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Bababekov YJ, Pomfret EA. Ethical Considerations for Simultaneous vs Sequential Liver-Kidney Donation From the Same Live Donor: Donor(s) Selection Is Key. Gastroenterology 2024; 166:365-368. [PMID: 37977309 DOI: 10.1053/j.gastro.2023.11.021] [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: 07/10/2023] [Revised: 11/01/2023] [Accepted: 11/11/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Yanik John Bababekov
- Division of Transplant Surgery, Department of Surgery, Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado; University of Colorado Hospital, Anschutz Medical Campus, Aurora, Colorado
| | - Elizabeth Anne Pomfret
- Division of Transplant Surgery, Department of Surgery, Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado; University of Colorado Hospital, Anschutz Medical Campus, Aurora, Colorado
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Fox AN, Liapakis A, Batra R, Bittermann T, Emamaullee J, Emre S, Genyk Y, Han H, Jackson W, Pomfret E, Raza M, Rodriguez-Davalos M, Rubman Gold S, Samstein B, Shenoy A, Taner T, Roberts JP. The use of nondirected donor organs in living donor liver transplantation: Perspectives and guidance. Hepatology 2022; 75:1579-1589. [PMID: 34859474 DOI: 10.1002/hep.32260] [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: 07/27/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 12/13/2022]
Abstract
Interest in anonymous nondirected living organ donation is increasing in the United States and a small number of transplantation centers are accumulating an experience regarding nondirected donation in living donor liver transplantation. Herein, we review current transplant policy, discuss emerging data, draw parallels from nondirected kidney donation, and examine relevant considerations in nondirected living liver donation. We aim to provide a consensus guidance to ensure safe evaluation and selection of nondirected living liver donors and a schema for just allocation of nondirected grafts.
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Affiliation(s)
- Alyson N Fox
- Columbia University Irving Medical Center (CUIMC) Center for Liver Disease and Transplanation NY Presbyterian HospitalColumbia University Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - AnnMarie Liapakis
- Yale-New Haven Health Transplanation CenterYale University School of MedicineNew HavenConnecticutUSA
| | - Ramesh Batra
- Yale-New Haven Health Transplanation CenterYale University School of MedicineNew HavenConnecticutUSA
| | - Therese Bittermann
- Penn Transplant InstitutePenn MedicinePerelman School of Medicine Unniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Juliet Emamaullee
- University of Southern California (USC) Transplant InstituteKeck School of Medicine of USCLos AngelesCaliforniaUSA
| | - Sukru Emre
- Yale-New Haven Health Transplanation CenterYale University School of MedicineNew HavenConnecticutUSA
| | - Yuri Genyk
- University of Southern California (USC) Transplant InstituteKeck School of Medicine of USCLos AngelesCaliforniaUSA
| | - Hyosun Han
- University of Southern California (USC) Transplant InstituteKeck School of Medicine of USCLos AngelesCaliforniaUSA
| | - Whitney Jackson
- Colorado Center for Transplantation Care, Research and EducationUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Elizabeth Pomfret
- Colorado Center for Transplantation Care, Research and EducationUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Muhammad Raza
- Keck School of Medicine of University of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Susan Rubman Gold
- Yale-New Haven Health Transplanation CenterYale University School of MedicineNew HavenConnecticutUSA
| | - Benjamin Samstein
- Weill Cornell Medicine Center for Liver Disease and Transplantation NY Presbyterian HospitalWeill Cornell School of MedicineNew YorkNew YorkUSA
| | - Akhil Shenoy
- Columbia University Irving Medical Center (CUIMC) Center for Liver Disease and Transplanation NY Presbyterian HospitalColumbia University Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Timucin Taner
- Mayo Clinic Transplant CenterMayo Clinic College of MedicineRochesterMinnesotaUSA
| | - John P Roberts
- Organ Transplant ProgramUniversity of California San Francisco (UCSF) HealthUCSF School of MedicineSan FranciscoCaliforniaUSA
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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.
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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
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