Living Donor Surgery Research Articles

Postoperative Complications in Living Donors for Lung Transplantation.

Living donor lobar lung transplantation is a life-saving procedure for critically ill patients. This requires 2 healthy donors exposed to risks and without medical benefit. Therefore, the donor's safety and minimal postoperative complications are crucial. This study aimed to investigate the short-term outcomes and identify the risk factors affecting these outcomes. The data of 175 living donors enrolled between 1998 and 2022 were analyzed. Donors were divided into era 1 (1998-2009) and era 2 (2010-2022). The overall incidence of postoperative complications was 39%, of which 7% were major complications. Donors who underwent surgery on the right side had a higher incidence of delayed pulmonary fistulae (P = 0.01) and elevated liver enzyme levels (P = 0.028). Living donor surgery on the right side (P = 0.01), era 2 (P = 0.01), and the need for plasty (P = 0.04) were predictors of postoperative complications. Updated data on complications and their correlation with postoperative quality of life from this study could aid in the selection of potential donors and facilitate informed consent.

Minimally Invasive Surgery in Liver Transplantation: From Living Liver Donation to Graft Implantation

Since the end of the 20th century and the establishment of minimally invasive techniques, they have become the preferred operative method by many surgeons. These techniques were applied to liver surgery for the first time in 1991, while as far as transplantation is concerned their application was limited to the living donor procedure. We performed a review of the literature by searching in Pubmed and Scopus using the following keywords: Liver transplantation, Minimally invasive surgery(MIS) living liver donor surgery. Applications of MIS are recorded in surgeries involving the donor and the recipient. Regarding the recipient surgeries, the reports are limited to 25 patients, including combinations of laparoscopic, robotic and open techniques, while in the living donor surgery, the reports are much more numerous and with larger series of patients. Shorter hospitalization times and less blood loss are recorded, especially in centers with experience in a large number of cases. Regarding the living donor surgery, MIS follows the same principles as a conventional hepatectomy and is already the method of choice in many specialized centers. Regarding the recipient surgery, significant questions arise mainly concerning the safe handling of the liver graft.

Roles and practice of living-related lobar lung transplantation.

Living-donor lobar lung transplantation (LDLLT) was first performed in the USA and thereafter it was introduced in Japan in 1998 as an alternative modality to brain-dead donor lung transplantation (BDLT). Although the LDLLT procedure was employed for rapidly deteriorating patients who were hospitalized and mechanically ventilated at the time of transplantation, LDLLT demonstrated better or comparable post-transplant outcomes in comparison to BDLT. Less injured lobar grafts and a significantly shorter graft ischemic time possibly contributed to a significantly lower incidence of severe primary graft dysfunction (PGD) after LDLLT in comparison to BDLT. In standard LDLLT, patients obtained lobar grafts from two different donors, and thus most patients developed chronic lung allograft dysfunction (CLAD) only in the unilateral lung graft. This indicates that the contralateral unaffected lung graft could reserve lung function after the unilateral development of CLAD. In our transplant program, the incidence of CLAD per donor in LDLLT (14.4%) was also significantly lower in comparison to BDLT (24.7%). The 1-, 5- and 10-year survival rates after LDLLT were 90.9%, 75.5% and 57.2%, respectively, which were equivalent to those after BDLT (92.9%, 73.4% and 62.2%). The inherent surgical risk to the living donors should always be considered. In our experience, living-donor surgery was associated with a complication rate of 12.7%, and importantly, all living donors finally returned to their previous social lives. Precise functional and anatomical size matching between donor lobar graft and recipient could provide a favorable pulmonary function after LDLLT. We recently established multimodal surgical approaches, such as native upper lobe-sparing, right-to-left horizontally rotated, segmental, and single-lobe transplantation, in order to resolve the issue of size mismatch between the donor lobar graft and the recipient.

Comparison of pure laparoscopic donor right posterior sectionectomy versus right hemihepatectomy for living donor liver transplantation.

The right posterior section (RPS) graft for living donor liver transplantation is an alternative graft in a live liver donor with insufficient remnant left lobe volume and portal vein anomaly. Although there have been some reports regarding pure laparoscopic donor right posterior sectionectomy (PLDRPS), no study has compared PLDRPS versus pure laparoscopic donor right hemihepatectomy (PLDRH). The aim of our study was to compare the surgical outcomes of PLDRPS versus PLDRH at centers achieving a complete transition from open to laparoscopic approach in liver donor surgery. From March 2019 to March 2022, a total of 351 living donor liver transplantations, including 16 and 335 donors who underwent PLDRPS and PLDRH, respectively, were included in the study. In the donor cohort, there were no significant differences in major complication (≥grade III) rate and comprehensive complication index between the PLDRPS versus PLDRH group (6.3% vs. 4.8%; p = 0.556 and 2.7 ± 8.6 vs.1.7 ± 6.4; p = 0.553). In the recipient cohort, there was a significant difference in major complication (≥grade III) rate (62.5% vs. 35.2%; p = 0.034) but no significant difference in comprehensive complication index (18.3 ± 14.9 vs. 15.2 ± 24.9; p = 0.623) between the PLDRPS and PLDRH groups. PLDRPS in live liver donors with portal vein anomaly and insufficient left lobe was technically feasible and safe with experienced surgeons. The PLDRPS group might be comparable with the PLDRH group based on the surgical outcomes of donors and recipients. However, in terms of recipient outcomes, more careful selection of donors of the RPS graft and further research in a large number of cases are necessary to evaluate the usefulness of PLDRPS.

Risk Factors Associated With Surgical Morbidities of Laparoscopic Living Liver Donors.

This study analyzed the incidence and risk factors for surgical morbidities of laparoscopic living donors. Although laparoscopic living donor programs have been established safely in leading centers, donor morbidities have not been discussed sufficiently. Laparoscopic living donors operated on from May 2013 to June 2022 were reviewed. Donor complications were reviewed, and factors related to bile leakage and biliary stricture were analyzed using the multivariable logistic regression method. A total of 636 donors underwent laparoscopic living donor hepatectomy. The open conversion rate was 1.6%, and the 30-day complication rate was 16.8% (n=107). Grade IIIa and IIIb complications occurred in 4.4% (n=28) and 1.9% (n=12) of patients, respectively. The most common complication was bleeding (n=38, 6.0%). Fourteen donors (2.2%) required reoperation. Portal vein stricture, bile leakage, and biliary stricture occurred in 0.6% (n=4), 3.3% (n=21), and 1.6% (n=10) of cases, respectively. The readmission rate and reoperation rate were 5.2% (n=33) and 2.2% (n=14), respectively. Risk factors related to bile leakage were 2 hepatic arteries in the liver graft (OR=13.836, CI=4.092-46.789, P <0.001), division-free margin<5mm from the main duct (OR=2.624, CI=1.030-6.686, P =0.043), and estimated blood loss during operation (OR=1.002, CI=1.001-1.003, P =0.008), while the Pringle maneuver (OR=0.300, CI=0.110-0.817, P =0.018) was protective against leakage. Regarding biliary stricture, bile leakage was the only significant factor (OR=11.902, CI=2.773-51.083, P =0.001). Laparoscopic living donor surgery showed excellent safety for the majority of donors, and critical complications were resolved with proper management. To minimize bile leakage, cautious surgical manipulation is needed for donors with complex hilar anatomy.

Kidney transplantation and withdrawal rates among wait-listed first-generation immigrants in Italy.

BackgroundMultiple barriers diminish access to kidney transplantation (KT) in immigrant compared to non-immigrant populations. It is unknown whether immigration status reduces the likelihood of KT after wait-listing despite universal healthcare coverage with uniform access to transplantation.MethodsWe retrospectively collected data of all adult waiting list (WL) registrants in Italy (2010–20) followed for 5 years until death, KT in a foreign center, deceased-donor kidney transplant (DDKT), living-donor kidney transplant (LDKT) or permanent withdrawal from the WL. We calculated adjusted relative probability of DDKT, LDKT and permanent WL withdrawal in different immigrant categories using competing-risks multiple regression models.ResultsPatients were European Union (EU)-born (n = 21 624), Eastern European-born (n = 606) and non-European-born (n = 1944). After controlling for age, sex, blood type, dialysis vintage, case-mix and sensitization status, non-European-born patients had lower LDKT rates compared to other immigrant categories: LDKT adjusted relative probability of non-European-born vs. Eastern European-born 0.51 (95% CI: 0.33–0.79; P = 0.002); of non-European-born vs. EU-Born: 0.65 (95% CI: 0.47–0.82; P = 0.001). Immigration status did not affect the rate of DDKT or permanent WL withdrawal.ConclusionsAmong EU WL registrants, non-European immigration background is associated with reduced likelihood of LDKT but similar likelihood of DDKT and permanent WL withdrawal. Wherever not available, new national policies should enable coverage of travel and medical fees for living-donor surgery and follow-up for non-resident donors to improve uptake of LDKT in immigrant patients, and provide KT education that is culturally competent, individually tailored and easily understandable for patients and their potential living donors.

Outcomes of Pure Laparoscopic Living Donor Right Hepatectomy at a Small-Volume Center.

Laparoscopic liver donor surgery is a technically difficult and demanding procedure. Our aim was toevaluate its feasibility at an established transplant center. Although our hospital is a small-volume center with <20 liver transplants per year, laparoscopic donor surgery has been performed regularly. In this study, we have reported our experiences with laparoscopic donor right hepa-tectomy and its outcomes. Between May 2014 and March 2021, 26 deceased donor liver transplants and 37 living donor liver transplants, approved by the Korean Network for Organ Sharing, were performed at out center. From these, we reviewed the medical records, including clinical and demographic characteristics and operative outcomes, of 3 living donors who under-went pure laparoscopic donor right hepatectomy and their recipients. Each of the 3 laparoscopic donor right hepatectomies took over 10 hours with the prolonged Pringle maneuver time and warm ischemic time. However, there were no significant events during surgery or critical postoperative complications. In the recipients, posttransplant complications included middle hepatic vein obstruction, postoperative bleeding, bile leak, septic shock, and primary nonfunction of the graft. We managed and resolved these complications using various approaches, including retransplant, and all 3 recipients recovered and survived. Laparoscopic donor right hepatectomy had a relatively long operative time at our small-volume center. We believe that successful laparoscopic donor hepatectomy is possible if the donor is selected appropriately according to the center's experiences and there are constant efforts to overcome the learning curve.

Living-donor lobar lung transplantation.

Living-donor lobar lung transplantation (LDLLT) has become an important life-saving option for patients with severe respiratory disorders, since it was developed by a group in the University of Southern California in 1993 and introduced in Japan in 1998 in order to address the current severe shortage of brain-dead donor organs. Although LDLLT candidates were basically limited to critically ill patients who would require hospitalization, the long-term use of steroids, and/or mechanical respiratory support prior to transplantation, LDLLT provided good post-transplant outcomes, comparable to brain-dead donor lung transplantation in the early and late phases. In Kyoto University, the 5- and 10-year survival rates after LDLLT were reported to be 79.0% and 64.6%, respectively. LDLLT should be performed under appropriate circumstances, considering the inherent risk to the living donor. In our transplant program, all living donors returned to their previous social lives without any major complications, and living-donor surgery was associated with a morbidity rate of <15%. Both functional and anatomical size matching were preoperatively performed between the living-donor lobar grafts and recipients. Precise size matching before surgery could provide a favorable pulmonary function and exercise capacity after LDLLT. Various transplant procedures have recently been developed in LDLLT in order to deal with the issue of graft size mismatching in recipients, and favorable post-transplant outcomes have been observed. Native upper lobe-sparing and/or right-to-left inverted transplantation have been performed for undersized grafts, while single-lobe transplantation has been employed with or without contralateral pneumonectomy and/or delayed chest closure for oversized grafts.

Operative and Clinical Outcomes of Minimally Invasive Living-Donor Surgery on Uterus Transplantation: A Literature Review.

Background: The surgical approach and choice of drainage veins for uterus transplantation living-donor surgery have been investigated to reduce invasiveness. Methods: A thorough search of the PubMed database was conducted. The search was not limited by language or date of publication. The data were collected on 13 October 2020. Two reviewers independently assessed each article and determined eligibility for inclusion in the review article. Inclusion criteria were English peer-reviewed articles reporting surgical information or postoperative course, articles regarding animal research on UTx, UTx on deceased donors, or not original articles. Results: Of the 51 operations within 26 articles reviewed, the mean operative time was shortest in the laparoscopic approach, and longest in the robot-assisted approach. The mean blood loss was less in the laparoscopic and robot-assisted approaches than in the open approach. In cases where the uterine veins were not preserved, the mean operative time was shortened by each approach and the mean blood loss decreased with the laparoscopic and robot-assisted approaches. Conclusions: These procedures may contribute to less invasive living-donor surgery.

Evolution and Outcome of First 100 Robotic Donor Hepatectomy

Minimal invasive liver donor surgery was established as a feasible technique with comparable outcome to open liver donor surgery that was mainly for left lateral sectionectomy and left lobe resection. The limitation of conventional laparoscopy was clear in the right hepatectomy due difficult maneuvering and accessibility. Robotic approach was induced as an alternative to conventional laparoscopic approach. Few Paper was published with limited number of cases. Here we present own experience in Robotic Liver Donor Surgery in King Faisal Specialist Hospital and Research Center which the largest number of cases up to our knowledge. A total of 100 Robotic liver resection was carried from November 2018 to October 2019. Male donors 72 and female 28. Median age 27 years. Left lateral was 38, left 19 and right 43. Average hospital stay was 4 days. No mortality was recorded nor conversion. Morbidity only 8 patients mainly in the left and right lobe group. Two bile leak in the right lobe donors and one patient in the left lobe. Three patient had wound hematomas at the extraction incision (Pfannenstiel) incision, one in each group. Over all graft survival was 93%. Here was can say Robotic donor hepatectomy is safe with comparable result to open surgery with better post-operative pain and shorter hospital stay and better cosmesis. Reproducibility and learning carve need further evaluation

TOWARDS UTERUS TISSUE ENGINEERING; SHEEP UTERUS DECELLULARIZATION PRODUCES BIOACTIVE SCAFFOLDS THAT CAN EFFICIENTLY BE RECELLULARIZED

Introduction: Uterus transplantation (UTx) was introduced as a treatment option for uterus-related infertility which affects about 1 in 500 women of fertile age. After pre-clinical studies, our center initiated the first clinical trial of UTx which lead to the world’s first born baby after such procedure and proved that uterus-related infertility can be cured. Nevertheless, the risks involved in live-donor surgery and negative side-effects caused by immunosuppression after engraftment opens up discussion for other donor sources. For instance, novel bioengineering techniques may be an option to overcome these restraints which includes the development of a biologically-derived scaffold populated with the patient’s own cells to replace a donor organ in a UTx setting. Promising results were shown using decellularized scaffolds in rodent models. We herein report a translational approach of these ideas to a large animal model, and provide protocols for scaffold generation of the sheep uterus which is of a similar size to a human uterus, and show how to efficiently recellularize it. Materials and Methods: Decellularization was performed using vascular perfusion. Solutions were based on 0.5% sodium dodecyl sulfate, or 2% sodium deoxycholate, or with a sequential perfusion of 2% sodium deoxycholate and 1% Triton X-100. The scaffolds were examined by histology, extracellular matrix (ECM) quantification and mechanical properties. The scaffold bioactivity was analyzed using the dorsal root ganglion- (DRG) and chorioallantoic membrane (CAM) assays. Recellularization efficacy was quantified after standard cell culturing conditions, or when transwell culturing plates were used with- or without scaffold pre-conditioning with matrix metalloproteinases (MMP:s) -2 and -9. Results: Decellularization was confirmed and electron microscopy showed that each protocol resulted in a porous ECM-rich scaffold. Mechanical studies confirmed no loss of strength. The DRG- and CAM-assays confirmed that the scaffolds had growth promoting qualities. Compared to standard culturing methods, the recellularization efficiency could be improved by 200%-300% (depending on scaffold-type) when scaffolds were pre-conditioned with MMP:s and cultured in transwell plates for up to 14 days in vitro. Conclusion: Uteri decellularized with sodium deoxycholate seemed favorable based on ECM quantifications. However, all scaffolds showed bioactivity and an ability to support stem cell growth. These cells continued to express markers for proliferating stem cells. Recellularization using MMP:s to pre-condition the scaffolds and transwells during culture was advantageous, independent of scaffold type. These bioengineering strategies are therefore valuable for future in vivo transplantation studies on the sheep animal model to evaluate novel treatments for uterine-related infertility. Additionally, these successful de- and recellularization schemes may be effective when bioengineering other organs of similar size.

Growth through adversity: posttraumatic growth in anonymous living liver donors

Purpose Post-traumatic growth (PTG) is positive change that occurs after struggling with challenging life crises. Research on PTG has typically been limited to oncology populations, first-responders, and individuals in warzones. We report the experience of PTG amongst a sample of 26 anonymous live liver donors. Methods Anonymous donors were those with no biological connection or prior relationship with recipients. Twenty-six participants participated in a semi-structured qualitative interview examining their experience with, and outcomes of donation. Interview transcripts were analyzed for themes about PTG using the constant comparison method. Results While some donors indicated that donation had little lasting impact on their life, most cited significant personal and interpersonal changes resulting from the experience. The most common positive changes included deepened bonds with others, appreciation for personal strength, clearer life direction, legacy-building, and a connection to the transplant community. Conclusion Despite the short-term physical trauma of living donor surgery, the act of anonymous donation appeared to be a catalyst for positive long-term psychological growth. These findings help to bolster the ethical argument in favour of anonymous donation. IMPLICATIONS FOR REHABILITATION There is a shortage of organ donors for recipients in need, and anonymous living liver donors can successfully reduce wait times and mortality rates for those on wait lists. There are some questions about the ethics of anonymous donation due to possible negative physical and psychological effects of donation surgery on donors. In a qualitative study, this study shows that donors ascribe significant meaning to, and derive many psychological benefits from, their donation experience. These findings provide insights about how to best support anonymous donors through and after their donation experience.

Complications and outcomes of 890 living liver donor hepatectomies at a single center: risks of saving loved one's life.

Living liver donor surgery is a major surgical procedure applied to healthy people with mortality and morbidity risks and does not provide any direct therapeutic advantage to the donor. We retrospectively analyzed the postoperative complication of our living liver donors to figure out the risks of donation. Between November, 2006 and December, 2018, a total of 939 living liver donor hepatectomies were performed with no mortality to the living-related donors. Eight hundred and ninety donors with a minimum 1-year follow-up were analyzed retrospectively. Of the 890 donors, 519 (58.3%) were males and 371 (41.7%) were females. Mean age was 35 years (18-64) and mean body mass index was 25.7 kg/m2 (17.7-40). Right donor hepatectomy was performed to 601 (67.5%), left donor hepatectomy to 28 (3.2%) and left lateral sector hepatectomy to 261 (29.3%) of the donors. Of the 890 donors, 174 (19.5%) donors experienced a total of 204 early and late complications including life- threatening and nearly life- threatening complications in 26 (2.9%) of them. Intraoperative complication occurred in 4 (0.5%) donors. Right donors hepatectomy complication rate (23.3%) was higher than left donor (14.3%) and left lateral sector donor hepatectomy (11.5%). All donor candidates should be well-informed not only on the details of early and late complications of living liver donation, also possible outcomes of the recipient. In addition to detailed physical evaluation, preoperative psychosocial evaluation is also mandatory. Comprehensive donor evaluation, surgical experience, surgical technique, close postoperative follow-up and establishing a good dialog with the donor allows better outcomes.

Introduction of an enhanced recovery protocol into a laparoscopic living donor nephrectomy programme.

Living-donor renal transplantation is the optimal treatment for patients with end-stage renal disease. The rate of living donation in the UK is sub-optimal, and potential donor concerns regarding postoperative recovery may be contributory. Enhanced recovery programmes are well described for a number of surgical procedures, but experience in living-donor surgery is sparse. This study reports the impact of introducing an enhanced recovery protocol into a living-donor renal transplant programme. All consecutive patients undergoing laparoscopic living-donor nephrectomy over a 25-month period were included. The principles of enhanced recovery were fluid restriction, morphine sparing and expectation management. Outcome measures were postoperative pain scores and complications for donor and recipients. Standard care was provided for 24 (30%) patients and 57 (70%) followed an enhanced recovery pathway. The latter group received significantly less preoperative intravenous fluid (0ml vs 841ml p < 000.1) and opiate medication (14.83mg vs 23.85mg p = 0.001). Pain scores, postoperative complications and recipient transplant outcomes were comparable in both groups. Enhanced recovery for living-donor nephrectomy is a safe approach for donors and recipients. Application of these techniques and further refinement should be pursued to enhance the experience of living donors.

Introduction: Uterus transplantation

Uterus transplantation is the first available treatment for absolute uterine factor infertility. Live births have been reported after transplantation of uteri both from live and deceased donors. Although this novel infertility treatment is still at its experimental stage, with human attempts performed within clinical trials, there is a rapid development in the field. Up until June 2019 more than 60 human uterus transplantation attempts have been performed and the scientific data of the published cases will be reviewed in relation to surgery and outcome. The assisted reproductive technologies that are used before and after uterus transplantation have to be modified for this patient group. The special demands for invitro fertilization in a patient with no uterus and with embryo transfer in a transplanted uterus will be discussed. Traditionally, uterus transplantation has been performed through laparotomy in both the donor and the recipient. There is now a move to introduce minimally invasive surgery in live donor surgery transplantation, and in the future this may also be applied to recipient surgery. There is a continuous debate whether live donor or deceased donor uterus is the organ source for optimal outcome. Ongoing studies and the general development of the uterus transplantation field will shed light on the pros and cons of each donor source.

Editorial introductions

Editorial introductions

Livebirth after uterus transplantation from a deceased donor in a recipient with uterine infertility

Uterus transplantation from live donors became a reality to treat infertility following a successful Swedish 2014 series, inspiring uterus transplantation centres and programmes worldwide. However, no case of livebirth via deceased donor uterus has, to our knowledge, been successfully achieved, raising doubts about its feasibility and viability, including whether the womb remains viable after prolonged ischaemia. In September, 2016, a 32-year-old woman with congenital uterine absence (Mayer-Rokitansky-Küster-Hauser [MRKH] syndrome) underwent uterine transplantation in Hospital das Clínicas, University of São Paulo, Brazil, from a donor who died of subarachnoid haemorrhage. The donor was 45 years old and had three previous vaginal deliveries. The recipient had one in-vitro fertilisation cycle 4 months before transplant, which yielded eight cryopreserved blastocysts. The recipient showed satisfactory postoperative recovery and was discharged after 8 days' observation in hospital. Immunosuppression was induced with prednisolone and thymoglobulin and continued via tacrolimus and mycophenalate mofetil (MMF), until 5 months post-transplantation, at which time azathioprine replaced MMF. First menstruation occurred 37 days post-transplantation, and regularly (every 26-32 days) thereafter. Pregnancy occurred after the first single embryo transfer 7 months post-transplantation. No blood flow velocity waveform abnormalities were detected by Doppler ultrasound of uterine arteries, fetal umbilical, or middle cerebral arteries, nor any fetal growth impairments during pregnancy. No rejection episodes occurred after transplantation or during gestation. Caesarean delivery occurred on Dec 15, 2017, near gestational week 36. The female baby weighed 2550 g at birth, appropriate for gestational age, with Apgar scores of 9 at 1 min, 10 at 5 min, and 10 at 10 min, and along with the mother remains healthy and developing normally 7 months post partum. The uterus was removed in the same surgical procedure as the livebirth and immunosuppressive therapy was suspended. We describe, to our knowledge, the first case worldwide of livebirth following uterine transplantation from a deceased donor in a patient with MRKH syndrome. The results establish proof-of-concept for treating uterine infertility by transplantation from a deceased donor, opening a path to healthy pregnancy for all women with uterine factor infertility, without need of living donors or live donor surgery. Fundação de Amparo à Pesquisa do Estado de São Paulo and Hospital das Clínicas, University of São Paulo, Brazil.

Uterus Allo-Transplantation in a Swine Model: Long-Term Graft Survival and Reproductive Function.

BackgroundThe present study examined the feasibility and safety of allogeneic uterus transplantation (UTx) from a living donor and assessed long-term graft survival and the resumption of reproductive function in a swine model.Material/MethodsTen female miniature swine with regular menstrual cycles were used; the animals were either donors or recipients (n=5) depending on the sibling. Retrieval surgery included uterus and uterine arteries together with the anterior branches of the internal iliacs from the living donor; the vaginal canal was cut. After the back-table had been prepared, bilateral internal iliac arteries were anastomosed end-to-side with the external iliac arteries. The transplanted uterus was evaluated based on the arterial blood flow by transabdominal ultrasonography and observed by secondary laparotomy after surgery; estrus recovery was stimulated by mating with a male, and artificial embryo transfer was performed in healing swine.ResultsAll 5 pigs revealed successful surgery without any surgical complications, injuries to other organs, or unanticipated vascular injury. All recipients survived for >3 months after the surgery, except pig 5, which died due to uterus necrosis 3 days post-surgery. A 100% surgical success rate and 80% long-term survival rate of the receptor were observed. Pig 2 had temporary estrus resumed, and the artificial embryo was transplanted 3 months after surgery; however, apparent gestation was not found by ultrasonography.ConclusionsThis study evaluated the safety and feasibility of the technology of allogeneic UTx, which was performed only by transplant uterine artery system from living-donor surgery in a swine model. Laboratory animals can show long-term survival and resumed estrous after UTx, which can be monitored by ultrasonography to assess the arterial blood flow of the grafted uterus.

The Evolution of Kidney Transplantation Surgery Into the Robotic Era and Its Prospects for Obese Recipients.

Robotic-assisted kidney transplantation (RAKT) represents the most recent innovation in the evolution of kidney transplantation surgery. Vascular techniques enabling kidney transplantation have existed since the early 20th century and contributed to the first successful open kidney transplant procedure in 1954. Technical advances have since facilitated minimally invasive laparoscopic and robotic techniques in live-donor surgery, and subsequently for the recipient procedure. This review follows the development of surgical techniques for kidney transplantation, with a special focus on the advent of robotic-assisted transplantation because of its potential to facilitate transplantation of those deemed previously too obese to transplant by standard means. The different techniques, indications, advantages, disadvantages, and future directions of this approach will be explored in detail. Robot-assisted kidney transplantation may become the preferred means of transplanting morbidly obese recipients, although its availability to such recipients remains extremely limited and strategies targeting weight loss pretransplantation should never be abandoned in favor of a "RAKT-first" approach.

Donor safety for minimal invasive hepatectomy in liver transplantation: the Korean Organ Transplantation Registry

Background: The most important concern in living donor liver transplantation (LDLT) is donor safety. Although minimally invasive living donor surgery has been increasingly accepted, its safety remains to be fully clarified in a large-scale study. This study evaluated the safety and effectiveness of minimal invasive living donor hepatectomy in comparison with conventional open procedure using Korean Organ Transplantation Registry data. Methods: We reviewed the prospectively collected data of all 1694 living liver donors who underwent procedures between April 2014 and December 2017. We allocated the donors to a minimal invasive group (MIG, n = 304) and a open group (OG, n = 1390) and analyzed the relations clinical data and complications. Results: The median follow-up was 31 months. During the study period, 1071 men and 623 women donated livers and there were no deaths after living liver donation. The overall complication rates were 7.3% and 4.5% in the two group. (p = 0.43) In the MIG, the AST level at I year after donation was lower than OG (20.4 ± 5.5 mg/dL versus 22.4 ± 9.1 mg/dL, p = 0.003) On the hand, the total bilirubin level at 6 months after donation was higher (0.84 ± 0.39 mg/dL versus 0.74 ±0.36 mg/dL, P < 0.001)The MIG was shorter than OG in duration of hospitalization. (9.04 ± 3.78 days versus 10.29 ± 4.01 days, p < 0.001) Conclusions: The minimal invasive donor hepatectomy was relatively some higher complication rate which was no statistically significant difference but lower duration of hospitalization in compare to conventional open procedure in our study.