Pairs of kidneys transplanted from the same donor: is there any difference?

OBJECTIVES: The aim of this study was to compare the evolution of the first kidney in relation to the second kidney transplanted from the same donor, focusing on the impact that a longer cold ischemia time may have as an independent variable. MATERIAL AND METHODS: The study included 44 pairs of kidneys transplanted from the same donor between February 2008 and October 2010, divided into Groups 1 and 2 according to the graft placement order. The variables analyzed were age, sex, comorbidities, number of transfusions, length of hospital stay, maximum peak PRA, immunologic incompatibility, ischemia time, delayed graft function (DGF), presence of rejection, creatinine clearance at first week, at 3 months and at 1 year, and vascular and tract complications in each group. RESULTS: The mean cold ischemia time was 15.6 hours in Group 1 and 20.1 hours in Group 2 (P < .001). The average recipient age was 52.79 years in Group 1 and 54.52 years in Group 2, with an equal sex ratio in the two groups; an average of 2.06 PRC were transfused prior to transplantation in Group 1 and 0.93 PRC in Group 2; the average length of stay was similar in the two groups. Major DR incompatibility was only found in Group 2 (P < .03). Creatinine clearance at first week, DGF and acute rejection showed worse results in Group 2, but these differences were not significant. Vascular complications were present in 4.5% and 2.3% of Groups 1 and 2, respectively, and tract complications were 6.8% and 11.4%. CONCLUSIONS: A greater tendency to DGF, early rejection and tract complications were found in the group with longer ischemia time, although the difference was not statistically significant. Larger series will be necessary to confirm our results.

[Analysis of the reasons for non graft initial function in our series of the last eleven years]. / Análisis de las causas de no función inicial del injerto en nuestra serie de los últimos once años.

UNLABELLED: FUNDAMENTAL: [corrected] To know which risk factor of delayed graft function in our patients. MATERIAL AND METHODS: We analyzed 469 transplants, 270 had good initial function and 199 had delayed function graft. Variables studies in booth groups were: age, sex and dead cause of donant, type of extraction and place were it was done, implantation side, vases multiple, isquemia times, age and receptor sex, HLA compatibility, retransplant, Ac Anti-VHC, PTH pretransplant, years in waiting list, hiperinmunization, number of transfusion, and type of inmunosupretion. RESULTS: Univariant study: significant differences were found in age and dead cause of donant, isquemia times, years in waiting list, hiperinmunization, number of transfusions, and HLA-B incompatibility. Multivariate study: we have significant differences in age of donant, could isquemia time, years in waiting list, cuadruple? Inmunosupretion. CONCLUSIONS: Results suggest to short could and revascularization isquemia time as possible, and use less nefrotoxic inmunosupretion pautes in high-risk patients.

Análisis de las causas de no función inicial del injerto en nuestra serie de los últimos once años / Analysis of the reasons for non graft initial function in our serie of the last eleven years

FUNDAMENTO: Conocer los factores de riesgo de disfunción inicial del injerto en nuestra serie. MATERIAL Y MÉTODO: Analizamos 469 trasplantes. 270 con buena función inicial y 199 sin función inicial. Las variables estudiadas en ambos grupos mediante estudio uni y multivariante fueron: edad, sexo y causa de muerte del donante, tipo de extracción y donde se realizó, lateralidad de la implantación, vasos múltiples, tiempos de isquemia fría, edad y sexo del receptor, compatibilidad HLA, retrasplante, Ac AntiVHC, PTH pretrasplante, años en lista de espera, hiperinmunización, número de transfusiones y tipo de inmunosupresión. RESULTADOS: Estudio univariante: hubo diferencias significativas en la edad y causa de muerte del donante, tiempos de isquemia, años en lista de espera, hiperinmunización, número de transfusiones e incompatibilidad HLA-B. Estudio multivariante: hubo diferencias significativas en la edad del donante, tiempo de isquemia fría y de revascularización, e inmunosupresión cuádruple. CONCLUSIONES: Los resultados aconsejan acortar en lo posible los tiempos de isquemia fría y de revascularización, y utilizar pautas inmunosupresoras menos nefrotóxica en casos de alto riesgo (AU)

FUNDAMENT: To know which risk factor of delayed graft function in our patients. MATERIAL AND METHODS: We analyzed 469 transplants, 270 had good initial function and 199 had delayed function graft. Variables studies in booth groups were: age, sex and dead cause of donant, type of extraction and place were it was done, implantation side, vases multiple, isquemia times, age and receptor sex, HLA compatibility, retransplant, Ac Anti-VHC, PTH pretransplant, years in waiting list, hiperinmunization, number of transfusion, and type of inmunosupretion. RESULTS: Univariant study: significant differences were found in age and dead cause of donant, isquemia times, years in waiting list, hiperinmunization, number of transfusions, and HLA-B incompatibility. Multivariate study: we have significant differences in age of donant, could isquemia time, years in waiting list, ¿cuadruple? Inmunosupretion. CONCLUSIONS: Results suggest to short could and revascularization isquemia time as possible, and use less nefrotoxic inmunosupretion pautes in high-risk patients (AU)

[Urinary lithiasis secondary to indinavir in an HIV-positive patient]. / Litiasis urinaria secundaria a Indinavir en enfermo HIV positivo.

OBJECTIVE: Indinavir is a protease inhibitor used in the treatment of HIV with a lithogenic capacity as a urological side effect. The pathogenesis, diagnosis and treatment of indinavir urolithiasis are briefly reviewed. METHODS: A 37-year-old male, seropositive for HIV on treatment with indinavir, lamiduvine and zidovudine, consulted for colicky left lumbar pain, nausea, vomiting and dark urine for the past three days. RESULTS: Patient evaluation showed a nonfunctioning left kidney and ureterohydronephrosis of unknown origin. URS showed a yellowish, friable material with a mucinous appearance that occupied the entire lumen of the ureter. Fragmentation was achieved with the lithotriptor probe. Six months later the patient had fully recovered and was asymptomatic. CONCLUSIONS: The incidence of protease inhibitor-induced urolithiasis is increasing. This condition should be distinguished from uric acid calculi whose treatment will aggravate the indinavir urolithiasis.

[Testicular epidermoid cyst]. / Quiste epidermoide testicular.

OBJECTIVE: Benign tumors account for less than 1% of testicular tumors and the incidence is even lower in children. A rare case of epidermoid cyst of the testis in a child is described. The differential diagnosis and treatment options are discussed. METHODS/RESULTS: A case of unilateral epidermoid cyst of the testis in an 11-year-old boy is presented. The clinical and diagnostic aspects are discussed. Definitive diagnosis could be made only after surgical excision. CONCLUSIONS: Pathological analysis of the entire testis is warranted to make the definitive diagnosis of epidermoid cyst. However, preservation of the testis can be considered, particularly in those cases with bilateral involvement, if supported by solid, consistent diagnostic evidence, including intraoperative biopsy.

[Complex renal lithiasis: conservative surgery]. / Litiasis renal compleja: cirugía conservadora.

We report a case of complicated renal lithiasis which had been successfully treated by conservative surgery. The present case shows that this surgical procedure continues to be a valid therapeutic option for this pathology, although occasionally the new, less invasive treatment modalities that continue to develop are utilized in the treatment of renal lithiasis far beyond the indications.

[Paratesticular rhabdomyosarcoma]. / Rabdomiosarcoma paratesticular.

Report of one paratesticular RMS in a 28 year-old male. The paper includes a review of the various clinical, etiopathogenic and therapeutic features involved. RMS is a neoplasia difficult to diagnose through M.O. and, quite often, it is necessary to use immunohistochemical techniques in order to discover some of the muscular fibre markers, such as Desmin, Myosin and Myoglobin. Several theories have been put forward to explain its origin, and the most widely accepted defends an origin in a poorly differentiated mesenchymal tissue. The advantages of retroperitoneal lymphadenectomy following orchiectomy are discussed as treatment.

[Skin metastasis in external ear canal of bladder carcinoma]. / Metástasis cutánea en conducto auditivo externo de carcinoma vesical.

A case of vesical carcinoma skin metastasis in the external ear is presented. Apart from its uncommonness, cutaneous dissemination of a vesical carcinoma implies a poor prognosis since it is indicative of metastasis spreading to other sites, death occurring in nearly all cases within three months of diagnosis.

[Calcified renal carcinoma. Diagnostic difficulty]. / Carcinoma renal quistificado. Dificultad diagnóstica.

Two cases of renal carcinoma presenting as renal cyst seen at our service in the past year are described. One presented as a large central cyst with several smaller cysts on its wall. The other presented as a renal cyst coexisting with several serous cysts. Imaging techniques are underscored due to the diagnostic difficulties. The currently available diagnostic techniques for classifying tumor masses with mixed or undefined features are briefly described.

[Antibiotic prophylaxis in endoscopic urologic surgery]. / Profilaxis antibiótica en cirugía urologica endoscópica.

Recent studies have shown the value of antibiotic prophylaxis with short therapy periods in patients submitted to transurethral surgery. We have carried out a prospective study on 46 patients, all with negative urine cultures prior to the intervention, divided into two groups: one control and the other with short cefuroxime prophylaxis. With the latter a reduction in post-operative infectious complications was obtained, and specifically of postoperative bacteriuria, from a 70% in the control group to al 13% in the prophylaxis group. The results are statistically significant.