Living-related Donor Research Articles

Use of robotics in liver donor right hepatectomy.

Liver transplantation is the best solution for end stage liver disease, and has been widely accepted and rapidly developed in the past decades. Along with the improved outcomes of liver transplantation, living-related donor transplantation has been conducted to overcome the shortage of the deceased donor. The most important aspects of the living-related liver transplantation are donor safety and fast recovery after graft procurement. Meanwhile, the rapid progress of minimally invasive surgery (MIS) in general surgery has generated heated debate regarding the appropriateness of MIS in living-related donor graft hepatectomy. Technical innovations and instrument enhancements have been allowing recruitment of more potential candidates through smaller wounds and better surgical experience. Although MIS has been documented with safety and feasibility in complex liver surgery, the progress is slow in regard to the application of MIS in donor graft hepatectomy. Pioneer surgeons have devoted themselves to develop the pure MIS approach for the liver donor surgery, but the steep learning curve for pure MIS major hepatectomy remains a major barrier for wide adoption. The introduction of robotic system may lower the barrier for entry for practice into MIS donor hepatectomy.

P164 Role of anti-mica antibodies in graft survival of renal transplant recipients of India: A single centre experience

Aim To find the incidence of MHC class I chain-related chain A (MICA) alloantibodies in patients undergoing live related donor (LRD) renal transplantation and their association with short-term graft survival. Methods Pre-transplant, consecutive, serum samples of ESRD patients undergoing first renal allograft transplantation were tested for anti-MICA antibodies. Association of various demographics, HLA-A + B + DRB1 mismatches and HLA antibody screen with MICA antibodies was assessed using Pearson’s Chi-square test. A multivariate analysis was also performed to check for potential confounders. The effect of pre-transplant blood transfusions on antibodies against HLA Class 1 & class II, or MICA was studied. Results Out of 646 serum samples for MICA antibodies, 94 (14.6%) were positive and 552(85.4%) negative for MICA antibodies. Patients with MICA antibody had a graft survival 89.3% as compared to 94.7% in patients without MICA antibody (P = 0.01). The hazards ratio for all patients was 3.744 (P = 0.01). MANOVA effect was determined for three factors (HLA antibody, MICA antibody & HLA mismatch) and Graft survival which was statistically significant. Two of the three ANOVA’s were statistically significant viz. MICA antibody and presence of HLA antibody. Conclusions MICA antibodies were present in 14.6% of the patients. Preformed MICA antibodies independently increase the risk of kidney rejection and therefore a guideline should be made for mandatory testing of these antibodies prior to transplant.

Midterm Outcome of Aged Donors from Living-Related Donation

Midterm Outcome of Aged Donors from Living-Related Donation

Comparison of Clinical Outcomes Between Spousal and Living-related Donor Kidney Transplantation in Mainland China: A Single-center Experience

Shortage of donors still is the major obstacle for kidney transplantation. Living-related donors are the major resource of kidney transplantation at present. To expand the donor pool, spousal-donor kidney transplantation as one of the types of living-unrelated donors has been used to alleviate the organ shortage. A total of 116 living-kidney transplantations were retrospectively analyzed. We classified these recipients into two groups: a spousal-donor group (n = 50) and a living-related donor group (n = 66), and analyzed the outcome of transplantation. The Kaplan–Meier method was used for survival analysis with the log-rank test. The occurrence of delayed graft function and biopsy-proven acute rejection showed no significant difference between the two groups. Serum creatinine values at different times after transplantation in recipients with functioning grafts were similar in the two groups. Kaplan-Meier 3-year patient and graft survival rates were, respectively, 98% and 94% for the spousal donor group, and 98.5% and 95.5% for living-related donor group without significant difference. The demonstration of similar patient and graft survival of spousal-donor kidney transplantation compared with living-related donor kidney transplantation has made spousal-donor kidney transplantation an acceptable alternative for donor supply.

Clinical Outcomes in Pediatric Renal Transplant Recipients Who Received Steroid-Based Immunosuppressive Regimen

BackgroundAlthough the clinical outcomes of pediatric renal transplantation (RT) in developed countries have improved significantly, the data on clinical outcomes in developing countries are wildly different. MethodsChildren and adolescents who had undergone RT at Ramathibodi Hospital between March 2001 and August 2014 were included. ResultsPatients were divided into 2 groups: living related donor (LRD) group (n = 13) and deceased donor (DD) group (n = 30). Prolonged cold ischemic time over 13 hours was significantly associated with delayed graft function (P = .029). The prevalence of infection was 90.7%, in which urinary tract infection (UTI) was the most common infection. Although almost none of the patients in the LRD group received induction therapy, the prevalence of rejection was not significantly different between the 2 groups (P = .817). The comparison of graft survivals between LRD and DD groups were 100% vs 100%, 92.3% vs 100%, and 85.7% vs 81.8% at 1, 3, and 5 years, respectively (P = .938). Recurrent UTI and cytomegalovirus (CMV) infection had a negative effect on graft function at 1-year follow-up (P < .05). Rejections, bladder dysfunction, and donors aged ≥50 years were associated with graft deterioration at 3 years after RT (P < .01). None of these patients died with functioning graft. ConclusionThis study demonstrated good graft and patient survival in Thai pediatric RT recipients. Although recurrent UTI and CMV infection were related to graft dysfunction at 1-year follow-up, infections had no effect on graft and patient survival in long-term follow-up.

Model of Short Bowel Syndrome and Segmental Intestinal Autotransplantation in Swine

Introduction: Intestinal transplantation using living-related donors could minimize the shortage of donor grafts. Nevertheless, the number of living donor small bowel transplantation in the clinical practice is small, probably due to lack of experimental models of this procedure. Objective: To describe a swine model of segmental intestinal autotransplantation producing short bowel syndrome and simulating living donor transplantation, based in our previous technique of liver autotransplantation1. Methods: Six males Landrace swine weighting 25 to 40 Kg were used. A midline incision with the exposition of the entire small bowel was performed (figure 1). The middle part of the mesenteric artery and vein were dissected to identify the pedicle (figures 2 and 3) from a segment in the middle of the small bowel with approximately 300 centimeters length that represents about 1/7 of the swine’s entire small bowel. These mesenteric artery and vein branches were sectioned near the main mesenteric artery and vein (figures 3 and 4). The graft was flashed with cold lactate ringer by the arterial branch (5). The remaining small bowel was removed from the proximal jejune to the distal ileum. A segment of the infrarenal aorta and inferior vena cava was dissected, cross clamped and anastomosed to the mesenteric artery and vein branches (figure 6). Following reperfusion, ileum and jejune anastomoses were performed. The grafts were monitored macroscopically. Animal were sacrificed after two hours of the reperfusion and samples from the graft were removed for histological analysis. Results: All animals survived until the end of the experiment. After reperfusion all grafts rapidly turned in a normal color (figure 7) and no major anastomosis complications were observed. The median period of total operation time, graft cold ischemia and vascular anastomosis were 104, 52 and 33 minutes respectively. The histological analysis observed mild reperfusion injury in two cases and normal in the other grafts. Conclusion: This model of segmental intestinal transplantation is feasible and simulates short bowel syndrome and living donation transplantation. This model is cheaper than allotransplantation and optimal for intestinal transplantation training and to study segmental intestinal graft physiology.Figure

Multi-detector CT in the pre-operative assessment of live donors for liver transplantation

Background: Transplantation surgeons are now performing living donor liver transplantation because of the severe shortage of cadaveric livers. This study was undertaken to assess the role of 64-slice multidetector CT in the pre op evaluation of living related liver donors for transplantation.Methods: This was a prospective correlation study of 26 patients who were referred to the Department of Radiodiagnosis, Narayana Hrudayalaya, Bangalore for evaluation of living related donors for liver transplantation from March 2008 to May 2009.Results: MDCT has 100% sensitivity, 93.7% specificity in detecting the hepatic arterial anatomy; 100% sensitivity and specificity in detecting portal venous anatomy and its variants, and 93.3% sensitivity and 100% specificity in detecting hepatic venous anatomy.Conclusions: Multi-detector CT is a single comprehensive, non-invasive and accurate imaging modality for pre-operative and postoperative evaluation of liver transplant patient. It allows an accurate assessment of liver parenchyma, hepatic vascular anatomy, graft volume and detection of post-operative complications in donors and recipients of LRLT.

Intrahepatic cholangiojejunostomy for complex biliary stenosis after pediatric living‐donor liver transplantation

The treatment of biliary stenosis after pediatric LDLT is challenging. We describe an innovative technique of peripheral IHCJ for the treatment of patients with complex biliary stenosis after pediatric LDLT in whom percutaneous treatment failed. During surgery, the percutaneous biliary drainage is removed and a flexible metal stylet is introduced trough the tract. Subsequently, the most superficial aspect of the biliary tree is recognized by palpation of the stylet's round tip in the liver surface. The liver parenchyma is then transected until the bile duct is reached. A side-to-side anastomosis to the previous Roux-en-Y limb is performed over a silicone stent. Among 328 pediatric liver transplants performed between 1988 and 2015, 26 patients developed biliary stenosis. From nine patients requiring surgery, three patients who had received left lateral grafts from living-related donors due to biliary atresia were successfully treated with IHCJ. After a mean of 45.6months, all patients are alive with normal liver morphological and function tests. The presented technique was a feasible and safe surgical option to treat selected pediatric recipients with complex biliary stenosis in whom percutaneous procedures or rehepaticojejunostomy were not possible, allowing complete resolution of cholestasis and thus avoiding liver retransplantation.

Novel Use of Percutaneous Thrombosuction for Hepatic Vein Thrombosis of the Liver Graft after Liver Transplantation

Introduction: Early thrombosis of hepatic vein graft of liver graft after living related donor liver transplantation (LDLT) is a challenging problem and poses a high potential of graft failure or/and patient failure. Re-exploration faces the risk of repeated general anesthesia, adhesion and anatomical difficulty, family’s attitude, and the potential of rethrombosis. Methods: A 54-year-old woman with hepatitis B viral infection related liver cirrhosis with two hepatocellular carcinoma (cT2N0M0 stage II) received LDLT with right hepatic lobe donated by her daughter. The outflow reconstruction using an artificial vascular conduit included the V5 and V8 with end-to-side anastomosis each. Anastomosis of the conduit with right hepatic vein orifice on IVC of the recipient was performed with 4-0 prolene suture. The liver enzyme, total bilirubin and lactate elevated since the 7th day postoperation. CT study showed thrombosis of V5 and V8 with hypoenhancement of the corresponding liver parenchyma. The hepatic artery and the portal vein were patent. Results: Heparin 5000U was given intravenously. After local anesthesia, we inserted a 7-French (Fr) sheath through right femoral vein, then 7-Fr Judkins guide catheter to approach hepatic vein, wiring to distal V5 branch with 0.014" HydroST wire (COOK medical). Thrombosuction with 7-Fr Pronto V4 (Vascular Solution) to extract thrombus was repeated smoothly. Balloon catheter angiography showed good flow from V5 to IVC. The function of the graft recovered and she discharged at the end of 3rd week after transplantation. She remained well for 6 months up to now. Conclusion: Thrombosuction had been used in the treatment of deep vein thrombosis of lower limbs, pulmonary embolism, thrombosis of hemodialysis fistula or of coronary vessels. We applied it for liver graft to avoid repeated major surgery and general anesthesia. To follow up imaging studies and appropriate anticoagulant therapy are necessary for those who had an episode of graft vein thrombosis.

Genetic, hematological, and immunological disorders transmissible with liver transplantation

It is well recognized that solid organ transplantation can transmit bacterial infection and chronic viral hepatitis as well as certain cancers. As indications for liver transplantation (LT) have expanded, it has been used to treat and even cure certain genetic cholestatic disorders, urea cycle defects, and coagulation abnormalities; many of these conditions are potentially transmissible with LT as well. It is important for clinicians and transplant patients to be aware of these potentially transmissible conditions as unexplained post-LT complications can sometimes be related to donor transmission of disease and thus should prompt a thorough exploration of the donor allograft history. Herein, we will review the reported genetic, metabolic, hematologic, and immunological disorders that are transmissible with LT and describe clinical scenarios in which these cases have occurred, such as in inadvertent or recognized transplantation of a diseased organ, domino transplantation, and with living related liver donation. Liver Transplantation 23 663-678 2017 AASLD.

Quality of Life of related liver donors in the late postoperative period

Introduction. Quality of life (QoL) is a new promising area of clinical medicine that provides the opportunity to assess the state of health of the patient and to have a notion of the surgery effects based on the parameters which are lying at the intersection of scientific approach of the surgeons and subjective point of view of the patient.Materials and methods. The study included 52 living-related liver fragment donors operated between 2009 and 2014. Donors were surveyed after 2–5 years from the surgery. Comparison group was formed by healthy volunteers, students of the Medical University. The Russian version of the non-specific SF-36 questionnaire was used to assess QoL.Results. Donors in the postoperative period have demonstrated a high level of physical parameter (57.65 ± 3.8). Parameter of psychological health in the postoperative period was (52.01 ± 5.2). These figures are comparable with the results in the comparison group (p &gt; 0.05). All donors have returned to normal life.Conclusions. Overall results of this study were similar to those of the foreign colleagues which confirm the high safety of liver resection surgery and the efficacy of SF-36 questionnaire in the assessment of quality of life of the living-related liver fragment donors.

Commercial Kidney Transplantation: Attitude, Knowledge, Perception, and Experience of Recipients

IntroductionKidney transplantation is the gold standard for patients with end-stage kidney disease. In view of shortages of available organs, long wait times for possible transplantation, and strict regulation, many patients opt for commercial transplantation. This study elicits the reasons and motivations for patients with end-stage kidney disease to elect for commercial transplant.MethodsA questionnaire-based evaluation was conducted during the period from July 2015 until late December 2015. It consisted of 29 multiple choice questions and was distributed to all patients who underwent commercial kidney transplantation.ResultsOne hundred and fifty patients were approached to participate and 106 agreed. Of the participants, 60% were male with an average age of 41.5 (SD 14.8) years and ranged from 18 to 83 years. The majority (82%) of our participants were educated ranging from primary to college level. The major reason (71%) for these participants to obtain commercial transplants was stated as the unavailability of a live related donor. Thirteen percent stated that they objected to getting a kidney donated from a family member, and 9% stated that they were worried about taking a kidney from a family member. Finally, 3% of participants stated that they needed prompt transplant and could not wait for a long time for transplant investigations and the workup associated with this program.DiscussionThe study showed that the most common underlying cause for seeking commercial transplantation is the unavailability of a national transplant program, particularly transplantation from deceased sources. All western ethical arguments turn out to become of vital importance in developing countries, because transplantation is the cheapest renal replacement therapy. However, it must be emphasized that commercial transplants should not be an alternative to building a national transplant initiative. The national diseased program must be a priority with full financial and administrative support. All government agencies including religious affairs must work together to support the program and to provide the citizens with a good transplantation service and ameliorate the impact of commercial transplantation.

Annual Data for Kidney Transplant Services in Kuwait (2015).

Renal transplant services have been provided by the Hamed Al-Essa Organ Transplant Center in Ibn Sina Hospital since 1979 for Kuwaitis and non-Kuwaiti citizens residing in Kuwait. We aimed to monitor the activity and outcome of annual renal transplants in 2015. Data on transplant patients were collected from hospital records from January 1, 2015, through December 31, 2015, at Ibn Sina Hospital. Eighty-one patients underwent a renal transplant in Kuwait in 2015; 46 patients (56.8%) were male and 35 (43.2%) were female. Of these 81 patients, 24 (29.6%) received a kidney from a deceased donor, 19 (23.5%) received a kidney from a living-unrelated donor, and 38 (46.9%) received a kidney from a living-related donor. Thirty-four patients (41.98%) who were highly sensitized immunologically underwent successful desensitization before transplant according the local protocol; 13 (38.2%) of these patients were male and 21 (61.8%) were female. Two patients (2.47%) experienced acute rejection within the first week after transplant. One diabetic female patient underwent a successful simultaneous deceased-donor kidney and pancreas transplant. Seventy-nine patients who underwent a transplant outside of Kuwait in 2015 were added to the follow-up list; 62 (78%) of these patients were male and 17 (22%) were female. Of these 79 patients, 31 patients (39%) received a kidney from a living-related donor, 45 (57%) received a kidney from a living-unrelated donor, and 3 (4%) received a kidney from a deceased donor. In addition, 303 patients were assessed for fitness for kidney transplant; 204 (67.3%) of these patients were male and 99 (32.7%) were female. Eight (2.6%) patients were not placed on the waiting list for a kidney transplant for medical reasons. A total of 81 patients underwent a renal transplant in Kuwait in 2015, only 2 (2.47%) of whom experienced acute rejection in the first week after transplant.

Living Kidney Donor Cancellation at King Hussein Medical Center.

Living-related kidney donation is the main source of renal grafts in Jordan, since kidneys from deceased donors are scarce. Although the Jordanian community accepts the idea of kidney donation to family members, not all potential donors manage to complete the required psychologic and medical evaluations. We review the causes of kidney-donation cancellation and suggest options to increase the number of available organs. We performed a retrospective chart review of all potential living-related kidney donors at King Hussein Medical Center between January 2008 and June 2016. Of 642 potential donors, 366 (57%) were male and 276 (43%) were female, ranging in age from 18 to 66 years with a mean age of 37 years. A total of 384 (59.8%) eventually donated a kidney. A donor issue was the cause of cancellation in 143 (22.3%), whereas 47 (32.9%) had a risk for renal impairment after donation (eg, hematuria, proteinuria, stones, multiple renal cysts, scarred kidney, congenital malformation, recurrent urinary tract infection), and 30 (21%) had blood group or immunologic incompatibilities. Fifteen (10.5%) withdrew during the evaluation process, 13 (9%) had hypertension, 10 (7%) had a high body mass index, 8 (5.6%) were diabetic or prediabetic, 7 (4.9%) were surgically unsuitable, 4 (2.8%) had hepatitis B virus infection, 4 (2.8%) were pregnant, 3 (2.1%) had significant cardiovascular disease, 1 (0.7%) had splenomegaly with lymph node enlargement, and 1 (0.7%) had thyroiditis. Cancellation of kidney donation in Jordan is mainly for medical reasons, the most common being renal issues. Paired donation between blood group and immunologically incompatible duos may increase the number of organs available, as may good psychologic assessment and counseling of those likely to change their mind. Support should be provided for donors who drop out of donation for any cause, especially for renal and vascular issues.

Preliminary Results of a Newly Established Organ Transplantation Program in a Teaching Hospital.

End-stage renal disease is the complete failure of kidney function; kidney transplant offers the best survival advantage. We analyzed data from Al-Basheer Hospital's newly established transplant program and present our kidney transplant results from the first year of operation. Between April 2015 and June 2016, 20 kidney transplants were performed (19 living-related donors and 1 deceased donor). We assessed the demographic data, surgical techniques employed, complications, immunosuppressive drugs used, and graft and patient survival rates. The mean recipient age was 32.8 years. There were 10 male and 10 female patients. Two patients underwent preemptive transplant, and 18 were on hemodialysis. Preparation of the donor and recipient employed an established transplant protocol. Induction immunosuppression therapy was used in 13.65% of patients. The left kidney was used from all living donors, and the right kidney was harvested from the deceased donor. The total ischemia time in the living-donor grafts ranged from 30 to 53 minutes; in the deceased donor, the ischemia time was 90 minutes. Intraoperative Doppler ultrasonography was used in most cases. There was no donor mortality, and no significant donor complications occurred, either intraoperatively or postoperatively. There was no recipient mortality, but there were complications in 6 patients. Intraoperative complications were reported in 2 patients: 1 with renal artery thrombosis and the other with external iliac artery dissection. Postoperative complications were reported in 4 patients: slow graft function in 1 patient with thrombotic thrombocytopenic purpura, 1 patient with acute cellular rejection treated with intravenous immunoglobulin, 1 patient with cytomegalovirus gastroenteritis, and 1 patient treated for varicella pneumonitis. The follow-up ranged from 1 week to 13 months. The first-year outcomes for our newly established transplant program at Al-Basheer Hospital are comparable to those of well-established programs.

Anaesthesia for liver transplantation

### Key points Mortality rates after liver transplantation (LT) have steadily improved in recent years as units continue to gain more experience. A prospective cohort study of 7906 liver transplants in the UK and Ireland showed an unadjusted 90 day mortality rate for first elective LT of 10.2% for the period 1994–6,1 decreasing to 3% for 2013–4.2 Seven UK centres performed 914 LT procedures during 2013–4,2 compared with 602 in 2005–6, with much of the increase occurring after a national initiative to increase donation rates.1,3 This improvement is attributed to improved surgical techniques, better recipient selection, and advances in anaesthetic and intensive care management. However, LT remains a complex undertaking—older patients, those with progressively more severe co-morbidity, and those with previous complex abdominal surgery (including previous LT) are now considered eligible. An important remaining outcome determinant is graft quality. There are three types of grafts used commonly: donation after brain death, donation after cardiac death, and living related donation (LRD). LRD, and also split liver donation where a cadaveric graft is divided for two recipients, have helped increase graft supply, but at the cost of increased complexity. LT remains the treatment of choice for end-stage liver disease (ESLD), and there is still …

A challenging male patient with retroviral infection on highly active antiretroviral therapy issues with re-transplantation

A 44-year-old African male with chronic kidney disease Stage V due to hypertension underwent a live related renal transplant in 2005. He was on triple immunosuppression postoperatively. Subsequently, he developed metastatic Kaposi sarcoma requiring reduction in immunosuppression and switching over to rapamycin. He was found to be retrovirus positive on a follow-up visit. His graft function progressively deteriorated requiring dialysis while continuing on highly active antiretroviral therapy. He had multiple infective episodes including acute bacterial endocarditis. He received a second renal transplant from a live-related donor in 2017. Despite repeated dosage adjustments, tacrolimus levels were persistently elevated due to drug-drug interaction with diltiazem and anti-retroviral drugs, despite good allograft function.

De Novo Focal Segmental Glomerulosclerosis in Renal Allograft-Histological Presentation and Clinical Correlation: Single Centre Experience.

Recurrent or de novo glomerulonephritis are one of the well-known causes for renal allograft dysfunction in early and late period after renal transplantation. Focal Segmental Glomerulosclerosis (FSGS) is a devastating lesion of the renal allograft. De novo FSGS is uncommon compared to recurrent FSGS. To find out the incidence of de novo FSGS. A retrospective evaluation of renal allograft biopsies was performed from 2007 to 2015, by light microscopy and immunohistochemistry including patient-donor demographics. Graft function status in terms of serum creatinine (SCr) and proteinuria were evaluated. Out of 2,599 renal allograft biopsies performed, 1.6% biopsies were reported as de novo FSGS. Majority were live related females donors with mean age of 43.8 years. Mean time of biopsy was 1.1 years post-transplant with proteinuria of 2.95 grams/24 hours and SCr of 2.24 mg/dL. Histopathological variants were collapsing 47.6%, Not Otherwise Specified/ classical 35.7%, cellular 9.5% and perihilar 7.1% biopsies. Associated Antibody Mediated Rejection (AMR) with T-Cell Rejection (TCR) was observed in 35.7% biopsies, acute on chronic CNI toxicity (calcineurin inhibitor) in five biopsies. Majority of the patients were on CNI based maintenance immunosuppression regimen. Total 28.6% patients and 23.8% grafts were lost over a mean follow up of 2.40 years. The mean SCr of remaining patients was 1.98 mg/dL. De novo FSGS can occur after the first year of renal transplant with related Human Leukocyte Antigen (HLA)matched donors leading to poor allograft survival. Close monitoring of urinary proteinuria and evaluation of allograft biopsy help in appropriate therapeutic modification to improve long term outcome of graft function.

Post Renal Transplant Surgical Complications; MRI Standard Applications and Diagnostic Outcomes

Objective: Fast MR imaging sequences together with paramagnetic contrast agents, offer multiple advantages in the assessment of renal function. It provides cross sectional and vascular information without the risk of ionizing radiation, iodinated contrast or arterial catheterization. Post transplantation complications can be grouped as surgical or medical. Immediate surgical complications include renal artery thrombosis or stenosis, urinary leak or lymphocele. Renal allograft frequently require repeated imaging studies during the immediate post-operative period and various times thereafter, when renal function is compromised. Background: End stage renal disease is common and can result from a variety of diseases. Kidney transplantation from living-related donors offered the best prognosis. Imaging modalities that are currently used to evaluate transplanted kidneys are ultrasound (US), computed tomography (CT), scintigraphy, intravenous urography (IVU), contrast angiography, and magnetic resonance imaging (MRI). Methods: This study was conducted on 181 renal transplant recipients. Recipients were 139 males and 42 females. Their age ranged from 20 to 58 years (mean age 39 years). The patients underwent clinical assessment, Laboratory investigations, and different Radiological imaging procedures as: I- Gray scale and color Doppler ultrasonography. II- Magnetic Resonance Imaging. 3D Gd-enhanced MRA. MR Urography. Selective IA-DSA of the graft artery. III- Percutaneous catheter nephrostomy (PCN) and antegrade pyelography. IV- Radio-isotope diuretic renogram using 99m Tc-MAG3. Results: 30 renal transplants were examined by MRI in the 1st 2 weeks after renal transplantation. At the end of 1st 2 weeks, MR examinations were carried out, as basal studies (including MRI, MRA and MRU) for 98 transplants. From this group, 64 transplants were subjected to other MR examinations. After the 1st 2 weeks, 53 transplants were subjected to MR examinations for the 1st time at variable post-transplant duration. Among the studied 181 renal transplants, MR examinations detected 3 cases with graft arteries thrombosis (1.6%), 10 with graft arteries stenosis (5.5%), 6 with segmental infarctions (3.3%), 3 cases with graft intrarenal arteries pseudo-aneurysms (1.6%) and 2 cases with arterio- venous fistulae (1.1%) after graft biopsies. Conclusion: MRI is highly recommended to evaluate intra-/extra-renal graft vascular lesions, urinary obstructive syndrome, compressive collections (urinoma, lymphocele), inflammatory and tumoral lesions of the renal graft.

Incidental nephrolithiasis in live related kidney donors: Epidemiology; long-term outcome of donor and recipient

Incidental nephrolithiasis in live related kidney donors: Epidemiology; long-term outcome of donor and recipient