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Bastani B. The present and future of transplant organ shortage: some potential remedies. J Nephrol 2019; 33:277-288. [PMID: 31399908 DOI: 10.1007/s40620-019-00634-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/30/2019] [Indexed: 12/24/2022]
Abstract
Transplantation remains the modality of choice for patients with end stage renal disease (ESRD). However, while there has been a steady rise in the number of patients with ESRD the supply of donors (combine living and deceased) has fallen far behind the need, resulting in an increasing number of qualified patients remaining on the wait-list, and thousands being removed from the list every year because of death or becoming too sick for transplantation. This has also fed to transplant tourism around the world. Several countries have implemented a variety of policies to overcome their organ shortage that are presented in this article. There is an urgent need for developing policies geared to the cultural norms of different societies and universally accepted ethical principles to remedy this public health issue.
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Affiliation(s)
- Bahar Bastani
- Division of Nephrology, Saint Louis University Hospital, Saint Louis University School of Medicine, 3635 Vista Avenue, Saint Louis, MO, 63110, USA.
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2
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Bekheit M, Catanzano M, Shand S, Ahmed I, ELKayal ELS, Shehata GM, Zaki A. The role of graft reperfusion sequence in the development of non-anastomotic biliary strictures following orthotopic liver transplantation: A meta-analysis. Hepatobiliary Pancreat Dis Int 2019; 18:4-11. [PMID: 30579736 DOI: 10.1016/j.hbpd.2018.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 11/22/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Liver transplant is a potential cure for liver failure and hepatic malignancy but there are many techniques which have been described for vascular reconstruction. This study was to compare the prevalence of non-anastomotic biliary stricture and other surgical complications based on Clavien-Dindo scoring system, in initial portal reperfusion (sequential) versus simultaneous or initial artery reperfusion. DATA SOURCES Meta-analysis of published studies comparing the outcomes of both techniques was carried out. Data search was conducted across the major databases and studies were selected under the guidance of the Cochrane guidelines for systematic reviews and meta-analysis. RESULTS Seven studies were included to address the primary and the secondary outcomes. No statistical difference was found in the incidence of non-anastomotic biliary strictures (OR = 0.40; P = 0.14), regardless of reperfusion technique. The pooled estimate of the Clavien-Dindo grading of complications was not significantly different between the techniques, though Clavien-Dindo II complications were higher in the simultaneous or initial artery reperfusion group than the initial portal reperfusion group (OR = 2.73; P = 0.01). Similarly, there was no difference in the operative time, hospital stay and other outcomes addressed in this report. CONCLUSIONS The available evidence suggests that there is no significant difference demonstrated in the rate of non-anastomotic biliary strictures or other complications, between the two techniques, except for Clavien-Dindo II complications.
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Affiliation(s)
- Mohamed Bekheit
- Center of Liver Surgery and Transplantation, Paul Brousse Hospital, University of Paris-Sud, Villejuif Cedex, France; Medical Research Institute, University of Alexandria, Alexandria, Egypt; HPB Surgery Unit Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK; Department of Surgery, Elkabbary General Hospital, Alexandria, Egypt; University of Aberdeen, Aberdeen, UK.
| | | | - Stuart Shand
- HPB Surgery Unit Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Irfan Ahmed
- HPB Surgery Unit Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK; University of Aberdeen, Aberdeen, UK
| | - ELSaid ELKayal
- Department of Surgery, Alexandria Main University Hospital, Faculty of Medicine, Alexandria, Egypt
| | | | - Adel Zaki
- Medical Research Institute, University of Alexandria, Alexandria, Egypt
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Al Sebayel M, Abaalkhail F, Al Abbad S, AlBahili H, Elsiesy H, Aleid M, Al-Hamoudi W. Liver transplantation in the Kingdom of Saudi Arabia. Liver Transpl 2017. [PMID: 28650090 DOI: 10.1002/lt.24803] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The first liver transplantation (LT) in Saudi Arabia was performed in 1991; however, it was not until 1994 that the first structured LT program was launched. Until 1997, all LTs in the Kingdom of Saudi Arabia (KSA) were deceased donor liver transplantations. Programs performing LTs needed the authorization of the Saudi Center for Organ Transplantation (SCOT), which provides the essential support for organ procurement and allocation as well as regulatory support for organ transplantation in the country. Currently, there are 4 LT centers in the KSA. Three centers are in Riyadh, the capital city of KSA, and 1 is in the city of Dammam in the Eastern province. Pediatric living donor liver transplantation (LDLT) began in 1997, while the adult LDLT program started 4 years later in 2001. Currently, more than 2000 LTs have been performed by the 4 centers in the KSA. Over 50% of those were performed at King Faisal Specialist Hospital and Research Center in Riyadh. The outcomes of these transplants have been comparable with the international standards. The aim of this review is to provide an overview of LT in KSA. Liver Transplantation 23 1312-1317 2017 AASLD.
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Affiliation(s)
- Mohammed Al Sebayel
- Department of Liver Transplantation and Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Faisal Abaalkhail
- Department of Liver Transplantation and Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saleh Al Abbad
- Department of Liver Transplantation and Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hamad AlBahili
- Department of Liver Transplantation and Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hussien Elsiesy
- Department of Liver Transplantation and Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Maha Aleid
- Department of Biostatistics, Epidemiology and Scientific Computing, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Waleed Al-Hamoudi
- Department of Liver Transplantation and Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Bahrami A, Khaleghi E, Vakilzadeh AK, Afzalaghaee M. Process and barriers to organ donation and causes of brain death in northeast of Iran. Electron Physician 2017; 9:3797-3802. [PMID: 28465809 PMCID: PMC5410908 DOI: 10.19082/3797] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/01/2016] [Indexed: 11/23/2022] Open
Abstract
Introduction Organ transplantation is the treatment of choice for some diseases. However, the need for cadaveric organ donation has either plateaued or is on a decreasing trend in some countries, especially in developed ones. In this study, we aimed to identify the barriers to organ donation in brain dead patients, who were referred to the organ procurement organizations (OPO) in northeast Iran. Methods In this cross-sectional study during 2006 to 2013, data were collected from medical records of brain dead patients. Demographic information, cause of brain death, the process of obtaining informed consent, and the reasons for declining organ donation were obtained from the OPO records. The data were analyzed using chi-square test by SPSS 13 software. Results Of 1034 brain dead patients, 751 cases (72.6%) were eligible for organ donation, and, ultimately, 344 cases underwent organ donation. The rate of organ donation increased during the course of the study; medical and legal reasons as well as family refusal to authorize donation were the main barriers to the process. Conclusion Based on the pattern of mortality, the need for living donors in developing countries, such as Iran and other countries in the Mediterranean region, can be reduced by improving the quality of healthcare, efficient identification of brain death, and obtaining consent with appropriate strategies.
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Affiliation(s)
- Abdollah Bahrami
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ebrahim Khaleghi
- Department of Organ Transplant, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Khorsand Vakilzadeh
- Department of Complementary and Chines Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Monavar Afzalaghaee
- School of Health, Social Determinant of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Zhang H, Siegel CT, Shuai L, Lai J, Zeng L, Zhang Y, Lai X, Bie P, Bai L. Repair of liver mediated by adult mouse liver neuro-glia antigen 2-positive progenitor cell transplantation in a mouse model of cirrhosis. Sci Rep 2016; 6:21783. [PMID: 26905303 PMCID: PMC4764864 DOI: 10.1038/srep21783] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 02/01/2016] [Indexed: 02/07/2023] Open
Abstract
NG2-expressing cells are a population of periportal vascular stem/progenitors (MLpvNG2(+) cells) that were isolated from healthy adult mouse liver by using a "Percoll-Plate-Wait" procedure. We demonstrated that isolated cells are able to restore liver function after transplantation into a cirrhotic liver, and co-localized with the pericyte marker (immunohistochemistry: PDGFR-β) and CK19. Cells were positive for: stem cell (Sca-1, CD133, Dlk) and liver stem cell markers (EpCAM, CD14, CD24, CD49f); and negative for: hematopoietic (CD34, CD45) and endothelial markers (CD31, vWf, von Willebrand factor). Cells were transplanted (1 × 10(6) cells) in mice with diethylnitrosamine-induced cirrhosis at week 6. Cells showed increased hepatic associated gene expression of alpha-fetoprotein (AFP), Albumin (Alb), Glucose-6-phosphatase (G6Pc), SRY (sex determining region Y)-box 9 (Sox9), hepatic nuclear factors (HNF1a, HNF1β, HNF3β, HNF4α, HNF6, Epithelial cell adhesion molecule (EpCAM), Leucine-rich repeated-containing G-protein coupled receptor 5-positive (Lgr5) and Tyrosine aminotransferase (TAT). Cells showed decreased fibrogenesis, hepatic stellate cell infiltration, Kupffer cells and inflammatory cytokines. Liver function markers improved. In a cirrhotic liver environment, cells could differentiate into hepatic lineages. In addition, grafted MLpvNG2(+) cells could mobilize endogenous stem/progenitors to participate in liver repair. These results suggest that MLpvNG2(+) cells may be novel adult liver progenitors that participate in liver regeneration.
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Affiliation(s)
- Hongyu Zhang
- Hepatobiliary Institute, Southwestern Hospital, No. 30 Gaotanyan, ShapingBa Distract, Chongqing 400038, China
| | - Christopher T. Siegel
- Department of Surgery, Division of Hepatobiliary and Abdominal Organ Transplantation, Case Western Reserve University Hospital, Cleveland OH 44106, USA
| | - Ling Shuai
- Hepatobiliary Institute, Southwestern Hospital, No. 30 Gaotanyan, ShapingBa Distract, Chongqing 400038, China
| | - Jiejuan Lai
- Hepatobiliary Institute, Southwestern Hospital, No. 30 Gaotanyan, ShapingBa Distract, Chongqing 400038, China
| | - Linli Zeng
- Hepatobiliary Institute, Southwestern Hospital, No. 30 Gaotanyan, ShapingBa Distract, Chongqing 400038, China
| | - Yujun Zhang
- Hepatobiliary Institute, Southwestern Hospital, No. 30 Gaotanyan, ShapingBa Distract, Chongqing 400038, China
| | - Xiangdong Lai
- Hepatobiliary Institute, Southwestern Hospital, No. 30 Gaotanyan, ShapingBa Distract, Chongqing 400038, China
| | - Ping Bie
- Hepatobiliary Institute, Southwestern Hospital, No. 30 Gaotanyan, ShapingBa Distract, Chongqing 400038, China
| | - Lianhua Bai
- Hepatobiliary Institute, Southwestern Hospital, No. 30 Gaotanyan, ShapingBa Distract, Chongqing 400038, China
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Park KM, Hussein KH, Ghim JH, Ahn C, Cha SH, Lee GS, Hong SH, Yang S, Woo HM. Hepatic differentiation of porcine embryonic stem cells for translational research of hepatocyte transplantation. Transplant Proc 2015; 47:775-9. [PMID: 25891729 DOI: 10.1016/j.transproceed.2015.01.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 01/02/2015] [Accepted: 01/28/2015] [Indexed: 12/28/2022]
Abstract
Porcine embryonic stem cells (ES) are considered attractive preclinical research tools for human liver diseases. Although several studies previously reported generation of porcine ES, none of these studies has described hepatic differentiation from porcine ES. The aim of this study was to generate hepatocytes from porcine ES and analyze their characteristics. We optimized conditions for definitive endoderm induction and developed a 4-step hepatic differentiation protocol. A brief serum-free condition with activin A efficiently induced definitive endoderm differentiation from porcine ES. The porcine ES-derived hepatocyte-like cells highly expressed hepatic markers including albumin and α-fetoprotein, and displayed liver characteristics such as glycogen storage, lipid production, and low-density lipoprotein uptake. For the first time, we describe a highly efficient protocol for hepatic differentiation from porcine ES. Our findings provide valuable information for translational liver research using porcine models, including hepatic regeneration and transplant studies, drug screening, and toxicology.
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Affiliation(s)
- K M Park
- Stem Cell Institute, Kangwon National University, Chuncheon, Korea; College of Veterinary Medicine, Kangwon National University, Chuncheon, Korea
| | - K H Hussein
- Stem Cell Institute, Kangwon National University, Chuncheon, Korea
| | - J H Ghim
- Stem Cell Institute, Kangwon National University, Chuncheon, Korea; College of Veterinary Medicine, Kangwon National University, Chuncheon, Korea
| | - C Ahn
- Stem Cell Institute, Kangwon National University, Chuncheon, Korea; College of Biomedical Science, Kangwon National University, Chuncheon, Korea
| | - S H Cha
- Animal, Plant and Fisheries Quarantine and Inspection Agency, Anyang, Korea
| | - G S Lee
- College of Veterinary Medicine, Kangwon National University, Chuncheon, Korea
| | - S H Hong
- Stem Cell Institute, Kangwon National University, Chuncheon, Korea; College of Medicine, Kangwon National University, Chuncheon, Korea
| | - S Yang
- Stem Cell Institute, Kangwon National University, Chuncheon, Korea; College of Medicine, Kangwon National University, Chuncheon, Korea
| | - H M Woo
- Stem Cell Institute, Kangwon National University, Chuncheon, Korea; College of Veterinary Medicine, Kangwon National University, Chuncheon, Korea.
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Elsiesy H, Al Sebayel M, Shoukri MM, Hashim A, Mohamed HH, Mahmoud T, Al Hamoudi W, Al Bahili H, Broering D, Abaalkhail F. Regional variation in organ donation in Saudi Arabia. Transplant Proc 2015; 46:2054-7. [PMID: 25131106 DOI: 10.1016/j.transproceed.2014.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION There is marked regional variation in organ donation among the different regions of Saudi Arabia. Our aim was to study the dominating factors for these variations to improve organ donation in low-donation areas. MATERIALS AND METHODS This study was a retrospective review of the Saudi Center for Organ Transplantation data for cadaveric organ donation from 2006 to 2012, with the number of cases reported, documented, consented, and harvested in various regions (northern, southern, eastern, western, and central). The region, number, and size of contributing intensive care units (ICUs), overall donation rate, and transplanted rate (potential donor and those harvested, respectively) were also reviewed. RESULTS Between 2006 and 2012, a total of 512 cases were procured and analyzed from Saudi Arabia. From the central region, 393 were acquired, representing 76.7% of the total consented cases. These 393 cases came from 30 of 97 contributing ICUs (31%). The eastern region was ranked second, followed by the western region. The conversion rate for all regions followed a similar trend. CONCLUSIONS There is marked variation with regard to organ donation in different regions throughout Saudi Arabia, from 1.9% in the southern region to 76.7% in the central region. This finding is related to the presence of a Mobile Action Donor Team in the central region. The number of potential donors and the contributing ICUs were strong predictors of the number of actual donors. We suggest that having a mobile donor team in each region will increase the number of donors by at least 3 times within the next 3 to 5 years.
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Affiliation(s)
- H Elsiesy
- King Faisal Specialist Hospital and Research Centre, Department of Liver and SB Transplantation & HBP Surgery, Riyadh, Saudi Arabia.
| | - M Al Sebayel
- King Faisal Specialist Hospital and Research Centre, Department of Liver and SB Transplantation & HBP Surgery, Riyadh, Saudi Arabia
| | - M M Shoukri
- King Faisal Specialist Hospital and Research Centre, Department of Liver and SB Transplantation & HBP Surgery, Riyadh, Saudi Arabia
| | - A Hashim
- Jeddah University, Jedda, Saudi Arabia
| | - H H Mohamed
- King Faisal Specialist Hospital and Research Centre, Department of Liver and SB Transplantation & HBP Surgery, Riyadh, Saudi Arabia; Department of Medicine, El Minia Faculty of Medicine, Egypt El-Minia
| | - T Mahmoud
- King Faisal Specialist Hospital and Research Centre, Department of Liver and SB Transplantation & HBP Surgery, Riyadh, Saudi Arabia; National Liver Institute, Menoufiya, Egypt
| | - W Al Hamoudi
- King Faisal Specialist Hospital and Research Centre, Department of Liver and SB Transplantation & HBP Surgery, Riyadh, Saudi Arabia; Department of Gastroenterology, King Saud University, Riyadh, Saudi Arabia
| | - H Al Bahili
- King Faisal Specialist Hospital and Research Centre, Department of Liver and SB Transplantation & HBP Surgery, Riyadh, Saudi Arabia
| | - D Broering
- King Faisal Specialist Hospital and Research Centre, Department of Liver and SB Transplantation & HBP Surgery, Riyadh, Saudi Arabia
| | - F Abaalkhail
- King Faisal Specialist Hospital and Research Centre, Department of Liver and SB Transplantation & HBP Surgery, Riyadh, Saudi Arabia
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Bruzzone P. Paid Organ Donation: An Italian Perspective. Transplant Proc 2015; 47:2109-12. [PMID: 26361655 DOI: 10.1016/j.transproceed.2015.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/11/2015] [Accepted: 01/28/2015] [Indexed: 11/30/2022]
Abstract
The only countries that have allowed financial incentives for organ donation are Iran since 1988, and later on, Singapore and Saudi Arabia. In Europe, and of course in Italy, financial incentives for donors are prohibited. The author has completed extensive research via the Internet (PubMed) of worldwide scientific literature on paid organ donation, also researching studies concerning public opinion on organ commercialism and "regulated markets". Italian transplant laws also have been reported and analyzed.
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Affiliation(s)
- P Bruzzone
- Department of General Surgery, Surgical Sciences and Transplantation "Paride Stefanini", Università di Roma "La Sapienza", Rome, Italy.
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