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

Papers by Deborah Verran

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

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.

Transplantation, 2008

Background: Despite the efforts for transplants, dialysis remains the usual way of treatment of E... more Background: Despite the efforts for transplants, dialysis remains the usual way of treatment of ESRD in the Balkans. The living renal transplantation (LRT) is still predominant but there is an enormous gap between the demand and supply of kidneys.Due to the very well known reasons, there is still no any cooperation in the fi eld of transplantation among the Balkan countries. Trying to solve the problem, we started to accept expanded criteria living donors (ECD) as well as preemptive transplants from ECD as a fi rst choice of treatment of ESRD. Methods: 185 LRT are performed in our Department in the last 18 years. ECD group has 54 donors older than 65 years, 2 ABO incompatible, 21 unrelated, 10 with mild arterial hypertension, 4 with large simple cyst, and 2 with multiple renal arteries, one with double ureter. 30 of ECD transplantations were preemptive without performing any dialysis and blood access. The quadruple sequential immunosuppressive protocol was used in all cases including induction with ATG or Il-2R antagonists, Cyclosporine A, MMF/AZA and Steroids. In ABO incompatible transplants a special preconditioning regimen for recipients was used including laparoscopic splenectomy, Rituximab, plasmapheresis and IvIg. The Kaplan-Meier one, three and fi ve years graft survival rate, rejection episodes, DGF and actual renal function were analysed. The results were compared with the group of 80 LRT with younger donors (YGD) performed in the same time. Results: One, three and fi ve years Kaplan-Meier graft survival rate for the ECD was 94%, 83% and 65% respectively compared with 95%, 87% et 75% of YGD. The group of preemptive ECD living transplantation showed superior graft (95, 87 and 78%) survival compared with the younger group of donors. The percentage of DGF was 15% in ECD group compared with 8% in YGD. Both differences are statistically signifi cant. The rejection episodes rate in ECD and YGD was 24% and 21%, respectively. The actual serum creatinin in ECD was 178 micromol/lit, compared with 154 in the YGD. The last two differences are not statistically signifi cant. Conclusion: The results in our study fully justify the use of ECD especially in the regions where the LRT is predominant transplant activity. Expanded criteria living donors are available and their use is much more easily. The treatment is cheaper and more effective compared with the cadaver transplantation. As elsewhere, it may ameliorate the actual organ shortage in the Balkans. Bearing in mind the very good results, the dialysis cost and underdevelopped cadaver program, the preemptive living ECD transplantation is recommended as a fi rst choice in the treatment of ESRD on the Balkans.

Transplantation Journal, 2010

ABSTRACT Body: Introduction Hepatic venous outflow tract obstruction (HVOO) is uncommon after ped... more ABSTRACT Body: Introduction Hepatic venous outflow tract obstruction (HVOO) is uncommon after pediatric liver transplantation. We report 7 children with post liver transplant HVOO; their clinical features, investigations, management and outcomes. Methods Retrospective chart review of children with HVOO, transplanted at Australian National Liver Transplant Unit, Sydney, Australia (1985-2009). Demographics Of 228 transplants performed in 197 children, 7(3%) developed HVOO. 5 male, 4.5 years mean age). Indications: alpha-1-antitrypsin deficiency(3), biliary atresia(1); retransplant(3). Grafts all reduced size: 6 cut-downs (2 left lobe; 4 left lateral segment (LLS), II and III); in-situ split LLS 1). 2 were urgent transplants, one of which included an urgent re-transplant. The same surgical team has performed the vast majority of the total pediatric liver transplants from our centre. The hepatic vein-inferior vena cava anastomosis was performed by piggy-backing the donor hepatic vein(s) to the recipients hepatic venous confluence via the triangulation technique, with modifications as required. Results HVOO diagnosed 20 months (mean) post transplant (range 1 month to 8.2 years). Symptoms often subtle: abdominal pain(3), diarrhea(1); 2 children asymptomatic. Clinical signs: splenomegaly(6), ascites(5), edema(3), hepatomegaly(3), rapid marked weight gain(2). Jaundice unusual(1). Liver function tests were minimally deranged. The bilirubin was normal in 5 patients, with mild elevations in the other two (total/conjugated 110/25 and 31/17). Transaminases (AST, ALT) were normal(3), and ranged from 1-2 x normal(3), to > 4 x normal (1 patient). Serum albumin was usually low, mean 20 g/L. Other laboratory parameters included full blood counts, with abnormal values seen in 4 patients, usually reflecting hypersplenism (low platelets, white cell count). Coagulation was abnormal (despite near normal LFT), mean INR of 1.9. Diagnostic imaging with doppler ultrasound (US) was unreliable in identifying HVOO - reports of normal hepatic veins (HV) in 3, while patency of the HV (4) but with flow anomalies (dampened trace, loss of triphasic pattern, monophasic character). CT (2) and MRI (1) scans had "normal HV" when performed. Hepatic venogram the gold standard investigation for HVOO. All seven patients had a stricture at the HV/IVC anastomosis, and when measured there was significant pressure gradient across the anastomosis. Liver biopsy when performed (3) directly led to hepatic venograms and the diagnosis of HVOO. Management was balloon dilatation in all 7 patients: once only (1), 1-5 (3), >5 (3). HV stents were placed (3); two patients required x 3 stents. Outcomes: retransplant (4) for graft failure due to HVOO. Three of these had already undergone 2nd transplant, and all had required stenting. 1 has evolving cirrhosis (multifactorial including HVOO), another requires regular dilatations (x 9 over 4 year period). Conclusion HVOO post pediatric liver transplant results in significant morbidity and graft loss. The clinical presentation can be subtle. LFT are often minimally abnormal, and doppler US is unreliable. Diagnosis requires a high index of clinical suspicion, and is confirmed by hepatic venography. Treatment is with balloon dilatation; stenting in our experience has not been successful. All our patients with HVOO had received reduced size grafts; three who developed HVOO after their 2nd graft required a 3rd graft.

Nephrology Dialysis Transplantation, 1998

Liver Transplantation, 2009

The use of extended criteria donors is an effective way of reducing the shortage of deceased dono... more The use of extended criteria donors is an effective way of reducing the shortage of deceased donor organs. Evidence of significant liver trauma in a deceased donor usually rules out transplantation of the liver. The aim of this study was to evaluate the use and outcomes of donor livers with preprocurement trauma. Records of all 312 deceased donors with a history of trauma between January 1986 and September 2007 were reviewed. Donors with macroscopic liver injuries were identified, and data from recipient medical records were obtained. Data on declined donor offers were also evaluated. The median donor age was 20 (range, 10-57) years, and 9 of 15 (60%) were male. The liver injuries were predominantly lacerations (grades 1-5) and vascular injury. The right lobe was resected because of extensive damage in 3 cases. This resulted in 2 left lobes (back-table cut-down) and 1 left lateral segment allograft (in situ split). For the 15 recipients, the median age was 43 (3-69) years. Primary nonfunction was not seen. There was no difference in survival between whole and partial allografts. Three deaths occurred within 3 months post-transplantation. During the same period, 42 of 1405 donor offers (3%) were declined because of extensive liver trauma or major ongoing intra-abdominal hemorrhage. In conclusion, the use of donor livers with preexisting trauma leads to acceptable outcomes. Strategies to deal with trauma include resection of the right lobe if required. Use of deceased donor livers with injury is a safe way to expand the donor pool.

Journal of Gastroenterology and Hepatology, 2012

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 r...

Clinical Transplantation, 2001

Transplantation of renal allografts (RA) from older donors has become more common, despite confli... more Transplantation of renal allografts (RA) from older donors has become more common, despite conflicting data on outcome between reports from large series versus individual centres. Factors other than donor age per se may contribute to RA outcome. The outcome of RA procured from 114 older donors over 55 yr of age in NSW, between 1990 and 1997, was analysed. Corresponding donor factors, including demographics, medical history, inotrope use, major hypotension and findings at procurement, were also analysed. Of the potential RA, 8% were discarded and the remainder transplanted. Factors significantly associated with renal discard were pre-transplantation donation biopsy abnormality (p < 0.001) and a history of cardiovascular (CV) disease in the donor (p < 0.02). Donor aortorenal atherosclerosis (AS; p < 0.09) and a donor age of 65 yr or older (p < 0.08) were common in the discard group. The never function rate was 7.6% and was associated with a history of a discarded partner kidney (p < 0.05). The delayed graft function rate was 33% and was associated with a history of donor CV disease. At a median follow up of 5 yr, the death censored allograft failure rate was 24%. Allograft failure was associated with a history of donor hypertension (p < 0.05). Donor AS (p < 0.7) tended to have been more common in the allograft failure group. A number of cadaveric organ donor factors documented at procurement may be associated with inferior outcome of RA. These include biopsy abnormality, history of donor CV disease and history of donor hypertension. A donor age of 65 yr or older or significant visible aortorenal AS may also be factors. This retrospective review of kidneys procured from 114 older cadaveric organ donors identifies factors apart from donor age, which may have a negative impact on both allograft utilisation and outcome. Theses factors include renal biopsy abnormality, history of donor CV disease, discard of a partner kidney and donor hypertension. Visible AS in the donor aorta documented at renal procurement may also be a factor.

ANZ Journal of Surgery, 1998

To test the effectiveness of a simpler surgical technique for cadaveric liver procurement for liv... more To test the effectiveness of a simpler surgical technique for cadaveric liver procurement for liver transplantation, a prospective randomized study was carried out between August 1994 and December 1995, to compare aortic perfusion only (APO) for flush-preservation of the liver with the conventional combined aortic and portal perfusion (APP) technique. Forty multiple organ donors were enrolled with 20 in each arm of the trial. Donor parameters (age, bodyweight, liver function tests), surgeons performing the operations, the involvement of other procurement teams and the total ischaemic times were similar in the two groups. The liver recipients had a wide range of native liver pathology but were of similar age, sex and bodyweight in the two groups. The mean procurement operation times for the APO and APP groups were 126.7+/-38.6 and 137.8+/-55.9 min, respectively (P=ns). The perfusion took longer to complete in the APO group (10.2+/-1.7 vs 7.2+/-1.4 min (APP), P < 0.001). The liver temperature fell to its lowest level (12.5+/-3.4 degrees C (APO) vs 11+/-3 degrees C (APP), P=ns) in a similar time (11.9+/-3.8 min (APO) vs 9.3+/-3.4 mins (APP), P=ns). There was no graft primary non-function or graft arterial injury in either group. There was no significant difference between the APO and APP initial graft outcomes. The 3-month patient survival rate was identical in the two groups (95%); 81% of renal grafts from the APO donors functioned well from the time of transplantation as did 76% of those from APP donors. It is concluded that the APO procurement technique produces equivalent results to those achieved with the APP method. The simplicity of the APO technique makes it the preferred technique.

Development, 1995

The vertebrate ocular lens undergoes a spatially defined pattern of differentiation which may be ... more The vertebrate ocular lens undergoes a spatially defined pattern of differentiation which may be regulated by the ocular distribution of proteins from the fibroblast growth factor (FGF) family. The ability of altered FGF-1 (acidic FGF) distribution to disrupt the normal pattern of lens differentiation was evaluated by the production of transgenic mice which express FGF-1 under the control of the lens-specific αA-crystallin promoter. Since FGF-1 lacks a classical signal peptide consensus sequence, transgenic mice were also produced with a chimeric construct containing the signal peptide sequence of the FGF-4 gene fused in frame to the coding sequences of the FGF-1 cDNA in order to obtain extracellular expression of the transgene. The presence of transgenic mRNA and protein was confirmed by in situ hybridization, Western analysis and immunohistochemistry. The ocular histology of newborn and young adult transgenic mice expressing FGF-1 without a signal peptide appeared normal. In contr...

Journal of Vascular Surgery, 2010

Introduction: Prosthetic arteriovenous grafts (AVGs) in the lower extremity represent a useful al... more Introduction: Prosthetic arteriovenous grafts (AVGs) in the lower extremity represent a useful alternative for hemodialysis vascular access when all upper limb access sites have been used or in some patients when freedom of both hands is necessary during dialysis. Reported complications include an increased risk of infection and limb ischemia. This study evaluated our experience with the patency outcomes and complication rates of polytetrafluoroethylene (PTFE) AVGs placed in the thigh. Methods: A retrospective outcomes analysis was performed of all femoral AVGs inserted between January 1992 and July 2007. Data were obtained by review of medical records for patient demographics, comorbidities, and AVG-related outcomes. Patency, complication rates, and risk factors for infection were determined. Results: A total of 153 prosthetic AVGs were placed in 127 patients (63 men). Mean patient age was 52.7 ؎ 16.3 years. Median follow-up was 25 months (range, 1-169 months). The most common underlying renal disease was glomerulonephritis in 27 (21%). Hypertension and coronary artery disease were common comorbidities, respectively, in 49 (39%) and 23 patients (18%). The primary and secondary AVG patency rates at 12 months were 53.9% and 75.3%, respectively, and 2-and 5-year patency rates were, respectively, 39.6% and 19.3% (primary) and 63.8% and 50.6% (secondary). The mean AVG survival for all cases was 31.6 months (range, 0-149 months). Surgical thrombectomy was required in 82 (54%), and 22 AVGs (14%) required surgical revision for stenosis. Infection occurred in 41 AVGs (27%), and limb ischemia occurred in 2 (1.3%). Statistical analysis did not reveal a significant risk factor for infection. Conclusions: Femoral AVGs are a suitable alternative to upper limb vascular access, with acceptable primary and secondary patency rates. Infection occurred in approximately one-quarter of cases, whereas steal was uncommon.

Liver Transplantation, 2003

Asia Pacific Journal of Health Management, 2021

Objective: To ascertain the gender distribution across public health boards in Australia. Design ... more Objective: To ascertain the gender distribution across public health boards in Australia. Design & Setting: Analysis of data and information obtained from a cross sectional audit of online publicly listed health boards within Australia from October to December 2019. Results: The majority of public health boards have close to equal representation of women as board members however women are underrepresented in Chair roles. Victoria has significantly more women on health boards, whereas New South Wales has significantly less women on health boards and in Chair positions. Conclusions: Further efforts are required to drive gender equity in senior leadership roles in public health boards across Australia