[Laparoscopic liver donor nephrectomy. Personal experiences and review of the literature]. / Laparoskopische Lebendspendernephrektomie. Eigene Erfahrungen und Literaturübersicht.

Despite improved success rates, the number of kidney transplantations in Germany in the last few years has stagnated, resulting in increasing waiting lists of patients on dialysis. In Germany, only 16.7% of kidney transplantations are living-donor nephrectomies, representing a relatively low rate compared to other countries (The Netherlands 28%, Sweden 35%). Since April 1998, we have performed ten retroperitoneoscopic living-donor nephrectomies (six left, four right side). The mean operating time was 216 min (155-290) with minimal blood loss. No intraoperative complications were observed. Warm ischemia time amounted to a mean of 4 min (2-7). The mean cold ischemia time was 165 min (76-290). Postoperative hospital stay of the donors was 6 days (4-10). All transplants functioned immediately; mean serum creatinine dropped from initially 8.0 mg/dl (5.3-11.5) on day 1 to 1.4 mg/dl (0.9-1.6) 3 months after surgery. This did not differ from previously operated open donor nephrectomies. An analysis of the literature included data of 4240 patients from 25 publications between 1980 and 2000 reporting on either open or laparoscopic living donor nephrectomies.

[The staging of renal-cell carcinomas in MRT and CT--a prospective histologically controlled study]. / Staging von Nierenzellkarzinomen in MRT und CT--prospektive histologisch kontrollierte Studie.

PURPOSE: To evaluate the accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) in staging renal carcinoma. MATERIAL AND METHODS: 33 renal carcinomas were preoperatively examined for tumour staging by CT and MR imaging and correlated with histopathological staging. CT imaging was performed at first as a non-contrast scan. Finally incremental images (10 mm) after intravenous contrast injection were obtained. In MR imaging we performed a transversal T1-weighted GE sequence (112/5) with and without GDTPA, a transversal fat-suppressed double-echo sequence (3900/22/90), a coronal T1-weighted GE sequence with and without GDTPA and a coronal T2-weighted TSE sequence (2800/128). In addition, dynamic T1-weighted GE imaging after GDTPA injection as well as TOF angiography in coronal direction were performed. Finally CT and MRI findings were correlated with surgical and histopathological staging results. RESULTS: CT and MRI staging was correct in 27 and 28 of 33 tumours. Sensitivity and specificity for tumour stage T3b to T4 was for MRI and CT 88.9% and 95.8%. With MRI 4 out of 7 thrombi were correctly diagnosed with high accuracy, but via CT none. CONCLUSION: In early stage renal carcinoma CT and MR imaging yielded similar staging accuracies. In advanced renal carcinoma MRI was superior to CT imaging, especially in diagnosing tumour thrombus. Consequently the extent of tumour thrombus may be assessed by MRI which may therefore replace conventional cavography.

[The clinical significance of renal cell carcinoma in dialysis dependent patients in comparison with kidney transplant recipients]. / Die klinische Bedeutung des Nierenzellkarzinoms beim dialysepflichtigen Patienten im Vergleich zu Nierentransplantatempfängern.

The clinical relevance of de novo Renal Cell Cancer was compared in chronic hemodialysis patients and renal allograft recipients. Clinical course of these patients was followed for 15 years. 21 of 788 patients who underwent radical nephrectomy were suffering from renal insufficiency at the time of surgery. Evaluated data included clinical symptoms; tumor histology and clinical course. 19 patients received chronic hemodialysis treatment. 7 patients demonstrated stable function of the allograft. 92% of patients receiving hemodialysis treatment did not show metastasis and none died of renal cell carcinoma. On the contrary, 71% of patients who underwent renal transplantation showed advanced tumor disease or metastasis. 3 patients have died of RCC. Aggressive tumor growth of RCC requires close follow up in patients who received a renal allograft.

[Tumor vaccination in renal cell carcinoma with and without interleukin-2 (IL-2) as adjuvant. A clinical contribution to the development of effective active specific immunization]. / Tumorvakzination bei Nierenzellkarzinom mit und ohne Interleukin-2 (IL-2) als Adjuvans. Ein klinischer Beitrag zur Entwicklung wirksamer aktiver spezifischer Immunisierung.

Interleukin 2 (IL2) production is known to bypass T-helper-cell function in the generation of an antitumour response. The present analysis was designed to assess the effects of application of renal cancer vaccine with and without IL2 on delayed-type hypersensitivity (DTH) skin responses to the vaccine itself and tumour cell challenge. The renal cancer vaccine consisted of Newcastle disease virus (NDV)-infected autologous irradiated tumour cells and topical application of low-dose rIL2 (75,000 Cetus units). As a result, the coadministration of a supplement of rIL2 proved to be important for augmentation of DTH responsiveness to tumour cell challenge. Patients with aneuploid tumours vaccinated without rIL2 developed an anergy to the vaccine throughout vaccination. This effect could be reversed by the topical coapplication of this cytokine. While the treatment of renal cancer patients with IL2-based immunotherapy regimens appears to be effective in advanced renal cell carcinoma the IL2-supplemented vaccines should be tested to assess their benefit in the situation of "minimal disease" after surgery especially in high-risk patients with aneuploid tumours.

[Tumor involvement of the vena cava in renal cell carcinoma. Surgical technique, results and prognosis]. / Tumorbefall der Vena cava beim Nierenzellkarzinom. Operationstechnik, Ergebnisse und Prognose.

In 45 patients with a vena cava tumor thrombus secondary to renal cell carcinoma we present the diagnostic and operative management and relevant data on the extent of the thrombus (classified into 4 stages), postoperative complications and patient survival. Extensive thrombi of the vena cava were removed surgically in hypothermia and with extracorporeal circulation. The importance of an interdisciplinary approach involving cardiac and urologic surgeons is therefore emphasized. With due consideration for relevant prognostic parameters such as tumor differentiation or spread, we estimated a 5-year survival of 29% for our Heidelberg patients. Neither the extent of the tumor thrombus nor tumor infiltration of the perirenal adipose tissue had any influence on patient survival.