Dual Kidney Transplantation: A Single-Center Experience in Thailand.

BACKGROUND: Dual kidney transplants (DKTs) from expanded criteria donors (ECDs) have been performed in our hospital since 2014. We needed to review our clinical outcome and update criteria to selected ECDs for DKTs. MATERIALS AND METHODS: Between January 2014 and December 2016, 4 DKTs and 269 deceased donor kidney transplants were performed. The outcome of DKTs was reviewed. The literature was reviewed for surgical technique and indication for DKT. RESULTS: Four DKTs were performed between 2014 and 2016. One-year graft survival rate was 100%. One patient developed delayed graft function. No morbidity or mortality occurred. CONCLUSIONS: DKTs in our center were safe and had good outcome with optimized selected criteria. DKT can improve the rate of kidney transplant in a developing country.

Clinical Outcomes in Pediatric Renal Transplant Recipients Who Received Steroid-Based Immunosuppressive Regimen.

BACKGROUND: Although the clinical outcomes of pediatric renal transplantation (RT) in developed countries have improved significantly, the data on clinical outcomes in developing countries are wildly different. METHODS: Children and adolescents who had undergone RT at Ramathibodi Hospital between March 2001 and August 2014 were included. RESULTS: Patients were divided into 2 groups: living related donor (LRD) group (n = 13) and deceased donor (DD) group (n = 30). Prolonged cold ischemic time over 13 hours was significantly associated with delayed graft function (P = .029). The prevalence of infection was 90.7%, in which urinary tract infection (UTI) was the most common infection. Although almost none of the patients in the LRD group received induction therapy, the prevalence of rejection was not significantly different between the 2 groups (P = .817). The comparison of graft survivals between LRD and DD groups were 100% vs 100%, 92.3% vs 100%, and 85.7% vs 81.8% at 1, 3, and 5 years, respectively (P = .938). Recurrent UTI and cytomegalovirus (CMV) infection had a negative effect on graft function at 1-year follow-up (P < .05). Rejections, bladder dysfunction, and donors aged ≥50 years were associated with graft deterioration at 3 years after RT (P < .01). None of these patients died with functioning graft. CONCLUSION: This study demonstrated good graft and patient survival in Thai pediatric RT recipients. Although recurrent UTI and CMV infection were related to graft dysfunction at 1-year follow-up, infections had no effect on graft and patient survival in long-term follow-up.

Severe nonfebrile dengue infection in an adolescent after postoperative kidney transplantation: a case report.

We herein have reported a case of severe nonfebrile dengue infection complicated with refractory pancytopenia and a large perinephric hematoma with shock in a 16-year-old adolescent during the early postoperative period after kidney transplantation. After the diagnosis of end-stage renal disease she underwent living-related kidney transplantation. Thirteen days after successful transplantation, she exhibited a notable amount of ascites, bilateral pleural effusions, thrombocytopenia, and increased hemoglobin without pre-existent fever. Further investigation revealed positive dengue nonstructural protein 1 antigen (dengue NS1 Ag) and dengue virus serotype 1 by a reverse transcriptase-polymerase chain reaction (RT-PCR) in the patient's serum. She exhibited hemophagocytic syndrome, manifested by refractory pancytopenia and refractory anemia resulting in hypovolemic shock and acute graft failure on day 28 posttransplantation. The anemia was attributed to a large hematoma around the transplanted kidney requiring surgical evacuation of clotted blood. Postoperatively, she gradually recovered with resolution of thrombocytopenia and excellent graft function. Persistent dengue antigenemia and viremia was shown by dengue NS1 Ag and RT-PCR of dengue serotype-1. The viremia was present longer than the dengue antigenemia. Dengue-specific immunoglobulin M (IgM) and IgG by enzyme-linked immunosorbent assay confirmed the primary dengue infection and evidence of a recent donor dengue infection.

Squamous cell carcinoma of the eviscerated bladder: a case report.

This is a report of a squamous cell carcinoma of the eviscerated bladder in a 52-year-old-Thai man. He had a history of pelvic fracture and failed urethroplasty. The bladder mucosa was eviscerated out from cystostomy tract after the spontaneous dislodging of the cystostomy tube. Squamous cell carcinoma developed at the eviscerated bladder 5 years later. The treatment consisted of radical cystectomy and ileal conduit with combination of radiotherapy. The patient died 7 months after operation due to liver metastasis. Correction or excision of the eviscerated bladder can prevent this kind of cancer.

The organization of Kidney Transplantation Services at Ramathibodi Hospital: fourteen years experience on waiting list, kidney donors and kidney transplantation.

The Kidney Transplantation Program at Ramathibodi Hospital was established in 1985. By the end of 1998, there were 1,614 patients on the cumulative waiting list. The first kidney transplantation (KT) was started in 1986 by using kidney from living-related donor (LD) while cadaveric KT (CD-KT) was started in 1987. A total of 528 KT were done, 278 cases (52.7%) were CD-KT and 250 cases (47.3%) were LD-KT. Six patients had two kidney transplants. 278 kidneys were donated from 189 cadaveric donors. Fifty cadaveric donors (26.4%) were from Ramathibodi Hospital while the rest were from other hospitals and the Organ Donation Center, Thai Red Cross Society. For LD, 233 out of 250 (93.2%) were from living-related, more than 50 per cent of these donors were from siblings. 17 spousal donors have been accepted for KT at Ramathibodi Hospital since 1997. Concerning the recipient pools, 522 patients (32.3%) were transplanted, 123 patients (7.6%) died without KT, 111 patients (6.9%) underwent KT at other hospitals, and 78 patients (4.8%) changed to waiting lists at other hospitals. The rest were lost to follow-up. At present, only 265 patients are still actively waiting (send serum every month). The number of KT and living donors has gradually increased, whereas, the number of cadaveric donors has decreased. However, cooperation with the "Organ Donation Center" has improved the number of cadaveric donation in the last two years. Sufficient organ donations and an active working team will provide a good kidney transplant service for the patients.

Ileal interposition for the treatment of a long gap ureteral loss.

We retrospectively reviewed 10 patients (7 males and 3 females) who were treated with ileal interposition for long gap ureteral loss between 1989-1995. The mean patient age was 42 years old (35-52), mean ureteral gap was 18 cms (10-25). The etiology of ureteral loss included: 4 retroperitoneal fibrosis, 2 recurrent stone, 2 after pancreatitis and its complication and 2 after ureteral injury. The mean follow-up was 4 years (2-7). The post operative course was uneventful with no immediate and long term complications detected and there was no metabolic problem. Only asymptomatic bacteriuria in 5 cases (50%) was noted but it was not clinically significant.

Renal artery embolism: therapy with intra-arterial streptokinase infusion.

Two patients with acute renal artery embolism were reported. One patient had a history of rheumatic valvular heart disease and the other patient had hereditary cardiomyopathy. Both patients had atrial fibrillation on physical examination. Both patients presented with acute back pain and one patient had hematuria. The final diagnosis of acute renal artery embolism was made after one to three days of hospitalization and renal angiography was finally done documenting complete occlusion of the main branch of the renal artery on one side. Intra-arterial streptokinase infusion 5,000 unit per hour was given to both patients using an arterial pump for 17 hours to 30 hours with complete recanalization of the intrarenal branches and complete recovery of signs and symptoms of renal artery embolism although the renal scan still showed diminished renal function.