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Freitas J, Francisco J, Coimbra M, Carvalho R, Silvano J, Ribeiro C, Malheiro J, Pedroso S, Almeida M, Martins LS. An Unexpected Catastrophe-Renal Artery Thrombosis in a Living Donor: A Case Report. Transplant Proc 2023; 55:1437-1440. [PMID: 37393168 DOI: 10.1016/j.transproceed.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/19/2023] [Accepted: 06/02/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Renal artery thrombosis is a devastating complication if not detected early. Cardioembolic disease or surgical and technical complications are frequent causes of renal artery thrombosis. There are some reports of renal artery thrombosis in a renal allograft, but to our knowledge, this is the first case of renal artery thrombosis reported in a kidney donor.
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Affiliation(s)
- Joana Freitas
- Nephrology Department, Centro Hospitalar de Santo António, Porto, Portugal.
| | - José Francisco
- Nephrology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Miguel Coimbra
- Nephrology Department, Hospital Espírito Santo de Évora, Évora, Portugal
| | | | - José Silvano
- Nephrology Department, Centro Hospitalar de Santo António, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Catarina Ribeiro
- Nephrology Department, Centro Hospitalar de Santo António, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Jorge Malheiro
- Nephrology Department, Centro Hospitalar de Santo António, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Sofia Pedroso
- Nephrology Department, Centro Hospitalar de Santo António, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Manuela Almeida
- Nephrology Department, Centro Hospitalar de Santo António, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - La Salete Martins
- Nephrology Department, Centro Hospitalar de Santo António, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
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Mansour AM, El-Nahas AR, Ali-El-Dein B, Denewar AA, Abbas MA, Abdel-Rahman A, Eraky I, Shokeir AA. Enhanced Recovery Open vs Laparoscopic Left Donor Nephrectomy: A Randomized Controlled Trial. Urology 2017; 110:98-103. [PMID: 28893633 DOI: 10.1016/j.urology.2017.08.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 07/18/2017] [Accepted: 08/30/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To compare recovery outcomes between laparoscopic donor nephrectomy (LDN) and open donor nephrectomy within a specified enhanced recovery program (ERP) for left kidney donations. PATIENTS AND METHODS A phase III randomized trial was conducted between January 2013 and June 2015; eligible left-side donors were randomized to laparoscopic or open donor nephrectomy in a 1:1 ratio with recovery optimized within a standardized ERP. The primary outcome was patient-reported measure of physical fatigue, as measured by the physical fatigue domain of the translated Multidimensional Fatigue Inventory 20. Secondary outcomes included other donor recovery outcomes, postoperative pain scores, hospital stay, perioperative complications, and graft outcomes. RESULTS A total of 224 donors (laparoscopy, n = 113; open surgery, n = 111) were randomly allocated. Six weeks postoperatively, physical fatigue domain scores in Multidimensional Fatigue Inventory 20 were significantly lower in the LDN group (mean: laparoscopy, 8.2 ± 3.2 vs open surgery, 13.05 ± 2.9) (P = .007). Median total hospital stay was also significantly shorter in the LDN group (median: laparoscopy, 2; interquartile range, 1-5 vs open surgery, 4; interquartile range, 2-9 days) (P = .002). LDN was associated with less pain scores and less non-opioid analgesic requirements. Warm ischemia times were not significantly different in both groups (mean: laparoscopy, 2.5 ± 0.8 vs open surgery, 2.2 ± 0.6) (P = .431). CONCLUSION Even when optimized within an ERP, LDN was associated with less general and physical fatigue and better physical function at 6 weeks postoperatively when compared with open surgery for left kidney donations.
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Affiliation(s)
- Ahmed M Mansour
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt; Department of Urology, University of Texas Health Science Center San Antonio, San Antonio, TX.
| | - Ahmed R El-Nahas
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Bedeir Ali-El-Dein
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed A Denewar
- Department of Nephrology, Urology and Nephrology Center, Mansoura, Egypt
| | - Mohammed A Abbas
- Department of Nephrology, Urology and Nephrology Center, Mansoura, Egypt
| | - Ahmed Abdel-Rahman
- Department of Nephrology, Urology and Nephrology Center, Mansoura, Egypt
| | - Ibrahim Eraky
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed A Shokeir
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Evolution of Laparoscopic Donor Nephrectomy Technique and Outcomes: A Single-center Experience With More Than 1300 Cases. Urology 2015; 85:107-12. [DOI: 10.1016/j.urology.2014.09.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/22/2014] [Accepted: 09/19/2014] [Indexed: 11/17/2022]
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Schold JD, Goldfarb DA, Buccini LD, Rodrigue JR, Mandelbrot DA, Heaphy ELG, Fatica RA, Poggio ED. Comorbidity burden and perioperative complications for living kidney donors in the United States. Clin J Am Soc Nephrol 2013; 8:1773-82. [PMID: 24071651 DOI: 10.2215/cjn.12311212] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Since 1998, 35% of kidney transplants in the United States have been derived from living donors. Research suggests minimal long-term health consequences after donation, but comprehensive studies are limited. The primary objective was to evaluate trends in comorbidity burden and complications among living donors. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The National Inpatient Sample (NIS) was used to identify donors from 1998 to 2010 (n=69,117). Comorbid conditions, complications, and length of stay during hospitalization were evaluated. Outcomes among cohorts undergoing appendectomies, cholecystectomies and nephrectomy for nonmetastatic carcinoma were compared, and sample characteristics were validated with the Scientific Registry of Transplant Recipients (SRTR). Survey regression models were used to identify risk factors for outcomes. RESULTS The NIS captured 89% (69,117 of 77,702) of living donors in the United States. Donor characteristics were relatively concordant with those noted in SRTR (mean age, 40.1 versus 40.3 years [P=0.18]; female donors, 59.0% versus 59.1% [P=0.13]; white donors, 68.4% versus 69.8% [P<0.001] for NIS versus SRTR). Incidence of perioperative complications was 7.9% and decreased from 1998 to 2010 (from 10.1% to 7.6%). Men (adjusted odds ratio [AOR], 1.37; 95% confidence interval [CI], 1.20 to 1.56) and donors with hypertension (AOR, 3.35; 95% CI, 2.24 to 5.01) were more likely to have perioperative complications. Median length of stay declined over time (from 3.7 days to 2.5 days), with longer length of stay associated with obesity, depression, hypertension, and pulmonary disorders. Presence of depression (AOR, 1.08; 95% CI, 1.04 to 1.12), hypothyroidism (AOR, 1.07; 95% CI, 1.04 to 1.11), hypertension (AOR, 1.38; 95% CI, 1.27 to 1.49), and obesity (AOR, 1.07; 95% CI, 1.03 to 1.11) increased over time. Complication rates and length of stay were similar for patients undergoing appendectomies and cholecystectomies but were less than those with nephrectomies for carcinoma. CONCLUSIONS The NIS is a representative sample of living donors. Complications and length of stay after donation have declined over time, while presence of documented comorbid conditions has increased. Patients undergoing appendectomy and cholecystectomy have similar outcomes during hospitalization. Monitoring the health of living donors remains critically important.
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Affiliation(s)
- Jesse D Schold
- Department of Quantitative Health Sciences,, ‡Glickman Urological and Kidney Institute, and, §Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio;, †Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, ‖The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Lentine KL, Segev DL. Better understanding live donor risk through big data. Clin J Am Soc Nephrol 2013; 8:1645-7. [PMID: 24071650 DOI: 10.2215/cjn.08530813] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Krista L Lentine
- Center for Outcomes Research and, †Department of Medicine, Divisions of Nephrology and Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, Missouri;, ‡Department of Surgery, Johns Hopkins University, Baltimore, Maryland, §Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Lentine KL, Patel A. Risks and outcomes of living donation. Adv Chronic Kidney Dis 2012; 19:220-8. [PMID: 22732041 DOI: 10.1053/j.ackd.2011.09.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 09/16/2011] [Indexed: 12/31/2022]
Abstract
Living donors supply approximately 40% of renal allografts in the United States. Based on current data, perioperative mortality after donor nephrectomy is approximately 3 per 10,000 cases, and major and minor perioperative complications affect approximately 3% to 6% and 22% of donors, respectively. Donor nephrectomy does not appear to increase long-term mortality compared with controls, nor does it appear to increase ESRD risk among white donors. Within the donor population, the likelihood of postdonation chronic renal failure and medical comorbidities such as hypertension and diabetes appears to be relatively higher among some donor subgroups, such as African Americans and obese donors, but the impact of uninephrectomy on the lifetime risks of adverse events expected without nephrectomy in these subgroups has not yet been defined. As national follow-up of living donors in the United States is limited in scope, duration, and completeness, additional methods for quantifying risk among diverse living donors are needed. In addition to improved national collection of follow-up data, possible sources of information on donor outcomes may include focused studies with carefully defined control groups, and database integration projects that link national donor registration records to other data sources. Given the growth and evolving characteristics of the living donor population, as well as changes in surgical techniques, tracking of short- and long-term risks after living kidney donation is vital to support truly informed consent and to maintain public trust in living donation. The transplant community must persist in their efforts to accurately assess risk across demographically diverse living kidney donors.
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Cannon RM, Eng M, Marvin MR, Buell JF. Laparoscopic Living Kidney Donation at a Single Center: An Examination of Donor Outcomes with Increasing Experience. Am Surg 2011; 77:911-5. [DOI: 10.1177/000313481107700730] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study was undertaken to examine short-term outcomes of laparoscopic donor nephrectomy performed by transplant surgeons at a medium volume institution, with the specific goal of determining the presence of a learning curve effect. With institutional review board approval, a retrospective chart review was performed examining patient demographics, operative factors, and in-hospital outcomes over a 12-year period. Specific attention was paid to differences in outcomes between patients undergoing operation in the first versus the most recent 6-year period. Continuous and categorical variables were examined using the Wilcoxon rank sum test and χ2 analysis, respectively. The study group consisted of 129 patients. Median operative time was 234 minutes with a median estimated blood loss of 100. The median preoperative creatinine was 0.9, with a postoperative median creatinine of 1.3. The overall complication rate was 12.4 per cent, with ileus being the most common. There were two cases of post op acute renal failure, both of which were self limited and did not require dialysis. No patients died. Patients in the most recent 6 years (n = 77) enjoyed a shorter length of stay (2 vs 3 days, P < 0.001) than patients in the first 6-year period (n = 52). Additionally, there was a trend towards decreased complications in the second era that did not reach significance (9.1% vs 17.3%, P = 0.17). Laparoscopic donor nephrectomy is an attractive means of donation, and can be performed with low risk to the donor and minimal learning curve effect.
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Affiliation(s)
- Robert M. Cannon
- Division of Transplantation, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Mary Eng
- Division of Transplantation, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Michael R. Marvin
- Division of Transplantation, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Joseph F. Buell
- Tulane Abdominal Transplant Institute, Department of Surgery, Tulane University, New Orleans, Louisiana
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