Donor Complications Research Articles

Should We Exclude Live Donor Liver Transplantation for Liver Transplant Recipients Requiring Mechanical Ventilation and Intensive Care Unit Care?

BackgroundPatients with acute and chronic liver disease often require admission to intensive care unit (ICU) and mechanical ventilation support before liver transplantation (LT). Rapid disease progression and high mortality on LT waiting lists makes live donor LT (LDLT) an attractive option for this patient population.MethodsDuring 2000 to 2011, all ICU-bound and mechanically ventilated patients receiving an LDLT (n = 7) were compared to patients receiving a deceased donor LT (DDLT) (n = 38).ResultsBoth groups were comparable regarding length of pretransplant ICU stay (DDLT: 2 [1-31] days vs LDLT: 2 [1-8] days; P = 0.2), days under mechanical ventilation (DDLT: 2 [1-31] days vs LDLT: 2 [1-5] days; P = 0.2), pretransplant dialysis (DDLT: 45% vs LDLT: 43%; P = 1) and model for end-stage liver disease score (DDLT: 33 ± 8 vs LDLT: 33 ± 10; P = 0.911). Live donors median evaluation time was 24 hours (18-561 hours). As expected, median time on waiting list was significantly lower in the LDLT group (DDLT: 13 [0-1704] days vs LDLT: 10 [1-33] days; P = 0.008). Incidence of postoperative complications was numerically, albeit not significantly higher in the DDLT versus LDLT (68% vs 29%; P = 0.08). No difference was detected between LDLT and DDLT patients regarding 1-year (DDLT: 76% vs LDLT: 85%), 3-year (DDLT: 68% vs LDLT: 85%), and 5-year (DDLT: 68% vs LDLT: 85%) graft and patient survivals (P = 0.41). No severe donor complication occurred after live donation.ConclusionsThe LDLT may provide a faster access to transplantation and therefore, offers an alternative treatment option for critically ill patients requiring ICU care and mechanical ventilation support at the time of transplantation.

Management of the middle hepatic vein in right lobe living donor liver transplantation: A meta-analysis.

Living donor liver transplantation (LDLT) is a curative treatment for end stage liver disease. It is advantageous due to the shortage of deceased donors. However, in LDLT, whether the middle hepatic vein (MHV) should be preserved in donors remains controversial. We conducted searches in Pubmed, Embase, Cochrane Library, Web of Science, Ovid, and Google Scholar using the key words "living donor liver transplantation" and "middle hepatic vein". Due to ethical issues, there were no randomized control trails focusing on MHV in LDLT. The majority of reports were retrospective studies. We examined the reference lists to identify related investigations. Google Scholar was then used to obtain full texts. Nine observational studies were analyzed. There were no significant differences in liver function (WMD, -5.51; P=0.12) and complications (RR, 0.98; P=0.89) in donors with or without MHV. However, the liver function in recipients was greatly improved after LDLT with MHV (WMD, -78.32; P=0.01). No definite conclusion was obtained in terms of the liver regeneration indices between LDLT with or without MHV. It was conclude that grafts with MHV in LDLT favor recipient outcomes and do not harm the living donor if a careful preoperative evaluation is performed.

Live Donor Liver Transplantation: A Valid Alternative for Critically Ill Patients Suffering From Acute Liver Failure

We report the outcome of live donor liver transplantation (LDLT) for patients suffering from acute liver failure (ALF). From 2006 to 2013, all patients with ALF who received a LDLT (n = 7) at our institution were compared to all ALF patients receiving a deceased donor liver transplantation (DDLT = 26). Groups were comparable regarding pretransplant ICU stay (DDLT: 1 [0-7] vs. LDLT: 1 days [0-10]; p = 0.38), mechanical ventilation support (DDLT: 69% vs. LDLT: 57%; p = 0.66), inotropic drug requirement (DDLT: 27% vs. LDLT: 43%; p = 0.64) and dialysis (DDLT: 2 vs. LDLT: 0 patients; p = 1). Median evaluation time for live donors was 24 h (18-72 h). LDLT versus DDLT had similar incidence of overall postoperative complications (31% vs. 43%; p = 0.66). No difference was detected between LDLT and DDLT patients regarding 1- (DDLT: 92% vs. LDLT: 86%), 3- (DDLT: 92% vs. LDLT: 86%), and 5- (DDLT: 92% vs. LDLT: 86%) year graft and patient survival (p = 0.63). No severe donor complication (Dindo-Clavien ≥3 b) occurred after live liver donation. ALF is a severe disease with high mortality on liver transplant waiting lists worldwide. Therefore, LDLT is an attractive option since live donor work-up can be expedited and liver transplantation can be performed within 24 h with excellent short- and long-term outcomes.

Donor Postoperative Biliary Complications After Living-Donor Liver Transplant.

Although the main factors responsible for donor deaths after living-donor liver transplant are liver failure and sepsis, the most common donor complications are associated with the biliary tract. Between April 2006 and May 2012, five hundred ninety-three donors underwent living-donor hepatectomy procedures for living-donor liver transplants. The mean age of donors was 31.0 ± 9.9 years and the ratio of men to women was 341:252. Of all donors, 533 (89.9%) underwent a right lobe hepatectomy, 45 (7.6%) underwent a left lateral segmentectomy, and 15 (2.5%) underwent a left hepatectomy. Biliary complications were observed in 51 liver donors (8.6%). Based on the Clavien-Dindo classification, grade I and grade II complications were 3.2% and 0%, while grade IIIa and grade IIIb complications were observed in 3.5% and 1.85% of cases. Right lobe donor biliary complications occurred at the rate of 8.2% in 44 donors. Grade IV and grade V complications were not observed. Grade IIIa complications necessitating radiologic and endoscopic procedures were observed in 21 liver donors (3.5%). Bile leakage unresponsive to medical therapy was detected in 19 donors (3.2%). Nasobiliary catheters were placed in 3 of 19 donors and internal stents were placed in 1. Two sessions of balloon dilatation were performed in the 2 grade IIIb donors (0.33%). Biliary strictures observed in 2 right lobe donors and 1 left lobe donor was treated by hepaticojejunostomy an average of 14 months after surgery. Avoidance of intraoperative issues and early recognition of bile leakage are fundamental in preventing complications in living-donor liver transplant donors.

Informed consent for live liver donors: A qualitative, prospective study

Adult-to-adult live donor liver transplantation (LDLT) poses serious health risks and no direct health benefits to donors. Ensuring live donors' autonomy through informed consent is critical. We assessed live liver donors' (LD) comprehension, information needs, risk perceptions, and demographics. Semi-structured interviews were prospectively conducted with LDs after completing donor evaluation and informed consent at our transplant center. Likert scales measured informed consent domains. Open-ended responses underwent thematic analysis. Thirty LDs participated (100% participation rate). Although 90% of LDs reported being informed about donation 'a great deal', only 66% reported understanding information about donation 'a great deal.' Many (40%) reported difficulty understanding medical terminology. Information LDs most desired to feel comfortable with their decision included: incidence and type of donor complications (67%), description of donation procedure (57%), and the process of donor preparation (43%). Most (83%) LDs rated risks to themselves as 'not at all' to 'somewhat' risky, and minimized these risks. Although LDs perceived that they were adequately informed, their actual comprehension about donation was inadequate. Findings suggest the value of informed consent for preparation for the procedure and potential periprocedural risks rather than for decision-making. More comprehensible information disclosure may optimize informed consent.

Postoperative pulmonary complications in living-liver donors: a retrospective analysis of 188 patients.

Living-donor liver transplant has become a viable option and an important source of hepatic grafts. The goal of this study is to establish postoperative pulmonary complications of liver donation surgery in our center. Data from 188 subjects (median age, 33.7 ± 8.4 y; male/female, 51.1%/48.9%) who had liver donation surgery from 1988 to 2013 were analyzed retrospectively. Patient demographic and clinical features were recorded. Postoperative complications and the correlation of risk factors for postoperative pulmonary complications were investigated. The incidence of early postoperative complications was 17% (n = 32), and 16 of these patients had postoperative pulmonary complications (8.5%); 2 of the postoperative pulmonary complications were detected on the day of surgery and the other 14 complications were observed between the second and seventh day after surgery. Most postoperative pulmonary complications were minor complications including atelectasis, pleural effusion, and pneumonia. There was 1 major postoperative pulmonary complication: pulmonary embolism that occurred on the fourth day after surgery in 1 patient. Late pulmonary complications also were reviewed and no late postoperative pulmonary complications were observed. There was no significant difference in early and late postoperative pulmonary complications between ex-smokers and smokers. Postoperative atelectasis was significantly higher in patients with body mass index ≤ 20 kg/m ² than patients with body mass index > 21 kg/m ² (P = .027). In our study population, no postoperative mortality was recorded. We believe that preoperative weight reduction strategies and early mobilization with postoperative respiratory physiotherapy could be important factors to reduce postoperative pulmonary complications in liver donors.

Major complications of adult right lobe living liver donors

The right lobe of the liver is generally preferred for living donor liver transplantation in adult patients with end-stage liver disease. It is important to know the preoperative factors relating to the major postoperative complications. We therefore evaluated the possible risk factors for predicting postoperative complications in right lobe liver donors. Data from 378 donors who had undergone right lobe hepatectomy at our center were evaluated retrospectively. The factors we evaluated included donor age, gender, body mass index (BMI), remnant liver volume, operation time, history of previous abdominal surgery, inclusion of the middle hepatic vein and variations in the portal and bile systems. Of the 378 donors, 219 were male and 159 female. None of the donors died, but 124 (32.8%) donors experienced complications including major complications (Clavien scores III and IV) in 27 (7.1%). Univariate analysis showed that complications were significantly associated with male gender and higher BMI (P<0.05), but not with donor age, remnant liver volume, operation time, graft with middle hepatic vein, variations in the portal and bile systems and previous abdominal surgery (P<0.05). Multivariate logistic regression analysis showed that major complications were significantly associated with male gender (P=0.005) and higher BMI (P=0.029). Moreover, the Chi-square test showed that there were significant relationships between major complications and male gender (P=0.010, X2=6.614, df=1) and BMI >25 kg/m2 (P=0.031, X2=8.562, df=1). Of the 96 male donors with BMI >25 kg/m2, 14 (14.6%) with major complications had significantly smaller mean remnant liver volume than those (82, 85.4%) without major complications (32.50%+/-4.45% vs 34.63%+/-3.11%, P=0.029). Male donors with BMI >25 kg/m2 and a remnant liver volume ≤32.50% had a significantly increased risk for major complications.

Living Donor Liver Transplantation: A Life-Saving Option in Emergency Situations for Diffuse Hepatic Neuroendocrine Tumor Metastasis

Liver metastasis is the main cause of death in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs), but only 10%–20% of metastasis in these cases is resectable at the time of diagnosis. In some cases, medical and interventional radiological treatments may not be effective. Liver transplantation, although controversial, may be an option. Worldwide organ-sharing systems do not provide exception points, but give recommendations for liver transplantation in cases of hepatic metastasis from GEP-NETs due to the issue of fair access to donor organs. Living donor liver transplantation is an option in select cases. Presented here are 2 cases in which living donor liver transplantation was performed in emergency situations as a life-saving procedure, with acceptable survival and without donor complications.

The use of hematocrit level for predicting the efficiency of peripheral blood CD34(+) cell collection after G-CSF Mobilization in Healthy Donors.

Recently, peripheral blood stem cell (PBSC) has been widely used and replaced bone marrow (BM) as the stem cell source in allogeneic hematopoietic stem cell transplantation (HSCT) because of a more rapid engraftment, easier accessibility, and lower risk of donor complications. We, therefore, report the predicting factors for the high PBSC harvest yields in 50 healthy donors. Among the 50 donors, median collected CD34(+) cell number was 4.6 × 10(6/) kg (1.5-16.3 × 10(6) /kg). Number of circulating CD34+ cells and hematocrit (HCT) level increased parallelly whereas peripheral CD34+ cell numbers were decreased with increasing donor age. In univariate analysis, HCT level≥ 35.5% at the time of PBSC collection was significantly associated with high PBSC number (≥ 5.0 × 10(6) cells/kg) and donor aged <30 years was significantly associated with collected CD34+ cells ≥ 6.0 × 10(6) /kg, P = 0.03. HCT level ≥35.5% was an independent parameter for high WBC count (≥50 × 10(9) /L), P < 0.05. None of donor who had both HCT < 35.5% and WBC < 50 × 10(9) /L had circulating CD34+ cells ≥ 5.0 × 10(6) /kg. Platelet count ≥ 200 × 10(9) /L was found significantly in donors with WBC ≥ 40 × 10(9) /L (P = 0.03) and HCT ≥ 35.5%, P < 0.05. Collected PBSC number tended to be higher in our donors with high levels of HCT, WBC, and platelet. We also found that HCT and platelet levels in our donors decreased after receiving G-CSF administration compared with the initial complete blood counts (CBC) results. We, therefore, concluded that HCT level at the time of initiation leukapheresis was an important predictor for PBSC collection yields.

Safety of assisted reproductive technology in the United States, 2000-2011.

Use of assisted reproductive technology (ART) continues to increase in the United States and globally. In an effort to improve patient safety, stimulation protocols have become less aggressive, oocyte retrieval has transitioned from laparoscopic to transvaginal, and pregnancy rates have improved.1 However, limited data exist regarding the incidence of maternal complications.2 We explored incidence and trends in reported patient and donor complications in fresh ART cycles using the US Centers for Disease Control and Prevention National ART Surveillance System (NASS).

Consequences of the use of extended criteria donors in living donor liver transplantation.

Donor selection criteria are being continuously modified to expand the potential donor pool in living donor liver transplantation (LDLT). This retrospective study reports our center's experience in utilizing extended criteria donors for LDLT. The charts of 342 LDLT donors who underwent right hepatectomy between September 2007 and December 2010 were reviewed. Donors who were older than 55 years, and/or with BMI >30, and/or with a remnant liver volume of <30% were defined as extended criteria donors. The surgical complications in the extended criteria donors and non-extended criteria donors were compared. There were 61 extended criteria donors (21 male, 40 female; mean age 41 years) and 281 non-extended criteria donors (189 male, 92 female; mean age 31 Years). Surgical morbidities were observed in 70 (20.4%) of donors. The number of patients with complications according to Clavien's system were: Grade I, 30 (43%); Grade II, 11 (16%); Grade IIIa, 12 (17%); Grade IIIb, 16 (23%); and Grade IV, 1 (1%). Postoperative complications were observed in 17 (28%) of 61 extended criteria donors, and 53 (19%) of 281 non-extended donors (p>0.05). However, only the Grade IIIb complication rate in donors with extended criteria was significantly higher than in non-extended criteria donors (p=0.04). Complications developed in 3 of 7 donors aged >55 years and with BMI >30. There was no donor mortality. Although there was no statistical difference between the 2 groups' postoperative complication rates, Grade IIIb complications were statistically significantly higher in the extended group. Having more than 1 extended criteria may increase the donor's postoperative complications in LDLT. Thus, the elimination of the donors should be considered in the presence of more than 1 extended criteria.

Effects of nephrectomy on respiratory function and quality of life of living donors: a longitudinal study.

BACKGROUND: A living donor transplant improves the survival and quality of life of a transplant patient. However, the impact of transplantation on postoperative lung function and respiratory muscular strength in kidney donors remains unknown. OBJECTIVE: To evaluate pulmonary function, respiratory muscle strength, quality of life and the incidence of postoperative pulmonary complications (PPCs) in kidney donors undergoing nephrectomy. METHOD: This prospective cohort enrolled 110 consecutive kidney donors undergoing nephrectomy. Subjects underwent pulmonary function (using spirometry) and respiratory muscular strength (using manovacuometry) assessments on the day prior to surgery and 1, 2, 3 and 5 days postoperatively. Quality of life (measured by the SF-36) was evaluated preoperatively and 30 days postoperatively. PPCs were assessed daily by a blinded assessor. RESULTS: Donors exhibited a decrease of 27% in forced vital capacity, 58% in maximum inspiratory capacity and 51% in maximum expiratory pressure on the 1stpostoperative day (p<0.001) but this improved over days 2, 3 and 5 but had not returned to preoperative levels. Patient quality of life was still impaired at 30 days with regards to functional capacity, physical role, pain, vitality and social functioning (p<0.05) but these parameters improved slowly. None of the patients developed PPCs. CONCLUSION: Kidney donors submitted to nephrectomy exhibited a reduction in pulmonary function, respiratory muscular strength and quality of life, most of which were improving toward pre-surgical levels.

Repairing peripheral nerve injury using tissue engineering techniques.

Each year approximately 360,000 people in the United States suffer a peripheral nerve injury (PNI), which is a leading source of lifelong disability (Kelsey et al., 1997; Noble et al., 1998). The most frequent cause of PNIs is motor vehicle accidents, while gunshot wounds, stabbings, and birth trauma are also common factors. Patients suffering from disabilities as a result of their PNIs are also burdensome to the healthcare system, with average hospital stays of 28 days each year (Kelsey et al., 1997; Noble et al., 1998).

Expanding the bounds of liver transplantation

Primum non nocere. First do no harm. Opponents of living donor liver transplantation argue that putting a healthy donor at risk goes against this sacred principle of medicine and is, therefore, unethical. True, there are myriad ethical issues embedded in the concept of living donor transplantation: but the eligibility for a Model for End-Stage Liver Disease-allocated deceased donor graft has been considered a prerequisite. The concept of living donation was born out of a need for more liver grafts for donation; in the absence of a shortage of livers, there would be no need to turn to healthy donors. The major ethical principles in living donation are the principles of autonomy and informed consent. The elements of autonomous decision-making include acting with understanding, without influence that determines the action and with intentionality. Informed consent requires people to understand and articulate the risks, benefits, and alternatives to the procedure in question. Potential donors go through an intensive educational process that includes all members of the transplant team, from surgeons, hepatologists, psychiatrists, and nurse practitioners to social workers. The process is designed to provide prospective donors with the necessary information such that they can make a decision that enhances their utility. This underlies the principle of autonomy; people will make decisions that bring them a certain benefit. A beneficial action is not necessarily risk-free. To be clear, living donation carries the risk of harm to the donor. This risk varies with individual donors and with center experience but definitely exists. This small but finite risk of harm to the donor must be weighed against the potential gain to the donor, that is, satisfaction and the potential to provide gain to the recipient. Thus much of the donor gain is quantified by recipient benefit of guaranteed transplantation. For the recipient, the alternative to transplant is death, although not necessarily imminently, particularly if the recipient is deemed not to be a candidate for deceased donor liver transplantation. The relative benefit may be the greatest if the recipient is not eligible for a deceased donor graft, because the likelihood of death without liver transplantation approaches 100%. If after an extensive donor evaluation such that the partial hepatectomy is anticipated to be routine, the survival benefit to the recipient far outweighs quantitatively the potential risk to the donor. Thus, with an autonomous decision, all ethical principles have been upheld. Donor satisfaction is a major component of living donation and should not be underestimated. Rewards include the ability to have their loved one enjoy extended life, and the psychological benefit derived from knowing that they helped save a life important to them. Literature suggests that living donors are overall satisfied with their donation process. In fact, most studies indicate that donors would undergo the process again if given the opportunity. Interestingly, the decision to donate again is correlated with recipient outcome, not with donor complications, supporting the notion that donors' benefits are intricately related to recipients. The practice of living donor liver transplant does raise several ethical issues. It is imperative that donors are given accurate and complete information and that they make their decision with complete autonomy. It remains to be determined which patients are the best candidates for living donation. Transplant teams, and surgeons in particular, are charged with the difficult task of weighing donor risks with recipient benefits. The only unethical aspect of living donation would be withholding it from appropriate patients in need.

Biliary complications in living donor right hepatectomy are affected by the method of bile duct division.

The bile duct division is a crucial step in the donor hepatectomy. Multiple small ducts will make the biliary reconstruction more difficult and may influence the outcome of the recipient. Biliary leakage, bilomas and biliary strictures are well recognized donor complications that may be directly linked to bile duct division. Biliary division still needs more standardization. This work aims to analyze our experience with two different methods of bile duct division in relation to the development of intraoperative and postoperative biliary complications. Between April 2004 and March 2013, 216 liver donors underwent right hepatectomy, in Gastro-Enterology Surgical Center, Mansoura University, Egypt. According to the method of bile duct division, the study population was divided into 2 groups; 1- extrahepatic dissection group (EDG) and 2- fluoroscopy guided transection group (FGG), each comprised 108 patients. Data were collected from a prospectively registered database, with special emphasis on the occurrence of biliary complications. Complications were classified according to the latest version of Clavien classification. Intraoperative biliary complications did not differ between both groups, p = 0.313. The commonest postoperative complication was biliary leak/biloma accounting for 32.5% of all donor complications, followed by non-biliary fluid collections. 24 (11.1%) donors developed 27 biliary complications. The FGG showed significantly less biliary complications (5.6%, 6 donors), when compared to EDG (15.7%, 18 donors), p = 0.015. Grade 3 complications were significantly higher in EDG, p = 0.024. On multivariate analysis, the only significant factor predicting the occurrence of biliary complications was the use of fluoroscopy guided bile duct division, p = 0.009. In conclusion, we believe that the proposed method of biliary division is safe, simple and reproducible.

WS3-5 - Allogeneic Hematopoietic Cell Transplantation for Adult T Cell Leukemia/Lymphoma

Adult T cell Leukemia Lymphoma (ATL) is a peripheral T-cell malignancy that is caused by human T-lymphotropic virus type 1 infection and commonly affects individuals at an average age of 67 years. Since the prognosis of the disease has been unsatisfactory by conventional chemotherapy, we had so far conducted trials of allogeneic hematopoietic stem cell transplantation (allo-SCT) with reduced-intensity conditioning regimen (RIC) for elderly patients. The overall survival of the patients, treated with RIC-allo-HCT using G-CSF-mobilized peripheral blood stem cells from HLA-identical sibling donors, was 34% and no death was observed beyond 36 months after transplantation. Acute GVHD of grade I-II was identified as a prognostic factor with a positive impact for both overall and progression free survival. The availability of suitable sibling donors, however, becomes difficult probably due to aging as well as complications of donors. Therefore, we conducted a clinical trial to evaluate the feasibility of an alternative strategy of RIC-allo-SCT using bone marrow cells from unrelated donors. Fifteen elderly patients were treated and thirteen of them achieved complete donor chimerism before day 100 and survived for 100 days after SCT, and we concluded that RIC-allo-SCT using bone marrow cells is a feasible therapeutic procedure. At a median follow up of 730 (56-765) days, ten of the 15 patients were alive. Disease status prior to SCT is one of the most important prognostic factors. It needs a several months to search the unrelated bone marrow donor, while a risk of relapse increases. The time from donor search to SCT would be shorter in cord blood. Therefore we conducted another clinical trial to evaluate the feasibility of RIC-allo-SCT using cord blood with the patients in complete or partial remission.In conclusion, continuous clinical studies are needed to optimize the SCT for ATL.

Use of the semitendinosus tendon for foot and ankle tendon reconstructions

ObjectiveTo demonstrate the results obtained from foot and ankle tendon reconstructions using the tendon of the semitendinosus muscle. The clinical results, the patient's degree of satisfaction and complications in the graft donor and recipient areas were evaluated. MethodsThis was a retrospective study in which the medical files of 38 patients who underwent this surgical procedure between 2006 and 2010 were surveyed. The functional results from this technique, the complications in the donor and recipient areas and the patients’ degree of satisfaction were evaluated. ResultsThree patients presented complications in the recipient area (skin necrosis); one patient showed complications in the donor area (pain and insensitivity); and all patients had satisfactory functional results, with complete range of motion. ConclusionThe semitendinosus muscle is a good option for treatments for foot and ankle tendon injuries.

LAPAROSCOPIC LIVING DONOR NEPHRECTOMY IN INDONESIA

Objective: To evaluate and analyze variables related to the surgical and direct post-operative outcomes of our initial experience of laparoscopic living donor nephrectomies (LLDN). Material &amp; methods: This retrospective analysis describes the first 10 laparoscopic nephrectomies in living donors performed in Cipto Mangunkusumo Hospital. All surgeries were performed by the same surgical team. Variables related to the surgical and post-operative outcome and complications in donors were evaluated and analyzed.Results: The average age of the donors was 31.8 years with male : female ratio of 7 : 3. Thirty percent of them were family related to the recipient. The left kidney was extracted from all patients and multiple renal vessels were found in one cases. The mean operation time was 321.9 ± 27 min, first warm ischemia time was 9.37 ± 3.34 min and estimated blood loss was 270 ± 182.87ml. The hospital stay was 4.1 ± 1.3 days, VAS in the first day post surgery was 3 ± 1 with epidural analgesia needed for 1.8 ± 0.6 days, and drain was kept in for 2.8 ± 1.2 days while urethral cathether for 2.4 ± 1.2. Time to return to work was 16 ± 8.4 days. Conclusion: LLDN results in acceptable blood loss,less post-operative pain, short hospital stay and short time to return to work for the donors, therefore promising to be the gold standard among living donor nephrectomy surgical options.Keywords: Laparoscopic living donor nephrectomy,renal transplantation, Indonesia.

Definitions in haemovigilance: guiding principles and current state of development of international reference definitions

BackgroundHaemovigilance systems capture data on adverse reactions and infections in recipients of blood transfusions as well as on errors and incidents in the transfusion chain. The objective is to analyse them and make recommendations for improving transfusion safety. Many haemovigilance systems also collect data on complications in blood donors with a view to monitoring and improving blood donor safety. Standardized definitions are necessary for classifying and comparing data in all these domains and at all levels.MethodSince 2004, at international meetings of blood transfusion professionals, members the International Haemovigilance Network (IHN) and the haemovigilance working party of the International Society for Blood Transfusion (ISBT) have collaborated in developing and validating definitions for non‐infectious transfusion complications, errors and incidents in the transfusion chain as well as adverse reactions in blood donors. From 2012, contacts with other groups including the World Health Organisation (WHO) have been put in place to ensure wide consultation as well as awareness and use of the definitions.ResultsStandardized definitions have been published for recipient adverse reactions, for complications of blood donation and for a limited number of types of incident in the transfusion chain. The ISBT haemovigilance working party and IHN are committed to ensuring that the definitions remain up‐to‐date and that revisions and improvements are conducted with wide consultation of professionals in relevant organizations worldwide. The haemovigilance working party and working party on transfusion‐transmitted infections are collaborating on the development of definitions and criteria for assessing suspected transfusion‐transmitted infections.ConclusionInternationally agreed definitions are available for registration and surveillance of complications of blood donation and most types of adverse reaction in patients receiving blood transfusions. For errors and incidents in the transfusion chain, further work is necessary to improve comparability of data between haemovigilance systems.

Hand Assisted Laparoscopic Donor Nephrectomy, Outcomes and Complications- A Single Center Study in a Developing Country.

Hand Assisted Laparoscopic Donor Nephrectomy, Outcomes and Complications- A Single Center Study in a Developing Country.