1
|
De Carlis R, Di Lucca G, Lauterio A, Centonze L, De Carlis L. The long-term follow-up of the living liver donors. Updates Surg 2024:10.1007/s13304-024-01894-4. [PMID: 38926232 DOI: 10.1007/s13304-024-01894-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 05/18/2024] [Indexed: 06/28/2024]
Abstract
Living donor liver transplantation (LDLT) has been proposed in many countries to reduce organ shortage. While the early postoperative outcomes have been well investigated, little is known about the long-term follow-up of the living donors. We, therefore, designed a systematic review of the literature to explore long-term complications and quality of life among living donors. We searched MEDLINE and EMBASE registries for studies published since 2013 that specifically addressed long-term follow-up following living-donor liver donation, concerning both physical and psychological aspects. Publications with a follow-up shorter than 1 year or that did not clearly state the timing of outcomes were excluded. A total of 2505 papers were initially identified. After a thorough selection, 17 articles were identified as meeting the eligibility criteria. The selected articles were mostly from North America and Eastern countries. Follow-up periods ranged from 1 to 11.5 years. The most common complications were incision site discomfort (13.2-38.8%) and psychiatric disorders (1-22%). Biliary strictures occurred in 1-14% of cases. Minimally invasive donor hepatectomy could improve quality of life, but long-term data are limited. About 30 years after the first reported LDLT, little has been published about the long-term follow-up of the living donors. Different factors may contribute to this gap, including the fact that, as healthy individuals, living donors are frequently lost during mid-term follow-up. Although the reported studies seem to confirm long-term donor safety, further research is needed to address the real-life long-term impact of this procedure.
Collapse
Affiliation(s)
- Riccardo De Carlis
- PhD Course in Clinical and Experimental Sciences, University of Padua, Via 8 Febbraio, 235122, Padua, Italy.
- Department of General Surgery and Transplantation, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
| | - Gabriele Di Lucca
- Department of General Surgery and Transplantation, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Andrea Lauterio
- Department of General Surgery and Transplantation, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Leonardo Centonze
- Department of General Surgery and Transplantation, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Luciano De Carlis
- Department of General Surgery and Transplantation, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
2
|
Bhatti ABH, Naqvi W, Mohsan M, Iqbal M, Arshad EB, Khan Z, Waheed A, Zia HH, Khan NY, Yousafzai AW, Khan NA. Long-term medical and quality of life outcomes among voluntary liver donors. J Gastrointest Surg 2024; 28:731-737. [PMID: 38704207 DOI: 10.1016/j.gassur.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/07/2024] [Accepted: 02/17/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Long-term medical and quality of life (QOL) outcomes in voluntary liver donors remain under investigated. The objective of the current study was to report long-term medical outcomes and re-evaluate QOL in living liver donors. METHODS This was a single-center retrospective cohort study of donors who underwent donor hepatectomy between 2012 and 2018. We investigated long-term outcomes in 7 domains. These include medical problems, surgical procedures, work-related issues, pregnancy outcomes, psychiatric interventions, willingness to donate again, and long-term mortality. QOL was evaluated using short-form 36. RESULTS The median follow-up time was 61.4 months (53.3-83.7). Among 698 donors, 80 (11.5%) experienced medical problems, 4 (0.6%) had work-related issues, and 20 (2.9%) needed psychiatric assistance. Surgery was performed in 49 donors (7%), and females were more likely to have undergone incisional hernia repair (5.8% vs 1.9%, P = .006). There were 79 postdonation pregnancies including 41 normal vaginal deliveries (51.9%), 35 cesarean sections (44.3%), and 3 miscarriages (3.8%). Willingness to donate again was reported by 658 donors (94.3%). Donors whose recipients were alive were more likely to donate again (95.5% vs 90.5%, P = .01). There were 3 deaths (0.4%) in the long-term. The mean physical composite score at initial and follow-up evaluation was 86.7 ± 13.9 and 76.5 ± 20.9 (P = .001), and the mean mental composite score at initial and follow-up evaluation was 92.1 ± 13.5 and 80.7 ± 16 (P = .001). CONCLUSION The overall long-term outlook in living liver donors is promising. QOL parameters might deteriorate over time and frequent re-evaluation might be considered.
Collapse
Affiliation(s)
- Abu Bakar Hafeez Bhatti
- Department of HPB Surgery and Liver Transplantation, Shifa International Hospital, Islamabad, Pakistan; College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan.
| | - Wajih Naqvi
- Department of HPB Surgery and Liver Transplantation, Shifa International Hospital, Islamabad, Pakistan
| | - Maheen Mohsan
- College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Moeza Iqbal
- College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Eman Binte Arshad
- College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Zainab Khan
- College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Anum Waheed
- Department of Public Health, Health Services Academy, Islamabad, Pakistan
| | - Haseeb Haider Zia
- Department of HPB Surgery and Liver Transplantation, Shifa International Hospital, Islamabad, Pakistan
| | - Nusrat Yar Khan
- Department of HPB Surgery and Liver Transplantation, Shifa International Hospital, Islamabad, Pakistan
| | | | - Nasir Ayub Khan
- Department of Anesthesiology, Shifa International Hospital, Islamabad, Pakistan
| |
Collapse
|
3
|
Fan Y, Nashan B, Wu X, Zhang H, Shi Y. Prevalence and factors associated with depression and anxiety in living liver donors: A systematic review and meta-analysis. J Psychosom Res 2023; 173:111443. [PMID: 37562147 DOI: 10.1016/j.jpsychores.2023.111443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/03/2023] [Accepted: 07/30/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE This study aimed to systematically review the prevalence and factors associated with depression and anxiety in living liver donors after liver transplantation. METHODS Five English language electronic databases and four Chinese language electronic databases were searched from inception to February 2023. Two investigators independently extracted the data and assessed the study quality. The pooled prevalence was calculated using STATA software (version 14.0). We performed a narrative review to summarize the factors associated with depression and anxiety in living liver donors after liver transplantation. The protocol of this study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) database, registration number: CRD42021290071. RESULTS This study included 39 articles involving 18,577 participants. The pooled prevalence was 6.3% [95% confidence interval (CI) (4.1-8.9%)] for depression in living liver donors, and 10.0% [95% CI (4.0-18.1%)] for anxiety. Prevalence of clinically significant depressive or anxiety symptoms was higher (15.7% and 17.4%) compared with disorders (2.7% and 2.2%). The prevalence of depression and anxiety was highest within 3 months post-donation. Specifically, female donors, serious postoperative complications, and recipients' poor health/death have been reported as factors having a negative influence on depression and anxiety. CONCLUSIONS Collected evidence showed that the overall prevalence of depression or anxiety of living liver donors was high. Therefore, early detection and timely treatment of psychological disorders are crucial to promote positive psychiatric health outcomes and ensure the quality of life of living liver donors.
Collapse
Affiliation(s)
- Yaru Fan
- School of Nursing, Peking University, Beijing, China.
| | - Björn Nashan
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China.
| | - Xiaxin Wu
- School of Nursing, Peking University, Beijing, China.
| | - Haiming Zhang
- National Clinical Research Center for Digestive Diseases and Beijing Key Laboratory of Tolerance Induction and Organ Protection in Transplantation, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Yuexian Shi
- School of Nursing, Peking University, Beijing, China.
| |
Collapse
|
4
|
Weng LC, Huang HL, Tsai YH, Tsai HH, Lee WC, Shieh WY. The effect of a web-based self-care instruction on symptom experience and quality of life in living liver donors: A randomized controlled trial. Heliyon 2023; 9:e17333. [PMID: 37484234 PMCID: PMC10361383 DOI: 10.1016/j.heliyon.2023.e17333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 06/05/2023] [Accepted: 06/14/2023] [Indexed: 07/25/2023] Open
Abstract
Objective Living liver donors need help to manage symptom distress and improve their quality of life. This study aims to test the effectiveness of a web-based symptom self-care instruction on symptom experience and health-related quality of life of living liver donors. Methods This study was a randomized controlled trial. Participants were recruited from January 2019 to August 2020. Participants in the experimental group had access to a web-based symptom self-care instruction, which included text and video. The control group received routine care. The primary outcomes were symptom distress and quality of life. Results A total of 90 living liver donors recruited in this study were assigned randomly to the web group (n = 46) and control group (n = 44). The symptom distress was significantly negatively correlated with quality of life at each data collection time. There was an interaction effect with the participants in the web group experiencing more symptom distress at three months after surgery than the control group (B = 3.616, 95% CI: 7.163-3.990, p = 0.046). There was no significant effect on the quality of life. Conclusion Patients in the web-based self-care group had higher symptom distress than those in the control group three months after surgery, but there was no difference in quality of life. Future studies could add some interactive elements to the website and include a larger sample size. Registration This study was registered at the Chinese Clinical Trial Registry (ChiCTR1900020518).
Collapse
Affiliation(s)
- Li-Chueh Weng
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of General Surgery, Liver Transplantation, Chang Gung Medical Foundation, Linkuo Medical Center, Taoyuan, Taiwan
| | - Hsiu-Li Huang
- Department of Long-Term Care, College of Health Technology, National Taipei University of Nursing and Health Science, Taipei, Taiwan
| | - Yu-Hsia Tsai
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Cardiovascular Medicine, Chang Gung Medical Foundation, Linkuo Medical Center, Taoyuan, Taiwan
| | - Hsiu-Hsin Tsai
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Medical Foundation, Linkuo Medical Center, Taoyuan, Taiwan
| | - Wei-Chen Lee
- Department of General Surgery, Liver Transplantation, Chang Gung Medical Foundation, Linkuo Medical Center, Taoyuan, Taiwan
| | - Wann-Yun Shieh
- Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
5
|
Tseng SC, Lee WC, Chen KH, Tsai HH, Kuo MC, Weng LC. Anxiety, pain intensity, and decision regret of living liver donors during postoperative period. Appl Nurs Res 2023; 69:151662. [PMID: 36635016 DOI: 10.1016/j.apnr.2022.151662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/03/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Abstract
AIM The aim of this study was to explore and examine the relationship between anxiety, acute pain intensity, and decision regret of living liver donors in the postoperative stage. METHODS This is a prospective correlational study. Data were collected consecutively for one year (from September 2017 to September 2018) at a medical center in northern Taiwan. Information about anxiety and acute pain intensity was collected preoperatively and on postoperative day (POD) 3 and POD 7. Satisfaction with pain management and decision regret was inquired about on POD 7. RESULTS Data of 57 consecutive living liver donors (56.1 % male, mean age 34.12 ± 9.92 years) were analyzed. Living liver donors experienced moderate anxiety and acute pain levels in the postoperative period. The mean score of decision regret was 12.63 (range 0-60), indicating a low level of regret. The acute pain intensity decreased significantly between POD 3 and POD 7 (p < .001); however, the anxiety level slightly increased (p = .031). Older and married living liver donors had higher anxiety levels. The satisfaction level of pain management was negatively correlated with the POD 7 acute pain intensity (r = -0.26, p = .049) and decision regret (r = -0.37, p = .005), but it was positively correlated with POD 7 anxiety (r = 0.38, p = .004). CONCLUSIONS The postoperative period was hard for living liver donors as they would experience moderate acute pain and anxiety. Although the decision regret was low, the satisfaction level of pain management would negatively affect it. Therefore, the effectiveness of pain management and anxiety management should be continually ensured in the postoperative period.
Collapse
Affiliation(s)
- Su-Chen Tseng
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wei-Chen Lee
- Department of General Surgery, Chang Gung Medical Foundation, Linkuo Medical Center, Taoyuan, Taiwan
| | - Kang-Hua Chen
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Hsin Tsai
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Mei-Chen Kuo
- Department of Nursing, Cardinal Tien Junior College of Healthcare and Management, New Taipei City, Taiwan
| | - Li-Chueh Weng
- Department of General Surgery, Chang Gung Medical Foundation, Linkuo Medical Center, Taoyuan, Taiwan; School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| |
Collapse
|
6
|
Horwich BH, Yang AH, Haser G, Carlis R, Lee BT, Maddur H, Dodge JL, Genyk Y, Fong TL, Han H. Living Liver Donation Does not Significantly Affect Long-Term Life, Disability, or Medical Insurability. Prog Transplant 2022; 32:274-282. [PMID: 36367716 DOI: 10.1177/15269248221122872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The growing practice of living liver donation requires comprehensive understanding of the financial implications for living liver donors. While obtaining and maintaining insurance is important to financial health, little is known about the impact of liver donation on future insurability. RESEARCH QUESTIONS The purpose of this study was to evaluate the donors' experiences with insurance following donation and identify the insurance provider-driven factors that contribute to donor insurability. DESIGN A two center cohort of living donors with donation between January 2000 and December 2018 (N = 442) were surveyed about postdonation insurance experiences. To understand insurance provider practices towards liver donors, life (n = 11) and disability (n = 4) insurance underwriters were asked to provide policy quotes for a standardized living liver donor profile. RESULTS Responses (N = 101) were received by August 2020 (response rate = 22.9%). Living liver donors reported owning life (58%), disability (35%), and medical (87%) insurance at rates comparable to the general population with low proportions reporting difficulty obtaining these insurance types (9%, 9%, 4%, respectively). Post-donation life insurance ownership was associated with post-donation employment (P = 0.01). Underwriter responses indicate life and disability insurability were adversely affected up to 12 months following donation. CONCLUSIONS Living liver donors did not have difficulty maintaining insurance in the long-term but should be counseled to purchase insurance prior to surgery as short-term insurability may be affected. Perception of difficulty obtaining insurance following donation remains of significant concern among living donors. Further collaboration between the transplant community and insurance companies is warranted.
Collapse
Affiliation(s)
- Brian H Horwich
- Department of Medicine, 12223Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Alexander H Yang
- Department of Medicine, 12223Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Grace Haser
- Department of Medicine, 12244Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rene Carlis
- Rene Carlis Insurance Services, Laguna Niguel, California, USA
| | - Brian T Lee
- Division of Gastrointestinal and Liver Diseases, 12223Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Haripriya Maddur
- Division of Gastroenterology & Hepatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jennifer L Dodge
- Division of Gastrointestinal and Liver Diseases, 12223Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Department of Preventive Medicine, 12223Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Yuri Genyk
- Department of Surgery, 12223Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Tse-Ling Fong
- Division of Gastrointestinal and Liver Diseases, 12223Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Hyosun Han
- Division of Gastrointestinal and Liver Diseases, 12223Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
7
|
Akamatsu N, Hasegawa K, Nojiri K, Muto K, Shimizu J, Soeda E, Kawagishi N, Marubashi S, Mizuta K, Kaido T, Taketomi A, Ohdan H, Uemoto S, Kokudo N. Long-term quality of life of living liver donors: A Japanese nationwide survey. Liver Transpl 2022; 28:1800-1803. [PMID: 35652234 DOI: 10.1002/lt.26518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/02/2022] [Accepted: 05/24/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Nobuhisa Akamatsu
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kayo Nojiri
- Department of Nursing, University of Tokyo Hospital, Tokyo, Japan
| | - Kaori Muto
- Interfaculty Initiative in Information Studies, Graduate School of Interdisciplinary Information Studies, The University of Tokyo, Tokyo, Japan
| | - Junichi Shimizu
- Department of Nursing, Tokyo Healthcare University, Tokyo, Japan
| | - Etsuko Soeda
- Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan
| | - Naoki Kawagishi
- The Division of Advanced Surgical Science and Technology, Imakane Town National Health Insurance Hospital, Hokkaido, Japan
| | - Shigeru Marubashi
- Division of Surgery, Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
| | - Koichi Mizuta
- Department of Transplant Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Toshimi Kaido
- Department of Gastroenterological and General Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University, Sapporo, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Norihiro Kokudo
- Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| |
Collapse
|
8
|
Abdel-Khalek EE, Abdel-Wahab M, Elgazzar MH, Khattab MA, El-Gilany AH, Elgouhari HM, Shehta A. Long-term follow-up of living liver donors: A single-center experience. Liver Transpl 2022; 28:1490-1499. [PMID: 35289076 DOI: 10.1002/lt.26455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/18/2022] [Accepted: 02/28/2022] [Indexed: 01/13/2023]
Abstract
Living donors are healthy individuals who are exposed to a major surgical procedure during which a major part of their liver is resected. Data on the long-term consequences of living liver donation are scarce. This study examined clinical, laboratory, and long-term health-related quality of life (HRQoL) in 237 living liver donors and 239 matched controls during 48-168 months of postdonation follow-up. We used the 36-item short-form health survey (SF-36), version 1. The scores for the four following subscales were higher in nondonors than in donors: physical functioning (p = 0.009), role limitations due to physical health (p = 0.002), energy/fatigue (p < 0.001), and bodily pain (p < 0.001). The scores on the eight subscales of the SF-36 were higher in donors with living recipients than in donors whose recipients died (p < 0.001). Our results suggest that living donor right hepatectomy is safe and results in a postdonation HRQoL similar to that of nondonors in those donors whose recipients are healthy, whereas donors whose recipients die have a lower HRQoL that is significantly negatively correlated with the time since recipient death and improves over time.
Collapse
Affiliation(s)
- Ehab E Abdel-Khalek
- Liver Transplant Unit, Department of Internal Medicine, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - Mohamed Abdel-Wahab
- Liver Transplant Unit, Gastrointestinal Surgery Center, Department of Surgery, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - Mohamed H Elgazzar
- Liver Transplant Unit, Department of Internal Medicine, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - Mahmoud A Khattab
- Department of Internal Medicine, Faculty of Medicine, University of Minia, Minia, Egypt
| | - Abdel-Hady El-Gilany
- Department of Public Health, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | | | - Ahmed Shehta
- Liver Transplant Unit, Gastrointestinal Surgery Center, Department of Surgery, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| |
Collapse
|
9
|
Hong SK, Choe S, Yi NJ, Shin A, Choe EK, Yoon KC, Lee KW, Suh KS. Long-term Survival of 10,116 Korean Live Liver Donors. Ann Surg 2021; 274:375-382. [PMID: 31850982 DOI: 10.1097/sla.0000000000003752] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the long-term mortality of Korean live liver donors using data from a national donor registry by comparing it with the mortality of the general population. SUMMARY OF BACKGROUND DATA Although live liver donors generally have a healthy status, their long-term mortality has not been properly addressed in a large donor registry. METHODS Data of 10,116 live liver donors were drawn from a mandated national registry of Korean live liver donors between 2000 and 2015. Matched controls were selected from the Korean National Health Insurance System-National Sample Cohort (NHIS-NSC). Median (range) follow-up of liver donors was 5.7 (0-15.9) years. Donors were 1:3 individually matched to controls by sex and 5-year age group; potential controls were from the whole NHIS-NSC (Control 1) or from NHIS-NSC after excluding people with contraindications to be organ donors (Control 2) (donor, n = 7538; Control 1, n = 28,248; Control 2, n = 28,248). RESULTS Fifty-three deaths occurred after donation. Ten-year cumulative mortality of live liver donors was 0.9%. The most common cause of death was suicide (n = 19) followed by cancer (n = 9) and traffic accident (n = 7). In the matched control analysis, overall risk of death was significantly lower in donors than in Control 1 (P < 0.001), but higher than in Control 2 (P < 0.001). CONCLUSIONS Liver donors have increased long-term mortality risk compared to similar healthy controls without contraindications to be organ donors. Therefore, long-term follow-up, including psychosocial support, is needed for live liver donors.
Collapse
Affiliation(s)
- Suk Kyun Hong
- Department of Surgery, Seoul National University College of Medicine
| | - Sunho Choe
- Department of Preventive Medicine, Seoul National University College of Medicine
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine
| | - Eun Kyung Choe
- Department of Surgery, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center
| | - Kyung Chul Yoon
- Department of Surgery, Division of HBP Surgery & Liver Transplantation, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine
| |
Collapse
|
10
|
Ng CH, Lim WH, Lim XC, Xiao J, Tan DJH, Syn N, Ho CS, Kow AWC, Tan EXX, Fung J, Muthiah MD. A Meta-Analysis on the Incidence of Donor Related Depression after Liver Transplant. Transpl Int 2021; 34:2061-2070. [PMID: 34273136 DOI: 10.1111/tri.13975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 11/26/2022]
Abstract
AIM Living donor liver transplantation (LDLT) is increasing, yet gaps exist in the understanding of psychological wellbeing of donors after liver transplant. This meta-analysis seeks to evaluate the incidence and risk factors for donor-related depression after liver transplantation. METHODS A search was conducted on Medline and Embase database. Articles assessing incidence of depression in LDLT donors were included. Incidence was pooled after Freeman-Tukey double-arcsine transformation. For risk factors, dichotomous variables were analyzed with generalized linear model while a conventional meta regression with logit transformation was conducted for continuous variables. RESULTS Of 1,069 abstracts, 40 articles underwent full-text review. 17 articles were included. The pooled incidence of depression among 1,888 LT donors was 7.66% (CI: 4.47% - 12.80%). Depression rates were significantly higher in Asian compared to Western studies (RR: 1.73, CI: 1.19 - 2.52, p=0.0039). Female gender (p<0.001), Caucasian ethnicity (p=0.047), employment status (p<0.001) and lower education levels (p=0.044) were significantly associated with depression. Donor relationship with recipients was not a significant risk factor. CONCLUSIONS LDLT remains a core aspect of the treatment of end-stage liver disease. However, the high depression rates after LT suggest that there remains room for improvement in the care of donors' mental health post-transplant.
Collapse
Affiliation(s)
- Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xiong Chang Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jieling Xiao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Biostatistics & Modelling Domain, Saw Swee Hock School of Public Health, National University of Singapore
| | - Cyrus Sh Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Alfred Wei Chieh Kow
- National University Centre for Organ Transplantation, National University Health System, Singapore.,Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital.,Division of Surgical Oncology, National University Cancer Institute, Singapore
| | - Eunice Xiang Xuan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - James Fung
- Division of Liver Transplantation, Department of Surgery at Queen Mary Hospital, Hong Kong
| | - Mark Dhinesh Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| |
Collapse
|
11
|
Yang JD, Lee KW, Kim JM, Kim MS, Lee JG, Kang KJ, Choi DL, Kim BW, Ryu JH, Kim DS, Hwang S, Choi IS, Cho JY, Nah YW, You YK, Hong G, Yu HC. A comparative study of postoperative outcomes between minimally invasive living donor hepatectomy and open living donor hepatectomy: The Korean organ transplantation registry. Surgery 2021; 170:271-276. [PMID: 33846007 DOI: 10.1016/j.surg.2021.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study evaluated the safety and effectiveness of minimally invasive living donor hepatectomy in comparison with the open procedure, using Korean Organ Transplantation Registry data. METHODS We reviewed the prospectively collected data of all 1,694 living liver donors (1,071 men, 623 women) who underwent donor hepatectomy between April 2014 and December 2017. The donors were grouped on the basis of procedure type to the minimally invasive procedure group (n = 304) or to the open procedure group (n = 1,390) and analyzed the relationships between clinical data and complications. RESULTS No donors died after the procedure. The overall complication rates after operation in the minimally invasive procedure group and the open procedure group were 6.2% and 3.5%, respectively. Biliary complications were the most frequent events in both groups (minimally invasive procedure group, 2.4%; open procedure group, 1.6%). The majority of complications occurred within 7 days after surgery in both groups. The duration of hospitalization was shorter in the minimally invasive procedure group than in the open procedure group (9.04 ± 3.78 days versus 10.29 ± 4.01 days; P < .05). CONCLUSION Based on its similar outcomes in our study, minimally invasive donor hepatectomy cannot be an alternative option compared with the open procedure method. To overcome this, we need to ensure better surgical safety, such as lower complication rate and shorter duration of hospitalization.
Collapse
Affiliation(s)
- Jae Do Yang
- Department of Surgery, Jeonbuk National University Medical School, Jeonju, Korea. https://twitter.com/hirojawa
| | - Kwang Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myoung Soo Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Geun Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Koo Jeong Kang
- Department of Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Dong Lak Choi
- Department of Surgery, Catholic University of Daegu, Daegu, Korea
| | - Bong Wan Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Je Ho Ryu
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan, Korea
| | - Dong Sik Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Shin Hwang
- Department of Surgery, Asan Medical Center, Seoul, Korea
| | - In Seok Choi
- Department of Surgery, Konyang University Hospital, Daegeon, Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yang Won Nah
- Department of Surgery, Ulsan University Hospital, Ulsan, Korea
| | - Young Kyoung You
- Department of Surgery, Catholic University of Korea School of Medicine, Seoul, Korea
| | - Geun Hong
- Department of Surgery, Ewha Women's University College of Medicine and Graduate School of Medicine, Seoul, Korea
| | - Hee Chul Yu
- Department of Surgery, Jeonbuk National University Medical School, Jeonju, Korea.
| |
Collapse
|
12
|
Hsu YL, Hsieh CE, Lin PY, Lin SL, Lin KH, Weng LC, Chen YL. Postoperative incision scars and cosmetic satisfaction of living liver donors. Medicine (Baltimore) 2021; 100:e26187. [PMID: 34115002 PMCID: PMC8202607 DOI: 10.1097/md.0000000000026187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/15/2021] [Indexed: 11/25/2022] Open
Abstract
Cosmetic appearance is a major concern for living donors. However, little is known about the impact of a surgical scar on body image changes in living liver donors. The aim of this study was to identify potential factors that cause displeasing upper midline incision scar, and to evaluate the overall satisfaction regarding body image and scarring after living donor hepatectomy.Donors who underwent right lobe hepatectomy were recruited. Exclusion criteria included reoperation, refusal to participate, and lost follow-up. All donors were invited to complete the Vancouver Scar Scale (VSS) and the body image questionnaire. According to the VSS results of upper midline incision scar, donors were divided into 2 groups: good scarring group (VSS ≤4) and bad scarring group (VSS >4). we compared the clinical outcomes, including the demographics, preoperation, intraoperation, and postoperation variables. The study also analyzed the results of the body image questionnaire.The proportion of male donors was 48.9%. The bad scarring group consisted of 63% of the donors. On multivariate analysis, being a male donor was found to be an independent predictor of a cosmetically displeasing upper midline incision scar with statistical significance. The results of body image questionnaires, there were significant differences in cosmetic score and confidence score among the 2 groups.The upper midline incision and male donors have higher rates of scarring in comparison with the transverse incision and female donors. Donors who reported having a higher satisfaction with their scar appearance usually had more self-confidence. However, the body image won't be affected. Medical staff should encourage donors to take active participation in wound care and continuously observe the impact of surgical scars on psychological changes in living liver donors.
Collapse
Affiliation(s)
- Ya-Lan Hsu
- Nurse Practitioner of liver transplantation, Department of Nursing, Changhua Christian Hospital, Changhua
| | - Chia-En Hsieh
- Nurse Practitioner of liver transplantation, Department of Nursing, Changhua Christian Hospital, Changhua
| | - Ping-Yi Lin
- Department of Nursing, Hung Kung University, Taichung
| | | | - Kuo-Hua Lin
- Department of General Surgery, Changhua Christian Hospital, Changhua
| | - Li-Chueh Weng
- Associate Professor, Department of Nursing, Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Li Chen
- Department of General Surgery, Changhua Christian Hospital, Changhua
| |
Collapse
|
13
|
Ong JQL, Lim LJH, Ho RCM, Ho CSH. Depression, anxiety, and associated psychological outcomes in living organ transplant donors: A systematic review. Gen Hosp Psychiatry 2021; 70:51-75. [PMID: 33721612 DOI: 10.1016/j.genhosppsych.2021.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 12/23/2022]
Abstract
With increasing demands for living organ donations, understanding the prevalence of depression and anxiety, which are the commonest psychiatric disorders in donors following organ transplantation, will serve to improve psychiatric care to safeguard donors' mental wellbeing. This descriptive systematic review examines all observational studies in English investigating prevalence of depression and anxiety in adult transplant donors using bibliographic databases. Sixty-two papers were included (kidney, n = 25; liver, n = 25; bone marrow, n = 7; uterus, n = 2; lung, n = 1; kidney and lung concurrently, n = 2). Post-transplantation depression and anxiety prevalence rates (Depression: 0-46.9%, Anxiety: 0-66.7%) did not differ significantly from pre-transplantation and were largely comparable to the general population. Other psychiatric disorders observed included bipolar disorder, conversion disorder, adjustment disorder and sleep disorder. Other psychological outcomes observed included lower quality of life, lower satisfaction of life and regret after donation. Pre-donation risk factors such as poor physical/psychological health status, and post-donation risk factors such as complicated post-surgical recovery and poor physical/psychological health in recipients were identified, predisposing donors to poor psychological outcomes. Individuals with risk factors should be monitored and provided with social support, psychoeducation, psychotherapy and long-term follow up. Future studies should adopt consistent methodological approaches to improve comparability between various studies. More research investigating poor psychological outcomes in other organ donors besides kidney and liver donors, donors who have past psychiatric history, unrelated and parent donors is warranted.
Collapse
Affiliation(s)
- Jun Q L Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | - Cyrus S H Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| |
Collapse
|
14
|
Raza MH, Jackson WE, Dell A, Ding L, Shapiro J, Pomfret EA, Genyk Y, Sher L, Emamaullee J. Health-related quality of life after anonymous nondirected living liver donation: A multicenter collaboration. Am J Transplant 2021; 21:1056-1067. [PMID: 32741102 PMCID: PMC8351218 DOI: 10.1111/ajt.16229] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 01/25/2023]
Abstract
Literature on living nondirected liver donation is sparse. The purpose of this study was to assess health-related quality of life (HR-QOL) in anonymous nondirected living liver donors (ND-LLDs). ND-LLDs at 3 centers: University of Alberta (n = 12), University of Colorado (n = 12), and University of Southern California (n = 12), were surveyed. Thirty donors (83%) responded to the Donor Quality of Life (USC DQLS) and Short-Form 36 (SF-36). Most respondents (n = 15, 50%) donated their left lateral segment, 27% right lobe, and 23% left lobe. The majority were female (67%) and mean age was 38.9 ± 11.2 years at donation. Median follow-up was 1.1 (interquartile range 0.4-3.3) years. Approximately 37% had previously donated a kidney. Eleven experienced ≥1 postoperative complication, with only 1 Clavien-Dindo IIIb. Most reported minimal impact on school or work performance, all felt positive or neutral about their overall health since donation, and none expressed postdonation regrets. No donor reported impacts on health insurability, and 3 of 4 respondents attempting to purchase life insurance postdonation were successful. ND-LLD SF-36 outcomes were similar to US population norms. Overall, ND-LLDs demonstrated acceptable HR-QOL after donation and are appropriate candidates for partial liver donation. Based on evaluation of donation impact, consideration should be given to postdonation support strategies.
Collapse
Affiliation(s)
- Muhammad H. Raza
- Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Whitney E. Jackson
- Department of Gastroenterology and Hepatology, University of Colorado, Aurora, CO USA
| | - Angela Dell
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Li Ding
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA USA
| | - James Shapiro
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | | | - Yuri Genyk
- Keck School of Medicine, University of Southern California, Los Angeles, CA USA,Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA USA
| | - Linda Sher
- Keck School of Medicine, University of Southern California, Los Angeles, CA USA,Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA USA
| | - Juliet Emamaullee
- Keck School of Medicine, University of Southern California, Los Angeles, CA USA,Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA USA
| |
Collapse
|
15
|
Expert Consensus Guidelines on Minimally Invasive Donor Hepatectomy for Living Donor Liver Transplantation From Innovation to Implementation: A Joint Initiative From the International Laparoscopic Liver Society (ILLS) and the Asian-Pacific Hepato-Pancreato-Biliary Association (A-PHPBA). Ann Surg 2021; 273:96-108. [PMID: 33332874 DOI: 10.1097/sla.0000000000004475] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The Expert Consensus Guidelines initiative on MIDH for LDLT was organized with the goal of safe implementation and development of these complex techniques with donor safety as the main priority. BACKGROUND Following the development of minimally invasive liver surgery, techniques of MIDH were developed with the aim of reducing the short- and long-term consequences of the procedure on liver donors. These techniques, although increasingly performed, lack clinical guidelines. METHODS A group of 12 international MIDH experts, 1 research coordinator, and 8 junior faculty was assembled. Comprehensive literature search was made and studies classified using the SIGN method. Based on literature review and experts opinions, tentative recommendations were made by experts subgroups and submitted to the whole experts group using on-line Delphi Rounds with the goal of obtaining >90% Consensus. Pre-conference meeting formulated final recommendations that were presented during the plenary conference held in Seoul on September 7, 2019 in front of a Validation Committee composed of LDLT experts not practicing MIDH and an international audience. RESULTS Eighteen Clinical Questions were addressed resulting in 44 recommendations. All recommendations reached at least a 90% consensus among experts and were afterward endorsed by the validation committee. CONCLUSIONS The Expert Consensus on MIDH has produced a set of clinical guidelines based on available evidence and clinical expertise. These guidelines are presented for a safe implementation and development of MIDH in LDLT Centers with the goal of optimizing donor safety, donor care, and recipient outcomes.
Collapse
|
16
|
Sinha PK, Mohapatra N, Bharathy KGS, Kumar G, Pamecha V. A Long-Term Prospective Study of Quality of Life, Abdominal Symptoms, and Cosmesis of Donors After Hepatectomy for Live-Donor Liver Transplantation. J Clin Exp Hepatol 2021; 11:579-585. [PMID: 34511819 PMCID: PMC8414308 DOI: 10.1016/j.jceh.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/30/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Comprehensive assessment of quality of life of live liver donors is required for adequate donor outcome reporting, but there is a lack of prospective data. Assessment of all aspects of liver donation over a long period is a necessity to have complete understanding of the donation process. METHODS Prospectively collected data of liver donors operated between March 2012 to August 2013, examined donors (n = 52) from predonation to five years after the donation. Participants were administered 'World Health Organization quality of life Brief and questionnaires' regarding their attitude predonation, their overall well-being in terms of abdominal symptoms, cosmesis, and satisfaction with donation and consent process at predefined time points till five years after donation. The weight of the donors was recorded at predefined time points. RESULTS The donors whose recipients died were less likely to continue with the study (8.9% vs. 71.4%; P < 0.001). After surgery, physical domain took 2 years to reach to predonation level while psychological and social relationship domains took 3 months and 1 month, respectively; environmental domain remained stable throughout. Even after recovery and discharge from hospital, donors experienced abdominal symptoms for a long period of time, but as the time increased from donation the reporting of symptoms decreased. Body image scores (12 ± 2.46 at 3 months vs. 14.9 ± 3.16 at five years, P < 0.001) and cosmesis scores (14.6 ± 3.67 at 3 months vs. 18.75 ± 3 at five years, P < 0.001) significantly improved over time. There was significant weight gain in donors (65.2 ± 6.1 kg predonation vs. 70.69 ± 2.4 kg at 2 years P < 0.001). Donors understood the consent process well, but did not use it for decision making. Overall, they showed a high level of satisfaction in the donation process. CONCLUSION Donors have good quality of life and show steady recovery in all aspects. Recipient death affects attitude towards donation process.
Collapse
Affiliation(s)
- Piyush K. Sinha
- Department of Hepato Pancreato Biliary and Liver Transplant Surgery, Institute of Liver & Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India
| | - Nihar Mohapatra
- Department of Hepato Pancreato Biliary and Liver Transplant Surgery, Institute of Liver & Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India
| | - Kishore GS. Bharathy
- Department of Hepato Pancreato Biliary and Liver Transplant Surgery, Institute of Liver & Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India
| | - Guresh Kumar
- Department of Biostatistics, Institute of Liver & Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India
| | - Viniyendra Pamecha
- Department of Hepato Pancreato Biliary and Liver Transplant Surgery, Institute of Liver & Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India
- Address for correspondence. Viniyendra Pamecha, Professor and Head, Department of Hepato Pancreato Biliary and Liver Transplant Surgery, Institute of Liver & Biliary Sciences, New Delhi, 110070, India.
| |
Collapse
|
17
|
Abstract
Liver transplantation has become established as a standard procedure in the treatment of end-stage liver diseases. Despite intense efforts by all parties involved up to the amendment of the German Transplantation Act, the lack of suitable donor organs was still one of the limiting factors of this therapeutic procedure. One way out of this problem is to make so-called marginal organs usable, e.g. with the help of machine perfusion or by utilizing living liver donation, which are used in some countries for more than 90% of organ donations. In general, there is no difference in the indications for liver transplantation between a (partial) organ obtained by post-mortem or living donation. Before any living donation, a thorough evaluation of the donor is carried out in order to minimize postoperative morbidity as far as possible. Technically the partial liver donation is based on the oncological liver resection, while the partial liver transplantation is a further development of split liver transplantation after post-mortem liver donation. In specialized centers comparable or even better results can nowadays be achieved using living liver donation instead of post-mortem donation.
Collapse
Affiliation(s)
- H-M Tautenhahn
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
- Research Programme "Else Kröner-Forschungskolleg AntiAge", Universitätsklinikum Jena, Jena, Deutschland.
| | - F Rauchfuß
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - A Ali Deeb
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - A Bauschke
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - U Settmacher
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| |
Collapse
|
18
|
Raza MH, Kim MH, Ding L, Fong TL, Romero C, Genyk Y, Sher L, Emamaullee J. Long-Term Financial, Psychosocial, and Overall Health-Related Quality of Life After Living Liver Donation. J Surg Res 2020; 253:41-52. [PMID: 32320896 PMCID: PMC8351216 DOI: 10.1016/j.jss.2020.03.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND To assess the impact of living liver donation (LD) in a diverse and aging population up to 20 y after donation, particularly with regard to medical, financial, psychosocial, and overall health-related quality of life (HRQOL). METHODS Patients undergoing LD between 1999 and 2009 were recruited to respond to the Short-Form 36 and a novel Donor Quality of Life Survey at two time points (2010 and 2018). RESULTS Sixty-eight living liver donors (LLDs) completed validated surveys, with a mean follow-up of 11.5 ± 5.1 y. Per Donor Quality of Life Survey data, physical activity or strength was not impacted by LD in most patients. All respondents returned to school or employment, and 82.4% reported that LD had no impact on school or work performance. LD did not impact health insurability in 95.6% of donors, and only one patient experienced difficulty obtaining life insurance. Overall, 97.1% of respondents did not regret LD. Short-Form 36 survey-measured outcomes were similar between LLDs and the general U.S. POPULATION LLDs who responded in both 2010 and 2018 were followed for an overall average of 15.4 ± 2.4 y and HRQOL outcomes in these donors also remained statistically equivalent to U.S. population norms. CONCLUSIONS This study represents the longest postdonation follow-up and offers unique insight related to HRQOL in a highly diverse patient population. Although LLDs continue to maintain excellent HRQOL outcomes up to 20 y after donation, continued lifetime follow-up is required to accurately provide young, healthy potential donors with an accurate description of the risks that they may incur on aging.
Collapse
Affiliation(s)
- Muhammad H Raza
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Michelle H Kim
- Keck School of Medicine, University of Southern California, Los Angeles, California; Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, California
| | - Li Ding
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Tse-Ling Fong
- Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California
| | - Christian Romero
- Department of Surgery, University of Southern California, Los Angeles, California
| | - Yuri Genyk
- Keck School of Medicine, University of Southern California, Los Angeles, California; Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, California
| | - Linda Sher
- Keck School of Medicine, University of Southern California, Los Angeles, California; Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, California
| | - Juliet Emamaullee
- Keck School of Medicine, University of Southern California, Los Angeles, California; Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, California.
| |
Collapse
|
19
|
Shi Y, Liu C, Zhang H, Huang Y, Sun M, Wang W, Shang S. Changes in the quality of life of living liver donors: A meta-analysis. Int J Nurs Stud 2020; 109:103586. [PMID: 32531567 DOI: 10.1016/j.ijnurstu.2020.103586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 03/04/2020] [Accepted: 03/10/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Comprehending the physical, psychological, social benefits, and harm associated with liver donation is critical in promoting practices to maintain donors' long-term health. However, changes in quality of life among living liver donors pre- and post-donation have not been established. OBJECTIVE This meta-analysis of prospective longitudinal studies examined the quality of life changes among living liver donors pre- and post-donation. METHODS PubMed, Embase, CINHAL with full text, and ProQuest Dissertations & Theses were mainly searched for full-text articles from inception till December 2018 to identify studies assessing the quality of life of living liver donors. The methodological quality of the included studies was examined. The quality of life post-donation at five assessment points, ≤1 month, 3 months, 6 months, 12 months, and ≥ 24 months were compared with the pre-donation, respectively. RESULTS The search yielded 2215 records, and a total of 15 articles (13 studies) with 715 donors were included in this meta-analysis. Physical functioning scores at ≤1 month, 3 months, 6 months, 12 months, and ≥24 months post-donation were significantly lower than pre-donation [overall standardized mean difference (SMD) = -0.67, 95% CI: -0.86, -0.49; p ≤]. Significantly higher level of pain was found at 3-month post-donation (SMD, -1.05; 95% CI: -1.26, -0.85; p < 0.00001). Also, a significantly higher level of anxiety was found at 3-month post-donation (SMD, -0.29; 95%CI: -0.51, -0.07; p = 0.01), but there were no significant changes in general psychological state and depression. A significant reduction in donors' social quality of life (SMD, -2.61; 95%CI: -4.75, 0.48; p = 0.02) was found at ≤1-month post-donation, and recovery to pre-donation levels occurred at 3 months post-donation. CONCLUSIONS Living liver donation was associated with a decline in physical functioning, which was sustained for longer than 2 years post-donation. Impaired social and psychological quality of life affected donors for 1-3 months after their donation. The quality of life of living liver donors has become a pressing issue requiring more attention from doctors and nurses within the transplant team. However, multicenter, prospective, and longitudinal studies are needed to confirm the long-term safety of living liver donors.
Collapse
Affiliation(s)
- Yuexian Shi
- School of Nursing, Peking University, Beijing, China.
| | - Chunxia Liu
- Department of urinary surgery, Peking University Third Hospital, 100161, Beijing, China
| | - Haiming Zhang
- Liver Transplantation Center; Clinical Center for Pediatric Liver Transplantation; National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
| | - Yaqi Huang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Meng Sun
- School of Nursing, Peking University, Beijing, China
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Shaomei Shang
- School of Nursing, Peking University, Beijing, China.
| |
Collapse
|
20
|
Minimally Invasive Donor Hepatectomy for Adult Living Donor Liver Transplantation: An International, Multi-Institutional Evaluation of Safety, Efficacy and Early Outcomes. Ann Surg 2020; 275:166-174. [PMID: 32224747 DOI: 10.1097/sla.0000000000003852] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Evaluating the perioperative outcomes of minimally invasive (MIV) donor hepatectomy for adult live donor liver transplants in a large multi-institutional series from both Eastern and Western centers. BACKGROUND Laparoscopic liver resection has become standard practice for minor resections in selected patients in whom it provides reduced postoperative morbidity and faster rehabilitation. Laparoscopic approaches in living donor hepatectomy for transplantation, however, remain controversial because of safety concerns. Following the recommendation of the Jury of the Morioka consensus conference to address this, a retrospective study was designed to assess the early postoperative outcomes after laparoscopic donor hepatectomy. The collective experience of 10 mature transplant teams from Eastern and Western countries was reviewed. METHODS All centers provided data from prospectively maintained databases. Only left and right hepatectomies performed using a MIV technique were included in this study. Primary outcome was the occurrence of complications using the Clavien-Dindo graded classification and the Comprehensive Complication Index during the first 3 months. Logistic regression analysis was used to identify risk factors for complications. RESULTS In all, 412 MIV donor hepatectomies were recorded including 164 left and 248 right hepatectomies. Surgical technique was either pure laparoscopy in 175 cases or hybrid approach in 237. Conversion into standard laparotomy was necessary in 17 donors (4.1%). None of the donors died. Also, 108 experienced 121 complications including 9.4% of severe (Clavien-Dindo 3-4) complications. Median Comprehensive Complication Index was 5.2. CONCLUSIONS This study shows favorable early postoperative outcomes in more than 400 MIV donor hepatectomy from 10 experienced centers. These results are comparable to those of benchmarking series of open standard donor hepatectomy.
Collapse
|
21
|
Raza MH, Aziz H, Kaur N, Lo M, Sher L, Genyk Y, Emamaullee J. Global experience and perspective on anonymous nondirected live donation in living donor liver transplantation. Clin Transplant 2020; 34:e13836. [PMID: 32154620 DOI: 10.1111/ctr.13836] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/21/2020] [Accepted: 02/16/2020] [Indexed: 12/13/2022]
Abstract
Anonymous nondirected living liver donation (ANLLD), sometimes referred to as "altruistic" donation, occurs when a biologically unrelated person comes forward to donate a portion of his/her liver to a transplant candidate who is unknown to the donor. Here, we explore the current status of ANLLD with special consideration of published reports; US experience; impact on donor psychosocial outcomes; barriers to donation; and current global trends with respect to ethical considerations. Between 1998 and 2019, 105 anonymous nondirected living liver donor (ND-LLD) transplants have been documented in the US Scientific Registry of Transplant Recipients. Sixteen donors (15%) were reported to experience a postoperative complication. Currently, 89 donors remain alive (85%), 16 (15%) have unknown status, and none are confirmed deceased. Although there are only a handful of case series, these data suggest that ANLLD is a feasible option. While there are no liver-specific data, studies involving anonymous nondirected kidney donors suggest that anonymous donation does not adversely impact psychosocial outcomes in donors or recipients. There are substantial financial burdens and ethical considerations related to ANLLD. Further studies are required to assess donor demographics, psychosocial motivations, long-term health-related quality of life, and financial impact of ANLLD.
Collapse
Affiliation(s)
- Muhammad H Raza
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hassan Aziz
- Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Navpreet Kaur
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Mary Lo
- Department of Preventative Medicine, University of Southern California, Los Angeles, CA, USA
| | - Linda Sher
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Yuri Genyk
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Juliet Emamaullee
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
22
|
LaPointe Rudow D, DeLair S, Feeley T, Florman S, Guarrera J, Kinkhabwala M, Orloff M, Teperman L, Morgan G. Longterm Impact of Living Liver Donation: A Self-Report of the Donation Experience. Liver Transpl 2019; 25:724-733. [PMID: 30589993 DOI: 10.1002/lt.25402] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 12/19/2018] [Indexed: 12/13/2022]
Abstract
Outcomes for adult-to-adult living liver donors (LDs) are largely based on short-term data drawn from single-center studies. The aim of this study was to determine how living liver donation (LLD) impacts self-reported quality-of-life (QOL) up to 6 years after donation in a sample of residents from New York State. New York transplant programs are state-mandated to track LDs as part of a quality assurance and patient safety effort. Donor-reported QOL within 1 year of donation and longitudinal data over a 10-year period were analyzed. Self-reported surveys include the following domains: employment, finances, health/life insurance, activities of daily living, physical/emotional health, donor experience, relationships, and LD opinions. There were 220 LDs in New York (2004-2013) who completed a survey over the 10-year period with many donors completing surveys at several points in time. Overall, longterm LDs remain as comfortable about LLD as they were during the first year after donation (95%). The majority of LDs reported feeling as well as before LLD (72%). At 1 year after donation, 60% of subjects self-reported medical problems, and 30% reported emotional issues. However, the majority reported that they would willingly donate again. In conclusion, LDs remain satisfied with their decision to donate over time. A minority of LDs report longterm medical and emotional issues. The conclusions provide information for educational interventions to improve informed choice to those considering donation.
Collapse
Affiliation(s)
- Dianne LaPointe Rudow
- Zweig Family Center for Living Donation, Recanati/Miller Transplantation Institute, Department of Health Evidence and Policy, Mount Sinai Hospital, New York, NY
| | | | | | - Sander Florman
- Zweig Family Center for Living Donation, Recanati/Miller Transplantation Institute, Department of Health Evidence and Policy, Mount Sinai Hospital, New York, NY
| | | | | | - Mark Orloff
- University of Rochester Medical Center, Rochester, NY.,Westchester Medical Center, Valhalla, NY
| | | | | |
Collapse
|
23
|
A Worldwide Survey of Live Liver Donor Selection Policies at 24 Centers With a Combined Experience of 19 009 Adult Living Donor Liver Transplants. Transplantation 2019; 103:e39-e47. [PMID: 30308575 DOI: 10.1097/tp.0000000000002475] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
24
|
Weng LC, Huang HL, Lee WC, Tsai YH, Wang WS, Chen KH. Health-related quality of life of living liver donors 1 year after donation. Hepatobiliary Surg Nutr 2019; 8:1-9. [PMID: 30881960 DOI: 10.21037/hbsn.2018.11.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Improving the health-related quality of life (HRQOL) of living liver donors post-donation is an important aspect of care quality. Analyzing the HRQOL of living liver donors prospectively could help improve our understanding of the recovery of HRQOL and help improve the quality of donor care. In this study, we examined the HRQOL of living liver donors at pre-donation and at 1-year post-donation and analyzed the effect of pre- and post-donation factors on the donors' physical and mental HRQOL. Methods This was a prospective study. During the enrollment period (August 2013 to December 2015), 68 living liver donors completed the study questionnaires 5 times: at pre-donation and at 1, 3, 6, and 12 months post-donation. The Medical Outcomes Study Questionnaire Short Form-36, which yields both physical (PCS) and mental (MCS) component summary scores, was used to measure the HRQOL. The pre- and post-donation factors included donation ambivalence, recipients' physical condition, post-donation complications, and recipients' survival status. Results Participants' mean PCS scores were 43.59 and 56.50 at 1 and 12 months after donation, respectively, whereas their mean MCS scores were 46.89 and 46.28, respectively. The mean PCS score was worse at 1 month after donation but improved significantly over time (P<0.05); conversely, the MCS was quite stable over time (P>0.05). A good PCS score was associated with no surgical complications of donation (coefficient =2.87, P=0.02), whereas a poor MCS score was associated with an education of less than a bachelor's degree (coefficient =-3.60, P=0.004), a higher Model for End-Stage Liver Disease (MELD) score in the recipient (coefficient =-0.13, P=0.03), and recipient death (coefficient =-3.48, P=0.03). Pre-donation ambivalence and sense of coherence were not significant predictors of the PCS or MCS scores. Conclusions The impact of living liver donation on HRQOL was strongest in the early stages of the post-surgery period for the physical domain. Health-care professionals should carefully manage and monitor the progress of surgical outcomes, particularly in high-risk groups such as donors with a low education level or donors whose recipients have severe illness or end up dying after the surgery. Doing so may allow for suitable intervention opportunities to improve the HRQOL of living liver donors.
Collapse
Affiliation(s)
- Li-Chueh Weng
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of General Surgery, Transplantation Center, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
| | - Hsiu-Li Huang
- Department of Long-Term Care, College of Health Technology, National Taipei University of Nursing and Health Science, Taipei, Taiwan
| | - Wei-Chen Lee
- Department of General Surgery, Transplantation Center, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
| | - Yu-Hsia Tsai
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Cardiovascular Medicine, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
| | - Woan-Shyuan Wang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kang-Hua Chen
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
| |
Collapse
|
25
|
Serrano OK, Mongin SJ, Berglund D, Goduguchinta V, Reddy A, Vock DM, Kirchner V, Kandaswamy R, Pruett TL, Chinnakotla S. Clinical utility of postoperative phosphate recovery profiles to predict liver insufficiency after living donor hepatectomy. Am J Surg 2019; 218:374-379. [PMID: 30660322 DOI: 10.1016/j.amjsurg.2019.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/06/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Living donor hepatectomy (LDH) is associated with significant postoperative hypophosphatemia. METHODS From January 1997 through July 2017, we performed 176 LDH and compared donors who developed liver insufficiency (LI) to those that did not within 30 days of LDH. Using smoothing splines, we constructed a mixed-effects model and assessed receiver operating characteristic curves. RESULTS Of the 176 donors, 161 were included in our study and 10 (6.2%) developed LI. The cohorts differed in minimum observed phosphate levels (1.77 mg/dL, LI cohort; 2.01 mg/dL No LI cohort) at a median nadir of 1.6 days (38 h) postoperatively (p = 0.003). In the ROC analysis, intraoperative time and postoperative phosphate levels best predicted LI (sensitivity, 90%; specificity, 55.6%). CONCLUSION Mean postoperative phosphate profiles differ significantly between those patients who develop LI and those who do not in the first 38 h after LDH.
Collapse
Affiliation(s)
- Oscar K Serrano
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
| | - Steven J Mongin
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Danielle Berglund
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Varshita Goduguchinta
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Apoorva Reddy
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - David M Vock
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Varvara Kirchner
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Raja Kandaswamy
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Timothy L Pruett
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Srinath Chinnakotla
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
26
|
Prevalence and Predictors of Patient-Reported Long-term Mental and Physical Health After Donation in the Adult-to-Adult Living-Donor Liver Transplantation Cohort Study. Transplantation 2018; 102:105-118. [PMID: 28885494 DOI: 10.1097/tp.0000000000001942] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prospective and longitudinal studies have examined liver donors' medical outcomes beyond the first 1 to 2 years postdonation. There is no analogous longitudinal evidence on long-term psychosocial outcomes, including patient-reported clinically significant mental health problems and perceptions of physical well-being. We examined prevalence, descriptive characteristics, and predictors of diagnosable mental health conditions and self-reported physical health problems, including fatigue and pain, in the long-term years after liver donation. METHODS Donors from 9 centers who initially completed telephone interviews at 3 to 10 years postdonation (mean, 5.8 years; SD, 1.9) were reinterviewed annually for 2 years using validated measures. Outcomes were examined descriptively. Repeated-measures regression analyses evaluated potential predictors and correlates of outcomes. RESULTS Of 517 donors initially interviewed (66% of those eligible), 424 (82%) were reassessed at least once. Prevalence rates of major depression and clinically significant pain were similar to general population norms; average fatigue levels were better than norms. All prevalence rates showed little temporal change. Anxiety and alcohol use disorder rates exceeded normative rates at 1 or more assessments. Longer postdonation hospitalization, female sex, higher body mass index, concerns about donation-related health effects, and burdensome donation-related financial costs were associated with increased risk for most outcomes (P's < 0.05). Men were at higher risk for alcohol use disorder (P < 0.001). CONCLUSIONS Anxiety and alcohol use disorders were more common than would be expected; they may warrant increased research attention and clinical surveillance. Surveillance for long-term problems in the areas assessed may be optimized by targeting donors at higher risk based on identified predictors and correlates.
Collapse
|
27
|
Complications after Living Donor Hepatectomy: Analysis of 176 Cases at a Single Center. J Am Coll Surg 2018; 227:24-36. [DOI: 10.1016/j.jamcollsurg.2018.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/31/2018] [Accepted: 03/05/2018] [Indexed: 02/06/2023]
|
28
|
Ennis SS, Guo H, Raman L, Tambyah PA, Chen SL, Tiong HY. Premenopausal women with recurrent urinary tract infections have lower quality of life. Int J Urol 2018; 25:684-689. [PMID: 29788547 DOI: 10.1111/iju.13698] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/30/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To examine the impact on quality of life of recurrent acute uncomplicated urinary tract infection among premenopausal Singaporean women, and to determine the risk factors for lower quality of life among these patients. METHODS A total of 85 patients with recurrent acute uncomplicated urinary tract infection who were referred to the Urology Department at the National University Hospital, Singapore, were prospectively recruited over a 3-year period to complete the validated Short Form 36 Health Survey version 1. In addition, demographic and clinical details including symptomology and medical history were analyzed for factors impacting quality of life. Short Form 36 Health Survey version 1 results were compared with published population norms. RESULTS After adjusting for age, gender and race, recurrent acute uncomplicated urinary tract infection patients had significantly lower quality of life on seven out of eight Short Form 36 Health Survey version 1 domains when compared with age-, gender- and race-adjusted population norms for Singapore. Among those with recurrent acute uncomplicated urinary tract infection, those who also reported caffeine consumption had significantly lower Short Form 36 Health Survey version 1 scores than those who did not. Those who reported chronic constipation also had consistently lower Short Form 36 Health Survey version 1 scores across all domains. CONCLUSIONS Recurrent acute uncomplicated urinary tract infection has a negative impact on the quality of life of premenopausal, otherwise healthy women. Recurrent acute uncomplicated urinary tract infection patients who also have chronic constipation or consume caffeine have lower quality of life than those who do not. More studies are required to understand the relationships between these common problems and risk factors.
Collapse
Affiliation(s)
- Siobhan S Ennis
- GERMS and Infectious Diseases Group, Genome Institute of Singapore, Singapore
| | - Huifang Guo
- Department of Urology, National University Health System, Singapore
| | - Lata Raman
- Department of Urology, National University Health System, Singapore
| | - Paul A Tambyah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Swaine L Chen
- GERMS and Infectious Diseases Group, Genome Institute of Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ho Yee Tiong
- Department of Urology, National University Health System, Singapore
| |
Collapse
|
29
|
Massey EK, Timmerman L, Ismail SY, Duerinckx N, Lopes A, Maple H, Mega I, Papachristou C, Dobbels F. The ELPAT living organ donor Psychosocial Assessment Tool (EPAT): from 'what' to 'how' of psychosocial screening - a pilot study. Transpl Int 2017; 31:56-70. [PMID: 28850737 DOI: 10.1111/tri.13041] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/20/2017] [Accepted: 08/14/2017] [Indexed: 11/28/2022]
Abstract
Thorough psychosocial screening of donor candidates is required in order to minimize potential negative consequences and to strive for optimal safety within living donation programmes. We aimed to develop an evidence-based tool to standardize the psychosocial screening process. Key concepts of psychosocial screening were used to structure our tool: motivation and decision-making, personal resources, psychopathology, social resources, ethical and legal factors and information and risk processing. We (i) discussed how each item per concept could be measured, (ii) reviewed and rated available validated tools, (iii) where necessary developed new items, (iv) assessed content validity and (v) pilot-tested the new items. The resulting ELPAT living organ donor Psychosocial Assessment Tool (EPAT) consists of a selection of validated questionnaires (28 items in total), a semi-structured interview (43 questions) and a Red Flag Checklist. We outline optimal procedures and conditions for implementing this tool. The EPAT and user manual are available from the authors. Use of this tool will standardize the psychosocial screening procedure ensuring that no psychosocial issues are overlooked and ensure that comparable selection criteria are used and facilitate generation of comparable psychosocial data on living donor candidates.
Collapse
Affiliation(s)
- Emma K Massey
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Lotte Timmerman
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Sohal Y Ismail
- Department of Psychiatry, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Nathalie Duerinckx
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium.,Heart Transplant Program, Department of Cardiovascular Sciences, University Hospitals of Leuven, Leuven, Belgium
| | - Alice Lopes
- Psychiatry and Health Psychology Unit, Centro Hospitalar do Porto, Porto, Portugal
| | - Hannah Maple
- Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Inês Mega
- Hepato-Biliar-Pancreatic and Transplantation Center, Hospital Curry Cabral, Lisbon, Portugal
| | - Christina Papachristou
- Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Fabienne Dobbels
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium
| | | |
Collapse
|
30
|
Fickert P, Hirschfield GM, Denk G, Marschall HU, Altorjay I, Färkkilä M, Schramm C, Spengler U, Chapman R, Bergquist A, Schrumpf E, Nevens F, Trivedi P, Reiter FP, Tornai I, Halilbasic E, Greinwald R, Pröls M, Manns MP, Trauner M. norUrsodeoxycholic acid improves cholestasis in primary sclerosing cholangitis. J Hepatol 2017; 67:549-558. [PMID: 28529147 DOI: 10.1016/j.jhep.2017.05.009] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/12/2017] [Accepted: 05/06/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIM Primary sclerosing cholangitis (PSC) represents a devastating bile duct disease, currently lacking effective medical therapy. 24-norursodeoxycholic acid (norUDCA) is a side chain-shortened C23 homologue of UDCA and has shown potent anti-cholestatic, anti-inflammatory and anti-fibrotic properties in a preclinical PSC mouse model. A randomized controlled trial, including 38 centers from 12 European countries, evaluated the safety and efficacy of three doses of oral norUDCA (500mg/d, 1,000mg/d or 1,500mg/d) compared with placebo in patients with PSC. METHODS One hundred sixty-one PSC patients without concomitant UDCA therapy and with elevated serum alkaline phosphatase (ALP) levels were randomized for a 12-week treatment followed by a 4-week follow-up. The primary efficacy endpoint was the mean relative change in ALP levels between baseline and end of treatment visit. RESULTS norUDCA reduced ALP levels by -12.3%, -17.3%, and -26.0% in the 500, 1,000, and 1,500mg/d groups (p=0.029, p=0.003, and p<0.0001 when compared to placebo), respectively, while a +1.2% increase was observed in the placebo group. Similar dose-dependent results were found for secondary endpoints, such as ALT, AST, γ-GT, or the rate of patients achieving ALP levels <1.5× ULN. Serious adverse events occurred in seven patients in the 500mg/d, five patients in the 1,000mg/d, two patients in the 1500mg/d group, and three in the placebo group. There was no difference in reported pruritus between treatment and placebo groups. CONCLUSIONS norUDCA significantly reduced ALP values dose-dependently in all treatment arms. The safety profile of norUDCA was excellent and comparable to placebo. Consequently, these results justify a phase III trial of norUDCA in PSC patients. Lay summary: Effective medical therapy for primary sclerosing cholangitis (PSC) is urgently needed. In this phase II clinical study in PSC patients, a side chain-shortened derivative of ursodeoxycholic acid, norursodeoxycholic acid (norUDCA), significantly reduced serum alkaline phosphatase levels in a dose-dependent manner during a 12-week treatment. Importantly, norUDCA showed a favorable safety profile, which was similar to placebo. The use of norUDCA in PSC patients is promising and will be further evaluated in a phase III clinical study. ClinicalTrials.gov number: NCT01755507.
Collapse
Affiliation(s)
- Peter Fickert
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gideon M Hirschfield
- Centre for Liver Research and NIHR Biomedical Research Unit, University of Birmingham, United Kingdom
| | - Gerald Denk
- Department of Medicine II, Liver Center Munich, Ludwig Maximilians University (LMU), Munich, Germany
| | - Hanns-Ulrich Marschall
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Istvan Altorjay
- Department of Gastroenterology, School of Medicine, Debrecen University, Debrecen, Hungary
| | - Martti Färkkilä
- University of Helsinki and Clinic of Gastroenterology, Helsinki University Hospital, Helsinki, Finland
| | - Christoph Schramm
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Spengler
- Department of Internal Medicine 1, Rheinische Friedrich-Wilhelm's University Bonn, Bonn, Germany
| | - Roger Chapman
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - Annika Bergquist
- Department of Gastroenterology and Hepatology, Karolinska University Hospital, Karolinska Institute, Huddinge, Stockholm, Sweden
| | - Erik Schrumpf
- Section of Gastroenterology, Department of Transplantation Medicine, Division of Cancer Medicine, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Frederik Nevens
- Hepatology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Palak Trivedi
- Centre for Liver Research and NIHR Biomedical Research Unit, University of Birmingham, United Kingdom
| | - Florian P Reiter
- Department of Medicine II, Liver Center Munich, Ludwig Maximilians University (LMU), Munich, Germany
| | - Istvan Tornai
- Department of Gastroenterology, School of Medicine, Debrecen University, Debrecen, Hungary
| | - Emina Halilbasic
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | | | | | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
| | | |
Collapse
|
31
|
Psychosocial Outcomes 3 to 10 Years After Donation in the Adult to Adult Living Donor Liver Transplantation Cohort Study. Transplantation 2017; 100:1257-69. [PMID: 27152918 DOI: 10.1097/tp.0000000000001144] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Studies of liver donors' psychosocial outcomes focus on the short term and rely largely on quality-of-life measures not specific to donation. We sought to examine long-term donation effects on 3 psychosocial domains: perceived physical, emotional, and socioeconomic outcomes. METHODS Individuals donating 3 to 10 years previously at 9 centers were eligible for telephone surveys. Survey responses were examined descriptively. Cluster analysis was used to identify distinct donor groups based on response profiles across psychosocial domains. Potential predictors of response profiles were evaluated with regression analysis. RESULTS Five hundred seventeen donors (66%) participated (M = 5.8 years postdonation, SD = 1.9). Fifteen percent to 48% of donors endorsed current donation-related physical health problems and concerns, and 7%-60% reported socioeconomic concerns (eg, insurance difficulties, financial expenditures). However, on average, donors experienced high psychological growth, and 90% felt positively about donation. Cluster analysis revealed 5 donor groups. One group showed high psychological benefit, with little endorsement of physical or socioeconomic concerns (15% of donors). Four groups showed less favorable profiles, with varying combinations of difficulties. The largest such group showed high endorsement of physical concerns and financial expenditures, and only modest psychological benefit (31% of donors). Men and nonHispanic whites were most likely to have unfavorable response profiles (Ps < 0.01). Compared with donors aged 19 to 30 years, older donors were less likely to have unfavorable profiles; these differences were significant for donors in the >40 to 50 year age group (Ps < 0.008). CONCLUSIONS Even many years postdonation, donors report adverse physical and socioeconomic effects, but positive emotional effects as well. Identification of response profiles and predictors may improve targeting of postdonation surveillance and care.
Collapse
|
32
|
Butt Z, Dew MA, Liu Q, Simpson MA, Smith AR, Zee J, Gillespie BW, Abbey SE, Ladner DP, Weinrieb R, Fisher RA, Hafliger S, Terrault N, Burton J, Sherker AH, DiMartini A. Psychological Outcomes of Living Liver Donors From a Multicenter Prospective Study: Results From the Adult-to-Adult Living Donor Liver Transplantation Cohort Study2 (A2ALL-2). Am J Transplant 2017; 17:1267-1277. [PMID: 27865040 PMCID: PMC5612366 DOI: 10.1111/ajt.14134] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/21/2016] [Accepted: 11/08/2016] [Indexed: 01/25/2023]
Abstract
Although single-center and cross-sectional studies have suggested a modest impact of liver donation on donor psychological well-being, few studies have assessed these outcomes prospectively among a large cohort. We conducted one of the largest, prospective, multicenter studies of psychological outcomes in living liver donors within the Adult-to-Adult Living Donor Liver Transplantation Cohort Study2 (A2ALL-2) consortium. In total, 271 (91%) of 297 eligible donors were interviewed at least once before donation and at 3, 6, 12, and 24 mo after donation using validated measures. We found that living liver donors reported low rates of major depressive (0-3%), alcohol abuse (2-5%), and anxiety syndromes (2-3%) at any given assessment in their first 2 years after donation. Between 4.7% and 9.6% of donors reported impaired mental well-being at various time points. We identified significant predictors for donors' perceptions of being better people and experiencing psychological growth following donation, including age, sex, relationship to recipient, ambivalence and motivation regarding donation, and feeling that donation would make life more worthwhile. Our results highlight the need for close psychosocial monitoring for those donors whose recipients died (n=27); some of those donors experienced guilt and concerns about responsibility. Careful screening and targeted, data-driven follow-up hold promise for optimizing psychological outcomes following this procedure for potentially vulnerable donors.
Collapse
Affiliation(s)
- Z Butt
- Departments of Medical Social Sciences, Surgery, & Psychiatry and Behavioral Sciences Northwestern University, Chicago IL
| | - MA Dew
- Departments of Psychiatry, Surgery, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh PA
| | - Q Liu
- Arbor Research Collaborative for Health, Ann Arbor, MI
| | - MA Simpson
- Department of Transplantation, Lahey Hospital and Medical Center, Burlington, MA
| | - AR Smith
- Arbor Research Collaborative for Health, Ann Arbor, MI,Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - J Zee
- Arbor Research Collaborative for Health, Ann Arbor, MI
| | - BW Gillespie
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - SE Abbey
- Department of Psychiatry and Transplantation, University Health Network, University of Toronto, Toronto, Ontario, CA
| | - DP Ladner
- Departments of Medical Social Sciences, Surgery, & Psychiatry and Behavioral Sciences Northwestern University, Chicago IL
| | - R Weinrieb
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - RA Fisher
- Professor of Surgery, Harvard Medical School Chief, Division of Transplantation, The Transplant Institute Beth Israel Deaconess Medical Center, Harvard University, Boston, MA
| | - S Hafliger
- Department of Psychiatry, Columbia University, New York, NY
| | - N Terrault
- Departments of Medicine and Surgery, University of California at San Francisco, San Francisco, CA
| | - J Burton
- Department of Medicine, University of Colorado, Denver, Aurora, CO
| | - AH Sherker
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - A DiMartini
- Departments of Psychiatry, Surgery, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh PA
| |
Collapse
|
33
|
Dew MA, Butt Z, Humar A, DiMartini AF. Long-Term Medical and Psychosocial Outcomes in Living Liver Donors. Am J Transplant 2017; 17:880-892. [PMID: 27862972 PMCID: PMC5510163 DOI: 10.1111/ajt.14111] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/27/2016] [Accepted: 10/30/2016] [Indexed: 01/25/2023]
Abstract
Due to the enduring organ shortage, living donor liver transplantation has been a valuable treatment strategy for advanced liver disease patients for over 20 years. A variety of reviews have summarized the extensive data now available on medical and psychosocial risks to living donors in the aftermath of donation. However, evidence on donor medical and psychosocial outcomes beyond the first year postdonation has not been synthesized in any previous review. The evidence base on such "long-term" outcomes has been growing in recent years. A review of this evidence would therefore be timely and could serve as an important resource to assist transplant centers in their efforts to fully educate prospective donors and gain informed consent, as well as develop appropriate postdonation clinical care and surveillance plans. We reviewed recent literature on long-term donor outcomes, considering (a) medical outcomes, including mortality risk, rates of complications, abnormalities detected in laboratory testing, and the progress of liver regeneration; and (b) donor-reported psychosocial outcomes reflecting physical, emotional, and interpersonal/socioeconomic well-being, as well as overall health-related quality of life. We summarize limitations and gaps in available evidence, and we provide recommendations for future research and clinical care activities focused on long-term outcomes in liver donors.
Collapse
Affiliation(s)
- M. A. 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,Corresponding author: Mary Amanda Dew,
| | - Z. Butt
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL,Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University, Chicago, IL
| | - A. Humar
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA,Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - A. F. DiMartini
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA,Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
34
|
Hays R, Rodrigue JR, Cohen D, Danovitch G, Matas A, Schold J, LaPointe Rudow D. Financial Neutrality for Living Organ Donors: Reasoning, Rationale, Definitions, and Implementation Strategies. Am J Transplant 2016; 16:1973-81. [PMID: 27037542 DOI: 10.1111/ajt.13813] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/13/2016] [Accepted: 03/19/2016] [Indexed: 01/25/2023]
Abstract
In the United States, live organ donation can be a costly and burdensome undertaking for donors. While most donation-related medical expenses are covered, many donors still face lost wages, travel expenses, incidentals, and potential for future insurability problems. Despite widespread consensus that live donors (LD) should not be responsible for the costs associated with donation, little has changed to alleviate financial burdens for LDs in the last decade. To achieve this goal, the transplant community must actively pursue strategies and policies to eliminate unreimbursed out-of-pocket costs to LDs. Costs should be more appropriately distributed across all stakeholders; this will also make live donation possible for people who, in the current system, cannot afford to proceed. We propose the goal of LD "financial neutrality," offer an operational definition to include the coverage/reimbursement of all medical, travel, and lodging costs, along with lost wages, related to the act of donating an organ, and guidance for consideration of medical care coverage, and wage and other expense reimbursement. The intent of this report is to provide a foundation to inform discussion within the transplant community and to advance initiatives for policy and resource allocation.
Collapse
Affiliation(s)
- R Hays
- Transplant Center, University of Wisconsin Hospital and Clinics, Madison, WI
| | - J R Rodrigue
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - D Cohen
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - G Danovitch
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - A Matas
- Department of Surgery, University of Minnesota Medical Center-Fairview, Minneapolis, MN
| | - J Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - D LaPointe Rudow
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York, NY
| |
Collapse
|