Donor Evaluation Research Articles

Genome-wide metabolite quantitative trait loci analysis (mQTL) in red blood cells from volunteer blood donors

The Red Blood Cell (RBC)-Omics study, part of the larger NHLBI-funded Recipient Epidemiology and Donor Evaluation Study (REDS-III), aims to understand the genetic contribution to blood donor RBC characteristics. Previous work identified donor demographic, behavioral, genetic, and metabolic underpinnings to blood donation, storage, and (to a lesser extent) transfusion outcomes, but none have yet linked the genetic and metabolic bodies of work. We performed a Genome-Wide Association (GWA) analysis using RBC-Omics study participants with generated untargeted metabolomics data to identify metabolite quantitative trait loci (mQTL) in RBCs. We performed GWA analyses of 382 metabolites in 243 individuals imputed using the 1000 Genomes Project phase 3 all-ancestry reference panel. Analyses were conducted using ProbABEL and adjusted for sex, age, donation center, number of whole blood donations in the past two years, and first ten principal components of ancestry. Our results identified 423 independent genetic loci associated with 132 metabolites (p < 5x10-8). Potentially novel locus-metabolite associations were identified for the region encoding heme transporter FLVCR1 and choline, and for lysophosphatidylcholine acetyltransferase LPCAT3 and lysophosphatidylserine 16.0, 18.0, 18.1, and 18.2; these associations are supported by published rare disease and mouse studies. We also confirmed previous metabolite GWA results for associations including N(6)-Methyl-L-lysine and protein PYROXD2, and various carnitines and transporter SLC22A16. Association between pyruvate levels and G6PD polymorphisms was validated in an independent cohort and novel murine models of G6PD deficiency (African and Mediterranean variants). We demonstrate that it is possible to perform metabolomics-scale GWA analyses with a modest, trans-ancestry sample size.

Pure Laparoscopic Versus Open Right Hepatectomy in Living Liver Donors: Graft Weight Discrepancy.

BACKGROUND Accurate volumetric evaluation of donors' livers before surgery is crucial for successful living-donor liver transplantation. However, there are few studies on the volumetric evaluation in the recently popularized pure laparoscopic donor hepatectomy method, in contrast to the number of studies for conventional donor hepatectomy. We aimed to analyze the difference between estimated graft weight and actual graft weight in pure laparoscopic donor right hepatectomy (PLDRH) and conventional donor right hepatectomy (CDRH) procedures. MATERIAL AND METHODS The medical records of 612 donors who underwent right hepatectomy in living-donor liver transplantation between January 2014 and December 2020 were retrospectively reviewed. The CDRH group targeted patients from January 2014 to October 2015, and the PLDRH group targeted patients from March 2016 to December 2020. RESULTS There were 119 and 376 donors who underwent CDRH and PLDRH, respectively. Although there was no significant difference in the estimated graft weights (P=0.994) and actual graft weights (P=0.489) between the groups, the estimated graft weights were significantly higher than the actual graft weights in both groups. However, the estimated graft weight and actual graft weight showed linear correlations in both the CDRH (r=0.81, P<0.001) and PLDRH (r=0.76, P<0.001) groups, with the CDRH group having greater linearity. CONCLUSIONS The estimates of graft weight were similar between the 2 groups. However, since the actual graft weight tended to be smaller in the PLDRH group, this should be considered before surgery.

Long-Term Outcomes of Living-Related Kidney Donation for Alport Syndrome Spectrum: A Propensity Score-Matched Analysis

Introduction: Data to guide the evaluation of living-related donor candidates for kidney transplant recipients with Alport syndrome (AS) spectrum are limited. We aimed to examine a cohort of living-related donors to recipients with AS and compare their outcomes with a control group to improve understanding of the clinical course and outcomes of living donation in this context. Methods: Living donors (LDs) of AS recipients and propensity score-matched control LDs without any family history of AS (control group) were followed for major cardiac events, death, post-donation estimated glomerular filtration rate (eGFR), and proteinuria. Results: There were 31 LDs (48.4% male), in whom relationship to AS recipient included mother (45.2%), father (32.3%), sibling (16.1%), grandparent (3.2%), and uncle (3.2%). Long-term outcomes over 10.0 (IQR, 3.0–15.0) years were evaluated in 25 and 25 LDs from study and control groups, respectively. During follow-up, 5 LDs (20.0%) in study group developed major cardiac event (acute coronary ischemia [n = 4] and severe congestive heart failure [n = 1]) after 5.5 (IQR, 4.5–10.3) years, whereas only 2 (8.0%) LDs in control group developed major cardiac events (p = 0.221). New-onset hypertension was higher in study group (56.0%) compared to the control group (16.0%) (p = 0.003). Three donors in study and 2 donors in control group who developed new-onset hypertension died during follow-up (p = 0.297). Major cardiac event rate was significantly higher in donors who developed hypertension after donation (0 vs. 28.0%, p < 0.001). There were no differences between study groups regarding last eGFR and proteinuria levels (p = 0.558 and p = 0.120, respectively). Discussion/Conclusion: Although the risk of kidney disease can be minimized by careful donor evaluation, our findings suggest that hypertension risk after the donation is higher than expected in related donors of recipients with AS.

Evaluation and characterization of indigenous rice (Oryza sativa L.) landraces resistant to brown planthopper Nilaparvata lugens (Stål.) biotype 4.

Evaluation and identification of resistant donors for brown planthopper (BPH) Nilaparvata lugens (Stål.), an economically important insect pest of rice, is a continuous process to develop new resistant rice varieties. However, several rice landraces of north-eastern India are not yet characterized for BPH resistance. In the present study, a set of 218 rice landraces were screened in both greenhouse and open-field conditions for three consecutive years, and thereafter forty selected promising entries were explored to evaluate their phenotypic and genotypic reactions against BPH biotype 4. Based on phenotypic evaluations, five landraces were identified as resistant, while 31 were moderately resistant, and grouped under the major cluster I and II, respectively, in a circular dendrogram. Antixenosis and antibiosis studies of these landraces divulged that, compared to the susceptible check variety, resistant landraces exhibited the lowest feeding rate, survival, and nymphal and adult settling, but higher frequency of unhatched eggs of BPH. Un-infested resistant landraces registered higher levels of ascorbic acid, oxalic acid and crude silica, however, elevated levels of total free amino acid, potassium and crude silica were observed under BPH herbivory. The present study focuses on identifying new donors having BPH resistance resources which could be useful in genomic studies for the development of BPH biotype 4 resistant rice varieties.

Recommendations for Evaluation and Selection of Deceased Organ Donor: Position Statement of ISCCM.

Zirpe KG, Tiwari AM, Pandit RA, Govil D, Mishra RC, Samavedam S, et al. Recommendations for Evaluation and Selection of Deceased Organ Donor: Position Statement of ISCCM. Indian J Crit Care Med 2022;26(S2):S43-S50.

Quality of life, depression and anxiety in potential living liver donors for pediatric recipients: A retrospective single center experience.

Living donor liver transplantation is a safe alternative for patients on a liver transplant list. Donor evaluation goes beyond physical variables to include social, emotional, and ethical aspects. The role of pre-donation sociopsychological evaluation of the donor candidate is as important to the success of the procedure as is the medical assessment. Success implies recovery from the operation and prompt engagement in pre-transplant professional and social activities, without leading to psychological or physical distress. Psychological profiling of potential living liver donors (PLLD) and evaluation of quality of life (QOL) can influence outcomes. To evaluate the socio-demographics and psychological aspects (QOL, depression, and anxiety) of PLLD for pediatric liver transplantation in a cohort of 250 patients. This was a retrospective cohort study of 250 PLLD who underwent psychological pre-donation evaluation between 2015 and 2019. All the recipients were children. The Beck anxiety inventory, Beck depression inventory, and 36-item short-form health survey (SF-36) scores were used to evaluate anxiety (Beck anxiety inventory), depression (Beck depression inventory), and QOL, respectively. A total of 250 PLLD were evaluated. Most of them were women (54.4%), and the mean age was 29.2 ± 7.2 years. A total of 120 (48.8%) PLLD were employed at the time of evaluation for donation; however, most had low income (57% earned < 2 times the minimum wage). A total of 110 patients (44%) did not finish the donation process, and 247 PLLD answered a questionnaire to evaluate depression, anxiety, and QOL (SF-36). Prevalence of depression was of 5.2% and anxiety 3.6%. Although most of the PLLD were optimistic regarding the donation process and never had doubts about becoming a donor, some traces of ambivalence were observed: 46% of the respondents said they would feel relieved if a deceased donor became available. PLLD had a low prevalence of anxiety and depression. The foundation for effective and satisfactory results can be found in the pre-transplantation process, during which evaluations must follow rigorous criteria to mitigate potential harm in the future. Pre-donation psychological evaluation plays a predictive role in post-donation emotional responses and mental health issues. The impact of such findings on the donation process and outcomes needs to be further investigated.

Analysis of disparities in time to allogeneic transplantation in adults with acute myelogenous leukemia

AbstractAlthough alternative donors extend transplant access, whether recipient ancestry affects the time to allogeneic transplant is not established. We analyzed the likelihood of clinically significant delays to allograft by patient ancestry in 313 adult patients with acute myelogenous leukemia (AML) who underwent transplantation. Non-European ancestry patients (n = 99) were more likely than Europeans (n = 214) to receive HLA-mismatched donor allografts (45% vs 24%). Overall, the median time from transplant indication to allograft was 127 days (range, 57-1683). In multivariable analysis, non-Europeans had an increased risk of prolonged indication to transplant time >180 days owing to significant delays in indication to consult >90 days and consult to transplant >120 days. Compared with recipients of HLA-matched unrelated donors (URDs), HLA-mismatched adult donor recipients were at an increased risk of delayed indication to transplant, whereas HLA-identical sibling and cord blood recipients were at a lower risk. Subanalysis showed more indication to transplant delays >180 days in non-European (44%) vs European (19%) 8/8 URD recipients. Finally, the pandemic further exacerbated delays for non-Europeans. In summary, although non-European patients with AML are less likely to receive 8/8 URDs as expected, if they do, their transplants are delayed. HLA-identical siblings and cord blood facilitate the fastest transplants regardless of patient ancestry, whereas other adult donor transplants are delayed. Strategies to mitigate referral barriers, hasten donor evaluation, and use all alternative donor sources are critical to ensure timely transplantation for patients with AML.

Predictors of hepatic steatosis in living liver donors

Fatty liver disease (steatosis) is considered a risk factor in donor liver transplantation (LT). Macrosteatosis (&gt;50%) is associated with primary graft dysfunction and may reduce long-term recipient survival.Objective: to identify predictors of macrovesicular steatosis (&gt;50%) by analyzing donor characteristics.Materials and methods. The retrospective study included 525 potential liver donors between January 1, 2019 and December 31, 2020. Clinical and morphological characteristics of donors were studied using logistic regression and receiver operating characteristic (ROC) analysis. Threshold values of parameters demonstrating statistical significance in multivariate analysis as predictors of &gt;50% hepatic steatosis were obtained by ROC analysis based on calculation of the optimal cutoff point.Results. Diabetes mellitus (DM), cause of donor’s death (traumatic brain injury), alanine transaminase (ALT) &gt;90 units/L and aspartate transaminase (AST) &gt;110 units/L were predictors of &gt;50% steatosis, revealed by time-zero biopsy in the donor. Almost identical sensitivity and specificity indicators were determined in ROC analysis for liver enzymes – ALT and AST – which were 69.1 and 80.6; 72.2 and 81.1, respectively. Given the obtained values, we can say that with elevated levels of liver enzymes in the donor’s blood, there is a high degree of probability of liver parenchymal damage, but low sensitivity indicates possible multifactoriality of liver damage, and fatty liver disease may be one of the factors, but there may also be no damage to the liver parenchyma. At the same time, the rather high specificity revealed in ROC analysis for liver enzymes is a reliable sign of the absence of fatty liver disease at enzyme values less than the threshold.Conclusion. The thresholds established for ALT and AST and their corresponding levels of sensitivity and specificity indicate that these parameters have a relatively low predictive level in the context of the presence of severe fatty liver disease in a donor. This allows, nevertheless, to use models built on their basis as screening models in the primary evaluation of liver donors.

Dengue Transmission From Donor to Recipient After Deceased Donor Liver Transplant; Report of a Case and Review of Literature: Is Liver a Privileged Organ?

Nonvector transmission of dengue virus via organ transplantis rare.We report a probable case of dengue virus transmission via deceased donorlivertransplant. The donor was asymptomatic for dengue infection, and the liver recipient developed fever and thrombocytopenia 8 days after transplant. The recipient's testresults were positive forthe antigen for nonstructural protein 1 and for immunoglobulin M; however, donor serum samples were not available. Other transplant recipients (renal allograft) also showed dengue-positive test results during the same period, and these patients eventually died. Dengue illness in the liver recipient was severe and associated with shock and cardiomyopathy that required mechanical ventilation, intensive care, and cessation of immunosuppression; however, the patient subsequently improved and was discharged. This case highlights the importance of a high index of suspicion for dengue infection in the presence of graft dysfunction in dengue-endemic areas like India, as well as the importance of the test for the nonstructural protein 1 antigen during dengue outbreaks. These considerations should be included on the standard evaluation of solid-organ transplant donors.

Fully automated preoperative liver volumetry incorporating the anatomical location of the central hepatic vein

The precise preoperative calculation of functional liver volumes is essential prior major liver resections, as well as for the evaluation of a suitable donor for living donor liver transplantation. The aim of this study was to develop a fully automated, reproducible, and quantitative 3D volumetry of the liver from standard CT examinations of the abdomen as part of routine clinical imaging. Therefore, an in-house dataset of 100 venous phase CT examinations for training and 30 venous phase ex-house CT examinations with a slice thickness of 5 mm for testing and validating were fully annotated with right and left liver lobe. Multi-Resolution U-Net 3D neural networks were employed for segmenting these liver regions. The Sørensen-Dice coefficient was greater than 0.9726 ± 0.0058, 0.9639 ± 0.0088, and 0.9223 ± 0.0187 and a mean volume difference of 32.12 ± 19.40 ml, 22.68 ± 21.67 ml, and 9.44 ± 27.08 ml compared to the standard of reference (SoR) liver, right lobe, and left lobe annotation was achieved. Our results show that fully automated 3D volumetry of the liver on routine CT imaging can provide reproducible, quantitative, fast and accurate results without needing any examiner in the preoperative work-up for hepatobiliary surgery and especially for living donor liver transplantation.

Optimizing pre-donation physiologic evaluation for enhanced recovery after living liver donation - Systematic review and multidisciplinary expert panel recommendations.

While preoperative physiologic evaluation of live liver donors is routinely performed to ensure donor safety and minimize complications, the optimal approach to this evaluation is unknown. We aim to identify predonation physiologic evaluation strategies to improve postoperative short-term outcomes, enhance donor's recovery, and reduce length of stay. We also aim to provide multidisciplinary expert panel recommendations. Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central. The systematic review followed PRISMA guidelines, and the recommendations were formulated using GRADE approach and experts' opinion. The search included retrospective or prospective studies, describing outcomes of physiologic evaluation predonation. The outcomes of interest were length of stay, postoperative complications (POC), recovery after donation, and mortality. PROSERO protocol ID CRD42021260662. Of 1386 articles screened, only three retrospective cohort studies met eligibility criteria. Two studies demonstrated no impact of age (<70 years) on POC. Increased body mass index's (BMI) association with POC was present in one study (23.8vs 21.7kg/m2 , OR 1.67 (1.14-2.48), P=.01) and absent in another (<30vs 30-35kg/m2 , P=.61). One study demonstrated decreased risk for postdonation subclinical hepatic dysfunction in donors with higher normal platelet count (PLT). None of the studies noted donor death. Given the scarce data on predonation physiologic testing, the expert panel recommended a battery of tests to guide clinical practice and future investigations. Advancing age (60-69 years) is not a contraindication for liver donation. There is insufficient evidence for a specific predonation BMI cut-off. Abbreviated predonation physiologic testing is recommended in all candidates. Comprehensive testing is recommended in high-risk candidates while considering the pretest probability in various populations (Quality of evidence; Low to Very Low | Grade of Recommendation; Strong).

Transplantation in a Recipient with Crossed Renal Ectopia and Donor with Early Branching of the Left Renal Artery - A Case Report

Comprehensive preoperative evaluation of potential donors is crucial for selecting the right donor. Early segmentary arterial branching is present in 10%–12% of cases. Expert surgeons require at least 1 cm of main donor renal artery to clamp and properly anastomose the artery in the recipient. We report a case of live-related renal transplantation wherein the recipient had a crossed renal ectopia and the donor had early branching of the left renal artery (&lt;5 mm from the aorta).

Ex vivo Renal Bench Pyelolithotomy for Renal Calculi in Live Related Kidney Transplant

Background and Objectives: Bench surgery performed just after donor nephrectomy is known as ex vivo Bench Surgery. We present a case series of Bench Pyelolithotomy in donor's kidney just before transplantation with our surgical experience and follow-up results. Patients and Methods: Fifteen ex vivo Bench Pyelolithotomy on renal graft was performed by an experienced surgeon from January 2018 to August 2020. All these patients underwent standard donor evaluation and metabolic workup. Pre- and post-operative parameters were analyzed for technical feasibility, intraoperative and postoperative complications, stone clearance, and stone recurrence rate. Results: All 15 donors were females with a mean age of 44 years. The mean stone size was 14.3 mm (range 5–30 mm). Stone extraction by pyelolithotomy on the bench was successfully performed, and a stone-free status was accomplished just before the transplantation. Complete stone clearance was achieved in all cases. Mean cold ischemia time was 32 min. Postoperatively, patients were stable with average urine output of 490 ml/h. All patients are in regular follow-up with graft functioning well measured with respect to serial serum creatinine and urine output. Conclusions: Bench surgery is safe, less time-consuming, and equally effective for a stone-bearing renal donor kidney without compromising renal allograft function.

CLINICAL AND GENETIC FACTORS ASSOCIATED WITH OSTEONECROSIS IN BRAZILIAN SICKLE CELL DISEASE PATIENTS: CASE-CONTROL STUDY

Sickle cell disease (SCD) includes a group of hereditary disorders characterized by mutations on the gene that codes hemoglobin (Hb). Patients with SCD are vulnerable to vascular occlusion within bone tissue, which may result in complications such as medullary infarction in the diaphysis and osteonecrosis (ON), which affects the epiphysis. Both processes may result in substantial morbidity and pain for the patients. This study aims to identify factors associated with the development of ON in patients with SCD. A nested case-control study of patients with SCD from six Brazilian blood centers, participating in the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) Brazil SCD Cohort was performed. A history of ON was abstracted from participants medical record using standardized definitions to define cases. Cases were matched to controls without ON in a 1:3 ratio matched by age, genotype and blood center using propensity score. A genome-wide association study (GWAS) was conducted to identify single nucleotide polymorphisms (SNPs) associated with ON. There were 307 ON cases in the 2793 cohort participants (prevalence 11%) who were compared to 921 controls without ON. The most common locations of ON were the proximal femur (91.2%) and proximal humerus (7.7%). Variables independently associated with ON in a multivariable model included patients with more severe sickle cell disease (SS, Sβ0, severe Sβ+ or SD genotypes, OR 1.81, 95% CI 1.11; 2.95 compared to less severe genotypes SC/SB+), higher values of hemoglobin (OR 1.25, 1.12; 1.39), hospitalization by pain crisis (OR 1.44, 1.06; 1.94), chronic transfusion treatment (OR 1.53, 1.10; 2.11), acute chest syndrome (OR 1.46, 1.06; 2.00), sepsis/bacteremia (OR 1.67, 1.03; 2.70) and osteomyelitis (OR 1.72, 1.05; 2.80). Increased indirect bilirubin and stroke were associated with a lower chance of developing ON (OR 0.81, 0.71; 0.93 for indirect bilirubin and OR 0.42, 0.24; 0.72 for stroke). The GWAS suggested an association of ON with the gene doublesex and mab-3 related transcription factor 2 (DMRT2) (p < 5 × 10−8). SCD is the most common monogenic disorder in Brazil and is associated with multisystem complications. Orthopedic complications represent 31.0% of these manifestations, with ON being the most common non-infectious joint complication. Knowing the risk factors that precede ON may help to diagnose and treat it early in order to improve the quality of life of patients. The few studies carried out in the Brazilian population on the occurrence of ON in SCD patients had small sample sizes. A higher chance of having ON was associated with patients with higher hemoglobin levels, more hospitalizations for pain crises and acute chest syndrome. Also the relationship of treatment with chronic transfusion, sepsis/bacteremia and osteomyelitis were associated with ON, which may indicate that the occurrence of this complication may be multifactorial or related to the severity of SCD. SNPs near DMRT2, a gene previously associated with skeletal disorders, rib malformation in a newborn and transition of endochondral bone formation, showed an altered risk for ON.

Does modification of portal pressure and flow enhance recovery of the recipient after living donor liver transplantation? - A systematic review of literature and expert panel recommendations.

Portal inflow modulation (PIM) aimed at reducing portal hyperperfusion is commonly used in in living donor liver transplantation (LDLT) to reduce the risk of small-for-size syndrome (SFSS). Many different techniques, both pharmacological and surgical have been used for this purpose. There is however, little consensus on the best method of PIM, its exact role in preventing SFSS and on early post-LDLT recovery. To identify whether modifications of portal pressures and flows enhance recovery after LDLT and to provide international expert panel recommendations. Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central. Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. CRD42021260997 RESULTS: 594 articles were identified through databases' search. Of the 24 included for a final review by the working group (WG), there were 5 randomized controls trials, 4 prospective studies and 15 retrospective series. Six outcomes measures which were likely to influence early recovery after LDLT, especially in small-for-size grafts (SFSG) were shortlisted. These included acute kidney injury, SFSS, morbidity including sepsis, length of ICU and hospital stay, morbidity of the PIM technique and overall mortality. The WG noted that PIM in this subset of LDLT recipients had a beneficial effect on all the outcomes measures. Considering all decision domains, the panel recommends pre- and intraoperative actual graft weight validation, portal pressure/flow measurements, and a comprehensive donor evaluation for the determination of potentially small-for-size/ small-for-flow grafts as mandatory . (QUALITY OF EVIDENCE: MODERATE | GRADE OF RECOMMENDATION: : Strong) Pharmacological PIM helps improve early renal function in LDLT recipients. (Quality of Evidence: High | Grade of Recommendation: Strong) In selected patients with SFSG, PIM helps reduce SFSS/EAD and sepsis. (Quality of Evidence: Moderate | Grade of Recommendation: Strong) PIM in the form of splenectomy has increased morbidity compared to splenic artery ligation (SAL). (Quality of Evidence: Low | Grade of Recommendation: Strong) In LDLT recipients with SFSG, PIM may help reduce morbidity/mortality. (Quality of Evidence: Low | Grade of Recommendation: Strong) In LDLT recipients with SFSG, modification of portal pressures and flows enhances recovery after LDLT. (Quality of Evidence: Moderate | Grade of Recommendation: Strong) This article is protected by copyright. All rights reserved.

CLINICAL PREDICTORS OF VASO-OCCLUSIVE PAIN HOSPITALIZATION IN PATIENTS WITH SICKLE CELL DISEASE (SCD)

Vaso-occlusive painful episodes (VOE) are the most common clinical manifestation of sickle cell disease (SCD) and the primary reason for hospitalizations and emergency visits. This project aims to identify the clinical predictors of VOE hospitalization in adult participants of the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) Brazil SCD Cohort. The REDS-III Brazil SCD Cohort enrolled participants from 2013 to 2015 who were followed until 2018. Participants were randomly selected as eligible from public blood centers in 6 cities. Medical records were reviewed to abstract clinical data including the indications for all hospitalizations that occurred from one year prior to enrollment through the end of follow up. Adult cohort participants with 3+ hospitalizations per year due to VOE (cases) were compared to controls with less frequent VOE admissions to identify predictors of frequent VOE. Of the 2793 participants enrolled in the cohort, 184 (6.7%) had 3+ VOE admissions per year (5.5% of 1330 children <18yr and 7.5% of 1453 adults). Compared to adults with <3 VOE admissions/ year, the adults with frequent VOE had higher white blood cell counts (11,566 vs. 98,659 cells/uL), platelet counts (389,500 vs 357,333 cells/uL) and lower hemoglobinF (4.4% vs 6.9%) and were more likely to have received red blood cell transfusions (80% vs. 41%) and hydroxyurea (60% vs. 49%) in the past year. Acute chest syndrome, bacteremia, and asthma were also more common in adult cases compared to controls (83% vs 61%, 16% vs 8% and 17% vs 8%, respectively). Independent predictors of 3+ VOE admissions/year in multivariable models included higher white blood cell (OR 1 [1.000-1.001], history of acute chest syndrome (OR 2.8 [1.581-5.202] and treatment with hydroxyurea (OR 1.8 [1.123-3.038]. Frequent hospitalizations due to VOE are a marker of severe SCD used to identify patients for disease modifying therapy or even curative therapies such as bone marrow transplant. Understanding the significant predictors of frequent VOE in adults may identify other surrogate markers of severe disease that can be used to target therapies for high risk individuals. In this multi institutional cohort of SCD, white blood cell count and a history of acute chest syndrome were identified as significant independent predictors of frequent VOE while the association of hydroxyurea likely reflects treatment with this disease modifying therapy for frequent pain. Individuals with high white blood cell counts and acute chest syndrome should have close follow up to be monitored frequently and considered for early and aggressive treatment of pain as well as other disease modifying therapies.

The psychological examination and evaluation of unrelated kidney donors in Israel: a suggested model

ABSTRACT Altruistic organ donors represent a special population when compared to related living donors, requiring appropriate protection and attention regarding informed consent and psychological aspects related to the donation. Following the introduction of the Israeli Transplant Law of 2008, a retrospective study of altruistic donor files revealed that important psycho-diagnostic aspects were not emphasized in the existing guidelines. Thus, a new tool was formulated which incorporated those elements, including assessment of emotional maturity, ego strength, degree of interest in others, reality testing, degree of pressure to donate, anxiety, dysphoric and depressive factors and the ability to function under stress. The study examined 598 cases reviewed by the Central Evaluation Board over the period May 2008 – June 2016. Overall, 23.4% candidates were disqualified of whom 41% were declined on grounds related to mental health. Most of the donors were rejected based on 3–5 elements. Of these, a deficient assessment of reality in ambiguous situations, lack of emotional maturity, and lacking or partial ability to function effectively under stress, were most commonly cited as reasons for rejection. This model allowed the detection of important conditions previously not incorporated into existing guidelines and may serve as a model for other transplantation programs worldwide.

Use of Donor with Wolff-Parkinson-White Syndrome in Heart Transplantation: Report of Two Cases and Review of Literature

Abstract: Donor shortage is a major limitation of heart transplantation. The use of high risk or marginal donors, donors with minor or correctable heart diseases are alternatives to face this problem. When identified in the evaluation, donors with Wolff-Parkinson-White syndrome (WPWS) are usually discarded for cardiac transplantation. In the literature, there are eight articles reporting single case of transplantation with donor with this syndrome. In this series, the management of recipient varied: clinical treatment, intraoperative donor heart anomalous band ablation and postoperative ablation. Results were good in all the eight cases. In the present article, we report two cases of cardiac transplantation with donors with WPWS, one treated clinically and the other one submitted to postoperative ablation. Based in the present experience and limited to eight reported cases, it seems that this type of donor heart can be successfully transplanted. It is controversial the management strategy for these patients. Careful evaluation of heart donor should be done regarding the presence of WPWS.

Living kidney donor evaluation is associated with early identification of life-changing diagnoses in potentially healthy donor candidates.

In order to ensure eligibility for living kidney donation, donor candidates undergo a thorough medical evaluation. This process might reveal hitherto undetected medical conditions, leading to refusal of the kidney donor candidate. Detection of such conditions may, however, also have a lifesaving effect. We report on 13 years of data from our living donor transplantation program on kidney donor candidates who were diagnosed with major medical conditions during evaluation. We performed a retrospective analysis of living kidney donor candidates who attended our transplant center between January, 2007 and December, 2019. The main focus was on newly diagnosed medical conditions that required immediate medical attention and their prognostic significance. Of the 436 donor candidates who were evaluated for living kidney donation at our transplant center, 192 (44%) were accepted, while 244 (56%) were excluded from donation. Interestingly, 81 (33.1%) of the ineligible donor candidates were newly diagnosed as having a medical condition that required immediate attention. While 45 (18.5%) candidates were newly diagnosed with diabetes or prediabetes, 12 (4.9%) candidates had hitherto undetected malignancies, 10 candidates (4.1%) cardiac disease, five (2.0%) hypertension with end-organ damage, and four (1.6%) suffered from kidney disease. The remaining four candidates (1.6%) were diagnosed with gastrointestinal diseases, and one candidate (.4%) had an endocrine disorder. A comprehensive evaluation process for living kidney donation facilitates the identification of life-changing diagnoses in a significant proportion of candidates and secures immediate medical attention.

Incidence and correlates of testicular pain after kidney donation

Some kidney donors experience testicular pain after donation. We studied the presence of testicular pain in male donors from The Renal and Lung Donor Evaluation (RELIVE) Study which investigated short- and long-term outcomes of 8922 kidney donors. Of the 2551 male donors with available testicular status data included in the analysis, 54 (2.12%) developed testicular pain 19 days (IQR 7, 40) after donation: 34 had testicular pain only, 6 had epididymitis, and 14 had both. Donors developing pain were 4 years older and pain occurred more often in those undergoing laparoscopic nephrectomy; 3.6% vs. 1.1% for open nephrectomy. Non-Hispanic White ethnicity and undergoing laparoscopic nephrectomy were associated with increased risk of testicular pain; RR 5.56 (95% CI 1.35, 22.84), p=0.02, RR 3.11 (95% CI 1.71, 5.65), p&amp;lt;0.001, respectively. Laterality of nephrectomy, however, was not associated with increased risk of testicular pain. Testicular pain is not infrequent and contrary to previous reports, left nephrectomy was not associated with a higher incidence of testicular pain. Donors should be routinely asked about this potentially bothersome complication.