Which One Is the Best for Living Donation: A Multiple-Artery Left Kidney Nephrectomy or a Right Kidney Nephrectomy?

INTRODUCTION: The current approach in living-donor kidney transplant is to preserve the best kidney for the donor and harvest the contralateral one. Due to a shorter renal vein and a greater incidence of venous thrombosis, left kidneys are more frequently elected. Notwithstanding, arterial anatomy may be complex and thus render the transplantation procedure more difficult and prone to complications. OBJECTIVES: To analyze the outcomes after multiple-artery left kidney nephrectomy (MALKN) and right kidney nephrectomy (RKN). RESULTS: Seventy-three cases were performed from 1999 to 2017 in our institution: 34 MALKN and 39 RKN. The mean operative time was significantly longer in MALKN. Warm ischemia time, donor and receptor hospital stay, and postoperative complications did not differ between groups. There was a positive correlation between renal arteries' ostia distance in MALKN and the duration of warm ischemia period. There was no significant difference in the incidence of acute tubular necrosis, first-year variations in serum creatinine, and glomerular filtration rate between groups. Long-term graft survival did not significantly differ between groups. Three cases of vein thrombosis after RKN were reported with graft loss. CONCLUSION: The safety and efficacy of MALKN does not differ from RKN, although there appears to be a higher incidence of vein thrombosis after right kidney transplantation. Despite being technically more demanding, particularly in cases with distant artery ostia, MALKN could be a better option than RKN for living donation, expanding the available donor pool, although more studies are needed to affirm this conclusion.

Female sexual function and depression after kidney transplantation: comparison between deceased- and living-donor recipients.

Disturbances in sexual function and depression are a common feature in women with chronic renal failure. Living-donor kidney transplantation seems to warrant better results than its cadaveric counterpart in many aspects but its impact on post-transplantation sexual function remains unknown. This study aimed to compare post-transplantation sexual function and depression in women receiving kidney grafts from living and deceased donors. From a single-center prospective database of 2016 renal transplantations between June 2011 and June 2013, we enrolled 50 sexually active women after kidney transplantation. Female sexual function was evaluated with the Female Sexual Function Index Questionnaire (FSFI) and depression was assessed using the Beck Depression Inventory-II (BDI-II) scale. Thirty-four patients referred the questionnaires. The sexual domains of satisfaction and desire were significantly better in living-donor receptors; in all other domains evaluated by FSFI no statistically significant difference was encountered between groups, although living-donor receptors tended to report better function. Total BDI-II was well correlated with total FSFI score in our study cohort (Spearman's rho = -0.80, P < .001). Only 34.6% of women referred to have discussed sexual issues with their physicians before transplantation, whereas 73.1% stated it would have been important. In conclusion, living-donor transplantation exerted a positive effect on women's sexual function.

Pediatric kidney transplantation: a single center experience with 134 procedures.

Renal transplantation confers substantial benefits on children with end-stage renal disease (ESRD), including improved growth as well as longer and better quality of life. The aim of this study was to report our experience with 134 pediatric renal transplantations. Epidemiological and clinical data of all patients transplanted who were younger than 18 years between January 1984 and May 2012 were collected from our prospective database. One hundred twenty-four patients (44% female) underwent 134 renal transplantations. Renal insufficiency was secondary to urological obstructive uropathy (46%), nephropathy (34%), and other causes (20%). Mean age at the time of the surgery was 13 years. Mean time of ESRD was 25 months. One hundred seventeen patients (95%) received cadaveric renal allografts. Mean cold ischemia time was 1302 minutes. Mean donor age was 19.7 years. Mean length of hospital stay was 17 days. Mean follow-up was 122 months. Graft survivals at 5 and 10 years were 84.1 and 71.9%, respectively. Ninety-six percent of kidney recipients were alive; 71% with functioning allografts. Mean current glomerular filtration rate among functioning kidneys is 55 mL/min. Renal transplantation in the pediatric population is a good option for ESRD patients.

Living versus cadaveric-donor renal transplant recipients: a comparison on sexual function.

Erectile dysfunction is experienced by 50% of men with end-stage renal disease (ESRD) and uremia. The origin of this dysfunction is multifactorial. The aim of this study was to compare living donor versus cadaveric donor transplant recipients regarding male sexual function. Seventy-seven sexually active male kidney transplant recipients (44 from living donors; 33 from cadaveric donors) were randomly selected from our single-center prospective database of 2016 renal transplants. Epidemiological and clinical data were collected between June 2010 and June 2011. Male sexual function was evaluated with the International Index of Erectile Function questionnaire (IIEF-15). We assessed the prevalence of male sexual dysfunction according to established cutoff points for each of the IIEF-15 domains. Mann-Whitney and Pearson's chi- square statistical tests were used to compare continuous and categorical variables, respectively. The median age at the time of completion of the questionnaires was 43 and 51 years (P = .003) with median times from transplantation was of 36 and 42 months for living donor and cadaveric donor recipients, respectively (P = .31). Median durations of ESRD before surgery were 17.5 and 57 months for living donor and cadaveric donor recipients, respectively (P < .001). Living donor and cadaveric donor recipients had median creatinine clearance values of 55 and 57 mL/min, respectively (P = .44). Median time after renal transplantation for first sexual intercourse was 1 and 2 months for living donor and cadaveric donor recipients, respectively (P = .35). Median body mass indices for living donor and cadaveric donor recipients were 24.8 and 24, respectively (P = .31). Regarding sexual function domains, there were significant differences only for intercourse satisfaction. In our cohort, living donor recipients tended to be younger, have shorter time of ESRD, and less incidence of hypertension or diabetes mellitus but with greater tobacco use. In conclusion, living donor transplantation exerted a favorable impact on sexual function.

Urological complications after 134 pediatric kidney transplants: a single-center study.

The incidence of surgical complications after kidney transplantation has been reported to range from 1% to 33%. The aim of this work was to report surgical urological complications among our cohort of 134 pediatric kidney transplantations. Epidemiological and clinical data of all patients younger than 18 years transplanted between January 1984 and May 2012 were collected from our prospective database. Urologic complications and management are reported herein. One hundred twenty-four patients, including 44% females underwent 134 renal transplants. Median age at the time of the surgery was 13 years. Mean time of end-stage renal disease was 25 months. We identified 10 subjects (7.5%) with urological complications: 5 ureterovesical stenoses, 2 lymphoceles, and 3 lower ureteral fistulas. All of the renal allografts were obtained from cadaveric donors. Mean age of these patients at the time of transplantation was 13 years. Mean cold ischemia time was 1613 minutes. All the patients required surgical management. All patients with ureterovesical stenoses underwent ureteral reimplantation using a Boari flap; those with lymphoceles underwent open marsupialization; 2 with ureteral fistulas underwent reimplantation of the ureter, and the other patient's case required placement of a nephrostomy tube and an antegrade ureteral catheter. All patients were treated successfully. Mean follow-up time of cases with urological complications was 9.5 years. Currently, 60% has nonfunctioning allografts; the mean current glomerular filtration rate of the functioning renal allografts is 55 mL/min. Despite requiring surgical management, all patients were treated successfully. Prompt identification and treatment of any complication are critical for graft and patient survival.

The incidence of cancer and potential role of sirolimus immunosuppression conversion on mortality among a single-center renal transplantation cohort of 1,816 patients.

INTRODUCTION: The chronic use of immunosuppressive drugs in renal transplant recipients increases the risk of developing de novo malignancies. Herein we analyze the incidence of de novo tumors and the potential role of sirolimus to improve cancer-specific survival among a cohort at a single center. METHODS: This retrospective analysis of our 1,816 patients allografted between January 1983 and December 2009 sought subjects who developed de novo tumors. Epidemiological and clinical data were examined using Mann-Whitney and Pearson's chi-square or Fisher exact tests for statistical comparisons of continuous and categorical variables, respectively. Kaplan-Meier survival curves were used to determine cancer-specific survival according to type of neoplasia and immunosuppressive regimen, namely, conversion to sirolimus. RESULTS: One hundred patients (5.5%) were diagnosed with a de novo malignancy. The 110 different cancers were diagnosed at a median interval of 73 months after kidney transplantation. The overall cancer-specific survivals at 1 and 5 years after cancer diagnosis were 87.0% and 76.9%, respectively. The 15 patients converted to sirolimus showed no difference in survival. CONCLUSION: The observed frequencies of cancer in our center are consistent with the literature. Among our cohort, sirolimus did not significantly impact survival among subjects who had de novo malignancies.