En-bloc transplantation: an eligible technique for unilateral dual kidney transplantation

Kidney transplantation is the best available treatment for patients with end-stage renal disease. To evaluate the en bloc anastomosis technique for unilateral dual kidney transplantation [DKT]. From May to October 2011, 5 patients [4 women and 1 man] with mean age of 31.8 years underwent unilateral DKT with this technique in which distal end of the aorta and proximal end of inferior vena cava [IVC] were closed with running sutures. Then, proximal end of the aorta and distal end of the IVC were anastomosed to internal [or external] iliac artery and external iliac vein, respectively. Post-operative course was uneventful. No vascular and urologic complications developed; all patient had acceptable serum creatinine at discharge time and up of 2-6 months of post-operation follow up. Unilateral DKT is a safe method for performing DKT. The proposed en bloc anastomosis can improve the outcome of the graft by reducing the cold ischemia and the operation time

Liver transplantation in the presence of old portal vein thrombosis

Portal vein thrombosis [PVT] has been mentioned as a potential obstacle to liver transplantation [LTx]. To review the impact of PVT on orthotopic liver transplant [OLT] outcome. Between January 2006 and April 2009, 440 OLT were performed in Shiraz Transplant Unit of whom, 35 [7.9%] cases had old PVT with recanalization. Data were retrospectively collected regarding the demograph- ics, indication for OLT, Child-Turgot-Pugh classification, pre-transplant diagnosis of PVT, perioperative course and managements, relapse of PVT, early post-operative mortality and morbidity. All patients received liver from deceased donors, underwent thrombendvenectomy with end-to-end anastomosis without interposition graft and evaluated daily for 5 days and thereafter, biweekly by duplex sonography during the follow-up period for 2 months. They were treated by therapeutic doses of heparin followed by warfarin to maintain an INR of 2-2.5. The causes of end-stage liver disease were hepatitis B in 11, cryptogenic cirrhosis in 11, primary scle- rosing cholangitis in 5 and other causes in 8 recipients. Extension of thrombosis was through confluence of superior mesenteric and splenic vein in 32 and to superior mesenteric vein in 3 patients. The mean +/- SD op- eration time was 7.2 +/- 1.5 hrs. The mean +/- SD transfusion requirement was 5.4 +/- 2.8 units of packed cells. The mean +/- SD duration of hospital stay in these patients was 17.7 +/- 10.9 days. Eight patients died; 1 developed early in-hospital PVT, 1 had hepatic vein thrombosis, and 1 died of in-hospital ischemic cerebrovascular ac- cident, despite a full anticoagulant therapy. The mean +/- SD follow-up period for those 28 patients discharged from hospital was 16.6 +/- 7.9 months; none of them developed relapse of PVT. The overall mortality and mor- bidity was 28% and 32%, respectively. There was no relapse of PVT in the other patients. The presence of PVT at the time of OLT is not a contraindication for the operation but those with PVT have a more difficult surgery, develop more postoperative complications, and experience a higher in-hospital mortality

Post-reperfusion syndrome and outcome variables after orthotopic liver transplantation

Post-reperfusion syndrome [PRS] is an important during liver transplantation. We studied the occurrence and severity of PRS in patients who underwent orthotopic liver transplantation [OLT] to investigate how PRS was correlated to clinical variables and outcomes. We retrospectively recorded intra- and peri-operative data for 184 adult patients who received cadaveric OLT during a 3-year period from 2005 to 2008. Patients were divided into two groups according to the severity of PRS: Group 1 [mild or no PRS] comprised 152 patients; and group 2 [significant PRS] consisted of 32 patients. There were no significant differences in demographic and pre-operative data between groups. Group 2 had more total blood loss than group 1 [p=0.036], especially after reperfusion [p=0.023]. Group 2 required more packed red cell transfusions [p=0.005], more fresh frozen plasma [p=0.003] and more platelets [p=0.043] than group 1. Fibrinolysis was more frequent in group 2 [p=0.004]. hospital stay in group 2 was significantly longer than in group 1 [p=0.034], but the frequencies of other outcomes including infection, re-transplantation, dialysis, rejection and extended donor criteria did not differ significantly between groups. Bleeding, blood transfusion and fibrinolysis occurred more often in the group of severe PRS after reperfusion. Although postoperative complications like rejection, infection and the dialysis rate were not significantly different in the two groups, hospital stay was more prolonged in the group with severe PRS

Cardiopulmonary arrest outcome in Nemazee hospital, southern Iran

Many factors are important determinants in the outcome of cardiopulmonary resuscitation [CPR] such as quality of CPR, age of patients, co morbidities, time and location of arrest, and skill of rescuers. This study was conducted to evaluate the efficacy of CPR in Shiraz, southern Iran. From October 2007 to March 2008, all patients who received in-hospital CPR in Nemazee Hospital affiliated to Shiraz University of Medical Sciences were enrolled. Two standard scales of ROSC [Return of Spontaneous Circulation] and DR [Discharge Rate] were used to evaluate the efficacy of CPR. Two hundred and seventy one patients [45.1%] had ROSC while 329 [54.9%] died immediately after resuscitation. Among ROSC patients, 18 [6.6%] cases were discharged from the hospital [3% of study population]. Although ROSC was comparable with developed countries, but the DR was lower. It shows that in our area, post-resuscitation care needs more attention in relation to organized trainings and the skills in post-resuscitation care together with expansion of the facilities