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"ASBTRACTPurpose: Airway complications (ACs) after living-donor lobar lung transplantation (LDLLT) could have different features from those after cadaveric lung transplantation (CLT). We conducted this study to compare the characteristics of ACs after LDLLT vs. those after CLT and investigate their impact on outcomes.Methods: We reviewed, retrospectively, data on 163 recipients of lung transplantation, including 83 recipients of LDLLT and 80 recipients of CLT.Results: The incidence of ACs did not differ between LDLLT and CLT. The initial type of AC after LDLLT was limited to stenosis in all eight patients, whereas that after CLT consisted of stenosis in three patients and necrosis in ten patients (p = 0.0034). ACs after LDLLT necessitated significantly earlier initiation of treatment than those after CLT (p = 0.032). The overall survival rate of LDLLT recipients with an AC was significantly lower than that of those without an AC (p = 0.030), whereas the overall survival rate was comparable between CLT recipients with and those without ACs (p = 0.25).Conclusion: ACs after LDLLT, limited to bronchial stenosis, require significantly earlier treatment and have a greater adverse impact on survival than ACs after CLT."

"ABSTRACTPurpose: Gastrointestinal complications after lung transplantation (LTx) are an important postoperative morbidity associated with malnutrition and the malabsorption of drugs. We reviewed our experience of managing gastrointestinal complications after LTx.Methods: Between June, 2008 and April, 2017, 160 lung transplants were performed at our institution, as living-donor lobar lung transplants in 77 patients, and as deceased-donor lung transplants in 83. We reviewed, retrospectively, the incidence, type and management of gastrointestinal complications.Results: Among the 160 LTx recipients, 58 (36.3%) suffered a collective 70 gastrointestinal complications, the most frequent being gastroparesis, followed by gastroesophageal reflux disease. Two complications were managed surgically, by Nissen fundoplication for gastroesophageal reflux disease in one recipient and Hartmann's operation for sigmoid colon perforation in one. The other 68 complications were managed medically. Two patients died of complications: one, of aspiration pneumonia caused by gastroparesis; and one, of panperitonitis caused by a gastric ulcer. There were no significant differences in overall survival or chronic lung allograft dysfunction-free survival between the patients with and those without gastrointestinal complications.Conclusions: Gastrointestinal complications are not uncommon in LTx recipients and may be serious; therefore, early detection and appropriate treatment are imperative. Surgical management is required for some complications, but most can be managed medically."

"Impaired quality of life is associated with increased mortality in patients with advanced lung disease. Using a randomized controlled trial with allocation concealment and blinded outcome assessment at 2 tertiary care teaching hospitals, the authors randomly assigned 328 patients with end-stage lung disease awaiting lung transplantation to 12 weeks of telephone-based coping skills training (CST) or to usual medical care (UMC). Patients completed a battery of quality of life instruments and were followed for up to 3.4 years to assess all-cause mortality. Compared with UMC, CST produced lower scores on perceived stress, anxiety, depressive symptoms, and negative affect and improved scores on mental health functioning, optimism, vitality, and perceived social support. There were 29 deaths (9%) over a mean follow-up period of 1.1 year. Survival analyses revealed that there was no difference in survival between the 2 groups. The authors conclude that a telephone-based CST intervention can be effectively delivered to patients awaiting lung transplantation. Despite the severity of pulmonary disease in this patient population, significant improvements in quality of life, but not somatic measures or survival to transplant, were achieved."

"Purpose: The body mass index (BMI) before lung transplantation (LT) is a benchmark of the post-LT survival. The aim of the study is to determine the BMI inadequate for the post-LT survival.Methods: We examined the survival after LT in patients grouped into the following BMI categories: <18.5 kg/m2 (underweight), 18.5-24.9 kg/m2 (normal weight), 25-29.9 kg/m2 (overweight), and ≥30.0 kg/m2 (obese) according to the World Health Organization (WHO) criteria. A more detailed categorization was made for further evaluation of the underweight group: mild (17.0 ≤ BMI < 18.5 kg/m2) and severely underweight (BMI <17.0 kg/m2).Results: There was no statistically significant difference in the post-LT survival between underweight and normal-weight patients (5-year survival: 78.7 vs. 76.1%). Patients with BMI <17.0 kg/m2 had a worse prognosis than those with 17.0 ≤ BMI < 18.5 kg/m2 (5-year survival: 70.3 vs. 90.0%).Conclusions: Standard BMI categorization per the WHO criteria is inadequate for determining the post-LT survival, especially in underweight patients. For the nutritional evaluation of underweight pre-LT patients, BMI <17.0 kg/m2 should be used instead of BMI <18.5 kg/m2."

"ABSTRACTPurposeLung transplantation is accepted as an effective modality for patients with end-stage pulmonary lymphangioleiomyomatosis (LAM). Generally, bilateral lung transplantation is preferred to single lung transplantation (SLT) for LAM because of native lung-related complications, such as pneumothorax and chylothorax. It remains controversial whether SLT is a suitable surgical option for LAM. The objective of this study was to evaluate the morbidity, mortality and outcome after SLT for LAM in a lung transplant center in Japan.MethodsWe reviewed the records of 29 patients who underwent SLT for LAM in our hospital between March, 2000 and November, 2017. The data collected included the pre-transplant demographics of recipients, surgical characteristics, complications, morbidity, mortality and survival after SLT for LAM.ResultsThe most common complication after SLT for LAM was contralateral pneumothorax (n = 7; 24.1%). Six of these recipients were treated successfully with chest-tube placement and none required surgery for the pneumothorax. The second-most common complication was chylous pleural effusion (n = 6; 20.7%) and these recipients were all successfully treated by pleurodesis. The 5-year survival rate after SLT for LAM was 79.5%.ConclusionLAM-related complications after SLT for this disease can be managed. SLT is a treatment option and may improve access to lung transplantation for patients with end-stage LAM."

"Background: living kidney donation is a safe medical procedure. Kidney function after donation is crucial for donors’ health and quality of life. Kidney hyperfiltration is a compensatory mechanism, which will preserve kidney function after unilateral nephrectomy. The number of studies regarding hyperfiltration in living kidney donors is limited. Our study aimed to explain kidney hyperfiltration mechanism and evaluate its effect on the kidney function within 30 days after surgery. Methods: our study was a prospective cohort study with 46 living-kidney donors participating in the study between April and December 2019. We evaluated main outcomes, the 30-day post-surgery kidney function, which was evaluated by calculating estimated glomerular filtration rate (eGFR) and Urinary Albumin to Creatinine Ratio (ACR). The subjects were categorized into two groups based on their 30-day outcomes, which were the adaptive (eGFR > 60 mL/min/1.73 m2 and/or ACR > 30 mg/g) and maladaptive (eGFR < 60 mL/min/1.73 m2 and/or ACR > 30 mg/g) groups. A series of evaluation including calculating the renal arterial resistive index (RI) and measuring urinary vascular endothelial growth factor (VEGF), neutrophil gelatinase-associated lipocalin (NGAL), and heparan sulfate (HS) levels were performed before surgery and serially until 30 days after surgery. Multivariate analysis with adjustments for confounding factors was done. Results: forty donors were included and mostly were female (67.5%). The average age and body mass index (BMI) were 45.85 (SD 9.74) years old and 24.36 (SD 3.73) kg/m2 , respectively. Nineteen donors (47.5%) had maladaptive hyperfiltration outcomes. The hyperfiltration process was demonstrated by significant changes in renal arterial RI, urinary VEGF, NGAL, and HS levels (p<0.005). There was no significant difference regarding RI, urinary VEGF, NGAL, and HS levels between both groups. Several confounding factors (BMI over 25 kg/m2 , familial relationship, age over 40 years old, and arterial stiffness) were significantly influenced by kidney hyperfiltration and outcomes (p<0.05). Conclusion: the hyperfiltration process does not affect the 30-day post-nephrectomy kidney function of the donors. Several other factors may influence the hyperfiltration process and kidney function. Further study is necessary to evaluate kidney function and its other related variables with a longer period of time study duration."

"BACKGROUND: kidney transplantation has been developing rapidly in Indonesia in recent years, yet data on transplants' characteristics and survival is still unavailable. In Indonesia, only living donors are permitted. Living donor are advantageous, but challenging to recruit. This study aimed to establish the graft and patient survival rates and to describe the characteristics of recipient and donor as well as the process of donor recruitment and evaluation of kidney transplantation in Indonesia.METHODS:the study was a retrospective cohort on all donors and kidney transplant recipients at Cipto Mangunkusumo General Hospital (CMGH) from January 2011 to May 2017. Only recipients from January 2011 to May 2014 were included to establish the 1-year and 3-year graft and patient survival; which were described using Kaplan-Meier method. RESULTS:data from 492 kidney transplant procedures were obtained (donor median age, 30 (17 - 66) years; 25.1% were family-related. Recipients mean age, 47 (SD 13.18 years). Data from total of 138 kidney transplant recipients were further analyzed. The 1-year death- censored graft survival, all-cause graft survival and patient survival were 92 %, 82.6 % and 87%. The 3-year death-censored graft survival, all-cause graft survival and patient survival were 90.6%, 76.1% and 79.7%. Kaplan-Meier's curve showed the highest mortality rates occured in the early months.CONCLUSION:the 1-year graft and patient survival rate were 92% and 87%. The 3-year graft and patient survival rate were 90.6% and 79.7%. Only small percentage of donor were family-related. Living donor recruitment and evaluation are still a big challenge in Indonesia.

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Latar belakang: transplantasi ginjal di Indonesia sedang berkembang pesat pada beberapa tahun terakhir, namun data mengenai karakteristik dan kesintasan transplan belum tersedia. Di Indonesia, hanya donor hidup yang diperbolehkan, namun pencarian donor ini seringkali sulit. Penelitian ini bertujuan untuk mendapatkan angka kesintasan graft dan pasien, mendeskripsikan karakteristik resipien dan donor serta proses rekrutmen dan evaluasi dari transplantasi ginjal di Indonesia.

Metode: studi dengan desain kohort retrospektif pada semua donor dan resipien di RSUPN Dr. Cipto Mangunkusumo (RSCM) Januari 2011 – Mei 2017. Hanya resipien pada Januari 2011 hingga Mei 2014 yang diikutsertakan dalam analisis kesintasan graft dan pasien 1 dan 3 tahun, datanya kemudian dideskripsikan menggunakan kurva Kaplan-Meier.

Hasil: dari 492 data transplantasi ginjal didapatkan median usia donor 30 (17-66) tahun, 25,1% diantaranya terkait hubungan saudara; rerata usia resipien 47 ± 13.18 tahun. Sebanyak 138 resipien diteliti lebih lanjut, lalu didapatkan kesintasan 1 tahun death-censored graft, all-cause graft, dan pasien sebesar 92%, 82,6 %, dan 87%. Kesintasan 3 tahun death-censored graft, all-cause graft, dan pasien sebesar 90,6%, 76,1% and 79,7%. Kurva Kaplan-Meier menunjukkan laju mortalitas tertinggi tampak pada bulan-bulan awal.

Kesimpulan: angka kesintasan 1 tahun graft dan pasien adalah 92% dan 87%, sementara kesintasan 3 tahun graft dan pasien adalah 90,6% dan 79,7%. Hanya sebagian kecil donor yang terkait keluarga. Rekrutmen dan evaluasi donor hidup masih merupakan tantangan besar di Indonesia."

"Latar belakang: Komplikasi vena hepatika merupakan komplikasi vaskular pascatransplantasi hati yang penting karena dapat mengakibatkan kongesti hati, sirosis dan kegagalan cangkok, dengan insidens lebih tinggi pada Transplantasi Donor Hidup (LDLT) dibandingkan teknik transplantasi lainnya.Tujuan: Mengetahui parameter ultrasonografi (USG) Doppler vaskular vena hepatika periode awal pascatransplantasi yang dapat berperan sebagai prediktor komplikasi vena hepatikaMetode: Penelitian dilakukan pada 44 pasien pediatrik yang menjalani LDLT di RSUPN Dr. Ciptomangunkusumo dari tahun 2010 hingga Juli 2022 yang memiliki imaging USG Doppler vaskular pada hari pertama hingga ketiga pascatransplantasi. Kecepatan dan pola gelombang vena hepatika dari USG Doppler dievaluasi pada kelompok dengan dan tanpa komplikasi vena hepatika pada tahun pertama pascatransplantasi. Nilai titik potong kecepatan vena hepatika ditentukan menggunakan receiver operating curve.Hasil: Kecepatan vena hepatika pada hari kedua pascaoperasi secara signifikan lebih rendah pada pasien dengan komplikasi vena hepatika, dengan nilai tengah 21,3 (16,6-23,3) cm/detik, dibandingkan 28,9 (10,7-75,0) cm/detik pada pasien tanpa komplikasi vena hepatika, (nilai p = 0,018). Nilai titik potong kecepatan vena hepatika hari kedua pascaoperasi dalam membedakan komplikasi dan tanpa komplikasi vena hepatika adalah 23,65 cm/detik, sensitivitas 100%, spesifisitas 76,3%, AUC 0,803 (IK95% 0,679-0,927), dan nilai p = 0,018. Tidak terdapat perbedaan proporsi pola gelombang monofasik vena hepatika antara pasien dengan komplikasi vena hepatika dibandingkan dengan pasien tanpa komplikasi vena hepatika.Kesimpulan: Kecepatan vena hepatika yang rendah pada USG Doppler vaskular periode awal pascaoperasi terutama di hari kedua dapat membantu memprediksi komplikasi vena hepatika sehingga meningkatkan kewaspadaan dini terhadap komplikasi vena hepatika pada tahun pertama pascatransplantasi.

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Background: Hepatic vein complication is an important postoperative complication in pediatric liver transplantation in which liver congestion may progress to cirrhosis and graft failure, with higher incidence in living donor liver transplantation (LDLT) compared to other liver transplantation technique.

Objective: This study aims to identify the role of Doppler ultrasound parameters of hepatic vein in early postoperative period of pediatric LDLT as predictors of hepatic vein complications.

Methods: From 2010 to July 2022, there were 44 pediatric LDLT patients in RSUPN Dr. Ciptomangunkusumo who had Doppler ultrasound imaging from first until third postoperative day. Hepatic vein velocity and waveform were compared in patients with and without hepatic vein complications in one year follow up. Cut off point of hepatic vein velocity is determined using receiver operating curve.

Results: Hepatic vein velocity in second postoperative day is significantly lower in patients with hepatic vein complication, with median of 21,3 (16,6-23,3) cm/s compared to 28,9 (10,7-75,0) cm/s in patients without hepatic vein complication (p value = 0,018), with cut off value to differentiate both group is 23,65 cm/s, sensitivity 100%, specificity 76,3%, AUC 0,803 (CI95% 0,679-0,927), and p value = 0,018. There is no difference in monophasic waveform proportion between patients with and without hepatic vein complication.

Conclusion: Lower hepatic vein velocity in early postoperative Doppler ultrasound of pediatric LDLT, especially in second postoperative day, may aid to predict hepatic vein complication in first year follow up. Such finding may increase awareness of hepatic vein complication in the first year after transplantation."

"Latar Belakang:.Donor transplantasi hati merupakan manusia yang sehat. Kualitas pelayanan transplantasi yang baik dinilai berdasarkan kualitas hidup donor dan resipien hati. Evaluasi kualitas hidup pasien donor hati sintas dan nonsintas merupakan hal yang penting untuk setiap pusat pelayan transplantasi hati.Metode: Dilakukan penilaian kualitas hidup seluruh donor hati di Rumah Sakit Cipto Mangunkusumo (RSCM) dengan mengunakan World Health Organization Quality of Life questionnaire abbreviated version (WHOQoL-BREF). Kualitas hidup donor hati dengan resipien sintas dan nonsintas dibandingkan.

Hasil: Terdapat 59 donor hati di RSCM. 3 subjek tidak bisa dihubungi, 1 subjek menolak untuk menjadi subjek penelitian. Kualitas hidup donor hati pada memiliki median domain fisik 69 (44-100), pada doman psikologis 69 (50-94), domain hubungan sosial 65 (44-100) dan domain lingkungan 69 (31-94). Tidak terdapat perbedaan bermakna antara kualitas hidup donor hati sintas dan nonsintas pada domain fisik (p=0,466), domain psikologis (p=1,00), domain hubungan social (p=0,77) dan domain lingkungan (p=0,13).

Kesimpulan: Subjek donor transplantasi hati di RSCM memiliki kualitas hidup yang baik. Tidak ada perbedaan bermakna kualitas hidup subjek donor transplantasi hati antara resipien sintas dan non sintas.

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Background: Liver donors are healthy people. The quality of liver transplantation is assessed based on the quality of life of donors and recipients. Evaluation of the quality of life of liver donors with surviving and non-surviving recipients is important for liver transplant centers.

Method: Quality of life of liver donors in RSCM was assessed using World Health Organization Quality of Life questionnaire abbreviated version (WHOQoL-BREF). The quality of life of donors with surviving and non-surviving recipients is compared.

Result: There are 59 liver donors in RSCM. Three subjects could not be contacted, one subject refused to participate in this research. Donors’ Quality of life physical domain median was 69 (44-100), psychological domain median was 69 (50-94), social relation domain median was 65 (44-100), and environmental domain median was 69 (31-94). There were no significant differences between the quality of life of donors with surviving and non-surviving recipient in physical domain (p=0,466), psychological domain (p=1,00), social relation domain (p=0,77), and environmental domain (p=0,13).

Conclusion: Liver donors in RSCM have good quality of life. There were no significant differences in quality of life of liver donors between Bedah Digestifsurviving and non-surviving liver recipients."