Cases Of Kidney Transplantation Research Articles

Increasing bladder capacity and vesicoureteral reflux in pediatric kidney transplant patients.

To investigate the frequency of vesicoureteral reflux, and the relationship of pretransplant decreased bladder capacity and post-transplant vesicoureteral reflux in children undergoing kidney transplantation. A voiding cystourethrography was carried out in 172 pediatric kidney transplantation recipients before, and 4months after, transplantation to evaluate bladder capacity and vesicoureteral reflux. The correlation of post-transplant vesicoureteral reflux with pretransplant bladder capacity, vesicoureteral reflux in the native kidney and the method of ureteral reimplantation (intravesical/extravesical) was analyzed. Atrophic bladder was defined as having ≤50% functional bladder capacity (age in years+2)×25 (mL) or ≤150mL in patients aged >10years. Bladder capacity increased remarkably after transplantation in both post-transplant vesicoureteral reflux- group (from 180 to 253mL) and vesicoureteral reflux+ group (from 82 to 171mL). Voiding cystourethrography showed vesicoureteral reflux in 12 cases of kidney transplantation (7%; grade1: 2, grade2: 3, grade3: 7). Pretransplant atrophic bladder was an independent risk factor of post-transplant vesicoureteral reflux (P=0.004, hazard ratio 9.5). There was no difference in renal function between the vesicoureteral reflux- group and vesicoureteral reflux+ group at 4months to 5years post-transplantation. Pretransplant atrophic bladder is a risk factor of post-transplant vesicoureteral reflux in pediatric patients. However, bladder capacity can remarkably increase after transplantation, and kidney function in the post-transplant vesicoureteral reflux+ group is stable.

Transplantation of a kidney with a heterozygous mutation in the SLC22A12 (URAT1) gene causing renal hypouricemia: a case report

BackgroundRenal hypouricemia (RHUC) is a genetic disorder caused by mutations in the SLC22A12 gene, which encodes the major uric acid (UA) transporter, URAT1. The clinical course of related, living donor-derived RHUC in patients undergoing kidney transplantation is poorly understood. Here, we report a case of kidney transplantation from a living relative who had an SLC22A12 mutation. After the transplantation, the recipient’s fractional excretion of UA (FEUA) decreased, and chimeric tubular epithelium was observed.Case presentationA 40-year-old man underwent kidney transplantation. His sister was the kidney donor. Three weeks after the transplantation, he had low serum-UA, 148.7 μmol/L, and elevated FEUA, 20.8% (normal: < 10%). The patient’s sister had low serum-UA (101.1 μmol/L) and high FEUA (15.8%) before transplant. Suspecting RHUC, we performed next-generation sequencing on a gene panel containing RHUC-associated genes. A heterozygous missense mutation in the SLC22A12 gene was detected in the donor, but not in the recipient. The recipient’s serum-UA level increased from 148.7 μmol/L to 231.9 μmol/L 3 months after transplantation and was 226.0 μmol/L 1 year after transplantation. His FEUA decreased from 20.8 to 11.7% 3 months after transplantation and was 12.4% 1 year after transplantation. Fluorescence in situ hybridization of allograft biopsies performed 3 months and 1 year after transplantation showed the presence of Y chromosomes in the tubular epithelial cells, suggesting the recipient’s elevated serum-UA levels were owing to a chimeric tubular epithelium.ConclusionsWe reported on a kidney transplant recipient that developed RHUC owing to his donor possessing a heterozygous mutation in the SLC22A12 (URAT1) gene. Despite this mutation, the clinical course was not problematic. Thus, the presence of donor-recipient chimerism in the tubular epithelium might positively affect the clinical course, at least in the short-term.

Comparative analysis of induction immunosuppressive therapy protocols in renal transplant recipients (retrospective review)

Objective: to evaluate the clinical efficacy and outcomes of kidney transplants performed using an alternative immunosuppressive therapy protocol that is based on double induction. Materials and methods. We examined 296 cases of kidney transplants performed in 295 patients between January 1, 2004 and December 31, 2018. Based on induction immunosuppressive therapy regimen, the patients were divided into two groups. Group 1 included patients who underwent transplantation from January 1, 2004 to June 30, 2013 and who used the standard induction immunosuppression protocol. Group 2 included patients who did transplant surgeries between the period January 7, 2013 and December 31, 2018 and who received the “double” induction protocol being analyzed. The method of dividing patients into these groups is associated with routine implementation of the analyzed protocol at the transplantation center since July 1, 2013. Results. Graft and recipient survival rates at all follow-up periods were higher in the group of patients who received the “double” induction immunosuppressive protocol than in the standard group. The studied protocol provides initially better and more stable graft function than in standard therapy. This is especially valuable in centers experiencing difficulties in assessing pre-transplant immunological risk. The graft and recipient survival rates achieved by the analyzed protocol are more pronounced in deceaseddonor kidney transplantation. Conclusion. Positive results obtained from retrospective analysis of the protocol under study justify a prospective randomized study.

Transplantation of a single kidney from pediatric donors less than 10\u2009kg to children with poor access to transplantation: a two-year outcome analysis

BackgroundAccess to kidney transplantation by uremic children is very limited due to the lack of donors in many countries. We sought to explore small pediatric kidney donors as a strategy to provide transplant opportunities for uremic children.MethodsA total of 56 cases of single pediatric kidney transplantation and 26 cases of en bloc kidney transplantation from pediatric donors with body weight (BW) less than 10 kg were performed in two transplant centers in China and the transplant outcomes were retrospectively analyzed.ResultsThe 1-year and 2-year death-censored graft survival in the en bloc kidney transplantation (KTx) group was inferior to that in the single KTx group. Subgroup analysis of the single KTx group found that the 1-year and 2-year death-censored graft survival in the group where the donor BW was between 5 and 10 kg was 97.7 and 90.0%, respectively. However, graft survival was significantly decreased when donor BW was ≤5 kg (p < 0.01), mainly because of the higher rate of thrombosis (p = 0.035). In the single KTx group, the graft length was increased from 6.7 cm at day 7 to 10.5 cm at 36 months posttransplant. The estimated glomerular filtration rate increased up to 24 months posttransplant. Delayed graft function and urethral complications were more common in the group with BW was ≤5 kg.ConclusionsOur study suggests that single kidney transplantation from donors weighing over 5 kg to pediatric recipients is a feasible option for children with poor access to transplantation.

ABO-Incompatible Kidney Transplantation After Bone Marrow Transplantation: A Case Report

Many studies have been made on ABO-compatible kidney transplants following hematopoietic stem cell transplantation. However, there have been few reports on ABO-incompatible kidney transplantation following hematopoietic stem cell transplantation (HSCT). We report on the case of a successful ABO-incompatible kidney transplantation with high titers after bone marrow transplantation experienced no infectious episodes. The patient was a 38-year-old man with end-stage kidney disease resulting from interstitial nephritis induced by drug toxicity or graft-vs-host disease (GVHD). He had received allogeneic bone marrow transplantation from a human leukocyte antigen-identical unrelated donor to treat chronic myelogenous leukemia. The patient with high anti-B antibody titers (IgM 1:1024 IgG 1:256) received a desensitization protocol consisting of 2 doses of rituximab and 5 courses of plasmapheresis. The patient had prolonged depletion of circulating B cells 2 years after the transplant and was infected with cytomegalovirus viremia, pneumocystis jiroveci pneumonia, and adenovirus urinary tract infection at 2, 3, and 17 months post-transplant, respectively. Currently, at 6 years after his transplant, the patient has had no rejection and is in good clinical condition with only mild renal insufficiency. Our results suggest that ABO-incompatible kidney transplantation may be an effective renal replacement therapy for patients with end-stage kidney disease after HSCT, but desensitization in combination with immunosuppressants could lead to a state of over-immunosuppression, causing various infections.

Successful Kidney Transplantation Alone With Severe Left Ventricular Systolic Dysfunction of Ejection Fraction 14%: A Case Report

It is well known that correction of uremia by kidney transplantation alone (KTA) improves left ventricular systolic dysfunction (LVSD). However, for kidney transplant candidates with extremely severe LVSD, KTA is considered to be contraindicated because of the high risk of peri-operative management. We report a case of successful kidney transplantation with severe LVSD with an ejection fraction (EF) of 14% and low systolic blood pressure (SBP) of approximately 65 to 80 mm Hg. In this case, in spite of an extremely low EF and SBP, functional capacity was assessed using metabolic equivalents (METs) and showed a level of almost 4. The operation was performed carefully, considering the cardiac, operative, and anesthetic risks. No surgical complications occurred, and the patient received intensive care during the peri-operative period. His postoperative course was almost favorable, and he was discharged on postoperative day 29. The present report concludes that evaluation of METs may expand the indication for KTA in patients with extremely severe LVSD.

Simultaneous Deceased Donor Liver and Kidney Transplantation in a Human Immunodeficiency Virus/Hepatitis C Virus -Coinfected Patient With Hemophilia in Japan: A Case Report

The authors describe the first case of simultaneous liver and kidney transplantation (SLK) in a human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-coinfected patient with severe hemophilia in Japan, and it could be second case in the world. The patient was a 61-year-old Japanese man with HCV cirrhosis complicated with HIV coinfection through contaminated blood product for hemophilia B at age 1 year. The patient’s liver disease was classified as Child-Pugh C, Model for End-Stage Liver Disease score 38. He had been on hemodialysis for 6 years, but HIV RNA and HCV RNA had been undetectable after appropriate antiviral therapies. In September 2019, the patient underwent successful deceased donor (DD) SLK. The donor was a man in his 60s deceased due to cerebral hemorrhage. Regular DD liver transplantation was performed using the piggyback technique with a full-sized liver graft. Cold ischemia time was 566 min, and the graft liver weighed 1154 g. The graft kidney was transplanted extraperitoneally in the right iliac fossa. The administration of clotting factor IX was discontinued on day 3. The immunosuppressive regimen was based on intravenous induction with 2 mg/kg of basiliximab and 1 g methylprednisolone and subsequent oral administration of mycophenolate mofetil and prednisolone, followed by low-dose tacrolimus after 1 week for kidney-sparing purpose. Steroid therapy was gradually discontinued at 3 months after SLK. The same pretransplantation antiretroviral therapy (ART; tenofovir and dolutegravir) was introduced after 3 days when the CD4 cell count was more than 300/μL and HIV RNA was within an undetectable range. The postoperative course was uneventful without infectious complication, and the patient was transferred to a referral hospital on day 90 and discharged home on day 111. Strategic surgical planning and meticulous pre- and post-transplant management of ART and clotting factors could lead to the success of SLK.

Transplantation of a Kidney With Duplicated Ureter Harvested From a Donor With Vascular Anomaly in the Form of Double Inferior Vena Cava: A Case Report

During the organ procurement procedure, a surgeon encounters anatomic anomalies not very often but also not uncommonly. These changes may put the success of the transplant into question. Despite the thorough diagnosis of the potential donor, these anomalies are often diagnosed during organ donation. In our paper we present a case of kidney transplantation with duplicated ureter. The organ was collected from a donor with duplicated inferior vena cava. After transplantation, the kidney functioned immediately. Taking into consideration the well-being of the recipient, organs with anatomic abnormalities should be carefully considered for transplantation. This is especially important when there is a constant shortage of organs for transplantation.

MP52-16 ROBOTIC TRANSVAGINAL ASSISTED LIVING DONOR KIDNEY TRANSPLANTATION

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery II (MP52)1 Apr 2020MP52-16 ROBOTIC TRANSVAGINAL ASSISTED LIVING DONOR KIDNEY TRANSPLANTATION Tarek Ajami*, Mireia Musquera, Lluis Peri, Maurizio D'Anna, and Antonio Alcaraz Tarek Ajami*Tarek Ajami* More articles by this author , Mireia MusqueraMireia Musquera More articles by this author , Lluis PeriLluis Peri More articles by this author , Maurizio D'AnnaMaurizio D'Anna More articles by this author , and Antonio AlcarazAntonio Alcaraz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000914.016AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Kidney transplantation is the treatment of choice for end stage renal disease (ESRD), for its better survival and quality of life in comparison with dialysis. Surgery has evolved over the past years towards minimally invasive techniques to improve cosmetic results and reduce morbidity. To this end, the vagina has been used for organ extraction and insertion. Also, the introduction of robotics has opened up the possibility of safe intracorporeal kidney transplantation. The objective is to describe the surgical technique of totally robotic kidney transplantation with transvaginal insertion and to assess its safety and feasibility. METHODS: It is a prospective analysis of the first 5 cases of robotic kidney transplantation with transvaginal insertion. Robotic assisted kidney transplantation was performed after transvaginal insertion of a living donor kidney graft. Donor’s and recipient’s characteristics, intraoperative variables, postoperative complications, and surgical outcomes were assessed. RESULTS: The median operative time was 220 min. Mean rewarming ischemia time of 53 minutes, with immediate diuresis. No intraoperative complications were observed. Mean hospitalization period was 9 days, with mean creatinine of 1.5 mg/dl at discharge time. CONCLUSIONS: Robotic kidney transplantation with transvaginal insertion is feasible. A greater number of procedures are required to confirm the safety of this new technique. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e778-e778 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tarek Ajami* More articles by this author Mireia Musquera More articles by this author Lluis Peri More articles by this author Maurizio D'Anna More articles by this author Antonio Alcaraz More articles by this author Expand All Advertisement PDF downloadLoading ...

V11-06 RENAL GRAFT IN A PATIENT WITH ILIAC DACRON PROSTHESIS

You have accessJournal of UrologyTransplant, Misc GU Cancers & Bladder Reconstruction (non-cancer) (V11)1 Apr 2020V11-06 RENAL GRAFT IN A PATIENT WITH ILIAC DACRON PROSTHESIS Anna Colomer, Oscar Buisan Rueda*, Mario Alves Oliveira, and Joan Areal Calama Anna ColomerAnna Colomer More articles by this author , Oscar Buisan Rueda*Oscar Buisan Rueda* More articles by this author , Mario Alves OliveiraMario Alves Oliveira More articles by this author , and Joan Areal CalamaJoan Areal Calama More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000945.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nowadays approximately more than 1% of the patients with aortoiliac prosthesis are candidates of renal transplantation in their life time. We present a case of kidney transplantation with renal graft artery anastomosis directly to a iliac Dacron prosthesis. METHODS: In this video we present a case of a 76 years old male undergoing kidney transplantation with renal graft artery anastomosis directly to a iliac Dacron prosthesis. Patient medical history includes arterial hypertension, auricular fibrillation, aortobifemoral bypass in 2002 due to abdominal aorta aneurism, chronic renal failure in hemodialysis since 2013. A previous kidney transplantation was performed in 2018 with early graft dysfunction. The steps of the surgical technique are described. RESULTS: Renal graft was placed in left iliac fossa. Arterial anastomosis to iliac Dacron bypass. Cold ischemia time was 20h and 20'. Postoperative recovery was with no vascular events, but delay in graft function was observed. Postoperative doppler ultrasound reveled good arterial and venous flow. Patient was discharged home on post-operative day 25. After 2 months follow-up the transplanted kidney is working well with a creatinine of 1,99. The patient presents good urinary diuresis and does not require dialysis. CONCLUSIONS: Renal transplantation can be a good option and safely performed in patient with iliac disease, presenting a good short-term outcome. Source of Funding: No source of funding. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1016-e1016 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anna Colomer More articles by this author Oscar Buisan Rueda* More articles by this author Mario Alves Oliveira More articles by this author Joan Areal Calama More articles by this author Expand All Advertisement PDF downloadLoading ...

SUN-353 A comprehensive review of 50 cases of kidney transplants performed over 10 months a single centre experience from an African country

Access to kidney transplantation has always been a problem in the African countries with many patients having to travel to other medically advanced countries in Asia, Europe and America. This involves unnecessary excessive expenditure and the travails of journey and stay in an unknown foreign land. To ease this situation and provide affordable Renal transplant services in their home land, we have made an effort to start the transplant services at our medical facility and have successfully carried out about 50 transplants in a period of 10 months from December 2018 till September 2019. A comprehensive overview of the cases has been presented forthwith. All the Kidney transplants done between the period Nov 2018- Sept 2019 ( 50 cases) were included in the analysis. All the transplants were performed at a single center and the data were collected progressively during their Pre transplant evaluation, perioperative course and post op follow up. All the laboratory and radiological tests were done locally at the center except the HLA cross matches and typing which were outsourced to Transplant immunology labs outside the country. All the patients underwent laparoscopic donor nephrectomy except in patients with technical difficulties. A series of 50 kidney transplants were performed over a period of 10 months [ DEC 2018- september 2019] at a private hospital successfully. All the cases were live donor kidney transplants with majority of the donors being 1st or 2nd degree relatives or spousal donors. There were no cases of mortality and all the patients had good immediate graft function except in 6 patients, who had delayed graft function; 5 of them improving over 2 – 6 weeks and one patient not in follow-up at the time of submission of this abstract]. Renal allograft biopsy was done in 5 patients. In 4 patients biopsy findings were suggestive of ATN, and the other, report awaited at the time of submission of this abstract. Of all patients, 2 were HBsAg +ve, and 2 were HIV +Ve. Two patients required simultaneous nephrectomy at the time of transplant, one for ADPKD and the other for VUR. Other postoperative problems included; one patient had sub-acute intestinal obstruction due to adhesions requiring laparoscopic intervention and the other segmental consolidation with cough and fever. All the patients received induction with rabbit Thymoglobulin, and IV methyl prednisolone. 12 patients required plasma exchange and IVIG for positive X match { 11 pre op’ and 1 post op’}. Overall patient survival was 100% and graft survival over 98% {49/50}. Our experience shows that kidney transplantation is a viable and practical option for the treatment of End stage kidney disease and can be performed even in resource constrained centers in third world countries.

A Case Report: First Ever ABO Incompatible Kidney Transplantation in Bangladesh: The Start of a New Era

Although ABO incompatible kidney transplantations are increasingly being practised worldwide, in Bangladesh it was never attempted. Here we report the first ever ABO incompatible kidney transplantation case performed in Bangladesh. The patient was a 23-year-old male with end-stage kidney disease secondary to chronic glomerulonephritis on haemodialysis. The only kidney donor available was his mother who had a different blood-group (patient O positive; mother A positive). His baseline anti-A IgG titre was 1:128. We used a modified desensitization protocol with low-dose Rituximab, triple immunosuppression (Tacrolimus, Mycophenolate Sodium and Prednisolone) and 3 sessions of plasmapheresis followed by IVIG. His Anti-A IgG titre was brought down to 1: 8 before transplantation. He also received basiliximab as induction therapy. He successfully underwent renal transplantation across the ABO barrier. After transplantation his IgG titre was monitored which was remained 1:4. At 1, 3 and 6 months of post transplant, serum creatinine level was 207 µmol/L, 182 µmol/L and 183 µmol/L, respectively. This was the first case of ABO-incompatible kidney transplantation in Bangladesh. This case gives us the confidence that more ABO-incompatible kidney transplantations can be performed in a resource limited setting and high infection risk countries like ours following a more cautious approach. This will substantially increase the living kidney donor pool; hence reduce the economic and health impact of continuing long term dialysis therapy in Bangladesh.

The specificity of the novel coronavirus infection in transplantation recipients

The specificity of the novel coronavirus infection in transplantation recipients

Acquired Hemophilia B Through Liver Transplantation: A Case Report and Literature Review

Hemophilia B, also called Christmas disease, is an X-linked inherited bleeding disorder that predominantly affects males, and it is caused by deficiency of coagulation factor IX. Factor IX is a coagulation factor produced in the liver. Liver transplantation from hemophilia B donors is neither widely documented nor performed due to presumed risk of developing increased bleeding tendency in the recipient due to potential acquired factor IX deficiency. In this review, we present a case of liver and kidney transplantation from a donor with mild hemophilia B to a recipient with no history of hemophilia B and literature review. This is a relatively rare situation with only two other prior case reports of acquired Hemophilia B through liver transplantation noted in 2015. The 2 cases presented in the literature lead to acquired hemophilia B in liver transplant recipients since donors were not screened due to mild disease and low suspicion level. In our case, the donor was known to have mild Hemophilia B and the recipient had a rapid decline – thus it is imperative to weigh risks and benefits of transplantation from this donor population. While those individuals with mild hemophilia B disease (and low bleeding burden) should be considered as an alternative donor for liver transplantation, appropriate counseling should be done with the recipient about possible bleeding risks and OLT should only occur after patient consent. A multidisciplinary approach should involve hematology in case factor replacement therapy is needed post transplantation and for long term follow up.

Клинический случай успешной трансплантации почки у пациента с вторичным амилоидозом на фоне анкилозирующего спондилоартрита

Clinical case of a successful kidney transplantation in a patient with secondary amyloidosis and ankylosing spondylitis, receiving genetic engineering biological therapy is presented.

Legal policy challenges in withdrawal of dialysis treatment in Japan

Abstract Issue/problem In 2017, Japanese dialysis patients and kidney transplant cases numbered roughly 330,000 and 1,700, respectively. In March 2019, a patient died after a physician terminated her kidney dialysis at a hospital in Tokyo. The Tokyo Metropolitan Government and the Japanese Society for Dialysis Therapy (JSDT) investigated the case, questioning the patient’s terminal status and desire to withdraw her request to terminate dialysis. Description of the problem No Japanese law addresses treatment withdrawal, but several court decisions and the Ministry of Health, Labor and Welfare’s process guidelines and JSDT guidelines address treatment withdrawal from terminal patients. We examined relevant court decisions and guidelines, identifying three legal policy issues that may impact legal policy discussions on treatment withdrawal in other countries, regardless of the enactment status of such laws. Results First, the patient was not “terminally ill” as defined by the court rulings and guidelines. Second, a clear decision based on appropriate informed consent from the patient seemed absent, violating the court rulings and guidelines. Third, the physician’s judgment of patient competency for decision-making may have been missing. Lessons We considered problems beyond the court rulings and guidelines by focusing on the patient’s right to self-determination and treatment refusal in other countries. The Patient Self-Determination Act and the Patient’s Bill of Rights (US) as well as court rulings and the NHS Charter (UK) guarantee such rights, and collectively enable competent patients in the US, UK, and elsewhere to refuse dialysis even if they are not terminal. Japanese legislation does not guarantee such patient rights or the explicit allowance/prohibition of treatment withdrawal, regardless of the patient’s terminal status; enactment of such laws should be considered. Key messages We identified legal ambiguity due to a lack of the patient’s right to both self-determination and treatment refusal. This could impact the international discussion on dialysis treatment withdrawal.

Risk Factors for 1-Year Graft Loss After Kidney Transplantation: Systematic Review and Meta-Analysis.

With expansion of the pool of kidney grafts, through the use of higher-risk donors, and increased attention to donor management strategies, the 1-year graft survival rate is subject to change. It is, therefore, useful to elucidate 1-year graft survival rates by dissecting the characteristics of the low-risk and high-risk kidney transplant cases. The objective of our study was to evaluate factors purported to influence the risk of 1-year graft loss in kidney transplant recipients. We searched bibliographic databases from 2000 to 2017 and included observational studies that measured the association between donor, recipient, the transplant operation, or early postoperative complications, and 1-year death-censored graft loss. We identified 35 eligible primary studies, with 20 risk factors amenable to meta-analysis. Six factors were associated with graft loss, with moderate to high degree of certainty: donor age (hazard ratio [HR], 1.11 per 10-year increase; 95% confidence interval [95% CI], 1.04 to 1.18), extended criteria donors (HR, 1.35; 95% CI, 1.28 to 1.42), deceased donors (HR, 1.54; 95% CI, 1.32 to 1.82), number of HLA mismatches (HR, 1.08 per one mismatch increase; 95% CI, 1.07 to 1.09), recipient age (HR, 1.17 per 10-year increase; 95% CI, 1.09 to 1.25), and delayed graft function (HR, 1.89; 95% CI, 1.46 to 2.47) as risk factors for 1-year graft loss. Pooled analyses also excluded, with a high degree of certainty, any associations of cold ischemia time, recipient race, pretransplant body mass index, diabetes, and hypertension with 1-year graft loss. Recipient age, donor age, standard versus extended criteria donor, living versus deceased donor, HLA mismatch, and delayed graft function all predicted 1-year graft survival. The effect of each risk factor is small.

Successful Kidney Transplantation Using a Deceased Donor Graft With Fibromuscular Dysplasia

All over the world there is serious concern about the shortage of organs available for transplantation. In an effort to address this, transplantation with grafts, which was previously considered a contraindication, are now performed. In some cases, this practice has contributed to increasing the organ pool. Fibromuscular dysplasia (FMD) is the second-most-common cause of renovascular hypertension and is observed in 2%–6.6% of potential live kidney donors. Kidney with FMD is generally considered to be a contraindication for renal transplantation because renal artery stenosis may progress after transplantation and cause graft loss. Here, we report on a successful case of kidney transplantation using a graft with FMD of a deceased donor who had multiple aneurysms in the renal artery.

Results of kidney transplantation in patients with end-stage renal failure caused by autosomal dominant polycystic kidney disease

Aim. To investigate the renal transplantation results for patients with end-stage renal disease (ESRD) due to autosomal dominant polycystic kidney disease (PKD). Materials and methods . The study included a prospective and retrospective analysis of the kidney transplantation results in 46 patients with ESRD caused by PKD, performed in the period from 2003 to 2018. Two groups of patients were formed. The comparison group consisted of 23 (50%) cases of kidney transplantation in patients whose polycystic-changed kidneys were preserved at the time of transplantation. The study group included 23 (50%) patients who underwent pretransplantation nephrectomy of native kidneys for clinical indications or to prepare for the waiting list. During the study, an algorithm of examination and surgical preparation for inclusion patients with PKD in the waiting list for kidney transplantation was developed and actively used. Results. The mean follow up period of patients who underwent pretransplantation nephrectomy was 3.6 ± 2.5 years, patients with preserved native kidneys - 5.3 ± 3.08 years (p &gt; 0.05). Periodic pain in the lumbar region disturbed 12 (52.2%) patients with preserved polycystic-changed kidneys. The frequency of episodes of leukocyturia, bacteriuria and(or) hematuria significantly differed and amounted to 0.27 ± 0.35 cases per year in the study group, 1.49 ± 0.54 (p &lt; 0.05) in the comparison group. Posttransplant nephrectomy of polycystic-changed kidneys at different times after transplantation was required in 5 (21.7%) patients. Five-year graft survival in the study group was 87.5%, in the comparison group - 76.1%. Among the patients of the comparison group, 76.4% of transplants lost their function after 10 years. The 5 and 10-year survival rates of patients with preserved native kidneys were 90.5% and 80%, respectively. In particular, there was one fatal outcome due to sepsis on the background of infection with cysts of preserved polycystic kidney. There were no deaths in the study group. Conclusion. Among patients whom polycystic-changed kidneys removed, there is a more favorable course of the post-transplant period due to the low frequency of infectious complications. More than 60% of patients with PKD need to perform nephrectomy of native kidneys during life for various reasons, including more than 21,7% need it after kidney transplantation due to complications during immunosuppressive therapy. Reasonable assessment of the polycystic kidneys and timely pretransplantation nephrectomy are an integral part of the preparation and management of the waiting list for transplantation of a patient with PKD.

P3.55: Allointestine colon conduit urinary diversion in combined intestine and kidney transplant: A case report

Introduction: In intestinal transplant candidates, the incidence of renal failure is high and is associated with increased mortality. Additionally previous surgeries and loss of abdominal domain may make standard kidney transplant with ureterocystostomy impossible. . Methods: We present an extreme case of combined small intestine, colon, and kidney transplant in a patient with short gut syndrome due to radiation enteritis, severe loss of abdominal domain, failed previous kidney transplant, and absence of native urinary system. Results: Our patient is a forty years old female with a past history of bladder Rabdomyosarcoma as an infant, who underwent bladder resection and post resection radiation. She developed radiation enteritis, renal failure, and eventually received a living related kidney transplant. Her renal allograft subsequently failed due to multiple urinary obstructions despite multiple revision surgeries, as well as chronic immunosuppression toxicity. As a result, she had short gut syndrome and renal failure with no feasible route of urinary drainage. In addition, she had severe loss of abdominal domain due to abnormal abdominal development from the radiation she received as an infant. She had multiple complications of her short gut syndrome and she underwent a simultaneous small intestine, colon, and kidney transplant. Donor was an eight years old female (132 cm, 23.4 kg), who became brain dead after severe exacerbation of asthma attack. Since there were no viable routes for urinary drainage, as there were no viable native intestines, and native and previous transplanted kidney ureter had been obstructed, a 10 cm allograft colon segment was used as a urinary conduit. The patient also underwent a complex abdominal closure with pedicled left anterior lateral thigh perforator flap by the plastic surgery team. One hundred days post transplant the patient is parenteral nutritional independent with normal renal function and her transplant colon conduit is healthy and functional. Conclusion: In extreme cases of kidney transplant in intestinal transplant recipient patients with no feasible urinary drainage path, transplant intestine can successfully be used as a conduit. In review of literature, and to the best of our knowledge, this is the first description of utilization of allograft intestine as a urinary conduit.