Death of related living-donor as a surgical complication following donor open nephrectomy

Herein we report a case of living-donor s death as a result of surgical complication. This living-donor nephrectomy was complicated by bleeding and many other visceral injuries. Our case raises the possibility of weather the death of this living-donor was a result of lack of experience of our team, who had performed more than one thousand kidney transplant operations upon the last two decades, or was undiagnosed pathologic or histologic disease in the donor s vasculature. The various points of view for both these possibilities are discussed. We concluded that it is very important to perform a comprehensive evaluation to all candidates for kidney donation preoperatively. Not to mention the good experience of surgical team should be available, in addition to the necessity of paying attention to the effect of a state of false sense of self-overconfidence and laxity in the adequate supervision of the surgical world of junior resident in training

results of kidney transplantation in recipients operated by DJ-stented versus non-stented ureteroneocystostomy

Objective: to verify if the routine use of DJ-stent in kidney transplantation is worthwhile we performed a comparison between stented versus non-stented ureteroneocystostomy in kidney transplant patients. We have evaluated the mean graft function one-year postoperatively in addition to some clinical and surgical complications

Methods: this study is performed in two centers of kidney transplantation in our university. From the beginning of January 2010 until the end of December 2013 we had 220 patients [mean age was 39 +/- 7 years]. All of them were transplanted from living donors [related or non-related], with or without DJ-stenting. The follow up was one-year postoperatively

Results: no important differences were noted between the two groups [group 1 is DJ-stented, group 2 is non-stented]. These results are eligible regarding either graft function one-year postoperatively [creatine clearance=79 +/- 15 in group 1 versus 83 +/- 11 in group 2, p-value=0.08 or in clinical and surgical complications. Ureteral obstruction was noted in 0.8% versus 5% in group 1 and group 2 respectively, p-value=0.9]. Urinary leakage was found in 2% versus 8% in group 1 and 2 respectively, p-value=0.08. Urinary tract infections were documented in 45% of group 1 versus 35% of group 2, p-value =0.08. Gross hematuria was seen in 22% of group 1 versus 17% of group 2, p-value=0.12. Irretitive lower urinary tract symptoms happened in 78% of group 1 versus 16% in group 2, p-value=0.03

Conclusions: the follow-up demonstrated similar results between two groups, with one exception, regarding irretitive lower urinary tract symptoms which were higher in stented group. We believe that a larger double-blinded prospective study is more capable, if it is performed in the future, to answer the main question in this study: is it worthwhile to use DJ-stent routinely in ureteroneocystostomy in kidney transplantation. In the mean while we do not recommend the routine use of ureteral stent in kidney transplantation, otherwise just in selected cases as compromised vascularity or difficult anstomosis

[Vascular complications in kidney transplant patients]

Vascular complications are impotent after kidney Transplantation, They influence on patient and graft survival. There are a lot of factors that play are a role in incidence of these vascular compilations as technical and anatomical ones. The aim is to determine the incidence of vascular complications in kidney transplant patients in addition to signs and symptoms related to these complications, diagnosis modalities, management and results. A retrospective study, including 288 kidney transplant patients, has been performed in Kidney Transplantation Unit in Al-Mouassat University Hospital, from January 2007 until December 2009, all of them are from living donors [relative and non-relative]. Duplex Doppler Ultrasound has been performed routinely one week postoperatively for all patients. In certain cases we performed Ultrasound when signs and symptoms indicated to vascular problems. five cases of renal artery thrombosis [1,7% of patients], four cases of renal vien thrombosis [1,3% of patients], 7 cases of renal artery stenosis [2,4% of patients], The management includes PTA [percutaneous transluminal angioplasty], revision of amastomosis, renal venotomy or arteriotomy and removal of clot, and graft nephrectomy. The incidence of vascular complications in this study is less than that of most international studies, may be the cause is that we use only living donors, not cadaveric ones. The only diagnosis modality is duplex Doppler Ultrasound, we didn't use MRA [Magnetic Resonance Angiogram] or multislices CT. Early surgical exploration may be a salvage procedure leading to management of vascular problem and prevention of graft toss

Renal artery anastomosis to internal and external iliac artery in kidney transplant patients

To verify what is the best technique, we performed a comparison between two techniques of renal artery anastomosis in kidney transplant patients, including end-to-end and end-to-side anastomosis. A cohort study has been performed including 76 patients suffering from end-stage renal disease, who have been undergone kidney transplantation from living donors in our kidney transplantation unit. We divided the patients randomizely into two groups, the first one contained the patients with end-to-end anastomosis to internal iliac artery, the second contained end-to-side anastomosis to external or common iliac artery. Clinical and surgical complications in addition to graft and patient survival have been evaluated. No differences in clinical and surgical complications were noted between the two groups in the primary hospitalization period [p=0.42, p=0.65], creatinine clearance was similar also [p=0.88]. One-year postoperative analysis showed similar results regarding graft and patient survival [p=0.25, p=0.82], and creatinine clearance [p=0.75]. Erectile dysfunction rate was higher in end-to-end anastomosis. The follow up demonstrated similar results in the two groups with one exception regarding erectile dysfunction [ED] rate which was higher in end-to-end anastomosis group. We think that a larger double blinded prospective study is more capable, if it is done in the future, to answer the main question in this study [what is the best technique?], in the meantime we recommend doing end-to-side renal artery anastomosis

[ effects of kidney with multiple arteries as a graft from living-donors on the results of kidney transplantation]

The aim of this study is to evaluate the effects of multiple-arteries kidney graft from living-donors on the results of kidney transplantation. The use of multiple-arteries kidney graft was considered in the past a relative contraindication because of high rate of urologic and vascular complication. The lack of organs and disequilibrium between the patients on waiting list and who were operated in kidney transplant centers result in the use of marginal organs [as example: increased blood pressure, Diabetes Mellitus, and the organs with anatomical abnormalities as duplication of urinary tract, multiple arteries, multiple veins]. The medical files of 750 patients transplanted in Kidney Transplant Unit between January 2004 and December 2009 were reviewed. The result were 48 cases with multiple arteries kidney. We performed a retrospective analysis of these 48 patient looking for complications, warm ischemia time, cold ischemia time, vascular anastomosis time, the duration of hospitalization and patient and graft survival. We noticed the following complications: 2 cases: lymphocele [4%], 2 cases: urinary fistula [4%], 2 cases: arterial stenosis [4%], 1 case: arterial thrombosis [2%], 8 cases: delayed graft function [16%]. The mean of warm ischemia time was 58 +/- 4 seconds, the mean of cold ischemia time was 11 +/- 4 minute, the mean of vascular anastomosis time was 32 +/- 7 minute, and the primary hospitalization was 8 +/- 2 days. One - year patient survival was 95.8% and one - year graft survival was 83.3%. This study revealed that the results and the complication rate after the multiple arteries kidney transplantation are comparable to that mentioned in international studies after kidney transplantation in general.