Living-related Donor Research Articles

Supplemental Material for Family Functioning Before Kidney Transplantation From Living-Related Donors: Perspectives of Donors and Recipients in Japan

Supplemental Material for Family Functioning Before Kidney Transplantation From Living-Related Donors: Perspectives of Donors and Recipients in Japan

Domino liver transplantation for maple syrup urine disease in children: A single-center case series.

Domino liver transplant (DLT) represents another type of liver donor to expand the donor pool. Recent reports of successful DLT in children with maple syrup urine disease (MSUD) show promising long-term outcomes. It was a retrospective study. All children with MSUD were paired with either recipients with end-stage liver disease (ESLD) or non-MSUD metabolic disease. Each pair underwent simultaneous liver transplant (LT), where the MSUD recipient received the graft from a living-related donor and the liver explanted from the MSUD donor was transplanted to the respective paired domino recipient. We report our experience regarding the techniques and outcomes of DLT at our center. Eleven children with MSUD and 12 respective DLT recipients were enrolled, one of which was domino split-liver transplantation. DLT recipients included seven ESLD, two propionic acidemia (PA), one glycogen storage disease(GSD) type-1, one GSD type-3, and one Citrullinemia. Post-LT ICU and hospital stays were comparable (p > .05). Patient and graft survival was 100% and 66.6% in the MSUD group and DLT recipients at a mean follow-up of 13.5 and 15 months. There was no death in the MSUD group as compared to four in the DLT group. The amino acid levels rapidly normalized after the LT in the children with MSUD and they tolerated the normal unrestricted diet. No vascular, biliary, or graft-related complications were seen in the post-transplant period. No occurrence of MSUD was noted in DLT recipients. DLTs have excellent post-surgical outcomes. DLT should be strongly considered and adopted by transplant programs worldwide to circumvent organ shortage.

1119 A Scoping Review of Kidney Transplantation in Africa: How Far Have We Come?

Abstract Aim Kidney transplantation is a life-saving treatment for patients with end-stage kidney disease. However, the availability of kidney transplantation in Africa has lagged behind other regions of the world, leading to significant disparities in access to care. In this study, we sought to analyse indications for transplant, demographic characteristics, and outcomes of kidney transplantation in Africa from inception till date. Method The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used in conducting this study. PubMed, Google Scholar, and African Journal Online were searched. Data on procedure done, graft outcomes, donor, prophylaxis given for graft, post-op complications, and survival timelines were pooled together and analysed. Thirty-three studies fully satisfied the eligibility criteria and were used in this review. Results The most common causes of end-stage kidney disease requiring transplant included glomerulonephritis and Nephroangiosclerosis. Overall, open nephrectomy accounted for 95% of the surgical approach used. The other approaches documented were Hand-assisted Laparoscopic Nephrectomy (3.88%), Extraperitoneal approach (0.55%), and Simultaneous Unilateral native nephrectomy (0.12%). In total, 56.3% (4221) of all donors were living donors of which 68.5% were related to the recipient (living-related donor), while 43.7% (3280) patients received transplants from cadaveric donors. The commonest surgical complication was graft rejection (39.44%). In the follow-up period, 60.49% of patients who had a kidney transplant developed hypertension. Conclusions In conclusion, our study not only highlights the potential for kidney transplantation to improve the lives of patients in Africa, but also the need for further research and infrastructure development to make this a more widespread and successful option.

Pregnancy after deceased donor vs living donor kidney transplant: associated obstetric and graft outcomes

Outside of pregnancy, recipients of a deceased donor kidney transplant experience worse graft and overall survival compared with recipients of a living donor kidney transplant. In pregnancy, it is unknown whether the type of donor graft modifies either graft health in the peripartum period or pregnancy outcomes. This study aimed to define characteristics and outcomes in pregnancy based on donor type in kidney transplant recipients. This was a retrospective cohort study of adult kidney transplant recipients who received their graft between 2000 and 2019 with a subsequent pregnancy enrolled in the Transplant Pregnancy Registry International. The primary outcome was graft loss within 2 years of delivery. The secondary outcomes included severe maternal morbidity and neonatal composite morbidity. Univariate, multivariable logistic regression, and Cox proportional-hazards models were constructed for statistical analysis, with recipients of a living unrelated donor as the referent. Overall, 638 pregnant patients after kidney transplant had pregnancy outcomes that met our inclusion criteria. Of these patients, 168 (26.3%) received a graft from a deceased donor, 310 (48.6%) received a graft from a living related donor, and 160 (25.1%) received a graft from a living unrelated donor. Recipients of a deceased donor were more likely to be nulliparous, have an unplanned pregnancy, and self-identify as non-White. Moreover, recipients of a deceased donor were more likely to experience urinary tract infections (deceased donor: 21.8%; living related donor: 10.1%; living unrelated donor: 20.6%; P=.018). Severe maternal morbidity (deceased donor: 3.4%; living related donor: 2.8%; living unrelated donor: 7.2%) and neonatal composite morbidity (deceased donor: 8.4%; living related donor: 17.1%; living unrelated donor: 14.4%) did not differ by donor type. Deceased donor transplant was associated with graft loss within 2 years of delivery (deceased donor: 6.7%; living related donor: 3.7%; living unrelated donor: 1.3%; adjusted odds ratio, 7.52; 95% confidence interval, 1.53-60.8) and long-term graft loss from transplant (adjusted hazard ratio, 2.08; 95% confidence interval, 1.10-3.95). Although our study demonstrated an association between deceased donor transplant and graft loss after pregnancy, it did not provide evidence that pregnancy itself causes graft loss. Recipients of a deceased donor kidney transplant should not be discouraged from pursuing pregnancy based on their donor type, but these patients should undergo preconception counseling with a discussion of their individualized obstetrical and graft risks, close intrapartum monitoring for infection and hypertensive disease, and continued surveillance for at least 2 years after delivery with a multidisciplinary obstetrics and transplant team.

Hypomagnesemia and its association with calcineurin inhibitor use in renal transplant recipients

Background Hypomagnesemia is a common electrolyte abnormality following kidney transplantation. Increased renal magnesium (Mg) waste has been linked to calcineurin inhibitors. We aimed to assess the prevalence and risk factors of hypomagnesemia and its association with calcineurin inhibitor use in renal transplant recipients. Patients and methods This is a cross-sectional study carried out on renal transplant recipients, who underwent living-related donor kidney transplantation. All participants underwent detailed history taking and complete physical examination. Serum Mg, trough level of cyclosporine or tacrolimus, fractional excretion of Mg (FEMg), and 24 h urinary Mg, Ca, Ph, Cl, and protein were measured. Results One hundred patients were screened and 80 patients, with a mean age of 39.65 ± 12.14 years, completed the study. Fifty (62.5%) patients were on tacrolimus, and 26 (32.5%) patients were on cyclosporine. Patients had a median serum Mg of 1.80 mg/dl. Hypomagnesemia (Mg<1.7) was present in 17 (21.3%) patients with a median FEMg of 3.08%. There was significant negative correlation between serum Mg level and trough level of tacrolimus and FEMg with a P value of 0.038 and 0.001, respectively. The results of multivariate analyses showed that tacrolimus trough level (P=0.010) and FEMg (P=0.025) were independently correlated with serum Mg. Hypomagnesemia was significantly higher in tacrolimus-treated patients (30%) compared with only 7.7% in cyclosporine-treated patients (P=0.027). Conclusions Hypomagnesemia is common in renal transplant recipients, especially with tacrolimus use mostly due to increased renal Mg wasting. Increased tacrolimus trough level and increased FEMg were predictors of hypomagnesemia.

Socio-demographic Factors Affecting Health-related-quality of Life in Post-renal-transplant Patients

Objective: The objective of this study was to identify the socio-demographic factors affecting health related quality of life in renal transplant recipients. Material and Methods: A census of all registered post-renal-transplant patients was conducted from October 1, 2018, to January 31, 2019. Data were collected on a Kidney Disease Quality of Life questionnaire (SF-1.3) and analysed by Statistical Package for the Social Science (SPSS). Scores in the three main domains, physical component summary (PCS), mental component summary (MCS), and kidney disease component summary, were calculated. Mean scores for gender, type of donor, and employment were compared by unpaired t-test, while mean scores for age, level of education, and duration of transplant were compared by analysis of variance. Results: Out of 315 patients, 277 (87.9%) were males and 38 (12.1%) were females. The mean age was 37.26 (±10.14) years. Live unrelated transplants were 58.41% while live related transplants were 41.58%. Males had a significantly higher average (p-value=0.001) PCS score, but females had significantly higher average (p-value=0.05) MCS score. There was variation with respect to the PCS (p-value=0.031) and MCS (p-value=0.001) scores in the different age categories. The education groups varied significantly with respect to MCS (p-value=0.05). The recipients of live unrelated transplants had significantly lower average PCS score. Conclusion: The female gender, live related donor and variations in ages were associated with lower PCS scores, while male gender, variations in ages, and education were associated with lower MCS scores. This study demonstrates that the Kidney Disease Quality of Life Short Form-1.3 (KDQOL SF-1.3) is a good tool to reveal differences in HRQOL scores in renal transplant recipients.

Living-related partial liver transplantation in unresectable liver metastatic colorectal cancer. A case report

Aim. The purpose of the article is to study the outcome of using living-related partial liver transplantation in the treatment of unresectable liver metastatic colorectal cancer. Case report. A woman, born in 1989, applied to the Medical Center Universal Clinic “Oberig” with a diagnosis of stage IV sigmoid colon cancer pT4N2M1 with synchronous liver metastases after sigmoidectomy and adjuvant chemotherapy. The patient underwent surgical intervention to the extent of right-sided hemihepatectomy with total caudate lobectomy, enucleation of metastases from the left liver lobe, cholecystectomy, extended lymphadenectomy, followed by systemic antitumor therapy. Six months later, according to laboratory and instrumental examinations, the progression of the disease was revealed in the form of new metastases development in the left liver lobe. After a thorough examination, a decision was made to treat the patient by living-related partial liver transplantation. On February 16, 2021, the patient underwent orthotopic transplantation of the left liver lobe from a living-related donor. The patient was discharged on the 31st postoperative day in a satisfactory condition. According to a control MRI after discharge, no signs of disease progression were detected. In the post-transplantation period, the patient developed an acute steroid-resistant rejection requiring antiplatelet immunoglobulin prescription. Three months after discharge, the patient was diagnosed with a high stricture of the bilio-biliary anastomosis, so resections of liver segment IV, hepaticocholedochus, and bihepaticojejunostomy on a defunctionalized Roux loop of the small intestine were performed. In the post-transplantation period, no signs of disease progression were detected, and no special antitumor treatment was used. Conclusions. Liver transplantation is an effective and radical method of treatment for patients with unresectable liver metastatic colorectal cancer.

Mucocutaneous Manifestations in Kidney Transplant Patients: Risk Factors.

Introduction Mucocutaneous complications in kidney transplant patients are due to drug toxicity or immunosuppression. The main objective of our study was to determine the risk factors associated with their occurrence. Methods We conducted a prospective analytical study (January 2020- June 2021) including kidney transplant patients seen at the Nephrology Department.We described the characteristics of the patients who presented mucocutaneous complications and then compared them to those who didn't to deduce the risk factors.Statistical analysis was performed using SPSS 20.0 (p<0.05). Results Of the 86 patients recruited, thirty patients had mucocutaneous complications. The mean age was 42.73, with a male predominance (73%). Ten kidney transplants were performed from a living-related donor. All the patients received corticosteroids, Mycophenolate Mofetil, and the Calcineurin Inhibitor: Tacrolimus (76.7%) or Ciclosporin (23.3%). Induction was performed with Thymoglobulin (n=20) or Basiliximab (n=10). Mucocutaneous complications were dominated by infectious manifestations (53.4%): eight cases of fungal infections; six cases of viral infections: warts (n=3), herpes labialis (n=2), intercostal herpes zoster (n=1), and two cases of bacterial infections: atypical mycobacteria and boils. Inflammatory complications (36.6%) included acne (n=4), urticaria (n=3), rosacea (n=1), simple maculopapular exanthema (n=1), aphthous lesion (n=1), and black hairy tongue (n=1). Actinic keratosis, skin xerosis, and bruises were found in one patient respectively. The evolution with a symptomatic treatment was good in all the patients.After statistical analysis, the factors significantly associated with the occurrence of mucocutaneous complications were advanced age, male gender, anemia, HLA non-identical donor, as well as the use of Tacrolimus or Thymoglobulin. Conclusion Infectious mucocutaneous complications are the most common dermatological manifestations among renal transplant recipients. Their occurrence is related to advanced age, male gender, anemia, HLA non-identical donor, and the use of Tacrolimus or Thymoglobulin.

Pulmonary Complications in Renal Transplant Recipients

Background Kidney transplantation recipients are at an increased risk of lung complications due to infectious or non-infectious reasons. We aimed to determine the lung complications after transplantation and what we could do to prevent the complications during the follow-up, retrospectively.&#x0D; Material and Methods The 296 patients who underwent kidney transplantation surgery in our centre between the years 1999 to 2006 were included in the study.&#x0D; Results 75% of the patients were male (n: 222). 77% of the patients (n: 228) had a living-related donor. The mean hospitalisation duration in the post-transplantation period was 13.3±9.07 days. During the follow-up, 37.2% of the patients (n: 110) had rejection, and pulse steroid treatments were given to the 74.5% of these patients. In our study, the lung complication development ratio was 16.2%, and 84% of these complications were due to infections. A specific aetiology was not identified in 63.5% of patients. The patients with a living-related donor had more lung complications due to infection (p

Early Branching of Bilateral Renal Arteries with Bilateral Accessory Renal Arteries: A Case Report of a Live-Related Donor Transplantation

Comprehensive preoperative evaluation of potential donors is crucial for selecting the right donor, with adequately functioning kidneys, and the best surgical approach for harvesting the organs to prevent donor-related complications and to assure good recipient graft function. Multidetector computed tomography is the choice of imaging in the preoperative evaluation of living renal donors with an accuracy of 95%–100%. The donor must retain one normal kidney. The left kidney is preferred for living donor nephrectomy because it has a longer renal vein and it is technically easier to remove. It is always preferable to choose kidneys with a single artery because both donor and recipient surgeries are less complicated and there is less risk for arterial thrombosis. We report in a case of successful transplantation wherein the donor had an early division of the main renal artery bilaterally as well as bilateral accessory renal arteries.

Unrelated versus related living-donor kidney transplantation is associated with higher acute rejection rate but similar graft survival Running title: Outcomes in living-donor kidney transplantation

Kidney transplantation (KT) from living donors has been shown to have multiple benefits compared with that from deceased donors. We sought to compare significant graft outcomes, namely acute rejection (AR), graft function, and survival, between transplant recipients who received a kidney from a living-related donor (LRD) and from a living unrelated donor (LURD). Our cohort comprised 198 donor and recipient pairs undergoing living-donor KT at our center over 10 years. LRD recipients were compared with LURD recipients according to demographic and clinical characteristics, transplant variables (including immunosuppression), graft function, survival, and AR rate. The estimated glomerular filtration rate (eGFR) was similar in both groups over the follow-up time, of 60-65 mL/min (p&lt;0.05 over a 10-year period). Censored graft survival was similar between LRD and LURD recipients (96.9% vs. 98.0% at 5 years and 87.8% vs. 79.4% at 10 years, respectively; p=0.837). LURD recipients had a higher incidence of AR, although LURD recipient status was not an independent risk factor for AR. Multivariate analysis showed that human leukocyte antigen (HLA) -DR mismatch (MM) was an independent predictor of AR (hazard ratio [HR] 2.256, p&lt;0.05). HLA-A and HLA-B MM did not affect the AR HR between the groups. Graft function and censored-death survival rates were similar between the LURD and LRD KT recipients. HLA-DR MM was an independent risk factor for AR.

Non-Contrast-Enhanced MR Arteriography of Potential Living-Related Liver Donor: Using Contrast Enhanced CT Arteriography as Standard Reference.

Contrast-enhanced computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are the primary modalities to assess donors' vessels before transplant surgery. Radiation and contrast medium are potentially harmful to donors. To compare the image quality and visualization scores of hepatic arteries on CTA and balanced steady-state free-precession (bSSFP) non-contrast-enhanced MRA (NC-MRA), and to evaluate if bSSFP NC-MRA can potentially be a substitute for CTA. Prospective. Fifty-six consecutive potential living-related liver donors (30.9 ± 8.4 years; 31 men). 1.5T; four bSSFP NC-MRA sequences: respiratory-triggered (Inhance inflow inversion recovery [IFIR]) and three breath-hold (BH); and CTA. The artery-to-liver contrast (Ca-l) was quantified. Three radiologists independently assigned visualization scores using a four-point scale to potential origins, segments, and branches of the hepatic arteries, determined the anatomical variants based on Hiatt's classification, and assessed the image quality of NC-MRA sequences. Fleiss' kappa to evaluate the readers' agreement. Repeat measured ANOVA or Friedman test to compare Ca-l of each NC-MRA. Friedman test to compare overall image quality and visualization scores; post hoc analysis using Wilcoxon signed-rank test. P-value <0.05 was considered statistically significant. Inhance IFIR Ca-l was significantly higher than all BH bSSFP Ca-l (0.56 [0.45-0.64] vs. 0.37 [0.29-0.47] to 0.41 [0.23-0.51]). Overall image quality score of BH bSSFP TI1200 was significantly higher than other NC-MRA (4 [4-4] vs. 4 [3 to 4-4]). The median visualization scores of almost all arteries on CTA were significantly higher than on NC-MRA (4 [3 to 4-4] vs. 1 [1-2] to 4 [4-4]). The median visualization scores were all 4 [4-4 ] on Inhance IFIR with >92.3% observed scores ≥3, except the segment 4 branch (3 [1-4], 53.6%). The identification rates of arterial variants were 92.9%-97% on Inhance IFIR. Although CTA is superior to the NC-MRA, all NC-MRA depict the donor arterial anatomy well. Inhance IFIR can potentially be an alternative image modality for CTA to evaluate the arterial variants of living donors. 3 TECHNICAL EFFICACY: Stage 2.

Renal Cell Carcinoma in Transplanted Kidney: A Case Report and Literature Review

Introduction: The incidence of renal cell carcinoma in the transplanted kidney is extremely rare. Case report: A 42-year-old female underwent a living-related donor kidney transplant from her 60-year-old mother due to glomerulonephritis leading to end-stage renal disease. Ultrasonography, nine years after transplantation, revealed a lower pole renal tumor in the renal graft with a suspicious image of malignant neoplasm on computed tomography. The patient underwent partial nephrectomy and histological analysis revealed clear cell carcinoma. Final considerations: After one year of follow-up, serum creatinine levels are normal and there are no signs of metastasis or tumor recurrence.

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.

Biologically Unrelated Living Donor for Kidney Transplantation Associated With Higher Acute Rejection Rate but With Similar Graft Survival of a Related Living Donor.

Kidney transplantation (KT) from living donors has been shown to have multiple benefits compared to those from deceased donors. We sought to compare significant graft outcomes, namely acute rejection (AR), graft function, and survival between transplant recipients who received a kidney from living related donor (LRD) and living unrelated donor (LURD). Our cohort comprised 198 donor and recipient pairs undergoing living-donor KT at our center over 10 years. The LRD recipients were compared with LURD recipients according to demographic and clinical characteristics, transplant variables (including immunosuppression), graft function, survival, and AR rate. The estimated glomerular filtration rate (eGFR) was similar in both groups over the follow-up time i.e.,60-65 mL/min (p>0.05 over 10 years). Censored graft survival was similar between LRD and LURD recipients (96.9% vs. 98.0% at five years and 87.8% vs. 79.4% at 10 years, respectively; p=0.837). The LURD recipients had a higher incidence of AR, although LURD recipient status was not an independent risk factor for AR.Multivariate analysis showed that human leukocyte antigen (HLA)-DR mismatch (MM) was an independent predictor of AR (hazard ratio (HR) 2.256, p<0.05). Both HLA-A and HLA-B MM did not affect the AR HR between the groups. Graft function and censored graft survival rates were similar between LURD and LRD KT recipients in our study. The AR was higher in LURD recipients, although the LURD recipient status was not an independent risk factor for AR. The HLA-DR MM was an independent predictor of AR, while HLA-A and HLA-B MM did not affect AR HR between groups of patients.

243.1: Pediatric Liver Transplantation Indications and Outcomes in Glycogen Storage Disease: A Single Center Experience

Introduction: Glycogen storage diseases (GSDs) are inherited metabolic disorders result from impaired glycogen storage, glycogen or glucose breakdown. Liver transplantation (LT) is considered as a treatment option for patients with glycogen storage diseases present with hepatic malignancy, liver failure or metabolic decompensation. GSD type Ia is associated with mutations in the G6PC gene due to deficiency of glucose-6-phosphotase, while glycogen storage disease type 9 results from phosphorylase kinase deficiency, an enzyme necessary for glycogen breakdown. Herein, we present our experience and transplantation outcomes in 7 pediatric patients with GSD who underwent LT. Methods: We retrospectively analyzed data from patients diagnosed with GSD who underwent LT between 1993-2021 years. Results: LT was performed in 6 patients with GSD type 1a and one patient with GSD type 9. Four patients had a family history of consanguinity (3 patients 1st degree, 1 patient 2nd degree). Mean age of diagnosis was 7.28 (1-24) months. Mean age of LT was 128.5 (13-216) months. Transplantation indications were hepatic adenoma (4/7), poor metabolic control (4/7) and cirrhosis (1/7). Extra-hepatic findings included proteinuria (4/7), Focal segmental glomerulosclerosis (1/7), proximal tubulopathy (4/7), nephrolithiasis (2/7), hyperlipidemia (7/7), delayed puberty (3/7), hypertension (2/7), short stature (6/7), epilepsy (2/7) and osteoporosis (4/7). One patient with GSD1a underwent cataract surgery. Three patients with GSD1a incidentally had the same G6PC gene mutations (c.247C>T). Three patients had normal cognitive functions and development (WISC-R Test). Two patients had mild where one patient had moderate mental retardation. One patient had %30 developmental delay (AGTE Test). Six patients underwent LT from living-related donors while one patient had cadaveric donor. Patients who underwent LT from live donors received left lateral segment. Explant liver pathology revealed variable numbers (1-12) of hepatic adenoma in 4 patients. Hepatocellular carcinoma (HCC) was detected in one patient. Serum lactate, uric acid and triglyceride levels normalized after LT. Tubulopathy resolved in one patient while epilepsy continued in two patients. Height SD scores were improved in 4 patients while remained unchanged in one patient after 5-year follow up. Acute graft rejection was detected in 4 patients. Mean follow up time was 80 (3-183) months. All patients are still alive and routinely followed up at our department. Conclusion: LT improved the quality of life in our GSD patients with metabolic decompensation and severe disease manifestations. Biochemical parameters (lactate, uric acid and triglyceride levels) normalized after transplantation. Our patients displayed improved height growth. LT should be considered in GSD patients with poor metabolic control despite dietary management, hepatic malignancy or progressive liver failure.

233.12: Commercial Kidney Transplantation: Sociodemographic and Clinical Characteristics

Background: Transplantation is the renal replacement therapy of choice for patients with end-stage kidney disease. In addition to the survival benefit and better life quality, it confers an economic advantage to the health care system. Although condemned by the international community, transplant tourism and commercial transplantation are still evident. The disparity between organ supply and demand finds an outlet whenever the regulations are less strict. Objectives: To describe the sociodemographic and clinical characteristics of patients who received a commercial transplant and address the causes to seek commercial transplantation. Methods: A questionnaire-based survey was done from September 2021 to December 2021 at the outpatient clinic of the Nephrology and Renal Transplantation Center, Baghdad. In Iraq, renal transplantation is a live donor, blood group compatible program. A central team should approve all donors to ascertain noncommercial conduct. As per Iraqi legislation, renal transplantation services and maintenance immunosuppression are provided free of charge at governmental hospitals. Commercial transplantation is defined as the state of paying a donor at a non-governmental unit. The questionnaire included 15 questions distributed to patients who received transplants at non-governmental units inside Iraq or sought a transplant outside the country. It provided demographic and clinical data and assessed the reason for performing a paid donation. Laboratory data were retrieved from patients records. Results: Seventy-eight patients accepted to participate in the study. The majority (66/85%) were male, and the study group’s mean age was (43.3 + 10.8 years). Fifty-four (69.2%) patients were below the college education level, and 47% were unemployed. The cause for ESRD was unknown in 51%. All donors were live unrelated, and five patients (6.41 %) had their transplants outside Iraq. The duration of the hospital stay was 5-14 days. The time since transplantation was 1 to 5 years. The reported complications at 1-year post-transplantation were: rejection (15%), wound infection (2.5%), CMV infection (1%), and recurrent disease (1%). The mean serum creatinine at one year was 1.27 + 0.52 mg/dl. At five years, 14 patients (17.94%) had a diagnosis of chronic allograft dysfunction. The leading reason for seeking commercial transplantation was the unavailability of the biologically related or unrelated altruistic donor in 74% of the study participants. The average cost was around 30,000-40,000 US$ exceeding the nearly free transplantation services at governmental units. Conclusion: Unavailability of live related or altruistic donors was the leading cause for seeking commercial transplantation in this sample of Iraqi renal transplant recipients. For a live donor transplant, the early graft function was acceptable. Commercial transplantation adds a lot of financial burden to patients and their families. This emphasizes improving transplantation services and implementing a deceased donor program.

Portal and Hepatic Venous Territorial Mapping in Healthy Human Livers: Virtual Three-Dimensional Computed Tomography Size-Shape-Topography Study.

This study aimed to assess portal and hepatic venous volumes as related to the planning of complex liver resections and segmental liver transplant. We analyzed 3-dimensional computed tomography of portal and hepatic vein territorial maps of 140 potential living related liver donors. Portal and hepatic vein maps were simulated both separately and in overlap (cross-mapping) to calculate inflow and outflow volumes. In total liver volume, the right hemiliver was always dominant (mean 64.7 ± 4.8%) and the right medial sector (mean 36.4 ± 6.8%) and segment 8 (mean 19.1 ± 4.3%) accounted for the largest volumes, whereas the left medial sector(mean 13.5 ± 3.1%) and segment 4A (mean 5.8 ± 1.8%) accounted for the smallest volumes (with exclusion of caudate lobe). The right hepatic vein was dominant for both right hemiliver and right lateral sector and had the largest drainage volume in total liver volume (mean 40.0 ± 11.2%). The left hepatic vein was dominant for both left hemiliver and left lateral sector but had the smallest drainage volume fortotal liver volume (mean 21.3 ± 5.0%). The middle hepatic vein drained 50.2 ± 12.5% of the right medial sector and 75.8 ± 15.4% of the left medial sector. In 67 cases, an accessory vein (inferior hepatic vein) drained 16.5 ± 13.2% ofthe right hemiliver, 31.4 ± 25.1% ofthe right lateral sector, 26.6 ± 23.2% of segment 7, and 37.4 ± 31.3% of segment 6. The portal and hepatic vein territorial anatomy was characterized by extensive individual variability. An extremely smallremnant volume (<25% of total liver volume) precluded a minority of virtual extended left and a majority of extended right hepatectomies. Left trisectionectomy was associated with risky drainage from the middle hepatic vein, extensive segment 6 remnant congestion volume in 8% of cases, and right lateral sector-favorable inferior hepatic vein large drainage pattern in 13% of livers.

Ethical Analysis of Appropriate Incentive Measures Promoting Organ Donation in Bangladesh.

Bangladesh, a Muslim-majority country, has a national organ donation law that was passed in 1999 and revised in 2018. The law allows living-related and brain-dead donor organ transplantation. There are no legal barriers to these two types of organ donations, but there is no legislation providing necessary costs and incentive measures associated with successful organ transplants. However, many governments across the globe provide different types of incentives for motivating living donors and families of deceased donors. This study assesses the merits and demerits of incentive measures already in use around the world and proposes ethical measures that can promote organ donation in Bangladesh. The primary focus of this paper is to present an ethical analysis of the comparison of incentive measures on organ donation between Bangladesh and the Islamic Republic of Iran as two Muslim countries that operate organ donation for transplantation practices according to Islamic principles. In this paper, I mainly argue that providing a fixed bare minimum financial incentive measure to distantly related living donors and families of deceased donors will encourage Bangladeshis to donate organs in a manner that is ethically justifiable, morally permissible, and socio-economically appropriate. The government of Bangladesh should revise the existing biomedical law to include a provision related to incentive measures and set a strict policy to properly regulate these measures as key stewardship that can ethically promote organ donation for transplantation.

Historical Background of Pediatric Kidney and Liver Transplantation in Turkey

The cornerstone events of kidney and liver transplant history in Turkey are summarized herein. In 1975, we performed the first pediatric living-related renal transplant in Turkey. We followed this in 1978 with the first deceased donor kidney transplant, using an organ supplied by Eurotransplant. In 1979 the law on harvesting, storage, grafting, and transplant of organs and tissues was enacted; the first local deceased donor kidney transplant was performed by our team in 1979. In 1988, another ground-breaking event in Turkey, the Middle East, and North Africa was successfully achieved: the first successful deceased-donor liver transplant, and in 1990, the first pediatric living-related segmental liver transplant in Turkey, the region and Europe was performed by our team. One month later, an adult-to-adult living-related liver transplant (left lobe) in the World was successfully performed. On May 16, 1992, we performed the first combined liver-kidney transplant from a living-related donor, which was the first operation of its kind in the World. Between November 1975 and January 2022, we have performed 3288 kidney (380 pediatric) at the Hacettepe University Hospitals and later on at Baskent University; since 1988, 701 (334 pediatric) liver transplants have been performed. In over 40 years of kidney and liver transplants history in Turkey, 46876 kidney (2502 pediatric patients) and 18203 liver (2612 pediatric patients) transplants have been performed nationwide. In 2001, the Ministry of Health established the National Coordination Center as an umbrella organization to promote transplant activities, especially for deceased donor organ procurement. Transplant activities are accelerating daily throughout the country, but deceased donors are still far below the desired rates.