Malignant disease in renal transplant recipients--our experience.

Kidney transplantation is a treatment of choice for patient with end stage renal disease. Chronic renal failure is characterized with weak cellular and humoral immunity. In our paper we present our experience with presence of malignancy in renal transplant patients. Urology clinic in Belgrade transplanted 411 patients over the period of 16 years. Living donor transplantation was performed for 272 and cadaveric kidney transplant for 139 patients. In the postoperative follow up, malignancies were diagnosed in 7 of the transplanted patients. Three patients developed basal cell skin carcinoma, one was diagnosed with adenocarcinoma of the transplanted kidney, one developed transitional cell carcinoma of the bladder and testicular tumors were diagnosed in two patients. Postoperative immunosuppressive therapy usually double or triple when patients are in the immunological high risk group. Incidence of malignancy according to big health centers is around 1 in every 1000 transplanted patients. It is also noted the rise of incidence of malignancies in transplanted patient in over 50%.

Ureteral fistulae after kidney transplantation: experience with 224 cases.

Ureteral fistulae after kidney transplantation represent major early urological complications with reported incidence from 1.2% to 12% in large series. The aim of the study is to establish the incidence, types and ureteral fistula related morbidity and lethality rates, by donor type. From 1995. to 2001, a total of 224 kidney transplantations (171 from living and 53 from cadaveric donor) have been performed at the Institute of Urology and Nephrology in Belgrade. Mean patients age was 36,67 years (11-64; SD = 10.69). Ureteral fistulae appeared only after living donor transplantation in a total of five patients (2.2%) (p > 0.05). In all patients open fistula repair was performed. Two patients had recidive ureteral fistula after primary and after secondary open repair. Following the third open repair one patient had lethal outcome. Ureteral fistulae after kidney transplantation still remain challenging urological problem with considerable morbidity and lethality rates.

[Vascular complications after kidney transplantation]. / Vaskularne komplikacije posle transplanticije bubrega.

INTRODUCTION: Despite high graft and recipient survival figures worldwide today, a variety of technical complications can threaten the transplant in the postoperative period. Vascular complications are commonly related to technical problems in establishing vascular continuity or to damage that occurs during donor nephrectomy or preservation [13]. AIM: The aim of the presenting study is to evaluate counts and rates of vascular complications after renal transplantation and to compare the outcome by donor type. MATERIAL AND METHODS: A total of 463 kidneys (319 from living related donor--LD and 144 from cadaveric donor--CD) were transplanted during the period between June 1975 and December 1998 at the Urology & Nephrology Institute of Clinical Centre of Serbia in Belgrade. Average recipients' age was 33.7 years (15-54) in LD group and 39.8 (19-62) in CD group. Retrospectively, we analyzed medical records of all recipients. Statistical analysis is estimated using Hi-squared test and Fischer's test of exact probability. RESULTS: Major vascular complications including vascular anastomosis thrombosis, internal iliac artery stenosis, internal iliac artery rupture, obliterant vasculitis and external iliac vein rupture were analyzed. In 25 recipients (5.4%) some of major vascular complications were detected. Among these cases, 22 of them were from CD group vs. three from LD group. Relative rate of these complications was higher in CD group vs. LD group (p < 0.0001). Among these complications dominant one was vascular anastomosis thrombosis which occurred in 18 recipients (17 from CD vs. one from LD). Of these recipients 16 from CD lost the graft, while the rest of two (one from each group) had lethal outcome. DISCUSSION: Thrombosis of renal allograft vascular anastomosis site is the most severe complication following renal transplantation. In the literature, renal allograft thrombosis is reported with different incidence rates, from 0.5-4% [14, 15, 16]. Data from the present study demonstrate that the rate of this complication in LD group was low, only 0.3%, but significantly higher in CD group--11.8%. Many factors should be considered in order to understand for such significant difference among these groups. First of all, cadaveric transplant activity in our country is very low. In our series, median waiting period for renal transplantation was 2.8 years in LD group vs. 4.8 years in CD group (p < 0.01). Also, vascular damages because of long term hemodialysis are contributing factors. Mean age of CD recipients was 7.4 years bigger vs. LD recipients. Primary cadaveric graft damage by accident and further manipulations during cadaveric donor nephrectomy, preservation and perfusion are additional factors compromising the quality of cadaveric renal transplant outcome. Also, preoperative evaluation of cadaveric grafts is not as exact as in cases of LD grafts (excretory urography, arteriography, etc). In the available transplant literature it is almost impossible to find data about vascular complications by different donor types. Mostly, authors offer experiences related to all transplants and most of them agree that in the present time better results are obtained using living donors [17].

[Effect of uremia and peritoneal dialysis on peritoneal mesothelial cells]. / Uticaj uremije i peritoneurske dijalize na celije mezotela peritoneuma.

The aim of the study was to investigate the morphology of mesothelial cells of the peritoneum of patients with terminal renal failure (TRF), taken by the biopsy immediately before the onset of peritonal dialysis (PD), and to compare it with the findings in patients with PD. The samples were prepared in the way standard for light microscopy and transmission electron microscopy. In patients with TRF intracytoplasmatic inclusions could be observed, unusual protrusions of mesothelial apical surfaces, deformation of mesothelial cells and their detachment from the basal membrane, as well as the dilatated cisternae of granulated endoplasmatic reticulum with filamentous structures in some of them. In patients on PD cytoplasmic protrusions of different shapes and contents were observed at the surface of mesothelial cells, multiplication of basal membrane, occurrence of young forms of mesothelial cells as well as the detachment of those cells from the basal lamina.