Native Ureterotransplant Ureterostomy for Ureteral Obstruction after Simultaneous Pancreas Kidney Transplantation

Significant surgical complications occur in about half of patients after simultaneous pancreas kidney transplantation (SPK) with bladder drainage. Urologic complications are very common in bladder-drained pancreas transplants. Urinary obstruction occurs in either the early or the late period following transplantation. Predictors of urological complications after transplantation have not been well established. Early obstruction is usually diagnosed by an increment of serum creatinine or through imaging studies, such as ultrasound and antegrade pyelogram. Surgical management is inevitable when conservative managements fails. If the length of the donor ureter is sufficient, it is possible to redo the ureteroneocystostomy. However, if this is not the case or the stricture is at a high level, a native ureterotransplant ureterostomy may be the procedure of choice. SPK was performed on a 36 year old male patient with insulin dependent diabetes mellitus and diabetic nephropathy. The pancreatic exocrine secretion was drained by duodenocystostomy. The patient developed an obstruction in upper ureter on the postoperative 16th day. On the postoperative 32nd day, a native ureterotransplant ureterostomy with a double J stent was performed. The postoperative course was uneventful. The double J stent was removed on postoperative 112nd day by cystoscope. A subsequent follow up showed excellent pancreatic and renal function.

Mast Cells in Renal Allografts

PURPOSE: Chronic rejection is the enemy in the battle for long term survival after renal allografts. Interstitial fibrosis is known to be the important finding in renal allografts with chronic rejection. Mast cells secrete a large number of fibrogenic factors and have been involved in chronic inflammation and tissue fibrosis. In this study the authors evaluated the relationship between mast cells and fibrosis in renal allografts with chronic rejection. METHODS: The authors evaluated 42 biopsied specimens of renal allografts. Immunohistochemistry using anti-mast cell tryptase (Dako, 1 : 200) and an LSAB kit (Dako) was applied to detect mast cells. The mean number of mast cells (MNM) per 10 high power fields was counted. RESULTS: MNM of implantation biopsies was 0.640+/-0.537, of acute rejection -1.969+/-1.216, of chronic rejection -6.0+/-3.133 (P0.05). CONCLUSION: Our data show that the number of mast cells in renal allograft was significantly associated with chronic rejection, donor sex and hypercholesterolemia.