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5. The Indications and Outcomes of Ileostomy Following Pancreas Transplantation

Author

Tavakoli A, Okidi Oo, Forgacs B, Babatunde Campbell, and Pretorian Mm

Subjects
medicine.medical_specialty, Ileostomy, surgical procedures, operative, business.industry, medicine.medical_treatment, Medicine, Pancreas transplantation, business, Surgery
Abstract

Background: Pancreas transplantation is associated with high incidence of intra-abdominal sepsis and reoperations. There is little data on the incidence and need for an ileostomy post pancreas transplantation. However, it is noted anecdotally that this is not uncommon occurrence post enteric drained pancreas transplantation.

Published
2020
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15. A prospective cohort study of risk prediction in simultaneous pancreas and kidney transplantation

Author

A. Tavakoli, T. Campbell, Moinuddin Z, R. Pararajasingam, Hussein Khambalia, Dhanda R, Titus Augustine, Forgacs B, van Dellen D, and Angela Summers

Subjects
Adult, Male, medicine.medical_specialty, Revised Cardiac Risk Index, medicine.medical_treatment, Pancreas transplantation, Risk Assessment, Severity of Illness Index, law.invention, Cohort Studies, Young Adult, law, Internal medicine, Severity of illness, medicine, Journal Article, Humans, Prospective Studies, Intensive care medicine, Prospective cohort study, Kidney transplantation, business.industry, General Medicine, Length of Stay, Middle Aged, medicine.disease, Intensive care unit, Kidney Transplantation, Tissue Donors, Treatment Outcome, Transplant Surgery, Surgery, Female, Pancreas Transplantation, Risk assessment, business, Cohort study
Abstract

Introduction Current risk prediction scoring systems in pancreas transplantation are limited to organ factors and are specific to predicting graft outcome. They do not consider recipient factors or inform regarding recipient morbidity. The aim of this study was to assess the utility of commonly used general surgical risk prediction models (P-POSSUM [Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity], MODS [multiple organ dysfunction score], Charlson co-morbidity index, revised cardiac risk index, ASA [American Society of Anesthesiologists] grade and Waterlow score), and to correlate them with total length of hospital stay (LOS) and critical care unit (CCU) LOS, important surrogate markers of patient outcome. Methods All risk prediction scores were calculated prospectively for all simultaneous pancreas and kidney (SPK) transplant recipients from November 2011 to October 2013, and correlated with outcome measures. Results Overall, 57 SPK transplant recipients were analysed. The mean age was 42.0 years (standard deviation [SD]: 7.60 years), 27 (52%) were male and the mean body mass index was 25.43kg/m2 (SD: 3.11kg/m2). The mean pancreas and kidney cold ischaemic times were 703 minutes (SD: 182 minutes) and 850 minutes (SD: 192 minutes) respectively. The median total LOS and mean CCU LOS was 17 days (range: 8–79 days) and 7 days (SD: 4.04 days) respectively. When correlated with risk prediction scores, Waterlow score was the only significant predictor of total LOS and CCU LOS (pConclusions Preoperative risk prediction plays an important part in planning perioperative care. To date, no validated risk prediction scoring system exists for SPK transplantation. This prospective study indicates that Waterlow score identifies high risk individuals and has value in the prediction of outcome following SPK transplantation.

Published
2015
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21. Trauma penieno: aspetti in eco-color Doppler

Author

Bertolotto, M, Serafini, G, Quaia, E, Forgacs, B, Locatelli, M., Bertolotto, Michele, Serafini, G, Quaia, Emilio, Forgacs, B, and Locatelli, M.

Subjects
ecocolor Doppler, " Doppler, trauma penieno, Pene ", " trauma ", " ecografia "
Published
2002

24. Short Term Outcomes of Recipients Transplanted With Machine Perfused Kidneys From Elderly Donors After Circulatory Death (DCD).

Author

Forgacs, B., primary, Di Benedetto, G., additional, Hodi, Z., additional, Shaw, E., additional, Giuffrida, G., additional, Masood, O., additional, Venkat, V., additional, Okidi, O., additional, Parrott, N., additional, Augustine, T., additional, Campbell, T., additional, van Dellen, D., additional, Pararajasingam, R., additional, and Tavakoli, A., additional

Published
2014
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27. Characterization of focal hepatic lesions in cirrhotic patients by Pulse Inversion Harmonic Imaging US contrast specific technique with Levovist

Author

Quaia, E, Forgacs, B, Calderan, L, Bertolotto, M, POZZI MUCELLI, Roberto, Quaia, Emilio, Forgács, B., Calderan, L., Bertolotto, Michele, and POZZI MUCELLI, Roberto

Subjects
Levovist, Liver Cirrhosis, Male, contrast agents focal lesion, US, Carcinoma, Hepatocellular, ultrasound, Liver Neoplasms, Contrast Media, contrast agents focal lesions, Pulse Inversion Harmonic Imaging (PIHI), Middle Aged, liver, focal liver lesions, Polysaccharides, Humans, cirrhotic patients, Female, Ultrasonography, Doppler, Color, Hemangioma, Aged
Abstract

To evaluate the capabilities of Pulse Inversion Harmonic Imaging (PIHI) with hepatospecific US contrast agent Levovist in the characterization of focal liver lesions in cirrhotic patients.Thirty-nine focal hepatic lesions in 25 consecutive cirrhotic patients identified by conventional ultrasound (US), were evaluated by color Doppler (CD), power Doppler (PD) with spectral analysis of tumoural vessels and PIHI. PIHI was performed 30 seconds (vascular phase) and 3-5 minutes (late phase) after Levovist injection. To definitely characterize the evaluated focal hepatic lesions, helical-CT (HCT) enhancement patterns (15 patients) and/or surgical/bioptic histologic findings (10 patients) were considered as reference procedures.Thirty focal hepatic lesions classified as hepatocellular carcinoma (HCC) by reference procedures appeared hypoechoic (n=19), isoechoic (n=5) or hyperechoic (n=6) on conventional US, with basket arterial pattern (n=10), vessels within the tumor (n=6), peripheral arterial pattern (n=4) or no vascular pattern (n=10) on CD/PD evaluation. On PIHI they appeared hyperechoic (n=26) or isoechoic (n=4) in the vascular phase, if compared to the surrounding liver parenchyma, and hypoechoic (n=23) or isoechoic (n=7) in the late phase. Four focal hepatic lesions classified as regenerative nodules (RNs) by reference procedures appeared hypoechoic on conventional US, with peripheral venous/arterial pattern (n=1) or no vascular pattern (n=3) on CD/PD. On PIHI they appeared hypoechoic (n=3) or isoechoic (n=1) in the vascular phase, remaining prevalently hypoechoic (n=3) or isoechoic (n=1) in the late phase. Five focal hepatic lesions classified as hemangioma by reference procedures appeared hyperechoic (n=4) or hypoechoic (n=1) on conventional US with few peripheral venous vessels on CD/PD. On PIHI they revealed progressive fill-in from the periphery toward the centre during the vascular and late phase after Levovist injection.PIHI seems to be a reliable technique to characterize focal lesions in cirrhotic patients.

Published
2002

30. Vascular Choices in Pancreas Transplantation: Does it Matter?

Author

Shapey, I., primary, van Dellen, D., additional, Ghazanfar, A., additional, Mitu-Pretorian, M., additional, Forgacs, B., additional, Pararajasingam, R., additional, Campbell, B., additional, Riad, H., additional, Parrott, N., additional, Augustine, T., additional, and Tavakoli, A., additional

Published
2012
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31. CMV Disease in Solid Organ Pancreas Transplantation: A Single Centre Experience

Author

Mitu-Pretorian, O.-M., primary, Hughes, S., additional, van Dellen, D., additional, Ghazanfar, A., additional, Di Benedetto, G., additional, Masood, O., additional, De Freitas, D., additional, Picton, M., additional, Forgacs, B., additional, Pararajasingam, R., additional, Campbell, B., additional, Parrott, N., additional, Augustine, T., additional, and Tavakoli, A., additional

Published
2012
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32. Hypertensive Live Kidney Donors Have An Exaggerated Increase in Serum Creatinine in the Post Donation Period Compared with Age and Sex Matched “Normotensive” Controls

Author

Chiu, D., primary, Tavakoli, A., additional, Parajasingam, R., additional, Forgacs, B., additional, Parrott, N., additional, Augustine, T., additional, DʼFrietas, D., additional, Picton, M., additional, Kost, S., additional, Gill, J., additional, and Campbell, T., additional

Published
2012
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37. Does Rapamycin Still Have a Role? Experience and Lessons from the Last Decade

Author

Di Benedetto, G., primary, van Dellen, D., additional, Ghazanfar, A., additional, Tavakoli, A., additional, Delargy, M., additional, Griffin, C., additional, Forgacs, B., additional, Campbell, T., additional, Parrott, N. R., additional, Pararajasingam, R., additional, Wood, G., additional, Woywodt, A., additional, Picton, M., additional, and Augustine, T., additional

Published
2012
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46. Case Report: Familial Hypocalciuric Hypercalcaemia and Hashimoto's Thyroiditis.

Author

Mobarak S, Tarazi M, Spiers H, Santhakumar A, and Forgacs B

Abstract

Introduction: Hypercalcaemia can be caused by many disorders. Primary hyperparathyroidism is the leading cause with parathyroidectomy being the definitive management. Familial hypocalciuric hypercalcaemia is a rarer cause in which resection of the parathyroid tissue does not result in normalized serum calcium. Case presentation: We report the unusual case of a 53-year-old lady who presented with hypercalcaemia and elevated parathyroid hormone with a presumed diagnosis of primary hyperparathyroidism. She remained hypercalcaemic after parathyroidectomy and was later diagnosed with familial hypocalciuric hypercalcaemia. During the first operation, a lymph node was also removed, and the histopathology report suggested a metastasis of follicular variant papillary thyroid carcinoma (FVPTC). After multi-disciplinary team (MDT) discussion, the patient underwent a second exploration where total thyroidectomy and removal of the other parathyroid glands were performed. Hypercalcaemia completely resolved on surgical resection of the thyroid and parathyroid tissue, however histopathology revealed normal parathyroid glands and florid Hashimoto's thyroiditis. The initial diagnosis of FVPTC in the lymph node was revisited and the final histopathology report suggested an accessory thyroid nodule with florid Hashimoto's thyroiditis mimicking a lymph node. Conclusion: Our case demonstrates the diagnostic dilemma in hypercalcaemia that may lead a patient to undergo unnecessary invasive procedures; the misdiagnosis of FVPTC after the first operation resulted in a second more extensive procedure. Patients with no clear surgical target and urine CCCR in the gray/non-diagnostic area should be routinely offered genetic testing despite negative family history., (Copyright © 2020 Mobarak, Tarazi, Spiers, Santhakumar and Forgacs.)

Published
2020
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47. Multiple Renal Arteries.

Author

Tuteja SY and Forgacs B

Subjects
Child, Female, Humans, Kidney blood supply, Kidney Transplantation, Renal Artery abnormalities
Published
2019
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48. Comparison of Ipsilateral and Contralateral Simultaneous Pancreas and Kidney Transplantation: A Single-Center Analysis with 5-Year Outcome.

Author

Papachristos S, Tavakoli A, Dhanda R, Pararajasingam R, Campbell T, and Forgacs B

Subjects
Adult, Age Factors, Female, Follow-Up Studies, Humans, Kidney Transplantation adverse effects, Male, Middle Aged, Operative Time, Pancreas Transplantation adverse effects, Postoperative Complications etiology, Sex Factors, Graft Survival, Kidney Transplantation methods, Pancreas Transplantation methods
Abstract

BACKGROUND It is routine to implant the pancreas on the right and the renal graft on the left iliac fossa during a simultaneous kidney and pancreas transplant (cSPK). Ipsilateral placement of both organs on the same side raises concerns that the pancreas graft might compromise the distally placed kidney. However, ipsilateral SPK (iSPK) can be faster than the conventional contralateral graft placement and allows for preservation of the other side for future transplants. MATERIAL AND METHODS In a single unit, 67 SPK transplantations (cSPK n=49, iSPK n=18) were performed from 2008 to 2011. The decision for graft placement was made during the procedure. Donor and recipient demographics, surgical complications, reoperations, surgical time, and patient and graft survival with 5-year follow-up were compared between the 2 groups. RESULTS Duration of operation was shorter in the iSPK group. Recipient and donor demographics were comparable, apart from more females receiving ipsilateral graft placement. The broader female pelvis was probably the determining factor contributing to this outcome. The iSPK group included marginally younger recipients. The ipsilateral group also demonstrated a trend to improved survival of patient, pancreas, and kidney graft, at 1- and 5-year follow-up. There was no difference in complication rates between the 2 groups. CONCLUSIONS There were no significant differences in overall outcomes. iSPK is a safe procedure, which proves similar patient and graft survival as with cSPK. Both procedures have comparable surgical complication rates. iSPK is a safe and quicker procedure that allows for preservation of the contralateral side for potential subsequent transplants.

Published
2019
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49. Transperitoneal Enucleation of a Kidney Transplant Allograft Renal Cell Carcinoma.

Author

Sarantitis I, Pararajasingam R, Forgacs B, Denley H, Wood G, and Augustine T

Subjects
Allografts, Carcinoma, Renal Cell chemically induced, Carcinoma, Renal Cell immunology, Carcinoma, Renal Cell pathology, Clinical Decision-Making, Humans, Immunosuppressive Agents adverse effects, Kidney Failure, Chronic diagnosis, Kidney Neoplasms chemically induced, Kidney Neoplasms immunology, Kidney Neoplasms pathology, Male, Middle Aged, Risk Factors, Tomography, X-Ray Computed, Treatment Outcome, Carcinoma, Renal Cell surgery, Kidney Failure, Chronic surgery, Kidney Neoplasms surgery, Kidney Transplantation adverse effects, Organ Sparing Treatments
Abstract

Development of malignancy after solid-organ trans?lant is a well-known long-term complication of immunosuppressive therapy. Thus far, there are no specific oncologic recommendations regarding management of de novo tumors in transplanted kidneys. Here, we present the case of a 63-year-old male patient who developed a de novo renal cell carcinoma 6 years after the transplant procedure. The patient underwent nephron-sparing surgery with transperitoneal enucleation of the tumor. We discuss the decision-making process and the operative challenges that we faced. We conclude that this technique should be considered as a therapeutic strategy for selected patients so that transplant nephrectomy can be avoided.

Published
2018
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50. Outcome of kidney transplant with double ureter: a multicenter study.

Author

Ghazanfar A, Zaki MR, Pararajasingam R, Forgacs B, and Tavakoli A

Subjects
Adolescent, Adult, Child, Child, Preschool, Female, Graft Survival, Humans, Infant, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Stents, Treatment Outcome, Kidney Transplantation mortality, Ureter abnormalities
Abstract

Objectives: Renal transplant with double ureters is uncommon. However, with increasing numbers of en bloc and dual transplants from marginal donors, we frequently observe 2 ureters for implant. The current study reviewed our experience with 76 double-ureter renal transplants., Materials and Methods: We performed a retrospective analysis of renal transplant performed in 2 institutes from 1996 to 2011. We recorded the outcomes of renal transplants with double ureters including complications. We compared outcomes with renal transplants with single ureters., Results: Irrespective of the technique used for implant, we recorded no significant risk of complications of double, compared with single, ureter renal transplants. There were no significant differences in patient and graft survival., Conclusions: We believe that double-ureter transplant does not require additional risk discussion with the recipient because it is safe. However, when ureteral stents are used, we should ensure that a mechanism is in place for both stents to be removed postoperatively.

Published
2015

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