Effect of warm ischemia on graft outcome in laparoscopic donor nephrectomy.

PURPOSE: To assess the impact of warm ischemia time (WIT) on delayed graft function (DGF), graft loss, and graft function in laparoscopic donor nephrectomy (LDN). PATIENTS AND METHODS: We prospectively studied 100 kidney recipients from LDN donors from 2001 to 2003. For comparison of graft outcome with different extents of WIT, recipients were divided into three groups: group A received kidneys having 4 to 6 minutes, group B kidneys having >6 to 10 minutes, and group C kidneys having >10 minutes of WIT. The median follow-up was 415 days (range 11-791) days. RESULTS: The mean kidney WIT was 8.7 minutes (range 4-17 minutes). Graft outcome (DGF, graft loss, and median serum creatinine) was not significantly different in the three groups. CONCLUSIONS: Different extents of WIT in LDN, within the range of our study, were not associated with an adverse outcome in kidney transplantation.

The efficacy of conventional PCNL and two modifications to standard procedure.

OBJECTIVE: To compare the efficacy of conventional Percutaneous Nephrolithotomy (PCNL) with two of its modified procedures. METHODS: A randomized controlled trial, was performed on 60 patients undergoing PCNL. Cases of renal stone regardless of stone size and configuration, having pre-operative negative urine culture, no coagulopathy, and no visible residual stone in intra-operative fluoroscopy, were included. They were randomly divided into 3 groups of 20 cases each with nephrostomy tube (NT) and temporary ureteral catheter (TU) in group A, only TU in group B and only indwelling ureteral catheter (IU) in group C. Mean age of cases were 43.2 (25-70), 40.1 (25-73), and 44 (25-70) years in groups A , B and C, respectively (P = 0.6). Procedures were performed under general anaesthesia, using standard techniques for access and lithotomy. Forty-eight hours, 2 weeks and 3 months after PCNL, plain X-ray abdomen, ultrasonography and IVP were performed for each case. RESULTS: Only one case in group A had urinary leakage after removal of nephrostomy tube. No cases in the other two groups encountered this problem. There was no haemorrhagic episode. Ultrasonic evaluation showed mild residue in 3, 1 and 1 cases of groups A, B and C, respectively (P = 0.2). No collective fluid was found in these groups. IVP showed dilatation without obstruction in 3 subjects of group A and none in group B or C (P = 0.03). CONCLUSION: Tubeless PCNL seems to be accompanied by better outcome. So, further evaluation on more patients seems necessary.

Correlation between human papillomavirus infection and bladder transitional cell carcinoma.

BACKGROUND: To determine the association of human papillomavirus infection (HPV) and transitional cell carcinoma (TCC). METHODS: Using polymerase chain reaction, fifty-nine bladder tissue specimens of patients with transitional cell carcinoma of bladder compared with 20 bladder samples of cases with non-neoplastic disorders. RESULTS: Male to female ratio was similar in the two groups (50/9 vs. 16/4, P = 0.62). Mean age was 67 +/- 10.8 years and 52 +/- 20.3 years in the case and control groups, respectively (P = 0.6). Of the 59 tissue specimens with diagnosis of transitional cell carcinoma, HPV DNA was detected in 21 (35.6%) samples, while it was present in only one sample (5%) in the control group (P = 0.008). HPV18 was the most common type of virus with the incidence rate of 17/21(81%). CONCLUSION: HPV might play a causative role in transitional cell carcinoma of bladder in our geographic area.

Preliminary report of a nationwide case-control study for identifying risk factors of tuberculosis following renal transplantation.

BACKGROUND: Tuberculosis (TB) is an important infection encountered posttransplantation, especially among patients in developing countries, where there are high incidences of morbidity and mortality. MATERIALS AND METHODS: One hundred and twenty subjects (1%) from 15 major kidney transplantation centers in Iran from 1984 to 2003 were compared with 440 controls who were matched for operative time, treatment center, and surgical team. RESULTS: Mean ages of research subjects and controls were 38.6 and 36.6 years (P = .04), respectively. The mean duration of pretransplantation hemodialysis was 29 months (range, 2 to 192 months) in research subjects and 20 months (range, 1 to 180 months) in controls (P = .003). Positive past history of tuberculosis was detected in 4 (3.3%) research subjects and in 7 (1.5%) controls (P = .2). Fifty-two research subjects (43.3%) and 241 controls (54.8%) had pretransplantation purified protein derivative of tuberculin less than 5 mm (P = .02). Mean dosages of initial and maintenance immunosuppressive drugs in research subjects and in controls were not significantly different. Sixty research subjects (50%) and 152 controls (34.5%) had rejection prior to diagnosis of TB (P = .03). CONCLUSION: To our knowledge, this is the first study that demonstrates an increased risk of posttransplant TB by prolonged duration of pretransplant hemodialysis and number of posttransplant rejection episodes. Further study is needed to clarify these findings specifically with respect to various immunosuppressive regimens.