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Robertson FP, Bessell PR, Diaz-Nieto R, Thomas N, Rolando N, Fuller B, Davidson BR. High serum Aspartate transaminase levels on day 3 postliver transplantation correlates with graft and patient survival and would be a valid surrogate for outcome in liver transplantation clinical trials. Transpl Int 2015; 29:323-30. [PMID: 26615011 DOI: 10.1111/tri.12723] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/10/2015] [Accepted: 11/23/2015] [Indexed: 12/29/2022]
Abstract
Aspartate transaminase, a liver specific enzyme released into serum following acute liver injury, is used in experimental organ preservation studies as a measure of liver IR injury. Whether post-operative serum transaminases are a good indicator of IR injury and subsequent graft and patient survival in human liver transplantation remains controversial. A single centre prospectively collected liver transplant database was analysed for the period 1988-2012. All patients were followed up for 5 years or until graft failure. Transaminase levels on the 1st, 3rd and 7th post-operative days were correlated with the patient demographics, operative outcomes, post-operative complications and both graft and patient survival via a binary logistic regression analysis. Graft and patient survival at 3 months was 80.3% and 87.5%. AST levels on the 3rd (P = 0.005) and 7th (P = 0.001) post-operative days correlated with early graft loss. Patients were grouped by their AST level (day 3): <107iU, 107-1213iU, 1213-2744iU and >2744iU. The incidence of graft loss at 3 months was 10%, 12%. 27% and 59% and 1-year patient mortality was 12%, 14%, 27% and 62%. Day 3 AST levels correlate with patient and graft outcome post-liver transplantation and would be a suitable surrogate endpoint for clinical trials in liver transplantation.
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Affiliation(s)
- Francis P Robertson
- Division of Surgery and Interventional Science, Royal Free Campus, University College London (UCL), London, UK
| | - Paul R Bessell
- School of Veterinary Medicine, Roslyn Institute, University of Edinburgh, Easter Bush, Edinburgh, Midlothian, UK
| | - Rafael Diaz-Nieto
- HPB and Liver Transplant Unit, Royal Free London NHS Foundation Trust, London, UK
| | - Niclas Thomas
- Division of Surgery and Interventional Science, Royal Free Campus, University College London (UCL), London, UK
| | - Nancy Rolando
- HPB and Liver Transplant Unit, Royal Free London NHS Foundation Trust, London, UK
| | - Barry Fuller
- Division of Surgery and Interventional Science, Royal Free Campus, University College London (UCL), London, UK
| | - Brian R Davidson
- Division of Surgery and Interventional Science, Royal Free Campus, University College London (UCL), London, UK.,HPB and Liver Transplant Unit, Royal Free London NHS Foundation Trust, London, UK
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52
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Heylen L, Naesens M, Jochmans I, Monbaliu D, Lerut E, Claes K, Heye S, Verhamme P, Coosemans W, Bammens B, Evenepoel P, Meijers B, Kuypers D, Sprangers B, Pirenne J. The effect of anastomosis time on outcome in recipients of kidneys donated after brain death: a cohort study. Am J Transplant 2015; 15:2900-7. [PMID: 26484837 DOI: 10.1111/ajt.13397] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/19/2015] [Accepted: 05/23/2015] [Indexed: 01/25/2023]
Abstract
Whether warm ischemia during the time to complete the vascular anastomoses determines renal allograft function has not been investigated systematically. We investigated the effect of anastomosis time on allograft outcome in 669 first, single kidney transplantations from brain-dead donors. Anastomosis time independently increased the risk of delayed graft function (odds ratio per minute [OR] 1.05, 95% confidence interval [CI] 1.02-1.07, p < 0.001) and independently impaired allograft function after transplantation (p = 0.009, mixed-models repeated-measures analysis). In a subgroup of transplant recipients, protocol-specified biopsies at 3 months (n = 186), 1 year (n = 189), and 2 years (n = 153) were blindly reviewed. Prolonged anastomosis time independently increased the risk of interstitial fibrosis and tubular atrophy on these protocol-specified biopsies posttransplant (p < 0.001, generalized linear models). In conclusion, prolonged anastomosis time is not only detrimental for renal allograft outcome immediately after transplantation, also longer-term allograft function and histology are affected by the duration of this warm ischemia.
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Affiliation(s)
- L Heylen
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.,Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
| | - M Naesens
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.,Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
| | - I Jochmans
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
| | - D Monbaliu
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
| | - E Lerut
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - K Claes
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.,Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
| | - S Heye
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - P Verhamme
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - W Coosemans
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
| | - B Bammens
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.,Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
| | - P Evenepoel
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.,Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
| | - B Meijers
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.,Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
| | - D Kuypers
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.,Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
| | - B Sprangers
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.,Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
| | - J Pirenne
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
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56
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Lo Monte AI, Damiano G, Palumbo VD, Spinelli G, Buscemi G. Renal Transplantation by Automatic Anastomotic Device in a Porcine Model. Artif Organs 2015; 39:916-21. [PMID: 25900063 DOI: 10.1111/aor.12467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Automatic vascular staplers for vascular anastomoses in kidney transplantation may dramatically reduce the operative time and, in particular, warm ischemia time, thus increasing the outcome of transplantation. Ten pigs underwent kidney auto-transplantation by automatic anastomotic device. Kidneys were collected by laparotomy with selective ligations at the renal hilum and perfused with cold storage solution. To overcome the shortage in length of renal hilum, a tract of the internal jugular vein was harvested to increase the length of the vessels. The anastomoses were totally performed by the use of the anastomotic device. On 10 kidney transplants, nine were successful and no complications occurred. Renal resistive indexes showed a slight increase in the immediate postoperative period returning normal at 10 days of follow-up. We demonstrated the possibility to perform renal vascular anastomoses by means of an automatic anastomotic device. This instrument developed for coronary bypass surgery by virtue of the small caliber of the vessels could be adopted on a larger scale for renal transplantation. The reduced warm ischemia time needed for anastomosis may help to achieve a better outcome for the graft and expand the pool of marginal donors in renal transplantation.
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Affiliation(s)
- Attilio Ignazio Lo Monte
- Department of Surgical, Oncological, and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Giuseppe Damiano
- Department of Surgical, Oncological, and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Vincenzo Davide Palumbo
- Department of Surgical, Oncological, and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Gabriele Spinelli
- Department of Surgical, Oncological, and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Giuseppe Buscemi
- Department of Surgical, Oncological, and Stomatological Disciplines, University of Palermo, Palermo, Italy
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57
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Weissenbacher A, Oberhuber R, Cardini B, Weiss S, Ulmer H, Bösmüller C, Schneeberger S, Pratschke J, Öllinger R. The faster the better: anastomosis time influences patient survival after deceased donor kidney transplantation. Transpl Int 2015; 28:535-43. [DOI: 10.1111/tri.12516] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 10/17/2014] [Accepted: 12/30/2014] [Indexed: 01/22/2023]
Affiliation(s)
- Annemarie Weissenbacher
- Department of Visceral, Transplant and Thoracic Surgery; Center of Operative Medicine; Innsbruck Medical University; Innsbruck Austria
| | - Rupert Oberhuber
- Department of Visceral, Transplant and Thoracic Surgery; Center of Operative Medicine; Innsbruck Medical University; Innsbruck Austria
| | - Benno Cardini
- Department of Visceral, Transplant and Thoracic Surgery; Center of Operative Medicine; Innsbruck Medical University; Innsbruck Austria
| | - Sascha Weiss
- Department of Visceral, Transplant and Thoracic Surgery; Center of Operative Medicine; Innsbruck Medical University; Innsbruck Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics; Innsbruck Medical University; Innsbruck Austria
| | - Claudia Bösmüller
- Department of Visceral, Transplant and Thoracic Surgery; Center of Operative Medicine; Innsbruck Medical University; Innsbruck Austria
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery; Center of Operative Medicine; Innsbruck Medical University; Innsbruck Austria
| | - Johann Pratschke
- Department of Visceral, Transplant and Thoracic Surgery; Center of Operative Medicine; Innsbruck Medical University; Innsbruck Austria
- Department of General Visceral and Transplant Surgery; Charité Campus Virchow-Klinikum; Berlin Germany
| | - Robert Öllinger
- Department of Visceral, Transplant and Thoracic Surgery; Center of Operative Medicine; Innsbruck Medical University; Innsbruck Austria
- Department of General Visceral and Transplant Surgery; Charité Campus Virchow-Klinikum; Berlin Germany
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58
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Leonard S, Wu KL, Kim Y, Krieger A, Kim PCW. Smart tissue anastomosis robot (STAR): a vision-guided robotics system for laparoscopic suturing. IEEE Trans Biomed Eng 2014; 61:1305-17. [PMID: 24658254 DOI: 10.1109/tbme.2014.2302385] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This paper introduces the smart tissue anastomosis robot (STAR). Currently, the STAR is a proof-of-concept for a vision-guided robotic system featuring an actuated laparoscopic suturing tool capable of executing running sutures from image-based commands. The STAR tool is designed around a commercially available laparoscopic suturing tool that is attached to a custom-made motor stage and the STAR supervisory control architecture that enables a surgeon to select and track incisions and the placement of stitches. The STAR supervisory-control interface provides two modes: A manual mode that enables a surgeon to specify the placement of each stitch and an automatic mode that automatically computes equally-spaced stitches based on an incision contour. Our experiments on planar phantoms demonstrate that the STAR in either mode is more accurate, up to four times more consistent and five times faster than surgeons using state-of-the-art robotic surgical system, four times faster than surgeons using manual Endo360(°)®, and nine times faster than surgeons using manual laparoscopic tools.
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