Simultaneous pancreas and kidney transplantation: first report from Shahid Beheshti University of Medical Sciences and review of anesthesia considerations

We report a 33 year-old woman presented with signs and symptoms of severe uncontrolled diabetes mellitus and chronic renal failure [diabetic nephropathy]. She was prepared for emergency simultaneous pancreas and kidney transplantation [SPK] using hemodialysis and after compensating for the acid - base abnormality. She was discharged from the hospital about 3 week after the surgery with good renal and pancreatic function. A 2-month follow-up revealed no complication and a good renal and pancreatic function. Due to the importance of this kind of treatment and several anesthetic considerations of SPK we present this case report along with some pearls about related anesthetic view points

The first successful simultaneous pancreas-kidney transplant in India.

Insulin-dependent diabetes mellitus is associated with renal failure, diabetic retinopathy, neuropathy and vasculopathy. We report the first successful simultaneous pancreas-kidney transplant in India in a young diabetic with renal failure. The dual transplant has cured his diabetes and renal failure and has had a beneficial effect on his neuropathy, retinopathy and quality of life. Obstacles to dual transplant in India include a lack of suitable recipients and a cadaver donor programme that is still in its infancy.

Nefropatía diabética / Diabetic nephropathy

Esta es una revisión sobre nefropatía diabética, incluyendo su historia, genética, incidencia, fisiopatología, tratamiento y trasplante de riñón-páncreas. Se recomienda la prevención y el adecuado conocimiento de esta entidad para disminuir su incidencia y severidad.

Pielonefritis enfisematosa: drenaje percutáneo y revisión actualizada / Emphysematous pyelonephritis: percutaneous drainage and review

La pielonefritis enfisematosa sigue siendo una infección grave del parénquima renal y tejidos perirrenales con gran riesgo vital, altamente asociado a pacientes diabéticos. El método de diagnóstico de elección sugerido es la TAC abdominal. En la actualidad es posible postular un tratamiento conservador como es el drenaje percutáneo guiado bajo visión tomográfica ante el tratamiento tradicional de la nefrectomía. El objetivo de este artículo es ilustrar y revisar este caso clínico tratado con drenaje percutáneo guiado por tomografía que en Chile aún no había sido reportado

Brief report: successful extension of the transplant renal vein with a synthetic vascular graft

Unexpected intraoperative vascular complications in the graft of the recipient during organ transplantation can be most vexing and require immediate attention and careful management so as not to impair the integrity and fate of the graft. We were confronted with a diabetic recipient with total fibrosis of the left iliac vein, patent inferior vena cava, totally and circumferentially calcified aorta and left iliac artery with the exception of a small area in the distal external iliac artery. The problem was solved by anastomosing the artery low onto the external iliac, and by interposing a venous polytetrafluoroethylene vascular graft between the renal vein and the inferior vena cava. The kidney function was excellent for 2 years but the patient succumbed to unrelated liver complications. A second patient with a renal vein PTFE graft has had normal graft function for 10 years. Probably because of the high blood flow through the kidney, venous synthetic grafts can be successfully used to correct venous problems during kidney transplantation

Live related renal transplantation for end stage diabetic nephropathy.

We report our results with live related renal transplantation in 43 diabetics, most of whom were non-insulin dependent, with end stage renal disease. The overall one year patient survival was 72.1% and graft survival was 65.1%. The use of Cyclosporine was associated with a significant improvement in the one year patient and graft survival (92.3% and 84.6% respectively). The most important cause of mortality was infection. Live related renal transplantation with Cyclosporine as immunosuppression is advisable for the uremic diabetic.

Pielonefritis enfisematosa: 3 casos / Enphysematous pyelonephritis: 3 cases

We report 3 patients who developed enphysemathous pyelonephritis. All were diabetic females over 50 years of age with unilateral necrotizing pyelonephritis. Intra and perirenal gas was demosntrated and all patients had infection by E. coli X ray and ultrasound studies allowed the diagnosis. Antibiotic therapy was unsuccessful and all patients had to be operated on

Transplante renal em diabéticos / Renal transplantation in diabetic patients

Foi analisada a experiência da Unidade de Transplante Renal da F.M.U.S.P. com 25 pacientes diabéticos submetidos a 26 transplantes renais e imunossuprimidos com azatiorpina e prednisona. Dezenove eram diabéticos juvenis e seis do tipo adulto. Cinco pacientes eram amauróticos no momento do transplante, sendo que dois se beneficiaram com facectomia feita no pós-transplante. A análise da sobrevida foi feita em dois períodos, sendo que no segundo (1979-1984) ela foi superponível à dos näo diabéticos transplantados na mesma ocasiäo. As complicaçöes infecciosas foram freqüentes (55% dos pacientes) tendo sido responsável por 60% dos óbitos. As complicaçöes urológicas ocorreram em 28% dos pacientes, tendo colaborado para o óbito em dois pacientes. As complicaçöes cárdio-vasculares ocorreram em 24% dos pacients e foram responsáveis por 23% dos óbitos. Vinte por cento dos pacienbtes sofreram amputaçöes nos membros inferiores decorrentes de microangiopatia. Uma paciente teve recidiva da nefropatia diabética documentada histologicamente dois anos e meio após o transplante. Um paciente biopsiado após seis anos do transplante mostrou o rim transplantado essencialmente normal. O controle clínico dos pacientes foi satisfatório e eles necessitaram doses elevadas de insulina no pós-transplante tardio, mesmo na vigência de doses baixas de corticosteróides. Conclui-se que o transplante renal é procedimento válido no tratamento do paciente diabético com insuficiência renal crônica, em que pese a elevada freqüência de complicaçöes