Outcome of Kidney Transplantation From Living Donors With Multiple Renal Arteries Versus Single Renal Artery.

INTRODUCTION: Receiving a kidney transplant from donors with multiple renal arteries (MRAs) is suggested to be associated with higher risk of vascular and urologic complications and poor allograft outcomes compared to the donors with single renal artery (SRA). We evaluated survival rates in the recipients from donors with MRAs compared to those from donors with SRA. MATERIALS AND METHODS: In a retrospective study on 115 kidney allograft recipients, demographic characteristics and the outcomes of kidney transplantation were compared between the recipients from donors with MRAs compared to those from donors with SRA. These included acute tubular necrosis, acute allograft rejection, hypertension, vascular complications, urologic complications, kidney function indicators, and allograft survival at 1 year. RESULTS: There was no significant difference in the recipients' age, sex distribution, and weight, donors' age, donor-recipient familial relation, urologic complications, and duration of hospitalization between the two groups. However, MRA was significantly associated with a higher likelihood of right-side kidney donation, longer warm and cold ischemia times, and lower glomerular filtration rate and higher serum creatinine concentrations at discharge and 12 months after transplantation, as compared to SRA transplants. No significant difference was seen in late complications including hypertension and renal artery stenosis. One-year graft survival was slightly poorer in the MRA group than the SRA group. CONCLUSIONS: Our results demonstrate that kidney allografts with MRAs are associated with risks but have acceptable outcomes during the 1st year after transplantation, as compared to SRA kidney allografts.

Comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy in a prospective randomized study.

PURPOSE: This article reports a prospective, randomized comparison of transperitoneal laparoscopic adrenalectomy (TLA) versus retroperitoneal laparoscopic adrenalectomy (RLA) for adrenal lesions with medium-term follow-up. SUBJECTS AND METHODS: Between September 2008 and November 2011, 24 patients with surgical adrenal diseases were prospectively randomized to undergo TLA (Group 1, 11 patients) or RLA (Group 2, 13 patients). Study exclusion criteria were patients with a body mass index of >40 kg/m(2), significant prior abdominal surgery, and bilateral adrenalectomy. Mean follow-up was 9 months in both groups. RESULTS: The groups were matched in regard to patients' age (P=.80), sex (P=.72), body mass index (P=.62), and laterality (P=.72). Median adrenal mass size was 2.92 cm (range, 2-5 cm) in the TLA group and 2.63 cm (range, 2-5 cm) in the RLA group (P=.55). TLA was comparable to RLA in terms of operative time (P=.22), estimated blood loss (P=.83), time to ambulation (P=.21), hospital stay (P=.25), analgesic requirement (P=.40), and postoperative pain (P=.40), whereas time to oral intake resumption (P=.001) and convalescence period (P=.002) were significantly shorter in the RLA group. One case from the RLA group was electively converted to open surgery. During a mean follow-up of 9 months, there were no late complications, and no deaths occurred in any group. CONCLUSIONS: Laparoscopic adrenalectomy is a viable treatment option for removal of benign adrenal lesions that can be performed safely and effectively by either the transperitoneal or retroperitoneal approach. All operative parameters are similar in the two approaches, except that the convalescence period and time to oral intake resumptions that are significantly shorter with retroperitoneal surgery.

Frequency of occurrence of vesico-ureteral reflux in kidney transplanted patients with the new technique of uretero-neo- cystostomy (Barry-Taguchi).

There are several ways of performing vesico-ureteral anastomosis in kidney trans-plantation (Tx); they are broadly classified into two categories: extra-vesical and intra-vesical. Extra-vesical methods are preferred in kidney transplantation. In this study, we attempt to integrate two extra-vesical techniques of Barry and Taguchi and to evaluate the frequency of occurrence of vesico-ureteral reflux (VUR) with this technique. Also, an attempt is made to compare the results with other techniques reported in the literature. Fifty consecutive transplant recipients, who underwent uretero-neo-cystostomy (uretero-vesical anastomosis) by the new technique of Barry-Taguchi were evaluated for VUR by sonography and cystoureterography, six months after Tx. The mean age of the study subjects was 34.8 years; there were 33 males and 17 females. The mean time between Tx and evaluating for VUR was 6.6 months. Two cases of asymptomatic VUR (4%) were detected at the end of the study period. The occurrence of 4% asymptomatic VUR suggests that this technique is more acceptable compared to others. Because of the simple nature of the procedure as well as the short time required, this technique could be a suitable choice in kidney transplantation.