Endovascular salvage of thrombosed haemodialysis vascular access.

Haemodialysis access thrombosis is associated with significant morbidity and access abandonment rates, for which endovascular salvage is a well described treatment option. This study aimed to evaluate the outcomes of endovascular salvage procedures of thrombosed vascular access circuits and identify factors influencing outcomes. Retrospective review of 328 consecutive procedures performed over 10 years at our institution between January 2010 and December 2019.

Crisis Containment: Tools for Harm Mitigation in Surgery.

Background: Surgical crises represent unrecognized opportunities for improving patient safety and adding value in healthcare. The first step in a crisis response is to contain and mitigate harm. While the principles of damage control are well established in surgery, methods of containing harm on broader clinical and organizational levels are not clearly defined.

Avoid, Trap, and Mitigate: Development of an Evidence-Based Crisis Management Framework in Surgery.

Background: Increasingly, surgeons are adopting broader roles in emergency response, on both clinical and executive levels. These have highlighted the need to develop healthcare-specific crisis management systems. Cross-professional research between safety-critical industries is a valuable method for learning crisis control.

The implications of donor-recipient size mismatch in renal transplantation.

Introduction: Transplanting kidneys small for recipient's size results in inferior graft function. Body surface area (BSA) is related to kidney size. We used the BSA index (BSAi) (Donor BSA/Recipient BSA) to assess whether the renal graft size is sufficient for the recipient.

Hypoperfusion warm ischaemia time in renal transplants from donors after circulatory death.

Background: The donor hypoperfusion phase before asystole in renal transplants from donors after circulatory death (DCD) has been considered responsible for worse outcomes than those from donors after brain death (DBD).

Methods: We included 10 309 adult renal transplants (7128 DBD and 3181 DCD; 1 January 2010-31 December 2016) from the UK Transplant Registry. We divided DCD renal transplants into groups according to hypoperfusion warm ischaemia time (HWIT).

Comparison between bovine carotid artery graft and polytetrafluoroethylene graft for haemodialysis vascular access: A systematic review and meta-analysis.

Background: There is a renewed interest in using bovine carotid artery grafts for haemodialysis vascular access after recent advances in conduit manufacturing and endovascular management of access-related complications. Our aim was to summarize the results of the recent studies comparing bovine carotid artery grafts with polytetrafluoroethylene grafts as vascular access for haemodialysis.

Methods: A systematic review was conducted for original articles comparing bovine carotid artery with polytetrafluoroethylene grafts for haemodialysis vascular access published between January 2000 and December 2019 searching the databases of Medline, Scopus, Google Scholar, ClinicalTrials.

Biological Mesh Repair of a Large Incisional Hernia Containing a Kidney Transplant in the Presence of Inflammation.

The incidence of incisional hernia after kidney transplantation varies between 1.1% and 3.8%.

Comparison Between Robotic and Laparoscopic or Open Anastomoses: A Systematic Review and Meta-Analysis.

Introduction: Robotic surgery has been increasingly used in fashioning various surgical anastomoses. Our aim was to collect and analyze outcomes related to anastomoses performed using a robotic approach and compare them with those done using laparoscopic or open approaches through meta-analysis.

Methods: A systematic review was conducted for articles comparing robotic with laparoscopic and/or open operations (colectomy, low anterior resection, gastrectomy, Roux-en-Y gastric bypass (RYGB), pancreaticoduodenectomy, radical cystectomy, pyeloplasty, radical prostatectomy, renal transplant) published up to June 2019 searching Medline, Scopus, Google Scholar, Clinical Trials and the Cochrane Central Register of Controlled Trials.

UK renal transplant outcomes in low and high BMI recipients: the need for a national policy.

Introduction: We assessed the effect of recipient body mass index (BMI) on the outcomes of renal transplantation and the management of obese patients with end-stage renal disease across the UK.

Methods: We analyzed data of 25539 adult renal transplants (2007-2016) from the UK Transplant Registry. Patients were divided in BMI groups [underweight: < 18.

Utilisation of small paediatric donor kidneys for transplantation.

With the increasing need for kidney transplantation in the paediatric population and changing donor demographics, children without a living donor option will potentially be offered an adult deceased donor transplant of marginal quality. Given the importance of long-term graft survival for paediatric recipients, consideration is now being given to kidneys from small paediatric donors (SPDs). There exist a lack of consensus and a reluctance amongst some centres in transplanting SPDs due to high surgical complication rates, graft loss and concerns regarding low nephron mass and long-term function.

Outcomes in Third and Fourth Kidney Transplants Based on the Type of Donor.

Background: An increasing number of patients are requiring multiple retransplants. We assessed outcomes of third and fourth kidney transplants, to aid decision making on the most suitable donor type.

Methods: Data were collected retrospectively for 2561 transplants, including 69 third and 8 fourth, performed from 2000 to 2017.

A novel 3D-printed hybrid simulation model for robotic-assisted kidney transplantation (RAKT).

Robotic-assisted kidney transplantation (RAKT) offers key benefits for patients that have been demonstrated in several studies. A barrier to the wider uptake of RAKT is surgical skill acquisition. This is exacerbated by the challenges of modern surgery with reduced surgical training time, patient safety concerns and financial pressures.

A Re-evaluation of Discarded Deceased Donor Kidneys in the UK: Are Usable Organs Still Being Discarded?

Background: A significant proportion of procured deceased donor kidneys are subsequently discarded. The UK Kidney Fast-Track Scheme (KFTS) was introduced in 2012, enabling kidneys at risk of discard to be simultaneously offered to participating centers. We undertook an analysis of discarded kidneys to determine if unnecessary organ discard was still occurring since the KFTS was introduced.

Successful endovascular treatment of transplant intrarenal artery stenosis in renal transplant recipients: Two case reports.

Transplant renal artery stenosis (TRAS) is a relatively rare complication after renal transplantation. The site of the surgical anastomosis is most commonly involved, but sites both proximal and distal to the anastomosis may occur, as well. Angioplasty is the gold standard for the treatment of the stenosis, especially for intrarenal lesions.

Mycophenolate mofetil and sirolimus in hepatocyte transplantation in an experimental model of toxic acute liver failure.

Introduction: Hepatocyte transplantation is proposed as a solution for liver failure. The allotransplantation of hepatocytes has been studied extensively, however, graft rejection remains a major problem. The aim of the present study was to evaluate the immunosuppressive activity of mycophenolate mofetil (MMF), sirolimus, and their combination in an experimental model of hepatocyte allotransplantation in rats with acute liver failure.