Native Kidney Nephrectomy Research Articles

Clinical characteristics and outcomes of kidney transplantation in autosomal dominant polycystic kidney disease patients.

Kidney transplantation (KT) is the best kidney replacementtreatment for autosomal dominant polycystic kidney disease (ADPKD). We aimed to investigate the clinical characteristics and outcomes of KT in ADPKD patients compared to those in non-ADPKD patients. We retrospectively analyzed KT recipients in two Korean transplantation centers from 2005 to 2020. Propensity score-matching and Cox regression analysis were used to assess the clinical outcomes of ADPKD compared to non-ADPKD and identifyprognostic factors influencing outcomes in ADPKD. Among a total of 4452 KT patients, 189 (4.2%) were ADPKD patients. Median age at transplantation was 53.0 and 47.0 in ADPKD and non-ADPKD patients, respectively. In both groups, living-donor KT was more common than deceased-donor KT. The ADPKD group had a 4.09-fold higher risk of post-transplant diabetes mellitus and a 1.65-fold higher risk of post-transplant infection compared to the non-ADPKD group; however, subjects with ADPKD had similar risk of rejection, graft failure, and mortality. In the ADPKD group, kidney volume decreased after KT, irrespective of kidney volume status (Mayo classification), while the size of hepatic cysts increased. Neither kidney volume nor nephrectomy of native kidneys were associated with risk of infection, graft failure, or mortality in the ADPKD group. ADPKD patients have a higher risk of post-transplant diabetes mellitus and infection than non-ADPKD patients, with no significant impact of kidney volume or nephrectomy on post-transplant outcomes.

Native Kidney Renal Cell Carcinoma in Renal Allograft Transplant Patients - Our Experience.

The immunosuppression administered to renal transplant recipients to safeguard renal function elevates their susceptibility to renal cancer, which is estimated to be 15 times higher than in the general population. The current study aimed to analyze various aspects of native kidney renal cell carcinoma (RCC) in renal transplant recipients. This study involved a retrospective analysis of 11 patients who underwent nephrectomy for RCC in native kidneys among renal transplant recipients at our institution since 1992. Our institutional incidence was 0.4%. Median age at presentation was 57 (49-60) years. The ratio of male: female was 10:1. Most patients were asymptomatic at presentation and native kidney disease before transplantation was undetermined. In our study, the median time interval between diagnosis of RCC and transplant was 9.1 (8.4-11.2) years. All patients underwent native kidney nephrectomy. Clear cell type was more common than papillary type, 3.5 (2.5-4.2). Ten patients were diagnosed with stage I disease and one patient had stage IV disease. Fuhrman nuclear grading revealed low grades in nine patients and three patients had Grade 3. Immunosuppressive therapy modification was done in nine patients. Meticulous follow-up of renal transplant patients is essential for earlier diagnosis and appropriate treatment of native kidney RCC in transplant recipients. Authors recommend every year follow-up in transplant recipients with special emphasis on ultrasound of native kidney.

Native Kidney Renal Cell Carcinoma in Renal Allograft Transplant Patients - Our Experience.

The immunosuppression administered to renal transplant recipients to safeguard renal function elevates their susceptibility to renal cancer, which is estimated to be 15 times higher than in the general population. The current study aimed to analyze various aspects of native kidney renal cell carcinoma (RCC) in renal transplant recipients. This study involved a retrospective analysis of 11 patients who underwent nephrectomy for RCC in native kidneys among renal transplant recipients at our institution since 1992. Our institutional incidence was 0.4%. Median age at presentation was 57 (49-60) years. The ratio of male: female was 10:1. Most patients were asymptomatic at presentation and native kidney disease before transplantation was undetermined. In our study, the median time interval between diagnosis of RCC and transplant was 9.1 (8.4-11.2) years. All patients underwent native kidney nephrectomy. Clear cell type was more common than papillary type, 3.5 (2.5-4.2). Ten patients were diagnosed with stage I disease and one patient had stage IV disease. Fuhrman nuclear grading revealed low grades in nine patients and three patients had Grade 3. Immunosuppressive therapy modification was done in nine patients. Meticulous follow-up of renal transplant patients is essential for earlier diagnosis and appropriate treatment of native kidney RCC in transplant recipients. Authors recommend every year follow-up in transplant recipients with special emphasis on ultrasound of native kidney.

Autologous Blood Transfusion During Elective Surgery in a Candidate for Living Donor Transplantation: A Case Report

Blood transfusions are risk factors for alloimmunization and unfavorable outcomes in solid organ transplant recipients. We propose the adoption of autologous blood transfusion (ABT) in transplant candidates and recipients referred to elective surgery. We present a case of a 45-year-old man with chronic kidney disease stage 5 due to polycystic kidney disease, who was qualified for a native kidney nephrectomy (NKN) before kidney transplantation. Before the scheduled surgery, the patient was referred to a blood donation center for blood collection. During 2 consecutive visits, autologous blood was collected uneventfully, and this allowed for the preparation of 2 units of red blood cell concentrates and a unit of plasma. Pre- and post-donation hemoglobin values were 11.9 and 10.4 g/dL, respectively. The NKN procedure was complicated by intra-abdominal bleeding from an accessory aberrant artery of the kidney. Hemoglobin dropped to 6.8 g/dL and was treated with ABT, followed by artery embolization. This allowed for an increase of hemoglobin to 8.3 mg/dL and avoidance of allotransfusion. Six weeks after NKN, the patient underwent successful kidney transplantation from a living donor. Panel reactive antibodies before transplantation were 0%, and graft function has been excellent during 20 months of observation. An autologous blood collection is a feasible option for patients with chronic kidney disease. ABT should be considered the procedure of choice when qualifying potential waiting list candidates and solid organ recipients for elective surgeries.

Incidence and risk factors for recurrent focal segmental glomerulosclerosis after kidney transplantation: a meta-analysis

Aims To systematically review the incidence and risk factors for recurrent FSGS after kidney transplantation. Methods We searched PubMed, Embase, Medline, Web of Science, the Cochrane Library, CNKI, CBMdisc, Wanfang, and Weipu for case-control studies related to recurrent FSGS from the establishment until October 2022. The protocol was registered on PROSPERO (CRD42022315448). Data were analyzed using Stata 12.0, with odds ratios (counting data) and standardized mean difference (continuous data) being considered as effect sizes. If the I 2 value was greater than 50%, the random-effects model was used; otherwise, a fixed-effects model was used. A meta-analysis on the incidence and risk factors for recurrent FSGS after kidney transplantation was performed. Results A total of 22 studies with 966 patients and 12 factors were included in the meta-analysis. There were 358 patients with recurrent FSGS and 608 patients without FSGS after kidney transplantation. The results showed that the recurrence rate of FSGS after kidney transplantation was 38% (95% CI: 31%–44%). Age at transplantation (SMD = −0.47, 95% CI −0.73 to −0.20, p = .001), age at onset (SMD = −0.31, 95% CI −0.54 to −0.08, p = .008), time from diagnosis to kidney failure (SMD = −0.24, 95% CI −0.43 to −0.04, p = .018), proteinuria before KT (SMD = 2.04, 95% CI 0.91 − 3.17, p < .001), related donor (OR 1.99, 95% CI 1.20 − 3.30, p = .007) and nephrectomy of native kidneys (OR 6.53, 95% CI 2.68 − 15.92, p < .001) were associated with recurrent FSGS, whereas HLA mismatches, duration of dialysis before KT, sex, living donor, tacrolimus use and previous transplantation were not associated with recurrent FSGS after kidney transplantation. Conclusions The recurrence of FSGS after kidney transplantation remains high. Clinical decision-making should warrant further consideration of these factors, including age, original disease progression, proteinuria, related donor, and nephrectomy of native kidneys.

A Case of Orthotopic Renal Transplant in a Patient with Diffuse Atherosclerosis

A 60-year-old male with long-standing diabetes, hypertension, and smoking developed an end-stage renal disease that necessitated hemodialysis. His drive-by angiograms revealed significant carotid and iliac calcifications and a triple-vessel disease on cardiac assessment. The abdominal aorta, common iliac, and the vascular tree below were all heavily calcified, according to a computed tomography angiography. Concerned about the location of the donor renal artery anastomosis, the decision was taken to do a left native kidney nephrectomy and orthotopic renal transplant. End-to-end anastomoses were made between the donor renal artery and splenic artery and between the donor renal vein and the recipient native kidney renal vein. The patient is doing well after the transplant, and the graft is functioning excellently with a creatinine of 0.9 mg/dl.

Native nephrectomy and arterial embolization of native kidney in autosomal dominant polycystic kidney disease patients: indications, timing and postoperative outcomes.

Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common causes of a need of renal replacement therapy. The need (elective vs. systematic) and timing of native kidney nephrectomy (before, after or during kidney transplantation) is a matter of debate and alternatives to surgery, mainly transcatheter arterial embolization have been explored. We performed a systematic review to report all available evidence on postintervention outcomes of native nephrectomy and arterial embolization in ADPKD patients. A search on Medline, Embase, and Cochrane databases was performed to identify all studies reporting outcomes of native nephrectomy or arterial embolization in APKDs. Concerning native nephrectomy, a total of 3626 patients in 37 studies were included with 735, 210 and 2681 patients who underwent native nephrectomy respectively before, after or during kidney transplantation. Major complications were 12.2% in unilateral nephrectomy before transplantation, 25.0% in bilateral nephrectomy before transplantation, 17.7% in unilateral nephrectomy during transplantation, 20.8% in bilateral nephrectomy during transplantation and 23.8% in unilateral and bilateral nephrectomy after transplantation. A total of 230 patients in 7 series of arterial embolization were included. All arterial embolization were performed before transplantation. Mean volume reduction ranged from 36.3% at 3 months to 49% at 6 months. The major postintervention complication rate was 1%. Unilateral native nephrectomy before kidney transplantation was associated with the lowest major postoperative complication rate and appears to be the preferred strategy. Arterial embolization reduces kidney volume by 49% at 6 months. Arterial embolization could be considered when the reduction in size of the native kidney is not urgent.

Sunitinib-related high-grade proteinuria and allograft dysfunction in a kidney recipient: a rare case report

BackgroundSunitinib-induced high-grade proteinuria and irreversible renal allograft dysfunction are rare conditions. Here, we present a patient who had received renal allograft and later developed metastatic clear cell renal cell carcinoma(cc-mRCC), for which he was prescribed sunitinib. High-grade proteinuria, hypoalbuminemia, peripheral edema and renal allograft dysfunction (manifesting as an increase in the serum creatinine concentration) occurred 5 months after sunitinib prescription.Case presentationThe patient was a 58-year-old male who had end-stage renal disease with regular hemodialysis through arteriovenous fistula for 17 years since 1998 and received a renal allograft from a deceased kidney donor in 2015. Unfortunately, in 2019, the patient developed cc-mRCC originating from the left native kidney. We suggested a needle biopsy on left native kidney or radical left nephrectomy, but the patient refused. Sunitinib was prescribed. Follow-up urine analysis showed proteinuria (500 mg/dL) 2 weeks after sunitinib prescription. He was hospitalized 5 months later because of body weight gain, decreased urine output, pitting edema of both lower extremities, and shortness of breath. The image studies showed progression in his cc-mRCC. His serum creatinine level and spot urine protein at admission increased to 4.26 mg/dL and 300 mg/dL, respectively. He agreed on a biopsy for the renal allograft and the pathology studies showed focal segmental glomerulosclerosis, acute interstitial nephritis, and acute tubular injury. Based on the time sequence of clinical presentations with the laboratory and pathological findings, sunitinib-induced renal allograft dysfunction secondary to high-grade proteinuria was most likely. Despite of discontinuation of sunitinib and increased dose of everolimus, renal impairment progressed. Thus, he had to receive hemodialysis starting 2 week after hospitalization. Unfortunately, the patient died of advanced metastasis despite of aggressive medical treatments 3 weeks after admission.ConclusionThis case report is a reminder that renal allograft dysfunction can happen secondary to proteinuria after taking sunitinib. Hence, clinicians must regularly check renal function and urine protein for renal allograft recipients. Monitoring and modifying drug prescription, especially sunitinib, is necessary if persistent proteinuria accompanied by deteriorating serum creatinine level occurs. Renal biopsy may be considered if more evidence is required to make a differential diagnosis.

Renal transplantasyonla eş zamanlı nativ nefrektomi: Deneyimlerimiz ve kısa bir literatür derlemesi

Objective: There is a need for native kidney nephrectomy to increase renal transplant surgery’s safety or improve postoperative function in some cases. The timing of the procedure is still controversial. This study aimed to present our native nephrectomy procedures performed simultaneously with the transplantation in light of the literature. Material and Methods: A retrospective analysis was performed on the data of 245 patients who underwent renal transplantation due to end-stage renal failure (ESRD) between September 2011 and February 2020. Patients who underwent unilateral or bilateral nephrectomy simultaneously with transplantation were included. Demographic characteristics of the patients, preoperative and postoperative laboratory data, primary disease, presence of comorbid diseases, duration of dialysis, duration of vascular anastomosis, surgical and clinical complications, duration of hospital stay, and graft functions were recorded. Results: 12 patients underwent ipsilateral or bilateral native nephrectomy simultaneously with renal transplantation. The primary diseases of the patients leading to ESRD were as follows; 6 (50%) patients with Polycystic Kidney Disease (PKD), 5 (41.6%) patients with vesicoureteral reflux (VUR), one (8.3%) patient with kidney stones. Postoperative fever in three patients, erythrocyte replacement therapy in three patients, urosepsis and urinary drainage catheter requirement in one patient due to lymphocele was recorded. Two patients developed humoral rejection, and two patients developed BK virus nephropathy. Conclusion: In the presence of appropriate indications, simultaneous native nephrectomy is a safe and effective method in patients preparing for renal transplantation. In centers with sufficient experience and equipment, it may be preferable to perform native nephrectomy simultaneously with renal transplantation. Keywords: Kidney transplantation, nephrectomy, bilateral nephrectomy, polycystic kidney disease, complications.

Application of Total Kidney Volume and Its Predictive Value in Assessment of Kidney Transplant Waitlist Candidates With Autosomal Dominant Polycystic Kidney Disease

BackgroundAutosomal dominant polycystic kidney disease (ADPKD) is one of the most prevalent causes of kidney transplantation (KTx) worldwide. About 40% of ADPKD patients require peritransplant native kidney nephrectomy (NKN). The decision regarding qualification for NKN usually relies on the surgeon’s expertise. Currently used qualification criteria are subjective and incomparable between clinical centers. There is a need to identify the indications for NKN by applying radiologically based methods to the decision-making process. AimTo assess the usefulness of radiologic parameters in the qualification process of ADPKD waitlist candidates for the NKN procedure. MethodA retrospective, observational study in a cohort of ADPKD patients in a single institution was conducted. The study included the participation of waitlist candidates and kidney transplant recipients with computed tomography (CT) or magnetic resonance imaging (MRI) obtained in the peritransplant period. The correlation of imaging-based measurements with the results of clinical qualification for the NKN procedure was assessed. ResultsIn the years 2012 to 2019, 19 patients completed the inclusion criteria. Total kidney volume (TKV) values were statistically more significant in the NKN group (n = 10) than in the non-NKN group (n = 9), with medians of 3351 mL and 1654 mL, respectively (P = .016). There were no significant differences between the groups in terms of the ratio of complex cyst volume to TKV, with the NKN group having a ratio of 19.2% and the non-NKN group 15.6% (P = .095). Venous compression was found only in the NKN group (n = 2). ConclusionsTKV highly correlates with the results of clinical qualification for NKN. Radiologic assessment enables the detection of complicated cysts or clinically silent states of venous compression. Pretransplant imaging should be routinely obtained.

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.

Comparison of fasting versus non-fasting lipid profile in school children aged 9-11

Autosomal dominant polycystic kidney disease (ADPKD) is one of the most prevalent causes of kidney transplantation (KTx) worldwide. About 40% of ADPKD patients require peritransplant native kidney nephrectomy (NKN). The decision regarding qualification for NKN usually relies on the surgeon’s expertise. Currently used qualification criteria are subjective and incomparable between clinical centers. There is a need to identify the indications for NKN by applying radiologically based methods to the decision-making process.To assess the usefulness of radiologic parameters in the qualification process of ADPKD waitlist candidates for the NKN procedure.A retrospective, observational study in a cohort of ADPKD patients in a single institution was conducted. The study included the participation of waitlist candidates and kidney transplant recipients with computed tomography (CT) or magnetic resonance imaging (MRI) obtained in the peritransplant period. The correlation of imaging-based measurements with the results of clinical qualification for the NKN procedure was assessed.In the years 2012 to 2019, 19 patients completed the inclusion criteria. Total kidney volume (TKV) values were statistically more significant in the NKN group (n = 10) than in the non-NKN group (n = 9), with medians of 3351 mL and 1654 mL, respectively (P = .016). There were no significant differences between the groups in terms of the ratio of complex cyst volume to TKV, with the NKN group having a ratio of 19.2% and the non-NKN group 15.6% (P = .095). Venous compression was found only in the NKN group (n = 2).TKV highly correlates with the results of clinical qualification for NKN. Radiologic assessment enables the detection of complicated cysts or clinically silent states of venous compression. Pretransplant imaging should be routinely obtained.

Pretransplant Nephrectomy for Large Polycystic Kidneys in ADPKD (Autosomal Dominant Polycystic Kidney Disease) Patients: Is Peritoneal Dialysis Recovery Possible after Surgery?

The choice of modality for renal replacement therapy in patients with ADPKD varies, often based on patient choice, physician-related factors, and resource availability. For a long time peritoneal dialysis (PD) was considered as relative contraindication due to the possible limited intraperitoneal space. In recent years, some studies suggested it is a valid option also in patients with ADPKD to be considered as a first line treatment in potentially fit patients. Diuresis volume lowering and potential permanent damage of peritoneal integrity, both leading to a necessary switch to haemodialysis, are the two most important dangers after nephrectomy, especially if bilateral, in PD patients. We performed a retrospective analysis of patient underwent native polycystic kidney nephrectomy in order to state the possibility to recover peritoneal dialysis after surgery.

Urged Nephrectomy in a Renal Transplant Recipient

Urged Nephrectomy in a Renal&#x0D; Transplant Recipient&#x0D; &#x0D; Ajaz Koul,&#x0D; Aadil Rafeeq, Imtiyaz Wani, M. Salim Wani, Basharat Kasana, Arif Hamid&#x0D; &#x0D; Department of Medicine (Infectious Diseases),&#x0D; Nephrology and Urology, Sher-i Kashmir Institute of Medical Sciences, Srinagar,&#x0D; Kashmir India&#x0D; &#x0D; &amp;nbsp;&#x0D; &#x0D; ABSTRACT&#x0D; &#x0D; Acute&#x0D; UTI not only affects a patient well-being but also gives rise to several issues&#x0D; like Interaction of antibiotics with immunosuppressive drugs, isolation of&#x0D; resistant strains, recurrent UTI, fungal UTI and most importantly Urosepsis,&#x0D; with impairment of graft function. We present the case of a patient with End&#x0D; stage renal disease. After successful allograft renal transplant the patient&#x0D; had multiple admissions with urosepsis. Received sensitive antibiotics for a&#x0D; prolonged period of time, almost six months but still persisted with infection.&#x0D; At last native kidney nephrectomy was done which removed the possible source&#x0D; and relieved the patient from antibiotics. This focuses the need for some&#x0D; pretransplant screening methods to gauge the possibility of getting serious&#x0D; urinary tract infections, better surgical techniques like early removal of&#x0D; urinary stents and highlights a huge void in understanding of UTIs in this&#x0D; group and lack of research work. J&#x0D; Microbiol Infect Dis 2018; 8(1):27-29&#x0D; &#x0D; Keywords:&#x0D; Urosepsis, Kidney transplant,&#x0D; Nephrectomy

Native Nephrectomy in Renal Transplant Recipients With Autosomal Dominant Polycystic Kidney Disease

IntroductionPatients with autosomal dominant polycystic kidney disease (ADPKD) represent about 10% of kidney transplant recipients (KTR) and have unique needs regarding acceptance for this procedure. Whether native kidney nephrectomy (NKN) affects kidney transplantation (KT) outcomes remains a matter of debate, and more data is needed to establish a standard approach to KTR with ADPKD. AimTo analyze the prevalence, timing, and short- and long-term outcomes of NKN in a cohort of ADPKD recipients in a single institution. MethodRetrospective, observational study. ResultsIn the years 1993 to 2016 we identified 162 KTR with ADPKD; of those, 149 had known NKN status. A high proportion of ADPKD KTR (n = 72) underwent NKN, the majority of which (69.4%) were performed before KT. There was no difference in short-term and long-term transplantation outcomes (including death, graft loss, delayed graft function, acute rejection, bacterial and cytomegalovirus [CMV] infection, and post-transplant diabetes mellitus) between NKN and non-NKN groups in a median of 98 months of follow-up. However, we found a significant difference in time on a waiting list, which was longer in the NKN group vs non-NKN. ConclusionsThere is a need for a consensus regarding indications and timing for NKN in recipients with ADPKD. The systematic acquisition, sharing, and analysis of accessible data on NKN between institutions is an important step toward meeting this need. In our cohort, we found no impact of the NKN procedure on KT impact. However, undergoing NKN significantly prolonged the time on the waiting list.

Graft Survival in Patients With Polycystic Kidney Disease With Nephrectomy of Native Kidney Pretransplant

IntroductionAutosomal-dominant polycystic disease (ADPKD) represents 5%–10% of cases of end-stage renal failure. However, management of these patients in terms of whether or not to perform a transplant and optimal timing remains controversial. The objective of our analysis was to evaluate graft survival in patients with ADPKD in which we conduct pretransplant nephrectomy. MethodsThis retrospective study including renal transplant patients secondary to ADPKD in our hospital between January 2000 and December 2012. Pretransplant native kidney nephrectomy was indicated in cases of need for space or repeated complications (cysts). We compared the initial function and graft survival between groups of transplanted based on whether nephrectomy had been performed or not. ResultsEighty-seven patients underwent a kidney transplant owing to ADPKD; 62% (n = 54) were male, with an average age of 55.22 years. Twenty-seven patients (30%) underwent nephrectomy native kidneys before transplantation. There were no serious postoperative complications. Patients who underwent nephrectomy (group 1) showed values of creatinine of 1.57 and 1.50 mg/dL at 3 and 6 months, respectively. In the no nephrectomy group, these values were 2.03 and 1.83 mg/dL, respectively. Graft survival after the first year was of 98% for group 1 and 95% for group 2. The 5-year implant survival was 95% and 80%, respectively. ConclusionsNative kidney nephrectomy before transplantation in ADPKD is safe in an experienced center, both in terms of surgery-related morbidity and mortality and graft survival and function.

Urological evaluation prior to renal transplantation.

In this issue Antoniewicz and collegues [1] review the standard of urological consultation of patients qualified for renal transplantation. Basic evaluation of the urinary tract is performed in all patients during qualification for kidney transplantation to exclude urinary tract infection, cancers, urinary obstruction and to assess the need for native kidney nephrectomy. Detailed medical history, physical examination, urine test and culture, blood PSA level in male recipients and ultrasound of the urinary tract are sufficient in most cases. Anatomical or functional abnormalities, such as urinary retention, vesicoureteral reflux, decreased urinary bladder capacity, are indications for more complex urological evaluation. These problems may result from congenital urinary tract disorders and affect up to 25% of children with end-stage kidney disease. However, detailed urological evaluation should be considered in all patients with unknown cause of renal failure. Some questions should be answered during urological evaluation: 1. Is there any potentially curable form of obstruction in urine outflow? Anatomic obstruction, i.e.: urethral stricture, posterior urethral valve or bladder neck fibrosis, requires surgical treatment before kidney transplantation. In case of benign prostatic hyperplasia in patients with oliguria, surgery, if necessary, may be postponed after kidney transplantation. 2. Is the recipient's bladder function sufficient to ensure proper excretion of urine? This assessment must cover both the size and capacity of the urinary bladder and detrusor activity. Reduced capacity of the urinary bladder is common problem in patients on dialysis with long lasting oliguria, however bladder dysfunction in such cases is temporary and usually rehabilitation is fast and uneventful after transplantation. In rare cases of permanently impaired bladder capacity surgical augmentation should be considered. 3. Does any of the following conditions exist: passive or active vesicoureteral reflux, urolithiasis, hydronephrosis, urinary fistula? In such cases, unilateral or bilateral nephrectomy is usually necessary before transplantation. Patients with significantly enlarged kidney may also need pretransplant nephrectomy. Proper diagnosis and correction of urological disorders during evaluation of a potential kidney recipient prevents complications after transplantation and improves kidney graft survival.

Intravesical Ligation as a New Technique to Manage a Refluxing Native Ureter Without Simultaneous Nephrectomy in Renal Transplantation

BackgroundThis article aims to describe an original technique to correct refluxing native ureters observed during a prerenal transplantation study. The correction is performed by intravesical ligation of the native refluxing ureters at the same time as renal transplantation without simultaneous nephrectomy. MethodsBetween January 2004 and December 2010 we performed intravesical ligation of a refluxing ureter simultaneous with a transplantation procedure without a concomittant native nephrectomy in 12 of 345 subjects (3.47%). The 8 bilateral and 4 unilateral ligations were performed on 11 cadaveric and 1 living-related nonidentical donor transplantations. The implantation of the kidney donor ureter was performed anatomically in the bladder trigone through a transvesical ureteroneocystostomy with a transmural, submucosal antireflux tunnel. ResultsEarly and late postoperative recovery was satisfactory in all patients. There was no documented kidney area pain, proven urinary tract infection, morbidity or mortality attributed to the procedure. ConclusionsIntravesical ligation is a practical technique to manage vesicoureteral reflux into the native ureters simultaneously with the ureteral implantation of the kidney donor in a single surgical renal transplant procedure without native kidney nephrectomy.

V2152 SIMULTANEOUS NATIVE KIDNEY AND ALLOGRAFT LAPAROSCOPIC NEPHRECTOMY FOR SINCRONOUS TUMOR

You have accessJournal of UrologySingle Port Surgery1 Apr 2012V2152 SIMULTANEOUS NATIVE KIDNEY AND ALLOGRAFT LAPAROSCOPIC NEPHRECTOMY FOR SINCRONOUS TUMOR Antonio Alcaraz, Mireia Musquera, Laura Izquierdo, Eduardo Garcia-Cruz, Alexandru Ciudin, and Lluis Peri Antonio AlcarazAntonio Alcaraz Barcelona, Spain More articles by this author , Mireia MusqueraMireia Musquera Barcelona, Spain More articles by this author , Laura IzquierdoLaura Izquierdo Barcelona, Spain More articles by this author , Eduardo Garcia-CruzEduardo Garcia-Cruz Barcelona, Spain More articles by this author , Alexandru CiudinAlexandru Ciudin Barcelona, Spain More articles by this author , and Lluis PeriLluis Peri Barcelona, Spain More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2324AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopy is not a common technique to be used in kidney allograft surgery due to the fibrosis that surround the kidney and difficults surgical maneuvers. We present our experience with a laparoscopic simultaneous native kidney nephrectomy and trasplantectomy. METHODS We present a 55 years old female with 2 previous kidney trasplantations who was diagnosed of a tumor in the left native kidney and a second one in the allograft during the study for a third kidney trasplantation. The CT Scan confirmed a 2 cm solid lesion in both the native kidney and the allograft and a 2.7 cm paraaortic adenophaty. A laparoscopic surgery was indicated. The patient was placed in right decubitus position and 3 abdominal trocars were placed (one trocar of 5 mm and 2 of 10mm). A left nephrectomy is performed following the same steps as usual. After sectioning the vascular pedicle, the native kidney is removed from the operative field. Then, we proceed with the paraortic adenopaty ressection by using blunt dissection and the Ligasure. Finally, the transplantectomy is performed. The allograft artery is localized following the native ureter. After having sectioned the artery, the renal vein is identified and sectioned between hem-o-loks. Then, the remaining kidney attachments are liberated using the Ligasure. Through a Gibson incision a 15 mm bag is placed, and the three surgical samples are wrapped and removed. RESULTS Operative time was 165 minutes with an estimated blood loss of 200 cc. The pathological report showed a 2 cm type I papillary clear cell renal carcinoma in the native kidney and a 2,2 cm chromophobe renal cell carcinoma in the allograft. The lymph node was a metastasis from the native kidney tumor. CONCLUSIONS Laparoscopy is a feasible approach to perform a nephrectomy and a trasplantectomy, allowing a single incision to remove both pieces. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e869 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Antonio Alcaraz Barcelona, Spain More articles by this author Mireia Musquera Barcelona, Spain More articles by this author Laura Izquierdo Barcelona, Spain More articles by this author Eduardo Garcia-Cruz Barcelona, Spain More articles by this author Alexandru Ciudin Barcelona, Spain More articles by this author Lluis Peri Barcelona, Spain More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Simultaneous Laparoendoscopic Single-site Radical Nephrectomy for Native Kidney and Open Nonischemic Partial Nephrectomy to Treat Concomitant Renal Cell Carcinomas in Native and Transplant Kidneys and to Preserve Allograft Function

To report a technique of minimally invasive radical nephrectomy for a native renal cell carcinoma (RCC) and nonischemic open partial nephrectomy for a transplant kidney RCC with only a laparoendoscopic single-site (LESS) incision. Concomitant RCCs in a native and transplant kidneys are very rare. Conventional surgical approach requires a long incision. A 50-year-old man 14 years after renal transplant was found incidentally to have concomitant RCCs in his native right kidney and transplant kidney. A right lower abdomen Gibson incision, along his transplant wound, was used initially for LESS right radical nephrectomy and lymphadenectomy, and that same wound was used for a nonischemic open partial nephrectomy in the transplant kidney. The LESS right radical nephrectomy took 3.25 hours with estimated blood loss (EBL) of 80 mL and the partial nephrectomy for the transplant kidney took 3 hours with EBL of 220 mL. No transfusion was required. Pathologic examination revealed both tumors to be RCC, clear cell type, and 6.5 cm in the right native kidney and 2.8 cm in the transplant kidney. The final wound measured 9 cm. Postoperative recovery was uneventful with inpatient narcotic requirement of 37 mg morphine sulfate equivalent, and oral intake of food resumed in 2.5 days. His allograft function was well preserved with a serum creatinine unchanged (1.4 mg/dL) at discharge. In a patient with concomitant tumors in a native kidney and a transplant kidney, this unique approach provides exceptional benefits of minimally invasive tumor excision for both tumors, and good preservation of renal function.