A Potential Solution to Make the Best Use of a Living Donor-Deceased Donor List Exchange

2016 ◽  
Vol 16 (12) ◽  
pp. 3580-3580 ◽  
Author(s):  
V. B. Kute ◽  
H. V. Patel ◽  
P. R. Shah ◽  
P. R. Modi ◽  
V. R. Shah ◽  
...  
Keyword(s):  
Living Donor ◽  
Deceased Donor ◽  
Potential Solution ◽  
List Exchange

scholarly journals Prediction model for early graft failure after liver transplantation using aspartate aminotransferase, total bilirubin and coagulation factor

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jinsoo Rhu ◽  
Jong Man Kim ◽  
Kyunga Kim ◽  
Heejin Yoo ◽  
Gyu-Seong Choi ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Prediction Model ◽  
Aspartate Aminotransferase ◽  
Graft Failure ◽  
Living Donor ◽  
Total Bilirubin ◽  
Deceased Donor ◽  
Time Dependent ◽  
Early Graft ◽  
Early Graft Failure

AbstractThis study was designed to build models predicting early graft failure after liver transplantation. Cox regression model for predicting early graft failure after liver transplantation using post-transplantation aspartate aminotransferase, total bilirubin, and international normalized ratio of prothrombin time was constructed based on data from both living donor (n = 1153) and deceased donor (n = 359) liver transplantation performed during 2004 to 2018. The model was compared with Model for Early Allograft Function Scoring (MEAF) and early allograft dysfunction (EAD) with their C-index and time-dependent area-under-curve (AUC). The C-index of the model for living donor (0.73, CI = 0.67–0.79) was significantly higher compared to those of both MEAF (0.69, P = 0.03) and EAD (0.66, P = 0.001) while C-index for deceased donor (0.74, CI = 0.65–0.83) was only significantly higher compared to C-index of EAD. (0.66, P = 0.002) Time-dependent AUC at 2 weeks of living donor (0.96, CI = 0.91–1.00) and deceased donor (0.98, CI = 0.96–1.00) were significantly higher compared to those of EAD. (both 0.83, P < 0.001 for living donor and deceased donor) Time-dependent AUC at 4 weeks of living donor (0.93, CI = 0.86–0.99) was significantly higher compared to those of both MEAF (0.87, P = 0.02) and EAD. (0.84, P = 0.02) Time-dependent AUC at 4 weeks of deceased donor (0.94, CI = 0.89–1.00) was significantly higher compared to both MEAF (0.82, P = 0.02) and EAD. (0.81, P < 0.001). The prediction model for early graft failure after liver transplantation showed high predictability and validity with higher predictability compared to traditional models for both living donor and deceased donor liver transplantation.

scholarly journals Aggravation of fibrin deposition and microthrombus formation within the graft during kidney transplantation

2021 ◽  
Author(s):  
Tamar A.J. van den Berg ◽  
Marius C. van den Heuvel ◽  
Janneke Wiersema-Buist ◽  
Jelle Adelmeijer ◽  
Gertrude J. Nieuwenhuijs-Moeke ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Living Donor ◽  
Graft Function ◽  
Deceased Donor ◽  
Potential Difference ◽  
Fibrin Deposition ◽  
Peritubular Capillaries ◽  
Deposition Intensity

Abstract In kidney transplantation, microthrombi and fibrin deposition may lead to local perfusion disorders and subsequently poor initial graft function. Microthrombi are often regarded as donor-derived. However, the incidence, time of development, and potential difference between living donor kidneys (LDK) and deceased donor kidneys(DDK), remains unclear. Two open-needle biopsies, taken at preimplantation and after reperfusion, were obtained from 17 LDK and 28 DDK transplanted between 2005 and 2008. Paraffin-embedded sections were immunohistochemically stained with anti-fibrinogen antibody. Fibrin deposition intensity in peritubular capillaries(PTC) and glomeruli was categorized as negative, weak, moderate or strong and the number of microthrombi/mm2 was quantified. Reperfusion biopsies showed more fibrin deposition (20–100% moderate/strong, p < 0.001) and more microthrombi/mm2 (0.97 ± 1.12 vs. 0.28 ± 0.53, p < 0.01) than preimplantation biopsies. In addition, more microthrombi/mm2 (0.38 ± 0.61 vs. 0.09 ± 0.22, p = 0.02) and stronger fibrin intensity in glomeruli (28% vs. 0%, p < 0.01) and PTC (14% vs. 0%, p = 0.02) were observed in preimplantation DDK than LDK biopsies. After reperfusion, microthrombi/mm2 were comparable (p = 0.23) for LDK (0.09 ± 0.22 to 0.76 ± 0.49, p = 0.03) and DDK (0.38 ± 0.61 to 0.90 ± 1.11, p = 0.07). Upon reperfusion, there is an aggravation of microthrombus formation and fibrin deposition within the graft. The prominent increase of microthrombi in LDK indicates that they are not merely donor-derived.

scholarly journals Hospitalization Rates Before and After Adult-to-Adult Living Donor or Deceased Donor Liver Transplantation

2010 ◽  
Vol 251 (3) ◽  
pp. 542-549 ◽  
Author(s):  
Robert M. Merion ◽  
Tempie H. Shearon ◽  
Carl L. Berg ◽  
James E. Everhart ◽  
Michael M. Abecassis ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Living Donor ◽  
Deceased Donor ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Hospitalization Rates ◽  
Deceased Donor Liver Transplantation ◽  
Before And After

Revaluation and lessons learned from the first 9 cases of a Czech uterus transplantation trial: Four deceased donor and 5 living donor uterus transplantations

2018 ◽  
Vol 19 (3) ◽  
pp. 855-864 ◽  
Author(s):  
Roman Chmel ◽  
Marta Novackova ◽  
Libor Janousek ◽  
Jan Matecha ◽  
Zlatko Pastor ◽  
...  
Keyword(s):  
Living Donor ◽  
Deceased Donor ◽  
Lessons Learned ◽  
Uterus Transplantation

Expanding Living Donor Liver Transplantation

2021 ◽  
pp. 214-240
Author(s):  
Lainie Friedman ◽  
J. Richard Thistlethwaite, Jr
Keyword(s):  
Liver Transplantation ◽  
Young Children ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Ethical Issues ◽  
Deceased Donor ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Split Liver ◽  
Donor Liver Transplant

In the 1980s in the United States (US), young children in liver failure were at proportionately greater risk of dying on the deceased donor liver transplant (DDLT) waitlist than adults because of the lack of appropriately sized grafts. This led to the development of two deceased donor liver techniques—reduced-size (trimming the graft to decrease its size) and split-liver (where one liver could provide grafts to two candidates). These developments decreased but did not eliminate waitlist mortality for young children. Split-liver DDLT paved the way for living donor liver transplantation (LDLT) in children using the lateral segments of the left lobe. Pediatric LDLT began slowly at only a few centers with successful donor and recipient results. Adult-to-adult LDLT expanded quickly despite many US programs having limited experience, low volumes, and significant donor morbidity. The ethical issues raised by the rapid expansion of adult-to-adult LDLT in the US are discussed.

scholarly journals COVID-19 and Living Donor Kidney Transplantation in Naples during the Pandemic

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Gaia Peluso ◽  
Silvia Campanile ◽  
Alessandro Scotti ◽  
Vincenzo Tammaro ◽  
Akbar Jamshidi ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Living Donor ◽  
Viral Infections ◽  
Elective Surgery ◽  
Deceased Donor ◽  
Kidney Transplants ◽  
Donor Kidney ◽  
Transplant Center ◽  
Living Donor Transplantation ◽  
Donor Kidney Transplantation

Introduction. SARS-CoV-2 is a virus that causes a potentially deadly syndrome that affects especially the respiratory tract. Kidney-transplanted patients are immunosuppressed and more susceptible to viral infections. We have examined our transplantation activity to explore the future role of kidney transplantation from deceased and living donors in COVID-19 era. Patients and Methods. The activity of our transplant center of Naples (one of the two transplant centers in Campania, South Italy) continued during the COVID-19 pandemic. We have analysed the kidney transplants carried out between March 9 and June 9, 2020, comparing these data with the numbers of procedures performed in the two previous years. Moreover, we have considered the possibility of performing living donor transplants during a worldwide pandemic. Results. From March 9, 2020, when the Italian lockdown begun, till June 9, 2020, five kidney transplants have been performed at our transplant center in Naples, all from deceased donors. The donors and the recipients have been screened for COVID-19 infection, and the patients, all asymptomatic, followed strict preventive measures and were fully informed about the risks of surgery and immunosuppression during a pandemic. All the transplanted patients remained COVID negative during the follow-up. The number of transplants performed has been constant compared to the same months of 2018 and 2019. In agreement with the patients, we decided to postpone living donor transplants to a period of greater control of the SARS-CoV-2 spread in Italy. Conclusion. Deceased donor kidney transplantation should continue, especially in a region with moderate risk, like Campania, with a more careful selection of donors and recipients, preferring standard donors and recipients without severe comorbidities. Living donor transplantation program, instead, should be postponed to a period of greater control of the SARS-CoV-2 spread, as it is an elective surgery and its delay does not determine additional risks for patients.

scholarly journals Incentivized Kidney Exchange

2020 ◽  
Vol 110 (7) ◽  
pp. 2198-2224 ◽  
Author(s):  
Tayfun Sönmez ◽  
M. Utku Ünver ◽  
M. Bumin Yenmez
Keyword(s):  
Renal Failure ◽  
Continuum Model ◽  
Living Donor ◽  
Deceased Donor ◽  
Kidney Exchange ◽  
Welfare Benefits

Over the last 15 years, kidney exchange has become a mainstream paradigm to increase transplants. However, compatible pairs do not participate, and full benefits from exchange can be realized only if they do. We propose incentivizing compatible pairs to participate in exchange by insuring their patients against future renal failure via increased priority in deceased-donor queue. We analyze equity and welfare benefits of this scheme through a new dynamic continuum model. We calibrate the model with US data and quantify substantial gains from adopting incentivized exchange, both in terms of access to living-donor transplants and reduced competition for deceased-donor transplants. (JEL D47, I11, I12, I18)

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