Titus Augustine

Central Manchester University Hospitals NHS Foundation Trust · Renal and Pancreas Transplantation and Endocrine Surgery

The parathyroid glands are situated in close proximity to the thyroid gland. They have an important endocrine function maintaining calcium and phosphate homeostasis in the body by the secretion of parathormone (PTH), which is responsible for this function. The parathyroid glands are commonly damaged during thyroid surgeries. This could lead to tran...

Poster presentation by Ahmed Gonnah

Unlabelled: The accuracy of intraoperative graft perfusion assessment still remains subjective, with doppler examination being the only objective adjunct. Laser speckle contrast imaging (LSCI) has been used to assess intraoperative blood flow in neurosurgery and in various surgical specialties. Despite its ability to accurately quantify perfusion...

Successful pancreas or islet transplantation is currently the only cure for type-1 diabetes mellitus. Since the first pancreas transplant in 1966, there have been various refinements of surgical technique along with improved immunosuppressive regimens, resulting in significantly improved outcomes, with contemporary research into graft monitoring an...

Introduction: Outcomes following pancreas transplantation are suboptimal and better donor selection is required to improve this. Vasoactive drugs (VaD) are commonly used to correct the abnormal haemodynamics of organ donors in intensive care units. VaDs can differentially affect insulin secretion positively (dobutamine) or negatively (noradrenalin...

Background: Assessing circadian rhythmicity from infrequently sampled data is challenging, however this type of data is often encountered when measuring circadian transcripts in hospitalised patients. Methods: We present ClinCirc. This method combines two existing mathematical methods (Lomb-Scargle periodogram and cosinor) sequentially, and is d...

Background Kidney transplantation is the definitive treatment for end stage renal disease (ESRD), offering improved quality of life and survival benefit over remaining on dialysis. There is, however, a prevailing significant mismatch between patients awaiting transplantation and available donor kidneys. Over time, initial stringent donor criteria h...

Aims Encapsulating peritoneal sclerosis (EPS) is a rare phenomenon characterised by encasement of the bowel by a thickened peritoneum due to prolonged peritoneal dialysis exposure. We are an international referral centre, typically managing cases with a planned open abdomen (OAM) and scheduled relook after 24–48 hours. We compare outcomes for those...

There is a need for IT systems that support the complex needs of data management in kidney transplantation. The KidneyCloud project aims to inform a transplant-specific digital solution by exploring patient pathways and data journeys. This paper reports on the early prototyping of the KidneyCloud clinician interface using an iterative codesign meth...

Background: Donor hepatitis-C (HCV) infection has historically represented a barrier to kidney transplantation (KT). However, direct-acting antiviral (DAA) medications have revolutionised treatment of chronic HCV infection. Recent American studies have demonstrated that DAA regimes can be used safely peri-operatively in KT to mitigate HCV transmiss...

Background Care pathways in renal transplantation involve multi-speciality coordination and administration of clinical data across organisational boundaries. The potential for information technology (IT) to support the service through data management, communication and national registration has been reported. However, no previous national-level eva...

Background Data journey modeling is a methodology used to establish a high-level overview of information technology (IT) infrastructure in health care systems. It allows a better understanding of sociotechnical barriers and thus informs meaningful digital transformation. Kidney transplantation is a complex clinical service involving multiple specia...

Aim Laparoscopic adrenalectomy is considered the optimal approach for most lesions. Various subsets of minimally invasive adrenalectomy are practiced in the UK, including trans-abdominal (TLA), hand-assisted (HLA) and retroperitoneal (RLA) laparoscopic procedures. We aimed to examine the relative operative outcomes between the 3 techniques. Method...

Pancreas transplantation (PT) allows improved glycaemic control for patients with complicated type 1 diabetes mellitus and is most commonly performed simultaneously with a renal transplant. Imaging modalities are critical for the assessment of pancreatic graft dysfunction, as clinical assessment and hyperglycaemia lack robust sensitivity for the tr...

Kidney transplantation has evolved over the years from transplants between identically matched donors and recipients to successfully transplanting allografts across virtually any degree of donor-recipient human leukocyte antigen mismatch and ABO-incompatibility. Integral to these improved outcomes has been the development and deployment of a range...

Renal transplantation has become the gold standard treatment for the majority of patients with established renal failure. Recent decades have seen significant progress in immunosuppressive therapies, and advances in post-transplant management of recipients, resulting in improved graft and patient outcomes. However, the open technique of allograft i...

Introduction: Arteriovenous grafts (AVG) for haemodialysis (HD) access are recommended as a second line modality due to higher morbidity and mortality rates than arteriovenous fistulae (AVF). Smoking is already established as a risk factor in lower extremity bypass graft failure used for peripheral vascular disease, but its effect on AVGs remains...

This retrospective study was performed to analyse if laterality of the retrieved living donor kidney had any effect on donor and recipient outcomes after hand assisted laparoscopic donor nephrectomy (HALDN). 739 donors who underwent HALDN between January 2006 and January 2018 at a large tertiary transplant centre in the United Kingdom were included...

Aims Allograft nephrectomy and pancreatectomy present a significant surgical challenge in contaminated surgical fields, with risks of post-operative pseudoaneurysms and mycotic bleeds. We report on our experience of prophylactic endovascular stenting shortly before or after allograft nephrectoym and pancreatectomy to reduce the risk of subsequent p...

Aims During donor multi-detector CT angiogram (MDCTA), incidental findings occur, commonly adrenal incidentalomas (AIs). These are usually benign and non-functional with an estimated incidence of 4%.1 These potentially limit organ donation due to the need to exclude malignancy. There is no consensus on the management of donors with AIs.1,2 This stu...

Aims Encapsulating peritoneal sclerosis (EPS) is a rare phenomenon characterised by encasement and obstruction of the bowel by thickened peritoneum. In our centre, EPS laparotomies are typically managed with open abdomen (OA) and planned relook at 24-48 hours. The aim of the study was to compare ABTHERATM open abdomen negative pressure wound therap...

Aim Encapsulating peritoneal sclerosis (EPS) is a rare morbidity associated primarily with peritoneal dialysis. Definitive diagnosis and management can often be prolonged and complicated. The pathogenesis is a two-hit hypothesis of inflammation and myofibroblast differentiation. This report aims to demonstrate the pathogenesis of EPS and provide in...

Background Encapsulating Peritoneal Sclerosis (EPS) is a rare phenomenon in paediatric patients with kidney failure treated with peritoneal dialysis (PD). This study highlights clinical challenges in the management of EPS, with particular emphasis on peri-operative considerations and surgical technique. Methods Retrospective analysis of all paed...

BACKGROUND Data journey modeling is a methodology used to establish a high-level overview of information technology (IT) infrastructure in health care systems. It allows a better understanding of sociotechnical barriers and thus informs meaningful digital transformation. Kidney transplantation is a complex clinical service involving multiple specia...

We describe a case where a patient received a successful dual kidney transplantation in a staggered fashion. Two kidneys from a deceased donor were accepted for 2 separate primary intended recipients, however, due to unforeseen circumstances, both kidneys were eventually transplanted in a staggered fashion into an alternate single recipient. The in...

To assess the impact of renal transplantation on peripheral nerve damage in patients with chronic kidney disease (CKD). Fifteen patients with CKD (eGFR <15 mL/min/1.73m²) underwent longitudinal assessment after renal transplantation (age-56.88 ± 2.53 years, eGFR-46.82 ± 4.86) and were compared to 15 age-matched controls (age-58.25 ± 2.18 years, eGF...

Aims/hypothesis Approximately 50% of organ donors develop hyperglycaemia in intensive care, which is managed with insulin therapy. We aimed to determine the relationships between donor insulin use (DIU) and graft failure in pancreas transplantation. Methods UK Transplant Registry organ donor data were linked with national data from the UK solid pa...

Optimal glycemic control in kidney transplant recipients with diabetes is associated with improved morbidity, mortality and allograft survival. Transplant options for patients with diabetes requiring insulin therapy and chronic kidney disease who are suitable candidates for kidney transplantation should include consideration of β-cell replacement t...

Background Arterio-enteric fistula (AEF) is a rare but potentially devastating complication of solid organ pancreatic transplantation. Traditional management has been to remove the pancreas-duodenum allograft and control the vascular defect. Interventional radiological (IR) techniques present a new method of managing AEF related haemorrhage without...

Endovascular coiling is a percutaneous endovascular technique used in the management of arterial aneurysms with high success rate and minimal associated morbidity. We present a series of three patients with incidental renal artery aneurysms treated successfully with endovascular coiling, despite co-morbidities. One patient had an aneurysm associate...

This is an article on the use of information technology in renal transplantation

Human leukocyte antigens (HLA) have been associated with renal function, but previous studies report contradictory findings with little consensus on the exact nature or impact of this observation. This study included 401,307 white British subjects aged 39–73 when they were recruited by UK Biobank. Subjects’ HLA types were imputed using HLA*IMP:02 s...

The role of the human microbiome in health and disease is becoming increasingly apparent. Emerging evidence suggests that the microbiome is affected by solid organ transplantation. Kidney transplantation is the gold standard treatment for End-Stage Renal Disease (ESRD), the advanced stage of Chronic Kidney Disease (CKD). The question of how ESRD an...

Encapsulating peritoneal sclerosis (EPS) is a rare life-threatening complication associated with peritoneal dialysis (PD). EPS is characterized by progressive fibrosis and sclerosis of the peritoneum, with the formation of a membrane and tethering of loops of the small intestine resulting in intestinal obstruction. It is very rare in children. We p...

Human leukocyte antigens (HLA) have been associated with renal function, but previous studies report contradictory findings. There has been a lack of research into how HLA affects renal function in Black, Asian and Minority Ethnic (BAME) people in the UK, despite BAME people being disproportionately affected by renal dysfunction. This study include...

Kidney transplant restores renal function in eligible patients with end-stage renal failure who require renal replacement therapy. There remains a significant disparity between the demand and supply of suitable kidneys for transplant. In recent years, pediatric donors have formed an important area for expansion of the donor pool. However, neonatal...

Background Screening with cardiac non-invasive stress studies (NISS) prior to listing for kidney transplantation can help in identifying treatable coronary disease and is considered an integral part of pre-kidney transplant evaluation. However, few studies assessed their effectiveness in all patients evaluated for transplantation in clinical practi...

Abstract BACKGROUND Encapsulating peritoneal sclerosis (EPS) is a rare, life-threatening, and serious complication of long-term peritoneal dialysis (PD). No evidence-based management strategy has been established until now. Surgical management, including enterolysis and excision of the sclerotic and obstructing adhesions, should be considered as s...

Patient: Male, 26-year-old Final Diagnosis: Encapsulating peritoneal dialysis Symptoms: Abdominal distension • abdominal pain • constipation • vomiting Medication:— Clinical Procedure: — Specialty: Nephrology • Surgery • Transplantology Objective Rare disease Background Encapsulating peritoneal sclerosis (EPS) is a rare, life-threatening, and ser...

Aims: The relationship between peri-transplant glycaemic control and outcomes following pancreas transplantation is unknown. We aimed to relate peri-transplant glycaemic control to pancreas graft survival and to develop a framework for defining early graft dysfunction. Methods: Peri-transplant glycaemic control profiles over the first five days...

Talaromycosis is a fungal infection endemic in Southeast Asia. We report a case of a renal transplant recipient who developed infection after a trip to South China. She presented with constitutional symptoms and was found to have an FDG‐avid lung mass. Histopathology demonstrated small yeast cells and the culture grew Talaromyces marneffei. The pat...

Background Kidney transplant recipients (KTRs) with “operational tolerance” (OT) maintain a functioning graft without immunosuppressive (IS) drugs, thus avoiding treatment complications. Nevertheless, IS drugs can influence gene-expression signatures aiming to identify OT among treated KTRs. Methods We compared five published signatures of OT in p...

COVID-19 is impacting provision of renal transplantation in the UK with a reduction in clinical activity. Publicly available Renal Registry and NHS Blood and Transplant reports were analysed to model the number of missed transplant opportunities, waiting list size and change in dialysis population over a six-month period starting 5 March 2020. An e...

Transplantation is the preferred treatment option for end-stage renal disease as it offers superior results and patient reported outcomes in comparison to dialysis. Patients treated with a transplant live longer, healthier and more independent lives. Transplantation is also more cost-effective, reducing the overall burden of renal disease. Despite...

Insulin is routinely used to manage hyperglycaemia in organ donors and during the peri‐transplant period in islet transplant recipients. However, it is unknown whether Donor Insulin Use (DIU) predicts beta‐cell dysfunction after islet transplantation. We reviewed data from the United Kingdom (UK) Transplant Registry and the UK Islet Transplant Cons...

Solid organ transplantation (SOT) is an established therapeutic option for chronic disease resulting from end-stage organ dysfunction. Long-term use of immunosuppression is associated with post-transplantation diabetes mellitus (PTDM), placing patients at increased risk of infections, cardiovascular disease and mortality. The incidence rates for PT...

THERAPEUTICS ituximab is a genetically engineered, therapeutic, chimeric murine-human anti-CD20 monoclonal antibody. 1 It consists of regions derived from the murine anti-CD20 antibody, linked to a human immunoglobulin G (IgG) region, 1,2 with 95% of the resulting protein being of human origin. 2 The CD20 receptor is exclusively expressed on B cell...

Fact box • Nearly 1000 living people donated a kidney last year – this number has been static for the last 8 years • Living donation can be directed (towards a specific recipient) and non-directed (towards the transplant waiting list) • Amongst transplantation LDKT offers the best outcomes in terms of graft function and patient survival • Elective...

Objective To identify whether renal transplant activity varies in a reproducible manner across the year. Design Retrospective cohort study using NHS Blood and Transplant data. Setting All renal transplant centres in the UK. Participants A total of 24 270 patients who underwent renal transplantation between 2005 and 2014. Primary outcome Monthly...

Curative surgery for retro-peritoneal tumours involving vascular structures is challenging and multi-visceral resection is often required to obtain clear resection margins. Abdominal transplant surgeons have considerable experience in all aspects of visceral, vascular and retro-peritoneal surgery. Application of these skills to resect tumours invol...

Aims/hypothesis: The study aimed to assess the impact on neuropathy of simultaneous pancreas and kidney transplantation (SPK) in individuals with type 1 diabetes. Methods: This longitudinal observational study examined neuropathic symptoms, deficits, quantitative sensory testing, neurophysiology, corneal confocal microscopy and skin biopsy resul...

There is an acute shortage of organ donors in the UK, specifically among South Asian communities. This article reports the findings from the largest ever study undertaken among South Asian people in the UK that seeks to explore attitudes and beliefs towards organ donation. This article highlights that seemingly intractable factors, such as religion...

A 26-year-old male, with a family history of Paraganglioma Syndrome 4 (PGL4) presented with an 18-month history of paroxysmal headaches, a one-month history of frequent diaphoresis, anxiety attacks and unintentional weight loss of one stone in 2 months. Physical examination and vital parameters were normal. Laboratory studies showed significant ele...

Pre-Implantation Trial of Histopathology In renal transplant Allografts (PITHIA) A stepped-wedge cluster registry randomised trial sponsored ny NHSBT, UK.

Hyperglycaemia is common in hospitalised individuals, and is often caused by physiological stress associated with critical illness or major surgery. Insulin therapy is an established treatment for hyperglycaemia, acute hyperkalaemia and has also been used for myocardial dysfunction resistant to inotropic support. Insulin is commonly used in both or...

Objective: People with type 1 diabetes and kidney failure have an increased risk for major adverse cardiovascular events (MACE). Simultaneous pancreas and kidney transplantation (SPKT) improves survival, but the long-term risk for MACE is uncertain. Research design and methods: We assessed the frequency and risk factors for MACE (defined as fata...

Background Normothermic regional perfusion (NRP) is a novel technique that aids organ recovery from donors after circulatory death (DCDs). However, ethical concerns exist regarding the potential return of spontaneous cerebral and cardiac activity (ROSCCA). This study aimed to determine the likelihood of ROSCCA in NRP‐DCDs of abdominal organs. Meth...

Background Central Nervous System (CNS) lymphoma is a rare presentation of post-transplantation lymphoproliferative disorder (PTLD). Methods This single center retrospective study reviewed presentations, management and outcomes of CNS lymphomas in kidney transplant patients transplanted 1968 to 2015, and reviews relevant current literature. Resul...

Objective Adrenal surgery remains a distinct surgical challenge. Technical challenges associated with laparoscopic adrenalectomy are tumour size, haemorrhage control, and oncological compromise. Hand Assisted Laparoscopic (HAL) Adrenalectomy, utilising a hand‐port device, offers minimally invasive surgery with the advantages and safety of tactile f...

Encapsulating peritoneal sclerosis (EPS) is a rare but devastating complication of peritoneal dialysis. It is characterized by peritoneal neovascularization, fibrosis, and calcification ultimately leading to intestinal obstruction and eventual failure. Surgery for EPS has a mortality approaching 50% and most patients require some form of postoperat...

Simultaneous pancreas and kidney transplantation (SPKT) is an effective treatment option for patients with type 1 diabetes and end stage renal disease. Increasing demands for organs for transplantation coupled with a rise in age and size of adult donors has led to greater utilization of paediatric donors, and with good outcomes. Nonetheless, there...

Simultaneous pancreas and kidney transplantation (SPKT) is an effective treatment option for patients with type 1 diabetes and end stage renal disease. Increasing demands for organs for transplantation coupled with a rise in age and size of adult donors has led to greater utilization of paediatric donors, and with good outcomes. Nonetheless, there...

Brexit may lead to major political, societal, and financial changes—this has significant implications for a tax revenue funded healthcare system such as the United Kingdom's (UK) National Health Service. The complex relationship between European Union (EU) legislation and clinical practice of organ donation and transplantation is poorly understood....

Taralomycosis, endemic in Southeast Asia and southern China, is a potentially fatal systemic infection typically affecting human immunodeficiency virus infected or immunosuppressed patients¹. The causative pathogen, Taralomyces marneffei (formerly Penicillium marneffei), is a thermally dimorphic fungus, existing as a yeast at body temperature and a...