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1.
Transplant Proc ; 49(3): 512-516, 2017 Apr.
Article in English | MEDLINE | ID: mdl-28340824

ABSTRACT

BACKGROUND: Symptomatic urinary tract infection (UTI) after renal transplantation (RT) is an important morbidity in transplant recipients and may cause pyelonephritis and sepsis. Surgical correction of high-grade vesicoureteral reflux (VUR) after RT is suggested, performing ureteral reimplantation or pyelo-ureteral/uretero-ureteral anastomosis. Recently, extravesical seromuscular tunnel lengthening techniques have been reported with favorable results and low complication rates. METHODS: We retrospectively reviewed the charts of 38 patients with post-transplantation VUR who underwent reflux correction surgery. Patient characteristics were analyzed to compare our extravesical seromuscular tunnel lengthening technique with uretero-ureteral and pyelo-ureteral anastomosis techniques. RESULTS: Twenty patients were treated with the extravesical approach (group I) and 18 patients by pyelo-ureteral or uretero-ureteral anastomosis with the use of native ureter (group II). Mean operative time was significantly shorter in group I than in group II (64.8 vs 110.1 min; P < .05), and mean duration of hospital stay after the operation also was shorter in group I (1.5 vs 5.1 d; P < .05). We determined persistent VUR in postoperative voiding cystouretrography in 2 patients (10%) in group I, but there was regression in VUR grades of all of the patients. There was no significant difference in postoperative number of UTI episodes and serum creatinine levels between the 2 groups. CONCLUSIONS: Extravesical seromuscular tunnel lengthening is an effective and safe technique for post-transplantation VUR management.


Subject(s)
Kidney Transplantation/adverse effects , Vesico-Ureteral Reflux/etiology , Vesico-Ureteral Reflux/surgery , Child, Preschool , Female , Humans , Length of Stay , Male , Operative Time , Retrospective Studies , Transplant Recipients , Ureter/surgery
2.
Transplant Proc ; 49(3): 528-531, 2017 Apr.
Article in English | MEDLINE | ID: mdl-28340827

ABSTRACT

BACKGROUND: Extravesical Lich-Gregoir ureteroneocystostomy (UC) is the most widely used method for urinary reconstruction during kidney transplantation. Sometimes it is difficult to perform UC in cases with disused atrophic bladder. Pyelo-ureteral anastomosis (PUA) and uretero-ureteral anastomosis (UUA) may be preferred to UC for these patients. METHODS: We retrospectively reviewed the charts of 833 kidney transplant recipients operated on by our transplantation team between July 2010 and November 2014. The patients were divided into two groups: Group I consisted of 16 patients who underwent end-to-side UUA and Group II consisted of 20 patients who underwent end-to-end UUA. The two groups were compared in terms of efficacy, safety, and graft function. RESULTS: As we performed end-to-side UUA as a relatively new technique compared with end-to-end UUA, the post-transplantation follow-up period of Group II was significantly longer than Group I (P = .000), but all the patients in both groups had at least 1 year of follow-up. Because the first two patients in Group II, who underwent native ureteral ligation without nephrectomy, developed hydronephrosis in their native kidneys, requiring nephrectomy in the post-transplantation period, we performed native nephrectomy in all of the remaining patients in this group. That is why the mean operative time was significantly longer in Group II compared with Group I (P = .000). There was no significant difference between the two groups in terms of postoperative surgical complications, post-transplantation urinary infections, and graft function. CONCLUSION: End-to-side UUA without native ureteral ligation is a safe surgical technique for urinary tract reconstruction during kidney transplantation in patients with disused atrophic bladder.


Subject(s)
Kidney Transplantation/methods , Ureter/surgery , Urinary Bladder/surgery , Adult , Anastomosis, Surgical/methods , Atrophy/surgery , Female , Humans , Kidney Transplantation/adverse effects , Ligation , Male , Middle Aged , Nephrectomy/methods , Postoperative Complications/etiology , Retrospective Studies , Transplant Recipients , Urinary Bladder/pathology , Urinary Tract Infections/etiology
3.
Transplant Proc ; 47(5): 1511-4, 2015 Jun.
Article in English | MEDLINE | ID: mdl-26093754

ABSTRACT

As vascular diseases are becoming more prevalent among renal transplant recipients, complications related to renal artery anastomosis are likely to occur more often. Here we report a renal transplant patient treated with femoro-femoral bypass who had renal allograft dysfunction due to aorto-iliac occlusive disease (AIOD) proximal to renal artery anastomosis. We performed living donor renal transplantation in the left iliac fossa of a 41-year-old male. At post-transplant 30 months, he was admitted with hypertension, increase in serum creatinine, and claudication of his left leg. Doppler ultrasonography showed poor flow characteristics of the renal allograft. Total occlusion of the left common iliac artery was diagnosed on angiography. Since endovascular approach was unsuccessful, we performed right-to-left femoro-femoral bypass to provide retrograde blood flow to the renal allograft. The patient was discharged at postoperative day 3 with decreased serum creatinine, normal blood pressure, no claudication, and normal flow characteristics in Doppler ultrasonography. AIOD should be suspected in renal transplant patients in case of hypertension, allograft dysfunction, and ipsilateral leg ischemia. Femoro-femoral bypass is a safe surgical procedure that may be performed in patients who cannot be treated using an endovascular approach.


Subject(s)
Aorta, Abdominal , Arterial Occlusive Diseases/etiology , Arterial Occlusive Diseases/surgery , Femoral Artery/surgery , Iliac Artery , Kidney Transplantation/adverse effects , Adult , Arterial Occlusive Diseases/diagnosis , Humans , Ischemia/etiology , Kidney Failure, Chronic/surgery , Leg/blood supply , Male , Renal Artery/surgery
4.
Transplant Proc ; 47(5): 1518-21, 2015 Jun.
Article in English | MEDLINE | ID: mdl-26093756

ABSTRACT

A 39-year-old man who had received cadaveric renal transplantation (RT) 1 month previously presented with rash and pain on his left lower extremity. Initially, bacterial cellulitis was suspected, and ampicillin/sulbactam was initiated; however, 3 days later, skin necrosis occurred and pain increased. Ampicillin/sulbactam was replaced with imipenem+ciprofloxacin, and surgical debridement was performed. Escherichia coli was identified in the wound culture, urine culture, and blood culture. After repeated debridement, wound care, and appropriate antimicrobial treatment, wounds began to heal and skin grafting was planned at the 4th month of therapy. However, the patient died of viral pneumonia. To date, 20 cases of necrotizing fasciitis (NF) after RT have been reported (including our case), and, as far as we know, this is the second E coli-related NF case. An analysis of all 20 cases showed that the most common infection site was the extremities (90%) and that 45% of pathogens were fungus. The mortality rate was 30%. NF is a rare but rapidly developing and life-threatening soft-tissue infection in RT patients. To reduce mortality rates, early diagnosis, recurrent surgical debridement, and aggressive therapy are mandatory.


Subject(s)
Escherichia coli Infections/etiology , Fasciitis, Necrotizing/microbiology , Kidney Failure, Chronic/surgery , Kidney Transplantation/adverse effects , Debridement , Escherichia coli Infections/diagnosis , Escherichia coli Infections/therapy , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/therapy , Fatal Outcome , Humans , Male , Middle Aged , Skin Transplantation
5.
Transplant Proc ; 47(5): 1522-4, 2015 Jun.
Article in English | MEDLINE | ID: mdl-26093757

ABSTRACT

Because of the strong association between uremia and atherosclerosis, incidence of aortic aneurysms is increasing among renal failure patients awaiting renal transplantation (RT). Successful RTs have been performed in these patients after surgical repair of the aneurysms. Since Parodi et al introduced endovascular aortic aneurysm repair (EVAR) in patients with high risk for conventional surgery, a new era has begun. The 1st successful RT after EVAR was published in 2001. Herein we report the 1st successful RT after thoracic EVAR (TEVAR) reported to date. We performed RT in a 54-year-old man with end-stage renal failure due to diabetic nephropathy, who had undergone TEVAR for type B aortic dissection (TBAD) 6 months earlier. The postoperative period was uneventful and the patient was discharged from the hospital at postoperative day 6 with a serum creatinine of 0.9 mg/dL. At follow-up examination at postoperative 6 months, graft function was stable. Because of its advantages over open surgery, including low mortality and morbidity, TEVAR is becoming more common among renal failure patients with thoracic aortic aneurysms and TBAD. Our case shows that successful RT can be performed in renal failure patients who have undergone TEVAR.


Subject(s)
Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Endovascular Procedures , Kidney Failure, Chronic/surgery , Kidney Transplantation , Aortic Dissection/complications , Aortic Aneurysm, Thoracic/complications , Blood Vessel Prosthesis Implantation , Humans , Kidney Failure, Chronic/complications , Male , Middle Aged , Retrospective Studies , Treatment Outcome
6.
Transplant Proc ; 47(5): 1525-7, 2015 Jun.
Article in English | MEDLINE | ID: mdl-26093758

ABSTRACT

A 27-year-old woman was admitted to our department with end-stage renal failure due to reflux nephropathy. She had no history of deep venous thrombosis. After pretransplantation evaluation, her father was accepted for kidney donation. We observed intraoperatively that the patient's iliac veins and inferior vena cava (IVC) were absent. There were many venous collaterals, but none of them was dilated enough for renal vein anastomosis. Since we could not find a suitable vein for venous drainage of the allograft, we decided to stop donor surgery and postpone renal transplantation (RT) for detailed radiologic examination. Contrast-enhanced computed tomography revealed the absence of an infrahepatic segment of IVC. Superior mesenteric vein was thin. Portal and splenic veins were normal, but we decided not to use them for venous drainage because of increased risk of torsion. We informed the patient and her family about the situation and cancelled RT. Iliac vein and IVC anomalies are not absolute contraindications for RT, but when a dilated collateral vein is not present or when there is no option for safe renal vein anastomosis as in our case, RT may not be possible.


Subject(s)
Iliac Vein/abnormalities , Kidney Failure, Chronic/surgery , Kidney Transplantation , Vena Cava, Inferior/abnormalities , Adult , Female , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/diagnostic imaging , Portal System/diagnostic imaging , Radiography
7.
Transplant Proc ; 45(3): 881-2, 2013 Apr.
Article in English | MEDLINE | ID: mdl-23622577

ABSTRACT

Laparoscopic donor nephrectomy (LDN) has numerous advantages over open donor nephrectomy. The cosmetic issues and pain that arise due to the 5 to 6-cm incisions on the abdominal wall in LDN have led to transvaginal laparoscopic donor nephrectomy (TVLDN). Between May and August 2012, we performed seven donor nephrectomies via a transvaginal approach. The mean age of the donors was 53.0 ± 9.52 years. The mean operative time was 97.29 ± 39.47 minutes and mean warm ischemia time, 220.71 ± 55.49 seconds. Donors were mobilized, began oral intake at 8 hours postoperative, and were all discharged within the first 24 hours. Except one dose of analgesic applied immediately after the operation, no additional medication was required. No infectious complications were encountered in any recipient. TVLDN may be a good alternative for female donors. Compared with LDN, TVLDN has benefits of less postoperative pain, faster recovery, shorter hospital stay, and excellent cosmetic results.


Subject(s)
Kidney Transplantation , Laparoscopy , Nephrectomy/methods , Tissue Donors , Vagina , Adult , Female , Humans , Middle Aged
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