Changing of the guard? A glance at the surgical representation in the Canadian renal transplantation community.

INTRODUCTION: Renal transplant is the gold standard treatment for end-stage renal disease (ESRD), and the prevalence of both ESRD and renal transplant has been steadily increasing over the past decade. However, involvement of urology in renal transplant has been declining. We examine the current state of urology involvement in renal transplant programs across Canada. METHODS: A telephone survey of all surgical transplant centres in Canada was performed. Information regarding the number of transplant surgeons, their individual training background, and their involvement in specific procedures, including open and laparoscopic living donor nephrectomy, deceased donor nephrectomy, and recipient renal transplant were collected. RESULTS: There are 59 Canadian transplant surgeons, including 27 (46%) who completed a urology residency and 32 (54%) with a general surgery background. With regards to procedures performed, 58 (98%) perform recipient renal transplant surgery, 36 (61%) perform laparoscopic donor nephrectomy, and 17 (29%) perform open donor nephrectomy. There was no significant difference in the number of surgeons that perform renal recipient surgery, laparoscopic or open donor nephrectomies, and deceased donor nephrectomies between surgeons of the two different training backgrounds. CONCLUSIONS: The role of urology in Canadian renal transplant has declined significantly over the past decade. Given the medical and surgical complexity of renal transplant, along with the growing need for renal transplants, a multidisciplinary team approach is imperative. Strong urology involvement with the transplant team is crucial for optimal care of these complex patients.

Catheter-directed thrombolysis with tPA to restore renal function after iliac venous thrombosis post-renal transplantation.

BACKGROUND: Successful salvage of a failing renal allograft secondary to compromised venous outflow from acute deep venous thrombus (DVT) has not been reported in the post-operative setting. CASE REPORT: We present a case of acute DVT extending from the popliteal vein to the bifurcation of the inferior vena cava leading to renal allograft dysfunction in the post-operative period. The allograft was successfully salvaged with catheter directed thrombolysis of the DVT with tPA through the ipsilateral popliteal vein over a 48 hr period. CONCLUSIONS: Post-operative renal transplant dysfunction secondary to iliac vein thrombosis can be successfully treated with catheter-directed thrombolysis using tPA.