Nadey Hakim

Imperial College London, Londinium, England, United Kingdom

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Publications (100)156.77 Total impact

  • [Show abstract] [Hide abstract]
    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; · 0.59 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; · 0.59 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; · 0.59 Impact Factor
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    ABSTRACT: 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.
    BMC Nephrology 05/2014; 15(1):83. · 1.64 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. · 6.19 Impact Factor
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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.
    Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 02/2013;
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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; · 4.12 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.
    Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 12/2012; 10(6):579-585.
  • 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.
    Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 06/2012; 10(3):282-9.
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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. · 3.78 Impact Factor
  • BMJ (online) 11/2011; 343:d7300. · 17.22 Impact Factor
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    ABSTRACT: Immunosuppressive regimens for kidney transplantation which reduce the long-term burden of immunosuppression are attractive, but little data are available to judge the safety and efficacy of the different strategies used. We tested the hypothesis that the simple, cheap, regimen of alemtuzumab induction combined with tacrolimus monotherapy maintenance provided equivalent outcomes to the more commonly used combination of interleukin-2 receptor monoclonal antibody induction with tacrolimus and mycophenolate mofetil combination maintenance, both regimens using steroid withdrawal after 7 days. One hundred twenty-three live or deceased donor renal transplant recipients were randomized 2:1 to receive alemtuzumab/tacrolimus or daclizumab/tacrolimus/mycophenolate. The primary endpoint was survival with a functioning graft at 1 year. Both regimens produced equivalent, excellent outcomes with the primary outcome measure of 97.6% in the alemtuzumab arm and 95.1% in the daclizumab arm at 1 year (95% confidence interval of difference 6.9% to -1.7%) and at 2 years 92.6% and 95.1%. Rejection was less frequent in the alemtuzumab arm with 1- and 2-year rejection-free survival of 91.2% and 89.9% compared with 82.3% and 82.3% in the daclizumab arm. There were no significant differences in terms of the occurrence of opportunistic infections. Alemtuzumab induction with tacrolimus maintenance monotherapy and short-course steroid use provides a simple, safe, and effective immunosuppressive regimen for renal transplantation.
    Transplantation 08/2011; 92(7):774-80. · 3.78 Impact Factor
  • Jeremy Crane, Nadey Hakim
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    ABSTRACT: After a kidney transplant, surveillance of the graft blood supply is crucial. Any delay in detecting compromised graft perfusion affects organ survival. Current practice uses Doppler ultrasound to monitor vessel patency and graft perfusion and is performed repeatedly after kidney and pancreas transplant. We have used an implantable probe that allows for easy vessel attachment and safe, continuous, audible monitoring of vascular anastomoses. It has been used to observe microvascular tissue transplants, free flaps, and pediatric liver transplants, but as yet, it has not been used to monitor kidney allografts. We feel a transplanted kidney could benefit greatly from continuous blood flow monitoring. To assess the feasibility of the probe in a renal transplant patient, we used the probe in 15 consecutive transplant recipients. Only 1 Doppler ultrasound was ordered during the 15 admissions compared with scans that are routinely ordered. There were no complications and all probes were removed easily. This probe can identify transplanted organs that are threatened owing to flagging or cessation of the blood supply, and allow for immediate intervention. This technique may save precious organs. Further controlled studies are needed to assess the use of the probe in routine clinical practice.
    Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 04/2011; 9(2):118-20.
  • P Rajagopal, N Hakim
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    ABSTRACT: This study assesses the use of microporous hemospheres (hemoStase) procedures to control bleeding and reduce associated unfavorable sequelae in live donor nephrectomy (LDN). Forty-four consecutive patients who underwent LDN between January 2009 and August 2009 were included in this prospective study. HemoStase (CryoLife, Inc), Kennesaw, Georgia) was used topically in the kidney bed to avoid bleeding. We recorded intraoperative and postoperative bleeding control, re-exploration to control bleeding, surgical site fluid collection, infection, and postoperative wound complications. Hemostasis was achieved in all 44 (100%) patients, none of whom experienced postoperative bleeding, fluid collection, infection or required re-exploration of the surgical site. HemoStase is a safe, facile hemostatic agent that effectively controls bleeding and reduces associated postoperative complications in LDN cases.
    Transplantation Proceedings 03/2011; 43(2):424-6. · 0.95 Impact Factor
  • E Aboutaleb, E Leen, N Hakim
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    ABSTRACT: The main concern in pancreas transplantation is potential thrombosis of the graft due to poor perfusion. To assess the viability of the pancreas before transplantation by using contrast-enhanced ultrasound scan (CEUS). Ten harvested pancreatas were studied using an iU22 (Philips, Bothell, USA) scanner together with an L9-3 linear probe for the CEUS. The ultrasound contrast agent SonoVue (Bracco spa, Milan), which is a commercially available second-generation microbubble-based agent, can be visualized in real time at low acoustic pressure (mechanical Index of 0.06). Prior to transplantation, the pancreas is placed in Via Span solution (Bristol-Mayer Squibb AB, Bromma, Sverige). Baseline conventional scale sonography is first performed to assess the parenchyma, which appears as homogenous soft tissue. The donor pancreas arterial supply is cannulated (16 gauge) and infused with Via Span solution. Two milliliters of SonoVue is slowly injected and the pancreas is scanned using the low MI nonlinear imaging mode to visualize the microbubbles enhancement of the pancreas to ensure uniform perfusion of the whole organ. Perfusion was scored visually (0 to 5) subjectively by two observers. Four grafts were not transplanted for different reasons. Lack of a recipient was the cause in one case with a high score (case 1). Cases 4 and 5 were turned down based on clinical evaluation, and arterial thrombosis was the cause in case 7. The last three cases showed a low mean perfusion score of 1.2. Of the six transplanted pancreatas, the four, that were successfully transplanted displayed a mean perfusion score of 4, compared with a mean score of 1.5 for the two cases who suffered rejection following transplantation. CEUS offers the potential to assess the perfusion of the pancreas transplant preoperatively, which may improve the selection criteria and potentially impact the outcomes of transplantation.
    Transplantation Proceedings 03/2011; 43(2):418-21. · 0.95 Impact Factor
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    ABSTRACT: The aim of this article is to compare different mini-incision donor nephrectomy techniques in the literature. We did a literature search using PUBMED using the search term "donor nephrectomy." We compared different surgical techniques using different parameters like length of incision, length of operation, pain medications required after the operation, site of the operation, and intraoperative and postoperative complications. We found 7 different surgical techniques of mini-invasive donor nephrectomy. Hakim and associates described the smallest initial incision size of 4 cm. There also are limited data on the analgesia requirements in 4 of the series, and 3 series that describe the requirements vary. These techniques offer advantages and disadvantages to the donor and the kidney. We hope to encourage further work. Ideally, there must be a working discussion, long-term outcomes of donor kidney and recipient, as well as accurate pain records, both quantitative and qualitative, and a discussion of time to mobilization.
    Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 09/2010; 8(3):189-95.
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    ABSTRACT: To determine operative parameters and complications, using a modified approach to mini-incision living donor nephrectomy. Three hundred fifty-nine consecutive living donor procedures were performed between October 2000 and November 2008 using the finger-assisted, mini-incision living donor nephrectomy. Patient demographics, intraoperative parameters, and postoperative complications were prospectively recorded, including operative time, blood loss, incision length, warm ischemia time, and intraoperative adverse events. Mean donor age was 44.2 +/- 12.3 years (range, 21-75 years), with an average body mass index of 28.2 +/- 5.3 kg/m(2) (range, 17.1-44.9 kg/m(2)). Right-sided donor nephrectomies were performed on 23 patients (6%), and 41 donors (11%) were found to have multiple renal arteries. Median incision length was 6.8 cm (range, 3.5-15 cm). Average operative time was 117 minutes (range, 50-265 minutes), with a median blood loss of 109 mL (range, 20-500 mL) and an average warm ischemia time of 4.5 minutes (range, 1.5-10 minutes). Four patients (1%) required perioperative blood transfusions. There were no other intraoperative complications, no patients required reexploration, and there were no donor deaths. Thirteen patients (4%) developed minor postoperative complications, including two incisional herniae, but no patients developed chronic wound pain, over a median follow-up period of 19 months (range, 2-97 months). This prospective series demonstrated that a modified approach to open mini-incision nephrectomy can result in a smaller incision length while maintaining patient safety, with few postoperative complications.
    Transplantation Proceedings 01/2010; 42(1):165-70. · 0.95 Impact Factor
  • Transplantation 01/2010; 90. · 3.78 Impact Factor
  • Transplantation 01/2010; 90. · 3.78 Impact Factor
  • Experimental and clinical transplantation: official journal of the Middle East Society for Organ Transplantation 01/2009; 6(4):245-8. · 0.59 Impact Factor

Publication Stats

460 Citations
156.77 Total Impact Points

Institutions

  • 2011–2014
    • Imperial College London
      Londinium, England, United Kingdom
  • 2013
    • Royal Free London NHS Foundation Trust
      Londinium, England, United Kingdom
  • 2007–2013
    • Imperial College Healthcare NHS Trust
      Londinium, England, United Kingdom
  • 2012
    • William Harvey Research Institute
      Londinium, England, United Kingdom
  • 2008
    • University of Birmingham
      Birmingham, England, United Kingdom
    • Ealing, Hammersmith & West London College
      Londinium, England, United Kingdom
  • 2006–2008
    • Athens State University
      Athens, Alabama, United States
  • 2006–2007
    • The Bracton Centre, Oxleas NHS Trust
      Дартфорде, England, United Kingdom
  • 2003–2004
    • WWF United Kingdom
      Londinium, England, United Kingdom