ABSTRACT
Immunosuppressive maintenance therapy after kidney transplantation leads to various undesired side effects such as calcineurin inhibitor (CNI)-associated nephrotoxicity or elevated cardiovascular risk due to posttransplantation diabetes and hypertension. These effects show negative impacts on long-term allograft function as well as patient morbidity and mortality. Therefore, we used an immunosuppressive regimen with early corticosteroid withdrawal (ESW), maintenance therapy containing tacrolimus, sirolimus (SRL), and mycophenolate sodium for 3 months followed by a prospective randomized trial comparing a CNI free versus a low-dose CNI therapy. The primary endpoint was 6-month graft function. Among 75 patients, ESW was performed after 4 days in 65 patients. Over the following 3 months before randomization to CNI-free maintenance therapy, we experienced a high number (25%) of SRL discontinuations due to adverse events, including leukopenia, anemia, arthritis, and pneumonitis. In addition there were significantly more allograft rejection episodes in the CNI-free group (P = .017) during the study period leading to a switch from SRL to a CNI. Despite the higher rate of rejection episodes in the CNI-free groups, glomerular filtration rates (GFR) at 6 months were comparable between the study groups (P = .25). After 1 year only 9.2% (6/65) of all patients treated with SRL remained on this drug. Conclusion, there was an unacceptably high rate of SRL intolerance using an ESW and CNI-free immunosuppressive regimen combined with a significantly higher rate of rejection episodes.
Subject(s)
Adrenal Cortex Hormones/administration & dosage , Calcineurin Inhibitors , Graft Rejection/prevention & control , Graft Survival/drug effects , Immunosuppressive Agents/administration & dosage , Kidney Transplantation/immunology , Sirolimus/administration & dosage , Adolescent , Adrenal Cortex Hormones/adverse effects , Adult , Aged , Chi-Square Distribution , Drug Administration Schedule , Drug Substitution , Drug Therapy, Combination , Female , Glomerular Filtration Rate/drug effects , Graft Rejection/epidemiology , Graft Rejection/immunology , Humans , Immunosuppressive Agents/adverse effects , Incidence , Kidney Transplantation/adverse effects , Male , Middle Aged , Mycophenolic Acid/administration & dosage , Mycophenolic Acid/analogs & derivatives , Prospective Studies , Sirolimus/adverse effects , Switzerland/epidemiology , Tacrolimus/administration & dosage , Time Factors , Treatment Outcome , Young AdultABSTRACT
Eighty-five Tension-free Vaginal Tapes (TVT) were compared with 96 Trans-obturator Tape (TOT). We confirm more bladder risk and more imperiosity when TVT was done. Satisfaction in both groups was the same at 2-year follow-up. There were 10 vaginal ulcerations in the TOT group.
Subject(s)
Patient Satisfaction , Pelvic Floor/surgery , Suburethral Slings , Urinary Incontinence, Stress/surgery , Urologic Surgical Procedures/instrumentation , Female , Follow-Up Studies , Humans , Retrospective Studies , Suburethral Slings/adverse effects , Urinary Bladder , Urologic Surgical Procedures/adverse effects , Urologic Surgical Procedures/methodsABSTRACT
The purpose of this pictorial essay is to describe the role of intraoperative color duplex ultrasound in detecting vascular complications during renal transplantation. Intraoperative color duplex scanning during renal transplantation detects vascular complications noninvasively. Reasons for disturbed perfusion can be malposition or external compression, intravascular thrombi, vessel wall dissection and vasospasm. Color duplex ultrasound is a useful procedure in selected conditions with an intraoperatively suspected perfusion problem during renal transplantation.
Subject(s)
Intraoperative Complications/diagnostic imaging , Kidney Transplantation , Monitoring, Intraoperative/methods , Renal Artery Obstruction/diagnostic imaging , Ultrasonography, Doppler, Color , Adult , Aged , Female , Graft Survival , Hematoma/diagnostic imaging , Hematoma/surgery , Humans , Male , Renal Artery Obstruction/surgeryABSTRACT
OBJECTIVES: The direction of vein grafts for infrainguinal arterial reconstruction is controversial. Long-term results of a single center following an all autogenous tissue policy in infrainguinal arterial reconstruction are reported with special attention to possible advantages for the in situ and non-reversed bypass using angioscopy. METHODS: From 10/88 until 12/00 540 bypasses with autogenous veins were performed on 497 patients. Veins were used in a non-reversed or in-situ direction, valve disruption was performed under angioscopic control. All grafts were prospectively included in our data base and follow-up was scheduled in our vascular lab before discharge and after 3, 6, 9, 12, 24 etc. months. RESULTS: Primary patency of all bypasses after 108 months was 55.2%, primary assisted 76.9% (SE +/- 9.87), survival 58.4% (SE +/- 8.88) and limb salvage 81.3% (SE +/- 9.75). Perioperative mortality was 0.9% (5 pat). Patency rates (primary assisted patency) after 72 months were 81.7% (98.2%) for supragenicular, 61.5% (79.4%) for infragenicular and 56.6% (78.1%) for tibial anastomoses and for pedal reconstructions after 48 months 49.3% (68.6%). CONCLUSION: Reviewing the literature neither the in situ and non-reversed nor the reversed grafts yielded better long-term results. Absence of size mismatch may be an advantage in smaller veins. Angioscopy may detect unsuspected vein disease.
