Frank Dor

Imperial College Healthcare NHS Trust · Division of Renal Medicine and Transplantation

Background: Minimally invasive live donor nephrectomy has become a fully implemented and accepted procedure. Donors have to be well educated about all risks and details during the informed consent process. For this to be successful, more information regarding short-term outcome is necessary. Methods: A literature search was performed; all studie...

Background: Whether vascular multiplicity should be considered as contraindication and therefore 'extended donor criterion' is still under debate. Methods: Data from all live kidney donors from 2006-2013 (n = 951) was retrospectively reviewed. Vascular anatomy as imaged by MRA, CTA or other modalities was compared with intraoperative findings. F...

Introduction Informed consent is mandatory for all (surgical) procedures, but it is even more important when it comes to living kidney donors undergoing surgery for the benefit of others. Donor education, leading to informed consent, needs to be carried out according to certain standards. Informed consent procedures for live donor nephrectomy vary...

Whether overweight or obese end stage renal disease (ESRD) patients are suitable for renal transplantation (RT) is often debated. The objective of this review and meta-analysis was to systematically investigate the outcome of low versus high BMI recipients after RT. Comprehensive searches were conducted in MEDLINE OvidSP, Web of Science, Google Sch...

As the organ shortage increases, inherently the demand for donor kidneys continues to rise. Thus, live kidney donation is essential for increasing the donor pool. In order to create successful expansion, extended criteria live kidney donors should be considered. This review combines current guidelines with all available literature in this field, tr...

Introduction Short-term fasting protects against renal ischemia reperfusion injury (IRI). mTOR signaling is downregulated and may be involved in its protective effect. Rapamycin is considered a possible mimetic as it inhibits the mTOR-pathway. This study examines the effect of rapamycin on renal IRI. Methods Mice were divided in four groups : Ad li...

Kidney transplantation (KT) is the preferred kidney replacement therapy (KRT) for suitable patients with end-stage kidney disease (ESKD). Donor kidneys could be from a deceased donor (DD) or a living donor (LD). LD kidney transplantation (LDKT) is preferred over DD kidney transplantation (DDKT), because of superior quality kidneys that result in im...

Background The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey , a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on...

The rates of live kidney donation (LKD) are increasing worldwide and surgical techniques in live donor nephrectomy (LDN) are evolving in response to this demand. This chapter describes current techniques in this field and highlights their respective safety profiles. Particular attention is drawn to geographical variations and the reasons underpinni...

Background Burnout is endemic in surgeons in the UK and linked with poor patient safety and quality of care, mental health problems, and workforce sustainability. Mechanisms are required to facilitate the efficient identification of burnout in this population. Multi-item measures of burnout may be unsuitable for this purpose owing to assessment bur...

Background: Kidney transplantation in older people has increased, however older transplant recipients experience mixed outcomes that invariably impacts on their quality of life. The increased vulnerability of older end stage kidney disease patients to frailty and cognitive impairment, may partially explain the differences in outcomes observed. The...

Background: The emergence and attendant mortality of vaccine-induced immune thrombocytopenia and thrombosis (VITT) as a consequence of vaccination against severe acute respiratory syndrome coronavirus 2 have resulted in some patients with VITT being considered as deceased organ donors. Outcomes after kidney transplantation in this context are poor...

Following the publication of the original article [1], the author name “Dragos Serban” under The WSES COVID-19 emergency surgery survey collaboration group was incorrectly written as “Dragos Seban” instead of “Dragos Serban”. The original article has been corrected.

The Covid-19 pandemic caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2) has faced the transplant community with unprecedented clinical challenges in a highly vulnerable patient category. These were associated with many uncertainties for patients and healthcare professionals and prompted many ethical debates regarding safe del...

Ethnic disparities in the outcomes after simultaneous pancreas kidney (SPK) transplantation still exist. The influence of ethnicity on the outcomes of pancreas transplantation in the UK has not been reported and hence we aimed to investigate our cohort. A retrospective analysis of all pancreas transplant recipients ( n = 171; Caucasians = 118/Black...

Background Kidney transplantation in older people has increased, however older transplant recipients experience mixed outcomes that invariably impacts on their quality of life. The increased vulnerability of older end stage kidney disease patients to frailty and cognitive impairment may partially explain the differences in outcomes observed. The Ki...

Barriers to accessing home dialysis became a matter of life and death for many patients with kidney failure during the COVID-19 pandemic. Peritoneal Dialysis (PD) is the more commonly used home therapy option. This paper provides a comprehensive analysis of PD catheter insertion procedures as performed around the world today, barriers impacting tim...

BACKGROUND Gigantism, characterized by excessive growth and height is due to increased secretion of growth hormone, most commonly from a pituitary adenoma. In addition to the surgical and anesthetic complexity, the extreme stature of these patients presents a unique challenge for kidney transplantation in deciding whether to proceed with a single o...

Clinical teams understandably wish to minimise risks to living kidney donors undergoing surgery, but are often faced with uncertainty about the extent of risk, or donors who wish to proceed despite those risks. Here we explore how these difficult decisions may be approached and consider the conflicts between autonomy and paternalism, the place of s...

Main Problem: Preemptive kidney transplantation (PKT) is performed prior to dialysis initiation to avoid dialysis-related morbidity and mortality in children and adolescents. We undertook a systematic review to compare clinical outcomes in PKT versus kidney transplantation after dialysis initiation in paediatric patients. Methods: The bibliographic...

Studies have been carried out to investigate the effect of a prolonged cold ischaemia time (CIT) on the outcomes of living donor kidney transplantation (LDKT). There is no clear consensus in the literature about the effects of CIT on LDKT outcomes, and therefore, we performed a systematic review and meta-analysis to provide evidence on this subject...

Social media (SoMe) is now widely accepted and used in medicine and considered a measure of scholarly output to support academic advancement at some institutions (1–4). In the field of transplantation, SoMe platforms, such as Twitter and Facebook, have been leveraged to promote both living and deceased donation, and for public engagement and outrea...

Background: Informed consent for living kidney donation is paramount, as donors are healthy individuals undergoing surgery for the benefit of others. The informed consent process for living kidney donors is heterogenous, and the question concerns how well they are actually informed. Knowledge assessments, before and after donor education, can form...

The organ shortage and the increasing demand for organs are universal, worldwide challenges. Health literacy is a powerful tool that can help to increase awareness about organ donation and transplantation on a large scale and to encourage and sustain support for organ donation. The unique perspectives, experiences, and expectations of medical stude...

In kidney transplantation (KTx), renal graft thrombosis (RGT) is one of the main reasons for early graft loss. Although evidence-based guidance on prevention of RGT is lacking, thromboprophylaxis is widely used. The aim of this survey was to obtain a European view of the different thromboprophylactic strategies applied in KTx. An online 22-question...

Objectives: The disruption to surgical training and medical education caused by the global COVID-19 pandemic highlighted the need for realistic, reliable, and engaging educational opportunities available outside of the operating theatre and accessible for trainees of all levels. This paper presents the design and development of a virtual reality c...

Background Surgeon burnout has implications for patient safety and workforce sustainability. The aim of this study was to establish the prevalence of burnout among surgeons in the UK during the COVID-19 pandemic. Methods This cross-sectional online survey was set in the UK National Health Service and involved 601 surgeons across the UK of all spec...

Introduction: Aorto-iliac vascular disease (AVD) is frequently found during the workup for kidney transplantation. However, recommendations on screening and management are lacking. We aimed to assess differences in screening, management, and acceptance of these patients for transplantation by performing a survey among transplant surgeons. Second,...

bstract: Herein, we performed a meta-analysis of published clinical outcomes of corona virus dis�ease 2019 (COVID-19) in hospitalized kidney transplant recipients. A systematic database search was conducted between 1 December 2019 and 20 April 2020. We analyzed 48 studies comprising 3137 kidney transplant recipients with COVID-19. Fever (77%), coug...

Herein, we performed a meta-analysis of published clinical outcomes of corona virus disease 2019 (COVID-19) in hospitalized kidney transplant recipients. A systematic database search was conducted between 1 December 2019 and 20 April 2020. We analyzed 48 studies comprising 3137 kidney transplant recipients with COVID-19. Fever (77%), cough (65%), d...

Objective: To assess the impact of cold ischaemia time (CIT) on living donor kidney transplantation (LDKT) outcomes in the UK living kidney sharing scheme (UKLKSS) versus outside the scheme. Background: LDKT provides the best treatment option for end-stage kidney disease (ESKD) patients. ESKD patients with an incompatible living donor still have...

As SARS-CoV-2 vaccines have started to be rolled out, a key question facing transplant units has been whether listing for transplantation should be contingent on recipients having received a vaccine. We aimed to provide an ethical framework when considering potential transplant candidates who decline vaccination. We convened a working group compris...

Live donor kidney transplantation (LDKT) is the optimal treatment modality for end stage renal disease (ESRD), enhancing patient and graft survival. Pre-emptive LDKT, prior to requirement for renal replacement therapy (RRT), provides further advantages, due to uraemia and dialysis avoidance. There are a number of potential barriers and opportunitie...

Background. The rapidly evolving novel coronavirus 2019 (COVID-19) pandemic bought many kidney transplant (KT) programs to a halt. Integral to resuming KT activity is understanding the perspectives of potential transplant candidates during this highly dynamic time. Methods. From June 1 to July 7, 2020, a telephone survey of KT candidates on th...

While the association of vascular calcification with inferior patient outcomes in kidney transplant recipients is well-established, the association with graft outcomes has received less attention. With this dual-centre cohort study, we aimed to determine the clinical impact of recipient pre-transplant aorto-iliac calcification, measured on non-cont...

There is ethnic inequity in access to living-donor kidney transplants in the UK. This study asked kidney patients from Black, Asian and minority ethnic groups why members of their family were not able to be living kidney donors. Responses were compared with responses from White individuals. This questionnaire-based mixed-methods study included adul...

Background The risk of COVID-19 infection in transplant recipients is unknown. Patients on dialysis may be exposed to greater risk of infection due to an inability to isolate. Consideration of these competing risks is important before restarting suspended transplant programs. This study compared outcomes in kidney and kidney/pancreas transplant rec...

Background From population studies, solid organ transplant recipients are at increased risk of mortality from RT-PCR confirmed COVID-19 infection. The risk factors associated with infection acquisition and mortality in transplant recipients using serological data has not been reported. Methods From 1725 maintenance transplant recipients, 855 con...

Introduction There is limited data pertaining to comparative outcomes of remaining on dialysis versus kidney transplantation as the threat of COVID-19 remains. This study aims to delineate the differential risks involved using serological methods to help define exposure rates. Methods From a cohort of 1433 patients with ESKD, we analysed COVID-19...

As vascular calcification is common in kidney transplant candidates, aorto-iliac vessel imaging is performed for surgical planning. The aim of the present study was to investigate whether a novel non-contrast enhanced computed tomography-based quantification technique for aorto-iliac calcification can be used for cardiovascular risk stratification...

Background: Individuals with benign kidney disorders undergoing nephrectomy have three possibilities: Autotransplantation, with a certain risk of complications, but without a clear benefit; discarding the kidney; or living kidney donation. Aim: To investigate whether patients with benign kidney disorders and a medical indication for nephrectomy...

Background: Despite technical refinements, early pancreas graft loss due to thrombosis continues to occur. Conventional coagulation tests (CCT) do not detect hypercoagulability and hence the hypercoagulable state due to diabetes is left untreated. Thromboelastogram (TEG) is an in-vitro diagnostic test which is used in liver transplantation, and in...

Introduction: Vascular complications after pancreas transplantation can be graft and life- threatening. Methods: All pancreas transplants performed between December 2005 and June 2019 were reviewed. All pseudoaneurysms (PA), arterio-enteric fistulas (AEF), arterio-venous fistulas (AVF) were analysed retrospectively. Results: Of the 158 pancrea...

Background and Aims A living-donor kidney transplant (LDKT) is one of the best treatments for kidney failure, yet in the UK there is evidence of ethnic inequity in access. We designed this questionnaire-based mixed-methods study to investigate the patient-reported reasons that family members of Black, Asian and Minority Ethnic group (BAME) individu...

The role of ureteral stents in living donor kidney transplantation remains uncertain. In this randomized controlled trial (SPLINT), we compared urological complications in living donor kidney transplantations performed with or without stents. We included 200 consecutive patients that received living donor kidney transplantations at the Erasmus MC,...

This paper addresses ethical, legal and psychosocial aspects of Global Kidney Exchange (GKE). Concerns have been raised that GKE violates the non‐payment principle, exploits donors in low and middle‐income countries, and detracts from the aim of self‐sufficiency. We review the arguments for and against GKE. We argue that while some concerns about G...

Background. There is evidence of socioeconomic inequity in access to living-donor kidney transplantation, but limited evidence as to why. We investigated possible mediators of the inequity. Methods. This questionnaire-based case-control study included 14 UK hospitals. Participants were adults transplanted between April 1, 2013 and March 31, 2017...

Objective: It is well known that repeat HLA incompatibilities confer a poor prognosis in kidney re-transplantation. We aimed to address the impact of repeat HLA mismatch in pancreas after kidney transplantation (PAK). Methodology: Single center retrospective analysis of 30 solitary pancreas transplants {PAK=29/ Pancreas after simultaneous pancreas...

Background Ischaemia-reperfusion injury in kidney transplantation leads to delayed graft function (DGF), which is associated with reduced long term graft function. Remote ischaemic conditioning (RIC) improved early kidney graft function in a porcine model of donation after brain death and was associated with improved long-term cardiac outcome after...

Differing beliefs about the acceptability of living-donor kidney transplants (LDKTs) have been proposed as explaining age, ethnic and socioeconomic disparities in their uptake. We investigated whether certain patient groups hold beliefs incompatible with LDKTs. This questionnaire-based case-control study was based at 14 hospitals in the United King...

Objectives: Social media are Internet-based tools to gather and communicate information. Our aim was to survey transplant professionals in their attitude toward social media, to allow a better understanding of these technologies and their impact on health communication. Materials and methods: An online survey was distributed through the European...

ISPD Guidelines on Peritoneal Dialysis Access http://www.pdiconnect.com/content/early/2019/04/26/pdi.2018.00232.full.pdf

Background: Short-term kidney graft dysfunction is correlated with complications and it is associated with a decreased long-term survival; therefore, a scoring system to predict short-term renal transplant outcomes is warranted. Aim: The aim of this study is to quantify the impression of the organ procurement surgeon in correlation with the foll...

Transplantation medicine is a rapidly evolving field and over the last years there has been substantial progress in organ exchange strategies. Organ exchange helps improve transplantation opportunities for patients in special groups, such as highly immunized or high urgent (HU) patients. It also ensures that organs that have no suitable recipient i...

Although health care is encouraged to follow an evidence-based approach, there are perceived instances where suboptimal practice persists in the presence of better options due to an inherent resistance to change within many health care systems. To continue striving for clinical excellence, it is important to identify deficient practices and make ap...

Background: Living donor kidney transplantation (LDKT) is the preferred treatment for patients with end-stage renal disease and unspecified living kidney donation is morally justified. Despite the excellent outcomes of LDKT, unspecified kidney donation (UKD) is limited to a minority of European countries due to legal constraints and moral objectio...

Introduction: There is a great need to increase the organ donor pool, particularly for living donors. This study analyses the difference in post-living donation kidney function according to pre-donation characteristics of age, genetic relationship with the recipient, sex, ethnicity, and Body Mass Index (BMI). Methods: Retrospective single centre...

Background. Native nephrectomy in Adult Polycystic Kidney Disease (ADPKD) patients is a major operation with controversy related to timing and indications. We present our single centre experience in transplanted patients and future candidates for transplantation. Methods. Retrospective analysis from an anonymised database of bilateral nephrectomies...

Implanting a ureteric stent during ureteroneocystostomy reduces the risk of leakage and ureteral stenosis after kidney transplantation (KTx), but it may also predispose to urinary tract infections (UTIs). The aim of this study is to determine the optimal timing for ureteric stent removal after KTx. Searches were performed in EMBASE, MEDLINE Ovid, C...

Tissue-resident memory T (TRM) cells are characterized by their surface expression of CD69 and can be subdivided in CD103+ and CD103− TRM cells. The origin and functional characteristics of TRM cells in the renal allograft are largely unknown. To determine these features we studied TRM cells in transplant nephrectomies. TRM cells with a CD103+ and...

Introduction: Despite technical refinements, early pancreas graft loss due to thrombosis continues to occur. Conventional coagulation tests do not detect hypercoagulability and hence is left untreated. Thromboelastogram (TEG) is a dynamic, in-vitro diagnostic test that provides a global hemostatic profile. This study compares the outcome between TE...

Background: Early markers to predict delayed kidney graft function (DGF) may support clinical management. We studied the ability of four biomarkers (neutrophil gelatinase associated lipocalin (NGAL), liver-type fatty acid-binding protein (L-FABP), cystatin C, and YKL-40) to predict DGF after deceased donor transplantation, and their association wi...