1
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Karakizlis H, van Rosmalen M, Boide P, Askevold I, Vogelaar S, Lorf T, Berlakovich G, Nitschke M, Padberg W, Weimer R. Retransplanting a previously transplanted kidney: A safe strategy in times of organ shortage? Clin Transplant 2021; 36:e14554. [PMID: 34862985 DOI: 10.1111/ctr.14554] [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: 09/10/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The shortage of organs for transplantation remains a global problem. The retransplantation of a previously transplanted kidney might be a possibility to expand the pool of donors. We provide our experience with the successful reuse of transplanted kidneys in the Eurotransplant region. METHODS A query in the Eurotransplant database was performed between January 1, 1995 and December 31, 2015, to find kidney donors who themselves had previously received a kidney graft. RESULTS Nine out of a total of 68,554 allocated kidneys had previously been transplanted. Four of these kidneys were transplanted once again. The mean interval between the first transplant and retransplantation was 1689±1682 days (SD; range 55-5,333 days). At the time of the first transplantation the mean serum creatinine of the donors was 1.0 mg/dl (.6-1.3 mg/dl) and at the second transplantation 1.4 mg/dl (.8-1.5 mg/dl). The mean graft survival in the first recipient was 50 months (2-110 months) and in the second recipient 111 months (40-215 months). CONCLUSION Transplantation of a previously transplanted kidney may successfully be performed with well-preserved graft function and long-term graft survival, even if the first transplantation was performed a long time ago. Such organs should be considered even for younger recipients in carefully selected cases.
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Affiliation(s)
- Hristos Karakizlis
- Department of Internal Medicine II, Division of Nephrology and Renal Transplantation, Justus-Liebig-University of Giessen, Giessen, Germany
| | | | - Philipp Boide
- Department of Internal Medicine II, Division of Nephrology and Renal Transplantation, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Ingolf Askevold
- Department of General, Visceral and Thoracic Surgery, Justus-Liebig-University of Giessen, Gießen, Germany
| | - Serge Vogelaar
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Thomas Lorf
- Department of General, Visceral and Pediatric Surgery, Georg-August-University of Göttingen, Göttingen, Germany
| | - Gabrielle Berlakovich
- Department of General Surgery and Transplantation, University of Vienna, Vienna, Austria
| | - Martin Nitschke
- Division of Nephrology and Transplantation, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Winfried Padberg
- Department of General, Visceral and Thoracic Surgery, Justus-Liebig-University of Giessen, Gießen, Germany
| | - Rolf Weimer
- Department of Internal Medicine II, Division of Nephrology and Renal Transplantation, Justus-Liebig-University of Giessen, Giessen, Germany
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2
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Vali S, Jones BP, Saso S, Fertleman M, Testa G, Johanesson L, Alghrani A, Smith JR. Uterine transplantation: legal and regulatory implications in England. BJOG 2021; 129:590-596. [PMID: 34532958 DOI: 10.1111/1471-0528.16927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 12/01/2022]
Abstract
Uterus transplantation (UTx) is fast evolving from an experimental to a clinical procedure, combining solid organ transplantation with assisted reproductive technology. The commencement of the first human uterus transplant trial in the United Kingdom leads us to examine and reflect upon the legal and regulatory aspects closely intertwined with UTx from the process of donation to potential implications for fertility treatment and the birth of the resultant child. As the world's first ephemeral transplant, the possibility of organ restitution requires consideration and is discussed herein. TWEETABLE ABSTRACT: Uterine transplantation warrants a closer look at the legal frameworks on fertility treatment and transplantation in England.
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Affiliation(s)
- S Vali
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, London, UK.,Cutrale Perioperative and Ageing Research Group, Imperial College London, London, UK
| | - B P Jones
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, London, UK.,West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, UK
| | - S Saso
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, London, UK.,West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, UK
| | - M Fertleman
- Cutrale Perioperative and Ageing Research Group, Imperial College London, London, UK
| | - G Testa
- Baylor University Medical Centre, Dallas, TX, USA
| | - L Johanesson
- Baylor University Medical Centre, Dallas, TX, USA
| | - A Alghrani
- School of Law and Social Justice, University of Liverpool, Liverpool, UK
| | - J R Smith
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, London, UK.,West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, UK
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3
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Nakazawa E, Yamamoto K, Akabayashi A, Shaw MH, Demme RA, Akabayashi A. Will you give my kidney back? Organ restitution in living-related kidney transplantation: ethical analyses. JOURNAL OF MEDICAL ETHICS 2020; 46:144-150. [PMID: 31537615 PMCID: PMC7035681 DOI: 10.1136/medethics-2019-105507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/04/2019] [Accepted: 09/08/2019] [Indexed: 06/10/2023]
Abstract
In this article, we perform a thought experiment about living donor kidney transplantation. If a living kidney donor becomes in need of renal replacement treatment due to dysfunction of the remaining kidney after donation, can the donor ask the recipient to give back the kidney that had been donated? We call this problem organ restitution and discussed it from the ethical viewpoint. Living organ transplantation is a kind of 'designated donation' and subsequently has a contract-like character. First, assuming a case in which original donor (A) wishes the return of the organ which had been transplanted into B, and the original recipient (B) agrees, organ restitution will be permissible based on contract-like agreement. However, careful and detailed consideration is necessary to determine whether this leaves no room to question the authenticity of B's consent. Second, if B offers to give back the organ to A, then B's act is a supererogatory act, and is praiseworthy and meritorious. Such an offer is a matter of virtue, not obligation. Third, if A wishes B to return the organ, but B does not wish/allow this to happen, it is likely difficult to justify returning the organ to A by violating B's right to bodily integrity. But B's refusal to return the donated organ cannot be deemed praiseworthy, because B forgets the great kindness once received from A. Rather than calling this an obligation, we encourage B to consider such virtuous conduct.
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Affiliation(s)
- Eisuke Nakazawa
- Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Keiichiro Yamamoto
- Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Aru Akabayashi
- Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Margie H Shaw
- Division of Medical Humanities and Bioethics, University of Rochester Medical Center, Rochester, New York, USA
| | - Richard A Demme
- Division of Medical Humanities and Bioethics, University of Rochester Medical Center, Rochester, New York, USA
| | - Akira Akabayashi
- Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan
- Division of Medical Ethics, New York University School of Medicine, New York, New York, USA
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4
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Tseng WH, Tian YF, Liao ACH, Chen MJ, Ho HY, Kuo JR, Huang SK. Successful reuse of a transplanted kidney 9 years after initial transplantation: 4-year follow-up. BMC Nephrol 2018; 19:234. [PMID: 30223782 PMCID: PMC6142365 DOI: 10.1186/s12882-018-1040-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/10/2018] [Indexed: 11/10/2022] Open
Abstract
Background Kidney transplantation is the preferred renal replacement therapy for patients with end-stage renal disease, but the waiting list for kidneys continues to grow because of a shortage of donor organs. The reuse of transplanted kidneys would seem to be a good approach to expand the pool of available organs. Here, we describe the reuse of a kidney 9 years after the initial transplantation. At 4-year follow-up, the second recipient is showing good renal function. Case presentation In 2005, a kidney was transplanted from a 40-year-old man, who suffered brain death due to an intracranial hemorrhage, into a 45-year-old man. Nine years later, the recipient suffered a ruptured cerebral aneurysm, resulting in brain death. The kidney was re-transplanted into a 40-year-old man with diabetic nephropathy who had received hemodialysis for 5 years. During 4 years of follow-up, the graft has functioned well. Conclusions This case demonstrates the successful regrafting of a transplanted kidney. We believe this is the longest period for reuse of kidney after initial transplantation. The outcome suggests that a well-functioning transplanted kidney can be reused years after transplantation.
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Affiliation(s)
- Wen-Hsin Tseng
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Yu-Feng Tian
- Division of Transplantation Surgery, Division of General Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan. .,Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
| | - Alex Chien-Hwa Liao
- Division of Urology, Division of Transplantation Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Ming-Jenn Chen
- Division of Transplantation Surgery, Division of General Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Hsuan-Ying Ho
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Division of Neurosurgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Steven K Huang
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
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5
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Nakazawa E, Maeda S, Yamamoto K, Akabayashi A, Uetake Y, Shaw MH, Demme RA, Akabayashi A. Reuse of cardiac organs in transplantation: an ethical analysis. BMC Med Ethics 2018; 19:77. [PMID: 30119629 PMCID: PMC6098651 DOI: 10.1186/s12910-018-0316-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/01/2018] [Indexed: 11/20/2022] Open
Abstract
Background This paper examines the ethical aspects of organ transplant surgery in which a donor heart is transplanted from a first recipient, following determination of death by neurologic criteria, to a second recipient. Retransplantation in this sense differs from that in which one recipient undergoes repeat heart transplantation of a newly donated organ, and is thus referred to here as “reuse cardiac organ transplantation.” Methods Medical, legal, and ethical analysis, with a main focus on ethical analysis. Results From the medical perspective, it is critical to ensure the quality and safety of reused organs, but we lack sufficient empirical data pertaining to medical risk. From the legal perspective, a comparative examination of laws in the United States and Japan affirms no illegality, but legal scholars disagree on the appropriate analysis of the issues, including whether or not property rights apply to transplanted organs. Ethical arguments supporting the reuse of organs include the analogous nature of donation to gifts, the value of donations as inheritance property, and the public property theory as it pertains to organs. Meanwhile, ethical arguments such as those that address organ recycling and identity issues challenge organ reuse. Conclusion We conclude that organ reuse is not only ethically permissible, but even ethically desirable. Furthermore, we suggest changes to be implemented in the informed consent process prior to organ transplantation. The organ transplant community worldwide should engage in wider and deeper discussions, in hopes that such efforts will lead to the timely preparation of guidelines to implement reuse cardiac organ transplantation as well as reuse transplantation of other organs such as kidney and liver.
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Affiliation(s)
- Eisuke Nakazawa
- Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shoichi Maeda
- Course for Health Care Management, Graduate School of Health Management/Department of Health Policy and Management, School of Medicine, Keio University, Kanagawa, Fujisawa, 252-0883, Japan
| | - Keiichiro Yamamoto
- Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Aru Akabayashi
- Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yuzaburo Uetake
- Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Margie H Shaw
- Division of Medical Humanities and Bioethics, University of Rochester Medical Center, Rochester, NY, USA
| | - Richard A Demme
- Division of Medical Humanities and Bioethics, University of Rochester Medical Center, Rochester, NY, USA
| | - Akira Akabayashi
- Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Division of Medical Ethics, New York University School of Medicine, New York, NY, USA.
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6
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Bobylev D, Salman J, Sommer W, Ius F, Siemeni T, Avsar M, Kühn C, Niehaus A, Gottlieb J, Haverich A, Tudorache I, Warnecke G. Single lung transplantation from a donor 8 months after double lung transplantation. Am J Transplant 2018; 18:1275-1277. [PMID: 29314647 DOI: 10.1111/ajt.14644] [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: 09/17/2017] [Revised: 11/15/2017] [Accepted: 12/16/2017] [Indexed: 01/25/2023]
Abstract
Scarcity of donors leads transplant surgeons to consider extended-criteria lungs and occasionally to accept the unlikely. Here we report a case of successful single lung transplantation from a donor 8 months after double lung transplantation.
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Affiliation(s)
- D Bobylev
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - J Salman
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - W Sommer
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Member of the German Centre for Lung Research, Hannover, Germany
| | - F Ius
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - T Siemeni
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - M Avsar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - C Kühn
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - A Niehaus
- German Organ Transplantation Foundation (DSO), Frankfurt, Germany
| | - J Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - A Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Member of the German Centre for Lung Research, Hannover, Germany
| | - I Tudorache
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - G Warnecke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Member of the German Centre for Lung Research, Hannover, Germany
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7
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Lee GS, Goldberg DS, Levine MH, Abt PL. Outcomes of organ transplants when the donor is a prior recipient. Am J Transplant 2018; 18:492-503. [PMID: 28992380 DOI: 10.1111/ajt.14536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/12/2017] [Accepted: 09/30/2017] [Indexed: 01/25/2023]
Abstract
Organ shortage continues to challenge the field of transplantation. One potential group of donors are those who have been transplant recipients themselves, or Organ Donation After Transplant (ODAT) donors. We conducted a retrospective cohort study to describe ODAT donors and to compare outcomes of ODAT grafts versus conventional grafts. From October 1, 1987 to June 30, 2015, 517 former recipients successfully donated 803 organs for transplant. Former kidney recipients generally survived a median of approximately 4 years before becoming an ODAT donor whereas liver, lung, and heart recipients generally survived less than a month prior to donation. In the period June 1, 2005 to December 31, 2014, liver grafts from ODAT donors had a significantly higher risk of graft failure compared to non-ODAT liver transplants (P = .008). Kidney grafts donated by ODAT donors whose initial transplant occurred >1 year prior were associated with significantly increased graft failure (P = .012). Despite increased risk of graft failure amongst certain ODAT grafts, 5-year survival was still high. ODAT donors should be considered another form of expanded criteria donor under these circumstances.
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Affiliation(s)
- G S Lee
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - D S Goldberg
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M H Levine
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - P L Abt
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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8
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Macesic N, Abbott IJ, Kaye M, Druce J, Glanville AR, Gow PJ, Hughes PD, Korman TM, Mulley WR, O'Connell PJ, Opdam H, Paraskeva M, Pitman MC, Setyapranata S, Rawlinson WD, Johnson PDR. Herpes simplex virus-2 transmission following solid organ transplantation: Donor-derived infection and transplantation from prior organ recipients. Transpl Infect Dis 2017; 19. [PMID: 28618165 DOI: 10.1111/tid.12739] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 03/24/2017] [Accepted: 04/02/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Owing to limited availability of donor organs, previous solid organ transplant (SOT) recipients are increasingly considered as potential organ donors. We report donor-derived transmission of herpes simplex virus type-2 (HSV-2) to two clusters of SOT recipients with transmission from the original donor and an HSV-2-infected recipient who subsequently became a donor. METHODS We reviewed medical records of the donors and recipients in both clusters. Pre-transplant serology and virological features of HSV-2 were characterized. Genotyping of HSV-2 isolates to determine potential for donor transmission of HSV-2 through transplantation of organs from prior organ recipients was performed. RESULTS A kidney-pancreas recipient died day 9 post transplant. Following confirmation of brain death, the lungs and recently transplanted kidney were donated to two further recipients. The liver was not retrieved, but biopsy confirmed HSV-2 infection. Testing on the original donor showed negative HSV-2 polymerase chain reaction and HSV immunoglobulin (Ig)M, but positive HSV-2 IgG. The liver recipient from the original donor developed HSV-2 hepatitis and cutaneous infection that responded to treatment with intravenous acyclovir. In the second cluster, lung and kidney recipients both developed HSV-2 viremia that was successfully treated with antiviral therapy. Genotyping of all HSV-2-positive samples showed 100% sequence homology for three recipients. CONCLUSIONS Donor-derived HSV infection affected two clusters of recipients because of transplantation of organs from a prior organ recipient. HSV should be considered as a possible cause of illness in febrile SOT recipients in the immediate post-transplant period and may cause disseminated disease and re-infection in HSV-2-seropositive recipients. Testing of HSV serology and prophylaxis may be considered in SOT recipients not receiving cytomegalovirus prophylaxis.
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Affiliation(s)
- Nenad Macesic
- Department of Infectious Diseases, Austin Health, Melbourne, VIC, Australia.,Division of Infectious Diseases, Columbia University Medical Center, New York City, NY, USA
| | - Iain J Abbott
- Victorian Infectious Diseases Reference Laboratory, Doherty Institute, Melbourne, VIC, Australia
| | - Matthew Kaye
- Victorian Infectious Diseases Reference Laboratory, Doherty Institute, Melbourne, VIC, Australia
| | - Julian Druce
- Victorian Infectious Diseases Reference Laboratory, Doherty Institute, Melbourne, VIC, Australia
| | - Allan R Glanville
- Department of Thoracic Medicine, St. Vincent's Hospital, Sydney, NSW, Australia
| | - Paul J Gow
- Liver Transplant Unit, Austin Health, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Peter D Hughes
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Tony M Korman
- Monash Infectious Diseases, Monash University, Monash Health, Melbourne, VIC, Australia
| | - William R Mulley
- Department of Medicine, Monash University, Melbourne, VIC, Australia.,Department of Nephrology, Monash Health, Melbourne, VIC, Australia
| | - Phillip J O'Connell
- National Pancreas Transplant Unit, Westmead Hospital, Sydney, NSW, Australia
| | | | - Miranda Paraskeva
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Matthew C Pitman
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Stella Setyapranata
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - William D Rawlinson
- Serology and Virology Division (SAViD), South Eastern Area Laboratory Services, University of NSW, Sydney, NSW, Australia
| | - Paul D R Johnson
- Department of Infectious Diseases, Austin Health, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
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9
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Rana AKS, Agarwal N, Dutta S, Dokania MK. Successful Transplant of Two Kidneys Harvested from a Young Brain-Dead Liver Transplant Recipient. Indian J Surg 2017; 79:262-265. [PMID: 28659683 DOI: 10.1007/s12262-016-1549-z] [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: 04/16/2016] [Accepted: 08/14/2016] [Indexed: 11/29/2022] Open
Abstract
Efforts to increase the dismal deceased renal transplantation (DRT): live renal transplantation (LRT) ratio in our country have gathered momentum recently, with governmental and non-governmental projects focussing on building public awareness and capacity-building, and appropriate legislation. Worldwide, efforts at increasing the number of organs from the deceased pool have focussed on the use of 'expanded criteria donors', including deceased cardiac donors (DCD). 'Reuse' transplant, where an organ is transplanted after removal from the first recipient, is a rare strategy, used more commonly in liver than in kidney transplantation. Exceptional circumstances, where other organs have been harvested from transplant recipients, are rare. We describe the successful transplants of two renal grafts obtained from a 19-year-old brain-dead liver transplant recipient; this is probably the second case in English-language literature. A 19-year-old male patient with hepatitis E-induced fulminant hepatic failure underwent live-related liver transplantation. On postoperative day 2, cerebral edema set in, and the patient was declared brain-dead. Despite the economical and emotional trauma, the family opted for donation of the well-perfused kidneys. The kidneys were transported in HTK solution (histidine-tryptophan-ketoglutarate) to our centre. Recipient 1 was a 32-year-old woman (B positive) and recipient 2 was a 29-year-old man (also B positive); the kidneys were placed extraperitoneally and anastomosed end-to-side to the external iliac artery and vein. Recipient 2 experienced delayed graft function; however, both are doing well 15 months posttransplant.
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Affiliation(s)
- Anil Kumar Singh Rana
- Department of Surgery, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, Delhi, 110001 India
| | - Nitin Agarwal
- Department of Surgery, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, Delhi, 110001 India
| | - Sushant Dutta
- Department of Surgery, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, Delhi, 110001 India
| | - Manoj Kumar Dokania
- Department of Surgery, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, Delhi, 110001 India
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10
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Yıldız S, Çelik A, Camsari T. Long-term Follow-up of a Reused Kidney Allograft. Am J Kidney Dis 2016; 67:992. [PMID: 27039254 DOI: 10.1053/j.ajkd.2016.02.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 02/11/2016] [Indexed: 11/11/2022]
Affiliation(s)
| | - Ali Çelik
- Dokuz Eylul University, Izmir, Turkey
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11
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Lugo-Baruqui J, Burke GW, Guerra G, Ruiz P, Ciancio G. Ten-Year Follow-up of a Reused Kidney Graft for Transplant Using Sirolimus for Maintenance Immunosuppression. Transplant Proc 2015; 47:3027-30. [PMID: 26707333 DOI: 10.1016/j.transproceed.2015.10.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 10/20/2015] [Indexed: 11/18/2022]
Abstract
Reused kidney grafts have been transplanted with successful outcomes, though not widely performed in the Unites States. We present the case of a reused kidney graft with 10-year follow-up. The first donation was from a patient who died from a cerebrovascular accident and whose organs were used for a simultaneous pancreas and kidney transplant. After 5 years, the patient died and kidney was considered for donation and reuse. The patient had a virtual crossmatch with the first donor and a complement-dependent and flow-dependent crossmatch with the second donor. Long-term immune suppression was kept with a calcineurin-inhibitor-free regimen with sirolimus to prevent further damage from the first recipient. Control kidney biopsy showed steady progression of previous CNI toxicity without further damage. We describe the immunological basis of reused graft, the technical aspects of procurement and transplantation, as well as the use of Mammalian target of rapamycin for maintenance immunosuppression with good long-term results. Reused kidney grafts can be a good source of kidney grafts when adequate selection between donor and recipients is made and immunosuppression protocol is tailored to the preexisting damage to the original graft.
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Affiliation(s)
- J Lugo-Baruqui
- The Lillian Jean Kaplan Renal Transplant Center, Department of Surgery, University of Miami School of Medicine, Miami, Florida; Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital, Miami, Florida.
| | - G W Burke
- The Lillian Jean Kaplan Renal Transplant Center, Department of Surgery, University of Miami School of Medicine, Miami, Florida; Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital, Miami, Florida
| | - G Guerra
- The Lillian Jean Kaplan Renal Transplant Center, Department of Surgery, University of Miami School of Medicine, Miami, Florida; Department of Medicine, Division of Nephrology, University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital, Miami, Florida
| | - P Ruiz
- Department of Surgery and Pathology, Transplantation Laboratories and Immunopathology, Miller School of Medicine, University of Miami, Miami, Florida
| | - G Ciancio
- The Lillian Jean Kaplan Renal Transplant Center, Department of Surgery, University of Miami School of Medicine, Miami, Florida; Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital, Miami, Florida
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Chon WJ, Kadambi PV, Xu C, Becker YT, Witkowski P, Pursell K, Kane B, Josephson MA. Use of leflunomide in renal transplant recipients with ganciclovir-resistant/refractory cytomegalovirus infection: a case series from the University of Chicago. Case Rep Nephrol Dial 2015; 5:96-105. [PMID: 26000278 PMCID: PMC4427155 DOI: 10.1159/000381470] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction Although antiviral prophylaxis for cytomegalovirus (CMV) is widely used, CMV infection remains common in renal transplant recipients with adverse consequences. Methods We report 5 cases of renal transplant recipients with resistant CMV infection who were successfully managed with leflunomide at the University of Chicago Medical Center. Results Five renal transplant recipients (2 simultaneous pancreas/kidney transplants, 3 deceased donor kidney transplants) were diagnosed with GCV-resistant CMV infection from 2003 to 2011. Of the 4 patients who had resistance genotype testing, 3 showed a UL97 mutation and 1 patient had a clinically resistant CMV infection. All patients received CMV prophylaxis with valganciclovir for 3 months. The number of days from the date of transplant to viremia ranged from 38 to 458 days (median 219). All 5 patients received other antiviral agents (e.g. ganciclovir, foscarnet), and in 4 patients, viremia was cleared before leflunomide was initiated as consolidation (or maintenance) therapy. Conclusion Leflunomide was well tolerated and successful in preventing recurrence of viremia in renal transplant recipients with resistant CMV infection. The beneficial effect of leflunomide in this setting warrants further investigation.
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Affiliation(s)
- W James Chon
- Section of Nephrology, University of Chicago, Chicago, Ill., USA
| | - Pradeep V Kadambi
- Division of Nephrology and Transplant Medicine, University of Arizona, Tucson, Ariz., USA
| | - Chang Xu
- Section of Nephrology, University of Chicago, Chicago, Ill., USA
| | - Yolanda T Becker
- Section of Transplant Surgery, University of Chicago, Chicago, Ill., USA
| | - Piotr Witkowski
- Section of Transplant Surgery, University of Chicago, Chicago, Ill., USA
| | - Kenneth Pursell
- Section of Infectious Disease, University of Chicago, Chicago, Ill., USA
| | - Brenna Kane
- Department of Pharmacy Services, University of Chicago, Chicago, Ill., USA
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