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Erratum: Advantages and limitations of clinical scores for donation after circulatory death liver transplantation. Front Surg 2024; 11:1411863. [PMID: 38680215 PMCID: PMC11047770 DOI: 10.3389/fsurg.2024.1411863] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/03/2024] [Indexed: 05/01/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fsurg.2021.808733.].
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Zhang G, Wang B, Liu H, Jia G, Tao B, Zhang H, Wang C. How many cases are required to achieving early proficiency in purely off-clamp robot-assisted partial nephrectomy? Front Surg 2024; 10:1309522. [PMID: 38234451 PMCID: PMC10792019 DOI: 10.3389/fsurg.2023.1309522] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 11/16/2023] [Indexed: 01/19/2024] Open
Abstract
Background and purpose Off-clamp robot-assisted partial nephrectomy (Offc-RAPN) is a technically challenging procedure that can effectively avoid renal ischemia owing to the absence of hilar vessel preparation and clamping. However, data on the learning curve (LC) for this technique are limited. The purpose of this study was to assess the LC of Offc-RAPN and compare the perioperative outcomes between different learning phases. Methods This retrospective study included 50 consecutive patients who underwent purely Offc-RAPN between January 2022 and April 2023. Multidimensional cumulative sum (CUSUM) analysis method was used to assess LC. Spearman's correlation and LOWESS analysis were performed to analyze the continuous variables of perioperative outcomes. Baseline characteristics and perioperative outcomes were compared using χ2-test, t-test and U-test. Results CUSUM analysis identified two LC phases: phase I (the first 24 cases) and phase II (the subsequent 26 cases). Phase II showed significant reductions in mean operative time (133.5 vs. 115.31 min; p = 0.04), mean console time (103.21 vs. 81.27 min; p = 0.01), and mean postoperative length of stay (5.33 vs. 4.30 days; p = 0.04) compared to phase I. However, no significant differences were observed in other perioperative outcomes or baseline characteristics between the two LC phases. Conclusions Offc-RAPN performed by a surgeon with experience in laparoscopic and robotic surgeries achieved early proficiency in 24 cases. Moreover, Offc-RAPN alone is safe and feasible even in the initial phase of the LC for an experienced surgeon.
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Affiliation(s)
| | | | | | | | | | | | - Chunyang Wang
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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Hawlina S, Cerovic K, Kondza A, Popovic P, Bizjak J, Smrkolj T. Does tumor rupture during robot-assisted partial nephrectomy have an impact on mid-term tumor recurrences? Radiol Oncol 2023; 57:348-355. [PMID: 37470753 PMCID: PMC10476903 DOI: 10.2478/raon-2023-0031] [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: 04/19/2023] [Accepted: 05/23/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Intraoperative kidney tumor rupture (TR) can occur during robot-assisted partial nephrectomy (RAPN) in daily clinical practice, but there are no solid guidelines on the management and implications of it. The purpose of the study was to investigate the impact of TR on tumor recurrences, what a surgeon should do if this adverse event occurs, and how to avoid it. PATIENTS AND METHODS We retrospectively analyzed the first 100 patients who underwent RAPN at University Medical Centre Ljubljana, between 2018 and 2021. Patients were stratified into 2 groups (TR and no-TR) and were compared according to patient, tumor, pathologic, perioperative and postoperative characteristics and tumor recurrences, using the Mann-Whitney U test and chi-squared test. RESULTS Of the 100 patients, 14 had TR (14%); this occurred in tumors with higher RENAL nephrometry scores (P = 0.028) and mostly with papillary renal cell carcinomas (P = 0.043). Median warm ischemia time was longer for the TR group (22 vs. 15 min, P = 0.026). In terms of studied outcomes, there were no cases of local or distant recurrence after a median observation time of 39 months (interquartile range, 31-47 months) in both groups. We observed positive surgical margins on the final oncologic report in one case in the no-TR group. CONCLUSIONS Tumor rupture during RAPN seems to be of no mid-term oncologic importance. According to presented results, we would recommend surgeons to proceed with tumor resection if this event occurs and abstain from conversion to radical nephrectomy or open partial nephrectomy. However, more similar cases should be studied to make more solid conclusions.
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Affiliation(s)
- Simon Hawlina
- Clinical Department of Urology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Surgery, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Kosta Cerovic
- Clinical Department of Urology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Andraz Kondza
- Clinical Department of Urology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Peter Popovic
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jure Bizjak
- Clinical Department of Urology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tomaz Smrkolj
- Clinical Department of Urology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Surgery, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Yan F, Dou X, Zhu G, Tang Q, Zhang B, Zhao B, Yu L, Wang H, Wang Y. Laparoscopic aspirator bracket: a new instrument facilitating the aspiration and exposure of operative field simultaneously in laparoscopic nephron-sparing surgery. Front Oncol 2023; 13:1216963. [PMID: 37655100 PMCID: PMC10466786 DOI: 10.3389/fonc.2023.1216963] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/31/2023] [Indexed: 09/02/2023] Open
Abstract
Background This study aims to describe a novel laparoscopic aspirator bracket (LAB) and its use in laparoscopic nephron-sparing surgery (NSS) by a simple enucleation (SE) technique. Methods A total of 123 renal tumor cases who underwent laparoscopic NSS via LAB or laparoscopic aspirator between July 2017 and April 2021 were retrospectively analyzed. General characteristics, perioperative data and postoperative follow-up data of patients were compared. Results The application of LAB in laparoscopic renal tumor SE surgery shortened the operation time (88.58 ± 38.25 vs. 102.25 ± 35.84 min, p < 0.05) and improved the zero ischemia rate (18.75% vs. 3.39%, p < 0.05), shortened warm ischemia time (16.17 ± 5.16 vs. 19.39 ± 5.62 min, p < 0.05) and decreased intraoperative blood loss (166.19 ± 111.60 vs. 209.15 ± 127.10 ml, p < 0.05). In addition, the serum creatinine and eGFR values in the LAB group also showed faster and better renal function recovery. Conclusion The new LAB could aspirate and expose the operative field with a single instrument. In operations that need to expose and aspirate simultaneously, such as in renal tumor simple enucleation, it could shorten operation time, reduce intraoperative blood loss and improve the postoperative renal function recovery.
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Affiliation(s)
- Fengqi Yan
- Department of Urology, Tang Du Hospital, Air Force Military Medical University, Xi’an, Shaan’xi, China
| | - Xiaoliang Dou
- Department of Urology, Tang Du Hospital, Air Force Military Medical University, Xi’an, Shaan’xi, China
| | - Guangfeng Zhu
- Department of Urology, Tang Du Hospital, Air Force Military Medical University, Xi’an, Shaan’xi, China
| | - Qisheng Tang
- Department of Urology, Tang Du Hospital, Air Force Military Medical University, Xi’an, Shaan’xi, China
| | - Bo Zhang
- Department of Urology, Tang Du Hospital, Air Force Military Medical University, Xi’an, Shaan’xi, China
| | - Bo Zhao
- Department of Urology, Bao Ji People’s Hospital, Baoji, Shaan’xi, China
| | - Lei Yu
- Department of Urology, Xi Jing Hospital, Air Force Military Medical University, Xi’an, Shaan’xi, China
| | - He Wang
- Department of Urology, Tang Du Hospital, Air Force Military Medical University, Xi’an, Shaan’xi, China
| | - Yong Wang
- Department of Urology, Tang Du Hospital, Air Force Military Medical University, Xi’an, Shaan’xi, China
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Jackson S, Combes A, Latif E, Tran M, Lam S, Gore N, Utsiwegota M, Mawson J, Smith L, Palma C, Laurence J, Crawford M, Pulitano C, Wyburn K, Chadban S, Leslie S, Vasilaras A. Laparoscopic donor nephrectomy-Technique and peri-operative outcomes in an Australian transplant center. Clin Transplant 2023; 37:e14945. [PMID: 36807636 DOI: 10.1111/ctr.14945] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 02/21/2023]
Abstract
INTRODUCTION Demand for donor kidneys far exceeds the availability of organs from deceased donors. Living donor kidneys are an important part of addressing this shortfall, and laparoscopic nephrectomy is an important strategy to reduce donor morbidity and increase the acceptability of living donation. AIM To retrospectively review the intraoperative and postoperative safety, technique, and outcomes of patients undergoing donor nephrectomy at a single tertiary hospital in Sydney, Australia. METHOD Retrospective capture and analysis of clinical, demographic, and operative data for all living donor nephrectomies performed between 2007 and 2022 at a single University Hospital in Sydney, Australia. RESULTS Four hundred and seventy-two donor nephrectomies were performed: 471 were laparoscopic, two of which were converted from laparoscopic to open and hand-assisted nephrectomy, respectively, and one (.2%) underwent primary open nephrectomy. The mean warm ischemia time was 2.8 min (±1.3 SD, median 3 min, range 2-8 min) and the mean length of stay (LOS) was 4.1 days (±1.0 SD). The mean renal function on discharge was 103 μmol/L (±23.0 SD). Seventy-seven (16%) patients had a complication with no Clavien Dindo IV or V complications seen. Outcomes demonstrated no impact of donor age, gender, kidney side, relationship to the recipient, vascular complexity; or surgeon experience, on complication rate or LOS. CONCLUSION Laparoscopic donor nephrectomy is a safe and effective procedure with minimal morbidity and no mortality in this series.
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Affiliation(s)
- Stuart Jackson
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Alexander Combes
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Edward Latif
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Minh Tran
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Susanna Lam
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Neel Gore
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Mike Utsiwegota
- Department of Renal Medicine and Transplantation, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Jane Mawson
- Department of Renal Medicine and Transplantation, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Laura Smith
- Department of Renal Medicine and Transplantation, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Catalina Palma
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Jerome Laurence
- Department of Surgical Transplantation, Royal Prince Alfred Hospital, Camperdown, Australia.,RPA Institute of Academic Surgery, Camperdown, Australia.,The University of Sydney, Camperdown, Australia.,Chris O'Brien Lifehouse, Sydney, Australia
| | - Michael Crawford
- Department of Surgical Transplantation, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Carlo Pulitano
- Department of Surgical Transplantation, Royal Prince Alfred Hospital, Camperdown, Australia.,RPA Institute of Academic Surgery, Camperdown, Australia.,The University of Sydney, Camperdown, Australia.,Chris O'Brien Lifehouse, Sydney, Australia
| | - Kate Wyburn
- Department of Renal Medicine and Transplantation, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Steve Chadban
- Department of Renal Medicine and Transplantation, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Scott Leslie
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia.,RPA Institute of Academic Surgery, Camperdown, Australia.,The University of Sydney, Camperdown, Australia.,Chris O'Brien Lifehouse, Sydney, Australia
| | - Arthur Vasilaras
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia.,Chris O'Brien Lifehouse, Sydney, Australia
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Li Q, Zhang Y, Liu M, Li H, Guan W, Meng X, Hu Z, Wang Z, Wang S, Li Z, Liu J, Liu Z. Identification of predictive factors for outcomes after robot-assisted partial nephrectomy based on three-dimensional reconstruction of preoperative enhanced computerized tomography. Front Oncol 2023; 13:927582. [PMID: 36925922 PMCID: PMC10011456 DOI: 10.3389/fonc.2023.927582] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 02/07/2023] [Indexed: 03/08/2023] Open
Abstract
Background Information from the RENAL score is limited. This study aimed to identify new parameters based on three-dimensional (3D) reconstruction of preoperative enhanced computerized tomography (CT) for predicting outcomes after robot-assisted partial nephrectomy (RPN). Materials and methods The records of kidney cancer patients who underwent RPN at Tongji Hospital from March 2015 to July 2019 were reviewed. Demographic data, laboratory examinations, postoperative hospitalization time, and enhanced CT were retrospectively collected. Some tumor parameters were obtained from 3D reconstruction of CT data. The association between these predictive factors and outcomes after RPN was analyzed. Results A larger tumor bed area (TBA) was associated with a longer warm ischemia time (WIT) (P-value <0.001) and tumor resection time (P-value <0.001). Moreover, TBA was significantly associated with the elevation of postoperative creatinine (P-value = 0.005). TBA (P = 0.008), distance from the tumor to the first bifurcation of the renal artery (DTA) (P <0.034), and RENAL score (P = 0.005) were significantly associated with WIT in univariate logistic regression. In multivariate logistic regression, TBA (P = 0.026) and DTA (P = 0.048) were independent risk factors for prolonged WIT (over 25 min). The predictive effect of the combination of TBA, DTA, and RENAL score was higher than the predictive effect of RENAL score alone for WIT (area under curve: 0.786 versus 0.72). Conclusion TBA and DTA are independently associated with the WIT of RPN, which provides additional assessment value for the complexity of kidney cancer in RPN over the RENAL score.
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Affiliation(s)
- Qinyu Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yucong Zhang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Man Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heng Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Guan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyan Meng
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiquan Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhihua Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zheng Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Skoworonska M, Blank A, Centeno I, Hammer C, Perren A, Zlobec I, Rau TT. Real-life data from standardized preanalytical coding (SPREC) in tissue biobanking and its dual use for sample characterization and process optimization. J Pathol Clin Res 2022; 9:137-148. [PMID: 36484086 PMCID: PMC9896154 DOI: 10.1002/cjp2.305] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/07/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022]
Abstract
The standardized preanalytical code (SPREC) aggregates warm ischemia (WIT), cold ischemia (CIT), and fixation times (FIT) in a precise format. Despite its growing importance underpinned by the European in vitro diagnostics regulation or broad preanalytical programs by the National Institutes of Health, little is known about its empirical occurrence in biobanked surgical specimen. In several steps, the Tissue Bank Bern achieved a fully informative SPREC code with insights from 10,555 CIT, 4,740 WIT, and 3,121 FIT values. During process optimization according to LEAN six sigma principles, we identified a dual role of the SPREC code as a sample characteristic and a traceable process parameter. With this preanalytical study, we outlined real-life data in a variety of organs with specific differences in WIT, CIT, and FIT values. Furthermore, our FIT data indicate the potential to adapt the SPREC fixation toward concrete paraffin-embedding time points and to extend its categories beyond 72 h due to weekend delays. Additionally, we identified dependencies of preanalytical variables from workload, daytime, and clinics that were actionable with LEAN process management. Thus, streamlined biobanking workflows during the day were significantly resilient to workload peaks, diminishing the turnaround times of native tissue processing (i.e. CIT) from 74.6 to 46.1 min under heavily stressed conditions. In conclusion, there are surgery-specific preanalytics that are surgico-pathologically limited even under process optimization, which might affect biomarker transfer from one entity to another. Beyond sample characteristics, SPREC coding is highly beneficial for tissue banks and Institutes of Pathology to track WIT, CIT, and FIT for process optimization and monitoring measurements.
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Affiliation(s)
| | - Annika Blank
- Institute of PathologyUniversity of BernBern,Institute of PathologyTriemli HospitalZurichSwitzerland
| | | | | | | | - Inti Zlobec
- Institute of PathologyUniversity of BernBern
| | - Tilman T Rau
- Institute of PathologyUniversity of BernBern,Institute of PathologyUniversity Hospital and Heinrich‐Heine‐University DüsseldorfDüsseldorfGermany
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El-Sayed Ahmed MM, Landolfo KP, Jacob S, Sareyyupoglu B, Thomas M, Pham SM, Makey IA. Safe heart flush technique during recovery from donors after circulatory death. J Card Surg 2022; 37:5646-5648. [PMID: 36229938 PMCID: PMC10092136 DOI: 10.1111/jocs.17023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/24/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Donation after circulatory death is the donation after cardiac arrest. This technique has been employed and adopted by clinicians to overcome the shortage of available hearts for transplant. Warm ischemia time plays a pivotal role in the survival outcome of the heart recipients. AIM OF THE STUDY To assess the efficacy of using the Foley catheter to flush the heart during procurement from donation after circulatory death donors. METHODS We utilized a 2-WAY Foley catheter to flush the heart during procurement. The catheter was prepared and modified on the back table. RESULTS We were successfully able to flush the heart within 3 minutes from skin incision with a good recipient outcome. CONCLUSIONS Using the Foley catheter to flush the heart during recovery from donation after circulatory death donors was both efficient and fast.
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Affiliation(s)
- Magdy M El-Sayed Ahmed
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA.,Department of Surgery, Zagazig University Faculty of Medicine, Zagazig, Egypt
| | - Kevin P Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Ian A Makey
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
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Hawlina S, Orožen B, Arnol M, Kšela J. Use of absorbable hemostat bolster for prevention of donor renal artery kinking in kidney transplant. Front Surg 2022; 9:1032946. [PMID: 36524201 PMCID: PMC9744755 DOI: 10.3389/fsurg.2022.1032946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/14/2022] [Indexed: 12/19/2023] Open
Abstract
Transplant renal artery stenosis due to mechanical kinking is a rare but significant complication in kidney transplantation that can lead to graft dysfunction due to graft hypoperfusion, delayed graft function, or even global kidney infarction. When detected during surgery, re-anastomosis is usually performed after re-clamping, which inevitably prolongs the warm ischemia time, and increases the possibility of primary graft non-function. In this report, we describe a novel, noninvasive surgical technique whereby the donor renal artery is padded with absorbable hemostatic material (i.e., Surgicel) bolster, placed below the middle third of the renal artery in recipients who were found to have mechanical kinking during the implantation procedure. The bolster technique was used in 12 kidney transplant recipients who were found to have kinking of the donor artery during the primary surgery. After pillowing the renal artery with absorbable hemostatic bolster, no residual kinking was observed intra-operatively, and good allograft perfusion was confirmed with no Doppler ultrasound evidence of renal artery stenosis confirmed at 1 week, 1 month, and 1 year after transplantation.
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Affiliation(s)
- Simon Hawlina
- Department of Urology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Surgery, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Blaž Orožen
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Miha Arnol
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Juš Kšela
- Department of Surgery, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Kim J, Yang Y, Hong SK, Zielonka J, Dash RK, Audi SH, Kumar SN, Joshi A, Zimmerman MA, Hong JC. Fluorescein clearance kinetics in blood and bile indicates hepatic ischemia-reperfusion injury in rats. Am J Physiol Gastrointest Liver Physiol 2022; 323:G126-G133. [PMID: 35700191 DOI: 10.1152/ajpgi.00038.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Quantitative measurement of the degree of hepatic ischemia-reperfusion injury (IRI) is crucial for developing therapeutic strategies for its treatment. We hypothesized that clearance of fluorescent dye through bile metabolism may reflect the degree of hepatic IRI. In this study, we investigated sodium fluorescein clearance kinetics in blood and bile for quantifying the degree of hepatic IRI. Warm ischemia times (WITs) of 0, 30, or 60 min followed by 1 h or 4 h of reperfusion, were applied to the median and lateral lobes of the liver in Sprague-Dawley rats. Subsequently, 2 mg/kg of sodium fluorescein was injected intravenously, and blood and bile samples were collected over 60 min to measure fluorescence intensities. The bile-to-plasma fluorescence ratios demonstrated an inverse correlation with WIT and were distinctly lower in the 60-min WIT group than in the control or 30-min WIT groups. Bile-to-plasma fluorescence ratios displayed superior discriminability for short versus long WITs when measured 1 h after reperfusion versus 4 h. We conclude that the bile-to-blood ratio of fluorescence after sodium fluorescein injection has the potential to enable the quantification of hepatic IRI severity.NEW & NOTEWORTHY Previous attempts to use fluorophore clearance to test liver function have relied on a single source of data. However, the kinetics of substrate processing via bile metabolism include decreasing levels in blood and increasing levels in bile. Thus, we analyzed data from blood and bile to better reflect fluorescein clearance kinetics.
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Affiliation(s)
- Joohyun Kim
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Yongqiang Yang
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Seung-Keun Hong
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jacek Zielonka
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ranjan K Dash
- Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin.,Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Said H Audi
- Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin.,Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Suresh N Kumar
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amit Joshi
- Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin.,Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Johnny C Hong
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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11
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Patrono D, Zanierato M, Vergano M, Magaton C, Diale E, Rizza G, Catalano S, Mirabella S, Cocchis D, Potenza R, Livigni S, Balagna R, Romagnoli R. Normothermic Regional Perfusion and Hypothermic Oxygenated Machine Perfusion for Livers Donated After Controlled Circulatory Death With Prolonged Warm Ischemia Time: A Matched Comparison With Livers From Brain-Dead Donors. Transpl Int 2022; 35:10390. [PMID: 35529593 PMCID: PMC9072630 DOI: 10.3389/ti.2022.10390] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/31/2022] [Indexed: 12/29/2022]
Abstract
Prolonged warm ischemia time (WIT) has a negative prognostic value in liver transplantation (LT) using grafts procured after circulatory death (DCD). To assess the value of abdominal normothermic regional perfusion (A-NRP) associated with dual hypothermic oxygenated machine perfusion (D-HOPE) in controlled DCD LT, prospectively collected data on LTs performed between January 2016 and July 2021 were analyzed. Outcome of controlled DCD LTs performed using A-NRP + D-HOPE (n = 20) were compared to those performed with grafts procured after brain death (DBD) (n = 40), selected using propensity-score matching. DCD utilization rate was 59.5%. In the DCD group, median functional WIT, A-NRP and D-HOPE time was 43, 246, and 205 min, respectively. Early outcomes of DCD grafts recipients were comparable to those of matched DBD LTs. In DCD and DBD group, incidence of anastomotic biliary complications and ischemic cholangiopathy was 15% versus 22% (p = 0.73) and 5% versus 2% (p = 1), respectively. One-year patient and graft survival was 100% versus 95% (p = 0.18) and 90% versus 95% (p = 0.82). In conclusion, the association of A-NRP + D-HOPE in DCD LT with prolonged WIT allows achieving comparable outcomes to DBD LT.
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Affiliation(s)
- Damiano Patrono
- General Surgery 2U-Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Marinella Zanierato
- Department of Anesthesia and Critical Care, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Marco Vergano
- Department of Anesthesia and Intensive Care, San Giovanni Bosco Hospital, Turin, Italy
| | - Chiara Magaton
- General Surgery 2U-Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Enrico Diale
- General Surgery 2U-Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Giorgia Rizza
- General Surgery 2U-Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Silvia Catalano
- General Surgery 2U-Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Stefano Mirabella
- General Surgery 2U-Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Donatella Cocchis
- General Surgery 2U-Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Raffaele Potenza
- Regional Procurement Organization, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Sergio Livigni
- Department of Anesthesia and Intensive Care, San Giovanni Bosco Hospital, Turin, Italy
| | - Roberto Balagna
- Anesthesia Department 2, A.O.U. Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Renato Romagnoli
- General Surgery 2U-Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
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12
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Takahara K, Ohno Y, Fukaya K, Matsukiyo R, Nukaya T, Takenaka M, Zennami K, Ichino M, Fukami N, Sasaki H, Kusaka M, Toyama H, Sumitomo M, Shiroki R. Novel Intraoperative Navigation Using Ultra-High-Resolution CT in Robot-Assisted Partial Nephrectomy. Cancers (Basel) 2022; 14:cancers14082047. [PMID: 35454953 PMCID: PMC9032210 DOI: 10.3390/cancers14082047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Successful surgery in robot-assisted partial nephrectomy (RAPN), especially for highly complex tumors, relies on a detailed understanding of the anatomical relations of the tumor absolute and relative to the urinary tract and the vascular structures, including the renal pedicle. Intraoperative navigation with accurate information regarding tumor position relative to the surrounding urinary vascular structures undoubtedly assists the surgeon during RAPN. In this report, we performed RAPN with intraoperative navigation using a novel computed tomography scanner (UHR-CT) and compared its perioperative and short-term functional outcomes to those of area-detector CT (ADCT). We found that this novel navigation system using UHR-CT provided a shorter warm ischemia time and lower estimated blood loss than ADCT, and concluded this could be a useful tool for patients who undergo RAPN. This is the first report to evaluate the feasibility and usefulness of UHR-CT for intraoperative navigation during RAPN. Abstract To assess the perioperative and short-term functional outcomes of robot-assisted partial nephrectomy (RAPN) with intraoperative navigation using an ultra-high-resolution computed tomography (UHR-CT) scanner, we retrospectively analyzed 323 patients who underwent RAPN using an UHR-CT or area-detector CT (ADCT). Perioperative outcomes and the postoperative preservation ratio of estimated glomerular filtration rate (eGFR) were compared. After the propensity score matching, we evaluated 99 patients in each group. Although the median warm ischemia time (WIT) was less than 25 min in both groups, it was significantly shorter in the UHR-CT group than in the ADCT group (15 min vs. 17 min, p = 0.032). Moreover, the estimated blood loss (EBL) was significantly lower in the UHR-CT group than in the ADCT group (33 mL vs. 50 mL, p = 0.028). However, there were no significant intergroup differences in the postoperative preservation ratio of eGFR at 3 or 6 months of follow-up (ADCT 91.8% vs. UHR-CT 93.5%, p = 0.195; and ADCT 91.7% vs. UHR-CT 94.0%, p = 0.160, respectively). Although no differences in short-term renal function were observed in intraoperative navigation for RAPN in this propensity score–matched cohort, this study is the first to demonstrate that UHR-CT resulted in a shorter WIT and lower EBL than ADCT.
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Affiliation(s)
- Kiyoshi Takahara
- Department of Urology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan; (K.F.); (T.N.); (M.T.); (K.Z.); (M.I.); (H.S.); (M.S.); (R.S.)
- Correspondence: ; Tel.: +81-562-93-2884
| | - Yoshiharu Ohno
- Department of Radiology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan; (Y.O.); (R.M.); (H.T.)
| | - Kosuke Fukaya
- Department of Urology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan; (K.F.); (T.N.); (M.T.); (K.Z.); (M.I.); (H.S.); (M.S.); (R.S.)
| | - Ryo Matsukiyo
- Department of Radiology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan; (Y.O.); (R.M.); (H.T.)
| | - Takuhisa Nukaya
- Department of Urology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan; (K.F.); (T.N.); (M.T.); (K.Z.); (M.I.); (H.S.); (M.S.); (R.S.)
| | - Masashi Takenaka
- Department of Urology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan; (K.F.); (T.N.); (M.T.); (K.Z.); (M.I.); (H.S.); (M.S.); (R.S.)
| | - Kenji Zennami
- Department of Urology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan; (K.F.); (T.N.); (M.T.); (K.Z.); (M.I.); (H.S.); (M.S.); (R.S.)
| | - Manabu Ichino
- Department of Urology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan; (K.F.); (T.N.); (M.T.); (K.Z.); (M.I.); (H.S.); (M.S.); (R.S.)
| | - Naohiko Fukami
- Department of Urology, Okazaki Medical Center, Fujita Health University, Okazaki 444-0827, Japan; (N.F.); (M.K.)
| | - Hitomi Sasaki
- Department of Urology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan; (K.F.); (T.N.); (M.T.); (K.Z.); (M.I.); (H.S.); (M.S.); (R.S.)
| | - Mamoru Kusaka
- Department of Urology, Okazaki Medical Center, Fujita Health University, Okazaki 444-0827, Japan; (N.F.); (M.K.)
| | - Hiroshi Toyama
- Department of Radiology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan; (Y.O.); (R.M.); (H.T.)
| | - Makoto Sumitomo
- Department of Urology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan; (K.F.); (T.N.); (M.T.); (K.Z.); (M.I.); (H.S.); (M.S.); (R.S.)
| | - Ryoichi Shiroki
- Department of Urology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan; (K.F.); (T.N.); (M.T.); (K.Z.); (M.I.); (H.S.); (M.S.); (R.S.)
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13
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Bluhme E, Henckel E, Gramignoli R, Kjellin T, Hammarstedt C, Nowak G, Karadagi A, Johansson H, Jynge Ö, Söderström M, Fischler B, Strom S, Ellis E, Hallberg B, Jorns C. Procurement and Evaluation of Hepatocytes for Transplantation From Neonatal Donors After Circulatory Death. Cell Transplant 2022; 31:9636897211069900. [PMID: 35094608 PMCID: PMC8811420 DOI: 10.1177/09636897211069900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Hepatocyte transplantation is a promising treatment for liver failure and inborn metabolic liver diseases, but progress has been hampered by a scarcity of available organs. Here, hepatocytes isolated from livers procured for a neonatal hepatocyte donation program within a research setting were assessed for metabolic function and suitability for transplantation. Organ donation was considered for infants who died in neonatal intensive care in the Stockholm region during 2015–2021. Inclusion was assessed when a decision to discontinue life-sustaining treatment had been made and hepatectomy performed after declaration of death. Hepatocyte isolation was performed by three-step collagenase perfusion. Hepatocyte viability, yield, and function were assessed using fresh and cryopreserved cells. Engraftment and maturation of cryopreserved neonatal hepatocytes were assessed by transplantation into an immunodeficient mouse model and analysis of the gene expression of phase I, phase II, and liver-specific enzymes and proteins. Twelve livers were procured. Median warm ischemia time (WIT) was 190 [interquartile range (IQR): 80–210] minutes. Median viability was 86% (IQR: 71%–91%). Median yield was 6.9 (IQR: 3.4–12.8) x106 viable hepatocytes/g. Transplantation into immunodeficient mice resulted in good engraftment and maturation of hepatocyte-specific proteins and enzymes. A neonatal organ donation program including preterm born infants was found to be feasible. Hepatocytes isolated from neonatal donors had good viability, function, and engraftment despite prolonged WIT. Therefore, neonatal livers should be considered as a donor source for clinical hepatocyte transplantation, even in cases with extended WIT.
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Affiliation(s)
- Emil Bluhme
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Department of Transplantation, Karolinska University Hospital, Stockholm, Sweden
| | - Ewa Henckel
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Department of Neonatology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Roberto Gramignoli
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Therese Kjellin
- Department of Neonatology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Christina Hammarstedt
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Greg Nowak
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Department of Transplantation, Karolinska University Hospital, Stockholm, Sweden
| | - Ahmad Karadagi
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Department of Transplantation, Karolinska University Hospital, Stockholm, Sweden
| | - Helene Johansson
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Öystein Jynge
- Organisation for Organ Donation in Central Sweden, Stockholm, Sweden
| | - Maria Söderström
- Organisation for Organ Donation in Central Sweden, Stockholm, Sweden
| | - Björn Fischler
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatric Gastroenterology, Hepatology and Nutrition, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Stephen Strom
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Ewa Ellis
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Boubou Hallberg
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Carl Jorns
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Department of Transplantation, Karolinska University Hospital, Stockholm, Sweden
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14
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Meier RPH, Kelly Y, Yamaguchi S, Braun HJ, Lunow-Luke T, Adelmann D, Niemann C, Maluf DG, Dietch ZC, Stock PG, Kang SM, Feng S, Posselt AM, Gardner JM, Syed SM, Hirose R, Freise CE, Ascher NL, Roberts JP, Roll GR. Advantages and Limitations of Clinical Scores for Donation After Circulatory Death Liver Transplantation. Front Surg 2022; 8:808733. [PMID: 35071316 PMCID: PMC8766343 DOI: 10.3389/fsurg.2021.808733] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Scoring systems have been proposed to select donation after circulatory death (DCD) donors and recipients for liver transplantation (LT). We hypothesized that complex scoring systems derived in large datasets might not predict outcomes locally. Methods: Based on 1-year DCD-LT graft survival predictors in multivariate logistic regression models, we designed, validated, and compared a simple index using the University of California, San Francisco (UCSF) cohort (n = 136) and a universal-comprehensive (UC)-DCD score using the United Network for Organ Sharing (UNOS) cohort (n = 5,792) to previously published DCD scoring systems. Results: The total warm ischemia time (WIT)-index included donor WIT (dWIT) and hepatectomy time (dHep). The UC-DCD score included dWIT, dHep, recipient on mechanical ventilation, transjugular-intrahepatic-portosystemic-shunt, cause of liver disease, model for end-stage liver disease, body mass index, donor/recipient age, and cold ischemia time. In the UNOS cohort, the UC-score outperformed all previously published scores in predicting DCD-LT graft survival (AUC: 0.635 vs. ≤0.562). In the UCSF cohort, the total WIT index successfully stratified survival and biliary complications, whereas other scores did not. Conclusion: DCD risk scores generated in large cohorts provide general guidance for safe recipient/donor selection, but they must be tailored based on non-/partially-modifiable local circumstances to expand DCD utilization.
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Affiliation(s)
- Raphael P. H. Meier
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
- Department of Surgery, University of Maryland, Baltimore, MD, United States
| | - Yvonne Kelly
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Seiji Yamaguchi
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Hillary J. Braun
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Tyler Lunow-Luke
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Dieter Adelmann
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
- Department of Anesthesia, University of California, San Francisco, San Francisco, CA, United States
| | - Claus Niemann
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
- Department of Anesthesia, University of California, San Francisco, San Francisco, CA, United States
| | - Daniel G. Maluf
- Department of Surgery, University of Maryland, Baltimore, MD, United States
| | - Zachary C. Dietch
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Peter G. Stock
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Sang-Mo Kang
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Sandy Feng
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Andrew M. Posselt
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - James M. Gardner
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Shareef M. Syed
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Ryutaro Hirose
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Chris E. Freise
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Nancy L. Ascher
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - John P. Roberts
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Garrett R. Roll
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
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15
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Scheuermann U, Rademacher S, Wagner T, Lederer A, Hau HM, Seehofer D, Sucher R. Influence of Multiple Donor Renal Arteries on the Outcome and Graft Survival in Deceased Donor Kidney Transplantation. J Clin Med 2021; 10:jcm10194395. [PMID: 34640413 PMCID: PMC8509629 DOI: 10.3390/jcm10194395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/19/2021] [Accepted: 09/22/2021] [Indexed: 02/02/2023] Open
Abstract
AIM Complex arterial reconstruction in kidney transplantation (KT) using kidneys from deceased donors (DD) warrants additional study since little is known about the effects on the mid- and long-term outcome and graft survival. METHODS A total of 451 patients receiving deceased donor KT in our department between 1993 and 2017 were included in our study. Patients were divided into three groups according to the number of arteries and anastomosis: (A) 1 renal artery, 1 arterial anastomosis (N = 369); (B) >1 renal artery, 1 arterial anastomosis (N = 47); and (C) >1 renal artery, >1 arterial anastomosis (N = 35). Furthermore, the influence of localization of the arterial anastomosis (common iliac artery (CIA), versus non-CIA) was analyzed. Clinicopathological characteristics, outcome, and graft and patient survival of all groups were compared retrospectively. RESULTS With growing vascular complexity, the time of warm ischemia increased significantly (groups A, B, and C: 40 ± 19 min, 45 ± 19 min, and 50 ± 17 min, respectively; p = 0.006). Furthermore, the duration of operation was prolonged, although this did not reach significance (groups A, B, and C: 175 ± 98 min, 180 ± 35 min, and 210 ± 43 min, respectively; p = 0.352). There were no significant differences regarding surgical complications, post-transplant kidney function (delayed graft function, initial non-function, episodes of acute rejection), or long-term graft survival. Regarding the localization of the arterial anastomosis, non-CIA was an independent prognostic factor for deep vein thrombosis in multivariate analysis (CIA versus non-CIA: OR 11.551; 95% CI, 1.218-109.554; p = 0.033). CONCLUSION Multiple-donor renal arteries should not be considered a contraindication to deceased KT, as morbidity rates and long-term outcomes seem to be comparable with grafts with single arteries and less complex anastomoses.
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Affiliation(s)
- Uwe Scheuermann
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (T.W.); (A.L.); (D.S.); (R.S.)
- Correspondence:
| | - Sebastian Rademacher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (T.W.); (A.L.); (D.S.); (R.S.)
| | - Tristan Wagner
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (T.W.); (A.L.); (D.S.); (R.S.)
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany
| | - Andri Lederer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (T.W.); (A.L.); (D.S.); (R.S.)
| | - Hans-Michael Hau
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl-Gustav-Carus, TU Dresden, 01307 Dresden, Germany;
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (T.W.); (A.L.); (D.S.); (R.S.)
| | - Robert Sucher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (T.W.); (A.L.); (D.S.); (R.S.)
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16
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Malik AR, Ali S, Kumar V, Sharma M, Rawat V, Agarwal A. Outcome of simultaneous angioembolization and nephron sparing surgery in large renal angiomyolipomas. Urologia 2021; 89:500-505. [PMID: 34346257 DOI: 10.1177/03915603211036428] [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] [Indexed: 11/15/2022]
Abstract
AIM To study the outcome of simultaneous angioembolization and nephron sparing surgery in large renal angiomyolipomas. MATERIALS AND METHODS A prospective study of carried out from 2016 to 2019. A total of 15 patients were included in the study with a lesion (angiomyolipoma) more than 10 cm in size, suitable for nephron sparing surgery. The workup of the patients included history, baseline blood investigations, ultrasonography, and CT urography including angiographic films. All the patients were taken up for selective of angioembolization of the feeding vessels of the AML carried out by the interventional radiologist followed by nephron sparing surgery in the same sitting. The short term outcomes studied were warm ischemia time, average blood loss, and length of post-operative hospital stay. The oncological outcome was evaluated by noting the surgical margins of histopathological specimen and functional outcome by assessing the function of the preserved renal parenchyma. RESULTS Twelve out of fifteen cases were female. The mean age was 42.25 years. All the patients had lesion more than 10 cm with seven tumors located at the lower pole, four at mid-pole, and four at upper pole. Eight patients had low complexity score on RENAL score (i.e. 4-6), five patients medium complexity score (i.e. 7-9), and two had high complexity score (i.e. ⩾10). Average blood loss was 200 ml, warm ischemia time was 18.46 min and postoperative stay was 3.55 days. All the 15 specimens sent for histopathology were confirmed as AML (angiomyolipomas) with margins free of tumor. Follow up CECT done at 4 months postoperatively revealed functioning residual renal parenchyma with prompt excretion of contrast. CONCLUSION Large AML's are also amenable to nephron sparing surgery. However patient should always be warned about the possibility of total nephrectomy. Selective angioembolization helps in reducing the blood supply and risk of torrential bleeding thus facilitates in the removal of the tumor and increasing the chances of nephron sparing surgery.
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Affiliation(s)
| | | | | | | | - Vijay Rawat
- Indraprastha Apollo Hospital, New Delhi, India
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17
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Kato D, Nakane K, Enomoto T, Tomioka M, Nakai C, Takai M, Iinuma K, Muramatsu Maekawa Y, Mizutani K, Tsuchiya T, Yokoi S, Koie T. The utility of laparoscopic partial nephrectomy with renal function preservation, regardless of warm ischemia time, compared with laparoscopic radical nephrectomy. Asian J Endosc Surg 2021; 14:386-393. [PMID: 33034158 DOI: 10.1111/ases.12876] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study aimed to evaluate the chronologic changes in renal function after laparoscopic partial (LPN) or radical nephrectomy (LRN) in patients with clinical T1 renal cell carcinoma. METHODS In this retrospective study, patients with clinical stage T1 renal cell carcinoma who underwent LPN or LRN were divided into three groups, namely, LPN-A group including LPN patients with WIT ≤25 minutes, LPN-B group including LPN patients with WIT >25 minutes, and LRN group. Perioperative complications that occurred within 30 days after surgery were retrieved. All patients were followed-up every 3 months to evaluate the estimated glomerular filtration rate. The primary endpoint of this study was to assess the chronological changes in renal function after surgery. RESULTS A total of 153 patients were enrolled in this study. The change in estimated glomerular filtration rate between day 1 and 2 weeks after surgery was significantly lower in the LPN-B group than in the LPN-A group (p<0.005). Both LPN-A and -B groups achieved eGFR ≥90% 2 weeks after surgery. In addition, the estimated glomerular filtration rate decline from post-operative day 1 through 24 months in the LPN-A group or the LPN-B group was significantly smaller than that in the LRN group (P < 0.001, P < 0.001, respectively). CONCLUSION Our results demonstrate the efficacy and safety of LPN in patients with T1 renal cell carcinoma. Although complication rates were similar in both groups, post-operative renal function was not different between the LPN-A and -B groups.
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Affiliation(s)
- Daiki Kato
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Keita Nakane
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Torai Enomoto
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Masayuki Tomioka
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Chie Nakai
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Manabu Takai
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Koji Iinuma
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | | | - Kosuke Mizutani
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Tomohiro Tsuchiya
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Shigeaki Yokoi
- Department of Urology, Kizawa Memorial Hospital, Minokamo, Japan
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
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18
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Suganuma N, Kawachi K, Yamashita T, Yamanaka T, Sugawara Y, Matsubara Y, Yamazaki H, Kohagura K, Toda S, Okamoto S, Yoshida T, Rino Y, Masuda M, Narimatsu H, Fujita H, Yoshioka E, Yokose T, Furuta K, Miyagi Y. Quality Control of Breast Cancer Surgery Samples: Introducing Time Stamp Checking. Biopreserv Biobank 2021; 19:369-375. [PMID: 33926234 DOI: 10.1089/bio.2020.0133] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Analytical information obtained from clinical tissue samples has recently become more important due to recent advancements in the clinical practice of medicine, for example, gene panel testing. However, acquiring and managing the sample quality, which greatly influences the analyses, are not sufficient and hence requires immediate attention. We introduced time stamp (TS) recording and documentation using the Standard PREanalytical Code (SPREC) for breast cancer surgery samples to monitor and control their quality. Materials and Methods: The TS recording used SPREC for quality control of each sample by recording seven factors: type of sample, type of collection, warm ischemia time (WIT), cold ischemia time (CIT), fixation type, fixation time (FT), and long-term storage. The responsibilities to record each factor were assigned among group members (breast surgeons, anesthesiologists, pathologists, operating room nurses, and medical technologists in pathology). Results: Records based on SPREC were recorded for 393 surgical cases of first-time breast cancer patients performed at the Kanagawa Cancer Center from May 2018 to April 2019. The vascular clamp time was defined as when skin flap formation was completed, regardless of the surgical procedure. An anesthesiologist recorded the vascular clamp time and sample collection time, and the pathologist recorded the fixation start time and fixation end time. WIT was 23 (3-116) minutes (breast-conserving surgery, 11 [3-38] minutes; mastectomy, 26 [5-116] minutes; and nipple-sparing mastectomy, 39 [31-43] minutes), CIT was 37 (3-1052) minutes, and FT was 43 (17-115) hours. The median CIT and FT were significantly shortened after introducing the TS system, and the variabilities were reduced. Conclusion: A TS system for quality control of breast cancer surgical sample functions well due to the establishment of highly versatile WIT and a working group consisting of multiple members of different occupations who shared roles.
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Affiliation(s)
- Nobuyasu Suganuma
- Department of Surgery, Yokohama City University, Yokohama, Japan.,Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Kae Kawachi
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Japan
| | - Toshinari Yamashita
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Takashi Yamanaka
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Yuko Sugawara
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Yuka Matsubara
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Haruhiko Yamazaki
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Kaori Kohagura
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Soji Toda
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Saki Okamoto
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Tatsuya Yoshida
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Hiroto Narimatsu
- Cancer Prevention and Control Division, Kanagawa Cancer Center Research Institute, Yokohama, Japan
| | - Hisae Fujita
- Department of Anesthesiology, Kanagawa Cancer Center, Yokohama, Japan
| | - Emi Yoshioka
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Japan
| | - Tomonori Yokose
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Japan
| | - Koh Furuta
- Division of Clinical Laboratory, Kanagawa Cancer Center, Yokohama, Japan
| | - Yohei Miyagi
- Molecular Pathology and Genetics Division, Kanagawa Cancer Center Research Institute, Yokohama, Japan
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19
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Liu T, Zhao Z, Feng B, Wang X, Li T, Xie S, Zhu W, Li X, Guo H, Yang R. Robotic-assisted laparoscopic tumor enucleation is a feasible technique for renal hilar tumors: A retrospective study. J Surg Oncol 2021; 124:135-142. [PMID: 33836093 DOI: 10.1002/jso.26479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/26/2021] [Accepted: 03/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE: This study aimed to evaluate the safety and efficacy of robot-assisted laparoscopic tumor enucleation (RAE) for the treatment of renal hilar tumors and to describe our experience with renorrhaphy-related surgical techniques. METHODS Retrospective data were collected from 173 consecutive patients who underwent RAE for localized renal tumors (cT1-cT2N0M0) at our hospital between September 2014 and November 2019. RESULTS Seventy-five patients had renal hilar tumors and 98 patients had nonhilar tumors. There were no statistical differences between the hilar and nonhilar groups in operation time (190 [115-390] vs. 190 [110-390] min, p = 0.889), warm ischemia time (26 [12-60] vs. 27 [17-41] min, p = 0.257), hospital stay duration (8 [3-16] vs. 7.5 [4-18] days, p = 0.386), renal function (estimated glomerular filtration rate, 102.5 [29.4-144] vs. 101.3 [64.2-134.7] ml/min/1.73 m2 , p = 0.631); creatinine level, (76 [43-169] vs. 78.5 [50-281.3] µmol/L, p = 0.673), perioperative complications rate, or surgical margin status. However, patients with hilar tumors lost significantly more blood than did those with nonhilar tumors (250 [50-1500] vs. 200 [20-1200] ml, p = 0.007). During the follow-up period (median, 30 months), three patients in each group experienced recurrence. The 5-year recurrence-free rates were 93.0% and 95.4% in the hilar and nonhilar tumor groups, respectively (p = 0.640). CONCLUSIONS For experienced robot laparoscopists, RAE is a safe, effective, and feasible procedure for renal hilar tumors, without increased risk of positive surgical margins or worse midterm oncologic outcomes compared with nonhilar tumors.
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Affiliation(s)
- Tianyao Liu
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zihan Zhao
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Baofu Feng
- Department of Urology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China
| | - Xin Wang
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Tianhang Li
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Shangxun Xie
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wenjie Zhu
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaogong Li
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hongqian Guo
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Rong Yang
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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20
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Liu N, Luo Y, Zhu Y, Peng H, Zou C, Zhou Z, Chen W, Wang H, Liu H, Hu Y, Zhang S, Qian K. Effects of Warm Ischemia Time, Cryopreservation, and Grinding Methods on RNA Quality of Mouse Kidney Tissues. Biopreserv Biobank 2021; 19:306-311. [PMID: 33577406 DOI: 10.1089/bio.2020.0129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: High-quality RNA extraction from tissue samples is of key importance for scientific research and translational medicine. Tissue collection and preparation may affect RNA quality. In this study, we investigated effects of warm ischemia time, cryopreservation, and grinding methods on RNA quality. Methods: Total RNA was extracted from mouse kidney tissues with warm ischemia times of 0, 30, 60, 90, and 120 minutes. Half of the tissues were used to extract RNA immediately, while the others were cryopreserved in the vapor phase of liquid nitrogen for 6 months before RNA extraction. A mortar, homogenizer, and tissue lyser were used to grind tissues. RNA was extracted by TRIzol, and RNA integrity was assessed by the RNA integrity number (RIN) value. Results: For fresh tissues and frozen tissues with warm ischemia time within 60 minutes, RIN values were above 7.0 and remained above 6.0 with warm ischemia time within 120 minutes. For the same warm ischemia time, RIN values of frozen tissues were slightly lower than those of fresh tissues. No significant RIN value alterations were observed among grinding methods, but for RNA extraction efficiency, a mortar was much less efficient than the homogenizer or tissue lyser. For frozen tissues, RNA tended to degrade within 8 minutes at room temperature. Conclusions: Mouse kidney tissues with a warm ischemia time within 120 minutes are suitable for general RNA-related research. For tissues with a warm ischemia time within 60 minutes, cryopreservation may not affect RNA quality. The duration of frozen tissues held at room temperature before grinding affects the integrity of RNA, while grinding methods do not affect RNA integrity.
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Affiliation(s)
- Nan Liu
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yi Luo
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yuan Zhu
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China.,Human Genetic Resources Preservation Center of Hubei Province, Wuhan, China
| | - Hongwei Peng
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Cong Zou
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zongning Zhou
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wen Chen
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hui Wang
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Huiqin Liu
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ying Hu
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shanshan Zhang
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Kaiyu Qian
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China.,Human Genetic Resources Preservation Center of Hubei Province, Wuhan, China
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21
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Artykov M, Haberal HB, Kahraman O, Gudeloglu A, Yazici S, Bilen CY. Comparison of clamping strategies in minimally invasive partial nephrectomy for cT1 tumors. MINIM INVASIV THER 2020; 31:609-614. [PMID: 33155497 DOI: 10.1080/13645706.2020.1840397] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To determine whether artery only (AO) clamping promises any advantage over artery and vein (AV) clamping in patients undergoing partial nephrectomy with minimally invasive surgical techniques. MATERIAL AND METHODS We retrospectively analyzed the data of 68 partial nephrectomy patients who were treated with minimally invasive techniques (robot-assisted laparoscopic or pure laparoscopic) for solitary, unilateral, cT1 renal masses during the period of 2008-2019 in a single institution. Patients were divided into two groups according to clamping strategy (AO and AV). The two groups were compared to each other in terms of perioperative outcomes and long-term functional results. RESULTS The mean patient age and median follow-up period were 56.8 ± 10.8 years and 13.5 (9-44.5) months, respectively. Warm ischemia time, estimated blood loss, transfusion rate and length of hospital stay were similar between the two groups, while operative time was significantly higher in the AO clamping group (p = .726, p = .604, p = .675, p = .103, and p = .038, respectively). Patients who underwent AV clamping had a significantly lower estimated glomerular filtration rate (eGFR) and higher chronic kidney disease rates six months postoperatively (p = .001 and p = .044, respectively) and at the last follow-up (p = .020 and p = .048, respectively). The percentage of eGFR change at six months and the last follow-up was higher in the AV clamp group but the difference was not statistically significant (p = .056 and p = .082, respectively). CONCLUSIONS Our findings suggest AO clamping is safe and comparable to AV clamping. In our study, AO clamping was found to be superior to AV in terms of long-term eGFR preservation.
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Affiliation(s)
- Meylis Artykov
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | | | - Oguzhan Kahraman
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ahmet Gudeloglu
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Sertac Yazici
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Cenk Yucel Bilen
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
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22
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Ebel NH, Hsu EK, Dick AAS, Shaffer ML, Carlin K, Horslen SP. Decreased Incidence of Hepatic Artery Thrombosis in Pediatric Liver Transplantation Using Technical Variant Grafts: Report of the Society of Pediatric Liver Transplantation Experience. J Pediatr 2020; 226:195-201.e1. [PMID: 32585237 PMCID: PMC9380891 DOI: 10.1016/j.jpeds.2020.06.053] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/26/2020] [Accepted: 06/17/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate risk factors for hepatic artery thrombosis (HAT) and examine the long-term outcomes of graft and patient survival after HAT in pediatric recipients of liver transplantation. STUDY DESIGN Using multicenter data from the Society of Pediatric Liver Transplantation, Kaplan-Meier and Cox regression analyses were performed on first-time pediatric (aged <18 years) liver transplant recipients (n = 3801) in the US and Canada between 1995 and 2016. RESULTS Of children undergoing their first liver transplantation, 7.4% developed HAT within the first 90 days of transplantation and, of those who were retransplanted, 20.7% developed recurrent HAT. Prolonged warm ischemia times increased the odds of developing HAT (OR, 1.11; P = .02). Adolescents aged 11-17 years (OR, 0.53; P = .03) and recipients with split, reduced, or living donor grafts had decreased odds of HAT (OR, 0.59; P < .001 compared with whole grafts). Fifty percent of children who developed HAT developed graft failure within the first 90 days of transplantation (adjusted hazard ratio, 11.87; 95% CI, 9.02-15.62) and had a significantly higher post-transplant mortality within the first 90 days after transplantation (adjusted hazard ratio, 6.18; 95% CI, 4.01-9.53). CONCLUSIONS These data from an international registry demonstrate poorer long-term graft and patient survival in pediatric recipients whose post-transplant course is complicated by HAT. Notably, recipients of technical variant grafts had lower odds of HAT compared with whole liver grafts.
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Affiliation(s)
- Noelle H. Ebel
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Evelyn K. Hsu
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington,Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - André A. S. Dick
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | | | - Kristen Carlin
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Simon P. Horslen
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington,Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
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23
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Würnschimmel C, Di Pierro GB, Moschini M, Grande P, Baumeister P, Roth M, Mordasini L, Mattei A. Robot-Assisted Laparoscopic Partial Nephrectomy Vs Conventional Laparoscopic Partial Nephrectomy: Functional and Surgical Outcomes of a Prospective Single Surgeon Randomized Study. J Endourol 2020; 34:847-855. [PMID: 32486864 DOI: 10.1089/end.2020.0143] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) are commonly used techniques for treating small renal masses. Regarding renal function (RF) preservation, no superiority of one technique over the other has yet been definitely demonstrated. Objective: To compare functional and surgical outcomes of LPN and RAPN. Patients and Methods: Between 2015 and 2019, we prospectively randomized 115 patients with cT1-T2 renal masses to LPN in total ischemia or RAPN in selective ischemia. Primary endpoint was RF preservation, assessed by renal scintigraphy (RS). RS assessments were performed preoperatively and at 6 months follow-up. Secondary endpoints included clinical, histopathologic, and surgical outcomes. Results: One hundred eight patients were included in the final analysis. Patient and tumor characteristics were comparable. No significant difference in RS values after 6 months was observed between both groups. Median (interquartile range) RF change after 6 months was -18.0% (-26.5 to -11.0) in LPN group and -20.0 (-33.2 to -12.0) in RAPN group (p = 0.3). Mean (standard deviation [SD]) warm ischemia time was 21.1 (6.1) minutes in LPN group and 19.6 (7.7) minutes in RAPN group (p = 0.2). No positive surgical margins (PSMs) occurred in the LPN group, whereas RAPN group had PSM in 4.9% (n = 3); p = 0.099. Renal volume loss after 6 months was 27.5% (22.7-45.7) in the LPN group vs 37.5 (13.7-54.2) in the RAPN group (p = 0.5). Mean operative times were lower in the LPN group (192.3 minutes [SD 44.5] vs 230.2 minutes [SD 59.6], p = 0.001). More complications occurred in the LPN group (31% vs 21%, p = 0.075). Transfusion rates were 15% for LPN and 11% for RAPN. Conclusions: In terms of preserving RF, LPN in total ischemia and RAPN in selective ischemia are comparable. In most patients, RF decrease of the affected kidney after PN seems to not exceed 25%, regardless of the surgical approach.
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Affiliation(s)
| | | | - Marco Moschini
- Klinik für Urologie, Luzerner Kantonsspital, Luzern, Switzerland
| | - Pietro Grande
- Klinik für Urologie, Luzerner Kantonsspital, Luzern, Switzerland
| | | | - Manuel Roth
- Klinik für Radiologie, Luzerner Kantonsspital, Luzern, Switzerland
| | - Livio Mordasini
- Klinik für Urologie, Luzerner Kantonsspital, Luzern, Switzerland
| | - Agostino Mattei
- Klinik für Urologie, Luzerner Kantonsspital, Luzern, Switzerland
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24
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Niederberger P, Farine E, Raillard M, Dornbierer M, Freed DH, Large SR, Chew HC, MacDonald PS, Messer SJ, White CW, Carrel TP, Tevaearai Stahel HT, Longnus SL. Heart Transplantation With Donation After Circulatory Death. Circ Heart Fail 2020; 12:e005517. [PMID: 30998395 DOI: 10.1161/circheartfailure.118.005517] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Heart transplantation remains the preferred option for improving quality of life and survival for patients suffering from end-stage heart failure. Unfortunately, insufficient supply of cardiac grafts has become an obstacle. Increasing organ availability with donation after circulatory death (DCD) may be a promising option to overcome the organ shortage. Unlike conventional donation after brain death, DCD organs undergo a period of warm, global ischemia between circulatory arrest and graft procurement, which raises concerns for graft quality. Nonetheless, the potential of DCD heart transplantation is being reconsidered, after reports of more than 70 cases in Australia and the United Kingdom over the past 3 years. Ensuring optimal patient outcomes and generalized adoption of DCD in heart transplantation, however, requires further development of clinical protocols, which in turn require a better understanding of cardiac ischemia-reperfusion injury and the various possibilities to limit its adverse effects. Thus, we aim to provide an overview of the knowledge obtained with preclinical studies in animal models of DCD heart transplantation, to facilitate and promote the most effective and efficient advancement in preclinical research. A literature search of the PubMed database was performed to identify all relevant preclinical studies in DCD heart transplantation. Specific aspects relevant for DCD heart transplantation were analyzed, including animal models, graft procurement and storage conditions, cardioprotective approaches, and graft evaluation strategies. Several potential therapeutic strategies for optimizing graft quality are identified, and recommendations for further preclinical research are provided.
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Affiliation(s)
- Petra Niederberger
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital and Department for BioMedical Research, University of Bern, Switzerland (P.N., E.F., M.D., T.P.C., H.T.T.S., S.L.L.)
| | - Emilie Farine
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital and Department for BioMedical Research, University of Bern, Switzerland (P.N., E.F., M.D., T.P.C., H.T.T.S., S.L.L.)
| | - Mathieu Raillard
- Experimental Surgery Unit (ESI), Experimental Surgery Unit, Department for BioMedical Research and Vetsuisse Faculty, Department of Clinical Veterinary Medicine, Institute of Anaesthesiology and Pain Therapy, University of Bern, Switzerland (M.R.)
| | - Monika Dornbierer
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital and Department for BioMedical Research, University of Bern, Switzerland (P.N., E.F., M.D., T.P.C., H.T.T.S., S.L.L.)
| | - Darren H Freed
- Cardiac Surgery, University of Alberta, Edmonton, Canada (D.H.F., C.W.W.)
| | - Stephen R Large
- Department of Transplantation, Royal Papworth Hospital, Papworth Everard, Cambridge, United Kingdom (S.R.L., S.J.M.)
| | - Hong C Chew
- St Vincent's Hospital, University of New South Wales, Victor Chang Cardiac Research Institute, Sydney, Australia (H.C.C., P.S.M.)
| | - Peter S MacDonald
- St Vincent's Hospital, University of New South Wales, Victor Chang Cardiac Research Institute, Sydney, Australia (H.C.C., P.S.M.)
| | - Simon J Messer
- Department of Transplantation, Royal Papworth Hospital, Papworth Everard, Cambridge, United Kingdom (S.R.L., S.J.M.)
| | | | - Thierry P Carrel
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital and Department for BioMedical Research, University of Bern, Switzerland (P.N., E.F., M.D., T.P.C., H.T.T.S., S.L.L.)
| | - Hendrik T Tevaearai Stahel
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital and Department for BioMedical Research, University of Bern, Switzerland (P.N., E.F., M.D., T.P.C., H.T.T.S., S.L.L.)
| | - Sarah L Longnus
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital and Department for BioMedical Research, University of Bern, Switzerland (P.N., E.F., M.D., T.P.C., H.T.T.S., S.L.L.)
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25
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Fan G, Meng Y, Zhu S, Ye M, Li M, Li F, Ye Y, Liu Z, Weiqin H, Xie Y. Three-dimensional printing for laparoscopic partial nephrectomy in patients with renal tumors. J Int Med Res 2019; 47:4324-4332. [PMID: 31327282 PMCID: PMC6753553 DOI: 10.1177/0300060519862058] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Objectives To explore the efficacy of three-dimensional printing physical model-assisted
laparoscopic partial nephrectomy (3D-LPN) in patients with renal tumors. Methods We retrospectively assessed all patients who underwent LPN with or without
3D-printed physical model assistance from January 2016 to February 2018 at
our institution. The demographic characteristics, operative findings, and
clinical outcomes from the procedure were collected and analyzed. Results Sixty-nine patients underwent 3D-LPN and 58 underwent traditional LPN. The
groups showed no differences in demographics, RENAL score, surgical
approach, operative time, estimated intra-/postoperative blood loss,
increased creatinine level, or complications. In the 3D-LPN group, warm
ischemia time was shorter, whereas surgery waiting time was longer, compared
with those parameters in the LPN group. Subgroup analysis indicated that for
patients with RENAL score ≥8, the 3D-LPN group had significantly shorter
warm ischemic time and less intraoperative blood loss than the traditional
LPN group. Intra- and postoperative hospital complication rates were similar
for 3D-LPN and traditional LPN groups (8.7% vs. 13.7%). Conclusions 3D printing provides an additional tool to assist with LPN. Use of a 3D model
can assist in planning and performance of LPN in patients with RENAL score
≥8.
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Affiliation(s)
- Gang Fan
- Department of Urology, Affiliated Cancer Hospital of Xiangya
School of Medicine of Central South University, Hunan Cancer Hospital, Changsha,
China
| | - Yanbin Meng
- Department of Human Anatomy, Xiangnan University, Chenzhou,
China
| | - Shuai Zhu
- Department of Urology, Affiliated Cancer Hospital of Xiangya
School of Medicine of Central South University, Hunan Cancer Hospital, Changsha,
China
| | - Mingji Ye
- Department of Urology, Affiliated Cancer Hospital of Xiangya
School of Medicine of Central South University, Hunan Cancer Hospital, Changsha,
China
| | - Mingfeng Li
- Department of Urology, Affiliated Cancer Hospital of Xiangya
School of Medicine of Central South University, Hunan Cancer Hospital, Changsha,
China
- The First People's Hospital of Huaihua, Huaihua, China
| | - Feiping Li
- Radiology, Affiliated Cancer Hospital of Xiangya School of
Medicine of Central South University, Hunan Cancer Hospital, Changsha,
China
| | - Yuanchun Ye
- Clinical Research Center and Department of Gastroenterology,
Quanzhou First Hospital Affiliated to Fujian Medical University, Fujian,
China
| | - Zhizhong Liu
- Department of Urology, Affiliated Cancer Hospital of Xiangya
School of Medicine of Central South University, Hunan Cancer Hospital, Changsha,
China
| | - Han Weiqin
- Department of Urology, Affiliated Cancer Hospital of Xiangya
School of Medicine of Central South University, Hunan Cancer Hospital, Changsha,
China
| | - Yu Xie
- Department of Urology, Affiliated Cancer Hospital of Xiangya
School of Medicine of Central South University, Hunan Cancer Hospital, Changsha,
China
- Yu Xie, Department of Urology, the
Affiliated Cancer Hospital of Xiangya School of Medicine of Central South
University, Hunan Cancer Hospital, Changsha, Hunan 410013, China.
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26
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Zhan H, Huang C, Li T, Yang F, Cai J, Li W, Mao Y, Zhou X. The Self-Retaining Barbed Suture for Parenchymal Repair in Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-Analysis. Surg Innov 2019; 26:744-752. [PMID: 31215335 DOI: 10.1177/1553350619856167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives. The warm ischemia time (WIT) is key to successful laparoscopic partial nephrectomy (LPN). The aim of this study was to perform a meta-analysis comparing the self-retaining barbed suture (SRBS) with a non-SRBS for parenchymal repair during LPN. Methods. A systematic search of PubMed, Scopus, and the Cochrane Library was performed up to March 2018. Inclusion criteria for this study were randomized controlled trials (RCTs) and observational comparative studies assessing the SRBS and non-SRBS for parenchymal repair during LPN. Outcomes of interest included WIT, complications, overall operative time, estimated blood loss, length of hospital stay, and change of renal function. Results. One RCT and 7 retrospective studies were identified, which included a total of 461 cases. Compared with the non-SRBS, use of the SRBS for parenchymal repair during LPN was associated with shorter WIT (P < .00001), shorter overall operative time (P < .00001), lower estimated blood loss (P = .02), and better renal function preservation (P = .001). There was no significant difference between the SRBS and non-SRBS with regard to complications (P = .08) and length of hospital stay (P = .25). Conclusions. The SRBS for parenchymal repair during LPN can significantly shorten the WIT and overall operative time, decrease blood loss, and preserve renal function.
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Affiliation(s)
- Hailun Zhan
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | | | - Tengcheng Li
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Fei Yang
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jiarong Cai
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wenbiao Li
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yunhua Mao
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiangfu Zhou
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Lee KS, Kim DK, Kim KH, Bang WJ, Kim HJ, Park SY, Rha KH, Chung BH, Cho JS, Koo KC. Predictive factors for the development of renal insufficiency following partial nephrectomy and subsequent renal function recovery: A multicenter retrospective study. Medicine (Baltimore) 2019; 98:e15516. [PMID: 31045843 PMCID: PMC6504325 DOI: 10.1097/md.0000000000015516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Patients who undergo partial nephrectomy (PN) may exhibit renal function insufficiency, and a subset of these patients achieves renal function recovery. We evaluated the predictors of renal insufficiency and subsequent renal function recovery following PN. Data on 393 patients who underwent PN for solid renal tumors between March 2001 and November 2013, obtained from 6 institutions, were retrospectively reviewed. Renal insufficiency was defined as new onset of chronic kidney disease stage ≥3 postoperatively on the second of 2 consecutive tests. Renal function recovery was defined as an estimated glomerular filtration rate ≥60 ml/minute/1.73 m following renal insufficiency. Tumor complexity was stratified according to the RENAL classification system. The median (interquartile range) age, tumor size, and follow-up period were 53 (45-63) years, 2.6 (1.9-3.8) cm, and 36 (12-48) months, respectively. Tumors were of low complexity in 258/393 (65.6%) of cases. Renal insufficiency developed in 54/393 (13.5%) patients, in which age ≥60 years and preoperative creatinine ≥1.1 mg/ml were independent predictors. Tumor complexity, clamp type, and operative method were not significant prognostic factors. Among patients with newly developed renal insufficiency, 18/54 (33.3%) patients exhibited renal function recovery within a median period of 18 months, of which preoperative creatinine <1.1 mg/ml was an independent predictor. Age ≥60 years and preoperative creatinine ≥1.1 mg/ml were risk factors for renal insufficiency following PN. Patients with renal insufficiency whose preoperative creatinine was <1.1 mg/ml were likely to have renal function recovery.
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Affiliation(s)
- Kwang Suk Lee
- Department of Urology, Yonsei University College of Medicine, Gangnam Severance Hospital
| | - Dae Keun Kim
- Department of Urology, CHA Seoul Station Medical Center, CHA University
| | - Kwang Hyun Kim
- Department of Urology, Ewha Women's University College of Medicine
| | - Woo Jin Bang
- Department of Urology, Hallym University College of Medicine, Chuncheon
| | - Hyung Joon Kim
- Department of Urology, Konyang University College of Medicine, Daejeon
| | - Sung Yul Park
- Department of Urology, Hanyang University College of Medicine
| | - Koon Ho Rha
- Department of Urology, Yonsei University College of Medicine, Shinchon Severance Hospital, Seoul, Korea
| | - Byung Ha Chung
- Department of Urology, Yonsei University College of Medicine, Gangnam Severance Hospital
| | - Jin Seon Cho
- Department of Urology, Hallym University College of Medicine, Chuncheon
| | - Kyo Chul Koo
- Department of Urology, Yonsei University College of Medicine, Gangnam Severance Hospital
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Kong J, Shen S, Yang X, Wang W. Transhepatic-intrahepatic branches of the portal vein catheterization for ex vivo liver resection and autotransplantation: Two case reports of novel approach to perfuse the liver. Medicine (Baltimore) 2019; 98:e14706. [PMID: 30882634 PMCID: PMC6426561 DOI: 10.1097/md.0000000000014706] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE There has been increased use of ex vivo liver resection and autotransplantation (ERAT) for treatment of end-stage hepatic alveolar echinococcosis (HAE). Rapid perfusion of the autograft in bench resection is always required to reduce the warm ischemia time (WIT) and to protect the function of the remnant liver. Nevertheless, the severe invasion of the portal hepatis sometimes makes it impossible to find a usable inflow rapidly and the process of perfusion could be delayed. PATIENT CONCERNS Two patients diagnosed with end-stage HAE combined with severe portal hepatis invasion were selected to undergo ERAT at our center. DIAGNOSIS Besides the large HAE lesions, the CT imaging of patient 1 showed that part of the intra- and extrahepatic portal vein (PV) had disappeared. Patient 2 had severe invasion of both of the right and left branches of the PV. INTERVENTIONS We introduced a new approach for perfusing the liver in ERAT using transhepatic-intrahepatic branches of the PV catheterization. Afterward, ERAT was successfully performed. OUTCOMES For patient 1, the WIT was 2 minutes and the cold ischemia time (CIT) was 296 minutes. For patient 2, the WIT was 2 minutes and the CIT was 374 minutes. Patient 1 suffered stenosis of the common bile duct on postoperative day 14, and patient 2 recovered uneventfully. Both of the 2 patients were discharged from the hospital with normal laboratory values on postoperative day 31 and 15, respectively. The laboratory values for both patients at recent follow-up were normal. LESSONS Transhepatic-intrahepatic branches of the PV catheterization is useful for decreasing WIT and facilitating the management of ERAT. It is a useful technical variant that could be used in ERAT for treating patients with severe portal hepatis invasion.
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Tanaka K, Teishima J, Takenaka A, Shiroki R, Kobayashi Y, Hattori K, Kanayama HO, Horie S, Yoshino Y, Fujisawa M. Prospective study of robotic partial nephrectomy for renal cancer in Japan: Comparison with a historical control undergoing laparoscopic partial nephrectomy. Int J Urol 2018; 25:472-478. [PMID: 29671904 DOI: 10.1111/iju.13544] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 01/31/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To evaluate the outcomes of robotic partial nephrectomy compared with those of laparoscopic partial nephrectomy for T1 renal tumors in Japanese centers. METHODS Patients with a T1 renal tumor who underwent robotic partial nephrectomy were eligible for inclusion in the present study. The primary end-point consisted of three components: a negative surgical margin, no conversion to open or laparoscopic surgery and a warm ischemia time ≤25 min. We compared data from these patients with the data from a retrospective study of laparoscopic partial nephrectomy carried out in Japan. RESULTS A total of 108 patients were registered in the present study; 105 underwent robotic partial nephrectomy. The proportion of patients who met the primary end-point was 91.3% (95% confidence interval 84.1-95.9%), which was significantly higher than 23.3% in the historical data. Major complications were seen in 19 patients (18.1%). The mean change in the estimated glomerular filtration rate in the operated kidney, 180 days postoperatively, was -10.8 mL/min/1.73 m2 (95% confidence interval -12.3-9.4%). CONCLUSIONS Robotic partial nephrectomy for patients with a T1 renal tumor is a safe, feasible and more effective operative method compared with laparoscopic partial nephrectomy. It can be anticipated that robotic partial nephrectomy will become more widely used in Japan in the future.
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Affiliation(s)
- Kazushi Tanaka
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.,Japanese Society of Endourology Robotic Partial Nephrectomy Study Group, Kobe, Japan
| | - Jun Teishima
- Department of Urology, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan.,Japanese Society of Endourology Robotic Partial Nephrectomy Study Group, Kobe, Japan
| | - Atsushi Takenaka
- Division of Urology, Tottori University, Yonago, Japan.,Japanese Society of Endourology Robotic Partial Nephrectomy Study Group, Kobe, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University, Toyoake, Japan.,Japanese Society of Endourology Robotic Partial Nephrectomy Study Group, Kobe, Japan
| | - Yasuyuki Kobayashi
- Department of Urology, Okayama University Graduate School of Medicine, Okayama, Japan.,Japanese Society of Endourology Robotic Partial Nephrectomy Study Group, Kobe, Japan
| | - Kazunori Hattori
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan.,Japanese Society of Endourology Robotic Partial Nephrectomy Study Group, Kobe, Japan
| | - Hiro-Omi Kanayama
- Department of Urology, Tokushima University Graduate School, Tokushima, Japan.,Japanese Society of Endourology Robotic Partial Nephrectomy Study Group, Kobe, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University, Tokyo, Japan.,Japanese Society of Endourology Robotic Partial Nephrectomy Study Group, Kobe, Japan
| | - Yasushi Yoshino
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Japanese Society of Endourology Robotic Partial Nephrectomy Study Group, Kobe, Japan
| | - Masato Fujisawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.,Japanese Society of Endourology Robotic Partial Nephrectomy Study Group, Kobe, Japan
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Ye J, Zhang S, Tian X, Wang G, Zhao L, Ma L. Knotless retroperitoneoscopic nephron-sparing surgery for small renal masses: Comparison of bipolar sutureless technique and barbed suture technique. J Int Med Res 2018. [PMID: 29517951 PMCID: PMC6091838 DOI: 10.1177/0300060518760737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective Laparoscopic knot-tying and suturing are the most difficult steps in shortening the warm ischemia time and learning curve of laparoscopic nephron-sparing surgery. This study was performed to demonstrate the safety, oncological efficacy, and technical tips of sutureless retroperitoneal laparoscopic nephron-sparing surgery (RPNSS). Methods This retrospective study included 78 cases of RPNSS using a sutureless technique and 126 cases of RPNSS using a single-layer barbed self-retaining suture technique performed from December 2012 to December 2016. Results The mean warm ischemia time was significantly shorter in the sutureless technique group than in the barbed self-retaining suture technique group (6.8 vs. 21.1 minutes, respectively). There was no significant difference in the mean age, body mass index, R.E.N.A.L. Nephrometry score, operative time, maximal tumor diameter, intraparenchymal depth, blood loss, operative time, transfusion rate, complication rate, or postoperative hospital stay between the two groups. No open conversion was needed. No positive margins or local recurrence were observed during follow-up. Conclusions The sutureless technique was proven to be safe and oncologically effective and may allow novice laparoscopic surgeons to easily and quickly master RPNSS, a technically difficult procedure.
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Affiliation(s)
- Jianfei Ye
- Department of Urology, 66482 Peking University Third Hospital , Beijing, China
| | - Shudong Zhang
- Department of Urology, 66482 Peking University Third Hospital , Beijing, China
| | - Xiaojun Tian
- Department of Urology, 66482 Peking University Third Hospital , Beijing, China
| | - Guoliang Wang
- Department of Urology, 66482 Peking University Third Hospital , Beijing, China
| | - Lei Zhao
- Department of Urology, 66482 Peking University Third Hospital , Beijing, China
| | - Lulin Ma
- Department of Urology, 66482 Peking University Third Hospital , Beijing, China
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刘 燕, 于 立, 邓 文, 李 凯, 刘 如, 叶 桂, 符 芳, 李 江, 苗 芸. [A high level of high-density lipoprotein cholesterol is a protective factor against transplant renal artery stenosis]. Nan Fang Yi Ke Da Xue Xue Bao 2018; 38:155-161. [PMID: 29502053 PMCID: PMC6743882 DOI: 10.3969/j.issn.1673-4254.2018.02.06] [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] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the factors associated with the occurrence of transplant renal artery stenosis (TRAS). METHODS A retrospective analysis was conducted in 26 recipients who developed TRAS and 40 concurrent renal recipients without TRAS. We also conducted a nested case-control study in 14 patients with TRAS (TRAS-SD group) and another 14 non-TRAS recipients who received the allograft from the same donor (non-TRAS-SD group). RESULTS Compared with those in the concurrent recipients without TRAS, acute rejection (AR) occurred at a significantly higher incidence (P=0.004) and the warm ischemia time (WIT) was significantly longer (P=0.015) and the level of high?density lipoprotein cholesterol (HDL--C) significantly lower (P=0.009) in the recipients with TRAS. Logistic regression analysis suggested that AR (P=0.007) and prolonged WIT (P=0.046) were risk factors of TRAS while HDL-C (P=0.022) was the protective factor against TRAS. In recent years early diagnosis of TRAS had been made in increasing cases, the interval from transplantation to TRAS diagnosis became shortened steadily, and the recipients tended to have higher estimated glomerular filtration rate at the time of TRAS diagnosis. CONCLUSION Apart from the surgical technique, AR and prolonged WIT are also risk factors of TRAS while a high HDL-C level is the protective factor against TRAS. The improvement of the diagnostic accuracy by ultrasound is the primary factor contributing to the increased rate of early TRAS diagnosis in recent years.
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Affiliation(s)
- 燕娜 刘
- />南方医科大学南方医院器官移植科,广州 广东 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 立新 于
- />南方医科大学南方医院器官移植科,广州 广东 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 文锋 邓
- />南方医科大学南方医院器官移植科,广州 广东 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 凯群 李
- />南方医科大学南方医院器官移植科,广州 广东 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 如敏 刘
- />南方医科大学南方医院器官移植科,广州 广东 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 桂荣 叶
- />南方医科大学南方医院器官移植科,广州 广东 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 芳翔 符
- />南方医科大学南方医院器官移植科,广州 广东 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 江涛 李
- />南方医科大学南方医院器官移植科,广州 广东 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 芸 苗
- />南方医科大学南方医院器官移植科,广州 广东 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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Abstract
OBJECTIVE To evaluate the efficacy and safety of self-retaining barbed suture in renorrhaphy during laparoscopic partial nephrectomy by comparing surgical outcomes in a prospective randomized manner. MATERIAL AND METHODS From July 2014 to July 2015, a total of 60 patients with T1 renal tumor were randomized into two equal groups: self-retaining barbed suture (SRBS) and conventional absorbable polyglactin suture (non-SRBS group). All patients were treated by retroperitoneal laparoscopic partial nephrectomy. One surgeon with high volume experience performed all procedures. The patient demographics and perioperative outcomes were compared. RESULTS The patient demographics and tumor characteristics were comparable. The mean tumor size and R.E.N.A.L. scores were comparable between the two groups. LPN was successfully accomplished in all patients without open conversion. The warm ischemia and renorrhaphy times were significantly shorter in the SRBS group (18.8 ± 8.2 vs. 22.9 ± 7.3 min, P = .04; 10.4 ± 3.7 vs. 13.8 ± 5.6 min, P = .01). The minor complication rate was 13.3% vs. 10.0%, which was comparable. No major complication occurred. CONCLUSIONS The randomized controlled trial demonstrates that SRBS for renorrhaphy during retroperitoneal laparoscopic partial nephrectomy is safe and efficient. Application of barbed suture simplifies the parenchymal repair procedure and reduces warm ischemia time in comparison with conventional suture.
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Affiliation(s)
- Mingshuai Wang
- a Urology , Beijing Chao-Yang Hospital, Capital Medical University , Beijing , China
| | - Xingyu Mu
- a Urology , Beijing Chao-Yang Hospital, Capital Medical University , Beijing , China.,b Urology , Beijing Electric Power Hospital , Beijing , China
| | - Feiya Yang
- a Urology , Beijing Chao-Yang Hospital, Capital Medical University , Beijing , China
| | - Yinong Niu
- a Urology , Beijing Chao-Yang Hospital, Capital Medical University , Beijing , China
| | - Nianzeng Xing
- a Urology , Beijing Chao-Yang Hospital, Capital Medical University , Beijing , China
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Xu G, Guo Z, Liang W, Xin E, Liu B, Xu Y, Luan Z, Schroder PM, Manyalich M, Ko DSC, He X. Prediction of potential for organ donation after circulatory death in neurocritical patients. J Heart Lung Transplant 2017; 37:358-364. [PMID: 29103844 DOI: 10.1016/j.healun.2017.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/04/2017] [Accepted: 09/26/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The success or failure of donation after circulatory death depends largely on the functional warm ischemia time, which is closely related to the duration between withdrawal of life-sustaining treatment and circulatory arrest. However, a reliable predictive model for the duration is absent. We aimed to compare the performance of the Chinese Donation after Circulatory Death Nomogram (C-DCD-Nomogram) and 3 other tools in a cohort of potential donors. METHODS In this prospective, multicenter, observational study, data were obtained from 219 consecutive neurocritical patients in China. The patients were followed until circulatory death after withdrawal of life-sustaining treatment. RESULTS The C-DCD-Nomogram performed well in predicting patient death within 30, 60, 120 and 240 minutes after withdrawal of life-sustaining treatment with c-statistics of 0.87, 0.88, 0.86 and 0.95, respectively. The DCD-N score was a poor predictor of death within 30, 60 and 240 minutes, with c-statistics of 0.63, 0.69 and 0.59, respectively, although it was able to predict patient death within 120 minutes, with a c-statistic of 0.73. Neither the University of Wisconsin DCD evaluation tool (UWDCD) nor the United Network for Organ Sharing (UNOS) criteria was able to predict patient death within 30, 60, 120 and 240 minutes after withdrawal of life-sustaining treatment (UWDCD tool: 0.48, 0.45, 0.49 and 0.57; UNOS criteria: 0.50, 0.53, 0.51 and 0.63). CONCLUSION The C-DCD-Nomogram is superior to the other 3 tools for predicting death within a limited duration after withdrawal of life-sustaining treatment in Chinese neurocritical patients. Thus, it appears to be a reliable tool identifying potential donors after circulatory death.
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Affiliation(s)
- Guixing Xu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China; Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, China; Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhiyong Guo
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China; Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, China.
| | - Wenhua Liang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Erye Xin
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China; Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, China
| | - Bin Liu
- Department of Neurosurgery, The People's Hospital of Dongguan City, Dongguan, China
| | - Ye Xu
- Department of Neurosurgery, The First People's Hospital of Foshan City, Foshan, China
| | - Zhongqin Luan
- Department of Neurosurgery, Jiangmen Central Hospital, Jiangmen, China
| | | | - Martí Manyalich
- Transplant Procurement Management-Donation & Transplantation Institute Foundation, Parc Científic de Barcelona, Barcelona, Spain
| | - Dicken Shiu-Chung Ko
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Xiaoshun He
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China; Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, China.
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Abstract
PURPOSE Saving warm ischemia time (WIT) in laparoscopic partial nephrectomy (LPN) is important. We have designed a new device, a remotely activated bulldog clamp, to facilitate LPN. In present study, the effectiveness, convenience, and safety of the new design device were compared with that of standard bulldog vascular clamp in a pig model. MATERIALS AND METHODS Fifteen cases of LPN were bilaterally operated on upper or lower pole of kidneys in five pigs. As the test group, eight cases involved the remotely activated bulldog clamp, whereas the remaining seven cases, as the control group, involved the common standard vascular bulldog clamp. The mean operative time, blood lost, and mean WIT were compared between the two groups. RESULTS The mean operative time and blood lost were not significantly different between the groups (p < 0.05). Continuous artery clamping was used in the two groups. With on-demand clamping, the mean WIT in the test group was 19.0 ± 3.42 minutes, which was significantly less compared with the control group (31.54 ± 5.23 minutes, p < 0.05). CONCLUSIONS The newly designed device can remotely control the renal artery, which made clamping and unclamping much easier. It is effective and safe in LPN.
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Affiliation(s)
- Wei Chen
- 1 Urology Department, Zhongshan Hospital, Fudan University , Shanghai, China
| | - Jian-Ming Guo
- 1 Urology Department, Zhongshan Hospital, Fudan University , Shanghai, China
| | - Jun Hou
- 2 Pathology Department, Zhongshan Hospital, Fudan University , Shanghai, China
| | - Guo-Min Wang
- 1 Urology Department, Zhongshan Hospital, Fudan University , Shanghai, China
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Lepiesza A, Chudoba P, Kamińska D, Pupka A, Zaleska P. [Methods of Reduction of Warm Ischemic Time in Kidney Transplantation and Their Role of Early and Late Outcomes]. Polim Med 2016; 46:71-77. [PMID: 28397421 DOI: 10.17219/pim/62901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 03/23/2016] [Accepted: 04/26/2016] [Indexed: 11/24/2022] Open
Abstract
Kidney is the organ transplanted most often. An increase in the number of expanded criteria donors (ECD) has been observed for years, and consequently the condition of transplanted organs worsened. In recent years, the possibility to recover organs from donors after cardiac death (DCD) became legally available in Poland, which will result in the increase of donors. Every DCD donor is at the same time ECD donor. One of the most important challenges the transplantology has to face is the improvement of the quality of transplanted organs. In this study the available data on the reduction of warm ischemic time (WIT) on transplanted kidney has been presented. WIT may influence early and late outcome of kidney allograft. Long WIT increases the risk of delayed graft function (DGF). DGF occurs more often in transplanted kidneys from DCD. One of the main reasons for that is the fact that DCD have longer WIT compared to donors after brain death (DBD). So-called WIT II appearing during vascular anastomosis in kidney transplantation may be reduced by various techniques. The model of clear sterilized polyethylene bag developed by the authors has been presented. The construction of the bag, consisting of three compartments, allow to safely perform vascular anastomosis while keeping the temperature of the transplanted kidney low. The article describes as well other techniques used to decrease WIT II. The effect of anastomosis time on allograft outcome is still not well researched. The article presents the newest information regarding the influence of WIT on graft and patient survival.
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Affiliation(s)
- Agnieszka Lepiesza
- Katedra i Klinika Chirurgii Naczyniowej, Ogólnej i Transplantacyjnej, Uniwersytet Medyczny im. Piastów Śląskich we Wrocławiu, Wrocław, Polska
| | - Paweł Chudoba
- Katedra i Klinika Chirurgii Naczyniowej, Ogólnej i Transplantacyjnej, Uniwersytet Medyczny im. Piastów Śląskich we Wrocławiu, Wrocław, Polska
| | - Dorota Kamińska
- Katedra i Klinika Nefrologii i Medycyny Transplantacyjnej, Uniwersytet Medyczny im. Piastów Śląskich we Wrocławiu, Wrocław, Polska
| | - Artur Pupka
- Katedra i Klinika Chirurgii Naczyniowej, Ogólnej i Transplantacyjnej, Uniwersytet Medyczny im. Piastów Śląskich we Wrocławiu, Wrocław, Polska
| | - Patrycja Zaleska
- Katedra i Klinika Chirurgii Naczyniowej, Ogólnej i Transplantacyjnej, Uniwersytet Medyczny im. Piastów Śląskich we Wrocławiu, Wrocław, Polska
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Tennankore KK, Kim SJ, Alwayn IPJ, Kiberd BA. Prolonged warm ischemia time is associated with graft failure and mortality after kidney transplantation. Kidney Int 2015; 89:648-58. [PMID: 26880458 DOI: 10.1016/j.kint.2015.09.002] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/17/2015] [Accepted: 09/24/2015] [Indexed: 11/29/2022]
Abstract
Warm ischemia time is a potentially modifiable insult to transplanted kidneys, but little is known about its effect on long-term outcomes. Here we conducted a study of United States kidney transplant recipients (years 2000-2013) to determine the association between warm ischemia time (the time from organ removal from cold storage to reperfusion with warm blood) and death/graft failure. Times under 10 minutes were potentially attributed to coding error. Therefore, the 10-to-under-20-minute interval was chosen as the reference group. The primary outcome was mortality and graft failure (return to chronic dialysis or preemptive retransplantation) adjusted for recipient, donor, immunologic, and surgical factors. The study included 131,677 patients with 35,901 events. Relative to the reference patients, times of 10 to under 20, 20 to under 30, 30 to under 40, 40 to under 50, 50 to under 60, and 60 and more minutes were associated with hazard ratios of 1.07 (95% confidence interval, 0.99-1.15), 1.13 (1.06-1.22), 1.17 (1.09-1.26), 1.20 (1.12-1.30), and 1.23 (1.15-1.33) for the composite event, respectively. Association between prolonged warm ischemia time and death/graft failure persisted after stratification by donor type (living vs. deceased donor) and delayed graft function status. Thus, warm ischemia time is associated with adverse long-term patient and graft survival after kidney transplantation. Identifying strategies to reduce warm ischemia time is an important consideration for future study.
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Affiliation(s)
- Karthik K Tennankore
- Department of Medicine (Division of Nephrology), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
| | - S Joseph Kim
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ian P J Alwayn
- Department of Surgery, Multi-Organ Transplant Program, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Bryce A Kiberd
- Department of Medicine (Division of Nephrology), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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Zhang ZY, Tang Q, Li XS, Zhang Q, Mayer WA, Wu JY, Yang XD, Zhang XC, Wang XY, Zhou LQ. Clinical analysis of the PADUA and the RENAL scoring systems for renal neoplasms: a retrospective study of 245 patients undergoing laparoscopic partial nephrectomy. Int J Urol 2013; 21:40-4. [PMID: 23675903 DOI: 10.1111/iju.12192] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 04/09/2013] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate the clinical significance of preoperative aspects and dimensions used for anatomic (PADUA) and radius exophytic/endophytic nearness anterior/posterior location (RENAL) scoring systems for renal neoplasms in patients undergoing laparoscopic partial nephrectomy. METHODS A retrospective analysis was carried out on clinical data of 245 Chinese patients with renal neoplasms undergoing laparoscopic partial nephrectomy from June 2008 to June 2012. The perioperative complications and variables, as well as PADUA and RENAL score, were compared. RESULTS The PADUA and RENAL scoring systems were significantly associated with percent change in estimated glomerular filtration rate (P = 0.032 and P = 0.026 respectively), whereas the RENAL scoring system was also significantly associated with warm ischemia time (P = 0.032). On multivariate analysis, both scores were able to predict percent change in estimated glomerular filtration rate (PADUA, P = 0.011; RENAL, P = 0.028). There were no significant associations between the two scoring systems assessed and the occurrence of complications or tumor stage. The correlation between PADUA classification and RENAL nephrometry score was significant (P < 0.0001). Fleiss' generalized kappa was 0.69-0.89 for the various components of the PADUA score and 0.67-0.89 for the RENAL nephrometry components. CONCLUSIONS The PADUA classification and RENAL nephrometry score are comprehensive assessment tools for delineating renal tumor anatomy. The reproducibility of the PADUA and RENAL scores is substantial, but further research is required to evaluate its performance in more accurately predicting operative and patient-related outcomes.
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Affiliation(s)
- Zhong-Yuan Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center
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