فهرست مطالب

International Journal of Organ Transplantation Medicine
Volume:1 Issue: 2, Spring 2010

  • تاریخ انتشار: 1389/05/30
  • تعداد عناوین: 10
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  • Page 55
  • N. Ghahramani Page 57
    The disparity between available and needed organs is rapidly increasing, and the number of patients dying while still on the waiting list is growing exponentially. As a partial solution to this disparity, living unrelated transplantation is being performed more frequently, and some have proposed providing financial incentives to donors. The aim of this discussion is to illustrate that with an ever-increasing number of living unrelated transplantations, society and the transplant community should adopt a more active role in developing specific strategies to scrutinize the process. The current paper will also examine the viewpoint that medical ethics is not separable from the prevailing needs of society and involves a constant balancing of often opposing goods. Issues surrounding living unrelated donor transplantation illustrate ethics as a dynamically evolving field, which is often influenced by necessity and which evolves with progression of science and society. As part of this evolution, it is the collective responsibility of society and the transplant community to devise safeguards to guarantee adherence to basic principles of ethics and to avoid «situational ethics.»
  • A. J Ghods Page 63
    During the past decade, the number of transplantation from living kidney donors has substantially increased worldwide. The rate of increase varies from one country to another. The risk of unilateral nephrectomy to the donor includes perioperative mortality and morbidity plus the long-term risk of living with a single kidney. The rate of perioperative mortality and morbidity is about 0.03% and 10%, respectively. More attention is required to prevent serious complications of laparoscopic donor nephrectomy. A grading system in recording perioperative complications is necessary for making it available to each potential donor. The number of studies on long-term outcome of living donors is very limited. The overall evidence suggests that the risk of end-stage kidney disease is not increased in donors, however, mild renal failure, hypertension and proteinuria are not uncommon in living donors. There is also concern that the incidence of cardiovascular disease may be higher in kidney donors. Establishing living donor registry and follow-up is extremely important. Only through these registries the long-term risk of kidney donation will become more apparent. Because of severe shortage of transplantable kidneys, some transplant centers are now using donors with comorbidities and few centers are involved in transplant tourism with inadequate donor screening and follow-up. Prevention of these unacceptable practices in living kidney donors was emphasized in Amsterdam Forum in 2004 and Istanbul Summit in 2008.
  • A. Halawa Page 73
    Tension-free muscle closure is essential in kidney transplantation, both in adult and pediatric patients. Tight muscle closure may lead to renal transplant compartment syndrome either due to compression of the renal parenchyma or due to kinking of the renal vessels. It may also cause kinking of the transplant kidney ureter, wound dehiscence and incisional hernia. Many techniques have been proposed in an attempt to achieve tension-free closure. There is a wrong belief among some surgeons that using prosthetic mesh may increase the incidence of infection complications in these immunosuppressed patients. Also, there is fear that one is not able to monitor the renal graft by ultrasound and perform biopsy in the presence of a mesh. Other alternative techniques to mesh closure include subcutaneous placement and intraperitonealization of the kidney transplant. These techniques however, are valuable when mesh closure is unfavorable or contraindicated as in case of the presence of a potential source of infection like a stoma. Abdominal wall fasciotomy can be adjunctive to various techniques of muscle closure.
  • M. R Mohammadi Fallah_A. Taghizadeh Afshari_M. Asadi_A. H Sharafi Page 77
    Background
    Renal transplantation is the treatment of choice for chronic renal failure. Using a suitable ureterovesical anastomosis technique can prevent most of risks for kidney graft. Extravesical ureteroneocystostomy is becoming popular in renal transplantation because of the low complication rate and technical ease. The decreased complication rate is due to limited bladder dissection and the need for a shorter ureteral segment from the donor.
    Objective
    In this study we assessed the effectiveness and complications of a new technique, Barry-Taguchi technique and compared it with Barry technique.
    Methods
    We recorded all urological complications developed in the recipient’s kidney between September 2004 and March 2007 (mean follow-up 12 months) after performing extravesical Barry-Taguchi (new technique) and Barry ureteroneocystostomy. The urological complications studied included complicated hematuria, urinary fistula, and ureteral stenosis.
    Results
    A total 100 patients who underwent Barry-Taguchi technique and 98 patients who underwent Barry technique were studied. The incidence of urological complications in Barry-Taguchi and Barry re-implantation technique was 4% (n=4) and 5% (n=5%), respectively. These complications included 1 urinary leakage and 3 ureteral obstructions for Barry-Taguchi technique, and 4 obstructions and 1 leakage from Barry group. In both trial groups, no complicated hematuria has occurred. In addition, the recorded time taken for ureteral anastomosis ranged from 4 to 16 (mean 8.3) min for Barry-Taguchi technique and 5 to 20 (mean 9.9) min in Barry technique.
    Conclusion
    The Barry-Taguchi extravesical ureteroneocystostomy technique is a rapid and rather simple technique. Without increasing the incidence of urological complication rate, it is a reliable method for performing ureteroneocystostomy.
  • J. Roozbeh_A. Sattarinezhad_R. Afshariani_A. Eshraghian_M. M Sagheb_G. Raeesjalali_S. Behzadi_S. Nikeghbalian_M. Salehipour_H. Salahi_A. Bahador_S. A Malek_Hosseini Page 85
    Background
    Patients with panel reactive antibodies (PRA) have many difficulties to find a crossmatch-negative kidney for transplantation and are at a higher risk of post-transplantation rejection.
    Objective
    To evaluate the effect of simvastatin on PRA and post-transplant outcome of these sensitized patients.
    Methods
    82 patients with end-stage renal disease (ESRD) with a PRA ≥25% were evaluated. In a one-year follow-up, the patients were treated with simvastatin. These patients were compared with 82 matched controls receiving placebo tablets. At the end of the second and 12th month, PRA was rechecked in all patients. Those patients who underwent transplantation continued to take simvastatin six months after transplantation. Serum creatinine levels were checked at monthly intervals post-operation.
    Results
    The mean±SD PRA level at the end of the second month was 36.63%±31.14% and 45.34%±24.36% in cases and controls, respectively (P=0.012). Seven patients in the case group and 10 in the control group were lost to follow-up. The remaining patients continued to take simvastatin for 12 month.The mean±SD PRA level at the end of the 12th month was 24.02%±31.04% in cases and 43.15%±26.56% in controls (P=0.001). 25 patients underwent renal transplantation and continued to receive simvastatin 6 months after transplantation. These patients were matched with 25 controls treating with placebo. The mean±SD creatinine level 6 months after kidney transplantation was 2.05±1.14 mg/dL and 3.15±1.09 mg/dL in cases and controls consecutively (P=0.02).
    Conclusion
    Simvastatin can be safely used to lower PRA and improve post-transplantation outcomes.
  • B. Einollahi_S. M Alavian_M. Lessan_Pezeshki_N. Simforoosh_M. H Nourbala_Z. Rostami_V. Pourfarziani_E. Nemati_M. Sharafi_M. Nafar_F. Pour_Reza Gholi_A. Firoozan Page 91
    Background
    With the success of kidney transplantation, liver disease has emerged as an important cause of morbidity and mortality in kidney recipients.
    Objective
    To determine the impact of hepatitis B virus (HBV) infection on patients and graft survival in both short- and long-terms.
    Methods
    99 renal transplant patients infected with HBV on follow-up in two major transplant centers were included in a retrospective study. These patients were grafted between 1986 and 2005 and divided into two groups: (1) those only positive for hepatitis B surface antigen (HBsAg) and (2) those who were also positive for hepatitis C virus antibodies (HCV Ab).
    Results
    There were 88 patients with HBsAg+ and 11 with both HBsAg+ and HCV Ab+. The mean±SD age of patients was 38.8±13.2 years, and the median follow-up after transplantation was 19 months. Although not significant, the allograft survival rate in the first group (HBV+) was better compared to that in the second group (HBV+ and HCV+); 1, 5 and 10 years graft survival rates were 91, 77 and 62 in the first group and 70, 56 and 28 in the second group, respectively (P=0.07). The overall mortality was 5% (4 of 88) in the first and 27% (3 of 11) in the second group (P=0.02).
    Conclusion
    Renal allograft recipients with HBV and HCV infections has a poor survival rate compared to patients with only HBV infection. However, there is no significant difference in terms of renal graft survival between the two groups.
  • S. Fry, Revere, B. Bastani Page 94
    The US Uniform Determination of Death Act provides two alternatives for determining death—the circulatory criteria and the neurological criteria—yet history and the public’s current understanding of death in the US may mean that only brain death criteria can be relied upon without raising public suspicion that the medical profession is sacrificing the well-being of one group of patients (i.e., those dying after traumatic injury) to save another group (i.e., those in need of organs). The problem is exacerbated by existing debate on the appropriate waiting time after which death is inevitable and when the brain should be actually considered dead through prolonged absence of autoresuscitation. Given the difficulty of definitive determination of the time when brain function has ceased, two solutions are proposed: abandon the Dead Donor Rule or redefine death. Implementing the former would mean convincing the public to accept organ harvesting before the dying patient is completely brain dead through the writing of advance directives to permit organ harvest when death is inevitable though not confirmed. For the latter, reeducation would be necessary to persuade the public to accept the circulatory criteria for death as an independent determinant for death or the medical community would need to reconsider if the cessation of higher brain function is enough to be the basis for determining death. In conclusion, organ retrieval policies, no matter how medically sound, should seek to avoid the possibility of a public backlash that could result in fewer organs available for transplant.
  • B. Geramizadeh_P. Keramati_A. Bahador_H. Salahi_S. Nikeghbalian_S. M Dehghani_S. A Malek_Hosseini Page 98
    Herein, we describe two patients who underwent liver transplantation with the clinical diagnosis of hepatic failure and cryptogenic cirrhosis; histopathology of the explanted hepatectomy specimen revealed congenital hepatic fibrosis. To the best of our knowledge, coexistence of hepatic failure and cirrhosis in congenital hepatic fibrosis, have not yet been reported in the English literature.
  • A. Kumar, H. Elenin, C. Clayton, C. Basarab, Horwath, B. Man Shrestha Page 101
    Acute abdominal pain following laparoscopic live donor nephrectomy (LLDN) might be a diagnostic dilemma, and prompt diagnosis and management is of paramount importance. Herein, we describe a case of acute appendicitis in a 62-year-old kidney donor who presented with acute abdominal pain 16 days following LLDN with features inconsistent with a diagnosis of acute appendicitis. An ultrasound scan suggested strangulated Spigelian hernia unrelated to the operative wound. Exploration of the wound and mini-laparotomy showed no evidence of wound dehiscence or a hernia, but revealed an inflamed appendix wrapped up with omentum. Appendectomy led to complete recovery of the patient. It is imperative to maintain a high index of suspicion for acute appendicitis in this situation to avoid septic complications that might adversely affect the residual renal function and cause negative impact on kidney donation. To the best of our knowledge, this is the first reported case of acute appendicitis following LLDN.