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Article: Environmentally sustainable kidney care through transplantation: Current status and future challenges.

Anastasopoulos, Nikolaos-Andreas / Papalois, Vassilios

The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

2024

Abstract: The environmental impact of healthcare is an issue currently examined with increased scrutiny and on a global scale with multiple stakeholders seeking to identify the appropriate interventions to reduce it. Interestingly, a significant portion of ... ...

Abstract	The environmental impact of healthcare is an issue currently examined with increased scrutiny and on a global scale with multiple stakeholders seeking to identify the appropriate interventions to reduce it. Interestingly, a significant portion of healthcare's environmental impact stems from intensive modalities of treatment for chronic disease. There is no better example than End-Stage Renal Disease (ESRD), where dialysis or transplantation are the modalities of treatment offered to the vast majority of these patients. Kidney transplantation (KTx) offers a longer life expectancy and improved quality of life in comparison to dialysis. Cost-effectiveness analyses have proven its financial superiority, as well. PubMed and EMBASE literature search using keywords "kidney transplantation", "carbon footprint", "sustainability" showed that there is no published work in the field of environmental sustainability in kidney transplantation. Relevant literature was identified for surgical services and applied to transplantation. Assuming its environmental superiority to dialysis, maximising KTx rate would be an important action towards "green" renal care services. That could be achieved through living organ donation, systematic use of machine perfusion for extended criteria deceased donors and individualised immune risk stratification techniques. All these measures aim towards implementing enhanced recovery protocols and two vital steps can be taken towards assessing their value. The first step is a detailed audit of the environmental impact of these novel techniques and secondly their impact in reducing the length of hospital stay and its subsequent environmental impact. Another key element is delivering appropriate post-operative care, substituting allograft biopsy with non-invasive techniques and reducing physical outpatient follow-up, using telemedicine. The gap in quantifying KTx services environmental impact needs to be addressed urgently, with development of strategies within the multidisciplinary transplant team. Introducing novel technologies can lead to donor pool expansion and improved organ utilisation rates, transforming transplant services in "green" hubs.
Language	English
Publishing date	2024-02-01
Publishing country	Scotland
Document type	Journal Article
ZDB-ID	2102927-1
ISSN	1479-666X
ISSN	1479-666X
DOI	10.1016/j.surge.2024.01.001
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Article ; Online: Post-transplant lymphoproliferative disorders following kidney transplantation: A literature review with updates on risk factors, prognostic indices, screening strategies, treatment and analysis of donor type.

Ergisi, Mehmet / Ooi, Bryan / Salim, Omar / Papalois, Vassilios

Transplantation reviews (Orlando, Fla.)

2024 Volume 38, Issue 2, Page(s) 100837

Abstract: Post-transplant lymphoproliferative disorders (PTLD) is a devastating complication of kidney transplantation with an insidious presentation and potential to disseminate aggressively. This review delineates the risk factors, prognostic indexes, screening, ...

Abstract	Post-transplant lymphoproliferative disorders (PTLD) is a devastating complication of kidney transplantation with an insidious presentation and potential to disseminate aggressively. This review delineates the risk factors, prognostic indexes, screening, current management algorithm and promising treatment strategies for PTLD. Kidneys from both extended criteria donors (ECD) and living donors (LD) are being increasingly used to expand the donor pool. This review also delineates whether PTLD outcomes vary based on these donor sources. While Epstein-Barr virus (EBV) is a well-known risk factor for PTLD development, the use of T-cell depleting induction agents has been increasingly implicated in aggressive, monomorphic forms of PTLD. Research regarding maintenance therapy is sparse. The international prognostic index seems to be the most validate prognostic tool. Screening for PTLD is controversial, as annual PET-CT is most sensitive but costly, while targeted monitoring of EBV-seronegative patients was more economically feasible, is recommended by the American Society of Transplantation, but is limited to a subset of the population. Other screening strategies such as using Immunoglobulin/T-cell receptor require further validation. A risk-stratified approach is taken in the treatment of PTLD. The first step is the reduction of immunosuppressants, after which rituximab and chemotherapy may be introduced if unsuccessful. Some novel treatments have also shown potential benefit in studies: brentuximab vedotin, chimeric antigen receptor T-cell therapy and EBV-specific cytotoxic T lymphocytes. Analysis of LD v DD recipients show no significant difference in incidence and mortality of PTLD but did reveal a shortened time to development of PTLD from transplant. Analysis of SCD vs ECD recipients show a higher incidence of PTLD in the ECD group, which might be attributed to longer time on dialysis for these patients, age, and the pro-inflammatory nature of these organs. However, incidence of PTLD overall is still extremely low. Efforts should be focused on optimising recipients instead. Minimising the use of T-cell depleting therapy while encouraging research on the effect of new immunosuppressants on PTLD, screening for EBV status are essential, while enabling shared decision-making during counselling when choosing kidney donor types and individualised risk tailoring are strongly advocated.
MeSH term(s)	Humans ; Kidney Transplantation/adverse effects ; Epstein-Barr Virus Infections/complications ; Epstein-Barr Virus Infections/diagnosis ; Epstein-Barr Virus Infections/therapy ; Herpesvirus 4, Human ; Prognosis ; Positron Emission Tomography Computed Tomography/adverse effects ; Risk Factors ; Lymphoproliferative Disorders/diagnosis ; Lymphoproliferative Disorders/etiology ; Lymphoproliferative Disorders/therapy ; Tissue Donors ; Immunosuppressive Agents/adverse effects
Chemical Substances	Immunosuppressive Agents
Language	English
Publishing date	2024-02-22
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	639400-0
ISSN	1557-9816 ; 0955-470X
ISSN (online)	1557-9816
ISSN	0955-470X
DOI	10.1016/j.trre.2024.100837
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Article ; Online: Corrigendum to "Post-transplant lymphoproliferative disorders following kidney transplantation: A literature review with updates on risk factors, prognostic indices, screening strategies, treatment and analysis of donor type" [Transplantation Reviews 2024; 38(2):100837].

Ergisi, Mehmet / Ooi, Bryan / Salim, Omar / Papalois, Vassilios

Transplantation reviews (Orlando, Fla.)

2024 Volume 38, Issue 2, Page(s) 100843

Language	English
Publishing date	2024-03-26
Publishing country	United States
Document type	Published Erratum
ZDB-ID	639400-0
ISSN	1557-9816 ; 0955-470X
ISSN (online)	1557-9816
ISSN	0955-470X
DOI	10.1016/j.trre.2024.100843
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Article ; Online: How can we address the ever-pressing need to 'green up' surgical practice in the National Health Service?

Anastasopoulos, Nikolaos-Andreas / Papalois, Vassilios

Journal of the Royal Society of Medicine

2022 Volume 115, Issue 6, Page(s) 213–219

Abstract: Clinical practice has inadvertently changed after the COVID-19 pandemic and currently the need to provide sustainable surgical services is more pressing than ever. The National Health Service has committed to a long-term efficient plan to reduce carbon ... ...

Abstract	Clinical practice has inadvertently changed after the COVID-19 pandemic and currently the need to provide sustainable surgical services is more pressing than ever. The National Health Service has committed to a long-term efficient plan to reduce carbon footprint but there is no detailed plan for surgical practice, the domain that contributes the most to hospital-derived pollution. A series of consecutive steps and measures ought to be taken, starting from a hybrid approach quantifying surgically attributed carbon footprint. Then, a variety of suggested measures can be widely discussed and accordingly applied on a wider or more local level. Appropriate training should always precede implementing new practices to ensure that staff is familiar with these. These measures cover a broad range and should be arranged on a patient-centred basis from preoperative preconditioning to an effective follow-up. The need for more intense research and implementation of enhanced recovery protocols is widely discussed. Also, the necessity of green research and reinvestment of materials and resources is highlighted. A change of philosophy from a cradle-to-grave approach to a repurposing approach is suggested. We are confident that a new era is dawning in surgical practice and teamwork is the key for providing greener surgical services.
MeSH term(s)	COVID-19 ; Humans ; Pandemics/prevention & control ; State Medicine
Language	English
Publishing date	2022-05-03
Publishing country	England
Document type	Journal Article
ZDB-ID	6731-3
ISSN	1758-1095 ; 0141-0768 ; 0035-9157
ISSN (online)	1758-1095
ISSN	0141-0768 ; 0035-9157
DOI	10.1177/01410768221095242
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Article ; Online: Evaluation of the usefulness of the Clavien-Dindo classification of surgical complications.

Golder, Henry / Casanova, Daniel / Papalois, Vassilios

Cirugia espanola

2023 Volume 101, Issue 9, Page(s) 637–642

Abstract: The Clavien-Dindo (CD) classification is widely used in the reporting of surgical complications in scientific literature. It groups complications based on the level of intervention required to resolve them, and benefits from simplicity and ease of use, ... ...

Abstract	The Clavien-Dindo (CD) classification is widely used in the reporting of surgical complications in scientific literature. It groups complications based on the level of intervention required to resolve them, and benefits from simplicity and ease of use, both of which contribute its to high inter-rater reliability. It has been validated for use in many specialties due to strong correlation with key outcome measures including length of stay, postsurgical quality of life and case-related renumeration. Limitations of the classification include concerns over differentiating grade III and IV complications and not classifying intraoperative complications. The Comprehensive Complication Index is an adaptation of the CD classification which generates a morbidity score from 0 to 100. It has been proposed as a more effective method of assessing the morbidity burden of surgical procedures. However, it remains less popular as calculations of morbidity are complicated and time-consuming. In recent years there have been suggestions of adaptations to the CD classification such as the Clavien-Dindo-Sink classification, while in some specialties, completely new classifications have been proposed due to evidence the CD classification is not reliable. Similarly, the Surgical Expertise and Validity Evaluation project aims to determine benchmarks against which surgeons may compare their own practice.
MeSH term(s)	Humans ; Postoperative Complications/etiology ; Reproducibility of Results ; Quality of Life ; Intraoperative Complications ; Outcome Assessment, Health Care
Language	English
Publishing date	2023-02-11
Publishing country	Spain
Document type	Journal Article
ISSN	2173-5077
ISSN (online)	2173-5077
DOI	10.1016/j.cireng.2023.02.002
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Article: Translational research and innovation in modern transplant practice: Paradigms from Greece and around the world.

Tsoulfas, Georgios / Boletis, Ioannis / Papalois, Vassilios

World journal of transplantation

2023 Volume 13, Issue 2, Page(s) 25–27

Abstract: The continuous clinical and technological advances, together with the social, health and economic challenges that the global population faces, have created an environment where the evolution of the field of transplantation is essentially necessary. The ... ...

Abstract	The continuous clinical and technological advances, together with the social, health and economic challenges that the global population faces, have created an environment where the evolution of the field of transplantation is essentially necessary. The goal of this special issue is to provide a picture of the current status of transplantation in Greece as well as in many other countries in Europe and around the world. Authors from Greece and several other countries provide us with valuable insight into their respective areas of transplant expertise, with a main focus on the field of translational research and innovation. The papers that are part of this Special Issue "Translational Research and Innovation and the current status of Transplantation in Greece" have presented innovative and meaningful approaches in modern transplant research and practice. They provide us with a clear overview of the current landscape in transplantation, including liver transplantation in the context of a major pandemic, the evolution of living donor kidney transplantation or the evolution of the effect of hepatitis C virus infection in transplantation, while at the same time explore more recent challen ges, such as the issue of frailty in the transplant candidate and the changes brought by newer treatments, such as immunotherapy, in transplant oncology. Additionally, they offer us a glimpse of the effect that technological innovations, such as virtual reality, can have on transplantation, both in terms of clinical and educational aspects. Just as critical is the fact that this Special Issue emphasizes the multidisciplinary, collaborative efforts currently taking place that link transplant research and innovation with other cutting-edge disciplines such as bioengineering, advanced information technology and artificial intelligence. In this Special Issue, in addition to the clinical and research evolution of the field of transplantation, we are witnessing the importance of interdisciplinary collaboration in medicine.
Language	English
Publishing date	2023-02-24
Publishing country	United States
Document type	Editorial
ISSN	2220-3230
ISSN	2220-3230
DOI	10.5500/wjt.v13.i2.25
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Article ; Online: Management of pancreatic trauma: a literature review.

Papalois, Vassilios

Cirugia espanola

2017 Volume 95, Issue 3, Page(s) 131–134

Abstract: The European Union of Medical Specialists, founded in 1958, is the largest and oldest european medical organization. It includes 39 member states (of the European Union and others), and represents a total of 1.600.000 medical specialists. The main ... ...

Title translation	Orientación terapéutica del traumatismo pancreático: revisión de la literatura.
Abstract	The European Union of Medical Specialists, founded in 1958, is the largest and oldest european medical organization. It includes 39 member states (of the European Union and others), and represents a total of 1.600.000 medical specialists. The main objective of the UEMS is to influence european healthcare politics by promoting the interests of the european medical specialists, establishing high standards in practice and training, as well as continuing medical education and professional development, and guaranteeing quality in specialist practice. The UEMS is developing several projects to face current and future challenges related to surgical training, education, acreditation, revalidation and professional development: i.- First, the UEMS is developing homogeneous requisites for European Training (ETRs), ii.- To manage the quality control process of the ETRs and evaluation of the organization, the UEMS has created the Council of european specialized medial evaluations (CESMA), iii.- The UEMS has been greatly involved in the acreditation process of training centres in all of Europe, iv.- in relation to continuing medical education, the European Accreditation Council for Continuing Medical Education (EACCME) is the main project of the UEMS for the accreditation of educational events and v.- the UEMS has established the Network of Accredited Clinical Skills Centres of Europe (UEMS-NASCE), that facilitates the accreditation and cooperation of training centres in Europe. In conclusion, with the great support of National Surgical Societies of the UEMS and the Surgery Section a series of solid projects have been established to support the professional development of the collective in Europe. This process constitutes a continuous effort that is very gratifying, with the aim to set the standards for a brilliant future for surgery students and specialized surgeons.
Language	Spanish
Publishing date	2017-03
Publishing country	Spain
Document type	Journal Article
ZDB-ID	730701-9
ISSN	1578-147X ; 0009-739X
ISSN (online)	1578-147X
ISSN	0009-739X
DOI	10.1016/j.ciresp.2017.03.001
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Article ; Online: Microdialysis in Abdominal Organ Transplantation and the Potential for Integration with Dynamic Preservation Platforms and Post Transplant Monitoring.

Hamaoui, Karim / Gowers, Sally / Boutelle, Martyn / Papalois, Vassilios

European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes

2023

Abstract: The perpetual organ shortage crisis worldwide has meant a paradigm shift in global thinking with subsequent expansion of the accepted criteria for an organ donor to meet the demand. Robust pre-transplant organ viability assessment is the next great ... ...

Abstract	The perpetual organ shortage crisis worldwide has meant a paradigm shift in global thinking with subsequent expansion of the accepted criteria for an organ donor to meet the demand. Robust pre-transplant organ viability assessment is the next great challenge in the field of transplantation today. Organ preservation in the nature of static cold storage has reached its limits, and machine perfusion both cold and warm offers theoretically superior preservation and the potential to assess organs. Microdialysis is a novel technique with proven ability to allow remote assessment of tissue biochemistry and metabolism. It has been used in various pre-clinical and clinical models of abdominal organ preservation and transplantation. This review focuses on the use of microdialysis in the assessment of the kidney, liver, and pancreas, and where this novel technology is heading in the context of the assessing organ viability prior to and after transplantation.
Language	English
Publishing date	2023-12-11
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	205700-1
ISSN	1421-9921 ; 0014-312X
ISSN (online)	1421-9921
ISSN	0014-312X
DOI	10.1159/000535744
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Article ; Online: SEVE project (Surgical Expertise Validity Evaluation) risk adjusted quality by standard data.

Casanova, Daniel / Papalois, Vassilios

Cirugia espanola

2021

Abstract: The SEVE project (Surgical Expertise Validity Evaluation) is a collaborative effort of the AEC (Spanish Association of Surgeons) and the Section of Surgery of the European Union of Medical Specialists (UEMS) that aims to develop a model and an on line ... ...

Abstract	The SEVE project (Surgical Expertise Validity Evaluation) is a collaborative effort of the AEC (Spanish Association of Surgeons) and the Section of Surgery of the European Union of Medical Specialists (UEMS) that aims to develop a model and an on line application that can be used to evaluate surgical complications. The aim is to identify the optimal results that can be obtained in each intervention, in order to present them as a reference for our usual practice (benchmarking).
Language	Spanish
Publishing date	2021-04-23
Publishing country	Spain
Document type	Journal Article
ISSN	2173-5077
ISSN (online)	2173-5077
DOI	10.1016/j.ciresp.2021.03.016
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Article: Working towards an ERAS Protocol for Pancreatic Transplantation: A Narrative Review.

Elango, Madhivanan / Papalois, Vassilios

Journal of clinical medicine

2021 Volume 10, Issue 7

Abstract: Enhanced recovery after surgery (ERAS) initially started in the early 2000s as a series of protocols to improve the perioperative care of surgical patients. They aimed to increase patient satisfaction while reducing postoperative complications and ... ...

Abstract	Enhanced recovery after surgery (ERAS) initially started in the early 2000s as a series of protocols to improve the perioperative care of surgical patients. They aimed to increase patient satisfaction while reducing postoperative complications and postoperative length of stay. Despite these protocols being widely adopted in many fields of surgery, they are yet to be adopted in pancreatic transplantation: a high-risk surgery with often prolonged length of postoperative stay and high rate of complications. We have analysed the literature in pancreatic and transplantation surgery to identify the necessary preoperative, intra-operative and postoperative components of an ERAS pathway in pancreas transplantation.
Language	English
Publishing date	2021-04-01
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm10071418
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