Giuliano Testa M.D.

Testa, G., E. C. Koon, L. Johannesson, G. McKenna, T. Anthony, G. B. Klintmalm, R. T. Gunby, Jr., A. M. Warren, J. M. Putman, G. dePrisco, J. M. Mitchell, K. Wallis and M. Olausson (2017). “Living donor uterus transplantation: A single center’s observations and lessons learned from early setbacks to technical success.” Am J Transplant: Apr [Epub ahead of print].

Full text of this article.

Uterus transplantation is a vascularized composite allograft transplantation. It allows women who do not have a uterus to become pregnant and deliver a baby. In this paper we analyze the first 5 cases of Living Donor Uterus Transplantation performed in the US. The first 3 recipients lost their uterus grafts at day 14, 12 and 6 after transplant. Vascular complications, related to both inflow and outflow problems, were identified as the primary reason for the graft losses. Two recipients, 6 and 3 months post-transplant have functioning grafts with regular menstrual cycles. Ultimate success will be claimed only after a live birth. This paper is an in-depth analysis of evaluation, surgical technique and follow-up of these five living donor uterus transplants. The lessons learned were instrumental in allowing us to evolve from failure to technical and functional success. We aim to share our conclusions and build on the knowledge in the evolving field of uterus transplantation.

Testa, G., E. C. Koon and L. Johannesson (2017). “Living Donor Uterus Transplant and Surrogacy: Ethical Analysis According to the Principle of Equipoise.” Am J Transplant 17(4): 912-916.

Full text of this article.

The uterus is the most recent addition to the list of organs that can be successfully transplanted in humans. This article analyzes living donor uterus transplantation according to the ethical principle of equipoise. A comparison is made between living donor uterus transplantation and gestational surrogate motherhood. Both are solutions to absolute uterine infertility that allow the transfer of genetic material from intended parents to a child. The analysis concludes that living donor uterus transplantation does not violate the ethical principle of equipoise and should be considered an ethically acceptable solution to absolute uterine infertility.

Kim, P. T., H. Fernandez, A. Gupta, G. Saracino, M. Ramsay, G. J. McKenna, G. Testa, T. Anthony, N. Onaca, R. M. Ruiz and G. B. Klintmalm (2017). “Low measured hepatic artery flow increases rate of biliary strictures in deceased donor liver transplantation: An age-dependent phenomenon.” Transplantation 101(2): 332-340.

Full text of this article.

BACKGROUND: This study was conducted to determine effect of lower measured hepatic arterial (HA) flow (<400 mL/min) on biliary complications and graft survival after deceased donor liver transplantation. Hepatic artery is the main blood supply to bile duct and lack of adequate HA flow is thought to be a risk factor for biliary complications. METHODS: A retrospective review of 1300 patients who underwent deceased donor liver transplantation was performed. Patients with arterial complications were excluded to eliminate potential contribution to biliary complications from HA thrombosis. Patients were divided into low (<400 mL/min; N = 201) and high (>/=400 mL/min; N = 1099) HA flow groups. Incidence of biliary complications and graft survival were analyzed. RESULTS: HA flows less than 400 mL/min were associated with increased rate of biliary strictures in younger donors (<50 years old), and in patients with duct-to-duct anastomoses (P = 0.028). Lower HA flows were associated with decreased graft survival (P = 0.013). Donor older than 50 years was associated with increased rate of biliary strictures (hazard ratio [HR], 1.67; 95% confidence interval [CI], 1.14-2.45; P = 0.0085) and graft failure (HR, 1.68; 95% CI, 1.35-2.1; P <0.0001) on multivariate analyses. HA flow less than 400 mL/min was associated with biliary strictures (HR, 1.53; 95% CI, 1.04-2.24; P = 0.0297) on univariate analysis only. CONCLUSIONS: HA flow less than 400 mL/min was associated with higher rate of biliary strictures in younger donors with duct-to-duct reconstruction and lower graft survival. A consideration should be given to increase the intraoperative HA flow to prevent biliary strictures in such patients.

Testa, G., E. C. Koon and L. Johannesson (2016). “Living donor uterus transplant and surrogacy ethical analysis according to the principle of equipoise.” Am J Transplant: 2016 Oct [Epub ahead of print].

Full text of this article.

The uterus is the most recent addition to the list of organs that can be successfully transplanted in humans. This paper analyzes living donor uterus transplantation according to the ethical principle of equipoise. A comparison is made between living donor uterus transplantation and gestational surrogate motherhood. Both are solutions to absolute uterine infertility that allow the transfer of genetic material from intended parents to a child. The analysis concludes that living donor uterus transplantation does not violate the ethical principle of equipoise and should be considered an ethically acceptable solution to absolute uterine infertility.

Fernandez, H. T., P. T. W. Kim and G. Testa (2016). “Adrenal cortical carcinoma with pulmonary emboli: A unique presentation of a rare tumor with extensive tumor thrombus and inferior vena cava extension.” International Journal of Hepatobiliary and Pancreatic Diseases 6: 30-33.

Full text of this article.

Introduction: Adrenal cortical carcinoma (ACC) is rare, and presenting symptoms vary widely depending on functional or non-functional endocrine status. These tumors are most commonly treated with surgical resection and postoperative mitotane administration. Case Report: This is an unusual presentation of a 23-year-old female with no significant past medical history, admitted to the hospital with syncope and dyspnea. Computed tomography angiography (CTA) demonstrated extensive bilateral pulmonary embolisms, with an associated 16-cm assumed right lobe hepatic mass with suprahepatic vena cava tumor thrombus extension beyond the level of the hepatic veins. The patient underwent a complete resection of the right adrenal mass, with inferior vena cava resection, thrombectomy, and placement of caval interposition graft without the use of bypass. Pathology was consistent with adrenal cortical carcinoma. Conclusion: This case of an adrenal cortical carcinoma, with a rare presentation of bilateral pulmonary embolisms, was treated with a surgical R0 resection. This included a right adrenalectomy with IVC resection and interposition graft. Tumors with IVC involvement and tumor thrombus can be treated with surgical resection and IVC grafting, without the use of bypass.