Nadey Hakim

Imperial College London, Londinium, England, United Kingdom

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Publications (162)375.79 Total impact

  • Fungai Dengu · Bilal Azhar · Shaneel Patel · Nadey Hakim ·
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    ABSTRACT: Autosomal dominant polycystic disease is a multisystem inherited condition affecting the kidneys and is an important cause of end-stage renal disease. Patients with autosomal dominant polycystic disease experience symptoms related to size and cystic nature of their kidneys, which can be difficult to manage. Traditionally, the only surgical option for management was open bilateral/unilateral native nephrectomy, which carried with it significant morbidity and mortality. Therefore, it was deemed unsafe and rarely performed. However, surgery for autosomal dominant polycystic disease has evolved rapidly with the advent of minimally invasive surgery and improved medical management of end-stage renal failure patients. Laparoscopic and hand-assisted laparoscopic techniques have been adopted and have demonstrated reduced morbidity. The timing of this intervention in relation to transplant is controversial and presents a major challenge in managing this patient population.
    06/2015; 13(3):209-13. DOI:10.6002/ect.2015.0104
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    ABSTRACT: We describe a case of polytetrafluoroethylene vascular graft interposition between the internal iliac artery and the renal artery in a live-related kidney transplant. To the best of our knowledge, we present the first case in the literature that describes the salvage of a transplant kidney using this technique.
    05/2015; DOI:10.6002/ect.2014.0189
  • Bilal Azhar · Shaneel Patel · Priyanka Chadha · Nadey Hakim ·
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    ABSTRACT: Advances in transplantation led to the first renal autotransplant in 1963 performed due to high ureteral injury sustained during aortic surgery. The procedure involves excision of the kidney and autologous re-implantation. Subsequently, multiple cases of renal autotransplantation have been reported in the literature for a range of indications. This reviews aims to assess the literature and experiences reported to assess the varying indications for renal autotransplant. The evidence and literature generated from experiences in this procedure are largely limited to case reports and relatively small or moderately sized case series. The main indications reported for performing autotransplant broadly includes renovascular disease, ureteral pathology and neoplastic disease. The advent of laparoscopic techniques and their implications on renal autotransplant also are discussed. Varying degrees of success are reported with this procedure with controversial issues surrounding this procedure remain, particularly in the area of neoplastic surgery. Renal autotransplant may be a useful last resort in preventing kidney loss in highly selected circumstances and when conventional methods have failed.
    04/2015; 13(2):109-114. DOI:10.6002/ect.2014.0238
  • Hakim N · Papalois V · Epstein M ·

    02/2015; World Scientific., ISBN: 978-1-84816-246-4
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    ABSTRACT: Developments in transplantation have progressed dramatically over the past century. Current research is underway to optimize immune modulation, genetically engineering animals for xenografting, and breakthroughs are occurring in regenerative medicine. However, pioneering live-donor transplantation has transformed transplantation in the organ shortage, and these contribute an increased proportion of transplanted organs. Live-donor transplantation is associated with better long-term outcomes, and techniques to recover organs have become less invasive. We set out to examine the evolution of transplantation from its historical beginnings to the developments that make it successful today.
    Experimental and clinical transplantation: official journal of the Middle East Society for Organ Transplantation 12/2014; 13(1). DOI:10.6002/ect.2014.0258 · 0.62 Impact Factor
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    ABSTRACT: Observing graft blood supply post kidney transplantation is essential. Compromised graft perfusion must be identified without delay to preserve organ survival. Implantable probes have revolutionised the graft monitoring process in kidney transplantation leading to safe, continuous, and distinct monitoring of blood supply. The Implantable Cook-Swartz Doppler Flow Monitoring System allows immediate salvaging of a compressed kidney. The implantable Doppler probe can easily and effectively identify such cases and save the limited number of organs that are available to today's patients.
    Experimental and clinical transplantation: official journal of the Middle East Society for Organ Transplantation 10/2014; DOI:10.6002/ect.2014.0135 · 0.62 Impact Factor
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    ABSTRACT: Elongation of the right renal vein with the inferior vena cava (caval patch) using a vascular stapler offers a safe means of extending the deceased-donor right renal vein, while minimizing the ischemic time of the kidney during preparatory dissection. The aortic patch of the right renal artery also can be preserved, which minimize the danger of arterial stenosis, kinking, and dissection.
    Experimental and clinical transplantation: official journal of the Middle East Society for Organ Transplantation 09/2014; DOI:10.6002/ect.2014.0142 · 0.62 Impact Factor
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    ABSTRACT: We report a case of paratransplant hernia, a rare surgical complication of a renal transplant. It is caused by entrapment of the bowel through a defect in the peritoneum, which lines on the transplanted kidney. Careful dissection and meticulous surgical technique during transplant, closing any peritoneal defect, regardless of size, can avoid this complication. The prognosis depends on clinical suspicion, prompt diagnosis, and early surgical intervention. If strangulation occurs, the associated mortality is high.
    Experimental and clinical transplantation: official journal of the Middle East Society for Organ Transplantation 09/2014; 13(4). DOI:10.6002/ect.2014.0027 · 0.62 Impact Factor
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    ABSTRACT: Background There is no national policy for allocation of kidneys from Donation after circulatory death (DCD) donors in the UK. Allocation is geographical and based on individual/regional centre policies. We have evaluated the short term outcomes of paired kidneys from DCD donors subject to this allocation policy. Methods Retrospective analysis of paired renal transplants from DCD’s from 2002 to 2010 in London. Cold ischemia time (CIT), recipient risk factors, delayed graft function (DGF), 3 and 12 month creatinine) were compared. Results Complete data was available on 129 paired kidneys.115 pairs were transplanted in the same centre and 14 pairs transplanted in different centres. There was a significant increase in CIT in kidneys transplanted second when both kidneys were accepted by the same centre (15.5 ± 4.1 vs 20.5 ± 5.8 hrs p < 0.0001 and at different centres (15.8 ± 5.3 vs. 25.2 ± 5.5 hrs p = 0.0008). DGF rates were increased in the second implant following sequential transplantation (p = 0.05). Conclusions Paired study sequential transplantation of kidneys from DCD donors results in a significant increase in CIT for the second kidney, with an increased risk of DGF. Sequential transplantation from a DCD donor should be avoided either by the availability of resources to undertake simultaneous procedures or the allocation of kidneys to 2 separate centres.
    BMC Nephrology 05/2014; 15(1):83. DOI:10.1186/1471-2369-15-83 · 1.69 Impact Factor
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    ABSTRACT: In this study, we analyze the outcomes of transplant renal artery stenosis (TRAS), determine the different anatomical positions of TRAS, and establish cardiovascular and immunological risk factors associated with its development. One hundred thirty-seven of 999 (13.7%) patients had TRAS diagnosed by angiography; 119/137 (86.9%) were treated with angioplasty, of which 113/137 (82.5%) were stented. Allograft survival in the TRAS+ intervention, TRAS+ nonintervention and TRAS- groups was 80.4%, 71.3% and 83.1%, respectively. There was no difference in allograft survival between the TRAS+ intervention and TRAS- groups, p = 0.12; there was a difference in allograft survival between the TRAS- and TRAS+ nonintervention groups, p < 0.001, and between the TRAS+ intervention and TRAS+ nonintervention groups, p = 0.037. TRAS developed at the anastomosis, within a bend/kink or distally. Anastomotic TRAS developed in living donor recipients; postanastomotic TRAS (TRAS-P) developed in diabetic and older patients who received grafts from deceased, older donors. Compared with the TRAS- group, patients with TRAS-P were more likely to have had rejection with arteritis, odds ratio (OR): 4.83 (1.47-15.87), p = 0.0095, and capillaritis, OR: 3.03 (1.10-8.36), p = 0.033. Patients with TRAS-P were more likely to have developed de novo class II DSA compared with TRAS- patients hazard ratio: 4.41 (2.0-9.73), p < 0.001. TRAS is a heterogeneous condition with TRAS-P having both alloimmune and traditional cardiovascular risk factors.
    American Journal of Transplantation 01/2014; 14(1):133-43. DOI:10.1111/ajt.12531 · 5.68 Impact Factor
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    ABSTRACT: To see if: (i) a large vessel aortocaval vascular patch technique may bring about long-term graft survival after allogeneic uterine transplantation (UTn) in a rabbit model; and (ii) fertility can be achieved following natural mating post-allogeneic UTn. Allogeneic uterine cross transplantations were performed in New Zealand white rabbits using an aortocaval macrovascular patch harvested as part of the uterine allograft. Five rabbit recipients received a uterine graft from five unrelated donor rabbits. All female rabbits were unrelated and were of proven fertility with at least one previous litter each. Tacrolimus was administrated for immunosuppression post-transplant. Natural mating was attempted if long-term survival had been achieved. The main outcome measures were: (i) long-term recipient survival; (ii) long-term adequate uterine perfusion; and (iii) successful pregnancy post-UTn. All five recipient animals survived the surgery with satisfactory immediate postoperative recovery. Recipients 1, 2 and 4 died within the first 4 postoperative days. Both long-term survivors failed to conceive following introduction of a proven male breeder despite evidence of mating. Necropsy at 9 and 11 months showed a lack of patency of uterine cornua at the point of anastomosis, albeit a small uterus in recipient 3 and a reddish brown amorphous material at the site of the transplanted uterus in recipient 5. We have demonstrated the feasibility of uterine allotransplantation using a macrovascular patch technique, but could not demonstrate conception because of blocked cornua. To address this, we propose using embryo transfer techniques in order to achieve conception.
    Journal of Obstetrics and Gynaecology Research 12/2013; 40(3). DOI:10.1111/jog.12256 · 0.93 Impact Factor
  • Samir Damji · Angela Atinga · David Hakim · Nadey Hakim ·
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    ABSTRACT: The routine use of ureteric stents after a kidney transplant for prophylactic measures is debatable. Concerns have been raised regarding the potential complications and costs of routine stenting. Here, we review the literature based on studies in favor of and against the routine placement of ureteric stents in kidney transplant patients. Some studies have shown a benefit to patients who have routine stents placed, while others have not shown this benefit but have highlighted the associated financial implications. The decision to stent renal transplant patients will depend on robust multicenter, randomized controlled trials being carried out, as well as both short-term and long-term cost analyses.
    02/2013; 11(2). DOI:10.6002/ect.2012.0270
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    Shaneel R.H. Patel · David Hakim · John Mason · Nadey Hakim ·
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    ABSTRACT: Background: Surgical intervention is now the most effective modality with which to treat severe obesity. There is currently a lack of minimally invasive technology with which we can effectively treat obesity and reverse type 2 diabetes mellitus. The EndoBarrier is a fluoropolymer sleeve that is reversibly fixated to the duodenal bulb and extends 80 cm into the small bowel, usually terminating in the proximal jejunum. This endoscopically inserted device aids weight loss through malabsorption and activating hormonal triggers. Methods: We conducted a nonsystematic review on worldwide articles published on the MEDLINE database to ascertain progress in the development and use of the EndoBarrier. Results: Most studies used 12-week excess weight loss (EWL) as a primary outcome measure with results ranging from 11.9%-23.6%. One study to date used 52-week EWL as its primary measure with a significant outcome of 47%. Our group has seen this technology cause significant weight loss, resolution of type 2 diabetes mellitus, and improvement in cardiovascular risk factor profile. Conclusions: The EndoBarrier shows promise in the surgical weight loss arena. This review article summarizes the technical aspects of this new technology, provides preliminary efficacy results, and introduces the roles it may play in the future of bariatric surgery.
    Surgery for Obesity and Related Diseases 02/2013; 74(4). DOI:10.1016/j.soard.2013.01.015 · 4.07 Impact Factor
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    ABSTRACT: Objectives: To satisfy donor organ shortage, overweight and obese donors are becoming a greater proportion of the kidney donor pool. Although good safety data exist in overweight and moderately obese individuals (body mass index = 25 to 35 kg/m²), there is little information about outcomes in morbidly obese donors (body mass index ≥ 40 kg/m²). The purpose of this study was to review the experience with morbidly obese donors in a single center and assist in the discussion about the feasibility of nephrectomy in such cases. Materials and methods: Outcomes of nephrectomy in morbidly obese donors between January 2005 and June 2010 were reviewed retrospectively and compared with outcomes in nonobese donors. Results: Of 386 nephrectomies, 7 involved morbidly obese donors. Mortality and major complication rates were low in all body mass index categories. A high incidence of minor postoperative complications was observed in the morbidly obese, with 57% morbidly obese patients requiring treatment for complications including respiratory infection, compared with 30% in nonobese donors (P < .05). There were no significant differences in mean operative time, estimated blood loss, and length of hospital stay between all body mass index categories. Limited follow-up data (mean, 20 mo) showed similar renal function parameters between groups. Conclusions: The limited data suggest that nephrectomy may be feasible in selected morbidly obese donors. Further study is needed before major conclusions can be made.
    12/2012; 10(6):579-585. DOI:10.6002/ect.2012.0079
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    A M Ali · P Rajagoppal · A Sayed · N Hakim · T David · P Papalois ·
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    ABSTRACT: Renal cell carcinoma (RCC) is considered a contraindication for transplant. However, an increasing number of cases of transplant kidneys with RCC have been reported with encouraging results. We present our experience of two cases of transplanting kidneys with small RCCs. Donors and recipients were aware of the presence and possible consequences of RCC in the transplanted kidney before transplantation. Cases were discussed in the multidisciplinary team meetings. Regular, 6-12 monthly follow-up of donors and recipients was carried out with ultrasonography and/or computed tomography to detect recurrence of RCC or new tumours in the recipients' transplant kidneys or the donors' native kidneys. The outcome was recorded. There were no suspicious masses in the any of the kidneys during the follow-up period. The transplant kidneys are functioning.
    Annals of The Royal College of Surgeons of England 09/2012; 94(6):e189-90. DOI:10.1308/003588412X13373405384738 · 1.27 Impact Factor
  • Shaneel R Patel · John Mason · Nadey Hakim ·

    Indian Journal of Surgery 08/2012; 74(4):275-277. DOI:10.1007/s12262-012-0721-3 · 0.26 Impact Factor
  • Shaneel R Patel · Nadey Hakim ·
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    ABSTRACT: Pancreatic transplant effectively cures type 1 diabetes mellitus and maintains consistent long-term euglycemia. However, technical failure, and in particular graft thrombosis, accounts for the vast majority of transplants lost in the early postoperative period. The pancreas' inherently low microvascular flow state makes it vulnerable to vascular complications, as does the hypercoagulable blood of diabetic patients. Ultimately, the phenomenon is most definitely multifactorial. Prevention, as opposed to treatment, is key and should focus on reducing these multiple risk factors. This will involve tactical donor selection, optimal surgical technique and some form of anticoagulation. Close monitoring and early intervention will be crucial when treating thrombosis once preventative methods have failed. This may be achieved by further anticoagulation, graft salvage, or pancreatectomy with retransplant. This article will explore the multiple factors contributing to graft thrombus formation and the ways in which they may be addressed to firstly prevent, or more likely, reduce thrombosis. Secondly, we will consider the management strategies which can be implemented once thrombosis has occurred.
    06/2012; 10(3):282-9. DOI:10.6002/ect.2012.0003
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    ABSTRACT: Increasing demand for donor kidneys, in parallel with trends toward more elderly and obese populations, make it important to continuously review donor pool inclusion criteria. Acceptance of elderly and obese living donors remains controversial, with a higher incidence of comorbidity and the greater risk of postoperative complications sighted as reasons for caution. Drawing on our center's experience, we aim to determine whether older age and obesity are in fact associated with greater perioperative risk, and longer term complications in donors undergoing nephrectomy. Three hundred eighty-three living donor nephrectomies conducted at one of the United Kingdom's largest transplant units over the last 5 years were stratified into groups according to age and body mass index. Perioperative endpoints and postdonation follow-up data collected at 6-to-12-monthly intervals were analyzed and compared. No significant differences in operative parameters, including operative time and estimated blood loss, were reported between groups. Rates of early postoperative complications were not significantly different, although subgroup analysis showed a higher incidence of respiratory complications at the extremes of obesity (body mass index ≥ 40 kg/m²). On follow-up, renal function parameters showed significant change postnephrectomy, but between-group variation was not significant. Mortality and major complication rates were comparably low in all groups of study. In our unit's experience, nephrectomy in selected donors who may otherwise have been precluded from participation on account of their age or weight, is feasible and associated with perioperative and longer term outcomes comparable with their younger nonobese counterparts. It provides a basis for informed consent of "extended criteria" donors.
    Transplantation 04/2012; 93(11):1158-65. DOI:10.1097/TP.0b013e31824ef1ae · 3.83 Impact Factor
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    ABSTRACT: Incentives for organ donation, currently prohibited in most countries, may increase donation and save lives. Discussion of incentives has focused on two areas: (1) whether or not there are ethical principles that justify the current prohibition and (2) whether incentives would do more good than harm. We herein address the second concern and propose for discussion standards and guidelines for an acceptable system of incentives for donation. We believe that if systems based on these guidelines were developed, harms would be no greater than those to today's conventional donors. Ultimately, until there are trials of incentives, the question of benefits and harms cannot be satisfactorily answered.
    American Journal of Transplantation 02/2012; 12(2):306-12. DOI:10.1111/j.1600-6143.2011.03881.x · 5.68 Impact Factor

  • BMJ (online) 11/2011; 343(nov14 1):d7300. DOI:10.1136/bmj.d7300 · 17.45 Impact Factor

Publication Stats

2k Citations
375.79 Total Impact Points


  • 2011-2015
    • Imperial College London
      • Institute of Reproductive and Developmental Biology
      Londinium, England, United Kingdom
  • 2006-2014
    • Ealing, Hammersmith & West London College
      Londinium, England, United Kingdom
  • 1996-2014
    • Imperial College Healthcare NHS Trust
      Londinium, England, United Kingdom
  • 2005
    • NYU Langone Medical Center
      New York, New York, United States
  • 2004
    • The Queen Elizabeth Hospital
      Tarndarnya, South Australia, Australia
  • 2001-2004
    • WWF United Kingdom
      Londinium, England, United Kingdom
    • Azienda Ospedaliera San Gerardo
      Monza, Lombardy, Italy
  • 2002
    • CHU de Lyon - Groupement Hospitalier Edouard Herriot
      Lyons, Rhône-Alpes, France
  • 2000
    • St. Marys Medical Center
      West Palm Beach, Florida, United States
  • 1997
    • University of Leuven
      Louvain, Flanders, Belgium
  • 1994-1997
    • University of Minnesota Duluth
      Duluth, Minnesota, United States