共查询到20条相似文献，搜索用时 15 毫秒
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Portal hyperperfusion is detrimental to small-for-size livers (SFSLs) in liver transplantation. Surgical techniques modulating portal inflow provide the most effective approach to protect the SFSL. In this report, we describe a technique creating an allograft portacaval shunt that effectively attenuates portal inflow without a requirement of extensive surgical dissection in the recipient during the transplantation. 相似文献
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K.-L. Liu C.-H. Chien C.-Y. Hsieh X.-Y. Huang H.-H. Wang K.-J. Lin Y.-J. Chiang 《Transplantation proceedings》2018,50(10):3059-3064
Background
While most living kidney donors are satisfied with their decision and do not regret donating, few studies have been conducted on the determinants related to the effectiveness and regret of the decision. This study aims to explore the relationship between basic attributes, quality of life, positive affect, negative affect, effectiveness of decision-making, and regret in living kidney donors.Methods
In this cross-sectional study, living kidney donors were recruited from urology and kidney transplant outpatient services. The structured questionnaire used to collect the data included the Positive and Negative Affect Schedule, Medical Outcomes Study 12-Item Short-Form Health Survey, Decision Conflict Scale, and Decision Regret Scale.Results
The findings indicate that living donors with better health status, 24-hour creatinine clearance, physical health-related quality of life (HRQOL), and positive affect experienced greater feelings of effective decision-making. Moreover, women and donors with better physical HRQOL, positive affect, and decision effectiveness were less regretful about the decision of kidney donation.Conclusion
Health status, physical HRQOL, and positive affect are related to decision validity and regret of living donors. Therefore, clinical care providers should regularly assess the mood and health of living kidney donors. Furthermore, activities promoting their health should be encouraged, especially for men. 相似文献7.
C.I. Tsao M. Ting N.K. Chou N.-H. Chi Y.-S. Chen S.-C. Huang C.-Y. Tsan C.-H. Wang H.-Y. Yu C.T. Shun S.-S. Wang 《Transplantation proceedings》2018,50(9):2751-2755
Renal function after heart transplantation (HTx) typically follows a biphasic pattern and an initial decay within 1 to 2 years. Trajectory of renal function after HTx is less reported, especially in Asia. The aims of this cohort study were to describe the changes in HTx recipients' serum creatinine and estimated glomerular filtration rate (eGFR) levels 5 years following HTx in Taiwan.
Methods
We retrospectively reviewed 5 years of 440 consecutive adult patients (≥?18 years) who underwent first HTx from June 1987 to December 2014 at the National Taiwan University Hospital.Results
Among 422 participants, they received induction therapy consisting of intravenous rabbit antithymocyte globulin. Here, we illustrated the trends over the years by dividing the subjects into 2 groups based on their immunosuppressive regimen of transplantation (1987–2002 and 2003–2014) The pretransplantation median serum creatinine concentration level was 1.2 mg/dL, rose to 1.4 mg/dL at 3 months after surgery, and remained steady over 5 years after HTx. Pretransplant median eGFR was 67 mL/min/1.73 m2.The median serum creatinine concentration level and eGFR at baseline were all significantly difference than pretransplantation (P > .05). This result has showed that an initial steep decline within 3 months after transplant remained stable 5 years after HTx.Conclusion
As renal function deteriorates after HTx, we observed a steep decline in serum creatinine level and glomerular filtration rate within the 3 months after HTx, followed by a slow rate of deterioration over the following months. We found a time-related progressive deterioration in renal function during the 5 years after HTx. 相似文献8.
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M. Ting C.-I. Tsao C.-H. Wang N.-H. Chi S.-C. Huang N.-K. Chou Y.-S. Chen S.-S. Wang 《Transplantation proceedings》2018,50(9):2747-2750
Objectives
An oversized cardiac allograft may have a negative impact on survival outcomes according to previous studies; however, due to the shortage of pediatric donor hearts, the use of oversized cardiac allografts is sometimes inevitable. In this study, we reported the survival outcomes of pediatric patients in relation with the donor-recipient weight ratio.Methods
Twenty-eight children, aged 3 months to 17 years, with dilated cardiomyopathy underwent primary cardiac transplantation at the National Taiwan University Hospital between 1995 and 2012. We analyzed these patients according to the donor-recipient weight ratio: group 1 (n = 19) with donor-recipient weight ratio <2.5 (median 1.1, interquartile range 1.0–1.6), and group 2 (n = 9) with donor-recipient weight ratio ≥2.5 (median 3.0, inter-quartile range 2.87–3.5).Results
The 30-day survival rate was 100% for both group 1 and group 2 (P = 1). The survival rates for group 1 and group 2 were 95% vs 100% at 1 year, 84% vs 89% at 5 years, and 73% vs 61% at 10 years. The median survival was 14.4 years vs 12.9 years (P = .6313).Conclusion
In this cohort, the use of oversized cardiac allograft in pediatric patients for dilated cardiomyopathy did not have a negative effect on short-term and long-term survival. 相似文献11.
Mei-Yi Wu Yu-Wei Chen Lie-Yee Hung Chii-Hong Lee Hsin-An Chen Yung-Ho Hsu Mai-Szu Wu 《Transplantation proceedings》2019,51(5):1472-1474
IntroductionThe immunosuppressant agents in kidney transplantation (KT) may lead to various complications such as opportunistic infections and malignancies. BK virus associated nephropathy is a significant complication following KT, and it can result in graft failure. BK virus causes tubulointerstitial nephritis, ureter stenosis, and even graft failure in KT recipients with impaired immune system. We described a 63-year-old woman, who was a hepatitis C carrier and on dialysis for 22 years before KT, who received cadaveric-donor KT 2 years previously. She reported decreasing urine output and general weakness. The serum creatinine level was slightly increased from 2.94 to 4.38 mg/dL.MethodsImmunosuppressant medications including prednisolone, everolimus, cyclosporin, and mycophenolate sodium were continued as maintenance therapy post KT. Kidney biopsy was performed due to deterioration of graft function.ResultsThe kidney biopsy showed consistent results with early-stage polyomavirus nephropathy, characterized by focal viral cytopathic changes with positive immunohistochemical signals and mesangial proliferative glomerulonephritis, immune-complex-mediated (Fig 1 and Fig 2). Negative C4d staining at peritubular capillary was reported. The dosage of mycophenolate sodium was tapered from 720 to 360 mg daily and that of everolimus increased from 0.5 to 1.0 mg daily due to BK viral infection with BK nephropathy. The serum creatinine level was 2.75 mg/dL after treatment.ConclusionEarly detection of BK nephropathy and decreasing immunosuppressant agents are the mainstay of treatment. Substituting leflunomide for mycophenolate sodium and increasing dosage of everolimus has been proposed to solve BK nephropathy. We presented that the use of leflunomide in such situation is in a timely manner. 相似文献
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C.-J. Huang C.-H. Chang K.-W. Cheng C.-L. Chen S.-C. Wu T.-H. Shih S.-C. Yang Y.-E. Lee C.-E. Huang B. Jawan C.-H. Wang S.-E. Juang 《Transplantation proceedings》2018,50(9):2645-2647
Background
To evaluate the effect of dextrose contained in banked blood products on the changes of blood glucose levels in adult living donor liver transplantation patients retrospectively.Methods
Four hundred seventy-seven patients were divided into a non–blood transfusion (BT) group (G1) and a BT group (G2). The changes in blood glucose levels during the operation were compared using a Mann-Whitney U test, and a P value less than .05 was regarded as significant.Results
No significant changes were detected in blood glucose levels after anesthesia, during dissection phase, in the anhepatic phase, or after reperfusion between the groups. Estimated blood loss for G1 (n = 89) and G2 (n = 388) were 718 ± 514 and 5804 ± 877 mL respectively, G1 had no blood transfusion but G2 had received 4350 ± 6230 mL leukocyte-poor red blood cell transfusion, the pre- and end operation hemoglobin for G1 and G2 were 13.2 ± 2.0, 10.2 ± 1.9 and 10.1 ± 1.6, 10.2 ± 1.9 mg/dL respectively, indicating that they were not under or over transfused.Conclusion
When banked blood products are used to replace ongoing blood loss, the dextrose contained in citrate-phosphate-dextrose-adenine seems to have no effect on the changes in the blood glucose levels of the recipients. 相似文献13.
I.H. Hii N.-H. Chi Y.-S. Chen C.-I. Tsao B.-C. Cheng S.-S. Wang 《Transplantation proceedings》2018,50(9):2889-2890
We report a heart transplantation in a patient with no heart. A 60-year-old man suffered from severe infective endocarditis, and due to extensive involvement of the myocardium, only minimal myocardium was left after debridement of the necrotic myocardium and aortic annulus. We finally excised the entire heart to eradicate the infection source and employed 2 extracorporeal membrane oxygenations for full life support. The infection was controlled with strong antibiotics. The patient underwent successful heart transplantation 16 days following the excision and the patient fully recovered without any complications. 相似文献
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H.-K. Wang C.-Y. Chen N.-C. Lin C.-S. Liu C.-C. Loong Y.-H. Lin Y.-C. Lai H.-J. Chiou 《Transplantation proceedings》2018,50(4):1157-1159
Background
Intraoperative portal venous flow measurement provides surgeons with instant guidance for portal flow modulation during living-donor liver transplantation (LDLT). In this study, we compared the agreement of portal flow measurement obtained by 2 devices: transit time ultrasound (TTU) and conventional Doppler ultrasound (CDU).Methods
Fifty-four recipients of LDLT underwent intraoperative measurement of portal flow after completion of vascular anastomosis of the implanted partial liver graft. Both TTU and CDU were used concurrently. Agreement of TTU and CDU was assessed by intraclass correlation coefficient using a model of 2-way random effects, absolute agreement, and single measurement. A Bland-Altman plot was applied to assess the variability between the 2 devices.Results
The mean, median, and range of portal venous flow was 1456, 1418, and 117 to 2776 mL/min according to TTU; and 1564, 1566, and 119 to 3216 mL/min according to CDU. The intraclass correlation coefficient of portal venous flow between TTU and CDU was 0.68 (95% confidence interval, 0.51–0.80). The Bland-Altman plots revealed an average variation of 4.8% between TTU and CDU but with a rather wide 95% confidence interval of variation ranging from ?57.7% to 67.4%.Conclusions
Intraoperative TTU and CDU showed moderate agreement in portal flow measurement. However, a relatively wide range of variation exists between TTU and CDU, indicating that data obtained from the 2 devices may not be interchangeable. 相似文献15.
H.-W. Hsu L.L. Tsang H.-Y. Ou T.-L. Huang T.-Y. Chen C.-Y. Yu W.-X. Lim Y.-S. Tong C.-L. Chen Y.-F. Cheng 《Transplantation proceedings》2018,50(9):2588-2592
Objectives
This study aims to investigate postdonation outcomes of adult living donor liver transplantation donors and remnant liver regeneration in different graft types.Methods
A total of 236 adult living donor liver transplantation donors were classified into different groups: donors with <35% remnant liver volume (group A; n = 56) and donors with remnant liver volume ≥35% (group B, n = 180); left lobe grafts (LLG group; n = 98) including middle hepatic vein (MHV) and right lobe grafts (RLG group; n = 138) without MHV. The 98 LLG group donors were further classified into 2 subgroups based on hepatic venous drainage patterns: MHV-dominant (n = 20) and non-MHV-dominant (n = 78). The demographic data, postoperative laboratory data, complications, graft weight, remnant liver volume, remnant liver growth rate, and remnant liver regeneration rate (RLRR) after partial liver donation were analyzed.Results
The postoperative aspartate aminotransferase, alanine aminotransferase, total bilirubin, intensive care unit stays, and hospitalization stays were higher in A and RLG group donors. All the donor complications in our series were minor complications. The postoperative complication rate was higher in the A and RLG group, but failed to reach statistical significance. There was no significant difference in RLRR between the RLG/LLG and A/B groups. However, the MHV-dominant group had significantly lower RLRR than the non-MHV-dominant group (P < .05).Conclusions
Small remnant liver volume donors (<35% remnant liver) have higher risks of developing postdonation minor complications. Left lobe liver donation in MHV-dominant donor candidates are a major concern. 相似文献16.
Everolimus (EVR) can be used with calcineurin inhibitors to reduce the risk of renal dysfunction, with similar immunosuppressive effect. In this study, we compared renal function after heart transplantation (HT) under EVR with cyclosporine (CSA) or tacrolimus (TAC). Between 2004 and 2014, EVR with CSA or TAC was used in 117 HT at the National Taiwan University Hospital. After HT, all patients received corticosteroid, EVR (C0 target 3–8 ng/mL) and CSA (C0 blood level 100–200 ng/mL), or TAC (Co blood level 5–10 ng/mL). Renal function was evaluated before HT, every month after HT for up to 1 year, and then every 3 months for up to 2 years. Blood-drug levels of EVR, CSA, and TAC were also monitored simultaneously with renal function. The estimated mean glomerular filtration rate (eGFR) was 76.5 mL/min/1.73 m2 before HT. After HT, the eGFR was 64 mL/min/1.73 m2 at the third month, and 64 mL/min/1.73 m2 at the end of first year. The difference was significant between pre-HT and post-HT (P?=?.00) during the first year. No significant differences were noted between the CSA and TAC groups. Careful monitoring of blood-drug level and renal function is crucial after heart transplantation. It is concluded that under close monitoring blood-drug level and renal function, it is possible to reach acceptable postoperative renal function with no difference of renal function between EVR plus CSA and EVR plus TAC. 相似文献
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G.C. Sotiropoulos S. Vernadakis N. Machairas G.M. Kaiser I. Fouzas J. Treckmann A. Paul 《Transplantation proceedings》2019,51(2):390-391
Introduction
Organ procurement from deceased donors has been steadily augmented over the last 20 years. With a more aged donor population, a higher incidence of intraabdominal pathologies, including abdominal aortic aneurysms and atherosclerotic aortic disease, is commonly being encountered. The objective of our study was to report our institutional experience with abdominal aortic grafts during solid organ harvesting.Patients and methods
Data concerning the presence of aortic grafts in deceased solid organ donors during a 36-month period were retrospectively reviewed.Results
During the study period, the organ retrieval team of our institution performed 246 multiorgan retrievals from deceased donors. More specifically, we harvested 6 livers and 12 kidneys from 6 donors with abdominal aortic grafts, which were not known/diagnosed to the organ retrieving team prior to the harvesting procedure. Severe atherosclerosis was present in all these donors. All 18 harvested organs were successfully transplanted. Apart of the absence of the aortic patch in 5 kidney grafts, no further special technical difficulties have been reported by the transplant teams. Data analysis of the recipient and graft outcome was performed through the Eurotransplant database.Conclusion
There are so far no literature data on the outcome of recipients and grafts from deceased donors with abdominal aortic grafts. Although retrieval of such organs is very challenging and requires a very experienced team, the transplantation of the corresponding organs can be performed without special technical problems. 相似文献18.
H.-K. Wang Y.-C. Lai Y.-H. Lin H.-J. Chiou Y.-H. Chou 《Transplantation proceedings》2017,49(5):1073-1075
Background
Liver stiffness is associated with the degree of fibrosis along with other factors. Abrupt change of liver perfusion after hepatectomy is one such factor. In this study, we performed ultrasound elastography to explore the stiffness of the right lobe liver before and after hepatectomy in donors who underwent resection of left lobe or lateral segment of liver.Methods
A total of 32 left lobe liver donors (18 male and 14 female; age range, 21–55 years; mean age, 35.1 years; 19 left lobectomy with middle hepatic reserved for graft and 13 lateral segmentectomy with middle hepatic vein reserved in the remnant liver) were included in this study. Liver stiffness was measured by means of ultrasound elastography with the use of acoustic radiation force impulse imaging. Stiffness of the right lobe liver was obtained by means of right intercostal approach.Results
The stiffness of remnant right lobe liver significantly increased after hepatectomy (1.24 ± 0.18 vs 1.10 ± 0.13 m/s; P = .001). Donors of left lobe liver showed higher stiffness in the remnant right lobe liver compared with donors of lateral segment (1.30 ± 0.18 vs 1.15 ± 0.14 m/s; P = .027). There was no significant correlation between the remnant right lobe liver stiffness, postoperative liver function, and flow parameters of hepatic artery and portal vein.Conclusions
The stiffness of remnant liver significantly increased after hepatectomy. Furthermore, the stiffness was higher in donors undergoing left lobectomy compared with those undergoing lateral segmentectomy. 相似文献19.
Sanghoon Kim Seon Min Sin Hyun Yong Lee Ui Jun Park Hyoung Tae Kim Young-Nam Roh 《Transplantation proceedings》2019,51(8):2508-2513
BackgroundFinancial incentives for deceased organ donation are associated with many controversial ethical issues. This study examines the perspectives of medical students and staff members on financial incentives for the families of brain-dead organ donors.MethodologyA structured survey form was used between December 7, 2017 and January 28, 2018 to elicit opinions on financial incentives for the families of brain-dead organ donors. Forty-three medical staff members and 81 medical students participated in the survey voluntarily. The opinions on the financial incentive system and the relationship between willingness to give information about organ donation to families and a financial incentive system were assessed.ResultsThe majority of the participants (81.4%) had positive thoughts on organ donation. More than half of the participants (60.5%) thought that the financial incentive system did not erode the ethical purity of organ donation. As charge doctors, most respondents (84.6%) were willing to give information about organ donation to family members in the presence of financial incentives. However, the percentage decreased significantly to 60.5% when financial incentive was no longer factored into consideration (P < .001).LimitationThe study population is small, and the participants are not representative of the general population.ConclusionThe opinions of medical students and medical staff on financial incentives for deceased organ donation were generally positive. Financial incentives proved to be a potential influencing factor as an option of organ donation to be given to families. 相似文献
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H.-K. Wang Y.-C. Lai Y.-H. Lin H.-J. Chiou Y.-H. Chou 《Transplantation proceedings》2017,49(5):1001-1004