Select Utilization of Obese Donors in Living Donor Liver Transplantation: Implications for the Donor Pool

Moss, Jonah R; Lapointe-Rudow, Dianne; Renz, John F.; Kinkhabwala, Milan; Dove, Lorna; Gaglio, Paul J.; Emond, Jean C.; Brown, Robert S.

doi:10.1111/j.1600-6143.2005.01124.x

Cited by 43 publications

(35 citation statements)

References 26 publications

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“…In a study on donors, Moss et al collected the postoperative data of living liver donors to assess the influence of obesity (BMI > 30 kg/m 2 ) on post‐explant wound complications. They found a significantly higher incidence of wound infections in donors with higher BMIs, but no increase in the rate of wound hernias and no affect on mortality (54). With a few exceptions, the majority of evaluative studies on the role of BMI and obesity in wound complication have shown that obesity, especially BMI over 30 kg/m 2 , has a very strong influence on the occurrence of wound healing problems, and this effect may even be escalated with more potent IS regimens.…”

mentioning

confidence: 99%

Wound complications following kidney and liver transplantation

Mehrabi¹,

Fonouni²,

Wente³

et al. 2006

Clinical Transplantation

149

126

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Advances in surgical techniques and immunosuppression (IS) have led to an appreciable reduction in postoperative complications following transplantation. However, wound complications as probably the most common type of post-transplantation surgical complication can still limit these improved outcomes and result in prolonged hospitalization, hospital readmission, and reoperation, consequently increasing overall transplant cost. Our aim was to review the literature to delineate the evidence-based risk factors for wound complications following kidney and liver transplantation (KTx, LTx), and to present the preventive and therapeutic modalities for this bothersome morbidity. Generally, wound complications are categorized as superficial and deep wound dehiscences, perigraft fluid collections and seroma, superficial and deep wound infections, cellulitis, lymphocele and wound drainage. The results of several studies showed that the most important risk factors for wound complications are IS and obesity. Additionally, there are surgical and/or technical factors, including type of incision, reoperation, and surgeon's expertise, as well as comorbidities such as advanced age, diabetes mellitus, malnutrition, and uremia. Preventive management of wound complications necessitates defining their etiological factors so that their detrimental effects on healing processes can be addressed and reduced. IS modalities and agents, especially sirolimus (SRL), and steroids (ST) should be adjusted according to the patient's co-existing risk factors. SRL should be administered three months after transplantation and ST should be tapered as soon as possible. A body mass index (BMI) lower than 30 kg/m2 is advisable for inclusion in a transplantation program, but higher BMIs do not exclude recipients. Surgical risk factors can be prevented by applying precise surgical techniques. Therapeutic modalities must focus on the most efficient and cost-effective medications and/or interventions to facilitate and improve wound healing.

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mentioning

confidence: 99%

Wound complications following kidney and liver transplantation

Mehrabi¹,

Fonouni²,

Wente³

et al. 2006

Clinical Transplantation

149

126

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“…Similar to other centres, 28–31 methods to improve access and utilization of donor livers are evident at the ANLTU. Although there has been a greater proportion of utilization of the deceased donor offers in recent years, it is concerning to find that the overall number of deceased organ offers for LTx is not increasing.…”

Section: Discussionmentioning

confidence: 95%

Increasing liver transplantation waiting list mortality: a report from the Australian National Liver Transplantation Unit, Sydney

Prakoso

Verran

Dilworth

et al. 2010

Internal Medicine Journal

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“…However, in emergency transplantations, lower ratios such as 0.6 have been used successfuly. In previous studies conducted on donor morbidity, the main points of discussion were MHV harvesting, age, steatosis and per cent remnant volume 12–18 . The effects of volume calculation based on body weight in donors as is the case for the recipient were not analyzed.…”

Section: Discussionmentioning

confidence: 99%