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Kikuchi R, Kamibeppu K. Parents' quality of life and family functioning in pediatric organ transplantation. J Pediatr Nurs 2015; 30:463-77. [PMID: 25605616 DOI: 10.1016/j.pedn.2014.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 12/16/2014] [Accepted: 12/19/2014] [Indexed: 11/15/2022]
Abstract
Solid organ transplantation is an important treatment option for pediatric patients in end-stage organ failure. The impact of pediatric organ transplantation on parents' quality of life and family functioning has been found to be substantial, but findings on this topic have not previously been consolidated. Thirty-one studies were selected for analysis after a database search on this topic. We present future research questions and suggestions to improve clinical practice based on the integration of this knowledge.
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Affiliation(s)
- Ryota Kikuchi
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, the University of Tokyo.
| | - Kiyoko Kamibeppu
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, the University of Tokyo
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DiMartini AF, Dew MA, Butt Z, Simpson MA, Ladner DP, Smith AR, Hill-Callahan P, Gillespie BW. Patterns and predictors of sexual function after liver donation: The Adult-to-Adult Living Donor Liver Transplantation Cohort study. Liver Transpl 2015; 21:670-82. [PMID: 25779554 PMCID: PMC4412809 DOI: 10.1002/lt.24108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 01/29/2015] [Accepted: 02/08/2015] [Indexed: 12/31/2022]
Abstract
Although sexual functioning is an important facet of a living donor's quality of life, it has not received an extensive evaluation in this population. Using data from the Adult-to-Adult Living Donor Liver Transplantation Cohort Study, we examined donor sexual functioning across the donation process from the predonation evaluation to 3 months and 1 year after donation. Donors (n = 208) and a comparison group of nondonors (n = 155) completed self-reported surveys with specific questions on sexual desire, satisfaction, orgasm, and (for men) erectile function. Across the 3 time points, donor sexual functioning was lower at the evaluation phase and 3 months after donation versus 1 year after donation. In the early recovery period, abdominal pain was associated with difficulty reaching orgasm [odds ratio (OR), 3.98; 95% confidence interval (CI), 1.30-12.16], concerns over appearance were associated with lower sexual desire (OR, 4.14; 95% CI, 1.02-16.79), and not feeling back to normal was associated with dissatisfaction with sexual life (OR, 3.58; 95% CI, 1.43-8.99). Efforts to educate donors before the surgery and prepare them for the early recovery phase may improve recovery and reduce distress regarding sexual functioning.
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Affiliation(s)
- AF. DiMartini
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA,Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - MA. Dew
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA,Department of Psychology, University of Pittsburgh, Pittsburgh, PA,Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA,Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA
| | - Z. Butt
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL,Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Northwestern University Feinberg School of Medicine, Chicago, IL,Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - MA. Simpson
- Lahey Hospital and Medical Center Clinical Research and Education and Department of Transplantation, Burlington, MA
| | - DP. Ladner
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL,Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Northwestern University Feinberg School of Medicine, Chicago, IL,Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL,Center for Healthcare Studies at the Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - AR. Smith
- Department of Biostatistics, University of Michigan, Ann Arbor, MI,Arbor Research Collaborative for Health, Ann Arbor, MI
| | | | - BW. Gillespie
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
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Ladner DP, Dew MA, Forney S, Gillespie BW, Brown RS, Merion RM, Freise CE, Hayashi PH, Hong JC, Ashworth A, Berg CL, Burton JR, Shaked A, Butt Z. Long-term quality of life after liver donation in the adult to adult living donor liver transplantation cohort study (A2ALL). J Hepatol 2015; 62:346-53. [PMID: 25195558 PMCID: PMC4300258 DOI: 10.1016/j.jhep.2014.08.043] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 08/21/2014] [Accepted: 08/29/2014] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS There are few long-term studies of the health-related quality of life (HRQOL) in living liver donors. This study aimed to characterize donor HRQOL in the Adult to Adult Living Donor Liver Transplantation Study (A2ALL) up to 11 years post-donation. METHODS Between 2004 and 2013, HRQOL was assessed at evaluation, at 3 months, and yearly post-donation in prevalent liver donors using the short-form survey (SF-36), which provides a physical (PCS) and a mental component summary (MCS). RESULTS Of the 458 donors enrolled in A2ALL, 374 (82%) had SF-36 data. Mean age at evaluation was 38 (range 18-63), 47% were male, 93% white, and 43% had a bachelor's degree or higher. MCS and PCS means were above the US population at all time points. However, at every time point there were some donors who reported poor scores (>1/2 standard deviation below the age and sex adjusted mean) (PCS: 5.3-26.8%, MCS 10.0-25.0%). Predictors of poor PCS and MCS scores included recipient's death within the two years prior to the survey and education less than a bachelor's degree; poor PCS scores were also predicted by time since donation, Hispanic ethnicity, and at the 3-month post-donation time point. CONCLUSIONS In summary, most living donors maintain above average HRQOL up to 11 years prospectively, supporting the notion that living donation does not negatively affect HRQOL. However, targeted support for donors at risk for poor HRQOL may improve overall HRQOL outcomes for living liver donors.
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Affiliation(s)
- Daniela P. Ladner
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University, Chicago, IL, United States
| | - Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology and Biostatistics, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA, United States
| | - Sarah Forney
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States
| | - Brenda W. Gillespie
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States
| | - Robert S. Brown
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Robert M. Merion
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Chris E. Freise
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Paul H. Hayashi
- Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Johnny C. Hong
- Department of Surgery, Medical College of Wisconsin, WI, United States
| | - April Ashworth
- Virginia Commonwealth University, Richmond, VA, United States
| | - Carl L. Berg
- Duke University Health System, Durham, North Carolina, United States
| | - James R. Burton
- Department of Medicine, University of Colorado, Aurora, CO, United States
| | - Abraham Shaked
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Zeeshan Butt
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University, Chicago, IL, United States, Department of Medical Social Sciences, Northwestern University Feinberg School of ssMedicine, Chicago, IL, United States, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Ríos A, López-Navas AI, Ayala-García MA, Sebastián MJ, Abdo-Cuza A, Martínez-Alarcón L, Ramírez EJ, Muñoz G, Palacios G, Suárez-López J, Castellanos R, González B, Martínez MA, Díaz E, Ramírez P, Parrilla P. [Hospital-based multicenter study in Spain, Mexico and Cuba on attitudes to living liver donation]. GASTROENTEROLOGIA Y HEPATOLOGIA 2015; 38:364-72. [PMID: 25623418 DOI: 10.1016/j.gastrohep.2014.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 10/29/2014] [Accepted: 12/11/2014] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Given the lack of a sufficient number of livers available for transplantation, living liver donation (LLD) is being developed in the Spanish-speaking world. To do this, it is essential that health workers in hospitals are in favor of such donation, given that they are a key component in this treatment and that their attitudes influence public opinion. OBJECTIVE To analyze attitude toward LLD among hospital personnel from healthcare centers in Spain and Latin America. MATERIAL AND METHOD Ten hospitals were selected from the «International Donor Collaborative Project»: 3 from Spain, 5 from Mexico and 2 from Cuba. Random sampling stratified by type of service and job category was used. Attitudes to LLD were evaluated through a validated questionnaire on psychosocial aspects. The questionnaire was anonymous and self-administered. Statistical tests consisted of Student's T test, the chi-square test and logistic regression analysis. RESULTS Of the 2,618 employees surveyed, 85% (n=2,231) were in favor of related LLD; of these, 31% (n=804) were in favor of unrelated LLD. No association was found between the country of the interviewed, personal-social variables or work-related variables. The following factors were associated with a favorable attitude toward related LLD donation: having had personal experience of donation and transplantation (P<.001); being in favor of deceased donation (P<.001); believing that one might need a possible transplant (P<.001); being in favor of living kidney donation (P<.001); being willing to accept a liver from a living donor (P<.001); having discussed the matter of donation and transplantation within the family (P<.001) and with one's partner (P<.001); carrying out pro-social type activities (P<.001); being Catholic (P=.040); believing that one's religion is in favor of donation and transplantation (P<.001); and not being concerned about the possible mutilation of the body after donation (P<.001). CONCLUSIONS Hospital personnel from Spain and Latin America had a favorable attitude toward LLD, which was associated with factors directly and indirectly related to donation and transplantation, family and religious factors, and attitudes toward the body.
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Affiliation(s)
- Antonio Ríos
- Proyecto Colaborativo Internacional Donante, Murcia, España; Coordinación Regional de Trasplantes, Consejería de Sanidad y Consumo de la Región de Murcia, España; Unidad de Trasplantes, Servicio de Cirugía, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Departamento de Cirugía, Ginecología y Pediatría, Universidad de Murcia, Murcia. España.
| | - Ana Isabel López-Navas
- Proyecto Colaborativo Internacional Donante, Murcia, España; Coordinación Regional de Trasplantes, Consejería de Sanidad y Consumo de la Región de Murcia, España; Departamento de Psicología, Universidad Católica de San Antonio, Universidad Católica de San Antonio de Murcia, Murcia, España
| | - Marco Antonio Ayala-García
- Hospital Regional de Alta Especialidad del Bajío, León, Guanajuato, México; Hospital General de SubZona n.(o) 10 del Instituto Mexicano del Seguro Social, Delegación Guanajuato, México
| | - María José Sebastián
- Centro de Coordinación de Trasplantes, Unidad Médica de Alta Especialidad, Hospital de Especialidades n.(o) 25 Instituto Mexicano del Seguro Social (IMSS), Monterrey, México
| | | | - Laura Martínez-Alarcón
- Proyecto Colaborativo Internacional Donante, Murcia, España; Coordinación Regional de Trasplantes, Consejería de Sanidad y Consumo de la Región de Murcia, España; Unidad de Trasplantes, Servicio de Cirugía, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | | | - Gerardo Muñoz
- Centro Médico Nacional Siglo XXI del Instituto Mexicano del Seguro Social, México
| | - Gerardo Palacios
- Centro de Coordinación de Trasplantes, Unidad Médica de Alta Especialidad, Hospital de Especialidades n.(o) 25 Instituto Mexicano del Seguro Social (IMSS), Monterrey, México
| | | | | | - Beatríz González
- Hospital Regional de Alta Especialidad del Bajío, León, Guanajuato, México; Universidad de Guanajuato, Guanajuato, México
| | | | - Ernesto Díaz
- Hospital Regional de Alta Especialidad del Bajío, León, Guanajuato, México; Hospital General de SubZona n.(o) 10 del Instituto Mexicano del Seguro Social, Delegación Guanajuato, México
| | - Pablo Ramírez
- Proyecto Colaborativo Internacional Donante, Murcia, España; Coordinación Regional de Trasplantes, Consejería de Sanidad y Consumo de la Región de Murcia, España; Unidad de Trasplantes, Servicio de Cirugía, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Departamento de Cirugía, Ginecología y Pediatría, Universidad de Murcia, Murcia. España
| | - Pascual Parrilla
- Unidad de Trasplantes, Servicio de Cirugía, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Departamento de Cirugía, Ginecología y Pediatría, Universidad de Murcia, Murcia. España
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Xu DW, Long XD, Xia Q. A review of life quality in living donors after liver transplantation. Int J Clin Exp Med 2015; 8:20-26. [PMID: 25784970 PMCID: PMC4358425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/07/2015] [Indexed: 06/04/2023]
Abstract
Living-donor liver transplantation (LDLT) has increasingly performed all around the world. However, LDLT donors achieve no medical benefits and are exposed to the risk of complications, and even death. The potential effects of LDLT on donor safety, donor recovery, and post-donation psychological impairment are essential to be better understood. We searched the MEDLINE database to identify articles about the quality of life (QOL) in adults after LDLT donation. Twenty-eight studies with a total of 1944 donors were included in the review. 14 of the 28 studies (50%) had a cross-sectional design, and the remaining half had a prospective design. The Physical Component Score (PCS) decreased immediately after the donation, then returned to the baseline within 6 to 12 months while the Mental Component Score (MCS) remains comparable to that of normative population throughout the procedure. Compared with the left graft (LG) donors, right graft (RG) donors were significantly older, had longer hospital stays and higher rates of postoperative complications, and a higher recipient mortality rate, while there were no difference in the PCS and MCS between the two groups. Our review clearly indicates that the LDLT donors can endure the donation procedure and return to their normal daily life without major problem in the short term. However, to improve the donor selection criteria and ensure the QOL in donors throughout donation procedure, more studies with longer follow up and larger samples are essential and predictors of poor QOL should be identified in study with sufficient response rate and ideal control groups.
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Affiliation(s)
- Dong-Wei Xu
- Department of Liver Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai 200127, China
| | - Xi-Dai Long
- Department of Liver Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai 200127, China
- Department of Pathology, Youjiang Medical College for NationalitiesBaise 533000, China
| | - Qiang Xia
- Department of Liver Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai 200127, China
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Liu X, Hakucho A, Liu J, Fujimiya T. Delayed ethanol elimination and enhanced susceptibility to ethanol-induced hepatosteatosis after liver resection. World J Gastroenterol 2014; 20:18249-18259. [PMID: 25561792 PMCID: PMC4277962 DOI: 10.3748/wjg.v20.i48.18249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 07/04/2014] [Accepted: 07/30/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate ethanol-induced hepatic steatosis after liver resection and the mechanisms behind it.
METHODS: First, the preliminary examination was performed on 6 sham-operated (Sham) and 30 partial hepatectomy (PH) male Wistar rats (8-wk-old) to evaluate the recovery of the liver weight and liver function after liver resection. PH rats were sacrificed at the indicated time points (4, 8, and 12 h; 1, 3, and 7 d) after PH. Second, the time point for the beginning of the chronic ethanol exposure (1 wk after sham- or PH-operation) was determined based on the results of the preliminary examination. Finally, pair-feeding was performed with a controlled diet or with a 5-g/dL ethanol liquid diet for 28 d in another 35 age-matched male Wistar rats with a one-week recovery after undergoing a sham- (n = 15) or PH-operation (n = 20) to evaluate the ethanol-induced liver injury after liver resection. Hepatic steatosis, liver function, fatty acid synthase (Fas) gene expression level, the expression of lipid metabolism-associated enzyme regulator genes [sterol regulatory element binding protein (Srebp)-1 and peroxisome proliferator-activated receptor (Ppar)-α], the mediators that alter lipid metabolism [plasminogen activator (Pai)-1 gene expression level and tumor necrosis factor (Tnf)-α production], and hepatic class-1 alcohol dehydrogenase (Adh1)-associated ethanol elimination were investigated in the 4 groups based on histological, immunohistochemical, biochemical, Western blotting, reverse transcriptase chain reaction, and blood ethanol concentration analyses. The relevant gene expression levels, liver weight, and liver function were assessed before and 1 wk after surgery to determine the subject’s recovery from the liver resection using the rats that had been subjected to the preliminary examination.
RESULTS: In the PH rats, ethanol induced marked hepatic steatosis with impaired liver functioning, as evidenced by the accumulation of fatty droplets within the hepatocytes, the higher increases in their hepatic triglyceride and blood alanine aminotransferase and blood aspartate aminotransferase levels after the 28-d pair-feeding period. The Sham-ethanol rats, not the PH-ethanol rats, demonstrated the up-regulation of Srebp-1 and the down-regulation of Ppar-α mRNA expression levels after the 28-d pair-feeding period. The 28-d ethanol administration induced the up-regulation of Pai-1 gene expression level and an overproduction of TNF-α in the Sham and the PH rats; however, the effect was more significant in the PH rats. The PH-ethanol rats (n = 4) showed higher residual blood ethanol concentrations than did the Sham-ethanol rats (n = 6) after a 5-h fast (0.66 ± 0.4 mg/mL vs 0.2 ± 0.1 mg/mL, P < 0.05); these effects manifested without up-regulation of Adh1 gene expression, which was present in the Sham-ethanol group after the 28-d pair-feeding period. One week after the liver resection, the liver weight, function, the gene expression levels of Fas, Srebp-1, Ppar-α, Pai-1 and Tnf-α recovered; however, the Adh1 gene expression did not recover in rats.
CONCLUSION: Desensitization to post-hepatectomy ethanol treatment and slow recovery from PH in Adh1 gene expression enhanced the susceptibility to ethanol-induced hepatic steatosis after PH in rats.
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Rios A, Lopez Navas A, Ayala Garcia MA, Sebastian J, Abdo Cuza A, Martinez Alarcon L, Ramirez EJ, Munoz G, Palacios G, Suarez Lopez J, Castellanos R, Gonzalez B, Martinez MA, Diaz E, Ramirez P, Parrilla P. Opinion toward living liver donation of hospital personnel from units related to organ donation and transplantation: a multicenter study from Spain and latin-america. HEPATITIS MONTHLY 2014; 14:e15405. [PMID: 25737727 PMCID: PMC4329234 DOI: 10.5812/hepatmon.15405] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 01/27/2014] [Accepted: 03/12/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hospital personnel of services related to donation and transplantation process play a fundamental role in the development of transplantation. OBJECTIVES The aim of this study was to investigate the attitude toward living liver donation (LLD) among hospital personnel from services related to donation and transplantation in hospital centers in Spain and Latin America. MATERIALS AND METHODS Eight hospitals within the "International Donor Collaborative Project" were selected, three in Spain, three in Mexico and two in Cuba. The study was performed in transplant-related services, using a randomized sample, which was stratified by the type of service and job category. RESULTS In total, 878 workers were surveyed of which 82% (n = 720) were in favor of related LLD, 10% (n = 90) were against and 8% (n = 68) undecided. Attitudes toward related LLD were more favorable in the following groups: the Latin Americans (86% in favor vs. 77% among the Spanish; P = 0.007); younger people (37 vs. 40 years, P = 0.002); those in favor of either deceased donation (P < 0.001) or living kidney donation (P < 0.001); those who believed that they might need a transplant in the future (P < 0.001); those who would accept a liver from a living donor (P < 0.001); those who discussed the subject of donation and transplantation with their families (P = 0.040); and those whose partner was in favor of donation and transplantation (P = 0.044). CONCLUSIONS Personnel from donation and transplantation-related units had a favorable attitude toward LLD. This attitude was not affected by psychosocial factors, although it was influenced by factors directly and indirectly related to the donation and transplantation process.
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Affiliation(s)
- Antonio Rios
- International Collaborative Donor Proyect, Murcia, Spain
- Regional Transplant Center, Ministry of Health, Murcia, Spain
- Transplant Unit, Surgery Service, Virgin of Arrixaca University Hospital, Murcia, Spain
- Department of Surgery, University of Murcia, Murcia, Spain
- Corresponding Author: Antonio Rios, International Collaborative Donor Proyect, Murcia, Spain. Tel: +968-270757; Fax: +968-369716;, E-mail:
| | - Ana Lopez Navas
- International Collaborative Donor Proyect, Murcia, Spain
- Regional Transplant Center, Ministry of Health, Murcia, Spain
- Department of Psychology, San Antonio Catholic University, UCAM, Murcia, Spain
| | - Marco Antonio Ayala Garcia
- Regional Hospital of High Specialty Bajio, Leon, Mexico
- Mexican Social Security Institute Delegation, Guanajuato, Mexico
| | - Jose Sebastian
- Transplant Coordination Center, UMAE Specialist Hospital, Monterrey, Mexico
| | | | - Laura Martinez Alarcon
- International Collaborative Donor Proyect, Murcia, Spain
- Regional Transplant Center, Ministry of Health, Murcia, Spain
- Transplant Unit, Surgery Service, Virgin of Arrixaca University Hospital, Murcia, Spain
| | | | - Gerardo Munoz
- The 21st Century National Medical Center of the Mexican Institute of Social Security, Mexico City, Mexico
| | - Gerardo Palacios
- Transplant Coordination Center, UMAE Specialist Hospital, Monterrey, Mexico
| | | | | | - Beatriz Gonzalez
- Regional Hospital of High Specialty Bajio, Leon, Mexico
- The 21st Century National Medical Center of the Mexican Institute of Social Security, Mexico City, Mexico
| | | | - Ernesto Diaz
- Regional Hospital of High Specialty Bajio, Leon, Mexico
- Mexican Social Security Institute Delegation, Guanajuato, Mexico
| | - Pablo Ramirez
- International Collaborative Donor Proyect, Murcia, Spain
- Regional Transplant Center, Ministry of Health, Murcia, Spain
- Transplant Unit, Surgery Service, Virgin of Arrixaca University Hospital, Murcia, Spain
- Department of Surgery, University of Murcia, Murcia, Spain
| | - Pascual Parrilla
- Transplant Unit, Surgery Service, Virgin of Arrixaca University Hospital, Murcia, Spain
- Department of Surgery, University of Murcia, Murcia, Spain
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Holtzman S, Clarke HA, McCluskey SA, Turcotte K, Grant D, Katz J. Acute and chronic postsurgical pain after living liver donation: Incidence and predictors. Liver Transpl 2014; 20:1336-46. [PMID: 25045167 DOI: 10.1002/lt.23949] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 07/02/2014] [Indexed: 12/12/2022]
Abstract
Despite its prominence as a concern among potential surgical candidates, there is little information in the literature regarding the short- and long-term pain experience after living liver donation. We undertook a prospective study to examine (1) the nature and incidence of acute and chronic pain after living donor hepatectomy and (2) the factors associated with an increased or decreased risk of adverse pain outcomes. Before donation, a comprehensive assessment of potential predictors of acute and chronic pain outcomes was conducted; this included donors' pain expectations, psychosocial factors, medical histories, and demographic factors. Detailed data regarding pain outcomes were collected postoperatively (days 1 and 2) and again during 6- and 12-month follow-up telephone interviews. Sixty-five adults (32 females and 33 males) scheduled for donor hepatectomy participated. Substantial proportions of the donors reported a moderate-to-severe level of pain intensity (≥4 on a 0-10 scale) at rest and after movement on day 1 (42% and 74%, respectively) and day 2 (33% and 32%, respectively). Persistent postsurgical pain was reported by 31% of the donors at the 6-month follow-up and by 27% of the donors at the 12-month follow-up. Generally, this pain was mild, and pain-related life interference was minimal. Female sex, a younger age, and several predonation measures of pain-related anxiety were associated with a significantly greater risk of developing persistent postsurgical pain. In conclusion, this study has identified a subset of patients who experience persistent pain after living liver donation. Additional prospective research using larger samples of liver donors is needed to replicate this work, to obtain a more detailed account of the acute and long-term pain experience, and to determine whether targeted interventions can minimize the frequency and severity of chronic pain.
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Affiliation(s)
- Susan Holtzman
- Department of Psychology, University of British Columbia, Kelowna, Canada
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Rudow DL, Iacoviello BM, Charney D. Resilience and personality traits among living liver and kidney donors. Prog Transplant 2014; 24:82-90. [PMID: 24598570 DOI: 10.7182/pit2014448] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To explore the psychosocial characteristics of living liver and kidney donors to identify common traits including personality traits, purpose in life, resilience, and post donation growth. METHODS Questionnaires were mailed to 835 living donors. Included were a survey of demographic characteristics and donation experiences, the NEO Five-Factor Inventory, the Purpose in Life Scale, the Posttraumatic Growth Inventory, and the Connor-Davidson Resilience Scale. Analyses compared the donor groups with the scale norms (where available) and compared differences between donor groups. RESULTS Eighteen percent of donors (n=151) responded anonymously. The sample was as resilient as the general population and significantly more resilient than the population of primary care patients. Kidney donors were significantly more resilient than liver donors. Live donors demonstrated scores on the NEO Five-Factor Inventory in the "high" range for agreeableness and conscientiousness and "low" for neuroticism. Kidney donors scored significantly lower on the neuroticism scale than liver donors scored. Purpose in Life scores and Post Donation Growth scores were skewed and were overwhelmingly high in this sample. Additional differences in psychosocial variables are also described. CONCLUSION Live donors are resilient and show adaptive personality traits. It is difficult to conclude whether these traits were inspired by the act of donation or if they make one more apt to choose donation. Moreover, the study methods introduce the possibility of selection bias: those with certain characteristics may have been more likely to respond. Prospective studies before and after donation are warranted.
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Molinari M, Matz J, DeCoutere S, El-Tawil K, Abu-Wasel B, Keough V. Live liver donors' risk thresholds: risking a life to save a life. HPB (Oxford) 2014; 16:560-74. [PMID: 24251593 PMCID: PMC4048078 DOI: 10.1111/hpb.12192] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 09/19/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is still some controversy regarding the ethical issues involved in live donor liver transplantation (LDLT) and there is uncertainty on the range of perioperative morbidity and mortality risks that donors will consider acceptable. METHODS This study analysed donors' inclinations towards LDLT using decision analysis techniques based on the probability trade-off (PTO) method. Adult individuals with an emotional or biological relationship with a patient affected by end-stage liver disease were enrolled. Of 122 potential candidates, 100 were included in this study. RESULTS The vast majority of participants (93%) supported LDLT. The most important factor influencing participants' decisions was their wish to improve the recipient's chance of living a longer life. Participants chose to become donors if the recipient was required to wait longer than a mean ± standard deviation (SD) of 6 ± 5 months for a cadaveric graft, if the mean ± SD probability of survival was at least 46 ± 30% at 1 month and at least 36 ± 29% at 1 year, and if the recipient's life could be prolonged for a mean ± SD of at least 11 ± 22 months. CONCLUSIONS Potential donors were risk takers and were willing to donate when given the opportunity. They accepted significant risks, especially if they had a close emotional relationship with the recipient.
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Affiliation(s)
| | - Jacob Matz
- Department of Surgery, Dalhousie UniversityHalifax, NS, Canada
| | - Sarah DeCoutere
- Department of Infectious Disease, Dalhousie UniversityHalifax, NS, Canada
| | - Karim El-Tawil
- Department of Surgery, Dalhousie UniversityHalifax, NS, Canada
| | | | - Valerie Keough
- Department of Radiology, Dalhousie UniversityHalifax, NS, Canada
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Donor quality of life up to two years after living donor liver transplantation: a prospective study. Transplantation 2014; 97:582-9. [PMID: 24595117 DOI: 10.1097/01.tp.0000438206.04348.b2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND There is a lack of longer-term prospective data on living liver donors' quality of life (QOL). This is the first prospective study examining QOL up to 2 years after donation. METHODS A consecutive sample of living donors (n=40) was compared with a sample of potential donors (n=27) with respect to QOL, anxiety, and depression. Performing mixed-effects model analysis, both groups were assessed before transplantation, with and without simultaneous donation (T0), and at three postoperative data points: 3 months (T1), 1 year (T2), and 2 years (T3). Subsequently, both groups were compared with reference data of the general population and healthy individuals. RESULTS At T1, living donors' physical QOL was impaired. At T2 and T3, physical QOL was slightly lower than the preoperative level but within the range of healthy individuals in both living donors and potential donors. Neither mental QOL nor depression showed significant changes across time, while anxiety decreased in both groups. Subgroup analysis of adult-to-adult (AA) donors and adult-to-pediatric (AP) donors revealed different trajectories of mental QOL, anxiety, and depression. AP donors experienced more preoperative psychological strain, which improved after donation, whereas AA donors showed unchanged anxiety and depression, and a slight decrease in mental QOL 2 years after surgery. Two AA donors, whose recipients had died, reported persisting depressive symptoms after donation. CONCLUSIONS One and two years after donation, QOL is not substantially impaired in the majority of donors. Future research needs to provide an even longer prospective follow-up and should more rigorously explore risk factors for a negative donor outcome.
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Fukuda A, Sakamoto S, Shigeta T, Uchida H, Hamano I, Sasaki K, Kanazawa H, Loh DL, Kakee N, Nakazawa A, Kasahara M. Clinical outcomes and evaluation of the quality of life of living donors for pediatric liver transplantation: a single-center analysis of 100 donors. Transplant Proc 2014; 46:1371-6. [PMID: 24836837 DOI: 10.1016/j.transproceed.2013.12.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 12/16/2013] [Indexed: 01/10/2023]
Abstract
There are few reports about the quality of life (QOL) and morbidities of pediatric living donor liver transplantation (LDLT) donors. We evaluated the potential morbidities and identified the predictive factors regarding the QOL of living donors after pediatric LDLT. This cross-sectional study was a single-center analysis of 100 donors for pediatric LDLT. The severity of morbidities was assessed with the Clavien classification, the QOL was investigated with the short form-36 (SF-36), and the decision-making process regarding donation was analyzed with questionnaires. The median follow-up period was 3.8 years (range, 2.2-6.0 years). A total of 13% of the donors developed postoperative complications of Clavien grades I (7%), II (3%), and IIIA (3%). There was no grade IV morbidity or mortality. Eighty-one donors responded to the questionnaire and SF-36. The analysis of the questionnaires revealed that the donors had difficulty in the decision-making process, and suggested that it may be necessary to administer multistep informed consent. We identified unique predictive risk factors for lower SF-36 scores in the donors, which were the time to donation (more than 4 weeks) and the predonation self-oriented perception. The donors who have risk factors require enhanced pre- and post-donation psychological care.
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Affiliation(s)
- A Fukuda
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
| | - S Sakamoto
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - T Shigeta
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - H Uchida
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - I Hamano
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - K Sasaki
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - H Kanazawa
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - D L Loh
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - N Kakee
- Department of Health Policy, National Research Institute for Child Health and Development, Tokyo, Japan
| | - A Nakazawa
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - M Kasahara
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
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Miller-Matero LR, Eshelman A, Paulson D, Armstrong R, Brown KA, Moonka D, Abouljoud M. Beyond survival: how well do transplanted livers work? A preliminary comparison of standard-risk, high-risk, and living donor recipients. Clin Transplant 2014; 28:691-8. [PMID: 24654861 DOI: 10.1111/ctr.12368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2014] [Indexed: 12/17/2022]
Abstract
To help decrease mortality on the liver transplant waitlist, transplant centers are using living donors (LD) and high-risk donors (HRD) in addition to standard-risk donors (SRD). HRD is defined as having a donor risk index score higher than 1.6, which suggests a great risk of graft failure. Recent studies have examined survival rates between HRD and SRD recipients; however, little is known about outcomes other than survival, specifically psychosocial outcomes. The purpose of this preliminary, prospective study was to compare post-transplant psychosocial and recovery outcomes between SRD and LD and HRD liver recipients. These outcomes include cognitive functioning, psychological distress, quality of life, and self-reported and objective measures of recovery. Eighty-four patients provided baseline and six-month post-transplant data. There were generally no statistically significant differences at baseline or the six-month follow-up, suggesting that patients receiving HRD livers have similar outcomes to those who receive SRD livers. However, some effect sizes suggest potential advantages for LD recipients compared to SRD recipients. Transplant centers may be more willing to encourage patients to accept HRD or LD livers knowing that they may have comparable outcomes to SRD recipients, which also has implications for the transplant waitlist.
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64
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Dew MA, Myaskovsky L, Steel JL, DiMartini AF. Managing the Psychosocial and Financial Consequences of Living Donation. CURRENT TRANSPLANTATION REPORTS 2013; 1:24-34. [PMID: 24592353 DOI: 10.1007/s40472-013-0003-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
There has been dramatic growth in the last decade in the literature on psychosocial and financial impacts of living organ donation. With this growth has come recognition that these impacts must be considered when educating prospective donors about the donation process, and when planning donor follow-up care after donation. Our review highlights recent studies that provide new information on the nature of psychosocial and financial outcomes in living donors, with special attention to studies examining unrelated donors (i.e., those with no biologic or longstanding emotional connection to the transplant patient), given that these individuals represent a growing segment of the living donor population. Limitations and gaps in available evidence are noted. We also discuss recent recommendations for post-donation monitoring of donors' psychosocial and financial outcomes, and we consider advances in evidence regarding interventions and prevention strategies to minimize any adverse psychosocial and financial impacts of living donation.
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Affiliation(s)
- Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology, Biostatistics, and Clinical and Translational Science, University of Pittsburgh School of Medicine and Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213 USA, 412-624-3373
| | - Larissa Myaskovsky
- Departments of Medicine, Psychiatry and Clinical and Translational Science, University of Pittsburgh School of Medicine and Medical Center and Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, 412-692-4856
| | - Jennifer L Steel
- Departments of Surgery, Psychiatry and Psychology, University of Pittsburgh School of Medicine and Medical Center, 3459 Fifth Avenue; MUH 7S, Pittsburgh PA 15213, 412-692-2041
| | - Andrea F DiMartini
- Departments of Psychiatry and Surgery, University of Pittsburgh School of Medicine and Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213 USA, 412-383-3166
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Chen F, Oga T, Sakai H, Matsumoto I, Yamada T, Sato M, Aoyama A, Bando T, Mishima M, Chin K, Date H. A prospective study analyzing one-year multidimensional outcomes in living lung transplant donors. Am J Transplant 2013; 13:3003-9. [PMID: 24102773 DOI: 10.1111/ajt.12476] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 08/16/2013] [Accepted: 08/16/2013] [Indexed: 01/25/2023]
Abstract
The success of living-donor lobar lung transplantation (LDLLT) largely depends on donor outcome; but to date, no authors have studied health-related quality of life (HRQOL) of donors. We prospectively evaluated multidimensional outcomes before and 1 year after donor lobectomies. Patient-reported HRQOL, dyspnea, psychological status and sleep quality, and physiological pulmonary function were determined. All donors were alive without any limitations in their activities of daily living after 1 year. Postoperative pulmonary function was better than the estimated preoperative values; but, with respect to HRQOL, four of the eight subscales of the Medical Outcomes Study 36-item short form (SF-36) deteriorated significantly after donation. In addition, dyspnea assessed by the modified Medical Research Council scale also worsened significantly. In contrast, postoperative anxiety assessed by the Hospital Anxiety and Depression Scale significantly improved from baseline. The donors whose recipients died reported lower SF-36 scores with worsening sleep quality measured by Pittsburgh Sleep Quality Index. Thus, although postoperative pulmonary functions in donors were preserved, their HRQOL and dyspnea deteriorated postoperatively. Moreover, HRQOL and sleep quality were impaired in recipients who experienced poor outcomes. To capture the comprehensive outcomes in LDLLT donors after donation, patient-reported outcomes should be analyzed separately from physiological outcomes.
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Affiliation(s)
- F Chen
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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66
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Dew MA, DiMartini AF, Dabbs AJD, Zuckoff A, Tan HP, McNulty ML, Switzer GE, Fox KR, Greenhouse JB, Humar A. Preventive intervention for living donor psychosocial outcomes: feasibility and efficacy in a randomized controlled trial. Am J Transplant 2013; 13:2672-84. [PMID: 23924065 PMCID: PMC3837427 DOI: 10.1111/ajt.12393] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 06/18/2013] [Accepted: 06/20/2013] [Indexed: 01/25/2023]
Abstract
There are no evidence-based interventions to prevent adverse psychosocial consequences after living donation. We conducted a single-site randomized controlled trial to examine the postdonation impact of a preventive intervention utilizing motivational interviewing (MI) to target a major risk factor for poor psychosocial outcomes, residual ambivalence (i.e. lingering hesitation and uncertainty) about donating. Of 184 prospective kidney or liver donors, 131 screened positive for ambivalence; 113 were randomized to (a) the MI intervention, (b) an active comparison condition (health education) or (c) standard care only before donation. Ambivalence was reassessed postintervention (before donation). Primary trial outcomes-psychosocial variables in somatic, psychological and family interpersonal relationship domains-were assessed at 6 weeks and 3 months postdonation. MI subjects showed the greatest decline in ambivalence (p = 0.050). On somatic outcomes, by 3 months postdonation MI subjects reported fewer physical symptoms (p = 0.038), lower rates of fatigue (p = 0.021) and pain (p = 0.016), shorter recovery times (p = 0.041) and fewer unexpected medical problems (p = 0.023). Among psychological and interpersonal outcomes, they had a lower rate of anxiety symptoms (p = 0.046) and fewer unexpected family-related problems (p = 0.045). They did not differ on depression, feelings about donation or family relationship quality. The findings suggest that the intervention merits testing in a larger, multisite trial.
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Affiliation(s)
- Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA
| | - Andrea F. DiMartini
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Annette J. DeVito Dabbs
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA
| | - Allan Zuckoff
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Henkie P. Tan
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mary L. McNulty
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Galen E. Switzer
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
- Center for Health Equity Research and Promotion, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, PA
| | - Kristen R. Fox
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Joel B. Greenhouse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
- Department of Statistics, Carnegie Mellon University, Pittsburgh, PA
| | - Abhinav Humar
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
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67
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Imamura H, Soyama A, Takatsuki M, Muraoka I, Hara T, Yamaguchi I, Tanaka T, Kinoshita A, Kuroki T, Eguchi S. Self-assessment of postoperative scars in living liver donors. Clin Transplant 2013; 27:E605-10. [DOI: 10.1111/ctr.12226] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2013] [Indexed: 01/01/2023]
Affiliation(s)
- Hajime Imamura
- Department of Surgery; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Akihiko Soyama
- Department of Surgery; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Mitsuhisa Takatsuki
- Department of Surgery; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Izumi Muraoka
- Department of Surgery; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Takanobu Hara
- Department of Surgery; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Izumi Yamaguchi
- Department of Surgery; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Takayuki Tanaka
- Department of Surgery; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Ayaka Kinoshita
- Department of Surgery; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Tamotsu Kuroki
- Department of Surgery; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Susumu Eguchi
- Department of Surgery; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
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68
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Duerinckx N, Timmerman L, Van Gogh J, van Busschbach J, Ismail SY, Massey EK, Dobbels F. Predonation psychosocial evaluation of living kidney and liver donor candidates: a systematic literature review. Transpl Int 2013; 27:2-18. [DOI: 10.1111/tri.12154] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 03/18/2013] [Accepted: 06/28/2013] [Indexed: 01/10/2023]
Affiliation(s)
- Nathalie Duerinckx
- Health Services and Nursing Research; Department of Public Health and Primary Care; KU Leuven; Leuven Belgium
- Heart Transplant Program; University Hospitals of Leuven; Leuven Belgium
| | - Lotte Timmerman
- Internal Medicine, Nephrology & Transplantation; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Johan Van Gogh
- Section Medical Psychology and Psychotherapy; Department of Psychiatry; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Jan van Busschbach
- Section Medical Psychology and Psychotherapy; Department of Psychiatry; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Sohal Y. Ismail
- Section Medical Psychology and Psychotherapy; Department of Psychiatry; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Emma K. Massey
- Internal Medicine, Nephrology & Transplantation; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Fabienne Dobbels
- Health Services and Nursing Research; Department of Public Health and Primary Care; KU Leuven; Leuven Belgium
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69
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Quality of life, risk assessment, and safety research in liver transplantation: new frontiers in health services and outcomes research. Curr Opin Organ Transplant 2013; 17:241-7. [PMID: 22476225 DOI: 10.1097/mot.0b013e32835365c6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW In this review, we briefly summarize three fruitful, emerging areas in liver transplantation research, quality of life; risk assessment; and patient safety. Our goal is to highlight recent findings in these areas, with a call for increased integration of social scientists and transplant clinicians to address how best to shape policy and improve outcomes. RECENT FINDINGS After liver transplantation, recipients generally experience clinically significant, sustained improvement in their physical, social and emotional well being. However, a sizeable minority of patients do experience excess morbidity that may benefit from ongoing surveillance and/or intervention. There is growing body of research that describes risks associated with liver transplantation, which can be useful aids to better inform decision making by patients, clinicians, payers, and policy makers. In contrast, there has been a relative lack of empirical data on transplant patient safety vulnerabilities, placing the field of surgery in stark contrast to other high-risk industries, wherein such assessments inform continuous process improvement. SUMMARY Health services and outcomes research has grown in importance in the liver transplantation literature, but several important questions remain unanswered that merit programmatic, interdisciplinary research.
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70
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[Liver transplantation with living donor : current aspects, perspectives and significance in Germany]. Chirurg 2013; 84:398-408. [PMID: 23595852 DOI: 10.1007/s00104-012-2414-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
More than 20 years ago living donor liver transplantation was introduced into clinical practice. Specifics of this method were developed initially for children and later on for adults particularly in regions where a liver transplantation program using deceased donors was not readily available. The most sensitive aspect of living donation, namely the danger to a healthy relative in order to perform the transplantation is immanent in the system and, thus, it is definitively a secondary option as compared to deceased organ donation. Following worldwide initial euphoria the numbers have markedly decreased in the western world since the start of the new millennium. In Asian countries in particular, much work has been done to optimize the procedure so that the donor safety and the outcome quality for the recipient have been impressively demonstrated in large patient populations. There is still a severe donor organ shortage and the option to allocate an optimal (partial) organ on an individual basis by living donation has given new impact to the discussion about a further rise in the profile of living donations here as well. The new version of the German transplantation legislation implemented in summer 2012 requires a number of conditions with respect to insurance for living donors. The current state and perspectives are presented here.
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71
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Reliability and validity of a new living liver donor quality of life scale. Surg Today 2013; 43:732-40. [PMID: 23325493 DOI: 10.1007/s00595-012-0476-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 04/09/2012] [Indexed: 01/17/2023]
Abstract
PURPOSE To develop a living liver donor (LLD) quality of life (QOL) scale and test its reliability and validity. METHODS We sent a draft questionnaire comprising 38 questions to 965 LLDs from five hospitals. To evaluate test-retest reliability, the questionnaire was re-sent 2 weeks later to some of the donors from one hospital. RESULTS Of the 447 (54.5 %) donors who responded, 15 were excluded. Factor analysis of 26 items extracted 7 subscales; namely, damage from the operation, scarring, satisfaction, burden, after-effects, digestive symptoms, and lack of understanding of donor health. We analyzed construct validity on the basis of factor analysis and observed significant correlations among the seven subscales. Criterion-related validity was confirmed by significant correlation with the 36-item Short-Form Health Survey scores. None of the subscales showed unreasonable values. We evaluated the subscale reliability for internal consistency (α = 0.670-0.868, except for "digestive symptoms", α = 0.431) and test-retest reliability (r = 0.749-0.918). The factor "digestive symptoms" needs careful consideration because of low internal consistency. CONCLUSION The findings of this study confirmed the reliability and validity of the LLD QOL scale, which can be used for quantitatively evaluating the QOL of LLDs.
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72
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Ladner DP, Alonso EM, Butt Z, Caicedo JC, Cella D, Daud A, Friedewald JJ, Gordon EJ, Hazen GB, Ho BT, Hoke KR, Holl JL, Ison MG, Kang R, Mehrotra S, Preczewski LB, Ross OA, Sharaf PH, Skaro AI, Wang E, Wolf MS, Woods DM, Abecassis MM. NUTORC-a transdisciplinary health services and outcomes research team in transplantation. Transl Behav Med 2012; 2:446-458. [PMID: 23667403 PMCID: PMC3647618 DOI: 10.1007/s13142-012-0176-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The field of solid organ transplantation has historically concentrated research efforts on basic science and translational studies. However, there has been increasing interest in health services and outcomes research. The aim was to build an effective and sustainable, inter- and transdisciplinary health services and outcomes research team (NUTORC), that leveraged institutional strengths in social science, engineering, and management disciplines, coupled with an international recognized transplant program. In 2008, leading methodological experts across the university were identified and intramural funding was obtained for the NUTORC initiative. Inter- and transdisciplinary collaborative teams were created across departments and schools within the university. Within 3 years, NUTORC became fiscally sustainable, yielding more than tenfold return of the initial investment. Academic productivity included funding for 39 grants, publication of 60 manuscripts, and 166 national presentations. Sustainable educational opportunities for students were created. Inter- and transdisciplinary health services and outcomes research in transplant can be innovative and sustainable.
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Affiliation(s)
- Daniela P. Ladner
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
- />Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Estella M. Alonso
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Zeeshan Butt
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Juan Carlos Caicedo
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - David Cella
- />Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - Amna Daud
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - John J. Friedewald
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Division of Nephrology, Department of Medicine, Northwestern University, Chicago, IL USA
| | - Elisa J. Gordon
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Gordon B. Hazen
- />Department of Industrial Engineering and Management Sciences, McCormick School of Engineering, Northwestern University, Chicago, IL USA
| | - Bing T. Ho
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Division of Nephrology, Department of Medicine, Northwestern University, Chicago, IL USA
| | - Kathleen R. Hoke
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Jane L. Holl
- />Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Michael G. Ison
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Division of Infectious Diseases, Department of Medicine, Northwestern University, Chicago, IL USA
| | - Raymond Kang
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Sanjay Mehrotra
- />Department of Industrial Engineering and Management Sciences, McCormick School of Engineering, Northwestern University, Chicago, IL USA
| | - Luke B. Preczewski
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
| | - Olivia A. Ross
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Pamela H. Sharaf
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Anton I. Skaro
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Edward Wang
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
| | - Michael S. Wolf
- />Division of General Internal Medicine, Department of Medicine, Northwestern University, Chicago, IL USA
| | - Donna M. Woods
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Michael M. Abecassis
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
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Takada Y, Suzukamo Y, Oike F, Egawa H, Morita S, Fukuhara S, Uemoto S, Tanaka K. Long-term quality of life of donors after living donor liver transplantation. Liver Transpl 2012; 18:1343-52. [PMID: 22821503 DOI: 10.1002/lt.23509] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aims of this study were to investigate the long-term effects of living donor liver transplantation (LDLT) on the health-related quality of life (HRQOL) of donors with the Short Form 36 health survey and to determine the risk factors for poor outcomes. Between June 1990 and June 2004, LDLT was performed 1000 times at Kyoto University Hospital. In July 2005, 997 of the 1000 donors were contacted by mail so that data on their HRQOL could be collected. In all, 578 donors responded (ie, there was a 58.0% response rate). The norm-based HRQOL scores for donors were better than the scores for Japanese norms across all time periods. All scores were similar for left lobe donors (n = 367) and right lobe donors (n = 211). For all donors, a multivariate logistic regression analysis revealed that age, the number of months until recovery to the preoperative health status, hospital visits due to donation-related symptoms, rest from work related to donation in the past month, and the existence of 2 or more comorbidities were significantly associated with decreased HRQOL scores. Postoperative complications and recipient mortality were not predictors of poor HRQOL. In conclusion, HRQOL was better for both right lobe donors and left lobe donors versus the Japanese norm population in the long term (mean postdonation period = 6.8 years). However, the prolongation of symptoms or sequelae related to donation lowered mental health or social functioning. The emergence of comorbidities after donation also significantly affected HRQOL in the long term. Careful follow-up and sustained counseling are required for donors with risk factors for lower HRQOL.
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Affiliation(s)
- Yasutsugu Takada
- Department of Hepatopancreaticobiliary and Transplant Surgery, Ehime University Graduate School of Medicine, Toon, Japan.
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Dew MA, Zuckoff A, DiMartini AF, DeVito Dabbs AJ, McNulty ML, Fox KR, Switzer GE, Humar A, Tan HP. Prevention of poor psychosocial outcomes in living organ donors: from description to theory-driven intervention development and initial feasibility testing. Prog Transplant 2012; 22:280-92; quiz 293. [PMID: 22951506 DOI: 10.7182/pit2012890] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CONTEXT Although some living donors experience psychological, somatic, and interpersonal difficulties after donation, interventions to prevent such outcomes have not been developed or evaluated. OBJECTIVE To (1) summarize empirical evidence on psychosocial outcomes after donation, (2) describe a theoretical framework to guide development of an intervention to prevent poor outcomes, and (3) describe development and initial evaluation of feasibility and acceptability of the intervention. METHODS Based on a narrative literature review suggesting that individuals ambivalent about donation are at risk for poor psychosocial outcomes after donation, the intervention targeted this risk factor. Intervention structure and content drew on motivational interviewing principles in order to assist prospective donors to resolve ambivalence. Data were collected on donors' characteristics at our institution to determine whether they constituted a representative population in which to evaluate the intervention. Study participants were then recruited to assess the feasibility and acceptability of the intervention. They were required to have scores greater than 0 on the Simmons Ambivalence Scale (indicating at least some ambivalence about donation). RESULTS Our population was similar to the national living donor population on most demographic and donation-related characteristics. Eight individuals who had been approved to donate either a kidney or liver segment were enrolled for pilot testing of the intervention. All successfully completed the 2-session telephone-based intervention before scheduled donation surgery. Participants' ratings of acceptability and satisfaction were high. Open-ended comments indicated that the intervention addressed participants' thoughts and concerns about the decision to donate. CONCLUSIONS The intervention is feasible, acceptable, and appears relevant to donor concerns. A clinical trial to evaluate the efficacy of the intervention is warranted.
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Affiliation(s)
- Mary Amanda Dew
- University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania 15213, USA.
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Kim-Schluger L, Florman S. Quality of life after living donor liver transplantation: what we have learned and how we can do better. Liver Transpl 2012; 18:1272-3. [PMID: 22887898 DOI: 10.1002/lt.23528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Ríos A, López-Navas A, Ayala-García M, Sebastián MJ, Abdo-Cuza A, Martínez-Alarcón L, Ramírez EJ, Muñoz G, Suárez-López J, Castellanos R, González B, Martínez MÁ, Díaz E, Ramírez P, Parrilla P. [Attitudes among Spanish and Latin American non-medical health professionals to living donor liver transplantation]. GASTROENTEROLOGIA Y HEPATOLOGIA 2012; 35:625-33. [PMID: 23084665 DOI: 10.1016/j.gastrohep.2012.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 07/08/2012] [Accepted: 07/10/2012] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Hospital professionals are an opinion group that influences the general population. OBJECTIVE To analyze attitudes to living donor liver transplantation (LDLT) among non-medical professionals working in Spanish and Latin American hospitals and to determine the variables that influence these attitudes. MATERIAL AND METHOD A random sample, stratified by department, was selected from non-medical staff in the "International Donor Collaborative Project": there were three hospitals in Spain, five in Mexico and two in Cuba. Attitudes were evaluated through a validated, anonymous, self-administered questionnaire. RESULTS There were 951 non-medical professionals: 277 from Spain, 632 from Mexico and 42 from Cuba. A total of 86% (n = 818) were in favor of related living donation and 31% (n = 299) were in favor of unrelated living donation. This attitude was associated with the following: country (Mexico 88%, Cuba 83%, Spain 81%) (p =0.016), female sex (p =0.026), having experience of donation and transplantation (p =0.001), having a favorable attitude to donation (P <0.001), considering the possibility of needing a transplant (P <0.001), being in favor of living kidney donation (P <0.001), being willing to accept a transplant from a living donor if necessary (P <0.001), discussing donation and transplantation with the family and partner (P <0.001), carrying out pro-social activities (P <0.001), believing that one's religion was in favor of donation and transplantation (P<0.001), and not worrying about bodily mutilation after donation (P <0.001). CONCLUSIONS Attitudes toward related LDLT among non-medical staff in various Spanish, Mexican and Cuban hospitals are favorable. In 86% of those surveyed, this attitude was not influenced by classical psychosocial factors.
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Affiliation(s)
- Antonio Ríos
- Proyecto Colaborativo Internacional Donante, Murcia, España.
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Nagai S, Brown L, Yoshida A, Kim D, Kazimi M, Abouljoud MS. Mini-incision right hepatic lobectomy with or without laparoscopic assistance for living donor hepatectomy. Liver Transpl 2012; 18:1188-97. [PMID: 22685084 DOI: 10.1002/lt.23488] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Minimally invasive procedures are considered to be safe and effective approaches to the management of surgical liver disease. However, this indication remains controversial for living donor hepatectomy. Between 2000 and 2011, living donor right hepatectomy (LDRH) was performed 58 times. Standard right hepatectomy was performed in 30 patients via a subcostal incision with a midline extension. Minimally invasive procedures began to be used for LDRH in 2008. A hybrid technique (hand-assisted laparoscopic liver mobilization and minilaparotomy for parenchymal dissection) was developed and used in 19 patients. In 2010, an upper midline incision (10 cm) without laparoscopic assistance for LDRH was innovated, and this technique was used in 9 patients. The perioperative factors were compared, and the indications for minimally invasive LDRH were investigated. The operative blood loss was significantly less for the patients undergoing a minimally invasive procedure versus the patients undergoing the standard procedure (212 versus 316 mL, P = 0.001), and the operative times were comparable. The length of the hospital stay was significantly shorter for the minimally invasive technique group (5.9 versus 7.8 days, P < 0.001). The complication rates were 23% and 25% for the standard technique and minimally invasive technique groups, respectively (P = 0.88). Patients undergoing minilaparotomy LDRH had a body mass index (24.0 kg/m(2)) similar to that of the hybrid technique patients (25.8 kg/m(2), P = 0.36), but the graft size was smaller (780 versus 948 mL, P = 0.22). In conclusion, minimally invasive LDRH can be performed without safety being impaired. LDRH with a 10-cm upper midline incision and without laparoscopic assistance may be appropriate for donors with a smaller body mass. Laparoscopic assistance can be added as needed for larger donors. This type of LDRH with a 10-cm incision is innovative and is recommended for experienced centers.
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Affiliation(s)
- Shunji Nagai
- Division of Transplant and Hepatobiliary Surgery, Henry Ford Transplant Institute, Henry Ford Hospital, Detroit, MI 48202, USA
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Manyalich M, Menjívar A, Yucetin L, Peri J, Torres X, Dias L, Hiesse C, Papachristou C, Fehrman-Ekholm I, Kvarnström N, Ballesté C, Paredes D, Revuelta I, Diekmann F, Rimola A, Fondevila C, Martínez M, Legendre C, Pereira R, Carvalho I, Lopes A. Living Donor Psychosocial Assesment/Follow-up Practices in the Partners' Countries of the ELIPSY Project. Transplant Proc 2012; 44:2246-9. [DOI: 10.1016/j.transproceed.2012.07.106] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Donor Quality of Life After Living Donor Liver Transplantation: Single-Institute Experience. Transplant Proc 2012; 44:341-3. [DOI: 10.1016/j.transproceed.2012.01.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Long-term follow-up after right hepatectomy for adult living donation and attitudes toward the procedure. Ann Surg 2012; 254:694-700; discussion 700-1. [PMID: 22005145 DOI: 10.1097/sla.0b013e31823594ae] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To determine the long-term health status of donors after right hepatectomy for adult live donor liver transplantation (ALDLT). BACKGROUND The long-term outcomes for ALDLT donors are unknown. METHODS ALDLT donors undergoing right hepatectomy from April 1998 to June 2007 were invited to complete a questionnaire regarding health status, satisfaction (1-10/worst-best scale), self-esteem, willingness to donate again, and suggestions for improvement. In addition, donor files and cholecystectomy specimens were reviewed. Fisher's exact test, Kaplan-Meier and logistic regression analyses were performed. RESULTS Eighty-three donors were contacted (median age: 36 years; median follow-up: 69 months). 39 (47%) were free of symptoms. The remaining 44 (53%) reported: intolerance to fatty meals and diarrhea (31%), gastroesophageal reflux associated with left liver hypertrophy (9%), incisional discomfort requiring pain medications (6%), severe depression requiring hospitalization (4%), rib pain affecting lifestyle (2%), and exacerbation of psoriasis (1%). Median satisfaction score was 8. Self-esteem diminished in 5%. Thirty-nine (47%) recommended improvements particularly more detailed informed donor consent and a centralized living donor liver registry. Seventy-eight (94%) were willing to donate again. There were no differences between donors with and without complaints with respect to: donor age, gender, early complications and follow-up time, young-to-old donation, recipient diagnosis of malignancy and death of the recipient. Noninflamed donor cholecystectomy specimens correlated with intolerance to fatty meals and diarrhea (P = 0.001). CONCLUSIONS ALDLT donors are at risk for long-term complaints that are neither reflected nor related to early complications. This information should be included in both the donor evaluation and the ALDLT decision-making process.
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Kousoulas L, Emmanouilidis N, Klempnauer J, Lehner F. Living-donor liver transplantation: impact on donor's health-related quality of life. Transplant Proc 2011; 43:3584-7. [PMID: 22172809 DOI: 10.1016/j.transproceed.2011.10.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 10/07/2011] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the health-related quality of life of living liver donors after living-donor liver transplantation (LDLT). METHODS Health-related quality of life (HRQOL) in 55 living liver donors operated on at our center between 2002 and 2009 was assessed using the German Version of the 36-Item Health Survey (SF-36). RESULTS Donors after full right-lobe hepatectomy (n=18) scored similarly to and without statistically significant difference from the German reference population, whereas donors after left lateral segmentectomy (n=37) revealed statistically significant higher average score values (P<.005) in the categories of physical functioning, bodily pain, and general health compared with the German reference population. In the analysis between donors after full right-lobe hepatectomy and donors after left lateral segmentectomy no statistically significant difference was observed in any of the SF-36 categories. Postoperative complications of the donors and postoperative recipient mortality were particularly revealing regarding HRQOL. Donors who developed postoperative complications presented a lower HRQOL, especially in the categories of role physical, bodily pain, and social functioning, where statistically significant differences (P<.005) were observed. Similarly, postoperative recipient mortality correlated with lower mean score values in all SF-36 categories, but a statistically significant difference (P<.005) was reached only in the categories of role emotional and mental health. CONCLUSIONS Donors did not regret their decision to donate, because HRQOL was not negatively affected by the donation procedure. Living liver donors scored as well as or even better than the German reference population, but it was clearly shown that the development of postoperative donor complications and the postoperative recipient mortality had a negative effect on the HRQOL of donors.
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Affiliation(s)
- L Kousoulas
- Department of General, Visceral, and Transplant Surgery, Hanover Medical School, Hanover, Germany.
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