[Surgical complications after kidney transplantation. Research based on 185 cases]. / Complicaciones quirúrgicas post-trasplante renal. Estudio en 185 casos.

OBJECTIVE: To analyze the incidence of surgical complications its diagnosis and treatment after renal transplantation. METHODS: A retrospective study measuring the incidence of surgical complications and reviewing its diagnosis and treatment in 185 renal single transplants. RESULTS: 185 transplants, 27% had surgical complications. Only one patient lost the graft due to surgical complications and there was no associated mortality. Cold ischemia time 20 hours. Double J stenting in 19%, under surgeon's opinion. Vascular complications 3.2% (all of them renal artery stenosis). Urological complications 6.4%. Perinephric haematoma 7%. Lymphocele 4.9%. Peritoneum related complications 4%. Other 4%. The diagnosis was clinical and radiological in most of cases. 14% needed any kind of intervention. CONCLUSIONS: Our results are similar to those reported in other recent series. Only one surgical team involved and the same technique for vascular and vesico-ureteric anastomosis probably makes lower our complications rate. Early postoperative abdominal ultrasonography contributes to the diagnosis of surgical complications. The initial treatment approach is the endoscopic-conservative one, with exceptions.

Complicaciones quirúrgicas post-trasplante renal. Estudio en 185 casos / Surgical complications after kidney transplantation. Research based on 185 cases

Objetivo: Análisis de incidencia, diagnóstico y tratamiento de complicaciones quirúrgicas en el trasplante renal. Método: Estudio retrospectivo de la incidencia de complicaciones quirúrgicas en 185 trasplantes renales únicos, revisando su diagnóstico y tratamiento. Resultados: En 185 trasplantes se producen un 27% de complicaciones quirúrgicas. Sólo un paciente perdió el injerto secundario a éstas y su mortalidad asociada fue nula. Tiempo medio de isquemia fría 20horas. Utilización de catéter doble J (19%), a criterio del cirujano. Complicaciones vasculares 3,2% (todas estenosis de arteria renal). Complicaciones urológicas 6,4% (en similar porcentaje estenosis y fístulas). Hematomas perirrenales 7%. Linfoceles 4,9%. Complicaciones peritoneales 4%. Otras 4%. Diagnóstico clínico-radiológico en la mayoría de los casos. Requirieron intervención (endo-radiológica o quirúrgica) el 14%, individualizada según el caso. Conclusiones: Nuestros resultados no difieren de los de otras grandes series publicadas. La implicación de un único equipo de cirujanos manteniendo la misma técnica vascular y de ureteroneocistostomía parece influir en nuestra baja incidencia de complicaciones. La ecografía-doppler abdominal sistemática como control en los primeros días post-trasplante contribuye al diagnóstico de las complicaciones quirúrgicas. El tratamiento inicial de elección, salvo excepciones, es endoscópico-conservador (AU)

Objective: To analyze the incidence of surgical complications its diagnosis and treatment after renal transplantation. Methods: A retrospective study measuring the incidence of surgical complications and reviewing its diagnosis and treatment in 185 renal single transplants. Results: 185 transplants, 27% had surgical complications. Only one patient lost the graft due to surgical complications and there was no associated mortality. Cold ischemia time 20 hours. Double J stenting in 19%, under surgeon’s opinion. Vascular complications 3,2% (all of them renal artery stenosis). Urological complications 6,4%. Perinephric haematoma 7%. Lymphocele 4,9%. Peritoneum related complications 4%. Other 4%. The diagnosis was clinical and radiological in most of cases. 14% needed any kind of intervention. Conclusions: Our results are similar to those reported in other recent series. Only one surgical team involved and the same technique for vascular and vesico-ureteric anastomosis probably makes lower our complications rate. Early postoperative abdominal ultrasonography contributes to the diagnosis of surgical complications. The initial treatment approach is the endoscopic-conservative one, with exceptions (AU)

Association between vitamin D receptor FokI. Polymorphism and serum parathyroid hormone level in patients with chronic renal failure.

We investigated the relationship between vitamin D receptor (VDR) start codon polymorphism and serum levels of PTH, calcidiol, and calcium in 64 Spanish patients with chronic renal failure (CRF). An exon 2 fragment of the VDR gene was amplified by PCR, and cleaved with the restriction enzyme FokI. The alleles were identified according to the digestion pattern obtained as F (absence of restriction site) and f (presence of restriction site). Genotype frequencies in the patient population were 54.7% FF, 28.1% Ff and 17.2% ff, vs 46.7% FF, 43.3% Ff and 10% ff in a healthy control population. The difference between the two populations was statistically significant (p<0.01). Within the patient population, mean serum PTH level in the FF group was significantly higher (159.77+/-25.69 pg/ml) than in both the Ff and ff groups (106.67+/-19.07 and 77.55+/-15.85 pg/ml, respectively; p<0.05). However there were no significant differences in serum levels of calcidiol or calcium among genotypes. These results suggest that FokI polymorphisms of the VDR gene may determine parathyroid response in CRF patients.

[Ureteral implantation in peritoneum. Exceptional complication in renal transplantation]. / Implantación ureteral en peritoneo. Una complicación excepcional en el trasplante renal.

Because of the extraperitoneal location, generally used for renal grafting, intraperitoneal urine leaks are a rare complication after transplantation. We report a patient on peritoneal dialysis who developed ascites, abdominal pain, anuria and shock suddenly after renal transplantation. The patient was immediately taken back to the operating room. An abnormal implantation of ureter into the peritoneum overlying the bladder when carrying out an unstented parallel incision extravesical ureterone-ocystostomy was identified. After correcting ureter implantation the patient had immediate diuresis, renal function rapidly improved, with no further complications. Contributing causes were poor exposure, thickened peritoneum secondary to recurrent peritonitis, and the presence of residual peritoneal dialysis fluid.

Implantación ureteral en peritoneo. Una complicación excepcional en el trasplante renal / Ureteral implantation into periotoneum. An unusual complication of kidney transplantation

En el trasplante renal la fuga de orina intraperitoneal es una complicación rara, debido a la implantación habitual en retroperitoneo. Informamos del caso de un paciente en diálisis peritoneal que inmediatamente al trasplante presenta ascitis, dolor abdominal, anuria y shock. Con rapidez es llevado de nuevo a quirófano. Se identificó una implantación del uréter en peritoneo y no en vejiga, en el curso de una ureteroneocistostomía extravesical no tutorizada. Después de corregir la implantación ureteral el paciente recuperó la diuresis, mejoró rápidamente su función renal, sin más complicaciones. Fueron factores contribuyentes la limitada exposición, el engrosamiento peritoneal secundario a peritonitis recurrente y la presencia de fluido de diálisis peritoneal residual (AU)