Kidney Transplantation Using Gonadal Vein for Venous Anastomosis in Patients With Iliac Vein Thrombosis or Stenosis: A Series of Cases.

BACKGROUND: Kidney transplantation is the treatment of choice for patients with end-stage renal disease. The standard surgery uses the recipient's iliac vessels for vascular anastomosis. Thrombosis and/or stenosis of the iliac vein, which are possible complications of multiple vascular access points for dialysis, can be detected intraoperatively, constituting a surgical challenge. An infrequently reported option is the use of the gonadal vein. OBJECTIVES: This study aims to evaluate the outcomes of venous anastomosis in the gonadal vein in patients with iliac vein thrombosis and/or stenosis submitted to kidney transplantation. METHODS: We reviewed the records of five adult recipients with iliac vein thrombosis and/or stenosis detected intraoperatively during emergency kidney transplantation with deceased donor due to vascular access failure from February 2013 to December 2014. Antithrombotic prophylaxis was not performed. We evaluated the postoperative complications, length of stay, early graft echo-Doppler, and renal function during the first year postoperatively. RESULTS: Delayed graft function occurred in three cases. Two patients developed postoperative infection requiring antibiotics. One patient required reoperation due to post-renal biopsy complications. The mean length of stay was 31.2 days and the mean serum creatinine levels at discharge, at 6 months, and at 12 months postoperatively were 1.42 mg/dL, 0.86 mg/dL, and 0.82 mg/dL, respectively. All patients had normal ultrasonography. There were no losses of graft or deaths during follow-up. CONCLUSION: Venous anastomosis using the gonadal vein in kidney transplantation for patients with iliac vein thrombosis and/or stenosis showed good clinical and surgical results, showing this method to be a viable alternative to venous drainage in these complex patients.

Effect of age of donor on embryo production in Morada Nova (white variety) ewes participating in a conservation programme in Brazil.

In order to evaluate embryo production in Morada Nova (white variety) ewes superovulated with porcine follicle-stimulating hormone, 20 cycling ewes were used as embryo donors and allocated into two groups according to age: group 1 (ewes aged 1-2 years; n = 9) or group 2 (ewes aged 3-4 years; n = 11). Embryo recovery was performed by laparotomy 5-6 days after oestrus. The evaluation of embryos was made under stereomicroscope according to International Embryo Transfer Society rules. The overall recovery rate was 64.6% (5.0 +/- 0.7 structures per ewe) and 86.3% of the recovered structures were fertilized. Group 1 was superior (p < 0.05) to group 2 according to recovered (6.6 +/- 0.9 vs 3.6 +/- 0.8) and fertilized structures (5.6 +/- 1.1 vs. 3.5 +/- 0.7) per ewe. In conclusion, the ovarian response and the embryo production in Morada Nova (white variety) sheep subjected to a standard superovulation treatment were considered satisfactory. In addition, the use of multiple ovulation and embryo transfer in younger ewes ( < or = 2 years old) of this sheep breed appears to be an efficient tool to accelerate the preservation of the Morada Nova (white variety) breed, since younger ewes are as responsive as older ones.