Practical reduction of transplantation costs. Use of commercial transportation instead of charter aircraft for sharing pancreas grafts.

OBJECTIVE: To demonstrate cost savings in pancreas transplantation through use of commercial organ transportation. DESIGN: Retrospective study. SETTING: Independent Organ Procurement Organization, Denver, Colo. SUBJECTS: Forty-three consecutive pancreas grafts recovered by Colorado transplantation surgeons and transported via charter aircraft (53.4%) or commercial airlines (46.6%) to transplantation centers outside Colorado. MEASUREMENTS: Actuarial graft survival at 1 year was calculated. Transportation costs were also obtained. MAIN RESULTS: Transportation of organs via charter aircraft cost an average of $3658.37 compared with an average of $102.40 for commercial airline transportation (average cost difference, $3555.97). Graft survival was 73.9% for chartered grafts vs 80.0% for commercially shipped grafts. Mean preservation times were 13 hours 54 minutes for chartered grafts vs 17 hours 50 minutes for commercial transportation. CONCLUSION: Our data demonstrated a significant cost savings when pancreas grafts were transported via commercial airlines instead of chartered aircraft. These cost savings were obtained without negative sequelae in clinical outcome, encouraging widespread use of commercial airlines for transporting shared pancreas grafts.

Renal artery stenosis after renal transplantation: the impact of the hypogastric artery anastomosis.

A review of 402 renal allotransplants performed during a 5-year period revealed 25 cases of transplant renal artery stenosis in 377 evaluable patients. To our knowledge this is the first large study of this transplant complication in which all patients received cyclosporine immunotherapy. The incidence of transplant renal artery stenosis was 6.6%. The mean internal from transplantation to onset of transplant renal artery stenosis was 11 months. No significant differences in atherosclerotic risk factors were detected between the groups with and without transplant renal artery stenosis. The incidence of acute allograft rejection was not increased in the stenosis group. There was no difference in the incidence of transplant renal artery stenosis following end-to-end (hypogastric artery) or end-to-side (common or external iliac artery) arterial anastomoses. Among patients having end-to-end hypogastric artery anastomoses the incidence of transplant renal artery stenosis was significantly greater (p < 0.01) when endarterectomy was required to render the hypogastric artery suitable for use. Percutaneous transluminal angioplasty was performed in 20 patients and open repair was performed in 18. After percutaneous transluminal angioplasty of hypogastric artery anastomoses, more additional procedures were required and there was a higher allograft loss rate when compared to percutaneous transluminal angioplasty of the external iliac artery. These data suggest that treatment of transplant renal artery stenosis in patients with end-to-end hypogastric artery anastomosis is more difficult and results in a higher morbidity rate than treatment in the external iliac artery group.

Extravesical versus Leadbetter-Politano ureteroneocystostomy: a comparison of urological complications in 320 renal transplants.

The urological complications of 320 consecutive renal transplants performed at our institution between October 17, 1985 and November 10, 1989 are reviewed. The Leadbetter-Politano technique of ureteroneocystostomy was used in the first 160 patients (group 1) and an anterior extravesical technique modified from the methods of Witzel, Sampson and Lich was performed in the second 160 patients (group 2). Urological complications occurred in 15 patients (9.4%) in group 1 and 6 (3.7%) in group 2 (p = 0.04). Ureterovesical junction obstruction occurred in 6 patients (3.7%) in group 1 and 1 (0.6%) in group 2 (p = 0.05). Complications of leakage, ureteral necrosis and ureteral stricture were comparable in the 2 groups. Therefore, we advocate the use of the anterior extravesical technique over Leadbetter-Politano ureteral reimplantation based on the lower incidence of urological complications and various technical advantages, including less operative time, avoidance of a separate cystotomy, less hematuria and ability to use short donor ureters.