Papers by Andrzej Baranski
American Journal of Transplantation, 2006
Auxiliary liver transplantation (ALT) is a treatment for acute liver failure when regeneration of... more Auxiliary liver transplantation (ALT) is a treatment for acute liver failure when regeneration of the native liver is possible or for metabolic disorders. In selected cases ALT and orthotopic liver transplantation (OLT) have similar survival when ALT is performed in the orthotopic position (auxiliary partial orthotopic liver transplantation, APOLT). Drawback of ALT with portal vein to portal vein anastomosis is the frequent occurrence of thrombosis, compromising both graft and native liver, and the necessity of a significant resection. To avoid division of portal flow we performed ALT with an end-to-end anastomosis between the graft portal vein and the left renal vein of the recipient (reno-portal ALT, REPALT). The hepatic artery was anastomosed to the aorta using an iliac arterial graft conduit. The bile duct was anastomosed to the stomach. In the two cases presented here excellent immediate graft function occurred with rapid regeneration of the graft and without early vascular complications.
Transplant international : official journal of the European Society for Organ Transplantation, Jan 19, 2016
Between March 2012 and August 2013, 591 quality forms were filled out for abdominal organs in the... more Between March 2012 and August 2013, 591 quality forms were filled out for abdominal organs in the Netherlands. In 133 cases (23%), there was a discrepancy between the evaluation from the procuring and transplanting surgeons. Injuries were seen in 148 (25%) organs of which 12 (2%) led to discarding of the organ: one of 133 (0.8%) livers, five of 38 (13%) pancreata and six of 420 (1.4%) kidneys (P < 0.001). Higher donor BMI was a risk factor for procurement-related injury in all organs (OR: 1.06, P = 0.011) and donor after cardiac death (DCD) donation in liver procurement (OR: 2.31, P = 0.034). DCD donation is also associated with more pancreata being discarded due to injury (OR: 10.333, P = 0.046). A higher procurement volume in a centre was associated with less injury in pancreata (OR = -0.95, P = 0.013) and kidneys (OR = -0.91, P = 0.012). The quality form system efficiently monitors the quality of organ procurement. Although there is a relatively high rate of organ injury, the ...
Transplantology, 2020
Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common hereditary disorde... more Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common hereditary disorders. Once progressed to end-stage renal disease, kidney transplantation may be needed. Whether and when to perform a (bilateral) native nephrectomy in case of end-stage renal failure are issues under debate. At our institution, with a growing number of living kidney donations, the general trend is to perform a native nephrectomy prior to transplantation. Our aim was to compare the outcomes of this approach to a nephrectomy during or after transplantation and to compare our findings to results reported in the literature. Data were prospectively collected from all ADPKD patients undergoing native nephrectomy and kidney transplantation at the Leiden University Medical Center between 2000–2017. A literature search was performed in the PubMed and Scopus databases. The clinical results were retrospectively reviewed and were stratified according to the timing of the nephrectomy. From the literat...
Transplant International, 2013
Dear Sirs, The success of pancreas transplantation has led to an increased number of pancreas tra... more Dear Sirs, The success of pancreas transplantation has led to an increased number of pancreas transplantations, which again has led to an increased need for suitable pancreas allografts. This initiated a search for alternative ways to increase the number of pancreas donors. Donation-aftercirculatory-determination-of-death (DCDD) is such an alternative and is a recognized form of transplantation with regard to kidney, liver, and lung transplantation. However, there is limited experience with DCDD in pancreas transplantation [1–6]. A large study with Scientific Registry of Transplant Recipients (SRTR) data showed DCDD-status to have a marginally significant risk (HR 1.39; P = 0.10) compared with a donation-after-brain-death (DBD)-donor [1]. Nevertheless, similar patient survival and graft survival rates between DBD and DCDD-groups at 1-year, 5-years [2,3,6], and even 10-years follow-up [5] have been reported. Results describe higher rate of renal complications such as delayed graft function (DGF) or urinary tract infections [2,3] after DCDD transplantation, however, there were no higher rates in pancreas-related complications [2,5]. Interestingly, these reports are always with rather short 1st warm ischemia times (WITs), ranging from 14 min [4] to 21 min [5]. Within the Eurotransplant region DCDD is only performed in Austria, Belgium, and The Netherlands. In February 2011, the first DCDD pancreas transplantation within the Eurotransplant region was performed in our center. Since then four more DCDD pancreas transplantations were performed. All five allografts were procured from DCDD-donors in The Netherlands. Pancreas allografts were matched and offered via Eurotransplant. Donor, transplant, and recipient characteristics are shown in the Table 1. HTK perfusion-fluid was used in all procedures. All patients were treated with alemtuzumab (Campath) induction-therapy and maintained on duo therapy, consisting of tacrolimus and mycophenalate mofetil. At 1-year follow-up all recipients are alive with optimally functioning pancreas and kidney allografts. There were no perioperative complications. Three pancreas allografts were enteric-drained and two were initially bladder-drained and converted to enteric drainage afterward, according to a two-step protocol [7]. All patients had immediate pancreas function, measured as peroperative lowering of the blood glucose levels, and, except for the fourth recipient, all SPKpatients had immediate kidney function, measured as peroperative diuresis. There were a few long-term complications: the first patient developed moderate interstitial and vascular rejection after 3 months, which was treated with antirejection therapy consisting of methylprednisolone. The third recipient developed a hematoma near the pancreas allograft, for which he was reoperated twice. After 2 months this recipient developed acute kidney insufficiency because of a ureteral stricture caused by a renal BK-infection, for which he was reoperated and reinsertion of the ureter to the bladder was performed. After lowering the immunosuppressive therapy, this recipient developed an interstitial rejection episode of the kidney, which was treated with methylprednisolone. The fourth recipient had a DGF of the kidney, for which he was treated with dialysis on days 2, 3, 4, and 6 postoperatively. After 6 weeks, a CT-scan showed a distal, partial venous thrombosis in the splenic vein, for which anticoagulant therapy (coumarine) was started liberally. The fifth recipient showed acute respiratory insufficiency because of a rhinovirus-infection 2 days after the operation, for which he was shortly admitted to the intensive care unit (ICU). HbA1c-values at 3-months follow-up were normal (mean of 32.6 mmol/mol) and most recent values are still within the normal ranges for all patients. Most of the postoperative complications our recipients experienced are not necessarily directly related to DCDD-allografts. Only DGF of the kidney in the fourth recipient is seen more often after DCDD transplantation [2,3,5]. Although DCDD pancreas transplantation is not a new concept worldwide, only few reports of pancreas transplantation using allografts from DCDD-donors have been published [1–5]. Within Europe, UK-Transplant has the largest series of DCDD pancreas transplantation [8], with
American Journal of Transplantation, 2007
We describe the first cases of reuse of auxiliary liver grafts for orthotopic transplantation in ... more We describe the first cases of reuse of auxiliary liver grafts for orthotopic transplantation in chronic liver disease. A reduced liver graft (segments 2, 3, half of 4) was first transplanted auxiliary for acute liver failure using a new technique. After regeneration of both native liver and graft, the auxiliary graft was removed and immunosuppression discontinued in the first recipients. After informed consent of donors and recipients, both auxiliary grafts were then orthotopically transplanted into second recipients. Both grafts function normally. Reuse of auxiliary grafts may help to reduce the shortage or liver grafts available for transplantation.
Transplant International, 2013
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Papers by Andrzej Baranski