1
|
Giglio MC, Dolce P, Yilmaz S, Tokat Y, Acarli K, Kilic M, Zeytunlu M, Unek T, Karam V, Adam R, Polak WG, Fondevila C, Nadalin S, Troisi RI. Development of a model to predict the risk of early graft failure after adult-to-adult living donor liver transplantation: An ELTR study. Liver Transpl 2024; 30:835-847. [PMID: 38079264 DOI: 10.1097/lvt.0000000000000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 11/18/2023] [Indexed: 01/12/2024]
Abstract
Graft survival is a critical end point in adult-to-adult living donor liver transplantation (ALDLT), where graft procurement endangers the lives of healthy individuals. Therefore, ALDLT must be responsibly performed in the perspective of a positive harm-to-benefit ratio. This study aimed to develop a risk prediction model for early (3 months) graft failure (EGF) following ALDLT. Donor and recipient factors associated with EGF in ALDLT were studied using data from the European Liver Transplant Registry. An artificial neural network classification algorithm was trained on a set of 2073 ALDLTs, validated using cross-validation, tested on an independent random-split sample (n=518), and externally validated on United Network for Organ Sharing Standard Transplant Analysis and Research data. Model performance was assessed using the AUC, calibration plots, and decision curve analysis. Graft type, graft weight, level of hospitalization, and the severity of liver disease were associated with EGF. The model ( http://ldlt.shinyapps.io/eltr_app ) presented AUC values at cross-validation, in the independent test set, and at external validation of 0.69, 0.70, and 0.68, respectively. Model calibration was fair. The decision curve analysis indicated a positive net benefit of the model, with an estimated net reduction of 5-15 EGF per 100 ALDLTs. Estimated risks>40% and<5% had a specificity of 0.96 and sensitivity of 0.99 in predicting and excluding EGF, respectively. The model also stratified long-term graft survival ( p <0.001), which ranged from 87% in the low-risk group to 60% in the high-risk group. In conclusion, based on a panel of donor and recipient variables, an artificial neural network can contribute to decision-making in ALDLT by predicting EGF risk.
Collapse
Affiliation(s)
- Mariano Cesare Giglio
- Department of Clinical Medicine and Surgery, Division of HPB and Robotic Surgery, Federico II University Hospital Naples, Italy
| | - Pasquale Dolce
- Department of Translational Medicine, Federico II University of Naples, Naples, Italy
| | - Sezai Yilmaz
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Yaman Tokat
- International Liver Center & Acibadem Healthcare Hospitals, Istanbul, Turkey
| | - Koray Acarli
- Department of Organ Transplantation, Istanbul Memorial Hospital, Istanbul, Turkey
- Department of Surgery, Istanbul Memorial Hospital, Istanbul, Turkey
| | - Murat Kilic
- Department of Liver Transplantation, Izmir Kent Hospital, Izmir, Turkey
| | - Murat Zeytunlu
- Departments of General Surgery and Gastroenterology, Ege University, School of Medicine, Izmir, Turkey
| | - Tarkan Unek
- Department of General Surgery, Hepatopancreaticobiliary Surgery and Liver Transplantation Unit, Dokuz Eylul University Faculty of Medicine, Narlidere, Izmir, Turkey
| | - Vincent Karam
- Paul Brousse Hospital, Univ Paris-Sud, Inserm, Villejuif, France
| | - René Adam
- Paul Brousse Hospital, Univ Paris-Sud, Inserm, Villejuif, France
| | | | - Constantino Fondevila
- Department of General and Digestive Surgery, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Roberto Ivan Troisi
- Department of Clinical Medicine and Surgery, Division of HPB and Robotic Surgery, Federico II University Hospital Naples, Italy
| |
Collapse
|
2
|
Magyar CTJ, Choi WJ, Li Z, Cattral MS, Selzner N, Ghanekar A, Sayed BA, Sapisochin G. The aim of donor safety: surgical approaches and current results. Updates Surg 2024:10.1007/s13304-024-01881-9. [PMID: 38916620 DOI: 10.1007/s13304-024-01881-9] [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: 02/26/2024] [Accepted: 05/13/2024] [Indexed: 06/26/2024]
Abstract
Living liver donation (LLD) has been suggested as a potential solution to reduce the waitlist mortality for liver transplantation (LT) recipients by facilitating living donor liver transplantation (LDLT). Ensuring both donor and recipient safety is a critical aspect of LDLT. An accurate understanding of the complexity and extend of safety outcomes of the donor is imperative to maintain the high-quality standard this medical program requires. This review seeks to outline safety outcome parameters of interest for donors. Early postoperative mortality is very low with no significant differences comparing left lobe to right lobe LLD. Complications most commonly are biliary (leakage or strictures), bleeding, respiratory or pulmonary, gastrointestinal or infectious. Return to full-time work and quality of life are essential parameters in the mid and long term. As evidence continues to accumulate, outcomes may evolve with the expansion of minimal invasive surgery practice and currently laparoscopic approach is recommended in large experienced centers. By offering safer operations that require fewer incisions or liver resections, living liver donations can be further encouraged, and the perception of the procedure can be improved. Rational consideration of the safety of the donor and in-depth discussion and evaluation with the patient is of utmost importance.
Collapse
Affiliation(s)
- Christian Tibor Josef Magyar
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- HBP and Multi Organ Transplant Program, Division of General Surgery, University Health Network, HPB Surgical Oncology, Toronto, ON, Canada
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Woo Jin Choi
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- HBP and Multi Organ Transplant Program, Division of General Surgery, University Health Network, HPB Surgical Oncology, Toronto, ON, Canada
| | - Zhihao Li
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- HBP and Multi Organ Transplant Program, Division of General Surgery, University Health Network, HPB Surgical Oncology, Toronto, ON, Canada
| | - Mark Steven Cattral
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- HBP and Multi Organ Transplant Program, Division of General Surgery, University Health Network, HPB Surgical Oncology, Toronto, ON, Canada
| | - Nazia Selzner
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- HBP and Multi Organ Transplant Program, Division of General Surgery, University Health Network, HPB Surgical Oncology, Toronto, ON, Canada
| | - Anand Ghanekar
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- HBP and Multi Organ Transplant Program, Division of General Surgery, University Health Network, HPB Surgical Oncology, Toronto, ON, Canada
| | - Blayne Amir Sayed
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- HBP and Multi Organ Transplant Program, Division of General Surgery, University Health Network, HPB Surgical Oncology, Toronto, ON, Canada
| | - Gonzalo Sapisochin
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
- HBP and Multi Organ Transplant Program, Division of General Surgery, University Health Network, HPB Surgical Oncology, Toronto, ON, Canada.
| |
Collapse
|
3
|
Kanneganti M, Byhoff E, Serper M, Olthoff KM, Bittermann T. Neighborhood-level social determinants of health measures independently predict receipt of living donor liver transplantation in the United States. Liver Transpl 2024; 30:618-627. [PMID: 38100175 DOI: 10.1097/lvt.0000000000000313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/06/2023] [Indexed: 01/10/2024]
Abstract
Disparities exist in the access to living donor liver transplantation (LDLT) in the United States. However, the association of neighborhood-level social determinants of health (SDoH) on the receipt of LDLT is not well-established. This was a retrospective cohort study of adult liver transplant recipients between January 1, 2005 and December 31, 2021 at centers performing LDLT using the United Network for Organ Sharing database, which was linked through patients' ZIP code to a set of 24 neighborhood-level SDoH measures from different data sources. Temporal trends and center differences in neighborhood Social Deprivation Index (SDI), a validated scale of socioeconomic deprivation ranging from 0 to 100 (0=least disadvantaged), were assessed by transplant type. Multivariable logistic regression evaluated the association of increasing SDI on receipt of LDLT [vs. deceased donor liver transplantation (DDLT)]. There were 51,721 DDLT and 4026 LDLT recipients at 59 LDLT-performing centers during the study period. Of the 24 neighborhood-level SDoH measures studied, the SDI was most different between the 2 transplant types, with LDLT recipients having lower SDI (ie, less socioeconomic disadvantage) than DDLT recipients (median SDI 37 vs. 47; p < 0.001). The median difference in SDI between the LDLT and DDLT groups significantly decreased from 13 in 2005 to 3 in 2021 ( p = 0.003). In the final model, the SDI quintile was independently associated with transplant type ( p < 0.001) with a threshold SDI of ~40, above which increasing SDI was significantly associated with reduced odds of LDLT (vs. reference SDI 1-20). As a neighborhood-level SDoH measure, SDI is useful for evaluating disparities in the context of LDLT. Center outreach efforts that aim to reduce disparities in LDLT could preferentially target US ZIP codes with SDI > 40.
Collapse
Affiliation(s)
- Mounika Kanneganti
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elena Byhoff
- Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Marina Serper
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kim M Olthoff
- Division of Transplant Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Therese Bittermann
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
4
|
Kaplan A, Aby ES, Scott S, Sonnenday C, Fox A, Mathur A, Olthoff K, Heimbach J, Ladin K, Emamaullee J. Financial toxicity in living donor liver transplantation: A call to action for financial neutrality. Am J Transplant 2024:S1600-6135(24)00337-X. [PMID: 38763318 DOI: 10.1016/j.ajt.2024.05.012] [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: 01/20/2024] [Revised: 04/22/2024] [Accepted: 05/14/2024] [Indexed: 05/21/2024]
Abstract
After 2 decades of limited growth, living donor liver transplant (LDLT) has been increasingly accepted as a promising solution to the growing organ shortage in the US. With experience, LDLT offers superior graft and patient survival with low rates of rejection. However, not all waitlisted patients have equal access to LDLT, with financial toxicity representing a substantial barrier. Potential living liver donors face indirect, direct, and opportunity costs associated with donation as well as insurance-based discrimination and variable employer leave policies. There are multiple potential national, local, and patient-centered solutions to address some of the cost-related issues associated with living LDLT. These include standardization of employer leave policies, creation of federal and state-led tax relief programs, optimization of National Living Donor Assistance Center use, engagement of independent living donor advocates, creation of financial toolkits, and encouragement of recipient or donor-led fundraising. In this piece, members of the North American Living Liver Donation Group, a consortium of 37 LDLT programs, explore these financial challenges and discuss solutions to achieve financial neutrality, where individuals can donate free from financial constraints or gains. As a community, it is imperative that we confront factors driving financial toxicity to improve equity and access to LDLT.
Collapse
Affiliation(s)
- Alyson Kaplan
- Department of Gastroenterology and Hepatology, Transplant Institute, Tufts University Medical Center, Boston, Massachusetts, USA
| | - Elizabeth S Aby
- Department of Gastroenterology and Hepatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sonia Scott
- Department of Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York, USA
| | | | - Alyson Fox
- Department of Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York, USA
| | - Amit Mathur
- Department of Transplant Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Kim Olthoff
- Department of Transplant Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julie Heimbach
- Department of Transplant Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Keren Ladin
- Department of Gastroenterology and Hepatology, Transplant Institute, Tufts University Medical Center, Boston, Massachusetts, USA
| | - Juliet Emamaullee
- Department of Transplant Surgery, University of Southern California, Los Angeles, California, USA.
| |
Collapse
|
5
|
Tien C, Han HH. Current status and challenges of living donor liver transplantation in the United States. Clin Liver Dis (Hoboken) 2023; 22:177-180. [PMID: 38026119 PMCID: PMC10653593 DOI: 10.1097/cld.0000000000000078] [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: 05/25/2023] [Accepted: 07/03/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Christine Tien
- Department of Medicine, University of Southern California, Los Angeles, California, USA
| | - Hyosun H. Han
- Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
6
|
Shi Y, Zhang H, Zhu Z. A systematic review of the factors significantly influencing the quality of life of living liver donors. Int J Nurs Sci 2023; 10:579-586. [PMID: 38020831 PMCID: PMC10667322 DOI: 10.1016/j.ijnss.2023.09.012] [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: 06/14/2023] [Revised: 08/21/2023] [Accepted: 09/19/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives This systematic review aimed to synthesize the literature on factors influencing the quality of life in living liver donors post-donation and to provide a reference for developing targeted interventions in clinical practice. Methods A systematic search guided by the PRISMA 2020 approach was performed on specific databases: PubMed, EMBASE, CINHAL with full text, Web of Science, and ProQuest Dissertations & Theses databases. Peer-reviewed articles published in English from inception to October 2022 covering cross-sectional studies and longitudinal studies on factors affecting the quality of life of living liver donors after donation were included in this systematic review. The methodological quality of the studies was examined using a modified version of the National Institutes of Health Quality Assessment Tool. Results A total of 6,576 studies were retrieved, and 16 eligible studies were finally included. Four types of independent influencing factors: sociodemographic (gender, donor age, education, ethnicity, and marital status), donation-related (length of hospital stay and number of hospitalizations/hospital visits related to donation surgery, recipient outcome, time from donation, complications, donation decision, ambivalence about donating, donor-recipient relationship), health-related (body mass index and pre-donation physical symptoms), and psychosocial (pre-donation physical and mental score, household income, anxiety, depression), were extracted from the included studies. Several studies consistently identified old age, recipient death, recent donation, postoperative complications experienced by donors, and donor concerns about their well-being as negative influencing factors on physical function. Female donors, low education levels, longer hospital stays, and/or more hospital visits due to donation, poor recipient outcome, recent donation, pre-donation concerns regarding their well-being, and first-degree relative and spouse/partner donors were reported in several studies as negative predictors for psychological status. Factors affecting social function were considered by only two included articles. Conclusions The quality of life of living liver donors could be affected by both donation surgery and psychosocial factors. Based on the above-influencing factors, clinical nurses can develop targeted interventions to improve the quality of life of living liver donors.
Collapse
Affiliation(s)
- Yuexian Shi
- School of Nursing, Peking University, Beijing, China
| | - Haiming Zhang
- Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Clinical Center for Pediatric Liver Transplantation, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhijun Zhu
- Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Clinical Center for Pediatric Liver Transplantation, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
7
|
Pillai A, Goldaracena N, Rosenblatt R, Verna EC. CAQ Corner: Evaluation and management of living liver donors. Liver Transpl 2023; 29:1118-1128. [PMID: 37243369 DOI: 10.1097/lvt.0000000000000183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Anjana Pillai
- Division of Gastroenterology, Department of Internal Medicine, Hepatology and Nutrition, University of Chicago Medicine, Chicago, Illinois, USA
| | - Nicolas Goldaracena
- Division of Transplantation, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Russell Rosenblatt
- Center for Liver Disease and Transplantation, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Elizabeth C Verna
- Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, New York, USA
| |
Collapse
|
8
|
Jesse MT, Jackson WE, Liapakis A, Ganesh S, Humar A, Goldaracena N, Levitsky J, Mulligan D, Pomfret EA, Ladner DP, Roberts JP, Mavis A, Thiessen C, Trotter J, Winder GS, Griesemer AD, Pillai A, Kumar V, Verna EC, LaPointe Rudow D, Han HH. Living donor liver transplant candidate and donor selection and engagement: Meeting report from the living donor liver transplant consensus conference. Clin Transplant 2023:e14954. [PMID: 36892182 DOI: 10.1111/ctr.14954] [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: 12/28/2022] [Revised: 02/14/2023] [Accepted: 02/25/2023] [Indexed: 03/10/2023]
Abstract
INTRODUCTION Living donor liver transplantation (LDLT) is a promising option for mitigating the deceased donor organ shortage and reducing waitlist mortality. Despite excellent outcomes and data supporting expanding candidate indications for LDLT, broader uptake throughout the United States has yet to occur. METHODS In response to this, the American Society of Transplantation hosted a virtual consensus conference (October 18-19, 2021), bringing together relevant experts with the aim of identifying barriers to broader implementation and making recommendations regarding strategies to address these barriers. In this report, we summarize the findings relevant to the selection and engagement of both the LDLT candidate and living donor. Utilizing a modified Delphi approach, barrier and strategy statements were developed, refined, and voted on for overall barrier importance and potential impact and feasibility of the strategy to address said barrier. RESULTS Barriers identified fell into three general categories: 1) awareness, acceptance, and engagement across patients (potential candidates and donors), providers, and institutions, 2) data gaps and lack of standardization in candidate and donor selection, and 3) data gaps regarding post-living liver donation outcomes and resource needs. CONCLUSIONS Strategies to address barriers included efforts toward education and engagement across populations, rigorous and collaborative research, and institutional commitment and resources.
Collapse
Affiliation(s)
- Michelle T Jesse
- Transplant Institute, Henry Ford Health System, Detroit, Michigan, USA
| | - Whitney E Jackson
- Division of Gastroenterology and Hepatology, University of Colorado, Aurora, Colorado, USA
| | - AnnMarie Liapakis
- Yale School of Medicine and Yale New Haven Transplant Center, New Haven, Connecticut, USA
| | - Swaytha Ganesh
- Thomas E Starzl Transplant Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Abhinav Humar
- Thomas E Starzl Transplant Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nicolas Goldaracena
- Division of Transplant Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Josh Levitsky
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David Mulligan
- Division of Transplant Surgery, Yale University, New Haven, Connecticut, USA
| | | | - Daniela P Ladner
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - John P Roberts
- UCSF Department of Surgery, San Francisco, California, USA
| | - Alisha Mavis
- Pediatric Gastroenterology, Hepatology, and Nutrition, Duke University Health, Durham, North Carolina, USA
| | - Carrie Thiessen
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - James Trotter
- Transplant Hepatology, Baylor University Medical Center, Dallas, Texas, USA
| | | | - Adam D Griesemer
- Department of Surgery, NYU Langone Heath, New York, New York, USA
| | - Anjana Pillai
- Department of Internal Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Vineeta Kumar
- Department of Medicine, Division of Nephrology/Transplant, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth C Verna
- Center for Liver Disease and Transplantation, Columbia University, New York, New York, USA
| | - Dianne LaPointe Rudow
- Recanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, New York, USA
| | - Hyosun H Han
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | |
Collapse
|
9
|
Penninti P, Guerrero J. Living donor liver transplant: A strategy to increase transplant access. Clin Liver Dis (Hoboken) 2023; 21:89-91. [PMID: 37095777 PMCID: PMC10121436 DOI: 10.1097/cld.0000000000000022] [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: 06/30/2022] [Accepted: 12/23/2022] [Indexed: 04/26/2023] Open
Affiliation(s)
- Pranav Penninti
- University of Texas Health Science Center at San Antonio, Gastroenterology, Texas, USA
| | - Juan Guerrero
- UT Health San Antonio, Transplant Center, San Antonio, Texas, USA
| |
Collapse
|
10
|
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
|
11
|
Jang H, Im HY, Nam HJ. The life experiences of living liver donors: A qualitative meta‐synthesis. Res Nurs Health 2022; 45:693-706. [DOI: 10.1002/nur.22273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/26/2022] [Accepted: 09/04/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Hye‐Young Jang
- College of Nursing, Hanyang University Seoul South Korea
| | - Hyei Yeon Im
- College of Nursing, Hanyang University Seoul South Korea
| | - Hye Jin Nam
- College of Nursing, Seoul National University Seoul South Korea
| |
Collapse
|
12
|
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
|
13
|
Al Harakeh H, Emmanuel B, Hughes C, Tevar A, Steel JL, DiMartini A, Ganesh S, Sood P, Humar A. Sequential liver and kidney living donors: Making the ultimate gift twice. Clin Transplant 2022; 36:e14750. [PMID: 35695890 DOI: 10.1111/ctr.14750] [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: 10/12/2021] [Revised: 05/01/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
There are nearly 150 living donors in the United States who donated more than one solid organ. Using our divisional database, we found 20 individuals who donated a liver and a kidney at different times. We performed a retrospective chart review of these donors, studying their motivating factors, complications and outcomes. The donors included 11 (55%) males and nine females. Thirteen (65%) donated the kidney before the liver. Fourteen (70%) were nondirected donors at the first donation, and four of the six directed donors in the first donation became nondirected in the second donation. Seventeen (85%) were nondirected at the second donation. Common reasons for donating the second time were a good experience with the first donation and knowing that one can donate again. Outcomes and the incidence of early complications were not significantly different after the 2nd versus the 1st donation. All donors recovered and currently are doing well. Our results show a significant number of dual organ donors are nondirected and motivated by their strong desire to help. A positive experience with the 1st donation often was the driving factor for the 2nd. A history of previous organ donation did not negatively impact the 2nd donation.
Collapse
Affiliation(s)
- Hasan Al Harakeh
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Bishoy Emmanuel
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Amit Tevar
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Andrea DiMartini
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Swaytha Ganesh
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Puneet Sood
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Abhinav Humar
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
14
|
Kaplan A, Wahid N, Lee J, Fortune BE, Halazun KJ, Fox A, Brown RS, Samstein B, Rosenblatt R. Sociodemographic characteristics of living liver donors: Few changes over 20 years. Clin Transplant 2022; 36:e14701. [PMID: 35532183 DOI: 10.1111/ctr.14701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/05/2022] [Accepted: 04/23/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Although there are well-documented challenges in access to living donor liver transplant (LDLT) among recipients, it is unclear whether living liver donors (LLDs) face similar challenges. METHODS We analyzed the UNOS Standard Transplant Analysis and Research database, including LLDs ≥ 18 years in the United States from 1/1998-12/2018. We compared sociodemographic characteristics (age, gender, race/ethnicity, education level, employment status, BMI, and relationship to recipient) of LLDs across three eras-pre-MELD (1998-2002), MELD (2003-2013), and post-direct acting antivirals (DAA) (2014-2018). We also described sociodemographic characteristics of living donor recipients and waitlisted patients. Chi-squared and one-way analysis of variance (ANOVA) were used to compare categorical and continuous variables, respectively. RESULTS From 1998-2018, 4,756 LDLTs and 99,765 DDLTs were performed. Across the three eras, LLD age did not change significantly (p = 0.3), but donors were generally young (mean age 37+/-11). While men comprised most LLDs in the pre-MELD era (55.2%), women surpassed them in the post-DAA era (52.9%), p<0.001. In total, White donors comprised 81.5% of total LLDs, while Black and Asian donors were a small minority of total donors (3.7% and 2.5%, respectively). Most donors had at least a college education and were employed. Educational attainment and employment did not significantly change over the study period. CONCLUSIONS During the last twenty years, LLDs have remained White, employed, highly educated, and young with increasing numbers of women LLDs. The relative lack of change in the characteristics of donors is likely attributable largely to socioeconomic factors, which should be assessed in future investigation. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Alyson Kaplan
- Department of Gastroenterology and Hepatology, New York Presbyterian Weill Cornell School of Medicine
| | - Nabeel Wahid
- Department of Medicine, New York Presbyterian Weill Cornell School of Medicine
| | - Jihui Lee
- Division of Biostatistics of Department of Population Health Sciences, Weill Cornell School of Medicine
| | - Brett E Fortune
- Department of Gastroenterology and Hepatology, New York Presbyterian Weill Cornell School of Medicine
| | - Karim J Halazun
- Department of Surgery, New York Presbyterian Weill Cornell School of Medicine
| | - Alyson Fox
- Department of Gastroenterology and Hepatology, New York Presbyterian Columbia University Irving Medical Center
| | - Robert S Brown
- Department of Gastroenterology and Hepatology, New York Presbyterian Weill Cornell School of Medicine
| | - Benjamin Samstein
- Department of Surgery, New York Presbyterian Weill Cornell School of Medicine
| | - Russell Rosenblatt
- Department of Gastroenterology and Hepatology, New York Presbyterian Weill Cornell School of Medicine
| |
Collapse
|
15
|
Sakai T, Ko JS, Crouch CE, Kumar S, Choi GS, Hackl F, Han DH, Kaufman M, Kim SH, Luzzi C, McCluskey S, Shin WJ, Sirianni J, Song KW, Sullivan C, Hendrickse A. Perioperative management of living donor liver transplantation: Part 2 - Donors. Clin Transplant 2022; 36:e14690. [PMID: 35477939 DOI: 10.1111/ctr.14690] [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: 12/10/2021] [Revised: 02/26/2022] [Accepted: 04/23/2022] [Indexed: 01/10/2023]
Abstract
Living donor liver transplantation was first developed to mitigate the limited access to deceased donor organs in Asia in the 1990s. This alternative liver transplantation method has become a widely practiced and established transplantation option for adult patients suffering with end-stage liver disease, and it has successfully helped address the shortage of deceased donors. The Society for the Advancement of Transplant Anesthesia and the Korean Society of Transplantation Anesthesiologists jointly reviewed published studies on the perioperative management of adult live liver donors undergoing donor hemi-hepatectomy. The goal of the review is to offer transplant anesthesiologists and critical care physicians a comprehensive overview of the perioperative management of adult live donors. We featured the current status, donor selection process, outcomes and complications, surgical procedure, anesthetic management, Enhanced Recovery After Surgery protocols, avoidance of blood transfusion, and considerations for emergency donation. Recent surgical advances, including laparoscopic donor hemi-hepatectomy and robotic laparoscopic donor surgery, are also addressed.
Collapse
Affiliation(s)
- Tetsuro Sakai
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Clinical and Translational Science Institute, University of Pittsburgh, Pennsylvania, USA.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pennsylvania, USA
| | - Justin Sangwook Ko
- Department of Anesthesiology & Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cara E Crouch
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sathish Kumar
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Florian Hackl
- Department of Anesthesiology and Interventional Pain Management, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Dai Hoon Han
- Department of HBP Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Michael Kaufman
- Department of Anesthesiology and Interventional Pain Management, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Seong Hoon Kim
- Organ Transplantation Center, National Cancer Center, Gyeonggi-do, Republic of Korea
| | - Carla Luzzi
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stuart McCluskey
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Won Jung Shin
- Department of Anesthesiology & Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joel Sirianni
- Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ki Won Song
- Department of Hepato-Biliary Surgery and Liver Transplantation, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Cinnamon Sullivan
- Department of Anesthesiology, Emory University, Atlanta, Georgia, USA
| | - Adrian Hendrickse
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
16
|
Abstract
BACKGROUND Living donor liver transplants (LDLTs) including those from nondirected donors (NDDs) have increased during the past decade, and center-level variations in LDLTs have not yet been described. We sought to quantify changes in the volume of NDD transplants over time and variation in NDD volume between transplant centers. We further examined characteristics of living liver donors and identified factors potentially associated with receiving an NDD liver transplant. METHODS Using Scientific Registry of Transplant Recipients data between March 01, 2002, and December 31, 2020, we compared 173 NDDs with 5704 DLDs and 167 NDD recipients with 1153 waitlist candidates. RESULTS NDDs increased from 1 (0.4% of LDLTs) in 2002 to 58 (12% of LDLTs) in 2020. Of 150 transplant centers, 35 performed at least 1 NDD transplant. Compared with waitlist candidates, adult NDD recipients were less frequently males (39% versus 62%, P < 0.001), had a lower model for end-stage liver disease (16 versus 18, P = 0.01), and spent fewer days on the waitlist (173 versus 246, P = 0.02). Compared with waitlist candidates, pediatric NDD recipients were younger (50% versus 12% age <2 y, P < 0.001) and more often diagnosed with biliary atresia (66% versus 41%, P < 0.001). Compared with DLDs, NDDs were older (40 versus 35 y, P < 0.001), college educated (83% versus 64%, P < 0.001), White (92% versus 78%, P < 0.001), and more frequently donated left-lateral segment grafts (32.0% versus 14%, P < 0.001). CONCLUSIONS Liver NDD transplants continue to expand but remain concentrated at a few centers. Graft distribution favors female adults and pediatric patients with biliary atresia. Racial inequities in adult or pediatric center-level NDD graft distribution were not observed.
Collapse
|
17
|
Leung KK, Kim A, Hansen BE, Lilly L, Selzner N, Patel K, Bhat M, Hirschfield GM, Galvin Z. The Impact of Primary Liver Disease and Social Determinants in a Mixed Donor Liver Transplant Program: A Single-Center Analysis. Liver Transpl 2021; 27:1733-1746. [PMID: 34092028 DOI: 10.1002/lt.26195] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/16/2021] [Accepted: 05/06/2021] [Indexed: 12/13/2022]
Abstract
Organ allocation in liver transplantation (LT) remains imperfect. Periodic center reviews ensure programs transparently evaluate the impact of practice on access to transplantation, reflecting, in particular, patient (primary disease, social determinants) and program (deceased versus live donation) factors. Adult Ontario residents waitlisted for first LT at Toronto General Hospital from November 2012 to May 2019 were reviewed. Analyses were performed between distance to transplant center, income, education level, population density and primary liver disease, with LT, deceased donor liver transplant (DDLT), living donor liver transplant (LDLT), and delisting. Of 1735 listed patients, 549 were delisted (32%), while 1071 were transplanted (62%), with 819 DDLT recipients (76%) and 252 LDLT recipients (24%), while 115 (7%) remained actively listed at data census. On univariate analysis, DDLT recipients lived 30% closer (median 39.7 versus 60.6 km; P < 0.001), lived in more populous areas (median 8501.0 versus 6868.5 people in a 1-km radius; P < 0.001), and resided in households that annually earned 10% less (median $92,643.17 versus $102,820.89 Canadian dollars; P < 0.001) compared with LDLT recipients. These findings with population density and income differences between DDLT versus LDLT receival remained significant on multivariate modeling even when accounting for primary liver disease. Primary liver disease was a statistically significant factor on multivariate analyses in LT receival (P = 0.001) as well as DDLT versus LDLT receival (P < 0.001). Of patients listed for end-stage liver disease, more patients with autoimmune cholestatic liver diseases received LDLT (34%-41%) than DDLT (27%-30%); this contrasted with patients with noncholestatic diseases LDLT (8%-19%) versus DDLT (37%-59%) receival (P < 0.001). Review of transplant allocation in a large mixed-donor North American liver transplant program demonstrates how patient social determinants and primary liver disease etiology continue to be significantly associated with ultimate transplantation.
Collapse
Affiliation(s)
- Kristel K Leung
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Audrey Kim
- Multi-Organ Transplant Program, Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Bettina E Hansen
- Institute of Health Policy, Management and Evaluation, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Les Lilly
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Multi-Organ Transplant Program, Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Nazia Selzner
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Multi-Organ Transplant Program, Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Keyur Patel
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Multi-Organ Transplant Program, Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada.,Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Mamatha Bhat
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Multi-Organ Transplant Program, Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Gideon M Hirschfield
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Zita Galvin
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Multi-Organ Transplant Program, Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| |
Collapse
|
18
|
Shi YX, Zhang HM, Chen J, Huang YQ, Yu MM, Jin YH, Wang WR, Gao W. Health-Related Quality of Life in Predominantly Young Parental Living Liver Donors: A Cross-Sectional Study in China. Front Med (Lausanne) 2021; 8:726103. [PMID: 34660636 PMCID: PMC8517132 DOI: 10.3389/fmed.2021.726103] [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: 06/16/2021] [Accepted: 08/23/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: The health-related quality of life (HRQoL) of donors deserves attention and must be considered for a long time. Many of the published studies had small sample sizes, and research from mainland China, in particular, is scant. Thus, this study aimed to investigate the HRQoL of living liver donors and identify the influencing factors of the HRQoL in mainland China. Methods: This is a cross-sectional study. The data were collected from the liver transplantation center, the Tianjin First Center Hospital, China. Living liver donors older than 18 years and at a minimum of 1-month, post-donation was included. The HRQoL was evaluated using the Medical Outcome Study Short form 36 (SF-36). Sociodemographic and clinical-related variables, HRQoL status, and its potential impact factors were analyzed. Results: A total of 382 living liver donors completed the survey. The median number of months post-donation was 25, and parental donors (99.2%) were the most frequent relationship. The majority of the participants (372, 97.4%) donated their left lateral lobes. Thirty-two (8.4%) donors suffered complications, and of them, 7 suffered from biliary leakage (1.8%), which was the most common one in this study. The physical functioning (PF), role–physical (RP), bodily pain (BP), general health (GH), social functioning (SF), role–emotional (RE), and mental health (MH) scores among the living liver donors were significantly better than those of the Chinese norms. Short-time post-donation [odds ratio (OR): 0.008; p < 0.001] and male recipients (OR:0.195; p = 0.024) were associated with the likelihood of a poor physical related quality of life. Conclusions: Despite, in general, good HRQoL outcomes, we also believed that liver donation has an obvious influence on the physical functions of liver donors. More attention and long-term follow-ups are necessary for donors at higher risk based on identified influencing factors and correlates.
Collapse
Affiliation(s)
- Yue-Xian Shi
- School of Nursing, Peking University, Beijing, China
| | - Hai-Ming Zhang
- Liver Transplantation Center, Clinical Center for Pediatric Liver Transplantation, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jing Chen
- Department of Liver Transplantation, Tianjin First Center Hospital, Tianjin, China
| | - Ya-Qi Huang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Ming-Ming Yu
- School of Nursing, Peking University, Beijing, China
| | - Yin-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wen-Ru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wei Gao
- Department of Liver Transplantation, Tianjin First Center Hospital, Tianjin, China
| |
Collapse
|
19
|
Yoeli D, Jackson WE, Adams MA, Wachs ME, Sundaram SS, Sater A, Cisek JR, Choudhury RA, Nydam TL, Pomposelli JJ, Conzen KD, Kriss MS, Burton JR, Pomfret EA. Challenging the Traditional Paradigm of Supply and Demand in Pediatric Liver Transplantation Through Nondirected Living Donation: A Case Series. Liver Transpl 2021; 27:1392-1400. [PMID: 34048131 DOI: 10.1002/lt.26108] [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: 02/15/2021] [Revised: 04/20/2021] [Accepted: 05/12/2021] [Indexed: 12/13/2022]
Abstract
A gap exists between the demand for pediatric liver transplantation and the supply of appropriate size-matched donors. We describe our center's experience with pediatric liver transplantation using anonymous nondirected living liver donors (ND-LLD). First-time pediatric liver transplant candidates listed at our center between January 2012 and June 2020 were retrospectively reviewed and categorized by donor graft type, and recipients of ND-LLD grafts were described. A total of 13 ND-LLD pediatric liver transplantations were performed, including 8 left lateral segments, 4 left lobes, and 1 right lobe. Of the ND-LLD recipients, 5 had no directed living donor evaluated, whereas the remaining 8 (62%) had all potential directed donors ruled out during the evaluation process. Recipient and graft survival were 100% during a median follow-up time of 445 (range, 70-986) days. Of ND-LLDs, 69% were previous living kidney donors, and 1 ND-LLD went on to donate a kidney after liver donation. Of the ND-LLDs, 46% were approved prior to the recipient being listed. Over time, the proportion of living donor transplants performed, specifically from ND-LLDs, increased, and the number of children on the waiting list decreased. The introduction of ND-LLDs to a pediatric liver transplant program can expand the benefit of living donor liver transplantation to children without a suitable directed living donor while achieving excellent outcomes for both the recipients and donors.
Collapse
Affiliation(s)
- Dor Yoeli
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, CO.,Division of Abdominal Transplant Surgery, Department of Surgery, Children's Hospital Colorado, Aurora, CO
| | - Whitney E Jackson
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Megan A Adams
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, CO.,Division of Abdominal Transplant Surgery, Department of Surgery, Children's Hospital Colorado, Aurora, CO
| | - Michael E Wachs
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, CO.,Division of Abdominal Transplant Surgery, Department of Surgery, Children's Hospital Colorado, Aurora, CO
| | - Shikha S Sundaram
- Division of Gastroenterology, Hepatology and Nutrition, The Digestive Health Institute, Department of Pediatric Medicine, Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Anna Sater
- Division of Abdominal Transplant Surgery, Department of Surgery, Children's Hospital Colorado, Aurora, CO
| | - Jaime R Cisek
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Rashikh A Choudhury
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Trevor L Nydam
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - James J Pomposelli
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Kendra D Conzen
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Michael S Kriss
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - James R Burton
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Elizabeth A Pomfret
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| |
Collapse
|
20
|
Sonnenberg EM, Lee-Riddle GS, Walls DO, Caicedo JC, Jackson WE, Hughes L, Ladner DP, Liapakis A, Pomfret EA, Sarkar M, Selzner N, Torres AM, Abt PL, Olthoff KM. Pregnancy Outcomes After Living Liver Donation: A Multi-Institutional Study. Liver Transpl 2021; 27:1262-1272. [PMID: 33993632 DOI: 10.1002/lt.26098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 04/07/2021] [Accepted: 05/03/2021] [Indexed: 01/13/2023]
Abstract
Nearly half of living liver donors in North America are women of child-bearing age. Fetal and maternal outcomes after donation are unknown. We conducted a retrospective cohort study of female living liver donors (aged 18-50 years at donation) from 6 transplant centers. Participants were surveyed about their pregnancies and fertility. Outcomes were compared between predonation and postdonation pregnancies. Generalized estimating equations were clustered on donor and adjusted for age at pregnancy, parity, and pregnancy year. Among the 276 donors surveyed, 151 donors responded (54.7% response rate) and reported 313 pregnancies; 168/199 (68.8%) of the predonation pregnancies and 82/114 (71.9%) of the postdonation pregnancies resulted in live births, whereas 16.6% and 24.6% resulted in miscarriage, respectively. Women with postdonation pregnancies were older (32.0 versus 26.7 years; P < 0.001) and more frequently reported abnormal liver enzymes during pregnancy (3.5% versus 0.0%; P = 0.02) and delivery via cesarean delivery (35.4% versus 19.7%; P = 0.01). On adjusted analysis, there was no difference in cesarean delivery (odds ratio [OR], 2.44; 95% confidence interval [95% CI], 0.98-6.08), miscarriage (OR, 1.59; 95% CI, 0.78-3.24), combined endpoints of pregnancy-induced hypertension and preeclampsia (OR, 1.27; 95% CI, 0.36-4.49), or intrauterine growth restriction and preterm birth (OR, 0.91; 95% CI, 0.19-4.3). Of the 49 women who attempted pregnancy after donation, 11 (22.5%) self-reported infertility; however, 8/11 (72.7%) eventually had live births. Aside from increased reporting of abnormal liver enzymes and cesarean deliveries, there was no significant difference in pregnancy outcomes before and after living liver donation. One-fifth of women who attempt pregnancy after liver donation reported infertility, and although the majority went on to successful live births, further exploration is needed to understand the contributing factors. Future research should continue to monitor this patient-centered outcome across a large cohort of donors.
Collapse
Affiliation(s)
| | - Grace S Lee-Riddle
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - David O Walls
- Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Juan C Caicedo
- Comprehensive Transplant Center, Northwestern University Transplant Outcomes Research Collaborative, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Whitney E Jackson
- Division of Gastroenterology and Hepatology, Department of Medicine, and the Colorado Center for Transplantation Care, Research and Education, University of Colorado, Aurora, CO
| | - Lisa Hughes
- Department of Medicine, Yale University, New Haven, CT
| | - Daniela P Ladner
- Comprehensive Transplant Center, Northwestern University Transplant Outcomes Research Collaborative, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Elizabeth A Pomfret
- Department of Surgery and the Colorado Center for Transplantation Care, Research and Education, University of Colorado, Aurora, CO
| | - Monika Sarkar
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Nazia Selzner
- Department of Medicine, Toronto General Hospital, Toronto, ON, Canada
| | - Ana Marie Torres
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Peter L Abt
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Kim M Olthoff
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
21
|
Flaig C, Humar A, Kirshner E, Hughes C, Ganesh S, Tevar A, Steel JL. Post-operative outcomes in anonymous living liver donors: What motivates individuals to donate to strangers. Clin Transplant 2021; 35:e14438. [PMID: 34292636 DOI: 10.1111/ctr.14438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 11/29/2022]
Abstract
Anonymous living donor liver transplantation (LDLT) is a strategy to address the shortage of available transplantable livers; however, few studies have been conducted on this population. The objective of this study was to describe the motivations and medical, psychosocial, and financial outcomes of anonymous living liver donors. Between 2010-2019, 116 anonymous living liver donors were evaluated, 59 (51.7%) of whom proceeded to surgery. A subset of 21 anonymous donors were matched to biologically/emotionally related donors according to age, gender, race, and duration since surgery. A medical chart review and post-surgical interviews were performed to assess medical and financial outcomes. The primary motivation for donors was an unselfish desire to help others (43, 72.9%). A total of 13 (22%) anonymous donors experienced complications. Of these, 7 (11.9%) were grade I Clavien-Dindo classification, 5 (8.5%) grade II, and 1 was grade III (1.7%); and no patients had grade IV-V Clavien-Dindo complications. Increased anxiety was reported by 3 (5.1%) donors, and one donor reported clinical levels of depression (1.7%). Within the matched controls, anonymous donors were not significantly different to biologically/emotionally related donors with regard to surgical complications, psychosocial, or financial outcomes. Allowing a greater number of anonymous donors may facilitate the reduction of the waitlist for liver transplant candidates. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Carly Flaig
- University of Pittsburgh School of Medicine Department of Surgery.,University of Pittsburgh Department of Psychology
| | - Abhinav Humar
- University of Pittsburgh School of Medicine Department of Surgery
| | - Emily Kirshner
- University of Pittsburgh School of Medicine Department of Surgery
| | | | - Swaytha Ganesh
- University of Pittsburgh School of Medicine Department of Surgery
| | - Amit Tevar
- University of Pittsburgh School of Medicine Department of Surgery
| | - Jennifer L Steel
- University of Pittsburgh School of Medicine Department of Surgery.,University of Pittsburgh Department of Psychology.,University of Pittsburgh School of Medicine Department of Psychiatry
| |
Collapse
|
22
|
Mental Health and Well-Being of Solid Organ Transplant Donors. The Forgotten Sacrifices. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2030026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In light of a global organ shortage, living donor transplantation has become increasingly relevant as an alternative to deceased donor transplantation. While current research has revolved around the medical aspects of transplantation, there remains a paucity of literature regarding the quality of life (QOL) of living donors. Hence, this review aims to provide a comprehensive outline of the current landscape of living liver and kidney transplantation, with a focus on the mental health and wellbeing of donors. As highlighted in previous studies, organ donation has a significant impact on both physical and mental aspects of donor wellbeing, with marked deteriorations occurring in the short term. Furthermore, other qualitative aspects such as financial burden contribute greatly to donor distress, reflecting a need for improved donor care. To address these pertinent issues, recommendations for a successful transplant program are detailed in this review, which encompasses psychological and social aspects of donor care throughout the donation process. Further research can be done on the impact of recipient deaths on donor QOL and appropriate interventions. Overall, given the selfless sacrifices of living donors, the care of their mental wellbeing is essential. Therefore, greater emphasis should be placed on the provision of adequate psychosocial support for them.
Collapse
|
23
|
Emamaullee JA, Aljehani M, Hogen RVT, Zhou K, Lee JSH, Sher LS, Genyk YS. Potential association between public medical insurance, waitlist mortality, and utilization of living donor liver transplantation: An analysis of the Scientific Registry of Transplant Recipients. Clin Transplant 2021; 35:e14418. [PMID: 34236113 DOI: 10.1111/ctr.14418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/28/2021] [Accepted: 07/04/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The Affordable Care Act (ACA) and subsequent Medicaid expansion has increased utilization of public health insurance. Living donor liver transplantation (LDLT) increases access to transplant and is associated with improved survival but consistently represents < 5% of LT in the United States. STUDY DESIGN National registry data were analyzed to evaluate the impact of insurance payor on waitlist mortality and LDLT rates at LDLT centers since implementation of the ACA. RESULTS Public insurance [Medicare RR 1.18 (1.13-1.22) P < .001, Medicaid RR 1.22 (1.18-1.27) P < .001], Latino ethnicity (P < .001), and lower education level (P = .02) were associated with increased waitlist mortality at LDLT centers. LDLT recipients were more likely to have private insurance (70.4% vs. 59.4% DDLT, P < .001), be Caucasian (92.1% vs. 83% DDLT, P < .001), and have post-secondary education (66.8% vs. 54.1% DDLT, P < .001). Despite 78% of LDLT centers being located in states with Medicaid expansion, there was no change in LDLT utilization among recipients with Medicaid (P = .196) or Medicare (P = .273). CONCLUSION Despite Medicaid expansion, registry data suggests that patients with public medical insurance may experience higher waitlist mortality and underutilize LDLT at centers offering LDLT. It is possible that Medicaid expansion has not increased access to LDLT.
Collapse
Affiliation(s)
- Juliet A Emamaullee
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery, University of Southern California, Los Angeles, California, USA
| | - Mayada Aljehani
- Lawrence J. Ellison Institute for Transformative Medicine, University of Southern California, Los Angeles, California, USA
| | - Rachel V T Hogen
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery, University of Southern California, Los Angeles, California, USA
| | - Kali Zhou
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jerry S H Lee
- Lawrence J. Ellison Institute for Transformative Medicine, University of Southern California, Los Angeles, California, USA
| | - Linda S Sher
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery, University of Southern California, Los Angeles, California, USA
| | - Yuri S Genyk
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
24
|
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
|
25
|
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
|
26
|
Wanis KN, Sarvet A, Ruffolo LI, Levstik MA, Tomiyama K, Al-Judaibi BM, Stensrud MJ, Hernandez-Alejandro R. Estimating the effect of increasing utilization of living donor liver transplantation using observational data. Transpl Int 2021; 34:648-656. [PMID: 33527506 DOI: 10.1111/tri.13835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/22/2020] [Accepted: 01/29/2021] [Indexed: 11/30/2022]
Abstract
There has been a recent increase in enthusiasm for expansion of living donor liver transplantation (LDLT) programmes. Using all adults initially placed on the waiting list in the United States, we estimated the risk of overall mortality under national strategies which differed in their utilization of LDLT. We used a generalization of inverse probability weighting which can estimate the effect of interventions in the setting of finite resources. From 2005 to 2015, 93 812 eligible individuals were added to the waitlist: 51 322 received deceased donor grafts while 1970 underwent LDLT. Individuals who underwent LDLT had more favourable prognostic factors, including lower mean MELD score at transplant (14.6 vs. 20.5). The 1-year, 5-year and 10-year cumulative incidence of death under the current level of LDLT utilization were 18.0% (95% CI: 17.8, 18.3%), 41.2% (95% CI: 40.8, 41.5%) and 57.4% (95% CI: 56.9, 57.9%) compared to 17.9% (95% CI: 17.7, 18.2%), 40.6% (95% CI: 40.2, 40.9%) and 56.4% (95% CI: 55.8, 56.9%) under a strategy which doubles LDLT utilization. Expansion of LDLT utilization would have a measurable, modest effect on the risk of mortality for the entire cohort of individuals who begin on the transplant waiting list.
Collapse
Affiliation(s)
- Kerollos Nashat Wanis
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Surgery, Western University, London, ON, Canada
| | - Aaron Sarvet
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Luis I Ruffolo
- Division of Transplantation/Hepatobiliary Surgery, Department of Surgery, University of Rochester, Rochester, NY, USA
| | - Mark A Levstik
- Division of Transplant Hepatology, University of Rochester, Rochester, NY, USA
| | - Koji Tomiyama
- Division of Transplantation/Hepatobiliary Surgery, Department of Surgery, University of Rochester, Rochester, NY, USA
| | - Bandar M Al-Judaibi
- Division of Transplant Hepatology, University of Rochester, Rochester, NY, USA
| | - Mats J Stensrud
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Roberto Hernandez-Alejandro
- Division of Transplantation/Hepatobiliary Surgery, Department of Surgery, University of Rochester, Rochester, NY, USA
| |
Collapse
|
27
|
Emamaullee J, Tenorio L, Khan S, Butler C, Kim S, Tucker‐Seeley R, Kwon Y, Shapiro J, Saigal S, Sher L, Genyk Y. Living donor financial assistance programs in liver transplantation: The global perspective. Clin Transplant 2020; 34:e14073. [DOI: 10.1111/ctr.14073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/23/2020] [Accepted: 08/22/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Juliet Emamaullee
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery University of Southern California Los Angeles CaliforniaUSA
- Keck School of Medicine University of Southern California Los Angeles CaliforniaUSA
| | - Lisa Tenorio
- School of Medicine St. Louis University St. Louis MissouriUSA
| | - Sara Khan
- Keck School of Medicine University of Southern California Los Angeles CaliforniaUSA
| | - Chante Butler
- Keck School of Medicine University of Southern California Los Angeles CaliforniaUSA
| | - Susan Kim
- University of Southern California Transplant Institute Los Angeles CaliforniaUSA
| | | | - Yong Kwon
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery University of Southern California Los Angeles CaliforniaUSA
- Keck School of Medicine University of Southern California Los Angeles CaliforniaUSA
| | - James Shapiro
- Department of Surgery University of Alberta Edmonton Alberta Canada
| | | | - Linda Sher
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery University of Southern California Los Angeles CaliforniaUSA
- Keck School of Medicine University of Southern California Los Angeles CaliforniaUSA
| | - Yuri Genyk
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery University of Southern California Los Angeles CaliforniaUSA
- Keck School of Medicine University of Southern California Los Angeles CaliforniaUSA
| |
Collapse
|
28
|
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
|
29
|
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
|
30
|
Ryu S, Yoon SC, Hong KE, Kim JM. Psychosocial Issues Related to Donor's Decision-Making in Living Donor Liver Transplantation. Ann Transplant 2019; 24:576-583. [PMID: 31624226 PMCID: PMC6820347 DOI: 10.12659/aot.916340] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The aim of this study was to investigate the detailed motives, concerns, and psychological defensiveness of living liver donor candidates in a Korean population. Material/Methods We analyzed data of 102 donor candidates obtained from routine psychosocial evaluation for living donor liver transplantation (LDLT) using descriptive methods. Donor candidates completed 2 questionnaires regarding their motivations and concerns, as well as a validity scale, the K scale from the Minnesota Multiphasic Personality Inventory-2. Results Donor candidates were more likely to cite family-related issues (77.5% to 94.1%) including well-being of the whole family and family affection as the reasons for their liver donation rather than personal motives (38.2% to 57.8%). Donors were also more likely to concern about the recipient’s survival and recovery (52.9% to 58.8%) rather than their own difficulties such as surgical complications and occupational disadvantages (19.6% to 38.2%). Twenty-six donors (25.5%) took a psychologically defensive attitude (T-score of K scale ≥65) during the pre-donation evaluation. Psychologically defensive donors expressed a significantly lower level of concern about liver donation compared to non-defensive donors (P<0.01). Conclusions We need to pay more attention to the family-related issues and psychological defensiveness of living liver donor candidates when evaluating psychosocial status before LDLT.
Collapse
Affiliation(s)
- Seunghyong Ryu
- Department of Mental Health Research, National Center for Mental Health, Seoul, South Korea.,Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Se Chang Yoon
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ki Eun Hong
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| |
Collapse
|
31
|
Mogul DB, Lee J, Purnell TS, Massie AB, Ishaque T, Segev DL, Bridges JF. Barriers to access in pediatric living-donor liver transplantation. Pediatr Transplant 2019; 23:e13513. [PMID: 31215155 PMCID: PMC9421564 DOI: 10.1111/petr.13513] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 05/09/2019] [Accepted: 05/12/2019] [Indexed: 12/13/2022]
Abstract
Children receiving a LDLT have superior post-transplant outcomes, but this procedure is only used for 10% of transplant recipients. Better understanding about barriers toward LDLT and the sociodemographic characteristics that influence these underlying mechanisms would help to inform strategies to increase its use. We conducted an online, anonymous survey of parents/caregivers for children awaiting, or have received, a liver transplant regarding their knowledge and attitudes about LDLT. The survey was completed by 217 respondents. While 97% of respondents understood an individual could donate a portion of their liver, only 72% knew the steps in evaluation, and 69% understood the donor surgery was covered by the recipient's insurance. Individuals with public insurance were less likely than those with private insurance to know the steps for LDLT evaluation (44% vs 82%; P < 0.001). Respondents with public insurance were less likely to know someone that had been a living donor (44% vs 56%; P = 0.005) as were individuals without a college degree (64% vs 85%; P = 0.007). Nearly all respondents generally trusted their healthcare team. Among respondents, 82% believed they were well-informed about LDLT but individuals with public insurance were significantly less likely to feel well-informed (67% vs 87%; P = 0.03) and to understand how donor surgery might impact donor work/time off (44% vs 81%; P = 0.001). Substantial gaps exist in parental understanding about LDLT, including its evaluation, potential benefits, and complications. Greater emphasis on addressing these barriers, especially to individuals with fewer resources, will be helpful to expand the use of LDLT.
Collapse
Affiliation(s)
- Douglas B. Mogul
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joy Lee
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN
| | - Tanjala S. Purnell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Tanveen Ishaque
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | | |
Collapse
|
32
|
Al-Samkari H, Patel AA, Schiano TD, Kuter DJ. Recurrence of Acute Intermittent Porphyria After Liver Transplantation. Ann Intern Med 2019; 170:904-905. [PMID: 30716770 DOI: 10.7326/l18-0623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Hanny Al-Samkari
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (H.A., D.J.K.)
| | - Arpan A Patel
- Icahn School of Medicine, New York, New York (A.A.P., T.D.S.)
| | | | - David J Kuter
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (H.A., D.J.K.)
| |
Collapse
|
33
|
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
|
34
|
Pulsipher MA, Logan BR, Kiefer DM, Chitphakdithai P, Riches ML, Rizzo JD, Anderlini P, Leitman OF, Kobusingye H, Besser RM, Miller JP, Drexler RJ, Abdel-Mageed A, Ahmed IA, Akard LP, Artz AS, Ball ED, Bayer RL, Bigelow C, Bolwell BJ, Broun ER, Delgado DC, Duckworth K, Dvorak CC, Hahn TE, Haight AE, Hari PN, Hayes-Lattin BM, Jacobsohn DA, Jakubowski AA, Kasow KA, Lazarus HM, Liesveld JL, Linenberger M, Litzow MR, Longo W, Magalhaes-Silverman M, McCarty JM, McGuirk JP, Mori S, Parameswaran V, Prasad VK, Rowley SD, Rybka WB, Sahdev I, Schriber JR, Selby GB, Shaughnessy PJ, Shenoy S, Spitzer T, Tse WT, Uberti JP, Vusirikala M, Waller EK, Weisdorf DJ, Yanik GA, Navarro WH, Horowitz MM, Switzer GE, Confer DL, Shaw BE. Related peripheral blood stem cell donors experience more severe symptoms and less complete recovery at one year compared to unrelated donors. Haematologica 2019; 104:844-854. [PMID: 30381298 PMCID: PMC6442962 DOI: 10.3324/haematol.2018.200121] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/30/2018] [Indexed: 11/26/2022] Open
Abstract
Unlike unrelated donor registries, transplant centers lack uniform approaches to related donor assessment and deferral. To test whether related donors are at increased risk for donation-related toxicities, we conducted a prospective observational trial of 11,942 related and unrelated donors aged 18-60 years. Bone marrow (BM) was collected at 37 transplant and 78 National Marrow Donor Program centers, and peripheral blood stem cells (PBSC) were collected at 42 transplant and 87 unrelated donor centers in North America. Possible presence of medical comorbidities was verified prior to donation, and standardized pain and toxicity measures were assessed pre-donation, peri-donation, and one year following. Multivariate analyses showed similar experiences for BM collection in related and unrelated donors; however, related stem cell donors had increased risk of moderate [odds ratios (ORs) 1.42; P<0.001] and severe (OR 8.91; P<0.001) pain and toxicities (OR 1.84; P<0.001) with collection. Related stem cell donors were at increased risk of persistent toxicities (OR 1.56; P=0.021) and non-recovery from pain (OR 1.42; P=0.001) at one year. Related donors with more significant comorbidities were at especially high risk for grade 2-4 pain (OR 3.43; P<0.001) and non-recovery from toxicities (OR 3.71; P<0.001) at one year. Related donors with more significant comorbidities were at especially high risk for grade 2-4 pain (OR 3.43; P<0.001) and non-recovery from toxicities (OR 3.71; P<0.001) at one year. Related donors reporting grade ≥2 pain had significant decreases in Health-Related Quality of Life (HR-QoL) scores at one month and one year post donation (P=0.004). In conclusion, related PBSC donors with comorbidities are at increased risk for pain, toxicity, and non-recovery at one year after donation. Risk profiles described in this study should be used for donor education, planning studies to improve the related donor experience, and decisions regarding donor deferral. Registered at clinicaltrials.gov identifier:00948636.
Collapse
Affiliation(s)
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Deidre M Kiefer
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - Pintip Chitphakdithai
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - Marcie L Riches
- University of North Carolina Hospitals, Division of Hematology and Oncology Chapel Hill, NC
| | - J Douglas Rizzo
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Paolo Anderlini
- Department of Stem Cell Transplantation and Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX
| | - O'Susan F Leitman
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, MD
| | - Hati Kobusingye
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - RaeAnne M Besser
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - John P Miller
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Rebecca J Drexler
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - Aly Abdel-Mageed
- Department of Pediatrics and Human Development, Helen DeVos Children's Hospital, Grand Rapids, MI
| | - Ibrahim A Ahmed
- Department of Hematology and Oncology, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | - Luke P Akard
- Indiana Blood and Marrow Transplantation, Indianapolis, IN
| | | | - Edward D Ball
- University of California, San Diego Medical Center, La Jolla, CA
| | | | | | | | | | | | | | - Christopher C Dvorak
- Division of Pediatric Blood and Marrow Transplantation, University of California San Francisco Benioff Children's Hospital, CA
| | | | - Ann E Haight
- Aflac Cancer and Blood Disorders Center, Division of Hematology/Oncology-Bone Marrow Pediatric Hematology & Medical Oncology, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA
| | | | | | | | | | - Kimberly A Kasow
- Pediatric Hematology Oncology Program, Bone Marrow and Stem Cell Transplantation Program, University of North Carolina Healthcare, Chapel Hill, NC
| | - Hillard M Lazarus
- Seidman Cancer Center-University Hospitals Cleveland Medical Center, OH
| | - Jane L Liesveld
- Strong Memorial Hospital - University of Rochester Medical Center, NY
| | | | | | - Walter Longo
- University of Wisconsin Hospital and Clinics, Madison, WI
| | | | - John M McCarty
- Virginia Commonwealth University Massey Cancer Center Bone Marrow Transplant Program, Richmond, VA
| | | | - Shahram Mori
- Florida Hospital Cancer Institute, Florida Center for Cellular Therapy, Orlando, FL
| | | | - Vinod K Prasad
- Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | | | | | - Indira Sahdev
- Cohen Children's Medical Center of New York, New Hyde Park, NY
| | | | - George B Selby
- HCA Health Services of Oklahoma, Inc., University of Oklahoma, Oklahoma City, OK
| | | | - Shalini Shenoy
- Division of Hematology/Oncology, St. Louis Children's Hospital, MO
| | | | - William T Tse
- Ann & Robert H. Lurie Children's Hospital of Chicago, IL
| | | | - Madhuri Vusirikala
- Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | | | - Willis H Navarro
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Galen E Switzer
- Division of General Internal Medicine, University of Pittsburgh, PA, USA
| | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
35
|
Martin DE, Van Assche K, Domínguez-Gil B, López-Fraga M, García Gallont R, Muller E, Capron AM. Strengthening Global Efforts to Combat Organ Trafficking and Transplant Tourism: Implications of the 2018 Edition of the Declaration of Istanbul. Transplant Direct 2019; 5:e433. [PMID: 30882038 PMCID: PMC6411225 DOI: 10.1097/txd.0000000000000872] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 01/06/2019] [Accepted: 01/08/2019] [Indexed: 12/31/2022] Open
Abstract
The 2018 Edition of the Declaration of Istanbul on Organ Trafficking and Transplant Tourism (DoI) provides an updated set of principles and definitions to guide policymakers and health professionals working in organ donation and transplantation. A draft of the new edition was circulated to the public and transplant professionals through an online consultation process, which also sought feedback on a draft explanatory article that explained the principles and discussed some of their practical implications. Both drafts were revised in response to feedback from participants in the consultation. We present here the discussion article, which is intended to assist stakeholders in applying the principles of the DoI by providing more detailed information about the meaning and potential implications of implementing the DoI in various contexts.
Collapse
Affiliation(s)
| | - Kristof Van Assche
- Research Group Personal Rights and Property Rights, University of Antwerp, Antwerp, Belgium
| | | | - Marta López-Fraga
- European Directorate for the Quality of Medicines & HealthCare, Council of Europe, Strasbourg, France
| | | | - Elmi Muller
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Alexander M. Capron
- Gould School of Law and Keck School of Medicine, University of Southern California, Los Angeles, CA
| |
Collapse
|
36
|
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
|
37
|
Abu-Gazala S, Olthoff KM. Current Status of Living Donor Liver Transplantation in the United States. Annu Rev Med 2019; 70:225-238. [DOI: 10.1146/annurev-med-051517-125454] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Adult-to-adult living donor liver transplantation (LDLT) was introduced in response to the shortage of deceased donor liver grafts. The number of adult living donor transplants is increasing due to improved outcomes and increasing need. Advantages of LDLT include optimization of the timing of transplant, better organ quality, and lower rates of recipient mortality compared to staying on the wait list for deceased donor liver transplant. Donor safety remains the major focus when considering LDLT. Recent advancements have supported the increased use of LDLT to help decrease wait list death and improve long-term survival of transplant recipients.
Collapse
Affiliation(s)
- Samir Abu-Gazala
- Transplantation Unit, Department of Surgery, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Kim M. Olthoff
- Division of Transplant Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104-4283, USA
| |
Collapse
|
38
|
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
|
39
|
Butt Z, DiMartini AF, Liu Q, Simpson MA, Smith AR, Zee J, Gillespie BW, Holtzman S, Ladner D, Olthoff K, Fisher RA, Hafliger S, Freise CE, Mandell MS, Sherker AH, Dew MA. Fatigue, Pain, and Other Physical Symptoms of Living Liver Donors in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study. Liver Transpl 2018; 24:1221-1232. [PMID: 29698577 PMCID: PMC6153054 DOI: 10.1002/lt.25185] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/10/2018] [Indexed: 12/15/2022]
Abstract
Little is known about living liver donors' perceptions of their physical well-being following the procedure. We collected data on donor fatigue, pain, and other relevant physical outcomes as part of the prospective, multicenter Adult-to-Adult Living Donor Liver Transplantation Cohort Study consortium. A total of 271 (91%) of 297 eligible donors were interviewed at least once before donation and 3, 6, 12, and 24 months after donation using validated measures when available. Repeated measures regression models were used to identify potential predictors of worse physical outcomes. We found that donors reported more fatigue immediately after surgery that improved by 2 years after donation, but not to predonation levels. A similar pattern was seen across a number of other physical outcomes. Abdominal or back pain and interference from their pain were rated relatively low on average at all study points. However, 21% of donors did report clinically significant pain at some point during postdonation study follow-up. Across multiple outcomes, female donors, donors whose recipients died, donors with longer hospital stays after surgery, and those whose families discouraged donation were at risk for worse physical well-being outcomes. In conclusion, although not readily modifiable, we have identified risk factors that may help identify donors at risk for worse physical outcomes for targeted intervention. Liver Transplantation 00 000-000 2018 AASLD.
Collapse
Affiliation(s)
- Zeeshan Butt
- Departments of Medical Social Sciences, Surgery, & Psychiatry and Behavioral Sciences Northwestern University, Chicago IL
| | - Andrea F. DiMartini
- Departments of Psychiatry, Psychology, Epidemiology, Biostatistics, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh PA
| | - Qian Liu
- Arbor Research Collaborative for Health, Ann Arbor, MI
| | - Mary Ann Simpson
- Department of Transplantation, Lahey Hospital and Medical Center, Burlington, MA
| | - Abigail R. Smith
- Arbor Research Collaborative for Health, Ann Arbor, MI,Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Jarcy Zee
- Arbor Research Collaborative for Health, Ann Arbor, MI
| | | | - Susan Holtzman
- Department of Psychology, University of British Columbia, Kelowna, BC
| | - Daniela Ladner
- Departments of Medical Social Sciences, Surgery, & Psychiatry and Behavioral Sciences Northwestern University, Chicago IL
| | - Kim Olthoff
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Robert A. Fisher
- Division of Transplantation, The Transplant Institute Beth Israel Deaconess Medical Center, Harvard University, Boston, MA
| | | | - Chris E. Freise
- Departments of Medicine and Surgery, University of California at San Francisco, San Francisco, CA
| | | | - Averell H. Sherker
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology, Biostatistics, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh PA
| |
Collapse
|
40
|
Psychological and Emotional Aspects in Living Donor Kidney Transplantation. Transplant Proc 2018; 51:124-127. [PMID: 30655155 DOI: 10.1016/j.transproceed.2018.04.085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/13/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND The decision to resort to living donor transplantation determines a particular condition characterized by a strong mental and emotional anguish, both for the patients and their families. The purpose of the study was to correlate the relational dynamics between donor-recipient, donor/recipient couple with the health team, and the family support perceived by the couple with the quality of life 6 months before transplant and 12 months after transplant and compare the data between the 2 time points after participating in the psychotherapy program of counseling about behavioral change. PATIENTS AND METHODS Twenty-seven donor and recipient pairs consented to participate. The quality of life was studied through the Complete Form Health Survey (SF-36). All subjects completed a questionnaire that investigated the 3 types of fundamental relationships (donor-recipient, donor/recipient with the health team, and family support perceived by the couple). All participants were involved in an 18-month psychotherapy program in the pre- and post-transplant phase. RESULTS The quality of the donor-recipient relationship significantly positively influences the subjective perception of psychophysical well-being before and after transplant. Post-transplant family support is crucial in ensuring a good perception of psychological and emotional health in donors and recipients. The relationship with the health team is important in ensuring a good perception of psychophysical health only in recipients after transplant. CONCLUSIONS This study suggests that patients should be assisted by a multidisciplinary health care team and receive continuous support from relatives during the post-transplant adaptation process. This facilitates the donor and recipient postoperative quality of life.
Collapse
|
41
|
Abu-Gazala S, Olthoff KM. Status of Adult Living Donor Liver Transplantation in the United States: Results from the Adult-To-Adult Living Donor Liver Transplantation Cohort Study. Gastroenterol Clin North Am 2018; 47:297-311. [PMID: 29735025 DOI: 10.1016/j.gtc.2018.01.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
This article reviews the Adult-to-Adult Living Donor Liver Transplant Cohort Study (A2ALL). The findings show that the number of adult-to-adult living donor liver transplants is consistently increasing. Living donor liver transplantation has an important benefit for patients with acute liver failure, does not compromise donor safety, and has lower rates of acute cellular rejection in biologically related donor and recipient. The conclusions from the A2ALL consortium have been critical in transplant advancement, supporting increased use to help decrease waitlist death and improve long-term survival of transplant recipients.
Collapse
Affiliation(s)
- Samir Abu-Gazala
- Department of Surgery, Transplantation Unit, Hadassah Hebrew University Medical Center, Kiryat Hadassah, POB 12000, Jerusalem 91120, Israel.
| | - Kim M Olthoff
- Department of Surgery, Division of Transplant Surgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| |
Collapse
|
42
|
Living donor liver transplantation: eliminating the wait for death in end-stage liver disease? Nat Rev Gastroenterol Hepatol 2017; 14:373-382. [PMID: 28196987 DOI: 10.1038/nrgastro.2017.2] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Adult-to-adult living donor liver transplantation (A2ALDLT), outside of Asia, remains an important yet underutilized gift of life. For patients with end-stage liver disease, A2ALDLT is a proven transplantation option, with lower waiting list mortality and suffering, and equivalent or better allograft and patient survival than deceased-donor liver transplantation (DDLT). The risks to living donors and the benefit to their recipients have been carefully defined with long-term level 1 and 2 evidence-based study. An overview of the development and practice of living donor liver transplant (LDLT), including donor and recipient surgical allograft innovation, is provided. The issues of recipient selection, outcomes and morbidity, including disease-variable study and challenges past and present are presented in comparison with DDLT cohorts, and future insights are described. Central to practice is the careful and concise review of donor evaluation and selection and donor outcome, morbidity, quality of life and present and future strategies for donor advocacy and growth of the technique.
Collapse
|
43
|
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
|