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García-Baquero R, Fernández-Ávila CM, Salvatierra Pérez C, García Álvarez TM, Ledo Cepero MJ, Álvarez-Ossorio Fernández JL. [Living-donor renal transplant. State of the art.]. ARCH ESP UROL 2021; 74:979-990. [PMID: 34851313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Living donor kidney transplantation is the best therapeutic option in a patient with end-stage renal failure, because it provides excellent functionality and graft survival. Laparoscopic living donor nephrectomyis the gold-standard for obtaining the graft. In exper thands, different minimally invasive surgeries can be offered with the main advantage of improving the a esthetic results. Although there may be controversy regarding laparoscopic devices for vascular ligation during living donor nephrectomy, both endostaplers and locking clips have proven to be safe as long as the proper techniqueis performed. Living donor nephrectomy has minimal morbidity and mortality. Age and glomerular filtration rate of the donor candidate are prognostic factor of long-term renal failure. In relation to the implant surgery,robotic kidney transplantation is now probably at the beginning of its development. Published series still do not allow to clearly establish its role compared to conventional open surgery.
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Martínez Urrutia MJ, Lobato Romera R, Rivas Vila S, Amesty Morello V, López Pereira P. [Kidney transplantation in pediatric age.]. ARCH ESP UROL 2021; 74:991-1001. [PMID: 34851314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Kidney transplantation (KT) is the best treatment for children in end-stage renal disease. KT has less mortality than dialysis and provides a better quality of life. Thus, the inclusion criteria have been progressively broadened. Histocompatibility and the source of donation are the most relevant factors that influence graft survival. Graft and patient survival have improved dramatically in recent decades, coming close to the results of KT in adults. Some of the specific factors that differentiate it from the adult are: donor-recipient size mismatch,the impact on growth and therapeutic non-compliance. Overall graft survival at 5-years is 90% for living donor KT and 70% for cadaveric donor KT.The most frequent cause of graft loss is chronic rejection.Mortality in the first post-transplant years is less than 6.5%. Infections and cardiovascular complications are the main causes of transplant-related death.Despite the good results, it is imperative to continue investigating how to achieve immunological tolerance. In order to improve the long-term results of the kidney graftis necessary to reduce immunosuppressive treatment and its side effects, such as chronic rejection.
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Affiliation(s)
| | | | - Susana Rivas Vila
- Servicio de Urología Pediátrica. Hospital Infantil La Paz. Madrid. España
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Abstract
The decision to become a living kidney donor is full of conflicts. It is generally believed that the candidates are aware of their reasons, that they have thought long about it, and have even asked questions about it. Thus it is surprising that, in many cases, they are only vaguely aware of their reasons and their validity. Sometimes, it is an impulsive decision guided by their emotions and entrusted to their luck or faith. Sometimes, they are undecided and put under pressure due to various circumstances. The mental health assessment should help to clarify their reasons, and to put them into words. It should be a positive experience, enriching their decision. It should give the candidate the inner feeling of having received help for taking the best decision. The psychosocial evaluation should be the first of multiple assessment ratings that the living kidney donor must face. A well-taken decision is a requirement to start the process properly. The author reviews the conditions in which that interview should be developed, the requirements to be met by the decision, and the proper techniques to obtain accurate information.
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Sánchez Cabús S, Estalella L, Pavel M, Calatayud D, Molina V, Ferrer J, Fondevila C, Fuster J, García-Valdecasas JC. Analysis of the long-term results of living donor liver transplantation in adults. Cir Esp 2017; 95:313-320. [PMID: 28476200 DOI: 10.1016/j.ciresp.2017.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/13/2017] [Accepted: 03/27/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Living donor liver transplantation (LDLT) is an alternative to conventional transplantation given its excellent results. The aim of this study is to evaluate long-term outcomes in LDLT recipients. METHODS 100 consecutive THDV recipients from the Hospital Clínic of Barcelona from March 2000 to October 2015 were included. The main indication for transplantation was end-stage liver disease (58%) followed by hepatocellular carcinoma (41%). 95% of grafts consisted of the right liver of the donor and the 5% of the left liver. RESULTS After a median follow-up of 65.5 months, patient and graft survival at 1, 3, and 5 years was 93%, 80% and 74% and 90%, 76%, and 71%, respectively. The overall re-transplant rate was 9%. The most common long-term complication was biliary stenosis (40%) with an average time of onset of 13.5±12 months, with repeated admissions and an average of 1.9±2 endoscopic procedures and 3.5±3 Radiological procedures per patient. The definitive treatment was radiological dilation in 40% of cases, surgical intervention in 22.5% and re-transplantation in 7.5%. CONCLUSIONS Given the long-term results, LDLT is confirmed as an alternative to conventional transplantation. However, the high rate of late biliary complications involves repeated admissions and invasive treatments that, while not compromising survival, can affect the patient's quality of life.
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Affiliation(s)
- Santiago Sánchez Cabús
- Unidad de Cirugía HPB y Trasplantes, ICMDiM. Hospital Clínic de Barcelona, Barcelona, España
| | - Laia Estalella
- Unidad de Cirugía HPB y Trasplantes, ICMDiM. Hospital Clínic de Barcelona, Barcelona, España
| | - Mihai Pavel
- Unidad de Cirugía HPB y Trasplantes, ICMDiM. Hospital Clínic de Barcelona, Barcelona, España
| | - David Calatayud
- Unidad de Cirugía HPB y Trasplantes, ICMDiM. Hospital Clínic de Barcelona, Barcelona, España
| | - Víctor Molina
- Unidad de Cirugía HPB y Trasplantes, ICMDiM. Hospital Clínic de Barcelona, Barcelona, España
| | - Joana Ferrer
- Unidad de Cirugía HPB y Trasplantes, ICMDiM. Hospital Clínic de Barcelona, Barcelona, España
| | - Constantino Fondevila
- Unidad de Cirugía HPB y Trasplantes, ICMDiM. Hospital Clínic de Barcelona, Barcelona, España
| | - Josep Fuster
- Unidad de Cirugía HPB y Trasplantes, ICMDiM. Hospital Clínic de Barcelona, Barcelona, España
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Ríos A, López-Navas A, Ayala-García MA, Sebastián MJ, Abdo-Cuza A, Martínez-Alarcón L, Ramírez EJ, Muñoz G, Suárez-López J, Castellanos R, Ramírez R, González B, Martínez MA, Díaz E, Ramírez P, Parrilla P. Ancillary personnel in Spanish and Latin-American hospitals faced with living related kidney donation. Actas Urol Esp 2014; 38:347-54. [PMID: 24594399 DOI: 10.1016/j.acuro.2013.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 12/01/2013] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Ancillary hospital personnel represent an important body of opinion because as they work in a hospital their opinion has more credibility for the general public as a result of their activity in hospitals. However, in most cases they do not have any health care training which means that their attitude could be based on a lack of knowledge or unfounded fears. OBJECTIVE To analyze the attitude toward living kidney donation (LKD) among ancillary personnel in Spanish and Latin-American hospitals and to analyze the variables that might influence such attitude. PATIENTS AND METHOD from «International Collaborative Donor Project» a random sample was taken among ancillary personnel in Spain, Mexico and Cuba hospitals. Attitude towards LKD was evaluated using a validated, anonymously filled and self-administered survey. RESULTS 951 professionals were surveyed (Spain: 277, Mexico: 632, Cuba: 42). 89% (n=850) are in favor of related kidney donation, lowering to 31% (n=289) in non-related donation. Of the rest, 8% (n=78) are not in favor and the 3% (n=23) are unsure. By country, Cubans (98%) and Mexicans (91%) are more in favour than Spanish (84%) (P=.001). The following variables are related to favourable attitude towards LKD: female sex (P=.017), university degree (P=.010), work in health services (P=.035), labour stability (P=.016), personal experience in donation and transplantation (P=.001), positive attitude toward cadaveric donation (P<.001), belief that he or she might need a transplant in the future (P<.001), positive attitude towards living liver donation (P<.001), a willingness to receive a donated living liver if needed (P<.001), having discussed the subject of organ donation and transplantation within the family (P<.001), partner's positive attitude towards the subject (P<.001), participation in voluntary type pro-social activities (P=.002) and not being concerned about possible mutilation after donation (P<.001) CONCLUSIONS: The attitude toward living related kidney donation is favourable among ancillary personnel in Spanish and Latin-Americans hospitals. Because living donation is a better source of organs than cadaveric ones, this favourable predisposition can be used as promoting agent of living donation in order to develop it in Spanish-speaking countries.
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Affiliation(s)
- A Ríos
- Proyecto Colaborativo Internacional Donante (International collaborative Donor Projet), Murcia, España; Coordinación Regional de Trasplantes, Consejería de Sanidad y Consumo de la Región de Murcia, Murcia, España; Unidad de Trasplantes, Servicio de Cirugía, Hospital Universitario Virgen de la Arrixaca, Murcia, España; Departamento de Cirugía, Universidad de Murcia, Murcia, España.
| | - A López-Navas
- Proyecto Colaborativo Internacional Donante (International collaborative Donor Projet), Murcia, España; Coordinación Regional de Trasplantes, Consejería de Sanidad y Consumo de la Región de Murcia, Murcia, España; Departamento de Psicología, Universidad Católica San Antonio, UCAM, Murcia, España
| | - M A Ayala-García
- Hospital Regional de Alta Especialidad del Bajío, León, Guanajuato, México; HGSZ No, 10 del Instituto Mexicano del Seguro Social Delegación Guanajuato, Guanajuato, León, México
| | - M J Sebastián
- Centro de Coordinación de Trasplantes, UMAE Hospital de Especialidades n.° 25 IMSS, Monterrey, México
| | - A Abdo-Cuza
- Centro de Investigación Médico-Quirúrgica, La Habana, Cuba
| | - L Martínez-Alarcón
- Proyecto Colaborativo Internacional Donante (International collaborative Donor Projet), Murcia, España; Coordinación Regional de Trasplantes, Consejería de Sanidad y Consumo de la Región de Murcia, Murcia, España; Unidad de Trasplantes, Servicio de Cirugía, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - E J Ramírez
- Facultad de Medicina, Universidad de Guanajuato, Guanajuato, León, México
| | - G Muñoz
- CMN Siglo XXI del Instituto Mexicano del Seguro Social, México DF, México
| | - J Suárez-López
- Unidad de Intensivos, Coordinación de Trasplantes, Hospital Hermanos Ameijeiras, La Habana, Cuba
| | - R Castellanos
- Centro de Investigación Médico-Quirúrgica, La Habana, Cuba
| | - R Ramírez
- Centro de Investigación Médico-Quirúrgica, La Habana, Cuba
| | - B González
- Hospital Regional de Alta Especialidad del Bajío, León, Guanajuato, México; Facultad de Medicina, Universidad de Guanajuato, Guanajuato, León, México
| | - M A Martínez
- Instituto de Salud Pública del Estado de Guanajuato, Guanajuato, León, México
| | - E Díaz
- Hospital Regional de Alta Especialidad del Bajío, León, Guanajuato, México; HGSZ No, 10 del Instituto Mexicano del Seguro Social Delegación Guanajuato, Guanajuato, León, México
| | - P Ramírez
- Proyecto Colaborativo Internacional Donante (International collaborative Donor Projet), Murcia, España; Coordinación Regional de Trasplantes, Consejería de Sanidad y Consumo de la Región de Murcia, Murcia, España; Unidad de Trasplantes, Servicio de Cirugía, Hospital Universitario Virgen de la Arrixaca, Murcia, España; Departamento de Cirugía, Universidad de Murcia, Murcia, España
| | - P Parrilla
- Unidad de Trasplantes, Servicio de Cirugía, Hospital Universitario Virgen de la Arrixaca, Murcia, España; Departamento de Cirugía, Universidad de Murcia, Murcia, España
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