1. THE EARLY RESULTS OF 363 DONOR OPERATIONS IN CENTRAL OIL WORKER’S HOSPITAL, AZERBAIJAN

2. Eldar Ahmadov, Mirjalal Kazimi, Kamran Beydullayev, Ceyhun Isayev, Mail Sadiyev Department of Surgery and Organ Transplantation, Central Hospital of Oil Workers, Azerbaijan

3. Central Hospital of Oil Workers
Transplantation Center founded in 2009
First Organ transplantation center in Azerbaijan
Routinely performing liver and kidney transplantation operations
So far 273 kidneys and 90 livers transplantation were performed
Central Hospital of Oil Workers

5. Only Living Donors Living donor liver transplantation (LDLT)
No cadaveric liver transplantation program is established yet
Only Living Donors

6. Cadaveric Organ Donation

7. Outcome of our first 90 LDLTs at the Central Oil Workers Hospital, Baku.
Discuss the lessons learned
Retrospective review between 2009 and for the following end point: donor complications.
Liver donors

8. 90 cases of adult-to-adult LDLT were performed
90 cases of adult-to-adult LDLT were performed. The frequency of this operation has increased over time, with 16 cases performed over the past year.
All donors were related to the recipient.
Liver Donors

9. Related donors only

10. Liver Donors Donor age ranged from 19 to 54 years
All donors presented on a strictly voluntary basis
Each donor underwent a thorough physical examination and laboratory evaluation.
Liver Donors

11. Thrombophily panel

12. Imaging modalities of the donor not included magnetic resonance angiography and cholangiography
Absolute liver volume was calculated based on these scans
Liver Donors

13. KT Volumetria

14. Liver biopsies were performed infrequently; only 3 of the 90 eventual donors underwent a biopsy
Liver Biopsy

15. Marginal donor avoided in early stages of our transplantation activity.
Now we consider their candidateship possible
Marginal donors

16. Donor Demographics No. of donors 90 Sex (M/F) 64/26 Mean age (yr) 32
Mean Length of Stay (d)
Donor Demographics

17. Types of Operation Right donor hepatectomy 82 Left donor hepatectomy 4
Left lateral segmentectomy 4
Types of Operation

18. General anesthesia, with a thoracic epidural catheter used for postoperative pain management. A right subcostal incision with upper midline extension similar to that performed on the transplant recipient is used. For left side hepatectomy and left lateral segment resection upper midline incision is adequate.
Operation technique

19. Incision

20. Parenchymal transection
Using both clamp crush method and CUSA , parenchymal transection proceeds
Intraoperative cholangiogram is obtained in all cases
Parenchymal transection

21. Parenchymal transection

22. Cholangiogram

23. All 90 donors are alive, well, and have returned to normal predonation activity.
Of 90 donors, 3 required nonautologous blood transfusions (2.7%). One of these was for profuse bleeding secondary to IVC tear. The second was in a patient whose hematocrit decreased on postoperative day 2 and stabilized after relaparotomy
Results

24. Complications One patient had postoperative bile leaks.
The patient was treated conservatively with percutaneous drainage, resulting in resolution of the leak from the cut liver surface.
Also, a temporary neuropraxia occurred in the dominant hand of one donor.
2 donor had prolonged hyperbilirubinaemia
Complications

25. Kidney donors

26. Living donors has advantage
Longer kidney survival
Shorter wait time for transplant
Surgery scheduled for convenience
Healthy donor kidney
Kidney works right away
May be close genetic match
Lower cost
Living donors has advantage

27. Kidney Donors Age 18 and older Good physical and mental health
No chronic kidney stones
No Diabetes
No current and recent cancer
Not a lot overweight
High Blood pressure may be considered
Kidney Donors

28. Surgery Goals Remove Healthy Kidney for Donation
Ensure Safety of Donor Patient
Ensure graft safety
Minimize Scarring
Minimize Recovery Time
Surgery Goals

29. In our center overall 273 renal transplantation were performed between 2010-2016.
2010-1
2011-9
Our Experience

30. We retrospectively analyzed the data and surgical complications for 273 patients who underwent living donor nephrectomy between and 2016.
Initial 116 operations were open nephrectomy.
137 operations performed by hand assisted laparoscopic approach
25 nephrectomy by pure laparoscopic.
Outcomes

31. Hand assisted laparoscopy

32. Positions of patient and surgeons

33. Pure laparoscopy

34. The donor mean age was 51.9 ± 7.6 years (range 19 to 76),
38% of the donors were men
mean Body Mass Index was 26.4 ± 2.9 kg/m2.
Mean operative time was ± 35.0 minutes.
Warm ischemic time was 2.5 ± 0.62 minutes.
The donor’s mean hospital stay was 3.3 (range 2 to 7) and
Donor Demographics

35. Hand assisted and pure donor nephrectomies were successfully completed in all patients.
After a mean follow-up all donors are alive.
There were no major donor complications.
No conversion to open.
Outcomes

36. One patient presented a wound hematoma responding to conservative treatment.
And one case of lymphorrhea were registered.
Complications

38. Thank you