Publications by authors named "Vassilios E Papalois"

20 Publications

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New Year's greeting and overview of in 2021.

World J Transplant 2021 Feb;11(2):7-15

Department of Transplantation Renal Unit, Careggi University Hospital, Florence 50139, Italy.

() was launched in December 2011. While we are celebrating 's 10-year anniversary, we are very proud to share with you that since its first issue, has published 312 articles, which have been cited 2786 times (average cites per article of 9.0). Together with an excellent team effort by our authors, Editorial Board members, independent expert referees, and staff of the Editorial Office, advanced in 2020. In this editorial, we summarize the journal's bibliometrics, including its citation report, published articles in 2020, peer review rate and manuscript invitation metrics, as well as its Editorial Board members and existing problems of . The overall aim of this editorial is to promote the development of in 2021. We appreciate the continuous support and submissions from authors and the dedicated efforts and expertise by our invited reviewers. This collective support will allow us to be even more productive in 2021. In addition, we commit to working with you all to raise the academic influence of over the upcoming year. Finally, on behalf of , we wish you and your families the best for the New Year.
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http://dx.doi.org/10.5500/wjt.v11.i2.7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7896244PMC
February 2021

COVID-19 pandemic: Building organisational flexibility to scale transplant programs.

World J Transplant 2020 Oct;10(10):277-282

Imperial College Renal and Transplant Center, Department of Surgery and Cancer, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, United Kingdom.

The prevailing coronavirus disease 2019 pandemic has challenged our lives in an unprecedented manner. The pandemic has had a significant impact on transplantation worldwide. The logistics of travel restrictions, stretching of available resources, unclear risk of infection in immunosuppressed transplant recipients, and evolving guidelines on testing and transplantation are some of the factors that have unfavourably influenced transplant activity. We must begin to build organisational flexibility in order to restart transplantation so that we can be mindful stewards of organ donation and sincere advocates for our patients. Building a culture of honesty and transparency (with patients, families, colleagues, societies, and authorities), keeping the channels of communication open, working in collaboration with others (at local, regional, national, and international levels), and not restarting without rethinking and appraising all elements of our practice, are the main underlying principles to increase the flexibility.
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http://dx.doi.org/10.5500/wjt.v10.i10.277DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579434PMC
October 2020

Anticoagulation in simultaneous pancreas kidney transplantation - On what basis?

World J Transplant 2020 Jul;10(7):206-214

Imperial College Renal and Transplant Center, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, United Kingdom.

Background: Despite technical refinements, early pancreas graft loss due to thrombosis continues to occur. Conventional coagulation tests (CCT) do not detect hypercoagulability and hence the hypercoagulable state due to diabetes is left untreated. Thromboelastogram (TEG) is an diagnostic test which is used in liver transplantation, and in various intensive care settings to guide anticoagulation. TEG is better than CCT because it is dynamic and provides a global hemostatic profile including fibrinolysis.

Aim: 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 recipients.

Methods: 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 results. Graft 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 compared.

Results: Seventeen patients who received TEG-directed anticoagulation were compared against 51 contemporaneous SPK recipients (ratio of 1: 3) who were anticoagulated based on CCT. No graft losses occurred in the TEG group, whereas 11 grafts (7 pancreases and 4 kidneys) were lost due to thrombosis in the CCT group ( 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 45.10% in the CCT group ( 0.05, Fisher's exact test). The incidence of radiologically confirmed partial thrombus in pancreas allograft was 41.18% in the TEG and 25.50% in the CCT group ( 0.23, Fisher's exact test). All recipients with partial thrombi detected in computed tomography (CT) scan had an anticoagulation dose escalation. The thrombus resolution rates in subsequent scan were 85.71% and 63.64% in the TEG group the CCT group ( 0.59, Fisher's exact test). The TEG group had reduced blood product usage {10 packed red blood cell (PRBC) and 2 fresh frozen plasma (FFP)} compared to the CCT group (71 PRBC/ 10 FFP/ 2 cryoprecipitate and 2 platelets). The proportion of patients requiring transfusion in the TEG group was 17.65% 39.25% in the CCT group ( 0.14, Fisher's exact test). The median length of hospital stay was 18 days in the TEG group 31 days in the CCT group ( 0.03, Mann Whitney test). The 1-year pancreas graft survival was 100% in the TEG group 82.35% in the CCT group ( 0.07, log rank test) and, the 1-year kidney graft survival was 100% in the TEG group 92.15% in the CCT group ( 0.23, log tank test).

Conclusion: TEG is a promising tool in guiding judicious use of anticoagulation with concomitant prevention of graft loss due to thrombosis, and reduces the length of hospital stay.
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http://dx.doi.org/10.5500/wjt.v10.i7.206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416362PMC
July 2020

Live kidney donation: attitudes towards donor approach, motives and factors promoting donation.

Nephrol Dial Transplant 2012 Jun 13;27(6):2517-25. Epub 2011 Dec 13.

Imperial College Kidney and Transplant Institute, Hammersmith Hospital, London, UK.

Background: There are many views regarding the initiation of the process for live donor kidney transplantation (LDKT), the motives of the donor and the appropriate ways to promote LDKT.

Methods: Health care professionals and patients were recruited in a tertiary renal and transplant centre and completed an anonymous questionnaire. They were then divided into focus groups and a structured interview was performed in order to discover the rationale behind the answers in the questionnaire.

Results: Four hundred and sixty-four participants completed the questionnaire. There were 168 health care professionals and 296 patients. Most of the participants (26.9%) suggested that the first approach to a potential donor should be made by the potential recipient. Participants believed that the most important motives for a kidney donor are relief as a result of the recipient's improved health after the transplant (82.5%) and altruism (80.4%). About 89.2% of participants believed that proper long-term medical follow-up of the donor is the most important factor for LDKT promotion. Fifty-five participants discussed the rationale of their answers in the focus group interview.

Conclusions: In our study, participants preferred an initial approach of the donor by the recipient. The relief as a result of the recipient's improved health was suggested as a very strong motive for donation. Proper donor follow-up was considered to be paramount for the further development of LDKT.
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http://dx.doi.org/10.1093/ndt/gfr642DOI Listing
June 2012

Live donor kidney transplantation: attitudes of patients and health care professionals concerning the pre-surgical pathway and post-surgical follow-up.

Int Urol Nephrol 2012 Feb 26;44(1):157-65. Epub 2011 May 26.

Imperial College Kidney and Transplant Institute, Hammersmith Hospital, London, UK.

Objectives: We surveyed the following groups of individuals concerning their attitudes towards the pathway leading up to live donor kidney transplantation (LDKT) and post-operative follow-up: kidney transplant (deceased and live donor) recipients, live kidney donors and medical and nursing staff caring for end-stage renal disease and dialysis patients.

Materials And Methods: Participants were recruited within a tertiary renal and transplant centre and invited to complete anonymized questionnaires, be involved in focus groups and undertake structured interviews.

Results: A total of 464 participants completed the questionnaire (36% health care professionals and 64% patients). Most perceived donor risk as small or very small (62%), and 49% stated that a potential donor should be given up to 3 months to reconsider the decision to donate. Participants were almost equally divided as to whether consensus of the donor's family is necessary (46%) or not (44%) in LDKT. Seventy-one percentage of the participants suggested that patients have a greater appreciation of a LDKT if they have been on dialysis; 58% of participants thought that donor and recipient should recuperate beside each other after surgery; 45% thought that the post-operative follow-up for the donor should last up to a year; and 83% thought that donor follow-up should include medical status and quality of life. In the interviews, participants expressed several interesting views.

Conclusions: Participants believed that LDKT is safe for the donor, and the pathway to surgery and post-operative follow-up should be performed in a way that ensures lack of coercion and includes family support and an extensive post-operative follow-up.
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http://dx.doi.org/10.1007/s11255-011-9987-9DOI Listing
February 2012

Attitudes toward live donor kidney transplantation and its commercialization.

Clin Transplant 2011 May-Jun;25(3):E312-9. Epub 2011 Mar 1.

The West London Renal and Transplant Centre, Imperial College, London, UK.

Development of live donor kidney transplantation (LDKT) programs has intensified debate regarding acceptability of certain donor categories and potential commercialization. Concerning these issues, we surveyed the views of medical and nursing staff caring for patients with renal failure and renal transplant recipients and donors. Participants were recruited from a tertiary transplant unit and invited to complete an anonymous questionnaire. Four hundred and sixty-four participants completed the questionnaire (42% response). One hundred and sixty-eight (36.2%) were health care professionals and 296 (63.8%) patients; 85.6% of participants were willing to donate to their children, 80.2% to siblings, 80.8% to parents, 72% to a non-blood-related relative or friend, and 15.3% to a stranger. If participants had hypothetical renal failure, they were prepared to accept a kidney from a parent (79.5%), sibling (78.7%), child (56.3%), a non-blood-related relative or friend (79.3%), or stranger (54.1%). Regarding commercialization, responders' attitudes were that the donor should not accept financial reward (29.1%), be compensated for expenses only (60.6%), or should receive a direct financial reward (10.1%). For non-directed donation, 23.5%, 55.6%, and 20.7% were not in support of reward, compensation only, and financial reward, respectively. While live kidney donation was accepted by the majority of individuals surveyed, only the minority approved of commercialization.
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http://dx.doi.org/10.1111/j.1399-0012.2011.01418.xDOI Listing
September 2011

Ethical issues in live donor kidney transplant: views of medical and nursing staff.

Exp Clin Transplant 2009 Mar;7(1):1-7

West London Renal and Transplant Centre, Imperial College Kidney and Transplant Institute, Hammersmith Hospital, DuCane Road, London W12 0HS, UK.

Objectives: The ongoing development of live donor kidney transplant has generated many ethical dilemmas. It is important to be aware of the attitudes of transplant professionals involved in this practice.

Materials And Methods: An anonymous and confidential questionnaire was sent to 236 members of the medical and nursing staff of the West London Renal and Transplant Centre, to assess their views on the ethics of the current practice of live donor kidney transplant.

Results: Of the 236 questionnaires, 108 (45.8%) were returned. Respondents considered live donor kidney transplant ethically acceptable between blood relatives (100%), nonblood relatives and friends (92.6%), and strangers (47.2%). Most respondents were willing to donate a kidney to a blood relative (92.6%) or a nonblood relative or friend (81.5%), and 12.0% were willing to donate to a stranger. Considering themselves as potential recipients if they had end-stage renal disease, most would accept a kidney from a blood relative (91.7%) or nonblood relative or friend (85.2%),while 44.5% would accept a kidney from a stranger. The highest number of respondents (43.5%) believed that the recipient should approach the potential donor. About one-third believed there should be no financial reward, not even compensation for expenses, for donors; 8% favored direct financial rewards for donors known to recipients, and 18% favored rewards for donors not known to recipients. Slightly more than half were in favor of accepting donors with mild to moderate medical problems.

Conclusions: Live related and unrelated kidney donation are considered ethically acceptable procedures, and nondirected donation is gaining support among transplant professionals. A substantial minority favored direct financial rewards for donors, especially in the case of nondirected donation.
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March 2009

A meta-analysis of mini-open versus standard open and laparoscopic living donor nephrectomy.

Transpl Int 2009 Apr 20;22(4):463-74. Epub 2009 Jan 20.

Department of Biosurgery and Surgical Technology, Imperial College London, St Mary's Hospital, London, UK.

Mini-open donor nephrectomy (MODN) potentially combines advantages of standard open (SODN) and laparoscopic techniques (LDN). This article is a comparison of these techniques. A literature search was performed for studies comparing MODN with SODN or LDN. Nine studies met our selection criteria. Of the 1038 patients, 433 (42%) underwent MODN, 389 (37%) SODN and 216 (21%) LDN. MODN versus SODN: Operative time (P = 0.17), warm ischemia time (P = 0.20) and blood loss (P = 0.30) were not significantly different. Hospital stay and time to return to work were shorter for MODN by 1.67 days (P < 0.001) and 5 weeks (P = 0.03). Analgesia requirement and overall complications were less in the MODN group (P < 0.001) and (P = 0.03). Ureteric complications (P = 0.21) and 1-year graft survival (P = 0.28) were not significantly different. MODN versus LDN: Operative and warm ischemia times were significantly shorter for the MODN by 55 min (P = 0.005) and 147 s (P < 0.001). Analgesia requirement was greater for the MODN group by 9.62 mEq morphine (P = 0.04). No significant differences were found for blood loss (P = 0.8), hospital stay (P = 0.35), donor complications (P = 0.40) or ureteric complications (P = 0.83). MODN appears to provide advantages for the donor in comparison to SODN and also has a shorter operative time when compared with the LDN.
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http://dx.doi.org/10.1111/j.1432-2277.2008.00828.xDOI Listing
April 2009

Autogenous brachio-cephalic arterio-venousautogenous brachio-cephalic arterio-venous fistulae: effect of age, diabetes,fistulae: effect of age, diabetes, atherosclerosis, and anticoagulation on theatherosclerosis, and anticoagulation on the long-term outcomelong-term outcome.

Int Surg 2008 Jul-Aug;93(4):196-201

West London Transplant Centre, Hammersmith Hospital, London, United KingdomWest London Transplant Centre, Hammersmith Hospital, London, United Kingdom.

Age, diabetes, and generalized atherosclerosis are thought to be limiting factors forAge, diabetes, and generalized atherosclerosis are thought to be limiting factors for creating an autogenous arterio-venous fistula (AVF) unlike the use of anticoagulants. Wecreating an autogenous arterio-venous fistula (AVF) unlike the use of anticoagulants. We retrospectively assessed the effect of these factors on the outcome of 75 autogenousretrospectively assessed the effect of these factors on the outcome of 75 autogenous brachio-cephalic AVFs created between January 1, 2002 and August 31, 2005. Differentbrachio-cephalic AVFs created between January 1, 2002 and August 31, 2005. Different groups of patients were compared and the longevity of the AVFs was calculated. Fifty-twogroups of patients were compared and the longevity of the AVFs was calculated. Fifty-two percent of the patients were >65 years old, 41.3% werepercent of the patients were >65 years old, 41.3% were diabetic, 48% were arteriopaths,diabetic, 48% were arteriopaths, and 41.3% were not using anticoagulants. The maximum follow-up was 35 months (mean,and 41.3% were not using anticoagulants. The maximum follow-up was 35 months (mean, 11.2 +/- 10.3 months; median, 7 months). The success rate of the operation was 93.3% (mean 11.2 +/- 10.3 months; median, 7 months). The success rate of the operation was 93.3% (70 patent AVFs); 79.3% of the AVFs were functioning at 35 months. Age >65 years old,patent AVFs); 79.3% of the AVFs were functioning at 35 months. Age >65 years old, diabetes, generalized atherosclerosis, and the lack of use of anticoagulants were notdiabetes, generalized atherosclerosis, and the lack of use of anticoagulants were not associated with an increased rate of technical failures or a decreased long-term patencyassociated with an increased rate of technical failures or a decreased long-term patency rate of the AVFs.rate of the AVFs.
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September 2009

Laparoscopic versus open live donor nephrectomy in renal transplantation: a meta-analysis.

Ann Surg 2008 Jan;247(1):58-70

Department of Biosurgery and Surgical Technology, Imperial College London, St Mary's Hospital, London, UK.

Objective: The aim of this study was to compare laparoscopic versus open live donor nephrectomy using meta-analytical techniques.

Summary Background Data: Laparoscopic live donor nephrectomy has gained widespread acceptance and is increasingly performed. The body of evidence assessing the safety and efficacy of laparoscopic compared with established open techniques is growing; however, very few randomized control trials exist and individual studies often have small patient numbers with varying results. We combined the available raw data to strengthen the current literature in comparing these techniques.

Methods: A literature search was performed and comparative studies published between 1997 and 2006 of open versus laparoscopic donor nephrectomy were included. Outcomes evaluated were operative and warm ischemia times, blood loss, donor complications, length of hospital stay, time to return to work, and delayed graft function.

Results: Seventy-three studies matched the selection criteria and included 6594 patients, 3751 (57%) had undergone laparoscopic surgery and 2843 (43%) open nephrectomy. The open nephrectomy group had shorter operative and warm ischemia times by 52 minutes (P < 0.001) and 102 seconds (P < 0.001), respectively. This did not translate into higher delayed graft function or graft loss rates between the 2 groups. Patients in the laparoscopic group had a shorter hospital stay and a faster return to work by 1.58 days (P < 0.001) and 2.38 weeks (P < 0.001), respectively. There was a significantly higher rate of overall donor complications in the open group (P = 0.007), a finding not reproduced in any subsequent sensitivity analyses. When only randomized control trials were considered, there were shorter operative times (P = 0.002) for the open group but nonsignificantly different warm ischemia times. In contrast to the main analysis there were no differences in the overall complication rate, postoperative analgesia, hospital stay, or time taken to return to work.

Conclusions: Laparoscopic nephrectomy in live donor transplantation is a safe alternative to the open technique. Although open nephrectomy may be associated with shorter operative and warm ischemia times, patients undergoing laparoscopic nephrectomy may benefit from a shorter hospital stay and faster return to work without compromising graft function.
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http://dx.doi.org/10.1097/SLA.0b013e318153fd13DOI Listing
January 2008

Ethical issues in living donor kidney transplantation.

Exp Clin Transplant 2006 Dec;4(2):485-97

The West London Renal and Transplant Center, Hammersmith Hospital, London, United Kingdom.

The ethical issues of living donor kidney transplantation, which is the treatment of choice for patients with end-stage renal failure, are the focus of intense debate. Some of those issues are related to the safety of the operation for the donor, and others are related to the motivation of the donor, the approach to and evaluation of the donor, donation by strangers, the commercialization of donation, surrogate consent for donation, and the acceptance of minors as donors. The lack of clear consensus regarding these issues results in differences in practice, not only among countries but also among transplant centers. We believe that after an open debate, agreement on certain generally accepted principles can be achieved. Such an agreement would protect potential donors and recipients and would ensure the future of living donor kidney transplantation.
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December 2006

Islet cell allotransplantation: development of a clinical programme in West London.

Adv Exp Med Biol 2006 ;574:89-93

St. Mary's and the Hammersmith Hospitals, London, UK.

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http://dx.doi.org/10.1007/0-387-29512-7_10DOI Listing
August 2006

Professor Panayotis I. Chrysospathis, MD, PhD, FACS, FICS: the golden sword and the great ambassador of Greek surgery.

Int Surg 2006 Jan-Feb;91(1):2-4

Transplant Unit, St Mary's Hospital, London, United Kingdom.

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October 2006

The effect of machine perfusion on the arteries of porcine kidneys.

Exp Clin Transplant 2005 Dec;3(2):375-80

The West London Renal and Transplant Centre, Hammersmith Hospital, London, and Imperial College of Science, Technology and Medicine, University of London, UK.

Objectives: Machine perfusion is an excellent method of assessing the viability of a kidney graft and can also potentially improve the quality of an equivocal kidney. Several authors have expressed concerns that machine perfusion can potentially damage the vessels of the kidney but until now, no studies have been performed to clarify this issue. We aimed to examine the effect of machine perfusion on the renal arteries of porcine kidneys.

Materials And Methods: Eight pairs of kidneys were removed from pigs in the abattoir. One kidney of each pair was preserved on ice for 24 hours. The other kidney from the same animal was initially stored on ice until arrival at the laboratory when it was perfused on the RM3 machine for 4 hours and then stored again on ice for the remainder of the 24 hours. After 24 hours, since the retrieval and initial storage on ice at the abattoir, tissue samples were obtained from all renal arteries at 3 different sites. These samples were sent for histologic evaluation.

Results: Machine perfusion caused more damage at a statistically significant level compared with simple cold storage only for the first sample site, which was the part of the renal artery closest to the perfusion cannula.

Conclusions: Our experiments suggest that machine perfusion, even when it is done lege artis, can damage the part of the renal artery closest to the adaptor, which can potentially result in a higher incidence of posttransplant arterial thrombosis. Therefore, excision of the first part of the renal artery should be considered prior to transplantation, and modifications of the perfusion technique must be developed to minimize damage to the renal arteries.
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December 2005

Effective use of kidneys for transplantation from asystolic donors.

Int Surg 2005 Apr-Jun;90(2):66-70

Renal and Transplant Unit, St Mary's Hospital, London, United Kingdom.

Severe organ shortage for transplantation is an increasing problem because the number of traditional heart-beating cadaveric donors is declining. Ways need to be found to expand the donor pool without commercializing organ transplantation, especially from unrelated live donors, and to maintain high medical standards of these procedures and their follow-up. Kidneys from asystolic or nonheart-beating donors (NHBDs) are a valuable source of organs, which can be of excellent quality, with good long-term function after transplantation. This organ source is widely underused at the moment; even so, there is increased popularity during the last few years in different countries. In addition, the rate of discarding viable kidneys from these NHBDs is still too high. Logistical and legal aspects are other important issues that need to be addressed to promote these NHBD programs more effectively. Waiting lists for renal transplantation could be significantly reduced in the future.
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November 2005

Hepatocyte transplantation: a review of worldwide clinical developments and experiences.

Exp Clin Transplant 2005 Jun;3(1):306-15

Division of Surgery, Hammersmith Hospital and 2Transplant Unit St. Mary's Hospital, London, UK.

Hepatocyte transplantation is a promising treatment for several liver diseases and can also be used as a "bridge" to liver transplantation in cases of liver failure. Although the first animal experiments with this technique began in 1967, it was first applied in humans in 1992. Clearly, the most important advantage of this treatment, compared with liver transplantation, is its simplicity, since no surgery is required for implantation of the cells. Much work has been done over the years to maximize the number of viable hepatocytes that can be isolated from a liver, to prepare the cells prior to transplantation so that the outcome will be more successful, and to identify the optimal site for implantation. We review these efforts along with the worldwide clinical experience with hepatocyte transplantation during the last 13 years.
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June 2005

Laparoscopic live donor nephrectomy: a step forward in kidney transplantation?

JSLS 2003 Jul-Sep;7(3):197-206

Transplant Unit, St. Mary's Hospital, London, UK.

Open donor nephrectomy for live donor kidney transplantation is a safe procedure that has been used for more than 30 years with excellent results. Laparoscopic donor nephrectomy is a relatively new technique that has the potential of decreased postoperative pain, less incisional morbidity, and shorter recovery time. Furthermore, it has been reported that this potentially less traumatic approach increases the number of potential live donors. This review article focuses on the currently used laparoscopic techniques in live kidney donation as well as the controversy regarding its efficacy, safety, and future.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3113198PMC
January 2004

Successful reversal of steal syndrome following creation of arteriovenous fistula by banding with a ringed Gore-Tex cuff: a new technique.

Int Surg 2003 Jan-Mar;88(1):52-4

Transplant Unit, St. Mary's Hospital, London, United Kingdom.

Steal syndrome, especially in elderly patients with peripheral vascular disease, is a serious complication following creation of an arteriovenous fistula (AVF) that, if neglected, can lead to amputation. The classic maneuver to deal with the steal syndrome is ligating the AVF and performing another procedure to gain dialysis access. We describe a simple technique of effectively reversing the steal syndrome by banding the vein of the AVF with a ringed Gore-Tex cuff that salvages the AVF and allows its immediate use for dialysis.
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August 2003

Outcome of renal allografts from non-heart-beating donors with delayed graft function.

Transpl Int 2002 Dec 19;15(12):660-3. Epub 2002 Oct 19.

Department of Renal Medicine and Transplantation, St. George's Hospital, London, UK.

Delayed graft function (DGF) in renal transplantation using non-heart-beating donors (NHBDs) usually exceeds 80%. There is debate whether DGF in this subgroup is associated with poor long-term outcome. Between 1 January 1988 and 31 January 2000, 130 of 158 (82.3%) NHBD graft recipients with functioning grafts transplanted within our regional NHBD programme developed DGF. Overall graft survival and graft survival censored for recipient death was 113/130 (86.9%) versus 113/121 (93.4%) at year 1, 55/84 (65.5%) versus 55/64 (85.9%) at year 5 and 18/40 (45.0%) versus 18/28 (64.3%) at year 10 after transplantation. Seventeen grafts (13.1%) were lost due to rejection or graft nephropathy. Nine of these kidneys failed during the 1st year. Twenty-seven patients (20.8%) died with functioning grafts, eight within the 1st year after transplantation. In those patients who survived, DGF was associated with excellent long-term outcome in this study. The number of grafts lost due to recipient death exceeded those lost due to rejection or graft nephropathy.
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http://dx.doi.org/10.1007/s00147-002-0471-4DOI Listing
December 2002

Abdominoplasty in a patient with severe obesity.

Int Surg 2002 Jan-Mar;87(1):15-8

St Mary's Hospital, London, United Kingdom.

Abdominoplasty and dermolipectomy are, in some cases, the only tools that a surgeon has to treat patients with severe obesity. Although liposuction is useful in removing fatty deposits without traditional surgical incisions, its application is limited in extremely obese patients. In response to current esthetic expectations, reconstructive surgeons have to deal effectively both with the actual complaint and with the desire of the patient to have an incision as small as possible. We present a case of severe obesity with large amounts of redundant skin and fat extending to below the knees. At the time of surgery, a large area of the patient's lower abdomen had become ischemic, thus making abdominoplasty the only option for treatment. We believe it is important for the surgeon be familiar with this approach because it can occur in general practice and he should be prepared to deal with it both as a relative emergency and as an elective procedure.
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February 2003