Application of tunnel and penetrating ureteroneocystomy in kidney transplantation / 中华器官移植杂志

Objective To investigate the new method of ureter bladder anastomosis in renal transplantation.Methods The ureter was pulled into bladder for 1.2 cm through tunnel at the lateral- top of bladder wall,and the ureter fixed on the bladder wall by 2-3 acus with catgut suture.Results Forty of 42 patients had no complications,and recovered very well,except for 1 cases of necrosis caused by acute rejection and 1 case on urine leakage caused by catheter obstruction from blood clot.Conclu- sion This method is simple,easy to operate,safe and reliable with less complications.

Avascuar Necrosis of Bone after Kidney Transplantation / 대한정형외과학회잡지

As transplantation for end-stage renal disease has become more common, avascular necrosis has become a major cause of disability after a successful transplantation. We studied the relationship between development of avascular necrosis of bone and the administration and dosage of steroid, cholesterol level and triglyceride level after transplantation in 909 patients who received kidney transplantation from March 1969 until August 1994 at Catholic University, Medical College. These patients were compared against 60 patients who received kidney transplantation and steroid therapy without developing osteonecrosis. Osteonecrosis was observed in 62 of the patients (6.8 per cent) from 3 to 37 months (mean 10) after the transplant operation. The average age was thirty-eight years (range, twenty to sixty-three years). A single bone was involved in 28 patients, while in the rest of the patients there were between two and four different sites. Altogether 109 bones were affected, 102 of them being weight-bearing. The most common sites were the femoral heads, with 32 patients having bilateral involvement. There was no association between the cumulative dosage of prednisone and the development of avascular necrosis. Although the post renal transplant cholesterol and triglyceride level were significantly elevated compared to the pre-renal transplant state, there were no significantly difference between the avascular group and control group.

Indication and surgical technique for transplant nephrectomy / 대한비뇨기과학회지

The criteria for removal of failed renal allografts are not clearly defined. Between December, 1985 and June. 1991, 269 renal transplantations were performed at Kosin Medical Center, Pusan, Korea. Of these 29 lost renal allograft and transplant nephrectomy was carried out within 6 weeks of transplantation in 4 instances: 1 case because of ABO incompatibility and 3 due to oliguria, progressively increasing serum creatinine and enlarged tender graft despite of pulsing therapy. Of these a patients, one patient had rupture of transplanted kidney, 4 kidney allografts were removed at least 6 months after transplsntation: three had graft pain and tenderness, graft enlargement and persistent gross hematuria. The surgical approach was carried out through the transplantation incision. In the postoperative period, there were some complications: 2 of these were wound hematoma and bleeding which resulted in no further complication but in one case immediately after transplant nephrectomy sepsis resulted in death. In conclusion, absolute indication for tansplant nephrectomy was hyperacute rejection and if chronic rejection was present, it should be considered with clinical findings. During removal of the transplanted kidneys, we think it is benefit that the vessels were ligated "en mass".