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Anticoagulation in simultaneous pancreas kidney transplantation - On what basis?

World Journal of Transplantation 2020年第7期10卷 206-214页

作者： Jeevan Prakash Gopal frank jmf dor Jeremy S Crane Paul E Herbert Vassilios E Papalois Anand SR Muthusamy Imperial College Renal and Transplant Center Imperial College Healthcare NHS TrustHammersmith HospitalLondon W120HSUnited Kingdom Department of Surgery and Cancer Imperial CollegeLondon W120HSUnited Kingdom

BACKGROUND Despite technical refinements,early pancreas graft loss due to thrombosis continues to *** coagulation tests(CCT)do not detect hypercoagulability and hence the hypercoagulable state due to diabetes is left ***(TEG)is an in-vitro diagnostic test which is used in liver transplantation,and in various intensive care settings to guide *** is better than CCT because it is dynamic and provides a global hemostatic profile including *** To compare the outcomes between TEG and CCT(prothrombin time,activated partial thromboplastin time and international normalized ratio)directed anticoagulation in simultaneous pancreas and kidney(SPK)transplant *** A single center retrospective analysis comparing the outcomes between TEG and CCT-directed anticoagulation in SPK recipients,who were matched for donor age and graft type(donors after brainstem death and donors after circulatory death).Anticoagulation consisted of intravenous(IV)heparin titrated up to a maximum of 500 IU/h based on CCT in conjunction with various clinical parameters or directed by TEG *** loss due to thrombosis,anticoagulation related bleeding,radiological incidence of partial thrombi in the pancreas graft,thrombus resolution rate after anticoagulation dose escalation,length of the hospital stays and,1-year pancreas and kidney graft survival between the two groups were *** Seventeen patients who received TEG-directed anticoagulation were compared against 51 contemporaneous SPK recipients(ratio of 1:3)who were anticoagulated based on *** graft losses occurred in the TEG group,whereas 11 grafts(7 pancreases and 4 kidneys)were lost due to thrombosis in the CCT group(P=0.06,Fisher’s exact test).The overall incidence of anticoagulation related bleeding(hematoma/gastrointestinal bleeding/hematuria/nose bleeding/re-exploration for bleeding/post-operative blood transfusion)was 17.65%in the TEG group and 45

关键词： Anticoagulation Pancreas transplantation Thromboelastography Thrombosis Hypercoagulability

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Pre-emptive live donor kidney transplantation-moving barriers to opportunities:An ethical,legal and psychological aspects of organ transplantation view

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World Journal of Transplantation 2021年第4期11卷 88-98页

作者： David van Dellen Lisa Burnapp Franco Citterio Nizam Mamode Greg Moorlock Kristof van Assche Willij CZuidema Annette Lennerling frank jmf dor Department of Renal and Pancreas Transplantation Manchester University NHS Foundation TrustManchester M139WLUnited Kingdom Department of Faculty of Biology Medicine and HealthUniversity of ManchesterManchester M139PLUnited Kingdom Department of Transplantation Guy's and St.Thomas'NHS Foundation TrustLondon SE19RTUnited Kingdom Department of Surgery Renal TransplantationCatholic UniversityRome 00153Italy Warwick Medical School University of WarwickCoventry CV47ALUnited Kingdom Res Grp Personal Rights&Property Rights University of AntwerpAntwerp 2000Belgium Departments of Internal Medicine Erasmus Medical CentreRotterdam CE 1015Netherlands The Transplant Centre Sahlgrenska University HospitalGothenburg S-41345Sweden Institute of Health and Care Sciences The Sahlgrenska AcademyUniversity of GothenburgGothenburg S-40530Sweden Imperial College Renal and Transplant Centre Hammersmith HospitalLondon W21NYUnited Kingdom

Live donor kidney transplantation(LDKT)is the optimal treatment modality for end stage renal disease(ESRD),enhancing patient and graft ***-emptive LDKT,prior to requirement for renal replacement therapy(RRT),provides further advantages,due to uraemia and dialysis *** are a number of potential barriers and opportunities to promoting pre-emptive *** infrastructure is needed to deliver robust programmes,which varies based on socio-economic *** frameworks can impact on national prioritisation of pre-emptive LDKT and supporting education *** on other programme’s components,including deceased kidney transplantation and RRT,can also hamper *** programmes are designed to provide maximal benefit to the recipient,which is specifically true for pre-emptive *** care providers need to be educated to maximize early LDKT *** access for varying population groups,without socioeconomic bias,also requires *** barriers,including religious influence,also need consideration in developing successful *** addition,the benefit of pre-emptive LDKT needs to be emphasised,and opportunities provided to potential donors,to ensure timely and safe work-up *** education and preparation for pre-emptive LDKT needs to ensure increased *** of the benefits of pre-emptive transplantation require prioritisation for this population *** recommend an approach where patients approaching ESRD are referred early to pre-transplant clinics facilitating early discussion regarding pre-emptive LDKT and potential donors for LDKT are prioritized for work-up to ensure *** regarding preemptive LDKT should be the norm for patients approaching ESRD,appropriate for the patient’s cultural needs and physical ***-emptive transplantation maximize benefit to potential recipients,with the potential to occur within successful service *** f

关键词： Pre-emptive Kidney transplantation Living donor Ethics End-stage renal disease

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Renal transplantation in gigantism: A case report

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World Journal of Transplantation 2022年第4期12卷 65-71页

作者： Jeevan Prakash Gopal Sotirios Charalampidis Jinpo Xiang frank jmf dor Vassilios E Papalois Imperial College Renal and Transplant Center Imperial College Healthcare NHS TrustHammersmith HospitalLondon W120HSUnited Kingdom Imperial College School of Medicine Imperial CollegeLondon W120HSUnited Kingdom Department of Surgery and Cancer Imperial CollegeLondon W120HSUnited Kingdom

BACKGROUND Gigantism,characterized by excessive growth and height is due to increased secretion of growth hormone,most commonly from a pituitary *** addition to the surgical and anesthetic complexity,the extreme stature of these patients presents a unique challenge for kidney transplantation in deciding whether to proceed with a single or dual kidney *** lack of relevant literature further adds to the *** SUMMARY A 45-year-old patient with untreated gigantism and end stage renal failure on renal replacement therapy was waitlisted for a deceased donor dual kidney transplantation due to the extreme physical stature(Height-247 cm and weight-200 kg).He was offered 2 kidneys from a 1-0-1 HLA mismatched 24-year-old DCD donor(Height-179 cm and weight-75 kg),and was planned for a bilateral retroperitoneal implantation into the recipient external iliac *** immunosuppression consisted of alemtuzumab induction(50 mg)and steroidfree maintenance with *** donor’s right kidney was uneventfully implanted extra-peritoneally into the right external iliac *** contralateral exposure,the left common and external iliac arteries were ectatic and frail.A complex vascular reconstruction was not preferred in order to preserve the arterial supply to the left lower limb,to minimise the cold ischemia time and prevent additional warm ischemic insult to the second ***,it was decided not to proceed with dual *** concerns of nephron mass insufficiency,the graft function was remarkable with a serum creatinine of 120μmol/L within a month from transplantation and 94μmol/L at 1-year post transplantation,and without *** To our knowledge,this is the first case report on kidney transplantation in *** it is believed that dual kidney transplantation is ideal,a single kidney transplantation from an appropriately selected donor can provide sufficient functioning nephron mass in patients with

关键词： Gigantism Giantism Renal transplantation Kidney transplantation Pituitary adenoma Case report

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Unspecified live kidney donation by urological patients

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World Journal of Transplantation 2020年第8期10卷 215-222页

作者： Sebastiaan Ceuppens Hendrikus J A N Kimenai Karel W J Klop Willij C Zuidema Michiel G H Betjes Willem Weimar Jan N M IJzermans frank J M F dor Robert C Minnee Division of Transplant Surgery Department of SurgeryErasmus MC University Medical CenterRotterdam 3015GDNetherlands Department of Internal Medicine Nephrology and Kidney Transplant UnitRotterdam 3000CANetherlands Imperial College Renal and Transplant Unit Hammersmith HospitalImperial College Healthcare NHS TrustLondon W120HSUnited Kingdom

BACKGROUND Individuals with benign kidney disorders undergoing nephrectomy have three possibilities:Autotransplantation,with a certain risk of complications,but without a clear benefit;discarding the kidney;or living kidney *** To investigate whether patients with benign kidney disorders and a medical indication for nephrectomy are suitable as unspecified live kidney *** We searched all clinical data from 1994-2019 for unspecified donors and their transplant recipients(n=160).Nine of these 160 donors had pre-existing kidney disorders necessitating nephrectomy and had decided to donate their kidney anonymously after discussing the possibility of kidney *** studied the clinical course of these nine donating patients and their transplant *** Seven of nine donating patients indicated unbearable loin pain as the main complaint,one donating patient refused ureterocutaneostomy and one had two aneurysms of the renal ***,seven donating patients described absence of pain and one a significant reduction after the *** average 1-year creatinine level in the donating patients was 88μmol/L and after a median of 6.9 years the average creatinine level was 86.6μmol/*** the transplant recipients,one major complication occurred which led to death and in one transplant recipient graft function failed to normalize at first but has been stable for nine years ***,all transplant recipients are off *** Our data show that patients undergoing nephrectomy as part of treatment in selected kidney disorders can function as live kidney donors.

关键词： Unspecified donor Live kidney donation Benign kidney disorder Living donors Kidney Transplantation

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SPIRIT 2013声明：定义临床研究方案的标准条目

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中国循证医学杂志 2013年第12期13卷 1501-1507页

作者： An-Wen Chan Jennifer M.Tetzlaff Douglas G.Altman Andreas Laupacis Peter C.GΦtzsche Karmela Krleza-Jeri AsbjΦrn Hróbjartsson Howard Mann Kay Dickersin Jesse A.Berlin Caroline J.doré Wendy R.Parulekar William S.M.Summerskill Trish Groves Kenneth F.Schulz Harold C.Sox frank W.Rockhold Drummond Rennie David Moher 钟丽丹郑颂华吴泰相李幼平商洪才张伯礼唐旭东吕爱平卞兆祥 SPIRIT中文工作組

临床研究方案是临床研究设计、实行、报告和评价的基础。然而，临床研究方案及现存的临床研究方案指引在内容和质量上差异很大。本文描述了《规范临床研究方案内容》（Standard Protocol Items：Recommendations for Interventional Tri... 详细信息

临床研究方案是临床研究设计、实行、报告和评价的基础。然而，临床研究方案及现存的临床研究方案指引在内容和质量上差异很大。本文描述了《规范临床研究方案内容》（Standard Protocol Items：Recommendations for Interventional Trials 2013 ）,简称SPIRIT2013声明，一个临床研究方案必须报告的条目指引的系统建立和范围。

关键词：临床研究条目标准

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