Search

Abstract: Background: Living donor liver transplantation (LDLT) has been accepted as a valuable treatment for patients with end-stage liver disease seeking to overcome the shortage of organs and the waiting list mortality. The aim of this study was to report our experience with LDLT. Methods: We retrospectively analyzed 50 LDLTs performed in our organ transplant center from January 1997 to March 2008. We reviewed the demographic data, family history, operative and hospital stay durations as well as postoperation complications among donors and recipients. We also performed a retrospective analysis of recipient chemical and biochemical data. Results: Among 50 patients (30 males and 20 females) of overall mean age of 7.21 ± 5.35 who underwent LDLT (10 right lobe, 38 left lobe, and 2 left lateral segments), 47 received a liver graft from their parent, two from a brother, and one from an uncle. The most common indications for LDLT were end-stage liver disease due to Wilson''s disease (16%), cryptogenic cirrhosis (16%), tyrosinemia (14%), biliary atresia (12%), autoimmune hepatitis (12%), and progressive familial intrahepatic cholestasis (12%). The mean follow-up was 16.91 ± 23.74 months. There were 13 (26%) recipient mortalities including vascular complications; three to sepsis after bowel perforation, two from liver dysfunction, two from chronic rejection due to noncompliance, and one from diffuse aspergillosis. The morbidity rate was 50%, including 19 reexplorations during the hospital course and five biliary complications. Conclusion: This study demonstrated that LDLT can decrease the number of patients awaiting liver transplantation especially in the pediatric group. However, because of relatively high mortality and morbidity, we must improve our treatment outcomes. [Copyright &y& Elsevier]

Abstract: Background: The role of ischemia/reperfusion injury in the pathogenesis of acute pancreatitis is still ill-defined. It is accepted, however, that ischemia/reperfusion induces the development of postimplantation pancreatitis that is responsible for considerable morbidity. Preconditioning by brief exposure to ischemia protects the organ against damage evoked by subsequent severe ischemia. This study was undertaken to examine whether two brief ischemic periods protect the pancreas against severe ischemia/reperfusion-induced pancreatitis. Materials and methods: This study was performed on 30 rats in three groups. The first group (control) underwent a laparatomy without clamping of any artery. The second group underwent 30-minute clamping of the inferior splenic artery followed by 1-hour reperfusion of the pancreas, and the third group underwent clamping of inferior splenic artery (2 × 5 minutes with 5-minute interval) as ischemic preconditioning and then 30-minute clamping of inferior splenic artery followed by 1-hour reperfusion. Results: Exposure to 30-minute pancreatic ischemia followed by 1-hour reperfusion led to the development of severe alterations greater than the other group that underwent ischemic preconditioning and then ischemia/reperfusion. Ischemia preconditioning applied prior to induction of pancreatitis reduced plasma lipase and interleukin-1β concentrations as well as less histological signs of pancreatic damage. Conclusion: We concluded that pancreatic ischemic preconditioning reduced the severity of ischemia/reperfusion-induced pancreatitis. This effect seemed to be related at least in part to the release of the proinflammatory mediator interleukin-1β. [Copyright &y& Elsevier]

Abstract: Background: Some intra-abdominal or retroperitoneal tumors such as low-grade slow-growing malignancies may seem unresectable due to major vessel encasement or presence of intra-abdominal dissemination, but the slow growth rate and to some extent long life expectancy of the patients urge us to find some strategies to cure the patients or at least achieve tumor remission or symptom palliation. En bloc resection, followed by multivisceral or liver-sparing “modified” multivisceral transplantation has recently been used for treatment of these patients. Results: Between May 2010 and October 2012, 3 multivisceral and 3 modified multivisceral transplantations were performed in 6 patients (aged 14 to 55 years; mean, 32 years) with some slow growing intra-abdominal malignancies (2 neuroendocrine tumors, 2 gastrointestinal stromal tumors, 1 desmoid tumor, and 1 low-grade sarcoma). All patients survived the procedure. One patient died of pancytopenia 2 months after transplantation and another died with pulmonary emboli at 4 months. The remaining 4 patients are alive without any evidence of disease recurrence. Conclusions: Although large intra-abdominal desmoid tumors, well-differentiated neuroendocrine tumors, and gastrointestinal stromal tumors are slow growing, they tend to invade locally, especially to the mesenteric root and/or celiac axis and other abdominal viscera. Complete resection followed by multivisceral transplantation could be a therapeutic option for these advanced tumors. [Copyright &y& Elsevier]

Abstract: Homozygous familial hypercholesterolemia (HFHC) is a rare inherited condition with an incidence of one in one million. It is associated with severe premature atherosclerosis and early death from cardiovascular complications. Mutation in the gene that encodes the synthesis of the cellular receptor for low-density lipoprotein (LDL) is responsible for this metabolic disorder. Currently, the only effective treatment for this disease is liver transplantation, which alone or in association with medications, normalizes plasma cholesterol level. The authors report the results of liver transplantation for two cases of HFHC. The first case, a 15-year-old boy received a whole liver from a deceased donor, and the second, an 11-year-old boy, received a left liver lobe transplant from his mother''s sister. Their preoperative fasting lipid concentrations were grossly raised. The older boy had severe atherosclerotic heart disease and had undergone coronary artery bypass grafting 5 months before transplantation. Both had preoperative plasma cholesterol levels higher than 750 mg/dL with normal thyroid and liver function tests. After the operation, the patients received methylprednisolone as pulse therapy followed by oral prednisolone, mycophenolate mofetil, and tacrolimus for immunosuppression. Their hospital stays were 24 and 13 days, respectively. The first case needed reexploration because of bleeding on the second day after the operation. The lipid concentrations rapidly returned to the normal range in the first week after the operation, remaining in this range over the first 6 months of follow-up. Liver transplantation offers an highly effective treatment for HFHC. It is better to operate on patients before severe atherosclerotic changes in the coronary arteries. All patients must undergo a complete cardiac evaluation before surgery. [Copyright &y& Elsevier]

Abstract: Unfortunately, pancreas transplantation (PTx) has been associated with the highest surgical complication rate of all the routinely performed organ transplant procedures. Complications can arise not only from the pancreas itself but also from the simultaneously transplanted duodenum. One of these complications is gastrointestinal bleeding, which might be from anastamotic site ulcer, pseudoaneurysm, arterioenteric fistula, severe rejection, or cytomegalovirus infection. In this case series, we present three patients presented with severe anemia 3 to 6 months after PTx with enteric drainage by end-to-end anastomosis of ascending loop of a Roux-en-Y to donor duodenal C-loop. The source of bleeding in all three cases was non–marginal donor duodenal C-loop ulcers. High donor pancreas exocrine output associated with relatively low drainage of a small end-to-end anastomosis may be the cause of these ulcers. It is recommended to use a side-to side anastomosis to prevent this complication. [Copyright &y& Elsevier]

Abstract: Background: The effect of donor fatty liver on graft survival is still uncertain. The aim of this study was to determine the influence of steatosis on the outcomes of OLT among our recipients. Methods: In this retrospective study, we evaluated the effect of donor liver steatosis on postoperative liver function and prognosis. Data obtained from liver transplantation data registry of our organ transplant center. Liver biopsies taken before transplantation were reviewed by two pathologists. Pathology reports were divided into four groups: normal pathology; mild fatty change (10%–30%); moderate (30%–60%); and severe steatosis (>60%). Livers with severe steatosis were excluded from transplantation. Factors determining transplantation outcome, such as early mortality, duration of intensive care unit (ICU) and hospital stay, clinical rejection episodes, and graft surgical complications, were compared between subjects who received donor liver, with various degrees of steatosis. Results: Three-month survival rates in recipients without donor liver fatty change, subjects with mild fatty change (10%–30%) and those with moderate (30%–60%) steatosis were 68%, 72%, and 76%, respectively, which were not significantly different (P > .05). Furthermore, short-term (hospital) mortality (20%, 14.3%, and 21.2%), hospital stay (30.89, 29.93, and 23.62 days), and length of ICU admission (5.06, 5.89, and 4.39 days) were not significantly different. In addition, Child score of recipients, pre- and postoperative liver function enzyme changes were similar. Conclusion: Mild-to-moderate (up to 60%) liver fatty change was not found to be associated with a worse prognosis in OLT. [Copyright &y& Elsevier]

Abstract: Background: Due to the shortage of organ donations and the rising number of patients with terminal renal insufficiency, living donor kidney donation has become increasingly important during recent years. Hand-assisted laparoscopic living donor nephrectomy (LLDN) is an alternative to the conventional open approach and may decrease the surgical trauma to the donor. The aim of this study was to report our experience with this technique. Materials and methods: We reviewed demographic data, operative duration, hospital stay, and postoperative complications among 100 LLDNs performed from August 2006 to July 2008. We also performed a retrospective analysis of chemical and biochemical data of recipients. Results: Thirty female and 70 male subjects of mean age of 35.88 ± 12.21 years were operated on during this period. The mean operative time for donor nephrectomy was 138.30 ± 31.92 minutes (range 60–205) and for recipients, 87.66 ± 11.79 minutes (range = 75–120), with a mean warm ischemia time of 5.19 ± 1.76 minutes (range = 2–8). The donors'' mean hospital stay was 28.34 ± 8.31 hours (range = 24–72). Five donor operations were converted to open nephrectomy because of uncontrolled bleeding or abnormal anatomy. There was no need for blood transfusions or reoperations in the donors. Mean hospital stay for the recipients was 9.44 ± 3.61 days (range = 5–22). Creatinine and blood urea nitrogen decreased from preoperative values of 10.46 ± 3.73 and 66.10 ± 25.16 to 1.39 ± 0.38 and 29.64 ± 8.83 mg/dL at discharge. The renal graft was rejected in two cases due to immunologic causes without any response to therapy. There was no vascular thrombosis in the transplanted kidneys. Conclusion: LLDN is a viable alternative to the standard open nephrectomy. It may have a positive impact on the donor pool by minimizing disincentives to living donation. The results of our program were acceptable; this approach may be the procedure of choice in the future in our center. [Copyright &y& Elsevier]

Abstract: The use of extended criteria liver donors has become a necessity in an era of organ scarcity for transplantation. We present here a case report of orthotopic liver transplantation using a liver with a giant right lobe hemangioma without backtable resection. Case Report: There were no data regarding the liver mass before organ procurement. The donor liver function tests and electrolyte profile were normal. During donor exploration a hemangioma was identified in segments V–VI, occupying approximately 20% of the total liver volume. It was prepared for transplantation on a sterile backtable without performing backtable hemangioma resection. A standard orthotropic liver transplant procedure was performed uneventfully, without veno-veno bypass. There was no bleeding from the hemangioma. The ischemic time was 9 hours and 20 minutes. Postoperative course was uneventful and the patient was discharged at 19 days after the operation. The hemangiomas showed evolution with some decrease in size upon later follow-ups. No clinically important complication was observed. Conclusion: Our case and other previous reports show that even large hemangiomas should not be considered to be a contraindication to organ procurement. These benign lesions either could be left in situ and observed or resected. [Copyright &y& Elsevier]

Abstract: Background: The clinical and pathological findings of enteric-drained (ED) versus bladder-drained (BD) pancreas transplantation are still controversial. In this study, we compared early outcome and histological findings of these 2 methods. Methods: In an experimental animal model, after diabetization, 16 dogs were randomly divided into 2 groups. In the first group, the pancreas was transplanted with enteric drainage, and in the second group, with bladder drainage. We evaluated early clinical and pathological outcomes. Results: The mean survival time was 11.25 ± 5.0 (range, 5–20) days for group 1 and 13.6 ± 7.2 (range, 3–23) days for group 2 (P > .05). Fasting blood sugar values (FBS) before transplantation were 279 ± 26.8 mg/dL versus 278 ± 41.6 mg/dL, respectively (P > .05). Two weeks postoperative serum FBS had decreased to 84.9 ± 2.9 versus 84.2 ± 0.98, respectively (P > .05). Serum amylase in the BD and ED groups were 378.5 ± 328 versus 422.6 ± 54.7 mg/dL, respectively (P > .05). Early leakage was not observed in dogs with BD, whereas it was 37.5% among dogs with ED (P < .05). Clinical and pathological evidences of pancreatic necrosis occurred in 37.5% of dogs with BD versus 62.5% of dogs with ED (P > .05). Discussion: Although the early outcomes of these drainage methods (ED vs BD) were statistically similar more dogs with ED experienced early complications than with BD. [Copyright &y& Elsevier]

Abstract: Background: Hepatic artery thrombosis (HAT) occurs in 3% to 9% of all liver transplantations with acute graft failure as a possible sequel. Methods: Eleven episodes of HAT were identified among 256 orthotropic liver transplantations (whole, LDCT, split) performed on 253 patients between April 1993 and July 2006. HAT was suspected clinically and confirmed by Doppler ultrasonography, magnetic resonance angiography, angiography, or reexploration. One patient was excluded due to poor follow-up. Treatment options included exploration with HA thrombectomy plus thrombolysis, retransplantation, or conservative treatment of hepatic and biliary complications. Results: Among 11 patients of mean age 29.98 ± 17.14 years (range, 10 months to 56 years). 2 had split right lobe liver transplantations and 9 received whole organs. None of LDLTs were identified to have HAT. The causes of liver cirrhosis among HAT patients were autoimmune hepatitis (n = 3), cryptogenic (n = 3), Wilson (n = 1), PBC (n = 1), biliary atresia (n = 1), and HBs (n = 1). HAT was diagnosed at 5.9 ± 4.43 (range, 2 to 16) days after operation. Most patients developed right upper quadrant (RUQ) pain at presentation. Two patients developed acidosis, fever, or SIRS and underwent retransplantation. Four underwent exploration of HA and 1 was treated conservatively. Three cases expired due to HAT complications. Conclusion: We found RUQ pain to be the presenting sign of early HAT in majority of cases. RUQ pain has been reported to occur in late HAT. Whenever HAT is confirmed, liver transplanted patients should be revascularized or even retransplanted. Intra-arterial thrombolysis and thrombolytic therapy for HAT should be done cautiously due to the potential risk of hemorrhage. [Copyright &y& Elsevier]

Abstract: Background/aim: End-stage renal failure patients requiring long-term hemodialysis need a durable vascular access. The arteriovenous fistula (AVF) with its long patency rate and low complication profile is usually the first choice for vascular access creation. However, when superficial veins are not suitable for AVF creation or all have been exhausted as a result of repeated AVF procedures, arteriovenous grafts (AVGs) using expanded polytetraflouroethylene (ePTFE) is an alternative. This study reviewed our experience in using PTFE AVGs for vascular access in patients requiring chronic hemodialysis. Materials and methods: In a prospective study, from September 2002 to October 2004, 21 PTFE AVGs were placed in 21 patients. We evaluated the complications and patency. Results: There were 12 female and nine male patients of mean age 58 ± 8.7 years (range = 45 to 76 years). Nine patients (43%) had hypertensive nephrosclerosis, 6 (29%) diabetic, 2 (10%) glomerulonephritis, 3 (14%) systemic lupus erythematosis requiring long-term steroids, and 1 (4.7%) unknown cause. The patency rate at 24 months was 85.7%. Complications included graft thrombosis (three; 14.3%), wound infection (three; 14.3%) and graft infection (one; 4.8%). Conclusion: ePTFE AVGs offer reasonable patency and serviceability rates as a vascular access modality, but in view of their complication profile, the native vein arteriovenous fistula should continue to be the first choice for vascular access for patients requiring chronic hemodialysis. [Copyright &y& Elsevier]

Abstract: Background: Liver transplantation (OLT) is accepted as the standard therapy for end-stage liver disease. The current shortage of organ donors has led to the use of split grafts and living related donors to provide timely liver transplants for these children. Herein we have reported our experience with pediatric OLT over a 9-year period. Materials and methods: We retrospectively studied 138 infants and children who underwent OLT from April 1999 to August 2008 including pretransplantation status, medical and surgical complications, and survival. Results: There were 83 (60.1%) boys and 55 (39.9%) girls. The mean patient age was 9.1 ± 5.6 years (range = 0.5–18) with a mean weight of 28.1 ± 17.0 kg (range = 7–80). The main indications were Wilson''s disease (20.3%); cryptogenic cirrhosis (16.7%); autoimmune cirrhosis (14.5%); biliary atresia (13.8%); tyrosinemia (9.4%); and progressive familial intrahepatic cholestasis (8.7%). We used living related donors in 54 (39.1%) and split livers in 20 (14.5%) cases with 64 (46.4%) patients receiving a whole liver from a deceased donor. The mean follow-up was 25.3 ± 20.3 months (range = 1–100). The mortality rate was 27.5% with a 26.1% in-hospital mortality. The main causes of mortality were vascular complications (32.6%); primary nonfunction (19.6%); sepsis (17.4%); chronic rejection (17.4%); and biliary complications (6.5%). The mortality rate among patients under 10 kg (58.8%) was higher than that of patients over 10 kg (23.1%). Among those patients who were discharged from the hospital (73.9%), the most common cause of mortality was chronic rejection from noncompliance (n = 4), chronic rejection (n = 3 cases), or posttransplant lymphoproliferative disease (n = 2). Conclusion: Our results demonstrated that pediatric OLT is a feasible undertaking in Iran. The organ shortage in our area led to liberal use of living related and split-liver techniques. The overall results of pediatric OLT in Iran were acceptable. [Copyright &y& Elsevier]

Abstract: Endogenous Aspergillus endophthalmitis (AE) is a rare complication of invasive aspergillosis in transplant patients. In this report, we have described a patient who underwent liver transplantation because of drug-induced cholestatic cirrhosis and developed AE at 2 weeks after the surgery. The patient was a 22-year-old man who received a right liver lobe from his father. The operation was uneventful but the patient developed signs and symptoms of small-for-size syndrome after the second day of surgery. The patient received intense immunosuppression with methylprednisolone for 3 days, tacrolimus and mycophenolate mofetil from the first day after the operation, with ceftriaxone and metronidazole as prophylactic antibiotics. Because of signs of respiratory distress with pneumonia, vancomycin and amphotericin B were added empirically to his regimen. Polymerase chain reaction for aspergillus DNA in the blood was positive. The patient received one course of methylprednisolone pulse therapy for signs of acute rejection at day 10, and tacrolimus was changed to sirolimus because of a rising serum creatinine and convulsions. After 2 weeks, the patient''s symptoms improved and liver function tests were normal, but the complained of sudden intense pain in the left eye with unilateral blurred vision, redness, and other signs of endophthalmitis upon examination by an ophthalmologists. After 24 hours, visual acuity decreased to light perception. AE was confirmed by microscopy and culture of the vitreous fluid and retinal biopsy. Despite changing amphotericin to intravitreal injection of voriconazole followed by intravenous voriconazole and transient resolution of the symptoms, no improvement was seen in visual acuity. Pain and signs of inflammation in the eye recurred after 2 weeks. At last the patient underwent enucleation for resistant infection and fear of involvement of the other eye by aspergillosis or sympathetic ophthalmia. [Copyright &y& Elsevier]

Abstract: Background: Cadaveric organ splitting emerged from an improved understanding of the surgical anatomy of the liver as a possible mechanism to expand the organ pool. In this study, we have reported our first series of split liver transplantations (SLT). Materials and Methods: From June 2006 to June 2008, we performed 17 pairs of SLT: 70.6% ex situ and 29.4% in situ. The mean age of the donors (32 males, 2 females) was 23.15 ± 9 years. All of them had been stable at the time of harvest according to vital signs, liver function tests, electrolytes, and urine output. The decision on splitting was made by the surgical team according to the donor''s status and the urgency of the recipient. Results: The main indications were biliary atresia (17.6%) followed by Wilson disease (14.7%) and cryptogenic cirrhosis (14.7%). The left lateral segment and the left lobe were used in 6 and 11 cases, respectively. In-hospital mortalities for the pediatric and adult groups were 68.4% and 26.7%, respectively. Primary graft nonfunction (52.9%), vascular complications (29.4%), sepsis (11.8%), and biliary complications (5.9%) were the main causes of mortality. Conclusion: Our experience indicated that SLT showed a high rate of mortality and morbidity. [Copyright &y& Elsevier]

Abstract: Background and purpose of study: The pathogenic role of important hepatotropic viral agents to induce hepatic dysfunction and failure may lead to the need for liver transplantation. We focused on the use of hematologic and biochemical laboratory diagnostic indexes to follow the clinical impact of hepatitis B virus (HBV); hepatitis C virus (HCV); and hepatitis G virus-related liver complications in transplant patients. Materials and methods: We collected 141 EDTA-treated blood samples pre- and post–liver transplantation for 2 years among 67 transplant patients. We evaluated the statistical relationships between hematologic and biochemical indices with HBV, HCV, and HGV infections among transplant recipient samples using version 15 of SPSS software. Results: HBV polymerase chain reaction (PCR) positivity significantly correlated with partial thromboplastin (P = .011) pretransplant, with creatinine (P = .026) and Na (P = .034) levels at 1-week posttransplant, and also with alkaline phosphatase (P = .027) and mean corpuscular hemoglobin concentration (P = .050) at 2 weeks posttransplantation. Significant correlations were detected between HCV-reverse transcriptase (RT)-PCR-positive results and blood urea nitrogen (P = .008) and Na (P = .021) levels in the first aspartate aminotransferase and with (P = .025) in the second week after liver transplantation. Also, significant relationships were noted between HGV-RT-PCR-positive results and alkaline phosphatase (P = .05) and creatinine (P = .002) levels in the first and second weeks after liver transplant, respectively. Conclusion: Detection of significant correlations between HBV, HCV, and HGV infections with laboratory indices suggested that monitoring hematologic and biochemical liver function-related criteria aid the management of clinical complications of viral hepatitis in liver transplant patients. [Copyright &y& Elsevier]

Abstract: Introduction: The incidence, risk factors, and natural history of de novo nonalcoholic fatty liver disease (NAFLD) after liver transplantation have not been well described. In this report we examined the risk factors and demographic characteristics of 3 patients. Materials and Methods: During a 16-year period, we performed 900 liver transplantations. We reviewed donor and recipient liver biopsies to identify patients who developed de novo fatty liver following liver transplantation, recording the pretransplantation and posttransplantation blood sugar values and lipid profiles as well as body mass indices (BMI) of affected patients. Results: Three patients developed de novo fatty liver after transplantation. The primary liver diseases among these patients were as follows: Crigler-Najjar syndrome, biliary atresia, and tyrosinemia. All of the patients who developed NAFLD were children. None of them had obesity; all had normal blood sugar values and lipid profiles (triglyceride cholesterol) at the time of and after the operation. Two patients received liver allografts from living related donors and 1 from a deceased donor. The BMI, lipid profile, and blood sugars of all donors were normal. Preoperative donor liver biopsy specimens showed normal histological findings with no evidence of a fatty liver, but the postoperative liver biopsy in recipients specimens revealed steatosis and fatty liver (20%–40% fat). Portal vein thrombosis and hepatic artery thrombosis were observed in the patients using color Doppler sonography. Conclusion: De novo NAFLD after liver transplantation occurred less frequently than noted in previous reports. All 3 patients experienced complicated courses. Portal vein thrombosis and hepatic artery thrombosis seemed to be important factors for development of de novo fatty liver after transplantation. [Copyright &y& Elsevier]

Abstract: Hepatoportal sclerosis (HPS) is one of the causes of noncirrhotic portal hypertension. In most patients, hepatic synthetic dysfunction does not occur; rarely they may require liver transplantation. In this study, we have reported the clinicopathologic characteristics of 3 patients diagnosed with HPS after examination of the explanted liver. Small liver volume, significant portal fibrosis, and phlebosclerosis may contribute to hepatic synthetic dysfunction in patients with HPS. [Copyright &y& Elsevier]

Abstract: Background: The pediatric end-stage liver disease (PELD) scoring system has been used widely for prioritizing children awaiting orthotopic liver transplantation (OLT). The aim of the present study was to compare the Child-Turcotte-Pugh scoring system with PELD to predict morbidity and mortality of children scheduled for OLT before the organ was available. Materials and Methods: From 1999 to 2006, 83 infants and children were evaluated and scheduled for OLT. Child and PELD scores were determined according to the initial assessment at the time of listing. Outcome was examined using records and follow-up data. Results: Among 83 patients, 12% were Child A; 53%, Child B; and 35%, Child C. The mean PELD score at listing was 19.8 ± 12.8. Patients with Child scores A, B, and C displayed mean PELD scores of 7.1 ± 4.9, 15.7 ± 9.3, and 30.5 ± 11.7, respectively. Child classification and scoring showed a positive correlation with the PELD score (Spearman’s correlation coefficient: 0.666, P = .001). A higher PELD score was associated with greater morbidity and mortality. Conclusion: Child classification has several shortcomings; therefore, PELD scores appear to be the best metric to prioritize children listed for OLT. [Copyright &y& Elsevier]

Abstract: Background: Family refusal is an important factor that limits the number of organ donations. Some studies from different centers have reported various reasons for family decisions of organ donation refusal. This study evaluated the reasons for organ donation refusal by family members covered in our organ procurement organization. Methods: This cross-sectional study was performed among families of potential organ donors who satisfied brain death criteria as identified between March 2009 and March 2010. Results: Among 125 potential donors 73 (58.4%) families refused donation. Their main reasons were as follows: lack of acceptance of brain death n = 26 (35.6%), belief in miracle and patient recovery (n = 22; 30.1), fear of gossip regarding sale rather than autonomous organ donation (n = 11; 15.1%), and fear about deformation of the donor''s body (n = 9; 12.3%). Conclusion: Family members play an important role in the final decision for organ donation. The general public should be encouraged to register their donation preferences in the case of brain death. [Copyright &y& Elsevier]

Abstract: Background: Intraoperative hypotension, massive transfusion, liver disease, coexistent renal dysfunction, and decreased glomerular filtration rate during the anhepatic phase are major hazards for kidney function. We undertook this study to determine the change in urine output during clamping. Method: Twenty-four patients without preexistent renal disease, who were undergoing liver transplantation using the piggyback method, were enrolled in this study. Patients with a serum creatinine level >1.2 mg/dL were excluded. Urine output was monitored over 30 minutes before inferior vena cava and portal vein clamping, during clamping, and for 30 minutes after declamping. None of the patients had a clamping time >70 minutes. Our goal was to maintain mean arterial blood pressure and heart rate just by fluid administration diuretics were avoided. Results: Participants had a mean age of 39.12 ± 13.52 years (range, 15–67 years) with a male to female ratio of 1:4. Urine output 30 minutes before clamping was 3.64 ± 3.58 (range, 1.25–15.18) mL/kg/h, decreased to 1.28 ± 2.58 (range, 0–11.39) mL/kg/h during clamping (P = .00), and increased to 3.56 ± 3.64 (range, 0.51–15.18) mL/kg/h 30 minutes after declamping (P = .00). Conclusion: Urine output was significantly reduced in all patients after clamping of the IVC and portal veins. This observation may be explained by increased venous pressure leading to decreased renal perfusion pressure. It has been stated that one of the advantages of veno-veno bypass (VVB) is increased renal perfusion pressure. However, if the clamping time in the piggyback method is <70 minutes and patients have normal preoperative renal function, the decreased renal perfusion pressure will not cause postoperative kidney dysfunction. [Copyright &y& Elsevier]

Abstract: Objectives: The objective of this study was to evaluate the effect of bilateral nephrectomy on posttransplantation urinary tract infection (UTI) among patients with end-stage renal disease (ESRD) due to autosomal dominant polycystic kidney disease (ADPKD). Methods: In a retrospective case-control design, 62 patients with ESRD with ADPKD were divided into 2 groups: (A) 24 patients who underwent bilateral nephrectomies, and (B) 38 patients in whom bilateral nephrectomies had not been done. Pretransplantation and posttransplantation urine cultures were evaluated for UTI. Results: Sixty-two patients with ESRD with ADPKD were enrolled in this study. The average age was 42 years (range, 6–60 years). Forty patients (64.5%) were male and 22 (35.5%) were female. The mean duration of hemodialysis was 24 months (range, 2–120 months), which was the same for both groups. Bilateral nephrectomies were done for 24 participants (38.7%). There were 38 patients (61.3%) in group B who did not have the operation. UTI occurred in 23 patients (37.1%): 6 patients (25%) in group A and 17 patients (44.7%) in group B. The incidence of UTI was not statistically different between the 2 groups (P > .05). Furthermore, no relationship was found between age, gender, blood group, and UTI in patients with ADPKD (P > .05). Conclusion: According to our study, the presence of large nonfunctional kidneys is not a risk factor for posttransplantation UTI in patients with ADPKD and ESRD. [Copyright &y& Elsevier]