Advancements in transplantation offer promising treatment options for a variety of diseases. Orga... more Advancements in transplantation offer promising treatment options for a variety of diseases. Organ donation, an essential part of organ transplantation, may be performed at hospitals even if the facility is not a transplant center; therefore, perioperative nurses should be aware of developments in transplantation and the implications for patient care at their facilities. Considerations for organ transplant protocols include the type of documentation required, the elements of the transplant OR time out, and the use of intraoperative anti-rejection medications. Considerations for organ donation protocols include issues specific to a deceased donor, a living donor, or a donation after cardiac death. Newer developments in the transplant OR include laparoscopic kidney donation and transplantation, kidney paired donation transplantation, other living donor procedures, and transplantation procedures using robotic technology.
Seminars in cardiothoracic and vascular anesthesia, 2017
Worldwide 715 482 patients have received a lifesaving organ transplant since 1988. During this ti... more Worldwide 715 482 patients have received a lifesaving organ transplant since 1988. During this time, there have been advances in donor management and in the perioperative care of the organ transplant recipient, resulting in marked improvements in long-term survival. Although the number of organs recovered has increased year after year, a greater demand has produced a critical organ shortage. The majority of organs are from deceased donors; however, some are not suitable for transplantation. Some of this loss is due to management of the donor. Improved donor care may increase the number of available organs and help close the existing gap in supply and demand. In order to address this concern, The Organ Donation and Transplantation Alliance, the Association of Organ Procurement Organizations, and the Transplant and Critical Care Committees of the American Society of Anesthesiologists have formulated evidence-based guidelines, which include a call for greater involvement and oversight ...
The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society
Exit-site infections involving peritoneal dialysis catheters are a cumbersome issue that can be d... more Exit-site infections involving peritoneal dialysis catheters are a cumbersome issue that can be difficult to manage. Such infections are usually due to gram-positive organisms and are often treated successfully with oral and/or topical antibiotics. Infections associated with Mycobacterium sp. are much more rare and difficult to treat. We report our experience with four cases of exit-site infections with Mycobacterium sp. in the New Orleans area, along with a review of risk factors and current literature.
WMJ : official publication of the State Medical Society of Wisconsin, 2006
Herein is reported a case of a putative tumor of the left adrenal gland found incidentally during... more Herein is reported a case of a putative tumor of the left adrenal gland found incidentally during the workup of a cirrhotic patient with portal hypertension. This mass manifested vascular enhancement and other features of an adenoma both on computed tomography (CT) and magnetic resonance imaging (MRI) scans. Additional workup revealed elevated salivary cortisol and plasma aldosterone levels. A proposed biopsy of this mass was deferred because of an episode of variceal bleeding that required placement of a transjugular intrahepatic portosystemic shunt (TIPS). Post TIPS placement, repeat CT and MRI scans showed that the mass had disappeared, indicating that this pseudotumor was, in fact, a knot of peri-adrenal varices, which was now decompressed. In this report, the anatomic and pathologic basis of peri-adrenal varices in a patient with portal hypertension is discussed, as well as the ability of current imaging studies at establishing this diagnosis. Liver disease may cause abnormalit...
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Continuous ambulatory peritoneal dialysis has become an increasingly popular modality of renal re... more Continuous ambulatory peritoneal dialysis has become an increasingly popular modality of renal replacement therapy. Laparoscopic placement of peritoneal dialysis catheters may help overcome previous barriers to peritoneal dialysis, such as previous abdominal surgical procedures or the presence of hernias, without incurring substantially greater risks. We performed a retrospective review of 120 consecutive patients who underwent attempted laparoscopic peritoneal dialysis catheter placement between July 2009 and June 2014 by a single surgeon. Patient and catheter characteristics and outcomes were compared between patients with and without complications, as well as between patients with a history of major abdominal surgery and those without such a history. Laparoscopic peritoneal dialysis catheter placement was aborted in 4 patients because of an inability to safely achieve sufficient access to the abdominal cavity through dissection; these patients were excluded from subsequent analys...
The use of living donor kidneys has dramatically increased the number and success of kidney trans... more The use of living donor kidneys has dramatically increased the number and success of kidney transplants across the world. But questions remain regarding the subjection of a healthy individual to surgery for the benefit of another. Donors do have medical and financial risks. The stigma of organ brokering remains today, with evidence of commercial transplantation in other countries. Here in the US, we are exposed to advertising for donors using the media. In the hope of increasing living donations, we run the risk of stretching altruism too far. In this manuscript, we highlight and discuss some of the current controversies surrounding living donor kidney transplantation across the world.
A 53-year-old male with hepatitis C cirrhosis, who had been refused liver transplantation because... more A 53-year-old male with hepatitis C cirrhosis, who had been refused liver transplantation because of hypertrophic cardiomyopathy (HC), underwent nonsurgical septal ablation using alcohol with resolution of his ventricular outflow obstruction. This patient was able to subsequently undergo a successful deceased donor liver transplantation. This is the first reported case of alcohol induced septal ablation being performed in a cirrhotic patient with HC. Such nonsurgical procedures may be attractive in cirrhotic patients who are refused access to liver transplantation because of high surgical risk.
We examined the effects of increasing human leukocyte antigen (HLA) mismatches (MM) on long-term ... more We examined the effects of increasing human leukocyte antigen (HLA) mismatches (MM) on long-term graft outcomes in patients transplanted with a panel reactive antibody (PRA) >80% over a 10-yr period. A total of 142 recipients were divided into three groups based on the number of HLA MM with their allograft (0-2, 3-4 and 5-6 MM; Groups I, II and III). All patients received the same immunosuppression protocol. The higher MM groups had a higher incidence of rejection (4.4% vs. 11.4% vs. 31.3%, p < 0.01). A multivariate analysis showed that rejection was the only significant variable affecting graft loss (OR = 7.45, p = 0.01). There was a trend toward more CMV infection and worse graft function with higher MM. Kaplan-Meier five-yr graft survival estimates were 100% vs. 81% vs. 74% for Groups I, II and III, respectively (p = 0.14). In patients with PRA levels >80%, a higher HLA MM is associated with higher incidence of acute rejection. Acute rejection was the only significant variable affecting graft loss. We found a trend toward more CMV infections and worse graft outcomes with higher MM. Closer HLA matching and immunologic monitoring needs to be considered to improve graft outcomes among sensitized recipients.
Advancements in transplantation offer promising treatment options for a variety of diseases. Orga... more Advancements in transplantation offer promising treatment options for a variety of diseases. Organ donation, an essential part of organ transplantation, may be performed at hospitals even if the facility is not a transplant center; therefore, perioperative nurses should be aware of developments in transplantation and the implications for patient care at their facilities. Considerations for organ transplant protocols include the type of documentation required, the elements of the transplant OR time out, and the use of intraoperative anti-rejection medications. Considerations for organ donation protocols include issues specific to a deceased donor, a living donor, or a donation after cardiac death. Newer developments in the transplant OR include laparoscopic kidney donation and transplantation, kidney paired donation transplantation, other living donor procedures, and transplantation procedures using robotic technology.
Seminars in cardiothoracic and vascular anesthesia, 2017
Worldwide 715 482 patients have received a lifesaving organ transplant since 1988. During this ti... more Worldwide 715 482 patients have received a lifesaving organ transplant since 1988. During this time, there have been advances in donor management and in the perioperative care of the organ transplant recipient, resulting in marked improvements in long-term survival. Although the number of organs recovered has increased year after year, a greater demand has produced a critical organ shortage. The majority of organs are from deceased donors; however, some are not suitable for transplantation. Some of this loss is due to management of the donor. Improved donor care may increase the number of available organs and help close the existing gap in supply and demand. In order to address this concern, The Organ Donation and Transplantation Alliance, the Association of Organ Procurement Organizations, and the Transplant and Critical Care Committees of the American Society of Anesthesiologists have formulated evidence-based guidelines, which include a call for greater involvement and oversight ...
The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society
Exit-site infections involving peritoneal dialysis catheters are a cumbersome issue that can be d... more Exit-site infections involving peritoneal dialysis catheters are a cumbersome issue that can be difficult to manage. Such infections are usually due to gram-positive organisms and are often treated successfully with oral and/or topical antibiotics. Infections associated with Mycobacterium sp. are much more rare and difficult to treat. We report our experience with four cases of exit-site infections with Mycobacterium sp. in the New Orleans area, along with a review of risk factors and current literature.
WMJ : official publication of the State Medical Society of Wisconsin, 2006
Herein is reported a case of a putative tumor of the left adrenal gland found incidentally during... more Herein is reported a case of a putative tumor of the left adrenal gland found incidentally during the workup of a cirrhotic patient with portal hypertension. This mass manifested vascular enhancement and other features of an adenoma both on computed tomography (CT) and magnetic resonance imaging (MRI) scans. Additional workup revealed elevated salivary cortisol and plasma aldosterone levels. A proposed biopsy of this mass was deferred because of an episode of variceal bleeding that required placement of a transjugular intrahepatic portosystemic shunt (TIPS). Post TIPS placement, repeat CT and MRI scans showed that the mass had disappeared, indicating that this pseudotumor was, in fact, a knot of peri-adrenal varices, which was now decompressed. In this report, the anatomic and pathologic basis of peri-adrenal varices in a patient with portal hypertension is discussed, as well as the ability of current imaging studies at establishing this diagnosis. Liver disease may cause abnormalit...
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Continuous ambulatory peritoneal dialysis has become an increasingly popular modality of renal re... more Continuous ambulatory peritoneal dialysis has become an increasingly popular modality of renal replacement therapy. Laparoscopic placement of peritoneal dialysis catheters may help overcome previous barriers to peritoneal dialysis, such as previous abdominal surgical procedures or the presence of hernias, without incurring substantially greater risks. We performed a retrospective review of 120 consecutive patients who underwent attempted laparoscopic peritoneal dialysis catheter placement between July 2009 and June 2014 by a single surgeon. Patient and catheter characteristics and outcomes were compared between patients with and without complications, as well as between patients with a history of major abdominal surgery and those without such a history. Laparoscopic peritoneal dialysis catheter placement was aborted in 4 patients because of an inability to safely achieve sufficient access to the abdominal cavity through dissection; these patients were excluded from subsequent analys...
The use of living donor kidneys has dramatically increased the number and success of kidney trans... more The use of living donor kidneys has dramatically increased the number and success of kidney transplants across the world. But questions remain regarding the subjection of a healthy individual to surgery for the benefit of another. Donors do have medical and financial risks. The stigma of organ brokering remains today, with evidence of commercial transplantation in other countries. Here in the US, we are exposed to advertising for donors using the media. In the hope of increasing living donations, we run the risk of stretching altruism too far. In this manuscript, we highlight and discuss some of the current controversies surrounding living donor kidney transplantation across the world.
A 53-year-old male with hepatitis C cirrhosis, who had been refused liver transplantation because... more A 53-year-old male with hepatitis C cirrhosis, who had been refused liver transplantation because of hypertrophic cardiomyopathy (HC), underwent nonsurgical septal ablation using alcohol with resolution of his ventricular outflow obstruction. This patient was able to subsequently undergo a successful deceased donor liver transplantation. This is the first reported case of alcohol induced septal ablation being performed in a cirrhotic patient with HC. Such nonsurgical procedures may be attractive in cirrhotic patients who are refused access to liver transplantation because of high surgical risk.
We examined the effects of increasing human leukocyte antigen (HLA) mismatches (MM) on long-term ... more We examined the effects of increasing human leukocyte antigen (HLA) mismatches (MM) on long-term graft outcomes in patients transplanted with a panel reactive antibody (PRA) >80% over a 10-yr period. A total of 142 recipients were divided into three groups based on the number of HLA MM with their allograft (0-2, 3-4 and 5-6 MM; Groups I, II and III). All patients received the same immunosuppression protocol. The higher MM groups had a higher incidence of rejection (4.4% vs. 11.4% vs. 31.3%, p < 0.01). A multivariate analysis showed that rejection was the only significant variable affecting graft loss (OR = 7.45, p = 0.01). There was a trend toward more CMV infection and worse graft function with higher MM. Kaplan-Meier five-yr graft survival estimates were 100% vs. 81% vs. 74% for Groups I, II and III, respectively (p = 0.14). In patients with PRA levels >80%, a higher HLA MM is associated with higher incidence of acute rejection. Acute rejection was the only significant variable affecting graft loss. We found a trend toward more CMV infections and worse graft outcomes with higher MM. Closer HLA matching and immunologic monitoring needs to be considered to improve graft outcomes among sensitized recipients.
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