Publications by authors named "Jorge Ortiz"

152 Publications

Disparate Formulations for Machine Perfusion: A Survey of Organ Procurement Organizations' Medication Additives and Outcome Analyses.

Exp Clin Transplant 2021 Nov;19(11):1124-1132

From the Department of Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA.

Objectives: Machine perfusionfor kidney preservation is a common practice. There is no consensus on the best formula for perfusion solutions. We aimed to discern the additives that organ procurement organizations in the United States include in their perfusate and the impact of these additives on transplant outcomes.

Materials And Methods: A telephone survey of all 58 organ procurement organizations in the United States regarding additives to their perfusion solutions was conducted. The survey data were merged with transplant recipient outcome data from the United Network for Organ Sharing database.The final analysis included perfused kidneys between January 2014 and March 2019. Logistic regressions were performed to investigate whether a particular perfusion formula was associated with delayed graft function, primary nonfunction, or early graft failure.

Results: Additives correlated with decreased rates of graft failure were mannitol in all kidneys and kidneys of lower quality (P < .01) and penicillin/ampicillin in all kidneys (P < .05). Additives associated with increased graft failure regardless of type included verapamil in all kidneys (P < .05) and kidneys of lower quality (P < .01) and arginine with glutathione in all kidneys and low-quality kidneys alone (P < .01).

Conclusions: Further outcomes research and standardized guidelines for additives in machine perfusion of kidneys across all organ procurement organizations are needed.
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http://dx.doi.org/10.6002/ect.2021.0037DOI Listing
November 2021

Transplant surgery departmental leaders do not represent workforce demographics especially among women and underrepresented minorities - A retrospective analysis.

Am J Surg 2021 Nov 14. Epub 2021 Nov 14.

Albany Medical College, NY, USA.

Introduction: The diversity among surgical directors for liver, kidney, and pancreas transplant departments has not been previously evaluated. We aim to quantify the sex and racial demographics of transplant department leaders and assess the impact on patient outcomes.

Methods: Demographics were collected for 116 liver, 192 kidney, and 113 pancreas transplant directors using Organ Procurement and Transplantation Network (OPTN) directory and program websites. Scientific Registry of Transplant Recipients (SRTR) 5-tier program outcomes rankings were obtained for each program and matched to leader demographics. A retrospective analysis of transplant recipients from 2010 to 2019 was performed using the United Network for Organ Sharing (UNOS) database.

Results: 91.5% of transplant surgical directors were male. 55% of departments had a Non-Hispanic White leader. Asian, Hispanic and Black transplant chiefs were at the helm of 23.3%, 9%, and 5% of divisions respectively. Multivariate cox regression analysis did not identify any differences in patient outcomes by transplant director demographics.

Conclusion: There is a paucity of female and URM leaders in transplant surgery. Initiatives to promote research, mentorship, and career advancement opportunities for women and URM are necessary to address the current leadership disparity.
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http://dx.doi.org/10.1016/j.amjsurg.2021.11.008DOI Listing
November 2021

Diversity in American Society of Transplant Surgeons Governance: Equitable but Unequal.

Exp Clin Transplant 2021 Sep 7. Epub 2021 Sep 7.

From the Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA.

Objectives: The diversity in the governance of the American Society of Transplant Surgeons has not been described. We aimed to quantify the present state of its leadership as a baseline to inform future research.

Materials And Methods: Lists of leaders on the American Society of Transplant Surgeons Council, the COVID-19 Strike Force, and 20 different American Society of Transplant Surgeons committees were obtained from the Society's website. Demographic and training information for the members were compiled through internet searches and analyzed.

Results: The American Society of Transplant Surgeons Council included 15 members, with 20% women. It was 93.3% non-Hispanic White. The COVID-19 Strike Force included 12 surgeons, 16.7% of whom were female, with 75% non-Hispanic White. Of the 198 committee members, 23.7% were women, 68.7% were nonHispanic White, 16.6% were Asian, 8.1% were Hispanic, and 6.6% were Black. Among female committee members, underrepresented minorities comprised 23.6%. Committee chairs included 23% women, 23% underrepresented minorities, and 2.3% minority women. International medical graduates were more likely men (P = .02).

Conclusions: Representation of women in the American Society of Transplant Surgeons leadership has kept pace with their membership in the transplant surgery workforce. There is a deficiency of female under - represented minorities in leadership positions at the Society. Further interventions are required to recruit underrepresented minorities to transplant surgery, catalog their footprint in the workforce, and champion their role as leaders within the American Society of Transplant Surgeons.
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http://dx.doi.org/10.6002/ect.2021.0111DOI Listing
September 2021

Diversity among transplant surgery fellowship program directors: a call to action.

HPB (Oxford) 2021 Jul 24. Epub 2021 Jul 24.

Albany Medical College, NY, USA.

Background: The diversity among general surgery residency, HPB and other fellowship program directors has been previously analyzed. However, the diversity in abdominal transplant surgery fellowship program directors remains unknown.

Methods: Abdominal transplant fellowship programs and the corresponding program directors were identified from the American Society of Transplant Surgeons website. Demographic and training information for the members was compiled through internet searches and analyzed.

Results: 72 program directors were included. 83.33% were male. 63.9% were non-Hispanic White, 25% were Asian, along with 5.56% Hispanic and Black each. Male program directors were more likely to be Associate Professor (p = 0.041), while females were more likely to be Assistant Professor (p = 0.021). 66% of female program directors were non-Hispanic White.

Conclusion: Transplant surgery fellowship programs are primarily led by male and non-Hispanic White surgeons. Female representation as leaders is on par with their membership in the transplant surgery workforce. There is a deficiency of both male and female underrepresented minorities in program director positions.
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http://dx.doi.org/10.1016/j.hpb.2021.07.006DOI Listing
July 2021

Rankings From US News and World Report Have Minimal Correlation With Kidney and Liver Transplant Recipient Survival Results From Retrospective Data.

Exp Clin Transplant 2021 Oct 26;19(10):1014-1022. Epub 2021 Jul 26.

From the University of Toledo Medical Center, Toledo, Ohio, USA.

Objectives: Increased demand for quality health care has led to lay-press ranking systems, such as the ranking from US News and World Report (US News). Their "Best Hospitals" publication advertises itself as the go-to resource for patients seeking care in a number of specialty areas. We sought to test the relationship between US News rankings and transplant outcomes.

Materials And Methods: Using data from 2014 to 2018, we compared outcomes from the Scientific Registry of Transplant Recipients database for liver and kidney transplants against US News-ranked centers using the categories "Nephrology" and "GI Surgery and Gastroenterology" as substitutes, as US News does not rank transplant centers specifically. P < .05 was set as significant.

Results: Using hazard ratio data, we found that kidney transplant center rank had only a small impact on postoperative outcomes in terms of patient survival (hazard ratio = 0.996, P = .049) but had no impact on graft survival (hazard ratio = 0.997, P = .077). In addition, liver transplant center rank had no impact on liver graft survival (hazard ratio = 1.003, P = .304). The impact of hospital ranking on survival was minimal compared with other variables.

Conclusions: The US News rankings for "Nephrology" and "GI Surgery and Gastroenterology" have minimal values as a measure of liver and kidney transplant outcomes, highlighting that these lay press rankings are not useful to the unique transplant patient population and that providers should help guide patients to transplant-specific resources.
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http://dx.doi.org/10.6002/ect.2021.0043DOI Listing
October 2021

Letter Regarding: Gender Differences in Authorship Among Transplant Physicians: Are We Bridging the Gap?

J Surg Res 2021 10 31;266:352. Epub 2021 May 31.

Department of Surgery, Albany Medical Center, Albany, New York.

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http://dx.doi.org/10.1016/j.jss.2021.02.058DOI Listing
October 2021

Colorectal Resection in Transplant Centers Benefits Kidney But Not Pancreas Transplant Recipients.

Int J Angiol 2021 Jun 13;30(2):139-147. Epub 2021 May 13.

Department of Surgery, Albany Medical Center, Albany, New York.

As graft and patient survival rates improve, transplant recipients are likely to undergo colorectal surgery in their lifetime. Current literature on the surgical outcomes of colorectal resection in kidney and pancreas transplant recipients is sparse. This investigation identifies areas of surgical risk for kidney, pancreas, and pancreas-kidney transplant recipients undergoing colorectal resection at transplant and teaching centers. Multivariate logistic regression and linear regression tests computed odds ratios (OR) and coefficients of the linear regression using National Inpatient Sample data from 2005 to 2014 to identify differences in mortality, morbidity, length of stay (LOS), and total hospital charges among people with pancreas transplant alone (PTx), kidney transplant alone (KTx), pancreas and kidney transplant (PKTx), and nontransplant (non-Tx) undergoing colorectal resection in transplant and teaching centers. Of the 2,737,454 individuals who underwent colorectal resection, 138 PTx, 3,874 KTx, 130 PKTx, and 2,733,312 non-Tx met the inclusion criteria. Overall KTx, PTx, and PKTx were not more likely to suffer a mortality. However, PTx were more likely to suffer a mortality in transplant and teaching centers. Overall, PTx and PKTx had significantly higher morbidity odds ratios (PTx OR: 2.268,  = 0.002; PKTx OR: 2.578,  < 0.001) along with longer LOS and higher total hospital charges. KTx incurred no increased morbidity risk in transplant centers. Surgeons and transplant recipients should be aware of the increased morbidity and mortality risks when considering colorectal resection at different center types.
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http://dx.doi.org/10.1055/s-0041-1727137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159591PMC
June 2021

Kidney-Pancreas Transplant Recipients Experience Higher Risk of Complications Compared to the General Population after Undergoing Coronary Artery Bypass Grafting.

Int J Angiol 2021 Jun 3;30(2):107-116. Epub 2021 Feb 3.

Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio.

This retrospective analysis aims to identify differences in surgical outcomes between pancreas and/or kidney transplant recipients compared with the general population undergoing coronary artery bypass grafting (CABG). Using Nationwide Inpatient Sample (NIS) data from 2005 to 2014, patients who underwent CABG were stratified by either no history of transplant, or history of pancreas and/or kidney transplant. Multivariate analysis was used to calculate odds ratio (OR) to evaluate in-hospital mortality, morbidity, length of stay (LOS), and total hospital charge in all centers. The analysis was performed for both nonemergency and emergency CABG. Overall, 2,678 KTx (kidney transplant alone), 184 PTx (pancreas transplant alone), 254 KPTx (kidney-pancreas transplant recipients), and 1,796,186 Non-Tx (nontransplant) met inclusion criteria. KPTx experienced higher complication rates compared with Non-Tx (78.3 vs. 47.8%,  < 0.01). Those with PTx incurred greater total hospital charge and LOS. On weighted multivariate analysis, KPTx was associated with an increased risk for developing any complication following CABG (OR 3.512,  < 0.01) and emergency CABG (3.707,  < 0.01). This risk was even higher at transplant centers (CABG OR 4.302,  < 0.01; emergency CABG OR 10.072,  < 0.001). KTx was associated with increased in-hospital mortality following emergency CABG, while PTx and KPTx had no mortality to analyze. KPTx experienced a significantly higher risk of complications compared with the general population after undergoing CABG, in both transplant and nontransplant centers. These outcomes should be considered when providing perioperative care.
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http://dx.doi.org/10.1055/s-0040-1721680DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159610PMC
June 2021

Letter Regarding: Gender Equity at Surgical Conferences: Quantity and Quality.

J Surg Res 2021 10 25;266:319. Epub 2021 May 25.

Department of Surgery, Albany Medical Center, Albany, New York.

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http://dx.doi.org/10.1016/j.jss.2021.01.051DOI Listing
October 2021

Women's footprint in hepatopancreaticobiliary surgery.

HPB (Oxford) 2021 Jun 29;23(6):979. Epub 2021 Jan 29.

Department of Surgery, Albany Medical Center, Albany, NY, USA.

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http://dx.doi.org/10.1016/j.hpb.2021.01.008DOI Listing
June 2021

Risk factors for delayed graft function and their impact on graft outcomes in live donor kidney transplantation.

Int Urol Nephrol 2021 Mar 4;53(3):439-446. Epub 2021 Jan 4.

Department of Urology and Renal Transplant, University of Toledo, 3000, Arlington Ave, MS1091, Toledo, OH, 43614, USA.

Background: Delayed graft function (DGF) is a manifestation of acute kidney injury uniquely framed within the transplant process and a predictor of poor long-term graft function1. It is less common in the setting of living donor (LD) kidney transplantation. However, the detrimental impact of DGF on graft survival is more pronounced in LD2.

Purpose: To study the effects of DGF in the setting of LD kidney transplantation.

Methods: We performed a retrospective analysis of LD kidney transplantations performed between 2010 and 2018 in the UNOS/OPTN database for DGF and its effect on graft survival.

Results: A total of 42,736 LD recipients were identified, of whom 1115 (2.6%) developed DGF. Recipient dialysis status, male gender, diabetes, end-stage renal disease, donor age, right donor nephrectomy, panel reactive antibodies, HLA mismatch, and cold ischemia time were independent predictors of DGF. Three-year graft survival in patients with and without DGF was 89% and 95%, respectively. DGF was the greatest predictor of graft failure at three years (hazard ratio = 1.766, 95% CI: 1.514-2.059, P = 0.001) and was associated with higher rates of rejection (9% vs. 6.28%, P = 0.0003). Among patients with DGF, the graft survival rates with and without rejection were not different.

Conclusion: DGF is a major determinant of poor graft functional outcomes, independent of rejection.
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http://dx.doi.org/10.1007/s11255-020-02687-5DOI Listing
March 2021

Analysis of Linguistically and Culturally Tailored Initiatives in Websites of Kidney Transplant Programs in the United States Between 2013-2018.

Prog Transplant 2021 03 23;31(1):13-18. Epub 2020 Dec 23.

Comprehensive Transplant Institute, 9968University of Alabama at Birmingham, Birmingham, AL, USA.

Introduction: Minority patients constitute the majority of the kidney transplant waiting list, yet they suffer greater difficulties in listing and longer wait times to transplantation. There is a lack of information regarding targeted efforts by transplant centers to improve transplant care for minority populations.

Research Question: Our aim was to analyze all kidney transplant websites in the United States to identify changes over a 5-year period in the number of multilingual websites, reported culturally targeted initiatives, and center and provider diversity.

Design: Surveys were developed to analyze center websites of all transplant programs in the United States. Those with incomplete information about their nephrology or surgical teams were excluded, resulting in 174 (73%) sites in 2013 and 185 (76%) in 2018. Results: Few websites were available in a language other than English, 6.3% in 2013 and 9.7% in 2018 (P = 0.24). Only 3 websites (1.3%) in 2013 and 7 (3.7%) in 2018 reported any evidence of a culturally targeted initiative (P = 0.23). In 2018, 35% of centers employed a Hispanic transplant physician, 77% had a transplant physician who spoke a language other than English, and 39% had a transplant physician who spoke Spanish.

Discussion: Although minority patients are expected to grow in the United States, decreased access to transplantation continues to vex the transplant community. Very little progress has been made in the development of multilingual websites and culturally targeted initiatives.
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http://dx.doi.org/10.1177/1526924820978593DOI Listing
March 2021

Donation after circulatory death liver recovery-Time for consensus.

Clin Transplant 2021 02 12;35(2):e14168. Epub 2020 Dec 12.

Department of Surgery, Albany Medical Center, Albany, NY, USA.

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http://dx.doi.org/10.1111/ctr.14168DOI Listing
February 2021

Plasmacytoid variant of urothelial carcinoma of the bladder manifesting as bilateral ureteral and small bowel obstruction.

Urol Case Rep 2020 Nov 16;33:101415. Epub 2020 Sep 16.

The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.

Plasmacytoid urothelial carcinoma (PUC) is a rare variant of bladder cancer characterized by distinct histopathology and advanced stage at diagnosis. Multimodal treatment is usually indicated. We present a case of PUC causing bilateral ureteral obstruction with subsequent renal failure followed shortly by malignant small bowel obstruction, demonstrating the need for a high degree of clinical suspicion in diagnosis of this aggressive subtype. Moreover, the local invasiveness of the disease cannot be understated, given that it can rapidly spread with little radiologic evidence of progression until it is at an advanced stage.
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http://dx.doi.org/10.1016/j.eucr.2020.101415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7574283PMC
November 2020

Surgical correction of recurrent pectus excavatum of an adult patient, case report, and review of literature.

Indian J Thorac Cardiovasc Surg 2020 May 16;36(3):226-230. Epub 2020 Jan 16.

Thoracic Surgery Division, Hospital General de Mexico, Dr. Eduardo Liceaga, 06720 Mexico City, Mexico.

Purpose: The aim of this paper is to review the literature on recurrent pectus excavatum (PE) and present our surgical approach to a complex case of recurrent PE in an adult patient at a Mexican Hospital.

Methods: We present the case of an adult patient with severe and symptomatic PE, with history of a failed Nuss procedure 1 year previous our intervention, which consisted of a combination of both classic techniques, by performing an osteochondrectomy of affected cartilages and placing a titanium bar substernal and stabilizing coastal arches with secondary osteosynthesis system (Stratos ™ system, medXpert, Germany).

Results: Adequate correction of thoracic silhouette and both cardiac and respiratory disorders in the 1-year follow-up was achieved as indicated by the improvement of the patient's Haller index.

Conclusion: Successful surgical correction of pectus excavatum is achieved when the thoracic silhouette is restored, thus improving cardiopulmonary symptoms. As there are many different techniques available, the more minimally invasive ones are reserved for mild cases, but the treatment of complex cases as in our patient requires a combination of multiple techniques and reconstruction materials in order to achieve adequate correction of the thoracic deformity and reduce recurrence rate.
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http://dx.doi.org/10.1007/s12055-019-00913-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7525687PMC
May 2020

Renal Transplant Patients Undergo Abdominal Aortic Aneurysm Repair at a Younger Age and Experience More Complications: Review of the Healthcare Cost and Utilization Project Database.

Transplant Proc 2021 Apr 10;53(3):1032-1039. Epub 2020 Oct 10.

Department of Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio.

Objective: The objective of this study was to determine whether history of kidney transplant is a risk factor for increased complications in patients who undergo abdominal aortic aneurysm (AAA) repair.

Background: The incidence of renal failure and subsequent kidney transplant is steadily rising. Many risk factors leading to AAA overlap with those of renal disease. Due to these similarities, a rising incidence of kidney transplant patients undergoing AAA repair is expected. We surmised a notable difference in AAA surgical repair outcomes in renal transplant recipients compared to the general population.

Methods: A retrospective analysis was performed on 59,836 adult patients with history of AAA repair and kidney transplant from 2008 to 2015. Data were obtained from the Nationwide Inpatient Sample database developed for the Healthcare Cost and Utilization Project.

Results: Significant differences in age, race, hospital characteristics, and complications were identified. The results suggest that patients with prior transplant generally have AAA repair at a significantly younger age (P < .001). A difference in race (P = .017), with 75% vs 87.4% non-Hispanic whites and 5% vs 1.5% Asian/Pacific Islander in the transplant and nontransplant groups, respectively, was shown. Procedures at transplant centers had significantly longer lengths of stay (P < .001) and higher total charges (P < .001). In addition, transplant recipients exhibited a higher in-hospital mortality index (P < .001) than the nontransplanted population.

Conclusion: A history of kidney transplant significantly influences multiple aspects of care and complications regarding future AAA repair and is associated with increased in-hospital mortality index. Significant findings include increased total charges, longer lengths of stay, postoperative complications, and differences in age and race.
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http://dx.doi.org/10.1016/j.transproceed.2020.09.004DOI Listing
April 2021

African American polycystic kidney patients receive higher risk kidneys, but do not face increased risk for graft failure or post-transplant mortality.

Am J Surg 2021 05 28;221(5):1093-1103. Epub 2020 Sep 28.

Department of Surgery, Albany Medical College, Albany, NY, USA.

African Americans (AA) are disproportionately affected by end-stage renal disease (ESRD) and have worse outcomes following renal transplantation. Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic condition leading to ESRD necessitating transplant. We explored this population with respect to race by conducting a retrospective analysis of the UNOS database between 2005 and 2019. Our study included 10,842 (AA n = 1661; non-AA n = 9181) transplant recipients whose primary diagnosis was ADPKD. We further stratified the AA ADPKD population with respect to blood groups (AA blood type B n = 295 vs AA non-B blood type n = 1366), and also compared this cohort to AAs with a diagnosis of DM (n = 16,706) to identify unique trends in the ADPKD population. We analyzed recipient and donor characteristics, generated survival curves, and conducted multivariate analyses. African American ADPKD patients waited longer for transplants (924 days vs 747 days P < .001), and were more likely to be on dialysis (76% vs 62%; p < .001). This same group was also more likely to have AA donors (21% vs 9%; p < .001) and marginally higher KDPI kidneys (0.48 vs 0.45; p < .001). AA race was a risk factor for delayed graft function (DGF), increasing the chance of DGF by 45% (OR 1.45 95% CI 1.26-1.67; p < .001). AA race was not associated with graft failure (HR 1.10 95% CI 0.95-1.28; p = .21) or patient mortality (HR 0.84 95% CI 0.69-1.03; p = .09). Racial disparities exist in the ADPKD population. They should be continually studied and addressed to improve transplant equity.
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http://dx.doi.org/10.1016/j.amjsurg.2020.09.028DOI Listing
May 2021

Kidney and pancreas transplant recipients undergoing cholecystectomy experience superior outcomes in transplant centers.

HPB (Oxford) 2021 Apr 24;23(4):609-617. Epub 2020 Sep 24.

Albany Medical Center, Department of Transplant Surgery, 43 New Scotland Ave, Albany, NY, 12208, USA.

Background: This retrospective analysis aims to identify differences in surgical outcomes between pancreas and/or kidney transplant recipients and the general population undergoing cholecystectomy.

Methods: Multivariate logistic regression and linear regression tests computed odds ratios (OR) and coefficients of the linear regression by analyzing weighted data from the NIS database between 2005 and 2014 to identify differences in mortality, morbidity, length of stay (LOS) and costs amongst KTx, PTx, PKTx, and non-Tx undergoing cholecystectomy in all centers and transplant centers.

Results: Overall 6007 KTx, 164 PTx, 535 PKTx, and 4,207,241 non-Tx met the inclusion criteria. Mortality from cholecystectomy was 1.0%. Transplant recipients did not experience a significant increase in mortality. However KTx and PTx suffered increased morbidity risks (KTx OR1.244 p < 0.01; PTx OR2.165 p < 0.01) compared to non-Tx. However transplant recipients did not incur an increased morbidity risk in transplant centers.

Conclusion: Transplant recipients undergoing cholecystectomy should be counseled about their increased complication risks. Surgeons should consider transferring KTx and PTx to transplant centers for their cholecystectomy procedure to mitigate these risks.
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http://dx.doi.org/10.1016/j.hpb.2020.09.001DOI Listing
April 2021

Clinical Outcomes, Health Care Costs and Prognostic Factors for Total Knee Arthroplasty: A Multilevel Analysis of a National Cohort Study Using Administrative Claims Data.

J Knee Surg 2020 Aug 24. Epub 2020 Aug 24.

Department of Surgery, Hospital Universitario Nacional de Colombia, Bogotá, DC, Colombia.

Total knee arthroplasty (TKA) is one of the most frequent orthopaedic surgeries. The purpose of this study was to determine the 30-day postoperative mortality rate, total episode-of-care costs, and prognostic factors associated with these outcomes, for adult patients who underwent TKA in Colombia's contributory health care system. A retrospective cohort study of all adult patients enrolled in Colombia's contributory health system, who underwent TKA between January 1, 2012 and November 30, 2015 was performed. Thirty-day postoperative mortality rates, 30-day ICU admissions rates, 30-day hospital readmission rates, 1-year arthroplasty revision rates, and total episode-of-care costs were estimated. Multilevel, generalized linear models were generated, to determine the prognostic factors associated with outcomes presented. A total of 12,453 patients were included. The 30-day mortality rate was 0.13 per 100 surgeries and the ICU admissions rate at 30 days postoperative was 4.44 per 100 surgeries. The 30-day hospital readmission rate was 4.28 per 100 surgeries and the 1-year arthroplasty revision rate was 1.22 per 100 surgeries. The prognostic factors associated with mortality were age, Charlson Index, and type of insurer. The prognostic factors associated with hospital readmission were age category, Charlson Index, and geographic region; younger age and higher Charlson Index were found to be associated with a higher 1-year arthroplasty revision rate. The median of total episode-of-care costs was USD$ 6,190.07 (interquartile range: 2,299-7,282). The multivariate model found that age, the Charlson Index, the Atlantic region, and type of insurer were associated with the costs incurred by the health system. For patients undergoing TKA in Colombia, age, the Charlson Index, insurers, and geographic region are associated with mortality, ICU admissions, 30-day hospital readmissions, 1-year arthroplasty revisions, and total costs incurred by the health system.
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http://dx.doi.org/10.1055/s-0040-1715097DOI Listing
August 2020

RE: Spinal Cord Ischemia Post-pancreas Transplant.

Transplantation 2020 09;104(9):e283

Department of Surgery, University of Toledo Medical Center, Toledo, OH.

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http://dx.doi.org/10.1097/TP.0000000000003190DOI Listing
September 2020

Kidney Transplants From a Deceased Donor After 11 Days of Venovenous Hemodialysis.

Exp Clin Transplant 2021 Nov 7;19(11):1224-1227. Epub 2020 Aug 7.

From the Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA.

There have been several studies exploring the viability of kidneys procured from extended criteria donors with acute kidney injury. Previous publications have evaluated the long-term outcomes of kidneys after acute kidney injury. We describe the case of 2 transplants from a donor with acute renal failure after a motor vehicle accident. The donor required 11 days of venovenous hemodialysis before procurement. There have not been any previous reports of donations following such a prolonged period of dialysis. The kidneys were shared across organ procurement organization service areas and had cold ischemia times of 32 hours and 26 hours. Both recipients had delayed graft function. One recipient had several complications that required multiple readmission for treatment. At last follow-up, both transplanted organs were functioning adequately and producing urine. This case report presents a novel opportunity to understand the extent of possible kidney transplant after acute kidney injury.
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http://dx.doi.org/10.6002/ect.2020.0003DOI Listing
November 2021

Robotic-assisted Donor Nephrectomy: As Safe as Laparoscopic Donor Nephrectomy.

Surg Technol Int 2020 Nov;37:171-174

University of Toledo Medical Center, Department of Urology and Renal Transplantation Toledo, OH, USA.

Objectives: Robotic-assisted donor nephrectomy has become increasingly popular in recent years. We sought to compare robotic-assisted outcomes to operative outcomes in a historical cohort of laparoscopic donor nephrectomies.

Materials And Methods: A retrospective review of 58 consecutive donor nephrectomies at a single center by two surgeons from 2015 to 2019 was performed.

Results: Robotic-assisted (n = 32) and laparoscopic (n =26) donors were comparable in terms of estimated blood loss (66.4 vs. 62.5 mL; p=0.81) and length of stay (1.6 vs. 1.5 days; p=0.37). The post-operative change in creatinine was not significantly different between the groups (-0.45 vs. -0.45; p=0.97). Warm ischemia time was longer in the robotic group (7.36 vs. 5.15 minutes; p < 0.01). Case duration was significantly longer for robotic-assisted cases (306 vs. 247 minutes; p < 0.01). However, robotic cases were more likely to be right-sided (6/32 (18.8%) vs. 1/26 (3.8%)) and have vascular multiplicity (7/32 (21.9%) vs. 0/26 (0%)). There was one Clavien II or greater complication in the robotic group, and none in the laparoscopic group.

Conclusions: Our data agree with previous reports that robotic-assisted donor nephrectomy is safe and has similar outcomes to a laparoscopic approach. Moreover, cases with multiple renal arteries or veins and right-sided cases were completed safely using the robotic approach. The longer case duration in the robotic group was attributed to the learning curve associated with implementing a new technique, and later robotic operative times approached laparoscopic operative times.
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November 2020

Small donor size does not negatively impact outcomes after deceased-donor renal transplantation.

Clin Transplant 2020 07 22;34(7):e13886. Epub 2020 May 22.

Department of Surgery, University of Toledo, Toledo, OH, USA.

Higher body mass index (BMI) of deceased-donors is associated with poorer outcomes in transplant recipients. The effect of low donor BMI on recipient graft function is not clear. Scientific Registry of Transplant Recipients data on recipients of deceased-donor kidneys from 2000 to 2019 were categorized by donor BMI (donor BMI < 18, 18-27, and >27). Primary outcome was death-censored graft survival. The impact of multiple recipient and donor variables, including low donor BMI and the difference between donor and recipient BMI, was evaluated using a multivariate Cox proportional-hazards model. Low BMI donors (LBD) were more likely to be younger, female, and white (all P < .05). LBD were less likely to be Hispanic, diabetic, or have hypertension (all P < .001). LBD recipients were more likely to be younger and female (both P < .001). Low donor BMI was not significantly associated with recipient graft survival. Donor-recipient BMI difference did not correlate with an increased risk of graft failure. Similar results were obtained when donors were classified using body surface area (BSA). Small donor size in terms of BMI or BSA or a large discrepancy between donor and recipient size should not necessarily preclude transplantation of an otherwise acceptable kidney.
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http://dx.doi.org/10.1111/ctr.13886DOI Listing
July 2020

Robotic Laparoscopic Sigmoid Colectomy: Analysis of Healthcare Cost and Utilization Project Database.

Am Surg 2020 Mar;86(3):256-260

Minimally invasive sigmoid colectomy the laparoscopic approach (LA) has numerous benefits. We seek to compare outcomes between laparoscopic and robotic sigmoid colectomies. We analyzed the data using the National Inpatient Sample database between 2008 and 2014. Utilization and outcome measures were compared. The seven-year average number of patients who underwent elective sigmoid colectomy in the United States from 2008 to 2014 was estimated to be 197,053. Of these, 95.1 per cent were conducted using the LA. The mean age was 58.33 + 13.6 years and 58.23 + 12.8 years in laparoscopic and robotic approaches, respectively. No significant differences existed in respect to morbidities. Postoperative complications were comparable with respect to other complications. Length of hospital stay was statistically significantly shorter in the robot-assisted approach compared with the LA (mean 4.8 + 4 5.7 + 5 days, respectively, < 0.001). Patients who underwent robotic surgery had significantly higher total hospital charges than those who underwent laparoscopic surgery (median $45,057 $57,871 USD, < 0.001). The advent of robot-assisted surgery has provided more options for patients and surgeons. Compared with laparoscopy, robot-assisted sigmoid colectomy has no clinical advantages in morbidity and mortality. However, the robotic approach has a significantly higher total charge to the patient.
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March 2020

Role of Synthetic Mesh Renorrhaphy and Neocapsule Reconstruction to Salvage Posttransplant Severely Damaged Renal Allografts.

Exp Clin Transplant 2021 01 4;19(1):32-37. Epub 2020 Mar 4.

From the Department of Urology, The University of Toledo, Toledo, Ohio, USA.

Objectives: As the recipient pool continues to rise, it is vital to conserve donor organs whenever possible. Injured renal allografts continue to be discarded for a variety of reasons, and salvaging potentially useable grafts is of utmost importance. Little information is available on outcomes of salvaged allografts. Here, we present an easily replicable technique to salvage damaged renal allografts using polyglactin mesh.

Materials And Methods: Polyglactin woven mesh was used to salvage 4 otherwise irreparably injured allografts. In the first case, unidentified extracorporeal shockwave lithotripsy-induced microfractures 2 months before procurement of a deceased-donor kidney led to significant capsular injury. In the second case, rapid recovery of a deceased-donor kidney limited evaluation, and severe capsular rupture was diagnosed after perfusion. In the third case, an anticoagulated pediatric recipient received a living related-donor kidney from his mother, and a biopsy-induced hematoma 2 months posttransplant led to severe capsular denudation. In the fourth case, a pumped kidney from a donor after cardiac death developed severe focal capsular denudation. In each case, a keyhole hilar-sparing incision was made in an industry-standard 12 × 12-inch polyglactin mesh sheet, which was then fitted and sutured in a vest-over-pants method to provide a scaffold for hemostasis and capsular healing. Topical hemostatic agents were added in the first and fourth cases. Patients were followed longitudinally.

Results: All allografts were successfully salvaged using our technique, and none developed Page kidney, hydronephrosis, urinoma, or hemorrhage. At last follow-up, recipient 1 had kidney loss 7 years postrepair secondary to chronic allograft nephropathy, recipient 2 was lost to follow-up at 1 year with normal renal function, and recipients 3 and 4 had normal renal function at years 3 and 7 posttransplant.

Conclusions: This simple technique using readily available materials can salvage allografts that would have been potentially explanted or discarded.
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http://dx.doi.org/10.6002/ect.2019.0308DOI Listing
January 2021

Disparities in DCD organ procurement policy from a national OPO survey: A call for standardization.

Clin Transplant 2020 04 6;34(4):e13826. Epub 2020 Mar 6.

Department of Surgery, University of Toledo Medical Center, Toledo, OH, USA.

Introduction: Procurement practices across organ procurement organizations (OPOs) for donation after cardiac death (DCD) transplants have not been evaluated.

Methods: A national telephone survey of all 58 OPOs inquiring about their procurement practices of DCD organs was conducted. Policies concerning maximum donor body mass index (BMI), location of care withdrawal, pre-mortem heparin administration, vasodilator use, wait times after declaration of death before incisions, inclinations between rapid laparotomy and pre-mortem cannulation, and maximum time before aborting DCD procurement were queried.

Results: The survey revealed substantial differences across OPOs. Donor BMI restriction was considered by 36 of 58 OPOs, and 23 sites preferred OR for donor withdrawal of care. Pre-mortem heparin was utilized by 53 OPOs. Only 2 recommended vasodilators. Minimum wait time of 5-minutes was implemented by 41 OPOs. Rapid laparotomy was preferred by 57 organizations. 28 OPOs had a 90-minute limit before aborting DCD procurement.

Conclusion: There are substantial variations across OPO protocols for procuring DCD organs. Current practices do not conform to ASTS guidelines for DCD procurement. Further investigations are needed to quantify the impact of OPO policies on transplant outcomes.
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http://dx.doi.org/10.1111/ctr.13826DOI Listing
April 2020
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