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Living Donation in the News / Genetic evaluation of living kidney donor candidates: Review and...best practice

« Last post by Clark on September 10, 2023, 05:58:23 PM »

https://www.amjtransplant.org/article/S1600-6135(23)00305-2/fulltext

COMPREHENSIVE REVIEW| VOLUME 23, ISSUE 5, P597-607, MAY 2023

Genetic evaluation of living kidney donor candidates: A review and recommendations for best practices

Christie P. Thomas †

Reem Daloul †
Krista L. Lentine

Neetika Garg
Brian K. Lee ‡
Yasar Caliskan ‡
et al.

American Journal of Transpalntation
Published:February 28, 2023
DOI:https://doi.org/10.1016/j.ajt.2023.02.020

Abstract
The growing accessibility and falling costs of genetic sequencing techniques has expanded the utilization of genetic testing in clinical practice. For living kidney donation, genetic evaluation has been increasingly used to identify genetic kidney disease in potential candidates, especially in those of younger ages. However, genetic testing on asymptomatic living kidney donors remains fraught with many challenges and uncertainties. Not all transplant practitioners are aware of the limitations of genetic testing, are comfortable with selecting testing methods, comprehending test results, or providing counsel, and many do not have access to a renal genetic counselor or a clinical geneticist. Although genetic testing can be a valuable tool in living kidney donor evaluation, its overall benefit in donor evaluation has not been demonstrated and it can also lead to confusion, inappropriate donor exclusion, or misleading reassurance. Until more published data become available, this practice resource should provide guidance for centers and transplant practitioners on the responsible use of genetic testing in the evaluation of living kidney donor candidates.

Living Donation Forum / September 2023 Living Organ Donor Anniversaries

« Last post by Clark on September 05, 2023, 09:09:01 PM »

The wheel of the year turns again, summer fades as the daylight shortens, and classrooms and offices, whether downtown or at home, fill up. Harvest time is ‘round the corner.

Remember with us this wonderful collection of folks who have enduring reasons to take stock every September. Donors and recipients, family, friends, strangers. Add your own: https://livingdonorsonline.org/donor-experiences/donation-anniversaries/

Personally, my imagination pulls me toward Christine, the surgical teams, and the family gathered two days after 9/11. All those in 2001 and since have some complex feelings in September. I started on my path to donation that same day, 9/13/2001, getting my first blood draw at the Brigham, where all this started.

Best wishes all, truly, whatever time has done to your memories of extraordinary altruism. We are thinking of you.

Thirty-second anniversary:
Lee donated a kidney to his father on September 11th, 1991

Thirtieth anniversary:
Rory Eckmann donated part of his liver to his niece, Megan, on September 7th, 1993

Twenty-third anniversary:
Cindy Leuty Jones donated a kidney to her brother on September 20th, 2000

Twenty-second anniversary:
Becky Bailey donated a kidney to her daughter, Brittney, on September 5th, 2001
Christine donated a kidney to a stranger on September 13th, 2001
Suzanne Hunter donated a kidney to her son, Ian, on September 17th, 2001. The graft failed four years later and Ian has been back on dialysis.
Marcia Pitlor donated a kidney to her brother on September 18th, 2001
Irene Lewis donated a kidney to her husband's ex's daughter on September 19th, 2001

Twenty-first anniversary:
The Reverend Ronda L. Hawkins donated a kidney to one of her parishioners on September 4th, 2002
Brandi Wittman donated a kidney to a co-worker on September 25th, 2002
Wendy Miller donated a kidney to her sister on September 25th, 2002
Joe Zangara donated a kidney to his mother, Audrey, on September 30th, 2002

Twentieth anniversary:
Beth Wilson donated a kidney to her mother, Lola, on September 16th, 2003
Clay donated a kidney to a stranger on September 26th, 2003
Christopher Yanakos donated part of his liver to his mother on September 28th, 2003

Nineteenth anniversary:
Joyce A. Falsey donated a kidney to a stranger on September 7th, 2004
Emalene Englestad donated a kidney to her sister-in-law on September 9th, 2004
Nancy Foster donated part of her liver to her brother on September 13th, 2004
Debbie Petway donated a kidney to her father, Melvin, on September 21st, 2004
Shelby Humberg Richardson donated a kidney to her brother on September 22nd, 2004

Eighteenth anniversary:
Chaya Lipschutz donated a kidney to a stranger in September 2005
Cindy Fox donated part of her liver to her husband, Victor, on September 1st, 2005
Jenn donated a kidney to her brother on September 20th, 2005
Lisa Branting donated a kidney to her best friend's husband on September 25th, 2005
Suzanne Weiner donated a kidney to a friend on September 26th, 2005
Lillie donated a kidney to an unrelated recipient on September 27th, 2005
Rose Crawford donated a kidney to her brother on September 30th, 2005

Seventeenth anniversary:
Janice Kost donated a kidney to her nephew on September 5th, 2006
Christina Dobosiewicz donated a kidney to her stepfather, John Fattorusso, now deceased, on September 6th, 2006
Kelvin Hockstock donated a kidney to his wife on September 8th, 2006
Kathie Jackson donated a kidney to Ken Singer, no relation, on September 26th, 2006
Malkah Buchweitz donated a kidney to her brother on September 28th, 2006

Sixteenth anniversary:
Kimberly Hill donated a kidney to her brother, Tim Edgar, on September 5th, 2007
Kim Alice donated a kidney to her stepfather on September 12th, 2007
Ray Vidic donated a kidney to his friend, Troy Kahklen, on September 13th, 2007
Stacey Canas donated a kidney to her best friend's mom on September 13th, 2007
Gabrielle Benson donated a kidney to her husband on September 24th, 2007

Fifteenth anniversary:
Ailey donated a kidney to a church associate on September 16th, 2008
Carmen Spanglers donated a kidney to her friend's husband on September 22nd, 2008
Diane donated a kidney to her brother-in-law, Mark, on September 23rd, 2008
Margaret Florence donated a kidney to her cousin on September 23rd, 2008
Krystal Star Garcia donated a kidney to her husband, Manuel, on September 24th, 2008
Jill Andahazy donated a kidney to her husband's cousin Katie on September 25th, 2008
Carla Giampaglia donated a kidney to an unrelated person on September 26th, 2008
Angi Kaltenbach donated a kidney to a friend on September 30th, 2008
Jeff Hill donated a kidney to Eric Miller on September 30th, 2008
Tammy Stickney donated a kidney to her father on September 30th, 2008

Fourteenth anniversary:
Tom Stalsitz donated a kidney to his friend, Joseph R. Brugger, on September 4th, 2009
Cathleen Aliberti donated part of her liver to her sister, Maureen Manning, on September 9th, 2009
Melissa Foskett Goleno donated a piece of her liver to her then 12 year old niece on September 10th, 2009
Leonard Spogis donated part of his liver to his brother-in-law, Michael Olson, on September 23rd, 2009
Terri O'Brien donated her left kidney to her cousin's wife on September 29th, 2009

Thirteenth anniversary:
Julie Coronel donated a kidney to her husband, Ruben, on September 7th, 2010
Brett Hartmann donated a kidney to a friend's son on September 18th, 2010
Andria donated a kidney to her son, Daniel, on September 28th, 2010
George Taniwaki made a non-directed kidney donation on September 10th 2010

Twelfth anniversary:
Michelle Wortman donated a kidney to her sister on September 1st, 2011
Jeff Smith made a non-directed kidney donation on September 5th, 2011
Tori Neese Bergstrom donated "Billy the Kidney" to her friend on September 6th, 2011
Angela Stimpson became a non-directed kidney donor on September 22nd, 2011

Eleventh anniversary:
Pam donated part of her liver to her brother, Edwin Dudley, on September 4th, 2012
Sue donated a kidney to her husband, Jeff, on September 4th, 2012
Sara Stallings donated a kidney to her son, Mac Yeida, on September 12th, 2012
Dawn donated a kidney to her daughter, Mandy, on September 27th, 2012

Tenth anniversary:
Brian Hartung donated a kidney to his brother, Brad, on September 9th, 2013
Sally Obrien donated a kidney to her friend, Sally Busset, on September 18th, 2013
Patty Hogan Jack donated part of her liver to her sister on September 24th, 2013
Terry Hunter made a non-directed kidney donation on September 30th, 2013

Eighth anniversary:
Julianne Bancroft made a non-directed kidney donation on September 16th, 2015
Archie White donated a kidney to his daughter, Carrie, on September 30th, 2015

Seventh anniversary:
Susan Huizenga donated a kidney to Buddi Subba, found through their church bulletin, on September 12th, 2016
Natasha Richards donated a kidney to her step-father, Bernardo Bermudez, on September 20th, 2016

Fourth anniversary:
Constance M. Smith made a non-directed donation to Connie Cull on September 27th 2019

Using the Message Board / Re: MOVED: Be aware, the entire world reads our forums!

« Last post by Clark on August 02, 2023, 08:18:22 PM »

Hello, all!

I wish this thread wasn't still relevant. I'm adding this here as this update is due to the changes we made nearly a decade ago.

Please be aware, as part of our vigilance against sellers, brokers, and scammers, we delete completely inactive accounts one year after they've been created. If you've ever posted, even once, and that post wasn't pulled by one of us for violating our acceptable use policy so egregiously we had no other lesser action we could choose, your post(s) all stay up as long as we can keep the site up.

I've tried to do wellness checks from time to time of long time frequent posters who've gone silent. Long timers, newer folks, how are you? Well, I hope! Take good care, all!

Living Donation Forum / August 2023 Living Organ Donation Anniversaries

« Last post by Clark on August 02, 2023, 08:03:20 PM »

We are a hopeful lot, aren’t we? Hope that our actions can make a difference, as so few opportunities in this life so allow us to think. Lives are changed by what we attempt, directly, radically, one by one, and massively through family, friends, and media stories. There are the sad notes to remember this month, as always, but even they, before the event, were brought about with hope on all sides.

Take care wherever this August 2023 finds you, whatever your circumstances. Twenty years ago, when I donated a kidney to an acquaintance, my one daughter had just had her thirteenth birthday. Now she’s the eldest of three, and made me Grandpa JoJo. I never dared hope for the joy my life now brings me.

Every one of these folks have their own stories of family, love, friends, acquaintances, and folks literally unknown, never met, never likely to meet. Though I did once meet someone who had donated after reading the Newsweek article about my donation…

Best wishes, all!

Fifty-sixth anniversary:
Theodore Charles Lombard donated a kidney to his daughter on August 30th, 1967

Forty-third anniversary:
Julie Edmonds donated a kidney to her sister, Susan Martin, on August 21st, 1980

Thirty-first anniversary:
Patrick M. Emmett donated a kidney to his ex-wife on August 28th, 1992

Twenty-ninth anniversary:
Donna Luebke donated a kidney to her sister on August 26th, 1994

Twenty-fifth anniversary:
Michael McGhee donated a kidney to his son, Michael, on August 25th, 1998

Twenty-fourth anniversary:
Lisa Weisenberger donated a kidney to her brother, Chad, on August 5th, 1999

Twenty-third anniversary:
Rita Kocian (deceased 2/12/04) donated a kidney to her mother in August, 2000
Ellen donated part of her liver to her cousin on August 8th, 2000
Laurie donated part of her liver to her cousin on August 8th, 2000
Walter E Kitter donated a kidney to his friend, Roger Kohlhoff, on August 21st, 2000
Myron Thirtle donated a kidney to his father on August 31st, 2000. His father survived 10 years until succumbing to cancer in 2010

Twenty-second anniversary:
Katherine Coe donated a kidney to a friend on August 8th, 2001

Twenty-first anniversary:
Kristin Barnes donated part of her liver to her father on August 29th, 2002

Twentieth anniversary:
Chuck Swartout donated part of his liver to his stepsister on August 5th, 2003
Julie donated a kidney to her brother on August 20th, 2003
Bruce Dobben donated a kidney to a friend on August 27th, 2003
Kevin Rodgers donated a kidney to a friend on August 29th, 2003

Nineteenth anniversary:
Carolyn Ambrose donated a kidney to her husband on August 4th, 2004
Ana Mora donated a kidney to her cousin on August 7th, 2004
Jennifer Leigh McGuinn donated a kidney to her father on August 10th, 2004
Michele Moeller donated a kidney and bone marrow to an unrelated person she found on LDO! on August 10th, 2004
Alfonso Gaspar became a bone marrow donor to a young child on August 12th, 2004
Jayne Kavanagh donated bone marrow to an internationally matched recipient on August 12th, 2004
Amber D. Murray donated a kidney to her brother on August 17th, 2004

Eighteenth anniversary:
Amber Allen donated a kidney to her cousin on August 9th, 2005
Amber Billings donated a kidney to her cousin on August 10th, 2005
Janet Saulter-Hemmer donated a kidney to her friend, Jim Morgenland, on August 18th, 2005

Seventeenth anniversary:
Jennifer donated a kidney to her father on August 1st, 2006
Ruth Spang donated a kidney to her father, James, on August 3rd, 2006
Lana J. James donated a kidney to her cousin on August 30th, 2006

Sixteenth anniversary:
Tammy Pigion donated part of her liver to her son on August 2nd, 2007
Melanie Hubbard donated a kidney to her friend, Dale Nix, on August 10th, 2007
Amy Covert donated a kidney to a friend on August 15th, 2007
Marsha Moran donated a kidney to her spouse, James, on August 15th, 2007
Matthew Lynette donated a kidney to his brother, Andrew, on August 15th, 2007
Katherine Howe donated part of her liver to her husband, David, on August 20th, 2007

Fifteenth anniversary:
Melissa Swanson donated a kidney to a stranger met on LDO on August 5th, 2008
Marybeth Marshall donated a kidney to her brother on August 12th, 2008
John Tran donated part of his liver to his wife, Christine, on August 14th, 2008
Lonnie Howell donated a kidney to a stranger who had become a close friend by the time of donation on August 19th, 2008
Kayla Asher donated a kidney to her cousin, Julie Mitchell, on August 20th, 2008
Dominion Giventer gave part of his liver to his 1 year old nephew on August 29th, 2008

Fourteenth anniversary:
Marian Mamayek donated a kidney to her friend, Sharlene Bender, on August 6th, 2009
Tania Eggleston donated a kidney to her Dad on August 11th, 2009
Carleen Dickerson donated a kidney to her cousin on August 12th, 2009
Patricia Roussin donated a kidney to Anthony Lopez, an unrelated person, on August 12th, 2009
Rabbi Ephraim Simon donated a kidney to a stranger on August 13th, 2009
Lessa Ennis donated a kidney to an unrelated person, Lee Kingery, on August 25th, 2009
Patti Bartlett donated a kidney to her brother, Mark Manwar, on August 26th, 2009

Thirteenth anniversary:
Samantha Perouty donated her left kidney to her uncle on August 2nd, 2010
Stacie Brane donated a kidney to her sister, Kristie Goade, on August 12th, 2010

Twelfth anniversary:
Avis Lynch donated a kidney to her mother, Winnetta F. Guthrie, on August 10th, 2011
John made a non-directed kidney donation on August 11th, 2011
Rick made a non-directed kidney donation that started an open chain with 17 donor-recipient pairs so far on August 15th, 2011
David Lieu donated a kidney to his twin brother, Michael, on August 23rd, 2011
Jodi Dykstra donated a kidney to her father on August 23rd, 2011
Melinda Stern donated a kidney to her sister, Kristine Brenneman on August 31st, 2011

Eleventh anniversary:
Cathy May donated a kidney to her friend, Amy Gray Light, on August 16th, 2012
Jennifer Ross made a non-directed kidney donation on August 16th, 2012
Jeannette Myers-Whitney donated a kidney to a stranger on August 23rd, 2012, as a paired donation to benefit her husband, Rod
Kim Merrell made an anonymous, non-directed kidney donation on August 30th, 2012

Tenth anniversary:
Margaret Koppelman donated a kidney on August 7th, 2013
Linda donated a kidney to Priscilla's mom, Karen, on August 16th, 2013

Ninth anniversary:
Joshua Davies donated a kidney anonymously on August 8th, 2014
Corey Zaretsky donated a kidney to his brother, Matthew, on August 14th, 2014

Eighth anniversary:
Elle Gillum donated part of her liver to her dad, Dean Toney, on August 12th, 2015

Seventh anniversary:
Diana Castillo donated a kidney to her friend, German Alech, on August 31st, 2016

Fifth anniversary:
Danielle DiMartino donated a kidney to a stranger on August 2nd, 2018
Kelly Thoele donated a kidney to Minh Le, the fiancé of a former employee on August 23rd, 2018

Third anniversary:
Annette donated a kidney to Hailey, her future daughter-in-law, on August 22, 2020

Living Donation in the News / Evaluating a unique enhanced recovery protocol in laparoscopic donor nephrectomy

« Last post by Clark on August 02, 2023, 05:22:37 PM »

https://onlinelibrary.wiley.com/doi/abs/10.1111/ctr.15051?campaign=wolearlyview

Evaluating a unique enhanced recovery protocol in laparoscopic donor nephrectomy: A single center experience

Clinical Transplantation
Early View
Online Version of Record before inclusion in an issue
Samuel W. Atherton, Michael S. Massey, Tho Nguyen, David W. Wang, Kathirvel Subramaniam, Eman Abdelwahid, Ahmed Bahnaswy, Michael S. Trostler, Manuel Lombardero … See all authors
First published: 19 June 2023 https://doi.org/10.1111/ctr.15051

Abstract
Introduction
Enhanced recovery after surgery (ERAS) protocols have been associated with a reduction in opioid consumption and a hastening in recovery in abdominal surgery. However, their impact on laparoscopic donor nephrectomy (LDN) has not been fully elucidated. The aim of this study is to evaluate opioid consumption and other relevant outcome measures before and after implementation of a unique LDN ERAS protocol.
Methods
244 LDN patients were included in this retrospective cohort study. Forty-six underwent LDN prior to implementation of ERAS, whereas 198 patients received ERAS perioperative care. The primary outcome was daily oral morphine equivalent (OME) consumption averaged over the entire postoperative stay. Due to removal of preoperative oral morphine from the protocol partway through the study period, the ERAS group was further subdivided into morphine recipients and non-recipients for subgroup analysis. Secondary outcomes included the incidence of postoperative nausea and vomiting (PONV), length of stay, pain scores, and other relevant measures.
Results
ERAS donors consumed significantly fewer average daily OMEs than Pre-ERAS donors (21.5 vs. 37.6, respectively; p < .0001). There were no statistically significant differences in OME consumption between morphine recipients and non-recipients. The ERAS group experienced less PONV (44.4% requiring one or more rescue antiemetic postoperatively, vs. 60.9% of Pre-ERAS donors; p = .008).
Conclusions
A protocol pairing lidocaine and ketamine with a comprehensive approach to preoperative PO intake, premedication, intraoperative fluid management and postoperative pain control is associated with reduced opioid consumption in LDN.

Living Donation in the News / Social network interventions to reduce race disparities in living kidney donatio

« Last post by Clark on August 02, 2023, 05:19:36 PM »

https://onlinelibrary.wiley.com/doi/full/10.1111/ctr.15064?campaign=wolearlyview

Social network interventions to reduce race disparities in living kidney donation: Design and rationale of the friends and family of kidney transplant patients study (FFKTPS)

Clinical Transplantation
Early View
Online Version of Record before inclusion in an issue
Jonathan Daw, Ashton M. Verdery, Selena E. Ortiz, Rhiannon Deierhoi Reed, Jayme E. Locke, Robert R. Redfield III, David Kloda, Michel Liu, Heather Mentsch, Deirdre Sawinski … See all authors
First published: 03 July 2023 https://doi.org/10.1111/ctr.15064

Abstract
Introduction
Racial/ethnic disparities in living donor kidney transplantation (LDKT) are a persistent challenge. Although nearly all directed donations are from members of patients’ social networks, little is known about which social network members take steps toward living kidney donation, which do not, and what mechanisms contribute to racial/ethnic LDKT disparities.
Methods
We describe the design and rationale of the Friends and Family of Kidney Transplant Patients Study, a factorial experimental fielding two interventions designed to promote LKD discussions. Participants are kidney transplant candidates at two centers who are interviewed and delivered an intervention by trained center research coordinators. The search intervention advises patients on which social network members are most likely to be LKD contraindication-free; the script intervention advises patients on how to initiate effective LKD discussions. Participants are randomized into four conditions: no intervention, search only, script only, or both search and script. Patients also complete a survey and optionally provide social network member contact information so they can be surveyed directly. This study will seek to enroll 200 transplant candidates. The primary outcome is LDKT receipt. Secondary outcomes include live donor screening and medical evaluations and outcomes. Tertiary outcomes include LDKT self-efficacy, concerns, knowledge, and willingness, measured before and after the interventions.
Conclusion
This study will assess the effectiveness of two interventions to promote LKD and ameliorate Black-White disparities. It will also collect unprecedented information on transplant candidates’ social network members, enabling future work to address network member structural barriers to LKD.

Living Donation in the News / How...websites of...US centers address the risks of living kidney donation

« Last post by Clark on August 02, 2023, 05:17:19 PM »

https://onlinelibrary.wiley.com/doi/full/10.1111/ctr.15054?campaign=wolearlyview

How the websites of high-volume US centers address the risks of living kidney donation

Clinical Transplantation
Early View
Online Version of Record before inclusion in an issue
Robert W. Steiner, Walter Glannon
First published: 03 July 2023 https://doi.org/10.1111/ctr.15054

Abstract
Background
The websites of US transplant centers may be a source of information about the renal risks of potential living kidney donors.
Methods
To include only likely best practices, we surveyed websites of centers that performed at least 50 living donor kidney transplants per year. We tabulated how risks were conveyed regarding loss of eGFR at donation, the adequacy of long-term ESRD risk data, long-term donor mortality, minority donor ESRD risk, concerns about hyperfiltration injury versus the risk of end-stage kidney diseases, comparisons of ESRD risks in donors to population risks, the increased risks of younger donors, an effect of the donation itself to increase risk, quantifying risks over specific intervals, and a lengthening list of small post-donation medical risks and metabolic changes of uncertain significance.
Results
While websites had no formal obligation to address donor risks, many offered abundant information. Some conveyed OPTN-mandated requirements for counseling individual donor candidates. While actual wording often varied, there was general agreement on many issues. We occasionally noted clear-cut differences among websites in risk characterization and other outliers.
Conclusions
The websites of the most active US centers offer insights into how transplant professionals view living kidney donor risk. Website content may merit further study.

Living Donation in the News / Single versus multiple renal arteries in living donor kidney transplantation

« Last post by Clark on August 02, 2023, 05:13:20 PM »

https://onlinelibrary.wiley.com/doi/abs/10.1111/ctr.15069?campaign=wolearlyview

Single versus multiple renal arteries in living donor kidney transplantation: A systematic review and patient-level meta-analysis

Clinical Transplantation
Early View
Online Version of Record before inclusion in an issue

Ee Jean Lim, Khi Yung Fong, Jingqiu Li, Yiong Huak Chan, Edwin Jonthan Aslim, Lay Guat Ng, Valerie Huei Li Gan
First published: 06 July 2023 https://doi.org/10.1111/ctr.15069
Ee jean Lim and Khi Yung Fong are the co-first authors.

Abstract
Introduction
Grafts with multiple renal arteries (MRAs) were historically considered a relative contraindication to transplantation due to the higher risk of vascular and urologic complications. This study aimed to evaluate graft and patient survival between single renal artery (SRA) and MRA living-donor kidney transplants.
Methods
An electronic literature search was conducted on PubMed, EMBASE, and Scopus for prospective or retrospective studies comparing SRA versus MRA in living donor renal transplantation, with the provision of Kaplan–Meier curves for recipient overall survival (OS) or graft survival (GS). A graphical reconstructive algorithm was used to obtain OS and GS of individual patients, which was then pooled under random-effects individual patient data (IPD) meta-analysis using Cox-models to determine hazard ratios (HRs) and 95% confidence intervals (CIs). Meta-regression of baseline covariates versus HRs of OS and GS was performed for variables reported in 10 or more studies.
Results
Fourteen studies were retrieved, of which 13 (8400 patients) reported OS and 9 (6912 patients) reported GS. There were no significant differences in OS (shared-frailty HR = .94, 95%CI = .85–1.03, p = .172) or GS (shared-frailty HR = .95, 95%CI = .83–1.08, p = .419) between SRA and MRA. This comparison remained non-significant even when restricted to open- or laparoscopic-only studies. Meta-regression yielded no significant associations of GS with donor age, recipient age, and percentage of double renal arteries within the MRA arm.
Conclusions
The similar rates of GS and OS between MRA and SRA grafts suggest that there is no need for discrimination between the two when evaluating donors for nephrectomy.

Living Donation in the News / Advances and innovations in LDLT techniques, matching and surgical training

« Last post by Clark on August 02, 2023, 05:10:49 PM »

https://onlinelibrary.wiley.com/doi/abs/10.1111/ctr.14968?campaign=woletoc

Advances and innovations in living donor liver transplant techniques, matching and surgical training: Meeting report from the living donor liver transplant consensus conference

Mark Sturdevant, Swaytha Ganesh, Benjamin Samstein, Elizabeth C. Verna, Manuel Rodriguez-Davalos, Vineeta Kumar, Marwan Abouljoud, Oya Andacoglu, Medhat Askar, Dieter Broering … See all authors
First published: 11 April 2023 https://doi.org/10.1111/ctr.14968Citations: 1
Mark Sturdevant and Swaytha Ganesh are co-first authors.
Nazia Selzner Sukru Emre are co-senior authors.

Abstract
The practice of LDLT currently delivers limited impact in western transplant centers. The American Society of Transplantation organized a virtual consensus conference in October 2021 to identify barriers and gaps to LDLT growth, and to provide evidence-based recommendations to foster safe expansion of LDLT in the United States. This article reports the findings and recommendations regarding innovations and advances in approaches to donor-recipient matching challenges, the technical aspects of the donor and recipient operations, and surgical training. Among these themes, the barriers deemed most influential/detrimental to LDLT expansion in the United States included: (1) prohibitive issues related to donor age, graft size, insufficient donor remnant, and ABO incompatibility; (2) lack of acknowledgment and awareness of the excellent outcomes and benefits of LDLT; (3) ambiguous messaging regarding LDLT to patients and hospital leadership; and (4) a limited number of proficient LDLT surgeons across the United States. Donor-recipient mismatching may be circumvented by way of liver paired exchange. The creation of a national registry to generate granular data on donor-recipient matching will guide the practice of liver paired exchange. The surgical challenges to LDLT are addressed herein and focuses on the development of robust training pathways resulting in proficiency in donor and recipient surgery. Utilizing strong mentorship/collaboration programs with novel training practices under the auspices of established training and certification bodies will add to the breadth and depth of training.

Living Donation in the News / A survey of transplant providers regarding attitudes, barriers, and facilitators

« Last post by Clark on August 02, 2023, 05:08:20 PM »

https://onlinelibrary.wiley.com/doi/abs/10.1111/ctr.14967?campaign=woletoc

A survey of transplant providers regarding attitudes, barriers, and facilitators to living donor liver transplantation in the United States

AnnMarie Liapakis, Uchenna Agbim, Therese Bittermann, Mary Amanda Dew, Yanhong Deng, Geliang Gan, Sukru Emre, Heather F. Hunt, Kim M. Olthoff, Jayme E. Locke … See all authors
First published: 20 March 2023 https://doi.org/10.1111/ctr.14967Citations: 1
AnnMarie Liapakis and Uchenna Agbim are co-first authors.

Abstract
Introduction
A successful living donor liver transplant (LDLT) is the culmination of a multifaceted process coordinated among key stakeholders.
Methods
We conducted an electronic survey of US liver transplant (LT) centers (August 26, 2021–October 10, 2021) regarding attitudes, barriers, and facilitators of LDLT to learn how to expand LDLT safely and effectively in preparation for the American Society of Transplantation Living Donor Liver Transplant Consensus Conference.
Results
Responses were received from staff at 58 programs (40.1% of US LT centers). There is interest in broadening LDLT (100% of LDLT centers, 66.7% of non-LDLT centers) with high level of agreement that LDLT mitigates donor shortage (93.3% of respondents) and that it should be offered to all suitable candidates (87.5% of respondents), though LDLT was less often endorsed as the best first option (29.5% of respondents). Key barriers at non-LDLT centers were institutional factors and surgical expertise, whereas those at LDLT centers focused on waitlist candidate and donor factors. Heterogeneity in candidate selection for LDLT, candidate reluctance to pursue LDLT, high donor exclusion rate, and disparities in access were important barriers.
Conclusion
Findings from this study may help guide current and future expansion of LDLT more efficiently in the US. These efforts require clear and cohesive messaging regarding LDLT benefits, engagement of the public community, and dedicated resources to equitably increase LDLT access.