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Shapey IM, Summers A, Yiannoullou P, Fullwood C, Augustine T, Rutter MK, van Dellen D. Donor noradrenaline use is associated with better allograft survival in recipients of pancreas transplantation. Ann R Coll Surg Engl 2024; 106:19-28. [PMID: 36927080 PMCID: PMC10757882 DOI: 10.1308/rcsann.2022.0161] [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] [Accepted: 12/09/2022] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Outcomes following pancreas transplantation are suboptimal and better donor selection is required to improve this. Vasoactive drugs (VaD) are commonly used to correct the abnormal haemodynamics of organ donors in intensive care units. VaDs can differentially affect insulin secretion positively (dobutamine) or negatively (noradrenaline). The hypothesis was that some VaDs might induce beta-cell stress or rest and therefore impact pancreas transplant outcomes. The aim of the study was to assess relationships between VaD use and pancreas transplant graft survival. METHODS Data from the UK Transplant Registry on all pancreas transplants performed between 2004 and 2016 with complete follow-up data were included. Univariable- and multivariable-adjusted Cox regression analyses determined risks of graft failure associated with VaD use. RESULTS In 2,183 pancreas transplants, VaDs were used in the following numbers of donors: dobutamine 76 (3.5%), dopamine 84 (3.8%), adrenaline 161 (7.4%), noradrenaline 1,589 (72.8%) and vasopressin 1,219 (55.8%). In multivariable models, adjusted for covariates and the co-administration of other VaDs, noradrenaline use (vs non-use) was a strong predictor of better graft survival (hazard ratio [95% confidence interval] 0.77 [0.64-0.94], p = 0.01). CONCLUSIONS Noradrenaline use was associated with better graft survival in models adjusted for donor and recipient variables - this may be related to inhibition of pancreatic insulin secretion initiating pancreatic beta-cell 'rest'. Further research is required to replicate these findings and establish whether relationships are causal. Identification of alternative methods of inducing beta-cell rest could be valuable in improving graft outcomes.
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Affiliation(s)
- IM Shapey
- University of Manchester, UK
- Manchester University NHS Foundation Trust, UK
| | - A Summers
- Manchester University NHS Foundation Trust, UK
| | | | - C Fullwood
- University of Manchester, UK
- Manchester University NHS Foundation Trust, UK
| | - T Augustine
- Manchester University NHS Foundation Trust, UK
| | - MK Rutter
- University of Manchester, UK
- Manchester University NHS Foundation Trust, UK
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Bannon A, Leatherby R, Birtles L, Augustine T, Moinuddin Z, Van Dellen D. OC-059 TEMPORARY ABDOMINAL CLOSURE NEGATIVE THERAPY IMPROVES DEFINITIVE FASCIAL CLOSURE RATES IN PATIENTS WITH OPEN ABDOMEN MANAGEMENT. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Encapsulating peritoneal sclerosis (EPS) is a rare phenomenon characterised by encasement of the bowel by a thickened peritoneum due to prolonged peritoneal dialysis exposure. We are an international referral centre, typically managing cases with a planned open abdomen (OAM) and scheduled relook after 24–48 hours. We compare outcomes for those patients whose OAM was with simple packing (betadine-soaked-gauze) with negative pressure therapy providing temporary abdominal closure (TAC).
Methods
A retrospective review of a contemporaneous database of patients who underwent surgery for EPS between 2010–2020 was performed. Primary endpoints were time to definitive closure and closure method (primary fascial closure vs. bridged biologic mesh closure vs. failure to close fascia). Secondary endpoints included comparison of stoma formation, bowel resection, fistulation rate, enterotomy formation, re-operation post closure, and wound infection.
Results
99 patients had OAM (56 static packing; 43 TAC.) Patients with TAC were significantly more likely to undergo primary closure of fascia when compared to those patients managed with static packing, (63% vs 13%, p<0.0001, Chi Sq). The TAC group required fewer theatre episodes (n=2.27 vs. 4.78, p<0.0001, t-test) and time in days to achieve closure (n=2.78 vs n=4.68, p<0.005, Chi Sq), with less failure to close episodes and returns to theatre 30 days post closure.
Conclusion
This study provides definitive evidence of TAC efficacy for fascial closure following OAM. This provides definitive benefit over traditional open abdominal methods. It may provide benefit in definitive open abdominal management in other areas (sepsis and trauma) and requires further study.
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Affiliation(s)
- A Bannon
- Centre for Transplantation , Manchester Royal Infirmary, Manchester , United Kingdom
| | - R Leatherby
- Centre for Transplantation , Manchester Royal Infirmary, Manchester , United Kingdom
| | - L Birtles
- Centre for Transplantation , Manchester Royal Infirmary, Manchester , United Kingdom
| | - T Augustine
- Centre for Transplantation , Manchester Royal Infirmary, Manchester , United Kingdom
| | - Z Moinuddin
- Centre for Transplantation , Manchester Royal Infirmary, Manchester , United Kingdom
| | - D Van Dellen
- Centre for Transplantation , Manchester Royal Infirmary, Manchester , United Kingdom
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Doherty D, Khambalia H, Summers A, Moinuddin Z, Yiannoullou P, Krishnan A, Augustine T, Naish J, van Dellen D. Future imaging modalities for the assessment of pancreas allografts a scan of the horizon. Transplant Rev (Orlando) 2022; 36:100692. [DOI: 10.1016/j.trre.2022.100692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
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4
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Spiers HVM, Augustine T. 958 Encapsulating Peritoneal Sclerosis with Pericardial Tamponade: A Case Report. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Encapsulating peritoneal sclerosis (EPS) is a rare morbidity associated primarily with peritoneal dialysis. Definitive diagnosis and management can often be prolonged and complicated. The pathogenesis is a two-hit hypothesis of inflammation and myofibroblast differentiation. This report aims to demonstrate the pathogenesis of EPS and provide insight into management.
Method
We present a unique case of a patient with EPS who follows a ‘classical’ disease course before developing a concomitant pericardial sclerosis, presenting with cardiac tamponade. We explore the proposed pathophysiology and provide a hypothesis for both uncommon pathologies presenting in the same patient.
Results
A 45-year-old male was treated for EPS and went on to develop a concomitant pericardial sclerosis. Following referral to our centre, the patient underwent a semi-elective surgical enterolysis and peritonectomy for EPS, with excision of all sclerotic and obstructing peritoneal membrane. Two weeks following the surgery, he developed a pericardial tamponade with cardiovascular compromise, unresolved by two separate episodes of pericardiocentesis, leading to surgical intervention. A pericardial pleural window was created via open thoracotomy and 800ml of thick clotted blood was removed from the pericardial cavity. Histology demonstrated pericardial sclerosis.
Conclusions
This case of EPS is unique given the concomitant pericardial sclerosis. Uraemia may be a common mediator of inflammation in the peritoneum and pericardium, predisposing to sclerosis of both membranes of identical embryological origin. Pericardial sclerosis may be present in EPS patients but may not manifest itself clinically by and large. It also demonstrates that effective surgical intervention can lead to excellent patient outcomes.
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Affiliation(s)
- H V M Spiers
- Department of Transplantation, Addenbrooke's Hospital, Cambridge, United Kingdom
- University of Cambridge, Cambridge, United Kingdom
| | - T Augustine
- Department of Transplantation, Manchester Royal Infirmary, Manchester, United Kingdom
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5
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Raji YR, Ajayi SO, Abiola BI, Augustine T, Adekanmbi O, Arije A. Impact of Impaired Kidney Function on Outcomes of Nigerians with COVID-9 Infection: Report of Two Cases from the University College Hospital, Ibadan. West Afr J Med 2021; 38:292-296. [PMID: 33767423] [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: 06/12/2023]
Abstract
COVID-19 infection predominantly affects the respiratory system; however, other systems and organs are also affected. The kidneys are among the organs commonly affected by SARS-CoV-2 and this has been reported to be a predictor of increased severity, need for intensive care (ICU), admission, and death. We presented two cases of COVID-19 that were associated with co-morbidities that include diabetes mellitus, systemic hypertension and impaired kidney function. The relationship of the multiple co-morbidities particularly the impaired kidney function with the outcomes of COVID-19 infection and the challenges of offering dialysis for patients with COVID-19 infection with kidney failure were discussed. The two cases presented also highlighted the state of preparedness for the management of COVID-19 and its various complications and co-morbidities, particularly kidney failure in a tertiary hospital in Nigeria at onset of the COVID-19 outbreak.
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Affiliation(s)
- Y R Raji
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - S O Ajayi
- Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
| | - B I Abiola
- Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
| | - T Augustine
- Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
| | - O Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
| | - A Arije
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
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Kayastha S, Chitrathara K, Sigdel B, Sanam P, Anupama S, Remi A, Augustine T, Peter BC. Adult Granulosa Cell Tumor of Ovary: Clinical Study of 10 Cases. Indian J Gynecol Oncolog 2020. [DOI: 10.1007/s40944-019-0343-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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7
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Shapey IM, Ball S, Mastan A, Summers A, Griffiths A, Dellen DV, Augustine T, Moinuddin Z. The Transplant Surgeon: An Unlikely, Yet Suitably Qualified, Member of The Complex Neuro Endocrine Multi-Disciplinary Team. Surg Case Rep 2019. [DOI: 10.31487/j.scr.2019.04.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Curative surgery for retro-peritoneal tumours involving vascular structures is challenging and multi-visceral resection is often required to obtain clear resection margins. Abdominal transplant surgeons have considerable experience in all aspects of visceral, vascular and retro-peritoneal surgery. Application of these skills to resect tumours involving vascular structures, and re-implant organs to preserve function is unique. We present the case of a 15- year old girl with a complex retro-peritoneal tumour which was resected en-bloc with the kidneys and vena-cava followed by auto-transplantation of the left kidney. Seven years later, the patient represented with a recurrent tumour which was successfully excised in its entirety. We discuss how innovative surgical strategies can be performed safely on an individualized basis. We highlight the importance of balancing the benefits of the ‘technically possible procedure’ with its risks, along with consideration of the outcomes of treatment and non-treatment alike.
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8
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Shapey IM, Summers A, Augustine T, van Dellen D. Systematic review to assess the possibility of return of cerebral and cardiac activity after normothermic regional perfusion for donors after circulatory death. Br J Surg 2019; 106:174-180. [PMID: 30667536 PMCID: PMC6749564 DOI: 10.1002/bjs.11046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/13/2018] [Accepted: 10/10/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Normothermic regional perfusion (NRP) is a novel technique that aids organ recovery from donors after circulatory death (DCDs). However, ethical concerns exist regarding the potential return of spontaneous cerebral and cardiac activity (ROSCCA). This study aimed to determine the likelihood of ROSCCA in NRP-DCDs of abdominal organs. METHODS Extracorporeal cardiopulmonary resuscitation (ECPR) for refractory out-of-hospital cardiac arrest (OOHCA) was identified as a comparator for NRP-DCDs and as a validation cohort. A systematic search identified all articles relating to NRP-DCDs and ECPR-OOHCA. Rates of ROSCCA and survival outcomes (ECPR-OOHCA only) were recorded and analysed according to the duration of no perfusion. RESULTS In NRP-DCDs, 12 of 410 articles identified by database searching were eligible for inclusion. There were no instances of ROSCCA recorded among 493 donors. In ECPR-OOHCA, eight of 947 screened articles were eligible for inclusion (254 patients). Where the absence of perfusion exceeded 5 min in ECPR-OOHCA, there were no survivors with a favourable neurological outcome. CONCLUSION ROSCCA is unlikely following commencement of NRP and has not occurred to date. Strict observance of the 5-min interval following asystole provides satisfactory assurance that ROSCCA will not occur following NRP.
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Affiliation(s)
- I M Shapey
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Department of Renal and Pancreatic Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - A Summers
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Department of Renal and Pancreatic Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - T Augustine
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Department of Renal and Pancreatic Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - D van Dellen
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Department of Renal and Pancreatic Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
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9
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Ma W, Thiryayi SA, Holbrook M, Shelton D, Narine N, Sweeney LC, Augustine T, Bailey S, Al-Najjar H, Rana DN. Rapid on-site evaluation facilitated the diagnosis of a rare case of Talaromyces marneffei
infection. Cytopathology 2018; 29:497-499. [DOI: 10.1111/cyt.12563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2018] [Indexed: 11/28/2022]
Affiliation(s)
- W. Ma
- ST1 Histopathology Training School and Manchester Cytology Centre; Manchester University NHS Foundation Trust; Manchester UK
| | - S. A. Thiryayi
- Manchester Cytology Centre; Manchester University NHS Foundation Trust; Manchester UK
| | - M. Holbrook
- Manchester Cytology Centre; Manchester University NHS Foundation Trust; Manchester UK
| | - D. Shelton
- Manchester Cytology Centre; Manchester University NHS Foundation Trust; Manchester UK
| | - N. Narine
- Manchester Cytology Centre; Manchester University NHS Foundation Trust; Manchester UK
| | - L. C. Sweeney
- Department of Microbiology; Manchester University NHS Foundation Trust; Manchester UK
| | - T. Augustine
- Department of Renal Transplant; Manchester University NHS Foundation Trust and University of Manchester; Manchester UK
| | - S. Bailey
- Department of Respiratory Medicine; Manchester University NHS Foundation Trust; Manchester UK
| | - H. Al-Najjar
- Department of Respiratory Medicine; Manchester University NHS Foundation Trust; Manchester UK
| | - D. N. Rana
- Manchester Cytology Centre; Manchester University NHS Foundation Trust; Manchester UK
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10
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Ekpo E, Yiannoullou P, Moinuddin Z, Summers A, Augustine T, Van Dellen D. Mortality Prediction in Recipients with Diabetes Mellitus and End Stage Renal Failure Undergoing Simultaneous Pancreas Transplant: A Focus on Cardiovascular Risk Factors. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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11
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Kirby LC, Banerjee A, Augustine T, Douglas JF. An ethical dilemma: malignant melanoma in a 51-year-old patient awaiting simultaneous kidney and pancreas transplantation for type 1 diabetes. Br J Dermatol 2017; 175:172-4. [PMID: 27484276 DOI: 10.1111/bjd.14554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2016] [Indexed: 11/26/2022]
Abstract
Malignant melanoma is a high-risk skin cancer that, in potential transplant recipients, is considered a substantial contraindication to solid organ transplantation due to significant risk of recurrence with immunosuppression. Current guidelines stipulate waiting between 3 and 10 years after melanoma diagnosis. However, in young patients with end-stage organ failure and malignant melanoma, complex ethical and moral issues arise. Assessment of the true risk associated with transplantation in these patients is difficult due to lack of prospective data, but an autonomous patient can make a decision that clinicians may perceive to be high risk. The national and worldwide shortage of available organs also has to be incorporated into the decision to maximize the net benefit and minimize the risk of graft failure and mortality. The incidence of malignant melanoma worldwide is increasing faster than that of any other cancer and continues to pose ethically challenging decisions for transplant specialists evaluating recipients for solid organ transplantation.
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Affiliation(s)
- L C Kirby
- Southport and Ormskirk District General Hospital, Ormskirk, U.K
| | - A Banerjee
- Wirral University Teaching Hospital, Wirral, U.K
| | - T Augustine
- Manchester Royal Infirmary, Manchester, U.K.,University of Manchester, Manchester, U.K
| | - J F Douglas
- Belfast City and Royal Victoria Hospitals, Belfast, U.K.,Queen's University Belfast, Belfast, U.K
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Jose A, Yiannoullou P, Bhutani S, Denley H, Morton M, Picton M, Summers A, van Dellen D, Augustine T. Renal Allograft Failure After Ipilimumab Therapy for Metastatic Melanoma: A Case Report and Review of the Literature. Transplant Proc 2017; 48:3137-3141. [PMID: 27932166 DOI: 10.1016/j.transproceed.2016.07.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 07/26/2016] [Indexed: 02/07/2023]
Abstract
Transplant recipients are at an increased risk of malignant melanoma, a result of chronic immunosuppression. Ipilimumab is a newer biological agent targeting T lymphocytes to potentiate an immune response against melanoma, and the use of this agent results in a new adverse effect profile that the clinician must be aware of while a patient is on therapy. We report the case of a male renal transplant recipient who developed graft failure while treated with ipilimumab and minimal immunosuppressive therapy for metastatic ocular melanoma, with biopsy evidence of glomerulonephritis and acute rejection. We highlight the immunological side effects that can manifest from ipilimumab therapy and conclude that it did influence graft function in this patient. Our case illustrates the importance of weighing the risks and benefits to graft function and long-term survival as well as the importance of considering other treatment modalities in this specific group of melanoma patients.
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Affiliation(s)
- A Jose
- Department of Transplant Surgery, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom.
| | - P Yiannoullou
- Department of Transplant Surgery, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - S Bhutani
- Department of Nephrology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - H Denley
- Department of Histopathology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - M Morton
- Department of Nephrology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - M Picton
- Department of Nephrology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - A Summers
- Department of Transplant Surgery, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - D van Dellen
- Department of Transplant Surgery, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom
| | - T Augustine
- Department of Transplant Surgery, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom
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13
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Shapey IM, Summers AM, Augustine T, Rutter MK, van Dellen D. Circulating Cell-Free Unmethylated DNA as a Marker of Graft Dysfunction in Pancreas Transplantation. Am J Transplant 2016; 16:3064-3065. [PMID: 27376346 DOI: 10.1111/ajt.13949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- I M Shapey
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester, UK.,Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - A M Summers
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester, UK
| | - T Augustine
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester, UK
| | - M K Rutter
- Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester, UK
| | - D van Dellen
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester, UK
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Khambalia HA, Moinuddin Z, Summers AM, Tavakoli A, Pararajasingam R, Campbell T, Dhanda R, Forgacs B, Augustine T, van Dellen D. A prospective cohort study of risk prediction in simultaneous pancreas and kidney transplantation. Ann R Coll Surg Engl 2015; 97:445-50. [PMID: 26274754 PMCID: PMC5126239 DOI: 10.1308/rcsann.2015.0001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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] [Accepted: 04/19/2015] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Current risk prediction scoring systems in pancreas transplantation are limited to organ factors and are specific to predicting graft outcome. They do not consider recipient factors or inform regarding recipient morbidity. The aim of this study was to assess the utility of commonly used general surgical risk prediction models (P-POSSUM [Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity], MODS [multiple organ dysfunction score], Charlson co-morbidity index, revised cardiac risk index, ASA [American Society of Anesthesiologists] grade and Waterlow score), and to correlate them with total length of hospital stay (LOS) and critical care unit (CCU) LOS, important surrogate markers of patient outcome. METHODS All risk prediction scores were calculated prospectively for all simultaneous pancreas and kidney (SPK) transplant recipients from November 2011 to October 2013, and correlated with outcome measures. RESULTS Overall, 57 SPK transplant recipients were analysed. The mean age was 42.0 years (standard deviation [SD]: 7.60 years), 27 (52%) were male and the mean body mass index was 25.43kg/m(2) (SD: 3.11kg/m(2)). The mean pancreas and kidney cold ischaemic times were 703 minutes (SD: 182 minutes) and 850 minutes (SD: 192 minutes) respectively. The median total LOS and mean CCU LOS was 17 days (range: 8-79 days) and 7 days (SD: 4.04 days) respectively. When correlated with risk prediction scores, Waterlow score was the only significant predictor of total LOS and CCU LOS (p<0.001 [Spearman's correlation] and p=0.001 [Pearson's correlation] respectively). CONCLUSIONS Preoperative risk prediction plays an important part in planning perioperative care. To date, no validated risk prediction scoring system exists for SPK transplantation. This prospective study indicates that Waterlow score identifies high risk individuals and has value in the prediction of outcome following SPK transplantation.
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Affiliation(s)
- H A Khambalia
- Central Manchester University Hospitals NHS Foundation Trust , UK
| | - Z Moinuddin
- Central Manchester University Hospitals NHS Foundation Trust , UK
| | - A M Summers
- Central Manchester University Hospitals NHS Foundation Trust , UK
| | - A Tavakoli
- Central Manchester University Hospitals NHS Foundation Trust , UK
| | - R Pararajasingam
- Central Manchester University Hospitals NHS Foundation Trust , UK
| | - T Campbell
- Central Manchester University Hospitals NHS Foundation Trust , UK
| | - R Dhanda
- Central Manchester University Hospitals NHS Foundation Trust , UK
| | - B Forgacs
- Central Manchester University Hospitals NHS Foundation Trust , UK
| | - T Augustine
- Central Manchester University Hospitals NHS Foundation Trust , UK
| | - D van Dellen
- Central Manchester University Hospitals NHS Foundation Trust , UK
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15
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Yiannoullou P, van Dellen D, Khambalia H, Forgacs B, Tavakoli A, Murray D, Augustine T. Successful Management of a Ruptured Mycotic Pseudoaneurysm Following Pancreas Transplantation Using Bovine Pericardial Patch: A Case Report. Transplant Proc 2014; 46:2023-5. [DOI: 10.1016/j.transproceed.2014.06.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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16
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Oliveira-Cunha M, Bowman V, di Benedetto G, Mitu-Pretorian MO, Armstrong S, Forgacs B, Tavakoli A, Augustine T, Pararajasingam R. Outcomes of methicillin-resistant Staphylococcus aureus infection after kidney and/or pancreas transplantation. Transplant Proc 2014; 45:2207-10. [PMID: 23953529 DOI: 10.1016/j.transproceed.2013.01.097] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 01/14/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND The true extent of Methicillin-Resistant Staphylococcus aureus (MRSA) colonization and incidence of infection after solid organ transplantation in adults and children is not well-known. The aim of this study was to evaluate the incidence and the outcomes of MRSA infection following kidney and/or pancreas transplantation. MATERIAL AND METHODS We reviewed the case notes of all patients who developed MRSA colonization and infection within the first year of transplantation between September 2002 and December 2009. The primary endpoint of this study was mortality. The secondary endpoints included morbidity, graft failure, and length of hospital stay. RESULTS During the study period 1116 transplantations were performed. MRSA colonization was detected in 14 patients (1.25%) and infection occurred in 6 cases (0.53%) post-transplantation. Graft failure was not associated with MRSA colonization/infection in any of the cases. The mortality rate attributed to MRSA was 10% (n = 2). The overall median length of stay was 16 days (range, 6-243 days). CONCLUSIONS Our study demonstrates that the prevalence of MRSA colonization and infection in our unit is low in spite of immunosuppression. The incidence of MRSA infection was higher among patients who underwent pancreas transplantation. Patients who had MRSA colonization and then developed infection had higher morbidity and mortality rates.
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Affiliation(s)
- M Oliveira-Cunha
- Renal and Pancreas Transplant Unit, Central Manchester University Hospitals Foundation Trust, Manchester, United Kingdom.
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17
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Di Benedetto G, van Dellen D, Ghazanfar A, Tavakoli A, Delargy M, Griffin C, Forgacs B, Campbell T, Parrott NR, Pararajasingam R, Wood G, Woywodt A, Picton M, Augustine T. Does Rapamycin Still Have a Role? Experience and Lessons from the Last Decade. Transplantation 2012. [DOI: 10.1097/00007890-201211271-01475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Abstract
Would you recognize this condition?
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Affiliation(s)
- D van Dellen
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.
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Liong SY, Dixon RE, Chalmers N, Tavakoli A, Augustine T, O'Shea S. Complications following pancreatic transplantations: imaging features. ACTA ACUST UNITED AC 2011; 36:206-14. [PMID: 20563577 DOI: 10.1007/s00261-010-9632-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Whole organ vascularized pancreatic transplant is a recognized treatment for diabetes and is increasingly being performed worldwide. The procedure itself is complex and is associated with significant mortality and morbidity. Despite improvements in surgical techniques, postoperative complications of pancreatic transplantation are still common and include graft rejection, pancreatitis, peripancreatic fluid collections, exocrine leaks, vascular thrombosis, and hemorrhage. In this pictorial essay, we review clinical presentation and imaging features of these complications. We also briefly discuss technique and complications of islet cell transplants.
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Affiliation(s)
- S Y Liong
- Department of Clinical Radiology, Manchester Royal Infirmary, Oxford Road, Manchester, UK.
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Kirkman MA, Forgacs B, Heap S, Howell SJ, Davis JRE, McWilliam L, Prescott M, Augustine T. Third resection of pheochromocytoma aided by preoperative ¹²³I-MIBG scintigraphy and intraoperative gamma probe measurements. Nuklearmedizin 2011; 50:N8-N11. [PMID: 21336418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 10/14/2010] [Indexed: 05/30/2023]
Affiliation(s)
- M A Kirkman
- Department of Transplant and Endocrine Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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Augustine T, Vithiya SM, Ignacimuthu S, Ramkumar V. 3'-Benzoyl-1'-methyl-4'-phenyl-spiro[acenaphthyl-ene-1(2H),2'-pyrrolidin]-2-one. Acta Crystallogr Sect E Struct Rep Online 2010; 66:o3002. [PMID: 21589163 PMCID: PMC3009230 DOI: 10.1107/s160053681004376x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 10/26/2010] [Indexed: 11/10/2022]
Abstract
In the title compound, C29H23NO2, the pyrrolidine ring adopts a twisted conformation about one of the C—N bonds. The acenaphthone ring (r.m.s. deviation = 0.025 Å) lies almost perpendicular to the pyrrolidine ring [dihedral angle = 88.08 (8)°]. The dihedral angle between the phenyl rings is 88.12 (11)°. In the crystal structure, weak C—H⋯π interactions connect the molecules.
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Kirkman MA, Heap S, Forgacs B, Williams R, Tavakoli A, Pararajasingam R, Shrestha B, Wilkie ME, Augustine T. Encapsulating peritoneal sclerosis presenting as acute limb ischemia. ARCH ESP UROL 2010; 30:578-80. [PMID: 20829556 DOI: 10.3747/pdi.2010.00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Mitu-Pretorian O, Forgacs B, Qumruddin A, Tavakoli A, Augustine T, Pararajasingam R. Outcomes of Patients Who Develop Symptomatic Clostridium difficile Infection After Solid Organ Transplantation. Transplant Proc 2010; 42:2631-3. [DOI: 10.1016/j.transproceed.2010.04.057] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Accepted: 04/11/2010] [Indexed: 10/19/2022]
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Kirkman M, Heap S, Mitu–Pretorian O, McGrath S, Pararajasingam R, Tavakoli A, Augustine T. Posttransplant Encapsulating Peritoneal Sclerosis Localized to the Terminal Ileum. Perit Dial Int 2010; 30:480-2. [DOI: 10.3747/pdi.2009.00232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- M.A. Kirkman
- Renal and Pancreas Transplant Unit, United Kingdom
| | - S. Heap
- Renal and Pancreas Transplant Unit, United Kingdom
| | | | - S. McGrath
- Department of Histopathology Manchester Royal Infirmary Central Manchester University Hospitals NHS Foundation Trust Manchester, United Kingdom
| | | | - A. Tavakoli
- Renal and Pancreas Transplant Unit, United Kingdom
| | - T. Augustine
- Renal and Pancreas Transplant Unit, United Kingdom
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Ghazanfar A, Tavakoli A, Zaki MR, Pararajasingam R, Campbell T, Parrott NR, Augustine T, Riad HN. The Outcomes of Living Donor Renal Transplants With Multiple Renal Arteries: A Large Cohort Study With a Mean Follow-Up Period of 10 Years. Transplant Proc 2010; 42:1654-8. [PMID: 20620494 DOI: 10.1016/j.transproceed.2009.12.067] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Accepted: 12/08/2009] [Indexed: 02/05/2023]
Affiliation(s)
- A Ghazanfar
- Department of Transplant Surgery, Central Manchester University Hospitals NHS Foundation Trust Manchester Royal Infirmary, Manchester, England.
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Pretorian OMM, Tavakoli A, Pararajasingam R, Augustine T. Staged bilateral renal auto-transplantation preserves renal function in a complicated case of reflux nephropathy. Clin Kidney J 2009. [DOI: 10.1093/ndtplus/sfp172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Augustine T, Kanakam CC, Vithiya SM, Ramkumar V. A facile entry into a novel class of dispiroheterocyclic framework through 1,3-dipolarcycloaddition of azomethine ylides with 3-arylidene-4-chromanones as dipolarophiles. Tetrahedron Lett 2009. [DOI: 10.1016/j.tetlet.2009.08.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ablorsu E, Mehra S, Tavakoli A, Augustine T, Pararajasingam R. Staged Enteric Conversion After Duodenal Necrosis in Simultaneous Kidney and Pancreas Transplant From a Donor After Cardiac Death: A Case Report. Transplant Proc 2009; 41:1778-80. [DOI: 10.1016/j.transproceed.2009.02.081] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Accepted: 02/09/2009] [Indexed: 10/20/2022]
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Augustine T, Brown PW, Davies SD, Summers AM, Wilkie ME. Encapsulating peritoneal sclerosis: clinical significance and implications. Nephron Clin Pract 2009; 111:c149-54; discussion c154. [PMID: 19147997 DOI: 10.1159/000191214] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication of peritoneal dialysis (PD). This review discusses the current understanding of the aetiology and pathogenesis of EPS, highlighting histological features which differentiate it from simple sclerosis of the peritoneal membrane which develops with time on PD. Diagnostic criteria are presented, including the role of imaging techniques. To date there are no randomised controlled trials to guide therapy; however, surgical techniques are an important treatment option. Collaborative research will be essential if this serious problem facing PD is to be solved.
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Affiliation(s)
- T Augustine
- Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester, UK
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Augustine T, Vithiya SM, Ramkumar V, Kanakam CC. 3-Benzyl-idene-6-methoxy-chroman-4-one. Acta Crystallogr Sect E Struct Rep Online 2008; 64:o2080. [PMID: 21580945 PMCID: PMC2959532 DOI: 10.1107/s1600536808031541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2008] [Accepted: 09/30/2008] [Indexed: 11/23/2022]
Abstract
In the title compound, C17H14O3, the dihedral angle between the phenyl ring and the benzene ring of the chromanone moiety is 67.78 (3)°. The six-membered heterocyclic ring of the chromanone moiety adopts a half-chair conformation. The structure is stabilized by weak intermolecular C—H⋯O interactions that link the molecules into inversion dimers.
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Tavakoli A, Surange RS, Pearson RC, Parrott NR, Augustine T, Riad HN. Impact of stents on urological complications and health care expenditure in renal transplant recipients: results of a prospective, randomized clinical trial. J Urol 2007; 177:2260-4; discussion 2264. [PMID: 17509336 DOI: 10.1016/j.juro.2007.01.152] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2006] [Indexed: 02/08/2023]
Abstract
PURPOSE We performed a randomized, prospective trial to compare the incidence of early urological complications and health care expenditures in renal transplant recipients with or without ureteral stenting. MATERIALS AND METHODS Patients receiving a renal transplant at a single center were randomized preoperatively to undergo Double-J stent or no-stent ureterovesical anastomosis from November 1998 to October 2001. Early urological mechanical complications were recorded, including urinary leakage or obstruction, or urinary tract infections within 3 months of transplantation. Direct health care costs associated with stenting, urological complications and urinary tract infection management were also collected. RESULTS A total of 201 patients were randomized to a stent (112) and a no-stent (89) group. In the no-stent group 11 patients received a stent due to intraoperative findings and were excluded from study. At 3 months there were significantly more cases of urinary leakage (8.9% vs 0.9%, p <0.008) and ureteral obstruction (7.7 % vs 0%, p <0.004) in the no-stent than in the stent group. Mean time of stent removal was 74.3 days. A significant increase in urinary tract infections was observed when stent was left greater than 30 days after transplantation compared to the rate in the no-stent group (p <0.02). An additional cost of 151 UK pounds per patient was incurred in the no-stent group vs the stent group. CONCLUSIONS Using a ureteral stent at renal transplantation significantly decreases the early urinary complications of urine leakage and obstruction. However, there is a significant increase in urinary tract infections, primarily beyond 30 days after transplantation. Stent removal within 4 weeks of insertion appears advisable.
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Affiliation(s)
- A Tavakoli
- Renal and Pancreas Transplant Unit, Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom.
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Abstract
The major adverse effect of azathioprine is its myelotoxicity, with leukocytes being affected more commonly than the other bone marrow elements. Although megaloblastic change is frequent, reportedly seen in 16% to 82% of bone marrow aspirates, long-term use of azathioprine rarely causes severe anemia. We report a case of refractory pure red cell aplasia resulting from long-term use of azathioprine in a renal transplant recipient and examine the possible underlying mechanisms. There was no response to dose reduction or to erythropoietin administration. However, there was immediate recovery after complete drug withdrawal. A review of the literature revealed that only ten cases of azathioprine-induced red cell aplasia have so far been described, all in transplant recipients.
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Affiliation(s)
- A Agrawal
- Transplant Unit, Manchester Royal Infirmary, Manchester M13 9WL, UK
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Surange RS, Johnson RWG, Tavakoli A, Parrott NR, Riad HN, Campbell BA, Augustine T. Kidney transplantation into an ileal conduit: a single center experience of 59 cases. J Urol 2003; 170:1727-30. [PMID: 14532763 DOI: 10.1097/01.ju.0000092023.39043.67] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE Congenital and acquired conditions of the lower urinary tract can lead to renal failure requiring transplantation. Under these circumstances transplantation into a urinary diversion or an augmented bladder may be the only option. We report our experience with renal transplantation into ileal conduits in the last 22 years. MATERIALS AND METHODS Between January 1980 and August 2002, 59 renal transplants were drained into an ileal conduit in 54 patients at our center, accounting for 2.3% of the total number of transplants during this period. Median patient age was 28 years (range 1 to 63) and 13 patients were children. There were 12 living related and 47 cadaveric kidneys transplanted. Spina bifida, the most common cause of end stage renal disease, was seen in 22 patients (41%). Patient and graft survival following transplantation into an ileal conduit were compared with that in the 2,579 other transplants done at this center between January 1980 and December 2001. RESULTS Actuarial graft survival was 90% at 1 year, 63% at 5 years, 52% at 10 years and 52% at 15 years. Actuarial patient survival was 95% at 1 year, 83% at 5 years, 69% at 10 years and 69% at 15 years. Graft and patient survival was statistically similar to the outcome of the 2,579 other transplants done at our center between January 1980 and December 2001. At a mean followup of 4.6 years (range 0.1 to 20) mean serum creatinine in the 39 functioning grafts was 156 mmol/l. Of the surgical complications 21% were directly attributable to the ileal conduit and it could be considered a risk factor contributing to the complication in a further 39%. Symptomatic urinary tract infection was noted in 65% of the patients, although it did not lead to graft loss. At followup 7 patients had died with a functioning graft. Grafts were lost due to chronic allograft nephropathy in 3 cases, renal artery stenosis in 2, renal vein thrombosis in 2, and acute severe rejection, staghorn calculus and ureteroileal stricture in 1 each. CONCLUSIONS Kidney transplant drainage into an ileal conduit for urinary diversion is an effective treatment for patients with end stage renal disease due to abnormal lower urinary tracts. Despite preexisting co-morbidity and the increased complication rate long-term graft and patient survival is comparable to that in the normal transplant population.
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Affiliation(s)
- R S Surange
- Renal Transplant Unit, Manchester Royal Infirmary, Manchester, UK
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Abstract
Even though the number of patients awaiting renal transplant is rapidly increasing, the donor pool remains relatively stable. In an attempt to increase this pool, marginal kidneys and kidneys with congenital anatomical variations are being used. Horseshoe kidneys, being the most common renal fusion anomaly, can provide a useful solution to the ever-increasing gap between demand and supply. These kidneys have been successfully transplanted en bloc into a single recipient or, alternatively they have been divided and transplanted into 2 recipients. We report a case of the successful transplantation of an en bloc horseshoe kidney into a single recipient. To the best of our knowledge this is the first of its kind in the U.K. The relevant literature is also reviewed with the aim of raising awareness about the necessity and promising outcomes of such transplants.
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Affiliation(s)
- C S Zipitis
- Renal Transplant Unit, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
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Asderakis A, Dyer P, Augustine T, Worthington J, Campbell B, Johnson RW. Effect of cold ischemic time and HLA matching in kidneys coming from "young" and "old" donors: do not leave for tomorrow what you can do tonight. Transplantation 2001; 72:674-8. [PMID: 11544430 DOI: 10.1097/00007890-200108270-00020] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Kidneys from older donors are likely to have a lower nephron mass. Nevertheless they constitute a valuable source of kidney allografts. Long cold ischemic time (CIT), with or without delayed graft function (DGF), has been associated with reduced graft survival. The aim of this study was to review the experience of a single UK center to assess the interaction of cold storage time, donor age, organ exchange, and HLA-DR mismatching on short- and long-term survival. METHODS We analyzed 788 first cadaver kidney transplants that were performed in our center from 1990 to 1997 and had complete data available. A donor age of 55 years was the cutoff age for "old" and "young" donor kidneys. The primary outcome measured was graft failure from any cause. RESULTS There were 132 grafts from donors 55 years or older (16.7%), with 76.8% of the kidneys implanted after >20 hr of CIT. Kidney grafts from donors older than 55 years had worse graft survival than grafts from donors younger than 55 (87% vs. 78% at 1 year and 80% vs. 58% at 5 years after transplant, P=0.0001). A CIT of >20 hr significantly reduced graft survival (91% vs.74.3% at 5 years after transplant, P=0.0002) in the young donor group and was associated with an overall graft survival in the old donor group of 57.5% at 5 years. In the same group, ignoring the HLA-DR mismatching to achieve shorter CIT, the predicted initial cost on graft survival at 1 year would have been 3.7% but would have increased to 9% 5 years after transplant. For young donors a CIT of >20 hr had a cost of approximately 18% at 5-year graft survival, far higher than a single DR mismatch. Occurrence of DGF decreased survival in both short (P=0.001) and long (P=0.00001) CIT groups. CONCLUSION Forming local alliances (common recipient lists) and minimizing delays within the hospital might reduce CIT and DGF while achieving excellent HLA matching. This should improve significantly the outcome of both old and young donor kidney grafts.
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Affiliation(s)
- A Asderakis
- Renal Transplant Unit, Manchester Royal Infirmary, UK.
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Asderakis A, Augustine T, Dyer P, Short C, Campbell B, Parrott NR, Johnson RW. Pre-emptive kidney transplantation: the attractive alternative. Nephrol Dial Transplant 1998; 13:1799-803. [PMID: 9681731 DOI: 10.1093/ndt/13.7.1799] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Dialysis can be life-saving for patients with end-stage renal failure. However, not only is it associated with significant morbidity and a greater mortality than transplantation, but it is also expensive. Therefore renal transplantation is generally regarded as the treatment of choice for patients in whom this form of renal replacement therapy is appropriate. Transplantation usually takes place after a variable period of dialytic therapy, but pre-emptive kidney transplantation (PKT) has established itself as an attractive alternative. MATERIALS AND METHODS 1463 consecutive first kidney transplants performed between January 1980 and December 1995 in a single centre were analysed. The 161 patients (11%) transplanted without prior dialysis were compared with the 1302 patients who had been dialysed prior to being transplanted. The pre-emptive group did not differ from the dialysis group in respect of donor age, donor and recipient gender, HLA mismatch, or cold ischaemic time, although there were more live donor transplants within the pre-emptive group. RESULTS Delayed graft function occurred more frequently in the dialysis group (25% vs 16%) but more patients experienced an acute rejection episode in the pre-emptive group (67 vs 55%). The actuarial graft survival in the pre-emptive group at 1, 5, and 10 years (84, 76 and 67%) was significantly higher than the respective values in the dialysis group (83, 69, and 56%). Within the live donor recipient cohort the survival advantage for the pre-emptive group was even more striking. CONCLUSION Pre-emptive kidney transplantation not only avoids the risks, cost, and inconvenience of dialysis, but is also associated with better graft survival than transplantation after a period of dialysis, particularly within the live donor cohort.
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Affiliation(s)
- A Asderakis
- Renal Transplant Unit, Manchester Royal Infirmary, UK
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Augustine T, Bhat BV, Bhatia BD. Aerococcus viridans endocarditis. Case report. Indian Pediatr 1994; 31:599-601. [PMID: 7875897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- T Augustine
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry
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Augustine T, Bhatia BD. Early neonatal morbidity and mortality pattern in hospitalised children. Indian J Matern Child Health 1994; 5:17-9. [PMID: 12318797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Affiliation(s)
- K Badrinath
- Department of Surgery, St John's Medical College, Bangalore, India
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Long EG, Lawrence MC, Augustine T. ELISA for Schistosoma mansoni infection: durability of blood spots on filter paper. Trans R Soc Trop Med Hyg 1981; 75:740-1. [PMID: 7330929 DOI: 10.1016/0035-9203(81)90167-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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