Deborah Verran - Profile on Academia.edu (original) (raw)

Papers by Deborah Verran

Case reports in transplantation, Sep 24, 2019

Surgical site infections (SSI) of the abdominal wall in renal transplant recipients can on occasi... more Surgical site infections (SSI) of the abdominal wall in renal transplant recipients can on occasion require management with negative pressure wound therapy (NPWT). is is o en successful, with a low risk of further complications. However, we describe three cases in which persistent or recurrent surgical site sepsis occurred, whilst NPWT was being deployed in adults with either wound dehiscence or initial SSI. is type of complication in the setting of NPWT has not been previously described in renal transplant recipients. Our case series demonstrates that in immunosuppressed transplant recipients, there may be ine ective microbial or bacterial bioburden clearance associated with the NPWT, which can lead to further infections. Hence recognition for infections in renal transplant patients undergoing treatment with NPWT is vital; furthermore, aggressive management of sepsis control with early debridement, antimicrobial use, and reassessment of the use of wound dressing is necessary to reduce the morbidity associated with surgical site infections and NPWT.

Impact of renal allograft implantation and immunosuppression on body composition using in vivo neutron activation analysis

PubMed, Feb 1, 1992

Comparative Experience of a Simple Technique for Laparoscopic Chronic Ambulatory Peritoneal Dialysis Catheter Placement: Comment

Australian and New Zealand Journal of Surgery, May 1, 1999

ABSTRACT

Liver Transplantation, May 1, 2000

When the Deceased Donor Has Sustained Blunt Trauma to the Liver: What Happens Next?

Transplantation, Nov 22, 2022

Frontiers in Surgery, Nov 25, 2022

Editorial: The path towards achieving gender equity for surgeons: The role of individuals, their ... more Editorial: The path towards achieving gender equity for surgeons: The role of individuals, their professional organizations along with the associated healthcare systems.

Peer Support Helps Physicians Navigate Workplace Conflict

Journal of General Internal Medicine, Mar 14, 2023

Narrative Inquiry in Bioethics, 2019

hirteen years ago our daughter had a severe adverse reaction to vaccination. Audra was ten months... more hirteen years ago our daughter had a severe adverse reaction to vaccination. Audra was ten months old in June 2003 when she received the second round of Hepatitis B (Hep B) and Diphtheria-Tetanus-Pertussis (DTaP) vaccines. Audra received her vaccines on a Wednesday and was totally paralyzed, with severe breathing difficulties, and on life support by Sunday.

Journal of The American College of Surgeons, Nov 1, 2020

Background: The aim of this study was to compare pain intensity, fatigue perception and pain thre... more Background: The aim of this study was to compare pain intensity, fatigue perception and pain threshold between manual therapy group (MTG), Instrument Assisted Soft Tissue Mobilization group(IASMTG) and no intervention group (CG) on the recovery of triathlon athletes who finished long-distance ironman triathlon. Methods: A randomized trial with concealed allocation and blinded outcome assessors was conducted with thirty triathlon athletes who completed a long-distance ironman triathlon. For seven minutes The MTG received a manual massage on quadriceps while the IASMTG received an instrument assisted soft tissue mobilization (Mioblaster®) and GC rested in sitting position. They were reassessed after intervention. The interaction group x time was calculated through mixed linear models on SPSS20 e difference in means and 95% confidence interval were calculated, and statistical significance was considered when p < 0.05. The clinical change above 2 points in the evaluation of pain and fatigue was considered relevant. Results: IASMTG presented clinical change on primary outcomes of pain (2.06cm; 0.21 to 3.91; p¼0.02) and fatigue (2.26cm; 0.48 to 4.04; p¼0.01). MTG showed changes lower than 2 points for pain (1.26; -0.58 to 3.11; p¼0.17) and fatigue (1.26; -0.57 to 3.04; p¼0.16). IASMTG was superior to MTG for pain threshold on rectus femoris (2.66 Kgf/cm 2 ; 0.12 to 5.20; p¼0.05) and thigh muscles (1.66 Kgf/cm2; 0.04 to 3.37; p¼0.05). Conclusion: Both interventions were efficient; however, IASMTG was better than manual massage on the recovery of long-distance ironman triathlon athletes.

In 2016, the Transplantation Society of Australia and New Zealand, with the support of the Austra... more In 2016, the Transplantation Society of Australia and New Zealand, with the support of the Australian Government Organ and Tissue authority, commissioned a literature review on the topic of infectious disease transmission from deceased donors to recipients of solid organ transplants. The purpose of this review was to synthesize evidence on transmission risks, diagnostic test characteristics, and recipient management to inform best-practice clinical guidelines. The final review, presented as a special supplement in Transplantation Direct, collates case reports of transmission events and other peer-reviewed literature, and summarizes current (as of June 2017) international guidelines on donor screening and recipient management. Of particular interest at the time of writing was how to maximize utilization of donors at increased risk for transmission of human immunodeficiency virus, hepatitis C virus, and hepatitis B virus, given the recent developments, including the availability of direct-acting antivirals for hepatitis C virus and improvements in donor screening technologies. The review also covers emerging risks associated with recent epidemics (eg, Zika virus) and the risk of transmission of nonendemic pathogens related to donor travel history or country of origin. Lastly, the implications for recipient consent of expanded utilization of donors at increased risk of blood-borne viral disease transmission are considered.

Anz Journal of Surgery, Aug 1, 1988

Blunt injury causing laceration of the intrdhepatic bile-ducts is fonunately rare. Two cases arc ... more Blunt injury causing laceration of the intrdhepatic bile-ducts is fonunately rare. Two cases arc presented: neither was diagnosed until 48 h after initial presentation. Both were managed by laparotomy. placement of drains in the liver lacerations, and intravenous nutrition until the leaks had stopped spontaneously. The literature is reviewed and two other cases discussed. Such injuries, once diagnosed. should be treated by surgical placement of drains right at the site of leak.

Journal of …, 2011

Background and Aim: Donor liver steatosis can impact on liver allograft outcomes. The aim of the ... more Background and Aim: Donor liver steatosis can impact on liver allograft outcomes. The aim of the present study was to comprehensively report on the impact of type and grade of donor steatosis, as well as donor and recipient factors, including the reported Donor Risk Index (DRI), on liver allograft outcomes. Methods: A review of unit data for all adult liver transplant procedures from 2001 to 2007, as well as donor offers. Donor liver biopsies were regraded for steatosis by an experienced histopathologist. Results: Steatosis was detected in 184/255 (72%) of biopsies, of which 114 (62%) had microvesicular steatosis (MiS; 68 mild, 22 moderate, 24 severe) and 70 (38%) macrovesicular steatosis (MaS; 59 mild, 7 moderate, 4 severe). The majority (66/70, 94%) of biopsies with MaS also contained MiS. Allograft steatosis was associated with increasing donor body mass index (P = 0.000), plus donor male sex (P < 0.05). Primary non function (P = 0.002), early renal failure (P = 0.040), and requirement for retransplantation (P = 0.012) were associated only with severe MaS. Early biliary complications were associated with moderate MaS (P = 0.039). Only severe MaS was significantly associated with inferior allograft survival at 3 months (relative risk = 12. 09 [8.75-19.05], P = 0.000) and 1 year (P = 0.000). Conclusions: MiS is a common finding and frequently coexists with MaS on liver allograft biopsy, while isolated MaS is uncommon. Only the presence of moderate to severe MaS is associated with inferior early allograft outcomes. The impact of severe MaS on allograft survival appears greater than other donor factors, including the calculated DRI.

Negative Pressure Wound Therapy is currently frequently used for dealing with either non-healing ... more Negative Pressure Wound Therapy is currently frequently used for dealing with either non-healing or open wounds following open abdominal surgical procedures. However, complications can arise including in particular infection, delayed and or slow wound healing, problems with device malfunction and in extreme cases failure to obtain complete healing of the abdominal wall. Due to the lack of accurate reporting of the rates of these particular complications, the true incidence remains unknown but could potentially be as high as 20% based on limited data from the last decade. The potential negative impact of NPWT on the bacterial bio burden in the abdominal wall is such that additional measures may be required to specifically address this, but evidence is lacking as to the best approach and in which patient sub groups. These particular complications can also pose additional challenges for surgeons, along with other members of the healthcare team, over and above the direct impact on patie...

Transplant International, Aug 1, 2009

Introduction: Our previous studies revealed presence of a number of growth factors and cytokines ... more Introduction: Our previous studies revealed presence of a number of growth factors and cytokines in human skin tissue fluid/lymph (TF/L) at levels higher than in serum. This prompted us to study whether TF/L may have a regulatory effect on keratinocyte (KC) growth. Aim: To study the effect of TF/L on proliferation and differentiation of KC and their stem cell markers expression. Material and methods: KC were isolated from lower limb skin and were cultured for 1 to 7 days in TF/L. Phenotypes were identified using antibodies against p63, CD29, Ki67 and PCNA. Blocking of cytokines with antibodies helped to estimate which cytokine stimulated KC proliferation and differentiation. Results: KC cultured in TF/L showed higher than in controls percentage of dividing and elongated cells from basal layer as well as lower percentage of differentiated cells from upper layers. Higher percentage of p63 and CD29 positive cells was also observed. Neutralization of IL-1β, IL-6, TNF-α, KGF caused decrease in percentage of mitotic cells. Neutralization of KGF decreased percentage of p63 and CD29 positive cells. Conclusion: TF/L cytokines have a stimulating effect on proliferation of basal KC but not on their differentiation. KGF turned to be a strong stimulator.

Nephrology Dialysis Transplantation, 1996

Renal Transplant Artery Autologous Saphenous Vein Graft Aneurysms: Late Presentation and the Need for Recall and Surveillance

Experimental and Clinical Transplantation, 2020

Autologous saphenous vein grafts are occasionally used in renal transplant recipients, particular... more Autologous saphenous vein grafts are occasionally used in renal transplant recipients, particularly in living donors with short donor vessels or after donor vessel injury during allograft procurement. Autologous saphenous vein graft aneurysm formation is described as a late complication following the use of this conduit in renal transplant. We report a case of a 45-year-old woman who developed an autologous saphenous vein graft aneurysm 21 years after her living donor transplant, which was successfully managed with explantation of the graft, cold perfusion ex situ, and resection of the aneurysm, which was followed by reconstruction using deceased donor iliac vessels. The graft was then successfully reimplanted. Based on this experience and after a review of the literature related to autologous saphenous vein graft aneurysms in renal transplant, we recommend that surveillance for this particular complication should be considered no later than 10 years after implant of an autologous saphenous vein graft when used as an arterial conduit.

OBM Transplantation, 2019

A range of corrective surgical procedures may be required in adult renal transplant recipients wh... more A range of corrective surgical procedures may be required in adult renal transplant recipients who sustain loss of integrity of the abdominal wall in the first month postoperatively. Where this involves the fascia, such as in acute fascial dehiscence or in renal allograft compartment syndrome, more sophisticated reconstructive procedures may also be required, particularly in the setting of surgical site infection. There is limited data on the use of prosthetic or biologic mesh for this type of scenario, where urgent reoperative surgery is required. Three cases are described where placement of prosthetic mesh was combined with negative pressure wound therapy in order to achieve complete healing of the abdominal wall.

Transplantation Proceedings, 2002

The author has experienced to practice the clinical works of cadaveric liver transplantation at a... more The author has experienced to practice the clinical works of cadaveric liver transplantation at a single transplantation center in Australia between 1999 and 2000. Hepatic arterial thrombosis causes higher rates of morbidity and mortality after liver transplantation. To know the associated factors, pathogenesis and patient outcome, data of 99 adult patients who underwent liver transplantation by the database for past two years were analysed. Ten patients (10%) had hepatic arterial thrombosis (HAT group). In donor demographics, brain death caused by cerebral stroke in the HAT group (90%) was significantly more than that in the non HAT group (49%) (p<0.05). The mean amount of blood transfusion in the HAT group (26665ml) was significantly greater than that in the control group (15606m1) (p<0.05). The mean hepatic arterial flow measured by Doppler flowmeter in the HAT group (214m1/min.) was lower than that in the control group (399m1/min) (p<0.01). The rate of in-hospital death or retransplantation caused by severely biliary abscess with hepatic infarction or graft failure in the HAT group (40%) tended to be higher compared to the control group (13%) (p=0.053). In conclusion, decrease of bleeding and blood transfusion, and obtaining the adequate arterial blood flow during operation were important to prevent hepatic arterial thrombosis causing higher morbidity and mortality after liver transplantation.