Open Donor Research Articles

A Prospective Study Comparing Quality of Life after Laparoscopic Donor Nephrectomy versus Open Donor Nephrectomy.

Laparoscopic donor nephrectomy (LDN) has advantages over open donor nephrectomy (ODN), with less bleeding and pain, and earlier discharge. However, the quality of life (QOL) has not been compared between these techniques. All consecutive donors undergoing left LDN or ODN from 2013 to 2015 at our center were included. The donors' QOL was measured with the brief World Health Organization QOL (WHOQOL-BREF) and the Hospital Anxiety and Depression Scale (HADS) questionnaires preoperatively and at 3 and 6 months postoperatively. Cosmesis was measured by the body image questionnaire, and patient satisfaction was scored on a verbal rating scale at 3 and 6 months. Of the 264 donors, 228 met the inclusion criteria (100 - LDN and 128 - ODN). The LDN group showed no difference in WHOQOL-BREF scores at 3 months, and significant improvements in the psychological and social domains at 6 months versus the baseline. The ODN group showed a significant decrease in the physical, psychological, and environmental domains at 3 and 6 months versus the baseline. Compared with the ODN group, the LDN group had better QOL scores at 3 and 6 months in all domains. The responses to the HADS questionnaire were similar between the groups at all time points. The mean body image, cosmesis, and satisfaction scores were significantly better in the LDN group. LDN minimized the negative effects of surgery on the donors' QOL, with improvements in the long-term psychological and social aspects versus the baseline. LDN was more cosmetic and was associated with higher satisfaction than ODN.

A Simple Rapid Method for Measuring Liver Steatosis Using Bioelectrical Impedance.

Easy measurement of liver steatosis without pathological diagnosis may help improve donor surgery efficiency and increase the chances of organ donations. We analyzed the correlations between bioelectrical impedance (BI) in human livers, liver fat content, and pathological findings. Sixteen tumor-free liver specimens resected during elective oncological surgery were analyzed. All samples were stored in ice chilled saline before BI measurement. The BI measurement was performed using a device with the tetrapolar circuit method in which the current and voltage electrodes are independent. Liver cholesterol and triglyceride levels were investigated from the same specimen using the Soxhlet extraction method. Pathological findings were examined by counting the number of hepatocytes with fatty changes per high-power field. The median liver steatosis percentage was 0.4%. The liver steatosis percentage was significantly correlated with the intrahepatic triglyceride content (r=0.82, p<0.001). Linear regression of the measurements and predicted values yielded an r2 of 0.63 between the BI at 100 kHz and liver steatosis, indicating reasonable agreement (p<0.001). BI analysis is a simple, non-invasive method that can be easily applied to evaluate liver steatosis.

Use of a Mini-subcostal Incision for Living Donor Right Hepatectomy: A Series of 189 Consecutive Cases

Introduction: Living donor hepatectomy is now a well-established surgical procedure. However, a large abdominal incision is still required, which results in a large permanent scar, especially for a right liver graft. Minimally invasive surgery has been widely used for donor operations. This study aimed to determine the safety and feasibility of mini- subcostal incision for living donor right hepatectomy. Methods: We reviewed 1456 patients who underwent living donor right hepatectomy (LDRH) between January 2015 and December 2019 at Asan Medical Center. We performed 1:1 propensity score matching of the LDRH with mini- subcostal incision and the LDRH with conventional incision (J-shape), with 144 patients subsequently included in each group. Results: The total operation time (P =0.018) were longer in the mini- subcostal incision group. None of the donors required intraoperative transfusion or experienced any irreversible disabilities or mortalities. The length of postoperative hospital stay was significantly shorter in the mini- subcostal incision group (P =0.043). The rate of complications in donors was similar between the 2 groups. Graft steatosis were independent predictors of postoperative morbidity after LDRH with mini- subcostal incision on multivariable analysis. Vascular and biliary complication rates in recipients were similar between the 2 groups. Conclusions: LDRH with mini- subcostal incision is feasible when performed at an experienced living donor liver transplantation center. Donor safety is paramount in living donor liver transplantation. In centers with difficulties in performing pure laparoscopic donor right hepatectomy, LDRH with mini-subcostal incision can be an alternative to pure laparoscopic donor right hepatectomy.

Cost-effective and Time-saving Three-Dimensional (3-D) Printing Protocol of Intra-abdominal Cavity of Liver Transplantation Recipient to Minimize Risk of Large-for-Size Syndrome: The Initial Experience

Introduction: The application of 3-D printing has been increasing and we invented a protocol for a cost-effective and time-saving 3-D model of intra-abdominal cavity to prevent large-for-size syndrome during liver transplantation. Methods: 3-D printing of the intra-abdominal cavity were performed on adult recipients with small cavity and pediatric patients scheduled for transplantation between July 2020 to July 2021. To reduce time and cost, boundaries of intra-abdominal cavity were outlined based on computed tomography of the recipient with a 1 to 3cm distances. The printed models of adult patients were used for comparing the size to the graft during deceased donor operation while models of pediatric patients were used for directly comparing the size to the 3-D printed graft of living donors. Results: Median time for model production was 10.8 hours (IQR 9.5–11.8) and estimated median cost for the filament used was 1.64 dollars (IQR 1.50–1.74). Transplantation of reduction graft (n=1), whole liver transplantation after giving up the previous donor match (n=2), and waiting for another donor match after giving up first matched donor (n=1) were resulted using 3-D printed model in adult patients. Among pediatric patients, two cases were resulted in reduction graft as planned during preoperative planning and three cases resulted in extended left lateral graft transplantation. All the cases ended up with successful closure of the abdomen with no large-for-size syndrome. Conclusion: Our cost-effective and time-saving 3-D printed model was proved to be useful for preventing large-for-size syndrome in small adult recipients and pediatric patients.

Complete Transition from Open to Laparoscopic Living Donor Hepatectomy: 8-Year Experience with More than 500 Laparoscopy Cases

Background: We designed this study to comprehensively review the laparoscopic living donor liver transplantation of our institution. Method: Living donor liver transplantation cases performed since the first laparoscopic living donor hepatectomy, until reaching 500th laparoscopic cases were reviewed. Laparoscopic cases were compared to open cases in a yearly basis, regarding the donor selection, donor morbidity, recipient morbidity and operation time. Results: During the period of May 2013 to July 2021, 754 living donor liver transplantations, 506 laparoscopic and 247 open cases were performed. Complete transition to laparoscopy was achieved in 2020, performing 112 transplantations laparoscopically. Variation of bile duct type of donor became similar in 2018. (P=1.000) There were no differences in the occurrence of grade III complication of donor and recipient throughout the study period. Mean donor operation time were significantly longer in the laparoscopy group which became similar since 2017 (P=0.313) There were no differences in the mean operation time of recipients throughout the study period. Regarding graft survival and overall survival of the recipient, there were no difference between the two group throughout the period. Conclusions: In the initial period, donor selection existed especially for bile duct variation maintaining the safety of the donor and recipient. However, with accumulated experience, complete transition to laparoscopy became possible after 7 years of practice.

European Liver Transplant Registry: Donor and transplant surgery aspects of 16,641 liver transplantations in children.

The European Liver Transplant Registry (ELTR) has collected data on liver transplant procedures performed in Europe since 1968. Over a 50-year period (1968-2017), clinical and laboratory data were collected from 133 transplant centers and analyzed retrospectively (16,641 liver transplants in 14,515 children). Data were analyzed according to three successive periods (A, before 2000; B, 2000-2009; and C, since 2010), studying donor and graft characteristics and graft outcome. The use of living donors steadily increased from A to C (A, n=296 [7%]; B, n=1131 [23%]; and C, n=1985 [39%]; p=0.0001). Overall, the 5-year graft survival rate has improved from 65% in group A to 75% in group B (p<0.0001) and to 79% in group C (B versus C, p<0.0001). Graft half-life was 31 years, overall; it was 41 years for children who survived the first year after transplant. The late annual graft loss rate in teenagers is higher than that in children aged <12 years and similar to that of young adults. No evidence for accelerated graft loss after age 18 years was found. Pediatric liver transplantation has reached a high efficacy as a cure or treatment for severe liver disease in infants and children. Grafts that survived the first year had a half-life similar to standard human half-life. Transplantation before or after puberty may be the pivot-point for lower long-term outcome in children. Further studies are necessary to revisit some old concepts regarding transplant benefit (survival time) for small children, the role of recipient pathophysiology versus graft aging, and risk at transition to adult age.

Pure Laparoscopic Living Donor Hepatectomy With/Without Fluorescence-Assisted Technology and Conventional Open Procedure: A Retrospective Study in Mainland China

Background: The application of laparoscopy in donor liver acquisition for living donor liver transplantation (LDLT) has become increasingly popular in the past decade. Indole cyanide green (ICG) fluorescence technique is a new adjuvant method in surgery. The purpose was to compare the safety and efficacy of laparoscopic and open surgery in living donor left lateral hepatectomy, and to evaluate the application of ICG in laparoscopy.Methods: Donors received LDLT for left lateral lobe resection from November 2016 to November 2020 were selected and divided into pure laparoscopy donor hepatectomy (PLDH) group, fluorescence-assisted pure laparoscopy donor hepatectomy (FAPLDH) group and open donor hepatectomy (ODH) group. We compared perioperative data and prognosis of donors and recipients. Quality of life were evaluated by SF-36 questionnaires.Results: The operation time of PLDH group (169.29 ± 26.68 min) was longer than FAPLDH group (154.34 ± 18.40 min) and ODH group (146.08 ± 25.39 min, p = 0.001). The blood loss was minimum in FAPLDH group (39.48 ± 10.46 mL), compared with PLDH group (52.44 ± 18.44 mL) and ODH group (108.80 ± 36.82 mL, p=0.001). The post-operative hospital stay was longer in PLDH group (5.30 ± 0.98 days) than FAPLDH group (4.81 ± 1.03 days) and ODH group (4.64 ± 1.20 days; p = 0.001). Quality of life of donors undergoing laparoscopic surgery was better.Conclusion: Laparoscopic approaches for LDLT contribute to less blood loss, better cosmetic satisfaction. The fluorescence technique can further reduce bleeding and shorten operation time. In terms of quality of life, laparoscopic surgery is better than open surgery. Laparoscopy procedure for living-donor procurement with/without fluorescence-assist can be performed as safely as open surgery.

Pure Laparoscopic vs. Open Right Hepatectomy in Living Liver Donors: Bench-Surgery Time.

Background: Recently, there have been several reports on pure laparoscopic donor right hepatectomy (PLDRH), but the effect of pure laparoscopy on bench surgery has not been evaluated. This study aimed to compare bench-surgery time between PLDRH and conventional donor right hepatectomy (CDRH).Methods: We retrospectively reviewed the medical records of 758 live liver donors between January 2012 and December 2019. We divided the patients into two groups: between January 2012 and September 2015, when we exclusively performed CDRH, and between March 2016 and December 2019, when PLDRH was standardized. We excluded all other types of graft donor hepatectomy, laparoscopic assisted donor hepatectomy, and cases with no recorded data.Results: In total, 267 donors were included in the PLDRH group and were compared with 247 donors in the CDRH group. Similar proportions of graft vascular variations were observed between the two groups. The mean bench-surgery time was longer in the PLDRH group than in the CDRH group (49.3 ± 19.9 vs. 39.5 ± 17.5 min; P < 0.001).Conclusion: The bench-surgery time was longer in the PLDRH group than the CDRH group, regardless of whether the vascular network was reconstructed. Expertise in bench-surgery as well as donor surgery and recipient surgery is mandatory for PLDRH to be safe and feasible.

Laparoscopic donor nephrectomy: technique and outcome, a single-center experience

BackgroundLaparoscopic donor nephrectomy (LDN) has been established as a surgical standard for living kidney donation. The aim of this work is to report our own experience with LDN regarding outcome and technique.MethodsWe prospectively identified 110 LDN cases between May 2017 and April 2020. Donor case files and operative notes were analyzed for age, sex, laterality, body mass index, warm ischemia time (WIT), intraoperative and postoperative complications, operative time, and length of hospital stay (LOS). Data were analyzed using SPSS version 10 (SPSS: An IBM Company, IBM Corporation, Armonk, NY, the USA).ResultsThe mean age was 38 years, and 77% were males. Three cases (2.72%) required conversion to conventional open donor nephrectomy (ODN). Nevertheless, none of cases required intraoperative blood transfusion. The mean WIT was 2.6 min. Two cases (1.8%) developed major vascular injury (Clavien grade IIIb) and required conversion to ODN. Postoperatively, one patient (0.9%) needed transfusion of one unit of packed RBCs (Clavien grade II). The mean LOS was 2 days. Most common early postoperative complication was ileus (Clavien grade II) that developed in 4 (3.6%) cases. Incisional hernia (Clavien grade IIIb) was encountered in two (1.8%) cases. Two (1.8%) cases developed wound infection at the incision site and treated conservatively (Clavien grade I).ConclusionsLDN is a safe technique with accepted intraoperative and postoperative morbidity. It offers short hospital stay, better cosmesis and early convalescence. In experienced hands, it can effectively deal with various vascular and ureteral anomalies without compromising early graft function.

Laparoscopic Living-Donor Nephrectomy of a Horseshoe Kidney: A Case Report and Review of the Literature

We present the case of a living-donor nephrectomy of a horseshoe kidney. The recipient was a 33-year-old male with a history of end-stage renal disease secondary to IgA nephropathy. The donor was his 33-year-old partner who on preoperative cross-sectional imaging was found to have a horseshoe kidney with a single artery, vein and ureter. The donor operation was performed using a laparoscopic hand-assisted technique with transection of the interpolar fibrotic band using a stapler device. The backtable organ preparation was performed in a standard fashion with addition of a reinforcing hemostatic suture of the stapled fibrotic band. The donated kidney was transplanted extraperitoneally in the right iliac fossa of the recipient. The patient had an unremarkable postoperative course and was discharged home on post operative day 2 with normalizing renal function. To our knowledge, this is the first living donor nephrectomy of a horseshoe kidney performed using a laparoscopic hand-assisted technique.

Is Laparoscopic Technique Suitable for Initial Experience in Live Donor Nephrectomy? Results of The First 51 Cases

Objective: Laparoscopic donor nephrectomy is included in advanced laparoscopic surgical procedures and is the most preferred method for live donor nephrectomy. It is discussed that teams who do not have experience with live donor nephrectomy prefer the laparoscopic method for the first experience in kidney transplantation. The present manuscript is aimed to present the results of laparoscopic live donor nephrectomy who’s the first 51 cases of a surgical team without any experience of open donor nephrectomy. Method: The medical records of donor nephrectomy which laparoscopic surgery was performed between April 2019-August 2020 reviewed retrospectively. Demographic features, routine transplantation preoperative data, donor nephrectomy side and reasons, surgical technique details, operation time, warm ischemia time, postoperative laboratory parameters, hospitalization time, early morbidity results were evaluated in detail. Result: Results of 51 donors between the specified dates were evaluated. The mean age of the patients was 44.6 ± 11.6 (22-69) years. The patients’ K / E ratio was 25/26. The number of patients with BMI⩾30 was 14 (27.4%). Right nephrectomy was performed on ten donors (19.6%). The mean operative time of the patients was 130 min. (120-160), and the mean warm ischemia time was 149 sec. (113-180). Postoperative complications were in 4 patients (7.8%). Conclusion: The laparoscopic method for live donor nephrectomy may be applied in safe from the initial stage by teams with advanced minimally invasive surgery experience.

Procurement-related liver injury for transplantation: an analysis of the risk factors and consequences in an Australian transplant centre.

Liver transplantation is an established treatment for liver failure, and its success relies on the quality of the donated organ amongst other factors. Studies on procurement-related liver injury (PRLI) are few and some may not apply to modern-day practice. This is the first Australian study examining risk factors and consequences of PRLI. The Victorian Liver Transplant Unit database was examined for deceased liver donors from 2010 to 2017. Information regarding the donor, retrieval and subsequent transplantation was obtained. PRLI details were sought from the 'organ retrieval report form'. PRLI risk factors and their complications were analysed. A total of 420 transplants were included, with 45 injuries in 44 livers (10%), and significant injuries were observed in 4%. Variant anatomy was associated with an increased risk of PRLI (11% vs. 2%, p< 0.001). Complication rates were not significantly different between livers with and without PRLI however a reduction in early graft survival was observed. This study shows that PRLI is common, and that variant anatomy is associated with an increased risk of injury. Appropriate feedback and benchmarking are important to maintain a high quality in donor surgery.

Auricular field nerve stimulation using the NSS-2 BRIDGE® device as an alternative to opioids following kidney donor surgery.

The purpose of this study was to investigate the role that the NSS-2 BRIDGE® device, an auricular field nerve stimulator, may play in reducing opioid requirement and pain in kidney donor surgery. It was not a randomized study. Electrophysiologic studies have demonstrated that the stimulation of the cranial nerves produced by the NSS-2 BRIDGE® device modulates the ascending/descending spinal pain pathways, especially at the level of the limbic system. The design compared the effects of the NSS-2 BRIDGE® device (NSS 2-BRIDGE® device group; n=10) to a control group (n=10). In both groups, the surgery was performed using the same standard enhanced recovery after surgery protocol based on the use of a multimodal analgesic approach. For the active treatment group, the NSS-2 BRIDGE® device was placed in the post anesthesia care unit. The primary endpoint was opioid requirement (oral morphine equivalent, OME in mg) at 24h post-surgery. Secondary endpoints included pain (0-10), at 24 and 48h, time to discharge from the recovery room, incidence of post-operative nausea and vomiting at 24h, time to oral intake, time to ambulation, and time to discharge from the hospital. Data was analyzed using unpaired t-test and presented as mean ± standard deviation. Compared to control, the use of the NSS-2 BRIDGE® was associated with a 75.4% reduction in OME (33.6 vs. 8.3mg; p=0.03) and 41.5% reduction in pain (5 vs. 3.28; p=0.06) at 24h and a 73.3% difference in pain at 48h (1.6±1.6 vs. 6.0±2.8; p=0.0004). There was no difference in non-opioid analgesics administration between groups. The tolerability of NSS-2 BRIDGE® device was reported by most to be excellent. This study suggests that the NSS-2 BRIDGE® device may represent a complementary approach for controlling postoperative opioid consumption and pain in patients undergoing kidney donation.

Liver Transplantation for Biliary Atresia in Adulthood: Single-Centre Surgical Experience.

Background: Biliary atresia (BA) is the most common indicator for liver transplant (LT) in children, however, approximately 22% will reach adulthood with their native liver, and of these, half will require transplantation later in life. The aim of this study was to analyse the surgical challenges and outcomes of patients with BA undergoing LT in adulthood. Methods: Patients with BA requiring LT at the age of 16 or older in our unit between 1989 and 2020 were included. Pretransplant, perioperative variables and outcomes were analysed. Pretransplant imaging was reviewed to assess liver appearance, spontaneous visceral portosystemic shunting (SPSS), splenomegaly, splenic artery (SA) size, and aneurysms. Results: Thirty-four patients who underwent LT for BA fulfilled the inclusion criteria, at a median age of 24 years. The main indicators for LT were synthetic failure and recurrent cholangitis. In total, 57.6% had significant enlargement of the SA, 21% had multiple SA aneurysm, and SPSS was present in 72.7% of the patients. Graft and patient survival at 1, 5, and 10 years was 97.1%, 91.2%, 91.2% and 100%, 94%, 94%, respectively Conclusions: Good outcomes after LT for BA in young patients can be achieved with careful donor selection and surgery to minimise the risk of complications. Identification of anatomical variants and shunting are helpful in guiding attitude at the time of transplant.

Robotic-Assisted Uterus Retrieval from Living Donor for Uterine Transplantation: First Case in Brazil

<h3>Study Objective</h3> To present the first robotic-assisted uterus retrieval from a living donor for uterine transplantation in Brazil. <h3>Design</h3> Stepwise demonstration of the technique with narrated video footage. <h3>Setting</h3> Three operating rooms were designated to carry out the transplantation: one for harvesting the donor's uterus by robotic surgery, another for the bench surgery, and another for the organ recipient. The donor was in the lithotomy position with steep Trendelenburg, intermittent pneumatic compression, and Allen Stirrups. She underwent robotic surgery with central docking. <h3>Patients or Participants</h3> The recipient was a 33-year-old patient with hypoplasia of the Müllerian duct system due to Mayer-Rokitansky-Küster-Hauser syndrome. The donor was a 50-year-old woman. <h3>Interventions</h3> Ureteral dissection was performed over its entire length. The vascular pedicles that emerged from the uterine arteries and the internal iliac arteries' posterior branches were clipped. The obliterated umbilical arteries, the internal iliac arteries, and the pelvic infundibulum ligaments were clipped and cut. The uterus was retrieved through a Pfannenstiel incision to avoid complications to the uterine vessels. The organ was transplanted in the recipient by end-to-end anastomosis of the internal iliac arteries and end-to-side anastomosis of the external iliac vein with a gonadal vein from the infundibulopelvic ligament. <h3>Measurements and Main Results</h3> Surgical intraoperative parameters were measured. The operative time from docking was 4 minutes. Robotic donor surgery took 400 minutes, bench surgery 62 minutes, and laparotomic recipient surgery was completed in 240 minutes. There were no intraoperative complications. The donor was discharged in 48 hours and the recipient in 5 days. <h3>Conclusion</h3> This is the first case in Brazil of uterine transplantation with a living donor to the best of our knowledge. Traditionally, patients who undergo uterine transplantation by minimally invasive surgery are managed by laparoscopy. However, this video demonstrates the feasibility of a robotic approach to uterine transplantation.

Don't Throw Your Heart Away: Increased Transparency of Donor Utilization Practices in Transplant Center Report Cards Alters How Center Performance Is Evaluated.

Publicly available report cards for transplant centers emphasize posttransplant survival and obscure the fact that some centers reject many of the donor organs they are offered (reflecting a conservative donor acceptance strategy), while others accept a broader range of donor offers (reflecting an open donor acceptance strategy). We assessed how the provision of salient information about donor acceptance practices and waitlist survival rates affected evaluation judgments of hospital report cards given by laypeople and medical trainees. We tested 5 different report card formats across 4 online randomized experiments (n1 = 1,003, n2 = 105, n3 = 123, n4 = 807) in the same hypothetical decision. The primary outcome variable was a binary choice between transplant hospitals (one with an open donor acceptance strategy and the other with a conservative donor acceptance strategy). Report cards featuring salient information about donor organ utilization rates (transplant outcomes categorized by quality of donor offers accepted) or overall survival rates (outcomes from both waitlist and transplanted patients) led lay participants (studies 1, 3, and 4) and medical trainees (study 2) to evaluate transplant centers with open donor acceptance strategies more favorably than centers with conservative strategies. Due to the nature of the decision, a hypothetical scenario was necessary for both ethical and practical reasons. Results may not generalize to transplant clinicians or patients faced with the decision of where to join the transplant waitlist. These findings suggest that performance evaluations for transplant centers may vary significantly based not only on what outcome information is presented in report cards but also how the information is displayed.

Fatty liver disease in living liver donors: a single-institute experience of 220 donors.

We retrospectively reviewed 220 living liver donors, with a focus on the development of postoperative fatty liver. Data regarding demographics, comorbidities, imaging tests, operations and biopsies were obtained from medical records. We used unenhanced CT and USG to diagnose fatty liver. Donor candidates with fatty liver underwent weight loss intervention until imaging tests no longer demonstrated any features of fatty liver. Among 220 donors, 61 were diagnosed with preoperative fatty liver. The mean BMI of these 61 donors significantly decreased from 24.9 at the first visit to 23.6 kg/m2 immediately before surgery (P = 0.0386). A multivariate analysis revealed the following significant risk factors for postoperative fatty liver: male sex (P = 0.0033), BMI immediately before surgery (P = 0.0028) and a history of treatment for preoperative fatty liver (P = 0.0231). Postoperative fatty liver was often refractory to weight loss intervention. No improvement was observed in 14 of the 32 donors who had been diagnosed with fatty liver postoperatively, and one of the 14 donors even developed NASH. In conclusion, special attention should be paid to prevent fatty liver after surgery in male donors who show a high BMI immediately before surgery and with a history of treatment for preoperative fatty liver, and lifelong follow-up is recommended.

Assessment of the global practice of living donor liver transplantation.

Criteria that drive the selection and utilization of living liver donors are limited. Herein, the global availability of living donor liver transplantation (LDLT) and components of donor selection and utilization were assessed via an international survey. There were 124 respondents representing 41 countries, including 47 from Asia/Middle East (A/ME), 20 from Europe, and 57 from the Americas. Responses were obtained from 94.9% of countries with ≥10 LDLT cases/year. Most centers (82.3%) have defined donor age criteria (median 18-60years), while preset recipient MELD cutoffs (median 18-30) were only reported in 54.8% of programs. Overall, 67.5% of programs have preset donor BMI (body mass index) ranges (median 18-30), and the mean acceptable macrosteatosis was highest for A/ME (20.2±9.2%) and lowest for Americas (16.5±8.4%, P=0.04). Americas (56.1%) and European (60.0%) programs were more likely to consider anonymous donors versus A/ME programs (27.7%, P=0.01). There were no differences in consideration of complex anatomical variations. Most programs (75.9%) perform donor surgery via an open approach, and A/ME programs are more likely to use microscopic arterial reconstruction. Despite variations in practice, key aspects of living donor selection were identified. These findings provide a contemporary reference point as LDLT continues to expand into areas with limited access to liver transplantation.

Uterine Transplantation with Robot-assisted Uterus Retrieval from Living Donor: First Case in Brazil

To present the first robot-assisted uterus retrieval from a living donor for uterine transplantation in Brazil. Stepwise demonstration of the technique with narrated video footage. A uterine transplantation was performed in a 33-year-old patient with Mayer-Rokitansky-Küster-Hauser syndrome. The donor was a 50-year-old woman who underwent a robotic-assisted uterus retrieval. The procedure was held at Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil. After approval from the national and local institutional review board, the protocol was submitted to ClinicalTrials.gov (NCT04249791), and the first case was performed. The screening of the patients was done. The uterus was retrieved through a Pfannenstiel incision to avoid complications to the uterine vessels. Uterus was transplanted in the recipient by end-to-end anastomosis of the internal iliac arteries and end-to-side anastomosis of the external iliac vein with a gonadal vein from the infundibulopelvic ligament. Surgical intraoperative parameters were measured. The docking time was 4 minutes. Robotic donor surgery took 400 minutes, bench surgery took 62 minutes, and laparotomic recipient surgery was completed in 240 minutes. There were no intraoperative complications. The donor patient was discharged from the hospital in 48 hours and the recipient patient in 5 days. To the best of our knowledge, this is the first case in Brazil of uterine transplantation with a living donor. Traditionally, patients who undergo uterine transplantation by minimally invasive surgery are managed by laparoscopy. This video demonstrates a feasible robotic approach to uterine transplantation with superior imaging affording a 3-dimensional vision and stabilization of instruments allowing wrist-like movements.

Donor quality of life after living donor liver transplantation: a review of the literature.

Living donor liver transplantation (LDLT) provides a source for transplant in the setting of the deceased donor organ shortage. Seeing as living donors do not derive any medical benefit from the procedure, fully understanding the impact of donation on donor health-related quality of life (HRQOL) is essential. A systematic search of the MEDLINE database was performed from 2008–2020, using relevant Medical Subject Headings. Articles were evaluated for study design, cohort size and follow-up time and excluded if they contained significant methodological flaws. A total of 43 articles were included: 20 (47%) were cross-sectional and 23 (53%) were longitudinal. The mean number of donors per study was 142 (range:8–578) with follow-up ranging from 12–132 months. Forty-two unique HRQOL metrics were implemented across the 43 studies, the majority of which were questionnaires. Of the 31 studies that used the Medical Outcomes Study Short Form 36 questionnaire, 9.1% of donors reported physical QOL did not return to pre-LDLT levels for at least 2 years after donation. Mental QOL remained stable or improved after LDLT, with mean mental composite scores increasing from 50 to 52 at 3 months post-LDLT in one study. The predicted probability of poor sexual desire decreased at 1-year post-LDLT (male: 0.08, female: 0.26) relative to pre-LDLT (male: 0.44, female: 0.76; P<0.001) and three months post-LDLT (male: 0.35, female 0.69; P=0.001). Forty percent of donors found LDLT to be financially burdensome at 3 months and 19% at 2 years post-LDLT. Female gender and obesity were consistent predictors of worse HRQOL. Laparoscopy-assisted donor hepatectomy was associated with shorter hospitalizations than open donor hepatectomy (10.3 vs. 18.3 days, P=0.02). No studies used the National Institutes of Health Patient Reported Outcomes Measurement Information System (PROMIS) measures of HRQOL. Our review demonstrates that LDLT can have a long-lasting negative impact on physical QOL in 9.1% of donors and can cause both sexual dysfunction and significant financial strain. Future studies should consider using standardized and extensively validated patient reported outcomes measures, such as PROMIS, in order to directly compare outcomes across studies and gain further insight into the impact of LDLT on D-HRQOL.