Publications by authors named "Henry Pleass"

97 Publications

Re: Laparoscopic EndoClose fixation of a peritoneal catheter reduces migration.

ANZ J Surg 2021 05;91(5):1040

Department of Transplant Surgery, Westmead Hospital, Sydney, New South Wales, Australia.

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http://dx.doi.org/10.1111/ans.16605DOI Listing
May 2021

Jurisdictional inequalities in deceased donor kidney allocation in Australia.

Kidney Int 2021 May 5. Epub 2021 May 5.

Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia; Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Sydney, New South Wales, Australia. Electronic address:

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http://dx.doi.org/10.1016/j.kint.2021.04.028DOI Listing
May 2021

Australian experience with total pancreatectomy with islet autotransplantation to treat chronic pancreatitis.

ANZ J Surg 2021 May 6. Epub 2021 May 6.

Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.

Background: This study aimed to describe the clinical outcomes of total pancreatectomy with islet autotransplantation (TP-IAT) in Australia.

Methods: Individuals selected for TP-IAT surgery according to the Minnesota Criteria (Appendix) without evidence of diabetes were evaluated including time to transplantation from pancreatectomy, islet numbers infused and post-transplantation HbA1c, C-peptide, total daily insulin and analgesic requirement.

Results: Sixteen individuals underwent TP-IAT from Australia and New Zealand between 2010 and 2020. Two recipients are deceased. The median islet equivalents/kg infused was 4244 (interquartile range (IQR) 2290-7300). The median C-peptide 1 month post-TP-IAT was 384 (IQR 210-579) pmol/L and at median 29.5 (IQR 14.5-46.5) months from transplant was 395 (IQR 139-862) pmol/L. Insulin independence was achieved in eight of 15 (53.3%) surviving recipients. A higher islet equivalents transplanted was most strongly associated with the likelihood of insulin independence (P < 0.05). Of the 15 surviving recipients, 14 demonstrated substantial reduction in analgesic requirement.

Conclusion: The TP-IAT programme in Australia has been a successful new therapy for the management of individuals with chronic pancreatitis including hereditary forms refractory to medical treatment to improve pain management with 50% insulin independence rates.
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http://dx.doi.org/10.1111/ans.16853DOI Listing
May 2021

Unique case of metachronous adrenal and hepatic myelolipomas.

BMJ Case Rep 2021 Mar 4;14(3). Epub 2021 Mar 4.

Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia.

We present a unique case of metachronous adrenal and hepatic myelolipomas in a 62-year-old man. Myelolipomas are most commonly found in the adrenal gland, with extra-adrenal sites such as the lung, retroperitoneum and liver reported. They are a form of benign mesenchymal tumour, with only 25 case reports of a hepatic location published to date. The are no guidelines to its management. Our patient underwent resection due to pain, and after a complicated postoperative period is pain free.
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http://dx.doi.org/10.1136/bcr-2020-240894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7934733PMC
March 2021

Protection From the Second Warm Ischemic Injury in Kidney Transplantation Using an Ex Vivo Porcine Model and Thermally Insulating Jackets.

Transplant Proc 2021 Mar 11;53(2):750-754. Epub 2021 Feb 11.

Sydney Medical School, University of Sydney, Sydney, Australia; Department of Surgery, Westmead Hospital, Westmead, Australia.

Background: Kidney transplantation is the optimum treatment for kidney failure in carefully selected patients. Technical surgical complications and second warm ischemic time (SWIT) increase the risk of delayed graft function (DGF) and subsequent short- and long-term graft outcomes including the need for post-transplant dialysis and graft failure. Intraoperative organ thermal regulation could reduce SWIT, minimizing surgical complications due to time pressure, and limiting graft ischemia-reperfusion injury.

Methods: A novel ischemic-injury thermal protection jacket (iiPJ) was designed and fabricated in silicone composite and polyurethane (PU) elastomer prototypes. Both were compared with no thermal insulation as controls. Time to reach ischemic threshold (15°C) and thermal energy transfer were compared. A water bath model was used to examine the thermal protective properties of porcine kidneys, as a feasibility study prior to in vivo translation.

Results: In both iterations of the iiPJ, the time taken to reach the warm ischemia threshold was 35.2 ± 1.4 minutes (silicone) and 38.4 ± 3.1 minutes (PU), compared with 17.2 ± 1.5 minutes for controls (n = 5, P < .001 for both comparisons). Thermal energy transfer was also found to be significantly less for both iiPJ variants compared with controls. There was no significant difference between the thermal performance of the 2 iiPJ variants.

Conclusion: Protection from SWIT by using a protective insulation jacket is feasible. With clinical translation, this novel strategy could facilitate more optimal surgical performance and reduce transplanted organ ischemia-reperfusion injury, in particular the SWIT, potentially affecting delayed graft function and long-term outcomes.
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http://dx.doi.org/10.1016/j.transproceed.2021.01.037DOI Listing
March 2021

Comparison of the effect of single vs dual antiplatelet agents on post-operative haemorrhage after renal transplantation: A systematic review and meta-analysis.

Transplant Rev (Orlando) 2021 Jan 26;35(1):100594. Epub 2020 Dec 26.

RPA Institute of Academic Surgery, University of Sydney, RPA Institute of Academic Surgery, Level 9 E, Tranplantation Services, Missenden Road, Camperdwon, NSW 2050, Australia.; Department of Surgery, Westmead Hospital, Corner of Hawkesbury Rd and Darcy, Westmead NSW 2145, Australia; Royal Prince Alfred Hospital, Missenden Road, Camperdwon, NSW 2050, Australia. Electronic address:

Objectives: A significant proportion of renal transplant patients have cardiovascular comorbidities for which they receive treatment with antiplatelet agents. The aim of this study was to systematically review the current literature reporting perioperative outcomes for patients receiving dual antiplatelet therapy compared to single antiplatelet therapy at the time of kidney transplantation with particular reference to the risks of postoperative haemorrhage.

Materials And Methods: Embase, Medline and Cochrane databases were utilized to identify articles reporting outcomes of renal transplant recipients on single antiplatelet therapy and dual antiplatelet therapy. These outcomes were compared using a random effects model meta-analysis where appropriate.

Results: Six articles were incorporated in the analysis, including 130 receiving dual antiplatelet therapy, and 781 in the single antiplatelet therapy group. There was a significantly higher risk of post-operative haemorrhagic events in the dual antiplatelet therapy group compared to the single antiplatelet therapy group (RR 1.58, 95% CI 1.19-2.09, p = 0.001). Post-operative cardiovascular event rates were similar between both groups in individual studies, although this could not be quantitatively analysed.

Conclusions: The use of dual antiplatelet therapy was associated with a higher risk of post-operative haemorrhage compared to the use of single antiplatelet therapy without increased rates of surgical intervention. However, the use of dual antiplatelet therapy may provide protection from cardiovascular events in an inherently higher risk patient group.
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http://dx.doi.org/10.1016/j.trre.2020.100594DOI Listing
January 2021

Successful Expectant Management of Nonocclusive Thrombosis in Simultaneous Pancreas-Kidney Transplantation.

Transplant Proc 2021 Jan-Feb;53(1):371-378. Epub 2021 Jan 5.

Sydney Medical School, University of Sydney, Sydney, Australia; Department of Surgery, Westmead Hospital, Westmead, Australia; Centre for Transplant & Renal Research, Westmead Institute for Medical Research, Westmead, Australia. Electronic address:

Background: Simultaneous pancreas-kidney (SPK) transplantation can be complicated by thrombosis in the early post-transplant period.

Methods: We performed a single-center retrospective study examining risk factors, management, and outcomes of modern era SPK transplants. We reviewed 235 recipients over 10 years (January 1, 2008, to September 1, 2017). We used multivariate analysis to examine donor, recipient, and operative risk factors for thrombosis.

Results: Forty-one patients (17%) had a thrombosis diagnosed on postoperative imaging, but 61% of these patients (n = 25/41) did not lose their graft secondary to the thrombosis. Nine patients (22%) were managed with watchful waiting and serial imaging, 12 (29%) were managed with therapeutic anticoagulation, and 4 (10%) required laparotomy and graft thrombectomy. Sixteen of 235 pancreas grafts (6.8%) required pancreatectomy, and 10 of these cases occurred in the first half of the study, before 2012. The risk of thrombosis leading to graft loss increased 11.2-fold in recipients with a body mass index (calculated as weight in kilograms divided by height in meters squared) > 25 compared with others (odds ratio, 11.2; 95% CI, 1.1-116.7; P = .043).

Conclusions: The majority of SPK transplants (61%) complicated by thrombosis of the pancreatic graft were salvaged by use of imaging, anticoagulation, and in select cases, laparotomy and graft thrombectomy.
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http://dx.doi.org/10.1016/j.transproceed.2020.10.042DOI Listing
May 2021

Day-only elective cholecystectomy: early experience and barriers to implementation in Australia.

ANZ J Surg 2021 04 28;91(4):590-596. Epub 2020 Dec 28.

Department of Upper Gastrointestinal Tract Surgery, Westmead Hospital, Sydney, New South Wales, Australia.

Background: Day-only laparoscopic cholecystectomy (DOLC) has been shown to be safe and feasible yet has not been widely implemented in Australia. This study explores the introduction of routine DOLC to Westmead Hospital, and highlights the barriers to its implementation.

Methods: Routine day-only cholecystectomy protocol was introduced at Westmead Hospital in 2014. A retrospective review of patients who underwent elective laparoscopic cholecystectomy during a 12-month period in 2014 was compared to a 12-month period in 2018, to examine the changes in practice after implementation of a unit protocol. Data were collected on patient demographics, admission category, outcomes and re-presentations.

Results: A total of 282 patients were included in the study, of these 169 were booked as day procedures, with 124 (73%) successfully discharged on the same day. There was a significant increase in the proportion of patients booked as day-only from 2014 to 2018 (48% versus 73%, P < 0.001). Day-only failure rates (unplanned overnight admissions), readmissions and complication rates were comparable between the two periods. The most common reason for unplanned overnight admissions were due to intraoperative findings (n = 28/45).

Conclusion: Routine DOLC can be adopted in Australian hospitals without compromise to patient safety. Unplanned overnight admission is predominantly due to unexpected surgical pathology and can be reduced by protocols for the use of drains and planned outpatient endoscopic retrograde cholangiopancreatography. Unplanned outpatient review can be minimized by optimizing both intra- and post-operative pain management. Individual surgeon and anaesthetist preferences remain an obstacle to a standardized protocol in the Australian setting.
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http://dx.doi.org/10.1111/ans.16526DOI Listing
April 2021

Fate of Abstracts Presented at the Transplantation Society of Australia and New Zealand Annual Scientific Meetings.

Transplant Proc 2020 Dec 13:755-761. Epub 2020 Dec 13.

Department of Surgery, Westmead Hospital, Westmead, NSW, Australia; Westmead Clinical School, The University of Sydney, Sydney, Australia. Electronic address:

Background: The numbers and characteristics of the abstracts presented at the Annual Scientific Meetings (ASM) of the Transplantation Society of Australia and New Zealand (TSANZ) that are converted to peer-reviewed publications have not been analyzed previously.

Methods: All abstracts presented at the TSANZ ASM from 2013 to 2017 were reviewed. A literature search was performed using a search algorithm to identify the full-text publications of the presented abstracts. Correlation between abstract characteristics and publication rate was then examined using Cox proportional hazards regression and Kaplan-Meier curves to distinguish the predictors for publication. Over the 5-year period, 576 abstracts were presented, with a total of 164 (28.6%) presentations converted to publications. The majority of publications occurred within the first 3 years, with the mean time to publication being 16.6 (standard deviation = 14.6) months. The median impact factor for published research was 4.74 (interquartile range = 3.06-5.58). Multivariate analysis identified clinical science papers, systematic reviews and surveys (likelihood ratio = 1.42, 5.02, and 2.01; P = .040, .000, and .010, respectively) as the most important predictors for publication.

Conclusions: The rate of abstracts presented at the TSANZ ASM over 5 years that were converted to publication in a peer-reviewed journal was 28.6%. Clinical papers, systematic reviews, and surveys were more likely to be published. An ongoing strict abstract selection process will contribute to improving conversion of abstracts into full-text peer-reviewed articles.
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http://dx.doi.org/10.1016/j.transproceed.2020.10.032DOI Listing
December 2020

Renal Transplant Artery Autologous Saphenous Vein Graft Aneurysms: Late Presentation and the Need for Recall and Surveillance.

Exp Clin Transplant 2020 11;18(6):725-728

From the Department of Transplantation Surgery, Royal Prince Alfred Hospital, Institute of Academic Surgery, Camperdown, New South Wales, Australia.

Autologous saphenous vein grafts are occasionally used in renal transplant recipients, particularly in living donors with short donor vessels or after donor vessel injury during allograft procurement. Autologous saphenous vein graft aneurysm formation is described as a late complication following the use of this conduit in renal transplant. We report a case of a 45-year-old woman who developed an autologous saphenous vein graft aneurysm 21 years after her living donor transplant, which was successfully managed with explantation of the graft, cold perfusion ex situ, and resection of the aneurysm, which was followed by reconstruction using deceased donor iliac vessels. The graft was then successfully reimplanted. Based on this experience and after a review of the literature related to autologous saphenous vein graft aneurysms in renal transplant, we recommend that surveillance for this particular complication should be considered no later than 10 years after implant of an autologous saphenous vein graft when used as an arterial conduit.
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http://dx.doi.org/10.6002/ect.2020.0301DOI Listing
November 2020

Paediatric kidney transplants from donors aged 1 year and under: an analysis of the Australian and New Zealand Dialysis and Transplant Registry from 1963 to 2018.

Transpl Int 2021 Jan 9;34(1):118-126. Epub 2020 Nov 9.

National Pancreas Transplant Unit, Westmead Hospital, Sydney, NSW, Australia.

Kidneys from very small donors have the potential to significantly expand the donor pool. We describe the collective experience of transplantation using kidneys from donors aged ≤1 year in Australian and New Zealand. The ANZDATA registry was analysed on all deceased donor kidney transplants from donors aged ≤1 year. We compared recipient characteristics and outcomes between 1963-1999 and 2000-2018. From 1963 to 1999, 16 transplants were performed [9 (56%) adults, 7 (44%) children]. Death-censored graft survival was 50% and 43% at 1 and 5 years, respectively. Patient survival was 90% and 87% at 1 and 5 years, respectively. From 2000 to 2018, 26 transplants were performed [25 (96%) adults, 1 (4%) children]. Mean creatinine was 73 µmol/l ±49.1 at 5 years. Death-censored graft survival was 85% at 1 and 5 years. Patient survival was 100% at 1 and 5 years. Thrombosis was the cause of graft loss in 12% of recipients in the first era from 1963 to 1999, and 8% of recipients in the second era from 2000 to 2018. We advocate the judicious use of these small paediatric grafts from donors ≤1 year old. Optimal selection of donor and recipients may lead to greater acceptance and success of transplantation from very young donors.
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http://dx.doi.org/10.1111/tri.13772DOI Listing
January 2021

Risk Factors for Early Pancreatic Allograft Thrombosis Following Simultaneous Pancreas-Kidney Transplantation: A Systematic Review.

Clin Appl Thromb Hemost 2020 Jan-Dec;26:1076029620942589

Sydney Medical School, University of Sydney, New South Wales, Australia.

Simultaneous pancreas-kidney (SPK) transplantation remains the most effective treatment for providing consistent and long-term euglycemia in patients having type 1 diabetes with renal failure. Thrombosis of the pancreatic vasculature continues to contribute significantly to early graft failure and loss. We compared the rate of thrombosis to graft loss and systematically reviewed risk factors impacting early thrombosis of the pancreas allograft following SPK transplantation. We searched the MEDLINE, EMBASE, The Cochrane Library, and PREMEDLINE databases for studies reporting thrombosis following pancreas transplantation. Identified publications were screened for inclusion and synthesized into a data extraction sheet. Sixty-three studies satisfied eligibility criteria: 39 cohort studies, 22 conference abstracts, and 2 meta-analyses. Newcastle-Ottawa Scale appraisal of included studies demonstrated cohort studies of low bias risk; 1127 thrombi were identified in 15 936 deceased donor, whole pancreas transplants, conferring a 7.07% overall thrombosis rate. Thrombosis resulted in pancreatic allograft loss in 83.3% of reported cases. This review has established significant associations between donor and recipient characteristics, procurement and preservation methodology, transplantation technique, postoperative management, and increased risk of early thrombosis in the pancreas allograft. Further studies examining the type of organ preservation fluid, prophylactic heparin protocol, and exocrine drainage method and early thrombosis should also be performed.
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http://dx.doi.org/10.1177/1076029620942589DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7573738PMC
October 2020

Recognition of the 'Reversed 4' pattern of surgical knot tying.

Clin Teach 2021 Jun 13;18(3):219-221. Epub 2020 Oct 13.

Department of Surgery, Westmead Hospital, Westmead, Australia.

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http://dx.doi.org/10.1111/tct.13292DOI Listing
June 2021

Prophylactic Wound Drainage in Renal Transplant: A Survey of Practice Patterns in Australia and New Zealand.

Exp Clin Transplant 2020 12 17;18(7):771-777. Epub 2020 Sep 17.

From the Royal Prince Alfred Hospital Institute of Academic Surgery, University of Sydney, Camperdown, New South Wales, Australia.

Objectives: Drains are used routinely in many centers at the conclusion of kidney transplant, despite a paucity of evidence to guide practice in kidney transplant. Studies have not shown benefit from prophylactic drain placement following other major abdominal and vascular operations, and usage is consequently declining. Our aim was to understand practice patterns and rationale for behavior in drain placement and management in kidney transplant.

Materials And Methods: We conducted an online survey of surgeons who routinely perform kidney transplants across Australia and New Zealand.

Results: The response rate was 66% (43/66). Of respondents, 61% reported routine drain insertion, whereas 21% seldom inserted drains. Concerns about bleeding and anticoagulation (63%) and routine practice (58%) were the dominant reasons for drain insertion. The factors selected as most significant in determining drain removal were both volume and time (44%) and volume alone (33%). A volume of < 50 mL/day (51%) was the most commonly reported threshold for removal. The postoperative period of days 3 to 5 was the most commonly selected time point for drain removal (63%). Seventy-four percent of respondents would consider enrolling their patients in a randomized controlled trial to determine the benefits and harms of drain insertion.

Conclusions: Although drain insertion is a common practice, transplant surgeons in Australia and New Zealand reported sufficient uncertainty concerning the potential benefits and harms to warrant design and conduct of a randomized controlled trial.
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http://dx.doi.org/10.6002/ect.2020.0071DOI Listing
December 2020

A Systematic Review and Meta-Analysis of the Significance of Body Mass Index on Kidney Cancer Outcomes.

J Urol 2021 02 18;205(2):346-355. Epub 2020 Sep 18.

Department of Urology, Westmead Hospital, Westmead, New South Wales, Australia.

Purpose: Obesity is a well-known risk factor for kidney cancer incidence. However, a number of studies have demonstrated more favorable kidney cancer prognosis in patients with elevated body mass index conferring a survival advantage, termed the "obesity paradox." We aimed to evaluate the association between body mass index and kidney cancer outcomes (progression-free survival, cancer specific survival and overall survival).

Materials And Methods: A computerized systematic search of Medline®, Embase®, ProQuest®, PubMed® and Google Scholar™ for literature published in English was performed between its inception and December 2018, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for reporting.

Results: Overall, 34 publications comprising a total of 50,717 patients were included in the analysis. The majority assessed the association between body mass index and cancer specific survival. Overweight and obese patients were associated with improved cancer specific survival compared to patients with normal body mass index (HR 0.85, 95% CI 0.79-0.93). A similar trend was demonstrated for progression-free survival (HR 0.68, 95% CI 0.59-0.78) and overall survival (HR 0.66, 95% CI 0.55-0.79). On the contrary, the underweight group was associated with inferior cancer specific survival (HR 2.16, 95% CI 1.15-4.04). Main drawbacks limiting the interpretation were the retrospective design in the majority of studies, heterogeneity in study population, body mass index classification and covariates in multivariate analysis.

Conclusions: This is the largest systematic review evaluating the potential phenomenon of the obesity paradox in kidney cancer outcomes. It demonstrated a favorable effect of body mass index on kidney cancer outcomes. However, due to significant heterogeneity of studies, multicenter prospective studies and further research on the fundamental biological mechanisms are warranted to confirm the significance of body mass index on kidney cancer prognosis.
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http://dx.doi.org/10.1097/JU.0000000000001377DOI Listing
February 2021

Spontaneous hepatic haemorrhage secondary to ruptured hepatocellular adenoma in a young male patient.

BMJ Case Rep 2020 Aug 25;13(8). Epub 2020 Aug 25.

Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia.

A 27-year-old man presented with acute right upper quadrant abdominal pain and vomiting. He was clinically in hypovolaemic shock. Investigations revealed normocytic anaemia with a normal bilirubin and moderate liver function test abnormalities. CT abdomen and pelvis demonstrated haemoperitoneum and a large solitary hepatic mass in segments V and VI, suspicious for a ruptured hepatic tumour. Massive transfusion protocol was commenced and angioembolisation of the inferior branch of the right hepatic artery was undertaken. Despite this, his haemorrhagic shock was resistant to resuscitation. Thus, he underwent emergent exploratory laparotomy, which resulted in segments V and VI liver resection and packing. Re-look laparotomy 2 days following initial exploration was performed where haemostasis was confirmed. Histopathology revealed a ruptured well-differentiated hepatocellular adenoma. The patient made a good recovery following a 2-week admission.
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http://dx.doi.org/10.1136/bcr-2020-235966DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7449593PMC
August 2020

Beware the band adhesion: an unexpected cause of double obstruction following intraperitoneal kidney transplantation.

J Surg Case Rep 2020 Aug 14;2020(8):rjaa239. Epub 2020 Aug 14.

Pancreas and Renal Transplant Unit, Westmead Hospital, Westmead, Australia.

Small bowel obstruction (SBO) following intraperitoneal renal transplantation, either solitary or due to simultaneous pancreas-kidney transplantation, is a known complication. While SBO is most commonly due to adhesions, there have been documented cases of internal herniation following simultaneous pancreas-kidney transplantation with enteric drainage due to the formation of a mesenteric defect. We present a unique complication in which the transplant ureter has caused strangulation and necrosis of a length of small intestine. The transplant ureter was mistaken for a band adhesion and divided. Post-operative anuria signalled this difficult diagnosis. Subsequent re-look laparotomy and ureteric reimplantation with Boari flap were required. Therefore, it is important to consider the ureter as a cause of internal herniation in kidney transplant patients and recognize that a band adhesion within the pelvis may in fact be the transplant ureter, obstructing a loop of small intestine beneath its course.
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http://dx.doi.org/10.1093/jscr/rjaa239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427041PMC
August 2020

Intraductal papillary mucinous neoplasm in a transplant pancreas: a rare occurrence.

ANZ J Surg 2021 03 8;91(3):E165-E166. Epub 2020 Aug 8.

Department of Transplantation, Westmead Hospital, Sydney, New South Wales, 2145, Australia.

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http://dx.doi.org/10.1111/ans.16232DOI Listing
March 2021

Culture of Transplant Perfusate Using BACTEC Technology and Antibiotic Prophylaxis Influences Wound Complications Within a Kidney Transplant and SPK Transplant Cohort.

Transplant Proc 2020 Dec 21;52(10):2909-2915. Epub 2020 Jun 21.

Sydney Medical School, University of Sydney, NSW, 2145, Australia; The Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, Westmead, NSW, 2145, Australia; The Department of Surgery, Westmead Hospital, Westmead, NSW, 2145, Australia. Electronic address:

Purpose: Routine screening for microbial contamination in organ recovery perfusion transport solution (ORPTS) is by microbiological culture without broth enrichment. Our aim was to examine the clinical utility of broth enrichment of perfusion solution, through use of BACTEC (Becton Dickinson) blood culture media, in preventing wound complications for transplant recipients in comparison with culture without enrichment.

Methods: We prospectively collected samples of ORPTS of 395 kidney (n = 250) or simultaneous pancreas-kidney (SPK, n = 145) donors over a 7-year period. Results of culture with and without broth enrichment (n = 285) using BACTEC blood culture media were examined to compare the sensitivity of BACTEC with non-BACTEC methods. We then conducted a paired analysis of 110 recipients with both BACTEC and non-BACTEC culture organ perfusion media. We examined the rates of wound infection and whether the use of targeted antimicrobials reduced infections in the BACTEC group and recipients with both types of cultures.

Results: Of 395 patients with cultures of ORPTS, first, the results of 79 cultures performed using BACTEC media only were compared with 206 non-BACTEC cultures (n = 285). Second, 110 cultures were performed using both methods. For the first part of the study, BACTEC media detected significantly greater microbial growth than non-BACTEC methods (n = 79, 64.6% vs n = 206, 14.6%; P < .001). In the 110 patients with both BACTEC (52.3%) and non-BACTEC cultures (9.9%), there was significantly higher sensitivity of the BACTEC method (P < .001); 68.2% of these patients had antimicrobial cover in the days immediately following transplant sufficient to cover the cultured organism. In the patients with appropriate antimicrobial cover, the rate of recipient wound infection was significantly reduced (P = .003).

Conclusions: Routine screening of ORPTS with BACTEC broth enrichment should always be employed. When paired with antimicrobial prophylaxis, it has the potential to significantly reduce the risk of recipient wound infection.
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http://dx.doi.org/10.1016/j.transproceed.2020.03.026DOI Listing
December 2020

Relative survival and quality of life benefits of pancreas-kidney transplantation, deceased kidney transplantation and dialysis in type 1 diabetes mellitus-a probabilistic simulation model.

Transpl Int 2020 11 10;33(11):1393-1404. Epub 2020 Jul 10.

Renal Unit, Westmead Hospital, Westmead, NSW, Australia.

For patients with type 1 diabetes mellitus who progress to the point of requiring renal replacement therapy, the relative benefits of simultaneous pancreas and kidney transplantation (SPK) and deceased donor kidney transplantation across different age categories compared to dialysis are uncertain. Using Australian and New Zealand registry data from 2006 to 2016, a probabilistic Markov model (n = 10 000) was built comparing patient survival between SPK and deceased donor kidney transplantation with dialysis. Compared to dialysis, the average life years saved (LYS) and quality-adjusted life years (QALY) for SPK and deceased donor kidney transplantation were 5.48 [95% CI 5.47, 5.49] LYS and 6.48 [6.47, 6.49] QALY, and 3.38 [3.36, 3.40] LYS and 2.46 [2.45, 2.47] QALY, respectively. For recipients aged 50 years or younger, receiving a deceased donor kidney, the average incremental gains compared to dialysis were 4.13 [4.10, 4.16] LYS and 2.99 [2.97, 3.01] QALY, and for recipients older than 50 years, 3.05 [3.02, 3.08] LYS and 2.25 [2.23, 2.27] QALY. Compared to dialysis, SPK transplantation incurs the greatest benefits in LYS and QALY for patients with type 1 diabetes requiring renal replacement therapy. Patients older than 50 years still experience survival benefits from deceased donor kidney transplantation compared to dialysis.
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http://dx.doi.org/10.1111/tri.13679DOI Listing
November 2020

Delayed emergency surgical presentation: impact of corona virus disease (COVID-19) on non-COVID patients.

ANZ J Surg 2020 Jul 8;90(7-8):1482-1483. Epub 2020 Jun 8.

Department of Surgery - UGI, Westmead Hospital, Sydney, New South Wales, Australia.

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http://dx.doi.org/10.1111/ans.16048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280650PMC
July 2020

How to do it: a robotic kidney autotransplant.

ANZ J Surg 2020 07 1;90(7-8):1472-1473. Epub 2020 May 1.

Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia.

We describe Australia's first reported case of robotic kidney autotransplantation for a complex renal artery aneurysm. It is potentially a safe, minimally invasive method of salvaging renal parenchyma and preservation of renal function in patients with complex renovascular conditions. This technique shows promise in carefully selected patients performed in centres with surgeons experienced in both kidney transplantation and the robotic platform.
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http://dx.doi.org/10.1111/ans.15936DOI Listing
July 2020

Pharmacologic targeting of renal ischemia-reperfusion injury using a normothermic machine perfusion platform.

Sci Rep 2020 04 24;10(1):6930. Epub 2020 Apr 24.

Department of Surgery, Westmead Hospital, Sydney, Australia.

Normothermic machine perfusion (NMP) is an emerging modality for kidney preservation prior to transplantation. NMP may allow directed pharmacomodulation of renal ischemia-reperfusion injury (IRI) without the need for systemic donor/recipient therapies. Three proven anti-IRI agents not in widespread clinical use, CD47-blocking antibody (αCD47Ab), soluble complement receptor 1 (sCR1), and recombinant thrombomodulin (rTM), were compared in a murine model of kidney IRI. The most effective agent was then utilized in a custom NMP circuit for the treatment of isolated porcine kidneys, ascertaining the impact of the drug on perfusion and IRI-related parameters. αCD47Ab conferred the greatest protection against IRI in mice after 24 hours. αCD47Ab was therefore chosen as the candidate agent for addition to the NMP circuit. CD47 receptor binding was demonstrated by immunofluorescence. Renal perfusion/flow improved with CD47 blockade, with a corresponding reduction in oxidative stress and histologic damage compared to untreated NMP kidneys. Tubular and glomerular functional parameters were not significantly impacted by αCD47Ab treatment during NMP. In a murine renal IRI model, αCD47Ab was confirmed as a superior anti-IRI agent compared to therapies targeting other pathways. NMP enabled effective, direct delivery of this drug to porcine kidneys, although further efficacy needs to be proven in the transplantation setting.
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http://dx.doi.org/10.1038/s41598-020-63687-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7181764PMC
April 2020

Re: Andrea Gallioli, Angelo Territo, Romain Boissier, et al. Learning Curve in Robotic-assisted Kidney Transplantation: Results from the European Robotic Urological Society Working Group. Eur Urol. In press. https://doi.org/10.1016/j.eururo.2019.12.008.

Eur Urol 2020 06 17;77(6):e165. Epub 2020 Apr 17.

Department of Urology, Westmead Hospital, Australia; National Pancreas Transplant Unit, Westmead Hospital, Australia; Faculty of Medicine and Health, University of Sydney, Australia. Electronic address:

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http://dx.doi.org/10.1016/j.eururo.2020.03.034DOI Listing
June 2020

Adult kidneys shrink to fit paediatric recipients.

Authors:
Henry Pleass

Transpl Int 2020 08;33(8):863-864

Department of Surgery Westmead Hospital, Faculty of Medicine and Health, Westmead Clinical School, The University of Sydney, Camperdown, NSW, Australia.

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http://dx.doi.org/10.1111/tri.13610DOI Listing
August 2020

Hybrid laparoscopic pancreaticoduodenectomy: an Australian experience and a proposed process for implementation.

ANZ J Surg 2020 07 6;90(7-8):1422-1427. Epub 2020 Mar 6.

Department of Hepato-Biliary Pancreatic/Upper Gastrointestinal Surgery, Westmead Hospital, Sydney, New South Wales, Australia.

Background: Laparoscopic pancreaticoduodenectomy (LPD) is gaining interest with several series reporting favourable outcomes. However, there are significant limitations to the successful implementation of LPD programmes in Australian and New Zealand (ANZ) settings. This study presents a local series of consecutive hybrid LPD (HLPD) and a suggested protocol for implementation of an LPD programme in ANZ settings.

Methods: A retrospective review of consecutive patients undergoing HLPD with a laparoscopic resection and open reconstruction performed by a single surgeon at two centres in Sydney, Australia, between February 2014 and October 2019 was undertaken. Data were collected from a prospectively maintained database and patient records.

Results: Eighteen patients underwent HLPD. Median operative time was 370 min, with a median laparoscopic resection time of 253 min. Median length of stay was 11 days. There was no mortality within 90 days. Post-operative complications included two patients requiring a return to operating theatre for post-operative pancreatic fistula, and five patients with delayed gastric emptying. Median number of lymph nodes harvested was 13 (interquartile range 11-15.8). Resection margins were negative in 15 patients (83.3%).

Conclusion: HLPD is associated with satisfactory perioperative outcomes and may be feasible as a first step towards eventual implementation of LPD in ANZ hospitals.
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http://dx.doi.org/10.1111/ans.15802DOI Listing
July 2020

Endovascular Management of Mycotic Pseudoaneurysm After Pancreas Transplantation: Case Report and Literature Review.

Transplant Proc 2020 Mar 17;52(2):660-666. Epub 2020 Feb 17.

Department of Surgery, Westmead Hospital, Sydney, Australia; Discipline of Surgery, University of Sydney Medical School, Sydney, Australia; National Pancreas Transplant Unit, Westmead Hospital, Sydney, Australia. Electronic address:

Introduction: Mycotic pseudoaneurysm is a rare complication of pancreas transplantation. Successful management relies on early diagnosis and expedient treatment comprising surgery and antibiotics. While the standard of care in recipients of pancreatic transplants is open repair of pseudoaneurysm with or without excision of the allograft, endovascular management has been reported. Endovascular repair is a less invasive treatment option with advantages of expedient control of hemorrhage, avoidance of adhesions with an open repair, and greater suitability for elderly and frail patients.

Material And Methods: We report a case of a 40-year-old recipient of a pancreas transplant who had a mycotic pseudoaneurysm managed with endovascular repair. A systematic search of PubMed-MEDLINE, Embase, and Cochrane Library was performed of all cases of mycotic aneurysms following pancreas or kidney transplantation managed with endovascular repair.

Results: There were 14 cases of mycotic aneurysms in transplant recipients managed with endovascular repair in the literature. Of those who received an endovascular stent as the only initial management strategy, 6 (54.5%) required a subsequent graft excision. Four (28.6%) patients required excision of their stent due to continued sepsis. There was 1 death from unrelated causes.

Conclusions: Endovascular repair was a reasonable bridging technique to further definitive surgical treatment in our case. Endovascular management may be used with caution in high-risk patients. We advocate for prolonged antibiotic therapy combined with vigilant surveillance of the clinical response, and a low threshold for allograft excision in the event of clinical deterioration.
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http://dx.doi.org/10.1016/j.transproceed.2019.09.015DOI Listing
March 2020

Paediatric en bloc kidney transplantation from a donor less than 5 kg.

ANZ J Surg 2020 09 31;90(9):1793-1794. Epub 2019 Dec 31.

Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.

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http://dx.doi.org/10.1111/ans.15642DOI Listing
September 2020

Survival outcomes of hepatic resections in Bismuth-Corlette type IV cholangiocarcinoma.

ANZ J Surg 2020 09 15;90(9):1604-1614. Epub 2019 Dec 15.

General Surgical Department, Westmead Hospital, Sydney, New South Wales, Australia.

Background: Surgical resection for Bismuth-Corlette type IV (BC-IV) hilar cholangiocarcinomas, also termed Klatskin tumours are technically challenging and were once considered unresectable tumours. Following advances in hepatobiliary imaging and surgical techniques, emerging evidence suggests that surgical resection is a viable avenue for long-term survival. We aimed to identify factors affecting survival outcomes of hepatic resections for BC-IV cholangiocarcinomas.

Method: A systematic review was performed across multiple databases and several clinical trial registries. Two reviewers independently screened and selected papers that contained survival data on BC-IV cholangiocarcinoma after hepatic resections.

Results: Of 13 499 papers from our search result, 21 papers satisfied the inclusion criteria. The median post-operative survival was 30.8 months. The average 1- and 5-year post-operative survivals were 61.6 and 33.3%, respectively. Predictors of long-term survival included achievement of R0 margins, minimisation of operative time and reduction intra-operative blood loss.

Conclusion: Our analysis demonstrates improving post-operative outcomes and survival in surgical resection of BC-IV cholangiocarcinoma and suggests that radical surgical resection is a valid treatment option for the disease.
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http://dx.doi.org/10.1111/ans.15531DOI Listing
September 2020