Jacopo Romagnoli

Today, living organ donation for transplantation has become a standardized practice, widely recognized for its incredible generosity and significant benefits to recipients in both the pediatric and adult fields. Living donor nephrectomy involves a singular surgical scenario where surgery is performed on a healthy individual with the primary objective of benefiting another patient. It is well recognized that living donor kidney transplantation (LDKT) offers better outcomes in terms of recipient and organ survival, particularly if carried out pre-emptively, than deceased donor transplantation 1. LDKT offers several significant benefits, including shorter waiting times for transplantation, higher quality kidney grafts and an elective surgical setting. The percentage of living donations in the kidney transplant field has grown exponentially over the last 20 years in many countries. The growth of this activity in recent decades has been driven, on one hand, by the development of ABO-incompatible transplant programs, kidney paired donation and HLA desensitization programs. On the other hand, a significant contribution can be found in the introduction of laparoscopic surgery in living donor nephrectomy, which has confirmed advantages over classic open surgery in terms of less postoperative pain, shorter hospital stay, faster recovery, and better cosmetic results. We summarize here the various minimally invasive approaches in living kidney donation available today and their impact on the development of this procedure, with a particular focus on the Italian scenario.

Antiphospholipid syndrome (APS) is characterized by recurrent arterial/venous thrombosis and miscarriages in the persistent presence of autoantibodies against phospholipid-binding proteins (aPLs), such as β2 glycoprotein I (β2GPI). In addition to the aPL thrombophilic effect, arterial thrombosis was related to accelerated atherosclerosis in animal models; however, contrasting findings were reported in primary APS patients with regard to the increased number of plaques or abnormal arterial wall thickness. We investigated the cytokine production induced by β2GPI in activated T cells that infiltrate in vivo atherosclerotic lesions of primary APS patients with atherothrombosis. We also examined the helper function of β2GPI-specific T cells for monocyte matrix metalloproteinase-9 and tissue factor production, as well as their cytolytic potential and their helper function for Ab production. APS patients with atherothrombosis harbor in vivo–activated CD4⁺ T cells that recognize β2GPI in atherothrombotic lesions. β2GPI induces T cell proliferation and IFN-γ expression in plaque-derived T cell clones. β2GPI-specific T cells display helper function for monocyte matrix metalloproteinase-9 and tissue factor production and promote Ig production in autologous B cells. Moreover, plaque-derived β2GPI-specific CD4⁺ T lymphocytes express perforin-mediated and Fas/Fas ligand–mediated cytotoxicity. β2GPI, and especially the DI domain, drive a local Th1 inflammatory response, with subsequent plaque instability that eventually favors atherothrombosis. This finding may explain the association between aPLs and arterial thrombosis, despite the lack of evidence of surrogate markers for atherosclerosis in primary APS.

Transplantation Surgery has lacked a structural education in most European countries thus far. The Transplant Working Group and subsequently the Division of Transplantation in the Section of Surgery under the European Union of Medical Specialists (UEMS) have established high quality criteria for the accreditation of training programs over the last 10 year providing transplant surgeons with an official recognition and certification. Here, we present details of our deliberations, specific aspects of the program and advantages of this program for transplant surgeons

The aim of this study was to evaluate psychological differences and quality of life between kidney recipients from living (mother) and multi-organ donor. Overall, 40 patients who had undergone both living (mother) and multi-organ kidney transplantation 3–6 months before were asked to complete four self-report instruments: Toronto Alexithymia Scale, Short Form Health Survey, Regulatory Emotional Self-efficacy, and Attachment Style Questionnaire. A greater difficulty in emotional, social, and mental health functioning was found in recipients receiving kidney from mother living donor. Moreover, in these patients, higher levels of avoidant attachment dimensions were associated with a worse quality of life.

The main purpose of this paper, written by a group of Italian expert transplant surgeons, is to provide clinical support and to help through the decision-making process over pre-transplant surgical procedures in potential kidney recipients, as well as selection of pancreas transplant candidates and perioperative management of kidney recipient. Current topics such as different approaches in minimally invasive donor nephrectomy, methods of graft preservation and treatment of failed allograft were addressed.