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Multiple Renal Arteries in Live Donor Renal Transplantation; Impact on Graft Function and Outcome: A Prospective Cohort Study  [PDF]
Dilushi Rowena Wijayaratne, Dinesha Himali Sudusinghe, Nalaka Gunawansa
Open Journal of Organ Transplant Surgery (OJOTS) , 2018, DOI: 10.4236/ojots.2018.81001
Abstract: Introduction: The presence of multiple renal arteries (MRA) in the donor allograft was once a contraindication to transplantation. Despite concerns about risks, these allografts are being increasingly used to overcome a shortage of renal donors. Objectives: To compare the outcomes of live-donor renal allografts with multiple and single renal arteries (SRA) in terms of overall ischemia times, early and late graft function, and vascular and urological complications. Methods: A prospective, non-randomized cohort study was conducted including all live donor renal transplants done by the Vascular and Transplant Unit of the National Institute of Nephrology Dialysis and Transplantation, Sri Lanka between March 2010 and March 2016. 312 recipients of live donor renal allografts were recruited to the study. Patients were divided into three groups: Group 1—SRA: single anastomosis (n = 264, 85%); Group 2—MRA: single conjoined anastomosis (n = 39, 12%); and Group 3—MRA: ≥2 anastomoses (n = 9, 3%). Results: Mean ischaemia times (donor clamping to graft reperfusion) in the three groups were 14, 21 and 17 minutes respectively. Failure to normalize creatinine within 72 hours was seen in 29/264 (11%), 4/39 (10.2%) and 1/9 (11%), (P >0.05). Delayed graft function (attributable to severe rejection) occurred in only one patient who was from group 2. One-year graft survival among the groups was 243/264 (92%), 35/39 (90%) and 8/9 (89%), (P > 0.05). One patient from groups 1 and 2 developed transplant renal artery stenosis. Two patients from group 1 needed stenting for ureteric stenosis. Conclusions: Donor grafts with MRA may be accepted safely with careful surgical reconstruction and close surveillance post-transplant.
D. Mehraban G.H. Naderi
Acta Medica Iranica , 1998,
Abstract: This study compare:.' [he results 0;,.1 outcome of live-donor transplantation between single-artery "',"' mull/pic-ana)' transplant kidneys. Cadaver kidneys with multiple vessels arc retrieved with a patch of the donor artery. 111is is not possible ill the !iI'C donation seuing. Therefore !i1'C donation of rcnal"nallografts with multiple arteries is lIot a straiglnjorward surgery. We studied 22 muttiplc-anery live donor renal allografts among 223 renal transplantations in a sequential. prospective mOllTlCr [or 3 ynJrs. One-year gra{! survival was l)(j.:V:(, ill single-anery group and 95.5":{, in tlns muliplc . arIer)' group. III the singleartery group the complications wae: dctavcd gm[l [unction ill 3.5'7;, rean astomosis o[ tlu: v-essels in 2,9':k, transient post-transplant dialysis in 1. 5 (X" graft nephrectomy ill 2,5';{, AT"' ill 1":'(" Urine leak in 2.5':{', renal anav stenosis in O.5S'(" and lvmpho cclc ill 1%. NOlie: o] thcsc occurred in the"nmultiptc-oncry group. This difference is statistically significant IX~ = 8.10). Cold ischemia time: l"'(lS significantly lunger in lilt' multiple . anery group (panastomosis was not siglliftcanl~"' dlffaelll among lht' 2,1,'Youps (I = 1.255). Ttu: totat tcngtli of tile operation IVas IOllga ill lhe mutsiptc-oncry group (p < O. 00(5). In conclusion it is appareIH snas t lu: intra-op crativc complications. posi-operati vc complications and one-year grafr survival are ccnnparabtc ill"nsingle - ane'Y' "'."'. mutsiptc - arrcry renal transplantation. tn other words, !i1'C - donor transptannuion with muliip!c . arIa)' reno! units is safe and has a good OI/lCO!1le.
Moving towards implementation of a clinical ethics consultation program in Egyptian liver transplant units
A H El-Elemi, G H El-Gazzaz
Transplant Research and Risk Management , 2010, DOI: http://dx.doi.org/10.2147/TRRM.S8439
Abstract: ving towards implementation of a clinical ethics consultation program in Egyptian liver transplant units Expert Opinion (3256) Total Article Views Authors: A H El-Elemi, G H El-Gazzaz Published Date March 2010 Volume 2010:2 Pages 23 - 27 DOI: http://dx.doi.org/10.2147/TRRM.S8439 A H El-Elemi1, G H El-Gazzaz2 1Forensic Medicine and Clinical Toxicology Department, 2Hepatobiliary and General Surgery Department, Suez Canal University, Ismailia, Egypt Abstract: The high prevalence of chronic liver disease in Egypt has led to increasing numbers of patients with end-stage liver disease in need of liver transplantation. To date, cadaveric liver transplantation is not legal in Egypt. However, introducing living-donor liver transplantation seems appropriate for patients who need transplantation. There are no clinical bioethicists in the Egyptian healthcare system. The idea of implementing an ethics consultation program has evolved as a response to complicated legal, ethical, and social dilemmas that accompany the transplantation process, especially in Egypt where organs are obtained by advertising without consideration of an acceptable level of risk to donors or recipients. Recommendations need to be made to start to implement peoples who do bioethics consultation in liver transplantation units. To achieve this goal there is a need to develop training standards, credentials, and certification before embarking on clinical consultation to ensure good ethics practice in Egypt.
Donante vivo renal: Experiencia de cirugía abierta y laparoscópica. Hospital La Paz
Aguilera Bazán,Alfredo; Pérez Utrilla,Manuel; Alonso,ángel; Jaureguizar Monereo,Enrique; Hidalgo Togores,Luis; Pe?a Barthel,Javier de la;
Actas Urológicas Espa?olas , 2009, DOI: 10.4321/S0210-48062009000100010
Abstract: laparoscopic live donor nephrectomy is a rare operation in our country because the complexity of the technique and the expansion of the cadaveric donor. we present our open and laparoscopic live donor nephrectomy from 1984. material and methods: from 1984 to 2007 we have done 84 live donor nephrectomies; 64 open, 20 laparoscopic surgeries. the transperitoneal approach is preferred in laparoscopy and lumbotomy for the open surgery. results: in the open technique the operating time is 112min (70-155), ischaemia time 20 seconds (15-47) and postoperative hospital stay 4,8 days (3-9). laparoscopic cases, the operating time is 146 min (90-210), ischaemia time 3 min 15 sec (2-3,25 min) and postoperative hospital stay 3,4 days (2-9). conclusions: the laparoscopic live donor nephrectomy is a difficult and demanding technique. it should be done by experienced team in laparoscopic renal surgery. the kidney from a live donor is a very good alternative for the cronic renal failure. it should be offered in our main hospitals.
The Renal Allograft Donor with Isolated Microhematuria
Karkar Ayman
Saudi Journal of Kidney Diseases and Transplantation , 2006,
Abstract: Recently, there has been extensive debate about extending the criteria for accepting living donors to include the presence of mild renal abnormalities such as isolated microhematuria. Hematuria defined as the detection of greater than five red blood cells per high power field can be associated with abnormalities throughout the urinary tract. Detection of casts or dysmorphic red blood cells in the urine sediment with or without proteinuria could indicate underlying intrinsic renal disease. Anatomic causes, such as stones and tumors, should be excluded; cystoscopy may be indicated to exclude bladder pathology. Obviously, urinary tract infection, uncontrolled hypertension and latent diabetes mellitus must be excluded. Microscopic hematuria could be associated with mesangial IgA deposits; as 10% of first-degree relatives of patients with IgA glomerulonephritis suffer from microhematuria and/or proteinuria that may require consideration of renal biopsy. Microhematuria could also be associated with other known hereditary renal diseases such as C3 deposits disease, IgM nephropathy, autosomal dominant polycystic kidney disease, Alport′s syndrome or thin basement membrane disease. In conclusion, careful assessment of isolated microhematuria, in the context of living kidney donation, is mandatory as results may reveal occult renal disease that may contraindicate kidney donation.
Trasplante renal
Martín,P.; Errasti,P.;
Anales del Sistema Sanitario de Navarra , 2006, DOI: 10.4321/S1137-66272006000400008
Abstract: the kidney transplant is the therapy of choice for the majority of the causes of chronic terminal kidney insufficiency, because it improves the quality of life and survival in comparison with dialysis. a kidney transplant from a live donor is an excellent alternative for the young patient in a state of pre-dialysis because it offers the best results. immunosuppressive treatment must be individualised, seeking immunosuppressive synergy and the best safety profile, and must be adapted to the different stages of the kidney transplant. in the follow-up to the kidney transplant, cardiovascular risk factors and tumours must be especially taken into account, given that the death of the patient with a working graft is the second cause of loss of the graft following the first year of the transplant. the altered function of the graft is a factor of independent cardiovascular mortality that will require follow-up and the control of all its complications to postpone the entrance in dialysis.
Comparison of Resistive Index in Live Kidney Donors Before and Aer Nephrectomy
Sirus Nekooei,Hassan Ahmadnia,Seyed Mohamad Hosein Alamolhodaee
Iranian Journal of Radiology , 2011,
Abstract: Background/Objective: Obstruction of solitary"nkidney is a serious problem because it usually leads"nto elevation of serum creatinin. Tests using iodinated"ncontrast materials are contraindicated. Doppler"nultrasound (DU) with measurement of the renal"nresistive index (RI) is useful in this regard. Obstruction"nleads to changes in the hemodynamics of the kidney"nwith increase in the RI."nPatients and Methods: The study included 41 healthy"nlive kidney donors. There were 38 males and three"nfemales with a mean age of 30 years. DU of the two"nkidneys was done the day before nephrectomy with"nmeasurement of the RI of each kidney in three levels"n(main, interlobar and interlobular). After nephrectomy,"nthe RI of the remaining kidney was measured on days"n7 and 90. The mean RI of the remaining kidney before"nnephrectomy was compared with values at different"ntime points after nephrectomy."nResults: The left kidney was selected for nephrectomy"nin 35 donors and the right one was used in the"nremaining six. There was difference between the mean"nRI of the right and left kidneys before nephrectomy"nin the interlobar and interlobular artery level. The"nmean RI of the remaining kidney increased 90 days"nafter nephrectomy but not at the seventh day. There"nwas no difference between the mean RI in three levels"nbefore nephrectomy and on day 7. The mean RI of"nthe left remaining kidney after the right nephrectomy"n(six donors) was compared with the right remaining"nkidney after the left nephrectomy (35 donors). The"ndifference of RI was statistically signiificant only in"nthe main artery level on day 90."nKeywords: Resistive Index(RI), Live Donor"nNephrectomy, Single Kidney
Early and Late Graft Function after Laparoscopic Hand-assisted Donor Nephrectomy for Living Kidney Transplantation: Comparison with Open Donor Nephrectomy
A. Hamza,M. R. Hoda,M. Tajjour,K. Weigand
Transplantationsmedizin , 2008,
Abstract: Introduction: The laparoscopic donor nephrectomy has become the procedure of choice in the living related kidney transplantation. Longer warm ischemia time and application of pneumoperitoneum have raised questions about the early and late function of the transplant graft. We report on our experience with laparoscopic hand- assisted donor nephrectomy, in particular concerning the graft function compared with open donor nephrectomy. Patients and methods: This study is a retrospective, non-randomized single-centre analysis. Between 1995 and March 2008, 72 patients with end-stage renal disease have received kidney transplantation from living related donors. Open nephrectomy was performed in 35 donors, whereas 37 donors had undergone laparoscopic hand-assisted nephrectomy. Immediate graft function, and the biochemical marker of glomerular filtration rate (GFR), serum creatinine and serum cystatin C were evaluated one year after the transplantation. Results: Both the rate of early graft function as well as late function parameters serum creatinine and serum cystatin C one year after transplantation showed no statistically significant difference between the two groups of patients. Conclusions: Laparoscopic hand-assisted donor nephrectomy is safe and has no negative impact on the graft function compared with open donor nephrectomy.
Day-of-surgery rejection of donors in living donor liver transplantation
Bassem Hegab,Mohamed Rabei Abdelfattah,Ayman Azzam,Hazem Mohamed
World Journal of Hepatology , 2012, DOI: 10.4254/wjh.v4.i11.299
Abstract: AIM: To study diagnostic laparoscopy as a tool for excluding donors on the day of surgery in living donor liver transplantation (LDLT). METHODS: This study analyzed prospectively collected data from all potential donors for LDLT. All of the donors were subjected to a three-step donor evaluation protocol at our institution. Step one consisted of a clinical and social evaluation, including a liver profile, hepatitis markers, a renal profile, a complete blood count, and an abdominal ultrasound with Doppler. Step two involved tests to exclude liver diseases and to evaluate the donor’s serological status. This step also included a radiological evaluation of the biliary anatomy and liver vascular anatomy using magnetic resonance cholangiopancreatography and a computed tomography (CT) angiogram, respectively. A CT volumetric study was used to calculate the volume of the liver parenchyma. Step three included an ultrasound-guided liver biopsy. Between November 2002 and May 2009, sixty-nine potential living donors were assessed by open exploration prior to harvesting the planned part of the liver. Between the end of May 2009 and October 2010, 30 potential living donors were assessed laparoscopically to determine whether to proceed with the abdominal incision to harvest part of the liver for donation. RESULTS: Ninety-nine living donor liver transplants were attempted at our center between November 2002 and October 2010. Twelve of these procedures were aborted on the day of surgery (12.1%) due to donor findings, and eighty-seven were completed (87.9%). These 87 liver transplants were divided into the following groups: Group A, which included 65 transplants that were performed between November 2002 and May 2009, and Group B, which included 22 transplants that were performed between the end of May 2009 and October 2010. The demographic data for the two groups of donors were found to match; moreover, no significant difference was observed between the two groups of donors with respect to hospital stay, narcotic and non-narcotic analgesia requirements or the incidence of complications. Regarding the recipients, our study clearly revealed that there was no significant difference in either the incidence of different complications or the incidence of retransplantation between the two groups. Day-of-surgery donor assessment for LDLT procedures at our center has passed through two eras, open and laparoscopic. In the first era, sixty-nine LDLT procedures were attempted between November 2002 and May 2009. Upon open exploration of the donors on the day of surgery, sixty-five don
Hand-assisted Retroperitoneoscopic Live Donor Nephretomy: Reduced Perioperative Risk and Excellent Outcome – Experience from the first 110 Consecutive Cases
J. Wadstr?m
Transplantationsmedizin , 2006,
Abstract: Aim/Background: Laparoscopic live donor nephrectomy is associated with two major life-threatening complications, sudden severe bleeding and intestinal injury. Hand-assisted and retroperitoneoscopic techniques reduces the risk of these life-threatening complications. In this study, we report on our experience from the first 110 consecutive live donor nephrectomies operated with a combined hand-assisted and retroperitoneoscopic technique (HARS). Material/Methods: The first consecutive 110 donors operated with the HARS technique are included in the study. The data has been collected prospectively according to intention to treat. Body Mass Index (BMI), warm ischemia time (WIT), operating time and blood loss were recorded. Complications, and allograft outcome in the recipient were followed postoperatively with a mean follow-up of 870 (1868-40) days. Results: The mean operating time was 142 (80-305) min and the mean WIT 172 (85-510) seconds. The operative time was significantly longer in male donors, 167 (110-305) min vs 126 (80-215) min, (p<0.001). BMI did not influence the operating time but kidneys with multiple arteries prolonged the operating time significantly, 137 (80-305) min vs. 182 (115-265) min (p<0.001). The mean bleeding was 185 (50-700) ml. Major complications were one non-lethal pulmonary embolus and two donors required blood transfusion. One donor was reoperated due to suspicion of trocar hernia. Fourteen patients had minor complications (fever, n=4; urinary tract infection, n=6; chylous ascites, n=1; orchialgia, n=2; subcostal pain, n=1). Two kidneys did not have immediate onset of function. Neither of these were attributed to the donor operation. Two recipients experienced urinary leakage and one a stenosis. Overall recipient- and graft survival were 97% and 95%, respectively. Conclusions: HARS enables short operating times and reduces the risks associated with endoscopic live donor nephrectomy.
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