Donor Outcomes Research Articles

Left liver graft in adult-to-adult living donor liver transplantation with an optimal portal flow modulation strategy to overcome the small-for-size syndrome – A retrospective cohort study

BackgroundAdult-to-adult living donor liver transplantation (LDLT) is a notable type of liver transplantation. Several centers prefer the right liver graft (RLG) over the left liver graft (LLG) for better recovery of recipients. We compared the outcomes of donors and recipients between LDLT using LLGs and RLGs. Materials and methodsThe study cohort comprised of 25 patients in the LLG group and 93 in the RLG group. When both hemiliver grafts met the selection criteria, an LLG was preferred. When portal flow (≥300 ml/min/100gLW) and hepatic venous pressure gradient (≥10 mmHg) were increased, intraoperative splenic artery ligation was performed for portal modulation. Postoperatively, somatostatin was administered when small-for-size syndrome (SFSS) was highly suspected. ResultsThe graft-to-recipient weight ratio was lower in the LLG group than in the RLG group. There was no significant complication above Clavien–Dindo grade IIIA in donors. Regarding recipient outcomes, SFSS occurred in four (16.0%) patients in the LLG group and three (3.2%) in the RLG group (P = 0.036). Splenic artery ligation was frequently performed in the LLG group than the RLG group (5 [20.0%] vs. 12 [12.9%], P = 0.035) and 5 patients received intravenous continuous somatostatin for 7 (5–12) days. SFSS-related hospital mortality did not occur. There was no significant difference in the short-term and long-term outcomes between the groups. ConclusionThis study demonstrates the comparable outcomes of donors and recipients between the LLG and RLG groups although with a higher risk of SFSS that needs high experience to avoid severe complications and graft loss. We expect LLG to be used more actively in adult-to-adult LDLT with portal flow modulation strategies to overcome fatal SFSS.

The BLOODSAFE program: Building the future of access to safe blood in Sub-Saharan Africa.

The supply of blood in many low- and middle-income nations in Sub-Saharan Africa (SSA) does not meet the patient care needs. Lack and delay of blood transfusion cause harm to patients and slow the rate of progress in other parts of the health system. Recognizing the power of implementation science, the BLOODSAFE Program was initiated which supports three SSA research study teams and one data coordinating center (DCC) with the goal to improve access to safe blood transfusion in SSA. The study team in Ghana is focusing on studying and decreasing iron deficiency in blood donors and evaluating social engagement of blood donors through different approaches. The study team in Kenya is building a "vein to vein" workflow model to elucidate and devise strategies to overcome barriers to blood donation and improve infrastructural components of blood product production and use. The Malawi team is studying the infectious disease ramifications of blood donation as well as blood donor retention strategies aimed at blood donors who commence their donation career in secondary schools. Together the project teams and the DCC work as a consortium to support each other through a shared study protocol that will study donor motivations, outcomes, and adverse events across all three countries. The BLOODSAFE Program has the potential to lead to generalizable improvement approaches for increasing access to safe blood in SSA as well as mentoring and building the research capacity and careers of many investigators.

Comparison of outcomes for HLA-matched sibling and haplo-identical donors in Myelodysplastic syndromes: report from the chronic malignancies working party of EBMT

Myelodysplastic syndromes (MDS) are the second common indication for an Allo-HCT. We compared the outcomes of 1414 matched sibling (MSD) with 415 haplo-identical donors (HD) transplanted with post-transplant cyclophosphamide (PTCy) as GVHD prophylaxis between 2014 and 2017. The median age at transplant with MSD was 58 and 61 years for HD. The median time to neutrophil engraftment was longer for HD being 20 vs 16 days for MSD (p < 0.001). Two-year overall survival (OS) and PFS (progression free survival) with MSD were significantly better at 58% compared with 50%, p ≤ 0.001, and 51% vs 47%, p = 0.029, with a HD. Relapse at 2 years was lower with a HD 23% than with MSD 29% (p = 0.016). Non relapse mortality (NRM) was higher with HD in the first 6 months post-transplant [HR 2.59 (1.5–4.48) p < 0.001] and was also higher at 2 years being 30% for HD and 20% for MSD, p ≤ 0.001. The incidence of acute GVHD grade II-IV and III–IV at 100 days was comparable for MSD and HD, however, chronic GVHD at 2 years was significantly higher with MSD being 44% vs 32% for HD (p < 0.001). After multivariable analysis, OS and primary graft failure were significantly worse for HD particularly before 6 months [HR 1.93(1.24–3.0)], and HR [3.5(1.5–8.1)]. The median age of HD 37 (IQR 30–47) years was significantly lower than sibling donors 56 (IQR 49–62 years) p < 0.001. However, there was no effect on NRM, relapse or PFS. This data set suggests that a MSD donor remains the preferred choice in MDS over a haplo donor. Transplants with haploidentical donors result in satisfactory long-term outcome, justifying it’s use when no better donor is available.

Potential organ donors with primary brain tumours: missed opportunities for donation and transplantation identified in Australian cohort study 2010-2015.

Potential organ donors with primary brain tumours (PBT) frequently donate, however some may be declined due to uncertainty about tumour classification or transmission risk to transplant recipients. We sought to describe transmission risk and donation outcome of potential donors with PBT, including identifying missed opportunities for transplantation, and any PBT transmission events. We undertook a population-based cohort study in NSW of all potential donors 2010-2015. PBT potential donors were characterized according to tumour grade and transmission risk, and whether they donated organs. Data linkage was used to determine agreement of risk assessment of potential donors to that in the Biovigilance Register, and to identify any PBT transmissions. Of 2957 potential donors, 76 (3%) had PBTs. There was agreement of risk assessment in 44 (58%) cases. PBT potential donors had fewer comorbidities (1.6 vs. 2.1, P=0.006) than non-PBT potential donors. Forty-eight (63%) potential donors were declined for non-PBT reasons, 18 (24%) were declined because of perceived PBT transmission risk and 10 (13%) donated. All PBT donors had WHO-I or -II tumours, and none had a ventriculo-pertioneal shunt. No transmission events occurred. Donors with WHO-I/II PBT appear to have minimal risk of tumour transmission in solid organ transplantation; it is reassuring that no PBT transmission occurred. There is evidence of risk aversion to referrals with WHO-III/IV tumours. There exists opportunity to improve potential donor risk assessment at the time of referral using integrated data sets, and to increase organ donation and transplantation rates through greater utilization of PBT referrals.

Living liver donor hilar anatomical variations and impact of variant anatomy on transplant outcomes.

Donor anatomy is an essential part of donor selection and operative planning in living donor liver transplantation. In this study, variations of hilar structures, and the effects of variant anatomy on donor and recipient outcomes were evaluated. Living donor liver transplantations in a single center between January 2013 and December 2020 were retrospectively reviewed. In total, 203 liver transplantations were analyzed. Type 1 arterial anatomy, type 1 portal vein anatomy and type 1 bile duct anatomy were observed in 144 (70.9%), 173 (85.2%), and 129 (63.5%) donors, respectively. Variant biliary anatomy was observed more frequent in donors with variant portal vein branching than in those with type 1 portal anatomy (60.0% vs 32.3%, P = .004). The overall survival rates calculated for each hilar structure were similar between recipients receiving grafts with type 1 anatomy and those receiving grafts with variant anatomy. When donors with variant anatomy and donors with type 1 anatomy were compared in terms of hilar structure, no significant difference was observed in the frequency of complications and the frequency of serious complications. Biliary variations are more common in individuals with variant portal vein anatomy. Donor anatomic variations are not risk factors for inferior results of recipient survival or donor morbidity.

Expectations and Experiences of Australian Online Sperm Donors Who Have Early Contact with Recipient Parents and Donor Conceived Children

Background: In recent years there has been an increase in the offering and uptake of informal online sperm donation in Australia. While there are a handful of survey-based studies exploring the motives of online sperm donors in Holland and the UK, (Graham et al 2019; Whyte 2018; Freeman et al 2016; Woetsneburg et al 2016) there is little qualitative research that enables a detailed analysis of the experiences of online donors. Aim: This paper aimed to explore the motivations experiences and outcomes of Australian and New Zealand online sperm donors who have had early contact (before the age of 18) with their donor conceived children and recipient parents. Method: Six semi-structured qualitative interviews were conducted with Australian online sperm donors who have had early contact with their donor conceived children. Additional data has been drawn from an analysis of a variety of media sources about online donors, including interviews with online sperm donors from the podcast Sperm Donation World and from newspaper stories about online sperm donors in Australia and New Zealand. Results: There was no universal experience or set of motivations among the donors. Some online sperm donors wanted to co-parent, while others wanted only limited contact with their donor conceived children. However, intentions did not always remain stable. Initial preferences changed during the process of donating and relating to the recipients and donor conceived children. Some study participants’ role preference aligned with what the RPs wanted, while others reported discord in their relationships with RPs, including around contact with their DCC. Conclusion: Our findings suggest that there is the potential for a mismatch of expectations between online sperm donors and recipient parent(s).

423.1: Characteristics and Long-term Outcomes of Female Kidney Donors

Introduction: Almost twice as many females donated a kidney in the United States between 1988-2021. Yet, detailed information regarding their long-term outcomes are sparse. Importantly, there has been no studies that addressed the possible contribution of pregnancy or gestational complications. Therefore, we compared mortality, cardiovascular disease (CVD), and development of hypertension, diabetes, proteinuria, reduced estimated glomerular filtration rate (eGFR) and kidney failure in 4,995 females and 3881 male donors. Methods: We studied female donors in a retrospective cohort study of kidney donors who donated between 1963 to 2007 at three US transplant centers as a part of The Renal and Lung Living Donor Evaluation Study. Mortality, CVD, diabetes, hypertension, proteinuria and reduced eGFR for the entire cohort and for females after adjusting for pregnancy and gestational complications were studied using multivariable analysis. Results: At 17.4±10.8 years after donation, 4.1% of female donors and 5.8% of male donors were deceased, aHR 0.53 (95% CI 0.37, 0.76), p = 0.001; 6.5% vs. 8.0% developed diabetes, aHR 0.98 (95% CI 0.71, 1.32), p = 0.88; and 32.5% vs. 42.5% developed hypertension, aHR 0.87 (95% CI 0.77, 0.97), p = 0.02. The multivariable risks of death, CVD and hypertension were higher in male donors. The risk of reduced eGFR, proteinuria and ESKD were, however, comparable in both sexes. A similar proportion of female and male donors developed eGFR < 30 mL/min/1.73m2 or kidney failure; 1.6% vs. 1.9%, aHR 0.68 (95% CI 0.34, 1.35), p = 0.98 (Figure 1, Figure 2). Donors with pregnancies prior to donation and gestational complications (compared to nulliparous donors) were at increased risk for this composite outcome; aHR 4.02 (95% CI 1.24, 13.02), p=0.02 and aHR 6.06 (95% CI 1.59, 23.15), p= 0.01, respectively.Conclusions: These results demonstrate that the overall risk of kidney failure is similar in female and male kidney donors. Pre-donation pregnancies and gestational complications were associated with a 4- to 6-fold increased risk of eGFR <30 mL/min/1.73m2 or ESKD compared to those without prior pregnancies. Our results are at odds with these previous studies that stated that males are at an increased risk of CVD and faster progression to ESKD. We believe the difference may stem from accounting not only for post-donation events such as diabetes and hypertension but also for prior pregnancies and gestational complications.

P8.048: Organ Preserving Cardiopulmonary Resuscitation in A Resource Limited Country to Increase Donor Pool

Background: In developing nation where modern advances in deceased donation is far from reach, cost effective procedures like organ preserving cardiopulmonary resuscitation (OPCPR) can result in considerable expansion of donor pool. Methods: A retrospective analysis from a single center of India. The outcome measured was difference in OPCPR compared to standard criteria donor (SCD) in censored patient and graft survival through Kaplan Meier analysis. The secondary outcomes were surgical, rejection, and infectious complications. Results: We report our experience of increasing donor pool by OPCPR by 35%. Patient survival was similar in OPCPR group compared to SCD (85.7% vs 96.5%; p-value = 0.19). Graft survival was similar in both groups (96.4% vs 95.1%; p-value = 0.85). The patient survival was similar in non-AKI (acute kidney injury) OPCPR compared to AKI OPCPR (85.7% vs 77.8%; p-value = 0.49). The graft survival was similar in both the groups (95.8% vs 92.9%; p-value = 0.70). The secondary outcomes measured were also similar. Conclusion: Our preliminary report shows acceptable outcomes in OPCPR donors. Hence, we encourage OPCPR worldwide in an effort to further increase the donor pool. This report will be a learning tool to replicate in other resource limited nations.

Normothermic liver machine perfusion as a dynamic platform for regenerative purposes: What does the future have in store for us?

Liver transplantation has become an immense success; nevertheless, far more recipients are registered on waiting lists than there are available donor livers for transplantation. High-risk, extended criteria donor livers are increasingly used to reduce the discrepancy between organ demand and supply. Especially for high-risk livers, dynamic preservation using machine perfusion can decrease post-transplantation complications and may increase donor liver utilisation by improving graft quality and enabling viability testing before transplantation. To further increase the availability of donor livers suitable for transplantation, new strategies are required that make it possible to use organs that are initially too damaged to be transplanted. With the current progress in experimental liver transplantation research, (long-term) normothermic machine perfusion may be used in the future as a dynamic platform for regenerative medicine approaches, enabling repair and regeneration of injured donor livers. Currently explored therapeutics such as defatting cocktails, RNA interference, senolytics, and stem cell therapy may assist in the repair and/or regeneration of injured livers before transplantation. This review will provide a forecast of the future utility of normothermic machine perfusion in decreasing the imbalance between donor liver demand and supply by enabling the repair and regeneration of damaged donor livers.

413.7: Normothermic Machine Perfusion Compared With Static Cold Storage of Liver Grafts for Late Liver Retransplantation: Results of the NAPLES Initiative

Introduction: The pool of donor organs available for patients undergoing liver retransplantation is small, due to the perceived need for an optimal graft. Strategies that can facilitate transplantation of suboptimal organs into retransplant candidates requires investigation. The aim of this study was to determine if patients undergoing liver retransplantation, can be safely transplanted with sub-optimal grafts following normothermic machine perfusion. Methods: Between November 2018 and November 2021, a prospectively enrolled group of retransplant candidates consented to receive livers with suboptimal features but preserved and viability tested with normothermic machine perfusion (NMP). Donor, graft and clinical outcomes were compared to a retrospective group that underwent retransplantation with a graft preserved via static cold storage (SCS) between January 2015 and November 2021. All recipients received grafts from deceased brain death donors. The primary outcome of this study was 6-month graft and patient survival. Results: During the study period, 37 patients underwent retransplantation with a NMP preserved graft. Three of these received two NMP preserved grafts. The CS control group comprised 54 patients, and two of these patients received two CS grafts. Therefore, the NMP and CS groups comprised 40 and 56 grafts respectively. Donor, graft, operative and outcome variables are displayed in table 1. The 6-month graft (90% v 86%. P=0.59) and patient (94% vs 93%, P=0.79) survival did not differ between groups (Table 1). This was despite the NMP group having significantly more steatotic grafts (Moderate steatosis; 30% vs 4%, P=<0.01), donors with transaminases >1000 IU/L (0% v 23%, P=<0.01), and grafts previously declined by at least one other transplant centre (78% v 26%, P=<0.01) (Table 1). The peak alanine transaminase in the initial post-operative 7 days was significantly lower (521 vs 796, P=0.02) in the NMP group, however the rate of early acute rejection was higher (50% vs 27%, P=0.02) but did not impact graft survival. Significantly higher rates of CVVH in the NMP group did not translate to a longer length of stay in ICU. Furthermore, longer term graft and patient survival did not differ between groups (Figure 1). Conclusion: This is the first study to demonstrate that NMP technology can be safely used for sub-optimal liver grafts, and these can be safely transplanted into patients that require retransplantation. This technology can therefore expand the graft options available to this high-risk group. Anne Fox Foundation, University Hospitals Birmingham Charity.

236.11: A Comparison of the Effects of Intravenous vs Oral Hydration on Subclinical Acute Kidney Injury in Laparoscopic Donor Nephrectomy: A Randomised Controlled Trial

Importance: Laparoscopic and laparoscopic assisted donor nephrectomy is the most common method of donor nephrectomy. Despite improving the outcome for donors by reducing post-operative pain and speeding up recovery, the technique exposes the kidney to additional haemodynamic stresses in terms of extreme position and pneumoperitoneum. Any intervention that could protect the kidney may further improve the residual function of both donated and remaining kidney. Objective: To determine if preoperative intravenous fluids given overnight, prior to morning kidney donation will result in a measurable improvement in intraoperative haemodynamics and a decrease in subclinical acute kidney injury. Trial Design: A single centre, prospective single-blinded randomised controlled trial. Participants: All adult patients aged >18 years of age undergoing live donor laparoscopic hand-assisted nephrectomy eligible to participate. Interventions: Intervention group: The evening prior to surgery, between midnight and 8am, patients in this group will receive three litres of crystalloid solution, IV, in addition to unrestricted oral fluid. Control group: Patients in this group will also be admitted on the evening prior to surgery but will not be given intravenous fluids. They will only receive unrestricted oral fluids. Main Outcomes: The primary outcome will be a rise in, serum biomarker for acute kidney injury, neutrophil-gelatinase associated lipocalin (N-GAL). Secondary outcomes include donor and recipient renal function, DGF, intraoperative haemodynamics, perioperative complications. Results: A total of 76 patients (median [IQR] age, 50 [42-57], 44[57%] male) were randomised (36 to preoperative intravenous fluids and 40 to no intravenous fluids) and followed up for 1 year. Serum N-GAL was significantly lower immediately post laparoscopic donation in the intervention group (median [95% CI] intravenous fluids, 95ng/ml [68-133] vs control, 131ng/ml [103-156]; P<.036) but not significantly different at day one post operatively. There was no significant difference between groups in renal function of donors at 6 weeks and 1 year post donation. Intraoperative urine output was significantly higher in the intervention group, but all haemodynamic parameters demonstrated a similar trend between both groups with no significant differences. Conclusions: Intravenous hydration prior to laparoscopic donor nephrectomy statistically reduces serum N-GAL post operatively but is unlikely to be clinically significant. Therefore, patients undergoing laparoscopic kidney donation would not seem to benefit from admission the day prior to surgery, for intravenous fluid hydration, and could be admitted the day of surgery in keeping with the principles of enhanced recovery protocols.

P9.15: What About the Heroes? Living Donor Liver Outcomes, From a Single Latin-American Center Experience Between 2009-2022

Background: The shortage of organs favors the need for considering the use of living donor´s grafts (LD) for liver transplantation (LT). Reports on long term donor outcomes are scarce. Our aim was to report the long term postoperative outcomes of all LD done in our center. Materials and methods: Retrospective observational study from 41 consecutive LD surgeries performed between 2009 and 2022 in a single center. Variables included were: donor (D) demographics, transplant indications, D-Recipient relationship, type of transplant, surgical approach, type of graft, operative time, days in ICU, length of hospital stay, graft weigh, estimated volume, graft/weight ratio (GRWR), postoperative complications using the Dindo- Clavien (DC) classification and mortality. As part of the evaluation, liver anatomy and volumetric assessment was done using CT-Scan and MRI. Biliary anatomy was studied with intraoperative cholangiography. Parenchymal transection was performed using CUSA. Statistical analyses were performed using SPSS v20.0. Results: Twenty four patients (58%) were woman. The mean donor age was 30(±7) years. Transplant indications were biliary atresia (N: 19, 46.3%); Alagille´s syndrome (N: 5, 12.2%), fulminant liver failure (N:5, 12.4%), primary biliary cholangitis (N:4, 9.8%), cryptogenic cirrhosis (N:2, 4.9%), colorectal CA liver metastasis (N:1, 2.4%), and others (N:5,12%). In 63% of cases the donors were parents, figure. Type of transplant was Adult-Pediatric (N: 35, 85%) and Adult-Adult (N: 6, 14%). Open surgery was used in (N: 38, 92%); using median laparotomy in 80% of cases (N: 33), 3 were hand assisted. Types of graft were: left lateral seccionectomy (N: 27, 66%), left lobe (N: 11, 26%) and right lobe (N:3, 8%). The median operative time was 302 (130-570) minutes. Mean graft weight was 309±177 grs, while the mean graft estimated volume calculated with the preoperative CT-Scan was of 342±174gr. Mean GRWR was 2.8±2. The overall complications rate was 12% (N: 5); minor complications were: intra-abdominal collections (N: 2, 4.9%; DC: IIIa and I), biliary fistula (N: 1, 2.4%; DC: I); while major complications were: one hemoperitoneum (DC IIIb) and one pyloric syndrome (DC IVa); all occurred within the first 30 pop. days. Mean ICU stay was 1±0.4 days; length hospital stay was 3±1 days. No postoperative deaths were observed.Conclusions: LD liver transplantation remains as a complex procedure, but the evolving experience, the sustained deficit of cadaveric organs, together with an acceptable morbidity, increases the team willingness to consider its use, in order to reduce the mortality in the waiting list.

Impact of Older Donor Age on Recipient and Graft Survival After LDLT: The US Experience.

The impact of selecting older donors for living donor liver transplantation (LDLT) in the United States is incompletely studied, particularly in light of the recent expansion of LDLT nationally. Adult LDLTs from January 01, 2005 to December 31, 2019 were identified using the United Network for Organ Sharing database. Multivariable Cox models evaluated living donor (LD) age as a predictor of LDLT recipient and graft survival. The impact of increasing donor age on recipient outcomes was compared between LD and deceased donor recipients. Donor postoperative outcomes were evaluated. There were 3539 LDLTs at 65 transplant centers during the study period. Despite the recent expansion of LDLT, the proportion of LDs aged ≥50 y was stable. There were no clinically significant differences in recipient or donor characteristics by LD age group. LD age ≥50 y was associated with an adjusted hazard ratio of 1.49 ( P = 0.012) for recipient survival and 1.61 ( P < 0.001) for graft survival (vs LDs aged 18-29 y). The negative impact of increasing donor age on graft survival was more profound after LDLT than deceased donor liver transplantation (interaction P = 0.019). There was a possible increased rate of early donor biliary complications for donors >55 y (7.1% versus 3.1% for age <40 y; P = 0.156). Increasing LD age is associated with decreased recipient and graft survival, although older donors still largely yield acceptable outcomes. Donor outcomes were not clearly impacted by increasing age, though this warrants further study.

Analysis of Donor Deferral in a Tertiary Health Institution in South-Western Nigeria

Aim: This study aimed at evaluating the deferral pattern among blood donors, in order to draw out lessons that will help canvass for a strengthened policy framework and encourage better outcomes in voluntary blood donation.&#x0D; Study Design: This was a retrospective study.&#x0D; Place and Duration of Study: All the data were sourced from the central database of donors, as recorded by the Haematology Department of Babcock University Teaching Hospital Ilisan-Remo, Ogun state, Nigeria. The data used spanned through a period of 5 years, from 2017 to 2021.&#x0D; Methodology: A total of 7,362 voluntary and non-remunerated blood donors were included in this study. Their records were accessed and used for the study. Data were analysed using SPSS version 25. The level of statistical significance was set at P &lt; 0.05.&#x0D; Results: In this study, half (50.2%) of the entire population of volunteers were between the ages of 18 and 30 years while only 3.7% of them were between 51 and 60 years of age. There were more male volunteers for blood donation compared to the females who only represented 10.8% of the population. 61% of the voluntary donors were accepted for blood donation while 39% were regarded as unfit and hence, deferred. The 3 main reasons for deferral in this study were inadequate hemoglobin (54.7% of deferral cases), unmatched blood group (30.9%) and transfusion transmissible infections (14.4%). Age and gender had a statistically significant (P &lt; 0.05) relationship with the pattern of deferral of the volunteers.&#x0D; Conclusion: The high deferral rate observed in this study may reveal an urgent need for a community-based intervention and targeted efforts by necessary agencies to help improve the general health status of possible future voluntary blood donors.

Lung Transplantation for COVID-19-related Lung Disease: Clinical Experience and Call for a Global Registry.

Lung Transplantation for COVID-19-related Lung Disease: Clinical Experience and Call for a Global Registry.

Impact of the donor hepatectomy time on short-term outcomes in liver transplantation using donation after circulatory death: A review of the US national registry.

During the donor hepatectomy time (dHT), defined as the time from the start of cold perfusion to the end of the hepatectomy, liver grafts have a suboptimal temperature. The aim of this study was to analyze the impact of prolonged dHT on outcomes in donation after circulatory death (DCD) liver transplantation (LT). Using the US national registry data between 2012 and 2020, DCD LT patients were separated into two groups based on their dHT: standard dHT (<42min) and prolonged dHT (≥42min). There were 3810 DCD LTs during the study period. Median dHT was 32min (interquartile range 25-41min). Kaplan-Meier graft survival curves demonstrated inferior outcomes in the prolonged dHT group at 1-year after DCD LT compared to those in the standard dHT group (85.3%vs 89.9%; P<.01). Multivariate Cox proportional hazards models for 1-year graft survival identified that prolonged dHT [hazard ratio (HR) 1.46, 95% confidence interval (CI) 1.19 - 1.79], recipient age ≥ 64 years (HR 1.40, 95% CI 1.14 - 1.72), and MELD score ≥ 24 (HR 1.43, 95% CI 1.16 - 1.76) were significant predictors of 1-year graft loss. Spline analysis shows that the dHT effects on the risk for 1-year graft loss with an increase in the slope after median dHT of 32min. Prolonged dHTs significantly reduced graft and patient survival after DCD LT. Because dHT is a modifiable factor, donor surgeons should take on cases with caution by setting the dHT target of<32min.

Living Kidney Donation Criteria of Baskent University.

Kidney transplant is the best treatment for patients with end-stage renal disease. Preparation of living related kidney donors and recipients is the major step to achieve their best long-term outcomes. Here, we present the Baskent University criteria for living kidney donors and recipients. The Baskent team has performed >2000 kidney transplants from 1985 to 2022 under leadership of Prof. Mehmet Haberal, a transplantation pioneer in Turkey, who facilitated Turkish legislation on procurement, storage, engraftment, and transplant of organs and tissues in June 1979, which has been adopted in other countries with few changes. Although the main frame is similar, we have constant principles in kidney donation. Baskent University is now known as an exceptional transplant center in Turkey, the Middle East, Europe, and the world and has established its own donor criteria for both kidney and liver transplant. Volunteerism remains a core principle of living kidney donation, regardless of other criteria. At Baskent University, donor protection from social, psychological, and health problems is paramount. Loss-profit and risk of transplant are assessed for every case. Donors must be followed up and remedies sought for failed criteria. Dr. Haberal's principles are the basis of Baskent University donation criteria, and unrelated kidney transplant donors are accepted only in cases of cross-donation. Major distinctions of Baskent University's living related donor criteria are (1) absence of unrelated or nondirected donation, (2) lowest acceptable donor glomerular filtration rate of 100 mL/min, (3) rejection of hypertensive donor candidates (regardless of medication), and (4) obesity must be corrected before transplant if body mass index (measured as body weight in kilograms divided by height in meters squared) is >30. The Baskent University donor selection criteria provide excellent long-term outcomes of kidney donors that have been proved by our recent studies.

Donor Selection and Outcome for Pediatric Living Donor Kidney Transplant.

Preemptive related living donor kidney transplant carries the best outcomes for pediatric patients with end-stage kidney disease. Donor age, sex, and comorbidities are to be considered in selecting donors, including marginal extended criteria donors. Kidney size and number of vessels, to match recipient weight and vasculature, are also important parameters. Genetic screening is occasionally required according to the recipient's primary disease. Posttransplant, follow-up and assessment of living related donors are mandatory to evaluate not only the clinical parameters but also to assess quality of life and social and psychological status. In a 1-year follow-up of 50 donors at Abo El-Reesh Hospital (Cairo, Egypt), there were no significant changes in serum creatinine versus glomerular filtration rate (at normal levels), a 16% elevation of blood pressure, and a tendency of impaired glucose tolerance among female donors. Donors reported positive social and psychological effects. Prompt donor selection before transplant is crucial, and posttransplant care and follow-up are mandatory.

Self-reported marijuana use and its effects on overall approval in potential living kidney donors.

Past and present substance use is an important part of the psychosocial evaluation of potential living kidney donors (LKDs). Increasing state legalizations and social acceptance of marijuana (MJ) use can create challenges for transplant centers. We investigated the frequency of reporting MJ use, and its effect on the LKD evaluation. A retrospective chart review was performed on all living donor candidates from December 2016 to December 2019 for reports of MJ use, both on an electronic intake form and during clinical evaluation with a licensed social worker (SW). Active MJ use was defined as current use or use within 1 year of evaluation. Baseline characteristics between MJ users and non-users were compared at each step of donor evaluation. We explored variables associated with MJ use including additional consults and testing during the donor evaluation. Overall approval and donation rates for living donors with active MJ use were compared to non-users. Additionally, 1-year donor follow-up was compared between the two groups. Results of 1818 living donor candidates who completed the intake form, 132 admitted to active MJ use. Compared to non-users, MJ users were more likely to be younger, male, single, renting a home, and with a lower level of education. Thirty three out of 338 candidates who completed a social work evaluation reported MJ use. Compared to non-users, MJ users were more frequently classified as moderate or high risk on SW evaluation, and often required a toxicology screen or psychiatry visit for clearance to donate. Altogether 24.2% of MJ users versus 9.5% of non-users discontinued their evaluation (p<.01). Altogether 42.4% of MJ users versus 56.1% of non-users donated their kidney (p=.13). For those who donated, MJ users were less likely than non-users to follow up at 1 year (57.1%vs. 83.0, p-value .02). MJ users were often asked to complete additional steps in their evaluation before an approval decision was made, which may have led to the higher rate of donor drop out observed in this group. Further research is needed to assess the effects of MJ use on living donor candidacy, as well as any effects of MJ use on long-term donor outcomes.

Short-term Outcome of Danish Kidney Donors: Postoperative Complications and Labor Affiliation

BackgroundLiving kidney donation is safe and effective, but disincentives to donation include risk of short- and long-term complications, which need to be addressed in order to ensure care of live kidney donors. MethodsFrom January 1, 2016 to December 31, 2019, 123 living kidney donors (LKDs) underwent LKD nephrectomy at Aarhus University Hospital, Aarhus, Denmark. Data from The Scandiatransplant registry and patient records were reviewed in order to identify short-term postoperative complications within 90 days after donation, as well as affiliation to the labor market and health data at follow-up. The Clavien-Dindo classification of surgical complications with modifications by Kocak et al was used to categorize minor and major complications. ResultsThere were available data for 119 of 123 LKDs. Of these, 25 (21%) developed minor complications and 4 (3%) developed major complications. Ninety LKDs (76%) had an uneventful course without any complications. The most common complications were pain and nausea that required additional medical treatment. Seventy-two of the 82 LKDs working before donation had returned to work within 3 months after donor nephrectomy. No one retired or became disabled as a result of being a live kidney donor. ConclusionsShort-term follow up of the LKDs showed that most donors experienced an uneventful course and that the frequency of major complications was low. Donation did not seem to impact the ability to resume work. At the 90-day follow-up the majority of donors with both minor and major complications resumed work and reported full convalescence at the same level as donors without any complications. Nine of the LKDs (8%), all women, were out of work for >3 months with the main reason being fatigue.