform anonymous living organ donation or "cross-over" transplantation. PMID:17692612

  5. Living donor liver transplantation for patients with alcoholic liver disease

    OpenAIRE

    Park, Yo-Han; Hwang, Shin; Ahn, Chul-Soo; Kim, Ki-Hun; Moon, Deok-Bog; Ha, Tae-Yong; Song, Gi-Won; Jung, Dong-Hwan; Park, Gil-Chun; Namgoong, Jung-Man; Park, Hyung-Woo; Park, Chun-Soo; Kang, Sung-Hwa; Jung, Bo-Hyeon; Lee, Sung-Gyu

    2013-01-01

    Backgrounds/Aims Since most transplantation studies for alcoholic liver disease (ALD) were performed on deceased donor liver transplantation, little was known following living donor liver transplantation (LDLT). Methods The clinical outcome of 18 ALD patients who underwent LDLT from Febraury 1997 to December 2004 in a large-volume liver transplantation center was assessed retrospectively. Results The model for end-stage liver disease score was 23±11, and mean pretransplant abstinence period w...

  6. Ethical aspects of renal transplantation from living donors.

    Science.gov (United States)

    Bruzzone, P; Berloco, P B

    2007-01-01

    Kidney transplantation from living donors is widely performed all over the world. Living nephrectomy for transplantation has no direct advantages for the donor other than increased self-esteem, but it at least remains an extremely safe procedure, with a worldwide overall mortality of 0.03%. This theoretical risk for the donor seems to be justified by the socioeconomic advantages and increased quality of life of the recipient, especially in selected cases, such as pediatric patients, when living donor kidney transplantation can be performed in a preuremic phase, avoiding the psychological and physical stress of dialysis, which in children is not well tolerated and cannot prevent retarded growth. According to the Ethical Council of the Transplantation Society, commercialism must be effectively prevented, not only for ethical but also medical reasons. The risks are too high, not only for the donors, but also for the recipients, as a consequence of poor donor screening and evaluation with consequent transmission of human immunodeficiency virus (HIV) or other infective agents, as well as of inappropriate medical and surgical management of donors and also recipients, who are often discharged too early. Most public or private insurance companies consider kidney donation a safe procedure without long-term impairment and therefore do not increase the premium, whereas recipient insurance of course should cover hospital fees for the donors. "Rewarded gifting" or other financial incentives to compensate for the inconvenience and loss of income related to the donation are not advisable, at least in our opinion. Our Center does not perform anonymous living organ donation or "cross-over" transplantation.

  7. Ethical considerations on kidney transplantation from living donors.

    Science.gov (United States)

    Bruzzone, P; Pretagostini, R; Poli, L; Rossi, M; Berloco, P B

    2005-01-01

    Kidney transplantation from living donors is widely performed all over the world. Living nephrectomy for transplantation has no direct advantage for the donor other than increased self-esteem, but at least remains an extremely safe procedure, with a worldwide overall mortality rate of 0.03%. This theoretical risk to the donor seems to be justified by the socioeconomic advantages and increased quality of life of the recipient, especially in selected cases, such as pediatric patients, when living donor kidney transplantation can be performed in a preuremic phase, avoiding the psychological and physical stress of dialysis, which in children is not well tolerated and cannot prevent retarded growth. According to the Ethical Council of the Transplantation Society, commercialism must be prevented, not only for ethical but also medical reasons. The risks are too high not only for the donors, but also for the recipients, as a consequence of poor donor screening and evaluation with consequent transmission of human immunodeficiency virus or other infectious agents, as well as inappropriate medical and surgical management of donors and also of recipients, who are often discharged too early. Most public or private insurance companies are considering kidney donation a safe procedure without long-term impairment and, therefore, do not increase the premium, whereas recipient insurance of course should cover hospital fees for the donors. "Rewarded gifting" or other financial incentives to compensate for the inconvenience and loss of income related to the donation are not advisable, at least in our opinion. Our center does not perform anonymous living organ donation or "cross-over" transplantation.

  8. Comparison of transperitoneal and retroperitoneal laparoscopic living donor nephrectomy

    Institute of Scientific and Technical Information of China (English)

    GAO Zhen-li; WANG Ke; WU Ji-tao; LIU Yu-jie; LIN Chun-hua; WANG Lin; SHI Lei; MEN Chang-ping; ZHANG Peng; YANG Dian-dong

    2007-01-01

    @@ Since its introduction in 1995,laparoscopic living donor nephrectomy (LDN) has been shown to alleviate postoperative pain,shorten hospital stay,reduce loss and improve cosmesis while hastening the recovery of normal activities of donors.1-3 However,there has been much controversy over minimally invasive surgery with transperitoneal or retroperitoneal approach for nephrectomy.In this non-randomized retrospective study,we analyzed some parameters of the donors who had undergone transperitoneal LDN compared with those who had had retroperitoneoscopic nephrectomy.

  9. Right Gastroepiploic Artery as an Alternative for Arterial Reconstruction in Living Donor Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Klaus Steinbrück

    2014-01-01

    Full Text Available Background. An adequate blood flow is directly related to graft survival in living donor liver transplantation. However, in some cases, unfavorable conditions prevent the use of the hepatic artery for arterial reconstruction. Herein, we report a case in which the recipient right gastroepiploic artery was used as an option for arterial reconstruction in adult-to-adult living donor liver transplantation. Case Report. A 62-year-old woman, with cirrhosis due to hepatitis B associated with hepatocellular carcinoma, was submitted to living donor liver transplantation. During surgery, thrombosis of the hepatic artery with intimal dissection until the celiac trunk was observed, which precluded its use in arterial reconstruction. We decided to use the right gastroepiploic artery for arterial revascularization of the liver graft. Despite the discrepancy in size between donor hepatic artery and recipient right gastroepiploic artery, anastomosis was performed successfully. Conclusions. The use of the right gastroepiploic artery as an alternative for arterial revascularization of the liver graft in living donor liver transplantation should always be considered when the hepatic artery of the recipient cannot be used. For performing this type of procedure, familiarity with microsurgical techniques by the surgical team is necessary.

  10. Donor exclusion in the National Blood Service Tissue Services living bone donor programme.

    Science.gov (United States)

    Pink, F; Warwick, R M; Purkis, J; Pearson, J

    2006-01-01

    National Blood Service (NBS) Tissue Services (TS) operates living donor and deceased donor tissue banking programmes. The living bone donor programme operates in collaboration with 91 orthopaedic departments across the country and collects bone donations, in the form of surgically removed femoral heads (FHs), from over 5,000 patients per annum undergoing total hip replacement. Bone donated via the living programme constitutes approximately 55% of the total bone donated to NBS. Non-NBS tissue banks, primarily in hospital orthopaedic departments, also bank donated bone for the UK. A survey of information received from 16 collaborating orthopaedic centres, between April 2003 and August 2004, identified 709 excluded donors. The total number of donations banked from these sites was 1,538. Donations can be excluded before collection if there are contraindications noted in a potential donor's medical history before their operation. Donors may also be excluded after collection of the FH, for instance because of reactive microbiology tests for blood borne viruses, or if the donation storage conditions or related documentation have not met stringent quality requirements. In this survey, bone or joint conditions were the major reasons for excluding potential donors before donation (154 of 709 exclusions, 22%), followed by a current or a past history of malignancy (139 of 709 exclusions, 20%). Local staffing and operational difficulties sometimes resulted in potential donors being missed, or specific reasons for exclusion not being reported (117 exclusions). These out numbered exclusions due to patient refusal (80 exclusions). A small number (quality. Training to ensure that standards are complied with and a firm evidence base for exclusion criteria, applied uniformly, will help focus donor identification efforts on individuals meeting rational criteria so that fewer potential donations are lost. PMID:16511660

  11. Donor exclusion in the National Blood Service Tissue Services living bone donor programme.

    Science.gov (United States)

    Pink, F; Warwick, R M; Purkis, J; Pearson, J

    2006-01-01

    National Blood Service (NBS) Tissue Services (TS) operates living donor and deceased donor tissue banking programmes. The living bone donor programme operates in collaboration with 91 orthopaedic departments across the country and collects bone donations, in the form of surgically removed femoral heads (FHs), from over 5,000 patients per annum undergoing total hip replacement. Bone donated via the living programme constitutes approximately 55% of the total bone donated to NBS. Non-NBS tissue banks, primarily in hospital orthopaedic departments, also bank donated bone for the UK. A survey of information received from 16 collaborating orthopaedic centres, between April 2003 and August 2004, identified 709 excluded donors. The total number of donations banked from these sites was 1,538. Donations can be excluded before collection if there are contraindications noted in a potential donor's medical history before their operation. Donors may also be excluded after collection of the FH, for instance because of reactive microbiology tests for blood borne viruses, or if the donation storage conditions or related documentation have not met stringent quality requirements. In this survey, bone or joint conditions were the major reasons for excluding potential donors before donation (154 of 709 exclusions, 22%), followed by a current or a past history of malignancy (139 of 709 exclusions, 20%). Local staffing and operational difficulties sometimes resulted in potential donors being missed, or specific reasons for exclusion not being reported (117 exclusions). These out numbered exclusions due to patient refusal (80 exclusions). A small number (quality. Training to ensure that standards are complied with and a firm evidence base for exclusion criteria, applied uniformly, will help focus donor identification efforts on individuals meeting rational criteria so that fewer potential donations are lost.

  12. ِAnalysis of donor motivations in living donor liver transplantation

    Directory of Open Access Journals (Sweden)

    Hesham eAbdeldayem

    2014-07-01

    Full Text Available Objectives: The introduction of the living donor liver transplantation (LDLT in Egypt as in elsewhere, has raised important psychological conflicts and ethical questions. The objective of this study was to get better understanding of the potential donors’ motives towards LDLT.Methods:This study was conducted on consecutive 193 living –liver donors who underwent partial hepatectomy as donors for LDLT during the period between April 2003 and January 2013, at the National Liver Institute Menoufeyia University, Egypt. Potential donors were thoroughly evaluated preoperatively through a screening questionnaire and interviews as regard their demographic data, relationship to the potential recipient and motives towards proceeding to surgery. They were assured that the information shared between them and the transplant centre is confidential. Results.The donors’ mean age was 25.53± 6.39 years with a range of 18-45 years. Males represented 64.7 % and females were 35.3%. The most common donors (32.1%, n_62, were sons and daughters to their parents (sons: n_43, daughters: n_19 while parents to their offsprings represent 15% (mothers: n_21, fathers: n_8. Brothers and sisters represent 16.5 % (brothers: n_22, sisters: n_10. Nephews & nieces giving their uncles or aunts were 14%. The number of wives donating to their husbands was 11 (5.7%. Interestingly, there was no single husband who donated his wife. Among the remaining donors, there were 11 cousins & one uncle. Unrelated donors were 20 (10.4%. Several factors seemed to contribute to motivation for donation: the seriousness of the potential recipient condition, the relationship and personal history of the donor to the potential recipient, the religious beliefs, the trust in the health care system, and family dynamics and obligations.Conclusions. Absolute absence of coercion on the living-liver donor’s motives may not be realistic because of the serious condition of the potential recipient. It is

  13. Life insurance for living kidney donors: a Canadian undercover investigation.

    Science.gov (United States)

    Yang, R C; Young, A; Nevis, I F P; Lee, D; Jain, A K; Dominic, A; Pullenayegum, E; Klarenbach, S; Garg, A X

    2009-07-01

    Some living kidney donors encounter difficulties obtaining life insurance, despite previous surveys of insurance companies reporting otherwise. To better understand the effect of donation on insurability, we contacted offices of life insurance companies in five major cities in Canada to obtain $100 000 of life insurance (20-year term) for 40 fictitious living kidney donors and 40 paired controls. These profiles were matched on age, gender, family history of kidney disease and presence of hypertension. The companies were blinded to data collection. The study protocol was reviewed by the Office of Research Ethics. The main study outcomes were the annual premium quoted and total time spent on the phone with the insurance agent. All donor and control profiles received a quote, with no significant difference in the premium quoted (medians $190 vs. $209, p = 0.89). More time was spent on the phone for donor compared to control profiles, but the absolute difference was small (medians 9.5 vs. 7.0 min, p = 0.046). Age, gender, family history of kidney disease and new-onset hypertension had no further effect on donor insurability in regression analysis. We found no evidence that kidney donors were disadvantaged in the first step of applying for life insurance. The effect donation has on subsequent phases of insurance underwriting remains to be studied.

  14. Life insurance for living kidney donors: a Canadian undercover investigation.

    Science.gov (United States)

    Yang, R C; Young, A; Nevis, I F P; Lee, D; Jain, A K; Dominic, A; Pullenayegum, E; Klarenbach, S; Garg, A X

    2009-07-01

    Some living kidney donors encounter difficulties obtaining life insurance, despite previous surveys of insurance companies reporting otherwise. To better understand the effect of donation on insurability, we contacted offices of life insurance companies in five major cities in Canada to obtain $100 000 of life insurance (20-year term) for 40 fictitious living kidney donors and 40 paired controls. These profiles were matched on age, gender, family history of kidney disease and presence of hypertension. The companies were blinded to data collection. The study protocol was reviewed by the Office of Research Ethics. The main study outcomes were the annual premium quoted and total time spent on the phone with the insurance agent. All donor and control profiles received a quote, with no significant difference in the premium quoted (medians $190 vs. $209, p = 0.89). More time was spent on the phone for donor compared to control profiles, but the absolute difference was small (medians 9.5 vs. 7.0 min, p = 0.046). Age, gender, family history of kidney disease and new-onset hypertension had no further effect on donor insurability in regression analysis. We found no evidence that kidney donors were disadvantaged in the first step of applying for life insurance. The effect donation has on subsequent phases of insurance underwriting remains to be studied. PMID:19519823

  15. Minimally invasive surgery for live kidney donors: techniques and challenges.

    Science.gov (United States)

    Brook, Nicholas R; Nicholson, Michael L

    2005-09-01

    Live kidney donation is assuming an increasingly prominent role in kidney transplantation programs. The traditional operative approach has been through an incision in the upper quadrant of the abdomen or in the loin, with the attendant potential postoperative complications associated with a large surgical wound. These problems may act as disincentives to prospective donors. The introduction of laparoscopic donor surgery in 1995 heralded a new era offering reduced post-operative pain and improved cosmetic result. It is hoped that these benefits may counter some disincentives and thereby increase donation rates. Three minimal-access approaches and their advantages and disadvantages are described: classical laparoscopic, hand-assisted laparoscopic, and retroperitoneoscopic surgery. Published reports indicate extensive experience with the first 2 of these approaches and less experience with the latter. All 3 approaches present technical, physiological, and anatomical challenges in the context of retrieving an organ that is fit for transplantation. For minimal-access surgery to be accepted as the procedure of choice for live kidney donors, it must be demonstrated that morbidity is not transferred from donor to recipient when these techniques are used. Some concerns about these procedures are addressed. High-level evidence in the form of randomized controlled trials is generally lacking, but experiences of surgeons and patients suggest that, with appropriate modifications, these techniques are safe for both donors and allografts and also benefit donors' recovery. PMID:16252632

  16. Living unrelated donor kidney transplantation: A fourteen-year experience

    Directory of Open Access Journals (Sweden)

    Ignjatović Ljiljana

    2010-01-01

    Full Text Available Background. In countries without a national organization for retrieval and distribution of organs of the deceased donors, problem of organ shortage is still not resolved. In order to increase the number of kidney transplantations we started with the program of living unrelated - spousal donors. The aim of this study was to compare treatment outcome and renal graft function in patients receiving the graft from spousal and those receiving ghe graft from living related donors. Method. We retrospectively identified 14 patients who received renal allograft from spousal donors between 1996 and 2009 (group I. The control group consisted of 14 patients who got graft from related donor retrieved from the database and matched than with respect to sex, age, kidney disease, immunological and viral pretransplant status, the initial method of the end stage renal disease treatment and ABO compatibility. In the follow-up period of 41 ± 38 months we recorded immunosuppressive therapy, surgical complications, episodes of acute rejection, CMV infection and graft function, assessed by serum creatinine levels at the beginning and in the end of the follow-up period. All patients had pretransplant negative cross-match. In ABO incompatible patients pretransplant isoagglutinine titer was zero. Results. The patients with a spousal donor had worse HLA matching. There were no significant differences between the groups in surgical, infective, immunological complications and graft function. Two patients from the group I returned to hemodialysis after 82 and 22 months due to serious comorbidities. Conclusion. In spite of the worse HLA matching, graft survival and function of renal grafts from spousal donors were as good as those retrieved from related donors.

  17. Cardiovascular Effects of Unilateral Nephrectomy in Living Kidney Donors

    OpenAIRE

    Moody, William E.; Ferro, Charles J.; Edwards, Nicola C.; Colin D Chue; Lin, Erica Lai Sze; Taylor, Robin J; Cockwell, Paul; Steeds, Richard P; Townend, Jonathan N.; ,

    2016-01-01

    Abstract— There is a robust inverse graded association between glomerular filtration rate (GFR) and cardiovascular risk, but proof of causality is lacking. Emerging data suggest living kidney donation may be associated with increased cardiovascular mortality although the mechanisms are unclear. We hypothesized that the reduction in GFR in living kidney donors is associated with increased left ventricular mass, impaired left ventricular function, and increased aortic stiffness. This was a mult...

  18. Recurrence of cholestatic liver disease after living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Sumihito Tamura; Masatoshi Hakuuchi; Yasuhiko Sugawara; Junichi Kaneko; Junichi Togashi; Yuichi Matsui; Noriyo Yamashiki; Norihiro Kokudo

    2008-01-01

    End-stage liver disease,due to cholestatic liver diseases with an autoimmune background such as primary biliary cirrhosis(PBC)and primary sclerosing cholangitis(PSC),is considered a good indication for liver transplantation.Excellent overall patient and graft outcomes,based mostly on the experience from deceased donor liver ransplantation(DDLT),have been reported.Due to the limited number of oraan donations from deceased donors in most Asian countries,living donor liver transplantation(LDLT)is the mainstream treatment for end-stage liver disease,including that resulting from PBC and PSC.Although the initial experiences with LDLT for PBC and PSC seem satisfactory or comparable to that with DLT,some aspects,including the timing of transplantation,the risk of recurrent disease,and its long-term clinical implications,require further evaluation.Whether or not the long-term outcomes of LDLT from a biologically related donor are equivalent to that of DDLT requires further observations.The clinical course following LDLT may be affected by he genetic background shared between the recipient and the living related donor.(C)2008 The WJG Press.All rights reserved.

  19. Multidetector row-CT in evaluation of living renal donors

    Institute of Scientific and Technical Information of China (English)

    ZHANG Ji-qing; HU Xiao-peng; WANG Wei; LI Xiao-bei; YIN Hang; ZHANG Xiao-dong

    2010-01-01

    Background Multidetector-row CT (MDCT) has been evolving to the standard evaluating method of potential living donor in most centers, and can provide excellent details for selecting candidates and determining surgical technique.This study aimed to assess the value of MDCT in evaluation of the anatomy of living kidney donors and to reveal the prevalence of renal vascular variations in a Chinese population.Methods One hundred and four potential donors underwent MDCT and the data sets were post-processed for reformatted images with various techniques, such as maximum intensity projection (MIP), a volume-rendering technique (VR), and multiplanar reformation (MPR). Donor nephrectomies were performed on 97 candidates after MDCT evaluation with the findings during surgery constituting the standard of reference. Resulting MDCT images were compared with actual anatomy found during surgery. Results The MDCT images accurately displayed the anatomic structure of the main renal arteries and veins as well as the upper ureters, except in one case with horseshoe kidney. The prevalence of accessory arteries revealed in images was 27.2% (28/103) and early branching was found in 12.6% (13/103). Compared with findings during surgery, the detection of accessory arteries in MDCT images was 85.7% (6/7), and the detection of larger accessory arteries (>1.5 mm in diameter) was 100%. Detection of early branching was 100%.Conclusion MDCT helps accurately evaluate the renal anatomy of potential donors thus facilitating the planning of surgery.

  20. Quality of life and psychological outcome of donors after living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Shu-Guang Jin; Bo Xiang; Lu-Nan Yan; Zhe-Yu Chen; Jia-Ying Yang; Ming-Qing Xu; Wen-Tao Wang

    2012-01-01

    AIM: To investigate the health related quality of life (HRQoL) and psychological outcome of donors after living donor liver transplantation. METHODS: Participants were 92 consecutive liver transplant donors who underwent hepatectomy without middle hepatic vein at West China Hospital of Sichuan University between January 2007 and September 2010. HRQoL was measured using the Chinese version of the Medical Outcomes Study Short Form-36 (SF-36), and psychological symptoms were measured using the Symptom Checklist-90-Revised (SCL-90-R). Data collected from donors were compared to previously published data from the general population. Clinical and demographic data were collected from medical records and questionnaires. RESULTS: The general health score of the SF-36 was significantly lower in females (59.78 ± 12.25) than in males (75.83 ± 22.09). Donors more than 40 years old scored higher in social functioning (85.71 ± 14.59) and mental health (82.61 ± 20.00) than those younger than 40 (75.00 ± 12.13, 68.89 ± 12.98; social functioning and mental health, respectively). Donors who had surgery more than two years prior to the study scored highest in physical functioning (P = 0.001) and bodily pain (P = 0.042) while those less than one year from surgery scored lowest. The health of the liver recipient significantly influenced the general health (P = 0.042), social functioning (P = 0.010), and roleemotional (P = 0.028) of donors. Donors with full-time employment scored highest in role-physical (P = 0.005), vitality (P = 0.001), social functioning (P = 0.016), mental health (P < 0.001), the physical component summary scale (P < 0.001), and the mental component summary scale (MCS) (P < 0.001). Psychological measures indicated that donors were healthier than the general population in obsessive-compulsive behavior, interpersonal sensitivity, phobic anxiety, and paranoid ideation. The MCS of the SF-36 was significantly correlated with most symptom scores of the SCL-90-R

  1. Clinical study of 28 patients with adult-to-infant living donor liver transplantation%28例婴儿活体肝移植的临床分析

    Institute of Scientific and Technical Information of China (English)

    张明满; 严律南; 蒲从伦; 李英存; 康权; 郭春宝; 戴小科; 任志美; 邓玉华

    2010-01-01

    目的 总结成人活体供肝婴儿肝移植临床经验,分析术后疗效、并发症及其原因.方法 回顾性分析我院28例成人活体供肝婴儿活体肝移植供、受者临床资料,手术策略、术后治疗和并发症发生情况及其原因.婴儿受者男性和女性各14例,均为胆道闭锁伴胆汁性肝硬化失代偿患者.移植时年龄80d~11.5个月、体质量3.08~10.3 kg;供者分别为:母亲15例,父亲9例、祖母3例和堂兄1例;供肝为:左外叶肝脏27例、Ⅱ段肝脏1例.随访时间5~24个月.结果 术后供者均顺利出院、无并发症发生;20例(71.4%)受者术后出现24个并发症,包括:肝动脉血栓形成4例,肝静脉狭窄1例,腹腔出血4例,肠穿孔4例,肠梗阻2例,呼吸道感染7例,排异反应3例等.围手术期因肝动脉血栓形成死亡3例(10.7%),手术成功率为89.3%.随访期内1例因肝静脉狭窄死亡,另1例因意外食物窒息死亡,其余23例(82.1%)健康生活至本研究结束.结论 成人活体供肝婴儿肝移植是治疗婴儿终末期肝病的有效方法,血管并发症是术后婴儿受者死亡的主要原因.%Objective To summarize our experience in adult-to-infant living donor liver transplantation (A-ILDLT) and to analyze the efficacy and complications of A-ILDLT. Methods The clinical data, surgical strategies and complications of 28 adult donors and infantile recipients who underwent A-ILDLT from April 2006 to December 2009 were retrospectively analyzed. These 28 patients (14 boys and 14 girls) aged from 80 days to 11.5 months with body weights of 3.08 to 10.3 kg at the time of operation. They suffered from biliary atresia with decompensated cirrhosis. The living donors were 15 mothers, 9 fathers, 3 grandma and 1 elder brother with ABO compatible with the infantile recipients. 27 Donor organs were the left lateral lobe grafts (segment Ⅱ, Ⅲ) and 1 graft was segment Ⅱ. All patients were followed up for 5 to 24 months. Results These grafts were

  2. Management of venous stenosis in living donor liver transplant recipients

    Institute of Scientific and Technical Information of China (English)

    Jie Yang; Ming-Qing Xu; Lu-Nan Yan; Wu-Sheng Lu; Xiao Li; Zheng-Rong Shi; Bo Li; Tian-Fu Wen; Wen-Tao Wang; Jia-Ying Yang

    2009-01-01

    AIM: To retrospectively evaluate the management and outcome of venous obstruction after living donor liver transplantation (LDLT).METHODS: From February 1999 to May 2009, 1 intraoperative hepatic vein (HV) tension induced HV obstruction and 5 postoperative HV anastomotic stenosis occurred in 6 adult male LDLT recipients. Postoperative portal vein (PV) anastomotic stenosis occurred in 1 pediatric left lobe LDLT. Patients ranged in age from 9 to 56 years (median, 44 years). An air balloon was used to correct the intraoperative HV tension. Emergent surgical reoperation, transjugular HV balloon dilatation with stent placement and transfemoral venous HV balloon dilatation was performed for HV stenosis on days 3, 15, 50, 55, and 270 after LDLT, respectively. Balloon dilatation followed with stent placement via superior mesenteric vein was performed for the pediatric PV stenosis 168 d after LDLT.RESULTS: The intraoperative HV tension was corrected with an air balloon. The recipient who underwent emergent reoperation for hepatic stenosis died of hemorrhagic shock and renal failure 2 d later. HV balloon dilatation via the transjugular and transfemoral venous approach was technically successful in all patients. The patient with early-onset HV stenosis receiving transjugular balloon dilatation and stent placement on the 15th postoperative day left hospital 1 wk later and disappeared, while the patient receiving the same interventional procedures on the 50th postoperative day died of graft failure and renal failure 2 wk later. Two patients with late-onset HV stenosis receiving balloon dilatation have survived for 8 and 4 mo without recurrent stenosis and ascites, respectively. Balloon dilatation and stent placement via the superior mesenteric venous approach was technically successful in the pediatric left lobe LDLT, and this patient has survived for 9 mo without recurrent PV stenosis and ascites.CONCLUSION: Intraoperative balloon placement, emergent reoperation, proper

  3. Ethical issues regarding related and nonrelated living organ donors.

    Science.gov (United States)

    Testa, Giuliano

    2014-07-01

    The ethics of the clinical practice of transplanting human organs for end-stage organ disease is a fascinating topic. Who is the "owner" of the transplantable organs of a deceased, brain-dead patient? Who should have a right to receive these organs? Who set the boundaries between a living donor's autonomy and a "paternalistic" doctor? What constitutes a proper consent? These questions are only some of the ethical issues that have been discussed in the last 60 years. All of these ethical issues are intensified by the fact that supply of human organs does not match demand, and that, as a consequence, living-donor organ transplantation is widely utilized. The aim of this article is not to be exhaustive but to present the general ethical principles of beneficence, nonmaleficence, and justice as applied to organ transplantation. Moreover, the topic of reimbursement for organ donation is also discussed. PMID:24705806

  4. Delayed Gastric Emptying after Living Donor Hepatectomy for Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Hanjay Wang

    2014-01-01

    Full Text Available Delayed gastric emptying is a significant postoperative complication of living donor hepatectomy for liver transplantation and may require endoscopic or surgical intervention in severe cases. Although the mechanism of posthepatectomy delayed gastric emptying remains unknown, vagal nerve injury during intraoperative dissection and adhesion formation postoperatively between the stomach and cut liver surface are possible explanations. Here, we present the first reported case of delayed gastric emptying following fully laparoscopic hepatectomy for living donor liver transplantation. Additionally, we also present a case in which symptoms developed after open right hepatectomy, but for which dissection for left hepatectomy was first performed. Through our experience and these two specific cases, we favor a neurovascular etiology for delayed gastric emptying after hepatectomy.

  5. Ethical issues relating to renal transplantation from prediabetic living donor

    OpenAIRE

    Ferreira-Hermosillo, Aldo; Valdez-Martínez, Edith; Bedolla, Miguel

    2014-01-01

    Background In Mexico, diabetes mellitus is the main cause of end − stage kidney disease, and some patients may be transplant candidates. Organ supply is limited because of cultural issues. And, there is a lack of standardized clinical guidelines regarding organ donation. These issues highlight the tension surrounding the fact that living donors are being selected despite being prediabetic. This article presents, examines and discusses using the principles of non-maleficience, autonomy, justic...

  6. Living unrelated kidney donors: ethical aspects of living kidney donation in Brazil.

    Science.gov (United States)

    Ferreira, Gustavo Fernandes; Guedes, Clarissa Diniz

    2011-01-01

    Brazil has established the largest public kidney transplantation system in the world .46.2% of transplants in 2008 came from living donors. The vast majority of these involved relatives of the recipient; less than 8% came from unrelated donors. In 2008, Brazil's health minister proposed banning unrelated donors in kidney transplantation. A large number of the over 35,000 Brazilians on the waiting list for a kidney would be denied a transplant without the use of unrelated donors. Brazilian culture has a unique feature, the "informal family", that is not legally recognised as a "family entity and is bound by affection rather than genetic or legal ties. It is vital that Brazil establishes a regulated, standardised, and ethical system of organ procurement; creates awareness about transplantation in physicians and the public; upgrades facilities and standardises medical care, and enforces legislation for transplantation. However, outlawing the use of unrelated donors would result in injustice for many patients who seek kidneys.

  7. Hand-assisted right laparoscopic nephrectomy in living donor

    Directory of Open Access Journals (Sweden)

    Fernando Meyer

    2005-02-01

    Full Text Available OBJECTIVE: To assess results obtained with the authors' technique of right hand-assisted laparoscopic nephrectomy in living kidney donors. MATERIALS AND METHODS: We retrospectively analyzed 16 kidney donors who underwent hand-assisted right laparoscopic nephrectomy from February 2001 to July 2004. Among these patients, 7 were male and 9 were female, with mean age ranging between 22 and 58 years (mean 35.75. RESULTS: Surgical time ranged from 55 to 210 minutes (mean 127.81 min and warm ischemia time from 2 to 6 minutes (mean 3.78 min with mean intra-operative blood loss estimated at 90.62 mL. There was no need for conversion in any case. Discharge from hospital occurred between the 3rd and 6th days (mean 3.81. On the graft assessment, immediate diuresis was seen in 15 cases (93.75% and serum creatinine on the 7th post-operative day was 1.60 mg/dL on average. Renal vein thrombosis occurred in 1 patient (6.25% who required graft removal, and lymphocele was seen in 1 recipient (6.25%. CONCLUSION: Hand-assisted right laparoscopic nephrectomy in living donors is a safe and effective alternative to open nephrectomy. Despite a greater technical difficulty, the procedure presented low postoperative morbidity providing good morphological and functional quality of the graft on the recipient.

  8. Hand-assisted laparoscopic nephrectomy in living donor

    Directory of Open Access Journals (Sweden)

    Luiz S. Santos

    2003-02-01

    Full Text Available OBJECTIVE: Report the authors’ initial experience with hand-assisted laparoscopic nephrectomy technique in renal donors for transplantation. MATERIALS AND METHODS: Twenty-seven donors submitted to hand-assisted laparoscopic nephrectomy were retrospectively analyzed from February 2001 to June 2002. Technical aspects of the donor surgery, results, and complications, are discussed, as well as recipient’s complications and outcomes. RESULTS: Among 27 hand-assisted laparoscopic nephrectomies, left kidney was withdrew in 18 donors (66.6%, and right kidney in 9 (33.3%. The operative time ranged from 55 to 210 minutes (mean 132.7 ± 37.6 min, and the time of hot ischemia ranged from 2 to 11 minutes (mean 4.7 ± 2.5 min, with an estimated mean blood loss during the intraoperative period of 133.3 mL. Conversion to open surgery was necessary for 1 (3.7% patient due to vascular lesion. In graft evaluation, immediate diuresis was observed in 26 (96.3% cases, and mean serum creatinine in PO day 7 was 1.5 ± 1.1 mg/dL. Renal vein thrombosis occurred in 1 (3.7% patient requiring graft removal. Lymphocele was observed in 3 recipients (11.1%, and urinary leakage due to ureteral necrosis in 1 case (3.7%. CONCLUSION: Hand-assisted laparoscopic nephrectomy in living donors is a safe procedure and an effective alternative to open nephrectomy. In this series, the procedure presented low morbidity after surgery providing to the recipient a good morphological and functional quality of the graft.

  9. Live donor hepatectomy for liver transplantation in Egypt: Lessons learned

    Directory of Open Access Journals (Sweden)

    Emad Kamel

    2012-01-01

    Full Text Available Purpose: To retrospectively review anesthesia and intensive care management of 145 consented volunteers subjected to right lobe or left hepatectomy between 2003 and 2011. Methods: After local ethics committee approval, anesthetic and intensive care charts, blood transfusion requirements, laboratory data, complications and outcome of donors were analyzed. Results: One hundred and forty-three volunteers successfully tolerated the surgery with no blood transfusion requirements, but with a morbidity rate of (50.1%. The most frequent complication was infection (21.1% (intraabdominal collections, followed by biliary leak (18.2%. Two donors had major complications: one had portal vein thrombosis (PVT treated with vascular stent. This patient recovered fully. The other donor had serious intraoperative bleeding and developed postoperative PVT and liver and renal failure. He died after 12 days despite intensive treatment. He was later reported among a series of fatalities from other centers worldwide. Epidural analgesia was delivered safely (n=90 with no epidural hematoma despite significantly elevated prothrombin time (PT and international normalization ratio (INR postoperatively, reaching the maximum on Day 1 (16.9±2.5 s and 1.4±0.2, P<0.05 when compared with baseline. Hypophosphatemia and hypomagnesemia were frequently encountered. Total Mg and phosphorus blood levels declined significantly to 1.05±0.18 mg/dL on Day 1 and 2.3±0.83 mg/dL on Day 3 postoperatively. Conclusions: Coagulation and electrolytes need to be monitored perioperatively and replaced adequately. PT and INR monitoring postoperatively is still necessary for best timing of epidural catheter removal. Live donor hepatectomy could be performed without blood transfusion. Bile leak and associated infection of abdominal collections requires further effort to better identify biliary leaks and modify the surgical closure of the bile ducts. Donor hepatectomy is definitely not a complication

  10. Factors influencing liver and spleen volume changes after donor hepatectomy for living donor liver transplantation

    International Nuclear Information System (INIS)

    To define the changes in liver and spleen volumes in the early postoperative period after partial liver donation for living-donor liver transplantation (LDLT) and to determine factors that influence liver and spleen volume changes. 27 donors who underwent partial hepatectomy for LDLT were included in this study. The rates of liver and spleen volume change, measured with CT volumetry, were correlated with several factors. The analyzed factors included the indocyanine green (ICG) retention rate at 15 minutes after ICG administration, preoperative platelet count, preoperative liver and splenic volumes, resected liver volume, resected-to-whole liver volume ratio (LVR/LVW), resected liver volume to the sum of whole liver and spleen volume ratio [LVR/(LVW + SV0)], and pre and post hepatectomy portal venous pressures. In all hepatectomy donors, the volumes of the remnant liver and spleen were increased (increased rates, 59.5 ± 50.5%, 47.9 ± 22.6%). The increment rate of the remnant liver volume revealed a positive correlation with LVR/LVW (r = 0.759, p R/LVW influences the increment rate of the remnant liver volume.

  11. Factors influencing liver and spleen volume changes after donor hepatectomy for living donor liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Ji Hee; Ryeom, Hunku; Song, Jung Hup [Kyungpook National University Hospital, Daegu (Korea, Republic of)

    2013-11-15

    To define the changes in liver and spleen volumes in the early postoperative period after partial liver donation for living-donor liver transplantation (LDLT) and to determine factors that influence liver and spleen volume changes. 27 donors who underwent partial hepatectomy for LDLT were included in this study. The rates of liver and spleen volume change, measured with CT volumetry, were correlated with several factors. The analyzed factors included the indocyanine green (ICG) retention rate at 15 minutes after ICG administration, preoperative platelet count, preoperative liver and splenic volumes, resected liver volume, resected-to-whole liver volume ratio (LV{sub R}/LV{sub W}), resected liver volume to the sum of whole liver and spleen volume ratio [LV{sub R}/(LV{sub W} + SV{sub 0})], and pre and post hepatectomy portal venous pressures. In all hepatectomy donors, the volumes of the remnant liver and spleen were increased (increased rates, 59.5 ± 50.5%, 47.9 ± 22.6%). The increment rate of the remnant liver volume revealed a positive correlation with LV{sub R}/LV{sub W} (r = 0.759, p < 0.01). The other analyzed factors showed no correlation with changes in liver and spleen volumes. The spleen and remnant liver volumes were increased at CT volumetry performed 2 weeks after partial liver donation. Among the various analyzed factors, LV{sub R}/LV{sub W} influences the increment rate of the remnant liver volume.

  12. 42 CFR 482.94 - Condition of participation: Patient and living donor management.

    Science.gov (United States)

    2010-10-01

    ... the donor evaluation, donation, and discharge phases of living organ donation. (a) Standard: Patient... donor management. 482.94 Section 482.94 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Condition of participation: Patient and living donor management. Transplant centers must have...

  13. Nutrition assessment and counseling of the medically complex live kidney donor.

    Science.gov (United States)

    Bergen, Carol R; Reese, Peter P; Collins, Donna

    2014-04-01

    Kidney transplantation is the preferred option for patients with end-stage renal disease facing the need for dialysis because it provides maximum survival benefit. The number of people seeking kidney transplantation greatly exceeds available deceased donor organs. Organs from live donors provide a survival advantage over organs from deceased donors while also broadening the pool of available organs. The purpose of this review is to discuss the clinical guidelines that pertain to live kidney organ donation and to describe the nutrition evaluation and care of live kidney donors. The process for living kidney donation is dictated by policies centered on protecting the donor. In a perfect world, the living donor would present with a flawless medical examination and a benign family health history. The obesity epidemic has emerged as a major health concern. Live donor programs are faced with evaluating increasing numbers of obese candidates. These "medically complex donors" may present with obesity and its associated comorbid conditions, including hypertension, impaired glycemic control, and kidney stone disease. The dietitian's role in the live donor program is not well defined. Participation in the living donor selection meeting, where details of the evaluation are summarized, provides a platform for risk stratification and identification of donors who are at increased lifetime risk for poor personal health outcomes. Guiding the donor toward maintenance of a healthy weight through diet and lifestyle choices is a legitimate goal to minimize future health risks. PMID:24523133

  14. Management of the middle hepatic vein and its tributaries in right lobe living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Peng-Fei Yu; Jian Wu; Shu-Sen Zheng

    2007-01-01

    BACKGROUND: Left liver graft from a small donor will not meet the metabolic demands of a larger adult recipient. To overcome the problem of graft size insufifciency, living donor liver transplantation (LDLT) using the right lobe has become a standard method for adult patients. As the drainage of the median sector (segmentsⅤ, Ⅷ andⅣ) is mainly by the middle hepatic vein (MHV), the issue of whether the MHV should or should not be taken with the graft or whether the MHV tributaries (Ⅴ5,Ⅴ8) should be reconstructed in the recipient remains to be settled. DATA SOURCES:An English-language literature search was conducted using MEDLINE (1985-2006) on right lobe living donor liver transplantation, middle hepatic vein, vein graft, hepatic venoplasty and other related subjects. RESULTS: Some institutions had proposed their policy for the management of the MHV and its tributaries. Dominancy of the hepatic vein, graft-to-recipient weight ratio, and remnant liver volume as well as the donor-to-recipient body weight ratio, the volume of the donor's right lobe to the recipient's standard liver volume and the size of MHV tributaries are the major elements for the criteria of inclusion of the MHV, while for the policy of MHV tributaries reconstruction, the proportion of congestive area and the diameter of the tributaries are the critical elements. Optimal vein grafts such as recipient's portal vein and hepatic venoplasty technique have been used to obviate hepatic congestion and venous drainage disturbance. CONCLUSIONS:Taking right liver grafts with the MHV trunk (extended right lobe grafts) or performing the MHV tributaries reconstruction in modiifed right lobe grafts, according to the criteria proposed by the institutions with rich experience, can solve the congestion problem of the right paramedian sector and help to improve the outcomes of the patients. The additional use of optimal vein grafts and hepatic venoplasty also can guarantee excellent venous drainage.

  15. Optimizing informed consent in living liver donors: Evaluation of a comprehension assessment tool.

    Science.gov (United States)

    Gordon, Elisa J; Mullee, Jack; Butt, Zeeshan; Kang, Joseph; Baker, Talia

    2015-10-01

    Adult-to-adult living liver donation is associated with considerable risks with no direct medical benefit to liver donors (LDs). Ensuring that potential LDs comprehend the risks of donation is essential to medically and ethically justify the procedure. We developed and prospectively evaluated the initial psychometrics of an "Evaluation of Donor Informed Consent Tool" (EDICT) designed to assess LDs' comprehension about the living donation process. EDICT includes 49 true/false/unsure items related to LD informed consent. Consecutive LDs undergoing evaluation at 1 academic medical center from October 2012 to September 2014 were eligible for participation in pretest/posttest interviews. Medical records were reviewed for postdonation complications. Twenty-seven LDs participated (96% participation rate). EDICT demonstrated good internal consistency reliability at pretest, 2 days before donating (Cronbach's α = 0.78), and posttest, 1 week after donating (α = 0.70). EDICT scores significantly increased over time (P = 0.01) and demonstrated good test-retest reliability (r = 0.68; P < 0.001). EDICT was associated with race/ethnicity (P = 0.02) and relationship to the recipient (P = 0.01; pretest), and income (P = 0.01) and insurance (P = 0.01; posttest), but not with decisional conflict, preoperative preparedness, satisfaction, or decisional regret (pretest and posttest). Donor complications did not impact postdonation EDICT scores. In conclusion, EDICT has promising measurement properties and may be useful in the evaluation of informed consent for potential LDs. PMID:25990592

  16. Glomerular filtration rate and segmental tubular function in the early phase after transplantation/uninephrectomy in recipients and their living-related kidney donors

    DEFF Research Database (Denmark)

    Kamper, A L; Holstein-Rathlou, N H; Strandgaard, S;

    1994-01-01

    1. Glomerular filtration rate and sequential tubular function were investigated in 18 adult renal transplant recipients and in their matched, adult living-related kidney donors before and 5 days after transplantation/uninephrectomy. At day 54, 13 donors and 11 recipients were re-investigated. Six......1. Glomerular filtration rate and sequential tubular function were investigated in 18 adult renal transplant recipients and in their matched, adult living-related kidney donors before and 5 days after transplantation/uninephrectomy. At day 54, 13 donors and 11 recipients were re......-investigated. Sixteen of these constituted eight matched pairs. This reduction in the study population was caused by the application of two withdrawal criteria. 2. In the recipients glomerular filtration rate was unchanged at day 5 and had increased to 61 ml/min at day 54 (P < 0.05). In the donors glomerular filtration...

  17. Psychosocial impact of pediatric living-donor kidney and liver transplantation on recipients, donors, and the family : a systematic review

    NARCIS (Netherlands)

    Thys, Kristof; Schwering, Karl-Leo; Siebelink, Marion; Dobbels, Fabienne; Borry, Pascal; Schotsmans, Paul; Aujoulat, Isabelle

    2015-01-01

    Living-donor kidney and liver transplantation intend to improve pediatric recipients' psychosocial well-being, but psychosocial impact in recipients strongly depends upon the impact on the donor and the quality of family relations. We systematically reviewed quantitative and qualitative studies addr

  18. Safety evaluation of donors for living-donor liver transplantation in Chinese mainland: A single-center report

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To discuss the safety of donors during living donor liver transplantation (LDLT) and the authors' experience with 50 cases.METHODS: Between January 1995 and March 2006, 50 patients with end-stage liver disease received LDLT in our department. Donors (at the age of 27-58 years) were healthy and antibody (ABO)-compatible. The protocol of evaluation and selection of donors, choice of surgical methods and strategy applied in the safety evaluation of donors were analyzed.RESULTS: A total of 115 candidate donors were evaluated for LDLT at our center. Of these, 50 underwent successful hepatectomy for living donation.The elimination rate for donors was 43.5%. Positive hepatitis serology and ABO incompatibility were the main factors for excluding candidates. All donors recovered uneventfully. The follow-up time ranged from 3 to 135 mo. The incidence of major and minor medical complications was 12.0% and 28.0%, respectively.CONCLUSION: LDLT provides an excellent approach to the problem of donor shortage in China. With a thorough and complete preoperative workup and meticulous intraand postoperative management, LDLT can be performed with minimal donor morbidity.

  19. Predictors of patient survival following living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Chuan Li; Tian-Fu Wen; Lu-Nan Yan; Bo Li; Jia-Ying Yang; Wen-Tao Wang; Ming-Qing Xu; Yong-Gang Wei

    2011-01-01

    BACKGROUND: Living donor liver transplantation (LDLT) is considered to be the alterative choice in light of the great shortage of cadaveric donors. However, the characteristics of the patients who will benefit from LDLT have not been well identified. The aim of this study was to define the pre- and intra-operative factors that may influence patient outcome. METHODS: The data from 102 LDLT patients who had operations between 2002 and 2009 were collected and analyzed retrospectively. Data were analyzed using uni- and multi-variate analysis according to factors that are known to be associated with outcome in these patients. RESULTS: Overall, the accurate survival rate of recipients at 1, 3, and 5 years was 84%, 76%, and 70%, respectively. The independent risk factors, preoperative renal dysfunction, intraoperative red blood cell transfusions of greater than 5 units, and female to male match (donor to recipient matching), were identified by Cox regression analysis. The pre-transplant model for end-stage liver disease score and a graft to recipient weight ratio of less than 0.8% were not predictive of outcome. The overall 1-, 3-, and 5-year survival of patients with one or no risk factors and two or more risk factors were 91%, 86%, and 83% and 67%, 56%, and 47%, respectively (P CONCLUSIONS: In our retrospective study, preoperative renal dysfunction, intraoperative red blood cell transfusions of greater than 5 units, and female to male gender match were independent risk factors for LDLT recipient outcome. Two or more of these risk factors may contribute to poor outcome.

  20. Psychosocial impact of pediatric living-donor kidney and liver transplantation on recipients, donors, and the family: a systematic review.

    Science.gov (United States)

    Thys, Kristof; Schwering, Karl-Leo; Siebelink, Marion; Dobbels, Fabienne; Borry, Pascal; Schotsmans, Paul; Aujoulat, Isabelle

    2015-03-01

    Living-donor kidney and liver transplantation intend to improve pediatric recipients' psychosocial well-being, but psychosocial impact in recipients strongly depends upon the impact on the donor and the quality of family relations. We systematically reviewed quantitative and qualitative studies addressing the psychosocial impact of pediatric living-donor kidney and liver transplantation in recipients, donors, and the family. In accordance with the PRISMA guidelines, we systematically searched the databases Medline, Web of Knowledge, Cinahl, Embase, ERIC, and Google Scholar. We identified 23 studies that satisfied our inclusion criteria. Recipients had improved coping skills and satisfactory peer relationships, but also reported anxiety and depressive symptoms, worried about the future, and had a negative body image. Similarly, donors experienced increased self-esteem, empowerment, and community awareness, but also complained of postoperative pain and a lack of emotional support. With respect to family impact, transplantation generated a special bond between the donor and the recipient, characterized by gratitude and admiration, but also raised new expectations concerning the recipient's lifestyle. As psychological problems in recipients were sometimes induced by feelings of guilt and indebtedness toward the donor, we recommend more research on how gift exchange dynamics function within donor-recipient relationships, enrolling donors and recipients within the same study.

  1. Intentions of becoming a living organ donor among Hispanics: a theory-based approach exploring differences between living and nonliving organ donation.

    Science.gov (United States)

    Siegel, Jason T; Alvaro, Eusebio M; Lac, Andrew; Crano, William D; Dominick, Alexander

    2008-01-01

    This research examines perceptions concerning living (n = 1,253) and nonliving (n = 1,259) organ donation among Hispanic adults, a group considerably less likely than the general population to become donors. Measures are derived from the Theory of Planned Behavior (Ajzen, 1991) and Vested Interest Theory (Crano, 1983, 1997). A substantial percentage of respondents reported positive attitudes and high personal stake concerning organ donation. Mean differences in norms, attitudes, intentions, and assumed immediacy of payoff were found between living and nonliving donor groups, suggesting that these two donation formats are dissimilar and should be examined independently. Accordingly, separate hierarchical multiple regression models were estimated for living and nonliving donation. Analyses supported both theoretical frameworks: Constructs associated with Planned Behavior and Vested Interest independently contributed to donor intentions. The implications of these results, and our recommendations for future health campaigns, are presented in light of these theoretical models. PMID:18307137

  2. Discontinuation of living donor liver transplantation for PSC due to histological abnormalities in intraoperative donor liver biopsy.

    Science.gov (United States)

    Hasegawa, Y; Kawachi, S; Shimazu, M; Hoshino, K; Tanabe, M; Fuchimoto, Y; Obara, H; Shinoda, M; Shimizu, H; Yamada, Y; Akatsu, T; Irie, R; Sakamoto, M; Morikawa, Y; Kitajima, M

    2007-09-01

    Liver transplantation is the only curative treatment known to date for end-stage liver disease occurring as a result of primary sclerosing cholangitis (PSC). Here, we report a case in which living donor liver transplantation (LDLT) for PSC was cancelled because of histological abnormalities in intraoperative biopsy of the donor liver. The donor was the mother of the recipient, and her preoperative evaluation revealed no abnormalities. In the donor operation, the donor liver biopsy revealed expansion of the portal zone with lymphocytic infiltration and dense concentric fibrosis developed around a bile duct. These histological findings were identical to those of early-stage PSC; therefore, the LDLT was called off. The experience in this case suggests that preoperative liver biopsy may be useful to exclude first-degree relative donors with potential PSC prior to LDLT for PSC.

  3. Effect of donor age on graft function and long-term survival of recipients undergoing living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Kai Wang; Wen-Tao Jiang; Yong-Lin Deng; Cheng Pan; Zhong-Yang Shen

    2015-01-01

    BACKGROUND: Donor shortage is the biggest obstacle in organ transplantation. Living donor liver transplantation (LDLT) has been considered as a valuable approach to short-ening waiting time. The objectives of this study were to inves-tigate the feasibility of utilizing donors older than 50 years in LDLT and to evaluate the graft function and recipient survival. METHODS: All LDLT cases (n=159) were divided into the older (donor age ≥50 years, n=10) and younger (donor age RESULTS: The median donor age was 58.5 (52.5-60.0) years in the older donor group and 25.0 (23.0-32.0) in the younger do-nor group. There was no significant difference in cold ischemic time, anhepatic phase and operation time between the older and younger donor groups (P>0.05). However, the volume of red blood cell transfused in operation was greater in the older donor group than in the younger donor group (1900 vs 1200 mL, P=0.023). The 1-, 3- and 5-year graft survival rates were 90%, 80% and 80% for the older donor group, and 92%, 87%and 87% for the younger donor group, respectively (P=0.459). The 1-, 3- and 5-year survival rates were 100%, 90% and 90%for recipients with older grafts, and 93%, 87% and 87% for those with younger grafts, respectively (P=0.811). CONCLUSION: It is safe for a LDLT recipient to receive liver from donors older than 50 years, and there is no significant adverse effect on graft function and long-term patients' survival.

  4. Living-donor vs deceased-donor liver transplantation for patients with hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Nobuhisa; Akamatsu; Yasuhiko; Sugawara; Norihiro; Kokudo

    2014-01-01

    With the increasing prevalence of living-donor liver transplantation(LDLT) for patients with hepatocellular carcinoma(HCC),some authors have reported a potential increase in the HCC recurrence rates among LDLT recipients compared to deceased-donor liver transplantation(DDLT) recipients.The aim of this review is to encompass current opinions and clinical reports regarding differences in the outcome,especially the recurrence of HCC,between LDLT and DDLT.While some studies report impaired recurrence- free survival and increased recurrence rates among LDLT recipients,others,including large database studies,report comparable recurrence- free survival and recurrence rates between LDLT and DDLT.Studies supporting the increased recurrence in LDLT have linked graft regeneration to tumor progression,but we found no association between graft regeneration/initial graft volume and tumor recurrence among our 125 consecutive LDLTs for HCC cases.In the absence of a prospective study regarding the use of LDLT vs DDLT for HCC patients,there is no evidence to support the higher HCC recurrence after LDLT than DDLT,and LDLT remains a reasonable treatment option for HCC patients with cirrhosis.

  5. Living kidney donor assessment: challenges, uncertainties and controversies among transplant nephrologists and surgeons.

    Science.gov (United States)

    Tong, A; Chapman, J R; Wong, G; Craig, J C

    2013-11-01

    The assessment of living kidney donors presents unique ethical challenges and complex psychosocial implications. This study aimed to ascertain the perspectives of transplant nephrologists and surgeons on living kidney donor assessment. Semi-structured, face-to-face interviews were conducted with 110 transplant nephrologists and surgeons from 43 transplant units in 12 countries from Europe, Australasia and North America. The challenge of defining acceptable risk to the donor was central to five themes identified: burden of responsibility (personal accountability, policing morality, democratic decision making, meeting legal obligations, optimizing outcomes and innovation, relinquished control); medical protectiveness (prognostic uncertainty, skepticism of donor risk perception, avoidance of undue coercion, concerns for dubious motivations and coercion, safeguard donor well-being, ethical information disclosure); respecting donor autonomy (facilitate informed-decision making, concede to donor risk acceptance, benefit of the doubt, donor mandate to maintain health, acceptable altruism); driving ideologies (preserving equity, championing living donation, cognizance of anti-paternalism) and contextual pressures (evolving donor demographic, resource limitations). Living kidney donor assessment involves complex interactions between safeguarding the donors' welfare and respecting their autonomy. In our opinion, authoritative and well-described transplant unit, hospital and public policy positions that make explicit the considerations that are often implicit may reduce the uncertainty within which living donors are assessed today. PMID:24020905

  6. Is biliary bile acid a good predictor for acute cellular rejection in living donor liver transplantation?

    Institute of Scientific and Technical Information of China (English)

    Mohammed Saied Hedaya; Walid M. El Moghazy; YamamotoYasutomo; Tomioka Kiyoshi; Toshimi Kaido; Hiroto Egawa; Shinji Uemoto; Yasutsugu Takada

    2009-01-01

    BACKGROUND: In liver transplantation, acute cellular rejection (ACR) is still a major complication that can lead to mortality. Bile secretion has been considered as a marker of early graft function. METHODS: The study included 41 adults who received living donor liver transplantation (LDLT) at Kyoto University Hospital between April 2007 and February 2008. The patients were stratified according to the presence or absence of ACR. Bile samples were collected from donors once and from recipients every other day for the first 2 weeks after transplantation. Total bile acid (BA) and taurine-conjugated bile acid (TCBA) in bile were measured by magnetic resonance spectroscopy. The recipient/donor (R/D) BA ratio and R/D TCBA ratio were calculated. RESULTS: The ACR group (n=12) showed a greater decrease in BA post-transplantation than the non-ACR group, but this difference was not statistically significant. On both day 7 and day 9 post-transplantation the R/D TCBA was significantly different between the two groups (P=0.038 on day 7 and P=0.036 on day 9). The R/D TCBA ratio ≥0.5 on days 7 and 9, and ≥0.38 on day 11 post-transplantation were associated with better ACR-free survival. CONCLUSION: The recipient/donor TCBA ratio can be a predictor for ACR after LDLT as early as post-transplantation day 7.

  7. Being Sherlock Holmes: the Internet as a tool for assessing live organ donors.

    Science.gov (United States)

    Bramstedt, Katrina A; Katznelson, Steven

    2009-01-01

    Donor advocacy is a critical feature of live donor transplantation. Donor Advocates and Donor Advocate Teams (DAT) are now routine to the practice of live donor evaluation in the USA. Multidisciplinary in nature, DATs gather both medical and psychosocial information about potential live organ donors and then render a decision as to whether or not these individuals are suitable to participate. Because of the critical ethical and psychosocial concerns about live donation, thorough donor evaluations are essential. Additionally, the information gathered must be accurate, and this requires honest disclosure by the donor candidate. In this paper, we describe how DATs can use various forms of free, public content available on the Internet to aid live donor assessments. In this way, the DAT assumes somewhat of an investigative role; however, this is ethically justified in light of the DAT duty to protect the donor. The protective effect can also spread to the transplant program, in general, when inappropriate donors are excluded from the donation process.

  8. Being Sherlock Holmes: the Internet as a tool for assessing live organ donors.

    Science.gov (United States)

    Bramstedt, Katrina A; Katznelson, Steven

    2009-01-01

    Donor advocacy is a critical feature of live donor transplantation. Donor Advocates and Donor Advocate Teams (DAT) are now routine to the practice of live donor evaluation in the USA. Multidisciplinary in nature, DATs gather both medical and psychosocial information about potential live organ donors and then render a decision as to whether or not these individuals are suitable to participate. Because of the critical ethical and psychosocial concerns about live donation, thorough donor evaluations are essential. Additionally, the information gathered must be accurate, and this requires honest disclosure by the donor candidate. In this paper, we describe how DATs can use various forms of free, public content available on the Internet to aid live donor assessments. In this way, the DAT assumes somewhat of an investigative role; however, this is ethically justified in light of the DAT duty to protect the donor. The protective effect can also spread to the transplant program, in general, when inappropriate donors are excluded from the donation process. PMID:19210684

  9. Outcomes of patients with benign liver diseases undergoing living donor versus deceased donor liver transplantation.

    Directory of Open Access Journals (Sweden)

    Chuan Li

    Full Text Available BACKGROUND/AIMS: The number of people undergoing living donor liver transplantation (LDLT has increased rapidly in many transplant centres. Patients considering LDLT need to know whether LDLT is riskier than deceased donor liver transplantation (DDLT. The aim of this study was to compare the outcomes of patients undergoing LDLT versus DDLT. METHODS: A total of 349 patients with benign liver diseases were recruited from 2005 to 2011 for this study. LDLT was performed in 128 patients, and DDLT was performed in 221 patients. Pre- and intra-operative variables for the two groups were compared. Statistically analysed post-operative outcomes include the postoperative incidence of complication, biliary and vascular complication, hepatitis B virus (HBV recurrence, long-term survival rate and outcomes of emergency transplantation. RESULTS: The waiting times were 22.10±15.31 days for the patients undergoing LDLT versus 35.81±29.18 days for the patients undergoing DDLT. The cold ischemia time (CIT was 119.34±19.75 minutes for the LDLT group and 346±154.18 for DDLT group. LDLT group had higher intraoperative blood loss, but red blood cell (RBC transfusion was not different. Similar ≥ Clavien III complications, vascular complications, hepatitis B virus (HBV recurrence and long-term survival rates were noted. LDLT patients suffered a higher incidence of biliary complications in the early postoperative days. However, during the long-term follow-up period, biliary complication rates were similar between the two groups. The long-term survival rate of patients undergoing emergency transplantation was lower than of patients undergoing elective transplantation. However, no significant difference was observed between emergency LDLT and emergency DDLT. CONCLUSIONS: Patients undergoing LDLT achieved similar outcomes to patients undergoing DDLT. Although LDLT patients may suffer a higher incidence of early biliary complications, the total biliary complication

  10. Psychologic functioning of unspecified anonymous living kidney donors before and after donation

    NARCIS (Netherlands)

    L. Timmerman (Lotte); W.C. Zuidema (Wilij); R.A.M. Erdman (Ruud); L.W. Kranenburg (Leonieke); R. Timman (Reinier); J.N.M. IJzermans (Jan); J.J. van Busschbach (Jan); W. Weimar (Willem); E.K. Massey (Emma)

    2013-01-01

    textabstractBACKGROUND: There has been discussion regarding the psychologic functioning of living donors who donate their kidney to an unrelated and unknown patient ("unspecified living donors"). This is the first prospective study to investigate group- and individual-level changes in psychologic fu

  11. Critical progressive small-graft injury caused by intrasinusoidal pressure elevation following living donor liver transplantation.

    Science.gov (United States)

    Sugimoto, H; Kaneko, T; Hirota, M; Nagasaka, T; Kobayashi, T; Inoue, S; Takeda, S; Kiuchi, T; Nakao, A

    2004-11-01

    In adult-to-adult living liver transplantation, small-for-size graft syndrome sometimes occurs. The relationship between the hemodynamic changes and histologic findings has not been studied in patients with failure of small-for-size grafts. We analyzed the relationship between the postoperative hemodynamic changes and pathologic findings in patients with small-for-size grafts that ended in graft failure. From March 1999 to December 2002, adult-to-adult living-donor liver transplantation with small-size grafts (graft volume/standard liver volume less than 40%) was performed in eight patients. Three patients died from graft failure caused by overperfusion, which was diagnosed from pathologic findings. We analyzed the relation between hepatic hemodynamic parameters, such as portal venous blood velocity or splenic arterial pulsatility index, and histologic changes in patients with graft failure. Severe portal hyperperfusion (90 cm/sec at the umbilical portion) was observed on postoperative day 1. Among patients with graft failure, critical hemodynamic changes, such as sudden onset of extremely deteriorated portal venous blood flow, occurred during the early postoperative period (postoperative day 5, 3, 6, respectively). Histologic examination revealed vacuolar changes in the cytoplasm of hepatocytes, and submassive necrosis indicated intrasinusoidal pressure elevation. These changes were not observed in the biopsy obtained soon after reperfusion. In conclusion, critically decreased vascular beds may cause intrasinusoidal pressure elevation and sinusoidal circulatory disturbances.

  12. Current techniques for AB0-incompatible living donor liver transplantation

    Science.gov (United States)

    Rummler, Silke; Bauschke, Astrid; Bärthel, Erik; Jütte, Heike; Maier, Katrin; Ziehm, Patrice; Malessa, Christina; Settmacher, Utz

    2016-01-01

    For a long time, it was considered medical malpractice to neglect the blood group system during transplantation. Because there are far more patients waiting for organs than organs available, a variety of attempts have been made to transplant AB0-incompatible (AB0i) grafts. Improvements in AB0i graft survival rates have been achieved with immunosuppression regimens and plasma treatment procedures. Nevertheless, some grafts are rejected early after AB0i living donor liver transplantation (LDLT) due to antibody mediated rejection or later biliary complications that affect the quality of life. Therefore, the AB0i LDLT is an option only for emergency situations, and it requires careful planning. This review compares the treatment possibilities and their effect on the patients’ graft outcome from 2010 to the present. We compared 11 transplant center regimens and their outcomes. The best improvement, next to plasma treatment procedures, has been reached with the prophylactic use of rituximab more than one week before AB0i LDLT. Unfortunately, no standardized treatment protocols are available. Each center treats its patients with its own scheme. Nevertheless, the transplant results are homogeneous. Due to refined treatment strategies, AB0i LDLT is a feasible option today and almost free of severe complications. PMID:27683633

  13. Approach to the Pretransplant Evaluation of the Living Kidney Donor

    Directory of Open Access Journals (Sweden)

    Mala Sachdeva

    2011-01-01

    Full Text Available Evaluation of the potential kidney donor is a complex activity that differs substantially from other types of preoperative assessments. The well being of the donor, who derives no medical benefit from this surgery, must be assured in both the short term and long term, and the potential adverse consequences to the recipient must be determined as well. The criteria that must be met for a person to donate a kidney are rigorous and include medical, social, psychosocial, ethical, and legal issues. Donor evaluation can be divided into assessments to protect the health and safety of the donor and assessments to protect the health and safety of the recipient. This article provides an approach to evaluating a donor, focusing on the complex issues that an evaluator is faced with. A careful assessment of risks and benefits to both the donor and recipient can lead to favorable outcomes.

  14. Marginal living donor in kidney transplantation: experience in a Chinese single center

    Institute of Scientific and Technical Information of China (English)

    LI Gang; WANG Yun-peng; MA Lu-lin; ZHANG Jing; ZHANG Hong-xian; HUANG Yi; HOU Xiao-fei

    2013-01-01

    Background Living donor kidney transplantation is becoming popular in China,whereas,in clinical situations,some kidney donors may be sub-optimal,namely marginal living donor.The present study aimed to evaluate the safety and efficacy of marginal living donor kidney transplantation in a Chinese single center.Methods Between January 2001 and December 2009,888 kidney transplantations were performed in our center; 149were living donor kidney transplantations.The living donors and recipients were followed up regularly after the operation.Of the living donors,30 donors were marginal,who were older than 60 years or suffered from kidney anomaly or some benign diseases.Among the non-marginal living kidney transplantations,58 donors and recipients had complete perioperative and follow-up data.We compared the marginal and non-marginal living donor kidney transplantations with regard to donor age,follow-up period,donor's serum creatinine at the last follow-up,recipient's serum creatinine at the last follow-up,and graft survival at the last follow-up.Results The mean age of donors in the marginal and non-marginal living donors were (55±9) (37-66) and (43±12) (30-59) years.The mean follow-up times of the marginal and non-marginal groups were (26.4±13.4) months and (28.8±14.8)months.The donor and recipient serum creatinine levels at the last follow-up were (1.16±0.20) mg/dl and (1.30±0.24) mg/dl in the marginal group,and (1.12±0.32) mg/dl and (1.34±0.32) mg/dl in the non-marginal group.Three recipients in the marginal group and five recipients in the non-marginal group had acute rejection episodes during the first year.Actuarial 3-year graft survival was 96.7% in the marginal group and 100% in the non-marginal group.No significant differences were detected between the two groups with regard to these data.Conclusion Utilization of highly selective marginal living donors can be a safe,feasible,and effective way for the treatment of patients with end stage renal disease.

  15. MDCT evaluation of potential living renal donor, prior to laparoscopic donor nephrectomy: What the transplant surgeon wants to know?

    Science.gov (United States)

    Ghonge, Nitin P; Gadanayak, Satyabrat; Rajakumari, Vijaya

    2014-10-01

    As Laparoscopic Donor Nephrectomy (LDN) offers several advantages for the donor such as lesser post-operative pain, fewer cosmetic concerns and faster recovery time, there is growing global trend towards LDN as compared to open nephrectomy. Comprehensive pre-LDN donor evaluation includes assessment of renal morphology including pelvi-calyceal and vascular system. Apart from donor selection, evaluation of the regional anatomy allows precise surgical planning. Due to limited visualization during laparoscopic renal harvesting, detailed pre-transplant evaluation of regional anatomy, including the renal venous anatomy is of utmost importance. MDCT is the modality of choice for pre-LDN evaluation of potential renal donors. Apart from appropriate scan protocol and post-processing methods, detailed understanding of surgical techniques is essential for the Radiologist for accurate image interpretation during pre-LDN MDCT evaluation of potential renal donors. This review article describes MDCT evaluation of potential living renal donor, prior to LDN with emphasis on scan protocol, post-processing methods and image interpretation. The article laid special emphasis on surgical perspectives of pre-LDN MDCT evaluation and addresses important points which transplant surgeons want to know. PMID:25489130

  16. MDCT evaluation of potential living renal donor, prior to laparoscopic donor nephrectomy: What the transplant surgeon wants to know?

    Directory of Open Access Journals (Sweden)

    Nitin P Ghonge

    2014-01-01

    Full Text Available As Laparoscopic Donor Nephrectomy (LDN offers several advantages for the donor such as lesser post-operative pain, fewer cosmetic concerns and faster recovery time, there is growing global trend towards LDN as compared to open nephrectomy. Comprehensive pre-LDN donor evaluation includes assessment of renal morphology including pelvi-calyceal and vascular system. Apart from donor selection, evaluation of the regional anatomy allows precise surgical planning. Due to limited visualization during laparoscopic renal harvesting, detailed pre-transplant evaluation of regional anatomy, including the renal venous anatomy is of utmost importance. MDCT is the modality of choice for pre-LDN evaluation of potential renal donors. Apart from appropriate scan protocol and post-processing methods, detailed understanding of surgical techniques is essential for the Radiologist for accurate image interpretation during pre-LDN MDCT evaluation of potential renal donors. This review article describes MDCT evaluation of potential living renal donor, prior to LDN with emphasis on scan protocol, post-processing methods and image interpretation. The article laid special emphasis on surgical perspectives of pre-LDN MDCT evaluation and addresses important points which transplant surgeons want to know.

  17. Living donor liver transplantation from a donor previously treated with interferon for hepatitis C virus: a case report

    Directory of Open Access Journals (Sweden)

    Nakao Kazuhiko

    2011-07-01

    Full Text Available Abstract Introduction Selecting a marginal donor in liver transplantation (LT remains controversial but is necessary because of the small number of available donors. Case presentation A 46-year-old Japanese woman was a candidate to donate her liver to her brother, who had decompensated liver cirrhosis of unknown origin. Eight years before the donation, she had a mild liver dysfunction that was diagnosed as a hepatitis C virus (HCV infection (serotype 2. She had received anti-viral therapy with interferon α-2b three times weekly for 24 weeks and had a sustained viral response (SVR. A biopsy of her liver before the donation showed normal findings without any active hepatitis, and her serum was negative for HCV-RNA. Only 67 patients have undergone LT from a cadaveric donor in Japan. The family in this case decided to have living donor LT. A careful selection for the liver graft donation was made; however, since she was the only candidate, we approved her as a living donor. She was discharged nine days after the liver donation. Her liver function recovered immediately. A computed tomography scan showed sufficient liver regeneration one year later. Her brother also had good liver function after LT and had no HCV infection 48 months after surgery and no de novo malignancy. Neither of the siblings has developed an HCV infection. Conclusions A patient with SVR status after interferon therapy might be considered a candidate for living donor LT but only if there are no other possibilities of LT for the recipient. A careful follow-up of the donor after donation is needed. The recipient also must have a very close follow-up because it is difficult to predict what might happen to the graft with post-transplant immunosuppression.

  18. Health-related quality of life in living liver donors after transplantation

    Institute of Scientific and Technical Information of China (English)

    Pei-Xian Chen; Lu-NanYan

    2011-01-01

    BACKGROUND: Living donor liver transplantation (LDLT) has recently emerged as an effective therapeutic alternative for patients with end-stage liver disease. In the meantime, the health-related quality of life (HRQoL) of the donors is becoming better appreciated. Here we aimed to review the current literature and summarize the effects of liver donation on the long-term HRQoL of living donors. DATA SOURCES: A literature search of PubMed using "donors","living donor liver transplantation", "health-related quality of life", and "donation" was performed, and all the information was collected. RESULTS: The varied postoperative outcomes of liver donors are attributive to the different evaluation instruments used. On the whole, donors experienced good long-term physical and mental well-being with a few complaining of compromised quality of life due to mild symptoms or psychiatric problems. The psychosocial dimension has received increasing attention with the vocational, interpersonal and financial impact of liver donation on donors mostly studied. CONCLUSIONS: Generally, donors have a good HRQoL after LDLT. Nevertheless, to achieve an ideal donor outcome, further work is necessary to minimize the negative effects as well as to incorporate recent progress in regenerative medicine.

  19. PLASMA LEVEL OF SOLUBLE CD30 IN PEDIATRIC LIVING-DONOR LIVER TRANSPLANT PATIENT

    Directory of Open Access Journals (Sweden)

    O. P. Shevchenko

    2011-01-01

    Full Text Available Soluble CD30 (sCD30 is a marker of T-lymphocytes activation and is used for monitoring rejection in patients after heart, lung and renal transplantation. The aim of the study was to evaluate plasma levels of sCD30 in child- ren before and after living-donor liver transplantation (LDLT and its relationship with the postoperative course. The study included 72 children with end-stage liver disease (ESLD, aged 17 ± 11 (4–28 months before and after LDLT, 15 healthy children aged 9.9 ± 5.7 (3–21 months and 38 adult living-related liver donors, aged 37 ± 19 (18–56 years. In children with ESLD pre-transplant plasma level of sCD30 (84,9 ± 43,8 ng/ml was significantly higher than in healthy donors and healthy children (26.4 ± 12.0 and 32.6 ± 6.9 ng/ml, resp., p < 0.01. After LDLT plasma level of sCD30 was higher in children, who had graft dysfunction at days 28–32 (108.9 ± 17.7 ng/ml after LDLT than in children who had no graft dysfunction (40.2 ± 5.3 ng/ml, р < 0.01. In patients with graft dysfunction elevation of sCD30 concentration was observed before 2–5 days increasing of liver enzyme activity. The measurement of sCD30 concentration may be useful for monitoring of the postoperative course. 

  20. Postoperative endoscopic surveillance of human living-donor small bowel transplantations

    Institute of Scientific and Technical Information of China (English)

    Jie Ding; Chang-Cun Guo; Cai-Ning Li; An-Hua Sun; Xue-Gang Guo; Ji-Yan Miao; Bo-Rong Pan

    2003-01-01

    AIM: To determine the significance of endoscopic surveillance in the diagnosis of acute rejection after human living-donor small bowel transplantations.METHODS: Endoscopic surveillance was performed through the ileostomy after human living-donor small bowel transplantations. The intestinal mucosa was observed and biopsies were performed for pathological observations.RESULTS: Acute rejection was diagnosed in time by endoscopic surveillance. The endoscopic and pathological manifestations of acute rejection were described. CONCLUSION: Endoscopic surveillance and biopsy are reliable methods to diagnose the acute rejection after human living-donor small bowel transplantations.

  1. ABO-incompatible living-donor pediatric kidney transplantation in Japan

    Directory of Open Access Journals (Sweden)

    Atsushi Aikawa

    2014-01-01

    Full Text Available The Japanese ABO-Incompatible Transplantation Committee officially collected and analyzed data on pediatric ABO-incompatible living-donor kidney transplantation in July 2012. The age of a child was defined as <16 years, and 89 children who had undergone ABO-incompatible living-donor kidney transplantation from 1989 to 2011 were entered in a registry. These data were presented as the Japanese registry of pediatric ABO-incompatible living-donor kidney transplantation at the regional meetings of the International Pediatric Transplantation Association (IPTA in Nagoya in September 2012 and in Sao Paulo in November 2012.

  2. Living donor liver transplantation for inborn errors of metabolism - An underutilized resource in the United States.

    Science.gov (United States)

    Pham, Thomas A; Enns, Gregory M; Esquivel, Carlos O

    2016-09-01

    Inborn metabolic diseases of the liver can be life-threatening disorders that cause debilitating and permanent neurological damage. Symptoms may manifest as early as the neonatal period. Liver transplant replaces the enzymatically deficient liver, allowing for metabolism of toxic metabolites. LDLT for metabolic disorders is rarely performed in the United States as compared to countries such as Japan, where they report >2000 cases performed within the past two decades. Patient and graft survival is comparable to that of the United States, where most of the studies are based on deceased donors. No living donor complications were observed, suggesting that LDLT is as safe and effective as deceased donor transplants performed in the USA. Increased utilization of living donors in the USA will allow for early transplantation to prevent permanent neurological damage in those with severe disease. Pediatric transplant centers should consider utilizing living donors when feasible for children with metabolic disorders of the liver. PMID:27392539

  3. Measurement of FRET Efficiency and Ratio of Donor to Acceptor Concentration in Living Cells

    OpenAIRE

    Chen, Huanmian; Puhl, Henry L.; Koushik, Srinagesh V.; Steven S Vogel; Ikeda, Stephen R.

    2006-01-01

    Measurement of fluorescence resonance energy transfer (FRET) efficiency and the relative concentration of donor and acceptor fluorophores in living cells using the three-filter cube approach requires the determination of two constants: 1), the ratio of sensitized acceptor emission to donor fluorescence quenching (G factor) and 2), the ratio of donor/acceptor fluorescence intensity for equimolar concentrations in the absence of FRET (k factor). We have developed a method to determine G and k t...

  4. Rescue Living-donor Liver Transplantation for Liver Failure Following Hepatectomy for Hepatocellular Carcinoma

    OpenAIRE

    Chan, See Ching; Sharr, William Wei; Chan, Albert Chi Yan; Chok, Kenneth Siu Ho; Lo, Chung Mau

    2013-01-01

    Liver failure following major hepatectomy for hepatocellular carcinoma is a known but uncommon mode of early treatment failure. When post-hepatectomy liver failure becomes progressive, the only effective treatment for rescuing the patient is liver transplantation. Deceased-donor liver transplantation in this situation is often not feasible because of the shortage of deceased-donor liver grafts. Proceeding with living-donor liver transplantation is an ethical challenge because of the possibili...

  5. Donor-reactive cytokine profiles after HLA-identical living-related kidney transplantation

    NARCIS (Netherlands)

    J.H. Gerrits (Jeroen); J. van de Wetering (Jacqueline); J.J. Drabbels (Jos); F.H.J. Claas (Frans); W. Weimar (Willem); N.M. van Besouw (Nicole)

    2008-01-01

    textabstractBackground. After HLA-identical living-related (LR) kidney transplantation, only non-HLA antigen mismatches between donor and recipient may exist. We questioned whether donor-reactive responses against non-HLA antigens could be found after HLA-identical LR kidney transplantation, and won

  6. Living Kidney Donor: Continuity of Care Focused on Professional Expertise, Organisation and Interaction

    DEFF Research Database (Denmark)

    Holch, Kirsten

    -disciplinary collaboration. Methods: -Formulate a frame of reference for the principles of the continuity of care concept -Establishment of a working group with doctors, nurses, secretary and management, who represents the medical and surgical team, the living donor will meet. Furthermore, a research nurse as a coordinator......  Living Kidney Donor: Continuity of Care Focused on Professional Expertise, Organisation and interaction Aarhus University Hospital, Skejby would like to increase the number of kidneys from living donors for various reasons: - The number of kidneys from deceased persons does not meet the actual...... and a process manager. The group has the competence to make all decisions concerning the continuity of care concept. - Field observations of current practice describing facts about the actual practice concerning living donors including written testimonials from the patients. - Preparation of a flow diagram...

  7. 42 CFR 482.90 - Condition of participation: Patient and living donor selection.

    Science.gov (United States)

    2010-10-01

    ... candidate on its waiting list, the candidate's medical record must contain documentation that the candidate... principles of medical ethics. Transplant centers must: (1) Ensure that a prospective living donor receives...

  8. Glutathione-S-transferase subtypes α and π as a tool to predict and monitor graft failure or regeneration in a pilot study of living donor liver transplantation

    OpenAIRE

    Jochum C; Beste M; Sowa J-P; Farahani MS; Penndorf V; Nadalin S; Saner F; Canbay A; Gerken G

    2011-01-01

    Abstract Objective Glutathione-S-Transferase (GST) subtype α and π are differentially expressed in adult liver tissue. Objective of the study was if GST α and p may serve as predictive markers for liver surgery, especially transplantations. Methods 13 patients receiving living donor liver transplantation (LDLT) and their corresponding donors were analyzed for standard serum parameters (ALT, AST, gGT, bilirubin) as well as GST-α and -π before LDLT and daily for 10 days after LDLT. Patients (R)...

  9. Evaluation of living liver donors using contrast enhanced multidetector CT – The radiologists impact on donor selection

    International Nuclear Information System (INIS)

    Living donor liver transplantation (LDLT) is a valuable and legitimate treatment for patients with end-stage liver disease. Computed tomography (CT) has proven to be an important tool in the process of donor evaluation. The purpose of this study was to evaluate the significance of CT in the donor selection process. Between May 1999 and October 2010 170 candidate donors underwent biphasic CT. We retrospectively reviewed the results of the CT and liver volumetry, and assessed reasons for rejection. 89 candidates underwent partial liver resection (52.4%). Based on the results of liver CT and volumetry 22 candidates were excluded as donors (31% of the cases). Reasons included fatty liver (n = 9), vascular anatomical variants (n = 4), incidental finding of hemangioma and focal nodular hyperplasia (n = 1) and small (n = 5) or large for size (n = 5) graft volume. CT based imaging of the liver in combination with dedicated software plays a key role in the process of evaluation of candidates for LDLT. It may account for up to 1/3 of the contraindications for LDLT

  10. Living-Donor Kidney Transplantation: Reducing Financial Barriers to Live Kidney Donation--Recommendations from a Consensus Conference.

    Science.gov (United States)

    Tushla, Lara; Rudow, Dianne LaPointe; Milton, Jennifer; Rodrigue, James R; Schold, Jesse D; Hays, Rebecca

    2015-09-01

    Live-donor kidney transplantation (LDKT) is the best treatment for eligible people with late-stage kidney disease. Despite this, living kidney donation rates have declined in the United States in recent years. A potential source of this decline is the financial impact on potential and actual living kidney donors (LKDs). Recent evidence indicates that the economic climate may be associated with the decline in LDKT and that there are nontrivial financial ramifications for some LKDs. In June 2014, the American Society of Transplantation's Live Donor Community of Practice convened a Consensus Conference on Best Practices in Live Kidney Donation. The conference included transplant professionals, patients, and other key stakeholders (with the financial support of 10 other organizations) and sought to identify best practices, knowledge gaps, and opportunities pertaining to living kidney donation. This workgroup was tasked with exploring systemic and financial barriers to living kidney donation. The workgroup reviewed literature that assessed the financial effect of living kidney donation, analyzed employment and insurance factors, discussed international models for addressing direct and indirect costs faced by LKDs, and summarized current available resources. The workgroup developed the following series of recommendations to reduce financial and systemic barriers and achieve financial neutrality for LKDs: (1) allocate resources for standardized reimbursement of LKDs' lost wages and incidental costs; (2) pass legislation to offer employment and insurability protections to LKDs; (3) create an LKD financial toolkit to provide standardized, vetted education to donors and providers about options to maximize donor coverage and minimize financial effect within the current climate; and (4) promote further research to identify systemic barriers to living donation and LDKT to ensure the creation of mitigation strategies.

  11. Living-Donor Kidney Transplantation: Reducing Financial Barriers to Live Kidney Donation--Recommendations from a Consensus Conference.

    Science.gov (United States)

    Tushla, Lara; Rudow, Dianne LaPointe; Milton, Jennifer; Rodrigue, James R; Schold, Jesse D; Hays, Rebecca

    2015-09-01

    Live-donor kidney transplantation (LDKT) is the best treatment for eligible people with late-stage kidney disease. Despite this, living kidney donation rates have declined in the United States in recent years. A potential source of this decline is the financial impact on potential and actual living kidney donors (LKDs). Recent evidence indicates that the economic climate may be associated with the decline in LDKT and that there are nontrivial financial ramifications for some LKDs. In June 2014, the American Society of Transplantation's Live Donor Community of Practice convened a Consensus Conference on Best Practices in Live Kidney Donation. The conference included transplant professionals, patients, and other key stakeholders (with the financial support of 10 other organizations) and sought to identify best practices, knowledge gaps, and opportunities pertaining to living kidney donation. This workgroup was tasked with exploring systemic and financial barriers to living kidney donation. The workgroup reviewed literature that assessed the financial effect of living kidney donation, analyzed employment and insurance factors, discussed international models for addressing direct and indirect costs faced by LKDs, and summarized current available resources. The workgroup developed the following series of recommendations to reduce financial and systemic barriers and achieve financial neutrality for LKDs: (1) allocate resources for standardized reimbursement of LKDs' lost wages and incidental costs; (2) pass legislation to offer employment and insurability protections to LKDs; (3) create an LKD financial toolkit to provide standardized, vetted education to donors and providers about options to maximize donor coverage and minimize financial effect within the current climate; and (4) promote further research to identify systemic barriers to living donation and LDKT to ensure the creation of mitigation strategies. PMID:26002904

  12. Glutathione-S-transferase subtypes α and π as a tool to predict and monitor graft failure or regeneration in a pilot study of living donor liver transplantation

    Directory of Open Access Journals (Sweden)

    Jochum C

    2011-01-01

    Full Text Available Abstract Objective Glutathione-S-Transferase (GST subtype α and π are differentially expressed in adult liver tissue. Objective of the study was if GST α and p may serve as predictive markers for liver surgery, especially transplantations. Methods 13 patients receiving living donor liver transplantation (LDLT and their corresponding donors were analyzed for standard serum parameters (ALT, AST, gGT, bilirubin as well as GST-α and -π before LDLT and daily for 10 days after LDLT. Patients (R and donors (D were grouped according to graft loss (R1/D1 or positive outcome (R2/D2 and above named serum parameters were compared between the groups. Results R1 showed significantly increased GST-α and significantly lower GST-π levels than R2 patients or the donors. There was a positive correlation between GST-α and ALT, AST as well as bilirubin and a negative correlation to γGT. However, γGT correlated positively with GST-π. Graft failure was associated with combined low GST-π levels in donors and their recipients before living donor liver transplantation. Conclusion Our data suggest that high GST-α serum levels reflect ongoing liver damage while GST-P indicates the capacity and process of liver regeneration. Additionally, GST-π may be useful as marker for optimizing donor and recipient pairs in living donor liver transplantation.

  13. Association of metabolic syndrome with kidney function and histology in living kidney donors.

    Science.gov (United States)

    Ohashi, Y; Thomas, G; Nurko, S; Stephany, B; Fatica, R; Chiesa, A; Rule, A D; Srinivas, T; Schold, J D; Navaneethan, S D; Poggio, E D

    2013-09-01

    The selection of living kidney donors is based on a formal evaluation of the state of health. However, this spectrum of health includes subtle metabolic derangements that can cluster as metabolic syndrome. We studied the association of metabolic syndrome with kidney function and histology in 410 donors from 2005 to 2012, of whom 178 donors were systematically followed after donation since 2009. Metabolic syndrome was defined as per the NCEP ATPIII criteria, but using a BMI > 25 kg/m(2) instead of waist circumference. Following donation, donors received counseling on lifestyle modification. Metabolic syndrome was present in 50 (12.2%) donors. Donors with metabolic syndrome were more likely to have chronic histological changes on implant biopsies than donors with no metabolic syndrome (29.0% vs. 9.3%, p kidney function recovery following donation. At last follow-up, reversal of metabolic syndrome was observed in 57.1% of donors with predonation metabolic syndrome, while only 10.8% of donors developed de novo metabolic syndrome (p histological changes, and nephrectomy in these donors was associated with subsequent protracted recovery of kidney function. Importantly, weight loss led to improvement of most abnormalities that define metabolic syndrome.

  14. Evidence for a need to mandate kidney transplant living donor registries.

    Science.gov (United States)

    Emara, Mahmoud; Ragheb, Ahmed; Hassan, Abubaker; Shoker, Ahmed

    2008-01-01

    Kidney disease is a global public health problem of growing proportions. Currently the best treatment for end-stage renal failure is transplantation. Living organ donation remains a complex ethical, moral and medical issue. It is based on a premise that kidney donation is associated with short-term minimal risks to harm the donor, and is outweighed by the definite advantages to the recipient. A growing number of patients with end-stage renal disease and shortage of kidney donors poses a pressing need to expand the criteria needed to accept kidney donors. The current donor registries are structured and are driven to expand donor pool. As living kidney donation is not without risks, more attention should be given to protect the donor health. After kidney donation, mild to moderate renal insufficiency may occur. Renal insufficiency, even mild, is associated with increased risks of hypertension, proteinuria and cardiovascular morbidity. We, therefore, foresee a need to mandate the establishment of renal transplant donor registries at all transplanting programs as a prerequisite to protect the long-term well being of kidney donors. These registries can collect the database necessary to develop standards of practice and guidelines for future kidney donation. PMID:18549448

  15. The impact of living-unrelated transplant on establishing deceased-donor liver program in Syria.

    Science.gov (United States)

    Saeed, Bassam

    2014-10-01

    Liver transplant is the criterion standard for patients with end-stage liver disease. Yet there is no liver transplant in Syria. Traveling abroad for a liver transplant is a luxury few Syrians can afford. There is currently an on-going debate whether to start a liver transplant program using living or deceased donors. In 2003, a new law was enacted, authorizing the use of organs from volunteer strangers and deceased donors. Despite the positive aspects of this law (allowing unrelated donors to increase the number of transplants in the country); the negative aspects also were obvious. The poor used the law to sell their organs to the rich, and this model is in violation of the Istanbul Declaration. To better document transplant communities' perceptions on organ donation, an e-mail survey was sent to a nationally representative sample of physicians (n = 115) that showed that 58% of respondents did not support the start of liver transplant from live donors, as they fear a considerable risk for the donor and the recipient. Seventy-one percent of respondents believe that unrelated kidney donation has contributed to tarnishing the reputation of transplant, and 56% believe that a deceased-donor program can run in parallel with unrelated organ donations. The interest in deceased-donor program has been affected negatively by the systematic approach of using poor persons as the source of the organ. This lack of interest has affected starting a liver program that relies on deceased donors; especially the need for kidneys is more than livers. Health authorities in Syria were inclined to initiate a liver transplant program from live donors, despite the risks of serious morbidities and mortality. In conclusion then, paid kidney donation in actual effect is actually a hindrance to establishing a deceased-donor liver program.

  16. The impact of living-unrelated transplant on establishing deceased-donor liver program in Syria.

    Science.gov (United States)

    Saeed, Bassam

    2014-10-01

    Liver transplant is the criterion standard for patients with end-stage liver disease. Yet there is no liver transplant in Syria. Traveling abroad for a liver transplant is a luxury few Syrians can afford. There is currently an on-going debate whether to start a liver transplant program using living or deceased donors. In 2003, a new law was enacted, authorizing the use of organs from volunteer strangers and deceased donors. Despite the positive aspects of this law (allowing unrelated donors to increase the number of transplants in the country); the negative aspects also were obvious. The poor used the law to sell their organs to the rich, and this model is in violation of the Istanbul Declaration. To better document transplant communities' perceptions on organ donation, an e-mail survey was sent to a nationally representative sample of physicians (n = 115) that showed that 58% of respondents did not support the start of liver transplant from live donors, as they fear a considerable risk for the donor and the recipient. Seventy-one percent of respondents believe that unrelated kidney donation has contributed to tarnishing the reputation of transplant, and 56% believe that a deceased-donor program can run in parallel with unrelated organ donations. The interest in deceased-donor program has been affected negatively by the systematic approach of using poor persons as the source of the organ. This lack of interest has affected starting a liver program that relies on deceased donors; especially the need for kidneys is more than livers. Health authorities in Syria were inclined to initiate a liver transplant program from live donors, despite the risks of serious morbidities and mortality. In conclusion then, paid kidney donation in actual effect is actually a hindrance to establishing a deceased-donor liver program. PMID:25299377

  17. Spectrum of biliary complications following live donor livertransplantation

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Liver transplantation is the optimal treatment formany patients with advanced liver disease, includingdecompensated cirrhosis, hepatocellular carcinomaand acute liver failure. Organ shortage is the maindeterminant of death on the waiting list and hence livingdonor liver transplantation (LDLT) assumes importance.Biliary complications are the most common post operativemorbidity after LDLT and occur due to anatomical andtechnical reasons. They include biliary leaks, stricturesand cast formation and occur in the recipient as well asthe donor. The types of biliary complications after LDLTalong with their etiology, presenting features, diagnosisand endoscopic and surgical management are discussed.

  18. The Cost-Effectiveness of Using Payment to Increase Living Donor Kidneys for Transplantation

    Science.gov (United States)

    Barnieh, Lianne; Gill, John S.; Klarenbach, Scott

    2013-01-01

    Summary Background and objectives For eligible candidates, transplantation is considered the optimal treatment compared with dialysis for patients with ESRD. The growing number of patients with ESRD requires new strategies to increase the pool of potential donors. Design, setting, participants, & measurements Using decision analysis modeling, this study compared a strategy of paying living kidney donors to waitlisted recipients on dialysis with the current organ donation system. In the base case estimate, this study assumed that the number of donors would increase by 5% with a payment of $10,000. Quality of life estimates, resource use, and costs (2010 Canadian dollars) were based on the best available published data. Results Compared with the current organ donation system, a strategy of increasing the number of kidneys for transplantation by 5% by paying living donors $10,000 has an incremental cost-savings of $340 and a gain of 0.11 quality-adjusted life years. Increasing the number of kidneys for transplantation by 10% and 20% would translate into incremental cost-savings of $1640 and $4030 and incremental quality-adjusted life years gain of 0.21 and 0.39, respectively. Conclusion Although the impact is uncertain, this model suggests that a strategy of paying living donors to increase the number of kidneys available for transplantation could be cost-effective, even with a transplant rate increase of only 5%. Future work needs to examine the feasibility, legal policy, ethics, and public perception of a strategy to pay living donors. PMID:24158797

  19. New Onset Diabetes Mellitus in Living Donor versus Deceased Donor Liver Transplant Recipients: Analysis of the UNOS/OPTN Database

    Directory of Open Access Journals (Sweden)

    Anitha D. Yadav

    2013-01-01

    Full Text Available New onset diabetes after transplantation (NODAT occurs less frequently in living donor liver transplant (LDLT recipients than in deceased donor liver transplant (DDLT recipients. The aim of this study was to compare the incidence and predictive factors for NODAT in LDLT versus DDLT recipients. The Organ Procurement and Transplant Network/United Network for Organ Sharing database was reviewed from 2004 to 2010, and 902 LDLT and 19,582 DDLT nondiabetic recipients were included. The overall incidence of NODAT was 12.2% at 1 year after liver transplantation. At 1, 3, and 5 years after transplant, the incidence of NODAT in LDLT recipients was 7.4, 2.1, and 2.6%, respectively, compared to 12.5, 3.4, and 1.9%, respectively, in DDLT recipients. LDLT recipients have a lower risk of NODAT compared to DDLT recipients (hazard ratio = 0.63 (0.52–0.75, P<0.001. Predictors for NODAT in LDLT recipients were hepatitis C (HCV and treated acute cellular rejection (ACR. Risk factors in DDLT recipients were recipient male gender, recipient age, body mass index, donor age, donor diabetes, HCV, and treated ACR. LDLT recipients have a lower incidence and fewer risk factors for NODAT compared to DDLT recipients. Early identification of risk factors will assist timely clinical interventions to prevent NODAT complications.

  20. Immediate Impact of Uni-nephrectomy among Bangladeshi Healthy Live Kidney Donors: BIRDEM General Hospital Experience

    Directory of Open Access Journals (Sweden)

    Palash Mitra

    2016-05-01

    Full Text Available Background: Kidney transplantation is the preferred treatment option for end stage kidney disease. Live kidney donation is an established form of organ donation; but it carries the risk of an unnecessary surgery in a normal individual. These donors remain at an increased risk of multiple medical problems for the rest of their life. Objective: In this study, we evaluated the immediate impact of uninephrectomy among kidney donors during the period of post-transplant hospital stay. Materials and Methods: This cross-sectional study was done at BIRDEM General Hospital from January 2006 to June 2014. All kidney donors who had undergone graft nephrectomy during the study period were the study population. All the donors underwent Tc-99m diethylene triamine pentaacetic acid (Tc-99m DTPA renogram for measurement of glomerular filtration rate (GFR. GFR was also estimated by different equations in both pre-transplant and post-transplant periods. Pre-uninephrectomy GFR and post-uninephrectomy GFR of donors were compared. Results: Total number of subjects was 81, male 48 and female 33. Mean age was 36.3 ± 9.9 years. Mean postoperative hospital stay was 8.2 ± 2.0 days. The mean pre-operative measured glomerular filtration rate (mGFRDTPA was 99.54 ± 19.06 mL/min/1.73 m2 and mean estimated glomerular filtration rate (eGFRCKD-EPI was 99.0 ± 18.55 mL/min/1.73 m2 (p=0.855. In post-nephrectomy period mean urine output decreased from 2708.1 ± 842.8 to 2228.4 ± 702.4 mL/day (p=0.000. Mean SBP lowered from 120.3 ± 12.5 to 115.6 ± 9.2 mm of Hg (p=0.000 after nephrectomy. There was significant increase in blood urea (from 19.7 ± 5.7 to 30.4 ± 9.5 mg/dL, p=0.000 and serum creatinine (from 0.90 ± 0.16 to 1.26 ± 0.24 mg/dL, p=0.000 in post-uninephrectomy period. Mean mGFRDTPA of the subjects of non-nephrectomized kidney of the donors was 49.18 ± 9.50 mL/min/1.73 m2 and mean eGFRCKD-EPI of same kidneys was 69.09 ± 16.79 mL/min/1.73m2 (p=0.000 after uni

  1. Is it right to promote living donor liver transplantation for fulminant hepatic failure in pediatric recipients?

    Science.gov (United States)

    Reding, Raymond

    2005-07-01

    Good clinical results are currently achieved in elective pediatric liver transplantation (LT) with living-related donors. However, the question whether such therapeutic approach may also be promoted in case of fulminant hepatic failure (FHF) remains a matter of debate. This work briefly reviews the ethical background and overall medical results of living-related donation in pediatric LT. When considering FHF, success is essentially conditioned by the availability of a suitable organ donor before the onset of irreversible brain damage and death of the transplant candidate on the waiting list. Accordingly, living donor LT provides several advantages for patients with FHF, including the short waiting time and the access to a transplant with reduced ischemic injury and optimal graft quality; however, living donation is also characterized by several drawbacks to be carefully considered, particularly the possibility of coercion to the recipient's family as well as the operative risks of the emergency donor hepatectomy. The ethical soundness of living parental donor LT for FHF is discussed, with emphasis to the type of medical context, with or without access to an efficient emergency postmortem organ sharing system. PMID:15943615

  2. Considerations for screening live kidney donors for endemic infections: a viewpoint on the UNOS policy.

    Science.gov (United States)

    Levi, M E; Kumar, D; Green, M; Ison, M G; Kaul, D; Michaels, M G; Morris, M I; Schwartz, B S; Echenique, I A; Blumberg, E A

    2014-05-01

    In February 2013, the Organ Procurement and Transplantation Network mandated that transplant centers perform screening of living kidney donors prior to transplantation for Strongyloides, Trypanosoma cruzi and West Nile virus (WNV) infection if the donor is from an endemic area. However, specific guidelines for screening were not provided, such as the optimal testing modalities, timing of screening prior to donation and the appropriate selection of donors. In this regard, the American Society of Transplantation Infectious Diseases Community of Practice, together with disease-specific experts, has developed this viewpoint document to provide guidance for the testing of live donors for Strongyloides, T. cruzi and WNV infection, specifically identifying at-risk populations and testing algorithms, including advantages, limitations and interpretation of results. PMID:24636427

  3. Donors and Recipients of Living Kidney Donation: A Qualitative Metasummary of Their Experiences

    Directory of Open Access Journals (Sweden)

    Deborah Ummel

    2011-01-01

    Full Text Available With the notable growth in the qualitative investigation of living kidney donation, there is value in aggregating results from this body of research to learn from accumulated experience. The present paper aims to draw a complete portrait of living donors' and recipients' experience of donation by metasummarizing published studies. We found that donors' experience, particularly the decision-making process, has been more extensively studied than the recipients' perspective. Donors differ in their initial level of motivation to donate but on the whole report positive experiences and personal benefits. They also identify difficult periods and the need for additional resources. Recipients report an often positive but more ambivalent reaction to donation. In terms of relational issues between dyads, while the topic remains understudied, the donor-recipient relationship and gift reciprocity have received the most attention. Results are discussed in terms of their implications for future practice and research.

  4. Addressing Racial/Ethnic Disparities in Live Donor Kidney Transplantation: Priorities for Research and Intervention

    OpenAIRE

    Waterman, Amy D; Rodrigue, James R.; Purnell, Tanjala S.; Ladin, Keren; Boulware, L Ebony

    2010-01-01

    One potential mechanism for reducing racial/ethnic disparities in the receipt of kidney transplants is to enhance minorities’ pursuit of living donor kidney transplantation (LDKT). Pursuit of LDKT is influenced by patients’ personal values, their extended social networks, the healthcare system, and the community at large. This review discusses research and interventions promoting LDKT, especially for minorities, including improving education for patients, donors, and providers, utilizing LDKT...

  5. Living Donor Liver Transplant is not a Transparent Activity in India

    OpenAIRE

    Naidu, Sudeep

    2012-01-01

    Living donor liver transplant has gained rapid popularity in India as a life saving procedure for end stage liver disease. The undoubted benefit for the recipient is clouded by a few unfavorable outcomes in donors which have led to allegations of lack of transparency. These factors are easily remediable with an attitude of self audit and self disclosure by transplant centers, enabling a truly informed consenting procedure.

  6. Immediate Impact of Uni-nephrectomy among Bangladeshi Healthy Live Kidney Donors: BIRDEM General Hospital Experience

    OpenAIRE

    Palash Mitra; Muhammad Abdur Rahim; Tasrina Samnaz Samdani; Wasim Md Mohosinul Haque; Sarwar Iqbal; Md Abul Mansur

    2016-01-01

    Background: Kidney transplantation is the preferred treatment option for end stage kidney disease. Live kidney donation is an established form of organ donation; but it carries the risk of an unnecessary surgery in a normal individual. These donors remain at an increased risk of multiple medical problems for the rest of their life. Objective: In this study, we evaluated the immediate impact of uninephrectomy among kidney donors during the period of post-transplant hospital stay. Mater...

  7. Addition of Adult-to-Adult Living Donation to Liver Transplant Programs Improves Survival but at an Increased Cost1-2

    OpenAIRE

    Northup, Patrick G.; Abecassis, Michael M; Englesbe, Michael J.; Emond, Jean C.; Lee, Vanessa D.; Stukenborg, George J.; Tong, Lan; Berg, Carl L.

    2009-01-01

    We performed a cost-effectiveness analysis exploring the cost and benefits of LDLT using outcomes data from the Adult to Adult Living Donor Liver Transplantation Cohort Study (A2ALL). A multistage Markov decision analysis model was developed with treatment strategies including medical management only (strategy 1), waiting list with possible deceased donor liver transplant (strategy 2), and waiting list with possible LDLT or DDLT (strategy 3) over ten years. Decompensated cirrhosis with medica...

  8. First successful bilateral living-donor lobar lung transplantation in China

    Institute of Scientific and Technical Information of China (English)

    CHEN Qian-kun; JIANG Ge-ning; DING Jia-an; GAO Wen; CHEN Chang; ZHOU Xiao

    2010-01-01

    @@ Lung transplantation has been performed internationally as an effective treatment for a variety of end-stage lung diseases. A great disparity between the supply of donor organs and the demand of potential recipients has resulted in longer waiting time and annual increases in deaths on the lung transplant waiting list. Living-donor lobar lung transplantation (LDLLT) has become an established strategy to deal with the shortage of cadaveric donors. Encouraged by Starnes et al1 and Date et al,2 we began to apply the operation to a critically ill patient with bronchopulmonary dysplasia (BPD) firstly at Shanghai Pulmonary Hospital in China.

  9. Standardized video-assisted retroperitoneal minilaparotomy surgery for 615 living donor nephrectomies.

    Science.gov (United States)

    Choi, Kyung Hwa; Yang, Seung Choul; Lee, Seung Ryeol; Jeon, Hwang Gyun; Kim, Dong Suk; Joo, Dong Jin; Kim, Myoung Soo; Kim, Yu Seun; Kim, Soon Il; Han, Woong Kyu

    2011-10-01

    To increase the rate of living kidney donation, the long-term safety of nephrectomy must be demonstrated to potential donors. We analyzed long-term donor outcomes and evaluated the standardization of surgical technique. We evaluated 615 donors who underwent Video-assisted minilaparotomy living donor nephrectomy (VLDN) at Yonsei Severance Hospital between 2003 and 2009. Perioperative data and predictors of outcomes were prospectively analyzed. The mean operative time and mean warm ischemia time were 192.7 and 2.2 min, respectively. Mean estimated blood loss was 195.3 ml. The mean post-transplant serum creatinine levels and Modification of Diet in Renal Disease study equation for estimating glomerular filtration rate were 1.1 mg/dl and 68 ml/min/1.73 m(2) , respectively at 5 years after VLDN. The intra-operative and postoperative complication rate were 3.1% and 6.3%, respectively. Delayed renal function, 5-year graft survival, and complication rates of recipients were 1.1%, 98.4%, and 0.4%, respectively. Predictors of operative time were medical history, vessel anomaly, and surgeon experience (>50 cases). The single predictor of intra-operative complications was vessel anomaly. Standardized VLDN is feasible and safe. Our data on long-term outcomes can assist in demonstrating the long-term safety of donor nephrectomy to potential donors. To compare VLDN to other types of donor nephrectomy, a prospective multicenter study must be performed. PMID:21722200

  10. The value of MR cholangiography in preoperative evaluation of biliary anatomy of living liver donors

    International Nuclear Information System (INIS)

    Objective: To determine the value of MR cholangiography(MRC) in the preoperative evaluation of biliary anatomy of living liver donors. Methods: Fifty eight consecutive donors underwent MRC examinations and living liver transplantation. MRC was performed on a 1.5 T scanner with breath-hold rapid acquisition of T2WI slab and breathing-gating 3D FSE T2WI. Images of MRC and IOC were compared and classified according to the modified Huang's classification. Results: Thirty four (58.6%) liver donors showed normal biliary anatomy on IOC, and 24 (41.4%) donors revealed variant bile anatomy. MRC correctly depicted biliary anatomy in 91.4% (53/58) donors. The sensitivity, specificity, positive predictive value and negative predictive value of MRC in distinguishing normal and different types of variant biliary anatomy were 83.3% (20/24), 100% (34/34), 100% (20/20), 89.5% (34/38) respectively. Conclusion: MRC can accurately assess the biliary anatomy in living liver donors and may guide the preoperative planning of liver transplant. (authors)

  11. Therapy of central pontine myelinolysis following living donor liver transplantation: Report of three cases

    Institute of Scientific and Technical Information of China (English)

    Zhong-Wei Zhang; Yan Kang; Li-Jing Deng; Chuan-Xing Luo; Yan Zhou; Xin-Sheng Xue; Dong Wang; Wan-Hong Yin

    2009-01-01

    We analyzed the clinical manifestations and experiences of diagnosing and treating central pontine myelinolysis following living donor liver transplantation. The clinical data of three patients with central pontine myelinolysis following living donor liver transplantation from January 2005 to November 2007 were retrospectively analyzed at the West China Hospital, Sichuan University, China.The three patients developed hyponatremia prior to surgery. Case 1 suffered locked-in syndrome following surgery, and received a large dose of gamma globulin,and subsequently recovered. Case 2 was in a coma for three days, and received hyperbaric chamber treatment.This patient remained in a mild coma for six months following surgery. Case 3 developed consciousness disturbances, gradually went into a coma following surgery, and died due to pulmonary infection. Central pontine myelinolysis is a severe complication in patients following living donor liver transplantation. Largedose gamma globulin treatment, as well as hyperbaric oxygen, might be effective therapeutic methods.

  12. More than a decade after live donor nephrectomy: a prospective cohort study.

    Science.gov (United States)

    Janki, Shiromani; Klop, Karel W J; Dooper, Ine M M; Weimar, Willem; Ijzermans, Jan N M; Kok, Niels F M

    2015-11-01

    Previously reported short-term results after live kidney donation show no negative consequences for the donor. The incidence of new-onset morbidity takes years to emerge, making it highly likely that this will be missed during short-term follow-up. Therefore, evidence on long-term outcome is essential. A 10-year follow-up on renal function, hypertension, quality of life (QOL), fatigue, and survival was performed of a prospective cohort of 100 donors. After a median follow-up time of 10 years, clinical data were available for 97 donors and QOL data for 74 donors. Nine donors died during follow-up of unrelated causes to donation, and one donor was lost to follow-up. There was a significant decrease in kidney function of 12.9 ml/min (P QOL showed significant clinically relevant decreases of 10-year follow-up scores in SF-36 dimensions of physical function (P motivation (P = 0.030). New-onset hypertension was present in 25.6% of the donors. Donor outcomes are excellent 10 years post-donation. Kidney function appears stable, and hypertension does not seem to occur more frequently compared to the general population.

  13. Meta-Analysis of Laparoscopic versus Open Hepatectomy for Live Liver Donors

    Science.gov (United States)

    Zhang, Mang-Li; Ye, Song; Zheng, Shu-Sen; Wang, Wei-Lin

    2016-01-01

    Objective To document the safety and efficacy of laparoscopic living donor hepatectomy in comparison with open liver resection for living donor liver transplantation. Methods Medline database, EMASE and Cochrane library were searched for original studies comparing laparoscopic living donor hepatectomy (LLDH) and open living donor hepatectomy (OLDH) by January 2015. Meta-analysis was performed to evaluate donors’ perioperative outcomes. Results Nine studies met selection criteria, involving 1346 donors of whom 318 underwent LLDH and 1028 underwent OLDH. The Meta analysis demonstrated that LLDH group had less operative blood loss [patients 1346; WMD: -56.09 mL; 95%CI: -100.28-(-11.90) mL; P = 0.01], shorter hospital stay [patients 737; WMD: -1.75 d; 95%CI: -3.01-(-0.48) d; P = 0.007] but longer operative time (patients 1346; WMD: 41.05 min; 95%CI: 1.91–80.19 min; P = 0.04), compared with OLDH group. There were no significant difference in other outcomes between LLDH and OLDH groups, including overall complication, bile leakage, postoperative bleeding, pulmonary complication, wound complication, time to dietary intake and period of analgesic use. Conclusions LLDH appears to be a safe and effective option for LDLT. It improves donors’ perioperative outcomes as compared with OLDH. PMID:27788201

  14. A Case of Living Donor Liver Transplant Recipient Treated With Novel Blood Purification “Plasma Diafiltration”

    OpenAIRE

    HAYASHI, HIRONORI; Takamura, Hiroyuki; Taniguchi, Takumi; Nakanuma, Shin-ichi; Nakagawara, Hisatoshi; Tajima, Hidehiro; KITAGAWA, HIROHISA; ONISHI, ICHIRO; Tani, Takashi; OHTA, TETSUO

    2013-01-01

    Blood purification therapy is indispensable for liver transplant recipients. The case of a living donor liver transplant recipient who represented graft insufficiency and was supported by novel blood purification “plasma diafiltration” immediately after operation is presented. A 60-year-old woman was referred for living donor liver transplant because of liver cirrhosis due to hepatitis C. Elective living donor liver transplant was performed, but the graft was small for size. Thus, the signs o...

  15. Islamic Sunni Mainstream Opinions on Compensation to Unrelated Live Organ Donors

    OpenAIRE

    Ahmad Natour; Shammai Fishman

    2011-01-01

    This article focuses on contemporary Islamic attitudes towards the question of compensation to a non-relative live organ donor. This article presents the history of the debate on organ transplantation in Islam since the 1950s and the key ethical questions. It continues by presenting the opinions of the mainstream ulema such as Tantawi and Qaradawi. The article ends with a conclusion that there must be no compensation made to a non-related live organ donor, not even a symbolic gift of honor (i...

  16. Islamic Sunni Mainstream Opinions on Compensation to Unrelated Live Organ Donors

    Directory of Open Access Journals (Sweden)

    Ahmad Natour

    2011-04-01

    Full Text Available This article focuses on contemporary Islamic attitudes towards the question of compensation to a non-relative live organ donor. This article presents the history of the debate on organ transplantation in Islam since the 1950s and the key ethical questions. It continues by presenting the opinions of the mainstream ulema such as Tantawi and Qaradawi. The article ends with a conclusion that there must be no compensation made to a non-related live organ donor, not even a symbolic gift of honor (ikramiyya.

  17. Successful domino liver transplantation in maple syrup urine disease using a related living donor

    Directory of Open Access Journals (Sweden)

    F.H. Feier

    2014-06-01

    Full Text Available Maple syrup urine disease (MSUD is an autosomal recessive disease associated with high levels of branched-chain amino acids. Children with MSUD can present severe neurological damage, but liver transplantation (LT allows the patient to resume a normal diet and avoid further neurological damage. The use of living related donors has been controversial because parents are obligatory heterozygotes. We report a case of a 2-year-old child with MSUD who underwent a living donor LT. The donor was the patient's mother, and his liver was then used as a domino graft. The postoperative course was uneventful in all three subjects. DNA analysis performed after the transplantation (sequencing of the coding regions of BCKDHA, BCKDHB, and DBT genes showed that the MSUD patient was heterozygous for a pathogenic mutation in the BCKDHB gene. This mutation was not found in his mother, who is an obligatory carrier for MSUD according to the family history and, as expected, presented both normal clinical phenotype and levels of branched-chain amino acids. In conclusion, our data suggest that the use of a related donor in LT for MSUD was effective, and the liver of the MSUD patient was successfully used in domino transplantation. Routine donor genotyping may not be feasible, because the test is not widely available, and, most importantly, the disease is associated with both the presence of allelic and locus heterogeneity. Further studies with this population of patients are required to expand the use of related donors in MSUD.

  18. Hepatic artery thrombosis in live liver donor transplantation: how to solve--a case report.

    Science.gov (United States)

    Rodrigues, S; Martins, A; Barroso, E

    2014-01-01

    The decrease in the number of cadaveric donors has proved a limiting factor in the number of liver transplants, leading to the death of many patients on the waiting list. The living donor liver transplantation is an option that allows, in selected cases, increase the number of donors. One of the most serious complications in liver transplantation is hepatic artery thrombosis, in the past considered potentially fatal without urgent re-transplantation. A white male patient, 48 years old, diagnosed with hepatocellular carcinoma in chronic liver failure caused by hepatitis B virus, underwent living donor liver transplantation (right lobe). Doppler echocardiography performed in the immediate postoperative period did not identify arterial flow in the right branch, having been confirmed thrombosis of the right hepatic artery in CT angiography. Urgent re-laparotomy was performed, which consisted of thrombectomy and re-anastomosis of the hepatic artery with segmental splenic artery allograft interposition. The patient started anticoagulation and antiplatelet therapy with acetylsalicylic acid. Serial evaluation with Doppler echocardiography showed hepatic artery patency. At present, the patient is asymptomatic. One of the most devastating complications in liver transplantation, and particularly in living liver donor, is thrombosis of the hepatic artery; thus, early diagnosis and treatment is vital. The rapid intervention for revascularization of the graft avoids irreversible ischemia of the bile ducts and hepatic parenchyma, thus avoiding the need for re-transplantation.

  19. Multidetector CT in the evaluation of potential living donors for liver transplantation.

    Science.gov (United States)

    Alonso-Torres, Ana; Fernández-Cuadrado, Jaime; Pinilla, Inmaculada; Parrón, Manuel; de Vicente, Emilio; López-Santamaría, Manuel

    2005-01-01

    Living donor liver transplantation is increasingly being used to help compensate for the increasing shortage of cadaveric liver grafts. However, the extreme variability of the hepatic vascular systems can impede this surgical procedure. Evaluation of potential living donors was conducted in which a two-detector-row computed tomographic (CT) scanner was used to obtain arterial phase and portal dominant phase images following the intravenous injection of contrast material, after which three-dimensional maximum-intensity-projection and volume-rendered images were created. The vascular anatomy was evaluated, with special attention given to the origin and course of the artery to segment IV and the presence of variants, especially those considered relative or absolute contraindications for donation, those requiring reconstruction, or those potentially altering the surgical approach. In addition, graft and remnant liver volumes were determined and the liver parenchyma evaluated. Multidetector CT is proving to be valuable in the evaluation of potential living liver donors, contributing to donor safety and providing comprehensive information about the hepatic vascular anatomy, the liver parenchyma, and graft and remnant liver volume. This information is critical in choosing the most suitable potential donor, in surgical planning, and in obtaining an optimal graft that maintains the balance between blood supply and venous drainage. PMID:16009821

  20. Efficacy of mycofenolate mofetil for steroid-resistant acute rejection after living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Nobuhisa Akamatsu; Yasuhiko Sugawara; Sumihito Tamura; Yuichi Matsui; Junichi Kaneko; Masatoshi Makuuchi

    2006-01-01

    AIM: To discuss the use of mycophenolate mofetil (MMF) as an immunosuppressant in steroid resistant rejection after liver transplantation. METHODS: The clinical records of 260 adult patients who underwent living donor liver transplantation (LDLT) were reviewed. Tacrolimus and methylprednisolone were used for primary immunosuppression. Acute rejection was first treated with steroids. When steroid resistance occurred, the patient was treated with a combination of steroids and MMF. Anti-T-cell monoclonal antibody was administered to patients who were not responsive to steroids in combination with MMF.RESULTS: A total of 90 (35%) patients developed acute rejection. The median interval time from transplantation to the first episode was 15 d. Fifty-four patients were steroid resistant. Forty-four patients were treated with MMF and the remaining 10 required anti-T-cell monoclonal antibody treatment. Progression to chronic rejection was observed in one patient. Bone marrow suppression and gastrointestinal symptoms were the most common side effects associated with MMF use. There was no significant increase in opportunistic infections. CONCLUSION: Our results demonstrate that MMF is a potent and safe immunosuppressive agent for rescue therapy in patients with acute rejection after LDLT.

  1. Can value for money be improved by changing the sequence of our donor work-up in the living kidney donor programme?

    DEFF Research Database (Denmark)

    Larsen, Jesper; Sørensen, Søren Schwartz; Feldt-Rasmussen, Bo

    2009-01-01

    (range 22-69). Sixty-four participants were rejected as donors. Abdominal CT-scan with angiography and urography ruled out 22 of the above 64 potential organ donors; thus, 48% of the volunteers for living kidney donation were unsuited for donation. Abdominal CT-scan with angiography and urography...

  2. Analysis of donor selection for living related kidney transplantation and their postoperative outcome

    Directory of Open Access Journals (Sweden)

    Ležaić Višnja

    2002-01-01

    Full Text Available Lack of cadaveric organs for transplantation resulted in increased number of living related kidney donors examinations and consequent transplantations in our Department. Donor procedure, selection, drop-outs and final results for living related donors (LRD were retrospectively analyzed in this paper. Between 1987 and 1994 202 potential LRD were examined. Most of them were females (59% and about 30% were older than 60 years. The family relation between LRD and recipients were: parents (95%, siblings (3%, grandmother grandfather (1.5% and uncle (0.5%. Potential LRD were informed on risks advantages and procedure of living donor transplantation. After primary information 26% of potential LRD gave up further examinations. Following immunological and clinical evaluations 48% of LRD actually donated a kidney. The other 26% were excluded during the selection procedure. High immunological risks including ABO incompatibility, HLA mismatches and positive cross match test were the reasons for drop outs of 35 potential LRD (17%. Five more donors were excluded for medical reasons: one because of low creatinine clearance and four because of neoplasms, discovered during examination (kidney, laryngeal, lung. Fourteen transplantation were not realized due to different recipient reasons: 5 of them had clinical contraindications, two died and in 7 cadaveric kidney transplantations were performed. Mild hypertension, coronary disease and diabetes mellitus type 2 were presented in 5 LRD accepted for transplantation. Five more had to be operated before donation (abdominal or urological operation. Early complications after donor nephrectomy were acute renal failure, stress ulcus, pleuropneumonia in three and thromboflebitis in two donors. In conclusion, although kidney transplantation from LRD is highly successful careful examination during selection procedure is indispensable.

  3. Long-term follow-up of a randomized trial comparing laparoscopic and mini-incision open live donor nephrectomy.

    NARCIS (Netherlands)

    Dols, L.F.; Ijzermans, J.N.M.; Wentink, N.; Tran, T.C.K.; Zuidema, W.C.; Dooper, P.M.M.; Weimar, W.; Kok, N.F.

    2010-01-01

    Long-term physical and psychosocial effects of laparoscopic and open kidney donation are ill defined. We performed long-term follow-up of 100 live kidney donors, who had been randomly assigned to mini-incision open donor nephrectomy (MIDN) or laparoscopic donor nephrectomy (LDN). Data included blood

  4. CT examination of segmental liver transplants from living donors. Anatomy and pathological findings

    International Nuclear Information System (INIS)

    A lack of suitable pediatric donors and significantly better results than conventional transplantation have contributed to the steady increase in the number of segmental liver transplants from living donors throughout the world. This article describes the diagnostic impact of axial CT scans following transplantation in a retrospective evaluation of 18 CT examinations of 10 children with an average age of two years. Both spiral and conventional CT scans permit precise visualization of the postoperative anatomy of the upper abdomen that is more distinct than the images provided by ultrasonic scans. Thus, CT scans better facilitate detection of pathological findings. In 60% of the patients (67% of the examinations), the CT scan permitted a definite diagnosis; in the remaining cases, no morphological correlate to the clinical and laboratory findings was detected. In addition to traditional ultrasonic scanning, computed tomography represents a further noninvasive imaging technique for postoperative diagnostics following segmental liver transplants from living donors. (orig.)

  5. [Anesthetic considerations in laparoscopy for removal of a kidney from a live donor].

    Science.gov (United States)

    Monsma, M; Gómez, G; Vidal, A; Vera, C D; Barberá, M

    2010-05-01

    Kidney transplantation is the main therapeutic alternative for patients with end-stage renal failure. However, the main constraint at present is the lack of available organs. Removal of a kidney from a live donor is a better option than conventional transplantation of a cadaver-donated organ. Among the advantages are a shorter waiting time for the organ recipient and greater assurance of graft quality and survival. The postoperative conditions made possible by laparoscopic surgery have encouraged the donation of tissues by live donors. Anesthetic treatment for patients undergoing laparoscopic surgery must be based on an understanding of the pathophysiologic changes that occur in this type of procedure so that complications can be prevented. This review provides an update of progress in laparoscopic surgery and the repercussions of anesthetic management, particularly with respect to anesthesia for kidney donors. PMID:20527345

  6. Three-dimensional print of a liver for preoperative planning in living donor liver transplantation.

    Science.gov (United States)

    Zein, Nizar N; Hanouneh, Ibrahim A; Bishop, Paul D; Samaan, Maggie; Eghtesad, Bijan; Quintini, Cristiano; Miller, Charles; Yerian, Lisa; Klatte, Ryan

    2013-12-01

    The growing demand for liver transplantation and the concomitant scarcity of cadaveric livers have increased the need for living donor liver transplantation (LDLT). Ensuring the safety of donors and recipients is critical. The preoperative identification of the vascular and biliary tract anatomy with 3-dimensional (3D) printing may allow better preoperative surgical planning, avert unnecessary surgery in patients with potentially unsuitable anatomy, and thereby decrease the complications of liver transplant surgery. We developed a protocol and successfully 3D-printed synthetic livers (along with their complex networks of vascular and biliary structures) replicating the native livers of 6 patients: 3 living donors and 3 respective recipients who underwent LDLT. To our knowledge, these are the first complete 3D-printed livers. Using standardized preoperative, intraoperative, and postoperative assessments, we demonstrated identical anatomical and geometrical landmarks in the 3D-printed models and native livers.

  7. Can value for money be improved by changing the sequence of our donor work-up in the living kidney donor programme?

    DEFF Research Database (Denmark)

    Larsen, J.; Sorensen, S.S.; Feldt-Rasmussen, B.

    2009-01-01

    (range 22-69). Sixty-four participants were rejected as donors. Abdominal CT-scan with angiography and urography ruled out 22 of the above 64 potential organ donors; thus, 48% of the volunteers for living kidney donation were unsuited for donation. Abdominal CT-scan with angiography and urography......The aim of the study was to identify procedures of maximum importance for acceptance or rejection of kidney donation from a living donor as well as making the process more cost-effective. We identified all potential living related donors who were examined during the period between January 2002...... on time spent and number of tests needed for approving or rejecting subjects for living kidney donation Udgivelsesdato: 2009/8...

  8. [Donor risk in living-related liver transplantation - the surgeon's point of view].

    Science.gov (United States)

    Lang, H; Malagó, M; Testa, G; Nosser, S; Clauer, U; Broelsch, C E

    2001-12-01

    Living-related liver transplantation is a successful clinical approach to overcome organ shortage in hepatic transplantation. Possible advantages for the recipient of a living-donor transplant are a much shorter waiting period until transplantation and an almost elective time of operation which results in a decreased operative risk. Furthermore graft function of a living-related transplant is better than in cadaveric transplantation because of the shorter ischemic time and a careful examination of graft quality before organ donation. Removal of even more than 50 % of liver volume during the donor operation does not lead to an impairment of liver function in the organ donor. Intraoperative blood loss can usually be managed by re-transfusion of donor's own blood. Postoperative morbidity is about 10 - 15 % depending on the extent of the removed liver lobe. Most frequent postoperative complications are biliary leckages, wound infections and gastric/duodenal ulcerations. Up till now in more than 1000 living-related liver donations only three deaths occured due to thromboembolic and septic complications (< 0,3 %) (until 12/1998). PMID:11774047

  9. The use of mannitol in partial and live donor nephrectomy: an international survey

    NARCIS (Netherlands)

    Cosentino, M.; Breda, A.; Sanguedolce, F.; Landman, J.; Stolzenburg, J.U.; Verze, P.; Rassweiler, J.; Poppel, H. van; Klingler, H.C.; Janetschek, G.; Celia, A.; Kim, F.J.; Thalmann, G.; Nagele, U.; Mogorovich, A.; Bolenz, C.; Knoll, T.; Porpiglia, F.; Alvarez-Maestro, M.; Francesca, F.; Deho, F.; Eggener, S.; Abbou, C.; Meng, M.V.; Aron, M.; Laguna, P.M.; Mladenov, D.; D'Addessi, A.; Bove, P.; Schiavina, R.; Cobelli, O. De; Merseburger, A.S.; Dalpiaz, O.; D'Ancona, F.C.H.; Polascik, T.J.; Muschter, R.; Leppert, T.J.; Villavicencio, H.

    2013-01-01

    PURPOSE: Animal studies have shown the potential benefits of mannitol as renoprotective during warm ischemia; it may have antioxidant and anti-inflammatory properties and is sometimes used during partial nephrectomy (PN) and live donor nephrectomy (LDN). Despite this, a prospective study on mannitol

  10. More than a decade after live donor nephrectomy: a prospective cohort study

    NARCIS (Netherlands)

    Janki, S.; Klop, K.W.; Dooper, P.M.M.; Weimar, W.; Ijzermans, J.N.; Kok, N.F.

    2015-01-01

    Previously reported short-term results after live kidney donation show no negative consequences for the donor. The incidence of new-onset morbidity takes years to emerge, making it highly likely that this will be missed during short-term follow-up. Therefore, evidence on long-term outcome is essenti

  11. Decision making around living and deceased donor kidney transplantation: a qualitative study exploring the importance of expected relationship changes

    Directory of Open Access Journals (Sweden)

    de Groot Ingrid B

    2012-09-01

    Full Text Available Abstract Background Limited data exist on the impact of living kidney donation on the donor-recipient relationship. Purpose of this study was to explore motivations to donate or accept a (living donor kidney, whether expected relationship changes influence decision making and whether relationship changes are actually experienced. Methods We conducted 6 focus groups in 47 of 114 invited individuals (41%, asking retrospectively about motivations and decision making around transplantation. We used qualitative and quantitative methods to analyze the focus group transcripts. Results Most deceased donor kidney recipients had a potential living donor available which they refused or did not want. They mostly waited for a deceased donor because of concern for the donor’s health (75%. They more often expected negative relationship changes than living donor kidney recipients (75% vs. 27%, p = 0.01 who also expected positive changes. Living donor kidney recipients mostly accepted the kidney to improve their own quality of life (47%. Donors mostly donated a kidney because transplantation would make the recipient less dependent (25%. After transplantation both positive and negative relationship changes are experienced. Conclusion Expected relationship changes and concerns about the donor’s health lead some kidney patients to wait for a deceased donor, despite having a potential living donor available. Further research is needed to assess whether this concerns a selected group.

  12. Differences in willingness to donate cadaveric organ between young donor families and adult donor families: evidence from the Hunan Province, China

    Institute of Scientific and Technical Information of China (English)

    XIE Wen-zhao; YE Qi-fa; LIU Wei; SHAO Ming-jie; WAN Qi-quan; LI Cui-ying; LUO Ai-jing

    2013-01-01

    Background The Red Cross of China and Ministry of Health jointly started a pilot program of organ donation after cardiac death to overcome the shortage of available organs since 2010.The purpose of this qualitative study were to compare the consent rate of organ donation between young donor families and adult donor families; to explore and determine factors associated with differences in willingness to donate organs between them.Research objective was to provide a rationale for further preparation of professionals involved in this sensitive work.Methods Between March 2010 and June 2012,24 young deceased patients including donors and non-donors and 96 potential adult donors were collected,and consent rates of young donors' families and adult donors' families were calculated.A X2 test analysis to compare the consent rates of the two groups was conducted.We studied through semistructured interviews 15 parents of young donors and 15 relatives of old donors who were interviewed for petition of consent.Data collection and analysis of the overall study were performed according to the grounded theory methodology.Factors that influenced the families' decisions were identified and classified.We found the differences in willingness to donate organs between the two groups.Results The consent rate of young donor families was 66.67%,while the consent rate of adult donor families was 26.04%.Young donor families easily consented to organ donation than adult donor families (P<0.005).The donors' families had been affected by various factors throughout the process of deciding to give consent for donation.The findings led to the formulation of an empirically based model of interlinking categories that influence families' decision-making process in organ donation.These factors are grouped into five main categories:(1) personal factors,(2) conditions of organ request,(3) interpersonal factors,(4) ethical factors,and (5) traditional views.The funeral tradition influenced the young

  13. Adults living with heart failure and fatigue

    DEFF Research Database (Denmark)

    Schjødt, Inge; Sommer, Irene; Bjerrum, Merete

    Background Fatigue is one of the most common symptoms reported by patients with heart failure (HF). Fatigue negatively impacts on patients’ everyday life, prognosis and quality of life. No specific cure or effective interventions to alleviate fatigue are available. Over the past decade, qualitative...... studies have been performed to develop more coherent and effective interventions to support self-care among heart failure patients experiencing fatigue. The findings of qualitative research should be synthesised to optimise nurses' understanding of fatigue and develop recommendations for practice. Aim...... To synthesise the best available evidence related to the lived experiences and management of fatigue in everyday life in adult patients with stable heart failure to develop effective interventions to support self-care. Specific questions on the patients’ lived experiences included: • How do patients with HF...

  14. Vitamin A metabolism is changed in donors after living-kidney transplantation: an observational study

    Directory of Open Access Journals (Sweden)

    Henze Andrea

    2011-12-01

    Full Text Available Abstract Background The kidneys are essential for the metabolism of vitamin A (retinol and its transport proteins retinol-binding protein 4 (RBP4 and transthyretin. Little is known about changes in serum concentration after living donor kidney transplantation (LDKT as a consequence of unilateral nephrectomy; although an association of these parameters with the risk of cardiovascular diseases and insulin resistance has been suggested. Therefore we analyzed the concentration of retinol, RBP4, apoRBP4 and transthyretin in serum of 20 living-kidney donors and respective recipients at baseline as well as 6 weeks and 6 months after LDKT. Results As a consequence of LDKT, the kidney function of recipients was improved while the kidney function of donors was moderately reduced within 6 weeks after LDKT. With regard to vitamin A metabolism, the recipients revealed higher levels of retinol, RBP4, transthyretin and apoRBP4 before LDKT in comparison to donors. After LDKT, the levels of all four parameters decreased in serum of the recipients, while retinol, RBP4 as well as apoRBP4 serum levels of donors increased and remained increased during the follow-up period of 6 months. Conclusion LDKT is generally regarded as beneficial for allograft recipients and not particularly detrimental for the donors. However, it could be demonstrated in this study that a moderate reduction of kidney function by unilateral nephrectomy, resulted in an imbalance of components of vitamin A metabolism with a significant increase of retinol and RBP4 and apoRBP4 concentration in serum of donors.

  15. Organ transplantation from donors (cadaveric or living) with a history of malignancy: review of the literature.

    Science.gov (United States)

    Zhang, Sheng; Yuan, Jin; Li, Wei; Ye, Qifa

    2014-10-01

    The evolution of organ transplantation has resulted in extended lifespan as well as better life quality of patients with end-stage diseases, which in turn causes an increased demand for organs. The persistent organ shortage requires a careful reconsideration of potential donors (living or cadaveric) that have current or historical malignancies. Donors with low-grade skin tumors, carcinomas in situ of the uterine cervix, and primary central nervous system (CNS) tumors can be considered as potential donors for recipients dying on wait list longing for organ transplantation. Recently, transplant centers have turned to other types of malignancies including low grade renal cell carcinoma, prostate, ureteral, endometrial and breast cancer, and favorable outcomes have been shown in such innovations. When considering donors with a history of malignancy, general biologic behavior of the tumor type, histology and stage at the time of diagnosis, and the length of disease-free interval should be considered (Transplantation 2002;74(12):1657-1663). With the review of literatures, we illustrate the organ utilization from donors with malignancies all around the world since earlier times and give some suggestions for decision making under the circumstance of whether to choose those marginal donors or not on the basis of reviewed literatures. PMID:25135838

  16. Effects of nephrectomy on respiratory function and quality of life of living donors: a longitudinal study

    Science.gov (United States)

    Moraes, Karen; Paisani, Denise M.; Pacheco, Nathália C. T.; Chiavegato, Luciana D.

    2015-01-01

    BACKGROUND: A living donor transplant improves the survival and quality of life of a transplant patient. However, the impact of transplantation on postoperative lung function and respiratory muscular strength in kidney donors remains unknown. OBJECTIVE: To evaluate pulmonary function, respiratory muscle strength, quality of life and the incidence of postoperative pulmonary complications (PPCs) in kidney donors undergoing nephrectomy. METHOD: This prospective cohort enrolled 110 consecutive kidney donors undergoing nephrectomy. Subjects underwent pulmonary function (using spirometry) and respiratory muscular strength (using manovacuometry) assessments on the day prior to surgery and 1, 2, 3 and 5 days postoperatively. Quality of life (measured by the SF-36) was evaluated preoperatively and 30 days postoperatively. PPCs were assessed daily by a blinded assessor. RESULTS: Donors exhibited a decrease of 27% in forced vital capacity, 58% in maximum inspiratory capacity and 51% in maximum expiratory pressure on the 1stpostoperative day (p<0.001) but this improved over days 2, 3 and 5 but had not returned to preoperative levels. Patient quality of life was still impaired at 30 days with regards to functional capacity, physical role, pain, vitality and social functioning (p<0.05) but these parameters improved slowly. None of the patients developed PPCs. CONCLUSION: Kidney donors submitted to nephrectomy exhibited a reduction in pulmonary function, respiratory muscular strength and quality of life, most of which were improving toward pre-surgical levels. PMID:26443973

  17. Successful simultaneous pancreas kidney transplantation from living-related donor against positive cross-match.

    Science.gov (United States)

    Sammartino, Cinzia; Pham, Thuy; Panaro, Fabrizio; Bogetti, Diego; Jarzembowski, Tomasz; Sankary, Howard; Morelli, Nicola; Testa, Giuliano; Benedetti, Enrico

    2004-01-01

    A positive pretransplant flow cytometry cross-match (FC-XM) allows precise identification of high-risk recipients vulnerable to hyperacute or accelerated rejection after transplantation. Living donor kidney transplant recipient candidates with positive cross-match have been successfully treated with a combination of plasmapheresis (therapeutic plasma exchange, TPEX) and intravenous immunoglobulin (IVIG), achieving conversion to negative cross-match and successful transplant. We report the first successful case of simultaneous pancreas kidney transplant (SPKT) from a living donor (LD) performed against an initially positive FC-XM, converted to negative using a protocol based on TPEX and IVIG in combination with antiCD20 monoclonal antibody. This strategy of overcoming the cross-match barriers in living donation may offer a chance of successful transplantation to highly sensitized candidates for SPKT, for whom cadaveric transplant is difficult to achieve.

  18. Right lobe living-donor hepatectomy-the Toronto approach, tips and tricks.

    Science.gov (United States)

    Sapisochin, Gonzalo; Goldaracena, Nicolas; Laurence, Jerome M; Levy, Gary A; Grant, David R; Cattral, Mark S

    2016-04-01

    Living-donor liver transplantation (LDLT) is a well-established treatment for end-stage liver disease. Nevertheless, it has not been extensively accepted in North America or Europe as it has been in Asia. At the University of Toronto we initiated our LDLT program in 2000 and since then our program has grown each year, representing today the largest LDLT program in North America. Our right-lobe LDLT experience from 2000-2014 includes 474 right lobes. Only 30% of our grafts have included the middle hepatic vein. We present excellent outcomes in terms of graft and patient survival which is not different to that achieved with deceased donor liver transplantation. In the present study we will discuss the evolution, challenges and current practices of our LDLT program. We will discuss what is and has been the program philosophy. We will also discuss how we evaluate our donors and the extensive workup we do before a donor is accepted for live donation. Furthermore we will discuss some tips and tricks of how we perform the right hepatectomy for live donation.

  19. Reciprocating living kidney donor generosity: tax credits, health insurance and an outcomes registry.

    Science.gov (United States)

    Joshi, Shivam; Joshi, Sheela; Kupin, Warren

    2016-02-01

    Kidney transplantation significantly improves patient survival, and is the most cost effective renal replacement option compared with dialysis therapy. Living kidney donors provide a valuable societal gift, but face many formidable disincentive barriers that include not only short- and long-term health risks, but also concerns regarding financial expenditures and health insurance. Other than governmental coverage for their medical evaluation and surgical expenses, donors are often asked to personally bear a significant financial responsibility due to lost work wages and travel expenses. In order to alleviate this economic burden for donors, we advocate for the consideration of tax credits, lifelong health insurance coverage, and an outcomes registry as societal reciprocity to reward their altruistic act of kidney donation. PMID:26798480

  20. Comparison of the risk of viral infection between the living and nonliving musculoskeletal tissue donors in Australia.

    Science.gov (United States)

    Yao, Felix; Seed, Clive; Farrugia, Albert; Morgan, David; Wood, David; Zheng, Ming-Hao

    2008-10-01

    Screening of musculoskeletal tissue donors with nucleic acid testing (NAT) for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) has been implemented in the United States and other developed nations. However, in contrast to the donor demographics in the United States, the majority of Australian musculoskeletal tissue donations are primarily from living surgical donors. The objective of our study was to determine and compare the risk of viral infection associated with musculoskeletal tissue donation from living and nonliving donors in Australia. We studied serum samples from 12 415 consecutive musculoskeletal tissue donors between 1993 and 2004. This included 10 937 surgical donations, and 1478 donations obtained from postmortem organ donation patients and cadaveric donors. Current mandatory retesting of surgical donors 6 months postdonation reduces the risk of viral infection by approximately 95% by eliminating almost all donors in the window period. The addition of nucleic acid amplification testing for nonliving donors would similarly reduce the window period, and consequently the residual risk by approximately 50% for hepatitis B virus, 55% for HIV, and 90% for HCV. NAT, using appropriately validated assays for nonliving donors, would reduce the residual risk to levels comparable to that in living donors (where the 95% reduction for quarantining pending the 180-day re-test is included). PMID:18537922

  1. Major influence of renal function on hyperlipidemia after living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Qi Ling; Kai Wang; Di Lu; Hai-Jun Guo; Wen-Shi Jiang; Xiang-Xiang He; Xiao Xu

    2012-01-01

    AIM:To investigate the impact of renal and graft function on post-transplant hyperlipidemia (PTHL) in living donor liver transplantation (LDLT).METHODS:A total of 115 adult patients undergoing LDLT from January 2007 to May 2009 at a single center were enrolled.Data were collected and analyzed by the China Liver Transplant Registry retrospectively.PTHL was defined as serum triglycerides ≥ 150 mg/dL or serum cholesterol ≥ 200 mg/dL or the need for pharmacologic treatment at the sixth month after LDLT.Early renal dysfunction (ERD) was defined as serum creatinine ≥ 2 mg/dL and/or the need for renal replacement therapy in the first post-transplant week.RESULTS:In 115 eligible patients,the incidence of PTHL was 24.3%.Recipients with PTHL showed a higher incidence of post-transplant cardiovascular events compared to those without PTHL (17.9% vs 4.6%,P=0.037).Serum creatinine showed significant positive correlations with total serum triglycerides,both at posttransplant month 1 and 3 (P < 0.01).Patients with ERD had much higher pre-transplant serum creatinine levels (P < 0.001) and longer duration of pre-transplant renal insufficiency (P < 0.001) than those without ERD.Pretransplant serum creatinine,graft-to-recipient weight ratio,graft volume/standard liver volume ratio,body mass index (BMI) and ERD were identified as risk factors for PTHL by univariate analysis.Furthermore,ERD [odds ratio (OR) =9.593,P < 0.001] and BMI (OR =6.358,P =0.002) were identified as independent risk factors for PTHL by multivariate analysis.CONCLUSION:Renal function is closely associated with the development of PTHL in LDLT.Post-transplant renal dysfunction,which mainly results from pre-transplant renal insufficiency,contributes to PTHL.

  2. Risk factor for ischemic-type biliary lesion after ABO-incompatible living donor liver transplantation

    Science.gov (United States)

    Bang, Jun Bae; Kim, Bong-Wan; Kim, Young Bae; Wang, Hee-Jung; Lee, Hyun Yeong; Sim, Joohyun; Kim, Taegyu; Lee, Kyeong Lok; Hu, Xu-Guang; Mao, Wei

    2016-01-01

    AIM: To evaluate the risk factors for ischemic-type biliary lesion (ITBL) after ABO-incompatible (ABO-I) adult living donor liver transplantation (ALDLT). METHODS: Among 141 ALDLTs performed in our hospital between 2008 and 2014, 27 (19%) were ABO-I ALDLT and 114 were ABO-identical/compatible ALDLT. In this study, we extensively analyzed the clinico-pathological data of the 27 ABO-I recipients to determine the risk factors for ITBL after ABO-I ALDLT. All ABO-I ALDLT recipients underwent an identical B-cell depletion protocol with preoperative rituximab, plasma exchange (PE), and operative splenectomy. The median follow-up period after transplantation was 26 mo. The clinical outcomes of the 27 ABO-I ALDLT recipients were compared with those of 114 ABO-identical/compatible ALDLT recipients. RESULTS: ITBL occurred in four recipients (14.8%) between 45 and 112 d after ABO-I ALDLT. The overall survival rates were not different between ABO-I ALDLT and ABO-identical/compatible ALDLT (P = 0.303). Among the ABO-I ALDLT recipients, there was no difference between patients with ITBL and those without ITBL in terms of B-cell and T-cell count, serum isoagglutinin titers, number of PEs, operative time and transfusion, use of graft infusion therapy, or number of remnant B-cell follicles and plasma cells in the spleen. However, the perioperative NK cell counts in the blood of patients with ITBL were significantly higher than those in the patients without ITBL (P 150/μL and postoperative NK cell count > 120/μL were associated with greater relative risks (RR) for development of ITBL (RR = 20 and 14.3, respectively, P transplant recipient’s blood are associated with ITBL after ABO-I ALDLT. Further research is needed to elucidate the molecular mechanism of NK cell involvement in the development of ITBL.

  3. Early experiences on living donor liver transplantation in China: multicenter report

    Institute of Scientific and Technical Information of China (English)

    WANG Xue-hao; SUN Bei-cheng; GE Wen-gang; YAN Lü-nan; ZHANG Feng; LI Xiang-cheng; ZHU Ji-ye; PENG Zhi-hai; LIU Jin-hui; LI Guo-qiang; CHENG Feng

    2006-01-01

    Background Because of the lack of brain death laws in China, the proportion of cadaveric organ donation is low. Many patients with end-stage liver disease die waiting for a suitable donor. Living donor liver transplantation (LDLT) would reduce the current discrepancy between the number of patients on the transplant waiting list and the number of available organ donors. We describe the early experience of LDLT in the mainland of China based on data from five liver transplant centers.Methods Between January 2001 and October 2003, 45 patients with end-stage liver disease received LDLT at five centers in China. The indication and timing, surgical techniques and complications, nonsurgical issues including rejection, infection, and advantages of LDLT in the series were reviewed. Actuarial patient and graft survival rates were calculated by using the Kaplan-Meier product-limit estimate. Statistical analysis was completed by using SPSS 10.0.Results All LDLT recipients were cirrhotic patients, except for one man with fulminant hepatic failure. Among the 45 cases of LDLT, 35 (77.8%) were performed in one center (the First Affiliated Hospital of Nanjing Medical University). The overall 1 and 3 year survival rate of the recipients was 93.1% and 92.0%, respectively. Of the 45 LDLT donors, there were 3 cases of biliary leakage, 2 subphrenic collections, 1 fat liquefaction around the incision and 1 biliary peritonitis after T tube removal. All donors recovered completely.Conclusions LDLT provides an excellent approach to addressing the problem of donor shortage in China even though the operation is complicated, uncompromising and difficult with respect to the safety of the donors and receptors. Despite early technical hurdles having been overcome, perfection of technique is still necessarily. At present, LDLT is a good choice for the patients with irreversible liver disease.

  4. Glomerular volume and renal histology in obese and non-obese living kidney donors.

    Science.gov (United States)

    Rea, D J; Heimbach, J K; Grande, J P; Textor, S C; Taler, S J; Prieto, M; Larson, T S; Cosio, F G; Stegall, M D

    2006-11-01

    The link between obesity and renal disease is unclear, and there is no consensus as to whether obese individuals are at increased risk for kidney disease after living kidney donation if they otherwise meet acceptance criteria. We retrospectively studied time-zero (implantation) biopsies in 49 obese (body mass index (BMI) > or = 30 kg/m2) and 41 non-obese (BMI < 30 kg/m2) renal donors that met acceptance criteria. We found that our obese donor population had higher systolic blood pressure (P < 0.001 vs non-obese) and higher absolute iothalamate clearance (P = 0.001 vs non-obese) before donation. The obese donors had larger glomerular planar surface area compared to non-obese controls (P = 0.017), and this parameter correlated with patient weight and urinary microalbumin excretion. Detailed examination of the biopsies revealed that although most histologic findings were similar between groups, the obese donors had more tubular dilation (P = 0.01), but less tubular vacuolization (P = 0.02) than the non-obese controls. There was also a trend toward more arterial hyalinosis in the obese patients than controls (P = 0.08). From these data, our studies detected subtle differences in donor organs obtained from obese compared to non-obese individuals. Further studies should be carried out to quantify the long-term impact of these findings.

  5. Longterm clinical and radiological follow-up of living liver donors.

    Science.gov (United States)

    Darwish Murad, Sarwa; Fidler, Jeff L; Poterucha, John J; Sanchez, William; Jowsey, Sheila G; Nagorney, David; Rosen, Charles B; Heimbach, Julie K

    2016-07-01

    Although short-term risks of living donor hepatectomy have been well defined, little is known about the longterm impact. We aimed to perform a systematic follow-up to screen for unanticipated health consequences of liver donation. All donors who were more than 1 year from donation were invited for a systematic evaluation including physical and laboratory assessment, quality of life questionnaire, and magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP). Those unable to return were offered the questionnaire and laboratory assessment at home. Out of our total of 97 donors, 45 returned for a full assessment and 23 completed labs and survey locally (total n = 68; 70%) after a median of 5.5 years (1.5-10.9 years) after donation. The only laboratory abnormality was a significant decrease in platelet count (median 198 ×10(9) /L versus 224 ×10(9) /L before donation; P Liver regeneration was complete. Spleen volume did significantly increase (median 278 cm(3) versus 230 cm(3) before donation; P liver donation appears satisfactory. None of our donors have developed occult biliary strictures, failure of regeneration, abnormal liver function, or other important health consequences after a median of 5.5 years from surgery. These findings can be used when counseling potential donors in the future. Liver Transplantation 22 934-942 2016 AASLD. PMID:27144969

  6. Caudal shif ting of hepatic vein anastomosis inright liver living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Sheung Tat Fan

    2008-01-01

    BACKGROUND: In right liver living donor liver trans-plantation, hepatic venous anastomosis is performed using the recipient's right hepatic vein oriifce. There may be situations that the portal vein is short or the right liver graft is small, leading to dififculty in portal vein, hepatic artery or duct-to-duct anastomosis. METHODS: The recipient's right hepatic vein oriifce is closed partially for 2 cm at the cranial end or totally, and a new venotomy is made caudal to the right hepatic vein oriifce. Hepatic vein anastomosis is performed with the new venotomy. RESULTS: The distance between the liver graft hilum and hepatoduodenal ligament is reduced. Portal vein, hepatic artery and biliary anastomosis could be performed without tension or conduit. CONCLUSION: Caudal shifting of hepatic vein anasto-mosis facilitates implantation of a right liver living donor graft.

  7. Practice experiences of running UK DonorLink, a voluntary information exchange register for adults related through donor conception.

    Science.gov (United States)

    Crawshaw, Marilyn; Marshall, Lyndsey

    2008-12-01

    Previous practices of withholding information from those conceived through donor conception are changing. However, little is known about the service needs of those affected. In response to this, the UK Government-funded pilot voluntary information exchange and contact register, UK DonorLink, was launched in 2004, covering conceptions prior to August 1991. It is the only register worldwide that relies primarily on DNA testing to establish genetic connectedness in the absence of written records. Approximately 150 adults came forward to register in the first three years of operation, drawn from all interested parties. Matches between half-siblings have been made, but none yet between donor and offspring. Employing staff with expertise in post-adoption work has proved effective, as long as additional training and support specific to donor issues is provided. The infrastructure required to promote and deliver the service reflects the complex mix of skills and tasks required, and confirms that a service provided through independent counsellors alone would be inappropriate. Having a geographically and socially widespread potential registrant group, together with a limited budget, has limited the effectiveness of advertising and promotion campaigns. Ethical and emotional complexities arising through the direct service are highlighted, including those presented by DNA use. PMID:19085259

  8. Role of Nurses in Early Ambulation of Living Donor Liver Transplant Recipients

    OpenAIRE

    Sato, Orie; Osanai, Yumiko; Urushidate, Chie; Yamaguchi, Tomoko; Narumi, Shunji; Umehara, Minoru; Toyoki, Yoshikazu; Sugai, Michihiro; Hakamada, Kenichi; Kimura, Toshiko

    2013-01-01

    [Introduction] Liver transplant recipients suffer more complications than do patients undergoing other gastroenterological surgeries. Many factors inhibit ambulation in liver transplant patients, such as the level of restriction to bed rest and length of stay in the intensive care unit( ICU). Patients thus face ambulation difficulties. Support for ambulation is one of the major daily tasks of nurses. We reviewed the ambulation situations of patients who underwent living donor liver transplant...

  9. Acute paranoid psychosis as sole clinical presentation of hepatic artery thrombosis after living donor liver transplantation

    OpenAIRE

    Obed Aiman; Ramadori Giuliano; Meier Volker; Goralczyk Armin D; Lorf Thomas

    2010-01-01

    Abstract Background Hepatic artery thrombosis is a devastating complication after orthotopic liver transplantation often requiring revascularization or re-transplantation. It is associated with considerably increased morbidity and mortality. Acute cognitive dysfunction such as delirium or acute psychosis may occur after major surgery and may be associated with the advent of surgical complications. Case presentation Here we describe a case of hepatic artery thrombosis after living-donor liver ...

  10. Vascular complications following 1500 consecutive living and cadaveric donor renal transplantations: A single center study

    Directory of Open Access Journals (Sweden)

    Salehipour Mehdi

    2009-01-01

    Full Text Available The aim of this study was to document vascular complications that occurred fol-lowing cadaveric and living donor kidney transplants in order to assess the overall incidence of these complications at our center as well as to identify possible risk factors. In a retrospective cohort study, 1500 consecutive renal transplant recipients who received a living or cadaveric donor kidney between December 1988 and July 2006 were evaluated. The study was performed at the Nemazee Hospital, Shiraz, Iran. The assessment of the anatomy and number of renal arteries as well as the incidence of vascular complications was made by color doppler ultrasonography, angiography, and/or surgical exploration. Clinically apparent vascular complications were seen in 8.86% of all study patients (n = 133 with the most frequent being hemorrhage (n = 91; 6.1% followed by allo-graft renal artery stenosis (n = 26; 1.7%, renal artery thrombosis (n = 9; 0.6%, and renal vein thrombosis (n = 7; 0.5%. Vascular complications were more frequent in recipients of cadaveric organs than recipients of allografts from living donors (12.5% vs. 7.97%; P= 0.017. The occurrence of vascular complications was significantly more frequent among recipients of renal allografts with multiple arteries when compared with recipients of kidneys with single artery (12.3% vs. 8.2%; P= 0.033. The same was true to venous complications as well (25.4% vs. 8.2%; P< 0.001. Our study shows that vascular complications were more frequent in allografts with multiple renal blood vessels. Also, the complications were much less frequent in recipients of living donor transplants.

  11. Financial Neutrality for Living Organ Donors: Reasoning, Rationale, Definitions, and Implementation Strategies.

    Science.gov (United States)

    Hays, R; Rodrigue, J R; Cohen, D; Danovitch, G; Matas, A; Schold, J; LaPointe Rudow, D

    2016-07-01

    In the United States, live organ donation can be a costly and burdensome undertaking for donors. While most donation-related medical expenses are covered, many donors still face lost wages, travel expenses, incidentals, and potential for future insurability problems. Despite widespread consensus that live donors (LD) should not be responsible for the costs associated with donation, little has changed to alleviate financial burdens for LDs in the last decade. To achieve this goal, the transplant community must actively pursue strategies and policies to eliminate unreimbursed out-of-pocket costs to LDs. Costs should be more appropriately distributed across all stakeholders; this will also make live donation possible for people who, in the current system, cannot afford to proceed. We propose the goal of LD "financial neutrality," offer an operational definition to include the coverage/reimbursement of all medical, travel, and lodging costs, along with lost wages, related to the act of donating an organ, and guidance for consideration of medical care coverage, and wage and other expense reimbursement. The intent of this report is to provide a foundation to inform discussion within the transplant community and to advance initiatives for policy and resource allocation.

  12. Financial Neutrality for Living Organ Donors: Reasoning, Rationale, Definitions, and Implementation Strategies.

    Science.gov (United States)

    Hays, R; Rodrigue, J R; Cohen, D; Danovitch, G; Matas, A; Schold, J; LaPointe Rudow, D

    2016-07-01

    In the United States, live organ donation can be a costly and burdensome undertaking for donors. While most donation-related medical expenses are covered, many donors still face lost wages, travel expenses, incidentals, and potential for future insurability problems. Despite widespread consensus that live donors (LD) should not be responsible for the costs associated with donation, little has changed to alleviate financial burdens for LDs in the last decade. To achieve this goal, the transplant community must actively pursue strategies and policies to eliminate unreimbursed out-of-pocket costs to LDs. Costs should be more appropriately distributed across all stakeholders; this will also make live donation possible for people who, in the current system, cannot afford to proceed. We propose the goal of LD "financial neutrality," offer an operational definition to include the coverage/reimbursement of all medical, travel, and lodging costs, along with lost wages, related to the act of donating an organ, and guidance for consideration of medical care coverage, and wage and other expense reimbursement. The intent of this report is to provide a foundation to inform discussion within the transplant community and to advance initiatives for policy and resource allocation. PMID:27037542

  13. Predonation psychosocial evaluation of living kidney and liver donor candidates: a systematic literature review.

    Science.gov (United States)

    Duerinckx, Nathalie; Timmerman, Lotte; Van Gogh, Johan; van Busschbach, Jan; Ismail, Sohal Y; Massey, Emma K; Dobbels, Fabienne

    2014-01-01

    Evaluating a person's suitability for living organ donation is crucial, consisting not only of a medical but also of a thorough psychosocial screening. We performed a systematic literature review of guidelines, consensus statements, and protocols on the content and process of psychosocial screening of living kidney and liver donor candidates. We searched PubMed, Embase, CINAHL, and PsycINFO until June 22, 2011, following the PRISMA guidelines, complemented by scrutinizing guidelines databases and references of identified publications. Thirty-four publications were identified, including seven guidelines, six consensus statements, and 21 protocols or programs. Guidelines and consensus statements were inconsistent and lacked concreteness for both their content and process, possibly explaining the observed variability in center-specific evaluation protocols and programs. Overall, recommended screening criteria are not evidence-based and an operational definition of the concept "psychosocial" is missing, causing heterogeneity in terminology. Variation also exists on methods used to psychosocially evaluate potential donors. The scientific basis of predonation psychosocial evaluation needs to be strengthened. There is a need for high-quality prospective psychosocial outcome studies in living donors, a uniform terminology to label psychosocial screening criteria, and validated instruments to identify risk factors.

  14. Comparison of Multidetector CT Angiographic Findings with Operative Findings of Renal Vasculature in Living Renal Donors

    Directory of Open Access Journals (Sweden)

    Soodeh Sagheb

    2010-05-01

    Full Text Available Background/Objective: In kidney transplantation, decision about donation of the proper kidney is not the same between different surgeons. One of the most important factors for choosing the best kidney for transplantation is a simple vasculature anatomy and a kidney without abnormalities. In laparoscopic nephrectomy, the left kidney is preferred, because it has a longer renal vein and the renal artery is not behind the inferior vena cava (IVC. In other situations, in order to reduce the vascular morbidity of the surgery, nephrectomy is on the side which has a simpler vascular anatomy."nAssessment of renal vasculature of a live donor with noninvasive techniques is a necessity for live donors. For delineation of vascular anomalies of the kidney as well as urinary system abnormalities, Multi-Detector CT seems to be an excellent method for evaluation."nPatients and Methods: In this study, 59 live donors were assessed with multi-detector CT angiography. After injection of 80 ml contrast media, we acquired CT images with 0.6 mm slice thickness. Finally, processing and three dimensional reconstructions were performed and the accessory arteries, early branching of the main renal artery, the number of main renal vessels and the ureters were assessed. Findings were compared with the nephrectomy results."nResults: In multi slice CT angiography the prevalence of accessory renal artery was 3.4% with 98% accuracy, early branching of the main renal artery was 8.4% with 100% accuracy. Multiplicity of renal veins was seen in 8.4% of donors with 98% accuracy. Duplicated ureter was not seen in any of the donors."nDiscussion: The accuracy of CT angiography is 95% for depicting accessory renal artery and multiple renal artery and 100% for early branching. These results were comparable with the findings in conventional angiography and the studies showed that this method is more valuable in comparison with MR angiography and digital subtraction angiography. Also, it is

  15. Tacrolimus dosage requirements in living donor liver transplant recipients with small-for-size grafts

    Institute of Scientific and Technical Information of China (English)

    Fei Liu; Ya Li; Xiang Lan; Yong-Gang Wei; Bo Li; Lv-Nan Yan; Tian-Fu Wen; Ji-Chun Zhao; Ming-Qing Xu; Wen-Tao Wang; Jia-Yin Yang

    2009-01-01

    AIM: To investigate the tacrolimus dosage requirements and blood concentrations in adult-to-adult right lobe living donor liver transplantation (AALDLT) recipients with small-for-size (SFS) grafts.METHODS: During January 2007 and October 2008, a total of 54 cases of AALDLT with an observation period of 6 mo were enrolled in this study. The 54 patients were divided into two groups according to graftrecipient body weight ratio (GRBW): SFS grafts group (Group S, GRBW < 0.8%, n = 8) and non-SFS grafts group (Group N, GRBW ≥ 0.8%, n = 46). Tacrolimus 12-hour blood levels and doses were recorded during weeks 1, 2, 3 and 4 and months 2, 3, 4, 5 and 6 in group S and group N. Meanwhile, acute rejection rates,liver and renal function test results, and the number of potentially interacting medications were determined at each interval in the two groups. A comparison of tacrolimus dosage requirements and blood levels were made weekly in the first month post-surgery, and monthly from months 2 to 6.RESULTS: There were no differences in the demographic Demographic characteristics, acute rejection rates, liver and renal function test results, or the number of potentially interacting medications administered between the two groups. The tacrolimus dosage requirements in group S were significantly lower than group N at 2 wk (2.8 ± 0.4 mg/d vs 3.6 ± 0.7 mg/d, P = 0.006), 3 wk (2.9 ± 0.7 mg/d vs 3.9 ± 0.8 mg/d, P = 0.008), 4 wk (2.9 ± 0.8 mg/d vs 3.9 ± 1.0 mg/d, P = 0.023) and 2 mo (2.8 ± 0.7 mg/d vs 3.8 ± 1.1 mg/d, P = 0.033). Tacrolimus 12-h trough concentrations were similar between the two groups at all times except for 2 wk post-transplantation,when the concentrations were significantly greater in group S recipients than in group N recipients (11.3 ± 4.8 ng/mL vs 7.0 ± 3.8 ng/mL, P = 0.026).CONCLUSION: SFS grafts recipients have significantly decreased tacrolimus dosage requirements compared with non-SFS grafts recipients in AALDLT during the first 2 mo post-surgery.

  16. Living donor bone banking: processing and discarding--from procurement to therapeutic use.

    Science.gov (United States)

    Hovanyecz, Paula; Lorenti, Alicia; Lucero, José Manuel Juan; Gorla, Adrián; Castiglioni, Alejandro Enrique

    2015-12-01

    Skeletal muscle and osteoarticular tissue banks are responsible to procure, process, store and distribute tissues, from living and cadaveric donors. The procedures involve the application of protocols covering all aspects of the banking, ensuring the best tissue quality and maximum safety for the recipient. An analysis on the causes of bone tissue discarded by Biotar Tissue Bank between January 2005 and December 2012 was carried. Bone tissue was obtained from both hip and knee replacement (femoral heads and tibial plateau respectively) in living donors treated at different medical-surgical institutions in Argentina. These tissues were processed at the Bank to produce both frozen and lyophilized cancellous bone. Out of 3413 donated bones received by the Bank, 77.55 % resulted in final product, while the remaining 22.44 % was discarded in compliance with the quality standards of both the Bank and the regulatory authority. Comparing the last and the first year of the studied period, the number of discarded tissue increased 3.6 times, while the number of collected bones was approximately 10 times higher. Related to total disposed tissue, reactive serology was the most frequent cause (62.14 %), followed by inappropriate collection/storage of blood sample (30.81 %). A progressive reduction in the percentages of total discard was observed, and this was proportional to inappropriate collection/storage of blood sample. No significant differences were found in the discard rates due to positive serology throughout all the years studied. The success of a tissue bank requires full commitment of all the personnel especially the team members responsible for donor selection and the processing of allografts. It is important to critically screen donors in the early stages of donor recruitment. All of the procedures carried out by the tissue bank are parts of the quality control system which must be strictly carried out. Biotar Tissue Bank is continuously committed to ensure

  17. The value of multi-slice spiral CT in the preoperative assessment of living renal donor

    International Nuclear Information System (INIS)

    Objective: The purpose of this study is to assess the value of multi-slice spiral CT (MSCT) in the preoperative evaluation of living renal donor as a all in one modality. Methods: Thirty-six potential living renal donors underwent the examination using a GE light VCT scanner. Informed consent was obtained from all participants. The plain scan, early arterial phase, late arterial phase and excretory phase scans are performed in the former 25 donors (injection rate 5 rolls, total volume 100 mi, tube tension 120 kV). While in the later 11 donors (2 ml/s 40 ml +4 ml/s 60 ml), the scanning protocol included the plain scan ( 100 kV), vascular phase and excretory phase scans (100 kV). The excretory phase data were used in the reconstruction of CT urography in both groups. All images were reviewed by one radiologist and one urologist, and the findings of MSCT were compared with intraoperative findings for 33 donors, to investigate the utilities of MSCT in assessing renal vascularity, urinary tract and lesions of renal parenchyma. When discrepancies are found between the two reviewers, consensus was obtained via discussion. Au data was statiscally processed with SPSS for Windows. Results: MSCT angiography is in accordance with intraoperative findings in demonstrating the anatomy of renal arteries and renal vein trunk, accesary arteries, early branching of renal artery. The findings from CTA are highly in accordance with the intraoperative findings, which facilitate intraoperative ligation and reduce relevant complications. CTU demonstrates the anatomy of urinary, tract in good agreement with the intraoperative findings. The image quality of 3D vascularity and CTU between the two groups, scored 4.4 ± 1.2 vs 4.2 ± 1.3 and 4.6 ± 0.8 vs 4.4 ± 0.9 respectively, no statistical between-groups difference was found (Z=-0.89, -0.47, P>0.05). Conclusion: MSCT multiphase scanning combined with CTA and CTU play a important role in the evaluation of living renal donor, which

  18. Vascular management during live donor nephrectomy: an online survey among transplant surgeons.

    Science.gov (United States)

    Janki, S; Verver, D; Klop, K W J; Friedman, A L; Peters, T G; Ratner, L E; Ijzermans, J N M; Dor, F J M F

    2015-06-01

    In 2006, a survey from the American Society of Transplant Surgeons disclosed significant and sometimes fatal hemorrhagic events in live donor nephrectomies (LDN) related to failure of clips, leading to the contraindication of the Weck® Hem-o-lok® clip for control of the renal artery during LDN. A survey regarding vascular control techniques, their perceived safety ratings and their failures was sent to 645 European Society for Organ Transplantation members who profiled their profession as "surgeon" and selected "kidney" as organ type. Two hundred forty-three (41%) members responded, of whom 171 (63.3%) independently perform LDN. Their responses were analyzed. For arterial and venous vascular control, the GIA™ and TA™stapler are used most frequently, and were rated the safest. Of the 121 reported hemorrhagic events, slippage and dislodgement of clips occurred at least 58 times, while stapler malfunction occurred at least 40 times. One donor death from hemorrhage related to clip dysfunction was reported. Hemorrhagic complications of LDN with fatal and non-fatal outcomes still occur. Strikingly, many surgeons do not use the vascular closing technique that they consider most safe. Failure of non-transfixion techniques is associated with greater risks for the donor. Control of major vessels in LDN must employ transfixion techniques for optimal donor safety. PMID:25833120

  19. Comparison between spousal donor transplantation treated with anti-thymocyte globulin induction therapy and, living related donor transplantation treated with standard immunosuppression

    Directory of Open Access Journals (Sweden)

    Erkan Demir

    2014-01-01

    Full Text Available The worldwide shortage of organs available for transplantation has led to the use of living-unrelated kidney donors. In this context, spouses represent an important source of organ donors. We compared the allograft outcomes of spousal donor transplantation (SDT with anti-thymocyte globulin (ATG induction therapy and living related donor transplantation (LRDT with triple immonosuppression and basiliximab, in addition. Among the 335 living and deceased donor kidney transplantations performed between April 2001 and June 2010, there were 274 living donor kidney transplantations including 34 SDT and 240 LRDT. The minimum follow-up period was 36 months. All recipients of SDT received ATG (1.5 mg/kg induction therapy, which was stopped five to seven days after surgery. Maintenance immunosuppression included tacrolimus (TAC, mycophenolate mofetil (MMF and prednisolone. LRDT recipients received triple immunosuppressive protocol consisting of cyclosporine or TAC, MMF and prednisolone, in addition to basiliximab. There was a significant difference between the two groups in recipient age, while pre-operative duration on dialysis, recipient sex and donor age and sex were not significantly different. There was also a significant difference between the two groups in the number of human leukocyte antigen (HLA mismatches. The 1-, 3- and 5-year graft survival rates of SDT were 94.1%, 88.2% and 79.4%, respectively, and the frequency of acute rejection episodes was 5.8% (two cases. The 1-, 3- and 5-year graft survival rates of LRDT were 95.8%, 91.6% and 83.3%, respectively, with the frequency of acute rejection being 16.2%. The graft survival rates of SDT were as good as LRDT, while the acute rejection rates in SDT were lower than in LRDT, although the difference was not statistically different (P = 0.13.

  20. Comparison between spousal donor transplantation treated with anti-thymocyte globulin induction therapy and, living related donor transplantation treated with standard immunosuppression.

    Science.gov (United States)

    Demir, Erkan; Paydas, Saime; Erken, Ugur

    2014-05-01

    The worldwide shortage of organs available for transplantation has led to the use of living-unrelated kidney donors. In this context, spouses represent an important source of organ donors. We compared the allograft outcomes of spousal donor transplantation (SDT) with anti-thymocyte globulin (ATG) induction therapy and living related donor transplantation (LRDT) with triple immonosuppression and basiliximab, in addition. Among the 335 living and deceased donor kidney transplantations performed between April 2001 and June 2010, there were 274 living donor kidney transplantations including 34 SDT and 240 LRDT. The minimum follow-up period was 36 months. All recipients of SDT received ATG (1.5 mg/kg) induction therapy, which was stopped five to seven days after surgery. Maintenance immunosuppression included tacrolimus (TAC), mycophenolate mofetil (MMF) and prednisolone. LRDT recipients received triple immunosuppressive protocol consisting of cyclosporine or TAC, MMF and prednisolone, in addition to basiliximab. There was a significant difference between the two groups in recipient age, while pre-operative duration on dialysis, recipient sex and donor age and sex were not significantly different. There was also a significant difference between the two groups in the number of human leukocyte antigen (HLA) mismatches. The 1-, 3- and 5-year graft survival rates of SDT were 94.1%, 88.2% and 79.4%, respectively, and the frequency of acute rejection episodes was 5.8% (two cases). The 1-, 3- and 5-year graft survival rates of LRDT were 95.8%, 91.6% and 83.3%, respectively, with the frequency of acute rejection being 16.2%. The graft survival rates of SDT were as good as LRDT, while the acute rejection rates in SDT were lower than in LRDT, although the difference was not statistically different (P = 0.13).

  1. Malaria after living donor liver transplantation:report of two cases

    Institute of Scientific and Technical Information of China (English)

    Durgatosh Pandey; Kan-Hoe Lee; Sin-Yew Wong; Kai-Chah Tan

    2008-01-01

    BACKGROUND:Infectious complications are common during the postoperative course of a liver transplant recipient. Malaria, however, is a rare complication in such a setting. METHOD:We report post-transplantation malaria causing elevation of liver enzymes in two recipients. RESULTS:Both patients who had undergone living donor liver transplantation showed elevated levels of liver enzymes and fever during the postoperative course. Investigations (including liver biopsy in one patient) were initially inconclusive in determining the cause of liver dysfunction. The diagnosis of malaria was established in both cases by peripheral blood smear. Liver function transiently worsened with antimalarial treatment but subsequently became normal. CONCLUSION:This report highlights the importance of excluding such uncommon causes of post-transplantation liver dysfunction, especially when either the recipient or the donor comes from a region endemic for malaria.

  2. Living-Donor Liver Transplantation From a Heterozygous Parent for Infantile Refsum Disease.

    Science.gov (United States)

    Matsunami, Masatoshi; Shimozawa, Nobuyuki; Fukuda, Akinari; Kumagai, Tadayuki; Kubota, Masaya; Chong, Pin Fee; Kasahara, Mureo

    2016-06-01

    Infantile Refsum disease (IRD) is a rare autosomal recessive disorder of peroxisome biogenesis characterized by generalized peroxisomal metabolic dysfunction, including accumulation of very long-chain fatty acids (VLCFAs) and phytanic acid (PA), as well as decreased plasmalogen contents (PL). An effective therapy for this intractable disease has not been established, and only supportive management with docosahexaenoic acid supplementation and low PA diet has been reported so far. A boy of 3 years and 8 months presented with facial dysmorphism, transaminitis, and psychomotor retardation. Biochemical analysis showed elevated PA and VLCFAs, with reduced PL in the serum. Immunofluorescence study of fibroblasts from the patient indicated a mosaic pattern of catalase-positive and -negative particles, and molecular analysis revealed compound heterozygous mutations of PEX6 The failure of medical management to prevent the progression of clinical symptoms and abnormal biochemistry prompted us to consider liver transplantation (LT). With the chances of receiving a deceased donor liver being poor, we performed a living-donor LT from the patient's heterozygous mother. At 6-month follow-up, the patient's serum PA levels had normalized. VLCFAs and PL levels had declined and increased, respectively. To the best of our knowledge, this is the second reported case in which IRD was treated by living-donor LT by using a heterozygous donor. Only long-term follow-up will reveal if there is any clinical improvement in the present case. With the liver being a major site for peroxisomal pathways, its replacement by LT may work as a form of partial enzyme therapy for patients with IRD.

  3. Fibromuscular dysplasia in living renal donors: Still a challenge to computed tomographic angiography

    Energy Technology Data Exchange (ETDEWEB)

    Blondin, D., E-mail: blondin@med.uni-duesseldorf.d [Institute of Radiology, University Hospital Duesseldorf, Moorenstr. 5, D-40225 Duesseldorf (Germany); Lanzman, R.; Schellhammer, F. [Institute of Radiology, University Hospital Duesseldorf, Moorenstr. 5, D-40225 Duesseldorf (Germany); Oels, M. [Department of Nephrology (Germany); Grotemeyer, D. [Department of Vascular Surgery and Renal Transplantation (Germany); Baldus, S.E. [Institute of Pathology (Germany); Rump, L.C. [Department of Nephrology (Germany); Sandmann, W. [Department of Vascular Surgery and Renal Transplantation (Germany); Voiculescu, A. [Department of Nephrology (Germany)

    2010-07-15

    Background: Computed tomographic angiography has become the standard evaluating method of potential living renal donors in most centers. Although incidence of fibromuscular dysplasia is low (3.5-6%), this pathology may be relevant for success of renal transplantation. The incidence of FMD in our population of LRD and reliability of CTA for detecting vascular pathology were the aims of this study. Materials and methods: 101 living renal donors, examined between 7/2004 and 9/2008 by CTA, were included in a retrospective evaluation. The examinations were carried out using a 64 Multi-detector CT (Siemens Medical Solutions, Erlangen). The presence or absence of the characteristic signs of fibromuscular dysplasia, as 'string-of-beads' appearance, focal stenosis or aneurysms, were assessed and graded from mild (=1) to severe (=3). Furthermore, vascular anatomy and arterial stenosis were investigated in this study. Retrospective analysis of CTA and ultrasound were compared with operative and histological reports. Results: Four cases of fibromuscular dysplasia (incidence 3.9%) in 101 renal donors were diagnosed by transplanting surgeons and histopathology, respectively. Three cases could be detected by CTA. In one donor even retrospective analysis of CTA was negative. Ten accessory arteries, 14 venous anomalies and 12 renal arteries stenosis due to atherosclerosis were diagnosed by CTA and could be confirmed by the operative report. Conclusion: CTA is sufficient for detection of hemodynamic relevant stenosis and vascular anatomy. Only one patient with a mild form of FMD was under estimated. Therefore, if the CTA shows slightest irregularities which are not typical for atherosclerotic lesions, further diagnostic work up by DSA might still be necessary.

  4. Evaluation of factors causing delayed graft function in live related donor renal transplantation

    Directory of Open Access Journals (Sweden)

    Sharma A

    2010-01-01

    Full Text Available To determine the incidence and determinants of delayed graft function due to post-transplant acute tubular necrosis in live related donor renal transplantation. This is a retrospective study of 337 recipients of live related donor renal graft performed between1986 and 2006. Of these recipients, 24 (7.1% subjects developed delayed graft function with no evidence of acute rejection, cyclosporin toxicity, vascular catastrophe or obstructive cause and had evidence of acute tubular necrosis (ATN Group. These subjects were compared with recipients (n= 313, 92.9% who had no clinical or biochemical evidence of ATN. Mean age, and gender distribution of recipients was similar in the two groups (ATN group 35.7 ± 8.3, non-ATN group 34.3 ± 7.5, P= 0.43. Gender distribution of the recipients (men 279, 89.1% vs. 21, 87.5%, P= 0.80 as well as donors (women 221, 70.6% vs. 18, 75.0%, P= 0.75 was also similar. In ATN group as compared with non-ATN group the donor age was significantly greater (56.6 ± 8.3 vs. 46.6 ± 11.2 years, P< 0.0001. There was marginal difference in pre-operative systolic BP (154.5 ± 18.3 vs. 147.4 ± 20.2 mm Hg, P= 0.077 and significant difference in diastolic BP (87.8 ± 9.5 vs. 83.4 ± 11.4 mmHg, P= 0.041. Incidence of multiple renal arteries was similar (16.7% vs. 7.3%, P= 0.22. The warm ischemia time was significantly greater in ATN group (33.3 ± 6.2 min as compared to non-ATN group (30.4 ± 5.7 min, P= 0.042. Duration of hospital stay was more in ATN group (19.9 ± 6.7 vs. 16.8 ± 8.4 days, P= 0.04 but there was no difference in 1 year survival (284 subjects, 90.7% vs. 21 subjects, 87.5%, P= 0.873. This study shows that greater donor age, higher baseline diastolic BP and greater warm ischemia time are major determinants of delayed graft function due to acute tubular necrosis after related donor renal transplantation.

  5. Characteristics and outcome of living kidney donors after donation: A report from Cote d′Ivoire

    Directory of Open Access Journals (Sweden)

    Delphine Amélie Lagou

    2016-01-01

    Full Text Available Kidney transplantation from living kidney donors (LKDs because of its good results represents a good option for the treatment of patients with the end-stage renal disease. Kidney donation is a relatively safe procedure according to several studies. We conducted this cross-sectional study in order to describe the demographic, clinical, and renal outcome of LKD in Cτte d′Ivoire. From March to November 2014, LKD residing in Cτte d′Ivoire at the time of investigation and having donated the kidney more than one year ago were considered for the study. They were evaluated through a questionnaire. Of the 29 LKD listed in Cτte d′Ivoire, only 14 responded to the questionnaire. The mean age at donation was 43.29 ± 9.12 years (27-59 and 10 of the LKD were women. Eight were related to the recipients, and the remaining were spouses. Laparoscopic nephrectomy was performed in nine LKD. The left kidney was harvested in ten cases. The main motivation for donation in all donors was the desire to save a life. At the time of the survey, the average duration after the donation was 4.57 ± 2.56 years (1-8. Only five donors had a regular nephrological follow-up. Hypertension was observed in one donor, seven had significant proteinuria, and six had glomerular filtration rate 30 mL/min. Significantly higher proteinuria was noted in donors under 45 years as compared to those over 45 years (0.43 ± 0.17 g/24 h vs. 0.22 ± 0.03 g/24 h, P = 0.01. Our study suggests that renal disease in LKD in Cτte d′Ivoire is low after a mean follow-up period of four years. A donor registry is essential to ensure better follow-up of donors in order to detect potential adverse effects of kidney donation in the medium as well as in the long-term.

  6. Slow graft function and related risk factors in living donor kidney transplantation

    Directory of Open Access Journals (Sweden)

    Lesan Pezeshki M.

    2008-03-01

    Full Text Available Background: While excellent organ quality and ideal transplant conditions eliminate many of the known factors that compromise initial graft function (IGF, slow graft function (SGF, still occurs after living donor kidney transplantation (LDKT. The aim of our current study is determination SGF frequency and its risk factors in LDKT Methods: In this prospective study, between April 2004 and March 2006, data were collected on 340 LDKT, in Baghiyattallah Hospital, Tehran. Recipients were analyzed in two groups based on initial graft function (IGF: Creatinine <3 mg/dl 5 day after transplantation, SGF: Creatinine ≥ 3 mg/dl 5 day after transplantation with out dialysis in the first week. Donors' and recipients' characteristics and recipient lab. data were compared in two groups by chi-square, Mann-whitney & independent samples T-test.Results: The incidence of SGF was 22 (6.2% and IGF 318 (89.8%, Recipients' BMI in IGF were 22.1±3.9 and in SGF were 25.3±3.8 (P=0.001 95% Cl 1.097-1.401 OR= 1.24. SGF relative frequency in female donors is more than male donors. A multivariate analysis model confirms this significant difference. (P=0.044 95% Cl 1.028-7.971 OR= 2.862. SGF relative frequency in PRA (Panel Reactive Antibody positive recipients are more than negative ones. A multivariate analysis model confirms this significant difference. (P=0.007 95%Cl 1.755-35.280 OR= 7.849. Recipients' age and donors' BMI are significant in univariate analysis (P=0.002 & P=0.029 respectively but multivariate analysis model dose not confirm those significance. Serum ca & P & PTH levels don't have significant difference between IGF & SGF. Using calcium channels blockers have not a protective effect. Conclusions: We conclude that negative PRA and lower recipient BMI have protective effects on SGF. Recipients with female donors have higher chance to develop SGF. We recommend recipients reduce their BMI before transplantation. The male donors

  7. Glomerular filtration rate and segmental tubular function in the early phase after transplantation/uninephrectomy in recipients and their living-related kidney donors

    DEFF Research Database (Denmark)

    Kamper, A L; Holstein-Rathlou, N H; Strandgaard, S;

    1994-01-01

    1. Glomerular filtration rate and sequential tubular function were investigated in 18 adult renal transplant recipients and in their matched, adult living-related kidney donors before and 5 days after transplantation/uninephrectomy. At day 54, 13 donors and 11 recipients were re......-investigated. Sixteen of these constituted eight matched pairs. This reduction in the study population was caused by the application of two withdrawal criteria. 2. In the recipients glomerular filtration rate was unchanged at day 5 and had increased to 61 ml/min at day 54 (P glomerular filtration....../min to 2.10 ml/min at day 54 (P glomerular filtration rate, lithium clearance, absolute and fractional proximal...

  8. The changing determinants of UK young adults' living arrangements

    OpenAIRE

    Juliet Stone; Ann Berrington; Jane Falkingham

    2011-01-01

    The postponement of partnership formation and parenthood in the context of an early average age at leaving home has resulted in increased heterogeneity in the living arrangements of young adults in the UK. More young adults now remain in the parental home, or live independently of the parental home but outside of a family. The extent to which these trends are explained by the increased immigration of foreign-born young adults, the expansion in higher education, and the increased economic inse...

  9. The changing living arrangements of young adults in the UK

    OpenAIRE

    Stone, Juliet; Berrington, Ann; Falkingham, Jane

    2009-01-01

    More young adults in the UK now remain in the parental home, or live independently outside a family. This research, published in Demographic Research, examines for the period 1998-2008, the extent to which these trends are explained by increased immigration of foreign-born young adults, expansion in higher education and increased economic insecurity faced by young adults. The findings suggest that shared non-family living is particularly prominent among those with experience of higher educati...

  10. Qualidade de vida do doador após transplante hepático intervivos Donor quality of life after living donor liver transplantation

    Directory of Open Access Journals (Sweden)

    Júlio Cezar Uili Coelho

    2005-06-01

    Full Text Available RACIONAL: A qualidade de vida do doador após transplante hepático intervivos ainda não foi avaliada em nosso meio. OBJETIVO: Avaliar a qualidade de vida do doador após transplante hepático intervivos. MÉTODOS: De um total de 300 transplantes hepáticos, 51 foram de doadores vivos. Doadores com seguimento menor do que 6 meses e os que não quiseram participar do estudo foram excluídos. Os doadores responderam a um questionário de 28 perguntas abordando os vários aspectos da doação, sendo também avaliados dados demográficos e clínicos dos mesmos. RESULTADOS: Trinta e sete doadores aceitaram participar do estudo. Destes, 32 eram parentes de primeiro ou de segundo grau do receptor. O esclarecimento sobre o caráter voluntário da doação foi adequado para todos pacientes. Apenas um (2% não doaria novamente. A dor pós-operatória foi pior do que o esperado para 22 doadores (59%. O retorno às atividades normais ocorreu em menos de 3 meses para 21 doadores (57%. Vinte e um doadores (57% tiveram perda financeira com a doação devido a gastos com medicamentos, exames, transporte ou perda de rendimentos. Trinta e três (89% não tiveram modificação ou limitação na sua vida após a doação. Os aspectos mais negativos da doação foram a dor pós-operatória e a presença de cicatriz cirúrgica. A maioria das complicações pós-operatória foi resolvida com o tratamento clínico, mas complicações graves ou potencialmente fatais ocorreram em dois pacientes. CONCLUSÕES: A maioria dos doadores apresentou boa recuperação e retornou completamente as suas atividades normais poucos meses após a doação. O aspecto mais negativo da doação foi a dor pós-operatória.BACKGROUND: Quality of life of the donor after living donor liver transplantation has not been evaluated in Brazil yet. AIM: To evaluate the quality of live of the donor after living donor liver transplantation. METHODS: Of a total of 300 liver transplantations, 51 were

  11. Ultrasonographic diagnosis of fatty liver in preoperative evaluation of living liver donor candidates: Histologic correlation

    International Nuclear Information System (INIS)

    To analyze the correlation between the ultrasonographic (US) grading system of fatty liver (FL) and histologic grading system in living liver donor candidates and to investigate the clinical significance of this qualitative US grading system in the selection of living donor candidates. For a recent 21-month period, ninety three living donor candidates who underwent both preoperative US and parenchymal biopsy of the liver were consecutively selected. FL was ultrasonographically graded using the well-known three-Point grading system (ie, mild, moderate and severe degrees) whereas histologic grade of FL was divided into minimal (60%) degrees depending upon the percentages of each of macrovesicular, microvesicular and total fat-containing hepatocytes. US grade and histologic grade of FL in each patient were retrospectively correlated according to the US and pathologic records in their databases. Statistical analysis was conducted with the chi-square test and linear by linear association. US findings included the normal liver, mild FL, and moderate FL in 63, 23 and 7 patients, respectively. Analyzed with the total fat content, 38 of 63 patients (60%) whose US finding was normal proved to have FL of various histologic grades. Meanwhile, US grade of FL correlated well with the histologic grade in 16 (53%) of 30 patients who showed mild or moderate FL on US, and in the remaining patients, US grade was more commonly underestimated compared to the histologic grade. All patients with moderate FL on US Proved to have either moderate or severe FL at histology. US grade statistically correlated well with the histologic grade classified by either the total or macrovesicular fat contents (p<.001) while a poor correlation was seen when histologic grade using the microvesicular fat content was used. The well-known qualitative US grading system of fatty liver seems to show a relatively good correlation with the histologic grade, but it has a tendency to underestimate compared to the

  12. Ultrasonographic diagnosis of fatty liver in preoperative evaluation of living liver donor candidates: Histologic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seong Hyun; Lee, Won Jae; Lim, Hyo Keun; Kim, Soo Ah; Kim, Seung Hoon; Lee, Soon Jin; Lim, Jae Hoon [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2003-03-15

    To analyze the correlation between the ultrasonographic (US) grading system of fatty liver (FL) and histologic grading system in living liver donor candidates and to investigate the clinical significance of this qualitative US grading system in the selection of living donor candidates. For a recent 21-month period, ninety three living donor candidates who underwent both preoperative US and parenchymal biopsy of the liver were consecutively selected. FL was ultrasonographically graded using the well-known three-Point grading system (ie, mild, moderate and severe degrees) whereas histologic grade of FL was divided into minimal (<10%), mild (11-30%), moderate (31-60%) and severe (>60%) degrees depending upon the percentages of each of macrovesicular, microvesicular and total fat-containing hepatocytes. US grade and histologic grade of FL in each patient were retrospectively correlated according to the US and pathologic records in their databases. Statistical analysis was conducted with the chi-square test and linear by linear association. US findings included the normal liver, mild FL, and moderate FL in 63, 23 and 7 patients, respectively. Analyzed with the total fat content, 38 of 63 patients (60%) whose US finding was normal proved to have FL of various histologic grades. Meanwhile, US grade of FL correlated well with the histologic grade in 16 (53%) of 30 patients who showed mild or moderate FL on US, and in the remaining patients, US grade was more commonly underestimated compared to the histologic grade. All patients with moderate FL on US Proved to have either moderate or severe FL at histology. US grade statistically correlated well with the histologic grade classified by either the total or macrovesicular fat contents (p<.001) while a poor correlation was seen when histologic grade using the microvesicular fat content was used. The well-known qualitative US grading system of fatty liver seems to show a relatively good correlation with the histologic grade

  13. Resolution of severe graft steatosis following dual-graft living donor liver transplantation.

    Science.gov (United States)

    Moon, DeokBog; Lee, SungGyu; Hwang, Shin; Kim, KiHun; Ahn, ChulSoo; Park, KwangMin; Ha, TaeYong; Song, GiWon

    2006-07-01

    Although severely steatotic liver grafts are not suitable for transplantation, they have been used when other, more optimal donors were not available, especially for living donor liver transplantation (LDLT) using two liver grafts. Here we present two cases of dual-graft LDLT in which the recipients showed rapid and complete clearing of fat from livers with previously severe steatosis. In the first case, two left lateral segment grafts were used, one of which was 70% steatotic. Preoperative and posttransplant two-week liver-to-spleen computed tomography-value (L/S) ratios were 0.48 and 1.25, respectively. A liver biopsy taken two weeks after transplantation showed that the fatty changes had almost disappeared. The second case used one left lobe and one left lateral segment graft, the latter of which was 80% steatotic. Preoperative and two-week L/S ratio were 0.58 and 1.34, respectively, and a liver biopsy taken two weeks after transplantation showed less than 3% steatosis. The two donors of the severely steatotic liver grafts recovered uneventfully. These findings show that the fat content of the liver grafts was rapidly removed after transplantation. This observation is helpful in understanding the recovery sequences following transplantation of steatotic liver grafts, as well as expanding the acceptability of steatotic liver grafts.

  14. Quality of life following living donor nephrectomy comparing classical flank incision and anterior vertical mini-incision.

    Science.gov (United States)

    Jackobs, Steffan; Becker, Thomas; Lück, Rainer; Jäger, Mark D; Nashan, Björn; Gwinner, Wilfried; Schwarz, Anke; Klempnauer, Jürgen; Neipp, Michael

    2005-11-01

    In this study we focused on the quality of life and satisfaction of living kidney donors comparing traditional lumbar (LDN) and mini-incision donor nephrectomy (MIDN). From May 1996 to December 2002, 174 donor nephrectomies including 127 cases of LDN and 47 cases of MIDN were performed. Donors were evaluated using the SF-36 quality-of-life survey as well as a questionnaire dealing with donors' attitude towards kidney donation, financial burdens, pain, cosmetic satisfaction and duration of sick leave. Our donors achieved comparable or even higher scores in all the SF-36 categories in comparison to the general US population. Following MIDN, quality of life tended to be superior compared to that of LDN donors; however, statistical significance was reached only in one of the eight categories. Duration of sick leave following surgery was in favor of MIDN compared to LDN donors. Statistically significant differences favoring MIDN were observed regarding postoperative hospital stay and cosmetic satisfaction. The procedure would be again undergone by 94 of LDN and 97% of MIDN donors. Open-donor nephrectomy is a safe and cost-effective procedure. Introduction of the here-described MIDN has led to comparable or even improved results compared to LDN. PMID:16180026

  15. Living Related Donor Kidney Transplantation in Libya: A Single Center Experience

    Directory of Open Access Journals (Sweden)

    Elusta Ahmed

    2008-01-01

    Full Text Available The aim of this study is to report the experience from a single center in Libya, on the prevailing live-related kidney transplantation program. The results of three years work on kidney transplantation at the Tripoli Central Hospital (National Organ Transplant Program in Libya were evaluated. The transplant program was launched on 17 th August, 2004 and 135 patients have been transplanted since then till 17 th August, 2007. All donors and recipients were screened thoroughly prior to transplant and monitored closely in the post-transplant period. Our immuno-suppressive protocol was cyclosporine-based. Among the 135 accepted pairs, donors and reci-pients were genetically-related in 133 cases (98.5% and emotionally-related in two others. The mean donor age was 37 ± 9.5 years (range 18-56 years and recipient age 37 ± 13.6 years (range 7-67 years. There were 95 males (70.4% and 40 females (29.6% among the recipients while among the donors, there were 102 males (75.6% and 33 females (24.4%. Delayed graft function was seen in three patients (2.2%, acute rejection in six (4.4%, post-transplant urinary tract infection in six (4.4%, pneumonia in three (2.2%, ureteric kink in two (1.5% and urine leak in four (3.0%. Graft survival at 36 months was 93.3% while patient survival at the same period was 96.3%. This report indicates that the results of our transplant program are good and comparable with other international programs.

  16. Donor Complications Following Laparoscopic Compared to Hand-Assisted Living Donor Nephrectomy: An Analysis of the Literature

    Directory of Open Access Journals (Sweden)

    Whitney R. Halgrimson

    2010-01-01

    Full Text Available There are two approaches to laparoscopic donor nephrectomy: standard laparoscopic donor nephrectomy (LDN and hand-assisted laparoscopic donor nephrectomy (HALDN. In this study we report the operative statistics and donor complications associated with LDN and HALDN from large-center peer-reviewed publications. Methods. We conducted PubMed and Ovid searches to identify LDN and HALDN outcome studies that were published after 2004. Results. There were 37 peer-reviewed studies, each with more than 150 patients. Cumulatively, over 9000 patients were included in this study. LDN donors experienced a higher rate of intraoperative complications than HALDN donors (5.2% versus. 2.0%, <.001. Investigators did not report a significant difference in the rate of major postoperative complications between the two groups (LDN 0.5% versus HALDN 0.7%, =.111. However, conversion to open procedures from vascular injury was reported more frequently in LDN procedures (0.8% versus 0.4%, =.047. Conclusion. At present there is no evidence to support the use of one laparoscopic approach in preference to the other. There are trends in the data suggesting that intraoperative injuries are more common in LDN while minor postoperative complications are more common in HALDN.

  17. Doppler ultrasonography in living donor liver transplantation recipients: Intra- and post-operative vascular complications.

    Science.gov (United States)

    Abdelaziz, Omar; Attia, Hussein

    2016-07-21

    Living-donor liver transplantation has provided a solution to the severe lack of cadaver grafts for the replacement of liver afflicted with end-stage cirrhosis, fulminant disease, or inborn errors of metabolism. Vascular complications remain the most serious complications and a common cause for graft failure after hepatic transplantation. Doppler ultrasound remains the primary radiological imaging modality for the diagnosis of such complications. This article presents a brief review of intra- and post-operative living donor liver transplantation anatomy and a synopsis of the role of ultrasonography and color Doppler in evaluating the graft vascular haemodynamics both during surgery and post-operatively in accurately defining the early vascular complications. Intra-operative ultrasonography of the liver graft provides the surgeon with useful real-time diagnostic and staging information that may result in an alteration in the planned surgical approach and corrections of surgical complications during the procedure of vascular anastomoses. The relevant intra-operative anatomy and the spectrum of normal and abnormal findings are described. Ultrasonography and color Doppler also provides the clinicians and surgeons early post-operative potential developmental complications that may occur during hospital stay. Early detection and thus early problem solving can make the difference between graft survival and failure. PMID:27468207

  18. Assessment of Potential Live Kidney Donors and Computed Tomographic Renal Angiograms at Christchurch Hospital

    Science.gov (United States)

    Mark, Stephen; Armstrong, Sarah; McGregor, David

    2016-01-01

    Aims. To examine the outcome of potential live kidney donors (PLKD) assessment program at Christchurch Hospital and, also, to review findings of Computed Tomographic (CT) renal angiograms that led to exclusion in the surgical assessment. Methods. Clinical data was obtained from the database of kidney transplants, Proton. Radiological investigations were reviewed using the hospital database, Éclair. The transplant coordinator was interviewed to clarify information about PLKD who did not proceed to surgery, and a consultant radiologist was interviewed to explain unfavorable findings on CT renal angiograms. Results. 162 PLKD were identified during the period January 04–June 08. Of those, 65 (40%) proceeded to have nephrectomy, 15 were accepted and planned to proceed to surgery, 13 were awaiting further assessment, and 69 (42.5%) did not proceed to nephrectomy. Of the 162 PLKD, 142 (88%) were directed donors. The proportion of altruistic PLKD who opted out was significantly higher than that of directed PLKD (45% versus 7%, P = 0.00004). Conclusions. This audit demonstrated a positive experience of live kidney donation at Christchurch Hospital. CT renal angiogram can potentially detect incidental or controversial pathologies in the kidney and the surrounding structures. Altruistic donation remains controversial with higher rates of opting out. PMID:27034659

  19. Survival of living donor renal transplant recipients in Sri Lanka: a single-center study.

    Science.gov (United States)

    Galabada, Dinith Prasanna; Nazar, Abdul L M; Ariyaratne, Prasad

    2014-11-01

    Chronic kidney disease is one of the main public health concerns in Sri Lanka. In comparison with dialysis, successful kidney transplantation improves both patient survival and quality of life, relieves the burden of dialysis in patients suffering from end-stage renal disease and decreases the cost of healthcare to the society and government. The objective of this retrospective cohort study was to evaluate graft and patient survival rates in patients who were transplanted from living donors at the Nephrology Unit of the National Hospital of Sri Lanka from January 2005 to January 2011. Data were collected using an interviewer-administered questionnaire and through a review of past medical records. The Kaplan-Meier method was used to determine the survival rate, the log rank test was used to compare survival curves and the Cox proportional hazard model was used for multivariate analysis. Mean follow-up was 26.44±16.6 months. The five-year death-censored graft survival of kidney transplant recipients from living donors in our center was 93.5% and the five-year patient survival was 82.2%, which is comparable with other transplant programs around the world. The number of acute rejection episodes was an independent risk factor for graft survival. Delayed graft function, younger recipient age and unknown cause of end-stage renal disease were found to be risk factors for graft failure but after adjusting for confounding factors, and the difference was not apparent.

  20. Survival of living donor renal transplant recipients in Sri Lanka: A single-center study

    Directory of Open Access Journals (Sweden)

    Dinith Prasanna Galabada

    2014-01-01

    Full Text Available Chronic kidney disease is one of the main public health concerns in Sri Lanka. In comparison with dialysis, successful kidney transplantation improves both patient survival and quality of life, relieves the burden of dialysis in patients suffering from end-stage renal disease and decreases the cost of healthcare to the society and government. The objective of this retrospective cohort study was to evaluate graft and patient survival rates in patients who were transplanted from living donors at the Nephrology Unit of the National Hospital of Sri Lanka from January 2005 to January 2011. Data were collected using an interviewer-administered questionnaire and through a review of past medical records. The Kaplan-Meier method was used to determine the survival rate, the log rank test was used to compare survival curves and the Cox proportional hazard model was used for multivariate analysis. Mean follow-up was 26.44 ± 16.6 months. The five-year death-censored graft survival of kidney transplant recipients from living donors in our center was 93.5% and the five-year patient survival was 82.2%, which is comparable with other transplant programs around the world. The number of acute rejection episodes was an independent risk factor for graft survival. Delayed graft function, younger recipient age and unknown cause of end-stage renal disease were found to be risk factors for graft failure but after adjusting for confounding factors, and the difference was not apparent.

  1. Doppler ultrasonography in living donor liver transplantation recipients: Intra- and post-operative vascular complications

    Science.gov (United States)

    Abdelaziz, Omar; Attia, Hussein

    2016-01-01

    Living-donor liver transplantation has provided a solution to the severe lack of cadaver grafts for the replacement of liver afflicted with end-stage cirrhosis, fulminant disease, or inborn errors of metabolism. Vascular complications remain the most serious complications and a common cause for graft failure after hepatic transplantation. Doppler ultrasound remains the primary radiological imaging modality for the diagnosis of such complications. This article presents a brief review of intra- and post-operative living donor liver transplantation anatomy and a synopsis of the role of ultrasonography and color Doppler in evaluating the graft vascular haemodynamics both during surgery and post-operatively in accurately defining the early vascular complications. Intra-operative ultrasonography of the liver graft provides the surgeon with useful real-time diagnostic and staging information that may result in an alteration in the planned surgical approach and corrections of surgical complications during the procedure of vascular anastomoses. The relevant intra-operative anatomy and the spectrum of normal and abnormal findings are described. Ultrasonography and color Doppler also provides the clinicians and surgeons early post-operative potential developmental complications that may occur during hospital stay. Early detection and thus early problem solving can make the difference between graft survival and failure. PMID:27468207

  2. Assessment of Potential Live Kidney Donors and Computed Tomographic Renal Angiograms at Christchurch Hospital

    Directory of Open Access Journals (Sweden)

    Thamer Alsulaiman

    2016-01-01

    Full Text Available Aims. To examine the outcome of potential live kidney donors (PLKD assessment program at Christchurch Hospital and, also, to review findings of Computed Tomographic (CT renal angiograms that led to exclusion in the surgical assessment. Methods. Clinical data was obtained from the database of kidney transplants, Proton. Radiological investigations were reviewed using the hospital database, Éclair. The transplant coordinator was interviewed to clarify information about PLKD who did not proceed to surgery, and a consultant radiologist was interviewed to explain unfavorable findings on CT renal angiograms. Results. 162 PLKD were identified during the period January 04–June 08. Of those, 65 (40% proceeded to have nephrectomy, 15 were accepted and planned to proceed to surgery, 13 were awaiting further assessment, and 69 (42.5% did not proceed to nephrectomy. Of the 162 PLKD, 142 (88% were directed donors. The proportion of altruistic PLKD who opted out was significantly higher than that of directed PLKD (45% versus 7%, P=0.00004. Conclusions. This audit demonstrated a positive experience of live kidney donation at Christchurch Hospital. CT renal angiogram can potentially detect incidental or controversial pathologies in the kidney and the surrounding structures. Altruistic donation remains controversial with higher rates of opting out.

  3. Assessment of Potential Live Kidney Donors and Computed Tomographic Renal Angiograms at Christchurch Hospital.

    Science.gov (United States)

    Alsulaiman, Thamer; Mark, Stephen; Armstrong, Sarah; McGregor, David

    2016-01-01

    Aims. To examine the outcome of potential live kidney donors (PLKD) assessment program at Christchurch Hospital and, also, to review findings of Computed Tomographic (CT) renal angiograms that led to exclusion in the surgical assessment. Methods. Clinical data was obtained from the database of kidney transplants, Proton. Radiological investigations were reviewed using the hospital database, Éclair. The transplant coordinator was interviewed to clarify information about PLKD who did not proceed to surgery, and a consultant radiologist was interviewed to explain unfavorable findings on CT renal angiograms. Results. 162 PLKD were identified during the period January 04-June 08. Of those, 65 (40%) proceeded to have nephrectomy, 15 were accepted and planned to proceed to surgery, 13 were awaiting further assessment, and 69 (42.5%) did not proceed to nephrectomy. Of the 162 PLKD, 142 (88%) were directed donors. The proportion of altruistic PLKD who opted out was significantly higher than that of directed PLKD (45% versus 7%, P = 0.00004). Conclusions. This audit demonstrated a positive experience of live kidney donation at Christchurch Hospital. CT renal angiogram can potentially detect incidental or controversial pathologies in the kidney and the surrounding structures. Altruistic donation remains controversial with higher rates of opting out.

  4. Influence of the kidney histology at the time of donation on long term kidney function in living kidney donors.

    Science.gov (United States)

    Goecke, H; Ortiz, A M; Troncoso, P; Martinez, L; Jara, A; Valdes, G; Rosenberg, H

    2005-10-01

    Living donation is the best choice for kidney transplantation, obtaining long-lasting good results for the recipient. Some concern still remains regarding the donor's long-term health. Kidney biopsy was routinely performed in our donor population at the time of donation many years ago. We found the existence of morphological kidney disease in those samples, in spite of normal clinical evaluations before donation. We attempted to correlate those abnormalities with long-term clinical outcomes. Donors were at least 10 years after surgery. A medical interview, including the SF-36 Health Survey, laboratory evaluation, and ambulatory blood pressure monitoring was performed on 27 donors meeting the inclusion criteria. Two donors had died after donation from unrelated causes with no known nephropathy. Histological analysis showed abnormalities in 16 of 29 donors. We found an increased prevalence of hypertension compared to the general population. Interestingly, there was no proteinuria in the donor population, and none developed clinical nephropathy. All subjects felt emotionally rewarded with donation, stating that their lives had no limitations. Our results suggest that kidney biopsy is neither necessary nor useful prior to donation because, although many donors had morphological kidney disease, none developed clinical nephropathy in the long term.

  5. OUTCOME OF LIVE DONOR RENAL ALLOGRAFT TRANSPLANTATION FROM SINGLE VS MULTIPLE ARTERIES' GRAFTS

    Directory of Open Access Journals (Sweden)

    D. Mehraban G.H. Naderi

    1998-07-01

    Full Text Available This study compare:.' [he results 0;,.1 outcome of live-donor transplantation between single-artery "',"' mull/pic-ana' transplant kidneys. Cadaver kidneys with multiple vessels arc retrieved with a patch of the donor artery. 111is is not possible ill the !iI'C donation seuing. Therefore !i1'C donation of rcnal"nallografts with multiple arteries is lIot a straiglnjorward surgery. We studied 22 muttiplc-anery live donor renal allografts among 223 renal transplantations in a sequential. prospective mOllTlCr [or 3 ynJrs. One-year gra{! survival was l(j.:V:(, ill single-anery group and 95.5":{, in tlns muliplc . arIer' group. III the singleartery group the complications wae: dctavcd gm[l [unction ill 3.5'7;, rean astomosis o[ tlu: v-essels in 2,9':k, transient post-transplant dialysis in 1. 5 (X" graft nephrectomy ill 2,5';{, AT"' ill 1":'(" Urine leak in 2.5':{', renal anav stenosis in O.5S'(" and lvmpho cclc ill 1%. NOlie: o] thcsc occurred in the"nmultiptc-oncry group. This difference is statistically significant IX~ = 8.10. Cold ischemia time: l"'(lS significantly lunger in lilt' multiple . anery group (panastomosis was not siglliftcanl~"' dlffaelll among lht' 2,1,'Youps (I = 1.255. Ttu: totat tcngtli of tile operation IVas IOllga ill lhe mutsiptc-oncry group (p < O. 00(5. In conclusion it is appareIH snas t lu: intra-op crativc complications. posi-operati vc complications and one-year grafr survival are ccnnparabtc ill"nsingle - ane'Y' "'."'. mutsiptc - arrcry renal transplantation. tn other words, !i1'C - donor transptannuion with muliip!c . arIa' reno! units is safe and has a good OI/lCO!1le.

  6. Cadmium, mercury, and lead in kidney cortex of living kidney donors: Impact of different exposure sources,

    International Nuclear Information System (INIS)

    Background: Most current knowledge on kidney concentrations of nephrotoxic metals like cadmium (Cd), mercury (Hg), or lead (Pb) comes from autopsy studies. Assessment of metal concentrations in kidney biopsies from living subjects can be combined with information about exposure sources like smoking, diet, and occupation supplied by the biopsied subjects themselves. Objectives: To determine kidney concentrations of Cd, Hg, and Pb in living kidney donors, and assess associations with common exposure sources and background factors. Methods: Metal concentrations were determined in 109 living kidney donors aged 24-70 years (median 51), using inductively coupled plasma-mass spectrometry (Cd and Pb) and cold vapor atomic fluorescence spectrometry (Hg). Smoking habits, occupation, dental amalgam, fish consumption, and iron stores were evaluated. Results: The median kidney concentrations were 12.9 μg/g (wet weight) for cadmium, 0.21 μg/g for mercury, and 0.08 μg/g for lead. Kidney Cd increased by 3.9 μg/g for a 10 year increase in age, and by 3.7 μg/g for an extra 10 pack-years of smoking. Levels in non-smokers were similar to those found in the 1970s. Low iron stores (low serum ferritin) in women increased kidney Cd by 4.5 μg/g. Kidney Hg increased by 6% for every additional amalgam surface, but was not associated with fish consumption. Lead was unaffected by the background factors surveyed. Conclusions: In Sweden, kidney Cd levels have decreased due to less smoking, while the impact of diet seems unchanged. Dental amalgam is the main determinant of kidney Hg. Kidney Pb levels are very low due to decreased exposure.

  7. Cadmium, mercury, and lead in kidney cortex of living kidney donors: Impact of different exposure sources,

    Energy Technology Data Exchange (ETDEWEB)

    Barregard, Lars, E-mail: lars.barregard@amm.gu.se [Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, P.O. Box 414, SE 405 30 Gothenburg (Sweden); Fabricius-Lagging, Elisabeth [Department of Nephrology, Sahlgrenska University Hospital and Boras Hospital (Sweden); Lundh, Thomas [Department of Occupational and Environmental Medicine, Lund University Hospital and Lund University (Sweden); Moelne, Johan [Department of Clinical Pathology, Sahlgrenska University Hospital and University of Gothenburg (Sweden); Wallin, Maria [Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, P.O. Box 414, SE 405 30 Gothenburg (Sweden); Olausson, Michael [Department of Transplantation and Liver Surgery, Sahlgrenska University Hospital and University of Gothenburg (Sweden); Modigh, Cecilia; Sallsten, Gerd [Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, P.O. Box 414, SE 405 30 Gothenburg (Sweden)

    2010-01-15

    Background: Most current knowledge on kidney concentrations of nephrotoxic metals like cadmium (Cd), mercury (Hg), or lead (Pb) comes from autopsy studies. Assessment of metal concentrations in kidney biopsies from living subjects can be combined with information about exposure sources like smoking, diet, and occupation supplied by the biopsied subjects themselves. Objectives: To determine kidney concentrations of Cd, Hg, and Pb in living kidney donors, and assess associations with common exposure sources and background factors. Methods: Metal concentrations were determined in 109 living kidney donors aged 24-70 years (median 51), using inductively coupled plasma-mass spectrometry (Cd and Pb) and cold vapor atomic fluorescence spectrometry (Hg). Smoking habits, occupation, dental amalgam, fish consumption, and iron stores were evaluated. Results: The median kidney concentrations were 12.9 {mu}g/g (wet weight) for cadmium, 0.21 {mu}g/g for mercury, and 0.08 {mu}g/g for lead. Kidney Cd increased by 3.9 {mu}g/g for a 10 year increase in age, and by 3.7 {mu}g/g for an extra 10 pack-years of smoking. Levels in non-smokers were similar to those found in the 1970s. Low iron stores (low serum ferritin) in women increased kidney Cd by 4.5 {mu}g/g. Kidney Hg increased by 6% for every additional amalgam surface, but was not associated with fish consumption. Lead was unaffected by the background factors surveyed. Conclusions: In Sweden, kidney Cd levels have decreased due to less smoking, while the impact of diet seems unchanged. Dental amalgam is the main determinant of kidney Hg. Kidney Pb levels are very low due to decreased exposure.

  8. Normal liver stiffness: a study in living donors with normalliver histology

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    AIM To define the normal range of liver stiffness (LS)values using transient elastography in living-relatedliver transplantation candidate donors with normal liverhistology.METHODS: LS was measured using Fibroscan in 50 (16women, 34 men) healthy potential donors (mean age28.4 ± 5.9 years) who were being evaluated for liverdonation for their relatives at the National Liver Institute,Menoufeya University, Egypt. All potential donors hadnormal liver tests and were negative for hepatitis Bor C virus infection. Abdominal ultrasounds showednormal findings. None of the subjects had diabetes,hypertension, renal impairment, heart disease, or bodymass index 〉 30 kg/m2. All subjects had normal liverhistology upon liver biopsy. They all donated the rightlobe of their liver with successful outcomes.RESULTS: The mean LS was 4.3 ± 1.2 kPa (range:1.8-7.1 kPa). The 5th and 95th percentiles of normal LSwere 2.6 kPa and 6.8 kPa, respectively, with a medianof 4 kPa; the interquartile range was 0.6 ± 0.4. LSmeasurements were not significantly different betweenmen and women (4.4 ± 1.1 kPa vs 3.9 ± 1.3 kPa) anddid not correlate with age. However, stiffness valueswere significantly lower in subjects with a body massindex 〈 26 kg/m2 compared to those with an index ≥ 26kg/m2 (4.0 ± 1.1 kPa vs 4.6 ± 1.2 kPa; P 〈0.05). Therewere no differences in hospital stay or postoperativebilirubin, albumin,alanine and aspartate transaminases,or creatinine levels (at discharge) between donors withlivers stiffness ≤ 4 kPa and those with stiffness 〉 4 kPa.CONCLUSION: Healthy donors with normal liverhistology have a median LS of 4 kPa. Stiffness valuesare elevated relative to increase in body mass index.

  9. Prevalence of infection in kidney transplantation from living versus deceased donor: systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Mônica Taminato

    2015-06-01

    Full Text Available OBJECTIVE To verify if the type of donor is a risk factor for infection in kidney transplant recipients. METHODS Systematic Review of Literature with Meta-analysis with searches conducted in the databases MEDLINE, LILACS, Embase, Cochrane, Web of Science, SciELO and CINAHL. RESULTS We selected 198 studies and included four observational studies describing infections among patients distinguishing the type of donor. Through meta-analysis, it was shown that in patients undergoing deceased donor transplant, the outcome infection was 2.65 higher, than those who received an organ from a living donor. CONCLUSION The study showed that deceased kidney donor recipients are at an increased risk for developing infections and so the need for establishing and enforcing protocols from proper management of ischemic time to the prevention and control of infection in this population emerges.

  10. Environmental Adult Education: Women Living the Tensions.

    Science.gov (United States)

    Karlovic, Lee; Patrick, Kathryn

    2003-01-01

    Seven women involved in adult and popular education explored the collective development of environmental awareness through dialogue and learning activities. Two learning patterns emerged: paying attention and awakening awareness through ritual. (SK)

  11. Specific renal parenchymal-derived urinary extracellular vesicles identify age-associated structural changes in living donor kidneys

    OpenAIRE

    Anne E. Turco; Lam, Wing; Rule, Andrew D.; Denic, Aleksandar; Lieske, John C.; Miller, Virginia M.; Larson, Joseph J.; Kremers, Walter K.; Jayachandran, Muthuvel

    2016-01-01

    Non-invasive tests to identify age and early disease-associated pathology within the kidney are needed. Specific populations of urinary extracellular vesicles (EVs) could potentially be used for such a diagnostic test. Random urine samples were obtained from age- and sex-stratified living kidney donors before kidney donation. A biopsy of the donor kidney was obtained at the time of transplantation to identify nephron hypertrophy (larger glomerular volume, cortex per glomerulus and mean profil...

  12. Your Path to Transplant: a randomized controlled trial of a tailored computer education intervention to increase living donor kidney transplant

    OpenAIRE

    Waterman, Amy D.; Robbins, Mark L.; Andrea L. Paiva; Peipert, John D; Kynard-Amerson, Crystal S; Goalby, Christina J.; Davis, LaShara A; Thein, Jessica L.; Schenk, Emily A.; Baldwin, Kari A.; Skelton, Stacy L; Amoyal, Nicole R.; Brick, Leslie A

    2014-01-01

    Background Because of the deceased donor organ shortage, more kidney patients are considering whether to receive kidneys from family and friends, a process called living donor kidney transplantation (LDKT). Although Blacks and Hispanics are 3.4 and 1.5 times more likely, respectively, to develop end stage renal disease (ESRD) than Whites, they are less likely to receive LDKTs. To address this disparity, a new randomized controlled trial (RCT) will assess whether Black, Hispanic, and White tra...

  13. A cost-effective technique for pure laparoscopic live donor nephrectomy

    Directory of Open Access Journals (Sweden)

    Tiberio M Siqueira Jr

    2006-02-01

    Full Text Available OBJECTIVE: Compare two different techniques for laparoscopic live donor nephrectomy (LDN, related to the operative costs and learning curve. MATERIALS AND METHODS: Between April/2000 and October/2003, 61 patients were submitted to LDN in 2 different reference centers in kidney transplantation. At center A (CA, 11 patients were operated by a pure transperitoneal approach, using Hem-O-LokÒ clips for the renal pedicle control and the specimens were retrieved manually, without using endobags. At center B (CB, 50 patients were also operated by a pure transperitoneal approach, but the renal pedicles were controlled with endo-GIA appliers and the specimens were retrieved using endobags. RESULTS: Operative time (231 ± 39 min vs. 179 ± 30 min; p < 0.000, warm ischemia time (5.85 ± 2.85 min vs. 3.84 ± 3.84 min; p = 0.002 and blood loss (214 ± 98 mL vs. 141 ± 82 mL; p = 0.02 were statistically better in CB, when compared to CA. Discharge time was similar in both centers. One major complication was observed in both centers, leading to an open conversion in CA (9.1%. One donor death occurred in CB (2%. Regarding the recipients, no statistical difference was observed in all parameters analyzed. There was an economy of US$1.440 in each procedure performed in CA, when compared to CB. CONCLUSIONS: Despite the learning curve, the technique adopted by CA, showed no deleterious results to the donors and recipients when compared with the CB. On the other hand, this technique was cheaper than the technique performed in the CB, representing an attractive alternative for LDN, mainly in developing centers.

  14. Myeloablative allogeneic versus autologous stem cell transplantation in adult patients with acute lymphoblastic leukemia in first remission: A prospective sibling donor versus no-donor comparison

    OpenAIRE

    Cornelissen, Jan; Holt, Bronno; Verhoef, Gregor; Veer, Mars; Oers, Marinus; Ossenkoppele, Gert; Sonneveld, Pieter; Maertens, Johan; Marwijk Kooy, Marinus; Schaafsma, Martijn; Wijermans, Pierre; Biesma, Douwe; Wittebol, Shulamit; Voogt, Paul; Baars, Joke

    2009-01-01

    textabstractWhile commonly accepted in poor-risk acute lymphoblastic leukemia (ALL), the role of allogeneic hematopoietic stem cell transplantation (allo-SCT) is still disputed in adult patients with standard-risk ALL. We evaluated outcome of patients with ALL in first complete remission (CR1), according to a sibling donor versus no-donor comparison. Eligible patients (433) were entered in 2 consecutive, prospective studies, of whom 288 (67%) were younger than 55 years, in CR1, and eligible t...

  15. A meta-analysis of the biliary complications in adult living donor liver transplantation to compare duct-to-duct hepaticocholedochostomy with Roux-en-Y hepaticojejunostomy biliary reconstruction%成人活体肝移植R-Y吻合术与D-D吻合术对术后胆道并发症影响的Meta分析

    Institute of Scientific and Technical Information of China (English)

    张崇; 张佳林; 张成硕; 孙宁; 李鑫

    2015-01-01

    Objective To compare the incidences of biliary complication after adult living donor liver transplantation (ALDLT) using Roux-en-Y hepaticojejunostomy (R-Y HJ) with duct-to-duct hepaticocholedochostomy (D-D HC).Methods A meta-analysis was conducted by searching the Medline-PubMed,EMBASE,Scielo-LILACS,and Cochrane Databases.A comparison using 95% confidence intervals was performed on different biliary reconstruction techniques in liver transplantation with regard to occurrence of biliary complications.Results According to our predetermined inclusion and exclusion criteria,seven clinical studies were selected to compare D-D HC with R-Y HJ.The overall biliary comphcation rates,biliary stricture rates and biliary leakage rates were compared.The overall biliary complication rate and the biliary stricture rate of R-Y HJ were significantly less than D-D HC,but the biliary leakage rate of R-Y HJ was similar with the D-D HC (overall biliary complication rate P < 0.05,OR =0.35,95% CI:0.15 ~ 0.81,I2 =28% ; biliary stricture rate P < 0.05,OR =0.43,95% CI:0.29 ~ 0.65,I2 =49% ; biliary leakage rate P=0.05,OR=1.62,95% CI:1.01 ~2.60,I2 =19%).Conclusions The meta-analysis showed that biliary reconstruction in ALDLT should be performed using R-Y HJ.%目的 比较胆管空肠R-Y吻合术(Roux-en-Y hepaticojejunostomy,R-Y HJ)与胆管端端吻合术(duct-to-duct hepaticocholedochostomy,D-D HC)在成人活体肝移植中的并发症发生率.方法 检索Medline-PubMed、EMBASE、Scielo-LILACS数据库相关文献,使用Cochrane Databases进行数据处理,计算其在95%可信区间时的并发症例数.结果 依据纳入标准和排除标准,共筛选出7篇文献,均为有关成人活体肝移植R-Y HJ与D-D HC术后胆道并发症的临床研究.对两种方法总体并发症率、胆道狭窄率和胆汁漏率三项指标进行分析比较,显示总体并发症率和胆道狭窄率,R-Y HJ组均低于D-D HC组的治疗模式.胆漏发生率R-Y HJ

  16. Expectations from imaging for pre-transplant evaluation of living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Tiffany; Hennedige; Gopinathan; Anil; Krishnakumar; Madhavan

    2014-01-01

    Living donor liver transplant(LDLT)is a major surgi-cal undertaking.Detailed pre-operative assessment of the vascular and biliary anatomy is crucial for safe and successful harvesting of the graft and transplantation.Computed tomography(CT)and magnetic resonance imaging(MRI)are currently the imaging modalities of choice in pre-operative evaluation.These cross-sec-tional imaging techniques can reveal the vascular and biliary anatomy,assess the hepatic parenchyma and perform volumetric analysis.Knowledge of the broad indications and contraindications to qualify as a recipi-ent for LDLT is essential for the radiologist reporting scans in a pre-transplant patient.Similarly,awareness of the various anatomical variations and pathological states in the donor is essential for the radiologist to generate a meaningful report of his/her observations.CT and MRI have largely replaced invasive techniques such as catheter angiography,percutaneous cholan-giography and endoscopic retrograde cholangiopan-creatography.In order to generate a meaningful report based on these pre-operative imaging scans,it is also mandatory for the radiologist to be aware of the sur-geon’s perspective.We intend to provide a brief over-view of the common surgical concepts of LDLT and give a detailed description of the minimum that a radiologist is expected to seek and report in CT and MR scans per-formed for LDLT related evaluation.

  17. Chronic hepatitis E virus infection after living donor liver transplantation via blood transfusion: a case report.

    Science.gov (United States)

    Kurihara, Takeshi; Yoshizumi, Tomoharu; Itoh, Shinji; Harimoto, Norifumi; Harada, Noboru; Ikegami, Toru; Inagaki, Yuki; Oshiro, Yukio; Ohkohchi, Nobuhiro; Okamoto, Hiroaki; Maehara, Yoshihiko

    2016-12-01

    Although it occurs worldwide, hepatitis E virus (HEV) infection in developed countries is generally foodborne. HEV infection is subclinical in most individuals. Although fulminant liver failure may occur, progression to chronic hepatitis is rare. This study describes a 41-year-old man with liver cirrhosis caused by non-alcoholic steatohepatitis and hepatocellular carcinoma within the Milan criteria. His liver function was classified as Child-Pugh grade C. Living donor liver transplantation (LDLT) was performed, and he was discharged from the hospital on postoperative day (POD) 22. However, his alanine aminotransferase concentration began to increase on POD 60 and HEV infection was detected on POD 81. Retrospective assessments of stored blood samples showed that this patient became positive for HEV RNA on POD 3. The liver donor was negative for anti-HEV antibodies and HEV RNA. However, the platelet concentrate transfused into the liver recipient the day after LDLT was positive for HEV RNA. The patient remained positive for HEV infection for 10 months. Treatment with 800 mg/day ribavirin for 20 weeks reduced HEV RNA to an undetectable level. In conclusion, this report describes a patient infected with HEV through a blood transfusion after LDLT, who progressed to chronic hepatitis probably due to his immunosuppressed state and was treated well with ribavirin therapy. PMID:27059470

  18. Present status and recent advances in living donor liver transplantation for malignant hepatic tumors

    Institute of Scientific and Technical Information of China (English)

    Jian-Min Qin; Yasutsugu Takada; Shinji Uemoto; Koichi Tanaka

    2008-01-01

    BACKGROUND:Living donor liver transplantation (LDLT) has been increasingly used to treat hepatic tumors worldwide in recent years, and is currently the most effective alternative to deceased donor liver transplantation to overcome the problem of organ shortage. LDLT has played an enormous role in treating early malignant hepatic tumors. But the indication of LDLT for malignant hepatic tumors is based on indeifnite criteria. This review summarizes the recent studies in LDLT for treating malignant hepatic tumors. DATA SOURCES:A literature research of the PubMed database was conducted and research articles were reviewed. RESULTS:The current data on LDLT for malignant hepatic tumors, combined with our hospital experience, indicated that if a patient with hepatocellular carcinoma (HCC) who meets with the conventional Milan criteria cannot undergo tumor resection because of poorly preserved liver function, and a cadaveric graft is dififcult to obtain within six months, LDLT may be selected. In a patient with recurrence of HCC after conventional therapies, feasibility, optimal timing, and efifcacy of LDLT as a second-line treatment should be determined. CONCLUSIONS:Tumor recurrence is related to the biological behavior and staging of the tumor. New immunosuppressors which have anti-tumor effects and inhibit the immune system need to be developed. The indications of LDLT for hepatic malignant tumors should be selected meticulously.

  19. Pediatric live-donor kidney transplantation in Mansoura Urology & Nephrology Center: a 28-year perspective.

    Science.gov (United States)

    El-Husseini, Amr A; Foda, Mohamed A; Bakr, Mohamed A; Shokeir, Ahmed A; Sobh, Mohamed A; Ghoneim, Mohamed A

    2006-10-01

    Our objective was to evaluate our overall experience in pediatric renal transplantation. Between March 1976 and March 2004, 1,600 live-donor kidney transplantations were carried out in our center; 216 of the patients were 18 years old or younger (mean age 12.9 years). There were 136 male patients and 80 female patients. The commonest causes of end-stage renal disease (ESRD) were renal dysplasia (22%), nephrotic syndrome (20%), hereditary nephritis (16%), and obstructive uropathy (16%). Of the donors, 94% were one-haplotype matched and the rest were identical. Pre-emptive transplantation was performed in 51 (23%) patients. Triple-therapy immunosuppression (prednisone + cyclosporine + azathioprine) was used in 78.2% of transplants. Rejection-free recipients constituted 47.7%. Hypertension (62%) was the commonest complication. A substantial proportion of patients (48%) were short, with height standard deviation score (SDS) less than -1.88. The overall infection rate was high, and the majority (53%) of infections were bacterial. The graft survival at 1 year, 5 years and 10 years were 93.4%, 73.3% and 48.2%, respectively, while the patients' survival at 1, 5 and 10 years were 97.6%, 87.8% and 75.3%, respectively. Despite long-term success results of pediatric renal transplantation in a developing country, there is a risk of significant morbidity. PMID:16791608

  20. Noncontrast-Enhanced Magnetic Resonance Versus Computed Tomography Angiography in Preoperative Evaluation of Potential Living Renal Donors

    DEFF Research Database (Denmark)

    Blankholm, Anne Dorte; Pedersen, Bodil G; Østrat, Ernst Ø;

    2015-01-01

    RATIONALE AND OBJECTIVES: Living renal donors undergo an extensive examination program. These examinations should be as safe, gentle, and patient friendly as possible. To compare computed tomography angiography (CTA) and an extensive magnetic resonance imaging (MRI) protocol without contrast agents...... to observations from nephrectomy in living renal donors and to evaluate whether noncontrast-enhanced MRI can replace CTA for vessel assessment in living renal donors. MATERIAL AND METHODS: CTA and MRI results were compared to observations from nephrectomy, which served as the reference standard. Fifty...... for statistically significant differences. RESULTS: In the assessment of more than one renal artery, the sensitivity and specificity of MRI and CTA were high and in perfect agreement compared to observations from surgery. The results for both MRI and CTA were as follows: (sensitivity 100%/specificity100%/accuracy...

  1. Peritoneal Recurrence of Initially Controlled Hepatocellular Carcinoma after Living Donor Liver Transplantation

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    Nariman Sadykov

    2015-01-01

    Full Text Available It is well known that the presence of end-stage liver disease increases the risk of developing hepatocellular carcinoma (HCC. Liver transplantation (LT for patients within the Milan criteria has become a standard treatment for HCC in most developed centers worldwide. However, a major cause of death in cirrhotic patients with HCC after transplantation is tumor recurrence, including peritoneal recurrences, which develops rarely but presents a significant problem with regard to their management. Our experience includes two cases with HCC within the Milan criteria of peritoneal recurrences after living donor LT. Both patients had interventions for HCC in their medical history before LT, and we propose that these might have been a possible cause of the HCC peritoneal recurrence.

  2. Acute paranoid psychosis as sole clinical presentation of hepatic artery thrombosis after living donor liver transplantation

    Directory of Open Access Journals (Sweden)

    Obed Aiman

    2010-02-01

    Full Text Available Abstract Background Hepatic artery thrombosis is a devastating complication after orthotopic liver transplantation often requiring revascularization or re-transplantation. It is associated with considerably increased morbidity and mortality. Acute cognitive dysfunction such as delirium or acute psychosis may occur after major surgery and may be associated with the advent of surgical complications. Case presentation Here we describe a case of hepatic artery thrombosis after living-donor liver transplantation which was not preceded by signs of liver failure but rather by an episode of acute psychosis. After re-transplantation the patient recovered without sequelae. Conclusion This case highlights the need to remain cautious when psychiatric disorders occur in patients after liver transplantation. The diagnostic procedures should not be restricted to medical or neurological causes of psychosis alone but should also focus vascular complications related to orthotopic liver transplantation.

  3. Microsurgical reconstruction of hepatic ar ter y in living donor liver transplantation:experiences and lessons

    Institute of Scientific and Technical Information of China (English)

    Sheng Yan; Shu-Sen Zheng; Qi-Yi Zhang; Yu-Sheng Yu; Jiang-Juan He; Wei-Lin Wang; Min Zhang; Yan Shen; Jian Wu; Xiao Xu

    2009-01-01

    BACKGROUND: Hepatic artery (HA) reconstruction is one of the key steps for living donor liver transplantation (LDLT). The incidence of HA thrombosis has been reduced by the introduction of microsurgical techniques under a high resolution microscope or loupe. METHODS: We report our experience in 101 cases of HA reconstruction in LDLTs using the graft-artery-unclamp and posterior-wall-ifrst technique. The reconstructions were completed by either a plastic surgeon or a transplant surgeon. RESULTS: The rate of HA thrombosis was 2%(2/101). The risk factors for failed procedures appeared to be reduced by participation of the transplant surgeon compared with the plastic surgeon. For a graft with duplicate arteries, we considered no branches should be discarded even with a positive clamping test. CONCLUSIONS: HA reconstruction without clamping the graft artery is a feasible and simpliifed technique, which can be mastered by transplant surgeons with considerable microsurgical training.

  4. Simultaneous BK Polyomavirus (BKPyV)-associated nephropathy and hemorrhagic cystitis after living donor kidney transplantation.

    Science.gov (United States)

    Helanterä, Ilkka; Hirsch, Hans H; Wernli, Marion; Ortiz, Fernanda; Lempinen, Marko; Räisänen-Sokolowski, Anne; Auvinen, Eeva; Mannonen, Laura; Lautenschlager, Irmeli

    2016-03-01

    BK polyomavirus (BKPyV) commonly reactivates after kidney transplantation, and can cause polyomavirus-associated nephropathy (PyVAN), whereas after allogeneic stem cell transplantation the most frequent manifestation of BKPyV is polyomavirus-associated hemorrhagic cystitis (PyVHC). Despite high-level BKPyV replication in both, the pathogenesis and manifestation of both BKPyV entities appears to differ substantially. We describe an unusual case of simultaneous PyVAN and PyVHC presenting with acute symptoms in a BKPyV-IgG positive recipient eight months after kidney transplantation from a haploidentical living donor, who was BKPyV-IgG negative. Symptoms of cystitis and viremia subsided rapidly after reduction of immunosuppression. PMID:26771744

  5. Functional elements associated with hepatic regeneration in living donors after right hepatic lobectomy.

    Science.gov (United States)

    Everson, Gregory T; Hoefs, John C; Niemann, Claus U; Olthoff, Kim M; Dupuis, Robert; Lauriski, Shannon; Herman, Andrea; Milne, Norah; Gillespie, Brenda W; Goodrich, Nathan P; Everhart, James E

    2013-03-01

    We quantified the rates of hepatic regeneration and functional recovery for 6 months after right hepatic lobectomy in living donors for liver transplantation. Twelve donors were studied pre-donation (baseline); 8 were retested at a mean ± SD of 11±3 days after donation (T1), 10 were retested at a mean of 91±9 days after donation (T2), and 10 were retested at a mean of 185±17 days after donation (T3). Liver and spleen volumes were measured with computed tomography (CT) and single-photon emission computed tomography (SPECT). Hepatic metabolism was assessed with caffeine and erythromycin, and hepatic blood flow (HBF) was assessed with cholates, galactose, and the perfused hepatic mass (PHM) by SPECT. The regeneration rates (mL kg(-1) of body weight day(-1)) by CT were 0.60±0.22 mL from the baseline to T1, 0.05±0.02 mL from T1 to T2, and 0.01±0.01 from T2 to T3; by SPECT they were 0.54±0.20, 0.04±0.01, and 0.01±0.02, respectively. At T3, the liver volumes were 84%±7% of the baseline according to CT and 92%±13% of the baseline according to SPECT. Changes in the hepatic metabolism did not achieve statistical significance. At T1, the unadjusted clearance ratios with respect to the baseline were 0.75±0.07 for intravenous cholate (Pliver were up to 50% greater than the baseline values, suggesting recruitment of HBF by the regenerating liver. Increased cholate shunt, increased spleen volume, and decreased platelet count, were consistent with an altered portal circulation. In conclusion, initial hepatic regeneration is rapid, accounts for nearly two-thirds of total regeneration, and is associated with increases in HBF and cholate uptake. Right lobe donation alters the portal circulation of living donors, but the long-term clinical consequences, if there are any, are unknown.

  6. The clinical value of glomerular filtration rate with 99Tcm-DTPA on living kidney transplantation donor

    International Nuclear Information System (INIS)

    Objective: To determine the normal reference range of glomerular filtration rate (GFR) in different ages with 99Tcm-DTPA renal dynamic imaging on living kidney transplantation donor, and to evaluate the clinical value of GFR in living kidney transplantation. Methods: 99Tcm-DTPA renal dynamic imaging was performed in 300 patients on living kidney transplantation donor. The image was processed according to Gates' method to obtain GFR. The normal reference range of GFR was obtained in different ages and the relationship between GFR and gender, age and body mass index was also analyzed. Results: The left, right and total renal GFR of 300 living kidney transplantation donors were 49.25±10.34 ml/min. 49.27±9.69 ml/min and 98.52±19.03 ml/min, respectively. The GFR in the group of age 4 0 was higher significantly than that of age ≥50 (P 0.05). The study of logistic regression showed that the age was the only important impact factor on GFR. Conclusions: GFR obtained by 99Tcm-DTPA is simple and reliable, which can be used to accurately assess the individual renal filterability and the urinary drainage function, This affords an useful method on screening the living relative kidney transplantation donor. (authors)

  7. Effect of creatine phosphate on perioperative myocardial injury caused by living donor fiver transplantation in adult patients%磷酸肌酸钠对活体肝移植术患者围术期心肌损伤的影响

    Institute of Scientific and Technical Information of China (English)

    喻文立; 杜洪印; 翁亦齐

    2010-01-01

    Objective To investigate the effect of creatine phosphate on perioperative myocardial injury caused by living donor liver transplantation(LDLT)in adult patients.Methods Forty ASA Ⅱ -Ⅳ patients(liver function Child-Pugh grade B or C)aged 45-62 yr weighing 47-91 kg undergoing LDLT were randomly divided into 2 groups(n = 20 each): control group(group C)and creatine phosphate group(group CP).In group CP,creatine phosphate 30 mg/kg was injected intravenously at skin incision followed by creatine phosphate infusion at 4 mg· kg- 1 · h- 1 until the end of surgery.In group C,equal volume of normal saline was infused instead of creatine phosphate.HR,MAP,CVP,PCWP,CO and SvO2 were recorded immediately before skin incision,at 5 and 30 min of anhepatic phase,at 5 and 30 min of neohepatic phase and at the end of operation.Blood samples were taken from central vein immediately before skin incision(baseline,T0),at 30 min of anhepatic phase(T1),at 30min of neohepatic phase(T2),at the end of operation(T3)and at 4 and 24 h after operation(T4,5)for determination of serum cardiac troponin I(cTnI)and creatine kinase MB(CK-MB)concentrations and lactate dehydrogenase(LDH)activity.Postoperative adverse events were recorded.Results The serum cTnI and CK-MB concentrations and LDH activity were significantly increased at T2-5 as compared with the baseline value at T0 in both groups(P <0.05 or 0.01).MAP and CO were significantly higher from 5 min of neohepatic phase to the end of operation,the serum cTnI and CK-MB concentrations and LDH activity were significantly lower at T2-5,and the incidence of ventricular arrhythmia was significantly lower in group CP than in group C(P < 0.05 or 0.01).Conclusion Creatine phosphate can attenuate perioperative myocardial injury caused by LDLT in adult patients.%目的 评价磷酸肌酸钠对活体肝移植术患者围术期心肌损伤的影响.方法 活体肝移植术患者40例,ASA分级Ⅱ~Ⅳ级,肝功能Child-Pugh分级B或C级,年龄45

  8. Evaluation of renal vascular anatomy in live renal donors: Role of multi detector computed tomography

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    Vaidehi Kumudchandra Pandya

    2016-01-01

    Conclusions: Developmental variations in renal veins can be easily detected on computed tomography scan, which can go unnoticed and can pose a fatal threat during major surgeries such as donor nephrectomies in otherwise healthy donors if undiagnosed.

  9. Computed tomography perfusion in living donor liver transplantation: an initial study of normal hemodynamic changes in liver grafts.

    Science.gov (United States)

    Zhuang, Zhi Guo; Qian, Li Jun; Wang, Bi Xiong; Zhou, Yan; Li, Qi Gen; Xu, Jian Rong; Cheng, Yu Fan

    2009-01-01

    Hepatic hemodynamic changes in grafts after living donor liver transplantation (LDLT) are complicated. In this study, computed tomography (CT) perfusion parameter values, especially portal vein perfusion (PVP), was retrospectively analyzed in recipients both with and without small-for-size syndrome (SFSS). PVP was significantly higher in non-SFSS recipients on post-operative day (POD) 14 or 28 than in normal donors before donation (p spleen size ratio and PVP on POD 14 in non-SFSS group (r = -0.545, p = 0.002). Furthermore, PVP in the SFSS group was significantly greater than in the non-SFSS group on POD 14 (p = 0.042). In conclusion, we successfully evaluated normal hemodynamic changes in grafts without SFSS by CT perfusion examination. To our knowledge, this is the first study on hemodynamic changes of living donor liver grafts using CT technique.

  10. Argus versus manual methods to measure liver volume of living liver transplant donors

    International Nuclear Information System (INIS)

    Objective: To investigate the feasibility of measuring liver volume with Argus method. Methods: Thirty-two healthy liver transplant donor candidates underwent liver MRI on a 3.0 T MR unit. Volume interpolated body examination (VIBE) was performed after the administration of gadobenate dimeglumine. The VIBE data was transferred to the diagnostic workstation, and then multiple planar reconstruction (MPR) images were acquired. Firstly, two observers manually drawn the liver shape and calculated three volumes: the whole liver volume and right lobes volumes include middle hepatic vein (MHV) and exclude MHV, respectively. Secondly, the same data was transferred to Argus software, calculated that three volumes. Each measurement time was recorded. Actual graft volume (the right lobe)was measured during surgery. The correlation between right lobes volume of two measurements and actual graft volume was analyzed. The time needed for Argus and that needed for manual method were compared with paired t test. Results: The right lobe volumes measured by Argus, manually and surgery method were (813±187), (807±181) and (713±137) mm3, respectively. Argus method and manual method showed good correlation with surgery method, and the correlation coefficients were 0.897 (Argus method) and 0.884(manual method), respectively. The time for manual method and Argus method were(44.3±2.7) and (12.2±1.0)min, respectively. There was significant difference between Argus and manual methods (t=76.39, P<0.05). Conclusion: Compared with manual method, use of the Liver volumetric measurement by Argus software not only correlated well with Actual graft volume, but also saves time. Argus has potential clinical value for volumetric measurement in living liver transplant donors. (authors)

  11. Current diagnosis and treatment of benign biliary strictures after living donor liver transplantation.

    Science.gov (United States)

    Chang, Jae Hyuck; Lee, Inseok; Choi, Myung-Gyu; Han, Sok Won

    2016-01-28

    Despite advances in surgical techniques, benign biliary strictures after living donor liver transplantation (LDLT) remain a significant biliary complication and play an important role in graft and patient survival. Benign biliary strictures after transplantation are classified into anastomotic or non-anastomotic strictures. These two types differ in presentation, outcome, and response to therapy. The leading causes of biliary strictures include impaired blood supply, technical errors during surgery, and biliary anomalies. Because patients usually have non-specific symptoms, a high index of suspicion should be maintained. Magnetic resonance cholangiography has gained widespread acceptance as a reliable noninvasive tool for detecting biliary complications. Endoscopy has played an increasingly prominent role in the diagnosis and treatment of biliary strictures after LDLT. Endoscopic management in LDLT recipients may be more challenging than in deceased donor liver transplantation patients because of the complex nature of the duct-to-duct reconstruction. Repeated aggressive endoscopic treatment with dilation and the placement of multiple plastic stents is considered the first-line treatment for biliary strictures. Percutaneous and surgical treatments are now reserved for patients for whom endoscopic management fails and for those with multiple, inaccessible intrahepatic strictures or Roux-en-Y anastomoses. Recent advances in enteroscopy enable treatment, even in these latter cases. Direct cholangioscopy, another advanced form of endoscopy, allows direct visualization of the inner wall of the biliary tree and is expected to facilitate stenting or stone extraction. Rendezvous techniques can be a good option when the endoscopic approach to the biliary stricture is unfeasible. These developments have resulted in almost all patients being managed by the endoscopic approach. PMID:26819525

  12. Insufficient Portal Vein Inflow in Children without Major Shunt Vessels During Living Donor Liver Transplantation.

    Science.gov (United States)

    Matsuura, Toshiharu; Yoshimaru, Koichiro; Yanagi, Yusuke; Esumi, Genshiro; Hayashida, Makoto; Taguchi, Tomoaki

    2016-01-01

    BACKGROUND Liver cirrhosis is frequently accompanied by insufficient portal vein inflow (IPVF) with large portosystemic shunts. However, pediatric cases often manifested IPVF without any apparent major portosystemic shunts. Although IPVF is a very critical issue, the intraoperative assessment has not been well established. In this study, we reviewed the intraoperative approach and the outcome of the IPVF cases at our department. MATERIAL AND METHODS Eighty-three living donor liver transplantations (LDLT) were performed from 1996 to 2014. The IPVF occurred in 5 cases and necessitated some additional assessments and intraoperative PV flow modulations. We retrospectively reviewed the operative records and analyzed the risk factors and the outcome of the IPVF. RESULTS All 5 IPVF cases were biliary atresia and the mean age at LDLT was 0.74±0.19 years old. The mean recipient PV diameter was 4.3±0.8 mm and the donor IMV patch grafts were applied. To increase the PV inflow, the collaterals around the spleen were ligated in all cases. Intraoperative portal venography was performed in 1 case for selective shunt vessel ligation. In 1 case, the graft was removed and returned to the back table to prevent graft loss during the IPVF. As a result, the final PVF/GV increased to 66.4±20.0 ml/min/100 g. CONCLUSIONS IPVF is a very critical problem. Intraoperative portal venography is helpful and collateral veins ligation is crucial. In some cases, returning the graft to the back table during the PV inflow modulation can prevent graft loss. PMID:27306916

  13. Living Kidney Donor Transplantation in a Resource-limited Country: The Ivory Coast Experience.

    Science.gov (United States)

    Ackoundou-N'Guessan, C; Hoang, A D; Ben Abdallah, T; Gnionsahe, D A; Dollo, I; Ripoche, C; Coulibaly, N; Aye, D Y; N'Guessan, F Y; Diby Kouame, B; Guei, C M; Tia, M W; Amekoudji, Y; Lagou, D A

    2015-01-01

    Renal transplantation that offers a good quality of life still is not performed by the majority of countries of black Africa. We started a pilot project of renal transplantation in Ivory Coast 2 years ago. The present paper reports the preliminary results, difficulties related to the program, and perspectives regarding its expansion. Ten living related kidney transplantations have been performed over a 2-year period. Recipients and their respective donors were male. The mean age of the recipients was 42.8 years (22-57), and the mean age of the donors was 29.4 years (22-43). The mean number of mismatches was 3.2 (0-6). None was immunized. Recipients and donors were all EBV IgG positive and CMV IgG positive. All but 1 case were induced with basiliximab. The mean graft and patient survival time was 16.6 months (6-26). The mean cold ischemic time was 2.27 hours (1-3.32). The mean serum creatinine at discharge was 241.87 μmol/L (115.18-1063.2), at 6 months was 117.20 μmol/l (95.6-139.9), at 12 months was 104.55 μmol/L (62.02-132.9), and at 24 months was 104.55 μmol/L (62.02-132.9). The mean cyclosporine through level (C0) at 6 months was 137.57 ng/mL (70-366), at 12 months was 117.33 ng/mL (62-197), and at 24 months was 78 ng/mL. The mean cyclosporine 2-hour post-administration concentration levels (C2) at 6 months was 764.9 ng/mL (430-1421), at 12 months was 937.17 ng/mL (483-1292), and at 24 months was 690.66 ng/mL (488-853). Main complications were sepsis, adenovirus hemorrhagic cystitis, new-onset diabetes after transplantation, delayed graft function, polycythemia, and cytomegalovirus infection. No clinical rejection was diagnosed over the 2-year period. Patient and graft survival was 100% at a mean post-transplantation time of approximately 16.6 months.

  14. Predictive capacity of pre-donation GFR and renal reserve capacity for donor renal function after living kidney donation

    NARCIS (Netherlands)

    Rook, M; Hofker, HS; van Son, WJ; van der Heide, JJH; Ploeg, RJ; Navis, GJ

    2006-01-01

    Kidney transplantation from living donors is important to reduce organ shortage. Reliable pre-operative estimation of post-donation renal function is essential. We evaluated the predictive potential of pre-donation glomerular filtration rate (GFR) (iothalamate) and renal reserve capacity for post-do

  15. Role of multislice CT and magnetic resonance cholangiography in preoperative evaluation of potential donor in living related liver transplantation

    Directory of Open Access Journals (Sweden)

    Hossam M. Abdel-Rahman

    2016-03-01

    Conclusion: Multislice CT is a valuable tool in the evaluation of potential living liver donors that provides complete information on the hepatic vascular anatomy, the liver parenchyma, and volumetric measurements. MRC with a 3.0-T MR system demonstrates the preoperative biliary evaluation very well with a high accuracy rate.

  16. Treatment of hepatic venous stenosis by transfemoral venous balloon dilation following living donor liver transplantation: a case report

    Institute of Scientific and Technical Information of China (English)

    Weiwei Jiang; Yangsui Liu; Lianbao Kong

    2009-01-01

    Hepatic venous stenosis may be a cause of graft failure in living donor liver transplantation (LDLT). Balloon dilation and metallic frame approaches have been used successfully to treat hepatic venous stenosis. Here, we report the effect of transfemoral venous balloon dilation for treating a child with hepatic venous stenosis after LDLT.

  17. Serial measurement of Doppler hepatic hemodynamic parameters for the diagnosis of acute rejection after live donor liver transplantation.

    Science.gov (United States)

    Sugimoto, Hiroyuki; Kato, Koichi; Hirota, Masashi; Takeda, Shin; Kamei, Hideya; Nakamura, Taro; Kiuchi, Tetsuya; Nakao, Akimasa

    2009-09-01

    To elucidate the role of Doppler hepatic hemodynamic parameters as surrogate markers of acute rejection (AR) after live donor liver transplantation (LDLT), serial Doppler measurements were prospectively performed during the first 2 weeks after LDLT to compare the longitudinal hepatic hemodynamic changes between patients with histologically proven AR and patients without histologically proven AR. Forty-six patients that had undergone adult-to-adult LDLT using a right lobe graft were enrolled in this study. The portal venous maximum velocity (PVV; cm/second), portal venous flow volume, hepatic arterial peak systolic velocity, hepatic arterial pulsatility index, hepatic venous maximum velocity, hepatic venous pulsatility index, and splenic arterial pulsatility index were measured. Fourteen patients were diagnosed by biopsy to have clinically relevant AR. Markedly increased PVV was seen soon after surgery and gradually decreased in both patients with clinically relevant AR and patients without clinically relevant AR. This serial change of decreasing PVV was significantly greater in patients with clinically relevant AR (P patients with clinically relevant AR was significantly lower than that in patients without clinically relevant AR (PVV on postoperative day 6: 35.6 +/- 21.3 versus 58.3 +/- 27.1 cm/second, respectively, P = 0.0080). A PVV cutoff value of 20.2 cm/second demonstrated the best accuracy for predicting clinically relevant AR. The sensitivity and specificity for predicting clinically relevant AR were 92.9% and 87.1%, respectively. The area under the curve was 0.94. In conclusion, serial Doppler measurement of hepatic parameters in LDLT is useful for the diagnosis of clinically relevant AR. Clinically relevant AR should therefore be suspected when a marked unexpected decrease in the PVV is observed.

  18. Life satisfaction of older Chinese adults living in rural communities.

    Science.gov (United States)

    Li, Hong; Chi, Iris; Xu, Ling

    2013-06-01

    Guided by the socio-environmental theoretical framework, this study examined factors associated with life satisfaction experienced by older Chinese adults living in rural communities. The data used in this study were extracted from the Sample Survey on Aged Population in Urban/Rural China conducted by the China Research Center on Aging in 2000. This study included 10,084 rural older adults in mainland China. In this study 60.2 % of rural older adults were satisfied with their lives. Results from a multinomial logistic regression analysis showed that life satisfaction reported by rural older Chinese adults was significantly related to education, financial resources, self-rated health, financial support from children, satisfaction with children's support, house sitting for their children, visiting neighbors, and being invited to dinner by neighbors. Research and policy implications of these findings are also discussed.

  19. [Ethical considerations on live transplantation from living related donors. Le conseil d'éthique de l'hôpital Debrousse].

    Science.gov (United States)

    Sann, L

    1993-01-01

    This review examines the ethical problems of liver transplantation from living parental donors regarding the main ethical principles. It appears that this method of transplantation is a new possibility offered to patients that cannot be subtracted from the parents' choice without interfering with their liberty. Moreover, there is a social decisiveness to ensure the offering of this option which is limited by the conditions of realisation, timing and personal situations of the parents. The considerations of risks, benefits, advantages and prejudices between donor and recipient show a favourable balance for this type of transplantation provided that adequate medical indications are respected. However, the considerations of psychological cost and burden deserve special attention and are detailed in this paper especially regarding the motivations and the long-term effects on the donor. Futility and ethical generalisation examinations favour such a procedure. Moral justice will generally be respected. The consideration of autonomy required special attention owing to the situation pressure upon the donor's consent. Consent deserves adapted solicitation according to variable situations: whether the donor explicitly specifically wanted to donate part of his liver or only required information. Excessive solicitation of parents' participation to liver donation represents qualified "forced choice"; in some situations where the parents cannot effectively refuse their participation, paternalistic action is ethically acceptable. A general procedure is proposed to ensure the psychological, legal and ethical protection of the donor and recipient. PMID:8247642

  20. Dengue seroprevalence of healthy adults in Singapore: serosurvey among blood donors, 2009.

    Science.gov (United States)

    Low, Swee-Ling; Lam, Sally; Wong, Wing-Yan; Teo, Diana; Ng, Lee-Ching; Tan, Li-Kiang

    2015-07-01

    Routine national notifications of dengue cases typically do not reflect the true dengue situation due to large proportion of unreported cases. Serosurveys, when conducted periodically, could shed light on the true dengue infections in the population. To determine the magnitude of dengue infections of the adult population in Singapore following the outbreak in 2007, we performed a cross-sectional study on blood donor samples from December 2009 to February 2010. The residual blood of 3,995 donors (aged 16-60 years) was screened for the presence of dengue-specific immunoglobulin G (IgG) and IgM using enzyme-linked immunosorbent assay (ELISA) kits. The age-weighted IgG prevalence of residents was 50.8% (N = 3,627, 95% confidence interval [CI] = 49.4-52.3%). Dengue IgG prevalence increased with age, with the lowest in 16-20 years age group (16.1%) and the highest in 56-60 years age group (86.6%). Plaque reduction neutralization test (PRNT) on samples of young resident adults (aged 16-30 years) revealed lower prevalence of neutralizing antibodies to each serotype, ranging from 5.4% to 20.3% compared with the older age groups. The level of exposure to dengue among the young adults is relatively low despite the endemicity of the disease in Singapore. It partially explains the population's susceptibility to explosive outbreaks and the high incidence rate among young adults.

  1. The Impact of a Surgical Protocol for Enhanced Recovery on Living Donor Right Hepatectomy: A Single-Center Cohort Study.

    Science.gov (United States)

    Kim, Seong Hoon; Kim, Young Kyu; Lee, Seung Duk; Lee, Eung Chang; Park, Sang Jae

    2016-04-01

    The concept of surgery for enhanced recovery (SFER) program has never been an issue in the context of living donor right hepatectomy (LDRH), much less its effects. The purpose of this study was to evaluate outcomes after the establishment of an SFER protocol for LDRH in a single center.A single-center cohort study was performed in 500 consecutive living donors who underwent right hepatectomy from January 2005 to June 2014 by analyzing the outcomes before and after an established SFER protocol that evolved with continuous refinements in surgical technique and management over 300 LDRHs, being in place on September 2011. Donor characteristics, operative outcomes, and postoperative complications divided into 2 groups (group 1, stepwise adjustment; group 2, complete adherence to the protocol) were compared.Donor characteristics were comparable in the 2 groups. Overall complication rate was 10.0% with no mortality. In group 2, operative time, hospital stay, and overall complication rate decreased significantly, and the morbidity was 1% and confined in grade I complication without reoperation, perioperative blood transfusion, or readmission. All donors in this series recovered fully and returned to the previous functional lifestyle.An SFER protocol on LDRH can be established by the gradual implementation of various refinements of surgical technique, and the recent outcomes achieved after the establishment of an SFER protocol could provide a current guidance on LDRH toward the ultimate goal of zero morbidity. PMID:27057855

  2. Association of Live Donor Nephrectomy and Reversal of Renal Artery Spasm

    Directory of Open Access Journals (Sweden)

    Jalal Azmandian

    2014-01-01

    Full Text Available Background: Kidney transplantation is the best treatment option for kidney failure. Major medical progress has been made in the field of renal transplantation over the last 40 years. The surgical procedure has been standardized and the complication rate is low. Overall, the outcome of renal transplantation is excellent and has improved over time. Vascular complications after renal transplantation are the most frequent type of complication following urological complications. Renal artery spasm (RAS following manipulation of renal artery is a common problem during live donor nephrectomy (LDN. The aim of this study was to determine whether or not it is necessary to wait for reverse of RAS and resumption of urinary flow before nephrectomy. Materials and Methods: In this clinical trial 16 cases of LDN who developed RAS during surgery received intra-arterial injection of 40 mg papaverine. In 8 cases surgery continued towards nephrectomy and in other 8 cases we waited for reverse of RAS. All analyses were performed using SPSS-11. Results: In both groups urinary flow started a few minutes (Mean, 12 min after declamping of transplanted kidney and normal renal consistency and color were achieved. There was no significant difference between urinary volume during 12 h after transplantation in two groups. Conclusion: The results showed that it might not be necessary to wait for reverse of RAS before LDN. Both patient (less anesthesia complications and hospital (less expenses will benefit from this time saving.

  3. Successful laparoscopic splenectomy after living-donor liver transplantation for thrombocytopenia caused by antiviral therapy

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Although interferon (IFN) based therapy for recurrent hepatitis C virus (HCV) infection after liver transplantation has been widely accepted, it induces various adverse effects such as thrombocytopenia, resulting in its interruption. Recently, concomitant splenectomy at the time of living donor liver transplantation (LDLT) has been tried to overcome this problem, but this procedure leads to several complications such as excessive intraoperative bleeding and serious infection. A 60-year-old female received LDLT using a left lobe graft from her second son for liver failure caused by hepatitis C-related cirrhosis. Six months after LDLT, she was diagnosed as recurrent HCV infection by liver biopsy. IFN monotherapy was started from 7 mo after LDLT and her platelet count decreased to less than 50000/μL, which thus made it necessary to discontinue the treatment. We decided to attempt laparoscopic splenectomy (LS) under general anesthesia. Since intra-abdominal findings did not show any adhesion formations around the spleen, LS could be successfully performed. After LS, since her platelet count immediately increased to 225000/μL 14 d after operation, IFN therapy was restarted and we could convert the combination therapy of IFN and ribavirin, resulting in no detectable viral marker. In conclusion, LS can be performed safely even after LDLT, and LS after LDLT is a feasible and less invasive modality for thrombocytopenia caused by antiviral therapy.

  4. Outcome of patients from the west of Scotland traveling to Pakistan for living donor kidney transplants.

    Science.gov (United States)

    Geddes, Colin C; Henderson, Andrew; Mackenzie, Pamela; Rodger, Stuart C

    2008-10-27

    The aim of this study was to analyze the 3-year outcome of patients traveling from the west of Scotland to Pakistan for living donor kidney transplant. Baseline data and outcomes of 18 consecutive recipients who traveled to Pakistan between 2000 and 2007 and returned for follow-up at the regional transplant unit in the west of Scotland were retrieved from the electronic patient record. Mean follow-up was 775 days. No patients died. Two kidneys failed at 12 and 1400 days, respectively. The incidence of acute rejection in the first year was 11.1%. Mean eGFR at 1 and 3 years were 51.8 and 47.7 mL/min/1.73 m2, respectively. One patient developed malaria. No patients contracted hepatitis B, hepatitis C, or human immunodeficiency virus infection. The outcomes of this series of patients are better than previous reports and can be used to inform patients who ask for advice about the risks of traveling abroad for kidney transplantation. PMID:18946355

  5. Recurrent hepatitis C after living donor liver transplantation detected by Tc-99m GSA liver scintigraphy.

    Science.gov (United States)

    Kaibori, Masaki; Ha-Kawa, Sang Kil; Uchida, Yoichiro; Ishizaki, Morihiko; Hijikawa, Takeshi; Saito, Takamichi; Imamura, Atsushi; Hirohara, Junko; Uemura, Yoshiko; Tanaka, Koichi; Kamiyama, Yasuo

    2006-11-01

    Recurrence of hepatitis C virus (HCV) after living donor liver transplantation was investigated using technetium-99m- diethylenetriaminepentaacetic acid-galactosyl human serum albumin (Tc-99m-GSA) liver scintigraphy. Four patients with decompensated cirrhosis due to HCV infection were retrospectively reviewed in this study. Scintigraphy was performed to determine the hepatic uptake ratio of the tracer corrected for disappearance from the blood, as well as the maximal removal rate of the tracer by hepatocytes, as parameters of hepatic functional reserve. In all patients, serum HCV ribonucleic acid (RNA) was detected 3 months after transplantation. The corrected hepatic uptake ratio and removal rate showed little change after transplantation in two patients without the recurrence of HCV infection. In another two patients, these levels were decreased at 3 months after transplantation. In one patient, recurrent HCV infection was diagnosed by confirmatory histologic examination at 12 months after transplantation. In the other patient, both levels declined further at 8 months. Although treatment was initiated with a combination of interferon plus ribavirin, this patient died of progressive hepatic failure. In conclusion, a decrease in scintigraphic parameters at 3 months after transplantation suggests recurrent HCV infection affecting the graft. Tc-99m-GSA liver scintigraphy is a useful noninvasive method for evaluating graft functional reserve. PMID:16977504

  6. Impact of Right-Sided Nephrectomy on Long-Term Outcomes in Retroperitoneoscopic Live Donor Nephrectomy at Single Center

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    Kazuya Omoto

    2013-01-01

    Full Text Available Objective. To assess the long-term graft survival of right-sided retroperitoneoscopic live donor nephrectomy (RPLDN, we compared the outcomes of right- and left-sided RPLDN. Methods. Five hundred and thirty-three patients underwent live donor renal transplantation with allografts procured by RPLDN from July 2001 to August 2010 at our institute. Of these, 24 (4.5% cases were selected for right-sided RPLDN (R-RPLDN according to our criteria for donor kidney selection. Study variables included peri- and postoperative clinical data. Results. No significant differences were found in the recipients' postoperative graft function and incidence of slow graft function. Despite significant increased warm ischemic time (WIT: mean 5.9 min versus 4.7 min, in R-RPLDN compared to that in L-RPLDN, there was no significant difference between the two groups regarding long-term patient and graft survival. The complication rate in R-RPLDN was not significantly different compared to that in L-RPLDN (17% versus 6.5%, . No renal vein thrombosis was experienced in either groups. Conclusions. Although our study was retrospective and there was only a small number of R-RPLDN patients, R-RPLDN could be an option for laparoscopic live donor nephrectomy because of similar results, with the sole exception of WIT, in L-RPLDN, and its excellent long-term graft outcomes.

  7. Determinants of graft survival in pediatric and adolescent live donor kidney transplant recipients: a single center experience.

    Science.gov (United States)

    El-Husseini, Amr A; Foda, Mohamed A; Shokeir, Ahmed A; Shehab El-Din, Ahmed B; Sobh, Mohamed A; Ghoneim, Mohamed A

    2005-12-01

    To study the independent determinants of graft survival among pediatric and adolescent live donor kidney transplant recipients. Between March 1976 and March 2004, 1600 live donor kidney transplants were carried out in our center. Of them 284 were 20 yr old or younger (mean age 13.1 yr, ranging from 5 to 20 yr). Evaluation of the possible variables that may affect graft survival were carried out using univariate and multivariate analyses. Studied factors included age, gender, relation between donor and recipient, original kidney disease, ABO blood group, pretransplant blood transfusion, human leukocyte antigen (HLA) matching, pretransplant dialysis, height standard deviation score (SDS), pretransplant hypertension, cold ischemia time, number of renal arteries, ureteral anastomosis, time to diuresis, time of transplantation, occurrence of acute tubular necrosis (ATN), primary and secondary immunosuppression, total dose of steroids in the first 3 months, development of acute rejection and post-transplant hypertension. Using univariate analysis, the significant predictors for graft survival were HLA matching, type of primary urinary recontinuity, time to diuresis, ATN, acute rejection and post-transplant hypertension. The multivariate analysis restricted the significance to acute rejection and post-transplant hypertension. The independent determinants of graft survival in live-donor pediatric and adolescent renal transplant recipients are acute rejection and post-transplant hypertension. PMID:16269048

  8. Successful Management of Graft Reinfection of HCV Genotype 2 in Living Donor Liver Transplantation from a Hepatitis B Core Antibody-Positive Donor with Sofosbuvir and Ribavirin

    Science.gov (United States)

    Sasaki, Reina; Kanda, Tatsuo; Ohtsuka, Masayuki; Yasui, Shin; Haga, Yuki; Nakamura, Masato; Yokoyama, Masayuki; Wu, Shuang; Nakamoto, Shingo; Arai, Makoto; Maruyama, Hitoshi; Miyazaki, Masaru; Yokosuka, Osamu

    2016-01-01

    Direct-acting antivirals (DAAs) are relatively safe and highly effective for the eradication of hepatitis C virus (HCV) in liver transplant recipients. In this case study, we present a female with a graft reinfected with HCV genotype 2 who was treated with a combination of sofosbuvir and ribavirin after living donor liver transplantation (LDLT). Because the graft was from a hepatitis B core antibody-positive donor, passive immunization with hyperimmune hepatitis B immunoglobulin (HBIG) and entecavir were also provided to prevent hepatitis B virus (HBV) reactivation. It became clear that the combination of sofosbuvir and ribavirin promptly led to a sustained virologic response and that this combination was safe to treat graft reinfection with HCV genotype 2 after LDLT. Adverse events caused by DAAs were not observed, except for slight anemia. HBIG and entecavir were useful in the prevention of HBV reactivation. In conclusion, the present case indicated that DAA treatment for graft reinfection with HCV is safe and effective in LDLT from hepatitis B core antibody-positive donors. PMID:27721720

  9. Successful Management of Graft Reinfection of HCV Genotype 2 in Living Donor Liver Transplantation from a Hepatitis B Core Antibody-Positive Donor with Sofosbuvir and Ribavirin

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    Reina Sasaki

    2016-07-01

    Full Text Available Direct-acting antivirals (DAAs are relatively safe and highly effective for the eradication of hepatitis C virus (HCV in liver transplant recipients. In this case study, we present a female with a graft reinfected with HCV genotype 2 who was treated with a combination of sofosbuvir and ribavirin after living donor liver transplantation (LDLT. Because the graft was from a hepatitis B core antibody-positive donor, passive immunization with hyperimmune hepatitis B immunoglobulin (HBIG and entecavir were also provided to prevent hepatitis B virus (HBV reactivation. It became clear that the combination of sofosbuvir and ribavirin promptly led to a sustained virologic response and that this combination was safe to treat graft reinfection with HCV genotype 2 after LDLT. Adverse events caused by DAAs were not observed, except for slight anemia. HBIG and entecavir were useful in the prevention of HBV reactivation. In conclusion, the present case indicated that DAA treatment for graft reinfection with HCV is safe and effective in LDLT from hepatitis B core antibody-positive donors.

  10. Anesthetic complications including two cases of postoperative respiratory depression in living liver donor surgery

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    David Beebe

    2011-01-01

    Full Text Available Background: Living liver donation is becoming a more common means to treat patients with liver failure because of a shortage of cadaveric organs and tissues. There is a potential for morbidity and mortality, however, in patients who donate a portion of their liver. The purpose of this study is to identify anesthetic complications and morbidity resulting from living liver donor surgery. Patients and Methods: The anesthetic records of all patients who donated a segment of their liver between January 1997 and January 2006 at University of Minnesota Medical Center-Fairview were retrospectively reviewed. The surgical and anesthesia time, blood loss, hospitalization length, complications, morbidity, and mortality were recorded. Data were reported as absolute values, mean ± SD, or percentage. Significance (P < 0.05 was determined using Student′s paired t tests. Results: Seventy-four patients (34 male, 40 female, mean age = 35.5 ± 9.8 years donated a portion of their liver and were reviewed in the study. Fifty-seven patients (77% donated the right hepatic lobe, while 17 (23% donated a left hepatic segment. The average surgical time for all patients was 7.8 ± 1.5 hours, the anesthesia time was 9.0 ± 1.3 hours, and the blood loss was 423 ± 253 ml. Forty-six patients (62.2% received autologous blood either from a cell saver or at the end of surgery following acute, normovolemic hemodilution, but none required an allogenic transfusion. Two patients were admitted to the intensive care unit due to respiratory depression. Both patients donated their right hepatic lobe. One required reintubation in the recovery room and remained intubated overnight. The other was extubated but required observation in the intensive care unit for a low respiratory rate. Twelve patients (16.2% had complaints of nausea, and two reported nausea with vomiting during their hospital stay. There were four patients who developed complications related to positioning during the

  11. Are the imaging findings used to assess the portal triad reliable to perform living-donor liver transplant?; Os achados de imagem para avaliacao da triade portal sao confiaveis para realizacao do transplante hepatico com doador vivo?

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    Dazzi, Francisco Leoncio; Ribeiro Junior, Marcelo Augusto Fontenelle; Mancero, Jorge Marcelo Padilla; Gonzalez, Adriano Miziara; D' Albuquerque, Luiz Augusto Carneiro, E-mail: franciscodazzi@hotmail.com [Hospital Beneficencia Portuguesa, Sao Paulo, SP (Brazil). Departamento de Cirurgia Geral e Transplante; Leao-Filho, Hilton Muniz [Hospital Beneficencia Portuguesa, Sao Paulo, SP (Brazil). Departamento de Radiologia e Diagnostico por Imagem; Silva, Adavio de Oliveira e [Hospital Beneficencia Portuguesa, Sao Paulo, SP (Brazil). Departamento de Gastroenterologia e Hepatologia

    2013-07-01

    Background: a crucial aspect of living-donor liver transplant is the risk imposed to the donor due to a procedure performed in a healthy individual that can lead to a high postoperative morbidity rate Aim: To correlate the pre- and intraoperative hepatic imaging findings of living adult donors. Methods: From 2003 to 2008 the medical charts of 66 donors were revised; in that, 42 were males (64%) and 24 females (36%), mean age of 30±8 years. The preoperative anatomy was analyzed by magnetic resonance cholangiography to study the bile ducts and by computed tomography angiography to evaluate the hepatic artery and portal vein. Normalcy criteria were established according to previously published studies. Results: Anatomic variations of the bile ducts were found in 59.1% of donors, of the artery hepatic in 31.8% and of the portal vein in 30.3% of the cases during the preoperative period. The magnetic resonance cholangiography findings were in agreement in 44 (66.6%) of donors and in disagreement in 22 (33.3%). With regards to hepatic artery, in all donors the findings of the imaging examination were in agreement with those of the intraoperative period. As to the portal vein, the computed tomography findings were in agreement in 59 (89.4%) donors and in disagreement in seven (10.6%). Conclusions: the bile duct anatomic variations are frequent, and the magnetic resonance cholangiography showed moderate accuracy (70%) in reproducing the surgical findings; the computed tomography reproduced the intraoperative findings of the hepatic artery in 100% of donors, and of the portal vein in 89.4% of the cases, thus demonstrating high accuracy (89%). (author)

  12. Dengue Virus Transmission from Living Donor to Recipient in Liver Transplantation: A Case Report.

    Science.gov (United States)

    Gupta, Raman K; Gupta, Gaurav; Chorasiya, Vishal K; Bag, Pradyut; Shandil, Rajeev; Bhatia, Vikram; Wadhawan, Manav; Vij, Vivek; Kumar, Ajay

    2016-03-01

    Many infections are transmitted from a donor to a recipient through organ transplantations. The transmission of dengue virus from a donor to a recipient in liver transplantation is a rare entity, and currently, there is no recommendation for screening this virus prior to transplantation. We report a case of transmission of dengue virus from donor to recipient after liver transplantation. The recipient had a history of multiple admissions for hepatic encephalopathy and ascites. He was admitted in the ICU for 15 days for chronic liver disease, ascites, and acute kidney injury before transplantation. The donor was admitted 1 day before transplantation. The donor spiked fever on postoperative day 2 followed by thrombocytopenia and elevated liver enzymes. The donor blood test was positive for dengue NS1 antigen. The recipient also had a similar clinical picture on postoperative day 5 and his blood test was also positive for dengue NS1 antigen. Hence, the diagnosis for posttransplant donor-derived allograft-related transmission of dengue infection was made. Both recipient and donor were treated with supportive measures and discharged after their full recovery on postoperative days 9 and 18, respectively. The effect of immunosuppression on dengue presentation is still unclear and there is lack of literature available. In our case, the recipient developed dengue fever similar to general population without showing any feature of severe graft dysfunction. We have concluded that dengue virus can also be transmitted from donor to recipient, and immunosuppression did not have any adverse effect on the evolution of dengue fever within the recipient. Delhi being a hyperendemic zone, screening for donors (especially in season time) for dengue virus seems to be the best preventive method to control donor-derived transmission of dengue to recipient. PMID:27194898

  13. Using a nano-flare probe to detect RNA in live donor cells prior to somatic cell nuclear transfer.

    Science.gov (United States)

    Fu, Bo; Ren, Liang; Liu, Di; Ma, Jian-Zhang; An, Tie-Zhu; Yang, Xiu-Qin; Ma, Hong; Guo, Zhen-Hua; Zhu, Meng; Bai, Jing

    2016-01-01

    Many transgenes are silenced in mammalian cells (donor cells used for somatic cell nuclear transfer [SCNT]). Silencing correlated with a repressed chromatin structure or suppressed promoter, and it impeded the production of transgenic animals. Gene transcription studies in live cells are challenging because of the drawbacks of reverse-transcription polymerase chain reaction and fluorescence in situ hybridization. Nano-flare probes provide an effective approach to detect RNA in living cells. We used 18S RNA, a housekeeping gene, as a reference gene. This study aimed to establish a platform to detect RNA in single living donor cells using a Nano-flare probe prior to SCNT and to verify the safety and validity of the Nano-flare probe in order to provide a technical foundation for rescuing silenced transgenes in transgenic cloned embryos. We investigated cytotoxic effect of the 18S RNA-Nano-flare probe on porcine fetal fibroblasts, characterized the distribution of the 18S RNA-Nano-flare probe in living cells and investigated the effect of the 18S RNA-Nano-flare probe on the development of cloned embryos after SCNT. The cytotoxic effect of the 18S RNA-Nano-flare probe on porcine fetal fibroblasts was dose-dependent, and 18S RNA was detected using the 18S RNA-Nano-flare probe. In addition, treating donor cells with 500 pM 18S RNA-Nano-flare probe did not have adverse effects on the development of SCNT embryos at the pre-implantation stage. In conclusion, we established a preliminary platform to detect RNA in live donor cells using a Nano-flare probe prior to SCNT.

  14. Factors Affecting Changes in the Glomerular Filtration Rate after Unilateral Nephrectomy in Living Kidney Donors and Patients with Renal Disease

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    Kim, Hye Ok; Chae, Sun Young; Back, Sora; Moon, Dae Hyuk [University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2010-04-15

    We evaluated the factors affecting changes in the postoperative glomerular filtration rate (GFR) after unilateral nephrectomy in living kidney donors and patients with renal disease. We studied 141 subjects who underwent living donor nephrectomy for renal transplantation (n=75) or unilateral nephrectomy for renal diseases (n=66). The GFR of the individual kidney was determined by Tc-99m DTPA scintigraphy before and after nephrectomy. By performing multiple linear regression analysis, we evaluated the factors that are thought to affect changes in GFR, such as age, sex, body mass index (BMI), preoperative GFR, preoperative creatinine level, operated side, presence of diabetes mellitus (DM), presence of hypertension (HTN), and duration of follow-up. In both the donor nephrectomy and the disease nephrectomy groups, GFR increased significantly after nephrectomy (46.9{+-}8.4 to 58.1{+-}12.5 vs. 43.0{+-}9.6 to 48.6{+-}12.8 ml/min, p<0.05). In the donor nephrectomy group, age was significantly associated with change in GFR ({beta}=-0.3, P<0.005). In the disease nephrectomy group, HTN, preoperative creatinine level, and age were significantly associated with change in GFR ({beta}=-6.2, p<0.005; {beta}=-10.9, p<0.01; {beta}=-0.2, p<0.01, respectively). This compensatory change in GFR was not significantly related to sex, duration of follow-up, or operated side in either group. The compensatory change in the GFR of the remaining kidney declined with increasing age in both living kidney donors and patients with renal disease.

  15. Predictive factors for reintubation following noninvasive ventilation in patients with respiratory complications after living donor liver transplantation.

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    Yuichi Chihara

    Full Text Available BACKGROUND: Postoperative respiratory complications are a major cause of mortality following liver transplantation (LT. Noninvasive ventilation (NIV appears to be effective for respiratory complications in patients undergoing solid organ transplantation; however, mortality has been high in patients who experienced reintubation in spite of NIV therapy. The predictors of reintubation following NIV therapy after LT are not exactly known. METHODS: Of 511 adult patients who received living-donor LT, data on the 179 who were treated by NIV were retrospectively examined. RESULTS: Forty-three (24% of the 179 patients who received NIV treatment required reintubation. Independent factors associated with reintubation by multivariate logistic regression analysis were controlled preoperative infections (odds ratio [OR] 8.88; 95% confidence interval (CI 1.64 to 48.11; p = 0.01, ABO-incompatibility (OR 4.49; 95% CI, 1.50 to 13.38; p = 0.007, and presence of postoperative pneumonia at the time of starting NIV (OR 3.28; 95% CI, 1.02 to 11.01; p = 0.04. The reintubated patients had a significant higher rate of postoperative infectious complications and a significantly longer intensive care unit stay than those in whom NIV was successful (p<0.0001. Of the 43 reintubated patients, 22 (51.2% died during hospitalization following LT vs. 8 (5.9% of the 136 patients in whom NIV was successful (p<0.0001. CONCLUSIONS: Because controlled preoperative infection, ABO-incompatibility or pneumonia prior to the start of NIV were independent risk factors for reintubation following NIV, caution should be used in applying NIV in patients with these conditions considering the high rate of mortality in patients requiring reintubation following NIV.

  16. BARTERING FOR A COMPATIBLE KIDNEY USING YOUR INCOMPATIBLE, LIVE KIDNEY DONOR: LEGAL AND ETHICAL ISSUES RELATED TO KIDNEY CHAINS.

    Science.gov (United States)

    Tenenbaum, Evelyn M

    2016-01-01

    Kidney chains are a recent and novel method of increasing the number of available kidneys for transplantation and have the potential to save thousands of lives. However, because they are novel, kidney chains do not fit neatly within existing legal and ethicalframeworks, raising potential barriers to their full implementation. Kidney chains are an extension of paired kidney donation, which began in the United States in 2000. Paired kidney donations allow kidney patients with willing, but incompatible, donors to swap donors to increase the number of donor/recipient pairs and consequently, the number of transplants. More recently, transplant centers have been using non-simultaneous, extended, altruistic donor ("NEAD") kidney chains--which consist of a sequence of donations by incompatible donors--to further expand the number of donations. This Article fully explains paired kidney donation and kidney chains and focuses on whether NEAD chains are more coercive than traditional kidney donation to a family member or close friend and whether NEAD chains violate the National Organ Transplant Act's prohibition on the transfer of organs for valuable consideration. PMID:27263265

  17. Analysis of infections in the first 3-month after living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Chuan Li; Tian-Fu Wen; Kai Mi; Chuan Wang; Lu-Nan Yan; Bo Li

    2012-01-01

    AIM:To identify factors related to serious postoperative bacterial and fungal infections in the first 3 mo after living donor liver transplantation (LDLT).METHODS:In the present study,the data of 207patients from 2004 to 2011 were reviewed.The pre-,intra-and post-operative factors were statistically analyzed.All transplantations were approved by the ethics committee of West China Hospital,Sichuan University.Patients with definitely preoperative infections and infections within 48 h after transplantation were excluded from current study.All potential risk factors were analyzed using univariate analyses.Factors significant at a P < 0.10 in the univariate analyses were involved in the multivariate analyses.The diagnostic accuracy of the identified risk factors was evaluated using receiver operating curve.RESULTS:The serious bacterial and fungal infection rates were 14.01% and 4.35% respectively.Enterococcus faecium was the predominant bacterial pathogen,whereas Candida albicans was the most common fungal pathogen.Lung was the most common infection site for both bacterial and fungal infections.Recipient age older than 45 years,preoperative hyponatremia,intensive care unit stay longer than 9 d,postoperative bile leak and severe hyperglycemia were independent risk factors for postoperative bacterial infection.Massive red blood cells transfusion and postoperative bacterial infection may be related to postoperative fungal infection.CONCLUSION:Predictive risk factors for bacterial and fungal infections were indentified in current study.Pre-,intra-and post-operative factors can cause postoperative bacterial and fungal infections after LDLT.

  18. Report of 3 Patients With Urea Cycle Defects Treated With Related Living-Donor Liver Transplant.

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    Özçay, Figen; Barış, Zeren; Moray, Gökhan; Haberal, Nihan; Torgay, Adnan; Haberal, Mehmet

    2015-11-01

    Urea cycle defects are a group of metabolic disorders caused by enzymatic disruption of the urea cycle pathway, transforming nitrogen to urea for excretion from the body. Severe cases present in early infancy with life-threatening metabolic decompensation, and these episodes of hyperammonemia can be fatal or result in permanent neurologic damage. Despite the progress in pharmacologic treatment, long-term survival is poor especially for severe cases. Liver transplant is an alternative treatment option, providing sufficient enzymatic activity and decreasing the risk of metabolic decompensation. Three patients with urea cycle defects received related living-donor liver transplants at our hospital. Patients presented with late-onset ornithine transcarbamylase deficiency, argininosuccinate lyase deficiency, and citrullinemia. Maximum pretransplant ammonia levels were between 232 and 400 μmol/L (normal range is 18-72 μmol/L), and maximum posttransplant values were 52 to 94 μmol/L. All patients stopped medical treatment and dietary protein restriction for urea cycle defects after transplant. The patient with late-onset ornithine transcarbamylase deficiency already had motor deficits related to recurrent hyperammonemia attacks pretransplant. A major improvement could not be achieved, and he is wheelchair dependent at the age of 6 years. The other 2 patients had normal motor and mental skills before transplant, which have continued 12 and 14 months after transplant. Hepatic artery thrombosis in the patient with the ornithine transcarbamylase deficiency, intraabdominal infection in the patient with argininosuccinate lyase deficiency, and posterior reversible encephalopathy syndrome in the patient with citrullinemia were early postoperative complications. Histopathologic changes in livers explanted from patients with ornithine transcarbamylase deficiency and citrullinemia were nonspecific. The argininosuccinate lyase-deficient patient had portoportal fibrosis and cirrhotic

  19. A STUDY OF RENAL OUTCOMES IN AFRICAN AMERICAN LIVING KIDNEY DONORS

    Science.gov (United States)

    Nogueira, Joseph M.; Weir, Matthew R.; Jacobs, Stephen; Haririan, Abdolreza; Breault, Denyse; Klassen, David; Evans, Deb; Bartlett, Stephen T.; Cooper, Matthew

    2009-01-01

    Background Very little is known about the long-term outcomes of African American living kidney donors (AALKDs). We undertook this study to describe renal outcomes of AALKDs several years after donation. Methods We invited 107 AALKDs to come for follow-up health evaluation. Results 39 subjects (36.4%) completed evaluation at a mean of 7.1 +/− 1.6 (range 3.9–10.2) years post-donation. The mean estimated glomerular filtration rate using the abbreviated MDRD equation (eGFR(MDRD)) at followup was 72.1 +/− 16.3 (range 42–106) ml/min per 1.73m2, and 18% of subjects had an eGFR(MDRD) of 30–59. The mean absolute and relative decrease in eGFR(MDRD) from the time of donation to followup were 30.5 +/− 16.4 ml/min per 1.73m2 and 28.8%, respectively. Subjects whose BMI was ≥ 35 kg/m2 (n=8) were found to have a greater decrement in e(MDRD) than those with BMI 300 mcg/mg creatinine), and 6 (15.4%) had microalbuminuria (30–300 mcg/mg creatinine). Conclusions AALKDs experience a substantial incidence of hypertension and a modest drop in eGFR(MDRD) post-donation, and obesity may increase the magnitude of renal decline. Further study is urgently needed to determine the long-term risks of AALKDs. PMID:20029333

  20. Preoperative predictors of blood component transfusion in living donor liver transplantation

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    R N Makroo

    2013-01-01

    Full Text Available Context: Extensive bleeding associated with liver transplantation is a major challenge faced by transplant surgeons, worldwide. Aims: To evaluate the blood component consumption and determine preoperative factors that predict the same in living donor liver transplantation (LDLT. Settings and Design: This prospective study was performed for a 1 year period, from March 2010 to February 2011. Materials and Methods: Intra- and postoperative utilization of blood components in 152 patients undergoing LDLT was evaluated and preoperative patient parameters like age, gender, height, weight, disease etiology, hemoglobin (Hb, hematocrit (Hct, platelet count (Plt, total leukocyte count (TLC, activated partial thromboplastin time (aPTT, international normalized ratio (INR, serum bilirubin (T. bilirubin, total proteins (T. proteins, albumin to globulin ratio (A/G ratio, serum creatinine (S. creatinine, blood urea (B. urea, and serum electrolytes were assessed to determine their predictive values. Univariate and stepwise discriminant analysis identified those factors, which could predict the consumption of each blood component. Results: The average utilization of packed red cells (PRCs, cryoprecipitates (cryo, apheresis platelets, and fresh frozen plasma was 8.48 units, 2.19 units, 0.93 units, and 2,025 ml, respectively. Disease etiology and blood component consumption were significantly correlated. Separate prediction models which could predict consumption of each blood component in intra and postoperative phase of LDLT were derived from among the preoperative Hb, Hct, model for end-stage liver disease (MELD score, body surface area (BSA, Plt, T. proteins, S. creatinine, B. urea, INR, and serum sodium and chloride. Conclusions: Preoperative variables can effectively predict the blood component requirements during liver transplantation, thereby allowing blood transfusion services in being better prepared for surgical procedure.

  1. Differences in portal hemodynamics between whole liver transplantation and living donor liver transplantation.

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    Jiang, Shui-Ming; Zhang, Qi-Shun; Zhou, Guang-Wen; Huang, Shi-Feng; Lu, Hai-Ming; Peng, Cheng-Hong

    2010-11-01

    The aim of this study was to investigate the differences in portal hemodynamics between whole liver transplantation and living donor liver transplantation (LDLT). Twenty patients who underwent LDLT (the L group) and 42 patients who underwent whole liver transplantation (the W group) were enrolled, and colored Doppler ultrasonography was performed preoperatively and on postoperative days (PODs) 1, 3, 5, 7, 30, and 90. The changes in the portal blood flow velocity (PBV) and portal blood flow volume (PBF) were monitored. The graft and spleen sizes were measured with angiographic computed tomography, and upper endoscopy was used to measure esophageal varices on PODs 14, 30, and 90. Although the portal venous pressure (PVP) decreased after graft implantation, it was higher in the L group with a smaller graft size ratio (25.7 ± 5.1 cm H₂O for the L group and 18.5 ± 4.6 cm H₂O for the W group, P transplantation; however, the PBF and PBV peaks were significantly higher in the W group. The postoperative PVP and graft volume were greatly related to PBF on POD 1. Grafts in the L group regenerated rapidly after the operation, and the volume increased from 704 ± 115 to 1524 ± 281 mL as early as 1 month after transplantation. A rapid improvement in splenomegaly was observed in both groups. An improvement in esophageal varices was observed in the W group on POD 14 after transplantation, whereas no change was observed in the L group. The portal venous flow in patients with portal hypertension showed a high perfusion state after LDLT, but in contrast to whole liver transplantation, the PVP elevation after LDLT postponed the closing time of the collateral circulation and affected the recovery from splenomegaly.

  2. Diffusion-weighted MRI of kidneys in healthy volunteers and living kidney donors

    International Nuclear Information System (INIS)

    Aim: To establish the normal apparent diffusion coefficient (ADC) values in healthy kidneys, comparing them with the literature, and assessing the correlation between ADC values, creatinine blood level, and glomerular filtration rate (GFR). Materials and methods: Twenty-four healthy volunteers and 26 living kidney donors were examined on a 1.5 T magnetic resonance imaging (MRI) unit. Two diffusion-weighted imaging (DWI) sequences were included in the study protocol (protocol 1 with 16 b-values, protocol 2 with 10 b-values) before the examination blood and urine samples were collected. The GFR was calculated using Cockcroft & Gault and MDRD (Modification of Diet In Renal Disease) formulas and the ADC values were measured separately for the cortex and medulla of each kidney by two independent observers. All statistical analyses were performed using the STATISTICA (version 10.0) software package. Data were analysed using an unpaired t-test; p<0.05 indicated a statistically significant difference. Results: The average ADC value for protocol 1 for the cortex was 2.26×10−3 mm2/s, for the medulla 2.21×10−3 mm2/s. In protocol 2, the respective values were 2.13×10−3 mm2/s and 2.06×10−3 mm2/s. Neither statistically significant interobserver differences nor correlation between ADC values, GFR, and creatinine serum level were observed. Conclusion: The reference ADC values were established. The measurements show high interobserver consistency. The differences in ADC values reported in the literature suggest dependence on the equipment and methodology and point to the necessity of obtaining ADC norms for each MRI unit. -- Highlights: •Magnetic resonance diffusion-weighted imaging of kidneys. •Apparent diffusion coefficient in healthy individuals. •Monoexponential model of diffusion

  3. Effect of lymph leakage on renal allograft outcome from living donors

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    Abolfazl Bohlouli

    2012-01-01

    Full Text Available Lymph leakage is a cause of prolonged fluid discharge in renal transplant patients. Lymph leakage during early post-transplantation is responsible for extracting immune substances; therefore, it may play a role in prognosis of the transplanted kidney. In this study, we aimed to investigate the effects of lymph leakage on different factors that play significant roles in renal allograft outcome. During the present case-control study, we evaluated 62 renal allograft recipients in which 31 subjects were complicated with lymph leakage and enrolled as the study group. The other 31 subjects were included in the control group who did not experience any lymph leakage during their post-transplantation period. All kidneys were transplanted from living donors. We investigated and compared the renal allograft rejection rate, hospitalization duration, serum urea, creatinine (Cr and cyclosporine (CsA levels, antithymoglobin (ATG administration and treatment duration between the study and the control groups. There were no significant difference in the urea and Cr levels between the two groups (P >0.05. Early (one week and late (one month serum CsA levels of the study group were significantly higher than in the control group (P = 0.005 and P = 0.006. The number of days in which ATG receivers responded to therapy was significantly lower for the control group (P = 0.008. 21.93% of the study group subjects experienced allograft rejection, while this rejection probability was 28.38% for the control group (P = 0.799. Lymph leakage has no prominent role in renal function, which is estimated by Cr and urea levels in patients′ serum during the days after transplantation. CsA level was higher in patients with lymph leakage, and all cases of allograft rejection were in the subjects with lymph leakage.

  4. A Prospective Controlled Study of Living Kidney Donors: Three-Year Follow-up

    Science.gov (United States)

    Kasiske, Bertram L.; Anderson-Haag, Teresa; Israni, Ajay K.; Kalil, Roberto S.; Kimmel, Paul L.; Kraus, Edward S.; Kumar, Rajiv; Posselt, Andrew A.; Pesavento, Todd E.; Rabb, Hamid; Steffes, Michael W.; Snyder, Jon J.; Weir, Matthew R.

    2015-01-01

    Background There have been few prospective controlled studies of kidney donors. Understanding the pathophysiological effects of kidney donation is important for judging donor safety and for improving our understanding of the consequences of reduced kidney function in chronic kidney disease. Study Design Prospective, controlled, observational cohort study. Setting & Participants Three-year follow-up of kidney donors and paired controls suitable for donation at their donor’s center. Predictor Kidney donation. Outcomes Medical history, vital signs, glomerular filtration rate and other measurements at 6, 12, 24 and 36 months after donation. Results At 36 months, 182 of 203 (89.7%) original donors and 173 of 201 (86.1%) original controls continue to participate in follow-up visits. The linear slope of the glomerular filtration rate measured by plasma iohexol clearance declined 0.36±7.55 mL/min per year in 194 controls, but increased 1.47±5.02 mL/min per year in 198 donors (P = 0.005) between 6 and 36 months. Blood pressure was not different between donors and controls at any visit, and at 36 months all 24-hour ambulatory blood pressure parameters were similar in 126 controls and 135 donors (mean systolic: 120.0±11.2 [SD] v. 120.7±9.7 mmHg [P=0.6]; mean diastolic: 73.4±7.0 v. 74.5±6.5 mmHg [P=0.2]). Mean arterial pressure nocturnal dipping was manifest in 11.2%±6.6% of controls and 11.3%±6.1% donors (P=0.9). Urinary protein-creatinine and albumin-creatinine ratios were not increased in donors compared to controls. From 6 to 36 months post-donation, serum parathyroid hormone, uric acid, homocysteine and potassium levels were higher, whereas hemoglobin was lower in donors compared to controls. Limitations Possible bias resulting from an inability to select controls screened to be as healthy as donors, short follow-up duration, and drop-outs. Conclusions Kidney donors manifest several of the findings of mild chronic kidney disease. However, at 36 months after

  5. Resolution of preoperative portal vein thrombosis after administration of antithrombin III in living donor liver transplantation: case report.

    Science.gov (United States)

    Imai, H; Egawa, H; Kajiwara, M; Nakajima, A; Ogura, Y; Hatano, E; Ueda, M; Kawaguchi, Y; Kaido, T; Takada, Y; Uemoto, S

    2009-11-01

    A 59-year-old man with hepatitis C virus-associated liver cirrhosis was transferred to our hospital to undergo living donor liver transplantation. Coagulation was impaired (prothrombin time [International Normalized Ratio], 3.27), and antithrombin III (AT-III) activity was 23% (normal, 87%-115%). Contrast-enhanced computed tomography scans revealed portal vein thrombosis (PVT) from the junction between the splenic and superior mesenteric vein to the porta hepatica; the portal vein was completely obstructed (PVT). To prevent further development of PVT, 1500 U of AT-III was administered for 3 days, elevating the AT-III activity to 50%. A contrast-enhanced computed tomography scan obtained 9 days after AT-III administration showed resolution of PVT. Living donor liver transplantation was safely performed without portal vein grafting. Thus, a low AT-III concentration may have an important role in the pathogenesis of PVT in patients with cirrhosis. PMID:19917415

  6. Dominance and persistence of donor marrow in long-lived allogeneic radiation chimeras obtained with unmanipulated bone marrow

    International Nuclear Information System (INIS)

    Allogeneic, H-2-incompatible irradiation chimeras (H-2sup(d) → H-2sup(b)) constructed with normal, unmanipulated bone marrow and with marrow-derived factors live long and do not manifest a GvH disease. Their response to primary immunization is deficient but their alloreactivity is normal. This chimeric allotolerance cannot be passively transferred from chimeric donors to normal irradiated recipients. Passive transfer of both donor- or recipient-type immuno-competent T-cells into the chimeric mice does not lead to syngeneic reconstitution, rejection of the engrafted marrow or GvH disease, and the mice maintain permanently their chimerism. This new model demonstrates that chimerism is not eradicable in long-lived chimeras reconstituted with unmanipulated bone marrow, and that the bone marrow itself plays a dominant role in maintenance of chimerism. (Auth.)

  7. Liver remnant regeneration in donors after living donor liver transplantation. Long-term follow-up using CT and MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Klink, T. [INSELSPITAL - Bern University Hospital (Switzerland). Diagnostic, Interventional, and Pediatric Radiology; University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Diagnostic and Interventional Radiology; Simon, P. [Merciful Brethren Hospital, Trier (Germany). Dept. of Radiology, Neuroradiology, Sonography and Nuclearmedicine; University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Diagnostic and Interventional Radiology; Knopp, C.; Ittrich, H.; Adam, G.; Koops, A. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Diagnostic and Interventional Radiology; Fischer, L. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Dept. of Hepatobiliary Surgery and Transplant Surgery

    2014-06-15

    Purpose: To assess liver remnant volume regeneration and maintenance, and complications in the long-time follow-up of donors after living donor liver transplantation using CT and MRI. Materials and Methods: 47 donors with a mean age of 33.5 years who donated liver tissue for transplantation and who were available for follow-up imaging were included in this retrospective study. Contrast-enhanced CT and MR studies were acquired for routine follow-up. Two observers evaluated pre- and postoperative images regarding anatomy and pathological findings. Volumes were manually measured on contrast-enhanced images in the portal venous phase, and potential postoperative complications were documented. Pre- and postoperative liver volumes were compared for evaluating liver remnant regeneration. Results: 47 preoperative and 89 follow-up studies covered a period of 22.4 months (range: 1 - 84). After right liver lobe (RLL) donation, the mean liver remnant volume was 522.0 ml (± 144.0; 36.1%; n = 18), after left lateral section (LLS) donation 1,121.7 ml (± 212.8; 79.9%; n = 24), and after left liver lobe (LLL) donation 1,181.5 ml (± 279.5; 72.0%; n = 5). Twelve months after donation, the liver remnant volume were 87.3% (RLL; ± 11.8; n = 11), 95.0% (LS; ± 11.6; n = 18), and 80.1% (LLL; ± 2.0; n = 2 LLL) of the preoperative total liver volume. Rapid initial regeneration and maintenance at 80% of the preoperative liver volume were observed over the total follow-up period. Minor postoperative complications were found early in 4 patients. No severe or late complications or mortality occurred. Conclusion: Rapid regeneration of liver remnant volumes in all donors and volume maintenance over the long-term follow-up period of up to 84 months without severe or late complications are important observations for assessing the safety of LDLT donors. (orig.)

  8. Liver remnant regeneration in donors after living donor liver transplantation. Long-term follow-up using CT and MR imaging

    International Nuclear Information System (INIS)

    Purpose: To assess liver remnant volume regeneration and maintenance, and complications in the long-time follow-up of donors after living donor liver transplantation using CT and MRI. Materials and Methods: 47 donors with a mean age of 33.5 years who donated liver tissue for transplantation and who were available for follow-up imaging were included in this retrospective study. Contrast-enhanced CT and MR studies were acquired for routine follow-up. Two observers evaluated pre- and postoperative images regarding anatomy and pathological findings. Volumes were manually measured on contrast-enhanced images in the portal venous phase, and potential postoperative complications were documented. Pre- and postoperative liver volumes were compared for evaluating liver remnant regeneration. Results: 47 preoperative and 89 follow-up studies covered a period of 22.4 months (range: 1 - 84). After right liver lobe (RLL) donation, the mean liver remnant volume was 522.0 ml (± 144.0; 36.1%; n = 18), after left lateral section (LLS) donation 1,121.7 ml (± 212.8; 79.9%; n = 24), and after left liver lobe (LLL) donation 1,181.5 ml (± 279.5; 72.0%; n = 5). Twelve months after donation, the liver remnant volume were 87.3% (RLL; ± 11.8; n = 11), 95.0% (LS; ± 11.6; n = 18), and 80.1% (LLL; ± 2.0; n = 2 LLL) of the preoperative total liver volume. Rapid initial regeneration and maintenance at 80% of the preoperative liver volume were observed over the total follow-up period. Minor postoperative complications were found early in 4 patients. No severe or late complications or mortality occurred. Conclusion: Rapid regeneration of liver remnant volumes in all donors and volume maintenance over the long-term follow-up period of up to 84 months without severe or late complications are important observations for assessing the safety of LDLT donors. (orig.)

  9. One hundred and thirty-seven living donor pediatric liver transplants at Riyadh Military Hospital. Results and outlook for future

    International Nuclear Information System (INIS)

    To review the results of 137 living donor pediatric liver transplants performed at Riyadh Military Hospital (RMH). Retrospective analysis of the in- and out-patient case notes was carried out. Data were collected regarding age, gender, nationality, diagnosis, type of procedure, complications and survival of the grafts and the recipients. The first 137 living donor pediatric liver transplants were performed in 113 months. The age range was 4.5 months to 14 years. Eighty-four recipients (61%) were male. One hundred and twelve children were Saudi. Left lateral segment was used as allograft in 135 cases. One child each received full left lobe and full right lobe. Six auxiliary partial orthotopic liver transplants were carried out. Familial metabolic liver disorders made the largest group of children needing transplant. The most common indications were progressive familial intrahepatic cholestasis and biliary atresia (45 cases each). The numbers of major complications are: hepatic artery thrombosis (n=8); portal vein thrombosis (n=3); portal vein stenosis (n=3); hepatic vein stenosis (n=3) and biliary strictures (n=4). Fifteen patients died. Three further allografts have been lost. Thus, the overall patient survival rate is 89% and graft survival rate is 86.8%. Living donor liver transplantation is a viable option for children with end-stage liver disease. Metabolic liver disease is the most common indication in Saudi Arabia. The cadaveric donor supply is in shortage and living donation is a practical alternative. The incidence of complications and recipient and graft survival rates of the program at RMH are acceptable, (author)

  10. Detection of biliary and vascular anatomy in living liver donors: Value of gadobenate dimeglumine enhanced MR and MDCT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Artioli, Diana, E-mail: diansadiana@gmail.com [Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20162 Milano (Italy); Tagliabue, Marianna; Aseni, Paolo; Sironi, Sandro; Vanzulli, Angelo [Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20162 Milano (Italy)

    2010-11-15

    Objective: To evaluate the performance of magnetic resonance (MR) and multidetector computed tomography (MDCT) in the assessment of living donor's vascular and biliary anatomy, having surgical findings as reference standard. Methods: Thirty-two living liver donors underwent MR cholangiography (1.5-T; standard cholangiography pulse sequences and delayed acquisitions after administration of biliary contrast agent) for biliary anatomy evaluation. MDCT (16-row multidetector scanner, multiphase protocol, 3 mm slice thickness) was also performed in all cases for the assessment of vascular anatomy before transplantation. Hepatic veins (<4 mm in diameter) were not considered. MR and MDCT images interpretation was performed by two reviewers by consensus, based on source axial images, multiplanar reformats, and three-dimensional (3D) postprocessing images. Surgical intraoperative findings were used as standard of reference. Results: At surgery, 17 biliary anomalies, 3 portal anomalies, 32 venous and 8 arterial variants were found in the 32 patients. MR correctly identified 15/17 biliary anomalies, with a sensitivity of 88% and a specificity of 93%. MDCT correctly identified 8/8 arterial, 3/3 portal and 29/32 venous variants, with a sensitivity of 100% and 91%, respectively, and a specificity of 100%. Conclusions: MR and MDCT proved to be efficient in evaluating living liver donor's biliary and vascular anatomy.

  11. Bile leakage after living donor liver transplantation demonstrated with hepatobiliary scan using 9mTc-PMT.

    Science.gov (United States)

    Kanazawa, Akishige; Kubo, Shoji; Tanaka, Hiromu; Takemura, Shigekazu; Yamazaki, Keiichi; Hirohashi, Kazuhiro; Shiomi, Susumu

    2003-09-01

    Although it is recognized that hepatobiliary scan is of value in assessing postoperative complications of biliary surgery or cadaveric whole liver transplantation, there have been few reports regarding its usefulness following living donor liver transplantation. We performed living donor liver transplantation in a patient with biliary cirrhosis due to hepatolithiasis, using a right lobe graft from her sister. On the 15th postoperative day, bile discharge appeared from the operative wound. The leakage point could not be identified by computed tomography and cholangiography from the biliary drainage catheter. Hepatobiliary scan with Tc-99m Sn-N-pyridoxyl-5-methyltryptophan (99mTc-PMT) demonstrated biliary extravasation from the left side of the anastomosis of the hepatico-jejunostomy, indicating biliary leakage from the anastomosis. Conservative therapy was continued because the radioisotope flowed smoothly into the reconstructed jejunum and the biliary drainage catheter, and the leakage was stopped on the 63th postoperative day. Hepatobiliary scan is useful in determining the therapeutic plan as well as detection of bile leakage and identification of leakage points after living donor liver transplantation.

  12. Experimental transfer of adult Oesophagostomum dentatum from donor to helminth naive recipient pigs: a methodological study.

    Science.gov (United States)

    Bjørn, H; Roepstorff, A; Grøndahl, C; Eriksen, L; Bjerregaard, J; Nansen, P

    1995-12-01

    This study was carried out to compare potential methods of transplanting adult Oesophagostomum dentatum from experimentally infected donor pigs to helminth naive recipient pigs. The following methods were each tested in five pigs: A. Transfer of worms by stomach tube to the gastric ventricle of pigs per os pretreated with 0.5 mg/kg cisapride to increase gastrointestinal peristalsis; B. Transfer by stomach tube to the gastric ventricle of pigs per os pre-treated with cisapride (0.5 mg/kg) and omeprazol 20 mg which blocks hydrochloric acid secretion; C. Surgical transfer of worms to caecum of pigs. Worms for transplantation to pigs were obtained after slaughter of experimentally infected donor pigs and following isolation from the contents of the large intestine, using an agar gel migration technique. A mean of 1054 nematodes were transferred into each recipient pig within 2 hours. Procedures A and B resulted in establishment rates corresponding to only 0.5% and 7.6% of the transferred worms. In contrast, surgical transfer allowed 74.2% of the transplanted worms to be established. In all groups the transplanted worms migrated to the normal predilection site, i.e. the middle part of the large intestine. More female than male worms established in all groups. It was concluded from this study that surgical transfer was the most reliable of the methods tested for experimental establishment of adult O. dentatum in helminth naive pigs. PMID:8583123

  13. When Operating on Dead People Saves Lives: Benefits of Surgical Organ Donor Intensivists

    OpenAIRE

    Kristin Long; Cynthia Talley; Yarrison, Rebecca B.; Andrew Bernard

    2015-01-01

    Solid organ transplantation has emerged as a life-saving treatment for many patients suffering from end-stage organ failure. Organs have been successfully recovered after a variety of aggressive interventions. We propose that decompressive laparotomy, when clinically indicated, should be considered in the aggressive resuscitation of potential organ donors. A thorough literature review examining aggressive interventions on potential organ donors was conducted after experience with a unique cas...

  14. Factors affecting change in glomerular filtration rate after unilateral nephrectomy in living kidney donors and patients with renal disease

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hye Ok; Back, So Ra; Kim, Euy Nyong; Lee, Jang Han; Yang, Won Seok; Kim, Soon Bae; Moon, Dae Hyuk [Asan Medical Center, Seoul (Korea, Republic of)

    2007-07-01

    We evaluated factors affecting change in glomerular filtration rate (GFR) after unilateral nephrectomy in living kidney donors and patients with renal disease. We retrospectively reviewed the 435 individuals who underwent unilateral nephrectomy in 2006. Among them, we enrolled 141 patients who had performed 99mTc-DTPA scans before and after surgery. The study population consisted of 75 living donors (M=43, F=32) and 66 patients with renal disease (M=46, F=20). We evaluated factors affecting the GFR change by multiple linear regression analysis. The renal disease group was significantly older than the donors at baseline (53.9{+-}12.9 vs. 37.8{+-}11.1yr, P<0.05) and had higher preoperative Cr level (0.95{+-}0.20 vs. 0.85{+-}0.18mg/dL, p<0.05). The mean duration of the follow-up was 7.3{+-}3.3 months, (p<0.05). The disease group and donors significantly increased the GFR after nephrectomy (43.0{+-}9.6 to 48.6{+-}12.8 vs. 46.9{+-}8.4 to 58.1{+-}12.5 ml/min, respectively, P<0.05). The disease group had significantly lesser mean GFR change than the doners. (5.6{+-}7.2 vs. 11.1{+-}8.5 ml/min, respectively, p<0.05). In the renal disease group, multiple regression analysis showed that preop Cr level and age were significantly associated with GFR change ({beta} =-12.53, p=0.003; {beta} =-0.19, p=0.004). In the donor group, age was significantly associated with the GFR change ({beta} =-0.265, p=0.002). But change of GFR was not associated with sex, preop GFR, BMI, duration of follow-up, site of nephrectomy in both groups. Age and preoperative renal function were predictive factors affecting change in GFR after unilateral nephrectomy.

  15. Factors associated with falls among older adults living in institutions

    OpenAIRE

    Damián, Javier; Pastor-Barriuso, Roberto; Valderrama-Gama, Emiliana; Pedro-Cuesta, Jesús de

    2013-01-01

    Background Falls have enormous impact in older adults. Yet, there is insufficient evidence regarding the effectiveness of preventive interventions in this setting. The objectives were to measure the frequency of falls and associated factors among older people living institutions. Methods Data were obtained from a survey on a probabilistic sample of residents aged ≥65 years, drawn in 1998-99 from institutions of Madrid (Spain). Residents, their caregivers, and facility physicians were intervie...

  16. Factors associated with falls among older adults living in institutions

    OpenAIRE

    Damián Javier; Pastor-Barriuso Roberto; Valderrama-Gama Emiliana; de Pedro-Cuesta Jesús

    2013-01-01

    Abstract Background Falls have enormous impact in older adults. Yet, there is insufficient evidence regarding the effectiveness of preventive interventions in this setting. The objectives were to measure the frequency of falls and associated factors among older people living institutions. Methods Data were obtained from a survey on a probabilistic sample of residents aged ≥65 years, drawn in 1998-99 from institutions of Madrid (Spain). Residents, their caregivers, and facility physicians were...

  17. Impact of early reoperation following living-donor liver transplantation on graft survival.

    Directory of Open Access Journals (Sweden)

    Yoshikuni Kawaguchi

    Full Text Available BACKGROUND: The reoperation rate remains high after liver transplantation and the impact of reoperation on graft and recipient outcome is unclear. The aim of our study is to evaluate the impact of early reoperation following living-donor liver transplantation (LDLT on graft and recipient survival. METHODS: Recipients that underwent LDLT (n = 111 at the University of Tokyo Hospital between January 2007 and December 2012 were divided into two groups, a reoperation group (n = 27 and a non-reoperation group (n = 84, and case-control study was conducted. RESULTS: Early reoperation was performed in 27 recipients (24.3%. Mean time [standard deviation] from LDLT to reoperation was 10 [9.4] days. Female sex, Child-Pugh class C, Non-HCV etiology, fulminant hepatitis, and the amount of intraoperative fresh frozen plasma administered were identified as possibly predictive variables, among which females and the amount of FFP were identified as independent risk factors for early reoperation by multivariable analysis. The 3-, and 6- month graft survival rates were 88.9% (95%confidential intervals [CI], 70.7-96.4, and 85.2% (95%CI, 66.5-94.3, respectively, in the reoperation group (n = 27, and 95.2% (95%CI, 88.0-98.2, and 92.9% (95%CI, 85.0-96.8, respectively, in the non-reoperation group (n = 84 (the log-rank test, p = 0.31. The 12- and 36- month overall survival rates were 96.3% (95%CI, 77.9-99.5, and 88.3% (95%CI, 69.3-96.2, respectively, in the reoperation group, and 89.3% (95%CI, 80.7-94.3 and 88.0% (95%CI, 79.2-93.4, respectively, in the non-reoperation group (the log-rank test, p = 0.59. CONCLUSIONS: Observed graft survival for the recipients who underwent reoperation was lower compared to those who did not undergo reoperation, though the result was not significantly different. Recipient overall survival with reoperation was comparable to that without reoperation. The present findings enhance the importance of vigilant

  18. Living arrangements of older adults in Lebanon: correlates of living with married children.

    Science.gov (United States)

    Shideed, O; Sibai, A; Tohme, R

    2013-12-01

    Rapid increases in the proportion of older adults in the population present major challenges to policy-makers worldwide. Using a nationally representative sample from the PAPFAM survey in Lebanon, this study examined the living arrangements of older adults (aged > or = 65 years), and their correlates, with a focus on co-residence with married children. Of 1774 older adults 17.1% co-resided with their married children: 28.1% of the 559 unmarried (widowed/divorced/single) and 11.3% of the 1071 married older adults. Among both the married and unmarried, the likelihood of co-residence was significantly lower in regions outside the capital and decreased with increasing socioeconomic status. Among the unmarried elderly, co-residence with a married child was also significantly associated with increasing age and availability of sons, as well as presence of a vascular disorder and speech problems. While solitary living has traditionally been the focus for policy-makers, older people living with a married child may also be a vulnerable group. PMID:24684101

  19. Liver graft-to-recipient spleen size ratio as a novel predictor of portal hyperperfusion syndrome in living donor liver transplantation.

    Science.gov (United States)

    Cheng, Y F; Huang, T L; Chen, T Y; Concejero, A; Tsang, L L C; Wang, C C; Wang, S H; Sun, C K; Lin, C C; Liu, Y W; Yang, C H; Yong, C C; Ou, S Y; Yu, C Y; Chiu, K W; Jawan, B; Eng, H L; Chen, C L

    2006-12-01

    Portal hyperperfusion in a small-size liver graft is one cause of posttransplant graft dysfunction. We retrospectively analyzed the potential risk factors predicting the development of portal hyperperfusion in 43 adult living donor liver transplantation recipients. The following were evaluated: age, body weight, native liver disease, spleen size, graft size, graft-to-recipient weight ratio (GRWR), total portal flow, recipient portal venous flow per 100 g graft weight (RPVF), graft-to-recipient spleen size ratio (GRSSR) and portosystemic shunting. Spleen size was directly proportional to the total portal flow (p = 0.001) and RPVF (p = 0.014). Graft hyperperfusion (RPVF flow > 250 mL/min/100 g graft) was seen in eight recipients. If the GRSSR was Spleen size is a major factor contributing to portal flow after transplant. The GRSSR is associated with posttransplant graft hyperperfusion at a ratio of < 0.6.

  20. Advances in endoscopic management of biliary complications after living donor liver transplantation: Comprehensive review of the literature

    Science.gov (United States)

    Shin, Milljae; Joh, Jae-Won

    2016-01-01

    Apart from noticeable improvements in surgical techniques and immunosuppressive agents, biliary complications remain the major causes of morbidity and mortality after living donor liver transplantation (LDLT). Bile leakage and stricture are the predominant complications. The reported incidence of biliary complications is 15%-40%, and these are known to occur more frequently in living donors than in deceased donors. Despite the absence of a confirmed therapeutic algorithm, many approaches have been used for treatment, including surgical, endoscopic, and percutaneous transhepatic techniques. In recent years, nonsurgical approaches have largely replaced reoperation. Among these, the endoscopic approach is currently the preferred initial treatment for patients who undergo duct-to-duct biliary reconstruction. Previously, endoscopic management was achieved most optimally through balloon dilatation and single or multiple stents placement. Recently, there have been significant developments in endoscopic devices, such as novel biliary stents, as well as advances in endoscopic technologies, including deep enteroscopy, the rendezvous technique, magnetic compression anastomosis, and direct cholangioscopy. These developments have resulted in almost all patients being managed by the endoscopic approach. Multiple recent publications suggest superior long-term results, with overall success rates ranging from 58% to 75%. This article summarizes the advances in endoscopic management of patients with biliary complications after LDLT. PMID:27468208

  1. When Operating on Dead People Saves Lives: Benefits of Surgical Organ Donor Intensivists.

    Science.gov (United States)

    Long, Kristin; Talley, Cynthia; Yarrison, Rebecca B; Bernard, Andrew

    2015-01-01

    Solid organ transplantation has emerged as a life-saving treatment for many patients suffering from end-stage organ failure. Organs have been successfully recovered after a variety of aggressive interventions. We propose that decompressive laparotomy, when clinically indicated, should be considered in the aggressive resuscitation of potential organ donors. A thorough literature review examining aggressive interventions on potential organ donors was conducted after experience with a unique case at this institution. Articles were reviewed for the types of interventions performed as well as the time frame in relation to organ donation. In our case, several ethical issues were raised when considering decompressive laparotomy in a patient pronounced dead by neurologic criteria. We propose that having a surgical intensivist involved in the management of potential donors will further increase the salvage rate, as more invasive resuscitation options are possible. PMID:26078909

  2. When Operating on Dead People Saves Lives: Benefits of Surgical Organ Donor Intensivists

    Directory of Open Access Journals (Sweden)

    Kristin Long

    2015-01-01

    Full Text Available Solid organ transplantation has emerged as a life-saving treatment for many patients suffering from end-stage organ failure. Organs have been successfully recovered after a variety of aggressive interventions. We propose that decompressive laparotomy, when clinically indicated, should be considered in the aggressive resuscitation of potential organ donors. A thorough literature review examining aggressive interventions on potential organ donors was conducted after experience with a unique case at this institution. Articles were reviewed for the types of interventions performed as well as the time frame in relation to organ donation. In our case, several ethical issues were raised when considering decompressive laparotomy in a patient pronounced dead by neurologic criteria. We propose that having a surgical intensivist involved in the management of potential donors will further increase the salvage rate, as more invasive resuscitation options are possible.

  3. 关于活体器官供者的伦理思考%Ethical considerations of living organ donors

    Institute of Scientific and Technical Information of China (English)

    钟会亮

    2012-01-01

    背景:活体器官伦理问题逐渐成为人们视野中的焦点和难点.目的:对活体器官供体伦理问题进一步研究.方法:应用计算机检索CNKI和 VMIS数据库中2001-01/2011-05关于器官移植的文章,在标题和摘要中以"活体、供体"和"器官移植、伦理"为检索词进行检索.纳入与活体供体关联度高、本领域内的文献,主要选择权威杂志、核心期刊或者近期发表的文章.排除与此文目的无关的、内容和观点陈旧的及重复研究的文献.入选18篇文献和4本医学伦理学书籍进行综述.结果与结论:为了生命的健康续存,必须完善器官移植和捐献的法律法规,规范供体来源渠道,避免由于科技利益和经济利益的驱使任由活体供体买卖现象的存在空间,研究器官移植活体供体伦理问题,可促使人们提高活体供体捐赠积极性和主动性,解决器官移植供体短缺状况.%BACKGROUND:Ethical issues in living organs have gradually become the focus and difficult point in research.OBJECTIVE: To further study the ethical issues of living organ donors.METHODS: A computer-based online search in CNKI database and VMIS database from January 2001 to March 2011 wasperformed for articles on organ transplantation, with key words of “living donor” and “organ transplantation, ethics” by screeningtitles and abstracts. The documents closely related to living donor in the same field, and published in authoritative journals orrecently were preferred. Unrelated, antiquated and repetitive studies were excluded. Totally 18 literatures and four medical ethicsbooks were chosen to summarize.RESULTS AND CONCLUSION: Laws and regulations in organ transplantation and donation should be improved, and donorsources should be standardized in order to prevent sale of living donor driven by scientific and technological benefits andeconomic benefits to achieve healthy survivor. Study the ethical issues in living donors can improve the

  4. The “House Calls” Trial: A Randomized Controlled Trial to Reduce Racial Disparities in Live Donor Kidney Transplantation: Rationale and Design

    OpenAIRE

    Rodrigue, James R.; Pavlakis, Martha; Egbuna, Ogo; Paek, Mathew; Waterman, Amy D; Mandelbrot, Didier A.

    2012-01-01

    Despite a substantially lower rate of live donor kidney transplantation among Black Americans compared to White Americans, there are few systematic efforts to reduce this racial disparity. This paper describes the rationale and design of a randomized controlled trial aims evaluating the comparative effectiveness of three different educational interventions for increasing live donor kidney transplantation in Black Americans. This trial is a single-site, urn-randomized controlled trial with a p...

  5. Living unrelated donor kidney transplantation between spouses and living related donor kidney transplantation%夫妻活体供肾移植与血缘亲属供肾移植

    Institute of Scientific and Technical Information of China (English)

    沈蓓莉; 曲青山; 杨磊; 梁少峰; 李明

    2011-01-01

    BACKGROUND: Living unrelated donor kidney transplantation between spouses is poorer than living related donor kidney transplantation in tissue matching , but clinical practice shows that there is no obvious difference in short-term curative effects between these two types of kidney transplantation.OBJECTIVE: To compare the clinical cu rative effects between living unrelated donor kidney transplantation between spouses and living related donor kidney transplantation and summarize the clinical experience of kidney transplantation between spouses.METHODS: A retrospective clinical data analysis was made regarding 18 patients who received kidney transplantation between spouses and 100 patients who received living related donor kidney transplantation. The clinical curative effects ware compared between these two types of kidney transplantation by analyzing some indices including tissue matching before transplantation and renal fu nction recovery, acute rejection and infection incidence at 1, 3, and 6 months.RESULTS AND CONCLUSION: Tissue matching before transplantation was poorer in 18 patients undergoing kidney transplantation between spouses than in 100 patients undergoing living related donor kidney transplantation. Under the same transplantation proposal and immunosuppressive therapy, there was no significant difference in serum creatinine level, renal function recovery, acute rejection, and infection incidence within 6 months after transplantation between kidney transplantation between spouses and living related donor kidney transplantation (P > 0.05). These findings suggest that the clinical curative effects are similar between living unrelated donor kidney transplantation between spouses and living related donor kidney transplantation.%背景:夫妻间活体肾移植尽管在组织配型方面差于血缘关系供肾移植,但在临床实践观察中夫妻肾移植与血缘关系肾移植间近期疗效并无明显差异.目的:对比同期

  6. Postoperative coagulopathy after live related donor hepatectomy: Incidence, predictors and implications for safety of thoracic epidural catheter

    Directory of Open Access Journals (Sweden)

    S T Karna

    2015-01-01

    Full Text Available Background: Coagulopathy after living donor hepatectomy (LDH may endanger donor safety during removal of thoracic epidural catheter (TEC. The present study was conducted to evaluate the extent and duration of immediate postoperative coagulopathy after LDH. Materials and Methods: A retrospective analysis of perioperative record of LDH over three years was conducted after IRB approval. Variables such as age, gender, BMI, ASA classification, liver volume on CT scan, preoperative and postoperative INR, platelet count (PC and ALT of each donor for five days was noted. In addition, duration of surgery, remnant as percentage total liver volume (Remnant%, blood loss, day of peak in PC and INR were also noted. Coagulopathy was defined as being present if INR exceeded 1.5 or platelet count fell below 1 × 10 5 /mm 3 on any day. Data was analyzed using SPSS 20 for Windows. Between group comparison was made using the Student ′t′ test for continuous variables and chi square test for categorical variables. Univariate analysis was done. Multiple logistic regression analysis was used to find independent factor associated with coagulopathy. Results: Eighty four (84 donors had coagulopathy on second day (mean INR 1.9 ± 0.42. Low BMI, % of remnant liver and duration of surgery were independent predictors of coagulopathy. Right lobe hepatectomy had more coagulopathy than left lobe and low BMI was the only independent predictor. There was no correlation of coagulopathy with age, gender, blood loss, presence of epidural catheter, postoperative ALT or duration of hospital stay. High INR was the main contributor for coagulopathy. Conclusions: Coagulopathy is seen after donor hepatectomy. We recommend removal of the epidural catheter after the fifth postoperative day when INR falls below 1.5.

  7. 42 CFR 482.102 - Condition of participation: Patient and living donor rights.

    Science.gov (United States)

    2010-10-01

    ... confidential, in accordance with the requirements at 45 CFR parts 160 and 164. (2) The evaluation process; (3... medical or psychosocial risks; (5) National and transplant center-specific outcomes, from the most recent... about all Medicare outcome requirements not being met by the transplant center; (6) Organ donor...

  8. Nyretransplantation med levende donor

    DEFF Research Database (Denmark)

    Kamper, A L; Løkkegaard, H; Rasmussen, F

    2000-01-01

    In recent years transplantation from living donors has accounted for 25-30% of all kidney transplants in Denmark corresponding to 40-45 per year. Most of these living donors are parents or siblings, although internationally an increasing number are unrelated donors. Donor nephrectomy is associate...... in cadaver transplantation. The ethical and psychological aspects related to transplantation from a living donor are complex and need to be carefully evaluated when this treatment is offered to the patients....

  9. SUCCESSFUL ABO-INCOMPATIBLE KIDNEY TRANSPLANTATION FROM LIVING-RELATED DONOR IN HIGH-SENSITIZED PATIENT

    Directory of Open Access Journals (Sweden)

    A. I. Sushkov

    2012-01-01

    Full Text Available This case report describes a patient initially found to have an extremely high anti-B IgM (1:1024 and IgG (1:512 titres.Additionally, patient had previous diseased donor kidney transplantation and high level of anti-HLA panel- reactive antibodies (60%. We focused on immunological monitoring during the pretransplant conditioning and posttransplant period. 

  10. Application of computer-assisted three-dimensional quantitative assessment and a surgical planning tool for living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    WEI Lin; ZHU Zhi-jun; L(U) Yi; JIANG Wen-tao; GAO Wei; ZENG Zhi-gui; SHEN Zhong-yang

    2013-01-01

    Background Precise evaluation of the live donor's liver is the most important factor for the donor's safety and the recipient's prognosis in living donor liver transplantation (LDLT).Our study assessed the clinical value of computer-assisted three-dimensional quantitative assessment and a surgical planning tool for donor evaluation in LDLT.Methods Computer-assisted three-dimensional (3D) quantitative assessment was used to prospectively provide quantitative assessment of the graft volume for 123 consecutive donors of LDLT and its accuracy and efficiency were compared with that of the standard manual-traced method.A case of reduced monosegmental LDLT was also assessed and a surgical planning tool displayed the precise surgical plan to avoid large-for-size syndrome.Results There was no statistically significant difference between the detected graft volumes with computer-assisted 3D quantitative assessment and manual-traced approaches ((856.76±162.18) cm3 vs.(870.64±172.54) cm3,P=0.796).Estimated volumes by either method had good correlation with the actual graft weight (r-manual-traced method:0.921,r-3D quantitative assessment method:0.896,both P <0.001).However,the computer-assisted 3D quantitative assessment approach was significantly more efficient taking half the time of the manual-traced method ((16.91±1.375) minutes vs.(39.27±2.102) minutes,P <0.01) to estimate graft volume.We performed the reduced monosegmental LDLT,a pediatric case,with the surgical planning tool (188 g graft in the operation,which was estimated at 208 cm3 pre-operation).The recipient recovered without large-for-size syndrome.Conclusions Computer-assisted 3D quantitative assessment provided precise evaluation of the graft volume.It also assisted surgeons with a better understanding of the hepatic 3D anatomy and was useful for the individual surgical planning tool.

  11. Effect of autologous blood donation on the central venous pressure, blood loss and blood transfusion during living donor left hepatectomy

    Institute of Scientific and Technical Information of China (English)

    Bruno Jawan; Shih-Hor Wang; Chih-Che Lin; Tsan-Shiun Lin; Yueh-Wei Liu; Chao-Long Chen; Yu-Fan Cheng; Chia-Chi Tseng; Yaw-Sen Chen; Chih-Chi Wang; Tung-Liang Huang; Hock-Liew Eng; Po-Ping Liu; King-Wah Chiu

    2005-01-01

    AIM: Autologous blood donation (ABD) is mainly used to reduce the use of banked blood. In fact, ABD can be regarded as acute blood loss. Would ABD 2-3 d before operation affect the CVP level and subsequently result in less blood loss during liver resection was to be determined.METHODS: Eighty-four patients undergoing living donor left hepatectomy were retrospectively divided as group Ⅰ (GⅠ)and group Ⅱ (GⅡ) according to have donated 250-300 mL blood 2-3 d before living donor hepatectomy or not. The changes of the intraoperative CVP, surgical blood loss,blood products used and the changes of perioperative hemoglobin (Hb) between groups were analyzed and compared by using Mann-Whitney Utest.RESULTS: The results show that the intraoperative CVP changes between GⅠ (n = 35) and GⅡ (n = 49) up to graft procurement were the same, subsequently the blood loss,but ABD resulted in significantly lower perioperative Hb levels in GⅠ.CONCLUSION: Since none of the patients required any blood products perioperatively, all the predonated bloods were discarded after the patients were discharged from the hospital, It indicates that ABD in current series had no any beneficial effects, in term of cost, lowering the CVP, blood loss and reduce the use of banked blood products, but resulted in significant lower Hb in perioperative period.

  12. Salvage living donor liver transplantation after percutaneous transluminal angioplasty for recurrent Budd-Chiari syndrome: a case report

    Directory of Open Access Journals (Sweden)

    Mitoro Akira

    2011-03-01

    Full Text Available Abstract Introduction Budd-Chiari syndrome is a very rare pathological entity that ultimately leads to liver failure. Several therapeutic modalities, including percutaneous transluminal angioplasty, have been attempted to save the life of patients with Budd-Chiari syndrome. Few reports have described a salvage living donor liver transplantation performed after percutaneous transluminal angioplasty in a patient with acute Budd-Chiari syndrome. Case presentation A 26-year-old Japanese man developed severe progressive manifestations, such as massive ascites and hematemesis due to rupture of esophageal varices. After making several investigations, we diagnosed the case as Budd-Chiari syndrome. We first performed percutaneous transluminal angioplasty to dilate a short-segment stenosis of his inferior vena cava. The first percutaneous transluminal angioplasty greatly improved the clinical manifestations. However, after a year, re-stenosis was detected, and a second percutaneous transluminal angioplasty failed to open the severe stricture of his inferior vena cava. Since our patient had manifestations of acute liver failure, we decided to perform salvage living donor liver transplantation from his brother. The transplantation was successfully performed and all clinical manifestations were remarkably alleviated. Conclusion In cases of recurrent Budd-Chiari syndrome, the blocked hepatic venous outflow is not always relieved, even with invasive therapies. We have to take into account the possibility of adopting alternative salvage therapies if the first therapeutic modalities fail. When invasive therapy such as percutaneous transluminal angioplasty fails, liver transplantation should be considered as an alternative option.

  13. Short-lived electron transfer in donor-bridge-acceptor systems

    Science.gov (United States)

    Psiachos, D.

    2016-10-01

    We investigate time-dependent electron transfer (ET) in benchmark donor-bridge-acceptor systems. For the small bridge sizes studied, we obtain results far different from the perturbation theory which underlies scattering-based approaches, notably a lack of destructive interference in the ET for certain arrangements of bridge molecules. We also calculate wavepacket transmission in the non-steady-state regime, finding a featureless spectrum, while for the current we find two types of transmission: sequential and direct, where in the latter, the current transmission increases as a function of the energy of the transferred electron, a regime inaccessible by conventional scattering theory.

  14. Assessment of 82 Live Potential Renal Donors with Multi Detector Row Helical CT Angiography (MDCTA

    Directory of Open Access Journals (Sweden)

    R. Javadrashid

    2008-01-01

    Full Text Available Background/Objective: To retrospectively review the authors' experience with multi-detector row helical computed tomography (CT in assessing 82 consecu-tive alive potential renal donors."nPatients and Methods: Eighty-two potential renal donors underwent multi-detector row CT assess-ment, using a 64-slice scanner (Somatom Sensation, Siemens with 0.6-mm slice thickness followed by maximum intensity projection and volume rendering techniques post-processing algorithms. Arterial phase and venous phase examinations were performed. De-layed tomograms were acquired to visualize the col-lecting system anatomy. Two vascular radiologists prospectively interpreted the multi-detector row CT images. Forty candidates subsequently underwent donor nephrectomy. Surgical findings served as the reference standard for 40 kidneys. The imaging find-ings in all 82 candidates (164 kidneys were reviewed, although these findings were considered observa-tional data only because there was no reference stan-dard for 124 kidneys."nResults: Identification of vascular anomalies was best on direct viewing of the axial images using interactive scrolling through the images and cine-loop paging. In 164 kidneys evaluated, a single renal artery was pre-sent in 74.5% and a single renal vein in 87.5%. Mul-tiple renal arteries were more common on the right side (37.8% vs. the left side (20.7%. Early branching of the arteries was seen with equal frequency (10% on either side. Multiple renal veins were more often on the right side (20% vs. the left side (5%. CT an-giographic findings were concordant with the intra-operative findings in 100% of the cases that under-went nephrectomy. CT also revealed cortical cysts (four cases, duplex collecting system (two cases, hy-dronephrosis (one case, renal stone (one case, and liver hemangiomas (two cases. There was no signifi-cant interobserver disagreement between the vascular radiologists."nConclusion: CT angiography is highly accurate for

  15. Incidence of death and potentially life-threatening near-miss events in living donor hepatic lobectomy: a world-wide survey.

    Science.gov (United States)

    Cheah, Yee Lee; Simpson, Mary Ann; Pomposelli, James J; Pomfret, Elizabeth A

    2013-05-01

    The incidence of morbidity and mortality after living donor liver transplantation (LDLT) is not well understood because reporting is not standardized and relies on single-center reports. Aborted hepatectomies (AHs) and potentially life-threatening near-miss events (during which a donor's life may be in danger but after which there are no long-term sequelae) are rarely reported. We conducted a worldwide survey of programs performing LDLT to determine the incidence of these events. A survey instrument was sent to 148 programs performing LDLT. The programs were asked to provide donor demographics, case volumes, and information about graft types, operative morbidity and mortality, near-miss events, and AHs. Seventy-one programs (48%), which performed donor hepatectomy 11,553 times and represented 21 countries, completed the survey. The average donor morbidity rate was 24%, with 5 donors (0.04%) requiring transplantation. The donor mortality rate was 0.2% (23/11,553), with the majority of deaths occurring within 60 days, and all but 4 deaths were related to the donation surgery. The incidences of near-miss events and AH were 1.1% and 1.2%, respectively. Program experience did not affect the incidence of donor morbidity or mortality, but near-miss events and AH were more likely in low-volume programs (≤50 LDLT procedures). In conclusion, it appears that independently of program experience, there is a consistent donor mortality rate of 0.2% associated with LDLT donor procedures, yet increased experience is associated with lower rates of AH and near-miss events. Potentially life-threatening near-miss events and AH are underappreciated complications that must be discussed as part of the informed consent process with any potential living liver donor.

  16. Live attenuated varicella vaccine use in immunocompromised children and adults.

    Science.gov (United States)

    Gershon, A A; Steinberg, S P; Gelb, L

    1986-10-01

    Live attenuated varicella vaccine has been administered to 307 children with leukemia in remission and to 86 healthy adults. The vaccine was well tolerated and immunogenic. The major side effect in leukemic children receiving maintenance chemotherapy was development of a vaccine-associated rash. Vaccinees in whom a rash developed were potentially somewhat infectious to others about 1 month after immunization. Vaccination was not associated with an increase in the incidence of herpes zoster or in relapse of leukemia. Vaccination provided excellent protection against severe varicella. It was associated with a significant decrease in the attack rate of chickenpox following an intimate exposure to varicella-zoster virus, conferring about 80% protection in leukemic children. The cases of breakthrough varicella that occurred were mild. Thus, the vaccine may either prevent or modify varicella in high-risk individuals. It may also have use for prevention of nosocomial varicella.

  17. The science of Stewardship: due diligence for kidney donors and kidney function in living kidney donation--evaluation, determinants, and implications for outcomes.

    Science.gov (United States)

    Poggio, Emilio D; Braun, William E; Davis, Connie

    2009-10-01

    Living kidney donor transplantation is now a common treatment for ESRD because it provides excellent outcomes to transplant recipients and is considered a safe procedure for prospective donors. The short- and long-term safety of prospective donors is paramount to the continued success of this procedure. Whereas the initial experiences with living kidney donors mostly included the healthiest, the increase in the need for organs and the changing demographic characteristics of the general population have subtly reshaped the suitability for donation. Kidney function assessment is a critical component of the evaluation of prospective donors; therefore, special emphasis is usually placed on this aspect of the evaluation. At the same time, consideration of kidney function after donation is important because it assists with the determination of renal health in donors. This review summarizes the process of predonation kidney function assessment, determinants of pre- and postdonation renal function, and, importantly, the potential implications of kidney function to the long-term outcomes of kidney donors.

  18. Donor-Reactive T-cell Responses after HLA-Identical Living-Related Kidney Transplantation

    NARCIS (Netherlands)

    J.H. Gerrits (Jeroen)

    2010-01-01

    textabstractKidney transplantation is the preferred treatment of choice for almost all categories of patients with end-stage-renal disease (ESRD) including those with hypertension, glomerulonephritis, diabetes mellitus and genetic causes as polycystic renal disease. Transplanted patients will live a

  19. Predictive Role of Intraoperative Serum Brain Natriuretic Peptide for Early Allograft Dysfunction in Living Donor Liver Transplantation.

    Science.gov (United States)

    Chae, Min Suk; Koo, Jung Min; Park, Chul Soo

    2016-01-01

    BACKGROUND Early allograft dysfunction (EAD) is considered an important complication in liver transplantation. Serum brain natriuretic peptide (BNP) is a marker of cardiac dysfunction related to end-stage liver disease. We investigated the intraoperative change in the serum BNP level and its contribution to EAD after living donor liver transplantation (LDLT). MATERIAL AND METHODS The perioperative data of 104 patients who underwent LDLT were retrospectively reviewed and compared between patients with and without EAD. Serum BNPs were obtained at each phase, and potentially significant factors (Pdeveloped EAD after LDLT. In all phases, the EAD group showed higher serum BNP levels than the non-EAD group. The serum BNP level at each phase was less accurate than the mean serum BNP level for EAD. The intraoperative mean serum BNP level showed higher predictive accuracy than the Child-Pugh-Turcotte, model for end-stage liver disease (MELD), and D-MELD (donor age × recipient MELD) scores (p<0.05 for all). After multivariate adjustment, intraoperative mean serum BNP level ≥100 pg/mL was identified as an independent risk factor for EAD, along with kidney disease and graft ischemic time. CONCLUSIONS During LDLT, the EAD group showed higher serum BNP levels than the non-EAD group. An intraoperative mean serum BNP level ≥100 pg/mL is independently associated with EAD after LDLT. PMID:27572618

  20. Alternative Techniques for Cannulation of Biliary Strictures Resistant to the 0.035 System Following Living Donor Liver Transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Hee Mang; Kim, Jin Hyoung; Ko, Gi Young; Song, Ho Young; Gwon, Dong Il; Sung, Kyu Bo [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2012-03-15

    To assess the clinical efficacy of alternative techniques for biliary stricture cannulation in patients undergoing living donor liver transplantation (LDLT), after cannulation failure with a conventional (0.035-inch guidewire) technique. Of 293 patients with biliary strictures after LDLT, 19 (6%) patients, 11 men and 8 women of mean age 48.5 years, had the failed cannulation of the stricture by conventional techniques. Recannulation was attempted by using two alternative methods, namely a micro-catheter set via percutaneous access and a snare (rendezvous) technique using percutaneous and endoscopic approaches. Strictures were successfully cannulated in 16 (84%) of the 19 patients. A microcatheter set was used in 12 and a snare technique in four patients. Stricture cannulation failed in the remaining three patients, who finally underwent surgical revision. Most technical failures using a conventional technique for biliary stricture cannulation after LDLT can be overcome by using a microcatheter set or a snare (rendezvous) technique.

  1. Significant Improvements in the Practice Patterns of Adult Related Donor Care in US Transplantation Centers.

    Science.gov (United States)

    Anthias, Chloe; Shaw, Bronwen E; Kiefer, Deidre M; Liesveld, Jane L; Yared, Jean; Kamble, Rammurti T; D'Souza, Anita; Hematti, Peiman; Seftel, Matthew D; Norkin, Maxim; DeFilipp, Zachariah; Kasow, Kimberly A; Abidi, Muneer H; Savani, Bipin N; Shah, Nirali N; Anderlini, Paolo; Diaz, Miguel A; Malone, Adriana K; Halter, Joerg P; Lazarus, Hillard M; Logan, Brent R; Switzer, Galen E; Pulsipher, Michael A; Confer, Dennis L; O'Donnell, Paul V

    2016-03-01

    Recent investigations have found a higher incidence of adverse events associated with hematopoietic cell donation in related donors (RDs) who have morbidities that if present in an unrelated donor (UD) would preclude donation. In the UD setting, regulatory standards ensure independent assessment of donors, one of several crucial measures to safeguard donor health and safety. A survey conducted by the Center for International Blood and Marrow Transplant Research (CIBMTR) Donor Health and Safety Working Committee in 2007 reported a potential conflict of interest in >70% of US centers, where physicians had simultaneous responsibility for RDs and their recipients. Consequently, several international organizations have endeavored to improve practice through regulations and consensus recommendations. We hypothesized that the changes in the 2012 Foundation for the Accreditation of Cellular Therapy and the Joint Accreditation Committee-International Society for Cellular Therapy and European Society for Blood and Marrow Transplantation standards resulting from the CIBMTR study would have significantly impacted practice. Accordingly, we conducted a follow-up survey of US transplantation centers to assess practice changes since 2007, and to investigate additional areas where RD care was predicted to differ from UD care. A total of 73 centers (53%), performing 79% of RD transplantations in the United States, responded. Significant improvements were observed since the earlier survey; 62% centers now ensure separation of RD and recipient care (P < .0001). This study identifies several areas where RD management does not meet international donor care standards, however. Particular concerns include counseling and assessment of donors before HLA typing, with 61% centers first disclosing donor HLA results to an individual other than the donor, the use of unlicensed mobilization agents, and the absence of long-term donor follow-up. Recommendations for improvement are made.

  2. Comparison of Stored Umbilical Cord Blood and Adult Donor Blood: Transfusion Feasibility

    Directory of Open Access Journals (Sweden)

    Rola Sahyoun-tokan

    2012-09-01

    Full Text Available OBJECTIVE: This study aimed to compare the storage properties of red blood cell (RBC concentrates of umbilical cord blood (UCB and adult donor blood (ADB, and to evaluate the feasibility of UCB-RBC concentrate as an autologous source for blood transfusion in very low birth weight (VLBW preterm neonates. METHODS: In all, 30 newborn (10 preterm, 20 full term UCB and 31 ADB units were collected. RBC concentrates were stored and compared with regard to pH, potassium (K+, 2,3-biphosphoglycerate (2-3-BPG, adenosine tri-phosphate (ATP, plasma Hb, and bacterial contamination on d 1, 21, and 35 of storage. RESULTS: The K+ level increased with time and differed significantly between storage d 1 and 21, and between storage d 1 and 35 in both the UCB and ADB units. Initial and d 21 K+ levels were higher in the UCB units than in the ADB units. The 2,3-BPG level did not differ significantly between the UCB-PRC and ADB-PRC samples. After 35 d of storage both UCB-PRC and ADB-PRC samples exhibited significant differences from the initial free Hb, intracellular ATP, and pH values. Significant differences in intracellular ATP and pH were also observed between the UCB-PRC and ADB-PRC samples. CONCLUSION: The volume of harvested and prepared UCB-PRC can be used for some of the blood transfusions required during the neonatal period and thus may decrease the number of allogeneic transfusions, especially in preterm newborns. The hematological and biochemical changes that occurred in UCB during storage were comparable with those observed in ADB, and do not pose a risk to the immature metabolism of neonates. UCB-RPC prepared and stored under standard conditions can be a safe alternative RBC source for transfusions in VLBW newborns.

  3. Factors associated with falls among older adults living in institutions

    Directory of Open Access Journals (Sweden)

    Damián Javier

    2013-01-01

    Full Text Available Abstract Background Falls have enormous impact in older adults. Yet, there is insufficient evidence regarding the effectiveness of preventive interventions in this setting. The objectives were to measure the frequency of falls and associated factors among older people living institutions. Methods Data were obtained from a survey on a probabilistic sample of residents aged ≥65 years, drawn in 1998-99 from institutions of Madrid (Spain. Residents, their caregivers, and facility physicians were interviewed. Fall rates were computed based on the number of physician-reported falls in the preceding 30 days. Adjusted rate ratios were computed using negative binomial regression models, including age, sex, cognitive status, functional dependence, number of diseases, and polypharmacy. Results The final sample comprised 733 residents. The fall rate was 2.4 falls per person-year (95% confidence interval [CI], 2.04-2.82. The strongest risk factor was number of diseases, with an adjusted rate ratio (RR of 1.32 (95% CI, 1.17-1.50 for each additional diagnosis. Other variables associated with falls were: urinary incontinence (RR = 2.56 [95% CI, 1.32-4.94]; antidepressant use (RR = 2.32 [95% CI, 1.22-4.40]; arrhythmias (RR = 2.00 [95% CI, 1.05-3.81]; and polypharmacy (RR = 1.07 [95% CI, 0.95-1.21], for each additional medication. The attributable fraction for number of diseases (with reference to those with ≤ 1 condition was 84% (95% CI, 45-95%. Conclusions Number of diseases was the main risk factor for falls in this population of institutionalized older adults. Other variables associated with falls, probably more amenable to preventive action, were urinary incontinence, antidepressants, arrhythmias, and polypharmacy. Virtual slides The virtual slide(s for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/3916151157277337

  4. The Intersection of Black Lives Matter and Adult Education: One Community College Initiative

    Science.gov (United States)

    Miller, Brian; Schwartz, Joni

    2016-01-01

    This chapter is a call to action for adult educators to critically engage the Black Lives Matter Movement through pedagogy, community engagement and scholarly activism. It explores the intersection of the Black Lives Matter movement and adult education by highlighting the response of one community college initiative.

  5. Using Simultaneous Prompting to Teach Independent Living and Leisure Skills to Adults with Severe Intellectual Disabilities

    Science.gov (United States)

    Dollar, Chad A.; Fredrick, Laura D.; Alberto, Paul A.; Luke, Jaye K.

    2012-01-01

    The acquisition of independent living and leisure skills enables adults to experience an enhanced quality of life by increasing competence, self-reliance, and the development of autonomy. This study examined the effectiveness of simultaneous prompting to teach behavior chains (i.e., independent living and leisure skills) to adults with SID…

  6. Quantifying the benefit of early living-donor renal transplantation with a simulation model of the Dutch renal replacement therapy population.

    NARCIS (Netherlands)

    Liem, Y.S.; Wong, J.B.; Winkelmayer, W.C.; Weimar, W.; Wetzels, J.F.M.; Charro, F.T. de; Kaandorp, G.C.; Stijnen, T.; Hunink, M.G.M.

    2012-01-01

    BACKGROUND: Early living-donor transplantation improves patient- and graft-survival compared with possible cadaveric renal transplantation (RTx), but the magnitude of the survival gain is unknown. For patients starting renal replacement therapy (RRT), we aimed to quantify the survival benefit of ear

  7. Ischaemic preconditioning of the graft in adult living related right lobe liver transplantation: impact on ischaemia–reperfusion injury and clinical relevance

    Science.gov (United States)

    Andreani, Paola; Hoti, Emir; de la Serna, Sofia; degli Esposti, Davide; Sebagh, Mylène; Lemoine, Antoinette; Ichai, Philippe; Saliba, Fauzi; Castaing, Denis; Azoulay, Daniel

    2010-01-01

    Background Ischaemic preconditioning (IPC) of the right liver graft in the donor has not been studied in adult-to-adult living related liver transplantation (LRLT). Objective To assess the IPC effect of the graft on ischaemia reperfusion injury in the recipient and compare recipient and donor outcomes with and without preconditioned grafts. Patients and methods Alternate patients were transplanted with right lobe grafts that were (n =22; Group Precond) or were not (n =22; Group Control) subjected to IPC in the living donor. Liver ischaemia–reperfusion injury, liver/kidney function, morbidity/mortality rates and outcomes were compared. Univariate and multivariate analyses were performed to identify factors predictive of the aspartate aminotransferase (AST) peak and minimum prothrombin time. Results Both groups had similar length of hospital stay, morbidity/mortality, primary non-function and acute rejection rates. Post-operative AST (P =0.8) and alanine aminotransferase (ALT) peaks (P =0.6) were similar in both groups (307 ± 189 and 437 ± 302 vs. 290 ± 146 and 496 ± 343, respectively). In univariate analysis, only pre-operative AST and warm ischemia time (WIT) were significantly associated with post-operative AST peak (in recipients). In multivariate analysis, the graft/recipient weight ratio (P =0.003) and pre-operative bilirubin concentration (P =0.004) were significantly predictive of minimum prothrombin time post-transplantation. Conclusions Graft IPC in the living related donor is not associated with any benefit for the recipient or the donor and its clinical value remains uncertain. PMID:20815852

  8. Practices of healthcare professionals from the perspective of older adults living with cancer

    OpenAIRE

    Lucimara Sonaglio Rocha; Margrid Beuter; Eliane Tatsch Neves; Juliane Elis Both; Miriam da Silveira Perrando; Larissa Venturini

    2016-01-01

    Objective: understanding the care practices of health professionals caring for older adults living with cancer in outpatient treatment. Methods: a qualitative research conducted in a hematology oncology outpatient clinic in southern Brazil. A semi-structured interview was conducted with 15 older adults. Data were submitted to thematic analysis. Results: a category of care practice of health professionals amongst older adults living with cancer emerged with two subcategories: disclosure of the...

  9. The changing determinants of UK young adults' living arrangements

    OpenAIRE

    Juliet Stone; Ann Berrington; Jane Falkingham

    2011-01-01

    The postponement of partnership formation and parenthood in the context of an early average age at leaving home has resulted in increased heterogeneity in the living arrangements of young adults in the UK. More young adults now remain in the parental home, or live independently of the parental home but outside of a family. The extent to which these trends are explained by the increased immigration of foreign-born young adults, the expansion in higher education, and the increased economic inse...

  10. Cigarette smoking and alcohol consumption among Chinese older adults: do living arrangements matter?

    Science.gov (United States)

    Zhang, Jiaan; Wu, Liyun

    2015-02-23

    This study used five waves of the Chinese Longitudinal Healthy Longevity Survey to examine the relationship between living arrangements, smoking, and drinking among older adults in China from 1998-2008. We found that living arrangements had strong implications for cigarette smoking and alcohol consumption among the elderly. First, the likelihood of smoking was lower among older men living with children, and older women living either with a spouse, or with both a spouse and children; and the likelihood of drinking was lower among both older men, and women living with both a spouse and children, compared with those living alone. Second, among dual consumers (i.e., being a drinker and a smoker), the amount of alcohol consumption was lower among male dual consumers living with children, while the number of cigarettes smoked was higher among female dual consumers living with others, compared with those living alone. Third, among non-smoking drinkers, the alcohol consumption was lower among non-smoking male drinkers in all types of co-residential arrangements (i.e., living with a spouse, living with children, living with both a spouse and children, or living with others), and non-smoking female drinkers living with others, compared with those living alone. Results highlighted the importance of living arrangements to cigarette smoking and alcohol consumption among Chinese elderly. Co-residential arrangements provided constraints on Chinese older adults' health-risk behaviors, and had differential effects for men and women.

  11. Decline in perfluorooctanesulfonate and other polyfluoroalkyl chemicals in American Red Cross adult blood donors, 2000-2006.

    Science.gov (United States)

    Olsen, Geary W; Mair, David C; Church, Timothy R; Ellefson, Mark E; Reagen, William K; Boyd, Theresa M; Herron, Ross M; Medhdizadehkashi, Zahra; Nobiletti, John B; Rios, Jorge A; Butenhoff, John L; Zobel, Larry R

    2008-07-01

    In 2000, 3M Company, the primary global manufacturer, announced a phase-out of perfluorooctanesulfonyl fluoride (POSF, C8F17SO2F)-based materials after perfluorooctanesulfonate (PFOS, C8F17SO3-) was reported in human populations and wildlife. The purpose of this study was to determine whether PFOS and other polyfluoroalkyl concentrations in plasma samples, collected in 2006 from six American Red Cross adult blood donor centers, have declined compared to nonpaired serum samples from the same locations in 2000-2001. For each location, 100 samples were obtained evenly distributed by age (20-69 years) and sex. Analytes measured, using tandem mass spectrometry, were PFOS, perfluorooctanoate (PFOA), perfluorohexanesulfonate (PFHxS), perfluorobutanesulfonate (PFBS), N-methyl perfluorooctanesulfonamidoacetate (Me-PFOSA-AcOH), and N-ethyl perfluorooctanesulfonamidoacetate (Et-PFOSA-AcOH). The geometric mean plasma concentrations were for PFOS 14.5 ng/mL (95% CI 13.9-15.2), PFOA 3.4 ng/ mL (95% CI 3.3-3.6), and PFHxS 1.5 ng/mL (95% CI 1.4-1.6). The majority of PFBS, Me-PFOSA-AcOH, and Et-PFOSA-AcOH concentrations were less than the lower limit of quantitation. Age- and sex-adjusted geometric means were lower in 2006 (approximately 60% for PFOS, 25% for PFOA, and 30% for PFHxS) than those in 2000-2001. The declines for PFOS and PFHxS are consistent with their serum elimination half-lives and the time since the phase-out of POSF-based materials. The shorter serum elimination half-life for PFOA and its smaller percentage decline than PFOS suggests PFOA concentrations measured in the general population are unlikely to be solely attributed to POSF-based materials. Direct and indirect exposure sources of PFOA could include historic and ongoing electrochemical cell fluorination (ECF) of PFOA, telomer production of PFOA, fluorotelomer-based precursors, and other fluoropoly-mer production. PMID:18678038

  12. Delayed-Onset Chylous Ascites After a Living-Donor Liver Transplant: First Case Successfully Treated With Conservative Treatment?

    Science.gov (United States)

    Chen, Jian-Han; Chang, Chun-Ming; Lu, Min-Chi; Wei, Chang-Kuo; Yin, Wen-Yao

    2016-06-01

    Chylous ascites is a rare complication in liver transplant. Few cases have been reported to date. In most cases, chylous ascites is diagnosed within 1 month after surgery because of intraoperative injury of the hilar lymphatic system. Preoperative massive ascites and use of a LigaSure vessel sealing system for hilar dissection have been reported as risk factors. We report a case of chylous ascites after a living-donor liver transplant that was diagnosed after 6 months of uneventful follow-up. Sirolimus was added to cyclosporine early (2 wk after the operation) owing to poor renal function and it was found to be high (> 22 ng/mL) when the chylous ascites occurred. The patient was treated with total parenteral nutrition in combination with Sandostatin and rapid tapering of sirolimus after the failed initial conservative treatment. Residual abdominal fullness after meals and lymphedema of the legs disappeared 1 month after discontinuing sirolimus. This is the first case of delayed-onset chylous ascites after a liver transplant that was successfully treated conservatively. PMID:25365187

  13. How to explant a diseased liver for living donor liver transplantation after previous gastrectomy with severe adhesion (with video).

    Science.gov (United States)

    Eguchi, Susumu; Soyama, Akihiko; Takatsuki, Mitsuhisa; Hidaka, Masaaki; Adachi, Tomohiko; Kitasato, Amane; Baimakhanov, Zhassulan; Kuroki, Tamotsu

    2014-08-01

    We performed living donor liver transplantation (LDLT) in a patient who had undergone distal gastrectomy for gastric ulcer disease with Billroth I reconstruction 30 years before the LDLT. The adhesion was very severe between remnant stomach and hepatic hilum as well as left liver lobe with shortening of hepatoduodenal structures. After dissection of the infrahepatic inferior vena cava, the Spiegel lobe was identified from the dorsal side. The Spiegel lobe was then penetrated with a right angle dissector so that a plastic tape could be placed around the whole adhesion, including important structures in the hepatoduodenal ligament. Next, the right hepatic vein was transected with a vascular stapler using Pringle's maneuver using the plastic tape to fasten the entire adhesional structure. Subsequently, the trunk of the middle and left hepatic vein was transected after clamping. The remaining short hepatic veins in the left side were divided completely from the cranial to the caudal direction to dissect Spiegel's lobe. Finally, the hepatoduodenal ligament was identified from the attached remnant stomach and the duodenum and a vascular clamp was placed on the entire hepatoduaodenal ligament. Finally, the diseased liver was explanted for graft implantation. Thus, retrograde explantation of the liver was effective in decreasing the risk of damaging vital elements in the hepatoduodenal ligament, the remnant stomach, and the duodenum.

  14. Outcome of partial reconstruction of multiple hepatic arteries in pediatric living donor liver transplantation using left liver grafts.

    Science.gov (United States)

    Lee, Kyo Won; Lee, Sanghoon; Oh, Dong Kyu; Na, Byung Gon; Choi, Jin Yong; Cho, Wontae; Lee, Seunghwan; Kim, Jong Man; Choi, Gyuseong; Kwon, Choon Hyuck David; Joh, Jae-Won; Lee, Suk-Koo

    2016-08-01

    Partial liver grafts used in living donor liver transplantation (LDLT) may have multiple hepatic artery (HA) stumps. This study was designed to validate the safety of partial reconstruction of multiple HAs in pediatric LDLT cases. From January 2000 to June 2014, 136 pediatric LDLT recipients were categorized into three groups: single HA group (Group 1, n = 74), multiple HAs with total reconstruction group (Group 2, n = 23), and multiple HAs with partial reconstruction group (Group 3, n = 39). Partial reconstruction was performed only when there was pulsatile back-bleeding after larger HA reconstruction and sufficient intrahepatic arterial flow was confirmed by Doppler ultrasound (DUS). There was no significant difference in biliary complication rate, artery complication rate, patient survival, and graft survival among these groups. Risk factor analysis revealed that the presence of multiple HAs and partial reconstruction of multiple HAs were not risk factors of biliary anastomosis stricture. In conclusion, partial reconstruction of HAs during pediatric LDLT using a left liver graft with multiple HA stumps does not increase the risk of biliary anastomosis stricture or affect graft survival when intrahepatic arterial communication is confirmed by pulsatile back-bleeding and DUS. PMID:27112373

  15. Intrahepatic artery pseudoaneurysm associated with a metallic biliary stent after living donor liver transplantation: report of a case.

    Science.gov (United States)

    Harada, Noboru; Shirabe, Ken; Soejima, Yuji; Taketomi, Akinobu; Yoshizumi, Tomoharu; Asonuma, Katsuhiro; Inomata, Yukihiro; Maehara, Yoshihiko

    2013-06-01

    An intrahepatic artery pseudoaneurysm (IHAA) is a very rare but potentially lethal complication occurring after liver transplantation. This report presents a case of an IHAA associated with a metallic biliary stent after liver transplantation. A 40-year-old male underwent living donor liver transplantation (LDLT) using a left lobe graft. The bile duct reconstruction was performed with Roux-en-Y hepaticojejunostomy. He developed obstructive jaundice 5 years after LDLT, and had biliary stricture of the anastomosis area, therefore, the two metallic biliary stents were finally positioned at the stricture of the biliary tract. He suddenly developed hematemesis 8 years after LDLT, and computerized tomography scan showed an IHAA. Although seven interlocking detachable coils were placed at the neck of the aneurysm, hematemesis recurred 3 days after the initial embolization. Therefore, retransplantation was successfully performed 25 days after the embolization of IHAA using a right lobe graft from his son. In conclusion, metal stent insertion can lead to the fatal complication of HAA. The placement of a metallic stent could have been avoided in this case. Percutaneous metallic stent insertion for biliary stenosis after liver transplantation should therefore only be performed in carefully selected patients. PMID:22914885

  16. Percutaneous Balloon Dilatation and Catheter Maintenance Method in the Patients with Biliary Strictures after Living Donor Liver Transplantation

    International Nuclear Information System (INIS)

    The aim of this study was to evaluate the therapeutic efficacy of the percutaneous balloon dilatation and catheter maintenance (BDCM) method for postoperative biliary strictures following living donor liver transplantation (LDLT). Eighteen patients (14 duct-to-duct anastomosis and 4 hepaticojejunostomy) with post-LDLT biliary stricture were treated by the percutaneous BDCM method. A good response was defined as residual stricture over 3.5 mm after repetitive BDCM and refractory response as residual stricture below 3.5 mm. If they demonstrated good results on follow-up studies after catheter withdrawal, all the patients quit the therapy. We evaluated the technical and clinical success rates, major complication rate, mean total procedure time and mean follow-up duration. The percutaneous BDCM method was technically successful without major complication. Nine patients improved biliary stricture (good response, mean 5.5 mm), and the other 9 patients showed residual stricture with the diameter below 3.5 mm (refractory response, mean 2.5 mm). However, all the patients were improved clinically without significant complication. The total procedure time was 1-15 months (mean 7.3 months) and follow-up duration was 6-54 months (mean 24 months). The percutaneous BDCM method for post-LDLT biliary strictures was an effective therapy even in the patients showing a refractory response. It seemed that total procedure time could be reduced if the response was determined earlier.

  17. Transfemoral liver biopsy using a Quick-Core biopsy needle system in living donor liver transplantation recipients.

    Science.gov (United States)

    Li, Fen Qiang; Ko, Gi-Young; Sung, Kyu-Bo; Gwon, Dong-Il; Ko, Heung Kyu; Kim, Jong Woo; Yu, Eunsil

    2014-10-01

    The purpose of this study was to evaluate the efficacy and safety of transfemoral liver biopsy with a Quick-Core biopsy needle in select living donor liver transplantation (LDLT) recipients. Eight LDLT recipients underwent 9 transfemoral liver biopsy sessions. Six patients had undergone modified right lobe (mRL) LDLT, and 2 patients had undergone dual-left lobe LDLT. The indications for transfemoral liver biopsy were a hepatic vein (HV) at an acute angle to the inferior vena cava (IVC) on the coronal plane and a thin (length of obtained liver specimens in each session was 44 mm (range = 24-75 mm). The median number of portal tracts was 18 (range = 10-29), and the obtained liver specimens were adequate for histological diagnosis in all sessions. In conclusion, transfemoral liver biopsy with a Quick-Core biopsy needle is an effective and safe alternative for obtaining a liver specimen when standard transjugular liver biopsy is not feasible because of an unfavorable HV angle with respect to the IVC and/or a thin liver parenchyma surrounding the HV. PMID:24916429

  18. Percutaneous Balloon Dilatation and Catheter Maintenance Method in the Patients with Biliary Strictures after Living Donor Liver Transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Park, Dae Hong; Byun, Sung Su; Kim, Jeong Ho; Kim, Keon Kuk; Hwang, Hee Young; Kim, Hyung Sik; Choi, Hye Young; Park, Jae Hyung [Dept. of Gachon University School of Medicine, Gil Hospital, Incheon (Korea, Republic of)

    2013-04-15

    The aim of this study was to evaluate the therapeutic efficacy of the percutaneous balloon dilatation and catheter maintenance (BDCM) method for postoperative biliary strictures following living donor liver transplantation (LDLT). Eighteen patients (14 duct-to-duct anastomosis and 4 hepaticojejunostomy) with post-LDLT biliary stricture were treated by the percutaneous BDCM method. A good response was defined as residual stricture over 3.5 mm after repetitive BDCM and refractory response as residual stricture below 3.5 mm. If they demonstrated good results on follow-up studies after catheter withdrawal, all the patients quit the therapy. We evaluated the technical and clinical success rates, major complication rate, mean total procedure time and mean follow-up duration. The percutaneous BDCM method was technically successful without major complication. Nine patients improved biliary stricture (good response, mean 5.5 mm), and the other 9 patients showed residual stricture with the diameter below 3.5 mm (refractory response, mean 2.5 mm). However, all the patients were improved clinically without significant complication. The total procedure time was 1-15 months (mean 7.3 months) and follow-up duration was 6-54 months (mean 24 months). The percutaneous BDCM method for post-LDLT biliary strictures was an effective therapy even in the patients showing a refractory response. It seemed that total procedure time could be reduced if the response was determined earlier.

  19. One year follow-up of living kidney donors of laparoscopic and open live donor nephrectomy%腹腔镜与开放手术活体取肾供者1年随访研究

    Institute of Scientific and Technical Information of China (English)

    高振利; 万峰春; 方艳丽; 王科; 赵俊杰; 孙德康; 柳东夫; 王琳; 杨典东; 姜仁慧; 王建明; 石磊

    2008-01-01

    目的 比较腹腔镜活体取肾(LDN)与开放手术活体取肾(ODN)的手术安全性及供者术后1年肾功能及血压状况. 方法LDN和ODN各30例,比较2组手术时间、热缺血时间、术中失血量、术后开始进食时间及术后开始下床活动时间,并根据改良Clavien分级系统统计2组围手术期并发症情况.对2组供者术前及术后第1天、1周、3、6个月、1年的血肌酐、血压、24 h尿蛋白定量水平和术前及术后6个月、1年时的肾小球滤过率(GFR)值进行统计比较. 结果 LDN组和ODN组手术时间分别为(98.65±13.6)、(96.3±19.5)min,热缺血时间为(90.6±15.1)、(86.4±12.3)s,2组术中失血量为(105.2±34.8)、(206.35±126.4)ml(P0.05).术后1年内2组平均24 h尿蛋白定量水平及血压与术前相比及2组间同期比较差异均无统计学意义(P>0.05). 结论 LDN具有创伤小,出血少、恢复快的优点,手术安全性与ODN相当,术后1年内对供者的肾功能及血压无明显不良影响.%Objective To compare the safety of laparoscopic live donor nephreetomy(LDN) and open live donor nephrectomy(ODN), evaluate the kidney function and blood pressure of living donors during 1 year follow-up. Methods Thirty cases of LDN and 30 eases of ODN were retrospectively reviewed. The operation time, warm ischemia time, operative blood loss, time to post-operative intake and time to ambulation of the 2 grouups were compared. According to the modified Clavien classifica-tion system procedure-related complications were described and compared. Serum creatinine(SCr) le-vels, blood pressure and 24-h urine protein excretion were measured before nephreetomy and 1 d, 7 d, 3 months, 6 and 12 months after nephrectomy. Glomerular filtration rate (GFR) were measured preo-pratively and at 6 and 12 months postoperatively. These data were statistically analyzed. Results The operation time was (98. 6+13. 6)rain and (96.3+19. 5)rain in the LDN and ODN groups, re- spectively. Warm ischemia

  20. Effect of structured physical exercise program on older adult's daily living activities and cognitive functions

    OpenAIRE

    Manal Abo El Magd; Sahar Zaki

    2015-01-01

    Background: Older adults experience marked physiological and cognitive changes. Literature states that, daily exercising positively effects older adults' both physical and cognitive functioning. Aim: To evaluate the effect of the developed Structured Physical Exercise Program (SPEP) on both older adult's activities of daily living and cognitive functions. Subjects and methods: A quasi experimental design (pre/ post- tests) was utilized for the current study where the older adults' sample serv...

  1. The evolution of anterior sector venous drainage in right lobe living donor liver transplantation: does one technique fit all?

    Science.gov (United States)

    Tokat, Yaman

    2016-01-01

    In living donor liver transplantation (LDLT), an adequate hepatic venous outflow constitutes one of the basic principles of a technically successful procedure. The issue of whether the anterior sector (AS) of the right lobe (RL) graft should or should not be routinely drained has been controversial. The aim of this 10-year, single-center, retrospective cohort study was to review the evolution of our hepatic venous outflow reconstruction technique in RL grafts and evaluate the impact of routine AS drainage strategy on the outcome. The study group consisted of 582 primary RL LDLT performed between July 2004 and December 2014. The cases were divided into 3 consecutive periods with different AS venous outflow reconstruction techniques, which included middle hepatic vein (MHV) drainage in Era 1 (n=119), a more selective AS drainage with cryopreserved homologous grafts in Era 2 (n=391), and routine segment 5 and/or 8 oriented AS drainage with synthetic grafts in Era 3 (n=72). Intraoperative portal flow measurement with routine splenic artery ligation (SAL) technique (in RL grafts with a portal flow of ≥ 250 mL/min/100 g liver tissue) was added later in Era 3. These 3 groups were compared in terms of recipient and donor demographics, surgical characteristics and short-term outcome. The rate of AS venous drainage varied from 58.8% in Era 1 and 35.0% in Era 2 to 73.6% in Era 3 (P<0.001). Perioperative mortality rate of recipients significantly decreased over the years (15.1% in Era 1 and 8.7% in Era 2 vs. 2.8% in Era 3, P=0.01). After the addition of SAL technique in the 45 cases, there was only 1 graft loss and no perioperative mortality. One-year recipient survival rate was also significantly higher in Era 3 (79.6% in Era 1 and 86.1% in Era 2 vs. 92.1% in Era 3, P=0.002). Routine AS drainage via segment 5 and/or 8 veins using synthetic grafts is a technique to fit all RL grafts in LDLT. Addition of SAL effectively prevents early graft dysfunction and significantly

  2. Teaching Social Living Skills; Adult Basic Education, a Teacher's Manual.

    Science.gov (United States)

    Safran, Herbert

    A variety of methods in instructing adults is presented in this teacher's manual which also mentions the availability of packets of instructional materials and lists the subject areas covered. To this is added comments on the background material for the adult teacher, and on the importance of aims, motivation, and development in lesson plans for…

  3. Health status of independently living older adults in Romania

    NARCIS (Netherlands)

    Ghinescu, Minerva; Olaroiu, Marinela; van Dijk, Jitse P.; Olteanu, Tatiana; van den Heuvel, Wim J. A.

    2014-01-01

    AimAging is affecting health care all over Europe, but it is expected to have a much greater impact in Eastern Europe. Reliable data on various indicators of health of older adults in Eastern Europe are lacking. The objectives of the present study were to describe the health of older Romanian adults

  4. Creation of Superheterojunction Polymers via Direct Polycondensation: Segregated and Bicontinuous Donor-Acceptor π-Columnar Arrays in Covalent Organic Frameworks for Long-Lived Charge Separation.

    Science.gov (United States)

    Jin, Shangbin; Supur, Mustafa; Addicoat, Matthew; Furukawa, Ko; Chen, Long; Nakamura, Toshikazu; Fukuzumi, Shunichi; Irle, Stephan; Jiang, Donglin

    2015-06-24

    By developing metallophthalocyanines and diimides as electron-donating and -accepting building blocks, herein, we report the construction of new electron donor-acceptor covalent organic frameworks (COFs) with periodically ordered electron donor and acceptor π-columnar arrays via direct polycondensation reactions. X-ray diffraction measurements in conjunction with structural simulations resolved that the resulting frameworks consist of metallophthalocyanine and diimide columns, which are ordered in a segregated yet bicontinuous manner to form built-in periodic π-arrays. In the frameworks, each metallophthalocyanine donor and diimide acceptor units are exactly linked and interfaced, leading to the generation of superheterojunctions-a new type of heterojunction machinery, for photoinduced electron transfer and charge separation. We show that this polycondensation method is widely applicable to various metallophthalocyanines and diimides as demonstrated by the combination of copper, nickel, and zinc phthalocyanine donors with pyrommellitic diimide, naphthalene diimide, and perylene diimide acceptors. By using time-resolved transient absorption spectroscopy and electron spin resonance, we demonstrated that the COFs enable long-lived charge separation, whereas the metal species, the class of acceptors, and the local geometry between donor and acceptor units play roles in determining the photochemical dynamics. The results provide insights into photoelectric COFs and demonstrate their enormous potential for charge separation and photoenergy conversions.

  5. Late-Onset Drug-Induced Cholestasis in a Living-Related Liver Transplant Donor With Progressive Familial Intrahepatic Cholestasis.

    Science.gov (United States)

    Harmancı, Özgür; Ensaroğlu, Fatih; Özçay, Figen; Öcal, Serkan; Korkmaz, Murat; Özdemir, B Handan; Selçuk, Haldun; Moray, Gökhan; Haberal, Mehmet

    2015-11-01

    We present a rare case of progressive familial intrahepatic cholestasis within a family. A 34-yearold female became a living-related liver transplant donor for her son, who had the disease. Nine years after the transplant, the mother developed severe intrahepatic cholestasis, for which she was evaluated after using an oral contraceptive drug. She presented with jaundice, pruritus, and increased bilirubin levels, together with elevated gamma glutamyl transferase and alkaline phosphatase levels. A liver biopsy revealed findings consistent with intrahepatic cholestasis. However, despite follow-up management and cessation of the insulting drug, her total bilirubin count continuously increased to 20 mg/dL and was accompanied by intractable pruritus. A total of 9 plasmapheresis sessions were performed, and she was started on a regimen of ursodeoxycholic acid (13 mg/kg/d) and cholestyramine (4 g, 3 times daily). The clinical and laboratory picture dramatically improved following cessation of the oral contraceptive, plasmapheresis sessions, and drug treatment. The patient's cholestasis normalized within 3 months, and she recovered uneventfully. A genetic analysis of the whole family revealed that both parents were heterozygous for the mutation c.124G>A in ABCB11, and the son was homozygous for this mutation. These findings supported varying degrees of bile salt export pump deficiency in the family members. Defective bile salt excretory system function can result in a wide spectrum of clinical presentations, ranging from progressive familial intrahepatic cholestasis requiring liver transplant to late-onset drug-induced cholestasis. Our findings suggest that, in a heterozygous carrier of a progressive familial intrahepatic cholestasis mutation, drug-induced cholestasis is responsive to treatment, after which the clinical picture can normalize within 3 months.

  6. Late-Onset Drug-Induced Cholestasis in a Living-Related Liver Transplant Donor With Progressive Familial Intrahepatic Cholestasis.

    Science.gov (United States)

    Harmancı, Özgür; Ensaroğlu, Fatih; Özçay, Figen; Öcal, Serkan; Korkmaz, Murat; Özdemir, B Handan; Selçuk, Haldun; Moray, Gökhan; Haberal, Mehmet

    2015-11-01

    We present a rare case of progressive familial intrahepatic cholestasis within a family. A 34-yearold female became a living-related liver transplant donor for her son, who had the disease. Nine years after the transplant, the mother developed severe intrahepatic cholestasis, for which she was evaluated after using an oral contraceptive drug. She presented with jaundice, pruritus, and increased bilirubin levels, together with elevated gamma glutamyl transferase and alkaline phosphatase levels. A liver biopsy revealed findings consistent with intrahepatic cholestasis. However, despite follow-up management and cessation of the insulting drug, her total bilirubin count continuously increased to 20 mg/dL and was accompanied by intractable pruritus. A total of 9 plasmapheresis sessions were performed, and she was started on a regimen of ursodeoxycholic acid (13 mg/kg/d) and cholestyramine (4 g, 3 times daily). The clinical and laboratory picture dramatically improved following cessation of the oral contraceptive, plasmapheresis sessions, and drug treatment. The patient's cholestasis normalized within 3 months, and she recovered uneventfully. A genetic analysis of the whole family revealed that both parents were heterozygous for the mutation c.124G>A in ABCB11, and the son was homozygous for this mutation. These findings supported varying degrees of bile salt export pump deficiency in the family members. Defective bile salt excretory system function can result in a wide spectrum of clinical presentations, ranging from progressive familial intrahepatic cholestasis requiring liver transplant to late-onset drug-induced cholestasis. Our findings suggest that, in a heterozygous carrier of a progressive familial intrahepatic cholestasis mutation, drug-induced cholestasis is responsive to treatment, after which the clinical picture can normalize within 3 months. PMID:26640927

  7. Cigarette Smoking and Alcohol Consumption among Chinese Older Adults: Do Living Arrangements Matter?

    Directory of Open Access Journals (Sweden)

    Jiaan Zhang

    2015-02-01

    Full Text Available This study used five waves of the Chinese Longitudinal Healthy Longevity Survey to examine the relationship between living arrangements, smoking, and drinking among older adults in China from 1998–2008. We found that living arrangements had strong implications for cigarette smoking and alcohol consumption among the elderly. First, the likelihood of smoking was lower among older men living with children, and older women living either with a spouse, or with both a spouse and children; and the likelihood of drinking was lower among both older men, and women living with both a spouse and children, compared with those living alone. Second, among dual consumers (i.e., being a drinker and a smoker, the amount of alcohol consumption was lower among male dual consumers living with children, while the number of cigarettes smoked was higher among female dual consumers living with others, compared with those living alone. Third, among non-smoking drinkers, the alcohol consumption was lower among non-smoking male drinkers in all types of co-residential arrangements (i.e., living with a spouse, living with children, living with both a spouse and children, or living with others, and non-smoking female drinkers living with others, compared with those living alone. Results highlighted the importance of living arrangements to cigarette smoking and alcohol consumption among Chinese elderly. Co-residential arrangements provided constraints on Chinese older adults’ health-risk behaviors, and had differential effects for men and women.

  8. Nearly Half Of US Adults Living With HIV Received Federal Disability Benefits In 2009.

    Science.gov (United States)

    Huang, Ya-Lin A; Frazier, Emma L; Sansom, Stephanie L; Farnham, Paul G; Shrestha, Ram K; Hutchinson, Angela B; Fagan, Jennifer L; Viall, Abigail H; Skarbinski, Jacek

    2015-10-01

    The effects of HIV infection on national labor-force participation have not been rigorously evaluated. Using data from the Medical Monitoring Project and the National Health Interview Survey, we present nationally representative estimates of the receipt of disability benefits by adults living with HIV receiving care compared with the general US adult population. We found that in 2009, adults living with HIV were nine times more likely than adults in the general population to receive disability benefits. The risk of being on disability is also greater for younger and more educated adults living with HIV compared to the general population, which suggests that productivity losses can result from HIV infection. To prevent disability, early diagnosis and treatment of HIV are essential. This study offers a baseline against which to measure the impacts of recently proposed or enacted changes to Medicaid and private insurance markets, including the Affordable Care Act and proposed revisions to the Social Security Administration's HIV Infection Listings. PMID:26438741

  9. Complicações relacionadas à lobectomia em doadores de transplante pulmonar intervivos Complications related to lobectomy in living lobar lung transplant donors

    Directory of Open Access Journals (Sweden)

    Spencer Marcantônio Camargo

    2008-05-01

    Full Text Available OBJETIVO: Avaliar as complicações pós-operatórias imediatas de doadores vivos de lobos pulmonares para transplante. MÉTODOS: Entre setembro de 1999 e maio de 2005 foram realizadas lobectomias em 32 doadores saudáveis para transplante pulmonar em 16 receptores. Os prontuários médicos destes doadores foram analisados retrospectivamente para verificar a incidência de complicações pós-operatórias e as alterações da função pulmonar após a lobectomia. RESULTADOS: Vinte e dois doadores (68,75% não apresentaram complicações. Entre os 10 casos que apresentaram alguma complicação o derrame pleural foi a mais freqüente, ocorrendo em 5 deles (15,6% da amostra. Três doadores (9,3% necessitaram de transfusão de hemácias e, em 2 casos, foi necessária nova intervenção cirúrgica devido a hemotórax. Um doador apresentou pneumotórax após a retirada do dreno de tórax e houve um caso de infecção respiratória. Ocorreram duas intercorrências intra-operatórias (6,25%: em um doador foi realizada broncoplastia do lobo médio; em outro, foi necessária a ressecção da língula. Não houve mortalidade cirúrgica nesta série. As provas de função pulmonar do pós-operatório demonstraram uma redução média de 20% no volume expiratório forçado no primeiro segundo (p OBJECTIVE: To evaluate post-operative complications in living lobar lung transplant donors. METHODS: Between September of 1999 and May of 2005, lobectomies were performed in 32 healthy lung transplant donors for 16 recipients. The medical charts of these donors were retrospectively analyzed in order to determine the incidence of postoperative complications and alterations in pulmonary function after lobectomy. RESULTS: Twenty-two donors (68.75% presented no complications. Among the 10 donors presenting complications, the most frequently observed complication was pleural effusion, which occurred in 5 donors (15.6% of the sample. Red blood cell transfusion was

  10. Long-Term Placement of Subcutaneous Ruesch-Type Stents for Double Biliary Stenosis in a Living-Donor Liver Transplant Recipient

    International Nuclear Information System (INIS)

    Biliary reconstruction continues to be a major source of morbidity following liver transplantation. The spectrum of biliary complications is evolving due to the increasing number of split-liver and living-donor liver transplantation, which are even associated with a higher incidence of biliary complications. Bile duct strictures are the most common cause of late biliary complications and account for up to 40% of all biliary complications. Optimal therapy for posttransplantation anastomotic biliary strictures remains uncertain and requires a multidisciplinary approach. We report the case of a 54-year-old Caucasian male affected by hepatocarcinoma and hepatitis C-related cirrhosis who underwent right-lobe living-donor liver transplantation from his son complicated by double anastomotic stenosis of the main right hepatic duct and of an accessory biliary duct draining segments 6 and 7 of the graft that was successfully treated by percutaneous transhepatic cholangiography with long-term subcutaneous placement of two internal Ruesch-type biliary stents

  11. Removal of Foley Catheters in Live Donor Kidney Transplant Recipients on Postoperative Day 1 Does Not Increase the Incidence of Urine Leaks

    Science.gov (United States)

    Siskind, Eric; Sameyah, Emil; Goncharuk, Edwin; Olsen, Elizabeth M.; Feldman, Joshua; Giovinazzo, Katie; Blum, Mark; Tyrell, Richard; Evans, Cory; Kuncewitch, Michael; Alexander, Mohini; Israel, Ezra; Bhaskaran, Madhu; Calderon, Kellie; Jhaveri, Kenar D.; Sachdeva, Mala; Bellucci, Alessandro; Mattana, Joseph; Fishbane, Steven; D'Agostino, Catherine; Coppa, Gene; Molmenti, Ernesto

    2013-01-01

    Catheterization of the urinary bladder during kidney transplantation is essential. The optimal time to remove the Foley catheter postoperatively is not universally defined. It is our practice to remove the Foley catheter on postoperative day 1 in live donor kidney transplant recipients who meet our standardized protocol criteria. We believe that early removal of Foley catheters increases patient comfort and mobility, decreases the risk of catheter associated urinary tract infections, and allows for decreased hospital length of stay. The hypothetical risk of early removal of Foley catheters would be the increased risk of urine leak. We reviewed 120 consecutive live donor kidney transplant recipients and found that there was not an increased incidence of urine leaks in patients whose Foley catheters were removed on postoperative day 1. PMID:24436583

  12. Risk indicators associated with root decay in independently living older adults

    OpenAIRE

    Hayes, Martina; Da Mata, Cristiane; Cole, Margaret; McKenna, Gerald; Burke, Francis; Allen, Finbarr

    2016-01-01

    Objective: To determine the risk indicators associated with root caries experience in a cohort of independently living older adults in Ireland. Methods: The data reported in the present study were obtained from a prospective longitudinal study conducted on the risk factors associated with root caries incidence in a cohort of independently living older adults (n=334). Each subject underwent an oral examination, performed by a single calibrated examiner, to determine the root caries index and o...

  13. The structure of coping among older adults living with HIV/AIDS and depressive symptoms

    OpenAIRE

    Hansen, Nathan B.; Harrison, Blair; Fambro, Stacy; Bodnar, Sara; Heckman, Timothy G.; Sikkema, Kathleen J.

    2012-01-01

    One-third of adults living with HIV/AIDS are over the age of 50. This study evaluated the structure of coping among 307 older adults living with HIV/AIDS. Participants completed 61 coping items and measures of anxiety, depression, loneliness, and coping self-efficacy. Exploratory factor analyses retained 40 coping items loading on five specific first order factors (Distancing Avoidance, Social Support Seeking, Self-Destructive Avoidance, Spiritual Coping, and Solution-Focused Coping) and two ...

  14. Living with Multiple Health Problems: What Older Adults Should Know

    Science.gov (United States)

    ... other tip sheets. More than half of all adults 65 and older have three or more chronic (ongoing) medical problems, such as heart disease, diabetes, cancer, or arthritis. Caring for older patients with multiple ...

  15. Preventing Falls in Older Adults Who Live in Community Settings

    Science.gov (United States)

    ... not apply to older people living in nursing homes or other institutional settings. Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If ...

  16. The Groningen Active Living Model, an example of successful recruitment of sedentary and underactive older adults

    NARCIS (Netherlands)

    Stevens, Martin; de Jong, Johan; Lemmink, Koen A. P. M.

    2008-01-01

    Objective. Many physical activity interventions do not reach those people who would benefit the most from them. The Groningen Active Living Model (GALM) was successful in recruiting sedentary and underactive older adults. Method. In the fall of 2000 older adults in three municipalities in the Nether

  17. Education, Employment, and Independent Living of Young Adults Who Are Deaf and Hard of Hearing

    Science.gov (United States)

    Appelman, Karen I.; Callahan, Judy Ottren; Mayer, Margaret H.; Luetke, Barbara S.; Stryker, Deborah S.

    2012-01-01

    Little information is available on the education, employment, and independent living status of young deaf and hard of hearing adults who have transitioned from high school. The present article reports post-secondary outcomes of 46 young adults who had attended for at least 4 years a non-public agency school in the northwestern United States…

  18. Comparison live adult Artemia and squid meat on the growth of Penaeid shrimp Metapenaeus dobsoni (Miers)

    Digital Repository Service at National Institute of Oceanography (India)

    Nair, S.R.S.; Achuthankutty, C.T.; Royan, J.P.

    An experiment lasting 14 weeks was conducted to compare the efficiency of live adult Artemia with fresh squid meat on growth of penaeid shrimp Metapenaeus dobsoni. The shrimps were found actively feeding on live Artemia and grew 84% more than those...

  19. How Living or Traveling to Foreign Locations Influences Adults' Worldviews and Impacts Personal Identity

    Science.gov (United States)

    Yelich Biniecki, Susan M.; Conceição, Simone C. O.

    2014-01-01

    People are living and traveling to places all over the world. An exploration of how this movement influences learners' worldviews has implications for adult development, identity, and learning. The purpose of this paper is to present a phenomenological study conducted in the U.S. that examined how individuals' living or traveling…

  20. Spirituality: A Coping Mechanism in the Lives of Adults with Congenital Disabilities

    Science.gov (United States)

    Specht, Jacqueline A.; King, Gillian A.; Willoughby, Colleen; Brown, Elizabeth G.; Smith, Linda

    2005-01-01

    The purpose of this study was to gain insight into the perspective of individuals with congenital disabilities about spirituality as a coping mechanism during crucial times in their lives, Qualitative analysis of interviews assessing turning points in the lives of 15 adults (6 women and 9 men; M = 37 years) with spina bifida, cerebral palsy, or…

  1. Follow-up of 52 cases of living kidney donors and recipients%亲属活体供肾移植52例随访

    Institute of Scientific and Technical Information of China (English)

    宋振兰; 庄桂敏; 刘晓风; 高振利

    2009-01-01

    Objective To evaluate the renal function and the quality of life (QOL) in living related kidney donors and recipients after surgery. Methods Fifty-two living kidney donors and recipients were investigated with the correlated physiological index and the Mos 36-item short form health survey, and compared with healthy people and cadaveric donor renal transplantation. Results There were no statistically significant differences in Cr, GFR, 24-h urine protein excretion and QOL in kidney donors before and after surgery (P>0.05) , and there were no differences between kidney donors and healthy people (P>0.05). The levels of Cr and BUN were obviously lower in kidney donors than cadaveric donor renal transplantation at the same time (P0.05). Conclusion Donors' renal function was not decreased after surgery.The QOL show no significant difference between kidney donors and healthy people. Renal function in living donor group was better than that in cadaveric donor group.%目的 调查分析亲属活体供肾移植供、受者术后的肾功能及生活质量情况.方法 以行亲属活体供肾移植的供受者52对、接受尸体肾移植的受者56例以及随机抽取的同期健康人60名为研究对象.于移植术前、术后3个月和1年对研究对象进行调查,采用调查问卷和临床检验相结合的方式.调查内容包括年龄、性别、婚姻状况、供受者的关系等以及健康状况调查问卷SF-36量表.结果 供者术后3个月及1年的血Cr和24 h尿蛋白均高于术前,但未超过正常范围.供者术前、术后3个月及1年的血Cr、GFR和24 h尿蛋白与健康人相比,差异均无统计学意义(P>0.05).活体供肾移植受者术后3个月及1年的血Cr与BUN均低于相应时间点的尸体肾移植受者,差异有统计学意义(P0.05);供者术前、术后3个月及1年的生活质量与健康人相比,差异均无统计学意义(P>0.05).活体供肾移植受者术后3个月及1年的生活质量与相应时间点的尸体

  2. Children Living with HIV-Infected Adults: Estimates for 23 Countries in sub-Saharan Africa.

    Directory of Open Access Journals (Sweden)

    Susan E Short

    Full Text Available In sub-Saharan Africa many children live in extreme poverty and experience a burden of illness and disease that is disproportionately high. The emergence of HIV and AIDS has only exacerbated long-standing challenges to improving children's health in the region, with recent cohorts experiencing pediatric AIDS and high levels of orphan status, situations which are monitored globally and receive much policy and research attention. Children's health, however, can be affected also by living with HIV-infected adults, through associated exposure to infectious diseases and the diversion of household resources away from them. While long recognized, far less research has focused on characterizing this distinct and vulnerable population of HIV-affected children.Using Demographic and Health Survey data from 23 countries collected between 2003 and 2011, we estimate the percentage of children living in a household with at least one HIV-infected adult. We assess overlaps with orphan status and investigate the relationship between children and the adults who are infected in their households.The population of children living in a household with at least one HIV-infected adult is substantial where HIV prevalence is high; in Southern Africa, the percentage exceeded 10% in all countries and reached as high as 36%. This population is largely distinct from the orphan population. Among children living in households with tested, HIV-infected adults, most live with parents, often mothers, who are infected; nonetheless, in most countries over 20% live in households with at least one infected adult who is not a parent.Until new infections contract significantly, improvements in HIV/AIDS treatment suggest that the population of children living with HIV-infected adults will remain substantial. It is vital to on-going efforts to reduce childhood morbidity and mortality to consider whether current care and outreach sufficiently address the distinct vulnerabilities of these

  3. Does situs inversus totalis preclude liver donation in living donor liver transplantation? A series of 3 cases from single institution

    OpenAIRE

    Selvakumar N.; Neerav Goyal; Mohammed Nayeem; Sandeep Vohra; Subash Gupta

    2016-01-01

    Introduction: Liver transplantation (LT) is the gold standard for decompensated Chronic Liver Disease (CLD) in individuals satisfying the selection criteria. Organ scarcity is the rate limiting step in liver transplantation across the globe. Expanding the donor pool is practiced by transplant surgeons across the globe in view of perennial donor organ scarcity and ever increasing organ demand. Presentation of case: We have presented series of 3 cases of liver transplantation (LT) with modif...

  4. Living with Cystic Fibrosis: A Guide for the Young Adult.

    Science.gov (United States)

    Cystic Fibrosis Foundation, Atlanta, GA.

    Intended for the young adult with cystic fibrosis, the booklet provides information on dealing with problems and on advances in treatment and detection related to the disease. Addressed are the following topics: description of cystic fibrosis; inheritance of cystic fibrosis; early diagnosis; friends, careers, and other matters; treatment;…

  5. Autologous stem cell transplantation versus alternative allogeneic donor transplants in adult acute leukemias.

    Science.gov (United States)

    Claude Gorin, Norbert

    2016-04-01

    The availability of alternative sources of stem cells including most recently T-replete haploidentical marrow or peripheral blood, and the increasing use of reduced-intensity conditioning (RIC), renders feasible an allogeneic transplant to almost all patients with acute leukemia up to 70 years of age. Autologous stem cell transplantation (ASCT) for consolidation of complete remission (CR), however, offers in some circumstances an alternative option. Although associated with a higher relapse rate, autologous transplant benefits from a lower non-relapse mortality, the absence of graft-versus-host disease (GVHD), and a better quality of life for long-term survivors. The recent use of intravenous busulfan (IVBU) with high-dose melphalan, better monitoring of minimal residual disease (MRD), and maintenance therapy post autografting bring new interest. Few retrospective studies compared the outcome following alternative donor versus autologous transplants for remission consolidation. Genoidentical and phenoidentical allogeneic stem cell transplantations are undisputed gold standards, but there are no data showing the superiority of alternative allogeneic donor over autologous transplantation, at the time of undetectable MRD, in patients with good- and intermediate-1 risk acute myelocytic leukemia (AML) in first complete remission (CR1), acute promyelocytic leukemia in second complete remission (CR2), and Philadelphia chromosome-positive (Ph(+)) acute lymphocytic leukemia (ALL). PMID:27000734

  6. Autologous stem cell transplantation versus alternative allogeneic donor transplants in adult acute leukemias.

    Science.gov (United States)

    Claude Gorin, Norbert

    2016-04-01

    The availability of alternative sources of stem cells including most recently T-replete haploidentical marrow or peripheral blood, and the increasing use of reduced-intensity conditioning (RIC), renders feasible an allogeneic transplant to almost all patients with acute leukemia up to 70 years of age. Autologous stem cell transplantation (ASCT) for consolidation of complete remission (CR), however, offers in some circumstances an alternative option. Although associated with a higher relapse rate, autologous transplant benefits from a lower non-relapse mortality, the absence of graft-versus-host disease (GVHD), and a better quality of life for long-term survivors. The recent use of intravenous busulfan (IVBU) with high-dose melphalan, better monitoring of minimal residual disease (MRD), and maintenance therapy post autografting bring new interest. Few retrospective studies compared the outcome following alternative donor versus autologous transplants for remission consolidation. Genoidentical and phenoidentical allogeneic stem cell transplantations are undisputed gold standards, but there are no data showing the superiority of alternative allogeneic donor over autologous transplantation, at the time of undetectable MRD, in patients with good- and intermediate-1 risk acute myelocytic leukemia (AML) in first complete remission (CR1), acute promyelocytic leukemia in second complete remission (CR2), and Philadelphia chromosome-positive (Ph(+)) acute lymphocytic leukemia (ALL).

  7. The changing determinants of UK young adults' living arrangements

    Directory of Open Access Journals (Sweden)

    Juliet Stone

    2011-09-01

    Full Text Available The postponement of partnership formation and parenthood in the context of an early average age at leaving home has resulted in increased heterogeneity in the living arrangements of young adults in the UK. More young adults now remain in the parental home, or live independently of the parental home but outside of a family. The extent to which these trends are explained by the increased immigration of foreign-born young adults, the expansion in higher education, and the increased economic insecurity faced by young adults are examined. Shared non-family living is particularly prominent among those with experience of higher education, whilst labour market uncertainty is associated with an extended period of co-residence with parents.

  8. Clinical Risk Scoring Models for Prediction of Acute Kidney Injury after Living Donor Liver Transplantation: A Retrospective Observational Study.

    Directory of Open Access Journals (Sweden)

    Mi Hye Park

    Full Text Available Acute kidney injury (AKI is a frequent complication of liver transplantation and is associated with increased mortality. We identified the incidence and modifiable risk factors for AKI after living-donor liver transplantation (LDLT and constructed risk scoring models for AKI prediction. We retrospectively reviewed 538 cases of LDLT. Multivariate logistic regression analysis was used to evaluate risk factors for the prediction of AKI as defined by the RIFLE criteria (RIFLE = risk, injury, failure, loss, end stage. Three risk scoring models were developed in the retrospective cohort by including all variables that were significant in univariate analysis, or variables that were significant in multivariate analysis by backward or forward stepwise variable selection. The risk models were validated by way of cross-validation. The incidence of AKI was 27.3% (147/538 and 6.3% (34/538 required postoperative renal replacement therapy. Independent risk factors for AKI by multivariate analysis of forward stepwise variable selection included: body-mass index >27.5 kg/m2 [odds ratio (OR 2.46, 95% confidence interval (CI 1.32-4.55], serum albumin 20 (OR 2.01, 95%CI 1.17-3.44, operation time >600 min (OR 1.81, 95%CI 1.07-3.06, warm ischemic time >40 min (OR 2.61, 95%CI 1.55-4.38, postreperfusion syndrome (OR 2.96, 95%CI 1.55-4.38, mean blood glucose during the day of surgery >150 mg/dl (OR 1.66, 95%CI 1.01-2.70, cryoprecipitate > 6 units (OR 4.96, 95%CI 2.84-8.64, blood loss/body weight >60 ml/kg (OR 4.05, 95%CI 2.28-7.21, and calcineurin inhibitor use without combined mycophenolate mofetil (OR 1.87, 95%CI 1.14-3.06. Our risk models performed better than did a previously reported score by Utsumi et al. in our study cohort. Doses of calcineurin inhibitor should be reduced by combined use of mycophenolate mofetil to decrease postoperative AKI. Prospective randomized trials are required to address whether artificial modification of hypoalbuminemia, hyperglycemia

  9. Clinical significance of parenchymal excretion delay of unilateral graft on hepatobiliary scintigraphy after dual grafts living donors liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Y. J.; Kim, J. S.; Lee, S. K.; Hwang, S.; Park, G. M.; Lee, Y. J.; Moon, D. H. [Asan Medical Center, Seoul (Korea, Republic of)

    2005-07-01

    Clinical significance of unilateral graft parenchymal excretion delay (UED) after dual grafts living donors liver transplantation (DLDLT) on hepatobiliary scintigraphy (HBS) may be different from that of liver transplantation with single graft considering the immune reaction and surgical techniques. The purpose of this study was to evaluate the clinical significance of UED after DLDLT. Clinicopathologic findings of 136 patients (48{+-}9 yrs; M/F=119/17) who underwent HBS using Tc-99m DISIDA after DLDLT were retrospectively evaluated. UED was considered when HBS showed delayed parenchymal excretion of unilateral graft with normal contralateral graft and HBS findings of UED were further classified into biliary obstructive (BO) or non-biliary obstructive (NBO) pattern according to biliary to enteric transit time. The etiology and outcome of UED were determined by clinical and pathologic findings. Of 136 patients, 18 showed UED (Rt/Lt=11/7) within 1 mo (1.6{+-}1.4 wk) after transplantation and 18 (Rt/Lt=6/12) after 1 mo (7.7{+-}5.0 mo). Of 18 patients with UED within 1 mo, 16 resulted from the early postoperative graft dysfunction (EGD) which showed NBO pattern in all but three (81%), and 2 resulted from biliary stenosis of anastomotic site. After 1 mo, 9 of 18 UED resulted from biliary stenosis and parenchymal dysfunction due to unknown but non-biliary etiology in 7, acute rejection in 1, and vascular insufficiency in 1. Four of 9 UED with biliary stenosis showed BO pattern on HBS and 6 of 9 UED with parenchymal dysfunction showed NBO pattern. UED due to EGD was spontaneously resolved and longterm outcome of the involved graft were not different from the contralateral normal graft. Most of unilateral graft parenchymal excretion delay within 1 mo after DLDLT showed NBO pattern on HBS and resulted from transient EGD without longterm prognostic value. UED after 1 mo resulted from variable etiology and needed further diagnostic work-up regardless of scintigraphic pattern.

  10. DNA methylation and mRNA expression profiles in bovine oocytes derived from prepubertal and adult donors.

    Science.gov (United States)

    Diederich, Mike; Hansmann, Tamara; Heinzmann, Julia; Barg-Kues, Brigitte; Herrmann, Doris; Aldag, Patrick; Baulain, Ulrich; Reinhard, Richard; Kues, Wilfried; Weissgerber, Christian; Haaf, Thomas; Niemann, Heiner

    2012-09-01

    The developmental capacity of oocytes from prepubertal cattle is reduced compared with their adult counterparts, and epigenetic mechanisms are thought to be involved herein. Here, we analyzed DNA methylation in three developmentally important, nonimprinted genes (SLC2A1, PRDX1, ZAR1) and two satellite sequences, i.e. 'bovine testis satellite I' (BTS) and 'Bos taurus alpha satellite I' (BTαS). In parallel, mRNA expression of the genes was determined by quantitative real-time PCR. Oocytes were retrieved from prepubertal calves and adult cows twice per week over a 3-week period by ultrasound-guided follicular aspiration after treatment with FSH and/or IGF1. Both immature and in vitro matured prepubertal and adult oocytes showed a distinct hypomethylation profile of the three genes without differences between the two types of donors. The methylation status of the BTS sequence changed according to the age and treatment while the methylation status of BTαS sequence remained largely unchanged across the different age and treatment groups. Relative transcript abundance of the selected genes was significantly different in immature and in vitro matured oocytes; only minor changes related to origin and treatment were observed. In conclusion, methylation levels of the investigated satellite sequences were high (>50%) in all groups and showed significant variation depending on the age, treatment, or in vitro maturation. To what extent this is involved in the acquisition of developmental competence of bovine oocytes needs further study. PMID:22733804

  11. Diaphragmatic hernia after right donor and hepatectomy:a rare donor complication of partial hepatectomy for transplantation

    Institute of Scientific and Technical Information of China (English)

    Alan M. Hawxby; David P. Mason; Andrew S. Klein

    2006-01-01

    BACKGROUND: Because of the critical worldwide shortage of cadaveric organ donors, transplant professionals have increasingly turned to living donors. Partial hepatectomy for adult living donor liver transplantation has been performed since the late 1990s. Most often, the complications of living donor hepatectomy have been related to the biliary tract, speciifcally biliary leaks. METHODS: A 54-year-old man underwent donor right hepatectomy for living donor liver transplantation. Three years after liver donation he presented with upper abdominal pain and fullness. Radiographic workup revealed a diaphragmatic hernia of the right hemithorax. RESULTS: After thoracoscopic evaluation of the right hemithorax, diaphragmatic hernia was repaired. Currently the patient remains well several months after the repair with complete resolution of abdominal pain, normal chest X-ray examination demonstrating no recurrence of diaphragmatic hernia, and normal liver functions tests. CONCLUSIONS: Multiple complications of living donor liver transplantation have been described the transplant literature. Diaphragmatic hernia is a formerly-undescribed complication of right donor hepatectomy for transplantation.

  12. Protective effects of maternal methyl donor supplementation on adult offspring of high fat diet-fed dams.

    Science.gov (United States)

    Jiao, Fei; Yan, Xiaoshuang; Yu, Yuan; Zhu, Xiao; Ma, Ying; Yue, Zhen; Ou, Hailong; Yan, Zhonghai

    2016-08-01

    Obesity has become a global public health problem associated with metabolic dysfunction and chronic disorders. It has been shown that the risk of obesity and the DNA methylation profiles of the offspring can be affected by maternal nutrition, such as high-fat diet (HFD) consumption. The aim of this study was to investigate whether metabolic dysregulation and physiological abnormalities in offspring caused by maternal HFD can be alleviated by the treatment of methyl donors during pregnancy and lactation of dams. Female C57BL/6 mice were assigned to specific groups and given different nutrients (control diet, Control+Met, HFD and HFD+Met) throughout gestation and lactation. Offspring of each group were weaned onto a control diet at 3 weeks of age. Physiological (weight gain and adipose composition) and metabolic (plasma biochemical analyses) outcomes were assessed in male and female adult offspring. Expression and DNA methylation profiles of obesogenic-related genes including PPAR γ, fatty acid synthase, leptin and adiponectin were also detected in visceral fat of offspring. The results showed that dietary supplementation with methyl donors can prevent the adverse effects of maternal HFD on offspring. Changes in the expression and DNA methylation of obesogenic-related genes indicated that epigenetic regulation may contribute to the effects of maternal dietary factors on offspring outcomes. PMID:27183114

  13. Two Cases of Human T-Lymphotropic Virus Type I-Associated Myelopathy/Tropical Spastic Paraparesis Caused by Living-Donor Renal Transplantation

    Directory of Open Access Journals (Sweden)

    Yasutaka Tajima

    2016-01-01

    Full Text Available In rare instances, recipients of organ transplants from human T-lymphotropic virus type I- (HTLV-I- positive donors reportedly developed neurologic symptoms due to HTLV-I-associated myelopathy (HAM. We present herein two cases of HAM associated with renal transplantation from HTLV-I seropositive living-donors. The first patient was a 42-year-old woman with chronic renal failure for twelve years and seronegative for HTLV-I. She underwent renal transplantation with her HTLV-I seropositive mother as the donor, and she developed HAM three years after the transplantation. The second patient was a 65-year-old man who had been suffering from diabetic nephropathy. He was seronegative for HTLV-I and underwent renal transplantation one year previously, with his HTLV-I seropositive wife as the donor. He developed HAM eight months after renal transplantation. Both cases showed neurological improvements after the immunomodulating therapies. We tried to shed some light on the understanding of immunological mechanisms of transplantation-associated HAM, focusing on therapeutic strategies based on the immunopathogenesis of the condition.

  14. The Racial Residential Segregation of Black Single Adults Living Alone

    OpenAIRE

    Marsh, Kris; Iceland, John

    2010-01-01

    While many studies have examined the intersection of race and class with residential segregation and residential preferences, very little is known about the role played by household composition in shaping residential patterns. This paper focuses on the residential patterns of a particular kind of household: those consisting of persons single and living alone (SALA). We compare the residential segregation of black SALA households—an important subset of non-family households and a rapidly growi...

  15. Robotics to Enable Older Adults to Remain Living at Home

    Directory of Open Access Journals (Sweden)

    Alan J. Pearce

    2012-01-01

    Full Text Available Given the rapidly ageing population, interest is growing in robots to enable older people to remain living at home. We conducted a systematic review and critical evaluation of the scientific literature, from 1990 to the present, on the use of robots in aged care. The key research questions were as follows: (1 what is the range of robotic devices available to enable older people to remain mobile, independent, and safe? and, (2 what is the evidence demonstrating that robotic devices are effective in enabling independent living in community dwelling older people? Following database searches for relevant literature an initial yield of 161 articles was obtained. Titles and abstracts of articles were then reviewed by 2 independent people to determine suitability for inclusion. Forty-two articles met the criteria for question 1. Of these, 4 articles met the criteria for question 2. Results showed that robotics is currently available to assist older healthy people and people with disabilities to remain independent and to monitor their safety and social connectedness. Most studies were conducted in laboratories and hospital clinics. Currently limited evidence demonstrates that robots can be used to enable people to remain living at home, although this is an emerging smart technology that is rapidly evolving.

  16. Effects of Living Alone on Social Capital and Health Among Older Adults in China.

    Science.gov (United States)

    Xu, Qingwen; Norstrand, Julie A; Du, Yan

    2015-12-01

    Social capital has been connected with positive health outcomes across countries, including China. Given the rise in the number of seniors living alone, there is a need to examine the health benefits of social capital, accounting for living arrangements. Data from the 2005 Chinese General Social Survey were used to test research hypotheses. Controlling for demographics, elders living alone possessed similar level of social capital compared with elders living with others. While bonding and linking social capital were significant factors in urban areas and linking social capital was a significant factor in rural areas, the relationship between living alone and health did not differ based on the level of social capital possession. When the traditional intergenerational living arrangement has not been a valid option for many older adults in China, seeking new way of family caring, and developing appropriate social and institutional structures to assist elders living alone, becomes critical.

  17. Associations and impact factors between living arrangements and functional disability among older Chinese adults.

    Directory of Open Access Journals (Sweden)

    Hui Wang

    Full Text Available OBJECTIVES: To examine the association of living arrangements with functional disability among older persons and explore the mediation of impact factors on the relationship. DESIGN: Cross-sectional analysis using data from Healthy Aging study in Zhejiang Province. PARTICIPANTS: Analyzed sample was drawn from a representative rural population of older persons in Wuyi County, Zhejiang Province, including 1542 participants aged 60 and over in the second wave of the study. MEASUREMENTS: Living arrangements, background, functional disability, self-rated health, number of diseases, along with contemporaneous circumstances including income, social support (physical assistance and emotional support. Instrument was Activities of Daily Living (ADL scale, including Basic Activities Daily Living (BADL and Instrumental Activities of Daily Living (IADL. RESULTS: Living arrangements were significantly associated with BADL, IADL and ADL disability. Married persons living with or without children were more advantaged on all three dimensions of functional disability. Unmarried older adults living with children only had the worst functional status, even after controlling for background, social support, income and health status variables (compared with the unmarried living alone, ß for BADL: -1.262, ß for IADL: -2.112, ß for ADL: -3.388; compared with the married living with children only, ß for BADL: -1.166, ß for IADL: -2.723, ß for ADL: -3.902. In addition, older adults without difficulty in receiving emotional support, in excellent health and with advanced age had significantly better BADL, IADL and ADL function. However, a statistically significant association between physical assistance and functional disability was not found. CONCLUSION: Functional disabilities vary by living arrangements with different patterns and other factors. Our results highlight the association of unmarried elders living with children only and functioning decline comparing with

  18. Laparoscopic donor nephrectomy

    Directory of Open Access Journals (Sweden)

    Gupta Nitin

    2005-01-01

    Full Text Available Of the various options for patients with end stage renal disease, kidney transplantation is the treatment of choice for a suitable patient. The kidney for transplantation is retrieved from either a cadaver or a live donor. Living donor nephrectomy has been developed as a method to address the shortfall in cadaveric kidneys available for transplantation. Laparoscopic living donor nephrectomy (LLDN, by reducing postoperative pain, shortening convalescence, and improving the cosmetic outcome of the donor nephrectomy, has shown the potential to increase the number of living kidney donations further by removing some of the disincentives inherent to donation itself. The technique of LLDN has undergone evolution at different transplant centers and many modifications have been done to improve donor safety and recipient outcome. Virtually all donors eligible for an open surgical procedure may also undergo the laparoscopic operation. Various earlier contraindications to LDN, such as right donor kidney, multiple vessels, anomalous vasculature and obesity have been overcome with increasing experience. Laparoscopic live donor nephrectomy can be done transperitoneally or retroperitoneally on either side. The approach is most commonly transperitoneal, which allows adequate working space and easy dissection. A review of literature and our experience with regards to standard approach and the modifications is presented including a cost saving model for the developing countries. An assessment has been made, of the impact of LDN on the outcome of donor and the recipient.

  19. 99mTc-DTPA dynamic SPECT and CT volumetry for measuring split renal function in live kidney donors

    International Nuclear Information System (INIS)

    Split renal function (SRF) estimated from the posterior view of 99mTc-diethylenetriaminepentaacetic acid planar scintigraphy (DTPA/P) is not sufficiently accurate even after correction for kidney depth by computed tomography (CT). To obtain more accurate SRF using 99mTc-DTPA dynamic single photon emission computed tomography (SPECT) method was carried out for the initial 5 min after bolus injection of 99mTc-DTPA (DTPA/SPECT). Also SRF was evaluated from the renal volume measured by CT. We compared the results with 99mTc-dimercaptosuccinic acid SPECT (DMSA/SPECT). In 60 consecutive live kidney donors, 30 DTPA/P, 30 DTPA/SPECT, 60 99mTc-DMSA/SPECT, and 60 CT studies were performed. In the DTPA/P studies, SRF was calculated from the posterior image recorded during 2-3-min postinjection with attenuation correction for kidney depth measured by CT. In the DTPA/SPECT studies, SPECT images were acquired continuously for 5 min with a dual-headed gamma camera. In 99mTc-DMSA scintigraphy, DMSA/SPECT images were acquired 3-h postinjection. The SRF on both SPECT studies was calculated from the total counts of each kidney. In the DTPA/SPECT study, SRF was evaluated on the three images summed for 1 min: 1-2 min (DTPA/SPECT1-2), 2-3 min (DTPA/SPECT2-3), and 1-3 min (DTPA/SPECT1-3). In the CT examination, to assess the global renal volume, the axial images in the excretory phase were chosen. Renal contours were identified on each image, and the areas (cm2) of these regions were summed and multiplied by the slice thickness (10 mm) to yield global renal volume (ml). Right renal function from DTPA/P, DTPA/SPECT, and CT were compared with that from DMSA/SPECT as a reference. Correlation coefficients of the right renal function between DMSA/SPECT and DTPA/P, DTPA/SPECT2-3, and CT were 0.663, 0.849 and 0.907, respectively (P<0.0001). The differences between DMSA/SPECT and DTPA/P, DTPA/SPECT2-3 and CT were 2.42±3.878, 0.867±1.672, and -0.421±1.077% (mean±standard deviation (SD

  20. Evidence-informed recommendations for rehabilitation with older adults living with HIV: a knowledge synthesis

    OpenAIRE

    O'Brien, K. K.; Solomon, P; Trentham, B.; MacLachlan, D.; MacDermid, J; Tynan, A. -M; Baxter, L.; Casey, A.; Chegwidden, W.; Robinson, G; Tran, T.; Wu, J.; Zack, E

    2014-01-01

    Objective Our aim was to develop evidence-informed recommendations for rehabilitation with older adults living with HIV. Design We conducted a knowledge synthesis, combining research evidence specific to HIV, rehabilitation and ageing, with evidence on rehabilitation interventions for common comorbidities experienced by older adults with HIV. Methods We included highly relevant HIV-specific research addressing rehabilitation and ageing (stream A) and high-quality evidence on the effec...

  1. Trends of fast food consumption among adolescent and young adult Saudi girls living in Riyadh

    OpenAIRE

    ALFaris, Nora A.; Jozaa Z. Al-Tamimi; Al-Jobair, Moneera O.; AL-SHWAIYAT, Naseem M.

    2015-01-01

    Background: Saudi Arabia has passed through lifestyle changes toward unhealthy dietary patterns such as high fast food consumption. Adolescents and young adults, particularly girls, are the main groups exposed to and affected by these adverse eating behaviors.Objective: The aim of this study was to examine the trends of fast food consumption among adolescent and young adult Saudi girls living in Riyadh, and to compare between them.Design: In a cross-sectional survey, 127 adolescent Saudi girl...

  2. Successful rescue of disseminated varicella infection with multiple organ failure in a pediatric living donor liver transplant recipient: a case report and literature review

    OpenAIRE

    Yamada, Naoya; Sanada, Yukihiro; Okada, Noriki; Wakiya, Taiichi; Ihara, Yoshiyuki; Urahashi, Taizen; Mizuta, Koichi

    2015-01-01

    A 12-year-old female patient with biliary atresia underwent living donor liver transplantation (LDLT). Twelve months after the LDLT, she developed acute hepatitis (alanine aminotransferase 584 IU/L) and was diagnosed with disseminated varicella-zoster virus (VZV) infection with high level of serum VZV-DNA (1.5 × 105 copies/mL) and generalized vesicular rash. She had received the VZV vaccination when she was 5-years-old and had not been exposed to chicken pox before the LDLT, and her serum was...

  3. Renal blood flow using arterial spin labelling MRI and calculated filtration fraction in healthy adult kidney donors pre-nephrectomy and post-nephrectomy

    Energy Technology Data Exchange (ETDEWEB)

    Cutajar, Marica; Clark, Christopher A.; Gordon, Isky [University College London, Imaging and Biophysics Unit, Institute of Child Health, London (United Kingdom); Hilton, Rachel; Olsburgh, Jonathon [Renal Unit, Guy' s and St Thomas' NHS Foundation Trust, London (United Kingdom); Marks, Stephen D. [Great Ormond Street Hospital for Children NHS Foundation Trust, Department of Paediatric Nephrology, London (United Kingdom); Thomas, David L. [University College London, Department of Brain Repair and Rehabilitation, Institute of Neurology, London (United Kingdom); Banks, Tina [Great Ormond Street Hospital for Children NHS Foundation Trust, Department of Radiology, London (United Kingdom)

    2015-08-15

    Renal plasma flow (RPF) (derived from renal blood flow, RBF) and glomerular filtration rate (GFR) allow the determination of the filtration fraction (FF), which may have a role as a non-invasive renal biomarker. This is a hypothesis-generating pilot study assessing the effect of nephrectomy on renal function in healthy kidney donors. Eight living kidney donors underwent arterial spin labelling (ASL) magnetic resonance imaging (MRI) and GFR measurement prior to and 1 year after nephrectomy. Chromium-51 labelled ethylenediamine tetraacetic acid ({sup 51}Cr-EDTA) with multi-blood sampling was undertaken and GFR calculated. The RBF and GFR obtained were used to calculate FF. All donors showed an increase in single kidney GFR of 24 - 75 %, and all but two showed an increase in FF (-7 to +52 %) after nephrectomy. The increase in RBF, and hence RPF, post-nephrectomy was not as great as the increase in GFR in seven out of eight donors. As with any pilot study, the small number of donors and their relatively narrow age range are potential limiting factors. The ability to measure RBF, and hence RPF, non-invasively, coupled with GFR measurement, allows calculation of FF, a biomarker that might provide a sensitive indicator of loss of renal reserve in potential donors. (orig.)

  4. Renal blood flow using arterial spin labelling MRI and calculated filtration fraction in healthy adult kidney donors pre-nephrectomy and post-nephrectomy

    International Nuclear Information System (INIS)

    Renal plasma flow (RPF) (derived from renal blood flow, RBF) and glomerular filtration rate (GFR) allow the determination of the filtration fraction (FF), which may have a role as a non-invasive renal biomarker. This is a hypothesis-generating pilot study assessing the effect of nephrectomy on renal function in healthy kidney donors. Eight living kidney donors underwent arterial spin labelling (ASL) magnetic resonance imaging (MRI) and GFR measurement prior to and 1 year after nephrectomy. Chromium-51 labelled ethylenediamine tetraacetic acid (51Cr-EDTA) with multi-blood sampling was undertaken and GFR calculated. The RBF and GFR obtained were used to calculate FF. All donors showed an increase in single kidney GFR of 24 - 75 %, and all but two showed an increase in FF (-7 to +52 %) after nephrectomy. The increase in RBF, and hence RPF, post-nephrectomy was not as great as the increase in GFR in seven out of eight donors. As with any pilot study, the small number of donors and their relatively narrow age range are potential limiting factors. The ability to measure RBF, and hence RPF, non-invasively, coupled with GFR measurement, allows calculation of FF, a biomarker that might provide a sensitive indicator of loss of renal reserve in potential donors. (orig.)

  5. Laparoscopic donor orchidectomy and living-related donor testicle transplantation (report of 2 cases)%腹腔镜下供睾切取术及亲属活体供睾移植二例报告

    Institute of Scientific and Technical Information of China (English)

    谈宜傲; 周林玉; 诸禹平; 朱明; 孙友文

    2009-01-01

    目的 总结腹腔镜下活体供睾切取及睾丸移植的体会.方法 2例患者因外伤导致双侧睾丸丧失,其血清睾酮水平分别为1.94和1.39 nmol/L,均出现第二性征减退或改变的症状.2名供者分别是受者的父亲和哥哥,均身体健康,彩色超声波检查提示睾丸大小、形态及血流均正常,在腹腔镜下切取右侧睾丸.2例供者手术时间分别为29和24 min,术中出血分别为15和18 ml,供睾热缺血时间分别为90和70 s.睾丸移植时,先将供睾静脉与受者的腹壁下静脉吻合,再将供睾动脉与受者的腹壁下动脉吻合,然后将供、受者的输精管行端端吻合,最后用手指伸入腹股沟斜切口向下扩张阴囊,并将移植睾丸推入阴囊内.术后对供、受者进行随访,观察供、受者术后情况.结果 2例受者均成功接受睾丸移植,术后恢复良好,复查血清睾酮较前明显升高,分别为12.8和14.2 nmol/L,有排精现象,但精液中无精子;术后3个月,彩色超声波检查显示移植睾丸血液供应良好,大小和形态正常.2名供者术后切口疼痛轻微,未使用止痛药,术后第1天可进食,第2天胃肠功能恢复正常,并可下床活动,第3天拔除引流管,第7天拆线出院,供者于术后1个月恢复正常生活和工作.随访期间,供者均未诉特殊不适,未发生并发症.结论 利用腹腔镜切取活体供睾安全可行,对供者创伤小,术后恢复快,对移植睾丸的功能无明显负面影响;成功的睾丸移植可改善患者的第二性征,提高血清睾酮水平.%Objective To summarize the experience in laparoseopic donor orchidectomy and living-related donor testicle transplantation.Methods In 2 patients with bilateral testicular trauma leading to loss of function,serum testosterone levels were 1.94 and 1.39 nmol/L respectively,and the secondary sexual characteristics decreased or changed.One donor was from his father and the other was from his brother,whose testes were healthy

  6. Psychiatric Morbidity and Social Functioning among Adults with Borderline Intelligence Living in Private Households

    Science.gov (United States)

    Hassiotis, A.; Strydom, A.; Hall, I.; Ali, A.; Lawrence-Smith, G.; Meltzer, H.; Head, J; Bebbington, P.

    2008-01-01

    Background: Approximately one-eighth of the population will have DSM-IV borderline intelligence. Various mental disorders and social disability are associated with it. Method: The paper uses data (secondary analysis) from a UK-wide cross-sectional survey of 8450 adults living in private households. Data were collected on psychiatric disorders,…

  7. Effects of Parental Suicide on the Adolescent Survivors' Lives When They Are Adults

    Science.gov (United States)

    Saatci, Yesim

    2013-01-01

    This qualitative inquiry, phenomenology, purported to provide insight into the role of parental suicide on the adolescent survivors' adult lives between 18 and 40. This study described the survivors' coping strategies, self-esteem, and effects of their grief and bereavement as a result of parental suicide on their emotional wellness or…

  8. Selected Resources on Adult Children Living at Home: An Annotated Bibliography for Researchers, Educators, and Consumers.

    Science.gov (United States)

    Frazier, Billie H.; Hayes, Kathleen C.

    The resources in this annotated bibliography were selected to help readers better understand what is known about adult children living at home. Data on this subject are scarce. The bibliography is a literature review--a State-of-the-Art report--which is applicable to many professionals and students in the social sciences. It was developed by…

  9. Loneliness in the daily lives of young adults: Testing a socio-cognitive model

    NARCIS (Netherlands)

    Roekel, G.H. van; Ha, P.T.; Scholte, R.H.J.; Engels, R.C.M.E.; Verhagen, M.

    2016-01-01

    A socio-cognitive model of loneliness states that lonely people are characterized by two characteristics, hypersensitivity to social threat and hyposensitivity to social reward. However, these characteristics have not yet been examined in the daily lives of young adults. Therefore, the main aim of t

  10. Preferences for food and nutritional supplements among adult people living with HIV in Malawi

    NARCIS (Netherlands)

    Rodas Moya, Carlos; Kodish, Stephen; Manary, Mark; Grede, Nils; Pee, de Saskia

    2015-01-01

    Objective: To elucidate the factors influencing food intake and preferences for potential nutritional supplements to treat mild and moderate malnutrition among adult people living with HIV (PLHIV). Design: Qualitative research using in-depth interviews with a triangulation of participants and an

  11. Acoustical Design Guidelines for Living Rooms for Adults with intellectual Disabilities

    NARCIS (Netherlands)

    Saher, K.

    2013-01-01

    The aim of this thesis is to investigate the effects of building design tools on acoustical quality parameters in living rooms for adults with intellectual disabilities (ID) and develop acoustical design guidelines for architects. This study is specifically concerned with the validation of auralizat

  12. 腹腔镜和手辅助腹腔镜活体供肾切取术%Laparoscopic and Hand-assisted Laparoscopic Live Donor Nephrectomy

    Institute of Scientific and Technical Information of China (English)

    孙立安; 朱同玉; 王国民

    2005-01-01

    肾移植是终末期肾病(end-stage renal disease,ES—DR)的理想治疗手段。由于尸肾来源匮乏,活体供肾移植的比例逐年增加。与尸肾移植相比,活体供肾移植的植肾功能和存活率均优于尸肾移植,人/肾存活率高,对病人和移植物长期存活有利。活体供肾切取术方式主要有3种,传统开放手术活体供肾切取术(open donor nephreetomy,ODN),经典腹腔镜活体供肾切取术(1aparoscopic live donor nephreetomy,LDN),手辅助腹腔镜活体供肾切取术(hand-assisted laparoscopic live donornephreetomy,HLDN)。美国大多数肾移植中心已将U)N作为首选的供肾切取方法,活体供肾比例大幅度提高。现对LDN、HLDN的适应证、手术方法、结果作一综述。

  13. Do the outcomes of living donor renal allograft recipients differ with peritoneal dialysis and hemodialysis as a bridge renal replacement therapy?

    Directory of Open Access Journals (Sweden)

    Narayan Prasad

    2014-01-01

    Full Text Available This study was undertaken to compare the outcomes of living donor renal transplant recipients using peritoneal dialysis (PD and hemodialysis (HD as a bridge modality for renal replacement therapy till renal transplantation. The demographic profiles of the recipients and donors, the patients′ native kidney disease (diabetic versus non-diabetic, duration on dialysis, requirement of anti-hypertensive drugs, number of blood transfusions, human leukocyte antigen (HLA mismatch status, pre- and post-transplant infectious complications, and post-transplant outcomes of patients were compared between the two groups. The demographic features of the study patients were similar in the two groups. The duration of dialysis prior to transplant was significantly longer in the PD group than in the HD group of patients. The anti-hypertensive drug requirement was lower and the hemoglobin level and residual urine volume at the time of transplant were relatively better in the PD patients compared to the HD patients. The number of acute rejection episodes, delayed graft function, surgical complications, glomerular filtration rate at one month and at the last follow-up, were also similar in both groups. The short-term and long-term graft survival was similar in both groups of patients. The one-, two-, five-, and eight-year death-censored graft survival rates of the PD patients were 98, 95, 85, and 73%, respectively, and in the HD group of patients, they were 100, 93, 84, and 79%, respectively. The one-, two-, five-, and eight-year patient survival rates in the PD group were 97, 92, 77, and 66%, respectively, and in the HD group, they were 97, 92, 79, and 69%, respectively. Our study suggests that the outcomes of the living donor renal allograft recipients did not differ between the groups of patients who used PD or HD as renal replacement therapy prior to renal transplantation.

  14. The structure of coping among older adults living with HIV/AIDS and depressive symptoms.

    Science.gov (United States)

    Hansen, Nathan B; Harrison, Blair; Fambro, Stacy; Bodnar, Sara; Heckman, Timothy G; Sikkema, Kathleen J

    2013-02-01

    One-third of adults living with HIV/AIDS are over the age of 50. This study evaluated the structure of coping among 307 older adults living with HIV/AIDS. Participants completed 61 coping items and measures of anxiety, depression, loneliness, and coping self-efficacy. Exploratory factor analyses retained 40 coping items loading on five specific first order factors (Distancing Avoidance, Social Support Seeking, Self-Destructive Avoidance, Spiritual Coping, and Solution-Focused Coping) and two general second order factors (Active and Avoidant Coping). Factors demonstrated good reliability and validity. Results suggest that general coping factors should be considered with specific factors when measuring coping among older adults. PMID:22453164

  15. Biological character of human adipose-derived adult stem cells and influence of donor age on cell replication in culture.

    Science.gov (United States)

    Lei, Lei; Liao, WeiMing; Sheng, PuYi; Fu, Ming; He, AiShan; Huang, Gang

    2007-06-01

    To investigate the biological character of human adipose-derived adult stem cells (hADAS cells) when cultured in vitro and the relationship between hADAS cell's replication activity and the donor's age factor, and to assess the stem cells as a new source for tissue engineering. hADAS cells are isolated from human adipose tissue of different age groups (from adolescents to olds: 61 years old groups). The protein markers (CD29, CD34, CD44, CD45, CD49d, HLA-DR, CD106) of hADAS cells were detected by flow cytometry (FCM) to identify the stem cell, and the cell cycle was examined for P20 hADAS cells to evaluate the safety of the subculture in vitro. The generative activity of hADAS cells in different age groups was also examined by MTT method. The formula "TD = t x log2/logNt - logN0" was used to get the time doubling (TD) of the cells. The results showed that the cells kept heredity stabilization by chromosome analysis for at least 20 passages. The TD of these cells increased progressively by ageing, and the TD of the 61 years old group (statistical analysis of variance (ANOVA), P=0.002, PhADAS cells replication activity was found in the younger donators, and they represent novel and valuable seed cells for studies of tissue engineering.

  16. Cadaveric donor selection and management.

    Science.gov (United States)

    Studer, Sean M; Orens, Jonathan B

    2006-10-01

    While there is little doubt that proper donor selection is extremely important to achieve good outcomes from transplantation, there are only limited data regarding the current criteria utilized to select the "ideal donor". Importantly, there are not enough donor lungs available for all of those in need. Until an adequate supply of donor organs exists, lives will be lost on the transplant waiting list. While efforts have been made to increase donor awareness, additional transplants can be realized by improving donor utilization. This can be achieved by active participation of transplant teams in donor management and by utilizing "extended criteria" organs. Further studies are needed to assess the impact of using "extended criteria" donors, as this practice could result in increased posttransplant morbidity and mortality. This article summarizes the approach to identification of potential lung donors, optimal donor management, and the clinical importance of various donor factors upon recipient outcomes.

  17. Independent donor ethical assessment: aiming to standardize donor advocacy.

    Science.gov (United States)

    Choudhury, Devasmita; Jotterand, Fabrice; Casenave, Gerald; Smith-Morris, Carolyn

    2014-06-01

    Living organ donation has become more common across the world. To ensure an informed consent process, given the complex issues involved with organ donation, independent donor advocacy is required. The choice of how donor advocacy is administered is left up to each transplant center. This article presents the experience and process of donor advocacy at University of Texas Southwestern Medical Center administered by a multidisciplinary team consisting of physicians, surgeons, psychologists, medical ethicists and anthropologists, lawyers, a chaplain, a living kidney donor, and a kidney transplant recipient. To ensure that advocacy remains fair and consistent for all donors being considered, the donor advocacy team at University of Texas Southwestern Medical Center developed the Independent Donor Ethical Assessment, a tool that may be useful to others in rendering donor advocacy. In addition, the tool may be modified as circumstances arise to improve donor advocacy and maintain uniformity in decision making. PMID:24919733

  18. Factors influencing Internet usage in older adults (65 years and above) living in rural and urban Sweden.

    Science.gov (United States)

    Berner, Jessica; Rennemark, Mikael; Jogréus, Claes; Anderberg, Peter; Sköldunger, Anders; Wahlberg, Maria; Elmståhl, Sölve; Berglund, Johan

    2015-09-01

    Older adults living in rural and urban areas have shown to distinguish themselves in technology adoption; a clearer profile of their Internet use is important in order to provide better technological and health-care solutions. Older adults' Internet use was investigated across large to midsize cities and rural Sweden. The sample consisted of 7181 older adults ranging from 59 to 100 years old. Internet use was investigated with age, education, gender, household economy, cognition, living alone/or with someone and rural/urban living. Logistic regression was used. Those living in rural areas used the Internet less than their urban counterparts. Being younger and higher educated influenced Internet use; for older urban adults, these factors as well as living with someone and having good cognitive functioning were influential. Solutions are needed to avoid the exclusion of some older adults by a society that is today being shaped by the Internet. PMID:24567416

  19. Effect of structured physical exercise program on older adult's daily living activities and cognitive functions

    Directory of Open Access Journals (Sweden)

    Manal Abo El Magd

    2015-01-01

    Full Text Available Background: Older adults experience marked physiological and cognitive changes. Literature states that, daily exercising positively effects older adults' both physical and cognitive functioning. Aim: To evaluate the effect of the developed Structured Physical Exercise Program (SPEP on both older adult's activities of daily living and cognitive functions. Subjects and methods: A quasi experimental design (pre/ post- tests was utilized for the current study where the older adults' sample served as their own control. The study was conducted at a charity geriatric home (Female section in Giza Governorate on a convenient sample of 45 older adult females. Data were collected through using three tools; Personal and clinical data assessment sheet, and the two pre-post scales (i.e. Activity of Daily Living scale "ADL" and Nurses’ Observation Scale for Cognitive Abilities "NOSCA"; both scales were already developed and tested before. Results: Data revealed that, after implementation of SPEP, statistically significant differences, indicating improvement, were found between the older adult's ADL and both their age, presence of support network, the number of offspring and medical history. Also Statistically significant difference, indicating improvement, was found between ADL and NOSCA scales among the study sample before and after implementing the SPEP. Conclusion: Both ADL level and cognitive functions of study sample were significantly improved after implementing the SPEP. Regular physical exercising is likely to have positive effect on both older adults' physical and cognitive functioning resulting in higher level of independency. Recommendation: This study recommends wide range application of the developed SPEP on older adults in Egypt.

  20. The haemodynamic effects of the perioperative terlipressin infusion in living donor liver transplantation: A randomised controlled study

    Directory of Open Access Journals (Sweden)

    Nagwa Ibrahim

    2015-01-01

    Full Text Available Background and Aims: Liver disease is usually accompanied with a decline in systemic vascular resistance (SVR. We decided to assess effects of the peri-operative terlipressin infusion on liver donor liver transplantation recipients with respect to haemodynamics and renal parameters. Methods: After Ethical Committee approval for this prospective randomised controlled study, 50 recipients were enrolled and allotted to control (n = 25 or terlipressin group (n = 25 with simple randomisation method. Terlipressin was infused at 1.0 μg/kg/h and later titrated 1.0-4.0 μg/kg/h to maintain mean arterial pressure (MAP >65 mmHg and SVR index 0.05 and was sustained post-operatively. Conclusion: Terlipressin improved SVR and MAP with less need for catecholamines particularly post-reperfusion. Terlipressin reduced PPV without hepatic artery vasoconstriction and improved post-operative UOP.

  1. The haemodynamic effects of the perioperative terlipressin infusion in living donor liver transplantation: A randomised controlled study

    Science.gov (United States)

    Ibrahim, Nagwa; Hasanin, Ashraf; Allah, Sabry Abd; Sayed, Eman; Afifi, Mohamed; Yassen, Khaled; Saber, Wesam; Khalil, Magdy

    2015-01-01

    Background and Aims: Liver disease is usually accompanied with a decline in systemic vascular resistance (SVR). We decided to assess effects of the peri-operative terlipressin infusion on liver donor liver transplantation recipients with respect to haemodynamics and renal parameters. Methods: After Ethical Committee approval for this prospective randomised controlled study, 50 recipients were enrolled and allotted to control (n = 25) or terlipressin group (n = 25) with simple randomisation method. Terlipressin was infused at 1.0 μg/kg/h and later titrated 1.0–4.0 μg/kg/h to maintain mean arterial pressure (MAP) >65 mmHg and SVR index 0.05) and was sustained post-operatively. Conclusion: Terlipressin improved SVR and MAP with less need for catecholamines particularly post-reperfusion. Terlipressin reduced PPV without hepatic artery vasoconstriction and improved post-operative UOP. PMID:25838587

  2. Home-based rehabilitation interventions for adults living with HIV: a scoping review.

    Science.gov (United States)

    Cobbing, Saul; Hanass-Hancock, Jill; Myezwa, Hellen

    2016-01-01

    Home-based rehabilitation (HBR) has been shown to improve the lives of people living with a wide range of chronic diseases in resource-rich settings. This may also be a particularly effective strategy in resource-poor settings, where access to institution-based rehabilitation is limited. This review aimed to summarise and discuss the evidence related to the effectiveness of home-based rehabilitation (HBR) interventions designed specifically for adults living with HIV. A scoping review methodology was employed, involving systematic search techniques and appraisal of appropriate evidence. English-language journal articles that assessed the quality of life or functional ability outcomes of HBR interventions for adults living with HIV were considered for this review. Out of an initial 1 135 publications retrieved from the search of databases, six articles met this review's inclusion criteria. While this review highlights the scarcity of empirical evidence related to HBR interventions for adults living with HIV, the findings of these six articles are that HBR is a safe management option that may confer a number of physical and psychological benefits for this population. Future research on HBR interventions should include a wider range of assessment measures, including cost-benefit analyses and specific tools designed to assess the functional ability and participation in activities of daily living of participants involved in these programmes. In particular, more research on HBR is required in resource-poor environments, such as sub-Saharan Africa where HIV is endemic, to assess whether this is a feasible strategy that is both effective and practical in the areas that may need it most. PMID:27002360

  3. Clinical analysis on the relationship between the donor resource and the result of living related donor kidney transplantation%亲属活体供肾来源对肾移植疗效影响的临床观察

    Institute of Scientific and Technical Information of China (English)

    严泽振; 朱同玉; 许明; 戎瑞明; 王国民

    2009-01-01

    Objective To analyze the impact of allograft category on the result of living related donor kidney transplantation (LRKT)and to evaluate the predominant donors. Methods A retrospective analysis of 104 recipients receiving LRKT from Apr. 2004 to Mar. 2008 was performed. Based on donor resource, all the recipient-donor pairs were divided into four groups: spousal donation group,parental donation group, sibling donation group and cousinly donation group. The observational parameters were selected for analysis, such as average post-transplant hospitalization dates, time for serum creatinine (Scr) back to normal level, Scr levels of every observational time point, incidence of major complications (infection, rejection, DGF) and recipient/graft survival rate. Results Recipient/graft survival rate of sibling donation group seemed higher. Recipients of sibling donation group seemed to have fewer post-transplant hospitalization dates, but higher rates of infection, while those of parental donation group seemed to have higher rates of rejection. Rates of rejection and infection of spousal donation group were lower than supposed. There was no statistically significant difference in time for Scr back to normal level and Set levels of every observational time point among these four groups. Conclusions The result of sibling donor renal transplantation is better, while short-term outcome of spouse donor renal transplantation is ideal, which is similar with parent or cousin donor renal transplantation. Except for human leukocyte antigen, aspects such as quality of donor kidney, predominance during operation and self-administration post-transplant are also the guarantee for the success.%目的 观察亲属活体供肾来源对肾移植临床疗效的影响,并探讨可能的优势供体.方法 回顾分析我院自2004年4月至2008年3月完成的104例亲属活体供肾移植的临床资料,按供肾来源分为夫妻间供肾组(10例)、父母供肾组(59

  4. 活体供者供肝术后早期并发症分析%The early postoperative complications in living liver transplantation donors

    Institute of Scientific and Technical Information of China (English)

    米凯; 李川; 文天夫; 严律南; 李波; 王文涛; 徐明清; 杨家印; 魏永刚

    2012-01-01

    Objective To investigate the incidence of early postoperative complications in living donor liver transplantation.Methods Postoperative data of 170 living liver donors were retrospectively collected from January 2002 to August 2009 and the collected data were divided into two groups according to the type of donors (right-lobe graft,R group and left lobe graft,L group). Early postoperative complications were analyzed using Clavien classification system.Results The difference between two groups was no statistically significant in donor's age,body mass index,operation time and other characters (P>0.05).R group had a bigger actual cut weight of donor liver (P<0.05),smaller residual liver weight (P<0.05) which also smaller than standard liver weight (P<0.05),and a longer hospital stay (P<0.05) than L group.During hospitalization,62 complications occurred in 55 cases with the total complication rate being 32.35% (55/170). In detail,the incidence of complications was 34.39% (54/157) in R group,and 7.69% (1/13) in L group (chi-square value =2.787,P>0.05).Among these 62 complications,there were 39 times of Ⅰ grade,5 times of Ⅱ grade,16 times of Ⅲ grade,2 times of Ⅳ a grade. All the complications were cured by active treatment and all donors survived well.Conclusion Although the security of living donor liver transplantation is better,the risk of serious complications must be faced.We must strictly select and assess the donor before the operation,very carefully carry out surgical operation,and pay more attention to postoperative management in order to avoid postoperative complications of donors.%目的 探讨活体肝移植供者术后早期并发症的发生情况.方法 对2002年1月至2009年8月间170例活体肝移植供者的临床资料进行回顾性分析,依据供肝类型分为右半供肝组和左半供肝组,采用Clavien分类系统对术后早期发生的并发症进行分析.结果 两组间供者年龄、身高体重指数、手

  5. Biological character of human adipose-derived adult stem cells and influence of donor age on cell replication in culture

    Institute of Scientific and Technical Information of China (English)

    LEI Lei; LIAO WeiMing; SHENG PuYi; FU Ming; HE AiShan; HUANG Gang

    2007-01-01

    To investigate the biological character of human adipose-derived adult stem cells (hADAS cells) when cultured in vitro and the relationship between hADAS cell's replication activity and the donor's age factor, and to assess the stem cells as a new source for tissue engineering, hADAS cells are isolated from human adipose tissue of different age groups (from adolescents to olds: <20 years old, 21-40years old, 41-60 years old and >61 years old groups). The protein markers (CD29, CD34, CD44, CD45,CD49d, HLA-DR, CD106) of hADAS cells were detected by flow cytometry (FCM) to identify the stem cell,and the cell cycle was examined for P20 hADAS cells to evaluate the safety of the subculture in vitro.The generative activity of hADAS cells in different age groups was also examined by MTT method. The formula "TD = t log2/logNt - logN0 "was used to get the time doubling (TD) of the cells. The results showed that the cells kept heredity stabilization by chromosome analysis for at least 20 passages. The TD of these cells increased progressively by ageing, and the TD of the <20 years old group was lower than that of the >61 years old group (statistical analysis of variance (ANOVA), P=-0.002, P<0.05). These findings suggested that a higher level of hADAS cells replication activity was found in the younger donators, and they represent novel and valuable seed cells for studies of tissue engineering.

  6. Adult Tobacco Use Among Racial and Ethnic Groups Living in the United States, 2002–2005

    Directory of Open Access Journals (Sweden)

    Joe Gfroerer, BA

    2008-07-01

    Full Text Available IntroductionU.S. data on adult tobacco use and the relationship between such use and tobacco-related health disparities are primarily limited to broad racial or ethnic populations. To monitor progress in tobacco control among adults living in the United States, we present information on tobacco use for both aggregated and disaggregated racial and ethnic subgroups.MethodsWe used data from the nationally representative sample of adults aged 18 years or older who participated in the National Survey on Drug Use and Health conducted 4 times during 2002–2005. We calculated 2 outcome measures: 1 use of any tobacco product (cigarettes, chewing or snuff tobacco, cigars, or pipes during the 30 days before each survey and 2 cigarette smoking during the 30 days before each survey.ResultsThe prevalence of tobacco use among adults aged 18 years or older varied widely across racial or ethnic groups or subgroups. Overall, about 3 of 10 adults living in the United States were tobacco users during the 30 days before being surveyed. The population groups or subgroups with a tobacco-use prevalence of 30% or higher were African Americans, American Indians or Alaska Natives, Native Hawaiians or other Pacific Islanders, Puerto Ricans, and whites.ConclusionThese results indicate that the prevalence of adult tobacco use is still high among several U.S. population groups or subgroups. Our results also support the need to design and evaluate interventions to prevent or control tobacco use that would reach distinct U.S. adult population groups or subgroups.

  7. Myeloablative allogeneic versus autologous stem cell transplantation in adult patients with acute lymphoblastic leukemia in first remission: A prospective sibling donor versus no-donor comparison

    NARCIS (Netherlands)

    J.J. Cornelissen (Jan); B. van der Holt (Bronno); G.E.G. Verhoef (Gregor); M.B. van 't Veer (Mars); M.H.J. van Oers (Marinus); G.J. Ossenkoppele (Gert); P. Sonneveld (Pieter); J. Maertens (Johan); M. van Marwijk Kooy (Marinus); M.R. Schaafsma (Martijn); P.W. Wijermans (Pierre); D.H. Biesma (Douwe); S. Wittebol (Shulamit); P.J. Voogt (Paul); J.W. Baars (Joke); P. Zachée (Pierre); L.F. Verdonck (Leo); B. Löwenberg (Bob); A.W. Dekker (Adriaan)

    2009-01-01

    textabstractWhile commonly accepted in poor-risk acute lymphoblastic leukemia (ALL), the role of allogeneic hematopoietic stem cell transplantation (allo-SCT) is still disputed in adult patients with standard-risk ALL. We evaluated outcome of patients with ALL in first complete remission (CR1), acco

  8. Comparison of different magnetic resonance cholangiography techniques in living liver donors including Gd-EOB-DTPA enhanced T1-weighted sequences.

    Directory of Open Access Journals (Sweden)

    Sonja Kinner

    Full Text Available Preoperative evaluation of potential living liver donors (PLLDs includes the assessment of the biliary anatomy to avoid postoperative complications. Aim of this study was to compare T2-weighted (T2w and Gd-EOB-DTPA enhanced T1-weighted (T1w magnetic resonance cholangiography (MRC techniques in the evaluation of PLLDs.30 PLLDs underwent MRC on a 1.5 T Magnetom Avanto (Siemens, Erlangen, Germany using (A 2D T2w HASTE (Half Fourier Acquisition Single Shot Turbo Spin Echo fat saturated (fs in axial plane, (B 2D T2w HASTE fs thick slices in coronal plane, (C free breathing 3D T2w TSE (turbo spin echo RESTORE (high-resolution navigator corrected plus (D maximum intensity projections (MIPs, (E T2w SPACE (sampling perfection with application optimized contrasts using different flip angle evolutions plus (F MIPs and (G T2w TSE BLADE as well as Gd-EOB-DTPA T1w images without (G and with (H inversion recovery. Contrast enhanced CT cholangiography served as reference imaging modality. Two independent reviewers evaluated the biliary tract anatomy on a 5-point scale subjectively and objectively. Data sets were compared using a Mann-Whitney-U-test. Kappa values were also calculated.Source images and maximum intensity projections of 3D T2w TSE sequences (RESTORE and SPACE proved to be best for subjective and objective evaluation directly followed by 2D HASTE sequences. Interobserver variabilities were good to excellent (k = 0.622-0.804.3D T2w sequences are essential for preoperative biliary tract evaluation in potential living liver donors. Furthermore, our results underline the value of different MRCP sequence types for the evaluation of the biliary anatomy in PLLDs including Gd-EOB-DTPA enhanced T1w MRC.

  9. Bile duct evaluation of potential living liver donors with Gd-EOB-DTPA enhanced MR cholangiography: Single-dose, double dose or half-dose contrast enhanced imaging

    International Nuclear Information System (INIS)

    Introduction: Detailed knowledge of the biliary anatomy is essential to avoid complications in living donor liver transplantation. The aim of this study was to determine the optimal dosage of Gd-EOB-DTPA for contrast-enhanced magnetic resonance cholangiography (ce-MRC) with reference to contrast-enhanced CT cholangiography (ce-CTC). Materials and methods: 30 potential living liver donors (PLLD) underwent both ce-CTC and ce-MRC. Ten candidates each received single, double or half-dose Gd-EOB-DTPA. Ce-MRC images with and without inversion recovery pulses (T1w ± IR) were acquired 20–30 min after intravenous contrast injection. Image data was quantitatively and qualitatively reviewed by two radiologists based on a on a 5-point scale. Data sets were compared using a Mann–Whitney-U-test or Wilcoxon-rank-sum-test. Kappa values were also calculated. Results: All image series provided sufficient diagnostic information both showing normal biliary anatomy and variant bile ducts. Ce-CTC showed statistically significant better results compared to all ce-MRC data sets. T1w MRC with single dose Gd-EOB-DTPA proved to be superior to half and double dose in subjective and objective evaluation without a statistically significant difference. Conclusions: Ce-MRC is at any dosage inferior to ce-CTC. As far as preoperative planning of bile duct surgery is focused on the central biliary anatomy, ce-MRC can replace harmful ce-CTC strategies, anyway. Best results were seen with single dose GD-EOB-DTPA on T1w MRC+IR

  10. Dual-energy CT-cholangiography in potential donors for living-related liver transplantation: Improved biliary visualization by intravenous morphine co-medication

    Energy Technology Data Exchange (ETDEWEB)

    Sommer, C.M., E-mail: christof.sommer@med.uni-heidelberg.de [Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg (Germany); Schwarzwaelder, C.B.; Stiller, W. [Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg (Germany); Schindera, S.T. [Department of Diagnostic, Interventional, and Pediatric Radiology, University Hospital and University of Berne, Berne (Switzerland); Heye, T.; Stampfl, U.; Bellemann, N.; Holzschuh, M. [Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg (Germany); Schmidt, J.; Weitz, J. [Department of General, Abdominal and Transplantation Surgery, University Hospital Heidelberg, Heidelberg (Germany); Grenacher, L.; Kauczor, H.U.; Radeleff, B.A. [Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg (Germany)

    2012-09-15

    Purpose: To prospectively evaluate whether intravenous morphine co-medication improves bile duct visualization of dual-energy CT-cholangiography. Materials and methods: Forty potential donors for living-related liver transplantation underwent CT-cholangiography with infusion of a hepatobiliary contrast agent over 40 min. Twenty minutes after the beginning of the contrast agent infusion, either normal saline (n = 20 patients; control group [CG]) or morphine sulfate (n = 20 patients; morphine group [MG]) was injected. Forty-five minutes after initiation of the contrast agent, a dual-energy CT acquisition of the liver was performed. Applying dual-energy post-processing, pure iodine images were generated. Primary study goals were determination of bile duct diameters and visualization scores (on a scale of 0 to 3: 0—not visualized; 3—excellent visualization). Results: Bile duct visualization scores for second-order and third-order branch ducts were significantly higher in the MG compared to the CG (2.9 ± 0.1 versus 2.6 ± 0.2 [P < 0.001] and 2.7 ± 0.3 versus 2.1 ± 0.6 [P < 0.01], respectively). Bile duct diameters for the common duct and main ducts were significantly higher in the MG compared to the CG (5.9 ± 1.3 mm versus 4.9 ± 1.3 mm [P < 0.05] and 3.7 ± 1.3 mm versus 2.6 ± 0.5 mm [P < 0.01], respectively). Conclusion: Intravenous morphine co-medication significantly improved biliary visualization on dual-energy CT-cholangiography in potential donors for living-related liver transplantation.

  11. Bile duct evaluation of potential living liver donors with Gd-EOB-DTPA enhanced MR cholangiography: Single-dose, double dose or half-dose contrast enhanced imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kinner, Sonja, E-mail: Sonja.Kinner@uni-due.de [Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen (Germany); Steinweg, Verena [Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen (Germany); Maderwald, Stefan [Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen (Germany); Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany); Radtke, Arnold; Sotiropoulos, Georgios [Department of General Surgery, University Hospital Essen (Germany); Forsting, Michael; Schroeder, Tobias [Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen (Germany)

    2014-05-15

    Introduction: Detailed knowledge of the biliary anatomy is essential to avoid complications in living donor liver transplantation. The aim of this study was to determine the optimal dosage of Gd-EOB-DTPA for contrast-enhanced magnetic resonance cholangiography (ce-MRC) with reference to contrast-enhanced CT cholangiography (ce-CTC). Materials and methods: 30 potential living liver donors (PLLD) underwent both ce-CTC and ce-MRC. Ten candidates each received single, double or half-dose Gd-EOB-DTPA. Ce-MRC images with and without inversion recovery pulses (T1w ± IR) were acquired 20–30 min after intravenous contrast injection. Image data was quantitatively and qualitatively reviewed by two radiologists based on a on a 5-point scale. Data sets were compared using a Mann–Whitney-U-test or Wilcoxon-rank-sum-test. Kappa values were also calculated. Results: All image series provided sufficient diagnostic information both showing normal biliary anatomy and variant bile ducts. Ce-CTC showed statistically significant better results compared to all ce-MRC data sets. T1w MRC with single dose Gd-EOB-DTPA proved to be superior to half and double dose in subjective and objective evaluation without a statistically significant difference. Conclusions: Ce-MRC is at any dosage inferior to ce-CTC. As far as preoperative planning of bile duct surgery is focused on the central biliary anatomy, ce-MRC can replace harmful ce-CTC strategies, anyway. Best results were seen with single dose GD-EOB-DTPA on T1w MRC+IR.

  12. Substance abuse treatment utilization among adults living with HIV/AIDS and alcohol or drug problems

    OpenAIRE

    Orwat, John; Saitz, Richard; Tompkins, Christopher P.; Cheng, Debbie M; Dentato, Michael P.; Samet, Jeffrey H.

    2011-01-01

    A prospective cohort study to identify factors associated with receipt of substance abuse treatment (SAT) among adults with alcohol problems and HIV/AIDS. Data from the Human Immunodeficiency Virus-Longitudinal Interrelationships of Viruses and Ethanol (HIV-LIVE) study were analyzed. Generalized estimating equation logistic regression models were fit to identify factors associated with any service utilization. An alcohol dependence diagnosis had a negative association with SAT (adjusted odds ...

  13. How Serious Is Erectile Dysfunction in Men's Lives? Comparative Data From Korean Adults

    OpenAIRE

    Ji, Yoon Seob; Choi, Ji Woong; Ko, Young Hwii; Song, Phil Hyun; Jung, Hee Chang; Moon, Ki Hak

    2013-01-01

    Purpose Whereas sexual function has long been assumed to be an important component of adult men's lives, the impact of sexual dysfunction has not been estimated in parallel to other modern disease entities. We compared the seriousness of erectile dysfunction (ED) with that of other diseases by use of self-administered questionnaires. Materials and Methods Between January 2012 and July 2012, 434 healthy male volunteers (group 1) and 263 ED patients (group 2) were enrolled. The questionnaire co...

  14. Building a Comprehensive System of Services to Support Adults Living with Long-Term Mechanical Ventilation.

    Science.gov (United States)

    Leasa, David; Elson, Stephen

    2016-01-01

    Background. Increasing numbers of individuals require long-term mechanical ventilation (LTMV) in the community. In the South West Local Health Integration Network (LHIN) in Ontario, multiple organizations have come together to design, build, and operate a system to serve adults living with LTMV. Objective. The goal was to develop an integrated approach to meet the health and supportive care needs of adults living with LTMV. Methods. The project was undertaken in three phases: System Design, Implementation Planning, and Implementation. Results. There are both qualitative and quantitative evidences that a multiorganizational system of care is now operational and functioning in a way that previously did not exist. An Oversight Committee and an Operations Management Committee currently support the system of services. A Memorandum of Understanding has been signed by the participating organizations. There is case-based evidence that hospital admissions are being avoided, transitions in care are being thoughtfully planned and executed collaboratively among service providers, and new roles and responsibilities are being accepted within the overall system of care. Conclusion. Addressing the complex and variable needs of adults living with LTMV requires a systems response involving the full continuum of care. PMID:27445527

  15. Everyday Living with Diabetes Described by Family Members of Adult People with Type 1 Diabetes

    Directory of Open Access Journals (Sweden)

    Tuula-Maria Rintala

    2013-01-01

    Full Text Available The aim of this study was to explore family members’ experiences of everyday life in families with adult people living with type 1 diabetes. The grounded theory method was used to gather and analyse data from the interviews of nineteen family members. Six concepts describing the family members’ views on everyday living with diabetes were generated on the basis of the data. Everyday life with diabetes is described as being intertwined with hypoglycemia. Becoming acquainted with diabetes takes place little by little. Being involved in the management and watching self-management from the sidelines are concepts describing family members’ participation in the daily management of diabetes. The family members are also integrating diabetes into everyday life. Living on an emotional roller-coaster tells about the thoughts and feelings that family members experience. Family members of adult people with diabetes are involved in the management of the diabetes in many ways and experience many concerns. The family members’ point of view is important to take into consideration when developing education for adults with diabetes.

  16. Clinical analysis of living-related donor kidney transplantation in 40 cases%亲属活体供肾移植40例临床分析

    Institute of Scientific and Technical Information of China (English)

    李聪然; 石炳毅; 蔡明; 李州利; 王爽

    2009-01-01

    总结40例亲属活体肾移植的临床观察要点,以及供者选择、配型结果与移植疗效的关系.选择解放军总医院第二附属医院2007-01/2008-07亲属活体肾移植40例进行回顾性分析,其中夫妻间供肾2例,血缘亲属供肾38例;ABO血型相同38例,相容2例:人类白细胞抗原无错配1例,4位点错配者4例,2位点错配者20例,1位点错配者16例;37例取供者左肾,3例取供者右肾.移植后采用环孢素A或他克莫司、霉酚酸酯及醋酸泼尼松预防排斥反应.39例受者移植肾功能恢复正常时间为(6.17±1.91)d,1例发生移植肾功能延迟恢复,2例移植后发生巨细胞病毒感染,更昔洛韦治疗后痊愈,2例发生肺部感染,减少免疫抑制剂用量及抗感染治疗后痊愈,2例术后3个月内发生急性排斥反应,激素冲击治疗后逆转.全部供者术后恢复顺利,于7~10d内出院,复查肝、肾功能均正常.提示移植前对供、受者双方进行全面评估,对供、受者手术前后特殊情况及时观察、及时处理是亲属活体肾移植预后的关键,对提高生存率,降低感染率有重要意义.%To summarize clinical observation points of living related donor kidney transplantation in 40 cases,as well as the correlation of donor selection,the matching results with efficacy of transplantation.Forty cases underwent living related donor kidney transplantation were selected from the Second Hospital Affiliated to General Hospital of Chinese PLA from January 2007 to July 2008 and were analyzed retrospectively,among these cases,2 were marital donors,38 were relative donors,38 were in the same blood group of ABO,2 were compatible cases;1 was matched in human leukocyte antigen,4 were mismatched in four sites,20 were mismatched in two sites,16 were mismatched in one site;37 cases donated the left kidney,while 3 cases the right kidney.Thirty nine recipients returning to normal renal function following renal transplantation was (6.17 ±1.91)days

  17. Factors related to unmet oral health needs in older adults living in Chile.

    Science.gov (United States)

    Mariño, Rodrigo; Giacaman, Rodrigo A

    2014-01-01

    To assess the oral health status and treatment needs of an ambulant population of older adults, living in the Maule Region, Chile, and provide descriptive information on its distribution by selected socio-demographic characteristics. The source of primary data was the Regional Oral Health Survey. A stratified random sample of 438 older adults, aged 65-74 years, living independently in the community was orally examined, and underwent an oral health interview. The sample was largely a dentate one (74.9%); with a mean DMFT score of 25.7 (s.d. 6.5) and an average number of missing teeth of 22.4 (s.d. 5.8). Dentate participants had 41% of their restorative care needs unmet, and 68.4% needed oral hygiene instruction plus removal of calculus on their teeth. Almost 30.1% required complex periodontal therapy. 21% of those fully edentulous were in need of full dentures. Comparing these findings with existing data on the oral health of older adults in Chile, participants in this study appear to have lower missing teeth scores and less need for complex periodontal treatment. Inequities were apparent in the proportion of unmet restorative and prosthetics needs. Community-based preventive care programs specifically tailored to older adults are needed to address this challenge.

  18. Living donor liver transplantation for end-stage liver disease%活体肝移植治疗终末期肝病

    Institute of Scientific and Technical Information of China (English)

    王学浩; 张峰; 李相成; 孔连宝; 孙倍成; 李国强; 成峰; 吕凌

    2008-01-01

    objective To investigate preoperative donor and recipient assessment,choice of surgical options in living donor liver transplantation(LDLT).Methods The clinical data of 95 patients who underwent LDLT from January 1995 to October 2007 in our center were retrospectively analyzed.Of all,92 recipients were benign end-stage liver disease patients (including 45 patients with Wilson disease),and 3 were malignant hepatic carcinbma patients.Results Thirty-one fight lobes without middle hepatic vein(MHV),3 right lobes with MHV,51 left lobes with MHV.and 10 left lobes or left lateral lobes without MHV were obtained.All the donors recovered after operation. Recipients with benign end-stage liver disease were followed up for 1 to 86 months,and the 1-,3-,5-year accumulative survival rates were 89%(82 cases),78%(71 cases)and 73%(67 cases),respectively. The 1-,3-,5-year survival rates of patients with Wilson disease were 92%(42 cases),89%(40 cases)and 76%(34 cases),respectively. For the 3 patients with malignant hepatic carcinoma,2 died and 1 was alive and well. The copper metabolism was back to normal in both donors and recipients. Conclusions Establishment of a system for the safety of donors is basic for LDLT. The key to raise the recipients' survival rates is to choose the optimal surgical approach. LDLT is effective in treating Wilson disease.%目的 探讨活体肝移植(1iving donor liver transplantation,LDLT)供、受者术前评估和手术方式的选择.方法 回顾性分析1995年1月至2007年10月我中心95例LDLT患者的临床资料.良性终末期肝病92例,其中Wilson病45例;肝脏恶性肿瘤3例.结果 供肝切取不带肝中静脉右半肝31例,带肝中静脉右半肝3例,带肝中静脉左半肝51例,不带肝中静脉左半肝或左外叶10例.所有供者术后顺利恢复,均未出现严重并发症.受者随访1~86个月,良性终末期肝病受者1、3、5年累积生存率分别为89%(82例)、78%(71例)和73%(67例),其中Wilson病受者1、3

  19. 活体肝移植治疗HBV相关性急性亚急性肝功能衰竭%Living donor liver transplantation for hepatitis B virus related acute or subacute liver failure

    Institute of Scientific and Technical Information of China (English)

    杨占宇; 董家鸿; 王曙光; 别平; 刘祥德; 卢倩

    2008-01-01

    目的 探讨活体肝移植(living donor liver transplantation,LDLT)HBV感染导致的急性肝功能衰竭(acute liver failure,ALF)和亚急性肝功能衰竭(subacute liver failure,SALF)患者的可行性,并评价其疗效.方法 回顾性分析2000年11月至2007年10月完成的10例LDLT治疗ALF、SALF患者的临床资料.10例LDLT的供、受者均为成人,切取右半肝为移植物,8例含肝中静脉(middle hepatic vein,MHV).10例供者的评估均在确定实施LDLT的24 h内完成,供、受者手术均在确定供者后的12 h内完成.移植物质量与受者体质量比为(1.03±0.17)%(0.86%~1.22%),移植物体积与受者标准肝体积比为(52.2±11.8)%(47.6%~70.1%).结果 10例受者中,2例分别于术后7、28 d时因肺部感染、十二指肠球部溃疡穿孔腹腔感染死亡.1例胆管吻合口胆漏,经十二指肠镜下置入鼻胆管引流治愈.2例术后1周出现轻度急性排斥反应,增强免疫抑制强度后肝功能恢复正常.8例中位随访期9.6个月(2~84个月),生存质量优良.10例供者中,1例出现急性门静脉高压症导致脾脏破裂,行脾脏切除术,其后出现胆管断端胆漏,经鼻胆管引流结合经皮穿刺腹腔引流治愈.其余9例无并发症发生.结论 LDLT适宜治疗HBV感染导致的ALF、SALF,而且能获得较好的中、远期疗效.%Objective To investigate the feasibility and evaluate the outcome of living donor.liver transplantation(LDLT) for hepatitis B virus(HBV)related acute liver failure(ALF)or subacute liver failure (SALF).Methods A retrospective analysis was done based on the clinical data of 10 patients with ALF or SALF who underwent LDLT from November 2000 to October 2007. All the liver grafts,including right lobe with middle hepatic vein(MHV)(n=8)and right lobe without MHV(n=2),were obtained from adult donors.The Drocess of donor evaluation was accomplished within 12 hours after making the decision of LDLT, and the donor and recipient operation was performed

  20. Effect of living donor liver transplantation on outcome of children with inherited liver disease and hepatocellular carcinoma.

    Science.gov (United States)

    Ozçay, Figen; Canan, Oğuz; Bilezikçi, Banu; Torgay, Adnan; Karakayali, Hamdi; Haberal, Mehmet

    2006-01-01

    We described six children with heritable liver disease and hepatocellular carcinoma treated with living-related liver transplantation. Underlying liver diseases were type-1 tyrosinemia (three patients), progressive familial intrahepatic cholestasis type II (two patients), and Wilson's disease (one patient). Two of the tumors were found incidentally during liver transplantation. Number of nodules was 12, 15, 3, 2, and 1 (in two patients). Three patients were treated with chemotherapy before the procedure. Chemotherapy was not given to any patient after liver transplantation. The mean follow-up was 17.7 +/- 6 months (range: 7-24). All patients are tumor recurrence free. Both graft and patient survival rates are 100% at a median of 18.5 months follow-up. Physicians in charge of treating children with heritable liver disease should screen them periodically for the development of hepatocellular carcinoma. Liver transplantation may offer these children better survival rates.

  1. Supports for and Barriers to Healthy Living for Native Hawaiian Young Adults Enrolled in Community Colleges

    Directory of Open Access Journals (Sweden)

    Jamie K. Boyd, PhD, APRN

    2007-10-01

    Full Text Available IntroductionPhysical inactivity and lower levels of education are associated with increased risk for obesity and chronic disease. Compared with other racial/ethnic groups in Hawai‘i, Native Hawaiians have a higher prevalence of chronic disease, including diabetes, cancer, and cardiovascular disease. In 2000, 72.5% of Native Hawaiians were overweight, 54.4% met national recommendations for physical activity, and about 10% enrolled in college.MethodsWe conducted four focus groups involving 32 Native Hawaiian young adults enrolled in community (i.e., 2-year colleges to explore perceived supports for and barriers to living a healthy lifestyle. Questions were based on social marketing concepts and proven physical activity strategies. We adhered to cultural protocol and engaged 10 key informants to help develop the study. Results of the study were presented to these key informants.ResultsNative Hawaiian young adults perceive themselves as invincible and cited demanding lifestyle and laziness as barriers to increasing their levels of physical activity. Young adults did not define health in terms of individual strength, endurance, and appearance. Rather, they defined it in terms of being purposefully engaged in life’s responsibilities, which include working, going to school, and caring for family. Native Hawaiian young adults expressed preferences for group-oriented and college-course–based opportunities to learn more about healthy living and to be encouraged to become more physically active.ConclusionOur research provides insights into the barriers to and supports for increasing physical activity levels among Native Hawaiian young adults and confirms the importance of talking to targeted end-users before designing interventions.

  2. Disability in instrumental activities of daily living among older adults: gender differences

    Directory of Open Access Journals (Sweden)

    Tiago da Silva Alexandre

    2014-06-01

    Full Text Available OBJECTIVE To analyze gender differences in the incidence and determinants of disability regarding instrumental activities of daily living among older adults. METHODS The data were extracted from the Saúde, Bem-Estar e Envelhecimento (SABE – Health, Wellbeing and Ageing study. In 2000, 1,034 older adults without difficulty in regarding instrumental activities of daily living were selected. The following characteristics were evaluated at the baseline: sociodemographic and behavioral variables, health status, falls, fractures, hospitalizations, depressive symptoms, cognition, strength, mobility, balance and perception of vision and hearing. Instrumental activities of daily living such as shopping and managing own money and medication, using transportation and using the telephone were reassessed in 2006, with incident cases of disability considered as the outcome. RESULTS The incidence density of disability in instrumental activities of daily living was 44.7/1,000 person/years for women and 25.2/1,000 person/years for men. The incidence rate ratio between women and men was 1.77 (95%CI 1.75;1.80. After controlling for socioeconomic status and clinical conditions, the incidence rate ratio was 1.81 (95%CI 1.77;1.84, demonstrating that women with chronic disease and greater social vulnerability have a greater incidence density of disability in instrumental activities of daily living. The following were determinants of the incidence of disability: age ≥ 80 and worse perception of hearing in both genders; stroke in men; and being aged 70 to 79 in women. Better cognitive performance was a protective factor in both genders and better balance was a protective factor in women. CONCLUSIONS The higher incidence density of disability in older women remained even after controlling for adverse social and clinical conditions. In addition to age, poorer cognitive performance and conditions that adversely affect communication disable both genders. Acute events

  3. Young adults' childhood experiences of support when living with a parent with a mental illness.

    Science.gov (United States)

    Nilsson, Stefan; Gustafsson, Lisa; Nolbris, Margaretha Jenholt

    2015-12-01

    There are several concerns in relation to children living with a parent suffering from a mental illness. In such circumstances, the health-care professionals need to involve the whole family, offering help to the parents on parenting as well as support for their children. These children are often helped by participating in meetings that provide them with contact with others with similar experiences. The aim of this study was to investigate young adults' childhood experiences of support groups when living with a mentally ill parent. Seven young women were chosen to participate in this study. A qualitative descriptive method was chosen. The main category emerged as 'the influence of life outside the home because of a parent's mental illness' from the two generic categories: 'a different world' and 'an emotion-filled life'. The participants' friends did not know that their parent was ill and they 'always had to…take responsibility for what happened at home'. These young adults appreciated the support group activities they participated in during their childhood, stating that the meetings had influenced their everyday life as young adults. Despite this, they associated their everyday life with feelings of being different. This study highlights the need for support groups for children whose parents suffer from mental illness. PMID:24486816

  4. Advances in Small-for-Size Syndrome in Living Donor Liver Transplantation%活体肝移植小肝综合征的研究进展

    Institute of Scientific and Technical Information of China (English)

    雷建勇; 严律南; 王文涛; 徐明清; 杨家印

    2011-01-01

    目的 探讨在活体肝移植中小肝综合征发生的原因、预防及治疗方法.方法 复习国内、外近几年活体肝移植术后有关小肝综合征的相关报道.结果 供体年龄、脂肪肝程度、受体术前疾病状态(MELD评分)、术后高门静脉灌注、流出道不畅及移植物大小和质量对活体肝移植术后小肝综合征的发生起着重要作用,术前选择最佳的供体,术中的脾脏切除或脾动脉结扎或对门静脉限流,保证流出道的绝对通畅,术后及早发现并积极治疗能显著减少小肝综合征的发生.结论 小肝综合征的危险因素是可以预测的,积极的应对措施可以用于小肝综合征的预防与治疗.%Objective To review the causes, prevention methods, and therapies of the small-for-size syndrome (SFSS) in living donor liver transplantation (LDLT). Methods The literatures about SFSS in recent years were reviewed and summarized. Results The donor's age, graft steatosis level, MELD score of the recipient, portal hypertension, low outflow, and graft size were risk factors of SFSS. Ideal donor, splenectomy, ligating splenic artery, keeping a satisfactory intraoperative outflow, early diagnosis and active therapy could obviously decrease the incidence of SFSS. Conclusion The risk factors of SFSS can be predicted before operation, and the positive actions can be used to prevent or cure the SFSS.

  5. Merging the person and the illness: the lived experience of emerging adults with childhood onset chronic illness

    OpenAIRE

    MacDermott , Siobhan J.

    2015-01-01

    Chronic illness is emerging as major health problem in the developing and developed world. The increased prevalence of childhood chronic conditions such as asthma and diabetes coupled with the successful management of childhood onset disease has altered the landscape of chronic illness among young people. The purpose of this study is to explore the lived experiences of emerging adults who have grown up and live with chronic illness since childhood. The health of emerging adults (18 to 25 year...

  6. Depression, Social Isolation, and the Lived Experience of Dancing in Disadvantaged Adults.

    Science.gov (United States)

    Murrock, Carolyn J; Graor, Christine Heifner

    2016-02-01

    This qualitative study described the lived experience of dancing as it related to depression and social isolation in 16 disadvantaged adults who completed a 12-week dance intervention. It is the first qualitative study to explore the experience of dance as an adjunct therapy, depression, and social isolation. A descriptive phenomenological framework consisted of two focus groups using semi-structured interviews. A Giorgian approach guided thematic analysis. Four themes emerged: (1) dance for myself and health, (2) social acceptance, (3) connection with others: a group, and (4) not wanting to stop: unexpected benefits from dancing. As the participants continued to dance, they developed a sense of belonging and group identity, which may have maintained group involvement and contributed to reducing depression and social isolation. Thus, dancing is a complementary therapy that should be considered when working with adults with depression and social isolation. PMID:26804498

  7. Back pain in adults living in quilombola territories of Bahia, Northeastern Brazil

    Directory of Open Access Journals (Sweden)

    Luis Rogério Cosme Silva Santos

    2014-10-01

    Full Text Available OBJECTIVE To analyze the factors associated with back pain in adults who live in quilombola territories. METHODS A population-based survey was performed on quilombola communities of Vitória da Conquista, state of Bahia, Northeastern Brazil. The sample (n = 750 was established via a raffle of residences. Semi-structured interviews were conducted to investigate sociodemographics and employment characteristics, lifestyle, and health conditions. The outcome was analyzed as a dichotomous variable (Poisson regression. RESULTS The prevalence of back pain was of 39.3%. Age ≥ 30 years and being a smoker were associated with the outcome. The employment status was not related to back pain. CONCLUSIONS The survey identified a high prevalence of back pain in adults. It is suggested to support the restructuring of the local public service in order to outline programs and access to healthy practices, assistance, diagnosis, and treatment of spine problems.

  8. Living with half a heart - experiences of young adults with single ventricle physiology

    DEFF Research Database (Denmark)

    Overgaard, Dorthe; King, Catriona; Christensen, Rie F;

    2013-01-01

    analyzed by a research group using a phenomenological methodology. RESULTS AND CONCLUSIONS:: The goal for SVP patients is to gain control over their disease to live normal lives. Patients require special support from their core network to overcome physical and psychological challenges. Respondents...... have a 90% survival rate. Several studies have described the somatic status of SVP patients using clinical parameters; however, only a few studies have researched the life perspectives and coping skills in this patient group. The aim of this study was to investigate how young adults with an SVP...... diagnosis are coping with adulthood and the emotional experiences of daily life. SUBJECTS AND METHODS:: Semistructured, qualitative interviews were held with 11 SVP respondents, selected by physical and psychological parameters identified in an earlier quantitative study. Data from the interviews were...

  9. Living With Half a Heart - Experiences of Young Adults With Single Ventricle Physiology

    DEFF Research Database (Denmark)

    Overgaard, Dorthe; King, Catriona; Christensen, Rie F;

    2013-01-01

    Research (UCSF), Rigshospitalet, Copenhagen, Denmark. Abstract BACKGROUND AND RESEARCH OBJECTIVE: Approximately 3% of children with congenital heart disease born in Denmark have single ventricle physiology (SVP). In previous decades, these children did not survive into adulthood. However, because of new......J Cardiovasc Nurs 2013;28(2):187-96 Living With Half a Heart-Experiences of Young Adults With Single Ventricle Physiology: A Qualitative Study. Overgaard D, King C, Christensen RF, Schrader AM, Adamsen L. SourceDorthe Overgaard, PhD, RN Researcher, The Heart Centre, Copenhagen University Hospital...

  10. Improving food and fluid intake for older adults living in long-term care

    DEFF Research Database (Denmark)

    Keller, Heather; Beck, Anne Marie; Namasivayam, Ashwini

    2015-01-01

    Poor food and fluid intake and malnutrition are endemic among older adults in long-term care (LTC), yet feasible and sustainable interventions that target key determinants and improve person-centered outcomes remain elusive. Without a comprehensive study addressing a range of determinants...... intake for persons living in LTC. Top determinants to address with intervention research included social interactions of residents at mealtime; self-feeding ability; the dining environment; the attitudes, knowledge, and skills of staff; adequate time to eat/availability of staff to provide assistance...

  11. Recruiting Older Adults into a Physical Activity Promotion Program: "Active Living Every Day" Offered in a Naturally Occurring Retirement Community

    Science.gov (United States)

    Hildebrand, Mary; Neufeld, Peggy

    2009-01-01

    Purpose: This article explores recruitment strategies based on the transtheoretical model (TTM) with older adults living in a naturally occurring retirement community (NORC) to encourage enrollment in a physical activity promotion program, "Active Living Every Day" (ALED). Reasons for participation or nonparticipation are identified. Design and…

  12. Putting Children on the Path to Becoming Responsible Adults: The Perspective of One Parent Living in the United Arab Emirates

    Science.gov (United States)

    Baker, Fiona S.

    2013-01-01

    Many parents seeking a sound education for their children are looking beyond the narrow boundaries of test scores into the realm of character education. This article explores how parenting approaches can help children live fulfilling lives in the present and also prepare them for future adult roles in personal, social, and professional spheres.…

  13. The Relationship between Autistic Symptomatology and Independent Living Skills in Adolescents and Young Adults with Fragile X Syndrome

    Science.gov (United States)

    Hustyi, Kristin M.; Hall, Scott S.; Quintin, Eve-Marie; Chromik, Lindsay C.; Lightbody, Amy A.; Reiss, Allan L.

    2015-01-01

    Few studies have examined the relationship between autistic symptomatology and competence in independent living skills in adolescents and young adults with fragile X syndrome (FXS). In this study, 70 individuals with FXS, aged 15-25 years, and 35 matched controls were administered direct measures of independent living skills and autistic…

  14. 无血缘夫妻活体供肾7例肾移植%Unrelated spouse living donor kidney transplantation in 7 cases

    Institute of Scientific and Technical Information of China (English)

    曲青山; 郭娟; 苗书斋; 刘旭华; 邢利; 张彦选

    2011-01-01

    BACKGROUND: It is a hot research point that immune tolerance to facilitate long-term survival in organ transplantations produced by induction for transplant recipients-receptor chimera receptor, and a number of successful experience and knowledge has been obtained in experimental animal models. The clinical practice also showed that the compared with other relatives, the rejection of husband-wife after organ transplantation is smaller.OBJECTIVE: To investigate clinical effects of unrelated living donor kidney transplantation (husband to his wife).METHODS: A retrospective analysis of 7 recipients receiving spousal renal donor transplantation was performed. The ages of donors