ABSTRACT
Enteric drainage is a sound surgical technique in SKP, and it avoids the majority of urological as well as metabolic complications. We did not see an increase in intraabdominal complications or of graft loss due to rejection. Intestinal leak is rare and easily managed provided a Roux-Y loop of jejunum is used. Even though the number of patients was small and the follow-up short, the results of the RY group were at least comparable to the BD group. In view of our results, we plan to use this technique in all our future SKP patients.
Subject(s)
Anastomosis, Roux-en-Y/methods , Kidney Transplantation/methods , Pancreas Transplantation/methods , Adult , Female , Follow-Up Studies , Graft Rejection/epidemiology , Humans , Jejunum/surgery , Kidney Transplantation/physiology , Male , Pancreas Transplantation/physiology , Postoperative Complications/epidemiology , Retrospective Studies , Time FactorsABSTRACT
Successful renal transplantation depends on the modification of the normal immunologic response. The earliest attempts at such modification involved the use of ionizing irradiation. The significant morbidity and mortality of total body irradiation led to its abandonment in favor of the safer technique of local graft irradiation. While still commonly used, the efficacy of this technique has never been evaluated in a prospective, randomized fashion. The present study is a prospective, randomized, double blinded evaluation of the efficacy of the addition of local graft irradiation to our immunosuppressive protocol. One hundred consecutive cadaveric renal transplants were randomized to receive either conventional immunosuppression alone or conventional immunosuppression plus local graft irradiation delivered in doses of 150 rads on the 1st, 3rd and 5th post-operative days. Patients were followed for a period of 2 years. No significant difference was demonstrated between the groups among any measured parameter. In conclusion, the addition of local graft irradiation in doses of 150 rads on d 1, 3, and 5 does not appear to offer any advantage over standard immunosuppressive therapy and its use cannot be recommended.
Subject(s)
Graft Rejection , Kidney Transplantation/methods , Kidney/radiation effects , Adult , Cadaver , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Immunosuppression Therapy/methods , Kidney Transplantation/adverse effects , MaleSubject(s)
Brain Neoplasms/diagnosis , Cerebral Hemorrhage/diagnosis , Choriocarcinoma/diagnosis , Tissue Donors , Transplantation, Homologous/adverse effects , Adolescent , Adult , Brain Neoplasms/secondary , Brain Neoplasms/transmission , Cadaver , Choriocarcinoma/secondary , Choriocarcinoma/transmission , Diagnostic Errors , Female , Humans , Middle AgedSubject(s)
Choriocarcinoma/etiology , Iatrogenic Disease , Kidney Transplantation , Neoplasm Transplantation , Adult , Cadaver , Female , Humans , Kidney Neoplasms/etiology , Lung Neoplasms/etiology , Male , Middle Aged , Tissue DonorsSubject(s)
Cadaver , Ethnicity , Kidney Transplantation , Actuarial Analysis , Black People , Graft Survival , Histocompatibility , Humans , Mexico/ethnology , United States , West Indies/ethnology , White PeopleABSTRACT
Absorbable and non-absorbable suture materials were evaluated for calculi formation and tissue reactivity in the rabbit bladder. Five-O chromic, polydioxinone and polypropylene sutures were used to close cystostomies made in New Zealand white rabbits. Bladders were evaluated at 15, 30, 60 and 90 days. Calculi formed on all sutures tested and the persistence of calculi appeared to be dependent on the longevity of the suture material used. This data suggests that the use of non-absorbable suture material in urologic surgery may contribute to calculus formation.
Subject(s)
Catgut/adverse effects , Plastics/adverse effects , Polyesters/adverse effects , Polypropylenes/adverse effects , Sutures/adverse effects , Urinary Bladder Calculi/etiology , Animals , Polydioxanone , Rabbits , Urinary Bladder/surgeryABSTRACT
The incidence of postbiopsy vascular lesions of the transplanted kidney is unknown. The complications of these lesions should be promptly recognized and treatment initiated when indicated. We have found transplant angiography and selective arterial embolization to be a safe and effective modality.
Subject(s)
Arteriovenous Fistula/therapy , Embolization, Therapeutic , Kidney Transplantation , Adult , Arteriovenous Fistula/etiology , Fistula/etiology , Fistula/therapy , Humans , Kidney Calices , Male , Renal ArteryABSTRACT
Ureteroneocystostomy was used as the primary method of urinary tract reconstruction in 282 allograft renal transplants at our center since 1965. A nonrefluxing anastomosis was incorporated whenever possible. Seven patients who suffered major urological complications involving the ureteroneocystostomy required pyeloureterostomy as the method of repair using the patient's distal native ureter. No ipsilateral nephrectomy was performed and simple ligation of the native ureter with nonabsorbable suture was accomplished. Of the 7 patients 3 suffered hydronephrosis of the native kidney. None of these patients had signs or symptoms secondary to acute and chronic ureteral occlusion. Our experience suggests that intentional ligation of the native ureter during pyeloureterostomy does not result in increased morbidity to the transplant patient, and that the need for ipsilateral nephrectomy with its own added morbidity may not be necessary.
Subject(s)
Kidney Transplantation , Ureter/surgery , Urinary Diversion/methods , Dilatation, Pathologic/surgery , Humans , Hydronephrosis/surgery , Kidney Calices/pathology , Kidney Pelvis/pathology , Kidney Pelvis/surgery , Ligation , Nephrectomy , SuturesABSTRACT
Severe, prolonged sodium-wasting (up to 38% FENa) occurred in a man after he received a cadaveric-donor kidney. Posttransplantation supplementation with large amounts of saline and/or salt tablets was mandatory. Fludrocortisone had no clinically apparent effect. Plasma renin activity and plasma aldosterone concentration were markedly increased. As chronic rejection progressed, the syndrome ameliorated. Renal biopsy showed cellular rejection and nephrocalcinosis.
